bluuebunny/crossref_metadata_2025 huggingface dataset:
Controversies in the pathogenesis of RVO – Systemic perspective
Authors: GRZYBOWSKI A
Published: November 2013

Although retinal vein occlusion (RVO) has been known for about 150 years, and traditionally was assumed to be one entity, there are many arguments that RVO actually is not one disease. It has been suggested that it actually consists of six different clinical entities, each with different clinical characteristics, prognosis and management. For example, central retinal vein occlusion (CRVO) etiologically, clinically and from the management point of view is totally different from branch retinal vein occlusion (BRVO), and that is also true in the case of the major and macular retinal vein occlusions. Similarly, it is well‐established now that CRVO is of two types, ischemic and non‐ischemic, with very different clinical characteristics and management. It has also been shown that pre‐existing ocular hypertension or glaucoma are important risk factors for CRVO and hemi‐central retinal vein occlusion but not for BRVO. Many risk factors indicate systemic nature of some forms of the disease, although their real value remains speculative. Therefore, the lumping them together as one disease might be incorrect and misleading. Taking all above into account the traditional single disease model of RVO should be re‐evaluated.
Anti‐VEGF agents in the treatment of RVO
Authors: REHAK MATUS
Published: November 2013

Vascular endothelial growth factor (VEGF) is a key player in the development of macular edema (ME) in patients with retinal vein occlusion (RVO). However various other factors influence the development of ME. In a rat model, we observed a fast and transient upregulation of the expression of VEGF, which is dominant for the acute stage of ME. In chronic ME an upregulation of inflammatory factors is presented. The intravitreal drugs reduce the ME, but the mechanism of action differs between steroids and anti‐VEGF. Anti‐VEGF drugs inhibit the VEGF whereas steroids presents an unspecific anti‐inflammatory effect inhibiting the expression of broad spectrum of molecules. The determination of the patients who benefit from each particular treatment would improve the functional results and reduce the possible side effects. In a retrospective study in which we investigated whether BRVO patients benefit more from injection of bevacizumab or triamcinolone if treated according to the duration of ME we found out a better visual gain under treatment with bevacizumab in the first 4 months. In patients with treatment later than 4 months since onset of BRVO no significant differences between bevacizumab and triamcinolone were observed.
Cognitive function associated with larger optic nerve heads
Authors: JONAS J , XU L , WANG YX , LI JJ
Published: November 2013

Purpose To assess associations between optic nerve head size and parameters of cognitive function in a population‐based study design.

Methods The Beijing Eye Study is a population‐based cohort study in Northern China and included 4442 subjects. The study participants underwent a detailed ophthalmologic examination and an interview with questions on the level of education. Using fundus photographs, we measured the size of the optic disc.

Results Assessable optic disc photographs were available for 4089 (92.1%) subjects. After adjusting for age, gender, refractive error, and best corrected visual acuity, optic disc size was significantly associated with a higher level of education (P<0.001) and shorter time needed to perform frequency doubling threshold perimetry (P<0.001). In a reverse manner, the level of education was significantly associated with increasing optic disc size (P<0.001) and shorter perimetric test duration (P<0.001) after adjustment for age, gender and best corrected visual acuity.

Conclusion In a population‐based study on adult Chinese, optic nerve head size was associated with the highest achieved level of education and time needed to perform a standardized perimetric test. Considering level of education and time needed to perform perimetry as surrogates of cognitive function, optic nerve head size was related to cognitive function.
Anterior pathway meningiomas
Authors: KAWASAKI A , BOSCHI A
Published: November 2013

Meningiomas can cause visual disturbance by interrupting the afferent or efferent pathway of vision. Optic nerve sheath and clinoid meningiomas cause optic neuropathy, cavernous sinus meningiomas cause ocular motor palsies and occipital meningiomas cause homonymous hemianopsias. Case examples , pearls for radiographic detection and issues related to management will be discussed
The eye screen of the German Mouse Clinic (GMC) ‐ New genetic insights into eye development and ocular disorders
Authors: PUK O , FUCHS H , GAILUS‐DURNER V , HRABE DE ANGELIS M , GRAW J
Published: November 2013

Purpose To summarize GMC ‐ Eye Screen findings with about 350 tested mouse mutant lines.

Methods Eye morphology was analyzed by Slit Lamp Biomicroscopy/Scheimpflug Imaging and Ophthalmoscopy/Optical Coherence Tomography, eye size by Laser Interference Biometry, and the Virtual Optokinetic Drum was used for testing visual ability.

Results The GMC is a large‐scale phenotyping center where mouse models for human diseases are analyzed in a standardized way. More than 550 parameters are investigated in 14 different areas including behavior, neurology, cardiovascular functionality and vision and eye development. In the past 12 years, we identified eye pathologies in 43 mutant lines of the GMC workflow. The majority of them exhibited irregular eye sizes (72%), followed by morphological changes as corneal and lens opacities (21%) or retinal damages (16%) and moderately reduced visual abilities (7%). Overall phenotype predictions (EuroPhenome database; http://www.europhenome.org/) indicated that 89% of these lines were additionally affected in behavioral and/or neurological parameters, pointing to general relations between eye and brain development. Moreover, 46% showed heart impairments, connecting eye diseases with cardiovascular risks. Our data further proved for 11 gene products a previously unknown participation in ocular processes. These include the chromatin modifiers Asxl1 and Mysm1, the transcription factor Nfya as well as Arvcf, Jmjd5 and Slc20a2 with a role in cell‐cell communication, protein hydroxylation and phosphate transport, respectively.

