bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in glaucoma surgery: an evolving landscape
Authors: Parkash Daniel , Gohil Anjali , Ansari Abdus Samad , Kulkarni Avi , Kailani Obeda
Published: January 2022

Purpose

The introduction of microinvasive glaucoma devices (MIGS), and changes in healthcare demands in consequence to the COVID‐19 pandemic, glaucoma surgeons have been required to evolve traditional practice techniques. We aimed to study trends in glaucoma surgery over a 5‐year period.

Methods

Electronic medical records for patients undergoing glaucoma surgical procedures were retrieved at our centre between January 2016 and March 2021. Data on demographics, co‐morbidities, aetiology of disease, ocular parameters and outcomes were retrieved. Changes in clinical guidelines and surgeon related preferences were compared at all time points. Trends in surgical practice including variance in the utilisation of MIGS surgery were studied.

Results

A total of 4028 operations were included. The mean age was 69.5 (SD 12.8). No significant variance in sex was seen (M:F 2061:1967). Trabeculectomies comprised of 10.2% (n = 411), glaucoma drainage devices (GDD) 2.8% (n = 111) and MIGS 22.2% (n = 895) of all operations performed. A 61.4% and 60.3% reduction in number of trabeculectomies and GDD’s was seen respectively between 2016 and 2020. There was a significant increase in the utilisation of MIGS (+293%) and combined procedures (+10%). A significant proportion of these novel procedures included endo‐cyclophotocoagulation (n = 178) and iStents (n = 642). During the COVID‐19 pandemic there appeared to be marked increase in the number of Preserflo implantations in comparison to trabeculectomies and GDD surgeries (+850% increase of Preserflo between 2019 and 2020, 9.4% and 54.6% decline for trabeculectomies and GDD’s respectively).

Conclusions

MIGS is becoming increasingly established as an effective tool in the glaucoma surgeons’ armamentarium. This is due to shorter surgical time, recovery periods and cost‐effectiveness of MIGS procedures. This continues to be an evolving landscape, with the advancement of canal‐based and subconjunctival MIGS procedures.
Evaluating the diagnostic generalizability of deep learning models trained with images of the ganglion cell layer of early glaucoma
Authors: Díaz‐Alemán Valentín Tinguaro , Miranda Silvia Alayón , Fumero Batista Francisco José , Perera Sandra Gómez , del Arco Rafael Arnay , Sigut Saavedra José Francisco
Published: January 2022

Purpose

To determine the diagnostic generalizability of two deep learning models when trained only with images of the ganglion cell layer (GCL) of mild glaucoma.

Methods

We have collected a sample from patients with primary and secondary open‐angle glaucoma and normal patients. The sample was divided into mild glaucoma (MD≤6 dB), and moderate‐advanced (MD > 6 dB). The GCL images were recorded with a spectral‐domain Optical Coherence Tomography. Two pre‐trained models were used, the ResNet101 and the Shufflenet. The sensitivity, specificity, diagnostic precision in training and test, and the ROC area were calculated for the two models with three different training conditions according to how the images were partitioned into training and test. In the first partition, mild glaucomas were used for training and moderate‐advanced for test. In the second, moderate‐advanced glaucomas were used for training and mild for test. In the third, the whole sample was used without classifying by severity. Gradient‐weighted Class Activation Mapping (GradCAM) was used to obtain saliency maps which highlight the more important components in the images for the model prediction. The correlation coefficient between the maps of the glaucoma and normal images of the two models was calculated.

Results

561 eyes were collected from 337 patients, 356 are glaucomatous and 200 are normal. The precision of the models in the test set in partition 1, was 90.9% (ResNet101) and 94.2% (Shufflenet). In partition 2, was 74.4% (ResNet101) and 73.5% (Shufflenet), and in partition 3 an accuracy of 94.6% was found with both models. The correlation coefficient between the GradCAM saliency maps of the models was 0.46 for glaucoma images and 0.83 for normal images.

Conclusions

The two deep learning models are able to generalize and have high diagnostic precision if they are trained only with images of the GCL of mild glaucoma. Both models show high correlation in the GradCAM saliency maps with normal images.
ASGARD – Adverse events and safety in glaucoma patients: assessing reports on eye drops
Authors: Thein Anna‐Sophie , Hedengran Anne , Arita Reiko , Cvenkel Barbara , Gazzard Gus , Heegaard Steffen , De Paiva Cintia , Petrovski Goran , Prokosch‐Willing Verena , Utheim Tor P. , Virgili Gianni , Azuara‐Blanco Augusto , Kolko Miriam
Published: January 2022

Purpose

There are large variations in how adverse events, safety and tolerability related to intraocular pressure (IOP)‐lowering eye drops are reported. Inconsistencies and discrepancies in outcomes and methods lead to missed opportunities when comparing studies and combining results in meta‐analyses, making it difficult to translate the findings into the clinic. The purpose of this study is to establish consensus among experts on measured outcomes when conducting future clinical trials examining ocular adverse events, safety, and tolerability in patients treated with IOP‐lowering eye drops.

Methods

A Delphi study of 2–4 rounds is conducted. International glaucoma and ocular surface experts are invited to participate. The importance of items is ranked using a 10‐point scale (1 as not important, 10 as very important). Background literature is used to identify relevant items to be included in the survey. Items are organized into domains, e.g. visual acuity, with subgroups regarding measurement method. A core group of 8–12 leading experts are recruited prior to generating the first questionnaire. The core group contributes to and reviews the study protocol, the questionnaire, the recruitment, and the final article.

