bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the peripapillary retinal nerve fiber layer and choroidal thickness in patients with Parkinson's disease using swept‐source optical coherence tomography
Authors: Obis J. , Cipres Alastuey M. , Villades E. , Garcia‐Martin E. , Satue M. , Rodrigo M.J.
Published: September 2016

Purpose

To analyze the thickness of several retinal layers and the thickness of the choroid in the peripapillary area in patients with Parkinson's disease (PD) using swept‐source optical coherence tomography (SS‐OCT) as a marker for neurodegenerative injury.

Methods

108 eyes of patients with PD and 90 eyes of healthy controls were included. All subjects underwent ophthalmologic evaluation, including retinal and choroidal assessment using SS‐OCT Triton (Topcon), 3DH Wide protocol. RNFL‐TSNIT data were analyzed in the peripapillary area, including retinal nerve fiber layer (RNFL), GCL+ layer (from RNFL to inner nuclear layer), GCL++ layer (from inner limiting membrane to inner nuclear layer) and choroidal thickness.

Results

Patients with PD revealed significant thinning in every retinal layer compared to healthy controls: average retinal thickness (280.25 ± 20.18 μm in patients vs. 288.18 ± 13.09 μm in controls; p = 0.013); inferotemporal sector of the RNFL thickness (135.08 ± 25.28 μm vs. 144.23 ± 17.19 μm; p = 0.024); superotemporal sector of the GCL+ layer thickness (38.52 ± 7.02 μm vs. 41.78 ± 9.24 μm; p = 0.047); inferotemporal sector of the GCL++ layer thickness (176.00 ± 28.07 μm vs. 187.07 ± 16.93 μm; p = 0.010). Contrary, patients with PD revealed significant thickening in total choroidal thickness compared to healthy controls (153.56 ± 62.48 μm in patients vs. 125.64 ± 52.53 μm in controls; p = 0.012), choroidal nasal (152.73 ± 50.54 μm vs. 129.32 ± 54.86 μm; p = 0.024), choroidal temporal (165.82 ± 80.16 μm vs. 128.40 ± 50.81 μm; p = 0.003) and choroidal inferior thickness (129.90 ± 64.70 μm vs. 98.83 ± 51.67 μm; p = 0.006).

Conclusions

Patients with PD present significant reduction of peripapillary retinal, RNFL and ganglion cell layer thickness and significant thickening of the choroid in the peripapillary area detectable with new SS‐OCT technology.
DNA damage in human llmbal epithelial cells expanded ex vivo
Authors: Lorenzo Corrales Y. , Haug Berg K. , Noer A. , Collins A.R. , Nicolaissen B.
Published: September 2016

Purpose

Limbal stem cell deficiency, secondary to insults and diseases, may be treated by transplantation of ex vivo engineered epithelial grafts. We here present preliminary data on levels of cellular DNA damage in grafts produced in two different types of culture medium.

Methods

Cultures were initiated using corneo‐limbal donor tissue after removal of the central area for transplant purposes. Explants (approx. 2 × 2 mm) were positioned epithelial side down on tissue culture treated polyester membranes and expanded for 4 weeks in complex medium or in medium with human serum. Cells were dissociated using Trypsin‐EDTA (0.05%) for 30 min, the enzyme activity was further inhibited by medium and serum. The cell suspension was transferred to tubes on ice and processed using the Comet Assay. Duplicate samples from each culture were analyzed in each assay by visual scoring. Using a fluorescence microscope, 100 comets (50 from each gel) were classified into five categories, 0–4, representing increasing relative tail intensities. Summing the scores (0–4) of 100 comets therefore gives an overall score of between 0 and 400 arbitrary units.

Results

Preliminary data show some levels of DNA damage in cells dissociated from the grafts regardless of the type of culture medium used. Anyway more experiments with other donors have to be done to have some conclusions.

Conclusions

Recent studies have shown that medium with human serum equally support production of grafts containing differentiated as well as undifferentiated cells suitable for clinical transplantation. Preliminary data from our experiments indicate that levels of molecular damage to the DNA do not increase in cells cultured in human medium despite its lacks of complexity.
Evaluation of the eyelid disorders in the daily ophthalmic practice in 9 European Countries: The MEIBUM* survey
Authors: Doan S. , Zagórski Z. , Palmares J. , Yağmur M. , Kaercher T. , Van Dooren B. , Jonckheere P. , Jensen P.K. , Benitez del Castillo J.M.
Published: September 2016

Purpose

To determine the incidence and characteristics of eyelid inflammatory disorders encountered during general ophthalmology consultations in Europe.

Methods

Multicenter, epidemiological survey implemented in 9 European countries (2012–2014). The participating ophthalmologists were asked to include 10 consecutive patients attending for consultations, no matter what reason for visit. A questionnaire recorded reason for visit, ocular history, symptoms, examination of eyelids and ocular surface, diagnosis of MGD or dry eye, impact on daily life, and management of eyelid disorders.

Results

6,250 patients were recruited from 9 countries; Poland (2,584), Spain (1,925) Portugal (415), Turkey (398), Germany (375), The Netherlands (230), France (185), Belgium (78) and Denmark (60);mean age was 57.2 ± 17.6. 79.5% of patients presented with at least one ocular problem; the most common presenting symptom was dry eye (29.6%). 77.7% of patients had eyelid disorders. MGD was diagnosed in 53.2% and dry eye in 60.9% of patients. MGD was diagnosed in more than half of the patients with a strong link to dry eye (p‐value < 0.001). In case of presence of eyelid disorders there was a 52.5% relative risk increase in having dry eye diagnosis. (RR: 1.525: Confidence Interval, CI, 1.424–1.632). Among the 3,215 patients diagnosed with MGD, 37.3% were classified as having a hyposecretory MGD, 37.3% an obstructive MGD and 38% a hypersecretory MGD. Management included warming (49.5%), cleansing (67.7%), massage (53.6%), and also eye drops for dry eye (81.7%). The impact of eyelid disorder on daily life concerned vision for 56.7%, daily activities/work (53%), leisure (43.1%), and also on emotions (20.6%) and sleep (17.6%).

