bluuebunny/crossref_metadata_2025 huggingface dataset:
Spherical aberration: Friend or Foe ?
Authors: NOCHEZ Y , MAJZOUB S , PISELLA PJ
Published: December 2011

Purpose To determine the level of residual spherical aberration that gives the best objective and subjective quality of image after cataract surgery with intraocular lens (IOL) implantation.

Methods Six months after microincision (1.8 mm) cataract surgery with aspheric IOL implantation, total aberrations were computed using a Wavescan aberrometer. The modulation transfer function (MTF), Strehl ratio, and objective index of scattering were measured using the Objective Quality Analysis System. Objective depth of focus was computed as the focus range at which the Strehl ratio did not fall below 50% of maximum. Subjective depth of focus was calculated as the difference between the vergence of the punctum remotum and that of the punctum proximum.

Results Thirty patients (54 eyes) were evaluated. The MTF cutoff values were higher with decreasing total ocular spherical aberration (r = 0.56; P<.05). Objective and subjective depth of focus were positively correlated with total spherical aberration (r = 0.26 and r = 0.46, respectively; P<.05).

Conclusion A final spherical aberration of zero obtained by compensation of IOL asphericity gave the greatest improvement in objective quality of vision and better MTF contrast. However, a final target ocular spherical aberration between 0.07 μm and 0.10 μm should be considered to be the best compromise between subjective depth of focus and objective contrast sensitivity.
Low pressure glaucoma: patients threatened of vision worsening and blindness
Authors: VASSILEVA P
Published: December 2011

Purpose To study the presence of systemic diseases in low pressure glaucoma (LPG) and primary open‐angle glaucoma (OAG) patients, and the specific characteristics of functional and structural damages in those two types of glaucoma.

Methods all consecutive glaucoma patients diagnosed and treated for a period of 6 months (October 2010 – March 2011). They were evaluated by routine methods and stereoscopic examination of the optic nerve, computer perimetry (Humphrey) and Stratus OCT. The existence of systemic diseases has been studied in details in all patients, with emphasis on vascular risk factors. Additional specialized consultations and examinations were conducted.

Results IOP was lower than the statistically defined normal IOP values in 44 (55%) out of 80 studied patients. Within this group of LPG patients we established the presence of specific topographic changes in the optic nerve and typical changes in the layer of ganglion cells and nerve fibers. In compliant patients with disease progress and IOP values between 19‐20 mm, we established significantly higher prevalence of systemic diseases leading to general and local ischemia: uncontrolled blood pressure, diabetes mellitus, etc. We followed also the subsequent functional differences in the development of damage in optic nerve and visual field in the two groups.

Conclusion Until recently, IOP has been considered the only factor for control and prevention of glaucomatous damage. Literature data and our observations explicitly demonstrate the existence of additional risk factors in the pathogenesis of glaucoma, indicating for the necessity of lower level of IOP. Preserving vision and quality of life of patients depends both on the timely decision for lower IOP target in patients with LPG and inju
Ocular response analyzer in pre‐perimetric glaucoma
Authors: MAY F , GIRAUD JM , HAMAM O , FENOLLAND JR , SENDON D , MOUINGA A , RENARD JP
Published: December 2011

Purpose To compare corneal biomechanical parameters measured by Ocular Response Analyzer (ORA) in pre‐perimetric glaucoma eyes (PPG), versus intra‐ocular hypertension (OHT), open angle glaucoma (OAG) and normal subjects (NS).

Methods Comparative study including 317 eyes: 165 normal (NS), 64 OHT, 46 OAG and 42 PPG. PPG criteria: intra‐ocular pressure (IOP) > 21 mm Hg, glaucomatous alterations of the optic disc and no visual field defect. Measured parameters: corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated IOP (IOPg), corneal compensated IOP (IOPcc), IOP by Goldmann aplanation tonometry (GAT) and central corneal thickness (CCT). Statistical analysis used non parametric tests and significant p value < 0,05.

Results Whatever the parameter, there is no significant difference between PPG and OAG groups. GPP mean CH value (9,5 ± 1,5) was statistically different compared with NS (10,2 ±1,5), but no difference was found with OHT (9,6 ± 2) or with OAG (9,2 ± 1,8). No significant difference was found between PPG mean CRF value (10,2 ± 1,6) and those measured in NS ( 10,1 ±1,6), OHT ( 10,9 ± 2,1), and OAG (9,9 ± 1,5). PPG mean CCT (533 ± 39 µm) value was different only from OHT (552 ± 46 µm). For IOP parameters (IOPg, IOPcc, TAG), PPG eyes presented no difference with OAG eyes, but there was difference with OHT and with NS. Whatever the parameter, there was a great overlap of values between groups. Previous reports have demonstrated that CH is lower in OAG, and CRF higher in OHT. This study found that PPG eyes have the same corneal biomechanical parameters as OAG, and that PPG presents difference with OHT (CCT) and with normal eyes (CH).

Conclusion ORA seems to be useful for early diagnosis of pre‐perimetric glaucoma.
Compared effectiveness of brilliant blue G for internal limiting membrane peeling in idiopathic epiretinal membrane in novice and experimented surgeons
Authors: CREUZOT C , KOEHRER P , DUGAS B , PASSEMARD M , BRON AM
Published: December 2011

Purpose To evaluate the reliability of expected peeled surface after internal limiting membrane (ILM) removal by junior and senior surgeons with or without Brilliant Blue G (BBG) dye.

Methods We conducted a prospective study based on videorecordings of epiretinal membrane surgeries. Surgeries were performed by a senior vitreoretinal surgeon (SS) and two junior surgeons (JS). Patients were included into two groups: SS(group 1) and JS(group 2). In each surgery, after the ILM peeling, the surgeon described the expected peeled area (A1). Then, the instillation of brilliant blue G stained the actual peeled area (A2). The third area (A3) corresponded to the additional surface peeled with the help of BBG. Areas were measured in square millimeters using the software ImageJ 1.43 µ.

