bluuebunny/crossref_metadata_2025 huggingface dataset:
Contribution of inflammation to the early stages of diabetic retinopathy
Authors: KERN T
Published: September 2008

Purpose Many biochemical and physiological abnormalities detected in retinas of diabetic animals are consistent with a potential role of inflammatory‐like processes in the capillary degeneration.

Methods We have used drugs and genetically modified rodents to investigate the role of inflammation in the development of early stages of diabetic retinopathy, focusing especially on the diabetes‐induced degeneration of retinal capillaries.

Results In animal models, vascular lesions characteristic of the early stages of diabetic retinopathy have been found to be inhibited by salicylates (which inhibit NF‐κB and cyclooxygenase), a PARP inhibitor (which inhibits inflammatory responses apparently by regulating NF‐κB), minocycline (which inhibits the generation of IL‐1β), a topical inhibitor of cyclooxygenase, and by an inhibitor of iNOS. These studies demonstrate that inflammation plays a critical role in the development of early stages of diabetic retinopathy.

Conclusion The concept that localized inflammatory processes play a role in the development of diabetic retinopathy is relatively new, but evidence that supports the hypothesis is accumulating rapidly. This new hypothesis offers new insight into the pathogenesis of diabetic retinopathy, and offers a novel target to inhibit the ocular disease.
New insights into the pathogenic role of advanced glycation in diabetic retinopathy
Authors: STITT AW
Published: September 2008

Purpose Retinopathy is the most common microvascular complication of diabetes. The clinicopathology of microvascular lesions and neuroglial dysfunction in the diabetic retina have been extensively studied, although the relative contribution of various biochemical sequelae of hyperglycaemia remains ill‐defined. The formation and accumulation of advanced glycation endproducts (AGEs) is an important pathogenic pathway in the progression of diabetic retinopathy although some of the cellular and molecular pathologies initiated by these adducts in retinal cells remain unknown.

Methods This presentation will cover several aspects of AGE‐linked retinal pathology and demonstrate opportunities for therapeutic intervention. The studies outlined will cover a wide range of molecular cell biology approaches using appropriate in vitro and in vivo model systems.

Results It will be demonstrated that AGEs form in vivo in the diabetic retina through the reaction of alpha‐oxaloaldehydes leading to significant modifications of retinal proteins. Evidence will be presented to demonstrate that these AGEs act as significant effectors of retinal vascular and neuroglial cell dysfunction, leading to pro‐inflammatory responses, growth factor imbalance and, ultimately, neurovascular lesions such as blood retinal barrier dysfunction and microvascular degeneration. The protective role of novel AGE‐inhibitors will also be shown.

Conclusion Evidence now points towards a pathogenic role for advanced glycation in the initiation and progression of diabetic retinopathy and this review lecture will outline the current state of knowledge of AGE‐related pathology in the retina at a cellular and molecular level.
Caspase‐1/interleukin‐1beta signaling in diabetic retinopathy
Authors: MOHR S
Published: September 2008

Purpose The pro‐inflammatory cytokine, interleukin‐1β (IL‐1β), is known to induce vascular dysfunction and cell death. Previously, we have shown that caspase‐1 activity is increased in retinas of diabetic and galactosemic mice, and diabetic patients. Therefore, we investigated the role of IL‐1β and caspase‐1 (the enzyme that produces it) in diabetes‐induced degeneration of retinal capillaries.

Methods First, we determined the effect of agents known to inhibit caspase‐1 (minocycline and tetracycline) on IL‐1β production and retinal capillary degeneration in diabetic and galactose‐fed mice. Diabetic and galactose‐fed mice were injected intraperitoneally with minocycline or tetracycline (5mg/kg). Second, we examined the effect of genetic deletion of the IL‐1β receptor on diabetes‐induced caspase activities and retinal capillary degeneration using IL‐1 receptor knock‐out mice.

Results At 2 months of diabetes, minocycline inhibited hyperglycemia‐induced caspase‐1 activity and IL‐1β production in the retina. Long‐term administration of minocycline prevented retinal capillary degeneration in diabetic (6 months) and galactose‐fed (13 months) mice. Tetracycline inhibited hyperglycemia‐induced caspase‐1 activity in vitro, but not in vivo. Mice deficient in the IL‐1β receptor were protected from diabetes‐induced caspase activation and retinal pathology at 7 months of diabetes.

Conclusion These results indicate that the caspase‐1/IL‐1β signaling pathway plays an important role in diabetes‐induced retinal pathology and its inhibition might represent a new strategy to inhibit capillary degeneration in diabetic retinopathy.
PARP, Na+/H+‐exchanger‐1, and early diabetes‐induced retinal changes
Authors: OBROSOVA IG
Published: September 2008

Purpose To evaluate the roles for PARP and Na+/H+‐exchanger‐1 (NHE‐1) in early diabetes‐induced changes in the retina and retinal capillary cells

Methods Control (C) and STZ‐diabetic (D) rats were treated with/without the PARP inhibitors, 1,5‐isoquinolinediol (ISO, 3 mgkg‐1d‐1 i.p.) or 10‐(4‐Methyl‐piperazin‐1‐ylmethyl)‐2H‐7‐oxa‐1,2‐diaza‐benzo[de]‐anthracen‐3‐one (GPI 15427, 30 mgkg‐1d‐1), for 10 wks after 2 wks without treatment. Apoptosis was evaluated in flat‐mounted retinas by TUNEL assay, and nitrotyrosine (NT), poly(ADP‐ribose) (PAR), GFAP, BiP/GRP78 and GRP94 expressions by immunohistochemistry and Western blot analyses. Primary bovine retinal pericytes and endothelial cells were cultured with/without 0.6 mM palmitate, or in 5 mM or 30 mM glucose. Apoptosis was assessed by TUNEL and caspase‐3 assays, superoxide production by ethidium fluorescence, and NT and PAR by immunocytochemistry.

