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Husum YS, Skogen K, Brandal P, Rønning PA, Wigers AR, Evang JA, Jørstad ØK. Idiopathic Duro-Optic Calcification. J Neuroophthalmol 2024; 44:e204. [PMID: 36255093 DOI: 10.1097/wno.0000000000001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yngvil Solheim Husum
- Departement of Ophthalmology, Oslo University Hospital, Oslo, Norway, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway, Department of Oncology, Oslo University Hospital, Oslo, Norway, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway, Departement of Ophthalmology, Oslo University Hospital, Oslo, Norway, Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway; and Departement of Ophthalmology, Oslo University Hospital, Oslo, Norway
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Melo GB, Santos LA, Agra LLDM, Meyer C, Moe MC, Jørstad ØK. Accuracy and residual volume of intravitreal injection syringes in administration of very small volumes. Eye (Lond) 2024; 38:395-396. [PMID: 37500753 PMCID: PMC10810777 DOI: 10.1038/s41433-023-02670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Gustavo Barreto Melo
- Hospital de Olhos de Sergipe, Aracaju, SE, Brazil.
- Federal University of São Paulo, São Paulo, SP, Brazil.
| | | | | | - Carsten Meyer
- Federal University of São Paulo, São Paulo, SP, Brazil
- Philipps University of Marburg, Marburg, Germany
| | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway
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Nilsen HY, Jørstad AKL, Ryan SJ, Moe MC, Grimstad K, Aamodt AH, Holmøy T, Jørstad ØK. En kvinne i 60-årene som ikke lenger gjenkjente det hun så. Tidsskr Nor Laegeforen 2023; 143:23-0198. [PMID: 37938009 DOI: 10.4045/tidsskr.23.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Neurological disorders can present with a vast array of visual disturbances. The constellation of symptoms and findings in this patient prompted workup for unusual causes of both stroke and neurodegenerative disorder. CASE PRESENTATION A woman in her sixties presented with visual disturbances, followed by weakness in her right arm and aphasia three days later. Her close acquaintances had suspected progressive cognitive decline during the previous year. CT and MRI showed an occluded left posterior cerebral artery with a subacute occipito-temporal infarction. The finding of extensive white matter lesions and segmental arterial vasoconstriction necessitated further workup of vasculitis and hereditary small vessel disease, which were ruled out. The stroke aetiology was considered to be atherosclerotic intracranial large vessel disease. FDG-PET scan revealed decreased metabolism in the left hemisphere, and cerebrospinal biomarkers had slightly decreased beta-amyloid. The findings were suggestive of early Alzheimer's disease or primary progressive aphasia, but currently inconclusive. INTERPRETATION Based on clinical-anatomical correlation, the patient's visual disturbances, in this case right hemianopsia and object agnosia, were solely related to the stroke and not to a neurodegenerative disorder. Knowledge and interpretation of visual agnosias can in many cases be clinically valuable.
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Affiliation(s)
| | | | | | - Morten Carstens Moe
- Øyeavdelingen, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | | - Anne Hege Aamodt
- Nevrologisk avdeling, Oslo universitetssykehus, og, Institutt for nevromedisin og bevegelsesvitenskap, NTNU
| | - Trygve Holmøy
- Nevrologisk avdeling, Akershus universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
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Jørstad ØK, Foss S, Gjølberg TT, Mester S, Nyquist-Andersen M, Sivertsen MS, Fossum D, Gleditsch E, Moe MC, Andersen JT. Pharmaceutical compounding and storage of faricimab in a syringe for intravitreal injection do not impair stability and bi-specific binding properties. Int J Retina Vitreous 2023; 9:65. [PMID: 37936232 PMCID: PMC10631190 DOI: 10.1186/s40942-023-00507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Intravitreal injection (IVI) of antibody biologics is a key treatment approach in ophthalmology. Pharmaceutical compounding and storage of prefilled syringes for IVI must take place without impairing the structure and function of the biologics. This study investigated the effect of withdrawing and storing the therapeutic antibody faricimab (Vabysmo, Roche, Basel, Switzerland) in the Zero Residual silicone oil-free, 0.2-mL syringe (SJJ Solutions, The Hague, the Netherlands). METHODS To assess the effect of syringe withdrawal on faricimab, we compared samples from syringes prepared at day 0 with samples taken directly from faricimab vials. To assess the effect of syringe storage on faricimab, we kept prefilled syringes in the dark at 4 oC for 7, 14, or 37 days and compared samples from these syringes with day 0. We measured protein concentration (with spectrophotometry), stability and integrity (with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), size-exclusion chromatography (SEC), and melting temperature (Tm)), as well as binding of faricimab to its cognate antigens: vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2) (with enzyme-linked immunosorbent assay (ELISA)). RESULTS Faricimab migrated in line with its expected molecular mass under both reducing and non-reducing conditions for all time points when analyzed with SDS-PAGE, without any sign of degradation products or aggregation. The SEC elution profiles were identical for all time points. There were slight variations in Tm for different time points compared to day 0 but without consistent relationship with storage time. ELISA did not detect differences in VEGF-A or Ang-2 binding between time points, and faricimab did not bind the neonatal Fc receptor. CONCLUSIONS Withdrawal and storage of faricimab in syringes for up to day 37 did not impair the structure and bi-specific binding properties of the therapeutic antibody.
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Affiliation(s)
| | - Stian Foss
- Department of Pharmacology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Precision Immunotherapy Alliance (PRIMA), University of Oslo, Oslo, Norway
| | - Torleif Tollefsrud Gjølberg
- Department of Pharmacology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Precision Immunotherapy Alliance (PRIMA), University of Oslo, Oslo, Norway
| | - Simone Mester
- Department of Pharmacology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Precision Immunotherapy Alliance (PRIMA), University of Oslo, Oslo, Norway
| | - Mari Nyquist-Andersen
- Department of Pharmacology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Precision Immunotherapy Alliance (PRIMA), University of Oslo, Oslo, Norway
| | | | - Dag Fossum
- The Hospital Pharmacy Oslo, Ullevål, Norway
| | | | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan Terje Andersen
- Department of Pharmacology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Precision Immunotherapy Alliance (PRIMA), University of Oslo, Oslo, Norway
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Agra LLM, Sverstad A, Chagas TA, Araújo RH, Oliveira LG, Kristianslund O, Petrovski G, Maia M, Moe MC, Jørstad ØK, Melo GB. Accuracy, Precision, and Residual Volume of Commonly Used Syringes for Intravitreal Injections and the Impact on Intraocular Pressure. Ophthalmol Retina 2023; 7:892-900. [PMID: 37302655 DOI: 10.1016/j.oret.2023.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To compare accuracy, precision, and residual volume of commonly used syringes for intravitreal injections (IVIs) and to assess the intraocular pressure (IOP) rise by variations in volumes delivered. DESIGN Experimental laboratory study. SUBJECTS No subjects were involved in this study. METHODS We tested 8 syringe models with 2 different needle setups, with 2 different solutions (distilled water or glycerin) and target volumes (50 and 70 μL). To obtain the delivered and residual volumes, we weighed the syringe-needle setups with scale before liquid withdrawal, with liquid, and after liquid release. We also created an experimental eye model to determine the transient rise in IOP following stepwise 10-μL increases in injection volumes. MAIN OUTCOME MEASURES Delivered and residual volumes, IOP rise. RESULTS We tested a total of 600 syringe-needle setups. Becton Dickinson (BD) Ultra-Fine (0.34 ± 0.28 μL), Zero Residual (1.53 ± 1.15 μL), and Zero Residual Silicone Oil-free (1.40 ± 1.16 μL) syringes showed the lowest residual volume (P < 0.001) in comparison with the others (range: 24.86 ± 1.78 μL for Injekt-F to 51.97 ± 3.37 μL for Omnifix-F). The most accurate setups were (percentage deviation from target volume): Zero Residual Silicone Oil-free (+ 0.70%), Zero Residual 0.3 ml (+ 4.49%), BD Ultra-Fine (+ 7.83%), Injekt-F (9.42%), Norm-Ject (+ 15.88%), Omnifix-F (+ 16.96%), BD Plastipak Brazil (+17.96%), and BD Plastipak Spain syringes (+ 19.41%). There was a statistically significant difference between the Zero Residual Silicone Oil-free syringe and all other syringes (P < 0.0001), except for the Zero Residual 0.3-ml syringe (P = 0.029). The coefficient of variation was low for all syringes. The modeled IOP rise ranged from 32.3 (standard deviation [SD], 1.4) mmHg for 20-μL injection volume to 76.5 (SD, 1.0) mmHg for 80-μL injection volume. For the standard 50-μL injection volume, the peak pressure was 50.7 (SD, 0.1) mmHg, and the pressure rise duration was 28 (SD, 2) minutes. CONCLUSIONS There were significant differences in accuracy and residual volume between syringes, whereas they showed a high precision. Volume excess results in a considerable increase in IOP rise after injection. These findings may provide a relevant overview to clinicians and to both device and drug manufacturers regarding pharmacoeconomic, safety, and efficacy issues. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Lydianne L M Agra
- Hospital de Olhos de Sergipe, Aracaju, Brazil; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Alexander Sverstad
- Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, Split, Croatia
| | - Maurício Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Morten Carsten Moe
- Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gustavo Barreto Melo
- Hospital de Olhos de Sergipe, Aracaju, Brazil; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
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Sauesund ES, Jørstad ØK, Brunborg C, Moe MC, Erke MG, Fosmark DS, Petrovski G. A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results. Biomedicines 2023; 11:biomedicines11041222. [PMID: 37189840 DOI: 10.3390/biomedicines11041222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway. METHODS This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR. RESULTS The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis > 5 years for T1D and >1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group. CONCLUSIONS This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).
