bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of TNF‐alpha blockers in uveitis therapy
Authors: ABU EL ASRAR AM
Published: September 2008

Tumor necrosis factor (TNF)‐α has been implicated as an important mediator in autoimmune ocular inflammatory disease pathogenesis as shown by animal studies and its detection in the ocular fluids of patients with uveitis. Blockade of TNF‐α has emerged as one of the most promising therapies in autoimmune diseases including uveitis. Currently, there are three TNF‐α antagonists: two monoclonal antibodies (infliximab and adalimumab) and a soluble receptor that binds soluble TNF‐α (etanercept). Infliximab is a chimeric monoclonal antibody directed against TNF‐α. It binds with high affinity to both the soluble and the membrane‐bound TNF‐α and inhibits a broad range of biologic activities of TNF‐α. Several studies reported that infliximab therapy was rapidly effective and safe treatment for refractory noninfectious uveitis including childhood uveitis and is indicated as rescue therapy for relapses of ocular inflammation or as maintenance therapy when conventional immunosuppression fails. It also allowed a reduction of corticosteroids and immunosuppressive drugs required to control the disease. However, repeated infusions are required to maintain long‐term remission. Moreover, infliximab administration is costly and requires hospital admission. Recently, adalimumab, fully humanized monoclonal anti‐ TNF‐α antibody, was also found to be effective and safe therapy for the management of refractory noninfectious uveitis. Several studies reported that infliximab was more effective than etanercept in the treatment of refractory uveitis. Perhaps infliximab’s ability to target membrane‐bound TNF‐α in addition to the soluble form may contribute to its increased efficacy in comparison with etanercept for uveitis.
Structural and optical changes in the eye after soft contact lens wear
Authors: MIRANDA MA , O'DONNELL C , RADHAKRISHNAN H
Published: September 2008

Purpose To investigate the magnitude and aetiology of structural and optical changes in the cornea after short‐term hydrogel contact lens wear and to explore the effect of these changes on visual performance.

Methods Sixteen healthy subjects were fitted with a low‐Dk hydrogel contact lens (CH) in one eye and a silicone hydrogel (SH) lens in the contralateral eye. Subjects wore the lenses for 1 month in daily wear (DW) and 1 week in extended wear (EW), with at least 1 week ‘wash out’ in between. All lenses were plano powered and were manufactured in matched designs with the same specifications. Measurements of corneal topography, corneal pachymetry (apical and peripheral), and corneal and ocular aberrations were performed at baseline and after lens wear using a Scheimpflug imaging system (Oculus Pentacam) and a Hartmann‐Shack aberrometer (IRX3). Best corrected visual acuity (BCVA, logMAR) and contrast sensitivity measurements (CS, Pelli‐Robson) were also performed.

Results The optical and structural changes in the cornea after 1 month of DW and 1 week of EW for both the CH and SH materials were of low magnitude. The topographic and pachymetric changes observed were not found to be significant (p>0.05, repeated measures ANOVA). After 1 month of DW, however, the corneal root mean square of quatrefoil aberrations was found to be significantly different after CH contact lens wear (mean difference ‐0.021 µm; 95% confidence interval for difference: ‐0.037 to ‐0.06 µm; p=0.003). BCVA and CS did not change significantly after lens wear.

Conclusion Our data showed that the CH and SH lenses tested do not significantly alter the structure or the optical performance of the cornea after one month of daily wear and 1 week of extended contact lens wear.
Re‐treatment after LASIK for correction of myopia and myopic astigmatism
Authors: FARES U , BRAGHEETH MA , DUA HS
Published: September 2008

Purpose To evaluate the results of LASIK re‐treatment for under‐correction or regression after primary LASIK procedures for myopia and myopic astigmatism.

Methods Of 360 consecutive LASIK‐treated eyes, for myopia and/or myopic astigmatism, 32 eyes of 34 patients were retreated and followed at 3, 6 and 12 months post retreatment. Re‐treatment was performed by lifting the original flap after cutting the epithelium around the flap edge with a fine needle. Standard ablation was performed based on the patient’s residual refraction.

Results 9.4% of eyes patients required retreatment. Prior to re‐treatment the mean manifest spherical equivalent (SE) was –0.99 D ± 1.48 D (range from ‐ 0.75 to ‐2.63). The mean sphere was ‐ 0.79 D ± 1.20 D (range from –2.50 to ‐0.50) and the mean cylinder was –0.90 D ± 1.14 D (from –2.75 to 1.25). At 1 year follow up 56% of the eyes were within ± 0.50 D SE and 78% were within ± 1.00 D SE. 78% percent of the eyes examined at one year post re‐treatment managed unaided vision of 6/9 or better. Peripheral epithelial ingrowth not requiring treatment, developed in two eyes. Second re‐treatment for regression was performed in one eye.

Conclusion LASIK re‐treatment for residual myopia, by lifting the original flap is an effective option. Refractive results are fairly predictable and refraction stabilizes by 3 months after re‐treatment. Lifting the corneal flap after cutting the epithelium on the flap edges, is easy to perform and has a very low incidence of epithelial ingrowth.
Endothelial cell loss 9 years after PRK and LASIK and its importance for eye banks
Authors: BOURNE WM , PATEL SV
Published: September 2008

Purpose To measure changes in the endothelium of corneas 9 years after myopic PRK and LASIK to determine if these corneas are suitable donor tissue for posterior lamellar transplantation.

