bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective clinical study of a new intraocular lens with extended depth of focus: ISOPURE, 1 year follow‐up
Authors: Bradly Dounia , Dany Salik , Elie Motulsky
Published: January 2024

Aims/Purpose: Monofocal lenses are currently the most frequently implanted intraocular lenses (IOL). New implants with enhanced depth of focus (EDOF) could improve intermediate and near visions with uncompromised far visual acuity and limited dysphotopsia. The objective of this study is to compare Group 1 – a bilateral implantation of an EDOF IOL‐ Isopure® versus Group 2 – a bilateral monofocal IOL – Micropure® – (BVI, Belgium).

Methods: Eligible patients with bilateral cataracts were randomly assigned to two groups. Monocular, binocular, corrected, uncorrected, near, intermediate and far visions were measured before, 1 month and 1 year after surgery using ETDRS charts. A pre‐ and post‐operative questionnaire was realized to assess the impact of their vision on daily routine.

Results: One year after the surgery near median visions were respectively 0.22 ± 0.18 and 0.44 ± 0.10 LogMar (p‐value = 0.0515) while intermediate visions were −0.02 ± 0.12 and 0.14 ± 0.07 LogMar (p‐value = 0.0595). No significant difference was demonstrated in the binocular distance visual acuities, respectively −0.09 ± 0.14 and −0.12 ± 0.15 (p‐value = 1.00). The study revealed no significant difference regarding sensitivity of contrast and the defocus curve had a larger curve plate of good visual acuity in the Isopure® group. The questionnaire's analysis showed no significant difference between the groups.

Conclusions: Although no significant difference was demonstrated, this study suggests that with a larger patient sample, the Isopure® implant may provide better near and intermediate visual activity, since our p‐values are close to 0.05, with the same distance vision and no deterioration of the contrast sensitivity. This implant provides a daily visual comfort and the patients reported a better satisfaction, fewer dysphotopsias, less difficulties with daily activities and less dependence on their glasses.
Evaluation of pan‐epithelial viability in the whole porcine lens
Authors: Poinard Sylvain , Coulomb Louise , Cortez Oliver Dorado , Thomas Justin , He Zhiguo , Perrache Chantal , Ganeau Alice , Forest Fabien , Mascarelli Frederic , Gain Philippe , Thuret Gilles
Published: January 2024

Purpose: The lens has a monolayer of epithelial cells on its anterior surface that contributes to its homeostasis. A quantification of the viability of these cells is essential to evaluate the safety of new therapies targeting the lens (cataract, presbyopia). The observation of this whole tissue is made difficult by its optical properties (transparency and refraction) and only simplified models have been used until now to measure epithelial viability (primary cell cultures or partial surgical specimens).

Aims: To develop a method to quantify the viability of epithelial cells on whole ex vivo lenses.

Methods: Ten fresh pairs of 6‐month‐old porcine lens were retrieved from local slaughterhouse. For each pair, one lens was randomly selected to undergo a localized lesion and the other lens remained intact. The lesion was made on the anterior surface with a steel hexagonal rod (to make the mark easily identifiable) previously immersed in liquid nitrogen for one minute. Both lenses were incubated for 1 h at 20°C in a HEC mixture. Images were acquired with a macroscope and analysed with ImageJ. Calcein‐AM and Ethidium images were used to calculate the area covered by living epithelial cells. Hoescht images allowed to count cell nuclei per unit area. Viable epithelial cell density (vECD) was defined as the number of viable cells per unit area. The lenses were immersed (isotonic saline) inside a black container during the measurements to minimize reflections and refractive phenomena or drying of the samples.

Results: The vECD median on the ten pairs was 2840 cells/mm2 [10th‐90th percentiles = 2479–3494] for cryo‐applied lenses versus 3364 cells/mm2 [2919–3739] for healthy lenses (p = 0.002).

Conclusions: The triple HEC staining adapted to the whole lens provides an unrivalled measure of pan‐epithelial viability without the need for a tedious capsule dissection step that destroys the lens architecture. Other studies will be necessary to determine its ability to discriminate small variations or type of mortality.
A novel approach for measurement of retinal oxygen extraction based on laser speckle flowgraphy and retinal oximetry
Authors: Pai Viktoria , Lindner Theresa , Janku Patrick , Pylypenko Liudmyla , Hommer Anton , Schmetterer Leopold , Schmidl Doreen , Garhöfer Gerhard
Published: January 2024

Aims/Purpose: Several ocular diseases lead to a reduction in retinal oxygen metabolism. However, measurement of retinal oxygen extraction is mostly based on time‐consuming and custom‐built devices. Hence, the aim of this study is to assess retinal oxygen extraction based on measurement of retinal blood flow with the commercially available laser‐speckle flowgraphy (LSFG) and measurement of retinal oxygen saturation with the commercially available retinal oximetry.

Methods: Ten young healthy subjects participated in the present study. Retinal blood flow and retinal oxygen saturation were measured in each vessel around the optic disc at the same position. The corrected arterial (co2, CRA) and venous (co2, CRV) oxygen content was estimated from the parameters evaluated and the difference between these two determined parameters (co2, DIFF) was assessed. Retinal oxygen extraction was calculated using mean vessel flow rate (MV) and cO2, DIFF. To validate the novel approach, baseline measurement and measurement during inhalation of 100% oxygen were performed, as retinal oxygen extraction is known to decrease during hyperoxia.

Results: MV significantly decreased during 100% oxygen breathing (−23 ± 10%, p < 0.001). While cO2, CRA only slightly increased by 1 ± 2% (p = 0.093), cO2, CRV increased by 9 ± 14% (p = 0.050). Consequently, cO2, DIFF decreased by 10 ± 20% (p = 0.087). This led to a pronounced decrease in retinal oxygen extraction by −31 ± 18% during hyperoxia (p < 0.001).

