bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate impact of hyaluronic and methylcellulose artificial tears on tear film stability
Authors: WYLEGALA E , SMEDOWSKI A , TARNAWSKA D , CIESLIK T , WEGLARZ B , NOWINSKA A , DOBROWOLSKI D
Published: August 2014

Purpose To evaluate immediate impact of hyaluronic and methylcellulose artificial tears on tear film stability.

Methods We performed keratography with tear film analyze in 21 volunteers using Keratograph 4 (Oculus, Germany). After base measurement, volunteers received topical artificial tears drops containing 0.15% Sodium Hyaluronate into right eye and 0.5% Carboxyl Methylcellulose into left eye. After 15 and 30 minutes keratography measurements were repeated.

Results In keratography analyzes we observed 4 types of tear film instability, short‐time break‐up on small area or big area, long‐time break‐up on small or big area. Mean size of tear meniscus in right eyes before drops was 0.3±0.1 mm and 0.32±0.09/0.33±0.09 mm 15/30 minutes after hyaluronic drops respectively (p<0.05, Kruskal‐Wallis test). In left eyes tear meniscus size was 0.32±0.1/0.33±0.1/0.34±0.1 mm respectively before and after methylcellulose drops (p<0.05, Kruskal‐Wallis test). First and mean non‐invasive break‐up‐time in right eyes was 10.7/16.8 sec before drops and 12/18; 12/17 – 15 and 30 minutes after hyaluronic drops application (p>0.05, Kruskal‐Wallis test). In left eyes these parameters were 12/16; 13/18 and 13/17 sec respectively before and after methylcellulose drops (p>0.05, Kruskal‐Wallis test).

Conclusion Immediate impact of hyaluronic and methylcellulose artificial tears on tear film seems to be related more to increase of tear meniscus size, not to tear film break‐up time or break‐up surface. Keratograhy measurements allow for detail analyzes of tear film state, which includes not only break‐up time but also break‐up surface, which could be novel indicator for tear film stability impossible to measure in classic slit lamp.
Structure and microanalysis of tear film ferning of camel tears, human tears and refresh plus
Authors: AKHTAR S , MASMALI A , KHAN A , ALMUBRAD T
Published: August 2014

Purpose We investigated the tear ferning pattern and microelements of the tear film of camel and compare them with human tears and fresh plus eye lubricant.

Methods The tear film pattern was investigated by light and scanning electron microscope. A small drop (1μl) of tears was placed on a glass slide at 23 degrees temperature and humidity of less than 45%. When the tears were dried, they were observed under the light microscope, Olympus BX1. The dried drop was also used to take images from an environmental scanning electron microscope. The microanalysis of the elements was done by using the STEM, JEOL 1400 transmission electron microscope. The Masmali grading scale for tear ferning was used to grade the ferning patterns.

Results Light microscopy observations showed that the tear film pattern was surround by a thick peripheral homogenous layers which contained small oily droplets. The peripheral and central ferning contained very thin branches. The tear ferning at the periphery was between grades 1 to 2 whereas tear ferning pattern of the centre was between grades 0 to 1. The tear ferning pattern of human tears and fresh plus were between grades 1 to 2. The scanning electron microscope showed very tiny crystals in between the tear ferning. Edax analysis showed that mass percentage of chloride as highest in the camel tears and mass percentage of potassium was more than in the human tears but less than in the ‘Reresh plus’ lubricant.

Conclusion Our observations suggest that camel tears are better quality than human tears and ‘Refresh Plus’ lubricant. This suggests that camels may have some extra tear compositions in their eyes, which help the animal to avoid the dryness in their eyes in the dry and harsh climatic conditions.
Effects of a tear supplement containing hyaluronic acid (HA) on tear film thickness in healthy subjects
Authors: WIRTH M , SCHMIDL D , KAYA S , NAPORA K , WERKMEISTER R , GARHOFER G , SCHMETTERER L
Published: August 2014

Purpose We have recently introduced a new technique for the measurement of tear film thickness (TFT) using ultra‐high resolution optical coherence tomography (OCT) in humans. In the present study we hypothesized that the effect of a hyaluronic acid (HA) containing lubricant on TFT can be evaluated using this technique after single instillation.

Methods 16 healthy volunteers were included into the present study. The design was randomized, double‐masked and placebo controlled. Subjects randomly received in one eye HA‐containing eye drops (0.15%, Olixia®, Croma Pharma, Austria) and in the other eye NaCl 0.9%. Measurement of TFT was performed at baseline and thereafter every 10 minutes until 60 minutes after start of instillation. A repeated measures ANOVA model was employed to study statistically significant differences.

Results 8 female and 8 male subjects with a mean age of 26.8±4.8 years were included in this study. Baseline TFT was 5.0±0.5 μm in placebo and 4.8±0.5 μm in HA treated eyes. A significant effect of HA containing eyedrops on TFT was seen over time (p=0.014). 10 minutes after instillation TFT increased to 5.5±0.8 μm in the HA containing eyedrops and remained almost stable in the placebo group (5.1±0.8 μm). Post hoc analysis revealed that TFT was increased up to 30 minutes after instillation and then returned to baseline.

Conclusion The results of the present study indicate that HA containing eyedrops increase pre‐corneal TFT for as long as 30 minutes in healthy subjects. This effect is not seen with NaCl administration. Our data also indicate that measurement of TFT with ultra‐high resolution OCT is a promising technique to study residence time of eye drops at the ocular surface.
Substitutes of fetal bovine sera for the culture of human corneal limbal stem cells
Authors: IÑIGO PORTUGUÉS A , MEANA A , VÁZQUEZ N , CHACÓN M , RIESTRA ANAC , ORIVE G , ANITUA E , MERAYO‐LLOVES J
Published: August 2014

Purpose We analyze the potential use of PRGF‐Endoret® and human sera (HS) as a substitute of xenogeneic sera in corneal cell cultures.

