bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced Intraocular Lens Designs
Authors: Buckhurst Phillip J , Naroo Shehzad A , Shah Sunil ,   Clinical Demonstrator, Ophthalmic Research Group, School of Life and Health Sciences, Aston University,   Senior Lecturer, Ophthalmic Research Group, School of Life and Health Sciences, Aston University,   Consultant Ophthalmologist, Ophthalmic Research Group, School of Life and Health Sciences, Aston University, and Midland Eye Institute, Solihull
Published: October 2015

Intraocular lenses (IOLs) have evolved since their introduction and spherical monofocal designs are no longer the only pseudophakic option. IOLs with a toric surface are able to correct astigmatism, but are dependent on the accuracy of placement. Haptic design is very important with toric IOLs as different designs demonstrate different post-operative rotational stability. Multifocal IOLs produce multiple focal points within the eye and so provide the capacity for simultaneous distance and near vision. Various mechanisms for creating these focal points exist, which determine how light is distributed. Accommodating IOLs use the optic shift principle in order to restore the accommodative response. Single and dual optic variations exist; however, the restoration of accommodation has been limited and variable with the current generation of these IOLs. Aspherical IOLs are designed to improve the optical quality of the image created by the IOL. Aspherical correcting IOLs are dependent on their centration and tilt. New phacoemulsification technology allows cataract removal through a sub-2mm incision, and microincisional IOLs can be implanted through these incisions, which results in minimal surgical impact on the cornea. Blue- and violet-blocking IOLs have been introduced, which might help prevent the development of age-related macular degeneration. Light-adjustable lenses are a relatively new technology and allow non-invasive post-operative adjustment of the IOL’s refractive power. This is a fast-moving area of research and development due to the high demands of clinical practice.
New Look at Ocular Inflammation Control – Powerful and Fast-acting Twice-daily Bromfenac for a Novel Standard in the Treatment of Inflammation
Authors: Cho Hyung , Mozayan Arash ,   Surgeon,   Resident, Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx
Published: October 2015

Inflammation in the eye arising from various factors  including allergy, infection, injury and surgery  can have serious consequences, and can continue long after the cause is removed, resulting in permanently damaged vision. The treatment of ophthalmic inflammation after surgery has traditionally consisted of topical corticosteroids, but adverse events such as delayed healing, rise in intraocular pressure and increased susceptibility to microbial infections have driven the search for alternative treatments. Non-steroidal anti-inflammatory drugs (NSAIDs) have been used as alternatives to steroid treatments but also have limitations and cause adverse events. Bromfenac has emerged as a potent and safe treatment for inflammation after cataract surgery. Its unique chemical structure makes it a highly lipophilic molecule that penetrates all major ocular tissues in a rapid and sustained manner. It is also a potent inhibitor of the enzyme cyclo-oxygenase-2, which is believed to be the primary mediator of ocular inflammation. These properties permit less frequent dosing (twice-daily [BID]) and greater patient tolerability. A body of efficacy and safety data support use of bromfenac in this indication and it compares favourably with other NSAIDs and steroids in limiting post-operative inflammation. NSAIDs and corticosteroids have different, potentially synergistic effects. However, benefits specific to NSAIDs include lowering prostaglandin E-induced intraocular pressure elevation, no increased risk of secondary infections and stabilisation of the bloodaqueous barrier. With increasing demand for ophthalmic surgery, bromfenac and other treatments are likely to be important components in the treatment of inflammatory conditions after cataract surgery, decreasing pain and contributing to favourable visual outcomes.
Adverse Effects, Adherence and Cost–Benefits in Glaucoma Treatment
Authors: Denis Philippe ,   University Professor, Hospital Consultant and Head, Ophthalmology Department, Croix-Rousse Hospital, Lyon
Published: October 2015

Intraocular pressure (IOP)-lowering eye drops can prevent glaucoma progression and hence preserve vision, but adherence may be inadequate in as many as 59 % of patients. Improving medication adherence is crucial for effective glaucoma control and represents a major challenge for physicians. Poor adherence, adverse events, poor health literacy and dissatisfaction with treatment are interrelated as well as being important risk factors for disease progression. Some adverse events may also reflect irreversible ocular damage with serious long-term consequences, including worsened outcomes following filtration surgery. Current treatment guidelines call for interventions that can maintain visual function and quality of life at a sustainable cost, including non-financial costs such as inconvenience and adverse events. Accumulating evidence suggests that the choice of first-line therapy is a leading determinant of long-term outcomes and economic costs. Effective early treatment that prevents or delays glaucoma progression could halve the long-term costs of disease management. Selecting an effective and well-tolerated IOP-lowering formulation is thus a vital first step to achieving effective disease control for the patient’s lifetime. A holistic approach to patient management should comprise a straightforward regimen including effective and well-tolerated drugs (and excipients), combined with patient-centred communication to optimise disease understanding. Available data suggest that addressing all known causes of non-adherence from the start may prove to be the best strategy for managing glaucoma. Ongoing research offers potential drug delivery technologies that could increase patient adherence while improving efficacy and decreasing adverse effects and, ultimately, maintaining vision for glaucoma patients. Until these innovations are introduced, we can only choose the best options currently available.
A Brief Review and Re-thinking of Proliferative Vitreoretinopathy
Authors: Pastor J Carlos , Pastor J Carlos , Pastor J Carlos ,   Professor and Chairman of Ophthalmology, University of Valladolid,   Director, Institute of Applied Ophthalmobiology, University of Valladolid,   Head, Ophthalmology, Clinical University Hospital, Valladolid
Published: October 2015

