bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating basal rear osmolarity in normal and dry eye subjects
Authors: Willshire C. , Buckley R. , Bron A.
Published: September 2017

Purpose

Tear osmolarity (tOsm) is used as a measure of severity in dry eye disease (DED) and has also been proposed as an index of body hydration. Currently in DED the level of tear hyperosmolarity is compared with that of a normal population. We propose that a more valid reference point for both DED and body hydration could be acquired by measuring tOsm after a period of evaporative suppression.

Methods

Eight normal (N) and eight DED subjects were recruited and their tOsm measured with a TearLab® osmometer in uncontrolled environmental conditions. They then entered a controlled environment chamber (CEC) set to 23°C and 0.08 m/s airflow and, either: (1) had tOsm measured after 45 min of eye closure and then at 15 min intervals for a further 45 min at 45% relative humidity (RH), or (2) had tOsm measured every 15 min for 45 min, at 70% RH, to suppress evaporation.

Results

Tear osmolality was significantly reduced after eye closure in both N and DED subjects, to levels in the range of plasma osmolarity, between 285 and 295 mOsm/L (N p = 0.03; DED p = 0.006). The tOsm rose towards the start value on eye opening. In subjects exposed to 70% RH, which was not expected to suppress evaporation completely, a fall in tOsm also occurred, but to a lesser extent than achieved with eye closure. This was significant in DED patients (p = 0.026) but not in N subjects (p = 0.12).

Conclusions

As predicted, total suppression of tear evaporation resulted in a fall in tOsm. We hypothesise that complete suppression of evaporation, for a sufficient period, drives down tOsm to a basal tear osmolarity value that will be a better measure of body hydration than tOsm measured in open eye conditions. It will also provide a personal baseline against which to gauge the severity of tear hyperosmolarity in DED patients.
Ocular chronic graft‐versus‐host disease after allogeneic haematopoietic stem cell transplantation in Denmark (1971–2011): Incidence and risk factors in adults
Authors: Jeppesen H. , Sengeloev H. , Eriksson F. , Kiilgaard J.F. , Lindegaard J. , Julian H.O. , Heegaard S.
Published: September 2017

Purpose

Ocular chronic graft‐versus‐host disease (cGVHD) is a bothersome complication to allogeneic hematopoietic stem cell transplantation (HSCT). The objective of this study was to assess incidence and risk factors of developing ocular cGVHD.

Methods

A retrospective study of 1021 consecutive patients who underwent HSCT at a single institution. The patients were examined by an ophthalmologist before HSCT, annually up to five years after HSCT and more frequently if ocular symptoms occurred. Ocular cGVHD was diagnosed using the criteria proposed by The International Chronic Ocular GVHD Consensus Group. Myeloablative(MA) and non‐myeloablative(NMA) transplants were analysed separately due to great differences in patient age, conditioning regimen and stem cell source.

Results

Out of 1021 patients 99 (9.7%) had dry eye disease before HSCT. The 5‐year cumulative incidence of ocular cGVHD was 0.16(95%CI 0.13–0.19) in the MA group and 0.30(95%CI 0.25–0.36) in the NMA group. In adjusted cox regression models, we identified five risk factors of developing ocular cGVHD in the MA group: Schirmer's test ≤10 mm/5 min before transplantation; malignant disease; peripheral blood as stem cell source; female donor and the use of an unrelated donor. Risk factors in the NMA group were: Schirmer's test ≤10 mm/5 min before transplantation, higher recipient age and the use of an unrelated donor.

Conclusions

The 5‐year cumulative incidence of ocular cGVHD was 16% after MA conditioning and 30% after NMA conditioning. A low Schirmer's test before transplantation is a potential predictive factor of ocular cGVHD. Surprisingly, many of the patients had dry eye disease already before transplantation. Special attention should be directed toward patients with malignant disease, older age and patients receiving graft from peripheral blood and the use of a female donor or an unrelated donor.
A novel in vivo model of puncture‐induced iris neovascularization
Authors: Locri F. , Beaujean O. , Aronsson M. , Kvanta A. , André H.
Published: September 2017

Purpose

To assess iris neovascularization by uveal puncture of the mouse eye and determine the role of angiogenic factors during iris neovascularization.

Methods

Uveal punctures were performed on BalbC mouse eyes to induce iris angiogenesis. VEGF‐blockage was used as an anti‐angiogenic treatment, while normoxia‐ and hypoxia‐conditioned media from retinal pigment epithelium (RPE) cells was used as an angiogenic‐inducer in this model. Iris vasculature was determined in vivo by noninvasive methods. Iris blood vessels were stained for platelet endothelial cell adhesion molecule‐1 and vascular sprouts were counted as markers of angiogenesis. Expression of angiogenic and inflammatory factors in the puncture‐induced model were determined by qPCR and western blot.

Results

Punctures led to increased neovascularization and sprouting of the iris. qPCR and protein analysis showed an increase of angiogenic factors, particularly in the plasminogen‐activating receptor and inflammatory systems. VEGF‐blockage partly reduced iris neovascularization, and treatment with hypoxia‐conditioned RPE medium led to a statistically significant increase in iris neovascularization.