Conclusions

This survey highlights the importance of examining eyelids more closely during routine eye examinations.
Histopathological findings after pars plana vitrectomy with a new hypersonic vitrector
Authors: Irion L. , Pastor‐Idoate S. , Bonshek R. , Zambrano I. , Bishop P. , Mironov A. , Carlin P. , Stanga P.
Published: September 2016

Purpose

Assess morphological changes in the retina and optic nerve head (ONH) after pars plana vitrectomy with a new prototype ultrasound‐based hypersonic vitrector (HV).

Methods

Six porcine cadaveric eyes, 6 human cadaveric eyes and 14 live porcine eyes underwent pars plana vitrectomy (PPV) using the HV or a pneumatic guillotine vitrector (GV). One extra eye from each porcine group had no procedure done, being used as a control. Eyes were fixed in formalin, examined macroscopically and processed for histological assessment. Microscopic analysis included assessment of any morphological intraocular change especially to the retina and ONH. Comparison was made between non‐vitrectomized (intenal control) and vitrectomized areas, respectively nasal and temporal to ONH .

Results

There were no macroscopic retinal or ONH defects associated with either HV or GV PPVs. Microscopically, cadaveric human and porcine retinas showed focal vacuolization and fragmentation at the nerve fibre layer and the ganglion cell layer as well as separation of the inner limiting membrane (ILM). Eyes from live swines following PPV with both vitrectors showed ILM fragmentation and separation. There were no differences between the ‘non‐vitrectomized’ nasal (control) and vitrectomized temporal areas of the ONH with HV.

Conclusions

Morphological examination of retina and ONH with light microscopy after PPV showed similar features using the HV or the GV. The HV might be a promising new alternative to the currently commercially available GV for PPV.
A link between diabetes mellitus and glaucoma — Danish Nationwide Study
Authors: Horwitz A. , Petrovski B.É. , Petrovski G. , Torp‐Pedersen C. , Kolko M.
Published: September 2016

Purpose

To determine the effect of anti‐diabetic medication on glaucoma. Furthermore, to investigate if diabetic comorbidities and concomitant medications are associated with glaucoma in patients treated with anti‐diabetic medication.

Methods

Retrospective nationwide cohort study, spanning a 16‐year follow‐up period. The National Danish Registry of Medicinal Products Statistics was used to identify all claimed prescriptions for glaucoma medication and anti‐diabetic drugs. Comorbidities with diabetic retinopathy and diabetic nephropathy were identified using the ICD‐10 classification and the Danish National Patient Register.

Results

A total of 6,343,747 individuals in the period 1996–2012 were included. The overall incidence rates of new‐onset glaucoma were 0.07 and 0.36 per 1,000 person‐years for the reference population and for diabetes mellitus, respectively. Patients treated with anti‐diabetic drugs at any time during the study period had a significantly higher overall relative risk of glaucoma (RR = 5.11, p < 0.0001), even when controlling for age, gender, diabetic retinopathies and calendar year‐fixed effects (RR = 2.05, p < 0.0001). For patients treated with anti‐diabetic drugs, we found an increased hazard for development of glaucoma in patients with diabetic retinopathies (HR = 1.40) and joint complications with diabetic retinopathies and diabetic nephropathy (HR = 1.40). Furthermore, we found that concomitant antihypertensive medications were associated with an increased likelihood of glaucoma overall, while treatment with β‐blocker and RAS, in combination, are associated with a significantly lower risk (HR = 0.87).

Conclusions

Use of anti‐diabetic drugs is strongly associated with use of anti‐glaucomatous drugs. Diabetic complication as well as concomitant antihypertensive medications affect the risk of glaucoma in patients treated with anti‐diabetic drugs.
Paraneoplastic retinopathy and optic neuropathy with Waldenström Macroglobulinemia
Authors: Ozturk N. , Havelange V. , Draganova D. , Boschi A.
Published: September 2016

Purpose

To report the clinical, electrophysiologic and immunopatholologic findings in a patient with progressive visual loss due to retinal and optic nerve degeneration associated with a Waldenström's macroglobulinemia (WM).

Methods

A 77‐year old man with mild stage WM, complained of progressive bilateral visual loss, with photopsia, intense photophobia and loss of color perception. Patient developed severe legs pain and unsteadiness.

Complete ophthalmological, neurological and hematological examinations were realized, and patient followed over a period of 2 years. Immunohistochemical studies to determine the presence of serum antiretinal antibodies were performed.

Results

Visual acuity was gradually reduced to 1/10 RE and 2/10 LE, with a severe loss of color perception. The visual field showed a deep central and peripheral visual loss in both eyes. Optic nerves were pale and excavated, macular remained normal as peripheral retina. Cerebral CT scan did not show anomalies in the brain as in the optic nerves, lumbar puncture was unremarkable. Neurological revealed a rest less leg syndrome. Electroretinogram showed a reduce rod response and a delayed combined and cone response. Hematologic evaluations confirmed the WM and immunohistochemistry showed reactivity of the patient's serum against the photoreceptors.

