bluuebunny/crossref_metadata_2025 huggingface dataset:
Urban Metabolism
Authors: Niza Samuel , Rosado Leonardo , Ferrão Paulo
Published: May 2009

Urban metabolism studies have been established for only a few cities worldwide, and difficulties obtaining adequate statistical data are universal. Constraints and peculiarities call for innovative methods to quantify the materials entering and leaving city boundaries. Such methods include the extrapolation of data at the country or the region level based, namely, on sales, population, commuters, workers, and waste produced.

The work described in this article offers a new methodology developed specifically for quantifying urban material flows, making possible the regular compilation of data pertinent to the characterization of a city's metabolism. This methodology was tested in a case study that characterized the urban metabolism of the city of Lisbon by quantifying Lisbon's material balance for 2004. With this aim, four variables were characterized and linked to material flows associated with the city: absolute consumption of materials/products per category, throughput of materials in the urban system per material category, material intensity of economic activities, and waste flows per treatment technology.

Results show that annual material consumption in Lisbon totals 11.223 million tonnes (20 tonnes per capita), and material outputs sum 2.149 million tonnes. Nonrenewable resources represent almost 80% of the total material consumption, and renewables consumption (biomass) constitutes only 18% of the total consumption. The remaining portion is made up of nonspecified materials.

A seemingly excessive consumption amount of nonrenewable materials compared to renewables may be the result of a large investment in building construction and a significant shift toward private car traveling, to the detriment of public transportation.
New and Low‐Cost Auto‐Algometry for Screening Hypertension‐Associated Hypoalgesia
Authors: Viggiano Andrea , Zagaria Nicola , Passavanti Maria Beatrice , Pace Maria Caterina , Paladini Antonella , Aurilio Caterina , Tedesco Michele Adolfo , Natale Francesco , Calabrò Raffaele , Monda Marcellino , De Luca Elena
Published: May 2009

Objective: The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto‐algometry method.

Design and Setting: Auto‐algometry consists of asking the subjects to push their fingers against a fixed round‐tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale.

Patients and Interventions: A group of hypertensive patients (n = 22) and a group of normotensive subjects (n = 22) underwent the auto‐algometry examination.

Results: The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4–6 range.

Conclusion: The data obtained from this study indicate that the auto‐algometer as described here can detect hypoalgesia associated with hypertension.
Spinal Cord Stimulation as a Novel Approach to the Treatment of Refractory Neuropathic Mediastinal Pain
Authors: Guttman Oren T. , Hammer Adam , Korsharskyy Boleslav
Published: May 2009

Spinal cord stimulation (SCS) offers new hope for patients with neuropathic pain. SCS “neuromodulates” the transmission and response to “painful” stimuli. The efficacy of SCS has been established in the treatment of a variety of neuropathic pain conditions and more recently in refractory angina pectoris, peripheral vascular disease, and failed back surgery syndrome. Recent publications suggest that visceral pain could be successfully treated with SCS. We report the first successful use of a spinal cord stimulator in the treatment of refractory neuropathic mediastinal, esophageal, and anterior neck pain following esophagogastrectomy.
Permanent Atrial Pacing Lead Implant Route after Fontan Operation
Authors: TAKAHASHI KAZUHIRO , CECCHIN FRANK , FORTESCUE ELIZABETH , BERUL CHARLES I. , ALEXANDER MARK E. , WALSH EDWARD P. , FYNN‐THOMPSON FRANCIS , TRIEDMAN JOHN K.
Published: May 2009

Background:

Atrial pacing is indicated for sinus node dysfunction (SND) after Fontan surgery; preferred lead implantation technique is debated. We compare outcomes of transvenous (TV) and epicardial (Epi) atrial lead implants in this population.

Methods:

Retrospective review of Fontan patients undergoing atrial lead implant between 1992 and 2007. Demographics, lead performance data, and outcomes were analyzed.

Results:

78 patients had 90 leads implanted: 25 via TV route and 65 via Epi route. Median follow‐up was 1.6 years (TV) and 3.6 years (Epi). TV leads were implanted in older patients (23.1 vs 9.3 years, P < 0.001) and at longer intervals after Fontan (15.2 vs 4.9 years, P < 0.001). Pacing indication for most TV leads was SND, while Epi leads were also indicated for atrioventricular block. Acute complication rates were similar (8% TV vs 19% Epi, P = 0.23), but median hospital stay was shorter for TV (2 vs 5 days, P = 0.03). Thrombus was observed in five patients (two in TV; three in Epi), but no thromboembolic events were observed. Mean lead survival was similar (TV 9.9 vs Epi 7.8 years, P = NS). Energy threshold was lower at implant for TV leads (0.9 vs 2.2 μJ, P = 0.049), but similar at follow‐up (1.2 vs 2.6 μJ, P = 0.35). Atrial sensing was unchanged over time for TV (2.2 to 2.1 mV, P = NS), but decreased for Epi (3.3 to 2.5 mV, P = 0.02).

