bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroprotective modifications in retinal Müller cells due to oxidative stress and energy restriction
Authors: Toft‐Kehler A.K. , Gurunbaram R. , Brændstrup C. , Desler C. , Rasmussen L. , Skytt D. , Kolko M.
Published: September 2015

Purpose

The viability of retinal ganglion cells (RGCs) is essential to maintain the neuronal function of the retina. Müller cells (MCs) are assumed to be vital in neuroprotection of the RGCs. In this study, we evaluated modifications in retinal MCs due to oxidative stress and energy restrictions.

Methods

The human Müller glial cell line, MIO‐M1, was used in all experiments. Changes in glutamate uptake were evaluated in oxidative stressed and energy restricted MCs. The cell viability was evaluated by LDH and MTT assays. Regulations in gene and protein expression were evaluated by qPCR and western blot. The ATP production was measured as well as the mitochondrial activity.

Results

Glutamate uptake was significantly in energy‐restricted MCs. Simultaneous energy restriction and oxidative stress significantly decreased glutamate uptake. The mitochondrial activity was reduced after exposure to energy restriction and further reduced during simultaneous exposure to energy restriction and oxidative stress. The intracellular ATP levels were decreased in the latter condition.

Conclusions

Oxidative stress and energy restriction alter the neuroprotective characteristics of MCs by increasing the glutamate uptake during energy restriction and by decreasing the uptake during simultaneous exposure to energy restriction and oxidative stress. The impaired mitochondrial activity and reduction of intracellular ATP levels may affect the ability of MCs to maintain a ellular homeostasis in such way that their ability to protect RGCs may to suffer.
Optic disc swelling: Prospective study of sixty‐seven patients
Authors: Sitbon C. , Fel A. , Bodaghi B. , Le Hoang P. , Touitou V.
Published: September 2015

Purpose

To assess the clinical features and etiologic work‐up of patients presenting with optic disc swelling (ODS) in the emergency room.

Methods

Patients seen in the ophthalmology emergency department of a single tertiary center between november 2014 and october 2015 were prospectively included. Each patient underwent an etiologic work‐up including a brain‐MRI, blood work, fluorescein angiography, and visual evoked potential.

Results

67 patients (39 female and 28 male) were included in this study. Average age was 46 years (17‐86 years). ODS was unilateral in 45% of cases and bilateral in 55% of cases. The average time between the onset of symptoms and diagnosis of papillary edema was 80 days (3 days to 8 months). The mean initial visual acuity was 0.2 logMAR, and the mean final VA was 0.1 logMAR. Final diagnosis was intracranial idiopathic hypertension (43%), anterior ischemic optic neuropathy (25%), inflammatory or infectious papillitis (22%), compressive optic neuropathy (2%) and unknown in 3 cases (8%). The etiologic work‐up was contributive for the final diagnosis in 10% of cases for fluorescein angiography; 35% for MRI of the optical nerve; 32% for laboratory tests; 67% for visual evoked potentials; 90% for the visual field of Goldman. Findings of Goldman's visual field included central or caecocentral scotoma (32%), exclusion or enlarged blind spot (41%), inferior altitudinal scotoma (19%), and bitemporal quadrantanopia (5%).

Conclusions

Our results demonstrate that causes of ODS could be identified in 92% of patients presenting with ODS. According to the clinical features at presentation, the etiologic work‐up can be further adjusted but a standard minimal etiologic work‐up is usually efficient to state the diagnosis.
Multifocal electroretinogram and en‐face OCT in patients who underwent retinal detachment surgery
Authors: Ricouard F. , Bigan G. , Tumahai P. , Flores M. , Castelbou M. , Delbosc B. , Saleh M.
Published: September 2015

Purpose

To study the anatomical and functional recovery after retinal detachment surgery (RD) by studying the reflectivity of the ellipsoid band (ISe) measured in en‐face OCT and multifocal electroretinography (M‐ERG) and investigate the factors involved in the results.

Methods

Prospective study of 39 patients operated successfully of RD and examined at baseline and at 3 (M3) and 6 months (M6). SD‐OCT and M‐ERG were performed at each visit. A coronal view of the ganglion cell layer (GCL) and the cone inner segment ellipsoid (ISe) band were reconstructed on en‐face OCT. The mean reflectivity in the 2 central degrees was calculated using image J and expressed as a gray level ranging from 0 (black) to 256 (white).

Results

M‐ERG waves amplitudes were reduced in RD involving the macula (p < 0.05). Best corrected visual acuity (BCVA) was correlated to the M‐ERG amplitudes at 6 months (p < 0.01). CGL and ISe reflectivity were lower in the group with macular involvement (p < 0.05). ISe reflectivity was correlated with the BCVA at M3 and M6 (p < 0.001). ISe reflectivity was also related to the duration of the macular detachment (p = 0.01). However, we did not observe any correlation between GCL reflectivity and BCVA. While, the GCL reflectivity was correlated with the RMS amplitudes (p = 0.03), there was no correlation between M‐ERG amplitudes and ISe reflectivity.

Conclusions

M‐ERG represents a valuable tool in the assessment of visual function after RD. En‐face OCT brings new insight on the integrity of the retinal structures after surgery, and shows that both inner and outer retinal layers are impaired after RD reattachment.
Subjective versus objective vertical cup‐disc‐ratio assessment in open angle glaucoma patients
Authors: Vandewalle E. , Willekens K. , Van Keer K. , Abegao Pinto L. , Stalmans I.
Published: September 2015

Purpose

To evaluate the difference in assessment between fundoscopic and confocal scanning vertical cup‐disc‐ratio (VCDR) in open angle glaucoma patients.