Methods Plasma rich in growth factors (PRGF) eye drop and HS was obtained at our local blood bank from human blood of healthy donors after informed consent. Briefly PRGF was purified using the Endoret kit in Ophthalmology. HS was obtained according to standardized protocols. Limbal stem cells were obtained from explants of 2‐3mm in diameter of the limbal region of corneoscleral tissue and cultured in culture medium containing 10% PRGF‐Endoret®, HS or fetal bovine serum (FBS) for 7 days. Afterwards, cells were fixed and growth area was quantified. Immunocytochemistry for p.63, ABCG‐2 and cytokeratin was also performed in order to check their immunological markers.

Results PRGF‐Endoret®, HS and FBS, cell cultures showed a positive expression in p.63, ABCG‐2 and cytokeratin. However some differences were found between cultures, limbal stem cell cultures supplemented with PRGF‐Endoret® and HS showed a better growth area in contrast with the ones supplemented with FBS. Moreover, there was cellular growth in more of the explants cultured in PRGF‐Endoret® and HS compared to FBS supplemented cultures.

Conclusion PRGF‐Endoret® and HS seems to improve the cellular growth and, while maintaining the p63 and ABCG‐2 expression compared to FBS supplemented cultures. Therefore, PRGF‐Endoret® or HS could be used as a substitute of xenogeneic sera, not only as an allogeneic product but also as an autologous product for the culture and expansion of corneal limbal stem cells.
In vivo confocal microscopy of mucous membrane pemphigoid, a new tool for the diagnosis. Reporting 6 cases
Authors: JULIENNE R , TRONE MC , HAOUAS M , PERROT JL , LABEILLE B , GRIVET D , CINOTTI E , CAMBAZARD F , THURET G
Published: August 2014

Purpose Mucous membrane pemphigoid (MMP), previously known as cicatricial pemphigoid, is an autoimmune disease characterized by linear deposition of IgG and IgA along the epithelial basement membrane zone in direct immunofluorescence (DIF). DIF requires mucosal biopsy, which can worsen the condition by triggering an inflammatory response of the mucosa, especially the conjunctiva. We assess in vivo confocal microscopy (IVCM) for the detection of the pathognomonic basement membrane cleavage zone (BMCZ) in MMP

Methods Six patients (4 M, 2 W), suffering from ocular and/or oral MMP were tested with IVCM, using the handheld Vivascope 3000. Three patients had ocular involvement, 2 oral involvement, and 1 had both.

Results Mean age was 76 years old. Out of the 4 patients with ocular involvement, 2 patients had active conjunctivitis and 2 patients had cicatricial lesions. A BMCZ was identified in both patients with active conjunctivitis, while none was observed in those with cicatricial lesions. All 3 patients with oral involvement had desquamative gingivitis with marked BMCZ.

Conclusion IVCM is non‐invasive and reliable for the diagnosis of MMP. Conjunctival fornix biopsy is at high risk of symblepharon. These biopsies are often performed blindly as the pathological zones are barely visible clinically. IVCM enables the observation of the whole inflammatory surface of the conjunctiva and gum. To our knowledge, these are the first 2 cases of patients with conjunctival BMCZ clearly identified with IVCM.
Role of PACAP for impairment of cornea epithelial wound healing
Authors: SEKI T , NAKAMACHI T , FARKAS J , WATANABE J , IZUMI S , SHIODA S
Published: August 2014

Purpose Corneal epithelium disorder causes by infection, chemical burn, use of contact lens and eye drops like benzalkonium chrolide. Pituitary adenylate cyclase‐activating peptide, PACAP is known to have trophic effects on various tissues. PACAP also exists in eye tissues, however, the effects on corneal epithelial wound healing is still unknown. The aim of this study is to investigate the therapeutical effects of PACAP on wound healing of mouse cornea.

Methods Cornea injury was performed in adult C57BL/6 male mice. One mm in diameter wounds were created on the cornea with a biopsy punch and the epithelium was removed. PACAP or saline were dropped on the eyes in every two hours until 12 hours post injury. Photographs were taken 0 h, 12 h and 24 h post injury with fluorescein staining. We also examined immunostaining or RT‐PCR against PAC1 receptor in the corneal tissue.

Results We found that the area and perimeter of corneal injury were significantly decreased in PACAP‐treated group compared with saline‐treated group. In this time, the most effective does was 10‐11M. The expression of PAC1 receptor was detected in the corneal epithelium with RT‐PCR and immunostaining. PACAP‐induced corneal healing was inhibited by co‐administration of PAC1 receptor antagonist, PACAP 6‐38.

Conclusion These results suggest that PACAP stimulates the corneal wound healing via PAC1 receptor.
Innovative, non‐contact wide field imaging of corneal endothelium
Authors: ABERRA GUEBROU S , HE Z , GUILHEM M , PINOLI JC , GAIN P , THURET G
Published: August 2014

Purpose Wide field imaging of corneal endothelial cells remains challenging since the development of non‐contact specular microscopes that all have a narrow field of observation (approx 0.15 sqmm). Nevertheless a “back to the future” with wide field imaging will definitely help clinicians to better assess the endothelial reserve of their patients and eye bankers to better the quality of the stored corneas. Aim: to present an innovative non‐contact optical device able to provide wide field endothelial images.

Methods We developed a new imaging prototype based on an hybrid numerical‐optical process.

Results Images with a field of about 1mm2 were obtained on stored human corneas.

