bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of iris melanomas with 125 iodine plaque radiotherapy
Authors: FERNANDES BF , KREMA H , FULDA E , PAVLIN CJ , PAYNE DG , MCGOWAN HD , BURNIER MN , SIMPSON ER
Published: November 2010

Purpose The experience with 125Iodine (I125) plaque brachytherapy in the treatment of IM at the Princess Margaret Hospital/University Health Network is the subject of the report to follow.

Methods All cases of IM submitted to I125 plaque radiotherapy were included. Patients' demographic, clinical, management, and follow‐up data were reviewed. Outcome measures included rates of tumor control, eye preservation, systemic metastases, and brachytherapy‐related complications.

Results Fourteen IMs were included in the study. All patients had blue/green irises. Mean largest basal dimension and thickness were 7.1 +/‐ 2.1 mm (range, 4.0 to 11.5 mm) and 2.2 +/‐ 0.8 mm (range, 1.0 to 3.5 mm), respectively. Ten patients (71%) had seeding and 2 (14%) had glaucoma at presentation. Median follow‐up was 26.6 +/‐ 19.5 months (range, 6 to 72 months). Tumor control was achieved in 100% of the cases and no eye was enucleated because of radiation‐induced complications. At last visit, all patients were alive and free of metastasis. Final visual acuity was the same as or better than before treatment in 9 patients (75%). Cataract was the most common complication (8; 75%), followed by persistent glaucoma (2; 17%) and anterior uveitis (1; 8%). No other significant complication was seen during the follow‐up period.

Conclusion Plaque radiotherapy is a safe and effective conservative treatment option for IM, although cataract is a common, yet treatable, complication. This treatment scheme circumvents an intraocular procedure and may avoid the dissemination of malignant cells, and provides a margin of safety in the treatment of clinically undetectable disease.
Lipid profile of Tenon’s capsule in glaucoma patients
Authors: BRON AM , BRETILLON L , GREGOIRE S , ACAR N , CREUZOT C
Published: November 2010

Purpose To provide data on the lipid profile of the Tenon’s capsule in Human glaucomatous eyes and to establish possible relationships with the short term outcome of filtration surgery.

Methods Fragments of Tenon’s capsule were collected during glaucoma surgery in patients suffering from open angle glaucoma (10 trabeculectomies and 17 non penetrating deep sclerectomies). The lipid profile of the human samples was determined by gas chromatography. A successful outcome after glaucoma surgery was defined by an intraocular pressure (IOP) ≤ 15 mmHg at 6 months without any IOP‐lowering agent.

Results We included 27 patients (12 males, 15 females) with a mean age of 65.5 ± 12.1 years. Twenty three surgeries were successful according to our criteria. The percentages of the main fatty acids were as follows: Mean STD Range Arachidonic acid 5.33 3.66 1.00‐14.80 DHA 0.88 0.62 0.28‐2.56 Omega 3 1.86 1.05 0.55‐4.19 Omega 6 18.97 5.94 11.64‐32.89 Omega6/omega3 11.86 3.95 6.99‐23.73 The IOP before and 6 months after the surgery was 20.8 ± 7.1 mm Hg, range [13‐37] and 11.7 ± 3.2 mmHg, range [6‐18] respectively. We did not find any statistically significant correlation between PUFAs content of Tenon’s capsule, IOP at 6 months, delta IOP and surgical outcome.

Conclusion Fatty acid composition of Tenon’s capsule was highly variable among patients. In this small series we failed to identify a specific PUFA profile of Tenon’s capsule as a risk factor for failure of glaucoma surgery.
Outcome of primary trabeculectomy with adjunctive bevacizumab versus 5‐fluorouracil: 24‐month results
Authors: ZARNOWSKI T , JURKOWSKA‐DUDZINSKA J , KOSIOR‐JARECKA E
Published: November 2010

Purpose Purpose. The aim of the study was to compare the effect of bevacizumab and 5‐fluorouracil on the efficacy and safety of trabeculectomy.

Methods Material and methods. Nonrandomized, prospective, interventional case series study was scheduled for 62 patients undergoing primary trabeculectomy in Department of Ophthalmology, Medical University, Lublin, Poland for primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). In group 1 that consisted of 30 patients (21 POAG, 9 PEXG) trabeculectomy with adjunctive 5‐FU was performed (4 min. intraoperative application). In group 2 that consisted of 32 patients (21 POAG, 11 PEXG) trabeculectomy enhanced by subconjunctival bevacizumab application (immediately before and after surgery, 1 and 7 days after surgery) was performed.

Results Results. Mean IOP before 5‐FU‐augmented trabeculectomy was 28.0±8.0 mmHg, and before bevacizumab‐augmented trabeculectomy was 27.8±9.5 mmHg (p=0.96). After 6 months mean IOP was 13.4±4.6 mmHg in the 5‐FU group and 13.7±5.2 mmHg in the bevacizumab group (p=0.39). After 12 months mean IOP was 13.6±4.4 mmHg in the 5‐FU group and 14.7±4.7 mmHg in the bevacizumab group (p=0.96). After 24 months mean IOP in 5‐FU group valued 13.4±3.8 mmHg and in Avastin group 15.0±3.3mmHg (p=0.24). No differences were noted with respect to corneal endothelial density, visual field indices and postoperative complications.

Conclusion Conclusions. 24‐month results comparing the outcome of bevacizumab and 5‐FU augmented trabeculectomy did not show significant difference between the application of bevacizumab and 5‐FU.
Changes in peripapillary blood flow after intraocular pressure reduction
Authors: KURVINEN L , HARJU M , SUOMINEN S , VESTI E
Published: November 2010

Purpose To study retinal blood flow changes after filtration surgery in eyes with normal tension glaucoma (NTG) and exfoliation glaucoma (ExG).

