bluuebunny/crossref_metadata_2025 huggingface dataset:
In vivo assessment of blue light attenuation of the crystalline lens and tinted and not tinted intraocular lenses
Authors: KONTADAKIS GA , TSIKA CI , PLAINIS S , MAKRIDAKI M , MOSCHANDREAS I , TSILIMBARIS MK
Published: September 2008

Purpose To compare lens absorption in vivo, as estimated by blue light luminance perception, of patients with tinted IOLs versus patients with clear IOLs, and with their status before cataract surgery.

Methods We tested 43 patients with variant density of nuclear senile cataract (18 had 0 to 1+ and 25 more than 1+), before and after lens extraction and IOL implantation. 21 received clear IOL and 22 the AcrySof® Natural (Alcon). The absorption of blue light was assessed by measuring the parafoveal relative sensitivity of blue‐green radiation using Heterochromatic Flicker Photometry (MPS 9000 QuantifEYETM, ZeaVision©).

Results Preoperative results indicate that blue light attenuation is increasing with age. The postoperative results show that tinted IOLs absorb significantly more compared to clear IOLs (p<0.001). The difference in postoperative absorption with tinted IOLs from preoperative status was not statistically signifficant (p=0.3), and in the group of patients with 0 to 1+ cataract density the preoperative with the postoperative absorption was similar (p=0.941). On the contrary, the absorption of clear IOLs was significantly reduced postoperatively in the low cataract density group (p<0.001) and also in the total group of patients (p<0.001).

Conclusion The tint may simulate the aged crystalline lens of patients with low cataract density in blue light attenuation.This may offer protection to the retina from the photochemical damage caused by high energy short wavelength radiation.
Comparison of parameters in cataract surgery between coaxial microincision and standard coaxial incision
Authors: GEORGET M , CARDON A , FAVARD A , CONTOUR S , ABID M , PISELLA PJ
Published: September 2008

Purpose To compare the outcomes of coaxial microincision cataract surgery (C‐MICS) versus standard coaxial cataract surgery.

Methods In a prospective study, 60 eyes of 30 patients with corticonuclear cataract were selected to have a crystalline lens extraction through a temporal clear corneal incision using either C‐MICS (30 eyes) or standard coaxial cataract surgery (30 eyes). C‐MICS was performed through a 1.8 mm incision, and coaxial standard cataract surgery through a 3 mm incision. In all cases, hydrophilic intraocular lens was implanted. Collected parameters during the surgery were total surgical time, ultrasound time, and total balanced salt solution used. Preoperative and postoperative parameters collected were refraction, visual acuity, slit lamp exams and endothelial cell counts with corneal thickness evaluation.

Results There was no significant difference in postoperative parameters between the 2 groups. On the other hand, there was a significantly lengthening of surgical total time and ultrasound time in MICS group.

Conclusion Although ultrasound and total surgical time were significantly higher in coaxial microincision cataract surgery, this technique appears to be as safe and efficient than standard coaxial cataract surgery.
Molecular genetic information ‐ impact on the family
Authors: CHURCHILL A
Published: September 2008

This talk will focus on the impact being given a diagnosis of genetic eye disease has on families. The first part will consider ways in which information can be given and received using examples, including questions that arise from knowing this information and issues surrounding confidentiality and consent. The second part of the talk will concentrate on issues surrounding predictive and pre‐natal genetic testing using examples from our Genetic Eye Clinic.
Doctor, my baby doesn't fix and follow
Authors: LEROY BP
Published: September 2008

Purpose To describe the phenotypes and genotypes of genetically determined disease leading to either abnormalities of, or complete absence of visual development in the first few years of life.

Methods A case presentation format will be used to illustrate different genetically determined conditions leading to delayed or absent visual development. Both clinical and electrophysiological phenotypes as well as genotypes will be discussed.

Results Phenotypes and genotypes of genetically determined diseases leading to delayed or absent visual development are very different. An important distinction to be made is the one between stationary and progressive diseases. Indeed, such distinction is important as the visual outcome varies considerably between those different conditions.

Conclusion Very diverse conditions may give rise to genetically determined abnormal visual development. Genetics and visual electrophysiology allows an important distinction between progressive and stationary conditions.
The effect of UVA and UVB irradiation of the rabbit cornea on matrix metalloproteinase 2 and 9 expression in the corneal epithelium
Authors: ARDAN T , CEJKOVA J
Published: September 2008

Purpose Matrix metalloproteinases (MMPs) synthetisized by corneal cells are primarily responsible for degrading and remodeling corneal stromal extracellular matrix. They participate in various pathophysiological processes in the cornea, including corneal wound healing and ocular diseases. Purpose of this study was to investigate the effect of UVA and UVB rays on the expression of matrix metalloproteinases (MMP‐2 and MMP‐9) in the corneal epithelium.

Methods In the first group of rabbits the corneas were irradiated with UVA lamp (365 nm, once a day during 4 days, a dose per day 1.01 J/cm2 ). In the second group of rabbits the corneas were irradiated with UVB lamp (312 nm, once a day during 4 days, a dose per day 1.01 J/cm2). Matrix metalloproteinases MMP‐2 and MMP‐9 were examined on cryostat sections immunohistochemically using mouse monoclonal anti‐MMP‐2 and anti‐MMP‐9 antibodies.

Results Immunohistochemical examination showed that UVA rays did not change the expression of MMPs studied in the corneal epithelium. In contrast, UVB rays induced the increased expression of MMPs in corneal epithelial cells. From both enzymes investigated in corneas irradiated with UVB rays the expression of MMP‐9 was more pronounced than the expression of MMP‐2.

