bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of tuberculosis uveitis
Authors: NGUYEN E , BAILLIF GOSTOLI S
Published: August 2012

Purpose Tuberculosis uveitis are difficult to diagnose because of their polymorphism of clinical presentations. As a consequence, a diagnostic delay is often observed in this pathology. The goal of this study is to determine the clinical features and the investigations leading to the diagnosis of tuberculosis uveitis.

Methods It is a retrospective study at the Saint Roch University Hospital in Nice. We followed eight patients (thirteen eyes) between September 1997 to March 2011, who presented with unilateral or bilateral tuberculosis uveitis.

Results A slit‐lamp examination revealed an anterior uveitis in twelve eyes. Six eyes presented granulomatous keratoprecipitates, five had posterior synechia. Funduscopy showed twelve eyes with vitritis, seven eyes presented snowball vitreous opacities, and four eyes were affected by a papillitis. Optical coherence tomography showed a macular oedema in six eyes. Fluorescein angiography revealed five cases of retinal vasculitis. We observed three exsudative retinal detachments, and four choroidal or retinal granulomas. Five tuberculin skin test were performed, and four were positive. Three interferon‐gamma release assays were realized, and were all positive. Six analysis of aqueous humor were negative, one vitreous sample was negative. All the patients were treated with anti‐tuberculosis therapy as well as systemic steroids with a favorable clinical outcome without any recurrences observed.

Conclusion Our case series shows that tuberculosis uveitis were mostly anterior granulomatous uveitis, associated with an intermediate uveitis. Some patients presented a posterior affection. Tuberculin skin test and interferon‐gamma release assays were efficient tests while analysis of intraocular fluid was less helpfull.
Danger of research in lasers: about two examples of retinal impacts in senior researchers
Authors: CAMPOLMI N , GRIVET D , THURET G , BERNARD A , GAIN P
Published: August 2012

Purpose We report two cases of accidental retinal lesions made by diode and femtosecond lasers in senior researchers in optics.

Methods The first case concerned a 29‐year old caucasian woman exposed to a 1053 nm wavelength femtosecond laser (0.5 mW) during mirror alignment. Immediately after exposure, she felt blurry central vision and scotoma in her left eye. Visual acuity was 20/60. Clinical examination showed yellowish dots in foveal region. No treatment was given. Two years later, visual acuity remained low. The second case was a 40‐year old causasian woman exposed to 670 nm wavelength diode laser (3 mW) in both eyes during repeated experiments. The patient had no symptoms. Visual acuity was 20/20 without central scotoma. The fundus revealed several extrafoveal macular white and yellow impacts of different ages. Ten years later, no neovascular complication was observed

Results These two different cases illustrate the danger of any type of laser. Thermic or blast effect can caused permanent damage to the retinal pigment epithelium affecting the fixation point with permanent visual acuity decrease. Choroidal infarction has been described in the literature. Main risks are neovascularization and enlargement of the impacts involving the fovea. When patient does not consult immediately after accidental exposition, differential diagnosis of white retinal infiltrates, as multifocal choroiditis, should be ruled out.

Conclusion Whatever their skill, researchers and workers exposed to any type of lasers should be reminded the importance of wearing suitable eye protections. Considering the possibility of asymptomatic lesions, a periodical screening remains justified.
Pathologic findings for patients with acute and symptomatic floater
Authors: CHOI MJ
Published: August 2012

Purpose To evaluate and establish the rate of pathologic findings for patiens with acute and symptomatic floater

Methods Retrospectively records of 3377eyes(2649 patients) with acute, symptomatic floater who visited Kim’s Eye Hospital from January 1, 2011 to December 31, 2011 were evaluated. Patients with previous retinal detachments resulting from other ocular pathologic features, direct ocular trauma, or previous vitreoretinal, cataract surgery were excluded. Their standard examination included visual acuity, IOP, anterior segment examination, and dilated fundus examination using a slit‐lamp and indirect ophthalmoscop

Results The incidence of floater symptom was common in female than male respectively(p<0.05). And the most common cause of floater was posterior vitreous detachment(10.4%). The incidence of retinal tear was 0.8%(28 eyes) and 27eyes of them were undergone barrier laser. The incidence of lattice degeneration was 1.8%(61 eyes) and 36 eyes of them were treated with barrier laser. 3 cases of all showed retinal detachment. 2 cases of them were managed with barrier laser, 1 case was treated with scleral buckling and cryotherapy. And the incidence of retinal hemorrhage and vitreous hemorrhage was 0.4%(15 eyes), 0.02%(8 eyes) each. Other pathologic findings include epiretinal membrane(0.5%, 19 eyes), uveitis(0.4%, 14 eyes), and endophthalmitis(1 eye)

Conclusion The study revealed that the pathologic findings of floaters may be encountered: retinal detachment, retinal tears, lattice degeneration, vitreous hemorrhage, retinal hemorrhage, uveitis and endophthalmitis. Patients with an acute, symptomatic floater should be examined closely and if the results of an initial examination are negative for pathologic finding, the necessity of early follow‐up should be needed.
Value of fundus autofluorescence imaging in a rare case of clonazepam associated retinopathy
Authors: MATEO J , JIMENEZ B , ASCASO F , MATEO A , PEREZ D , CASAS P
Published: August 2012

Purpose Many unwanted ocular effects have been described after the ingestion of psychotropic drugs. Clonazepam is an anticonvulsant and anxiolytic agent belonging to the family of benzodiazepines. Our aim is to report a case of toxic retinopathy associated with prolonged administration of clonazepam.