Methods Included were one eye of 18 patients with NTG (median age, range; 63 years, 53‐86 years) and 18 with ExG (72 years, 53‐84 years). Deep sclerectomy was performed on all eyes. Temporal peripapillary retinal blood flow was measured with the Heidelberg Retina Flowmeter before and three months after the operation. Automatic full field perfusion image analysis was used and mean flow (MF), peak systolic flow (SF), and minimum diastolic flow (DF) measured, and pulsation index (PI) calculated.

Results Intraocular pressure was reduced from 16 mmHg (11‐20 mmHg) to 11 mmHg (3‐20 mmHg) in NTG eyes (p<0.001) and from 24 mmHg (16‐32 mmHg) to 13 mmHg (0‐17 mmHg) in ExG eyes (p<0.001). Preoperatively, in NTG eyes MF (160 AU, 105‐259 AU ) and SF (207 AU, 143‐324 AU) were significantly lower compared with ExG eyes (186 AU, 112‐433 AU, p=0.039; and 261 AU, 180‐513 AU, p=0.024). The difference in DF was of borderline significance. Postoperatively, in ExG MF and SF were significantly reduced (157 AU, 111‐227 AU, p= 0.044; and 213 AU, 146‐291 AU, p=0.017). In NTG eyes there was no significant change in flow. The difference in flow between NTG and ExG eyes was no longer significant.

Conclusion A reduced flow in NTG was detected compared with ExG preoperatively. A reduction in IOP resulted in lower peripapillary flow in ExG but no change in flow in NTG.
Deep sclerectomy with and without mitomycin‐C in normal tension glaucoma
Authors: SUOMINEN S , HARJU M , KURVINEN L , IHANAMäKI T , VESTI E
Published: November 2010

Purpose To study the effect of deep sclerectomy (DS) with and without Mitomycin‐C(MMC) on intraocular pressure (IOP) in normal tension glaucoma (NTG) patients.

Methods We prospectively analysed the results of 29 eyes of 29 consecutive NTG patients (mean ±SD age, 62,9 ±7,0 years ) to whom DS was performed. Patients were randomized to the Mitomycin‐C and non‐MMC groups. MMC (0.4 mg/ml for 3 minutes) was used in 12 of 29 eyes.

Results There was a significant reduction from the preoperative IOP (mean, ±SD; 15,5 mmHg, ±2,8) to the postoperative IOP after 12 months follow‐up (11,1, ±2,0 mmHg, p<0,001). In MMC group the mean postoperative IOP after 12 months was 10,3, ±1,9 mmHg and in non‐MMC group 11,7 ±1,9 mmHg. This difference was not statistically significant (p=0,053). Total success, a 25% reduction in IOP without medication, was achieved in 15/29 eyes (7/12 in MMC group and 8/17 in non‐MMC group). At the end of 12 months follow‐up 19 eyes (66%) were without glaucoma medication. Goniopuncture was performed in 19 eyes (66%) and needling in 6 eyes (21%). Complications included loss of two or more snellen lines in visual acuity (6 eyes), microperforation (3), re‐suturation of con‐junctiva (4) and dellen formation (2).

Conclusion Clinically and statistically significant IOP reduction was achieved. There is a trend towards even lower postoperative IOP when MMC is used. DS seems to be effective and safe in reducing IOP during 12 months follow‐up in NTG patients.
The role of LOX and LOXL2 in wound healing after glaucoma filtration surgery
Authors: VAN BERGEN T , VAN DE VEIRE S , VANDEWALLE E , MOONS L , HERMAN J , STALMANS I
Published: November 2010

Purpose Lysyl oxidase (LOX) and lysyl oxidase‐like protein 2 (LOXL2) are involved in the crosslinking of collagen and elastin. We have shown that LOX and LOXL2 were upregulated after glaucoma surgery. The aim of this study was to investigate the efficacy of anti‐LOX (M64) and of anti‐LOXL2 (M20) antibodies (Arresto Biosciences) in a rabbit model of trabeculectomy.

Methods Treatment with the antibodies or control (PBS) was initiated on day 0 after surgery by giving an intracameral injection (0.6 mg) and a subconjunctival (SC) injection (0.3 mg). Thereafter the antibodies were injected twice a week SC (0.3 mg) until 30 days after the surgery. The outcome of the treatment was studied by clinical investigation (IOP, bleb area and bleb survival) and by analysis of angiogenesis (CD31), inflammation (CD45) and collagen deposition (Sirius Red).

Results Both antibodies were able to significantly improve surgical outcome by increasing bleb area and bleb survival compared to control (p<0.001). Analyses of the different stainings showed a significant reduction in angiogenesis (47%; p=0.01), inflammation (34%; p=0.0003) and fibrosis (16%; p=0.01), respectively, in the anti‐LOXL2 treated group compared to control. Anti‐LOX antibody resulted in a significant reduction only in collagen deposition (22%; p=0.0009 compared to control).

Conclusion These results showed that LOX and LOXL2 are important in ocular wound healing. We also provide evidence on effectiveness of repeated anti‐LOXL2 injections after trabeculectomy. The anti‐LOXL2 antibody was able to improve surgical outcome by reducing angiogenesis, as well as inflammation and collagen deposition. These new insights may have important therapeutic implications for glaucoma surgery.

Commercial interest
The importance of fine dust for the development of an environmentally induced dry eye
Authors: RABENSTEINER DF , STURMBAUER K , HORWATH‐WINTER J , SCHMUT O
Published: November 2010

Purpose Environmental conditions promote dry eye by destruction of tear fluid and induction of cell damage. Fine dust is not only present in an urban polluted environment, but also in a cigarette fume or candle light dust loaded home environment. We wanted to determine, if fine dust affects the tear fluid components and conjunctival cells.

Methods Human tear fluid from volunteers was obtained and incubated with fine dust suspensions. Possible tear protein changes were analysed by polyacrylamidegel‐electrophoresis (PAGE). Cultivated human conjunctival cells (CHANG‐cells) were incubated with fine dust suspensions as well as exposed to ultraviolet light (UV‐A). Cytomorphological changes and cell vitality were analysed via CASY1 Cell Counter and MTS‐assay.