Results 15 patients were included in each group. In the group 1, A1 was 15.1+/‐5.1 mm2, A2 was 13.0+/‐8.0 mm2 and A3 was 16.3+/‐5.0 mm2. In the group 2, A1 was 6.5+/‐4.4 mm2, A2 was 5.9+/‐5.3 mm2 and A3 was 11.2+/‐5.1 mm2. In both groups, there was no stastical difference between A1 and A2 (P = 0.1875 and P = 0.5186 respectivally in group 1 and 2). A2 in the group 1 was significantly larger than A2 in the group 2 (P = 0.0195)as well as A3 (P = 0.0166).

Conclusion In our study, both senior and junior surgeons were able to determine the surface of ILM peeled without BBG. However, the surface of ILM peeled with the dye was larger with BBG with both junior and senior surgeons.
Customized intraocular telescope implanted in high myopic patients with advanced maculopathy
Authors: NAVEA TEJERINA A , MORALES J , FELIPE A , ARTIGAS VERDE JM
Published: December 2011

Purpose To evaluate the results of intraocular personalized telescope implantation to improve distance best corrected visual acuity (BCVA) in high myopic patients having cataract surgery.

Methods This prospective non randomized observational study included 16 eyes of 9 consecutive patients with advanced maculopathy associate to high myopia having cataract surgery. Bilateral implantation of the intraocular telescope was performed after phacoemulsification in patients having the requisites. The telescope consists of two lenses a positive high power lens is implanted in the anterior chamber and a negative one is implanted in the posterior chamber. The lenses power, magnification and residual refraction were calculated for each eye using our own software. A complete ophthalmologic exploration and measurements of eye characteristics (keratometry, axial length…) refraction and VA were performed to the eye both before and after surgery.

Results The mean preoperative BCVA was 2/43. The mean postoperative BCVA was of 2/5 or better in 35% of eyes and 2/12.5 or better in 60%. The mean VA was 2/20 and only one eye had VA less than 2/40 (also before surgery). The prediction for the mean residual refraction (spherical equivalent, SE) was of ‐1.5 diopters (0.8 standard deviation, SD) and the achieved mean refraction was of ‐0.58 diopters SE (1.8 SD).

Conclusion Intraocular personalized telescope is an effective option for these low vision patients; which improves magnification and distance VA without significant adverse effects in one year follow up.
Reasons for reduced vision after anatomically successful retinal detachment surgery
Authors: CHALKIA A , TSIKA C , CHARISSIS SK , AGOROGIANNIS GI , TSILIMBARIS MK
Published: December 2011

Purpose To identify the cause of reduced visual acuity in patients with successful anatomical result after retinal detachment surgery.

Methods We retrospectively reviewed files of patients that underwent retinal detachment surgery in our clinic. Patients with anatomically successful operation and a postoperative visual acuity ≥ 0.18 logMAR were identified. Patients were called and they underwent thorough re‐examination including BCVA after refraction, slit lamp examination, fundus biomicroscopy, OCT and fluorescein angiography if considered necessary.

Results We reviewed the files of 78 patients with anatomically successful operation. 26 patients (33%) had a visual acuity better than 0.18 LogMAR. The remaining 52 (67%) patients had a visual acuity ranging from 1.1 LogMAR to 0.18 LogMAR. The reduced visual acuity was attributed to anterior segment problems in 8 patients (15.4%) (in 7 patients to cataract and 1 to bullous keratopathy), to cystoid macular edema in 18 patients (34.6%), to residual subretinal fluid in 5 patients (9.6%), to macular atrophic changes in 5 patients (9.6%), to epiretinal membrane in 11 patients (21.2%), to macular hole in 3 patients (5.8%), to optic nerve atrophy in 1 patient (1.9%) , while in 1 patient (1.9%) no apparent reason for reduced vision was found.

Conclusion Macular changes represent the most frequent reason for reduced visual acuity after anatomically successful retinal detachment surgery. Strategies to prevent or improve these alterations might improve the functional result of retinal detachment surgery.
Measurement of scleral rigidity in patients with age‐related macular degeneration
Authors: KAYA S , KNOGLER K , WEIGERT G , SACU S , GARHOFER G , SCHMETTERER L
Published: December 2011

Purpose It has been hypothesized that altered mechanical properties of the sclera may contribute to the pathogenesis of age‐related macular degeneration. Unfortunately, the determination of structural stiffness of the sclera in vivo is difficult. In this study, we present a new technique to estimate sclera stiffness in vivo. In addition, we aim to test the hypothesis that sclera stiffness is altered in patients with AMD.

Methods 44 patients with AMD and 22 healthy subjects, matched for age, sex and intraocular pressure were included in the study. Ocular pulse amplitude(PA) and pulsatile ocular blood flow were assessed using pneumotonometry. Ocular fundus pulsation amplitude(FPA) was measured by the means of laser interferometry. A coefficient for ocular rigidity(E1), based on the Friedenwald equation was calculated relating PA/FPA, as a measure for structural stiffness.

Results FPA was decresased in patients with AMD when compared to the healthy group (p = 0.025). However, no difference was observed PA between patients with AMD and healthy subjects ( p = 0.34). E1 was significantly higher in the patients with AMD (0.91 ± 0.11AU) than in the control subjects (0.70 ± 0.07AU; p < 0.001).