The patient was treated with 4 intravenous infusions of Rituximab, followed 1 month later by 1gr of Methylprednisolone for 3 days. Improvement of central vision (4/10 RE, 6/10 LE) and peripheral visual fields was reported.

Conclusions

The visual loss in this patient is due to a combined dysfunction in the retina and the optic nerve and presumed to result from antibodies IgM‐subtype reacting to proteins in different retinal antigens.
En face OCT of uncomplicated angioid streaks
Authors: Perestrelo S.
Published: September 2016

Purpose

The Optical Coherence Tomography (OCT) is not a good diagnostic method for uncomplicated angioid streaks. Even the most better resolution imaging forms such as Spectral Domain OCT or Swept Source OCT has no sufficient resolution to distinguish the locations of small splines. The aim of this study is to report the imaging characteristics of uncomplicated angioid streaks using en face Spectral Domain OCT (SD‐OCT).

Methods

Patients with uncomplicated angioid streaks were imaged using Spectralis SD‐OCT. A macular cube composed of 248 μm 20° × 15° 19‐line raster scans was obtained. En face SD‐OCT characteristics were evaluated by taking images at the retinal pigment epithelium level taking into account all its thickness.

Results

Large angioid streaks are visible in en‐face SD‐OCT as a hiporreflective groove structure, representing the pigment epithelium, surrounded by a hiperreflective area that corresponds to its absence.

Conclusions

SD‐OCT en face imaging can be used in clinical practice to identify and follow patients with uncomplicated angioid streaks. ‘Follow‐up’ functions of the SD‐OCT may help in the future to better understantd the behavior of these lesions.
The role of anterior segment optical coherence tomography (AS‐OCT) and ultrasound biomicroscopy (UBM) in conjunctival nevi
Authors: Lauwers N. , Janssens K. , Mertens M. , De Keizer R.J.W. , De Groot V.
Published: September 2016

Purpose

To compare AS‐OCT and UBM in the evaluation of conjunctival nevi.

Methods

Prospective, observational, non‐randomized trial. We examined 16 eyes of 15 consecutive patients with conjunctival nevi.

Results

The visualization of the margins of the nevus was categorized as good, fair or poor. There was a good resolution in 100% of anterior margins for both UBM and AS‐OCT cases. On UBM and AS‐OCT the posterior margin had a good or fair resolution in 94 and 88%, respectively. Except for 1 UBM image, all AS‐OCT and UBM images had a good or fair resolution of the lateral margins. Some degree of deep optical shadowing was seen on all AS‐OCT images, but it only hindered good visualization of the posterior margin in 3 cases.

AS‐OCT was able to visualize the nevi with a better resolution than UBM. Intrinsic cysts were seen in 6 cases (36%) with UBM and in 13 cases (81%) with AS‐OCT, not necessarily in the same cases.

Conclusions

AS‐OCT and UBM have the ability to accurately visualize the anterior and posterior margins of conjunctival nevi although AS‐OCT is more accurate in visualizing details. AS‐OCT is also more patient friendly but it has the disadvantage of deep optical shadowing, especially in thick nevi. We would advise to document conjunctival nevi with photographs and AS‐OCT first and to use UBM only when the nevus is too thick to visualize the posterior margin with AS‐OCT.
Dexamethasone induced glaucoma as part of chemotherapy for lymphoblastic lymphoma and colorectal cancer
Authors: Lockwood A. , Mitchell A. , Lewis K. , Papadopoulos M. , Gray J. , May K.
Published: September 2016

Purpose

To describe glaucoma in an 11‐year‐old girl and exacerbation of glaucoma in a 59 year old man after high dose oral corticosteroid chemotherapy.

Methods

Topical steroids are well known to cause intraocular pressure (IOP) elevation, but oral steroids are less commonly associated. We report 2 cases of significant IOP elevation after high dose dexamethasone treatment as part of chemotherapy for lymphoblastic lymphoma in an eleven‐year old girl, and for metastatic colorectal cancer in a 59‐year old man.

Results

A week after induction with dexamethasone combination chemotherapy an 11‐year old girl presented with headaches, photophobia and blurring of vision. Intraocular pressures were 48 and 52 mmHg in the right and left eye respectively with bilateral arteriolar disc pulsation. Control of IOP was achieved through topical and systemic treatment but requiring renal support after systemic carbonic anhydrase inhibitor use. The second patient was an adult male with preexisting glaucoma controlled medically in the right eye and with an aqueous shunt in the left eye. During the course of chemotherapy with systemic dexamethasone for colorectal cancer he presented to casualty with reduced right vision from 6/12 to 6/60 associated with an IOP of 42 mmHg in the right eye, while the left was 21 mmHg. His right eye required cyclodiode laser for IOP control.

Conclusions

These cases illustrate that high dose systemic dexamethasone treatment for chemotherapy may cause a considerable rise in IOP potentially leading to significant visual loss from glaucoma. This possibility should be anticipated especially in children and in patients with pre existing glaucoma who are at higher risk of steroid responsiveness.
Comparaison of the Plusoptix A12 and the 2WIN with the Retinomax K‐plus 3 in a pediatric population
Authors: Bouvier R. , Heripret A. , Promelle V. , Milazzo S.
Published: September 2016

Purpose

To compare non‐cycloplegic refractive results obtained with the Plusoptix A12 (Plusoptix, Germany) and the 2WIN (Adaptica, Italia), to Retinomax K‐Plus 3 (Righton, Virginia) in a pediatric cohort.

