bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct intraarterial (ophthalmic artery) chemotherapy for advanced intraocular retinoblastoma: Five years experience
Authors: DE FRANCESCO S , DE LUCA M , BRACCO S , GALLUZZI P , BORRI M , MICHELI L , HADJISTILIANOU T
Published: November 2013

Purpose To report five years of conservative treatment for advanced retinoblastoma with the direct intra‐arterial‐ophthalmic artery infusion of Melphalan alone or Melphalan and Topotecan.

Methods 75 children (82 eyes) with advanced retinoblastoma (Stage D‐E/VA –VB) were entered in phase two of one center open study‐approved protocol of ophthalmic artery infusion (Italian intra‐arterial protocol, approved by the Ethic Commettee – University Hospital of Siena). Seven cases have been treated bilaterally. 40 eyes were first diagnosis (naïve) and 42 were relapses following chemotherapy and focal therapy and/or radiotherapy.

Results Cannulation of the ophthalmic artery was performed by a femoral artery approach using microcatheters (magic 1.5) while the children were under general anesthesia and anticoagulated. Chemotherapy (Melphalan alone or Melphalan and Topotecan) was infused into the artery over a 30‐minute period (dose of 3‐7 mg of Melphalan and 0.3‐0.4 mg of Topotecan, according to the age and size of the globe). Local and systemic toxicity have been evaluated and documented.

Conclusion 75 children (82 eyes) with advanced retinoblastoma were eligible for the intra‐arterial Italian Protocol. The 65.8% of all treated eyes is in complete remission. Superselective chemotherapy delivered through the ophthalmic artery can avoid enucleation, primary radiation or abuse of systemic chemotherapy.
IgG4‐Positive orbitopathy
Authors: HEEGAARD S
Published: November 2013

Purpose To give an overview of IgG4‐positive orbitopathy. A newly described disease of the orbit.

Methods Critical review of the present literature demonstrated by a patient case.

Results The clinical appearance, high incidence of bilateral disease, association with lesions in other organs, and increased IgG 4 serum levels along with the histological findings of IgG4–positive cells, more background fibrosis, lymphoid hyperplasia, plasma cells and eosinophils are the characteristics of this disease.

Conclusion Patients with IgG4–positive cells in an orbital biopsy may have an orbital manifestation of IgG4‐associated systemic disease
What is important in present and future IOL materials & design?
Authors: BARRAQUER R
Published: November 2013

IOL progress has followed 2 main lines: optical performance,and materials/design. This talk reviews their impact and possible future trends.IOL optics evolved from spheric monofocal to aspheric (+optionally toric) to multifocal; from refractive to diffractive multifocality, currently with several choices regarding add, bi‐ vs trifocality, etc. Additionally a number of designs attempt to reproduce the lens accommodative mechanism. However,none of the available options truly restores the physiological accommodation of the youth. The main drive for the evolution of IOL materials and designs has been implantability through an ever‐decreasing incision width. While this may have created some compromises regarding materials and optical quality/stability, it seems unlikely that this process could revert. Next major issue is the prevention of PCO. Aspects as the posterior square edges and hydrophobic materials are widely assumed as useful to prevent PCO. However, a general proof is difficult due to the numerous factors involved (IOl & non‐IOL) and the great variability of designs. IOL materials durability lags in a 3rd position of interest (apart from cases of IOL opacification) but is likely an emerging topic for the near future.
Prevention of autophagy activates inflammasome signaling in ARPE‐19 cells treated with a proteasome inhibitor
Authors: KAUPPINEN A , PIIPPO N , HYTTI M , KINNUNEN K , SALMINEN A , KAARNIRANTA K
Published: November 2013

Purpose Age‐related macular degeneration (AMD) is the most prominent cause of severe vision loss in western countries. Inflammation is known to play a central role in the pathogenesis of AMD but the mechanisms are still largerly unknown. Lately, the novel signaling pathway of intracellular multi‐protein complexes called inflammasomes has been associated with the disease. In addition to inflammation, decline in the intracellular cleaning systems, i.e. autophagy and proteasomal degradation, is another hallmark of AMD. In the present study, we have studied the cross‐talk between NLRP3 inflammasomes and autophagy.

Methods ARPE‐19 cells were grown into confluence and exposed to the proteasome inhibitor MG‐132. Thereafter, Bafilomycin A was added and the cell cultures were incubated for another 24 hours.

Results Our results show that the inhibition of lysosome acidification by Bafilomycin A increased the release of inflammasome‐related cytokine IL‐1 in MG‐132‐treated ARPE‐19 cells. In addition, the amounts of inflammasome receptor and adaptor proteins, i.e. NLRP3 and ASC, respectively, as well as the activity of the executive Caspase‐1 enzyme were increased.

Conclusion Our present results suggest that intracellular protein aggregates could induce the inflammasome activation in ARPE‐19 cells especially in circumstances where autophagy is declined.
Functional and molecular characterization of ex vivo cultured epiretinal membrane cells from proliferative diabetic retinopathy
Authors: PETROVSKI G , VEREB Z , ANDJELIC S , LUMI X , GLOBOCNIK‐PETROVIC M , URBANCIC M , HAWLINA M , FACSKO A
Published: November 2013

Purpose To characterize the cell surface marker phenotype and function of ex vivo cultured cells growing out of human epiretinal membranes (ERMs) from proliferative diabetic retinopathy (PDR).

