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Table of Contents
doi : 10.1016/S0039-6257(21)00153-3
Volume 66, Issue 6, November–December 2021, Pages A2-A4
The ocular microbiome and microbiota and their effects on ocular surface pathophysiology and disorders
PasqualeAragonaMD, PhDaChristopheBaudouinMD, PhD, FARVObJose M.Benitez del CastilloMD, PhDcElisabethMessmerMD, FEBOdStefanoBarabinoMD, PhDeJesusMerayo-LlovesMD, PhDfFrancoiseBrignole-BaudouinMD, PhDghiLeandroInferreraMDaMaurizioRolandoMDjRitaMencucciMDkMariaRescignoPhDlStefanoBoniniMDmMarcLabetoulleMD, PhDn
doi : 10.1016/j.survophthal.2021.03.010
Volume 66, Issue 6, November–December 2021, Pages 907-925
The ocular surface flora perform an important role in the defense mechanisms of the ocular surface system. Its regulation of the immunological activity and the barrier effect against pathogen invasion are remarkable. Composition of the flora differs according to the methods of investigation, because the microbiome, composed of the genetic material of bacteria, fungi, viruses, protozoa, and eukaryotes on the ocular surface, differs from the microbiota, which are the community of microorganisms that colonize the ocular surface. The observed composition of the ocular surface flora depends on harvesting and examining methods, whether with traditional culture or with more refined genetic analysis based on rRNA and DNA sequencing. Environment, diet, sex, and age influence the microbial flora composition, thus complicating the analysis of the baseline status. Moreover, potentially pathogenic organisms can affect its composition, as do various disorders, including chronic inflammation, and therapies applied to the ocular surface.
Anti-VEGF crunch syndrome in proliferative diabetic retinopathy: A review
YiranTanMBBS MMedabAkiraFukutomiMDcMichelle T.SunMBBS PhDabShaneDurkinMMed FRANZCOabJagjitGilhotraMMed FRANZCOabWeng OnnChanMPhil FRANZCOab
doi : 10.1016/j.survophthal.2021.03.001
Volume 66, Issue 6, November–December 2021, Pages 926-932
Anti-vascular endothelial growth factor (anti-VEGF) crunch syndrome describes the progression to tractional retinal detachment following intravitreal anti-VEGF therapy in an eye with proliferative diabetic retinopathy . We reviewed the literature on the anti-VEGF crunch using the PubMed and Cochrane databases. Anti-VEGF crunch typically manifests as sudden vision loss in the affected eye between 1 and 6 weeks following intravitreal anti-VEGF injection, with a mean onset of 13 days. Risk factors for crunch development include the use of a higher anti-VEGF dose and increased severity of diabetic retinopathy with fibrosis. Our review found that intravitreal anti-VEGF, in particular bevacizumab, should be used with caution when treating patients with severe proliferative diabetic retinopathy and pre-existing intraocular fibrosis. In patients where anti-VEGF is used before a planned vitrectomy, we recommend close monitoring for crunch symptoms and proceeding promptly with surgery if there is new or progression of tractional retinal detachment. For eyes with minimal preexisting traction that develop crunch after anti-VEGF treatment, surgeons should proceed to vitrectomy within 7 days. The existing literature on the anti-VEGF crunch is limited by heterogeneity in the way crunch is documented and characterized and the presence of panretinal photocoagulation as a confounding factor. Because of these methodological flaws, the relative frequency of the anti-VEGF crunch cannot be accurately estimated.
