bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancement of Refractive Results after Intraocular Lens Implantation
Authors: Amon Michael , Kahraman Guenal ,   Academic Teaching Hospital of St John, Vienna,   Academic Teaching Hospital of St John, Vienna
Published: October 2015

Summary:An overview on polypseudophakia (‘piggyback’ intraocular lens [IOLs]) is given. Requirements on a sulcus-supported supplementary IOL are defined. Two-year results of a new IOL (Sulcoflex®) are presented and indications for this IOL are defined.Methods:The IOL is especially designed for implantation into the ciliary sulcus in pseudophakic eyes (piggyback). It is a single-piece implant made of hydrophilic acrylic. Optic- and haptic-edges are round. The optic has a diameter of 6.5mm and a concave/convex shape for perfect fit on the anterior convex surface of the primary IOL. The haptic is angulated, and has an undulated design to preclude IOL rotation. A monofocal, a multifocal or a toric version of the sulcoflex IOL were implanted into the ciliary sulcus of pseudophakic eyes. All IOLs were implanted by injector through a 3mm clear cornea incision. After surgery near and far uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and eye pressure were assessed. Inflammation was measured by laser flare/cell meter. Position and rotational stability of the IOL were documented regularly at all control visits. Furthermore, Scheimpflug photography and ultrasound biomicroscopy were performed.Results:Surgery was performed without any complication in all cases. Two years after surgery there were no severe intra- or post-operative complications detected. Emmetropia was achieved in all cases (±0.25dpt) and the refraction was stable. Flare values were lower than the values measured after standard cataract procedures. Rotational stability and centration were excellent. Intraocular pressure was within the normal range at all visits. After one year of follow-up no iris-chafing was documented. In all cases, a good distance was found between iris and the Sulcoflex-IOL and primary implant and the Sulcoflex-IOL. In those cases with the multifocal IOL-version all patient achieved independency from glasses.Conclusion:Surgery with implantation of a sulcus-IOL is safe and less traumatic than IOL-exchange. The material and design of the Sulcoflex IOL ensure that the implants are well tolerated within the eye. The implant can be used at the same time with the primary implant or as secondary implant. Indications for implantation of this IOL are the correction of ‘post-surgical’ ametropia, of astigmatism (toric IOL) of higher order aberrations (aspherical IOL) and of ‘pseudophakic presbyopia’ (multifocal IOL). In the future, other potential indications will be established.
Current Treatment of Retinal Vein Occlusion
Authors: Golan Shani , Fisher Naomi , Lowenstein Anat ,   Department of Ophthalmology, Tel Aviv Sourasky Medical Center,   Sackler Faculty of Medicine, Tel Aviv University,   Department of Ophthalmology, Tel Aviv Sourasky Medical Center,   Sackler Faculty of Medicine, Tel Aviv University
Published: October 2015

Retinal vein occlusion (RVO) was first described more than 150 years ago. Even though much has been written about this frequent condition, the aetiopathology appears to be multifactorial with many unclear aspects and varied expression, making it difficult to define treatment guidelines. The management of the patient with RVO is complex and a multidisciplinary approach is required in order to identify and correct the associated risk factors. In the past, laser therapy was the gold standard in RVO, but only modest functional improvement has been shown in branch retinal occlusion forms. Current multicentre studies of intravitreal drugs present them as an option to combine with laser. Anti-vascular endothelial growth factor, corticosteroids and sustained-release implants are attractive options to halt disease progression and achieve a better visual outcome. Consequently, it is useful to clarify some aspects of the pathology that allow better patient management.
Insight and Advancement in Hereditary Retinal Degenerations
Authors: Sigler Eric J , Huang John J ,   Chief Resident, Department of Ophthalmology and Visual Science, Yale University School of Medicine,   Associate Professor, Department of Ophthalmology and Visual Sciences, Director of Ocular Immunology and Uveitis and Director of Clinical Trials and Translational Research, Yale University
Published: October 2015

Hereditary retinal degenerations comprise a diverse group of inherited genetic defects in one or more retinal or retinal pigment epithelial cellular proteins. Traditionally, anatomic classification based on clinical and histopathological phenotype has been used to organise these disorders. In the modern era of advanced molecular biological techniques and genetic screening the current classification system may soon become obsolete, due to the fact that significant overlap between different retinal degenerations has been observed, resulting from variation in gene expression, common genetic pathways and variable inheritance patterns. In this article, we review the various clinical disease entities, emphasise a genetic classification system and give special attention to recent advances in molecular biology and gene therapy.
Age-related Macular Degeneration – Review and Current Concepts
Authors: Seth Rajeev K , Sigler Eric J , Adelman Ron A ,   Assistant Professor of Ophthalmology, and Director of Retina Service, Department of Ophthalmology, University of Arizona College of Medicine,   Chief Resident,   Associate Professor of Ophthalmology and Director of Retina Center, Department of Ophthalmology and Visual Science, Yale University School of Medicine
Published: October 2015