Methods

106 eyes of 53 childrens were included prospectively between March 2015 and June 2015. On each eye, no‐cycloplegic refraction was performed with the Plusoptix A12 and the 2WIN, and cycloplegic refraction was performed with the Retinomax K‐Plus 3, which was used as gold‐standard reference method. All data from each device, concerning sphere and cylinder power and axis, were compared to cycloplegic refractive measurements. The measures were considered reliable when the difference on sphere or cylinder power was between −0.5 D and +0.5 D, and when the difference on axis was less than 10°.

Results

The mean age was 7.3 years (range, 1–17 years). Regarding sphere, measures were reliable in 37.7% for the right eye and 35.8% for the left eye with the Plusoptix A12 and in 35.8% with the 2WIN, regardless the eye. The sphere was underestimated respectively in 59.3 and 57.5%. Regarding the cylinder power, measures were adequate in 66% for the right eye and 69.8% for the left eye with the Plusoptix A12 and in 79.2% for the right eye and 64.2% for the left eye with the 2WIN. Concerning the cylinder axis, values were reliable in 32% for the right eye and 47% for the left eye with Plusoptix A12 and 42% for the right eye and 62% for the left eye with the 2WIN .

Conclusions

The Plusoptix A12 and the 2WIN seem reliable for the evaluation of the cylinder power but not for the axis. These devices trend to underestimate the sphere. These devices can be used for screening of children refractive errors, but can not restitute cyloplegic retinoscopy measurements for prescription of optical corrections.
Warfarin use among wet AMD patients
Authors: Paterno J.J. , Ahola O. , Järvikallio R. , Kiviluoma J. , Turtiainen H. , Vuorinen I. , Kaarniranta K.
Published: September 2016

Purpose

To evaluate the prevalence of warfarin use among wet AMD patients, and impact on clinical outcome.

Methods

A retrospective analysis of patient records was conducted in Kuopio University Hospital, Finland. We obtained best possible medication history of 414 wet AMD patients and 247 controls, aged 60 years or over, and already excluding other causes of macular oedema by ophthalmologist. Controls were patients with glaucoma or age‐related cataract, with no wet AMD. Due missing medication history, 139 wet AMD patients and 71 controls (p = 0.216) were kept out from the study. When possible, we obtained real‐life 2‐year outcome data of wet AMD treatment for the patient's first eye, solely treated with anti‐VEGF pro re nata.

Results

The study included 276 wet AMD patients (mean age: 79.5 years) and 175 controls (mean age: 75.3 years). A positive warfarin medication history was detected in 57 (20.7%) wet AMD patients, compared to 16 (9.1%) in control group. Crude OR was 2.59 (95% CI 1.43–4.67, p = 0.001). Age‐adjusted OR was 1.92 (95% CI 1.02–3.60, p = 0.018). Treatment outcome data was obtained from 11 patients (mean age: 77.3 years) using warfarin and 54 patients (mean age: 79.1 years) without warfarin medication. Snellen visual acuity didn't differ between these wet AMD groups at the baseline (0.3 vs. 0.2, p = 0.319). After 2‐year follow‐up, no difference was seen in the change of visual acuity (+0.3 vs. +0.3, p = 0.696), or in number of anti‐VEGF injections (7.8 vs. 9.0, p = 0.435) with respect to the use of warfarin.

Conclusions

Our study suggest that warfarin use may be more common among wet AMD patients, but it does not have any effect on the outcome of wet AMD treatment. As the study sample is small and wet AMD‐related cardiovascular factors are susceptible to interfere, these initial findings should be verified in a larger prospective study.
Rupture of Descemet's membrane associated with forceps delivery
Authors: Idoate A. , Ascaso F. , Perez D. , Remón L. , Perez I. , Almenara C. , Esteban O. , Martinez M. , Sanchéz J.I. , Berniolles J. , Bartolomé I.
Published: September 2016

Purpose

In modern medicine forceps‐induced birth trauma to the eye is a rare clinical event. Forceps injury to the cornea occurs during complicated forceps delivery. The break in Descemet's membrane is the most common complication.

Methods

Interventional case report showing the rupture of Descemet's membrane due to a complicated forceps delivery.

Results

A 2 days‐old boy was referred for severe and diffuse corneal edema. Medical history was significant for forceps delivery. On examination, he was found to have a rupture of the Descemet's membrane. Conservative treatment and application of hypersomolar solution was decided. Corneal edema was resolved in three months. Actually the cornea remained clear but persists a residual corneal astigmatism of 6D.

Conclusions

The application of the forceps can cause accidental rupture of the cornea at the level of the Descemet's membrane. The edema resolves spontaneously within a few weeks or months eventually leaving the visible edges of the break and a clear cornea. Rupture of Descemet's membrane is not presented as an Ophtalmologic urgency but it′s crucial to follow these patients because failure to intervene leads to amblyopia or ‘lazy eye’.
Choroidal metastasis from thyroid cancer: a case series
Authors: Mamunur R. , Kivela T.
Published: September 2016

Purpose

To describe the clinical features, treatment, and outcome of primary thyroid cancer patients with choroidal metastases.

Methods

A retrospective observational case series of 3 consecutive thyroid cancer patients with choroidal metastasis in the Ocular Oncology Service, Helsinki University Hospital, Finland, from 2009 to 2015.

