bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous cataract formation in DBA/2J mice
Authors: OLESZCZUK AK , REJDAK R , RUMMELT C , KICZYNSKA M , ZARNOWSKI T , SCHUETTAUF F , THALER S , ZRENNER E , KRUSE F , JUNEMANN A
Published: September 2008

Purpose DBA/2J mouse develop spontaneously changes in anterior chamber like pigment dispersion syndrome, iris atrophy, posterior synechiae leading to IOP increase. Additionally, there are observations suggesting cataract formation. The aim of this study was to describe features of cataract formation in DBA/2J mice. Moreover, presence and pattern of the L‐ kynurenine aminotransferases (KAT I , II and III) immunoreactivity in the cataractous lens of DBA/2J mice was investigated.

Methods Immunohistochemistry was conducted using polyclonal antibodies against KAT I, II and KAT III on 18 cataractous lenses of 8‐, 11‐ and 24‐month old DBA/2J mice (6 in each group). All the sections of the lens were stained with Periodic Acid – Schiff (PAS), and normal anatomy of the anterior segment of the eye was confirmed. Moreover, all the animals subjected to the study were examined using slit lamp and anterior chamber photography.

Results As observed clinically, the animals developed cataract during aging. PAS staining revealed presence of lens opacification. Immunohistochemical analysis revealed presence of KAT I, II and KAT III in the extracellular structures of cataract showing specific pattern of the stain. In cortical cataract the immunoreactivity was observed on cortical lens fibres. In nuclear cataract, KAT II revealed stronger and diffused staining than KAT I. Additionally both KATs showed more pronounced staining at the edge of small clefts.

Conclusion Manifestation of L‐kynurenine aminotransferases in extracellular matrix during cataract formation in DBA/2J mice suggests that products of L‐kynurenine pathway might be involved in mechanisms of cataractogenesis in this animal model.
In vivo thermographic analysis of clear corneal incision during phacoemulsification: comparison for coaxial, microcoaxial and bimanual techniques
Authors: DUPONT‐MONOD S , LABBE A , CHASSIGNOL A , GRISE A , BAUDOUIN C
Published: September 2008

Purpose To measure the wound corneal temperature of clear corneal incisions (CCIs) during phacoemulsification (PKE) using different surgical techniques: standard coaxial, microincision coaxial and microincision bimanual.

Methods Human corneal emissivity was determined on corneal graft with the “Black Tape” method. After validation of the method on porcine corneas, the temperature of 35 CCIs was recorded continuously during PKE (7 coaxial with 1.8 mm incision, 14 coaxial 2.2 mm, 8 coaxial 2.75 mm, and 6 bimanual 1.3 mm) using portable laser targeted infrared thermometer.

Results No thermal differences were observed within the three groups in PKE mode 1 (nucleus sculpting and grooving) (p=0.56) and in PKE mode 2 (nuclear fragments phacoemulsification) (p=0.32). Bimanual 1.3 mm CCIs’s temperature was lower than the three other groups during irrigation‐aspiration mode (p<0.05).

Conclusion Clear corneal microincisions did not induce temperature increase of CCIs during phacoemulsification compared to larger incisions.
Single nucleotide polymorphisms of the tenomodulin gene (TNMD) in age‐related macular degeneration
Authors: NEVALAINEN T , TOLPPANEN AM , KOLEHMAINEN M , PULKKINEN L , UUSITUPA M , KAARNIRANTA K
Published: September 2008

Purpose TNMD is an X‐chromosomal gene, which encodes a putative angiogenesis inhibitor, a type II transmembrane glycoprotein, which has proven to be expressed in retina. Associations of single nucleotide polymorphisms of TNMD with the prevalence of age‐related macular degeneration (AMD) was examined.

Methods The study population comprised of 38 men and 65 women with exudative AMD, 16 men and 23 women with dry AMD and 35 men and 75 women without AMD (controls). Patients with choroidal neovascularization attributable to AMD were diagnosed by fundus photographs and fluorescein angiography in the Department of Ophthalmology at Kuopio University Hospital. There were no signs of AMD in the control group as visualized in fundus photographs. In both groups, selection criteria required subjects to be over 65 years of age and diabetes mellitus was considered an exclusion criterion.

Results Men with rs5966709‐G genotype had higher prevalence of AMD (exudative and dry form combined) than subjects with rs5966709‐T‐genotype (69% vs 47%, p=0.045). However, the difference in the prevalence of exudative and dry form of AMD was not statistically significant (p=0.061, p=0.179). Among women the subjects with rs2073163‐CT‐genotype had lower prevalence (28%) of exudative form of AMD than other genotypes (49% and 59% for subjects with rs2073163‐CC‐ and rs2073163‐TT‐genotypes, correspondingly, p=0.028).

Conclusion The rs5966709‐G genotype of TNMD is a modest AMD risk factor for men, while rs2073163‐CT‐genotype might be protective for women in exudative AMD.
Three Families with Best’s Disease and Normal Electro‐oculogram Recordings
Authors: ARNDT C , MEUNIER IA , BEN SALAH S , BAZALGETTE C , VALETTE L , MAZOIR E , SENECHAL A , HAMEL C
Published: September 2008

Purpose To describe 3 families with Best’s disease with normal electro‐oculogram (EOG) and without VMD2 mutations.

Methods Evaluation of the patients included visual acuity, fundus and autofluorescence (Heidelberg Retinal Angiograph), Goldmann visual fields, optical coherence tomography (Zeiss, OCT3), full field (ISCEV protocol) and multifocal electroretinograms, and EOG (ISCEV protocol). The diagnosis of Best’s disease was based on autosomal dominant inheritance, typical yellowish, autofluorescent material in the central macula accumulating beneath the retinal pigment epithelium, and decrease of the EOG Arden ratio.

