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 Table of Contents  
Year : 2016  |  Volume : 28  |  Issue : 2  |  Page : 150-152

Journal Review

Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India

Date of Web Publication20-Mar-2017

Correspondence Address:
R Jyothi
Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_34_16

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How to cite this article:
Jyothi R. Journal Review. Kerala J Ophthalmol 2016;28:150-2

How to cite this URL:
Jyothi R. Journal Review. Kerala J Ophthalmol [serial online] 2016 [cited 2020 May 28];28:150-2. Available from: http://www.kjophthal.com/text.asp?2016/28/2/150/202479

  Increased Risk of Stroke in Patients With Nonarteritic Anterior Ischemic Optic Neuropathy: A nationwide Retrospective Cohort Study Top

Lee YC, Wang JH, Huang TL, Tsai RK. Increased Risk of Stroke in Patients With Nonarteritic Anterior Ischemic Optic Neuropathy: A Nationwide Retrospective Cohort Study. American Journal of Ophthalmology. 2016 Oct 31;170:183-9.

The purpose of this study was to investigate the incidence and prevalence of nonarteritic anterior ischemic optic neuropathy (NAION) and to extrapolate the risk of cerebrovascular events following NAION. This was a retrospective cohort study with the study group composed of patients diagnosed with NAION seeking ambulatory care from 2000 to 2011. This study used data from 2000 to 2011 from the Longitudinal Health Insurance Database 2005 provided by the National Health Research Institutes of Taiwan, which covers more than 99% of the entire population of Taiwan.

Patients with a diagnosis of NAION from 2000 to 2011 were enrolled. The control group was extracted from the subset of the same database by randomly selecting two age and sex-matched patients for every NAION patient. Comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, and carotid artery disease were used as covariates. The study endpoint was a stroke-related hospitalization determined by the hospitalization records with a discharge diagnostic code of stroke. Cox proportional hazards regression analysis was performed to calculate adjusted hazard ratio (aHR) of stroke for the two groups.

Four hundred and fourteen patients were included in the study group and 789 in the control group. The mean follow-up period was 5.9 years. The incidence of NAION was 3.72/100,000 person-years in Taiwan, and the prevalence of NAION was 48.18/100000 persons. The risk of ischemic stroke among the patients with NAION was two times higher than in those without NAION. Hemorrhagic stroke was found to be rare in both the study and control groups (6 of 414 patients in the study group and 9 of 789 patients in the control group). There was no statistical difference between the risk of hemorrhagic stroke among the patients with NAION and those without NAION (95% CI: 0.43, 3.57). The risk of all strokes among the patients with NAION was 1.9 times higher than in those without NAION (95% CI: 1.26, 2.96). Among the subgroup without comorbidities, the risk of ischemic stroke among the patients with NAION was not statistically different from those without NAION (95% CI: 0.69, 2.80). Among the subgroup with comorbidities, the risk of ischemic stroke among the patients with NAION was 3.35 times higher than in those without NAION (95% CI: 1.67, 6.70).

Though in previous studies, diabetes, hypertension, and hyperlipidemia have been reported as common systemic risk factors of NAION, the association of coronary heart disease with NAION has not been reported in prior literature. The authors concluded that patients with NAION have an increased risk of ischemic stroke, compared with patients without NAION, especially in older patients with systemic risk factors. They suggested that patients who develop NAION should be referred for systemic examination of vasculopathy and control of modifiable risk factors and that these patients should also be given advice on lifestyle changes to prevent subsequent cerebrovascular events.

  Surgical Treatment of Presbyopia With Central Presbyopic Keratomileusis: One-Year Results Top

Yin GH, McAlinden C, Pieri E, Giulardi C, Holweck G, Hoffart L. Surgical treatment of presbyopia with central presbyopic keratomileusis: One-year results. Journal of Cataract & Refractive Surgery. 2016 Oct 31;42(10):1415-23.

All the surgical techniques for presbyopic correction involve some degree of compromise between distance and near visual acuity outcomes. The purpose of this prospective study was to evaluate the effectiveness, refractive outcomes, and subjective quality of vision of patients who had presbyopic surgery by central presbyopic LASIK with corneal asphericity modulation by the Custom Q algorithm of the Wavelight EX500 wavefront-guided excimer laser (Alcon Surgical, Inc.).

