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Worldwide, the incidence rate of myopia is maintained in a high level. Especially, the morbidity is rising continuously among children and adolescents. The progression of myopia affects visual acuity, vision related quality of life and productivity. Moreover, high myopia and its related ocular complications also aggravate the family and social burden. Therefore, the mechanism of myopia, related complications and methods of myopia prevention and control need further exploration. International Myopia Institute(IMI)published the second-edition white papers in April 2021. These white papers included reflections on the implications for clinical practice, the impact of myopia, the risk factors of myopia, the relationship among accommodation and binocular vision with myopia, pathologic myopia, prevention of myopia and digest. Comparing to the first edition, more than thousands of articles and conference abstracts were considered in white papers II, highlighting the latest research and progress related to myopia prevention and control. This article briefly summarizes and interprets the contents of the above white papers, including overview of myopia, impact of myopia, risk factors in myopia, ocular changes in the progress of myopia, and myopia prevention and control, hoping to provide advice for the clinical and scientific research work relating to myopia prevention and control.

Sihem Lazreg,1 Mohamed Hosny,2 Muhammad A Ahad,3 Mazen M Sinjab,4 Riadh Messaoud,5 Shady T Awwad,6 Antoine Rousseau7 1Ophthalmology Cabinet, Blida, Algeria; 2Refractive and Cornea Service, Cairo University Hospitals, Cairo, Egypt; 3Department of Ophthalmology, Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 4Dr Sulaiman Al Habib Hospital, DHCC, Dubai, United Arab Emirates; 5Department of Ophthalmology, Tahar SFAR University Hospital, Mahdia, Tunisia; 6Department of Ophthalmology, American University of Beirut - Medical Center, Beirut, Lebanon; 7Department of Ophthalmology, Bicêtre Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, FranceCorrespondence: Antoine Rousseau, Pierre Testas Building, Bicêtre Hospital, 78 Rue du Général Leclerc, Le Kremlin-Bicêtre, 94270, France, Tel +33145213690, Email arousseau1010@gmail.comAbstract: In the Middle East and Northern Africa (MENA), dry eye disease (DED) is often misdiagnosed or overlooked. This review summarizes a series of conversations with ophthalmologists in the region around a variety of climatic, lifestyle, and iatrogenic factors that contribute to specific features of DED in the MENA region. These considerations are further classified by patient lifestyle and surgical choices. All statements are based on discussions and formal voting to achieve consensus over three meetings. Overall, a deeper understanding of the disease characteristics of DED specific to MENA can better guide local eyecare practitioners on appropriate management and follow-up care. Additionally, population-based studies and patient and physician education on ocular surface diseases, together with the use of culturally appropriate and language-specific questionnaires can help ease the public health burden of DED in this region.Keywords: ocular surface, regional clinical practice, epidemiology, treatment, patient outcomes

Purpose: To study cases of hardware-associated secondary acquired lacrimal duct obstructions (SALDO) and the role of computed tomography dacryocystography (CT-DCG) scans in its diagnosis and management. Observations: Retrospective, interventional case review of four patients diagnosed as Hardware-associated SALDO, with primary maxillofacial repair performed elsewhere, were analyzed. The mean age was 36.5 years (range: 22–74 years), three of them being males. Left and right lacrimal systems were equally involved. Epiphora, swelling and discharge were the main presenting features. Three lacrimal sacs and nasolacrimal ducts on CT-DCG showed the screws of the orbital fracture plate directly piercing their walls, whereas a single case showed the sac displaced and pierced by the medial side of the orbital floor implant. Two cases underwent dacryocystorhinostomy with intubation, and the remaining two had to undergo dacryocystectomy due to extensive damage. Post-operatively all four cases were doing well at a mean follow-up of 2 months. Conclusions: The present series highlights the role of CT-DCG in delineating spatial relationship of lacrimal drainage system with the surrounding structures, facilitating planning as well as choice of surgery, and anticipating the intraoperative challenges. It also signifies importance of interdisciplinary coordination between oculoplastic and maxillofacial surgeons to avoid iatrogenic trauma to the lacrimal drainage system.

