bluuebunny/crossref_metadata_2025 huggingface dataset:
Is neurodegenerative retinal diseases the result of disturbed energy metabolism in Müller cells?
Authors: Kolko M.
Published: September 2016

Extensive evidence reveals decreased energy turnover in neurodegenerative brain diseases. A similar critical role of hypometabolism as a contributor to the pathogenesis of blinding neuro‐retinal diseases has been suggested. Although, neurons are the major consumers of glucose due to the high cost of signaling, the surrounding glial cells have multiple functions that are essential for neuronal metabolism. As such, the most abundant retinal glial cells, Müller cells, have been shown to possess unique features essential for maintenance of neuronal energetics and metabolism. The presentation will provide a brief overview on the current knowledge of metabolic cooperation between retinal neurons and Müller cells. Furthermore, perspectives of future strategies to improve retinal energy metabolism, and thereby prevent retinal neurodegeneration, will be discussed.
The tests
Authors: Thompson D.
Published: September 2016

Visual electrophysiology tests provide objective information about visual pathway function. They characterise ‘bio‐electrical’ changes in the retina and visual pathway to the striate cortex. The International Society for Clinical Visual Electrophysiology of Vision, [ISCEV], publishes standards and guidance for performing each test; download from www.ISCEV.com. There are five. The electro‐oculogram, EOG, indicates RPE physiology. A full field flash electroretinogram, ffERG, summates activity from the whole retina and distinguishes photoreceptor and inner retinal function. The pattern ERG, PERG, is a localised retina response produced by an alternating black and white checkerboard. The PERG has two components which may be used to measure macular function and retinal ganglion cell function. Multifocal patterns stimulate even smaller localised regions of retina and the resulting mfERG may depict the geographic extent of macular or cone dysfunction. The visual evoked potential, VEP, reflects changes in the striate cortex produced by flashes or patterns and distinguishes optic nerve, chiasmal and post chiasmal pathway function. This talk will describe the patient's perspective, what the results look like and how they are analysed.
Cases
Authors: Liskova P.
Published: September 2016

The spectrum of monogenic ocular disorders identified in the Czech Republic is diverse. Interesting cases will be presented.
Signs and symptoms of uveitis
Authors: Neri P. , Bisceglia P. , Cesari C. , Carrozzi G. , Pirani V.
Published: September 2016

Uveitis can be a sight‐threatening disease. Inflammation of uveal tract can be divided into: anterior, intermediate, posterior, and panuveitis. Blurred vision, ocular pain, photophobia and floaters are some of the symptoms complained by those who are affected by uveitis. The onset of uveitis can be either acute or insidious, bilateral rather than unilateral. Posterior uveitis is usually associated with vitritis. Anterior chamber cells and flare should be graded according to standardized uveitis nomenclature (SUN) working group. Binocular indirect ophthalmoscopy (BIO) score is used to evaluate the severity of vitritis. Vitreous changes may comprehend: vitreous hemorrhage, vitreous strands, and vitreous traction. A further classification of posterior uveitis depends on the primary site of inflammation, which can identify: retinitis, choroiditis, retinochoroiditis, and chorioretinitis. Posterior pole uveal involvement can be: focal, multifocal, and placoid. Retinal vasculitis can be present. Uveitis might be complicated by anterior and posterior synechiae, which can lead to uveitic glaucoma, cystoid macular oedema, retinal and choroidal neovascularizations, and retinal ischemia.
Central serous chorioretinopathy misdiagnosed as posterior uveitis
Authors: Khairallah M. , Kahloun R. , Jelliti B.
Published: September 2016

Central serous chorioretinopathy (CSCR) is a common disease characterized by serous detachment of the neurosensory retina and/or retinal pigment epithelium that often involves the macula. Atypical and chronic or recurrent forms of CSCR may be overlooked or misdiagnosed as chorioretinal inflammatory conditions, including Vogt Koyanagi Harada disease, sympathetic ophthalmia, posterior scleritis, multifocal choroiditis, serpiginous choroiditis, idiopathic posterior uveitis, or other uveitic entity that all usually require corticosteroid treatment. The use of systemic corticosteroids in such cases is not only ineffective, but it usually exacerbates the condition, leading to bilateral, severe, and chronic CSCR with irreversible chorioretinal damage and visual impairment.

A careful clinical examination and appropriate use and interpretation of multimodal imaging are mandatory to differentiate CSCR from any chorioretinal inflammatory condition and to prevent severe and irreversible visual damage resulting from misdiagnosis and management mistakes.
Photochemical reversal of cataract
Authors: Kessel L.
Published: September 2016

Globally, cataract is the second leading cause of blindness. Current treatment consists of surgical removal of the lens of the eye. Although sight‐threatening complications are rare they do occur. Opting for a non‐surgical treatment would abolish the risks associated with a surgical procedure (e.g. infection, bleeding, retinal detachments). Cataract is caused by a clouding of the lens due to accumulation of large protein aggregates. We have proposed to photochemically reverse the optical deterioration of the aged human lens. We have shown on human donor lenses that irradiation with visible light significantly improves the transmission of light through the lens. Although these results are promising, visible light may not be an attractive option for photochemical reversal of cataract due to the risk of retinal light induced damage. To overcome this obstacle, we have shown that the same effects can be obtained via two‐photon photolysis using a safe infra‐red femtosecond pulsed laser. Clinically relevant effects (up to 15 years of optical lens rejuvenation) have been demonstrated.
From time domain to high resolution and angio‐OCT: an historical perspective
Authors: Neri P. , Mariotti C. , Pirani V. , Bisceglia P. , Giovannini A.
Published: September 2016

