bluuebunny/crossref_metadata_2025 huggingface dataset:
Do not forget your slit lamp
Authors: BRON A
Published: August 2012

During their residency, young ophthalmologists are fascinated by all the imaging techniques now available almost everywhere. It is fair to acknowledge that the yield of these techniques in the screening, the diagnosis and the follow‐up of ocular hypertensive and glaucoma patients is invaluable. However before embarking to the prescription and the interpretation of these techniques it is mandatory to carefully retrieve the symptoms and signs of the patients. Ophthalmologists are still medical doctors and not only technicians. Therefore they cannot forget the basis of a medical examination. Like the stethoscope for general practitioners and cardiologists, the slit‐lamp is a key step of the examination for ocular diseases by ophthalmologists. In this course, young ophthalmologists will find a check list to help them in retrieving medical history, symptoms and a check list for the slit‐lamp examination from the lids to the optic nerve head. This rapid and systematic approach is designed to help them to improve their daily clinical practice with glaucoma patients.
How to become familiar with gonioscopy?
Authors: HOMMER A
Published: August 2012

Gonioscopy is an essential examination in Glaucoma care. There is no other technique available that can replace it. Differential diagnosis of the different types of glaucoma is not possible without it. This course will highlight the different lenses, examination technique, findings and classifications. It will be shown with Videos, Computer animation as well as clinical cases.
How to evaluate structure in glaucomas?
Authors: SUNARIC MEGEVAND G
Published: August 2012

This course is designed for young ophthalmologists and will give the opportunity to discuss aspects of the structure and structural changes of the optic nerve head and the retinal nerve fiber layer related to glaucoma and the alteration of the visual function related to this disease. In the last few years there is increasing evidence of the importance of structural measurements particularly early in the disease, and combining information from structure and function can significantly improve detection and assessment of glaucoma progression. Different tools and new technologies for measuring structural changes will be discussed in details such as stereo‐ photographs, HRT, GDx and OCT.
A step‐by‐step approach to examining eye movements
Authors: BORRUAT FX
Published: August 2012

The eyes move in order either to keep track of an object of interest or to change visual attention from an object to another. There are several types of eye movements, each of them can be altered due to different mechanisms and pathologies. Patients with eye movement disorders can be either symptomatic (diplopia, oscillopsia) or asymptomatic. This presentation will summarize the infranuclear, nuclear and supranuclear pathways of oculomotility with an emphasis on fixation, saccades, pursuit, convergence and basic examination of the vestibulo‐ocular reflex. Guidelines for an examination of eye movements in clinical practice will be provided with video presentations of both normal and abnormal situations. At the end of the session, participants should be able to examine eye movements adequately and recognize abnormal fixation, defective pursuit, and inappropriate saccades.
Pathology of pigmented fundus lesions
Authors: COUPLAND SE
Published: August 2012

Purpose To describe the pathology of the most common pigmented fundus lesions.

Methods A review of the histomorphological, immunophenotypical and genotypical features of the most common pigmented fundus lesions.

Results Pigmented fundus lesions range in nature from benign to malignant lesions involving the retinal pigment epithelium and the melanocytes within the choroid as well as metastatic lesions to the posterior segment.

Conclusion Although most pigmented fundus lesions can be diagnosed clinically, in some cases histomorphological confirmation of the diagnosis is required. Further, the additional information that can be obtained from genetic examination of the tissue sample, is of predictive and prognostic value.
Malignant melanoma of the uvea: diagnosis, characterization and prognosis
Authors: MIDENA E
Published: August 2012

Purpose To summarize available data on uveal melanoma biology, diagnosis and clinical characterization.

Methods Herein, we review diagnostic criteria, clinical characterization and therapeutic implications of the emerging molecular biology in posterior uveal melanoma/high risk indeterminate choroidal pigmented lesion.

Results The diagnosis of uveal melanoma is based on clinical examination with indirect ophthalmoscope and ultrasonograpy. The use of mnemonic "to find small ocular melanoma" is useful in risk stratification of small indeterminate melanocytic choroidal lesions. The use of optical choerence tomograpy and autofluorescence also help in identifying sub‐retinal fluid and orange pigment. In the cytogenetic era, tumor‐sampling procedures are becoming the main prognostic tools for uveal melanoma patients.

Conclusion Ophthalmic oncology is moving in the same direction as all other oncologic subspecialties, starting to determine the patient’s risk using sampling‐based laboratory techniques. However, it is essential to start treating patients earlier (in the premalignant tumor stage) and to develop consistent, selective and effective adjuvant therapy
Dealing with cataracts in vitreoretinal surgery
Authors: TADAYONI R
Published: August 2012

Purpose Discussing techniques of combining cataract surgery with vitrectomy.

Conclusion To achieve a sustainable gain of vision in selected cases, combined surgery is performed by an increasing number of vitreoretinal surgeons. This combination needs adaptation of both cataract surgery and vitrectomy techniques.
The iris‐diaphragm in vitreoretinal surgery
Authors: BECHRAKIS NE
Published: August 2012

Purpose of this lecture is the description of problems that can occur in vitreoretinal surgery from defects of the iris‐diaphragm. These are associated with different intraocular tamponades that can cause severe corneal decompensation in case of endothelial contact. A variety of surgical procedures can address these issues, including surgery of the iris and implantation of artificial iris and lens‐iris diaphragms.
The first consultation
Authors: SPILEERS W
Published: August 2012

Purpose Patients with "photophobia" need a full clinical ophthalmological work‐up.

