bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in protein composition of tear fluid in schoolchildren with high progressing myopia
Authors: IOMDINA E , TARUTTA E , KURYLEVA I , AKSENOVA Y , SURINA E , BOGACHUK A
Published: November 2013

Purpose Defining the protein composition of tear fluid (TF) of schoolchildren with high progressive myopia

Methods We tested TF samples of 35 patients aged 10‐17 (ave. 13.1±2.2 yrs) with myopia from 5.0 to 20.5D (ave. 9.5±3.7D) and year progression rate 0.98±0.8D. 19 had various forms of peripheral vitreochoreoretinal dystrophies. No patients used contact lenses to correct myopia. The control group contained TF samples of 9 children aged 10‐13 (ave. 12.4±0.5 yrs) with normal eye fundus. Total protein content (TPC) was determined according to M.Bradford. Qualitative determination of protein composition and content in TF was performed by SDS polyacrylamide gel electrophoresis. The proteins were separated by unidirectional gel electrophoresis and stained with coomassie solution. Qualitative determination of major proteins – lactoferrin (Ltf) and lysozyme (Lys) – was conducted using two different primary antibodies (sandwich ELISA). Variation significance of qualitative parameters was assessed by nonparametric methods using Mann‐Whitney U‐test.

Results Characteristic distinctions were found for TF of highly myopic children: 1) a significant reduction of TPC against the norm: 5.65 [4.85; 6.33] mg/ml and 7.66 [6.83; 8.16] mg/ml respectively (p=0.000408); 2) a significant increase of Ltf/TPC ratio against the norm: 0.23 [0.2; 0.29] and 0.37 [0.33; 0.43] resp., p=0.000185. The lysozyme share in the total protein content (Lys/TPC) was invariable.

Conclusion The data confirm the pathogenetic role of the damaged antioxidant protective system of eye media and tissues in the development of myopia. Reduced TPC and increased share of Ltf in TF may be considered as possible diagnostic signs of the progressing character of myopia.
Prevalence of binocular anomalies among preschool children in Mashhad, Iran
Authors: YEKTA AA , HAGHIGHI B , HASHEMI H , SHAFIEE H , REZVAN F , OSTADIMOGHADDAM H , HERAVIAN J , AZIMI A , YEKTA R , KHABAZKHOOB M , RASHID TORABI M
Published: November 2013

Purpose To determine the prevalence of binocular anomalies among preschool children in Mashhad, Iran

Methods In a cross‐sectional study with random cluster sampling, children aged 4 to 6 years old from kindergartens of Mashhad in Iran were selected. Examinations included: visual acuity, objective and subjective refractions, cover test, near point of convergence and stereopsis. Best corrected visual acuity worse than 8/10 or more than two Snellen lines difference between the eyes was defined as amblyopia. Anisometropia was defined as spherical equivalent refraction difference of 1.0 diopter and more between two eyes.

Results Of the 3765 selected children, 98.3% of them participated in the study. The mean age of the subjects was 5.09 (range: 4‐6) years and 51.3% of them were boys. Strabiamus was found in 1.2 % of the children and intermittent exotropia had the highest prevalence. Prevalence of amblyopia and anisometropia were 0.5% and 6% respectively. Heterophoria was found in 62.7% and shift was toward esophoria.The mean near point of convergence was 5.09 ± cm. Stereopsis of 100 sec/arc and better was found in 94.6% of the subjects.

Conclusion The results of this study indicated that the prevalence of strabismus was similar to other studies in Iran while there was a smaller prevalence of amblyopia. For preventing the incidence of binocular anomalies in children, a careful planning of the basic information is required to check the status of binocular vision.
Incidence of associated other oculomotor disturbances with internuclear ophthalmoplegia
Authors: VILA J , BORRUAT FX
Published: November 2013

Purpose Internuclear ophthalmoplegia (ION)is a central oculomotility disorder resulting from dysfunction of the medial longitudinal fasciculus. It is frequently associated with skew deviation and vertical nystagmus. We aimed to determine the incidence of oculomotility disorders associated with ION.

Methods Retrospective chart review of patients diagnosed with ION. Patients were retrieved from the Neuro‐Ophthalmology Database of the Hôpital Ophtalmique Jules‐Gonin. Patients’ demographics, etiologies, uni‐bilaterality, association with other oculomotility disorders were studied.

Results Our study comprised of 69 patients, 38F/31M, aged 16 to 77 years (mean 47 years). Etiologies included multiple sclerosis (MS, 39/69), stroke (20/69), tumor (5/69), and inflammatory/idiopathic (5/69). ION was unilateral in 39 cases and bilateral in 30 cases. Oculomotility disorders other than ION were found in 56 patients : upbeat nystagmus (31/56), downbeat nystagmus (29/56), oculo‐cerebellar syndrome (25/56), skew deviation (18/59), VI palsy (7/56), III palsy (6/56), dorsal midbrain syndrome (4/56), and one‐and‐a‐half syndrome (3/56). Stroke was responsible for the majority of skew deviation cases, whereas MS was the predominant cause of all the other oculomotility disturbances.

Conclusion More than 80% of patients with ION exhibited also other central oculomotility disturbances. Vertical nystagmus and oculomotor cerebellar syndrome outnumbered skew deviation. Other disturbances included VI nerve palsy, III nerve palsy, Parinaud’s syndrome and Fisher’s one‐and‐a‐half syndrome. ION is rarely isolated and the spectrum of other oculomotor abnormalities is wide.
Optical coherence tomography as a progression marker in mild cognitive impairment and Alzheimer´s disease
Authors: HERRERA L , CRUZ N , ZABADANI K , CARAMELLO C , ASCASO FJ , MINGUEZ E , CASAS P , CRISTOBAL JA
Published: November 2013

Purpose To study the role of optical coherence tomography (OCT) as a progression marker in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD).

