bluuebunny/crossref_metadata_2025 huggingface dataset:
High resolution imaging analysis of female carriers and patients of Choroideremia with CHM gene mutation
Authors: Gocho K. , Akeo K. , Kubota D. , Katagiri S. , Kikuchi S. , Hayashi T. , Yamaki K. , Takahashi H. , Kameya S.
Published: September 2017

Purpose

To report the high resolution imaging features of Japanese patient and female carriers of choroideremia using adaptive optics(AO) and other imaging modalities.

Methods

Three carriers and one patient underwent comprehensive examinations including AO fundus camera (rtx1™ Imagine eyes, France), spectral domain optical coherence topography (SD‐OCT)and fundus autofluoresence (FAF). Cone density was measured by peak density method and compared with the data of 34 normal controls. The mutation analysis of the CHM gene was performed by Sanger sequencing. The protocol conformed to the tenets of the Declaration of Helsinki and was approved by the IRB of The Jikei University and Nippon Medical School.

Results

Three female carriers 1, 2, 3 (sister 9 y.o, mother 37 y.o and grandmother 65 y.o) and one patient (6 y.o, male). They had same CHM mutation, c.646delA, p.T216LfsX16. All carriers did not complain any symptoms, the BCVA of all were over 20/20. Fundus examination of carrier 2 showed mild generation in only periphery, the other carriers showed diffuse degeneration. AF showed mottled hypo‐autofluoresence in degeneration area. SD‐OCT of the carriers showed nearly normal,although peripheral SD‐OCT and patient showed diffuse disruptions of interdigitation and ellipsoid zones.Cone density was measured at 2 to 8 degree temporal from the fovea in every 1 degree, using 50 x 50 micron images. Cone counting was performed by AO detect (Imagine eyes) with manual correction. Patient showed lower cone density more than 2 SD of normal control. The carriers showed lower cone density only at 7 and 8 degrees.

Conclusions

AO cone counting showed reduction of photoreceptors in carriers mainly at peripheral region. To elucidate the mechanism of peripheral degeneration and foveal sparing of female carriers may help preventing the disease progression of choroideremia patients.
Is the age a prognostic factor for the outcome after treatment of myopic CNV?
Authors: Kontadakis G. , Parikakis E. , Peponis V. , Batsos G. , Georgalas I. , Tsilimbaris M. , Karagiannis D.
Published: September 2017

Purpose

Choroidal neovascularization (CNV) can develop in eyes with pathologic myopia. The study investigates the role of age as a prognostic factor for the outcome of eyes with myopic CNV after treatment with intravitreal ranibizumab injections.

Methods

Retrospective review of charts of 21 eyes with myopic CNV treated with ranibizumab injections. Diagnosis was confirmed with fundus examination, fluorescein angiography, SD‐OCT, refraction and axial length measurement in all cases. Two age subgroups were created, putting the limit to 40 years of age. The correlation of age with the change in visual acuity and the number of injections was evaluated.

Results

The follow‐up period was for at least 30 months. Age of the patients was significantly correlated with the number of injections, as well as with the improvement in the LogMAR corrected distance visual acuity. All patients in the younger aged subgroup were stable or improved in comparison to the initial CDVA, versus 57% of patients in the older aged subgroup (p=0.04, chi square test). In the younger aged subgroup 86% of patients had final CDVA equal to or better than 20/40 and in the older aged subgroup 14% of patients (p=0.001, chi square test).

Conclusions

Younger than 40 years old patients found to need fewer intravitreal injections and to obtain a more prominent visual improvement. Age seems to be a critical prognostic factor for the outcome in cases of myopic CNV treated with reanibizumab.
Intravitreal bevacizumab administration for complicated retinal arterial macroaneurysm in a young male patient
Authors: Popa Cherecheanu A. , Pirvulescu R. , Dide C. , Iancu R.
Published: September 2017

Purpose

Retinal arterial macro aneurysms (RAM) represent aquired retinal vascular disorders encountered predominantly in elderly, with marked female predominance, and most often associated with hypertension, arteriosclerosis and cardiovascular disease.

In this poster we try to assess functional and anatomical results after bevacizumab (Avastin) injection in a young male with complicated RAM.

Methods

A 27 years old male presented in our clinic with decreased visual acuity into the right eye with the debut 10 days before. The patient underwent a comprehensive ophthalmologic and OCT examination. The diagnosis of retinal arterial macroaneurysm complicated with macular edema associated with lipoprotein exsudation was established. The patient underwent intravitreal injection of bevacizumab (Avastin) 1.25 mg/0.05 ml; two follow‐up visits were planned at 1 and 4 weeks after bevacizumab intravitreal administration.

Results

At 4 weeks after intravitreal bevacizumab, right eye BCVA improved from 0.17 logMAR to 0.1 logMAR; the retinal hemorrhage reduced considerable, retinophotography demonstrated resolution of the exsudative changes and OCT examination showed physiologic appearance of the fovea. The patient underwent thorough investigations in cardiovascular area, including cerebral MRI. He was also proposed for retinal angiofluorography.

Conclusions

Although many patients are asymptomatic, decreased visual acuity is the most frequent symptom, and it is determined by hemorrhage and/or macular edema with macular star formation. The differential diagnosis of RAM includes retinal and systemic diseases that require thorough investigation.
Long‐term outcome following ranibizumab treatment for CNV related to ND: YAG‐Laser macular injury
Authors: Batsos G. , Parikakis E. , Christodoulou E. , Karagiannis D. , Stefaniotou M.
Published: September 2017

Purpose

To present a case of a macular injury caused by Nd: YAG laser, the early clinical findings, the late complications and the anatomic and functional status after treatment with intravitreal ranibizumab in a five year follow‐up period.