Age-related macular degeneration (ARMD) continues to be a significant public health concern, given its high prevalence and potential blinding prognosis in the elderly. Several risk factors have been identified in the development of ARMD, including age, race and family history. The pathogenesis of ARMD continues to be elucidated and recent research has focused on genetic factors. ARMD presents in either the atrophic or exudative form. Treatment for atrophic disease consists of antioxidants and zinc and close monitoring. Treatment for exudative disease is aimed at targeting choroidal neovascularisation. The development of anti-vascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of exudative ARMD, providing a more favourable prognosis for previously blinding disease. A considerable amount of research is being carried out on new treatment modalities for both the atrophic and exudative forms of the disease.
Increasing Lutein Consumption – Are all Luteins Alike?
Authors: Maci Samanta ,   Senior Manager Europe, Scientific Affairs and Technical Services, Kemin Health Europe
Published: October 2015

Epidemiological and intervention studies suggest that lutein may act as a nutritional factor able to modulate visual performance as well as the processes implicated in the pathogenesis and progression of degenerative eye diseases. Since lutein cannot be synthesised by the body, and daily dietary consumption is generally below the level of intake found to be beneficial in clinical studies, increased consumption – through diet or supplementation ߝ is recommended. The prerequisites for lutein to benefit the eye are: release from the food or food supplement matrix in which it is included; absorption by the intestinal cell; presence in adequate concentrations in serum; and deposition of serum lutein into the macula of the eye. Not all lutein ingredients are alike so, when recommending eye supplements to patients, in addition to looking for safe products, it is critical to ensure that the lutein ingredient used is absorbed properly by the body and has proven its efficacy in clinical trials.
Long-term Results of a Novel Minimally Invasive High-frequency Deep Sclerotomy Ab Interno Surgical Procedure for Glaucoma
Authors: Pajic Bojan , Pajic-Eggspuehler Brigitte , Haefliger Ivan , Hafezi Farhad ,   Swiss Eye Research Foundation, Eye Clinic ORASIS, Titlisstrasse 44, Reinach,   Division of Ophthalmology, Department of Clinical Neurosciences, University Hospitals of Geneva,   Eye Hospital VIDAR-ORASIS Swiss, University of Novi Sad, Faculty of Physics, Novi Sad,   Swiss Eye Research Foundation, Eye Clinic ORASIS, Titlisstrasse 44, Reinach,   Swiss Eye Research Foundation, Eye Clinic ORASIS, Titlisstrasse 44, Reinach,   Division of Ophthalmology, Department of Clinical Neurosciences, University Hospitals of Geneva
Published: October 2015

High-frequency deep sclerotomy (HFDS) glaucoma surgery is a newab internoprocedure to lower the intraocular pressure in open-angle glaucoma. Using high-frequency energy, six small pockets are formed which significantly reduce the outflow resistance for aqueous humour. This article presents the impressive results of a long-term study about the HFDS glaucoma procedure and demonstrates its efficacy and safety. The operation technique and the devices used for a successful HFDS glaucoma intervention are described step by step.
Nutritional Supplements and Age-related Macular Degeneration – Focus on Omega-3 Fatty Acids
Authors: Souied Eric H ,   President, Age-related Macular Degeneration Association and Head of Department, Ophthalmology Service, Créteil Intercommunal Hospital
Published: October 2015

Age-related macular degeneration (AMD) is a leading cause of vision loss for which treatment options are limited. The socioeconomic benefits of prevention of AMD are enormous. While considerable observational evidence supports an association between dietary fats and AMD, the relation between specific types of fat and AMD has been unclear. Recent research has focused on the ω-3 polyunsaturated acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The diets of industrialised nations contain higher levels of saturated fats, trans fatty acids and ω-6 fatty acids and less ω-3 fatty acids than they did in the past. This imbalance may have important implications for retinal health. Several observational studies have found that consumption of oily fish and high dietary intakes of DHA and EPA are associated with a reduced risk of developing AMD. Recent studies evaluating nutritional supplements containing ω-3 fatty acids for the treatment of AMD suggest a potential beneficial effect but further research in this area is warranted.
Expanding Indications of Imaging with Optovue Optical Coherence Tomography in Children
Authors: Sacchi Matteo , Serafino Massimiliano , Nucci Paolo ,   Eye Clinic, San Giuseppe Hospital, University of Milan,   Eye Clinic, San Giuseppe Hospital, University of Milan,   Eye Clinic, San Giuseppe Hospital, University of Milan
Published: October 2015

Although interest in optical coherence tomography (OCT) has increased markedly during the past decade in many fields of ophthalmology, there are only a few reports of the use of spectral domain (SD)-OCT in paediatric ophthalmology. In this article, the authors describe the use of SD-OCT in children as a new indication for OCT. Paediatric patients with aniridia were examined for the presence of keratopaty, cataract, glaucoma and foveal hypoplasia. Children with cataracts were followed for six months after surgery. The type of cataract, intraocular lens position, posterior capsule opacity and corneal incision healing were visualised by SD-OCT. In total, 24 eyes with aniridia and seven eyes with congenital cataract were enrolled. OCT was able successfully to detect ocular conditions associated with aniridia. After cataract extraction, OCT was also used to follow corneal incision healing and the development of posterior capsule opacity. In children with aniridia and congenital cataract, OCT can provide clinically relevant information. With the introduction of new generation, high-speed OCT, paediatric ophthalmology is likely to become a new and interesting target for OCT.
Blue-light Filtering Intraocular Lenses
Authors: Blackmore-Wright Sally , Eperjesi Frank ,   Senior Optometrist, Optometry Department, University Hospitals Coventry and Warwickshire, UK,   Head of Optometry, Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
Published: October 2015

