bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome measures in JIA associated uveitis
Authors: FOELDVARI I
Published: December 2011

Purpose Uveitis associated to juvenile idiopathic arthritis (JIA) is still the most frequent cause of blindness in the western world. It is an orphan disease and there are up till now no controlled trials for the treatment. Our multidisciplenary group is focusing on the further development of outcome measures of the SUN group (1) ,which could be used for prospective controlled studies. To develop outcome measures for JIA associated uveitis, which enable us to score the disease activity and complications of uveitis.

Methods We established our group based on special interest in this topic, and had two face to face group meetings to develop a proposed outcome measure domains and items.

Results We reached consensus in the group in the face to face meeting and definedspecific domains to assess the activity of JIA associated uveitis and defined items to assess the domains.

Conclusion This proposed domain and items will be discussed with a larger group of specialist and after that prospectively tested on consecutive patients for validation. It is aimed to develop outcome criteria according the OMERACT procedure.
Long‐term follow‐up of patients with uveitis associated with juvenile idiopathic arthritis: a cohort study of three centers
Authors: BARISANI‐ASENBAUER T
Published: December 2011

Abstract not provided
Use of hypo‐osmolar riboflavin for corneal cross‐linking in thin keratoconic corneas
Authors: FRUSCHELLI M , BATISTI C , MOTOLESE I , SANGIUOLO M , MENICACCI F , MENICACCI C , MOTOLESE E
Published: December 2011

Purpose To evaluate the efficacy of UVA collagen cross linking (CXL) on thin keratoconic corneas with previous application of hypoosmolar riboflavin solution.

Methods Twelve eyes of 12 patients with progressive keratoconus and a corneal thickness of less than 400 µm without the epithelium, were submitted to collagen cross‐linking after the application of an hypoosmolar riboflavin solution. We instilled one drop every 5 seconds for 2 or 4 minutes to increase corneal thickness up to a minimum value of 400 µm. Pachimetry measurements were taken every 30 seconds to verify the effect on corneal stroma.

Results Mean corneal thickness improved in most cases with reduction of the mean K‐value of the keratoconus and no progression was observed at six and twelve months after CXL. One year after treatment no scarring lesions in the stroma were observed and all corneas were transparent. Improvement of visual acuity was significant in three patients (25%), low but detectable in seven patients (51%) and no modifications of visual acuity were observed in two patients (24%).

Conclusion Hypoosmolar riboflavin solution showed to be useful to allow CXL procedure in keratoconic corneas with low stromal thickness. No progression of keratoconus was observed six months and one year afer CXL., no developing of stromal scars and patients showed good stability of visual acuity delaying time of surgery.
Outcomes of trabeculectomy with transconjunctival application of Mitomycin C
Authors: MAHROO O , SCOPPETTUOLO L , ANSARI E
Published: December 2011

Purpose To assess outcomes of trabeculectomy surgery augmented with Mitomycin C (MMC) applied trans‐conjunctivally.

Methods An MMC applicator (Duckworth and Kent, UK) was developed for drug delivery. Fornix‐based conjunctival flap dissection was performed in each trabeculectomy case after trans‐consjunctival MMC application for 3 min. A retrospective, case‐note study was conducted. Records of patients who underwent the procedure over a one‐year period, were analysed. Duration of follow‐up, intraocular pressure (IOP) at last follow‐up, and complications were noted.

Results 33 eyes of 28 patients were included. 23 eyes had primary open angle glaucoma, 5 had chronic narrow angle glaucoma, 2 had ocular hypertension and 3 had secondary open angle glaucoma. Mean follow‐up duration was 8.4 months (range 3‐15 months). Mean IOP at last follow‐up was 11.9 mm Hg (range 2 to 21). Proportions of patients achieving IOPs at last follow‐up of less than or equal to 12, 15, 18 and 21 mm Hg were 66.7%, 72.7%, 93.9% and 100% respectively. Two eyes (6.1%) had an IOP of 6 or below at last follow‐up. Eight eyes (25%) required further needling or antimetabolite injection (2 of these underwent bleb revision). Other complications included choroidal effusions (4 eyes, 12.1%), transient bleb leakage (2 eyes, 6.1%) and corneal decompensation (1 eye, 3.0%).

Conclusion IOP outcomes in this preliminary study of trans‐conjunctival MMC application are comparable to those reported using the more conventional subconjunctival application of MMC (WuDunn et al. Am J Ophthalmol. 2002;134:521‐8; Wilkins et al. Cochrane Database Syst Rev. 2005;4:CD002897). Thus trans‐conjunctival application may be a viable alternative. A larger study is underway comparing the two methods.
Glaucoma and retinal detachment surgery
Authors: MANGOURITSAS G
Published: December 2011

Purpose Secondary transient or permanent elevation of intraocular pressure (IOP) is a quite common complication following vitreoretinal procedures.

Methods This presentation will focus on different mechanisms, clinical diagnosis and management of the secondary glaucoma after scleral buckling, vitrectomy with or without gas or silicone oil tamponade, and application of steroids.

Results In pre‐existing operated glaucoma with filtering surgery, maintenance of the bleb requires an approach for conjunctiva preservation with techniques such as small gauge vitrectomy. Secondary hypertension can occur after scleral buckling because of congestion and anterior rotation of the ciliary body. Medical therapy is usually successful in controlling IOP, however surgical intervention could also be needed. Intravitreal injection of gases (SF6, C3F8) may produce secondary angle‐closure glaucoma with or without pupillary block. Intraocular gas removal may be indicated. Secondary glaucoma can also develop after intravitreal injection of silicone oil due to pupillary block, inflammation, synechial angle closure, or migration of emulsified or nonemulsified silicone oil into the anterior chamber. Patients with medically uncontrolled glaucoma after silicone oil tamponade, with an open inferior iridectomy, may require oil removal with or without concurrent glaucoma surgery.

