bluuebunny/crossref_metadata_2025 huggingface dataset:
Infectious driven autoimmunity ‐ how to treat?
Authors: DICK A
Published: August 2012

Purpose The question of infectious drive to autoimmunity is highlighted in cases. The debate is when or how to treat with specific anti‐infectious agents versus immunosuppression and above all when does malignant transformation occur.

Methods Highlight controversy with cases

Results The outcome of such cases is disappointing given the difficulty in how best to control to progressive degeneration that occurs.

Conclusion To date we are left with delayed diagnosis and poor outcome for such cases. We will discuss how best in future to curtail such outcomes.
The association between myopia and glaucoma ‐ causality or classification?
Authors: KHAWAJA A
Published: August 2012

Myopia is frequently cited as a risk factor for glaucoma, based on findings from many epidemiological studies. However, these studies are potentially subject to misclassification bias. Glaucoma is largely diagnosed based on optic disc cupping together with a visual field defect. Myopic patients may also have anomalous (or difficult to assess) optic discs together with visual field defects. This talk will examine the epidemiological link between myopia and glaucoma, and address the question whether the observed association between myopia and glaucoma is causal. Published evidence will be critically reviewed and supplemented with the findings from the EPIC‐Norfolk Eye Study (European Prospective Investigation of Cancer).
Refractive surgery in myopic, glaucomatous patient
Authors: CHAVES A
Published: August 2012

Purpose This lecture will focus on preoperative examination, IOP changes and postoperative considerations, identifying the patients at higher risk for developing glaucoma and selecting an appropriate and personalized approach.

Conclusion Most refractive surgeries are performed between the 3th and the 5th decade of a patients’ life. The prevalence of glaucoma increases with age and the life duration expectancy increases with progress in medicine. Although myopia and increasing age are known risk factors for developing glaucoma, it is impossible to predict which patients undergoing refractive surgery will develop glaucoma later in their life.
Glaucoma surgery in high myopia
Authors: LIM K
Published: August 2012

This lecture will describe the special pre‐ and post‐operative considerations require for glaucoma drainage surgeries in this group of patient. There are special anatomical features that predisposed this group of patient to have potentially higher complication risk; thin sclera and subsequent difficulty in scleral closure. Once they developed hypotony, these eyes are also more likely to develop hypotonous maculopathy. Therefore, pre‐operative assessment must include axial length measurement and carful slit‐lamp examination, looking for localised thinning in and around the surgical sites. There is no evidence to choose tube over trabeculectomy with mitomycin‐C but it is recommended that surgery should be performed with an anterior chamber maintainer in‐situ.
The importance of blue light exposure to circadian integrity and general health
Authors: LUCAS R
Published: August 2012

Melanopsin‐expressing retinal ganglion cells are capable of supporting an array of visual responses even after complete degeneration of rods and cones. Among their most important roles is the synchronisation (entrainment) of endogenous circadian clocks to local time. Action spectrum studies reveal that these new photoreceptors are maximally sensitive in the 'blue' portion of the spectrum. This has led to the assumption that blue light is especially important for eliciting entrainment and other accessory visual responses. I will discuss how good practice in light measurement and application might be influenced by discovery of these new photoreceptors.
Large optico‐reconstructive corneal grafts in complicated cases
Authors: BARRAQUER J
Published: August 2012

Purpose Demonstration of different procedures for eye surface reconstruction and visual rehabilitation in complicated conditions.

Methods Case 1: LASIK photokeratomileusis is demonstrated in a case previously operated for penetrating keratoplasty. Case 2: Optico‐reconstructive penetrating 11 mm keratoplasty performed in a case of bilateral keratoconus‐keratoglobus. The fellow eye had been operated for 11 mm penetrating keratoplasty 20 years earlier, with good result. Two years after the operation of the second eye opacification of the graft developed in the second eye due to irreversible homograft reaction. A second penetrating graft, 7.6 mm in diameter was performed in the center of the previous, opaque, graft. The procedure was combined with simultaneous extracapsular lens removal and IOL implantation.

Results The excellent results of these three examples of complicated large penetrating corneal grafts are demonstrated in all three cases with video and slides.

Conclusion The prognosis of large diameter optico‐reconstructive penetrating keratoplasties in apparently unfavourable situations can be definitely improved selecting appropriate surgical indications, combined with a meticoulus surgical technique, adequate postoperative medication (local and systemic corticosteroids, cyclosporine A eye drops 2 %, immunosuppressors, topical cycloplegics, etc.)and rigurous postoperative follow‐up control.
Investigation of bacterial contamination of corneal donors using molecular biology
Authors: ROBERT PY , DUBOIS A , CHAIGNIER D , GARNIER F , PLOY MC
Published: August 2012

Purpose transmission of infectious agents is a major concern for every graft process. Corneal transplantation has been associated to transmission of virus and non conventional agents, but bacterial hazard remains possible in eyebanks. In this prospective study, we investigated the presence of resistant bacteriae in contact with the cornea throughout the whole preservation process.

Methods Samples were taken from donor aqueous humor, conjonctival cul‐de‐sac and limbus, and from Corneaprep®, Corneamax® and Corneajet® media. Scleral rim was harvested as well after surgery. Bacterial contamination was investigated using direct exam, culture and 16S RNA detection.