Methods Careful listening to the complaints and a clinical ophthalmological examination are the cornerstone of the decision making in the differential diagnosis.

Results Retinal disorders are indeed one of the possible causes of aversion to bright lights but many others have to be considered (refraction, lens, inflammation,...)

Conclusion When a patient does not like bright lights a well structured decision making tree of ophthalmological examinations is needed in order to proceed with the necessary technical investigations.
Photophobia in inherited retinal disease
Authors: LEROY BP
Published: August 2012

Purpose To describe the phenotypes and genotypes of photophobia due to inherited retinal disease.

Methods A case presentation format will be used to illustrate different genetically determined conditions leading to photophobia. Both clinical and electrophysiological phenotypes as well as genotypes will be discussed.

Results Phenotypes and genotypes of genetically determined diseases leading to photophobia are very different. An important distinction to be made is the one between stationary and progressive diseases. Indeed, such distinction is important as the visual outcome may differ considerably between different conditions.

Conclusion Genetically determined retinal diseases leading to photophobia are very diverse. Visual electrophysiology allows an important distinction between progressive and stationary conditions.
Highly elastic epoxy cross‐linked collagen hydrogels for corneal tissue engineering
Authors: RAFAT M , KOH LB , ISLAM MM , LIEDBERG BO , GRIFFITH M
Published: August 2012

Purpose Our objective is to develop novel materials that support the regeneration of diseased or damaged corneas. Despite the promising clinical results that we previously reported on biosynthetic corneas, more robust and elastic materials are required to withstand the adverse host conditions faced for high risk transplantation in severely damaged or diseased corneas. This presentation will provide details on an epoxy cross‐linked collagen‐based scaffold with enhanced mechanical properties.

Methods We have developed a range of collagen‐based materials as mimics of the cell‐free corneal stromal extracellular matrix. In this study, cross‐linked polymer networks of collagen hydrogels were prepared using a hybrid of 1,4‐butanediol diglycidyl ether (BDDGE) and carbodiimides (e.g. EDC‐NHS) as cross‐linkers. Briefly, 10w/w% porcine collagen type I was mixed in a T‐piece system at various compositions and pH, e.g. pH 5, pH 11, and incorporated with laminin adhesive peptides (YIGSR, and IKVAV). Promising material formulations were tested for their physiochemical properties (e.g. mechanical, optical, water uptake, FTIR, and thermal degradation) and physiological properties (e.g. interactions with corneal cells, and biodegradation).

Results The hybrid BDDGE hydrogels demonstrated improved mechanical properties and degree of cross‐linking while maintaining their optical clarity and biocompatibility compared to controls (e.g. EDC/NHS‐crosslinked hydrogels). Incorporation of laminin‐derived cell‐adhesive peptide (IKVAV) demonstrated significant increase in corneal cells (HCECs) proliferation compared to controls.

Conclusion The hybrid BDDGE‐crosslinked collagen‐based hydrogels have the potential for use as tissue‐engineered corneal substitutes.
New formulations for topical drug administration
Authors: GURNY R
Published: August 2012

Abstract not provided
Intraocular administration of biodegradable microspheres to increase drug bioavailability and extend therapeutic effect
Authors: HERRERO‐VANRELL R
Published: August 2012

Purpose Treatment of posterior segment diseases often requires repeated intravitreal injections to achieve and maintain steady state concentrations of the active substance in the target site. However, intraocular injections are associated to adverse effects and the risk of complications increases with the number of administrations. Biodegradable microspheres (MPs) are considered an alternative to multiple injections as they are able to release the encapsulated drug over weeks or months. Copolymers of lactic and glycolic acids (PLGA) are FDA approved biodegradable biomaterials commonly used to prepare MPs. They are biocompatible and degrade to metabolic products that are easily eliminated from the body. The main advantages of these systems is that they can be injected as a conventional suspension without surgical procedures. After intravitreal administration, PLGA microspheres suffer aggregation disappearing from the site of injection after delivering the drug. Microspheres can be loaded with different active substances (small molecules and biotechnological products) useful to treat vitreoretinal diseases. Administration of microparticles can be performed by periocular, intravitreal, sub‐ retinal, or other intraocular routes to treat posterior segment disorders.

Conclusion PLGA microspheres are emerging therapeutic tools for the treatment of posterior segment diseases in which steady state concentrations of the active substance is needed over an extended period of time. Acknowledgements: PANOPTES‐Peptide‐based Nanoparticles as Ocular Drug Delivery Vehicles‐ collaborative project (FP7‐NMP‐2009); Spanish Ministry of Economy MAT 2010‐18242, UCM Research Group 920415 and RETICs (RD07/0062/2002)
Suprachoroidal delivery: new directions and challenges
Authors: OLSEN T
Published: August 2012

Abstract not provided
Use of bevacizumab (anti‐VEGF treatment) in high‐risk corneal grafts
Authors: DEKARIS I , DRACA N , RATKOVIC M , PAUK M
Published: August 2012

Purpose We evaluated the effect of bevacizumab treatment in a prospective 2 year follow‐up study of 50 [bdquo]high risk“ eyes undergoing penetrating keratoplasty (PKP).

