bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of chromatic macular ERG and multifocal ERG in diabetic macular edema
Authors: ARAKELYAN MA , BORDEEVA YUN , RYABTSEVA AA , SHAMSHINOVA AM
Published: October 2007

Purpose: To evaluate the degree of macular function disturbances in patients with diabetes mellitus and high glycosylated haemoglobin (HbA1c).

Methods: 11 patients with type II diabetes were included in our study. In 6 patients a clinically significant macular edema was detected; other 5 patients showed slight vascular changes and absence of macular pathology. All patients had much too high (8‐10%) or extremely high (above 10%) levels of HbA1c and underwent a chromatic macular ERG test to red, green and blue stimuli (MBN, Russia). A RETIScan system for multifocal ERG was also used (Roland Consult, Germany).

Results: Patients with macular edema and long duration of the disease had significant reduction of a‐ and b‐wave amplitudes of macular ERG, whereas those with short duration of diabetes showed slight decrease of macular ERG amplitude. The density of photoreceptors in multifocal ERG and amplitudes of N1 and P1 components were analyzed in area of 15° of visual angle: the mean of 3 central rings’ values was calculated. Correlation between mf‐ERG data and macular ERG amplitudes were found. In patients without macular edema and duration of the disease from 7 to 10 years who had background diabetic retinopathy no significant changes of function testing of the macula were revealed. The amplitude values were close to lower normal data.

Conclusions: Macular function in diabetic patients is mainly safe in spite of high levels of glycosylated haemoglobin. The complexity of pathogenetic mechanisms of diabetic retinopathy along with functional tests is still the subject of an investigation.
Definition & classification of dry eye
Authors: BRON AJ
Published: October 2007

Purpose: To provide a contemporary definition and comprehensive classification of dry eye disease.

Methods: A literature search and a consensus process involving members of the Definition and Classification subcommittee and the DEWS membership.

Results: A new definition of dry eye was developed, reflecting the current understanding of dry eye disease. The committee recommended a three part classification comprising i. Aetiology ‐ accommodating the multiple causes of dry eye, ii. Mechanism, indicating how the several causes of dry eye may act through a common pathway, and, iii. Severity, offering a rational basis for therapy in an individual case. In the course of discussions certain principles were established, such that ocular surface health is maintained by a functional unit whose integrity is essential for surface homeostasis. Interruption of the regulatory feedback loops, for instance by reducing the sensory drive to lacrimal secretion, is a potential risk factor for dry eye. Further, it was stressed, that any form of dry eye may interact with and exacerbate any other forms of dry eye, as part of a vicious circle, and that, in time, a change in tissue reactivity may be established leading to a disease which is self‐perpetuating in the absence of its original trigger.

Conclusions: The guidelines presented are not intended to override the clinical assessment and judgment of an expert clinician but should prove helpful in the conduct of in clinical practice and research.
Management & therapy
Authors: LEMP MA
Published: October 2007

Purpose: The members of the Management and Therapy Subcommittee assessed current dry eye therapies.

Methods: Each member wrote a succinct level of evidence‐based review on an assigned aspect of the topic, and the final report was written after review by and with consensus of all subcommittee members and the entire DEWS membership. In addition to its own review of the literature, the Subcommittee reviewed the Dry Eye Preferred Practice patterns of the American Academy of Ophthalmology and the International Task Force (ITF) Delphi Panel on dry eye disease.

Results: The Subcommittee favored the approach taken by the ITF, whose recommended treatments were based on level of disease severity.

Conclusions: The recommendations of the Subcommittee are based on a modification of the ITF severity grading scheme, and suggested treatments were chosen from a menu of therapies for which convincing evidence of therapeutic effect had been presented.
Ocular response analyzer findings in keratoconic eyes undergoing Cross Linking procedure
Authors: ALBE E , VINCIGUERRA P , ROSETTA P
Published: October 2007

Purpose: To evaluate the effect of corneal collagen Cross Linking on IOP, corneal hysteresis (CH) and corneal resistance factor (CRF) using the Ocular Response Analyzer.

Methods: 20 keratoconic eyes underwent cross linking procedure after epithelium removal.

Eyes were studied by means of Ocular Response Analyzer before cross linking, after epithelium removale, after cross linking and at 3 months follow up. IOPcc, IOPg, CH and CRF were analyzed.

Results: At 3 months follow up mean IOPcc was found to be 15,78 mmHg, significantly higher than the mean IOPg, which was found to be 11,13 mmHg. Corneal Resistance Factor and Corneal Hysteresis were found to be significathly low after epithelium removal and higher than the preoperative value after cross Linking procedure.

Conclusions: The device allows us to study corneal biomechanical properties before and after cross linking and to follow over time the effect of corneal photodynamic therapy in strengthening the stromal collagen fibrillae.
Circadian rhythm of intraocular pressure in healthy subjects and glaucoma patients
Authors: ROMANET JP , PALOMBI K , NOEL C , CHIQUET C
Published: October 2007

Purpose: Intraocular pressure (IOP) varies and depends on many factors. Intraocular pressure variations throughout the nycthemeron (the full 24‐period of a night and a day) are the most interesting for studying.

Methods: With present techniques, it is impossible to measure continuously without waking the subject up. Thus, IOP must be hourly measured during 24 hours with a portable tonometer which allows short measurements in any posture, without requiring the subjects or patients to rise during the night.