Conclusion Comparing the effect of the same doses of UVA and UVB rays on the normal rabbit cornea, UVB rays /not UVA rays/ evoked the increased expression of MMPs in the corneal epithelium. To investigate the importance of these findings is the aim of our next study.
Atypical inflammatory lesions in the orbit and adnexae
Authors: BRISCOE D , TON Y , KIDRON D
Published: September 2008

Purpose The common use of an initial systemic steroid treatment trial in orbital and adnexal inflammatory disease is now more questionable and used less frequently. The increased availability of specialized oculoplastic and orbital surgeons has enabled us to biopsy masses of the orbit routinely in recent years. As a result unusual pathology appears more commonly than expected in previous years. We reviewed the diagnosis and presentation of unusual inflammatoty lesions of the orbit biopsied over the past 8 years in our oculoplastic and orbital clinic. Some interesting representative cases are presented.

Methods A search of the operation register and recorded diagnosis of pathology specimens was carried out and a retrospective review was made of all patients with unusual orbital inflammatory lesions presenting at the oculoplastic surgical service in Meir Medical Center between 1999 and 2008. All cases had CT imaging of the orbits and underwent biopsy of the lesion. Pathology examination was performed on all specimens following biopsy.

Results There were 5 cases of non caseating granulomas in the Orbit, 1 case of Churg Strausse syndrome, 2 cases of lymphoid hyperplasia, 1 case of infectious mononucleosis dacryoadenitis, 2 cases of Eosinophillic Granuloma, 1 case of malignant schwannoma, 2 cases of angiolymphoid hyperplasia, 1 case of Sclerosing type idiopathic orbital inflammatory disease and 1 orbital abscess with an unusual presentation

Conclusion We recommend biopsy of all orbital inflammatory masses before beginning treatment with steroids. Unusual pathology is more likely than expected and may have significant implications for the well being of patients.
Temperature‐ and osmosensing by the human corneal endothelium through activation of TRPV channels
Authors: MERGLER S , VALTINK M , ENGELMANN K , PLEYER U
Published: September 2008

Purpose The human corneal endothelium is essential for the physiology and transparency of the cornea. This is sustained by a number of different regulatory mechanisms and response to various stimuli. Exposure to hypotonic challenge and temperature changes may have major impact. This study was undertaken to identify such possible stimuli pathways in human corneal endothelial cells (HCEC).

Methods The functional expression of putative temperature‐ and osmosensing ion channels was investigated by measurements of intracellular free Ca2+ ([Ca2+]i) with fura‐2 and automated patch‐clamping (microchip technology). Highly selective agents were used to identify TRPV channel subtypes in an immortalized HCEC population (HCEC‐SV40) and two subcloned cell lines (H9C1, B4G12).

Results The TRPV1 selective agonist capsaicin (20 µM) increased [Ca2+]i and non‐selective cation channel outward currents. Cells pre‐treated with the antagonist capsazepine (10 µM) did not show any Ca2+ responses. Similar results were obtained with the TRPV4 selective agonist 4α‐PDD (5 µM) and the TRP channel blocker ruthenium red (10 µM). In addition, exposure to hypotonic challenge (150 mOsm) led to an increase in [Ca2+]i whereas the isotonic baseline (control) was stable. Furthermore, temperature rises from room temperature to 40‐43 °C led to an increase in [Ca2+]i in HCEC‐SV40 and H9C1.

Conclusion There is functional expression of TRPV channels in HCEC. Therefore, these cells are able to react to temperature rises by activating of TRPV channels. In particular, TRPV1 and TRPV4 may be functionally expressed which are known as heat receptor and osmosensor respectively. These findings may have direct clinical implication (eye banking procedures, keratoplasty).
Refractive changes after pterygium surgery
Authors: MATEO OROBIA AJ , IBANEZ J , LAFUENTE N , PEREZ D , PEIRO C , DEL BUEY MA , CRISTOBAL JA
Published: September 2008

Purpose To study the relationship between pterygium size (extension, width) and corneal astigmatism in eyes with unilateral primary pterygium. To evaluate the effect of successful pterygium surgery on corneal topography

Methods Computerized corneal topography was performed on 105 eyes with pterygium before and 3 months after successful excision and limbo‐conjunctival autograft surgery.

Results The degree of corneal astigmatism significantly correlated with the extension of pterygium on the cornea. With‐the‐rule astigmatism was the more frecuently finding.

Conclusion Corneal topographic changes caused by the pterygium are almost reversible after surgical treatment. Successful pterygium surgery significantly reduces topographic astigmatism, SRI, SAI, and corneal flattening. However, precise prediction of these refractive changes is not always accurate.
Confocal microscopy after descemet stripping automated endothelial keratoplasty (DSAEK): morphological findings in short term follow up
Authors: SAVASTANO A , SBORDONE S , PICCIRILLO V , FORTE R , TAMBURRINI L , SAVASTANO MC , SAVASTANO S
Published: September 2008

Purpose To evaluate the clinical findings, visual outcomes, and confocal microscopic corneal features after DSAEK in Fuchs endothelial dystrophy.

Methods A 70‐year‐woman patient with pseudophakia and Fuchs endothelial dystrophy underwent small‐incision DSAEK surgery. Best spectacle corrected visual acuity (BSCVA) was 1.30 (20/400) logMAR (Snellen) before treatment. Confocal scanning microscope (ConfoScan 4, Nidek Technologies, Padova, Italy) was performed before surgery procedure, after 7 days, at 1 and 6 months after DSAEK. Images of corneal structures, including endothelium, donor and recipient stroma were obtained. Endothelium density was evaluated using manual count and 40x probe.