Conclusions

This study presents the first evidence of a puncture‐induced iris angiogenesis model in the mouse. In a broader context, this novel in vivo model of neovascularization has the potential for noninvasive evaluation of angiogenesis modulating substances.
Biological model of Zebrafish‐ a new research trend in ophthalmology, for an antiangiogenic treatment
Authors: Danieluk K. , Święch‐ Zubilewicz A. , Osęka M. , Mackiewicz J.
Published: September 2017

Purpose

Zebrafish is an ideal biological model for studying human diseases because of many similarities with the human genome. The structure of zebrafish eye is also very comparable to the human eye. We focused on new therapies for wet age‐related macular degeneration (wAMD) and proliferative diabetic retinopathy (PDR). The aim of the study was to present the influence of dopamine's agonist on the angiogegesis of Zebrafish larvae in comparison with anti‐angiogenic effect of bevacizumab

Methods

3 substances were used: bromocriptine, pergolide, cabergoline in concentrations from 1 nmol to 2,5 umol. Process of angiogenesis was observed for 5 days in larvae of genetically modified Zebrafish Fli with labelled, luminescent blood vessels. Photo documentation was taken under the fluorescent microscope Stereo discover v8, fluorescence 200c hxp. Carl Zeiss Microscopy GmbH.

Results

Tested substances had inhibitive impact on process of angiogenesis in Zebrafish larvae. The strongest one was pergolide. We observed the diferences in Zebrafish vessels. Patological vessels were observed not only in the retina but also in the whole body of Zebrafish.

Conclusions

Zebrafish is getting more and more common model for pharmacologic research. Inhibition of angiogenesis by dopamine's agonist may be new therapeutic option in treatment of diseases, complicated by neovascularization like AMD and proliferative diabetic retinopathy.
Optic nerve cupping and lamina cribrosa sclerae depth as a resultant of translaminar pressure difference
Authors: Czak W. , Piróg‐Mulak M. , Nowakowski J. , Misiuk‐Hojło M.
Published: September 2017

Purpose

The aim of the research was to evaluate correlation between translaminar pressure difference (TLPD) and optic nerve head (ONH) morphology parameters: lamina cribrosa sclerae depth (LCD) and optic nerve cupping (ONC).

Methods

Study included 42 eyes of 25 patients qualified to undergo lumbar puncture (LP) due to neurological circumstances. LCD, ONC and intraocular pressure (IOP) were measured 1–3 h prior to LP during ophthalmic examination. IOP was measured using Goldmann applanation tonometry. ONH morphology parameters: LCD and ONC were assessed using enhanced depth imaging optical coherence tomography (EDI‐OCT). CSFP was measured during lumbar puncture. TLPD was calculated as a difference between IOP (mmHg) and CSFP (mmHg).

Results

20 female eyes and 22 male eyes were included in the study. Mean age of female subjects was 44.1 ± 18.00 while the mean age of male subjects was 54.73 ± 13.57. LCD was revealed to be significantly deeper in male population (mean 365.83 μm vs. 296.07 μm). Statistical analysis revealed a strong positive correlation between LCD and TLPD (p < 0.0001, R = 0.78) and between LCD and ONC (p < 0.0001, R = 0.71).

Conclusions

There is a strong positive correlation between TLPD and ONH morphology parameters. LCD and ONC should therefore be viewed as a resultant of two pressure compartments: IOP and CSFP. Intraocular pressure is since many years a confirmed modifiable risk factor for development and progression of glaucomatous neuropathy. CSFP was also proved to be significantly lower among primary open angle glaucoma subjects. In future LCD and ONC as a resultant of TLPD could therefore play a role in assessing the risk of glaucomatous neuropathy progression. According to significant correlation between TLPD and ONH morphology parameters, combined LCD and IOP measurement could moreover play a role as a non‐invasive CSFP assessment tool.
Acute retinal ischemia
Authors: Ambresin A.
Published: September 2017

Retinal ischemic injuries may occur in various clinical conditions. Untill recently, funduscopy and dye angiography were the only exams to evaluate the extention of occlusive damages. Acute arterial occlusive disorders can be clinically obvious such as in branch or central arterial occlusion but in more localised ischemic injuries, these exams can be silent. Recently, Bscan OCT allowed visualisation of hyperreflective lesions in various retinal layers suggesting ischemia of the related retinal plexus. The recent advance of OCT angiography allows us today to differentiate various depths of retinal ischemic injuries. Illustrations of paracentral acute middle maculopathy will be discussed.
Tube surgery techniques
Authors: Gandolfi S.
Published: September 2017

Tube surgery has has moved from the bottom line in the glaucoma treament stepladder, to be more conveniently placed as a surgical first‐line option.

This presentation will focus on (a) the mechanisms of action of tubes, (b) the most recent scientific evidences on efficacy and safety of tube surgery and (c) the technical still unmet needs to be addressed in the near future.
Ocular pharmacokinetics and pharmacodynamics
Authors: Urtti A. , Del Amo E. , Pelkonen L. , Rimpelä A.K. , Kidron H. , Reinisalo M.
Published: September 2017

Ocular pharmacokinetics is of crucial importance in ocular drug delivery and pharmacodynamics. Posterior segment drug pharmacokinetics is particularly important, since it seriously limits the applicable routes of drug delivery in the retinal treatment. In this presentation, some important aspects of posterior segment pharmacokinetics will be discussed, such as the role of blood retina barrier, drug transporters, and melanin binding. Quantitative and systematic pharmacokinetics approaches will be presented and discussed in the light of pharmacodynamics and drug delivery.
Iontophoretic targeting of drug delivery in the eye via the suprachoroidal space
Authors: Jung J.H. , Chiang B. , Prausnitz M.
Published: September 2017

Suprachoroidal space (SCS) injection has been developed using a microneedle to increase bioavailability of drugs. For many indications, the site of action is near the posterior pole, so targeting delivery within the SCS toward the back of the eye is of interest. Therefore, we hypothesize applying electric current (i.e., iontophoresis) can drive drugs having charge to specific areas within the SCS.

