bluuebunny/crossref_metadata_2025 huggingface dataset:
A mouse model of brittle cornea syndrome type 2
Authors: Findlay Amy , Stanton Chloe , Mustafa M. , Drake Camilla , Vitart Veronique
Published: December 2022

Purpose: Brittle Cornea Syndrome (BCS) is a rare disease that affects 1 in 1 000 000 people world wide. With a reduction in cornea thickness and therefore strength sufferers have an increase in loss of vision through injury. Our lab has previously published the first mouse model of BCS Type 1(1) and are currently characterizing a novel model of BCS type 2 in order to elucidate the underlying mechanisms causing this disease.

Methods: Mice carrying a 7 bp deletion which causes a frameshift and premature stop codon within the causative gene Prdm5 have been extensively phenotyped using Optical Coherence Tomography (OCT), Transmission Electron Microscopy (TEM) and Histology.

Results: These mice show a reduced central corneal thickness by OCT from as early as 1 month of age. TEM and histological analysis indicates that this reduction in thickness may be due to the dysregulation of collagen assembly – as stromal collagen fibre diameter is significantly reduced.

Conclusions: The structure of the stroma is crucial to corneal function: mechanical strength and transparency are achieved by the intricate arrangement of collagen fibrils, synthesized by keratocytes. Although it is known that the corneal stroma has a unique composition in which the ratio of Type I to Type V collagen is very different to anywhere else in the body, it remains unclear how the synthesis and maintenance of this specialized extracellular matrix by keratocytes is controlled. Characterization of the nature and extent of developmental defects in the cornea of this mouse model will be important to devise future therapeutic interventions.

Reference

1. Stanton, C. M., Findlay, A. S., Drake, C., Mustafa, M. Z., Gautier, P., McKie, L., Jackson, I. J., & Vitart, V. (2021). A mouse model of brittle cornea syndrome caused by mutation in Zfp469. Disease models & mechanisms, 14(9), dmm049175. https://doi.org/10.1242/dmm.049175
DSAEK in corneal decompensation by Baikoff lens implant after traumatic cataract and superior iridodialysis
Authors: Clavería Julia Aramburu , Martínez Marta Suñer , Fernández Miguel Castillo , de Rivas Marta Orejudo , Arias Pablo Andrés Cisneros , Moscarda Eva Josefina Núñez , El Bakkali Ismael Bakkali , Rivasés Guillermo Pérez , Puyuelo Javier Ascaso
Published: December 2022

Purpose: To present the assessment and surgical approach to late pseudophakic bullous keratopathy in a case of pseudophakia with Baikoff type anterior chamber (AC) IOL implantation with haptics synechiated to the iridian stroma. We opted for Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK), which allowed us to solve the corneal decompensation.

Methods: We present the case of a 72‐year‐old male with a history of traumatic cataract and superior iridodialysis, who was surgically treated with lens extraction and implantation of a three‐haptic Baikoff‐type AC IOL. During the 30 years after surgery, the patient remained stable. However, in 2021, he went for a revision with a decrease in visual acuity. During the slit‐lamp biomicroscopic examination and the images obtained, the presence of synechiae of the three haptics of the lens to the peripheral iridian stroma was evidenced, as well as the presence of generalized edema with increased thickness and loss of corneal transparency, which did not subside with medical treatment.

Results: Given the need for surgical intervention, the risk–benefit of performing a lens explant was studied. It was decided to perform a DSAEK endothelial transplantation keeping the IOL in its position, given the existence of a wide iridian dialysis and a wide anterior chamber. During the operation, the implanted gas bubble allowed the graft to adhere properly, although it did not remain in the anterior chamber, due to the presence of the traumatic superior iridodialysis. However, in the immediate postoperative period, the graft of the posterior corneal layers remained adhered without the need of the gas bubble, resolving the previous bullous keratopathy.

Conclusions: Late corneal decompensation is a complication to be taken into account in eyes with AC IOL. On the other hand, DSAEK offers advantages in the ease of positioning and maintenance of the graft compared to DMEK in cases with iridodialysis, obtaining a prompt recovery with good refractive results.
Changes in retinal thickness assessed by optical coherence tomography after successful rhegmatogenous retinal detachment surgery in 1 year follow up
Authors: Fernández Miguel Castillo , Sesé Isabel Bartolomé , el Bakali Ismael Bakali , Arias Pablo Andrés Cisneros , de Rivas Marta Orejudo , Moscarda Eva Josefina Núñez , Clavería Julia Aramburu , Martínez Marta Suñer , Rivasés Guillermo Pérez , Puyuelo Javier Ascaso , Lozano Isabel Pinilla
Published: December 2022

Purpose: To study retinal thickness using optical coherence tomography (OCT) (Spectralis OCT) in patients after undergone pars plana vitrectomy to repair rhegmatogenous retinal detachment (RRD) during different time points over 1 year follow up. OCT can detect retinal thickness changes in RRD. These changes can modify in the follow up time. RRD by itself or due to the surgical procedure could induces macular thickness changes.

Methods: We performed a single‐center cross‐sectional descriptive study including 49 eyes of patients with macula OFF RRD after 23 PPV + SF6 as tamponade; the contralateral eye was used as the control group. All participants underwent a complete ophthalmic examination that included refraction, axial length (AL), and Spectralis spectral‐domain (SD)‐OCT.

Results: Thirty‐six of the patients were male and 16 female; 40.8% of the eyes were right one. Central foveal thickness was diminished in 1 month and 3 months time points. There were not differences in the 6‐ and 12‐months examination. The parafoveal ring was similar in both groups but there were statistically significant differences in the inferior and nasal outer ring of the ETDRS grid, in the 1 month follow up. After 1 year, differences were only found in the outer temporal and nasal rings.