Conclusion Diode laser transcleral cyclophotocoagulation and drainage implants constitute approved methods for long‐term IOP regulation. The underlying cause of secondary glaucoma after vitreoretinal surgery is often multifactorial. Cooperation between vitreoretinal and glaucoma specialists may be helpful in successful treatment.
Lens phacoemulsification in treatment primary angle closure glaucoma with block induced lens after laser peripheral iridotomy
Authors: FAYZIEVA UMIDA , EGOROVA ELYA
Published: December 2011

Purpose To investigate the features of iridocilliary zone in patients with primary angle closure glaucoma (PACG) in cases of anterior chamber angle (ACA) block induced by lens after laser iridotomy and subsequent lens phacoemulsification with foldable IOL implantation.

Methods 45 patients (54 eyes) with PACG have been selected for this investigation. Parameters of iridocilliary structures were measured using ultrasound biomicroscopy (UBM) model «Humphrey‐840».

Results UBM allowed to determine the features of block induced by lens at PACG. In these cases there was the displacement of lens‐iris diaphragm forward independent of lens thickness with ACA block. The iris had a convex profile. The posterior chamber lost correct triangle configuration with decrease in section area by 1.3 times as compared to the norm. Most cases had a short‐term hypotensive effect after laser iridotomy with only segmental opening of ACA. The extreme anterior position of the lens‐iris diaphragm and small posterior chamber area persist at all cases. Configuration of the iris saved its convex. Subsequent phacoemulsiaicftion with foldable IOL implantation decreased the intraocular pressure (IOP) and eliminated block induced by lens with opening of the ACA. The restore of iris profile and posterior chamber configuration have been observed in all cases.

Conclusion Laser iridotomy creates optimal conditions for lens phacoemulsiaicftion by removing angular block and decreasing IOP from preoperative level. Phacoemulsiaicftion is pathogenic operation in cases of PACG with ACA block induced by lens.
Outcome of trabeculectomy in uveitis patients with secondary glaucoma
Authors: LEWKOWICZ D , WILLERMAIN F , JANSSENS S , MAKHOUL D , CASPERS L , JANSSENS X
Published: December 2011

Purpose To review the clinical outcome of our series of patients with uveitis and secondary glaucoma in which a trabeculectomy has been performed.

Methods Each patient was classified according to clinical presentation, pre and postoperative IOP, visual acuity and number of antiglaucoma drops needed. The outcome of trabeculectomy was classified in 3 categories: absolute success defined as IOP controlled (< 21 mmHg) without other treatment, relative success defined as IOP controlled with hypotensive drops and failed when IOP was not controlled or required hypotensive drops and oral acetazolamide. Success ratio with and without perioperative mitomycin were compared.

Results Mean visual acuity, IOP and number of drop used decreased at 3 month and at last follow‐up. The mean follow‐up was 19.3 months (2.9 – 67.1 months). At 3 month, we found 80% of overall success (53,33% of relative success and 26,67% of absolute success) and 20% of failure. At final follow‐up, we also found 80% of overall success(56,67% of relative success and 23,33% of absolute success ) and 20% of failure. Patients in whom perioperative mitomycin were used where more likely to have a favorable outcome (last follow‐up: 83.33% vs 75%) but this difference between the two groups was not statistically significant.

Conclusion Our data are in accordance with the rest of the literature which shows that trabeculectomy with antimetabolite agents allows IOP control in the majority of patients. However, many of them will still need topical hypotensive drugs.
Protective antioxidant system disorders in myopic patients
Authors: BOYCHUK IM , KOLOMIYCHUK SG , SUROVAYA EI
Published: December 2011

Purpose The early revealing of the antioxidant system disorders in myopic patients is extremely important for correction and prevention of dystrophic changes in retina and sclera of the eye. One of the most powerful intracellular antioxidants is glutathione (S.M. Cohen, 1994; Paula S. Samiec, 1998). Connected SH and S‐S – groups represent tiol and disulfide bonds in protein structures. As a whole concentration levels of these groups can be considered now as important link of antioxidant protection. To evaluate the protective antioxidant system in patients with myopia by the concentration levels of free and connected SH and S‐S – groups in tear liquid in patients with myopia of different degree the work was conducted.

Methods 34 children aged 8 ‐ 14 years with myopia of different degree and control group of the same age (10) were examined. Except ophthalmologic observations free and connected SH and S‐S – groups in tear liquid were defined by spectrocolormeter Spekol‐210 wave length 356 nm and 412 nm accordingly.

Results It was established that levels of connected SH and S‐S – groups in tear liquid had tendency to increase in average on (4, 8 – 14, 5) % in dependence of myopic degree. Free SH‐ groups content in tear of children with high myopia was lower in comparison with control group on 28% (54,2 ± 5,5) u., P<0,05.

Conclusion Free SH‐ groups content in tear of children with high myopia was significantly lower than in children of other groups. It confirmed that protective antioxidant system abilities are weakened in myopia and that they decrease with myopic severity.
Photodynamic therapy for symptomatic high risk choroidal melanocytic lesions
Authors: AMSELEM L , GARCíA‐ARUMí J , BADAL J , GüNDüZ K , ADAN A , ZAPATA MA , VALLDEPERAS X , CORCOSTEGUI B , HUSTE F
Published: December 2011

Purpose To evaluate the role of photodynamic therapy (PDT) for symptomatic high risk choroidal melanocytic (HRCM) lesions with subretinal fluid extending to the fovea.