Results Fine dust suspensions destroy tear fluid proteins, particularly in combination with UV‐A‐light irradiation. Moreover, the incubation of human conjunctival cells with fine dust suspensions leads to a statistically significant decrease of cell vitality, depending on the fine dust concentration and incubation period. Additional UV‐A‐irradiation induces a further reduction of cell vitality.

Conclusion Due to the alterations of human tear proteins and conjunctival cells caused by fine dust and exaggerated by UV‐A‐irradiation, fine dust can also be responsible for the development of an environmentally induced dry eye.
Traumatic optic neuropathy: diagnosis and management
Authors: CARTA A
Published: November 2010

Abstract not provided
Traumatic chiasmal and retrochiasmal dysfunction
Authors: BORRUAT FX
Published: November 2010

Chiasmal or retrochiasmal dysfunction can result from head trauma. Usually it is associated with a violent trauma such as car accident or fall from several meters. Their incidence is low but may be underdiagnosed. The frequency, the mechanisms, and the clinical presentations of such traumatic visual loss will be reviewed in this presentation.
Post‐traumatic oculomotor disorders
Authors: EGGENBERGER E
Published: November 2010

Trauma is a common ocular motor pathophysiology with a predilection for younger patients. Although afferent visual dysfunction is well known following trauma, the efferent conditions are perhaps less familiar. Trauma has a predilection to produce diplopia, and this may result from muscle, cranial nerve, nuclear, internucelar or supranuclear means. Orbital trauma commonly affects the extraocular muscles with signs to include proptosis and orbital bony abnormalities. CN4 is the most common ocular motor palsy post‐trauma, perhaps due to its long course around the midbrain; CN3 or 6 palsies are well know following trauma but often require more severe trauma than CN4 palsies. Supranuclear ocular motor dysfunction is common after trauma (e.g., skew deviation). Oscillopsia has been reported post‐trauma, most commonly related to vestibular ocular reflex abnormalities or nystagmus.
Post‐concussive syndrome
Authors: PURVIN V
Published: November 2010

Purpose Over 85% of traumatic brain injuries (TBI) are considered “mild”, also referred to as “concussion”. Mild TBI is increasingly recognized as an important public health problem. Despite their designation as “mild”, adverse outcomes from such injuries are significant, with 25% of patients still impaired at one year. Visual difficulties are common, reported by two‐thirds of patients in a Veterans Administration study.

Methods Visual symptoms of mild TBI typically include blurring, light sensitivity, eyestrain, difficulty with near focus, trouble tracking, seeing haloes around lights, and diplopia (monocular and binocular).

Results Despite the high incidence of visual symptoms, results of standard eye examination and neuro‐ophthalmic testing are typically normal. Conventional neuro‐imaging also fails to demonstrate objective evidence of neurologic dysfunction in most cases. Recent developments in neuroimaging (particularly diffusion tensor imaging) and serologic testing (S‐100B) have provided some correlates of such injury.

Conclusion New information from neuroimaging and serologic testing has helped to provide some objective markers for post‐concussive syndromes. The diagnosis of such post‐traumatic syndromes remains largely clinical.
Post keratoplasty glaucoma management: retrospective study
Authors: IBANEZ ALPERTE J , PEREZ GARCIA D , CHACON VALLES M , BROTO MANGUES MA , LORAS ALEGRE E , CRISTOBAL BESCOS JA
Published: November 2010

Purpose To realize a retrospective study on the glaucoma post keratoplasty glaucoma Between 20‐30% of patients undergoing a cornea transplant, require medical or surgical treatment, antihypertensive.

Methods A retrospective study of 50 penetrating keratoplasty. The variables analyzed included etiology of graft, control intraocular pressure (IOP) per week, 1, 3, 6 months and one year after surgery, number and type of treatments, and patient gonioscopic study.

Results The most common etiology implicated as a cause of keratoplasty was bullous keratopathy (50%), followed by herpes (15%). Triple procedure was performed in 50% (25 cases) followed by keratoplasty simple 30% (15 cases). In 60% of cases there normotensional behavior at 8 months follow‐up, showing the 12% of patients, an associated hypotensive treatment and in 6% the use of implants for blood pressure control valve.

Conclusion The triple procedure is shown as the safest, with a good blood pressure control per year, using the topical betobloqueantes use as first choice therapy. In refractory cases, the use of drainage systems, achieves blood pressure control in most of our cases.
Dry eye disease secondary to bacterial, fungal or acanthamoeba keratitis
Authors: SAUER A , M'GARRECH M , LABETOULLE M , BOURCIER T
Published: November 2010

Purpose To characterize dry eye disease after severe unilateral infectious (non‐viral) keratitis.

Methods Tear break‐up time (BUT), Schirmer I test, Ocular surface disease index (OSDI) and Tear film osmolarity by means of Tearlab* (Tearlab, San Diego, CA, USA) were collected in patients admitted for severe unilateral non‐viral infectious keratitis in Ophthalmology departments of Strasbourg and Paris‐Bicetre university hospitals (France) between January and May 2010. All of these data were collected in both eyes (infected eye and non‐infected controlateral eye as a control) at least 3 month after the beginning corneal infection and 1 month after the end of topical treatment. Severity of infection was defined as a large (> 2 mm) and/or a deep corneal infiltrates (> 50% thickness).

Results 21 patients (9 men, 12 women) were followed during the study. Mean age was 37 year‐old (range 19‐64). Bacteria, fungi and acanthamoeba were involved as pathogenic agents in 16, 3 and 2 cases respectively. The mean score of OSDI was 5.94+/‐3.83 in infected eyes and 2.17+/‐2.28 in control (non‐infected) eyes (p=0.0017). Tear osmolarity as 290.67+/‐7.56 mOsm/L in infected eyes as compared to 300.71+/‐6.40 in control eyes whereas tear BUT and Schirmer test were also significantly decreased in infected eye (p<0.001 p=0.0023 and 0.0011 respectively).