Blue-light filtering intraocular lenses are purported to reduce the incidence of potentially damaging UV and blue light on the retina. This article reviews their background, the proposed benefits on long-term eye health and the possible disadvantages on circadian rhythm, scotopic vision and colour vision.
The Light Adjustable Lens – A Review
Authors: Lichtinger Alejandro ,   Fellow, Cornea, External Diseases and Refractive Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
Published: October 2015

The purpose of this manuscript is to review the design, development and clinical results of the light adjustable lens (LAL). Evolution in techniques, biometry and intraocular lens (IOL) calculation have improved outcomes and increased expectations after cataract surgery. Nevertheless, Imprecise IOL power determinations, pre-existing and surgical-induced astigmatism, and previous corneal refractive surgery continue to limit post-operative uncorrected vision. The LAL was designed to provide a stable, precise correction of refractive errors with a safe, non-invasive post-operative procedure. The concept behind the LAL is based on photochemistry and diffusion. The adjustment occurs when all non-attached solutes equally distribute themselves throughout the optic after irradiation with ultraviolet light that causes the photosensitive macromers to polymerise in the irradiated region. Clinical results have been positive, with the largest series (122 eyes) showing 97 % of patients within 0.25 D of attempted spherical equivalent and 100 % uncorrected vision 20/25 or better. In conclusion, the LAL has demonstrated to be a safe, accurate and reliable method of post-operative, non-surgical correction of residual sphero-cylindrical refractive error.
Toric Iris Claw Lens Implantation for Keratoconic Eyes
Authors: Güell Jose Luis , Montes Diego Aristizábal ,   Director of Cornea and Refractive Surgery,   Cornea and Refractive Surgery Specialist, Cornea and Refractive Surgery, Unit, Institute of Ocular Microsurgery, Barcelona, Spain
Published: October 2015

Keratoconus and other ectatic disorders can be an unexpected finding in patients seeking refractive surgery. In this group of patients, refractive laser corneal procedures are in many cases contraindicated as they may worsen the disease. Implantation of toric phakic iris claw lenses is a safe and effective treatment in patients with stable keratoconus. Good results in terms of visual acuity, post-operative residual refractive error and patient satisfaction can be achieved.
Cell Therapy for Diabetic Retinopathy – A Work in Progress
Authors: Kent David ,   Consultant Ophthalmic Surgeon, The Vision Clinic, Kilkenny, Ireland
Published: October 2015

As the incidence of diabetes continues to rise worldwide, the challenge in preventing vision loss secondary to diabetic retinopathy (DR) remains a formidable one. Current treatments are only indicated in advanced disease when vision loss is imminent or has already occurred. In recent years, due to the discovery that postnatal vasculogenesis plays a role in vascular repair, there is increasing optimism that cell therapy using endothelial progenitor cells (EPCs) can be harnessed therapeutically for conditions such as DR. Although autologous EPC therapy offers promise for DR, EPCs from patients with diabetes are themselves dysfunctional while the diabetic milieu itself contributes further to this dysfunctionality. Additional research is also required to unravel the complete science of vasculogenesis and the role of EPCs in repair so that treatment can be optimised in terms of actual cell choice, pre-conditioning prior to transplantation, maximising cell survival in the recipient and preparation of the recipient tissue to ensure an adequate therapeutic response.
The Epigenetic Origin of Retinoblastoma
Authors: Mastrangelo Domenico , Loré Cosimo , Grasso Giovanni ,   Senior Scientist, Research,   Full Professor,   Full Professor of Anatomy and Biology, University of Siena, Italy
Published: October 2015

The aim of the present review is to give new insights into the pathogenesis of retinoblastoma, by applying the principles of epigenetics to the study of clinical, epidemiological and biological data concerning the disease. As an emerging new scientific approach linking the genome to the environment, epigenetics, can not only explain the inconsistencies of the mutational (‘two hit’) model in the genesis of retinoblastoma, but also open new outstanding scenarios in the fields of diagnosis, treatment and prevention of this eye tumour and cancer in general. After more than four decades of predominance of the ‘genetic’ theory, this review represents, to the authors’ knowledge, the first attempt to look at retinoblastoma from the point of view of epigenetics. The epigenetic model in the genesis of retinoblastoma, proposed herein, emphasises the role of environment and its interactions with the genome, in generating retinoblastoma in young children. Environmental toxicants, including, among others, radiations, wrong diets and infectious diseases, all play a major role in conditioning the degree of DNA methylation (one of the leading mechanisms of epigenetic gene regulation) in embryos and foetuses during pregnancy, thus leading to stable, functional alterations of the genome, which can be transmitted from one generation to the next, thus mimicking a hereditary disease. An accurate analysis of the currently available literature on both retinoblastoma and epigenetics, coupled with the knowledge of the variegated phenotypic expression of the disease, can easily lead to the conclusion that retinoblastoma is an epigenetic, rather than a genetic disease.
Optical Coherence Tomography – Segmentation Performance and Retinal Thickness Measurement Errors
Authors: Koleva-Georgieva Dessislava Nikolaeva ,   Assistant Professor, Department of Ophthalmology, University Hospital ‘St George’, Plovdiv, Bulgaria
Published: October 2015

