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Ophthalmology Nov 2017To document the ocular manifestations of xeroderma pigmentosum (XP), presenting via the United Kingdom (UK) XP service, and to analyze the correlations between XP... (Observational Study)
Observational Study
PURPOSE
To document the ocular manifestations of xeroderma pigmentosum (XP), presenting via the United Kingdom (UK) XP service, and to analyze the correlations between XP genotype and ophthalmic phenotype.
DESIGN
Prospective observational case series.
SUBJECTS
Eighty-nine patients seen by the UK Nationally Commissioned XP Service, from April 2010 to December 2014, with a genetically confirmed diagnosis of XP.
METHODS
Patients underwent a full ophthalmic examination at each visit. Clinical features from both eyes were recorded on a standard proforma. The most recent assessments were analyzed. A 2-tailed Fisher exact test was used to assess for differences in ocular features between patients in XP subgroups with impaired transcription coupled nucleotide excision repair (TC-NER) (category 1: XP-A, B, D, F, and G) and preserved TC-NER (category 2: XP-C, E, and V).
MAIN OUTCOME MEASURES
Lid and periocular abnormalities, ocular surface pathologies, neuro-ophthalmologic abnormalities, lens and retinal abnormalities, and visual acuity (VA).
RESULTS
Ninety-three percent of XP patients in our cohort had ocular involvement, with 65% describing photophobia. The most common abnormalities were in the periocular skin and ocular surface, including interpalpebral conjunctival melanosis (44%) and conjunctival injection (43%). Eleven percent of patients had required treatment for periocular cancers and 2% for ocular surface cancers. The most common neuro-ophthalmologic finding was minimal pupillary reaction to light (25%). Patients in category 2 had significantly more ocular surface abnormalities than patients in category 1, including a greater proportion of conjunctival injection (P = 0.003), conjunctival corkscrew vessels (P < 0.001), corneal scarring (P = 0.01) and pingueculae under the age of 50 (P = 0.02). Meanwhile, patients in category 1 had a higher proportion of poorly reactive pupils (P < 0.001) and abnormal ocular movements (P = 0.03) compared with those in category 2. Five patients (6%) presented to ophthalmologists with ocular surface signs related to XP, before any formal diagnosis of XP was made.
CONCLUSIONS
A large proportion of XP patients have ocular involvement. Regular examination by an ophthalmologist is essential, especially in screening for eyelid and ocular surface tumors. The ocular phenotype-genotype segregation within XP patients suggests that XP is a heterogeneous and complex disease. With further study, we hope to offer these patients more individualized patient care.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Color Vision; Eye Diseases; Female; Genetic Association Studies; Humans; Intraocular Pressure; Male; Middle Aged; Prospective Studies; Pupil; Tonometry, Ocular; United Kingdom; Visual Acuity; Xeroderma Pigmentosum
PubMed: 28554534
DOI: 10.1016/j.ophtha.2017.04.031 -
Contact Lens & Anterior Eye : the... Aug 2017To estimate the prevalence of Meibomian gland dysfunction (MGD) and determine the associated factors in the general population in Iran.
PURPOSE
To estimate the prevalence of Meibomian gland dysfunction (MGD) and determine the associated factors in the general population in Iran.
METHODS
This cross-sectional study is based on the data from the second phase of the Shahroud Eye Cohort Study conducted in 2014. Of the 4737 participants of the second phase, data was available for 4700 people; their mean age was 55.9±6.2 years and 2768 (58.9%) were women. Diagnosis of MGD was made based on the classification of the International Workshop on MGD as judged by the examining ophthalmologist. The prevalence of MGD was summarized as percentage and 95% confidence intervals (CI), and related factors were studied through simple and multiple logistic regressions.
RESULTS
The diagnosis of MGD in at least one eye was recorded for 1235 (26.3%) participants; the prevalence of unilateral and bilateral MGD was 26.3% (95% CI: 24.5-28.1) and 26.1% (95% CI: 24.3-27.9), respectively. In the multiple logistic regression analyses, MGD significantly correlated with pinguecula [odds ratio (OR)=1.3, 95% CI: 1.12-1.50], hypertension (OR=1.34, 95% CI: 1.11-1.61), high-density lipoprotein (HDL) level (OR=0.0992, 95% CI: 0.986-0.999), diabetes mellitus (OR=0.83, 95% CI: 0.71-0.97), and years of education (OR=0.98, 95% CI: 0.96-0.99).