Methods We present a case of a middle‐aged woman, with no significant ocular or familial ocular history, who complained of bilateral blurred vision and photophobia. She had a long‐lasting anxiety disorder and underwent clonazepam for the previous 8 years. We carried out a complete ophthalmological examination including visual acuity and color vision testing, funduscopy, fluorescein angiography, electrophysiologic retinal testing, optical coherence tomography and fundus autofluorescence (FAF). We found multiple retinal mild depigmentation dots in the posterior pole of both eyes that showed a clear hyperautofluorescence and slightly reduced electrophysiologic responses. Other possible diagnoses were ruled out as multiple evanescent white dot syndrome or macular dystrophy associated with hyperautofluorescence.

Results A large variety of drugs may have toxic effects on the human retina. Thus, retinopathy has been shown to be related to high doses of typical antipsychotics, mainly chlorpromazine and thioridazine, but only two cases of retinal toxicity by benzodiazepines have been described. To our knowledge, this is the first reported case of FAF imaging findings in a retinopathy associated with clonazepam.

Conclusion Neurologists and ophthalmologists should be aware of the possible retinal toxicity of clonazepam and FAF should be considered as a complementary imaging modality in the diagnosis of toxic or drug‐induced retinopathy.
Dramatic effect of bolus cyclophosphamide in a severe case of lupus retinopathy
Authors: KURUN S , BAUDOT A , MAALOUF T , ANGIOI K
Published: August 2012

Purpose To report the dramatic effect of bolus cyclophosphamide in a severe case of lupus retinopathy.

Methods A 31‐year‐old woman with active systemic lupus erythematosus (SLE) consulted for asymmetric rapidly progressive decreased visual acuity (8/10 P2 OD, 1/20 P14 OS). Fundus examination disclosed bilateral macular oedema, numerous peripapillary cotton wool spots and hemorrhages suggestive of the diagnosis of lupus retinopathy. Clinical and biological criteria allowed the diagnosis of severe multi systemic SLE with lupus glomerulonephritis. Treatment based on oral 1mg/kg daily steroids and 6 intravenous cyclophosphamide cures (100mg/m2). Rapid improvement in systemic and biological signs of SLE was observed with parallel disappearance of retinal signs. Full recovery of visual acuity was obtained within 6 months.

Results Prevalence of SLE varies between 10 and 50 p 100,000. Presence of ophthalmological manifestations is estimated between 5 and 50% of the patients depending on the series, and the most frequent one is lupus retinopathy. First line treatment is usually based on oral corticosteroids. Immunosuppressive drugs may be used as part of a steroid‐sparing strategy or for resistant forms of the disease. In case of severe acute cases, as in our patient, intensive treatment combining steroids and cyclophophamide cures enables regression of retinal signs and improvement of visual acuity, along with clinical and self‐immune and inflammatory tests.

Conclusion In severe forms of SLE a treatment combining cyclophosphamide cures and steroids is mandatory to obtain not only improvement of systemic manifestations but also complete visual recovery.
Unilateral Terson syndrome. Outcome after early vitrectomy
Authors: DE LA MATA G , SATUE M , BAMBO M , ARA M , EGEA MC , FERNANDEZ‐PEREZ S , HERRERO R , GARCIA‐MARTIN E
Published: August 2012

Purpose To report the clinical features and the results after an early vitrectomy of a case of a Terson syndrome following an aneurysmal subarachnoid hemorrhage

Methods 32 years old male with decreased visual acuity (VA) of the right eye (RE) of evolution difficult to determine. As recent precedent a month before stands out a subarachnoid and parenchymal hemorrhage secondary to ruptured aneurysm of the right medial cerebral artery, treated by external ventricular drainage and posterior surgical clipping with satisfactory outcome. The examination revealed visual acuity of light perception in RE and funduscopy shows widespread vitreous haze with impossibility of glimpse the retina, with fibrinous‐looking condensations

Results Suspecting Terson syndrome a pars plana vitrectomy is performed with aspiration of subhyaloid bleeding in the posterior pole. The patient achieved a VA of 0.9 and the funduscopy shows the demarcation zone of ancient bleeding in the posterior pole

Conclusion Terson's syndrome is the combination of intraocular bleeding and subarachnoid hemorrhage secondary to rupture of an aneurysm. The bleeding can be intraretinal, subretinal or vitreal. It is a commonly underdiagnosed pathology. It is associated with worse neurological prognosis with higher rates of morbidity and mortality. However, vitreous hemorrhage is usually resolved spontaneously within a few months, and generally has good long‐term visual prognosis. But early vitrectomy is indicated in bilateral cases, persistent bleeding or proliferative vitreoretinopathy
Subretinal injection of recombinant tissue of plasminogen activator and intravitreal injection in the management of subretinal hemorrhages secondary to age‐related macular degeneration. A report of eight cases
Authors: DJABAROUTI M , FRISER L , GOBERT F , DE BEKETCH C , YANI N , GICQUEL JJ
Published: August 2012

Purpose Complicated forms of AMD are the final stage of a disease leading to deep and permanent visual loss.All current therapeutic advances are opening up real prospects but no consensus has been established despite the efficiency of the subretinal injection of fibrinolytic un macular hematoma.We aimed to assess subretinal injection of rt‐PA associated with anti‐VEGF in the hematoma as a complication of AMD and to establish predictors of efficacy in order to identify target patients.

Methods Inclusion criteria were patients with subretinal hematoma as a complication of AMD active for less than 15 days and treated with the same surgical technique: vitrectomy, subretinal injection of rt‐PA, intravitreal gas and anti‐VEGF injections. Data from preoperative clinical exam at 3, 6 and 12 months postoperative were recorded.