Methods

Data from a single eye of normal tension (NTG) and primary open angle glaucoma (POAG) patients from the Leuven Eye Study were included: age, gender, visual field mean deviation (MD), fundoscopic and HRT III VCDR assessment as well as mean retinal nerve fiber layer thickness (mRNFL). Differences within groups were assessed by paired sample t‐tests. Receiver operator curves (ROC) were constructed to assess and compute the likelihood ratio and positive predictive value.

Results

303 eyes (161 POAG and 142 NTG) were included. The average VCDR clinically assessed was significantly larger than the value derived from the HRT III software (0.81 ± 0.14 versus 0.61 ± 0.16, p < 0.001) and this difference remained statistically significant in both groups. In advanced glaucoma (MD > −12 dB), the area under the curve for HRT III and fundoscopic VCDR was respectively 0.80 ± 0.05 versus 0.84 ± 0.04 for NTG and 0.66 ± 0.044 versus 0.82 ± 0.033 for POAG. To predict a MD of maximum ‐12 dB with 80% certainty in NTG patients the VCDR needs to be at least 0.79 and 0.88 for HRT III and fundoscopic VCDR values, whereas in POAG patients these numbers are 0.88 and 0.93, respectively.

Conclusions

Clinical assessment of VCDR renders significantly higher values than HRT III derived values. Fundoscopic assessment of the optic nerve can predict better the visual field damage compared to the HRT III assessment.
Oral eplerenone as a first line treatment in chronic central serous chorioretinopathy: A case series evaluation
Authors: Sendon D. , Graber M. , Chiche A. , Rambaud C. , Berguiga M. , Delbarre M. , Froussart‐Maille F.
Published: September 2015

Purpose

To evaluate the effect of oral eplerenone on subretinal fluid (SRF), visual acuity, and choroidal thickness in patients with chronic central serous chorioretinopathy (CSCR).

Methods

Retrospective review of all patients monitored for a minimum of 3 months with chronic CSCR lasting more than 3 months who were treated with oral eplerenone with four physicians retina practice. Visual acuity, dilated funduscopic examination, and spectral‐domain ocular coherence tomography (SD‐OCT) with enhanced depth imaging (EDI) were obtained at each visit. The primary outcome measure was the reduction in subretinal fluid (SRF) following initiation of therapy. Protocol was oral eplerenone 25 mg daily first week and 50 mg daily during 9 weeks.

Results

4 eyes of 4 patients were treated. At 3 months, all eyes had decreased SRF height on OCT and all eyes had improved their visual acuity. Mean SRF height decreased from 390 µm to 285 µm and mean visual acuity enhanced from logMAR 0.20 to 0.08 No significant side effect occurred. Only one eye showed reccurence after eplerenone was discontinued.

Conclusions

Oral eplerenone appeared to be a safe and reliable treatment with significant anatomic and visual improvements in eyes with chronic CSCR.
Functional Expression of Toll‐Like Receptors in Human Retinal and Choroidal Vascular Endothelial Cells
Authors: Stewart E. , Wei R. , Branch M. , Sidney L. , Amoaku W.
Published: September 2015

Purpose

Toll‐like receptors (TLRs) are a family of proteins that initiate the innate immune response in reaction to invading microbes. Studies confirm the expression of TLRs in a variety of ocular tissues and cells, and it has also been suggested that selected TLRs may be associated with geographic atrophy and neovascularisation in age‐related macular degeneration, diabetic retinopathy and other vascular and inflammatory diseases of the ocular posterior segment. However, TLR expression and localisation in the retinal and choroidal vasculature has not been defined.

Methods

In this study the gene (mRNA) expression of TLRs 1‐10 was investigated using RT‐PCR and comparative qPCR and the protein expression and localisation of selected TLRs (3, 4, 6 and 9) were examined using western blotting, flow cytometry and immunofluorescent staining.

Results

PCR showed gene expression of TLR1‐6 and 9 in human choroidal endothelial cells (hCEC) and TLR2‐6, 9 and 10 in human retinal endothelial cells (hREC). Western blotting detected TLR3, 4 and 9 proteins in both hCEC and hREC with higher levels in hCEC, whilst TLR6 protein was not detectable in either cell type. Flow cytometry detected all four TLRs (3, 4, 6 and 9) on the cell surface and intracellularly, TLR6 expression was detectable but low. The expression and localisation of TLR3, 4 and 9 were confirmed by immunofluorescent staining and TLR functionality tested by expression of IL‐6 (ELISA) in response to TLR ligands.

Conclusions

This study has, for the first time, identified the differential expression and localisation of TLRs in intraocular endothelial cells. This profiling will help inform our understanding of different retinal and choroidal vascular diseases, as well as the development of future treatments for intraocular vascular diseases.
Intraarterial thrombocytic material revelative of essential thrombocytaemia in a 59‐year‐old woman
Authors: Rospond‐Kubiak I. , Oszkinis G. , Kociecki J.
Published: September 2015

Purpose

Aim: to present a case of accidentally detected thrombocitic material in retinal arteries that was revelative of essential thrombocytaemia.

