ABSTRACT
Introduction: Ocular myasthenia gravis (OMG) is a common condition of the neuromuscular junction that may convert to generalized myasthenia gravis (GMG). Our aim in this study was to ...determine the conversion rate and predictive factors for generalization in OMG, in an Asian population. Methods: The investigation consisted of a retrospective study of OMG patients with a minimum 2 years of follow‐up. Results: Among 191 patients with OMG, 155 had the minimum 2‐year follow‐up. The conversion rate at median follow‐up (40.8 months) was 10.6% (95% confidence interval 7.9%–13.3%), and at the 2‐year follow‐up it was 7.7% (95% confidence interval 5.6%–9.8%). At baseline, the predictive factors for generalization were positive acetylcholine receptor antibodies (hazard ratio 3.71, P = 0.024), positive repetitive nerve stimulation (RNS) studies (hazard ratio 4.42, P = 0.003), and presence of radiologically presumed or pathologically confirmed thymoma (hazard ratio 3.10, P = 0.013). Discussion: The conversion rate of OMG to GMG in Asian patients is low, as predicted by presence of acetylcholine receptor antibodies, presence of thymoma, and positive RNS studies. Muscle Nerve 57: 756–760, 2018
Optical coherence tomography (OCT) is an in vivo imaging modality that provides non‐invasive, high resolution and fast cross‐sectional images of the optic nerve head, retina and choroid. OCT ...angiography (OCTA) is an emerging tool. It is a non‐invasive, dye‐free imaging approach of visualising the microvasculature of the retina and choroid by employing motion contrast imaging for blood flow detection and is gradually receiving attention for its potential roles in various neuro‐ophthalmic and retinal conditions. We will review the clinical utility of the OCT in the management of various common neuro‐ophthalmic and neurological disorders. We also review some of the OCTA research findings in these conditions. Finally, we will discuss the limitations of OCT as well as introduce other emerging technologies.
To determine the prognostic value of pretreatment optical coherence tomography (OCT) measurement of the peripapillary retinal nerve fibre layer (PRNFL) in final visual outcomes of patients with ...anterior visual pathway meningioma and optic neuropathy.
Retrospective case series from a tertiary care academic referral centre. Fourteen eyes (12 patients) in which pretreatment and post-treatment OCT, visual field and comprehensive neuro-ophthalmic exam data were available were evaluated for visual acuity, colour vision and visual field change after neurosurgical and/or radiation oncologic treatment.
Twelve patients and 14 eyes were analysed. Patients had tumours centred at the tuberculum sella (3), planum sphenoidale (3), anterior clinoid (2), optic nerve sheath (2), sphenoid wing (2) and olfactory groove (1). Nine eyes had normal PRNFL thickness (mean 95.5 μm± 11.0), whereas five eyes had thin PRNFL (mean 66.0 μm ± 14.2). The mean duration of follow-up was 9.7 months. There was no significant difference in age, duration of symptoms or duration of follow-up between both groups (p=0.22). After treatment, the normal PRNFL group experienced significant improvement in the visual acuity (p=0.03), colour vision (p=0.016), perimetric mean deviation (p=0.019) and foveal threshold (p=0.016) but not pattern SD (p=0.074) compared with the group with thin PRNFL. On multivariate analysis, duration of symptoms, but neither age nor follow-up duration, predicted final visual outcome.
Patients with compressive optic neuropathy due to anterior pathway meningiomas are more likely to improve post-treatment if they have a normal pretreatment PRNFL and shorter duration of symptoms.
Neurologically isolated ocular motor nerve palsies often present a management dilemma. Neuroimaging is more likely to be offered to patients <50 years without coexisting ischaemic risk factors as ...their risk of sinister underlying causes is thought to be higher. However, populations are rapidly ageing and advanced neuroimaging is now more widely available. We thus investigated the incidence of abnormal neuroimaging outcomes in the traditionally low-risk older patient group.
This is a retrospective cohort study of 353 patients presenting with isolated ocular motor nerve palsies to a tertiary neuro-ophthalmology service in Singapore over a four-year (2015 to 2019) period. Clinical data was obtained through manual review of case records. Common aetiologies, age-based differences in prevalence of causes and abnormal neuroimaging outcomes were statistically analysed.
Abnormal neuroimaging outcomes were significantly greater in the younger cohort only when age segregation was performed at 60 years of age. In a multivariate analysis, acute onset rather than ischaemic risk factors were independently predictive of normal neuroimaging outcomes. After adjusting for prior cancer risk and clinical bias from presumed ischaemic palsies, abnormal neuroimaging outcomes were seen in 14.1% ≥ 50 yrs, 10.9% ≥ 60 yrs and 15.1% ≥ 70 yrs.
In patients presenting with isolated ocular motor nerve palsies, acute onset may be a more reliable indicator of an ischaemic palsy rather than advanced age or presence of ischaemic risk factors. If onset is not acute, neuroimaging should be considered irrespective of age and coexisting ischaemic risk factors.
