bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and tomographic characteristics of anterior scleritis
Authors: Maamouri Rym , Aoun Safa Ben , Meriem Ouederni , Fatma Daoua , Zohra Aydi , Cheour Monia
Published: December 2022

Purpose: To describe clinical, etiological and tomographic features of anterior scleritis.

Methods: Retrospective case series study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between the 1st January 2021 and the 1st January 2022. Nine patients (12 eyes) with anterior scleritis were included. All patients underwent complete ophthalmic examination including anterior segment and fundus slit lamp examination. The cases were documented with multimodal imaging including anterior segment optical coherence tomography (AS‐OCT). All patients were referred to the internal medicine department for general examination.

Results: The median age of the patients was 37 years. 44% were male and 56% were female. Ophthalmic examination revealed diffuse conjunctival hyperemia and scleral vessel dilation with negative neosynephrine test in all eyes. The scleritis was bilateral in 3 patients, diffuse in 6 eyes, nodular in 5 eyes and necrotizing in 1 eye. One eye was complicated with angle closure glaucoma, 2 eyes had anterior uveitis, 1 eye had retinal vasculitis and 2 eyes were associated with posterior scleritis. AS‐OCT revealed a narrow anterior chamber and a closed angle in 1 eye, dilated scleral vessels in all eyes, thickening of the sclera in 11 eyes, dome‐shaped hyperreflective lesions corresponding to the nodules in 5 eyes and thinning of the sclera in the eye with necrotizing scleritis. Systemic disease was found in 7 patients. Main etiologies were tuberculosis in 3 patients and Behçet disease in 2 patients. The other two diagnosis were granulomatosis with polyangiitis and MacDuffie syndrome.

Conclusion: In our case series Behcet disease and tuberculosis were the main diagnosis of anterior scleritis. AS‐OCT could show different features of anterior scleritis depending on the clinical presentation and could consequently help to monitor the inflammation.
Analysis of retinal displacement by wide‐field retinography in combined vitreoretinal surgery at the Urduliz hospital
Authors: Costales‐Mier Felipe , Mendívil Estibaliz Ispizua , Salinas Gotzone Barbarias , Otxoa Iker , Ortega Concepción Hernaez
Published: December 2022

Purpose: To describe the findings of retinal displacement (RD) by autofluorescence (AF), and by Optomap imaging in patients with retinal detachment that underwent simultaneous scleral buckle (SB) and pars plana vitrectomy (PPV). Likewise, to describe the morphological findings by OCT‐SD and their association with the final visual acuity. Finally, assess the correlation of RD, depending on the use of gas or silicone oil (SO) as taponade.

Methods: Retrospective analysis of a series of 17 patients, operated by PPV and CE, with gaseous tamponades and SO. Postoperative funduscopic assessment was performed using Optomap (colour retinography and AF) and macular OCT.

Results: Of the 17 patients, 10 presented retinal displacement (58.82%), 9 with an inferior direction and 1 superior direction. The mean displacement distance being 0.185 mm. 80% of them were in the extramacular zone, and 20% in macular area. Superior RD was retinal redetachment case with SO as tamponade. On the OCT analysis, five patients presented alterations in the photoreceptor interdigitation zone, five patients developed an epiretinal membrane, one patient presented persistence of subretinal fluid. Half of those who suffered RD also presented alteration of photoreceptors. These were the ones with the worst VA (decimal VA 0.62 vs. 0.73 mean of all cases).

Conclusions: Retinal displacement assessed by wide‐field autofluorescence retinography, can be observed both in the early and later postoperative stages. It appears frequently in the inferior direction, as it seems to be more common when SO is used (75%) compared to a gas tamponade (53.8%). In patients with combined surgery, the proportion, direction, and rate of displacement seems to be similar to series previously described where isolated PPV or isolated SB is performed with pneumatic retinopexy, with gas tamponade. When SO is used as a tamponade, our series presents a higher RD rate than in isolated procedures. Apparently, the macular defects recorded in OCT occur mainly in patients associated with RD, especially in the macular area. To our knowledge, we have not found studies that describe the association of these findings in patients undergoing simultaneous SB and PPV procedure, requiring prolonged follow‐up of these patients, as well as possibly a larger number of them, in order to corroborate these findings.
Metallic intraocular foreign body removal assisted through the extrusion line
Authors: Costales‐Mier Felipe , Maeso Alicia Traveset , Cuesta‐Lasso Marta , Aguayo Javier
Published: December 2022

Purpose: To describe an alternative vitreoretinal surgical manoeuvre, to remove metallic intraocular foreign bodies.

Methods: Two patients, at different time lines, underwent vitrectomy to remove a metallic intraocular foreign body (IOFB). A 3‐port vitrectomy was performed, a 23‐G constellation vitrectomy equipment was used in both procedures, careful core vitrectomy was first done, vitreous adhesions and vitreous detachment was carefully done, retina was partially detached at the IOFB location, vitreous adhesions were cut and released gently not to increase the retinal detachment. Liquid prefluorocarbon was placed on the macula. As the vitreous adherences were cut, the IOFB was free from all potential tractional forces, the soft silicone tip cannula was held on to its surface, and at maximal vacuum aspiration, the IOFB was brought up to the anterior chamber, switching the light pipe for forceps in the other hand, and removed out of the eye. A complete as possible vitrectomy was performed, intraocular laser around the retinal brakes was performed, an intraocular lens was placed in the ciliary sulcus with the optic within the anterior capsule, and silicone oil was used as tamponade.

Results: No signs of intraocular inflammation were recorded postoperatively. Intraocular silicone oil removal was done at the third post‐operative month in both cases, retina remained attached through follow up, both patients had over 9 months follow‐up visits, visual acuity improved from initial presentation, and also improved after the silicone oil tamponade removal.