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Affiliation(s)
- Ellen Steffenssen Sauesund
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0450 Oslo, Norway
| | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Dag Sigurd Fosmark
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
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Blom K, Jørstad ØK, Faber RT, Stene-Johansen I, Holberg-Petersen M, Hermansen NO, Bragadóttir R. Primary vitrectomy or intravitreal antibiotics followed by early vitrectomy for acute endophthalmitis: A prospective observational study. Acta Ophthalmol 2023; 101:100-108. [PMID: 35751448 PMCID: PMC10084037 DOI: 10.1111/aos.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/30/2022] [Accepted: 06/05/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS To compare outcomes of acute endophthalmitis (EO) managed with either primary vitrectomy (PV) or primary intravitreal antibiotics (vancomycin and ceftazidime) followed by early vitrectomy (PIAEV) combined with polymerase chain reaction (PCR)-based diagnostics. METHODS This was a prospective, comparative observational study of acute EO cases admitted to a regional vitreoretinal service over 18 months. Depending on whether immediate vitrectomy (within 6 h) was achievable, the EO cases were treated with either (1) PV or (2) PIAEV. Microbiology samples were collected either (A) before or (B) after administration of intravitreal antibiotics. The samples were analysed with broad-range 16S PCR and culture. RESULTS The study included 41 EO cases. There were 19 post-injection EO, 18 post-cataract EO, three post-vitrectomy EO, and one blebitis-related EO. Fifteen of 19 PV cases and 15 of 21 PIAEV had a clinically meaningful improvement in best-corrected visual acuity (BCVA) of at least 15 letters at 3 months (p = 0.58). One patient was lost to follow-up. Twenty-three cases were culture- and PCR-positive, and seven additional cases were culture-negative but PCR-positive (p = 0.02). PCR increased the diagnostic yield for samples collected both before and after administration of intravitreal antibiotics. CONCLUSION Primary vitrectomy or PIAEV allowed for vitrectomy for all cases of acute EO in a large region. Most eyes in both groups achieved a clinically meaningful improvement in BCVA. By combining culture with PCR in connection with the vitrectomy procedure, intravitreal antibiotics could be injected before microbiological sampling, thereby improving the door-to-treatment time without sacrificing microbial identification.
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Affiliation(s)
- Kathrine Blom
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | - Ragnheiður Bragadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Hertzberg SNW, Moe MC, Jørstad ØK, Petrovski BÉ, Burger E, Petrovski G. Healthcare expenditure of intravitreal anti-vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema. Acta Ophthalmol 2022; 100:e1630-e1640. [PMID: 35467793 PMCID: PMC9790387 DOI: 10.1111/aos.15151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to estimate the 1-year costs associated with treating diabetic macular oedema (DME) patients using current intravitreal anti-vascular endothelial growth factor (anti-VEGF) biologics compared with the dexamethasone implant. METHODS We conducted a descriptive cost-evaluation analysis using data from Oslo University Hospital and literature to compare three different intravitreal drugs for DME: bevacizumab, aflibercept and dexamethasone. Stratification of patients into 'Naive' or 'Switch' group was based on treatment history. We estimated the costs from healthcare and 'extended' healthcare perspectives. Sensitivity analysis evaluated the impact of various parameters. RESULTS The average injections per patient per year for the Naive group (bevacizumab), Switch group (aflibercept) and dexamethasone were 9.5, 9.1 and 3.0 respectively. From a healthcare perspective, the 1-year costs for the Naive group were 15% lower (bevacizumab, €3619), and for the Switch group, 23% higher (aflibercept, €5226) compared with dexamethasone (€4252). The 'extended' healthcare perspective showed the cost per patient per year for bevacizumab remained nominally lower in the Naive group, while dexamethasone remained lower for the Switch group (€5116 for dexamethasone, compared to €4987 for bevacizumab and €6537 for aflibercept). CONCLUSIONS From a primary healthcare perspective, the dexamethasone as a first-line DME treatment may increase economic costs in settings where bevacizumab is used off-label. Treating resistant DMEwith dexamethasone may reduce the costs and treatment burden compared with switching to aflibercept.
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Affiliation(s)
- Silvia NW Hertzberg
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Morten Carstens Moe
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Beáta Éva Petrovski
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Emily Burger
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway,Center for Health Decision ScienceHarvard T. H. Chan School of Public HealthBostonMAUSA
| | - Goran Petrovski
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
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Sudmann TM, Brækhus A, Jørstad ØK. Helsekravene til førerkort – på riktig vei med ny teknologi. Tidsskriftet 2022; 142:22-0607. [DOI: 10.4045/tidsskr.22.0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Faraj S, Bathen ME, Galeckas A, Myrold A, Stene-Johansen I, Jørstad ØK, Moe MC. Retinal injuries in seven teenage boys from the same handheld laser. Am J Ophthalmol Case Rep 2022; 27:101596. [PMID: 35664446 PMCID: PMC9156801 DOI: 10.1016/j.ajoc.2022.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 10/27/2022] Open
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Sverstad A, Torheim EA, Jørstad ØK. A Multi-Lumen Glaucoma Stent With Titratable Pressure-Lowering Effect: A Proof of Concept Study. Transl Vis Sci Technol 2022; 11:20. [PMID: 36149647 PMCID: PMC9520513 DOI: 10.1167/tvst.11.9.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the feasibility of a glaucoma stent with a titratable pressure-lowering effect. Methods This was an in vitro study. We created a resin stent with a micro-precision three-dimensional printer. It represented a cylinder with one primary and two secondary lumina. The inner opening of each secondary lumen was sealed with a membrane. We used a surgical eye model to simulate implantation of the stent and a laser procedure analogous to argon laser trabeculoplasty (ALT) to ablate each membrane. To study the fluid dynamics, we used a high-precision syringe pump and measured the steady-state pressure for one, two, and three lumina in parallel at flow rates of 2.5, 5.0, and 10.0 µL/min. Results The stent could be implanted into the eye model and visualized in the anterior chamber angle. Coloring the membrane facilitated laser membranotomy, and a 0.1-second laser pulse with 250-mW power was enough to ablate one membrane. The steady-state pressure for one lumen increased linearly with increasing flow rate, in accordance with the Hagen–Poiseuille equation. Two and three lumina in parallel decreased the pressure by factors of 2.1 and 3.2, respectively, in accordance with the electronic–hydraulic analogy and Ohm's law applied to parallel resistors. Conclusions The study presents proof of concept for a glaucoma stent with multiple lumina, which can be separately opened with an ALT-like procedure to induce a predictable, stepwise increase in pressure-lowering effect. Translational Relevance The glaucoma stent in this experimental study can be reproduced in a biocompatible material and further studied in vivo.