Results: Intraocular pressure depends on a nyctohemeral rhythm, being higher at night than during the day in healthy subjects, with a nocturnal peak value (acrophase). In the same normal individual, several 24‐hour monitorings are identical. Each individual has his own 24‐hour pattern of IOP.

In glaucoma patients, however, the 24‐hour rhythm of IOP was reversed, with values being higher during the day (a midday peak in IOP) than during the night.

Conclusions: The time course of the nyctohemeral curve of intraocular pressure is considered to play a role in the prognosis of glaucoma and allows to classify the type of glaucoma (POAG, NTG). Lowering of IOP is still the only option that is available for treating patients with glaucoma. Variations encountered in the individual’s nyctohemeral IOP pattern must be taken into consideration to manage the most efficient treatment.
The relevance of nocturnal dip of diastolic blood pressure and the perfusion pressure of the optic nerve to glaucomatous disease progression
Authors: COLLIGNON N , COLLIGNON J
Published: October 2007

Purpose: Although age, genetics and intraocular pressure (IOP) help to define the risk of glaucoma progression, there also exists glaucoma in which the pathogenesis is mainly the results of vascular disorders. To investigate the combined IOP and arterial pressure fluctuations risk factors for the glaucoma disease progression.

Methods: The 24‐hour ambulatory blood pressure and round‐the‐clock curve of the intraocular pressure were recorded in seventy patients : 51 primary open angle glaucoma (POAG) and 19 normal tension glaucoma (NTG). The mean systolic (SBP), diastolic blood pressure (DBP) and diastolic ocular perfusion pressure (DOPP ; DOPP=DBP‐IOP) were calculated along with the nocturnal dip of systolic pressure and diastolic blood pressure. Two‐years disease progression were assessed for all patients by means of retrospective analysis of visual fields defects on repeated perimetries. We performed statistical analyses on the readings to study the relative risk of the disease progression

Results: Abnormal (absence or increased) nocturnal dip of the diastolic blood pressure, large IOP fluctuations, circadian DOPP fluctuations were significantly associated with disease progression in POAG and NTG patients whereas no significant correlation was found for the others risks factors envisaged (i.e.,myopia,heredity,vasospasm,..).

Conclusions: Circadian DOPP fluctuations was the most significant clinical risk factor for the glaucoma disease progression. Our data are in line with several population‐based epidemiologic studies that will be presented during the talk.

By monitoring this DOPP that does not require either sophisticated or invasive investigations, it would be wise to take this factor into account in the clinical evaluation of our glaucoma patients
Which glaucoma treatments best flatten the IOP fluctuations?
Authors: ORZALESI N , FOGAGNOLO P
Published: October 2007

Conclusions: Intraocular pressure (IOP) is the major risk factor for glaucoma and its progression. Since the beginning of its medical treatment, reducing IOP has been the only way of treating the majority of glaucoma cases.

The role of IOP fluctuations as an independent risk factor for glaucoma progression is controversial, even if data on the beneficial effect of a stable circadian IOP control have accumulated in the recent literature. The circadian evaluation of IOP is therefore an useful complement of the appropriate diagnosis and follow‐up of glaucoma.

After many years of medical treatment of glaucoma based almost exclusively on the effect of beta‐blockers in reducing the production of aqueous humour, other molecules with different mechanisms of action and pharmacodynamics have been introduced in large number.

In most cases, different classes of drugs are characterized by different duration of their effect, with variable timing of peaks and troughs and, as a consequence, different dosage. Moreover, some drugs may show reduced efficacy during the 24 hours, as is the case for beta‐blockers during the night. Taking this into consideration may help to control IOP fluctuations, thus improving the control of glaucoma and reducing progression. Combining different drugs with different mechanisms of action may add further advantages.

The aim of the presentation will be to review recent studies aimed at evaluating the role of medical, laser and surgical treatments in the control of IOP fluctuations in glaucoma patients.
Radiologic pitfalls in neuro‐ophthalmology
Authors: MILEA D
Published: October 2007

Purpose: Although standard neuro‐imaging methods have a major contribution to appropriate diagnosis in neuro‐ophthalmology, they do not represent «one size fits all» procedures. Structural lesions can sometimes escape detection, mainly because of suboptimal clinical information for the radiologists.

Methods: This presentation will illustrate some common errors in prescription or interpretation of neuroimaging in neuro‐ophthalmology.

Results: Several protocols are used by each center depending on the explored pathology (multiple sclerosis, aneurysms, carotid dissection) or the anatomical location of the condition (orbit, cavernous sinus, sella, etc). When an MRI is indicated, application of intravenous contrast is not routine, especially if the expected lesion is supposed to be large enough. Contrast injection may be mandatory for detection of small lesions, even though this increases study acquisition time and is more expensive. Fat suppression is critical for detection of small lesions located in areas containing fat, such as orbits, or neck. Multiple, thin, coronal images are very useful for visualization of the chiasm, cavernous sinus and the possible sourounding compressive structures (i.e. pituitary adenoma, small meningioma). Specially dedicated sequences explore the white matter in multiple sclerosis or can find abnormalities in early ischemic events, while standard MRI can overlook these lesions. One can not perform all these protocols in every patient, the choice being dependent on the clinical information, the technical availability and the local expertise.

Conclusions: Appropriate neuro‐imaging can result only from clear, informative clinical indications about symptoms with localizing value, whenever possible.
Topical 5‐fluorouracil treatment and topical interferon alpha‐2b treatment for conjunctival epithelial malignant lesions
Authors: MIDENA E
Published: October 2007

Purpose: To review the indications and limits of topical chemotherapy with 5 Fluorouracil (5 FU) and topical interferon alpha‐2b (INF) in the treatment of squamous cell neoplasia of the ocular surface.

