bluuebunny/crossref_metadata_2025 huggingface dataset:
What do patients with glaucoma do when they search and look at everyday scenes?
Authors: SMITH ND , GARWAY‐HEATH DF , CRABB DP
Published: September 2009

Purpose To test the hypothesis that patients with bilateral glaucoma exhibit different eye movements compared to normally‐sighted subjects when viewing computer displayed photographs, or searching for features or items within them.

Methods Thirteen glaucoma patients and 17 age‐matched subjects with normal vision viewed 28 randomised digital photographs of various everyday scenes displayed on a computer screen for 3 seconds each. Subjects were instructed to view the images as they would when looking at a slideshow. The subjects then viewed another set of images, but were timed to find a feature or item in the scene. Eye movements were simultaneously recorded using an Eyetracking system.

Results In the passive viewing experiment, there was a significant reduction in the average number of saccades for glaucoma patients compared to controls (p<0.0001). In addition, average fixation duration was longer and the average area scanned was more restricted in patients compared to controls. In the search task glaucoma patients took, on average, longer to find the objects (p<0.0001) compared to controls. For this task, saccades were still reduced in number. In some cases, individual scanning patterns appeared related to the type and nature of the binocular visual field defect.

Conclusion Eye movement behaviour in patients with glaucomatous defects in both eyes differ from normal‐sighted subjects when viewing images and photographs. These patients with glaucoma find it more difficult to locate items within scenes compared to normally sighted subjects. Acknowledgements: This work is generously supported by an unrestricted grant from the Special Trustees of Moorfields Eye Hospital.
A variant TGFBI corneal dystrophy from G623D mutation with an unusual amyloidogenic phenotype
Authors: AGOSTINI HT , AUW‐HäDRICH C
Published: September 2009

Purpose To present a unique corneal dystrophy never before described in a German family carrying the Gly623Asp mutation of the TGFBI gene with late clinical onset.

Methods Clinical documentation and isolation of genomic DNA from peripheral blood leucocytes were obtained from each family member examined. Exons 3, 4, 5, and 11 to 14 of the TGFBI gene were sequenced. 5 corneal buttons of 3 affected siblings were excised at the time of penetrating keratoplasty. Light and electron microscopic examination were performed including immunohistochemistry with antibodies against Keratoepithelin (KE) 2 and 15.

Results Specimens showed changes in Bowman's layer and the adjacent stroma. Congo red‐positive amyloid deposits were found within the epithelium in one cornea, in Bowman's layer and in the anterior stroma of all specimens, also showing KE2‐ but not KE15‐immunostaining. EM revealed deposits located in the anterior stroma and Bowman's layer and the basal area of some epithelial cells. These areas were strongly Alcian blue‐positive but negative in the Masson‐Trichrom‐stain. Only affected patients had a heterozygous missense mutation in exon 14 of the TGFBI gene (G‐>A transition at nucleotide 1915) with the change Gly623Asp in the keratoepithelin protein.

Conclusion In contrast to the patient carrying the Gly623Asp mutation of the TGFBI gene described by Afshari et al., our cases presented with Salzmann nodular degeneration like clinical features with KE2 positive amyloid. The reason for this now "meeting the expectation histological phenotype" is unclear. The histological findings emphasize that this is a unique corneal dystrophy which shares no clinical characteristics with Reis‐Bücklers dystrophy and should be treated as a distinct entity.
TGFBI gene mutations in Hungary – polymorphic corneal amyloidosis caused by the novel F547S mutation
Authors: BERTA A , LOSONCZY G , TAKACS L
Published: September 2009

Purpose To identify mutations in the Transforming Growth Factor Beta Induced (TGFBI) gene in Hungarian patients with corneal dystrophy and to characterize their histological features.

Methods Exons of TGFBI gene were sequenced in 38 members of 15 unrelated families with corneal dystrophy. Exon 12 was sequenced in 100 healthy controls. Immunohistological analysis of corneal buttons excised during penetrating keratoplasty was performed.

Results Molecular genetic analysis revealed a heterozygous R124C mutation in 18 patients with lattice type I dystrophy. A R555W heterozygous mutation was detected in five patients with granular Groenouw type I corneal dystrophy and the R555Q heterozygous mutation was found in four patients clinically diagnosed with Reis‐Bücklers (one patient) and Thiel‐Behnke (three patients) dystrophy. Three patients with “atypical granular” dystrophy later diagnosed as Avellino dystrophy were heterozygous for the R124H mutation. No other than the novel heterozygous T1640C mutation causing the F547S amino acid exchange was detected in a patient with polymorphic corneal amyloidosis. The mutation could not be found in healthy controls. Immunohistochemistry showed the presence of BIGH3 protein deposits in all examined corneal buttons. Electron microscopy confirmed the presence of amyloid fibrils in the case of the novel mutation.

Conclusion Our results indicate that molecular genetic analysis is required to confirm the diagnosis of corneal dystrophies. We report the first cases of Avellino dystrophy from Central‐Eastern Europe. The novel F547S mutation causes polymorphic corneal amyloidosis.
Evaluation of the improvement of sensibility with the new IOL Master software version 5.4.3
Authors: GALLEGO‐PINAZO R , DIAZ‐LLOPIS M , PARDO‐LOPEZ D , LOPEZ‐PRATS M , SANZ‐MARCO E , LOPEZ‐LIZCANO R , GARCIA‐DELPECH S , UDAONDO‐MIRETE P
Published: September 2009

Purpose To evaluate the improvement of sensibility of the new IOL‐Master version 5.4.3 compared with the version 4.08.

