[Ocular involvement in Stevens-Johnson syndrome: treatment with amniotic membrane transplantation in the acute phase]. / Oogafwijkingen bij Stevens-Johnson-syndroom.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are both part of a spectrum of serious mucocutaneous disorders, most often caused by drugs, with a high morbidity and mortality. In the acute stage, serious skin and mucocutaneous lesions with painful blistering, erosions and systemic involvement present the main focus of attention. The severity of skin manifestations in the acute stage, however, does not necessarily correlate with that of the mucosal lesions. Most feared are long-term sequelae, especially chronic eye involvement, which can be highly disabling. Here, we illustrate the importance of daily evaluation, early recognition and treatment of eye involvement in the acute stage of SJS/TEN, even when skin manifestations and/or initial eye involvement are relatively mild. Timely performed amniotic membrane transplantation in the acute stage can limit irreversible damage, caused by chronic inflammation, and therefore prevent cicatrisation at a later stage.

Incorporating life expectancy in glaucoma care.

AIM: To calculate for which combinations of age and perimetric disease stage glaucoma patients are unlikely to become visually impaired during their lifetime. METHODS: We used residual life expectancy data (life expectancy adjusted for the age already reached) as provided by Statistics Netherlands and rates of progression as derived from published studies. We calculated the baseline mean deviation (MD) for which an individual would reach a MD of -20 dB at the end of life as a function of age and rate of progression. For situations in which the individual rate of progression is unknown, we used the 90th percentiles of rate of progression and residual life expectancy. For situations in which the individual rate of progression is known, we used the 95th percentile of the residual life expectancy. RESULTS: An easily applicable graphical tool was developed that enables an accurate estimate of the probability of becoming visually impaired during lifetime, given age, current glaucomatous damage, and--if available--the individual rate of progression. CONCLUSIONS: This novel tool enables the clinician to incorporate life expectancy in glaucoma care in a well-founded manner and may serve as a starting point for personalized decision making.

The additional yield of a periodic screening programme for open-angle glaucoma: a population-based comparison of incident glaucoma cases detected in regular ophthalmic care with cases detected during screening.

AIM: To study the additional yield of a periodic screening programme for open-angle glaucoma (OAG) by comparing, in a population-based setting, incident OAG (iOAG) cases detected in regular ophthalmic care with those detected during screening. METHODS: Participants aged 55 and over from the population-based Rotterdam Study underwent the same ophthalmic examination at baseline (1991-3) and follow-up (1997-9), including visual field testing and simultaneous stereo optic disc photography. Of 3842 participants, 87 (2.3%) developed iOAG during a mean follow-up time of 6.5 years. Of these 87 iOAG cases, 78 (90%) were included in this study. RESULTS: Of the 78 iOAG cases detected at follow-up, 23 (29%) had already been detected before during regular ophthalmic care. The remaining 55 (71%) undetected iOAG cases more often showed glaucomatous optic neuropathy without glaucomatous visual field loss (29 of 55 (53%)) as compared with the detected cases (four of 23 (17%); p = 0.009). Of the undetected iOAG cases, only four had developed significant visual field loss in their better eye. CONCLUSION: The additional yield of a periodic OAG screening programme is lower than expected from published prevalence data. In the discussion, the authors estimate that-in a white population with a low prevalence of pseudoexfoliation-about one in 1000 screened persons could be saved from bilateral end-stage OAG.

Glaucoma screening during regular optician visits: can the population at risk of developing glaucoma be reached?

AIM: To determine the percentage of the population at risk of developing glaucoma, which can potentially be reached by conducting glaucoma screening during regular optician visits. METHODS: 1,200 inhabitants aged >40 years were randomly selected from Dutch community population databases. A questionnaire was mailed to these inhabitants with questions on their latest optician visit and risk factors for glaucoma. A second questionnaire was sent to their opticians, who were asked about their willingness to conduct an additional glaucoma screening programme in the future. RESULTS: The questionnaire was returned by 959 of 1,200 inhabitants and 37 of 50 opticians. The percentage of inhabitants who visited an optician during a 5-year period was 83% (95% confidence interval (CI) 80% to 85%). This percentage was adjusted for the presence of risk factors for glaucoma to obtain the percentage of the population at risk of developing glaucoma. The percentage of opticians willing to cooperate in a glaucoma screening programme extended beyond a non-contact tonometry measurement alone was 91% (95% CI 77% to 98%). CONCLUSION: By conducting glaucoma screening during regular optician visits, a large section of the population at risk of developing glaucoma can be reached.