Conclusions: Active aspiration through the soft silicon tip cannula can be used to reach, and assist removal of metallic intraocular foreign bodies, being this manoeuvre safe, reproducible, possibly time‐saving, and also it could potentially avoid the risk of IOFB mobilization, avoiding further damage to the retina.
Correlations between visual function and inner retinal structure in OPA1 autosomal dominant optic atrophy
Authors: Pemp Berthold , Schrittwieser Johannes , Kircher Karl , Schmidt Wolfgang , Reitner Andreas
Published: December 2022

Purpose: To evaluate the influence of autosomal dominant optic atrophy (ADOA) on visual function and inner retinal layer thickness in patients harbouring a pathogenic variant in the OPA1 gene.

Methods: We retrospectively investigated clinical data of 59 patients (118 eyes) with ADOA and genetically confirmed OPA1 variants. Visual function was evaluated by best corrected visual acuity (VA), and by mean deviation (MD) of automated static threshold perimetry. Macular ganglion cell layer (mGCL) volume and peripapillary retinal nerve fibre layer (pRNFL) thickness were measured by optical coherence tomography. The analysis was performed for all available data from both eyes in the whole sample. Furthermore, patients were stratified in 2 groups based on variant type (haploinsufficiency: 86 eyes, missense variants: 14 eyes).

Results: The mean age at examination was 30.5 ± 16.1 years, VA was 0.55 ± 0.33 logMAR, MD was −4.73 ± 3.59 dB, mGCL volume was 0.60 ± 0.10 mm3, and pRNFL thickness was 63.8 ± 10.6 μm. VA correlated significantly with mGCL volume (p < 0.001) and with pRNFL thickness (p = 0.021). MD also correlated with pRNFL thickness (p = 0.017). Patient age was associated with mGCL volume (p < 0.001) and pRNFL thickness (p = 0.024), but not with VA or MD. MD was significantly lower in the missense group than in the haploinsufficiency group (−9.31 ± 4.07 dB vs. −4.03 ± 2.85 dB; p < 0.001), whereas VA did not differ between groups. Thickness of the pRNFL was also lower in the patients with missense variants, but only the nasal sector was significantly thinner (48.2 ± 12.8 μm vs. 58.2 ± 19.2 μm; p = 0.035).

Conclusions: Visual function and inner retinal structure are closely associated in ADOA patients with OPA1 variants. Increasing age may be accompanied by a continuing degeneration of retinal ganglion cells, but seems to have less effect on further loss of visual function. Patients carrying missense variants show more pronounced optic atrophy and visual field defect.
A screening tool to detect chronic ocular graft versus host disease in a haematology/oncology outpatient setting
Authors: Greenan Emily , Vandenberghe Elizabeth , Conneally Eibhlin , Gabhann‐Dromgoole Joan Ní , Murphy Conor
Published: December 2022

Purpose: To develop an effective and efficient screening tool for chronic ocular graft versus host disease (oGvHD) that could be integrated into a post‐allogeneic transplant follow‐up clinic.

Methods: Consecutive patients attending the post‐allogeneic transplant follow‐up clinic were recruited. Participants completed questionnaires before ophthalmic examination to prevent bias and were considered to have chronic oGvHD if they fulfilled either the National Institute of Health or International Chronic Ocular Graft‐vs‐Host‐Disease Consensus Group diagnostic criteria. PHASE I participants completed the Ocular Surface Disease Index (OSDI) questionnaire. In this instance a threshold score of >33 was considered suggestive of chronic oGvHD. PHASE II participants completed the OSDI as part of a new algorithm in which score of >33 in the context of daily ocular lubricant usage was considered suggestive of chronic oGvHD. Those diagnosed with chronic oGvHD were recruited into a prospective study. This aimed to correlate ocular surface disease severity which was scored using the Oxford Grading schematic and OSDI results during subspecialist treatment.

Results: PHASE I (n = 100) resulted in a sensitivity of 100%, specificity of 86.9%, positive predictive value (PPV) of 0.59, negative predictive value (NPV) of 1.0 and likelihood ratio (LR) of 7.3 (p < 0.0001). PHASE II (n = 68) resulted in 100% sensitivity and specificity with a PPV and NPV of 1.00 (p < 0.0001). Finally OSDI score and ocular surface disease severity was found to be strongly correlated (n = 65, 0.67, p < 0.0001).

Conclusions: An algorithm including the self‐administered OSDI questionnaire and a polar ‘yes/no’ question relating to ocular lubricant usage can be used to reliably and consistently identify patients with chronic oGvHD, triggering earlier referral to ophthalmology. The OSDI score strongly correlates with disease severity and will aid ophthalmologists to accurately triage patients with oGvHD referred to their care.
The relationships between mesopic light sensitivity and macular inner and outer retinal layer thicknesses in older healthy adults
Authors: Puell María , Moreira‐Estebaranz Carolina , Remis‐Gonzalez Melisa , Cedrun‐Sanchez Juan
Published: December 2022

Purpose: Structural and functional markers are important for the early detection of neurodegenerative diseases of the eye. This study investigates the relationships between macular layer thicknesses and mesopic light sensitivity (MLS) in older healthy eyes.

Methods: Measurements were made in 38 eyes of 38 healthy individuals of mean age 67 ± 5.6 years (range 60–80 years) and good visual acuity. MLS was measured with macular integrity assessment (MAIA) microperimetry at the central 10° diameter circle. MLSs at the central subfield (1° radius) and at four regions (temporal, nasal, superior, inferior) of the parafoveal ring (3°–5° radius of eccentricity) were registered. Total, inner, and outer retinal layer (IRL and ORL) thicknesses were measured in the macular region through spectral‐domain optical coherence tomography (SD‐OCT). Relationships between MLS and the retinal thickness in the corresponding macular region were examined using forward stepwise multiple linear regression analyses.