Methods Hihg‐risk diseases were: 2 Stevens Johnson syndrome (SJS), 6 chemical burns, 9 post‐herpetic, 16 other vascularized scars, 13 rejected grafts and 4 ulcers. PKP was performed in all 50 patients; combined with other procedures as follows: 12 “triple” procedures (PKP + cataract),11 PKP+ amniotic membrane transplantation (AMT),4 triple+AMT+ transplantation of limbal cells (LCAT). Subconjunctival injection of 25 mg/ml of bevacizumab was given to all patients at the end of surgery. Recipient corneal buttons were dissected into 3 corneal layers, stored in media for 24 hours at 37oC, and frozen till detection of VEGF quantity by immunoassay (ELISA). Corneal buttons from patients with non‐inflammatory diseases served as controls.

Results Decrease of corneal neovascularization was observed in 88% of patients who received bevacizumab, and 86% of grafts remained clear. Mean best corrected visual acuity had statistically significant increase in all groups from 0.03 to 0.5, with the poorest visual outcome in SJS patients. Average postoperative astigmatism was ‐4,83 Dcyl. Average endothelial cell loss was 22.83% after one, and 31.97% after two years (similar in all groups). Secreted VEGF was significantly higher in high risk cases (2436.7 pg/ml) as compared to non‐inflamed corneas (504.7 pg/ml).

Conclusion Combined “anti‐inflammatory“approach of AMT, LCAT and bevacizumab may significantly improve corneal graft survival rate in [bdquo]high‐risk“ eyes.
Stem cell culture for limbal deficiency
Authors: BORDERIE V
Published: August 2012

Purpose Cultured stem cell transplantation is a new promising technology for eye diseases associated with destruction, dysfunction, or genetic abnormalities of ocular stem cells. The first group of ocular diseases targeted is limbal stem cell deficiency. Various ocular disorders, including ocular burns, Stevens‐Johnson syndrome, cicatricial ocular pemphigoid, severe infectious keratitis, contact lens‐induced keratopathy, multiple surgical procedures involving the limbal region, aniridia, congenital erythrokerato‐dermia, and keratitis associated with multiple endocrine deficiencies, may induce limbal deficiency.

Methods Various culture techniques have been developed that can be classified according to the type of stem cells (limbal epithelium or oral mucosal epithelium), the source of stem cells (autologous or allogeneic), the type of culture (explants or dissociated cells, feeders or no feeders), the carrier used to grow cells (amniotic membrane, fibrin, temperature‐responsive plastic), and culture media. Eye banks are often involved in the preparation of these cell therapy products.

Results Prospective clinical trials have shown that transplantation of cultured epithelial stem cells improves the ocular surface condition of patients with limbal deficiency with a high success rate, especially when autologous limbal stem cells can be used as the source of cultured cells.

Conclusion However, many issues are still to be investigated. Among them, selection and screening of donor tissue, microbiological safety of stem cell production process, safety of transplantation of cells cultured with products or feeder cells from animal origin, choice of the best technology to be used for growing stem cells, evaluation of the cell therapy product before transplantation, definition of success after transplantation.
Pan‐endothelial viability assessment with the triple HEC staining of organ cultured precut DSAEK vs full thickness corneas
Authors: CAMPOLMI N , HE Z , GAIN P , MURAINE M , TOUBEAU D , PIPPARELLI A , ACQUART S , GARRAUD O , PISELLI S , DUMOLLARD JM , PEOC'H M , THURET G
Published: August 2012

Purpose To assess the viable endothelial cell density (vECD) of posterior lamellar grafts, stored in organ culture, precut by eye bank technicians, and sent to a distant center.

Methods Paired corneas with an ECD >2200 cells/mm2 at the standard assessment with the SambaCornea analyser (TribVn, France), were stored in CorneaMax (Eurobio, France) and deswelled in CorneaJet (5% Dextran T500) for 6 to 24 hours prior to pre‐cutting. They were randomly assigned as full‐thickness grafts or as precut posterior transplants for DSAEK using a microkeratome with a 350μm head (Moria, France). Corneas were sent to a distant center where the vECD was assessed by using the triple Hoechst/Ethidium/Calcein (HEC) staining and ﬂuorescent image analysis of the entire posterior surface: calculation of the area covered by living cells (H+/C+/E‐) coupled with counting of nuclei in large areas allowed to determine the vECD, i.e. the useful cell pool (Pipparelli. IOVS 2011.52:6018). DSAEK and controls data were compared with non‐parametric tests.

Results In both groups, the vECD was lower than the standard ECD determined by the eye bank (for 20±7% for full thickness grafts, 34±16% for DSAEK), because living cells never completely covered the entire posterior surface. vECD were respectively of 2006+/‐349 vs 1661+/‐464 (P=0.075).

Conclusion The HEC triple staining combined with image analysis provides a unique accurate assessment of the endothelial quality by giving the vECD. This laboratory technique allows a reliable assessment of the endothelial quality of tissues supplied to surgeons, precut or not. It can also be used to assess any methods liable to modify EC.
Worldwide Eye Banking (WEB) project: international survey of demand and supply
Authors: JULIENNE R , ALDOSSARY M , NEFZAOUI C , HE Z , HA THI BM , CAMPOLMI N , THURET G , GAIN P
Published: August 2012

Purpose The whole eye banking (EB) process, from corneal retrieval to surgery, is improving. Paradoxically, corneal blindness worldwide is still increasing. Supply seems lagging far behind global demand but only partial data of the worldwide situation is available. We therefore launched an international survey on the balance of demand and supply, called the “Worldwide Eye Banking” (WEB)‐project. Our goal is to identify suitable solutions in countries willing to improve their corneal supply