Results 164 corneas of 83 donors were included. Cul‐de‐sacs conjonctivaux (CS). 131 cul‐de‐sac (79,9%) and 119 limbus (72,6%) were contaminated, from S. epidermidis in 50%. 7 aqueous humors (4%) were positive, 5 with S. epidermidis and 2 with Bacillus. We encountered 34 hemocultures (41%), 6 Corneaprep (4%), 6 Corneamax (4%), 0 Corneajet (0%) and 0 scleral rim (0%) positive.

Conclusion 16S RNA detection did not increase the number of positive samples. 92% of Coag. Neg. Staphylococcus, 19% of S. Aureus, 33% of enterobacteriae, 49% of streptococcus and 75% of enterococcus had an acquired phenotype of resistance to antibiotics. No link between blood contamination and corneal contamination is evidenced. Routine eyebank procedures achieve efficient antimicrobial security.
EBU ‐ European Blind Union ‐ The voice of blind and partially sighted people in Europe
Authors: ANGERMANN W
Published: August 2012

Abstract not provided
DBSV – A success story in forming a patient organization for blind and partially sighted people
Authors: HOLZAPFEL S , OSTROWSKI A
Published: August 2012

Purpose To develop a support and service system in form of counseling centers or mobile units to address the needs of the increasing number of partially sighted people, especially those who experience sight loss at a later stage in life, as well as their relatives and formal carers.

Methods The situation of support systems in Germany was analyzed. Predominantly partially sighted people were trained and instructed to create a network to other partners, like ophthalmologists, optometrists and rehabilitation specialists. With the support of the organization “Aktion Mensch!” and the “Bernd Mettmann Foundation” pilot projects were created. These new regional centers have been working since the beginning of 2012.

Results Meanwhile consultation centers, mobile units or working groups are running in five regions in Germany. The number of consultations is increasing. The centers are establishing a network of different experts, their organizations and other self‐help groups and patient organizations. Project workers assist the regional groups of the German Federation of the Blind and Partially Sighted (DBSV) in creating an area‐wide structure to support partially sighted people and their relatives. They have published various information material and papers to raise awareness of the issue of visual impairment.

Conclusion Patients as experts to support partially sighted people, relatives and formal carers in a network of support centers is a successful way to respond efficiently to the increasing number of partially sighted people. Starting in 2013, therefore the regional projects will be extended nationwide. Our positive experiences suggest that the concept of support centers where patients support patients could be transferred to other countries too.
Visual impairment, blindness in an aging society
Authors: SUTTIE A
Published: August 2012

Purpose We face a global growth in the prevalence of age related sight loss and yet services even in well developed countries in Europe, do not currently meet the rehabilitation needs of elderly blind. Nearly 25% of people in the European Union will be over the age of 65 by 2030. It is currently estimated that there are 12 million visually impaired older people in Europe and this is set to grow. The prevalence of serious sight loss increases exponentially with age, from 3.27% between 60 and 69 years up to 15% between 80 and 89 years. We need to think about how we meet the needs of the older old.

Methods Both the European and World Blind Union’s have supported expert groups looking to bring together knowledge and expertise in this area. Collaborative working across member countries has both raised the profile of age related sight loss and led to a better understanding of service design.

Results Current practice in the field of vision rehabilitation is primarily geared to meeting the needs of younger blind and partially sighted people. The vast majority of blind and partially sighted people in Europe are: female, over the age of 85 years, living alone and with useful residual sight. They often live with co‐morbid conditions such as memory loss, impaired hearing and other frailties of older age.

Conclusion Services firstly need to be designed around an understanding of co‐morbidity and partnership with those having expertise in the care of older people. They should encourage and facilitate maximum use of residual vision working on the key principles of size, lighting and tonal contrast. Above all they should help to address the major challenge of social isolation, resulting from living alone with a serious sight loss.
Prevention of AMD
Authors: CREUZOT C
Published: August 2012

Purpose The prevention of Age Related Macular Degeneration (ARMD) depends on the identification of the main risk factors of the disease.

Methods Clinicians will have to consider genetic and environmental risk factors like smoking habits and obesity. Nowadays, the identification of genetic risk factors mainly depends on the familial past history of the patient. However, an individual identification of the main genetic risk markers will probably have to be considered in the future.

Results Patients without any risk factors are mainly concerned by primary prevention based on nutritional advices based on the intake of macular pigments and polyunsaturated fatty acids. Patients with either genetic or environmental risk factors can benefit from nutritional advices based on the results given by epidemiological studies with higher dietary intake of antioxidants,macular pigments and polyunsaturated fatty acids.

Conclusion Clinicians should give dietary advices to post pone the consequences of ARMD in all patients especially those at high genetic risk.
Geographic atrophy
Authors: STAURENGHI G
Published: August 2012

Abstract not provided
Non diabetic CME
Authors: LOEWENSTEIN A
Published: August 2012

Purpose Cystoid macular edema (CME) occurs in a variety of pathological conditions beside diabetic retinopathy, such as retinal vein occlusion, pseudophakia, penetrating ocular injury and uveitis. CME is a major cause of vision loss following cataract and vitreoretinal surgery. This presentation overviews the major developments in the treatment of CME, and the contribution of recent clinical trials to the understanding of the pathophysiology and factors that play a role in non‐diabetic CME and outcomes of treatment, as well as the problems that remain to be solved by both the basic and clinical researchers.

