bluuebunny/crossref_metadata_2025 huggingface dataset:
Responce to intravitreal Bevacizumab for macular edema following central retinal vein occlusion in patients with pseudoexfoliation syndrome
Authors: STECH S , JURKUTE N , JUSKIENE D , CIMBALAS A , ASOKLIS R
Published: December 2011

Purpose To evaluate efficacy of intravitreal 1.25mg Bevacizumab in patients with pseudoexfoliation sindrome (PEX) and macular edema (ME) secondary to central or branch retinal vein occlusion.

Methods A retrospective study was performed on 168 patients with central retinal vein occlusion (CRVO) and branch retinal vein obstruction (BRVO) with significant decreased visual acuity (VA) due to ME. To evaluate the role of 1.25mg bevacizumab in patients with PEX, were created two groups: the first group – 21 patients with CRVO or BRVO and clinical diagnosis of PEX (mean age 74.5 [range 63 ‐ 87]) and the second group – 21 patients with CRVO or BRVO with no clinical signs of PEX (mean age 72.7 [range 60 ‐85]). All patients were analyzed for the best corected VA and optical coherence tomography changes of the central macular thickness.

Results A clinical diagnosis of PEX was present in 21 of 168 patients (12.5%), 17 (81.0%) of them had a CRVO and 4 (19.1%) – BRVO. The average of initial VA in the first group was 0.16 (SD±0.19), in the second group – 0.18 (SD±0.19). In the second group the VA after intravitreal injection of bevacizumab was significantly better (0.49 (SD±0.33)) compared to the first group (0.29 (SD±0.26)) (Mann‐Whitney test, p=0.043). Mean central retinal thickness decreased from 696.9µm (SD±261.9) to 261.0µm (SD±154.2) in the first group and 636.5µm (SD±236.9) to 254.5µm (SD±167.2) in the second group.

Conclusion Pseudoexfoliation syndrome is signiﬁcantly more common in eyes with central retinal vein occlusion compared to branch retinal vein occlusion. Pseudoexfoliation syndrome could be counted as one of the factors damaging functioning of the neurosensory retina.
Neurovascular coupling and retinal oxygenation
Authors: HAMMER M
Published: December 2011

Purpose Luminance flicker stimulation of the photoreceptors is known to increase retinal blood flow. Oxygen supply may be the target of blood flow regulation. Thus, we investigated the oxygen saturation in retinal arterioles and venules along with their diameters in healthy as well as diabetic subjects.

Methods 18 patients with non‐proliferative diabetic retinopathy (mean age: 62.2±8.3 years, diabetes type I/II: 4/14, HbA1c: 7.7±0.92, duration of diabetes: 24.1±9.3 years) and 20 healthy controls (71.2±7.5 years) were included. Dual – wavelength (548 nm and 610 nm) fundus images were taken before and during monochromatic (567 – 587 nm) luminance flicker stimulation (12.5 Hz, modulation depth: 1:20) for 90 s. Diameters (central retinal arterial and venous equivalents – CRAE and CRVE) and oxygen saturation (SO2, dual – wavelength optical oximetry) were determined and averaged for all arterioles and venules in an annular area centered at the optic disk (“ARIC”– grid). Changes of these parameters by the flicker were considered for statistical analysis.

Results Flicker light increased CRAE, CRVE, and venous SO2 by 1.42%±3.72%, 2.80%*±2.70%, and 2.03%*±2.43% in the patients as well as 4.98%*±6.23%, 8.94%*±5.26%, and 4.20%*±3.71% in the controls (*: p<0.05). This increase was significantly higher in the controls vs. patients for all parameters (t‐test, p<0.05). The arterial SO2 remained unchanged in both groups. After adjustment for the subject’s age, the increase of the venous SO2 correlated significantly (p=0.035) with that of the CRAE in the controls but not in the diabetics.

Conclusion Our data demonstrate a coupling of retinal neuronal activity and hemoglobin oxygenation addressing the need of oxygen by the outer retina. Blood flow regulation and oxygen supply seem to be impaired in diabetes.

Commercial interest
Retinal vessel oximetry in glaucoma
Authors: MCNAUGHT A , HARVEY A , MORDANT D , GORMAN A , RITCHIE P , RODMELL P , MORGAN S , CROWE J
Published: December 2011

Purpose We undertook retinal vessel oximetry, using spectral imaging, with both sequential and snapshot cameras. We have validated the values obtained using a model eye. We have explored the propagation of light through the retina using Monte Carlo modelling. Clinical retinal oximetry results are presented from normal volunteers, and glaucoma patients.

Methods The sequential spectral camera employs a liquid‐crystal tunable filter. Images were captured using a cooled CCD camera, at wavelengths between 550nm and 680nm. The snapshot camera captures multiple spectral images simultaneously. We used the spectral images from these devices to calculate retinal vessel oximetric values, with the output displayed as a retinal oximetric 'map'. We obtained oximetric maps from normal volunteers, and compared these with the oximetric maps from glaucoma patients with a range of visual field loss.

Results There were significant differences between oxygen saturation in the retinal venules of the most severely affected glaucoma patients, compared with the normals: the glaucoma patients had higher values of venous saturation, with a correlation between visual field mean deviation (MD) and venous saturation. There were no significant differences in ateriolar oxygen saturation between normals and glaucoma patients.