Conclusion Further developments are ongoing to assess the application domain of this new microscope, especially on patients. Grant: ANR2012 CORIMMO3D
Red light has the capacity to blunt corneal endothelial cell damage in situ.
Authors: NÚÑEZ ÄLVAREZ C , OLMO‐AGUADO S , MERAYO‐LLOVES J , OSBORNE NN
Published: August 2014

Purpose To cause damage to rat corneal endothelial cells in situ and determine whether exposure to red light blunts this influence.

Methods Corneal endothelial cells from one eye in anesthetised rats were damaged by placing a needle in the anterior chamber and elevating the intraocular pressure (IOP, approximately 130mm Hg) for 60 minutes in the dark. In some instances the cornea was exposed to red light (2500 lux). Rats were either killed immediately or after periods of up to 15 days. Flat mounts and transverse sections of cornea were processed for the localisation of tight junctional protein ZO‐1 and JC‐1 to monitor mitochondrial health with their degree of depolarization indicated by changes in the red to green intensity of fluorescence.

Results Raise IOP causes damage to the mosaic appearance of corneal endothelial cells clearly indicated by staining for ZO‐1. Exposure to red light during elevation of IOP reduced the amount of patchy damage to endothelial cells. Corneal endothelial cells appear green when stained with JC‐1 but after 60 minutes of raised IOP the cytoplasm of many cells appear red. Both the numbers and intensity of red endothelial cells increased in JC‐1 stained corneas exposed to red light. Three days after an insult of raised IOP, some red JC‐1 staining was present only in corneas exposed to red light.

Conclusion Raised IOP causes damage and disruption of corneal endothelial cells. This process is blunted by red light. JC‐1 staining suggests that endothelial cell mitochondria are activated by raised IOP (presumably as a protective mechanism) and that this process is enhanced by red light.
Distribution, molecular structure and functional analysis of carnitine transporter (SLC22A5) in canine lens epithelial cells
Authors: OCHIAI H
Published: August 2014

Purpose While carnitine has been reported to have an anti‐oxidative role on the ocular surface, there has been no report on the existence of a carnitine transporter (SLC22A5) in the lens. Therefore, we investigated the carnitine transport activity of canine lens epithelial cells (LEC) and determined the molecular structure of canine SLC22A5.

Methods The primary lens epithelial cells of dog were transfected with the expression plasmid DNA of large T antigen from replication origin‐defective simian virus 40 (SV40), then cloned using glass a cylinder. The transport activities of carnitine in lens epithelial cells were measured. The cDNA sequences of SLC22A5 were also determined.

Results The carnitine transport activity was 7.16 + 0.48 pmol/mg protein/30 min. Butyrobetaine, the analogue of carnitine, reduced 30% of the activity at 50 microM. A coding sequence of canine carnitine transporter was 1694 bp long and was predicted to encode 557 amino acid polypeptides. The deduced amino acid sequence of canine carnitine transporter showed > 80% similarity to that of mouse and human. Western blot analysis detected the band at 60 kDa in the membrane of lens epithelial cells.

Conclusion Lens epithelial cells possess　SLC22A5. The high content of carnitine in the lens is possibly transported from aqueous humor by SLC22A5.
Preliminary study of the association between corneal histocytological changes and surgically induced astigmatism after phacoemulsification
Authors: ZHAO G , LIN J , XU Q
Published: August 2014

Purpose SIA was one of the factors that influences the desirable refractive outcome, and it was related to the length, type, location, structure of the incision and to the suture closure technique, etc. The aim was to evaluate the association of corneal histocytological changes with surgically induced astigmatism (SIA) after phacoemulsification.

Methods The study enrolled 68 cases of cataract patient (68 eyes). Corneal histocytological parameters at corneal incision、central cornea and contralateral incision obtained by confocal microscope through focusing(CMTF) were compared preoperatively and 1 week, 2weeks, 1month, 3 months and 6 months postoperatively. These biometric factors included the endothelial cell density, keratocyte density of posterior stroma layer, and the morphological changes. SIA was calculated by Jaffe's vector analysis.

Results 1 From preoperatively to 1 week, 2weeks, 1month, 3 months and 6 months postoperatively, the endothelail cell density was decreased significantly(p＜0.05). 2 The histocytological observations indicated that the morphology changed significantly postoperatively at the corneal incision, including the cell absent area, wave‐like area, dot‐like and mass‐like hyperreflection, stripe‐like absent area, in the endothelial layer, and the keratocyte activation, microfolds, irregular hyporeflective or hyperreflective belt, and a little dot‐like hyperreflection in the posterior stroma layer. 3 The reduction of the endothelail cell density at the cormeal incision at 1 week, 2 weeks, 1 month postoperatively, were positively correlated with SIA.

Conclusion The reduction of endothelail cell density and the histocytological changes at the corneal incision were associated with SIA.
Lens capsular bag dislocated into the anterior chamber following calcific phacolysis in an immunocompromised patient.
Authors: ALMENARA MICHELENA C , RODRIGUEZ A , ASCASO FJ , SOLANAS S , MAYA R , ANDONEGUI J
Published: August 2014

Purpose Calcific phacolysis, a rare clinicopathologic entity that develops in long‐standing unilateral traumatized or cataractous lenses, results in complete liquefaction of cortex, which escapes through an intact lens capsular bag. Cytomegalovirus (CMV) retinitis is associated with high risk of cataract but calcific phacolysis had never been described in patients with this opportunistic infection.

Methods Interventional case report showing a calcific phacolytic process with dislocation of lens capsular bag into the anterior chamber.