Conclusion The GMC ‐ Eye Screen is an effective approach for improving knowledge about ocular genetics and detecting associations with non‐ocular disorders.
Global microarray analysis and metabolic pathway profiling of a transgenic model of conditional, selective Müller cell ablation
Authors: CHUNG SH , SHEN W , YANG J , JAYAWARDANA K , GILLIES MC
Published: November 2013

Purpose Müller cells, the principal glia cells in mammalian retina, play a critical role in retinal homeostasis. We have developed a transgenic Cre‐Lox model for selective, conditional Müller cell ablation to examine the relationship between Müller cell dysfunction and retinal diseases. The purpose of this study was to examine differentially expressed genes and their related pathways with microarray analysis, then to profile metabolic pathways in areas of Müller cell ablation.

Methods Affymatrix microarray was performed on whole retina samples 1 week, 1 month and 3 months after induced Müller cell ablation. Data were analysed with limma package (p<0.05) and qRT‐PCR was used for array validation. Isolation of patches of Müller cell ablation was achieved by laser capture microdissection (LCM) and qRT‐PCR was conducted on pathway related genes. Immunofluorescence microscopy was used to validate results.

Results Neuroprotection and apoptosis‐related genes were upregulated 1 week after Müller cell ablation, angiogenesis, tight junction and metabolic‐pathway related genes were downregulated later. Further analysis of glycolytic and mTOR pathways with tissue obtained by LCM revealed significant downregulation of genes related to these pathways in patches of Müller cell loss compared with controls. Immunofluorescent studies revealed that the dowregulations mainly occurred in the photoreceptor segments, although Enolase1 colocalised with Müller cells.

Conclusion We found reduction of transcription and expression of proteins involved in key metabolic pathways in patches of Müller cell ablation. This study provides new insights into the relationship between Müller cell dysfunction and retinal diseases.
Wound healing in health and disease
Authors: UUSITALO H
Published: November 2013

Wound healing is a complex process involved in ocular surgery, trauma and pathogenesis of several eye diseases. Due to the delicate and sensitive structures of the eye wound healing is playing a essential role in ophthalmology. The transparency and optical properties of the cornea makes the mechanisms involved in the wound healing after the corneal surgery important understand and treat in detailed way. In glaucoma surgery well controlled wound healing process is as important for the creation of a functioning passage to aqueous humor out of the eye. The state of the ocular tissues is of great importance for the success of ocular surgeries and further points out the role of inflammation in wound healing processes. For example in case of glaucoma surgery the ultimate goal is to prevent ganglion cell death by lowering the intraocular pressure. Because ocular surfaces are the most important pathway for the topical glaucoma drugs and thus most vulnerable to the topical adverse reactions, they influence on the preoperative state of these tissues and thus the success of glaucoma surgery. The wound healing SIS is focusing in the mechanism involved in the wound healing in general and particularly in corneal and glaucoma surgery.
Changes in choroidal thickness in adult onset foveomacular vittelliform dystrophy versus exudative AMD
Authors: COSCAS F , PUCHE N , SOUIED E , COSCAS G
Published: November 2013

To compare choroidal thickness (CT) between eyes with adult onset foveo macular vitelliform dystrophy (AOFVD) eyes with age‐related macular degeneration (AMD). 5 group (38 eyes each) with AOFVD, fellow eyes with AOFVD wet AMD, dry AMD, age‐matched normal subjects.Choroidal thickness was measured using enhanced‐depth imaging optical coherence tomography (EDI‐OCT) with Spectralis. Subfoveal choroidal thickness (SFCT) in each eye was analyzed with measurement of the vertical distance from the Bruch’s membrane to the innermost choroid/sclera junction, at 500µm intervals up to 1500µm, from temporal to nasal and from superior to inferior to the center of the fovea.The difference between SFCT AOFVD (325.66 +/‐ 86 µm) versus CT in wet AMD (168.21 +/‐ 57.7 µm) and CT in dry AMD (158.77 +/‐ 68 µm) and versus elderly normal (238,33 +/‐ 83µm) are statistically significant, (p < <0.0001).The difference found between the CT of the affected eye and the fellow eye in AOFVD (325.66 +/‐ 86 µm) is not statistically significant (p = 0.6).This study demonstrates thickening of choroid in the eyes with AOFVD, in contrast with choroidal thinning observed in eyes with AMD. CT could become criteria for diagnosis and specific treatment AMD vs AOFVD
Variations of choroidal thickness in exsudative AMD before and after treatment
Authors: MAUGET‐FAYSSE M , COSCAS G
Published: November 2013

