Purpose: To investigate the status of the blood–aqueous barrier and to evaluate the subfoveal choroidal thickness (SCT) in patients with asymptomatic untreated chronic hepatitis C virus (HCV) infection without any anterior or posterior ocular involvement and to search for possible correlations.Design: Observational case-control study.Participants and Controls: A total of 80 eyes of 20 HCV-positive patients (male-to-female ratio, 12:8; mean age, 46.9±7.23 years) and 20 healthy controls (male-to-female ratio, 10:10; mean age, 48.2±8.71 years) were examined.Methods: Participants underwent a complete ophthalmologic examination. Aqueous flare was quantified objectively by using the noninvasive laser flare cell meter FC-500 (Kowa Company Ltd, Tokyo, Japan), whereas SCT was evaluated by using enhanced depth imaging optical coherence tomography (Spectralis OCT; Heidelberg Engineering GmbH, Heidelberg, Germany). A Wilcoxon rank-sum test was performed to compare ocular findings between HCV patients and controls, and correlations were assessed by using the Spearman rank test.Main Outcome Measures: Retinal and choroidal thickness and anterior chamber inflammation of HCV patients and healthy controls.Results: Patients with HCV showed significantly higher aqueous flare values (8.37±2.25 photon counts/ms vs. 4.56±1.45 photon counts/ms; P<0.0001) and a significantly increased SCT (362.7±46.5 μm vs. 320.25±32.82 μm; P<0.0001) than healthy controls. Moreover, subjects with liver fibrosis had higher flare values than those with no significant hepatic fibrosis (9.62±1.99 photon counts/ms vs. 6.97±2.19 photon counts/ms; P = 0.0003) and thicker choroids (379.15±44.75 μm vs. 346.3±43.27 μm; P = 0.024). Statistical analysis revealed that there was a positive correlation between aqueous flare values and SCT in HCV patients (r = 0.69; P<0.0001) and between flare and the degree of liver fibrosis (r = 0.67; P = 0.0001).Conclusions: This study showed that impairment of the blood–aqueous barrier and thickened choroids are features of asymptomatic HCV patients, and that choroidal thickness increases as the degree of subclinical inflammation of the anterior chamber increases. Patients with significant liver fibrosis have the highest flare values and the thickest choroids.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Category: Peer-reviewed
Topical Cyclosporine in the Treatment of Allergic Conjunctivitis: A Meta-analysis – Corrected Proof
Purpose: To assess the efficacy and safety of topical cyclosporine versus placebo in the treatment of allergic conjunctivitis.Design: Systematic review and meta-analysis.Participants: Seven qualified studies incorporating 306 eyes of 153 patients were analyzed.Methods: Searches of randomized controlled trials were conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform.Main Outcome Measures: We assessed the methodologic quality of individual included trials and performed meta-analyses using the random effects model if P<0.1 in the test for heterogeneity, or otherwise used the fixed effect model. We assessed scores of composite signs and symptoms, reduction in steroid eye drop use in steroid-dependent patients, and safety outcomes (i.e., stinging or burning sensation).Results: At 2 weeks of follow-up or longer, evidence suggests a statistically significant improvement in the composite signs (standardized mean difference [SMD], −1.21; 95% confidence interval [CI], −1.80 to −0.62; I2 = 71%) and symptoms (SMD, −0.84; 95% CI, −1.51 to −0.16; I2 = 80%) after topical cyclosporine treatment for allergic conjunctivitis regardless of the dosage of treatment. There was a significant reduction (mean difference, −61.16; 95% CI, −101.61 to −20.72; I2 = 58%) in the use of steroid eye drops in patients with steroid-dependent allergic conjunctivitis. Stinging or burning sensation (odds ratio, 2.56; 95% CI, 0.19–35.06; I2 = 73%) was common in both the cyclosporine and placebo groups.Conclusions: This systematic review and meta-analysis suggests topical cyclosporine could be an effective and safe treatment method for allergic conjunctivitis. Further randomized controlled trials with larger sample sizes and standardized outcome measurements, follow-up periods, and cyclosporine concentrations are warranted to determine the short- and long-term efficacy and safety and the minimal effective dosage of topical cyclosporine for allergic conjunctivitis.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Orbital Cerebrospinal Fluid Space in Glaucoma