Methods Central endothelial photographs were taken before and at 9 years after PRK in 9 eyes of 6 patients and after LASIK in 20 eyes of 10 patients. Preoperative spheroequivalent refraction was ‐3.5 ± 1.7 D (range ‐1.25 to ‐5.75) in PRK eyes and ‐6.2 ± 1.4 D (range ‐4 to ‐9.25 D) in LASIK eyes with intended correction to emmetropia in all eyes. Endothelial cells were analyzed with the center method by the same masked investigator from the endothelial images after calibration for magnification. Comparisons were made by using generalized estimating equation models to account for any correlation between fellow eyes of the same subject.

Results Endothelial cell density at 9 years after PRK (2559 ± 423 cells/mm2) was not significantly lower than before PRK (2641 ± 340 cells/mm2, P=0.45, n=9). Endothelial cell density at 9 years after LASIK (2741 ± 308 cells/mm2) was lower than before LASIK (2925 ± 303 cells/mm2; P<0.001, n=20), representing an annual exponential cell loss of 0.7 ± 0.8%. This cell loss was not significantly different from the annual exponential cell loss of 0.6 ± 0.5 % during a ten‐year period measured in 42 normal (unoperated) corneas of control subjects from a previous study (P=0.41, minimum detectable difference = 0.5%, α=0.05, ß=0.20).

Conclusion We found no effect of PRK or LASIK on the corneal endothelium 9 years after the procedure. Eye banks and surgeons can use donor corneas from PRK eyes and from LASIK eyes for posterior lamellar keratoplasty procedures.
Retinal fiber layer measured by oct in patients with type I diabetes without retinopathy
Authors: PINILLA I , GARCIA‐MARTIN E , IDOIPE CORTA M , GIL ARRIBAS L , FERRERAS A , HONRUBIA FM
Published: September 2008

Purpose To evaluate the changes in the peripapillary retinal nerve fiber layer (RNFL) thickness measured with optical coherence tomography (OCT) in patients with type I diabetes without retinopathy.

Methods Comparative cross‐sectional study. Thirty eyes of 30 healthy subjects and 30 eyes of 30 patients with type I diabetes mellitus were studied. Ophthalmic examination of diabetic patients showed no retinopathy. One eye per patient was randomly selected for the study. All patients were examined by means of OCT.

Results The control group was formed by 9 women, 21 men, aged 18‐38 yr (mean ± SD 28.7 ± 6.01). Diabetic patients were 9 women and 21 men, aged 25.02 yr (± 8.1). Mean period from the onset of diabetes was 14.2 years (SD 5.46). None of the diabetic group had changes at the fundus examination. The RNFL average thickness was 106.1 and 101.8 in the control and in the diabetic group respectively. A significant difference was found in the superior quadrant thickness where the measures were 136 vs 127 respectively (p=0.05).

Conclusion Our results suggest that RNFL changes assessed by OCT can be detected early in the course of type I diabetes.
Clinical use of multifocal and focus shift IOLs
Authors: BARRAQUER RI , MICHAEL R
Published: September 2008

Purpose To compare the clinical experience with multifocal and focus shift IOLs in Austria, Germany and Spain.

Methods We give a summary of published and unpublished data, reviews and meta‐analyses. Main outcome measures are uncorrected distance and near visual acuity, and reading speed under different light conditions as well as subjective patient satisfaction and spectacle independence. The focus will be on ReStor, ReZoom and Technis IOLs in the multifocal group, and ICU, BioComFold, AT‐45 Crystalens in the focus shift group.

Results Multifocal IOLs can provide functional intermediate vision in bright light; under dim light the results vary depending on the IOL design. Hybrid design of the refractive‐diffractive IOL can reduce the increased optical aberrations induced by purely refractive multifocal IOLs. Aspheric apodized diffractive IOLs can reduce stray light artefacts and can enhance distance vision performance for large pupils. Focus shift IOLs result in a moderate to no improvement for uncorrected near visual acuity and minor or no forward movement, on average corresponding to less than 0.5 diopters.

Conclusion Multifocal IOLs provide pseudo‐accommodation and their optical quality has improved due to new design developments. Focus shift IOLs accommodate only by a minor amount abd give some pseudo‐accommodation by mechanisms not clearly understood.
Straylight effects in diffractive multifocal IOL compared to monofocal IOL
Authors: NUIJTS RMMA , FRANSSEN L , DE VRIES NE , TJIA KF , VAN DEN BERG TJTP
Published: September 2008

Purpose To measure levels of intraocular straylight following cataract surgery and implantation of either the ReSTOR SA60D3 IOL or the SA60AT monofocal IOL.

Methods A newly developed straylight meter was used to objectively measure straylight in a prospective open observational case series at 6 months postoperatively in 66 eyes with the diffractive ReSTOR SA60D3 IOL (Alcon Laboratories) and in a control group of 40 eyes with the monofocal SA60AT IOL. A comparison with straylight levels in an age‐matched population without cataract was performed.

Results The straylight levels in the ReSTOR SA60D3 IOL and in the control group with the monofocal SA60AT IOL were 1.20±0.16 logunits and 1.10±0.19 logunits. When the difference in mean level of straylight was adjusted for age by multivariate analysis of the combined pseudophakic groups, mean straylight levels were 0.078 logunits lower for the monofocal SA60AT IOL group as compared to the multifocal ReSTOR SA60D3 IOL group (p=0.026). Straylight levels in both pseudophakic groups were lower than those of the normal age‐matched control group without cataract (p<0.0001).