Conclusions: The findings of this study suggest that retinal thickness remains similar 1 year after RRD was successfully treated. These may indicate that there is a progressive anatomical restoration in the macular area.

References

1. Zghal I, et al. Macula analysis by spectral domain OCT in rhegmatogenous retinal detachment surgery. J Fr Ophthalmol. 2015; 38(3): 181–92.

2. Han KJ, et al. Optical coherence tomography automated layer segmentation of macula after retinal detachment repair. Plos One. 2019; 13 (5).

3. Terauchi G, et al. Recovery of photoreceptor inner and outer segment layer thickness after reattachment of rhegmatogenous retinal detachment. Br J Ophthalmol. 2015; 99(10): 1323–1327.
Clinical features of inflammatory vitreous haemorrhage: A comparative study between children and adults
Authors: Doukh Meryem , Abroug Nesrine , Dridi Tarek , Belghith Yassine , Jallouli Aida , Attia Sonia , Khairallah Moncef
Published: December 2022

Purpose: To compare clinical findings and visual outcomes of vitreous haemorrhage (VH) associated with inflammatory ocular conditions between children and adults patients.

Methods: Retrospective study including 46 patients (56 eyes) diagnosed with VH associated with inflammatory ocular conditions in Department of ophthalmology, Fattouma Bourguiba university hospital, Tunisia. Demographics, clinical findings, etiologies, treatment modalities, and visual outcomes were compared between adults and children. Mean follow‐up period was 18 months.

Results: There were 10 children (12 eyes) and 36 adults (44 eyes) patients. Mean age was 9.5 years in the children group (six males and four females) and 35 years in the adult group (26 males and 10 females). Comparative study showed that VH in the paediatric group was associated with a significantly lower presenting visual acuity, more frequently vitritis and fern‐like capillaritis, whereas VH in the adult group were more associated with vascular sheathing and retinal haemorrhages. The main mechanism of bleeding was inflammatory optic disc neovessels (NV) in the children group (66.6%, p ≤ 0.001) and ischemic posterior segment NV in the adult group (81.8%, p ≤ 0.001). Idiopathic intermediate uveitis (40%) was the leading cause of VH in the children group. However, tuberculosis (41.7%), Behçet's (19.4%) disease and sarcoidosis (11.1%) were the most common etiologies in the adult group. The mean final visual acuity was significantly higher in the paediatric group (20/25) than the adult group (20/50) (p = 0.045).

Conclusions: Inflammatory VH has a distinctive clinical and etiological profile between children and adults.

References

1. Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, et al. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary‐referral institutions: Inflammatory retinal vascular occlusion. Clin Experiment Ophthalmol. janv 2018;46(1):62–74.

2. Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, et al. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol. juill 2017;179:171–8.
Capsular bag transplantation
Authors: Abbas Khoja Amani , del Valle Fernando Gónzalez , Sanchez Javier Celis , Fernandez Maria Jose Dominguez , Sanchez Agustin Nuñez , del Pozo Encarnacion Asensio , Moraleda Laura Garcia Filoso
Published: December 2022

Purpose: To describe the surgical process of extraction of the capsular bag of the crystalline lens from the cadaveric donor and its posterior implant in aniridia and aphakia cases.

Methods: This surgical procedure was used in three posttraumatic aniridia and aphakia patients, and in a aphakic case with uveitis‐glaucoma‐ hyphema (UGH) syndrome. In a case was implanted a capsular bag, an intraocular lens (IOL) and an aniridia ring. In two cases in addition was implanted an artificial iris prothesis. In three surgeries, the capsular bag was preserved by freezing prior to the operation. A pars plana vitrectomy was performed in each case. The in‐the‐bag IOL complex was fixed using a cow hitch knot technique.

Results: The pseudophakic capsular bags complex remained stable and well positioned in all cases without any rejection phenomena. In the UGH syndrome, the capsular bag transplant avoided the mechanical trauma of the IOL over adjacent anatomical structures.

Conclusions: Capsular bag transplant could be a good option in posttraumatic aniridia with aphakia and in UGH syndrome, to resolve these conditions in only one‐stage surgery. This new surgical technique could be the best way to recuperate the anatomical compartmentalization of the eyeball in such cases.
An evaluation of patients with neovascular age‐related macular degeneration (nAMD) and receival of the first intravitreal injection at Rochdale Eye Unit, United Kingdom
Authors: Noor Maha , Mak Sammie , Hussin Hussin
Published: December 2022

Purpose: Both the National Institute for Health and Care Excellence (NICE)1, United Kingdom (UK), and the Royal College of Ophthalmologists2 guidelines for neovascular age‐related macular degeneration (nAMD) recommend that all patients referred with suspected nAMD should be reviewed and offered treatment within 14 days of referral. Therefore, the aim of our study was to evaluate the current percentage of patients with nAMD being referred to the Rochdale Eye Unit, UK, who are reviewed and offered therapy within 14 days and to establish any causes of delays.

Methods: A retrospective study of all patients newly referred for assessment and treatment of nAMD between 1st September 2021 – 30th April 2022 was performed. For each patient, data were collected (OpenEyes™) on dates of referral, review in medical retina clinic, 1st, 2nd, 3rd intravitreal injection (IVI), follow‐up, visual acuity at presentation and follow‐up, and any causes of delay in receiving injections or follow‐up. A total of 74 eyes were identified.