Purpose: To study the emerging trend of development of secondary acquired nasolacrimal duct obstruction (SALDO) in the cases treated for rhino-orbito-cerebral mucormycosis (ROCM). Observations: Prospective, interventional case series of five patients who developed SALDO post-surgical and medical management of ROCM. The mean age was 45.4 years (range: 40–62 years), all five being males. Right lacrimal drainage pathways was involved slightly more than the left (right:left = 3:2). Epiphora and discharge were the main presenting features. All five patients were treated with extensive debridement of the nose, sinuses, orbit and cerebral involvement as needed followed by medical management for ROCM. CT- Dacryocystography for all 5 patients showed obstruction at the lower end of the nasolacrimal duct. The patients underwent external dacryocystorhinostomy with mitomycin-C with or without intubation with good anatomical and functional outcomes at 6 months follow-up. Conclusions and importance: The present series highlights the possible etiology of development of SALDO in cases treated for ROCM, its management and discusses the role of Computed Tomography Dacryocystography (CT-DCG) in understanding the pathophysiology of the development of SALDO along with delineating the spatial relationship of the lacrimal drainage system with the surrounding structures.

AIM: To analyze research hotspots and trends of artificial intelligence in diabetic retinopathy(DR)based on bibliometrics and high-impact papers.METHODS: Papers on artificial intelligence in DR research published in the Web of Science Core Collection(WoSCC)from January 1, 2012, to December 31, 2022 were retrieved. The data was analyzed by CiteSpace software to examine annual publication number, countries, institutions, source journal, research categories, keywords, and to perform an in-depth analysis of high-impact papers.RESULTS: A total of 1 009 papers on artificial intelligence in DR from 79 countries were included in the study, with 272 papers published in 2022. Notably, China and India contributed 287 and 234 papers, respectively. The United Kingdom exhibited a centrality score of 0.31, while the United States boasted an impressive H-index of 48. Three prominent institutions in the United Kingdom(University of London, Moorfields Eye Hospital, and University College London)and one institution in Egypt(Egyptian Knowledge Bank)all achieved a notable H-index of 14. The primary academic disciplines associated with this research field encompassed ophthalmology, computer science, and artificial intelligence. Burst keywords in the years 2021～2022 included transfer learning, vessel segmentation, and convolutional neural networks.CONCLUSION: China emerged as the leading contributor in terms of publication number in this field, while the United States stood out as a key player. Notably, Egyptian Knowledge Bank and University of London assumed leading roles among research institutions. Additionally, IEEE Access was identified as the most active journal within this domain. The research focus in the field of artificial intelligence in DR has transitioned from AI applications in disease detection and grading to a more concentrated exploration of AI-assisted diagnostic systems. Transfer learning, vessel segmentation, and convolutional neural networks hold substantial promise for widespread applications in this field.

Manoj Motwani Cornea Revolution/Motwani LASIK Institute, San Diego, CA, 92121, USACorrespondence: Manoj Motwani, Cornea Revolution/Motwani LASIK Institute, 9710 Scranton Road, Suite 170, San Diego, CA, 92121, USA, Tel +1 858 554-0008, Email drmmlj@gmail.com

Majid Moshirfar,1–3 Joshua S Theis,4 David S Cha,5 Kaiden B Porter,4 Carter J Payne,1,6 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, University of Utah, School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA; 5Saint Louis University, School of Medicine, Saint Louis, MO, USA; 6Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USACorrespondence: Majid Moshirfar, Hoopes Vision Research Center, 11820 S. State St. #200, Draper, UT, 84020, USA, Tel +1 801 568 – 0200, Fax +1 415-476-0336, Email cornea2020@me.com

At present there is no curriculum to guide physician lifelong learning in a prescribed, deliberate manner. The Conjoint Committee on Continuing Medical Education, a group representing 16 major stakeholder organizations in continuing medical education, recommends that each specialty society and corresponding board reach consensus on the competencies expected of physicians in that specialty. Experts in a specialty will define content-based core competencies in the areas of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. These competencies, when cross-referenced with expertise, comprise a framework for specialty curricula and board maintenance of certification programs. The American Academy of Ophthalmology and the American Board of Ophthalmology already have implemented this recommendation. Their work is reported as a model for further development. A competency-based curriculum framework offers a foundation for continuing medical education in diverse practice settings and provider organizations.