Conclusion Levels of intraocular straylight log(s) were significantly lower (p<0.0001) for both types of IOL as compared to age‐matched subjects from the normal population, with expected reduction of complaints of glare and halos and higher levels of contrast sensitivity.The mean level of intraocular straylight 6 months postoperatively was higher for subjects with a ReSTOR SA60D3 IOL as compared to subjects with a monofocal SA60AT IOL, with expected less gain in contrast sensitivity and less reduction of glare and halo complaints.
Introduction
Authors: RAO GN
Published: September 2008

Abstract not provided
Molecular and functional genetics of inherited eye disorders in India
Authors: KANNABIRAN C
Published: September 2008

Purpose To understand the genetics of ocular diseases in India by identification of the underlying genes, characterizing the functional effects of pathogenic or disease‐associated variants in suitable systems and to develop applications of genetics in patient screening and counseling.

Methods Genetic analysis involves the screening of candidate genes, linkage and association studies on patients and families recruited for specific eye diseases including several Mendelian and complex diseases. Phenotypic correlations are drawn using clinical, histological and other data as applicable from medical records of patients.

Results Over the last 10 yrs, we have carried out studies on retinal dystrophies, retinoblastoma, congenital cataract, corneal dystrophies, anterior segemnt dysgeneses, congenital glaucoma, POAG, age‐related macular degeneration and myopia. These studies have led to the identification of new genes and genetic associations, as well as delineation of mutational spectra for various Mendelian disorders. Functional and/or structural effects of disease‐associated mutations are another area of activity and questions in this realm have been investigated for some proteins such as crystallins and optineurin.

Conclusion The challenge in the near future is to develop effective and relevant ways of translating genetic and molecular science towards the benefit of patients.
Stem cell therapy at LVPEI
Authors: SANGWAN V
Published: September 2008

Abstract not provided
Outreach programmes of LVP
Authors: RAO GN
Published: September 2008

Abstract not provided
“Vision care at all levels: From bench to bedside to the community”‐ A working model by L. V. Prasad Eye Institute, Hyderabad, India
Authors: BALASUBRAMANIAN D , KANNABIRAN C , KHANNA R , RAO GN
Published: September 2008

Purpose Of the 50 million blind people in the world, 60% live in developing countries. The three major causes of blindness here (cataract, infection, uncorrected refractive errors) are needless, since they are treatable or avoidable. In order to do so, we need a program of outreach to the countryside and village communities, involve them as partners in the endeavor, and thus make it successful and sustainable.

Methods Over the last twenty years, the L. V. Prasad Eye Institute (LVPEI), a non‐profit, non‐governmental eye care centre at Hyderabad, India, has set up a multi‐tier pyramid model to address this problem of winning over needless blindness. This pyramid connects a centre of excellence at Hyderabad on the top with tertiary eye care centres in two other cities, secondary care centres in 15 towns‐ each of which is served by 10 vision centres in villages, thus taking care of about 20 million people. Prescription of eyeglasses, drugs against infection, and cataract surgical care are delivered on a large scale through this pyramid approach. This model of translation from bench to bedside to the community appears to be replicable in other places and for other aspects of healthcare.

Results In basic and clinical research, LVPEI is involved in the molecular and functional genetics of some inherited forms of blindness, use of stem cells to reconstruct the damaged ocular outer surface, and biochemical aspects of cataract.

Conclusion This model of translation from bench to bedside to the community appears to be replicable in other places and for other aspects of healthcare. It also appears suitable for the goals of Vision 2020: The Right to Sight.
Natural killer/T‐cell lymphoma with primarily orbital involvement: case report
Authors: NOVAK ANDREJCIC K , DRNOVSEK OLUP B , PECARIC MEGLIC N , BRACKO M , JEZERSEK NOVAKOVIC B
Published: September 2008

Abstract not provided
Change of the diagnosis after retinal involvement in “CNS lymphoma”
Authors: SOUCEK P , SOUCKOVA I
Published: September 2008

Abstract not provided
Panoramic ICG and angiography in ocular oncology: new observations
Authors: ZOGRAFOS L
Published: September 2008

Abstract not provided
Choroideal neovascularisation in age related maculopathy and high myopia. A Laser Flare‐Cell Meter study
Authors: CELLINI M , RICCETTI A , LEONETTI P , CAMPOS EC
Published: September 2008

Purpose We studied the subclinical ocular inflammation by laser flare‐cell meter in patients with choroideal neovascularisation (CNV) in age related maculopathy (AMD) and in high myopia (HM).

Methods We enrolled 22 patients (12 males and 10 females) without diabetes, systemic inflammatory disease or previous ocular surgery or laser therapy, aged between 65 and 89 years (mean 78,2±6,3) with macular CNV. Twelve of these patients have an age related maculopathy (AMD) and ten have an high myopia (HM). The myopia was mean ‐14,25 D. We made an indocyanine angiography and measured the extension of neovascularization with the Heidelberg Eye Explorer analysis program. The flare was measured with laser flare‐cell meter (FM‐500, Kowa, Tokio, Japan) in both eyes of the same patient. Subsequently we compared the flare data of AMD‐patients that had an CNV with an area similar of the CNV of the HM‐patients. Statistical analysis was performed considering significant a p<0.05.

Results The flare in AMD and HM patients was 14,89±7,61 vs 8,00±0,86 photons/msec (p<0.013) and the CNV area was 4,03±2,236 vs 1,07±0,14 mm2 (p<0.001). We selected a sub‐group of AMD‐patients that had a CNV area similar to the CNV of HM‐patients: 1.13±0.18 vs 1,07±0,14 mm2 (p<0.192) and the flare was 13,48±3,08 vs. 8,00±0,86 photons/msec (p<0.001).

