High myopia and macular vascular density: an optical coherence tomography angiography study.

OBJECTIVE: To investigate whether there are differences inmacular vascular density (VD) between patients with high-myopia (HM) and those with non-high myopia (NHM) using Optical Coherence Tomography Angiography (OCTA). METHOD: OCTA was performed on 35 eyes with HM with spherical equivalence (SE) > - 6.00D and 35 eyes with NHM with SE ≤ -6.00D. Vascular densities of the macula (overall macula, fovea, parafovea, superior hemi and inferior hemi) were measured in each of the superficial, deep and choriocapillaris layers of the retina. RESULTS: In the superficial retinal layer, overall macular VFD was significantly higher in the NHM compared to the HM group (51.27 ± 3.74 vs. 48.07 ± 5.69, p < 0.05). There were significant differences between the NHM and HM in parafovea (52.58 ± 5.78 vs. 49.4 ± 6.43, p < 0.05), superior-hemi (53.38 ± 4.03 vs 49.78 ± 6.84, p < 0.05) and inferior-hemi regions (53.49 ± 4.61 vs 49.05 ± 6.41, p < 0.05), but not in the fovea region. Similarly, in the deep retinal layer, overall macular VFD was significantly higher in the NHM group compared to the HM group (58.69 ± 2.46 vs. 56.90 ± 4.08, p < 0.05). There was significant differences between the HM and NHM in superior-hemi region (61.97 ± 2.68 vs. 60.08 ± 3.98, p < 0.05), but not in the fovea, parafovea, and inferior-hemi region. In the choriocapillaris, there was no difference in the overall macular VFD, nor any of the individual sectors between the HM and the NHM groups. CONCLUSION: VFD in the superficial and deep retinal layers of the macula are significantly increased in the NHM compared to HM eyes. This is not the case in the choroidal capillary layers of the retina.

Determining patient preferences in a glaucoma service: A discrete choice experiment.

IMPORTANCE: Patient perspectives are crucial in informing design of acceptable services. BACKGROUND: This study determined patient preferences in glaucoma care. DESIGN: A discrete choice experiment was used to evaluate the relative importance of out-of-pocket costs, waiting time, continuity of care, service location and expertise. PARTICIPANTS: Ninety-eight glaucoma suspects or glaucoma patients were recruited from one public and two private clinics in Sydney. METHODS: Twelve choice-tasks were presented in random order and forced-choice preferences were elicited. Choice data were analysed using a multinominal logit model (NLOGIT 4.0). MAIN OUTCOME MEASURES: The relative importance and the likelihood of choosing services with each attribute were determined. Willingness-to-pay and willingness-to-wait were calculated. Analyses were stratified by whether the patient attended a public or private glaucoma clinic and other demographic features. RESULTS: Choice was influenced by four or five attributes: greater clinician expertise, the same clinician each visit, lower out-of-pocket costs and shorter wait times (all P < .05). Respondents were willing to pay an additional (Australian dollars) $325 (95% confidence interval [CI] 188-389) to see a senior eye doctor, and $87 (95% CI 60-116) to see the same clinician each visit. Respondents were willing to wait for these attributes; however, the estimates had wide confidence intervals and were beyond the range tested. Private patients had a stronger preference for expertise and continuity of care compared to public patients. CONCLUSIONS AND RELEVANCE: Expertise and continuity of care were important to glaucoma patients in this setting, and they were willing to pay out-of-pocket and concede longer waiting times to secure these preferences.

Retinal Nerve Fibre Layer Thickness Change Following Femtosecond Laser-Assisted in situ Keratomileusis.