Optical coherence tomography (OCT) has become an indispensable tool in the assessment of macular pathology in clinical settings and an integral part of many clinical trials. However, as with any imaging technology, some limitations exist. In this review, the author describes and discusses the various causes that might compromise automated retinal thickness measurements. The segmentation software might perform less accurately in the presence of scan artefacts (e.g. ‘out-of-range’, mirror, blink and motion artefacts), a low signal:noise ratio, dense media opacities and specific retinal pathological features (e.g. pigment epithelial detachment, subretinal fluid, fibrotic tissue, hard exudates and full-thickness macular holes). The awareness of the clinician and the particular search for, and recognition of, measurement errors would improve the accuracy of OCT interpretation and should be an integral part of OCT scan analysis.
Advances in the Surgical Management of Glaucoma – The Role of the EX-PRESS® Glaucoma Filtration Device
Authors: Fechtner Robert , Jong Leo de , Dahan Elie , Kahook Malik , Moster Marlene , Goldberg Ivan ,   Institute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, NJ, US,   Academic Medical Centre, Amsterdam, The Netherlands,   Ein Tal Eye Hospital, Tel Aviv, Israel,   Department of Ophthalmology, University of Colorado, Denver, CO, US,   Wills Eye Institute, Philadelphia, PA, US,   Glaucoma Unit, Sydney Eye Hospital, and Discipline of Ophthalmology, University of Sydney, Australia
Published: October 2015

Clinicians aim to arrest the glaucomatous process by reducing intraocular pressure (IOP).1–5Available strategies include medical, laser and surgical techniques. Trabeculectomy is the traditional standard drainage surgery technique to achieve this. These MIGS techniques therefore appear to be adequate for patients whose glaucomatous damage is mild to moderate and whose target IOPs fall into this range. To achieve lower IOPs in patients with more advanced visual loss, efforts have simultaneously been made to fine-tune trabeculectomy. The use of the EX-PRESS® Glaucoma Filtration Device (Alcon) under a scleral flap is one such approach. How does the EX-PRESS Glaucoma Filtration Device benefit the conventional trabeculectomy procedure? What tips and tricks can contribute to its successful use? How safe is it? Is the additional cost to our health system justifiable? The satellite symposium ‘Advances in glaucoma surgery: new evidence in filtration surgery’, held at the 2011 World Glaucoma Congress, chaired by Dr Ivan Goldberg and sponsored by Alcon, set out to try to answer these questions.
Clinical Optic Disc Evaluation in Glaucoma
Authors: Reis Alexandre SC , Toren Andrew , Nicolela Marcelo T ,   Research Fellow, Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada,   Research Fellow, Department of Ophthalmology, University of Sao Paulo, Brazil,   Resident,   Associate Professor, Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
Published: October 2015

Examination of the optic nerve head (ONH) is essential for the diagnosis of glaucoma and assessment of its progression. Slit-lamp biomicroscopy with a handheld lens is the best method of ONH examination since it provides good stereopsis and magnification. ONH stereo photographs are complementary and may identify findings missed on slit-lamp examination. As a result of its subjective nature, a standardised approach should be utilised for clinical ONH evalaution, including an assessment of ONH size and careful evaluation of the neuroretinal rim contour, the presence of retinal nerve fibre layer (RNFL) defects and optic disc haemorrhages. Other aspects, such as peripapillary chorioretinal atrophy, vessel alterations and asymmetry between fellow eyes, might help differentiate normal from glaucomatous eyes. Progressive changes in the appearance of the ONH or RNFL are best identified with optic disc photographs or automated devices. The findings of clinical ONH evaluation are of greater value when corroborated with other aspects of clinical examination and clinical test.
Treatment of Post-operative Inflammation following Cataract Surgery – A Review
Authors: Dua Harminder S , Attre Richa ,   Chair and Professor of Ophthalmology, Division of Ophthalmology and Visual Sciences, Eye, Ear, Nose and Throat Centre, University Hospital, Nottingham, UK,   Scientific Director, Infusion Communications Inc, US
Published: October 2015

Inflammation after cataract surgery, which can be persistent, remains an undesirable consequence despite many advances in surgical techniques. Although corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have traditionally been used to treat inflammation, prophylactically as well as post-operatively, there are no established guidelines for the treatment of inflammation induced by cataract surgery. The long-term use of corticosteroids has raised safety concerns, especially with regard to elevated intraocular pressure (IOP). This limitation of traditional corticosteroids led to the development of C-20 ester corticosteroids through retrometabolic drug design. This design modification allows the corticosteroid to be active at its site of action and then undergo predictable hydrolysis to inactive metabolites, resulting in reduced side effects. A review of studies published in the last 10 years indicates that C-20 ester corticosteroids provide effective control of post-cataract surgery inflammation without the elevation of IOP. Loteprednol etabonate ophthalmic suspension 0.5 % is the only topical C-20 ester corticosteroid approved for use in the treatment of corticosteroid-responsive inflammatory conditions including post-operative ocular inflammation. This corticosteroid, alone or in combination with NSAIDs, may provide effective and safe inflammation control, especially for high-risk patients, and may overcome concerns regarding side effects associated with traditional C-20 ketone corticosteroids. Ocular inflammation after cataract surgery presents healthcare providers with a treatment dilemma. While corticosteroids are traditionally the therapy of choice for inflammation, their long-term use for managing ocular inflammation can produce significant adverse events. This article discusses whether C-20 ester corticosteroids, alone or in combination with NSAIDs, offer effective treatment of post-cataract surgery inflammation while minimising adverse events.
Surgery for Myopic Macular Hole Without Retinal Detachment
Authors: Arumi Jose Garcia , Boixadera Anna , Martinez-Castillo Vicente , Zapata Miguel Angel , Macià Carme ,   Department of Ophthalmology, Instituto de Microcirugia Ocular,   Department of Ophthalmology, Hospital Vall d’Hebron, Barcelona, Spain,   Department of Ophthalmology, Hospital Vall d’Hebron, Barcelona, Spain,   Department of Ophthalmology, Hospital Vall d’Hebron, Barcelona, Spain,   Department of Ophthalmology, Hospital Vall d’Hebron, Barcelona, Spain,   Department of Ophthalmology, Hospital Vall d’Hebron, Barcelona, Spain
Published: October 2015