Results A 48‐year‐old man with a history of HIV, chronic hepatitis C, and CMV chorioretinitis, presented with left eye pain and redness for three days. Slit‐lamp biomicroscopy revealed the presence into the anterior chamber of a free‐floating lens capsular bag associating calcified lens particles. The patient underwent irrigation and aspiration to remove this spontaneously dislocated material and symptoms resolved after one‐month topical antibiotic‐steroid therapy.

Conclusion Phacolysis has been described as the breakdown of a hipermature cataract, causing an antigenic reaction to the proteins released into the anterior chamber through an intact lens capsular bag, in this case displaced anteriourly. Although it is thought to be a slow process, sometimes a cataract can rapidly mature and become phacolytic. To the best of our knowledge, this appears to be the first case of spontaneous phacolysis over the course of only three days in a patient with ocular history positive for a CMV chorioretinitis 15 years ago.
Simulation of stray light with a phakic intraocular lens with a central hole
Authors: EPPIG T , LANGENBUCHER A
Published: August 2014

Purpose Posterior chamber phakic intraocular lenses (pIOL) have been equipped with several holes to facilitate aqueous flow into the anterior chamber. The latest generation is equipped with a small hole in the center of the optic. The purpose of this study was to investigate whether a central cylindrical hole may increase intraocular stray light.

Methods We established a hyperopic (+4 D) model eye in the ray tracing software ASAP based on the Liou Brennan model eye (LBME). A pIOL was placed between the iris and the crystalline lens with a central thickness of 0.25 mm. We created one pIOL model with and without central hole of 360 microns in diameter. Beams were projected to the eye at visual field angles up to 70° temporally. Intensity distribution was compared at retinal plane between the lens with and the lens without the hole.

Results The pIOL model with central hole showed increased intraocular stray light at retinal plane originating from light sources in the peripheral visual field. When projecting light from a half visual field only, stray light is present in the entire visual field. However, intensity of stray light is rather small compared to direct rays. The pIOL without central hole showed stray light originating from interface reflections which are projected to retinal plane.

Conclusion Stray light caused by the pIOL central hole showed a negligible effect on visual acuity in an ideal environment. However, glare in the peripheral visual field (e.g. traffic lights) might affect visual acuity due to an increase in intraocular stray light. Stray light caused by the central hole is more likely to appear in hyperopic eyes due to increased pIOL central thickness.
Pseudophakic photopsia – Optical simulations with a model eye to evaluate IOL design and material
Authors: LANGENBUCHER A , EPPIG T
Published: August 2014

Purpose Photopic phenomena (photopsia) gain in relevance and may become key problems after modern cataract surgery. The purpose of this study is to evaluate potential influencing factors for these optical phenomena using ray tracing techniques in a model eye.

Methods A schematic model eye was used for simulations with professional optic design software (ASAP). The crystalline lens was replaced by an intraocular lens implant. We varied the lens’ edge design (edge radius from 0.00 mm (0.05 mm) 0.15 mm), refractive index (1.55 and 1.46), axial and lateral position (each ±0.5 mm), as well as the pupil diameter (2.5, 3.5 and 4.5 mm). Retinal illuminance was simulated for a Ganzfeld perimeter sphere (d=300 mm, 250° field of view) with 107 rays emitting in a Lambertian distribution.

Results Positive photopsia could be observed at the central and paracentral nasal visual field originating from total internal reflection at the lens’ optics edge, which becomes more intense with higher refractive index and smaller edge radius or larger peripheral thickness of the lens. Negative photopsia was seen at the far temporal visual field as a gap in illuminance originating by a gap between overlaying light pathways of primary image and direct path. Photopsia is less pronounced with larger pupil size and axial or lateral displacement of the lens.

Conclusion Photopsia is not a new phenomenon in pseudophakic eyes, but with lenses with a high refractive index (smaller incision) and sharp optic edges (for prevention of secondary cataract) the intensity of artificial light phenomena and gaps photopsia might become the main reason for patient dissatisfaction after cataract surgery.
Intravitreal Ranibizumab for the treatment of choroidal neovascularization associated with choroidal nevus
Authors: HERRERA L , ZABADANI K , ALMENARA C , CARAMELLO C , PEREZ NAVARRO I , ASCASO J , CAMINAL J , MARTINEZ M , ESTEBAN O , CRISTOBAL J
Published: August 2014

Purpose To report our visual outcomes in a series of five cases of classic choroidal neovascularization (CNV) associated with choroidal nevus which were treated with intravitreal ranibizumab injections.

Methods Interventional case series. Each patient underwent a complete ophthalmic evaluation, including fluorescein angiography and spectral domain optical coherence tomography (SD‐OCT). Data were retrospectively analyzed to evaluate both clinical and anatomical results following intravitreal treatment.

Results The CNV was juxtafoveolar in four cases and extrafoveolar in one case. Intravitreal ranibizumab therapy was used in all five cases by using 2‐5 injections (mean 3.4 injections). Moreover, two cases required other therapies: photodynamic therapy (PDT) in one case of juxtafoveolar CNV and laser photocoagulation in a case of extrafoveolar CNV. After a mean follow‐up of 18.6 months, final best‐corrected visual acuity (BCVA) increased in two cases, decreased in two cases and remained stable in one case. There were no adverse effects associated with ranibizumab injections. All choroidal nevi remained stable, showing no signs of malignancy.

Conclusion Intravitreal ranibizumab injections appear to be a safe and effective treatment modality for CNV associated with choroidal nevus.
White center retinal hemorrhages revealing acute lymphoblastic leukemia
Authors: BENLAHBIB M , BENCHERIFA F , HAJJI Z , BOULANOUAR A , BERRAHO A
Published: August 2014

Purpose Acute lymphoblastic leukemia is a severe affection related to invasion of the bone marrow by immature haematopoietic cells of the lymphoid lineage. Retinal hemorrhages with white center are secondary to a specific pathophysiological mechanism. They are exceptional when revealed acute leukemia.