To test this hypothesis, we injected fluorescent particles using a 30G hollow microneedle into rabbit eyes ex vivo. First, negatively charged particles were infused using the microneedle embedded a Ag/AgCl electrode, and then iontophoresis was applied to generate an electric current (0.14 mA for 3 min) between the injection site and the optic nerve where the other Ag/AgCl electrode was attached.

After injection of 100 μL without iontophoresis, we found 38% of particles were in the most anterior quadrant of the SCS (<3 mm from the limbus) and 9% of particles were in the most posterior quadrant of the SCS (>9 mm from the limbus). In the presence of iontophoresis, the number of particles found in the most anterior quadrant was almost cut in half to 20% and the number of particles in the most posterior quadrant was almost doubled to 17%.
Ophthalmic ophthalmology
Authors: Mccarty C.
Published: September 2017

How Do Patients Respond to Genetic Testing for AMD?

The goal of this project was to conduct a pilot AMD genomic medicine study. Eligible patients aged 50‐65 with no personal AMD history gave informed consent and DNA samples were genotyped for 5 single nucleotide polymorphisms (SNPs) in the CFH gene, 1 SNP in the ARMS‐2 gene, 1 SNP in the C3 gene and 1 SNP in the mitochondrial ND2 gene. The study optometrist provided risk scores and counseling for personal protective behaviors. 101 (85%) participated; 78 (77.2%) were female. The smoking status was: 67 (66.3%) never smoked, 31 (30.7%) former smokers, and 3 (3.0%) current smokers. More than half (n=48) of participants said they were motivated to participate because they had a family member with AMD or another eye or genetic disorder. Despite low risk levels, many participants made changes as a result of the genetic testing. Twenty‐seven people reported making specific changes, including wearing sunglasses and brimmed hat, or taking vitamin supplements. Another 16 people said that they were already doing the recommended activity(ies). Interest in genetic testing for future risk of AMD was high in this population and led to continuation or improvement of eye health behaviors.
Surgery of iris melanoma
Authors: Mouriaux F.
Published: September 2017

The most effective treatment for iris nevus and melanoma remains debatable. Typically, a melanocytic iris nevus is monitored until growth is identified. With documented growth, radiotherapy or surgical resection is usually performed. Surgical resection consists of iridectomy, which is characterized by removal of part of the iris with the tumor.

Rates of cataract and glaucoma development after treatment are generally higher following proton beam and plaque radiotherapy relative to surgical resection. Moreover, radiotherapy carries the risk of limbal stem cell deficiency. Finally, surgical resection does carry the rapidity of tumor removal.

Thus, localized, circumscribed, or discrete lesions that demonstrate growth are excellent candidates for conservative surgical resection.
Radiotherapy of iris melanoma
Authors: Lumbroso L.
Published: September 2017

Iris melanomas represent 2 to 3% of uveal melanomas. Conservative management is often possible, with either excision of the tumor or irradiation. Proton beam irradiation for iris melanoma is used since several years, for selected small circumscribed iris melanomas. The results are excellent in terms of local control and eye preservation. The main side effect is cataract formation (45%). Progressively larger tumors have been treated with whole anterior segment irradiation (large tumors or lesions associated with extensive pigment dispersion or iridocorneal angle invasion). Local control is also excellent in this setting. For these larger lesions side effects consisting in corneal alterations and glaucoma are frequent than for localized lesions, especially if there was high ocular pressure anterior to the treatment. Glaucoma, can be challenging to treat leading to vision loss. For all patients the survival is excellent. Proton beam irradiation allows the treatment and avoids surgery of small circumscribed iris melanomas with very little side effects and excellent local tumor control. For larger, not resectable lesions, it allows ocular preservation with good local control, corneal alterations and glaucoma are frequent.
Suspicious naevi: treat
Authors: Desjardins L. , cassoux N. , LumbrosoLeRouic L. , Levy C. , Dendale R.
Published: September 2017

According to the study performed by Shields the risk factors for growth of small melanocytic lesions are the presence of symptoms, subretinal fluid,proximity of ON, orange pigment, thickness of more than 2 mm and diameter of more than 7 mm. Performing genetic test on small melanocytic lesions is not always useful, as it has been shown that a good prognosis lesion can grow and change in a bad prognosis. In a recent European study, metastasis have been observed for lesion of 6 mm in diameter and 2, 3 mm in thickness

Ophthalmologists are always trying to preserve vision as a rule. Nevertheless with possibly malignant lesions, the metastatic risk has to be considered before a therapeutic approach is decided. Factors like age of the patient, number of risk factors for growth and location of the tumor should be taken in account. Thus the practician should advise the patient and discuss and explain the decision. We usually recommend treatment if there are at least 3 risk factors and if the patient is young and the lesion away from the posterior pole. In all different situations we usually recommend close follow up for suspicious lesions and treatment in case of documented growth.
Update in low vision reeducation
Authors: Atilla H.
Published: September 2017