Purpose: Although there are approximately 200 million people of Malay ethnicity living in Asia, the burden and risk factors of blinding eye diseases in this ethnic group are unknown. This study ...summarizes the rationale and study design of a population-based study of eye diseases among adult Malays in Singapore. Methods: A population-based cross-sectional study of Malays was designed in Singapore. The sampling frame consisted of all Malays aged 40-79 living in designated study areas in southwestern Singapore. From a list of 16,069 names provided by the Ministry of Home Affairs, age-stratified random sampling was used to select 5,600 names (1,400 people from each decade of 40-49, 50-59, 60-69, and 70-79 years). The target sample size for this study was 3,150 persons. Selected individuals were invited to a centralized clinic by letters, telephone calls, and home visits. Participants underwent standardized interview and assessment of blood pressure, anthropometry, presenting and best-corrected visual acuity, subjective refraction, ocular biometry, Goldmann tonometry, slit-lamp biomicroscopy, optic disc imaging, digital lens, and retinal photography. Blood and urine samples were collected for biochemical analyses and further stored for future studies. Selected participants also had gonioscopic examination, visual fields test, and assessment of ankle and brachial blood pressure to detect presence of peripheral vascular disease. Conclusions: This study provides population-based data on the prevalence of and risk factors for age-related eye diseases in people of Malay ethnicity in Singapore. Data from this study allow further understanding of the etiology and impact of eye diseases in this ethnic group.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To assess the prevalence and types of glaucoma in an Asian Malay population.
The Singapore Malay Eye Study is a population-based, cross-sectional survey that examined 3280 (78.7% response) persons ...aged 40 to 80 years. Participants underwent a standardized clinical examination including slit-lamp biomicroscopy, Goldmann applanation tonometry, and dilated optic disc assessment. Participants who were suspected to have glaucoma also underwent visual field examination (24-2 SITA standard, Humphrey Visual Field Analyzer II), gonioscopy, and repeat applanation tonometry. Glaucoma was defined according to International Society for Geographical and Epidemiologic Ophthalmology criteria.
Of the 3280 participants, 150 (4.6%) had diagnosed glaucoma, giving an age- and sex-standardized prevalence of 3.4% (95% confidence interval CI, 3.3%-3.5%). The age- and sex-standardized prevalence of primary open-angle glaucoma was 2.5% (95% CI, 2.4%-2.6%), primary angle-closure glaucoma 0.12% (95% CI, 0.10%-0.14%), and secondary glaucoma 0.61% (95% CI, 0.59%-0.63%). Of the 150 glaucoma cases, only 12 (8%) had a previous known history of glaucoma. Twenty-seven (18%) eyes had low vision (based on best corrected visual acuity logarithm of the minimal angle of resolution logMAR >0.30 to <1.00 in the eye with glaucoma for unilateral cases; and based on the better eye for bilateral cases) and 15 (10%) were blind (logMAR, >/=1.00).
The prevalence of glaucoma among Malay persons 40 years of age and older in Singapore is 3.4%, comparable to ethnic Chinese people in Singapore and other racial/ethnic groups in Asia. As in Chinese, Caucasians, and African people, primary open-angle glaucoma was the main form of glaucoma in this population. More than 90% of glaucoma cases were previously undetected.
The Optic Neuritis Treatment Trial was a landmark study with implications worldwide. In the advent of antibody testing for neuromyelitis optica spectrum disease (NMOSD) and myelin oligodendrocyte ...glycoprotein antibody-associated disease (MOGAD), emerging concepts, such as routine antibody testing and management, remain controversial, resulting mostly from studies in White populations. We evaluate the practice patterns of optic neuritis investigation and management by neuro-ophthalmologists and neurologists in Singapore.
21-question online survey consisting of 4 clinical vignettes.
The survey was sent to all Singapore Medical Council- registered ophthalmologists and neurologists who regularly manage patients with optic neuritis.
Forty-two recipients (17 formally trained neuro-ophthalmol-ogists 100% response rate and 25 neurologists) responded. Participants opted for routine testing of anti-aquaporin-4 antibodies (88.1% in mild optic neuritis and 97.6% in severe optic neuritis). Anti-MOG antibodies were frequently obtained (76.2% in mild and 88.1% in severe optic neuritis). Plasmapheresis was rapidly initiated (85.7%) in cases of nonresponse to intravenous steroids, even before obtaining anti-aquaporin-4 or anti-MOG serology results. In both NMOSD and MOGAD, oral mycophenolate mofetil was the preferred option if chronic immunosuppression was necessary. Steroids were given for a longer duration and tapered more gradually than in idiopathic optic neuritis cases.
Serological testing for NMOSD and MOGAD is considered as a routine procedure in cases of optic neuritis in Singapore, possibly due to local epidemiological features of these conditions. Chronic oral immunosuppression is preferred for the long term, but further research is necessary to establish the efficacy and cost-effectiveness of these practices.