Miki Uchino,1 Motoko Kawashima,1 Minako Kaido,1 Kazuhisa Suwaki,2 Yuichi Uchino,1 Ichiro Kawachi,3 Kazuno Negishi,1 Kazuo Tsubota1 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, 2Santen Pharmaceutical Co., Ltd, Osaka, Japan; 3Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA Purpose: To validate a paper-based visual acuity (PBVA) questionnaire.Methods: In 2015, a cross-sectional survey was conducted among 301 young and middle-aged, mostly male, Japanese subjects. The participants were asked to self-rate their visual acuity (VA) on a scale from 1 to 5. Self-ratings of VA were categorized into three groups: good (1 and 2), normal (3), and poor (4 and 5). For objective validation, we performed a functional VA (FVA) assessment in the same subjects.Results: A total of 301 subjects answered the PBVA and completed the FVA test including initial VA. We found out that the result of PBVA was significantly correlated with FVA test and initial VA (r=0.33, P

Eytan Nov,1 Elad Moisseiev1,2 1Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelCorrespondence: Elad Moisseiev Department of OphthalmologyMeir Medical Center, 59 Tshernichovsky Street, Kfar Saba 4428164, IsraelTel +97297471527Fax +97297472427Email elad_moi@netvision.net.ilPurpose: To analyze the top 100 most-cited papers on pars intravitreal injections.Methods: Literature search using the bibliographic databases of the ISI Web of Knowledge for all types of publications on intravitreal injections published between 1965 and 2019 in peer-reviewed journals.Results: Eighty-three of the top 100 papers on intravitreal injections were published in ophthalmology journals, their majority in the top five Q1 leading journals in the field. They originated from 16 different countries, predominantly from the USA (n=52), and were all published in English. These manuscripts cover a wide spectrum of topics but were mostly focused on retinal diseases (n=60) and the use of anti-VEGF or steroid agents (n=75).Discussion: This bibliographic study provides a unique perspective on the evolution and assimilation of intravitreal injections, from their introduction, through their present role as the most common therapeutic procedure in ophthalmology, to future developments.Keywords: bibliography, citation, historical, intravitreal injection

As the field of ophthalmology has evolved in the last several decades, so has the gender distribution of ophthalmologists. We conducted a narrative review to further characterise the status of women in the realm of publication, presentations, editorial positions, grants, academic promotion, and financial compensation. While the proportion of women publishing, presenting, and filling academic and editorial roles has increased over time, it still does not match that of men. Women are more likely to be first authors instead of senior authors, have lower average h‐indices, and are awarded fewer grants. The magnitude of some of these differences is smaller when adjusted for women's shorter career duration on average. Despite increased representation of women in ophthalmology, women continue to receive less compensation for the same work. This review highlights that more can be done to improve gender parity in ophthalmology. [ABSTRACT FROM AUTHOR]

AIM:To investigate the effect of case-based learning(CBL)teaching combination with paper review method in the teaching of ophthalmology residents.METHODS: The study was conducted from 2015 to 2016. The residents in Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital were included in the research. During the year of 2015, the traditional lecture-based learning(LBL)method was applied(as a control group). During the year of 2016, the CBL teaching combination with paper review teaching method was applied(as an experimental group). At the end of the course, exams and questionnaires were conducted to evaluate the teaching effect of two different methods. The exams consisted of theoretical and operational assessment. The teaching satisfactions, learning interests, scientific research interests and clinical abilities were included in the questionnaires. The data was analyzed by SPSS 16.0. RESULTS: The results of final exams indicated that the scores of the experimental group(88.2±6.5)were higher than the control group(75.6±6.0). The difference showed statistically significant(t=6.68, Pχ2=8.84, Pχ2=6.29, Pχ2=4.54, Pχ2=4.25, PPCONCLUSION: CBL teaching combination with paper review teaching method is beneficial to improve the teaching effect, and it is also beneficial to train residents' clinical skills and research abilities.

The 100 most-cited papers on age-related macular degeneration (AMD) were analysed using a bibliographic study. The bibliographic databases of the Institute for Scientific Information Web of Knowledge were searched, limited to research articles published between 1965 and 2020 in peer-reviewed journals. The papers were ranked in order of number of citations since publication. Five of the top 10 (and 3 of the top 4) papers reported randomised clinical trial results for either anti-vascular endothelial growth factor agents or nutritional supplements. Four of the top 10 papers reported genotype-phenotype associations between AMD and variants in Complement Factor H. This bibliographic study provides perspective and insight into many of the most influential contributions in the understanding and management of AMD and its evolution over time.

