bluuebunny/crossref_metadata_2025 huggingface dataset:
OOKP protocol update
Authors: LAM FC , GOMAA A , AL RAQQAD N , LEE R , HEROLD J , FRANCIS I , BUSUTTIL A , THORP S , HUGHES E , HULL C , LIU CSC
Published: November 2010

Purpose The OOKP remains the procedure of choice for restoring sight in patients with corneal blindness caused by end‐stage ocular surface disease not amenable to cadaveric keratoplasty. Falcinelli's modifications of Strampelli's technique of OOKP surgery remains the gold standard for its excellent visual and keratoprosthesis‐retention results. To maintain good outcomes, aid research and to maintain standards, it is important that benchmarks are maintained in patient selection and preoperative assessment, surgical technique and post‐operative care. We therefore present, for discussion, the updated protocol that is currently used in the British National OOKP Referral Centre at the Sussex Eye Hospital, Brighton.

Methods Members of the OOKP Study Group met in Rome, Italy in 2001 and Vienna, Austria in 2002 to produce and up‐to‐date standard and protocol. Since then, we have continued to update our protocol on the basis of our own outcomes and findings. We present our updated protocol for discussion and for use in other OOKP centres.

Results Our updated protocol includes a discussion on the indications and contraindications for surgery, criteria for patient selection, surgical technique, routine postoperative care, and the recognition and management of postoperative complications.

Conclusion 5 years have passed since the standards for modified OOKP surgery were published. This paper highlights changes to this standard resulting from our practice in our national OOKP centre.
Vitreoretinal considerations in OOKP
Authors: HUGHES E , GOMAA A , AL RAYYAD N , LIU CSC
Published: November 2010

Purpose To present the difficulties of managing vitreoretinal complications in patients with OOKP and open a discussion about future strategies to prevent and deal with these problems.

Methods Retrospective review of cases.

Results Vitreo‐retinal complications occurred in 14 of 54 patients receiving OOKP surgery. These included vitreous hemorrhage (4 patients), rhegmatogenous retinal detachment (3 patients), endophthalmitis with retinal detachment (5 patients), endophthalmitis without retinal detachment (1 patient) and intraoperative choroidal hemorrhage (1 patient). Most cases of endophthalmitis presented late and may result from lamina resorption, leak and hypotony. The prognosis of retinal detachment in an eye with OOKP was poor with successful repair in 1 of 3 cases not related to endophthalmitis and 0 of 5 cases with endophthalmitis. Overall, pars plana vitrectomy was performed on 10 occasions (8 patients), of which 2 were endoscopic and 2 utilised a temporary keratoprosthesis.

Conclusion There is a relatively high rate of posterior segment problems in OOKP patients and their management is challenging both in assessment (limited view and ultrasound amenability) and surgical approach. Surgical outcomes were poor for these complications. Other concepts in management, including endoscopic vitrectomy at stage I surgery should be considered, which will be discussed.
New biomaterials for keratoprostheses
Authors: LLOYD AW , TIGHE BJ , FRANKLIN V , HUHTINEN R , SANDEMANN S , LIU CSC
Published: November 2010

Purpose Although a wide range of keratoprostheses have been developed from various materials over the last 30 years there has been limited optimisation of material properties to enhance clinical performance and minimise tissue incompatibility within the ocular environment. The development of our understanding of the biological interactions between materials and corneal tissues, the failure of existing keratoprostheses, the advances in the design and synthesis of materials of controlled molecular architectures and the advancements in composite biomaterials in recent years provides an opportunity to design enhanced biomaterials for the fabrication of the next generation of keratoprosthetic with improved clinical performance.

Methods This paper will review studies undertaken by our group which have enhanced our understanding of the biological interactions of existing keratoprosthetic materials in the ocular environment and the development of novel approaches to new materials for the fabrication of keratoprosthetic based on the utilisation of biomimetic and composite systems and recent advances in the polymeric biomaterials.

Results The paper will review data relating to the biological degradation of biomimetic materials and approaches to optimising these processes to provide materials with enhanced tissue integration and reduced inflammatory response. The in vitro biological evaluation of some of these materials indicates that material engineering may improve the clinical performance of biomaterials in the corneal environment.

Conclusion The development of novel materials for the fabrication of keratoprostheses relies on improving our understanding of the mechanisms of failure of existing devices and how biomaterials can be engineered to overcome these challenges
Elschnig pearl formation and disappearance
Authors: HIRNSCHALL N , NEUMAYER T , FINDL O
Published: November 2010

Purpose To observe and analyze morphological changes of Elschnig pearls in eyes with after‐cataract.

Methods Pseudophakic eyes with pronounced regeneratory posterior capsule opacification were included in the prospective studies. In the first study the natural course of Elschnig pearls was observed during days and weeks. In the second study morphological changes immediately after a Nd:YAG‐capsulotomy were observed. And in two further studies the Nd:YAG laser capsulotomy was modified and the effect on Elschnig pearls was observed.

Results In the first study, in total 6309 Elschnig pearls (85 eyes) were analyzed. On average, four pearls were found per square millimeter (range, 0.2‐9.7/mm2) with a mean cumulative area of 0.66 mm2) (range, 0.03‐2.18 mm2) of all marked pearls per eye and follow‐up. The mean pearl size was 9630 microm2 (range, 2390‐33,745 microm2) at baseline. The mean change of a pearl per day was 583 microm2 (range, 175‐1631 microm2) or a 6% change in area. In the second study in total, 2431 Elschnig pearls (20eyes) were observed. Of these, 535 pearls (30.6%) disappeared, and 503 pearls (27.6%) survived on the remaining capsule peripheral to the capsulotomy opening.

