bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetics in polypoidal choroidal vasculopathy
Authors: ZERBIB J , SEMOUN O , LALLOUM F , SIKORAV A , TILLEUL J , COSCAS G , SOUIED E
Published: August 2014

Genetic factors have been identified these last years in polypoidal choroidal vasculopathy. Because genetic factors play an important role in the pathogenesis of AMD and because AMD and PCV share similarities, the genes involved in AMD have been investigated in PCV. To date, a lot of studies and even reviews have been published on the genetic of PCV, trying to answer if the genetic background between PCV and AMD could help classifying PCV as a subtype of AMD or a distinct disease. Several genes associated to AMD have been analyzed in PCV showing significantly association such as rs10490924 of ARMS2, Y402H of CFH, C2 and C3 genes… But some differences, in particulary, in the rs10490924 of the ARMS2 gene in the allele frequency and the oddsratio between PCV and AMD are observed. The genes associated with PCV are the same genes than those associated with AMD, underligning that PCV and AMD share common pathway of development. Genetic results to date do not help clearly to answer the controversy whether PCV is a subtype of AMD or a specific entity but show interestingly that AMD and PCV, share, at least partially similar molecular mechanisms. Additional genetic and environmental factors might be implicated in the pathophysiology of PCV
Handheld reflectance in vivo confocal microscopy for the diagnosis of conjunctival tumors
Authors: GRIVET D , HAOUAS M , JULIENNE R , PERROT JL , LABEILLE B , CAMBAZARD F , FOREST F , DUMOLLARD JM , PEOC'H M , GAIN P , THURET G , CINOTTI E
Published: August 2014

Purpose We evaluated whether the handheld in vivo confocal microscope (IVCM) that has been recently developed for the study of skin tumors is suitable for the diagnosis of conjunctival tumors.

Methods Prospective study, observational case series. We prospectively evaluated the IVCM features of 53 conjunctival lesions clinically suspicious of tumors of 46 patients referred to our University Hospital, by using the handheld device (vivascope 3000, Caliber/Mavig). Twenty‐three lesions were excised (3 nevi, 10 melanomas, 5 squamous cell carcinoma, 2 lymphomas and 3 pinguecula/pterygium) while the other 30, presenting no IVCM malignant features, were under follow‐up for at least 1 year. Clinical, IVCM and histological diagnosis were compared. Sensitivity and specificity of the IVCM for the diagnosis of conjunctival malignant tumors was calculated using as reference 1) the histolological diagnosis and 2) the histological diagnosis plus the clinical diagnosis at follow‐up greater than one year.

Results IVCM showed sensitivity and specificity for malignant tumors of 100% using both methods.

Conclusion IVCM with a handheld dermatology‐dedicated microscope can play a rôle in the non‐invasive diagnosis of conjunctival lesions. Further studies should be performed to better define the diagnostic ability of this technique. Grants: GIRCI2012
Peripheral neuropathy in chronic renal failure: an in vivo confocal microscopy study
Authors: VIEIRA L , ANJOS R , SOUSA H , SOUSA A , BORGES A , BRANCO P , ALVES N , MADURO V , CANDELARIA P
Published: August 2014

Purpose To analyse corneal nerve morphology alterations in patients with chronic renal failure by in vivo corneal confocal microscopy (CCM).

Methods A prospective study was conducted in 30 patients (30 eyes) with pre‐dialysis chronic renal failure (CRF) and 30 aged‐matched healthy volunteers (30 eyes). A complete ophthalmologic examination, esthesiometry (Cochet‐Bonnet esthesiometer), in vivo CCM (Heidelberg Retina Tomograph II/Rostock Cornea Module) and neurological evaluation were performed.

Results Corneal sensation was reduced in pre‐dialysis CRF patients compared with control subjects. Nerve fiber density, length and branch density were reduced and tortuosity was increased in the CRF group (p<0,05). These parameters were related with severity of neuropathy.

Conclusion In vivo CCM may be a valuable method for diagnosis of uremic neuropathy and may be used to grade its severity.
Mathematical model of corneal reendothelialization after inadvertent descemetorhexis
Authors: TRONE M , JULIENNE R , RANNOU K , BERNARD A , HE Z , GAVET Y , THURET G , GAIN P
Published: August 2014

Purpose To report a case of inadvertent descemetorhexis during phacoemulsification and our conservative approach based on the endothelial cells (EC) self‐healing capacity

Methods A 85‐year‐old man presented with an unusual complication of cataract surgery. During visco injection, the Descemet was accidentally dissected and removed during the capsulorhexis. On the next day, a massive corneal edema was observed. Based on the self‐healing capacity of the residual peripheral ECs, we proposed to observe the natural course. The posterior corneal surface geometry was measured in OCT (CASIA‐SS‐1000) and the residual endothelial area was calculated from a mathematical hemi‐ellipsoid model. Considering the EC density (ECD) from the fellow eye, we estimated the theoretical residual EC pool and thus the final post redistribution ECD in the patient.

Results The theoretical ECD after endothelial cell redistribution was 1680 cells/mm2, reinforcing the wait and see strategy. Visual acuity improved from counting fingers initially to 20/40 at 8 months. The central cornea was clear and 540µm thick. Specular microscopy and confocal microscopy confirmed the repopulation of the central defect by the ECs over the denuded posterior stroma. The central ECD measured at 5 months and 8 months were 550 and 516 cells/mm2 respectively.