Conclusion We have demonstrated retinal vessel oximetry using two types of spectral imager. We have attempted to validate our cameras using a model eye. We found higher venular oxygen saturation in glaucoma patients versus normals: these findings might suggest reduced inner retinal oxygen consumption in glaucoma. The venular oxygen saturation might represent an objective, clinically useful, measure of ganglion cell health.
Graft rejection in keratoplasty: Is there a place for topical immune modulation?
Authors: PLEYER U
Published: December 2011

Abstract not provided
Intraocular tumors and glaucomas
Authors: DE POTTER P
Published: December 2011

Anterior segment and posterior segment intraocular tumors and their treatments may induce secondary glaucomas. Their mechanisms and therapeutic approaches will be review in this presentation
Corneal Cell and Nerve Regeneration promoted by Biosynthetic Implants
Authors: LAGALI N , GRIFFITH M , FAGERHOLM P
Published: December 2011

Purpose To assess cell, nerve, and stromal regeneration in a biosynthetic material 3 years after implantation into human corneas, and compare results to human donor corneas.

Methods 10 patients received biosynthetic implants, and 10 received human donor corneas. At 12, 24, and 36 months postoperatively, slit lamp, anterior segment optical coherence tomography (ASOCT), contact esthesiometry, and in vivo confocal microscopy (IVCM) examinations were performed.

Results Thickness remained stable in biosynthetic corneas, while swelling was observed in donor material. Reduced transparency was apparent at graft borders in all corneas, while clear central corneas were observed in all donor corneas and in some biosynthetic corneas at 3 years. At the cellular level, biosynthetic material was incompletely populated by keratocytes after 3 years, while human tissue contained keratocytes and features indicative of stromal cell death, not seen in biosynthetic implants. Only partial touch sensitivity was restored in both groups after three years, corresponding to slow subbasal nerve recovery. Nerve regeneration into the central cornea was apparently impeded by peripheral interface scar tissue in all corneas. The epithelial‐to‐stromal transition was uneven in biosynthetic implants, while epithelium overlying human donor tissue often contained dendritic inflammatory cells.

Conclusion No cornea resembled a native cornea at 3 years. Nerve and sensitivity restoration were incomplete, and scar tissue was stable over the long term. Keratocytes slowly populated the biomaterial, and keratocyte death was common in human donor tissue. Only human donor corneas exhibited signs of an immune response at the microscopic level.
Intrasession reproducubility of retinal nerve fibre and macular thickness measurements using Cirrus Fourier‐domain OCT in DM patients without retinopathy
Authors: IDOIPE M , PRIETO E , EGEA MC , FERNANDEZ‐PEREZ S , GARCIA MARTIN E , PINILLA I , BORQUE E
Published: December 2011

Purpose To evaluate the intrasesion reproducibility of retinal thickness and retinal nerve fiber layer (RNFL) measurements in type 1 diabetic subjects without retinopathy using Cirrus Fourier‐domain optical coherence tomograph (OCT) (Carl Zeiss Meditec, Inc)

Methods 35 patients with diabetes Mellitus (DM) type 1 underwent 3 scans through Cirrus‐HD in the same session, separated for 3 minutes between each scan. Each scan included 2 adquision protocols: “Macular Cube 512 x 128” and “Optic Disc Cube 200 x 200”. Descriptive statistics, analysis of variance, intraclass correlation coefficients (ICCs) and coefficients of variation (COV) were calculated for nine areas corresponding to the Early Treatment Diabetic Retinopathy Study an for macular volume, and for quadrants and RNFL clock hours sectors.

Results Mean retinal thickness was 298,14 ± 12,76 µm at the first scan, 296,97 ± 12,75 µm at the second scan, and 296,86 ± 12,03 µm at the third scan. Coefficients of variation ranged from 0,7% to 2,2%. Intraclass correlation coefficients ranged from 0.622 to 0.972. Mean RNFL average thickness were 97,28 ± 9,26 µm at the first scan, 96,38 ± 9,98 µm at the second scan, and 95,91 ± 10,11 µm at the third scan. COV ranged from 1,9% to 5,5%. ICC ranged from 0.823 to 0.987. No significant differences were found except in macular central thickness.

Conclusion Retinal and RNFL thickness measurements obteined using Cirrus OCT were highly reproducible in type 1 DM patients with low intrassesion variabilities, so it can be consider a valid device for measuring retinal and optic nerve parameters in these patients.
Cytokines and adhesion molecules in proliferative diabetic retinopathy: High vitreous concentration of IL‐6 and IL‐8, but not of adhesion molecules in relation to plasma concentrations
Authors: LIINAMAA MJ , KOSKELA UE , KUUSISTO SM , NISSINEN AE
Published: December 2011

Purpose Inflammatory markers have been observed in vitreous in diabetic retinopathy, but the increases may be predominantely due to leakage than due to intraocular production. We assessed vitreous concentrations of adhesion molecules and cytokines in proliferative diabetic retinopathy (PDR) and non‐diabetic controls (C) in correlation to corresponding plasma levels. The purpose of the study is to differentiate intraocular production from breakdown of the blood retinal barrier.

Methods The study population was 38 patients with PDR undergoing vitrectomy. Group C consisted of 16 subjects vitrectomized for macular hole or epiretinal membrane. Vitreous and plasma concentrations of six adhesion molecules (sE‐Selectin, sICAM‐1, sICAM‐3, sPECAM‐1, sP‐Selectin, sVCAM‐1) and eleven cytokines (IL‐1β, IL‐2, IL‐4, IL‐5, IL‐6, IL‐8, IL‐10, IL‐12(p70), TNF‐α, TNF‐β, IFN‐γ) were detected by the flow‐cytometry based Multiplex assay (Bender).