Methods

A 32‐year‐old man working on the physics laboratory, suffered a macula injury in his right eye after accidental exposure of a 800 nm wave length Nd: YAG laser pulse. His measured best corrected visual acuity on the day of the accident was 0.70 logMAR. One month later the formation of a full‐thickness macular hole was observed. Any surgical intervention was postponed and a close monitor was proposed. A spontaneous closure of the hole was observed within the next month and the vision improved to 0.18 logMAR. Six months later the patient presented with sudden deterioration of his visual acuity again measured 0.70 logMAR. OCT and FA performed, which revealed macular oedema and hemorrhage due to choroidal neovascularisation. A single intravitreal injection of ranibizumab was applied to the affected eye.

Results

The oedema resolved within 45 days after the injection and the visual acuity improved to 0.48 logMAR. No regression was noticed and the BCVA and the macula area remain stable for a period of four and a‐half years after the resolution of the oedema,

Conclusions

All personnel working with laser products should take the necessary precautions and use protective goggles. In the event of a macular hole formation, spontaneous closure can occur and a close observation can be an alternative to the early surgical treatment. Choroidal neovascularization can occur and treatment with anti‐VEGF therapy may help to maintain a stable anatomic and functional outcome for a long period.
Types of diabetic retinopathy studied by wide field angiography
Authors: Maamouri R. , Falfoul Y. , Bouraoui R. , Kortli M. , Chebil A. , Fedra K. , Nafaa F. , El Matri K. , El Matri L.
Published: September 2017

Purpose

To evaluate the types of diabetic retinopathy (DR) using a wide field fluorescein angiography and to identify the associated factors.

Methods

In a retrospective study, consecutive wide‐field angiographs obtained using the Heidelberg Retina Angiograph 2 with a contact lens system Staurenghi were graded in: anterior, posterior or diffuse diabetic retinopathy. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven‐standard fields. In all patients central foveal thickness was measured on Spectral‐domain optical coherence tomography using Topcon 2000.

Results

A total of 69 eyes of diabetic patients were included. Diabetic retinopathy was anterior in 12 eyes (17.4%), posterior in 24 eyes (34.8%) and was diffuse in 33 eyes (47.8%). Retinal non perfusion was associated with anterior DR in 17.5%, posterior DR in 2.5% and diffuse DR in 80% of eyes (p < 0.001). Peripheral vessel leakage was present in 14.3% of anterior DR, and in 85.7% of diffuse DR, and none eye in posterior DR (p < 0.001). The average of central foveal thickness was 232 μm in anterior DR, 303 μm in posterior DR and 459 μm in diffuse DR (p = 0.01). No correlation was found between types of DR and age (p = 0.22), sex (p = 0.2), arterial hypertension (p = 0.12), cardiopathy (p = 0.16), nephropathy (p = 0.16) and dyslipidemia (p = 0.07).

Conclusions

This study highlighted that diffuse DR was significantly associated with retinal non perfusion and macular edema. Posterior DR was less associated with retinal non perfusion and peripheral vessel leakage. Eyes with anterior and diffuse DR are at greater risk of ocular complications, needing more clinical monitoring.
Choroidal vascular abnormalities by UWF ICGA in central serous chorioretinopathy
Authors: Sagong M. , Noh D. , van Hemert J. , Lee J.
Published: September 2017

Purpose

To evaluate vortex vein engorgement and choroidal vascular hyperpermeability in patients with central serous chorioretinopathy (CSC) using ultra‐widefield indocyanine green angiography (UWF ICGA).

Methods

Twenty two patients with unilateral (19 patients) or bilateral (3 patients) CSC were consecutively included and imaged by UWF autofluorescence, fluorescein angiography and ICGA, and spectral domain optical coherence tomography (OCT). The number of quadrant of vortex vein engorgement was evaluated in the early phase of ICGA, which was classified as effective if the dilated choroidal vessels affect the macula. The area of choroidal vascular hyperpermeability was quantified in the late phase using by stereographic projection method. And they were correlated with clinical findings and OCT features.

Results

In all affected eyes, choroidal hyperpermeability from dilated choroidal vessels was observed in association with 1 or more engorged vortex vein. Affected eyes showed significantly greater choroidal hyperpermeability area (P < 0.001) and thicker subfoveal choroidal thickness (P = 0.022) compared with unaffected eyes although both eyes in the patients with unilateral CSC demonstrated symmetry of vortex congestion (78.1%). The choroidal vascular hyperpermeability was significantly correlated with subfoveal choroidal thickness (P=0.012, rho=0.493) and the height of subretinal fluid (P=0.012, rho=0.514). The number of quadrant of the effective vortex vein engorgement was correlated with subfoveal choroidal thickness (P=0.010, rho=0.505).

Conclusions

UWF ICGA could demonstrate vortex vein engorgement and choroidal vascular hyperpermeability, suggesting outflow congestion as a potential contributor to the pathogenesis of CSC. And they may serve as diagnostic clues or even predictors of disease course.
Intra‐ and inter‐grader agreement in grading of coverage of panretinal photocoagulation by ultra‐wide field color fundus images
Authors: Torp T.L. , Jakobsen D.B. , Grauslund J.
Published: September 2017

Purpose

Panretinal photocoagulation (PRP) is the gold‐standard treatment for proliferative diabetic retinopathy (PDR), but evaluation of the coverage of PRP after treatment can be difficult and is not standardized. Ultra‐wide field (UWF) color fundus images may offer an objective alternative to subjective evaluation of PRP‐coverage. We propose a new model to quantify the coverage of PRP treatment in each retinal quadrant by UWF images. The purpose of the study was to evaluate the intra‐ and inter‐grader reliability of the model.