Methods All tissue collection complied with the Guidelines of the Helsinki Declaration. ERMs were obtained from vitrectomies due to intravitreal hemorrhage in PDR. Ex vivo cultivation under adherent conditions was performed in DMEM supplemented with FBS and the cell surface marker phenotype determined. Release of IL‐6, IL‐8 and TNFalpha was measured upon activation of the cells with TLR lingands and TNFalpha. The dynamics of the intracellular calcium was measured using fluorescent dye Fura‐2 and imaged in response to mechano‐stimulation.

Results The cultivated ERMs formed proliferating cell monolayers when cultivated ex vivo. These cells were negative for endothelial markers (CD31, VEGFR2), partially positive for hematopoietic (CD34, CD47) and mesenchymal markers (CD90, PDGFRb, CD73) and negative for CD105. IL‐6, IL‐8 and TNFalpha secretion could be measured upon activation of the cells by LPS, Poly I:C and TNFalpha. Mechano‐stimulation of the outgrowing cells induced intracellular calcium propagation representing their functional viability.

Conclusion ERMs from PDR contain cells of hematopoietic and mesenchimal origin which have proliferative potential, release pro‐inflammatory cytokines upon selective inflammatory stimulation and show functionality reflected through calcium dynamics upon mechano‐stimulation.
The effect of hyperglycaemia on permeability and tight junction components in human retinal and choroidal endothelial cells
Authors: STEWART EA , SAKER S , AMOAKU WM
Published: November 2013

Purpose Diabetic retinopathy is the leading cause of preventable blindness in the working population. The main cause of visual loss in diabetic retinopathy is diabetic macular oedema caused by an increase in microvascular endothelial permeability. The aim of this project was to determine the effect of hyperglycaemia, in vitro, on human choroidal (hCEC) and retinal microvascular endothelial cells (hREC).

Methods Microvascular permeability was assessed through passage of dye through a confluent cell layer in the presence of hyperglycaemia. Microarray analysis and western blotting was used to compare the expression of selected tight junction molecules (Occludin, Claudin‐5, JAM‐A and JAM‐C) and adheren junction (VE‐Cadherin) molecules was compared between hCEC and hREC and with hyperglycaemia.

Results Hyperglycaemic conditions significantly increased the permeability in both hCEC and hREC. Microarray analysis and western blotting determined that the baseline hREC expression of occludin and claudin‐5 was higher than hCEC. In hREC exposed to hyperglycaemia claudin‐5, occludin and JAM‐A were found to be reduced. None of the proteins were decreased by hyperglycaemia in hCEC.

Conclusion Although hyperglycaemia increased permeability in both hCEC and hREC, tight junction protein expression was only reduced in hREC, indicating a different mechanism of increased permeability in hCEC compared to hREC.

Commercial interest
Proteasome dysfunction in retinal pigment epithelium during aging contributes to the pathogenesis of Age‐Macular related Degeneration
Authors: GIRAO H , MARQUES C , SOARES A , FERNANDES R , PEREIRA P
Published: November 2013

Purpose Age‐related Macular Degeneration (AMD) is the leading cause of blindness in people older than 50 in developed countries, and is associated with formation of subretinal deposits (drusen) and damage to Bruch’s membrane (BM) basal to the retinal pigment epithelium (RPE). It has been reported that activities of the ubiquitin‐proteasome pathway (UPP) in retinal pigment epithelium decrease upon aging. Previous studies demonstrated that expression of ubiquitin in which lysine 6 is replaced by tryptophan (K6W‐Ub) impairs the function of UPP. The main objective of this work was to investigate the hypothesis that chronically impairment of UPP in RPE contributes to some of the cardinal features of AMD, including drusens.

Methods To address this question ARPE‐19 cells were infected with empty vector, K6W Ubiquitin mutant and Wild Type Ubiquitin. The drusen formation and accumulation in basal matrix was evaluated by confocal microscopy, using specific drusen markers such as APOE, while exosome realease was determined by western blot (such as CD63 and Tsg101) and flow cytometry following exosomes isolation by ultracentrifugation.

Results The results obtained showed that expression of K6W mutant Ub leads to an impairment of proteasome activity and an increased amount of exosomes release and drusen accumulation.

Conclusion In this study the data might provide a vaulable tool to eluciadte the biological determinats of age‐related proteolytic stress and its impacts on proteostasis in the retina.
The KORA‐AGE eye study: Eye diseases in the elderly
Authors: GRAW J , STROBL R , HEIER M , LINKOHR B , PETERS A , HOLLE R , GRILL E
Published: November 2013

Purpose To estimate the prevalence of major age‐related eye diseases in a population‐based regional study in Southern Germany.

Methods 822 randomly selected persons (age 68‐96 years) from the KORA AGE study were asked in 2012 in a standardized interview for the presence of major eye disorders like cataracts, glaucoma and age‐related macula degeneration (AMD). In case of any positive reply, the ophthalmologist in charge was asked for validation and specification of any eye disease.

Results 465 persons reported any eye disorder (57%); 71% of them could be validated and specified. There were 182 confirmed cases of cataracts, 7 of glaucoma and 5 of AMD. Additionally, there were 52 cases of cataracts and AMD, also 54 cases of cataract and glaucoma and 11 cases of cataract, glaucoma and AMD. In 62% cases cataracts developed prior to any of the other eye diseases. Adjusted for age, women had a significantly higher risk for cataracts (OR = 1.72) and for AMD (OR = 1.94) than men; no gender‐specific difference was observed for glaucoma. Among patients with cataracts, 69% had lens surgery.

