bluuebunny/crossref_metadata_2025 huggingface dataset:
Presentation of orbital aspergillosis
Authors: MISSOTTEN GS , DE KEIZER RJW
Published: September 2008

Purpose To describe the presentation, diagnostic difficulties and treatment in three rare cases of aspergillosis of the (peri)orbita.

Methods Retrospective reportage of three patient histories.

Results The first patient, known with leukemia, presented with total vision loss and ophthalmoplegia. Clinical suspicion was raised for a sinus cavernosis and apex syndrome, but could not be revealed by imaging at first, but only later in the disease progression. The patient was treated with chemotherapy and Amfotericine, but died few weeks later. A second patient presented with complaints with bilateral decrease of visual acuity and sinusitis. No process could be revealed in the cavernous sinus, but bilateraly in the ethmoids. An endonasal ethmoidectomy was done, and oral steroids were given, with good result. A third patient was referred with diplopia since four days. CT‐scan together with MRI made the suspicion of fungal disease with found after tumor excision of the sphenoid MRI showed at first desctruction of the sella floor, without intraorbital infection but forced duction invasion toh orbit. The patient was treated with amphotericin and itraconazole with vanishment of the infection in one month.

Conclusion These three cases with aspergillosis infection show that a combination of MRI and CT may be necessary to locate the infection but clinical suspicion and symptoms may be present before imaging can reveal them.
Management of ocular disease in epidermolysis bullosa variant: Laryngo‐onycho‐cutaneous (LOC) syndrome
Authors: ARALIKATTI A , KADYAN A , SHAH S
Published: September 2008

Purpose To assess the long term outcomes of ocular surface reconstruction and immunomodulation in Laryngo‐onycho‐cutaneous (LOC) syndrome

Methods Prospective, interventional, case series

Results Four children with LOC were treated by multiple operations involving excision of ocular granulation tissue and amniotic membrane graft reconstruction. The clinical course was monitored for an average period of 4.7 years +/‐ 2 SD (range 3 to 7 years). In all patients, surgical intervention was successful in the medium term with regression of granulation tissue, visual improvement and symptomatic relief from ocular discomfort. Granulation tissue recurred in 8 months (3.7 SD). One patient received Thalidomide trial which stabilized systemic manifestations but had limited effect on ocular disease progression. Immunomodulation with Infliximab infusions stabilized ocular disease in all patients. All patients had stabilisation or slight improvement in vision.

Conclusion Ocular disease in LOC syndrome can be successfully managed with repeated amniotic membrane grafts and immunomodulation. The treatment is effective in maintaining the ocular surface integrity and managing the symptoms of ocular inflammation, although long term visual outcomes remain disappointing.
IOL filters, is there an optimal absorption?
Authors: SÖDERBERG PG , ZOEGA G
Published: September 2008

Purpose To analyze the need for optical filtering in IOLs

Methods The spectral distribution of radiation from the sun, the action spectra for diurnal rhythm regulation and vision, and the action spectra for phototoxic effects in the aphacic and pseudophacic eye were analyzed.

Results Ultraviolet radiation (UVR), visible radiation and infrared radiation from the sun reaches the surface of the earth. In the aphacic eye, the retina is exposed to considerable amounts of toxic optical radiation. At the same time, optical radiation is required for vision and diurnal rhythm regulation. Therefore, an IOL needs to block toxic radiation while conserving enough light for vision and diurnal rhythm regulation. The cornea blocks out UVR below 290 nm and then gradually transmits more toward longer wavelengths. The aqueous humor and the vitreous provide some additional blocking of UVR up to 320 nm but then transmits large amounts of longer wavelength radiation up to 1400 nm. In the phacic eye, the crystalline lens, age dependently, blocks out UVR and short wavelength visible radiation. Diurnal rhythm is regulated by melatonin and the action spectrum for the regulation has a maximum around 450 nm. Scotopic vision has a maximum sensitivity around 505 nm and photopic vision around 555 nm. UVR is increasingly toxic towards shorter wavelengths. Visible light causes a retinal Type I phototoxicity with a maximum action around 505 nm and a Type II phototoxicity with a maximum action around 440 nm.

Conclusion It is possible and desirable to block the UVR hazard and the Type II phototoxic reaction with conserved diurnal rhythm regulation and scotopic and photopic vision with IOLs.
Macular pigment and its contribution to spatial vision
Authors: MUKUNDA CHAITANYA A , LOUGHMAN J , NOLAN JM , BEATTY S , O'DWYER V , DAVISON PA
Published: September 2008

Purpose The optical properties and distribution of macular pigment (MP) are such that it may theoretically contribute to visual performance by attenuating the effects of chromatic aberration and light scatter. We assess whether MP optical density (MPOD) influences spatial vision by means of selective short wavelength light absorption prior to photoreceptor light capture.

Methods 51 young (mean=29+/‐6 years) healthy subjects were recruited. The spatial profile of MPOD was assessed by customised heterochromatic flicker photometry. Visual performance was assessed by psychophysical tests including recognition acuity (VA), mesopic and photopic contrast sensitivity. Each subject completed a visual performance questionnaire, generating a performance index of the subjects’ perception of their functional vision.