Conclusion Secondary dry eye disease is a common finding after severe corneal infection. However, decreased tear film osmolarity has been observed in all patients. These results are in contradiction with increased tear osmolarity reported in primary mild to moderate dry eye disease. Prolonged inflammation and subsequent destruction of resident cells of the conjunctiva and lacrimal glands could be hypothetized.
Clinical and histological reversibility of intracorneal ring segment surgery: final results
Authors: IBARES FRIAS L , GALLEGO P , MARTINEZ‐GARCIA C , CANTALAPIEDRA R , BLANCO T , MERAYO‐LLOVES J
Published: November 2010

Purpose To evaluate the reversibility of the clinical and histological changes induced in the corneas of an animal model after removing intracorneal ring segment (ICRS).

Methods We performed surgery for this study in 30 eyes (15 hens) of an experimental animal model of ICRS surgery(Ferrara technique) previously described by us. The animals were randomized in 5 groups, in all of them, we implanted one segment in each eye and was removed in 3 months. Each Group was processed at different time points for clinical and histological analysis,7 days (first group)15 days (second group), 1 month (third group), 2 months (fourth group), and 3 months( fifth group). For histological analysis hematoxilin eosine and Masson Trichromic stains were made. Clinical evaluation was made with a surgical microscope.

Results Explantation was performed correctly in all cases, no complications were found. Histological analysis:At 7 days we observed hipercelularity and abnormal conformation of the collagen fibres, which at 15 days change to normal, with persistente of the hipercelularity.Later, at 3 months the hipercelularity decreased to normal values similar to preoperative. As regards clinical evaluation:in the first weeks we observed deposits of cells and a moderate degree of corneal opacity( haze) around the space where the ICRS was implanted, signs which decreased progressively. At 3 months neither deposits of cells nor corneal opacity were found.

Conclusion ICRS are safety explanted from non‐pathologic corneas of an experimental animal model.Most of the clinical and histological findings returned to near preimplantation levels.
Does VEGF polymorphism play a role in the treatment success with VEGF inhibitors in patients with CNV?
Authors: BOLTZ A , WEIGERT G , GARHOFER G , JONAS JB , SCHMETTERER L
Published: November 2010

Purpose Along with risk factors like smoking, hypertension, atherosclerosis, and low choroidal blood flow, genetic susceptibility is a primary contributor to the development and progression of wet age‐related macular degeneration (AMD). Vascular endothelial growth factor (VEGF) is a central angiogenic regulator and there is general agreement now that it is one of the most important triggers for the progression of neovascular AMD. In the present study we tested the hypothesis that VEGF gene polymorphisms play a role in the treatment success with VEGF inhibitors in patients with CNV.

Methods One‐hundred‐sixty‐two eyes of 143 patients with neovascular AMD who were scheduled for their first treatment with intravitreally administered ranibizumab were included in this trial. All patients were aged over 50 years and had angiographically verified neovascular AMD. Blood from the finger pad was collected on blood cards for genotyping for the VEGF polymorphisms rs1413711, rs3025039, rs2010963, rs833061, rs699947, rs3024997 and rs1005230. At each follow up visit, visual acuity was reassessed and an ophthalmic examination was carried out. The number of retreatments as well as the visual acuity outcome was analyzed in dependence of the VEGF polymorphisms.

Results The included patients were reinjected with ranibizumab 2 to 19 times, resulting in a total treatment period of 42 to 1182 days. Neither the number of retreatments nor the visual acuity outcome was associated with any of the studied haplotypes.

Conclusion The success of anti VEGF treatment is not dependent on VEGF gene polymorphisms.
Prevalence and prospective risk factors for age‐related macular degeneration: The Bristol Speedwell cohort, UK
Authors: NGAI LY , STOCKS N , SPARROW J , PATEL R , RUMLEY A , LOWE G , DAVEY SMITH G , BEN‐SHLOMO Y
Published: November 2010

Purpose Age‐related macular degeneration (AMD) is a progressive eye disease, with a pre‐clinical stage of age‐related maculopathy (ARM), and is the leading cause of blindness in the Western world. This study aimed to determine the population prevalence in a representative group of men (65‐83 years) and identify prospective risk factors for ARM/AMD.

Methods 2348 men (45‐63 years from Speedwell, Bristol) were enlisted into a cohort study in 1979. At phase V (mean of 17.9 years follow‐up) they had retinal photographs taken which were assessed using the Wisconsin Age‐related Maculopathy Grading System.

Results Data were obtained on 934 men from a potentially eligible sample of 1394 (67%). Early ARM was found in 9.2% of all men and late ARM in 0.5%; the rates increased with age. Baseline risk factors collected in 1979 that were associated with increased risk of AMD (ARM stage 2‐4) seen in 1997 were: diastolic blood pressure, C‐reactive protein, and increased consumption of lard, oils and fats whilst triglycerides were associated with a reduced risk. In multivariable analyses, elevated mean arterial pressure (OR per z‐score 1.37, 95% CI 1.04, 1.79) and fat consumption were significant predictors of increased risk, whilst triglycerides had reduced risk (OR 0.68, 95% CI 0.47, 0.99).

Conclusion Whilst the prevalence of AMD was only 0.5%, almost 10% of elderly men in this UK sample were at high risk of developing AMD over the next 5 years. Our observation that elevated triglycerides is associated with reduced risk, if replicated, may provide insights into pathophysiological pathways. Early detection and possible risk factor modification should be explored to prevent ARM progression and blindness.
Evidence for the efficacy of PlGF inhibition in age‐related macular degeneration
Authors: VAN DE VEIRE S , CARMELIET P , VAN BERGEN T , MOONS L , STALMANS I
Published: November 2010

Purpose We previously showed that an anti‐PlGF antibody (5D11D4) inhibits choroidal neovascularization (CNV) in a mouse model of AMD. An additive effect was shown in combination therapy with an anti‐VEGFR antibody. Specificity of 5D11D4 was assessed in this study.

