bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic allergy investigation of patients with red eyes
Authors: MUNK SJ , GARVEY LH , HEEGAARD S , HANSEN KS , SKOV L , ZACHARIAE C , MENNÉ T , JULIAN HO , HALKJÆR LB , JOHANSEN JD
Published: August 2014

Purpose“Red eyes” is a common patient complaint. Determining the underlying cause is often difficult as differential diagnoses are numerous. Allergic causes may be easily overlooked as the diagnosis relies on specialized investigation. We wanted to determine the prevalence of relevant allergy in patients with "red eyes", where initial ophthalmological consultation did not result in a definite diagnosis.

Methods A multidisciplinary cooperation was established between ophthalmologists, allergologists, dermatologists and pediatricians. The investigation algorithm was based on clinical presentation. Patients with eye symptoms only, or eye and skin symptoms, underwent dermatological investigation comprising patch testing with European baseline series, eye drops and skin prick tests with inhalant allergens and the patients' own ophthalmological products. Patients with eye and airway symptoms were reviewed by allergologists and underwent skin prick tests and specific IgE analysis for relevant allergens and lung function tests. Children were reviewed by pediatric allergologists. Multidisciplinary conferences were held regularly and patients were reviewed and cross‐referred if relevant.

Results In total 58 patients (21 males and 37 females) with “red eyes” were included over a one year period. In 21 patients (36%) a relevant allergy was found, diagnosing contact allergy in 15 patients (9 perfume, 3 phenylephrine, 3 others) and IgE‐mediated inhalant allergies in 6 patients. In 37 patients (64%) no allergy was found, and of these 10 patients were diagnosed with rosacea.

Conclusion Multidisciplinary cooperation and systematic investigation resulted in identifying relevant allergy in 36% of patients presenting with “red eyes”.
Postural control and binocular anomalies
Authors: KAPOULA Z , MORIZE A , DANIEL F , ORSSAUD C , JONQUA F , BREMOND GIGNAC D
Published: August 2014

Vergence insufficiency is an extraocular dysfunction screened regularly by ophthalmologists and orthoptists. Incidence increases with screen and computer work, resulting in visual quality and quality of life loss. Clinical diagnosis is based on associated well‐defined criteria (Alvarez 2010, Horwood 2014). Quantification of symptoms reported (Echelle CISS), evaluation of response to disparity stimuli and accommodation in natural spaces, calculation of ratio accommodation/vergence and measure of static performance. These criteria are essentially subjective and break the natural bond of two synergistic systems: convergence and accommodation. In the literature very few studies objectify dysfunction with video‐oculography because most authors induce either angular disparities by artificial haploscopic devices or defocusing. However, restricting the visual examination to each component, the vergence of the one part, and on the other hand accommodation, this analytical fragmentation is not representative of the daily behavior of patients. Indeed, in the natural space simultaneous variations of angles of disparity and focus stimulate and maintain synergy vergence‐accommodation. Therefore, we propose an ecological study of the vergence system by stimulating real space. In the meantime our daily actions seek simultaneously vergence and saccadic eye movements, we also extend the study to the combined movement.
Cavitary retinoblastoma: clinical features and treatment outcome
Authors: HADJISTILIANOU T , DE FRANCESCO S , BORRI M , GALLUZZI P , DELUCA MC , BRACCO S
Published: August 2014

Purpose To describe the ophthalmoscopic features of seven cavitary retinoblastomas and treatment outcome

Methods Patient demographics, tumor characteristics, ultrasounds, OCT and MRI findings and response to treatment (systemic chemotherapy, intrarterial chemotherapy, focal therapy ,external beam radiotherapy)were recorded.

Results Two cases were bilateral, three cases were unilateral. All cases were unifocal. The median age at first observation was 18 months. No vitreous or subretinal seeds were present. Two tumors were treated with systemic CH followed by IA‐CH ; one tumor with systemic CH and radiotherapy; four tumors with IA‐CH.All cases received adjuvant photocoagulation. Globe salvage was achieved in six out of seven cases (85.7%) Three months after treatment the mean reduction in tumor thickness was 19%. During a mean follow‐up of 18 months one case recurred and one gave rise to subretinal seeds.

Conclusion Cavitary retinoblastomas do not show a substantial decrease in size after treatment and do not display dramatic ophthalmoscopic changes.
Unusual lesion of the orbit in a larynx cancer patient
Authors: GRISHINA E
Published: August 2014

Purpose Orbital metastasis is uncommon accounting for 15% of all orbital malignant tumors. Aim. To present an unusual orbital lesion in a larynx cancer patient.

Methods 66‐year‐old male had laryngectomy due to larynx cancer 3 years ago. Histological study revealed squamous cell non‐keratinous carcinoma. Following 3 years, an infiltrate under the orbital roof that provoked recurrent upper eyelid edema, 3‐mm exophthalmos and mild limitation of upward movements was revealed. No larynx cancer recurrence or other organ lesions were detected.

Results Transcutaneous orbitotomy was performed. Intra‐op, living helminth Dirofilaria and its granuloma were removed.