Results Mean peak MPOD was 0.39+/‐0.14. Pearson’s correlation coefficient showed a statistically significant positive relationship between VA and MPOD at 0.25deg and 0.5deg retinal eccentricity (r=0.345 p=0.013; r=0.317 p=0.024 respectively); the questionnaire derived VA index (VAI) also correlated strongly with MPOD at 0.25deg (r=0.281 p=0.046). Photopic and mesopic contrast thresholds exhibited an inverse and statistically significant correlation with central MPOD (mesopic contrast threshold @ 5.7 cycles/deg and MPOD at 0.25deg: r=‐0.394 p=0.004; photopic contrast threshold @ 5.7 cycles/deg and MPOD at 0.25deg: r=‐0.313 p=0.027).

Conclusion Our results support the hypothesis that retinal image quality is optimised, and visual performance across the full contrast range is more refined, with higher levels of MP. The findings are limited by the observational nature of this study. However, further interventional studies are warranted.

Commercial interest
No‐induced retinal vasodilatation is maintained in type 1 diabetes
Authors: PEMP B , GARHOFER G , WEIGERT G , KARL K , WOLZT M , SCHMETTERER L
Published: September 2008

Purpose Various studies have shown that retinal vessels in patients with diabetes mellitus have a reduced capacity to adapt to changes of perfusion pressure. The mechanisms lying behind this abnormal autoregulation have not been completely identified yet. Histomorphological changes of retinal vessels in diabetes could possibly reduce their capacity of vasodilation and vasoconstriction. To test this hypothesis we compared the response of retinal vessel diameters to systemic glyceryl trinitrate (GTN) in patients with diabetes and healthy controls.

Methods 20 patients with insulin dependent diabetes mellitus featuring no or mild non‐proliferative diabetic retinopathy were included into this study. In addition, 20 healthy and age‐matched subjects were included as controls. Retinal vessel diameters were measured before and immediately after sublingual application of 0.8 mg of the NO‐donor GTN. The IMEDOS Retinal Vessel Analyzer was used for continuous measurement of diameters of retinal arteries and veins.

Results Oral application of GTN induced vasodilatation of retinal arteries and veins. This effect was not different between patients with diabetes and healthy controls. Systemic arterial blood pressure was reduced in both groups after GTN application, but to a comparable degree.

Conclusion The present study indicates that in patients with no or mild non‐proliferative diabetic retinopathy the vasodilatory response of retinal vessels to a direct NO‐donor is maintained. This indicates that abnormal retinal autoregulation in diabetes mellitus, as observed previously, is not a consequence of generally reduced retinal vascular reactivity.
Lipid and fatty acid profile of the retina, RPE/choroid and lacrimal gland, and associations with dietary fatty acids in human subjects
Authors: BRETILLON L , THURET G , GREGOIRE S , ACAR N , JOFFRE C , BRON AM , GAIN P , CREUZOT CP
Published: September 2008

Purpose The contribution of dietary lipids to the accumulation of lipids in the retina during ageing and in the course of age related maculopathies remains under debate. Our objective was to establish associations between fatty acid profiles of ocular structures, and adipose tissue as a surrogate for the past dietary intake of the subjects.

Methods Lipids and fatty acids were analyzed by tandem thin‐layer chromatography‐flame ionization detection and gas chromatography‐flame ionization detection from the neural retina, RPE/choroid, lacrimal gland and adipose tissue, collected from 19 women and 8 men, aged 59–95 years.

Results DHA concentrations in the neural retina were positively associated with those in cholesteryl esters (CE) from RPE/choroid, and negatively associated with DHA concentrations in phospholipids (PL) from RPE/choroid. DHA in orbital fat was positively associated with DHA in lacrimal gland, whereas no significant association was observed in the other ocular structures. Linoleic acid in orbital fat was positively associated with linoleic acid in the lacrimal gland, followed by neural retina and CE from RPE/choroid, and slightly correlated with PL from RPE/choroid. Other fatty acids that are exclusively of dietary origin such as trans fatty acids were detected in orbital fat, lacrimal gland, PL and CE from RPE/choroid.

Conclusion DHA in the neural retina was poorly associated with its dietary intake, on the contrary to others fatty acids like linoleic acid. Although epidemiological studies have reported the benefit of dietary DHA for the prevention of AMD, the relevancy for supplementing patients with DHA is questioned.
Comparison of Lucentis monotherapy vs. combination therapy for neovascular AMD
Authors: PHAN AP , JACOBS DJ , BOWMAN KB , FORSEY ZF
Published: September 2008

Purpose To compare the efficacy of neovascular AMD(NAMD) treatment options by monthly Lucentis(L)(monotherapy), combination therapy utilizing RF‐PDT(P), and Lucentis combined with Kenalog(LK).

Methods IRB‐approved retrospective chart review of therapies administered only as‐needed over 20 months. Inclusion criteria: active primary/recurrent subfoveal or juxtafoveal CNV (all types); Snellen BCVA ≥20/400. Exclusion criteria: f/u <3 months or noncompliance; subfoveal atrophy/fibrosis. Kenalog offered with Lucentis when active PED or subretinal fibrosis threatening fovea. RF‐PDT combined with Avastin ± Kenalog(PA±K) or Kenalog alone(PK). Primary outcome measure: mean change in Snellen VA from baseline at last f/u. Secondary outcome measures: incidence of moderate/severe VA change; resolution of leakage; treatment‐free interval.

Results 21 eyes received L; 16 eyes LK; 10 eyes RF‐PDT (5 PA±K; 5 PK). Mean f/u was 8.8 (range 3–18) months. At last f/u, mean Snellen VA for L improved ‐0.25; RF‐PDT remained stable +0.06 overall (although PA±K improved ‐0.135; PK worsened +0.27); LK worsened +0.13 logMAR units (p=0.02 for L vs. LK). VA loss <15 letters was greater for L>PA±K>LK>PK, occurring 91%, 80%, 75%, 60%, respectively. 14% L gained ≥30 letters. 20% PK lost ≥30 letters. Leakage resolved greater for L>PA±K>LK>PK, occurring 86%, 80%, 69%, 40%, respectively.