Conclusion The ECD was less than expected suggesting a higher traumatic loss and a larger defect. The originality lies in the mathematical modeling of the spontaneous self‐healing capacity of the endothelium, deferring penetrating or endothelial keratoplasty. Interestingly, despite the 85 years old, ECs keep important migration and enlargement capacities. Grant: ANR/CORRIMO3D
Developing a clinically viable protocol for measuring and analysing the human contrast sensitivity function on a standard computerised chart
Authors: DONALD J , LI J , SAROSSY M , WEYMOUTH A
Published: August 2014

Purpose Contrast sensitivity testing is an important part of visual assessment and can identify visual deficits that go undetected by measuring visual acuity (VA) alone. Despite this, contrast sensitivity testing is rarely performed clinically due to the expensive processes required and limited test availability, with few spatial frequencies used. Further, gratings can be difficult for subjects to learn and results are often not standardized. We developed and tested a convenient, inexpensive protocol using Snellen optotypes to measure the CSF using a widely available computerised VA chart. Effects of blur and neutral density (ND) light attenuation were analysed to evaluate the technique under different conditions.

Methods 34 eyes of 34 subjects were tested monocularly under photopic conditions. Subjects had corrected VA of 6/4.8 (or better) and normal ocular health. A computerised chart (Luneau) was used to measure contrast sensitivity thresholds across 19 spatial frequencies between 0.9 and 60.0 cpd using an ascending Method of Limits. This was repeated with +1.50DS blur and a 2.9 ND filter. CSFs were analysed and modeled using R and Prism to extract useful parameters: the area under the log10 CSF (AULCSF), CSF peak, high‐ and low‐spatial frequency limits.

Results A quadratic function was found to best fit the pooled log CSF data, minimising cross‐validation error. The AULCSF was calculated between log spatial frequencies of 0.6 and 1.4 using integration of the fitted quadratic function. Mean AULCSF was 1.82±0.133.

Conclusion Our method can measure, display and calculate the normal CSF. This can be used to compare and assess the CSFs of patients with ocular diseases.
Flash visual evoked potentials (FVEP) in various stimulation conditions
Authors: POJDA‐WILCZEK D
Published: August 2014

Purpose Comparison between the results of FVEP examinations conducted with various stimulators (Ganzfeld, Mini Ganzfeld i Flash Goggles) as well as for opened and closed eyes.

Methods 17 volunteers (34 eyes), including 11 females, aged 23‐56 (average age: 30 years) have been examined with Roland Consult electrophysiological equipment. Basing on Wilcoxon signed‐rank test the amplitude and the latency of P2 wave have been compared: 1. of results acquired with each of three stimulators; 2. of results acquired with eyes opened and eyes closed.

Results Mean P2 amplitude (latency) acquired with Ganzfeld stimulation amounted to 12 µV (130 ms), acquired with Mini Ganzfeld stimulation amounted to 7 µV (124 ms) and acquired with Flash Goggles amounted to 9 µV (113 ms). The results statistically significantly differed (p < 0,0001) between all compared stimulators. Mean P2 amplitude (latency) acquired with Ganzfeld stimulation amounted to 12 µV (130 ms), acquired with Mini Ganzfeld stimulation amounted to 7 µV (124 ms) and acquired with Flash Goggles amounted to 9 µV (113 ms) with eyes opened and accordingly 11 µV (131 ms), 9 µV (126 ms) and 6 µV (120 ms) with eyes closed. The results for eyes opened and eyes closed statistically significantly differed (p < 0,001) for Mini Ganzfeld as well as for Flash Goggles stimulators.

Conclusion The amplitude and latency of P2 FVEP acquired with different stimulators cannot be compared. Keeping eyes closed does not significantly alter the amplitude and latency of P2 FVEP only in case of Ganzfeld stimulation. The results acquired with other stimulators can be faulty if the patient closed eyes during examination.
Simulation of DME changes on OCT
Authors: CORREIA A , ARAÚJO A , BARBEIRO S , CARAMELO F , SERRANHO P , MORGADO M , BERNARDES R
Published: August 2014

Purpose To identify the changes at the cellular level responsible for the differences seen in OCT scans of DME patients.

Methods Cirrus HD‐OCT (Carl Zeiss Meditec, Dublin, CA, USA) scans of DME eyes (12 eyes of 8 patients: 68.9±7.5 yrs) and healthy control (HC) eyes (12 eyes of 11 controls: 63.0±3.6 yrs) were acquired from our database. The ONL was segmented by a human grader (AC) and each segmentation was aligned to its upper boundary, averaged into an A‐scan and then normalized by the intensity at the RPE to discard the effect of media opacities. To understand the significant differences found between the profiles of DME and HC, a Monte Carlo method for simulating light scattering with a model of the ONL was implemented. The inputs for the method are calculated using Mie theory by assuming that the ONL may be modelled as a homogeneous medium filled with nuclei. Changes in each model parameter (e.g. nucleus' size) were tested and compared with the measured profile to identify which cellular change could best reproduce the OCT differences found between HC and DME patients. Moreover, the DME group was divided into those without significant visible changes and those with increased ONL volume.

Results The simulation method successfully reproduced the differences observed between the HC and DME groups. For the DME cases with increased volume, it was possible to match the simulated and acquired profiles by using the measured increase in ONL thickness. In the DME case with no significant changes, it was necessary to increase only the nucleus size to be able to reproduce the measured profiles.

