bluuebunny/crossref_metadata_2025 huggingface dataset:
Gefitinib-induced Acute Kidney Injury in a Patient with Advanced NSCLC Harbouring an EGFR-activating Mutation
Authors: Romanidou Ourania , Califano Raffaele ,   Consultant in Medical Oncology, Cancer Research UK Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK,   Department of Medical Oncology, Papageorgiou General Hospital, Thessaloniki, Greece,   Consultant in Medical Oncology, Cancer Research UK Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK,   Consultant in Medical Oncology, Department of Medical Oncology, University Hospital of South Manchester, Manchester, UK
Published: October 2015

Gefitinib, erlotinib or afatinib represent standard of care as first-line treatment for advanced non-small cell lung cancer (NSCLC) harbouring an activating mutation of epidermal growth factor receptor (EGFR). The toxicity profile of these drugs is well known with rash, diarrhoea, nausea, anorexia, fatigue and derangement of liver function being the most commonly observed adverse events. We report a case of an 82-year-old patient with EGFR-mutant advanced NSCLC who developed gefitinib-induced acute kidney injury, which slowly improved on discontinuation of the drug.
Reaching Patients in the Himalayas – The Growth of ‘Eye Camps’
Authors: Nowak Rafal ,   Consultant, Eye Department, City Hospital, Poznan
Published: October 2015

Nepal is a small, landlocked country draped along the greatest heights of the Himalayan mountains. Despite the fact that it is the major tourist destination in the region, it remains a poor country with the burden of problems typical for underserved populations, including an insufficient medical service system. Cataract continues to be the main cause of blindness in this country. However, in recent years there has been a significant positive change in this situation: Nepal has managed to develop a specific, relatively efficient eye-care service system whose highlights are well-organised eye hospitals, eye camps and the manual small-incision cataract surgery (SICS) technique of cataract removal. The aim of this article is to describe these latest advances in the Nepalese eye-care system, with an emphasis on eye camps as the particular manner of eye-care delivery to patients living in rural, mountainous areas.
Evaluating Risk Factors of Glaucoma Following Paediatric Cataract Surgery
Authors: Haargaard Birgitte , Thygesen John ,   Department of Ophthalmology, Copenhagen University Hospital, Glostrup Hospital and Rigshospitalet,   Department of Ophthalmology, Copenhagen University Hospital, Glostrup Hospital and Rigshospitalet
Published: October 2015

The risk of developing glaucoma after paediatric cataract surgery is substantial. A number of risk factors have been associated with the post-operative development of glaucoma, the most important and consistent one being age at the time of surgery. Glaucoma occurs in up to one-third of patients who have had cataract surgery at an early age (<9 months), with a particularly high risk when surgery is performed during the first four weeks of life. The discovery of glaucoma in children <2 years of age often requires additional measurements apart from the intraocular pressure measurement. Young children have elastic eye bulbs, and an increase in axial length, an increase in corneal diameter and/or an increase in excavation of the optic disc may be the only indication of glaucoma. The risk of glaucoma after paediatric cataract surgery continues throughout life, and it is therefore pertinent to perform glaucoma evaluation of these patients during follow-up.
Therapy-resistant Inflammatory Glaucoma – 647nm Krypton and 670nm Diode Lasers for Transscleral Contact Cyclophotocoagulation
Authors: Puska Päivi , Tarkkanen Ahti ,   Helsinki University Eye Hospital,   Helsinki University Eye Hospital
Published: October 2015

Only a few reports exist on the treatment of therapy-resistant inflammatory glaucoma with contact transscleral cyclophotocoagulation (CPC), and only one in which the red 647nm krypton or 670nm diode lasers are used. The lasers most frequently employed in clinical practice are the 810nm diode and the 1,064nm neodynium:yttrium–aluminium–garnet (Nd:YAG) lasers. Although transmission through the sclera is lower with the red 647nm krypton and 670nm diode lasers than with the infrared 810nm diode and Nd:YAG lasers, this is compensated for by using contact application and compressing the sclera with the probe. Also, the red lasers have a higher affinity for the pigment epithelium of the pars plicata. Transscleral red laser CPC has proved to be an effective, simple and well tolerated procedure for the treatment of therapy-resistant inflammatory glaucoma, particularly in adults.
The Mechanism of Glaucomatous Damage to the Optic Nerve
Authors: Flammer Josef , Mozaffarieh Maneli ,   Professor and Head,   Medical Doctor, Department of Ophthalmology, University of Basel
Published: October 2015

The pathogenesis of glaucomatous damage involves activation of astrocytes and involvement of oxidative stress in the mitochondria, which are located numerously in the axons of the optic nerve head (ONH). Astrocytes are activated by both mechanical and ischaemic stress. The major cause of oxidative stress is unstable blood flow, which is unstable if either intraocular pressure (IOP) fluctuates on a high level, exceeding the capacity for autoregulation from time to time, or if autoregulation by itself is disturbed. The main cause of disturbed autoregulation is primary vascular dysregulation syndrome. The simultaneous production of superoxide anions and nitric oxide leads to the damaging peroxinitrite, which induces apoptosis. Simultaneously, the entire microenvironment is changed, including an upregulation of matrix metalloproteinases (MMPs), contributing to tissue remodelling and thereby to excavation.
Is There Any Evidence for Surgical Intervention in Childhood Epiphora?
Authors: MacEwen Caroline J , Ho Whye Onn ,   Consultant Ophthalmologist,   Specialist Registrar, Department of Ophthalmology, Ninewells Hospital, Dundee
Published: October 2015