Conclusion Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly between eyes. Capsulotomy had an immediate impact on the morphology of PCO outside the capsulotomy opening. Knowledge about Elschnig pearl turnover may be of importance for attempts to modulate lens epithelial regeneration or lens regrowth and for lens‐refilling procedures.
Posterior capsule surgery and posterior capsulorhexis
Authors: BARRAQUER RI
Published: November 2010

Purpose To review the available intraoperative maneuvers to reduce the occurrence of posterior capsule opacification (PCO) after cataract surgery, including lens epithelial cell aspiration (LECA), posterior capsular membrane removal (PCMR), and posterior capsulorhexis (PCRX).

Methods Review of the literature and of the available techniques to prevent PCO. Case‐control retrospective studies on the efficacy of LECA for PCO prevention and on the safety of PCRX, namely its influence on vitreoretinal complications.

Results To reduce PCO, a number of surgical maneuvers have been described, including LECA, PCMR and PCRX, with variable results. In a series of consecutive 1574 eyes of 1147 patients followed‐up a minimum of 3 years, performing a meticulous LECA following phacoemulsification (PE) reduced PCO occurrence from 36.6% to 17.2% (p>0.01). In another series of consecutive 2.441 eyes operated of PE with or without PCRX, the rate of retinal detachment and cystoid macula edema was nonsignificantly higher after PCRX than cases with an intact capsule (respectively p=0.065 and p=0.32), while comparing favorably to Nd:YAG laser capsulotomy and with unplanned capsule tears.

Conclusion Intraoperative capsular techniques such as LECA, PCMR and PCRX may effectively and safely reduce PCO. The variability of the results in the literature may be due to the multiple nonsurgical factors involved (lens design and materials, associated conditions, etc.), as well as minor surgical details indicating that the surgeon factor should not be understated.
Non‐surgical strategies for PCO prevention
Authors: WORMSTONE IM
Published: November 2010

Purpose Surgical approaches and IOL design have gone some way to reduce the rate of PCO progression. Despite these efforts PCO remains a common and important problem which diminishes the visual quality of patients and is a major financial burden on healthcare providers. If we are to effectively respond to the problem of PCO then a biological solution has to be adopted to reduce/prevent formation of light scattering changes.

Methods Methods have been employed to investigate PCO development, which include in vitro cell culture and capsular bag models; in vivo animal models and post‐mortem analysis. These have greatly aided our understanding of PCO.

Results A number of basic approaches have been identified to prevent PCO. 1) To kill the entire lens epithelial population. This will require a pharmacological agent, therefore delivery of this drug needs to be localised to the target cells, but have limited access to non‐target cells; closed capsular bag systems such as perfect capsule provides opportunity to achieve this aim. 2) Maintenance of a cell monolayer on the posterior capsule. In particular the role of TGFβ has been investigated, which is known to cause matrix deformation. Disruption of TGFβ signalling pathways can suppress matrix deformation and thus reduce light scatter. 3) Recreation of a lens is the ultimate solution. While it has been shown that lens fibre differentiation can be promoted in animal systems, perfect formation of the lens is not achieved and the protein density is typically low relative to the native lens.

Conclusion Strategies to prevent PCO are being actively developed, which will are greatly aided by improved drug delivery systems. The development of biological/pharmacological approaches in concert with improved surgical methods and IOL designs should yield benefit to patients.

Commercial interest
Regression of choroidal melanoma after primary chemotherapy
Authors: BECHRAKIS NE , WILLERDING G , SCHMITTEL A , KEILHOLZ U
Published: November 2010

Purpose To describe the local regression of an intraocular choroidal melanoma after primary chemotherapy with fotemustine.

Methods A 30 y.o. young man presented with drop of visual acuity in his lest eye to 0,8. The right eye was unremarkable with VA 1,2. On the same time he developed upper abdominal pain. On ophthalmic examination a circumpapillary choroidal melanoma was detected with possible optic nerve infiltration on his left eye. Ultrasound and MRI scan of the upper abdomen revealed a diffuse metastatic liver disease.

Results In consultation with the department of oncology it was decided to prescribe systemic chemotherapy with fotemustine. After 4 cycles of chemotherapy, there was impressive local regression of the choroidal tumour and the liver metastases. Unfortunately after the initial response and the stable intraocular situation, there was tumour progression in other sites such as subcutaneous and lung metastases. After administration of some cycles of cisplatin as an alternative regime, the patient succumbed to the metastatic disease.

Conclusion This case demonstrates that intravenous fotemustine can be effective for a limited time period as a primary treatment option in a case of choroidal melanoma, without other local treatment.
Inhibitory isoforms of VEGF in uveal melanoma
Authors: COUPLAND SE
Published: November 2010

Purpose Uveal melanoma (UM) affects around 600 new patients in the UK each year with half of these being treated at the Liverpool Ocular Oncology Centre. UM is an unusual tumour in that gross chromosomal abnormalities are strongly associated with metastatic spread, especially monosomy 3 & chromosome 8q gain. Mechanisms that underlie this remain unclear.