Methods: The Author reports the data of his long term prospective studies where 5‐FU (or INF) wrere applied as primary or adjuvant therapy in the treatment of squamous cell tumors of the conjunctiva. Clinical, cytological and more recently confocal microscopy data are presented and critically analyzed.

Results: 5 FU represents the first choice topical chemotherapy for squamous cell tumors of the conjunctiva (including the entire spectrum of this disease) as sole treatment (in multifocal tumors, recurrent neoplasia or selected cases) or adjuvant treatment (following surgery and reconstruction with amniotic membrane). INF may be also used, when tumors are less agggressive

Conclusions: Topical chemotherapy is becoming the standard in the intergrated therapeutic approach to conjunctival squamous cell tumors, limiting the indications for more aggressive therapies (radiotherapy).
A rare case – a diagnostic challenge
Authors: PRAUSE JU
Published: October 2007

Purpose: To present a rare tumour of the optic nerve, and to present the clinical differential diagnostic aspects.

Methods: Case story, clinical and histopathological presentation.

A 3‐year‐old boy with a few weeks of nausea, orbital edema and proptosis. Imaging and clinical findings indicated optic nerve glioma. Surgical removal of the tumour and subsequent histopathological analysis were performed. Due to regrowth of remaining tumour, orbital exenteration was performed half a year later. Histopathological analysis of the exenteration material demonstrated change in tumour morphology.

Results: The tumour was a medulloepithelioma with benign morphology and a MIB‐1 count below 5 %.

The regrowth demonstrated a malignant transformation with a MIB‐1 count close to 100 %.

This is the 8th documented medulloepithelioma of the optic nerve.

All eight cases had the presurgical diagnosis of optic nerve glioma. All behaved malignant.

Conclusions: Medulloepithelioma of the optic nerve is a rare tumour, however, the malignant course and the possibility to cure the patient, indicates that medulloepithelioma is an important differential diagnosis in optic nerve lesions.
MMPs in glaucoma
Authors: SCHLOETZER SCHREHARDT U
Published: October 2007

Purpose: Extracellular matrix turnover is mediated by matrix metalloproteinases (MMPs), a large family of endopeptidases with variable substrate spectra. The activity of these enzymes is regulated in part by specific endogenous inhibitors, the tissue inhibitors of metalloproteinases (TIMPs). Dysregulated expression of MMPs and TIMPs has been implicated in many ocular disease processes accompanied by abnormal matrix production including glaucoma. The purpose of this review is to highlight recent insights into the roles of MMPs and TIMPs in the regulation of aqueous humor outflow and retinal ganglion cell death in chronic open‐angle glaucoma.

Methods: Basic research and review of the literature.

Results: MMPs have been shown to affect matrix remodeling and outflow resistance in the trabecular meshwork, and to influence ganglion cell fate by matrix remodelling and glutamate receptor processing in the retina. Several current glaucoma therapies including topical prostaglandin analogues and laser trabeculoplasty have been shown to induce MMP activation in the outflow pathways. Changes in the expression of MMPs and TIMPs have been also shown to be involved in conjunctival wound healing after glaucoma filtration surgery.

Conclusions: Modulation of MMP activity may provide an attractive adjunctive treatment option to improve outflow facility, to attenuate retinal ganglion cell loss, and to reduce conjunctival scarring in glaucoma patients.
Photophobia in inherited retinal disease
Authors: LEROY BP
Published: October 2007

Purpose: To describe the phenotypes and genotypes of genetically determined photophobia.

Methods: A case presentation format will be used to illustrate different genetically determined conditions leading to photophobia. Both clinical and electrophysiological phenotypes as well as genotypes will be discussed.

Results: Phenotypes and genotypes of genetically determined diseases leading to photophobia are very different. An important distinction to be made is the one between stationary and progressive diseases. Indeed, such distinction is important as the visual outcome may differ considerably between different conditions.

Conclusions: Genetically determined photophobia is diverse. Visual electrophysiology allows an important distinction between progressive and stationary conditions.
Optical coherence tomography of the choroid at 1050nm
Authors: UNTERHUBER A , POVAZAY B , HERMANN B , HOFER B , SATTMANN H , DREXLER W
Published: October 2007

Purpose: Optical coherence tomography is a well established imaging modality for the retina at 800 nm, but is limited in its capability to visualize through scattering tissue, like through cataract or into the choroid.

Methods: Utilizing the lower scattering at longer wavelengths (1050 nm) high speed (>17 kHz), high axial resolution (~7 μm) optical coherence tomography (OCT) demonstrates its abil‐ity to exploit the three dimensional anatomic microstructure of the choroid. Volumetric images, obtained with spectrometer based frequency domain OCT system are presented and compared with their counterparts acquired at the commonly used 800 nm range.

Results: Tomograms of normals and patients with pathologic morphological changes of the retinal structure as well as with cataract depict improved signal strength and image contrast at the longer wavelength. The deeper penetration allows reconstruction of the choroidal vascular structure despite strong scattering of superficial tissues at the retinal pigment epithelium, the choriocapillaris also including pathologic retinal thickening. Visualisation of modifications in the choroidal vascular structure associated with wet age related macu‐lar degeneration or diabetic retinopathy indicate the diagnostic potential of this technique. Furthermore, being well outside the spectral sensitivity of the eye the wavelength band at 1050 nm also allows for depth resolved profiling of reflectivity changes to directly moni‐tor light stimulus related retinal activity, without interference due to the sampling OCT beam.