Results IL‐6 and IL‐8 were 26‐fold and 6‐fold higher in vitreous than in plasma in PDR, respectively. Vitreous concentrations of IL‐10, sPECAM‐1, sE‐selectin, sICAM‐1 and sVCAM‐1 were higher in PDR than C. However, concentrations of adhesion molecules in vitreous in PDR were less than 10 % of corresponding concentrations in plasma. Also anti‐inflammatory IL‐10 was lower in vitreous than in plasma and vitreous IL‐10/IL‐8 ratio significantly lower in PDR than in C.

Conclusion There is an active role of cytokines IL‐6 and IL‐8 in proliferative diabetic retinopathy, which might be due to their intraocular production. Furthermore, there is an imbalance between inflammatory and anti‐inflammatory cytokines in vitreous.
Retinal photoxicity related to xenon light
Authors: GARCIA M , CASTRO J
Published: December 2011

Purpose To describe the anatomical and functional changes observed after surgery, in three patients with idiopathic macular hole, who developed retinal toxicity related to Xenon light.

Methods Three eyes (3 patients), two females and one male, underwent three‐port pars plana vitrectomy with internal limiting membrane (ILM) peeling and fluid‐gas exchange. In all cases we used a new Xenon light during surgery with an intensity power ranging between 50 and 75%. In order to facilitate ILM peeling, Indocyanine Green (ICG) (0.05%) was used in one case and Brilliant Blue G (BBG) in two cases. Full clinical examination, with determined Best Corrected Visual Acuity (BCVA), fundus examination, retinography and Optical Coherence Tomography (OCT), were performed prior and after surgery. Fluorescein angiography (FA) was also performed in all cases after surgery.

Results One week after surgery, the macular hole was closed in all cases and it remained stable during follow‐up. One month later, BCVA was lower than before surgery and we observed changes in retinal pigment epithelium at the posterior pole. These changes were more intense three months later: retinal atrophic areas combined with patches of hyperplasia of the RPE in the macular area. The FA confirmed the diagnosis of retinal phototoxicity. Similar changes were observed at six months, one, two and three years later in all cases with a final BCVA lower than 1/10 in all eyes.

Conclusion The light we use to perform vitrectomy may cause photoxicity. As we used two different dyes during surgery, and previously we had operated more than two hundred cases of macular hole with ICG and halogen light without problem, we postulate that changes observed in these cases could be due to Xenon light, independently of the use of different dyes.

Commercial interest
Intravitreal ranibizumab in the treatment of subretinal neovascularization in a case of punctate inner choroidopathy
Authors: PEREZ GARCIA D , PINILLA I , JIMENEZ DEL RIO B , IBANEZ J , PEIRO EMBID C , CABEZON L , CRISTOBAL JA
Published: December 2011

Purpose To report a case of a subretinal neovascular membrane in a bilateral retinal lesions compatible with punctate inner choroidopathy (PIC) treated with intravitreal ranibizumab obtaining excellent results.

Methods A 28‐year old woman suffering loss of visual acuity with her left eye, who presented an image suggestive of subretinal neovascular membrane in her left eye and bilateral retinal lesions compatible with punctate inner choroidopathy(PIC).

Results In this situation it was decided to initiate treatment with intravitreal ranibizumab in OD,(monthly for a total of three injections). The visual acuity improved to 20/30 after 1 st injection. One month after the third injection, the BCVA was 20/20 and remained stable. During the year the patient has been followed in our department were no new symptoms or signs of activity.

Conclusion The differential diagnosis must be made between PIC and the rest of “white dot syndromes" and the presumed ocular histoplasmosis syndrome (POHS). Angiogenic drugs may be a good alternative for the treatment of such diseases when they develop a subretinal neovascular membrane.
Retinal manifestations in catastrophic antiphospholipid syndrome
Authors: VILLAFRUELA I , COLAS T , PRIETO M , CLARIANA A , RIVAS O , FERNANDEZ A , BORREGO R , DE PABLO P
Published: December 2011

Purpose We present a case report with an ocular vascular event and multiple organ thrombosis and dysfunction in the presence of antiphospholipid antibodies.

Methods We report a case of a 79 years old female related visual loss in left eye. She had a venous occlusion and vitreous haemorrhage. In two weeks presented a maculopapular, bullous skin lesions on the legs, rapidly followed by widespread cutaneous necrosis and skin ulceration on all the limbs showing the tendons tissues of the heels. Later, she had an extension of thrombotic events to other vessels in the body. With medical treatment, there was initially a small functional improvement and then a general degradation in 10 weeks, followed by the death of the patient secondary to sever pulmonary emboli in the intensive care unit.

Results It was found histopathologic evidence of multiple small‐vessel occlusions, and laboratory confirmation of the presence of antiphospholipid and anticardiolipin antibodies, in high title. It was refractory to anticoagulation, steroids and immunomodulation treatment

Conclusion Catastrophic antiphospholipid syndrome is an autoimmune disorder characterized by a rapidly progressive life‐threating disease. Catastrophic occurs when three or more organ systems are affected by thromboses in a very short time less than a week. Roughly 50% of these patients have systemic lupus erythematosus. The overall mortality of this desvasting syndrome is about one‐half.
Laser and surgery treatment of retinoschisis
Authors: BAGDASAROVA T
Published: December 2011

Purpose To find new methods to cure retinoschisis.