Conclusions: During breathing of 100% oxygen a significant decrease in TRBF and retinal oxygen extraction was assessed. The decrease in retinal oxygen extraction during hyperoxia is consistent with findings in literature and is physiologically expected. Therefore, the novel approach for measurement of retinal oxygen extraction appears to be feasible. Larger studies in patient cohorts using this method should be conducted in the future.
Catapol might protect against retinal ischaemia by anti‐oxidation, anti‐ischaemia, Wnt pathway inhibition and VEGF downregulation
Authors: Chao Howard Wen‐Haur , Chao Hsiao‐Ming
Published: January 2024

Aims/Purpose: Retinal ischaemic disorders, including retinal vascular occlusion, age‐related macular degeneration and glaucoma, pose a threat to vision. This study examines the potential protective effects of catalpol against retinal ischaemia.

Methods: RGC‐5 cells were cultured in DMEM with 10% FBS, penicillin (100 U/mL) and streptomycin (100 mg/mL) at 37°C. Cell viability was assessed using the MTT assay. H2O2 (1 mM)/OGD induced oxidative stress and ischaemic‐like injury. Catalpol or vehicle was administered 15 min before the insult. Retinal ischaemia was induced in Wistar rat eyes by increasing intraocular pressure to 120 mmHg for 60 min, followed by reperfusion. Intravitreous injections of catalpol (0.5 or 0.25 mM), WNT inhibitor Dkk1 (1 μg/4 μL), anti‐VEGF lucentis (20 μg/2 μL), or anti‐VEGF eyelea (80 μg/4 μL) were given 1 day before or after retinal ischaemia. Effects were evaluated using electrophysiology, histopathology, immunohistochemistry, fluorogold retrograde labeling, and Western blotting.

Results: H2O2 (1 mM)/OGD significantly (p < 0.001) reduced RGC‐5 cell viability by inducing reactive oxygen species and ischaemic‐like insult. Pretreatment with catalpol (0.5 mM) dose‐dependently attenuated this oxidative/ischaemic‐like effect (p < 0.05), suggesting its antioxidative properties. Pre‐ischaemic treatment with catalpol (0.5 and 0.25 mM) dose‐dependently and significantly (p < 0.05; 0.5 mM) mitigated ischaemia‐induced reductions in ERG b‐wave amplitude and RGC cell number. Compared to eyes treated with DKK1, lucentis, or eyelea, catalpol appeared to protect against retinal ischaemia by downregulating WNT and VEGF expression (downstream).

Conclusions: Catalpol may provide protection against retinal ischaemia through antioxidation and anti‐ischaemic mechanisms by downregulating the upstream WNT pathway and downstream VEGF concentration.

References

1. Chao, et al. Ferulic acid, but not tetramethylpyrazine, significantly attenuates retinal ischaemia/reperfusion‐induced alterations by acting as a hydroxyl radical scavenger. J. Ocul. Pharm. Ther. 24:461–472, 2008.

2. Liu, et al. Baicalein significantly protects hRPE cells against H2O2‐induced oxidative stress by scavenging ROS and down‐regulating the expression of MMP9 and VEGF. J. Ocul. Pharm. Ther. 26:421–429, 2010.
Comparative effect of intravitreal faricimab versus aflibercept in a patient with diabetic macular oedema
Authors: Montero‐Moreno Javier , Diez‐Montero Cecilia , Sanchis‐Merino Maria Eugenia , Hernandez‐Fernandez Rosario , Cañibano‐Perez Elisabeth
Published: January 2024

Aims/Purpose: To report the changes in diabetic macular oedema (DME) and visual acuity (VA) in a single patient with bilateral DME treated with intravitreal 2 mg aflibercept (AFL) and 6 mg faricimab (FAR) in the context of a randomized clinical trial during 44 weeks.

Methods: Interventional case report within a clinical trial.

Results: A 57‐year‐old female patient entered a clinical trial to test the efficacy of FAR for DME. DME was present in both eyes. The left eye (LE) was randomized to masked treatment (which resulted to be 6 consecutive intravitreal FAR every 4 weeks followed by FAR every 8 weeks, totalling 8 injections). The RE received open label treatment with monthly AFL at baseline; and then every 4 weeks after Week 16, until Week 44, totalling 8 injections). Baseline best corrected VA was RE 50 letters and LE 64 letters; at Week 24, RE 46 and LE 62; and at Week 44, RE 46 and LE 76. Optical coherence tomography (OCT) revealed a progressive reduction of central macular thickness (CMT) as well as hard exudates and disorganization of retinal layers in both eyes. Angio OCT showed a progression of non‐perfused macular areas in both eyes; the anti‐vascular endothelial growth factor effect of the treatment induced a reduction in the severity of diabetic retinopathy in both eyes demonstrated by fluorescein angiography and colour fundus imaging.

Conclusions: Our results show that treatment with AFL and FAR in the eyes of the same patient may cause a similar reduction in CMT, even though a better visual outcome was observed in the eye treaded by FAR.
Acute zonal occult outer retinopathy as a luetic ocular manifestation
Authors: Sanchez Manuel Morales , Ortega Mª Mar Esteban , Lozano Carmen Isabel García , Hernandez Eduardo Conesa , Artola Ines , Pernas Sergio
Published: January 2024

Aims/Purpose: Based on a clinical case seen in our setting, the purpose of this communication is to describe a case of ocular syphilis with an uncommon initial manifestation as well as its clinical and imaging features, diagnosis, treatment and evolution.

Methods: We selected a case seen at the University Hospital Infanta Sofía in 2023. A 54‐year‐old male with Acquired Inmune Deficiency Syndrome (AIDS) under antiretroviral (ARV) treatment, diagnosed with cataract, who 1 month after surgery presented a paradoxical worsening of baseline visual acuity (VA) bilaterally accompanied by nyctalopia.

