Survey Of Ophthalmology Research Articles

Bibliometric analysis of the most cited articles on congenital cataract from 1980 to 2022

Aim: It was aimed to present a summary of the articles published between 1980-2022 on congenital cataract, to identify the most cited articles in the field, to analyze the most active journals and the development in countries by years.Material and Method: Search was made using keywords “Congenital Cataract”, “OR: Pediatric Cataract”, “OR: Infantile Cataract”, “AND: 1980-2022 (Year Published)”, “AND: English (Language)” in Web of Science (WOS) database via Boolean operators (Access Date: 01.11.2022). Bibliometric analyzes were made using VOSviewer (ver.1.6.18), statistical analyzes were made using rstudio (ver.2022.02.1), other analyzes were made using Microsoft Excel. Results: In the bibliometric analysis, 1383 articles were included between the dates determined. Over the past few decades, the total number of publications on congenital cataracts continually increased from 2 in 1980 to 68 in 2022 November. The most productive year was 2021 (n=93), while the most cited year was 2004 (1,184 citations, 32 publications). The most studied WOS categories were ophthalmology (n=900), pediatrics (183) and genetics (167). The most widely used keywords were congenital cataract (n=235), cataract (n=124) and pediatric cataract (n=75). The most cited paper in congenital cataract was “Pax6 gene dosage effect in a family with congenital cataracts, aniridia, anophthalmia and central-nervous-system defects”, which was published in Nature Genetics in 1994 and cited 562 times (impact factor: 8.78). In ophthalmology journals, the most cited article was published in Survey of Ophthalmology (267 times, 1996) and the Molecular Vision was the most attractive journal with 104 publications. The United States of America, England and Peoples R China had the highest total link strength (TLS), 226 (10,325 citations), 134 (3,621 citations) and 73 (3,871 citations), respectively.Conclusion: These findings provide useful information on the status and trends of current clinical research on congenital cataracts. Our study can be used to identify areas of study and standard bibliographic references for better diagnosis and disease control.

THE DAMAGE OF THE OPTIC NERVE AS THE OUTCOME OF UNINTENTIONAL POISONING BY CLOSANTEL

Background: In recent decades, the problem of toxic damage of the visual system due to poisoning by various medicines has become particularly relevant. The clinical case of a bilateral acute optic neuropathy of toxic genesis in a patient by the unintentional application of closantel used in veterinary practice is presented in the report. Closantel is a structural derivative of the salicylanilides, which is used exclusively in veterinary medicine for the prevention and treatment of large and small-scale cattle. Neurological and ophthalmic symptoms are often associated with the intoxication of closantel. Objective: To describe the toxic damage of the optic nerve due to unintentional poisoning by closantel. Methods: A patient aged 55 years is examined. A standard survey of ophthalmology was carried out. Photoregistration of the ocular fundus was used by a funduscamera Visucam 500 (Carl Zeiss Meditec AG, Germany), from special methods of research - the spectral optical coherence tomography (OCT) with a study of the macular area of the retina and the disc of the optic nerve on the device Zeiss Cirrus 5000 (Carl Zeiss Meditec, USA) and the optical coherence tomography with the function of angiography (OCT-A) of the macular area of the retina using RTVue XR Avanti (Optovue, USA) Results: The patient complained of a severe, yet painless, reduction in vision of both eyes after an accidental intramuscular injection of the medicine called "Closantrem" in dose 4.0 ml. The visual acuity OU - an accounting of fingers on the face at a distance of 10 cm. By ophthalmoscopy OU: the disc of the optic nerve is discolourated, its boundaries are indistinct, the arteries and the veins are narrowed, in the macular area of the retina without a visible physical pathology. The perimetry is in the correct projection of the light. A reduction in the thickness of the external and internal layers of the retina was observed as a result of the OCT of the macular zone OU. According to OCT of the disc of the optic nerve: the thickness of the layer of nerve fibres is in the upper and lower nasal segments. OS – the prominence of the disc of the optic nerve in vitreous. The fascinated changes of the cerebral cortex have not been found during the MRT. The diagnosis was made OU: Acute optic neuropathy of toxic genesis. A course of integrated conservative treatment has been introduced: the anti-inflammatory, metabolic, nootropic, vitamin therapy, magnetotherapy, electrostimulation and electrophoresis. Conclusion: Potentially, any medicines are toxic, which may cause a number of side effects from the visual and central nervous system. The toxic damage of the ganglion cells of the retina was initially occurring due to unintentional application of closantel, resulting in a reduction of the central visual acuity, followed by the development of the optic nerve atrophy.

