bluuebunny/crossref_metadata_2025 huggingface dataset:
Visual function vs. spastic quadriplegia & brain damage
Authors: KAPSOS A , KOZEIS N , BOSKOS G , MOSCHOU V , LAKE S
Published: October 2007

Purpose: To investigate whether visual function is related to severity of spastic quadriplegia (SQCP) and brain damage.

Methods: 52 SQCP children participated in this study. All of them were classified according to Gross Motor Functional Classification System (GMFCS) and also had a brain MRI and an eye testing (visual resolution evaluation and strabismus assessment), using the VFA‐K test.

Results: The brain MRI showed that: 18 children appeared with mild to moderate periventricular leukomalacia (PVL), 14 with severe PVL, 3 with cortical atrophy, 13 with combined PVL and cortical atrophy and 4 appeared with parenchymatic atrophy. According to GMFCS classification, 6 appeared with good motor function, 8 with a mild motor problem, 9 with moderate motor problem, 29 with severe to very severe motor disability. In visual testing, 14 children appeared with visual resolution (VR) < 0.21cpd, 19 children appeared with 0.43cpd <VR< 0.87cpd and 19 children appeared with VR> 1.75cpd. Also, 23 children were orthophoric, 19 esotropic (25‐60Δ) and 10 children were exotropic (25‐50Δ).

Conclusions: SQCP with poor GMFCS score, moderate to severe PVL, or with combined PVL and cortical atrophy, appeared with the most affected visual function.
Mechanisms of secondary glaucoma in eyes with advanced retinoblastoma: histopathological
Authors: HADJISTILIANOU T , FREZZOTTI P , MENICACCI F , MITTICA V
Published: October 2007

Purpose: The association between retinoblastoma (RTB) and secondary glaucoma is well known. The most common cause of secondary glaucoma in RTB is iris neovascularization, followed by pupillary block and tumor seeding in the anterior chamber. Aim of this study is to review the glaucoma‐inducing mechanism in a large italian population of RTB patients and discuss our experience with these cases

Methods: .

In the last five years we observed 152 cases of RTB; in 18 cases (17%) during the first examination under general anesthesia, elevated intraocular pressure was observed. Histopathological examination of these eyes was performed to understand the mechanisms inducing glaucoma.

Results: In six patients only (33%) the mechanism seemed to be an isolated one (four tumor seeding and two angle closure), in 12 patients (66%) a combination of more than one mechanism was observed (angle closure, tumor seeding and iris neovascularization

Conclusions: Although glaucoma is a secondary clinical issue in RTB management and care of its presence, revealed by a thorough ocular exam of the anterior segment, can guide the clinician in assessing the overall condition of the affected eye
Visual functional assessment‐ Kozeis test: a new eye test for cerebral palsied children
Authors: AGGELIDOY A , KOZEIS N , STOJANOVIC N , KAPSOS A
Published: October 2007

Purpose: To present a new test assessing the visual function of cerebral palsied (CP) children. The reliability and validity of the test are also presented.

Methods: 200 CP children (2 ‐16 years old) (145 spastic quadriplegics and 58 spastic diplegics), 90 healthy children (2‐15 years old) as norms and two doctors as examiners. The realibility and validity of VFA test were evaluated by the intraobserver agreement, test‐ retest. The VFA test assesses 10 important visual parameters ((i) assessment of visual attention, (ii) assessment of visual grating / acuity for far, (iii) visual acuity for near, (iv) contrast sensitivity, (v) peripheral vision, (vi) colour perception, (vii) binocular status, (viii) execution of saccades, (ix) execution of smooth pursuits, (x) eye‐hand coordination), leading to 10 subscores. The sum of these is called Index K, ranging from 0 to 62, and represents the visual ability of each CP child.

Results: The statistical analysis proved that the VFA‐K test is a reliable and valid test. Further analyzing our data, we found that 31 CP children(15%) appeared with Index K 0‐20, 34 children(17%) with Index K 21‐40, 50 children(25%) with Index K 41‐ 50 and 86 children(43%) with Index K 51‐62. 20.83% of spastic quadriplegics appeared with Index K < 20, 23.61% with 21<Index K<40, 27.77% with 41<Index K<50 and 27.77% with 51<Index K <62. In diplegics subgroup: none of the children appeared with index K < 41, 17.85% appeared with 41<Index K<50 and 83.15% with 51<Index K< 62

Conclusions: The VFA‐Kozeis test is a reliable, valid, easy to perform, cost and time consuming procedure, assessing the visual function of CP children.
The vasodilatory effect of juxta‐arteriolar microinjection of endothelin‐A receptor inhibitor in healthy and in acute branch retinal vein Occlusion Minipig Retinae
Authors: POURNARAS CJ , STANGOS AN , POURNARAS JAC , PETROPOULOS IK
Published: October 2007

Purpose: To investigate the vasoactive effect of endothelin‐A receptor inhibitor BQ‐123 on the retinal arteriolar vasculature in normal and in acute branch retinal vein occlusion (BRVO) minipig retinae.

Methods: Under general anesthesia, 6 normal eyes of 6 minipigs and 5 eyes of 5 minipigs with acute experimental BRVO were evaluated. In all eyes, a slow, continuous microinjection of 30 μl BQ‐123 (0.67 μg/ml) was performed 50 to 100 μm away from a retinal arteriole, avoiding exerting pressure on retina’s anatomic structures. After the microinjection, the retinae were observed for changes in vessels’ diameter. The procedure was recorded in real time. Throughout the procedure, the animals’ vital signs were monitored.