Results Among the 1130 families with various retinal dystrophies followed up in Montpellier, 40 (3.5%) were found with vitelliform macular dystrophy. Best’s disease was observed in 20 of them while 13 families had adult macular vitelliform dystrophy and 7 had reticular dystrophy. In the group with Best’s disease, a normal EOG was recorded in 3 families. None of these 3 families carried mutations in VMD2 or RDS, and linkage to the VMD2 locus was excluded in one of them.

Conclusion In patients with Best’s disease and VMD2 (bestrophin) mutations, the decreased response of the EOG is attributed to an abnormal transepithelial chloride transport. However, the observation of families with normal EOG and no VMD2 mutations suggests that other genes are responsible for Best’s disease which could not impair the ionic transport but yet lead to similar subretinal deposits.
EyeDiagnostics – a collaboration tool in eye care
Authors: MARTIN LM , DOCKMO Y , SONNSJÖ B , GLÜCKMAN T , WANGER P
Published: September 2008

Purpose An Internet‐based system for inter‐professional collaboration between opticians/optometrists and ophthalmologists was developed and tested during 2007‐2008. The purpose of the current study was to describe the main screening findings and the actions taken, based on the test results.

Methods State‐of‐the‐art non‐mydriatic fundus cameras and visual field testing equipment were installed and the opticians were offered targeted training in the use of these instruments. The examination results were uploaded to EyeDiagnostics server and evaluated by ophthalmologists. 2301 subjects,63% women and 37% men, age 24 to 91 years (median 63, IQ 53‐73), have been examined by one of 55 different opticians and the findings evaluated by one of two experienced ophthalmologist.

Results 63% (1 335) of the examined subjects showed no abnormalities. In 30% (675) a follow‐up examination was judged to be indicated, which could be performed by the optician. 7% (159) of the tested subjects were referred to ophthalmic health care for treatment or further examinations.

Conclusion Modern technology in communication, fundus imaging and visual field examination have made it possible to reach a large number of people with advanced ophthalmic testing. This increase in diagnostic facilities can be expected to reduce workload in medical ophthalmic care, since many subjects, e.g. with family history of glaucoma, can be screened and followed using the EyeDiagnostics system.

Commercial interest
Ophthabase: a generic extensible patient registry system
Authors: TRÖGER E , WILKE R , PROKOFYEVA E , ZRENNER E
Published: September 2008

Purpose To allow analyses on large amounts of patient datasets as well as to assemble populations of patients for clinical trials it is of great importance to have a robust and easily accessible patient registry system. Problems regarding technological and organisational aspects are usually reappearing among such systems. To enhance reusability we are pursuing a generic approach for our system, using a standardized model as a basis for free specifications of data definitions.

Methods The system is a Web application based on the Java. The model containing the data definitions is based on the CDISC Operational Data Model (ODM), a common standard for interchange of clinical data. The ODM‐file is parsed at compile‐time to generate the persistence layer, as well as templates for the Web‐masks, reports, search‐forms and interfaces. The application includes reusable aspects, e.g. auditing mechanisms, user management and input validation.

Results The generic system was successfully used in Tuebingen to construct a concrete patient registry called Ophthabase. Although created for ophthalmology, the generic concept allows creation of almost any kind of patient registry. The patient registry can easily be modified by editing the ODM‐file. The generated system is less error‐prone during system development, since data modelling is separated from technological concerns.

Conclusion The generic concept will be extended in the future to further augment the patient registry systems, e.g. by adding sophisticated search routines, analytic functionality or optional pedigrees. Multi‐centre data interchange will be possible based on Web Services using a mediator‐server able to match ODM‐models of different patient registries. The ODM‐file can also be used to configure clinical trial systems.
Prevalence of age‐related macular degeneration in the AGES ‐ Reykjavik Study
Authors: ARNARSSON A , JONASSON F , EIRIKSDOTTIR G , HARRIS T , LAUNER L , KLEIN BEK , KLEIN R , COTCH MF , GUDNASON V
Published: September 2008

Purpose To determine the prevalence of age‐related macular degeneration in the Age, Gene/Environment Susceptibility ‐ Reykjavik Study.

Methods The random sample includes individuals born between 1907 and 1935 who were recruited to participate from 2002‐2006. 5272 participated in the 3rd follow‐up visit which included an eye examination. After a maximum dilatation of the pupil all had a digital fundus photography centered on the macula. The photographs were graded by masked graders at the Wisconsin Ocular Epidemiology Grading Center using a modification of the Wisconsin Age‐related Maculopathy Grading System.

Results The participants were 67 years and older. There were 5138 right macular fundus photographs gradable for early age‐related maculopathy (ARM). The prevalence of early ARM was 18.3% (95% CI 17.3‐18.9). Among the participants 4.4% (95% CI 3.9‐4.7) had late age‐related macular degeneration (AMD). For pure geographic atrophy (GA) there were 5036 gradable photographs of the right macula and the prevalence was 2.1% (95% CI 1.7‐2.3). Those with GA and also exudative AMD (mixed type) are not included in this category. For exudative late AMD there were 5152 gradable photographs of the right macula and the prevalence was 2.3% (95% CI 1.9‐2.5). GA, when present, was located in the centre circle (foveal area) in the vast majority of cases.