Results: During the exam, we found VA from right eye (RE) of 0.03 and from left eye (LE) of 0.03. Fundus examination showed a bilateral central vitreous organization. Macular OCT from both eyes showed preserved foveal profile with pachychoroid associated with patchy absence of external limiting membrane, evident focal loss of ellipsoid zone and cysts in outer layers of the RE. Campimetry with practically abolished fields, neuroimaging study, complete serology including antirecoverin antibodies, and vitreous sample for microbiology were performed. From this study, it was found that the patient had a positive luetic seroconversion within a maximum period of five years. With these data, we oriented the differential diagnosis of the described retinopathy towards an infectious or toxic aetiology due to ARV drugs as the most probable causes. The patient was treated with intravenous penicillin with great improvement of vision and nyctalopia.

Conclusions: Ocular syphilis is the great simulator par excellence and although infrequent, it can debut with atypical forms of uveitis.

References

1. Lima BR, Mandelcorn ED, Bakshi N, Nussenblatt RB, Sen HN. Syphilitic outer retinopathy. Ocul Immunol Inflamm 2014; 22: 4–8.

2. Dutta Majumder P, Chen EJ, Shah J, Ching Wen Ho D, Biswas J, See Yin L, et al. Ocular syphilis: an update. Ocular Immunology and Inflammation 2017; 1–9.

3. Roe RH, Jumper JM, Galino V, et al. Retinal pigment epitheliopathy macular telangectasias, and intraretinal crystal deposits in HIV‐positive patients receivingritonavir. Retina 2011; 31: 559–565.
Association between localized retinal nerve fibre layer defects and metabolic syndrome in nonglaucomatous eyes: A propensity score‐matched analysis
Authors: Jung Youn hea , Ohn Kyoung , Moon Jung Il
Published: January 2024

Aims/Purpose: To investigate the association between metabolic syndrome and localized retinal nerve fibre layer (RNFL) defects in nonglaucomatous subjects.

Methods: We examined 20 385 adults at the Health Promotion Center in Seoul St. Mary's Hospital between May 2015 and April 2016. Subjects with and without localized RNFL defects were 1:5 propensity score matched. Metabolic syndrome components, central obesity, elevated triglyceride, reduced HDL cholesterol, elevated blood pressure and elevated fasting glucose, were compared between two groups. Logistic regression was performed to investigate the association between RNFL defects and each metabolic syndrome component as well as the number of metabolic syndrome components.

Results: Subjects with RNFL defects showed higher waist to hip ratio, systolic and diastolic BP, fasting blood glucose and HbA1c compared to those without RNFL defects before and after propensity score matching. The number of metabolic syndrome components was significantly greater in those with RNFL defects (1.66 ± 1.35) compared to those without (1.27 ± 1.32, p < 0.01). In multivariate logistic regression, the odds of RNFL defects were significantly increased in subjects with central obesity (OR = 1.53, 95% confidence interval [CI] = 1.11–2.13), elevated blood pressure (OR = 1.50, 95% CI = 1.09–2.05), and elevated fasting glucose (OR = 1.42, 95% CI = 1.03–1.97). Greater number of metabolic syndrome components was associated with higher odds of RNFL defects.

Conclusions: The presence of localized RNFL defects in nonglaucomatous subjects is associated with metabolic syndrome components, including central obesity, elevated BP and elevated fasting glucose, suggesting that comorbid metabolic syndromes should be considered when evaluating subjects with RNFL defects.
Secondary full thickness macular holes following vitrectomy for rhegmatogenous retinal detachment: Clinical data, surgical outcome and prognosis
Authors: Schöneberger Verena , Jonas Rahul , Menghesha Leonie , Brockmann Claudia , Krohne Tim , Cursiefen Claus , Fuchsluger Thomas , Schaub Friederike
Published: January 2024

Aims/Purpose: Formation of a full‐thickness macular hole (MH) after vitrectomy is extremely rare. Previous studies only included small numbers of cases. Aim of the present study was to describe course, functional prognosis and risk factors of secondary macular hole development following surgical treatment of a primary rhegmatogenous retinal detachment (RRD) in a large data set from two tertiary eye clinics.

Methods: Formation of a full‐thickness macular hole (MH) after vitrectomy is extremely rare. Previous studies only included small numbers of cases. Aim of the present study was to describe course, functional prognosis and risk factors of secondary macular hole development following surgical treatment of a primary rhegmatogenous retinal detachment (RRD) in a large data set from two tertiary eye clinics.

Results: Out of 9317 eyes following PPV 28 eyes (mean age 58.7 ± 9.6 yrs, 50% male, 60.7% right eyes) could be included. The interval between vitrectomy and MH formation was 46.9 ± 80.3 (range: 1–373) months. 15 eyes showed history of macular involving RRD, 7 macular sparing RRD. Sulphur‐hexafluoride (SF6) 20–25% was used as endotamponade in 18 cases for RRD repair, silicone oil (Sil5000® and Sil2000®) in 4 cases. Six cases were not assessable due to earlier external surgery. In secondary MH re‐PPV with SF6 20–25% endotamponade in 21 eyes (thereof with an ILM flap in 8 cases), Sil5000® in 6 eyes and Densiron® in one eye was performed. A primary closure rate of 88.2% with gas was achieved with a final best corrected visual acuity of 0.67 ± 0.99 logMAR. Degree of myopia, which correlated with functional results (p = 0.019) and earlier time of onset (p = 0.007), as well as timing of cataract surgery (p < 0.001) could be identified as risk factor for secondary MH development.