Wang et al present an interesting, well-designed study on intracranial and intraocular pressure (IOP). Based on standardized measurements with magnetic resonance imaging, they demonstrated a narrower orbital optic nerve (ON) subarachnoid space (SAS) in…
Conjunctival Thickness Measured by Optical Coherence Tomography
In vivo monitoring of changes in conjunctival thickness may provide valuable insight into disorders characterized by or featuring conjunctival thinning. However, to the best of our knowledge, there have been no studies reporting total conjunctival thic…
Contents
Fire Risk During Ophthalmic Plastic Surgery
A high oxygen concentration was reported as the major risk factor behind 74% of all surgical fires. Given that surgical fires are a dreaded complication of combining electrocautery and oxygen use, minimizing increases in oxygen concentration above atmo…
Ethical Authorship and the Ingelfinger Rule in the Digital Age
Ophthalmology’s Guide for Authors includes a policy regarding prior and repetitive publication that states: “The Journal will not consider manuscripts that have appeared, in part or in total, in other publications, except in special circumstances app…
Author reply
We thank Sabour and Ghassemi for their interest in our paper and their comments about the interpretation of the statistical analysis. The predictive value of the temporal–superior and temporal–inferior positions of the Moorfields Regression Analysi…
Author reply
We thank Yoon et al for their interest in our article and their comments on their cited publication and personal experience. As noted in their letter, the incidence of brow ptosis after temporal artery biopsy (TAB) had not been reported previously. We …
Author reply
We thank Dr. Killer for his interest in our study. We fully agree with him that (1) the assumption of a narrow orbital cerebrospinal fluid (CSF) space indicating a low intracranial CSF pressure is valid only if there is a free communication between the…
Brow Ptosis After Temporal Artery Biopsy
Recently we described 4 patients referred over a period of 5 years after suffering facial nerve injury from superficial temporal artery biopsy. A literature search uncovered 3 more cases, bringing the total number of reported cases to 7. From this low …
Cataract Extraction and the Iris Configuration
Mansberger et al recently described a 16.5% reduction in intraocular pressure (IOP) after cataract extraction. We agree that “the exact mechanism of IOP lowering after cataract surgery is unknown.”
Macular Hole and Choroidal Thickness
We read with great interest and attention the recent article from Zeng et al regarding the choroidal thickness in both eyes of patients with unilateral idiopathic macular hole. They concluded that choroidal thickness was thinner in eyes affected with i…
Author reply
We thank Hong et al for their interest in our recent study describing the characteristics of anterior segment herpes simplex in a large cohort of children. We are in complete agreement that data generated from randomized clinical trials are desirable. …
Oral Acyclovir for Herpes Simplex Blepharoconjunctivitis in Children
We read the article by Liu et al on the clinical characteristics, treatment, and outcomes of pediatric herpes simplex virus (HSV) infections of the anterior segment with great interest. The researchers found that of the 53 patients (57 eyes), 18 eyes h…
This Issue At A Glance
Bothun et al (p. 1227) have found that intraocular lens (IOL) placement in infants aged 1 month to 6 months does not prevent the early development of strabismus following congenital cataract surgery. However, strabismus is less likely to develop in inf…
Predictive Value of Confocal Scanning Laser for the Onset of Visual Field Loss
We were interested to read the paper by Larrosa et al published in the August 2012 issue of Ophthalmology. The authors report the ability of Moorfields regression analysis (MRA) to predict the onset of glaucoma in a population of patients with suspecte…
Editorial Board
MRI in Retinoblastoma with Orbital Cellulitis
Retinoblastoma-associated orbital cellulitis is a well-recognized clinical entity. Inflammation of orbital soft tissues can clinically mimic extraocular tumor invasion, potentially affecting patient management decisions. Magnetic resonance imaging (MRI…
A Simple Vista en Este Número
Bothun y otros (p. 1227) determinaron que el uso de un lente intraocular (IOL) en infantes de 1 a 6 meses no evita el desarrollo temprano del estrabismo después de cirugía de catarata congénita. Sin embargo, hay menos probabilidad de que se desarrol…