AIM: To investigate the published papers of ophthalmology in past ten years and explore the development of ophthalmology. RESULTS: The number of ophthalmology papers increased from 7450 to 9089 during 2007 to 2017. The average rate increased 2.2% annually. USA accounts for one thirds of the total and two thirds of the highly cited papers. In Asia, China, Japan and South Korea were in Top 10 by the number of ophthalmology papers. UK, Germany, Japan and Australia also had great impact in global ophthalmology. The hot spots included endothelial growth factor, optical coherence tomography and open-angle glaucoma. CONCLUSION: USA is in the leading position in global ophthalmology. Part of Asian countries play an important role in the development of ophthalmology, but the impact needs to be improved.

AIM: To identify the 100 most cited papers in cataract surgery, we performed a comprehensive bibliometric analysis basing on the literature search on the Thomson Reuters Web of Knowledge. METHODS: The number of citations, including the total citations, latest 5y citations and average citation number per year (ACY), authorship, year of publication, major topics, journal of publication, country and institution of origin of each paper were recorded and then analyzed. Pearson’s correlation analysis was conducted to evaluate the correlation between the published year and the number of citations. The correlation between journal’s impact factor (IF) and number of citations was assessed as well. RESULTS: The most cited paper was the classic paper done by the European Society of Cataract & Refractive Surgeons (ESCRS) group. This paper focused on the topic of endophthalmitis. Not only the most cited papers originated from the USA, but also some American institutions like Johns Hopkins University, Harvard Medical School, etc. had the most citations. Pearson’s correlation analysis indicated that the latest 5y citations and ACY were significantly related with the published year (5y citations: r=0.615, P

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Clinicians adopt varying strategies for antisepsis with PI, which to this day remains efficient, economical and effective. Clinicians should prudently consider effective PI application, and we thank Koerner and Grzybowski for encouraging debate and raising the profile of this issue.

Purpose: Conventionally, keratoconus (KC) has been considered a noninflammatory corneal ectatic disorder. Recent evidence suggests a possible role of inflammation in the pathogenesis of KC. Hence, we analyzed the levels of inflammatory factors in the tear fluid of Indian KC patients. Methods: Tear fluid samples were collected from age- and sex-matched healthy controls and KC patients (with different grades). The levels of the inflammatory factors in tears were analyzed using cytometric bead array (Human Soluble Protein Flex Set System, BD Biosciences) for levels of interleukin-1α (IL-1α), IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-9, IL-10, IL-12p70, IL-23p40, IL-13, IL-17A, IL-17F, IL-21, interferon-α (IFNα), IFNγ, tumor necrosis factor-α, CCL2/monocyte chemotactic protein-1, CCL4/macrophage inflammatory protein-1β (MIP-1β), MIP-1α, CCL5/RANTES, CXCL10/IP10, ICAM1, CD62E, vascular endothelial growth factor and transforming growth factor β. Results: An increase in Kmax and Kmean, and a decrease in central corneal thickness was observed with increasing grades of KC. Tear analysis showed that most of the tear soluble factors, including cytokines, chemokines, growth factors and cell adhesion molecules were significantly elevated in the KC patients compared to the controls. Conclusion: Our findings suggest that inflammatory factors associated with KC may play a role in its pathogenesis. This opens the potential to explore anti-inflammatory strategies to either halt or delay the progression of KC.