Conclusion Our data indicate that the mechanical properties of the sclera are different in patients with AMD compared to healthy subjects. In particular, our data indicate an increased sclera stiffness in the AMD group. Whether this causatively involved in the pathogenesis of AMD or a consequence of the disease, has yet to be shown.
New cyanine dye for ILM staining
Authors: LAUBICHLER P , VARJA A , LANGHALS H , EIBL K , KERNT M , HARITOGLOU C
Published: December 2011

Purpose To investigate the biocompatibility and staining properties of a new cyanine dye (DSS: 3,3´‐Di‐(4‐sulfobutyl)‐1,1,1´,1´‐tetramethyl‐di‐1H‐benz[e]indocarbocyanine).

Methods Dye concentrations of 0.5%, 0.25% and 0.1% were evaluated (osmolarity between 290 and 295 mOsm). Toxicity was assessed using a colorimetric test measuring the inhibition of ARPE 19 cell, human primary RPE cell and human Müller cell proliferation. Exposure time was 30, 60, 120 and 300 seconds. Indocyanine green (ICG) (0.5%, 0.25% and 0.1%) served as a control. Besides staining of porcine and human lens capsule, internal limiting membrane (ILM)‐staining was assessed by applying 0.25% and 0.5% DSS over the macula in two human post‐mortem eyes.

Results The dye DSS did not reveal any toxicity on ARPE‐19, primary human RPE cell and human Müller cells proliferation in all concentrations and exposure times investigated. The absorption maximum is found at 591 nm, the even more bathochromic fluorescence proceeds with a common Stokes’ shift where maxima at 620 and 660 nm with a quantum yield of 32% were found. The fluorescence is sufficiently hypsochromic and the fluorescence quantum yield high enough for an easy visual detection. The contrast and staining properties at the ILM was excellent because of matched optical properties and allowed for a controlled removal of the ILM during surgery. No penetration into deeper retinal layers was noted.

Conclusion Our results indicate that this new cyanine dye DSS may represent an alternative for ILM staining due to its matched absorption concerning visibility and fluorescence qualities as well as its good biocompatibility. The dye is superior compared with ICG where there is no matching of the UV/Vis spectra.
Intraocular pressure after cataract surgery measured with Pascal Dynamic Contour Tonometer, Goldmann Applanation Tonometer and Pneumotonometer
Authors: VILLAFRUELA I , PRIETO M , COLAS T , RIVAS O , FERNANDEZ A , CLARIANA A , BORREGO R
Published: December 2011

Purpose The aim of this study was to compared the effect of cataract extraction by phacoemulsification and posterior chamber lens implantation on measured intraocular pressure (IOP) using the Goldmann applanation tonometer, the Pascal dynamic contour tonometer (DCT), the Goldmann applanation tonometer (GT) and pneumotonometer (PT)

Methods 97 eyes were measured in the operated eye one day before and one day, one week and one month after cataract surgery with the three tonometers, the IOP, ocular pulse amplitude (OPA),and central corneal thickness (CCT)

Results Corneal edema induced by phacoemulsification cataract surgery resulted in statistically significant increases in CCT (87,8 μm SD 56,8 ;p< 0,001), Pascal DCT IOP (4,8 mmHg, SD 8,0; p< 0,001),Goldmann IOP (1,4 mmHg, SD 5,1;p<0,015) and OPA (0,9 mmHg, SD 3,5; p< 0,025) but not in pneumotonometry IOP (1,1mmHg, SD 5,3; p=0,065). Changes in IOP measured by GT and PT were less than those measured by the Pascal DCT. The variation between the Pascal DCT (Rho 0,247; p=0,038), and Pneumotonometer (Rho 0,358; p=0,002) was strongly correlated to the change in CCT

Conclusion Corneal edema after phacoemulsification cataract surgery increased IOP readings in the three tonometer compared, this increment is bigger in Pascal DCT readings. Changes in CCT are statistically significant associated with increased Pascal DCT IOP readings. Change in corneal biomechanics may in part be responsible for increased in the measured of IOP with Pascal DCT and GT
Molecular Ophthalmic Genetics Tools
Authors: DE BAERE E
Published: December 2011

Purpose To provide an overview of recent developments in molecular genetic tools applied in ocular genetics.

Methods Genomewide strategies for copy number screening (arrayCGH), identity‐by‐descent (IBD) mapping and massive parallel sequencing (MPS) or next‐generation sequencing (NGS) technologies (targeted resequencing, whole exome and genome sequencing) will be discussed.

Results Genetic variation, comprising both copy number variation (CNV) and sequence variation, has a great impact on ocular genetic disease. Recent advances in genomewide technologies such as arrayCGH, SNP chip based IBD mapping and NGS have revolutionarized the concept of gene identification and diagnostics of ocular genetic disorders. Examples will be given of applications of arrayCGH in gene identification and molecular diagnostics of developmental ocular disease and the power of IBD mapping and NGS in gene identification and routine diagnostics of retinal dystrophies.

Conclusion The throughput and quality of these genomewide technologies now bring DNA‐based personalized diagnostics within immediate reach for research, routine diagnostics and treatment strategies of ocular genetic disease.
Inherited Ocular Developmental Disease
Authors: BLACK GCM
Published: December 2011

Purpose High throughput technologies offer considerable opportunities to understand the genetic basis of developmental ocular disorders, both common and rare. This presentation will provide an overview of recent progress illustrated with specific examples including early‐onset corneal, cataract and retinal disorders.

Methods A review, including case presentations, to illustrate insights into genes underlying developmental ocular disorders including the understanding of novel pathways underlying common and rare developmental disorders and the utility in clinical practice of high throughput technologies including next generation sequencing.