The purpose of this paper is to review the indications, surgical technique and surgical outcome of myopic macular holes (MHs). In myopic MH, the use of optical coherence tomography has been very useful both in the diagnosis and follow-up after surgery due to the difficulty in biomicroscopic diagnosis in high myopes. Myopic MH surgery is more difficult than idiopathic MH surgery due to the increased axial length, retinal pigment epithelium and choroidal atrophy, and thinner retina making internal limiting membrane and posterior hyaloid staining more important. Myopic MH vitreoretinal surgery achieves comparable anatomical success rates when compared with idiopathic MHs except in cases with posterior staphyloma and axial lengths equal to or over 30 mm where a macular buckle may be needed. The closure of myopic MH decreases the risk of retinal detachment secondary to MH.
Management of Glaucoma Following Boston Keratoprosthesis
Authors: Vora Gargi Khare , Colby Kathryn A ,   Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, US,   Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, US
Published: October 2015

Boston keratoprosthesis (KPro) surgery has revolutionised the treatment of corneal and ocular surface disease. At present, glaucoma is the most important vision-threatening complication following KPro surgery. Diagnosis of glaucoma in KPro patients is difficult since the current method of determining intraocular pressure (IOP) by digital palpation is subjective and dependent upon the skill of the examiner. Optic nerve evaluation and visual field testing are important tools to follow glaucoma progression. Management of glaucoma following Boston KPro consists of medical therapy and surgical options. Glaucoma drainage devices are useful in this population but can have a variety of complications. Cyclophotocoagulation, either the non-invasive transscleral method or endocyclophotocoagulation, is also useful as an adjunctive measure in glaucoma management. Appropriate diagnosis and management of glaucoma is essential after KPro surgery to reduce the chance of vision loss.
Effects of Glaukos® Trabecular Stent in the Treatment of Glaucoma
Authors: Arriola-Villalobos Pedro , Morales-Fernández Laura , Martínez-de-la-Casa José M , García-Feijoó Julián ,   Ophthalmology Unit, Clinico San Carlos Hospital Health Research Institute,   Ophthalmology Unit, Clinico San Carlos Hospital Health Research Institute,   Ophthalmology Unit, Clinico San Carlos Hospital, Ophthalmology and Otorhinolaryngology Department, School of Medicine, Universidad Complutense, Clinico San Carlos Hospital Health Research Institute,   Ophthalmology Unit, Clinico San Carlos Hospital, Ophthalmology and Otorhinolaryngology Departament, School of Medicine, Ophthalmic Research Institute, Universidad Complutense, Clinico San Carlos Hospital Health Research Institute, Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Health Institute Carlos III
Published: October 2015

Micro-invasive glaucoma surgery (MIGS) is gaining interest in very recent years, due to a better safety profile and good tensional results, often associated to cataract surgery. Glaukos iStent® is the only FDA-approved device for micro-invasive glaucoma surgery. It connects the anterior chamber to Schlemm´s canal by bypassing the trabecular meshwork, increasing the outflow facility. The Glaukos iStent is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate open-angle glaucoma currently treated with ocular hypotensive medication. This article summarises the results of all the clinical and experimental studies published regarding iStent effectiveness and safety. Glaukos iStent, in conjunction with cataract surgery, is a safe and effective option in the treatment of open angle glaucoma, with a significant but modest IOP drop and a significant and more clinically relevant decrease in glaucoma medications, with no serious adverse events. Some aspects concerning the number of iStent used or other indications like ocular hypertension or secondary glaucoma remain under study, although good results in both clinical situations have been published. A new model of iStent has just been developed and its first clinical results are near to be published.
ILUVIEN® Intravitreales Implantat bei diabetischem Makulaödem – Erste Fallstudien
Authors: Bertelmann Thomas , Messerschmidt-Roth Anke ,   Oberarzt,   Studienkoordinatorin, Abteilung für Augenheilkunde, Philipps-Universität, Marburg, Deutschland
Published: October 2015