Epiphora in infants is common, and there is no evidence that surgical interventions during the first year of life have any advantage over the natural history of spontaneous resolution in terms of cure rate. Probing at between 12 and 15 months of age has been shown to provide an earlier improvement than simple observation, but by two years of age there is no difference between those probed and those not probed. There are no good studies comparing the value of endoscopic probing versus the use of intubation and balloon dacryocystplasty either as primary or secondary procedures. External and endonasal dacrycystorhinostomies (DCRs) are both useful procedures, but they have not been directly compared in terms of the benefits of one versus the other.
Peri-operative Management of Antithrombotic Therapy in Vitreoretinal Surgery
Authors: Tan Lee Teak , Ziahosseini Kimia , Cormack Graham , Charles Stephen ,   Manchester Royal Eye Hospital,   Manchester Royal Eye Hospital,   Manchester Royal Eye Hospital,   Manchester Royal Eye Hospital
Published: October 2015

With an ageing population, it is increasingly common to encounter patients on anticoagulation or antiplatelet therapy in our practices. Vitreoretinal surgeons often have to balance the risks of sight-threatening peri-operative haemorrhage with continuing antithrombotic therapy against the systemic complications of stopping it. A recent survey showed marked variability in practice, reflecting individual surgeon preferences and the controversies surrounding the matter. In this article, we review current evidence for cessation or continuation of antithrombotic therapy and discuss important considerations for the safe peri-operative management of antithrombotics.
Applications of Autologous Serum Eye Drops in Aniridic Keratopathy
Authors: López-García José Santiago ,   Ophthalmology Service, Hospital Cruz Roja, Madrid
Published: October 2015

Aniridia is an uncommon congenital bilateral disease that involves the cornea, anterior chamber, lens, retina and optic nerve. Corneal changes in aniridic keratopathy include recurrent erosions of corneal epithelium, tear film instability, chronic pain, corneal vascularisation, dry eye, progressive corneal opacification and blindness. The autologous serum contains a variety of growth factors, vitamins and immunoglobulins, some of which are in higher concentrations than in natural tears. The growth factors and protein found in the serum may help the proliferation, migration and adhesion of epithelial corneal cells. They are by nature non-allergenic and their biochemical and biomechanical properties are similar to those of normal tears. The ocular surface, including corneal impression cytology and tear film evaluation, of patients with congenital aniridia was studied prior to and after treatment with autologous serum eye drops.
The WIOL-CF Accommodative Intraocular Lens
Authors: Portaliou Dimitra M , Kymionis George D , Pallikaris Ioannis G ,   Institute of Vision and Optics, University of Crete,   Institute of Vision and Optics, University of Crete,   Institute of Vision and Optics, University of Crete
Published: October 2015

A few years ago, the goal of cataract surgery was simply removal of an opaque crystalline lens. Nowadays, clear lens extraction is used in everyday clinical practice in order to correct refractive errors, especially presbyopia. Different intaocular lens (IOL) designs have been proposed, such as monofocal IOLs with monovision or multifocal IOLs. Accommodative IOLs are considered one of the greatest accomplishments in ophthalmology today. The WIOL-CF is an accommodative IOL with unique design and properties that guarantee excellent uncorrected vision at all distances, glare-free optics, position stability and posterior capsule opacification resistance. The WIOL-CF IOL can combine the advantages of other accommodative intraocular lenses regarding spectacle-free near vision, while at the same time its main technical parameters can overcome the major problems that other accommodative IOLs present.
Possible Role of Pigment-epithelium-derived Factor in Corneal Angiogenesis
Authors: Abdiu Oran , Setten Gysbert Van ,   St Erik’s Eye Hospital, Stockholm,   St Erik’s Eye Hospital, Stockholm
Published: October 2015

The detection of pigment-epithelium-derived factor (PEDF) in corneal tissue has allowed greater understanding of the avascularity of corneal tissue. The ability of the cornea to maintain the avascular nature of this tissue, also referred to as the angiogenic privilege of the cornea, could be partly attributed to the presence of this factor. This privilege is severely impaired by various diseases of the ocular surface associated with inflammation and infection that are often followed by neovascularisation, which compromises the transparency of the cornea and results in visual impairment. The rapidly increasing insights into the basic mechanisms controlling neovascularisation, i.e. balance of growth factor activation and enzymatic activity, has most recently led to the development of large-scale use of specific antiangiogenic agents in the treatment of neovascular age-related macular degeneration (AMD). Focusing on the effects of vascular endothelial growth factor (VEGF), the use of such agents, including bevacizumab (Avastin®), a humanised anti-VEGF monoclonal antibody originally used in the treatment of metastatic colorectal cancer, has been investigated in corneal angiogenesis. PEDF is only one of the many factors involved in ocular angiogenesis. However, although it is only a small protein, it has strong antiangiogenic actions that are expressed in the retinal pigment epithelial (RPE) layer, as well as in other parts of the eye. There are specific characteristics that could designate a special role for PEDF in the regulation of avascularity in the eye. In this article, we focus on corneal angiogenesis and highlight the special features of this somewhat unexplored cytokine, outlining the current knowledge and possible role of PEDF in corneal neovascularisation.
Evaluating Central Serous Chorioretinopathy with Multifocal Electroretinogram
Authors: Moschos Marilita M , Moschos Michael ,   Department of Ophthalmology, University of Athens,   Department of Ophthalmology, University of Athens
Published: October 2015