Conclusions: Secondary MH after RRD repair is rare. In our study with the largest cohort studied so far, we can identify risk factors that lead to earlier MH formation. Myopia was shown to be a prognostic factor for functional outcome.
Molecular characterization of an iPSC line derived from a patient with cone‐rod dystrophy related to a mutation in the PROM1 gene
Authors: Puertas‐Neyra Kevin , Fernandez‐Bueno Ivan , Hernández‐Rodríguez Leticia , García‐Ferrer Yenisey , Gobelli Dino , Coco Rosa , de la Fuente Miguel Angel
Published: January 2024

Aims/Purpose: The PROM1 gene encodes the protein Prominin‐1, which plays a crucial role in the morphogenesis of photoreceptor outer segments. The c.1354dupT mutation, associated with various inherited retinal diseases (IRD) phenotypes, leads to a premature stop codon. This study aimed to assess the silencing efficiency of reprogramming vectors and the expression of endogenous pluripotency genes in the iPSC line [DCB]‐FiPSC1‐Ep5F‐2.

Methods: The iPSC line [DCB]‐FiPSC1‐Ep5F‐2 was generated from a patient with Cone‐rod dystrophy (CRD) linked to the c.1354dupT mutation in the PROM1 gene. iPSC colonies were stained using alkaline phosphatase (AP) blue membrane substrate. The c.1354dupT mutation was Sanger sequenced. To confirm the absence of episomal vector integration, quantitative PCR (qPCR) targeting a region common to all reprogramming vectors (within the EBNA1 gene) was conducted. Vector‐specific primer‐based quantitative reverse transcription PCR (qRT‐PCR) was used to assess the expression of reprogramming genes from the episomal vectors. Additionally, qRT‐PCR with gene‐specific primers was utilized to evaluate the expression of endogenous pluripotency genes. Untransfected fibroblasts served as the negative control, while fibroblasts transfected with the episomal vectors 72 h earlier were used as the positive control.

Results: The iPSC line [DCB]‐FiPSC1‐Ep5F‐2 exhibited positive AP activity. The presence of the c.1354dupT mutation was confirmed. Furthermore, the number of copies of the EBNA1 gene was significantly lower in the generated iPSC line compared to the control. The relative mRNA expression of the reprogramming vectors was also significantly lower in the iPSC line, while the relative mRNA expression of the endogenous pluripotency genes was significantly higher than in the control.

Conclusions: While further immunocytochemical characterization is necessary to fully ascertain iPSC pluripotency, the patient‐derived iPSC line [DCB]‐FiPSC1‐Ep5F‐2 shows promise as a disease model for personalized therapy development.
Human iPSC‐derived RPE cells implantation into minipig eye: Two weeks follow‐up study
Authors: Ardan Taras , Erceg Slaven , Artero‐Castro Ana , Studenovska Hana , Mueller Brigitte , Stieger Knut , Lytvynchuk Lyubomyr , Straňák Zbyněk , Ellederová Zdeňka , Juhás Štefan , Motlik Jan , Petrovski Goran
Published: January 2024

Aims/Purpose: Retinal pigment epithelium (RPE) replacement is a very promising cell‐based therapy for retinal degenerative diseases including age‐related macular degeneration (AMD). RPE dysfunction is the main cause of secondary damage to the photoreceptors. We hereby present RPE implantation into the minipig eye with a 2‐week follow‐up.

Methods: Cultured human iPSC‐derived RPEs (iRPE) on nanofibrous membranes, with properties very similar to Bruch's membrane, were characterized for expression of differentiation and polarization markers using immunohistochemistry. The implantations of iRPE‐scaffolds were carried out into the minipig eyes using 3‐port pars plana vitrectomy. Due to the xenogeneic transplantation of human cells into minipig eyes, tacrolimus immunosuppression therapy was used. At the 2‐week follow‐up from transplantation, non‐invasive OCT and fundus camera examinations of the implanted iRPE‐scaffolds were performed. Consequently, euthanasia, histological and immunohistochemical investigations of the implanted retina were performed.

Results: OCT and fundus camera examinations revealed successfully implanted iRPE‐scaffolds into the subretinal space with a healthy neuroretina above the implant, and healed retinotomy, without immune cell reaction against the implant. Histological and immunohistochemical investigation of the iRPE implants and adjacent retina showed structurally healthy iRPE‐scaffold implant and neuroretinal cells above the implant.

Conclusions: RPE cell therapy for replacement of diseased RPEs by ex vivo cultured Ipsc–RPEs on highly permeable nanofibrous membranes supports the survival of adjacent photoreceptors and thus positively affects the structural changes seen in retinal neurodegeneration.
Proteome changes in ferroptosis‐induced retinal pigment epithelial cell death in age‐related macular degeneration
Authors: Qu Sichang , Perumal Natarajan , Pfeiffer Norbert , Grus Franz , Manicam Caroline
Published: January 2024

Aims/Purpose: Ferroptosis is known to be involved in the pathogenesis of age‐related macular degeneration (AMD). We elucidated the potential roles and related pathways of ferroptosis in an in vitro AMD cell culture model and the mass spectrometry (MS)‐based proteomics analysis.

Methods: To mimic ferroptosis in AMD, ARPE‐19 cells were treated with erastin (ERS; 1, 2, 5 and 10 μM) or RSL3 (1, 2, 4, and 6 μM) for 24 h. Cells without treatment were used as control. Cell viability and glutathione peroxidase 4 (Gpx4) expression levels were used to determine the optimal AMD model. The MS‐based proteomics approach was employed to profile the protein expressions in ferroptotic RPE cells compared to controls. Next, bioinformatics analysis identified the significantly affected functions and pathways of the differentially expressed proteins.

