Acta Ophthalmologica Scandinavica (Acta Ophthalmol Scand)

Publications in this journal

• Article: Paediatric cataract surgery.

  Charlotta Zetterström, Maria Kugelberg
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  ABSTRACT: Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is non-progressive, while lamellar cataract usually develops later and is progressive. Prompt surgery has to be performed in cases with dense congenital cataract: if nystagmus has developed, the amblyopia is unfortunately irreversible. A treatment regime based on surgery within 2 months of life, combined with prompt optical correction of the aphakia and occlusion therapy with frequent follow-up, have been successful in both unilateral and bilateral cases. The surgery ought to include anterior and posterior capsulorexis in all children at the present time. Intraocular lens implantation has been safely performed below the age of 1 year and has also been successfully performed in bilateral cases. Anterior dry vitrectomy should be performed in preschool children to avoid visual axis opacification. Visual axis opacification is the most common complication found after cataract surgery in children. Secondary glaucoma is by far the most sight-threatening complication and is, unfortunately, common in the newborn so lifelong follow-up is essential in these cases.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):698-710.
• Article: Entry-site-related retinal detachment after pars plana vitrectomy.

  Barbara Wimpissinger, Susanne Binder
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  ABSTRACT: Today, pars plana vitrectomy represents a standard surgical procedure for a number of retinal diseases that were previously considered inoperable. The aim of the present study is to investigate the entry site of pars plana vitrectomy as a possible source of retinal detachment. We reviewed retrospectively all cases of uncomplicated pars plana vitectomies because of macular hole, macular pucker and diabetic macular oedema performed in our department between 1 January 2001 and 7 July 2004. Over 3.5 years, 244 pars plana vitrectomies because of macular disease were performed. Sclerotomy-related retinal detachment was observed in 11 (4.5%) cases. These retinal detachments occurred at a mean of 37 (2-100) days after surgery. They appeared within the first 4 weeks in 55% of the cases. Iatrogenic retinal breaks and detachment continue to be a severe complication of pars plana vitrectomy, despite improvements in instrumentation and surgical techniques. A 4.5% incidence of sclerotomy-related retinal detachment after simple vitrectomy calls for action. Current approaches to reduce this complication - such as circular peripheral cryoretinopexy, scleral buckling or 360 degrees laser treatment - are invasive. We recommend extended vitreous base cleaning with scleral indentation and examination of the entry sites, performed with a three-mirror lens or via careful indirect ophthalmoscopy into the periphery, 4 weeks after surgery.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):782-5.
• Article: Intraocular lenses in children.

  Michael O'Keefe
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):696-7.
• Article: Impact of triamcinolone acetonide on retinal endothelial cells in a retinopathy of prematurity mouse model.

  Imren Akkoyun, Gursel Yilmaz, Sibel Oto, Burcu Kahraman, Nihan Haberal, Yonca A Akova
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  ABSTRACT: To evaluate the efficacy of different concentrations of triamcinolone acetonide (TA) on retinal endothelial cell proliferation in a retinopathy of prematurity (ROP) mouse model. A total of 24 C57BL/J6 mice were exposed to 75% oxygen from postnatal day 7 to day 12. On day 12, 10 mice (group B) were injected with 20 microg intravitreal TA (IVTA) and 14 mice (group C) were injected with 40 microg IVTA in one eye. The contralateral eyes were injected with isotonic saline (control group = group A). Four non-exposed mice served as negative controls (group D). The mice were killed on day 17 and the eyes removed for quantitative analysis of preretinal neovascularization. Neovascularization was quantified by counting the endothelial cell nuclei on the vitreal side of the inner limiting membrane of the retina. The endothelial cell count per histological section was lower in groups B (1.4 +/- 1.7 cells; p < 0.00001) and C (0.9 +/- 1.4 cells; p < 0.000001) compared with the control group (group A, 17.0 +/- 4.8 cells). However, there was no significant difference in cell count between groups B and C (p = 0.430). Triamcinolone acetonide suppresses endothelial cell proliferation in an ROP mouse model in vivo. There is no difference between dosages of 20 microg and 40 microg IVTA in experimental use in the suppression rates of endothelial cell proliferation.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):791-4.
• Article: Neuronal adaptation in the human retina: a study of the single oscillatory response in dark adaptation and mesopic background illumination.