Methods

Material/methods: 59‐year‐old woman presented in July 2013 with a suspicion of intraocular tumour. The patient was asymptomatic. There was a white nodular mass in her left eye infernasally, highly reflective on ultrasound. Initial diagnosis of choroidal granuloma was made. 4 weeks later, on the next follow‐up visit, a massive thromobocytic material circulating freely in the retinal arteries and multiple yellowish lesions were detected in her both eyes. Visual acuity was not disturbed.

Results

The patient was admitted to hospital with the suspicion of right heart failure. Apart from the high level of thromobocytes and D‐dimers no pathology was revealed. The patient was sent for further counselling and bone marrow biopsy which revealed no pathology. Few months later she was readmitted with a severe cerebral ischaemia, throbocytaemia and critical stenosis of right internal carotid artery (RICA) to 80%. Haematologic treatment was not effective and the patient died due to cerebral ischeamia in June 2014.

Conclusions

Thromobocytic material associated with essential thrombocytaemia might be visible in retinal vessels. This is a rare phenomenon and might be associated with a poor prognosis for the patient.
Dexamethasone reverses the effects of high glucose on human retinal endothelial cells in vitro
Authors: Stewart E. , Saker S. , Amoaku W.
Published: September 2015

Purpose

Diabetic retinopathy is the leading cause of preventable blindness in the working population and its prevalence continues to increase as the worldwide prevalence of diabetes grows. The main cause of visual loss in diabetic eye disease is diabetic macular oedema caused by an increase in microvascular endothelial permeability. Endothelial cell permeability is influenced by multiple factors which have not been fully elucidated, particularly in human models. Inflammation has been reported in the pathogenesis of diabetic retinopathy and the potential use of anti‐inflammatory agents such as the glucocorticoid dexamethasone is being extensively studied.

Methods

The effect of high glucose (25 mM) and dexamethasone on retinal endothelial cell proliferation and permeability were assessed using Cell‐8 proliferation reagent and passage of Evan's blue albumin, respectively. qPCR was used to quantify gene expression of selected tight junction molecules (Occludin, Claudin‐5, JAM‐A and JAM‐C) and adheren junction (VE‐Cadherin) molecules with high glucose and dexamethasone.

Results

High glucose decreased endothelial cell proliferation and this effect was reversed by dexamethasone. High glucose conditions significantly increased endothelial cell permeability and this effect was decreased with dexamethasone treatment for 24 and 72 hours. In retinal endothelial cell exposed to high glucose claudin‐5, occludin and JAM‐A gene expression were reduced and that of JAM‐C increased when evaluated with qPCR; dexamethasone was effective in partially reversing these changes.

Conclusions

Dexamethasone reverses high glucose induced alterations in retinal endothelial cell behaviour.
Localized changes in retinal nerve fiber layer reflectance intensity are related to localized functional loss in glaucoma
Authors: Gardiner S. , Demirel S. , Reynaud J. , Fortune B.
Published: September 2015

Purpose

Reflectance within the retinal nerve fiber layer (RNFL) may change prior to, or concurrent with, RNFL thinning in glaucoma. We hypothesize that reductions in RNFL reflectance intensity may be observed by optical coherence tomography (OCT), and may provide useful additional information beyond RNFL thickness.

Methods

Participants enrolled in an ongoing longitudinal study of glaucomatous progression had peripapillary circle scans acquired using spectral‐domain OCT, and performed automated perimetry, every 6 months. Data were analyzed from the most recent 8 visits with reliable results, from 211 eyes of 143 individuals. For each of the 52 visual field locations, intensity ratio and RNFL thickness were calculated within a 30º sector centered at the average location where corresponding nerve fibers enter the disc. Intensity ratio was defined as the mean intensity of pixels within the delineated RNFL boundaries divided by the mean intensity of pixels between the outer RNFL boundary and Bruch's Membrane. Rates of localized change were defined as the rate of change within each sector/location, minus the rate of global change. A mixed effects model was used to predict the rate of localized functional change from the rates of localized thickness and intensity ratio change within the corresponding sector.

Results

In a combined model, the rate of localized functional loss was predicted by both rate of thinning and the interaction between the rates of thinning and intensity ratio change (both p < 0.0001). For a given rate of RNFL thinning, a more negative rate of intensity ratio change predicted more rapid loss of sensitivity.

Conclusions

Reduction of RNFL reflectance over time is associated with loss of sensitivity at corresponding locations. While these are early results, they suggest potential improvements to the interpretation and quantification of OCT scans.
Endogenous panophthalmitis caused by sphingomonas paucimobilis; A postpartum devastating rare condition
Authors: ozcan A.A. , Esen E.
Published: September 2015

Purpose

Endogenous panophthalmitis is known as an infrequent condition with poor prognosis that mainly occurs in patients having underlying medical conditions. We present a very rare case of endogenous panophthalmitis in a postpartum patient.

Methods

A 31‐year‐old woman was admitted with vision loss and pain in the right eye for two days that began the day after the delivery.

Results

Her ophthalmologic examination revealed panophthalmitis. Despite intensive medication corneal melting and spontaneous perforation occurred, so evisceration had to be performed. Sphingomonas paucimobilis, an opportunistic infection agent, was isolated in the conjunctival swab and evisceration specimen cultures of the patient.