Methods 214 eyes of 115 patients were examined in a cataract preoperative evaluation making use of both IOL‐Master software versions 5.4.3 and 4.08. The type and severity of the lens opacification was assessed by slitlamp biomicroscopy.

Results In 182 of the eyes examined both versions were capable to determine the AL; in 29 the version 4.01 could not determine AL whereas the version 5.4.3 was able to measure it; these cases showed posterior capsular cataract (16), dense nuclear cataract (11), posterior synechiae (1) and asteroid hyalosis (1). Finally, the AL of 3 eyes could not only be evaluated with none of the two softwares; these cases showed brunescent cataract (2) and moderate vitreous hemorrhage (1).

Conclusion The 5.4.3 software version incorporated in the new IOL‐Master improves the sensibility from 85,04% to 98,59% when compared to the previous version 4.08 in the capability of measuring AL.
Aspheric intraocular lenses: effect of residual spherical aberration on objective quality of vision
Authors: NOCHEZ Y , FAVARD A , MAJZOUB S , PISELLA PJ
Published: September 2009

Purpose To assess the impact of residual spherical aberration (SA) on objective quality of vision in pseudophakic patients.

Methods 15 patients (25 eyes) were divided into 2 groups: 13 eyes received an aspherical AcriSmart36A® generating a negative SA, 12 eyes received a zero‐aberration AcriSmart46LC®. Postoperative evaluations were conducted 6 months after a 1.8mm micro incision cataract surgery. Aberrometric measurements were done for a standardized pupil size of 5 mm in mesopic conditions using Wavescan Aberrometer®. Modulation Transfer Function (MTF), Strehl ratio and depth of field were measured with Objective Quality Analysis System®.

Results Best corrected 100% LogMar distance visual acuity (BCVA) was similar in both groups (p=0.89). 20% and 9% BCVA was increased in 36A® group (p=0.009 and 0.005). Mesopic contrast sensitivity was better and total spherical aberration were significantly less with 36A® IOL(SA=0.075±0.05 μm with 36A® and 0.20±0.05 μm with 46LC®,p=0,0002). Coma and trefoil were not different between the two groups (p>0,05). 36A® induced better image quality with an average MTF of 32.7±9.6 c/deg with 36A® and 23.8±8.1 c/deg with 46LC®, p=0.0002. The 36A® group had 1D less depth of focus than the 46LC® group at 6 months : respectively 1.3±0.59D and 2.27±0.63D. For the whole population, depth of focus appeared to be correlated with SA (r2=0.28, p=0.02) and with trefoil (r2=0.49, p=0.0009).

Conclusion While reducing total ocular SA, aspheric IOLs improved mesopic contrast sensitivity, quality of vision with greater MTF values. Reduction of aberrations may be responsible for reduced depth of focus with 36A® IOLs. However, residual trefoil aberrations may be advantageous for depth of focus and reading ability.
New perspectives of optical coherrence tomography in diagnosis and follow‐up of macular holes
Authors: KABANAROU SA , XIROU T , KOURENTIS C , KIDESS A , FERETIS E
Published: September 2009

Purpose To compare Time Domain (TD) with Spectral Domain (SD) OCT for imaging macular holes, identify retinal pathology and correlate anatomical morphology after surgical intervention for hole closure with visual outcome.

Methods 34 eyes of 34 patients with idiopathic macular holes stage II‐ IV were included in this study. Comparative studies were performed with both SD OCT (Heidelberg, Germany) and TD OCT (Stratus) using standard scanning protocols of 6 radial 6‐mm scans through the fovea. All patients underwent a standard three port‐ pars plana vitrectomy. Postoperatively, all patients were evaluated using both OCTs. ETDRS visual acuities were recorded pre‐ and post‐operatively.

Results In general TD and SD OCTs showed comparable images of macular holes. However, the boundary line between the inner and outer segments of the photoreceptors was better imaged with the SD OCT preoperatively and postoperatively. Poor visual acuity postoperatively was measured mainly in cases with morphological disruption in this boundary line despite hole closure.

Conclusion SD OCT imaging enhances the visualization of retinal anatomy in macular holes relative to TD OCT.
Macular hole surgery with and without internal limiting membrane peeling
Authors: KOURENTIS C , XIROU T , KABANAROU SA , KIDESS A , FERETIS E
Published: September 2009

Purpose To compare the results of surgery for idiopathic macular hole with or without the surgical removal of the internal limiting membrane (ILM) and the effect on anatomical and functional success rates.

Methods 41 consecutive patients with idiopathic macular hole stage II (n=11), III (n=22) and IV (n=8) underwent pars plana vitrectomy and intraocular gas tamponade in this study. The surgery was performed either with ILM peeling,Group A (n=28), or without, Group B (n=13). Ocular coherence tomography and ETDRS visual acuity were measured pre‐ and postoperatively to assess macular hole size and anatomical hole closure as well as visual function.