Results: Cell viability and Gpx4 expression levels of ARPE‐19 cells were decreased in a dose‐dependent manner after induction with ERS (1, 2, 5 and 10 μM) and RSL3 (1, 2, 4, and 6 μM). Doses corresponding to ~60% cell viability (5 μM ERS and 2 μM RSL3) were selected for the proteomics analysis. A total of 1356 proteins were identified in all groups, with 300 and 209 significantly (p < 0.05) differentially expressed proteins in the ERS and RSL3 group, respectively. The induction of ferroptosis in this optimized model with ERS (p = 6.3 × 10−3) and RSL3 (p = 1.5 × 10−4), and disruption of iron homeostasis signalling pathway (p = 1.9 × 10−4 in RSL3) were further confirmed by proteomics analysis. Iron metabolism‐related proteins ferritin light chain and heme oxygenase 1 were significantly up‐regulated in the RSL3 group. Notably, a large cluster of proteins were highly significantly implicated in the eukaryotic initiation factor 2 signalling pathway (p = 2.0 × 10−30 in ERS and 1.0 × 10−5 in RSL3), which was correlated with ferroptosis. Furthermore, the upregulation of autophagy‐related Ras‐related protein Ral‐A and involvement of mTOR signalling pathway were found in both groups (p = 3.2 × 10−6 in ERS and p = 1.9 × 10−3 in RSL3).

Conclusions: In summary, this study established an optimum model for ferroptosis and demonstrated that it is involved in RPE cell death and is autophagy‐dependent. Our results also suggested that the disruption of iron uptake and intracellular storage in RPE cells are involved in AMD progression.
Be mindful of the blood glucose measurement: The relevance of blood glucose in the eye emergency department
Authors: Nazeer Shanees , Stone Amy
Published: January 2024

Aims/Purpose: Diabetic eye disease is a leading cause of blindness worldwide and diabetes‐related eye conditions are frequent presentations in Eye Emergency Departments (EEDs). Early detection and intervention of inadequate blood glucose control in the EED could be sight‐saving.

The aims of this study are to determine the:

prevalence of pre‐existing diabetes mellitus (DM) in the EED.

prevalence of suboptimal (HbA1c 53–70 mmol/mol) or poor (HbA1c >70 mmol/mol) glycaemic control in the EED.

proportion of diabetes patients with this diagnosis documented in the EED.

proportion of EED patients at risk of undiagnosed diabetes.

number of EED patients that had a capillary blood glucose measurement (BgM).

Methods: A retrospective review of 683 patients attending the EED over 10 consecutive weekdays at Manchester Royal Eye Hospital, Manchester, United Kingdom. The following parameters were assessed:

EED documentation: patient age, gender, presentation, diagnosis, management plan and whether a BgM was done.

General Practitioner records: diabetes diagnosis cross‐referenced with EED documentation.

If diabetes patients: diabetes type, duration, and glycaemic control.

Potentially undiagnosed diabetes.

Results: The prevalence of diabetes patients was 9.5%–64.6% of these patients had diabetes documented in EED and 1 had a capillary BgM. 70.7% of diabetes patients had pre‐existing suboptimal [33.8%] or poor [36.9%] glycaemic control. 8.5% of patients were considered high‐risk for undiagnosed diabetes of which 1 had a BgM.

Conclusions: There is a high prevalence of diabetes patients in the EED, and most have inadequate glycaemic control. This makes the EED an important setting to detect patients at high risk of diabetes‐related ocular disease and complications. BgM testing for all suspected patients is a quick test to allow earlier detection and intervention of inadequately controlled diabetes and reduce the risk of diabetes‐related vision loss.
The impact of elevated lipoprotein a levels on retinal vein occlusion in young individual: Case report with 7 months follow‐up
Authors: Smiri Meryam , Haddoum Karim Nassim , Mansouri Abdeldjalil , El Sanharawi Mohamed
Published: January 2024

Aims/Purpose: Branch retinal vein occlusion (BRVO) occurs when a branch of the retinal vein becomes obstructed. The aim of this study case was to provide insights into the potential role of Lipoprotein (Lp) (a) in the pathogenesis of BRVO.

Methods: Case of a 47‐year‐old woman with no significant ophthalmological or general medical history, except the use of oral contraception and smoking habits. Presented to the emergency care after 5 days of experiencing a sudden vision loss in her right eye.

Results: The ophthalmological examination revealed a visual acuity of 10/10 on the left (OS) and VBLM/10 on the right eye (OD). Slit lamp and Fundus examination showed on OD a relative afferent pupillary defect and the classic features of acute retinal branch vein occlusion, including tortuous veins, capillary occlusion, papillary and macular oedema and haemorrhages. While all was normal in OS. A comprehensive ophthalmic examination was conducted, including fluorescein angiography and optical coherent tomography that showed no abnormal vessel growth at this stage. Then, the indication for a dexamethasone intravitreal implant has been made along with panretinal photocoagulation (PRP) in the ischaemic areas. More, discontinuing oral contraception, the serum concentrations of specific antibodies, as anticardiolipin and antiphospholipids, as well as homocysteine and Lp (a) levels. The blood tests yielded negative results except for the abnormal plasma level of lipoprotein (a), which was measured at 900 mg/L. After 2 months of follow‐up. The visual acuity in OD was measured at 9/10. Moreover, the restoration of normal macular thickness after 4 months. However, at 6 months follow‐up, the appearance of a neovascularization adjacent to the previously laser‐treated area. As a result, a series of closely spaced PRP was performed along with an intravitreal anti‐vascular endothelial growth factor. After 1 month, a complete disappearance of the neovascularization was observed.

Conclusions: Identification of independent and highly predictive risk factors for BRVO is still a big challenge. The main goals are the preservation of visual acuity and the prevention of relapses. This case report emphasizes the importance of incorporating a systematic Lp (a) testing into clinical practice, even in young individual.
Ridge‐shaped peripapila dry, fluid associated, and self‐resolved fluid associated presentations
Authors: Sancho Ainhoa Mimendia , Maeso Alicia Traveset , Bertomeu Pau Cid , Costales‐Mier Felipe
Published: January 2024

Purpose: We aim to describe three different clinical presentations of ridge‐shaped peripapilla.

Methods: A series of case reports. Fundus images, autofluorescence (AF), optical coherence tomography (OCT) Angio‐OCT, indocyanine (ICG) and fluorescein angiography (FA) was performed.