Results In the PARP study, the number of TUNEL‐positive nuclei was increased ~4‐fold in D, and this increase was prevented in D+ISO and D+GPI 15427. PARP inhibitors counteracted oxidative‐nitrosative and endoplasmic reticulum stresses, and glial activation. Palmitate dose dependently increased superoxide production in cultured retinal cells. GPI 15427, 20 microM, prevented FFA‐induced increase in the rate of apoptosis, and alleviated NT and PAR accumulation in both pericytes and endothelial cells. In the NHE‐1 study, the specific NHE‐1 inhibitor cariporide (10 microM) prevented high glucose‐induced apoptosis, and alleviated oxidative‐nitrosative stress and PAR accumulation in bovine retinal pericytes. In vivo studies in the STZ‐diabetic rat model are in progress.

Conclusion PARP and NHE‐1 play an important role in early diabetes‐induced changes in retina and retinal capillary cells.
OCT, a value adding technique (VAT) in the appraisal of macular inflammation
Authors: DE SMET MD
Published: September 2008

Abstract not provided
The role of gamma‐interferon tests for suspected tuberculous ocular inflammation
Authors: CIMINO L , LOSI M , RICHELDI L , BOIARDI L , CAPPUCCINI L , SALVARANI C
Published: September 2008

Purpose To evaluate the introduction of new T‐cell based blood tests for tuberculosis infection in order to improve the diagnosis of ocular tuberculosis.

Methods Patients with presumed ocular tuberculosis from the Ocular Immunology Unit of the hospital of Reggio Emilia underwent both Mantoux skin tests and Gamma Interferon assays to confirm the diagnosis of tuberculosis.

Results 8 patients (7/8 male; mean age 58 yrs) were diagnosed with presumed ocular tuberculosis. Three patients presented with serpiginous retinochoroiditis and five with bilateral panuveitis. Four patients had undergone immunosuppressive therapy before the correct diagnosis was made. All the patients were positive both with Mantoux skin test and Gamma Interferon assays (ELISpot and QuantiFERON TB‐Gold). They started the specific anti‐tuberculous tritherapy, improving significantly in visual acuity and decreasing intraocular inflammation.

Conclusion These results confirm the feasibility of these new blood tests in routine clinical work‐up. These new methods are important for the ophthalmologist in order to follow and evaluate developments in every method of detection of tuberculosis for the containment of this global public health epidemic.
The role of interferon alpha in uveitis therapy
Authors: BODAGHI B , GUEUDRY J , TERRADA C , CASSOUX N , PIETTE JC , LEHOANG P
Published: September 2008

Purpose Severe uveitis is potentially associated with visual impairment or blindness in young patients. Therapeutic strategies remain controversial. Efficacy of interferon alpha‐2a (IFN‐a2a) in severe uveitis, refractory to steroids and conventional immunosuppressive agents has been evaluated.

Methods Patients were included after a major relapse of uveitis occurring under corticosteroids and immunosuppressants. IFN‐a2a (3 millions units three times a week) was administered subcutaneously. Efficacy was assessed by the improvement of VA, decrease of vitreous haze, resolution of retinal vasculitis and macular edema, and decrease of oral prednisone threshold.

Results Forty‐five patients were included. Mean age was 30.6 years (range 8‐58 years) and sex ratio (F/M) was 0.66. Uveitis was associated with Behçet’s disease in 23 cases (51.1%) and with other entities in 22 cases (48.9%). Mean duration of uveitis before interferon therapy was 50.5 months and an average of 3 relapses under corticosteroids and immunosuppressants has been noted. Uveitis was controlled in 82.6% of patients with BD and 59% of patients with other types of uveitis (p=0.07). During a mean follow‐up of 29.6 months, mean oral prednisone threshold decreased significantly from 21.5 mg/d to 9.8 mg/d (p<0.001). Interferon has been discontinued in 10 patients (22.2%) with BD and 4 patients without BD. Relapses occurred in 4 and 1 cases, respectively.

Conclusion Though our study carries several limitations, interferon‐therapy seems an efficient strategy in severe and relapsing forms of BD but also other uveitic entities. However, it seems more suspensive than curative. Therefore, IFN‐α2a may be proposed as a second line strategy after the failure of conventional immunosuppressants.
Evolution of the laser treatment of diabetic retinopathy (DR): from laser surgery to laser therapy
Authors: DORIN G , BUZAWA D , MERCEREAU J
Published: September 2008

Purpose To review benefits and collateral effects of conventional photocoagulation, the standard of care for DR, in comparison with newer laser techniques reported to provide comparable benefits with reduced treatment’s hardship and side effects.

Methods Literature review and physical/technical considerations.

Results Conventional photocoagulation lowers the risk of severe visual loss, but is associated with long, painful, multiple treatments and with iatrogenic anatomical and functional damage. Light panretinal photocoagulation (PRP) has shown efficacy similar to that of conventional PRP with fewer sessions and complications. A patterned scanning laser (PASCAL) allows PRP with reduced surgeon’s time, in 1 or 2 sessions, but still with discomfort and anatomical‐functional damages due to the visible "burn" endpoint. Conversely, subthreshold diode‐laser micropulse (SDM) PRP is a new laser therapy that comparably reduces the incidence of vitreous hemorrhage and vitrectomy with a gentle well tolerated treatment that does not cause iatrogenic vision deterioration or laser‐lesions detectable at any time postoperatively.

