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Who should write a Survey of Ophthalmology review?
John W. Gittinger Jr., MD
doi : 10.1016/j.survophthal.2021.02.001
VOLUME 66, ISSUE 4, P551, JULY 01, 2021
Photodynamic therapy for choroidal melanoma: What is the response rate?
Sari Yordi,Hansell Soto,Randy C. Bowen,Arun D. Singh
doi : 10.1016/j.survophthal.2020.09.006
VOLUME 66, ISSUE 4, P552-559, JULY 01, 2021
To determine the response rate of choroidal melanoma following primary photodynamic therapy, we conducted a meta-analysis of published studies. A total of 7 studies reporting photodynamic therapy as primary treatment of choroidal melanoma in 162 patients with a mean tumor height of 2.8 mm (1.4 to 4.2) were identified. Forty-six percent of tumors were amelanotic, 48% were fully pigmented, and 6% had partial pigmentation. The photodynamic therapy parameters in all studies included 10-minute intravenous infusion of verteporfin (6 mg/m2), but varied in number of sessions (1 to 3), fluence (1× to 19×), and number of spots (single or multiple). The response was defined as tumor regression (partial or total) or lack of growth after initial treatment. The response to photodynamic therapy was predominantly observed as regression (126 [78%]). Overall response rate was 80% (mean) with a wide range among studies (58%–100%) over a period of 50 months (mean) with variable follow-up (range, 1–156 months). None of the studies reported progression- or recurrence-free survival; however, the recurrence rate was not related to the follow-up duration. Favorable prognostic factors were smaller size and lack of pigmentation. The overall response rate of 80% suggests that photodynamic therapy may be an effective primary treatment for small choroidal melanoma, especially in cases without pigmentation. Artifacts in study design (inclusion criteria and outcome measure) may have contributed to the variable observed response rate. Further studies with uniform inclusion criteria, standardized treatment parameters, well-defined outcome measures, and long follow-up are needed.
Dome-shaped macula—Review of literature
Vinod Kumar,Saurabh Verma,Shorya Vardhan Azad,Abhidnya Surve,Rajpal Vohra,Pradeep Venkatesh
doi : 10.1016/j.survophthal.2020.11.002
VOLUME 66, ISSUE 4, P560-571, JULY 01, 2021
Dome-shaped macula is a convex retinochoroidal elevation within the region of a posterior staphyloma seen commonly in high myopia on optical coherence tomography. With growing awareness of the condition facilitated by inclusion of optical coherence tomography in routine retinal practice, coupled with evolution of enhanced depth optical coherence tomography imaging, multiple studies have attempted to shed light on pathogenesis of this complex pathology, its clinical implications, and treatment of associated complications such as serous macular detachment and choroidal neovascularization with variable success. Our review aims to assimilate, scrutinize, and discuss the available literature for a comprehensive insight into dome-shaped macula.
Intravitreal antivascular endothelial growth factor injection versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3,701 eyes
Marko M. Popovic,Prem Nichani,Rajeev H. Muni,Kamiar Mireskandari,Nasrin N. Tehrani,Peter J. Kertes
doi : 10.1016/j.survophthal.2020.12.002
VOLUME 66, ISSUE 4, P572-584, JULY 01, 2021
We investigate the efficacy and safety of intravitreal injection (IVI) of antivascular endothelial growth factor agents and laser photocoagulation (LPC) for retinopathy of prematurity. We performed a systematic search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL (2005–2019). Comparative studies reporting on ocular efficacy and/or safety outcomes after IVIs and LPC for retinopathy of prematurity were included. The primary outcome was the regression rate, whereas secondary endpoints included the likelihood of requiring additional treatment, visual and refractive outcomes, and complications. Overall, 777 publications were identified. Twenty-four articles were included, with 1,289 eyes receiving IVI and 2,412 eyes undergoing LPC. There was no significant difference in the regression rate between IVI and LPC (P = 0.68); however, eyes that underwent IVI were associated with a significantly higher likelihood of requiring additional treatment (risk ratio = 2.16, 95% confidence interval (CI) = [1.26, 3.73], P = 0.005) and longer time from treatment to retreatment or recurrence (weighted mean difference = 6.43 weeks, 95% CI = [2.36, 10.51], P = 0.002). Eyes receiving IVI required surgical intervention significantly less often (risk ratio = 0.45, 95% CI = [0.23, 0.89], P = 0.02). Astigmatism was significantly lower after IVI relative to LPC (weighted mean difference = ?0.25 D, 95% CI = [?0.45, ?0.06], P = 0.01), and there was a lower proportion of emmetropic eyes at last follow-up after LPC (risk ratio = 0.51, 95% CI = [0.27, 0.99], P = 0.05). There were no differences in visual and safety outcomes between IVI and LPC. LPC had a lower likelihood of requiring additional treatment, whereas IVIs were associated with a longer interval from treatment to retreatment or recurrence, reduced risk of surgical intervention and superior refractive outcomes. All other outcomes were comparable between IVIs and LPC.