Methods Angiogenesis is a requirement for tumour survival & metastasis. Vascular Endothelial Growth Factor (VEGF) is known to be the most potent stimulator of angiogenesis and increased expression of VEGF‐A is linked to enhanced metastatic potential in UM. Treatment with bevacizumab (anti‐VEGF therapy) suppresses hepatic micrometastasis of ocular melanoma cells in animal models. However, VEGF‐A data in UM are variable, with some studies demonstrating no correlation between VEGF‐A expression and metastasis or survival.

Results VEGF‐A was accepted as a single pro‐angiogenic family of protein isoforms generated from alternatively spliced mRNA (VEGF189, VEGF165 etc). However, recently a family of sister isoforms named VEGFxxxb, where xxx is the amino acid number and b a different six C‐terminus amino acids (VEGF189b, VEGF165b) has been discovered. The VEGFxxxb variants are exactly the same size as pro‐angiogenic VEGFxxx, yet are antiangiogenic. VEGF165b is down‐regulated in primary cutaneous melanoma that later metastasises, and over‐expression of VEGFxxxb isoforms confers a protective anti‐tumour effect.

Conclusion Immunohistochemical expression of pro‐ and anti‐angiogenic VEGF‐A in 19 UM was assessed using pan‐VEGF‐A and VEGF165b specific antibodies. A statistically significant reduction in expression of VEGF165b was observed in monosomy 3 UM (non‐parametric ANOVA; p<0.05). This suggests that VEGF165b expression may be a useful predictor of UM metastasis.
Efficacy of sunitinib in the treatment of metastatic uveal melanoma
Authors: JMOR F , COUPLAND SE , DAMATO BE , KALIRAI H
Published: November 2010

Purpose Almost 50% of uveal melanoma (UM) patients develop metastatic disease, despite successful treatment of the primary tumour. There is currently little in the way of therapeutic options for metastases, which are invariably fatal. Thus, there is interest in adjuvant treatments for high‐risk UM patients to treat micro‐ rather than macro‐metastatic disease. Sunitinib is a small molecule inhibitor of multiple receptor tyrosine kinases (RTKs) (VEGFR, PDGFR, C‐KIT, and RET), which play major roles in angiogenesis, tumour growth, and metastasis.

Methods In this study we used 4 UM cell lines to (1) examine the expression of sunitinib target RTKs by RT‐PCR and immunofluorescence and (2) determine the effects of sunitinib alone or in combination with cisplatin, on proliferation and apoptosis.

Results C‐KIT was expressed in the Mel270 and 92.1 (primary tumour) but not the Omm2.3 or Omm2.5 (metastatic lesion) cell lines. PDGFRα/β were expressed in differing cell numbers across all cell lines. VEGFR2 was expressed in Mel270’s only. VEGFR1 and RET were not expressed in any of the cell lines. A single bolus of Sunitinib (0‐1µM) reduced overall cell number in a dose dependent manner compared with untreated cells in all 4 cell lines. This was not due to a significant increase in apoptotic cell death. Furthermore, by day 7 following treatment with sunitinib ≤0.5µM, cell numbers had recovered almost to control values. This recovery was significantly reduced when an IC50 dose of sunitinib was used in combination with cisplatin (0‐1µg/ml) for each cell line.

Conclusion In conclusion, these data demonstrate that a combined therapy of sunitinib and cisplatin can effectively reduce uveal melanoma cell number in vitro.
Metadifferentiation of iris nevi after iridectomy: a clinicopathological small case series.
Authors: SCHALENBOURG A , ROBERTI P , ZOGRAFOS L
Published: November 2010

Purpose Iridectomy of suspicious pigmented tumors provides the presumed advantage of both a histopathological diagnosis and treatment of the lesion. We present 2 patients that developed an iris melanoma with extrascleral extension at the site of their iridectomy of a histopathologically proven nevus, 46 and 2.5 years later.

Methods Retrospective, clinicopathological small case series of 2 patients.

Results Two patients underwent iridectomy for a suspicious tumor, the first in 1963 and the second in 2006. Pathological diagnosis was a benign and a borderline nevus respectively. In 2009, both patients presented with a recurrent melanocytic iridociliary tumor with an extrascleral extension adjacent to the surgical scar. Pathological examination confirmed melanoma. Consequently, the two patients underwent proton beam therapy of the whole anterior segment, with limbus deposition and reposition.

Conclusion Iridectomy of a histopathologically proven nevus doesn’t exclude the possibility of a metadifferentiation of remaining nevus cells into melanoma, even after 46 years. Additionally, treatment in case of a recurrence is more complicated than a primary radiotherapy of the unbiopsied iris tumor, with clinical proof of growth, would have been.
Cell adhesion molecule expression in human lens epithelial cells after glucocorticoid exposure
Authors: PETERSEN A , CARLSSON T , JOHANSSON BR , NANNMARK U , CELOJEVIC D , KARLSSON JO , ZETTERBERG M
Published: November 2010

Purpose The aim of the study was to investigate changes in cell adhesion molecule expression in human lens epithelial cells subjected to glucocorticoids.

Methods Human lens epithelial cells (HLEC) were exposed to dexamethasone for 24 hours. Cell morphology was examined by transmission electron microscopy (TEM), cell adhesion molecule expression was studied by western blot and immuno‐histochemistry.

Results TEM showed multilayering of cells, vacuole formation and appearance of electron‐dense multivesicular bodies in HLEC exposed to 0.1, 1, 10 and 100 µM dexamethasone. Western blot and densitometry analysis revealed that α‐catenin, β‐catenin and GR expression were significantly decreased in dexamethasone exposed HLEC compared to unexposed cells. No significant change in N‐cadherin, γ‐catenin or vimentin expression between dexamethasone exposed and unexposed cells were present. Immunohistochemical analysis showed no significant change in antigen expression for any of the antigens examined.