Methods Differential diagnosis is essential for management and distinction between diabetic, age‐related macular degeneration, and other causes of CME. Pseudophakic CME is characterized by poor visual acuity following surgery. Clinically significant CME generally develops 4‐12 weeks after surgery. The workup of CME is performed with fluorescein angiography and optical coherence tomography. While pseudophakic CME can resolve spontaneously, some cases of CME require treatment.Refined surgical techniques contribute to reducing the incidence of CME. Intraoperative complications may elevate the risk of developing postoperative CME.

Results Peri‐ or intraocular corticosteroids can be useful in persistent cases. Topical non‐steroidal anti‐inflammatory drugs (NSAIDs) and corticosteroids show the highest success rate for post‐surgical CME.

Conclusion While the etiology of CME remains to be elucidated, the recent years have been the framework of major advances in treatment of CME. The response to antiangiogenic treatment is currently under evaluation, with some reported improvements from bevacizumab monotherapy, and combination therapies with NSAIDs and corticosteroids. Surgical treatment is considered in severe case.

Commercial interest
Etiologic distribution of necrotizing retinopathies : a nine‐year experience at a university referral centre
Authors: JOUFFROY T , BODAGHI B , ROZENBERG F , LEHOANG P
Published: August 2012

Purpose To assess the etiologic distribution of necrotizing retinopathies based on an extensive work‐up including molecular tools applied to ocular fluids

Methods All patients referred for the diagnostic and therapeutic management of an atypical posterior or panuveitis underwent an extensive work‐up to exclude an infectious condition. All patients underwent anterior chamber paracentesis or vitrectomy for diagnostic purposes. PCR and cytology were performed in order to confirm an infectious entity or a masquerade syndrome

Results The clinical findings of 218 patients were analyzed in this retrospective study. The sex‐ratio (M/F) was 1.44 including 129 men and 89 women. The mean age was 46.6 years (range from 7 To 90 yo). A viral infection was confirmed in 146 cases (67,5%). Viral distribution determined 55 CMV retinitis, 48 VZV retinitis, 34 HSV 1 or 2 retinitis and 9 EBV panuveitis. Nonviral causes of infectious or inflammatory retinopathies were determined in 66 cases, masquerading as a viral retinopathy. Most of the cases were due to a parasitic infection (59%) followed by a primary intraocular lymphoma (12,1%), a bacterial uveitis (7,5%), Behçet’s disease (7,5%), endogenous endophthalmitis (3%), sarcoidosis (1,5%) and others (9,4%). Six cases remained idiopathic

Conclusion All patients with an atypical retinopathy and a suspicion of infectious etiology deserve an extensive work‐up, including ocular fluid analysis. The yield of PCR technology remains excellent for viral retinopathies. Even though most of the cases are viral‐induced, other entities may present with similar clinical findings. Therefore, prompt diagnosis remains the best strategy to avoid further sight and rarely life‐threatening complications
Ocular prognosis of congenital toxoplasmosis (genotypes II and III)
Authors: DELMAS J , DARDE ML , AJZENBERG D , ADENIS JP , ROBERT PY
Published: August 2012

Purpose There are in France 3 main strains of T. gondii (genotypes I, II and III). Ocular lesions of congenital toxoplasmosis have been reported in 80% of untreated, infected children. But no data were available in Europe on the genotype, on the prevalence of the different strains of T. gondii and on their virulence. Our purpose was to investigate the genotype of strains and the outcome of babies born with congenital toxoplasmosis in our university hospital.

Methods From 1980, every newborn with congenital toxoplasmosis was prospectively referred to the Parasitology Department. Date of birth, sex, time of congenital contamination, pre‐ and post‐natal treatment were recorded. We designed a retrospective follow‐up of all these children. Fetal infection was detected using serologic analysis and parasitologic investigations, such as mice inoculation and PCR from samples of amniotic fluid or placenta. For 43 newborns, genotyping of T. gondii strains was performed, using multilocus analysis.

Results The median follow‐up was 38.6 months. 28,2% of 78 infected children were treated in‐utero upon detection of the maternal infection. 66.1% of 71 alive new borns underwent a post‐natal treatment.Genotype of T. gondii was analysed for 55% of infected children. 41 strains were identified as genotype II and 2 strains as genotype III. Among the 10 children with at least 1 retinochoroidal lesion, 5 strains were analyzed: 4 were genotype II (2 peripheral lesions, 1 macular, 1 peripapillar) and 1 was genotype III (1 macular lesion).