Pneumatic retinopexy: A critical reappraisal
Argyrios Chronopoulos,Lars-Olof Hattenbach,James S. Schutz
doi : 10.1016/j.survophthal.2020.12.007
VOLUME 66, ISSUE 4, P585-593, JULY 01, 2021
Pneumatic retinopexy (PR) has been widely advocated for treatment of selected rhegmatogenous retinal detachments: those with small, anterior, superior, retinal breaks and little or no proliferative vitreoretinopathy. It has been suggested that PR is underused and is advantageous because it is an outpatient clinic or office procedure, short in duration, nonincisional, and cost saving – with reduced perioperative morbidity, faster postoperative recovery, better and faster visual recovery, a low rate of complications and a high rate of overall success compared with scleral buckling or pars plana vitrectomy. We reevaluated these advantages to substantiate the effectiveness and efficiency of PR and critically define its role in the treatment of rhegmatogenous retinal detachment. We found that PR has a much higher rate of subsequent reoperation and proliferative vitreoretinopathy than scleral buckling or pars plana vitrectomy for simple, good prognosis rhegmatogenous retinal detachments. PR often involves multiple procedures that largely negates its potential cost savings and subjects the patient to prolonged stress and disability. Scleral buckling rather than PR is ideally suited for simple, good prognosis rhegmatogenous retinal detachments for surgeons who feel comfortable with the technique; alternatively, pars plana vitrectomy is indicated.
The clinical and pathogenic spectrum of surgically-induced scleral necrosis: A review
Raul E. Ruiz-Lozano,Lucas A. Garza-Garza,Osvaldo Davila-Cavazos,C. Stephen Foster,Alejandro Rodriguez-Garcia
doi : 10.1016/j.survophthal.2020.12.008
VOLUME 66, ISSUE 4, P594-611, JULY 01, 2021
The onset of scleral necrosis after ocular surgery may have catastrophic ocular and systemic consequences. The two most frequent surgeries causing surgically-induced scleral necrosis (SISN) are pterygium excision and cataract extraction. Several pathogenic mechanisms are involved in surgically induced scleral necrosis. All of them are poorly understood. Ocular trauma increasing lytic action of collagenases with subsequent collagen degradation, vascular disruption leading to local ischemia, and immune complex deposition activating the complement system represents some of the events that lead to scleral necrosis. The complex cascade of events involving different pathogenic mechanisms and the patient's abnormal immune response frequently leads to delayed wound healing that predisposes the development of scleral necrosis. The management of SISN ranges from short-term systemic anti-inflammatory drugs to aggressive immunosuppressive therapy and surgical repair. Therefore, before performing any ocular surgery involving the sclera, a thorough ophthalmic and systemic evaluation must be done to identify high-risk patients that may develop SISN.
Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction
Morten Magno,Emily Moschowits,Reiko Arita,Jelle Vehof,Tor Paaske Utheim
doi : 10.1016/j.survophthal.2020.11.005
VOLUME 66, ISSUE 4, P612-622, JULY 01, 2021
Meibomian gland dysfunction (MGD) is a major cause of dry eye, affecting millions worldwide. Intraductal meibomian gland probing (MGP) aims to open obstructed meibomian glands using a small probe to promote meibum secretion. MGP has received increasing interest since 2010, and we critically evaluated the literature on the efficacy and safety of MGP. Despite positive results of MGP on dry eye symptoms in early single-group studies, MGP was not shown to consistently outperform controls in later controlled trials. Furthermore, MGP alone did not show improvement beyond placebo in the only placebo-controlled RCT conducted. Overall, the procedure appears safe. Self-limited intraoperative bleeding was frequent, but no major complications were reported. In conclusion, MGP has not yet been shown to be an effective treatment for MGD. Larger placebo-controlled trials need to be conducted to establish the potential effect of this novel treatment modality.