Conclusion We found a steep age‐related increase in the prevalence of age‐related maculopathy in this elderly white population and geographic atrophy was usually located in the foveal area. The prevalence was similar for both late types of age‐related macular degeneration.
Anthropomorphic measurements and general and ocular parameters in adult Chinese. The Beijing eye study
Authors: JONAS JB , XU L , WANG Y , ZHANG H
Published: September 2008

Purpose To determine whether anthropomorphic measurements are associated with ocular and general parameters.

Methods The population‐based Beijing Eye Study, which included 4439 subjects (age: 40+ years) out of 5324 subjects invited to be examined in the year 2001, was repeated in 2006 with 3251 (73.2% of 4439, or 61.1% of 5324) subjects participating. The anthropomorphic measurements body height and weight, socioeconomic variables, and ocular parameters were evaluated.

Results Out of the 3251 subjects included in the study, measurements of body height and weight were available for 3214 (98.9%) subjects. In multivariate analysis, body height was significantly associated with the systemic parameters higher level of education (P=0.004), higher income (P<0.001), lower body mass index (P<0.001), lower systolic blood pressure (P=0.012), higher diastolic blood pressure (P<0.001), male gender (P<0.001), lower age (P<0.001) and living in an urban region (P<0.001), and with the ocular parameter of a deep anterior chamber (P<0.001).

Conclusion In adult Chinese, body length is associated with higher level of education, higher income, lower systolic blood pressure, higher diastolic blood pressure, lower body mass index, in addition to living in an urban region and to be male. From an ophthalmic point of view, tall subjects had deeper anterior chambers. Since the socioeconomic, systemic and ocular parameters examined influence occurrence and therapy of ocular diseases, these data may helpful in the assessment of risk factors and in the diagnosis and treatment of ocular diseases.
Diagnostic ability of glaucoma probability score to discriminate between healthy individuals and glaucoma suspects
Authors: FERRERAS A , PAJARIN AB , PINILLA I , FOGAGNOLO P , GUERRI MONCLUS N , EGEA ESTOPINAN MC , GARCIA‐MARTIN E
Published: September 2008

Purpose To evaluate the diagnostic performance of the contour‐line independent glaucoma probability score (GPS) classification obtained with the Heidelberg retina tomograph (HRT) 3 to differentiate between healthy and suspected glaucoma subjects (SG).

Methods 62 normal eyes and 48 SG (normal standard automated perimetry, intraocular pressure higher than 21 mmHg, and retinal nerve fiber layer defects measured with Stratus optical coherence tomography or scanning laser polarimetry GDx VCC) were included. The receiver operating characteristic (ROC) curves were plotted for the GPS numerical values and compared with HRT3 stereometric parameters.

Results GPS nasal and the FSM discriminant function had the best ability to differentiate between healthy and suspected glaucoma eyes. The areas under the ROC curve were 0.830 and 0.818, respectively. Sensitivity was 47.9% for GPS nasal at a fixed specificity of 90%.

Conclusion GPS had a good diagnostic ability to discriminate between normal and SG. There are structural changes at early stages of the disease that can be quantified by means of GPS.
Optic disc and retinal nerve fiber layer analysis in perimetrically unaffected eyes of glaucoma patients: an optical coherence tomography study
Authors: DI STEFANO G , DA POZZO S , FANNI D , RAVALICO G
Published: September 2008

Purpose To evaluate whether optical coherence tomography (StratusOCT) may detect early changes in perimetrically unaffected (PU) fellow eyes of glaucomatous patients by analysis of retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH).

Methods 37 glaucomatous patients with unilateral field loss and 34 age‐matched controls were recruited. In glaucoma patients, PU eyes and the affected ones were analyzed separately. For each group, mean values (±SD) of age, mean deviation, pattern standard deviation, as well as RNFL thickness parameters and ONH measurements were calculated. Comparisons between fellow eyes of glaucoma patients and between healthy and PU eyes of glaucoma patients conducted with t test and Mann‐Whitney U‐test, respectively. Number of clock‐hour sectors flagged with probability levels <5% or <1% were collected and differences between healthy subjects and PU eyes of glaucoma patients evaluated on Fisher exact test.

Results Global (Average Thickness) and sectoral parameters (Inferior and Nasal Average), Max‐min, as well as 2‐ and 6‐o’clock sectors resulted significantly thinner in PU eyes than in control group, whereas ONH analysis did not provide any significant difference between the two groups. Proportion of eyes with clock‐hour position flagged with probability <5% or <1% was not significantly different between healthy and PU eyes.

Conclusion PU eyes of glaucoma patients represent a group at risk to develop functional impairment over time since an early RNFL thinning was identified on OCT.
Impact of continuous myopic defocus on the refractogenesis and myopia progression
Authors: TARUTTA E
Published: September 2008

Abstract not provided
Pharmacological control of myopia ‐ current options and future possibilities
Authors: WILDSOET C
Published: September 2008

Purpose To review current pharmacological options for myopia control and explore future options. The underlying cause of both myopia and associated retinal complications is excessive ocular growth, which is a logical target for pharmacological intervention.

Methods This presentation will review relevant research using animal models for myopia as well as clinical myopia research.

Results The first attempts to control human myopia with drugs date back to the middle of the 19th century and involved topical atropine, an antimuscarinic drug. Possible reasons for why it remains the only drug in wide‐spread use for myopia control today, despite its significant adverse ocular side‐effects, will be considered along with general and drug‐specific clinical issues associated with long‐term use of topical ophthalmic formulations. Other plausible pharmacological treatment options will also be explored.