Methods Descriptive epidemiological worldwide transversal study. A questionnaire was designed and e‐mailed to EB staff and ophthalmologists involved in corneal grafts using mailing lists from local and international ophthalmological societies or by face to face interview during international ophthalmology, eye research or EB congresses

Results Significant disparities were highlighted. Developed countries tended to satisfy corneal demand. EBs in the United‐States use short term storage and are exporters, while Europeans use long‐term organoculture and nearly satisfy local demand. Keratoplasty indications have 2 profiles: infections, mainly trachoma, for developing countries and keratoconus, endothelial dystrophy or iatrogenic edema in developed countries

Conclusion This demand/supply disparity, at this stage of the study (ongoing), is severe in most developing countries. Decreasing demand requires: 1) Trachoma fight in endemic zones, 2) Iatrogenic edema prevention. Increasing supply requires: 1) Corneal donation politic dynamism, 2) Local eye banking implantation in each country, 3) Optimizing storage technique for better efficiency (retrieved/delivered graft ratio), 4) Bioengineering of endothelial graft
Light microscopy of the corneal pathologies that we meet in our daily practice as an eye banker
Authors: JIRSOVA K
Published: August 2012

Purpose Organ culture is the method of choice for the preservation of a human donor cornea for transplantation throughout Europe. This method is often closely connected with the assessment of the cornea using light microscopy. The corneal endothelium, its polymeghatism, pleomorphism, cornea guttata and other endothelial abnormalities as well as epithelial and stromal pathologies will be presented to show the usefulness of light microscopy in the evaluation of corneal pathologies.

Methods Photographs from light microscopy (both phase contrast and bright field) taken before and after corneal storage in organ culture will be compared and discussed in relation to changes in endothelial morphology and the swelling of the intercellular spaces. The individual corneal layers (the corneal epithelium, the stroma and the endothelium) of pathological corneas will be compared to those of control corneas.

Results Among corneal pathologies, cornea guttata, corneal dystrophies (Fuchs endothelial corneal dystrophy, posterior polymorphous corneal dystrophy) and crystalline keratopathy will be shown using pathological explants. Moreover, the corneal pathologies will be correlated with histological findings. Finally, bacterial and fungal contamination of the cornea during organ culture will be shown.

Conclusion Light microscopy is an essential part of qualitative and quantitative corneal assessment, which allows corneas with a variety of pathologies, mostly endothelial in origin, to be excluded from grafting. This work was supported by the project PRVOUK‐P24LF13 of Charles University in Prague.
Appraisal of choroiditis in birdshot retinochoroiditis is essential and only possible using indocyanine green angiography
Authors: HERBORT CP , PAPADIA M
Published: August 2012

Purpose Birdshot retinochoroiditis (BRC) belongs to the group of stromal choroiditis entities including also VKH disease. In contrast to VKH where the origin of inflammation is limited to tha choroid, inflammation starts both in the choroid and the retina in BRC.Without indocyanine green angiography (ICGA), global appraisal of BRC is not possible as choroidal inflammation cannot be detected nor followed. The aim here was to analyze the practical contribution of ICGA to the management of BRC.

Methods Charts of patients with the diagnosis of BRC seen in the Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland from 1995‐2011 were reviewed. Standard fluorescein‐ICGA work‐up was performed at presentation and during follow‐up. Diagnostic and monitoring contribution of ICGA was analyzed.

Results In a collective of 1268 patients seen from 1995‐2011 at the COS, 25 patients (2.0%) were diagnosed as BRC. 19 had sufficient data to be included in the study. Mean age was 49 years, HLA‐A29 positivity was 100% and follow‐up was 112 months. IGA contribution was twofold; (1) Early diagnosis could not have been without ICGA in 3/19 patients a proportion that increased to 3/7 (43%) if only considering patients with early stage disease at entry. (2) ICGA further showed that choroidal disease responded well to therapy and stayed under control as long as therapy was continued.

Conclusion ICGA was found to be essential for early diagnosis of BRC, an element that is crucial as early therapy is crucial in the control of disease. ICGA further allowed to monitor choroidal disease showing a good response in contrast to retinal disease. Hence global appraisal is needed for BRC and is not possible without ICGA.
Voclosporin: newer analyses of a randomized, controlled trial for noninfectious uveitis
Authors: BODAGHI B , LUMINATE INVESTIGATOR GROUP
Published: August 2012

Purpose To provide an overview of the voclosporin clinical development program for noninfectious uveitis involving the posterior segment.

Methods Two trials, LX211‐01 (active uveitis) and LX211‐02 (clinically controlled, quiescent uveitis), were conducted for noninfectious uveitis involving the posterior segment. All trials were dose‐ranging and double‐masked. Study LX211‐01 enrolled 218 patients with active, posterior segment uveitis. The co‐primary efficacy endpoints were mean change from baseline in vitreous haze (VH) score after 16 and 24 weeks of therapy or at time of rescue, if earlier. Study LX211‐02 enrolled 232 patients with clinically quiescent posterior segment uveitis. The primary endpoint for this study was the proportion of patients who experienced an inflammatory exacerbation.

Results In Study LX211‐01, the voclosporin 0.4 mg/kg group BID demonstrated statistically significant differences from placebo in the co‐primary endpoints, Week 16 and Week 24 (p=0.008 at 16 weeks, p=0.027 at 24 weeks). Analyses of important subpopulations, support the effect of voclosporin on severe uveitis. In Study LX211‐02, voclosporin 0.4 mg/kg BID reduced the rate of recurrence of inflammatory exacerbation in patients with quiescent disease by up to 50% over a 26‐week period.