Results: Overall (n=11), an increase of 18.56% and 26.45% in arteriolar diameter was evidenced 5 and 15 minutes respectively after BQ‐123 microinjection. When separately examining normal (n=6) versus OBVR (n=5) eyes, the increase in arteriolar diameter 5 minutes post injection was 16.75% versus 19.86% respectively (P=0.491), whereas the increase in arteriolar diameter 15 minutes post injection was 25.14% versus 27.4% (P=0.591).

Conclusions: Our results demonstrate a significant increase in retinal arteriolar diameter after juxta‐arteriolar BQ‐123 microinjection, both in healthy and in acute OBVR retinae. There was no statistically significant difference between the amount of vasodilation exerted by BQ‐123 on healthy and on BRVO retinae. This vasodilatory effect may be beneficial in counterbalancing or reversing the arteriolar vasoconstriction that settles within hours following BRVO, with subsequent improvement of arteriolar blood flow.
Visual function vs. spastic diplegia & brain damage
Authors: GOGAKI EG , KOZEIS N , FELEKIDIS A , GEORGIADIS N
Published: October 2007

Purpose: To investigate whether visual function is related to severity of spastic diplegia (SDCP) and brain damage.

Methods: 28 SDCP children participated in this study. All of them were classified according to Gross Motor Functional Classification System (GMFCS) and also had a brain MRI and an eye testing (visual resolution evaluation and strabismus assessment), using the VFA‐K test

Results: The brain MRI showed that: 23 children appeared with mild to moderate periventricular leukomalacia (PVL), 2 with severe PVL, none with cortical atrophy, 3 with combined PVL and cortical atrophy and none with parenchymatic atrophy. According to GMFCS classification, 6 appeared with good motor function, 11 with a mild motor problem, 9 with moderate motor problem, 2 with severe motor disability and none with very severe disability. In visual testing, 7 children appeared with 0.87cpd and 21 children appeared with 1.75cpd; also, 24 children were orthophoric, 4 esotropic (25‐60Δ) and none was exotropic.

Conclusions: The visual function is not much affected in the majority of SDCP children, unless GMFCS score and brain damage are significantly affected.
A case of lead toxicity and associated maculopathy
Authors: PIERCE CO , BOOTH AJ
Published: October 2007

Purpose: To present a case of a 50 year old man who presented with reduced visual acuity in his left eye following a history of occupational lead poisoning dating back 3 years.

Methods: The initial presentation was in March 2006 when the visual acuity in the right eye was 6/9 and the left CF. There was a left RAPD. The anterior segment examination and IOP were normal. The left macula showed pigmentary epithelial changes similar to a Bull's Eye type‐maculopathy. The right eye had a granular appearance at the macula.

Results: MRI scans performed were normal and the VF result for the right eye was noncontributory. Electrodiagnostic testing showed a left sided optic nerve dysfunction but well‐preserved ERGs with no interocular difference. FFA showed a window defect at the site of the pigment epithelium atrophy. OCT demonstrated a cystic space at the level of the outer segment of the photoreceptors in the fovea. Tests for potential inflammatory, infective and congenital causes for unilateral optic neuraopathy found no abnormality.

Conclusions: The case provides evidence of lead toxicity being the cause of unilateral optic neuropathy and RPE changes leading to significant visual impairment.
Intravitreal bevacizumab for neovascular glaucoma
Authors: ANDRIJEVIC DERK B , MANDIC Z , BENCIC G , VATAVUK Z , NOVAK‐LAUS K
Published: October 2007

Purpose: To study the short term efficacy of intravitreal bevacizumab in a series of patients with neovascular glaucoma.

Methods: Eleven patients with neovascular glaucoma and symptomatic elevation of intraocular pressure were treated with 1.25 mg/0.05 ml of bevacizumab. In three patients intravitreal Avastin was given preoperatively, one day before pars plana vitrectomy.

Additional cyclocryopexy was performed only if intraocular pressure was not controlled with topical medication. All patients were followed‐up for a minimum of 8 weeks.

Results: Intravitreal application of bevacizumab resulted in a marked regression of iris neovascularization in all patients in the first three postoperative days. Intraocular pressure was sufficiently controlled in seven patients. Four patients required additional cyclocryopexy. We noted no side effects from intravitreal bevacizumab.

Conclusions: Intravitreal application of bevacizumab resulted in a marked regression of iris neovascularization in all patients in the first three postoperative days. Intraocular pressure was sufficiently controlled in seven patients. Four patients required additional cyclocryopexy. We noted no side effects from intravitreal bevacizumab.
Effects of autologous translocation of the choroid and retinal pigment epithelium on the retinal light response in patients with neovascular age‐related macular degeneration
Authors: LÜKE C , KOCH A , KUTZER J , LÜKE M , JOERES S , JOUSSEN AM , KIRCHHOF B
Published: October 2007

Purpose: The aim of the present study was to evaluate potential electrophysiological changes after autologous translocation of the choroid and retinal pigment epithelium for subfoveal choroidal neovascularisation in patients with age‐related macular degeneration.

Methods: A consecutive series of 20 patients suffering from subfoveal choroidal neovascularisation secondary to age‐related macular degeneration underwent autologous tranlocation of the choroid and the retinal pigment epithelium The ERG was recorded one day prior to the translocation surgery and no earlier than 4 weeks after the silicone oil removal.

Results: The ERG amplitudes were significantly reduced after translocation surgery. The mean b‐wave amplitude reduction of the scotopic ERG was 36,1%. The a‐ and b‐waves of the saturating light response decreased significantly by 42.9 and 43.1 %, respectively. The photopic a‐ and b‐wave amplitudes were significantly lower after the translocation surgery resulting in a mean reduction of 23.7 and 40.1 %, respectively. Furthermore, the mean amplitude of the flicker ERG showed a mean decrease by 26.2%.