Methods CNV was induced in mice by placing 3 laser burns on the choroid. Mice with a PlGF deficiency or a lacking tyrosin kinase domain of the Flt‐1R or with a knock‐down of the monocyte chemoattractive protein were generated. The optimal dose of 25mg/kg of 5D11D4 was injected in all mice ip. 3 times a week.

Results In a first experiment, loss of PlGF inhibited CNV. However, administration of 5D11D4 to PlGF‐/‐ mice did not inhibit CNV further than in control‐treated PlGF‐/‐ mice, indicating that 5D11D4 did not have off‐target effects. Second, Ccl2‐/‐ mice developed a CNV lesion that was slightly larger than in WT mice within 14 days after laser‐injury. Notably, 5D11D4 was able to inhibit CNV again by 53%. Third, we investigated whether PlGF signaling works specifically through Flt1 in CNV. FITC‐dextran perfused flatmounts revealed that CNV lesions were indeed reduced by 70% in Flt1‐TK‐/‐ mice, comparably as observed in PlGF‐/‐ mice. 5D11D4 was unable to inhibit CNV in Flt1‐TK‐/‐ mice any further. Fourth, we also tested the murine anti‐human PlGF mAb 16D3 in humanized PlGF‐/‐ mice. Human PlGF‐2 increased laser‐induced CNV after 5 days, but this increase was again blocked by 16D3. And finally, of two other anti‐mPlGF mAbs, 3C7A8 and 12H6B6, the first one inhibited CNV, while 12H6B6 was ineffective

Conclusion We have proven that 5D11D4 specifically inhibits laser‐induced CNV formation, in different transgenic models and that this effect is mediated via the Flt1 receptor.
Efficacy of photodynamic therapy associated with intravitreal triamcinolone to treat subfoveal choroidal neovascularization secondary to age related macular degeneration (VERTA study)
Authors: MONTERO MORENO JA , RUIZ MORENO JM
Published: November 2010

Purpose To report the efficacy of photodynamic therapy with Visudyne (PDT) associated with two different concentrations of intravitreal triamcinolone (TA) to treat subfoveal choroidal neovascularization (CNV) secondary to age related macular degeneration (AMD).

Methods Prospective, controlled, randomized, multicenter, phase IIIb clinical trial. Fifty five eyes from 55 patients presenting CNV secondary to AMD were randomized to be treated by PDT as monotherapy, PDT associated with 4mg TA or PDT associated with 20mg TA. Primary outcome measure was the average change in visual acuity at one year. Secondary outcome measures were the proportion of patients with severe vision loss (≥15 letters) at one year, the proportion of patients with moderate vision loss (<15 letters) and CNV activity as determined by fluorescein angiography at three month intervals, and the appearance of side effects.

Results No statistically significant differences were observed for the average change in visual acuity and for the proportion of patients with severe vision loss at one year. The proportion of patients with moderate vision loss was higher among patients treated by PDT combined with 4mg TA at 3 and 6 months. The most frequent adverse events were increased intraocular pressure and retinal pigment epithelium detachment.

Conclusion Combined treatment PDT‐4mg TA may increase the proportion of patients with moderate vision loss at month 3 and 6 compared with PDT monotherapy and combined PDT‐20mg TA.
Evolution of visual acuity in patients with wet type of AMD and good initial visual aquity
Authors: PATERAKI O , CHALKIA A , ELEFTHERIADOU M , PAPADAKI TH , TSILIMBARIS MK
Published: November 2010

Purpose The evaluation of wet type of AMD after intravitreal injections with anti‐angiogenic factors in patients with good initial visual aquity. Correlation between final and initial visual acuity, as well as with the number of injections

Methods 101 patients of average age 76 participated in the study. All of them suffered from wet type of AMD. Study group included 24 of them with good initial visual acuity, defined as visual acuity of 6/10 of the decimal scale or higher. The remaining 77 patients served as control group. The initial evaluation included full ophthalmologic examination, OCT imaging and fluorescein angiography. The decision for the treatment was based on the findings of the first examination and of the monthly reevaluation thereafter.

Results In the 24 patients of the study group, visual acuity increased significantly from 0,61 (+/‐0,2) to 0,82 (+/‐0,2) in decimal scale or from 0,27 (+/‐0,22) to 0,14 (+/‐0,2) in LOGMAR scale (p<0,001). The average number of intravitreal injections was 4,9 in a mean monitoring time of 9 months. In this team the final visual acuity depends on the initial one (p= 0,013), but not on the number of intravitreal injections (p> 0,05).

Conclusion the final visual acuity in the group with good initial visual acuity correlates well with the initial visual acuity and does not correlate with the number of injections. This finding shows the significance of early diagnosis of subretinal neovascularisation in AMD, when the vision is still high.
Pathophysiology of dry eye syndrome
Authors: HORWATH‐WINTER J
Published: November 2010

Dry eye or dysfunctional tear syndrome is a highly prevalent disease worldwide. It is related to a pathological condition of anyone of the parts of the “ocular surface system” that involves the cornea, conjunctiva, lacrimal gland, accessory lacrimal glands, nasolacrimal duct and the lids with the meibomian glands. These are linked as a functional system by innervation, the endocrine and immune system. Endogenous or exogenous caused alterations in one or several components of the ocular surface system or its secretions result in changes of the tear film or ocular surface provoking inflammation. With time, inflammatory reactions may lead to corneal neuropathy compromising the reflex response of the lacrimal glands. Additionally a self‐perpetuating vicious circle with loss of function and damage can be initiated also by an immune‐modulated inflammation.
A comparison of the effect on the keratocyte population of mechanical vs femtosecond‐assisted LASIK
Authors: CANADAS SUAREZ P , DRAKE P , HERNÁNDEZ‐VERDEJO JL , DE BENITO‐LLOPIS L , TEUS MA
Published: November 2010

Purpose To analyze the changes in the corneal keratocyte population three months after mechanical (M‐Lasik) versus femtosecond‐assisted (FS‐Lasik) laser in situ keratomileusis