In pediatric age group, diagnosis of retinal diseases require detailed clinical evaluation, mostly under general anesthesia and comprehensive diagnostic tests such as electroretinography, genetic tests, and systemic examination. With the advances in treatment modalities for premature retinopathy vision can be restored even in very low birth weight babies. Advances in chemotherapy result in higher survival rates in retinoblastoma. For hereditary dystrophies gene therapy is promising. However in spite of advances in therapies for retinal diseases, it is still one of the main reasons of low vision. In infants with low vision and normal ocular structures, retinal disorders such as hereditary dystrophies, should be considered. Neurological and developmental problems may be associated with retinal abnormalities and detailed evaluation are needed in these babies and children in order to increase vision and quality of life.
New insights on the anatomy and function of the retina in sickle cell disease
Authors: Martin G.C. , Brousse V. , De Montalembert M. , Albuisson E. , Grevent D. , Denier C. , Michel S. , Abadie V. , Chalumeau M. , Boddaert N. , Bremond‐Gignac D. , Robert M.P.
Published: September 2017

Introduction

The recent rise of OCT showed that asymptomatic atrophy of the median temporal raphe of the retina (ATR) was a frequent occurrence in sickle cell disease (SCD). However, the prevalence, mechanisms and significance of ATR is not known, especially in the paediatric field.

Methods

SCD‐children prospectively underwent a fundus examination and an OCT of the macula and the temporal retina. Atrophy of the MTR was quantified on thickness maps. Data from brain imaging were collected in SS‐type SCD children.

Results

Eighty‐one children were studied; 64.2% exhibited ATR, while 29.2% had peripheral SCD retinopathy. ATR was often limited to areas located temporally from the usual macular map OCT programs, so that it could be missed with these programs. Patients with peripheral retinopathy were more likely to also exhibit ATR (p = 0.02). While peripheral retinopathy was significantly associated with the children age (p = 0.02), ATR was not.

Conclusion

ATR seems to occur very early in children with SCD and to display most distinct features from the well‐known peripheral SCD retinopathy.
Scleral lenses ‐ What we don't (but should) know
Authors: NAU A.
Published: September 2017

Advances in scleral lens technology have resulted in a surge of practitioners wanting to offer this modality for patients with ocular surface diseases and, increasingly, normal refractive issues. The current literature consists primarily of case reports and case series, with few prospective clinical trials. This leaves significant gaps in our understanding of how these devices interact with the tissues of the ocular surface, and offers significant opportunity for further study. Areas of research interest which could deepen our knowledge of how and when to fit (or avoid) scleral lenses will be reviewed in this lecture.
Long term outcome of Intrastromal corneal ring segment in keratoconus
Authors: Kang M.J. , Lee J.H. , Choi M.H. , Joo C.K.
Published: September 2017

Purpose

The Intrastromal corneal ring segment (ICRS) has been widely used to correct the astigmatism and to halt the progression in keratoconus. Although short term outcomes are well known to be effective, long term outcomes have been rarely reported and showed no consensus. Therefore, we planned to evaluate the effectiveness of ICRS in keratoconus for 5 years.

Methods

The retrospective chart review was done. In total, 23 eyes of keratoconus which received ICRS were included. Visual acuity, refraction, keratometer, thinnest corneal thickness and higher order aberration were evaluated at preoperative, 2 months, 1 year, 3 years and 5 years of postoperative day.

Results

Both uncorrected (UCVA) and best corrected visual acuity (BCVA) was improved at 1 year and maintained until 3 years (p < 0.05). UCVA worsened at 5 years but similar to preoperative measurement. On the other hand, BCVA maintained until 5 years (p < 0.05). Spherical equivalent and anterior corneal keratometer were improved at 2 months and maintained until 3 years, but it was worsened similar to preoperative level (p < 0.05). Vertical coma was improved consistently for 5 years (p < 0.05).

Conclusions

Both Refractive and topographic findings were improved at 2 months and the effect was maintained until 3 years. Although both of it have worsened at 5th year, the level of the measurements was not worsen than that of the preoperative day. The ICRS in keratoconus is effective in correcting astigmatism and visual acuity for 3 years and also helpful in halting the progression for 5 years.
Optimisation of novel small molecule inhibitors of SRPK1‐mediated VEGF‐A splicing through modelling of permeability properties required for trans‐scleral eye drop delivery
Authors: Batson J. , Toop H. , Daubney J. , Liddell S. , Stewart E. , Bourne J. , Blackley Z. , Morris J. , Bates D.O.
Published: September 2017

Purpose

Development of non‐invasive therapies for wAMD and DME has not yet been successful due to poor PK/PD properties. SRPK1 is a novel target that controls VEGF‐A splicing. Delivery of potent small molecules to the retina as eye drops is an unmet need due to lack of insight into drug required properties. We used rational medicinal chemistry and permeability models to identify physicochemical properties for retinal delivery.

Methods

Porcine eyes were dissected, and full thickness tissue clamped into a scaffold with drug formulations facing the sclera. Tissue sections were dissected after 24 hours and compound extracted and analysed by mass spectrometry. Efficacy, toxicity and PK were evaluated in C57/Bl6 mice. PK was assessed in pigmented and albino rabbits.