Conclusions: The present study indicates that a significant electrophysiological decrease is caused by autologous translocation of the choroid and retinal pigment epithelium. However, this surgical procedure proved to substantially reduce the neuroretinal trauma when compared with the ERG data of historical controls that underwent 360° retinotomy and macular translocation.
Trabeculectomy and Mitomycin C (Trab‐MMC) for uveitic glaucoma: post surgical interventions
Authors: LOCKWOOD A , SII F , CHIANG M , WILLIAMS TA , SHAH P
Published: October 2007

Purpose: To examine the outcome of patients at who underwent trabeculectomy and MMC for refractory uveitic glaucoma and determine the post operative interventions required

Methods: The Birmingham ReGAE (Research into Glaucoma and Ethinicity) Project is an open, prospective, consecutive series of patients who had undergone trabeculectomy with MMC. The surgery was performed by a single surgical team at the Birmingham and Midland Eye Centre

Results: Twenty eyes of 25 patients with uveitic glaucoma underwent Trab‐MMC for uncontrolled IOP despite maximally tolerated medical treatment. Mean follow‐up was 650 days. Mean pre‐op IOP was 26.7 mmHg and post‐op was 11.5 mmHg. 92 % of trabeculectomies reached complete success (IOP ≤ 21 mmHg without medication). Subconjunctival injections of 5‐fluorouracil were performed on 10 eyes (36 %). Bleb needling revision was performed on 5 eyes (18 %).Visual loss > 2 lines occurred in 1 case (3.8%) due to delayed hypotony maculopathy

Conclusions: Trabeculectomy and Mitomycin C is effective in this complex series of patients but do require considerable post surgery manipulation
Are pachymetric and tonometric asymmetry related?
Authors: ALEMANY MARQUEZ P , JIMENEZ‐CARMONA S , FAILDE I , CARRAL F , JORDANO J
Published: October 2007

Purpose: Goldmann applanation tonometry readings are affected by central corneal thickness. We have determined the level of pachymetric and tonometric asymmetry in normal, diabetic, ocular hypertensives and diabetic ocular hypertensive patients, and the relationship between both asymmetries.

Methods: Four groups, one of 77 normal patients (N), one of 59 type II diabetic patients (DM), one of 74 patients with ocular hypertension (OHT), and one group of 61 type II diabetic ocular hypertensive patients (DMOHT) have been included. Ocular exploration, including ultrasound pachymetry, has been performed in all of them. Time from diagnosis and current treatment are also recorded. Interocular differences are analyzed by the SPSS 14.0 program using ANOVA and Pearson tests.

Results: The pachymetric asymmetry between groups is not significant (ANOVA P < 0,072). The difference between pachymetric assymetry in diabetic patients (DM+DMOHT) 6,83±5,45μ and non‐diabetic patients (N+OHT) 5,50±5,01μ is statistically significant (P < 0.037). This difference is not significant between ocular hypertensives (OHT+DMOHT) and ocular normotensives (N+DM) (P < 0,982). There is not linear correlation between pachymetric and tonometric asymmetry in the whole sample (r = 0,003). Pachymetric asymmetry correlates with time from diagnosis, and asymmetry is bigger under treatment with insuline, and in retinal proliferative stages. IOP asymmetry correlates with time from diagnosis, is bigger for insuline treated patients and is similar through the different stages of retinopathy.

Conclusions: Pachymetric asymmetry is not related to tonometric asymmetry in this study. Diabetic patients showed bigger pachymetric asymmetry than non diabetic patients, but is not related to tonometric asymmetry.
Proof of new collagen synthesis in lid skin after Er:YAG laser skin resurfacing with in‐situ hybridization
Authors: BELTRAM M , DRNOVSEK‐OLUP B
Published: October 2007

Purpose: The aim of the study is to prove new collagen synthesis in lid skin fibroblasts and correlate it to laser energy fluence after Er:YAG laser skin resurfacing, using the method of in situ hybridization.

Methods: Lid skin of 9 patients with blepharochalasis was treated with laser at day 7 and 21 before elective blepharoplasty, when it was excised for further investigation. We used a 2940 nm Er:YAG laser (Fidelis by Fotona) with smooth mode parameters: laser fluence 0.75 – 2.00 J/cm2, spot size 5 mm, repetition rate 20 Hz, pulse length 550 μs, 6 pulses per packet, packet length 250 ms, no overlapping. We designed 2 oligonucleotide RNA probes for pro‐alpha 1 and pro‐alpha 2 collagen and labeled them with radioactive Sulphur 35. At time of surgery the excised tissue was frozen in dry ice. Tissue sections were incubated with the probes and marked with film emulsion for 10 days. We counted silver grains over specific cells, which were identified with imunohistochemistry.

Results: We noticed significant elevation of pro‐alpha‐collagen mRNA expression in the laser treated areas of lid skin compared to untreated areas. Pro‐alpha‐collagen mRNA expression was particularly dense in cells, identified as fibroblasts by imunohistochemistry. Pro‐alpha‐collagen mRNA expression in these cells correlated with laser fluence used in treatment of lid skin.