PURPOSE: To evaluate choroidal morphological changes 3 and 6 months after intravitreal injection of Ranibizumab for exudative age related macular degeneration. METHODS: Retrospective, nonrandomized study, including patients with exudative AMD treated with Ranibizumab intravitreal injection and followed during 6 months. Non treated eye of AMD patients will be consider as control. All patients underwent a complete ophthalmological examination. At baseline, 3 months and 6 months, foveal and non‐subfoveal areas were evaluated with Spectralis optical coherence tomography on both eye: under the fovea and at 500 and 1500 μm nasally and temporaly . RESULTS and CONCLUSION: All studied eyes had exudative AMD at baseline treated with at least 3 Ranibizumab (Three Ranibizumab followed by injections if necessary were done for each patients). The results will be presented during the meeting.
Congenital hypertrophy of the RPE related to familial adenomatous polyposis
Authors: DESJARDINS L
Published: November 2013

Introduction: Familial adenomatous polyposis is a rare condition found in 1/10000 births. Multiple bowel polyps can lead to bowel cancer if untreated. Multiple pigmented retinal lesions are present in 60 to 80% of patients with this condition. Clinical presentation and imaging: Fundus lesions are classified in five groups: ovals pigmented with halo, small pigmented round , large pigmented round, depigmented round and small hypopigmented. They can be grouped with a bear track aspect. The lesions are asymptomatic A total number of at least four lesions is considered a good marker of the disease. Angiographic aspect is only mask or window depending on the degree of pigmentation. Pathology: Histologically the lesions are made of one or several layers of pigmented hypertrophic epithelial cells. Genetic: familial adenomatous polyposis is linked to a germinal mutation of the APC gene which is localized on the long arm of chromosome 5.
The role of in vitro studies in eye research
Authors: UUSITALO H
Published: November 2013

In vitro techniques are commonly used in eye research and they are valuable tools with several benefits like their modest price, well controlled test environment and the relatively simple interpretation of the results. They are after their validation usually relatively easily and quickly performed and in most cases suitable for automated analyses. In many cases their use can replace in vivo studies with experimental animals and thus they are ethically sustainable. By using valid in vitro techniques it is also possible to simplify the research frame from very complex in vitro situation and to set more specified hypothesis. There are, however, several drawbacks in the use of in vitro techniques. The results of them should be analyzed critically and the validity of the used in vitro technique should be rechecked on the basis of the new knowledge. It should also be kept in mind that an in vitro technique is usually valid for one specific cell mechanism and could be unacceptable for another.
Why is the optic nerve the canary in the coal mine of mitochondrial diseases?
Authors: SADUN A
Published: November 2013

Mitochondrial Optic Neuropathies (MON) present characteristic clinical and pathological features. Loss of visual acuity, dyschromatopsia and a central scotoma speak to involvement of the papillomacular bundle (PMB). Histopathology confirms this. These features are seen in hereditary diseases (Leber's Hereditary Optic Neuropathy—LHON and Dominant Optic Atrophy), Syndromes (such as MELAS, Wolfram's or FA), or toxic MONs. So why is the optic nerve involved so early and so often in mitochondrial disease? The brain weighs 2% of the body but consumes 20% of the body's oxygen. This expensive consumption of energy is largely due to the need for repolarization of the axon's membrane after each action potential. This is largely mitigated by myelin such that the sodium/potassium pumps only work at the Nodes of Ranvier. However, the retinal nerve fiber layer remains unmyelinated due to the need for inner retinal transparency. We present a mathematical model of these conditions that predicts the order of fiber loss in MON as a function of myelin and axon diameter. We demonstrate, with morphometry of postmortem samples of normal and LHON optic nerves, that this pattern is strictly observed.
Toward a new classification of RVOs?
Authors: PAQUES M
Published: November 2013

The proteiform features of RVO challenges classification. The discovery of patients with abrupt visual loss due to severe hypoperfusion, manifesting by perivenular whitening (PVW) in the absence of nonperfusion, raises the question of the pertinence of the ischemic versus nonischemic classification. High resolution OCT showed that focal ischemia in these cases was restricted to the inner nuclear layer, the atrophy of which accounted for clinical sequelaes. On the opposite, there are evidence that most cases of chronic macular edema are preceded by weeks or months of progressive venous dilation, hence raising the question of the true duration of the disease. Finally, we evidenced that venous macroaneurysms are a frequent consequence of longstanding RVO, whose identification by ICG angiography and subsequent photocoagulation may improve visual outcome. We will propose here a novel classification of retinal vein occlusions taking into account these features.
Reliability of the cone counts by an Adaptive Optics Retinal Camera
Authors: BIDAUT GARNIER M , FLORES M , TUMAHAI P , MEILLAT M , DEBELLEMANIèRE G , PUYRAVEAU M , SCHWARTZ C , MONTARD M , DELBOSC B , SALEH M
Published: November 2013

Purpose To report the reproducibility and the repeatability of cone imaging in healthy human eyes, using the RTx‐1™ Adaptive Optics Retinal Camera, (Imagine Eyes, Orsay, France) and AOdetect v0.1 cone counting software.

Methods Cones were imaged in healthy emmetropic aduts. Mean cone density (cells/mm2), spacing between cells (µ) and percentage of hexagonal cells calculated on Voronoi diagrams, were measured with the proprietary software of the device, from a 0.3°square, positioned on a horizontal line crossing the fovea. The square was moved horizontally following a 10µ step, until reaching the parafoveal density peak. Intersession reproducibility was assessed by imaging 3 subjects, 5 consecutive day. Intrassession repeatability was assessed by comparing 10 acquisitions of 3 subjects, in a row. Inter‐operator reproducibility was evaluated by comparing 10 subjects imaged by 2 operators. Inter grader reproducibiliy was evaluated by assessing 60 different images by 2 masked graders. Correlation coefficient and coefficients of variation(COVs) were calculated.