Results

Highly potent and selective SRPK1 inhibitors with improved permeability (×10‐6 cm/s) ex vivo (Compound A 1.47, Compound B 4.07) had improved PK in in vivo models. SRPK1 inhibitors did not inhibit retinal function yet inhibited laser‐CNV following eye drops given to mice (EC50s<0.5 μM, n = 6–8, p < 0.05, One‐way ANOVA).

Conclusions

Ex vivo screening enabled modelling and design of novel compounds with improved permeability and optimisation for in vivo retinal delivery.
Real‐life Experience with glaucoma surgical training using SOS eyes
Authors: Mercieca K.
Published: September 2017

Surgical training in Europe is very different according to each region. National regulations, different settings and allocated resources allow for a great heterogeneity in surgical opportunities. The equation of providing adequate training and performance levels to the surgeon while upholding the best possible practices of maximizing patient safety is a difficult task. Throughout Europe, surgeons are increasingly resorting to solutions that allow them to train in simulated scenarios before being confronted with a real life scenario. From wet‐labs to electronic simulations, there is a wide range of solutions that could be adapted to each reality. In this section of the symposium we look at real life experiences using specifically designed advanced ‘dry lab eye’ models (Simulated Ocular Surgery, or SOS, eyes) from the perspective of residents, glaucoma fellows and consultant trainers/supervisors. Videos and first hand experiences will be shared with the audience with useful tips, practical advice and potential drawbacks presented and described by a young qualified consultant trainer from one of the largest and oldest ophthalmic teaching hospitals in the U.K.
New intraocular therapies for non‐infectious uveitis
Authors: Albini T.
Published: September 2017

Traditional local treatment of non‐infectious uveitis was limited to steroids with side effects such as cataract and ocular hypertension. Intravitreal (IVT) sirolimus is a novel, non‐steroid, locally delivered mTOR inhibitor under investigation. The SAKURA Program, which represents the largest study of non‐infectious uveitis to date, was comprised of two Phase III (one pivotal, one supportive) multinational randomized double‐masked studies evaluating sirolimus 440 μg vs 44 μg active control in subjects with active NIU‐PS. 80% of subjects had Multiple Measures of Inflammation (MMI) at baseline, defined as vitreous haze (VH) ≥1.5+ and ≥1 of the following: systemic corticosteroids (overall prednisone‐equivalent dose ≥7.5 mg/day), BCVA ≤ 75 ETDRS letters, and/or presence of macular edema. In the integrated ITT population, 21.2% vs 13.5% of subjects receiving 440 μg vs 44 μg achieved VH=0 at Month 5 (p = 0.0381). Among subjects with MMI at baseline, 21.1% vs 8.0% in 440 and 44 μg, respectively, achieved VH = 0 (p = 0.0007). In the SAKURA Program, treatment with 440 μg IVT sirolimus demonstrated statistically significant improvements in VH in subjects with active NIU‐PS, including in subjects with MMI at baseline.
Photophobia in neuro‐ophthalmic disorders
Authors: Kawasaki A.
Published: September 2017

This course examines various neurologic conditions which are associated with excessive light sensitivity. These conditions vary from lesions compressing the chiasm to brainstem degenerative disorders. In the absence of corneal lesions or retinal photoreceptor disease, the basis of photosensitivity with intracranial disease remains yet undetermined. A hypothesis is proposed.
Aqueous humor cytokines report in congenital cataract
Authors: SAUER A.
Published: September 2017

Congenital cataract and glaucoma are an important cause of lifelong visual impairment. The management of these diseases is specific because of physiological and anatomical features of the children eye and changes related to growth. Compared to the management in adults, the strong inflammatory tissue reactivity following surgery is particularly noteworthy and challenging in post‐operative care. The presence of postoperative fibrinous uveitis is thus not uncommon in children, notably after cataract surgery. Many intraoperative and post‐ operativetherapeutic options have been considered to minimize post‐operative inflammation, but none of these is formally recommended. The occurrence of post‐operative complications should be analysed in regard to intraocular inflammation. The aim of the presentation is to describe cohorts of congenital cataracts and glaucomas, to measure cytokines levels in operated eyes and to compare these levels to control groups (senile cataract). These datas will be discussed taking into account clinical determinants and previously published studies. These analyses may open new axes for the understanding of the pathogenesis of congenital cataract and glaucoma, based on inflammatory processes.
MabThera use and efficacy in patients with active moderate to severe Graves’ Orbitopathy: a multicentre retrospective study of 40 cases
Authors: Lebranchu P. , Deltour J.B. , Cariou B. , Vabres B. , D'Assigny M. , Drui D.
Published: September 2017

Purpose

The efficacy of MabThera to treat Graves'orbitopathy (GO) is actually controversial, because of opposite results of the 2 randomized controlled trials (Stan M et al. J Clin Endocrinol Metab 2015; Salvi M et al. J Clin Endocrinol Metab 2015).

Methods

Real‐life use and efficacy of Mathera in GO in a multicentre retrospective study. Patients were enrolled in case of cortico‐dependant/resistant GO, with the help of endocrinologists of the French Thyroid Research Group. GO were classified according 3 components: inflammatory (CAS ≥3), muscular (constant diplopia) and neurological (visual acuity<20/40). Success was defined by the improvement of one component of the orbitopathy, without any deterioration of others.