Conclusion Progress in developing acceptable drug treatments for myopia control has been disappointing, especially given the near epidemic levels of myopia in some countries. However, the increased attention paid to the translation value of biomedical research may help to change this situation.
Derangement of pigment epithelium derived factor (PEDF) activity in progressive myopia
Authors: IOMDINA E , KOSTANYAN I , RADCHENKO V , KAKUEV D , MINKEVICH N , SHEKHTER A , TARUTTA E , KVARATSKHELIJA N
Published: September 2008

Purpose To study the Tenon’s capsule ultrastructure and PEDF metabolism of the sclera and Tenon’s capsule in progressive myopia.

Methods Transmission electron microscopy, western blot analysis and immunohistochemistry using polyclonal antibodies against PEDF molecule, nucleotide sequence of PEDF mRNA and histochemistry with Kongo red staining specific to amyloid structures have been used to study 140 samples of 106 eyes of patients aged 7‐22 with progressive myopia of 5.5‐31.0 D and 29 eyes of patients aged 7‐23 with emmetropia or low hyperopia (control group). The samples were obtained during scleroplasty, squint and eye trauma surgery.

Results Myopic samples of the Tenon’s capsule showed a looser and less regular organization of collagen fibrils, and a fall of the mean fibril diameter (d=75.7±7 nm) as compared to control samples (d=87±9 nm). These structural abnormalities are similar to those of highly myopic sclera. Soluble PEDF level decreased 2‐3 times, while accumulation of insoluble PEDF around fibroblasts was found to correlate with the formation of amyloid‐like fibril structures and an increased PEDF stability to hydrolysis. In PEDF’s mRNA obtained from myopic sclera 3 point mutations were revealed. All these substitutions change conservative amino acid residues near the serpin loop and can affect the conformation and stability of PEDF molecule.

Conclusion Serious defects of extracellular matrix organization and disorders in PEDF metabolism in the highly myopic Tenon’s capsule were detected.These disorders may contribute to myopia progression and development of its complications.
Use of imposed myopic defocus to control the progression of myopia
Authors: MORGAN IG
Published: September 2008

Purpose Animal studies suggest that axial elongation of the eye is controlled by pathways that detect hyperopic defocus (growth‐promoting) and others that detect myopic defocus (growth‐inhibiting). The inhibitory pathways generate more powerful signals, and brief periods of imposed myopic defocus block the axial elongation induced by otherwise constant hyperopic defocus. An intervention to prevent myopic progression based on these findings was trialled in a Sydney paediatric ophthalmology practice.

Methods The study was approved by the ANU Human Ethics Committee. Informed consent was obtained from the parents of 30 progressing myopes. Participants removed their corrections for 30 minutes per day, replacing them with +3D glasses. During this period, they were encouraged to avoid nearwork. Participants were followed for two years, with initial and final cycloplegic retinoscopy, and subjective refraction and axial length measured at 4 monthly intervals.

Results Complete data was obtained for 20 participants. In 13 cases, there was sufficient pre‐trial data on subjective refractions to compare pre‐trial progression with progression during the trial. Of the 26 eyes available for this analysis, progression was reduced by over 80‐100% in 7 eyes, by 60‐80% in 7 eyes, by 40‐60% in 5 eyes, by 20‐40% in 1 eye, and by less than 20% in 6 eyes. In 16/26 eyes, the estimated reduction in progression was at least 1D over the two years.

Conclusion These results are consistent with other data on the impact of imposed myopic defocus in humans. However, an RCT in Singapore using monocular rather than binocular treatment has given negative results. A school‐based trial of binocular treatment has now commenced in Guangzhou in collaboration with Professor Mingguang He of the Zhongshan Ophthalmic Centre.
Central corneal thickness effect on GDx VCC parameters
Authors: BORQUE E , FERRERAS A , PUEYO V , POLO V , LARROSA JM , ALIAS EG
Published: September 2008

Purpose Evaluate the effect of extreme central corneal thickness in RNFL parameters measured by GDx VCC.

Methods A total of 131 eyes of 131 subjects were included divided into 60 control and 71 glaucoma patients. All of the glaucoma eyes had reproducible defects on standard automated perimetry. Central corneal thickness was measured with an ultrasonic pachymeter. ROC curves were plotted in the sample subgroups with exteme pachimetry values (outside mean ± 2SD) and were compared with ROC curves of the subjects in the normal pachimetry range (mean ± 2SD).

Results No differences were found in the areas under the ROC curve of the parameter of the GDx VCC in thinnest and thickest subgroups when compared with the mean pachymetry group.

Conclusion Central corneal thickness has no influence in RNFL measurements of GDx VCC.
Clinical Assessment of Disc at Risk
Authors: LATIES AM , JONAS JB
Published: September 2008

Purpose Diagnostic agreement among clinicians is fundamental to a clinical diagnostic criterion. We assessed the inter‐observer variability among examiners for the clinical entity popularly called Disc at Risk, a risk factor for non‐arteritic ischemic optic neuropathy (NAION).

Methods Examiners graded a randomized series of 40 monoscopic optic nervehead images, yes or no, as to whether each individual image merited the clinical diagnosis of a Disc at Risk. Ten academic ophthalmologists including (7 neuroophthalmologists) Group 1 and Group 2, 51 comprehensive ophthalmologists familiar with NAION participated.

Results Good agreement was found for Group 1 at lower cup‐disc ratios, (CD ratio) reaching 100% for horizontal CD ratios below 0.27. Agreement fell sharply at horizontal CD ratios 0.28 and above. Disagreement was high in horizontal CD ratios from 0.38 to 0.47 (26 Yes responses to 44 No). When vertical or when horizontal and vertical ratios were combined percent agreement followed a similar pattern. For comprehensive ophthalmologists (Group 2) percent agreement was consistently less than Group 1. Agreement varied from 26 to 74% across the full range of horizontal CD ratios.