Results

The median age at presentation with primary thyroid carcinoma was 45 years. Two primary tumors were medullary and one was a papillary carcinoma. All patients had synchronous metastases to various tissues, and the choroidal metastasis from a papillary carcinoma was the first sign of cancer. The choroidal metastases from the medullary carcinomas developed 4 and 15 years after diagnosis. Two patients had unilateral and one bilateral choroidal metastases. The median tumour height was 1.9 mm and all were 10–12 mm by largest basal diameter. The primary cancer was treated with radiotherapy and thyroidectomy in 2 who also received systemic chemotherapy and sorafenib. The choroidal metastases permanently vanished with 40 Gy external beam radiotherapy. The patient with papillary carcinoma died within 4 months from cerebral metastases, whereas the two with medullary carcinoma survived 34 and 45 months from detection of choroidal metastasis and 7 and 17 years from detection of the primary tumor with synchronous metastases.

Conclusions

The choroid is not a common site for metastatic thyroid carcinoma: to the best of our knowledge, there is only one previous series with three affected patients although in addition there are about 50 single case reports.
Validation of an antiretinal antibody detection strategy for the diagnosis of autoimmune retinopathies
Authors: Draganova D. , Debaugnies F. , Postelmans L. , Caspers L. , Willermain F. , Corazza F.
Published: September 2016

Purpose

Antiretinal antibody (ARA) detection is a key element in the diagnosis of autoimmune retinopathies (AIR). We present the indirect immunofluorescence data from a series of suspected AIR patients and controls.

Methods

Primate retinal sections were incubated with 1:100 diluted sera. Patients with suspected paraneoplasic AIR (pAIR) (n = 13) or non paraneoplasic AIR (npAIR) (n = 15) were included. Diagnosis of AIR was based on a combination of symptoms (visual loss, photopsia, nyctalopia) and signs (decreased visual acuity, reduced visual field, abnormal electroretinography and retinal imaging) in a context of history of cancer or autoimmune disease. 3 control groups were used to define the threshold of positivity: negative: sera from healthy individuals without ophthalmological history (n = 15), pathological: patients with outer retinal inflammation (ORI) (n = 12) and positive: commercial antibodies against recoverin, α‐enolase, IRBP and TRPM‐1. Antinuclear antibodies (ANA) were screened when a nuclear pattern was observed.

Results

As expected, in sera positive for ANA there was a signal in all nuclear layers, complicating ARA interpretation. ANA positivity was found in 4/15 negative controls, 2/12 ORI, 2/13 pAIR, 7/15 npAIR. In ORI, 1/12 patient had positive ARA. We found ARA respectively in 6/13 pAIR and 4/15 npAIR patients. ARA were localized at the following retinal layers: photoreceptors (PR), external limiting membrane, outer plexiform layer, outer nuclear layer. In pAIR, PR staining was most frequently observed. In contrast, no predominant location was found in npAIR.

Conclusions

We show that ARA detection can help the management of suspected AIR patients but should be integrated in the overall clinical context. Furthermore, we underline the importance of using negative controls and being aware that positive ANA complicate interpretation of results.
Prevention and reversal of selenite‐induced cataracts by N‐acetylcysteine amide in Wistar rats
Authors: Maddirala Y. , Tobwala S. , Karacal H. , Ercall N.
Published: September 2016

Purpose

The present study sought to evaluate the efficacy of N‐acetylcysteine amide (NACA) eye drops in reversing the cataract formation induced by sodium selenite in male Wistar rat pups.

Methods

Forty male Wistar rat pups were randomly divided into treatment groups. Cataracts were evaluated at the end of week 2 (postpartum day 14) when the rat pups opened their eyes. NACA eye drops were administered beginning week 3 till the end of week 4 (postpartum days 15–30) and the rats were sacrificed at the end of week 4. Lenses were isolated and examined for oxidative stress parameters such as glutathione, lipid peroxidation, and calcium levels along with the glutathione reductase and thioltransferase enzyme activities. Casein zymography and Western blot of m‐calpain were performed using water soluble fraction of lens proteins.

Results

Morphological examination of the lenses in the NACA‐treated group indicated that NACA was able to reverse the cataract grade. In addition, glutathione (GSH) level, thioltransferase (Ttase) activity, m‐calpain activity, and m‐calpain level (as assessed by Western blot) were all significantly higher in the NACA‐treated group than in the Na2SeO3‐induced cataract group. Furthermore, sodium selenite injected rat pups had significantly higher levels of malondialdehyde (MDA), glutathione reductase (GR) enzyme activity, and calcium levels, which were reduced to control levels upon treatment with NACA.

Conclusions

NACA has the potential to significantly improve patient health and the clinical care of cataracts. Further development of pharmacological agents like NACA may eventually help ophthalmologists prevent cataract formation in high‐risk populations and non‐surgically treat early stage cataracts, producing favorable patient outcomes while decreasing medical costs.
Stargardt disease phenotype‐genotype correlation – first results of a Lithuanian cohort study
Authors: Strupaite R. , Cimbalistienė L. , Ambrozaitytė L. , Utkus A. , Asoklis R.
Published: September 2016

Purpose

To describe the first phenotype‐genotype correlation results of the patients with Stargardt disease in Lithuanian population.

Methods

From May 2015 till April 2016 a prospective study was performed, 16 patients with Stargardt disease were involved. Ophthalmological examination included best‐corrected visual acuity (BCVA), ophthalmoscopy, fundus photography, fundus autofluorescence (FAF), spectral‐domain optical coherence tomography (SD‐OCT) and specular microscopy. Different DNA variants in several genes have been identified for all patients.