Results BSCVA improved at 0.3 (20/40) log MAR (Snellen) at 6 months. No astigmatism change was recorded at the end of follow‐up. Endothelial cell density was about 850 cells/mm2 after 6 months surgery procedure. Interface and donor stroma reflectivity were highest at 7 days showing progressive decrease over time.

Conclusion The DSAEK procedure represents a promising alternative to conventional penetrating keratoplasty (PK) for patients with Fuchs’ dystrophy. Confocal microscopy is able to detect precise evaluation of corneal features, interface morphologic characteristics and reflectivity to improve therapeutic choice and to understand the pathophysiology of visual recovery.
Donor tissue detachment after descemet stripping automated endothelial keratoplasty (DSAEK): a 35 mhz probe ubm study
Authors: SAVASTANO A , SBORDONE S , VALERIO P , FORTE R , TAMBURRINI L , SAVASTANO S
Published: September 2008

Purpose To evaluate the UBM role in cases of donor lamella detachment after DSAEK using a 35 MHz probe and immersion technique.

Methods Two patients ,a 68 yo woman and a 70 yo man,underwent to uncomplicated DSAEK for bullous keratopathy.An initial corneal clearing was observed in the first 48 hours followed by a progressive increase of corneal oedema causing a difficult evaluation of donor lamella and anterior chamber structures. In one case,an acute glaucoma occurred.Ecographic evaluation was performed with 35 MHz probe and immersion technique(Hi Scan Ecographer,Optikon 2000,Rome,Italy ).Six scans centered on the cornea and 30 degrees angled were aquired in order to obtain a topographic map.

Results UBM allowed to distinguish between two morphological patterns according to donor lamella’s position: partial detachment(PD)(double chamber appearance without lammela’s dislocation)or total detachment(TD)if associated to donor graft dislocation. In the case complicated by acute glaucoma , a pupillary block caused by a PD was seen.The main UBM findings were:donor lamella tickening with high hyporeflectivity of recipient stroma due to oedema .

Conclusion The donor lamella detachment is the main complication of DSAEK procedure . Posterior lamella and anterior chamber evaluation may be difficult in this cases due to corneal oedema.UBM allows to distinguish between partial and total detachment of posterior lamella and main related complications;trought a topographic map,it offers informations usephul to the reattachment surgical strategy.
Ultrastructural organisation of arthritis corneal stroma
Authors: AKHTAR S , ALMUBRAD TM , OGBUEHI KC , BONSHEK RB
Published: September 2008

Purpose Normal corneal stroma consists of uniformly organised collagen fibrils regulated by corneal proteoglycans. The focus of the study is the ultrastructural organisations of the collagen fibrils and proteoglycans in patients suffering with corneal melting due to rheumatoid arthritis (RA).

Methods Corneas of two patients (ages 50 & 61 years) suffering from RA were fixed in 2.5% glutaraldehyde containing cuprolinic blue in sodium acetate buffer. The tissue were dehydrated in a graded series of ethanol and embedded and polymerised in spurs resin. The sections were studied under an electron microscope.

Results The epithelial cells were degenerated and Bowman’s layer was replaced by fibrous pannus containing large abnormal proteoglycans and lucent spaces. In the stroma, longitudinally running collagen fibrils were curled and fused to each other. In cross section, collagen fibrils were not rounded and were separated with large spacings. Large proteoglycans and lucent spaces were present throughout stroma. The Descemet’s membrane was followed by posterior collagenous layer. Degenerated keratocytes were present in the pannus and throughout the stroma.

Conclusion The collagen fibrils and proteoglycans were severely degenerated which resulted in the disorganisation of the corneal stroma. We believed that due to the disease, alteration in keratan sulphate and chondroitin sulphate might occur which possibly affected the structure of the corneal proteoglycans (lumican, keratocan and mimican) which were responsible for the collagen fibrils organisation.
Analysis of visual outcome with rigid contact lenses in keratoconic eyes
Authors: KOPITO R , WAJEMAN S , GAUJOUX T , TOUZEAU O , LAROCHE L
Published: September 2008

Purpose To analyze the variation of best corrected visual acuity (BCVA) obtained with rigid gas permeable (RGP) lenses in keratoconic eyes compared to best spectacle‐corrected visual acuity (BSCVA).

Methods We prospectively recorded visual acuity data (BSCVA and BCVA with RGP), subjective refraction, keratometric readings and lens geometry in 135 eyes of 78 patients with keratoconus. Acuity data was converted into LogMAR units for statistical analysis. BSCVA was compared to BCVA with RGP lenses, and the differences were correlated with all parameters.

Results The decimal BSCVA and decimal BCVA with RGP lenses was 0.36 (0.44 LogMAR, 20/56) and 0.70 (0.15 LogMAR, 20/29), respectively. The mean difference after RGP lens fitting was +2.83 lines ±2.55 (range 0‐11.6). The gain was superior to 1 line in 70%, 3 lines in 40% and 6 lines in 16%. The difference was correlated with the BSCVA (rS=0.90 p<0.001), mean keratometry (rS=0.33 p<0.001), subjective cylinder (rS=0.26; p<0.001). The difference remained unaffected by age and sex (p≥0.31). The difference was correlated with the lens radius rO (rS=0.27; p=0.002) and the lens power (rS=0.25; p=0.003). The lens diameter did not affect the variation in visual acuity (rS= ‐0.04; p=0.62).