CONCLUSIONS
MGD prevalence in this study was lower than the rates reported in other studies on Asian populations. Besides HDL level, MGD is associated with another ocular surface disorder, namely pinguecula, as well as certain systemic diseases such as hypertension and diabetes mellitus. These associations should be taken into consideration when diagnosing MGD.
Topics: Adult; Age Distribution; Aged; Cross-Sectional Studies; Eyelid Diseases; Female; Humans; Iran; Male; Meibomian Glands; Middle Aged; Ophthalmoscopy; Population Surveillance; Prevalence; Retrospective Studies; Sex Distribution; Tears
PubMed: 28501443
DOI: 10.1016/j.clae.2017.05.003 -
Eye & Contact Lens Sep 2018To determine the prevalence of conjunctivochalasis and its determinants in a middle-aged Iranian population.
OBJECTIVES
To determine the prevalence of conjunctivochalasis and its determinants in a middle-aged Iranian population.
METHODS
This population-based study was conducted in the context of the second phase of Shahroud Eye Cohort Study in 2014. Of 4,737 participants aged 45 to 69 years who participated in the second phase, the data of 4,702 participants were available for this report. A diagnosis of conjunctivochalasis was made based on the physician's judgment on ophthalmic examinations.
RESULTS
Diagnosis of conjunctivochalasis in at least one eye was confirmed in 295 (6.2%) participants. The prevalence of unilateral and bilateral conjunctivochalasis was 0.7% and 5.5%, respectively. Older age (odds ratio [OR] = 1.96, 95% confidence interval [CI]: 1.22-3.15), use of Losartan (an angiotensin II receptor antagonist) (OR=1.47, 95% CI: 1.05-2.08), Meibomian Gland Dysfunction (OR=2.32, 95% CI: 1.78-3.03), Pinguecula (OR=0.57, 95% CI: 0.42-0.77), and blepharitis (OR=0.24, 95% CI: 0.07-0.77) had a significant association with conjunctivochalasis.
CONCLUSION
The prevalence of conjunctivochalasis in our study was less than other reports from Asian population. Conjunctivochalasis has a significant association with some eyelid disorders and the use of Losartan which should be noted when diagnosing and treating this disease.
Topics: Adult; Age Distribution; Conjunctival Diseases; Eyelid Diseases; Female; Humans; Incidence; Iran; Male; Middle Aged; Population Surveillance; Prevalence; Prognosis; Risk Assessment; Risk Factors; Sex Distribution
PubMed: 28346280
DOI: 10.1097/ICL.0000000000000379 -
Canadian Journal of Ophthalmology.... Aug 2016
Topics: Adult; Aged; Amnion; Female; Humans; Ophthalmologic Surgical Procedures; Pinguecula; Pterygium; Scleral Diseases
PubMed: 27521676
DOI: 10.1016/j.jcjo.2016.03.004 -
The British Journal of Ophthalmology May 2017To investigate the role of high-resolution anterior segment optical coherence tomography (HR-ASOCT) in the assessment of pterygia.
AIMS
To investigate the role of high-resolution anterior segment optical coherence tomography (HR-ASOCT) in the assessment of pterygia.
METHODS
Single centre cross-sectional study. Patients with primary pterygium and/or pingueculae were included. Clinical assessment included HR-ASOCT, colour photography, keratometry followed by histology. Associations were tested between HR-ASOCT features of the pterygium and the degree of corneal scarring and elastotic degeneration, astigmatism and best-corrected visual acuity.
RESULTS
29 eyes of 26 patients with pterygium and 6 patients with pinguecula were included. Apical anterior stromal scarring was found in 23 cases (79.3%) reaching a mean depth of 68.8±21.7 µm (minimum: 33 µm, maximum: 126 µm). Increased stromal scarring and subepithelial elastotic degenerative tissue was significantly associated with HR-ASOCT features of flat bridging of the corneoscleral transition zone (p<0.01) reduced thickness of the pterygium head (p=0.01), and a greater degree of corneal astigmatism (p=0.04).
CONCLUSIONS
HR-ASOCT is a useful tool for the assessment and monitoring of pterygia in clinical practice. Features associated with increased stromal scarring and astigmatism are reduced thickness of the head of the pterygium and flat bridging of the corneoscleral transition zone.
Topics: Adult; Aged; Aged, 80 and over; Anterior Eye Segment; Cicatrix; Corneal Stroma; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Pterygium; Tomography, Optical Coherence; Visual Acuity
PubMed: 27488179
DOI: 10.1136/bjophthalmol-2016-308685 -
BMJ Case Reports May 2016We describe the case of a presumed metastatic adenocarcinoma discovered in the conjunctival limbus of a 75-year-old male with a history of prostate adenocarcinoma. After...