Results

The age of patients ranged from 18 to 66 years. Initial ophthalmoscopy revealed either no abnormalities or foveal retinal pigment epithelium (RPE) changes, foveal atrophy, atrophic RPE lesions, and/or irregular yellow‐white fundus flecks. Different FAF patterns were observed: central atrophy surrounded by ring of increased AF, irregular hypo/hyper AF or spots of hypo AF in the posterior pole. SD‐OCT revealed photoreceptor damage followed by atrophy of the outer retina, RPE, and choroid. The mean central retinal thickness of the right eye was 96.5 ± 57.004 μm and 110.9245 ± 54.84872 of the left eye. The mean subfoveal choroidal thickness, the endothelial cell count and corneal thickness were also evaluated.

Conclusions

These are the first results of Stargadt disease in Lithuanian population. All patients had a different phenotypic expression. Further investigations conserning individual mutations contribution to phenotype are necessary.
Composition of phacoemulsificated human lenses analyzed by infrared spectroscopy
Authors: Chaniecki P. , Miszczyk J. , Rekas M. , Paluszkiewicz C.
Published: September 2016

Purpose

Phacoemulsification is one of the most popular techniques of treating cataract. During the surgery the vibrating phaco‐probe emulsifies the lens into pieces that are vacuumed into a cassette. Afterwards the shredded lens material is usually disposed. Currently spectroscopic methods are ordinarily applied for studying biological materials due to their high sensitivity, reliability and non‐destructive character. The study attempts to determine whether the infrared spectroscopy technique is appropriate to reveal the differences in the structure of the lenses, especially focusing on the content of substances indicating changes in the secondary protein structure or mineralization process.

Methods

In the study 99 randomly selected dispersed human lenses were analyzed. The procedures of phacoemulsification were performed at the Military Hospital in Cracow and Military Institute in Warsaw. Obtained shredded lenses were forwarded to the Institute of Nuclear Physics at Polish Academy of Sciences in Cracow for further investigation. After appropriate preparation, the material was analyzed by FTIR spectroscopy using Nicolet spectrometer equipped with DTGS detector and ATR attachment. For the accurate interpretation of the spectra of lenses, exemplary samples of albumin, DNA, glucose and hydroxyapatite were also analyzed.

Results

The FTIR spectra of lenses are characteristic for natural tissues and are dominated by intense bandwidth derived from amides and lipids. The FTIR spectra of the lenses are most similar to the spectrum of albumin.

Conclusions

The material obtained during phacoemulsification is suitable for infrared spectroscopic investigation. The FTIR method allows for the determination of human eye lenses structure and enables to indicate the differences in their composition.
Static retinal vessel analysis in routine optometric practice
Authors: French C. , Heitmar R.
Published: September 2016

Purpose

To evaluate the use of objective retinal vessel calibre measurements in optometric practice and its utility in clinical decision making.

Methods

A sub‐sample [n = 56] was extracted from a prospective study including patients booked for routine eye examinations in optometric practice. All participants underwent a standard examination including subjective refraction and slit lamp biomicroscopy. Undilated fundus photography and/or optical coherence tomography (OCT) was also performed. Optic nerve‐centred (camera angle: 50 degrees), red‐free photographs were analysed using VesselMap software (Imedos, Germany) to give objective vessel calibre measurements (central retinal artery and vein equivalents (CRAE / CRVE)).

Results

Mean age of the cohort was 56 years (range: 21–82 years; consisting of 32 women and 24 men). Univariate analysis showed a significant association between systolic blood pressure and CRAE which was lost in multivariate analysis (p = 0.02). Stepwise forward multiple regression analysis found age to be significantly, negatively associated with CRAE (CRAE: 157au (SD ± 20); β = −0.54; p < 0.001) and CRVE (β = −0.56; p < 0.001), whereas BMI was positively associated with CRVE (198au (SD ± 20) au; β = 1.84; p = 0.005) only. Two patients were measured twice: on initial presentation, one with a significant retinal haemorrhage and one with unilateral papilloedema; both showed normalisation of vessel diameters on follow up.

Conclusions

Participants with the largest CRVE had the highest BMI and/or were diabetic. Cross‐sectional results from this sample are in agreement with results published from large cohort studies, including the negative association with age and CRAE. Retinal vessel calibres can help provide information on a patient's vascular system and systemic health, and therefore be a useful tool to refine optometric referrals and aid patient monitoring.
Trends in glaucoma surgical procedures in Portugal – a national database report 2000–2014
Authors: Barbosa Breda J. , Gonçalves‐Pinho M. , Vasco Santos J. , Rocha Sousa A. , Freitas A.
Published: September 2016

Purpose

To analyze trends in the surgical management of glaucoma, in Portugal, from 2000 to 2014.

Methods

We performed a retrospective analysis of all episodes for inpatients or surgery outpatients in all public nationwide hospitals, with a diagnosis of glaucoma/ocular hypertension (coded 365.xx) or trabeculectomy ab externo (code 12.64) or insertion of glaucoma drainage device (GDD, code 12.67) or other scleral fistulizing procedure (code 12.69, used for GDDs prior to 2011), and analyzed associated eye procedures (ICD 9‐CM codes 08.xx to 16.xx).