Methods This study included 22 eyes treated with M‐Lasik to correct a mean refractive error of ‐2,3+1,1 D sphere and ‐0,9+0,4 D cylinder, and 23 eyes treated with FS‐Lasik to correct a mean refractive error of ‐3,2+2,2 D sphere and ‐0,8+‐0,7 D cylinder. Both groups were compared with a control group comprised of healthy eyes. Corneas were examined using confocal microscopy three months after the procedures. Keratocyte densities were determined in the anterior stroma, stromal bed, central and posterior stroma

Results Keratocyte density in the anterior stroma was 23263, 8 + 9030,2 cells/mm3 in the M‐Lasik group, and 25959,4 + 8007 cells/mm3 (p= 0,2) in the FS‐Lasik group. In the stromal bed it was 25269,4+ 8438,6 cells/mm3 and 20856,9 + 5012,2 cells/mm3 (p= 0,03) in M‐Lasik and FS‐Lasik respectively. In the mid stroma it was 29311,1+ 10606 cells/mm3 in M‐Lasik and 27173,9 + 8709,7 cells/mm3 in FS‐Lasik (p= 0,4), and in the posterior stroma it was 29350 + 9395,8 cells/mm3 and 27515,9 + 98284 cells/mm3 (p= 0,5) in M‐Lasik and in FS‐Lasik respectively. The comparison between the average keratocyte density throughout the whole cornea showed no statistically significant difference between M‐Lasik and FS‐Lasik 3 months after surgery, but it was significantly increased in both groups when compared with the control group (p=0.001)

Conclusion Both M‐Lasik and FS‐Lasik seem to cause a similar change in the corneal keratocyte population 3 months after surgery
Effectiveness of a new lubricant for dry eye after photoablation using an osmolarity measurement
Authors: COCHENER B , BAUMANN A
Published: November 2010

Purpose LASIK has been shown to lead to corneal hypoesthesia, which can trigger a decrease in the reflex arc regulating tears secretion. The goal of this study was to evaluate the benefits of a new lubricant after LASIK compared to a classical treatment by measuring tear osmolarity.

Methods Twenty patients scheduled to undergo LASIK were enrolled in the study and randomized into two groups. A baseline osmolarity measurement was taken (TearLab Osmolarity System, TearLab Corp) and then randomized into one of two groups. Patients in the first group received two artificial tears (Refresh and Celluvisc, Allergan) following surgery while the 2nd group received a PEG 400 and hylauronic acid (HA) artificial tear (Blink, Abbott Medical Optics) following treatment. These patients were assessed at 1 month postoperative for changes in osmolarity.

Results Normal values of osmolarity with Tear Lab range between 275 and 308 mOsm/L; above this, we consider that the eye is dry. The single tear treatment had the same efficiency as our standard two‐drop therapy. No side effects were noted in any patients. Most patients found it easier to have only one kind of lubricant instead of a combination of two, which lead to a better observance. The use of the tear osmolarity system provided a quick, reliable test for detecting patient with a risk of postoperative dry eye and for assessing the effectiveness of the therapy.

Conclusion The new lubricant, Blink, is another choice in the therapeutic panel for treatment of dry eye disease. It is well tolerated and as efficient as the combination of Refresh and Celluvisc. New osmolarity measurement is an easy, fast and non‐invasive well tolerated test for detecting infraclinical dryness especially before refractive surgery.
Stability of corneal shape and morphology in patients with Fuchs’ dystrophy after phacoemulsification with soft shell technique.
Authors: MILKA M , NOWIńSKA A , JANISZEWSKA D , DOBROWOLSKI D , WYLEGALA E
Published: November 2010

Purpose To evaluate effectiveness of soft shell cataract surgery technique on the corneal structure in group of Fuchs’ dystrophy patients.

Methods 24 patients (mean age 52,7±13,8), 31 eyes after phacoemulsification were examined before and 10 months after surgery. BCVA, mean central corneal thickness (CCT) and corneal endothelial cell density (CD) were evaluated. Corneal aberrations root‐mean‐square (RMS) was calculated 1 and 10 months after surgery for 4.0mm pupil.

Results Corneal higher‐order aberrations (RMS) 1 month after surgery was 0,372±0,058 and 10 months after surgery was 0,345±0,076, BCVA 10 months after surgery was 0,75±0,27 (before surgery 0,32±0,28), the mean CCT was 563,37±21,42µm (before surgery 559,62±45,29µm), CD 1786,341±493,127 (before surgery 1912,783±381,963).

Conclusion All patients revealed good stability and protection of the cornea confirming safety of the soft shell technique.
Application of autologous cultivated corneal epithelium for restoring of corneal surface
Authors: DOBROWOLSKI D , WYLEGALA W , WOWRA B , NOWINSKA A
Published: November 2010

Purpose To present results of transplantations of cultured corneal epithelium in limbal stem cell insufficiency.

Methods 26 patients were donors of limbal epithelium for corneal epithelial culture. Patients suffered from limbal deficiency in one eye after chemical or thermal burn. Limbal cells from 2 mm2 biopsy were seeded on amniotic membrane. Cultures were carried in standard conditions in supplememted DMEM in presence of 3T3 fibroblasts. After superficial keratectomy amniotic carries with epithelial cells were transplanted on denuded corneas. Stabilisation of corneal surface was evaluated.

Results 3 months after surgery 61,5% of eyes showed stabile epithelium with corneal slight haze caused by the amnion. In 50,0% of eyes there was no recurrent conjuntival neovascularisation. 38,4% of eyes remained cloudy due to stromal revascularization. In 4 eyes total conjuctival pannus developed again. Visual acuity ranged from counting fingers to 0,5.

Conclusion Grafting of cultured epithelium is a promising method in treatment of limbal stem cell insufficiency in burns.
Effect of glutaredoxin 2 gene knockout on lens epithelial cells against oxidative stress
Authors: LOU M , WU HL , HO YS
Published: November 2010

Purpose The mitochondrial glutaredoxin 2 (Grx2) is known to possess both dethiolase and peroxidase activities, and has shown an ability to protect cells from oxidative stress‐induced apoptosis in the human lens epithelial cells. In this study, we further studied the function of Grx2 by using Grx2 knockout mouse lens epithelial (MLE) cells as a model.

