Acute Retinal Detachment Research Articles

Systemic Fluoroquinolone Use and Risk of Uveitis or Retinal Detachment

Fluoroquinolone use has been associated with increased risk of uveitis and retinal detachment in noninterventional studies, but the findings have been conflicting and causality is unclear. To estimate the association of systemic fluoroquinolone use with acute uveitis or retinal detachment, using multiple analyses and multiple databases to increase the robustness of results. This cohort study used data from the Clinical Practice Research Datalink Aurum and GOLD UK primary care records databases, which were linked to hospital admissions data. Adults prescribed a fluoroquinolone or a comparator antibiotic, cephalosporin, between April 1997 and December 2019 were included. Adults with uveitis or retinal detachment were analyzed in a separate self-controlled case series. Data analysis was performed from May 2022 to May 2023. Systemic fluoroquinolone or comparator antibiotic. The primary outcome was a diagnosis of acute uveitis or retinal detachment. Hazard ratios (HRs) were estimated in the cohort study for the association of fluoroquinolone prescription with either uveitis or retinal detachment, using stabilized inverse probability of treatment weighted Cox regression. Rate ratios (RRs) were estimated in the self-controlled case series, using conditional Poisson regression. Estimates were pooled across databases using fixed-effects meta-analysis. In total, 3 001 256 individuals in Aurum (1 893 561 women [63.1%]; median [IQR] age, 51 [35-68] years) and 434 754 in GOLD (276 259 women [63.5%]; median [IQR] age, 53 [37-70] years) were included in the cohort study. For uveitis, the pooled adjusted HRs (aHRs) for use of fluoroquinolone vs cephalosporin were 0.91 (95% CI, 0.72-1.14) at first treatment episode and 1.07 (95% CI, 0.92-1.25) over all treatment episodes. For retinal detachment, the pooled aHRs were 1.37 (95% CI, 0.80-2.36) at first treatment episode and 1.18 (95% CI, 0.84-1.65) over all treatment episodes. In the self-controlled case series, for uveitis, the pooled adjusted RRs (aRRs) for fluoroquinolone use vs nonuse were 1.13 (95% CI, 0.97-1.31) for 1 to 29 days of exposure, 1.16 (95% CI, 1.00-1.34) for 30 to 59 days, and 0.98 (95% CI, 0.74-1.31) for 60 days for longer. For retinal detachment, pooled aRRs for fluoroquinolone use vs nonuse were 1.15 (95% CI, 0.86-1.54) for 1 to 29 days of exposure, 0.94 (95% CI, 0.69-1.30) for 30 to 59 days, and 1.03 (95% CI, 0.59-1.78) for 60 days or longer. These findings do not support an association of systemic fluoroquinolone use with substantively increased risk of uveitis or retinal detachment. Although an association cannot be completely ruled out, these findings indicate that any absolute increase in risk would be small and, hence, of limited clinical importance.

Manifestations of COVID-19 in the posterior eye segment - Up-to-date.

Since coronavirus disease infection-19 (COVID-19) entry to the cells is angiotensin enzyme receptor (ACEII) dependent, extrapulmonary manifestations have been suspected. Ocular manifestations reported in several studies to involve the anterior as well as posterior eye segments. However, the predominance of the anterior eye segment reduced the attention of the scientific community on the posterior eye segment. Our results showed that the incidence of changes in the posterior eye segment is 1/5 of the anterior eye segment. Posterior eye segment manifestations include acute macular neuroretinopathy and paracentral middle maculopathy, central retinal vein/artery occlusion, reactivation of previous uveitis, varicella zoster virus-related acute retinal necrosis in an immunocompromised patient, chorioretinitis, macular hemorrhage, paracentral acute middle maculopathy, retinal detachment, and vitritis with outer retinal abnormalities. The pathogenesis of posterior eye segment manifestations under COVID-19 includes viremia, autoimmune vasculitis, hyperimmune response, coagulopathy, and cytokine storm. A full ophthalmological examination is crucial for patients recovering from COVID-19. The paper provided up-to-date manifestations with potential underlying pathophysiological mechanisms of development, as well as pathogenetic therapy.