Purpose: To evaluate central serous chorioretinopathy (CSCR) by multifocal electroretinogram (mf-ERG). Patients and methods: Twenty-one patients (21 eyes) with unilateral CSCR were examined. Both eyes of each patient underwent complete ophthalmological examination, including measurement of best corrected visual acuity, fluorescein angiography and mf-ERG recording. Our results were compared with the corresponding findings of 33 age-matched normal volunteers. Results: At presentation, the mean retinal response density (RRD) of the affected eyes in area 1 was 50.8% lower compared with normal controls (p<0.001). After CSCR regression, the mean RRD of the affected eyes was 30.1% lower compared with normal controls (p<0.001). Six fellow unaffected eyes showed a mean RRD in area 1 equal to 12nV/deg2. Conclusion: During the acute phase of CSCR, the mean RRD of the fovea was significantly abnormal. After its regression, mf-ERG values ameliorate, but they remain significantly abnormal. Abnormal values in area 1 were also found in the unaffected eyes.
Retinal Progenitor Cells in Regeneration and Repair Highlight New Therapeutic Targets
Authors: Mayer Eric J , Balasubramaniam Balini , Carter Debra A , Dick Andrew D ,   Academic Unit of Ophthalmology, University of Bristol,   Academic Unit of Ophthalmology, University of Bristol,   Academic Unit of Ophthalmology, University of Bristol,   Academic Unit of Ophthalmology, University of Bristol
Published: October 2015

The quest to understand the ability of the retina to not only sustain its function throughout life but also, as a result of pathological degeneration, to promote repair via stimulating endogenous regenerative capacity or via cell replacement is nearing clinical assessment. However, we still need to understand the kinetics and dynamics of cell replacement in healthy or ageing retina. This would lead to the possibility of manipulating endogenous ocular progenitor cells towards facilitating cell replacement when degeneration has ensued. Arguably, the most clinically immediate benefits will arise from cell-based therapies. However, the questions of which cells to use to maximise clinical outcome – including ocular sources or manipulation of non-ocular cell sources, including embryonic stem cells, as neuralised progenitor cell sources – and how best to deliver therapy remains unqualified. Ultimate success will depend on integration into damaged host tissue, prevention of gliosis and knowing which cells to target to replace.
Proximal Lacrimal Obstruction – A Review
Authors: Philpott Carl , Yung Matthew W ,   Rhinology and Anterior Skull Base Fellow, St Paul’s Sinus Centre, St Paul’s Hospital, Vancouver,   Department of Otolaryngology, Ipswich Hospital NHS Trust
Published: October 2015

While less common than distal lacrimal obstruction, proximal obstruction causes many cases of epiphora. This article examines the aetiology of proximal lacrimal obstruction and considers current management strategies with reference to recent literature. The Lester Jones tube is the favoured method of dealing with most cases of severe proximal obstruction; other methods have been tried with less success.
Effectiveness of Adalimumab in the Therapy of Paediatric Uveitis
Authors: Zierhut Manfred , Deuter Christoph ,   Centre for Ophthalmology, University of Tübingen,   Centre for Ophthalmology, University of Tübingen
Published: October 2015

In recent years, no drugs have been received with such enthusiasm as the tumour necrosis factor-〈 (TNF-〈)-blocking agents etanercept (Enbrel®), infliximab (Remicade®) and adalimumab (Humira®). This article summarises our knowledge of these drugs in the treatment of juvenile idiopathic arthritis (JIA)-associated uveitis. These agents offer a very effective treatment method when the disease is refractory to second-line immunosuppressive therapy. Of the three drugs available, infliximab and adalimumab seem to have a better effect in terms of reducing ocular inflammatory activity. Etanercept may also be effective, but can reactivate the disease and probably also result in new onset of uveitis, which has been described only rarely with infliximab and adalimumab. Important side effects of these drugs include reactivation of tuberculosis and induction and reactivation of demyelinating diseases. Because of its administration by subcutaneous injection and its better side-effect profile, at present adalimumab may be the most favourable TNF-〈-blocking agent.
Vitrectomy in Diabetic Retinopathy
Authors: Antao Sheelah , Sullivan Paul ,   Specialist Registrar,   Consultant Ophthalmic Surgeon, Moorfields Eye Hospital, London
Published: October 2015