Results The postoperative macular hole closure rate was 100% (28/28) in Group A and 84,6% (11/13) in Group B. The 2 cases that failed to close with primary surgery had a hole size greater than 400µm. There was no significant difference between the two groups in the postoperative visual outcome once anatomical success was achieved.

Conclusion The study suggests that more evidence based trials are necessary to investigate the benefit of ILM peeling especially in the treatment of larger macular holes.
Sulfur hexafluoride (SF6) versus perfluoropropane (C3F8) gas tamponade for macular hole surgery
Authors: STEFANIOTOU M
Published: September 2009

Purpose In Macular Hole surgery gas tamponade is hypothesized to enhance macular hole closure after removal of tangential force. Sulfur hexafluoride (SF6) was described in the initial report of Macular Hole surgery (MHS). Long lasting gas (such as C3F8) may offer more extensive tamponade . To compare outcomes of Macular Hole Surgery using SF6 gas versus C3F8 gas for idiopathic macular hole repair.

Methods A consecutive group of patients undergoing MHS with SF6 group A (24 eyes of 24 patients) and a consecutive comparison group B with S3F8 was used (19 eyes of 19 patients). All patients had PP Vitrectomy, ILM peeling, using Kenacort or Blue and two different gases for internal tamponade.

Results The macular hole closure rate was similar in both groups.

Conclusion Macular Hole surgery using SF6 gas yields similar results as with C3F8 gas and may be a good option.
Visual hallucinations and illusions: neurological considerations
Authors: BORRUAT FX
Published: September 2009

Visual hallucinations (seeing what is not present) or illusions (perceiving differently what is actually present) can result from either ophthalmological or neurological disorders. This presentation will be focused on the neurological causes of such visual disorders, with an emphasis on the clinical presentations, anatomical correlations and diagnostic procedures.
A bilateral congenital pits of the optic nerve head. A case report
Authors: VILLAFRUELA I , CLARIANA A , RIVAS O , FERNADEZ A , BORREGO R , COLAS T , ARTEAGA P , CACHO L
Published: September 2009

Purpose The authors report a patient with a multiple optic nerve head pit

Methods A bilateral optic nerve head pit was found in a woman patient of 55 years old without macular retinal detachment. An 8‐microm axial resolution prototype spectral domain optical coherence tomography (OCT) and stereo fundus photography were used to observe the patient. The visual acuity remained stable at 20/20.

Results The pits of the optic nerve head is a congenital anomaly of the eye and it is attributed to incomplete closure of the foetal fissure.The prevalence is 1: 10000 eyes. This depression is frequently situated in the temporal or infra‐temporal region of the optic disc. There is usually only one pit per optic disc, although two or three occasionally occur. Optic pits are unilateral in 85‐90% of cases. Visual acuity usually remains unaffected unless the patient develops a serous non‐rhegmatogenous retinal detachment of the macula (over 60% of eyes). Visual fields characteristics of pits were found in our patient.

Conclusion High resolution OCT technology and appropriate imaging software is able to observe changes of the micro architecture of the optic nerve as this unusual pits bilateral.
Predicted long‐term outcome of corneal transplantation
Authors: BORDERIE VM
Published: September 2009

Purpose To analyze graft survival and the outcome of the corneal endothelium after corneal transplantation in a single model to predict the long‐term prognosis of these grafts.

Methods Cohort study. Data were prospectively recorded and then analyzed retrospectively. Participants: One thousand one hundred and forty‐four consecutive eyes of 1,144 patients who underwent corneal transplantation between 1992 and 2006. Interventions: Penetrating keratoplasties and deep anterior lamellar keratoplasties. Main Outcome Measures: Slit lamp examination and wide‐field specular microscopy. A joint analysis of endothelial cell loss and time to graft failure was undertaken. From mid‐term simultaneous analysis of graft survival and endothelial cell loss, long‐term graft survival was predicted.

Results The observed 5‐ and 10‐year graft survival estimates were, respectively, 74% and 64%. The average endothelial cell density (cell loss) was 2,270 cells/mm2 preoperatively, 1,058 cells/mm2 (‐53%) during the 6th post‐operative year, and 865 (‐61%) cells/mm2 during the 10th post‐operative year. Overall, the predicted graft survival estimate was 27% at 20 years and 2% at 30 years. Both observed and predicted graft survival were higher in patients with lamellar keratoplasty than in patients with penetrating keratoplasty and normal recipient endothelium and higher in patients with penetrating keratoplasty and normal recipient endothelium than in patients with penetrating keratoplasty and impaired recipient endothelium.

Conclusion For corneal diseases involving the endothelium, penetrating keratoplasty appears to be a good therapeutic approach in elderly patients as the graft lifespan may be similar to the patient life expectancy. Conversely, for younger patients, penetrating keratoplasty is only a mid‐term therapeutic approach. For corneal diseases not involving the endothelium, deep anterior lamellar keratoplasty appears to be a promising therapeutic approach with higher long‐term expected survival.
Experimental assessment of endothelial viability of grafts
Authors: THURET G , PIPPARELLI A
Published: September 2009

Purpose Endothelial quality of penetrating keratoplasty or posterior lamellar grafts (be they manually, mechanically or femto laser dissected) remains of paramount importance for the graft survival in recipients, especially when the recipient endothelial cell peripheral reserve is weak or absent (bullous keratopathy)