Conclusion At intermediate‐term f/u, Lucentis monotherapy administered only as‐needed had results similar to larger studies and was the most effective in maintaining or improving VA in NAMD. Lucentis monotherapy had the greatest leakage resolution and treatment‐free interval. RF‐PDT with Avastin was more effective than with Kenalog alone. Kenalog supplementation to Lucentis unlikely provided added benefit.
Open evaluation of science: can we simply say "no, thank you?"
Authors: STEFANO G
Published: September 2008

In today’s world of information doubling at faster rates because of rapid technological and biomedical advances nations must pay closer attention to the productivity and creativity that can be obtained from their universities. A professor’s intellectual property may have important patent consequences. Thus, universities must foster lines of communication that aid the professor in making critical decisions not only about the advance but its potential to generate a revenue stream. In the same light, universities must also be able to evaluate the contribution and the potential of a lab to make future contributions in an objective manner since all laboratories and projects cannot be funded in a nation/university due to the high cost of doing so. In the past, this evaluation has taken the form of a grant, which depends on peer evaluations. Now however, due to ever increasing flow of information, which generates new technologies, additional evaluation processes must be in place so the funding can be prioritized and revenue not wasted. This calls for a rapid evaluation process, taking advantage of the increase in informational flow. This process must be as objective as possible, providing documentation of the ability to generate successful projects without damaging continuing research and hurting the ability of high risk projects to reach fruition.
Relationship between macular pigment and straylight on the retina
Authors: PUELL MC , PEREZ‐CARRASCO MJ , BARRIO AR , PALOMO‐ALVAREZ C , SANCHEZ R
Published: September 2008

Purpose Macular pigment (MP) filters short‐wave light, counteracting the deleterious effects on foveolar resolution of scattering in the ocular media. Large individual differences in MP might also be expected to lead to variations in disability glare and reduce contrast in the retinal image. This study was performed to relate variations in foveal MP density levels to light scattering in the eye

Methods Measurements were obtained from 138 healthy subjects aged 52 ± 22.3. The optical density of the MP was estimated at the fovea using the Metropsis Test (Cambridge Research System), which is based on the apparent motion photometry method and employs a CRT monitor for stimulus presentation. Scattered light on the retina was measured using the C‐Quant straylight meter (Oculus AG, Germany) according to the psychophysical compensation comparison method. Values are expressed as logs (of the straylight parameter) for which higher values indicate more scattered light and more sensitivity to glare.

Results Mean foveal MP optical density was 0.28 density units (SD 0.16; range 0.0 to 0.74). Mean straylight value was 1.10 log units (SD 0.24; range 0.73 to 1.68). With the regression analysis of linear model, we found a significant correlation (Pearson’s correlation = ‐0.25; p‐value < 0.01) between foveal MP and light scattering in the eye at the 99% confidence level. Straylight was significantly higher for subjects with lower foveal MP level.

Conclusion Inter‐subject differences in foveal MP density levels showed correlation with light scattering in healthy non‐cataractous eyes.
Photodynamic therapy without verteporfin for central serous chorioretinopathy
Authors: MATEO OROBIA AJ , IBANEZ ALPERTE J , SALINAS ALAMAN A , MATEO GABAS J , LAFUENTE N , CRISTOBAL JA
Published: September 2008

Purpose To report the use of photodynamic therapy without verteporfin as treatment for patients with focal retinal pigment epithelial leaks secondary to central serous chorioretinopathy (CSC).

Methods Four symptomatic patients with CSC without clinical improvement in a period of time up to three months were included. Photodynamic therapy without verteporfin was applied without any other treatment.

Results Neurosensory detachment and fluorescein leakage resolved in all patients within two months. Visual acuity improved in all of them and none lost vision or suffered any treatment‐related complications.

Conclusion The treatment of CSC with photodynamic therapy without verteporfin may result in resolution of persistent neurosensory detathment and fluorescein leakage. Although this case series is limited in follow‐up and number of patients, the encouraging results, lack of complications and cheap procedure suggest that further investigation is warranted.

Commercial interest
Dynamic phototherapy as a treatment of central serous chorioretinopathy
Authors: BERTHOUT A , MALTHIEU D , JANY B , THOMAS F , MILAZZO S
Published: September 2008

Purpose To analyse the angiographic and tomographic results both the visual acuity of a group of patients presenting a serous central chorioretinopathy (which is acute or chronic) treated by dynamic phototherapy. This treatment has been guided by the data of the ICG angiography.

Methods This is a retrospective‐prospective nonrandomized study bearing on 31 eyes of 27 patients including 8 acute forms and 23 chronic forms. One or more spots were managed according to the standard protocol of the DMLA and delivered on the zones of choroidal hyperpermeability highlighted by the ICG angiography. The criteria of success are founded on functional signs, visual acuity, sensitivity to contrasts, and persistence of a point of leakage in angiofluorographic control at 3 months and on study of serous retinal detachment in OCT.