Results Although individually rare, the group of developmental ocular disorders are an important contributor to childhood visual disability. Many of the issues regarding diagnosis and counselling apply to the entire group allowing the development of a unified care pathway. An important challenge is to improve diagnosis. Currently diagnostic genetic testing still focuses on single genes; this will be illustrated for ocular conditions such as brittle cornea syndrome (ZNF469, PRDM5) and Lenz microphthalmia syndromes (BOCR). Future prospects will employ high throughput technologies (e.g. next generation sequencing, microarray analysis). Examples will include inherited congenital cataract phenoptyes.

Conclusion The recent identification of genes underlying disorders of the anophthalmia/microphthalmia spectrum, of corneal development and of congenital cataract sheds light on the pathways and processes underlying a range of the biological processes underlying ocular development. Their identification has a direct bearing on clinical management, allowing the development of individualised care pathways.
Electrodiagnosis in Inherited Retinal Disease
Authors: HOLDER GE
Published: December 2011

The presentation will use a case based approach to describe the value of electrophysiological assessment in the diagnosis and management of patients with inherited retinal disease.
Comparison of ex‐press miniature implant with standard trabeculectomy after combined glaucoma surgery
Authors: IBANEZ J , PEREZ GARCIA D , PEIRO C , JIMENEZ B , RAMIRO P , CABEZON L , MATEO A , CRISTOBAL JA
Published: December 2011

Purpose To evaluate postoperative outcomes after combined phacoemulsification and glaucoma surgery with Ex‐PRESS miniature implant compared with combined surgery with standard trabeculectomy.

Methods Prospective series of 24 consecutive eyes we compared 12 eyes in patients treated with combined phacoemulsification and glaucoma filtering surgery with the Ex‐PRESS miniature glaucoma implant under a scleral flap with 12 matched control eyes in patients who underwent combined cataract and glaucoma surgery with trabeculectomy.

Results The average follow‐up was 10 months (range 3.4 to 14) for the Ex‐PRESS group and 12.3 months (range 4.0 to 16.5) for the trabeculectomy group. The mean IOP was significantly higher in the early postoperative period in the Ex‐PRESS group compared with the trabeculectomy group. Complications rate in the early postoperative period was significantily higher in the trabeculectomy group. No significant differences were objectified in success between both groups after the first week.

Conclusion The Ex‐PRESS implant is an effective alternative to standard trabeculectomy in selected cases which makes possible to reduce the classic early postoperative complications associated with trabeculectomy.
A grading system for alterations of the lid wiper zone in ocular surface disease
Authors: NEPP J , MUNK M
Published: December 2011

Purpose The lid wiper is a part of the lid margin, with many important functions for the ocular surface. Until now changes of the lid wiper where said to be symptoms of dry eyes. This study should observe the changes according pathogenesis and etiology of ocular surface diseases.

Methods Worse eye of 61 outdoor department patients were observed. We evaluated the etiology according the triple classification and the pathogenesis auf lipids, mucins and water layer as well as the corneal epithel. The wiper was observed by clinical changes of vessels and staining with lissamin green. We observed the relation of these changes with the etiology and pathogenetic cause.

Results There was a correlation of Lid‐Wiper changes with inflammation and immune diseases, as well with hormonal disorders. There was a low correlation with psychologic problems and with patient‘s age.

Conclusion By these observations the grading system could be modified by including vessel changes and locations of lissamin green staining for definition of the ocular surface dysfunction.
Prevalence of MGD in a clinical dry eye population
Authors: HORWATH‐WINTER J , RABENSTEINER DF , SCHWANTZER G , BOLDIN I , WACHSWENDER C , SCHMUT O
Published: December 2011

Purpose The meibomian glands inside the tarsal plates of the eyelids contribute to the superficial lipid layer of the tear film. These lipids reduce evaporation of tears, enhance tear film stability, protect the ocular surface and provide a clear optical image. Meibomian gland dysfunction (MGD) is a common condition and can lead to evaporative dry eye. The purpose of this study was to characterize patients in an Austrian dry eye unit with MGD.

Methods Between 2004 and 2010, 1372 consecutive patients with ocular discomfort from the dry eye unit of the Ophthalmological Department, Medical University Graz, were analysed retrospectively. Subjective symptoms were evaluated with a visual analogue scale. Fluorescein‐break up time, Schirmer test without local anaesthesia, fluorescein and lissamine green staining of the ocular surface and evaluation of the lid margins were performed. MGD patients were defined as follows: presence of teleangiectasia, irregularity of the lid margins, altered expressibility of meibomian glands and poor quality of expressed meibomian gland secretions.

Results Overall 70.2% of all patients suffered from MGD. The mean age of these patients was 55.3 ± 16.6 years and 70.9% were women. 52.1% of the MGD patients had Schirmer test values equal or below 10mm/5min and 30.1% of the MGD patients had Schirmer test values equal or below 5mm/5min. Sjögren's syndrome according to the American‐European Consensus Group was found in 4% of the MGD patients. The intensity of subjective symptoms did not differ among these patients.

Conclusion MGD is a major cause of ocular discomfort as evaluated in a large clinic‐based population of Austria. Tear deficiency is often accompanied with this disorder.
Correlation of non‐contact Meibography to dry eye symptoms and signs in Sjögren`s syndrome and graft‐versus‐host disease
Authors: RABENSTEINER DF , HORWATH‐WINTER J , BOLDIN I , BAUER H , NITSCHE M , SCHMUT O
Published: December 2011

Purpose Severe dry eye is often observed in patients suffering from Sjögren’s syndrome (SS) or chronic graft‐versus‐host‐disease (cGVHD). Although the underlying pathomechanisms differ, deficient tear production, as well as meibomian gland dysfunction (MGD) are present in both. Non‐contact Meibography can achieve a non‐invasive investigation of the meibomian glands inside the tarsal plates of the eyelids. The purpose of this study was to evaluate the correlation of non‐contact Meibography to dry eye symptoms in patients suffering from SS or cGVHD.