Results The mean cone counts was respectively 23623±3831/mm2 and 22851±3543/mm2 for the first and the second operator (t test, p <0.05). Coefficient correlation was 0.81 between operators, and 0.97 between the 2 graders. The intrasession and intersession COVs were under 7%. The percentage of hexagonal cells and the spacing, varied in the same proportion (COV range from 1.66 to 10.05%).

Conclusion Cone counts using the RTx‐1™ device and its software are reliable in normal human eyes. Further studies in the normal clinical setting are needed.
Comparison of macular pigment optical density measured by autofluorescence and reflectometry: The LIMPIA study
Authors: CREUZOT C , DELYFER MN , ROUGIER MB , SAVEL H , CHENE G , DELCOURT C , KOROBELNIK JF
Published: November 2013

Purpose To compare macular pigment optical density (MPOD) measured by two techniques (autofluorescence, reflectometry) in healthy subjects at high risk for age‐related macular degeneration (AMD).

Methods The Limpia Study is a double‐blind, placebo controlled, prospective randomized clinical trial performed in 120 subjects with at least one parent affected by neovascular AMD. Subjects having used supplements containing lutein and/or zeaxanthin in the preceding year were not included. MPOD was measured using two methods: the two‐wavelength autofluorescence method with a modified scanning laser ophthalmoscope (Heidelberg Retinal Analyzer

Results At baseline, mean MPOD within 0.51°, measured with the modified HRA method, was 0.5 (standard deviation 0.2). Maximal MPOD, measured with Visucam, was 0.4 (standard deviation 0.1). Parameters from the modified HRA (optical density within 0.5°, 1°, 2° and 6°) and from the Visucam method (volume, area, mean and maximum optical density) were weakly correlated. The best correlations were observed for MPOD within 2° and 6° with volume from Visucam(r=0.21 and r=0.22, respectively), and mean MPOD from Visucam (r=0.21 and r=0.18).

Conclusion The two methods propose different parameters to evaluate macular pigment, which overall correlated weakly in this population of middle‐aged healthy subjects at high risk for AMD. Further research is needed to characterize the differences between the methods and identify the best parameters and techniques to measure macular pigment.

Commercial interest
Evaluation of ultra‐widefield fundusautofluorescence in non‐infectious posterior uveitis
Authors: KERNT M , REZNICEK L , THURAU S , KAMPIK A
Published: November 2013

Purpose Posterior uveitis comprises a heterogenous group of diseases with inflammatory alterations of the posterior fundus and is a common cause of visual impairment and blindness. The goal of this study is to evaluate the diagnostic value of wide‐field‐fundusautofluorescence (FAF) of patients with non‐infectious posterior uveitis and chorioretinal alterations.

Methods 73 eyes from 51 patients were included. Best‐corrected visual acuity, wide‐field color and FAF images achieved by a wide‐field SLO (Optomap P200Tx, Optos PLC, Dunfermline, Fife, Scotland, UK) and a full ophthalmological examination were obtained from each patient. A systematic analysis of chorioretinal alterations detected with FAF and color images was conducted followed by the evaluation of the diagnostic information of wide‐field FAF compared to the clinical finding and wide‐field color images respectively.

Results 52 of 73 included cases showed peripheral alterations. In 32 cases, wide‐field FAF images revealed a greater number and more extended chorioretinal alterations than corresponding wide‐field color images of the posterior fundus.

Conclusion In this study, wide‐field FAF images showed more chorioretinal alterations than seen in funduscopy or in color SLO images. Therefore, wide‐field FAF images offer important additional information in detection and documentation of peripheral and central chorioretinal alterations.
Fluid of choroidal origin
Authors: SOUBRANE G
Published: November 2013

The choroidal circulation is crucial in supplying nutrients as well as oxygen to the outer retina. The capillaries of the choriocapillaris are fenestrated and have a high protein permeability that allows the establishment of a high oncotic pressure, presumably contributing to movement of fluid out of the retina through the stroma to the sclera. The pores of the choriocapillaris are facing the RPE. Bruchs membrane acts as a sieve depending on the amount and chemical properties of the deposited waste products. The accumulation of fluid under the RPE or within the retina implies a tight Bruchs membrane. Lipids as result of the the outer segment turn over accumulate and decrease the permeability of Bruchs membrane precluding the evacuation of the waste products and initiate a vicious circle. Active transport by the RPE is impaired. The tight junctions of the RPE are ruptured, the fluid irruption into the retina results in the disorganisation of the outer layers of the retina. A progressive breakdown of all defense mechanisms especially the reabsorbtion pump tips over the balance. The mechanismsm of the restauration are partially known. All choroidal diseases can induce these featuree and clinicians may analyze the resulting steps
Introduction, Surgical treatment options for corneal dystrophies
Authors: WYLEGALA E
Published: November 2013

