Purpose: Aqueous humor glucose levels play a role in the anterior segment disorders’ pathophysiology, mainly in diabetics. Our purpose was to evaluate the ratio of aqueous humor glucose levels to blood glucose levels in diabetics and to evaluate the correlation between this ratio and blood glycated hemoglobin (HbA1c) levels. Methods: This prospective study was performed in Sheba Medical Center during 2016–2018. The study included type 2 diabetic patients admitted for elective cataract surgery. Blood glucose levels were measured immediately before surgery. HbA1c was obtained within 3 months preoperatively. At the beginning of surgery, 0.05–0.1 mL aqueous humor was drawn. Main outcome measures were aqueous humor glucose/blood glucose ratio and the correlation between HbA1c and aqueous humor glucose/blood glucose ratio. Results: Thirty-seven patients (mean age 75.2 ± 11.2 years) were recruited. The average aqueous humor glucose/blood glucose ratio was 0.69 ± 0.20. A significant positive correlation was found between aqueous humor and blood glucose levels, Pearson coefficient constant R = 0.63 (p < 0.01), and specifically stronger among older patients R = 0.89 (p < 0.01), females R = 0.74 (p < 0.01), patients with short-term disease (<10 years) R = 0.80 (p < 0.01), and patients treated with oral anti-diabetic treatment R = 0.74 (p < 0.01). A significant strong positive correlation was found between HbA1c levels and aqueous humor glucose/blood glucose ratio R = 0.62 (p < 0.01), and specifically stronger among older patients R = 0.82 (p < 0.01), males R = 0.70 (p < 0.01), patients with prolonged disease (⩾10 years) R = 0.540 (p < 0.05), and patients treated with oral anti-diabetic treatment R = 0.62 (p < 0.01). Conclusion: A significant strong correlation was found between aqueous humor glucose levels and blood glucose levels. Poor glycemic control was strongly correlated with an increased ratio, reflecting an increased anterior chamber’s glucose permeability. Older age group was found to have stronger correlation of poor glycemic control with this ratio.
Postoperative endophthalmitis is a severe complication which may result in loss of vision. Intracameral antibiotics have been shown to reduce the risk of this complication and are extensively used worldwide, with vancomycin, cefuroxime and moxifloxacin most commonly used. Choices in Australia are currently limited to vancomycin and cefazolin, since cefuroxime and moxifloxacin are not available. Vancomycin has been safely and effectively used in our department for more than two decades. Recent publications have risen concerns regarding the association of haemorrhagic occlusive retinal vasculitis a potentially blinding complication with intracameral vancomycin. This concern has driven us to review the safety and efficacy of currently available antibiotics in the context of Australian practice.
Objective To assess the effect of reduced contrast sensitivity on three commonly used colour vision tests in order to establish key discrepancies that may be relevant for clinical practice. Methods A prospective non-interventional clinical study of colour vision testing using three commonly used devices: Ishihara and Hardy-Rand-Rittler (H-R-R) pseudoisocochromatic plate tests, and Farnsworth D-15 arrangement test performed under progressively reduced contrast sensitivity conditions achieved with a neutral density filter bar. Results The Pelli-Robson contrast sensitivity (PRCS) at which 5% of the population should first experience a 10% reduction in colour vision testing from baseline was calculated for each of the three colour vision devices: Farnsworth D-15 test: 1.81 log contrast sensitivity (CS), H-R-R test: 1.69 log CS, and Ishihara test: 1.34 log CS. Single factor repeated measures analyses, conducted separately at each contrast sensitivity level, revealed no difference between the colour vision testing devices at PRCS ≥1.80 log CS (P ≥ 0.367). However, in all PRCS ≤1.65 log CS, the differences were statistically significant (all P ≤ 0.004), demonstrating a significantly lower percentage of errors in the Ishihara test compared with both the Farnsworth D-15 (P < 0.023) and H-R-R (P < 0.035) tests. Conclusions At high contrast sensitivities, all colour vision tests function almost equally; however, at decreased levels of contrast sensitivity, H-R-R and Farnsworth D-15 are more greatly affected.
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