Results Eight patients with extensive hematoma were included. 62 % patients showed significant improvment at 6 months (p=0,04) contrary to the one year results.Displacement of hematoma was observed in all patients and no complication during the surgery is noted. The mean dose of rt‐PA is 50 µg/ml. All patients received locoregional anesthesia. Postoperative complications were cataract (25%), recurrent hemorrhage (25%), and ocular hypertension (12%). No cases of endophtalmitis or retinal detachment is observed.

Conclusion The extensive recent hemorrhage with underlying healthy macula appears to respond to treatment contrary to the old hematoma with pigment epithelium rupture and the hematoma after anti‐VEGF injections responsible of large pigment epithelium detachment.
20 versus 23 Gauge sclerotomies for silicone oil extraction in vitreoretinal surgery
Authors: RADOI C , HAYATE F , DUCASSE A , ARNDT C
Published: August 2012

Purpose The visco‐elastic features of silicone oil are a limiting factor transconjunctival vitreoretinal surgery. The flow resistence increases with the reduction of the inner diameter of the extrusion canula. Thise increases the duration of silicone oil extraction. The purpose of this study was to compare 2 surgical procedures for silicone oil extrusion: 20 versus 23 Gauge.

Methods A retrospective pilot study compared two groups of patients scheduled for silicone oil extraction. In the first group silicone oil extraction was performed through a 20 Gauge scllerotomy after conjunctival dissection whereas a 25 Gauge tranconjunctival sclerotomy enabled saline infusion. In the second group both infusion and silicone oil extraction was performed through 23 Gayge transconjunctival sclerotomies. The duration of each procedure was the main outcome measure.

Results The mean duration of the 23 Gauge procedure was 42 minutes compared with 22 minutes in the combined 20/25 Gauge procedure. Transitory intraoperative hypotonia was encountered in two patients, one in each group. During the post‐operative follow up, a vitreous hemorrhage occurred in one patient of the 23 Gauge procedure group.

Conclusion Comparing two surgical procedures for silicone oil extraction, the conjunctival dissection time in the 20/25 Gauge group seems to be largely counterbalanced by the rapidity of the silicone oil extraction through a larger sclerotomy. The use of a combined 20/25 Gauge full transconjunctival procedure could probably reduce furthermore the duration of surgery .
Long term evolution of combined hamartoma of the retina and retinal pigment epithelium: a report of two cases
Authors: CASTRO NAVARRO J , GARCÍA FERNÁNDEZ M
Published: August 2012

Purpose To show the long‐term evolution of two cases of Combined Hamartoma of Retina and Retinal Pigment Epithelium (CHRRPE), one managed by vitrectomy, and other managed conservatively.

Methods A 46‐year‐old male and a 35‐year‐old female, diagnosed as having a CHRRPE, were observed during four years. One of them underwent pars plana vitrectomy due to an extense associated epiretinal membrane (ERM), and the other patient declined surgery. Full clinical examination, including Best Corrected Visual Acuity (BCVA), funduscopy examination and Optical Coherence Tomography (OCT) was performed.

Results For the patient who underwent vitreoretinal surgery, the evolution was initially satisfactory, with anatomic improvement (assesed by funduscopy and OCT examination) and visual acuity stabilization. However, four years later he presented with a complaint of visual loss, and severe macular distorsion was confirmed by OCT. The patient who asked for a conservative management, showed no visual nor funduscopic changes during the follow‐up.

Conclusion Vitreoretinal surgery for CHRRPE can improve retinal architecture and visual acuity, but in the long‐term functional recuperation is frequently not possible, with similar visual outcomes to those managed conservatively.
Intraretinal brilliant blue infiltration during membrane limiting intern peeling: a case report
Authors: SAVARY P , LEAL C , MACHKOUR‐BENTALEB Z , CHAISE F , FORTOUL V , DENIS P , KODJIKIAN L
Published: August 2012

Purpose Surgical treatment of epiretinal membrane (ERM) have been facilitated by use of dyes such as brilliant blue G (BBG) whose harmlessness by intravitrael injection have been fully reported.

Methods We describe the case of a seventy‐two year old female patient addressed for surgical treatment of left idiopathic ERM that caused metamorphopsia and a decrease of visual acuity. Pars plana vitrectomy and ERM peeling staining with BBG was performed.

Results During the procedure, an unusual complication occurs: intraretinal BBG infiltration. The area was limited (under a disc diameter) located in macular area, in temporal and superior to the fovea; the infiltration reached all retinal layers according to our OCT images. A defect in retina nerve fiber layer seems to be the origin of that staining. No damage in the field or in fluorescein and indocyanine angiography were observed. A progressive resorption of the staining appeared with atrophy of the inners retinal layers as aftereffect. Visual acuity reached 9/10 Pa2 a month and a half after the surgery.

Conclusion In spite of the benefits of vital dyes in vitreoretinal surgery which are widely used, this case remains us the damage that can occur.
Bilateral intermediate uveitis asociated with retinosis pigmentosa
Authors: HERRERO LATORRE R , FERNANDEZ‐PEREZ S , GARCIA‐MARTIN E , SATUE M , IDOIPE M , DE LA MATA G , TORRóN C
Published: August 2012

Purpose Retinitis pigmentosa (RP) is a group of inherited dystrophies with great clinical genetic and evolutionary heterogeneity. We report a patient with retinitis pigmentosa who presented a bilateral intermediate uveitis with cystoid macular edema associated and no other systemic disease.