Results

An item is considered important when the mean value of importance is ranked ≥7 and the interquartile range of scores is ≤3. At least 30 experts are required to participate in all rounds to complete the study. Not all domains are expected to reach consensus. Consensus within 90% of the domains surveyed is considered a valid consensus status for conclusion.

Conclusions

Achieving consensus on standardized methods for assessing adverse events, safety, and tolerability of IOP‐lowering eye drops will provide a valuable basis for evaluating eye drops in randomized clinical trials. This will then enable systematic reviews, which are most valuable to decision makers.
Assessing the role of cross‐linked sodium hyaluronate in improving the quality of circumpapillary OCT scans
Authors: Yap Timothy , Abdulhussein Dalia , Ahmed Faisal , Francesca Cordeiro M , Normando Eduardo
Published: January 2022

Purpose

Assessment of cross‐linked sodium hyaluronate (XLHA) in improving circumpapillary OCT scan quality and segmentation accuracy

Methods

Circumpapillary OCT scans (Heidelberg Spectralis) of prospectively recruited glaucoma clinic patients were assessed. Patients were included if suboptimal image quality was suspected, based on live preview images. Exclusion criteria included severe loss of media clarity due to corneal opacification or dense cataract, adverse reaction to any constituents of the investigative eyedrop, contact lens use, eyedrop use in the preceding two hours, significant imaging artefact, or scanning and segmentation failure. Prior to repeat scanning, within‐patient eyes were randomised to receive topical application of XLHA (VisuXL) or blinking alone as a control group. The objective primary outcome measure was the mean proprietary image quality indicator (QI). Subjectively, masked clinician assessment of image preference was assessed. Global circumpapillary RNFL thickness and the improvement of segmentation errors were secondary outcomes.

Results

Sixty‐seven patients (134 eyes) were eligible for analysis with a mean age (±SD) of 69.7 ± 14.4 years, of whom 57% were male and 43% female. Mean baseline QI in the XLHA group was 23.0 ± 4.95, and 23.3 ± 5.04 in the control eyes (p = 0.76). The mean change in QI was +0.28 ± 3.93 in the XLHA eyes, and +0.34 ± 4.01 in the control eyes (p = 0.93). No significant effect on RNFL thickness (p = 0.82), subjective image preference (p = 0.73) or the extent of segmentation errors (p = 0.46) was seen. Post‐hoc analysis revealed baseline QI as a predictor of repeat scan improvement across all groups, with a baseline QI less than 24.5 associated with improvement on repeat scanning (OR 4.49, 95% CI 2.06 – 9.59).

Conclusions

Repeat scanning was beneficial with baseline QI below 24.5; however, no evidence was found to support the use of XLHA over blinking to improve repeat OCT scan quality.
Evaluation of the ultrastructural and in vitro flow properties of the PreserFlo® microShunt
Authors: Barberá Marta Ibarz , Bragard Jean , Fernández laura Morales , Rivero Pedro Tañá , de Liaño Rosario Gomez , Guezala Miguel Teus
Published: January 2022

Purpose

The purpose of this study was to measure the luminal diameter of the PreserFlo® microshunt and to calculate the theoretical resistance to flow for comparison with the outcomes of the in vitro flow testing of this device.

Methods

The PreserFlo® was designed to control the flow of aqueous humor by means of its length and width according to the Hagen‐Poiseuille equation. Scanning electron microscopy (SEM) was performed to measure the internal lumen of the tube and flow testing was carried out using a constant gravity‐flow test.

Results

The SEM images of the PreserFlo® implant showed that the luminal diameter measured 63.6 x 70.5 μm. The theoretical calculation of the resistance to flow (R) for an aqueous humor viscosity of 0.7185 was 1.3 mmHg/μL/min. Assuming a constant aqueous humor flow of 2 μL/min, the calculated pressure differential (△p) across the device was 2.6 mmHg. The experimental gravity‐flow test showed that the theoretical flow (Qtheo) and the in vitro flow (Qexp, 15.75 g/24 h) were consistent.

Conclusions

The internal diameter of the PreserFlo® implant measured by SEM fits the dimensions described by the manufacturer. The experimental and theoretical flow testing showed that the pressure drop across this device is lower than the pressure required to avoid numerical hypotony.

References

1. Ibarz Barberá M, Morales Fernández L, Tañá Rivero P, Gómez de Liaño R, Teus, MA (2021), Anterior‐segment optical coherence tomography of filtering blebs in the early postoperative period of ab externo SIBS microshunt implantation with mitomycin C: Morphological analysis and correlation with intraocular pressure reduction. Acta Ophthalmol. https://doi.org/10.1111/aos.14863

2. Sheybani A, Reitsamer H, Ahmed II. Fluid Dynamics of a Novel Micro‐Fistula Implant for the Surgical Treatment of Glaucoma. Invest Ophthalmol Vis Sci. 2015 Jul;56(8):4789–95.

3. Pinchuk L, Riss I, Batlle JF, Kato YP, Martin JB, Arrieta E, Palmberg P, Parrish RK 2nd, Weber BA, Kwon Y, Parel JM. The development of a micro‐shunt made from poly(styrene‐block‐isobutylene‐block‐styrene) to treat glaucoma. J Biomed Mater Res B Appl Biomater. 2017 Jan;105(1):211–221.

4. Gardiner BS, Smith DW, Coote M, Crowston JG. Computational modeling of fluid flow and intra‐ocular pressure following glaucoma surgery. PLoS One. 2010;5(10):1–11.
Health‐related behaviours and visual impairment among people aged 50 years and older in Gegharkunik province of Armenia: rapid assessment of avoidable blindness survey
Authors: Giloyan Aida , Harutyunyan Tsovinar , Petrosyan Varduhi
Published: January 2022

Purpose

This study assessed the prevalence of visual impairment (VI) and the association between VI and health‐related behaviours in population aged 50 years and older in Gegharkunik province of Armenia.