Conclusions

It is known that immune system is influenced and inflammatory responses are altered in pregnants and puerperants, so any symptom of eye infection should not be ignored in peripartum and puerperium periods.
Early experiences with intravitreal ocriplasmin: a series of cases with vitreomacular traction
Authors: Schulz C. , Saunders D. , Lockwood A. , Begum S.
Published: September 2015

Purpose

Ocriplasmin is a vitreolytic agent that may improve the chances of non‐surgical resolution of vitreomacular traction (VMT), based on phase III trials. Since it gained regulatory approval, only a handful of small retrospective studies have reported its efficacy. To date, no study has commented on the chronicity of VMT prior to treatment.

Methods

Case notes were examined for all patients with VMT that underwent intravitreal ocriplasmin injection at a single district general hospital. Baseline characteristics were recorded including patient demographics, sub‐classification of VMT, and the length of time from diagnosis to treatment with ocriplasmin. The main outcome was non‐surgical resolution of VMT within 28 days.

Results

All 9 eligible cases were included. The mean length of time between diagnosis of VMT and treatment with intravitreal ocriplasmin was 655 days. Only 1 patient (11%) experienced non‐surgical resolution of VMT within 28 days of treatment. This patient had the shortest time between diagnosis and treatment (17 days), and this was significantly distant from the sample mean (p = 0.01). The mean age of our sample (81) was higher than that reported in other studies. All other baseline characteristics were consistent with prior studies.

Conclusions

This study adds to the limited dataset regarding treatment of VMT with ocriplasmin since it gained regulatory approval. While the small sample size of this study is appreciated, the rate of success is disappointing when compared to phase III trials. The observations of this series raise the possibility that prolonged vitreomacular adhesion may limit the efficacy of non‐surgical resolution with ocriplasmin.
Tarsal inflammatory response after topical prostaglandin analogues treatment ‐ pilot study
Authors: Trzeciecka A. , Paterno J.J. , Toropainen E. , Wylegala E. , Kaarniranta K. , Smedowski A.
Published: September 2015

Purpose

To describe impact of topical preservative‐free (PF) prostaglandin analogues on inflammatory response within eyelid tarsus.

Methods

New Zealand rabbits’ eyes (n = 12 animals) were exposed to topical PF prostaglandins for 8 weeks daily. Each right eye was treated and each left eye kept as a control – topical PBS application. As eye drops we used PF tafluprost (Taflotan, Santen), PF latanoprost (Monoprost, Thea) and PF bimatoprost (Lumigan, Allergan). After 8 weeks animals were sacrificed, eyelids were post‐fixed in 4% paraformaldehyde and embedded in paraffin. Tarsal sections were immunostained for macrophage‐specific Iba‐1 and mucin. Tissue histology was evaluated by Masson trichrome staining. Quantitative analysis of macrophages (MFs) infiltration within tarsal: conjunctiva, stroma and glands was performed.

Results

PF prostaglandin treatment for 8 weeks did not affect mucin expression within analyzed tissues. Total number of MFs forming infiltration in tarsal conjunctiva of PF tafluprost group was 3.5 ± 2.5 vs 2.2 ± 1.5 cells (p > 0.05, respectively for treated vs control eye), in PF latanoprost group was 11.6 ± 9.8 vs 3.8 ± 1.8 cells (p < 0.05) and in PF bimatoprost group was 6.8 ± 5.1 vs 3.9 ± 2.5 (p = 0.05). There was significantly different intensity of MFs infiltration within tarsal conjunctiva between groups: PF latanoprost>PF bimatoprost>PF tafluprost (p < 0.05, Kruskal‐Wallis test). MFs infiltration within tarsal stroma and glands was slightly increased in PF latanoprost group when compared with control (p < 0.05), however it was not significantly different from other prostaglandins (p > 0.05).

Conclusions

Applied PF prostaglandin analogues affected MFs infiltration within tarsus. The strongest macrophage‐associated inflammatory reaction was related to PF latanoprost application, however there is a need for further analyses of other inflammatory response pathways.
Visual acuity increases up to 7 years after Descemet Stripping Automated Endothelial Keratoplasty
Authors: Hansen M.S. , Correll M.H. , Julian H.
Published: September 2015

Purpose

Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for corneal endothelial dysfunction restores vision up to 5 years post‐surgery, yet outcome exceeding this time span remains unknown. This study reports outcomes up to 7.8 years post‐DSAEK in a prospective observational study.

Methods

The cohort consists of the first 30 consecutive DSAEK‐surgeries in 25 subjects at Rigshospitalet Copenhagen, in 2006–2007. Data are reported for 14 eyes of 10 subjects (median age 65.8 years, range 55–79 years) who completed more than 5 years of follow‐up (mean 6.8 years, range 5.6–7.8). Best spectacle‐corrected visual acuity (BSCVA) was obtained using Snellen charts and transformed to logMAR. Endothelial cell density (ECD) was calculated by a digital Topcon SP‐3000P specular microscope camera. Central corneal thickness (CCT) was measured by OCULUS Pentacam.