Conclusion The multilayering of HLEC seen with TEM, indicate defects in regulation of cell migration, which is supported by a decrease in cell adhesion molecule expression.
Central serous chorioretinopathy shows reduced retinal circulation in retinal function imaging (RFI)
Authors: BEUTELSPACHER SC , SERBECIC N , BARASH HILA , BURGANSKI‐ELIASH ZVIA , GRINVALD A , JONAS JB
Published: November 2010

Purpose Central serous chorioretinopathy (CSR) describes a chorioretinal microvascular disorder which in its active form is characterized by detachment of the neurosensory retina. Current opinion suggests that a combination of choroidal hyperpermeability and an impaired retinal pigment epithelial (RPE) function leads to pooling of serous fluid in the sub‐RPE space.

Methods Twelve patients with acute onset of CSR as well as 12 age‐, and sex‐matched control subjects were included into this study. None of the patients has had a history of prior CSR. Prior to inclusion into the study, all patients received a fluorescein‐angiography (FLA), an optical coherence tomography and measurements on the retinal function imager (RFI).

Results Flow velocity was 2.76 mm/s in retinal veins and 4.13 mm/s in retinal arteries in the case of the CSR patients. This was in contrast to the findings in the controls. Here the flow velocity was 3.34 mm/s in retinal veins and 4.24 mm/s in retinal arteries. The highest differences of flow velocity were found in the case of the wide retinal veins (2.87 vs. 3.47 mm/s). This difference was highly significant (p=0,003). In the medium sized veins the retinal fow velocity was als significantly different (2.69 vs. 3.42 mm/s). Again this difference was significantly different (p=0,02). The comparison of the retinal arterial vessels did not show any significant differences.

Conclusion The findings suggest that the technique applied by the RFI can be helpful to diagnose CSR and to visualize abnormal areas of retinal blood flow in a non‐invasive manner.
Intravitreal bevacizumab for macular telangiectasia
Authors: LIBONDI T , VON BALTZ S , JONAS JB
Published: November 2010

Purpose Idiopathic macular telangiectasia Type 2 (idiopathic perifoveolar telangiectasia, ITP) is an uncommon, slowly progressive, usually bilateral disease of the macula, characterized by dilated, tortuous capillaries in the perifoveolar region, preferably in the temporal part. It is the scope of our study to report about a 36 month follow‐up of patients affected by ITP and treated with multiple intravitreal injection of bevacizumab

Methods Our retrospective, interventional study included 8 eyes of 8 patients, 4 of whom were male, affected by IPT and treated with multiple intravitreal injections of 1,25 mg. bevacizumab, whose maximum follow‐up extended to 36 months (range 3‐36 months). Age ranged from 37 to 83 yo.They underwent a complete ophthalmic examination including best corrected visual acuity (BCVA) testing, slit lamp examination with indirect ophtalmoscopy, fluorescein angiography and time‐domain OCT (Status OCT Carl Zeiss Meditec, ver. 4.01). All the diagnosis were made by a single examiner based on the unique features of the disease

Results The injection provided a time‐limited positive effect on both visual acuity and OCT central thickness (1 month). It was only slightly effective on both parameters if we consider the 6th month follow‐up, while at 24 month follow‐up the considered parameters did not show any significant difference from the baseline.

Conclusion Our results show a limited benefit on visual acuity and retinal edema in the short follow‐up. While not demonstrating a positive therapeutical effect in the long term, they seem to point out to a time‐limited positive effect on retinal edema.
Optical coherence tomography speckle denoising
Authors: BERNARDES R , MADURO C , SERRANHO P , LOBO C , CUNHA‐VAZ J
Published: November 2010

Purpose To reduce the speckle noise for improved structure segmentation on high‐definition spectral domain optical coherence tomography (OCT).

Methods Eyes of 30 healthy volunteers and eyes of patients with age‐related macular degeneration (20), diabetic retinopathy (23), cystoid macular edema (2) and choroidal neo‐vascularization (13) underwent high‐definition spectral domain Cirrus OCT (Carl Zeiss Meditec, Dublin, CA, USA) using both the 200x200x1024 and the 512x128x1024 Macular Cube protocols.

Results In the work herewith presented we have modified the traditional diffusion coefficient function, of the nonlinear complex diffusion type, to achieve an improved OCT data despeckling. The new filter was tuned in order to preserve edges, as in the transition from the vitreous to the ILM, to preserve the information within the retinal tissue and to be more effective while filtering the vitreous. A total of 88 volumetric scans gathered with the Cirrus OCT were filtered using the new nonlinear complex diffusion filter (NCDF) as well as with implementation current available filters, showing that the new NCDF filter allows for a better despeckling while preserving edges between retinal layers for eyes of healthy volunteers and patients with different pathologies.

Conclusion These findings suggest that the speckle noise present in the Cirrus OCT can be successfully reduced while preserving important features using the newly developed NCDF filter.
Evidence for retinal neuronal dysfunction prior to breakdown of the blood‐retinal barrier or onset of vasculopathy in type I diabetes
Authors: REIS AA , MATEUS CA , MELO P , CASTELO‐BRANCO M
Published: November 2010

Purpose To characterize visual function in type I diabetic patients prior to breakdown of the blood‐retinal barrier or onset of vasculopathy as compared with patients with early diabetic retinopathy (DR).