Conclusions:

Compared to epicardial leads, transvenous atrial pacing leads may be placed in Fontan patients with lower procedural morbidity and equivalent expectation of lead performance and longevity.
BNP/NT‐ProBNP and Cardiac Pacing: A Review
Authors: WANG RU‐XING , GUO TAO , LI XIAO‐RONG
Published: May 2009

Natriuretic peptide (NP) levels (B‐type natriuretic peptide [BNP] and N‐terminal proBNP) are now widely used in clinical practice and cardiovascular research all over the world and have been incorporated into many cardiovascular guidelines for heart failure (HF). The roles of NP levels are evolving rapidly not only in diagnosis, therapy monitoring, and risk stratification of HF, but also in differential diagnosis of acute dyspnea, predicting death and rehospitalization in HF patients. NP assays have been applied in permanent cardiac pacing in recent years, whereas it is still not well known how NP levels change and whether NP levels can predict HF in permanent cardiac pacing. Therefore, this article reviews the role of NP levels in permanent cardiac pacing, mainly including NP changes in different cardiac pacing modes and cardiac resynchronization therapy.
Giant Left Atrial Thrombus Associated with Ablation for Atrial Tachycardia
Authors: PU ZHAO‐XIA , LEI YU , YOU XIANG‐DONG , HONG PAN‐XIAO
Published: May 2009

We report a very rare case of giant left atrial thrombus (size: 7.2 × 4.5 mm2) associated with radiofrequency catheter ablation for atrial tachycardia in a 72‐year‐old man. After 4 weeks of anticoagulation with warfarin, a repeat echocardiogram demonstrated partial resolution of the thrombus (size: 4.5 × 2.6 mm2) without systemic embolization.
Use of a Wireless Implantable Cardioverter Defibrillator in a Patient with a Preexisting Neurostimulator
Authors: KATWAL ARABINDRA B. , McCOTTER CRAIG J.
Published: May 2009

We report the case of a 54‐year‐old man with a previously implanted neurostimulator who presented with palpitations and was found to have sustained ventricular tachycardia on electrophysiologic study. A Medtronic wireless implantable cardioverter defibrillator (ICD; Medtronic Inc., Minneapolis, MN, USA) with home monitoring (HM) was successfully implanted. Interaction testing during implantation, follow‐up, and HM showed that there was no device‐device interaction.
Successful Balloon Dilatation of the Valve of Vieussens for Left Ventricular Lead Placement
Authors: HASDEMIR CAN , ALP ALPAY , CAN LEVENT H.
Published: May 2009

Successful balloon dilatation of an obstructive valve of Vieussens for left ventricular lead placement is described in a case with severe left ventricular systolic dysfunction.
Ecclesial opposition to nonferrous mining in Guatemala: neoliberalism meets the church of the poor in a shattered society
Authors: HOLDEN WILLIAM N. , JACOBSON R. DANIEL
Published: May 2009

Guatemala, a nation plagued by the legacy of its brutal 36‐year civil war, has, in recent years liberalized its mining law to encourage the entry of multinational mining corporations. These mining companies have included two Canadian companies, which have developed the two most prominent, and controversial, mining projects in Guatemala. Using the lens of political ecology to demonstrate how environmental analysis and policy can be reframed towards addressing the problems of the socially vulnerable, this article analyses the opposition of the Roman Catholic Church to mining in Guatemala. The article reviews the development of liberation theology in Latin America and how this has imparted empathy for the poor into the pastoral praxis of the church. The church is opposed to mining largely because of the potential implications of mining's environmental effects upon the livelihoods of the poor. The article postulates that the opposition of the church to mining is an example of an environmental issue connecting groups of people across class and ethnic lines to offset powerful global political and economic forces. The article concludes with a discussion of how this opposition to mining is a demonstration of the opposition of the progressive church to neoliberalism in general.
La mise en forme d’un pôle de haute technologie en proche banlieue: d’un aménagement fonctionnaliste à un urbanisme de créneau. Le cas de Saint‐Laurent dans la région métropolitaine de Montréal
Authors: DARCHEN SÉBASTIEN , TREMBLAY DIANE‐GABRIELLE
Published: May 2009

De nouvelles formes de développement sont privilégiées dans certains espaces de la proche banlieue des principales métropoles canadiennes. Cette évolution est liée à la maturation de ces espaces sur le plan économique. Par l’étude d’un cas représentatif de cette maturation économique à l’échelle métropolitaine de Montréal, l’arrondissement de Saint‐Laurent, nous mettons en valeur l’évolution des stratégies d’aménagement des acteurs du développement pour les deux principales phases de développement du territoire (1950–1980 et 1980–2000). Nous relions l’évolution sur le plan économique du cas étudié et les stratégies d’aménagement des acteurs du développement en nous référant à la thèse de la régulation. Par une méthode de collecte de données de type qualitatif basée sur une analyse documentaire et l’usage d’entretiens avec les acteurs du développement (du secteur privé et municipal), nous comparons les pratiques d’aménagement pour les deux périodes étudiées. En faisant appel à la distinction entre le fordisme et le post‐fordisme pour caractériser la maturation économique, nous concluons que l’évolution sur le plan morphologique du territoire est marquée par le passage d’un aménagement fonctionnaliste à un urbanisme de créneau.
Reoperations after photorefractive keratectomy for moderate and high myopia
Authors: Pedersen O.Øyvind
Published: May 2009

Purpose: To contribute data regarding results of reoperation with excimer laser for the treatment of residual myopia, and to improve corneal clarity following previous photorefractive keratectomy for ‘moderate’ (< ‐ 9 D) and ‘high’ (> ‐ 9 D) myopia.