Methods

The retinal coverage of PRP in each quadrant of the retina on 20 UWF color fundus images in patients treated for PDR was quantified by two independent graders (grader A and B), and intra‐ and inter‐grader association (Kappa) were calculated. In each retinal quadrant, OPTOS UWF color fundus images (Optomap, Optos PLC., Dunfermline, Scotland, UK) were used, and each grader evaluated the total retinal area covered by laser. The graders categorized the amount of laser visible on the retina into four categories (no visible laser spots, <50%, 51‐75%, 76‐100%).

Results

The total retinal area covered by laser was 76‐100% (for both graders). Intra‐grader association was 0.715 and 0.464 for Grader A and Grader B, respectively, and inter‐grader association was substantial at 0.627.

Conclusions

Using Optos UWF images, we were able to achieve high intra‐ and inter‐grader reliability for the quantification of the retinal area covered with PRP in patients with PDR. This might aid clinicians when comparing PRP coverage between patients.
Relationship between macular thickness and mesopic visual acuity in older subjects without retinal disease
Authors: Puell M. , Palomo‐Alvarez C. , Gómez‐García S. , Ayala‐Ayerbes M. , Chozas‐Enrique J. , Pérez‐Carrasco M.J.
Published: September 2017

Purpose

Impaired mesopic visual acuity (VA) is a risk factor for incident early age‐related macular degeneration 3 years later. However, there is a lack of data on the retina structure‐function relationship in healthy eyes. In this study, the correlations of macular thicknesses with photopic and mesopic VA were analyzed in young and older subjects without retinal disease.

Methods

Retinal thickness was measured by spectral‐domain optical coherence tomography in one eye of 40 young and 41 older healthy subjects with best corrected VA of 20/20. Macular thicknesses measurements from complete and inner and outer retinal‐segmentation (IRS and ORS) of the central fovea, inner ring, outer ring, and ganglion cell complex were used in analyses. Best‐corrected distance VA was measured using HC and LC logMAR charts under photopic and mesopic (1 cd/m2) luminance conditions. The decrease in mesopic VA when compared to photopic VA (low luminance VA deficit) was registered. Pearson correlation followed by multiple forward stepwise regression analyses were performed in each age group.

Results

In the older group, the macula was thicker in the ORS of the central fovea and inner ring, and thinner in the IRS of inner ring and outer ring (all, P < 0.01). Mean photopic and mesopic HC‐VA and LC‐VA, and mean HC‐low luminance VA defict were significantly worse in the older group (all, P < 0.01). Significant correlations were detected only in the older group. Multiple regression analysis showed that ORS thickness of inner ring was independent contributor to mesopic LC‐VA (r = 0.40, P = 0.01) and the complete thickness of central fovea was independent contributor to HC‐ and LC‐low luminance VA deficit (r = 0.45, P = 0.003; r = 0.32, P = 0.04
The effect of internal limiting membrane peeling in surgical treatment of combined hamartoma and epiretinal membrane
Authors: Park J.M. , Soo Jung L. , Ji Hyun P. , Myung In Y.
Published: September 2017

Purpose

This study was designed to evaluate the effect of internal limiting membrane (ILM) peeling in the surgical management of combined hamartoma of the retina and retinal pigment epithelium and epiretinal membrane (ERM).

Methods

The records of 11 patients (11 eyes) with ERM of combined hamartoma of the retina and retinal pigment epithelium, 22 patients (22 eyes) with ERM who had undergone pars plana vitrectomy with removal of the ERM were retrospectively reviewed. The patients were divided into four groups: eyes without (6 eyes) or with (5 eyes) ILM peeling in ERM of combined hamartoma of the retina and retinal pigment epithelium and eyes without (12 eyes) or with (10 eyes) ILM peeling in ERM. Anatomical outcomes, functional outcomes, complications and recurrences were compared between the eyes without and with ILM peeling. Anatomical outcome included the central retinal thickness and subfoveal choroidal thickness from optical coherence tomography (OCT). Functional outcomes included the change in best‐corrected visual acuity (BCVA).

Results

Central retinal thickness and subfoveal choroidal thickness decreased and postoperative BCVA improved in without and with ILM peeling in ERM of combined hamartoma and ERM. But there were no statistically significant differences in central retinal thickness, subfoveal choroidal thickness, BCVA between without and with ILM peeling in ERM of combined hamartoma and ERM. There was no complicated and recurred case in four groups.

Conclusions

The additional ILM peeling in patients with ERM of combined hamartoma of the retina and retinal pigment epithelium, ERM doesn't affect the postoperative results in central retinal thickness, subfoveal choroidal thickness and visual acuity.
Effects of dexamethasone implant on macular morphology and visual function in patients with different diseases
Authors: Lopez Sangros I. , Marco Monzon S. , Honrubia Grijalbo A. , Sanchez Marin I. , Idoate Domenech A. , Bartolome Sese I. , Berniollles Alcalde J. , Ascaso Puyuelo J.
Published: September 2017

Purpose

To evaluate the effects of dexamethasone implant in patients with different retina diseases.

Methods

In the study 194 eyes of patients treated with Dexamethasone implant were included restrospectively in the study. Best‐corrected visual acuity (BCVA) measurement, complete ophthalmic evaluation with Intraocular pressure (IOP), and spectral‐domain optical coherence tomography (OCT) were performed at baseline and 30 days after treatment.