Methods Visual function was assessed by Multifocal Electroretinography (RetiScan ‐ Roland Consult), Colour Vision (CCT ‐ Cambridge Research Systems) and Frequency‐Doubling Perimetry (FDT ‐ Zeiss) in a population of 42 patients (age=26.6+5.3 years) divided into 2 groups: with no DR (n=26; VA=1.088+0.128) and with mild nonproliferative DR (n=16; VA=1.093+0.137). Fluorescein angiography was also performed in order to determine the absence or presence of initial vascular lesions. These data were compared with age‐matched controls. Non‐parametric statistical analysis was performed at a significance cut‐off level of p<0.05.

Results MfERG yielded a significant decrease in amplitude in all eccentricity rings in both patients groups, when compared with control subjects (p<0.0001). Interestingly, implicit time showed a paradoxical pattern between patient groups with a significant decrease in rings 2‐4 (0.002<p<0.02) in the absence of clinical DR. Impaired contrast sensitivity along protan, deutan and tritan chromatic axes (0.0001<p< 0.02) was also observed, except for the Deutan axis in the group without DR. FDT quadrantic thresholds were also different between controls and both type of patients (0.0009<p<0.002), but the central location showed no difference between the controls and the patients with no DR.

Conclusion This work suggests that retinal neuronal changes do occur in Type I Diabetes even before breakdown of the blood‐retinal barrier or onset of vasculopathy.
The P300 signal is monotonically modulated by target saliency level irrespective of the visual feature domain
Authors: TEIXEIRA M , CASTELO‐BRANCO M , NASCIMENTO SM , ALMEIDA VMN
Published: November 2010

Purpose Event related responses to infrequent and task‐relevant stimuli often include an attentional peak, the P300 component. This component is typically regarded as independent from the sensory modality, with amplitude depending on target occurrence probability. In this study, we investigated whether the P300 signal could similarly be modulated by the degree of perceptual difference across visual target properties.

Methods We used an oddball block design with texture and colour as perceptual category features and a frequency ratio of 1:16. EEG/ERP responses were recorded from 68 channels in 9 healthy participants, matched for age and educational level. For the colour condition, 3 targets with increasing steps of categorical deviation in perceived redness from the standard stimulus were used. Concerning the texture segmentation condition, 3 targets with increasing spatial phase difference were chosen. Colour target patches were presented against a reference background of a standard additive primary red patch, and texture patches against a standard grating one with no phase segregation contrast.

Results Repeated measure analysis results suggest a significant modulation of P300 amplitude target levels in midline central and parietal channels for both conditions. Significant Spearman correlations (positive with amplitude and negative with latency) support this order effect between target perceptual level and the P300 response.

Conclusion We conclude that the amplitude and latency of the P300 response is monotonically modulated by saliency levels of distinct target categories.
Anterior segment optical coherence tomography (AS‐OCT): a novel diagnostic instrument for conjunctivochalasis
Authors: GUMUS K , GIRE A , PFLUGFELDER S
Published: November 2010

Purpose To evaluate cross‐sectional conjunctivochalasis area (CChA) and tear meniscus area (TMA) using Fourier‐Domain‐RTVue‐100 optical coherence tomography (OCT) before and after conjunctival cauterization and to evaluate inter‐ and intraobserver reliability.

Methods A total of twelve eyes of 7 patients with conjunctivochalasis aged 56 to 87 were evaluated. After topical anesthesia, conjunctival cauterization was performed on the inferior bulbar conjunctiva. All patients underwent anterior segment OCT (AS‐OCT) imaging prior to and 4 weeks after the procedure. Cross‐sectional TMA and CChA at 3 locations (nasal, center and temporal areas) were measured in all patients.

Results Non‐significant increases (p= 0.177) in TMA as a whole (3 locations combined) were observed at following cauterization. CChA measurements significantly decreased in all 3 locations after cauterization (p< 0.001). Mean CChA decreased from 0.247 ± 0.24 mm2 to 0.054 ± 0.79 mm2. For two measurements of TMA by examiner 1, intraclass correlation coefficients (ICC) ranged from 0.998 to 0.999. Among two examiners, Cronbach’s alpha reliability coefficients were as high as 0.993 and 0.997 before and after conjunctival cauterization. Regarding the CChA measurements, ICC values were similar to those of TMA, but Cronbach’s alpha reliability coefficients were slightly less.

Conclusion This study indicates the AS‐OCT is a useful and reproducible instrument to measure cross‐sectional area of conjunctiva prolapsing into the tear meniscus of patients with conjunctivochalasis. The method can monitor effectiveness of thermo reduction of conjunctivochalasis.
Determination of corneal endothelial cell density in French eye banks: second look
Authors: DELESALLE N , THURET G , DUBUS J , FLEURY L , MOUILLOT L , GAIN P
Published: November 2010

Purpose Considering the importance of having a precise, robust and especially reproducible ECD counting method, Afssaps organized from April 2008 to June 2009 a second assessment of the reliability of the routine cell count within the 18 french Eye banks.

Methods The study design was similar to the first assessment driven by the laboratory ‘Biology, engineering and imaging of Corneal Graft’ in 2003 (Transplantation 2004; 78: 1299‐1302).5 test corneas (1 mm2 of flat mounted, fixed and alizarin stained human corneal endothelium) were selected and sent to the 18 Eye banks. All the usual technicians of each bank had to count the test corneas using the routine method(s) employed to assess grafts.