Results: Of the 74 eyes, 17 (23%) received the 1st IVI within 14 of days of referral. 42 eyes (56%) received the first IVI within 1 month of referral. The number of days between referral to 1st IVI varied considerably, with an average of 74 days, and mode of 25 days. The causes for delay included patients being lost to follow up (25%), awaiting fundus fluorescein angiography (5%), being re‐booked due to other health concerns (7%), and incapacity to meet demands (63%).

Conclusions: A growing aging population has increased the demands on Ophthalmology departments, such as Rochdale Eye Unit, to provide a robust nAMD service. We recommend establishment of an independent referral system for patients with suspected/known nAMD and higher training of senior registrars and advanced nurse practitioners, using college approved courses, to meet the demands of such service in order to avoid delaying treatment for these patients.

References

1. National Institute for Health and Care Excellence. (2018). Age‐related macular degeneration [NG82].

2. The Royal College of Ophthalmologists. (2021) Commissioning Guidance: Age Related Macular Degeneration Services.
Healing features of outer retinal layers on SS OCT in VKH disease
Authors: Aoun Safa Ben , Nefzi Dhouha , Salem Zeineb , Doukh Meriem , Ksiaa Imen , Khairallah Moncef
Published: December 2022

Purpose: To describe restoration of outer retinal layers on Swept‐Source OCT (SS OCT) in Vogt Koyanagi Harada (VKH) disease over a year after the disease onset.

Methods: Prospective longitudinal study carried out at the department of Ophthalmology of Fattouma Bourguiba University Hospital of Monastir. Twenty‐one patients (42 eyes) were followed‐up for 12 months after the disease onset. The patients were included at the acute phase and subsequently treated. Sequential SS OCT changes were assessed.

Results: Structural SS OCT changes occurred in 24 eyes (57.1%) on month 3 (M3), in 23 eyes (54.8%) on month 6 (M6), and in 19 eyes (45.2%) on month 12 (M12). They included external nuclear layer atrophy (14.3% on M3; 11.9% on M6; and 9.5% on M12); ellipsoid zone disruption (40.5% on M3; 38.1% on M6; and 33.3% on M12); interdigitation zone disruption (42.9% on M3; 40.5% on M6; and 33.3% on M12); and multifocal retinal pigment epithelium thickening (50% on M3; 45.2% on M6; and 31% on M12). No significant association between final visual acuity and external retinal layers alterations at any stage of the study was found. Stepwise analysis showed that the presence of serous retinal detachment at presentation was an independent factor for structural SS OCT changes on M3.

Conclusions: After initial onset, SS OCT shows thinning of the outer nuclear layer, disruption of the ellipsoid and interdigitation zones, and multifocal retinal pigment epithelium thickening. Serous retinal detachment at presentation is an independent factor for structural SS OCT changes during the first year of the disease.
Periosteal graft and conjunctival pedicle flap for re‐exposed glaucoma drainage device tube
Authors: Saldianovitta Rahajeng Anugrahing , Hamid Aulia Abdul , Dewi Debby Shintiya
Published: December 2022

Purpose: To report the management of exposed glaucoma drainage device (GDD) tube using periosteal graft.

Methods: A case report of patient from ophthalmology outpatient clinic in Dr. Saiful Anwar general Hospital.

Results: A 26‐year‐old male with history of steroid induced glaucoma came to ophthalmology clinic. Patient already underwent several procedures to control his intraocular pressure (IOP), including trabeculectomy and implantation of GDD. Implantation of GDD is widely used to control IOP in glaucoma patients. One month after implantation, patient experienced exposed GDD tube. Exposed GDD tube is one of the most common complications. The incidence is about 12% and tend to happen in eyes that already underwent many surgeries previously. This condition needs a further operative procedure such as adding patch graft on exposed area, in this case patient underwent conjunctival and pericardial graft. One month after additional patch graft procedure, patient felt uncomfortable sensation and redness on his right eye, even though IOP was 12 mmHg. During anterior segment examination, tube expose was found again. Patient underwent periosteal graft from his right tibial bone and conjunctival pedicle flap. After 2 months of evaluation, the graft is attached and IOP controlled at 14 mmHg.

Conclusions: Periosteal graft and conjunctival pedicle flap could be one of the appropriate choices to cover re‐exposed GDD tube.
Anatomical changes in the retinal capillary plexuses assessed by optical coherence tomography angiography in diabetic patients
Authors: Fernández‐Espinosa Guisela , Orduna‐Hospital Elvira , Boned‐Murillo Ana , Sopeña‐Pinilla María , Díaz‐Barreda María Dolores , Bielsa‐Alonso Sofía , Bartolomé‐Sesé Isabel , Pinilla Isabel
Published: December 2022

Purpose: To assess anatomical changes in the retinal superficial capillary (SCP) and deep capillary (PCP) plexuses, as well as choriocapillary (CC) in patients with diabetes mellitus (DM) without diabetic retinopathy (DR), and in DM patients with mild and moderate DR without diabetic macular edema (DME) using optical coherence tomography angiography (OCTA).

Methods: Ninety eyes were included, 34 patients with long‐term DM (more than 10 years) but without DR signs, and 54 patients with mild or moderate DR (levels 35 and 43 on the ETDRS scale) without DME. All participants underwent a complete ophthalmic examination including best corrected visual acuity (BCVA) and OCTA examination using deep‐range imaging with the DRI‐Triton SS‐OCT.