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Affiliation(s)
- Alexander Sverstad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | | | - Øystein Kalsnes Jørstad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
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12
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Eriksen KO, Wigers AR, Wedding IM, Erichsen AK, Barøy T, Søberg K, Jørstad ØK. A novel homozygous variant in the SPG7 gene presenting with childhood optic nerve atrophy. Am J Ophthalmol Case Rep 2022; 26:101400. [PMID: 35243150 PMCID: PMC8861420 DOI: 10.1016/j.ajoc.2022.101400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe a case of hereditary spastic ataxia (HSP) presenting with childhood optic nerve atrophy and report a novel homozygous variant in the SPG7 gene. Observations A 57-year-old man suffering from progressive optic nerve atrophy since childhood eventually underwent genetic testing. A targeted whole exome gene sequencing panel for optic neuropathy identified a novel homozygous variant in the SPG7 gene, c.2T > G, p.(Met?), which likely abolished production of paraplegin, an inner mitochondrial membrane protein. Subsequent neurologic examination revealed subtle signs of spastic paraplegia and ataxia in keeping with the genetic diagnosis of SPG7. Conclusion and importance Spastic paraplegia 7 (SPG7) is an autosomal recessive form of the neurodegenerative disorder HSP. Pure HSP is characterized by spastic paraparesis in the lower limbs, whereas complicated HSP presents additional neurological manifestations. This case report adds to the evidence that SPG7 can present with childhood optic nerve atrophy, preceding the characteristic SPG7 manifestations. SPG7 should be considered in the workup of suspected hereditary optic neuropathy. Spastic paraplegia 7 (SPG7) may present with childhood optic nerve atrophy. In this case we identified a likely pathogenic, homozygous variant in the SPG7 gene: c.2T > G, p.(Met1?). Workup for suspected hereditary optic neuropathy should include testing for SPG7.
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Affiliation(s)
- Kathrine O. Eriksen
- Department of Ophthalmology, Oslo University Hospital, Norway
- Corresponding author. Department of ophthalmology, Oslo University Hospital, Postboks 4950 Nydalen, 0424, OSLO, Norway.
| | | | | | | | - Tuva Barøy
- Department of Medical Genetics, Oslo University Hospital, Norway
| | | | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Norway
- Faculty of Medicine, University of Oslo, Norway
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Blom K, Bragadóttir R, Sivertsen MS, Moe MC, Jørstad ØK. Mask use by patients in the context of COVID-19 can increase the risk of postinjection endophthalmitis. Acta Ophthalmol 2022; 100:e859-e860. [PMID: 34155818 PMCID: PMC8444794 DOI: 10.1111/aos.14945] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Kathrine Blom
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | | | - Morten Carstens Moe
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
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14
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Jørstad ØK, Jonsdottir TE, Ødegaard EM. Forskjellsbehandling av en- og toøyde i førerkortregelverket. Tidsskr Nor Laegeforen 2022; 142:22-0031. [PMID: 35239269 DOI: 10.4045/tidsskr.22.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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15
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Sudmann TM, Jonsdottir TE, Rowe FJ, Jørstad ØK. National application of the European visual field standards for driving: a survey study. BMJ Open Ophthalmol 2022; 7:e000904. [PMID: 35295687 PMCID: PMC8867315 DOI: 10.1136/bmjophth-2021-000904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/28/2022] [Indexed: 11/03/2022] Open
Abstract
AimsTo provide an overview of how the European visual field standards for driving (specified in Commission Directive 2009/113/EC) are applied and determine whether individuals with visual field defects are treated equally across Europe.MethodsOne ophthalmic expert from each of 32 European countries was invited to participate in an electronic survey. They were presented with threshold and Esterman perimetry results of 15 cases of visual field defects and asked to classify each case as either passed or failed in reference to their national standards. The results were compared with the European Driving Test Group 1 (EDT1), which is a new perimetry algorithm that adheres to the recommendations by the Eyesight Working Group. Fleiss’ kappa was used to determine the inter-rater agreement.ResultsTwenty-five countries responded. Three of 15 cases were passed by all. Full agreement on a failed case was not reached. Denmark graded most leniently and passed 12 cases. Bulgaria, Romania and Slovakia graded most strictly and passed five cases. The Fleiss’ kappa score was 0.52 (95% CI 0.49 to 0.55). Only Slovenia was in full agreement with the EDT1. Fifteen countries endorsed specific perimetric tests for assessing fitness to drive. Five of these also defined pass/fail criteria.ConclusionThe directive fails to establish a uniform approach to the visual field requirements, as evident by moderate pass/fail agreement between the national experts. Because the visual standards for driving are enforced differently, identical visual field loss can result in either revocation or approval of a driving license.
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Affiliation(s)
| | | | - Fiona J Rowe
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Jacobsen HH, Jørstad ØK, Moe MC, Petrovski G, Pripp AH, Sandell T, Eide PK. Noninvasive Estimation of Pulsatile and Static Intracranial Pressure by Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:31. [PMID: 35050344 PMCID: PMC8787623 DOI: 10.1167/tvst.11.1.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the ability of optical coherence tomography (OCT) to noninvasively estimate pulsatile and static intracranial pressure (ICP). Methods An OCT examination was performed in patients who underwent continuous overnight monitoring of the pulsatile and static ICP for diagnostic purpose. We included two patient groups, patients with idiopathic intracranial hypertension (IIH; n = 20) and patients with no verified cerebrospinal fluid disturbances (reference; n = 12). Several OCT parameters were acquired using spectral-domain OCT (RS-3000 Advance; NIDEK, Singapore). The ICP measurements were obtained using a parenchymal sensor (Codman ICP MicroSensor; Johnson & Johnson, Raynham, MA, USA). The pulsatile ICP was determined as the mean ICP wave amplitude (MWA), and the static ICP was determined as the mean ICP. Results The peripapillary Bruch's membrane angle (pBA) and the optic nerve head height (ONHH) differed between the IIH and reference groups and correlated with both MWA and mean ICP. Both OCT parameters predicted elevated MWA. Area under the curve and cutoffs were 0.82 (95% confidence interval [CI], 0.66–0.98) and -0.65° (sensitivity/specificity; 0.75/0.92) for pBA and 0.84 (95% CI, 0.70–0.99) and 405 µm (0.88/0.67) for ONHH. Adjusting for age and body mass index resulted in nonsignificant predictive values for mean ICP, whereas the predictive value for MWA remained significant. Conclusions This study provides evidence that the OCT parameters pBA and ONHH noninvasively can predict elevated pulsatile ICP, represented by the MWA. Translational Relevance OCT shows promise as a method for noninvasive estimation of ICP.
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Affiliation(s)
- Henrik Holvin Jacobsen
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten C Moe
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Ophthalmology, University of Split School of Medicine, Split, Croatia
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Tiril Sandell
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Department of Ophthalmology, Vestre Viken Hospital, Drammen, Norway
| | - Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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17
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Jørstad ØK, Kongsrud A, Kinge B, Fossen K, Basit S, Forsaa VA, Moe MC, Haugen OH. Choosing Wisely: recommendations from the Norwegian Ophthalmological Society. Acta Ophthalmol 2021; 100:716. [PMID: 34904382 DOI: 10.1111/aos.15080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Anne Kongsrud
- Department of Ophthalmology Drammen Hospital Drammen Norway
| | | | - Kristian Fossen
- Department of Ophthalmology University Hospital of North Norway Tromsø Norway
| | - Sammy Basit
- Visus Ophthalmologist Centre Trondheim Norway
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18
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Husum YS, Moe MC, Bragadóttir R, Jørstad ØK. Switching to aflibercept versus continuing bevacizumab for treatment-resistant neovascular age-related macular degeneration: a one-year comparative observational study. Acta Ophthalmol 2021; 99:e1354-e1359. [PMID: 33638291 DOI: 10.1111/aos.14825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE To compare outcomes of a treatment algorithm that allows for switching treatment-resistant neovascular age-related macular degeneration (nAMD) eyes to aflibercept with continuing bevacizumab. METHODS Retrospective study of nAMD patients who initiated treatment in 2012 (aflibercept unavailable) and 2018 (aflibercept available). Eyes were included in the case of residual macular fluid after a minimum of 4 monthly bevacizumab injections. Only eyes in the 2018 group could then switch to aflibercept. RESULTS The study included 40 eyes from 2012 and 88 eyes from 2018. Patient characteristics were similar across the groups at baseline and 4 months. In 2018, 59 eyes (67%) were switched to aflibercept after 4 months. Mean change in BCVA from 4 months to one year was +2.8 letters in 2018 versus -1.7 letters in 2012 (p = 0.043). Mean change in BCVA from baseline to one year was +9.4 letters in 2018 (p < 0.001) and +4.4 letters in 2012 (p = 0.073). Mean change in CRT from 4 months to one year was -36 µm in 2018 versus -23 µm in 2012 (p = 0.373). Mean change in CRT from baseline to one year was -100 µm in 2018 (p < 0.001) and -75 µm in 2012 (p < 0.001). Mean number of injections given in one year was 11.8 in 2018 versus 10.4 in 2012 (p < 0.001). After one year, a majority of eyes in both groups still received treatment at 4-week intervals. CONCLUSION The study suggests that the possibility of switching eyes with treatment-resistant nAMD to aflibercept leads to a modest visual benefit compared with continuing first-line bevacizumab therapy.