Methods

Twenty‐four clusters with 50 people in each were sampled for the interviewer‐administered survey in Gegharkunik in 2019. Ophthalmic examination assessed presenting and pinhole corrected visual acuity using Rapid Assessment of Avoidable Blindness methodology. The structured questionnaire collected information about participants’ socio‐demographics, body mass index, self‐assessed general health status, utilisation of eye services, presence of chronic non‐communicable diseases, and health‐related behaviours (smoking, physical activity and alcohol consumption).

Results

The mean age of participants was 64.8 (SD = 10.2), ranging from 50 to 97. Women constituted 62.4% of the sample. About 26% of participants had mild to severe VI and 2% were blind. Approximately 58% of participants were physically inactive or insufficiently active. Most of the respondents never used alcohol (62.5%), while 33.4% were moderate and 4.1% were heavy alcohol users. After adjusting for health characteristics and health‐related behaviours, being physically inactive or insufficiently active was associated with VI in the first logistic regression model. Advanced age and self‐assessed “poor” general health status were associated with VI after adjusting for demographics, health characteristics and health‐related behaviours. Moderate alcohol consumption had protective effect on VI in both models.

Conclusion

The prevalence of VI in this population was higher compared to the global rate and estimates from the European region. Regular ophthalmic examination and public health interventions might reduce VI and improve health‐related behaviours among target population.
Corneal biomechanical parameters after 60 years old
Authors: Yekta Abbas Ali , Hashemi Hassan , Khabazkhoob Mehdi , Shokrollahzadeh Fereshteh , Ostadimoghaddam Hadi
Published: January 2022

Purpose

To determine the distribution of corneal biomechanical parameters in an elderly population and their correlation with some demographic and ocular variables.

Methods

This cross‐sectional study was conducted in subjects above 60 years living in Tehran, Iran. The participants were selected using multi‐stage cluster sampling. All of the subjects underwent optometric and ophthalmic examinations as well as imaging using the Pentacam and IOL Master. Corneal biomechanical parameters were measured in a subsample of this population randomly selected from subjects using the Reichert Ocular Response Analyzer.

Results

Of 470 subjects, the data of 420 participants aged over 60 years were analyzed (mean age = 69.3 ± 6.5 years). The mean corneal hysteresis (CH) and corneal resistance factor (CRF) was 8.37 mmHg (95% CI: 8.02–8.72) and 9.06 mmHg (95% CI: 8.69–9.44), respectively. The mean CH was 8.27 mmHg (95% CI: 7.92–8.62) in men and 9.25 mmHg (95% CI: 8.56–9.93) in women, and the mean CRF was 9.00 mmHg (95% CI: 8.60–9.40) in men and 9.63 mmHg (95% CI: 8.86–9.98) in women. According to the results of multiple linear logistic regression analysis, CH had a significant correlation with younger age (Coefficien = −0.05, p = 0.032), female sex (Coefficien = 1.83, p < 0.001), reduced maximum keratometry (Coefficien = −0.22, p = 0.060), and increased anterior chamber volume (Coefficien = 0.01, p = 0.007). The results also showed that CRF was significantly correlated with a younger age (Coefficien = −0.06, p = 0.022), female sex (Coefficien = 1.01, p = 0.053), central corneal thickness (Coefficien = 0.02, p < 0.001), and reduced maximum keratometry (Coefficien = −0.39, p = 0.010).

Conclusions

The mean CH and CRF were low in the Iranian population aged over 60 years indicating the weaker elasticity of the corneal connective tissue. Advanced age and male sex were associated with a decrease in corneal biomechanical parameters. Due to the relationship between CRF and maximum keratometry, it seems that this parameter can be used to predict keratoconus in the elderly.
The functional consequence of the pathogenic variant in the inflammasome component NLRP3 as the underlying cause of keratitis fugax hereditaria
Authors: Kawan Sabita , Backlund Micheal , Immonen Annamari , Turunen Joni
Published: January 2022

Purpose

Keratitis fugax hereditaria (KFH) is a rare periodic autoinflammatory corneal disease caused by a heterozygous pathogenic variant c.61G>C in the NLRP3 gene. Other NLRP3 variants cause cryopyrin‐associated periodic syndromes (CAPS), characterized by enhanced production of IL‐1β. While more than 50% of KFH patients use prednisolone to relieve pain, there are no data on how the c.61G>C NLRP3 variant or prednisolone treatment affects IL‐1β production in KFH patients. We carried out a functional study to elucidate these questions.

Methods

Peripheral blood mononuclear cells (PBMCs) isolated from whole blood of patients with KFH (n = 8) and healthy controls (n = 4) were grown under steady‐state conditions or exposed to NLRP3 inflammasome priming with LPS (500 ng/ml) together with or without prednisolone (100 µM) and subsequently activating inflammasome with ATP(1 mM). Proteins precipitated from the cell culture media were separated by SDS‐PAGE and transferred to a membrane by western blotting. IL‐1β was visualized from the membranes by immunodetection. Alternatively, the concentration of secreted IL‐1β in the media was quantified by ELISA.