Conclusion Poor agreement among comprehensive ophthalmologists over a wide range of CD ratios, undermines the creditability of the assessment in regular clinical practice. Even though skilled practitioners of Group I demonstrated better agreement than did comprehensive ophthalmologists, lack of agreement was evident over a broad range of common CD ratios. As a result, the diagnosis of a Disc at Risk is rendered suspect in many instances even by this specialist group.
Douglas Argyll Robertson (1837‐1909) – what did he do other than describe the Argyll Robertson Pupil?
Authors: GRZYBOWSKI A , PLANT G
Published: September 2008

Purpose To study medical achievements of Douglas Argyll Robertson in ophthalmology.

Methods The data dealt with in this paper is analysed both from the historical and present‐day perspectives.

Results Douglas Argyll Robertson (1837‐1909) was the first surgeon in Scotland to practice entirely in the field of ophthalmology. In this he was no doubt encouraged by the memory of his father, John Argyll Robertson, who was one of the founders of the Edinburgh Eye Dipensary but who had died when his son was only 18 years of age. Douglas completed his medical education under von Arlt in Prague and Albrecht von Graefe in Berlin. Argyll Robertson made major contributions to ophthalmic surgery. He introduced extracts of Calabar bean (Physostigma venenosum), in the treatment of glaucoma. He also described in cases of spinal cord disease that there may be loss of the light reflex of the pupil but retention of its movement in accommodation. This condition was named the "Argyll Robertson pupil" and as a clinical sign is almost always indicative of neurosyphilis. His other contributions include: lupus of the eyelid, aetiology of glaucoma, melanotic tumor, diphtheritic ophthalmia, sympathetic ophthalmia, retinitis pigmentosa, hypertrophy of the lacrimal gland, senile entropion, hydrophthalmos, asteroid hyalitis, pulsating exophthalmos, conjunctival filiariasis, albuminuric retinitis, miner’s nystagmus and microphthalmos. Argyll Robertson is also credited with being the first to recommend trephining the sclera in those cases of glaucoma where extensive degenerative changes in the iris made an iridectomy impracticable.

Conclusion As we approach the centenary of his death Argyll Robertson deserves to be celebrated for more than his pupil.
The use of femtosecond laser in corneal transplantation
Authors: NUBILE M
Published: September 2008

Purpose Femtosecond laser (FSL) devices, based on the physical phenomena of ultrashort laser pulses in the sub‐picosecond range of duration, have gained significant interest in ophthalmology thanks to their potential for high‐precision microsurgery, particularly in applications involving the transparent tissue of the cornea that take the greatest advantage of these attributes. The potential advantages and limits in using FSL in the field of corneal grafts are presented

Methods FSL is applied in performing deep lamellar (DALK), penetrating keratoplasty (PK) and arcuate keratotomy (AK) in human eyes. Clinical and histological analysis was performed.

Results FSL technology enables multiple cut configurations and customized‐shaped PK, DALK and AK are feasible techniques. PK with complex wound shapes including top‐hat profile and orientation teeth and notches can be performed. FSL‐deep lamellar dissection both for DALK and endothelial transplantation presents a good morphology of the dissection plane. The graft geometry in DALK for keratoconus, in contrast, shows limits related to the posterior stromal bed shape. Transmission electron microscopy revealed precise geometry and good quality of the cuts. Customised shaped paired AK can be successfully performed to treat high post‐keratoplasty astigmatims.

Conclusion Femtosecond laser technology may offer further promising approaches towards customized trephination, and dissection procedures in the field of corneal transplantation.
UVR‐effects in human versus animal eyes: more contradictions or more similarities?
Authors: WEGENER A
Published: September 2008

Purpose To compare the characteristics and time scales of UV‐radiation effects in the eye, especially the lens, investigated and documented in human and various animal species. The target is to test the predictability potential of animal experiments for characterization of human UV‐risk scenarios.

Methods Experimental studies on UV‐effects to the cornea and lens in mice and rats are critically compared to epidemiological studies on UV‐ effects to the human eye.

Results Animal studies provide a broad spectrum of data on genetical and environmental factors leading to various types of cataracts and corneal alterations. Many patho‐physiological factors are identified. Epidemiological studies in humans identify other noxious factors but the most important difference seems to be the time scale and thus the age‐related difference in UV‐sensitivity of the lens and the anterior eye segment.

Conclusion Future studies should focus more on species‐ and age‐related sensitivities of the lens to UVR effects and on the influence of systemic effects, also in relation to ocular immunology.
Oxidative stress in lens epithelial cells after UVR exposure
Authors: LÖFGREN S , GALICHANIN K , LOU MF , SÖDERBERG PG
Published: September 2008

Purpose The lens epithelium is the primary target in solar photooxidation. Thioltransferase is a repair enzyme capable of reactivating oxidized critical proteins and enzymes in the cells.

Methods Primary lens epithelial cell cultures from wild type and thioltransferase knockout mice were exposed to various doses of UV radiation or hydrogen peroxide. The short‐term reaction pattern of several glutathione‐related enzymes were investigated, as well as long‐term growth rate and cell adhesion.

Results UV radiation induces a reaction pattern comparable to that of hydrogen peroxide, with initial increase or decrease in activity of antioxidative enzymes, and a subsequent recovery within 1‐2 hours. Low dose UVR exposure induces cell stimulating effects similar to treatment with low peroxide concentration.