Conclusion The method proposed is capable of reproducing the reflectivity changes measured on OCT scans of the ONL of DME eyes and to justify these at the subcellular level.
Visual impairment in diabetic patients with and without established blood‐retinal barrier leakage and relation with the status of the blood‐brain barrier
Authors: QUENDERA B , AMORIM A , CORDEIRO M , FERREIRA C , MARQUES J , BERNARDES R , REIS A , RIBEIRO L , CASTELO‐BRANCO M
Published: August 2014

Purpose To assess visual impairment in diabetic patients with and without established blood‐retinal barrier leakage and relation with the status of the blood‐brain barrier.

Methods We assessed 37 diabetic patients (29 type2; mean Hb1Ac 7.93[1.44]) using four different approaches: a two‐alternative forced‐choice multi‐psychophysical channel test for speed discrimination and achromatic contrast as well as chromatic L, M and S cone contrast discrimination; multifocal electrorretinography(mfERG) and brain barrier integrity assessment using a permeability measure Ktrans for dynamic contrast enhanced MRI (Cramer et. al, 2013) in 4 regions of interest(ROIs). We selected two diabetic groups with and without measured retinal barrier leakage. Spearman’s rank were used for correlations and Mann‐Whitney U test for comparison between groups for a set p value threshold of 0.05.

Results We found that presence of retinal leakage was not associated with changes in blood brain barrier permeability at any of the studied ROIs. Interestingly we found, in particular in diabetic type 2 patients, significant negative correlations between the amplitude and/or implicit time of N1 and P1 components of the multifocal electrorretinogram and brain leakage, for the most external stimulation rings. Psychophysical performance was impaired in particular for S but was not correlated with barrier status.

Conclusion Our findings suggest that retina and brain blood barriers are patho physiologically unrelated in diabetes. We found a direct correlation between neurophysiological measures and brain barrier damage, suggesting that both may have a direct common cause.
Chromatic pupillometry for assessment functional rod and cone patterns in Usher syndrome patients
Authors: SLIESORAITYTE I , MACHIN C , MAKOWIECKA K , MOHAND‐SAID S , SAHEL J
Published: August 2014

Purpose The aim of the study was to characterize the functional rod and cone patterns using chromatic pupillometry in Usher syndrome patients.

Methods Prospective case series study enrolled 45 Usher syndrome patients. All patients underwent in‐depth phenotypic examination. Functional rod and cone patterns were obtained using custom‐made chromatic pupillometer(AMTech, Dosenheim, Germany). Pupil diameter was recorded monocular in response to red (640 nm) and blue (462 nm) light stimuli for varied intensity levels (ranged from 1000 cd/m2 to 0.001cd/m2). Response amplitudes were analyzed and compared to the clinical phenotype.

Results Pupil responses to rod‐ and cone‐weighted stimulation were significantly diminished in all Usher syndrome patients for all intensity levels (mean decrease 60% and 30%, respectively p<0.001). Lower rod‐weighted responses were related with decreased b‐wave amplitude in full field ERG (r=0.37,p<0.001). Decreased cone‐weighted responses were correlated with diminished photopic ERG b‐wave amplitude (r=0.43,p<0.001) and mfERG amplitudes (r=0.65,p<0.001). Higher cones‐weighted responses were associated with preserved cone mosaic in adaptive optics and presence of inner/outer segment in optical coherence tomography, although not always related with preserved visual field and visual acuity. Rod‐ and cone‐weighted responses were recordable even in a very advanced Usher syndrome cases associated with abolished ERG.

Conclusion Chromatic pupillography is an objective tool to assess functional rod and cone patterns in Usher syndrome, which potentially could be used as an outcomes measure to assess safety and efficacy in therapy trials, in particularly in advanced cases.
Curable forms of childhood strabismus
Authors: MOHNEY B
Published: August 2014

Background: The literature on the management of childhood strabismus emphasizes some subtypes while ignoring others, based upon the experience of the author or the popularity of the topic, and are often from single‐institution, tertiary‐care referral centers. The purpose of this study is to review which forms of childhood strabismus are potentially curable. Methods: This overview identified surgically curable forms of strabismus, defined as a life‐long result of orthotropia to small angle strabismus with > 50 seconds or better of stereoacuity and normal ocular motility. Results: Children with a developmental disorder, sensory strabismus, convergence insufficiency, dissociated strabismus and Browns syndrome were excluded. Curable forms of childhood strabismus included some children with partial sixth nerve palsy, accommodative and acquired nonaccommodative estropia and, in rare instances, a small percentage of children with intermittent exotropia. Conclusions: In declining order, some children with partial sixth nerve palsy, accommodative esotropia, acquired nonaccommodative esotropia, and only a handful with intermittent exotropia, can be said to be curable forms of childhood strabismus.
What genetics has taught us about keratoconus
Authors: VINCENT AL
Published: August 2014