Methods We studied 36 eyes of 18 patients meeting criteria for AD (6 patients with mild AD, 7 patients with moderate AD and 5 patients with severe AD), and 21 eyes of 42 patients meeting criteria for MCI. In these two groups, we evaluated cognitive impairment through the Mini‐Mental State Examination (MMSE), the verbal fluency test (VFT) and the clock test (CT) and we measured peripapillary retinal nerve fiber layer (RNFL) thickness, and macular volume and thickness using OCT.

Results There is a significant correlation between the decrease in peripapillary RNFL thickness, macular volume and macular thickness and the severity of the cognitive impairment measured by the three neuro‐psychological tests (p=0.00).

Conclusion The reduction in peripapillary and macular thickness and macular volume is related to the severity of cognitive impairment. Thus, OCT can be used for the diagnosis of AD and MCI (especially in the diagnosis of early‐ stage AD), as well as to evaluate cognitive impairment progression.
Neuromyelitis optica (devic‘s disease): The use of the spectral domain optical coherence tomography (OCT) in the follow up of the disease
Authors: XIROU T , PORTALIOU D , BOURANTANI S , PANOUSOPOULOU A , KOURENTIS C , KABANAROU SA
Published: November 2013

Purpose To report a case of neuromyelitis optica (Devic’s disease) which followed up with the use of optical coherence tomography (spectral domain OCT)

Methods A 24 year old female patient presented with vision deterioration due to acute onset of unilateral optic neuritis in her left eye (OS)She was referred to the neurologic department of our hospital for further assessment and the diagnosis of Devic’s disease was set by the presence of anti – NMO – IgG antibodies. Patient’s follow – up included visual acuity measurements, visual fields testing and electrophysiological evaluation with pattern visual evoked potentials (PVEP) according to ISCEV standards. Peripapillary RNFL thickness was assessed by the spectral domain OCT

Results Visual acuity was measured at 1.0 at her right eye and 0.4 at her left eye. Visual field of her left eye showed a characteristic scotoma due to optic neuritis. The latency of the P100 was delayed demonstrating dysfunction of the optic nerve pathway. Thinning of the RNFL layer was documented in her left eye at OCT imaging. During follow up of the patient there was no further deterioration of the RNFL thickness despite recurrence of the optic neuritis three times

Conclusion OCT is a valuable and sensitive tool in evaluating peripapillary RNFL in patients with neuromyelitis optica (νόσ[omicron][sigmaf] Devic).
Retinal nerve fibre layer thickness as a neurological dysfunction marker in fibromyalgia patients
Authors: CARAMELLO ÁLVAREZ CM , ASCASO FJ , GARCíA‐MARTíN E , HERRERA L , HERRERA P , GARCíA‐CAMPAYO J , PABLO L , CRISTóBAL JA
Published: November 2013

Purpose To assess retinal nerve fiber layer (RNFL) thickness in patients affected by fibromyalgia.

Methods 39 patients diagnosed with fibromyalgia and 39 age‐matched healthy controls underwent a complete neuropsychiatric and ophthalmologic examination including best‐corrected visual acuity, contrast sensitivity test, and the new Nsite Axonal Analytics application of the spectral domain Optical Coherence Tomography (SD‐OCT). Statistical analysis was conducted to compare RNFL thicknesses between patients and controls.

Results RNFL thickness was significantly reduced in fibromyalgia patients (94.2±16.8) compared with healthy controls (102.9±10.2) in the mean values (p=0.007, Student t test), the ratio (cases=0.9±0.3, controls=1.1±0.3, p=0.022), the superonasal (cases=99.3±20.3, controls=116.4±16.7, p<0.001), inferonasal (cases=96.7±28.5, controls=126.2±25.9, p<0.001) and inferotemporal quadrant (cases=134±26.9, controls=144.7±19, p=0.048).

Conclusion Fibromyalgia patients showed a reduction of peripapillary RNFL thickness evaluated by SD‐OCT. These findings, which have never been document in patients with fibromyalgia, suggest that neuronal degeneration could be present in the retina of fibromyalgia patients as previously observed in other neurodegenerative disorders.
Optical coherence tomography and electrophysiology to evaluate Parkinson disease severity
Authors: GARCIA MARTIN E , SATUE M , FUERTES I , OTIN S , ALARCIA R , HERRERO R , BAMBO MP , SERAL M , POLO V , LARROSA JM , PABLO L , ASCASO J
Published: November 2013

Purpose To evaluate correlations between visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and the severity of Parkinson disease (PD).

Methods Forty‐six patients diagnosed with PD were enrolled in this study and underwent VEP, PERG, and Cirrus and Spectralis OCT measurements of macular and RNFL thicknesses, and evaluation of PD severity using the Hoehn & Yahr scale to measure PD symptom progression, the Schwab and England Activities of Daily Living Scale (SE‐ADL) to evaluate patient quality of life (QOL), and disease duration. Logistical regression was performed to analyze which measures, if any, could predict PD symptom progression or effect on QOL.

Results Visual functional parameters (best corrected visual acuity, mean deviation of visual field, PERG P50 and N95 component amplitude, and PERG P50 component latency) and structural parameters (Cirrus and Spectralis OCT measurements of RNFL and retinal thickness) were decreased in PD patients compared with healthy controls. OCT measurements were significantly negatively correlated with the Hoehn & Yahr scale, and significantly postively correlated with the SE‐ADL scale. Based on logistical regression analysis, fovea thickness provided by Cirrus OCT predicted PD severity, and QOL and amplitude of the PERG N95 component predicted a lower SE‐ADL score.