Conclusion There was a significant increase in visual acuity with RGP lenses compared to BSCVA: the lower the initial BSCVA, the better the gain with RPG lenses. The gain was independent of the patients’ age. The eccentricity of the keratoconus did not influence the visual outcome with RGP lenses.
Comparison of metabolic profile of normal and keratoconus corneas using HR MAS 1HNMR spectroscopy and HPLC
Authors: KRYCZKA T , EHLERS N , MIDELFART A
Published: September 2008

Purpose The aim of this study is to examine possible differences in the metabolic profile between keratoconus and normal corneas.

Methods Samples of corneas with keratoconus were obtained during the transplantation surgery from 3 patients (age: 22‐27 years). The control corneal tissues were excised during enucleating of eyes with malign melanoma in the retina from 4 patients (age: 65‐72 years). The samples were immediately frozen at ‐80 ºC. The metabolic profiles of the samples were investigated either with HR MAS (High Resolution Magic Angle Spinning) 1H NMR (Nuclear Magnetic Resonance) spectroscopy (14.1 T) operating at 600.132 MHz and HPLC (High Performance Liquid Chromatography). All data obtained with both methods were analysed using special software for: (i) analysis of complex mixtures, (ii) principal component analysis – PCA, (iii) detailed statistical analysis.

Results In all samples, 9 amino acids were detected with HPLC, and 19 metabolites (including amino acids) with HR MAS 1H NMR spectroscopy, respectively. PCA analysis of NMR spectra showed no grouping pattern between the keratoconus and control samples. Detailed analysis of data obtained with NMR spectroscopy and with HPLC revealed no significant differences in amino acid profiles between keratoconus and control corneas.

Conclusion The study presents metabolic profiles of human cornea examined with new approach combining NMR spectroscopy and HPLC. Significant differences in the metabolic profiles of corneas with keratoconus and healthy corneas examined with both methods were not revealed. Small number of samples analysed in this study represents a limitation of the results, and further investigation will be performed to focus on particular metabolites.
The roles of T and natural killer cells in a pig‐to‐mouse corneal xenotransplantation
Authors: OH JY , KWON JW , HAN ER , WEE WR , LEE JH , KIM MK
Published: September 2008

Purpose To determine the role of T cells and natural killer (NK) cells in mediating corneal xenograft rejection of a pig‐to‐mouse model.

Methods Pig corneas were orthotopically transplanted to C57BL/6, Balb/c‐nu and CB.17 SCID mice with or without NK depletion. NK cells were depleted by an intraperitoneal injection of anti‐NK1.1 mAb three days before and one day after transplantation. Graft survival was clinically assessed by slit‐lamp microscopy, and median survival times (MST) were calculated. The rejected grafts were histologically evaluated.

Results The pig corneal xenografts were acutely rejected by C57BL/6 mice (MST 7.00±0.61 days), while Balb/c‐nu and CB.17 SCID mice rejected pig corneas in more delayed fashion (MST 14.00±0.77 and 15.00±0.58 days, respectively). NK depletion failed to a further prolongation of the pig corneal xenograft survival in Balb/c‐nu mice. The rejected grafts in C57BL/6 mice were heavily infiltrated with inflammatory cells, the majority of which were macrophages. Many CD4+ T cells were observed, but either CD8+ T cells or NK cells were rarely found. In contrast, the grafts in Balb/c‐nu mice had markedly decreased inflammatory infiltration with small amounts of macrophages and CD4+ T cells, and the infiltration was further reduced in CB.17 SCID mice.

Conclusion Acute rejection of the pig corneal xenografts in mice is not solely a consequence of an adaptive immunity although CD4+ T cells play an important role in the graft rejection. Other innate immune effectors than NK cells seem to be involved in the rejection of a pig‐to‐mouse corneal xenotransplantation.
Tear meniscus height and lipid layer pattern in seasonal allergic conjunctivitis patients outside the season
Authors: HAGYO K , VERES A , FODOR E , LANG ZS , MEZEI GY , KRASZNAI M , CSAKANY B , NEMETH J
Published: September 2008

Purpose to exam whether the previously published tear film abnormalities in allergic season remain outside the season in patients with seasonal allergic conjunctivitis (SAC).

Methods Thirty seven subjects’ (21 female, 16 male, mean age 27.2 ± 6.5 years) right eye were examined. Twenty three normal subjects and 14 asymptomatic allergic patients with positive allergic prick test were examined outside the season. All allergic patients had allergic symptoms at least during two earlier ragweed seasons. The tear film lipid pattern and tear meniscus height (TMH) were determinate with Keeler Tearscope Plus. The lipid pattern and the tear meniscus were recorded five times in each subject after a blink and three independent observers evaluated the photos. The lipid pattern was graded according to the user manual of Keeler Tearscope Plus. The non invasive tear break time (NIBUT) was also measured.

Results The mean TMH were 0.204 ± 0.048 and 0.234 ± 0.101 mm in normal and allergic patients, respectively. The lipid patterns were in normal range in control and allergic patients except 1 normal and 1 allergic participant. There were no significant differences in TMH and lipid patterns between allergic and control subjects. The mean NIBUT were 17.0 ± 8.4 and 21.5 ± 10.1 seconds in normal and allergic group, and did not correlate with TMH and lipid pattern.