Methods We examined 37 patients suffering from SS and 11 patients with cGVHD of our dry eye unit. Subjective dry eye symptoms were evaluated with a visual analogue scale and the Ocular Surface Disease Index© (OSDI). Clinical signs of MGD were graded from 0 to 3 according to the Report of the TFOS Workshop on MGD. Non‐contact Meibography was performed by a Heidelberg Retina Angiograph 1, featuring two infrared diode lasers. Partial or complete loss of the meibomian glands was scored according to the meiboscore of Arita and colleagues.

Results The mean age of the study population was 55.3 ± 13.4 years and 91.7% were women. The Meiboscore correlated significantly with the subjective symptoms assessed by visual analogue scale. The grading of the lid margins correlated significantly with the Meiboscore.

Conclusion Non‐contact Meibography is a valuable tool in the diagnosis of MGD. Standard ophthalmic angiography cameras equipped with infrared diodes can easily perform it. The meiboscore correlates with the intensity of subjective symptoms and lid margin changes in patients suffering from SS or cGVHD.
PCR, principles, advantages and pitfalls: focus in some viral infections of the anterior segment of the eye
Authors: LABETOULLE M
Published: December 2011

Gene amplification using polymerase chain reaction (PCR) has become the gold standard for microbiological diagnosis in eye diseases, particularly in those related to viruses. Even if the specificity and the sensibility indexes are much higher than conventional methods, gene amplification may present some limits. For example, uveitis with low grade viral replication may induce false‐negative PCR results while assessment of the immune charge in aqueous may be positive in such cases. For infections of the ocular surface, PCR is usually much more effective than isolation of the virus in cell culture, but the high sensibility may inversely induce false‐positive results. For example, continuous shedding of herpes simplex in tears is known to occur regularly even in asymptomatic patients, which could mask the real diagnosis of any other cause of ocular redness. Even latest technologies, such as real time quantitative PCR, are not completely satisfying since a misuse of this very sensitive technique may also lead to false positive results if effective controls are not systematically used for each assay, due to the self‐fluorescence of the PCR mix when the number of thermal cycles increases. Inversely, vital dies, anesthetics eye drops or non‐optimal tissues purification may lead to false negative results due to the inhibition of the polymerase reaction.
New test for rapid Acanthamoeba diagnosis
Authors: GOLDSCHMIDT P , DEGORGE S , BENALLAOUA D , BORSALI E , LE BOUTER A , BATELLIER L , BORDERIE V , LAROCHE L , CHAUMEIL C
Published: December 2011

Purpose Acanthamoeba keratitis (AK) is a sight‐threatening infection. Classic PCR enhanced sensitivity but required post‐amplification procedures, increasing contamination risks. The reported real‐time PCRs are unable to detect all the genotypes associated with pathology. We present a new strategy validated American Type Cell Collection strains and corneal scrapings.

Methods A were detected by a fast PCR (f‐d‐real‐t PCR) and negativity confirmed by SYBR Green. Sequences selected in the mitochondrion were: forward primer: 5‘GCAGTCGCGGTAATACGA; reverse: 5’ACCACCTACGCACCCTTTACA and probe: 6‐FAM‐AGTGTTATTCGCATTGACTGGGTGTAA‐TAMRA.

Results The new test detects all A with different lab equipment (1 cyst or less/specimen). A.astronyxis signals are inferior to others; however, primers diluted in SYBR Green mix (without probe) detect 0.1 cyst/µl or less of this strain. For clinical samples microscopic examination and cultures detected 6 out 10 but f‐d‐real‐t PCR 100% with results confirmed by SYBR Green. Other PCRs bracketing different regions (ribosome) detected 80 % and produced false positives for samples containing Salmonella lexinton, C. sporulans, S. marcescens and Propionibacteria.

Conclusion Highly sensitive diagnosis is necessary to administrate efficient treatments at the onset of AK. The strains from the ATCC with higher sensitivity and specificity than techniques previously reported. New approaches based on High Resolution Melting r‐t PCR are in development in the CHNO to detect and molecularly characterize in one run different strains of protozoa and Fungi infecting the eye.
PCR in acute bacterial endophthalmitis
Authors: CHIQUET C
Published: December 2011

Purpose this review aims to summarize studies which assessed the use of PCR in post operative endophthalmitis. Endophthalmitis is a rare but devastating complication of ocular surgeries. There is a need for more rapid and more sensitive microbiological techniques since clinicians should rapidly identify bacterial pathogens.

Methods different microbiological techniques will be presented, eubacterial PCR, real time PCR

Results Column‐based nucleic acid purification allows removal of DNA‐polymerase inhibitors. Real time PCR is more sensitive than culture, allows the detection and identification of specific micro‐organisms, DNA quantification, and has a faster turn around time (no post‐PCR step). The PCR amplification of 16S rDNA uses consensus primers (panbacterial PCR) and is followed by identification from analysis of 16S rDNA sequence (BIBI). This technique has the advantages of amplification of DNA from all bacteria, and identification of bacteria difficult to identify phenotypically (e.g. coagulase‐negative Staphylococcus species). However drawbacks are the possible contaminations, the duration (2‐3 days including sequencing), and the impossibility of differentiating mixed bacterial species in the same clinical sample. A summary of the main published clinicomicrobiological studies will be presented.

Conclusion PCR techniques are complementary tools to culture. New techniques of PCR are needed in order to be faster and more sensitive. Genomic characterization of strain virulence of bacteria involved in endophthalmitis could help clinicians to identify patients needing a more aggressive treatment and to develop new drugs.
Digital analysis of the trabecular pigmentation using Positive Pixel Count algorithm
Authors: PETROSKA D , PAJAUJIS M , LEVINAITE G , RIAUKA R , ASOKLIS R
Published: December 2011

Purpose To analyze the trabecular pigmentation after sinustrabeculectomy using semi thin slices with optical microscopy and morphometrically and compare with clinical data.