Methods Retrospective review of the medical records of all patients who underwent PDT for a HRCM lesion.

Results Seventeen patients were included in the study. The mean initial visual acuity was 20/80 (range CF‐20/20). The mean initial tumor thickness was 1.23 mm (range 0.66‐1.93). All tumors presented at least 2 risk factors for growing. The mean number of PDT sessions was 1.41 (range 1‐3). The mean final visual acuity improved to 20/60 (range CF‐ 20/20). Subretinal fluid was reduced in all (100%) eyes and had completely disappeared in 9 (53%) eyes after PDT. The mean final tumor thickness increased to 1.24 mm (range 0.66 to 2.01) at a mean follow‐up of 22.47 months (range 6‐60). Tumor thickness increased in 3 (18%) eyes, remained unchanged in 13 (76%) eyes, and 1 (6%) lesion shrank down to a flat chorioretinal scar.

Conclusion PDT prevents vision loss with improvement of choroidal leakage in HRCM lesions with serous macular detachment, but doesn´t allow a good local tumor control. Longer follow‐up is required to determine its value in these patients.
Juvenile xanthogranuloma of the iris treated with proton beam radiotherapy.
Authors: DAMATO EM , COUPLAND SE , DAMATO BE
Published: December 2011

Purpose To report a case of juvenile xanthogranuloma of the iris treated with proton beam radiotherapy.

Methods An 18‐year‐old male presented in October 2010 with blurred vision of the left eye. Clinical examination showed a hyphaema. A yellow‐pink tumour was noted in the temporal aspect of the iris. Ultrasonography showed the tumour to have a low internal reflectivity, measuring 7.8mm by 6.4mm in basal diameter with a thickness of 1.4mm. The lesion was noted to be extending to the pars plana. Incisional biopsy showed the tumour confirmed a diagnosis of juvenile xanthogranulomatosis. Treatment with topical steroids was unsuccessful. The patient was therefore treated with proton beam radiotherapy, comprising 18 Gy delivered in four fractions, penetrating to 4mm. Margins of 8mm around the lesion were also treated.

Results The patient was followed up in March 2011 where significant tumour shrinkage was observed on slitlamp examination. The response to treatment was confirmed on ultrasound. There were no new lesions and no evidence of anterior chamber activity. The patient remains under review.

Conclusion Proton beam therapy is an effective alternative local treatment for this condition.
Supraselective intraarterial melphalan as the primary treatment for advanced retinoblastoma in older children
Authors: DE FRANCESCO S , BRACCO S , GENNARI P , GALLUZZI P , CERASE A , D'AMBROSIO A , CAINI M , GALIMBERTI D , TOTI P , VENTURI C , HADJISTILIANOU T
Published: December 2011

Purpose To report 4 late retinoblastoma cases treated with supraselective injection of intraarterial melphalan as the primary treatment. In advanced retinoblastoma in older children enucleation remains the most common treatment option although some eyes can be salvaged with combinations of systemic chemotherapy, focal techniques and external beam radiotherapy. Direct infusion of chemotherapy into the ophthalmic artery has be attempted to achieve tumor control and avoid enucleation.

Methods The authors prospectively collected data of all retinoblastoma cases treated with selective intra‐ophthalmic melphalan at the Referral Center for Retinoblastoma of Siena, Italy, from 2008 to 2011. Four out of 43 cases (4 eyes out of 49 eyes) of late unilateral advanced retinoblastoma received intraarterial melphalan infusion therapy as the primary treatment.

Results Complete remission was obtained in 1 out of 4 cases.

Conclusion The role of intraarterial chemotherapy as primary treatment for advanced retinoblastoma in older children remains to be elucidated.
Superselective intra‐arterial chemotherapy complications in advanced retinoblastoma
Authors: HADJISTILIANOU D , DE FRANCESCO S , DE LUCA M , BORRI M , MENICACCI C , MICHELI L , BRACCO S , GENNARI P
Published: December 2011

Purpose The purpose of this study is to report the complications of superselective intra‐arterial chemotherapy with melphalan in children undergoing treatment for advanced intraocular retinoblastoma.

Methods 49 eyes of 43 children with advanced intraocular retinoblastoma (Reese‐Ellsworth Group Vb or International Classification Group D) were treated with superselective intra‐ophthalmic artery infusion of melphalan. 22 eyes of 43 children were first diagnosis. 27 eyes of 43 children had previously failed traditional management with systemic chemotherapy and focal therapies and underwent intra‐ophthalmic artery infusion of melphalan as an alternative option to enucleation. Serial complications RETCAM images were collected.

Results Ophthalmic artery cannulation was successfully performed in 49 eyes of 43 patients. 9 eyes out of 43 (20.9%) patients were enucleated. 4 eyes out of 43 (9.3%) patients were lost to follow‐up. No severe systemic side effects occurred. Grade III neutropenia was seen in 3 patients (0.6%). No transfusions were required. 25 (58.1%) patients developed eyelid hyperaemia, 10 (23.2%) frontal region skin rash, 12 (27.9%) emiptosis, 6 (13.9%) eyelid edema, 2 (4.6%) frontal alopecia, 2 (4.6%) eyelashes loss, 2 (4.6%) chorioretinal atrophy, 1 (2.3%) acute ischemic optic neuropathy, all resolved spontaneously. 1 case (2.3%) with permanent ptosis underwent surgery. 1 case (2.3%) presented Roth’s spots.