Results: The first case is a 55‐year‐old woman, that was referred to the clinic due to central visual acuity loss in her left eye. RPE atrophy, and a scleral nasal protrusion (same configuration on both eyes) with a thinned overlying choroid, with subretinal fluid around the peripapillary area and the submacular area was observed on the OCT. FA and ICG with no hotspots, nor any dilated choroidal vascular pattern was observed, nor any signs of a neovascular membrane (NVM). On FA patched hypoAF was observed around the nasal retina. Posterior staphyloma was corroborated with ocular echography. Four months after initial presentation, fluid resolved spontaneously, visual acuity improved, but fundus pigmentary defects remained unchanged. The second case is a 60 year‐old woman (OS), peripapillary subretinal fluid was observed on the oct, choroidal thinning and scleral protrusion nasal to the optic disc. The third case, a 70‐year‐old male (OD), showed a temporal whitish lesion, engorged scleral protrusion was seen on oct, with overlying RPE atrophy, very thinned choroid and retina, without subretinal fluid.

Conclusions: Pathologic myopia is defined as myopic refractive error greater than −6.00 diopters. Many chorioretinal findings have been described regarding this condition, one of these is a ridge shaped peripapilla, a form of scleral protrusion around the optic disc. These patients presented on the fluorescein angiography and OCT findings, signs of protrusion of the sclera that seemed to result in overlying choroidal thinning with choroidal blood flow disturbances, and consequent RPE atrophy, leading to the subretinal fluid accumulation.
Comparative analysis of the effects of limbal and adipose‐derived mesenchymal stem cell conditioned media on oxidative stress‐induced damage in retinal pigment epithelial cells
Authors: Aydemir Ayse Dilara , Canbulat Zehra , Hasanreisoğlu Murat
Published: January 2024

Aims/Purpose: The purpose of this investigation was to evaluate the impact of adipose and limbal tissue‐derived mesenchymal stem cell‐conditioned media on survival, and inflammation in H2O2‐induced retinal pigment epithelial cells.

Methods: Following national regulations and with the approval of the Koç University Ethics and Investigation Committee, human limbal (L) and adipose‐derived (Ad) mesenchymal stem cells (MSCs) were isolated from cadaveric corneaoscleral rims from donors that originated from the cornea bank of Ministry of Health in Turkey and adipose tissue from discarded human liposuction surgery specimens, respectively. Conditioned medium (CM) that obtained by culturing MSCs in absence of serum was concentrated by filtration. Following a 24‐h pre‐treatment with H2O2, retinal pigment epithelial (RPE) cells were treated with MSC‐CM. Groups were defined as follows: Control, H2O2‐treatment (OS), OS‐Basal Medium, OS‐AdMSC‐CM and OS‐LMSC‐CM. Cell viability was assessed using MTT assay. Gene expression levels of pro‐ and anti‐inflammatory cytokines were analysed by qRT‐PCR.

Results: Based on MTT assay, H2O2 inhibited the growth of RPE cells with IC50 values of 150 μM at 24 h. We found that MSC‐CM attenuated H2O2‐induced loss of cell viability. In comparison to the OS group, the LMSC‐CM and AdMSC‐CM treatments demonstrated significantly decreased levels of IL‐6, IL‐8, IL‐10 and TGF‐β1 gene expression.

Conclusions: MSC‐CM ameliorated H2O2‐induced retinal pigment epithelial cell damage by alleviating inflammation.
Therapeutic potential of photobiomodulation on hydrogen peroxide‐induced oxidative damage in retinal pigment epithelial cells
Authors: Aydemir Ayse Dilara , Canbulat Zehra , Hasanreisoğlu Murat
Published: January 2024

Aims/Purpose: Photobiomodulation (PBM) is a cutting‐edge therapeutic method for restoring the functioning of injured mitochondria in experimental settings. Our goal was to find out how 780 nm PBM therapy affected the apoptosis and cell survival of hydrogen peroxide‐treated retinal pigment epithelial cells.

Methods: After being treated with 150 μM hydrogen peroxide for 24 h, the retinal pigment epithelial (RPE) cells were exposed to continuous wave laser radiation with the following parameters: wavelength of 780 nm, power density of 140 mW/cm2, 65 mW/cm2 and 40 mW/cm2 and duration of 10 min and 30 min. Furthermore, light therapy was given to untreated control cells to check PBM effect on healthy group. After PBM therapy in a time‐dependent manner, cell survival and apoptosis were assessed by MTT assay and Annexin V/PI staining, respectively.

Results: Based on MTT findings, PBM showed no obvious effect on cell viability in H2O2‐treated RPE cells, while after 48 h post‐PBM incubation, cell viability was dramatically improved. It was significantly increased at the power density of 140 mW/cm2 for 30 min application without unacceptable effect on control cells. RPE apoptosis was strikingly decreased in post‐PBM incubation group compared to H2O2‐treated group in a time‐dependent manner, as detected by flow cytometry.

Conclusions: As a result, photobiomodulation supported its potential utility in the prevention and treatment of retinal disorders associated with oxidative stress by promoting cell survival and reducing apoptosis under oxidative stress.
Tomographic findings in the retina of unvaccinated patients with COVID pneumonia: Prospective longitudinal study
Authors: Lucas Carlos Enrique Monera , Diaz Manuel Vicente Baeza , Quesada Jose Antonio , Pineda Adriana Lopez , Martinez Cristian Fernandez , Toldos Jose Juan Martinez , Guillén Vicente Francisco Gil
Published: January 2024

Aims/Purpose: There is no definitive evidence on the extent of SARS‐CoV‐2's effect on the retina. This study aimed to determine if the natural history of SARS‐CoV‐2 infection influences tomographic findings in the retina of patients with COVID‐19 pneumonia.

Methods: Prospective cohort study of patients hospitalized with COVID‐19 pneumonia. Patients underwent ophthalmological explorations and optical coherence tomography during the acute phase of the infection and at 12 weeks' follow‐up. Primary outcomes were central retinal thickness and central choroidal thickness, which were compared longitudinally and with non‐COVID‐19 historical controls.