Methods A 16 year old man with a history of Retinosis pigmentosa since birth presented blurred vision associated with a bilateral intermediate uveitis. The visual acuity was 0,4, Tyndall ++, and intense vitritis with snowballs in both eyes. All systemic examinations were normal (analytics, autoimmunity and serology tests).

Results Patient was treated with orals corticosteroids maintained in decreasing doses. Response to treatment was favorable, but then macular edema appeared. Due to the inability to control uveitis symptoms with steroids, azathioprine was associated and response has been favorable with resolution of macular edema and decreasing inflammation.

Conclusion RP includes a large group of degenerative and hereditary diseases that may be associated with a number of ocular complications. Intermediate uveitis is a rare complication described but can cause decreased vision and requiring monitoring and appropriate treatment for their control.
Ischemic maculopathy with temporal macular thinning on spectral‐domain optical coherence tomography in sickle cell retinopathy: about three cases
Authors: MEZIANI L , BONNEL S , LAROCHE L , HAMARD P , MONIN C
Published: August 2012

Purpose Ischemic maculopathy with temporal macular thinning was recently described on OCT in patients with sickle cell disease. In the current study, we describe the features on Spectral Domain OCT(SD‐OCT)in three patients.

Methods We report 3 cases of sickle cell patients presenting ischemic maculopathy documented by ophthalmologic clinical evaluation, fluorescein angiography (FA),and SD‐OCT.

Results The three patients present stage 3 sickle cell peripheral ischemic retinopathy (Goldberg classification) and bilateral enlargement of ACV in FA. The first patient is a 35 year old man. SD‐OCT shows bilateral thinning in temporal macula retina. Thickness measurement is respectively in right and left eye, 271µm and 219 µm in foveolar region, 275µm and 302µm in temporal perifoveolar region, 203µm and 265 µm in temporal parafoveolar region. The second patient is aged 15. Angiograms reveal a small arteriolar occlusion in the right temporal macula. On SD‐OCT retinal thickness measurement is decreased in both temporal macula: 240µm and 261µm in foveolar region, 233µm and 265µm in temporal perifoveolar region vs 276µm and 358µm in nasal perifoveolar region, 199µm and 230 µm in temporal parafoveolar region vs 292µm and 319µm in nasal parafoveolar region (respectively in right and left eye). The third patient is aged 19 and present the same OCT aspect. Temporal retinal thinning is predominant in inner layers in the three patients.

Conclusion Sickle cell retinopathy can affect macular area through the same process of peripheral terminal vascular occlusion. SD‐OCT provides high resolution images that shows temporal macular thinning which is predominant in the retinal inner layers.
Effect of Crocus sativus stigmas (saffron) extract on sodium selenite induced cataract formation
Authors: MAKRI OE , FERLEMI AV , LAMARI FN , GEORGAKOPOULOS CD
Published: August 2012

Purpose To study the effect of Crocus sativus (CS) stigmas (saffron) extract on sodium selenite induced cataract formation in vivo.

Methods Twenty‐four Wistar rat pups were randomized into 3 groups (n=8/group). Control group received subcutaneous injection of normal saline on postnatal day 10. Selenite and CS treated group received a subcutaneous injection of sodium selenite (20 µmol/kg body weight) on postnatal day 10. CS group also received intraperitoneal injections of CS extract (60 mg/kg body weight) on postnatal days 11 and 12. On postpartum day 21, rats were sacrificed and the lenses were isolated and examined for cataract formation. Activities of superoxide dismutase (SOD) and catalase (CAT) and levels of reduced glutathione (GSH) and glutathione disulfide (GSSG) in the isolated lenses were measured. SDS‐PAGE of lens water soluble protein fraction (WSF) was done.

Results Selenite resulted in significant cataract formation compared to control group, p<0.001. In the CS group, cataract formation was significantly prevented compared to selenite group, p< 0.0001. The mean activities of SOD and CAT were significantly increased in the CS group compared to the selenite group (p=0.025 and 0.0009 respectively). The GSSG/GSH ratio was significantly decreased in the CS group compared to selenite group (p=0.001). CS prevented selenite induced proteolysis of the lens WSF.

Conclusion CS extracts prevented selenite induced cataract formation in Wistar rats possibly by enhancement of antioxidant status and inhibition of proteolysis of the lens WSF.
Gaps between lens epithelial cells due to contractions
Authors: ANDJELIC S , ZUPANCIC G , DRASLAR K , PEROVSEK D , HAWLINA M
Published: August 2012

Purpose The purpose of the study was to characterize the contractions of human anterior lens capsule epithelial cells that create gaps between cells, and to assess the physiological mechanisms and a possible association of the contractions with cataract formation.

Methods Lens capsules obtained during cataract surgery were stained with fluorescent dye Fura‐2. Its fluorescence, upon excitation at 360 and 380 nm, was imaged to monitor changes in cell morphology and cytosolic free Ca2+ concentrations ([Ca2+]i) in response to pharmacological stimulation by acetylcholine and to mechanical stimulation. Contractions were also studied by scanning electron microscope.

Results Epithelial cells contracted in about a third of preparations after stimulation. Contractions started either before or at best simultaneously with the rise in [Ca2+]i. They also occurred when there was hardly any change in [Ca2+]i upon application of physiological saline alone. The probability of contractions occurring did not differ significantly among cortical, nuclear and combined cortical+nuclear cataract.