Conclusion Retinal destruction has never been demonstrated to be a prerequisite for the therapeutic benefits. Whatever the elusive mechanisms of action of laser photocoagulation are, long term benefits can be provided either with high intensity/low density laser surgery or with low intensity/high density laser therapy. Non‐laser treatments for DR are being tested, often with good, rapid, but also only transient effects. The combination of pharmacotherapy's short term beneficial effects with the long term benefits of a less damaging laser therapy appears as a new treatment paradigm that should undergo rigorous investigation.

Commercial interest
Corneal keratocyte density after mechanical versus femtosecond laser in situ keratomileusis
Authors: CANADAS SUAREZ P , ARRANZ E , GIL‐CAZORLA R , TEUS M
Published: September 2008

Purpose To determine changes in keratocyte density three months after mechanical versus femtosecond laser in situ keratomileusis.

Methods This was a retrospective study in which 20 consecutive eyes received LASIK to correct a mean refractive error of ‐2,3+/‐2,1 D sphere and ‐0,8+/‐2,1 D cylinder, and 21 consecutive eyes received femtosecond laser to correct a mean refractive error of ‐1,8+/‐3,5 D sphere and ‐2,2+/‐2,9 D cylinder. Both groups were compared with a control group of 20 normal and healthy eyes with a mean refractive error ‐2,2+/‐2,9 D sphere and ‐0,5+/‐0,6 D cylinder. Corneas were examined by using confocal microscopy three months after the procedures. Keratocyte densities were determined in the anterior stroma, stromal bed, central and posterior stroma.

Results Keratocyte density in the anterior stroma and in the stromal bed was 500,8 +/‐ 108,4 cells/mm2 in the control group, 506,1 +/‐ 130,6 cells/mm2 and 475,9 +/‐ 147 cells/mm2 respectively in the LASIK group, and 446 +/‐ 120,7 cells/mm2 and 416,3 +/‐ 115 cells/mm2 respectively in the femtosecond group (p>0,05). In central and posterior stroma the difference was also not significant.

Conclusion Keratocyte density is decreased in the stromal bed after mechanical and femtosecond laser in situ keratomileusis as compared to controls, however, there is not difference between both procedures.
Effectiveness of moisturizing daily disposable lenses with additives
Authors: GILES TG
Published: September 2008

Purpose Recently, contact lens manfacturers are incorporating moisture additives in their contact lenses. Examples include povidone in 1‐DAY ACUVUE MOIST lenses, polyvinyl alcohol (PVA) in DAILIES with AquaComfort lenses and hydroxypropyl‐methylcellulose, polyethylene‐glycol and PVA in the DAILIES AquaComfort Plus lenses. These two trials were aimed to compare the effectiveness of these additives to general lens performance.

Methods In the first trial, 20 investigators in the US and Germany enrolled 276 subjects currently wearing nelfilcon A with PVA (nefA+1) lenses in daily disposable modality of comparison to nelfilcon A with moisturizing additives (HPMC, PEG and PVA (nefA+3) for ten days. In the second trial, 14 investigators in Germany enrolled 314 current daily disposable wearers to wear nelfilcon A with moisturizing additives HPMC, PEG and PVA (nefA+3), and etafilcon A with added PVP (etaA+1) for one week each.

Results 273 subjects completed the first trial. Comfort upon insertion was rated 9.1 for nelfilcon A with moisturizing additives (nefA+3) and 8.7 for nelfilcon A lenses (nefA+1); comfort during the day was 8.7 and 8.7, respectively; end of day comfort was 7.9 and 7.2, respectively; overall comfort was 8.6 and 8.4, respectively. 309 subjects completed the second trial. Comfort upon insertion was rated 8.6 for nefA+3 and 7.6 for etaA+1; comfort during the day was 8.4 and 7.8, respectively; end of day comfort was 7.2 and 6.6, respectively; overall comfort was 8.4 and 7.5, respectively.

Conclusion Mean comfort ratings were significantly in favor of nelfilcon A with additives HPMC, PEG and PVA in both trials. Future innovations in daily disposable lenses with added moisturizes to last throughout the day should be expected.

Commercial interest
Refractive surgery using CustomVis Solid State Laser 213nm. One year post‐op clinical evaluation supported by an experimental study
Authors: PALLIKARIS IG
Published: September 2008

Purpose To report our experimental and clinical findings using a solid state laser system 213nm in refractive surgery.

Methods 40 pigmented rabbits underwent myopic PRK using a solid state laser in one eye and excimer laser in the fellow eye. Rabbits were sacrificed immediately after the ablation, at 7days and at one, 3 and 12months after surgery. Corneal tissue was preserved for Light, Scan and Transmission electron microscopy. 60 patients (115eyes) underwent PRK [mSEQ ‐4.43±1.81D] and 20 patients (40eyes) LASIK [mSEQ ‐5.55±1.52D] using CustomVis quintupled Nd:YAG Solid State laser at 213nm.

Results Experimental study: Immediately after the ablation, LM, scan and TEM microscopy revealed relatively smooth ablation surfaces in both groups. At 1,3 and 12m postoperatively, there was tissue appearance, typical for post‐PRK samples, of all corneal layers in both groups. Clinical study: At one year follow‐up for the PRK mRSEQ was ‐0.11±0.52D and mUCVA was 1.03. 39% gained more than 1 line, 48% had no loss or gain of lines and 12% lost more than 1 line. For the LASIK group at 12m the mRSEQ was 0.42±0.70D and the mUCVA was 0.94; 61% of eyes gained more than 1 line, 33.3% of eyes gained had no loss of lines and 5.6% of eyes lost more than 1 line. 67% of eyes were in the +/‐ 0.25 and 72% of eyes were in the +/‐0.5 interval for the Lasik patients. For the PRK patients 49% of eyes were in the +/‐ 0.25 and 80% of eyes were in the +/‐0.5 interval for the Lasik patients.