Introduction, Surgical treatment options for corneal dystrophies Corneal dystrophies are the group of hereditary disorders affecting all corneal layers. Since 2008 when IC3D classification was published there are new advances in diagnosis and treatment of corneal dystrophies. During this course we would like to present the current methods of diagnosis including genetic testing and different treatment options. The choice of the surgical treatment option depends on the corneal dystrophy type and includes: anterior lamellar keratoplasty for dystrophies without Descemet membrane involvement, descemet stripping endothelial keratoplasty for Fuchs corneal dystrophy and penetrating keratoplasty for dystrophies characterized by full corneal thickness involvement. All types of keratoplasty could be performed traditionally or with the assistance of the femtosecond laser. The corneal graft survival depends on the corneal dystrophy type and possible complication of the surgery related to the diagnosis of the corneal dystrophy is the recurrence of the disease.
Classification of corneal dystrophies (IC3D)
Authors: NIELSEN K
Published: November 2013

Corneal dystrophies have been described and assigned various names in different regions at different times in history. A group of skilled cornea experts from four continents, the International Committee for Classification of Corneal Dystrophies (IC3D), reviewed the literature, agreed on common signs and symptoms, and presented a new classification system. As more corneal dystrophies become genetically characterized, this element has also been included in the system. The structure of the IC3D classification system will be discussed.
Imaging methods of the corneal dystrophies
Authors: JANISZEWSKA D
Published: November 2013

Corneal imaging techniques used for corneal dystrophies diagnosis and follow up include: optical coherence tomography, endothelial and confocal microscopy. In this part of the course we would like to describe different optical coherence tomography modalities and compare time and spectral domain OCT in visualization of the corneal deposits accumulated in the corneal dystrophies. We also would like to present the analysis of corneal morphology in vivo by confocal microscopy as well as describe the characteristic features of each corneal dystrophy in the histopathologic examination.
Curie experience with transvitreal and transcleral FNAB
Authors: CASSOUX N
Published: November 2013

Fine needle aspiration biopsies (FNAB) with different techniques have been recently developed during the management of intraocular tumors especially uveal melanoma. The need of a biopsy to diagnosed intraocular tumors remains rare. However in some difficult cases of achromic tumors FNAB can be helpful to distinguished achromic melanoma, metastasis, or choroidal malt lymphoma. FNAB is mainly used for choroidal melanoma prognostication. It has been shown that choroidal melanoma prognosis depends on well‐known clinical factor but also genetic factors within the tumor (monosomy 3 and 8q addition or GEP class II). Determination of patient prognosis by FNAB open the way to adjuvant chemotherapy for high risk patients. Different techniques can be used to obtain sufficient tumor samples and these different techniques will be exposed during this symposium. Curie experience using transcleral or transvitreal FNAB will be described.
How to handle ophthalmic biopsy specimen to optimize the results
Authors: COUPLAND S
Published: November 2013

Ophthalmic biopsies are performed for diagnostic & increasingly for prognostic purposes. The aim of the presentation is to provide "tips and tricks" for the surgeon, ophthalmic technician and pathologist in the work‐up of the typical and the "atypical" ophthalmic biopsy. The Liverpool Ocular Oncology Centre is one of three referral centres for adult ocular oncology in the UK. It receives close to 800 new referrals each year, with some of these being quite unusual cases. Contrary to practice in some centres, where there is a suspicion of choroidal metastasis of an underlying (possibly unknown) systemic tumour, an intraocular biopsy is performed as one of the initial investigations to confirm (or refute) the clinical impression. Morphological and immunocytological analysis can confirm the diagnosis and provide an indication of the site of the primary tumour. Further, genetic analysis of the tumour cells (e.g. EGF‐R mutations) may enable treatment choice. In the case of clear clinical diagnoses, biopsies are performed for prognostication purposes: e.g. in uveal melanoma. Close collaboration is required between surgeon and the pathology laboratory, in order to obtain the best diagnostic and prognostic yields from these samples.
Retinal ganglion cell impairment in Leber Optic Neuropathy carriers triggers cortical compensatory plasticity in extrastriate cortex
Authors: CASTELO‐BRANCO M , MATEUS C , D' ALMEIDA O , REIS A , SILVA E
Published: November 2013

Purpose To establish a link between silent retinal progressive impairment and cortical reorganization in a cohort of 15 asymptomatic patients harboring the 11778G>A mutation with good visual acuity and normal ocular examination (pre‐clinical phase). We aimed to phenotype preclinical silent degeneration from the psychophysical, neurophysiological and structural point of view. Moreveover we aimed to establish whether retinal measures could explain cortical reorganization.

Methods We studied RGC function at the population level using pattern electrophysiology and chromatic contrast sensitivity along three chromatic axes. We used optical coherence tomography to measure macular, RGC nerve fiber layer as well as inner and outer retinal layer thickness. We then asked whether such measures could explain previously identified cortical reorganization as assessed by cortical magnetic resonance imaging thickness measures in extrastriate visual cortex.

Results We found that compensatory cortical plasticity occurring in V2 and V3 is predicted by thickness of macular RGC axonal layer. This was also the most discriminative measure between carriers and controls, as revealed by ROC analysis. Moreover we found that the substantial cortical reorganization that occurs in the carrier state, can be used to provide statistical discrimination between carrier and normal groups to a level that is similar to measures of retinal dysfunction.