Results

Following NLRP3 inflammasome activating stimuli, a reduced threshold for IL‐1β secretion was observed in severely affected KFH patients compared to mildly affected patients or healthy controls. In these patients, LPS priming alone was able to trigger IL‐1β secretion while in the mildly affected patients and healthy controls IL‐1β secretion required a canonical two‐hit activation of the NLRP3 inflammasome by both LPS and ATP. In both KFH and healthy control‐derived PBMCs, IL‐1β secretion declined after prednisolone treatment.

Conclusions

Our study demonstrated that patients with severe KFH are more prone to IL‐1β secretion, thus indicating that the c.61G>C is a gain‐of‐function variant. Furthermore, prednisolone is a potent treatment for reducing IL‐1β secretion in KFH.
MicroRNA‐mRNA genetic networks in refractive eye development and myopia
Authors: Tkatchenko Andrei , Tkatchenko Tatiana
Published: January 2022

Purpose

Myopia is a complex disease controlled by both environmental and genetic factors. Recent genetic studies suggested that the development of myopia is controlled by numerous coding genes. However, the contribution of non‐coding genes, such as microRNAs, is poorly understood. The purpose of this study was to investigate the role of microRNAs in refractive eye development and the development of myopia.

Methods

Differential expression of both microRNAs and mRNAs was analyzed in the retina, RPE, choroid, and sclera of C57BL mice upon induction of experimental myopia with −20 D lenses using RNA‐seq and microRNA‐mRNA genetic networks were reconstructed. We also explored the impact of microRNAs on signaling pathways and evaluated the role of microRNAs in refractive eye development in vivo using conditional Dicer1 knockout mice.

Results

Gene expression profiling revealed large number of differential mRNAs and microRNAs in the retina and RPE/choroid/sclera complexes. MicroRNAs were involved in the regulation of several key canonical pathways and biological processes previously implicated in refractive eye development. We then compared visual acuity, contrast sensitivity, and refractive errors in Dicer1 knockouts (Dicer1−/−) and wild‐type littermates (Dicer1+/+) at baseline. We found that loss of miRNAs in the postnatal eyes resulted in a large hyperopic shift in refractive error (+16.3 ± 3.6 D in Dicer1 knockouts versus +4.7 ± 3.0 D in wild‐type animals, p < 1.44 × 10−4), which was accompanied by a small reduction in visual acuity (0.360 ± 0.006 cpd in Dicer1−/− versus 0.403 ± 0.002 cpd in Dicer1+/+, p < 1.16 × 10−7) and contrast sensitivity (12.01 ± 0.27 in Dicer1−/− versus 13.65 ± 0.40 in Dicer1+/+, p < 1.91 × 10−5). Loss of miRNAs also caused a statistically significant increase in susceptibility to form‐deprivation myopia in Dicer1 knockouts compared to wild‐type animals (−19.1 ± 6.8 D in Dicer1−/− versus −9.7 ± 2.7 D in Dicer1+/+, p < 1.51 × 10−4).

Conclusions

Our data suggest that microRNAs play significant role in refractive eye development and the development of myopia via modulation of several canonical signaling pathways. MicroRNAs appear to be integrated in the signaling cascade involved in the optical‐defocus‐regulated refractive eye development at multiple levels.
Epidemiological evolution of viral conjunctivitis in ophthalmology emergency departments during the Covid‐19 pandemic
Authors: Reina Alfonso Rubio , Blazquez Javier Guzman , Diaz Oier Perez , Cardeñosa Nuria Cuenca , De Paz Sergio Pérez , Alvarez Quiroz Nolvis Marina , Morcillo Lozano María Belén , Rodríguez Beatriz González , Serrano Famara Doblado , Lopez Fernando Sellers , Martin Laura Alonso , Leal González Maria De Los Angeles , Silva Bruno Casco , Fernández García Maria Josefa , Hernandez Carranza Maria Zulema
Published: January 2022

Purpose

The COVID‐19 pandemic has substantially changed hygiene habits and measures to reduce the transmission of viruses through the respiratory route. The purpose is to analyse the influence of these measures on the incidence of adenovirus eye infections during the first phase of the COVID‐19 pandemic in Spain.

Methods

Retrospective study by consecutive sampling of patients who attended the Ophthalmology Emergency Department of our hospital between March 19 and April 30, 2019 and 2020. Quantitative variables were analysed using Student's t‐test for independent data and the difference in the proportion of patients diagnosed with viral conjunctivitis was measured using the chi‐square test (IBM spss 20).

Results

All medical records of patients in the 2020 group were reviewed and no evidence of COVID infection was found in the 10 days following their visit to the hospital. We found no significant differences in age or sex. In the 2019 period, a total of 1139 patients were seen, of which 162 (14.2%) had a clinical diagnosis of adenovirus conjunctivitis vs. 977 (85.8%) had other diagnoses. In 2020, there were 280 patients seen in the same time period, with 19 (6.8%) diagnosed with conjunctivitis compared to 261 with other diagnoses (93.2%).

We found a significant decrease in the incidence of cases of adenovirus conjunctivitis in 2020 compared to 2019 (p = 0.001). The 17.90% of patients (29) returned to the emergency department after a diagnosis of viral conjunctivitis in 2019, while only one of the patients seen in 2020 returned.

Conclusions

The use of face masks as well as hand and surface hygiene measures, especially in the healthcare setting, clearly reduce the incidence of adenovirus eye infections. Although the sample collected during 2020 covers the first period of confinement in Spain, our impression is that the trend of decreasing cases of adenovirus conjunctivitis cases is sustained over time.

References

Romano MR, et al. Facing COVID‐19 in Ophthalmology Department. Curr Eye Res. 2020;45(6):653–658.