Results An increase of the visual acuity ( 3,58 +/‐ 3,22 lines (p<0,0001)) has been observed whatever the form of treated CSCR. 90,32% patients presented a reapplication of serous retinal detachment within a period of 7,28 weeks +/‐ 3,93. No tear of the retinal pigmentary epithelium or choroidal neovascularization were observed. 12,9% patients presented recurrence within a period of 28 weeks +/‐ 16,24, only chronic CSCR were concerned. At 8 +/‐ 4,2 months, visual acuity of patients (except patients with recurrence) remained unchanged (0,356 +/‐0,4 LogMAR or 20/50‐20/40).

Conclusion Although the number of patients included in this study is limited, dynamic phototherapy seems to be currently an effective and sure treatment of CRSC. A randomized study on a great series is desirable to confirm these results.
Morphological features of abnormal fundus autofluorescence (FAF) using Spectral Domain OCT
Authors: PICCIRILLO V , SAVASTANO A , SBORDONE S , FORTE R , TAMBURRINI L , SAVASTANO MC , SAVASTANO S
Published: September 2008

Purpose To evaluate morphological features of hyper and hypo autofluorescence areas using Spectral Domain OCT technology.

Methods 16 patients ( 10 male , 6 females ) with first diagnosis of age related maculopathy and dry AMD have been enrolled.Visual acuity test ( Snellen chart ) and Amsler’ grid test have been performed. Patients underwent to fundus autofluorescence ( FAF ) study (cSLO HRA 2 Laser source 488 nm , Barrier filter 500 nm, Heidelberg , Germany ) and Specral Domain OCT evaluation ( SD OCT OTI , Canada ). The FAF abnormalities have been compared to OCT images using gray scale and colour inversion system. Abnormalities in outer limiting membrane ( OLM ) profile , photoreceptor inner‐outer segment junction and RPE layer have been recorded for each patient.

Results OCT did not show any morphological changes in areas of hyperautofluorescence . In cases of hypoautofluorescence , main OCT changes were : abnormal profile of the OLM with continuous gaps , disruption of the IS/OS junction with focal breaks and granular destructuration of the RPE layer .No alterations inside neurosensory retina or modifications of retinal thickness and volume have been recorded.

Conclusion Abnormal FAF is mainly derived from RPE lipofuscin . Excessive accumulation of lipofuscin has been associated with degeneration of RPE cells and photoreceptors. SD‐OCT is able to show retinal morphological changes associated to abnormal FAF improving our knowledge in pathophisiologic pathways.
Retinal thickness and age ‐ optical coherence tomography study
Authors: RADOVIC N , BEKO M , GOLUBOVIC N
Published: September 2008

Purpose To test the hypothesis is retinal thickness of the temporal disc margine ‐ just independent of age.

Methods 60 eyes in 60 healthy volunteers were included in this study. Three OCT (STRATUS ‐ Zeiss) scans were performed, aligned vertically and placed at the temporal edge of the optic disc. Retinal Thickness (RT) and retinal nerve fiber layer thickness (RNFLT) were calculated, with variance and correlated with age.

Results Both of paramethers tested ‐ RT and RNFLT decrease with age. The mean nerve fibre layer thickness was 112 (SD=21) ‐ in correlation with increasing age, and the mean retinal thickness (MRT) was 237 (SD=24) ‐ not in correlation with age increase . The mean coefficients of variation were 8,3% for RNFLT and 3,9%for total RT.

Conclusion OCT testing is of high reproducibility for total retinal thickness and in nerve fibre layer thickness messurements. Both of paramethers decrease with age, but decrease of RNLFT, only, significantly correlates with increasing age. This put optic disc parameters (when a reference plane) in three dimensional tomography, for possible reassesment ‐ adjusting to age.
Malignancies after Tacrolimus therapy in the management of ocular inflammatory disease
Authors: MATHEW MANU , RAJ D , MOHAMMED K , ABEDIN A , SULEMAN H , DUA HS
Published: September 2008

Purpose The appearance of “de novo” tumors in adults receiving immunosuppressive treatment with tacrolimus in ocular inflammatory disorders has not been elucidated.

Methods All 180 patients who received Tacrolimus as a steroid sparing agent for the management of high risk PKP, uveitis, scleritis or corneal stem cell allograft were studied. Tacrolimus treatment schedule, monitoring and duration of treatment was noted.

Results During the last 8 years a total of 11 patients who had received Tacrolimus for their immunosuppresion developed a malignancy. Three patients developed cancer of prostate, bladder (1), bronchogenic carcinoma – squammous cell carcinoma (SCC) (1), cancer skin ‐ (SCC) (1), breast cancer(2), recurrence of NHL (1) and recurrence of breast cancer (1) and large intestinal tumour (1). The primary diagnosis for the commencement of Tacrolimus included high‐risk PKP (8), Scleritis (1), Panuveitis (1) and Wegeners Granulomatosis (1). The rate of increase of bladder cancer was 149.26 followed by NHL 82.33 and recurrent breast carcinoma 30.7. The rest of tumours had a rate of increase in the range of 10 ‐ 20 fold. The average dose of Tacrolimus was 1954.37 mg SD +/‐ 2197 mg. Female/male ratio was 2:1. The mean age of patients was 73 years SD +/‐ 10.4 years. The mean follow‐up time of tumour patients on treatment was 45 months with SD +/‐ 26 months and the mean duration of follow‐up after diagnosis was 23 SD +/‐ 19 months. None of the eleven patients had any additional predisposing factors or were on any other carcinogenic agents which could affect their mortality by the cancer identified.