Retinal imaging in infants
Timothy H.M.FungFRCOphthabMong-LoonKuetFRCOphthabChetan K.PatelFRCOphthcRogerHoldenFRCOphthaShaliniOjhaMRCPCHabdWinfried M.K.AmoakuFRCOphthbd
doi : 10.1016/j.survophthal.2021.01.011
Volume 66, Issue 6, November–December 2021, Pages 933-950
Digital retinal imaging is at the core of a revolution that is continually improving the screening, diagnosis, documentation, monitoring, and treatment of infant retinal diseases. Historically, imaging the retina of infants had been limited and difficult to obtain. Recent advances in photographic instrumentation have significantly improved the ability to obtain high quality multimodal images of the infant retina. These include color fundus photography with different camera angles, ultrasonography, fundus fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. We provide a summary of the current literature on retinal imaging in infants and highlight areas where further research is required.
Ocular side effects of checkpoint inhibitors
CarmenAlba-LineroMD, PhDabEmilioAlbaMD, PhDc
doi : 10.1016/j.survophthal.2021.01.001
Volume 66, Issue 6, November–December 2021, Pages 951-959
The incidence and impact of ocular side effects in patients treated with checkpoint inhibitors are not clearly defined.
Corneal lymphangiogenesis as a potential target in dry eye disease - a systematic review
MohansrinivasChennakesavaluBS+Sri Raghurama R.SomalaBS+Sunil R.DommarajuBS+Meghna PriyankaPeesapatiBSKaiGuoMD, PhDMark I.RosenblattMD, PhD, MBAJin-HongChangPhDDimitri T.AzarMD, MBA
doi : 10.1016/j.survophthal.2021.03.007
Volume 66, Issue 6, November–December 2021, Pages 960-976
Dry eye disease (DED) is a common ocular surface condition causing symptoms of significant discomfort, visual disturbance, and pain. With recent advancements, DED has become recognized as a chronic self-perpetuating inflammatory condition triggered by various internal and environmental factors. DED has been shown to arise from the activation of both the innate and adaptive immune systems, leading to corneal epithelium and lacrimal gland dysfunction. While the cornea is normally avascular and thus imbued with angiogenic and lymphangiogenic privilege, various DED models have revealed activated corneal antigen-presenting cells in regional lymph nodes, suggesting the formation of new corneal lymphatic vessels in DED. The recent availability of reliable lymphatic cell surface markers such as LYVE-1 has made it possible to study lymphangiogenesis. Accordingly, numerous studies have been published within the last decade discussing the role of lymphangiogenesis in DED pathology. We systematically review the literature to identify and evaluate studies presenting data on corneal lymphangiogenesis in DED. There is considerable evidence supporting corneal lymphangiogenesis as a central mediator of DED pathogenesis. These findings suggest that anti-lymphangiogenic therapeutic strategies may be a viable option for the treatment of DED, a conclusion supported by the limited number of reported clinical trials examining anti-lymphangiogenic modalities in DED.
Peripheral ulcerative keratitis
YogitaGuptaMDAlishaKishoreMDPoojaKumariMSNeelimaBalakrishnanMBBSNeiweteLomiMDNoopurGuptaMS, PhDM.VanathiMDRadhikaTandonMD
doi : 10.1016/j.survophthal.2021.02.013
Volume 66, Issue 6, November–December 2021, Pages 977-998
Peripheral ulcerative keratitis (PUK) is an inflammatory condition of the peripheral cornea with hallmark features of epithelial defects and stromal destruction as a result of a complex interplay of factors including host autoimmunity and the peculiar anatomic and physiologic features of the peripheral cornea and environmental factors. PUK may be the result of local or systemic causes and infectious or noninfectious causes. Arriving at a specific etiological diagnosis requires a meticulous clinical workup that may include a battery of laboratory and radiological investigations. Management by a team of internists or rheumatologists and ophthalmologists and judicious use of immunosuppressive agents may yield favorable results minimizing adverse effects. We review current clinical knowledge on the diagnosis and management of PUK.