Prevention of proliferative vitreoretinopathy (PVR) continues to be a challenge for retinologists despite almost 30 years of research history. New diagnostic tools, based on the genetic profiles of patients with retinal detachment (RD), are now available. In addition, clinical trials in humans are about to begin of new pharmacological approaches, based on so-called ‘biological agents’. Thus, it might be that, in the near future, it will be possible to reduce the incidence of PVR, which currently accounts for 8–10 % of all cases of RD.
Spectral-domain Optical Coherence Tomography Imaging of Age-related Macular Degeneration
Authors: Filho Carlos Alexandre de Amorim Garcia , Rosenfeld Philip J , Yehoshua Zohar , Gregori Giovanni ,   Postdoctoral Associate,   Professor of Ophthalmology,   Assistant Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine,   Assistant Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
Published: October 2015

Spectral-domain optical coherence tomography (SD-OCT) high-speed, high-resolution imaging of the macula has become an essential tool for evaluating dry and wet age-related macular degeneration (AMD). This high-speed, high-resolution imaging strategy, combined with new innovative algorithms, permits reproducible measurements of the anatomical changes associated with AMD, which include drusen, geographic atrophy (GA) and choroidal neovascularisation (CNV). To visualise drusen and larger retinal pigment epithelial detachments, an algorithm was developed for Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) to detect elevations in the retinal pigment epithelium (RPE). To visualise GA, an algorithm was developed to provide en face visualisation of the macula, which easily identifies and measures areas where the RPE has been lost. To visualise CNV and the associated macular fluid, an algorithm was developed to measure the retinal thickness between the internal limiting membrane and the RPE. No other imaging modality is capable of qualitatively and quantitatively following patients at all stages of AMD, which makes SD-OCT the ideal instrument for following disease progression and the effect of therapies.
CO2 Laser-assisted Sclerectomy Surgery for Open-angle Glaucoma
Authors: Geffen Noa , Ton Yokrat , Muñoz Gonzalo , Mariotti Cesare , Assia Ehud I ,   Department of Ophthalmology, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University,   Department of Ophthalmology, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University,   Department of Refractive Surgery and Glaucoma, Centro Oftalmológico Marqués de Sotelo, Valencia,   Azienda Ospidaliero Universita, Ospedali Riuniti, Universita Politecnica delle Marche, Ancona,   Department of Ophthalmology, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University
Published: October 2015

Purpose:To evaluate the safety and performance of CO2 laser-assisted sclerectomy surgery (CLASS).Materials and Methods:CLASS using the IOPtiMate system was performed in experimental models and in patients with primary and pseudoexfoliative open-angle glaucoma. CO2 laser was used to achieve deep scleral ablation. Percolation and perforation rates were recorded. Histopathological analysis was performed on laboratory models, complications were recorded and postoperative intraocular pressure (IOP) was measured.Results:Deep scleral ablation and aqueous percolation were repeatedly achieved. Histology disclosed deep scleral craters with a thin intact sclero-corneal tissue at the ablation area with mild, transient and limited thermal damage. Thirty of 37 patients with glaucoma completed 12 months of follow-up. The baseline IOP of 26.3 ± 7.8 mmHg (mean ± SD) dropped to 14.4 ± 3.4 mmHg and 14.3 ± 3.1 mmHg at six and 12 months, respectively (p<0.001). Complications were mild and transitory with no sequelae.Conclusions:CLASS using the IOPtiMate system is a safe and efficacious procedure for achieving effective fluid percolation.
Intraocular Lens Calculation After Refractive Surgery
Authors: Haigis Wolfgang ,   Professor, Department of Ophthalmology, University of Wuerzburg
Published: October 2015

More and more patients who have had corneo-refractive surgery present for intraocular lens (IOL) implantation. IOL calculation in these patients is still a challenge. After refractive surgery, if eyes are treated as normal eyes, high hyperopic errors can occur in previously myopic eyes and moderate myopic errors in formerly hyperopic eyes. Three main sources for these errors can be identified: the radius measurement error, the keratometer index error and the IOL formula error. The literature presents a confusing variety of procedures and formulas to cope with this situation. An analysis of the available literature reveals the different methods used to address the individual error contributions, the magnitude of which is assessed by model calculations. The most relevant formulas for clinical practice are the no-history procedures, which require no previous patient data. Using these methods to calculate IOL power after refractive surgery makes it possible to obtain clinical outcomes of a similar quality to that for normal eyes.
Triamcinolone Acetonide for the Treatment of Diabetic Macular Oedema
Authors: Sarao Valentina , Veritti Daniele , Lanzetta Paolo ,   Department of Ophthalmology, University of Udine,   Department of Ophthalmology, University of Udine,   Department of Ophthalmology, University of Udine
Published: October 2015