Methods 1/Review of the literature on the available methods to measure the endothelial quality. 2/presentation of a new concept: experimental quantification of the actual endothelial cell density of cell deemed viable, thus representing the actual number of cells capable of surviving in the recipient eye. This method uses a live/dead assay coupled with the microscopy analysis of the whole endothelium. A comparative series of graft pre‐cut for DMEK versus intact organ cultured paired corneas will illustrate our method

Results For the first time the exact number of viable endothelial cells can be directly measured. The notion of viable endothelial cell density is introduced. Though it cannot be a routine technique but only a laboratory one, the method can be ‐and perhaps should be‐ applied for all kind of graft preparation during its experimental development. Lamellar posterior grafts are good candidates. As expected, the viable ECD is lower than the ECD determined with the routine method used in eye banks, even the most precise ones

Conclusion The new notion of viable ECD may participate in our understanding of the dramatic endothelial cell loss ineluctably observed shortly after all types of grafts
Endothelial grafts with manually dissected endothelio‐Descemet. Eye bank and surgical point of view
Authors: MURAINE M
Published: September 2009

Purpose to describe a manual technique for the preparation of thin endothelial grafts or DMEK and to report clinical results in patients with Fuchs dystrophy.

Methods We report here a series of 92 patients with Fuchs dystrophy undergoing endothelial keratoplasty. A manual dissection is performed on an artificial chamber to obtain posterior graft. After completing the learning curve, it is possible to select the depth of dissection: from pure descemet membrane isolation, to very thin posterior graft.

Results Visual acuity is significantly higher after DMEK (0.7) than after thin posterior grafts (0.58), 6 months after surgery. However, endothelial density is much lower with 1190 cel/mm² after DMEK compared to thin posterior grafts which have 1870 cell/mm² 6 months after grafting.

Conclusion Manual dissection is more difficult to perform than automated techniques but allow preparation of much thinner grafts. Among these, pure descemet membrane grafts have the best visual rehabilitation but less endothelial cells due to surgical manipulations.
Comparison of spectral‐domain and time‐domain optical coherence tomography for evaluation of macular thickness and peripapillary retinal nerve fiber layer in multiple sclerosis patients
Authors: GARCIA MARTIN E , PUEYO V , PINILLA I , IDOIPE M , GIL ARRIBAS L , FUERTES I , FERNANDEZ J
Published: September 2009

Purpose To compare Cirrus HD Fourier‐domain optical coherence (OCT) with Stratus time‐domain OCT for measuring retinal and peripapillary retinal nerve fiber layer (RNFL) thickness in multiple sclerosis (MS) patients.

Methods Fifty eyes from 25 patients with MS (7 men and 18 women, aged 28 to 69 years) were prospective and consecutively studied. All of them underwent a ophthalmic examination that included assessment of visual acuity and colour vision visual field examination, Stratus OCT (Carl Zeiss Meditec, Inc.) and 3 Cirrus HD‐OCT (Carl Zeiss Meditec, Inc.). Both OCT devices were used to evaluate RNFL and macular thickness. Comparison of OCTs measurements were done for the following parameters: peripapillary quadrants and RNFL clock hour sectors and the 9 macular areas corresponding to the Early Treatment Diabetic Retinopathy Study (ETDRS). Coefficients of variation (COV) using Cirrus OCT were calculated.

Results Mean RNFL average thickness were 95.70 ±15.43 and 87.19 ±14.52 μm using Cirrus and Stratus OCT, respectively. RNFL measurements did not show significant differences. Mean total RT was 273.65 ±20.17 μm using Cirrus OCT and 200.33 ±24.10 μm using Stratus OCT. Retinal thickness measurements from Cirrus HD‐OCT were approximately 46.91 µm larger than those from Stratus OCT. All retinal measurements showed significant differences (p<0.001). Mean COV was 3.68 ±2.75% (ranged from 0.92 to 8.41%).

Conclusion MS patients evaluate with Cirrus and Stratus OCT show differences in their macular measurements in, but no at the RNFL. All measurements obtained using Cirrus OCT show good reproducibility in these patients.
Oxidative effects on the glutathione enzyme systems
Authors: LÖFGREN S
Published: September 2009

Purpose Lens ageing is associated with oxidative processes, with photo‐oxidation as one of the stressors. Cataract has traditionally been viewed as a one‐way progressive event, but in vivo and in vitro animal studies on ultraviolet radiation‐induced cataract during the last years show repair capacity in the lens. Little is known about what these repair systems are and how they might be influenced by pharmaceuticals. The glutathione redox enzymes have critical antioxidative functions and are a potential target for pharmaceutical intervention.

Methods Primary cultures of lens epithelial cells were obtained from mouse and human pediatric lens capsules. The cells were stressed with varying concentrations of hydrogen peroxide. The short‐term activity pattern of primary glutathione‐reducing enzymes and other glutathione‐associated enzymes were determined.

Results The main picture was a concentration‐dependent decrease in enzyme activity within 15 minutes, with subsequent recovery within one hour.