Conclusion In Study LX211‐01, clinically meaningful reduction in vitreous haze with strong statistical significance was observed. The response to treatment with voclosporin was early and sustained. In Study LX211‐02, there was an up to 50% reduction vs. control in inflammatory exacerbation recurrence rate. Voclosporin safety is consistent with the class and is manageable with routine monitoring.

Commercial interest
How to stain ILM in macular surgery
Authors: HARITOGLOU C
Published: August 2012

Abstract not provided
What to peel in macular surgery?
Authors: GAUDRIC A
Published: August 2012

Abstract not provided
Genotype‐phenotype correlations in Stargardt disease/ABCA4‐related retinopathy
Authors: HOLDER GE , FUJINAMI K , ROBSON AG , WEBSTER AR , MICHAELIDES M
Published: August 2012

Purpose To investigate genotype‐phenotype correlations in patients with Stargardt Disease (STGD) / ABCA4‐related retinopathy

Methods 195 patients diagnosed with STGD and harbouring ABCA4 variants were recruited. A detailed clinical history and examination were undertaken. Pattern and full‐field ERGs (PERG; ERG) were used to classify 175 patients into three groups (Lois et al. 1999); dysfunction confined to the macula; macular and cone ERG abnormality; and macular and both cone and rod abnormality. Patients were also grouped by genotype: G1 ‐ two null variants (N=9); G2 ‐ at least one null variant with or without missense variants (67); G 3 ‐ at least two missense variants (50); G 4 ‐ one missense variant (69).

Results All G1 patients had a group 3 ERG. 26/58 G2 were in ERG group 1; 26/58 in Group 3. 24/47 G3 patients were ERG group 1; 7/47 group 2; and 16/47 in ERG group 3. 31/61 G4 patients were in ERG group 1; 5 in group 2; and 25/61 in group 3. Significant clinical differences were also observed between the genotypes.

Conclusion Patients with two null ABCA4 variants had the most severe phenotype. In comparison, patients with two or more missense variants had a more variable phenotype and included many with normal full‐field ERGs. This large survey confirms previous suggestions based on smaller cohorts and individual families.
Recovery of the ERG from very low SNR recordings using a robust frequency domain approach: an Internet open source implementation
Authors: FISHER A , ELEUTERI A , TEYMOURI R , HAGAN RP
Published: August 2012

Purpose To present a statistically robust method of estimating the transient electroretinogram (ERG) in extremely poor recordings (very low SNR) contaminated by continuous noise (electrode noise, EMG, exogenous electrical interference) and discontinuous noise (eye‐movements and blinks). The transient ERG (ERG) is estimated by ensemble averaging with standard errors and p value, derived by either Magnitude Square Coherence or Bootstrap Resampling. However, both techniques are susceptible to noise. A robust estimator noise is required.

Methods A series of ERG’s was recorded in normal subjects, containing numbers of prescribed eye movements and blinks. AR models were derived using the Burg algorithm over a range of explicit SNR’s. The ERG record was recovered as its Fourier Series representation over 9 harmonics. p values were derived for all estimates. An Excel implementation is presented which accesses remote Internet resources using MatSOAP©.

Results The robust estimator was validated in Monte Carlo realisations of the AR model with expected high levels of performance for amplitudes and p values. In estimations in the raw data sets, high levels of statistical agreement were achieved for each subject across no‐noise:noise series. The recovery by ensemble averaging performed poorly.

Conclusion The robust estimation in the ERG as presented here is novel and offers an important advance in clinical ERG measurement. The complexity is hidden from the User by providing a familiar Excel© spreadsheet interface.
Mechanisms & recovery of vitamin A deficiency
Authors: LEROY BP , DE ZAEYTIJD J , DE LOOZE D , DELANGHE J , KESTELYN P
Published: August 2012

Purpose To illustrate different mechanisms which lead to vitamin A deficiency and result in retinal dysfunction. To show how a diagnosis can be made, and how, and to which degree, in such cases, retinal function can be recovered.

Methods A case presentation format will be used to illustrate different mechanisms of retinal dysfunctions due to vitamin A deficiency. Patient history taking, clinical and electrophysiological phenotypes and therapeutic approaches will be addressed.

Results Mechanisms of vitamin A deficiency are very different, but all have fat malabsorption in common. Often, other concomitant vitamin deficiencies exist. With vitamin A repletion therapy, either partial or complete restoration of retinal function can be attained.

Conclusion Causes of vitamin A deficiency are very diverse. Thorough history taking, in combination with an extensive clinical examination and psychophysical and electrophysiological tests, most often allows making a more specific diagnosis of an underlying malabsorption. Vitamin A repletion therapy is effective in such cases.
Spherical aberration and binocularity
Authors: VANDERMEER G , NOCHEZ Y , GICQUEL JJ , LEGRAS R , PISELLA PJ
Published: August 2012

Purpose To evaluate the effect of different combinations of spherical (SA4) and secondary spherical (SA6) aberration on each eye on binocular subjective quality of vision.