Conclusion The contractions of the anterior lens epithelial cells occur in significant part of human lens anterior capsule postoperative preparations. They can be mechanically induced, are localized and reversible, have a fast response and did not differ among different types of cataract. They are at least partly independent of changes in [Ca2+]i. This mechanism could represent physiological basis of cataract formation in phakic intraocular lenses that touch the crystalline lens.
Corneal changes after a 3 incision cataract surgery by 2.2mm
Authors: DOT C , ELCHEHAB H , AGARD E , RUSSO A , RACT‐MADOUX G , SWALDUZ B , DUSSART C
Published: August 2012

Purpose a prospective study to analyze the effects of the miniincision coaxial phacoemulsification (2.2 mm) combined with bimanual irrigation/aspiration (I/A) on the corneal optical quality characterized in terms of corneal aberrations.

Methods One hundred and eith eyes underwent mini‐incision phacoemulsification, by the same surgeon. Cataract surgery was performed through a clear corneal incision of 2.2mm, placed at 130°. Two paracentesis of 1mm were performed 90° apart for bimanual irrigation/aspiration. An aberrometry (OPD scannII, Nidek®, Japan) was performed preoperatively (Day 0), 15 days after surgery (Day 15) then 1 month after (M1).

Results The corneal surgical induced astigmatism (SIA) was quite neutral : 0.091 D +/‐0.428 at Day 15, and 0.065 D +/‐0.86 at Day 30. Between Day 15 and D30, its variation was not significant ‐ 0.026 D +/‐0.871 (p=0.74). At 1 month: we observed a mean reduction of ‐ 0,25D +/‐ 0.96 in the direct astigmatism group (n=46), and a mean induced astigmatism of + 0.23D +/‐ 0.94 in the inverse astigmatism group (n=37), of + 0.21D +/‐ 0.6 in the oblique stigmatism group (n=25).Corneal topographic astigmatism is modified in the axis : mean rotation was 29.95° +/‐ 27.6 between Day 0 and 30. Congenital astigmatism superior to 1,5D appears to be more stable. Corneal asphericity didn’t change statistically between Day 0 and 30 (1.14 D +/‐ 0.5 versus 1.11 D +/‐ 0.49 p=0,13).

Conclusion This 3 incision procedure permits a real neutral power SIA through a 2.2 mm main incision, compared to classical coaxial procedure.The stability of refractive data between Day 15 and M1 allows early spectacles prescription and a quick return to normal life. SIA rotation could explain some undercorrections after toric IOL.
Cataract surgery rationing in an age of austerity – Is a UK district general hospital compliant with regional cataract booking guidelines?
Authors: HO J , MOORE S , PAUL B , ISLAM N
Published: August 2012

Purpose The rate of cataract surgery in Outer North East London (ONEL) is significantly higher than the standardised admission rate (SAR) for England. Financial pressures have forced cost savings by restricting cataract operations, aiming for 22% reduction through new clinical acceptance criteria for the region since April 2011. This involves: 1. Best corrected distance visual acuity 6/10 or worse in the better eye AND Impaired lifestyle due to cataract: OR 2. Severe glare, diplopia or anisometropia >/= 1.5 D Exceptions include: • Significant posterior subcapsular lens opacity despite good vision • If surgery is needed to help co‐manage conditions such as glaucoma or for the view of the retina in patients with diabetic retinopathy

Methods Retrospective audit of cataract surgery from Aug 2010 ‐ Dec 2011. Medisoft electronic database query identified patients with VA > 6/9 for case‐note review to ascertain reasons for (non/)compliance with cataract booking criteria.

Results 1084 cataract operations were performed. Median age was 73.5 years. n=34 eyes with pre‐op VA 6/9 or better; pre‐April 2011 (9 cases) vs post‐April 2011 (25 cases). Case‐note review revealed: • Glare (8) / Anisometropia (3): 11 • Posterior Subcapsular cataract: 4 • Co‐management of other pathology: 23 Glaucoma (15), Diabetic Retinopathy (7), ARMD (1) • Not valid: 2

Conclusion Rationing must be balanced with individual clinical needs. 99.8% of cataract operations met the new restricted criteria. This sample is an underestimate as not all cataract operations are registered on the Medisoft database. A re‐audit in 6‐8 months would establish compliance and feasibility as policies are tightened.
Improving effective lens position : comparison of femtosecond laser vs manual capsulotomy
Authors: COLAS E , ABRIEU M , LAAYOUN J , MOUINGA ABAYI DA , LUSSATO M , BLAVIER B , FROUSSART F , RIGAL‐SASTOURNE JC
Published: August 2012

Purpose Every IOL formula has its limits in estimating Effective lens position (ELP). The main one is the variability in capsulotomy size and centration. Our purpose was to compare the variability and predictability in ELP based on capsulotomy created by a femtosecond laser with those using manual continual curvilinear capsulorhexis.

Methods 32 eyes from 24 patients undergoing cataract surgery had either femtosecond created 5.2 mm capsulotomy (VICTUS™ Femtosecond Laser Platform ‐ Technolas Perfect vision) (n=16) or manual continuous curvilinear capsulorhexis performed with an attempted diameter of 5.2 mm (n=16). One surgeon performed all the surgeries during a period of one month in April 2012, at Percy military hospital, Clamart. Three type of monofocal IOL were implanted in the bag. At one month after surgery, ELP was measured by Pentacam HR and compared to preoperative estimated lens position. Accuracy to target refraction was also calculated, being the difference between target refraction with Iolmaster v5 (Haigis, SRK/T and Holladay formula) and postoperative objective refraction

Results Precision of IOL position was improved, as shown by statistically significant reduced variability of ELP (0,27 vs 0,45, p=0,03) in the laser group at one month. Better accuracy to target refraction using SRK/T formula (0,16 vs 0,5, p=0.02) and Holladay formula (0,26 vs 0,50, p=0,02) was also observed in the laser‐treated eyes compared to the manual group.