Bilateral Extensive Serous Retinal Detachment in a Patient with Multiple Myeloma

Purpose: To describe a case of bilateral serous retinal detachment in a patient with multiple myeloma.Case summary: A 75-year-old woman presented with sudden-onset of reduced visual acuity in both eyes which had begun 2 days prior. Initial ophthalmological assessment revealed that visual acuities were 0.03 in the right eye and 0.05 in the left eye. Optical coherence tomography indicated pronounced macular elevation and extensive subretinal fluid accumulation in the posterior pole of both eyes. Fluorescein angiography did not detect any significant vascular leakage. Blood tests showed an albumin level of 2.1 g/dL, and plasma protein electrophoresis revealed an M protein level of 0.19 g/dL. Multiple myeloma-related hypoalbuminemia and paraprotein were suspected. The patient's retinal statuses were closely monitored and compared with blood test outcomes. Over 2 months, there was significant improvement, characterized by decreasing macular elevation and reduction of subretinal fluid. This progress was sustained thereafter. Plasma protein electrophoresis showed a gradual decline in paraproteins which coincided with the amelioration of serous retinal detachment.Conclusions: We encountered a case of acute and extensive serous retinal detachment in both eyes of a patient with multiple myeloma. When fluorescein angiography does not definitively show vascular leakage, light chain deposition disease-related serous retinal detachment should be considered. In such instances, it is important to address and monitor the underlying multiple myeloma.

Upregulation of Neuroinflammatory Protein Biomarkers in Acute Rhegmatogenous Retinal Detachments.

The purpose of this study is to characterize the inflammatory cytokine profile in rhegmatogenous retinal detachments (RRDs) compared to surgical controls. Vitreous humor was collected from patients undergoing vitrectomy for RRD and noninflammatory vitreoretinal diseases. A quantitative immunoassay was used to measure the levels of 36 cytokine markers. Linear regression analysis with the duration of detachment as the predictor and log-transformed cytokine levels as the outcome was conducted for normally distributed cytokines as determined by the Shapiro-Wilk test. The analysis was adjusted for age, sex, and race. The Kruskal-Wallis test was used for cytokines not normally distributed. Twenty-seven RRD cases and thirteen control cases were studied. Between all RRDs and controls, fibroblast growth factor 2 (FGF2) (p = 0.0029), inducible protein-10(IP-10) (p = 0.0021), monocyte chemoattractant protein-1 (MCP-1) (p = 0.0040), interleukin (IL)-16 (p = 0.018), IL-8 (p = 0.0148), IL-6 (p = 0.0071), eotaxin (p = 0.0323), macrophage inflammatory protein (MIP)-1 alpha (p = 0.0149), MIP-1 beta (p = 0.0032), and the thymus and activation regulated cytokine (TARC) (p = 0.0121) were elevated in RRD cases. Between acute RRDs (n = 16) and controls, FGF2 (p = 0.0001), IP10 (p = 0.0027), MCP-1 (p = 0.0015), MIP-1β (p = 0.0004), IL-8 (p = 0.0146), and IL-6 (p = 0.0031) were elevated. Determining alterations in inflammatory cytokine profiles may aid in understanding their impact on RRD development, clinical course, and complications before and after surgical repair.

Malignant hypertension causing severe chorioretinopathy

A 20-year-old male with uncontrolled hypertension secondary to cytoplasmic-staining antineutrophil cytoplasmic antibody (C-ANCA)–associated renal vasculitis presented with 3 weeks of gradual blurred vision bilaterally. His blood pressure (189/127 mm Hg at presentation) had reached 200/130 mm Hg in the preceding weeks. Visual acuity was 20/70 OD and 20/60 OS. Fundus examination revealed subtle bilateral optic disc edema, abundant acute Elschnig spots, flame-shaped hemorrhages, and inferior exudative retinal detachments (Fig.