Optical coherence tomography (OCT) is a non‐invasive tool that allows in vivo imaging of almost all the structures of the eye. It was introduced into the clinical practice more than twenty years ago. The advances in OCT technology are mainly based on ultra high‐resolution, adaptive optics, eye‐tracking, and changes in signal detection. Regarding this last aspect, the technology has evolved from time‐domain (TD) to spectral‐domain (SD) detection, providing a higher definition of the analyzed structures. Today, SD OCT has become a part of the routine practice. Apart from its diagnostic value, OCT has allowed an objective assessment of treatment response. In addition, it has provided predictive value for visual recovery and prognosis of several diseases. Recently, SD‐OCT has given to the ophthalmic researchers a renewed enthusiasm: a special processing algorithm has been developed for high‐speed OCT devices. This OCT technique, known as OCT angiography, can produce images of capillary‐level blood flow in the retina and choroid. OCT technology continues to develop further and this will provide new insights for the pathogenesis of several eye diseases.
Latest diagnostic possibilities in unsolved uveitis, suspicious for malignancy
Authors: Neri P. , Arapi I. , Pirani V. , Giovannini A. , Mariotti C.
Published: September 2016

Vitreo Retinal Lymphomas (VRL) are rare malignancies that display a wide spectrum of clinical patterns. Almost all VRL are non‐Hodgkin's lymphomas, B‐cell sub‐type. Since the clinical presentation of VRL might be confused with a non‐responder eye inflammation, VRL are also known as ‘masquerade syndromes’. On the basis of the potential severity of such disease, vitreous biopsy might be indicated for all the cases which can be potential VRL. Since vitreous biopsy is not diagnostic in all cases, further techniques can provide further essential data. Immunohistochemistry can be used for identifying important Cluster of Differentiation (CD) such as CD45 for leukocytes, CD20, CD79a, PAX‐5 for B‐cells, CD45RO for T‐cells, and CD68 for macrophages. Furthermore, clonality can be established by using antibodies targeting the kappa and lambda light chains. Polymerase chain reaction gene rearrangement studies can identify monoclonality of the heavy chain variable (V), diversity (D), and joining (J) immunoglobulin gene segments. Recently, measurement of Interleukin (IL)‐6 and IL‐10 in aqueous and/or vitreous fluid can lead to the correct diagnosis, even though an elevated IL‐10/IL‐6 ratio is not specific for VRL.
Counting microglial cells in the adult rodent retina
Authors: Gallego B.I. , De Garcia P. , Sebastian A.I. , De Hoz R. , Salazar J.J. , Rojas B. , Trivino A. , Ramirez J.M.
Published: September 2016

Glaucoma is a chronic optic neuropathy linked to the damage and death of retinal ganglion cells. Microglial cells seem to play a critical role on glaucomatous physiopathology, and their proliferation has been considered a hallmark of neurodegenerative diseases ongoing, also in the retina. Quantitative microglial studies require big sets of images analysed. Because manual cell counting methods are tedious and time consuming, computational approaches have been developed for counting cells in the nervous system. Nonetheless, microglial complex morphology makes difficult proper cell identification with standard methods. We present a new and interactive algorithm implemented in MATLAB for quantitative analysis of Iba‐1+ microglial cells in adult mice retinas. Without any computation knowledge, this technique enabled a fast quantification of microglial cells with reliability similar to manual method, in both non‐proliferative and in a proliferative state in a mouse model of unilateral laser‐inducer ocular hypertension. Although this algorithm has been developed for retinal microglial analysis in a specific model, some parameters can be modified in the interactive interface for its application in other retinal pathologies or either tissues.
Role of glial cells in regulating retinal blood flow during flicker‐induced hyperemia and systemic hyperoxia‐induced hyporemia in cats
Authors: Nagaoka T.
Published: September 2016

Background

To investigate the role of glial cells in the regulation of retinal circulation in response to flicker stimulation, which is related to neurovascular coupling, and systemic hyperoxia in the retina.

Methods

Using laser Doppler velocimetry, we measured the retinal blood flow (RBF) in first‐order retinal arterioles in anesthetized cats. After intravitreal injection of l‐2‐aminoadipic acid (LAA) as gliotoxic compound, we examined the changes in RBF in response to flicker stimulation of 16 Hz for 3 min and systemic hyperoxia induced by the inhalation of 100% oxygen for 10 min.

Results

The RBF increased gradually and reached a maximal level after 2–3 min of flicker stimuli in the PBS group. In the LAA‐treated eyes, the increases in RBF during the flicker stimulation were significantly attenuated by one third of those in the control eyes. During hyperoxia, the decreases in RBF in response to hyperoxia were significantly attenuated in the LAA‐treated eyes compared with the control.