Keratoconus most likely represents complex disease, with different modes of inheritance, genetic heterogeneity, and environmental factors contributing to the disease manifestation. The relative contribution of each is subject to debate and likely varies between individuals. At one end of the spectrum, disease in some individuals is probably due entirely to environmental influences, yet at the other end is solely under the control of genetic mechanisms. However the majority of cases will most likely be the result of a genetic predisposition with precipitating environmental stressors or modifiers Over the last decade significant progress has been made in identifying genetic risk factors for keratoconus. These genetic risk factors have been identified using multiple approaches including candidate gene studies, linkage analysis, genome‐wide studies and new sequencing technologies. This presentation will summarize how the genes implicated provide clues to the molecular etiology and pathways involved in the pathogenesis of keratoconus.
Twin studies in keratoconus
Authors: LISKOVA P
Published: August 2014

Genetic determinants of keratoconus are still largely unknown. Over the last two decades there has been a shift from regarding keratoconus as a monogenic disease with variable expression towards a general consensus that it is most likely to be a multifactorial disorder with multiple genetic and environmental components​ contributing to its development. Twins are useful in assessing the heritability of traits. Discordant monozygotic twin pairs can be used to look for environmental and epigenetic factors. The contribution of twin studies to the understanding of keratoconus genetics will be discussed.
New evidence from French investigation
Authors: KOROBELNIK J
Published: August 2014

Abstract not provided
Classification of DR
Authors: MASSIN P
Published: August 2014

Abstract not provided
Anti VEGF
Authors: POURNARAS C
Published: August 2014

The diabetic macular edema (DME) related to visual loss, results mainly from changes in the affected blood‐retina barrier. VEGF, originally described as vascular permeability factor, is considered not only as a critical stimulus of retinal neovascularization but also as the primary inducer of increased vascular permeability involved in the formation of diabetic macular edema. Increased levels of VEGF in retina, vitreous and aqueous humor were found in diabetic patients with macular edema (DME). There is increasing evidence that favorable outcomes can be achieved by the use of anti‐vascular endothelial growth factor therapy. Anti‐VEGF therapy combined with laser photocoagulation, is superior to laser photocoagulation for the treatment of moderate‐to‐severe visual impairment caused by DME. Data provided from large phase III clinical trials for ranibizumab showed evidence of visual improvement and favorable safety profile. Further studies for bevacizumab, aflibercept and pegaptanib in DME, although limited, also proved the benefits of using anti‐VEGF therapy instead of laser. As a result, the use of anti‐VEGF therapy as the first line of treatment,is recommended instead of laser photocoagulation in the management of DME.
Current and emerging concepts in neuroprotection
Authors: CORDEIRO M
Published: August 2014

The realisation that lowering IOP is unable to prevent progressive vision loss in all glaucoma patients, has led to investigation of neuroprotection as an alternative or additional treatment option. Neuroprotection has gained renewed interest recently as a therapeutic approach to prevent neuronal degeneration and loss of function in glaucoma, since the publication of the LoGTS study. Although confirmation of neuroprotective effects by other randomized clinical trials is needed, there is now a demonstration of positive non‐IOP dependent effects. Furthermore, it has been proposed as a treatment strategy in other diseases, such as AMD, Alzheimer’s and Parkinson’s Disease. Imaging biomarkers are used in medicine to provide measures that correlate with a clinically significant outcome in disease. By definition they should identify disease early, be easy to assess, have the ability to help predict disease severity and have high enough sensitivity and specificity to be useful. Retinal ganglion cell imaging in glaucoma should fulfil all these criteria. Ideally, a good end‐point in glaucoma would be one that could directly measure RGC dysfunction and disease. Continuing developments in imaging technologies offer great potential in glaucoma. More recently, advances in this field have allowed unprecedented in vivo access to the retinal layers, using many different properties of light to differentiate cellular structures. Over the next few years, advances in therapy & diagnostic methodologies, such as imaging, offer great potential in future for glaucoma.
Customization of Intraocular Lenses: a practical approach
Authors: PISELLA P
Published: August 2014

Abstract not provided
Straylight for dummies: applications in your daily practice
Authors: VAN DEN BERG T
Published: August 2014

If we consider limitations and defects in the optical apparatus of the eye, two distinct types of defect must be distinguished: (1) errors and irregularities in refraction, and (2) light scattering. Those two effects together determine retinal image quality. Light scattering is recognized from the radiation of light around bright light sources against a dark background, leading to glare. The intensity of this “false” light can be assessed and is called “straylight”. It disturbs not only night driving, but also day time situations, and can be voiced by patients as “hazy vision”, face recognition problems, spatial orientation problems, etc. It is of great importance to realize that these problems often do not coincide with visual acuity loss. So, if visual acuity is good, you may need to assess straylight in order to understand your patient’s complaint. This occurs often in case of early cataract. Studies have shown the existence of a large proportion of non‐acuity cataract that needs treatment all the same. But also in other conditions straylight can be the more important problem. Practical examples and population data will be discussed, including Fuch’s dystrophy, pigmentation defects, IOL deposits and inclusions, etc.