Conclusions: Imaging at 1050 nm enables not only to track morphological but also functional changes of the retina.
The role of the Femtosecond (FS) laser in lamellar keratoplasty
Authors: NUYTS RMMA , CHENG YY , PELS E ,   THE DUTCH LAMELLAR CORNEAL TRANSPLANTATION STUDY GROUP
Published: October 2007

Purpose: To evaluate the safety and feasibility of the FS laser for the preparation of posterior lamellar discs and to evaluate the first clinical results of a new technique – Femtosecond Laser Descemet Stripping Endothelial Keratoplasty (FS‐DSEK) – for surgical treatment of corneal diseases.

Setting: Department of Ophthalmology, Academic Hospital, Maastricht, The Netherlands. Cornea Bank, Amsterdam, The Netherlands. University Medical Center, Groningen, The Netherlands. University Medical Center St. Radboud, Nijmegen, The Netherlands, Eye Hospital Rotterdam.

Methods: A 30 kHz FS laser (IntraLase Corp., Irvine, CA) was used to prepare a lamellar cut in the cornea of human donor eyes. After FS laser preparation of a 9.5 mm wide lamellar cut at a depth of 400 micron, the corneoscleral button was stored in organ culture medium. The endothelial viability was assessed after preparation of the lamellar cut and after dissection of the donor posterior lamellar disc (PLD) from the anterior cornea. In ten eyes of ten patients with pseudophakic bullous keratopathy the PLDs were used for endothelial keratoplasty. The follow‐up ranged from 13 to 26 weeks.

Results: The mean±sd endothelial cell loss after FS preparation of the lamellar cut (n=4) was 3.4%±3.5% and after dissection of the posterior lamellar disc (n=5) was 6.5%±3.2%. There was no significant difference in endothelial cell loss between FS and non‐FS laser treated corneas after organ culture (p=0.46).

All eyes had a clear graft with functioning endothelium. In 4 eyes BCVA was 20/40 to 20/50. In the other 6 eyes BCVA ranged from 20/200 to 20/40 and 5/6 eyes had pre‐existing maculopathy. The surgically induced astigmatism was 2.1 D. Longer‐term results will be presented to assess graft clarity and visual outcomes in the other eyes.

Conclusions: FS laser preparation of posterior lamellar discs is safe and feasible for performing FS‐DSEK. We believe that FS‐DSEK offers a great potential for facilitating endothelial keratoplasty in a more standardized, automated fashion. Longer‐term follow‐up will be necessary to assess final corneal graft clarity and visual outcome.
Overview of the lacrimal stents
Authors: JAVDANI Z , VALVANIS A , SALU C , LACHMUND U , WILHELM K
Published: October 2007

Purpose: Evaluation of the clinical usefulness CV balloon‐expandable stent for maintenance of the opened (post‐surgical) or dilated nasolacrimal duct.

Methods: Under local anesthesia, injection of contrast for visualisation of the obstruction and fluoroscopic guidance placement of the CV balloon‐expandable stent

Results: Complications of the existing stents are as follows: concerning expandable metallic double stents(Song, 1993), where implanted under fluoroscopic guidance with severe epiphora after failed balloon dacryocystoplasty. During follow‐up of 4‐20 weeks complete blockage of the stent occurred in one of seven patients. Concerning Plastic stents (Song ,1994) 19 eyes ‐ 79% complete resolution and 21% partial resolution of epiphora. Concerning Polyurethane stent, cause of failure was normal physiological reaction to foreign body, namely post‐intervention infection, inflammation and fibrosis following obstruction (complete or partial), prolapse, occlude stents and stent malpositioning.

Technical problems and complications during negotiation of the guidewire, the guidewire create a false passage, improperly positioned or partial outside the nasolacrimal system.

Conclusions: Treatment of nasolacrimal stenosis with CV balloon‐expandable stents can be a solution for a higher percentage of success and less complications due to the biocompatibility of the material and design. Also it obtains antifibrotic material (will have much less inflammation, infection, and following obstruction) that release and prevent the fibrosis and indirectly the obstruction and blockage of the lacrimal duct.

CV expandable metallic stents seem to be of value in the treatment of the complete or partial obstruction of the nasolacrimal duct
Riboflavin/Ultraviolet a corneal collagen Cross‐Linking: one‐year results
Authors: ROSETTA P , VINCIGUERRA P , ALBE E
Published: October 2007

Purpose: To evaluate one‐year results of riboflavin/ultraviolet A corneal collagen Cross‐Linking (CL) in 28 eyes with progressive keratoconus.

Methods: Refraction, visual acuity, pachymetry, corneal topography and wavefront analysis were evaluated preoperatively and at one year after CL.

Results: At year one, topographic and subjective astigmatism decreased, respctively from 4.76D to 4.44D and from 3.03 to 2.91D. Wavefront analysis showed coma reduction form 0.90 to 0.76μm. UCVA increased from 0.15 to 0.25 and BSCVA from 0.45 to 0.65. Cone area, cone diameter , apical keratometry and curvature gradient remained stable.