Conclusion We conclude that cortical compensatory plasticity in visual areas V2 and V3 is triggered by pathology in retinal ganglion cell axons.
STARflo™ Glaucoma Implant: 12 month clinical results
Authors: POURJAVAN S , COLLIGNON N , DE GROOT V
Published: November 2013

Purpose STARfloTM Glaucoma Implant is made entirely with silicone STAR® Biomaterial, a flexible tissue‐friendly, micro‐porous structure designed to reduce fibrotic response and maximize long‐term performance. Here we share our 12months experience with the first patients implanted with the STARflo.

Methods Four patients with advanced open angle glaucoma underwent implantation. Under anesthesia, a conjunctival flap and a superficial scleral flap were created. An incision in the second layer of sclera until choroid was performed to insert the implant body in the suprachoroidal space while the STARflo head was inserted into the anterior chamber. The scleral flap was sutured tight.

Results Patient ages were 65.3 years. Mean pre‐operative IOP was 37.0 mmHg and mean pre‐operative glaucoma medication was 3.25 intake/day. At 12 months (3 cases), mean IOP was 14.3 mmHg and mean glaucoma medication was 1.5 intake/day. No adverse events were reported during or immediately after the surgical procedure and no device‐related adverse events were reported during follow‐up. Early post‐operative complications included transient hypotony, transient choroidal hemorrhage and transient abnormal macula. Bleb disappeared between month 1and month 3. One patient, with posttraumatic COAG, was dropped out following a cyclophotocoagulation.

Conclusion clinical results for STARflo have met the safety and performance endpoints of the study and shown encouraging results in the control of the IOP with a reduction of glaucoma medications. Although long‐term success still has to be demonstrated, this newly‐CE marked device is promising as a novel, suprachoroidal implant for bleb‐free, IOP reduction for patient suffering from refractory open angle glaucoma.

Commercial interest
Efficacy and safety of combined trans‐scleral cyclophotocoagulation (TSCPC) and phacoemulsification surgery
Authors: ANSARI E , HAWKES E
Published: November 2013

Purpose To assess the effect of combined TSCPC and phaco+IOL with respect to; a) IOP ; b) VA; c) topical therapy d) side effect profile at 6 months post surgery.

Methods A retrospective review of 24 eyes undergoing combined TSCPC and phacoemulsification was conducted at 6 months post‐operatively. The procedures were performed by one surgeon (EA) under peribulbar local anaesthesia. TSCPC was applied across 270 degrees after completion of phaco+IOL. Subtenons Triamcinolone Acetonide 40mg was administered after each case. G. Prednisolone 1% x6 daily was used post‐operatively for 6 weeks. The patients were reviewed at weeks 1, 4, 12 and 24.

Results 24 eyes were included. 20 had open angle glaucoma, 3 had mixed mechanism glaucoma and 1 neovascular glaucoma (NVG). The average total energy used was 87.5W, (Range: 33.8‐346W). Mean pre‐treatment IOP was 22.1mmHg (Range 12‐47mmHg) and mean IOP at 6 months post treatment was 14mmHg (Range 0‐20mmHg);(p<0.05). Mean total medication was reduced from 2.1 to 1.9;(p=0.55). Diamox was discontinued in all 7 cases who were taking this pre‐operatively. VA was stable or improved in 18 eyes (76%) and worse in 6 eyes (25%). Uveitis occurred in 5 eyes following treatment, 1 patient developed optic atrophy and chronic hypotony occurred in only 1 eye which had NVG. The causes of worsening of visual acuity at 6 months were chronic hypotony (n=1), chronic cystoid macular oedema (n=2), worsening of glaucoma (n=3).

Conclusion Combined TSCPC and phacoemulsification is effective in treating cataract and glaucoma. Post‐operative inflammation is a potential threat to visual improvement.
Argon laser trabeculoplasty (ALT) for advanced glaucoma: A 12 months follow‐up study
Authors: PELOSINI L , FAYEMI A , ANSARI E
Published: November 2013

Purpose ALT has been used for lowering the intraocular pressure (IOP) for over 25 years. The aim of this study was to investigate the safety and efficacy of ALT in cases of advanced glaucoma unsuitable for surgery due to ocular or systemic conditions.

Methods This retrospective observational study had the following inclusion criteria: advanced POAG with uncontrolled IOP, maximum medical treatment, previously failed ALT or filtration surgery and unsuitability for surgical intervention due to ocular or systemic comorbidities. The data collected included: pre‐ and postoperative number of medications, visual acuity (VA), visual fields mean deviation (VF MD), IOP and adverse events during the study period. All ALT treatments were carried out by the same clinician.

Results A total of 40 patients (40 eyes; mean age: 79 years; range 56‐92 years) were identified. The number of medications remained unchanged in 75% patients, decreased by 2‐4 medications in 12.5% of patients and increased by 1‐2 in 12.5% of patients. Mean Log MAR VA (baseline 0.27±SD 0.45; final 0.19±SD 0.3) and the VF MD (baseline ‐9.17±SD 8.9; final ‐9.45±SD 9.3) did not change significantly over the 12 months study period (Log MAR p=0.29; VF MD p=0.18). The change in IOP was statistically significant, p=0.00018 (p<0.001), with an average IOP reduction by 18.14% at 12 months. In 76% of patients the mean IOP decreased by 6 mmHg and in 47.5% of patients the final IOP was lower than 16mmHg. No adverse events were observed during the study.