Results: No statistically relevant differences were observed in the longitudinal analysis of the thickness of the central retina (p = 0.056), central choroid (p = 0.99), retinal nerve fibre layer (p = 0.21) or ganglion cell layer (p = 0.32). Patients with acute COVID‐19 pneumonia showed significantly greater central retinal thickness than non‐COVID controls (p = 0.006).

Conclusions: In conclusion, tomographic measures of the retina and choroid are not influenced by the phase of COVID‐19 infection and remain stable during 12 weeks. Central retinal thickness may increase in the acute phase of COVID‐19 pneumonia, but more epidemiological studies using optical coherence tomography in early stages of the disease are needed.

References

1. Invernizzi A, Torre A, Parrulli S, Zicarelli F, Schiuma M, Colombo V, Giacomelli A, Cigada M, Milazzo L, Ridolfo A, Faggion I, Cordier L, Oldani M, Marini S, Villa P, Rizzardini G, Galli M, Antinori S, Staurenghi G, Meroni L. Retinal findings in patients with COVID‐19: Results from the SERPICO‐19 study. EClinicalMedicine 2020 Oct;27:100550. doi: 10.1016/j.eclinm.2020.100550

2. Patel NS, Moon JY, Katz R, et al. Retrospective Analysis of Retinal Imaging in COVID‐19 Positive Patients at a Tertiary Eye Care Center. Clin Ophthalmol 2021 Sep 3;15:3727–3731. doi: 10.2147/OPTH.S309346
Uncommon case of basal linear deposits and its tomographic and indocyanine green angiography findings
Authors: Braham Imene Zhioua , Hachicha Ines , Mili Ilhem , Boukari Mejdi , Zhioua Raja Gmar
Published: January 2024

Purpose: To report a rare and uncommon case of patient presenting drusen associated to basal linear deposit (BlinD) and macular vitelliform material (VM).

Methods: Patient was assessed with multimodal imaging: fundus autofluorescence (FAF), indocyanine green angiography (ICGA) and enhanced depth imaging optical coherence tomography (EDI‐OCT). Electroretinogram (ERG) and visually evoked potentials (VEP) along with systemic evaluation were also performed.

Results: A 52‐year‐old woman consulted for ophthalmological check‐up, without any complaint. Past history revealed breast cancer treated with chemotherapy and hormone therapy, currently in remission. Visual acuity was 10/10 in the right eye (RE) and 8/10 in the left eye (LE). Slit‐lamp anterior examination was unremarkable. Fundus examination revealed multiple interlaced round yellowish lesions mainly in the posterior pole associated to a pigmented macular lesion on the LE. FAF showed bilateral macular hypoautofluorescent lesions. ICGA highlighted bilateral scattered hypofluorescent spots (SHS) mainly noted in the late phase, distributed throughout the posterior pole, with partial confluence. EDI‐OCT featured the presence of drusenoid retinal pigment epithelium (RPE) elevation along with a thick and distinctive hyperreflective band between the RPE and Bruch's membrane (BM). Associated bilateral hyperreflective VM were also detected. ERG and VPE were unremarkable. Patient underwent systemic evaluation insuring absence of cancer recurrence, choroidal metastases, paraneoplastic syndrome or any systemic disease.

Conclusions: BlinD is defined as a deposit located between the RPE and the BM. Recently, this entity has been correlated with SHS seen in late stages on ICGA and might be a precursor sign of age‐related macular degeneration. Associations between drusen and BlinD and between drusen and VM have been previously reported; however, the concomitance of these three features has, to our knowledge, never been reported.
The two extremes of retinal fold management
Authors: Stappler Theodor
Published: January 2024

Aims/Purpose: Retinal folds represent a debilitating complication following retinal detachment surgery. While some patients may experience partial retinal flattening with minimal or moderate improvement of visual function, many will go on to suffer severe permanent vision loss. The indication and timing of possible reintervention is still debated, particularly for how long after initial retinal fold formation there can still be a reasonable expectation of anatomical and functional improvement.

Methods: We present the cases of two patients suffering debilitating postoperative macular folds at opposite ends of the intervention window, who were referred to the Jules Gonin Hospital at different postoperative timepoints following retinal detachment surgery. Patient Nr 1 was reoperated within 20 days of the initial surgery, patient Nr 2 10 months later. Retinal folds were confirmed by preoperative OCT and pre‐ and post‐op cyclotorsion was measured on fundus photography.

Results: Patient Nr 1 recovered vision from CF to 0.2 logMar within 3 months, improving to 0.0 logMar after one year. Patient No 2 recovered from HM to 0.6 after 3 months and further to 0.5 logMar after one year. Most importantly, while patient Nr 1 had no more cyclotorsion, undisturbed binocular vision already on day one postoperatively, even to the absence of metamorphopsia during follow‐up, patient Nr 2 recovered slowly, also regaining binocularity without cyclotorsion, but with lasting metamorphopsia. During the video presentation, the different retinal elasticity at these differing timepoints can be demonstrated intraoperatively as well as different strategies to induce retinal separation so that the central retina can be reattached in a new, more physiological position.

Conclusions: Our cases illustrate that early intervention can lead to a virtually symptom‐free result while even delayed intervention may still be able to achieve some improvement in visual function and the avoidance of monocularity.

References:

Heimann H, Bopp S. Retinal folds following retinal detachment surgery. Ophthalmologica. 2011;226 Suppl 1:18–26

Wong R. Longitudinal study of macular folds by spectral‐domain optical coherence tomography. Am J Ophthalmol. 2012 Jan;153(1):88–92.e1
Sunrays epiretinal membrane
Authors: Hachicha Ines , El Matri Khaled , Rim Bouraoui , Fatma Mghaieth , Limaiem Rim , El Matri Leila
Published: January 2024

Aim: To report a unique aspect of an opalescent, symmetrical, sun rays like epiretinal membrane (ERM), assessed with swept source optical coherence tomography (SS‐OCT).