Conclusion Oxidative stress from peroxide and UVR might be channeled through same oxidant cellular pathway.
Systemic inflammatory response after ocular in vivo UVR‐300 nm exposure
Authors: MEYER L , WEGENER A , LÖFGREN S , GALICHANIN K , HOLZ FG , SÖDERBERG PG
Published: September 2008

Purpose To investigate if unilateral in vivo UVR‐B exposure of one eye affects the contralateral eye in a co‐cataractogenic, sympathetic reaction and to determine if an inflammatory response is involved in the pathogenesis.

Methods C57BL/6 mice were unilaterally exposed in vivo to UVR‐B for 15 minutes. Groups of 24 animals each received 0x/ 2x/ 3x/ or 4x cataract threshold equivalent dose. 48 hours following UVR ‐ B exposure cataract morphology was documented in dark field illumination photography and light scattering was quantified, in both lenses in vitro. Serum levels of pro‐inflammatory cytokines IL‐1ß, IL‐6 and TNF‐α were analyzed with ELISA. Immunohistochemistry was performed for inflammatory infiltration in exposed and contralateral eyes.

Results UVR‐B exposure induced cataract in all exposed lenses. There was additionally a significant UVR dose dependent increase of light scattering in contralateral not exposed lenses. Inflammatory infiltration was detected immunohistochemically in the anterior segment of both eyes. IL‐1β serum concentration increased with increasing UVR‐B exposure dose. There was a similar trend for serum IL‐6 but not for TNF‐α.

Conclusion Unilateral UVR‐B exposure increases light scattering also in the contralateral eye and triggers a systemic inflammatory response mediated by IL‐1β and possibly IL‐6. Age related cataract is almost exclusively a bilateral event. Since a systemic inflammatory response might be an important factor in cataractogenesis our results might initiate new strategies in the prevention of the disease.
Perfusion pressure and blood flow: difference and relevance
Authors: ORGUL S
Published: September 2008

Purpose Maintenance of appropriate levels of regional blood flow play an essential role in the maintenance of a stable internal environment of an organism. The relative contributions of the different mechanisms vary between and within vascular beds. The ability of vascular beds, especially those not or not particularly responsive to neuronal regulatory mechanisms, to maintain, within certain limits, an independence of regional blood flow from local perfusion pressure is called autoregulation.

Methods A proper appraisal of local perfusion pressure is mandatory if one is to understand blood flow and the effects of its perturbation. When speculating about ocular perfusion pressure, it has become customary to estimate mean blood pressure within the ophthalmic artery and to subtract the value of intraocular pressure, assumed to be equal to venous pressure. This concept, likely to be adequate under steady state condition in healthy eyes, may not hold under stress conditions or therapeutic interventions, as well as in disease states. Examples are manifold.

Results Simple starvation may put a burden on the circulation to maintain the supply of metabolites, possibly solved by increasing transmural capillary filtration pressure. In glaucoma, an increased venous pressure has been described and, indeed, more force must be applied to the eye to induce retinal venous pulsations. These conditions are simple examples where our current approach in estimating ocular perfusion pressure is probably incorrect.

Conclusion The regulatory responses of ocular vascular beds have not yet been elucidated in full detail, and care must be applied when speculating about ocular perfusion pressure, and many of our current assumptions with regards to autoregulation in the ocular circulation may need a very critical scrutiny.
Blood flow and metabolism measurements: are they ready for the clinic?
Authors: HARRIS A
Published: September 2008

Purpose A growing number of epidemiological studies clearly identified reduced ocular diastolic perfusion pressure as a significant risk factor for open angle glaucoma (POAG), suggesting that optic nerve ischemia and hypoxia may play a role in the etiology and pathogenesis of POAG.

Methods Advances in ultrasound, laser computerized image analysis and Doppler technologies, within the last two decades have made it possible to objectively measure ocular hemodynamics. Each technique, however, examines different facets of the vascular system focusing on varying anatomical location of blood vessels and providing differing hemodynamic outcomes.

Results My talk will cover the pros and cons of the existing technologies for measuring ocular blood flow. Focusing on color Doppler imaging, scanning laser ophthalmoscopy with fluorescein, scanning laser ophthalmoscopy with indo‐cyanine green, Heidelberg retinal flowmetry, laser Doppler flowmetry, retinal vessel analyzer (RVA) as well as the new generation of technologies aimed at measuring oxygen saturation in the optic nerve head and retina.

Conclusion At present no single technique can accurately assess all relevant vascular beds. More development and emphasis is necessary. This presentation will also focus on possible clinical utilization of ocular blood flow and metabolism measurements.
Available educational material from the European Glaucoma Society on ocular blood flow techniques
Authors: STALMANS I , ORGüL S , SCHMETTERER L , HARRIS A , TRAVERSO C
Published: September 2008

One of the major aims of the European Glaucoma Society is to provide education on glaucoma. Recently, an educational DVD was developed thanks to a joint effort of experts in the field. This DVD provides a comprehensive overview of various techniques that are used in the field of glaucoma. In the chapter on ocular blood flow, the following techniques are described: color Doppler imaging (CDI), retinal vessel analyzer (RVA), laser Doppler flowmetry (LDF) and confocal scanning Doppler flowmetry (HRF). The physical principles, the measured vascular beds and parameters, the clinical protocol, as well as the advantages and disadvantages are discussed and illustrated.
Variation of intraocular pressure (IOP) & central corneal thickness (CCT) in neonates
Authors: AGGELIDOY E , KOZEIS N , FELEKIDIS A , DROSOU‐AGAKIDOU V
Published: September 2008

Purpose To record the variation of IOP and CCT during the neonatal period. Also, to investigate the relationship between IOP & CCT.