Diabetic macular oedema is a major cause of severe visual loss whose pathogenesis appears to be complex and multifactorial. For many years laser photocoagulation has been the standard of care for the treatment of this condition. Emerging pharmacologic approaches are being evaluated through randomised controlled trials. Triamcinolone acetonide has been proposed as a promising option, due to its well-known anti-inflammatory, anti-permeability and anti-angiogenic properties. Intravitreal delivery allows bypassing of the bloodretinal barrier to achieve a more concentrated dose of steroid in the vitreal cavity for a prolonged time. Intravitreal triamcinolone acetonide is effective in reducing central macular thickness and improving visual acuity, even if the duration of action is often provisional and requires repeated injections. Drug-related and injection-related side effects have been reported; the most common are induced cataract and increased intraocular pressure. To extend the duration of steroid effects and to minimise the risk of complications, alternative routes of administration and extend-release implants are being investigated.
Vitreomacular Adhesion in Exudative Age-related Macular Degeneration
Authors: Punjab Omar S , Kaiser Peter K ,   Vitreoretinal Fellow, Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic,   Professor of Ophthalmology, Cleveland Clinic Lerner College of Medicine
Published: October 2015

There have been several recent studies that support the idea that posterior vitreomacular adhesion (VMA) might be associated with the development and progression of exudative age-related macular degeneration (AMD). Although VMA itself does not cause exudative AMD, retina specialists should consider the presence or absence of VMA when evaluating and treating patients with exudative AMD. This article reviews the recent literature regarding the posterior hyaloid and its relationship to exudative AMD.
Biomarkers In Dry Eye Disease
Authors: Lemp Michael A , Sullivan Benjamin D , Crews Leslie A ,   Chief Medical Officer, TearLab Corporation, California and Clinical Professor of Ophthalmology, Department of Ophthalmology, Georgetown University and Department of Ophthalmology, George Washington University, Washington DC,   Chief Scientific Officer, TearLab Corporation, California,   Consultant, TearLab Corporation, California, US
Published: October 2015

Dry eye disease is a multifactorial chronic disorder of the ocular surface that affects up to 100 million people worldwide. During the pathogenesis of dry eye, impaired function of the lacrimal and meibomian glands results in hyposecretion of aqueous tear fluid, coupled with increased evaporation and instability of the tear film, which becomes increasingly hyperosmolar in character at more severe stages of disease. One critical issue in the field is that the commonly used clinical signs and symptoms for the diagnosis or classification of dry eye often do not correlate with one another. This underscores the need to systematically evaluate current tests and highlights the importance of developing new markers of disease progression for use as endpoints in clinical trials of diagnostic devices and potential therapeutics. In this review, we examine the utility and limitations of commonly used signs and symptoms of dry eye disease and comment on newer biomarkers and analytical devices that show promise for future diagnostic and therapeutic use.
Nepafenac in the Prevention and Treatment of Ocular Inflammation and Pain Following Cataract Surgery and in the Prevention of Post-operative Macular Oedema in Diabetic Patients
Authors: Nardi Marco ,   Professor of Ophthalmology, Ophthalmology Unit, Neuroscience Department, University of Pisa, Pisa, Italy
Published: October 2015

Nepafenac ophthalmic suspension is a topical non-steroidal anti-inflammatory drug (NSAID) approved in the US and Europe for prevention and treatment of post-operative pain and inflammation associated with cataract surgery, and recently approved in Europe for reduction in risk of post-operative macular oedema associated with cataract surgery in diabetic patients. Unlike conventional NSAIDs, nepafenac is a prodrug that is uncharged and this results in great corneal permeability. Experimental studies on nepafenac demonstrated enhanced permeability compared with other NSAIDs, and rapid bioactivation to amfenac by intraocular hydrolases within ocular tissues including ciliary body epithelium, retina, choroid and cornea, which results in targeted delivery of active drug to anterior and posterior segments. Furthermore, these study results have been confirmed in clinical trials. Nepafenac may have prolonged activity in vascularised tissues of the eye because bioconversion is targeted to the iris/ciliary body, and to a greater extent the retina and choroid. Nepafenac and amfenac are potent inhibitors of cyclo-oxygenase (COX) enzyme isoforms, COX-1 and COX-2. Topical nepafenac penetrated into the posterior segment in a rabbit model of concanavalin-A induced retinal inflammation, where it diminished vitreous protein and prostaglandin E2concentrations and reduced breakdown of the blood–retinal barrier. Other NSAIDs, including ketorolac, failed to reduce the increase of these inflammatory markers in the same study. A randomised clinical study showed that based on retinal thickening and vision, treatment with nepafenac beginning pre-surgery and used for up to 90 days post-cataract surgery is effective in preventing macular oedema and associated loss of visual acuity in diabetic patients.
Pathogenesis of Pseudophakic Cystoid Macular Oedema
Authors: Lobo Conceição ,   Ophthalmologist, Department of Ophthalmology, University Hospital of Coimbra; Principal Investigator, Association for Innovation and Biomedical Research on Light and Image (AIBILI) and Institute of Biomedical Research on Light and Image (IBILI); and Invited Professor of Ophthalmology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Published: October 2015