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Affiliation(s)
| | - Morten Carstens Moe
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute for Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
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19
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Jørstad ØK, Wigers AR, Marthinsen PB, Evang JA, Moe MC. The Value of Macular Optical Coherence Tomography in Watchful Waiting of Suprasellar Masses: A 2-Year Observational Study. J Neuroophthalmol 2021; 41:e516-e522. [PMID: 33252889 DOI: 10.1097/wno.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A possible benefit of optical coherence tomography (OCT) in the approach to tumors involving the optic chiasm may be the ability to foresee visual deterioration. This study investigated the value of OCT in watchful waiting for compressive optic neuropathy as the primary management of suprasellar masses. METHODS The research was conducted as a 2-year observational study of a patient cohort with conservatively managed mass lesions involving the optic chiasm on MRI. Threshold perimetry and macular OCT were performed at baseline and each follow-up examination. Univariate Cox regression was used to determine the effect of baseline and longitudinal covariates upon development of visual field (VF) loss compatible with chiasmal dysfunction. RESULTS Nineteen eyes of 19 patients were included. The optic chiasm-tumor relationship on baseline MRI was abutment in 6 cases and compression in 13 cases. Seven eyes developed VF loss. None of the baseline covariates were predictors of VF loss. The longitudinal decrease in mean macular ganglion cell complex (mGCC) thickness on OCT was 2.5 μm/yr for eyes that developed VF loss and 0.2 μm/yr for eyes that did not develop VF loss (P = 0.02). The hazard ratio for VF loss per 1-μm/yr decrease in mGCC thickness was 1.30 (95% confidence interval [CI] 1.04-1.62; P = 0.02) for the inferior nasal quadrant and 1.45 (95% CI 1.02-2.07; P = 0.04) for the inferior temporal quadrant. CONCLUSIONS OCT offers a valuable complement to perimetry in monitoring for compressive optic neuropathy. Longitudinal mGCC thinning can anticipate VF loss.
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Affiliation(s)
- Øystein Kalsnes Jørstad
- Departement of Ophthalmology (ØKJ, ARW, MCM), Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine (ØKJ, MCM), Faculty of Medicine, University of Oslo, Oslo, Norway ; The Integrative Pituitary Team (ØKJ, ARW, PBM, JAE), Oslo University Hospital, Oslo, Norway ; Section of Neuroradiology (PBM), Oslo University Hospital, Oslo, Norway ; and Section of Specialized Endocrinology (JAE), Oslo University Hospital, Oslo, Norway
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20
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Jørstad ØK, Jonsdottir TE, Zysset S, Rowe FJ. A traffic perimetry test that adheres to the European visual field requirements for group 2 drivers. Acta Ophthalmol 2021; 99:e1253-e1254. [PMID: 33421353 DOI: 10.1111/aos.14742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | | | | | - Fiona J. Rowe
- Faculty of Health and Life Sciences University of Liverpool Liverpool UK
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21
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Sivertsen MS, Lode HE, Gjølberg TT, Petrovski G, Andersen JT, Jørstad ØK, Moe MC. Cluster of symptomatic silicone oil droplets following intravitreal injections: a 1-year observational study. BMJ Open Ophthalmol 2021; 6:e000764. [PMID: 34485702 PMCID: PMC8378358 DOI: 10.1136/bmjophth-2021-000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To describe a cluster of symptomatic intravitreal silicone oil (SiO) droplets following intravitreal injections (IVIs) and assess the effect of switching to a SiO-free syringe. Methods and analysis Observational quality registry study of patients receiving IVI at a large Norwegian ophthalmology centre between April 2018 (start of cluster) and November 2019 (1 year after switching to SiO-free syringes). At onset, anti-vascular endothelial growth factor drugs were administered using SiO-containing insulin syringes. From November 2018, SiO-free syringes were implemented. Spontaneously reported symptomatic SiO cases were confirmed by slit-lamp examination. A follow-up interview was performed after 1 year, assessing visual complaints. The prevalence of non-symptomatic cases was assessed in a sample of 50 eyes from 50 consecutive IVI patients. Results Among 13 429 IVIs, 50 eyes of 46 patients (29 women) with symptomatic intravitreal SiO droplets were identified. Forty-one patients reported floaters at regular appointments, whereas five patients contacted the department regarding symptoms between scheduled appointments. After 1 year, 34 patients (79%) still experienced floaters, 21 (49%) reported reduced symptoms and 3 (7%) reported worsened symptoms. Eighteen patients (42%) reported being bothered, and eight (18.6%) reported that their lives were negatively affected by the floaters. Among 50 non-symptomatic eyes that had received IVI during the same period, intravitreal SiO was found in 34 (68%). No cases of symptomatic intravitreal SiO droplets were identified after switching to SiO-free syringes. Conclusion Symptomatic intravitreal SiO following IVI can cause significant and prolonged distress for affected patients. It can be avoided by using SiO-free syringes.
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Affiliation(s)
| | - Heidrun Elisabeth Lode
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Immunology, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, University of Oslo, Oslo, Norway
| | - Torleif Tollefsrud Gjølberg
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Immunology, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Jan Terje Andersen
- Department of Immunology, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, University of Oslo, Oslo, Norway
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22
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Eidet JR, Akopian M, Olstad OK, Jørstad ØK, Moe MC, Petrovski G, Pepaj M. The acute phase response protein SERPINA3 is increased in tear fluid from the unaffected eyes of patients with unilateral acute anterior uveitis. J Ophthalmic Inflamm Infect 2021; 11:19. [PMID: 34212267 PMCID: PMC8249488 DOI: 10.1186/s12348-021-00249-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To identify candidate tear fluid biomarkers in patients with unilateral acute anterior uveitis (AAU) that can aid in the differentiation between these patients and patients with bacterial keratitis or healthy controls. METHODS Thirteen patients (40.1 ± 16.2 years of age) with unilateral AAU, seven patients with unilateral bacterial keratitis (40.2 ± 15.3 years of age), and 14 healthy subjects (41.1 ± 11.6 years of age) were included. The tear proteome of affected eyes was compared with that of the unaffected eye or healthy controls. Proteins were identified by liquid chromatography tandem mass spectrometry and enzyme-linked immunosorbent assay. RESULTS Relative protein ratios were detected and calculated for 272 unique proteins. Compared with healthy controls and the unaffected eye, the top upregulated proteins in AAU eyes were submaxillary gland androgen regulated protein 3B (SMR3B) and SMR3A. Similarly, the top upregulated proteins in bacterial keratitis were S100 calcium-binding protein A9 and orosomucoid 2. The acute phase response protein Serpin Family A Member 3 (SERPINA3) was increased in the healthy eye of AAU patients (P = 0.019) compared with healthy controls. Laser flare measurements in affected eyes of AAU patients showed positive logarithmic correlation with SERPINA3 in tear samples of the unaffected eye (P = 0.022). The use of SERPINA3 as a tear biomarker yielded a sensitivity of 85% and a specificity of 71% in detecting patients with AAU in the study population. CONCLUSIONS The acute phase response protein SERPINA3 was increased in tear samples of unaffected eyes of patients with unilateral AAU compared with healthy controls. This study highlights SERPINA3 as a potential biomarker for AAU. Future research should explore the dynamic properties of SERPINA3 in the tear fluid of active and quiescent uveitis eyes.