Methods 10 glaucoma patients (10 eyes), 6 males and 4 females, underwent conventional sinustrabeculectomy. The trabecular specimens were prepared as semi thin slices (stained with Toluidin Blue) and analyzed using optical microscopy. The semi thin virtual slides were made by ScanScope and analyzed with Aperio Positive Pixel Count algorithm. The demographic, clinical and morphometrical data were analyzed using SAS Enterprise Guide 4.2 statistic software.

Results Correlation analysis of quantitative morphometric and clinical variables were not statistically significant: the probability coefficient between number of positive pigment pixels and pachymetry, highest IOP and glaucoma duration was higher than 0.05.

Conclusion 1. There was no statistic significance between morphometric and clinical variables. 2. Further studies of the trabecular tissue, using larger cohort are required.
Deep Scelerectomy: Contra
Authors: ZEYEN T
Published: December 2011

Deep sclerectomy claims to be safer than trabeculectomy. This might have been true in the past but, with modern techniques, “safe trabeculectomy” can be performed with few complications. Deep sclerectomy claims to be a “non‐perforating” procedure. It is probably more correct to name it a two‐stage perforating procedure since post‐operative Yag‐laser goniopuncture is necessary in > 50% of the cases. Since an iridectomy is not performed during deep sclerectomy, iris incarceration can occur after goniopuncture and can be easily missed. Furthermore, it is puzzling that new modifications of deep sclerectomy include using an Express implant, converting it right away to a perforating procedure. Finally, a trabeculectomy usually provides lower post‐operative IOPs than a deep sclerectomy. Since one of the reasons to operate is to obtain a low target IOP, it is advisable to perform a trabeculectomy.
Relationship between retinal nerve fiber layer evaluation and visual field results in healthy and glaucoma individuals
Authors: CALVO P , GIL‐ARRIBAS L , GÜERRI N , OTIN S , FERRANDEZ ARENAS B , ALTEMIR I , GARCIA MARTIN E , FERRERAS A
Published: December 2011

Purpose To determine the relationship between retinal nerve fiber layer (RNFL) thickness measured with spectral‐domain optical coherence tomography (OCT) and the retinal sensitivity tested by standard automated perimetry (SAP).

Methods Two hundred and five subjects (100 healthy and 105 with different levels of glaucomatous damage subjects) were prospective and consecutively recruited. Only one eye per participant was randomly chosen. Glaucoma patients had intraocular pressure higher than 21 mmHg and glaucomatous optic disc appearance. All of them underwent imaging with the Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) and at least one reliable perimetry. SAPs were performed with a Humphrey Field Analyzer, using the 24‐2 SITA Standard strategy. Left eye data were converted to a right eye format. The Kolmogorov Smirnov test was applied to check that the data were normally distributed. Threshold values of SAP were converted to a linear scale. Pearson correlations were calculated between the 52 threshold values tested by 24‐2 algorithm of SAP and OCT parameters

Results Age was not different between both groups (p=0.09). In the whole sample, the strongest correlation was found between point 15 of SAP and RNFL thickness at inferior quadrant (r=0.670; p<0.001). The healthy group showed few and mild correlations. In the glaucoma group, the strongest correlation was also found between point 15 of SAP and inferior RNFL thickness at inferior quadrant (0.664; p<0.001).

Conclusion Normal individuals had mild correlations between few functional and structural parameters, while glaucoma patients showed mild to moderate correlations.
Kinetics of TP53, CASP3 and GADD45 genes expression in the rat lens after in vivo exposure to subthreshold dose of UV‐B radiation
Authors: GALICHANIN K , TALEBIZADEH N , YU Z , SÖDERBERG P
Published: December 2011

Purpose Subthreshold dose exposures of UVR‐B over long time accumulate in the lens to cause cataract. The purpose of this study was to investigate kinetics of p53, caspase 3 and gadd45 genes in the rat lens after in vivo exposure to subthreshold UVR‐B around 300 nm.

Methods Forty 6‐week‐old female albino Sprague‐Dawley rats were exposed to subthreshold dose (1 kJ/m2) UVR at 300 nm unilaterally for 15 minutes. The animals were sacrificed at 1, 5, 24 and 120 h following the exposure to UVR‐B. p53, caspase 3 and gadd45 mRNA expression of the lenses was analysed by quantitative RT‐PCR.

Results p53 is upregulated in 24 h and 120 h groups. Caspase 3 is upregulated in 120 h group. Gadd45 is upregulated in 1 h group.

Conclusion p53 mRNA increased expression precedes caspase 3 mRNA increased expression in the rat lens after in vivo UVR‐B exposure. There was initial repair at 1 h showed by increased mRNA expression of DNA repair gene GADD45.
On the impact of multifocal IOL decentration and tilt on retinal image quality
Authors: PALLIKARIS IG , KONTADAKIS G , GINIS H
Published: December 2011

Purpose The design of advanced (such as multifocal) intraocular lenses (IOLs) is based on the exact alignment of the optical element with the center of the pupil and its optical axis with the line of sight of the eye. It is the purpose of this study to evaluate the impact of multifocal IOL decentration and tilt on retinal image quality.

Methods A series of patients implanted with multifocal IOLs were evaluated with a Scheimpflug imaging device (GALILEI Dual Scheimpflug Analyzer, Ziemer Switzerland), that was utilised to evaluate centration and tilt of the IOLs. Wavefront aberration was recorded using a retinal ray tracing device (iTrace, Tracey Technologies Houston, USA). Induced high order aberrations were correlated to the orientation of tilt and the location of the IOL.