Results

40 patients were included. 5 of the 8 patients treated simultaneously by mabthera and orbital decompression (visual threatening disease) had favourable evolution. 32 were treated because of corticoresistant disease (mean cumulative corticoid dose of 8 g; mean disease duration of 19,1 months). 6 months success was achieved for 67,5% of this group. Initial CAS (3,28 ±1,57) was significantly reduced after 3 and 6 months (1,61 ±1,1; p< 0,01). Initial visual acuity improved significantly after 3 months. All diplopic patients remained diplopic. Logistic regression revealed that initial CAS ≥3 were associated with positive treatment response (OR 3.43); smoking status was a negative pronostic factor (OR 10).

Conclusions

We present the largest cohort of patients treated by Mabthera for GO. Our mean decrease of CAS after 6 months (1.68) is better than Stan's study (1.2), but not as good as Salvi (3.8). This could be explained by our delay before treatment initiation, quicker than Stan (28.9 months) but longer than Salvi (4.5 months). Mabthera could be useful second line treatments in case of recent and still active GO.
Retinal re‐modelling following ILM flap technique for FTMH
Authors: Stappler T. , Hussain R. , Heimann H. , Wong D.
Published: September 2017

Introduction

Surgical challenges remain for large macular holes, long standing holes as well as repeat surgery for non‐closed macular holes. For these indications the success rate drops dramatically. The role of ILM flaps in anatomical and visual rehabilitation remains controversial.

Method

OCT‐based longitudinal cohort study of ILM flaps mapping OCT changes over time. Inclusion criteria were macular holes larger than 500 μm. Primary outcome measure: anatomical macular hole closure. Further outcome measures: OCT‐based longitudinal assessment of ELM as well as ellipsoid layer.

Results

We present a case series of (n = 33) patients who underwent ILM flap surgery between June 2015‐Jun 2016. All holes 33/33 have been anatomically closed. OCT's were recorded and anatomical and functional changes mapped. 23/33 regained a distinguishable ELM by 3/12 (70%) and 22/33 regained the ellipsoid layer by 3/12 (67%). Follow up was between 4‐6/12.

Discussion

The ILM flap technique for FTMH clearly helps hole ‘closure’ since all holes showed anatomical closure. The regeneration of outer retinal layers seems to help visual outcome. Yet the significance of the amorphous flap tissue remains undetermined and the study cannot yet predict postoperative vision.
Newer goniotomy devices
Authors: Varma D.
Published: September 2017

Newer goniotomy devices will discuss the role of Kahook dual blade and GATT in the spectrum of glaucoma surgical management. Patient selection, expected clinical results, surgical technique and common complications will be presented. Video and cases will be used to supplement learning.
Sub‐conjunctival drainage
Authors: Ratnarajan G.
Published: September 2017

Minimally invasive glaucoma surgery (MIGS) has a favourable safety profile compared to traditional filtering glaucoma surgery. The term MIGS was originally coined to utilize the eyes natural outflow pathways. Newer subconjunctival surgeries have shown much promise in the published literature thus far whilst still maintaining excellent safety, and therefore the remit of MIGS has expanded. Xen surgery is an ab‐interno implant that has internal lumen of 45 microns and total length of 6mm. It is inserted via both gonioscopic and external visualisation penetrating sclera 3mm from the limbus usually in the superior nasal quadrant. I will discuss strategies to try and achieve reproducible sub‐conjunctival placement of the Xen implant to achieve and maintain target IOP and reduce the risk of encapsulation and further post‐op manipulations. Innfocus micro‐shunt is an ab‐externo implant. Its internal lumen is 70microns and total length is 8mm. Its placement involves a periotomy and dissection of tenon's to create a potential space for drainage. It is inserted 3mm from the limbus and can be placed in any quadrant of the eye. Pearls on intra‐operative and post‐operative management will be discussed in the symposium.
Age related changes of the crystalline lens
Authors: Navarro R.
Published: September 2017

The crystalline lens has a double function to aid the cornea in focusing light rays on the retina and to accommodate to focus near objects. The refractive power of the lens is about half of that of the cornea, but a young lens can increase its power by more than 50%. Its gradient refractive index (GRIN) provides additional refractive power and amplitude of accommodation (AA). The optical properties of the lens change dramatically with age. The lens continues to grow throughout life (lens thickness increases about 0.024 mm/year) which has a strong impact on its optical properties. With ageing most of the GRIN tends to concentrate near the surface, which causes a decrease of both power and AA. The lens also gets stiffer with age. The maximum AA is reached early (ages 8‐12 years) and then declines at a mean rate of 0.25 D/year; accommodation becomes residual after 50 years. The optical quality of the lens suffers a strong age‐related deterioration: progressive lens yellowing tends to filter short wavelengths, stray light increases with age, which strongly increases the probability of cataracts. Spherical and other higher order aberrations of the lens increase so that they can duplicate their RMS value from 35 years to 75 years.
Novel genes associated with isolated optic nerve hypoplasia in 6 family trios ‐ a clinical and exome study
Authors: Bitoun P. , Boland Auge A. , Bacq Daian D. , PIpiras E. , Benzacken B. , Kuzbari S. , Renault V. , Parfait B. , Deleuze J.F.
Published: September 2017

Purpose

Optic nerve hypoplasia (ONH) is a rare blinding malformation,ONH is often syndromic with MRI pituitary anomalies. We explore genetic causes of isolated ONH