Methods Primary culture of MLE cells was established from the lenses of wild‐type (WT) and Grx2‐knockout (Grx2 KO) mice. Cells were probed for αA‐crystallin and Grx2 by Western blot analysis while cell viability was examined by WST‐8 assay. Glutathione (GSH) level, Grx2 and Complex I activities, and lactate dehydrogenase (LDH) release were determined by spectrophotometric assays. Reactive oxygen species was detected using DCF‐DA fluorescein with a cell sorter. Apoptosis was quantified by flow cytometry.

Results Both primary cell cultures were confirmed to be lens epithelial cells by the presence of αA‐crystallin. Western blotting showed normal expression of Grx2 in WT cells but absent in Grx2 KO cells. Both cell types showed similar morphology and growth rate with same level of GSH pool and complex 1 activity in the mitochondrial fraction. However, KO cells were more sensitive to oxidative stress (100 μM H2O2 for 6 h) and exhibited lower cell viability and more LDH leakage in comparison with the WT cells. In addition, knockdown of Grx2 weakened the cell’s ability to detoxify H2O2 and enhanced the H2O2‐induced inactivation of complex I in the electron transport chain.

Conclusion Grx2 can protect MLE cells from H2O2‐induced cell injury, and the mechanism of this protection is likely associated with its ability to detoxify H2O2 and its preservation of complex I activity in the mitochondria.
MsrA repair of Cytochrome c and α‐crystallin links chaperone and oxidative repair pathways with mitochondrial protection and apoptotic control in lens cells.
Authors: KANTOROW M , BRENNAN L , MCGREAL R , LEE W , DAVID L , GIBLIN F
Published: November 2010

Purpose Methionine sulfoxide reductase A (MsrA) is essential for lens defense against oxidative stress and cataract formation through its ability to repair oxidized protein methionine (PMSO). Here, we examined α‐crystallin and cytochrome c (Cyt c) as potential targets for MsrA‐repair in the lens.

Methods The oxidized methionine content of α‐crystallin and Cyt c was evaluated from the lenses of MsrA knockout and w+ mice. The activities of α−crystallin and Cyt c were evaluated upon methionine oxidation. The ability of MsrA to repair these proteins and restore their respective chaperone and electron transport activities was determined. All three proteins were localized in lens cells and their abilities to form complexes in vitro and in vivo evaluated.

Results Cyt c was oxidized at met 80 and αβ‐crystallin at met 68 in MsrA‐knockout relative to w+ mice. Methionine oxidization of 138 of αA‐crystallin and 68 of αB‐crystallin resulted in loss of α‐crystallin chaperone function while oxidation of met 80 resulted in loss of Cyt c electron transport function. α‐crystallin protected Cyt c against methioinine oxidation. MsrA repaired and restored the functions of all three proteins which co‐localized and formed complexes in lens mitochondria.

Conclusion MsrA is likely required for repair of α‐crystallin and Cyt c in lens cells suggesting that it maintains and regulates the activities of α‐crystallin and Cyt c in lens mitochondria where all three proteins were localized. Loss of MsrA‐repair could contribute to cataract formation through loss of chaperone function, loss of oxidative phosphorylation and/or increased Cyt c mediated apoptosis.
In vivo quantitative measurement of oxidation repair of glutaredoxin‐1
Authors: SÖDERBERG PG , KRONSCHLÄGER M , GALICHANIN K , LOU M
Published: November 2010

Purpose Quantitative determination of the impact of glutaredoxin‐1 on sensitivity to oxidative stress induced by in vivo exposure to ultraviolet radiation in the 300 nm wavelength region.

Methods Altogether, 20 glutredoxin‐1 knockout mice (Grx1 ‐/‐) and 20 wild type C57BL/6, bred on the same background were in vivo exposed unilaterally to ultraviolet radiation in the 300 nm wavelength region (UVR‐300 nm). For both the Grx1‐/‐ and the Grx1+/+ groups, respectively, the animals were subdivided into 5 dose groups of four receiving 0.0, 2.1, 2.9, 3.6 or 4.1 kJ m^‐2, depending on group belonging. At 48 hrs after exposure the animals were sacrificed, the lenses were extracted and measured for intensity of forward light scattering. The threshold dose for damage was estimated as the Maximum Tolerable Dose‐2.3:16. The protection factor (PF), defined as the ratio between the threshold with protection and the threshold without protection was calculated.

Results The MTD‐2.3:16 was for the Grx1+/+ estimated to 3.81 kJ/m2 (95% CI, 2.82 – 6.37) and for the Grx1‐/‐ estimated to 2.99 kJ/m2 (95% CI, 2.33 – 4.00). The PF factor for the Grx1 gene thus was 1.3.

Conclusion The Grx‐1 gene provides a higher tolerance to in vivo oxidative stress induced by in vivo exposure to ultraviolet radiation, allowing a 1.3 longer exposure times at the same intensity before cataract develops.
The significance of ER stress in cataractogenesis
Authors: SHINOHARA T
Published: November 2010

Abstract not provided
Caffeine, an antioxidant in the lens
Authors: VARMA S
Published: November 2010

Abstract not provided
Synthetic antioxidants for prevention of cataract
Authors: KADOR P
Published: November 2010

Abstract not provided
LASIK vs femtosecond sub‐Bowmann keratomileusis to correct myopic astigmatism: a pilot study
Authors: TEUS MA , GIMÉNEZ C , PAZ‐MORENO J , CANADAS‐SUAREZ P
Published: November 2010

Purpose To evaluate the safety and efficacy of LASIK and Femtosecond sub‐Bowmann Keratomileusis (FSBK) in the correction of myopic astigmatism

Methods Prospective, masked study of consecutive eyes, with myopic astigmatism higher than ‐1.5D. LASIK was performed using the M2 microkeratome, Intralase® was used in FSBK. Visual results were evaluated 3 months post op