Results

We have analyzed the results of the administration of dexamethasone implant in 194 eyes, during the years 2015 and 2016. The main indications for the treatment with dexamethasone implant were central retinal oclusion (54.20%), diabetic macular edema (35.35%), Irvine Gass syndrome (4.71%), uveitis (3.03%), macular degeneration (2.02%), vitreous‐ macular traction syndromes (0.33%) and neovascularization of the anterior segment (0.33%). The best visual acuity and the IOP before the administration of dexamethasone implant were respectively 0.21(+/‐ 0.15) and 16 mmHg. After the treatment the best visual acuity improves to 0.27 (+/‐ 0.2) and the IOP was 18.9 mmHg (+/‐6.28). The macular thickness has been reduced to 519.72 micron (+/‐ 157.86) to 429.96 microns (+/‐153.98) after the dexamethasone implant.

Conclusions

Intravitreal dexamethasone implant showed an early and fast effect in reducing CRT and moderatly improving BCVA. There are IOP variations, but it rarely exceeds normal limits.
Neural degeneration mechanisms in diabetic retinopathy: The role of apoptosis and autophagy
Authors: Amato R. , Dal Monte M. , Cervia D. , Catalani E. , Cammalleri M. , Casini G.
Published: September 2017

Purpose

That neuronal injury plays a major role in diabetic retinopathy (DR) is gaining increasing recognition. In particular, we have recently shown, using an ex vivo model of early DR, that neuroprotection may also reduce the expression of proangiogenic factors. Given the importance of neuronal health in DR, we chose to better analyze the mechanisms of cell death involved in this disease. Our hypothesis was that the balance between neuronal death and survival may depend on a similar equilibrium between apoptosis and autophagy: in this context, a neuroprotective treatment would act by influencing this equilibrium.

Methods

Ex vivo mouse retinal explants were treated with high glucose (HG, 75 mM) for 10 days and the somatostatin analog octreotide (OCT, 1µM) was used as a neuroprotectant. Chloroquine (CQ, 10µM) was used as an autophagy inhibitor. Apoptotic and autophagic markers were evaluated using  Western blot and immunohistochemistry.

Results

Consistent with our previous observations, HG‐treated retinal explants displayed a significant increase of apoptosis. Concurrently, HG treatment caused a significant decrease of the autophagic flux, which was likely to be due to increased activity of the autophagy regulator mTOR. Treatment with OCT rescued HG‐treated retinal explants from apoptosis and determined an increase of autophagic activity with concomitant mTOR inhibition. Blocking the autophagic flux with CQ completely abolished the anti‐apoptotic effect of OCT.

Conclusions

Apoptosis and autophagy seem to play opposite roles and a delicate balance between apoptotic and autophagic fluxes is responsible for the death or survival of retinal neurons in stressing conditions like HG. Consistently, the data obtained with CQ suggest that the anti‐apoptotic effect of OCT in HG‐treated retinas is mediated by an increase of the autophagic flux.
Retinal vessel geometry and oxygen saturation in patients suffering from diabetes mellitus and/ or cardiovascular disease
Authors: Heitmar R. , Blann A.
Published: September 2017

Purpose

To explore the association of retinal vessel parameters such as calibres, reactivity and complexity with vessel oxygen saturation in patients with Diabetes Mellitus and/ or cardiovascular disease.

Methods

All 123 patients underwent a full eye examination including IOP and dilated fundus photography. Retinal oxygen saturation of arteries and veins were measured from dual wavelength retinal photographs (IMEDOS Oxygen module). A‐V saturation was calculated as an estimate of oxygen consumption. Retinal vessel calibre's, tortuosity and fractal dimension were measured using a semi‐automated software to determine CRAE and CRVE (Visualis, IMEDOS and Iflexis, Vito).

Results

Patients mean ranged in age from 32 to 85 years (77 out of the 123 were diabetic). Principal component analysis was performed to establish if the cohort should be split into sub‐groups for further analyses but showed a clear overlap of all patients with no distinct clustering. Subsequently a stepwise forward multiple regression analysis was conducted to explore the relationship between retinal vessel geometry and saturation parameters. Following adjustment for axial length (to account for magnification errors), diastolic blood pressure, retinal vessel fractal dimension and intraocular pressure were significantly associated with A‐V saturation (all p<0.05) meaning a retinal vascular network with a lower fractal dimension (i.e. less vessel density and branching) showed a lower A‐V saturation.

Conclusions

The current study shows that in patients suffering from Diabetes Mellitus and/ or cardiovascular disease, the amount of oxygen used is depending on the complexity of its vascular bed as well as on local and global pressure parameters. These findings could be useful to explore in patients over time or those diabetic retinopathy manifest in different retinal locations.
Effect of intravitreal bevacizumab and aflibercept on retrobulbar blood flow in injected and uninjected sound eyes of patients with neovascular age‐related macular degeneration
Authors: Sebastiani S. , Corcioni B. , Pazzaglia A. , Gaudiano C. , Cellini M. , Golfieri R. , Campos E.C.
Published: September 2017

Purpose

To evaluate early changes in retrobulbar blood flow following intravitreal injection of anti‐vascular endothelial growth factor (VEGF) agents.

Methods

Ten patients affected by neovascular age‐related macular degeneration in 1 eye were enrolled. Five eyes received intravitreal bevacizumab (1.25mg/0.05mL) and 5 eyes aflibercept (2mg/0.05mL). Retrobulbar blood flow was examined by color doppler ultrasonography (Aplio 500, Toshiba Medical System, Tokyo, Japan). Peak systolic velocity (PSV) and resistivity index (RI) was measured from ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in both injected and uninjected sound eyes, before and 21 days after treatment.