Abstract Background Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease characterized by weakness of bodily skeletal muscles. Office-based diagnostic tests such as repetitive nerve ...stimulation (RNS), single fiber electromyography (SFEMG), and the ice test, are used to refine the differential clinical diagnosis of this disease. Evaluating the clinical sensitivity and specificity of these tests, however, may be confounded by lack of a gold standard, non-blinding, incorporation bias, use of non-representative populations and retrospective data. Objective In this study comprising a large Asian cohort of 127 patients recruited from a Neuro-ophthalmology clinic, we minimized aforementioned confounders and tested the diagnostic value of 3 office-based tests against 2 reference standards of MG by virtue of clinical features, antibody assay and response to treatment. Results Regardless of the reference standard used, the ice and SFEMG tests displayed a higher sensitivity (86.0 to 97.3%) compared to the RNS test (21.3 to 30.6%). Conversely, the specificity of the ice (31.3%) and SFEMG (21.7% and 17.2%) tests were reduced compared to the RNS test (82.6% and 84.4%). The combined use of the ice test and SFEMG, improved the specificity of MG diagnosis to 63.6% and 64.3%, without affecting the sensitivity of those tests. Conclusion Our findings indicate, in an Asian population, high sensitivity of the SFEMG test and suggest the ice test as a valid, affordable and less technically demanding approach to diagnose MG with ocular involvement. Both ice test and SFEMG alone, however, yielded poor specificity. We suggest that the combination of SFEMG and ice test provides a more reliable diagnosis of MG.
The aim of the study is to examine the baseline intraocular pressure (IOP) and its changes after performing a water drinking test (WDT) in patients with unilateral hemifacial spasm (HFS).
In this ...prospective observational study, patients aged 21 years and above diagnosed with unilateral HFS were recruited from the Singapore National Eye Centre between January 2015 and August 2016. The unaffected eye of each patient served as a matched control. An interviewer-administered standardized questionnaire on HFS symptoms and ophthalmic examination was performed. Automated perimetry, optical coherence tomography (OCT) of the optic nerve head, color disc stereophotography and water drinking test (WDT) were done. The primary outcome measure was the difference in IOP between eyes affected by HFS and fellow eyes at baseline and at 15, 30 and 45 minutes of the WDT.
Fifty-four patients with unilateral HFS were included. Mean age was 59.8±9.9 years (range, 37.0-84.0). Of these, 54% were female and 94% were Chinese. Mean baseline IOP was significantly higher in eyes with HFS (13.9±3.1mmHg) compared to fellow eyes (13.3±2.8mmHg) (p=0.008). There was no significant difference in absolute or percentage change in IOP from baseline between the 2 groups at 15, 30 and 45 minutes of the WDT. Mean vertical cup-disc ratio (VCDR) on clinical examination was significantly higher in eyes with HFS (0.5±0.2) compared to fellow eyes (0.4±0.2) (p=0.02). There was no significant difference between the groups for visual field parameters and mean retinal nerve fiber layer thickness on OCT.
Hemifacial spasm is associated with a small but significant difference in mean baseline IOP and VCDR between affected and fellow eyes. However, when eyes affected by HFS and fellow eyes were challenged with the WDT, both responded in similar ways.
Visual outcomes in patients with paranasal mucoceles Loo, Jing-Liang; Looi, Audrey Lee-Geok; Seah, Lay-Leng
Ophthalmic plastic and reconstructive surgery,
2009 Mar-Apr, Letnik:
25, Številka:
2
Journal Article
Recenzirano
To describe the ophthalmic complications and visual outcome of patients with paranasal mucoceles.
This is a retrospective case series of patients with a diagnosis of paranasal mucocele. Their medical ...records were examined with particular emphasis on the location of the paranasal mucoceles, presence of inflammation (mucocele vs. pyelocele), presence of optic neuropathy, and final visual outcome.
Ten patients with an average age of 57.6 years (range, 30-71 years) were studied. Seven mucoceles were in the frontal or fronto-ethmoidal sinuses, one was in the sphenoidal sinus, one was within an Onodi cell, and one was in the maxillary sinus. Four patients developed optic neuropathy, of which 2 cases were related to fronto-ethmoidal mucoceles. Four patients had pyeloceles. Two of these 4 patients had resultant loss of light perception: one case was associated with a fronto-ethmoid sinus and the other with an Onodi cell).
Our series highlights the greater risk of optic neuropathy and poor visual outcome with sphenoid sinus and Onodi cell mucoceles because of their proximity to the optic nerve. However, fronto-ethmoidal mucoceles are not benign and may compromise vision, especially if a posterior ethmoid component is present, or if treatment is delayed and secondary infection has ensued to form a pyelocele. Management of paranasal mucoceles should be prompt, particularly when signs of inflammation are present.
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