Methods Through clinical observation of a case of acute lymphocytic leukemia revealed by retinal hemorrhages with white center, we recall the pathophysiological mechanisms and clinical aspects of this rare retinal disease.

Results A 16 years old child consult for myodesopsia in his left eye. The ophtalmological examination show a correct visual acuity 10/10 P2 in the right eye and 9/10 P2 in the left. We note a discolored conjunctiva with vascular occlusions. The examination of the fundus of eyes reveal a diffuse retinal hemorrhages with white center. The blood count analysis show ; 120.000/mm3 WBC, Hb 3.5 g / dl and platelet 37.000/mm3. The diagnosis of acute lymphoblastic leukemia is made. The child is cared for in a pediatric oncology service. He received a blood transfusion and chemotherapy with complete remission at the last control.

Conclusion Ophthalmologic examination has a major interest in the diagnostic and therapeutic management of this disease.
Caruncular naevi investigated by in vivo confocal microscopy: reporting the first 5 cases
Authors: JULIENNE R , GRIVET D , CINOTTI E , PERROT JL , LABEILLE B , CAMBAZARD F , FOREST F , DUMOLLARD JM , PEOC'H M , GAIN P , THURET G
Published: August 2014

Purpose During body screening of melanocytic lesions, naevi of the eyelids, conjunctiva and caruncula, although accessible to the dermatologist, are often missed out. These tumors have similar characteristics and prognosis as oral or genital ones. We report the first cases of caruncular naevi observed by in vivo confocal microscopy (IVCM).

Methods Five patients, 4 men and 1 woman, who presented with a caruncular melanocytic lesion, were examined by IVCM, using the handheld dermatological IVCM Vivascope 3000 (Lucid Inc, NY, MAVIG GmbH, Germany) equipped with 830nm class IB laser.

Results Mean age was 39 years old (25‐71). The tumors which were 2.2mm width on average (0.5 ‐ 3.0 mm) were present since 4 years on average (1‐10). Two patients had family history of skin melanoma. IVCM showed hyperreflective round cells that were either isolated or grouped within the lamina propria. No abnormal cells were observed. Despite the benign IVCM aspect, a surgical excision biopsy was performed on 4 patients, for definitive histopathology or esthetic reasons. All 4 were compound naevus on histopathology. The remaining patient had no progression at 6 months follow up

Conclusion The caruncular site is inaccessible to both dermatoscopic imaging and standard dedicated ophthalmological IVCM. The Vivascope 3000 overpass this site limitation thanks to the small head of the camera and its handy and portable dimensions. In all cases, the IVCM imaging correlated with histopathology. This is the first reported series of caruncular melanocytic lesions explored in IVCM. Grant: GIRCI Rhone Alpes Auvergne 2012
Follow‐up of patients under therapy with hydroxichloroquine via merg, sd‐oct, af and automated perimetry
Authors: MOGAVERO V , RUBERTO G , RAIMONDI M , LANTERI S , PICCININI P , BIANCHI PE
Published: August 2014

Purpose To analyze alterations in patients in therapy with hydroxychloroquine via multiple functional tests.

Methods We examined 55 patients (mean age 56.1±1.9) in long term therapy (93.8±95.6 months) with hydroxichloroquine. The patients were divided into 4 patological groups (RA,LES,connectivitis and others) and assuming therapy from less than 5 years (47 eyes), 5 to 10 (28 eyes) and more than 10 (36 eyes). They had a complete ophthalmologic visit, including logMAR visual acuity, multifocal ERG(61 hexagons program), frequency doubling technology, automated perimetry program 10‐2, spectral domain optical coherence tomography and autofluorescence at time 0 and at after 1 year. For the statistical analysis we considered the latencies and amplitudes of the 5 mfERG rings, the mean and pattern deviation (MD, PSD) results of the FDT and SD‐OCT.

Results The patients were treated for 78 months in median and the median total dose was 115 gr. We found a reduction of the mfERG rings statistically significant (N1nV1, P1nV1, P1nVdeg1, N1nV2, P1nV2, P1nVdeg2, P1nV3, P1nVdeg3, P1nV4, P1nVdeg4, P1nV5, P1nVdeg5) while PSD and the MD did't show a loss of sensitivity in the follow up. We found a statistically significant thicker in 4 sector of retina(foveal, superior, nasal and periferical inferior)with SD‐OCT. The AF was positive in 9 eyes and negative in 58 eyes and did not change at the follow up.

Conclusion In our study mfERG has been the first exam to show early damage in absence of manifest retinal changes. The meaning of thickening at SD‐OCT remains uncertain. Our aim now is to estabilish the eventual relationship between the thickened areas in SD‐OCT and the mfERG reduction lasting the follow up.
Treatment satisfaction: Can we trust our glaucoma patients?
Authors: TISSIER P , LEMIJ H , BAUDOUIN C
Published: August 2014

Purpose To determine the characteristics and satisfaction regarding tolerance of glaucoma patients currently treated by prostaglandin analogues, in general ophthalmological consultations.

Methods Multi‐centre, European and epidemiological survey among glaucoma patients receiving prostaglandin analogues. In a two page questionnaire, the participating ophthalmologists recorded: glaucoma history, previous treatments and reasons for change, tolerability and patient satisfaction, ocular surface disease (OSD) prevalence and other ocular signs.