Paraneoplastic causes of vision loss

AbstractParaneoplastic occular disorders are clinical syndromes resulting from nonmetastatic systemic effects of underlying cancers. While not fully elucidated the underlying mechanism is presumed to be a cross reaction of the immune reaction to the underlying cancer that attaches normal host tissue. This cross reaction can happen in a variety of occular tissues resulting in dysfunction of the retina, optic nerve and tear film and extraocular muscles. (1‐3). The lists of cancers and associated antibodies is constantly growing but, in many cases, the clinical phenotype is very similar. Cancer associated retinopathy (CAR) for example is associated with several antibodies including anti‐recoverin, anti‐alpha enolase, anti‐transducin, and anti‐carbonic anhydrase(2, 3). Each of these antibodies have been associated with a distinct cancer including skin, genital and small cell lung cancer (SCLC). CAR causes a slowly progressive asymmetric vision loss due to damage to retinal ganglion cells and bipolar cells which can result in optic nerve pallor. Melanoma associated retinopathy (MAR), similarly can present with nyctalopia, photopsia’s and loss of peripheral vision. The antibodies associated with MAR; anti‐transducin, anti‐rhodopsin and anti‐arrestin typically attack the on bipolar system. As with CAR the visual dysfunction can predate the discovery of the cancer. Conversely, autoimmune related retinopathy and optic neuropathy occurs without an underlying cancer and is associated with anti‐GAD and anti‐ anti‐collapsin‐responsive mediator protein‐5 (CRMP‐5) antibodies(2). In all three cases electroretinograms are key to making the diagnosis as the objective clinical examination can be normal. Electroretinograms are key to distinguishing retinal dysfunction which can cause an optic neuropathy from a paraneoplastic optic neuropathy (PON). The classical antibody in PON is. CRMP‐5 is associated with SCLC and thymoma and can produce optic disc edema with subsequent atrophy. The treatment and management of occular paraneoplastic disorders requires appropriate investigations to look for an underlying cancer. Knowing the specific antibody associated with the disorder can be helpful in this regard and in some cases a panel of antibody tests is appropriate in the right clinical context(4). Treatment of the underlying cancer can, in some cases, can lead to a resolution of the clinical symptoms. Symptom control can also be accomplished using immunosuppression with steroids or IVIG and in some cases plasmapheresis has been useful(4, 5).References Grewal DS, Fishman GA, Jampol LM. Autoimmune retinopathy and antiretinal antibodies: a review. Retina. 2014;34(5):827–45. Bataller L, Dalmau J. Neuro‐ophthalmology and paraneoplastic syndromes. Current opinion in neurology. 2004;17(1):3–8. Rahimy E, Sarraf D. Paraneoplastic and non‐paraneoplastic retinopathy and optic neuropathy: evaluation and management. Survey of ophthalmology. 2013;58(5):430–58. Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010;85(9):838–54. Damek DM. Paraneoplastic Retinopathy/Optic Neuropathy. Current treatment options in neurology. 2005;7(1):57–67.

The Role of the Complex Clinical-Anamnestic and the Laboratory Examination in Establishing the Etiology of Endogenous Uveitis