Commercial interest
Aqueous humor cytokine profile of patients with primary or recurrent ocular toxoplasmosis
Authors: THIEME C , PLEYER U , METZNER S , DAMES C , SCHLICKEISER S , DOBNER B , VOLK HD
Published: August 2014

Purpose Toxoplasma gondii infection remains the most frequent cause of infectious posterior uveitis and a significant cause of visual impairment worldwide. Still, the immune mechanisms are largely unexplored. The aim of this study is to investigate the cytokine profiles of aqueous humor samples in patients with first or recurrent manifestation of ocular toxoplasmosis and to correlate findings with clinical characteristics

Methods Using the BioRad Multiplex immunoassay, we determined the concentrations of 27 cytokines/chemokines in aqueous humor specimens obtained from 16 patients with active (n=7) or recurrent (n=9) ocular toxoplasmosis. Results were compared to 5 matched control patients without intraocular infection

Results Using the Wilcoxon‐Mann‐Whitney‐Test significant changes could be identified in both groups affected by either initial or recurrent ocular toxoplasmosis compared to controls. Patients with initial manifestation revealed a significant increase (p < 0.05) of IL‐1RA, IL‐7, MIP1a and IP‐10. In addition significant changes in individuals affected by recurrent disease also differed from controls and became significant (p< 0.05) for TNF‐alpha, MIP‐1b and IP‐10. The cytokine/chemokine profiles however did not differ significantly between initial or recurrent ocular toxoplasmosis subgroups.

Conclusion Our data suggests that MIP1 and IP‐10 are associated with both primary and recurrent ocular toxoplasmosis. These findings may support the important role of IP‐10 and MIP, as specific chemoattractants for activated T cells in parasitic disorders. In contrast to a recent report we were not able to correlate IL‐5 and VEGF with recurrences of the disease. A larger cohort is recruited to underline the results.
Specifics of viral entry in epidemic keratoconjunctivitis
Authors: RAJAIYA J , YOUSUF MA , MUKHERJEE S , LEE JS , ZHOU X , RAMKE M , LEE JY , CHODOSH J
Published: August 2014

Cellular entry pathways for viruses dictate the types of immune responses elicited upon infection. Human adenovirus species D type 37 (HAdV‐D37) causes epidemic keratoconjunctivitis (EKC), associated with severe ocular surface inflammation. However, viral entry is known to be cell type and virus specific. To examine basic mechanisms of HAdV‐D37 pathogenesis in EKC, we studied entry of HAdV‐D37 in vivo in our mouse corneal adenovirus keratitis model, and in vitro in cultured human corneal cells. In the mouse model at 1 hour post infection, viruses appeared to be entering cells by macropinocytosis. By 8 hours post infection, viruses formed regular packed intracytoplasmic arrays adjacent to cell nuclei, with minimal capsid uncoating. Therefore, viral entry occurred, but transport of virus to the cell nucleus appeared abortive, possibly explaining the failure of HAdV‐D37 replication in the mouse cornea. In vitro, inhibition of PKCα reduced viral entry and phosphorylation of both Src and caveolin‐1 in lipid raft fractions, suggesting that PKCα activity occurs upstream of both molecules. Phosphorylated PKCα and Src were found in same endosomal fractions and may be physically associated. These results suggest a central role for PKC in HAdV‐D37 entry and regulation of downstream molecules in corneal cells, including caveolin‐1. Interestingly, the small GTPase dynamin II, did not appear necessary for HAdV‐D37 entry into corneal epithelial cells, but was critical for viral entry in corneal fibroblasts.
Eswab® transport media and 16S RNA PCR in the microbiological diagnosis of infectious keratitis
Authors: BAUDONNET R , GARNIER F , ROBERT PY
Published: August 2014

Purpose The microbiological diagnosis of infectious keratitis based on a corneal scrapping is necessary in order to adapt the treatment. Our study aimed to determinate if the use of Eswab® transport media and 16S RNA PCR increase the sensitivity of this microbiological diagnosis

Methods Retrospective cohort study including all patients who benefited from a corneal scrapping for an infectious keratitis suspicion from June 1, 2007 to June 1, 2011. They were divided into two groups according to the methods of microbiological analysis. In non‐Eswab® (NES) group, four samples per patient were collected, directed to laboratories: bacteriology (direct exam and culture); virology (PCR and culture); mycology and parasitology (direct exam and Acanthamoeba PCR). In the Eswab® (ES) group, three samples per patient were collected. The first one, on Eswab® transport media, was directed to PCR analysis, including 16S RNA, viral and Acanthamoeba research and bacteriological culture. The two others samples were analysed in mycology and parasitology. Infectious gravity factors and the use of antibiotics before corneal scraping, were reported. The main criteria of judgement was the number of patients with a microbiological diagnosis

Results 190 patients were included, 84 in the NES group and 106 in the ES group. Infectious keratitis gravity factors (47,6% vs 56,6% p=0,356) and use of antibiotics before the corneal scrapings (23,8% vs 29,2% p=0,5) was not significantly different between two groups. The diagnosis sensibility in the NES group was 36,9% versus 60,4% in the ES group (p=0,002)

Conclusion The usage of a transport media such as Eswab® and 16S RNA PCR research on corneal scrapping significantly improves the sensibility of microbiological diagnosis
Genotypes & molecular strategies in albinism
Authors: ARVEILER B , LASSEAUX E , MORICE‐PICARD F
Published: August 2014