Methods: Surface reablations with excimer laser (5 mm treatment diameter) were performed to correct residual myopia and remove subepithelial scars. Refraction, visual acuity, and corneal clarity were recorded with average follow‐up of one and two years after reoperation.

Results: In 27 eyes with ‘moderate’ myopia before the first operation, significant improvement was obtained regarding refraction (changed from ‐ 2.3 ±1.56 D before retreatment to ‐ 0.58 ± 1.31 D after retreatment (p< 10‐3)), and uncorrected visual acuity (improved to ≥ 0.8 in 51.8% of the cases). All cases (6 eyes) with corneal scars improved. Six eyes with ‘high’ myopia showed no improvement of refraction following reoperation. Effects on corneal clarity were mixed in that group.

Conclusion: We were able to improve the results of photorefractive keratectomy for ‘moderate’ myopia with a second excimer laser ablation. The risks involved in retreatments of such eyes are small. In ‘high’ myopia, reablations with a 5 mm treatment zone did not improve the refractive outcome on a long‐term basis.
The ratio of albumin to lactoferrin in tear fluid as a diagnostic tool in primary Sjogren's syndrome
Authors: Bjerrum K. B.
Published: May 2009

Purpose: To compare the protein composition of tear fluid obtained from patients with primary Sjogren's syndrome, patients with other connective tissue diseases and control individuals.

Methods: SDS polyacrylamide gel electrophoresis followed by staining with Coomassie blue and Western blotting.

Results: Comparison revealed the presence of a characteristic difference in the ratio of intensity between the albumin and lactoferrin bands. An albumin:lactoferrin ratio above 2:1 was significantly more common in patients with primary Sjögren's syndrome than in patients with other connective tissue diseases or the controls.

Conclusion: An albumin:lactoferrin ratio above 2:1 may therefore prove of use when diagnosing 1°SS. Used as a test, its sensitivity was 67% and its specificity 100%.
Retinal mean transit time determined with an impulse‐response analysis from video fluorescein angiograms
Authors: Sperber G. O. , Alm A.
Published: May 2009

Purpose: To evaluate a new technique for determing the Mean Transit Time (MTT) of retinal circulation, based on an impulse‐response analysis. The results obtained were compared to those obtained with a conventional method based on semilogarithmic extrapolation.

Methods: 128 frames at a rate of 5 frames per second were digitized from video fluorescein angiograms and processed with a specially designed image analysis system. The MTT was determined from 25 curve pairs from 12 eyes in 8 young, healthy volunteers by the conventional technique (MTTSLOPE) and by our newly developed Impulse‐Response analysis (MTTIR).

Results: MTTSLOPE and MTTIR calculated for the 25 curve pairs were 3.54 ± 1.00 and 2.67 ± 0.88 seconds, respectively (Mean ± SD). There was a good correlation between the two techniques (r2 = 0.81, p<0.001). Unlike MTTSLOPE MTTIR could be calculated also from curves with a badly defined bolus. Conclusion: We conclude that MTTiR‐analysis of the retinal circulation may be used for clinical studies on retinal blood flow from angiograms obtained in patients.
Cataract patients in a defined Swedish population 1986–1990
Authors: Ninn‐Pedersen K. , Bauer B.
Published: May 2009

Purpose: Cataract surgery is often followed by a posterior capsule opacification, usually treated with YAG laser capsulotomy, however, there are huge variations in the incidence figures available in the literature, from 18 to 50% (Sterling & Wood 1986). We have therefore analyzed the incidence of secondary cataracts in a population‐based cohort of patients, as revealed by the number of YAG laser capsulotomies performed postoperatively.

Methods: Data for all patients undergoing cataract surgery from 1986 up to and including 1990 in the Lund Health Care District were prospectively recorded, and 4722 patients were retrieved for analysis, using only one eye per patient. The patients had been operated on with extracapsular extraction (phacoemulsification or planned large incision procedure) or a combined trabeculectomy and cataract extraction procedure leaving an intact capsule after surgery. Death dates for each patient were obtained from the Swedish Bureau of Census up to and including 1991. Different risk factors were considered such as sex, age, preoperative axial length, preoperative average keratometry, preoperative intraocular pressure, glaucoma history, diabetes history, uveitis history (including both anterior and posterior uveitis), history of age related macular degeneration and a history of rheumatoid arthritis. We also considered the influence of factors connected to the operation itself on the incidence of secondary capsular haze: extraction mode (ordinary ECCE versus phacoemulsification or trabeculectomy) and the type of implant and the surgeon's surgical activity.

Results: Besides age, four variables significantly influenced the risk of having postoperative YAG laser treatment. They were gender, iris sphincterotomy, operation date, and whether the patient came from a rural or an urban region. After about four to five years, the percentage of patients not having had a YAG laser capsulotomy was reduced to around 50% for women and 60% for men. These percentages were based on a survival analysis, minimizing the confounding effect of the limited life span of these elderly patients.

Conclusions: In this material, the most important predisposing factors for YAG laser capsulotomy after extracapsular cataract surgery are: young age, female gender, if the patient was operated late in the period observed, and if the patient came from an urban area.
A new generation of algorithms for computerized threshold perimetry, SITA
Authors: Bengtsson Boel , Olsson Jonny , Heijl Anders , Rootzén Holger
Published: May 2009

Purpose: The purpose of this work was to develop a new family of test algorithms for computerized static threshold perimetry which significantly reduces test time without any reduction of data quality.