Purpose: to estimate the results of the clinical and laboratory survey among patients with uveites for refinement of the disease’s etiology.Patients and Methods. 107 patients with uveites (114 eyes) were under control. A standard ophthalmologic survey was done with them; a serodiagnosis (immunoassay analysis) towards Toxoplasma gondii, Herpes simplex virus Ist, IInd types, Citomegalovirus, Chlamidia trachomatis; a bacteriological examination of tear fluid, some material from nose and cavity to definite factors of virulence and antibiotic sensitivity of exuded microorganisms. A molecular and genetic survey (PCR) of tear fluid towards Toxoplasma gondii , Herpes simplex virus Ist, IInd types, Citomegalovirus was done among 30 people.The results. Provocative factors of the disease were detected in 42 % of cases. Concomitant diseases were in 77 %. Diseases of cardiovascular system prevailed in 49 %; ceiling of mouth cavity in 42 %; systemic diseases in 29.3 %. The most widespread were anterior uveites in 60.5 %; recur character prevailed in 51 %; deteriorations progressed in 58.8 % of cases. A chronic infection with herpes viruses was among almost all the patients (HSV I, II — 100 %, CMV — 96.3 %). To Toxoplasma gondii specific IgG were detected in 44.9 %, IgM in 2.8 %; to Clamidia trachomatis specific IgG in 21.5 %. 66 strains of bacteria were selected: from tear fluid — 34, from mouth — 17, from nasal cavity — 15; gram-positive bacteria of Staphylococcus prevailed in 83.3 %. In some cases of revealing S. aureus, which were isolated from all three biotypes, they were close to their phenotypic characteristics, which indicates to their etiologic importance in uveites’ progress. The research of tear fluid in PTSR turned to be less informative. Based on the anamnesis and the results of a complex survey it managed to become possible to decipher the etiology of the disease in 74.6 %. Among them were 67.1 % of infectious and infectious-allergic uveites; 80.7 % of bacterial uveites; 15.8 % of virus uveites and 3.5 % of parasitic uveites. 28.2 % of inflammations occurred on a background of system and syndromic diseases, the majority of diseases were on a background of Behterev’s disease and rheumatoid arthritis, 45.5 % for each. Non-infectious autoimmune and toxical-allergic reasons were set in 4.7 % of cases.Conclusion. It is more expediently to use a complex diagnostic approach with taking into account clinical and anamnestic information and laboratory information of the survey in the investigation of uveitis etiology.

Удовлетворенность лечением пациентов с неоваскулярной возрастной макулярной дегенерацией, получающих антиангиогенную терапию

Objective: clinical testing of original ophthalmologic survey to assess treatment satisfaction (TS) in patients getting antiangiogenic therapy for neovascular macular diseases. Methods . Tested group consisted of 38 people (31 women, 9 men) aged from 51 to 93 y.o. with neovascular age-related macular degeneration, they got antiangiogenic therapy (ranibizumab, aflibercept). Ptients were divided into subgroups with high (n=20) and low (n=18) compliance levels. We conducted a single survey with a questionnaire which included standard validated questionnaire on treatment satisfaction in macular diseases (MacTSQ) and questions assessing aspects of antiangiogenic therapy composed by authors. Results. We determined significant direct correlation between and high level of compliance, and patients with high level of treatment adherence were more willing to return to therapy and were less dependent on outside help. The survey took 7 minutes in average. Despite elderly age patients did not struggle with understanding of questions and answering them. Conclusions . We developed a method of TS level detection in patients with macular pathology who received antiangiogenic therapy. The method is based on scoring the answers to survey questions. The analysis of survey results can contribute to effectiveness of the therapy due to customized dosing schedule.

Current screening practice in patients under long-term hydroxychloroquine medication in Taiwan: A nationwide population-based cohort study.

Hydroxychloroquine (HCQ), an analog of chloroquine, is widely used in various rheumatologic and dermatologic disorders. However, it may cause severe retinopathy with long-term use. The guidelines proposed by the American Academy of Ophthalmology suggested a baseline fundus examination and an annual screening after 5 years by using automated visual fields (VF) plus spectral-domain optical coherence tomography (SD-OCT). Both multifocal electroretinogram (mfERG) and fundus autofluorescence (FAF) can also be used to improve the accuracy of diagnosis. The purpose of this study was to examine if the current HCQ screening practice in Taiwan was sufficient according to the guidelines to prevent severe macular complications.This study could remind every doctor to explain visual side effects thoroughly to every patient using HCQ, and refer patients for the ophthalmologic survey to eliminate potential visual impairment caused by this medicine.This nationwide population-based cohort study included all patients who started taking HCQ (n = 5826) from January 1, 1997, to December 31, 2007, in the Longitudinal Health Insurance Database 2000. The ICD codes used for HCQ retinopathy were 362.10, 362.55, 362.89, and 362.9. Patients previously diagnosed these retinal disorders were excluded. Demographic data including sex, age, diagnostic tools used, and the date of the initial diagnosis of the subsequent HCQ-related retinal disorder were collected. Patients were divided into 2 groups. The patients taking HCQ <5 years were defined as group 1, and >5 years as group 2. The risk of developing retinal diseases between these 2 groups was compared with a 2-sample t-test for continuous variables, and Fisher's exact test for discrete variables. Multiple logistic regressions were used for odds ratio calculation.The baseline examination ratio of the automated VF, SD-OCT scans, and multifocal electroretinograms (mfERGs) in the first 3 months were only 0.2% in both groups. The screening ratio of the 3 examination tools after 5 years were 1.1% in group 1 and 1.2% in group 2. 2.5% and 3.9% of patients developed a retinal disorder after HCQ use in group 1 and 2, respectively. The risk of developing retinal disorder was significantly higher in group 2 (relative risk = 1.53, P = .006). The odds ratio (OR) was also significantly higher in group 2 (1.67 with 95% cumulative incidence 1.20–2.30)The examination ratio according to the guidelines was very low in Taiwan. Thus, it is very important for doctors who prescribe HCQ to schedule both baseline and annual ophthalmology screening tests and inform patients of possible severe ocular complications, even in the patient taking HCQ <5 years. It is also important for ophthalmologists to review medical history carefully to find out the causes of retinotoxicity. Medications should be stopped, if possible when toxicity is recognized or strongly suspected.