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Affiliation(s)
- Jon Roger Eidet
- Department of Ophthalmology, Center for Eye Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
| | - Maja Akopian
- Department of Ophthalmology, Center for Eye Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ole K Olstad
- Department of Medical Biochemistry, Blood Cell Research Group, Section for Research, Oslo University Hospital, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Center for Eye Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Morten C Moe
- Department of Ophthalmology, Center for Eye Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Center for Eye Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Milaim Pepaj
- Department of Medical Biochemistry, Hormone Laboratory, Oslo University Hospital, Oslo, Norway
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23
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Pihl-Jensen G, Ødegaard EM, Skogen K, Jørstad ØK, Holmøy T. A woman in her forties with unilateral blurred vision and pain upon eye movement. Tidsskr Nor Laegeforen 2021; 141:20-0932. [PMID: 34107654 DOI: 10.4045/tidsskr.20.0932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Toxoplasmosis is a relatively common cause of infectious papillitis and neuroretinitis, which may affect both immunocompetent and immunodeficient patients. CASE PRESENTATION A previously healthy woman in her mid-forties presented with subacute onset of unilateral blurred vision and retrobulbar pain exacerbated by eye movements. Ophthalmological assessment revealed decimal best-corrected visual acuity of 0.75, an ipsilateral swollen disc and a peripapillary infiltrate. Serology indicated acute infection with Toxoplasma gondii. Cerebral MRI showed a periventricular lesion, and oligoclonal bands were detected in the cerebrospinal fluid. INTERPRETATION This case illustrates that even when symptoms, MRI and cerebrospinal fluid findings suggest demyelinating disease, differential diagnoses must be considered in order to mitigate the negative therapeutic and prognostic consequences of a misdiagnosis.
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24
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Jørstad ØK, Jonsdottir TE, Zysset S, Rowe F. A traffic perimetry test that adheres to the European visual field requirements. Acta Ophthalmol 2021; 99:e555-e561. [PMID: 32996716 DOI: 10.1111/aos.14633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/11/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE European visual requirements for driving generally follow the standards of the European Union (EU), but the lack of a uniform perimetry algorithm leads to differing practices in enforcing visual field regulations. The purpose of this study was to develop a perimetry algorithm for group 1 driving licenses (car and motorcycle) that adheres to the European requirements. METHODS We determined the features of a traffic perimetry algorithm complying with the EU directive 2009/113/EC and the underlying scientific report by the Eyesight Working Group. The final algorithm was a binocular, supra-threshold test with 37 central and 86 peripheral test points within 140º x 40º. It was created as a custom test for an Octopus 900 perimeter and tested on participants with known visual field defects. Findings were compared with the Esterman program in reference to British and Norwegian regulations, which both recommend the Esterman program for assessing fitness to drive but differ in definition of negative and positive results. RESULTS Twenty-five participants were examined. In comparison with the traffic perimetry algorithm, sensitivity and specificity of the British regulations were 0.78 (95% confidence interval (CI) 0.40-0.97) and 1.00 (95% CI 0.79-1.00). Similarly, sensitivity and specificity of the Norwegian regulations were 0.89 (95% CI 0.52-1.00) and 0.81 (95% CI 0.54-0.96). CONCLUSION The lack of a perimetry algorithm that conforms to the scientific recommendations challenges the fundamental right of European drivers for legal equality. This study demonstrates a binocular supra-threshold test that adheres to the European visual field requirements for group 1 driving licenses.
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Affiliation(s)
- Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | | | | | - Fiona Rowe
- Faculty of Health and Life Sciences University of Liverpool Liverpool UK
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25
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Husum YS, Skogen K, Brandal P, Rønning PA, Wigers AR, Evang JA, Jørstad ØK. Bilateral calcification of the optic nerve sheath: A diagnostic dilemma. Am J Ophthalmol Case Rep 2021; 22:101106. [PMID: 33997471 PMCID: PMC8102398 DOI: 10.1016/j.ajoc.2021.101106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/13/2021] [Accepted: 04/11/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To present a case of symptomatic optic nerve sheath calcification and highlight clues and pitfalls for the final diagnosis: bilateral optic nerve sheath meningioma. Observations A 48-year-old man presented with painless vision loss in his left eye and findings consistent with left optic nerve atrophy. Magnetic resonance imaging (MRI) displayed thinning of the left optic nerve without contrast-enhancement or evidence of compressive lesions. A supplementary computed tomography angiography (CTA) exposed scattered dural calcification, which included the optic nerves. This was regarded as an incidental finding. The initial diagnosis was ischemic optic neuropathy. Over the next two years, the vision loss in the left eye progressed. A CT of the orbits revealed extensive calcification surrounding both optic nerves. A second MRI was unchanged in comparison to the first MRI. The diagnosis was changed to idiopathic duro-optic calcification. The vision in the left eye further declined over another two years. Consecutive optical coherence tomography measurements of the peripapillary retinal nerve fiber layer suggested bilateral progressive thinning. A third MRI displayed progression of tubular contrast-enhancement surrounding the optic nerves. On the basis of this finding, the patient was finally diagnosed with a bilateral optic nerve sheath meningioma and received external beam radiotherapy. Conclusion and importance It is crucial to differentiate an optic nerve sheath meningioma from idiopathic calcification of the optic nerve. In the present case the initial MRI did not detect optic nerve sheath abnormalities. To better demonstrate characteristic calcification, additional CT imaging should be considered when a bilateral optic nerve sheath meningioma is suspected.
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Affiliation(s)
| | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Norway.,Institute for Cancer Genetics and Informatics, Oslo University Hospital, Norway
| | | | | | - Johan Arild Evang
- Section of Specialized Endocrinology, Oslo University Hospital, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Norway.,Faculty of Medicine, University of Oslo, Norway
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Holmøy T, Jørstad ØK. The first Norwegian doctorate in multiple sclerosis. Tidsskr Nor Laegeforen 2021; 141:20-0993. [PMID: 33754679 DOI: 10.4045/tidsskr.20.0993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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27
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Eriksen E, Jørstad ØK. Transient smartphone blindness. Tidsskr Nor Laegeforen 2021; 141:20-0972. [PMID: 33754676 DOI: 10.4045/tidsskr.20.0972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The aetiology of transient monocular vision loss is not necessarily thromboembolic, and careful history-taking is crucial in making the correct diagnosis. CASE PRESENTATION A previously healthy woman in her thirties was referred to our outpatient stroke clinic on suspicion of recurring amaurosis fugax in her right eye. The ophthalmic and neurologic examinations were normal. A review of the medical history revealed that her symptoms occurred in connection with using her smartphone in bed, typically while lying on her left side with the left eye covered by the pillow. When standing up from the bed again with the lights turned off in the bedroom, she noticed vision loss in her right eye. INTERPRETATION We concluded that the patient had experienced transient smartphone blindness. This phenomenon can occur when monocularly using a smartphone under scotopic lighting conditions; only the occluded eye adapts to darkness, and the other eye is perceived to be blind if looking away from the bright smartphone screen.