Conclusion We confirmed cataracts as the major age‐related eye diseases; however, the number of glaucoma and AMD were surprisingly low. Further analyses are planned to identify risk factors and to show how eye diseases are independent risk factors for increased frailty and disability in the aged. This study was supported by the German Federal Ministry of Education and Research (BMBF) within the programme "Healthy Ageing" (FKZ 01ET1003)
Novel glaucoma surgery techniques
Authors: ZEYEN T
Published: November 2013

Novel glaucoma surgery techniques can be divided into ab‐interno gonio‐surgeries and ab‐externo procedures involving the conjunctiva. An overview of the new procedures will be provided with emphasis on their efficacy and complications. The evidence of the available studies will be presented and an attempt will be made to clarify the role of the novel procedures within our glaucoma treatment algorithm.
Ocular surface reconstruction
Authors: SHORTT AJ
Published: November 2013

The ocular surface is a highly specialised environment with complex homeostatic mechanisms. Severe ocular surface disease can cause significant morbidity through recurrent epithelial breakdown, predisposition to infection and blindness. Ocular surface reconstruction (OSR) strategies aim to restore sufficient ocular surface function to permit the maintenance of an intact transparent epithelium. OSR begins by addressing the quality and volume of tears. Next the position and closure of the eyelids are evaluated and addressed. Only once these factors have been addressed can attention be turned to surgical reconstruction of the ocular surface. The algorithms that guide the choice and timing of surgical interventions are becoming more clear. These universally advocate transplantation of limbal epithelial stem cells prior to surgical replacement of stroma with or without endothelium. Results for autologous ex‐vivo expanded limbal stem cell transplants in chemical injuries are excellent. Results for allogeneic grafts are no better than older whole limbal transplants such as keratolimbal allografts. Ex‐vivo cultured autologous oral mucosal stem cells offer an alternative in bilateral disease but such grafts are less optically transparent.
Angiogenic role of glycerol in laser‐induced choroidal neovascularization
Authors: YASUMA R , YASUMA T , KIM Y , GELFAND B , FOWLER B , KERUR N , BASTOS DE CARVALHO A , MIZUTANI T , AMBATI J
Published: November 2013

Purpose It has been reported that intravitreous administration of anti‐mouse IL18 antibody increases laser‐induced choroidal neovascularization (CNV) in mice (Doyle et al. Nat Med 2012). However, since those experiments compared an anti‐mouse IL18 antibody to a sham injection group, we tested the putative angiogenic effects of this antibody using biologically and chemically rigorous controls in order to clarify the role IL18 in laser‐induced CNV.

Methods Laser photocoagulations were performed to perforate Bruch’s membrane followed by intravitreous injections, and the eyes were collected and analyzed on day 7 after laser treatment. Laser‐induced CNV lesions were stained with isolectin B4 and volumes quantified using z‐stack on a confocal microscope system (Leica). We tested the Abcam anti‐mouse IL18 antibody used by Doyle et al. which was dissolved in 50% glycerol, an MBL anti‐mouse IL18 antibody, as well as isotype control antibodies in appropriate control buffers.

Results We found that MBL anti‐mouse IL18 antibody neutralized IL18‐induced cellular signaling whereas the Abcam antibody did not do so. We also found that the Abcam IL18 antibody increased CNV whereas the MBL antibody did not. We found that glycerol increased CNV to the same extent as the Abcam IL18 antibody, and that the Abcam IL18 antibody in glycerol did not increase CNV in mice deficient in Aquaporin‐1, a channel that is permeant to glycerol and promotes angiogenesis.

Conclusion IL18 blockade does not increase CNV. The previously reported results are an artifact of pro‐angiogenic glycerol in which the Abcam IL18 antibody is dissolved.
Outcomes of vitrectomy for vitreous haemorrhage (VH) in patients with presumed choroidal neovascularization (CNV)
Authors: KOH L , LAUDE A
Published: November 2013

Purpose To evaluate the role of vitrectomy for eyes with dense VH presumed secondary to CNV, as well as their clinical outcomes.

Methods Retrospective, consecutive case series from a single centre of 11 eyes of 11 patients over 2 years who underwent vitrectomy, and with no other identified ocular pathology e.g. diabetic retinopathy or trauma.

Results Visual acuity (VA) improved in 9 (82%) patients with mean logMAR VA change of 1.19 (+/‐ 0.69). Prior to vitrectomy, intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) had been given to 2 patients; pneumatic displacement of submacular haemorrhage to 1 patient; and photodynamic therapy with verteporfin to 1 patient. There were no pre‐existing retinal breaks found in all patients intraoperatively. Intraoperative complications include 1 posterior capsule rupture with anterior chamber intraocular lens insertion and 2 iatrogenic retinal breaks treated with laser. Angiography identified polypoidal choroidal vasculopathy in six, occult CNV in one and retinal pigment epithelium rip but no identifiable vascular lesion in one. Angiography was not done in three due to extensive disciform scarring. Lesions beyond the vascular arcade were found to have better prognosis. Recurrence of vitreous haemorrhage occurred in 2 patients.

Conclusion Vitrectomy for patients with dense VH and presumed CNV (most commonly PCV) was found to be useful to improve visual acuity, especially for lesions beyond the vascular arcade, although effect is limited. Vitrectomy also allows for subsequent retinal evaluation and angiography. The absence of pre‐existing retinal tears is in agreement with the reported outcome that the pathophysiology of breakthrough VH does not involve retinal tears.
Idiopathic macular hole closure toward the optic disc after internal limiting membrane peeling
Authors: OHTA K , SATO A , FUKUI E
Published: November 2013

Purpose To compare the distance between the optic disc and the fovea before and after successful closure of a macular hole (MH) by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. In addition, to investigate whether the distance is significantly correlated with the retinal thickness around the MH.