Compliance of systematic reviews in ophthalmology with the PRISMA statement

BackgroundSystematic reviews and meta-analyses are becoming increasingly important methods to summarize published research. Studies of ophthalmology may present additional challenges because of their potentially complex study designs. The aim of this study was to evaluate the reporting quality of systematic reviews and meta-analyses on topics in ophthalmology to determine compliance with the PRISMA guidelines. We assessed articles published between 2010 and 2015 in the five major relevant journals with the highest impact factors.MethodsThe MEDLINE and EMBASE databases were searched to identify systematic reviews published between January 2010 and December 2015 in the following 5 major ophthalmology journals: Progress in Retinal and Eye Research, Ophthalmology, Archives of Ophthalmology, American Journal of Ophthalmology, and Survey of Ophthalmology. The screening, identification, and scoring of articles were independently performed by two teams, and the results were submitted to statistical analysis to determine medians, ranges, and 95% CIs.ResultsA total of 115 articles were included. The median compliance was 15 out of 27 items (56%), the range was 5–26 (26–96%), and the inter-quartile range was 10 (37%). Compliance was highest in items related to the ‘description of rationale’ (item 3, 100%) and sequentially lower in ‘the general interpretation of results’ (item 26, 96%) and ‘the inclusion of a structured summary in the abstract’ (item 2, 90%). Compliance was poorest in the items ‘indication of review protocol and registration’ (item 5, 9%), ‘specification of risk of biases that may affect the cumulative evidence’ (item 15, 24%), and ‘description of clear objectives in the introduction’ (item 4, 26%).ConclusionThe reporting quality of systematic reviews and meta-analyses in ophthalmology should be significantly improved. While we recommend the use of the PRISMA criteria as a guideline before journal submission, additional research aimed at identifying potential barriers to compliance may be required to improve compliance with PRISMA guidelines.

Drivers with visual field defects; diagnosis, health and experiences

Not being able to drive your own car can be devastating for mobility, health, finances and self-esteem. Driving is a visually demanding task (Owsley et al., 2008) and insufficient visual field can lead to revoked license. Acquired brain damage can impair the visual field and stroke is a very common diagnosis among drivers with visual field defects. de Haan et al. (2015) identified several undocumented difficulties among patients with homonymous visual field defects. License holders with visual field defects and interested in being assessed in a driving simulator were invited to answer a short web questionnaire. During the period December 2013 to June 2015, close to 400 people responded. The group is however not representative for the population of drivers with visual filed defects. Instead, it comprise the subgroup that is most concerned to get a new driver license issued (or to keep the license if it not yet withdrawn). A vast majority in the studied group was men (83 %). Almost 3 out of 4 were aged 55 years or more. The three most common diagnosis were stroke (39 %), glaucoma (31 %) and diabetes (13 %). General health status, vision and driving ability was self-estimated as very good or relatively good by 90-95 % of the respondents on a 5-grade scale. Weekly distance driven was estimated to 200 km (median). Involvement in accidents with only property damage, near-accidents and personal injury accidents during the period 2008-2013 was experienced by 8 %, 5 % and 1 %, respectively. Drivers with visual field defects regard themselves as healthy and good drivers. The drivers do often not understand the withdrawal of the driving license; many comments that they had driven for many years without any problems and that they can compensate for the defect by head movements.