Conclusion The time frame for enzyme inhibition is co‐inciding with that of maximally efficient exposure time in ultraviolet radiation‐induced cataract.
Enhanced age‐related and diabetes‐induced cataract in mice lacking CuZn‐superoxide dismutase
Authors: OLOFSSON EM , MARKLUND SL , BEHNDIG A
Published: September 2009

Purpose In the lens, light and oxygen generate harmful reactive oxygen species (ROS) that may cause age‐related cataract. In diabetes mellitus, increased glucose levels may contribute to increased generation of ROS which may accelerate cataract formation. We have here explored the role of the antioxidant enzyme copper‐zinc superoxide dismutase (SOD1) in the protection against age‐related and diabetes‐induced cataract development.

Methods Cataract formation in relation to the oxidative status of the lens was evaluated in streptozotocin‐induced diabetic as well as in non‐diabetic SOD1 null and wild‐type mice. Also, the spontaneous age‐related cataract development was followed in both genotypes.

Results Cataract was seen in the SOD1 null and the wild‐type mice after 8 weeks of diabetes, although the SOD1 null mice showed a more pronounced cataract formation than the wild‐type mice in relation to the level of hyperglycaemia. As cataract formation was accentuated the lenses showed diminishing levels of glutathione but increasing amounts of protein carbonyls, suggesting a reduced lens anti‐oxidative capacity as well as increased lens protein oxidation. Spontaneous incipient age‐related cataract was seen in the 1‐year old SOD1 null mice whereas the wild‐type mice showed equivalent changes at 2 years of age.

Conclusion The results presented here show that SOD1 null mice are more prone to develop diabetes‐induced and age‐related cataract than wild‐type mice. The findings thus further endorse the importance of oxidative stress as a contributor to cataract development and indicate that superoxide radicals may be damaging to the lens. We therefore conclude that the antioxidant enzyme SOD1 is important for the protection against cataract.
Rehabilitative treatment of alexia
Authors: VILLAFRUELA I , GANGOITI L
Published: September 2009

Purpose Homonymous hemianopia is the commonest form of acquired homonymous visual field defect; it can affect visual search and reading, producing alexia. For these patients we use different rehabilitative techniques such us eye movement‐based therapies, in which the damaged visual field is more effectively sampled with compensatory or adaptative eye movements.

Methods Four left occipital stroke patients with complete right homonymous hemianopia (2 female) aged 40 to 70 years, took part. They were Spanish speaking and right‐handed. All of them had complete impairment of right parafoveal vision assessed with a Humphrey perimeter. Recordings were made while the participants silently read 10 trails of single words, 10 trails each of three‐and‐five word arrays. For word arrays, the average fixation time per word was calculated. Single‐ word and text reading speed and comprehension and several cognitive functions were assessed in all patients.

Results Eye movement’s therapy approaches to rehabilitation attempt to improve visual performance by the application of a regularized framework of eye movement training, with practice over 20 h of intensive training.As a group the patients had significantly shorter mean single word and text reading and comprehension after training (p<0.001) and demonstrated a variety of mechanisms to account for this. Improvements were confined to the training period and maintained at follow up.

Conclusion Patients can improve visual search and reading with practice. These changes translate to improved overall reading and visual function, assessed objectively and subjectively, suggesting that they represent good training effects. The underlying mechanism may involve the adoption of compensatory eye movement strategies and these techniques all rely on mass practice.
We're still under pressure: postoperative hypertony
Authors: STALMANS I
Published: September 2009

Purpose Postoperative hypertony is a frequent complication after trabeculectomy. This problem may occur from the early, to the late stages, and may be an acute or chronic situation. The aim of this lecture is to review the various causes with their clinical presentation and therapeutic strategy.

Methods An overview will be provided on the different mechanisms that may cause hypertony after trabeculectomy, ranging from tight flap sutures or blocking of the constructed channel by various substances, over encapsulation and failing bleb to steroid response. For each of these situations, the clinical presentation and differential diagnosis will be discussed. Finally, the therapeutic options will be reviewed. Photographic and video material will be used to illustrate the various clinical presentations and therapeutic interventions.

Conclusion This lecture will provide the audience with a practically oriented overview of the clinical management of hypertony after trabeculectomy.
Help, I've been too successful: postoperative hypotony
Authors: ZEYEN T
Published: September 2009

Purpose To give an overview of the etiology and treatment of hypotony post‐trabeculectomy.

Methods Postoperative hypotony is most commonly caused by either overfiltration or bleb leakage. This condition can lead to a flat anterior chamber, hypotony maculopathy, choroidal detachment, and cataract.

Results Possible strategies to decrease overfiltration and heal bleb leaks will be highlighted. We will review when and how to refill the anterior chamber, and discuss the proper timing and technique to treat choroidal detachments. Finally, the indications, pros and cons of cataract surgery after trabeculectomy will be discussed.

Conclusion This presentation will give guidance on how to diagnose and treat hypotony after trabeculectomy.
Immune responses to gene therapy vectors in the context of corneal transplantation
Authors: RITTER T , WILK M , GONG N , PLEYER U , NOSOV M
Published: September 2009

Purpose The genetic engineering of grafts or cells prior to transplantation is an attractive approach to protect the graft from allogeneic rejection. Virus vector‐based gene therapy is a promising method for successful ex‐vivo gene transfer however, the induction of an immune response against gene‐modified tissues raises concern.

Methods Different virus families (Adenovirus, Retrovirus, Adeno‐associated virus, Herpesvirus) have been studied as gene therapy vehicles for the delivery of therapeutic molecules. Moreover, different serotypes or envelope proteins have been used to modulate transduction efficiencies of target cells or to evade pre‐existing immunity.