  Anna-Lena Lundström, Ling Wang, Lillemor Wachtmeister
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  ABSTRACT: The single oscillatory response in complete dark adaptation (DA) and the effect of mesopic illumination were studied in order to investigate the behaviour of the neuronal adaptation system as reflected in the oscillatory potentials (OPs) of the electroretinogram (ERG). The rapid oscillatory and slow components (a- and b-waves) of single ERGs were simultaneously recorded in nine healthy, young subjects in response to first flash after both DA of 45 mins and light adaptation to a steady background light (BGL) of low mesopic intensity. Two low-amplitude oscillatory peaks were present in the single response to the first flash recorded in DA. There was no increase in the summed amplitudes of the OPs (SOP) when recorded in the single response to the first flash in mesopic BGL. However, the morphology of the oscillatory response altered. The first OP was reduced and a third oscillatory peak appeared. We conclude that early, scotopically related OPs may indeed be activated in the single response to the first flash in DA (i.e. without using conditioning flashes). Secondly, on its own, adaptation to mesopic BGL does not seem to trigger enhancement of the overall oscillatory response. The altered single oscillatory response to the first flash apparent in the mesopic BGL comprises a third cone-associated OP and seems to reflect a reorganization of the retinal microcircuitry from a predominantly rod-activated system to one of mixed rod/cone neuronal activity in the inner part of the retina at the level at which individual OPs have their respective origins.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):756-63.
• Article: Intraocular lens geometry makes a difference.

  Wolfgang Haigis
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):803-4; author reply 804-5.
• Article: True polycoria or pseudo-polycoria?

  Niaz Islam, Jodbhir S Mehta, Gordon T Plant
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):805-6.
• Article: Full-thickness macular hole in a patient with diabetic cystoid macular oedema treated by intravitreal triamcinolone injections.

  Amélie Lecleire-Collet, Olivier Offret, David Gaucher, François Audren, Belkacem Haouchine, Pascale Massin
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  ABSTRACT: Full-thickness macular hole associated with diabetic macular oedema is a rare feature and its pathogenesis remains incompletely elucidated. We report the occurrence of a full-thickness macular hole, documented with optical coherence tomography (OCT), in a patient with diabetic cystoid macular oedema treated by intravitreal triamcinolone injections. A 48-year-old woman with refractory diabetic cystoid macular oedema underwent successive intravitreal triamcinolone injections, which were followed by a progressive thinning of the neurosensory retina at the fovea, and then by a full-thickness macular hole, associated with a perifoveal posterior hyaloid detachment, visible on OCT. During pars plana vitrectomy, a thin epiretinal macular membrane was diagnosed and removed. Pathogenesis of the present full-thickness macular hole associated with diabetic macular oedema is different from that of idiopathic macular holes because anteroposterior vitreous tractions were not involved in its formation. Recurrent intravitreal triamcinolone injections may have had an indirect role in the development of the macular hole, by favouring the rupture of distended Muller cells and intraretinal pseudocysts.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):795-8.
• Article: Optical coherence tomography as a means of evaluating acute ischaemic retinopathy in branch retinal artery occlusion.

  Wener Cella, Marcos Avila
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):799-801.
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  Article: Interaction of anaesthetic drugs and UV-B irradiation in the anterior segment of the rat eye.

  Fengju Zhang, Stefan Löfgren, Per G Söderberg
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  ABSTRACT: To determine the impact of anaesthesia on acute transient cataractogenesis and ultraviolet radiation (UVR)-induced cataractogenesis. Sprague-Dawley rats were anaesthetized with pentobarbital, which caused almost full eyelid closure, or xylazine/ketamine, which caused eyelid retraction and proptosis. The eyelids of one eye were kept open with either a suture or adhesive tape, or both. The other eye was kept closed with either a suture or tape. Cataract was graded clinically and quantified in vitro as intensity of forward light scattering. In two UVR experiments, anaesthetized rats were irradiated unilaterally with 5 kJ/m2 UVR-B 300 nm for 15 mins. The difference between the two UVR experiments was the degree of proptosis in the pentobarbital group. Corneal drying was judged clinically with a grading scale. Within 60 mins of anaesthesia induction in the first experiment, almost all lenses in open eyes developed cataract, whereas all lenses in closed eyes remained clear. In the first UVR experiment the lens light scattering was significantly higher in the xylazine/ketamine group. In the second UVR experiment the pentobarbital group was treated to achieve proptosis similar to that in the xylazine/ketamine group, which led to a smaller difference in lens light scattering between the two anaesthesia groups. Lens light scattering in the pentobarbital groups was significantly higher with forced proptosis than without prominent proptosis. Xylazine/ketamine anaesthesia facilitates the development of UVR-induced cataract, whereas pentobarbital anaesthesia does not. Xylazine/ketamine anaesthesia induces more proptosis and therefore leads to increased exposure of the cornea and, secondarily, the lens.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):745-52.
• Article: Chronic conjunctivitis in a patient with folic acid deficiency.