Authoring critical situations for assessing driving ability among drivers with visual field defects

Driving is a visually demanding task (Owsley, et al., 2008), manifested in visual ability requirements. Sweden, does not allow on road assessment of drivers with visual field defects. However, driving simulators can be used for fitness to drive assessment (Rizzo, 2011) but authoring driving scenarios is a critical task Vardaki et al. (2014). This paper discuss a driving simulator based assessment method aiming to assess drivers with visual field defects. The driving task includes 37 situations based on well-known critical driving situations along three driving environments: rural, motorway and urban. Most of the situations occur in urban context, e.g. pedestrians crossing the road, vehicles suddenly appearing. Each situation was assessed with a set of critical measures, e.g. brake reaction time, time based safety margins, speed keeping etc. Driving data from almost a hundred drivers, both with and without visual field defects, were collected and analyzed. The results are currently being analyzed. So far it seems like some situation were better than others, specifically in terms of timing. The possibility to drive at your own pace made some participants drive very careful and others over the speed limit. This had a strong impact on the criticality of the situations and their usefulness in determining driving ability. The developed situation on rural road worked very well, in terms of timing and criticality. The option to overtake at your own choice on the motorway introduced some variation in behavior that need further consideration. Urban road driving included critical situations difficult to master even for a driver with no visual defect. The next step will be to investigate behavior metrics in term of the ability to discriminate between those with visual field defects and those without.

Ophthalmic surgical training in Karnataka and Southern India: Present status and future interests from a survey of final-year residents.

Settings and Design:This study documents a survey of final-year ophthalmology postgraduates on the subject of their surgical training and their future plans after residency.Purpose:This survey aimed to answer the question, What is the present status of surgical training in ophthalmic training centers? by obtaining information from students about (1) various methods used in surgical training (2) numbers and types of surgeries performed by them in the training centers (3) their plans after residency.Materials and Methods:A questionnaire containing 21 questions was distributed to 155 students attending an intensive 4-day teaching program. The questions related to orientation training, wet lab training, facilities for training, free surgical camps and detailed information about numbers and types of surgeries observed and performed. Completed questionnaires were collected, and responses analyzed.Results:One hundred and seven completed responses were analyzed. The majority had not received formal orientation training. More than half had undergone wet lab training. Most residents performed their first ophthalmic surgery during the 1st year of residency and went to the operation theatre multiple times a week. Most of the students planned to undergo further training after residency. More than half of the students found their surgical training to be fair or satisfactory.Conclusions:The number and frequency of ophthalmic surgeries done by residents appear satisfactory, but further efforts from trainers on enhancing the quality and range of surgical training would benefit students and improve their satisfaction.

An Overview of Ophthalmologic Survey Methodology in the 2008-2015 Korean National Health and Nutrition Examination Surveys.

The Korea National Health and Nutrition Examination Survey (KNHANES) is a national program designed to assess the health and nutritional status of the noninstitutionalized population of South Korea. The KNHANES was initiated in 1998 and has been conducted annually since 2007. Starting in the latter half of 2008, ophthalmologic examinations were included in the survey in order to investigate the prevalence and risk factors of common eye diseases such as visual impairment, refractive errors, strabismus, blepharoptosis, cataract, pterygium, diabetic retinopathy, age-related macular degeneration, glaucoma, dry eye disease, and color vision deficiency. The measurements included in the ophthalmic questionnaire and examination methods were modified in the KNHANES IV, V, and VI. In this article, we provide detailed information about the methodology of the ophthalmic examinations in KNHANES in order to aid in further investigations related to major eye diseases in South Korea.

How to Write a Thesis and Turn It into Publication

As a fellow or a researcher, we should completely be clear why we want to begin a thesis and to be published? Science progresses through writing a thesis that begins with brainstorming about novel ideas, iterative nature of drafting, soliciting feedback from the professors, and revising. The main finality of a thesis is to reach to a reader by publication of it in a prestigious peer-reviewed scientific or medical (inter)national journal. Therefore, learning of writing a thesis is central to science progress and writing skills are critical for this. In other words, a thesis is the first writing experience and opportunities of you to learn scientific writing, which should motivate you as you make the journey, for instance, to the front page of the “Survey of Ophthalmology” (1).