Results: The mean age was 63.82 ± 8.56 years and 63.00 ± 13.21 years in long‐term DM without DR and with DR, respectively. In patients with long‐term DM without DR, foveal avascular zone (FAZ) abnormalities were seen in both SCP and DCP (55% and 5%), and microaneurysms (MAs) were present in SCP and DCP (35% and 47.5%). Loss of perfusion was detected in SCP and DCP (30% and 47.5%), and ischemia was observed in SCP, DCP and CC (60%, 37.5% and 10%). In patients with mild or moderate DR without DME, OCTA also detected morphological abnormalities such as FAZ changes and MAs (79.6% and 81.11%), loss of perfusion (83.3% and 64.2%), and ischemia (66.67%, 81.1% and 18.5%) in SCP, DCP and CC respectively. Microvascular tortuosity and intraretinal microvascular anomalies (IRMAs) were detected in 48.1% and 46.3% in SCP vs 22.6% and 20.8% in DCP, respectively.

Conclusions: Patients with long‐term DM without DR present morphological changes measured with OCTA, such as MAs in both retinal plexuses. The changes in the FAZ are more evident in the SCP due to the capillary anastomosis. Capillary dropout can be found in both plexuses. Patients with DR show more evident changes that include MAs, loss of perfusion and ischemia and other vascular abnormalities.
Unilateral neuroretinitis as manifestation of syphilitic disease
Authors: Martínez Marta Suñer , Clavería Julia Aramburu , Fernández Miguel Castillo , deRivas Marta Orejudo , Moscarda Eva Josefina Núñez , Arias Pablo Cisneros , El Bakkali Ismael Bakkali , Rivasés Guillermo Pérez , Ascaso Javier
Published: December 2022

Purpose: Syphilis is a systemic sexually transmitted disease caused by the spirochete Treponema Pallidum. Ocular symptoms indicate neurological compromise, corresponding to 5%–8% of syphilis cases. The clinic is varied and involvement of practically any of the ocular structures has been described. The most frequent presentation is uveitis, which can be posterior, intermediate, anterior or panuveitis, unilateral or bilateral, granulomatous or not. It is responsible for 1%–2% of uveitis cases. This clinical experience aims to reinforce the existence of this entity and the importance of early treatment and adequate control of symptoms.

Methods: A 35‐year‐old man presented blurred vision in the left eye of sudden onset of 2 days of evolution. On examination, visual acuity of right eye 1.0 and left eye 0.05 according to decimal scale. Biomicroscopy shows Tyndall, without retrokeratic precipitates or synechiae. Transparent cornea and isochoric normoreactive pupils. The eye fundus shows obliterated papillae with fibrinoid‐like material, vasculitis, scattered haemorrhages and macular folds. Right eye without alterations. He reports the possibility of a risky sexual relationship. In serological tests, IgM for Syphilis is detected. He is admitted to the Infectious Diseases service for intravenous treatment with Benzylpenicillin 4 million Ul/ 4H.

Results: One month later, inflammation of the anterior pole has disappeared, but the fundus shows persistent neuroretinitis with edema of the optic nerve, macular star exudates and a focus of vasculitis in the superior temporal artery. Ozurdex is indicated. One month later, he shows visual acuity of 1 in left eye, and reduced inflammation of the optic nerve, exudates and haemorrhages.

Conclusions: Ocular syphilis is an entity that is still present, as well as the importance of actively searching for it. It is a potentially serious disease that affects young adults, with a good response to treatment if the diagnosis is made early.
Microglial activation and retinal pigment epithelium alteration in a model of focal LED‐induced phototoxicity. Neuroprotection afforded by bFGF and minocycline
Authors: Ollero Juan Antonio Miralles De Imperial , Ortega Alejandro Gallego , Muñoz María Norte , Di Pierdomenico Johnny , Valiente‐Soriano Francisco Javier , Vidal‐Sanz Manuel
Published: December 2022

Purpose: To study the microglial reaction and degeneration of the retinal pigment epithelium (RPE) and its protection with basic fibroblast growth factor (bFGF) administered alone or combined with minocycline (MC) in a model of focal light‐emitting diode (LED)‐induced phototoxicity (LIP) in mice.

Methods: In dark‐adapted adult C57 mice (20–25 g), the left eye was dilated and exposed for 45 seconds to a blue LED (400 nm; 500 lux) placed 2 mm perpendicular to the corneal apex (n = 71). Mice were treated with bFGF (0.5 μg) administered alone or in combination with MC (45 mg/kg). bFGF was administered in a single intravitreal injection just after LIP and the MC was daily injected intraperitoneally, starting the day before LIP (n = 10–13 per group). Vehicle or naïve groups were used as controls (n = 6–10 each group). Retinas were immunodetected with anti‐arrestin and anti‐Iba1 antibodies to study cone outer segments (a+OS) and microglial cells (Iba1+cells) and RPEs were immunodetected with anti‐ZO1 to study RPE cells, at 3 and 7 days after LIP. The number of cones and microglial cells was studied within a pre‐fixed area (PFA) of 0.9 mm diameter at the centre of the lesion.

Results: Treatment with bFGF alone or in combination with MC was effective in protecting a+OS within the PFA compared to vehicles at 7 days after LIP (p = 0.034 and p = 0.001, respectively). The combined treatment of bFGF and MC was effective in reducing the number of Iba1+cells within the PFA in the outer plexiform layer at 7 days after LIP (p = 0.0003). However, the treatments had no restorative effect on RPE cell survival or morphological integrity at 7 days after LIP (p = 0.6762).