Conclusion Femtosecond laser system provides a perfectly round, well‐centered, and precise diameter capsulotomy. In this study, this translated to more accurate and predictable ELP and IOL power calculation in femtosecond laser group compared to manual group.
Clear lens extraction in high myopic
Authors: CABEZON L , RAMIRO P , PADGETT E , ZABADANI K , ITURBE F , MINGUEZ E , CRISTOBAL JA , JIMENEZ DEL RIO B
Published: August 2012

Purpose To evaluate the visual results and complications in high myopic patients who underwent clear lens extraction by phacoemulsification with intraocular lens implantation.

Methods We performed a retrospective, observational and descriptive study in 61 eyes of 40 patients from HCU Lozano Blesa from Zaragoza collected between January 2002 and January 2012. We evaluated preoperative and postoperative visual acuity, visual satisfaction and early and late complications.

Results The mean age at intervention was 51,3 years. The mean visual acuity at 3 months postoperatively was 0,8. 30% of the patients needed yag capsuloyomy during the first postoperative year. 2 patients had a retinal detachment.

Conclusion The clear lens extraction in high myopia may be a reasonable option if alternative procedures are not feasible.
Comparative analysis of changes in the macular region following cataract surgery by phacoemulsification with Ozil Intelligent Phaco technology according to different fluidics parameters
Authors: DE LA MATA G , FERNANDEZ‐PEREZ S , SATUE M , GARCIA‐MARTIN E , BAMBO M , PRIETO E , LARROSA JM , POLO V , PABLO L
Published: August 2012

Purpose To assess the change in macular thickness values following cataract surgery by phacoemulsification with Ozil Intelligent Phaco (IP) technology comparing high and low fluidics parameters

Methods A randomized, prospective, comparative trial, including 40 eyes with age‐related cataracts and nuclear opalescence below 4 in the The Lens Opacities Classification System III (LOCS III). Half of the eyes were assigned to phacoemulsification with low fluidics (300mmHg vacuum and 20cc/min maximum aspiration flow), and the other half to high fluidics (500mmHg vacuum and 40cc/min maximum aspiration flow). Data were collected from the thickness map of the macular region by optical coherence tomography (OCT) prior to surgery as well as successive visits in the first postoperative month

Results All the sectors of the macular thickness in OCT were compared based on fluidics groups. No statistically significant differences in none of the 9 sectors in the macular region at both preoperative and first postoperative month were found. There was a slight increase in overall macular thickness after cataract surgery in both study groups, with no significant differences between both. However, this increase was not clinically significant

Conclusion Modifying fluidics parameters in phacoemulsification surgery with Ozil IP technology does not change the damage parameters into the macular region due to surgical trauma within the first 30 postoperative days
Tele‐ophthalmology research in post‐phacoemulsification diagnostic outcomes (TORPEDO) study – preliminary results
Authors: YANG FP , LIM TH
Published: August 2012

Purpose To evaluate the accuracy of tele‐medicine in detecting post‐phacoemulsification outcomes and complications at the one‐month post‐operative visit, as compared to a face‐to‐face clinical consultation.

Methods A prospective study of 30 patients who underwent uneventful phacoemulsification surgery was conducted. At the one‐month post‐operative visit, patients underwent a novel tele‐medicine work‐flow which included visual acuity testing, refraction, intraocular pressure measurement, and slit‐lamp and fundus photography. Images were read by a masked investigator and the findings compared against those of a face‐to‐face clinical examination, performed at the same visit.

Results On clinical examination, corneal and wound‐related complications occurred in 2 patients, anterior chamber inflammation of occasional to 1+ cells was noted in 4 patients and posterior capsular opacification in 1 patient. When compared against the clinical examination findings, tele‐medicine detected corneal and wound‐related complications with a sensitivity and specificity of 100%; anterior chamber inflammation with a sensitivity of 75% and specificity of 92.3% and the presence of posterior capsular opacification with a sensitivity of 100% and specificity of 96.6%.

Conclusion Preliminary results suggest that tele‐medicine detects post‐phacoemulsification outcomes and complications with a high level of sensitivity and specificity. It best detects corneal and intraocular lens‐related complications; with a lower sensitivity and specificity in detecting anterior chamber inflammation.
Customized intraocular lenses enhance binocular depth‐of‐focus and optimize stereoscopic vision
Authors: TARFAOUI N , NOCHEZ Y , PISELLA PJ
Published: August 2012

Purpose The purpose of this study was to evaluate mono and binocular near vision and depth‐of‐focus using two different aspheric monofocal intraocular lenses (IOL) profiles after micro‐incision cataract surgery.

Methods Forty eyes (20 patients) were included. The reference group (28 eyes, 14 patients) received a ‐0.18 µm spherical aberration (SA) aspheric IOL in each eye (Acrismart 36A®, Carl Zeiss Meditec) whereas the aspheric‐customized group (12 eyes, 6 patients) received on the dominant eye an AcriSmart 36A® and on the other eye a zero‐aspheric IOL (Acrismart 46 LC®, Carl Zeiss Meditec). Inclusion criteria were a 0,15‐0,3 µm preoperative corneal SA and a monocular postoperative visual acuity (VA) ≥ 20/20. Reported visual outcomes were best corrected mono and binocular distance Snellen VA and uncorrected mono and binocular near VA. A binocular defocus curve was performed from +0.0 to ‐ 4.0 Diopters (D) by ‐0.25D step. A corneal and total higher‐order aberrations (KR1®, Topcon) evaluation was assessed. Stereoscopic vision was performed using TNO stereo test.