Cystoid macular oedema (CMO) is a primary cause of reduced vision after cataract surgery even after uneventful surgery. The incidence of clinical CMO following modern cataract surgery is 1.0–2.0 % but the high number of surgeries performed worldwide makes this entity an important problem. Pre-existing conditions such as diabetes and intra-operative complications increase the risk of developing CMO post-operatively. CMO is caused by an accumulation of intra-retinal fluid in the outer plexiform and inner nuclear layers of the retina, as a result of the breakdown of the blood–retinal barrier. The mechanisms that lead to this condition are not completely understood. However, the principal hypothesis is that the surgical procedure is responsible for the release of inflammatory mediators, such as prostaglandins. Optical coherence tomography is at present an extremely useful non-invasive diagnostic tool. Guidelines for the management CMO should be focused essentially on prevention and are based on the principal pathogenetic mechanisms, including the use of anti-inflammatory drugs.
The Role of Optical Coherence Tomography in the Diagnosis of Early Age-related Maculopathy
Authors: Heng Ling Zhi , Sivaprasad Sobha ,   Clinical Research Fellow,   Consultant Ophthalmologist, National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
Published: October 2015

There has been increasing interest in improving imaging technologies to identify and grade early age-related maculopathy (ARM). Recently, advances in optical coherence tomography (OCT) has allowed a virtual biopsy of the retina and identification of different types of drusen in relation to early ARM. Several investigators have improved our understanding of both the qualitative and quantitative analyses of drusen, the clinical hallmark of ARM. The purpose of this article is to critically review the current literature in OCT in the evaluation of early ARM. Although seemingly useful and ideal, the current analysis of the retina using OCT is highly complex and lacking. It is currently too premature to use OCT as a grading tool for early ARM. However, the authors are hopeful that the rapid progress in this field will enable the use of an OCT-defined outcome measure in early ARM clinical trials in the foreseeable future.
Evaluation of the Optic Nerve and Retinal Nerve Fibre Layer in Myopic Individuals
Authors: Aref Ahmad A , Budenz Donald L ,   Assistant Professor, University of Illinois Eye and Ear Infirmary, Chicago, US,   Professor and Chairman, Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, US
Published: October 2015

Clinical discrimination between myopic tilted optic discs and glaucomatous optic neuropathy is often challenging, especially when considering that myopia is a risk factor for the development of glaucoma. Myopic tilted discs are usually larger than average, with associated relative cupping and thinner neuroretinal rim tissue. Histopathological study has revealed thinner parapapillary retinal tissue in these eyes. Optical coherence tomography (OCT)-measured average retinal nerve fibre layer (RNFL) thickness has been found to decrease with longer axial length and higher myopic refractive error. Parapapillary RNFL quadrant and clock-hour analyses result in a higher false-positive rate in myopic eyes. Careful slit-lamp examination, quality baseline stereoscopic disc photographs and frequent serial visual field testing are essential to the follow-up of myopic individuals with suspected glaucoma. A novel diagnostic parameter, OCT-derived ganglion cell analysis, may prove to be useful in the diagnosis and follow-up of these individuals.
Tractional Maculopathies in Age-related Macular Degeneration
Authors: Qian Cynthia X , Foster William J , Rezende Flavio A ,   Chief Resident, Department of Ophthalmology, University of Montreal, Quebec, Canada,   Associate Professor, Department of Ophthalmology, Weill-Cornell Medical College at The Methodist Hospital, Houston, US,   Associate Professor, Department of Ophthalmology, Weill-Cornell Medical College at The Methodist Hospital, Houston, US,   Associate Professor, Department of Physics, The University of Houston, Texas, US,   Associate Professor, The Methodist Hospital Research Institute, Houston, Texas, US,   Chief Resident, Department of Ophthalmology, University of Montreal, Quebec, Canada,   Associate Professor, Department of Ophthalmology, University of Montreal, Quebec, Canada
Published: October 2015

Age-related macular degeneration (AMD) is the leading cause of blindness among the elderly in developed countries. Much progress has been and continues to be made in search of better visual outcomes for dry and exudative AMD. Over the past decade, the importance of vitreomacular attachments has been recognised in AMD. In this article, the authors better characterise and describe vitreomacular and photoreceptor-retinal pigment epithelium interface relationships in AMD among treated and untreated patients and describe the surgical options available as well as their outcomes and possible complications.
The Effectiveness of Trans-scleral Cyclodiode Treatment
Authors: Samia-Aly Emma , Shahid Humma ,   University of Cambridge Medical School,   Addenbrookes Hospital, Cambridge, UK
Published: October 2015

Transcleral cyclodiode laser treatment is increasingly being used in the management of complex glaucoma. This review discusses the literature with reference to the effectiveness of this treatment modality as well as its potential limitations.
Ocular Surface Disorders and Cataract and Refractive Surgery Success
Authors: Vergés Carlos ,   Professor and Chairman of Ophthalmology, Area Oftalmológica Avanzada, Universidad Politécnica de Cataluña, Barcelona, Spain
Published: October 2015