Conclusion In a suspected orbital metastasis, histological verification of the lesion is required.
Mechanical performance of the lens capsule in accommodation
Authors: BURD H
Published: August 2014

The human lens consists of a relatively stiff capsule surrounding a soft lens substance. It is generally understood that an intralenticular pressure exists within the lens. A simple mechanical model, in which the capsule is represented as a fluid‐filled membrane, suggests that any intralenticular pressure will cause bi‐axial tensile stresses to occur in the capsule near the optical axis. In the equatorial region, however, the circumferential stresses in the capsule are found to be compressive. This indicates that wrinkles may occur in this region. Images of isolated human lenses (e.g. Rosen et al. 2006) typically indicate a smooth outline when viewed in the sagittal plane (suggesting that meridional stresses are tensile at all locations). When viewed in the frontal plane, however, wrinkles are typically visible around the equator. These observations are consistent with the simple capsule model. To investigate the influence that capsule wrinkling might have on the accommodation mechanism, a finite element analysis is conducted, of a 29‐year lens, in which equatorial wrinkles are included in the model. The results indicate that equatorial wrinkles have a modest, but significant, influence on the accommodation amplitude.
FRO 2014: Exploring the role of cis‐acting pre‐mRNA splicing dynamics in the pathogenesis and treatment of Stargardt disease
Authors: BAUWENS M , DE BAERE E , LEROY BP
Published: August 2014

To functionally study the effect of cis‐acting splice site mutations of ABCA4 found in Stargardt patients in vitro and in vivo. To increase our insights into the role of pre‐mRNA splicing in the pathogenesis of Stargardt disease. To explore antisense oligonucleotide‐mediated treatment in patient‐derived cells. To uncover novel treatment strategies for Stargardt disease.
Analysis of the vitreomacular interface in a French population‐based study (The MONTRACHET study: Maculopathy, Optic Nerve, nuTRition, neurovAsCular and HEarT diseases)
Authors: BOUCHE‐PILLON J , KOEHRER P , BINQUET C , TZOURIO C , BRON AM , CREUZOT‐GARCHER C
Published: August 2014

Purpose To analyse prevalence and distribution of vitreomacular adhesion (VMA) in a french population over 75 years old within MONTRACHET study.

Methods Three city study (3C) included 9294 subjects aged 65 years or more from three cities (Bordeaux, Dijon and Montpellier) in 1999. After a 10 year follow up, Dijon’s cohort had a complete ophthalmic examination in the MONTRACHET study. Vitreomacular interface (VMI) was analysed with a spectral‐domain OCT. VMA of each patient was classified according to the IVTS (International Vitreomacular Traction Study) criteria, defining the presence of vitreomacular adhesion (VMA), vitreomacular traction (VMT) isolated or associated with a foveal distorsion.

Results One thousand one hundred fifty three subjects were included in the study, the median age was 84 [79‐99] years. Prevalence of vitreomacular adhesion (VMA) was 12.2%. VMA affected both eyes in 28.5% of cases (80 patients). The median size of the diameter of vitreous attachment to the macular surface was 1377 [50‐5639] µm. Attachment was focal (≤1500 ųm) for 52.3% of cases (147 eyes) and broad (>1500 ųm) for 47.7% of cases (134 eyes). Prevalence of isolated VMT was 0.9% (22 eyes) and was focal (<1500 µm) for all cases. Prevalence of lamellar holes was 0.6% (13 eyes) and macular pseudoholes was 0.2% (4 eyes). Prevalence of full‐thickness macular hole was 0.01% (2 eyes). ARMD (Age Related Macular Degeneration) was associated with VMA in 4 eyes (2.49%).

Conclusion The analysis of vitreomacular interface (VMI) is interesting due to the emergence of enzymatic vitreolysis. These results provide new data in old population over 75.
Cystoid macular edema after epiretinal membrane surgery: Incidence, risk factors and evolution with treatments
Authors: LEROY B , CONART JB , SELTON J , HUBERT I , ANGIOI K , BERROD JP
Published: August 2014

Purpose To report the incidence, the risk factors and the evolution after treatment of cystoid macular edema (CME) complicating epiretinal membrane (ERM) surgery.

Methods This study included 647 consecutive patients with ERM operated by 23‐gauge parsplana vitrectomy between January 2011 and July 2013. Combined phacoemulsification of the lens was performed in 71% of cases. Patients were considered as having a CME if they presented augmentation of central macular thickness with presence of cysts on OCT scans in the first year after surgery. Patients with history of retinal detachment, vein occlusion, uveitis, diabetic macular edema or neovascular AMD were excluded.

Results The incidence of CME was 2.6% (16/605) occurring within an average time of 129 ± 101 days. Predictive factors were the presence of preoperative CME on OCT scans (p=0.04) and preoperative prostaglandin use (p=0.02). Combined phacoemulsification was not identified as a risk factor. Treatment consisted in topical applications of non‐steroidal anti‐inflammatory drugs (NSAIDs) associated with dexamethasone and/or acetazolamide for a mean duration of 4 months. Intravitreal or subconjonctival corticoids injections were performed in 6 patients. A two‐line or more improvement in visual acuity was achieved respectively in 6 of 14 (43%) and 4 of 6 patients (67%). A dissipation of cysts on OCT scans was observed respectively in 4 of 14 (29%) and in 5 of 6 patients (83%).