Methods: A comprehensive visual field model constructed from available knowledge of normal and glaucomatous visual fields is continuously updated during testing. The model produces threshold estimates and also estimates of the certainty to which the threshold is known at each point. Testing is interrupted at each test location at predetermined levels of threshold certainty. New time‐saving methods are employed for estimation of false answers, and test pacing is optimized. After completion of the test, all threshold estimates are re‐computed, taking into account the complete body of patient responses. Computer simulations were used to optimize the different parameters of the new algorithms, to evaluate the relative importance of those parameters, and to evaluate the performance of the algorithm as a whole in comparison with a standard algorithm.

Results: Simulated test results obtained with this algorithm were slightly more accurate than those of the Humphrey Full Threshold test algorithm. The number of simulated stimuli presented was reduced by an average of 29% in normal fields and 26% in glaucomatous fields. Actual clinical test time should be further reduced, since the influence of the improved timing algorithm was not included in the simulations.

Conclusions: We applied new methods which take available knowledge of visual field physiology and pathophysiology into account, and employ modern computer‐intensive mathematical methods for real time estimates of threshold values and threshold error estimates. In this way it was possible to design a family of testing algorithms which significantly reduced perimetric test time without any loss of quality in results.
The effect of a shear force on the cell shedding rate of the corneal epithelium
Authors: Ren Hongwei , Wilson Graeme
Published: May 2009

Purpose: During blinking the lids apply a shear force to the corneal epithelium. The aim of this study was to determine if a shear force applied to the epithelial surface increases the rate at which cells shed.

Methods: The shedding rate was studied in perfused whole rabbit eyes, and the effect of a shear force examined by exposing the corneas to a stirred solution. Control corneas were exposed to a static solution. The shedding rate and size of shed cells were measured, and the number of terminally differentiated cells on the corneal surface determined after 6 h of perfusion using ethidium bromide.

Results: Compared with controls, the shear force increased the cell shedding rate from the corneal surface significantly (p<0.01, paired t‐test). The increase was due to small cells with a longest dimension less than 25 μm. The number of terminally differentiated cells on the epithelial surface did not increase.

Conclusion: Because of the decrease in size, and the change in appearance of shedding cells, it is proposed that the increase in cell shedding rate was due to an increase in the number of apoptotic cells, and not to an increase in terminally differentiated cells. It is suggested that in the human eye, under adverse conditions, shear forces due to blinking may play a role in creating apoptotic cells.
Immunohistochemical characterization of retinal glial cell changes in areas of vascular occlusion secondary to diabetic retinopathy
Authors: Bek Toke
Published: May 2009

Purpose: To study changes in retinal glial cell components in areas of vascular occlusion secondary to diabetic retinopathy.

Material: The retina from ten eyes of six diabetic patients and from five eyes of five normal controls were studied for immunoreactivity to glial fibrillary acid protein and vimentin (glial cells), S‐100 protein (perivascular glial cells), carbonic anhydrase isoenzyme II and CD‐57 antigen (Müller cells), and CD‐68 antigen (microglia).

Results: The study showed increased immunoreactivity to S‐100 protein, corresponding to perivascularly located glial cells in the retina from diabetic patients, except for areas of vascular occlusion where this immunoreactivity was absent. Furthermore, the material invading the lumen of former retinal vessels in areas of vascular occlusion showed immunoreactivity to CAH‐II and CD‐57, suggesting that this material represents ingrowth of retinal Müller cells.

Conclusions: The findings suggest that at least two types of changes in retinal glial cells are involved in the pathophysiology of diabetic retinopathy, i.e. 1) Reactive changes in the perivascular glial cells in the retina, and 2) Müller cell ingrowth into the former lumen of occluded retinal vessels.
Inflammatory response after endocapsular phacoemulsification or conventional extracapsular lens extraction in the rabbit eye
Authors: Laurell Carl‐Gustaf , Wickström Kerstin , Zetterström Charlotta , Lundgren Björn
Published: May 2009

Purpose: We compared the inflammatory response after phacoemulsification and conventional extracapsular lens extraction in New Zeeland albino rabbits.

Methods: One eye was selected at random and phacoemulsification was performed. Extracapsular lens extraction was done in the fellow eye. In both eyes a polymethylmetacrylate intraocular lens was implanted into the capsular bag and the wound was sutured with a 9–0 polypropylene continuous suture. The levels of prostaglandin E2 in aqueous humour and wet mass of the iris‐ciliary bodies were measured at day 1. The number of white blood cells and protein levels in the aqueous humour were measured at day 1, 3, 7, 14 and 30. Corneal thickness was estimated with pachymetry.

Results: Prostaglandin E2 levels and wet masses of iris‐ciliary bodies were significantly higher after extracapsular lens extraction, which also induced significantly higher white blood cells counts at day 1 and 3 and higher protein levels at day 7. Extracapsular lens extraction caused more corneal edema at day 3, 7 and 14.

Conclusion: The results suggest that phacoemulsification induced less surgical trauma with less breakdown of the blood‐aqueous barrier.
Graft survival and risk factors of penetrating keratoplasty for microbial keratitis
Authors: Lomholt Jeanet A. , Ehlers Niels
Published: May 2009

Purpose: To evaluate graft survival rates and prognostic factors in relation to penetrating keratoplasty for microbial keratitis.