Conclusion Patients with greater damage in the RPE or in the ganglion cells tend to have a lower QOL and more severe PD symptoms. Foveal thicknesses and the PERG N95 component provide good biomarkers for predicting QOL and disease severity.
Adult‐onset aqueductal stenosis: A case report
Authors: BATTA B , TRECHOT F , CLOCHE V , MAALOUF T , ANGIOI K
Published: November 2013

Purpose The authors describe a case of an adult‐onset aqueduct stenosis.

Methods A 37‐year‐old man presented with a progressive blurring of vision in his left eye for a few days. He reported a fever episode two weeks before. Visual acuity was 10/10 P2 OD and 7/10 P2 OS. Pupils were equal without afferent defect. Neurologic examination was normal. Fundoscopic examination revealed a left optic disc oedema and a mild swelling of the right disc margins. Visual field examination demonstrated a bilateral enlargement of the blind spot associated with an infero‐nasal defect on the left eye. Computed tomography showed enlargement of the third and lateral ventricles suggestive of aqueduct stenosis, which was confirmed by MRI. Ultimately we learned that the patient's mother presented an aqueduct stenosis too. Otherwise the febrile episode was linked to infectious mononucleosis attested by serology. Following endoscopic third ventriculostomy, there was an visual acuity improvement to 10/10 P2 OD and 9/10 P2 OS. Visual field was normal on the right eye, but infero‐nasal defect remained on the left eye.

Results Hydrocephalus secondary to aqueduct stenosis may present at any age, however it is more frequent in childhood. Stenosis can be attributed to different causes. In three quarters of cases, etiology remains unknown. Clinical course may vary according to the age of the patient. In our case age of onset is atypical, as symptomatology, consisting of isolated visual disturbances. The unilateral infero‐nasal visual field defect turns out to be also uncommon.

Conclusion In view of bilateral optic disc oedema, clinicians have to hint at the possibility of hydrocephalus secondary to aqueduct stenosis, even if clinical manifestations are not much suggestive.
Glaucomatous optic neuropathy in congenital glaucoma
Authors: KATARGINA L , MAZANOVA E , TARASENKOV A
Published: November 2013

Purpose Morphometric analysis of posterior pole structures of the eye in children with congenital glaucoma (CG)

Methods 34 children aged 3 months‐11 yrs with various forms and stages of CG were examined with HRT‐3 and Spectralis HRA+OCT .

Results We established the early appearance of deep and bulk excavation and reduction of neuroretinal rim area and volume at the beginning of glaucoma manifestation, mean total RNFL thickness reducing, reflecting the degree of the optic nerve structures atrophy. Correlations between changes of the optic disc parameters, glaucoma stages and the eye size were revealed. In all glaucoma eyes we noted thinning of peripapillary RNFL. 89% of children showed a decrease of arteries caliber (8‐25% of normal) and veins (23‐40% of normal). In 80% of the eyes there was an increase in AVI (ave 0.81).The choroidal topography study showed an increase of the subfoveolar thickness (305‐957 µm) in 80% of children. Examination of the macular area revealed OD‐OS asymmetry of total macular volume in glaucoma eyes(healthy eyes ‐ 8,50±0.36mm³, glaucoma eyes ‐ 7.51±0,63 mm³,p<0.001).Ganglion cell layer (GCL) thickness in the perifoveolar area in glaucoma eyes was significantly below normal and averaged 34.4±9.65 µm, the thickness of the temporal section was lower than the nasal (34.20±9.53 µm, 39.06±10.60 µm, resp.). GCL is affected earlier than the changes in other layers of macular area.

Conclusion The distinctive feature of glaucomatous optic neuropathy in CG is a combination of significant structural changes in the optic nerve and retinal layers due to secondary distension of the membranes of the eye, with retinal vessels involved in the process, with some hemodynamic changes in the retina and choroid, all of which worsened with the progression of glaucoma.
First outcomes of silicon rod frontalis suspension prospective follow‐up in congenital blepharoptosis
Authors: GRIVET D , NEZAR H , CAMPOLMI N , REYMOND M , THURET G , GAIN P
Published: November 2013

Purpose Frontalis suspension is an efficient surgical solution for moderate to severe congenital blepharoptosis. Compared to autologous fascia lata, silicon rod allows faster surgery but long‐term results are still needed. Aim: to assess the long‐term results of silicon rod frontalis suspension

Methods This one year bicentric non‐comparative prospective study included ten patients who underwent frontalis suspension using silicon rod sling (FCI, France). The main criterion was the palpebral height measured before surgery and at one week, three months and one year postoperatively. Palpebral height was measured with Image J using a standardized technique on digital picture

Results The intermediate results are shown. The palpebral height was significantly improved in all patients at one week and three months compared to the preoperative values but tended to decrease between one week and 3 months

Conclusion The intermediate results show that silicon rod frontalis suspension seems an efficient method to treat congenital blepharoptosis. One‐year results are necessary to validate this outcome
The Leonardo Da Vinci Program in the ophthalmological formation of residents
Authors: JANUSCHOWSKI K , ZARZO‐VARGAS MONICA M , SOLE GONZALEZ L , DELGADO MIRANDA JOSE
Published: November 2013

Purpose To present an EU sponsored program in the formation of residents in ophthalmology. With the introduction of the FEBO (federal board of education of ophthalmolgy) the formation of residents in ophthalmolgy in Europe has taken a big step towards equal standards. Nevertheless, differences still exist mostly due to differnt durations of residency programs, different priorities and different patient and disease spectrum in each country and each region oft he EU.