Results

Before and after intravitreal bevacizumab mean retrobulbar blood flow parameters significantly change in PCA: PSV 15.24±3.96 cm/sec vs 12.90±2.63 cm/sec (p=0.0012), RI 0.74±0.02 vs 0.77±0.07 (p=0.009) and in CRA: PSV 14.16±1.8 cm/sec vs 12.29±1.54 cm/sec (p=0.005), RI 0.77±0.03 vs 0.79±0.03 (p=0.029). In the sound fellow eyes, significant changes resulted in PCA: PSV 17.26±3.45 cm/sec vs 13.63±3.3 cm/sec (p=0.003), RI 0.74±0.05 vs 0.79±0.03 (p=0.026). Before and after intravitreal aflibercept measured data significantly change in PCA: PSV 12.8±3.09 cm/sec vs 7.20±0.62 cm/sec (p=0.023), RI 0.68±0.03 vs 0.77±0.03 (p=0.007) and in CRA: PSV 14.28±1.2 cm/sec vs 11.04±0.77 cm/sec (p=0.037), RI 0.73±0.03 vs 0.78±0.05 (p=0.022). In the sound fellow eyes, significant changes resulted in PCA: PSV 12.44±2.89 cm/sec vs 9.18±1.42 cm/sec (p=0.044), RI 0.69±0.05 vs 0.75±0.02 (p=0.028).

Conclusions

Intravitreal injections of bevacizumab and aflibercept significantly reduce ocular hemodynamic parameters both in treated and in untreated eyes. These evidences suggest a possible systemic effect.
Modulation of iris sphincter and ciliary muscles by Urocortin 2
Authors: Rocha De Sousa A. , Ferreira D. , Tavares‐Silva M. , Raimundo A.R. , Barbosa‐Breda J. , Leite‐Moreira A.
Published: September 2017

Purpose

Urocortin 2 (UCN2) is a peptide related to corticotropin‐releasing factor, capable of activating CRF‐R2. Among its multisystemic effects, it has actions in all 3 muscle subtypes, either increasing or decreasing contractility.

This study's aim was to determine its potential role in two of the intrinsic eye muscle kinetics and to study the likely subcellular pathways involved.

Methods

Strips of iris sphincter (rabbit) and ciliary (bovine) muscles were dissected and mounted in isometric force‐transducer systems filled with aerated‐solutions, subjected to 0.5 mN and 1.0 mN preloads, respectively. Contraction was elicited using carbachol (10–6M for iris sphincter, 10–5M for ciliary muscle), prior to all testing substances.

Results

UCN2 induced relaxation in iris sphincter muscle, being the effect maximal at 10‐7M concentrations (‐12.2% variation, versus control, n = 6). This effect was abolished with incubation of indomethacin (n = 8), antisauvagine‐30 (n = 7), chelerytrine (n = 6) and SQ22536 (n = 8), but preserved with L‐nitro‐L‐arginine (n = 9). In carbachol pre‐stimulated ciliary muscle, UCN2 (10‐5M) enhanced contraction (maximal effect of 18.2% increase, versus control, n = 10 pairs); pre‐contraction studies were negative.

Conclusions

UCN2 is a new neurohumoral modulator of iris sphincter relaxation, dependent on CRF‐R2 activation, synthesis of prostaglandins (COX pathway) and both adenylate cyclase and PKC signaling pathways, but independent of nitric oxide production. Regarding ciliary muscle, UCN2 enhances carbachol‐induced contraction, in higher doses.
Micro‐instillation of fluorescein with an inoculation loop for ocular surface staining in dry eye syndrome
Authors: Renault D. , Courrier E. , Kaspi M. , Marcon A. , Lambert V. , Garcin T. , Chiambaretta F. , Garhofer G. , Thuret G. , Gain P.
Published: September 2017

Purpose

To describe and validate the micro‐instillation of fluorescein on the ocular surface by a disposable calibrated inoculation loop in order to improve corneal and conjunctival staining quality.

Methods

Prospective interventional non‐randomized low risk study performed in the Department of Ophthalmology at Saint‐Etienne University Hospital. Twenty patients (40 eyes) suffering from dry eye syndrome were enrolled. Accuracy and precision of 0.5% sodium fluorescein collected by a disposable 1 μL‐calibrated inoculation loop were measured using a precision balance. Fluorescein was instilled in patients’ eyes with the loop, and slit lamp images were taken within 30 seconds using cobalt blue light with and without a yellow barrier filter. For comparison, after a washout period, the same images were retaken after instillation of one drop of fluorescein from a single‐dose unit. The main outcome measure was the staining quality assessed by three experts, blind to the instillation method and to discomfort felt by patients.

Results

The mean amount collected by the loop was 1.18 ± 0.12 μL, compared with 33.70 ± 6.10 μL using the single‐dose unit. Tolerance was excellent. The loop avoided excess dye responsible for unpleasant tearing, masking of lesions, and rapid diffusion into the stroma. Micro‐instillation greatly improved image quality without losing information. The yellow filter further improved image contrast.

Conclusions

The 1 μL‐calibrated inoculation loop is a safe, convenient, inexpensive, disposable, sterile, well‐tolerated tool for reproducible micro‐instillation of commercial fluorescein. By greatly improving staining quality, it will help standardize assessment of dry eye severity.
Refractive Lenticule Transplantation (RLT) for correction of iatrogenic hyperopia and high astigmatism afterLASIK
Authors: Lazaridis A. , Reinstein D.Z. , Archer T.J. , Schulze S. , Sekundo W.
Published: September 2017

Purpose

To describe a novel technique for intrastromal transplantation of stromal lenticules with specific refractive power for correction of post‐LASIKinduced hyperopia and astigmatism.