Methods: The records of 95 patients treated with penetrating keratoplasty for microbial keratitis during a twenty‐year period were reviewed. Data were analysed by construction of survival curves using the Kaplan‐Meier non parametric method.

Results: The overall survival of a clear cornea was 72% after one year, 71% after two years and 52% after five years. A significantly lower survival rate (p<0.05) was found in the presence of preoperative local risk factors such as wear of contact lenses and trauma and in inflamed eyes. In contrast, systemic diseases like diabetes, cancer or rheumatoid arthritis did not affect survival and neither did recipient age nor the degree of vascularization of the eye. Male donor buttons showed superior survival compared to female ones (p < 0.05), while females seemed to constitute the best recipients. Recurrence rates of microbial keratitis postoperatively were 11%, 16% and 24% after one, two and five years, respectively. Corresponding graft rejection rates were 9%, 15% and 27%.

Conclusions: Patients suffering from microbial keratitis have a relatively high risk of graft failure. To improve the prognosis care should be taken to minimize local risk factors. Surgery should whenever possible be performed on quiet eyes. The unexpected finding of a better prognosis for male donor buttons might suggest the preferred use of male donors in patients suffering from microbial keratitis, but the observation needs further documentation.
Senile entropion ‐ cure rate by retractor tightening and horizontal shortening
Authors: Hedin Anders
Published: May 2009

Purpose: In order to clarify the efficiency of two operations aimed at curing the principal causes of senile entropion, a consecutive series of patients were examined.

Material: In 19 lids, the lower lid retractors were tightened transcutaneously and in 45 a simultaneous horizontal lid shortening was performed. Surgery was uneventful in all cases. The patients were reexamined 7–53 months after surgery.

Results: In the group with mere retractor surgery were five recurrences; all lids that also had a horizontal shortening were satisfactorily cured.

Conclusion: Lower eyelid retractor tightening with simultaneous horizontal shortening of the lid is recommended to correct senile operation with a lasting result.
Photographic detection of retinopathy in insulin‐treated diabetes
Authors: Kuiv Reet , Tein Pille , Algvere Peep V. , Bäcklund Lars B. , Holm Olle
Published: May 2009

Purpose: To perform a cross‐sectional baseline investigation of diabetic retinopathy prevalence and metabolic control.

Methods: Using a register of insulin‐dependent diabetes mellitus in Tartu (pop. 104,791), 175 patients were invited to fundus photography; 149 (89%) participated, 99 of them diagnosed with diabetes before the age of thirty. Four Kodach‐rome 64 photographs per eye were taken with a Canon CR4 ‐ 45NM camera through tropicamide‐dilated pupils; slides were projected and systematically graded. Capillary blood samples (n = 132) for HbA1c determination were mailed on filter paper. Following cysteine buffer elution, Mono S ion exchange chroma‐tography was performed (reference range 3.7 to 5.3%).

Results: Any diabetic retinopathy was found in 114 patients (76.5%; 95% confidence interval, CI, 70 to 83%); mild to moderate non‐proliferative retinopathy in 59 (40%; 95% CI 32 to 48%); severe non‐proliferative retinopathy in 29 (19.5%; 95% CI 13 to 26%); proliferative retinopathy in 26 (17%; 95% CI 11 to 24%); 47 patients (32%) needed laser photocoagulation. Vitreous haemorrhage was observed in 9 (6%) of subjects. In patients diagnosed with diabetes before the age of 30 years, prevalence of any retinopathy was 82% (95% CI 73 to 89%) and of proliferative retinopathy 23% (95% CI 15 to 33%). Median HbA1c was 9.7% for women and 8.6% for men (95% CI for difference 0.7 to 2.1%).

Conclusion: Retinopathy prevalences (76–82%) are the highest reported from population‐based studies. Glycaemia levels were very high and should be gradually lowered. Methods capable of validation can be successfully introduced for population‐based assessment of hyperglycaemia and retinopathy prevalences.
Corneal anesthesia in a case with Vogt‐Koyanagi‐Harada syndrome
Authors: Brouzas Dimitrios , Chatzoulis Dimitrios , Galina Eleni , Liaskou Aikaterini , Koukoulomatis Pavlos
Published: May 2009

Purpose: To add clinical features to the discription of the Vogt‐Koyanagi‐Harada syndrome.

Method: Case report.

Results: The case presented with a typical medical history of Vogt‐Koyanagi‐Harada syndrome, including headaches, low‐grade fever, nuchal rigidity, and from the eyes bilateral visual loss, a reaction from the anterior chambers, bilateral uveities with localized exudative retinal detachment from the left. In addition there were tonic pupils, anesthesia of the corneas, and an accommodative deficit.

Conclusion: Corneal anesthesia, tonic pupils and accommodative impairment can be features of the Vogt‐Koyanagi‐Harada syndrome.
Metastatic bacterial endophthalmitis
Authors: Piczenik Yoa , Kjer Birgit , Fledelius Hans C.
Published: May 2009

Purpose: To draw attention to the rare but severe entity of endophthalmitis as encountered due to metastatic spread of bacteria.

Methods: We report our experience from four cases of metastatic bacterial endophthalmitis.