Conclusions: The method of in situ hybridization brings a definitive proof of new collagen synthesis in skin fibroblasts after Er:YAG laser skin resurfacing; and it is possible to measure the rate of new collagen synthesis as a function of the applied laser fluence.
Periocular Er:YAG laser skin resurfacing in ablative, dual mode and smooth mode – a histological comparison
Authors: BELTRAM M , DRNOVSEK‐OLUP B
Published: October 2007

Purpose: The aim of the study is to histologically compare Er:YAG laser skin resurfacing using ablative, dual‐mode and smooth mode parameters.

Methods: 30 patients with blepharochalasis were treated with a 2940 nm Er:YAG laser (Fidelis by Fotona) at day 0, 7 and 21 before elective blepharoplasty. At time of surgery the irradiated lid tissue has been removed and prepared for histological analysis. The laser settings used in the ablative mode were: fluence 2.5 – 4.5 J/cm2, spot size 5 mm, repetition rate 5 – 8 Hz, pulse length 300 μs; dual mode: first pass as in ablative mode, then second pass with fluence 0.5 – 1.5 J/cm2, spot size 5mm, repetition rate 12 – 15 Hz, pulse length 300 μs and 60% overlapping; smooth mode: fluence 0.75 – 2.00 J/cm2, spot size 5 mm, repetition rate 20 Hz, pulse length 550 μs, no overlapping.

Results: We observed deep collagen denaturation at fluences above 1.25 J/cm2 and total epidermal damage at fluences above 1.75 J/cm2; complete regeneration of epidermis at day 7 and collagen remodeling up to 240 μm deep at day 21 after smooth mode laser treatment. These changes were statistically significantly different compared to changes after ablative and dual‐mode treatment.

Conclusions: Smooth mode Er:YAG laser skin resurfacing is a safe and effective method producing new collagen synthesis and remodeling, with less epidermal damage compared to ablative and dual‐mode resurfacing.
Dacryoendoscopy: feasibility and value as diagnostic tool
Authors: WILKE M , KLAUSS V , KAMPIK A
Published: October 2007

Purpose: To access the feasibility and value of endoscopy of the lacrimal duct as a diagnostic method in setnoses of the lacrimal drainage system.

Methods: In this prospective study 50 patients with prolonged complaints of epiphora or history of recurrent dacryocystitis were included. All patients underwent clinical examinations including syringation, digital dacryocystography and dacryoendoscopy before a decision for appropriate surgical treatment was made. Findings of clinical examinations, dacryocystography and dacryoendoskopy were compared in regard of feasibility, localization of the obstruction, particular informations provided and correlation between the three methods.

Results: Dacryoendoscopy could be performed in all patients included in the study. Concerning the localization of stenoses, 48% of the patients were found to have complete post‐saccal stenosis, 20% stenoses of the canaliculus, 10% combined complete post‐saccal stenosis and partial stenosis of the canaliculus and 2% a partial stenosis of the distal lacrimal duct. In 18% of the patients no definitive location could be found using dacryoendoscopy. The localization of the stenosis determined with dacryoendoskopy correlated in 66,67% with the clinical diagnosis according to syringation, and in 70% with the localization of the stenosis as determined by dacryocystography. Endoscopy could provide additional information about pathologies of the lacrimal system, like lithiasis or polyposis.

Conclusions: Dacryoendoscopy can provide valuable information under direct visualization of the lacrimal system. However it must be doubted whether the benefits of this method may justify to subsitute the other well established methods in the diagnostics of dacryostenoses.
980 nm Diode laser retinochoroidal photocoagulation – in vitro comparison with frequency doubled Nd:YAG (532 nm) laser
Authors: URBANCIC M , MOCNIK G , PIZEM J , DRNOVSEK‐OLUP B
Published: October 2007

Purpose: To evaluate acute effects of diode laser (980 nm) on retina and choroid and to compare these effects with the effects of frequency doubled Nd:YAG laser (532 nm) on same eye structures.

Methods: Freshly enucleated pig's eyes were treated with diode laser (980 nm) and frequency doubled Nd:YAG (532 nm) through the slit lamp adaptors. Same energy densities were used. Histological examination of the treated eyes was performed after photocoagulation.

Results: Changes in photoreceptor layer (slightly increased eosinophilia) and outer nuclear layer (slightly condensed nuclear chromatin) of retina and coagulation necrosis of choroid were present in all laser lesions. There were no significant differences in retinal changes produced by both lasers. Coagulation necrosis of choroid was more pronounced in lesions produced by 980 nm diode laser.

Conclusions: Acute effects of both lasers were similar, although thermal damage produced by 980 nm diode laser extended deeper. The 980 nm diode laser could be used for retinochoroidal photocoagulation.
Influence of diabetes on central corneal thickness in type II ocular hypertensive patients
Authors: JIMENEZ‐CARMONA S , ALEMANY MARQUEZ P , FAILDE I , CARRAL F , JORDANO J
Published: October 2007

Purpose: Are central corneal thicknes values in ocular hypertensive patients comparable to that of non‐diabetic patients?. Is there some influence of diabetic disease on these values?

Methods: A samle of 271 patients has been distributed in 4 groups: 77 normal control patients (N), 74 ocular hypertensive (OHT), 59 diabetic patients without ocular hypertension (DM) and 61ocular hypertensive type II diabetic patients (DMOHT). Time from diagnosis and diabetes treatment are recorded. Also central corneal thickness (CCT), intraocular pressure (IOP) and diabetic retinopathy stage are also recorded. SPSS 14.0 statistical program was used and one‐factor ANOVA, Kruskal‐Wallis and chi‐square tests, and Pearson calculation have been applied.