Methods The Leonardo Da Vinci Program is designed as an educative program of lifelong learning and teaching. Three different groups can apply: 1. people during their formation 2. regular working people 3. persons working in the educational field Application can be performed online

Results Two persons were sent to United kingdom (UK) and Spain (ES), with different objectives Basic investigation: one subject was able to obtain an profound insight into basic investigation at Nuffield Department of Clinical Neurosciences, UK. As a result of his stay many international collaborations were founded. Clinical routine: The second person was able to obtain and insight into the clinical routine at the Hospital Nuestra Señora de la Candelaria, ES. Especially surgery of pterigium and the keratits due to acaneamoeba were strong points in the clinical routine. As a result a vivid exchange between hospitals was established.

Conclusion Regional differences concerning clinical routine and basic investgation in the EU will always exist due to different circumstances in different countries. Residents will profit in their personal and professional formation taking advantage oft he existing EU‐scholarships and thus improving patient care on a European level.
Tear secretion impairment as a function of severity of herpetic keratitis
Authors: LABETOULLE M , M'GARRECH M , ROUSSEAU A , KASWIN G , SAUER A , BOURCIER T , BARREAU E
Published: November 2013

Purpose To assess the quality of tear secretion in eyes of patients with a history of unilateral and recurrent herpetic keratitis

Methods 33 patients with a history of recurrent herpetic keratitis (either archipelago keratitis, KA, or kerato‐uveitis, KU, or neurotrophic keratitis, KN) were compared with 33 normal subjects. A complete ophthalmologic examination was performed, with successively the assessment of tear osmolarimetry, tears break‐up time (TBUT), Schirmer I test, and corneal sensitivity. Patients with other potential causes of abnormal tears were excluded, and all tests were performed at least 3 months after the last relapse of keratitis. Controls were selected among asymptomatic patients scheduled for cataract surgery or refraction disorders, and were matched for age and gender with patients.

Results The patients group (19 men, 14 women, aged 52 ± 7 years) included 16 patients with KA, 13 with KU, and 6 with KN. In the control group (similar sex ratio and mean age), all tests were symmetrical between the two eyes. In the 3 groups of patients, tear osmolarimetry was significantly greater in affected eyes than in controls, as well as TBUT was significantly reduced. In contrast, Schirmer I test was reduced only in eyes of patients with a history of KU or KN. Finally, only KN eyes were statistically less sensitive than healthy eyes.

Conclusion Recurrent herpes keratitis induced changes in lacrimal secretion, even when the disease is apparently quiescent, and the abnormalities are more important as the corneal disease is progressing In the context of our study, tear hyperosmolarity appeared to be a particularly sensitive test to detect impairment of tear secretion.
Ocular tolerability of preservative‐free prostaglandin eye drops
Authors: PELLINEN P , ESAKI Y , SHIMAZAKI A
Published: November 2013

Purpose Taflotan® (tafluprost) and Monoprost® (latanoprost) are preservative‐free anti‐glaucoma eye drops. In order to compare the ocular irritation potential these preservative‐free prostaglandin products were instilled repeatedly on rabbit eyes. Cell viability in vitro was studied using immortalized human corneal epithelial (HCE) cells.

Methods To study the in vitro cytotoxicity of Taflotan and Monoprost, HCE cells were exposed to the test solutions for 5 to 30 minutes, after which the cytotoxicity was evaluated by MTS assay. Secondly, to compare their in vivo ocular tolerance, Taflotan or Monoprost solution was instilled 10 times at 30‐minute intervals onto eyes of male albino rabbits. Left eyes were treated while right eyes remained as untreated controls. Besides scoring macroscopic findings using MacDonald‐Shadduck system, slit lamp examination and corneal fluorescein staining were performed after the last instillations.

Results In MTS test, the 30 minutes treatment with Taflotan had no effect on the cell viability, whereas the cell viability was decreased by Monoprost treatment. After repeated instillations on rabbit eyes conjunctival redness and swelling were observed in both groups. Their irritation scores and occurring frequency were lower in Taflotan treated eyes than in those treated with Monoprost. In addition, discharge was observed only in Monoprost treated eyes from 30 minutes until 3 hours after the last instillation.

Conclusion Under the conditions of this study, the ocular irritation potential of Taflotan was weaker than that of Monoprost. The results indicate that Taflotan eye drops may have a better ocular tolerability profile than Monoprost.

Commercial interest
Tear levels of loteprednol etabonate following instillation of a novel gel formulation
Authors: SIOU‐MERMET R , ONG T , LOWE E
Published: November 2013

Purpose A new gel formulation of loteprednol etabonate (LE) has been developed which is non‐settling, provides a pH close to physiological, and a reduced level of benzalkonium chloride. This study sought to examine the levels of LE in tear fluid following a single topical instillation of LE ophthalmic gel 0.5% to healthy volunteers.

Methods Single center, open label study. Twelve healthy subjects received LE ophthalmic gel 0.5% in one eye and tear sampling was performed at 6 hours (h), 9 h, 12 h, and 24 h after instillation. LE levels in tears were determined by LC‐MS/MS. Ocular and non‐ocular treatment emergent adverse events (AEs) were recorded.

Results 17 subjects were screened and 12 were enrolled. Mean age was 46 years and all but one subject was male. LE was detected in all tear fluid samples at all time points assessed. Mean (SD) LE levels were 114 (116) µg/g at 6 h, 19.7 (18.2) µg/g at 9 h, 26.9 (29.6) µg/g at 12 h and 2.41 (3.36) µg/g at 24 h. No drug‐related AEs were reported.