Results

BSCVA improved from −0.54 ± 0.17 logMAR (mean ± SD; Snellen equivalent 6/18) pre‐DSAEK to −0.29 ± 0.32 logMAR (6/12) at 1 year (mean 1 year, range 0.6–1.4 years) and further improved to −0.17 ± 0.09 logMAR (6/9) at 7 years (mean 6.8, range 5.6–7.8 years). The proportion of eyes with BSCVA better than Snellen 6/12 was 64% at 1 year and 93% at 7 years. All grafts had ECD above 2000 cells/mm2 pre‐DSAEK. ECD decreased in most grafts from 1 to 7 years (mean loss 31%, range 10–43%), yet 5 grafts showed increased ECD (mean gain 39%, range 6–81%). CCT remained unchanged from 1 to 7 years post‐DSAEK (p = 0.39). 16 of the initial 30 eyes were lost to follow‐up due to death (8 eyes), graft failure (3 eyes), or other circumstances (5 eyes).

Conclusions

DSAEK provides continuous improvement of visual acuity up to 7.8 years post‐surgery with stable corneal thickness, and decreasing endothelial cell density in most grafts, yet some grafts showed surprising increase.
Ghrelin inhibits choroid‐retinal cell migration, proliferation and in vitro angiogenesis, under a high glucose environment
Authors: Rocha De Sousa A. , Silva‐Gomes R. , Conceição G. , Moleiro A. , Santos C. , Leite‐Moreira A.
Published: September 2015

Purpose

Ghrelin is a peptide expressed in many organs and tissues. Recently, ghrelin has been implicated in the pathophysiology of proliferative retinopathy, although its true involvement remains unclear. The aim of this study is to test the effect of ghrelin in the migration, proliferation, apoptosis and in vitro angiogenesis of primate choroid retinal endothelial cells (RF/6A), cultured under high glucose conditions.

Methods

RF/6A cells were incubated for 24 hours with different glucose concentrations (0–300 mM). Cell migration was assessed using wound‐healing assay. Colorimetric immunoassay was used for the quantification of cell proliferation, based on the measurement of BrdU incorporation. Cell apoptosis was assessed by TUNEL technique. For each glucose concentration, the effect of ghrelin (10–10 to 10–5 nM) was determined after 24 hours of incubation. The in vitro angiogenesis was assessed by tube formation assay after exposure to the same glucose concentrations and ghrelin (10–7 nM) for 4 hours.

Results

Ghrelin significantly inhibited RF/6A cell migration at every glucose concentrations, although this effect is more consistent under low glucose environment. Ghrelin, at the concentration of 10–7 nM, significantly reduces cell proliferation at every glucose concentration. In vitro angiogenesis is decreased by ghrelin under a high glucose environment. No differences on the apoptosis assay were seen.

Conclusions

In conclusion, ghrelin significantly inhibits RF/6A cells migration, proliferation and in vitro angiogenesis, under high glucose environment.
The Damato Multifixation Campimetry Online (DMCO) – A possible visual field test to detect neurological visual field defects
Authors: Steensberg A.T. , Olsen A.S. , Pinborg L.H. , Kolko M.
Published: September 2015

Purpose

The aim of the present study is to determine the ability of DMCO to detect visual field (VF) loss after epilepsy surgery and to determine the risk of visual field defects related to the operation.

Methods

Sixty patients will be tested by DMCO and Humphrey VF Analyzer (HFA). The patients will get a full eye examination to exclude eye diseases. A questionnaire will determine the subjective claims from the patients.

Results

16 DT Standard tests have been performed on ten eyes. HFA found that two patients had an almost complete quadrant anopsia, two had a smaller degree of quadrant anopsia, and one had no VF loss. DMCO detected the VF defect in the two patients with almost complete quadrant anopsia and not in the patients with the smaller VF loss. None of the patients perceived their VF loss before the test.

Conclusions

The preliminary results indicate an eighty percent risk of VF loss after epilepsy surgery. Our study indicates that DMCO may be a useful tool to detect neurological unrecognized VF losses.
Small pupil and pupil dilatation methods. Comparative study in cataract surgery
Authors: Caramello C.M. , Del Buey M. , Cristobal J. , Mateo Orobia A.J. , Martinez Velez M. , Sanchez Marin J.I. , Idoate A. , Pinilla I. , Casas P.
Published: September 2015

Purpose

To compare dilatation pupil devices implemented on cataract surgery, their advantages and disadvantages.

Methods

Prospective, interventional study to analyze the following pupil dilatation techniques: iris‐retractor hooks and Morcher‐5s, Perfect‐pupil, Graether, Malyugin and Oasis dilator ring. The following properties were studied: handiness, dilatation obtained, stability, and facility to remove the dilator ring in relation with the form, material, size and length of the necessary incision to proceed with the insertion.

Results

Iris‐retractor hooks are the best option in cases of zonular instability and retropulsion syndrome. The principal advantage is their versatility. Dilator‐rings obtained similar results in stability and dilatation. Malyugin and Oasis dilator rings had the best handiness results. Graether and Oasis were the easiest to remove and Morcher and Perfect‐pupil the most complicated.

Conclusions

Having a small pupil is one of the main causes of complications in cataract surgery. There are different surgical devices that allow minimizing intra‐operative risks. Each surgeon needs to select the best option compatible with to his surgical technique. Our study revealed that the most used devices were the iris‐retractor hooks due to the capsular stability that they provides and the Oasis dilator‐ring because of its flexibility and how easy they are to remove.
Retinal Layers Changes in Diabetic Patients without Diabetic Retinopathy
Authors: Ferreira J. , Vicente A. , Proença R. , Costa L. , Dias‐Santos A. , Santos B. , Cunha J.P. , Abegão Pinto L.
Published: September 2015

Purpose

To evaluate retinal layers thickness in diabetic patients without diabetic retinopathy (DR) using spectral‐domain optical coherence tomography (SD‐OCT). To correlate retinal layers thickness in diabetic patients with disease duration, systemic blood pressure (BP), glycemia, glycosylate haemoglobin (HbA1c), intraocular pressure (IOP) and ocular pulse amplitude (OPA).