Results: Mean CCT in N group (536,50±38,1μ), and mean CCT in DM group (545,49±29,06μ) are not statistically different. Mean CCT in DMOHT group (570,45±33,59μ) and mean CCT for OHT group (570,51±38,26μ) are not statistically different. Mean ECC difference between diabetic and non‐diabetic subgroups is not statistically significant. However, the mean ECC difference between ocular hypertensives and ocular normotensives subgroups is highly significant in both eyes (P < 0,000). Diabetes treatment has not influence on mean CCT intergroup comparisons. CCT and IOP correlate significantly in the whole sample for both eyes (P < 0,000). There was no linear correlation between mean CCT and age, nor between mean CCT and time of diagnosis.

Conclusions: Like OHT patients, DMOHT patients showed thick corneas. DM patients have normal CCT. Neither diabetes treatment, nor time of diagnosis are correlated to CCT. Corneal thickness is probably not related to the disease in DMOHT patients.
Fundus autofluorescence pattern as risk factor for development of geographic atrophy in patients with age‐related maculopathy
Authors: MOESSNER A , HOLZ F , FOJA C
Published: October 2007

Purpose: This subgroup analysis within the prospective multicenter natural history FAM study (Fundus Autofluorescence in age‐related Macular Degeneration) investigates the tendency of different fundus autofluorescence patterns (FAF) to convert into geographic atrophy (GA). Only eyes with drusen at baseline were observed.

Methods: In addition to ophthalmologic standard examination we took FAF images using a confocal scanning laser ophthalmoscope (HRA, Heidelberg Engineering). FAF was classified into eight different FAF patterns according to the “international fundus autofluorescence classification group” (IFAG).

Results: 131 eyes of 131 patients with drusen were observed. Incidence rate of FAF patterns was as follows: minimal change in 29 (22%), focal in 28 (21%), patchy in 26 (20%), reticular in 14 (11%), lace‐like in 11 (8%), speckled in 7 (5%), focal plaque‐like in 4 (3%), and linear in 4 eyes (3%). During follow‐up 20 eyes (15%) developed GA. Initially 8 eyes showed lace‐like pattern (73% of all eyes with lace‐like pattern). Three eyes with focal plaque‐like pattern and 3 eyes with linear pattern developed GA (75% of all eyes showing those patterns). Speckled pattern led in 3 eyes (43%) showing this pattern to GA. Two eyes with patchy pattern turned into GA (8%). One eye with focal pattern progressed to GA (4%).

Conclusions: Lace‐like, linear, and focal plaque‐like FAF patterns showed the highest risk for progression to GA. At the same time these patterns are relatively rare among all observed eyes with drusen. FAF as a non‐invasive examination method and different FAF patterns are usable tools to give a predictive interpretation concerning the risk of a progression from drusen to GA.
Use of a wide field scanning laser ophthalmoscope for screening purposes
Authors: ARNDT CF , NABHOLZ N , GUERIN M , BAZALGETTE C , RENARD E , AVIGNON A , NGUYEN F
Published: October 2007

Purpose: The wide field (200°) imaging system (Optos, Great Britain) using a scanning laser ophthalmoscope (SLO) enables to visualize a large part of the retina including the periphery. The present study was designed to evaluate the imaging system for screening purposes.

Methods: The SLO system was used in 2 groups of patients:

1) Outpatient clinic:

An undilated retinal biomicroscopy was performed by a resident, and an undilated SLO image was taken by an orthoptist in training. The images were reviewed by another resident masked to results of the previous retinal biomicroscopy.

2) Screening for diabetic retinopathy

An undilated and dilated retinal biomicroscopy was performed by a senior ophtalmologist. An undilated SLO image was taken by an orthoptist in training. The images were reviewed by a resident masked to results of the previous retinal biomicroscopy.

The results of the clinical examination were compared with the results of the SLO image analysis.

Results: In the outpatient group (n=123 eyes), the undilated retinal biomicroscopy missed 18% of the retinal lesions detected on the undilated SLO images. Less than 1% of the retinal lesions detected with the undilated retinal biomicroscopy were missed on the SLO images.

In the diabetes group (n=134 eyes), the undilated retinal biomicroscopy missed 10% and the dilated retinal biomicroscopy missed 5% of the retinal lesions detected on the undilated SLO images. None of the retinal lesions detected with the undilated retinal biomicroscopy were missed on the SLO images.

Conclusions: In both groups of patients, the diagnostic rate of undilated SLO images was significantly higher when compared with the diagnostic rate of undilated retinal biomicroscopy.
Evolution of light scattering after in vivo close to threshold dose of ultraviolet radiation 300 nm
Authors: HUANG S , GALICHANIN K , MODY V , LÖFGREN S , SÖDERBERG PG
Published: October 2007

Purpose: To determine the evolution of light scattering in the albino rat lens after in vivo close to threshold UVR‐300 nm.

Methods: Alltogether 4 groups of 20 6 weeks old albino Sprague‐Dawley rats were exposed unilaterally in vivo to 8 kJ/m2 UVR‐300 nm. The animals were sacrificed at 1, 7, 48 and 336 hrs after exposure after exposure to UVR, depending on group belonging and the lenses were removed for macroscopic imaging of dark‐field anatomy, and quantitative measurement of intensity of forward light scattering.

Results: The intensity of light scattering increased exponentially declining with a rate constant (1/k) of 71 hrs and an asymptote maximum light scattering of 0.16 tEDC. This is consistent with findings for a dose of 30 kJ/m2 although the current time constant was higher. There was an indication of a transient increase of light scattering on the contralateral side peaking at 7 hrs after expsoure. There was an indication for some repair at 336 hrs.