Pars plana vitrectomy (PPV) is integral to the management of late complications in diabetic retinopathy. As a greater understanding of the pathophysiology of diabetic eye disease has developed, so the role of PPV has evolved. This article reviews the current indications for PPV in diabetes (vitreous haemorrhage, tractional retinal detachment and combined rhegmatogenous and tractional retinal detachment) and the evidence for potential future applications, such as in diabetic macular oedema. The role of pharmacological adjuncts, such as antivascular endothelial growth factor (VEGF) agents, to reduce intraocular complications, improve success rates and minimise post-operative complications is examined. Drug-induced vitreolysis as a tool in achieving complete vitreoretinal separation, thus reducing progression of diabetic retinopathy, is discussed. It has already become routine practice for endolaser photocoagulation to be employed during PPV and, in the future, vitreolytic and antiproliferative agents may also be important as adjuncts to achieve good outcomes.
Retinal Ganglion Cell Life and Death – Mechanisms and Implications for Ophthalmology
Authors: Corredor Raul G , Goldberg Jeffrey L ,   Neuroscience Program,   Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
Published: October 2015

Retinal ganglion cell (RGC) survival is critical for vision, but these neurons are exquisitely sensitive to insults. In acute diseases such as ischaemic optic neuropathy or optic neuritis, or in chronic diseases such as glaucoma, injury to RGC axons in the optic nerve may lead to rapid RGC death. Retinal ischaemia and retinal artery or vein occlusions directly injure RGC cell bodies in the ganglion cell layer. Enhancing RGC viability (neuroprotection) or RGC function (neuroenhancement) remains a major goal of basic and translational research. In this article we review the many mechanisms that lead from such insults to RGC death in clinically relevant pathological processes, and discuss avenues being pursued to enhance RGC survival in human disease.
Progression Under the Microscope – Can Basic Science Provide the Link Between Structural and Functional Deterioration?
Authors: Martin Keith R ,   Centre for Brain Repair and Department of Ophthalmology, University of Cambridge
Published: October 2015

The mechanisms of progression in glaucoma remain incompletely understood, but basic science research is gradually elucidating the processes involved. Axonal injury is a major event in glaucoma and the cellular mechanisms involved in axonal degeneration are different from those that lead to retinal ganglion cell body death. Thus, preventing cell body death is necessary but not sufficient to prevent progressive loss of function in glaucoma, and axonal protection is an important therapeutic goal. Basic science approaches are also suggesting new ways to detect and monitor progression. Techniques to image individual retinal ganglion cells and their axons in the living eye are improving rapidly. Cells undergoing apoptosis can be labelled and identified, and it may be possible in the future to use retinal ganglion cell apoptosis rates as a biomarker of glaucoma progression. However, slow progression may be difficult to detect using such techniques; therefore, biomarkers that identify ganglion cells that are sick but not yet committed to die are an important research goal.
Management of the Progressing Glaucoma Patient
Authors: Centofanti Marco , Oddone Francesco ,   Aggregate Professor, Department of Ophthalmology, University of Tor Vergata, Rome,   IRCCS ߝ Fondazione GB Bietti per la Ricerca in Oftalmologia, Rome,   IRCCS ߝ Fondazione GB Bietti per la Ricerca in Oftalmologia, Rome
Published: October 2015

The objective of glaucoma therapy is to preserve the patient’s vision at moderate cost. Life expectancy, stage of disease and progression rate, jointly, are considered the pivotal standard of assessment of the glaucoma patient, and correct therapeutic management is fundamental. Decreasing the progression rate of functional damage is the only strategy to reach the therapy objective in glaucoma today. From this point of view, ocular hypotensive therapy represents the only available instrument to reduce the risk of progression, minimising the risk of visual loss for each patient. Decreasing intraocular pressure should be considered the instrument by which the clinician can reduce the speed of a patient’s disease progression. The choice of aggressive or less aggressive treatment can be made on a case-by-case basis to slow down the progression rate of the disease to a secure level for the patient’s individual risk profile. In conclusion, the management of the glaucoma patient should be based on perimetric data, which should be considered as the way to judge the efficacy of the ocular hypotensive therapy.
Advanced Glaucoma Surgery with a Focus on Schlemm’s Canal
Authors: Grieshaber Matthias C ,   Department of Ophthalmology, Glaucoma Service, University of Basel
Published: October 2015

New surgical strategies for open-angle glaucoma aim to re-establish the physiological aqueous outflow by directly targeting the site of maximal resistance, i.e. the juxtacanalicular meshwork and inner wall of Schlemm’s canal. Canaloplasty uses anab externoapproach, whereas Trabectome (trabeculotomy) and trabecular micro-bypass (iStent) use anab internoapproach. They all work independently of a filtering bleb and have an inherently lower complication rate than trabeculectomy. Preliminary data suggest that they lower intraocular pressure (IOP) to the mid-teens and are more efficient in combination with phacoemulsification. However, their ability to lower IOP is limited by the level of the episcleral venous pressure. Its good safety profile means that Schlemm’s canal surgery may become more popular in the near future, but the outcome of these procedures still needs to be validated in long-term randomised, controlled studies.
Corneal Wound Healing After Keratorefractive Procedures
Authors: Kuo Irene C ,   Associate Professor of Ophthalmology, Cornea and Refractive Surgery Services, Wilmer Eye Institute, Johns Hopkins University School of Medicine
Published: October 2015