  Vesta Chan Cheuk Ki, Lulu Cheng Lu, Philip Lam Tsze Ho
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):802; author reply 802-3.
• Article: Strabismus and eye muscle function.

  Gunnar Lennerstrand
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  ABSTRACT: Studies of external eye muscle morphology and physiology are reviewed, with respect to both motor and sensory functions in concomitant strabismus. The eye muscles have a more complex fibre composition than other striated muscle, and they are among the fastest and most fatigue-resistant muscles in the body. However, it is not generally believed that concomitant strabismus is due to a primary abnormality of the eye muscles or the ocular motor system. The gross anatomy of eye muscles, including the shape and position of the eye muscle pulleys, was not changed in strabismus. The histology of the eye muscle fibres was also basically the same, but changes have been observed in the cellular and biochemical machinery of the fibres, most notably in the singly innervated orbital fibres. Functionally, this was seen as slower contractions and reduced fatigue resistance of eye muscles in animals with strabismus and defects of binocular vision. Most likely the changes represented an adaptation to modified visual demands on the ocular motor control, because of the defects of binocular vision in strabismus from an early age. Adaptation of eye muscle function to visual demands could be seen also in the adult human ocular motor system, but here the effects could be reversed with treatment in some conditions. External eye muscles in the human have sensory organs, muscle spindles and tendon organs, responding to changes in muscle force and length. It is not known how these proprioceptors are used more specifically in ocular motor control, and there is no stretch reflex in the external eye muscles. However, a clear influence on space localization and eye position can be demonstrated with vibratory stimulation of the eye muscles, presumably activating muscle spindles. Different effects were observed in normal subjects and in adult patients with strabismus, which would indicate that the proprioceptive input from one eye of strabismic patients could be suppressed by the other eye, similar to visual suppression in concomitant strabismus. Such an interaction would most likely occur in the visual cortex, and not in the ocular motor system. Further studies of proprioceptive mechanisms, during the postnatal developmental stage and in adult concomitant strabismus may shed light on the mechanisms of childhood strabismus and may, in this respect, be a more fruitful avenue for further research than eye motor studies.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):711-23.
• Article: The effect of short-term exposure of triamcinolone acetonide on fibroblasts and retinal pigment epithelial cells.

  Jaeryung Oh, You Sun Jung, Geun Soo Kim, In Kyung Oh, Bo-Kun Rho, Kuhl Huh
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  ABSTRACT: We investigated the effects of short-term exposure to triamcinolone on cultured choroidal fibroblast (CFB) cells and retinal pigment epithelial (RPE) cells. To evaluate the effect of triamcinolone on cell proliferation, CFB and RPE cells were divided into three groups: a short-term exposure group; a longterm exposure group, and a non-treated control group. Cells in the short-term exposure group were briefly exposed (5, 15 or 30 mins) to triamcinolone (0.01 mg/ml, 1 mg/ml or mitomycin C (0.01 microg/ml, 1 microg/ml). Cells in the longterm exposure group were continuously incubated in culture medium containing the drug until assessment. The control group was cultured without drugs. Cell viability and the number of cells were assessed at day 5 after exposure. To investigate the direct toxicity of triamcinolone on confluent RPE cells, completely confluent cells were exposed to the drugs in the manner as described above. Cell viability was determined on days 0, 3 and 5 after treatment. In the short-term exposure group, 1 mg/ml triamcinolone caused a significant reduction in the proliferation of CFB and RPE cells. The proliferation of CFBs decreased even with exposure to 0.01 mg/ml triamcinolone. In the longterm exposure group, triamcinolone and mitomycin C reduced the proliferation of both CFB and RPE cells. Even very short periods of exposure to triamcinolone caused a significant reduction in the viability of completely confluent RPE cells. Even short periods of exposure to triamcinolone inhibited the proliferation of fibroblasts and RPE cells and were significantly toxic to completely confluent RPE cells.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):786-90.
• Article: Functional and anatomical investigations in racemose haemangioma.