Methods Observed:130 patients. In1and 2 stages of process there were 80 patients (80 eyes). For these cases we used our method – step‐by‐step progression – beginning laser coagulation around the macula and toward the periphery retina. We used diode laser. Radiation power: 350mW‐850mW, wavelength: 0,83 mm, exposition 0,2 s, spot diameter: 150‐200mm. In 3 stage there were 50 patients (50 eyes), but in 3 stage laser coagulation was used only in 27 cases. In 23 cases we used surgery because these patients had new retina ruptures with traction by vitreous body. Before operation laser coagulation around macula zone and along the vessels. For surgery a segment‐oval silicone sponge imрlants was used. This implant is constructed with unilateral protuberant surface that affords to get sufficient press roller to blockade any schisis holes in eye retina. Application method of segment oval consists: implant lies on sclera on its convex surface and is fixed by several nodulous sutures in projection of retinal ruptures. Implant is not strengthening out in length but is applanated toward retina. It is possible to blockade large gigantic ruptures, dialysis and group of ruptures in retina. We did not drainage intraretinal fluid; repeated laser‐coagulation in 7 days after operation

Results 1‐2 stages of retinoschisis after 4 session of laser coagulation we observed complete cysts delimitation outside macular zone. Complete intraretinal fluid resorption was achieved in 2 years.

Conclusion Full fluid resorption was observed in 15 patients in 3 stage of retinoschisis after 5 sessions of laser coagulation. In 12 patients of 3 stage we observed complete cysts delimitation outside macular zone. In 23 cases of 3 stage operations ended with good results
Ligneous conjunctivitis. Response to topical cyclosporine and mitomycin
Authors: DE LA MATA G , FERNANDEZ‐PEREZ S , FERNANDEZ TIRADO J , PRIETO E
Published: December 2011

Purpose We report a case of a 50‐years‐old female referred for pseudomembranous conjunctivitis in the left eye(LE) that is unresponsive to conventional antibiotic treatment, presenting continual recurrence of the membranes after extraction.

Methods Left eye showed hyperemia with yellowish‐white pseudomembranes adherent to the tarsal conjunctiva.The extraction of the membranes lead to relapse within a few days.She was treated with antibiotics and topical anti‐inflammatory without improvement.

Results The culture was negative.We associated systemic steroids and excision of the membranes with topical mitomycin.Pathological anatomy confirmed the diagnosis of ligneous conjunctivitis,so topical cyclosporine A is added,but persisted upper tarsal pseudomembrane.At this time,repeated injections of mitomycin were performed at the upper eyelid,with remarkable clinical improvement.After months of gradual withdrawal of treatment,the disease remited leaving a retraction in the upper eyelid.

Conclusion Ligneous conjunctivitis is a rare form of chronic conjunctivitis characterized by recurrent formation of conjunctival pseudomembranes‐rich fibrin.It begins in childhood as a bilateral conjunctivitis that does not respond to conventional treatments,with yellowish‐white pseudomembranes that progress to form woody masses that replace the normal mucosa.Its pathogenesis is unknown,but recently has been associated with type I plasminogen deficiency.These patients may have lesions on other mucous membranes.Treatment consists of topical antibiotics and anti‐inflammatories as well as heparin, cyclosporine and topical mitomycin, or the recent addition of topic plasminogen.The visual prognosis is closely related to corneal involvement present in 30% of cases.
Fourier‐domain OCT and keratoconus
Authors: IDOIPE M , EGEA MC , PRIETO E , HERRERO LATORRE R , FERNANDEZ‐PEREZ S , SANCHEZ PEREZ A , BRITO C
Published: December 2011

Purpose Optical coherence tomography (OCT) is an optical imaging technique that provides high resolution, cross‐sectional, in vivo, noninvasive measurements of the eye. The OCT is widely used in ophthalmology, especially in retina and neurophthalmology. For the study of anterior segment, Visante® OCT has so far been the most widespread, with the disadvantage of high cost and lacks posterior pole module.Currently one of the posterior pole tomographs, Cirrus HD‐OCT (Carl Zeiss Meditec Inc., Dublin, CA), has introduced an anterior segment high‐resolution module.

Methods We describe the use of Cirrus HD‐OCT (Carl Zeiss Meditec Inc., Dublin, CA) and its application in Keratoconus, a prevalent pathology. We present several images of anterior segment Cirrus HD OCT. We can appreciate its use in the study, analysis and follow‐up of the keratoconus, as well as for the evaluation of the corneal status after surgical treatments.

Results Cirrus HD allows the measurements of corneal thickness and show the thinning process,it shows the corneal ectasia,the presence and quantification of hydrops, defines the exact depth of the placement of intracorneal rings and the visualization of them, the tunnels of implantation, the condition of the epithelium in the main incision, the condition of the keratoplasty seeing the donor‐recipient interface, etc.

Conclusion Cirrus HD allows the measurements of corneal thickness and show the thinning process,it shows the corneal ectasia,the presence and quantification of hydrops, defines the exact depth of the placement of intracorneal rings and the visualization of them, the tunnels of implantation, the condition of the epithelium in the main incision, the condition of the keratoplasty seeing the donor‐recipient interface, etc.
The Effect of Anti‐VEGF Treatment and Triamcinolone in Experimental Retinal Vein Occlusion
Authors: REHAK M , HOLLBORN M , WIEDEMANN P , BRINGMANN A
Published: December 2011

Purpose We investigated the effect of intravitreal injection of anti‐VEGF antibodies and triamcinolone acetonide (TA) in a rat model of central retinal vein occlusion (CRVO).

Methods In one eye of adult Brown Norway rats (n=81) CRVO was induced with laser photocoagulation. Animals were divided into 3 groups (each n=27): 1. CRVO only without any treatment; 2. CRVO with anti‐VEGF antibodies; and 3. CRVO with TA. The injection of anti‐VEGF antibodies or TA was performed 15 minutes after CRVO induction. The gene expression was investigated using RT‐PCR in the neural retina 1, 3 and 7 days after CRVO. We analyzed the expression of VEGF‐A, VEGF‐B, PEDF; of channels implicated in retinal osmohomeostasis (Kir4.1, AQP4, AQP1), and of inflammatory factors IL‐1ß and IL‐6.