Results 430 counts were carried out by 70 eye banks technicians, by manual and/or image analysis system. 42% (180/430) deviated by more than 10% from the expected ECD. Among them, 128 were over‐estimated (max +88%) and 52 were under‐estimated (max ‐31%). 2 banks constantly over‐estimated (in the mean +31,7% and +42,7%, no calibration and/or material problem) but the 16 other banks were in average within ±13% from expected ECDs. For manual methods, a statistically significant difference between banks was observed for the 5 test corneas, whereas no difference was observed with image analyzers. ECD obtained with the analysers were closer to expected values than with the manual methods. Compared to the 2003 study, reliability of ECD determination globally improved.

Conclusion Image analysis systems prove more reliable (precise and with a lower intra and inter observer variability) than manual counting methods. This ‘second look’ of Eye banks will allow editing recommendations to improve ECD determination.
Fully automated corneal endothelial morphometry of a large set of images captured by clinical specular microscopy
Authors: BUCHT C , SÖDERBERG PG
Published: November 2010

Purpose The endothelial cell density is the most important morphological factor of the corneal endothelium. Morphometry of the corneal endothelium is an important part of several clinical applications. Morphometry of the endothelium is presently carried out by semi automated analysis of pictures captured by Clinical Specular Microscopy (CSM). The need of operator involvement makes this process time consuming. This study presents a method for fully automated analysis of a large range of in vivo images of the corneal endothelium, captured by CSM, using Fourier analysis.

Methods Software was developed in the mathematical programming language MATLAB. Pictures of the corneal endothelium, captured by CSM, were read into the analysis software. The software performed automated digital enhancement of the images. The enhanced images were Fourier transformed, using the Fast Fourier Transform. Relevant characteristics of the Fourier transformed images were identified and sampled. The data obtained from each transformed image was used to calculate the mean cell density of the original image, which in turn was compared to a semi automated method cell density estimate. The calculation was based on well known diffraction theory.

Results Estimated cell densities of the corneal endothelium were obtained, using fully automated analysis software on 292 images captured by CSM. Using linear regression, a relatively large correlation between the estimates of the fully automated method and the semi automated method was found.

Conclusion The results using the considerably faster fully automated method are highly encouraging for further development and implementation of the method.
Correlation of diabetic corneal neuropathy and retinopathy
Authors: NITODA E , PALLIKARIS A , KALLINIKOS P , GANOTAKIS [Epsilon] , AMOIRIDIS G , TSILIMBARIS MK
Published: November 2010

Purpose Corneal confocal microscopy is a rapid, non‐invasive and reiterative technique, suitable for the accurate detection and quantification of corneal subbasal nerve plexus. The aim of this study is to correlate corneal nerve fibre alterations with the abnormalities in the retina of diabetic patients and compare them with those of nondiabetic people

Methods 278 diabetic corneas and 94 corneas of age‐matched control subjects were included in the study. Diabetic patients were further classified with respect to the stage of retinopathy, according to indirect fundoscopy, fundus photography and fluorescein angiography. The central corneas were scanned with HRT II and we estimated nerve fibre density (NFB) nerve branch density (NBD), nerve fibre length (NFL) and nerve fibre tortuosity (NFT). Finally, we made out the glycemic and lipidemic profile of patients.

Results NFD values for control, NDR, NPDR and PDR groups were 31.27 ± 0.99, 27.35 ± 0.77, 23.67 ± 0.83 and 18.77 ± 0.77 respectively and NBD values were 45.12± 2.85, 39.86 ± 3, 30.56 ± 2.71 and 24.98 ± 2.08 respectively. NFL values for control, NDR, NPDR and PDR were 16.58 ± 0.55, 14.82 ± 0.56, 12.27 ± 0.49 and 10.41± 0.45 respectively and NFT values were 5.78 ± 0.28, 6.6 ± 0.52, 6.57 ± 0.22 and 7.02 ± 0.39 respectively. NFD, NBD, NFL were significantly reduced and NFT appeared to be higher in diabetic patients, according to the stage of diabetic retinopathy. The glycemic profile was analogue to the retina status, but the lipidemic one appeared to vary.

Conclusion Alterations in corneal nerve plexus are apparent in diabetic patients and more pronounced in PDR.Corneal confocal microscopy could be a promising technique for the early diagnosis and treatment of diabetic neuropathy.
Epidemiological and scanning‐slit topography variables in keratoconus
Authors: CORTES MORA N , MARTIN SANZ R , PENA RUIZ D , GALARRETA MIRA D , CARRASCO HERRERO B , MERAYO‐LLOVES J
Published: November 2010

Purpose To identify and to correlate epidemiological and scanning‐slit topographical variables of keratoconus in a homogeneous caucasian population from Valladolid, Spain.

Methods Retrospective, cohort study of a group of keratoconic patients followed at the Ocular Surface Unit in the Hospital Clínico Universitario de Valladolid. Clinical records were reviewed to get information about: age, gender, central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior best fit sphere (aBFS), posterior best fit sphere (pBFS), steepest simulated K (SSK), flattest simulated K (FSK), mean k at 3 and 5 mm (M3, M5), irregularity index at 3 and 5mm (II3, II5) and topographical pattern in the keratometric map. Correlation analysis were made among the variables mentioned above.