Many ophthalmologists stress the importance to success of considering the state of the ocular surface in cataract and refractive surgery. The problem is that surgeons do not always attach the same required attention and there is not a well-defined protocol for diagnosis and treatment of ocular surface disorders. This article aims to highlight these facts and provide a guide, both simple and practical, for both diagnosis and for treatment.
Diagnosis and Management of Uveal Melanoma
Authors: Koopmans Anna E , Klein Annelies de , Naus Nicole C , Kilic Emine ,   Medical Doctor, Department of Clinical Genetics and Ophthalmology,   Associate Professor, Department of Clinical Genetics,   Ophthalmologist, Department of Ocular Oncology, Erasmus Medical University Centre, Rotterdam, the Netherlands,   Ophthalmologist, Department of Ocular Oncology, Erasmus Medical University Centre, Rotterdam, the Netherlands
Published: October 2015

Uveal melanoma (UM) is the most common cause of primary eye cancer in the developed world. UM may arise in the iris, ciliary body or choroid. Choroidal melanomas are the most frequent and usually display a discoid, dome- or mushroom-shaped growth pattern. Diagnosis is based on a clinical examination with the slit lamp and indirect ophthalmoscope together with ultrasonography of the eye. Despite improvements of primary treatment and a shift towards more conservative eye treatments, survival has not improved during the past decades. Aims of conservative treatment of UM are to elucidate the tumour and to retain the eye and in some cases the visual function. Primary treatment of UM consists of several options such as brachytherapy with either ruthenium-106 (Ru-106) and iodine-125 (I-125) isotopes, transpupillary therapy, proton beam therapy, stereotactic radiotherapy, photodynamic therapy and surgical excision. Enucleation must be reserved for patients with large or advanced tumours, or when extraocular extension is present.
Current Ophthalmic Management for Retinal Vein Occlusion
Authors: Mall Sonia P , Kiire Christine A , Chong N Victor ,   Ophthalmic Specialty Trainee Yr 7,   Ophthalmic Specialty Trainee Yr 6,   Consultant Ophthalmic Surgeon, Oxford Eye Hospital, Oxford University Hospitals, Oxford, UK
Published: October 2015

Retinal vein occlusion is associated with ocular morbidity and blindness as a result of macular oedema, macular ischaemia and neovascular glaucoma. New treatment options have become available, particularly for the management of the associated macula oedema; however, there is no consensus as to the best therapeutic option. Ongoing trials will provide further evidence to aid decision-making as to the most cost-effective treatment option with the best visual outcome. We present a synopsis of the most recent trial data for the management of retinal vein occlusion. At present it is recommended that treatment choices are tailored to individual patient needs.
New Developments in the Lenticule Extraction Procedure
Authors: Hjortdal Jesper , Ivarsen Anders ,   Clinical Professor,   Assistant Professor, Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
Published: October 2015

For the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia and astigmatism. Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient and safe procedure for correction of myopia and astigmatism. Technological developments related to further improved cutting quality, hyperopic and individualised treatments are desirable.
Diabetic Macular Oedema and the Importance of Vascular Endothelial Growth Factor Therapies in its Treatment
Authors: Wolf Sebastian ,   Director and Chief Physician, Department of Ophthalmology, Inselspital, University Hospital and University Bern, Bern, Switzerland
Published: October 2015

Diabetic macular oedema (DMO) is a major cause of blindness that has an increasing prevalence associated with the general population in diabetes worldwide. In DMO, increased expression of factors including vascular endothelial growth factor (VEGF) disrupts the blood retina barrier causing leakage and accumulation of extracellular fluid in the macula with resultant loss of vision. Focal and grid laser photocoagulation has been used to treat DMO for many years, but can cause scarring and atrophy. Vitrectomy is also associated with undesirable effects and its use is mainly confined to tractional DMO cases. Intravitreal steroids have been used successfully but are associated with increased intraocular pressure and cataracts. The intravitreal anti-VEGF treatments have shown improved vision and reduced macular thickness in DMO with good tolerability. Among these, ranibizumab is the only treatment approved in the US and EU for this indication. Its use is supported by extensive clinical trials in which it was shown to be effective with or without laser treatment. Ranibizumab is cost-effective and is likely to have a continuing role in DMO therapy.
The First Decade of Global Trabectome Outcomes
Authors: Mosaed Sameh ,   Associate Professor, Cataract and Glaucoma Surgery, Ophthalmology, Director of Glaucoma Services, Department of Ophthalmology, Director of Glaucoma, Long Beach Veterans Hospital; Director of Glaucoma Fellowship, Department of Ophthalmology, Gavin Herbert Eye Institute, Department of Ophthalmology, School of Medicine, University of California, Irvine, US
Published: October 2015