  Carsten H Meyer, Eduardo B Rodrigues, Stefan Mennel, Volker Klingmüller, Peter Kroll
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  ABSTRACT: To determine the vascular morphology of racemose haemangioma and related functional alterations in arteriovenous (AV) malformation type 3. A 17-year-old patient with unilateral racemose haemangioma received a full ophthalmic examination including Snellen visual acuity (VA) and Goldmann visual field. The central vision was investigated by scanning laser ophthalmoscope (SLO) and multifocal electroretinogram (mfERG). The ocular haemodynamics were examined by fluorescence angiography and Doppler ultrasound. The tomographic contour of the vascular architecture was visualized using B-scan ultrasound, Stratus optical coherence tomography (OCT) and three-dimensional Heidelberg retina tomograph (3D-HRT II). The VA of the patient's right eye was reduced to 20/400 and her visual field was constricted concentrically. Microperimetry revealed a small central field with good central fixation. The mfERG demonstrated reduced amplitudes of the central retina. On fluorescein angiography, there was a fast filling of the retinal branches related to the racemose vessels. Doppler ultrasound confirmed a significantly changed haemodynamic flow in the racemose vessels. Ultrasound, OCT and HRT demonstrated a prominent optic nerve head. The racemose haemangioma led to a marked visual field defect. Racemose haemangiomas are associated with severe changes in the haemodynamics of the retinal vasculature.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):764-71.
• Article: Tumour necrosis factor-alpha in conjunctivae affected by ocular cicatricial pemphigoid.

  Miguel Cordero Coma, Taygan Yilmaz, C Stephen Foster
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  ABSTRACT: The presence of tumour necrosis factor-alpha (TNF-alpha) in conjunctivae affected by ocular cicatricial pemphigoid (OCP) was investigated. Biopsy specimens from the conjunctivae of eight patients with OCP, three patients with atopic keratoconjunctivitis (AKC) and two normal subjects were studied for the expression of TNF-alpha by immunohistochemistry. Two independent, masked investigators evaluated the specimens. All samples were similarly processed by a third investigator. No TNF-alpha was discerned in the normal conjunctival sections; small amounts of TNF-alpha were observed in the atopic keratoconjunctivitis specimens. TNF-alpha was present in substantial amounts in conjunctival sections of patients with OCP. The expression of TNF-alpha was detected in both epithelial and stromal cells of conjunctivae from OCP patients. The presence of TNF-alpha in conjunctivae affected by OCP may indicate that this cytokine plays an important role in the production and maintenance of conjuctival inflammation response and subsequent conjunctival scarring in patients with OCP. Further studies clarifying this potential role are warranted.
  Acta Ophthalmologica Scandinavica 12/2007; 85(7):753-5.
• Article: Visual outcome and cataract development after allogeneic stem-cell transplantation in children.

  Kristina Teär Fahnehjelm, Alba-Lucia Törnquist, Monica Olsson, Jacek Winiarski
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  ABSTRACT: To report visual functions and prevalence of cataract after haematopoetic stem-cell transplantation (SCT) during childhood and to determine the impact of different conditioning regimes and other possible risk factors. Assessment of visual acuity (VA), slit-lamp biomicroscopy of the lenses and examination of the ocular fundii were performed in 79 subjects 2-18 years (median 7 years) after SCT. Best-corrected decimal VA > or = 0.5 was achieved in 152/158 eyes (96%). There was an increased risk of cataract after conditioning with single-dose total body irradiation (s-TBI) or fractionated TBI (f-TBI) compared to busulfan or other chemotherapy (P < 0.001) and an increased risk of developing cataract earlier if treated with s-TBI compared to f-TBI (P < 0.01). The TBI mode did not affect the time to first surgical intervention. Apart from s-TBI and f-TBI, age was found to be an independent risk factor. Cataract also developed in patients prepared with chemotherapy but no patient required surgery. Neither treatment with steroids for 6 months or longer nor history of chronic graft versus host disease (GVHD) influenced cataract development. Conditioning with full dose f-TBI compared to s-TBI postpones but does not prevent cataract or cataract surgery while chemotherapy-based conditioning induces less severe cataracts, usually not requiring surgery. Corticosteroids or GVHD do not appear as risk factors.
  Acta Ophthalmologica Scandinavica 11/2007; 85(7):724-33.
• Article: Management of dry eye related to systemic diseases in childhood and longterm follow-up.