Conclusion Our results show that sub‐clincal inflammation in AMD with CNV is higher than in HM with CNV. Furthermore in AMD the flare is correlated with CNV (p<0.021)but not in HM. These data could be explain with inflammatory pathogenesis of CNV in AMD. whereas in HM the CNV could be related to a spontaneous ruptures of the Bruch’s membrane.
Diabetic retinopathy : facts and resources
Authors: MIDENA E
Published: September 2008

Diabetic retinopathy (DR) is the most frequent ocular complication in patients with diabetes and the main cause of blindness in the working age population in industrialized and developing countries. The most important risk factors that contribute to the pathogenesis of DR are chronic hyperglycaemia, hyperlipidemia and hypertension. Epidemiologic data show that each year 12 percent of new cases of legal blindness are attributed to diabetic retinopathy (DR) and that its prevalence increases with both increased duration of diabetes and the age of patients. Of insulin‐dependent patients with diabetes for 30 or more years, 12% are blind. Diabetic macular edema (DME) is a frequent manifestation of DR and the leading cause of legal blindness in patients with type 2 diabetes. Over a 10‐year period, non clinically significant DME and clinically significant DME will respectively develop in 14% and 10% of known diabetic patients. Approximately half of patients with DME will loose two or more lines of visual acuity within 2 years. Overall social costs (expenditures and lost productivity) caused by DR are about $174 billion in the USA. Approximately 20% of health care expenditures for persons with DM (50% with DM as a co‐morbidity), 10% of expenditures for complications of DM and 15% of expenditures for health care for DM are ophthalmic. Therefore, DR accounts for significant economic costs that can be reduced with early diagnosis, achieved with screening methods. Screening of DR allows for timely treatment, vision preservation and consequent saving costs. Implementation of screening systems in different environments worldwide is the first necessary step in order to prevent blindness caused by diabetes mellitus.
Timing of diabetic retinopathy screening
Authors: STEFANSSON E
Published: September 2008

Abstract not provided
A novel murine model of aging of the human retina
Authors: BRETILLON L , ACAR N , SEELIGER MW , MAIRE MA , GREGOIRE S , JUANEDA P , MARTINE L , JOFFRE C , BRON AM , CREUZOT CP
Published: September 2008

Purpose Accumulation of lipids, and especially of cholesteryl esters, under the retinal pigment epithelium and within Bruch’s membrane is a normal feature of aging and has also been observed in human eyes with age‐related maculopathy. Our objective was to evaluate the retinal phenotype of apoB100,LDLR‐/‐ mice, a model for lipid metabolism dysfunction and potentially of aging of the retina.

Methods ApoB100,LDLR‐/‐ mice were studied at 7 and 14 months of age by standard scotopic and photopic electroretinography by comparison to control animals. Fundus images were obtained with a confocal SLO (Heidelberg Retina Angiograph). The integrity of the vascular system was investigated by means of fluoresceine and indocyanine green angiography. Sections of eye cups were stained by filipin to detect cholesterol deposits.

Results Both scotopic and photopic b‐wave amplitudes were reduced in apoB100,LDLR‐/‐ mice compared to control mice (Rmax=125 µV vs 208 µV for the scotopic b‐wave amplitude at 7 months, and 83 µV vs 162 µV at 14 months). Similarly rods and cones sensitivity was 0.5log unit lower in apoB100,LDLR‐/‐ mice at 14 months, compared to control mice. Although the retinal and the choroidal vascular systems were normal, apoB100,LDLR‐/‐ mice displayed white auto‐fluorescent dots in the retinal pigment epithelium layer which likely corresponded to cholesterol deposits.

Conclusion The present apoB100,LDLR‐/‐ mouse, is one of the only models with neutral lipid deposits at the basement of RPE that can potentially be very useful to study the mechanisms of lipid deposition that occurs universally in human retina while aging.
In vivo confocal microscopy in the diagnosis of corneal conjunctivalization
Authors: LANZINI M , NUBILE M , CALIENNO R , COLESANTI E , CIAFRE M , CURCIO C , MASTROPASQUA L
Published: September 2008

Purpose The diagnosis of corneal conjunctivalization (CC) due to limbal stem cells deficiency(LSCD)is usually based on clinical features and on impression cytology (IC) which provides ex vivo morphology and immunoistochemical features of the corneal epithelium. The aim of this study was to validate laser scanning in vivo confocal microscopy (IVCM) as a new method to assess CC, based on the morphology of epithelium in central cornea and microstructural analysis of the limbal architecture

Methods 15eyes of 15patients with suspected CC were enrolled. All patients underwent IVCM (HRT2‐Heidelberg Eng.)on the central cornea and limbus. CC was defined as presence of monolayered epithelium with goblet cells and subepithelial fibrovascular tissue. These findings were related with limbal alterations. Patients underwent IC of the central cornea to evaluate epithelial features in a masked fashion by mean of PAS and immunofluorescence CK12 staining. The epithelia were then classified into corneal,conjunctival and mixed pattern and the diagnostic hypotheses of in vivo and ex‐vivo findings were compared .

Results The diagnostic hypotheses were concordant in 87% of the cases. In 3 we found corneal epithelium with corneal morphology by IVCM, no goblet cells and k12 positive cells by IC. In 2 we found an epithelium with conjunctival morphology by IVCM, presene of goblet cells and ck12 negative cells by IC.In 5 we found mixed epithelia with both methods.The last two cases were discordant.IVCM showed limbal alterations in the cases of mixed and conjunctival epithelium.

Conclusion IVCM is a useful non invasive method to help the diagnosis of LSCD and CC which well correlates with IC allowing also the analysis of the limbal structure.
Diagnostic and therapeutic applications of alcohol delamination (ALD) of the corneal epithelium
Authors: RAJ A , SAID DG , RAJ DEV , DUA HS
Published: September 2008

Purpose Application of a weak alcohol solution to delaminate the corneal epithelium was first popularised for LASEK (Laser subepithelial keratomielusis). We subsequently reported successful results using ALD for the treatment of recurrent corneal erosion syndrome. In this study we explored the uses of this technique for other therapeutic and diagnostic indications.