Post-SMILE-What myopes know about their secondary emmetropic eyes

Small incision lenticule extraction (SMILE) is popular among young myopic adults for long-term correction of myopia; however, the excessive axial lengths of myopic eyes and the associated risks for more serious eye diseases later on remain with surgical correction of the refractive error. These risks are greater the higher the myopia is. Are patients well informed about this and to what extent does further eye growth occur even after SMILE? Myopic young adults who underwent binocular SMILE before 2019 were given the opportunity to have their eyes examined at afollow-up visit (biometry using IOL-Master 700 [Zeiss, Oberkochen, Germany], subjective refraction, examination of the anterior and posterior segments of the eye using the slit lamp) and to participate in asurvey. Patients with a preoperative axial length ≥ 25.5 mm and a preoperative axial length < 25.5 mm (high myopia) were statistically evaluated separately. A total of 44patients (age 30.39 ± 2.39years) appeared at the visit and the SMILE was 3.18 ± 0.82years ago: The spherical equivalent at the follow-up visit was -0.05 ± 0.21 dpt in the weaker myopes and -0.18 ± 0.23 dpt in the high myopes. Of the respondents 27% estimated that SMILE would reduce the risk of retinal detachment and cataract, with 80% of high myopes underestimating the individual risk of retinal detachment. Also, 57% said they would not see an ophthalmologist until within 1week if they had symptoms consistent with acute retinal detachment, and only 27% would go to an emergency room immediately. In general, 59% reported having normal health awareness and 41% reported going for annual ophthalmological check-ups. The collected axial lengths and refractions show no relevant change in the eyes regarding progression of myopia; however, the patients' statements in the survey point out that most patients are not aware of the risk of serious eye diseases (retinal detachment, cataract). Therefore, repeated risk education and close postoperative care are needed, especially in preoperatively highly myopic patients.

Prevalence of intraocular tumours detected by ultrasonography in eyes with opaque media

ObjectifÉtudier la prévalence des tumeurs intraoculaires découvertes pendant une échographie de dépistage dans des yeux présentant un trouble de transparence des milieux. MéthodesExamen rétrospectif des échographies en mode B réalisées entre le 1er janvier 1994 et le 31 décembre 2013 dans des yeux présentant un trouble de transparence des milieux et qui ont reçu un diagnostic de cécité ou de phtisie du globe oculaire. Ont été exclues les échographies réalisées en vue d'un diagnostic d'endophtalmie aiguë, de décollement de la rétine ou d'hémorragie du vitré. RésultatsOn a réalisé une échographie en mode B dans 119 yeux aveugles qui présentaient un trouble de transparence des milieux. L’âge moyen des patients était de 59 ans; l'acuité visuelle se limitait, au mieux, aux mouvements de la main dans 89 yeux (74,8 %). On a noté une élévation de la pression intraoculaire dans 23 yeux (19,3 %) et de la douleur dans 30 yeux (25,4 %). La durée du suivi était ≥ 1 an dans 69 yeux (58 %), soit une moyenne de 64 mois (médiane : 56 mois; fourchette : 12–129 mois). Au sein de ce sous-groupe de 69 yeux, la fréquence des échographies se déclinait comme suit : plus de 1 fois par année dans 2 yeux (2,9 %), 1 fois par année dans 2 yeux (2,9 %), tous les 13 à 60 mois dans 43 yeux (62 %), tous les 61 à 120 mois dans 19 yeux (27,5 %) et moins fréquemment que tous les 120 mois dans 3 yeux (4,3 %). Par ailleurs, 16 yeux qui présentaient un trouble de transparence des milieux n'ont fait l'objet d'une échographie de dépistage qu'au moment de la visite initiale, tandis que 6 yeux n'ont fait l'objet d'une échographie qu'au moment de l’éviscération ou de l’énucléation. On n'a décelé aucune tumeur intraoculaire dans le cadre de la présente étude. ConclusionsDans notre étude, l’échographie de dépistage n'a mis au jour aucune tumeur intraoculaire dans des yeux présentant un trouble de transparence des milieux. Il serait intéressant de réaliser des études de plus grande envergure dotées d'un suivi de longue durée afin de déterminer l'utilité et la rentabilité du dépistage échographique périodique. La plus grande utilité de l’échographie se trouve peut-être dans le contexte d'une évaluation initiale, en cas de modification de l’état clinique et pendant le bilan préopératoire, afin d’éviter l’éviscération en présence d'un cancer occulte.

Outcomes of weekend surgery for acute retinal detachment.

Outcomes of weekend surgery for acute retinal detachment.