Oculocutaneous albinism (OCA) affects 1/17000 person. It is characterized by hypopigmentation of the skin, hair and eyes. The main handicap in patients is at the ophthalmologic level. There are 6 known OCA genes (TYR, OCA2, TYRP1, SLC45A2, SLC24A5, C10ORF11) (OCA1,2,3,4,6,7 respectively). An OCA5 locus has been localized, but the gene is not known yet. Apart from the OCA types, an X‐linked ocular albinism gene (OA1, GPR143) as well as 17 genes involved in syndromic forms (HPS, CHS, WS, GS) of albinism have been identified. We routinely search for mutations (point mutations, deletions) in the OCA1, 2, 3, 4, 6 ,7, OA1 and HPS1 genes. Our data in more than 400 patients show 36% OCA1, 25% OCA2, 2% OCA3, 11% OCA4, 1.25% OCA6, 0% OCA7, 6% OA1, 1% HPS1. 17.75% of patients remain without a molecular diagnostic either because only one mutation (6%)or no mutation at all (11.75%) was found. This suggests two main alternative hypotheses. First of all the patient may have a hitherto clinically undiagnosed form of syndromic albinism. For this reason, we are now heading towards analyzing all 24 known albinism genes by next generation sequencing. Secondly, it is likely that additional OCA genes remain to be identified.
Innovative treatments for MGD ‐ EVER more important for ocular surface disease
Authors: KNOP N , KNOP E
Published: August 2014

The 2011 TFOS MGD Report has translated into several new developments in the therapy of Dry Eye Disease with a focus on MGD. Lipid supplementation is recognized as crucial for dry eye therapy either as liposomal spray or in many new tear substitutes. Physical therapy is recognized as a causative treatment in order to re‐liquify inspissated secretum before the application of mechanical pressure in order to eventually release obstructed glands. Since the application of adequate heat is time consuming and tricky, pre‐heated gel applicators or controlled heating googles can be used but must still be repeated every day. Even then, manual expression of the multitude of meibomian glands can be painful or ineffective. A new automated device that allows the computer controlled application of heat and pressure under the supervision of the ophthalmologist in his practice presently occurs as the most advance and effective therapy option that can lead to longterm restoration of meibomian gland function over several months. Azithromycin, a new topical drug has, besides a long‐term tissue uptake, not only an antibiotic but also an anti‐inflammatory and a newly observed promotive effect on gland function and is widely used for MGD.
Restoration of meibomian gland function in severe dry eye disease due to obstructive MGD with an automated physical therapy device
Authors: FINIS D , HAYAJNEH J , KÖNIG C , BORRELLI M , SCHRADER S , GEERLING G
Published: August 2014

We compared the effectiveness of a single Lipiflow® treatment with combined lid warming and massage in patients with Meibomian gland dysfunction (MGD) in a prospective, randomized, crossover, observer‐masked trial. Subjects were randomized to receive either a single 12‐min Lipiflow® treatment or to perform combined twice‐daily lid warming and massage for 3 months. All subjects received an examination pattern of subjective symptoms, lipid layer thickness, Meibomian gland assessment, tear break‐up time, tear osmolarity, corneal and conjunctival staining, Schirmer test values, and tear meniscus height before, and 1 and 3 months after initiation of treatments. A total of 31 subjects completed the 3‐month follow up. At 1 and 3 months, patients in the Lipiflow® treatment group had a significant reduction in subjective symptomes compared with those in the lid‐margin hygiene group. With regard to objective parameters, both treatments produced a significant improvement in expressible Meibomian glands; no other significant differences were noted between the two groups. Results of our study show that both a single Lipiflow® treatment and a 3‐month, twice‐daily lid margin hygiene regimen are effective therapies for MGD.

Commercial interest
Interventions to slow the progression of myopia
Authors: OHLENDORF A
Published: August 2014

Purpose The purpose of the talk is to assess the effectiveness of different strategies, including optical refractive corrections with either spectacles or contact lenses as well as pharmaceutical approaches, to control the progression of myopia. Methods Interventions that have been explored to slow the progression of myopia include monofocal, bifocal and multifocal spectacles, cycloplegic drops, drugs to lower the intraocular pressure, muscarinic receptor antagonists and contact lenses. The scientific background for the different interventions will be presented and results of clinical trials will be reviewed. Results Clinical trials have shown negligible positive effects of progressive additional and bifocal lenses on myopia progression compared to single vision lenses. Observed beneficial effects of rigid gas permeable contact lenses could be related to the ethnicity of participants. The largest positive effects for slowing myopia progression were exhibited with anti‐muscarinic medications. Conclusion Further investigations of myopia control must be conducted in order to find treatments which are clinically meaningful and beneficial. The leading potential candidates at this time are anti‐muscarinic topical medications.

Commercial interest
Experiences with developing virtual clinics in a specialist centre
Authors: KOTECHA A
Published: August 2014

A challenge facing many ophthalmology departments is how to manage the increasing numbers of glaucoma patients efficiently without compromising patient care. There are a number of approaches to meeting the increasing demand for services. One is to increase clinic capacity, which is not a viable long term solution. Another is to implement community eye care schemes, whereby ‘stable’ patients may be discharged from secondary care to be followed up within the community. However, there will always be a number of patients who are not suitable for, or who do not want, community monitoring. These patients need to be managed efficiently within the secondary‐care hospital setting. The 'virtual clinic consultation' has traditionally thought of as a model to manage patients in remote areas, who have limited access to specialist care. However, as information technologies improve, there is scope for this style of 'consultation' to be used within the hospital setting. This talk will discuss the practical aspects of developing a 'virtual' service within a UK National Health Service hospital, the challenges faced, and overcome, when developing the service, and the overall impact the service has had within the Glaucoma Service itself.
Customised amniotic membrane: a surgeon's dream come true
Authors: HOPKINSON A
Published: August 2014