Methods Eight patients were studied. In 3 the indication was for diagnosis only, in 3 it was for diagnosis and treatment and in 2 for treatment only. Following slitlamp evaluation, a 6mm well was placed over the site to be delaminated and 20% alcohol applied for 30‐40 seconds following which the alcohol was removed and the cornea washed before peeling off the loosened epithelial sheet, which was spread on paper and covered with fixative for light and/or electron microscopy.

Results Of the 3 that had ALD for diagnosis, clinical suspicion of conjunctival intraepithelial neoplasia was confirmed in all 3 with preservation of cell morphology and orientation. 3 patients had chronic epitheliopathies manifesting as persisting epithelial defects and sick corneal epithelium. One showed epithelial cell apoptosis and the other 2 showed non specific or conjunctival features. All conditions resolved with visual improvement. Two symptomatic patients, 1 with extensive basement membrane dystrophy and the other with recurrence of granular dystrophy in the epithelium of a graft, showed improvement after ALD. Histology confirmed the diagnosis.

Conclusion ALD is a simple, safe and effect intervention for removal of an intact epithelial sheet that can be histologically examined with proper tissue orientation facilitating accurate diagnosis. It also serves as a therapeutic intervention.
Comparison between liposomes spray and non preserved tears substitutes in patients with meibomian gland dysfunction
Authors: LANGMAN ME , AMOUROUX GICQUEL N , GICQUEL JJ
Published: September 2008

Purpose Many elderly people present with lachrymal film lipid phase disorder caused by a meibomian dysfunction. During a prospective randomised study performed in Poitou‐Charente, we compared the use of vegetal liposomes in spray (intended for stabilizing the lipid phase) against one of the gold standard lachrymal substitutes.

Methods 50 patients aged 75 years old or older with a functional dry eye syndrome due to a meibomian dysfunction were studied between March and June 2007 in the department of ophthalmology of St Louis Hospital. The first group was treated with vegetal liposomes spray (Vyséo®) (3 sprays /day, eyelids closed). The control group received lachrymal substitutes (Refresh Tears® (Polyvynilic alcohol and Polyvidone) 1 eyedrop 6 tid). The following criteria have been studied: inflammation of the eyelids edge, lid‐parallel conjunctival folds (LIPCOF), break up time (BUT), Schirmer I, best corrected visual acuity (BCVA) and Root Mean Square (RMS) with the Imagine Eyes IRX3 wavefront aberrometer. The statistical analysis was done with Prism for Windows.

Results The improvement of inflammation at the eyelids edge, LIPCOF, BUT, and RMS was significantly higher in the group treated by Vyséo®. The Schirmer I had not been modified in neither of the two groups. The best patients’ satisfaction and ease of use scores were found in the Vyséo® group.

Conclusion Vegetal liposomes spray is easy to use for elderly patients with meibomian dysfunction and provide them with effective long term discomfort relief.
Role of oxidative stress in glaucoma
Authors: ERB C
Published: September 2008

Purpose Glaucoma is the second major cause of permanent blindness worldwide. It is a group of chronic progressive neuropathies of the optic nerve with a loss of visual field resulting from the death of retinal ganglion cells. There are a lot of risk factors known like genetic susceptibility factors, elevated intraocular pressure (IOP), increased age, myopia and vascular diseases but the real pathophysiology is still unknown.

Methods In the past several experimentel and clinical studies showed that oxidative stress is involved in this complex process.

Results First of all, mitochondria seems to be genetically vulnerable in glaucoma patients as well as damaged by elevated IOP. In the anterior segment trabecular meshwork cells show oxidative DNA damage as well as increased aging and lipid peroxidation. In addition aqueous humor has an reduced antioxidative status. In the posterior segment retina and the optic nerve are involved by an reduced antioxidative status, increased lipid peroxidation and increased apoptosis.

Conclusion In summary, oxidative stress is one of the major players in the glaucoma disease and should be taken into the therapeutic management .
Retinal microvascular signs as biomarkers of cardiovascular disease
Authors: KAWASAKI R
Published: September 2008

Purpose To review associations of retinal microvascular signs and cardiovascular disease.

Methods The retina is a unique site where the in vivo microvasculature can be directly observed and monitored repeatedly over time. Assessing the characteristics of the retinal small arteries and arterioles offers a surrogate means to evaluate associations of changes in the microcirculation in other organs that may be associated with systemic conditions in vivo. Recent advances in retinal photographic imaging techniques have facilitated the development of computer‐assisted methods to measure and quantify subtle variations and abnormalities in the retinal microvasculature. These quantitative assessments have been applied to large populations, of both adults and children, and in community and clinic settings.

Results Existing data now convincingly show links between a range of retinal microvascular signs to both clinical and subclinical ocular, cerebro‐vascular, cardiovascular and metabolic outcomes. This presentation will outline the major retinal vascular imaging methods used in large population based studies and provide an overview of novel methods under development.

Conclusion Retinal microvascular signs can be biomarkers of cardiovascular disease as well as ocular diseases, independent of traditional risk factors.
The predictive risk factors and grading of pathologic myopia for retinal photographs
Authors: SAW SM
Published: September 2008

Purpose To determine the predictive factors and grading for pathologic myopia in several population‐based studies.