Conclusion The incidence of CME after ERM surgery was 2.6%. Preoperative prostaglandin use and preoperative CME were associated with an increased risk of postoperative CME. Treatment with NSAIDs was effective in about one third of patients, corticoids injections in 5 of 6 patients.
Emerging evidence for the role of mitochondria in glaucoma
Authors: GARWAY‐HEATH D
Published: August 2014

Abstract not provided
Brain pressure and glaucomatous and non‐glaucomatous parameters
Authors: JONAS J
Published: August 2014

Eyes with normal‐pressure glaucoma and eyes with high‐pressure glaucoma show a similar optic disc appearance with marked differences to eyes with vascular optic neuropathies. Non‐vascular, potentially barotraumatic, factors in addition to intraocular pressure (IOP) may thus play a role in glaucoma. Recent studies showed that (1) cerebrospinal fluid pressure (CSFP), arterial blood pressure and IOP are correlated with each other; (2) higher CSFP is associated with younger age, higher blood pressure and higher body mass index; (3) some patients with normal‐(ÍOP)‐pressure glaucoma have abnormally low CSFP, and thus an abnormally high trans‐lamina cribrosa pressure difference, and a small orbital CSF‐space; (4) the orbital CSF‐space width is associated with CSFP; and (5) the estimated CSFP as compared to IOP correlated better with open‐angle glaucoma‐related parameters. The orbital CSFP as counter‐pressure against IOP may play a role in pathogenesis of glaucoma.
Ultrathin DSAEK vs. Conventional DSAEK: Results from a Dutch multicentre randomised clinical trial
Authors: NUIJTS R , DICKMAN MM , VAN DEN BIGGELAAR FJHM , BERENDSCHOT TTJM , VAN ROOIJ J , REMEIJER L , VAN DER LELIJ G , WIJDH RJH , VAN MARION FW
Published: August 2014

The Dutch Ultra‐Thin DSAEK study is a multicenter randomized controlled study comparing the effectiveness and cost‐effectiveness of precut ultra‐thin (<100 m) DSAEK with standard thickness DSAEK. Fifty‐eight adult patients with Fuchs endothelial dystrophy and no other visual limiting comorbidities were randomized to either ultra‐thin or standard DSAEK in four tertiary medical centers in The Netherlands. Preliminary (6 months follow‐up) outcomes, including: ETDRS best corrected visual acuity, refractive and topographic astigmatism, endothelial cell density, contrast sensitivity, straylight, complication profile, quality of life and vision related quality of life will be presented.
Semi‐automated quantification of the parafoveal capillary network in diabetic subjects
Authors: KAPSALA Z , PALLIKARIS A , MOSCHANDREAS J , TSILIMBARIS MK
Published: August 2014

Purpose The detection and quantification of the parafoveal capillary network in diabetic subjects using a novel semi‐automated computerized method.

Methods Using the MatLab R2011a we developed an algorithm that detects automatically the parafoveal capillary bed in fluorescein angiography (FA) images. The detection starts after delineating manually the foveal avascular zone (FAZ) in a cropped 1500μm subimage and hence excluding this area from the process. The algorithm calculates the capillary density in a 1000μm area measured from the centroid of the FAZ. The method was applied on high resolution FA images from 49 subjects (age=43±19years); 13 controls, 13 subjects with diabetes mellitus (type I or II) without diabetic retinopathy (DR) findings (no DR), 15 subjects with non‐proliferative DR (NPDR) and 8 subjects with proliferative DR (PDR). Using the statistical software SPSS (version 20) we assessed the mean capillary density for the mentioned subject groups.

Results Capillary density in the mentioned area was found 0.86±0.17, 1.01±0.22, 0.67±0.25 and 0.76±0.30 degrees‐1 for the studied groups, respectively (p=0.003). The no DR group did not differ significantly from the controls and the only statistically significant differences were those between the following three groups; control‐NPDR, no DR‐NPDR and no DR‐PDR.

Conclusion This semi‐automated algorithm could serve as a potential tool for detecting, classifying and monitoring automatically capillary abnormalities in this area. Our preliminary results indicate that the capillary density in the central 1000μm area varies among different DR stages. However, a larger sample is required to confirm these initial data.
FRO 2014: using targeted next‐generation sequencing to identify genes underlying keratoconus
Authors: VALGAEREN H
Published: August 2014

This project is part of a larger PhD project which aims to unravel the molecular pathology of keratoconus (KC). During the first part of my PhD, the focus was placed on the identification of genes that underlie KC. Using whole exome sequencing of large KC families, 8 genes were identified that might be implicated in the disease pathogenicity. In this project, we will further establish the (causative) role of these genes in KC. We will develop a gene panel that will be screened in a population of approximately 750 KC patients and 750 ethnically‐matched healthy individuals using next‐generation sequencing (NGS). The comparison between both groups will allow identification of genes that are frequently mutated in KC patients. As these genes most likely play a role in the pathogenesis, identification of causative genes and their functional role in biochemical pathways will allow us to unravel the biochemical background of the disease, and form the basis for potential new forms of therapy.
Validation of a novel device to easy the preparation of endothelial graft for DMEK
Authors: MURAINE M , HE Z , TOUBEAU D , GUEUDRY J , THURET G , LEFEVRE S , GAIN P
Published: August 2014

Purpose The DMEK is the only technique for endothelial graft without interface. It is however difficult to perform, especially the preparation of the graft. We present in this study a new simple device facilitating the preparation of grafts for DMEK.

Methods The device, named “Muraine Punch” is a circular trephine with a blade which was open in two places and a guard to 300 micronmeters deep. The blade was pressed against the endothelial surface so as to sever Descemet's membrane and cut part of stroma. The preparation of descemetic graft was then continued on an artificial anterior chamber using a 27 gauge cannula , reversed upwardly corneal endothelium. Three methods of assessing injury of endothelial cells (ECs) were then performed: 1 / conventional measurement of the endothelial cell density (ECD). 2 / laboratory measurement of the viable ECD by image analysis after staining of ECs by alizarin red, followed an counterstaining using Dioc 6 (cytoplasm) and Hoechst (nucleus). 3/ post operatory ECD of 47 patients.

Results Histological analysis confirmed this “Muraine technique” offered a pure Descemet membrane grafts for DMEK. The ECD analysis showed consistent with that of the grafts for transfixant keratoplasty.

Conclusion The new technique with “Muraine Punch” facilitates the preparation of grafts for DMEK and causes only a minimal cell loss.