Conclusion Photorefractive keratectomy in rabbits with ultraviolet solid state and excimer laser revealed similar histopathological findings up to one year postoperatively. PRK and LASIK were both effective and safe in the correction of myopic astigmatism.
Intracorneal lenses for the treatment of presbyopia: visual outcomes and safety
Authors: PALLIKARIS IG , BOUZOUKIS DI , KYMIONIS GD , PANAGOPOULOU S , PALLIKARIS AI
Published: September 2008

Purpose To investigate the visual outcomes and safety of Intracorneal lenses (Invue Lens, Biovision AG, Switzerland) for the treatment of presbyopia.

Methods This was a prospective clinical study. An intrastromal corneal tunnel was created using a microkeratome composed by a control unit, a suction ring and a cartridge. The lens was inserted within the cornea tunnel of the non‐dominant eye of 45 presbiopian patients. Mean age was 52,33 years old ± 3,29 (25 males and 20 females). The follow‐up was up to 12 months.

Results In the operated eye, mean uncorrected visual acuity for distance (UVA‐D) preoperatively, one day, one week one month, three months,six months and 1 year after surgery was 20/20, 20/40, 20/40, 20/32, 20/32, 20/32 and 20/32 respectively, whereas for near (UVA‐N) was 20/50, 20/40, 20/30, 20/30, 20/25, 20/25 and 20/30.Binocular far vision was not altered.Contrast sensitivity tests demonstrated a decrease in scotopic and mesopic conditions.Wavefront analysis demonstrated an increase in all high order aberrations, whereas maximum myopic effect was demonstrated in 3,5 mm zone,which corresponded in the diameter of the lens. No tissue alterations of the cornea were found using corneal confocal microscopy. No intra or post‐operative complications were demonstrated up to one year after surgery.

Conclusion Intracorneal lenses for presbyopia seems to be a safe and effective method to correct presbyopia in patients aged between 45 to 55 years old; a target group which is considered too old for refractive laser surgery and too young for clear lens extraction. Longer follow‐up and a larger population are necessary in order to draw more significant results of this new surgical approach for the treatment of presbyopia.
Multifocality and focus shift IOLs ‐ theoretical aspects
Authors: HULL CC
Published: September 2008

Purpose The purpose of this talk is to review the clinically relevant optical properties of multifocal and accommodative intraocular lenses and the potential visual consequences. The intention is to develop a fundamental understanding for clinicians and those working with them.

Methods Critical evaluation of the optical, clinical and vision science literature. Topics covered will include principles of refractive and diffractive lenses, apodization, effect of pupil size, compromises in design, single and dual optic accommodative intraocular lenses, objective and subjective accommodation, depth of focus and theories of accommodation.

Results Design of multifocal lenses involves a compromise in image quality that does not always manifest itself visually but can be measured optically. Accommodative intraocular lenses are limited in the amount of accommodation they can restore by the longitudinal shift in the lens and also post operative changes in the capsule. Changes in the radii of curvature of the lens surfaces are much more efficient at producing alterations in lens power.

Conclusion All surgeons and associated workers need a knowledge of the optical principles of multifocal and accommodative intraocular lenses together with their visual consequences if they are to understand the cause of unwanted side effects. In addition, they will be better equipped to understand new developments in this rapidly changing field.
Visiogen Synchrony dual‐optic lens
Authors: AUFFARTH GU
Published: September 2008

Purpose Currently available single optic accommodative IOLs have their limitatations in terms of maximal potential accommodative amplitudes. A dual optic system may theoretically have more accommodative power.

Methods The dual optic accommodative IOL Synchrony from the Company Visiogen (Irvine, Ca, USA) consists of a +30diopters anterior lens and a minus‐lens of variable power (depending on emmetropisation). The IOL is made of silicone material.

Results Since more than 3 years this IOL is already under clinical investigation showing promising results. The lens has been implanted in several hundred patients in Europe and South America. A FDA study is currently running, in Europe the IOL is CE‐marked Accommodative values around 1‐4 dioptes have been measured and documented in patients.

Conclusion Longterm results indicate low posterior capsule opacification and stable accommodative abilities.
Innovative IOL accommodative technologies: NuLens and TekClear
Authors: ALIO SANZ JL , BEN‐NUN J
Published: September 2008

Purpose To develop intraocular lenses capable of changing the power of the lens or the power of the eye related to active ciliary body function.

Methods Clinical pilot study on a consecutive series of patients implanted with the Nulens accommodative IOL (NuLens Ltd) and TekClear positional pseudoaccommodative IOL (Tekia Inc). Follow up was 3‐6 months. The tenets for the Helsinki declaration were followed in this investigation. Main outcome measures were improvement in near vision with distance correction and without near vision add, near vision add to reach best spectacle corrected vision for near, biometrical study of the IOL changes inside the eye at the postoperative.

Results The Nulens demonstrated a mean clinical accommodation of 8‐10 diopters. TekClear demonstrated a mean near vision improvement of 1.25 diopters. Some variability was observed with both lenses. Biometrical investigation of both lenses when implanted inside the eye demonstrated a potential for accommodation of up to 17 diopters for the Nulens and up to 2.5 diopters for the TekClear.

Conclusion Real accommodation restoration up to 8 diopters is feasible with the Nulens IOL and a near vision gain of 1‐2 diopters is possible with the TekClear IOL. In both cases, active ciliary body action was correlated with the near vision improvement observed in the patients.

Commercial interest
The difference in focal photocoagulation treatment decisions of clinically significant macular edema between different medical retina specialists
Authors: VAN DIJK HW , KOK PHB , SCHLINGEMANN RO , LESNIK OBERSTEIN SY , TAN HS , ABRAMOFF MD , VERBRAAK FD
Published: September 2008

Purpose To evaluate the difference in focal photocoagulation treatment decisions of clinically significant macular edema (CSME) between different medical retina specialists.