Conclusion Genotype II is confirmed to be the most common strain in France. Percentages of ophthalmological lesions accorded to the literature. No prognostic factor was identified for the occurrence or the seriousness of retinal lesions.
Inflammation in the pathogenesis of keratoconus
Authors: JUN A
Published: August 2012

Abstract not provided
Oxidative stress in keratoconus
Authors: MENEZO ROZALEN JL , PERIS‐MARTINEZ C
Published: August 2012

Abstract not provided
Endocrinology and keratoconus
Authors: GATZIOUFAS Z
Published: August 2012

Abstract not provided
Boleslaw Wicherkiewicz: interesting contributor to European ophthalmology
Authors: GRZYBOWSKI A , SCHMIDT D
Published: August 2012

Purpose Boleslaw Wicherkiewicz (1847–1915) was the most prominent Polish ophthalmologist at the end of the 19th century and beginning of the 20th century. Between 1877 and 1895, he founded in Poznan and developed the largest and internationally best known 19th century ophthalmic hospital in Poland. In 1895, the hospital had a total of 80 beds. With his extensive experience gained abroad, Wicherkiewicz was well prepared to become in 1895 the head of the most important university ophthalmology centre in Poland – the Department of Ophthalmology at the Jagiellonian University in Cracow. In 1899, Wicherkiewicz founded the first Polish ophthalmic journal ‘Progress in Ophthalmology'.

Methods The study is based on analysis of all papers written by Wicherkiewicz, mainly in Polish and German. The biographical details were verified in National Archives in Poznan and Cracow, cities where he lived and worked. The secondary sources, including review articles and other reports about his life and activities, were also collected and analyzed.

Results Original contributions on oculoplastic surgery (epicanthus, lid coloboma, ectropion and enctropion, trichiasis, distichiasis, lid replacement, free skin transplantation), cornea transplants (first in Poland), glaucoma surgery (sclerotomia cruciata posterior superficialis), cataract surgery (cataract irrigation technique), clear lens surgery in myopia (before Fukala).

Conclusion Wicherkiewicz played a crucial role in the development of Polish ophthalmology. He was internationally recognized due to his surgery innovations and scientific activities. He was a member of majority of ophthalmic European societies (including many honorary memberships), and he was given honorary doctorate by Leuven University in 1909.
Evaluation of the retinal fiber layer thickness as a biomarker for sleep apnea syndrome
Authors: FERRANDEZ ARENAS B , GIL‐ARRIBAS L , FERRERAS AMEZ A , ARA GABARRE M , SATUE M , BAMBO MP , CALVO PEREZ P
Published: August 2012

Purpose To evaluate the peripapillary retinal nerve fiber layer (RNFL) thickness measured with spectral‐domain optical coherence tomography (OCT) in obstructive sleep apnea syndrome (OSA) patients, as a biological marker of neuronal damage.

Methods Sixty‐four OSA patients and one hundred twenty‐nine healthy controls were consecutive and prospectively selected. Only one eye per subject was randomly chosen. AOS patients were classified in three groups according to apnea/hipopnea index: mild, moderate and severe. All participants performed a comprehensive ophthalmologic examination and at least a reliable standard automated perimetry (SAP). Peripapillary RNFL thicknesses were measured with the Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). After checking for a normal distribution of variables, differences between both groups were tested by Student t test.

Results Age was 50.6 ± 9.3 years in control eyes and 47.8 ± 11.5 years in AOS patients (p = 0.09). Mean deviation of SAP was ‐0.50 ± 1.0 dB and ‐1.4± 2.3 dB, in control and AOS patients, respectively (p<0.001). Pattern standard deviation and Visual Field Index (VFI) of SAP were also different between both groups. The RNFL thickness at temporal superior segment and the superior segment had lower thicknesses in AOS patients compared to healthy individuals.

Conclusion OCT detected a mild reduction of RNFL thickness in AOS patients compared with healthy subjects. Visual field indices were also different between both groups.
Cataract and glaucoma surgery, combined or staged: where do we stand?
Authors: SUNARIC MEGEVAND G
Published: August 2012

Purpose Glaucoma surgery in presence of a cataract is a challenging problem. Are patients better served by combined glaucoma and cataract surgery, or would cataract extraction alone be sufficient or is it best to establish a bleb before performing cataract surgery? As the techniques have evolved during the past years, the literature has enriched with new evidences and new suggestions. During this part of the course we will review in detail the past and actual literature in this field as well as more recent data from meta‐analysis studies.

Methods literature review

Results discussion of the most pertinent studies

Conclusion see above
Staging the surgeries: glaucoma first or cataract first?
Authors: ZEYEN T
Published: August 2012

A combined Phaco‐Trabeculectomy will often not have the same result as both procedures separately. The IOP lowering effect of a combined procedure is usually less than that of Trabeculectomy alone. Likewise, post‐operative fluctuations of the anterior chamber depth after a combined procedure will influence the post‐operative refraction, especially in the early post‐operative period and/or if additional procedures (e.g. needling) are necessary to rescue a failing bleb. Therefore, most surgeons will prefer to stage both procedures. Since cataract surgery might compromise an existing filtering bleb, it is recommended to perform Phaco first if the IOP is not too elevated. If the glaucoma is at risk to deteriorate in the short term, filtering surgery should be performed first. It is advisable to wait 6 months between the cataract and glaucoma surgery.
Combined approach: practical tips
Authors: MCNAUGHT A
Published: August 2012

Purpose The presentation will feature practical advice on undertaking combined phacoemulsification/IOL insertion with trabeculectomy. The specific indications, and particular advantages of this combined technique in groups of patients will be highlighted, and the techniques covered will include:

Methods 1) Approach to the case: whether a combined approach is optimal in the individual patient, contraindications, and choice of antimetabolite 2) Technical details: including ajustable suture techniques 3) Postoperative management

Results Video examples will be used to illustrate the surgical techniques discussed
An ex vivo assay to measure the intravitreal mobility of nanomedicines for retinal gene therapy
Authors: MARTENS TF , VERCAUTEREN D , FORIER K , DESCHOUT H , REMAUT K , DEMEESTER J , DE SMEDT SC , BRAECKMANS K
Published: August 2012

Purpose In retinal gene therapy, intravitreal injection is a promising technique for administering nanomedicines, granted they remain mobile in the vitreous humour. Here, we optimized an ex vivo assay to measure this mobility in intact bovine vitreous. The results from this work and the newly developed methodology are expected to aid in the rational design of nanomedicines for retinal drug delivery.