Conclusion Long term immunosuppressive management of patients requires regular oncologic screening.
Non‐surgical treatments to periocular basal cell carcinomas. Imiquimod versus photodynamic therapy
Authors: GARCIA MARTIN E , IDOIPE CORTA M , GIL ARRIBAS L , FERNANDEZ TIRADO J , ALFARO J , PUEYO V , PINILLA I
Published: September 2008

Purpose To study the efficacy of non‐surgical treatment in patients with nodular basal cell carcinoma (BCC) placed around the eyes that have been treated with imiquimod 5% (IMQ) on the skin versus those that have received photodynamic therapy (PDT). To analyze clinical development, pathological remissions, aesthetic results and tolerance to the treatment .

Methods Five patients with clinical and pathological diagnostic as nodular BCC were divided into two groups for therapeutic intervention: three of them received treatment with IMQ and the other two patients were treated with PTD after the application on the skin of metilaminolevulinate (MAL), a photosensitiser substance.

Results The tolerance to the treatment was better in the group treated with PTD. Clinical and pathological remissions were obtained in treated patients. One of them, who received PTD, presented residual tumour at the end of the treatment, but the biopsy showed granuloma without histologically BCC component.

Conclusion The effectiveness of BCC treated with IMQ 5% on the skin (five times a week for six weeks) is similar to the effectiveness of surgical treatment. Non‐ invasive treatment is better tolerated than surgical treatment in this kind of tumour. Moreover, the aesthetic and functional results are better than the surgical ones.
Clinical presentation of reactive lymphoid hyperplasia (RLH) on the ocular surface – report of 6 cases
Authors: HERWIG MC , FISCHER HP , HOLZ FG , LOEFFLER KU
Published: September 2008

Purpose Reactive lymphoid hyperplasia (RLH), also called inflammatory pseudotumor, benign lymphoma or pseudolymphoma, is a benign and reversible enlargement of lymphoid tissue probably as a reaction to antigen hyperstimulation. RLH consists of dense sheets of small mature lymphocytes with the formation of primary and secondary follicles reminiscent of normal lymph node architecture. In this study we wanted to evaluate the clinical presentation of RLH on the ocular surface.

Methods We reviewed 6 patients (3 males, 3 females) with RLH of the ocular surface. The mean age at the time of diagnosis was 28 yrs (range: 8 to 77 yrs). Paraffin sections were stained with H&E and PAS and further evaluated using immunohistochemistry.

Results In 2 patients, RLH was confined to the caruncle. One patient presented with a large cyst‐like lesion, another one with a conjunctival nodule near the medial canthus, and in the oldest patient the RLH manifested itself as a pemphigoid‐like conjunctival lesion in the lower fornix. A 26‐years old female patient with a Non‐Hodgkin‐Lymphoma of the left conjunctiva developed conjunctival RLH one month later in the lower fornix of the fellow eye. Follow‐up (1‐11 yrs) was uneventful in all patients.

Conclusion In our case series, RLH presented as a singular lesion with varying clinical morphology. Obviously, it has to be carefully distinguished from lymphoma and should be considered in the differential diagnosis even of cyst‐like lesions and at unusual sites such as the caruncle.
Lymphoma of the conjunctiva
Authors: MISSOTTEN GS , DE WOLFF‐ROUENDAAL D , DE KEIZER RJW
Published: September 2008

Purpose Description of the treatment and follow‐up of conjunctival lymphomas

Methods Retrospective reportage of 16 patients with a conjunctival lymphoma seen at the department of Ophthalmology of Leiden University.

Results In the last 20 years, 15 patients with a local conjunctival lymphoma and one patient with generalized lymphoma of the skin with a conjunctival lymphoma were treated. Histologically all 16 patients showed to have an extranodal marginal zone B‐cell lymphoma (MALT‐lymphoma). Mean age of the patients at presentation was 64.8 years (37.2‐84.5 years). In two patients there was a bilateral lymphoma. Thirteen patients were treated with external irradiation (30 Gray in 15 sessions), one patient with cryotherapy and one patient with CHOP chemotherapy. After a mean follow‐up time of 6 years, all patients are still alive, without recurrence.

Conclusion The new international classification of conjunctival lymphoma shows the great differences in survival of conjunctival lymphoma patients. Here we illustrate that patients with the favorable marginal zone B‐cell lymphoma have a very good prognosis. When treated with external irradiation, there is an extremely low rate of recurrence
International review of orbital diffuse large B cell lymphoma
Authors: IRION LD , BONSHEK R , LEATHERBARROW B , MCCORMICK A , PATEL I , MADGE S , PRABHAKARAN V , SELVA D , HATEF E , ESMAELI B , MENON V , HONAVAR S
Published: September 2008

Purpose Compare findings of orbital diffuse large B cell lymphomas (ODLBCL) from 4 international centres.

Methods 38 ODLBCL cases (14 Manchester (MA), 10 Adelaide (AD), 9 Houston (HO), 5 (Hyderabad (HY) were retrieved from Ophthalmology records of each centre. Clinical, radiological and pathological findings, and treatment and outcome were reviewed.