Results Residual postoperative spherical equivalent and best corrected distance VA was not different between the two groups (respectively p = 0,11 and p = 0,82). However, the customized group had a better near and intermediate VA during the defocus curve, for example 20/80 versus 20/125 with ‐4.0D of defocus (p < 0.05). Customized group did not have penalized stereoscopic vision while comparing frequency of patients with TNO stereo test ≥ 120 seconds.

Conclusion Differences in pseudophakic aspherical profiles of IOL in cataract surgery seemed to increase clinical depth‐of‐focus and near ability, without any disturbed distance vision or penalized stereoscopic outcomes.
Relationships between estradiol, progesterone, and plasminogen activator inhibitor longitudinally during normal human pregnancy
Authors: STEIBER Z , SILVER DM , TOZSER J , BAGOSSI P , JAKAB A , BERTA A , CSUTAK A
Published: August 2012

Purpose To investigate the hypothesis that the plasminogen activator proteolysis cascade in the eye is controlled locally instead of systemically. During pregnancy, systemic blood levels of estradiol (E2), progesterone (P4) and plasminogen activator inhibitors (PAI) are expected to rise with gestational age; is there a consequent rise in PAI normally present in tears?

Methods PAI‐2 levels were measured, using Imubind ELISA, longitudinally from three to four tear samples collected from each of 13 women between 8 and 36 weeks of pregnancy. During the same visits, blood samples were analyzed for PAI‐2, E2 and P4. The analysis included successful results from 36 tear samples (PAI‐2) and 45 blood samples (PAI‐2, E2 and P4).

Results Increases in blood levels of PAI‐2, E2 and P4 occurred over the measured gestational period, significantly correlated with time and with each other (all R2>0.75). Tear levels of PAI‐2 did not increase and were not correlated with gestation or blood PAI‐2 (both R2<0.06).

Conclusion Our finding is that tear PAI‐2 levels are dissociated from the progression of pregnancy and the concommitant elevated systemic blood E2 and P4 hormone and PAI‐2 levels, indicating the possibility of local control of proteolysis in the eye, perhaps due to a blood‐brain barrier to the elevated systemic blood composition levels.
The Brittle Cornea Syndrome: Study of a family with five affected siblings
Authors: ALHARBI A , DENIS D , AZAR N , MAUMENEE IH
Published: August 2012

Purpose To define the natural history,genotype‐phenotype correlation and differential diagnosis of the Brittle Cornea Syndrome (BCS),or Ehlers Danlos Syndrome (EDS) type VIB,caused by mutations in ZNF469 and PRDM5

Methods We evaluated one family in which 5 out of 8 siblings suffered from BCS. We performed complete eye and systemic evaluations of the siblings and their parents. We sequenced the candidate gene,ZNF469

Results On ocular evaluation we found keratoglobus and thinned corneas that tended to perforate spontaneously,as well as refractive errors caused by high myopia and irregular astigmatism. Progressive thinning of the corneas with keratoglobus led to visual deterioration due to spontaneous perforations and scarring. K readings were above 60 D and corneal thickness below 300um in 4 eyes that had not developed perforation. Systemic manifestations included joint hypermobility,increased elasticity of the skin but no cigarette paper scars, kyphoscoliosis,and progressive conductive hearing loss. Cardiovascular disease was not observed.The systemic findings overlap the kyphoscoliotic type of EDS VIA,the ocular manifestations of which consist of flattened corneal curvatures,fluid vitreous,radial perivascular lattice. Patients with BCS are often diagnosed as having the Marfan syndrome,even though spontaneous perforation of the cornea is not a feature of the latter condition. A 14bp insertion was found in exon 2 of ZNF469

Conclusion EDS VIB is a connective tissue disease referred to as BCS; it is characterized by keratoglobus,thinned corneas and Marfanoid body habitus. Two causative genes for BCS have been identified to date,ZNF469 and PRDM5. A 14bp insertion was found in exon 2 of ZNF469. It is possible to provide genetic counseling in the extended family
NHS gene mutations in non syndromic cataract
Authors: HABAY T , LAUMONIER F , LALA E , SPEEG‐SCHATZ C , TOUTAIN A , PISELLA PJ
Published: August 2012

Purpose Many genes can be involved in congenital cataracts according to different inheritance pattern. NHS (Nance‐Horan Syndrome) gene is involved in a rare X‐linked syndromic cataract associating dental anomalies and facial dysmorphia. NHS gene mutations are essentially protein truncating mutations. Studies of gene localization show that non‐syndromic form of congenital cataract have a gene located in the same region as the NHS gene. The purpose of this study was to determine if others mutations of the NHS gene might cause non syndromic cataracts and to analyse the expression of NHS in lenses.

Methods Genomic DNA was isolated from white blood cells from 30 patients diagnosed with non syndromic congenital cataracts. When a surgery was performed, lenses were collected (n=10). The 11 exons of NHS gene were amplified from genomic DNA by PCR, and the amplicon were directly sequenced. NHS gene copy number anomalies were search by real time PCR. mRNA was extracted from the front capsule of lenses. After reverse transcription mRNA expression was analyzed by real time PCR.

Results We identified 6 punctual mutations of NHS gene in different patients : 2 missenses mutations, 3 frameshift mutations and one intronic mutation. The analyze of NHS copy number revealed in one patient a duplication of exons 4 to 8. We manage to extract and amplified NHS mRNA in the front capsule. One patient with a missense mutation has a relative low expression.