Methods A numerical eye model was used to generate images (ie three 0.4 logMAR high contrast letters) viewed through a 4.7mm pupil diameter and degraded by various spherical aberrations (SA4‐0.4μm, SA4+0.4μm, SA4‐0.4μm and SA6+0.2μm, SA4+0.4μm and SA6‐0.2μm). Binocular vision was simulated using a 3D‐NVIDIA video system projecting different image on each eye. Through‐focus quality of vision was evaluated using a grading scale (ITU‐R 500 recommendation) by three subjects under monocular and binocular condition for each tested conditions (ie various combination of the five aberration profiles).

Results Binocular through‐focus curve followed the best monocular curve. Binocular inhibition was obtained if subjective image quality was too different between the two eyes. We rarely measured binocular summation in term of subjective quality of vision. Ocular dominance seemed to affect the level of inhibition: binocular inhibition was limited when the dominant eye saw the best image. Area under the binocular curve (ie a way to evaluate subjective depth‐of‐focus) measured for a fair or higher image quality was increased with all combinations compared to naked eye because of the summation of the two best monocular curves. The greatest increase was obtained with reverse profile of SA4 and SA6 between each eye (ie SA4‐0.4μm and SA6+0.2μm on one eye and SA4+0.4μm and SA6‐0.2μm on the other eye).

Conclusion The use of different spherical aberration on each eye leads to a better binocular through‐focus curve especially with combination of opposite sign of SA4 and SA6. However there is no binocular summation of vision quality.
Impact of higher‐order aberrations on accommodation in phakic presbyopic patients
Authors: PISELLA PJ
Published: August 2012

Abstract not provided
Quality of vision and 3D
Authors: COCHENER B , LAMARD M , FERRAGUT S , IORGOVAN D , FATTAKHOVA Y , DE BOUGRENET DE LA TOCNAYE JL
Published: August 2012

Purpose Multiple functional disturbances related to disorder of the stereoscopic vision have been revealed by the development during these last few years of 3D on all kinds of screens. In order to understand and potentially predict the occurrence of this new symptoms, a platform for detection and qualification has been designed at 3‐D Fovea Observatory ‐ Brest (France)

Methods ‐ This platform includes: • 3D 107 cm plasma screen • 3D active pair of glasses equipped with a LCD opturator specifically developed for the study (high blocker level > 1/1000 and contrast sensitivity C1 : 350‐400), • oculometer able to follow the visual strategy, • computer for the tests diffusion and collection of data ‐ We developed a first kit of 4 tests focused on the detection of capacities for 3D tolerance. The evaluated parameters are : stereo‐acuity, simultaneous perception, total fusion and hyper stereopsis.

Results Outcome issued from these 4 tests can be expressed in different ways according to the competence level of the user. A simple colored scale for the general population and quantification for the ophthalmologist and the orthoptist. Mean time required for performing this first series of exams is 403 seconds +/‐ 93. An evaluation in a risky population for abnormal binocular vision is ongoing.

Conclusion preliminary results seem encouraging and should allow an extrapolation to the quality of relief perception on a movie in 3D. The interest of this platform lies on its simplicity of use, its ability to predict the tolerance to 3D exposure and to offer new tools for a modern and dynamic evaluation of binocular vision.
Imaging and scleritis
Authors: HERBORT CP
Published: August 2012

Abstract not provided
Conditions mimicking scleritis
Authors: CASSOUX N
Published: August 2012

Scleritis is an inflammatory process due to a huge number of inflammatory systemic etiologies and treated with corticosteroids or immunosuppressive drugs. Pseudoscleritis are represented by tumoral diseases that looks like scleritis but with a painless clinical presentation, and unresponsive to corticosteroids. Theses tumoral pathologies that may simulate scleritis are usually tumors of the conjunctiva (carcinoma, achromic melanoma, sarcoma, Malt lymphoma…) however some atypical presentation of intraocular tumors can mimic anterior or posterior scleritis. The tumoral origin of ocular pathologies must not be delayed because it increases the risk of metastasis and death. One a tumor is suspected patient should be referred to an onco ophthalmologist for diagnosis and management. In this paper, the different tumoral pathologies and their management will be described.
PUK from diagnosis to treatment
Authors: NERI P , CAPUANO V , ARAPI I , PIRANI V
Published: August 2012

Purpose To describe the treatment strategy in the management of peripheral ulcerative keratitis (PUK).

Methods The current literature is reviewed and the experience of a tertiary referral centre is reported.

Results Peripheral ulcerative keratitis (PUK) is rare but severe sight‐threatening disease affecting the peripheral cornea. The causes of PUK are multiple and insidious. Infectious diseases, both secondary to systemic rather than purely local diseases, and non‐infectious diseases can be identified as a cause of PUK. Non‐infectious systemic diseases, which can induce deposition of immune complexes in the cornea and, hence, lead to corneal ulcers, include peripheral vasculitides and inflammatory diseases of collagen, such as Rheumathoid arthritis, Wegener Granulomatosis and Systemic Lupus Erythematosus. Mooren’s ulcer is one of the most characteristic PUKs: often unilateral and self‐limiting in the elderly, sometimes bilateral and relentless in young patients, may cause severe visual impairment following extensive corneal destruction. Immunosuppressive therapy has been demonstrated effective in improving the prognosis of progressive cases, although a certain number of patients remain refractory to treatment. Resolution of refractory cases of Mooren’s ulcer with new systemic biologic agents, such as campath‐1H and anti‐tumor necrosis factor (TNF)‐α, has been reported.