Results Two hundred and two patients were included, 116 men and 86 women. There were differences in CCT (p<0,001), TCT (p<0,001), aBFS (p<0,001), pBFS (p<0,001), SSK (p<0,001), FSK (p<0,001), M3 (p<0,001) and M5 (p<0,001) between men and women. There was no correlation between age and the other studied variables (p>0,05). The most prevalent topographic pattern was asymmetric bow tie with skewed radial axes (ABT SRAX) (34,1%), followed by inferior steepening (32,7%). The central nipple pattern presented the more advanced values in all the studied variables.

Conclusion Keratoconus is more frequent in males, however, women revealed more advanced values in scanning‐slit topography variables. Sex could be a prognostic factor in the evolution of keratoconic patients from Valladolid.
Retrobulber imagıng in glaucoma wıth dıffusıon tensor MRI/optıc tractography and fMRI: structural and functıonal analysıs
Authors: ENGIN KN , YEMISCI B
Published: November 2010

Purpose Evidences today proves that, glaucomateus damage proceeds from retinal ganglion cells to brain. The purpose of this study is to demonstrate the structural and functional eye‐brain connection in glaucoma, to develop favourable clinical methods for both glaucoma follow ups and large clinical trials, and finally, to establish a reference for further studies regarding pathogenesis, evaluation and treatment of glaucoma.

Methods Four glaucoma cases with symetrical (n=2) and asymetrical (n=2) involvement and 1 healthy subject are included in this study. Glaucoma analysis with optic coherens tomography (OCT) and central visual field (CVF) results of the subjects were recorded. By using diffusion‐tensor magnetic resonance imaging (DT‐MRI) technique, 3D‐T1 weighted images of the optic nerves and optic tracts were taken with optic tractography (OT). Then DT‐MRI parameters obtained from each patient were compared with the fellow eye and the healthy subject. Retinotopic Organizations (RO) of primary visual cortexes were produced from functional magnetic resonance imaging (fMRI) images and BOLD signals were evaluated with reciprocal CVF defects. All images were taken with 1,5T MRI system.

Results In DT‐MRI analysis, optic nerve volume, FA were found to be decreased in the eyes with severe RNFL loss. Optic nerve and tract deformation were showed with both OT and B0 coronal plane images. Lower bold signals were detected in the eyes of asymetric patients with severe glaucoma and in quadrants with large CVF defects.

Conclusion Strategies concerning beyond optic nerve head are needed in glaucoma. Structural and functional analysis can be made by taken together the OCT and DT‐MRI findings and CVF and fMRI findings, respectively.
Glaucoma and the Internet
Authors: ZAIDI F , ANSARI E
Published: November 2010

Purpose Glaucoma has received very little attention in terms of how the internet influences patient behaviour. We assessed the quality of information accessed by sufferers from glaucoma using the internet.

Methods The word ‘glaucoma’ was subjected to an advanced keyword search. This analyses average monthly search volumes over a 12 month period using the Google search engine. The search term ‘glaucoma’ was then inputted into Google and the first 5 pages of websites studied using a validated instrument. The 4 criteria published in the Journal of the American Medical Association (JAMA) for qualifying information from the internet were used in the analysis, yielding a possible score of between 0 and 4.

Results 50 websites were studied. All 4 criteria were satisfied by 4% of sites; 3 criteria were met by 38%; 2 criteria by 6%; 1 criterion by 24%. 28% of sites scored zero for objective quality of information on glaucoma. Superior scores were achieved by peer‐reviewed journals and medipedias (online medical encyclopedias). Counter‐intuitively the websites of professional bodies including academic institutions scored poorly (mean 0.3, median 0, mode 0). Information provided by charities scored poorly also (mean 0.25, median 0, mode 0). The websites of public hospitals scored above average (mean of 3 (mode 3, median 3). This is different from the quality of information available in other fields such as retinopathy of prematurity, though is, overall, superior to the quality of information found recently in areas of oculoplastic surgery.

Conclusion The quality of information accessed by patients on glaucoma is in need of improvement. This data is topical and of relevance to both clinicians and their patients in an age where more and more patients use the internet as a resource for healthcare information and misinformation.
Management of orbital tumours with adjuvant iodine brachytherapy using "inverted" plaques
Authors: KIVELÄ T
Published: November 2010

Purpose To describe our experience in using "inverted" iodine plaques as adjuvant treatment after resection of orbital tumours.

Methods Between 1999 and 2007, three patients (ages 17‐48 years) underwent resection of an lacrimal gland tumour followed by application of an "inverted" iodine plaque manage any microscopic infiltration, i.e. a gold plaque carrying iodine‐125 seeds on its convex rather than concave surface. In a fourth instance, the seeds were placed on the convex surface of a ruthenium rather than a gold plaque to manage an eye with a late extraocular recurrence of an irradiated uveal melanoma following resection of the extension.

Results The diameter of the plaque was 20 mm. It was sutured to the sclera so that when the eye was in primary position the lacrimal fossa was targeted. When the eye moved, the irradiated volume naturally enlarged. A 40‐56 Gy dose was calculated to the depth of 10 mm, and the dose at 5 mm was then calculated as 80‐134 Gy. Treatment time was 59‐154 hours. In one case, the iodine seeds were placed asymmetrically to limit radiation damage to the eyelid skin. In two patients, transient erythema of the upper eyelid developed, which resolved in a few months time. In case of the extraocular melanoma, dose was the same. Recurrent tumours have not developed.