Purpose: To evaluate the effect of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) on retinal fovea thickness, volume, and retinal nerve fibre layer (RNFL) thickness. Methods: Thirty-seven eyes (37 patients) undergoing FS-LASIK were included in this prospective study. Optical coherence tomography (OCT) was performed 1 day before, 1 h and 1 day after FS-LASIK surgery. Result: Eighteen male and nineteen females were enrolled. Mean patient age was 22.94 ± 4.22 years. One hour postoperatively, macula fovea thicknesses, macula fovea volume, macula parafovea thickness, macula parafovea volume, macula perifovea thickness, macula perifove volume, temporal RNFL thickness, and superior RNFL thickness measures showed significant decrease (t = 6.171, 6.032, and 9.837, 9.700, 2.532, 4.393, 4.926, 2.265; p = 0.000, 0.000, 0.000, 0.000, 0.016, 0.000, 0.000, and 0.011). Day 1 post-operation, macula fovea thicknesses, macula fovea volume, macula parafovea thickness, macula parafovea volume, and inferior RNFL thickness measures showed significant change compared to preoperative measures (t = 3.620, 3.220, 2.901, 2.910, 3.632; p = 0.001, 0.003, 0.006, 0.006, and 0.001). Conclusion: Our data suggest there are alterations in retinal foveal and RNFL measurements by OCT 1 h and 1 day after FS-LASIK surgery.

Prognostic Differences in ISUP Grade Group 4: a Systematic Review and Meta-Analysis.

The ISUP (Internal Society of Urologic Pathology) recently adopted a five-tiered prognostication system. There is evidence to suggest that the ISUP grade group 4 is a heterogeneous entity regarding prognosis. Our aim was to systematically examine the existing evidence to determine if outcome differences exist within the ISUP grade group 4. A systematic search of the literature for all studies examining the heterogeneity of the ISUP grade group 4 was conducted. Available studies were combined with meta-analysis to evaluate prognostic differences within the ISUP grade group 4 measured by all-cause mortality (ACM) and the prostate cancer-specific mortality (PCSM). Eight studies were identified and utilised a variety of outcome measures to answer the question of heterogeneity within the ISUP grade group 4. Four of these studies examined prognosis using both ACM and PCSM. These were combined into a meta-analysis. The combined group of 5 + 3/3 + 5 had statistically significant higher ACM (hazard ratio [HR] 1.23, 95% confidence internal [Cl] 1.08-1.41) when compared to the 4 + 4 group. There was no difference in the PCSM between the two groups (HR 1.34, 95% CI 0.89-2.01). However, heterogeneity was high for this analysis secondary to a range of methodological differences. Our meta-analysis showed that Gleason grade 3 + 5/5 + 3 had higher ACM than Gleason grade group 4 + 4. Measures of PCSM were statistically insignificant, although heterogeneity was high. Evidence suggests that heterogeneity is likely, although inconclusive. Further studies with consistent methodologies are required to answer this question.

Accelerated Versus Conventional Corneal Collagen Cross-Linking in the Treatment of Keratoconus: A Meta-analysis and Review of the Literature.

AIM: Our aim was to examine existing literature, and determine if there are outcome differences between accelerated corneal collagen cross-linking (A-CXL) and conventional corneal collagen cross-linking (C-CXL). METHODS: A systematic review of the literature was conducted examining studies which compared A-CXL to C-CXL. Available studies were combined and the weighted mean difference (WMD) was calculated for range of outcome measures including maximal keratometry (Kmax), mean keratometry (Kmean) and minimum keratometry (Kmin), spherical equivalent, best corrected visual acuity (BCVA), and central corneal thickness (CCT). RESULTS: Seven eligible studies were included in our meta-analysis, with 283 eyes (135 in A-CXLand 148 in C-CXL). In the combined analysis, there was no statistically significant difference observed in Kmin or Kmax between A-CXL and C-CXL for at least 6 months after the procedure. Kmean was statistically higher in the C-CXL group in comparison with the A-CXL group for at least 6 months after the procedure (WMD - 3.15, 95% CI - 4.34 to - 1.97, p < 0.01).No statistically significant difference observed in spherical equivalent or central corneal thickness between the A-CXL group and C-CXL group for at least 6 months after the operation. The BCVA was statistically higher in the A-CXL group in comparison with the C-CXL group for at least 6 months after the procedure (WMD - 0.05, 95% CI 0.00-0.10, p < 0.05). No surgery complication was recorded in the researches. CONCLUSION: Our study demonstrated greater reductions of Kmean in the A-CXL group in comparison with the C-CXL group. Overall A-CXL is comparable to C-CXL from outcome basis.