Conclusions: Collagen CL appears to be a safe procedure to stabilize keratoconus and to reduce aberrometric comatic component.
The development of psychiatric disease in young adults who had childhood strabismus
Authors: MOHNEY BG
Published: October 2007

Purpose: Although adverse psychosocial effects are common in patients afflicted with strabismus, no study has shown an association of strabismus and mental illness. We investigated the prevalence and types of psychiatric disorders diagnosed by early adulthood among patients who had strabismus as children.

Methods: The medical records of all children (< 19 years) diagnosed with esotropia (n=266) or exotropia (n=141) as residents of Olmsted County, Minnesota from January 1, 1985, through December 31, 1994, were retrospectively reviewed for the diagnoses of psychiatric disease. Each case was compared with a randomly selected one‐to‐one birth‐ and gender‐matched control from the same population.

Results: A mental health disorder was diagnosed in 181 (44.5%) of the 407 patients with a history of childhood strabismus followed to a mean of 17.4 years compared to 135 (33.2%) of controls (P=0.0012). Children with exotropia were 2.9 (CI: 1.8‐4.7) times more likely to develop a psychiatric disorder than controls when followed to a mean of 20.3 years. Esotropic children were no more likely to develop mental illness than controls when followed for a similar duration. Patients with intermittent exotropia were also significantly more likely to have a greater number of mental health disorders, mental health emergency room visits or hospitalizations, and suicidal or homicidal ideation.

Conclusions: Children with exotropia, unlike those with esotropia, are at an increased risk for developing mental illness by early adulthood. Children with intermittent exotropia appear to be particularly prone to developing significant psychiatric disease by the third decade of life.
Age‐related cataracts in a German population‐based study (KORA S4)
Authors: GRAW J , KLOPP N , ILLIG T , GIEGER C , WELZL G , LöWEL H , ZAHLMANN G , HOLLE R , WICHMANN HE
Published: October 2007

Purpose: The population‐based study in the region of Augsburg (Germany), KORA, is used to evaluate cataract prevalence.

Methods: 2.796 randomly selected probands were asked in a standardized interview for the presence of cataracts. A set of SNPs of functional candidate genes was tested for association.

Results: 115 probands reported cataracts (4.1%); 13 of them suffered also from glaucoma and are excluded from the further analysis. The prevalence increases from 0.9% (<55 years) to 4.9% (55‐64 years) and 12.6% (65‐74 years); there was no sex effect observed. After adjustment for age, there was no significant association between cataract and blood pressure, diabetes, smoking, body mass index and alcohol consumption.

Additionally, we investigated the hypothesis that the age‐related formation of cataracts might be associated with SNPs in genes, which have been shown previously to be involved in hereditary cataracts. Among 14 SNPs tested, one polymorphic site in the CRYGD gene showed statistically significant association with cataracts (Odds ratio 1.97; p=0.033).

Conclusions: Our data set could not confirm the major risk factors for age‐related cataracts, which might be due to the small numbers of cataracts. Nevertheless, even in the small sample size, an association to a well‐known cataract‐causing gene has been observed, which needs to be confirmed in independent studies.
The ocular and systemic factors associated with diabetes mellitus in the Beijing eye study
Authors: LIBONDI T , XU L , XIE X , WANG Y , JONAS JB
Published: October 2007

Purpose: To determine the ocular and systemic factors wich are associated with diabetes mellitus in the adult population in rural and urban China

Methods: The Beijing Eye Study, a population‐based, cross‐sectional cohort study was repeated in 2006, with 3251 aged 40+ years subjects participating. Blood samples were available for 2773 (85.3%) subjects. All participants underwent an ophthalmic examination, anthropometric measurements and blood biochemical analyses. Diabetes mellitus was defined by a fasting plasma glucose concentration ≥7.0 mmol/L or by a self‐reported history diagnosis of diabetes.

Results: By the criteria above defined, 334 subjects were diabetic (prevalence rate: 12.04%). In binary regression analysis, presence of diabetes mellitus was significantly associated with higher age, body mass index, systolic blood pressure, triglyceride concentrations, and intraocular pressure, and lower high‐density lipoprotein level and diastolic blood pressure. Diabetes mellitus was not statistically associated with the degree of cortical or and subcapsular cataract, size of the optic disc, neuroretinal rim and alpha zone and beta zone of peripapillary atrophy, retinal vessels diameters or abnormalities, retinal microvascular abnormalities, refractive error, and prevalence of glaucoma and early or late stage of age‐related macular degeneration.

Conclusions: In this population‐based setting, diabetes mellitus is not associated with optic disc, rim and peripapillary atrophy measurements, retinal vessel diameters and microvascular abnormalities, and prevalence of age‐related macular degeneration. Although diabetes mellitus is significantly correlated with higher intraocular pressure, it is not associated with glaucoma.
Macular abnormalities and the Rarebit Fovea Test
Authors: MARTIN L , NILSSON M , WANGER P
Published: October 2007

Purpose: To describe Rarebit Fovea Test (RFT) findings in healthy subjects with normal best corrected visual acuity (BCVA) and macular abnormalities, observed in fundus photographs

Methods: Forty‐two healthy subjects, mean age 40 years (SD 10), were recruited as controls in a previous study. Selection criteria were BCVA ≥ 1.0, refractive error within +/‐ 6 D, no ophthalmic or systemic disease. Reported here are RFT and fundus photography findings, and retinal thickness measurement values using optical coherence tomography (Stratus OCT, Carl Zeiss Meditec Int.).