Conclusion LE administered in the gel formulation remains present in tear fluid 24 hours after a single instillation. These results suggest a long residency time of LE on the ocular surface with the gel formulation. No safety concerns were identified.

Commercial interest
In vivo confocal microscopy of cystic lesions in corneal disorders
Authors: ORSKI M , WYLEGALA E , TARNAWSKA D , SMEDOWSKI A
Published: November 2013

Purpose The purpose of this study was to assess the correlation between slit‐lamp biomicroscopy and in vivo confocal microscopy and to describe the morphology of corneal intraepithelial cystic lesions by in vivo confocal microscopy in several corneal disorders.

Methods 15 patients with clinically diagnosed Cogan Dystrophy (9), Meesmann’s Dystrophy (2), Acanthamoeba Keratitis (2), Microsporidial Keratitis (1) and Incontinentia Pigmenti (1) were examined by slit‐lamp biomicroscopy and in vivo confocal microscopy. Confocal microscopy images were used to assess size, shape and reflectivity of the corneal cystic structures.

Results Confocal microscopy was able to identify cystic lesions in all cases in which cysts were observed by slit – lamp biomicroscopy. In vivo confocal scans showed multiple brightly reflective round, oval or circular structures with diameter from 10 microns (Incontinentia Pigmenti) to 140 microns (Meesmann‘s Dystophy). Large intraepithelial clefts were observed in Microsporidial Keratitis and Meesmann‘s Dysrophy.

Conclusion In vivo confocal microscopy provides a detailed microstructural image of cystic intraepithelial lesions in various corneal disorders and may play a role in appropriate diagnosis.
Ocular surface dysfunction and tear osmolarity after cataract surgery
Authors: KUZMIENE L
Published: November 2013

Purpose The aim of the study was to evaluate subjective symptoms, tear film break up time (BUT) and tear osmolarity before the cataract surgery and in the early postoperative period.

Methods 32 patients undergoing cataract surgery were included into the study. They were submited to clinical evaluations including the administration of Ocular Surface Disease Index (OSDI) questionaire, visual acuity, slit lamp examination, estimation of BUT. Tear samples were collected for osmolarity evaluation. All the tests were performed day before surgery, one week and one month after surgery.

Results Before the surgery 11 (47,8%) patients had no or mild dry eye disease, 21 (52,2%) – moderate and severe. The mean BUT was 7,4±3,2s and decreased in one week and one month after surgery (5,13±2,54s); paired differences were significant. Tear osmolarity was 306,25±15,38 mOsm/l with tendency to increase in one week (307,32±17,13) and decreased one month after surgery (293,7±24,05); paired differences were significant. OSDI score had tendency to increase one week and month after the surgery.

Conclusion Patients complaints increased in early postoperative period. Tear film stability significantly decreased one week and one month after surgery with the significant decrease of tear osmolarity. Decreased tear film stability could influence ocular discomfort after cataract surgery.
Variability of oxidative stress‐related genes in keratoconus and Fuchs endothelial corneal dystrophy
Authors: SZAFLIK JP , SYNOWIEC E , WOJCIK K , SZAFLIK J , BLASIAK J
Published: November 2013

Purpose In the present work we investigated polymorphism in nuclear genes encoding proteins important for the cellular reaction to oxidative stress and mutations in mitochondrial DNA in two eye diseases with established role of oxidative stress in their pathology: keratoconus (KC) and Fuchs endothelial corneal dystrophy (FECD).

Methods Over 200 FECD and KC patients as well as more than 300 sex‐ and age‐matched controls were enrolled in this study. Genetic variation in nuclear DNA was determined in peripheral blood lymphocytes by allele‐specific and restriction length fragment polymorphism PCR. Quantitative real‐time PCR with TaqMan probes was employed to study mutagenesis in mitochondrial DNA (mtDNA).

Results Genotypes of polymorphisms of genes encoding catalase and superoxide dismutase, glutathione transferase, enzymes neutralizing reactive oxygen species, were associated with the increased risk of AMD, FECD and KC. Polymorphism of numerous DNA repair genes, including hOGG1, MUTYH, UNG and SMUG1 was associated with AMD and KC. Finally, we found some associations between the occurrence of FECD and mtDNA mutagenesis, expressed by the number of mtDNA copies and specific deletions and point mutations, including 4977 bp deletion in mtDNA encoding 5 tRNAs and 7 proteins of respiratory chain as well as the 414T>G transversion.

Conclusion Polymorphism in nuclear genes encoding oxidative stress‐related proteins and mutations in mitochondrial DNA may contribute to the risk of occurrence and development of KC and FECD by modulating the cellular reaction to the stress.
Chitosan‐based biocompatibile materials in ophthalmology
Authors: WOWRA B , GROLIK M , SZCZUBIALKA K , NOWAKOWSKA M , DOBROWOLSKI D , ORZECHOWSKA‐WYLEGALA B , WYLEGALA E
Published: November 2013

Purpose The goal of current research was to develop the material for scaffold preparation providing optimal conditions for the corneal epithelium cell culturing and to determine their physicochemical and biological properties. The scaffolds, which could be applied in ophthalmology should fulfill some requirements such as biocompatibility, biodegradability, restorability, and also should have adequate mechanical strength

Methods A membrane was obtained from chitosan‐polysaccharide derived from chitin. Chitosan is nontoxic,biologically inert,stable in the natural environmental. It has found numerous applications in biomedical field,e.g.3Dscaffolds,fibers,membranes, hydrogels. This materials have shown support for adhesion,proliferation,expression of cells. The chitosan supports will be crosslinked with genipin‐product from the Gardenia jasminoides. The genipin is more than 5000 times less cytotoxic than typical chemical cross‐linking reagents (glutaraldehyde). The mechanical properties of the supports obtained will be controlled mainly by the addition other biopolymers