PURPOSE: To report the response of choroidal neovascularization (CNV) to intravitreal ranibizumab treatment in the setting of age-related macular degeneration (AMD) with extensive pre-existing geographic atrophy (GA) and a revision paper. METHODS: This is a revision paper and a retrospective case series of 10 eyes in nine consecutive patients from a photographic database. The patients were actively treated with ranibizumab for neovascular AMD with extensive pre-existing GA. Patients were included if they had GA at or adjacent to the foveal center that was present before the development of CNV. The best corrected visual acuity and optical coherence tomography (OCT) analysis of the central macular thickness were recorded for each visit. Serial injections of ranibizumab were administered until there was resolution of any subretinal fluid clinically or on OCT. Data over the entire follow-up period were analyzed for overall visual and OCT changes. All patients had been followed for at least 2 years since diagnosis. RESULTS: The patients received an average of 6 ± 3 intravitreal injections over the treatment period. Eight eyes had reduced retinal thickening on OCT. On average, the central macular thickness was reduced by 94 ± 101 µm. Eight eyes had improvement of one or more lines of vision, where as one eye had dramatic vision loss and one had no change. The average treatment outcome for all patients was -0.07 ± 4.25 logMAR units, which corresponded to a gain of 0.6 ± 4.4 lines of Snellen acuity. The treatment resulted in a good anatomic response with the disappearance of the subretinal fluid, improved visual acuity, and stabilized final visual results. CONCLUSION: The results of this case series suggest that the use of an intravitreal anti-vascular endothelial growth factor (VEGF) agent (ranibizumab) for CNV in AMD with extensive pre-existing GA is effective. Our results are not as striking as published results from large-scale trials of anti-VEGF therapy for subfoveal CNV, presumably due to the limitation in the baseline visual acuity caused by the underlying GA. The good anatomic response with the disappearance of the subretinal fluid, improved visual acuity, and stabilized final visual results were consistent with other ranibizumab studies.

Purpose: The Covid-19 pandemic has significantly impacted world healthcare, with ophthalmology being one of the most severely affected area. The study aims to perform a bibliometric analysis of global literature published on "Ophthalmic Manifestations of Covid-19" to explore the scientific productivity and trends in research in this field. Methods: Bibliometric methods have been used to analyze global literature on this topic using quantitatively and qualitatively indices from the Scopus database up to 20th September 2021. The keywords related to "Covid-19" and "ophthalmology" are used in search strategy through the boolean operator. Primary data were exported in CSV and BibTxt file format for further analysis using different software. The literature on "Ophthalmic Manifestations of Covid-19" was assessed using a variety of metrics. Results: A total of 3453 publications were published on "Ophthalmic Manifestations of Covid-19", which received 32935 citations, averaging 9.54 citations per paper. Of the total publications, 557 received external funding support and registered 10802 citations. The U.S.A. and India published the most significant number of papers among countries. The U.S.A. and U.K. occupied the top position in international collaborative publications. Medicine and Neurosciences were the most productive areas. The Indian Journal of Ophthalmology is the most productive source. A total of 46 high-cited papers have been identified on this topic, which are published in 35 journals, with the U.S.A. contributing the most papers. Conclusion: In this study, the bibliometric assessment presents a quantitative and qualitative matrix of research in the field "Ophthalmic Manifestations of Covid-19". The study gives proof of the enhanced global collaboration that global researchers have created in order to combat the epidemic. The authors have used various bibliometric metrics and tools to present this study efficiently. This study will be helpful for the scholars who were researching in this field. [ABSTRACT FROM AUTHOR]

Steven J Lichtenstein1, David B Granet21Associate Clinical Professor of Pediatrics and Surgery, University of Illinois College of Medicine at Peoria and Chicago, Peoria, IL, USA, 2Anne F. Ratner Professor of Ophthalmology and Pediatrics, University of California at San Diego, San Diego, CA, USAIn a recent issue of Clinical Ophthalmology, Friedlaender and Protzko (2007) review the development and efficacy of 1% azithromycin in DuraSite® (AzaSite™, Inspire Pharmaceuticals, Inc., Durham, NC) for the treatment of bacterial conjunctivitis. The authors conclude that 1% azithromycin in DuraSite offers a simplified dosing regimen with sustained bactericidal levels that decrease resistance development. While 1% azithromycin in DuraSite is a new formulation of azithromycin that allows topical ocular use, azithromycin and DuraSite have been around for many years. Evidence demonstrates a greater potential for emerging resistance with azithromycin, an older drug, especially when formulated in a vehicle that prolongs low levels of antibiotic exposure over time. Mitchell H Friedlaender1, Eugene Protzko21Division of Ophthalmology, Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla, CA, 92037 USA; 2Seidenberg Protzko Eye Associates, 930 Revolution St, Havre De Grace, MD, 21014 USAIn our review of the development and efficacy of 1% azithromycin in DuraSite® (AzaSite™, InSite Vision, Alameda, CA, USA) published in Clinical Ophthalmology (Friedlaender and Protzko 2007), we describe azithromycin as a well known anti-infective agent with pharmacokinetic properties that were not sufficiently exploited for topical use in the eye until the development of AzaSite. A sustained release ocular antibiotic, AzaSite delivers sufficiently high concentrations of azithromycin to the eye to eradicate common causative pathogens of bacterial conjunctivitis. The means by which azithromycin is delivered to the eye in the AzaSite formulation gives it much greater tissue concentrations than expected.