Commercial interest
Understanding and managing steroid induced elevation of IOP
Authors: GONI F
Published: August 2014

Abstract not provided
European early experience
Authors: AUGUSTIN A
Published: August 2014

Abstract not provided
Development of new anti‐VEGF drug by SRPK1 inhibitor screening
Authors: MOROOKA S , OKUNO Y , HOSOYA T , HAGIWARA M , YOSHIMURA N
Published: August 2014

Purpose AMD is a major cause of blindness. Current therapy aims to suppress VEGF levels in order to prevent CNV, which causes AMD. Recently we found that SRPIN340, a specific inhibitor of SR protein kinase 1 (SRPK1) which phosphorylates Serine‐arginine‐rich (SR) proteins and regulates splicing and transcription, suppressed the expression of VEGF and CNV. Here we screened for more active SRPK1 inhibitors which suppressed CNV effectively than SRPIN340.

Methods In‐silico screening; Structure‐based virtual screening (SBVS) was applied against the general chemical library, which include 71955 compounds. In vitro kinase assay; The reaction mixture was incubated at 30 °C for 15 min and detected the residual ATP was measured by Kinase Glow following the manufacturer’s instruction. VEGF ELISA; We added 10μM compounds or control to ARPE‐19 cells. The medium was collected 72 hours after the addition of the compounds. We evaluated the VEGF protein level in the culture medium by ELISA with manufacturer’s instruction. In vivo examination; The compound was intravitreally injected to laser CNV model mice immediately after laser photocoagulation. Seven days after laser injury, the mice were perfused with 1mL of 0.5% FITC‐labeled dextran. Flat mounts of RPE‐choroid complex were obtained and the area of CNV was measured by fluorescence microscopy.

Results 11994 compounds were selected by SBVS, and we were able to obtain 9535 compounds among them. Next we screened by in vitro kinase assay and selected four compunds, which were named SRPIN801‐804. SRPIN(03 decreased the VEGF protein levels most effectively as measured by VEGF ELISA, and suppressed CNV growth in a dose‐dependent manner.

Conclusion We obtained a new anti‐VEGF drug, which inhibits SRPK1 kinase acitivity.
Rapamycin down‐regulates REDD1 to blunt cell death: a potential way to maintain retinal ganglion cell function as in glaucoma
Authors: DEL OLMO AGUADO S , NÚÑEZ ÄLVAREZ C , OSBORNE NN
Published: August 2014

Purpose Determine whether REDD1 is present the retina and located to retinal ganglion cells (RGCs). Moreover, to deduce whether siRNA silencing of REDD1 synthesis and/or rapamycin counteract insults to cells in culture.

Methods Western blot, quantitative PCR and immunohistochemistry were used to show the presence and localisation of REDD1 in the rat retina and RGC‐5 cells (a cell line derived from the retina). REDD1 was down‐regulated in RGC‐5 cells by gene silencing (siRNA) methodology. RGC‐5 cells where REDD1 was silenced or not were subjected to insults of either cobalt chloride (CoCl2) or blue light, for defined times.

Results REDD1 is present in the rat retina. Moreover, REDD1‐immunoreactivity is located to different retinal cell‐types but intensely concentrated to a many but not all RGCs. REDD1 is also present in the cytoplasm of RGC‐5 cells and appears not to particularly locate in mitochondria. CoCl2 or blue light insults to RGC‐5 cells resulted in cell death and an up‐regulation of REDD1. Loss of cell viability was significantly nullified in RGC‐5 cells exposed to rapamycin or where REDD1 was silenced. Moreover, rapamycin was not toxic to RGC‐5 cells even at high concentrations.

Conclusion Evidence is provided to suggest that rapamycin can down regulate REDD1, part of the mTOR complex receptor mechanism. It is concluded that REDD1, present in RGCs, is activated when insulted as in glaucoma and that this process can be attenuated by use of rapamycin.
Macular Bruch's membrane defects in Hi
Authors: JONAS J , YOU Q , PENG XY , XU L , WEI WB , WANG Y , CHEN CX
Published: August 2014

Purpose To examine prevalence and associations of macular Bruch's membrane defects (MBMDs) in a population‐based setting.

Methods The Beijing Eye Study 2011 included 3468 subjects with an age of 50+ years. MBMDs were defined as an interruption of Bruch´s membrane on the OCT images in the macular region.

Results MBMDs could be detected only in highly myopic eyes (≤‐6 diopters or axial length of ≥26.5 mm). Prevalence of MBMDs in the highly myopic group was 17/164 (10.4±2.4%). Mean axial length of eyes with MBMD was 29.6±0.3 mm. Best corrected visual acuity of <0.05 was found in 5 (29%) out of 17 eyes with MBMDs, and in 7 (41%) eyes, visual acuity was <0.3 and ≥0.05. In the MBMD region, RPE and choriocapillaris were completely lost, and the deep and middle layers of the retina and the choroid were almost completely absent. In the MBMD region, mean retinal thickness was 153±57μm (range 20‐234μm) and choroidal thickness was 12.7±28.1μm (range 0‐88μm). On the fundus photographs, MBMDs appeared as whitish areas with round borders and without signs of RPE and choroid except of large choroidal vessels. In multivariate regression analysis, presence of MBMD was significantly associated only with longer axial length (P=0.002; Odds ratio: 3.87; 95% confidence interval: 1.64, 9.14).