Conclusions

The current results suggest that the retinal glial cells play an important role in the regulation of retinal blood flow during Flicker‐Induced Hyperemia and Systemic Hyperoxia‐Induced Hyporemia.
Cases
Authors: Leroy B.
Published: September 2016

Cases in ophthalmic genetics

Clinical cases will be shown. Everyone is encouraged to present unknown of interesting diagnostic cases in inherited eye disease. Submission of cases can be done in the room where the Grand Rounds in Ophthalmic Genetics are being held.
Follow‐up: which one and for whom?
Authors: Damato B.
Published: September 2016

In theory, surveillance of patients with uveal melanoma is aimed at detecting and treating ocular recurrence and morbidity as well as systemic metastases. In practice, the scope of such follow‐up is uncertain and controversial. Regular examination by an ocular oncologist can be difficult for patients who live far from the oncology center whereas inexpert ophthalmologists close to the patient's home may fail to detect tumor recurrence and other ocular morbidity in a timely manner. Screening for metastatic disease is expensive, can expose patients to harmful ionizing radiation, and only rarely seems to result in prolongation of life. Follow up protocols also have psychological impacts on patients, both positive and negative. There is scope for evidence‐based guidelines, which at present are lacking. The aims of this presentation are to consider the benefits and costs of ocular and systemic surveillance and to propose suggestions for personalized care.
Repairing the ageing brain – neural ECM in regeneration and rehabilitation
Authors: Kwok J.
Published: September 2016

Perineuronal nets (PNNs) are meshed‐like extracellular matrix structures present on the surface of sub‐populations of neurons and are involved in regulating plasticity in the central nervous system (CNS). PNNs are formed at the end of the critical period during development and their formation closes the critical period for plasticity, as demonstrated in ocular dominance plasticity. One of the major components of PNNs are chondroitin sulphate proteoglycans (CSPGs), a family of inhibitory molecules for neuronal growth and regeneration. CSPGs are highly up‐regulated after injury in the CNS, including spinal cord and optic nerve. Enzymatic removal of CSPGs in the PNNs enhances plasticity, allows re‐organisation of circuitry and improves functional recovery. Recently, we also observed specific changes in chondroitin sulphate composition in ageing brains when compared to young adult brains. This change may underlie the loss of plasticity in ageing animals. We shall discuss the role of PNNs in regulating plasticity, regeneration and rehabilitation in the CNS, including the visual system in this talk.
Retina proteomics provide new insights in glaucoma
Authors: Funke S. , Perumal N. , Schmelter C. , Teister J. , Markowitsch S. , Beck S. , Pfeiffer N. , Grus F.H.
Published: September 2016

Proteomic alterations have been studied in retina samples of glaucoma and non‐glaucoma control donor eyes (N = 5/group) by use of a bottom up proteomic platform implementing LC ESI LTQ Orbitrap XL MS analysis and label‐free quantification following functional analysis using gene ontology (GO) annotation. Furthermore, candidate abundances were examined in porcine retina and optic nerve head preparations (N = 12/tissue type). Approximately 10% of identified proteins (>600, FDR < 1%) showed significant level alteration (p < 0.05) or distinct tendencies in glaucomatous retinae, predominantly encircling mitochondrial and nucleus residing proteins. Thereby, new candidates, e.g. ADP/ATP translocase 3 and methyl‐CpG‐binding protein 2 could be proposed to be associated to glaucoma. Numerous candidates, e.g. retinol‐binding protein 3 show characteristic distribution of abundance comparing optic nerve head and retina proteomes in porcine model eyes (p < 0.05). In conclusion, distinct proteomic alterations could be documented in the human glaucomatous retina highlighting new retinal protein candidates. Moreover, characteristic distribution of ocular proteins and candidates could be revealed.
Severe clinical features in Vernal Keratoconjunctivitis
Authors: Lazreg S.
Published: September 2016

Vernal keratoconjunctivitis (VKC) is a severe form of ocular allergy, that can causes severe visual complications, it is more frequent on warm climates. VKC occurs mainly in children, the incidence is higher in males by a ratio of 3 to1, and usually appears seasonally, from early spring untill automn. Clinically we can observe 3 forms, tarsal VKC, limbal and mixed forms, tarsal forms are the most common, with a giant papillae in the tarsal side of the conjunctiva, limbal forms may be oeudematous or nodular with trantas nods. Cornea is very frequently involved, and corneal lesions are various from punctuate keratitis to ulcers and in some cases to vernal plaques. Most of the patients presents an irregular astigmatism, and some of them keratoconus probably due to eye rubbing. The first step of the treatment is to identify the allergens by the allergologist, to avoid them or to begin desensitization. Medical treatment consists on topical steroids during acute phases, associate to topical mast cell stabilizers; for severe cases topical ciclosporine 2% is prefered to steroids, when it is available, if not, intratarsal injection of triamcinolone can help to improve corneal healing, vernal plaques must be removed surgically.
How can we improve?
Authors: Sunaric Megevand G.
Published: September 2016

How can we improve glaucoma training in Europe?