Conclusion Outside the ragweed season the patients with SAC had healthy tear film status similar to normal patients. The allergic ocular inflammation during the season did not induce traceable tear film abnormalities outside the season.
Occult traumatic nasolacrimal duct obstruction causing anophthalmic socket contraction presenting 20 years later
Authors: SAEDON H , CHEUNG D
Published: September 2008

Purpose To highlight undiagnosed nasolacrimal duct obstruction as a cause of multiple problems related to conjunctival cicatrisation of the anophthalmic socket and the importance of early diagnosis and treatment in their prevention.

Methods Case report with high resolution digital clinical photography.

Results We present a 43 year old Asian gentleman, who sustained penetrating trauma to the right globe and midface in 1984. At the time, he underwent primary repair of the globe, followed by enucleation. Over the next ten years, he suffered myriad problems with recurrent entropion and trichiasis of upper and lower lids, a dry socket with an uncomfortable artificial eye and chronic mucoid discharge. Twenty years later his initial diagnosis was revisited. On examination, he had a contracted socket with mucosal keratinisation, cicatricial entropion of the eyelids, forniceal shortening and mucoid discharge. There was also nasolacrimal duct obstruction with an occult mucoceole. He underwent external dacrocystorhinostomy with correction of the entropions and anophthalmic socket refashioning. He remains symptom free twelve months following surgery.

Conclusion Contracted anophthalmic sockets can occur spontaneously or secondarily to a disease process. These may lead to changes in tear composition and have pro‐inflammatory effects on the ocular surface. We hypothesise that the chronic toxic tear film secondary to the mucocoele led to chronic conjunctivitis with cicatrisation over time and multiple structural lid & socket problems that ensued. This case highlights the importance of looking for occult causes of chronic cicatrisation in the anophthalmic socket.
The use of intralesional injection of 5 fluorouracil to induce regression of recurrent pterygium
Authors: RAHMAN I , JAYASWAL R , TINT NL , DUA HS , MAHARAJAN VS
Published: September 2008

Purpose To investigate the benefit of intralesional injections of 5FU for the treatment of recurrent pterygium

Methods Retrospective case note review of patients following surgical excision for pterygium identified 6 patients with recurrence treated with 0.1‐0.2ml (2.5‐5mg) of intralesional 5 FU post operatively. The time to recurrence, post recurrence injections, grade of pterygium pre and post treatment and time to regression were identified.

Results The study group consisted of 5 male and 1 female patients, affecting 6 right eyes. 3 patients developed primary recurrence. The other 3 patients had previous surgery with recurrence followed by further surgical excision and repeat recurrence. The average grade of recurrence was 3.5. All 6 patients showed regression of the fibrovascular tissue following intralesional 5FU injections with an average dose of 0.1‐0.2 ml (2.5‐5mg). 5 patients required 3 injections or less for regression, whilst one patient required 14 post recurrence 5FU injections. The average grade following regression was 1.7. This level of regression was maintained at an average of 9 months follow‐up. No complications of 5FU were reported.

Conclusion The use of 5FU for the treatment of recurrent pterygium is safe and effective in limiting both progression and inducing regression of recurrent pterygium.
Are Ocular Response Analyzer useful to measure corneal hysteresis in patients with intracorneal rings?
Authors: MENEZO ROZALEN JL , PERIS‐MARTINEZ C , ARTIGAS JM , DIEZ AJENJO M , FELIPE A
Published: September 2008

Purpose Corneal hysteresis is a viscoelastic property characterized by the difference in behavior under loading and unloading. The aim of the study was to determine corneal hysteresis in different eyes: healthy eyes, keratoconic eyes and keratoconic eyes after intracorneal ring implants.

Methods This study comprised 95 eyes of 59 patients. The study population was divided into 3 groups. We analyze 30 healthy human eyes, 35 keratoconic eyes (Amsler grade II‐III) and 30 keratoconic eyes after intracorneal rings implantation. Corneal biomechanical properties of these eyes were measured with the Ocular Response Analyser (ORA‐Reichert) according to two parameters: corneal hysteresis (CH) and corneal resistance factor (CRF. The unpaired T student test was used for statistical analysis.

Results Mean CH and CRF in normal eyes (10.78 ± 1.6 (SD) mm Hg, 11.91 mm Hg ± 1.2) was clearly superior than in keratoconus group (8.01 ± 1.5 mm Hg, 7.32 ±1.8 mm Hg). However the difference of these parameters between keratoconus group without intracorneal rings and after corneal ring implantation (7.27mm Hg, 6.32 mm Hg) was not statistically significant (p ≤ 0.01). Mean follow‐up period was of one year.

Conclusion Corneal hysteresis and CRF values were significantly lower in keratoconic eyes than in normal eyes. But there is no marked differences if we compare these two biomechanical parameters in keratoconic corneas, before and after corneal ring implants. Improvements in the software accuracy of the ORA devices are needed to characterize corneal biomechanics.
Assessment of visual outcomes of deep anterior lamellar keratoplasty (DALK)
Authors: RAHMAN I , JAYASWAL R , DUA HS , MAHARAJAN VS
Published: September 2008

Purpose To evaluate visual outcomes following Anwar's 'Big Bubble' technique for deep anterior lamellar keratoplasty (DALK)

Methods Retrospective Case note review of all patients who were treated with DALK in a single university teaching hospital in the UK between January 2004 and December 2007. The main outcome measures were intra operative and postoperative complications, graft clarity and best corrected visual acuity.