Results 228 eyes were analyzed, 105 LASIK and 123 FSBK. Preoperative sphere and cylinder was similar in both groups (p=0.2). Safety and Efficacy indexes were 1.01 vs 1.01 and 1.02 vs 0.91 in LASEK and FSBK groups, respectively (p=0.8 and 0.3)

Conclusion LASIK and FSBK achieve comparable visual results when used to correct myopic astigmatism at 3 months follow‐up
Basic mechanisms and factors influencing the neurovascular coupling in the eye
Authors: GARHOFER G
Published: November 2010

Neuro‐vascular coupling is a basic physiological mechanism in the eye that allows for adapting retinal and optic nerve head blood flow to changing metabolic demands, induced by an increase in neural activity. Despite many efforts, the mechanisms that leads to this coupling process are largely unknown. Among others, nitric oxide seems to play an important role in the vasodilatory answer. It has been shown that the unspecific blockade of nitric‐oxide syntheses leads to a pronounced reduction of flicker induced vasodilatation in healthy subjects. This indicates that nitric oxide plays an important role in this signaling cascade. Additionally, there is evidence that astrocytes act as a mediator between ganglion cells and blood vessels in the retina. This hypothesis is strengthened by the observation that the presence and distribution of retinal astrocytes correlates with the presence and distribution of retinal blood vessels. This talk will summarize the concept of neuro‐vascular coupling in the eye and give an overview about our current understanding of the mechanisms and factors involved in this process.
Ocular neurovascular coupling in glaucoma patients
Authors: GUGLETA K
Published: November 2010

Purpose Defining property of glaucoma, cupping of the optic disc in parallel to loss of retinal ganglion cells and their axon, implies tissue remodeling of the optic nerve head which in turns requires involvement of astrocytes. Their malfunction may lead not only to cupping, but also to disturbance in ocular neurovascular coupling.

Methods We analyzed 122 glaucoma patients, ocular hypertensives and healthy controls who all received no IOP‐lowering therapy at least four weeks prior to the study examination. One eye per subject entered the primary analysis: in the POAG group, an eye with the biggest damage, in the OHT group an eye with the highest average IOP was selected. Relative vessel diameter increase in response to flicker light was used as the measure of neurovascular coupling.

Results This response was impaired in untreated POAG patients, affecting both superior and inferior temporal retinal vessels. In general, inferior vessel dilated more than superior ones. The dilation amplitude was inversely correlated to the level of morphological (retinal nerve fiber layer thickness) and functional (visual field mean defect) glaucomatous damage. Despite the relatively high level of inter‐ and intraocular correlation of vessel responses, in a separate analysis of contralateral eyes, they seem to display higher dilation amplitudes than the more damaged eyes which were included in the original analysis.

Conclusion Neurovascular coupling is impaired in untreated glaucoma patients. Prospective studies are underway in an attempt to clarify the cause versus consequence relationship between the glaucomatous damage and disturbance of neurovascular coupling.
Neurovascular coupling in the retrobulbar ciliary circulation
Authors: ZEITZ O
Published: November 2010

Purpose Perfusion of the retina is adapted to the metabolic demand by neurovascular coupling. Neurovascular coupling has shown to be present in the retinal vasculature, but not in vessels supplying the optic nerve.The present study investigated the presence of neurovascular coupling in the anterior part of the optic nerve in healthy and glaucoma subjects.

Methods Retrobulbar blood flow velocities were determined by color Doppler imaging (CDI). A Siemens Elegra ultrasound system with a 7.5L40 transducer was used. Peak‐systolic and end‐diastolic velocities (PSV and EDV) in the central retinal artery (CRA) or the short posterior ciliary artery (SPCA) were the primary readout. CDI measurements were performed shortly before, during, immediately after, 60 s after, and 120 s after a 10‐Hz flicker stimulation of the retina.

Results Thirty‐five glaucoma patients and 44 healthy control subjects were included in the study. In the SPCA of healthy controls, flicker stimulation led to a rise of PSV from 9.7±0.8 to 12.5±0.8 cm/s (P<0.001; N=24) and of EDV from 2.4±0.3 to 3.6±0.3 cm/s (P<0.001; N=24). This effect was not detectable in glaucoma patients. In the CRA, flicker light led to an increase of EDV from 2.1±0.2 to 3.0±0.3 cm/s (P=0.002; N=20) in healthy volunteers and from 1.3±0.2 to 2.0±0.2 cm/s in glaucoma patients (P=0.004; N=15). PSV was affected by flicker stimulation in neither the healthy volunteers nor glaucoma patients.

Conclusion The data indicate the presence of neurovascular coupling in the vascular bed supplied by the paraoptic SPCA. The response pattern to the flicker stimulus differs between healthy and glaucoma subjects.
Visual results after lasik performed to correct myopic astigmatism in amblyopic eyes
Authors: TEUS MA , ARRUABARRENA‐SANCHEZ C , SANCHEZ‐PINA JM , CANADAS‐SUAREZ P
Published: November 2010

Purpose To evaluate the visual results obtained in amblyopic eyes after LASIK performed to correct myopic astigmatism

Methods Prospective, masked study of 80 consecutive eyes, with myopic astigmatism higher than ‐3.00D and a mean BCVA before surgery 0, 74+ 0,1; LASIK was performed using the M2 microkeratome and the Esiris (Schwind) Excimer Laser. Visual results were evaluated three months post‐op. To be included in the study, the eyes must had no other potential cause of amblyopia than the high astigmatism

Results Preoperative sphere and cylinder was ‐3,7+ 2,3 and ‐3,9 + 0,8 respectively. BCVA 3 months post‐op was 0,8 + 0,1. 13 eyes (16,2%) showed a decrease in their BCVA after surgery, while 50 eyes improve their BCVA after surgery; in 32 eyes the BCVA improvement was 1 line or more, and in 8 eyes it was 2 lines or more

Conclusion LASIK to correct high myopic astigmatism may improve significantly the BCVA in amblyopic eyes