Results Here we review gene therapeutic applications using viral vectors in the context of cornea transplantation. Both local and systemic expression of immunomodulatory molecules have led to the prevention of corneal graft rejection. However, different results have been obtained with regard to the induction of immune responses after local or systemic expression of the gene therapy vector. Not surprisingly over‐expression of anti‐inflammatory molecules not only modulated allograft rejection but also influenced the immune response against the viral vector and virally transduced cells.

Conclusion Recent clinical trials indicate that the application of viral vectors in ophthalmology is promising however, the generation of immune responses against the viral vector or virally transduced cells are still a serious obstacle for a broader application of gene therapy. Supported by Deutsche Forschungsgemeinschaft (DFG Pl 150/14‐1 and Ri 764/10‐1) and Science Foundation of Ireland (SFI 06/RFP/BIC056 and SFI 07/IN.1/B925)
Gene therapy: can we prevent/modulate apoptosis in EC?
Authors: FUCHSLUGER T , JURKUNAS U , KAZLAUSKAS A , DANA R
Published: September 2009

Purpose Regardless of the inciting cause, CEC loss is a common denominator of corneal graft failure. CEC loss during storage results in significant loss of suitable tissue for grafting, CEC loss after transplantation is a major cause of graft failure. The purpose of this study is to investigate the role of apoptosis in CEC in order to prevent CEC loss during storage.

Methods Gene transfer of Lenti‐Bcl‐xL or –p35 was accomplished in human donor corneas, primary cultured CEC and an immortalized CEC line and compared to untreated controls. Cell death (apoptosis) was induced by Actinomycin or Etoposide (external vs. internal apoptotic pathway, respectively). In addition, CEC loss during preservation was studied both during Optisol GS (4C) and organ culture storage (37C, Biochrome Medium I). Both storage media were diluted with PBS to promote cell loss. CEC were enumerated, apoptosis was detected by TUNEL staining and confocal microscopy.

Results The percentage of TUNEL‐positive CEC provoked by the apoptotic inducers was significantly reduced relative to controls. Transfected corneas preserved an almost intact endothelial monolayer while controls nearly entirely lost vital CEC. During long‐term storage experiments at 4C and at 37C, CEC counts in corneas expressing anti‐apoptotic genes remained significantly higher compared to the controls.

Conclusion Protection of CEC by anti‐apoptotic genes appears to be an effective method to reduce CEC loss during storage. The application of this technique could increase the amount of high quality grafts in eye banking and further reduce graft failure following corneal transplantation, and is be of specific interest as to precut corneas and DSAEK procedures.
Orbital and periorbital cystic lesions in Indian children : A retrospective analysis from a tertiary care hospital
Authors: SETHI S , BAJAJ MS , PUSHKER N , MEHTA M , KASHYAP S , SEN S , CHAWLA B , GHOSE S
Published: September 2009

Purpose Cystic lesions in orbital and periorbital area constitute a group with diverse etiopathogenesis and varied clinical and histopathologic findings. Through this study we present a review of all patients 18 years or less diagnosed histopathologically as orbital or periorbital cystic lesions, over a period of 3 years.

Methods Retrospective observational case series of histopathologically proven cysts or lesions with cystic changes, in patients 18 years or less, from Jan 2006 to Dec 2008.

Results There were a total of 97 patients, age 4 months to 18 years (mean 11.63 ± 4.48). Cysts of the surface epithelium were the most frequent lesion seen (n:50; 51.5%), of which 39 (40.2%) were dermoid cysts and 11 (11.3%) were simple epithelial cysts. Other lesions in decreasing order of frequency were: inflammatory cystic lesions ‐ abscesses and parasitic cysts (n:16, 16.5%); neural cysts associated with ocular maldevelopment or associated with brain and meningeal tissue (n:14; 14.4%); non‐cystic lesions with cystic components like lymphangioma (n:12; 12.4%); and secondary cysts ‐ mucoceles and lacrimal cysts (n:5; 5.2%).

Conclusion In our series cysts of the surface epithelium were the most commonly seen cystic lesion. Also noticeable is the high frequency of inflammatory lesions including parasitic and cysticercosis cysts. Cystic lesions behave clinically as benign lesions, however significant morbidity can be associated because of aesthetic considerations and vision loss owing to optic nerve compression.
Metastatic cancer presenting with ocular symptoms: a series of cases
Authors: PEREZ GARCIA D , TOBENA PUYAL M , VALYI Z , IBANEZ J , ROJO ARNAO M , JIMENEZ DEL RIO B , CRISTOBAL JA , FERRER A
Published: September 2009

Purpose Choroidal metastasis is the most frequent intraocular tumour. Lung cancer in men and breast cancer in women are the most common primary sources, followed by the digestive tract. The incidence of uveal metastasis is much higher after authopsy than in clinical series so its impact is underestimated. We present a series of cases of choroidal metastasis as the initial presentation of malignant disease.

Methods We collected 5 patients in our hospital from August 2006 to April 2009 of choroidal metastasis as initial presentation of malignant disease. Primary sources, clinical and therapeutic management were analysed.