Conclusion PUK can be a severe disease, leading to significant visual impairment. Although no guideline is provided, the current medical literature can give the basis for a successful treatment strategy. The detection of the infectious trigger can lead to the correct, specific therapy. Non‐infectious diseases are basically treated with the combination of steroids with immunesuppresives and, when necessary, biologics.
Choroidal thickness in glaucoma patients and glaucoma suspects measured by spectral domain optical coherence tomography
Authors: FRANCOZ A , NICOT F , CATTANEO A , CREUZOT‐GARCHER C , AHO S , BRON A
Published: August 2012

Purpose The aim of our study was to evaluate and compare retro‐foveolar choroidal thickness (RFCT) of healthy subjects, individuals with intraocular hypertension, patients with primary open‐angle glaucoma (POAG), patients with normal tension glaucoma (NTG) and patients with primary angle‐closure glaucoma (PACG) by spectral domain optical coherence tomography (SD‐OCT).

Methods Sixty‐five healthy eyes, 30 eyes with intraocular hypertension, 90 eyes with POAG, 30 eyes with NTG and 20 eyes with PACG were included in this cross‐sectional study. RFCT, foveolar retinal thickness and average retinal nerve fiber layer thickness (RNFL) were measured by SD‐OCT (Spectralis HRA‐OCT, Heidelberg Engineering). Choroidal area was measured centered on the fovea, extending 2500 μm in temporal and nasal directions with Image J software. Parapapillary atrophy (PPA) was noted with optic nerve digital stereophotography. Humphrey 24‐2 visual field was also performed and spherical equivalent (SE) was measured with an automatic refractometer.

Results In univariate analysis, significant correlations were observed between RFCT and age, choroidal area, PPA (p<0.001), SE, intraocular pressure, topical prostaglandin analogs (p<0.030), POAG, PACG (p<0.001) and NTG (p=0.006). In multivariate analysis, RFCT was correlated with age, choroidal area, PPA and PACG (p<0.001). Average RFCT was statistically thicker in PACG patients compared to healthy subjects (341 ± 95 μm versus 235 ± 56 μm, p<0.001).

Conclusion This preliminary study showed that RFCT measured by SD‐OCT was significantly thicker in PACG compared to healthy subjects.
Manual placement of SD‐OCT peripapillary circle scan: possible influence on RNFLT classification and profile shape
Authors: SCHULZ S , ZINSER G
Published: August 2012

Purpose Automatic classification of peripapillary retinal nerve fiber layer thickness (RNFLT) with Spectral Domain OCT (SD‐OCT) using a circle scan centered at the optic nerve head (ONH) is a standard test in glaucoma diagnosis. Possible influences of manual center selection on the double‐hump (DH) shape of RNFLT profile and classification have been evaluated.

Methods SD‐OCT (Spectralis , Heidelberg Engineering GmbH, Germany) standard circle scans were performed on 17 healthy eyes. Based on the infrared (IR) reflectance image, the center (C) of the circle scan was manually aligned to the ONH center and then shifted half way to the rim and on the rim at 3, 6, 9 and 12 o’clock position. Angle (AHP) and thickness (THP) of the highest peak in the superior and inferior RNFLT profile were calculated. Changes in RNFLT classification were analyzed.

Results Horizontal shift of C significantly affects the AHP. Temporal shift moves the DH together, nasal shift diverges it. Temporal or nasal shift results in higher changes of superior than inferior RNFLT profile. Vertical shift induces a significant difference between THP and AHP. Superior shift increases inferior THP, decreases superior THP and moves the DH slightly to the left. Inferior shift does the opposite. The first temporal shift changed normal RNFLT classification in 15 of 119 sectors: 10 borderline (BL), 5 outside normal limits (ONL). Shifting C further on the temporal rim changed 33 sectors: 9 to BL, 24 to ONL.

Conclusion Extreme decentration of the circle scan center (C) can significantly affect position and height of the RNFLT profile double hump (DH). If the RNFLT DH profile does not match the typical normal shape, decentration of C should be considered as a possible reason.

Commercial interest
Clinical trial for the evaluation of neuroprotective effects of palmitoylethanolamide: Visual Field and Pattern‐ERG
Authors: GAGLIANO C , LONGO A , UVA MG , REIBALDI M , AMATO R , RUSSO V , BIONDI P , AVITABILE T
Published: August 2012

Purpose To study the effects of palmitoylethanolamide (PEA), a fatty acid ethanolamide, on IOP, visual field and pattern‐ERG in glaucoma patients.

Methods 36 glaucoma (POAG) patients treated topically with timolol 0.5% were randomly assigned to either orally PEA 300 mg/die 2 times daily (Group A) or placebo (Group B). The patients had at least 5 VF tests using the Humphrey Visual Field Analyzer (Threshold 30‐2) for more than a 2‐year period before PEA treatment. At baseline and after 6, 12, 18, 24 months of treatments we evaluated in both groups the change of progression rate of visual field using mean deviation (MD), and pattern standard deviation (PSD). Comparison of means was performed with the paired t‐test.The involvement of retinal ganglion cells (RGCs) were investigated using pattern electroretinograms (PERG) recorded twice a year in 36 glaucoma patients over at least 2 years.

Results Significative IOP reduction was observed in the Group A, PEA treated patients (16.94 ± 3.96 vs. 13.8 ± 3.24 mm Hg; P < 0.001).A statistically significant difference in the MD was found between the two groups (PEA treated, ‐2.9 dB±2.93; Placebo treated, ‐8.55 dB±6.51 P=0.001). Furthermore, the change in PSD reached statistical significance: PEA 2.63 dB ±1.47; Placebo 6.59 dB ±6.51 P=0.002. PERG amplitude decreased significantly (P<0.01) in patients treated with placebo compared with PEA. PEA tablets continued to be safe and well‐tolerated, with no drug‐related adverse events.