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Jørstad ØK, Sivertsen MS, Andersen JT, Moe MC. Can vials of COVID-19 vaccine be used more effectively? Tidsskr Nor Laegeforen 2021; 140:20-1039. [PMID: 33528143 DOI: 10.4045/tidsskr.20.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Jørstad ØK, Steffensen LA, Eriksen K, Bragadóttir R, Moe MC. Thirteen years of intravitreal anti-vascular endothelial growth factor therapy: the promises and burdens of a paradigm shift told from the perspective of the largest retina service in Norway. Acta Ophthalmol 2020; 98:774-779. [PMID: 31264363 DOI: 10.1111/aos.14177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To describe the first 13 years of anti-vascular endothelial growth factor (anti-VEGF) therapy from the perspective of a public ophthalmic department serving a local community of almost one million people. METHODS Retrospective registry study. Data from Oslo University Hospital, Norway were collected from 2006 through 2018. Hospital episode statistics were searched for episodes of care encompassing intravitreal anti-VEGF procedures. Patient-specific ID numbers, diagnoses, and drug codes were registered. In general, bevacizumab was used as first-line treatment, with aflibercept reserved for resistant cases from 2013. RESULTS The number of unique patients treated per year increased from 130 in 2006 to 3428 in 2018. In 2018, 2488 (73%) patients had also received treatment the previous year. The number of yearly injections increased from 228 in 2006 to 25 570 in 2018. In 2018 the diagnosis macular degeneration constituted 69% of injections, diabetic retinopathy constituted 15%, retinal vein occlusion constituted 13%, and other diagnoses constituted 3%. In the same year 49% of injections were with bevacizumab, 46% with aflibercept, 4% with ranibizumab, and 1% with dexamethasone implants. The bevacizumab to aflibercept ratio was almost 1:1 for macular degeneration and diabetic retinopathy; for retinal vein occlusion the ratio was 13:7. CONCLUSION In 13 years there was an approximately 100-fold increase in the number of yearly intravitreal injections. A majority of patients received long-term treatment. Macular degeneration was the most common diagnosis. Using bevacizumab as first-line treatment, with aflibercept reserved for resistant cases from 2013, eventually resulted in a nearly 1:1 ratio in drug usage.
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Affiliation(s)
- Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Norway
- Faculty of Medicine University of Oslo Norway
| | | | - Ketil Eriksen
- Department of Ophthalmology Oslo University Hospital Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology Oslo University Hospital Norway
- Faculty of Medicine University of Oslo Norway
| | - Morten Carstens Moe
- Department of Ophthalmology Oslo University Hospital Norway
- Faculty of Medicine University of Oslo Norway
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Jacobsen HH, Sandell T, Jørstad ØK, Moe MC, Ringstad G, Eide PK. In Vivo Evidence for Impaired Glymphatic Function in the Visual Pathway of Patients With Normal Pressure Hydrocephalus. Invest Ophthalmol Vis Sci 2020; 61:24. [PMID: 33201186 PMCID: PMC7683855 DOI: 10.1167/iovs.61.13.24] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Impaired ability to remove toxic metabolites from central nervous system may be an important link between cerebral and ophthalmic degenerative diseases. The aim of the present study was to compare the glymphatic function in the visual pathway in patients with idiopathic normal pressure hydrocephalus (iNPH), a neurodegenerative dementia subtype, with a reference group. Methods We compared 31 subjects with Definite iNPH (i.e., shunt-responsive) with 13 references in a prospective and observational study. After intrathecal injection of the magnetic contrast agent gadobutrol (Gadovist, 0.5 mL, 1.0 mmol/mL, Bayer Pharma AG), serving as a tracer, consecutive magnetic resonance imaging (MRI) scans were obtained (next 24-48 hours). The normalized MRI T1 signal recorded in the cerebrospinal fluid (CSF) and along the visual pathway served as a semi-quantitative measure of tracer enrichment. Gadobutrol does not penetrate the blood-brain barrier and is thus confined to the extravascular space. Overnight measurements of pulsatile intracranial pressure were used as a surrogate marker for the intracranial compliance. Results The tracer enriched the prechiasmatic cistern similarly in both groups, but clearance was delayed in the iNPH group. Moreover, both delayed enrichment and clearance of the tracer were observed in the visual pathway in the iNPH subjects. The enrichment in the visual pathway and the CSF correlated. Individuals with elevated pulsatile intracranial pressure showed reduced enrichment within the visual pathway. Conclusions There was delayed enrichment and clearance of a tracer in the visual pathway of iNPH patients, which suggests impaired glymphatic function in the visual pathway in this disease.
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Affiliation(s)
- Henrik Holvin Jacobsen
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tiril Sandell
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Vestre Viken Hospital, Drammen, Norway
| | | | - Morten C Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Ringstad
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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31
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Blom K, Bragadóttir R, Sivertsen MS, Moe MC, Jørstad ØK. Does Pharmaceutical Compounding of Vascular Endothelial Growth Factor Inhibitors for Intravitreal Use Alter the Risk of Post-injection Endophthalmitis? Ocul Immunol Inflamm 2020; 30:713-716. [DOI: 10.1080/09273948.2020.1820530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kathrine Blom
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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32
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Eidet JR, Jørstad ØK, Fostad IG, Olstad OK, Sørland RØ, Moe MC, Petrovski G, Pepaj M. Unilateral acute anterior uveitis is associated with ipsilateral changes in the tear fluid proteome that involves the LXR/RXR pathway. J Ophthalmic Inflamm Infect 2020; 10:13. [PMID: 32458144 PMCID: PMC7250997 DOI: 10.1186/s12348-020-00204-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 05/03/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To determine whether unilateral acute anterior uveitis (AAU) induces ipsilateral changes in the tear fluid proteome. METHODS Five patients (25-77 years old) with unilateral AAU were included. Tear fluid samples were obtained using Schirmer's test strips. The healthy eye served as control. Proteins were identified by liquid chromatography tandem mass spectrometry. RESULTS Two hundred forty-two tear fluid sample proteins were identified, of which 75 were present in at least three patients. Nine proteins were at least 1.5-fold increased, whereas eight were at least 1.5-fold decreased in tears from the diseased eye compared with the healthy eye. APOBEC3A was significantly increased (1.43-fold; P = 0.04), whereas TGM2 was significantly decreased (- 1.21-fold; P = 0.03) in tears from the diseased eye relative to the healthy eye. Ingenuity Pathway Analysis identified LXR/RXR (P < 1.02E-4) as a top canonical pathway. CONCLUSION Unilateral AAU induced detectable changes in the ipsilateral tear fluid proteome and involvement of the inflammation-associated LXR/RXR pathway.
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Affiliation(s)
- Jon Roger Eidet
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway.
| | - Øystein Kalsnes Jørstad
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Ida G Fostad
- Faculty of Dentistry, Department of Oral Biology, University of Oslo, Oslo, Norway
| | - Ole K Olstad
- Blood Cell Research Group, Section for Research, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Ø Sørland
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Morten C Moe
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Milaim Pepaj
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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33
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Kristiansen IS, Haugli Bråten R, Jørstad ØK, Moe MC, Sæther EM. Intravitreal therapy for retinal diseases in Norway 2011-2015. Acta Ophthalmol 2020; 98:279-285. [PMID: 31587508 DOI: 10.1111/aos.14262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/06/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE During the past decade, intravitreally administered biologic drugs have advanced the treatment of retinal diseases, such as wet age-related macular degeneration (AMD), diabetic macular oedema and retinal venous occlusions. The drugs as well as the necessary disease management imply considerable economic burden on healthcare systems. This Norwegian study documents the rates of use of intravitreal therapies and intercounty variation over a 5-year period. METHODS We collected data from the Norwegian Patient Register for all episodes of care encompassing intravitreal therapy during the period 2011-2015. For each episode, we received information on patient age, sex, county of residence, diagnosis and name of drug injected. RESULTS During the study period, 21 277 patients had in total 236 857 episodes of care. The number of intravitreal injections doubled from 2011 to 2015, reaching 63 601 injections in 2015, of which 77% were for diagnosed wet AMD. In 2015, the age-adjusted number of episodes varied from 19 to 55 per 1000 population aged 50+ across Norway's 19 counties. The age-adjusted number of patients treated per 1000 population aged 50+ varied from 5.22 to 8.35. CONCLUSION The use of intravitreal injections increased rapidly with wet AMD as the most frequent diagnosis and with varying utilization across Norway's 19 counties. The causes of the varying use of intravitreal therapies could not be established but may reflect variation in disease prevalence, treatment capacity, travel distance to the nearest ophthalmic service and lack of national treatment guidelines. The geographic variation in utilization may challenge policy goals of equitable care and warrants further studies.