Conclusion Ophthalmic intra‐arterial infusion with melphalan is a promising globe‐conserving treatment option in advanced retinoblastoma cases with minimal systemic side effects.
Anterior segment OCT and histopathologic data in conjunctival, limbal and subconjunctival tumors
Authors: PAJAUJIS M , PETROSKA D , SVALBONAITE E , ASOKLIS R
Published: December 2011

Purpose To show the use of anterior segment optical coherence tomography (AS‐OCT) in conjunctival, limbal, subconjunctival tumors and to compare the data with histopathologic specimens.

Methods 15 patients (15 eyes) with conjunctival, limbal and subconjunctival lesions were examined using AS‐OCT (Visante OCT 2.0, Carl Zeiss Meditec, Dublin, CA). Eyes were scanned using Anterior Segment Single, High Resolution Corneal and Raw Image modes. Gray‐scale, OCT Color and Rainbow Color images were analyzed using built‐in software. All tumors were excised and histopathologicaly examined.

Results In all small tumor cases AS‐OCT allowed to see the deeper lesion structure with complete penetration. In conjunctival melanoma, papilloma, subepithelial naevus and pterygia cases AS‐OCT showed tumor structure, layers and extension clearly. Underlying cornea was also visible. In larger and solid tumors (squamous cell carcinoma, fibroma and lipoma) anterior surfaces were hyper‐reflective, but the deeper structures of the lesions were incompletely penetrated. However, in all cases it was possible to differentiate cystic lesions from solid lesions. Histopathologic examination revealed the diagnosis and in small tumors confirmed the AS‐OCT data showing tumor epithelium and underling layers.

Conclusion AS‐OCT may be a useful non‐invasive diagnostic tool for the evaluation of ocular surface tumors in selective cases. AS‐OCT may give useful information before planning the surgery.
Squamous cell carcinoma (SCC) of the caruncle, with clinical presentation of an inflammatory mass.
Authors: DE KEIZER RJW , VAN DE PUT MAJ , DE WOLFF ROUENDAAL D , HAESEKER BI
Published: December 2011

Purpose The presentation of 2 cases with a very rare adenoidlike SCC of the lacrimal caruncle, clinical referred with a inflammation mass apparent as an abscess.

Methods The tissue of a lacrimal caruncle is arising as well as from skin as mucous and adnexal structures, where in most of the patients only benign laesions could be developed. In our cases inflammation and malignant tumours were found. The diagnosis were made clinical, by imaging methods, (as coherence tomography scan (CT), and ultrasound) and histological analyses. In both cases good differentiated squamous cell carcinomas of the right caruncle were characterized

Results Although in the literature very rarely found, the adenoid type of SCC is described as a less malignant type but in our cases with inflammation a more aggressive behaviour was demonstrated during the follow‐up. Both patients refused orbital exenteration and radiotherapy was performed. However in the second patient, at a later stage, an exenteration was done for a recurrence and extension to the nose and sinus, she died several months later.

Conclusion The very rarely published adenoid caruncle SCC , which first was presented in two cases as an
Adenocarcinoma of the retinal pigment epithelium: clinicopathological case report
Authors: GKARAGKANI E , SCHALENBOURG A , ZOGRAFOS L
Published: December 2011

Purpose Adenocarcinomas of the retinal pigment epithelium (RPE) are rare adult tumors, treated with enucleation or surgical excision. We present a child with an adenocarcinoma of RPE, treated with protontherapy.

Methods A 10‐year‐old girl with loss of vision had a pigmented macular tumor, diagnosed as hamartoma. Five years later, tumor growth led to a transvitreal incisional biopsy.

Results Histopathology and immunohistochemistry were compatible with an adenocarcinoma of the RPE. The tumor was irradiated. After 5 years of follow‐up, the tumor is under control and the patient presents no distant metastases.

Conclusion Adenocarcinomas of the RPE can simulate a combined hamartoma of the retina and RPE. Diagnosis can only be established after biopsy. Protontherapy is a valid therapeutic alternative.
Ocular surface epithelial thickness evaluation with spectral‐domain optical coherence tomography in patients with dry eye syndrome
Authors: FRANCOZ M , KARAMOKO I , BAUDOUIN C , LABBE A
Published: December 2011

Purpose To use spectral‐domain optical coherence tomography (SD‐OCT) to measure corneal, limbal and bulbar conjunctival epithelial thickness in patients with dry eye syndrome.

Methods A total of 111 eyes of 56 subjects were enrolled in 3 groups: (1) young control (YC group), < 40 years; (2) middle‐aged control (MAC group), > 40 years; (3) patients with dry eye syndrome (KCS group). The central corneal epithelium (CE) thickness, and the limbal (LE) and bulbar conjunctival epithelium (BCE) thickness in four quadrants were measured using a SD‐OCT. All patients underwent a complete examination of the ocular surface including Schirmer test, TBUT and fluorescein staining.

Results The ocular surface epithelial thickness was not significantly different between the YC and MAC groups. CE thicknesses were not significantly different between the KCS (49.0 ± 4.1 µm) and control groups (48.3 ± 2.9 µm in YC and 48.8 ± 3.0 µm in MAC). The mean LE thickness was significantly lower in the KCS group (77.3 ± 17.2 µm) compared to the MAC group (84.3 ± 10.1 µm, p=0.031). The mean BCE was significantly thicker in the KCS group (50.4 ± 11.1 µm) compared to the MAC group (42.2 ± 7.9 µm, p=0.005). In the KCS group, the BCE thickness was significantly higher in the superior and inferior quadrants compared to nasal and temporal. The mean BCE thickness was significantly higher in ocular surface severity grades 3 and 4 (53.3 ± 12.1 µm) compared to grades 1 and 2 (45.7 ± 7.2 µm) (p=0.031).