Results: Systemic infection (Pneumococcus meningitis) was evident in two cases, but in the other two there was no early clue to systemic infection. Eventually, however, endocardial vegetations were disclosed as the source of bacterial emboli (E.coli, peptostreptococcus). In the most atypical patient, magnetic resonance scanning had indicated disseminated brain tumours, and only autopsy revealed the infectious nature of the disease. Ocular ultrasonography being part of the work‐up, the four eyes under study all showed marked morphological intraocular changes, including ‘solid tumour’ in the presumed neoplastic case.

Conclusion: Our cases stress the severity of metastatic bacterial endophthalmitis and the easily missed early diagnosis, even where experienced clinicians are involved. The role of diagnostic ultrasound is discussed.
Assessment of visual acuity in adult patients with strabismic amblyopia: A comparison between the preferential looking method and different acuity charts
Authors: Rydberg Agneta
Published: May 2009

Purpose: Grating acuity values obtained with preferential looking techniques do not correspond to test results obtained with letter charts. The aim of the study was to investigate the agreement between grating acuity and other acuity tests.

Methods: Twenty‐eight adult patients with strabismic amblyopia were assessed with the preferential looking‐method and other linear and single letter and symbol tests.

Results: Assessment with preferential looking regularly led to an overestimation of the acuity values, but between preferential looking and single optotypes there was a much better agreement. This is most likely due to ‘crowding’ in strabismic amblyopia. A crowding ratio was calculated in the amblyopic eye, and crowding was found to be more prominent for comparisons of preferential looking with optotypes in rows, than for preferential looking and single optotypes.

Conclusions: Strabismic amblyopia cannot be reliably identified with grating acuity. Preferential looking‐testing is therefore of limited use as a screening method for the detection of amblyopia, but preferential looking could still be useful in the assessment and treatment.
Measurement of thickness of retinal nerve fiber layer by scanning laser polarimetry and high‐pass resolution perimetry in patients with primary open‐angle or normal‐tension glaucoma
Authors: Shirakashi Motohiro , Abe Haruki , Sawaguchi Shoichi , Funaki Shigeo
Published: May 2009

Purpose: To evaluate the correlation between neural capacity, determined by high‐pass resolution perimetry, and thickness of the retinal nerve fiber layer, evaluated by scanning laser polarimetry, in patients with primary open‐angle glaucoma or normal‐tension glaucoma.

Methods: Thickness of the peripapillary retinal nerve fiber layer was measured by scanning laser polarimetry in 19 eyes of 19 patients with primary open‐angle glaucoma and in 23 eyes of 23 patients with normal‐tension glaucoma. There were no significant differences between the two groups in mean age, sex ratio, or mean neural capacity.

Results: Neural capacity was significantly correlated with thickness of the retinal nerve fiber layer in all 42 eyes (r = 0.31, P = 0.0429). Neural capacity was significantly correlated with thickness of the retinal nerve fiber layer in the eyes of patients with primary open‐angle glaucoma (r = 0.60, P = 0.0061), but not in the eyes of patients with normal‐tension glaucoma (r = 0.04; P = 0.8522).

Conclusion: The degree of correlation between neural capacity determined by high‐pass resolution perimetry and thickness of the retinal nerve fiber layer measured by scanning laser polarimetry appeared to differ in patients with primary open‐angle glaucoma vs those with normal‐tension glaucoma.
Topography of corneal grafts before and after penetrating keratoplasty
Authors: Hjortdal Jesper Ø. , Ehlers Niels , Erdmann Lotte
Published: May 2009

Purpose: Refractive error after penetrating keratoplasty is a major clinical problem. The purpose of the present study was to investigate whether the topography of the donor cornea influence the topography of the graft after transplantation.

Methods: Twenty‐five donor corneas were measured with a video‐keratograph (TMS‐1): in situ and before and after organ culture. Clinical video‐keratographic images of the transplanted grafts were subsequently obtained one week, 1, 3, 6, 12, and 24 months after surgery. The central spherical equivalent power and corresponding regular and irregular astigmatic powers were computed.

Results: A statistically significant correlation between spherical equivalent central donor power and spherical equivalent central graft power after keratoplasty was found at all times up to two years after surgery. Only 13–50% of the variation in post‐keratoplasty spherical graft power could, however, be explained by the donor graft power. Corresponding 95% confidence limits for prediction of post‐keratoplasty power from donor graft power were approximately ± 6.5 diopters. Post‐keratoplasty regular or irregular corneal astigmatism did not correlate with astigmatism in the donor graft.

Conclusion: Corneal donor graft spherical equivalent power does influence the spherical equivalent corneal power after keratoplasty, especially during the first months after surgery. The dependency is, however, not very strong and until other determinants of post‐keratoplasty corneal shape are known and controllable, ‘power‐typing’ of donor corneas appears to be of limited clinical use.
Vascular endothelial growth factor (VEGF) in normal human corneal epithelium: Detection and physiological importance
Authors: van Setten Gysbert B.
Published: May 2009

Purpose: Corneal neovascularization is a major challenge following chemical burns and corneal inflammation. The factors triggering corneal neovascularization involve various growth factors. In the release and control of these factors the regenerating tissue plays a decisive role. Only recently has vascular endothelial growth factor been shown to be involved in the basic events of retinal neovascularization. From the cornea current knowledge allows only for the statement that corneal epithelium could be able to produce vascular endothelial growth factor. The present study was designed to show the presence of vascular endothelial growth factor‐like substances in the corneal epithelium of the normal eye in vivo.