Conclusion ALT appeared safe and effective in lowering the IOP in cases of advanced glaucoma unsuitable for surgery.
In Vivo Bioimaging of RPE cell death
Authors: AMBATI J , KLEINMAN ME
Published: November 2013

We have now demonstrated the ability to non‐invasively image RPE cell death in a targeted fashion with a custom engineered NIRF dye conjugated to an irreversibly binding pan‐caspase substrate. The bio‐probe detection was sensitive and specific for degenerating RPE and overlying outer retinal layers in a mouse model with geographic atrophy (GA)‐like features. No significant ocular toxicity was noted, and eyes maintained a clear visual axis with undetectable anterior or posterior segment inflammation. While the potential role of caspase inhibition in the treatment of GA remains uncertain and will be addressed in future studies, an ideal translation of this knowledge would be to utilize caspase imaging as a means for the early detection, prognosis, and indication for therapeutic intervention in GA.
Basics of forward and backward scatter in the human eye lens
Authors: VAN DEN BERG TJTP
Published: November 2013

This presentation will treat basics of light scattering from the physical point of view, and as applicable to the human eye lens. The type of light scattering most easily recognized in ophthalmology is volume scattering, i.e. the more or less uniform lightness as seen in the slitlamp image. In fact this seeming uniformity derives from light scattering by a dense distribution of small particles. The ratio between backward and forward scatter strongly depends on particle size. Particles much smaller than wavelength scatter about equally in forward and backward directions; larger particles scatter (much) more strongly in forward direction. The particles dominating backward scatter in the human eye lens (towards the slitlamp, scheimpflug camera, etc.) are much smaller than wavelength. The particles dominating forward scatter have sizes of the order of wavelength. So, no direct link exists between slitlamp observation and hinder to the patient, as can be assessed with straylight. However statistically, the amounts of both types of scatterers can be linked. The less easily observed and understood type of scatter is surface scatter, e.g. from "Wasserspalten". Optical bench study of human eye lenses on these phenomena will be presented.

Commercial interest
Pentacam HR and C‐Quant – forward versus back‐ward light scattering, what is the correlation?
Authors: WEGENER A
Published: November 2013

A pilot study with 20 patients of varying age and sex has been conducted to compare light scattering measurements performed with the Pentacam HR and the C‐Quant in patients with various ocular problems. The Pentacam HR measurements were done in mydriasis with the standard 25 image recording process. The C‐Quant measurements were done in miosis according to the manufacturer’s instructions. Pentacam images were exported for densitometric analysis to a custom‐made software, whereas the C‐Quant data were evaluated with the instrument software. During normal, age‐related light scattering increase, C‐Quant data were less sensitive for the detection of scattering changes than densitometric evaluation of the Scheimpflug images. However, certain disease conditions like diabetes evidenced a sensitive difference between the 2 measurement techniques.
Conjunctival provocation test in ophthalmology daily practice
Authors: FAUQUERT J
Published: November 2013

Conjunctival provocation Test (CPT) is the main technique that may lead to the etiologic diagnosis of allergic conjunctivitis (AC). In most cases of seasonal and acute AC, the relationship with an allergen exposure is easily assessed. But in cases of perennial AC or in vernal as well as in atopic keratoconjunctivitis, the pertinence of the sensitization should be evidenced. To do this, CPT is the one tool available. The ophthalmologist plays a major role in its daily practice. Before CPT, a slit lamp examination is mandatory to avoid any contraindication (elevated clinical scoring, corneal impairment). The rating of symptoms occurring during CPT requires the ophthalmologist's collaboration as well as management of reactions consecutive to the instillation of increasing doses of allergens. Thus CPT requires a narrow collaboration between the ophthalmologist and the allergist.
The latest developments in the genetics of Fuchs corneal dystrophy
Authors: BARATZ K
Published: November 2013

Fuchs endothelial corneal dystrophy (FECD) is a common, familial trait. Several genes have been associated with the disease, including LOXHD1, SLC4A11, TCF4, ZEB‐1 and COL8A2 which has been identified as a cause of an early‐onset Fuchs‐like disease. The evidence for these genetic associations will be reviewed and new data will be shared. To date, the most sensitive biomarker for FECD is an intronic TGC trinucleotide expansion in the TCF4 gene which is present in the majority of FECD cases and in a small proportion of normal control subjects. Within families, this tricnucleotide expansion tends to segregate with the disease phenotype. The biology of trinucleotide expansion diseases and possible mechanisms by which TGC expansion may conribute to FECD will be presented. A brief discussion of recent advances in our understanding of the pathophysiology of FECD, such as the unfolded protein response and oxidative stress, will also be presented in order to highlight the challenges in linking the implicated causative genes with the biochemical pathways involved in the disease.
Morphological and proliferative studies on ex vivo cultured human anterior capsule lens epithelial cells
Authors: ANDJELIC S , DRASLAR K , HAWLINA M , PETROVSKI G
Published: November 2013

Purpose The proliferation and migration of lens epithelial cells (LECs) that remain in the capsular bag after cataract surgery can lead to development of posterior capsule opacification (PCO) ‐ a major cause of post‐operative visual loss. The multipotency of anterior lens capsule (LC) LECs is still controversial. We aimed to test the proliferating and migrating potential and to characterize structurally the ex vivo cultured LECs growing out off human anterior LC.