Conclusion MBMDs with a prevalence of about 10% in highly myopic eyes are associated with a complete loss of RPE and choriocapillaris, an almost complete loss of photoreceptors and choroid, and marked reduction in visual acuity. Characterized by a whitish fundus lesion with round borders, MBMDs can be differentiated from a chorioretinal atrophic lesion with Bruch´s membrane present. MBMDs may be added to the panoply of features of myopic maculopathy.
Performance characteristics of multicolor versus blue light and infrared imaging in the identification of reticular pseudodrusen
Authors: AL MUHTASEB H , BADAL J , BIARNÉS M , MONÉS J
Published: August 2014

Purpose To describe the appearance of reticular pseudodrusen (RPD) on multicolor imaging (MC) and to evaluate its diagnostic accuracy as compared with the two modalities considered the current reference standard, blue light (BL) and infrared (IR).

Methods A retrospective study reviewing all multicolor images of a series of consecutive patients. Inclusion criteria involved the presence of > 1 RPD on a 30º x 30º image centered on the fovea as seen with the BL channel derived from the multicolor imaging of the Spectralis HRA+OCT ®. The diagnosis of RPD was confirmed by the identification of subretinal debris on a tracking‐assisted SD OCT Heidelberg. A 3.0 mm diameter circle divided in 4 fields (S, N, I and T) was overlaid on each image and manually centered on the foveola. Three experienced observers, masked to their own results with other imaging modalities, independently classified the number of RPD in each field in each image with each modality, according to this classification: Category 0: 0‐5 RPD ; 1: 6‐20; 2: 21‐35; 3: 36‐49; and 4: >50. Friedman and Wilcoxon tests were used for the comparison between different imaging modalities per field by the same observer. The kappa (K) coefficient was used to measure interobserver agreement

Results MC and IR modalities showed higher sensitivity and interobserver agreement in RPD detection than BL. No clinically significant differences were found between multicolor and IR.

Conclusion Multicolor imaging modality (the new index test) can play an important role in the identification, quantification and categorization of RPD when compared to the reference standard test (images of BL and IR), a result which is still the subject of much debate.
Prognostic factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy: comparative study in the same person
Authors: LEE S , YEOM M , PARK J
Published: August 2014

Purpose To investigate the prognostic factors for neovascularg after vitrectomy in eyes with proliferative diabetic retinopathy.

Methods To evaluate intraindividual, interocular differences, eleven patients(22 eyes) who had undergone pars planavitrectomy for PDR and had only one eye neovascular glaucoma were retrospectively reviewed. They were underwent vitrectomy for PDR between March 2008 and July 2013 at Maryknol hospital.The clinical data on preoperative, intraoperative, and postoperative factors for these patients’s eyes were compared each other. Statistical analysis was performed using the Wilcoxon matched‐pairs signed‐rank (Mann–Whitney) test and Chi‐square test in order to evaluate the significance of differences within the groups of patients.

Results Of the 22 eyes(11 patients), the mean age was 50.64±11.66 years(range27‐69)and the mean follow‐up period was 37±17months. The decrease of photopic b‐waves amplitude on preoperative electroretinogram was significantly correlated with the development of neovascular glaucoma after vitrectomy for PDR.

Conclusion Our findings suggested that the decrease of photopic b‐waves amplitude on preoperative electroretinogram is considered an effective prognostic factorsfor the development of neovascular glaucoma after vitrectomy for PDR.
Complete retinal fluid resorption with low visual acuity in patients with diabetic macular edema (DME) over the course of ranibizumab treatment: OCT analysis
Authors: PENAUD B , GIOCANTI‐AUREGAN A , LEVY O , CHAINE G , FAJNKUCHEN F
Published: August 2014

Purpose Intravitreal ranibizumab injections in DME often leads to resorption of edema. Nevertheless, complete resorption of DME is weakly correlated with good visual acuity (VA). The purpose of our study was to investigate the anatomical OCT features of patients treated with ranibizumab for DME with low VA despite of complete dry retina.

Methods We included in a retrospective fashion all patients over the course of ranibizumab treatment for DME at Avicenne Hospital (Bobigny, France) with a dry retina after treatment (central foveal thickness (CFT) ≤ 250 μm and presence of foveal pit). We analyzed the characteristics of outer retinal layers in spectral‐domain OCT (Optos OCT SLO) in case of low final VA (best‐corrected VA (BCVA) with dry retina < 5/10 after at least 3 injections).

Results We included 40 patients. Complete retinal fluid resorption was achieved for 24 patients (60%). Among these patients, half of them (12 patients ie 30 % of our cohort) had low VA (group 1) and 12 patients had good VA ( group 2). Mean CFT was 713 μm in group 1 (G1) and 666μm (p = 0.64) in group 2 (G2). After treatment, mean CFT in G1 was 165 μm against 174 μm (p = 0.6) in G2. For all patients in G1, anatomical changes were noted on OCT pictures after treatment: loss or thinning of ellipsoid band (n = 6), atrophic cyst (n = 6), exudates (n = 3), epiretinal membrane (n = 2).

Conclusion Insufficient improvement of BCVA after complete retinal fluid resorption happened in about 30% of patients over the course of ranibizumab treatment for DME, and was often associated in our study with alterations of outer retinal layers in SD‐OCT imaging.
Effect of a single intravitreal injection of anti‐VEGF agents on retinal arteriolar caliber in mini pig eyes
Authors: MANGIORIS G , PETROPOULOS I , MENDRINOS E , POURNARAS C
Published: August 2014

Purpose The aim is to investigate the short‐term effect of a single intravitreal bevacizumab, ranibizumab or pegaptanib sodium injection on the retinal arteriolar caliber in minipigs.