Ophthalmological findings in a closed herd of Lipizzaners

There are no studies on the ophthalmic health status in the Lipizzaner breed. To perform an ophthalmological survey in a closed herd in 3 housing systems. All horses at the Federal Stud Piber, Heldenberg and the Spanish Riding School Vienna were subjected to ophthalmological examination. Findings were documented and correlated with factors such as age, gender, location and housing situation. The interrelation of abnormalities of different regions was determined by calculating accuracy. Pedigree analysis of horses affected by cataract was performed. A total of 267 horses met the inclusion criteria of this study. Of these, 172 horses were stabled in Piber, 72 in Vienna and 23 in Heldenberg. Ophthalmological examination revealed 203 cases with ocular findings, predominantly involving the conjunctiva (44.6%), cornea (21.7%) and fundus (37.5%). In 24 (8.9%) horses a diagnosis of cataract was made. There was no interrelation between different eye diseases. Horses stabled at Piber were significantly more affected by conjunctival and fundic abnormalities. Fewer abnormalities were found in horses stabled in open boxes. Access to free stalls resulted in more cases of conjunctivitis. Pedigree analysis showed no evidence of inbreeding as a cause of cataract formation. Acquired corneal abnormalities were over-represented in this study. This survey may serve as a basis for further research on the pathogenesis of ophthalmic diseases in Lipizzaners.

Therapeutic targets in glaucoma

AbstractGlaucoma leads to irreversible blindness and is characterized by changes in the optic disc and the visual field. The elevated intraocular pressure is considered the most important factor responsible for the glaucomatous optic neuropathy. There are multiple factors involved in the development of retinal ganglion cell death. The goal of glaucoma treatment is to preserve the visual field of patients and prevent the loss of visual function that is associated with the disease (European Guidelines). We should focus at least on three separate targets of glaucoma treatment (Brubaker RF. Survey of Ophthalmology 2003: Three targets for glaucoma management): Intraocular pressure (IOP), outflow facility, and the retinal ganglion cell (RGC). Elevated IOP is still the primary risk factor for the development and progression of glaucoma, and many studies have shown that IOP reduction can limit the progression of glaucoma and slow the loss of visual function. IOP lowering can be beneficial for normal‐tension as well as high‐tension glaucoma patients, and it may also prevent or delay the onset of visual field loss and optic disk damage in individuals with ocular hypertension. The second target of glaucoma treatment is outflow facility. In a healthy eye, aqueous production (flow) equals aqueous outflow through the trabecular and uveoscleral outflow pathways. Any imbalance between flow and outflow results in a change in IOP, yet even a transient elevation of IOP may cause significant glaucomatous damage. The third target of glaucoma treatment is the RGC itself. RGC death in glaucoma might have many causes, including vascular insufficiency, blockage of axonal transport, diffusion of toxic agents into the nerve cell, or initiation of apoptosis. Treatment that aims to directly protect the RGC from every possible insult might be the ultimate treatment for glaucoma because a strategy of neuroprotection could preserve the visual function of patients regardless of the etiology of their glaucoma.

Blindness due to mistake of antituberculosis treatment

AbstractPurpose Antituberculosis drugs such as Ethambutol and Isoniazid may induce toxic optic neuropathy, that has lead to recommendations on the follow‐up of patients under antituberculosis treatment. In Central African Republic, as in many countries where tuberculosis is endemic, this affection may also develop as an opportunist illness of AIDS. Treatment with antituberculosis drugs is often long, and the incidence of ocular toxicity increase.Methods Since 1998, we noticed an increasing number of bilateral blindness in the population of patients treated by Ethambutol in our outpatient practice. We report here 10 from 23 clinical cases of visual impairment, observed in ophthalmological service of Bangui Teaching National Hospital Center.Results Two patients received the recommended dose (25mg/Kg/day) throughout the treatment. The others have found themselves in overdose because of a loss of weight. Visual symptoms begin on the average during the 3rd month of treatment. Three patients had a visual improvement, 3 others a stabilization of vision, and the remaining 4 a worsening of vision.Conclusion We raise from this series a necessary awareness for patients, prescribers and the practitioners in charge of the National program for Tuberculosis Control, on importance of the ocular toxicity of antituberculosis drugs. Yet efficient and extensively used, these drugs require special clinical and biologic balance before every prescription, and close ophthalmologic survey throughout the treatment.