Methods The explants of LCs were obtained from uneventful cataract surgery and consisted of basal membrane and monolayer of LECs that were cultivated under adherent conditions. The size and shape of the outgrowing cells were recorded by scanning electron microscopy (SEM) and their migration and proliferation potential were followed on a daily basis throughout their continued growth using light microscope.

Results The migration and proliferation of anterior LC LECs filling up the denuded region of the LC could be followed by light microscopy. These cells could also migrate to the opposite side of the capsule as shown by both, light microscopy and SEM. The migration and proliferation of LECs on glass or plastic culture surfaces could be shown by both techniques, while the distribution of the LECs and their morphology could be analyzed in details by SEM.

Conclusion Classic light microscopy and SEM studies can be used to show that human anterior LC harbors LECs that can migrate and proliferate, suggesting their multipotency and putative stem cell nature. The anterior LC explants can be used to study PCO and the potential of different pharmaceutical or physical treatments against PCO development.
Enhanced 3D retinal vascular network reconstruction from high‐definition SD‐OCT
Authors: RODRIGUES P , GUIMARãES P , SERRANHO P , BERNARDES R
Published: November 2013

Purpose To compute the 3D vascular network of the human retina from high‐definition spectral‐domain optical coherence tomography (OCT).

Methods A method able to compute a fundus reference from SD‐OCT scans of the human macula to an extent similar to what can be achieved with color fundus photography was recently proposed by our research group. We resort to this new method and to an automatic supervised‐learning classification algorithm (both submitted for publication) to identify OCT A‐scans that cross the vascular network. A multi‐scale wavelet analysis is performed on each of these A‐scans to identify the transition between the hyper‐reflectivity due to the vessel and the shadow cast due to light absorption by hemoglobin. This transition is set as the vessel depth location, and the respective diameter estimated as the width from the computed fundus reference.

Results Eyes of healthy controls (N = 10) and eyes (ETDRS levels 10 to 35) from type 2 diabetic patients (N = 20) were imaged with the Cirrus HD‐OCT (Carl Zeiss Meditec, Dublin, CA, USA) and photographs were obtained with the Topcon TRC 50DX (Topcon Medical Systems, Inc., Oakland, NJ, USA) or the Zeiss FF 450. The vascular tree from the OCT reference presents an extension similar to that of the color fundus photography, 99.7(10.68)% (average(SD)). The 3D reconstruction of the vascular network allows to clearly distinguish between crossovers and bifurcations and the vascular network distribution is in agreement with the known anatomy of the human retina.

Conclusion The herewith presented method allows the visualization of the vascular network in 3D and compares favourably to the previous method both in terms of quality and extension of the vascular tree.
Early and sustained treatment modifies the phenotype of birdshot retinochoroiditis
Authors: PAPADIA M , KNECHT P , HERBORT CP
Published: November 2013

The present appraisal of Birdshot retinochoroiditis (BCR) is based on obsolete criteria that only represent advanced disease. Early diagnosis of BC can only be done using indocyanine green angiography (ICGA) showing the typical choroidal involvement. The aim of this study was to investigate long‐term follow ups of BRC patients regarding the impact of early treatment on the phenotype of BRC, both on ICGA findings as well as fundus appearance. 13 patients had sufficient data to be included in the study. Out of 13 patients, 8 showed typical birdshot lesions at presentation according to the presently used criteria. A significant proportion of the “no lesions” group did not develop typical birdshot lesions throughout the course. Mean treatment delay was 45.50 ± 33.39 months in the “typical lesions” group and 5.80 ± 2.95 months in the “no lesions” group. Early treatment can avoid the apparition of typical BRC lesions in the same fashion as early and heavy treatment can avoid the development of “sunset glow” fundus in Vogt‐Koyanagi‐Harada disease (VKH). Early diagnosis relies heavily on ICGA, that together with FA, visual field testing and presence of HLA‐A29 antigen allows the diagnosis before typical birdshot lesions can be seen.
Uveitis has become a precise clinical science: Multimodal investigational approach and management
Authors: HERBORT C
Published: November 2013

In recent years the appraisal of (posterior) uveitis has substantially improved. Classical investigational modalities such as fluorescein angiography (FA) and echography have been completed by an array of new preceise and complementary investigational methods. Laser flare photometry (LFP) together with imaging methods including indocyanine green angiography (ICGA), optical coherence tomography (OCT), ultrasound biomicroscopy (UBM), fundus autofluorescence (FAF) together with functional tests such as microperimetry and computerized visual testing allow us to exactly determine the level of inflammation as well as morphological and functional involvement. This new comprehensive approach brought enhanced diagnostic possibilities as well as precise monitoring of disease evolution and impact of treatment.
Results of epicorneal keratoprostheses
Authors: LIU C , AVADHANAM V
Published: November 2013

Epicorneal keratoprostheses sit on the cornea with only the posterior optical part protruding through the cornea into the globe. Examples include the osteo‐odonto‐keratoprosthesis (OOKP), tibial KPro, Pintucci KPro, and coralline KPro. Typically they have a biological cover usually buccal or labial mucosa. This paper examines the relative advantages and disadvantage of this family of devices, and their published results in terms of vision and retention.