Hoeferlin C, Review of Clinical and Operative Recommendations for Ophthalmology Practices During the COVID‐19 Pandemic. SN Compr Clin Med. 2021;1–6.

Güemes‐Villahoz N, et al. Conjunctivitis in COVID‐19 patients: frequency and clinical presentation. Graefes Arch Clin Exp Ophthalmol. 2020.
Progressive retinal thinning in patients with fibromyalgia syndrome: longitudinal study over a period of 5 years
Authors: Vicente Altabás María José , Roger Álvaro Tello , Roger Luisa Castro , Palomar Elisa Vilades , Ciordia Beatriz Cordón , Rodrigo Sanjuán María Jesús , Perié Manuel Subías , Campo Lorena Arias , García‐Campayo Javier , Palacián María Satué
Published: January 2022

Purpose

To quantify changes in visual function parameters and the macular neuroretina of patients with Fibromyalgia (FM) over a period of 5 years, and to compare with changes in healthy controls.

Methods

Eighty patients with FM and 38 age and sex‐matched healthy controls were recruited for the study. Only one eye per subject was randomly selected and included. All subjects underwent evaluation of visual acuity (VA) by ETDRS charts, contrast sensitivity vision (CSV) using CSV 1000E test and retinal evaluation using Spectralis Optical coherence tomography (OCT). All subjects were re‐evaluated after 5 years to quantify changes in visual function parameters and ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness. Association between progressive structural, functional and disease severity changes was analysed. Additionally, in order to analyse progression depending on disease phenotype, the patients were classified into three different groups and compared.

Results

After a period of 5 years of follow‐up, patients with FM showed worse low contrast VA (p = 0.024), and low frequency CSV (p = 0.004). Furthermore, they presented a progressive decrease affecting the GCL thickness (nasal 1, p = 0.004; temporal 1, p < 0.001; inferior 1, p = 0.001) and the RNFL (nasal 1 and 2, p < 0.001; superior 1, p < 0.001; and inferior 1, p = 0.002). Changes affecting the GCL were correlated with progression in disease severity scores (EQ‐5D, r = 0.560, p < 0.001; FIQ, r = −0.470, p = 0.003). Correlations between structural changes and disease severity scores were only observed in the atypical and biologic phenotypes.

Conclusions

Patients with FM present progressive retinal neurodegeneration and visual function changes with time. The evaluation of visual parameters and GCL/RNFL thickness using SD‐OCT could constitute a useful tool in monitoring FM progression.
Retina analysis with optical coherence tomography in patients with fibromyalgia
Authors: Ciordia Beatriz Cordón , Rodrigo Maria Jesus , Perié Manuel Subías , Campo Lorena Arias , Vicente Altabás María José , Tello Alvaro , Castro‐Roger Luisa , Viladés Palomar Elisa , Satue Maria
Published: January 2022

Purpose

To evaluate the inner layers of the retina in patients with fibromyalgia (FM) compared to healthy subjects using a posterior pole protocol analysis in optical coherence tomography (OCT) and the relationship of structural measures with quality of life.

Methods

Seventy‐four eyes of healthy subjects and 55 eyes of FM patients were analyzed. FM group was divided into three subgroups depending on the phenotype of the disease (group 1, biologic phenotype; group 2, depressive phenotype; group 3, atypical phenotype). All of them were evaluated using Pole Posterior protocol of OCT Spectralis, which analyzes the thickness of the macular area divided into 64 cells. The thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) were evaluated. All patients completed the EuroQol questionnaire (EQ‐5D) and the Fibromyalgia Impact Questionnaire (FIQ) to assess health‐related quality of life.

Results

The FM patients presented a significant thinning of the RNFL in 17/64 cells and the GCL in 47/64 cells, compared with the control group. The depressive FM phenotype presented the highest number of cells significantly decreased compared to controls. A significant correlation was observed between the GCL and the EuroQol 5D questionnaire results in the lower temporal cells of the posterior pole grid.

Conclusions

FM patients showed a loss of retinal ganglion cells and RNFL detectable by the Posterior Pole protocol of OCT. This is a safe, easy and fast test which provides very complete macular data to quantitatively and objectively assess the disease and its different phenotypes in this patients.
High index of suspicion and complementary studies. Keys in the diagnosis of Fundus Albipunctatus
Authors: Dolores Díaz‐Barreda Mª , Boned Ana , Pérez Rivasés Guillermo , Bakkali El Bakkali Ismael , Núñez Moscarda Eva , Orejudo Derivas Marta , Cisneros Pablo , Ramiro Millan Patricia , Remon Leon , Ascaso Francisco , Perez Garcia Diana
Published: January 2022

Purpose

Due to its low prevalence Fundus albipunctatus (FA) constitutes a diagnostic challenge for any ophthalmologist. FA belongs to the heterogeneous group of "flecked retinal syndromes" characterised by the presence of a whitish‐yellowish stippling, located in the periphery in FA respecting the macular area with normal papilla and vascularisation. It is a congenital form of non‐progressive night blindness with autosomal recessive inheritance mostly caused by mutations in the RDH5 gene. Electroretinogram (ERG) shows an altered rod response in the dark that normalises with scotopic adaptation.

Methods

We present the case of a 12‐year‐old boy who was referred to our department for retinopathy under consideration. Ophthalmological examination showed a visual acuity of unity in both eyes according to the decimal scale, highlighting in the fundus a peripheral whitish stippling respecting the posterior pole with no other alterations. Given the clinical features suggestive of AF, additional tests were performed.