Ocular Features in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type: A Clinical and In Vivo Confocal Microscopy Study

To investigate ocular anomalies in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT). Prospective, cross-sectional study. Forty-four eyes of 22 consecutive patients with an established diagnosis of JHS/EDS-HT and 44 eyes of 22 age- and gender-matched control subjects. Administration of a standardized questionnaire (Ocular Surface Disease Index) and a complete ophthalmologic examination, including assessment of best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, indirect ophthalmoscopy, tear-film break-up time, Schirmer I testing, axial length and anterior chamber depth measurement, corneal topography, corneal pachymetry, and confocal microscopy. Main outcome measures included comparing ocular anomalies in JHS/EDS-HT and control eyes. JHS/EDS-HT patients reported dry eye symptoms more commonly than controls (P < .0001). Scores of tear-film break-up time and Schirmer I test were significantly lower in JHS/EDS-HT eyes (P < .0001). Minor lens opacities were significantly more common in the JHS/EDS-HT group (13.6%; P < .05). Pathologic myopia with abnormal vitreous was found in 7 JHS/EDS-HT eyes (15.9%) and 0 controls (P = .01). Corneas were significantly steeper and the best-fit sphere index was significantly higher in JHS/EDS-HT group (P < .01). By confocal microscopy, the JHS/EDS-HT group showed lower density of cells in the superficial epithelium (P < .001) and higher density of stromal keratocytes in anterior and posterior stroma (P < .0001). The most consistent association of eye anomalies in the JHS/EDS-HT group included xerophthalmia, steeper corneas, pathologic myopia, and vitreous abnormalities, as well as a higher rate of minor lens opacities. These findings indicate the need for ophthalmologic survey in the assessment and management of patients with JHS/EDS-HT.

Bernard Schwartz, MD, PhD, Founding Chair of Ophthalmology, Tufts University School of Medicine, and Founding Editor of Survey of Ophthalmology

Bernard Schwartz, MD, PhD (1927–2007) was first and foremost a scholar. He was a teacher, serving as Professor of ophthalmology for many years at Tufts University; an administrator, chairing the department of ophthalmology for over 20 years; a clinician, practicing primarily in the field of glaucoma; a scientist with a broad interest in ophthalmic research; an historian, especially of medical history; and an editor, primarily of Survey of Ophthalmology. Throughout all of his activities, the central theme was always scholarship.

Eigenheiten der Begutachtung in der Privaten und der Gesetzlichen Unfallversicherung

In this manuscript the basic ophthalmological survey criteria for the private and compulsory accident insurance have been collected in order to illustrate their diversity.

Accuracy of references in the ophthalmic literature

Accuracy of references in the ophthalmic literature

Physiological effects of vitrectomy and retinal laser treatment explain their clinical effects: Vitrectomy and laser treatment both affect retinal oxygenation and benefit ischemic retinopathies

AbstractClinical studies have established that retinal laser photocoagulation on one hand and vitrectomy on the other have a positive clinical effect on the development of diabetic retinopathy and other ischemic retinopathies. Both reduce retinal neovascularization and macular edema. The clinical effect of laser and vitrectomy is related to the physiological effect of these treatment modalities. Both improve retinal oxygenation, but through different mechanisms. Laser treatment destroys some of the photoreceptors, reduces the oxygen consumption of the outer retina and allows oxygen to diffuse from the choroid to the inner retina.In vitreous surgery the viscous vitreous gel is replaced by low viscosity water. According to the Stokes‐Einstein equation viscosity is inversely related to the diffusion coefficient. Diffusion (and convection) of any substance is many times higher in water than vitreous gel, and this includes oxygen, growth factors and drugs. In the vitrectomized eye, oxygen diffuses more easily from well perfused to hypoxic areas of the retina. At the same time growth factors are cleared from the retina more rapidly than before and may indeed be transported to the anterior segment and produce iris neovascularization.Laser and vitrectomy reduce retinal hypoxia and thereby reduce the production of hypoxia induced growth factors such as VEGF. Vitrectomy also clears VEGF away from the retina at a more rapid rate than when the vitreous gel is in place. VEGF and other growth factors influence both neovascularization and capillary permeability, and the latter influences the osmotic balance between blood and tissue and the osmotic arm of Starling´s law. In addition, improved oxygenation reduces the hypoxia‐induced vasodilatation and this decreases capillary blood pressure and reduces edema formation according to the hydrostatic arm of Starling´s law.By understanding the physiological effects of laser and vitrectomy, we can understand the mechanism of the clinical effect. Classical laws of physiology and physics help complete the picture and give us an understanding of the nature of these treatment modalities and how they may be combined with other agents.For details and references please see Stefánsson E: Survey of Ophthalmology 2006.