ISUP Group 4 - a Homogenous Group of Prostate Cancers?

The International Society of Urological Pathology (ISUP) and the World Health Organisation have adopted a five-tiered prognostic grade group for prostate cancer in 2014. Grade group 4 is comprised of Gleason patterns 4 + 4, 3 + 5 and 5 + 3. Recent articles have suggested heterogeneity in their prognostic outcomes. We aimed to determine whether there was a difference in mortality outcomes within the ISUP 4 grouping, as identified on needle biopsy. A total of 4080 men who were diagnosed with non-metastatic (N0 M0) prostate cancer on biopsy with Gleason scores of 7, 8 and 9 were included. Multi-variable Cox Regression and Fine and Grey competing risk analysis were used to determine the All-Cause Mortality (ACM) and the Prostate Cancer Specific Mortality (PCSM) as a function of Gleason Scores (Gleason 3 + 4, 4 + 3, 4 + 4, 3 + 5/5 + 3, 9). Gleason score 4 + 4 was utilized as the referent. The 60 months' prostate cancer specific mortality with Gleason patterns 4 + 4 and 3 + 5/5 + 3 were 17% and 20% respectively (P < 0.01). Patients with 3 + 5/5 + 3 disease, had no statistically significant difference in the ACM (adjusted hazard ratio [aHR] 0.99, 95% confidence interval [Cl] 0.68-1.4, p = 0.99) and PCSM risk (aHR 0.77, 95% Cl 0.47-1.2, p = 0.31) when compare with the referent group of patients. Patients with Gleason patterns 4 + 3 and 9 had statistically significant difference in their PCSM risk (aHR 0.70, 95% CI 0.54-0.91, P < 0.001 and aHR 1.5, 95% Cl 1.2-1.9, P < 0.001) when compared to the referent group. Our analysis suggest that ISUP group 4 is homogenous in terms of the all-cause mortality and the prostate cancer specific morality risk as differentiated by the presence of Gleason 5 score.

Tuck-in Lamellar keratoplasty with an lenticule obtained by small incision lenticule extraction for treatment of Post- LASIK Ectasia.

Corneal ectasia is a rare but serious post-operative complication of LASIK. Our main aim was to describe and evaluate the efficacy and safety of tuck-in lamellar keratoplasty with an lenticule obtained by SMILE for treatment of Post LASIK Ectasia. Tuck-in lamellar keratoplasty was performed on three post-LASIK cornea ectasia patients (three eyes) with central corneal thickness less than 400 µm. Each patient was monitored for at least 12 months. Our primary outcomes measured pre and post-operatively included: Anterior segment optical coherence tomography(AS-OCT), corneal topography and monitored by slit-lamp microscopy. The mean total corneal thickness preoperatively and 1 day, 1 month, 3 months and 12 months post-op were 360.00 ± 32.07 µm, 590.00 ± 10.00 µm, 536.67 ± 11.54 µm, 523.33 ± 37.85 µm, 466.67 ± 41.63 µm. The mean lenticule implanted 1 day, 1 month, 3 months and 12 months post-op were 173.33 ± 41.63 µm,136.67 ± 25.16 µm, 133.33 ± 40.41 µm, 130.00 ± 17.32 µm. There was no evidence of immune rejection or other complications. Tuck-in lamellar keratoplasty with an lenticule obtained by SMILE seems to be a safe and alternative surgical approach in the treatment of post - LASIK cornea ectasia, especially for severe cases with cornea thickness less than 400 µm.