Conclusion SD‐OCT can provide a non invasive in vivo evaluation of ocular surface epithelial thickness. Limbal and conjunctival epithelium thicknesses were modified in dry eye patients whereas aging seemed to have no effect.
Ocular Surface evaluation in children Presenting Ongoing Ocular Allergy
Authors: BREMOND‐GIGNAC D , COPIN H , MILAZZO S
Published: December 2011

Purpose to evaluate in a retrospective study ocular surface impairment and tear osmolarity in children presenting ongoing ocular allergy. Tears are necessary for continued health of ocular surface and tear osmolarity is considered a key point for tear film impairment and ocular surface damage.

Methods Our retrospective study included 20 children (mean age 11 yo, range 6 to 17 yo) of two groups that presented at ocular consultation of our hospital. Group a, 10 children with ongoing ocular allergy, group b 10 control children who had been tested but finally did not present any sign of allergy or dry eye. All the children underwent a tear osmolarity measure prior to complete ocular consultation to be aware of influencing results by the examination. The tear osmolarity measure was obtained with the Tear Lab Osmolarity System (OcuSense). A complete ocular examination was also performed. So the type of ocular allergy was diagnosed.

Results In group a, all the children presented clinical signs of on going ocular allergy with conjunctival redness, follicles and/or papillae. In two cases severe keratitis was present. In group b no ocular signs of conjunctiva anomalies were found. Mean tear osmolarity in group b, was 305mOsm/l and in group a, was 316mOsm/l. Tear osmolarity appeared higher in the ocular allergy group than in the non symptomatic children. Younger children had a higher measure of tear osmolarity.

Conclusion In adults 305mOsm/l is a cut‐off value for dry eye. In our study this measure appears similar to adults but could be higher in youngest children. In children with ocular allergy, higher measure of tear osmolarity indicates an ocular surface damage that is underestimated. Tear osmolarity can be useful to manage ocular surface disease in children.
The correlation between ocular surface inflammation and corneal fluorescein staining (CFS) in patients with moderate to severe dry eye disease (DED) participating in a randomized clinical trial
Authors: BUGGAGE R , AMRANE M , ISMAIL D , LEMP M , BAUDOUIN C , BAUDOUIN F
Published: December 2011

Purpose The relationship between ocular surface inflammation, signs and symptoms in DED remains poorly understood. A correlation between ocular surface inflammation and CFS in DED patients is reported.

Methods DED patients with tear break up time ≤8 seconds and CFS grades 2‐4 modified Oxford scale and Schirmer test without anesthesia ≥2 and <10 mm/5min and lissamine green staining, Van Bijsterveld >4 and at least 1 dry eye symptom were randomized to CYCLOKAT® (unpreserved 0.1% cyclosporine cationic emulsion) or vehicle QD. Impression cytology for conjunctival HLA‐DR expression (an ocular surface inflammatory biomarker) was performed in a subset of patients.

Results Cytology samples were collected in 89 of 492 patients. At baseline the mean HLA‐DR expression was higher in the CYCLOKAT® (84,345 AUF vs 46,888 AUF) arm. Notably, the mean HLA‐DR expression increased with baseline CFS grade (grade 2: 48,343; grade 3: 56,749; grade 4: 127,623). At month 6, CYCLOKAT® significantly reduced the HLA‐DR expression (‐50896 AUF vs ‐1192 AUF, p=0.022). The efficacy of CYCLOKAT® on improving CFS [as measured by mean change (delta of CYCLOKAT® over vehicle) and % achieving ≥ 2 grade improvement] increased with the CFS grade at baseline (grade 2‐4: 0.22 and 33.6% vs 21.8%, grades 3‐4: 0.32 and 40.4% vs 27.7%, grade 4: 0.77 and 48.8% vs 19.5%, p<0.05 for all comparisons).

Conclusion The demonstrated correlation between HLA‐DR expression and CFS support the role of inflammation in DED and justifies the need for anti‐inflammatory therapy. The benefit of CYCLOKAT® appears to be greatest in patients with severe DED.

Commercial interest
Response of the lipid and aqueous layers of the precorneal tear film to horizontal saccades. Novel findings and a new paradigm
Authors: BRON AJ , YOKOI N , GEORGIEV GA , TIFFANY JM
Published: December 2011

Purpose To consider the effect of horizontal saccades on the lipid and aqueous layers of the tear film.

Methods i. The interference pattern of the tear film lipid layer (TFLL) was studied in the left eye of 6 normal subjects, using the DR‐1TM video‐interferometer. Images were recorded continuously within a single interblink, with the eye in the primary position to capture the TFLL pattern: a. at least 1 second after the blink, when the pattern had stabilised and b. immediately after return to the primary position following a nasal saccade. ii. In a separate study, the movements of the aqueous layer, stained with fluorescein, were recorded during horizontal saccades, using standard slit‐lamp video equipment.

Results i. In all subjects, the TFLL pattern after the first return saccade strongly resembled the initial pattern, but showed some degradation with multiple saccades. ii. The stained, precorneal aqueous layer moved with the cornea during saccades, with minimal displacement which was rectified on return to the primary position.

Conclusion Two alternative explanations are offered for these findings: i. The precorneal TFLL is ‘glued’ to the aqueous subphase so that these fluid layers move together with the cornea, during horizontal rotations of the eye. ii.Cooling of the tear film during the interblink, causes an increase in stiffness of the viscoelastic TFLL, so that it behaves like a stable carapace, uninfluenced by movements of the aqueous layer. Further experiments are planned to resolve these alternative hypotheses.
Altered corneal nerve morphology and epithelial wound healing in experimental lacrimodeficient dry eye
Authors: GALLAR J , LUNA C , FERNANDEZ‐SANCHEZ L , BERBEL D , SESMA J , MIZERSKA K , QUIRCE S , KOVACS I , BELMONTE C , CUENCA N , ACOSTA MC
Published: December 2011

Purpose To analyze the morphological changes of corneal nerves and its influence on corneal epithelial wound healing in a lacrimodeficient dry eye model in the guinea‐pig.