Methods: Using specific antibodies to the N‐terminus of human vascular endothelial growth factor indirect immuno‐histochemistry was applied to sections of normal human corneal epithelium and to five sections of enucleated human eyes with a morphologically normal anterior segment.

Results: In all sections specific staining for vascular endothelial growth factor was found over the entire epithelium. Staining was most intense in the basal layer of epithelial cells. Only a weak staining was detectable in the cell layers closer to the surface. Here, however, the samples of corneal epithelium having been subject to traumatic erosion showed a slightly more intense staining than the sections from the undisturbed corneal tissue of whole globe sections.

Conclusion: It was shown that vascular endothelial growth factor‐like protein is present in the human corneal epithelium. Observed differences in the staining pattern could suggest that the expression of vascular endothelial growth factor might be enhanced due to ocular surface trauma. It is suggested that corneal epithel vascular endothelial growth factor might be an important factor in the cascade leading to te onset of corneal neovascularization
Indocyanine green angiography and transmission defects
Authors: Schneider Ulrike , Sherif‐Adel Saleh , Gelisken Faik , Kreissig Ingrid
Published: May 2009

Purpose: Several reports have suggested that indocyanine green angiography is of value in identifying late hyperfluorescent subretinal tissue presumed to be choroidal neovascularization. However, fluorescein angiography may also reveal late hyperfluorescence from transmission defects caused by atrophy of the retinal pigment epithelium. We studied the indocyanine green angiographic characteristics of transmission defects to determine if indocyanine green angiography can differentiate choroidal neovascularization from the retinal pigment epithelium atrophy.

Methods: Indocyanine green angiograms of 23 eyes with geographic atrophy secondary to age‐related macular degeneration and without any signs or history of choroidal neovascularization were reviewed.

Results: Indocyanine green angiography demonstrated late hypofluorescence of various degrees in the area of geographic atrophy. There was no evidence of late hyperfluorescence.

Conclusion: Late hyperfluorescence evident on fluorescein angiography which can be caused by choroidal neovascularization or transmission defects is not seen in retinal pigment epithelium atrophy imaged by indocyanine green angiography. According to these results indocyanine green angiography is useful to differentiate occult choroidal neovascularization from areas of retinal pigment epithelium atrophy.
Pulsatile ocular blood flow in untreated diabetic retinopathy
Authors: MacKinnon Jane R. , O'Brien Colm , Swa Kenneth , Aspinall Peter , Butt Zahida , Cameron Donald
Published: May 2009

Purpose: To measure the pulsatile component of total ocular blood flow in patients with untreated diabetic retinopathy.

Subjects and Methods: An adapted pneumotonometer attached to a slit‐lamp biomicroscope. 82 age‐matched subjects divided into 4 groups: non‐diabetic controls (n = 22); diabetics with no clinical retinopathy (n = 20); background diabetic retinopathy (n = 20); pre‐proliferative/proliferative diabetic retinopathy (n = 20).

Results: The mean pulsatile ocular blood flow values were found to be increased in all grades of diabetic retinopathy (no retinopathy 818 μl/min, background 1015 μl/min, pre‐proliferative/proliferative 1097 μl/min) compared to the control group (644 μl/min). These pulsatile ocular blood flow values were significantly higher (p<0.05) in the background and pre‐proliferative/proliferate retinopathy groups compared to controls. Pulse volume and pulse amplitude were also higher in the diabetic subjects. Mean arterial blood pressure did not differ across the groups studied.

Conclusion: Pulsatile ocular blood flow was found to be higher in diabetics compared to controls and appears to increase as the severity of retinopathy progresses. Such a hyperdynamic circulation may contribute to the pathogenesis of diabetic eye disease.
A perimetric learner's index
Authors: Olsson Jonny , Åsman Peter , Heijl Anders
Published: May 2009

Purpose: Certain individuals need earlier perimetric experience before producing normal fields on automated static threshold perimetry. Mid‐peripheral depressions and an unaffected central field are typical findings in such cases. We have devised a learner's index, to detect defect patterns that may be due to such perimetric inexperience.

Methods: The central visual field was partitioned into 5 concentric zones and averages of deviations from the age‐corrected normal threshold values were studied in each zone. The third test session in 74 randomly selected normal subjects provided an experienced reference material. Visual field results typical of normal individuals lacking perimetric experience were represented by the first field test obtained from each of 7 subjects (‘learners’) from the same group, who showed significant learning during three test sessions. A linear discriminant function, learner's index, was constructed that discriminates between typically experienced and typically inexperienced field results in normals.

Results: Average deviation from age‐corrected normal threshold increased with increasing eccentricity in the learner's initial fields. Clinical examples illustrate the intended use of the new index.

Conclusions: The learner's index highlights those first field tests from eyes with normal visual fields, that deviate significantly from a normal experienced result in the direction of a learner's result. Patients showing significant learner's index are candidates for repeated visual field testing.
Management of ocular hypertension and open angle glaucoma: Clinical practice and computer‐assisted decision‐making
Authors: Wanger Peter , Martin Lene
Published: May 2009

Purpose: To evaluate the feasibility of computerized decision support in the management of patients with open angle glaucoma or ocular hypertension.