Methods

A 28‐year‐old patient was referred for consultation after complicatedLASIKfor moderate myopia and astigmatism. The refractive error of the right eye was severely overcorrected due to a data entry error. Post‐LASIKrefraction showed high astigmatism (OD:+6.50/‐9.00/84 ) andCDVAof 20/32. The corneal thickness was 282 mm. Due to contact lens intolerance, poor visual acuity and severe anisometropia a Refractive Lenticule Transplantation was performed. A toric and myopic lenticule, obtained from a donor using the ReLEx®FLEx technique, was implanted under the flap, in order to reduce the refractive error and restore the corneal volume.

Results

Six weeks after surgery the donor lenticule was spread smoothly in the interface with a minor temporal decentration in relation to the pupil centre. The refraction showed a reduction of astigmatism as expected, but a stronger myopisation compared to preoperative calculations (OD:‐6.50/‐4.0/70 ). At three months, theCDVAreturned to preoperative value of 20/32. One year postoperatively corneal tomography showed no signs of ectasia and biomicroscopy showed no signs of rejection. After an additional implantation toric myopicICLthe patient regained anUDVAof 20/40 and a full stereopsis.

Conclusions

The Refractive Lenticule Transplantation technique offers a solution for rare cases of post‐LASIKhyperopia and astigmatism while restoring the volume of very thin corneas. Moreover, it is a reversible procedure with low probability of rejection.
Confocal characterization of recurrent corneal erosion syndrome suspects
Authors: Smedowski A. , Mazur R. , Tarnawska D. , Wylegala E.
Published: September 2017

Purpose

To characterize and differentiate recurrent corneal erosion syndrome (RCES) suspects according to cytological findings using in vivo corneal confocal microscopy (IVCM).

Methods

We performed IVCM (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III) in 58 patients recommended to outpatients clinic with symptoms of recurrent corneal allodynia. First, patients underwent slit‐lamp examination with anterior segment photographs. The IVCM was performed with an examination frame of 400x400 μm. Screening, full‐thickness corneal scans were performed to evaluate general condition of corneal architectonic. Focal scans aimed to analyze localized changes within corneal epithelium in all corneal quadrants.

Results

From among of 58 analyzed cases, 18 (31%) presented dot‐map‐fingerprint confocal changes involving epithelial basal membrane. Eight of patients (14%) presented cystic degeneration of epithelial cells, 26 patients were diagnosed with epitheliopathy of inflammatory origin – 13 patients (22%) with Thygesson keratitis and 13 patients (22%) presented features typical for post‐adenoviral keratitis. Three patients (5%) suffered from allodynia related to epithelial instability after corneal refractive procedures. There were also 3 (5%) casual cases of allodynia – 1 patient with epithelial squamous cell metaplasia, 1 patient with corneal changes associated with pemphigus vulgaris and 1 patient with post‐traumatic neuroma of corneal superficial nerve plexus. The initial clinical diagnosis of RCES was confirmed with IVCM in 34 patients (59%), other 25 patients suffered from recurrent corneal allodynia due to other than RCES causes, mostly inflammatory.

Conclusions

IVCM of corneal epithelium allows differentiating patients with RCES from other causes of recurrent corneal allodynia, which can determine therapeutic decisions.
Corneal clarity measurements in patients with myopia undergoing laser assisted in situ keratomileusis and laser assisted sub‐epithelial keratectomy
Authors: Alzahrani K. , Din N. , Brahma A. , Carley F. , Hillarby M.C.
Published: September 2017

Purpose

To compare the preoperative and postoperative corneal densitometry of patients undergoing Laser Assisted in Situ Keratomileusis (LASIK) and Laser Assisted Sub‐epithelial Keratectomy (LASAK) and to determine how result differed between the 2 types of surgery.

Methods

A retrospective and comparative study was performed at Manchester Royal Eye Hospital,UK. Preoperative and postoperative corneal densitometry data were collected from the Oculus Pentacam. The data were taken at 3 corneal depths (anterior,centre and posterior) and at 3 corneal annulus ring diameter (0‐2 mm, 2‐6 mm and 6‐10 mm). Postoperative data were collected at the time 6 weeks, 3 and 6 months post treatment.Quality of vision pre and post‐surgery was determined by BCVA.

Results

Data of 60 eyes from 16 LASIK and 14 LASEK patients were collected with a mean age of 37.06 ± 10.0 and 37.7 ± 6.6 respectively. There was statistically significant increase of corneal densitometry in all concentric zones in all corneal layers after 6 weeks in the LASIK treatment group (p < 0.05). There was a statistically significant increase in densitometry after LASEK but only in the central and posterior layers at all concentric zones (p < 0.05). Pre and Postoperative BCVA did not significantly differ after LASIK but found statistically difference at 6 weeks and 3 months in post LASEK (p < 0.05).BCVA post treatment was significantly different between groups at 6 weeks (p < 0.0001) and 3 months (p = 0.001).

Conclusions

Corneal wound healing plays an important role in determining corneal transparency and may be responsible for an increase in corneal haze following refractive surgery.This response differs based on the type of procedure used shown by the increased haze in the anterior layer of the LASIK group which corresponds to the region where the flap was cut which will lead to increased would healing and inflammation.
Corneal clarity after Descemet membrane endothelial keratoplasty versus Descemet stripping endothelial keratoplasty: Two‐year outcomes
Authors: Lazaridis A. , Giallouros E. , Sekundo W. , Kymionis G. , Papaconstantinou D. , Chatzistefanou K. , Droutsas K.
Published: September 2017

Purpose

To compare the course of Scheimpflug corneal densitometry (CD) after Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK) versus age‐matched controls.