A review on the use of telemedicine in glaucoma and possible roles in COVID-19 outbreak
Pun YuetLamMBBS studenta#Shing ChuenChowMBBS studenta#Jimmy Shiu MingLaiMDbBonnie Nga KwanChoyFRCSb
doi : 10.1016/j.survophthal.2021.03.008
Volume 66, Issue 6, November–December 2021, Pages 999-1008
We review the use of telemedicine in glaucoma and its possible roles in the COVID-19 outbreak. We performed a literature search of published human studies on teleglaucoma on May 12, 2020, using search terms including “telemedicine” and “glaucoma” that were in English and published over the prior 10 years. This search strategy yielded a total of 14 relevant articles after manual curation. Of the 14 articles, 4 were from the same randomized control trial, 7 were prospective studies, 2 were retrospective studies, 1 was descriptive analysis, and 1 was cost-effective analysis. Seven discussed the common ophthalmologic measurements used in teleglaucoma. Four demonstrated the cost effectiveness of the use of teleglaucoma, and 3 articles investigated patient satisfaction with the use of teleglaucoma. Three articles investigated the correlation between teleglaucoma and face-to-face clinics. Five articles discussed the current use and opportunities of teleglaucoma.
Primary central nervous system lymphoma – ocular variant: an interdisciplinary review on management
VishalRavalMDaElaineBinkleyMDbMary E.AronowMDcJuanValenzuelaMDdDavid M.PeereboomMDeArun D.SinghMDa
doi : 10.1016/j.survophthal.2021.03.004
Volume 66, Issue 6, November–December 2021, Pages 1009-1020
Primary central nervous system lymphoma-ophthalmic variant (PCNSL-O) is an ocular subset of PCNSL predominantly involving subretinal pigment epithelium space, retina, and vitreous. The ophthalmic manifestations can precede, occur simultaneously, or follow other compartments of the CNS. Clinical trials have resulted in a significantly improved outcome in PCNSL patients over the past 2 decades, with a higher proportion of patients receiving frontline high dose methotrexate-based polychemotherapy regimens with curative intent; however, the current management of PCNSL-O remains controversial owing to lack of prospective data. The goals of PCNSL-O treatment are both to achieve local (ocular) control and to prevent tumor-specific mortality from further CNS involvement. Despite achieving high rates of ocular control with intravitreal agents like methotrexate and rituximab, the overall survival is poor, as 65-85% of patients eventually succumb to CNS disease. Few studies define the role of systemic chemotherapy with/without local treatment as a first line induction treatment for PCNSL-O considering limiting factors such as ocular penetration of systemically administered drugs and treatment related neurotoxicity. Also, the role of adjuvant treatment for PCNSL-O to prevent CNS progression and to improve overall survival is unknown. In this systematic review of the literature, we analyze treatment outcomes of various regimens (local, systemic, and combination) in terms of local control, CNS progression, and overall survival.
Septic cavernous sinus thrombosis: A review
Jonathan TCaranfaMDabMichael KYoonMDcd
doi : 10.1016/j.survophthal.2021.03.009
Volume 66, Issue 6, November–December 2021, Pages 1021-1030
Septic cavernous sinus thrombosis (SCST) is a rare, yet severe, process typically arising from infections of the paranasal sinuses (predominately ethmoid and/or sphenoid sinusitis) and less commonly, otogenic, odontogenic, and pharyngeal sources. Clinical symptoms of SCST arise from obstruction of venous drainage from the orbit and compression of the cranial nerves within the cavernous sinus. In the preantibiotic era SCST was considered universally fatal (80-100%); however, with the introduction of antibiotics the overall incidence, morbidity, and mortality of SCST have greatly declined. In spite of dramatic improvements, morbidity and mortality remain high, with the majority of patients experiencing neurological sequalae, highlighting the severity of the disease and the need for prompt recognition, diagnosis, and treatment. Here we review of the literature on SCST with a focus on the current recommendations and recent evidence for diagnostic and medical management of this condition.