Methods Corneal nerve architecture and the rate of corneal epithelial wound healing were studied in guinea‐pigs to whom the main lacrimal gland was removed 4 weeks before (dry eye) and in control animals. Eyes were fixed, cryoprotected and incubated with neuronal class III Beta‐tubulin antibody. Epithelial migration rate (EMR) and estimated time of healing (ETH) were calculated for 2mm‐diameter epithelial corneal debridations stained with fluorescein, photographed regularly until complete closure and analyzed with image processing software.

Results Density (16±6 vs 27±11 nerves/mm2) and length (115±45 vs 186±74 µm) of subbasal nerves decreased significantly in dry eye. Subbasal nerves were less branched and tortuous. Epithelial nerve terminals were also reduced. EMR decreased significantly (63±4 vs 110±1 µm/h) and ETH increased significantly (38.6±1.8 vs 20.1±0.1 h) in dry eye.

Conclusion The morphological appearance and the decreased density, length and branches of corneal subbasal nerves are suggestive of corneal nerve degeneration at 4 weeks after lacrimal gland removal. Lacrimodeficient eyes presented also a slowing‐down in corneal epithelial wound healing suggesting an early trophic defect consecutive to nerve damage. (Supported by: SAF2008‐00529, CSD2007‐00023, BFU2008‐04425, BFU2009‐07793 and RETICS RD07/0062/0012 from Ministerio de Ciencia e Innovación, Spain, and the Leonardo da Vinci Lifelong Learning Program.)
Efficacy of amnion membrane transplantation (AMT) on corneal surface in annular abscess and anterior uveitis
Authors: KOEV K , GEORGIEV R
Published: December 2011

Purpose To determine the effect of amniotic membrane transplantation (AMT) on a patient with an annular abscess with a stromal defect of the cornea and anterior uveitis. To determine the effect of amniotic membrane transplantation (AMT) on a patient with an annular abscess with anterior uveitis.

Methods In June 2010 a transplantation of amniotic membrane was performed on a patient suffering from an annular abscess with a stromal defect of the cornea and anterior uveitis. On examination objective findings show a mixed hyperemia with conjuctival chemosis and corneal opacifications, a hypopyon reaching a level of 4 mm and the presence of posterior synechiae, as well as opacities in the vitreous body. We also established corneal epithelial disruption, detected with fluorescein staining of the eye.

Results One month after the AMT a significant improvement was established. We observed epithelization of the cornea, disappearance of the ciliary hyperemia, closure of the stromal defect , resorption of the hypopyon, of the corneal opacifications and opacities in the vitreous body. There was a partial presence of posterior synechiae. The inflammatory process was overcome. Three months after the AMT a semi‐transparent leucoma was observed and an increased visual acuity was registered. We inspected solitary posterior synechiae.

Conclusion The AMT was efficient, has manifestivе anti‐inflammatory effects and could be successfully applied in cases of sever inflammation processes, anular abscess, corneal defects and anterior uveitis.
Ocular surface changes and corneal sensitivity in Keratoconus
Authors: CHO KJ , MOK JW , CHOI MY , JOO CK
Published: December 2011

Purpose This study aims to describe ocular surface, tear function, corneal nerve and sensitivity in patients with keratoconus.

Methods Thirty‐one patients diagnosed as having asymmetrical KC (31 keratoconus eyes, and 31 subclinical keratoconus eyes) and 31 normal control subjects (one eye) were studied in a prospective, cross‐sectional study. The subjects underwent routine ophthalmic examinations, corneal topography, corneal sensitivity measurements, Schirmer test, conjunctival impression cytology, and tear osmolarity. Western blot analysis and Immunofluorescent staining with monoclonal antibodies for Class III β‐tubulin in corneas of keratoconus and normal were done.

Results The mean corneal sensitivity and Schirmer test values were significantly lower in eyes of keratoconus and subclinical keratoconus compared with control. Conjunctiva of keratoconus and subclinical keratoconus had significantly higher grades of squamous metaplasia and goblet cell loss compared with normal. Corneal nerves were significantly decreased in eyes of keratoconus and subclinical keratoconus compared with control.

Conclusion Whatever the keratoconus‐related factors might be, we found marked changes on the ocular surface that affected not only the corneal, but also the conjunctival epithelium. The loss or decreae of trophic effects of corneal nerves due to primary or secondary events with the progression of keratoconus may plays a role in the pathogenesis of the ocular surface change in keratoconus.
Pneumatic Retinopexy for Uncomplicated Rhegmatogenous Retinal Detachment
Authors: KISS S
Published: December 2011

Purpose Since its introduction in 1985, pneumatic retinopexy (PR) has become an important office based procedure for treating an ever‐expanding group of rhegmatogenous retinal detachments (RRD). As an alternative to scleral buckling (SB) or pars plana vitrectomy (PPV), estimates suggest that over 40% of primary RRDs may be managed by PR.

Methods The efficacy of PR is dependant on 4 cardinal steps: (1) Identification and localization of all retinal breaks; (2) Induction of retinopexy around all breaks with cryopexy or laser; (3) Intraocular gas injection; and (4) Consistent post‐operative head positioning for appropriate gas tamponade to achieve closure of the retinal breaks.