Conclusions: Light scattering evolves quicker, the higher the dose, but increases exponentially declining towards an assymptote. The current study suggest that observations of damage from close to threshold in vivo UVR exposure should be made at 1 week after exposure in order to detect the maximum damage.
Recurrent giant chalazia in hyperimmunoglobulinemia E (Job's) syndrome
Authors: PATTERI P , SERRU A , CHESSA ML , LOI M , DORE S , PINNA A
Published: October 2007

Purpose: To report a case of recurrent, multiple giant chalazia in a patient with hyperimmunoglobulinemia E (Job's) syndrome, a rare autosomal dominant disorder characterized by markedly increased immunoglobulin E levels and recurrent pulmonary and skin infections.

Methods: A 50‐year‐old man was referred with a 4‐year history of recurrent, multiple giant chalazia in all eyelids. Medications and surgical intervention produced only transient improvement. The patient also had a history of pulmonary and scalp infection.

Results: Laboratory tests disclosed elevated plasma immunoglobulin E (> 500 IU/ml) and eosinophilia. As a result, based on clinical and laboratory findings, a diagnosis of hyperimmunoglobulinemia E (Job's) syndrome was made.

Conclusions: Even though rarely, recurrent multiple giant chalazia may occur as an ophthalmic feature of the Job's syndrome. The hyperimmunoglobulinemia E syndrome should be suspected in any case of recurrent giant chalazia. Measurament of plasma immunoglobulin E and eosinophils, along with internal evaluation, are essential to establish a proper diagnosis.
Epidemiology of severe uveitis in France: a prospective multicentre study
Authors: BODAGHI B , SANCHEZ‐POTON A
Published: October 2007

Purpose: To determine the distribution and characteristics of severe uveitis, referred to university referral centres (URC) in France during a 3‐month period.

Methods: All new cases of uveitis referred between January and April 2006, to 31 specialized URC, for diagnostic or therapeutic management were prospectively reviewed. Characteristics of ocular inflammation were reported at the end of the first examination on a questionnaire.

Results: 527 patients were finally included. Median age was 44.1 (range 1‐95) and the sex‐ratio was 1. The majority of patients (60.92%) were referred by their ophthalmologist and no previous episode of uveitis was noted in 62.75% of cases. Acute‐onset uveitis was present in 68.22% of cases. Anterior uveitis was the most common type of presentation (54.7%) followed by panuveitis (21.1%). Complications at referral included a visual loss < 20/100 (20%), posterior synechiae (21.6%), secondary glaucoma (15.3%), cataract (7%), macular edema (7.8%) and retinal necrosis (1.7%). An infectious entity was suspected in 27.8% of cases. Among these patients, a viral infection was suspected in 11.6% of cases followed by toxoplasmic retinochoroiditis in 10.2% of cases. A noninfectious etiology was proposed in 46% of cases, including B27‐like uveitis in 15.5% of cases.

Conclusions: Even though classical forms of acute anterior uveitis are still referred to tertiary eye care centres, severe presentations of posterior or panuveitis should be managed properly. Initial ophthalmological examination is a key step for the diagnostic and therapeutic management of these patients. An infectious etiology may be easily suspected and should be excluded before the further use of corticosteroids or immunosuppressive drugs.
Intermedial uveitis: clinical course in ten years follow up
Authors: VIDOVIC VALENTINCIC N , KRAUT A , HAWLINA M , STUNF S , ROTHOVA A
Published: October 2007

Purpose: Intermedial uveitis (IU) is a chronic ocular disorder of unknown origin with frequent development of macular edema. The long term course of IU is not yet known and is a subject of this study

Methods: Retrospective study of 28 patients with IU (12 males, 16 females; 49 affected eyes) in whom a follow up of at least 10 years starting with the onset of IU was available.

Results: The average age at the onset of IU was 37. Five patients had an associated systemic disease (2 sarcoidosis and 3 multiple sclerosis). At onset bilateral involvement was observed in 20/28 (71%) patients. Visual acuity (VA) of more than 0.8 was noted in 19/48 (39%) affected eyes; and VA of less than 0.1 in 2/48 (4%) affected eyes. Systemic treatment with immunosuppressant drugs was required in 7/28 cases (25%) and 13 eyes underwent one or more surgical procedures (cataract surgery in 10 eyes, pars plana vitrectomy in 2 eyes, scleral buckling in 1 eye). At ten‐year follow‐up VA of more than 0.8 was noted in 22/49 (45%) affected eyes; and VA of less than 0.1 in 10/49 (8%) affected eyes. The causes of visual loss included predominantly cataract, macular edema and vitreous opacities. Moreover, during the ten‐year follow up intraocular inflammation diminished in 10/28 (36%) patients. The mean time to remission was 5.4 years (range 2‐12 years). During the follow up, systemic disease sarcoidosis and multiple sclerosis manifested in two additional patients.

Conclusions: The main complication of IU consisted of cataract, followed by macular edema and vitreous opacities. Within ten‐year of follow‐up one third of patient with IU achieved the long‐term remission of the intraocular inflammation.
Diagnostic methodology
Authors: TOMLINSON A
Published: October 2007

Purpose: The Diagnostic Methodology Subcommittee of the International Dry Eye Workshop (DEWS) identified tests used to screen, diagnose and monitor dry eye disease, and established criteria for test performance and considered of the utility of tests in clinical settings.

Methods: The Subcommittee, created a database of tests for diagnosis and monitoring dry eye, each test was compiled by an expert in the field (rapporteur) and presented within a standard template. The completed database is searchable by an alphabetical list of test names, as well as by functional groupings, for instance, tests of aqueous dynamics, lipid functions, etc. The templates can be accessed on the website of the Tear Film and Ocular Surface Society (www.tearfilm.org).