Methods More than 12,000 fundus photographs are available from large population‐based studies in Singapore including the Singapore Cohort Study of the Risk Factors for Myopia (SCORM) of 1,600 children and SIMES of Malays aged 40 to 80 years. Refractive error measures were performed using the Canon RK‐F1 machine and fundus photographs using the Canon CR6‐45NM non‐mydriatic camera. The number, type and position of the following will be assessed: staphylomas, lacquer cracks, cytotorsion of optic disc, Fuch’s spots, choroidal neovascularization, lattice degeneration, and B peripapillary atrophy. In SCORM, the predictive factors including age of onset of myopia will be assessed. Additionally, genome‐wide analyses (GWA) studies using the Illumina Sentrix HumanHap 550K BeadChips were performed in 1043 SCORM samples.

Results The different grades of pathologic myopia with severity of refractive error or axial length will be correlated. In 679 children in SCORM with myopia and 100 with emmetropia, the prevalence of lattice degeneration was 0.15%, there was increased PPA‐to‐disc area ratio with increased axial length and smaller cup‐to‐disc ratios in myopes compared with emmetropes. The GWA scans were run on 969 buccal‐derived and 74‐saliva derived) after excluding 82 samples.

Conclusion Myopia has a huge burden because high myopia is associated with potentially visually disabling ocular pathology. Further research should identify the environmental and genetic risk factors for pathologic myopia.
Grading techniques for the assessment of retinal
Authors: GROSSO A
Published: September 2008

Historical perspective Brief history of vascular measurement ‐Leishman ‐Kagan ‐Parr ‐Wisconsin (WESDR, ARIC, CHS) ‐CERA, Melbourne Retinal vessel measurement ‐Validation as epidemiological tool ‐Brief history of technology ‐Retinal arteriolar signs predict various vascular diseases Application of retinal vessel measurement to retinal diseases ‐Diabetic retinopathy, retinal vascular occlusive disorders, uveitis, age‐related macular degeneration, glaucoma ‐Response to treatment (laser, VEGF inhibitors) Exploration of vessel measurement as a vascular test ‐Retinal microvascular evaluation to predict systemic disease Challenges regarding vessel measurement Conclusion
Follow up of a slowly growing melanocytic lesion during 12 years
Authors: VAN GINDERDEUREN R , BLANCKAERT J , LEYS A , SPILEERS W , VAN DEN OORD J
Published: September 2008

Purpose We report an atypical case of a very slowly growing and rather flat pigmented lesion in the posterior pole.

Methods A women 53 years old at presentation, was followed during more than 12 years for a posterior pole lesion. Periodical fundoscopy, fluoangiography, ICG angiography and ultrasounds were performed. After enucleation in 2008, the definitive diagnosis was made after histopathologic examination.

Results Visual decrease because of macular oedema in the left eye was the reason for referral. Fundus examination and fluo‐angiography revealed a slowly enlarging subretinal lesion with abnormal pigmentation and leakage with signs of chronic neurosensory detachment; ultrasound examination showed a cystic lesion with macular oedema. The lesion increased very slowly in thickness until a maximum of 1.5mm. Finally a chronic retinal detachment caused an intractable neovascular glaucoma and necessitated enucleation in 2008. Histopathology showed a diffuse proliferation of small spindled melanocytes with bland, uniform nuclei lacking mitotic activity with some small nests of larger, haevely pigmented epitheloid melanocytes with nuclear pleimorphism, embedded in collageneous matrix. The cell proliferation marker Ki67 showed only rare tumor cells with immunoreactive nuclei,indicating a very low fraction of cycling tumor cells. Other immunohistochemical markers are currently performed in order to elucidate the biological behaviour.

Conclusion This case shows a unusually slowly growing lesion with classical histological features of melanoma and suggests the existence of a type of ocular melanoma of extremely low grade malignancy. Further phenotypical profiling is warranted in order to understand the cause of this "benign" behaviour.
Structural and cellular diagnosis of ocular surface squamous neoplasia using in‐vivo confocal microscopy
Authors: PARROZZANI R , GHIRLANDO A , CORTESE M , MIOTTO S , URBAN F , MIDENA E
Published: September 2008

Purpose Aim of this study was to analyze in‐vivo structural and cellular features of ocular surface squamous (OSS) neoplasia using clinical confocal microscopy (CM).

Methods Ten consecutive cases of OSS neoplasia were investigated using in‐vivo corneo‐conjunctival CM (ConfoScan4, Nidek, Gamagori, Japan) with a 40X surface‐ noncontact objective. Data obtained using CM were also compared to standard histopathology or cytologic samples obtained by scraping technique.

Results CM analysis of OSS neoplasia showed good agreement with correspondent tumor cytology or histopathology, revealing some structural and cellular features of the lesions, including: loss of the normal epithelium structure in 10 cases (100%), high‐reflective areas in 10 cases (100%), inhomogeneous cell density in 8 cases (80%), cells debris in 8 cases (80%), abrupt demarcation at the lateral edge of the lesion in 7 cases (70%), nodular zone of cell proliferation in 6 cases (70%), fibrovascular structures in 3 cases (30%), keratin pearls in 1 case (10%) and pre‐Bowman space involvement in 1 case (10%). No anterior stroma involvement was documented. Cells anisocytosis, pleocytosis and anisonucleosis were also documented in 9 of 10 tumors (90%).

Conclusion In‐vivo CM seems a reliable, non‐invasive method useful for in‐vivo diagnosis of OSS neoplasia.
Foreign body conjunctival granuloma
Authors: MACHOWICZ‐MATEJKO E , RYMGAYLLO‐JANKOWSKA B
Published: September 2008

Purpose To present a case of a small inflammatory epibulbar mass developed soon after a branch of the tree injury.