Results: ORL and IRL thickness in the inferior parafoveal ring were significant contributing factors to the inferior MLS (ORL: p < 0.0001; IRL: p = 0.0003; R2 model = 51%). Increased ORL thickness and decreased IRL thickness correlated with worse MLS. The total retinal thickness, age, sex, refractive error, axial length, retinal illuminance or visual acuity variables were not found to be significant predictors of MLS.

Conclusions: ORL and IRL thicknesses predict inferior parafoveal MLS in healthy older eyes. The measurement of MLS in combination with macular layer thicknesses may be useful for detecting loss of sensitivity caused by early degenerative diseases of the retina.
Performance evaluation of cataract surgery on a virtual reality simulator
Authors: Yu Zhaohua , Popa Alexandru , Söderberg Per
Published: December 2022

Purpose: To evaluate the cataract surgery performance of non‐experienced trainees on a virtual reality simulator.

Methods: Ten medical students familiar with the anatomy and physiology of the eye, but naive to cataract surgery, were admitted to the study. Each subject was introduced to the simulator and then registered 40 simulations spanning 10 consecutive days with 4 simulations each day. Each simulation contains two phases, the capsulorhexis plus sculpting phase and the evacuation phase. The simulator automatically measured 38 variables during the simulation. All the variables were converted to performance index previously formulated by Söderberg et al. to assess the performance in both phases.

Results: In the capsulorhexis plus sculpting phase the asymptote of the trainee overall performance index was, estimated as 95% CI, 0.9 ± 0.7 and a number of simulations needed to reach 90% of the asymptote was 37 ± 24, indicating that the performance asymptote of a naive trainee achieves approximately after 40 simulations. An average incidence of capsular damage was 30% for the first 10 simulations whereas 9% for the last 10 simulations. In the evacuation phase the trainee overall performance index of 1 which is equivalent to the reference performance index was reached within the first 5 simulations and quickly plateaued, and less performance variation and better performance correlated with more training on the simulator.

Conclusions: A high‐level performance asymptote occurs in the capsulorhexis plus sculpting phase after 40 simulations. In the evacuation phase performance asymptote can be reached at very early stage. Evacuation is less difficult than capsulorhexis plus sculpting.
Point‐of‐care diagnostic devices for dry eye disease
Authors: Shi Yuqi , Hu Yubing , Yetisen Ali
Published: December 2022

Purpose: Tears can be utilized as a surrogate medium for blood constituents to perform continual analyte measurements in point‐of‐care settings. This work aims to develop fluorescent tear lactoferrin sensor and implement the sensor on different point‐of‐care (POC) platforms for ocular health diagnosis through a smartphone camera‐based application.

Methods: The fluorescent lactoferrin sensor was developed based on the binding with trivalent terbium (TbCl3) and its sensitivity and selectivity were examined in Tris buffer solutions and artificial tear fluid (ATF). The lactoferrin sensor was then integrated on various platforms including lateral flow detection, capillary tube detection, and contact lens detection. A smartphone camera and 3D printed readout device were applied for data collection. The smartphone application was designed and employed for data processing.

Results: A relative high linearity of lactoferrin (0.0–5.0 mg/ml) in buffer solutions and ATF were achieved with a slope of 3.32 (R2 = 0.99) and 4.28 (R2 = 0.98) respectively. The linear regression for lactoferrin sensors in lateral flow sensing, capillary tube sensing and contact lens sensing platforms was 0.90, 0.93 and 0.97, respectively. Their corresponding limit of detection was yielded at 0.57, 0.12 and 0.44 mg/ml, respectively.

Conclusions: This work provides various platforms for sensitively and selectively tear lactoferrin monitoring at POC platform for potential clinical applications. The region of interest and auto‐exposure adjustment for smartphone application can be developed further in future experiments. The contact lens sensor is promings to provide patients with quantitative readouts to monitor ocular diseases continually.
Juvenile glaucomas and multi locus disease causing genomic variations
Authors: Gupta Viney , Somarajan Bindu , Gupta Shikha , Singh Abhishek , Mahalingam Karthikeyan , Sharma Arundhati
Published: December 2022

Purpose: Multilocus disease‐causing genomic variations (MGVs) and multiple genetic diagnoses (MGDs) are increasingly being recognized in individuals and families with Mendelian disorders. This can mainly be attributed to the widespread use of next generation sequencing (NGS) for the evaluation of these disorders. We conducted an NGS study of 40 juvenile onset open angle glaucoma (JOAG) families to evaluate the known and unknown gene mutations.

Methods: Whole Exome sequencing was undertaken for 40 unrelated trios (proband and both parents) where the proband had JOAG. Out of these, eight were autosomal dominant, while rest were non familial.

Results: Out of the 8 autosomal dominant JOAG families, MYOC mutations were detected in 3 (37.5%) and LTBP2 in 1 (12.5%). The family with LTBP2 mutation also had a MYOC mutation. One autosomal dominant family (12.5%) out of 8 had a rare EFEMP1 mutation in both affected father and daughter. The daughter also had Stickler syndrome (STL), that was later identified on observing a pathogenic COL11A1 mutation.

Conclusions: These findings underline the importance of genetic evaluation in systematic phenotyping families with JOAG for MGVs and MGDs.

References

1. Collantes ERA, Delfin MS, Fan B, Torregosa JMR, Siguan‐Bell C, Florcruz NVG, Martinez JMD, Masna‐Hidalgo BJ, Guzman VPT, Anotado‐Flores JF, et al. EFEMP1 rare variants cause familial juvenile‐onset open‐angle glaucoma. Hum Mutat. 2021. 43(2):240–252.