Research into corneal wound healing is gaining renewed interest with the increasing volume of keratorefractive procedures. Such research may help avoid the complication of ectasia after laser refractive surgery. There are three histopathological types of wound healing after keratorefractive surgery – whether laser refractive surgery, penetrating keratoplasty or radial keratotomy – and these are reviewed in this paper. They are hypercellular fibrotic stromal scar preceded by activated keratocytes, epithelial hyperplasia or hypertrophy and hypocellular primitive stromal scar. All can be identified with light, electron and immunofluorescence microscopy (or, with less detail, by confocal microscopy). A single procedure can manifest all three types of wound healing. Tissue destruction is part of tissue remodelling, but in successful procedures destruction cannot be uncontrolled or excessive. The elucidation of the signalling components remains an important area of research.
Descemet’s Stripping Automated Endothelial Keratoplasty – A Review
Authors: Hwang Anita M , Lee Jimmy K ,   Resident, Department of Ophthalmology and Visual Science, Yale University School of Medicine,   Director of Cornea and Refractive Surgery, Yale Eye Center
Published: October 2015

Descemet’s stripping automated endothelial keratoplasty (DSAEK) has become the procedure of choice to treat corneal endothelial dysfunction. The technique involves replacing the diseased host endothelium with a graft consisting of a thin layer of posterior stroma, Descemet’s membrane and endothelium. In comparison with penetrating keratoplasty (PK), DSAEK confers quicker visual and structural recovery with absence of corneal surface incisions or sutures, and also limits astigmatism. DSAEK has been proved to successfully achieve favourable visual acuity and graft clarity in bullous keratopathy, posterior polymorphous dystrophy and failed PK grafts. This literature review discusses various DSAEK surgical techniques, short- and long-term post-surgical results, complications and comparisons with other types of keratoplasty. With the advent of Descemet’s membrane endothelial keratoplasty (DMEK), in which only Descemet’s membrane is transplanted, visual rehabilitation may be attained sooner.
Refractive Aspect of Cataracts – Towards Customisation
Authors: Rozot Pascal , Rigal-Sastourne Jean-Claude ,   Clinique Monticelli, Marseille,   Clinique Monticelli, Marseille
Published: October 2015

Currently, posterior chamber intraocular lenses (IOLs) correct totally or partially spherical aberrations. In this article we present the visual results of a prospective multicentre study evaluating the Micro AY IOL correcting 0.11μm of spherical aberration, which is a good compromise between optimal vision and a consistent depth of focus. We evaluated 124 eyes that were operated on using bi-manual micro-cataract surgery (BiMICS: 75%) or co-axial micro-cataract surgery (CoMICS: 25%) phacoemulsification with insertion of a Micro AY IOL through a 1.8–2.2mm incision. Mean post-operative best corrected visual acuity was 0.97±0.25; pre-operative spherical aberrations were +0.24±0.13μm, and reached +0.10±0.11μm post-operatively. There were no complications due to the lens, and photopic contrast sensitivity reached high levels.
Diabetic Vitrectomy – An Update
Authors: Smith Henry , Zambarakji Hadi ,   Registrar, Ophthalmology, Eye Clinic, Chelsea & Westminster Hospital, London,   Consultant Vitreoretinal Surgeon, Eye Treatment Centre, Whipps Cross University Hospital, Leytonstone, London
Published: October 2015

Aim:To review the literature relating to diabetic vitrectomy, providing an update on topics where new information is available.Method:Reference to articles in peer-reviewed journals, the minutes of international academic meetings and authoritative textbooks.Results:We discuss aspects of management that will assist the vitreoretinal surgeon in evidence-based decision-making, including indications and timing of surgery, the use of pharmacological adjuvants, the influence of lens status, choice of vitrectomy gauge and the use of tamponades.Conclusions:Improvements in safety and outcome from diabetic vitrectomy have led a trend towards earlier surgery. A growing body of evidence supports the role of vitrectomy in diabetic macular oedema in the presence of traction. Anti-vascular endothelial growth factor (anti-VEGF) may aid surgery, but the risk of progression of tractional retinal detachment should be considered. The evidence for the efficacy of other adjuvants is discussed. We examine the role of cataract surgery in diabetic vitrectomy, discuss the use of tamponades and recommend a pragmatic approach when selecting a vitrectomy gauge.
New Trends in the Management of Inflammatory Choroidal Neovascularisation
Authors: Neri Piergiorgio ,   Head, Ocular Immunology Unit, The Eye Clinic, Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona
Published: October 2015

Choroidal neovascularisation (CNV) can be a severe, sight-threatening sequela in patients with uveitis. CNV can occur in both infectious and non-infectious diseases. In the majority of cases, fluorescein angiography, indocyanine green angiography and optical coherence tomography allow the clinical characteristics of the CNV to be accurately determined. An infectious disease should be looked for so that patients can be given a suitable therapy when available. Regarding non-infectious inflammatory CNV, the treatment strategy should be aimed at controlling inflammation. Systemic corticosteroids with or without immunosuppressants are suggested, even when the CNV occurs with apparently inactive uveitis. In this case, chronic sub-clinical inflammation can be the basis for the CNV pathogenesis. Additional therapies aimed directly at the neovascular process, such as intravitreal antivascular endothelial growth factor agents, are recommended, particularly when the therapy shows insufficient efficacy. However, the current data are still only based on case reports or small series. For such reasons, further trials are mandatory to validate the preliminary results.
Лечение глаукомы препаратами, не содержащими консервантов, является важной и реалистичной целью будущего
Authors: Хоупс Марина , Бродвэй Дэвид ,   Отделение Офтальмологии Клиники Университета Норфолка и Нориджа,   Отделение Офтальмологии Клиники Университета Норфолка и Нориджа
Published: October 2015