Methods Excised bovine eyes were prepared in such a way to preserve the fragile structure of the vitreous humour, while permitting fluorescence microscopy inside the bovine vitreous. This assay was used to determine by single particle tracking analysis the intravitreal mobility of both model polystyrene beads with different sizes and surface groups, as well as gene nanomedicines composed of poly(amido amine)s and plasmid DNA.

Results Cationic nanoparticles were readily immobilized in the vitreous humour, while anionic polystyrene beads remained mobile. Surface modification with the hydrophilic polymer polyethylene glycol (PEG) resulted in the best mobility of the polystyrene beads. In correspondence with these results, the cationic gene nanomedicines were immobilized in the vitreous humour, while modification with PEG resulted in a drastic improvement of their mobility.

Conclusion Here an ex vivo assay is presented to study nanoparticle mobility in intact vitreous humour by single particle tracking microscopy, which showed that cationic surface charge limits intravitreal diffusion of nanoparticles by binding to biopolymer structures, while anionic and PEGylated nanoparticles remain mobile. These results should help in the rational design of nanomedicines used for intravitreal drug delivery.
Ghrelin’s expression in the eye and its implication in the reduction of intraocular pressure
Authors: ROCHA DE SOUSA A , PEREIRA‐SILVA P , AZEVEDO‐PINTO S , RODRIGUES‐ARAUJO J , TAVARES‐SILVA M , PINHO S
Published: August 2012

Purpose To investigate ghrelin’s and GHSR‐1 distribution in the rat’s ocular tissue and ghrelin’s role in the modulation of IOP in animal models of acute glaucoma.

Methods Immunolocalization of ghrelin and GHSR‐1 was performed in male Wistar rats (200–300g). Acute glaucoma was induced in male New Zealand white rabbits (2,0‐3,0Kg) and male Wistar rats (200–300g) through an intravitreous injection of 20% NaCl. Afterwards either ghrelin or des‐acyl ghrelin was subconjunctivaly injected. In the rabbit, ghrelin’s effect in the presence of L‐NAME or ketorolac.

Results Ghrelin and GHSR‐1 were detected in the rat’s eye, being ghrelin expressed in the ciliary processes, having co‐localization with lectin, an endothelial cell marker, been also verified. GHSR‐1 expression was detected in the base of the ciliary body and in the choroid, presenting focal co‐localization with α‐smooth muscle actin. Ghrelin, but not des‐acyl ghrelin, decreased the IOP in rabbit’s and rat’s glaucomatous eyes (maximal percentual decrease relative to peak versus control in rabbit: 65,9±12,4%; maximal percentual decrease relative to peak versus control in rat:27,45±4,8%). In the rabbit, this effect was blunted in the presence of L‐NAME and ketorolac.

Conclusion Ghrelin and GHSR‐1 are expressed in the rat’s eye. Ghrelin promoted a decrease in the IOP of rat’s and rabbit’s glaucomatous eyes. These data suggest a role for ghrelin in the pathophysiology of glaucoma.

Commercial interest
Polyunsaturated fatty acids and Plasmalogens in diabetics
Authors: KOEHRER P , SAAB S , BRON A , ACAR N
Published: August 2012

Purpose Plasmalogens (PLS) are phospholipids characterized by a vinyl ether bond and a preferential esterification of polyunsaturated fatty acids (PUFA). We have previously shown that the lack of PLS leads to retinal hyper‐capillarization. We hypothesize that PLS are negative regulators of vascular development, and aimed to check their circulating levels in diabetic patients.

Methods Blood samples were collected from 88 patients and 14 control subjects. Among diabetics we had 14 patients without diabetic retinopathy (DR), 12 with a mild non proliferative DR, 12 with a moderate non proliferative DR, 22 with a severe non proliferative DR and 24 with a proliferative DR (PDR). Erythrocytes were isolated from total blood samples. The PLS content and the fatty acid composition of erythrocyte phospholipids were determined using capillary column gas chromatography. Individual species of phospholipids, including PLS, were quantified by liquid chromatography coupled with a triple quadrupole mass spectrometry instrument (HPLC‐ESI+MS/MS).

Results Gas chromatographic analyzes showed significant reduced levels of omega‐3 PUFAs including docosahexaenoic acid (DHA) and omega‐6 PUFAs including arachidonic acid in diabetic patients without DR and in patients with DR at any stage. The analysis of individual species of phospholipids by HPLC‐ESI+MS/MS showed reduced levels of choline‐phospholipids esterified with DHA in PRD patients and ethanolamine‐phospholipids esterified with DHA at the mild, moderate, severe stages of DR but not in PRD. Levels of cholin and ethanolamine‐PLS remained stable in all the diabetic patients when compared to controls.