Results In multifocal IOLs, decentration in recpect to the pupil center is more detrimental to retinal image quality than tilt. Moreover, multifocal IOLs are more sensitive to tilt and decentration than monofocal IOLs in respect to the induced aberrations.

Conclusion Modern imaging technologies in combination with wavefront abberation measurements may elucidate the impact of IOL location in the eye in retinal image quality. In certain cases, such as in diffractive lenses, where wavefront sensing has inherent limitations, retinal image quality may be evaluated by appropriate computer modeling.
Creating endothelial lenticules with femtoseconde laser: the double layer technique
Authors: BOURGES JL , ROUSSEAU A , SARAGOUSSI JJ , RENARD G , BEHAR‐COHEN F
Published: December 2011

Purpose Femtosecond laser(FS) enhances reproducibility and accuracy in corneal surgery. However, visual outcomes of Femtoseconde Lamellar Endothelial Keratoplasty (FLEK) are still impaired by lenticule irregularities. We aimed to enhance the smoothness of interface of FLEK lenticules.

Methods We proceeded for corneal cuts on experimental human corneas with the 60 and 150 kHz Intralase FS (AMO, USA). Laser settings were optimized to obtain the best interface quality while delivering minimal energy to the corneal stroma. We did each procedure in triplicate with the appropiate settings to test reproducibility. We created posterior lenticules for FLEK with the following FS various cut profiles: a single path profile (SP) performing a 500µm deep full lamellar cut, a double path profile (DP) with an identical lamellar cut performed twice, a double layer profile (DL) performing two successive lamellar cuts at 350µm and then at 150 µm depth. We created 100 µm LASIK free flaps as a control. The stromal interface quality of the so‐obtained interfaces was analyzed by scanning electron microscope (SEM).

Results Stromal adherences persisted after both the SP and the DP procedure, creating central irregularities on the endothelial lenticule. The DL profile created the smoothest interfaces with the best reproducibility when FS parameters for lamellar cut were set for diameter (mm), depth (µm), energy (µJ), and spot size/step (µm) respectively on 9.0mm, 350µm, 2.1µJ, 4:4µm and 8.3mm, 150µm, 0.9µJ, 4:4µm. Observed with SEM, EK lenticules created with the DL profile and LASIK flap had similarly smooth interfaces.

Conclusion Femtosecond lasers can creat EK lenticules with a quality of stromal interface comparable to refractive surgery.
Riboflavin’s time dependent degradation rate induced by ultra violet – A irradiation at 370 nm wavelength
Authors: DIAKONIS V , GRENTZELOS M , KANKARYIA V , TZATZARAKIS E , KARAVITAKI A , KYMIONIS G
Published: December 2011

Purpose To evaluate the time dependent degradation rate of riboflavin standard solution used for corneal cross linking (CXL) treatment, after ultra violet – A irradiation at 370 nm wavelength

Methods Riboflavin solution (> 0.1%) was diluted in nanopurewater to a final concentration of 10 ppm. Two solutions were used, one served as control, while the second was irradiated using an optical system with a light source consisting of an array of UV diodes (370 nm). Four samples of riboflavin solution were retrieved prior to irradiance (time point: 0), at 1, 5, 15, 30 and 60 minutes after irradiation (Group A); while, at the same time points samples of riboflavin were retrieved from the control solution in order to assess environmental time ‐ induced degradation of riboflavin (Group B). All samples were immediately analyzed using liquid chromatograph mass spectrometry to detect riboflavin and its two sub products (lumiflavin and lumichrome)

Results The mean percentage of riboflavin degradation was 2.38, 11.08, 15.30, 20.75 and 34.78 at 1, 5, 15, 30 and 60 minutes after UV‐A irradiation for Group A (p<0.05), while for group B (no UV‐A exposure) there was no change in riboflavin concentration

Conclusion The time dependent degradation of standard riboflavin solution is significant, reaching after 30 minutes of UV‐A exposure 20%. It seems that only a small fraction of the overall riboflavin molecules break down since, more than 65% remain intact even after one hour of UV‐A irradiation
Proteases and Proteolysis in the tears of people with Keratoconus
Authors: BALASUBRAMANIAN SIVA , PYE DAVID , WILLCOX MARK
Published: December 2011

Purpose Keratoconus is a degenerating disease of the eye which causes an irregularly shaped cornea leading to impairment of vision.The role of proteases in keratoconus has been a topic of substantial discussion and speculation over many years.This study was designed to examine the levels and activity of proteases in the tear film of people with keratoconus.

Methods A case‐controlled study was performed studying the tear proteome of keratoconus patients(K) and controls(N).Basal tears were collected using a capillary tube.Total protein(TP)in tears was estimated using BCA assay;the levels of lactoferrin(Lf),secretory immunoglobin A(sIgA) and serum albumin were measured using specific ELISAs.Levels and activity of tear proteases were studied using Raybiotech® Antibody Array and EnzChek® Assay Kits respectively.

Results There was a two‐fold (p=0.0001) decrease in TP levels between K(3.86+1.62 mg/ml) and N(7.00+1.58 mg/ml). Levels of Lf(0.67+0.28 vs. 1.13+0.29 mg/ml) and sIgA(0.78+0.36 vs. 1.70+0.66 mg/ml) were also significantly(p=0.0001) reduced in K. The expression levels of matrix metalloproteinases(MMP)‐1,‐2,‐3,‐7,‐13,interleukins(IL)‐1α,‐3,‐4,‐5,‐6,‐8,‐10 and tumour necrosis factor(TNF)‐α,‐β were significantly(p=0.01)altered between K and N. Tear proteolysis(gelatinase/collagenase)was expressed as Fluorescence Intensity(FI).The activity of gelatinases(87.54+33.57 vs. 45.79+24.60 FI,p=0.0002)and collagenases(6.11+3.18 vs. 3.56+2.03 FI,p=0.03)were significantly increased in K.