Infectious keratitis after lamellar keratoplasty
Namrata Sharma,Manpreet Kaur,Jeewan S. Titiyal,Anthony Aldave
doi : 10.1016/j.survophthal.2020.11.001
VOLUME 66, ISSUE 4, P623-643, JULY 01, 2021
Infectious keratitis after lamellar keratoplasty is a potentially devastating complication that may severely limit the visual and anatomical outcomes. The deep-seated location of the infiltrates, sequestration of the pathogenic microorganisms and limited penetration of the currently available antimicrobial agents often results in delayed diagnosis that may jeopardize the management in these cases. Fungal keratitis is more common as compared with bacterial or viral keratitis and classically presents as white interface infiltrates that may not be associated with significant inflammation. Confocal microscopy may help to establish a rapid diagnosis in such cases, and anterior segment optical coherence tomography may be used to determine the extent of infection and monitor its progression. Conservative measures such as topical antimicrobials and interface irrigation with antimicrobial agents may be done. Surgical intervention in the form of partial excision/removal of the graft in endothelial keratoplasty or a full-thickness keratoplasty is often required for the effective management of deep-seated infections. Timely diagnosis and intervention may result in complete resolution of infection in both anterior lamellar and endothelial keratoplasty. Infections after anterior lamellar keratoplasty have a fair prognosis, and a clear graft with functional visual acuity may be achieved in most cases. By contrast, infections after endothelial keratoplasty have a guarded prognosis, and the presence of concomitant endophthalmitis may further complicate the graft survival and visual outcomes.
Improvement in structure and visual function in patients with glaucoma: the possible key to better treatment?
Osama M. Ahmed,Michael Waisbourd,George L. Spaeth,L. Jay Katz
doi : 10.1016/j.survophthal.2020.12.004
VOLUME 66, ISSUE 4, P644-652, JULY 01, 2021
Glaucoma is characterized by retinal ganglion cell loss that can lead to permanent visual loss. Current clinical management practice assumes that glaucomatous visual loss is irreversible; however, there is increasing evidence that permanent vision loss and cell death are preceded by reversible functional and structural changes. We propose that these changes should be considered by glaucoma specialists when treating their patients. We discuss the neurobiological basis of this phenomenon and provide clinical evidence of reversibility in both structure and function. Specifically, we review the findings of visual field testing, contrast sensitivity, electroretinography, and imaging of the optic nerve and their correlation with functional changes. We then discuss the clinical value of these observations in helping guide approaches toward the diagnosis and treatment of patients with glaucoma.
Vascular abnormalities in uveitis
Nazanin Ebrahimiadib,Arash Maleki,Kaveh Fadakar,Ambika Manhapra,Fariba Ghassemi,C. Stephen Foster
doi : 10.1016/j.survophthal.2020.12.006
VOLUME 66, ISSUE 4, P653-667, JULY 01, 2021
Inflammation can involve several ocular structures, including the sclera, retina, and uvea, and cause vascular changes in these tissues. Although retinal vasculitis is the most common finding associated with uveitis involving the posterior segment, other vascular abnormalities may be seen in the retina. These include capillary nonperfusion and ischemia, vascular occlusions, preretinal neovascularization, microaneurysms and macroaneurysms, and telangiectasia. Moreover, vasoproliferative tumors and subsequent coat-like response can develop secondary to uveitis. Fluorescein angiography is ideal for the investigation of retinal vascular leakage and neovascularization, while optical coherence tomography angiography can provide depth resolved images from the superficial and deep capillary plexus and can demonstrate vascular remodeling. Choroidal vascular abnormalities primarily develop in the choriocapillaris or in the choroidal stroma and can appear as flow void in optical coherence tomography angiography and filling defect and vascular leakage in indocyanine green angiography. Extensive choriocapillaris nonperfusion in the presence of choroidal inflammation can increase the risk of choroidal neovascular membrane development. Iris vascular changes may manifest as dilation of vessels in stroma due to inflammation or rubeosis that is usually from ischemia in retinal periphery secondary to chronic inflammation. More severe forms of scleral inflammation, such as necrotizing scleritis, are associated with vascular occlusion in the deep episcleral plexus, which can lead to necrosis of sclera layer and uveal exposure.
A shotgun wedding
Leroy Ekeh,Christopher R. Dermarkarian,Rod Foroozan,M. Tariq Bhatti
doi : 10.1016/j.survophthal.2020.06.007
VOLUME 66, ISSUE 4, P668-673, JULY 01, 2021
Letter: vision therapy: occlusion, prisms, filters, and vestibular exercises for mild traumatic brain injury
Kenneth J. Ciuffreda,William V. Padula,Patrick Quaid,Daniella Rutner
doi : 10.1016/j.survophthal.2021.01.006
VOLUME 66, ISSUE 4, P674-676, JULY 01, 2021
Authors' Response
Paul J. Ranalli,Jason J.S. Barton
doi : 10.1016/j.survophthal.2021.01.007
VOLUME 66, ISSUE 4, P677-679, JULY 01, 2021
Comments on: Intraductal Meibomian Gland Probing and its Efficacy in the Treatment of Meibomian Gland Dysfunction
Steven L. Maskin
doi : 10.1016/j.survophthal.2021.02.007
VOLUME 66, ISSUE 4, P680-685, JULY 01, 2021
Authors' Response
Morten S. Magno
doi : 10.1016/j.survophthal.2021.02.014
VOLUME 66, ISSUE 4, P686-692, JULY 01, 2021