Methods

Probands (2F/4M) 0.5‐6 yrs with normal pituitary MRI were enrolled after consent with Pediatric, dysmorphologic and ophthalmologic endocrine examinations SNP aCGH, WES & Sanger validation sequencing. Ophth. exam: VEP,ERG,fundoscopy, color & acuity testing. Male patients tested for HESX. DNA extracted from lymphoblastoid lines or blood. DNA sequenced 30X in > 92% on Illumina platform; QC used Sam, Picard, Bed tools, variant call GATK, annotation snpEff/snpSift; filter using Autosomal Dominant hypothesis, absence in 1k, 65k 19 genomes,Exac databases. Variants present in subjects but not parents were selected and tested using polyphen2, Sift and mutation taster. 2nd approach for variant filtering using ANOVAR yielded 197 variants with strong deleterious effect; variants present in at least 2 pedigrees were then prioritized

Results

Patients followed 2‐15 yrs had normal intelligence, eye examination showed normal ERG with abnormal VEP, dyschromatopsia VA ~20/200. 3 had learning difficulties, One F severe dyspraxia, and one M GH, Cortisol testosterone deficit and micropenis. 3 had sleeping disorders treated with melatonin. No HESX mutations were identified. All parents were healthy but 3 fathers were unavailable for blood sampling.SNP array CGH revealed a paternally inherited single 410,4 kb deletion of the 2p26.1 VRK2 gene described in complex intellectual disability. 5 genes showed deleterious missense mutations identified and being confirmed by Sanger sequencing

Conclusions

A 2p16.1 inherited deletion variant of unknown significance was identified on array CGH. WES analysis identified 5 candidate genes confirmed by Sanger sequencing which will need confirmation in a different dataset
Ocular traumas in the Finnish elderly‐ Helsinki Ocular Trauma (HOT) Study
Authors: Sahraravand A. , Haavisto A.K. , Holopainen J.M. , Leivo T.
Published: September 2017

Purpose

To describe epidemiology, causes, treatments, and outcomes of all ocular injuries in southern Finland among people aged 61 and older.

Methods

All new ocular trauma patients, admitted to the Helsinki University Eye Hospital, during one year in 2011–2012. The data was from hospital records and prospectively from patient questionnaires. The follow‐up time was three months.

Results

The incidence for ocular injuries among the elderly was 38/100,000/year. From 118 patients 69% were men. The mean age was 70.9 years old (median 67). Hospitalization rate was 14%. Injury types were minor traumas (48%), contusions (22%), chemical injuries (10%), eyelid wounds (8%), open globe injuries (OGI) (7%), and orbital fractures (5%). The injuries occurred at home (58%), in institutions (12%), and in other public places (12%). The main causes of ocular injury were falls (22%), sticks (19%), superficial foreign bodies (18%), and chemicals (12%). All OGI and 88% of contusions needed a life‐long follow‐up. A permanent visual or functional impairment occurred in 15 (13%) patients. Of these 53% were OGI, 40% contusions, and 7% chemical injuries. The causes of permanent injuries were falls (7 cases, 47%), work tools, sports equipment, sticks, chemicals, and eyeglasses.

Conclusions

Minor trauma was the most frequent type, and home was the most common place of eye injuries. Falls were the most frequent and serious cause, but behavioral causes (alcohol consumption and assaults) were not significant. Preventive measures should be directed towards the main identified causes and risk factors of the eye injuries in the elderly.
Corneal nerves as a biomarker of peripheral neuropathy : the example of transthyretin amyloidosis
Authors: Rousseau A. , Cauquil C. , Dupas B. , Labbé A. , Baudouin C. , Lacroix C. , Guiochon‐Mantel A. , Benmalek A. , Labetoulle M. , Adams D.
Published: September 2017

Transthyretin amyloidosis (TTR‐A) is a rare autosomic disease associated with severe sensorimotor and autonomic neuropathy. A practical and objective method for the clinical evaluation of TTR‐A neuropathy is needed to improve the management of this disease.

We conducted a study on 15 patients and 15 controls to determine the correlations of sensorimotor and autonomic neuropathy with corneal nerve parameters in TTR‐A patients. We found that corneal nerve fiber length (CNFL) measured using IVCM was inversely correlated with the severity of autonomic and sensorimotor neuropathy, assessed both with clinical and paraclinical tests, including intra‐epidermal nerve length in skin biopsy.

In these 15 subjects, IVCM measurement permitted rapid, non‐invasive evaluation of small‐fiber alterations in TTR‐A patients and could be used to assess neuropathy. CNFL could be measured in all patients, thus avoiding the floor effect seen with other neuropathy measures. Through the example of this rare disease, our study illustrates the emerging idea that corneal nerve parameters assessed with IVCM could become a potent surrogate biomarker for peripheral neuropathy.
OCT in age related macular degeneration
Authors: Mantel I.
Published: September 2017

This part of the special interest symposium gives an overview about the features on OCT that can be seen in the context of age‐related macular degeneration (AMD). The role of OCT in diagnosis, treatment guidance, and the functional relevance are the topics approached. In addition, the signs that need to be distinguished in order to avoid misleading interpretation are presented. The overview focuses on topics with clinical relevance, using numerous imaging examples.
OCT in retinal and choroidal inflammatory disease
Authors: Vaudaux J.
Published: September 2017