Results The study group consisted of 37 eyes of 36 patients (21 male, 15 female). Average age of the cohort was 34.5 years (range: 16 ‐‐ 65), with a mean follow‐up of 20.4 months (range: 6 ‐‐ 46) Keratoconus was the most common indication for attempted DALK (65%). Big bubble was achieved in 62% of cases with microperforations in 14%. A further 14% needed to have manual dissection. Clear Graft Host interface was achieved in 87% of cases where the big bubble was achieved and 76% gained best corrected visual acuity (BCVA) of >6/12.

Conclusion DALK offers visual outcomes similar to that of a penetrating keratoplasty and should be offered to all patients with a healthy endothelium undergoing corneal transplantation.
Conjunctival impression cytology as a tool for clinical diagnosis, follow‐up and treatment of a patient affected by severe keratoconjunctivitis
Authors: PASTOR S , RODRIGUEZ‐PRATS JL , WALEWSKA‐SZAFRAN A , RODRIGUEZ AE , ALIO SANZ JL
Published: September 2008

Purpose To use Conjunctival Impression Cytology (CIC) as a tool for the diagnosis, follow‐up and treatment decision of a patient affected by severe keratoconjunctivitis after exposure to alkali.

Methods A 48 year‐old female patient affected by severe keratoconjunctivitis on her right eye after air exposure to alkali was monitored by CIC. Polyether sulphone filter papers were used to obtain samples from the superior (SB) and inferior bulbar (IB) conjunctiva from the affected eye and stained by PAS‐Giemsa staining to reveal the status of goblet cell (GC) population. After observing a dramatic decrease of GC by CIC, we decided to perform a limbal‐conjunctiva autograft transplantation from the healthy left eye (LE) to the affected right eye (RE).

Results CIC helped in the diagnosis, treatment and follow‐up of a patient affected by severe keratoconjunctivitis after alkali exposure. The decision to perform a limbal‐conjunctival autograft transplantation came after CIC results. This procedure resulted in a significant increase in GC density going from 30 cells / mm2 to 362 cells / mm2 on IB and from 0 cells / mm2 to 430 cells / mm2 on SB conjunctiva of the transplanted right eye, 1 month after the surgery.

Conclusion CIC is a very useful tool for the diagnosis and follow‐up of cases of severe keratoconjunctivitis providing very relevant information about the status of GC and helping with the decision of the treatment to follow.
The effect of four commercially available preserved and unpreserved prostaglandin analogues on human corneal epithelial and human conjunctival epithelial cells in vitro
Authors: UUSITALO HMT , HUHTALA A
Published: September 2008

Purpose Four commercially available ophthalmic preparations of prostaglandin analogues: latanoprost, travoprost, bimatoprost, and the more recently developed prostaglandin analogue tafluprost as a BAC‐free unit dose formulation, were tested for cytotoxicity using cell culture methods.

Methods The cells were exposed to eye drop concentrations diluted 0.1%‐10% in culture medium without fetal bovine serum for one hour. Correspondingly, the cells were exposed to 0.00008%‐0.005% BAC in serum‐free medium for one hour. Cytotoxicity was assessed by measuring mitochondrial activity with the tetrazolium salt WST‐1 assay for cellular growth and viability, and by measuring the lactate dehydrogenase (LDH) leakage in the culture medium.

Results The order of decreasing cytotoxicity of the tested drugs, assessed with the WST‐1 test, was latanoprost > travoprost > bimatoprost > tafluprost. Conjunctival epithelial cells appeared to be more sensitive than corneal epithelial cells. The EC50 value of BAC, assessed with the WST‐1 assay, was 0.0013% in corneal epithelial cells and 0.00047% in conjunctival epithelial cells. In corneal cells, only the commercial preparation of latanoprost with the highest concentration tested (10%) increased LDH leakage. In conjunctival cells, LDH leakage was also very minor and was statistically significant only after 3‐10% travoprost and 10% latanoprost exposures.

Conclusion The cytotoxic effects of the commercially available formulations of latanoprost, travoprost, and bimatoprost were dependent on the BAC concentration of the eye drop. Preservative‐free tafluprost had the least cytotoxic effects of the drugs tested.

Commercial interest
Dietary prevention of visual function and cognitive decline by omega‐3 polyunsaturated fatty acids in senescence accelerated mouse P8 (SAM P8)
Authors: ACAR N , GREGOIRE S , MORANIS A , LABROUSSE V , PASQUIS B , JOFFRE C , BRON AM , CREUZOT CP , BRETILLON L , LAYE S
Published: September 2008

Purpose Cerebral and retinal neurons contain high amounts of omega‐3 polyunsaturated fatty acids and especially docosahexaenoic acid (DHA). DHA levels decrease in the aging brain together with the cognitive performances. We evaluated the effects of a dietary supplementation with DHA on mood, cognition and visual functionality in a mouse model for aging, the SAM P8.

Methods SAM P8 and control animals were fed from weaning until 12 months of age with a standard diet or a diet supplemented with DHA (6%). After 5 and 12 months of diet, we evaluated the scotopic ERG, the working memory and the despair behaviour. The fatty acid content of the retina and the brain were determined by gas chromatography.

Results DHA supplementation led to its significant incorporation in the retina and the brain. An age‐related loss of the ERG b‐wave amplitude was observed from 5 to 12 months of age in control SAM P8 whereas this visual impairment was prevented by DHA supplementation. Dietary DHA supplementation reduced the despair behaviour of control mice but not that of SAM P8.