Methods Thirty‐seven eyes of 36 patients with an idiopathic MH that underwent PPV with ILM peeling were studied. The distance between the point of intersection of the disc margin with a temporal‐inferior vessel and the center of the opened or closed MH was measured manually with the Spectralis HRA+OCT (Heidelberg Engineering, Germany). The retinal thickness of macula was also measured by the volume scan mode.

Results The mean disc‐foveal distance was significantly shorter postoperatively than preoperatively (3783.7 ±308.5 um and 3914.5 ± 320.4 um, respectively; P<0.0001). The distance in eyes with stage 3 and 4 MH (n=22) was significantly greater than in eyes with stage 2 MH (n=15) (136.7 ± 134.9 um vs. 107.8 ± 107.7 um, respectively; P=0.012). The distance in stage 3 and 4 MHs (n=21) was weakly but significantly correlated with the mean postoperative parafoveal nasal thickness (r=0.45; P=0.038).

Conclusion The significantly shorter postoperative disc to fovea distance in eyes with closed MH especially in stage 3 or 4 MH suggests that the MH moves nasally after PPV with ILM peeling.
Association of OCT parameters with HbA1c level and diabetes duration in early stage of diabetic retinopathy
Authors: OSHITARI T , NONOMURA S , ARAI M , YAMAMOTO S
Published: November 2013

Purpose To investigate the association of the Fourier domain optical coherence tomography (FD‐OCT, Optovue) parameters with the level of HbA1c and duration of the diabetes mellitus (DM) in patients at the early stage of diabetic retinopathy (DR).

Methods Thirty eyes of 30 patients with minimal DR (non‐DR or mild NPDR) that were examined at the Chiba University Hospital from December 2011 to March 2012 were studied. The participants had no other ocular diseases and no history of surgeries. Three parameters embedded in the Optovue, the macular mapping 5 (MM5), RNFL, and ganglion cell complex (GCC), were performed, and the coefficients of correlation between these parameters and the HbA1c and the DM duration were analyzed with the Spearman rank correlation. A P<0.05 was considered significant.

Results All of the GCC parameters and RNFL parameters were not significantly correlated with both the HbA1c and the DM duration. The thickness of the outer‐inferior area (mean=275.9±18.1µm) was significantly correlated with the HbA1c (P=0.046, Rs=0.371). The outer‐superior area (mean=276.0±17.7µm) and the outer‐temporal area (means=277.9±14.6µm) were significant correlation with the DM duration (P=0.015, Rs=0.468; P=0.022, Rs=0.439, respectively).

Conclusion The significant positive‐correlation between the retinal thickness of the outer area of the MM5 sector and HbA1c and DM duration may be due to a subclinical increase of vascular permeability. It might also be due to Müller cell swelling because Müller cell density is known to be higher in the outer area than the center area.
New diagnostic and therapeutic strategies in acute and chronic central serous corioretinopathy
Authors: FRUSCHELLI M , DENARO R , ESPOSTI G , FREZZOTTI P , TORCHIA R , ESPOSTI PL
Published: November 2013

Purpose Central serous chorioretinopathy (CSCR) is a disease in which a serous detachment of the neurosensory retina occurs over an area of leakage from the choriocapillaris through the retinal pigment epithelium (RPE). CSCR can be acute or chronic. Classic image studies for CSCR are Fluorescine Angiography (FA) and Optical Coherence Tomography (OCT).No medical therapy is currently indicated for CSCR despite a range of potential medical treatments evaluated in many case reports. Argon laser photocoagulation can be considered only with a single leak located more than 300 µm from the center of the fovea. Autofluorescence (AF) with ultra‐widefield scanning laser and Subthreshold Micropulse (SDM) photostimulation with true yellow 577nm diode laser are the newer diagnostic and therapeutic options.

Methods AF with ultra‐widefield scanning laser (Daytona™, Optos plc UK) was performed in fifteen patients affected by acute and chronic CSCR. All the areas of serous retinal detachment visible at AF as hyperfluorescence were treated with SDM photostimulation (IQ 577™ true yellow laser, Iridex CA). Controls were made at 15 days, 1 and three months after the treatment.

Results Ultra‐widefield AF allowed to identify several zones of serous detachment not detected with FA and out of range of OCT scans. In most of cases we obtained the complete resolution of serous detachment and visual acuity improvement. Gain in visual acuity was better in acute cases of CSCR.

Conclusion Ultra‐widefield AF followed by SDM photostimulation can be an effective diagnostic and therapeutic option for patients with acute and chronic CSCR.
Leopard‐spot pattern of yellow‐orange subretinal deposits in central serous chorioretinopathy
Authors: DE ZAEYTIJD J , SCHELFHOUT V , LEROY BP
Published: November 2013

Purpose Central serous chorioretinopathy (CSC) is characterized by a serous detachment of the neurosensory retina caused by focal or diffuse dysfunction of the retinal pigment epithelium. A patient with a leopard‐spot pattern of yellow‐orange subretinal deposits as a rare dramatic form of CSC is described.

Methods A 65 year‐old man with severe chronic obstructive pulmonary disease and congestive heart failure noticed a poor visual acuity after waking up from a coma elicited by an acute exacerbation of COPD and need for ventilation treatment. He underwent a full ophthalmic exam and extensive imaging including fluorescein‐angiography, OCT and the use of infrared and auto‐fluorescent light.