Conclusion We found 23% mutations of NHS gene in our cohort study. For some patients we can’t yet absolutely eliminate a Nance Horan Syndrom because of their young age. This high rate of mutations mean either the diagnostic of NHS is under evaluate or NHS gene is frequently involved in non syndromic cataracts.
Non‐syndromic retinitis pigmentosa: Phenotype‐genotype correlation in twelve Tunisian families
Authors: EL MATRI L , CHEBIL A , FALFOUL Y , LARGUECHE L , MUNIER F , SCHORDERET D
Published: August 2012

Purpose To evaluate the clinical phenotype of twelve families with non syndromic retinitis pigmentosa (RP), to characterize genes and mutations causing these conditions and to elaborate phenotype/genotype correlations.

Methods Ophthalmic examination and various visual tests were performed. DNA was analyzed using single nucleotide polymorphism, microsatellite genotyping and direct sequencing to determine the genes and mutations involved.

Results We identified 8 genes: RPE65, RDH12, USHER 2A, PDE6a, PDE6b, CRB1, NR2E3 and RGR. Many of the phenotypes were more prevalent with particular genes. Analysis of phenotype‐genotype correlation indicated that some genes were associated with specific phenotypes. In RPE65 mutations we found early onset dystrophy, nystagmus, keratoconus, white dot deposits in earlier stages and clumped pigment in later stages. The RDH12‐associated phenotype showed severe and early‐onset dystrophy, diffuse spicule pigmentation, macular edema and tomographic re‐organization of retinal lamination with thickened macula. CRB1 mutation was characterized by preserved para‐arteriolar retinal pigment epithelium and yellow round deposits in the posterior pole and there was no hemeralopia.

Conclusion RP is clinically and genetically heterogeneous.The two ultimate goals of research are to provide efficient clinical diagnostic of affected gene by phenotype‐genotype correlation and to design novel treatment regimes. Our aim is to create a specific chip for our population, and then future research will focus on the identification of the remaining causal genes, the elucidation of the molecular mechanisms of disease in the retina and the development of gene therapy approaches.
Vascular endothelial growth factor A genetic polymorphisms and AMD in Tunisians
Authors: EL MATRI L , HABIBI I , CHEBIL A , SFAR I , KORT F , GORGI Y
Published: August 2012

Purpose To determine whether vascular endothelial growth factor (VEGF) gene polymorphism plays a role in either susceptibility risk for exudative AMD, serum VEGF levels variations and treatment with intravitreal bevacizumab in Tunisians

Methods In this case–control study, we included 96 patients with exudative AMD and 207 age‐matched controls treated with intravitreal bevacizumab. Single nucleotide polymorphism (SNP) genotyping was performed using restriction fragment length polymorphism (RFLP) analysis of polymerase chain reaction (PCR) products. The serum VEGF was assayed by ELISA (R&D).

Results The frequency of the VEGF ‐2578 A allele was significantly higher in AMD patients than in controls (p=0.005; OR: 2.12[1.23‐3.66]) and was statistically associated to higher serum levels of VEGF (93.30 pg/ml versus 39.75 pg/ml for C allele) (p: 0.021). When examining the effect of this polymorphism on post‐treatment visual acuities (VA), we observed that A variant allele was also statistically more prevalent among patients with better outcome for distance and reading visual acuity after three bevacizumab injections compared to those with loss of 3 or more lines in visual acuity (OR = 2.5, 95% CI [1.13‐5.73], p = 0.02). Furthermore, the mean of VEGF plasma level is significantly higher (170.97 pg/ml) in patients with enhanced VA compared to those with worse outcome for distance and reading visual acuity (45.52pg/ml) (p=0.003).

Conclusion In addition to the higher risk for exudative AMD in Tunisian patients with the ‐2578 A VEGF, our results show that this allelic variant also correlates with better visual acuity outcome after treatment with bevacizumab probably through a functional or quantitative variation of plasma levels of this molecule.
Nailfold capillaroscopic examination and T786C endothelial nitric oxide synthase polymorphism in normal tension glaucoma patients
Authors: LUKASIK U , KOSIOR‐JARECKA E , BARTOSINSKA J , KOCKI J , WROBEL‐DUDZINSKA D , CHODOROWSKA G , ZARNOWSKI T
Published: August 2012

Purpose The purpose of this study was assessment of nailfold capillary changes and their possible relation to polymorphism of a gene encoding endothelial nitric oxide synthase (eNOS) in normal tension glaucoma (NTG) patients

Methods The study included 35 normal‐tension glaucoma (NTG) patients (23 female and 12 male). Capillaroscopic examination of the nailfold capillaries of II to V fingers of both hands was performed (before and after the cold provocation test) by means of a videocapillaroscope. T786C eNOS gene polymorphism was determined by RT‐ PCR methods.

Results 31 (88.6%) patients suffered from cold extremities. In 24 (68.5%) patients nailfold capillaroscopy was within normal limits, in 11 (31.5%) patients the results were abnormal, 4 (11.4%) of them mimicked changes observed in sclerodermia. The cold provocation test was positive in 43.5% of NTG patients. The patients with NTG presented the following nailfold capillaries: megacapilaries or dilatated capillaries (44.4%), ramified/bushy (18.9%), coiled (17.1%). Assessing the T786C polymorphism of eNOS gene in NTG patients, TT genotype was present in 36% patients, TC in 52.6% and CC in 11.3%. There were no correlation between SNP variants and capillaroscopy results nor cold provocation test ( p=0.9 and 0.5, respectively).

Conclusion The T786C polymorphism of eNOS gene does not influence the capillaroscopy results. The high incidence of sclerodermia ‐ like changes in capillaroscopy in NTG needs further studies.