In Europe teaching and training in ophthalmology is very heterogenous. The EBO (European Board of Ophthalmology), as the official educational working body of the UEMS has gained respect in working on improvement of standards in the field of general ophthalmology by organizing a yearly EBO exam and providing to successful candidates the FEBO – diploma. Recently EBO has introduced the project of Fellow of the European Board of Ophthalmology Subspecialty Diploma (FEBOS) examinations. The EGS was the first European society invited to actively take the lead in organizing and chairing FEBOS examinations in Glaucoma. While EBO remains the ‘umbrella organization’, EGS has received the responsibility to determine clear eligibility criteria for candidates to sit the exam. Among other documents, EGS has elaborated a detailed log‐book, requirements defined as ‘mandatory’ or ‘suggested’ in theoretical and clinical knowledge. By setting these requirements reflecting high standards of knowledge in the field of glaucoma EGS aspires to influence in future fellowship‐programs in glaucoma‐teaching centers in Europe.
Accommodative IOLs: an update on recent developments
Authors: Vega‐Estrada A. , Alio J.
Published: September 2016

Purpose

To compare the clinical results of the Lumina accommodative intraocular lens (IOL) with a standard monofocal IOL.

Methods

Clinical study including 86 eyes that underwent cataract surgery. The study group included 61 eyes implanted with the Lumina. The control group included 25 eyes implanted with an Acrysof monofocal IOL. Visual function, contrast sensitivity (CS) and accommodation with an open‐field autorefractor were measured during 1 year.

Results

Uncorrected near visual acuity (UNVA) was 0.07 ± 0.08 LogRAD for the Lumina group and 0.37 ± 0.19 in control group (p < 0.01); corrected distance near visual acuity (CDNVA) was 0.11 ± 0.12 for the Lumina group and 0.41 ± 0.15 for the control group (p < 0.01). Defocus curves showed significant better results for the Lumina group for defocus ranging from −4.50 to −0.50D (p < 0.01). Accommodation was 0.63 ± 0.41, 0.91 ± 0.51 and 1.27 ± 0.76D for the Lumina group and 0.10 ± 0.15, 0.06 ±  and 0.07 ± 0.10D for the control group at accommodation stimuli of 2.0, 3.0 and 4.0D, respectively. CS was the same for both groups (p ≥ 0.26).

Conclusions

The Lumina accommodative IOL effectively restores the visual function and accommodation after cataract surgery with no influence on the postoperative CS.
Euthyroid Graves’ Orbitopathy
Authors: Boschi A.
Published: September 2016

Euthyroid GO is defined as an orbitopathy without present or past thyroid dysfunction Euthyroid GO is a rare condition (+/−10% of GO).

The phenotype of Euthyroid GO is still undetermined. Usually reported as a unilateral mild and poorly active GO, but no difference between GO with or without thyroid dysfunction have also been described. Antibodies anti‐TSH receptors, as imaging, usually contribute to the diagnosis.

We will review and discuss the clinical, radiological and biological features that are helpful for differential diagnosis.
OPA analysis – oscillatory and autonomic influence
Authors: Schmidl D.
Published: September 2016

Dynamic contour tonometry allows for a measurement of the ocular pulse amplitude. This parameter can relate to a number of local and systemic variables that can influence the fluctuation of intraocular pressure (from ocular rigidity to axial length and intraocular pressure itself).

Generating this pulse in ocular pressure mostly involves the flow pattern of the terminal branches of the carotid artery (ultimately responsible for 80% of ocular blood volume fluctuation). The pressure pulse can thus be analyzed from the systemic variables influencing the systolic volume injection, thus allowing for the interpretation of the oscillatory and autonomic input through the use of a local, eye‐related device.
Tear lipids in corneal stress and inflammation
Authors: Holopainen J.
Published: September 2016

Traditionally, ophthalmology was based on observing, trying, deducing and remembering. Yet, this view is rapidly changing. Research in the field of cornea and ocular surface has made significant advances in recent years. In this field major advances have been made in understanding the pathophysiology of common corneal and ocular surface disorders and moreover, we are beginning to understand that fats or lipids play a major role in the pathogenesis of these diseases. This has only been possible because of translational applications and approaches as well as methods to investigate ‘big data’. This talk will provide a short summary of some of the translational research performed in our lab in understanding the pathogenic mechanisms and the role of lipids in corneal diseases.
Specific gene in microphthalmia
Authors: Rozet J.M. , Fares‐Taïe L. , Chassaing N. , Gerber S. , Kaplan J. , Ragge N. , Calvas P.
Published: September 2016

Anophthalmia and microphthalmia (A/M) are early‐eye‐development anomalies resulting in absent or small ocular globes, respectively. Genetically determined A/M are characterized by major genetic heterogeneity. In addition, there is a genetic overlap with some genes being involved in both anophthalmia and microphthalmia. Recently, we reported that mutations in the gene encoding the A3 isoform of the aldehyde dehydrogenase 1 (ALDH1A3) cause A/M with occasional orbital cystic, neurological, and cardiac anomalies in three consanguineous families. ALDH1A3 is a key enzyme in the formation of a retinoic acid (RA) gradient along the dorso‐ventral axis during early eye development. Although the role of (RA) signaling in eye development is well established, these findings provided genetic evidence of a direct link between RA‐synthesis dysfunction and early‐eye‐development anomalies. Since the original report, A/M has been ascribed to homozygous ALDH1A3 mutations in sixteen additional consanguineous families describing variable clinical expression, within and between families, ranging from silent expression to multisystemic diseases. The variable expression of ALDH1A3 mutations which are a leading cause of A/M will be discussed.
Gene transfer of E2F2 induces in situ regeneration of retinal pigment epithelium
Authors: Luhmann U. , Kampik D. , Nishiguchi K. , Basche M. , Smith A.J. , Ali R.R.
Published: September 2016