2. Stickler GB, Hughes W, Houchin P. Clinical features of hereditary progressive arthro‐ophthalmopathy (Stickler syndrome): a survey. Genet Med. 2001;3(3):192–6.
Evaluation of severity and time disease using new optical coherence tomography tool in multiple sclersosis patients
Authors: Ciordia Beatriz Cordón , Altabás María José Vicente , Tello Alvaro , Castro‐Roger Luisa , Palomar Elisa Viladés , Rodrigo Maria Jesus , Perié Manuel Subías , Campo Lorena Arias , Munuera Ines , Satue Maria , Garcia‐Martin Elena
Published: December 2022

Purpose: To assess the ability of Posterior Pole new protocol in optical coherence tomography (OCT) to detect areas with significant differences on retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thicknesses in patients with multiple sclerosis (MS) versus healthy controls; in addition, to assess the correlation between RNFL and GCL thicknesses, disease duration and the Expanded Disability Status Scale (EDSS).

Methods: We analysed 64 eyes of healthy controls and 100 eyes of remitting–relapsing multiple sclerosis (RR‐MS) patients by OCT Posterior Pole protocol. Analysis based on clinically definite time point (CDMS) dividing patients in two subgroups [CDMS‐1 (≤5 years) and CDMS‐2 (≥6 years)].

Results: Significant differences in RNFL and GCL were found between RR‐MS group and healthy controls, and also for each CDMS subgroups on both layers. Moderate to strong correlations were found between RNFL and GCL thicknesses and CDSM; furthermore, we observed a strong correlation with EDSS 1 year after OCT exam.

Conclusions: Posterior Pole protocol is a useful tool to assess MS; it can reveal differences even in early stages of the disease. RNFL thicknesses demonstrate strong correlation with disability status, while GCL correlates better with time of disease.
rho kinase inhibitor for primary open‐angle glaucoma and ocular hypertension ‐ a Cochrane systematic review
Authors: Freiberg Josefine Clement , von Spreckelsen Alexander , Azuara‐Blanco Augusto , Kolko Miriam , Virgili Gianni
Published: December 2022

Purpose: To compare the efficacy and safety of rho kinase inhibitor (ROKi) with placebo or other glaucoma medication in people diagnosed with open‐angle glaucoma (OAG), primary open‐angle glaucoma (POAG) or ocular hypertension (OHT).

Methods: We searched CENTRAL, MEDLINE, Embase, PubMed, LILACS, ClinicalTrials and ICTRP for randomized clinical trials and controlled clinical trials with no restrictions of type, year, and publication status. Two review authors independently screened, extracted data, and evaluated risk of bias.

Results: We included 17 trials (4953 participants) evaluating the efficacy and safety of marketed ROKI‐based drugs; netarsudil and ripasudil. Trial duration varied from 24 h to 12 months. The intraocular pressure (IOP) lowering effect of netarsudil may be superior to placebo (mean difference (MD) 3.11 mmHg 95% CI 2.59–3.62; low‐certainty evidence), but inferior to latanoprost (MD 0.97 mmHg 95% CI 0.67–1.27; moderate‐certainty) and timolol (MD 0.66 95% CI 0.41–0.91; low‐certainty). Combining netarsudil and latanoprost probably further reduces IOP compared with either netarsudil (MD 2.66 mmHg 95% CI 2.35–2.98; moderate‐certainty) or latanoprost (MD 1.64 mmHg 95% CI 1.11–2.16; moderate‐certainty). Combining ripasudil and timolol may probably reduce IOP compared with timolol monotherapy (MD 0.75 mmHg 95% CI 0.21–1.29; moderate‐certainty). The certainty of evidence reporting ocular adverse events (AEs) was very low or low. However, compared to timolol, netarsudil (21 additional ocular AEs per 100‐person‐months 95% CI 14–27; moderate‐certainty) and combination therapy with ripasudil/timolol (35 additional ocular AEs per 100 person‐months 95% CI 25–45; moderate‐certainty) probably lead to more ocular AEs. ROKi was not associated with any particular serious AEs.

Conclusions: The current evidence suggests that in people diagnosed with OHT or (P)OAG, the hypotensive effect of netarsudil may be inferior to latanoprost and slightly inferior to timolol. Combining netarsudil and latanoprost probably further reduces IOP compared with monotherapy. However, differences are small and may not be clinically significant. Netarsudil as mono‐ or combination therapy may result in more ocular AEs, but the evidence on AEs is limited.
Retinal blood flow and oxygen saturation in patients previously infected with COVID‐19
Authors: Lindner Theresa , Hommer Nikolaus , Kallab Martin , Schlatter Andreas , Nadvornik Clemens , Janku Patrick , Kauer Victoria , Rumpf Benedikt , Haslacher Helmuth , Garhöfer Gerhard , Schmidl Doreen
Published: December 2022

Purpose: The SARS‐CoV‐2 pandemic has affected all countries in the world and is still ongoing. Although respiratory symptoms are the main manifestation of acute infection, there is also increasing evidence that neurological and vascular symptoms occur, and it is unknown whether residuals remain after patients have recovered. We therefore set out to investigate whether ocular vascular alterations remain after patients have recovered.

Methods: Patients that had recovered from COVID‐19 infection within the last 6 months before inclusion and healthy age‐ and sex‐matched controls were recruited. Main inclusion criteria for patients were confirmed positive PCR test for SARS‐CoV‐2 in the medical history and positive testing for SARS‐CoV‐2 seroprevalence while controls had no history of COVID‐19 infection. Arteriovenous (AV) difference in oxygen saturation was calculated out of retinal arterial and venous oxygen saturation, which were measured with a commercially available Dynamic Vessel Analyser (DVA, Imedos, Germany). Retinal vessel diameters and arteriovenous ratio (AVR) were assessed using the same device. In addition, mean blur rate in the tissue area of the optic nerve head (MT) was quantified using laser speckle flowgraphy (LSFG, Nidek, Japan).