Results 3 of the 5 patients were women (60%). Ophthalmological symptoms were decreased visual acuity in 2 patients (40%) and metamorphopsia in 3 (60%). As primary source were found lung cancer in 2 cases ( 1 adenocarcinoma and 1 oat cell carcinoma), pancreas adenocarcinoma in 2 cases and 1 unknown origin. Only one of the patients was considered candidate to receive brachytherapy.

Conclusion Metastasis to the uvea is not a rare event due to the prolonged survival time of many cancer patients. Ophthalmologist should be aware of incidence, clinical features and management of choroidal metastasis as well as the prognosis for affected patients.
Comparison of mono‐ and bicanalicular silicone stent intubation in dacryocystorhinostomy
Authors: BELTRAM M , PAJTLER A , DRNOVSEK‐OLUP B
Published: September 2009

Purpose Silicone stent intubation is used in DCR procedures to prevent a restenosis of the surgical ostium. However, use is not generally accepted due to concers on cost/effectiveness. The goal of our study was to analyze the types and rate of complications associated with monocanalicular and bicanalicular silicones stent intubation nad success rate of DCR procedure.

Methods A consecutive series of 114 patients who underwent 120 DCR procedures at our institution from November 2005 on has been included in the study. All DCR (transcanalicular laser DCR’s) procedures were performed under general anaesthesia. One of two types of silicone intubation was inserted at each procedure: bicanalicular silicone stent (72 cases), and inferior monocanalicular stent alone (38 cases). In the former a metallic clip was used to secure the stents in the nasal cavity, in the latter a double knot was applied. The intubation has been removed after 4 months.

Results We encountered the following complications: cheese‐wiring of lacrimal punctum (14 cases), prolaps of intubation at the punctual side (9 cases), irritation of conjunctiva (3 cases), corneal erosion (1 case), retention of metallic clip in lacrimal sac (1 case). We statistically analyzed and compared the rate of complications for both types of intubation. Decubitus of the lacrimal punctum was less frequent with monocanalicular intubation compared to bicanalicular intubation; other complications were present at similar rates.

Conclusion Complications with silicone stent intubation are not difficult to cope with and normally do not produce adverse effect on DCR success rate with the exception of early and complete prolaps of intubation, which is associated with a lesser success rate of DCR.
Optico‐anatomical changes of prematurity children eyes
Authors: KRIAUCIUNIENE L , AUKSTIKALNIENE R , PAUNKSNIS A
Published: September 2009

Purpose The aim of our work was to determine changes in optical‐anatomical elements of myopic eyes of full‐term and premature children during accommodation by means of precise ultrasonic biometry.

Methods The study was made on healthy full‐term children’s eyes with emmetropic refraction (group, n = 20); full‐term 1st degree myopic children’s eyes with refraction from ‐1.0 D to ‐3.0 D (group 2, n = 16), and premature children’s myopic eyes with refraction ‐1.0 D to ‐3.0 D (group 3, n = 12). The age of children ranged from 6 to 15 years. Gestation age in the pre‐term group ranged from 25 to 34 weeks. All were seen in the clinic for the risk of developing retinopathy of prematurity.

Results Ultrasonic biometry evaluates optical‐anatomical parameters in premature children’s myopic eyes. Axial length was longer than in healthy and full‐term myopic children’s eyes (mean, 24.09 ± 0.69 mm) and lens thickness was bigger (mean 3.35 ± 0.14 mm). In the healthy children’s group: axial length was 23.49 ± 0.48 mm and lens thickness 3.00 ± 0.07 mm, and in the full‐term myopic children’s group the axial length was 23.79 ± 0.59 mm and lens thickness 3.24 ± 0.14 mm.

Conclusion In the group of premature children changes in the optical‐anatomical elements parameters of myopic eyes were more pronounced than in the group of full‐term children, and it could lead to higher myopia development.
Wavefront map analysis of single vision and progressive ophthalmic lenses
Authors: PHILIPPAKI E , PLAINIS S , PALLIKARIS A , PAPADIAMANTIS A , PALLIKARIS IG
Published: September 2009

Purpose To evaluate and compare wavefront aberration maps in single‐vision (SVL) and progressive power lenses (PPL) of different materials and designs.

Methods The monochromatic wavefront aberrations of SVL and PPL were evaluated using a Shack‐Hartmann wavefront sensor. The lenses were categorized according to their material, power, design and refractive index. Measurements were taken along vertical and horizontal axes starting from the lens optical center and moving towards its periphery in 3mm steps. Artificial pupils of 3mm and 6mm diameter were used to simulate photopic / mesopic viewing conditions. For each point the average of three measurements was analysed. Zernike expansion coefficients up to 4th order, defocus sphere, astigmatism and paraxial curvature matching were calculated using custom‐made scripts in Matlab computational software.

Results In all cases the magnitude of aberrations was higher when a 6mm viewing pupil was used. The most prominent aberrations were the second order astigmatic components, especially in PPLs and positive SVLs. Spherical aberration and third order aberrations (coma and trefoil) were more pronounced in specific designs. Finally, the magnitude and the pattern of aberrations are affected by lens material, power and refractive index.

Conclusion Wavefront aberration data offers, in addition to the common power mapping, the evaluation of the higher order aberrations profiles of the lens, which may compromise visual performance. This allows a more accurate assessment of the visual enhancement provided by modern PPLs with advanced designs.
The effect of ocular higher order aberrations on contrast sensitivity.
Authors: GIANNAKOPOULOU T , PLAINIS S , PALLIKARIS A , PALLIKARIS IG
Published: September 2009

Purpose The objective of the study was to evaluate the impact of ocular higher order aberrations on the contrast sensitivity function(CSF).