Results CRVO induced a rapid transient upregulation of Vegfa, and a delayed upregulation of Pedf. Further strong, downregulation of Kir4.1, Aqp4, and Aqp1, and striking rapid upregulation of Il1ß and Il6 was observed. Anti‐VEGF antibodies fully prevented the upregulation of Vegfa and of Pedf, and decreased the upregulation of Il1ß. This treatment had no effect on the expression of Kir4.1, Aqp4, Aqp1, and Il6. Intravitreal TA reversed the downregulation of Kir4.1 and accelerated the normalization of the upregulated expression of Il1ß and Il6, but had no significant effect on the expression of Vegfa.

Conclusion The anti‐VEGF treatment inhibits strongly the upregulation of Vegfa but influences only marginally the water channels or inflammatory factors. TA inhibits the expression of IL‐1ß and IL‐6, and has neuroprotective effects via improvement of retinal potassium homeostasis.
Retinal vascular profiles
Authors: MACKAY FREITAS A
Published: December 2011

Purpose It is our aim to study the retinal arterial and venous vascular profiles, in health and in arterial hypertension and glaucoma

Methods The temporal arteries and veins were studied, from the optical disk margin to the first bifurcation,Their trajectory was pinpointed in a digital platform, and their coordinates in the two dimensional plane were noted.A polynomial function was found that was graphically equal to the profile, To compare polynomials, a Pearson correlation was used. The variables to be compared were the coefficients and the squares of x. The intercept of the regression line (on the y axis) made the distinction between arteries and veins, and between pathological entities studied. We used the t test, with P< .05 to analyze groups.

Results NORMAL: 3 for the arteries and 2, 7 for the veins. HIPERTENSION: 4, 4 for the arteries and 4,6 for the veins. GLAUCOMA: eighteen eyes, all with primary open angle, two with pseudo exfoliation. We divided them in two groups: A with a stabilized clinical control and B with a degrading ophthalmological situation. The P values between intercepts of the arteries and the veins of the two groups were respectively 0,037 (<0, 05) and 0, 11

Conclusion The correlation between the coefficients and the squares seems to be characteristic for arterial hypertensive patients. For glaucoma patients, the low values of the arterial intercepts are characteristic of the group with worse response to medical and surgical therapy. Those with normal values stabilized their clinical glaucomatous condition with medical therapy.
Measurement of retinal oxygen saturation in patients with chronic obstructive pulmonary disease
Authors: PALKOVITS S , LASTA M , SCHMIDL D , BOLTZ A , TOLD R , KAYA S , GARHOFER G , SCHMETTERER L
Published: December 2011

Purpose In the recent years several systems for the measurement of retinal oxygen saturation became commercially available. These systems rely on spectral analysis of the light reflected and scattered at the fundus. To measure the validity of the obtained results is difficult, because no gold standard method for the measurement of retinal oxygen saturation exists. We measured oxygen saturation in patients with reduced arterial oxygen saturation due to chronic obstructive pulmonary disease (COPD) and correlated data obtained in retinal arteries with systemic oxygen saturation values.

Methods Eleven patients with COPD were included in this study and two identical study days were scheduled. The patients were in need of long term oxygen therapy to reach normal values for the oxygen saturation. Retinal arterial oxygen saturation was studied using spectral analysis of fundus photos using the Retinal Vessel Analyzer (Imedos®). Systemic oxygen saturation was studied with a pulse oximeter. The measurements were repeated 20 minutes after the oxygen therapy was paused.

Results On day one systemic oxygen saturation in patients with COPD was 93 ± 4% and 86 ± 6% with and without oxygen therapy, respectively. Retinal arterial oxygen saturation was 91 ± 5% and 87 ± 6%, respectively (similar findings on day two). The correlation between systemic and retinal oxygen saturation was high (Day 1: r=0.68, p=0.023; Day 2: r=0.91,b p=0.001). In addition we found a high correlation coefficient of the change in oxygen saturation values (Day 1: r=0.88, p=<0.001; Day 2: r=0.67, p=0.047).

Conclusion Our data indicate that measurements of arterial retinal oxygen saturation using the Retinal Vessel Analyzer show adequate validity.
Lamellar and penetrating keratoplasties
Authors: WYLEGALA E
Published: December 2011

Abstract not provided
Living with juvenile idiopathic arthritis
Authors: LANDGRAFF OESTLIE I , JOHANSSON I , MÖLLER A
Published: December 2011

Purpose The purpose of the current study was to get a deeper insight into adolescents' experience of life with juvenile idiopathic arthritis (JIA) in the transition process from childhood to adult life, as described by young adults with JIA.

Methods The method used was individual qualitative interview, and 15 young adults were interviewed. The interviews were tape recorded and transcribed. Data were analysed using a qualitative content analysis approach.

Results From childhood into adult life, living with JIA involves struggle and adjustment to an insecure everyday life and an unpredictable life course. The informants' experiences emerged as dicotomies on a continuum describing the dynamics in life experiences individually and over time. The categories include bodily experiences of limitations or freedom, being acknowledged or set aside in interpersonal relationships, and intrapersonal experiences of insecurity or confidence. The findings indicate a change to greater acceptance and adjustment to the disease over time. However, the perception of being weak and different continued, and in adult life concerns about future health and life were more pronounced.