Methods 52 neonates, pre‐ and full terms, with GA 24 to 40 weeks (31.9 w) and BW 720 – 3180 gr (1913 gr) participated in this study. IOP measurement was done by Tono‐Pen applanation tonometer and CCT measurement was done by Accutome ultrasound pachymeter only to the right eye. All the measurements were done between 15.00 and 17.00 am. Babies who had undergone an eye operation, babies with eye dysplasias or anomalies, or using corticosteroids recently, were excluded from the study.

Results Average CCT= 651,02 μm (STD= 63,19138) (min 528‐ max 750 μm) and the average IOP= 9.12 mmHg (STD= 2,931129). More specifically, in neonates with GA < 32 w, average CCT= 677.25 μm (STD= 51,13031) and average IOP= 9.4 mmHg (STD= 2,79). In neonates with 32<GA<37 w, average CCT= 638,5 μm (STD= 69,57379) and average IOP= 8.95 mmHg (STD= 2,601282). Finally, in neonates with GA > 37 w, average CCT= 613 μm (STD= 44,38919) and average IOP= 8,15 mmHg (STD= 3,275286).

Conclusion CCT is reduced as the neonate grows, while the IOP is increased. Finally, lower IOP is accompanied by thinner CCT.
Epidemiology of conjunctival melanocytic neoplasms
Authors: KIVELÄ T , TUOMAALA S
Published: September 2008

Purpose To summarise the epidemiology of conjunctival melanocytic neoplasms.

Methods Review of population‐based data on 85 patients with primary conjunctival melanoma (CM) and recently published literature.

Results CM accounts for 5‐7% of ocular melanoma in Europe. Its age‐adjusted incidence has increased 2‐fold in North Europe (Finland, from 0.40 to 0.80/million) and North America (USA, from 0.27 to 0.54) during the last 25 y. In both regions, age‐adjusted incidence is higher in men. Different rates between regions result from differences in registries, ethnicity and solar radiation. Age‐adjusted incidence of CM is 3‐fold in non‐Hispanic Caucasians and 2‐fold in Hispanics relative to Asians, African Americans and American Indians; among non‐Hispanic Caucasians it increases 2.5‐fold from 48 deg. (e.g. Paris) to 21 deg. (e.g. Mecca) of latitude. CM is rare below 30 y of age (age‐specific incidence, 0.06) but increases steadily thereafter (0.48, 1.05 and 1.57 for 30‐49, 50‐70 and >70 y, respectively). Median age at diagnosis is 58‐60 y. Most CM arise in limbal (57‐64%) followed by bulbar (12‐13%), palpebral (7‐9%) and caruncular (3%) conjunctiva. Tumor‐specific 5‐and 10‐y mortality estimates are 14‐20% and 29‐38%, respectively. Non‐limbal location, increasing tumor thickness and local recurrence are consistently associated with higher mortality. Clinically detectable primary acquired melanosis (PAM) and nevus precede or accompany CM in 57‐61% and 7‐23% of patients, respectively. Median age at diagnosis of PAM is 56 y. The risk of malignant change is not precisely known and depends heavily on subtype of PAM, ranging from 10 to 90%.

Conclusion Recent studies provide epidemiological data on CM which are remarkably consistent. The epidemiology of conjunctival nevi and PAM is less precisely known.
Treatment of conjunctival melanocytic neoplasms: the Liverpool experience
Authors: DAMATO B , COUPLAND SE
Published: September 2008

Purpose To audit the results of treatment of conjunctival melanoma in Liverpool.

Methods Patients treated between 1993 and 2006 were identified by searching the Ocular Oncology Service database and pathology archives. The casenotes were reviewed. Patients were included if their conjunctival tumour was histologically diagnosed as invasive melanoma. Tumour extent and location were defined using a mapping system we developed. During the course of this study, cryotherapy was abandoned in favour of topical chemotherapy for intra‐epithelial melanocytic neoplasia and brachytherapy for invasive disease.

Results Forty patients with invasive conjunctival melanoma were initially treated at our centre and another 36 were referred to us for salvage therapy after a surgical intervention elsewhere (11 with no visible tumour, 9 with intra‐epithelial disease and 16 with invasive melanoma). The patients we initially treated all retained the eye, most without significant visual loss. Recurrence occurred in six patients, none of whom had adjunctive brachytherapy. Four patients died of metastasis, all with caruncular involvement. After salvage therapy in 16 patients referred with recurrent or persistent invasive disease, two eyes were lost and five patients died, only one of whom had caruncular involvement.

Conclusion Excision of invasive conjunctival melanoma with adjunctive brachytherapy and topical chemotherapy achieved high rates of local tumour control with little ocular morbidity. Without caruncular involvement, disease‐specific mortality was rare unless the patient was referred with invasive disease after a surgical procedure elsewhere. Our results suggest that inexpert surgical intervention increases the risk of local tumour recurrence and metastatic death.
Conjunctival melanoma : the Curie experience
Authors: LEVY‐GABRIEL C , DENDALE R , SASTRE X , PLANCHER C , LUMBROSO‐LE ROUIC L , ASSELAIN B , DESJARDINS L
Published: September 2008

Purpose To evaluate the treatment of conjunctival melanoma at the Institut Curie in term of local recurrences, ocular preservation, distant metastasis and survival

Methods Retrospective study of patients with conjunctival melanoma treated for their first tumoral localisation between January 2000 and December 2005. The clinical records, histologic features, ocular treatments were rewiewed. The rate of local recurrences, ocular preservation, regional and distant metastasis, and survival were recorded.