Results Numerous prospective and retrospective reports have confirmed that the single operation success rate for PR ranges from 65‐75%, with a final anatomical success rate of over 95%. New retinal breaks typically occur in 10% of PR cases, and proliferative vitreoretinopathy is noted in approximately 5% of eyes. For repair of primary RRD, final post‐operative visual acuity does not appear to differ among eyes initially treated with PR when compared to those treated with SB or PPV.

Conclusion PR has become a valuable technique in the modern era of RRD management. Despite its limitations and shortcomings, multiple clinical studies have clearly established its essential role in the armamentarium of surgical techniques utilized for the primary repair of RRD.
Prognostic factors for anatomical and functional results after retinal detachment surgery. The SPR study
Authors: HEIMANN H
Published: December 2011

Purpose In the "Scleral buckling vs. primary vitrectomy in rhegmatogenous retinal detachment study (SPR study)" two different surgical methods for the treatment of retinal detachment (RD) were compared in a randomised prospective multicentre clinical trial. This secondary analysis was conducted to investigate possible associations between pre‐ and intraoperative factors with the functional and anatomical outcomes.

Methods Univariate and multivariate analysis of 48 pre‐ and intraoperative factors and their association with anatomical outcome, functional outcome and the number of secondary surgical interventions.

Results In phakic patients, a significant correlation of successful outcome could be associated with number of retinal breaks, large breaks, cryotherapy, duration of symptoms, baseline visual acuity, central RD, total RD, drainage during buckling surgery and chain formation of breaks. In pseudophakic patients, factors identified were number of breaks, capsular fibrosis, Yag‐laser capsulotomy, retinal laser photocoagulation, and inferior RD.

Conclusion The most important risk factor for functional and anatomical failure was a higher number of retinal breaks. Other risk factors varied between the phakic and pseudophakic patients as well as between functional and anatomical outcomes. These findings are of clinical importance for identification of patients with a higher risk for failure and for the planning of future trials on RD surgery.
Subretinal fluid lavage: a novel concept in retinal detachment surgery
Authors: VECKENEER M
Published: December 2011

Purpose To review possible causes and therapeutic options for persistent submacular fluid after retinal detachment surgery.Optical coherence tomography identifies persistent subretinal fluid (PSF) after apparently successful retinal detachment repair surgery in up to 94% of patients. PSF is associated with delayed recovery of visual function.

Methods Based on the literature and the results of subretinal fluid analyses, we hypothesised that highly viscous PSF, which interferes with the normal function of the retinal pigment epithelium, can lead to these persistent blebs. We reviewed all reported interventions for PSF. We devised a novel surgical manoeuvre of subretinal lavage to dilute the subretinal fluid (SRF) during surgery. We expected that this would reduce the incidence of PSF. We report our experience with a modified surgical drainage technique in patients with long standing retinal detachments.

Results No postoperative medical or surgical intervention has been proven to be effective in a series of patients. On the contrary, none of the patients undergoing modified drainage and lavage developed PSF.

Conclusion In the absence of an effective cure, prevention appears to be a promising option.
Rhegmatogenous retinal detachment associated to vitreous hemorrhage. Role of primary vitrectomy?
Authors: POURNARAS CJ
Published: December 2011

Purpose The incidence of retinal break formation following acute posterior vitreous detachment is variously reported as occurring in between 8% to 15% of patients, associated up to 39% of the eyes with rhegmatogenous retinal detachment.

Methods Retrospective review of noncomparative interventional case series and cases treated in our department

Results The management of patients with fundus‐obscuring dense vitreous haemorrhage due to presumptive retinal tears advocates waiting for spontaneous resolution. Surgery is indicated only when a definite retinal tear or retinal detachment is identified. However, the degree of agreement between ultrasound and clinical findings, indicate retinal diagnosed and localized accurately in only 44% of eyes. Early vitrectomy for spontaneous dense fundus‐obscuring vitreous haemorrhage and posterior vitreous detachment seems safe. Rhegmatogenous retinal detachment with severe VH is associated with longer duration of preoperative haemorrhage, a higher incidence of severe PVR and worse visual outcome. An 75% incidence of retinal detachment was reported in eyes with a history of retinal detachment in the contralateral eye. Close follow‐up and aggressive surgical interventions are suggested in these patients.

Conclusion Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus‐obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow‐up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.
Primary vitrectomy alone for pseudophakic retinal detachment
Authors: MENDRINOS E
Published: December 2011

Purpose To report the anatomic and functional results of primary vitrectomy without scleral buckling for the treatment of pseudophakic rhegmatogenous retinal detachment(PsRD)

Methods One hundred eyes of 98 patients with PsRD were operated by vitrectomy alone. Internal subretinal fluid drainage, cryocoagulation and/or endolaser and fluid‐air exchange with sulfur hexafluoride 20% was applied in all cases. The preoperative and postoperative characteristics were analyzed. Main outcome measures were anatomic success rates after initial surgical intervention and after reoperation for primary failures, visual outcome at the last follow‐up visit,and complications.

Results Mean follow‐up +/‐ standard deviation (SD) was 12 +/‐ 6.3 months (range, seven to 36 months). Mean final visual acuity +/‐ SD was 0.42 +/‐ 0.45 logarithm of the minimum angle of resolution (logMAR) compared with 0.95 +/‐ 0.73 logMAR before surgery (P < .01). Mean number +/‐ SD of retinal breaks found before surgery was 1.36 +/‐ 1.12 (range, zero to five), and an additional 1.58 +/‐ 2.26 (range, zero to 15) retinal breaks were found during surgery. The retina was reattached successfully after a single surgery in 92 eyes (92%). Recurrence of retinal detachment occurred in eight eyes (8%), caused by proliferative vitreoretinopathy in six eyes (75%) and by new breaks in two eyes (25%). Final anatomic reattachment was obtained in these cases after a mean of 1.75 subsequent operations. Three eyes required permanent silicone oil tamponade so that final anatomic success was achieved in 97 eyes (97%). The most common postoperative complication was ocular hypertonia of more than 21 mm Hg, observed in 36 (36%) eyes, which was managed successfully.