Methods 15 eyes received an intravitreal injection: bevacizumab 1,25mg (n=5), ranibizumab 0,5mg (n=5) and pegaptanib sodium 0,3mg (n=5). The diameter of the retinal arterioles was measured in vivo with a Retinal Vessel Analyzer (RVA) every 15 minutes for 2 hours.

Results After the injection of bevacizumab statistical significant vasoconstriction was reached 1h after injection (p< 0.01) and persisted until the end of the measurements (2h). Although there appears to be a trend towards vasoconstriction after ranibizumab injection, analysis of measurements indicate that statistical significance (p<0.05) is reached only 1h 30min following injection. After the injection of pegaptanib sodium injection revealed no vasomotor effect of the substance. (p>0.05)

Conclusion The results suggest that intravitreal injection of anti‐VEGF that blocks all isoforms of VEGF, induces retinal vasoconstriction. Further studies with a larger number of subjects would be helpful in establishing more clearly the effect of intravitreal anti‐vascular endothelial growth factor treatment on retinal vessel diameters.
Assessment of risk factors of age macular degeneration in general population with STARS 2.0 questionnaire
Authors: CREUZOT‐GARCHER C , CHIAMBARETTA F , COHEN SY , KOROBELNIK J , SOUIED E , WEBER M , DELCOURT C
Published: August 2014

Purpose Age‐related Macular Degeneration (AMD) is the leading cause of blindness and visual impairment in industrialized countries.STARS questionnaire was developed as a fast and simple tool for detecting individuals at high risk of AMD. A study performed with first version included more than 12,000 people and confirmed the relevance of different items. Some limits were also noticed and corrected in the present questionnaire named STARS 2.0.

Methods All patients over 55 years examined by eighty French ophthalmologists were included during one week selected at clinicien disctretion between March 2013 and March 2014. AMD risks factors were collected with a statistical weight assigned to each risk factors. A composite score given by the sum of each risk factors was calculated. Fundus examination to detect macular disease was performed in the same time.

Results 6837 Patients with 60% of female were included. 31%, 29.6%, 29.6% and 9.9% of the patients were respectively between [55 and 65] ,[65 and 74], [75 and 85], and over 85. Fundus exam found that 71% of the patient did not suffer from AMD on both sides while 10.3% of the patients presented with an advanced AMD on at least one eye.

Conclusion STARS 2.0 questionnaire can help ophthalmologists to identify AMD risk factors to prevent AMD in clinical practice. It should be used also in general population to detect patients at high risk for AMD.

Commercial interest
Intravitreal ranibizumab for neovascular age­related macular degeneration with a Treat and Extend protocol: anatomical and functional results
Authors: MEILLON C , KOEHRER P , ISAICO R , BONNABEL A , BRON AM , CREUZOT‐GARCHER C
Published: August 2014

Purpose To evaluate the efficacy of the Treat andExtend regimen using intravitreal ranibizumab for neovascular age‐related macular degeneration (nAMD)

Methods A retrospective single‐center study including naive nAMD patients confirmed with a fluorescein and indocyanine green angiography and a macular SD‐OCT. After 3 monthly intravitreal ranibizumab injections, the interval between two injections was sequentially extended or shortened by 2 weeks depending on the presence or the absence of exudative disease with a maximum of 12 weeks. At each visit, an ETDRS VA and a macular SD‐OCT were performed. The functional outcomes were the gain in VA and the proportion of patients gaining at least three lines. The anatomical outcome was central retinal thickness (CRT) on OCT. The secondary outcomes were the number of injections.

Results 111 patients were followed for one year, and 66 of them for two years. At baseline, the median VA was 59 [45‐70] letters and the median CRT was 326 [271‐402] µm. The median VA gain was 9 [2‐17] letters after one year and 10 [2‐23] letters after two years. Almost 30% gained more than three lines after 1 year and 42% after 2 years. The median decrease in CRT was 80 [29‐161] µm and 100 [57‐151] µm after 1 and 2 years, respectively. The median number of injections was 9 [8‐10] after one year and 10 [2‐23] after 2 years.

Conclusion A Tret and Extend regimen with ranibizumab provides good visual outcomes after 1 and 2 years of follow‐up and seems to be an efficient strategy for the treatment of nAMD.
A rare case of Crohn’s disease with papilledema of the optic nerve
Authors: KOEV K
Published: August 2014

Purpose A case of а thirty year old woman is described with Crohn’s disease who presented with ocular symptoms. Crohn's disease is a type of inflammatory bowel disease, resulting in swelling and dysfunction of the intestinal tract.

Methods The patient was examined for visual acuity, Оptical coherence tomography (OCT), automatic computerized perimetry (ACP) and fundoscopy. Except the intestinal manifestations peculiar for Crohn's Disease, in the patient were observed articular, dermatological manifestations (dermatitis and psoriasis of the forehead and the head).

Results The patient examined presented with ocular changes, which is very uncommon with the disease. VOD = 1.0 +0,75 DS VOS = 1.0 +0,75 DS. We observed changes in the course of the conjunctival vessels, tortuosity and a light edema of the vessels. Similar changes were observed in the vessels of the posterior pole of the retina. We observed changes in the papilla of the optic nerve, which are unrecognized in literature. Under the OCT performed, we observed edema in the central areas of the optic nerves, more pronounced in the vascular funnel of the right eye ‐ 534 µm, and less pronounced in the left eye ‐ 356 µm. Under an ACP, we observed changes in the blind spot.

Conclusion Generally, in ophthalmologic aspect, Crohn’s Disease affects episclera, cornea, conjunctiva, iris and uvea. There is presented a rare case of Crohn’s Disease with changes in the papilla of the optic nerve.
Cystoid macular edema and ocular toxocariasis in adult patients
Authors: DESPREAUX R , FARDEAU C , CHAMPION E , BRASNU E , BODAGHI B , LEHOANG P
Published: August 2014

Purpose To report clinical features in proven ocular Toxocariasis in adult patients.