Results In the ocular history there was prior cataract surgery because of severe subcapsular posterior cataract in both eyes. Visual acuity (VA) was reduced to counting fingers in the right eye and perception of light in the left eye. Fundoscopy showed a leopard‐spot pattern of yellow‐orange subretinal deposits in the posterior pole more pronounced in the right eye compared to the left. On FFA, the deposits were hypofluorescent with additional multiple pinpoint areas of hyperfluorescence spread over the posterior pole. Spectral OCT demonstrated a shallow detachment of the neurosensory retina with extensive intraretinal fluid and alternating atrophic areas and deposits at the level of the RPE which corresponded with hypo‐ and hyperfluorescent areas with autofluorescent light.

Conclusion Coarsely mottled or leopard‐spot hyperpigmentation and secondary retinal detachment may develop as a rare dramatic complication in patients with CSC.
Effect of intravitreal bevacizumab for chronic, recurrent, or atypical central serous chorioretinopathy
Authors: SONG JH , CHUNG YR , KIM MH , LEW HM
Published: November 2013

Purpose To evaluate the efficacy of intravitreal bevacizumab injection (IVB) for the treatment of chronic, recurrent, or atypical central serous chorioretinopathy (CSC).

Methods Forty‐nine eyes of 49 patients who were diagnosed with chronic, recurrent, or atypcial CSC and treated with intravitreal injection of 1.25 mg/0.05 ml bevacizumab, were included for this retrospective study. Best‐corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed at baseline, 3, 6, 9, and 12 months after initial IVB.

Results Patients received the mean of 2.16±1.34 IVB during the mean follow‐up period of 11.8±7.4 months, and 20.4% of patients had recurrent episode after initial resolution of subretinal fluid in this period. The mean baseline BCVA was 0.27±0.26 logarithm of minimum angle of resolution, and the mean baseline CMT was 353 ± 129 um. BCVA was significantly improved to 0.16 ± 0.18 (P = 0.005) and 0.14 ± 0.12 (P = 0.000) at 3 and 6 months, respectively. However, the improvement of BCVA was not significant at 9 months and 12 months. CMT was significantly reduced throughout the follow‐up period and 216±101 um (P = 0.008) at 12 months.

Conclusion Intravitreal bevacizumab injection may be an effective treatment option for patients with chronic, recurrent, or atypical CSC. Further prospective, long‐term studies are warranted.
Choroidal thickness in eyes with idiopathic epiretinal membrane
Authors: ZABADANI K , ASCASO FJ , PADGETT E , HERRERA L , MATEO J , CRISTOBAL JA
Published: November 2013

Purpose To compare the choroidal thickness in the macular area in eyes with an idiopathic epiretinal membrane (ERM) with that of unaffected fellow eyes and eyes of healthy controls.

Methods Enhanced depth imaging (EDI) was obtained by spectral‐domain optical coherence tomography (SD‐OCT) (Spectralis, Heidelberg‐Engineering,Germany) in 66 eyes of 50 patients (73.91 ± 11.1 years) with ERM and 96 eyes of 96 healthy controls (74.04 ± 8.5 years). Eyes were divided into 3 groups: 66 eyes in group A (affected eyes with ERM), 36 eyes in group B (unaffected fellow eyes), and 96 eyes in group C (right eyes of age‐matched controls). Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid‐scleral junction in the subfoveal area (SCT) and 1 mm away from the fovea in the nasal (NCT) and temporal (TCT) regions. Statistical analysis was conducted to compare mean choroidal thicknesses.

Results In the ERM group the mean choroidal thicknesses were 241.1± 98.1 µm at the fovea (SCT), 225.7 ± 88.7 µm nasally (NCT), and 232.6 ± 85.6 µm temporally (TCT). In the unafected fellow eyes these measurements were 216.4 ± 72 µm, 213.3± 73.7 µm, and 214.8 ± 71 µm, respectively. Finally, the control group showed the following values: 234.9 ± 100.4 µm, 224.7± 96.4 µm, and 233.0 ± 95.5 µm, respectively. Choroidal thickness did not show any statistically significant differences among the three groups of eyes when age was counted as a confounding variable (p>0.05, ANOVA test).

Conclusion No relationship between the presence of an ERM and changes in choroidal thickness was found. Epiretinal membrane is a disease caused by changes in the vitreous humor. Choroid does not seem to participate in the pathogenesis of this disorder.
Variation of online Amsler grid from mobile apps, YouTube and Google
Authors: LUK S , CHEN K , DAVIES N
Published: November 2013

Purpose To analyse and evaluate the dimensions and instructions of Amsler grid from three sources: Mobile Phone Apps, YouTube and Google.

Methods Searches were performed for Amsler grid in the three areas. Mobile Apps were viewed on a smartphone with 8.9 cm screen. Grids were measured on a 33.7cm computer screen with 1368 x768 resolution. Grids were assessed for number of squares, size, viewing distance and instructions on use. Calculation of subtended visual angle was made where possible.

Results 10 apps and 7 videos were identified. Over 2 million Amsler grids were found from Google and the first 100 grids were chosen. Black grid on white background design was used in 72%, 11% with white‐on‐black and other formats in 17%. Instructions about monocular testing, distortion and scotoma detection were described in 96%, 97% and 89% respectively. Frequency of testing was only stated in 24%, of which most advised between daily to weekly (75%) and up to monthly (1%). 66% of the grids were presented as 20x20, range from 8x8 to 30x30. Viewing distance was specified in 51%, range 30–40cm. The average calculated retina projection was 12.3° (range 6.8° to 21.4°). Only two grids would project to 20°of the macula. Google and YouTube are freely available and Mobile Apps can cost up to £28.99. Most of the sources are produced by ophthalmologist practices (39%) followed by Optometrist related groups (16%).