Conclusion The impact of JIA on life in a time of transition from childhood to adult life involves complex challenges on coping strategies and adjustment processes. Understanding this complexity is urgent for health professionals in order to contribute to both normal developmental task achievements and overall well‐being for young people with JIA.
Patients with advanced glaucoma with controlled intraocular pressure and visually significant cataract: phacoemulcification vs combined surgery
Authors: LIASKA A , CHATZISTEPHANOU K , PAPAKONSTANTINOU D , THEODOSIADIS P
Published: December 2011

Purpose cataract surgery alone may have a beneficial effect in glaucoma patients by mildly lowering the intraocular pressure but loss of intraocular pressure (IOP) control may occur after cataract operation. It has also been suggested that patients presenting with more advanced glaucoma may have better outcomes with surgery than medical treatment. The purpose of the study is to investigate the postoperative results of two surgical alternatives: phaco only versus combined phaco trab operation in eyes with advanced glaucoma and controlled IOP.

Methods Prospective study of 78 patients with advanced open angle glaucoma (MD≥12 dB) with IOP≤21mmHg on topical medication and visually significant cataract (VA ranging from Hand Movements to 4/10). All patients were randomized to have either combined surgery (phaco‐trab, two‐sites, using adjustable sutures) (Group A, 39 eyes) or phaco only ( clear cornea temporal approach) (Group B, 39 eyes). Follow up for 6 months. VA, IOP and VF were measured regularly with appropriate IOP control. Postoperative complications were recorded.

Results Phaco group showed faster visual recovery, higher peak IOP, greater IOP fluctuations and less MD difference than phaco_trab group, with the latter performing worse. Final VA didn't differ significantly between groups. Major complications: 9 choroidal detachments and 1 hyphema in Group A.

Conclusion for the first 6mo postoperatibvely higher IOPs in phaco only patients do not seem to worsen glaucoma lesions given strict IOP control. Even more, phaco_only eyes show faster visual improvement and need less prolonged intensive postoperative monitoring than phaco_trab eyes.
Evaluation of the efficacy of patterned laser trabeculoplasty: Pilot study
Authors: DENEYER J , POURJAVAN S , DETRY‐MOREL M
Published: December 2011

Purpose To evaluate the efficacy of Pascal Laser Trabeculoplasty (PLT) employing reduced energy levels in patients with OHT or POAG.

Methods Prospective, pilot study including 12 patients with OHT or POAG. Pascal laser trabeculoplasty was performed on the inferior 180° of the treated eye after titrating the energy for each patient. The IOP was measured with Goldmann applanation tonometer (GAT) on laser treatment day (D0), 1 week post laser (D7) and 1 month post laser (D30). Anova for repeated measurements was used for the statistical analysis.

Results The mean IOP on D0 was 25.2 ± 1.4 mmHg (range: 22 to 28.4 mmHg), mean IOP on D7 was 23.1 ± 1.5 mmHg (range: 19.8 to 26.4 mmHg) and mean IOP on D30 was 20.6 ± 1.1 mmHg (range: 18 to 23.1 mmHg). There was no significant difference between the D0 IOP and D7 IOP (p= 0.43) but between D0 IOP and D30 IOP (p= 0.001)

Conclusion Patterned laser trabeculoplasty causes significant IOP decrease after 1 month. In this pilot study The IOP drops by 20% after 1 month.
Follicular lymphoma of the ocular adnexal region in Denmark
Authors: RASMUSSEN PK , RALFKIAER E , PRAUSE JU , SJÖ LD , HEEGAARD S
Published: December 2011

Purpose To characterize the clinicopathological features of follicular lymphoma of the ocular adnexal region.

Methods The present nation‐based series of orbital and adnexal follicular lymphoma was collected between 1980 and 2009. Histological specimens were re‐evaluated using a panel of monoclonal antibodies. Clinical files from all patients with confirmed follicular lymphoma were collected.

Results A total of 24 patients with follicular lymphoma of the ocular adnexal region were identified. Fourteen of the patients were females. The patients had a median age of 63 years (range 42 to 96 years). Eighty‐eight percent of the patients had unilateral ocular adnexal region involvement, and the most frequently affected sites were: the conjunctiva (35%), the orbit (29%), and the lacrimal gland (21%). Fifteen patients (63%) presented with Stage I lymphoma. Three patients (12%) had Stage II, one patient (4%) had Stage III, and five patients (21%) presented with Stage IV lymphoma. Patients were treated with: radiotherapy (58%), chemotherapy (37%), and surgery alone (5%). Complete remission was observed in 79% of the patients. However, seven (37%) of these had a relapse, and were treated with local radiotherapy prior to setback. The 5‐year and 10‐year overall survival rate for the whole study group was 89% and 66%.

Conclusion Follicular lymphoma of the ocular adnexal region is mainly prevalent in elderly patients. The conjunctiva is the most commonly affected location. The majority of patients present with Stage I/II lymphoma, and the overall prognosis is relatively good. However, relapse or disease progression is frequently seen in this patients group.
High resolution images of the tear film lipid layer: effect of the blink cycle
Authors: KING‐SMITH PE , BRAUN RJ , NICHOLS JJ , NICHOLS KK
Published: December 2011

Purpose Deficiency of the lipid layer causes evaporative dry eye. We have therefore developed a high‐resolution microscope to investigate lipid layer structure and how it may relate to evaporation and the blink cycle.

Methods The microscope images a 200 um diameter spot at the center of the cornea, with a resolution of about 1 um. Time after a blink is also recorded. Over 10,000 images of at least “fair” quality were recorded from 375 subjects including dry eyes and normals.