Methods Twenty‐one subjects (age:25.4±5.0) volunteered to participate in the study.Best spectacle‐corrected contrast sensitivity of the dilated dominant eye was evaluated using vertical gratings (Gabor patches with a sd of 1.2deg at 2m distance) displayed on a Sony F520 CRT monitor by means of a VSG2/5 stimulus generator card.Average screen luminance was 30cd/m2.Contrast sensitivity was assessed for 6 spatial frequencies(1,2,4,8,12 and 16c/deg) and for artificial pupils of 3 and 6mm diameter.Retinal illuminance was equalised in both conditions by using an NDfilter.Threshold was determined using a binary‐search staircase with a contrast resolution of 1dB.Ocular aberrations were recorded at 6mm pupil with a COAS wavefront sensor(Wavefront Sciences Ltd).Objective image quality metrics,e.g Modulation Transfer Function(MTF)and Root Mean Square(RMS)wavefront error,were calculated using custom‐written scripts in Matlab.

Results CSF and MTF were fitted using 3rd order polynomials.The area calculated by the integral of the fitted functions was used as a measure of performance.CSF was found depressed for 6 compared to 3mm pupils,as was the case for the MTF.Moreover,the decrease in performance at 6mm was always more pronounced for the MTF than the CSF.No significant correlation was found between the CSFarea and the respective MTFarea or any other image quality metrics.

Conclusion Ocular higher order aberrations adversely affect contrast sensitivity,particularly at high spatial frequencies.However,objective measures of higher order aberrations,such as the MTF and the RMS error cannot simulate their impact on the CSF.
The AGREE instrument applied to visual health: an assessment of the health protocols used in Spain to measure the effects exposure to VDT
Authors: SEGUI CRESPO MM , LOPEZ NAVARRO A , RONDA PEREZ E , TASCON BERNABEU E , MARTINEZ VERDU FM
Published: September 2009

Purpose Developing an instrument for appraising health protocols and testing its application through the assessment of a specific clinical protocol applied in Spain to protect the visual health of workers using computers.

Methods In the development of the appraisal tool, the Spanish version of the AGREE instrument was taken as the starting point and modifications were then introduced. For the assessment of the health protocol a Delphi technique and the nominal group were used. A group of 9 experts carried out the individual anonymous assessment. The level of agreement between experts for responses to each of the questions was defined, as was the number who had chosen the same option for closed responses.

Results The appraisal tool comprised 13 questions organised into 5 domains, and one final question aimed at eliciting a global evaluation of the protocol. Regarding the agreement between experts, this exceeded 50% for 10 of the 14 questions. Responses most frequently chosen by the assessors for all of the questions were the least favourable to the protocol indicating the protocol significantly failed to fulfil the conditions addressed in the majority of the questions considered.

Conclusion Application of this appraisal tool has enabled a good degree of agreement to be reached for experts’ responses when assessing aspects related to the clinical protocol for visual health of workers using computers demonstrating its applicability and capacity for obtaining conclusive widely endorsed assessments.
Hans Goldmann (1899 – 1991) – the man who coined the daily practice of ophthalmology worldwide during half a century until today
Authors: GLOOR B
Published: September 2009

Goldmann presented 1937 a slit lamp, which allowed for the first time to examine the whole eye from the surface of the cornea to the fundus on the sitting patient with ease. Motion in three dimensions was possible with the fingertips of one hand. A reduction of the angel between observation and illumination beam allowed to use contact lenses with the free hand to investigate 360° of the chamber angle. Since then the difference between angle closure and open angle glaucoma is established. The illumination system of the slit‐lamp was brought in vertical position in 1958, the Haag‐Streit slit lamp 900 was born. It sets, with a few modifications, still the standard. In the meantime the Goldmann cupola perimeter was developed (1945), which allowed the standardization of background and target illumination for the first time. The applanation tonometer was introduced in 1954, again a standard instrument until today. Meanwhile these instruments determine the daily practice, for Goldmann they were, with other inventions, the tools to measure patho‐physiologic processes and to understand diseases. Most determined was Goldmann in glaucoma research: Gonioscopy, perimetry to follow the increase of glaucomatous damage, detection of the aequeous veins, measurement of the production of the aqueous by fluorescein‐dilution curves, determination of the outflow facility and pseudofacility, establishment of the “Goldmann‐Formula”, tonometry by applanation and finally stereochronoscopy, these were the steps that unveiled glaucoma. Goldmann, a most gifted fascinating personality, born in Komotau in Bohemia, grew up in Prague, was educated in arts, mathematics and physics, was trained by von Tchermak‐Seysenegg and Elschnig in Prague, then by Siegrist in Berne. He became Siegrists successor in Berne 1935, this in spite of dangerous feuds with Alfred Vogt on the etiology of the glass blower cataract. He was granted Swiss citizenship 1936. He was an exceptionally great teacher for the students. He became Rector magnificus of the University of Berne in 1965. He retired in 1968, having chaired the department for 44 years. He remained active in research until his late eighties. 1991 ophthalmology lost one of his greatest genius.