Medical hypothesis discovery and innovation in ophthalmology

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Urgent eye care services in the UK have been facing increasing number of attendances over the recent years with hospitals struggling to keep up with the demand. The high number of patients presenting to these services poses great challenges for their sustainability. Inappropriate referrals, the introduction of the European Working Time Directive for junior doctors, the “never refuse†policy of some casualty eye services- ophthalmic Accident and Emergency departments, as well as, the lack of equipment and experience in primary care are some of the main causes of this phenomenon. Several studies and audits have demonstrated that the majority of urgent eye care attendances can be managed safely outside hospital. For this reason, numerous solutions and innovative schemes have been proposed in order to shift urgent eye care towards the community. Among others, the increased use of emergency ophthalmic nurse practitioners, the use of optometrists ,as a first point of contact for urgent cases, and better training of General Practitioners and A&E doctors have been proposed.

Advances in optical coherence tomography have enabled a better appreciation of the role of pathologic choroidal changes in a variety of retinal disease. A “pachychoroid†(pachy-[prefix]: thick) is defined as an abnormal and permanent increase in choroidal thickness often showing dilated choroidal vessels and other structural alterations of the normal choroidal architecture. Central serous chorioretinopathy is just one of several pachychoroid-related macular disorders. This review summarizes the current state of knowledge of the pachycoroid spectrum and the hallmark features seen with multimodal imaging analysis of these entities

Implantation of intraocular lens with Iris-fixation is a safe, efficient and predictable surgical procedure, which empowers the refractive surgeon with singular capabilities. Among their advantages are the reversibility, preservation of accommodation and a broad spectrum of ametropic correction. This lens also appears to be a valid option, with a favorable complication rate, for the treatment of aphakic eyes without capsular support. This article is a review of iris-fixated intraocular lenses and considers their principal indications, complications, and outcomes.

Purpose: To assess foveal thickness by spectral-domain optical coherence tomography (SD-OCT) during acute anterior uveitis (AAU) in HLA–B27 patients. Methods: Foveal thickness was measured at baseline and after clinical resolution of the uveitis. Data of the affected eyes of 11 patients were compared to those of a fellow, healthy eyes and to those of counterpart volunteers. Results: At baseline mean foveal thickness ± SD) was 190 ± 28 µm in affected eyes, 166 ± 20 ï­m in fellow eyes (p < 0.001), and 162±14 µm in control group (p = 0.01). On the second OCT evaluation, no significant change was observed in affected eyes while the difference versus fellow eyes and control group remained statistically significant. Conclusions: A significant increase in foveal thickness was observed in eyes with HLA –B27 AAU when compared with healthy eyes. The difference persisted for at least one month, despite full clinical and functional recovery

This study is a case report of bilateral perivascular chorioretinal lesions associated with Bartonella henselae. A 37-year-old woman presented with headache and blurred vision in both eyes aggravating occasionally during five years. She was otherwise healthy, with best-corrected visual acuities were 20/20 in both eyes. History of close contact with cats was more than merely eye-catching upon examination of her fundus. In both eyes, fundi were coated with yellow-brown pigmented perivenous chorioretinal lesions along the superotemporal and inferotemporal vascular arcades and their branches. The perivenous lesions were associated with vascular fibrous bands and corresponding changes in vascular calibers. There were no associated intraocular inflammatory signs in both eyes. The serologic tests confirmed the diagnosis of cat-scratch disease. The patient received no treatment, and she was followed for three years without any signs of ocular inflammation