Conclusion Our results suggest that omega‐6 and omega‐3 PUFAs from conventional phospholipids but not PLS may be involved in the pathogenesis of DR.
Cicrulating markers of retinal and optic nerve lipids
Authors: ACAR N , BERDEAUX O , HE Z , GREGOIRE S , CABARET S , MARTINE L , GAIN P , THURET G , CREUZOT‐GARCHER C , BRON A , BRETILLON L
Published: August 2012

Purpose Blood lipids are frequently used as a surrogate of lipid composition of peripheral tissues. Even if it is well accepted such a relationship has never been clearly demonstrated for the eye. The aim of this study was to determine in human samples whether a lipidomic approach based on red blood cells could reveal associations between circulating and ocular lipid profiles.

Methods Red blood cells, retinas and optic nerves were collected from 9 human donors. The lipidomic analyses on these tissues consisted in gas chromatography and liquid chromatography coupled to an electrospray ionization source‐mass spectrometer (LC‐ESI‐MS).

Results Gas chromatographic approach did not shpw any relevant association between circulating and ocular lipids except for arachidonic acid whose circulating amounts were positively associated with its retinal and optic nerve levels. However, significant associations emerged from LC‐ESI‐MS analyses. Indeed, phospholipid species in red blood cells were positively or negatively associated with representative pools of retinal DHA (docosahexaenoic acid), retinal VLC‐PUFA (very‐long chain polyunsaturated fatty acids) or optic nerve plasmalogens.

Conclusion First, our results show that LC‐ESI‐MS methodology is more appropriate than gas chromatography for lipidomics on red blood cells, and further extrapolation to ocular lipids. Second, this study has identified several individual lipid species as good candidates to represent circulating biomarkers of ocular lipids.
Obvious, non‐obvious MGD and new therapy options & the German perspective on MGD
Authors: KNOP N , KORB DR , BLACKIE CA , KNOP E
Published: August 2012

Purpose The concept of meibomian gland dysfunction (MGD) has drastically changed during the last century. Obstructive MGD has often few or no symptoms although an atrophic process proceeds inside the gland tissue. This conceivably most frequent form of MGD is called non‐obvious MGD or NOMGD.

Methods A literature review on MGD together with own findings is discussed in order to explain the different types of MGD and new options for their diagnosis and treatment.

Results Historically, MGD was thought to have purulent hypersecretion with ouvert inflammation. Since a few decades it has occurred that MGD also includes obstructive, hyposecretory forms, that had escaped attention because of less obvious symptoms. In fact this represents the vast majority of disease and results from stasis due to hyperkeratinization of the ducts and hardened secretum. It often leads to a still borderline normal tear film and hence symptoms only occur due to environmental stress like air condition, video terminal work or contact lenses. The term MGD was coined only 30 years ago when apparently normal patients became symptomatic after fitting of a contact lens. The diagnosis of tear film lipid deficiencies and the removal of hardened secretum by physical measures require new diagnostic and therapeutic approaches and instruments but may offer, for the first time, a causative approach to dry eye disease

Conclusion Recognition of MGD with tear film instability due to lipid deficiency and with atropic gland destruction has lead to a paradigm shift in the understanding of dry eye disease and to new developments in diagnostics and therapy. This requires new sophisticated forms of lipid layer diagnostics and physical therapy together with addition of lipids to tear substitutions.
Effect of light source size on discomfort glare thresholds
Authors: JIA Y , BARGARY G , BARBUR JL
Published: August 2012

Purpose Bright light sources, such as car headlamps or residential street lights, can cause visual discomfort. The origins of discomfort glare (DG) or the factors that contribute to it remain poorly understood, even after 50 years of multidisciplinary research [American Journal of Ophthalmology, 153(4):587‐593(2012)]. This study examined the effect of the light‐source intensity, size, surround luminance and pupil size on DG thresholds.

Methods The pupil was measured in real time to calculate retinal illuminance, a more pertinent parameter in studies of DG. DG thresholds were estimated with a staircase procedure: the retinal illuminance was increased or decreased based on whether the participant indicated the absence or presence of DG, respectively. The subjects were required to view a source of light presented against a simulated residential street background. The size of the disc source was selected randomly under computer control. Five different source sizes were used to produce a 40 fold variation in stimulus area. The light source behind the aperture disc was designed to produce uniform flashes of light of varying intensity, while the surround light level remained unchanged.

Results It was found that at the threshold for DG, the retinal illuminance is approximately constant and independent of source size. On the other hand, pupil plane illuminance increases as source size increases.

Conclusion These findings suggest that DG depends mostly on localised retinal illuminance, rather than the total amount of light entering the eye. DG therefore appears to be largely related to saturation of photoreceptor signals. The results also suggest that higher levels of street illumination can be achieved by increasing the size of light source without causing any increase in DG.
The effect of discomfort glare on parallel processing of visual information
Authors: BARGARY G , BARBUR JL
Published: August 2012

Purpose When a person is confronted with a bright light source against a dim background, scattered light can cause visual discomfort in addition to reducing object contrast on the retina. Previous work addressing the effect of glare on visual performance has focused mainly on the reduction in retinal image contrast (known as disability glare) rather than the often accompanying experience of discomfort glare. This study examines how parallel processing of visual information is affected under conditions of discomfort glare.