Results: 29 patients that had recovered from moderate to severe COVID‐19 requiring hospitalization (mean age 35 ± 17 years) and 11 control subjects (mean age 36 ± 12 years) were included in the present study. No differences between groups regarding sex or concomitant diseases in the medical history were found. Body mass index (BMI) was significantly higher in patients that had recovered from COVID‐19 (27.5 ± 5.6 vs. 24.5 ± 2.8 m2/kg, p = 0.036). AVR as well as AV difference in oxygen saturation was significantly lower in patients compared to healthy controls (p = 0.021 for AVR and p = 0.023 for AV difference in oxygen saturation). MT in the optic nerve head also was significantly lower in patients (23.4 ± 10.1 a.u.) than in control subjects (47.3 ± 26.6 a.u., p < 0.001).

Conclusions: The results of this study imply that retinal metabolism is still altered in patients after recovering from COVID‐19 infection. Longitudinal studies are required to investigate whether these changes in retinal vessels as well as optic nerve head blood flow are temporary or remain.
COVID‐19 vaccination and vision loss in three older male individuals homoplasmic for m.14484 T > C mutation in the ND6 gene
Authors: Votruba Marcela
Published: December 2022

Purpose: To report three older male individuals, all homoplasmic for m.14484 T > C mutation in the ND6 gene, presenting onset of vision loss weeks‐months after covid vaccination. None reported a history of covid‐19 infection.

Methods: All clinical data was extracted and reported here as a Case Series.

Results: A 68 years old man (A) had a 3rd dose of BioNTech/Pfizer COVID‐19 vaccination on 1st Nov 2021. 10 days later his vision was 6/6 OD and 6/60 OS. By Dec 2021 VA was 6/36 OD and 6/60 OS. His nephew lost vision age of 18 years with LHON. In March 2022, visual acuities were HM OD and HM OS. In May 2022 visual acuity was HM OD, PL OS. He started on idebenone 300 mg tds.

A 55 years old man (B) had a 1st dose Astra Zeneca COVID‐19 vaccination in mid Feb 2021. 12 days later, March 2021 he developed a Bell's Palsy and sensory neuropathy at the top of his legs, feet and upper arms, with difficulty walking. MRI showed enhanced optic nerves and enhanced lesions at C2. In April 2021, he lost vision in his right eye, followed by left eye in June 2021. By September 2021 vision was CF BEs. He started on idebenone 300 mg po tds. In May 2022 he was LogMAR @ 2 m 1.34 OD and MH OS.

A 72 years old man (C) had his 2nd dose of BioNTech/Pfizer COVID‐19 vaccination in April 2021. In Sept 2021 he reported loss of vision in both eyes but could not date onset. He was the maternal cousin of individual B. In May 2022 vision was 3/60 OD CF OS. He started on idebenone 300 mg po tds.

Conclusions: Adverse ocular events related to COVID‐19 vaccines are remarkable rare. There are >20 published case reports (~89 patients) of adverse ocular events within 28 days of COVID‐19 vaccination, with all three vaccines (Pfizer, AstraZeneca and Moderna). Reports incl. conjunctivitis, facial and abducens nerve palsy, CSR, uveitis, MEWDS, VKH, Graves' Disease, endothelial graft rejection, AAION and AZOOR. The role of vaccination in subsequent vision loss in those with underlying mitochondrial mutation is not clear.
Ocular surface assessment of preserved and preservative‐free brimonidine tartrate in glaucoma patients: A parallel‐grouped comparison trial
Authors: Kim Myungjin , Rho Seungsoo , Lee Chang Kyu , Kim Ko Eun , Shin Jonghoon , Kim Eunsol
Published: December 2022

Purpose: To evaluate and compare the efficacy and safety of preservative‐free and preserved brimonidine tartrate 0.15% in open‐angle glaucoma and ocular hypertension.

Methods: We conducted a multicenter (four institutions), randomized, investigator‐masked, parallel‐group clinical trial. A total of 60 eyes of 60 patients with intraocular pressure (IOP) ≥ 15 mmHg diagnosed with open‐angle glaucoma or ocular hypertension were randomized to preserved (n = 31) and preservative‐free (n = 29) brimonidine groups. Enrolled eyes received three times daily monotherapy of brimonidine. Main outcome measures were corneal/conjunctival staining score, ocular surface disease index, patient satisfaction score, drug tolerance, and drug adherence rate at 12 weeks after the first administration. Secondary outcome measurements included visual acuity, IOP, drug tolerance, tear‐film break‐up time, hemodynamic changes including blood pressure and heart rates, and ocular adverse events.

Results: After 12 weeks, both preserved and preservative‐free groups showed similar amount of IOP reduction, corneal and conjunctival staining score, drug tolerance, and adherence rate. The preservative‐free group showed significantly better TBUT and higher patient satisfaction with regard to drug use and management. The reduction amount of systolic and diastolic blood pressures during 12 weeks were significantly lower in the preserved group than the preservative‐free group.

Conclusions: Preservative‐free brimonidine tartrate showed comparable efficacy and safety with better corneal tear film stability and patient satisfaction compared to preserved brimonidine.
Estimation of the adherence to Mediterranean diet by Greek glaucomatous patients
Authors: Vlachogianni Ioanna , Chatzistefanou Klio , Droutsas Konstantinos , Moschos Marilita
Published: December 2022

Purpose: An estimation of the nutritional profile of patients with primary open angle glaucoma (POAG). We focused on the evaluation of the adherence to Mediterranean diet in Greek population.