Results The in vitro cell culture experiments with corneal epithelium cells have indicated that a membrane prepared from chitosan blends provided the regular stratified growth of the epithelium cells, good surface covering and increased number of the cell layers. Some of chitosan membrane is comparable with that of the amniotic membrane which is currently recommended for clinical applications

Conclusion Novel polymeric hydrogel scaffolds for corneal epithelium cell culturing based on blends of chitosan with some other biopolymers such as hydroxypropylcellulose, collagen and elastin crosslinked with genipin, a natural substance, were prepared
Topical treatment with a new matrix therapy agent (RGTA) in combination with limbal allograft in ocular surface desease and corneal anesthesia
Authors: MARINGE E , GUEUDRY J , AIFA A , DELCAMPE A , MURAINE M
Published: November 2013

Purpose The surgical management of limbal deficiency is difficult, especially when it is bilateral and occupies more than half of the cornea. In these advanced cases, the presence of an associate corneal anesthesia, worsen the prognosis of allo‐limbal transplantation. We aimed to assess the efficacy and tolerance of a new matrix therapy agent (RGTA, Cacicol20), mimicking heparan sulfates, in combination with limbal allograft for the reconstruction of the ocular surface with complete corneal anesthesia.

Methods It is a prospective, single‐center study. Six eyes of six patients were included. All were men. The average age was 53 years [range : 35‐87]. Mean follow‐up was 4.8 months [range : 3‐9 months]. Etiologies were corneal burn in three cases, an herpes infection in one case and idiopathic in 2 cases. All patients underwent limbal allograft associated with instillation of eye drops RGTA once every two days in the absence of healing after 7 days postoperatively. A topical steroid is prescribed in all cases. RGTA eye drops were stopped after complete healing. Patients were followed every 7 days until healing. Visual acuity, corneal sensitivity and the surface of the ulcer are evaluated each time using photography.

Results Despite the persistence of total corneal anesthesia, the epithelium healed in all cases before 2 months [range 7 days to 2 months}. Two of 6 patients showed significant improvement in their visual acuity. One patient had a corneal abscess regressing under treatment.

Conclusion RGTA seems to be a potentially useful, alternative, noninvasive therapeutic in association with limbal allograft in advanced limbal deficiency
Uniformity of the thickness of LASIK corneal flaps made by IntraLase FS 60 laser femtosecond (IntraLase, AMO USA) measured by OCT spectral domain (Heidelberg, Germany)
Authors: ABRIEU LACAILLE M , RAMBAUD C , CREPY P , FROUSSART MAILLE F , RIGAL‐SASTOURNE JC
Published: November 2013

Purpose The objective of this study was to appreciate the uniformity of the thickness of Lasik corneal flaps made by The IntraLase FS60 laser femtosecond (IntraLase, AMO USA).

Methods It was a retrospective, randomized, double‐blind study.Twenty eight eyes were included in the study. Every flap was programmed to measure 120 µm. The flaps were measured by Spectral Domain OCT (Heidelberg), one month after surgery in five points on a horizontal line through the center of the pupil (center, 1mm and 2 mm from the center pupil in nasal and temporal) The scheduled and the obtained thicknesses were compared in each point.

Results Double reading by two different doctors showed no significant difference in the thickness flap measurements (p<0.3). There was no significant difference between the thickness in each point of the flap and the center of the flap.

Conclusion We have shown in this study that the cutting of a corneal stromal flap with the IntraLase FS 60 laser femtosecond during a LASIK procedure realize uniform flap.
Extracellular matrix derived hydrogel for corneal tissue engineering
Authors: AHEARNE M , LYNCH A
Published: November 2013

Purpose Several different synthetic and natural hydrogels have been suggested for use in corneal tissue engineering however these hydrogels lack many of the matrix constituents present in the real cornea. To overcome this problem we developed a new hydrogel derived from decellularized porcine cornea extracellular matrix for use in corneal tissue engineering.

Methods Porcine corneas were decellularized using a combination of detergents and nucleases. The corneas were then freeze dried and milled into a fine powder. The powder was dissolved using a pepsin digest solution which underwent gelation at 37°C by neutralizing the solutions pH. Keratocytes were cultured on the hydrogels over several weeks to determine the hydrogels biocompatibility and ability to regulate cell behavior. Immunohistochemical staining was performed on the cell seeded hydrogels to examine the influence the hydrogel had on the cells phenotype.

Results Decellularization of the corneal matrix was confirmed using a DNA assay prior to matrix digestion. The hydrogels that were formed using this technique were highly transparent and able to maintain viable cells. Keratocytes seeded onto the hydrogels had fully infiltrated them after 2 weeks. Markers of keratocyte cell behavior were observed after 2 weeks in culture suggesting that the hydrogel supports the maintenance of a keratocyte phenotype

Conclusion We have demonstrated a new hydrogel that can be used for engineering corneal tissue. The next step will be to test corneal epithelial with these hydrogels to determine their suitability for corneal transplantation.
Expression levels of purinergic receptors in the endothelium of human and murine cornea
Authors: CZUGALA M , FUCHSLUGER T , FUNAKI T , CHAUHAN S , DANA R
Published: November 2013

Purpose Since loss of corneal endothelial cells (EC) due to cell death is the major problem in numerous corneal conditions as well as in tissue storage for corneal transplantation, finding ways to improve cell survival is of great importance. Purinergic receptors P2RY [G protein‐coupled receptors] and P2RX [ligand‐gated ion channels] are both known to be implicated in inflammation and apoptosis pathways, therefore modulation of these receptors may provide an efficient way to increase EC survival. The aim of this study was to study expression levels of P2RY2 and P2RX7 receptors (P2R) in murine and human corneal endothelium, as well as the association to the purinergic receptor ligand ATP.