Retinal detachment

British Journal of Healthcare AssistantsVol. 16, No. 5 ClinicalRetinal detachmentIan PeateIan PeateSenior Lecturer, School of Life and Health Sciences, University of RoehamptonSearch for more papers by this authorIan PeatePublished Online:11 May 2022https://doi.org/10.12968/bjha.2022.16.5.236AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleResourceswww.fightforsight.org.uk The only UK charity 100% dedicated to funding pioneering eye research. Aspiring to create a world without sight loss. Google Scholarhttps://www.rcophth.ac.uk/wp-content/uploads/2014/12/2010_PROF_064_OSG-Retinal-Detachment-June-2010.pdf The professional body in this area. Google Scholarwww.rnib.org.uk One of the UK's leading sight loss charities and the largest community of blind and partially sighted people. Google ScholarDriver and Vehicle Licensing Authority. Assessing fitness to drive—a guide for medical professionals. 2021. www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals (accessed 12 April 2022) Google ScholarKhan AA, Kelly RJ, Carrim ZI. Flashes, floaters, and a field defect. BMJ. 2013 Nov 4;347:f6496. doi: https://doi.org/10.1136/bmj.f6496 Crossref, Google ScholarMistry D, Charteris D, Yorston D et al. The epidemiology and socioeconomic associations of retinal detachment in Scotland: a two-year prospective population-based study. Invest Ophthalmol Vis Sci. 2010 Oct;51(10):4963–4968. doi: https://doi.org/10.1167/iovs.10-5400. Epub 2010 Jun 16 Crossref, Google ScholarRoyal College of Ophthalmologists. Management of acute retinal detachment. 2013. www.rcophth.ac.uk/wp-content/uploads/2014/12/2010_PROF_064_OSG-Retinal-Detachment-June-2010.pdf (accessed 12 April 2022) Google ScholarRoyal National Institute of the Blind. Understanding retinal detachment. 2020. www.rnib.org.uk/sites/default/files/Understanding-Retinal-Detachment-2020.pdf (accessed 12 April 2022) Google ScholarShah V, Hall N, Goldacre MJ. Retinal detachment in England: database studies of trends over time and geographical variation. Br J Ophthalmol. 2015 May;99(5):639–643. doi: https://doi.org/10.1136/bjophthalmol-2014-305774. Epub 2014 Nov 19 Crossref, Google ScholarSharma P, Sridhar J, Mehta S. (2015) Flashes and floaters. Prim Care. 2015 Sep;42(3):425–435. doi: https://doi.org/10.1016/j.pop.2015.05.011 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 May 2022Volume 16Issue 5ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 11 May 2022 Published in print 2 May 2022 Information© MA Healthcare LimitedAcknowledgementI would like to thank Mrs Frances Cohen for her help and supportPDF download

Acute Serous Retinal Detachment after the Same Operating Session of Uncomplicated Cataract Surgeries: A Case Series.

To report four cases of acute serous retinal detachment (ASRD) after the same operating session of uncomplicated cataract surgeries. In this case series, data of patients who developed ASRD after uncomplicated phacoemulsification with intraocular lens implantation during the same operating session were collected. Diagnosis was made on the first postoperative day, when all patients had a very low best-corrected visual acuity (BCVA), despite a good aspect of the anterior segment, without significant keratopathy and with only trace cells in the anterior chamber. Spectral-domain optic coherence tomography (SD-OCT) revealed serous retinal detachment with subretinal fluid accumulation in the macular area. Patients received a parabulbar injection of 40 mg/mL triamquinolone in addition to usual the postoperative topical treatment of 0.1% dexamethasone and 0.3% netilmicin eye drops. Patients were examined postoperatively on days 1, 3, 7, and 1 month. BCVA and central foveal thickness (CFT) measured by SD-OCT were evaluated at each visit. A relationship between demographics, preoperative ocular conditions, systemic diseases, parameters of surgery, and the development of ASRD was analyzed. After a single operating session of 10 uneventful cataract surgeries, operated by the same expert surgeon, on postoperative day 1, ASRD was detected in 4 patients (3 male, 1 female; mean age 71 ± 4.1 years). Preoperatively, the mean BCVA was 0.6 ± 0.1 decimals and mean CFT was 191.3 ± 13.7 µm. On the first postoperative day, mean BCVA was 0.01 ± 0.1 decimals, and all eyes had serous retinal detachment, with a mean CFT of 682.0 ± 97.4 µm. On the following visits, BCVA improved and CFT reduced significantly. On day 7, BCVA was at least 0.7 decimals in all eyes, with complete reabsorption of subretinal fluid. At 1 month, mean BCVA was 1.0 ± 0.0 decimals and no eye had recurrence of serous retinal detachment, with a mean CFT of 202.3 ± 26.7 µm. No relevant data were found on other parameters investigated. Acute serous retinal detachment is a rare event that can occur after uncomplicated phacoemulsification, which in our cases, resolved in a few days without recurrence.