Results Median age was 69 (7‐89). M:F ratio was 1.6:1, however, 7/10 AD patients were women. 24(63%) patients had an extraconal mass, which also involved lacrimal gland or apex in 2 and 3 cases respectively. Extension to bone or sinus was observed in 12(31%) cases. Proptosis (47%) and periocular swelling (39%) were common presenting findings. Interestingly 8/14 MA patients complained of visual acuity loss, which was not relevant in other centres. A positive B‐cell marker (CD20 or CD79a) was confirmed in these cases. Other positive markers were CD30 (30%), CD10 (23%) and BCL2 (8%). Evidence of transformation from other lymphoma type was seen in 6 cases. Almost 50% presented at stage II, 26% stage IV and 21% stage I, however, in MA at least 44% were at stage IV followed by stage II (33%). More than 80% of patients had chemotherapy but 1/2 of them also had a combination with radiotherapy at least. After an average 28 month follow up, 19(50%) patients were reported to be alive, 5 died and 14 lost follow up. All HO patients were alive at the end of the study.

Conclusion ODLBCL is an aggressive tumour. Most cases presented initially as an extraconal mass. Treatment varied slightly across centres. Although most MA cases presented at a more advanced stage, the MA survival rate was in keeping with the overall figures.
Imaging techniques in the dosimetry of epiescleral brachytherapy
Authors: DE FRUTOS‐BARAJA JM , DE LUIS‐PEREZ FJ , SAORNIL‐ALVAREZ MA , LOPEZ‐LARA‐MARTIN F , CEBALLOS GARCIA MA , GARCIA‐ALVAREZ C
Published: September 2008

Purpose To compare the doses calculated from the measurements of the tumour obtained by different imaging techniques.

Methods It is a retrospective study of 50 enucleated eyes corresponding to 50 patients with diagnosis of choroidal melanoma. For every case, there was recorded information about height of the tumour obtained by means of studies of pathological anatomy both in the macroscopic and in the microscopic preparation, and the obtained with the available imaging techniques for this measurement: magnetic nuclear resonance RNM, computerized tomography CT and B ultrasound US. Dose distribution was calculated in the tumour apex by means of the brachytherapy treatments planning system Bebig for three applicators type COMS of three and all slots filled for a duration of treatment of 1 hour, and was analyzed later by a spreadsheet Excel and the statistical application SPSS.

Results Apex dose differences (%) Comparison with the macroscopic preparation Applicator size 10 mm 16 mm 22 mm CT 16,5 14,8 13,4 MNR 3,6 4,9 5,5 US 6,0 7,3 5,0

Conclusion Obtained results can be influenced partly by the size of the studied tumours, in the main of big size, and for the small muestral size in someone of the imaging techniques. They show the importance of the election of the imaging technique to obtain the information for dosimetry. Particularly relevant they are the obtained ones in the comparison with the CT due to the difficulty for this technology of distinguishing between the tumour and the detachment of retina associated. Acknowledgments: This work has been financed partly by a grant of the Junta de Castilla y León (Order SAN/1829/2007 of November 13, BOCYL of November 15, 2007)
In vivo confocal microscopy of keratic precipitates in anterior uveitis related to Herpesviridae
Authors: LABETOULLE M , LABBE A , DUPAS B , DE MONCHY I , POGORZALEK N , GENDRON G , OFFRET H , BAUDOUIN C
Published: September 2008

Purpose To study the pattern of keratic precipitates (KPs) in anterior uveitis due to Herpesviridae using in vivo confocal microscopy

Methods KPs of 17 consecutive patients (average age: 54+/‐8 years), addressed for anterior uveitis related to either Herpes simplex virus (HSV), Varicella‐zoster virus (VZV) or cytomegalovirus (CMV), were examined using the HRT II Rostock Cornea module, between May 2006 and June 2007. The diagnosis of HSV, VZV or CMV infection was based on PCR or specific antibodies production within the aqueous humor, or on clinical history for uveitis that rapidly followed herpes zoster ophthalmicus. At the time of in vivo confocal microscopy, the uveitis was in an acute period (recent increase of inflammation).

Results The HRT II Rostock Cornea provided reproducible images of KPs, with both a heap‐shaped pattern and stars which were characterized by branches in weak number and of modest size. HRT imaging of the fellow eye was normal in all cases (control eyes).

Conclusion Herpesviridae are a classic cause of unilateral and hypertonic uveitis. If the clinical pattern is often very suggestive, certain cases may be difficult to differentiate from other causes of uveitis, notably Fuch’s heterochromic cyclitis. The reproducible pattern of KPs in viral uveitis using in vivo confocal microscopy should be helpful to differentiate from non‐herpetic etiologies.
Retrospective study of 40 cases of sarcoid uveitis
Authors: COUVIDAT M , MOURIAUX F
Published: September 2008

Purpose The aim of this study was to describe the clinical characteristics,the evolution and prognosis of sarcoid uveitis and to assess the best diagnostic procedure for the disease.

Methods All patients with sarcoid uveitis have been seen in Caen University hospital over the last ten years. Inclusion criteria were a positive biopsy showing noncaseating granuloma or patients with a high presumption of sarcoidosis (at least 2 abnormalities amongst the main systemic diagnostic investigations).

Results Biopsy was positive for 27 patients. Thoracic CT‐scan,negative tuberculin skin test, serum angiotensin converting enzyme, bronchoalveolar lavage and gallium scanning suggested the diagnosis in all other cases. Forty patients were included. There were 25 women (62%). The mean age was 43 years. The mean follow‐up duration was 55 months. Uveitis was bilateral in 29 cases. Anterior segment manifestations occured in 83% of cases,associated with a posterior segment involvement in 66% of cases. We reported a high frequency of cystoid macular oedema (CMO)(37%)and optic disc swelling(35%). The lung was the most common organ involved over the uveitis evolution period and CT‐scan was a superior imaging modality compared to chest X‐rays. Corticosteroids were the mainstay of treatment. Visual prognosis was good: mean final visual acuity was 15/20. CMO played a decisive role in poor visual outcome (p<0,05). Ocular complications were early cataract(7),epiretinal membrane(4),chronic glaucoma(3),retinal neovascularisation(1) and retinal detachment(1).