Results During the study period, 91 patients were referred for conjunctival melanoma. 67 of them were treated for a first occurrence of malignant melanoma (38 women and 29 men). The mean age was 62 years (25 – 90). 32/67 patients (47 %) presented a primary acquired melanosis (PAM). Most cases (55 patients) were treated by surgical excision and adjunctive radiotherapy (Iodine plaque, protonbeam or external beam irradiation), 5 cases were treated by surgery alone, and the last 6 by surgery and adjunctive cryotherapy or adjunctive topical chemotherapy. 3 patients were lost of follow‐up. With a mean follow‐up of 52 months (15‐101months) 20/64 patients developped at least one local recurrence (between 1 and 7 recurrences). 16 of them presented a PAM. An enucleation was finally necessary for 1 patient and an exenteration for 2 patients. 7 patients developped metastatic disease (all but one presented a PAM) and 6 of them died.

Conclusion Local recurrences, metastatic disease and tumor related death appear to occur at higher frequency when melanoma is associated with PAM. This risk must be taken into account in the therapeutic approach of conjunctival melanoma.
Comparison of the Schioetz indentation tonometer with the Tonopen® tonometer and the influence of two different anaesthetic techniques on the IOP in the porcine eye
Authors: BUEHNER E , PIETSCH U , WIEDEMANN P , UHLMANN S
Published: September 2008

Purpose The aim of this study was to examine the accuracy of the intraocular pressure (IOP) reading of two portable tonometer in the porcine eye in situ. The influence of two anaesthetic techniques on the IOP was analysed.

Methods Experiments were conducted in 20 healthy domestic white pigs. After a standard premedication 9 pigs were investigated under a total IV propofol anaesthesia (A) and 11 pigs under an isoflurane inhalation anaesthesia (B). IOP was measured at two different time points: prior to anaesthesia (time 1) and 15 minutes after induction of anaesthesia (time 2). To compare IOP measurements obtained with the digital Tonopen® with those of Schioetz tonometry, one single measurement, generated by Tonopen® tonometer was compared with a single reading from Schioetz tonometer in 11 pigs at time point 1 and 2 (isoflurane anaesthesia).

Results A significant decrease in IOP of 13.8 % (A) and of 10.2 % (B) was measured in comparison to baseline IOP prior to general anaesthesia. There was a high significant (r = 0.68; p<.05) correlation at time 1 between the Schioetz and the Tonopen® tonometer but no significant correlation at time 2.

Conclusion The significant IOP‐lowering effect of inhalation and total intravenous anaesthesia has to be considered in animal models. We point out that there are established methods for clinical measurements of the IOP but the user should be aware that there are differences in measured IOP when methods are compared.
Intraocular pressure variation during different surgical procedures in rabbit eyes.
Authors: VIEIRA DE SOUZA N , VIEIRA DE SOUZA E , VERONESE RODRIGUES ML
Published: September 2008

Purpose To analyse intraocular and infusion line pressures during vitrectomy and cataract extraction (manual extracapsular extraction, phacofragmentation and phacoemulsification) in rabbit eyes.

Methods Twenty‐two rabbits were submetted to vitrectomy (25 eyes) and cataract extraction (42 eyes) ‐ extracapsular approach (14 eyes), phacofragmentation (14 eyes) and phacoemulsification (14 eyes). Their intraocular pressures were recorded through an antertior chamber cannula connected to a computed polygraph. Infusion line pressure was monitored only during vitrectomy and phacofragmentation.

Results Intraocular pressure spikes above 100 mmHg and sometimes almost reaching 200 mmHg were observed in this study. Phacoemulsification showed the greatest variation and phacofragmentation the smallest. The minimun pressures in all surgeries were around 0 mmHg. Infusion line pressure showed smaller variations than intraocular pressure.

Conclusion During surgical procedures in rabbit eyes, such as vitrectomy, extracapsular cataract extraction, phacofragmentation and phacoemulsification, there is a great intraocular pressure variation. Intraocular pressure did not show a good relation to infusion line pressure.
Invasive measurement of outflow facility in the living human eye
Authors: GINIS H , DE BROUWERE D , DASTIRIDOU A , TSILIMBARIS MK , PALLIKARIS I
Published: September 2008

Purpose To measure the pressure‐volume relationship (ocular rigidity) and outflow facility in the living human eye using a manometric device.

Methods Fourty cataract patients (aged 63 (13)) were enrolled in the study. An invasive manometric intraoperative dynamic measurement procedure was employed, using a computer controlled device, comprising a pressure sensor and a dosimetric pump. The anterior chamber of the eye is cannulated through a 21 gauge needle, under topical anaesthesia with drops and the initial IOP is recorded. The IOP is artificially set to 10 mmHg and the eye is infused with microvolumes of BSS. The IOP is recorded for 2 seconds after each infusion step in order to calculate the average IOP and its fluctuation during this interval. At 40 mmHg, the infusion stops and the sensor records the IOP decay curve for 60 sec. The ocular rigidity coefficient is calculated by the IOP‐volume relation in the stepping sequence corrected for the volume loss from the outflow pathways. A model incorporating the value of ocular rigidity was developed to calculate the outflow facility from the outflow sequence. The study was approved by the Institutional Board and performed under the patient’s informed consent.

Results The average rigidity coefficient of Friedenwald was of 0.0206 (sd 0.0042)μl ‐1. A nonlinear pressure volume relationship is found. The outflow facility was measured to be 0.31(sd 0.08) μl/min/mmHg. There were no complications related to the procedure.

Conclusion This invasive method of measuring ocular rigidity and outflow facility is safe and effective. Accurate measurements obtained with this method, avoiding the errors of tonography, may provide a normal database of these parameters in living human eyes.