Methods Expression levels of P2R were determined by qRealTime‐PCR relying on untreated and Interleukin‐1b‐treated murine and human EC. EC apoptosis was also studied in response to ATP in a “cornea‐in‐a‐cup” assay.

Results In murine EC P2RX7 were significantly predominant compared to P2RY1 and P2RY2, while in human EC P2RY2 were significantly prevailing compared to P2RX7. Exposure to ATP in increasing concentrations resulted in a steady increase of apoptosis. As indicators of EC stress, changes in cell size (polymegathism) and cell shape (loss of EC hexagonality, polymorphism) could be demonstrated.

Conclusion Our data describe distinct differences in P2R expression levels in murine versus human EC showing the limitations of using the mouse model in P2R EC research. As P2R seem to be evenly distributed over the entire concave surface of the EC monolayer, inhibiting P2R interaction with their ligands (e.g. extracellular ATP) may present an effective way to prevent EC apoptosis.
Improvement of delivery of molecules into corneal endothelium using nanoparticles activated by femtosecond laser pulses
Authors: JUMELLE C , CAMPOLMI N , BERNARD A , PISELLI S , BAUBEAU E , MAUCLAIR C , GRANIER J , EGAUD G , GAIN P , THURET G
Published: November 2013

Purpose NanoFemtoTransfection (NFT) is an innovative and promising technique of gene transfer (Nature nanotechnology 2011). It consists in permeabilizing cell membrane with nanoparticles (NP) of black carbon activated by Ti‐Sapphire femtosecond laser (FsL) in order to safely introduce molecule of interest. Initially described for cell suspension, we adapted during last year NFT to human corneal endothelial cells (EC) Aim: to further optimize NFT of EC in vitro

Methods The model of NFT of calcein (a small molecule) in an EC line (B4G12, DMSZ, Germany) was used to optimize exposition times, fluence and Ti‐Saphir FsL beam movements in order to determine the best efficiency/toxicity ratio. Calcein transfer was observed with fluorescent microscopy (IX81, Olympus) and quantified by flow cytometry (FACSCalibur, BD, CA). Viability of EC was assessed by propidium iodide staining. Staining of actine with phalloidin and immunostaining of ZO‐1 was performed to study cell alteration caused by NFT

Results With a static laser beam increasing FsL fluence and exposure time increased transfection efficiency but also EC mortality. The use of mobile FsL beam (with a XY micrometric stage, cheaper than a scanner), permitted an irradiation of the entire area of EC culture resulting in a noticeably increased efficiency that reached 38% of transfected EC and a limited toxicity (3%). Calcein positive EC presented the same phalloidin and ZO‐1 patterns as control EC

Conclusion Optimized NFT parameters are currently being tested in our laboratory to transfect plasmids. Grants: Fondation pour la Recherche Médicale, Fondation des Aveugles de France
Femtosecond laser cutting of multiple ultrathin corneal stromal lamellae for endothelial graft bioengineering
Authors: BERNARD A , HE Z , CAMPOLMI N , PISELLI S , FOREST F , PEOC'H MC , DUMOLLARD JM , THURET G , GAIN P
Published: November 2013

Purpose The bioengineering of endothelial grafts (EG) is developing in several countries as an answer to the shortage of donor corneas worldwide. They are composed of a thin transparent biocompatible carrier evenly covered with tightly packed fully functional endothelial cells. Multiple options exist for the carriers. In our laboratory, we are focused on the optimization of human donor tissue because the well‐organised cornea donation in France is not the most limiting point. Aim: to present the preparation of ultrathin stromal lamellae from a single human cornea

Methods Human organ‐cultured corneas unsuitable for graft were used either with our without deswelling in Dextran containing medium. They were mounted on a artificial anterior chamber and cut with a femtosecond laser (femto LDV Z6, Ziemer) with aplanation. Six horizontal parallel cuts were realized on a 9 mm diameter area without vertical section. Cornea was then trephine at 8.00mm on a punch trephine. Thickness map was obtained before and after the cut with an AS‐OCT equipped with a custom adapter for ex vivo corneas. Lamellae were separated under an operating video‐microscope and again observed with OCT. Quality of surface were analysed with scanning electron microscopy and multiphotonic confocal microscopy with SHG for collagen fiber imaging

Results Seven regular lamellae of approximately 100μm were obtained on a single cornea and easily detached. Characterisation of surface quality is ongoing

Conclusion Femtosecond laser cutting of multiple lamellae on a single human cornea could allow obtaining a sufficient number of thin transparent and fully biocompatible carriers for EG bioengineering
Ferrara ring’s effects on corneal asphericity in keratoconus treatment
Authors: BONNEL S , LUSSATO M , FENOLLAND JR , SAIB N , RAMBAUD C , ABRIEU M , FROUSSART F , RIGAL‐SASTOURNE JC
Published: November 2013

Purpose In keratoconus treatment, Ferrera® rings nomogram integrates the Q factor defining corneal asphericity. Our study deals with the effect of the implantation of Ferrerra rings on the Q factor

Methods This retrospective and monocentric study involves forty eyes of thirty‐one patients suffering from keratoconus implanted with Ferrara® rings, with an uncorrected visual activity (UCVA), a best spectacle‐corrected visual acuity (BSCVA) and a videokerato‐topography, before and six months after surgery. The items followed are the UCVA, the BSCA, the average (Kmean) and maximum keratometry (Kmax) and the Q factor in the central 20° (Q20) and 40° (Q40). The analyse of the visual acuity (more or less than a line) enables to differentiate two groups of “good” and “bad” responders. The statistical tests are a Wilcoxon signed rank for pre and post operative comparisons, a Wilcoxon‐Mann Whithey for group comparisons, and a Spearsman for correlations.