The retinal pigment epithelium (RPE) interacts closely with photoreceptors and is important for maintaining visual function. In degenerative diseases such as age‐related macular degeneration (AMD), the leading cause of blindness in the developed world, RPE cell loss is followed by photoreceptor cell death. RPE cells can proliferate under certain conditions, suggesting an intrinsic regenerative potential, but so far this has not been utilised therapeutically. Here we use E2F2, a potent transcriptional regulator of cell proliferation, to induce RPE regeneration in vitro and in vivo. Gene transfer of E2F2 induced upregulation of Ki67 and uptake of BrdU in growth arrested ARP19 cells in vitro. In both, young and old C57Bl/6 mice, subretinal lentiviral delivery of E2F2 to the RPE caused a 40‐fold ±27.2 increase in E2F2 positive RPE cells that correlated with a 10‐fold ±4.7 increase in BrdU positive cells and a mean increase of RPE cell density. E2F2 also induced BrdU uptake and increased cell density in the central RPE of RPECreER/DTA mice, where pathology, induced by the activation of diphtheria toxin‐A, was strongest. These results provide proof of concept for a strategy to treat progressive RPE cell loss by in situ regeneration.
How to perform a vitreal, retinal or choroidal biopsy? What justifies an invasive technique?
Authors: Van Calster J.
Published: September 2016

A first question to ask is: what justifies the risk to be invasive? Although the risk profile of biopsy procedures has been reduced due to improvement of the technique, operating on an inflamed eye induces a higher perioperative risk. The technique, results and limitations of a single port vitreous biopsy procedure will be discussed, and compared with the diagnostic outcome after a full vitrectomy. Finally, the approach to obtain a chorioretinal biopsy will be highlighted, including risk profile and management of complications.
How to recognize a masquerade syndrome? What is the differential diagnosis?
Authors: Van Calster J.
Published: September 2016

In masquerade syndromes, the clinical picture is mimicking uveitis. They are simulating a chronic idiopathic uveitis, but the underlying primary cause is not immune mediated. In most cases, there is a limited response to corticosteroid treatment. Being great masqueraders, infectious causes have to be ruled out first. Other causes of masquerade syndromes will be discussed, emphasizing malignant processes.
OCT as a Novel useful tool in corneal transplantation
Authors: Thuret G. , Gabison E. , Guindolet D. , Lepine T. , Rolland J. , Gain P.
Published: September 2016

Fast and high‐resolution cross sectional imaging of the cornea by OCT proves essential in corneal graft: (i) during Eye Banking: non‐contact safe and accurate thickness measurements are available to guide pre‐cutting of DSAEK and control cut regularity; (ii) diagnosis and follow‐up of corneal diseases undoubtedly benefit from OCT that can help establishing indication for graft; (iii) after endothelial keratoplasty (EK), OCT shows graft position and adherence to the recipient bed and endothelial function through corneal thickness; (iv) after all grafts, OCT provides topography, thickness (useful during rejection and late endothelial failure), and images of donor/host interface and irido‐corneal angle; (v) The place of Iintra operative OCT expands rapidly, allowing an easy control of EK orientation, improving the safety of DALK or femtosecond laser‐assisted keratoplasty, and allowing the development of new techniques like intrastromal lamellar graft. Exciting perspectives will be illustrated with 2 examples: (i) an Optical Coherence Microscope that combines the large field of OCT and the cellular resolution of confocal microscopy; (ii) the monitoring of thickness during storage in a innovative bioreactor that restores the intra ocular pressure.
Algorithms looking for patterns of cell loss in glaucoma models
Authors: Davis B.
Published: September 2016

Whole‐retinal mounts have proven an invaluable tool for the assessment of retinal health in rodent models of disease with well‐established protocols for labelling of a variety of retinal cell populations including Retinal Ganglion Cells (RGCs). Loss of RGCs is thought to play a central role in many ocular disorders such as glaucoma, and RGC preservation is an established therapeutic endpoint. Nevertheless, a limitation of this approach is the high variability in RGC density between central and peripheral rodent retina, which can complicate RGC quantification by sampling. Whilst automated whole‐retinal measures of RGC density have added scientific rigour to the quantification of RGC populations, this technique still discards a lot of useful information. This talk outlines recent developments in the extraction of additional information from retinal whole‐mounts and reviews future directions for this technique in developing our understanding of disease pathology.
Novel diagnostic tools in DRP – from science to clinical relevance
Authors: Brunner S.
Published: September 2016

Due to a diabetes pandemia with more than 360 million people affected by 2030 worldwide, Diabetic Retinopathy (DRP) will remain the leading cause of vision loss although the percentage incidences of DRP have been substantially reduced. By careful management more than 90% of cases with blindness can be prevented. This presentation will demonstrate new findings from medical science with a potential to ease or improve diagnostics of DRP in the future. In particular, these methods can be used by non‐ophthalmologists to estimate or suggest the individual risk for DRP, as well as by ophthalmologists to refine diagnosis and learn more about the systemic situation of their patients. Some of the most promising methods in the past years were (1) blood‐circulating factors, as Angiogenin, other cytokines and different Endothelial Progenitor Cells (EPCs) in correlation to DRP and furthermore (2) the use of the 1060‐μm Optical Coherence Tomography (OCT) to map choroidal thickness in patients with DRP. Results of clinical trials as well as considerations for a possible practial implementation of these new methods will be presented.
OCT in AD
Authors: Normando E.M. , Crawley L. , Ahmed F. , Bloom P. , Cordeiro M.F.
Published: September 2016

Alzheimer's (AD) and Parkinson's disease (PD) are the most common cause of dementia characterized by progressive deterioration in cognitive function.