  Flávio Mac Cord Medina, Rosane Silvestre de Castro, Suzana C Leite, Eduardo M Rocha, Gutemberg de Melo Rocha
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  ABSTRACT: Dry eye in children is not common in general practice and is usually referred to tertiary centres for diagnostic confirmation. In the present review we examine the potential causes of dry eye in children and report the management and longterm follow-up of dry eye in childhood with reference to clinical diversity, systemic associations, ocular outcomes and treatment trends. A retrospective, consecutive case series was studied by evaluating the clinical charts of children with dry eye over a 96-month period. Minimal diagnostic inclusion criteria were presence of ocular surface damage and tear deficiency. Fourteen patients with an age range at presentation of 1-17 years were evaluated. Ten patients were female, four were male and all had bilateral involvement. The most frequent symptoms were red eye, photophobia and low visual acuity (VA). Four patients had corneal ulcers. Two patients had best corrected visual acuity (BCVA) < or = 20/200 at first examination. One of these plus another patient presented with BCVA < or = 20/200 at the last visit. All patients were treated with artificial tears; three received autologous serum tears and five submitted to conjunctival flaps to preserve the integrity of the eye. Associated systemic conditions were found in all patients and were congenital in six of them. Early manifestations of dry eye in childhood are a potential indication of systemic disease. The ocular condition may be misdiagnosed and correct treatment delayed. Most diseases are bilateral and may jeopardize VA. Systemic investigation, close follow-up and preparing the family for longterm and multidisciplinary treatment are necessary to preserve ocular health and identify systemic associations.
  Acta Ophthalmologica Scandinavica 11/2007; 85(7):739-44.
• Article: Glycaemic control and control of risk factors in diabetes patients in an ophthalmology clinic: what lessons have we learned from the UKPDS and DCCT studies?

  Gareth T Higgins, Javeed Khan, Ian A Pearce
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  ABSTRACT: The Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) have studied glycaemic control as well as other risk factors in preventing the progression of diabetic end-organ disease, including diabetic retinopathy. We wished to determine to what extent a cross-section of diabetes patients attending our eye clinic met the targets laid down by recent landmark studies. We prospectively assessed 44 consecutive diabetes patients attending outpatient clinics for assessment of diabetic retinopathy. Each patient had HbA1c levels, serum cholesterol and blood pressure checked. A proforma was completed for each patient. Of the 44 patients studied, 11 had type 1 diabetes mellitus (DM) and 33 had type 2 DM (11 insulin-dependent DM [IDDM], 22 non-insulin-dependent DM [NIDDM]). The mean age of type 1 DM patients was 43 years; that of type 2 DM patients was 62 years. Five of 11 (46%) type 1 DM patients had poorly controlled diabetes (HbA1c > 9%) compared with four of 33 (12%) type 2 DM patients. Overall, 27 of 44 (62%) patients were on antihypertensive medication. The prevalence of poorly controlled blood pressure (> 150/85 mmHg treated; > 160/90 mmHg untreated) was 16 of 44 (36%) patients overall, and was higher for type 2 DM patients (13/33, 39%) than for type 1 DM patients (3/11, 27%). Random serum cholesterol levels > 5.2 were found in 10 of 44 (23%) patients overall (4/11 [36%] type 1 and 6/33 [18%] type 2 DM patients). Control of HbA1c, hypertension and hypercholesterolaemia can slow progression of retinopathy and other DM end-points. Many of our patients were poorly controlled in terms of these risk factors. More attention should be addressed to these primary preventative factors in the management of diabetes patients.
  Acta Ophthalmologica Scandinavica 11/2007; 85(7):772-6.