Methods: Patient was assessed with multimodal imaging: colour photography and SS‐OCT with B‐scan and en face imaging.

Results: A 65‐year‐old male with hypertension and diabetes history, followed in our consultation for pre‐proliferative diabetic retinopathy (DR), lost of sight for two years, presented with progressive visual decrease in his left eye (LE). Best corrected visual acuity (BCVA) of the right eye was 8/10 without any sign of DR activity on fundus examination. BCVA of the LE was limited to hand motion. Anterior segment examination was unremarkable. Fundus examination highlighted the presence of opaque dense ERM lining the posterior pole mimicking a symmetrical wheel spoke or sunrays, centred by a foveal pigmented lesion. En face SS‐OCT showed patterned retinal folds and B‐Scan SS‐OCT showed a thick hyperreflective layer above the internal limiting membrane (ILM) associated to underlying retinal surface wrinkling. We also noted thickened disorganized retinal layers, ectopic inner foveal layers (EIFL) and loss of the foveal depression. The central bouquet assessed the presence of subretinal hyperreflective vitelliform‐like deposit associated to intraretinal hyperreflective foci corresponding to pigment migration.

Conclusion: This case corresponds to the final stage ERM of Govetto classification. It reveals a migration process of retinal pigment cells towards inner retinal layers. The advent of high‐resolution SS‐OCT offered a better detection of ERM stages and alterations of the central bouquet, in order to improve our pathophysiological understanding. In fact, many hypotheses on ERM development processes were suggested. Glial cells and retinal pigment epithelial cells would undergo trans‐differentiation to a myofibroblastic pre‐retinal cells through the retina, via microdefects above ILM. Accumulated myofibroblastic cells, along with extracellular matrix deposition are the main precursors of ERM.
Ozurdex insert dislocated to the anterior chamber after postration in a patient who underwent secondary implant surgery with Canabrava technique: A case report
Authors: Remacha Carla Sánchez , Simón Cristina Calvo , Borghi Luca Bueno , Fernández Miguel Castillo , Clavería Julia Aramburu , Martínez Marta Suñer , Arias Pablo Cisneros , De Rivas Marta Orejudo , Moscarda Eva Josefina Nuñez , Sánchez Adrián Moñux , Pascual Paula Casas , Puyuelo Francisco Javier Ascaso
Published: January 2024

Aims/Purpose: To present a case report of a 64‐year‐old man with dislocation of a dexamethasone anterior chamber (AC) implant, who underwent secondary implantation with the Canabrava technique.

Methods: A male patient underwent surgery for a secondary implant in the left eye using the Canabrava technique.

Post‐operatively, cystic macular oedema was observed on optical coherence tomography (OCT). After 15 days, with no anatomical improvement despite treatment with Nevanac eye drops, a dose of intravitreal injection with Ozurdex® was prescribed. A few days later, the patient came to the emergency department and reported seeing a foreign body in the treated eye. On biomicroscopic examination, an Ozurdex® insert was found in the AC. When the patient was questioned again, he stated that he had been in the praying position the previous days. A new macular OCT was performed, showing resolution of the foveal oedema. Dilation of the LAA with phenylephrine was performed with cephalic manoeuvres in the supine decubitus position, achieving the repositioning of the dexamethasone implant in the vitreous chamber. Finally, an OCT of the anterior pole shows that the secondary implant is normally positioned without complications.

Results: After initial treatment with Ozurdex® intravitreal implant, total resolution of the post‐operative cystic macular oedema is achieved, even with dislocation to the anterior chamber. After outpatient management of the dislocation of the implant, we were able to relocate it to the vitreous chamber without the need for surgical management of the patient.

Conclusions: In the clinical case, it is demonstrated that the anti‐inflammatory effect of Ozurdex® remains active despite dislocation of the implant to the anterior chamber. Likewise, a good ambulatory technique in the supine position with directed cephalic manoeuvres may be sufficient to reposition the implant without the need for surgery.
Ocular involvement in a patient with POEMS syndrome, 2 years follow‐up with OCTA
Authors: Millas Sara Crespo , Di Lauro Salvatore , Galarreta‐Mira David
Published: January 2024

Aims/Purpose: To report the microvascular changes in a case of POEMS syndrome over 2‐years follow‐up with OCT angiography.

Methods: Case report of a 54 years old man with POEMS syndrome derived to our department from Neurology to evaluate visual acuity (VA) and fundus. OCT and OCTA (Triton, Topcon, Inc, Tokyo, Japan) was performed in each visit.

Results: At the time of the first examination the patient and the VA… was 0.8 right eye (RE) and 1 left eye (LE) and fundus exploration revealed some microaneurysms (MA) and hard exudates. The OCT was normal and OCT‐A revealed some MA. In the follow‐up in 2022, the VA was 0.8 RE and 0.9 LE, in the fundus we found an increased number of MA and hard exudates, in OCT appeared some cysts in the parafoveal region and a higher number of MA in OCTA. After 2 years follow‐up, the VA was 0.9 in both eyes, and as new findings in fundus examination, some intraretinal haemorrhages and vascular proliferation in periphery in LE. In OCT persist parafoveal cysts and OCTA showed a mild increase in the number of MA. We did not found any affectation in optic nerve or signs of vasculitis.

Conclusions: POEMS syndrome is a multiorganic disease with an increase production of vascular endothelial growth factor (VEGF). The ocular involvement is rare and the more common findings are optic neuropathy, macular oedema or retinal occlusive vasculitis. In this case report we made a follow‐up in the changes in OCT and OCTA. These two ancillary tests help to found microvascular changes that can be unnoticed in these patients. As far as we know, there is not others publications with a 2 years follow‐up with OCTA in POEMS syndrome.