Results: The limitations of the effectiveness of tests in the diagnosis of dry eye and the factors which affect the sensitivity, specificity and predictive value of tests are discussed. Ways in which sensitivity and specificity can be optimised are illustrated in relation to diagnosis by tear hyperosmolarity.

Conclusions: A number of diagnostic tests, used singly and in combination, are available for the screening and diagnosis of dry eye disease; these are presented within a standard template prepared by DEWS.
Aspects of safety of riboflavin‐UVA crosslinking of the cornea
Authors: SPOERL E , MROCHEN M
Published: October 2007

Purpose: To investigate potential damages to ocular tissue during corneal collagen crosslinking (X‐linking) by means of the riboflavin/UVA (370 nm) approach.

Methods: Comparison of the currently used technique with officially accepted guidelines regarding direct UV‐damages (without riboflavin) and the damages created by the induced free radicals (photochemical damage).

Results: The currently used UVA dose density of 5.4 J/cm² and the corresponding irradiance of 3 mW/cm² without riboflavin is below the known damage thresholds of UVA for the corneal endothelium, lens, and retina. Regarding the photochemical damages due to the free radicals, the damage thresholds for keratocytes and endothelial cells are 0.45 mW/cm² and 0.35 mW/cm². In a 400 μm thick cornea saturated with riboflavin the irradiance at the endothelial level is 0.18 mW/cm² which is a factor of 2 smaller than the damage threshold.

Conclusions: After corneal X‐linking the stroma is depopulated of keratocytes approximately 300 microns deep. Repopulation of this area takes up to 6 months. As long as the cornea treated has a minimum thickness of 400 microns (as recommended) the corneal endothelium will not experience damages nor will deeper structures such as lens or retina. The light source should provide a homogenous irradiance avoiding hot spots which may locally destruct the endothelium.
Micromorphological analysis of cross‐linked cornea by in vivo scanning laser
Authors: MAZZOTTA C , CAPOROSSI A , BAIOCCHI S , CAPOROSSI O
Published: October 2007

Purpose: to assess In vivo micromorphological corneal modifications and healing process after Riboflavin‐UVA collagen cross‐linking in 44 human patients with progressive keratoconus, by means of HRT II scanning laser system confocal microscopy

Methods: Second phase prospective non randomised open study in 44 keratoconus patients treated and assessed as described in PURPOSE at Siena University. Treatment in topical anaesthesia included a 9 mm diameter epithelial debridement, instillation of 0.1% Riboflavin phosphate ‐ 20% dextran T 500 solution 15 minutes before UVA irradiation and every 5 min. Radiant energy was 3 mW/cm2 or 5.4 Joule/cm2 min, exposure time 30 min. The source was a led UVA illuminator 370 nm developed by Caporossi Baiocchi and Mazzotta X Linker (CSO). After removal of the soft contact lens, all patients were assessed by HRT II system confocal microscopy in vivo at 1, 3, 6 and 12 months.

Results: Disappearance of stromal nerves was observed in the central irradiated area of 9 mm. Six months after, the stroma was recolonised by nerve fibres with restoration of normal corneal sensitivity clinically detectable. Rarefaction of keratocytes in the anterior‐mid stroma, associated with edema was observed. Keratocytes repopulation in the central treated start 3 months after the operation becoming complete at about 6 months. The incresed reflectivity of extracellular matrix in all cases represent the most important indirect sign of a crosslinked cornea.

Conclusions: HRT II system confocal microscopy confirm in vivo corneal reinnervation, keratocytes repopulation of the stroma and the real depth of tratment. Healing process, limbal stem cells and transient haze were also analyzed for a complete safety evaluation of the method.
Crosslinking in iatrogenic keratectasia after LASIK: pregnancy‐related exacerbation
Authors: HAFEZI F , SEILER T
Published: October 2007

Purpose: Corneal collagen crosslinking can arrest the progression of LASIK‐induced keratectasia. We report a patient who developed bilateral iatrogenic keratectasia only during her first pregnancy at three years after initial LASIK. We performed bilateral corneal collagen crosslinking. In the following two consecutive years, keratectasia remained stable and even regressed. Upon her second pregnancy at two years after crosslinking, keratectasia exacerbated again.

Methods: We performed corneal collagen crosslinking with riboflavin and UVA in March 2005 (right eye) and April 2005 (left eye) as described previously.

Results: UV‐induced crosslinking led to an arrest and regression of keratectasia progression over a postoperative follow‐up period of 22 months, which was demonstrated by stable pre‐ and postoperative corneal topography and reduction of maximal K readings. However, in the fifth month of the patient’s second pregnancy, keratectasia exacerbated again.

Conclusions: We report the first case of exacerbation of keratectasia after corneal collagen crosslinking. Remarkably, exacerbation occurred during pregnancy indicating that hormonal changes might affect biomechanical stability of the cornea.
Reconstruction and replacement of the ocular surface
Authors: DUA HS
Published: October 2007

Purpose: To describe a protocol for the reconstruction and replacement of the ocular surface (OS)

Methods: Corneal epithelial stem cell deficiency (SCD) can result in a number of changes ranging from metaplastic corneal epithelium to complete corneal breakdown. Diagnosis of SCD is essentially clinical. Demonstration of goblet cells in corneal epithelium by impression cytology or biopsy is confirmatory. The extent of SCD is defined as unilateral or bilateral and partial (visual axis affected or spared) or total. Evaluation of the thickness and clarity of the corneal stroma underlying the fibrovascular pannus, the visual potential by electrophysiological tests, the intraocular pressure, workup of the patient for imunosuppession and HLA typing of the patient and potential living related donors are also required before embarking on treatment.