Медикаментозная терапия обычно является методом первого выбора в лечении глаукомы. Однако нежелательные эффекты офтальмологических препаратов потенциально угрожают безопасности и эффективности лечения. Глазные капли во флако- нах содержат множество компонентов, каждый из которых способен вызвать нежелательные реакции, хотя основной причи- ной их возникновения являются консерванты. Влияние консервантов на ткани глаза интенсивно исследовалось как с участием животных, так и человека. Бензалкония хлорид (БАХ) – это высокоэффективный и наиболее часто используемый консервант в препаратах для лечения глаукомы. Тем не менее, БАХ оказывает токсическое воздействие на ткани глаза и потенциально спо- собен вызывать нежелательные эффекты. Применение менее токсичных консервантов или препаратов без консервантов спо- собно улучшить терапию глаукомы.
New Applications of Femtosecond Lasers
Authors: Hurmeric Volkan , Shousha Mohamed Abou , Yoo Sonia H ,   Bascom Palmer Eye Institute, University of Miami Miller School of Medicine,   Bascom Palmer Eye Institute, University of Miami Miller School of Medicine,   Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
Published: October 2015

Femtosecond laser (FL) platforms are gaining popularity in the refractive and ophthalmic surgery market owing to the quality of the surgical outcomes, predictability and safety. The latest generation of FL offers faster surgery and better surgical outcomes. Today, FL can be used for laserin situkeratomileusis (LASIK) flap creation, Intacs implantation, lamellar and penetrating keratoplasty and astigmatic keratectomy. Recent refinements and developments in FL technology have introduced even newer surgical options, and the most recent applications of FL include refractive corrections with stromal lenticule extraction, treatment of presbyopia and cataract surgery.
Effective Surgical Management of Ectatic Corneal Dystrophies
Authors: Jhanji Vishal , Vajpayee Rasik B ,   Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital,   Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital
Published: October 2015

The management options for ectatic disorders of the cornea range from contact lenses to corneal transplantation. Although contact lenses and s ectacles are effective in the early stages, advanced corneal ectasias require surgical measures including partial- and full-thickness keratoplasty. In recent years, a variety of novel treatment modalities have emerged, which include collagen cross-linking, intra-stromal implants and the use of femtosecond lasers for performing keratoplasties. This article outlines a few important surgical approaches that can be used for the management of ectatic corneal disorders.
The Role of Lutein in Eye Health
Authors: Maci Samanta ,   Technical Service Manager Europe, Kemin Health Europe
Published: October 2015

Lutein and zeaxanthin are oxycarotenoids that are naturally present in the typical human diet. They are the only two dietary carotenoids selectively deposited in the macula lutea, where they are referred to as the macular pigment (MP), and in the eye lens. The rationale for the protective role of lutein in the eye stems from its ability to filter short wavelengths of visible blue light, function as an antioxidant and stabilise membrane integrity. These functions are believed to play an important role in reducing light-induced oxidative damage caused by reactive oxygen intermediates and involved in the pathogenesis of age-related degenerative disease such as age-related macular degeneration and cataract. Recent research is now paying particular attention to the blue-light-filtering properties of lutein and zeaxanthin and to the role of MP in improving visual performance.
What Ophthalmologists Should Know About Sjögren’s Syndrome
Authors: Utine Canan Asli , Akpek Esen K ,   Department of Ophthalmology, Yeditepe University, Istanbul,   Wilmer Eye Institute, Johns Hopkins University School of Medicine,   Wilmer Eye Institute, Johns Hopkins University School of Medicine
Published: October 2015

About one-quarter of patients with dry-eye syndrome (DES) have an underlying rheumatic condition, most commonly Sjogren’s syndrome (SS). SS is a common, frequently underdiagnosed cause of dry eye with multisystemic involvement. The immunological background of SS involves activation of both innate and acquired immune systems. According to the 2002 American and European classification systems, presence of any four of the six criteria (i.e. symptoms of dry eye, symptoms of dry mouth, ocular signs of dry eye, objective salivary gland involvement, typical histopathology findings in minor salivary gland biopsy specimens and presence of serum autoantibodies) as long as either the biopsy or serology is positive or presence of any three of the four objective criteria is considered diagnostic of SS. The main goal of treatment of ocular involvement is the alleviation of dry-eye symptoms with replacement therapy, stimulation of tear secretion and supportive surgical procedures to conserve tears. Preservative-free tear substitutes, topical steroids, cyclosporine A, autologous serum eye-drops and punctal plugs are commonly used for this purpose.
Treatments for Age-related Macular Degeneration
Authors: Amoaku Winfried MK ,   Associate Professor/Reader and Honorary Consultant Ophthalmologist, Division of Ophthalmology and Visual Sciences, University Hospital, Queen’s Medical Centre, Nottingham
Published: October 2015