К вопросу об отслойках сетчатки при цитомегаловирусном увеите у ВИЧ-инфицированных пациентов

Cytomegalovirus uveitis (CMV-uveitis) is one of the most common causes of vision loss in HIV-infected patients. The purpose is to characterize the clinical features of the course of retinal detachment in HIV infection. Material and methods. The study group included 29 patients, 34 eyes (9 men and 20 women). All patients underwent a standard routine ophthalmological examination. To confirm the diagnosis, an ultrasound of the eyeball was performed. Results. The following forms of retinal detachment were identified: acute retinal necrosis, regmatogenic and traction detachment. In 50% of cases, the disease occurred as acute retinal necrosis of CMV-etiology. Visual acuity in the group of patients with operated retinal detachment became significantly lower after complex treatment. Conclusions. CMV-uveitis has a chronic sluggish course, despite multicomponent treatment. Key words: cytomegalovirus, uveitis, HIV, HIV-infection, AIDS, retinal detachment.

Conditional Knock out of High-Mobility Group Box 1 (HMGB1) in Rods Reduces Autophagy Activation after Retinal Detachment.

After retinal detachment (RD), the induction of autophagy protects photoreceptors (PR) from apoptotic cell death. The cytoplasmic high-mobility group box 1 (HMGB1) promotes autophagy. We previously demonstrated that the deletion of HMGB1 from rod PRs results in a more rapid death of these cells after RD. In this work, we tested the hypothesis that the lack of HMGB1 accelerates PR death after RD due to the reduced activation of protective autophagy in the retina after RD. The injection of 1% hyaluronic acid into the subretinal space was used to create acute RD in mice with a rhodopsin-Cre-mediated conditional knockout (cKO) of HMGB1 in rods (HMGB1Δrod) and littermate controls. RD sharply increased the number of apoptotic cells in the outer nuclear layer (ONL), and this number was further increased in HMGB1Δrod mouse retinas. The activation of autophagy after RD was reduced in the HMGB1Δrod mouse retinas compared to controls, as evidenced by diminished levels of autophagy regulatory proteins LC3-II, Beclin1, ATG5/12, and phospho-ATG16L1. The cKO of HMGB1 in rods increased the expression of Fas and the Bax/Bcl-2 ratio in detached retinas, promoting apoptotic cell death. In conclusion, endogenous HMGB1 facilitates autophagy activation in PR cells following RD to promote PR cell survival and reduce programmed apoptotic cell death.

Case Report: Diagnosis of Late Spontaneous Intraocular Lens Dislocation on Point-of-care Ultrasound.

IntroductionSpontaneous intraocular lens (IOL) dislocation is a rare, but serious, complication following cataract surgery.Case ReportWe report a case of patient with a remote history of cataract surgery presenting to the emergency department with monocular blurred vision. Ocular point-of-care ultrasound (POCUS) facilitated diagnosis of a late spontaneous IOL dislocation.DiscussionProsthetic IOL dislocations are being reported with increasing frequency. Prompt recognition of IOL dislocation is essential to prevent secondary complications, including acute angle-closure glaucoma and retinal detachment, which can result in permanent vision loss.ConclusionPoint-of-care ultrasound is a rapid, noninvasive imaging modality for early detection of IOL dislocation to help guide management, improve patient outcomes, and mitigate long-term sequelae.