Results

Multifocal and Ganzfeld bell ERG showed altered rod response with recovery of the scotopic adaptation response. There was an absence of autofluorescence (AF) indicating reduced retinal 11‐cis input to the photoreceptors. Fleckes on Optic Coherence Tomography (OCT) appeared as hyper‐reflective lesions. We confirmed the diagnosis by genetic study showing RDH5 mutation. It was not possible to study relatives.

Conclusions

FA is a rare pathology whose characteristics must be known in order to suspect and properly diagnose it, distinguishing it from other similar diseases with a worse prognosis that may require a different follow‐up and approach, such as retinitis punctata albescens or fundus flavimaculatus, for which ERG, OCT and FA play a fundamental role.
Bilateral Sixth nerve palsy in a pediatric patient as first presentation of atypical miller fisher syndrome
Authors: Arias Pablo Cisneros , El Bakkali Ismael Bakkali , Pérez‐Rivasés Guillermo , Moscarda Eva Nuñez , de Rivas Marta Orejudo , Díaz Barreda Maria Dolores , Murillo Ana Boned , García Diana Perez , Grijalvo Leon Remon , Alperte Juan Ibañez , Puyuelo Javier Ascaso
Published: January 2022

Purpose

To describe a case of bilateral sixth nerve palsy in the setting of an atypical Miller Fisher Syndrome (MFS), extremely rare in the pediatric population and barely documented in the literature

Methods

We present a case of a 12‐year‐old girl who came to the emergency room for diplopia of 24 hours. She had no history of a previous infectious or febrile process, except for an episode of abdominal pain 8 days earlier. The examination revealed bilateral sixth nerve palsy. Hospital admission was decided. Two days later the clinical picture worsened, appearing swallowing difficulty, decreased strength and muscle tone in all 4 extremities. The tendon reflexes were preserved. Craniospinal MRI and lumbar puncture were normal. The electroneurogram was consistent with early stage of polyradiculoneuritis. Autoimmunity tests showed positive anti‐GT1a antibodies and negative anti‐GQ1b antibodies.

Results

Based on the findings, treatment with immunoglobulin and intravenous corticosteroids was decided. Clinical resolution was progressive and the oculomotor alteration completely remitted at 2 months.

Conclusions

MFS is a rare autoimmune disease characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia. It is considered a variant of Guillain‐Barré syndrome. There are few cases or series of cases described in the literature on MFS and its behavior in pediatrics. Therefore, almost all clinical and laboratory findings have been described in adults, but in pediatrics, there is still uncertainty. This can lead to difficulties in the diagnosis of MFS in these patients. MFS should always be suspected in the context of acute diplopia or oculomotor paralysis in pediatrics, especially if it is bilateral; despite that its bilateral character seems to be less than in adults. Fortunately, even in these patients, it maintains its self‐limited behavior, so a full recovery is expected.

Mane S, (2020) Miller Fisher in a Child. Journal of Pediatric Neurosciences.
The effects of visible and blue light exposure on growth and melanogenesis of ocular melanoma cell lines
Authors: Wu Chieh‐Lin (Stanley) , Zhu Ling , Chen Yingying , Conway R. Max , Madigan Michele
Published: January 2022

Purpose

Cumulative ultraviolet (UV) exposure is important in skin and conjunctival melanomas and melanogenesis. UV light does not reach the inner posterior eye, but visible light radiates the retina, underlying retinal pigmented epithelium (RPE) and the choroid. The effects of visible light on the choroidal microenvironment and potential roles in choroidal melanoma progression are unknown. We examined human ocular melanoma cells for responses to white or blue light exposure, specifically, cell viability and cytotoxicity, and melanin production.

Methods

Ocular melanoma cells were grown in RPMI/L‐glutamine/sodium pyruvate (Choroidal: MP38 and MP46 (RPMI + 20% FBS), 92.1 (RPMI + 10% FBS); conjunctival: CM2005.1 (RPMI + 10% FBS)). Cells were grown in 96 well black plates (8000/well; n = 5 per cell line; triplicate) for 18 hrs, then fresh medium (1% FBS) for 16 hr. Cells were exposed to: (1) white light (λ: 400–700 nm), 32,000 lux (direct sunlight) for 4 hr (short‐term), or 4 hr/day × 4 days (16 hr, cumulative); or (2) blue light (λ: 460 nm): 3100 lux for 4 hr (short‐term) or 16 hr/day X 2 days (32 hrs, cumulative). Unexposed control cells were grown in parallel. Viability and cytotoxicity of light‐exposed and control cells were measured with alamarBlue and LDH assays, respectively. Intracellular melanin was assessed after cumulative white or blue light exposure.

Results

Short‐term and cumulative white light reduced viability (alamarBlue) by 5–15% (92.1, MP46 and CM2005.1 cells, but not MP38) and 10–25% (92.1, MP38, MP46 and CM2005.1 cells), respectively. Short‐term blue light did not affect viability of any cell lines; cumulative blue light exposure reduced viability by 10% in MP38 cells only. No significant change in cell cytotoxicity (LDH) or intracellular melanins was noted after white or blue light exposure for any cell lines.

Conclusions

Melanoma cells showed no light‐induced cytotoxicity (measured by LDH leak), although viability (measured by alamarBlue) was reduced after cumulative light exposure, suggesting reduced cell numbers rather than cell death. Although melanoma cell lines showed variable intracellular melanins, levels were unchanged with light exposure, despite cells expressing melanogenesis‐related proteins.
Our experience in the use of modern computer technology with the manufacture of navigation templates for surgical decompression of the orbit in patients with endocrine orbitopathy
Authors: Petrenko Oksana , Kopchak Andriy , Rykov Sergiy , Chepurnyi Yurii , Prusak Olha , Slobodianiuk Alina
Published: January 2022

Purpose

Optimization of bone orbit decompression in patients with endocrine orbitopathy using Computer‐Aided Design (CAD) / Computer‐Aided Manufacturing (CAM) technologies with the manufacture of navigation templates.