Results: Fifteen of the 42 subjects had visible macular changes in the fundus photographs; 10 had drusen and 5 pigment epithelium defects. Mean RFT mean hit rate (MHR) was 99+/‐2%. Two subjects had MHR 91% and 96%, respectively, i.e. below the pre‐defined limit for normality (97%). The subject with a MHR of 91% had drusen, the one with 96% had normal fundus. OCT values were within normal limits in all subjects (center zone mean 212.41 μm, SD 19.35, range 166‐257, inner perifoveal zone mean 238.99 SD 13.34, range 258.3‐308.5 and outer perifoveal zone 241.53 SD 11.54, range 218‐267.8). In the subject with RFT MHR 91% corresponding values were 228 μm, 288.5μm and 249.3 μm and in the subject with RFT MHT 96% 211μm, 279.8μm and 231.8μm, respectively, well inside the normal range.

Conclusions: The Rarebit Fovea Test may be useful for discriminating between age‐related macular changes with and without detrimental effects on visual function.
Comparative analysis of donor derived, gene modified dendritic cells in keratoplasty
Authors: PLEYER U , SCHLICKEISER S , LI XQ , RITTER T , SAWITZKI B
Published: October 2007

Purpose: Dendritic cells (DCs) play an essential role during the initiation of immune responses against non‐self antigens. Following organ transplantation, activated donor‐ and recipient‐derived DCs participate actively in graft rejection by sensitising recipient T cells. There is increasing evidence that immature DCs induce antigen‐specific unresponsiveness to self antigens in central lymphoid tissue and in the periphery through different mechanisms.

Methods: In this study, we compared the immunoregulatory properties of CTLA4‐Ig and vIL‐10 secreting DC in a high responder corneal transplantation model (BALB/c; H‐2d into C57BL/6; H‐2b). Both the in vitro and in vivo immune response to this approach were monitored.

Results: Transduction of DC with AdCTLA4‐Ig prior to LPS stimulation dramatically diminished their allostimulatory capacity in vitro, as demonstrated by an inhibition of proliferation of cocultured allogeneic T cells. Compared to controls, AdvIL‐10 transduced DC also showed a significant decrease in their ability to activate T cells. Whereas adoptive transfer of CTLA4‐Ig transduced DC could not prolong the mean survival time (MST) (MST= 9.7 ± 3.9 days, p = 0.45, n = 6), vIL‐10 expressing DC significantly prolonged corneal allograft survival (MST = 13.4 ± 5.0 days, p = 0.019, n = 7) as compared to controls (MST = 8.3 ± 2.6 days, n = 7).

Conclusions: Whereas adoptive transfer of CTLA4‐Ig transduced DC could not prolong the mean survival time (MST) (MST= 9.7 ± 3.9 days, p = 0.45, n = 6), vIL‐10 expressing DC significantly prolonged corneal allograft survival (MST = 13.4 ± 5.0 days, p = 0.019, n = 7) as compared to controls (MST = 8.3 ± 2.6 days, n = 7).
Differrence in laser treatment decisions for diabetic macular edema, based on biomicroscopy or OCT
Authors: VERBRAAK FD , VAN DIJK HW , KOK PHB , SCHLINGEMANN RO , ABRAMOFF MD
Published: October 2007

Purpose: Comparison between laser treatment decisions for diabetic clinical significant macular edema (CSME) diagnosed by slitlamp biomicroscopy or OCT (Stratus)

Methods: Diabetic patients (n=25) with a clinical suspicion of the presence of clinical significant macular edema (CSME) were examined by stereo slitlamp biomicroscopy and OCT for the exact location and extend of CSME. Results of these observations were drawn into a set of FA images (early / mid / late phase). Independent observers made decisions regarding lasertreatment (position, pattern, and number of laserspots) based on these images.

Results: The diagnosis of CSME differed between the two methods in 11 of the patients. Treatment decisions based on these different observations differed with respect to the amount and localisation of the laserspots.

Conclusions: A diagnosis of CSME in diabetic patients differs comparing slitlamp biomicroscopy with OCT, and treatment decisions based on either method likewise differed.
Erythropoeitin (epo) and the survival of retinal cells in diabetic retinopathy
Authors: DE SOUZA RAMALHO P , PEREIRA DA SILVA A , BICHO MP
Published: October 2007

Purpose: Purpose:EPO is approved drug for anaemia treatment. Its antiapoptotic effects in animal models of glaucoma and retinal degeneration, when administered systemic or intravitreous are known. It provides neuroprotection and avoids cell damage in diabetic rats. It is upregulated in the retina in proliferative diabetic retinopathy (PDR). We studied serum EPO expression in diabetics and in normal non diabetic controls.

Methods: Methods:In 58 type 2 diabetics, 24 with and 34 without retinopathy, of both sexes aged 64.24±11.64 years, EPO serum expression was determined by ELISA and compared to 44 non diabetic controls age and sex matched. Statistical analyses was applied (Χ2, Student t test).

Results: Results:Serum EPO expression was highest in diabetics with retinopathy (15.15±11.44 mIu/ml, high in diabetics without retinopathy, 10.084±6.63 p=0.043), compared to the controls 9.47±6.57.