Evolving outcomes of surgery for retinal detachment in retinopathy of prematurity: the need for a national service in the United Kingdom : An audit of surgery for acute tractional retinal detachment complicating ROP in the UK.

To audit the structural and functional outcomes of surgery for acute tractional retinal detachment due to retinopathy or prematurity between 2004 and 2014 in Oxford UK. Consecutive operations were identified from a surgical log. Clinical data including demography, perioperative data, and retinal outcomes were extracted into a spreadsheet and compared against two international data sets referenced in the method section. Nonparametric tests (Fisher's exact, and the Mann-Whitney U-tests) were used for statistical analysis with a p-value < 0.05 considered significant. Twenty-nine eyes of 19 babies underwent surgery. The mean age (SD) at final follow-up was 6.4 (3.7) years of age and comparable to the reference data sets. The mean birth weight and gestational age of babies matched the ETROP data set referenced in the method section. Anatomical success was obtained in 16/29 (55.2%) of eyes and more likely with stage 4 ROP than stage 5 disease (p < 0.05). Thirteen of 29 eyes (44.8%) obtained form vision post-operatively. All instances of macular retinal reattachment during follow up were verified with post-operative OCT. Surgery for stage 5 ROP is not worthwhile. For stage 4 ROP it yielded better visual outcomes than ETROP but registration for visual impairment was not prevented. Innovation such as endoscopic vitrectomy could yield better outcomes. Earlier detection of vitreoretinal fibrosis could result in timelier referral. A formally funded national service is needed to ring-fence resource to avoid delays in access to surgery, which has a narrow surgical window.

Отслойка сетчатки при цитомегаловирусном увеите у ВИЧ-инфицированных пациентов: исходы лечения

Cytomegalovirus (CMV) uveitis in HIV infection is one of the most dangerous secondary diseases of the visual organ, leading to blindness in the absence of treatment. The aim is to characterize the clinical features of the course of retinal detachment in HIV infection. Materials and methods. The study group included 29 patients, 34 eyes (9 men and 20 women). All patients underwent a standard routine ophthalmological examination. To confirm the diagnosis, an ultrasound of the eyeball was performed. Results. Retinal detachment was detected in 29 patients (34 eyes) out of 72 (94 eyes) and was 40.3% (95% CI=29.3-51.79%). According to the mechanism of retinal detachment, the following forms were identified: acute retinal necrosis, regmatogenic and traction detachment. In 50% of cases, the disease occurred as acute retinal necrosis of CMV-etiology. Visual acuity in the group of patients with operated retinal detachment became significantly lower after complex treatment. Conclusions. CMV-uveitis has a chronic sluggish course, despite multicomponent treatment. Retinal detachment is detected in 40% of HIV-infected patients with CMV-uveitis and in half of cases has the character of acute retinal necrosis. Keywords: cytomegalovirus, uveitis, HIV, HIV-infection, AIDS, retinal detachment.

Evidence Supporting the Management of Medical Conditions During Long-Duration Spaceflight: Protocol for a Scoping Review.