Methods

To achieve this goal, the results of bone decompression of the orbit in 12 patients were analyzed. Each patient underwent a standard ophthalmological examination and assessment of binocular vision. Before and after surgery, patients underwent multislice computed tomography, the size of the exophthalmos was performed by the method of Ramli et al., 2015. With the help of CAD / CAM technologies, resection surgical templates were made for bone decompression of the orbit.

Results

The study included 12 patients (24 orbits) – 7 (58.3%) women and 5 (41.7%) men. All patients underwent combined bilateral orbital decompression. The average value of exophthalmos before surgery was 24.6 ± 3.5 mm on the left and 23.6 ± 2.9 mm on the right, and after surgery 21.4 ± 2.8 mm and 21.1 ± 2.9 mm, respectively, indicating a significant improvement in eye position (p > 0.05).

In 2 patients (16.6%) diplopia was observed, in one patient (8.3%) ‐ hypoesthesia of the second branch of the trigeminal nerve in the early postoperative period. Late postoperative complications (follow‐up 3 months) were not observed.

Conclusions

Surgical decompression of the orbit using navigation templates can significantly reduce the degree of exophthalmos by an average of 3.2 mm, while reducing the area of bone resection, which reduces the risk of postoperative complications due to damage to the oculomotor muscles and the hyoid nerve. An individualized approach using CAD/CAM technologies is necessary to achieve optimal treatment results in patients with endocrine orbitopathy.
Two different modalities for treating iris cysts
Authors: De Keizer RJW , Jordy Goemaere , Noemie Lauwers , Sorcha Ní Dhubhghail , Jose Tassignon Marie
Published: January 2022

Purpose

To present two patients with recent onset iris cysts where two different treatments were applied.

Methods

While generally benign, stromal iris cysts can increase in size very rapidly and if treatment is not prompt, can result in enucleation,as in traumatic related induced epithelial cysts. To avoid this, two different treatment modalities were performed in our clinic. The first case was a traumatic iris cyst and the second case was a congenital cyst; they underwent intralesional photocoagulation and intralesional alcohol injection (Shields method) respectively.

Results

For the first case of the patient, a 38‐year‐ old man with a secondary traumatic epithelial cyst, intralesional photocoagulation was performed over 270 degrees. The cyst shrivelled, and postoperatively the visual acuity increased from finger counting to 0.3. This was followed by a cataract surgery. In the months after the cataract surgery, the cornea became oedematous and the IOP elevated. After further decompensation, the patient elected to abstain from further surgery. In the second a 19‐year‐old man, with a congenital stromal cyst and progressive myopia was treated with intralaesional absolute alcohol. After the first treatment session, the cyst appeared to resolved but after several months it returned. A second intralesional alcohol treatment session was performed and while there is some return of fluid in the cyst this is accumulating very slowly. The patient remains symptom free for the past 2 years, the pupillary zone remains clear of the cyst and the visual acuity is 1.0 (Decimal Snellen).

Conclusions

In stromal iris cyst, the very rapidly progression can be blocked or stabilized by intralesional photocoagulation or alcohol. In our experience with these cases, the latter approach demonstrated better results in the long‐term and enucleation could be avoided.

CL Shields S Aregalli ,EB Lally,SE Lally, JA Shields: Iristromal cyst management with absolute alcohol induced sclerosis. JAMA Ophthalm 2014,132,(6) 703‐708.
Plexus‐specific analysis of retinal neurovascular coupling using optical coherence tomography angiography
Authors: Kallab Martin , Hommer Nikolaus , Tan Bingyao , Pfister Martin , Schlatter Andreas , Werkmeister René M. , Chua Jacqueline , Schmidl Doreen , Schmetterer Leopold , Garhöfer Gerhard
Published: January 2022

Purpose

To analyse retinal neurovascular coupling (NVC) in a plexus‐specific manner at baseline and during flicker light stimulation using optical coherence tomography angiography (OCTA) and to thereby use the retina as a model for non‐invasive microvascular assessment of NVC in humans.

Methods

22 healthy subjects were included in the study. Macular 10°x10° volume scans were acquired at baseline and during flicker light stimulation using the Spectralis OCTA module (Heidelberg Engineering, Heidelberg, Germany). Vessel densities (VDs) in the superficial (SCP), intermediate (ICP) and deep capillary plexus (DCP) as well as in the full retina (FR) were assessed after thresholding the respective slabs by mean values. Large vessels and resulting projection artefacts were removed using a threshold‐based approach. Capillary representation was optimized using a “Frangi filter”. Volumetric blood flow and vessel diameters were measured using a Doppler‐OCT prototype.

Results

Flicker light stimulation induced a significant FR VD increase from 39.7 ± 1.7 to 41.2 ± 1.6% (+3.8 ± 2.7%; p < 0.001). Upon separate analysis of the three retinal plexus, VD significantly increased by +9.9 ± 6.7% in SCP, by ±6.6 ± 1.7% in ICP and by +4.9 ± 2.3% in DCP (p<0.001 for all three). This increase was significantly higher in SCP than in ICP (p = 0.02) and DCP (p = 0.002). Arterial diameters increased by +3.7 ± 3.1% (p < 0.001), venous diameters rose by +4.5 ± 3.0% (p<0.001). Volumetric blood flow increased by +39.9±34.9% (p<0.001) in arteries and by +29.8 ± 16.8% (p < 0.001) in veins.