Conclusion Primary vitrectomy provides high anatomic success rate in PsRD eyes
20‐gauge pars plana vitrectomy vs 23‐g, 25g in the management of primary and recurrent retinal detachment: pros and cons
Authors: BRAZITIKOS P
Published: December 2011

Abstract not provided
A Case of Lattice Corneal Dystrophy due to the L527R Mutation in the TGFBI Gene in Korea
Authors: CHO KJ , MOK JW , JOO CK
Published: December 2011

Purpose The purposes of this study are to report the first case of LCD type Ⅳ with different phenotype in each eye.

Methods A 67‐year‐old Korean female patient who was otherwise in good medical health presented with gradual impairment of vision over the previous 1 year. After informed consent was given, slit lamp biomicroscopy and genetic analysis were performed. All the exons from the entire coding regions of stromal corneal dystrophy related genes, TGFBI, CHST6 and M1S1 genes, were directly sequenced to determine if there were any mutations.

Results Relatively thick lattice lines that extended from limbus to limbus in the superficial stromal layers were observed in the right eye by slit lamp biomicroscopy, whereas gray‐colored nodular deposits deep in the central stroma were observed in the left eye. We could not find lattice lines in the left eye or any nodular deposits in the right eye. We detected a heterozygous point mutation, CTG  CGG (c.1580 T>G: Leu527Arg in exon 12 by IC3D classification) in codon 527 of TGFBI.

Conclusion Given that we identified a Korean patient with lattice corneal dystrophy due to the L527R Mutation in the TGFBI Gene, although this mutation is very rare, LCD type Ⅳ may occur in individuals of races other than Japanese.
What limits normal visual performance in the dark?
Authors: RAUSCHER F
Published: December 2011

Purpose Visual performance is affected by changes in the spatial and temporal properties of the retina and/or changes in the quality of the retinal image as a result of increased aberrations and scattered light. The aim of the study was to establish the extent to which retinal and/or optical factors set the limits of visual performance at low light levels.

Methods Pupil size, ocular aberrations, scattered light, chromatic sensitivity and contrast acuity were measured as a function of retinal illuminance. Pupil size was measured continuously and display luminance adjusted for constant retinal illuminance.

Results Mesopic vision describes the range of light levels over which signals from both rods and cones contribute to the visual response. Visual performance changes with light level: Both the amount of scattered light and the rms wavefront aberration were found to increase rapidly with decreasing light level in the mesopic range. This was paralleled by a massive increase in contrast acuity thresholds and a rapid loss of both red‐green and blue‐yellow chromatic sensitivity.

Conclusion The gradual increase in rod signal as the light levels decreases causes changes in the overall spectral sensitivity of the eye with consequences for visual effectiveness. Cone dominated vision is affected most by optical factors; in rod dominated vision the limiting factor becomes the resolving power of the retina. Key aspects of visual performance, such as spatial and temporal contrast sensitivity and acuity, visual delay and colour sensitivity change with light level. Linking such changes allows us to predict visual performance at low light levels where characteristics of the rod and cone system are so different.
Fluorescein angiography in uveitis
Authors: KHAIRALLAH M , JELLITI B
Published: December 2011

Purpose Fluorescein angiography (FA) is an important test in the evaluation and management of patients with uveitis. FA in uveitis is giving information principally on the superficial structures of the fundus (retina, retinal vessels and optic nerve head / disc), on the retinal pigment epithelium, on the choriocapillaris in the first 60 seconds of angiography as well as immediatelly subclinical pathology such as subretinal neovascular membranes.

Methods FA is indicated when a posterior segment involvement is present or suspected. It should examine the posterior pole, optic disc, and periphery, with angiograms at early, intermediate, and late phases. FA results should be interpreted in relation to the results of clinical examination and other tests

Results There are many roles for FA in the evaluation of patients with uveitis 1. Evaluation of the activity and extent of chorioretinitis: 2. Diagnosis of uveitic entities with typical features. 3. Evaluation of retinal vascular involvement : focal, multifocal, or diffuse retinal vascular leakage, occlusive complications, optic disc or retinal neovascularization, 4.Identication of macular complications 5. Evaluation of optic disc involvement. 6. Monitoring of response to treatment

Conclusion FA can be helpful in the diagnosis, treatment, and monitoring of patients with posterior segment inflammation.
Fundus autofluorescence (FAF) in uveitis
Authors: MANTOVANI A , HERBORT C
Published: December 2011

Abstract not provided
Practical & quiz cases II
Authors: MARKOMICHELAKIS N
Published: December 2011

Abstract not provided
Practical & quiz cases III
Authors: BODAGHI B
Published: December 2011

Imaging techniques have definitely changed our diagnostic approach to posterior and panuveitis. Based on their interpretation, it is also possible to revisit the diagnostic work‐up in order to propose a more simplified strategy. During this presentation, different situations will be discussed in order to emphasize targeted diagnostic tools and therapeutic options.
Practical & quiz cases V
Authors: HERBORT C , KHAIRALLAH M , NERI P
Published: December 2011

Abstract not provided
How can we improve the review process (view of the Editor and beyond..)
Authors: STEFANSSON E
Published: December 2011

Abstract not provided