Results

In 15 years, the total number of eye procedures was 55,081 (17.6% of all coded procedures), with an increase in the number of eye procedures from 2,614 in 2000 to 5,400 in 2014 (34.1 and 11.3% of all coded procedures, respectively). Overall, trabeculectomy ab externo was the second most performed eye procedure (20.6%), second only to cataract extraction with phacoemulsification. Although the absolute number per year has an almost steady profile (747 in 2000, 643 in 2014), the relative frequency of this procedure has decreased from 28.6% in 2000 to 11.9% in 2014. On other hand, GDDs had an increase both in absolute and relative values [(17 (0.7%) in 2000, steady until 2008 – 21 procedures (0.5%), and then increasing until 2014 – 327 procedures (6.1%)]. As for cyclodestruction (cryotherapy or photocoagulation), there is an increase in the total number of procedures (75 in 2000, 217 in 2014), but their relative frequency is stable throughout the study period (2.9% in 2000, 4.0% in 2014).

Conclusions

Trabeculectomy ab externo remains the most widely performed IOP‐lowering surgical procedure. However, there is a trend showing a reduction in the frequency of trabeculectomies, whereas there is an increase in GDD use. Cyclodestruction has a stable frequency in the number of procedures throughout the study period.
Deep learning approach for diabetic retinopathy screening
Authors: Colas E. , Besse A. , Orgogozo A. , Schmauch B. , Meric N. , Besse E.
Published: September 2016

Purpose

Diabetic retinopathy (DR) is the major cause of blindness in the working‐age population. With an increasing number of diabetic patients worldwide, automated screening tools become indispensable. Recent progress in machine learning and image analysis enables efficient automated screening.

Methods

DreamUp Vision uses state‐of the art technology based on deep‐learning. Our algorithm was trained on over 70,000 labeled retinal images. Images were graded by ophthalmologists as follows: 0 (no retinopathy), 1 (mild non proliferative DR), 2 (moderate non proliferative DR), 3 (severe non proliferative DR) and 4 (proliferative retinopathy). Each patient in the dataset is represented by two images of left and right eyes. Grading is done for each eye image separately. Our algorithm performs quick and reliable detection of anomalies in retinal images, diagnoses their stage of diabetic retinopathy and provides the location of the anomalies detected in the pictures. We consider a patient as referable if the DR stage is between 2 and 4, otherwise we consider the patient as non‐referable. We evaluate our model on over 10,000 fundus images from 5,000 patients taken from the Kaggle DR Detection Challenge dataset, provided by California Healthcare Foundation.

Results

Our algorithm achieves an area under the receiver operating characteristic curve AUROC of 0.946 with 96.2% sensitivity (95% CI: 95.8–96.5) and 66.6% specificity (95% CI: 65.7–67.5) for identifying referable DR on the Kaggle dataset.

Conclusions

The performances we have obtained enable a reliable automated DR screening. As the amount of available labeled data grows and given our technology's ability to learn from labeled images, we believe that significant performance improvement can be achieved. The same process can be applied to the detection of other eye diseases as well.
Visualizing retinal vessel dynamics of young type 1 diabetic patients using self‐organizing map
Authors: Haikonen S. , Kytö J. , Kämäräinen J.K. , Kauppi J.P. , Huttunen H. , Groop P.H. , Summanen P.
Published: September 2016

Purpose

To reveal possible differences in retinal arterial dynamics between patients with type 1 diabetes (T1D) and healthy subjects using data‐driven analysis.

Methods

The retinal arterial diameter was measured as a function of time in one eye of 94 T1D‐patients (mean age 32 years, range 22–54) and 29 healthy subjects (mean age 33 years, range 24–50) during stable light conditions and flickering light stimulus using Dynamic Retinal Vessel Analyzer (DVA; Imedos GmbH, Jena, Germany). Diabetic retinopathy (DR) of T1D patients was graded using ETDRS classification: 41 without DR, 50 only mild DR and 3 moderate or more severe DR. The raw DVA data was preprocessed and subsequently analyzed with Self‐Organizing Map (SOM). SOM is a data‐driven method which was here used to cluster DVA time courses of the subjects and to visualize the data in a map‐like image.

Results

There were differences in retinal arterial response patterns between healthy subjects and T1D patients. The response patterns of the T1D patients seemed milder than those of the healthy subjects. The severity of DR was associated with flatter shape of the response curve. SOM also revealed distinct subgroups among T1D patients.

Conclusions

Weaker vascular responses observed in T1D patients as compared to healthy subjects were in line with earlier studies. However, in this series, the interest was to study mostly T1D patients with no or only mild retinopathy, making the detection of differences in artery dynamics challenging. The response patterns of the T1D patients fell into distinct clusters, indicating that there may be other factors explaining the shape of the curves than T1D.
Heads‐up eye surgery: pros and cons
Authors: Lytvynchuk L.
Published: September 2016

Purpose

To evaluate the use of Heads‐up approach for eye microsurgical procedures.

Methods

The Heads‐up system TrueVision 3D Surgical (Santa Barbara, CA, USA) combined with operating microscope Lumera 700 (Carl Zeiss Meditech, Oberkochen, Germany) was used during the surgeries on anterior and posterior segment of the eye by two experienced surgeons. The time that was necessary for getting used to the heads‐up surgery was assessed. The magnification and the colours on the screen were compared with those seen through the ocular of the microscope. The surgeon's posture using standard oculars and heads‐up system was assessed and compared as well.

Results

The first surgery performed by each surgeon was fully done with he use of heads‐up system. The duration of the first 2 surgeries was approximately 15–20 min longer comparing to the standard approach. The duration of every next surgery was shorter and finally on the 5th surgery didn't differ from the one done with standard approach. The colours on the 3D display were different from those seen through the oculars, but it was possible to do the digital adjustment of the colours. The magnification of the ocular structures with 3D system was bigger comparing to the magnification in standard oculars. The posture of the surgeon was more flexible during the surgeries with 3D system.