Method: Based on a Swedish consensus document a computer program was developed, which provided one of 25 different recommendations for appropriate action. In 373 patient visits to seven different eye clinics, the program's recommendations were compared to the actual decisions made by the responsible ophthalmologists.

Results: Notable differences were observed between the clinics' management strategies, especially regarding follow‐up frequency and start or increase of anti‐glaucoma treatment. The program's recommendations conformed with the clinical decisions in 23 to 92% of the cases when a standard management strategy was simulated. The concordance increased to 93 to 100%, when policy differences between the clinics were taken into account.

Conclusion: Clinical decision‐making in the management of patients with ocular hypertension or open angle glaucoma can be implemented in a computer program. The optimum management protocol remains to be defined.
Phacoemulsification trabeculectomy compared to other methods of combined cataract and glaucoma surgery
Authors: Anand N. , Menage M. J. , Bailey C.
Published: May 2009

Purpose: To compare three methods of combined cataract extraction and glaucoma surgery.

Methods: Retrospective review of 35 eyes of patients who had extracapsular cataract extraction and trabeculectomy using a corneoscleral incision (SAME), 54 eyes undergoing extracapsular cataract extraction and trabeculectomy using a separated corneal incision for cataract extraction and 43 eyes undergoing pha‐coemulsification and trabeculectomy.

Results: Ninety‐one percent of the eyes in the SAME group, 85% of the SEPARATE group and 97% of the phacoemulsification and trabeculectomy group had an IOP <22 mmHg at 6 months with or without medication (NS). Postoperative visual acuity and astigmatism were not significantly different between the groups. The number of eyes requiring YAG laser capsulotomy was significantly greater in the extracapsular cataract extraction and trabeculectomy (same and separated incision) as compared to the phacoemulsification and trabeculectomy group (P< 0.001).

Conclusion: Phacoemulsification and trabeculectomy was not significantly more successful than the other methods of combined surgery. Although complication rates were similar, visual rehabilitation was faster and there was a reduced incidence of early posterior capsule opacification.
Interferon α for ocular Behçet's disease
Authors: Pivetti‐Pezzi Paola , Accorinti Massimo , Pirraglia Maria Pia , Priori Roberta , Valesini Guido
Published: May 2009

Purpose: To investigate the therapeutic role of interferon α in ocular Behçet's disease.

Methods: Three patients with B‐ or C‐hepatitis and ocular sight‐threatening Behçet's disease unresponsive to steroids were treated subcutaneously with interferon α 3 times 106/unit three times per week for a mean period of 22 months (range: 12–31 months). The course of ocular and systemic lesions was recorded and compared with a similar pre‐treatment period.

Results: At least a 50% reduction in the number of ocular relapses was observed in all the patients (mean relapse/month: 0.41 versus 0.16 in the pre‐ and in‐treatment period, respectively) while during therapy also each relapse lasted less in all subjects. A reduction of steroid dependence was observed in all patients, while no significant side‐effects were related to interferon α administration. Two patients who tried to stop interferon α therapy showed after a mean period of 12.5 days a recurrence of diffuse uveitis and, one of them experienced oral and genital aphthae as well.

Conclusion: In patients with Behçet's disease interferon α seems to be a useful alternative therapy for sight‐threatening ocular involvement.
Retinoblastoma which developed in microphthalmia
Authors: Lee Jong Soo , Shin Young Kun , Geun Jung , Oum Boo Sup
Published: May 2009

We report a rare case of retinoblastoma which developed in unilateral microphthalmia. A 4‐year‐old girl presented with a large, intraocular mass in microphthalmia without a family history of retinoblastoma. The eyeball was enucleated due to rapid growth of the intraocular tumor. Microscopically it proved to be a retinoblastoma with some Flexner‐Wintersteiner rosettes. This unusual case shows that retinoblastoma should not be excluded just because the eye is small, particularly if the family history is not available or is incomplete.
Five years' experience with the Grating Disc
Authors: Katsumi Osamu , Denno Sachiko , Chedid Siham G. , Hirose Tatsuo
Published: May 2009

The Grating Disc (GD) is a simplified visual test designed for children 18 months to 4 ˜ 5 years. Two hundred pediatric patients (103 males, 97 females; aged 5 months to > 6 years) participated in this study to determined how the GD visual acuity (VA) correlates with the Preferential Looking (PL) VA. Forty‐six percent of the patients had varying degrees of retinopathy of prematurity. The PL acuity was determined using the up‐and‐down staircase procedure. To measure GD acuity, six GDs with vertical gratings equivalent to acuities of 20/1920 to 20/60 were used. The examiner presented one GD simultaneously with the homogeneous disc from 57 cm. The VA was determined by the finest GD that the child could differentiate from the homogeneous disc. The overall correlation between the PL and the GD acuities was very high (R2 = 0.861). One hundred twenty‐eight patients (64.0%) had an acuity agreement within 0.5 octave and 178 (89.0%) patients were within 1.0 octave. When the PL acuity was ≥ 20/100, the GD and PL acuities showed good agreement. When the PL acuity was poorer, the GD acuity was poorer than the PL acuity. Although the GD acuity tended to be lower than the PL acuity in severely visually impaired patients, the GD acuity agreed with the PL in most visual assessments of young children. GD testing could be a useful alternative when sophisticated assessment systems such as the PL are unavailable.