Results: For Partial SCD where the visual axis is involved, Sequential Sector Conjunctival Epitheliectomy is indicated. For total unilateral cases auto limbal transplantation is the treatment of choice and for total bilateral cases allo‐limbal, cadaver or living related donor transplants are indicated. Amniotic membrane as a patch or graft and ex‐vivo expanded cell sheets can also be used.

Associated lid abnormalities, symblepharon (buccal mucosa graft), glaucoma and cataract should ideally be dealt with prior to undertaking OS restorative surgery. When a corneal graft is needed it is best done as a second procedure after the ocular surface has been restored. When an intumescent cataract is associated with raised pressure, corneal gafting may become a necessity if a dense fibravascular pannus or corneal scar precludes visualisation of the interior of the eye. Longterm immunosuppession is usually required

Conclusions: This approach provides the best chance of success
The DSAEK development and its modification for improved endothelial survival
Authors: BUSIN M
Published: October 2007

Purpose: To evaluate the effect on postoperative endothelial survival of a modified DSAEK technique for the insertion of the donor tissue into the anterior chamber.

Methods: Twenty consecutive patients undergoing DSAEK and with a minimum follow‐up of 12 months are included in this study. The first 6 patients were operated on with a standard technique, including the so‐called “taco” manoeuvre to introduce the donor tissue folded and held with a special forceps into the anterior chamber. In the following 34 patients surgery was modified by using a crocodile vitreous forceps to “drag” the donor graft into the anterior chamber in various ways. The cornea module of the HRT II system (Heidelberg, Germany) was used to perform endothelial cell counts in all patients, 12 months after surgery (3 counts were made for each examination an the results averaged). The results were analyzed statistically with an unpaired Student’s t‐test.

Results: Endothelial cell loss varied between 28% and 75% in the first group (2 grafts showed evident clinical signs of endothelial decompensation and were exchanged) and between 16% and 24% in the second group. The difference between the two groups was highly significant (p < 0.01).

Conclusions: Endothelial cell survival after DSAEK can be substantially improved by reducing surgical manipulation at the time of insertion of the donor graft into the anterior chamber.
DLEK to DSEK to DMEK
Authors: MELLES GRJ , ONG TS , VERVERS B , VAN DER WEES J
Published: October 2007

Purpose: To describe the preliminary clinical results of selective transplantation of organ cultured donor Descemet membrane (DM) carrying autologous corneal endothelium through a 3.5 mm incision, tentatively named Descemet membrane endothelial keratoplasty (DMEK), for the management of corneal endothelial disorders.

Design: Non‐randomized clinical trial.

Methods: In ten patients with Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy, DMEK was performed. A 3.5 mm clear corneal tunnel incision was made, the anterior chamber was filled with air, and DM was stripped off from the posterior stroma. A 9.0 mm diameter DM roll was harvested from an organ cultured donor corneo‐scleral rim, and inserted into a recipient anterior chamber. The donor tissue was gently unfolded, positioned onto the posterior stroma, and secured by completely filling the anterior chamber with air for 30 minutes.

Results: At one month, six eyes had a best corrected visual acuity of 0.5 (20/40) or better, and three eyes reached 1.0 (20/20) or better. At six months, the endothelial cell density averaged 2030 (± 373) cells/mm2 (n=7). Three eyes showed a complete detachment of the donor tissue in the early postoperative course, that was managed by removal of the transplant and a secondary Descemet stripping endothelial keratoplasty procedure.

Conclusions: DMEK may have potential to become the most preferable technique to manage corneal endothelial disorders, because it provides quick and nearly complete visual rehabilitation. Since the donor tissue required can be prepared from organ cultured corneo‐scleral rims, the procedure may be readily accessable to most corneal surgeons.
Optical Coherence Tomography (OCT) and Ultrasonic Biomicroscopy in corneal diseases
Authors: NUBILE M
Published: October 2007

Purpose: To present the utility of ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography Visante (AS‐OCT) in the imaging of the human cornea.

Methods: UBM and OCT analysis of healthy and pathological corneas are investigated, with the aim to define morphological/morphometric patterns of clinical relevance.

Results: Cross sectional scans provided by UBM and Visante OCT enable morphological investigations of the cornea, ocular surface, and anterior chamber. Particularly AS‐OCT allows morphometric and quantitative analysis of the entire cornea, without invasiveness, together with corneal pachymetric maps. The anatomical relationships between the cornea and the adjacent anterior segment structures can be evaluated also in cases of loss of corneal transparency. Quantitative parameters can be obtained in cases of progressive corneal thinning, in degenerative and ulcerative diseases, descemetoceles, corneal oedema, and in the evaluation of post‐surgical corneal anatomy, such as lamellar interfaces, keratoplasties, ocular surface reconstruction, and amniotic membrane transplantation. Dynamic evaluations, over time, clearly allows clinicians to objectively assess variations of the corneal parameters (i.e. overall and sublayer thicknesses, lesion size, wound healing of stromal and transplanted tissues).

Conclusions: UBM and AS‐OCT are complementary analysis to biomicroscopy, and furnish morphometric and objective parameters also when the cornea is opaque. Being non‐contact, and providing a higher resolution, AS‐OCT should be preferred in the investigation of acutely diseased or surgically treated corneas. Cross sectional morphology, tissue reflectivity assessment and precise measurements are the main advantages over traditional slit‐lamp examination.