Conclusions: Conclusions:EPO serum upregulation in diabetic retinopathy supports endogenous over production seen in the retina with PDR. High EPO expression could be an attempt of nature’s protective mechanism. Human recombinant EPO is known to protect retinal neurones in various animal models of stress: ischemia/reperfusion/ocular hypertension/glaucoma (rats, mice, rabbits). EPO administration to RCS rats appears to exert (in vivo) neuroprotective effect on the photoreceptors. HrEPO may be necessary to protect the damage of retinal tissue in diabetics. Constitutional EPO seems to be insufficient to give effective protection in diabetic retinopathy. Thus EPO could be an important therapeutic target molecule for the survival of damaging retinal cells.
Reproducibility of OCT in choroidal neovascularization secondary to ARMD
Authors: MENCHINI F , PARRAVANO C , ROMAN POGNUZ D , MORGANTE L , VARANO M , BANDELLO F
Published: October 2007

Purpose: Optical coherence tomography (OCT) is commonly used to quantitatively measure macular thickness in several macular diseases, especially in conditions associated with macular vascular leakage such as diabetic macular edema (DME) and choroidal neovascularization (CNV). Several studies reported good reproducibility of commercially available Time Domain OCTs. Few studies have investigated the role of OCT in the diagnosis and management of CNV. These studies involve relatively small numbers of patients. To date no proper reproducibility studies has been conducted in exudative AMD. With the increasing importance of OCT in patient care and the common use of OCT as a key outcome measure in recent clinical trials of exudative AMD, it is important to determine the reproducibility of OCT measures in a large population of patients with CNV.

Methods: In the current study, we report the reproducibility of retinal thickness measurements made with the Zeiss OCT3 in 100 patients with exudative AMD. Reproducibility is assessed for retinal thickness in the central subfield, center point thickness (measured using the automatic software algorithm), and foveal thickness measured manually. Furthermore particular changes in retinal morphology, such as cystoid abnormality, subretinal fluid, or presence of pigment epithelial detachment are analysed.

These findings will be compared with the currently available litterature
The basics of wavefront aberrometry
Authors: LANGMAN ME , DIGHIERO PL , GICQUEL JJ
Published: October 2007

Wavefront technology has been first used by astronomers for years in order to reduce higher order aberrations induced by the earth’s atmosphere, it has been introduced into clinical eye care recently.

Ophthalmological practice involves performing a full subjective refraction. The sphere, cylinder and axis of astigmatism are measured. We are only correcting two components of a whole host of refractive components of the optics of an eye. These two components (sphere and cylinder) constitute by far the majority of the optical aberration of an eye.

Even a basic exam yields important information about optical quality. However, all ophthalmologists have been faced with patients reporting visual acuity (or contrast sensitivity, glare, etc.) at levels much lower than would be expected from an eye exam.

Wavefront aberrometry measures aberrations over the entire eye taking into account not only spherocylindrical refractive error, but also spherical aberration, trefoil, coma, secondary astigmatism as well as other “higher order” aberrations described by Zernike polynomials. Higher order aberrations are thought to contribute to more than 20% of the total number of aberrations in a normal eye an increase with pupil size. In the majority of normal patients, these high order aberrations play a minor role, however, in cases of refractive surgery, keratoconus and orthokeratology, they can induce a number of visual disturbances.

We will define higher‐order aberrations and show how to measure them, giving you a basic working knowledge of wavefront sensing (also known as aberrometry).

We will show how wavefront sensors work, what are Zernike polynomials, what they tell us and we will show present and future clinical applications of wavefront aberrometry.
Effects of bevacizumab on HUVEC migration and capillary formation
Authors: FALCAO M , SOARES R , AZEVEDO I , FALCAO‐REIS F , CARNEIRO A
Published: October 2007

Purpose: Angiogenesis is required for retinal and choroidal neovascularization (CNV), main physiopathological causes of blindness in age‐related macular degeneration, diabetic retinopathy and retinopathy of prematurity. Angiogenesis is a complex process involving endothelial cell proliferation, migration and tubule formation. Recently, anti‐VEGF molecules (pegaptanib, bevacizumab and ranibizumab) have been used intravitreally to control CNV. The aim of the present study was to evaluate the short term in vitro effects of bevacizumab in human umbilical vein endothelial cells (HUVECs) migration and capillary‐like structures formation.

Methods: Cultures of HUVECs were established and treated during 24 h with bevacizumab (0.25 – 2.5mg/ml) diluted in culture medium. Controls were incubated with excipient solutions in identical volumes. HUVECs migration was evaluated using double‐chamber assay. The formation of capillary‐like structures was assessed in plates coated with growth factor reduced‐matrigel.

Results: Although bevacizumab at 0.25 mg/ml did not affect HUVECs migration, a significant inhibition was achieved whenever cells were incubated with 2.5 mg/ml (p< 0.05). The formation of capillary structures was prevented in the cultures treated with bevacizumab at both concentrations used in a dose dependent manner.

Conclusions: These findings indicate that bevacizumab may inhibit angiogenesis by acting on different cellular mechanisms including diminished endothelial cell migration and inhibition of the formation of new capillary‐like structures in a dose dependent manner.
Retrobulbar hemodynamics in normal tension glaucoma compared to anterior ischemic optic neuropathy
Authors: REMKY A , KAUP M , AREND KO , PLANGE N
Published: October 2007

Purpose: To compare flow velocities of the retrobulbar vessels in chronic vascular neuropathy in normal tension glaucoma (NTG) to those of acute circulatory disorder of anterior ischemic neuropathy (AION).

Methods: Fifty‐two patients with NTG (mean age: 66 ± 8 ys) and 50 patients with AION (mean age: 68 ± 10 ys) were included in the study. Blood flow velocities (peak systolic velocity PSV and end–diastolic velocity EDV) and resistive indices of the ophthalmic artery (OA), central retinal artery (CRA) and nasal and temporal posterior ciliary arteries were measured by means of colour Doppler imaging (CDI).