Results The average age of patients is 32,8 years with 83,1% of male gender. Twelve eyes were implanted with two rings and twenty‐eight with one. We find an average gain of 3.6 lines for UCVA, 1.1 lines for BSCVA and a decrease in Kmean of 1,4 dioptry. Q20 and Q40 are meaningly improved after surgery, but there is no significant difference between the studied groups. Lastly, before surgery, BSCVA is correlated to Q20, and Kmax to Q40. After surgery, UCVA is correlated to Q20 and Kmax to Q20. But the Kmax variation and the UCVA or BSCVA gains are not correlated.

Conclusion Including the Q factor in the nomogram establishing ring’s choice improves the keratometric field but not the visual outcome.
Intracorneal foreign body in the confocal microscopy in vivo images
Authors: WOJCIK L , WYLEGALA E , SMEDOWSKI A
Published: November 2013

Purpose Presentation of a patient with intreacorneal foreign body, differentiation in images of corneal confocal microscopy in vivo.

Methods The patient admitted because of suspicion of post‐traumatic epithelial ingrown syndrome, to diagnosis and treatment, the following tests were performed: basic slit lamp examination, corneal scans using Scheimpflug camera (Pentacam, Oculus) and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina tomograph III).

Results On a slit lamp examination we described macroscopic limited opacity without evidence of inflammation. In the images from the Scheimpflug camera ‐ hiperreflective deposits obscuring other structures of the cornea. The corneal confocal microscopy images describes post‐traumatic corneal scar changes with clearly marked wound after the foreign body intake and single round conjunctival epithelial cells within the corneal stroma. In addition activation of keratocytes was observed. On about 350 microns depth, small deposits of number from few to several, with increased linear streak hyperreflexy and large, organized foreign body (piece of glass) of 1.5x0.7 mm diameter, irregular margins, with a similar hiperreflexy.

Conclusion Corneal confocal microscopy is a useful tool for the detection and differentiation of corneal opacities of uncertain etiology.
Can we consider syphilitic uveitis as neurosyphilis? A retrospective analysis of lumbar puncture results in a cohort of syphilitic uveitis patients
Authors: LHOIR S , WILLERMAIN F , JANSEN J , LIBOIS A , VAN CALSTER J , CASPERS L , MAKHOUL D
Published: November 2013

Purpose To investigate the cerebral spinal fluid (CSF) composition of patients with syphilitic uveitis (SU) and classify SU as neurosyphilis or not.

Methods Retrospective study of SU patients from 2 Belgian university centers from 2003 to 2012. The diagnosis of SU was based on a positive syphilitic serology (FTA‐Abs and RPR) and a treatment response. Charts were reviewed for uveitis anatomical location, HIV status, serum RPR and CSF findings. Diagnosis criteria for neurosyphilis were: positive CSF‐RPR and/or CSF‐white blood cells (WBC) ≥ 5/μl for HIV‐, and positive CSF‐RPR and/or CSF‐WBC ≥ 20/μl for HIV+.

Results 20 patients were included. 5 were HIV+. There were 3 papillitis, 10 posterior uveitis and 7 panuveitis. Cells were found in CSF in all patients (mean 40/μl) and were predominantly lymphocytes. Mean CSF‐proteins, lactate and glucose were 0.57g/l, 17mg/dl and 62mg/dl respectively. No differences were found between HIV+ and – patients. CSF‐RPR was + in 2/5 (40%) of HIV+ and in 11/15 (73%) of HIV‐ with no statistical difference.

Conclusion In our series, all patients had a CSF cellular reaction, mostly lymphocytic. This strongly suggests that the blood brain barrier is disrupted during syphilitic uveitis. However, a positive RPR was not observed in all CSF. Despite this discrepancy, following our criteria, 100% of our patients could be classified as neurosyphilis.
Adaptive optics imaging of retinal vasculitis
Authors: ERRERA MH , PAQUES M
Published: November 2013

Purpose To document perivascular infiltrates in the retina using high resolution flood illumination adaptive optics (AO) imaging in patients with retinal vasculitis.

Methods The charts of five subjects with retinal vasculitis showing evidence of perivascular infiltrates by means of AO imaging (rtx1 camera, Imagine Eye, Orsay, France) were reviewed.

Results Diagnoses included primary idiopathic retinal vasculitis (n=1), Lyme’s disease (n=2), TB related retinal vasculitis (n=1) and idiopathic retinitis, vasculitis and aneurysm (IRVAN; n=1). Using AO imaging, perivascular infiltrates appeared as discrete, linear areas of opacification along the veins, often surrounding the venous narrowing. AO imaging was more sensitive that either fundus photographs or fluorescein angiography for their detection. Follow‐up examinations (n=3) showed a changing pattern of narrowing of the vessel lumen, and eventual disappearance of these perivascular infiltrates. In the IRVAN case, inflammatory infiltrates were found around arterioles and veins as well, suggesting an inflammation induced‐phenomenon.

Conclusion AO imaging has a higher sensitivity than fundus photographs or fluorescein angiography to detect perivascular inflammatory infiltrates. Vascular inflammation is strongly linked to changes in vascular lumen diameter. AO imaging may have a particular interest when diagnosis and following subjects with retinal vasculitis.