Conclusions: Administration of bFGF alone or in combination with MC increased a+OS survival and reduces Iba1+cell activation but does not reduce RPE damage.
Ultra‐wide field fluorescein angiography in intermediate and posterior uveitis: A retrospective study
Authors: Stavropoulou Theodora , Theodorakis Andreas , Papadedes Konstantinos
Published: December 2022

Purpose: To review the diagnostic value of the Ultra‐wide field imaging system Optomap Panoramic 200A (Optos, PLC, Scotland) in patients with intermediate, posterior uveitis or panuveitis of our department and the presence of findings in the periphery of the retina compared to the conventional 7 standard field fluorescein (7SF) angiography, as well as the contribution of the findings to the change of the therapeutic approach.

Methods: This is a retrospective study. A medical records electronic search using Medisoft (Medisoft Limited, UK) conducted and included 69 patients and 121 eyes with intermediate, posterior uveitis or panuveitis that underwent Ultra‐wide field fluorescein angiography imaging. Subsequently, imaging was observed for detection of vasculitis, ischemia, neovascularisation and/or choroidal lesions in areas beyond 75° that was detected by conventional fluorescein angiography. The therapeutic approach based on the presence/absence of relevant findings was also reviewed.

Results: Out of 121 eyes in total, 67 were classified as intermediate uveitis, 44 as posterior uveitis and 5 as panuveitis. The presence of at least one form of peripheral angiographic finding was noted in 52 eyes, peripheral vasculitis was observed in 40 eyes and peripheral ischemia in 31 eyes. Decision to change the therapeutic approach was decided in 42 eyes overall, 31 of which presented peripheral findings and 11 lacked any. 21 eyes were noted with peripheral findings, but no change of treatment was decided. There was a statistically significant correlation between presence and absence of findings and change of treatment (p < 0.00001). No other statistically significant correlation between treatment alteration and score or specific uveitis type was found.

Conclusions: Compared with conventional 7SF imaging, the Ultra‐wide field fluorescein angiography is an extremely useful diagnostic test for the detection of active disease and can significantly change the therapeutic approach in patients with intermediate, posterior uveitis or panuveitis.
The monitoring of the speed of re‐epithelization after refractive surgery performed with the method of Trans‐PRK, with the use of hydrocortisone sodium phosphate (Softacort)”
Authors: Sakellaris Dimitris
Published: December 2022

Purpose: To exhibit the advantages of preservative‐free hydrocortisone in the postoperative treatment regimen of transepithelial photorefractive keratectomy (Trans‐PRK) for the promotion of epithelization and minimalization of early haze appearance.

Methods: In this prospective, randomized controlled study, 40 patients who had undergone trans‐PRK were divided into two equal groups, the first group received hydrocortisone (Softacort®, Laboratoires Thea) 2 drops 4 times daily for 7 days and the control group received no complementary medication. Both groups were given: artificial tears 2 drops hourly for 7 days, then administered every 2 h for 21 days and tapered till 3 months post‐operation, antibiotic drops (quinolone) 4 times daily and autologous serum hourly for 7 days, and a bandage contact lens till complete epithelization of the surgical wound. Patients were monitored daily to determine the time of a complete epithelization and then on day 15 and 30 to assess any signs of early‐onset haze and visual acuity. Scheimpflug topography and anterior segment OCT were performed on day 15 and 30 as well as IOP tonometry.

Results: The results showed a significant decrease in recovery days in patients treated with hydrocortisone compared to the control group (p < 0.0006) which was associated with a higher rate of early‐onset haze presentation. Both groups had satisfactory visual acuity and no significant differences in their IOP were observed.

Conclusions: The use of hydrocortisone sodium phosphate drops (Softacort®) has been shown to be efficient in corneal epithelization and haze management and safe in patients after trans‐PRK.
Determination of the activation regions of three deep learning models in infrared images of glaucoma
Authors: Díaz‐Alemán Valentín Tinguaro , Perera Sandra Gómez , Batista Francisco José Fumero , Miranda Silvia Alayón , del Arco Rafael Arnay , Saavedra José Francisco Sigut
Published: December 2022

Purpose: The main objective of this study is to characterize the activation regions of three Deep Learning models using infrared images of the optic nerve of glaucoma patients.

Methods: We have retrospectively collected a sample of patients with primary and secondary open‐angle glaucoma and normal patients. The images in infrared were recorded with a spectral domain optical coherence tomography. Three previously trained models were used, VGG19, ResNet101 and the Shufflenet. Sensitivity, specificity, diagnostic accuracy in training and testing, and ROC area were calculated for all three models. The gradient‐weighted class activation map (GradCAM) was used to obtain the activation regions that highlight the most important components in the images for model prediction. The correlation coefficient between the glaucoma activation maps and between normal activation maps of the three models was calculated, and the location of the activation regions in the glaucoma and normal images was determined for each model.

Results: 639 eyes of 415 patients were collected, 432 glaucomatous and 207 normal. The accuracy of the models on the test set was 96.9% (VGG19), 95.3% (ResNet101), and 93.8% (Shufflenet). The activation maps of the ResNet101 and Shufflenet models obtained a high correlation in glaucoma (0.75) and normal (0.68) cases. For the three models, the region of interest was located mainly in the inferior temporal quadrant in 65.2% of the cases (VGG19), in 52.9% (Shufflenet) and in 54.1% (ResNet101).

Conclusions: In glaucoma eyes, the regions of interest assessed with the gradient‐weighted class activation maps of the three models analysed are located in more than half of the cases in the inferior temporal quadrant of the optic nerve.
Refractive management of a bilateral lens subluxation case in marfan syndrome patient
Authors: Dinnarwika Syarah Nandya , Wulandari Lely Retno , Sulistya Triana Budi , Anandita Nanda Wahyu
Published: December 2022

Purpose: To report refractive management of bilateral lens subluxation case in Marfan Syndrome patient.