We describe the case of a presumed metastatic adenocarcinoma discovered in the conjunctival limbus of a 75-year-old male with a history of prostate adenocarcinoma. After an initial clinical diagnosis of pinguecula and unsuccessful topical steroid therapy, the lesion was excised and sent for pathological evaluation and special staining. The histopathological evaluation was consistent with a diagnosis of adenocarcinoma, without evidence of lacrimal tissue. Surprisingly, results from special staining were most consistent with lung adenocarcinoma rather than that from a prostate origin. Systemic radiographic evaluation did not locate the primary tumour, and the patient did not present with any symptoms consistent with malignancy. Watchful waiting was chosen as the therapeutic strategy to manage the patient. This is the first report of an adenocarcinoma, likely metastatic, at the conjunctival limbus.
Topics: Adenocarcinoma; Adenocarcinoma of Lung; Aged; Conjunctival Neoplasms; Diagnosis, Differential; Disease Management; Humans; Lung Neoplasms; Male; Prostatic Neoplasms; Watchful Waiting
PubMed: 27190113
DOI: 10.1136/bcr-2016-214501 -
Eye & Contact Lens May 2017To determine the change in local vascularization after pinguecula excision and conjunctival autograft secured with fibrin glue at 12 months.
OBJECTIVES
To determine the change in local vascularization after pinguecula excision and conjunctival autograft secured with fibrin glue at 12 months.
METHODS
Thirty-one eyes of 31 patients which underwent excision and conjunctival autografting with fibrin glue were retrospectively reviewed. Anterior segment photography was obtained before and after the surgery. Cosmetic outcome was evaluated by patient self-grading (five-point scale; excellent (5), good (4), acceptable (3), poor (2), and very poor (1)), and medical evaluation of treatment outcome was based on subjective evaluation of vascularization on anterior segment photography (four-point severity scale; 0 [low] to 3 [high]). Clinical outcome and complications are reported at 12 months.
RESULTS
Overall cosmetic results were excellent or good in 93.5% (29 of 31) (score 4.68±0.60). Anterior segment photography showed that most cases demonstrated complete removal of pinguecula and regression of surrounding vascularization with mean change in score from 2.13±0.34 preoperatively to 0.09±0.30 postoperatively.
CONCLUSIONS
Pinguecula excision and conjunctival autograft using fibrin glue is an effective and safe method to remove pinguecula for cosmetic purposes. The method presented facilitated regression of vascularization.
Topics: Adult; Anterior Eye Segment; Autografts; Conjunctiva; Conjunctival Diseases; Disease Progression; Female; Fibrin Tissue Adhesive; Follow-Up Studies; Humans; Male; Middle Aged; Neovascularization, Pathologic; Ophthalmologic Surgical Procedures; Postoperative Complications; Retrospective Studies; Tissue Adhesives; Tissue Transplantation; Young Adult
PubMed: 27058827
DOI: 10.1097/ICL.0000000000000250 -
Optometry and Vision Science : Official... Jun 2016Information on ocular anomalies can help in developing specific interventions to prevent visual impairment especially among children. The aim of this study was therefore...
PURPOSE
Information on ocular anomalies can help in developing specific interventions to prevent visual impairment especially among children. The aim of this study was therefore to determine the prevalence, the causes of ocular anomalies, and their impact on vision of schoolchildren in Ghana.
METHODS
A cluster random sampling technique was used to select four government primary schools in Ashaiman Municipal for this study. Each pupil underwent ocular examination involving visual acuity, external examination, anterior and posterior segment examination, and objective and subjective refraction. They also answered questions relating to ocular problems affecting them.
RESULTS
A total of 811 pupils were sampled, with ages ranging from 6 to 16 years. The mean age of the sampled population was 10.6 years (95% confidence interval, 10.4 to 10.8). Prevalence of ocular anomalies was 27.3% (95% confidence interval, 24.2 to 30.5). Allergic conjunctivitis (17.3%) and refractive errors (6.8%) were the main causes of ocular anomalies. Others include pinguecula (1.2%), pterygia (0.9%), infectious conjunctivitis (0.3%), corneal opacity (0.1%), lens opacity (0.1%), and retinal degeneration (0.1%). Ocular anomalies and refractive errors were significantly associated with sex (p = 0.04 and p = 0.01, respectively). Presenting visual acuity in the better eye 20/40 or worse was identified in 5.3% of schoolchildren, and 0.5% had moderate visual impairment. Only 11.8% of schoolchildren with ocular anomalies had been treated for their ocular problems before the study.