Methods

Prospective, observational case–control study. A total of 175 eyes from 175 patients (125 diabetic patients without DR; 50 healthy controls) were recruited from the outpatient clinic in a tertiary center. A complete ophthalmological examination was performed (visual acuity, refraction, Goldmann applanation and dynamic contour tonometries, fundoscopy, axial length and SD‐OCT‐Spectralis®). After automated retinal segmentation the thickness of each layer was calculated in the 9 ETDRS areas.

Results

A significant increase of retinal nerve fiber layer (RNFL) thickness in inner and outer rings was found in diabetic eyes vs. controls (p between <0.0001 and 0.02). Thickness was also increased in specific sites of ganglion cell layer (GCL), inner nuclear layer (INL) and retinal pigment epithelium (RPE) in diabetic eyes (p between 0.001 and 0.03). A significant decrease of outer plexiform layer (OPL) was detected in diabetic eyes at two sites of the inner ring (p = 0.04 and p < 0.0001). The different retinal layers weren't correlated with systemic BP, glycemia, HbA1c, IOP and OPA, but the photoreceptor layer was negatively correlated with disease duration at 3 sites (r between −0.18 and −0.21, p < 0.05).

Conclusions

In diabetic patients without DR thickness of the inner retina seems to be increased. This suggests that metabolic and morphological changes of the cells of these inner retinal layers occur early and before the apoptosis and neural degeneration.
Retinal Vessel Oxygen Saturation and its implications in myopia
Authors: Heitmar R.
Published: September 2015

Purpose

To evaluate retinal vessel oxygen saturation and its relationship with ocular volume and axial length.

Methods

We included 65 healthy individuals (age range: 19–51 years) of varying axial lengths (20.74–28.24 mm). All subjects underwent full ocular examination including intra‐ocular pressure measurements and systemic blood pressure measurements which was followed by auto‐refraction, axial length, anterior chamber, corneal radii and retinal oxygen saturation assessments. In addition, all subjects underwent routine retinal photography which was used to determine their retinal arterial and venular calibres.

Results

Retinal vessel calibres, both arteries and venules were significantly decreasing with increasing axial length (arteries: β = −0.37; p < 0.001 and venules: β = −0.37; p < 0.001). Arterial vessel oxygenation showed a statistical significant relationship with axial length but not posterior volume (axial length: β = −0.88; p = 0.032 and posterior volume: β = 0.73; p = 0.075). Venous vessel saturation and oxygen consumption (A‐V) were independent of ocular length and volume.

Conclusions

Structural vascular changes such as vessel narrowing combined with changes in posterior volume and those brought about from vitreous detachment and degeneration could explain oxygenation related glaucomatous changes in highly myopic individuals.
Ampiginous choroiditis: heterogeneity in 2 cases
Authors: Vandeputte J. , Lambrecht P. , Leroy B.P. , De Schryver I. , De Zaeytijd J.
Published: September 2015

Purpose

We report two heterogeneous cases with ampiginous choroiditis and describe fundus photography, blue light autofluorescence, fluorescein angiography, indocyanine green angiography and cross‐sectional optical coherence tomography.

Methods

Observational report about 2 heterogeneous cases of ampiginous choroiditis.

Results

A 70‐year old woman and a 21‐year old man were referred to us with posterior uveitis. The female patient showed unilateral scattered chorioretinal lesions, whereas the male patient featured bilateral geographic chorioretinal lesions. In the first case, the lesions did not threaten the fovea. In the second case, the lesions involved the fovea of one eye and threatened the fovea of the second eye. Both patients presented with lesions showing blue light hyperautofluorescence. Fluorescein angiography showed early hypofluorescence with late staining of the borders whereas indocyanine green angiography showed hypofluorescent lesions through the early and late stages. Cross‐sectional optical coherence tomography of the lesions showed outer retinal atrophy. The tuberculin skin test and interferon‐gamma release assay were negative. The diagnosis of ampiginous choroiditis was withholded. A stepladder approach to obtain a corticosteroid‐sparing immunomodulatory treatment was initiated with azathioprine and visual acuity remained stable.

Conclusions

Ampiginous choroiditis is a primary inflammatory choriocapillaropathy with distinct features. However, the heterogeneous clinical findings can complicate the diagnosis.
Cystoid macular edema associated with retinitis pigmentosa resolved by a dexamethasone intravitreal implant
Authors: Almenara C. , Ascaso F.J. , Martínez M. , Pérez I. , Esteban O. , Bartolomé I. , Cristobal J.
Published: September 2015

Purpose

Cystoid macular edema (CME) is a serious complication that threatens the relatively preserved central vision in patients with retinitis pigmentosa (RP). It occurs in 10–40% of RP patients and, although the exact origin is unknown, a chronic low grade inflammation has been implicated. Currently, there is no gold‐standard therapeutic option and treatment should be individualized.

Methods

Interventional case report evaluating the efficacy of intravitreal dexamethasone implant (Ozurdex®) in the management of CME secondary to RP.