Methods This retrospective study included 14 adults suffering from chronic uveitis whose clinical signs suggested an ocular toxocariasis, secondarely confirmed by semi‐quantitative western blot (WB) in aqueous or vitreous humor. The clinical characteristics and signs of uveitis had been analysed, especially : anterior chamber flare meter measurement, vitreous aspect, presence of retinal granuloma, retinal haemorrhages or cystoid macular edema.

Results We had included 6 women and 8 men. The average age of patients at diagnosis was 45.6 years with an average time of diagnosis of 15.1 months. Uveitis was unilateral. All patients having a vitreous inflammation whose 11 also had a panuveitis. The main clinical signs observed were : one or more active focal deep whitish lesions in retinal periphery (78%), retinal hemorrhages (36%) or vitreoretinal tractions (64%). The main posterior segment complication observed was a chronic macular edema (71%). Patients had been followed during an average of 21.4 months.

Conclusion Ocular toxocariasis could induce chronic unilateral posterior uveitis in adults. The presence of a vitreous cellular inflammation is consistenly found. While whitish peripheral granuloma and vitreoretinal tractions appear very suggestive, a chronic cystoid macular edema is found as main complication. This diagnosis could be delayed in atypical forms so aqueous humor and vitreous sampling for testing toxocariasis by semi‐quantitative WB remains still helpful.
Serous macular detachment of the neuro‐epithelium in patient with tuberculous choroidal granuloma.
Authors: HALFELD FURTADO DE MENDONCA R , DE OLIVEIRA MAIA JR. O
Published: August 2014

Purpose To describe an interesting serous macular detachment of the neuro‐epithelium in a patient with tuberculous choroidal granuloma. Setting : Choroidal tubercles are a common manifestation of ocular tuberculosis and represent a direct mycobacterial infection of the choroid.

Methods A 41 year old man complained of blurred vision in his right eye over the past 5 days. His brother was recently treated for pulmonary tuberculosis. Visual acuity in the right eye was 20/40 and in the left eye 20/20. The intraocular pressure was 12 mmHg in RE and 10 mmHg LE. Fundus examination of the right eye showed an active tuberculous choroidal granuloma. Fundus examination of the left eye was normal. The OCT of the right eye showed a serous macular detachment of the neuro‐epithelium. The tests were positive for tuberculosis.

Results The patient underwent a specific treatment for tuberculosis. At 3‐months follow‐up, the visual acuity in both eyes was 20/20. Fundus examination showed a complete resolution of the tuberculous choroidal granuloma and of the serous macular detachment of the neuro‐epithelium.

Conclusion Ocular tuberculosis may occur in the absence of systemic clinical activity and may mimic several clinical entities. In some cases, the ophthalmologic exams are very important for the early diagnosis to avoid systemic complications.
Immunosuppressive treatment in sympathetic ophthalmia long‐term visual outcome
Authors: HRARAT L , FARDEAU C , LEHOANG P
Published: August 2014

Purpose Sympathetic ophthalmia(OS) is a chronic bilateral recurrent granulomatous pan uveitis following a traumatic or surgical transfixing wound.The aim of the study is to evaluate retrospectively the long‐term visual outcome on various immunosuppressants(IS) used in the OS management

Methods Serial patients with fitting clinical and ancillary data were included in the study.On admission, all patients were treated with a methylprednisolone bolus followed by oral prednisone to 1mg/kg/day,tapered before beginning IS therapy.Three phases have been identified for the collection of various parameters:Admission time,after one and three year under various IS treatments.The primary endpoint is a criterion combining cellular vitreous decrease of 2 marks with steroid dose sparing.

Results 10 eyes of 10 patients with OS were included.After admission time the administrated IS were: Azathioprine(1year N=6 and 3years N=3),Mycophenolate mophetyl(1year N=2),Methotrexate(1year N=1) Interferon alpha2a(1year N=6,3 years N=1).Evaluation of the primary endpoint is success at 1 year under IS:4 with Azathioprine(66%),with Mycophenolate mophetyl(50%),No success with Methotrexate and 6 with Interferon(100%). The mean steroid sparing was 12mg under Interferon,18mg under Azathioprine,20mg under Mycophenolate mophetyl,20mg under Methotrexate.Evaluation of the primary endpoint is Success At 3 years under IS: 3 with Azathioprine(100%)and 1 with Interferon(100%). The mean steroid sparing was 7mg under Azathioprine and 5 mg under Interferon.

Conclusion Interferon alpha2a and Azathioprine appeared the most effective in controlling the disease and in terms of steroid sparing effect.
Intravitreal ranibizumab for the treatment of irvine‐gass syndrome
Authors: CHATZIRALLI I , PARIKAKIS E , PEPONIS V , TSIOTRA V , MITROPOULOS P
Published: August 2014

Purpose The purpose of our study was to evaluate the potential efficacy and safety of intravitreal ranibizumab in patients with pseudophakic cystoid macular edema (CME).

Methods This retrospective study comprised seven eyes with CME treated with intravitreal ranibizumab. Patients were examined at one week, one month after injection and monthly thereafter. Main outcome measures included changes in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety was assessed by ophthalmic examination and report of systemic adverse effects.

Results There was a statistically significant difference on BCVA (p<0.001) and CRT (p<0.001) before and after the ranibizumab injection. One injection appeared to be sufficient for the resolution of CME, while recurrence was observed in one patient, in a long‐term follow‐up. No observable ocular or systemic side‐effects were found.