Methods 57‐years old healthy men presented to our Department with complaints of discomfort, foreign body sensation, mild tearing and redness of his left eye. The patient sustained branch tree injury two weeks before. Slit lamp examination demonstrated a small red mass measuring about 3mm in diameter, located at the 3 o`clock position, loosely connected with adjacent tissues. An excisional biopsy of the mass was performed and tissue was send to histopathology laboratory for microscopic analysis.

Results Microscopic examination revealed a massive infiltrate composed with multiple giant cell (of foreign body type) surrounding organic material (pieces of wood and plants) together with multiple plasma cells and lymphocytes. Focally neutrophils were also present. Histopathology diagnosis: foreign body conjunctival granuloma. Clinical differential diagnosis should considered: conjunctival benign lesions, Splendore‐Hoeppli fenomenon, inclusion conjunctival cyst or nodular episcleritis.

Conclusion 1.Foreign body granuloma should be considered in differential diagnosis of conjunctival epibulbar lesions. 2.Histopathology is crucial for proper and final diagnosis.
Unmet needs in the treatment of glaucoma related to compliance, tolerability and concomitant dry eye
Authors: HOLLO G
Published: September 2008

Purpose Compliance to long‐term topical treatment of glaucoma can be less than optimal. This may decrease the efficacy of the treatment. This presentation summarises the unmet needs in the current topical treatment of glaucoma related to compliance, tolerability and concomitant dry eye and discusses the expectations for future therapies.

Results Glaucoma is a life long conditions and its management is multifactorial. However, compliance to topical glaucoma treatment can be less than optimal. Forgetfulness and topical side effects have been identified as important reasons for non‐compliance. Topical side effects decrease the quality of life of the patient, which impacts on compliance. Dry eye and glaucoma are often concomitant diseases. Therefore, it is advisable to consider the management of both diseases together for the optimal care for these patients. Preservative free preparations may have benefits for the long term treatment of glaucoma patients, especially those with dry/sensitive eyes.

Conclusion Compliance remains a key issue in the management of glaucoma. Glaucoma and dry eye as concomitant diseases present specific challenges for the optimal care of the patient.
Switching from latanoprost to preservative‐free tafluprost
Authors: KAARNIRANTA K
Published: September 2008

Ocular signs and symptoms of irritation may be of concern for glaucoma patients using preserved eye drops over long term. Jeannen et. al. have shown that switching from preserved beta‐blockers to preservative free beta‐blockers reduces these signs and symptoms in a statistically significant manner(1). This open‐label, multinational, phase IIIb study investigated the changes in ocular signs and symptoms when patients were switched from preserved latanoprost 0.005% to preservative‐free tafluprost 0.0015% (q.d. at 20:00) for 12 weeks. Patients with open‐angle glaucoma or ocular hypertension who had received latanoprost for at least 6 months and had at least 2 ocular symptoms or one symptom and one sign were enrolled (n=158). Change from screening in ocular signs and symptoms were main endpoints. (1)Jeannen at. al. Eur J Ophthalmol 2007; 17(3): 341‐49
To investigate the effectiveness of transpupillary thermotherapy (TTT) for neovascular age‐related macular degeneration (ARMD)
Authors: THIAGARAJAN M , MATTHEWS N
Published: September 2008

Purpose The effectiveness of TTT was investigated in terms of the change in Snellen visual acuity (VA) in patients having neovascular ARMD.

Methods A total of 84 patients with neovascular ARMD were recruited and the main outcome measures were Snellen VA both before and after TTT. Those with persistent oedema were retreated when assessed after 8 weeks with FFA or after subsequent visits.

Results No more than 1 Snellen line was lost in 44(68.8%) patients at 3 months, 41(71.9%) patients at 6 months, and 23 (53.5%) patients at 12 months. There was more than 2 Snellen lines lost in 20(31.2%) patients at 3 months, 16(28.1%) patients at 6 months and 20(46.5%) patients at 12 months. Only 24 patients required more than a single treatment.

Conclusion TTT treatment for neovascular ARMD shows the VA to be stable in the short‐term as the majority had no more than a single Snellen line of VA loss. The limitations of this study are the mean follow‐up of 6 months and no more than 50% having 12‐month follow‐up.
Evidence for association of HTRA1 promoter polymorphism in Polish patients with age‐related macular degeneration
Authors: OLDAK M , SZAFLIK JP , MAKSYM RB , FRANASZCZYK M , SZAFLIK J , PIOSKI R
Published: September 2008

Purpose Age‐related macular degeneration (AMD) is a leading cause of visual impairment in developed countries, particularly in the Caucasian population above 65 years. It is a complex disorder with both genetic and environmental factors playing a role. Variants of HTRA serine peptidase 1 gene (HTRA1), particularly a single nucleotide polymorphism (SNP) in its 5’ regulatory region –512G>A (rs11200638), is among those most strongly associated with AMD susceptibility but so far its frequency has not been analyzed in the Polish population. The purpose of this study was to investigate the association of rs11200638 with AMD in Polish patients.

Methods AMD patients (n=140) and age‐matched controls (n=162) were enrolled in the study. Total genomic DNA was isolated from blood and rs11200638 was genotyped in both groups by restriction fragment length polymorphism (PCR‐RFLP) analysis using MspI endonuclease and direct sequencing. PCR primers were designed based on the reference sequence of the gene (AF157623). Allele and genotype frequencies were compared between the groups by Chi square test and odds ratio (OR) with 95% confidence intervals (95% CI) were calculated to estimate risk.

Results Frequencies of the GG, GA and AA genotypes were 52%, 33% and 15% in control subjects and 28%, 15% and 57% in AMD patients, respectively. The AA genotype was significantly more prevalent in patients with AMD than among control subjects (OR= 7.7, 95%CI: 4.4‐13.2, Chi square 53.6, P<10‐6).