Methods: Diagnosis based on a history‐taking, a physical examination, and an ancillary test. The refractive state of the patient was examined by an autorefractometer, streak retinoscopy and best‐corrected visual acuity (BCVA), before and after cycloplegic on each eye.

Results: A 7‐years‐old girl diagnosed with Marfan Syndrome by the Department of Paediatric Cardiology complained for blurred vision in both eyes. Initial visual acuity of the patient was 0.027 in her right and left eyes. Anterior segment examination showed phacodenesis in both eyes. After cycloplegic refraction with enlarging pupil diameter and performed streak retinoscopy, BCVA in the right eye was 0.040 with a refractive correction of −22.00 diopters (D) and left eye was 0.021 with −20.00 D. After several follow ups, the refractive state remains highly fluctuates due to severe lens subluxation degree, which is seen through a half pupillary area. Consequently, operative approach using intracapsular lens extraction technique is considered. A month after the surgery, the distance visual acuity in right eye was 0.125 and 0.080 in left eye. With a refractive correction of +5.50 D, visual acuity became 0.500, while for the left eye became 0.125 with +5.00 D. Whereas, binocular distance visual acuity with refractive correction became 0.400. Therefore, spectacle was prescribed to achieve optimal visual acuity.

Conclusions: The refractive management steps in lens subluxation associated with Marfan Syndrome case is very challenging depends on patient's condition. The intracapsular lens extraction procedure prior to spectacle prescription should be considered as a management of severe lens subluxation in patient with Marfan syndrome, in order to achieve BCVA.
Corneal morphological and structural changes measured with pentacam induced by pterygium surgery
Authors: Villalba Mateo , Argudo Alejandro Tocón , Fernández Pilar Margarita Álvarez , Sanchez Javier Benitez‐del‐Castillo
Published: December 2022

Introduction: Pterygium has been related to the induction of astigmatic and optical aberrations and surgery could induce a reduction in these corneal characteristics.

Purpose: Study main objective was to evaluate corneal changes and optical aberrations that occura after primary pterygium surgery, and as a secondary objective, to evaluate changes depending on the used surgical technique (simple excision vs. conjunctival plasty).

Methods: Data collection was performed through Scheimpflug camera system for anterior segment analysis (Pentacam®): corneal astigmatism in diopters (K) and curvature radius and corneal aberration (Root Mean Square (RMS) Low order aberrations (LOA) and RMS High Order aberrations HOA) in a total of 18 eyes of 18 patients from the Hospital Universitario de Jerez (HUJ) who need pterigion surgery. Variables measured were analysed before surgery and 3 months later.

Results: Results showed that there is no statistically significant change in astigmatism after pterygium surgery, although there is a statistically significant reduction in total RMS of the anterior cornea (p = 0.02), RMS LOA of the anterior cornea (p = 0.03) and RMS HOA of total cornea (p = 0.007), anterior cornea (p = 0.03) and posterior cornea (p = 0.03). There are not statistically significant differences between both groups when comparing the surgical technique used.

Conclusions: No statistically significant changes in astigmatism after pterygium surgery have been found, but there is a significant decrease in optical aberrations, especially in the anterior cornea. It cannot be concluded that one surgical technique is superior to another.
The effect of sodium glucose transporter 2 inhibitor in diabetic macular edema. A pilot study
Authors: Hernández Irene Gil , Perez Delia Hernandez , Montesa Maria Jesus Puchades , Teruel Jose Luis Gorriz , Duch‐Samper Antonio M.
Published: December 2022

Purpose: To investigate if the oral administration of sodium‐glucose cotransporter 2 (SGLT2) inhibitors may have a relevant role modifying the diabetic macular edema (DME) in naïve eyes of diabetic patients.

Methods: We conducted a single‐arm pilot study including 6 eyes from 4 patients with type 2 DM with de novo DME who had never been treated with intravitreal injections of VEGF. We performed a first visit to ensure adequate metabolic control and blood pressure of the patients. Later, we add 100 mg/day of oral canagliflozin with an increase of 300 mg of canagliflozin at second month. In this study, visual acuity (VA) and central retinal thickness (CRT, μm) prior to and at 3 months after the initiation of SGLT2 inhibitors were retrospectively compared.

Results: 3 of 4 patients maintained or improved their visual acuity. Only one patient worsened their visual accuracy in both eyes at week 12, and since this case exceeded the preset limit of 5 letters, the progression of DME was considered, requiring rescue with intravitreal anti‐VEGF treatment, according to the pre‐established protocol. After 12 weeks of follow‐up, median CRT improved from 317.5 to 302 μm (mean 15.5 μm).

Maximum ILM‐EPR height of edema also reduced from 482 to 438 μm (mean 42.1 μm) None of the four patients reported severe adverse effects.

Conclusions: To our knowledge, this pilot study is the first to evaluate the effect of oral canagliflozin in a series of patients with DME who have not previously received intraocular therapy or undergone vitreoretinal surgery. Based on our preliminary results, we could speculate that SGLT2i inhibitors may be useful to decrease DME within 12 weeks of treatment, with improvement of visual accuracy avoiding invasive treatments. Larger clinical studies are needed to confirm this relationship.
Modulation of retinal cytokine expression by saffron in an experimental glaucoma model
Authors: Fernández‐Albarral José A. , Martínez‐López Miguel A. , Salobrar‐Garcia Elena , Martín‐Sánchez Beatriz , Felipe Diego San , López‐Cuenca Inés , Marco Eva M. , Salazar Juan Jose , de Hoz Rosa , Ramirez Jose Manuel , López‐Gallardo Meritxell , Ramirez Ana Isabel
Published: December 2022

Purpose: To analyse the anti‐inflammatory effect of saffron extract, by regulating the expression of cytokines and chemokines involved in the neuroinflammatory process leading to retinal ganglion cell (RGC) damage, in a mouse model of unilateral laser‐induced ocular hypertension (OHT).