Results The data from the first country, The Netherlands, (164 patients) were analyzed. At the time of the study, 94% of patients were treated for glaucoma with preserved products. Of all patients, 89% declared to be satisfied or very satisfied. The mean score of tolerability evaluated on VAS (Visual Analog Scale) was 76.4 ± 17.5 mm. Signs of OSD were evident in 44% of patients. Of all patients, 32% reported symptoms upon instillation and 47% between instillations. Conjunctival Hyperemia was present in 47% of patients. The prevalences of both blepharitis/Meibomian gland dysfunction and dry eye were more than twice as high compared to the time of onset of therapy, with a change from 8 to 19% of patients for blepharitis and 14% to 33% for dry eye. Artificial tears were used in 38% of patients. Patient dissatisfaction was significantly associated with the presence of OSD, hyperaemia, ocular signs, symptoms upon and between instillation and the use of artificial tears.

Conclusion These first results highlight the disconnection between the patients’ reported satisfaction and their ocular signs and symptoms. Ocular surface dysfunction needs to be investigated thoroughly in those who use preserved prostaglandin analogues.

Commercial interest
The effect of preservative free tafluprost on intraocular pressure in patients with ocular hypertension or primary open angle glaucoma
Authors: HOMMER A , KROMUS M , SCHMIDL D , GARHOFER G , SCHMETTERER L
Published: August 2014

Purpose Since increased intraocular pressure (IOP) is the most important modifiable risk factor for the development and progression of glaucoma, potent and save IOP lowering therapy is of special importance. Preservative free prostaglandins offer a new treatment option using a potent topical drug without the disadvantages of a co‐administered preservatives. The aim of the present study was to investigate the effect of 8 weeks treatment with preservative free tafluprost on IOP in patients with glaucoma or ocular hypertension.

Methods 16 patients with either primary open angle glaucoma with an uncontrolled intraocular pressure ≥ 30mmHg or patients with ocular hypertension with an IOP ≥ 30mmHg were included in the present open pilot study. For patients who were already on antiglaucoma therapy, a washout period with a duration of 4 weeks was scheduled. IOP was measured at 8am and 6pm after the washout period as well as 4 and 8 weeks of after start of topical drug treatment.

Results A total of 16 patients (age range 31‐76 years) were included in the study. After the 4 week washout period, mean IOP was 35.6±4.5mmHg at the morning and 32.9±5.4mmHg at the evening measurement. 4 weeks after treatment start, a decrease in IOP by ‐31%±12% to 24.4±4.6mmHg (p<0.01) was observed at the morning measurement and by ‐34%±14% to 21.6±4.6mmHg (p<0.01) at the evening measurement. 8 weeks after treatment start IOP remained low, on average 24.4±4.6mmHg (‐31%±13% compared to baseline, p<0.01) in the morning and 21.9±3.9mmHg (‐32%±16% compared to baseline, p<0.01) in the evening.

Conclusion The present data indicate that treatment with preservative free saflutan is safe and has the capacity to significantly decrease IOP in patients with primary open angle glaucoma and ocular hypertension. Further studies are needed to investigate the effect of preservative free formulations for long term treatment.
Test‐retest reliability on measuring anterior chamber parameters with a novel automatic algorithm using anterior segment optical coherence tomography
Authors: ANG L , LEE T , NG J , YIP L
Published: August 2014

Purpose To describe the test‐retest variability in anterior chamber and iris parameters obtained on anterior segment optical coherence tomography (AS‐OCT) when measured with a novel automatic Location‐Based Graph Search segmentation algorithm.

Methods Patients with open angles and primary angle closure on gonioscopic finding were invited for anterior chamber (AC) angle imaging with the Visante AS‐OCT. 3 scans of each eye were acquired in darkness with the patients repositioning their heads after each scan. The images were analysed with a custom software which used the iris rim as the landmark instead of the sclera spur. The parameters analyzed included angle opening distance and angle recess area at 750μm from the angle (AOD750 & ARA750), AC depth and width, lens vault, iris curvature, thickness, length and angle recess area. The test‐retest intrasession variability, coefficient of variation (COV) and intraclass correlation coefficient (ICC) were calculated to evaluate repeatability and reproducibility.

Results 17 eyes with closed angles and 15 eyes with open angles were recruited. The ICC was >0.75 for most parameters of eyes with open angles and COV was <15%. For narrow angled eyes, the ICC was >0.75 for AC depth and width, lens vault, iris length and area, left AOD750 and ARA750 and angle recess, and <0.75 for other parameters. The COV for AC depth and width, iris length and area was <10% and >10% for other parameters.

Conclusion There is test‐retest variability in AC parameters measured with the Visante AS‐OCT. The variability is greater in eyes with narrow angles but reliable in eyes with open angles. Caution must be exercised when using the AS‐OCT to follow up patients with narrow angles.
Hemifield patter electroretinogram and macular thickness asymmetry parameters in ocular hypertension patients
Authors: FINZI A , TASSI F , GIZZI C , CELLINI M
Published: August 2014

Purpose To assess which is the most sensitive and specific exam for detecting an early retinal ganglion cells (RGC) damage between hemifield test pattern electroretinogram (PERG HF) and the posterior pole asymmetry analysis with optical coherence tomography (OCT‐PPAA) in ocular hypertensive patients (OH).

Methods Forty‐two OH patients (mean age of 56.0±5.6 yrs.) with an intraocular pressure (IOP)>21mmHg and forty healthy controls (mean age of 55.2±6.4 yrs.) with IOP<21mmHg were assessed. All patients had normal visual acuity, normal optic disc appearance and normal standard achromatic perimetric (SAP) indices. All subjects underwent an OCT‐PPAA with the OCT‐Spectralis and PERG HF examination. Data were analyzed with Wilcoxon test and Receiver Operating Characteristic (ROC) curve analysis taking p < 0.05 as significant.