Results 1. Within about 0.1 seconds after a blink, lipid layer reflectance was less than at later times, implying that lipid thickness was lower. In this early interval, cloud‐like patches of lipid were more often seen than at later times; they were surrounded by darker (thin) lipid. 2. Some structures in the lipid layer were very fluid, showing pronounced shape changes in a fraction of a second, whereas other structures were stable, with no evident change over several seconds.

Conclusion 1. Immediately after a blink, the lipid layer tends to be thin and often has an unusual appearance. 2. At later times, some structures vary rapidly in shape, indicating that the lipid layer is fluid with a low viscosity. Other structures are stable, suggesting that the lipid layer can have a gel‐like structure.
Analysis of factors affecting the decrease of endothelial cell density of imported donor corneas
Authors: HOSIK H , MAN SOO K , EUN CHUL K , SEOK JOON K
Published: December 2011

Purpose To evaluate the difference between corneal endothelial cell density at the moment of preservation and keratoplasty in imported donor corneas, and analyze the correlated factors of the difference.

Methods Eighty‐seven corneas imported between March 2009 and February 2011 were evaluated. Corneal endothelial cell density at the moment of preservation was obtained from the medical record and was measured just before the keratoplasty.

Results All of the corneas showed decrease of endothelial cell density. Mean endothelial cell density of imported donor corneas at the moment of preservation and keratoplasty was 2789±235 cells/mm2 and 2592±254 cells/mm2(p=<0.001). Mean endothelial cell loss was 197±148 cells/mm2, which was significantly correlated with preservation to surgery time, death to surgery time and preservation period more than 7 days(p=0.042, p=0.045, p=0.036 respectively).

Conclusion Decrease of death to surgery time and keratoplasty before 7days of preservation period are needed for better surgical outcome.
A retrospective comparison of enhancement rate between low myopic astigmatism and high myopic astigmatism in patients treated with Femtosecond LASIK
Authors: CANADAS SUAREZ P , IGLESIAS M , GIMENEZ P , CANONES R , TEUS M
Published: December 2011

Purpose To analyze the retreatment rate between patients with low myopic astigmatism versus patients with high myopic astigmatism; all of them treated with Femtosecond Laser‐ Assisted Sub‐Bowman Keratomileusis ( FSBK ).

Methods To analyze the retreatment rate between patients with low myopic astigmatism versus patients with high myopic astigmatism; all of them treated with Femtosecond Laser‐ Assisted Sub‐Bowman Keratomileusis ( FSBK ).

Results The preoperative mean data were: Group I: Sphere was –3.98  2.09. Cylinder was –0.44  0.3 and best corrected visual acuity ( BSCVA ) was 1.15  0.1. Group II: Sphere was –3.66  2.54. Cylinder was –2.41  0.87 and BSCVA was 1.00  0.1. Three months after FSBK: The mean postoperative uncorrected visual acuity ( UCVA ) remained slightly higher in group I ( 1.08  0.2 ) than in group II ( 0.88  0.2 ) with p  0.001. The mean sphere was + 0.02  0.4 in group I and + 0.11  0.5 in group II ( p  0.009 ), and the mean cylinder was statistically significant superior ( p  0.0001 ) in group II ( ‐0.55  0.6 ) than in group I ( ‐0.11  0.2 ). This is correlated with the retreatment rate found, which was 26.9% ( 110 eyes) in group II and 6.48% ( 28 eyes ) in group I ( p  0.0001 ).

Conclusion In patients with primary myopic astigmatism treated with FSBK, we found an statistically significant higher rate of enhancements in eyes with high myopic astigmatism ( 26.9 % ) than in eyes with low myopic astigmatism ( 6.48 % ).
Strontium brachytherapy in conjunctival melanoma
Authors: MISSOTTEN G , DE KEIZER RJW , SPILEERS W , BLANK L
Published: December 2011

Purpose To describe the experience, the indications, the outcome, complications and prognosis of strontium brachytherapy in bulbar conjunctival melanoma.

Methods 46 with conjunctival melanoma, treated with strontium brachytherapy in Leuven, Leiden or Amsterdam, were revised. Clinical indications, visual outcome, prognosis and complications were registered.

Results In 38 patients 6x10 Gy was used, with 2 recurrences and 1 scleral melting. In 7 cases 6x5,9 Gy was used with 4 recurrences. In 3 cases a second strontium brachytherapy application was needed. Although there were in almost all cases transient dry eye symptoms, no major anterior segment problems were seen. With the exception of 1 scleral melting,in a patient where also a previous extended surgery was done with excision of sclera.

Conclusion Strontium brachytherapy is a safe treatment for conjunctival melanomas, when a dosis of 60 Gy is used. It gives rarely complications.
Chromosomal alterations in iris melanoma
Authors: COUPLAND SE , BAUDO MM , LAKE SL , KALIRAI H , DAMATO BE
Published: December 2011

Purpose Melanomas arising in the iris (IM) are rare comprising about 5% of all uveal melanomas (UM). They are seldom lethal with only 2‐4% of IM associated with metastatic spread. The genetic pathogenesis of IM and its favourable outcome, compared with choroidal and ciliary body UMs, is still not well understood. The aim of this study was to investigate whether genetic changes associated with prognosis in choroidal/ciliary body UMs (i.e. monosomy 3 and polysomy 6p or 8q) are also indicative of prognosis in IM.

Methods Changes in chromosome 1p, 3, 6 and 8 copy number were detected in seven IMs by Multiplex Ligation‐dependent Probe Amplification. Full clinical, histomorphological and survival information was available for each patient.