Methods Twenty five eyes of 16 diabetic patients with a clinical suspicion of CSME were examined by stereo slitlamp biomicroscopy to determine the exact location and extend of CSME. Results of these observations were drawn into a set of FA images (early / mid / late phase) and color fundus photographs. Based on these images, seven medical retina specialists, marked the position, pattern, and number of laserspots on the corresponding color photograph.

Results We found considerable differences between the medical retina specialists in treatment decisions with respect to the amount and localisation of the fictional laserspots.

Conclusion The focal photocoagulation treatment for CSME differs between medical retina specialists with respect to the amount and localisation of the laserspots. Therefore future studies concerning photocoagulation treatment outcome should define their treatment protocol precisely.
Epidemiological study of the blindness burden in the state of AP, India
Authors: KHANNA R
Published: September 2008

Abstract not provided
Clinical research and trials
Authors: SANGWAN V
Published: September 2008

Abstract not provided
Nerve fiber layer thickness measured with polarimetry (GDX) in patients with type I diabetes
Authors: IDOIPE CORTA M , GARCIA‐MARTIN E , GIL ARRIBAS L , FERRERAS A , ABECIA E , PINILLA I
Published: September 2008

Purpose To evaluate the efficacy of GDX to detect loss of the retinal nerve fiber layer thickness in patients with type I diabetes without retinopathy.

Methods Comparative cross‐sectional study. Thirty eyes of 30 healthy subjects and 30 eyes of 30 patients with type I diabetes mellitus were studied. Ophthalmic examination of diabetic patients showed no retinopathy. One eye per patient was randomly selected for the study. The nerve fiber layer thickness was measured with polarimetry (GDx).

Results The control group was formed by 9 women, 21 men, aged 18‐38 yr (mean ± SD 28.7 ± 6.01). Diabetic patients were 9 women and 21 men, aged 25.02 yr (± 8.1). Mean period from the onset of diabetes was 14.2 years (SD 5.46). None of the diabetic group had changes at the fundus examination. No differences were found between control and diabetic group.

Conclusion GDx is not able to find differences in the retinal nerve fiber layer thickness in diabetic patients without retinopathy.
Upper eyelid tumour
Authors: LOEFFLER KU
Published: September 2008

Purpose To describe the clinical and histologic features of a rare eyelid tumour.

Methods A 56‐year‐old male patient presented with a nodular subcutaneous tumour in his right upper eyelid close to the eye brow. The lesion had been present for 2 years; there was no pain or inflammation but a slow increase in size. No other significant ocular abnormality was noted, and the patient's general health was good without any medication. On MRI, the tumour presented as a circumscribed non‐infiltrating pseudocystic mass, 20mm in diameter in size and located in the subcutis.

Results Histopathology showed a loose myxoid stroma with low cellularity and occasional small blood vessels. A distinct capsule or pseudocapsule was not identified. Near the periphery some fat lobules were seen. The mucoid ground substance stained lightly with Alcian blue. The tumour cells were sparsely distributed throughout the tumour without any particular pattern; most appeared spindle‐shaped with an inconspicuous nucleus and no mitotic figures. Several mast cells were identified. Together with immunohistochemical findings (CD34+, SMA‐, Desmin‐), the diagnosis of myxoid spindle cell lipoma was made.

Conclusion To our knowledge, no tumour has been documented in the literature that was histologically really similar to the one present in our patient. There was only very little normal adipose tissue, and a floret‐like nuclear pattern typical for pleomorphic lipoma (but also seen occasionally in normal orbital fat) was not observed. Even though the distinction from other lesions might in some cases be somewhat academic the differential diagnosis includes herniated orbital fat, other lipoma variants such as myolipoma and the hitherto mentioned pleomorphic lipoma, other myxoid tumours, and obiously malignant lesions such as (especially myxoid) liposarcoma.
Topical 5‐FU vs. mitomycin C in conjunctival squamous cell tumours
Authors: PE'ER J , MIDENA E
Published: September 2008

Abstract not provided
Choroidal collision tumour
Authors: COUPLAND SE , DAMATO BE
Published: September 2008

Abstract not provided
Fundus autofluorescence imaging of choroidal tumors
Authors: PILOTTO E , PARROZZANI R , MIDENA E
Published: September 2008

Purpose To investigate the different pattern of fundus autofluorescence imaging of choroidal tumors generated with short‐wavelength and near‐infrared

Methods Thirty‐one eyes of 31 consecutive patients affected by choroidal tumor performed standard fundus autofluorescence with short‐wavelength (SW FAF) and fundus autofluorescence with near‐infrared (NIR FAF). Fundus photography, A and B scan ultrasound and OCT were performed. Autofluorescence features of choroidal tumor and overlying retinal pigment epithelium (RPE) were correlated with clinical features.

Results Twelve of 31 choroidal tumors were choroidal melanoma, 8 choroidal nevus, 5 circumscribed choroidal hemangioma and one was choroidal granuloma. Different pattern of SW FAF and NIR FAF were detected related to the presence of pigment, drusen, RPE atrophy and hyperplasia, RPE detachment and subretinal fluid over or around the lesion.