Conclusion Dietary supplementation of DHA increased its retinal and cerebral incorporation. DHA successfully prevented the age‐related loss of visual function in SAM P8 but did not improve the depression‐like symptoms.
Choroidal blood flow variations to gas in healthy young subjects before and after intermittent hypoxia
Authors: KHAYI H , TONINI M , TAMISIER R , GEISER M , PEPIN JL , LEVY P , ROMANET JP , CHIQUET C
Published: September 2008

Purpose To evaluate the effect of 14‐day intermittent hypoxia on the response of the sub‐foveal choroidal blood flow (ChBF) after gas inhalation, in healthy subjects. Recent studies have emphasized the effect of the obstructive sleep apnea (OSA) on CO2 vasodilatation and O2 vasoconstriction. A human model of OSA has been developed in our laboratory with healthy subjects submitting to intermittent hypoxia during 14 consecutive nights. The aim of our study was to determine if these subjects exhibit a dysregulation in ChBF response during and after exposition to intermittent hypoxia.

Methods The ChBF was measured before, at the end (D14) and 5 days after the period of exposition to intermittent hypoxia. ChBF was measured using laser Doppler flowmetry (LDF) in 6 healthy young volunteers exposed to night time intermittent hypoxia. We measured the variations in ChBF during 10 minutes of air inhalation (placebo), 100% O2, and carbogen (8% CO2) at each visit

Results The ChBF response to carbogen was considered as normal (increase of 11%) before the exposition to intermittent hypoxia, and was reduced at the end (+5%) and after the exposition (+5%). The response to 100% O2 in these subjects was not altered by the exposition to intermittent hypoxia. Using placebo, the ChBF remained unchanged at each visit. The sensitivity of the ChBF measurement was 6 %.

Conclusion Healthy subjects exposed to intermittent hypoxia exhibit an altered response of ChBF to carbogen. This CO2 responsiveness could be related to an alteration of the nitric oxide synthase expression.
Philatelic aspects on WHO Year Glaucoma 2008
Authors: SVEDBERGH BOC
Published: September 2008

Purpose WHO dedicates anno 2008 to Glaucoma. Here we like to present philatelic aspects from Hippocrates to modern Glaucoma Screening, spiced with issues of stamps in 2008.

Methods Collecting stamps.

Results To be seen.

Conclusion Philatelic/historical aspects of glaucoma may induce a humble view.
Posterior sub‐tenon injection of triamcinolone acetonide as a pretreatment of focal laser photocoagulation for diabetic macular edema
Authors: OGATA N , SHIMA C , MINAMINO K , YOSHIKAWA T , MATSUYAMA K , MATSUMURA M
Published: September 2008

Purpose To determine whether a posterior sub‐Tenon injection of triamcinolone acetonide (TA) before focal photocoagulation is a safe and effective treatment for diabetic macular edema.

Methods Sixteen eyes of 11 diabetic patients with unresolved diffuse macular edema were treated with a 20 mg sub‐Tenon injection of TA 1 to 2 months before focal photocoagulation. Focal photocoagulation was applied only to microaneurysms, and grid laser photocoagulation was not performed. The main outcome measures were visual acuity (VA), the optical coherence tomographically (OCT)‐determined central macular thickness (CMT), and the fluorescein angiographic appearance of the retina. Patients were followed for at least 6 months.

Results One month after the sub‐Tenon injection of TA, the macular edema was resolved with a significant reduction of the CMT by OCT. The VA was slightly improved. Subsequent focal photocoagulation of the microaneurysms maintained the significant reduction of CMT for up to 6 months. A significant improvement of VA was observed in 37.5% patients at 6 months, and no patient had a decrease of VA.

Conclusion A 20 mg of sub‐Tenon's TA injection prior to focal laser photocoagulation is a safe and beneficial treatment for diabetic macular edema.
Calcium dobesilate prevents changes in tight junction proteins in the retina induced by diabetes
Authors: LEAL EC , MARTINS J , CHIAVAROLI C , CUNHA‐VAZ J , AMBROSIO AF
Published: September 2008

Purpose Calcium dobesilate has been found to correct the excessive vascular permeability associated with diabetes in the retina of diabetic patients and in experimental diabetes. However, the molecular mechanisms underlying these effects are not elucidated yet. In this study, we investigated the potential protective effect of calcium dobesilate against changes in tight junction proteins (occludin, ZO‐1 and claudin‐5) induced by diabetes in the retina.

Methods Diabetes was induced by an intraperitoneal injection of streptozotocin (65 mg/kg) in two months old male Wistar rats (1 month diabetes duration). The animals were divided in three groups (7‐8 animals/group): control, diabetic, diabetic treated with calcium dobesilate (100 mg/kg/day; orally given) during the last 10 days of diabetes. The protein levels and distribution of the tight junction proteins were evaluated by western blotting and immunohistochemistry, respectively.

Results Diabetes decreased occludin and claudin‐5 protein levels (65.2 ± 7.6% and 63.2 ± 5.4% of the control, respectively) in the retina. ZO‐1 levels were unchanged, but its distribution in retinal vessels was altered in the retinal vessels of diabetic animals. The treatment with calcium dobesilate prevented the changes in tight junction proteins induced by diabetes.

