Year: 2004
Type: article
Abstract: Retina dominates this issue of Acta Ophthalmologica. There are ten original retina papers and two guest editorials, each dealing with some of the retina papers published here. The first guest editorial, by la Cour and titled ‘Photodynamic therapy for AMD: smaller is better!’ was inspired by two papers on photodynamic therapy (PDT) by Frennesson and Nilsson, of Linköping. In the first paper, the authors describe the effects of PDT in a material with smaller lesions than those in the TAP and VIP Studies. Visual outcomes were comparable to those of the TAP and VIP Studies, but after 12 months many more of the patients in the Swedish study – with smaller lesions – were free from leakage. The second paper, authored by Frennesson alone, describes follow-up data on 30 consecutive patients with age-related macular degeneration (AMD) and juxtafoveal choroidal neovascularizations. These studies demonstrate, as pointed out in the guest editorial, that PDT results in exudative AMD are best if treatment is initiated while the neovascular lesion is small. Screening for diabetic retinopathy and the subsequent treatment of sight-threatening retinal disease is one of the great success stories of modern ophthalmic care. The Nordic countries have been among the leaders in the development and implementation of such screening programmes, and these programmes are now a large and important part of the activities carried out at or by ophthalmic departments. The methodology has differed somewhat in the five Nordic countries, but image-based screening has generally been preferred over ophthalmoscopy. There are three original papers on diabetic retinopathy screening in the current issue of Acta, plus a guest editorial. In two papers Hansen and coworkers in Herlev investigate implementations of technologies. In the first paper the authors compare the retinopathy level gradings of monoscopic images obtained with and without pupillary dilatation to those obtained with a digital non-mydriatic camera and standard stereoscopic seven-field colour transparencies. All these images were taken in an ophthalmic hospital department. Images were also obtained with a non-mydriatic digital camera in an inexperienced setting at an optician's shop. There was substantial agreement between the classifications of the different sets of images. Agreement was almost perfect with respect to the need for referral to an ophthalmologist. The second paper from the same group studied the performance of an automated image analysis system designed to detect single red lesions. The results indicate that the new automated system can be valuable as a first-step screening tool. These two articles are commented upon in the guest editorial by Einar Stefánsson. The third paper, from the same group, describes the screening situation throughout Denmark. Approximately 43% of Danish patients live in counties that are still without any systematic programme of screening. In a fourth paper on diabetic retinopathy, Hove et al., from Århus, describe the early morphological retinopathy features typical of diabetes patients who later develop vision-threatening retinopathy, with the aim of helping us recognize those features that are associated with increased risk. There is much more on retina in the current issue. Our success in treating AMD is still limited, at best. The surgical removal of newly formed vessels is a rather uncommon and controversial method. In a very unusual paper, Guthoff and Schrader describe the results of a retrospective analysis of 50 patients who were operated on for surgical removal of choroidal neovascularizations in AMD and who were followed for at least 3 years. This represents the largest series in the literature. The results are quite encouraging – visual acuity remained stable or improved in more than half the eyes. Vitreomacular traction syndrome (VTC) is caused by incomplete posterior vitreous detachment and can cause macular changes and reduced visual acuity. Larsson here demonstrates that optical coherence tomography (OCT) is a useful clinical tool for evaluation, and that the majority of patients can be helped by vitrectomy. Many methods have been tested to improve the reading ability of patients with AMD. Eperjesi and coworkers studied the influence of coloured filter overlays. Unfortunately, no filter improved reading ability, and some filters (rose, purple and blue) actually made reading more difficult. Gränse et al. report their study of a group of retinitis pigmentosa patients with full-field electroretinography (ERG), multifocal ERG and multifocal visual evoked potential (VEP) and conclude that the latter two methods can be used to evaluate remaining visual function. It is clear, however, that it is still too early to define the clinical role of these new diagnostic techniques in retinitis pigmentosa. This issue includes two papers on the cornea, both from Linköping. Fagerholm and coworkers describe treatment with scraping and with phototherapeutic keratectomy (PTK) for epithelial ingrowth after LASIK procedures. Using a rabbit model, Podskochy shows the corneal epithelium to have a very strong protective effect against deep stromal damage by ultraviolet radiation. In a prospective study, Ricci et al., from Rome, implanted patients with bilateral cataract with prolate anterior surface intraocular lenses (IOLs) in one eye and conventional IOLs in the other. The prolate anterior surface IOLs gave significantly better low contrast visual acuity. In medical school we all learned that sarcoidosis is a great mimic. In this issue Heuser and Kerty, of Trondheim, report the results of a retrospective analysis of no less than 15 patients with neurosarcoidosis. Ten of those had ophthalmological/neuro-ophthalmological signs, and some of them presented for ophthalmic examination before the systemic disease had been diagnosed. There are three papers related to glaucoma in this issue. Januleviciene and coworkers studied pulsatile ocular blood flow (POBF) after latanoprost and a fixed dorzolamide-timolol combination in patients with primary open-angle glaucoma. Both drugs increased POBF. This, of course, is in agreement with many studies that have found that reduction of intraocular pressure (IOP) is often associated with increased POBF. Teuchner et al., of Basel, compared thirst, drinking behaviour and endothelin-1 plasma levels in patients with primary vasospastic syndrome and age-matched controls. The vasospastic subjects drank less and had more migraine and headaches, lower blood pressure and higher levels of endothelin-1 than the controls. There are, of course, many publications from the same research group describing associations between primary vasospastic syndrome and glaucoma, particularly normal tension glaucoma. A very interesting paper is presented by Akar and coworkers. They studied the effect of the menstrual cycle on optic nerve head topography as measured with the Heidelberg retina tomograph (HRT). There were statistically significant changes during the cycle, one of which involved a decrease in the neuroretinal rim during the luteal phase. Why is this interesting? Because it shows that the topographic measurements used for glaucoma diagnosis and follow-up are subject to systematic (and random) changes. Other studies have shown that optic disc cupping varies with IOP during the day, and that HRT measurements fluctuate similarly to visual fields. The clinical implication is absolutely clear: whether we use structural (optic disc and/or retinal nerve fibre layer) or visual function (perimetry) measurements, small longitudinal changes need to be confirmed in order to have clinical importance. There is no free lunch in glaucoma follow-up. There are two case series in this issue. The first, by Vianna et al., reports follow-up changes over an average of 6 years in 19 patients with multifocal choroiditis and panuveitis. Unfortunately, the prognosis was not good; visual function deteriorated quite a lot over time. A short case series about concomitant intraocular and periocular lymphomas is reported by Neudorfer. There are also case reports, one, by Polizzi et al. from Genoa, reporting positive effects by topical and systemic voriconazole on a corneal abscess caused by Fusarium, the other, by Lai et al. from Adelaide, on rosacea lymphoedema of the eyelid.
Author: Anders Heijl
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4232423174