Conclusion Video‐sharing media and Internet may be an effective way to disseminate the test for patients. Our study show there is wide variation in the charts that are available which may affect the result of self monitoring tool.
The socio‐economic status of young adults with type 1 diabetes since childhood
Authors: HANNULA V , HAUTALA N , FALCK A
Published: November 2013

Purpose The aim of the study was to evaluate the socio‐economic status of young adults with type 1 diabetes (T1D) since childhood with particular interest in its relation to the severity of diabetic retinopathy (DR).

Methods During 1989‐90 the prevalence of DR was evaluated in a population‐based cohort of 5‐16‐year‐old children with T1D living in the catch‐area of the Northern Ostrobothnia Hospital District, Finland. These 216 individuals were contacted 18 years later and evaluated for retinopathy as well as asked to fill out a socio‐economic status questionnaire.

Results 136 subjects (78 men) aged 30±3 years with median T1D duration of 23 years took part in the study. Proliferative DR (PDR) was diagnosed in 42 (31%) their mean age being 31±3 years. 97 (71%) were married, 31 (23%) single and 8 (6%) divorced. 61 subjects (45%) had a total of 123 children. A university degree was held by 12 (9%), that from a university of applied sciences by 45 (33%), 61 (45%) had finished vocational school, 10 (7%) were full‐time students while 6 (4%) had received no education after comprehensive school. A full‐time job was held by 66 subjects (72%) with no or non‐PDR and 24 (57%) with PDR; 4 (4%) vs. 6 (14%) subjects were unemployed, respectively (p=0.071), and none vs. 5 (12%) were on pension, respectively. The patients with PDR were more likely to be outside working life (p=<0.001), but equally likely to have a spouse (p=0.683) and children (p=0.457).

Conclusion The majority of young adults with T1D have an active role in the society with work or study, spouse, and raising children. A third of the patients had PDR, and although they had similar educational level and families, they were more likely not to be taking part in working life than those with less severe DR.
Differential diagnostic of eye morphometric parameters in patients with refractive and axial myopia
Authors: BUSHUYEVA NN , MALIIVA EV
Published: November 2013

Purpose Many authors have shown that myopia is associated with changes in the anatomical parameters of the eye. The aim: To study morphometric parameters in patients with refractive and axial myopia

Methods The observation involved 264 patients (502 eyes) with varying degrees of myopia (myopic refraction of ‐2.75 diopters), age ‐ 18.41 year. Patients were divided by type of myopia: refractive (RM) ‐ 133 eyes, axial ‐ 217 eyes, mixed (SM) ‐ 91 eyes, and combined ‐ 61 eyes. Methods: visometry for distance, keratometry and refractometry after cycloplegia with cyclomed 1% with Accuref‐K 9001, Shin Nippon, the definition of the horizontal pupil diameter by keratotopograf PCT‐110, Optopol and horizontal corneal diameter by KR‐8900 Topcon and HRK‐7000 Huvitz.

Results Results Analysis of the data showed that the axial myopia has significantly larger average diameter , the radius and refraction of cornea, pupil diameter , length of the vitreous humor, axis length of the eye and the degree of myopia, compared with refractive myopia. Significantly higher mean values of intraocular pressure and the width of the anterior chamber angle were established in refractive myopia in comparison with axial myopia (p <0,01). Values of anterior chamber depth and lens thickness between patients with axial and refractive myopia showed no significant differences (p> 0,1).

Conclusion Obtained results showed that morphometric parameters of the eye, intraocular pressure in patients with axial and refractive myopia have practical value for early detection and prediction of the development and progression of myopia in patients with myopia
Epidemiology of patients undergoing strabismus surgery at adult age: Retrospective study of 221 patients
Authors: PROMELLE V , BREMOND‐GIGNAC D , MILAZZO S
Published: November 2013

Purpose The strabismus in adult patients could be either the persistence of misalignment since the infancy before the age of visual maturation, or as a consequence of neurological, traumatic or orbital pathology. The aim of this study is to characterize the patients population undergoing strabismus surgery at adult age.

Methods In this retrospective and monocentric study were reviewed 221 patients aged of 18 years and above ; the time frame was 3 years. For each patient we analyzed different parameters : age, sex, the treated deviation, the performed surgery, the etiology of the deviation and the presence of diplopia or amblyopia.

Results Our patients, aged of 18 to 82 years, reported an onset of strabismus during childhood in 62% (50% with no previous surgical treatment, 20% with a recurrence of already treated strabismus and 30% with a consecutive deviation); 75% of them suffered of amblyopia. The cause of strabismus in 32% of our patients was a secondary deviation due to cranial nerve palsy (55%), traumatism (30%) or orbital pathology (20%). Exotropia was more frequent in our population than esotropia (40% versus 30%). Diplopia was reported in 12% of the patients. The surgery was performed on one eye in 90% and the most frequent operation was on horizontal rectus muscles (64%).

Conclusion Adult patients are most frequently suffering of infancy strabismus. When the strabismus onsets at adult age, the most common causes were paralytic strabismus followed by traumatic strabismus. Exotropia was the most prevalent deviation. Surgery could be a simple monocular intervention on rectus muscles or more complex in some cases. The adult patients undergoing strabismus surgery represent a heterogeneous population.
Screening of visual disorders among high school students without expressed complaint
Authors: KOVARSKI C , CARLU C , PORTALIER S , FAUCHER C , DUFIER JL , ROCHE O , ORSSAUD C
Published: November 2013

Purpose Many students understate their visual discomfort, although it may have an educational impact. We studied the prevalence of visual disorders among students without self‐reported complaints.