Conclusion In conclusion, calcium dobesilate is able to prevent changes in tight junction proteins in retinal vessels induced by diabetes, which may explain its beneficial effects against diabetes‐induced blood‐retinal barrier breakdown. Support: OM PHARMA, Switzerland
A pilot study of prevalence of diabetic retinopathy in diabetic patients using non‐mydriatic retinography and telemedicine
Authors: CASTRO MCR , VLEMING EN , TEUS M
Published: September 2008

Purpose To asses whether the use of non‐mydriatic retinography and telemedicine is an adequate method of screening DR in diabetic population

Methods We included all patients suffering from type I, type 2 noninsulin dependant and type 2 insulin dependant diabetes whose ocular fundus were examined in the specialist care center. A 3 field non‐stereoscopic retinographies were taken both eyes and an ophthalmologist at hospital evaluated the presence of DR and its severity.

Results 81.2% of the subjects examined had no DR, 10.20% had mild non‐proliferative DR, 7.24% had moderate non‐proliferative DR and 0.15% had severe non‐proliferative DR. The approximate prevalence of DR in area sanitaria 3 was 18.8%. 7, 12% of the examinations were invalid and the patients required mydriatic examination at hospital.

Conclusion The use of non‐mydriatic retinography and telemedicine is an adequate method for the screening of DR in diabetic population.
Metabolic memory puzzle and progression of diabetic retinopathy
Authors: KOWLURU R
Published: September 2008

Purpose Retinopathy is one of the most feared complications of diabetes. Good glycemic control can inhibit its development, but the effects of good glycemic control on the progression of retinopathy are not immediate. Diabetic patients may take years after re‐establishment of good glycemic control to show signs of arrest of its progression. Further, good glycemic control after a profound period of poor glycemic control does not immediately benefit the progression of retinopathy, and the imprinted effects of prior glycemic control produce the long lasting benefits of good glycemic control, thus suggesting a ‘metabolic memory’ phenomenon.

Results Animal models of diabetic retinopathy, including dogs and rats, have duplicated this metabolic memory phenomenon. In rats, histopathology associated with diabetic retinopathy does not stop for at least six months when good glycemic control is initiated six months after induction of diabetes. Increase in retinal oxidative stress and peroxynitrite levels and activation of apoptosis execution enzyme‐caspase‐3 resist reversal after re‐institution of good glycemic control. Hyperglycemia‐induced inactivation of retinal glyceraldehyde dehydrogenase that is postulated to activate some of the key pathways associated with the development of diabetic complications remains inactive and covalently modified, and pro‐inflammatory markers elevated.

Conclusion This suggests that the process of metabolic memory is complex, and multiple pathways contribute to this resistance of diabetic retinopathy to arrest. Understanding the mechanism responsible for the tendency of diabetic retinopathy to progress after reestablishment of good glycemic control should help reveal targets for therapies to prevent its progression.
Utility of retinal photography in the diagnosis of diabetic macular edema
Authors: IBANEZ J , MATEO OROBIA AJ , PEIRO C , PEREZ D , VALYI S , ROJO M , SAINZ A , CRISTOBAL JA
Published: September 2008

Purpose To determine the validity of the simple photography and stereo photography in the diagnosis of diabetic macular edema.

Methods Photographies were realized of 427 eyes of diabetic patients, previously dilated with tropicamide eye drops. The color and green filtered 45º and 30º photographies were centered on the posterior pole. Considering the difficulty of the detection of retinal thickenning on a flat photo, we decided to realize two photos to achieve stereopsis. This permits an easier perception of retinal thickening. Sensibility and specificity were compared of the photos to determine the validity in the diagnosis of diabetic macular edema. We used the optical coherence tomography (OCT) as the gold standard test.

Results We obtained approximately an 80% sensibility for the detection of diabetic macular oedema (45 º color photos,45 º green photos, 45 º stereoscopic green photos, 30 º stereoscopic color photos and 30 º stereoscopic green photos ). With the 30 º stereoscopic green photos we achieved a sensibility of 94%. The specificity reached values close to 95%. The coefficients of interobserver agreement were at 80%.

Conclusion The stereoscopic color photos, the 30 º green photos and both the 45 º and 30 º stereoscopic green photos offer sufficient sensibility and specificity to be used for the diagnosis of diabetic macular edema.
Modern exploration of choroidal inflammation
Authors: HERBORT C
Published: September 2008

Purpose The choroid is the site of intraocular inflammation as often as the retina. Because choroidal structures were not accessible to sensitive and performing investigational procedures, analysis of inflammatory events lagged behind. This was at the origin of the inadequate appraisal of choroiditis and the use of imprecise or vague terminologies such as “White Dot Syndromes”. Thanks to indocyanine green angiography (ICGA), access to the choroidal compartment has been granted to the clinician and more precise information on inflammatory mechanisms has allowed to establish a classification based on disease behaviour as well as direct monitoring of disease evolution in the choroid.

Methods With the help of ICGA, choroiditis could be subdivided into at least two inflammatory patterns touching 2 different choroidal structures are occuring. Firstly, inflammation of the choriocapillaris causing non perfusion is very well recognised by its typical ICGA features and constitutes a group of diseases that are called inflammatory choriocapillaropathies, including MEWDS, APMPPE or multifocal choroiditis.

Results Secondly, there is a totally different type of choroiditis, with inflammation occurring in the choroidal stroma in form of a mostly granulomatous infiltration called stromal choroiditis. When the target is specifically in the choroid such as in VKH disease or Sympathetic Ophthalmia (SO) we speak of primary stromal choroiditis and when the choroid is just the structure where a systemic disease such as sarcoidosis elects to manifest itself we speak of secondary stromal choroiditis.

Conclusion Beside the fact that ICGA has helped us classify choroiditis based on disease mechanism, it also allows proper monitoring of disease activity reaching a high degree of accuracy.