OCT angiography (OCT‐A) is a novel method of retinal imaging enhancing visualization of retinal and choroidal vascular components. OCT‐A clinical applications are increasingly described in various retinal and choroidal diseases such as diabetes, AMD and vascular occlusive conditions. Its use in retinal and choroidal inflammatory diseases begins to be acknowledged, but clinical descriptions remain few in the literature. OCT‐A allows for more detailed analysis of normal retinal vascular networks and pathological conditions of the retina and choroids, particularly when neovascularization is suspected. It may contribute to a better understanding of the pathogenesis of certain retinal and choroidal inflammatory conditions, and may turn out to be a very useful tool in the follow up and monitoring of therapy. However, additional studies and experience will be required to further describe the fundamental semiology of OCT‐A in retinal and choroidal inflammatoy diseases.
Nanoparticle eye drops: A new generation of corticosteroid eye drops
Authors: Stefansson E.
Published: September 2017

Nanotechnology solves the main obstacles in topical drug delivery. Nanotechnology provides increased solubility of lipophilic molecules in tear fluid and sustained release for several hours.

Cyclodextrin nanoparticles containing dexamethasone increase solubility of dexamethasone in tear fluid 30 fold and the drug stays in tear film for 6 hours compared with minutes for conventional eye drops. The high concentration gradient from tear film into eye wall creates a flux which is active for many hours following eye drop application. This delivers approximately 10 times more drug into the eye and reaches the posterior segment in significant concentration. At the same time relatively less drug is absorbed systemically.

Several clinical trials have demonstrated the efficacy of the cyclodextrin nanoparticle platform both for posterior and anterior segment use.

Two clinical trials in 41 patients have shown significant improvement in visual acuity and retinal structure in diabetic macular edema. Two reports show compelling effect on intermediate/posterior uveitis with cystoid macular edema. Once a day treatment following cataract surgery is effective and the dexamethasone nanoparticle eye drops can replace mitomycin C in trabeculectomy.
Anterior vitreo‐lenticular interface in children
Authors: Tassignon M.J.
Published: September 2017

To demonstrate that developmental cataract involves more than opacification of the lens: the anterior vitreo‐lenticular interface plays an important role in the surgical approach.

All babies and children operated for congenital cataract since 2004 using the bag‐in‐the‐lens technique, which requires both anterior and posterior capsulorhexis, independently of the presence of persistant hyperplastic primary vitreous or fetal vasculature.

By reviewing the surgical video's the relationship between anterior hyaloid and posterior capsule, defining Berger's space, shows a large variety of anatomical particularities. It is possible to carefully dissect these structures in an attempt to reduce anterior vitrectomy to a minimum. Bridges between anterior hyaloid and posterior capsule can easily be ruptured by ocular viscoelastic dissection.

Better knowledge of the anterior vitreo‐lenticular interface would largely increase the surgical outcome of developmental cataract. Currently medical devices allowing to visualize this interface prior to surgery are lacking. Dissection of primary vitreous from posterior capsule is time‐consuming but feasible. Chemicals, like microplasmin, may be of some benefit for the cataract surgeon to optimize the separation.
Protein analysis of the plaques in congenital cataracts
Authors: Van Looveren J. , Van Gerwen V. , Schildermans K. , Laukens K. , Baggerman G. , Tassignon M.J.
Published: September 2017

Purpose

To identify the protein composition of posterior capsular plaques (PCP) in congenital idiopathic unilateral cataract with anterior vitreolenticular interface dysgenesis (AVLID).

Methods

Samples of PCP's were collected during cataract surgery in children with congenital unilateral cataract presenting with a PCP and with vitreolenticular adherences observed during posterior capsulorhexis procedure. Proteome analysis was performed on the collected PCPs.

Results

PCP collection and proteome analysis was feasible from four children. A large portion of the proteins found in the PCPs were similar to the proteins known to be present in lens epithelial cells and fibers. Proteins like vimentin, fibronectin, actin, collagen type I, collagen type VI, lumican and keratin were also found which typically are present in mesenchymal tissue but not in lens tissue or capsule.

Conclusions

Cases of unilateral idiopathic congenital cataract with AVLID typically present with a PCP. The protein composition in these PCPs, measured by means of proteome analysis, includes atypical proteins for lens and lens capsule and may be suggestive for an epitheliomesenchymal transformation (EMT).
Contact lens service in pseudophakic and aphakic children
Authors: ROSENSVÄRD A.
Published: September 2017

In Sweden cataract surgery is performed at two specialized centers during the first 2 years of life. Intraocular lenses (IOL) are implanted if possible. Amblyopia treatment and contact lens (CL) service is also provided for at these centers for the youngest. At the clinic the patient meets a team; an orthoptist, an optician and a pediatric ophthalmologist. Newborn aphakic children first get a standard CL +37 D. Children with IOL are made hyperopic with the ambition to obtain emmetropia in adult life. CL are prescribed after retinoscopy finding. Infants are corrected to a slight myopia. From 2 years of age the correction is for emmetropia and near addition of 2,5 diopters are prescribed in bifocal glasses. Aphakic children combine CL with bifocals and the children with IOL have only bifocals. The CL are inserted every morning and removed and cleaned every evening. Some children learn to handle their CL themselves (video). There are advantages with CL in comparison to glasses such as visual fields, aberration, flexibility and cosmetic. PECARE (PEdiatric CAtaract REgistry) is a web‐based national register in Sweden for children operated for cataract. Many of the congenital bilateral cases develop vision enough for driving licence.