Results There were five male and two female patients, whose age ranged from 32‐68 years (median 51 yrs). Three patients had received previous proton beam therapy. Two patients died due to metastatic melanoma; both tumours showed polysomy 8q, with one tumour also showing monosomy 3 and the other showing polysomy 6p. Time from diagnosis to metastatic death was longer for the patient with a polysomy 6p tumour (6 yrs) than for the monosomy 3 tumour (3 yrs). The remaining five patients demonstrated no consistent genetic alterations and were alive with no evidence of metastases at the time of analysis.

Conclusion This study suggests that genetic changes in chromosomes 3, 6p and 8q, previously observed for choroidal/ciliary body UM, could also be associated with survival in IMs. Further high‐resolution studies with a larger cohort of IM are currently being performed to validate these data.
Are liver function tests relevant for early detection of liver metastasis of uveal melanoma?
Authors: MOURIAUX F , DIORIO C , BERGERON D , BERCHI C , ROUSSEAU A
Published: December 2011

Purpose The liver is the main target for screening for uveal melanoma metastasis, which could be achieved by liver function tests (LFTs). The aim of our study is to analyze the relevance of LFTs for detection of metastatic disease in term of prognostic value and cost evaluation

Methods Patients (n=88, who developed metastasis while undergoing semi‐annual follow‐up with LFTs including aspartate‐aminotransferase (AST), alanine‐aminotransferase (ALT), gammagutamylransferase (γGT), lactodeshydrogenase (LDH), and phosphatase alkaline (PA) were included. For assessing the level of LFTs for metastasis only the one preceding screening LFTs before the diagnostic by imaging was recorded. Consecutive patients (n=174) with uveal melanoma were chosen as control from patients who did not develop metastasis

Results We were able to detect metastasis after LFTs abnormality in 40 (45%) patients. However, at the time of the one preceding screening LFTs before the metastasis diagnosis, 51(58%) patients had at least one abnormal LFT. The metastasis diagnosis was missed in 11 patients (13%). The overall sensitivity of LFTs ranged from 12.5 to 58.0% and the predictive positive value ranged from 9.4 to 38.6%. Interestingly we observed false positives in 20.3% with the variable “at least one abnormal LFT”. Using financial approach, we calculated the semi‐annual screening by LFTs.

Conclusion Using the most important retrospective series analyzing semi‐annually all LFTs, we demonstrate that LFTs screening (AST, ALT, γGT, LDH and PA) is not relevant for detection of early metastasis even if the over cost induced by imaging requested for false positive is low
Blood‐Ocular Barriers and Macular Edema
Authors: CUNHA‐VAZ J
Published: December 2011

The blood‐ocular barrier system is formed by two main barriers: the blood‐aqueous barrier (BAB) and the blood‐retinal barrier (BRB). Homeostasis in the retina microenvironment is maintained by the function of the BRB which regulates the movement of chemicals and cells between the intravascular compartment and the retina. The BRB consists of two major topographically distinct components: the endothelium of the retinal vessels (inner BRB) and the retinal pigment epithelium (outer BRB). The barrier function of the retinal vascular endothelium depends on its continuous epithelial‐like arrangement with the endothelial cells united by tight junctions, whereas the ability of the retinal pigment epithelium to regulate solute transport depends on the apical tight junctions between these cells. The tight junctions are membrane fusion areas between adjacent cells that serve as a diffusion barrier for paracellular transport and as a “molecular fence”, restricting the free movement of transmembrane proteins, and thus maintaining cell polarity and the asymmetric distribution of transmembrane proteins. Among the most important proteins that are associated with tight junctions are occludin, zonula occludens and claudins. Pathologic increase in blood retinal permeability can be caused by endothelial damage, tight junction disassembly, or cytokines such as vascular endothelial growth factor. Several methods have been developed to allow detection, quantification and monitoring of BRB breakdown in experimental and clinical settings. In humans, fluorescein angiography, vitreous fluorophotometry and OCT are the most commonly used. Alterations of the BRB play a crucial role in the development of retinal edema. Macular edema is the result of an accumulation of fluid in the retinal layers around the fovea, contributing to vision loss by altering the functional relationship in the retina and promoting an inflammatory reparative response. The accumulation of fluid is directly associated with an alteration of the BRB. In this situation the protective effect of the BRB is lost and Starling’s law applies.
Macular edema: clinical pattern and imaging
Authors: GIANI A , PELLEGRINI M , INVERNIZZI A , STAURENGHI G
Published: December 2011

Macular edema is a common feature in different retinal and chorioretinal disorders. It is often the major cause of vision impairment in these pathologies. Edema can be evaluated in clinic practice with different diagnostic modalities. Optical coherence tomography (OCT) has become the most important tool for the evaluation and quantification of macular edema. Spectral‐domain OCT (SD‐OCT) represents the latest advancement in OCT technology and provides unprecedented visualization of retinal structure. Therefore, using SD‐OCT it is possible to better characterize the pattern of presentation of macular edema, in regards of the retinal layers involved. Moreover, SD‐OCT allows the visualization of photoreceptors alteration, which is directly correlated with visual loss. Another fundamental tool for the evaluation of macular edema is fluorescein angiography (FA). However, this diagnostic technique allows studying the leakage from the vessels, rather than the accumulation of fluid within the retina. Therefore FA provides different information compared to SD‐OCT, and the two tools should be considered complementary, rather than interchangeable. Fundus autofluorescence (FAF) is a non‐invasive tool that provides additional information in pathologies characterized by macular edema. In particular, the displacement of macular pigment induced by cystoid spaces within the retina increases the autofluorescence from the underlying pigment epithelium. In a confocal system, this results in precise visualization of the cysts that can be therefore monitored throughout the time.