Conclusions

In summary, a robust increase of retinal VD which was most pronounced in SCP could be observed upon flicker light stimulation. These data propose a plexus‐specific mechanism, to precisely meet the metabolic needs of retinal cells. The location of SCP in the inner retinal layers, where increase of metabolic demands is suggested to be greatest during flicker light stimulation, could be explanatory for the locally bigger response.
Acute ocular hypertension in adult pigmented mice: longitudinal functional and morphological studies
Authors: Gallego Ortega Alejandro , Norte Muñoz María , de Imperial Ollero Juan Antonio Miralles , Javier Valiente‐Soriano Francisco , De La Villa Pedro , Vidal‐Sanz Manuel
Published: January 2022

Purpose

Transient ischemia‐reperfusion (I/R) is a commonly employed method to study acute angle‐closure glaucoma. Here, we assess with functional and histological techniques the effects of various ischemic and reperfusion intervals.

Methods

I/R was induced in C57BL/6J mice by inserting a 30G needle in the anterior chamber of the left eye connected to a 500 mL reservoir of 0.9%NaCl elevated over 150 cm, to increase the IOP from 8 to ≈90 mmHg for several intervals of 45', 60', 75' or 90' (n = 4; each group) and 3 days later mice were perfused, their retinas were prepared as flat‐mounts and immunostained with Brn3a antibodies to identify retinal ganglion cells (RGCs). In addition, the effects of 60' I/R were analyzed longitudinally in vivo with full field electroretinogram recordings at 3, 7, 14, and 21 days after injury (n = 12) and ex vivo with immunohistochemical techniques at 3, 7, 14 or 21 days to determine the survival of RGCs, horizontal cells, S‐cone or L/M cone photoreceptors that were identified with Brn3a, calbindin, S‐ or L/M‐Opsin antibodies, respectively.

Results

At 3 days of 45' of I/R the Brn3a+RGC population remained intact, however, after 60', 75' or 90' the Brn3a+RGC population was reduced to 75, 37.5 and 12.5%, respectively, of its original value. At 7 days after 60' of I/R, Brn3a+RGCs decreased to 50%, and remained unchanged for up to at 21 days. Horizontal cells and S‐cones remained unchanged at every time interval examined. L/M cones diminished significantly at 7 days (≈70%) and further decreased to 58% at 14 days without further changes at 21 days. Functional analysis showed a permanent decrease in all waves studied, from 3 to 21 days after I/R.

Conclusions

Pigmented mice retina shows a damage threshold between 45' and 60' min of I/R for RGC survival. 60' of I/R leads to a rapid loss of innermost retina from 3 to 7 days, the horizontal cells are not affected, while in the outer retina, L/M cones are affected but S cones are not.CT
Successful treatment of intraocular inflammation following intravitreal brolucizumab
Authors: Enders Christian , Jens Ulrich Werner
Published: January 2022

Purpose

To describe the management of intraocular inflammation after treatment with vascular endothelial growth factor (VEGF)–inhibitor brolucizumab in two patients.

Methods

We present the treatment course of two patients who received an upload with brolucizumab in one eye due to age‐related macular degeneration (AMD) after previous intravitreal therapy with other VEGF‐inhibitors had not been effective anymore. Both patients developed a delayed intraocular inflammation (IOI) with emphasis on the vitreous.

Results

Further intravitreal therapy with brolucizumab was stopped in both patients, other causes than sterile uveitis were excluded and local therapy with steroidal eye drops was initiated. Patient B additionally received body weight‐adapted therapy with oral steroids due to severe inflammation in the vitreous space. Initially and during the whole course, there was no evidence of vasculitis. Both patients reached their initial visual acuity within 4 weeks.

Conclusions

Successful treatment of IOI after treatment with brolucizumab requires thorough and frequent examinations to identify IOI early. With an immediate cessation of therapy with brolucizumab and additional therapy with either local steroids or a combination of local and systemic steroids both patients fully recovered from medication‐associated uveitis without any remnants.
Multimodal imaging in retinal artery macroaneurysms
Authors: Maamouri Rym , Meriem Ouederni , Wijdene Nabi , Fehmy Nafaa , Hela Sassi , monia cheour
Published: January 2022

Purpose

To describe multimodal imaging features in eyes with retinal artery macroaneurysms (RAM).

Methods

A retrospective case series of 4 eyes diagnosed with RAM. All patients underwent a detailed ophthalmic examination, fundus photography, fluorescein angiography, swept source optical coherence tomography (SS‐OCT) and swept source optical coherence tomography angiography (SS‐OCTA).

Results

All patients were females with a mean age of 57‐year‐old. There was a history of systemic hypertension in 3 patients. An acute vision loss was reported in 2 cases. The best corrected visual acuity at presentation ranged between +1.7 and +0.1 LogMar. RAM was single and unilateral in all cases. The RAM were seen in the temporal half of the retina in all cases and were localized in the superior temporal arcade in 2 cases and in the inferior temporal arcade in 2 cases. Fluorescein angiography allowed for the visualization of the RAM in 3 cases. SS‐OCT visualized the RAM in all cases and their consequences on the surrounding area and on the macula. SS‐OCTA allowed observation of blood flow in each layer of the RAM. En face OCT permitted delineation of the macroaneurysm wall in 2 cases.

Conclusions

Retinal artery macroaneurysm is an acquired rare vascular disease that may mimic a variety of other conditions. Multimodal imaging approach is very useful for planning and assessing therapy.