Results: No differences were detected for heart rate, diastolic arterial pressure and IOP between the two groups. In AION patients systolic arterial blood pressure was significantly higher compared to the NTG group (148 ± 26 mm Hg vs. 131 ± 18 mmHg, p = 0.0004). CDI revealed significant differences of the resistive index of the OA (RI AION: 0.80 ± 0.06; NTG: 0.76 ± 0.07). In AION, PSV of CRA was significantly lower compared to NTG (AION: 7.2 ± 1.9 cm/s; NTG 8.0 ± 1.6 cm/s).

Conclusions: The chronic vascular deficiency in NTG seems to be similar to that of the acute circulatory breakdown in AION. In both vascular disorders of the optic nerve only small differences of flow velocities may be detected by CDI.
Treatment of juxtapapillary choroidal melanoma
Authors: MISSOTTEN GS , NAUS NC , SCHALIJ‐DELFOS NE , LUYTEN GP
Published: October 2007

Purpose: To compare different treatment for juxtapapillary choroidal melanomas.

Methods: Retrospective study comparing recurrence, survival and complications in 14 patients treated with proton beam treatment, 11 patients treated with stereotactic radiotherapy and 28 patients treated with Ruthenium brachytherapy in combination with transpupillary thermotherapy.

Results: Mean follow‐up time was 45.3 months, in which 4 patients died due to their melanoma. There was a significant faster decrease of the tumour prominence in the Ruthenium group. Earlier radiation retinopathy (from 6 months onward) in the Ruthenium group, but no significant more radiation retinopathy after 5 years. The vision after 5 years was significant lower in the stereotactic radiotherapy group, but this was also due to the fact that there were more patients with a juxtapapillary melanoma on the macular side in this group.

Conclusions: A prospective randomised study is neaded to determine which therapy is best in treating juxtapapillary melanomas. In this retrospective study, there was no difference in local recurrence or survival in the 3 treatment groups.
Influence of bone marrow transplantation on the eye and psychopathology
Authors: KOUBA M , NEPP J , BERGER P , GREINIX H , KALHS P , FUNK M , MITTERBAUER M
Published: October 2007

Purpose: Introduction: Bone Marrow Transplantation because of Leukemia is followed by changes of the immunological system. Patients suffer from complaints of the disease and its consequences, like Graft versus host reactions. In ophthalmologic observations we often can asses chronic inflammations with dry eyes. Those are induced by stress reaction, any kind of inflammation and any kind of irritations.

Now we wanted to know, if there is a correlation of the ophthalmological changes, especially the dryness and the mental state, according to the bone marrow transplantation.

Methods: 26 patients were observed, 11 of them in a follow up after 100 days. For ocular evaluations slit lamp obeservation were done. Severeness of Dryness was defined by a Sicca‐Score, a mean of results of Schirmer‘s test, break up time, lipid layer thickness, and estimation of the tear meniscus. All results were equated. 0 for normal and 1 for worst possible result.

Psychiatric symptoms were assesed by the symptom check list 90R (Derogatis) at baseline and follow up. We compared the results before and 100 days after the transplantation. For statistical analysis students‐T‐test and the Pearson correlation by SPSS was used.

Results: There was a significant aggravation of the dryness in one eye; and there was a correlation in parts of the records between the dryness and the mental state.

Conclusions: Bone marrow transplantation is an event, which influences the immunological system, the tearing system and the mental state of health.
SITA‐SWAP in glaucoma diagnosis
Authors: MILANO G , BOSSOLESI L , MACERI C , COLOMBO M , BORDIN M , SERRA U
Published: October 2007

Purpose: The aim of the study is to verify the characteristics of the new algorithm SITA‐SWAP in glaucoma diagnosis.

Methods: 25 consecutive patients followed by the glaucoma service of the University Eye Clinic, Fondazione Policlinico San Matteo, were selected as glaucoma suspects on the basis of the outcomes of standard automated perimetry (SAP), Scanning Laser Polarimetry and Confocal Scanning Laser Ophthalmoscopy. Test duration and global indices MD (mean defect) and PSD (pattern standard deviation) of 24‐2 SITA‐SWAP were compared to the same data from 24‐2 SITA‐SAP (SS) and 24‐2 Full Threshold‐SWAP (FS). A questionnaire about individual tolerability, perception of test duration and fatigue connected to the different perimetric exams, was also submitted to each patient.

Results: SITA‐SWAP mean test duration was 3.56­±0.56, significantly less than FS (11.47±1.12) and SS (5.03±0.41).

The mean MD for SITA‐SWAP was ‐3.42±4.3, significantly different from SS (‐1.31±1.4) but not from FS (‐2.27±4.5), indicating the influence of lens opacities on blue light transmission. The mean PSD for SITA‐SWAP was 3.33±1.02, significantly different from SS (1.70±0.37) and from CPSD provided by FS (2.25±1.17), showing a promising sensitivity of SITA‐SWAP in pointing out localized defects. SITA‐SWAP was evaluated as shorter, easier to perform, better tolerated as compared to FS and shorter but more challenging as compared to SS by most of the patients.

Conclusions: SITA‐SWAP seems to be a rapid and easy perimetric test, able to help physician in glaucoma diagnosis. The blue light transmission through optic media is constantly influenced by their opacities.