Purpose:To present available primary outcome results of global Trabectome experience for patients receiving Trabectome procedure including cases with up to 90 months of follow-up.Method:A total of 5,435 cases were included in the study. Baseline demographics were collected and outcome measures included intraocular pressure (IOP), number of glaucoma medications and secondary glaucoma surgery, if any. Survival analysis was performed and success was defined as IOP ≤21 mmHg, at least 20 % of IOP reduction from baseline, and no additional glaucoma surgery.Results:At 90 months, IOP was reduced from 23.0±7.9 mmHg to 16.5±3.8 mmHg (29 %) and the number of glaucoma medications was reduced from 2.6±1.3 to 1.6±1.3 (38 %). At 90 months, the survival rates were 60 % for all cases, 76 % for combined cases and 50 % for Trabectome alone cases.Discussion:These results are generally consistent with previously published outcome results for patients receiving the Trabectome procedure.Conclusion:Considering this outcome analysis of the available global Trabectome experience in combination with outcome data surveyed from the literature, patients receiving Trabectome on average have about a 30 % reduction in IOP and a 60 % reduction in glaucoma medication. The Trabectome procedure can be considered for initial glaucoma therapy, as well as for end-stage patients who have been refractory to other surgical and medical treatments.
Visual Function and Structure Outcomes in a Patient with Diabetic Macular Oedema Insufficiently Responsive to Available Therapies – Treatment with Fluocinolone Acetonide Implant
Authors: Guerreiro Paulo Érica ABC , Eckardt Claus ,   Ophthalmology Resident, Department of Ophthalmology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany,   Chief, Department of Ophthalmology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
Published: October 2015

Importance:Early experience with intraocular, non-biodegradable fluocinolone acetonide (FAc) (0.2 μg/day) implant (ILUVIEN®), comparing visual function before and after treatment in an insufficiently responsive diabetic macular oedema (DMO) patient.Observations:This 62-yearold male patient with type 2 diabetes mellitus was first treated for DMO in 2004, when best corrected visual acuity (BCVA) was 0.8 for his right eye. He did not visit an ophthalmologist again until 2011 when BCVA had declined to 0.2. Three separate, monthly intravitreal (IV) ranibizumab injections and additional laser photocoagulation resulted in no improvement. Subsequently, 0.7 mg IV dexamethasone was administered, giving short-term DMO improvement. However, six further IV ranibizumab injections produced no effect and a combined injection of IV ranibizumab with 0.7 mg IV dexamethasone provided only short-term improvements. Following phacoemulsification, a 0.2 μg/day FAc implant was administered. Optical coherence tomography (OCT) indicated complete DMO regression after 3 weeks, sustained 6 months post-implant. BCVA improved to 0.25 and the patient reported greater vision-related quality of life. Intraocular pressure increased gradually but resolved with daily timolol/dorzolamide and tafluoprost eye drops.Conclusions and relevance:In a DMO patient showing insufficient response to IV ranibizumab and dexamethasone injections, FAc implant provided an effective therapeutic option with manageable side effects.
An Overview of Intravitreal Aflibercept in Diabetic Macular Oedema
Authors: Korobelnik Jean-François , Wolf Sebastian ,   Professor, Université de Bordeaux, Bordeaux, France,   INSERM (Institut National de la Santé et de la Recherche Médicale), ISPED (Institut de Santé Publique d’épidémiologie et de éveloppement), Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France,   Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d’Ophtalmologie, Bordeaux, France,   Director and Chief Physician, Department of Ophthalmology, Inselspital, University Hospital and University Bern, Bern, Switzerland
Published: October 2015

Diabetic macular oedema (DMO) is responsible for much of the vision loss associated with diabetic retinopathy, which is the leading cause of blindness in working-age adults. Approximately 21 million people worldwide have DMO. The standard of care for DMO has been laser photocoagulation: this option has only a limited ability to reverse vision loss and is associated with a risk of scarring and complications. Corticosteroids have also been used in DMO treatment, but are associated with side effects such as elevated intraocular pressure and cataract. Knowledge of the role of vascular endothelial growth factor (VEGF) in the pathogenesis of DMO has led to the widespread use of anti-VEGF agents. Intravitreal bevacizumab, which is not approved for any retinal disorders, is used off-label for the treatment of DMO. Intravitreal ranibizumab (IVT-AFL) (once monthly) and intravitreal aflibercept (once every 2 months after a loading dose) have been approved for the treatment of DMO. This review summarises the clinical evidence supporting the role of IVT-AFL in the treatment of DMO. Analysis of efficacy and safety data suggests that aflibercept could be used as a first-line treatment in DMO.
Real-world Experience of Fluocinolone Acetonide (0.2 μg/day) Intravitreal Implant in the Treatment of Diabetic Macular Oedema
Authors: Quhill Fahd ,   Consultant, Department of Ophthalmology, Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire, UK
Published: October 2015