Methods Light scatter sources surrounded a monitor on which the subject carried out standard contrast acuity (CA) tasks. All CA tasks were carried out with and without discomfort glare (estimated in a prior experiment). In the parallel task, a fovea target (Landolt C) and four peripheral stimuli (three distractors and one target) were presented concurrently; the subject had to indicate both the orientation of the gap for the foveal target and the quadrant containing the peripheral target. The size of the peripheral target was increased relative to the foveal target to ensure that all targets were equally detectable. This was done separately with and without discomfort glare, thus negating any influence of disability glare.

Results The presence of discomfort glare degrades visual performance in the parallel processing task even when adjustments are made to cancel out the effects of disability glare.

Conclusion Studies that have focused only on disability glare may be underestimating the adverse effect glaring light sources can have on visual performance, particularly in real world scenarios where attention to objects in both the fovea and periphery is often required.
Adjuvant stem cell‐based therapy in acute retinal injury after sodium iodate administration in mice
Authors: MACHALINSKA A
Published: August 2012

Purpose The aim of this study was to determine and optimize a new strategy of SC‐based therapy of selectively damaged retina after sodium iodate (NaIO3) administration in C57BL/6J mice.

Methods To address this issue, we investigated the effects of NaIO3 administrated in two different concentrations, i.e. 40 and 20 mg per kg of the body mass. Electrophysiological function of the retina using dark‐and light‐adapted full field flash ERG as well as morphological characteristics, were determined at several time points after each dose administration. Next, we performed intravitreal transplantation of murine GFP+Lin‐ cells on the 1st day since NaIO3 administration. We analyzed the retinal functional changes as well as the number, localization and phenotype of intravitreally injected GFP+Lin‐ cells within recipients’ retinas.

Results Our findings revealed that massive destruction of the tissue was associated with irreversible retinal dysfunction, whereas moderate retinal injury triggered regenerative mechanisms that restore bioelectrical function of the damaged retina.By employing SC‐based therapy we achieved noticeable improvement of the retinal function, particularly in the short‐term observation. We observed the presence and proliferation of the injected cells at the site of RPE injury.

Conclusion Our study provides evidence that NaIO3‐induced retinal damage triggers a sequence of pathophysiological events dedicated to supporting the self‐regeneration of injured tissue. Our results indicate that if the scope of retinal destruction is profound, endogenous regeneration is ineffective and may ultimately require therapeutic transplantation of specific stem cell subpopulations and other adjuvant therapies.
Fructose diet induced short‐term impairment of cone sensitivity and gene expression in rat retina
Authors: THIERRY M , BUTEAU B , PASQUIS B , ACAR N , BRON A , CREUZOT‐GARCHER C , BRETILLON L
Published: August 2012

Purpose A high fructose diet has been widely used to trigger insulin resistance in rodent; insulin resistance is one of the major risk factor for the development of type 2 diabetes. Thirty to 40% of diabetic patients develop diabetic retinopathy. In this study, we aimed to evaluate the short‐term effect, at 1, 3, 5, 8 days, of a 60% fructose diet, on photoreceptor sensitivity and gene expression in the retina of Brown Norway rats.

Methods Flicker electroretinograms (8Hz) were recorded under anesthesia, from both eyes simultaneously in order to study sensitivity of photoreceptors. Then, rats were euthanized and enucleated. Retinae and posterior poles were collected to analyze gene expression by RT‐PCR. We specifically focused on 45 genes involved in cholesterol homeostasis, lipid trafficking, vascular changes and inflammation.

Results Our data showed that a short period of fructose feeding induced early changes in retinal functionality and homeostasis. Interestingly, we reported a partial loss of cone sensitivity after 8 days of feeding rats with the high‐fructose diet. No effect was found in rod sensitivity.

Conclusion These findings are consistent with the sensibility and susceptibility of cones to dietary changes. These data deserve further investigations on the cross‐talk between cones and rods upon metabolic changes associated with aging.
Diced Alu: Canning the blinding inflammasome
Authors: AMBATI J
Published: August 2012

Purpose To determine the mechanisms of retinal pigmented epithelium (RPE) cell death induced by DICER1 deficient and Alu RNA accumulation, which are observed in human geographic atrophy RPE.

Methods Human and mouse RPE cell culture studies were combined with in vivo mouse models of RPE degeneration induced by DICER1 targeting or Alu RNA exposure.

Results DICER1 deficit or Alu RNA exposure activates the NLRP3 inflammasome and triggers TLR‐independent MyD88 signaling via IL18 in the RPE. Genetic or pharmacological inhibition of inflammasome components (NLRP3, Pycard, Caspase‐1), MyD88, or IL18 prevents RPE degeneration induced by DICER1 loss or Alu RNA exposure. Human GA RPE contains elevated amounts of NLRP3, PYCARD, and IL18 and evidence of increased Caspase‐1 and MyD88 activation.

Conclusion These findings provide a rationale for targeting the NLRP3 inflammasome and IL18/MyD88 pathways in GA.