Conclusions

New 3D technology allows the surgeon to work with the bigger magnification and in more relaxed position. The colours of the ocular tissues with 3D system differ from the colours seen through the standard oculars, but can be adjusted by the special software. Heads‐up surgery necessitates a learning curve, which is relatively short.
Congenital aniridia: an epidemiological approach on 105 patients
Authors: Salviat F. , Robert M. , Michel S. , Bremond‐Gignac D.
Published: September 2016

Purpose

Aniridia is a rare ocular disorder affecting beside iris, cornea, angle structures, lens and fovea, and possibly associated with other anomalies. This study aims at understanding features of patients with congenital aniridia, identifying the characteristics phenotypes of the disease and its associated anomalies.

Methods

Patients affected by congenital aniridia were prospectively included and clinically examined at two french pediatric reference centers, with local ethics committee approval. Following parameters were assessed: sex ratio, sporadic or familial history, associated eye anomalies (glaucoma, limbal deficiency, cataract).

Results

The study included 105 patients of the 135 registered at Ophtara Rare Disease Center with CEMARA data basis. The median age at last examination were 10 years old (3 days; 75 years) with a 65% rate and a mild female predominance (sex ratio 0.65). All patients had bilateral aniridia, with a remaining iris insertion uni or bilateral in 32 patients (30.5%). Thirty patients had a familial form of aniridia (28.6%). Aniridia was isolated in 94 p. (89.5%), and associated with 7 WAGR syndromes, one WAGRO syndrome, one Gillespie syndrome. Cataract was described in 51 patients (49%) – bi (41%) or unilateral (8%) –, limbal deficiency in 59 p. (56.2%), and glaucoma in 45 p. (42.9%). A mutation of the PAX6 gene was registered in 23 p. (21.9%), with no obvious genotype‐phenotype correlation. In absence of iris insertion, the relative risk of glaucoma was assessed at 1.6 (IC 95% [1.03; 2.58]).

Conclusions

The aniridia phenotype characteristics varies widely. Risk factors for glaucoma/limbal insufficiency have to be better defined by further studies and a standardization of the flow charts clinical elements to collect should provide better insight in further congenital aniridia data collection.
The role of LRG1 in vessel normalization
Authors: Sepetis A. , O'Connor M. , Dowsett L. , Hoeh A. , Gourlaouen M. , Moss S. , Greenwood J.
Published: September 2016

Purpose

In diseases characterized by abnormal neovascularization, the new vessels lack adequate pericyte (PC) coverage. TGFβ is involved in the recruitment of PC through ALK1‐Smad1/5/8 and ALK5‐Smad2/3 signalling. The first signalling pathway inhibits differentiation into mural cells while the latter promotes it. Leucine‐rich α‐2‐glycoprotein 1 (LRG1) is a modulator of TGFβ signalling. By binding to endoglin, LRG1 promotes the ALK1‐Smad1/5/8 signalling pathway. We hypothesized that LRG1 may have an important role in PC recruitment.

Methods

Retinae from Lrg1−/− and WT mice were trypsin‐digested and the endothelial cell (EC)/PC was calculated. The oxygen‐induced retinopathy mouse model was used to assess PC coverage in the neovascular tufts and the leading edge of the revascularization in Lrg1−/− and WT mice. The retinae were stained for the PC markers NG2 and αSMA and the EC marker CD31. NG2/CD31 and αSMA/CD31 ratios were quantified in the above areas. Moreover, metatarsals from mice fetuses were treated with PBS, LRG1 and angiogenic factors either alone or in combination. Then they were stained for NG2 and CD31 and the fraction of CD31 overlapping with NG2 was quantified.

Results

Quantification of EC/PC ratio revealed no difference between the control genotypes. In the neovascular tufts, Lrg1 deletion leads to a higher ratio of NG2+ PC whilst at the leading edge of the revascularization of the avascular region, PC coverage was not affected. In the metatarsals the combination of VEGF + LRG1 leads to significantly lower PC coverage compared to the control.

Conclusions

We demonstrate that under physiological conditions, deficiency of Lrg1 does not alter perivascular coverage. However, during abnormal neovascularization, Lrg1 deficiency seems to lead to increased PC recruitment while exogenous supplementation of LRG1 especially in combination with VEGF decreases it.
Correlation between retinal and mixed venous oxygen saturation
Authors: Van Keer K. , Abegão Pinto L. , Stalmans I. , Vandewalle E.
Published: September 2016

Purpose

To investigate the correlation between mixed venous (SvO2) and retinal vessel (SrO2) oxygen saturation, using non‐invasive spectroscopy in pre‐ and post‐ heart transplant patients.

Methods

Retinal oxygen saturation and vessel caliber were measured in dark‐adapted patients, breathing ambient air in a seated position, using dual wavelength retinal oximetry, within 24 h of a SvO2 sampling during right heart catheterization. Correlations were analyzed using Pearson correlation coefficients and linear regression models.

Results

Twelve patients aged 57.4 ± 18.2 years were analyzed. A strong negative correlation was found between retinal arteriovenous oxygen difference and SvO2 (r = −0.64, p = 0.024), as well as between retinal arterial diameter and time since heart transplantation (r = −0.77, p = 0.009), independent of demographic and systemic parameters.

Conclusions

Retinal oximetry provides a non‐invasive method to visualize and quantify the oxygen saturation of arteries and veins of the central circulatory system. This pilot study provides proof of concept for the use of retinal oximetry in the follow‐up of patients after heart transplantation, to assess cardiac function as well as cardiovascular health.