Conclusion The tears of people with keratoconus expressed high levels of proteases, increased proteolysis and a profoundly altered protein profile, which might change with the severity of the disease.These findings may lead the way to understanding or monitoring disease progression.
Mechanical reinforcement of the cornea with an intrastromal in‐situ photo‐polymerised implant.
Authors: PENNOS A , PENTARI IG , GINIS H , KARIOTAKIS N , KYMIONIS G , PALLIKARIS IG
Published: December 2011

Purpose A photo‐polymerisable hydrophilic material (PEG/Irg) has been previously evaluated in terms of biocompatibility and toxicity in a series of laboratory animals. It was the purpose of this study to evaluate the bio‐mechanical effect of lamellar implants created from PEG/Irg in porcine cadaver eyes.

Methods Twenty porcine corneas where removed along with a 3 mm corneoscleral rim, de‐epithelialised and mounted on an artificial anterior chamber. The pressure was maintained at 22 mmHg hydrostatically. In each cornea, a circular lamellar pocket (7mm diameter) was created manually. Thirty microliters of PEG/Irg in liquid form were injected in each pocket. A rigid contact lens was pressed on top of the cornea and the excessive quantity of PEG/Irg was leaked out of the pocket. The cornea was then irradiated with UV light (390nm, 4mW/cm2) and the PEG/Irg underwent a polymerization and the associated phase transition to form a rigid film. Mechanical measurements were performed by means of a purposely‐developed device featuring a stepping motor and a load cell. By keeping the pressure constant the role of corneal stiffness is isolated. The force as a function of indentation was recorded for each specimen before and after the in‐situ creation of the PEG/Irg film.

Results The mean slope of force versus indentation for the reinforced group was 166.72 (±74.14) and the mean slope for the non‐reinforced group was 116.94 (±21.16). The two‐tailed P value equals 0.0033, equally meaning that the difference between those two groups was statistically different.

Conclusion According to the results, there was a significant biomechanical reinforcement of the cornea following the in‐situ creation of the polymer film.
Relationship between time‐ and spectral‐domain optical coherence tomography in glaucoma
Authors: GIL ARRIBAS L , GÜERRI N , OTIN S , FERRANDEZ ARENAS B , CALVO P , GARCIA‐MARTIN E , ALTEMIR I , FERRERAS A
Published: December 2011

Purpose To evaluate the relationship of retinal nerve fiber layer (RNFL) thicknesses obtained with two different optical coherence tomography (OCT) systems, time‐domain OCT (Stratus; Carl Zeiss Meditec, Dublin, Ca) and spectral‐domain OCT (Cirrus; Carl Zeiss Meditec), in healthy and glaucomatous eyes.

Methods Seventy healthy and 71 glaucoma individuals were prospective and consecutively selected. Only one eye per subject was included in the study. Glaucoma patients had intraocular pressure higher than 21 mmHg and abnormal standard automated perimetry (SAP). All participants underwent a comprehensive ophthalmic examination and at least 2 reliable SAPs. Peripapillary RNFL measurements were acquired with 2 different OCT systems (Stratus and Cirrus OCTs). Kolmogorov‐Smirnov test was applied to check normality of variables. Then, Pearson´s correlations were calculated between parameters of both OCTs in the healthy and glaucoma groups.

Results Mean age was 56.1 ± 12.1 and 62.2 ± 9.1 years in the healthy and glaucoma groups, respectively (p=0.07). Moderate to strong correlations were observed between equivalent parameters of both devices. The strongest correlations were found for average RNFL thickness (r=0.928; p<0.001) and RNFL thickness at inferior quadrant (r=0.925; P<0.001) in the glaucoma group. The RNFL thickness at 3 o’clock position showed the mildest correlation (r=0.435; p<0.001) in the healthy group.

Conclusion Although RNFL parameters cannot be interchanged between both devices, the RNFL measurements of time‐ and spectral‐domain OCTs had strong correlations in glaucoma patients.
Oxygen and VEGF in venous occlusion
Authors: STEFANSSON E
Published: December 2011

Abstract not provided
Mechanisms involved in vein occlusion related macular edema
Authors: POURNARAS JAC
Published: December 2011

Purpose To describe the pathophysiological processes involved in vein occlusion related macular edema.

Methods Review of the experimental and clinical published data explaining the pathophysiological mechanisms involved in vein occlusion related macular edema.

Results Venous stasis lead to internal blood‐retinal barrier breakdown, extravasation of blood vessel content and finally to macular edema. Tissular hypoxia of the internal retinal layers develops secondary to arterial blood flow decrease, followed by Na+/K+ ATPase pump dysfunction, intracellular edema, and neuronal cell death by necrosis and apoptosis. Many vasopermeability factors will be subsequently released, as inflammatory mediators and VEGF. The rationale for clinical treatment of macular edema is based on the understanding and the inhibition of these pathophysiological mechanisms. On the medical side, nonsteroidal anti‐inflammatory drugs inhibit the production of prostaglandins and leukotrienes, and modulate fluid movement coupled to chloride movement. Corticosteroids block cyclooxygenase and interleukin, downregulate VEGF and decrease the phosphorylation of occludin, thereby increasing the tightness of the blood‐retinal barrier. Anti‐VEGF agents restore occludin proteins in the blood‐retinal barrier and reduce protein kinase C activation.

Conclusion New advances in understanding the mechanisms involved vein occlusion related macular edema lead to development of new therapeutical strategies which have to be confirmed by clinical randomized trials.