These neurodegenerative disorders present ocular manifestations which could precede systemic signs and symptoms of disease. Correlations between the eye and the brain have been confirmed by recent advances in imaging technologies such as Optical Coherence Tomography (OCT). Hardware and software improvements have given the possibility of examining structures previously inaccessible. Retinal Nerve Fibre Layer (RNFL) thinning has been recognised to occur in both AD and PD and OCT segmentation software are now available as an aid for understanding the involvement of retinal layers other than the RNFL in these pathological processes.

The aims of this talk is to explore the current application of OCT retinal imaging in AD and PD. Additionally, novel OCT applications will be discussed to generate a multidisciplinary debate.
Suspicious choroidal naevi: when to observe, when to treat
Authors: Kivelä T.
Published: September 2016

To find and characterize all existing choroidal naevi, a systematic fundus examination with the indirect ophthalmoscope and the slit lamp using a non‐contact or contact lens for detail are mandatory. These are ideally supplemented with optical coherence tomography (subretinal fluid, thickness and internal structure of lesions <1 mm thick), fundus autofluorescence (recent and chronic subretinal fluid, orange pigment), and ultrasonography (thickness and acoustic profile of lesions >1 mm thick). Despite such imaging, the challenge lies in telling a small melanoma from a naevus. The mnemonic ‘To Find Small Ocular Melanomas’ reminds us to look for tumour Tickness more than 2 mm, subretinal Fluid, visual Symptoms, Orange pigment and tumour Margin touching the optic disc. Each of these features roughly doubles the likelihood of growth and, hence, malignancy. None of them are specific though – about 8% of benign naevi have orange pigment and subretinal fluid, and naevi can grow slowly, especially in patients <45 years of age, whereas the smallest melanomas show none of these 5 features. Surveillance for growth, a biopsy, or both may thus be needed for a treatment decision. This talk will introduce these principles with examples.
Pseudophakic retinal detachment
Authors: Pournaras C.
Published: September 2016

Pars plana vitrectomy alone or combined with scleral buckling and scleral buckling are effective methods for repairing pseudophakic retinal detachments (PRDs). The currently available literature points to no compelling difference in single surgery or final anatomic success rates between those techniques.

The considerable improvements of the vitrectomy tools have created an increasing interest for their use as an initial procedure for the management of (PRDs). There is little evidence to support the routine addition of a scleral buckle to pars plana vitrectomy. Combined vitrectomy and scleral buckle results to an added operative time, greater postoperative (and sometimes intraoperative) discomfort, the induced refractive error and the potential for other buckle‐related complications.

Pars plana vitrectomy alone, allows the avoidance of complications associated with scleral buckles and at this time seems to be the procedure of choice for pseudophakic retinal detachment.
Are scleral lenses safe for the meibomian gland?
Authors: Mekki M.B. , Yahiaoui S. , Titah O. , Belaoudmou R. , Taibi A. , Bouguerfa R.
Published: September 2016

Nowadays, we are experiencing scleral lens rebirth through the development of new designs and materials respecting the anterior ocular surface represented by the cornea, the limbus and the anterior bulbar conjunctiva. But what about the posterior ocular surface, represented by the tarsal conjunctiva, the lid margin and meibomian glands? The interaction of the scleral lens with the posterior ocular surface will be assessed clinically in keratoconus patients wearing scleral lens for more than 2 years and compared in a randomized manner with soft lens, hybrid lens and corneal rigid gas permeable lens wearers and with control sample. Lid wiper epitheliopathy grade, tear film break up time, quality of meibum and meibomian gland trophicity will be compared between different groups…
Transparency of the lens and the eye
Authors: Prieto P.
Published: September 2016

Eye media transparency, and in particular that of the crystalline lens, is a requirement for good vision. Incipient lens opacification reduces retinal illumination and also increases intraocular scattering, producing unwanted visual artifacts, such as glare, that affect retinal image quality. A ripe cataract results in blindness.

Even before a cataract can be observed and diagnosed, intraocular scattering is known to gradually increase with age but also to depend on genetic and environmental factors.

Precise quantification of intraocular scattering can be a very useful tool to study some aspects of the eye's aging process and to develop an objective classification method for cataracts. However, this is not a simple task, especially at an early stage. In recent years, several objective, subjective or mixed‐approach procedures and devices have been developed, aiming to tackle this issue.