Conclusion Standard autofluorescence (SW FAF) and NIR FAF provide different information on intrinsic autofluorescence of choroidal tumor and on the related RPE and retinal changes
Non mydriatic retinograph for the diagnosis and follow‐up of diabetic retinopathy
Authors: PEREZ GARCIA D , MATEO OROBIA AJ , IBANEZ J , PEIRO C , SAINZ A , CRISTOBAL JA
Published: September 2008

Purpose To determine the validity of the non mydriatic retinograph for the early diagnosis and follow‐up of diabetic retinopathy

Methods 367 eyes of diabetic patients were examined using a non mydriatic retinograph. 45º and 30º pictures were taken of 9 fields, with and without pupilar dilation. Retina was examined in mydriasis with slit lamp biomicroscopy and conventional oftalmoscopy. Both methods were compared to determine their validity in the diagnosis and gradeing of diabetic retinopathy.

Results For the early diagnosis of diabetic retinopathy there was obtained a sensibility of 88‐95 %, with a specificity of 96 %. 9,5 % of the photos were not valid. To obtain a good sensibility of the retinograph in establishing the grade of diabetic retinopathy, being comparable to the established one, the conventional exploration, it was necessary to realize photos in all the nine fields and with pupilar dilation. The sensibility of detecting edema was low

Conclusion The non mydriatic retinograph is a useful a tool for the screening of diabetic retinopathy in the population. Nevertheless, to determine the correct grade of the pathology, in order to permit a good follow‐up of the retinopathy, the obtained sensibility was insufficient not being adequate to substitute the indirect oftalmoscopy and slit lamp biomicroscopy.
Intravitreal pegaptanib sodium (Macugen) for diabetic macular edema
Authors: QUERQUES G , BUX AV , MARTINELLI D , IACULLI C , DELLE NOCI N
Published: September 2008

Purpose To report the functional and anatomic outcomes resulting from the use of intravitreal pegaptanib sodium as primary therapy in patients with diabetic macular edema (DME).

Methods We conducted a retrospective outcome analysis, by optical coherence tomography (OCT) and best‐corrected visual acuity (BCVA), of eyes with DME treated with primary intravitreal pegaptanib sodium (Macugen). Moreover, we evaluated the foveal transverse photoreceptor (PR) band integrity in the OCT images, at the time of the last follow‐up visit.

Results Sixty‐three eyes of 48 patients with a minimum of 6 months’ follow‐up (FU) were included for analysis. Intravitreal pegaptanib was found to produce significant improvements in mean BCVA (p = 0.019) and reductions in mean central macular thickness (CMT) (p <0.001), as soon as the 6‐weeks FU. Most eyes (60/63) required a mean of 3 repeated treatments, over a mean FU period of 6.7 +/‐ 1.2 months, to achieve significant improvements in mean BCVA (p <0.001) and mean CMT (p <0.001). In our series, the lower visual acuities tended to congregate in the group with the less‐defined PR band (p <0.001), and the lower CMT tended to congregate in the group with the best‐defined PR band (p=0.04), even though the higher CMT did not tend to congregate in the group with the less‐defined PR band.

Conclusion Our findings demonstrate that selective inhibition by intravitreal pegaptanib sodium of VEGF165 may produce a clinically meaningful and statistically significant benefit in the treatment of DME.
Specificity and sensitivity of Heidelberg retina tomograph macular edema maps and the effect of exudate and hemorrhage
Authors: HUDSON C , SU L , KANCHANARANYA N , GUAN K , LAM WC , DEVENYI RG , MANDELCORN M , HARVEY P , FLANAGAN JG
Published: September 2008

Purpose To assess the specificity and sensitivity of the Macular Edema Module (MEM) of the Heidelberg Retina Tomograph (HRT, Heidelberg Engineering, Heidelberg, Germany) versus Stereoscopic Color Fundus Photographs (SCFP) for patients with different grades of diabetic macular edema (ME) and non‐diabetic subjects. The effect of local exudates and hemorrhage on the specificity and sensitivity of MEM was also investigated.

Methods The study included 20 eyes of 20 normal subjects without diabetes and 60 eyes of 60 diabetic patients. Eyes of diabetic patients were classified as without ME (n = 20), with questionable ME (n =20) and with Clinically Significant Macular Edema (CSME, n =20). All participants underwent a full ophthalmological evaluation, plus SCFP and HRT II MEM assessment. The sectors with exudate and/or hemorrhage on the SCFP were removed from the CSME group to generate a modified group (n=20) with CSME and without exudate or hemorrhage.

Results In the normal subject group, the specificity of MEM was 92.2%. In the diabetes without macular edema group, the specificity of MEM was 91.7%. In the questionable ME group, the specificity of MEM was 93.1%. In the CSME group, the specificity of MEM was 87.3%, and the sensitivity for detecting CSME was 77.1%. In the modified group with CSME and without exudate or hemorrhage, the specificity of MEM was 85.7% and the sensitivity for detecting CSME was 96.9%.

Conclusion The determination of diabetic macular edema by MEM shows good to moderate sensitivity and very good specificity. Furthermore, removing the influence of the exudate and/or hemorrhage resulted in excellent sensitivity and very good specificity.
TOPCON 3D OCT 1000 reproducibility in normal and diabetic patients
Authors: PEROVSEK D , URBANCIC M , HAWLINA M
Published: September 2008

Purpose TOPCON 3D OCT 1000 is a spectral domain OCT, used in our everyday’s practice. There are many studies reporting reproducibility of commercially available time domain OCTs. The reproducibility of spectral domain OCTs is expected to be better. To our knowledge there are no reproducibility studies with TOPCON 3D OCT 1000. Our purpose was to evaluate its reproducibility in normal and diabetic patients.

Methods 10 normal maculae and 10 maculae with diabetic edema were scanned for 5 times. Data presented as retinal thickness and retinal volume were analyzed and statistically evaluated.

Results TOPCON 3D OCT 1000 shows excellent reproducibility in normal patients. Differences in measured parameters in patients with diabetic macular edema are not statistically significant.