Results We found that OH patients compared to healthy controls with full field PERG had a not significant decrease of the N95 wave amplitude (p<0.097) with a significant increase of its peak‐time (103.88 ± 11.11 vs 92.78 ± 4.30 msec; p<0.027). With PERG HF we found a significant intraeye asymmetry of the N95 wave (‐1.99±1.58 vs ‐0.67± 0.35 µVolt; p<0.023). With OCT‐PPAA in OH patients we found a decrease in macular thickness but not a statistical significant intraeye hemispheric asymmetry (3.94± 2.89 vs 5.98±4.74 µ; p<0.116). ROC curve analysis revealed a sensitivity of 80% and specificity of 87.6% for PERG HF whereas by using OCT‐PPAA we found a sensitivity of 70% and a specificity of 74%.

Conclusion Our study shows that at the moment the PERG HF is the most sensitive and specific technique than OCT‐PPAA for detecting early RGC damages in eyes with ocular hypertension.
HRT versus OCT in diagnosing preperimetric glaucoma
Authors: BOUHACINA BENMANSOUR A , ROULAND J
Published: August 2014

Purpose To compare the final classification of Glaucoma Probability Score (GPS) and analyze RNFL of OCT and to evaluate their capacities to detect precociously the glaucomatous defects

Methods Retrospective study, led in the regional center of glaucoma, in CHUR of Lille, including 122 eyes of 71 patients All the eyes included had, to the maximum, a light visual field defects and having profited all of them of a complete ophthalmic examination including vision, measurement of the PIO, standard automated perimetry, optic nerve head analysis was performed by using a confocal scanning laser ophthalmoscopy type Heidelberg retinal tomography (HRT III) and retinal nerve fiber layer (RNFL) by Optical Coherence Tomography (Cirrus OCT) The patients were divided into 3 groups according to the defect of the visual field: ‐ Group 1 : normal visual field ‐ Group 2 : MD between [0, ‐2] decibels ‐ Group 3 : MD between [‐ 2.1, ‐6] decibels The results of analysis RNFL on OCT and analysis GPS on the HRT were compared in each group.

Results The discordance is important in group 2. The sensitivity of the two apparatuses increases with the depth of the defect but remains higher with the HRT.

Conclusion There is not a difference between the two analyzers from ‐ 2,1 Decibels The GPS appears to be an algorithm more sensitive than analysis RNFL on OCT in detecting preperimetric glaucoma.
Evaluation of CANON SD HS 100 OCT : Reproducibility of macular ganglion cell complex (GCC) thickness measurement in normal, hypertensive and glaucomatous eyes
Authors: ROSENBERG R , MARILL AF , FENOLLAND JR , EL CHEHAB H , DELBARRE M , MARECHAL M , MOUINGA A , RENARD JP
Published: August 2014

Purpose To evaluate intra‐ and interobserver reproducibility of macular GCC thickness measurement by automated segmentation on CANON SD HS 100 OCT (Japan) in normal (N), hypertensive (OHT) and glaucomatous eyes.

Methods A total of 179 eyes of 93 patients were included: 88 N, 26 OHT and 65 glaucoma. All patients underwent a complete ophthalmologic exam, pachymetry and 24‐2 automated perimetry (HFA SITA Standard). Each of two observers performed three times macular imaging with SD HS 100 OCT. Acquisitions were analyzed with Glaucoma 3D mode which estimated the macular GCC thickness in global, upper and lower macular parts and in eight separate areas. Reproducibility was assessed by intraclasss correlation coefficient (ICC), coefficient of variation (CV) and test‐retest variability (TRTV) calculated as 1.96 times the standard deviation.

Results Mean GCC thickness was respectively 92.6µm, 88.7µm, 77.4µm in N, OHT and glaucomatous eyes. In all groups, intra‐ and interobserver reproducibility was respectively ranged for ICC from 96 to 99.7% and from 84.5 to 99.7%, for CV from 0.44 to 2% and from 0.37 to 1.1% and for TRTV from 0.75 to 2.62 µm and from 0.59 to 1.47µm. Reproducibility is significantly better in N and OHT group than in glaucoma group (p<0.001).

Conclusion Reproducibility of GCC thickness measurements using the new OCT SD HS 100 is high. These results might be related to a high axial resolution (3µm). They underline reliability data for analyze of GCC.
Visual field defects in pre‐perimetric glaucoma identified by customized oct ‐ guided white‐on‐white automated perimetry
Authors: MAGOURITSAS G , GEORGIADIS O , PORTALIOU DM , MOSCHONAS K
Published: August 2014

Purpose We studied cases of “preperimetric” glaucoma using detailed strategies of the AP in order to detect any functional disturbance in visual field areas corresponding to the localized structural damage.

Methods We enrolled 5 patients with inter‐ocular optic disc cupping asymmetry, ocular hypertension asymmetry, optic disc hemorrhage and retinal nerve fiber layer (RNFL) outside normal limits, as measured by means of optical coherence tomography (OCT). All of the 5 patients fulfilled the diagnostic criteria for “preperimetric” glaucoma, showing a normal standard visual field analysis. They were submitted in a more specific white‐on‐white AP using customized programs with a 3 degrees grid, instead of the standard 6 degrees used in routine 24‐2 and 30‐2 programs of the Humphrey AP. The examination of the visual field test points in a customized pattern has been guided by the corresponding abnormal region of the OCT, according to the structure‐function map proposed by Garway‐Heath et al (Ophthalmology. 2000;107:1809)

Results Using the denser grid of 3 degrees spot, we detected reduced threshold sensitivity in 3 study eyes, in specific areas of the visual fields. The topography of these areas corresponded to the morphology of the localized RNFL lesion. In 2 eyes the 3 degrees customized, OCT guided, AP could not identify any functional disturbance.