CONCLUSIONS
The prevalence and causes of ocular anomalies found in this study suggest a need for more targeted eye health interventions such as school eye screening for early diagnosis and treatment of any presenting conditions among schoolchildren.
Topics: Adolescent; Child; Conjunctivitis, Allergic; Cross-Sectional Studies; Female; Ghana; Humans; Male; Prevalence; Refractive Errors; Surveys and Questionnaires; Vision Disorders; Vision Tests; Visual Acuity; Visually Impaired Persons
PubMed: 26905691
DOI: 10.1097/OPX.0000000000000836 -
Cornea Dec 2015Fuchs flecks (FFs) have been previously identified at the leading edge of pterygia and may represent collections of epithelial stem-like cells that give rise to this... (Observational Study)
Observational Study
PURPOSE
Fuchs flecks (FFs) have been previously identified at the leading edge of pterygia and may represent collections of epithelial stem-like cells that give rise to this condition. This study aims to evaluate the clinical significance of FFs in patients with ocular surface disorders, such as pterygium and pinguecula, by in vivo confocal microscopy (IVCM).
METHODS
This study is a Single-center, retrospective, observational case series of 40 eyes from 20 patients with clinical diagnoses of pinguecula or pterygium, or both. IVCM (Rostock Cornea Module; Heidelberg Engineering, Heidelberg, Germany) was performed on patients with pinguecula or pterygium, or both. The presence of FFs on the ocular surface of patients with pterygium and pinguecula was assessed by IVCM and subsequently documented.
RESULTS
FFs were present in 24 of 30 eyes (80.0%) in paired macroscopically normal nasal or limbal regions, 19 of 20 (95.0%) in pinguecula, 13 of 15 (86.7%) in primary pterygia, and 7 of 7 (100%) in recurrent pterygia.
CONCLUSIONS
High rates of FFs were identified at the head of pinguecula, primary pterygium, recurrent pterygium, and macroscopically normal nasal and temporal limbus. We postulate that FFs may represent precursor lesions to UV-associated ocular surface pathology. Identification of Fuchs fleck by IVCM may permit clinicians to predict the patients who may progress to develop more advanced pathology.
Topics: Adult; Aged; Conjunctiva; Female; Humans; Limbus Corneae; Male; Microscopy, Confocal; Middle Aged; Pinguecula; Pterygium; Radiation Injuries; Retrospective Studies; Stem Cells; Ultraviolet Rays
PubMed: 26398157
DOI: 10.1097/ICO.0000000000000621 -
The Ocular Surface Jul 2015To evaluate the use of a commercially available, high-resolution, spectral-domain optical coherence tomography (HR-OCT) device in the diagnosis of corneal and... (Review)
Review
PURPOSE
To evaluate the use of a commercially available, high-resolution, spectral-domain optical coherence tomography (HR-OCT) device in the diagnosis of corneal and conjunctival pathologies, with a focus on malignant lesions.
METHODS
Eighty-two eyes of 71 patients were enrolled in this prospective case series, including 10 normal eyes, 21 with ocular surface squamous neoplasia (OSSN), 24 with a pterygium or pingueculum, 3 with lymphoma, 18 with pigmented conjunctival lesions (nevus, flat melanosis, or melanoma), and 6 with Salzmann nodular degeneration. Subjects were imaged using photography and HR-OCT (RTVue, Optovue, Fremont, CA). When clinically indicated, surgery was performed and histopathologic specimens were correlated with OCT images.
RESULTS
HR-OCT was useful in differentiating among various lesions based on optical signs. Specifically, in OSSN, HR-OCT findings included epithelial thickening and hyper-reflectivity, whereas pterygia and pinguecula showed a subepithelial mass under thinner epithelium. In lymphoma, a hypo-reflective, homogenous subepithelial mass was observed. Differentiating between pigmented lesions with HR-OCT was more difficult, but certain characteristics could be identified. Eyes with nevi and melanoma both displayed intensely hyper-reflective basal epithelial layers and discrete subepithelial lesions, but could be differentiated by the presence of cysts in nevi and intense shadowing of sublesional tissue in most melanomas.
CONCLUSION
We found that a commercially available HR-OCT was a useful noninvasive adjunctive tool in the diagnosis of ocular surface lesions.
Topics: Conjunctiva; Conjunctival Diseases; Cornea; Corneal Diseases; Humans; Image Processing, Computer-Assisted; Tomography, Optical Coherence
PubMed: 26045235
DOI: 10.1016/j.jtos.2015.02.001