Results

A 39‐year‐old man diagnosed with RP and a 5‐month history of deteriorating vision was referred for evaluation. Best‐corrected visual acuity (BCVA) was 0.1 and 0.4 in RE and LE, respectively. Slit‐lamp examination and intraocular pressure (IOP) were normal in both eyes. On funduscopy, the findings were mottled retinal pigment epithelium (RPE) caused by bone spicule formation and attenuation of blood vessels. Spectral domain optical coherence tomography (SD‐OCT) revealed CME in RE which was treated with topical dorzolamide twice a day. As no visual improvement was achieved, two months later the patient underwent 0.7 mg Ozurdex® implant in his RE. One month following the injection CME resolved (from 546 µm to 310 µm) and BCVA improved to 0.3. An IOP spike (34 mmHg) was controlled with topical antiglaucoma medications and no recurrence was observed during 1‐year follow‐up.

Conclusions

Intravitreal dexamethasone implant (Ozurdex®) seems to be an effective treatment option for patients with macular edema associated with RP.
Endophthalmitis associated with intravitreal Ranbizumab: Microbiology and visual outcomes
Authors: Penwarden A. , Weston K. , Lockwood A.
Published: September 2015

Purpose

The purpose of this study was to examine the spectrum of pathogenic organisms isolated from all cases of endophthalmitis identified during an 11 year period (2003–2014) at a single eye unit. The study was undertaken at the Queen Alexandra Hospital in Portsmouth, UK.

Methods

Eye casualty and theatre data bases (HICCS, Medisoft) were used to capture cases of endophthalmitis. Case notes were reviewed to identify whether an intravitreal tap had been taken and to note visual acuities prior to ranibizumab treatment as well as the best visual acuity achieved post endophthalmitis treatment. Microbiological data was gathered for these cases by using the pathology database (ICE).

Results

There were 8 cases of endophthalmitis in the 11 year period. All except 1 had an intravitreal tap taken for gram staining and microbiological culture. 4 cultures grew coagulase negative Staphylococcus, 1 grew a Streptococcus species, 1 grew the gram negative organism Haemophilus influenza and 1 culture was sterile. All cases were treated with the intravitreal antibiotics Vancomycin and Ceftazidine.

5 patients had a starting visual acuity 6/12 or better and 3 were 6/18 or worse. Post recovery from endophthalmitis 4 patients had VA of 6/24 or better and 2 had Hand Movements or worse. The patient with the gram negative culture had NPL (no perception of light) vision.

Conclusions

The proportion of coagulase negative Staphylococci was slightly higher than other published reports. 2 patients had a poor visual outcome of Hand Movements or worse despite treatment with intravitreal antibiotics, one of which had a gram negative culture. However, half of the patients retained a reasonable vision of 6/24 or better.
Visual quality assessment and imaging techniques used to study biomaterials
Authors: Spalton D.
Published: September 2015

Cataract surgery has evolved from a sight saving procedure to one which improves the quality of vision. Quality of vision can be thought of as the physical resolving power of the eye, what the patient sees together with associated dysphotopsia, quality of the IOL relies on quality of manufacture and quality of the optics influenced by quality of surgery. Environmental scanning electron microscopy has proved extremely useful in assessing the profile of an IOL, intra lenticule glistenings can be imaged and semi quantified and atomic force microscopy examines surface smoothness and a wide range of other techniques are require to assess other biomaterial properties. Optics can be characterised by measuring modulation transfer function, Strehl ratio and wavefront, and vision by acuity and contrast sensitivity, measurement of forward scatter of light remains difficult and controversial. Patient reported outcomes are being increasingly used to differentiate clinical from subclinical improvement.
Visual outcome following treatment with aflibercept in patients with neovascular age‐related macular degeneration
Authors: Sander B. , Rasmussen A. , Lund‐Andersen H.
Published: September 2015

Purpose

Objective: To evaluate the visual outcome, number of injections and causes for discontinuation of treatment with aflibercept in patients with neovascular age‐related macular degeneration (nAMD).

Methods

Design: Retrospective chart review.

Participants: The study included 350 eyes in 350 patients who initiated first time intravitreal therapy for nAMD in 2013–14.

Descriptive statistical analysis of change in best‐corrected visual acuity (BCVA) from presentation to 3 and 12 months after the first injection.

Results

The patients’ mean age and visual acuity at baseline were stable at 80 years and 0.24 Snellen. Visual acuity increased significant with a mean of 6 injections; at 3 months to 0.38 Snellen, by 1 year to 0.41 Snellen for patients still in treatment; and to 0.35 Snellen for all patients with last observation carried forward.

By 1 year 77% of eyes were still in treatment, 10% had discontinued treatment with no apparent activity of disease and only a mean of 3.3 injections; 10% had discontinued treatment due to low visual acuity, 3% were lost to follw‐up

Conclusion

Treatment with aflibecept in patients with nAMD showed excellent visual outcome for the majority of eyes treated.
Prospective study about activity of emergency unit in the Department of Ophthalmology (Nancy, University Hospital, France)
Authors: Baudot A. , Ameloot F. , Trechot F. , Angioi K.
Published: September 2015

Purpose

Ophthalmological emergencies are common. Actually, access to care is difficult because of the low medical demography. The Department of Ophthalmology (Nancy, University Hospital, France) created a unit devoted to emergency in 2012.