Conclusion Retinal thickness and retinal volume measurements with TOPCON 3D OCT 1000 are very reliable, although care must be taken in interpreting small differences in pathologic conditions.
The Moorfields diabetes survey: lessons learnt
Authors: PETO T , POWLING A , DIABETES RETINOPATHY SCREENING TEAM THPCT
Published: September 2008

Purpose The purpose of this talk is to describe the lessons learnt from the Moorfields Diabetes Survey and the Tower Hamlets Diabetic Retinopathy Screening Programme in order to emphasise the importance of good communication between components of screening.

Methods The Moorfields Diabetes Survey highlighted that most patients in eye clinics have diabetes related complications, but little understanding of diabetes itself and its relevance to eye disease. In order to help these patients, it was essential to understand how diabetic retinopathy screening could help with the detection, the education and the referral of patients with diabetic eye disease requiring treatment. The screening episode consists of proper identification of the target population and appropriate funding for the whole service, a robust call‐recall system, a protocol driven screening episode and the timely treatment of sight threatening retinopathy. All elements must have in‐built quality assurance.

Results In England, the National Screening Committe's guidelines govern the screening process. Although it provides strict quality control and reporting guidance, there is considerable freedom for the individual programs to set up the best service for their population. Tower Hamlets is one of the most deprived boroughs of the UK and as such, faced a difficult task to build a programme to such standards. To identify and keep track of the highly mobile population, deal with several religious requirements are the first challenges, followed by obtaining enough funding for the screening, the educational activities and for the treatment of retinopathy.

Conclusion A well‐trained and committed workforce working in good partnership between primary care and the treatment centre has made this possible.
Improvements in visual acuity within one year following intravitreal bevacizumab in neovascular age‐related macular degeneration
Authors: JAKI MEKJAVIC P , KRAUT A , URBANCIC M , LENASSI E , HAWLINA M
Published: September 2008

Purpose To evaluate the effects of intravitreal treatment with bevacizumab on vision and anatomic outcome in patients with neovascular AMD.

Methods Retrospective review of 153 eyes that received three or more intravitreal injections of bevacizumab (1.25 mg) for neovascular AMD over a one‐year period. Patients underwent ophthalmological examinations, measurements of the best‐corrected visual acuity (VA), fluorescein angiography and optical coherence tomography, at baseline and at monthly follow‐up visits. Repeated injections were given in the presence of persistent leakage or retinal oedema. We analyzed the data obtained at three time intervals: 1 month (first evaluation) after the third injection, 6 months (second evaluation), and one year (third evaluation) after the onset of treatment. Changes from baseline in VA, central retinal thickness (CRT), and total macular volume (TMV) were analyzed using paired t‐tests.

Results Mean baseline VA improved from 50.5 to 57.6 letters (P < 0.0001, N = 153) at first evaluation, 58.3 letters (P < 0.0001, N = 119) at second evaluation, and 59.5 letters (P = 0.002, N = 48) at third evaluation. Baseline mean CRT (344.6 μm) and baseline mean TMV (8.6 mm3) decreased at the first evaluation, to 219.0 μm (P < 0.0001) and 7.2 mm3 (P < 0.0001), respectively. No systemic or serious ocular side effects were noted.

Conclusion Intravitreal bevacizumab is an effective treatment for neovascular AMD, resulting in significant functional and anatomical improvement seen up to one year. After one year, VA in 27% of patients was improved by 15 letters or more, was maintained stable in 67% of patients, and was worsened by 15 letters or more in 6% of patients.
In vivo confocal microscopy of abnormal cornea: a clinical and pathological correlation
Authors: ALOMAR TS , LOWE J , DUA HS
Published: September 2008

Purpose To establish correlations between in vivo confocal microscopic (IVCM) images with histopathology of various ocular surface disorders.

Methods 50 patients with various ocular surface/corneal diseases scheduled to undergo biopsy, impression cytology or surgery such as keratoplasty were clinically examined and assessed by IVCM with emphasis on area of pathology. The tissue obtained was then oriented and studied by light and/or electron microscopy. The microscopic anatomy was then correlated with the IVCM findings to establish a pathological basis for the observations. Conditions studied included corneal degenerations & dystrophies, conjunctival tumours, conjunctivalisation of the cornea and others. The Rostock Cornea Module (RCM) attached to HRT II machine from Heidelberg Engineering was used for IVCM.

Results By precise histological characterization of tissue changes we have been able to assign diagnostic criteria to IVCM features such as hyper and hypo reflective dots and shapes, linear straight and branching images and smaller dendritic figures. A diagnostic feature of intraepithelial neoplasia by IVCM has been established. A distinct pre Descemet’s layer, termed the posterior stromal layer has also been defined. Subepithelial bright shadows in advanced Fuch’s endothelial dystrophy have been identified as fibroblasts. Other interesting correlations are emerging.

Conclusion High quality in vivo corneal confocal microscopic imaging can highlight pathological changes comparable to those found in histopathology slides in a way that can help establishing diagnostic confocal microscopic criteria obviating the need for histopathology and biopsy in some cases.
Antimicrobial peptides expression in activated human corneal keratocytes
Authors: MUSHTAQ F , MOHAMMED I , TINT NL , HOPKINSON A , DUA HS
Published: September 2008

Purpose The eye despite being a delicate structure,has evolved many protective mechanisms.Antimicrobial peptides(AMPs) and Toll‐like receptors(TLRs)have an important role in the ocular defense system.However during an infection or trauma, the innate defense system is breached.In this instance,keratocytes and fibroblasts aids in wound healing as well as provide a second line of defense.Little is known about AMP expression by TLR signalling pathways in corneal fibroblasts.This study therefore demonstrates the mRNA expression of both novel and known AMPs in various fibroblast phenotypes(myofibroblasts and keratocytes).In addition, AMPs were also shown in microbial ligand and/or pro‐inflammatory cytokine stimulated human corneal fibroblast cultures (HCFC).