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Affiliation(s)
- Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics Institute of Health and Medicine University of Oslo Oslo Norway
- Oslo Economics Oslo Norway
| | | | - Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Morten Carstens Moe
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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34
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Jørstad ØK, Moe MC, Eriksen K, Petrovski G, Bragadóttir R. Coronavirus disease 2019 (COVID-19) outbreak at the Department of Ophthalmology, Oslo University Hospital, Norway. Acta Ophthalmol 2020; 98:e388-e389. [PMID: 32227668 DOI: 10.1111/aos.14426] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of clinical medicine Faculty of medicine University of Oslo Oslo Norway
| | - Morten Carstens Moe
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of clinical medicine Faculty of medicine University of Oslo Oslo Norway
| | - Ketil Eriksen
- Department of Ophthalmology Oslo University Hospital Oslo Norway
| | - Goran Petrovski
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of clinical medicine Faculty of medicine University of Oslo Oslo Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of clinical medicine Faculty of medicine University of Oslo Oslo Norway
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35
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Jonsdottir TE, Ødegaard EM, Jørstad ØK. Synstest må tilpasses førerkortkravene. Tidsskriftet 2020; 140:20-0777. [DOI: 10.4045/tidsskr.20.0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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36
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Eriksen KO, Jørstad ØK. Multiple Vitelliform Lesions as a Retinal Manifestation of Alport Syndrome. Case Rep Ophthalmol 2020; 11:79-84. [PMID: 32231557 PMCID: PMC7098359 DOI: 10.1159/000505948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022] Open
Abstract
Alport syndrome is associated with various ocular phenotypic features, including several retinal manifestations. The purpose of this case report was to describe a case of multiple vitelliform lesions in Alport syndrome. This particular finding has, to our knowledge, not been reported previously. A 63-year-old man with known Alport syndrome presented with symptomatic, bilateral anterior lenticonus. Fundoscopic examination revealed multiple vitelliform lesions, which were symmetrically distributed at the posterior poles. Additional retinal findings included an irregular foveal contour and central macular thinning in both eyes, as well as a multilayered retinoschisis in the left eye. The underlying pathophysiology of the vitelliform lesions may be a dysfunctional Bruch's membrane.
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Affiliation(s)
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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37
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Bro T, Derebecka M, Jørstad ØK, Grzybowski A. Off-label use of bevacizumab for wet age-related macular degeneration in Europe. Graefes Arch Clin Exp Ophthalmol 2019; 258:503-511. [PMID: 31889214 DOI: 10.1007/s00417-019-04569-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/27/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To analyse current off-label use of bevacizumab for wet age-related macular degeneration (AMD) in Europe. METHODS The study was conducted as a combined survey and literature review. It included the 22 most populous countries in Europe. In each country, ophthalmologists with particular knowledge about off-label treatment responded to a questionnaire. RESULTS Answers were obtained from twenty European countries. The off-label use of bevacizumab for wet AMD greatly differed between nations; the bevacizumab proportion varied from non-existent (0%) to very high (97%). There were also large disparities within single countries (e.g. 0-80%), which were attributable to differences in regional decision-making. Both governmental institutions and national ophthalmological societies expressed highly diverging opinions on the use of off-label treatment. Intravitreal administration of bevacizumab had been a matter of legal dispute in several countries. The question about responsibility for off-label therapy mainly remained unanswered. CONCLUSIONS There was a highly varying utilization of bevacizumab between European countries. Despite an intention of a consistent approach to medical regulations, Europe has not yet reached a professional or political consensus on the ophthalmic off-label use of bevacizumab.
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Affiliation(s)
- Tomas Bro
- Futurum, the Academy for Health and Care in Region Jönköping, Jönköping, Sweden. .,Ögonmottagningen, Höglandssjukhuset, 575 81, Eksjö, Sweden.
| | | | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
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38
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Jacobsen HH, Ringstad G, Jørstad ØK, Moe MC, Sandell T, Eide PK. The Human Visual Pathway Communicates Directly With the Subarachnoid Space. Invest Ophthalmol Vis Sci 2019; 60:2773-2780. [PMID: 31247084 DOI: 10.1167/iovs.19-26997] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Explore in vivo whether there is direct communication between the cerebrospinal fluid (CSF) and extravascular compartment of human visual pathway structures. Methods A prospective and observational study included 10 subjects who underwent intrathecal gadolinium-enhanced magnetic resonance imaging (MRI) for suspected CSF circulation disorder, but with a negative result and with no known ophthalmic diseases. After precontrast T1-weighted MRI, 0.5 mL of gadobutrol (Gadovist, 1.0 mmol/mL) was injected intrathecally. Gadobutrol distributes in the extravascular space, and served as a CSF tracer. Consecutive MRI scans were obtained throughout 24 to 48 hours. To assess gadobutrol contrast enrichment, regions of interest (ROIs) were placed at multiple locations along the visual pathway, from the primary visual cortex to the eye's vitreous body. CSF tracer dependent T1 signal was measured in each ROI. A linear mixed-model was used for statistical analyses. Results CSF tracer enrichment was found within the optic nerve, optic chiasm, optic tract, and primary visual cortex (P < 0.001). Peak tracer enrichment in the visual pathway generally occurred after 24 hours and was preceded by peak enhancement in the prechiasmatic cistern after 4 to 6 hours. Conclusions The results indicate direct communication between CSF of subarachnoid space and the extravascular space of the human visual pathway. Extravascular entry of the CSF tracer is a prerequisite for a glymphatic system, the present findings may suggest its presence. The existence of a glymphatic system in the human visual pathway could bring novel perspectives on the pathophysiology and treatment of ophthalmic diseases.
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Affiliation(s)
- Henrik Holvin Jacobsen
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Ringstad
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten C Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tiril Sandell
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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39
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Jørstad ØK, Wigers AR, Marthinsen PB, Evang JA, Moe MC. Could optical coherence tomography add to the history of the pituitary incidentaloma? Acta Ophthalmol 2019; 97:e1157-e1158. [PMID: 31184420 DOI: 10.1111/aos.14151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Jelin E, Wisløff T, Jørstad ØK, Heiberg T, Moe MC. Patient-reported outcome measures in the management of neovascular age-related macular degeneration: a 1-year prospective study. BMJ Open Ophthalmol 2019; 4:e000353. [PMID: 31673632 PMCID: PMC6797267 DOI: 10.1136/bmjophth-2019-000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/03/2019] [Accepted: 09/14/2019] [Indexed: 11/04/2022] Open
Abstract
Objective To prospectively explore the following patient-reported outcome measures (PROMs) in the management of neovascular age-related macular degeneration (nAMD): (1) self-reported visual function, (2) symptom-state, (3) general-health and (4) satisfaction of treatment. Methods and analysis Corresponding to the four PROMs, participants responded to the following questionnaires: (1) National Eye Institute Visual-Functioning-Questionnaire (NEI-VFQ-25), (2) Patient-Acceptable-Symptom-Status (PASS 5), (3) EuroQol-Group-Questionnaire (EQ-5D-3L) and (4) Dimensions of Importance in Treatment of nAMD (DITAMD). Data were collected at baseline and after 3, 6 and 12 months of intravitreal antivascular endothelial growth factor treatment. Results were evaluated with t-tests and mixed linear regression analyses. Results The study included 197 patients. At baseline NEI-VFQ-25 (79.53±14.52) and EQ-5D (0.74±0.28) had relatively high scores, whereas PASS 5 was below 'acceptable' (3.30±0.80). At 12 months NEI-VFQ-25 and PASS 5 showed significant improvement, whereas EQ-5D and DITAMD remained unchanged. At baseline patients receiving treatment of the better-seeing eye (BSE) (n=52) reported significantly worse NEI-VFQ-25 and PASS 5 than patients for whom treatment only involved the worse-seeing eye (WSE), (n=145). In contrast to BSE patients, there was no improvement of NEI-VFQ-25 for WSE patients at 12 months, despite a significant improvement in best-corrected visual acuity (BCVA). Two independent variables, treatment including the BSE and BCVA for the treated eye, were found to predict both NEI-VFQ-25 and PASS 5. Conclusion After 12 months of nAMD treatment, there was a significant improvement in PASS 5 and NEI-VFQ-25, the latter depending on whether therapy included BSE. EQ-5D and DITAMD remained unaltered.