Congenital aniridia – A comprehensive review of clinical features and therapeutic approaches
Erlend C.S.LandsendMD, PhDaNeilLagaliPhDbTor P.UtheimMD, PhDac
doi : 10.1016/j.survophthal.2021.02.011
Volume 66, Issue 6, November–December 2021, Pages 1031-1050
Congenital aniridia is a rare genetic eye disorder with total or partial absence of the iris from birth. In most cases the genetic origin of aniridia is a mutation in the PAX6 gene, leading to involvement of most eye structures. Hypoplasia of the fovea is usually present and is associated with reduced visual acuity and nystagmus. Aniridia-associated keratopathy, glaucoma, and cataract are serious and progressive complications that can further reduce visual function. Treatment of the ocular complications of aniridia is challenging and has a high risk of side effects. New approaches such as stem cell therapy may, however, offer better prognoses. We describe the various ocular manifestations of aniridia, with a special focus on conditions that commonly require treatment. We also review the growing literature reporting systemic manifestations of the disease.
The impact of strabismus on psychosocial heath and quality of life: a systematic review
Angela N.BuffennMD, MPH
doi : 10.1016/j.survophthal.2021.03.005
Volume 66, Issue 6, November–December 2021, Pages 1051-1064
Strabismus can hinder an individual's ability to perform daily functions and negatively affect their well-being. I examine the impact strabismus has on psychosocial health and quality of life in children and adults and evaluate the challenges confronted by parents of children with strabismus. Numerous misconceptions exist regarding the impact strabismus has on overall health. Negative attitudes persist toward those affected, resulting in difficulties with self-image. Individuals with strabismus are at increased risk for both visual system and psychiatric disorders. Misinformation regarding available treatment options for children and adults with strabismus continues to exist, resulting in decreased access to care. Improved education of health care providers can increase appropriate referrals and initiation of treatment. Treatment of strabismus is not merely cosmetic and has the potential to improve psychosocial health and quality of life for children and adults with and without diplopia.
Escaping from the hunt
BenjaminParkBBAaSubahariRaviskanthanMBBSbPeterMortensenMDbAndrew G.LeeMDbcdJurij R.BilykMDe
doi : 10.1016/j.survophthal.2020.10.005
Volume 66, Issue 6, November–December 2021, Pages 1065-1069
A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V1,2,3, and VI). She was initially diagnosed with Tolosa-Hunt syndrome and had a partial response to systemic corticosteroids. Skull base biopsy eventually showed poorly differentiated carcinoma consistent with perineural spread of squamous cell carcinoma.
Cannabinoids and eye: Focus on angiogenesis and endothelial cells
Amir HosseinNorooznezhadMDNazaninAshtar NakhaeiMD
doi : 10.1016/j.survophthal.2021.02.005
Volume 66, Issue 6, November–December 2021, Pages 1070-1071
Author's Response
HelenDanesh-Meyer
doi : 10.1016/j.survophthal.2021.02.016
Volume 66, Issue 6, November–December 2021, Page 1072
Letter to the Editor regarding Chronopoulos and colleagues “Pneumatic retinopexy, a critical re-appraisal”
Peter J.KertesMD, FRCSCabcRoxane J.HillierMBChB, FRCOphthdeRajeev H.MuniMD, FRCSCacfg
doi : 10.1016/j.survophthal.2021.04.005
Volume 66, Issue 6, November–December 2021, Pages 1073-1075
Authors' Response
ArgyriosChronopoulosMDaLars-OlofHattenbachMDaJames S.SchutzMDb
doi : 10.1016/j.survophthal.2021.04.004
Volume 66, Issue 6, November–December 2021, Pages 1076-1078
Corrigendum to, “Fibromyalgia Syndrome and Eye – a review”, [Surv Ophthalmol. 2021; 66(1); 132-137]
NataliaZdebikAlexanderZdebikJoannaBogus?awskaJoannaPrze?dziecka-Do?ykAnnaTurno-Kr?cicka
doi : 10.1016/j.survophthal.2021.02.009
Volume 66, Issue 6, November–December 2021, Page 1079