Conclusion An "inverted" iodine plaque is one option for adjuvant irradiation of the orbit which shields the eye from radiation damage.
Iodine‐125 orbital irradiation : improvement of cosmetic results for patients needing postenucleation irradiation
Authors: LEVY‐GABRIEL C , DENDALE R
Published: November 2010

Purpose Patients enucleated for malignant intraocular tumors (as retinoblastoma or uveal melanoma) that have extrascleral extension and/or optic nerve resection margin involvement, are at risk of orbital recurrence. These enucleated orbits were previously treated with external beam radiotherapy which induced late sequelae, in particular facial atrophy. Iodine 125 Orbital brachytherapy (BRT) was first realised in 1983 in South Africa as a technique to irradiate the content of the orbit while minimizing the dose to the surrounding bone and eyelids. We report our experience since 2000 with this technique

Methods Six nylon tubes containing 125 I seeds were implanted though the eyelids around the periphery of the orbit. Each contained a metal gutter that screened the outer part of the seeds from the bony orbit. A seventh unscreened tube was placed in the center and a golden plaque with 125 I seeds on its inner surface was secured beneath the eyelid. The reference dose around the target was 45 Gy for retinoblastoma and 60 Gy for uveal melanoma

Results Since 2000 13 patients underwent BRT : 9 retinoblastomas (median follow up 36 months, 1 child died of craniospinal metastasis), 3 uveal melanomas (median follow up 55 months, 1 patient developed a metastatic disease), and 1 medulloepithelioma (median follow up 45 months). No patient developed orbital recurrence after BRT. Regarding cosmesis, results were much more acceptable than with other forms of irradiation with a normal size prothesis adaptation

Conclusion 125 I orbital brachytherapy is an effective method of irradiating the orbit to prevent recurrent tumor after enucleation with better cosmesis results than with other forms of irradiation, especially in case of children

Commercial interest
Direct intra‐arterial (ophthalmic artery) chemotherapy with melphalan for advanced intraocular retinoblastoma: the Italian experience
Authors: HADJISTILIANOU T , DE FRANCESCO S , VENTURI C , BRACCO S , GALLUZZI P , CAINI M , DAMBROSIO A
Published: November 2010

Purpose To report the preliminary results of the conservative treatment of advanced retinoblastoma (Stage Va e Vb) obtained with the melphalan protocol (direct intraarterial‐ophthalmic artery infusion ).

Methods 33 children (35 eyes) with advanced retinoblastoma who were eligible for enucleation were entered in phase two of one center open study‐approved protocol of ophthalmic artery infusion of Melphalan to avoid enucleation (Italian Melphalan protocol, approved by the Ethic Commettee – University Hospital of Siena). Two cases have been treated bilaterally. 15 eyes were first diagnosis and 18 were relapses following chemo and/or radiotherapy. In two cases has not been possible to conclude the procedure due to haemodynamic problems.

Results The ophthalmic artery was successfully cannulated in 35 eyes (total, 121 procedures). In 2 attempts was impossible to successfully conclude the procedure due to hemodynamic problems. 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. Melphalan was infused into the artery over a 30‐minute period (dose of 3‐7 mg according to the age and size of the globe). Local and systemic toxicity have been evaluated and documented.

Conclusion 33 children (35 eyes) with advanced retinoblastoma (Stage Va and Vb Reese classification) were eligible for the Melphalan Italian Protocol. The 78.7% of treated eyes is in complete remission. Superselective chemotherapy delivered through the ophthalmic artery can avoid enucleation, primary radiation or abuse of systemic chemotherapy.
Intravitreal injection of anti‐VEGF and diagnosis of primary intraocular‐central nervous system lymphoma
Authors: GAMBRELLE J , MISSOTTEN GS , DELHOUM S , DESJARDINS L , COCHENER B
Published: November 2010

Purpose We report the case of the diagnosis of primary intraocular‐ central nervous system (CNS) lymphoma in a patient treated by anti‐VEGF.

Methods An 88‐year old female, with a medical history of bilateral ARMD treated by intravitreal injections of ranibizumab for 1 year, was referred to our department for bilateral vitritis diagnosed 10 days after the last anti‐VEGF injection. A complete vitritis work‐up including aqueous humour analysis, magnetic resonance imaging of the brain and vitreous biopsy enabled us to confirm the diagnosis of primary intraocular‐CNS lymphoma.

Results To the best of our knowledge, this is the first report of the diagnosis of primary intraocular‐CNS lymphoma in a patient treated by anti‐VEGF for ARMD. In our opinion, the occurrence of lymphoma in this case was coincidental and not due to the anti‐VEGF injections. The differential diagnosis of vitritis in elderly patients is relatively large. Endophthalmitis or uveitis has been described after anti‐VEGF injections. In such a situation, there is actually a risk of overlooking a diagnosis of intraocular lymphoma in the mistaken belief that the observed vitritis may be a reaction to administred anti‐VEGFs. If no direct time‐relationship with the anti‐VEGF injections can be found, a classic vitritis work‐up should be performed. Anti‐VEGF treatment did not impede cytological diagnosis in our patient.

Conclusion Although in some none‐CNS non‐Hodgkin lymphomas (NHL) systemic anti‐VEGF therapy is added to chemotherapy schedules, the use of anti‐VEGF did not halt the spread of the lesion within the eye in this case. It can, therefore, be presumed that local anti‐VEGF therapy has no adjuvant effect in primary intraocular lymphoma.