Patients aged between 40 and 65 years, spherical refractive error between 0.0 D and +6.0 D, corneal cylinder up to 3.0 D, preoperative corrected distance visual acuity (CDVA) of 20/20 or better, central corneal thickness more than 500 mm, and no other ocular pathology or previous ocular surgery were included in this study. Under topical anesthesia, a 9.2-mm diameter superior 40-degree hinged corneal flap with a 90-degree side-cut and a 120 mm thickness was dissected using a femtosecond laser. The flap was manually raised, and photoablation was performed using the wavefront-guided excimer laser. The dominant eye was corrected for distance vision with the Wavefront Optimized algorithm, and the nondominant eye was corrected with the Custom Q software set to a postoperative refractive target of −0.50 D and a postoperative corneal asphericity target Q between −0.60 and −0.80. This treatment aims to change the mean asphericity by adjusting the number of mid-peripheral laser pulses. Patients were examined 7 days, 1 month, 3 months, 6 months, 9 months, and 1 year after surgery. The study included 138 eyes from 69 patients with hyperopia with a mean age of 53.84 ± 4.19 years.

There was no significant correlation in binocular UDVA with the preoperative Q factor. The binocular UDVA was significantly better in patients treated with a planned −0.8Δ Q. Q factor modulation might improve depth of focus, which is useful for near vision. The authors concluded that central presbyopic LASIK using the Q factor modulation to increase depth of field by the algorithm software using the wavefront-guided excimer laser was safe, accurate, and effective in treating presbyopia.

  Clinical Significance of High Levels of Survivin and Transforming Growth Factor Beta-1 Proteins in Aqueous Humor and Serum of Retinoblastoma Patients Top

Shehata HH, Ghalia AH, Elsayed EK, Said AM, Mahmoud SS. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2016 Oct 31;20(5):444-e1.

Survivin is a bifunctional inhibitor of apoptosis protein (IAP) that has been implicated in regulation of mitosis and protection from apoptosis. Elevated survivin levels are found in most human neoplasms, and it is used as a prognostic factor in several human neoplasms. Transforming growth factor beta (TGF-B) is the prototype for a family of multifunctional secreted peptides that controls proliferation, cellular differentiation, apoptosis, and other functions in most cells.

This was a prospective, comparative case-control study that was carried out at the Ophthalmology and the Medical Biochemistry Departments at Ain Shams University from March 2008 to November 2014. The aim of this study was to evaluate the diagnostic and prognostic value of survivin and TGF-B1 expression in serum and aqueous humor of retinoblastoma (RB) patients in comparison to the conventional RB marker LDH in terms of sensitivity, specificity, and accuracy, as well as to elucidate the possible correlation between them and the clinicopathological features of the disease.

Study group consisted of 88 children who were newly diagnosed with RB in whom enucleation was indicated at the time of diagnosis in at least one eye and no history of prior treatment, and 80 age-matched controls with ophthalmic conditions other than tumors who were prepared for intraocular surgeries. RB children received one or a combination of the following treatment modalities: chemoreduction with focal consolidation therapies (cryotherapy, laser thermotherapy, and brachytherapy), external beam radiotherapy, and/or enucleation. Venous blood samples (2 mL) were collected at the time of enucleation, and another sample was taken 6 months after completion of the therapy. Aqueous humor samples were also obtained. Survivin and TGF-β1 levels were measured in serum and aqueous samples. The mean aqueous humor concentrations of survivin, TGF-B1, and LDH in RB group were significantly higher than those of the control group. Mean serum and aqueous humor concentrations of survivin, TGF-B1, and LDH in the RB group before and after treatment were significantly higher than the corresponding values in the control group. Mean serum concentrations of survivin, TGF-B1, and LDH were statistically significantly higher in the malignant and follow-up groups compared to control group. Mean serum concentration of the three proteins were reduced after treatment.

The authors reported significant moderate positive correlation between the stage of RB and mean aqueous humor concentration of survivin. They concluded that the high sensitivity, specificity, and accuracy of serum and aqueous humor survivin and TGF-B1 proteins make them promising markers for the early detection and follow-up of RB patients.

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