Methods

From two consecutive series of 130DMEKand 49DSAEKcases, 54DMEKand 25DSAEKcases without prior corneal surgery, complicated intraoperative or postoperative course or vision‐limiting ocular comorbidities were included in this study. Pseudophakic eyes of age‐matched subjects were recruited as controls (n=20). ScheimpflugCDof the optically relevant zones (0‐2 mm and 2‐6 mm), best‐corrected visual acuity (BCVA) endothelial cell density (ECD) and central corneal thickness (CCT) were evaluated preoperatively and at 3, 6, 12 and 24 months postoperatively.

Results

CDwas significantly lower afterDMEKat 3 and 6 months compared toDSAEK(P≤0.012). The two groups reached similar levels ofCDat 12 and 24 months after surgery (P≥0.056). Compared to healthy pseudophakic controls, centralCDat 24 months afterDMEKdid not differ significantly (P=0.152). PostoperativeBCVAwas significantly higher afterDMEKfor every examination time point compared toDSAEK(P<0.001).ECDwas similar in both groups (P≥0.081).

Conclusions

The first 6 postoperative monthsCDwas lower andBCVAhigher afterDMEKcompared toDSAEK. Notably, althoughCDreached similar levels in the midterm after bothDMEKandDSAEK,BCVAremained significantly better afterDMEK. Two‐yearCDafterDMEKwas similar toCDof healthy pseudophakic eyes indicating an excellent restoration of corneal clarity in the midterm.
Ultraestructural analysis of human pre‐Descemet's tissue
Authors: GONZALO‐SUAREZ B. , Ramirez A.I. , de Hoz R. , Salazar J.J. , Rebolleda G. , Casas‐Llera P. , Rojas B. , Triviño A. , Ramirez J.M.
Published: September 2017

Purpose

To analyze the elastic component of the posterior corneal stromal using electron transmission microscopy and inmunohistochemical techniques.

Methods

Four pieces of cornea and sclero‐corneal angle were included in the study which were obtained from three deceased donors. The mean age was 57,67 years. From each piece a sample of tissue was processed for transmission electron microscopy examination and another sample was paraffin‐embedded for their study using optic microscopy. The optical sections were immunostained with anti‐fibrillin1 antibody.

Results

The ultrastructural study showed that the posterior corneal stroma was comprised of fibrillary collagen lamellae.The number of lamellae vary from 3 to 10 in a random distribution from the line formed by the last queratocytes to the Descemet′s membrane. Mainly, the lamellae were separated by type IV collagen and elastic tissue. There were no differences between fibrillary collagen lamellas of the stroma anterior and posterior to the last line of queratocytes.In all cases, an electrodense band was observed alongside being closely related to the Descemet's membrane. This band was interrupted with gaps between the interruptions that vary in size and shape, like stitching. This band was continued towards the trabecular meshwork, where this material was located principally inside the trabecular sheets. This material appeared to be elastic tissue, this was confirmed by inmunostaining with anti‐ Fibrillin 1 antibody.

Conclusions

Posterior stroma does not constitute a special layer of the cornea. However, a band of elastic tissue is observed close to the Descemet membrane that is continued into the trabecular meshwork. This elastic band could contribute notably to corneal biomechanical properties.
IOP‐lowering efficacy of prostaglandin analogues adjunctive to a Supercilliary Micro‐Stent (CyPass®)
Authors: Uzunov R. , Landry T. , Dickerson J.
Published: September 2017

Purpose

Minimally invasive glaucoma surgery (MIGS) procedures are proving to be a safe, efficacious alternative to medical management of glaucoma. Most frequently employed concomitantly with cataract surgery, they add little if any additional risk while, in many instances, decreasing or even eliminating the need for ocular hypotensive medication. The optimum target intraocular pressure (IOP) varies from patient to patient and is dependent on multiple factors including degree of glaucomatous damage, rate of progression, age and race, central corneal thickness. The purpose of this work is to investigate IOP lowering effect of PGAs added to MS in patients with mild to moderate POAG.

Methods

In a recent large randomized controlled trial (the COMPASS Trial; n = 505, 374 micro‐stent, 131 control), the supracilliary micro‐stent (MS) used in conjunction with phacoemulsification demonstrated superior IOP lowering effectiveness at 24 months compared to phacoemulsification alone (CON) and allowed 85% of patients to remain off of all ocular hypotensives. Despite this success, 8 (2%) patients in the MS group and 15 (11%) in the CON group required a prostaglandin (PGA) in addition to the MS to reach their IOP target. Mean pre‐PGA IOP for MS and CON groups were 24.4 and 18.7 mmHg.

Results

Addition of the PGA resulted in mean percentage IOP reductions of 23% and 18.5% for the MS and CON groups respectively. Measurement of IOP post‐PGA was at 24 months post‐surgical visit so that the duration of treatment with the PGA was variable but was initiated over 3 months earlier, on average, in the CON group than in the MS group.