Methods: An observational study was conducted to assess the adherence to the Mediterranean diet in patients who attended the General Hospital of Athens G. Gennimatas. An experienced dietitian interviewed both healthy and glaucomatous patients and filled the Med Diet Score (range 0–55). The scoring includes food groups close to Mediterranean dietary pattern like non‐refined cereals, fruits, vegetables, legumes, olive oil, fish and potatoes.

Results: A total of 132 questionnaires were completed successfully by 64 healthy and 68 patients. Both groups were equally distributed for sex (50/50 males/females) and age (71.9 years ± 10). The overall adhesion to the Mediterranean diet was similar in both groups with the majority of them (around 80%) having moderate adherence. There is no difference between 2 groups for Body Mass Index (BMI), dietary supplements and salt consumption, smoking habits or comorbidities like diabetes type II and hypertension.

Conclusions: There is no data concerning adherence to Mediterranean diet in Greek glaucomatous patients. This study indicated that both healthy and glaucomatous patients have moderate adherence to the Mediterranean diet.

Reference

1. Demosthenes B Panagiotakos et al. Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med. 2007;44(4):335–40. doi: 10.1016/j.ypmed.2006.12.009.
clinical grade of genetically corrected RPE cells for autologous cell therapy of hereditary retinal dystrophies
Authors: Ureña‐Peralta Juan , Brymova Anna , Mayordomo Noelia Pimentel , Jendelova Pavla , Ardan Taras , Studenovska Hana , Motlik Jan , Petrovski Goran , Erceg Slaven
Published: December 2022

Purpose: The generation of genetically corrected RPE cells from patient‐derived human induced pluripotent stem cells (hiPSCs) may provide a source for autologous therapeutically‐relevant therapy for this rare retinal dystrophy as well to create the human cellular disease models. Recently we generated a faithful RPE model from patient bearing mutation in MERTK gene and genetically corrected these cells using CRISPR/Cas9 system. For further application in humans is necessary to differentiate the hiPSC towards RPE in clinical grade conditions.

Methods: The RPE cells from the genetically corrected patient‐derived hiPSC (1 and 2 alleles) as well as patient's RP‐hiPSC and control healthy hiPSC were characterized using immunocytological methods for the differentiation and polarization markers, electronic microscopy, RT‐PCR, TEER measurement, ELISA test, Western Blot and phagocytic assay.

Results: All generated RPE cells exhibit typical features of RPE cells We demonstrated the reestablishment of the expression of full‐length MERTK protein as well as the reversion of lost phagocyte function of hiPSC‐RPE in vitro, which represents the first example of its kind in this field.

Conclusions: The generated hiPSC‐derived RPE in clinical grade conditions display the typical characteristics of mature RPE cells re‐establishing the function of phagocytosis in genetically corrected patient‐derived RPE cells in vitro. Functional in vivo studies in animal models such as RCS rats or larger animals will confirm whether this strategy can completely restore the vision and be employed as a potential treatment for patients.
Cyclodiode vs micropulse transscleral laser treatment
Authors: Kelada Monica , Bloom Philip , Normando Eduardo Maria
Published: December 2022

Purpose: Continuous wave transscleral cyclophotocoagulation (CW‐TSCPC), is reserved for refractory glaucoma with poor visual potential due to its complication rate, attributed to continuous energy damaging adjacent tissues. Micropulse (MP‐TSCPC), however, utilizes short energy pulses separated by ‘off’ periods, and is associated with a lower complication rate. The National Institute for Health and Care Excellence has deemed evidence surrounding MP‐TSCPC as inadequate, limiting its use to research purposes. This study aims to evaluate the efficacy and safety of MP‐TSCPC compared to CW‐TSCPC. It also aims to investigate whether glaucoma type affects treatment outcomes.

Methods: This retrospective study included 86 CW‐TSCPC eyes and 188 MP‐TSCPC eyes at a London tertiary centre. Follow‐up was conducted for 24‐months. Primary outcome was overall treatment success defined as success at the last available follow‐up. Success required at least 20% IOP reduction, with the same or fewer medications, and IOP between 6–18 mmHg (complete success)/19–21 mmHg (qualified success). Secondary outcomes were retinal nerve fibre layer (RNFL) thickness progression, and visual field (VF) change. Safety outcomes were visual acuity (VA) and complication rate.

Results: 24‐months success rate was 27.6% for CW‐TSCPC and 30.1% for MP‐TSCPC, p = 0.96. Average IOP was reduced by 44.8% (CW‐TSCPC) and 26.5% (MP‐TSCPC) from baseline 19.0 ± 3.0 mmHg and 19.1 ± 2.2 mmHg, respectively. Both interventions significantly reduced glaucoma medications at 24‐months (p ≤ 0.05). The proportion of patients experiencing complication(s) was significantly higher after CW‐TSCPC (32.9%) vs MP‐TSCPC (16.2%, p = 0.002). Both procedures displayed VA worsening. RNFL thickening rate was greater following CW‐TSCPC (p = 0.31). MP‐TSCPC reduced VF loss rate significantly among severe disease (p = 0.04).

Conclusions: Both interventions demonstrated similar success rates, and reduced IOP and glaucoma medications. MP‐TSCPC displayed minimal complications. There was no clear association between glaucoma type and treatment outcomes. Further prospective studies, with measures of medication compliance, are required to further evaluate MP‐TSCPC efficacy and safety compared to CW‐TSCPC.
Implantation of a novel glaucoma drainage with a small lumen silicone tube in rabbits: A pilot study
Authors: Kim Myungjin , Rho Seungsoo , Han Jongchul , Kim Eunsol , Kim Hae Rang
Published: December 2022

Purpose: To assess surgical safety and expert usability of a novel glaucoma drainage implant with a smaller lumen compared to conventional silicone tubes.