Amniotic membrane (AM) is a proven ophthalmic clinical adjunct, but crude manufacturing and cold chain storage, damage its functional properties and greatly restricts clinical access. Overcoming these problems, Nottingham have developed an innovative, effective and accessible ophthalmic bandage with enhanced wound healing properties. Their AM is produced in a dry, stable and sterilised format, which allows long‐term room temperature storage and distribution, creating an ‘off the shelf’ product. Their AM has improved function over conventional frozen AM, and has the potential to become the first effective, scientifically and clinically validated, low cost treatment for ocular injury. As well as a conventional surgical adjunct for chronic indications, their pre‐clinical data suggests a ‘first of its kind’ acute and emergency application to treat superficial ocular surface injuries. It can potentially be opened and applied directly to the surface of the injury without the need for expensive surgery. As well as pain relief and protecting the wound from infection, the greatly improved profile of trophic factors of their AM facilitates wound healing to limit visual loss and reduce the burden of long‐term clinical treatment.
Proton beam radiotherapy of uveal melanomas
Authors: DESJARDINS L
Published: August 2014

Abstract: Proton beam therapy is a conservative treatment of choroidal melanoma. This study reports our results in terms of overall survival, metastasis‐free survival and secondary enucleation in 3404 patients We present a retrospective, single‐center study of patients treated for choroidal melanoma with proton beam therapy between January 1992 and December 2010 (total dose of 60 cobalt Grays equivalent delivered in 4 fractions over 4 days). The initial clinical tumor characteristics, treatment and follow‐up were recorded prospectively. Overall survival, metastasis‐free survival and enucleation free survival and their prognostic factors were statistically analyzed. 3404 patients were included during this period. The median follow‐up was 98 months. The overall survival rate, metastasis‐free survival rate, local recurrence and secondary enucleation at 5 years were respectively 64%, 74%, 3.82%, 6.79%. The prognostic factors for metastasis‐free survival: the location, the diameter and tumor thickness, and cytogenetic factors body. Risk factors of secondary enucleation are essentially tumor size (diameter, thickness and TNM). Treatment with proton therapy provides excellent local control of choroidal melanoma.
Irradiation treatment of metastatic tumors and lymphomas
Authors: SCHALENBOURG A
Published: August 2014

Intraocular metastases are usually uveal, secondary to breast or lung carcinoma. Lymphoma is most frequently vitreoretinal, in a context of primary central nervous system lymphoma, while a uveal location points towards systemic lymphoma. Management is influenced by a palliative context and bilateral ocular involvement. Close collaboration with the oncologist is required as to the histopathology of the primary tumor, its global extent, oncologic treatment strategy and life expectancy. Stereotactic irradiation is often the principal ocular treatment. A circumscribed treatment of individual lesions carries the risk of local recurrences. The hemato‐ocular barrier often prevents chemotherapy from being effective within the uvea. Radiotherapy usually allows a quick reattachment of the retina and preservation of vision. Evolution towards a painful globe and enucleation should be avoided. With the increasing life expectancy of oncologic patients, treatment of ischemic retina with anti‐VEGFs and PRP becomes more indicated. Conclusion: Irradiation of intraocular metastases and lymphomas is the most important tool in preserving vision and the eye(s). Its indication should be made within a global oncologic treatment strategy.
Oxidative stress and retinal vascular damage in diabetic retinopathy
Authors: LYONS T
Published: August 2014

Abstract not provided
Regenerating the retinal vasculature using endothelial progenitor cells
Authors: STITT A
Published: August 2014

Hypoxia‐related stimuli from oxygen‐deprived retinal neurons and glia networks can drive expression of growth factors and cytokines which induce leakage from the surviving vasculature and/or pre‐retinal and papillary neovascularisation. Current therapies for ischemic retinopathies include laser photocoagulation, injection of corticosteroids or VEGF‐antibodies and vitreoretinal surgery. Unfortunately these treatments fail to address the underlying retinal vasodegeneration and they also involve significant side effects. An alternative approach is to regenerate the retinal vasculature using endothelial progenitor cells (EPCs) to promote vascular repair and reversal of ischemia. This presentation emphasises the molecular and phenotypic nature of EPCs and how they become altered in disease. There will also be discussion about the potential for some EPC sub‐types to be harnessed for cell therapy and the building evidence for how these cells could eventually lead to exciting new therapeutic options for retinal ischemia
Cases
Authors: LEROY BP
Published: August 2014

Clinical cases will be shown. Everyone is encouraged to present unknown of interesting diagnostic cases in inherited eye disease. Submission of cases can be done in the room where the Grand Rounds in Ophthalmic Genetics are being held.
Cases
Authors: LISKOVA P
Published: August 2014

Interesting Czech cases with monogenic ocular disorders will be presented.
Cases
Authors: AUDO I
Published: August 2014

Presentation of case report
Matrix wound healing in the optic nerve
Authors: O'BRIEN C
Published: August 2014

The risk factors associated with optic disc cupping in glaucoma include intraocular pressure and ocular perfusion pressure. The mechanisms of optic disc cupping result in significant extra‐cellular matrix alterations for the lamina cribrosa. A number of cell types play a key role in this ECM re‐modelling including lamina cribrosa cells and astrocytes. A dysfunction in these cell types include high intra‐cellular calcium, mitochondrial dysfunction, and oxidative stress. A greater understanding of the mechanisms involved lead to new therapeutic approaches.
Visualization of tear film thickness after eyedrop instillation
Authors: SCHMETTERER L
Published: August 2014