Das diabetische Makulaödem (DMÖ) ist eine wesentliche Ursache für den Verlust der Sehkraft, und die Herausforderungen in der Behandlung dieser progressiven Erkrankung bestehen weiter fort. Kortikosteroide bieten einen umfassenden Behandlungsansatz, indem sie die Konzentration inflammatorischer Zytokine und von Wachstumsfaktoren, wie z. B. des vascular endothelial growth factor (VEGF), reduzieren. Jedoch haben intravitreale Injektionen häufig nur einen kurzen Erfolg und sind mit intraokulären Nebenwirkungen verbunden. Das intravitreale Implantat ILUVIEN® enthält Fluocinolonacetonid und wird durch eine Injektion in den Glaskörperraum verabreicht. Seine Wirksamkeit und Sicherheit wurden in klinischen Studien nachgewiesen, und eine Subgruppen-Analyse zeigte, dass es insbesondere bei Patienten mit seit langem bestehendem DMÖ  mit schlechtem Visus und begrenzten Behandlungsmöglichkeiten  vorteilhaft ist. Infolgedessen wurde das ILUVIEN-Implantat in Europa für die Behandlung von Sehstörungen aufgrund von chronischem DMÖ zugelassen, das auf verfügbare Therapien unzureichend anspricht. Diese Daten wurden durch klinische Erfahrungen in der praktischen Anwendung gestützt. Es werden zwei Fälle vorgestellt, welche die Wirksamkeit des ILUVIEN-Implantats an zwei Patienten demonstrieren, bei denen vorherige Therapien, darunter Ranibizumab, keine nachhaltige und positive Wirkung erbrachten.
The Role of Preservative-free Therapies in the Treatment of Glaucoma
Authors: Baudouin Christophe , Hommer Anton , Konstas Anastasios , Traverso Carlo E ,   Vision Institute, University of Paris, France,   Hera Hospital, Vienna, Austria,   1st University, Thessaloniki, Greece,   University of Genova, Italy
Published: October 2015

The satellite symposium Role of Preservative-free Therapies in the Treatment of Glaucoma at the 2013 annual meeting of the European Society of Ophthalmology in Copenhagen included presentations from four leaders in the field of glaucoma treatment. The first of these stressed that among patients with glaucoma, 2030 % have severe ocular surface disease (OSD). The risk of OSD is significantly increased by preservatives such as benzalkonium chloride in topical glaucoma medications. To reduce this risk, preservative-free (PF) treatments have been developed. One such treatment, PF-tafluprost has proved effective in real-world use in controlling intraocular pressure (IOP) and patients may benefit when switched to this medication from other treatments. When using these treatments it is important to recognise that continuous monitoring in glaucoma is vital to fully assess the IOP profile and determine the risk of disease progression. It is also important that advances in glaucoma treatment are reflected in current recommendations. Since 1998, the European Glaucoma Society has published guidelines that aim to improve definitions, diagnosis, treatment goals and practice in this disease. These have been regularly updated and constitute the consensus on best practice in glaucoma including recommendations on use of PF medications and patient management at all stages of the disease.
Intracorneal Inlays – Special Focus on the Raindrop
Authors: Güell José L , Barrada Omar A ,   Director, Cornea and Refractive Surgery Unit, Ocular Microsurgery Institute, Barcelona and Associate Professor of Ophthalmology, Autonoma University of Barcelona, Barcelona, Spain,   Fellow, Cornea and Refractive Surgery Unit, Ocular Microsurgery Institute, Barcelona and Autonoma University of Barcelona, Barcelona, Spain,   Consultant Ophthalmogist, Ophthalmology Department, Cairo University Medical School, Cairo, Egypt
Published: October 2015

Presbyopia remains the last frontier for refractive surgeons. With increased demand for spectacle independence at all ages, ophthalmologists are exploring different approaches for presbyopia correction. The idea of adding synthetic material to the cornea for the management of presbyopia has come a long way since its inception. The Raindrop® (ReVision Optics®), KAMRA Inlays (AcuFocus) and the Flexivue Microlens (Presbia) are three very different inlays that attempt to reverse presbyopia through different mechanisms. The Raindrop changes the curvature of the anterior cornea in the plane of the pupil, the Kamra uses the principle of the pinhole to increase depth of focus, while the Flexivue is a refractive annular add lenticule that creates a paracentral zone for near vision. The decreased incidence of complications, ease of insertion, reversibility and potential applicability to patients with various refractive statuses make inlays a powerful addition to the armamentarium in the management of presbyopia.
Femtosecond Lasers in Ophthalmology
Authors: Raoof Duna A , Shtein Roni M ,   Cornea Fellow, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, US,   Associate Professor, Kellogg Eye Center, University of Michigan, Michigan, US
Published: October 2015

The use of the femtosecond laser in ophthalmic surgery over the last decade has resulted in the development of innovative procedures. The ultra-short infrared laser pulses of the femtosecond laser can be applied precisely and predictably with minimal collateral tissue damage, making it an ideal tool for highly precise ophthalmic surgery. Flap creation in laserin situkeratomileusis (LASIK) is the most common use of this laser. It can also be used for other corneal refractive procedures, lamellar and full-thickness corneal transplantation and cataract surgery. This article summarises recent advanced applying femtosecond laser technology in ophthalmology.
Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema
Authors: Medeiros Marco Dutra , Alkabes Micol , Nucci Paolo ,   Consultant Ophthalmologist  Vitreoretinal Surgeon, Central Lisbon Hospital Center, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal,   Consultant Ophthalmologist  Vitreoretinal Surgeon, University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy,   Professor of Ophthalmology, University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
Published: October 2015

Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Corticosteroid drugs have been demonstrated to inhibit the expression of both the vascular endothelial growth factor (VEGF) gene and other anti-inflammatory mediators, such as prostaglandins. Triamcinolone, fluocinolone and dexamethasone are the main steroids that have been studied for the treatment of macular oedema. Over the last few years, several studies have suggested an important role for dexamethasone in the management of DMO. The dexamethasone intravitreal implant (DEX implant) (Ozurdex®; Allergan, Inc., Irvine, CA) is a novel approach approved by the US Food and Drug Administration (FDA) and by the EU for the intravitreal treatment of macular oedema after branch or central retinal vein occlusion, and for the treatment of non-infectious uveitis affecting the posterior segment of the eye. We reviewed manuscripts that had investigated the pharmacokinetics, efficacy and safety of the DEX implant regarding DMO treatment.
Comprehensive Glaucoma Management – Novel Insights
Authors: Baudouin Christophe , Traverso Carlo E , Konstas Tasos , Pfeiffer Norbert , Pillunat Lutz ,   Quinze-Vingts National Ophthalmology Hospital, Paris, France,   University of Genova, Italy,   Aristotle University, Thessaloniki, Greece,   Mainz University, Germany,   University Eye Hospital Dresden, Germany
Published: October 2015

The satellite symposium Comprehensive Glaucoma management  Novel Insights was convened at the 2014 European Glaucoma Society Congress and included presentations from four experts who identified several factors in current practice for the assessment and treatment of glaucoma and provided valuable solutions to potentially improve outcomes. In glaucoma, there are multiple risk factors associated with disease progression: some cannot be controlled (e.g. age and the extent of existing glaucoma damage); others such as ocular perfusion pressure can be determined and sometimes influenced. The use of 24-hour intraocular pressure (IOP) monitoring provides a much more complete assessment of the effects of glaucoma treatments than is possible with single IOP measurements and adds to the clinical evaluation. Various eye medications for use in glaucoma contain benzalkonium chloride (BAK), which is known to cause superficial inflammation. The extent of BAK penetration into deep ocular tissue and associated damage is only now being realised with the use of novel chemical and imaging techniques. These findings highlight the importance of preservative-free medications. Treatment of glaucoma is also being improved with the use of fixed-dose combinations of molecules that facilitate treatment and, in terms of IOP lowering, are non-inferior to medications used separately. These improvements in glaucoma management are therefore likely to improve understanding of disease status, improve efficacy and ultimately decrease the risk of vision loss.
The Treatment of Diabetic Macular Oedema with ILUVIEN® Intravitreal Implant Following Prior Anti-VEGF Therapy – Case Study
Authors: Quhill Fahd ,   Consultant Ophthalmologist, Royal Hallamshire Hospital, Sheffield, UK
Published: October 2015

Diabetic macular oedema (DMO) is the main cause of vision loss in diabetic retinopathy. The ILUVIEN® intravitreal implant, which contains fluocinolone acetonide and is administered by injection into the vitreous cavity, should be considered if the patient is not responding to anti-vascular endothelial growth factor (VEGF) therapy, and the patient fulfils the recommendations of the National Institute for Health and Care Excellence (NICE) Technology Appraisal 301. The efficacy and safety of the ILUVIEN implant has been demonstrated in clinical studies, and a pre-planned subgroup analysis has shown that it is particularly beneficial in patients with chronic DMO. This case study is the first report in the UK of the effectiveness of the ILUVIEN implant in a patient in whom therapy with ranibizumab did not result in sustained improvements in terms of visual outcomes and foveal thickness.
Changing Perspectives in Diabetic Macular Oedema – Recognising and Understanding Chronic Diabetic Macular Oedema
Authors: Chakravarthy Usha , Augustin Albert , Yang Yit , Diestelhorst Michael , Massin Pascale ,   Ophthalmology and Vision Sciences, Queens University Belfast, UK,   Augenklinik Karlsruhe, Karlsruhe, Germany,   Wolverhampton Eye Infirmary, New Cross Hospital, Wolverhampton, UK,   Department of Ophthalmology, University of Cologne, Cologne, Germany,   Hôpital Lariboisière, Paris, France
Published: October 2015

The satellite symposium moderated by Usha Chakravarthy entitled ‘Changing Perspectives in Diabetic Macular Oedema: Recognising and Understanding Chronic Diabetic Macular Oedema’ was convened at the 2014 EURETINA Congress. The symposium discussed the multiple processes involved in chronic diabetic macular oedema (DMO) and the use of medications, in particular, corticosteroids in its management. As DMO progresses, inflammatory cytokines are up-regulated relative to vascular endothelial growth factor (VEGF) and these promote various pathways that ultimately result in retinal damage in chronic disease. It is important therefore that treatments for chronic DMO address this altered inflammatory cytokine profile to effectively manage the condition. ILUVIEN®, a 190 μg intravitreal implant in applicator (with a daily release rate of 0.2 μg/day fluocinolone acetonide [FAc] implant) is a second-line therapy indicated for the treatment of chronic DMO. This implant has been shown in phase III trials to lead to marked improvements in visual acuity and in retinal thickness in patients with chronic DMO that were insufficiently response to first-line therapy (i.e. laser). Clinical trial data strongly support the use of the FAc implant in chronic DMO and now ‘real world’ data from its use in regular clinical practice are becoming available and interim results complement those reported in a clinical trial setting.
Transepithelial High Fluence Crosslinking for Keratoconus – Case Report of 1-year Follow-up
Authors: Pinelli Roberto , Amin Zahran Yazan ,   Scientific Director, Switzerland Eye Research Institute, Lugano, Switzerland,   Refractive Surgeon, Yazan Zahran Eye Clinic, Amman, Jordan
Published: October 2015