Methods: The newly constructed devices have been implanted via a specially designed injector system in 4 eyes of 4 New Zealand White rabbits, and their intraocular pressure was measured on days 7, 14, 21, and 28 postoperatively. The histopathologic evaluation was done after the 1 month‐follow up period using H&E staining and Masson‐trichrome staining. For the implantation, a limbal incision without mitomycin‐C (MMC) was performed in one eye, and a fornix incision with MMC was performed in three eyes.

Results: The histologic sections showed well‐tolerated tissue response in all 4 eyes. All eyes showed filtering blebs on day 28 except one eye that had a buttonhole during the implantation. IOPs were better controlled in the 2 eyes done fornix incision with MMC plus without the buttonhole than other 2 eyes (6 mmHg vs 12.5 mmHg at day 28). The device was highly visible during the procedure of operation and had the flexibility to fit the surgeon's various procedures.

Conclusions: The novel glaucoma drainage implant was effective and flexible to fulfil the surgeon's need in a pilot study with rabbits.
Leber congenital amaurosis and early onset severe retinal dystrophy in the Czech Republic: Mutational spectrum and clinical findings
Authors: Vajter Marie , Kousal Bohdan , Moravikova Jana , Chylova Monika , Dudakova Lubica , Stankova Daniela , Boday Arpad , Krutilkova Vera , Liskova Petra
Published: December 2022

Purpose: Leber congenital amaurosis (LCA)/early onset severe retinal dystrophy (EOSRD) is a group of ultra‐rare retinal diseases with an estimated prevalence of 1/80 000. The aim of this study was to perform a detailed clinical characterization in patients with LCA/EOSRD confirmed at the DNA level.

Materials and methods: 16 patients (eight females, eight males) from 16 families underwent ocular examination in the Department of Ophthalmology, 1st Faculty of Medicine and General University Hospital in Prague between the years 2010–2021. Pathogenic variants in genes associated with LCA/EOSRD were searched using targeted gene panels, exome and/or genome sequencing. Confirmation of the presence of causal variants and segregation within the families was performed by Sanger sequencing. Next we have performed review of available clinical documentation of five additional probands examined elsewhere in the Czech Republic.

Results. The mean age at the first examination was 17.8 years (range 2–42 years). The mean age of symptoms onset was 1,99 years (range 6 weeks to 5 years). In five patients, the disease was caused by biallelic mutations in the RPE65 gene, in 4 patients in the CEP290 gene and in three patients in the CRB1 gene. Biallelic mutations in the GUCY2D, LCA5, RPGRIP1 and CLN3 genes were the cause of the disease in one patient each. As for probands suffering from LCA/EOSRD and examined elsewhere two were documented carriers for pathogenic variants in the CEP290 gene, two in the CRB1 gene and one in the GUCY2D gene.

Conclusions: This is the first study presenting molecular genetic and clinical characteristics of patients with LCA/EOSRD from the Czech Republic. Biallelic mutations in the CEP290 gene are the most common genetic cause of LCA/EOSRD in our patient group.

This work was supported by NU20‐07‐00182; EJPRD19‐234 Solve‐RET.
ELAVL1/HuR regulates both endo‐ and exogenous neuroprotection in retinal ganglion cells
Authors: Smedowski Adrian , Pacwa Anna , Liu Xiaonan , Machowicz Joanna , Rodak Piotr , Pietrucha‐Dutczak Marita , Akhtar Saeed , Amadio Marialaura , Lewin‐Kowalik Joanna
Published: December 2022

Purpose: To evaluate the impact of HuR gene silencing on the ratio of age‐related degeneration of Retinal Ganglion Cells (RGC), which potentially describes the efficiency of endogenous neuroprotection mechanisms, as well as to assess the exogenous neuroprotection capacity of HuR‐ silenced RGC in rat glaucoma model treated with Metallothionein.

Methods: Thirty‐five eight‐week‐old male Long Evans rats were divided into two groups: experimental and control. Animals from experimental group received intravitreal injection of AAV‐shRNA‐HuR. Control group received injection of AAV‐shRNA scramble control. Animals from both groups were sacrificed in 3 different time points: 2, 4 and 6 months after injection. Both healthy and treated retinas from each animal were collected and processed as whole mounts for immunostainings and RGC count. For the second trial, animals were divided into groups and transfected with virus particles as described above. To induce chronic glaucoma model, 8 weeks after AAV injection, unilateral episcleral vein cauterization was performed. Half of animals from each group received intravitreal injection of Metallothionein (MT), the other group received PBS injection. During the experiment IOP was monitored. Both healthy and treated retinas from each animal were collected and processed as whole mounts for immunostainings and RGC count.

Results: RGC count (per visual field under 20× magnification) was 310 ± 31, 296 ± 25, 189 ± 41 in experimental group and 399 ± 51, 395 ± 49, 390 ± 23 in control respectively for 2, 4 and 6 months after injection (Kaplan‐Mayer trend rank p < 0.0001). Loss of RGC in central retina was 33.7% in animals from shRNA‐MT‐treated glaucoma and 11.4% in shRNA control‐MT‐treated glaucoma (p < 0.05). In peripheral part of the retina the loss was 37.4% in animals from shRNA‐MT‐treated glaucoma and 11.5% in shRNA control‐MT‐treated glaucoma (p < 0.01).