Methods Fresh Keratocytes and HCFC were cultured and collected at different stages of growth and/or after stimulation with microbial ligands. Total RNA was extracted and cDNA was synthesized for semi‐quantitative gene expression studies. Polymerase chain reaction (PCR) amplified product were analyzed on ethidium bromide stained 1% agarose gels.

Results Constitutive expression of Thy‐1(CD‐90), vimentin, keratocan and alpha SMA was shown in all cultures.Keratocyte phenotype marker CD‐34 showed decreased expression from 1st to 4th passage.Positive expression of Human beta defensin 109, Liver‐expressed AMP(LEAP‐2) and cathelicidin/LL‐37 was demonstrated in cytokine and microbial ligand stimulated HCFC.

Conclusion Reminiscent with previous studies,we have demonstrated the mRNA expression of novel and known AMPs in corneal fibroblast mediated by TLR dependent signalling mechanisms. This result warrants the further study to fully understand the role of AMPs in ocular wound healing.
In vitro evaluation of adhesion of adipose‐derived adult stem cells to chitosan for the treatment of ocular surface pathologies
Authors: PASTOR S , ALIO SANZ JL , GAMBOA‐MARTINEZ TC , ARNALICH‐MONTIEL F , DE MIGUEL MP , GOMEZ‐RIBELLES JL , GALLEGO‐FERRER G
Published: September 2008

Purpose To analyze the ability of adhesion of adipose‐derived adult stem cells (ADAS) to porous materials made of chitosan for the future design of biodegradable autologous membranes for the treatment of ocular surface pathologies

Methods We used porous chitosan scaffolds prepared by cold neutralization in a 4% chitosan aqueous solution at acid pH, some of the materials were treated with argon plasma to favour cell adhesion. ADAS cells were obtained after adipose tissue processing from patients undergoing liposuction surgery. 5,000 cells were seeded per each scaffold in DMEM/F12 medium and cellular growth was analyzed on these materials by scanning electron microscopy (SEM) after ten days in culture.

Results Adhesion was observed and cell growth was optimal on the surface of non‐plasma‐treated biomaterials. Chitosan scaffolds treated with argon plasma showed better adhesion properties. Extracellular matrix production was also observed

Conclusion 4% chitosan biomaterials allow for adhesion, proliferation and extracellular matrix production of ADAS cells. Biocolonization of these biomaterials with ADAS cells will imply the future design of biological autologous membranes containing cells from the very same patient that would act as patches for the treatment of ocular surface pathologies for which current treatments show certain risks such immune rejection, infections or low effectivity.
No consequence of dietary omega‐3 polyunsaturated fatty acid deficiency on the severity of scopolamine‐induced dry eye
Authors: CREUZOT CP , VIAU S , PASQUIS B , MAIRE MA , BRETILLON L , GREGOIRE S , ACAR N , BRON AM , JOFFRE C
Published: September 2008

Purpose Epidemiological studies suggest that dietary omega‐3 polyunsaturated fatty acids (PUFAs) may protect against prevalence of dry eye. This work aimed to evaluate whether a dietary deficiency in omega‐3 PUFAs may increase the severity of dry eye in a scopolamine‐induced rat model.

Methods Three consecutive generations of Lewis rats were bred under diets deprived of omega‐3 PUFAs. Dry eye was experimentally induced by continuous scopolamine delivery in female animals from the third deficient generation and in female Lewis rats fed with a balanced diet. After 14 days of treatment, the clinical signs of ocular dryness were evaluated in vivo using fluorescein staining. MHCII and the mucin Muc5AC were immunostained on eyeball cryosections. Lipids were extracted from the exorbital lacrimal glands and phospholipid fatty acids were analyzed by gas chromatography.

Results The percent of fluorescein stained area to total area of the cornea was significantly increased in scopolamine‐treated animals when compared to not implanted animals. Scopolamine treatment decreased Muc5AC immunostaining and tended to increase MHCII immunostaining in the conjunctival epithelium for both diets. In exorbital lacrimal gland phospholipids, arachidonic acid (AA) and the delta5‐desaturase index were significantly increased by scopolamine treatment for both diets. There was no significant diet‐difference in scores of fluorescein staining, Muc5AC and MHCII immunostaining. The omega‐3 PUFA deficiency induced a significant increase in AA in the exorbital lacrimal gland.

Conclusion Our data suggest that, unexpectedly, an omega‐3 PUFA deficiency did not increase the severity of dry eye in the rat.
Cyanoacrylate tissue gluing in corneal perforations associated with herpetic keratitis
Authors: JHANJI V , MOORTHY S , BELTZ J , CONSTANTINOU M , VAJPAYEE RB
Published: September 2008

Purpose To evaluate the success of cyanoacrylate tissue adhesive for the management of corneal perforations associated with herpetic keratitis.

Methods Forty six eyes of 46 patients with microbiologically proven herpetic keratitis associated with corneal perforation were included in a retrospective analysis. N‐Butyl cyanoacrylate tissue adhesive and bandage contact lens were applied in addition to antiviral therapy. Outcome measure was the preservation of the structural integrity of the globe.

Results After glue application, the corneal perforation healed with scar formation in only 12 (26%) eyes. Keratoplasty had to be performed in 32 eyes (70%) due to failure of the glue. Fourteen (31%) eyes required multiple applications of tissue adhesive. Two eyes underwent enucleation and 1 eye became phthisical.

Conclusion Glue application for corneal perforation in cases of herpetic keratitis is not effective and most cases require a corneal graft to maintain the ocular structural integrity.