Purpose:To evaluate the efficacy and safety of transepithelial crosslinking for halting the progression of keratoconus.Methods:Uncorrected and corrected visual acuity, simulated keratometry, corneal topography and pachymetry data were evaluated at baseline and 1 year after bilateral transepithelial crosslinking using ParaCel™ and the KXL™ device (Avedro, Waltham, Massachusetts, US).Results:The keratometry, uncorrected visual acuity, best corrected visual acuity at the baseline and after 1 year of follow-up was stable and even improved with time.Conclusion:Transepithelial crosslinking can safely and effectively halt the progression of keratoconus as demonstrated by follow-up.
Successful Treatment of a Case of Unilateral Endogenous Klebsiella pneumoniae Endophthalmitis
Authors: Takes Omer , Kocaoglu Gamze , Ayhan Ziya , Saatci A Osman ,   Resident,   Resident,   Fellow,   Professor, Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
Published: October 2015

A 52-year-old woman with diabetes was examined for acute visual loss and ocular pain in oculus dexter (OD). Two weeks earlier, a nephrostomy catheter was inserted for the treatment of nephrolithiasis and 10 days after this procedure she suffered an acute myocardial infarction. During hospitalisation, she developed a high fever andKlebsiella pneumoniaewas detected in the blood cultures. On eye examination, mild corneal oedema, minimal hypopyon, vitritis and subretinal abscess of 3DD size at the uppertemporal retina were noted in the right eye. Single intravitreal injection of vancomycin, ceftazidime and clindamycin was given in addition to systemic antibiotic treatment for 14 days. Intraocular inflammation resolved rapidly within days and she regained a visual acuity of 8/10 with a residual chorioretinal scar 2 months later. Endogenous endophthalmitis can be treated successfuly if the diagnosis can be established early enough and treated accordingly.
Ocriplasmin for the Treatment of Symptomatic Vitreomacular Adhesion/Traction
Authors: Kuppermann Baruch D ,   Professor of Ophthalmology and Biomedical Engineering; Chief, Retina Service; Vice-Chair, Clinical Research, Ophthalmology School of Medicine, Gavin Herbert Eye Institute, University of California, Irvine, California, US
Published: October 2015

Ocriplasmin has recently been introduced as a new treatment option for patients with symptomatic vitreomacular adhesion/vitreomacular traction (VMA/VMT). Understanding its potential as well as its limitations is crucial as it becomes an additional tool in the management of these diseases. In this article the overall efficacy and safety of ocriplasmin are reviewed, focusing on the results from the phase III clinical trials as well as recently published case reports and postmarketing data analysis. Efficacy data from ocriplasmin use in a clinical setting support the subanalysis of the phase III clinical trial data. This analysis demonstrated that certain baseline ocular characteristics, namely focal VMA, and absence of epiretinal membrane, are predictive of VMA resolution. Safety findings show that the overall percentage of patients experiencing adverse events during the clinical trial program was low in ocriplasmin-treated patients. Postmarketing surveillance data corroborate findings from the phase III trials, and provide additional insights into the characterization of the safety profile of this new treatment option.
Immediately Sequential Bilateral Cataract Surgery—A Global Perspective
Authors: Arshinoff Steve A ,   Directing Partner, York Finch Eye Associates, Humber River Hospital, Toronto, Ontario, Canada; Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Assistant Clinical Professor, Surgery (Adjunct), McMaster University, Hamilton, Ontario, Canada
Published: October 2015

By the mid 1990s, the evolution of progressively safe and predictable cataract surgery saw the resurgence of centuries of interest in performing immediately sequential bilateral cataract surgery (ISBCS). Within 10 years ISBCS had become generally accepted and the International Society of Bilateral Cataract Surgeons (iSBCS) was formed (September 2008) to “promote education, mutual cooperation, and progress in simultaneous bilateral cataract surgery.” The first initiative of the society members was to create a document “iSBCS General Principles for Excellence in ISBCS 2009,” which was intended to disseminate information about the best practices they had discovered to assist novice ISBCS surgeons. Next, ISBCS needed to be studied. Soon, data began to clarify some advantages of ISBCS, and risks were carefully evaluated. It soon became apparent that the main impediment to the performance of ISBCS, globally, was money, in that many jurisdictions financially penalized surgeons who performed ISBCS. Presently, we know that ISBCS carries many benefits to the patient, his/her family, the surgical facility, and society. The feared risks for simultaneous bilateral endophthalmitis, the requirement to adjust intraocular lens (IOL) selection for second eyes, based on first eye results, and others, have simply not been borne out under scrutiny. ISBCS is now rapidly increasing in its performance and acceptance globally, but the financial factors remain to be solved.