BackgroundFuture long-duration space exploration missions, such as traveling to Mars, will create an increase in communication time delays and disruptions and remove the viability of emergency returns to Earth for timely medical treatment. Thus, higher levels of medical autonomy are necessary. Crew selection is proposed as the first line of defense to minimize medical risk for future missions; however, the second proposed line of defense is medical preparedness and crew member autonomy. In an effort to develop a decision support system, the Canadian Space Agency mandated a team of scientists from Thales Research and Technology Canada (Québec, QC) and Université Laval (Québec, QC) to create an evidence-based medical condition database linking mission-critical human conditions with key causal factors, diagnostic and treatment information, and probable outcomes.ObjectiveTo complement this database, we are currently conducting a scoping review to better understand the depth and breadth of evidence about managing medical conditions in space.MethodsThis scoping review will adhere to quality standards for scoping reviews, employing Levac, Colquhoun, and O’Brien's 6-stage methodology; the reported results will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. In stage 1, we identified the research question in collaboration with the Canadian Space Agency (CSA), the main knowledge user. We prioritized 10 medical conditions: (1) acute coronary syndrome, (2) atrial fibrillation, (3) eye penetration, (4) herniated disk, (5) nephrolithiasis, (6) pulmonary embolism, (7) retinal detachment, (8) sepsis, (9) stroke, and (10) spaceflight associated neuro-ocular syndrome. In stage 2, with the help of an information specialist from Cochrane Canada Francophone, papers were identified through searches of the following databases: ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO, and Web of Science. In stage 3, studies will be selected and assessed using a 3-step process and emerging, refined exclusion criteria. In stage 4, the data will be charted in a table based on parameters required by the CSA and developed using Google spreadsheets for shared access. In stage 5, evidence-based descriptive summaries will be produced for each condition, as well as descriptive analyses of collected data. Finally, in stage 6, the findings will be shared with the CSA to guide the completion of this project.ResultsThis study was planned in December 2018. Stage 1 has been completed. The initial database search strategy with all target conditions combined identified a total of 10,403 citations to review through title and abstract screening and after duplicate removal. We plan to complete stages 2-6 by the beginning of 2021.ConclusionsThis scoping review will map the literature on the management of 10 priority medical conditions in space. It will also enable us to identify knowledge gaps that must be addressed in future research, ensuring successful and medically safe future missions as humankind embarks upon new frontiers of space exploration.International Registered Report Identifier (IRRID)DERR1-10.2196/24323

Outcomes of 25-gauge pars plana vitrectomy with encircling scleral band for acute retinal necrosis-related rhegmatogenous retinal detachment.

Purpose:The aim of this study was to evaluate the anatomic and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) with encircling scleral band (ESB) in patients with acute retinal necrosis (ARN)-related rhegmatogenous retinal detachment (RRD).Methods:Single-center retrospective interventional case series of patients who underwent 25G PPV with ESB for ARN-related RRD. Complete anatomic success was defined as the complete attachment of retina after primary PPV. Functional success was measured by the final best-corrected visual acuity (BCVA) ≥20/400. Intraoperative and postoperative complications were also noted.Results:14 eyes of 13 patients were included in the study. Six patients (46.1%) were immunocompromised. The mean follow-up was 23.64 ± 9.95 (range 6-42) months. Silicone oil was used as tamponade in 13 eyes and C3F8 gas in one eye. After the primary PPV, complete anatomical success was seen in all eyes (100%), however, one eye developed phthisis bulbi after silicone oil removal (SOR). Statistically significant improvement of BCVA was seen, from LogMAR 2.03 ± 0.29 preoperatively to LogMAR 1.57 ± 0.63 postoperatively (p-value 0.014). Six eyes (42.9%) had functional success. Nine eyes (64.3%) had improvement in vision while 4 eyes (28.6%) maintained preoperative vision. 10 eyes (71.4%) underwent cataract surgery, nine eyes (64.3%) underwent SOR while 2 eyes (14.3%) had epiretinal membrane (ERM) under oil during follow-up.Conclusion:25G PPV combines the advantages of minimally invasive vitrectomy surgery while offering improved anatomic outcomes in patients with ARN-related RRD. The functional outcome varies depending on the status of the optic disc and macula.

Comparative study of intraocular pressure measured by non-contact, rebound and goldmann applanation tonometer and their correlation with corneal thickness and true IOP in a general population