Abstract not provided
Glial cells as producers of VEGF and opponents in the retina
Authors: EICHLER WOLFR
Published: August 2014

Vascular endothelial growth factor (VEGF) is a key cytokine for the development of pathologic neovascularization in the retina. While Müller glial cells upregulate VEGF in the ischemic retina they constitutively secrete anti‐angiogenic factors such as pigment epithelium‐derived factor (PEDF) and transforming growth factor (TGF)‐β2, thereby determining an anti‐proliferative milieu for microvascular endothelial cells. Neutralization of PEDF or TGF‐β partially abrogates the angiostatic action of Müller cells. PEDF and TGF‐β2 are able to control retinal endothelial cell proliferation via suppressing the activity of ERK‐1/‐2 MAP kinases, even in VEGF‐stimulated cells. TGF‐β2 exerts its anti‐proliferative effect through increased Smad phosphorylation. Exposure of retinal endothelial cells to TGF‐β2 or Müller‐cell derived secreted factors causes an increased activation of Smad2/3, which leads to a decreased ERK‐1/‐2 phosphorylation. Given their impact on endothelial signaling and cell growth, Müller cells have emerged as an important cellular element for the control of angiogenesis and retinal neovascularization.
Simulated Ocular Surgery (VR)
Authors: HAYNES R
Published: August 2014

Simulation of ocular surgery has advanced in recent years with the advent of high quality virtual reality platforms such as the Eyesi vitreoretinal module, which simulate the look and feel of ocular tissues & various pathological conditions encountered during pars plana vitrectomy surgery. However, computer simulation has not yet extended to the simulation of Cryobuckling surgery that is used to treat retinal detachment & involves techniques & manoeuvres that are often outside the comfort zone of even quite senior ophthalmic trainees. This session will demonstrate how model eyes can be used to train surgeons in all of the steps involved in cryobuckle surgery, including the location & treatment of retinal breaks with the indirect ophthalmoscope, peritomy incisions, slinging of rectus muscles, marking the external location of breaks, measuring the break position & choosing an appropriately sized buckle, placing scleral buckle sutures of the correct length & depth, & tightening them with the appropriate tension to create an adequate indent effect. Transcleral drainage of subretinal fluid & injection of intraocular gas can also be practiced, reducing the stress of performing these crucial steps when first performed for real.
Simulated ocular surgery: cataract, glaucoma, strabismus and VR surgery
Authors: FERRIS J
Published: August 2014

The emergence of high fidelity virtual reality simulators has helped to raise the profile of simulation for cataract and vitreoretinal surgery. However, with the advent of the EYESi there is a misconception that all simulation needs to be high tech and expensive and is out of the reach of many training units across the globe. We will describe how innovative model eyes, can be used to teach the same skills and in many instances offer a more realistic and versatile simulation experience than virtual reality simulators and how to incorporate this form of simulation into your training programmes. With reference to cataract surgery we will demonstrate how the building blocks of phacoemulsification, such as wound construction, continuous curvilinear capsulorhexis, nucleus sculpting and IOL implantation can be practice on the model eyes. We will also demonstrate how one can simulate intraoperative complications of cataract surgery, such as posterior capsule rupture with vitreous loss, zonular dialysis and suprachoroidal haemorrhage. We will also show how these eyes can be used to simulate rectus muscle and oblique muscle surgery in a highly life‐like fashion.

Commercial interest
Plastic eye surgery simulator for trabeculectomy
Authors: MCNAUGHT A
Published: August 2014

Glaucoma surgical training is becoming difficult for surgical trainees to access, because of increasing subspecialisation, reduced practical experience in suturing using 10‐0 nylon, and a proliferation of new glaucoma surgical procedures. Traditional early practical experience eg surgical wet‐labs, using perhaps porcine eyes, are not always easily accessible. The presentation outlines the continued importance of training in trabeculectomy surgery, and describes recent innovations in plastic artificial eye technology. Parallels between actual trabeculectomy surgery in patients, versus modern plastic eye simulated trabeculectomy surgery are described. The potential value, and easy availability, of this new simulated eye surgery training is highlighted.
The science from ocular war injuries
Authors: SCOTT ROBER
Published: August 2014

Approximately 10% of war injuries with major trauma have eye injuries. Primary ocular blast injuries are from the transfer of kinetic energy from the explosive blast wave alone. Secondary ocular blast injuries are the most common type of blast injury (42%) from the impact of shrapnel from the explosive device itself or from exogenous debris propelled by the explosion. Tertiary ocular blast injuries (1%) are caused by indirect damage to the eye when an individual is thrown by the blast wind. Quaternary blast injures (3%) are from any other mechanism related to the blast, usually thermal burns. Quinary blast injuries are a new entity that describes a hyperinflammatory state occurring after an explosion that is thought to cause retinal vascular occlusion. IOFB injuries are given prophylactic systemic antibiotics to protect against endophthalmitis, before surgical removal. Combat eye protection (CEP) significantly reduces secondary and tertiary blast injuries, but increased the proportion with commotio retinae. We rehabilitate blind patients with the BrainPort (Wicab, USA) vision device that substitutes the sense of sight with electrotactile stimulation of the tongue and improves navigation and object recognition