Methods Four hundred students between 15 and 22 years of age responded to a questionnaire followed by a visual screening (refraction and binocular vision) in order to detect any visual discomfort that they might be unaware of. When visual problems were detected, the participants were suggested to have an ophthalmology and orthoptic assessment.

Results Visual disorders were found in 346 students. Thirty‐two percent of them agreed to have an ophthalmology and orthoptic assessment. Best‐corrected visual acuity was 20/20 in more than 95% of them. Nearly 60% were hyperopes, from which more than two thirds required an optical correction. Over or under‐corrected myopia and uncorrected astigmatism were uncommon. Convergence insufficiency was found in 80%, and only a few ophthalmologic pathologies were diagnosed.

Conclusion Many students have vision problems to which they are accustomed. It was rare to find underlying ophthalmologic pathologies (strabismus, nystagmus, ...). In most cases, these functional symptoms are due to under‐corrected hyperopia, possibly associated with convergence insufficiency. As visual demand is lower during primary education, some visual discomfort may only become symptomatic during the following years. However, the nature of these disorders suggests that they may interfere with education. We are now investigating the prevalence of learning difficulties among these participants, and whether there is an improvement after intervention.
A case of cortical blindness due to cerebral isquemia during OPCAB surgery and later recovery
Authors: GUTIéRREZ BONET R , QUIJADA ANGELI S , SANTOS VICENTE E
Published: November 2013

Purpose To describe a case of cortical blindness caused by hypoxia during a bilateral lung transplant in a 19‐year‐old patient affected with cystic fibrosis and later recovery.

Methods 19‐year old male diagnosed with cystic fibrosis is set to be operated of a bilateral lung transplant by OPCAB surgery. After the procedure the patient referred marked visual loss (hand movement). Slit lamp exploration was normal as well as funduscopy, OCT, IOP and pupillary reflexes, finding severe alterations in the visual fields performed.

Results The patient was diagnosed with bilateral occipital ischemia confirmed by MRI and caused by cerebral hypoxia during surgery. During the last 4 weeks visual acquity has improved to 0.2 (OD) and 0.4 (OS). Visual field results have also improved. As of today the patient evolution is still being followed.

Conclusion The critical importance of reducing as much as possible the time of surgery when OPCAB techniques are performed and the possibility of clinical improvement patients may show after cortical isquemia.
Presumed eosinophilic granuloma of the orbital roof in an adult man
Authors: BLASETTI F , MAIORE I , BRUNDU E , PINNA A
Published: November 2013

Purpose To report on an unusual case of presumed adult‐onset eosinophilic granuloma of the orbital roof, which showed spontaneous resolution.

Methods Descriptive review of the clinical records of one patient.

Results A 42‐year‐old man presented with a 3‐month history of relapsing edema in his right upper eyelid. Visual acuity was 20/20 bilaterally. Apart from the detection of a group of dilated vessels in the right lower bulbar conjunctiva, both eyes were unremarkable. There was no proptosis and ocular motility was normal. CT and gadolinium‐enhanced MRI head scans disclosed a 15 mm solid mass in the right anterior cranial fossa, which had eroded the orbital roof, penetrated into the orbit, and caused mild displacement of the levator palpebrae and superior rectus muscles. An initial diagnosis of intradiploic meningioma of the orbital roof was made. Total resection of the lesion was planned and the patient was put in the waiting list for neurosurgery. One year later, preoperative MRI head scans disclosed a significant regression of the lesion; consequently, neurosurgery was postponed. Six months later, MRI scans showed complete disappearance of the solid mass and full reossification of the orbital roof. A presumptive, final diagnosis of solitary eosinophilic granuloma of the orbital roof was made. He was cancelled from the waiting list for neurosurgery and MRI at 6‐month intervals has been scheduled.

Conclusion Persistent upper eyelid edema may be the presenting sign of an osteolytic intracranial mass eroding the orbital roof and extending into the orbit. Radiological differential diagnosis may be difficult; in this report, the detection of an osteolytic lesion and its subsequent spontaneous resolution are suggestive of an adult‐onset eosinophilic granuloma.
Augmented dried versus cryopreserved amniotic membrane as an ocular surface dressing
Authors: ALLEN C , CLARE G , STEWART E , BRANCH M , MCINTOSH O , VERMA M , DUA HS , HOPKINSON A
Published: November 2013

Purpose Dried amniotic membrane (AM) can be a useful therapeutic adjunct in ophthalmic surgery and possesses logistical advantages over cryopreserved AM. Differences in preservation can significantly influence the bio‐ chemical and physical properties of AM, affecting clinical efficacy. This study investigates a novel drying technique and the biochemical and structural effects on AM and following pre‐treatment of AM with novel lyoprotectants.

Methods AM was cryopreserved (CPAM) or dried (DAM) with and without pre‐treatment with lyoprotectants. Structural and visual comparisons were assessed using electron microscopy. Localisation, expression and release of AM biological factors were determined using immunofluorescence and immunoassays. The biocompatibility of AM preparations co‐cultured with primary corneal epithelial cell (CEC) or keratocyte monolayers were assessed using standard cellular health assays.

Results Drying devitalised AM epithelium, but less so than cryopreservation, and cellular damage was reduced in DAM pre‐treated with lyoprotectant. DAM alone, and pre‐treated with lyoprotectant showed greater factor retention efficiencies and bioavailability compared to CPAM. In addition cellular health assays showed that DAM alone and pre‐treated with lyoprotectant are compatible and superior substrates compared to CPAM for CEC expansion, with increased proliferation and reduced cytotoxicity profiles. This was supported by improved wound healing in CEC co‐cultured with DAM and pre‐treated DAM, compared to CPAM.