Methods: Three groups of Albino Swiss mice treated with saffron extract were used; saffron naïve group (SNG), saffron laser group 1 day (SLG1d) and saffron laser group 3 days (SLG3d). Both eyes with OHT (treated with laser photocoagulation) and their contralateral were analysed. Retinal samples were processed and multiarray kits (MILLIPLEX MAP Mouse Cytokine/Myokine Magnetic Bead Panel) were used to quantify the expression of: IL‐1β, IL‐4, IL‐6, IL‐10, IL‐17, IFN‐ϒ, TNF‐α, Brain‐derived Neurotrophic Factor (BDNF), Vascular Endothelial Growth Factor (VEGF) and Fractalkine. Immunohistochemical analysis was performed to locate cells expressing the factors and cytokines detected in the multiplex assay.

Results: After saffron treatment, no significant differences were found, at 1 and 3 days after laser‐induced OHT, between the concentration of proinflammatory cytokines (IL‐1β, IFN‐γ, TNF‐α and IL‐17), anti‐inflammatory cytokines (IL‐4 and IL‐10), BDNF, VEGF, and fractalkine in both the OHT eye and its contralateral eye, compared to saffron naïve. IL‐6 levels increased significantly in the OHT eye in SLG1d, reaching normal values at SLG3d compared to SNG. These results are contrary to those found in OHT eyes and their contralateral not treated with saffron, in which changes in cytokine levels were observed.

Conclusions: Saffron is effective in regulating the production of proinflammatory cytokines, VEGF, and fractalkine induced by increased IOP, thus protecting the retina from its related damage. Saffron could be beneficial as coadjutant therapies in the treatment of glaucoma, thus helping to decrease the inflammatory process that occurs in this pathology.
Perceived prescription for multifocal contact lenses
Authors: Raso Alicia López , Alonso Jose Manuel Lopez , Alcocer Javier Ruiz , Prieto Elena Durán , Martínez Mercedes Burgos , Goodenough Neil
Published: December 2022

Purpose: Multifocal contact lenses have a variable power map that is typically radial. The prescription of these lenses is given as a Sphere plus Addition values in diopters. They are calculated by assigning different radial rings of the lens to different mean power values (near and far vision zones). Depth of focus (DOF) should be high in order to focus both images on the retina. This calculation usually depends on each manufacturer and design type. The purpose of this work is to give a simple common criterion for perceived prescription, based on visual criteria and patient's pupil.

Methods: The radial power profile of different multifocal contact lens designs was measured with a NIMO TR1504 (Lambda‐X). Using geometrical optics and MATLAB, ray tracing is performed and the position of the smallest spot size plane, noted as Df, is recorded. Spot size in that plane is recorded too. From Df, graphs of perceived diopters (inverse of Df in meters) versus different diameter portions of the lens are obtained.

Results: The method provides the sphere and addition values for lenses with zonal designs based on the maximum and minimum effective power seen by the patient as a function of pupil size. The main perceived diopter grows or decrease smoothly depending on centre‐near or centre‐distance designs. The calculation of the approximate size of the spot with the diameter also allows estimating the DOF too. In Extended Depth of Focus (EDOF) lenses the method is also applicable without changes of criteria.

Conclusions: The determination of the prescription perceived by the patient with multifocal contact lenses is important and there are no uniform methods for the different designs. The inclusion of the diameter used by each patient allows the inclusion of visual criteria for calculation of main perceived diopter and the use of a common method.
Systemic lupus erythematosus Purtscher like retinopathy optical coherence tomography angiography assessment implications
Authors: Garcia‐Soler Enrique , Rubio Clara Martínez , De Smet Marc Dominique , Mirete Patricia Udaondo , Alonso David Salom
Published: December 2022

Purpose: to underline the importance of optical coherence tomography angiography (OCT‐A) in the diagnosis, assessment of final visual outcome and better understanding of the Purtscher like retinopathy, as well as to emphasize on performing an ophthalmologic evaluation in all patients with systemic lupus erythematosus, as eye involvement is closely related with disease activity.

Methods: case report. Ophthalmologic multimodal imaging assessment of a patient short after experiencing a systemic lupus erythematosus severe outset.

Results: fundus examination revealed multiple cotton‐wool exudates and sharp defined intraretinal white flecken lesions, concentrated in the posterior pole, which along macular edema and the context of lupus disease led to the diagnosis of Purtscher like retinopathy, raising concern about underlying disease activity. OCT‐A evidenced ischemic affront in the superficial and deep vascular plexuses but also at choroidal level, preconizing a poor visual outcome. Precapillary retinal vascular stops and choroid lobular ischemic images were of note. Six months after initial consultation, previously displayed ischemic images gave rise to retinal and choroidal atrophy translated in counting fingers best corrected visual acuity with the posterior ensue of retina neovascularization.

Conclusions: This case proves ophthalmologic evaluation mandatory for all patients suffering from lupus and reveals OCT‐A as an imaging tool of great value in the assessment of Purtscher retinopathy. To our knowledge, this is would be the first report of a SLE Purtscher‐like retinopathy characterized by OCT‐A, matching graphically and unprecedently vascular micro‐embolism stops and ischemic areas, seen as void signals, with the pathognomonic Purtscher flecken and Paracentral Acute Middle Maculopathy (PAMM) lesions.
Inner limiting membrane bridges within Bruch's membrane defects in pathological myopia
Authors: Jonas Rahul , Jonas Jost , Auffarth Gerd , Panda‐Jonas Songhomitra
Published: December 2022

Purpose: To examine peculiarities of the inner limiting membrane (ILM) in axially elongated eyes.