In this talk, the effects of a decreased lens transparency and increased will be summarized, the factors involved in the progression of this condition will be reviewed, and the methods to quantitatively study the problem will be briefly discussed.
Interpretation of keratoconus indices
Authors: Eppig T. , Spira‐Eppig C. , Szentmáry N. , Langenbucher A.
Published: September 2016

We provide an overview on the dedicated keratoconus indices of Pentacam (Scheimpflug‐based tomographer), CASIA SS‐1000 (anterior segment optical coherence tomographer), TMS‐5 (Scheimpflug and Placido tomo‐/topographer) and Ocular Response Analyzer (pneumotonometer which features measurement of biomechanical properties). We demonstrate how modern keratoconus screening software modules such as the Belin‐Ambrósio Enhanced Ectasia Display (BAD) or the ectasia screening of the CASIA/TMS‐5 work in comparison to the classical McDonnell/Rabinowitz and Smolek/Klyce/Maede indices, and we point out the differences between metric keratoconus indices and classificators. We will also discuss the diagnostic capacity of the devices and indices/classificators in detail.
Imaging in uveitis: techniques and indications
Authors: Herbort C.P.
Published: September 2016

Uveitis has become a precise clinical science, in part thanks to the development of performing imaging methods. Laser flare photometry (LFP), although not an imaging method ‘stricto sensu’, measures back‐scattered photons from the anterior chamber produced by a laser beam and so establishes the exact level of intraocular inflammation at any time and allows precise monitoring of uveitis. Fluorescein angiography (FA) has been used for more than 50 years and gives indications on inflammation of superficial structures of the fundus, optic disc and the retinal pigment epithelium. Indocyanine green angiography (ICGA) became available in the early 1990 ties and is essential in the precise investigation of the inflammatory, otherwise occult reaction in the choroidal compartment, giving panfundal information that is otherwise not available. Optical coherence tomography (OCT) analyses both the retina and choroid (in the enhanced depth mode – EDI) of the posterior pole. Ultrasound biomicroscopy (UBM) is useful to analyse inflammation in the retroiridal space. Other imaging methods such as fundus autofluorescence (FAF) or Angio‐OCT are still being evaluated for their utility in uveitis.
Instrument assisted diagnostics – biometry, topography and wave‐front analysis
Authors: Eppig T. , Spira‐Eppig C. , Szentmáry N. , Langenbucher A.
Published: September 2016

We start with an overview on biometric, tomographic, topographic and other complimentary examination techniques and instruments. Criteria and indicators are presented to tailor out whether measurements qualify for an appropriate calculation of pseudophakic and phakic toric lens implants. As a hot topic we show how to discriminate between regular and irregular portion of astigmatism in a tomographic or topographic measurement and how to use this information for calculation. We will address the issue, which data from the large set of information provided by the instrument software should be used for toric lens calculation. We will provide hints where to look at the printouts from the devices. Finally, we provide a compact workflow for device assisted examination for toric lens planning.
Central serous chorioretinopathy complicating inflammation suppressive treatment
Authors: Herbort C.P. , Papadia M.
Published: September 2016

Central serous chorioretinopathy (CSC) can sometimes be mistaken for posterior uveitis. Its diagnosis is of utmost importance as CSC as failure to do so will worsen when steroid therapy is erroneously given. The situation is even more tricky when CSC is complicating IST including steroids given for uveitis. In a collective of 1739 patients seen from 1995 to 2014 at the COS, 16 patients (0.9%) with CSC were misdiagnosed as posterior uveitis of which the development of CSC was missed in 4 uveitis patients under IST including corticosteroids. The mean diagnostic delay in the latter group was 2.4 ± 1.9 months, substantially shorter than the group of patients misdiagnosed at the onset (56.3 ± 60.6 months). The key to rapid diagnosis of a decrease of VA due to CSC in uveitis, is to search on one side whether inflammatory parameters such as laser flare photometry and dual fluorescein (FA) and indocyanine green angiography (ICGA) are improving combined with the search of CSC signs including serous detachments and/or small PEDs on OCT as well as typical CSC angiographic signs on dual FA/ICGA angiography. Although CSC complicating uveitis treatment is rare, prompt diagnosis is of utmost importance to avoid deleterious consequences.
Inside out Diode laser for rubeotic glaucoma in the anti VEGF era
Authors: Ahmed F.
Published: September 2016

Modern management for recalcitrant rubeotic glaucoma involves a multi‐step process involving intra‐vitreal anti‐ VEGF injection, out patient pan retinal photocoagulation and glaucoma drainage device surgery implant in theatre.

We re‐visit the use of a 2 step pathway with intra‐vitreal anti‐VEGF injection followed by combined ciliary body ablation and pan‐retinal photocoagulation using a transcleral diode laser. This out of vogue treatment can performed in an out patient setting under local anaesthetic and is an effective method of treating rubeotic glaucoma and may also be more cost‐ effective.

In addition the role of Micro‐pulse Diode laser will be also reviewed.
OCT‐A and FA findings in ocular Drepanocytosis
Authors: Ambresin A.
Published: September 2016

Sickle cell disease (SCD) can present various degrees of retinal vascular alterations both in the periphery and in the macular region. The aim of the presentation is to describe OCTA features of consecutive pediatric and adult SCD patients seen in the Medical Retina Unit of Jules Gonin Eye Hospital, Switzerland. Comparison of architectural changes will be made with fluorescein angiography.

Quantitative measures of vascular density, foveal avascular zone (FAZ) and non‐flow area (NF) measured in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) using the automated software will be presented. Qualitative assessment of perifoveal architecture changes made on the central 3 × 3 mm OCTA images will be detailed. Published studies on OCTA and sickle cell disease will be reviewed.
OCT‐A versus FA guided focal laser, in macular ischemic microangiopathies
Authors: Pournaras C.
Published: September 2016

The clinically significant macular oedema, related to the macular microcirculation abnormal permeability, ischemic changes or aneurysmal changes, were identified during the evolution of the most common retinal ischemic micro‐angiopathies.