Conclusion There is a high incidence of posterior involvement in sarcoid uveitis. CMO is frequent and correlated with a worse final visual acuity. Pulmonary involvement occurs in more than 90% of cases, therefore CT‐scan must always be performed.
Cytokine profile in intermediate uveitis
Authors: VIDOVIC VALENTINCIC N , KRAUT A , KOROSEC P , HAWLINA M , ROTHOVA A
Published: September 2008

Purpose Intermediate uveitis (IU) represents a chronic type of uveitis of unknown cause with the vitreous as the major site of the inflammation. The associated diseases include mostly multiple sclerosis (MS) and sarcoidosis, the majority of cases is idiopathic. The aim of this prospective study was to elucidate intraocular and serum cytokine profiles of patients with IU and relate the laboratory results to clinical features.

Methods Aqueous humor (AqH) and serum samples were collected from 39 IU patients in various stages of uveitis activity and from 10 controls with cataract and no uveitis during cataract surgery. The concentration of inflammatory mediators was measured by multiplex immunoassay and included interleukin (IL) 8, 1β, 6, 10, 12p70, TNFα, CCL5/RANTES, CCL3/MIP‐1alpha, CCL4/MIP1‐beta, CCL2/MCP1.

Results Serum samples of patients and controls were not distinct; however intraocular samples of IU patients had higher levels of interleukin‐6 (IL 6), interleukin‐8 (IL 8) and MCP 1 than non‐uveitis controls (for all P=<0.05). Intraocular IL6 and IL8 levels exceeded that of serum in 22/39 (56%; P= 0.001) and 29/39 (74%; P= < 0.001) respectively. Active intraocular inflammation and the presence of CME were associated with higher levels of IL 6 and IL 8 than intraocular samples from patients with quiescent uveitis (P=<0.05) and those not affected by CME (P=<0.05). No significant associations were found for other measures cytokines.

Conclusion IL 6 and IL 8 are two most abundant cytokines in intraocular environment of patients with IU and their levels were associated with IU activity and the presence of CME. The findings of normal serum levels of proinflammatory cytokines in patients do not support the presence of associated systemic inflammation.
Can tumor necrosis factor inhibitors induce scleritis ?
Authors: LE GARREC J , MARCELLI C , MOURIAUX F
Published: September 2008

Purpose Tumor necrosis factor alpha is a pro‐inflammatory cytokine which plays an important role in the physiology of many inflammatory diseases. There are three tumor necrosis factor inhibitors : etanercept, infliximab, adalimumab. Etanercept’s most consistent side effect is injection‐site reaction. Inflammatory eye disease has also been one of the rare adverse events associated with etanercept.

Methods We report two cases of female patients who presented a scleritis , while they were treated for rheumatoid arthritis by etanercept 35 mg twice a week.

Results These two patients presented a first episode of unilateral anterior nodular scleritis after respectively 16 and 12 months of etanercept. Their rheumatoid disease was in remission. The non steroidal anti‐inflammatory agents and steroids were not much effective on the scleritis symptoms. After having stopped the etanercept, the scleritis decreased. A review of the literature pertaining to inflammatory eye disease associated with the use of etanercept was performed. Multiples drugs have been associated with ocular inflammation : in scleritis (biphosphonates, topiramate) and in uveitis (rifabutine, sulfonamides, metipranolol eyedrops,…). These cases suggest that etanercept is one of them.

Conclusion The possibility of a iatrogenic cause must be envisaged in case of non efficacity of usual treatment (non steroidal anti‐inflammatory agents, steroids, immunosuppressive therapies). The question of a specific ophthalmological follow‐up of such patients is also addressed.
Patient demographic data for phase 2/3 clinical trials of a novel calcineurin inhibitor, lx 211, for the treatment of non‐infectious uveitis
Authors: BODAGHI B
Published: September 2008

Purpose LX211 is the oral formulation of a novel calcineurin inhibitor (CNi) possessing four‐fold greater potency, an altered metabolic and pharmakokinetic profile, and potentially improved safety compared to the prototypical CNi, cyclosporine A.

Methods Three global, prospective, double‐masked, parallel‐group, dose‐ranging, placebo‐controlled, randomized multicenter studies comprise the LUMINATE Program, which is currently in progress. Study LX211‐01‐UV evaluates 210 patients with active predominantly posterior manifestations. Study LX211‐03‐UV evaluates 100 patients with active predominantly anterior manifestations. Study LX211‐02‐UV evaluates 220 patients whose disease is controlled and will evaluate the role of LX211 in sparing systemic corticosteroid.

Results The studies are ongoing. Pooled masked data from the studies to date indicate that in Study LX211‐01 (N=81) the distribution of patient anatomic diagnoses is : panuveitis (48.1%), intermediate uveitis (29.6%), anterior + intermediate uveitis (8.6%) and posterior uveitis (13.6%). The mean age is 42 years with a F/M of 2. Study LX211‐02 (N=101) has a similar distribution of anatomic diagnosis. The mean age of subject ins LX211‐02 is 43.4 years with a F/M of 2. Study LX211‐03 was similar to Studies LX211‐01 and LX211‐02 with respect to the proportion of female (68.6%) to male (31.4%) subjects.