Age-related macular degeneration (AMD) is the most common cause of irreversible visual loss in the developed world. There are two types of AMD: dry and wet. The exact cause of the disease is unknown, but is thought to result from interplay of genetic and environmental factors. Smoking, hypertension and low intake and/or low levels of serum antioxidants are known risk factors for both forms. As yet there are no treatments available for the dry form of AMD. Smoking cessation and healthy lifestyles are important in the prevention of progression of AMD. Progression of early stages of AMD to advanced forms is slowed by regular intake of ocular nutritional supplements as found in the Age-Related Eye Disease Study (AREDS) Study. Recently, there have been significant breakthroughs in the treatment of wet or neovascular AMD, including photodynamic therapy (PDT), intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs, including pegaptanib, ranibizumab and bevacizumab. Newer agents including aflibercept and anti-platelet-derived growth factor (anti-PDGF) compounds are under investigation. The current gold standard for treatment of wet AMD is intravitreal injections of ranibizumab. Combination therapy with PDT and anti-VEGF agents is useful especially in idiopathic polypoidal choroidopathy (IPCV) or when anti-VEGF monotherapy has failed. Rapid referral of patients with neovascular AMD is important as the visual outcome is dependent on the visual acuity at treatment. Diagnostic confirmation with retinal imaging, particularly fundus fluorescein angiography and optical coherent tomography, are required before treatment commencement. The new treatments for wet AMD are repetitive, and have significant service implications. These implications occur irrespective of which anti- VEGF agent is adopted. Visual rehabilitation is still important in the management of AMD.
A Focus on the Most Important Innovation in Cataract Surgery and Future Perspectives
Authors: Franchini Alessandro ,   Eye Institute, University of Florence
Published: October 2015

Our patients having cataract surgery are much more demanding in terms of contrast sensitivity and visual acuity at all distances. Today, we have many opportunities to satisfy their expectations thanks to the new premium intraocular lenses and finally, the possibility to really perform cataract surgery using lasers.
Translational Research in Ophthalmology – A European Perspective
Authors: Cunha-Vaz José , Zrenner Eberhart ,   Faculty of Medicine, University of Coimbra,   Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra,   Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen,   STZ Biomed & STZ Eyetrial, Centre for Ophthalmology, University Hospital of Tübingen
Published: October 2015

Loss of vision is a major threat for the ageing European society as its incidence quickly increases with age. While cataract is handled well by microsurgery, other blinding conditions such as age-related macular degeneration, retinal dystrophies, glaucoma and diabetic retinopathy cannot be treated well. On the other hand, knowledge about endogenous and exogenous factors increases rapidly in basic research, opening new pathways to therapy. It will be increasingly important to foster translational research to bring such new strategies in genetics, proteomics, metabolomics and new drug delivery systems for neuroprotection, stem cell research and optogenetics from bench to bedside. Adequate funding for this translational research has to be ensured. These goals are strongly supported by the European Vision Institute (EVI) and by the European Vision Institute Clinical Research Network (EVICR.net), a clinical research network that comprises more than 70 certified sites to perform clinical studies in the field of ophthalmology and by the European Clinical Research Infrastructures Network (ECRIN). These developments, their aims and accomplishments are described here.
Colour Doppler Imaging of Ocular and Orbital Blood Vessels in Retinal Diseases
Authors: Dimitrova Galina ,   Ophthalmologist, Neuromedica Polyclinic, and Assistant Professor of Ophthalmology, Faculty of Dentistry, European University, Skopje
Published: October 2015

Colour Doppler imaging (CDI) is an established method for investigation of the ocular and orbital blood flow characteristics. It has been employed for assessment of blood flow parameters in a number of studies that investigated retinal diseases, including vascular pathology, degenerations, dystrophies, tumours, retinal detachment, etc. Decreased retrobulbar blood flow velocity in the central retinal and the short posterior ciliary artery has been reported in diabetic retinopathy. Reduced blood flow velocity in the central retinal artery and vein was also reported in patients with central retinal artery and vein occlusion. In exudative age-related macular degeneration there was an irregular blood flow in the retrobulbar short posterior ciliary arteries that was suggested to play a role in the pathogenesis of the disease. In addition to research, CDI has also been reported as a valuable tool for the clinical management of retinal diseases.
Minimally Invasive Strabismus Surgery
Authors: Mojon Daniel S ,   Head, Department of Strabismology and Neuro-ophthalmology, Kantonsspital St Gallen, University of Bern
Published: October 2015

In strabismus surgery, the post-operative visibility of the procedure and level of patient discomfort will mainly be influenced by the number and type of muscles operated on and the type and location of the conjunctival openings. For strabismus surgeries minimising tissue disruption, the term minimally invasive strabismus surgery (MISS) has been introduced. MISS uses several keyhole openings (instead of one large muscle access), which are placed where the main surgical steps will be performed. If necessary, tunnels are created between the cuts for some surgical steps. The openings are always placed far away from the limbus. Post-operatively, such cuts will minimise the risk of corneal complications and remain covered by the eyelids. There is increasing evidence to suggest that the disruption of the perilimbal episcleral vessels, which occurs with a limbal incision, may predispose to anterior segment ischaemia. MISS will preserve the majority of perilimbal episcleral vessels. Since MISS also significantly reduces the anatomical disruption between the muscle and the surrounding tissue, reoperations might be easier and the function of the muscle may be better preserved. MISS openings allow the practitioner to perform all types of strabismus surgeries, namely rectus muscle recessions, resections, plications, reoperations, retroequatorial myopexias, transpositions and oblique muscle recessions or plications.
Recent Advances in the Treatment of Glaucoma – The Need to Maintain Intraocular Pressure Over 24 Hours
Authors: Shaarawy Tarek , Bhartiya Shibal ,   Director, Glaucoma Sector, Geneva University Hospital,   Clinical Research Fellow, Glaucoma Sector, Ophthalmology Service, Department of Clinical Neurosciences, Geneva University Hospital
Published: October 2015