Intravitreal anti‐VEGF or steroids demonstrated their efficacy to reverse the macular blood retinal barrier changes, resolving the characteristic oedematous macular changes leading to the observed clinically significant functional improvement.

The confrontation of the OCT‐angiography monitoring of the superficial and deep capillaries plexus changes to the fluoresceine angiography observed persistent leaking capillaries segment or micro‐aneurysms, allows the applications precise focal laser treatment.

Intravitreal anti‐VEGF associated to focal laser treatment results to superior functional results than intravitreal anti‐VEGF alone in late onset treated BRVO cases.
OCT and IVCM in corneal imaging
Authors: Dua H.S.
Published: September 2016

Optical coherence tomography (OCT) and In vivo confocal microscopy (IVCM) are two very useful imaging modalities in examination of the cornea. OCT provides non‐contact, cross sectional images with a wide angle of view, under high magnification, simulating histology but in fact are dependent on the reflectivity of tissues. Imaging through scars is poor. Clinically is it very useful in examining interfaces created by refractive surgery and lamellar corneal surgery.

IVCM provides en‐face images with a restricted field of view but with a resolution range of 1.5–4 μm allowing examination at a cellular level. The different layers of the epithelium, sub‐basal plexus, Bowman's zone, stroma with keratocytes and nerves, the Descemet's membrane and endothelial cells can be clearly visualised in health and disease. Besides providing detailed morphology of the above structures it also enable visualisation of invading organisms such as acanthamoeba and fungi.

Software associated with both OCT and IVCM allow measurement of dimensions of objects/area (s) of interest. OCT is more accurate in measurement of depth while IVCM enables quantification of cell size, shape and numbers. Interpretation skills require experience for both.
Linear and nonlinear microscopy for AS imaging: principles and pathbreaking application
Authors: Stachs O.
Published: September 2016

Linear microscopy is an established imaging technology for ocular surface imaging. Nonlinear microscopy is a new non‐invasive imaging technique, which allows a visualization of biological tissue with high signal contrast due to spectral separation combined with high resolution. This talk presents the physical principles of different contrast mechanisms. Exemplary experimental results based on various linear and nonlinear signals are shown, opportunities of this technology are discussed and the prospect of translating this imaging technique into a clinical application is addressed.
Usefulness of OCT for imaging the choroid, the vitreous and the optic nerve during uveitis
Authors: Denniston A.
Published: September 2016

Imaging – and its quantitative analysis – provides the opportunity for us to transform how we assess intraocular inflammation. The use of optical coherence tomography (OCT), particularly as it increases in depth of sampling and width of field, supported by novel approaches to the analysis of these images have the potential to supersede many of our subjective clinical assessments. In this presentation, we consider how OCT of the whole posterior segment – not just the retina – has the potential to facilitate both diagnosis and quantitative objective assessment of intraocular inflammation. Finally we consider how this is likely to impact both routine clinical practice and the design of clinical trials.
Anterior segment OCT in corneal diseases and surgery
Authors: Nubile M. , Calienno R. , Salgari N. , De Nicola C. , Lappa A. , Mastropasqua A.
Published: September 2016

Purpose

Optical coherence tomography (OCT) after extended use in diagnosis of retinal diseases has now become a new cross‐sectional imaging approach useful for anterior segment (AS) imaging. The potential advantages and limits using AS‐OCT in corneal diseases and surgery are presented.

Methods

Systematic literature review search and clinical examples focused in the fields of corneal ulcerations, opacities and corneal graft penetrating and lamellar surgery.

Results

AS‐OCT provides accurate morphology and measurements of different structures of the AS and of the cornea. Corneal loss of transparency in general permits visualization of the deeper AS structures facilitating surgical choice in complex cases. In contrast ciliary bodies are barely visualized, in contrast to UBM, due to light absorption by pigmented iris layers. Morphometry of corneal structures is particularly useful in the preoperative evaluation of thinning disorders, corneal ulcerations, infections and loss of transparency and after penetrating and lamellar surgery, including assessment of LASIK flaps and of deep anterior keratoplasty interfaces and endothelial keratoplasty lenticules adhesion. New generation optical coherence tomography angiography (OCTA) system for the assessment of corneal neovascularisation may be useful to evaluate ocular surface and corneal diseases in which the growth of vessels plays a role in the history and management of pathology.

Conclusions

AS‐OCT presents advantages in the clinical practice in the field of corneal disease and surgery. This technology alone should not substitute a comprehensive clinical examination but may offer valuable insights in the quantification and observation of fine details which can be obscured or not detectable during conventional slit‐lamp examination.
The view of a director of training
Authors: Garcia‐Feijoo J.
Published: September 2016

Training residents is a task that poses a challenge and an opportunity to every Institution. A teaching centre has a dual responsibility, first to assure the adequate care for the patients and second to guaranty the residents and fellows the best possible training. For these reasons management decisions have to promote the best standard of care for the patient while creating the opportunities for residents to learn. Moreover, residents should not only be trained in just clinical Ophthalmology as research is an important part or the learning process. So trainees should be actively involved in the research program of the Institutions. All these and the continuous rotation of the residents creates logistical and planning challenges that should be solve.

In summary a complete and successful program requires commitment of the Institution, the Staff/Consultant Ophthalmologists and the residents.