Conclusion The LUMINATE Program are the first randomized placebo‐controlled trials for a corticosteroid‐sparing immunomodulatory agent in various anatomic forms of sight‐threatening non‐infectious uveitis.

Commercial interest
Changes on optic nerve with sarcoidosis patients
Authors: RADUNOVIC M , VUKSANOVIC A
Published: September 2008

Purpose Sarcoidosis is a rare autoimmune disorder. Since in 20% of the cases optical manifestations represent the first sign of a systemic disease and that 75% of sarcoidosis patients are under the age of 40, we considered it appropriate to perceive the manifestations of sarcoidosis on the optic nerve and to notice the consequences for the vision.

Methods The examination was being carried out on 32 patients who had come for an ophthalmological check‐up in the Eye Clinic of the Clinical Centre of Montenegro for the first time, and who had been made sarcoidosis diagnosis. With the patients showing the obvious signs of neurosarcoidosis with the spreading over the optic nerve, additional diagnostic examinations were being carried out: FA, ICG, NMR, EEG, VEP, lumbar punction, as well as endocrinological examinations. The patients were being monitored during the following year, with monthly control check‐ups.

Results Optical manifestations within the framework of the basic disease were found with 17 patients, whilst optical symptomatology was the first sign of the disease with 4 patients. The changes on the optic nerve were noticed in various forms and they appeared either as the initial manifestation of sarcoidosis or at any time during the duration of the disease.

Conclusion The changes found on the optic nerve within the framework of sarcoidosis were numerous and variable. PNO edema, papillitis, granuloma PNO, retrobulbar neuritis, are only part of clinical manifestations which appear upon the optic nerve being affected by sarcoidosis.
Third‐party brachytherapy source calibrations and physicist responsibilities: Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group
Authors: Butler Wayne M. , Bice William S. , DeWerd Larry A. , Hevezi James M. , Huq M. Saiful , Ibbott Geoffrey S. , Palta Jatinder R. , Rivard Mark J. , Seuntjens Jan P. , Thomadsen Bruce R.
Published: September 2008

The AAPM Low Energy Brachytherapy Source Calibration Working Group was formed to investigate and recommend quality control and quality assurance procedures for brachytherapy sources prior to clinical use. Compiling and clarifying recommendations established by previous AAPM Task Groups 40, 56, and 64 were among the working group's charges, which also included the role of third‐party handlers to perform loading and assay of sources. This document presents the findings of the working group on the responsibilities of the institutional medical physicist and a clarification of the existing AAPM recommendations in the assay of brachytherapy sources. Responsibility for the performance and attestation of source assays rests with the institutional medical physicist, who must use calibration equipment appropriate for each source type used at the institution. Such equipment and calibration procedures shall ensure secondary traceability to a national standard. For each multi‐source implant, 10% of the sources or ten sources, whichever is greater, are to be assayed. Procedures for presterilized source packaging are outlined. The mean source strength of the assayed sources must agree with the manufacturer's stated strength to within 3%, or action must be taken to resolve the difference. Third party assays do not absolve the institutional physicist from the responsibility to perform the institutional measurement and attest to the strength of the implanted sources. The AAPM leaves it to the discretion of the institutional medical physicist whether the manufacturer's or institutional physicist's measured value should be used in performing dosimetry calculations.
TLD assessment of mouse dosimetry during microCT imaging
Authors: Figueroa Said Daibes , Winkelmann Christopher T. , Miller William H. , Volkert Wynn A. , Hoffman Timothy J.
Published: September 2008

Advances in laboratory animal imaging have provided new resources for noninvasive biomedical research. Among these technologies is microcomputed tomography (microCT) which is widely used to obtain high resolution anatomic images of small animals. Because microCT utilizes ionizing radiation for image formation, radiation exposure during imaging is a concern. The objective of this study was to quantify the radiation dose delivered during a standard microCT scan. Radiation dose was measured using thermoluminescent dosimeters (TLDs), which were irradiated employing an x‐ray source, with Al filtration and a total of for a full rotation of the unit. The TLD data were validated using a CT ion chamber probe. TLD results showed a single microCT scan air kerma of when using a poly(methylmethacrylate) (PMMA) anesthesia support module and an air kerma of without the use of the anesthesia module. The validation CT ion chamber study provided a measured radiation air kerma of and with and without the PMMA anesthesia module, respectively. Internal TLD analysis demonstrated an average mouse organ radiation absorbed dose of . The author's results have defined x‐ray exposure for a routine microCT study which must be taken into consideration when performing serial molecular imaging studies involving the microCT imaging modality.
Deterministic photon kerma distribution based on the Boltzmann equation for external beam radiation therapy
Authors: Yuan Jiankui , Jette David , Chen Weimin
Published: September 2008

A photon transport algorithm for fully three‐dimensional radiotherapy treatment planning has been developed based on the discrete ordinates solution of the Boltzmann equation. The algorithm is characterized by orthogonal adaptive meshes, which place additional points where large gradients occur and a procedure to evaluate the collided flux using the representation of spherical harmonic expansion instead of the summation of the volume‐weighted contribution from discrete angles. The Boltzmann equation was solved in the form of spatial, energy, and angular discretization with mitigation of ray effects by the first‐collision source method. Unlike existing codes, which were designed for general purpose for multiparticle transport in areas such as nuclear engineering, our code is optimized for medical radiation transport. To validate the algorithm, several examples were employed to calculate the photon flux distribution. Numerical results show good agreement with the Monte Carlo calculations using EGSnrc.