Conclusions

Addition of a PGA in MS patients provided IOP reductions at least as good and numerically better than for CON patients, albeit somewhat less than IOP reductions observed (~ 30%) for PGA monotherapy when used in the overall OAG population.
Modifications in corneal biomechanics and intraocular pressure after deep sclerectomy
Authors: Ibanez J. , Martinez J. , Perez D. , Sanchez I. , Idoate A. , Berniolles J. , Bartolome I. , Lopez I. , Ascaso Puyuelo F.J.
Published: September 2017

Purpose

To compare preoperative and postoperative measurements of corneal biomechanical properties and intraocular pressure (IOP) using Goldmann applanation tonometry (GAT) and the ocular response analyzer (ORA, Reichert Inc, Depew, NY) in eyes undergoing deep sclerectomy with implant (DSCI).

Methods

Ninety eyes of 90 glaucomatous patients undergoing deep sclerectomy with SNOPER® implant and and 30 eyes of 30 normal subjects were included were included. Goldmann applanation IOP, central corneal thickness (CCT), and ORA measurements [corneal compensated IOP (IOPcc), Goldmann‐correlated IOP (IOPg), corneal resistance factor (CRF), and corneal hysteresis (CH)] were taken the day before deep sclerectomy with collagen implant and on days 1, 8, and 30 and three months after surgery.

Results

Preoperative CH and CRF values of the glaucomatous patients were statistically significantly lower than the values in normal subjects. Corneal hysteresis values increased significantly on day 1 after DSCI, and then showed a statistically significant decrease up to day 30. GAT IOP and all the other ORA parameters changed significantly on day 1 after DSCI, but there was no time effect variation up to 3 months. Only CH showed variations up to 3 months after surgery.

Conclusions

CH statistically increased between preoperative and postoperative day 1 DSCI. On days 8 and 30, the change in CH values was statistically significant.
Glaucoma in screening of diabetic retinopathy programme
Authors: Summanen P. , Kivelä T. , Sipilä V. , Uhlenius N. , von Wendt G.
Published: September 2017

Purpose

To assess the proportion of new glaucoma suspects among diabetic patients aged 18 years or older attending photographic screening for diabetic retinopathy arranged by the City of Helsinki.

Methods

Two 60 degree monochromatic digital fundus images, one macula and the other disc centered were taken with Canon DF‐60 DSi Digital Fundus Camera using a green filter by trained nurses after instillation of mydriatic drops (tropicamide and if needed, cyclopentolate). All images with abnormalities were analyzed by one ophthalmologist. Patients screened during the year 2012 were included in the analysis. Glaucoma suspicion was based on disc hemorrhage and/or glaucomatous cupping and nerve fiber defects.

Results

Of 6937 patients attending fundus photography for screening of diabetic retinopathy, 24 (0,3%) had glaucoma diagnosed earlier and two were currently under examination for glaucoma suspicion. Altogether 520 patients were referred to further examination (7.5%, 95% confidence interval (CI) 6.9‐8.1), and of them the cause for referral was glaucoma suspicion in 50 (9.6, CI 7.3‐12.5). Excluding the known glaucoma patients or those currently under examination, the suspicion of new glaucoma, 50 out of 6911, was 0.72% (95% CI 0.55‐0.95). Ten patients had disc hemorrhage, one advanced nerve fiber defect and the rest suspiciou disc cupping. The majority, 44 patients with glaucoma suspicion had type 2 diabetes, 5 had type 1 diabetes and one had secondary diabetes.

Conclusions

Diabetes is a risk factor of glaucoma and changes related to it are thus not unusual in diabetic population, especially in elderly patients with type 2 diabets. Glaucoma suspicion constituted ca. 10% of all referrals. Graders of fundus images need to be aware of these changes. Known glaucoma patients in ophthalmologist's follow‐up are, however, not expected to attend screening programme.
ISNT rule applicability based on optical coherence tomography parameters in a normal Portuguese population
Authors: Barata A. , Teixeira F. , Pinto F.
Published: September 2017

Purpose

We aim to determine the applicability of the inferior, superior, nasal and temporal neuroretinal rim (NRR) area characteristic configuration (ISNT rule) in adult normal Portuguese population based on spectral‐domain optical coherence tomographic (SD‐OCT) and assess demographic variations by age, sex, race and relation to optic disc area.

Methods

Prospective study with 188 eyes of 94 patients that underwent SD‐OCT with the new glaucoma module premium edition software (v.6.0). Patients with confirmed or suspected glaucoma, visual field defects, other optic disk or retinal abnormalities were excluded. Optic Nerve Head parameters such as Minimum Rim Width (MRW), Bruch's membrane opening (BMO) and thickness of peripapilar nerve fibre layer (RFNL) on four quadrants were analysed.

Results

The mean age group was 55 years, 44% were men, 83% Caucasian and 17% melanodermic. Mean spherical equivalent was 0.10 (min −6.5, max +5), and mean best‐corrected visual acuity was 20/20 (min 20/40, max 20/16). NRR thickness area (MRW) was 376.0 μm ± 75.9, 345.4 μm ± 81.8, 365.1 μm ± 86.8, 240.5 μm ± 57.4, respectively on inferior, superior, nasal and temporal quadrants and ISNT rule was present in 23%. When excluding nasal quadrant (inferior > superior > temporal (IST) or inferior > superior (IS)) such configuration was present in 71% and 73% of patients, respectively. Mean age and mean optic disk/scleral area was higher in those with ISNT rule present (58.8 vs 53.7 years and 2.08 mm² ± 0.4 vs 1.98 mm² ± 0.5, respectively) but was not significant (p > 0.05) as were not sex and race differences.

Conclusions

ISNT rule in normal population is not confirmed by SD‐OCT assessed with ONH parameters and it is only present in 23% of eyes. The authors propose that a “IS/IST rule” seems more representative in a normal population as exclusion of nasal quadrant consideration increases prevalence.