Fluocinolone acetonide intravitreal implant (ILUVIENR, FAc intravitreal implant) is approved for clinical use in Europe and US for the treatment of diabetic macular oedema (DMO). In Europe, the implant is indicated for chronic DMO patients who are insufficiently responsive to available therapies. The use of FAc intravitreal implants has been shown to be effective in pivotal clinical trial studies. Case reports and case series of FAc intravitreal implants in chronic DMO are now emerging and combined analysis of these reveals interesting findings that complement the findings in the clinical studies. Visual improvement and central retinal thickness reductions are similar to those of the clinical trials, which is surprising given that treatments often perform less well in the real-world. In addition, the incidence of intraocular pressure (IOP) elevations is lower than reported in the clinical studies. However, further follow-up is ongoing and this needs to be confirmed in a larger population of subjects. This article reviews some of these important real-world data and their likely impact on future chronic DMO treatment practice as well as the impact in terms of the functional benefit to patients with impaired vision.
Microincision Vitrectomy Trocars – Redefining Surgical Practices Through a New Range of Applications
Authors: Marques João Pedro , Azenha Cátia , Figueira João ,   Ophthalmologist, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal,   Ophthalmologist, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal,   Ophthalmologist, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal,   Professor of Ophthalmology, Faculty of Medicine of the University of Coimbra (FMUC), Coimbra, Portugal
Published: October 2015

Transconjunctival microincision vitrectomy surgery (MIVS) has grown increasingly popular among vitreoretinal surgeons over the last few years. Technical advances have led to the development of cutting-edge vitrectomy systems and instruments that significantly contributed to the success of MIVS. Trocar evolution has added extra safeness and effectiveness to the technique. In the hands of an experienced surgeon, microincision vitrectomy trocars offer a new range of applications that can redefine surgical practices and facilitate otherwise complex surgical techniques.
Wheezing Phenotypes in Childhood – Is it Already Asthma?
Authors: Morais-Almeida Mário , Pité Helena ,   Head of the Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal,   CINTESIS – Center for Research in Health Technologies and Information Systems – Faculty of Medicine, University of Porto, Porto, Portugal,   Specialist in Immunoallergy, Allergy Center, CUF Descobertas and CUF Infante Santo Hospital, Lisbon, Portugal,   PhD Student, CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Published: October 2015

Wheezing in early childhood is common but highly heterogeneous. Distinguishing early wheeze phenotypes to predict long-term asthma persistence is of major clinical relevance. The comprehensive analysis of longitudinal datasets, including novel ‘unbiased’ statistical approaches to detect clusters from objective data, may allow better comparisons in different population settings. The recognition of such distinct outcome groups is valuable for parents’ informed counselling and a prerequisite for phenotype-specific tailored interventional measures to reduce asthma burden from paediatric age until adulthood.
Tuberculosis Multidrug-resistant Tuberculosis – From Epidemiology to Treatment Design
Authors: Zellweger Jean-Pierre ,   Consultant, TB Competence Centre, Swiss Lung Association, Berne, Switzerland
Published: October 2015

Multidrug-resistant tuberculosis (MDR-TB) and extensively resistant tuberculosis (XDR-TB) are present in most regions of the world and represent a serious threat to the control of tuberculosis. They usually result from errors somewhere along the chain of management of the disease that favoured the selection of resistant mutants, progressively replacing drug-sensitive strains and transmitted to further patients. The currently recommended strategies for the control of this serious situation is the rapid identification of drug-resistant strains, careful drug management of patients with second-line drugs and prevention of the transmission of mycobacteria to contacts. Optimal selection and number of drugs and duration of treatment are not clearly defined. Prevention of the creation of additional cases of MDR-TB is crucial.
Colorectal Liver Metastases—Enhancing Outcomes Through Combination Treatments
Authors: Taylor Irving ,   Professor of Surgery, Vice Dean, and Director of Clinical Studies, Division of Surgery and Interventional Science, University College London
Published: October 2015

Colorectal liver metastases are common and should be considered for treatment in a multidisciplinary setting. Surgery is the treatment of choice providing the metastases are resectable. In recent years the benefit of neoadjuvant chemotherapy has been established to downstage metastases and render them amenable to surgical excision. This aspect, as well as the role of adjuvant chemotherapy, is discussed and critically appraised in this article.
Therapeutic Approach to Castration-resistant Prostate Cancer
Authors: Saad Fred ,   Professor of Surgery/Urology, University of Montréal
Published: October 2015

Androgen deprivation therapy (ADT) has been and continues to be the most common treatment for men with advanced prostate cancer and is now used earlier in the continuum of care for prostate cancer. Unfortunately, the majority of prostate cancer patients on ADT will develop a castration-resistant form of the disease that is responsible for the majority of the morbidity and mortality related to prostate cancer. Given recent advances, there are now therapeutic options available that can reduce the morbidity and improve survival in patients with castrationresistant prostate cancer (CRPC). Research is intensifying in this area and further improvements can be expected in the near future. This review will briefly summarize what is currently available and propose strategies for the management of CRPC.
Pre-operative Targeted Therapies in Patients with Hepatic Colorectal Cancer Metastases—Bevacizumab versus Cetuximab
Authors: Aubin Francine , Blanke Charles D ,   Gastrointestinal Oncology Fellow, British Columbia Cancer Agency,   Head, Division of Medical Oncology, University of British Columbia, and Head, Medical Oncology, British Columbia Cancer Agency
Published: October 2015