Conclusion Intravitreal ranibizumab seems to be effective and safe for the treatment of pseudophakic CME, demonstrating a statistically significant difference in BCVA as well as CRT.
Role of SD‐OCT in the diagnosis and management of a late‐onset corneal LASIK flap tear secondary to screwdriver trauma
Authors: ESTEBAN O , RODRIGUEZ NA , ASCASO FJ , SOLANAS S
Published: August 2014

Purpose Traumatic flap displacement is a known possible complication after LASIK. It occurs most commonly in the first 24 h following surgery in approximately 1%‐2% of cases. However, late flap dislocations have also been reported. We present a case of traumatic flap displacement occurring four years after the initial LASIK surgery.

Methods Interventional case report showing the role of spectral domain optical coherence tomography (SD‐OCT) in the management of the LASIK flap dislocation.

Results A 29‐year‐old man presented with blurred vision, photophobia, and pain after trauma to his left eye caused by a screwdriver. He had a history of moderate myopia and had undergone uneventful bilateral LASIK 10 years previously. On examination, he had a 180‐degree traumatic corneal flap dislocation with an inverted tear in the temporal cornea. We performed a precise exploration by SD‐OCT after repositioning the corneal flap and a disposable contact lens, used as a therapeutic bandage, was placed on the cornea. Topical antibiotics and glucocorticoids were administered. One month postoperatively, his previous visual acuity had recovered and the dislodged flap showed an epithelial ingrowth, which did not require removal.

Conclusion Early recognition, precise control by SD‐OCT and reposition the flap along with hydrating the flap together with a contact lens, topical antibiotics and steroids may be a good treatment option. Late traumatic flap dehiscence is a rare complication which demonstrates the vulnerability the flap‐bed stromal interface how a potential zone of weakness for many years following the procedure. Patients should be advised to visit ophthalmologist for injury after LASIK.
Comparison of the lubricant eye drops Optive®, Vismed® and Cationorm® on the corneal healing process in an ex‐vivo model of the anterior ocular segment, the Ex Vivo Eye Irritation Test (EVEIT) System.
Authors: DUTESCU R , PINHEIRO R , PANFIL C , SCHRAGE N
Published: August 2014

Purpose Evaluation of the impact of lubricant eye drops on the corneal healing process and corneal toxicity.

Methods Optive and Cationorm were tested regarding corneal irritability and effect on corneal healing against Vismed and 0.01% benzalkonium chloride (BAK) as negative and positive control. Formulas were applied hourly over 3 days on rabbit corneas cultured on artificial anterior chambers (Ex‐Vivo Eye Irritation Test (EVEIT) system). Five corneae were used for each substance except for BAK (n=1). Initially, four corneal abrasions (2 ‐ 5.4 mm²) were induced. All defects were monitored by fluorescein stains and photographes.

Results Optive and Vismed showed a complete corneal healing on day 2. In one cornea (Optive) erosion reoccurred on day 3. Erosion sizes of Cationorm treated corneae increased significantly from 12.20 mm² to a subtotal erosion of 51.89 mm² on day 3. Histology revealed epithelial loss and severe alterations of the superficial stroma for Cationorm. Glucose and lactate concentrations were about unchanged after application of Optive and Vismed. In contrast, Cationorm and BAK treated cornea showed a significant increase in lactate concentrations.

Conclusion Vismed application led to a rapid corneal healing. Whether the toxicity seen for Optive in one cornea is a valid result should be examined in a long term application study. Cationorm shows considerable corneal toxicity that could be caused by its additive, cetalkonium chloride. Otherwise, Cationorms electrostatic properties lead to a drug film on the area of epithelial loss that could hinders epithelial cell migration and adhesion to heal the lesion.

Commercial interest
Looking at the eyelids of 4884 patients in Germany, Poland and Spain: the MEIBUM* survey
Authors: KAERCHER T , ZAGORSKI Z , BENITEZ DEL CASTILLO JM
Published: August 2014

Purpose To assess the incidence and characteristics of eyelid disorders during ophthalmology consultations.

Methods Multicenter, epidemiological survey implemented in 9 European countries (2012 – 2014). The participating ophthalmologists were asked to include the next 10 patients attending their consultations, whatever the motive of the visit. A 2 page questionnaire recorded: reason for visiting, ocular history, symptoms, examination of eyelids and ocular surface, diagnosis of MGD or Dry eye, impact on daily life, management of eyelid disorders.

Results 4884 patients were analyzed within the 3 first countries; Germany (375), Poland (2584), Spain (1925). Mean age was 57.5. 80% of patients had some ocular history, mainly dry eye (31%). Diagnosis of MGD was established in 55% of patients and dry eye in 64%. The impact of eyelid disorder on daily life was mainly on vision for 60% of the patients, on daily activities/work (57%), on leisure (46%), but also on emotions (22%) and sleep (19%). Eyelid disorders were treated by eyelid hygiene recommendations; warming (42%), cleansing (61%), massage (47%) and eye drops for dry eye (82%). Nutritional supplements were recommended in only 32% of patients. 92% of the patients declared at least one symptom related to ocular surface. Conjunctival hyperemia was found at examination in 62% of patients. Fluorescein staining was positive on conjunctiva in 10% and on cornea (SPK) in 23%.

Conclusion MGD was diagnosed in more than half of the patients with a strong link to dry eye (p‐value<0.001). The impact of eyelid disorders on daily life is notable. Dry eye seems to be taken in charge more often than MGD. This survey highlights the need to take a closer look at the patients’ eyelids.

Commercial interest