Conclusions: Silencing of hur gene enhanced age‐related loss of RGC which translates into impaired endogenous neuroprotection pathways, moreover the absence of HuR critically limits neuroprotective activity of exogenously delivered Metallothionein.
Spontaneous corneal perforation in treatment‐resistant MPO‐ANCA‐associated small vessel vasculitis
Authors: Zehnder Karin , Reinhold Aja , Gugleta Konstantin , Gatzioufas Zisis
Published: December 2022

Purpose: Spontaneous corneal perforation is a rare complication in peripheral ulcerative keratitis (PUK). Identifying the systemic cause of PUK is essential for optimal treatment. MPO‐ANCA‐associated small vessel vasculitis is a potential cause of PUK. Being an autoimmune disorder, immunosuppressive therapy is indicated. Besides steroids, biologicals such as rituximab can be used with excellent results.

Methods: In this case report, we would like to present a 83‐year‐old male patient with PUK caused by MPO‐ANCA‐positive small vessel vasculitis.

Results: In this patient with PUK due to small vessel vasculitis, a spontaneous corneal perforation could not be prevented despite maximal immunosuppressive therapy. Thus, a tectonic penetrating keratoplasty à chaud was inevitable.

Conclusions: Ophthalmologists should be aware of the rare complication of corneal perforation secondary to PUK caused by vasculitis.
Metabolic long‐term monitoring of transcorneal electrical stimulation in retinitis pigmentosa
Authors: Zabek Olga Maria , Meral Nesrin , Zuche Hanna Camenzind , Müller Ursula , Prétot Dominique , Rickmann Annekatrin , Scholl Hendrik Peter Nicolas , Volpe Waizel Maria della
Published: December 2022

Purpose: Transcorneal electrical stimulation (TES) is a new therapeutical approach for retinitis pigmentosa (RP). With progression of RP, degeneration of photoreceptors results in lower oxygen consumption of the retina. Retinal oximetry (RO) is a noninvasive method to analyse oxygen saturation in retinal vessels and has shown promising short‐term results as a therapy monitoring tool for TES. The aim of our study was to measure the long‐term effects of TES on RO parameters over a period of 3 years (3Y).

Methods: A total of 18 eyes of 9 subjects (5♀ 4♂) suffering from RP were examined at baseline (BL), 6 months, and 3Y of TES (OkuStim®) treatment. TES was performed for 30 min once a week at 200% of the individual phosphene threshold simultaneously on both eyes. The oxygen saturation was examined at BL and following TES therapy with the oxygen saturation tool of the Retinal Vessel Analyser (IMEDOS Systems UG, Jena, Germany). The global oxygen saturation parameters (in %), within 1.0–1.5 optic‐disc diameters from the disc margin, in retinal arterioles (A‐SO2) and venules (V‐SO2) were measured and their difference (A‐V SO2) was calculated. In addition, we recorded the diameters in the main arterioles (D‐A) and venules (D‐V). ANOVA‐based linear mixed‐effects models were employed for statistical analysis using SPSS®.

Results: After 3Y of TES treatment both the mean A‐SO2 (from 96.35 ± 12.76% to 100.89 ± 5.87%, p = 0.22) and V‐SO2 (from 62.20 ± 11.55% to 64.55 ± 8.24%, p = 0.77) increased slightly. The A‐V SO2, which corresponds to the oxygen consumption of the retina, presented also with a slight increment from 34.15 ± 9.68% at BL to 36.23 ± 7.71% without reaching statistical significance (p = 0.27). TES also did not appear to alter the vascular diameter parameters, D‐A and D‐V (p > 0.05).

Conclusions: Our long‐term observations indicate that TES therapy in RP might lead to a slight increment in oxygen consumption of the retina. However, a larger cohort and longer duration may be needed to adequately power a follow‐up study and to confirm this trend reflecting a possible benefit of TES for RP.
Comparison of three types of scleral fixation of intraocular lens
Authors: Byun Zeeyoon , Kong Mingui
Published: December 2022

Purpose: To compare the clinical outcomes of three different surgical methods of scleral fixation of intraocular lens (IOL); Conventional Ab‐externo sutured scleral fixation, modified Yamane sutureless fixation and Four‐point scleral fixation.

Methods: This was a single referral center, one surgeon, retrospective study. Main outcome measures included best‐corrected visual acuity (BCVA), spherical equivalent (SE) and surgically induced astigmatism (SIA). To find out how much astigmatism purely occurred by surgery, excluding the effect of corneal astigmatism, SIA was calculated at 1 year after surgery. Clinical outcomes were compared before and 1‐, 3‐, 6‐ and 12‐month follow‐ups after the operation.

Results: Total 75 eyes underwent scleral fixation of IOL: 22 eyes in the 4‐point fixation, 30 eyes in the modified Yamane and 23 eyes in the conventional sutured group. From 1 month after surgery, mean BCVA recovered significantly faster in the order of 4‐point, modified Yamane and conventional groups (0.12 ± 0.11 vs. 0.25 ± 0.21 vs. 0.34 ± 0.25 logMAR, p = 0.004), also showed the same tendency in cylindrical error values (−1.15 ± 0.77 vs. −1.54 ± 0.94 vs. −2.06 ± 1.56 diopter, p = 0.031). The modified Yamane group had the shortest operation time and the conventional group was the longest (7.25 ± 1.22 vs. 18.44 ± 4.05 vs. 25.19 ± 6.26 min, p < 0.001). In terms of SIA, 4‐point fixation caused significantly less astigmatism (1.13 ± 0.59 vs. 1.67 ± 1.02 vs. 2.43 ± 1.42 diopter, p = 0.001).

Conclusions: 4‐point fixation technique showed the strengths of faster vision recovery, less cylindrical error and lower SIA values. The modified Yamane group had the shortest operation time attributed to the relatively simple procedure, however, has a weakness with the higher complication rate of IOL malposition, which might require reoperation. Both techniques have each pros and cons, but provide more favourable clinical outcomes than the conventional sutured fixation.