: To compare the Intraocular Pressure (IOP) measured by Non-contact tonometer (NCT), Rebound tonometer (RBT) and Goldmann Applanation tonometer (GAT) and their correlation with central corneal thickness (CCT) and true IOP.Reliability of each tonometer. 500 random patients aged 18 years and above were taken up for the study. Patients with anterior and posterior segment pathologies like corneal ulcer, leukoma, staphyloma, corneal lacerations, ectatic corneal conditions, corneal dystrophies, oedema, perforations, acute angle closure glaucoma, retinal detachments, vitreous haemorrhage and unwilling patients were excluded from the study. IOP was recorded using NCT, RBT and GAT after assessing the patient's visual acuity. Following IOP measurement, central corneal thickness (CCT) of each patient was measured using pachymetry. All the data were collected and tabulated for statistical analysis to obtain results. The mean CCT in males was 0.5350 mm and in females 0.5340 mm respectively. The mean IOP measured by NCT is 16.43 mm hg whereas the mean IOP measured by GAT is 15.43 mm hg. IOP measured by NCT is significantly higher than the IOP measured by GAT (p&amp;#60;0.001). When NCT and RBT are compared NCT values are significantly higher than that of RBT(p&amp;#60;0.001). Although the mean RBT IOP 15.83 mm hg is higher than the mean GAT IOP of 15.42 mm hg the values are not statistically significant. When correlated with CCT all the tonometers showed significant correlation with GAT showing the strongest correlation. NCT overestimates IOP in normal, thin and thicker corneas when compared to GAT and are statistically significant. RBT also overestimates in the normal and thick corneas when compared to GAT but their values are much closer to GAT values in thinner corneas. The IOP measured by all the 3 tonometers correlated with corrected IOP with NCT showing the best correlation followed by GAT. From the present study we can conclude that IOP measured by NCT and RBT is higher than GAT. NCT values are significantly higher than GAT values in thin and normal corneas whereas it overestimates more in thicker corneas. RBT values are significantly higher than that of GAT in normal and thick corneas. So, it is always advisable to measure the corrected IOP for each patient after considering the CCT.

Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States.

Background/objectivesPatients with ophthalmic emergencies often present to emergency rooms. Emergency medicine (EM) physicians should feel comfortable encountering these conditions. We assessed EM physicians’ comfort working up, diagnosing, and managing ophthalmic emergencies.Subjects/methods329 EM physicians participated in this cross-sectional multicentre survey. Questions inquired about the amount, type, and self-perceived adequacy of ophthalmic training. Likert scales were used to assess confidence and comfort working up, diagnosing, and managing ophthalmic emergencies.ResultsParticipants recall receiving a median of 5 and 10 h of ophthalmic training in medical school and residency, respectively. Few feel this prepared them for residency (16.5%) or practice (52.0%). Only 50.6% feel confident with their ophthalmic exam. Most (75.0%) feel confident in their ability to identify an ophthalmic emergency, but 58.8% feel well prepared to work them up. Responders feel more comfortable diagnosing acute retrobulbar hematoma (72.5%), retinal detachment (69.8%), and acute angle closure glaucoma (78.0%) than central retinal artery occlusion (28.9%) or giant cell arteritis (53.2%). Only 60.2% feel comfortable determining if canthotomy and cantholysis is necessary in the setting of acute retrobulbar hematoma, and 40.3% feel comfortable performing the procedure. There was a trend towards attending physicians and providers in urban and academic settings feeling more comfortable diagnosing and managing ophthalmic emergencies compared to trainees, non-urban, and non-academic physicians.ConclusionsMany participants do not feel comfortable using ophthalmic equipment, performing an eye exam, making vision or potentially life-saving diagnoses, or performing vision-saving procedures, suggesting the need to increase ophthalmic training in EM curricula.

Acute retinal detachment after Nd:YAG treatment for vitreous floaters and postertior capsule opacification: a case report

BackgroundModern laser surgery uses Nd:YAG laser capsulotomy for posterior capsule opacification (PCO) and Nd:YAG laser vitreolysis for symptomatic vitreous floaters (VF). We report a case of acute retinal detachment seven days after Nd:YAG laser capsulotomy combined with Nd:YAG laser vitreolysis and analyze the cause of this complication.Case presentationA 58-year-old myopic woman complained of decreased visual acuity and symptomatic floaters with her left eye for 3 months. We found she had significant PCO and VF in the posterior vitreous. She underwent neodymium-doped yttrium aluminum (Nd:YAG) laser vitreolysis immediately after Nd:YAG capsulotomy. After 7 days, she complained of rapid vision decline and dark shadows in her treated eye. We found she had a acute severe rhegmentogenous retinal detachment (RD) involving the macula. Then she underwent vitrectomy, retinal reattchment and silicone oil tamponade surgery immediately. Six months later, silicone oil was removed and the best corrected visual acuity (BCVA) of her left eye gradually improved to 10/20 and maintained during a 1-year follow-up period.ConclusionAs myopic patients are at risk of developing retinal detachment, Nd:YAG vitreolysis and capsulotomy should be performed with caution. The laser energy should be as low as possible and careful focus is necessary to reduce interference to the retina.