Writing a scientific article requires proper planning and a methodical approach. This article provides practical tips to organize the materials before writing, and discusses how to approach the writing of different parts of an article; that is, introduction, materials and methods, results, and discussion. It also provides guidelines on authorship, citing references, selecting photographs, tables and legends, and finally on style, grammar and syntax.

AIM: To explore the effectiveness of the self-monitoring for changes in vision with paper vision chart under the guidance of chronic disease self-management program(CDSMP).METHODS: A total of 74 teenagers with myopia were randomly divided into the experimental group and the control group. The patients of the experimental group self-monitored their vision with paper vision chart according to the CDSMP. The patients of the control group were provided with education on tips to keep eyes healthy. All patients were followed up once every 3 months, and their myopia diopter was measured 2 years later.RESULTS: There was no statistically significant difference in average diopter between the experimental group and the control group before research(P>0.05). However, after the research, there was statistically significant difference in average diopter(PPCONCLUSION: The vision self-monitoring with paper vision chart according to CDSMP can control the progress of myopia in teenagers.

Problems with indoor husbandry and immunological challenges are some of the stressors that broilers may face which can affect production. Infectious diseases can compound the effects of excessive concentrations of ammonia causing respiratory and ocular inflammation and increased lacrimal production in broiler chickens. The objectives of this investigation were to establish normal values of tear production in chicks and compare the practicality of the different methods. Palpebral fissure length (PFL) and tear production were evaluated in Cobb 500 chicks at 5 d old and then at 5 d of age by the following methods: modified Schirmer's test I (mSTT1), phenol red cotton thread tear test (PRCTTT), and standardized endodontic absorbent paper point test (EAPPTT). Ten chicks at the age of 5 and 42 d were evaluated for each method. In addition, at 42 d, when the palpebral fissure permitted, a regular-sized Schirmer tear test I (STT1) was performed in another group of 10 chickens. Overall, PFL and the secretion of the aqueous phase of the tear film increased with age. Mean mSTT1 results were 5.00 ± 1.83 mm and 10.45 ± 2.58 mm for 5- and 42-d-old chicks, respectively. Mean PRCTTT results were 12.37 ± 1.80 mm and 25.58 ± 4.8 mm for 5- and 42-d-old chicks, respectively. Mean EAPPTT results were 7.13 ± 0.72 mm and 12.03 ± 0.92 mm for 5- and 42-d-old chicks, respectively. Mean STT1 for 42-d-old chicks was 11.40 ± 2.60 mm. Results obtained with endodontic paper points showed the lowest coefficient of variation and investigators found the test easier to perform. These values reported for broilers at different ages may be applied in poultry ophthalmology to help the diagnosis of lacrimal production disorders and to detect early disease symptoms that could cause economic losses in poultry production. [ABSTRACT FROM AUTHOR]

Pier E Gallenga1, Lucio Lobefalo21University Eye Clinic, G.D’Annunzio University, Chieti, Italy; 2Ethical Committee, Italian Ophthalmological Society – SOI, ItalyThe paper by Kocabora and coworkers (2008) underlines the message that patients treated with intravitreal triamcinolone acetonide are at risk of increased intraocular pressure (IOP) even after the clearance period of the drug. Furthermore, the development of intractable secondary glaucoma requiring surgical intervention is clear advice to monitor these patients carefully. M Selim KocaboraVatan caddesi, Vakif Gureba Egitim ve Arastirma Hastanesi, Fatih, 34 000, Istanbul, Turkey.We thank Dr. Gallenga and Dr. Lobefalo for their interest in our article (Kocabora et al 2008) and for their comments. We agree with them on the importance of pharmacovigilance and of warning the ophthalmology community about the potential risks of intravitreal triamcinolone (IVTA). We should always follow the principle of primum, non nocere in our medical practices. ...