Conclusion In the present study, polymorphic variant of HTRA1 gene (rs11200638) showed strong association with AMD, verifying its significant role as a disease susceptibility gene also in Polish patients.
The in vitro effects of anti‐angiogenic AMD treatments on human choroidal endothelial cells
Authors: STEWART EA , AMOAKU WMK
Published: September 2008

Purpose Age‐related macular degeneration (AMD) is the most common cause of irreversible visual loss in elderly populations in the western world. Neovascularisation by choroidal endothelial cells (hCEC) causes AMD; however, the mechanisms responsible are not fully understood. Vascular endothelial growth factor (VEGF) is thought to be the most significant growth factor in AMD and subsequently, molecular inhibitors including pegaptanib (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin) have been developed as treatments for AMD.

Methods hCEC were isolated from cadaver eyes and cultured in EBM2‐MV medium as previously published. hCEC proliferation after exposure to VEGF isoforms 165 and 121 and anti‐angiogenic treatments was measured using the WST‐1 assay. The effect of the VEGF isoforms and anti‐angiogenic treatments on angiogenesis was assessed using a double layer Matrigel technique.

Results hCEC proliferation in response to VEGF 121 and 165 was found to be equivalent. Individually and in combination both Ranibizumab (Lucentis) and bevacizumab (Avastin) were effective in decreasing proliferation of hCEC. Pegaptanib (Macugen) was moderately effective in controlling the proliferation of hCEC stimulated by VEGF 165, but was ineffective against the stimulatory effect of VEGF 121.

Conclusion Although molecular inhibitors of angiogenesis have been shown to have a beneficial effect as treatments for AMD, direct comparison of the efficiency of the drugs is complicated, due to variations between trials and dosing regimes. In vitro testing of the drugs on the proliferation and angiogenesis of hCEC showed that the efficacy is in the order Lucentis>Avastin>Macugen, in line with the current clinical outcomes seen.
Intravitreal bevacizumab versus triamcinolone acetonide for exudative age‐related macular degeneration
Authors: LIBONDI T , JONAS JB , IHLOFF AK , HARDER B , KREISSIG I , SCHLICHTENBREDE F , SPANDAU UHM , VOSSMERBAEUMER U
Published: September 2008

Purpose To compare an intravitreal high‐dose injection of triamcinolone acetonide versus an intravitreal injection of bevacizumab for treatment of progressive exudative age‐related macular degeneration (AMD).

Methods The comparative non‐randomized retrospective clinical interventional study included 305 patients with progressive AMD, divided into a bevacizumab group of 36 patients (1.5 mg bevacizumab) and a triamcinolone group of 269 patients (about 20 mg triamcinolone). All patients were consecutively included, in the first phase of the study for triamcinolone, and in the second phase of the study for bevacizumab. Mean follow‐up was 8.5 ± 6.8 months (2‐35.7 months).

Results In the bevacizumab group, best visual acuity increased significantly (P<0.001) by 3.2±3.4 Snellen lines, with 25 (69%) eyes and 21 (58%) eyes, improving by at least 2 Snellen lines and 3 lines, respectively. In the triamcinolone group, the visual acuity change was not statistically significant whenever within the first 3 months. Maximal increase in visual acuity, visual acuity change at 2 months after injection, and the percentage of patients with an improvement by at least 2 Snellen lines and 3 lines were significantly (P<0.001) higher in the bevacizumab group than in the triamcinolone group. Intraocular pressure increased significantly (p<0.001) in the triamcinolone group, and did not change significantly (P=0.47) in the bevacizumab group.

Conclusion In exudative AMD, intravitreal bevacizumab (1.5mg) compared with intravitreal triamcinolone acetonide (about 20mg) results in a higher improvement of visual acuity and does not markedly influence intraocular pressure within 2 months after injection
Intravitreal bevacizumab (Avastin®) in wet AMD: the OCT‐assisted “wait and see” management
Authors: NERI P , HERBORT CP
Published: September 2008

Purpose To retrospectively review the evolution of our patients managed with the OCT‐assisted “wait and see” approach after intravitreal bevacizumab (IB) injection.

Methods Charts of 46 consecutive patients affected by wet AMD that had received IB (1.25 mg) for recent CNV and completed ≥ 9‐month follow‐up were reviewed. The patients were divided into 3 groups, on the basis of the number of injections: “1 injection” (group 1), “2 injections” (group 2) and “≥ 3 injections” (group 3). Visual gain and loss were defined as improvement or worsening of 2 or more lines of BCVA, respectively. Injections were repeated in case of OCT worsening and decreased BCVA, confirmed by FA. Main outcome measures were the stability/improvement of the BCVA, and both the FA and OCT stability/improvement.

Results Sixteen patients needed only 1 injection (34.8%), 11 needed 2 injections (23.9%) and 16 (41.3%) patients ≥ 3 injections. In group 1, the median follow‐up time, was 14 months, while, in group 2 and 3, it was 12 months. In group 1, 14/16 patients (87.5%) had stable/improved BCVA (P<.05), while in group 2 and 3, 9/11 (81.8%, P<.05) and 17/19 (89.5%, P<.05) patients had stable/improved BCVA, respectively. All the patients that had stable/improved BCVA had both stable/improved FA and OCT. No differences were observed between the outcomes of the groups (P>.05).

Conclusion In 1 patient out of 3 a single IB and in more than 50% of patients no more than 2 IB were sufficient to treat CNVs. Our data indicate that bevacizumab is effective even if administered on the basis of the CNV activity, and the scheme of 3 automatic initial injections proposed in trials using other anti‐VEGF agents should be revised at least for bevacizumab. Further trials are mandatory to validate our data.