Conclusion Our modified preservation process and our resultant optimised DAM has enhanced structural properties and biochemical stability and is a superior substrate to conventional CPAM.
Optimisation of a standardised chemical burn animal model for use in corneal wound healing
Authors: MCINTOSH OD , ALLEN CL , HOPKINSON A , DUA HS
Published: November 2013

Purpose The rabbit ocular surface has been used for many years as a reliable comparison for the study of human corneal injuries. This work aimed to create a standardised corneal epithelial injury using an alkali insult, which results in a type III healing response with wound healing. The ultimate aim is the use of this in vivo injury model to test novel ocular bandages and substrate treatments.

Methods De‐epithelialisation first required in vitro optimisation for reproducibility before use in in vivo rabbit models. Corneas obtained from New Zealand White rabbits were de‐epithelialised with sodium hydroxide (NaOH) solution using a range of concentrations, durations and modes of application. The injury area, depth and severity were assessed using haematoxylin and eosin staining and transmission electron microscopy. The optimised in vitro model was applied to an in vivo pilot study in rabbits and tested for reproducibility using normal and fluorescein slit lamp images.

Results In vitro optimisation revealed that higher NaOH concentrations and extended durations caused undesirable irreversible damage to the cornea. Lower concentrations and durations produced the injury required. The injury model was established in an in vivo pilot study using our optimal parameters and tested to see if a chemical burn with little variation in area or severity could be achieved. Following 48 hour treatment we were able to detect reliable wound healing using our refined model.

Conclusion The in vitro optimisation showed us parameters that were sufficient to de‐epithelialise the cornea, creating an injury without causing stromal damage. The model is now in use in vivo, to test the biocompatibility and efficacy of various ocular surface substrate treatments.
Treatment of Meibomian gland disease with the Lipiflow® system: A prospective study
Authors: MICHEE S , RABUT G , BAUDOUIN C , LABBE A
Published: November 2013

Purpose To evaluate the safety and efficacy of Lipiflow® in the treatment of meibomian gland disease (MGD).

Methods Twenty eyes of 17 consecutive patients with MGD and evaporative dry eye were included in this study. MGD was associated with ocular rosacea in 58.8% of cases. There were 9 women (52.9%) and 8 men (47.1%) with a mean age of 58.1 ± 16.2 years (28‐82 years). Patients underwent a complete ophthalmologic evaluation including two symptoms questionnaires, SPEED® and ocular surface disease index (OSDI), tear film break‐up time (TBUT), Schirmer test, meibomian gland evaluation with the Meibomian Gland Evaluator® (MGE), tear film thickness measured with the Lipiview® Ocular Surface Interferometer and tear osmolarity (Tearlab®). Then all eyes were treated with the Lipiflow® system. All patients were evaluated before and one month after treatment.

Results According to SPEED questionnaire, symptoms improved significantly one month after treatment (15.4 ± 4.9 vs. 12.7 ± 5.8; p<0.001). However, OSDI was not modified (22 ± 8.4 vs. 21.7 ± 9.5, p=0.06). After treatment, TBUT increased (3.1 ± 1.6 sec. vs. 5.8 ± 2.5 sec., p<0.001) and the number of functional meibomian glands was significantly higher (2.8 ± 1.1 versus 6.8 ± 2.3, p<0.001). Schirmer test (13.4 ± 12.2 vs. 15.1 ± 14, p=0.6) and tear film thickness (57.3 ± 21.8 µm vs. 62.5 ± 23 µm, p=0.15) were not modified after treatment. Similarly, no change was observed in tear osmolarity (321.3 ± 19.1 mOsm/mL versus 321.7 ± 24.1 mOsm/mL, p=0.79). No adverse effect was observed for any patient during treatment and follow‐up.

Conclusion The use of the Lipiflow® system was safe and seemed to improve symptoms and some ocular surface parameters in eyes with MGD.
Semiology of patient derivated to ptergium surgery at Fuan Noe c. Hospital in Arica city, Chile
Authors: CHAVEZ C , VETTERLEIN V , FONTECILLA C , RAMIREZ JM , DE HOZ R
Published: November 2013

Purpose Knowing the semiological characteristics of surgical patient diagnosed with symptomatic pterigium, who has permanent resident at the desertical city of Arica, Chile.

Methods A transversal type study of 119 people was performed by applying them a survey, a physical exam and a pre surgical ophthalmologic evaluation. After surgery the removed tissue was sent to anatomopathological analysis. The survey data and test results were tabulated and analyzed using the statistical software Stata 11.0

Results Over 90% have permanent residence for more than 11 years in this desertical region; 89% work outdoors, 87.1% have nasal pterygium, 54% reported never used sunglasses. 73% has another visual disturbance. The 45.16% presents Pterygium of angiomatous and 45.15% Mixed type. Only 9.68% is fibrous. A 18.28% present metaplasia. Over 60% presents altered the Schirmer test results (higher than 24mm) and 50% in Break Up Time (BUT) altered lower or equal to 10 seconds.

Conclusion The Pterygium is a disease with high prevalence in the desertical city of Arica, Chile and it is evident that the absence of laws in prophylactic measures and educational activities, increase the damage that is produced by ultraviolet radiation. The relationship between the habitability of the desert and the correspondence with the use or not of lenses with UV protection is proportional.