In the treatment of glaucoma, maintenance of intraocular pressure (IOP) over a 24-hour period is of considerable importance. Some glaucoma medications do not sustain low IOP, allowing it to fluctuate with the potential to damage the optic nerve, leading to blindness. Several topically applied prostaglandins have become available, which have the advantage of maintaining 24-hour control. With these developments, it is timely to consider the relative merits of glaucoma surgery compared with medical treatments including eye drops and systemic medications, and which of the medications provides the most benefit to patients. Medications that control IOP over 24-hour periods require monitoring methods to assess their efficacy. Most determination procedures are carried out in a clinician or ophthalmologists office and provide only a single measure at one point in time. These require fixed equipment and cannot provide an overview of IOP variation over time or indicate whether treatments are providing continuous control. A development to address this monitoring need is the Sensimed Triggerfish®. This system uses a soft contact lens with an embedded pressure-sensing chip and associated monitoring equipment to provide multiple readings over a 24-hour period. The initial clinical experience with this device led to an immediate treatment change in two-thirds of patients. A clinical trial evaluating the efficacy of a new prostaglandin treatment, tafluprost, over 24 hours using the contact lens IOP monitoring system is currently underway. Based on the initial data, tafluprost effectively reduces IOP during the full 24-hour period, further supporting its use in the treatment of glaucoma.
How to Diagnose the Ocular Surface Disease in Treated Glaucoma Patients
Authors: Rossi Gemma Caterina Maria ,   University Eye Clinic of Pavia, Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation
Published: October 2015

Glaucoma is a disease usually treated with topical drugs, but the chronic use of preserved intraocular pressure (IOP)-lowering medications is associated with some symptoms of ocular surface toxicity. The ocular surface status should be evaluated regularly in glaucoma patients to ensure the detection and early treatment of pathological signs that might alter patients quality of life. The author suggests a possible sequence of evaluations to examine symptoms (adopting vision-specific quality-of-life questionnaires) and signs (using low methodologies to analyse the ocular surface status) that can be easily performed in daily clinical practice.
A High-tech New Device Eyevispod™ Helps Evaluate Refractive Lens Surgery and Other Presbyopic Surgeries On Near and Intermediate Vision Quality
Authors: Hauranieh Nicola , Giardini Pietro ,   Polivisus SRL, Ophthalmic Laser and Microsurgery, Brescia,   Polivisus SRL, Ophthalmic Laser and Microsurgery, Brescia
Published: October 2015

Purpose:Presbyopia-correcting intraocular lenses (Pr-C IOLs) can provide a full range of visual corrections for far, intermediate and near vision. It is important to evaluate the outcomes to improve our results.Methods:The Eyevispod is a multilingual, computerised system, which allows the convenient measurement, collection and recording of a detailed assessment of near and intermediate visual performance. Easy to use, relatively time-efficient (a five-minute time test) and the results are easily understandable. Near visual acuity and reading speed are measured. A comprehensive test is provided of a series of everyday visual tasks that are often problematic for presbyopic patients. All are actual size images, which allow us to directly test the patients everyday social visual performance. The creation of a monocular or binocular defocus curve is the final section on the test.Results:The Eyevispod system performs a comprehensive assessment of near and intermediate visual function and gives a score of the patients visual performance. Eyevispod provides us with a complete profile of both the patients visual acuity and quality (including near vision). Results are then automatically archived in the digital database included. By testing patients, both pre- and post-operatively, we can obtain a true objective measure of how much their visual performance has improved or worsened after IOL implantation.Conclusion:Standardised outcome testing has become increasingly critical, as we continue to have many new and different IOLs and procedures to scientifically compare. We are confident that this improved and high-tech way of testing patients visual outcomes will lead to a greater standardisation of clinical methods traditionally used to measure near acuity.
A Review of Refractive Surgery
Authors: Fares Usama , Al-Aqaba Mouhamed Ali , Muneer Otri Ahmad , Dua Harminder S ,   Clinical Research Fellow,   Clinical Research Fellow,   Clinical Research Fellow,   Professor and Head, Division of Ophthalmology and Visual Sciences, University of Nottingham
Published: October 2015

Refractive surgery has become the most rapidly developing field in ophthalmology over the last two decades. Several modern refractive procedures have become available over the last 10 years including phakic intraocular lenses (pIOLs), epithelial laser-assistedin situkeratomileusis (epi-LASIK), wavefront-guided (WG) laser treatments and a few others. Laser and non-laser refractive surgical procedures are currently used to address refractive errors. No single procedure works best for everyone; each one has its own set of advantages and disadvantages. Careful patient selection is the key for optimum visual outcomes. Treatment algorithms have been refined over the years, improving accuracy. Laser technology and delivery platforms are under continuous improvement, leading to increasingly precise results. Further modifications and refinements are ongoing, offering expanding surgical options in this rapidly evolving field.