Conclusion These findings show substantial clinical benefits of PEA treatment in POAG patients:reduction of IOP as well as significative improvement in visual field and PERG.
Case from hell in narrow angle glaucoma patient
Authors: VAN DE VEIRE S , WEBERS C , BECKERS H
Published: August 2012

Purpose To present the complicated case of a young man with Bechterew uveitis and secondary glaucoma, who underwent glaucoma implant surgery.

Methods From the age of 8 years he presented with multiple attacks of anterior uveitis of his right eye. Each attack was treated with high dose of corticosteroids, leading to pressure rise. Quickly tampering the amount of steroids lead to reactivation of his uveitis. From 2011 on, he developed intraocular pressures up to 40 mmHg, treated with local drops and acetazolamide.

Results A tube implantation (Baerveldt 350) was performed with good eye pressure for the first 6 postoperative weeks continuing under maximal therapy (due to the Vicryl ligature). After these 6 weeks he developed multiple attacks of hypotony, for what an anterior chamber filling was performed each time with different types of viscoelasticum. After 3 attempts a bleb revision was performed, leading again to a massive intraocular pressure rise. Mainwhile the uveitis remained fairly inactive.

Conclusion Patients with juvenile rheumatoid arthritis often have a very difficult intraocular pressure regulation. Their response to a Baerveldt implantation is really unpredictable. It is either too high or too low.
Bilateral progressive coats‐type exudative retinopathy in Usher syndrome type IIIA from c.528T>G Clarin 1 (CLRN1) mutation
Authors: KIVELÄ T , TÄLL M , LINDAHL P , IMMONEN I , LOUKOVAARA S , SANKILA EM
Published: August 2012

Purpose To describe bilateral, progressive, Coats‐type exudative retinopathy in a boy with Usher syndrome type IIIA.

Methods An interventional case report from a tertiary referral center.

Results A 9‐year‐old boy with a hearing loss of medium severity diagnosed 4 y earlier developed nyctalopia and began to stumble on objects, leading to suspicion of a visual field defect. His visual acuity (VA) was 20/50 OD and 20/40 OS with no significant refractive error. The RPE was distinctly flecked. Dilated retinal vessels with a confluent accumulation of subretinal lipid were seen temporally, OD, and two similar smaller lesions without obvious vascular pathology, OS. The vitreous showed diffuse cellular or lipoid deposits. The ERG was almost isoelectric and Goldmann visual fields were constricted. Two months later, vision had deteriorated to 20/100 and exudates extended to the macula, OD. He underwent bilateral peripheral cryocoagulation. Genetic testing uncovered the predominant Finnish c.528T>G homozygous mutation of CLRN1 (clarin‐1). During the next 8 months, exudates slowly regressed with vision improvement to 20/40, OD, but the telangiectasias appeared leading to extension of exudation to the macular area, OS. Twenty months after a second cryocoagulation, OS, the exudates remain regressed bilaterally with 20/40 vision, OD, and 20/30 vision, OS.

Conclusion Bilateral Coats‐like exudative retinopathy is well known from diverse types of retinitis pigmentosa and from Usher syndrome type II unrelated to CLRN1. It has not been reported in Usher syndrome type IIIA, which predominates in Finland, highlighting the possibility that other genes may may contribute to Coats’ type retinitis pigmentosa.
The effect of a Gas6 c.834+7G>a polymorphism and the interaction of known risk factors on AMD pathogenesis in Hungarian patients
Authors: LOSONCZY G , BALOGH I , VAJAS A , BERTA A
Published: August 2012

Purpose We performed a case‐control study to search for genetic interactions and for differences in dry and wet age‐related macular degeneration (AMD) pathogenesis.

Methods We enrolled 213 patients with exudative, 67 patients with dry AMD and 106 age and ethnically matched controls. Altogether 12 polymorphisms in Apolipoprotein E, complement factor H, complement factor I, complement component 3, blood coagulation factor XIII, HTRA1, LOC387715, Gas6 and MerTK genes were tested.

Results No association was found between either the exudative or the dry form and the genetic backround in the case of Apolipoprotein E, complement factor I, FXIII and MerTK polymorphisms. Gas6 c.834+7G>A polymorphism was found to be significantly protective irrespective of other genotypes, reducing the odds of wet type AMD by a half (OR=0.50, 95%CI: 0.26‐0.97, p=0.04). Multiple regression models revealed a genetic interaction in the dry AMD subgroup. In the absence of a C3 risk allele, mutated alleles of both CFH and HTRA1 behaved as strongly significant risk factors (OR=7.96, 95%CI: 2.39=26.50, p=0.0007, and OR=36.02, 95%CI: 3.30‐393.02, p=0.0033, respectively), but reduced to neutrality otherwise. The risk allele of C3 was observed to carry a significant risk in the simultaneous absence of homozygous CFH and HTRA1 polymorphisms only, in which case it was associated with a near‐five‐fold relative increase in the odds of dry type AMD(OR=4.93, 95%CI: 1.98‐12.25, p=0.0006)

Conclusion Our results shed light on the protective role of Gas6 c.834+7G>A polymorphism in exudative AMD development. In addition, novel genetic interactions were revealed in dry AMD pathogenesis.