Complete resection offers the greatest chance of cure for patients with isolated colorectal cancer liver metastases. While few patients present as candidates for curative surgery, induction chemotherapy may make patients with initially unresectable disease amenable to surgery. Even those whose disease is potentially curable at presentation may benefit from pre-operative neoadjuvant systemic therapy, particularly those deemed at high risk for relapse. Biological targeted therapies such as bevacizumab and cetuximab improve on standard systemic chemotherapeutic regimens in incurable patients; the rationale for their pre-operative use is also strong. Uncertainties remain as to which (if either) agent to preferentially use and their ultimate role in this setting must be better defined. This article reviews the concepts behind, and current data on, the use of pre-operative cetuximab and bevacizumab in patients with hepatic colorectal cancer metastases.
A Comparison of Mineral Bone Graft Substitutes for Bone Defects
Authors: Allison Daniel C , Lindberg Antoinette W , Samimi Babak , Mirzayan Raffy , Menendez Lawrence R ,   Assistant Director and Attending Surgeon, Division of Musculoskeletal Oncology,   Resident Surgeon, Department of Orthopedics, University of Southern California and Los Angeles County Medical Center,   Attending Surgeon, Samimi Orthopedic Group, West Covina,   Attending Surgeon, Department of Orthopedics, Southern California Permanente Medical Group and University of Southern California and Los Angeles County Medical Center,   Professor and Attending Surgeon, Department of Orthopedics, and Chief, Division of Musculoskeletal Oncology, University of Southern California and Los Angeles County Medical Center
Published: October 2015

Synthetic bone graft substitutes have evolved in response to the downsides of autograft and allograft. This article consolidates the literature regarding the use of mineral bone graft substitutes in the treatment of cavitary bone defects. No level I studies regarding their use in the treatment of bone tumors have been performed, but the clinical studies that have been published indicate that calcium sulfate resorbs too quickly and incites inflammatory reaction and hydroxyapatite resorbs too slowly and blocks new bone ingrowth; tricalcium phosphate and mineral bone graft composites have the biochemical profile that is most compatible with new bone formation. These studies also indicate that mineral bone grafts are safe and may be as effective as other graft options; however, radiographic interpretation may be inaccurate and no evidence exists to suggest that mineral bone graft substitutes are superior to no graft at all. The trauma literature has yielded numerous level I studies that indicate that calcium phosphate cements result in increased metaphyseal fracture stability, but have not yet detected any improvement in healing. Prospective randomized clinical trials in the treatment of bone tumors are necessary to properly delineate the real indications for bone grafting and to demonstrate the graft’s efficacy in this regard.
Treating Endometrial Adenocarcinoma—Do Data Support the Use of Pegylated Liposomal Doxorubicin?
Authors: Sakr Bachir J , Dizon Don S ,   Hematology and Oncology Specialist, Program in Women’s Oncology, Women and Infants Hospital of Rhode Island,   Director, Medical Oncology, Program in Women’s Oncology, Women and Infants Hospital of Rhode Island and Assistant Professor of Medicine, and Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University
Published: October 2015

Most women who are diagnosed with endometrial carcinoma present at an early stage and are usually cured of their disease by surgery with or without adjuvant radiation therapy and/or chemotherapy. For those patients who present with advanced disease or develop recurrent disease, survival is greatly diminished. Chemotherapy plays an important role in the management of these patients. Doxorubicin is one of the most active chemotherapy drugs in the advanced or recurrent setting, with response rates in the order of 25%. The use of doxorubicin is limited by its cumulative dose-dependent cardiotoxicity. Pegylated liposomal doxorubicin is a newer formulation of conventional doxorubicin. Its altered pharmacokinetics result in a longer half-life, decreased exposure in healthy tissues, and enhanced delivery of the active drug to the tumor bed. Pegylated liposomal doxorubicin has a relatively milder toxicity profile and a lower incidence of cardiac adverse events. In this article the data on the use of pegylated liposomal doxorubicin in advanced or recurrent endometrial cancer, including the serous papillary histologic variant, are reviewed.
Inflammation and Acute Venous Thrombosis
Authors: Diaz Jose Antonio ,   Research Investigator, Department of Surgery, Section of Vascular Surgery, and Conrad Jobst Vascular Research Laboratories, University of Michigan
Published: October 2015

Inflammation is known as a controlled response to an injury that protects against further injury and clears damaged tissue. However, uncontrolled inflammation can lead to a marked breakdown of the extracellular matrix as well as organ destruction. Stewart et al. demonstrated in a vein thrombosis model that leukocytes migrate into vein walls with an intact layer of endothelial cells, subsequently linking inflammation and thrombosis. Since then, multiple studies have reported on the interaction between inflammation and vein thrombosis. This article summarizes published material that assesses the relationship between inflammation and acute vein thrombosis. The article will focus on the role of endothelial cells, leukocytes, platelets, and microparticles in acute vein thrombosis and discuss the role of thrombin, P-selectin, platelet-activating factor, endothelin-1, and nitric oxide from the perspective of inflammation.