Conclusion Early defects of visual fields may coexist with morphological damage of optic nerve and RNFL, even in “preperimetric” glaucoma, but remain undetected by the currently available routine 6 degrees grid programs of AP. Customized OCT guided AP may establish the diagnosis of glaucoma and put controversy in the term of “preperimetric” glaucoma.
Interest of central 10‐2 visual field in glaucomatous and glaucoma suspects patients with normal central 24‐2 visual field
Authors: MARECHAL M , CHAPRON T , EL CHEHAB H , FENOLLAND JR , MARILL AF , ROSENBERG R , DELBARRE M , MOUINGA A , RENARD JP
Published: August 2014

Purpose To evaluate benefit of performing central 10‐2 visual field (VF) in association with 24‐2 VF in glaucomatous or glaucoma suspect patients.

Methods 20 glaucoma suspect (Mean Deviation MD=0.19±0.8dB) and 48 glaucomatous eyes (MD=‐2.33±1.9dB) with normal central 24‐2 VF were included. Patients without macular pathology underwent a complete ophthalmological examination and a reproducible VF testing (Humphrey Field Analyser, SITA standard 24‐2 and 10‐2, Carl Zeiss Meditec) and analyze of ganglion cell inner plexiform layer and of retinal fiber layer thickness by Cirrus HD‐OCT.

Results Central 10‐2 VF detect a central defect in 15 eyes (22%). In glaucoma suspect group, a defect was detected by 10‐2 VF whereas 24‐2 VF was normal for 2 patients (10%). In glaucomatous group a central 10‐2 VF defect missed by 24‐2 VF was detected in 7 patients (15%). An extended central 10‐2 VF defect associated with a suspect or a small paracentral 24‐2 VF defect was reported for 6 glaucomatous patients (13%).

Conclusion Central VF defect may be missed by 24‐2 VF analyze. Central 10‐2 VF seems to be useful in glaucoma suspect and in glaucomatous eyes for a better detection of early central functional defect.
Comparison of two methods for location of the ciliary body before glaucoma treatment using High Intensity Focused Ultrasound (HIFU)
Authors: APTEL F , ROULAND J , CHAVEROT D , DUPUY C , COPPIN J
Published: August 2014

Purpose To evaluate the ability of the white‐to‐white (WTW) and axial length (AL) measurements to determine the location of the ciliary body before High Intensity Focused Ultrasound (HIFU) glaucoma treatment.

Methods 189 eyes (104 phakic, 85 pseudophakic) of 161 patients were included. WTW and AL measurements were measured with the IOLMaster. The HIFU size probe selection was done based using ultrasound biomicroscopy (UBM) and a computer assisted overlay drawing method performed by the manufacturer of the HIFU device. Three probe models with different ring diameters (11, 12 and 13mm) are available for HIFU treatment. Eyes were divided into 3 groups: “11” (n=11), “12” (n=83) and “13” (n=95) corresponding to the size of the probe recommended based on UBM images. The agreement between the group and the WTW and AL were evaluated.

Results For groups "11", “12” and “13”, mean WTW and AL measurements were respectively 11.44 ± 0.11 mm and 22.04 ± 0.28 mm, 11.84 ± 0.04 mm and 23.22 ± 0.20 mm, and 12.36 ± 0.06 mm and 25.43 ± 0.3 mm. Mann&Whitney and ANOVA tests showed a significant difference between the 3 groups (p<.05). By placing all the data in a coordinate system WTW‐AL, we can distinguish 3 areas (11, 12 and 13) allowing to choose the diameter with a 93% agreement with the UBM‐based determination.

Conclusion It seems possible to determine the probe model with a nomogram based on easily measurable ocular parameters.
Multicenter clinical trial of ultrasonic circular cyclo coagulation in glaucoma patients naive of filtering surgery. Preliminary results at 6 months
Authors: APTEL F , DENIS P , ROULAND J , RENARD JP , BRON AM
Published: August 2014

Purpose To evaluate the efficacy and safety of the Ultrasonic Circular Cyclo Coagulation (UC3) procedure in patients naive of previous filtering glaucoma surgery.

Methods Prospective non comparative interventional clinical study performed in 5 French glaucoma centers. Thirty eyes of 30 patients (24 primary open‐angle glaucoma and 6 secondary glaucoma), with intraocular pressure (IOP) > 21 mmHg, naïve of previous filtering glaucoma surgeries, were insonified with a therapy probe comprising 6 piezoelectric transducers. The 6 transducers were activated with a 6 seconds exposure time. Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after. Primary outcomes were surgical success (defined as IOP reduction from baseline ≥ 20% and IOP > 5mmHg) at the last follow‐up visit, and vision‐threatening complications. Secondary outcomes were mean IOP at each follow‐up visits compared to baseline, medication use, and complications.

Results IOP was significantly reduced (p<0.05), from a mean preoperative value of 28.3 ± 7.0 mmHg to a mean value of 19.5 ± 7.2 mmHg at 6 months. Success (IOP reduction >20%) was achieved in 63% of eyes at 6 months after one HIFU procedure, with a mean IOP decrease of 39%. No major intra‐ or post‐operative complications occurred.

Conclusion Ultrasonic Circular Cyclo Coagulation seems to be an effective and well tolerated method to reduce intraocular pressure in glaucoma patients naïve of previous glaucoma surgery.

Commercial interest