Commercial interest
Neurodegeneration in retinal diseases and new strategies in its inhibition
Authors: REHAK M , WIEDEMANN P , RAO NA
Published: August 2012

Purpose Recent studies showed the role of toll‐like receptors (e.g.TLR4) in the generation of inflammatory cytokines, initiation of oxidative DNA damage, and induction of mitochondrial oxidative stress.

Methods Several retinal diseases result in photoreceptor mitochondrial oxidative damage. The oxidative‐stress‐induced nitration of photoreceptor mitochondrial proteins and peroxidation of membrane lipids led to activation and migration of microglia toward the photoreceptors. These observations suggest oxidative stress could be an initial pathologic event leading to amplification of inflammation inducing photoreceptor damage. Molecules that prevent mitochondrial oxidative stress and photoreceptor apoptosis may help prevent retinal damage and preserve vision in patients with different retinal disease.

Results Several different agents were investigated to reduce the mitochondrial oxidative stress. The small heat shock protein alpha‐A crystallin prevents photoreceptor mitochondrial oxidative stress‐mediated apoptosis in inflammatory disease such an experimental autoimmune uveitis (EAU). Interestingly, only alpha‐A and not alpha‐B‐crystallin, a closely related small heat shock protein works, pointing to molecular specificity in the observed retinal protection. based on modulation of the systemic B and T cell immunity.

Conclusion In the ischemic retinal diseases the neuroprotective role of neuroglobin has been shown. Neuroglobin overexpression plays a protective role against retinal ischemia reperfusion injury due to decreasing of mitochondrial oxidative stress‐mediated apoptosis.
ICGA: why I think that it is still relevant today
Authors: NERI P , ARAPI I , CAPUANO V , PIRANI V
Published: August 2012

Purpose To discuss the role of indocyanine green angiography (ICGA) in ophthalmology and the breaking news on this methodology.

Methods The current literature is reviewed and the experience of a tertiary referral centre is reported.

Results ICGA is an essential method used to explore the posterior pole in several sight‐threatening diseases. Although this technique has been proven effective in detecting anomalies which were unappreciable with the traditional methods, there is still reluctancy in making use of such method. In the recent past months the topic of ICGA has again moved to the forefront of angiographic actuality with two editorial articles in largely diffused ophthalmological journals. The scientific dignity of ICGA is discussed and advocated by the western World, mostly by highly specialized ophthalmic centres in Europe. We will discuss the state of the art of the clinical use and the evidences in the medical literature of the ICGA.

Conclusion ICGA is a validated method for the evaluation of the posterior pole, which can provide essential informations for the clinical assessment and management of several diseases. Albeit the validity of such technique has been proven, there is still some unjustified reluctancy in accepting its pivotal role in ophthalmology: the evidences suggest its use for every single disease that can affect the choroid and cannot be appreciated by the traditional tests.
ICGA in inflammatory diseases
Authors: HERBORT CP
Published: August 2012

Purpose Choroidal involvement in uveitis is present at least as often if not more often than retinal involvement. Imaging of the different choroidal compartments is only possible using indocyanine green angiography (ICGA). The trend presently seems to shift away from ICGA for diseases of the fundus. Unlike other fundus conditions where use of ICGA is debated, this imaging technique is crucial for inflammatory conditions in order not to miss choroidal involvement especially in diseases where the primary lesion process is exclusively situated either in the choroidal stroma as for Vogt‐Koyanagi‐Harada (VKH)disease or at the level of the choriocapillaris as for MEWDS or APMPPE.

Methods ICGA is ideal to explore the choroid as the ICG molecule has two crucial properties : (1)it fluoresces in the infrared, allowing to "see" through the RPE into the choroid; linked to proteins it forms a macromolecular complex that is trapped in the choroidal stroma so outlining inflammatory foci. Hence, different lesion processi were identified by ICGA which allowed a classification of choroiditis into choriocapillaritis and stromal choroiditis according to the anatomic location of the disease. Mostly these lesions are occult and can only be identified by ICGA.

Results Primary choroidal diseases (choriocapillaritis, stromal choroiditis) could only meaningfully be investigated and followed by ICGA. It was found to be diagnostic in a substantial proportion of cases. In those entities such as VKH where the inflammatory insult is exclusively limited to the choroid, ICGA is the only mean to monitor subclinical disease and adjust therapy.

Conclusion In inflammatory diseases, unlike in other fields where opinions diverge, ICGA is not only relevant but essential for global appraisal and follow‐up.
Advances in central serous chorioretinopathy: from diagnosis to treatment
Authors: NICOLO M
Published: August 2012

Purpose To discuss the role of indocyanine green angiography (ICGA) in central serous chorioretinopathy (CSC)

Methods Review of the current literature and the experience of a tertiary referral centre is reported.

Results ICGA is an essential method used to diagnose, treat and follow patient affected by central serous chorioretinopathy. This technique enabled ophthalmologists to have more insight in the pathogenesis of CSC. Recently the utility of ICGA in CSC has been re‐discussed again in relation to the different patterns of choroidal permeability, distribution of the fluid and the reponse to photodynami therapy. We will discuss the state of the art of clinical use and the evidences in the medical literature of the ICGA.

Conclusion ICGA is an validated method for the evaluation of CSC, which can provide essential informations for the clinical assessment and management of this disease. The evidences suggest its use in every case of CSC in order to make diagnosis and guide photodynamic therapy.