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Affiliation(s)
- Elma Jelin
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health and Society, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Turid Heiberg
- Regional Research Support, Oslo University Hospital, Oslo, Norway.,Østfold University College, Halden, Norway
| | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abstract
PURPOSE To study the incidence, aetiology, pathogenic causes, treatment and visual outcomes of endophthalmitis (EO) at the Department of Ophthalmology, Oslo University Hospital (OUS), Norway. METHODS Retrospective registry study. Medical records of all EO patients treated at OUS over a 2-year period were reviewed. RESULTS The study identified 46 EO eyes of 44 patients; 19 eyes had postcataract surgery EO (PCE), and 6 eyes had postinjection EO (PIE). Of 4778 primary cataract surgeries performed at OUS, there was one PCE (incidence 0.21 per 1000; 95% CI 0.04-1.19 per 1000). Of 38 134 intravitreal injections performed at OUS, there were 3 PIE (incidence 0.08 per 1000; 95% CI 0.03-0.23 per 1000). Among 15 751 cataract surgeries performed at other ophthalmic centres in Oslo and Akershus County (OOC), there were 15 PCE (incidence 0.95 per 1000; 95% CI 0.58-1.57 per 1000). Of 3000 intravitreal injections performed at OOC, there was one PIE (incidence 0.33 per 1000; 95% CI 0.059-1.89 per 1000). For neither PCE nor PIE, there were significant differences in odds ratios between OUS and OOC. The odds ratio for PCE versus PIE was, however, 8.0 (95% CI 2.7-24.0; p < 0.001). Cultures were positive in 35 of 46 eyes (76%). The most common pathogen was Staphylococcus epidermidis. Twenty-two eyes (48%) achieved a clinically significant improvement in visual function (≥0.3 logMAR) following treatment. CONCLUSION The overall risk of PCE and PIE was low. It was, however, higher for PCE than PIE, probably reflecting the relative difference in invasiveness between the procedures.
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Affiliation(s)
- Kathrine Blom
- Department of Ophthalmology Oslo University Hospital Oslo Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- University of Oslo Oslo Norway
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- University of Oslo Oslo Norway
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Innerdal C, Ekstrand JR, Wankel VD, Jørstad ØK. Visual field requirements for driving in Europe: the risk of inaccurate interpretation of visual field findings when using the binocular Esterman programme. Acta Ophthalmol 2019; 97:e939-e941. [PMID: 30801982 DOI: 10.1111/aos.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Cato Innerdal
- Municipality of Molde Molde Norway
- The Norwegian Directorate of Health Oslo Norway
| | | | - Vibeke Dons Wankel
- Private Ophthalmic Practice Moss Norway
- Working Group on Driving and Vision Standards Norwegian Ophthalmological Society Oslo Norway
| | - Øystein Kalsnes Jørstad
- Working Group on Driving and Vision Standards Norwegian Ophthalmological Society Oslo Norway
- Departement of Ophthalmology Oslo University Hospital and University of Oslo Oslo Norway
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43
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Eidet JR, Biernat D, Dahlberg D, Wiedmann MKH, Jørstad ØK. Foster Kennedy Syndrome. Tidsskr Nor Laegeforen 2019; 139:18-0719. [PMID: 31238653 DOI: 10.4045/tidsskr.18.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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44
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Wankel VD, Bondø G, Jørstad ØK. Wankel og medarbeidere svarer. Tidsskriftet 2019; 139:18-0951. [DOI: 10.4045/tidsskr.18.0951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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45
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Jørstad ØK, Wigers AR, Marthinsen PB, Moe MC, Evang JA. Loss of horizontal macular ganglion cell complex asymmetry: an optical coherence tomography indicator of chiasmal compression. BMJ Open Ophthalmol 2018; 3:e000195. [PMID: 30519642 PMCID: PMC6243475 DOI: 10.1136/bmjophth-2018-000195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To estimate the macular ganglion cell complex (GCC) asymmetry in patients with suprasellar tumours, to compare its diagnostic performance to the nasal GCC thickness and visual field (VF) and to investigate how the parameters correlate with magnetic resonance imaging (MRI) findings. Methods and analysis Cross-sectional study of patients with suprasellar tumours affecting the optic chiasm. Macular optical coherence tomography (OCT) scans were evaluated for nasal GCC sector thinning and loss of normal GCC asymmetry between corresponding nasal-temporal sectors. Equivalently, VFs were analysed for defects compatible with chiasm dysfunction. The relationship between optic chiasm and tumour was measured on MRI. Results Thirty-three eyes of 33 patients were included. There were OCT findings in 14 eyes. Nasal GCC thinning was found in 9 eyes and loss of GCC asymmetry in 12 eyes; the two parameters were not significantly different with respect to number of positive findings (p=0.45). Loss of GCC asymmetry, however, occurred in 5 eyes among 24 without GCC thinning (proportion 0.21; 95% confidence interval 0.071 to 0.42). In 8 eyes, VF indicated pathology; of these, 7 had concurring OCT findings. The prevalence of OCT and VF findings increased significantly with suprasellar tumour extension on MRI. Conclusion The diagnostic capabilities of nasal GCC thinning and loss of GCC asymmetry were comparable, whilst their complementary performances increased the proportion of eyes in which OCT suggested compression. The prevalence of both OCT and VF findings grew with suprasellar tumour extension. In several cases, however, structural findings on OCT preceded detectable VF deficits.
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Affiliation(s)
| | - Andreas Reidar Wigers
- Department of Ophthalmology, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | | | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | - Johan Arild Evang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway
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Ødegaard EM, Jørstad ØK, Kerty E. En tenåring med akutt bilateralt synstap. Tidsskriftet 2018; 138:17-0802. [DOI: 10.4045/tidsskr.17.0802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Wankel VD, Bondø G, Jørstad ØK. Synskravene til førerkort. Tidsskriftet 2018; 138:18-0559. [DOI: 10.4045/tidsskr.18.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Jørstad ØK, Faber RT, Moe MC. Two-year functional and anatomical results after converting treatment resistant eyes with exudative age-related macular degeneration to aflibercept in accordance with a treat and extend protocol. Acta Ophthalmol 2017; 95:460-463. [PMID: 28556485 DOI: 10.1111/aos.13480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 04/23/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE To study the effects of converting to aflibercept in accordance with a treat and extend (T&E) strategy in eyes with treatment resistant exudative age-related macular degeneration (AMD). METHODS Two-year prospective study of eyes with exudative AMD and persistent macular fluid despite monthly treatment with ranibizumab or bevacizumab. Eyes were converted to 2.0 mg aflibercept in accordance with a T&E protocol. RESULTS Fifty eyes from 47 patients were included. At baseline, the mean central retinal thickness (CRT) was 273 μm and mean best-corrected visual acuity (BCVA) 0.25 logarithm of the minimal angle of resolution (logMAR). The mean number of aflibercept injections the first year was 9.2. After 1 year, there was a reduction in mean CRT to 228 μm (p < 0.001); 22 eyes (44%) had a dry macula; and the mean BCVA was 0.24 logMAR (p = 0.531). The mean number of aflibercept injections the second year was 8.0 (p = 0.013 compared to first year). After 2 years, 24 eyes (48%) received treatment more frequently than every eighth week. The mean CRT was 225 μm (p < 0.001 compared to baseline); 31 eyes (62%) had a dry macula; and mean BCVA was 0.32 logMAR (p = 0.005 compared to baseline). Five eyes did not complete 2 years of aflibercept treatment after failing to improve. CONCLUSION A majority of eyes showed improved anatomic outcomes. There was a small decrease in mean BCVA after the second year of treatment. About half of the eyes required treatment more frequently than the recommended aflibercept label of an 8-week interval.
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Affiliation(s)
| | - Rowan Thomas Faber
- Department of Ophthalmology; Oslo University Hospital and University of Oslo; Oslo Norway
| | - Morten Carstens Moe
- Department of Ophthalmology; Oslo University Hospital and University of Oslo; Oslo Norway
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Tazmini K, Meling TR, Skattør TH, Jørstad ØK, Jørgensen AP. A woman in her 50s with chronic fatigue syndrome, sepsis and hyponatraemia. Tidsskr Nor Laegeforen 2017; 137:372-377. [PMID: 28272569 DOI: 10.4045/tidsskr.16.0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Kiarash Tazmini
- Medisinsk avdeling Diakonhjemmet Sykehus og Oslo universitetssykehus, Ullevål
| | | | - Thor Håkon Skattør
- Øyeavdelingen Seksjon for radiologi Oslo universitetssykehus, Rikshospitalet
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Sand MK, Stubhaug TT, Jørstad ØK. Atypisk optikusnevritt. Tidsskriftet 2017; 137:731. [DOI: 10.4045/tidsskr.16.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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