Methods: The histomorphometric study included human globes enucleated due to reasons such as painful secondary angle‐closure glaucoma or malignant uveal melanomas. Using light microscopy, we searched for regions with ILM‐specific features in association with a marked axial elongation.

Results: Out of 279 eyes (279 patients) (mean age: 61.8 ± 13.9 years; axial length: 25.5 ± 3.1 mm (range: 20.0–37.0 mm)), two eyes (axial length: 30 mm and 34 mm, respectively) showed one region and two regions, respectively, characterized by ILM presence and absence of all other retinal layers, retinal pigment epithelium, Bruch's membrane (BM) and choroid. The length of these regions, called ILM‐bridges, was 1.06, 0.73, and 0.62 mm, respectively. All ILM‐bridges were spatially associated with a larger, underlying BM defect and with localized scleral thinning without a staphylomatous scleral configuration. The distance between the ILM‐bridges and the optic disc ranged between 1.92 and 4.21 mm. In univariable analysis, ILM‐bridge number increased with longer axial length (beta: 0.19; p = 0.002) and higher BM defect prevalence (beta: 0.21; p = 0.001), while in multivariable analysis, the ILM‐bridges number remained to be significantly correlated with a higher prevalence of BM defect (beta: 0.15; p = 0.048).

Conclusions: ILM‐bridges are a hallmark of pathologic myopia and occur in spatial association with underlying, larger BM defects. ILM‐bridges may be due to a local stretching and rupture of all other retinal layers, caused by the BM defect‐related enlargement of the retinal underground, with the ILM as a basal membrane presenting the highest resistance against the stretching‐associated biomechanical force.
The retina in amblyopic subjects: Controversy of the scientific literature
Authors: Hernández‐Rodríguez Carlos Javier , Albertos‐Arranz Henar , Piñero‐Llorens David P.
Published: December 2022

Purpose: Amblyopia is a visual developmental disorder characterized by unilateral, or rarely bilateral, reduction of the best‐corrected visual acuity. Some controversy existed since some authors have observed greater macular and choroidal thickness in amblyopic eyes using the optical coherence tomography (OCT) and OCT angiography (OCTA). The aim of this study was gathering the scientific literature to define if structural changes are present in the retina and choroid of amblyopic patients.

Methods: Articles from 2016 up to January 2021 were searched in PubMed database. The study eligibility criteria included articles of structural and anatomic changes in the human retina, the vascular network, and the choroid in anisometropic, strabismic or mixed amblyopia.

Results: Thirty‐three of 72 articles were included. A significant increase of the macular thickness, the retinal nerve fibre layer (RNFL) and the choroid along with a lower vascular density were shown in some articles. However, amblyopic eyes usually present different axial length than the fellow eye and most studies do not consider it despite structural differences in the retina have been described. In fact, no differences in the thickness of the macula were observed in studies that compared amblyopic with control eyes when considering the axial length. These studies did observe a tendency to a thicker RNFL, smaller foveal avascular zone, a decrease vascular density and a lower blood flow in the macula and optic nerve. Regarding the choroid, most articles suggest amblyopic eyes present greater choroidal thickness, luminal area volume and more vessels once axial length is adjusted.

Conclusions: Only 11 studies that considered the axial length suggest amblyopic eyes do not present significant differences in the macular thickness compared to control, but they suggested an increased RNFL, lower density and retinal vascular flow and an increase in choroidal thickness.
New potential markers for Fuchs corneal endothelial dystrophy: A proteomic study
Authors: Aouimeur Inès , Hanielle Vaitinadapoule , Naoki Okumura , Koizumi Noriko , Gain Philippe , Thuret Gilles , He Zhiguo
Published: December 2022

Purpose: Fuchs Endothelial Corneal Dystrophy (FECD) is characterized by the progressive slow accumulation of extra cellular matrix (ECM) forming Descemetic excrescents named guttae and by an increase in the thickness of the Descemet membrane (DM). Nevertheless, FECD pathophysiology remains only partially understood.

Aim: To present the expression of newly identified proteins, using proteomics methods.

Methods: DM were obtained from FECD patients undergoing DMEK and from donor corneas (controls) (University Hospital St‐Etienne). Some samples were analysed using MALDI imaging and shotgun proteomics (Kyoto, Doshisha University) to identified proteins selectively under or over expressed in FECD vs controls. Other samples were used for immunostaining (IS) of the top over‐expressed proteins. We used IS on flat mounts of DM in order to study the differences between the center and the periphery and cross sections to study the DM layer affected. Cross sections were performed using a cryostat on DM embedded in a mixture of gelatin, optimal cutting temperature compound and sucrose. Expression of each protein was observed using a fluorescence microscope. At least 3 different samples were used for each protein.

Results: MALDI imaging and shotgun analysis identified 11 potential targets overexpressed in FECD, belonging to different families: mainly collagen, proteogylcans, and TGF beta signalling. Using IS, none of the 11 proteins was expressed in healthy samples, except for fibronectin. In FECD samples we identified proteins selectively expressed in different structures of the diseased DM: embryonic layers, Guttae, posterior fibrous layers. Notable differences were also observed between the periphery and the center.

Conclusions: These new potential FECD markers located in different ECM abnormal structures suggest a dynamics phenomenon where different proteins are successively expressed and accumulated with time.