Methods

We conducted a cross sectional study to describe this activity. All consecutive patients seen in the unit were included from February to April 2012 and from October to December 2014. We used a standardized evaluation (age, sex, access to care, geographic origin, symptoms, diagnosis, treatment, patient outcome). Every physician considered the real nature of the emergency.

Results

1496 patients were included during the first period (series 1) and 1116 during the second (series 2). The most common patient was a 45 years old man (55.3% and 56.3%). Many patients came by themselves without medical advice (40.1% and 58.4%). Principal symptoms were redness (31.5% and 24.8%), pain (28.5% and 25.0%), visual loss (22.6% and 17.7%), and irritation (20.6% and 17.8%). Traumatic context was frequent (about 25.0% of patients).The most prevalent diagnosis concerned the cornea. Serious infectious condition and vascular diseases were rare. 5.0% of patients were hospitalized and 6.0% received surgical treatment. 62.7% of them benefited only one consultation in emergency. They did not need another clinical control. 62.1–63.1% of consultations were qualified as real emergency.

Conclusions

Actually, the management of ophthalmic emergencies is a real public health problem. It is important to train emergency physicians and general practitioners, to address wisely to the specialist. Structures such as our unit seem to be an effective way to access care.
Utility of peripheral lamelar corneal graft in PUK with corneal perforation treatment
Authors: Sanchez Marin J.I. , Del Buey M.A. , Perez I. , Almenara C. , Esteban O. , Martinez M. , Idoate A. , Ascaso F.J.
Published: September 2015

Purpose

Peripheral ulcerative keratitis (PUK) is a destructive inflammation of the limbal corneal stroma with oval morphology. It is characterized by a sectorial affection with corneal thinning, usually associated with an epithelial defect, cell infiltration and progressive lysis of the stroma, which can progress to corneal perforation.

We present a case of a 88 years old woman who came to our hospital with epifora and foreign body sensation in the left eye. It was observed perforated marginal corneal ulceration in inferonasal quadrant with iris incarceration. She was treated with therapeutic contact lens and topical antibiotics and was programmed for surgery. In order to maintain the corneal integrity and due to the dimensions of the perforation, we decided to employ a lamellar corneal grafting because the use of tissue adhesives or amniotic membrane coating would be insufficient. This prevents the elimination of healthy cornea and keep better the anatomy. In the same surgery the graft was covered with amniotic membrane patch securing it with biological glue and coated with therapeutic contact lens.

Methods

The lamellar corneal grafting was obtained by manually cutting one of the corneoscleral edges of a donor cornea, in which the central corneal button was drilled and used for another patient in a penetrating keratoplasty the same day of surgery.

Results

The postoperative time coursed with no complications and showed good integration of corneal graft, through images of the anterior segment and AS‐OCT.

Conclusions

Lamellar corneal graft seems to be a good treatment option for maintaining the tectonic integrity in perforated patients due to peripheral ulcerative keratitis.
How accurate are optometrist referrals for glaucoma in the NICE era?
Authors: Bobat H. , Begum S. , Lockwood A. , Kirwan J.F.
Published: September 2015

Purpose

To determine if the reason(s) stated by the optometrist affect the positive predictive value (PPV) of referrals for suspected glaucoma.

Methods

Optometrist referrals in Portsmouth are streamlined though the Glaucoma Referral Refinement Scheme (GRRS). We retrospectively analysed 100 ‘positive’ and 100 ‘negative’ referrals to the GRRS. Positives: those referred on to a secondary care glaucoma clinic; negatives: those discharged from the GRRS. Reason(s) for referral were determined and classified: intraocular pressure (IOP) optic disc changes (OD), visual field defect (VF), shallow anterior chamber depth (ACD). Since negative referrals to GRRS are four times more prevalent than positives, we calculated a ‘corrected’ PPV for each reason by multiplying the number of negatives by 4.

Results

The overall PPV was 0.16. 70.4% cases were referred for a single reason (47.2% IOP, 12.2% OD, 8.8% VF, 2.4% ACD); the PPV was 0.11 for IOP and for OD, 0.05 for VF, 0.17 for ACD. 26.2% were referred for two reasons; the PPV was 0.47 for IOP + OD, 0.21 for OD + VF and 0.14 for IOP + VF. 4.2% were referred for IOP + OD + VF with a PPV of 0.62. Positive family history of glaucoma (21.4% referrals) did not increase PPV. The GRRS increased the PPV to 0.8.

Conclusions

The majority of patients are referred for a single reason, yet the chance of a positive diagnosis is low. Accuracy is increased when IOP is reported in combination with OD, but VF adds little value as a second parameter. The highest PPV is found when all three reasons are stated (IOP + OD + VF). The proportion of referrals for IOP alone is similar to that found prior to the NICE guidelines. However, the PPV is considerably lower; 0.11 compared to 0.3–0.4 found in previous studies. In the NICE era, refinement schemes play an important role in reducing false positive referrals.
Preoperative intravitreal bevacizumab effects on the course of Pars Plana vitrectomy in diabetic vitreous hemorrhage
Authors: Zahaf A. , Zghal I. , Fekih O. , Zayani M. , Mahjoub A. , Bouguila H. , Nacef L.
Published: September 2015

Purpose

To compare the rate of rehemorrhage in patients with diabetic vitreous hemorrhage (VH) undergoing pars plana vitrectomy (PPV) with versus without preoperative intravitreal bevacizumab (IVB) injection

Methods

Forty patients with proliferative diabetic retinopathy (40 eyes) with an indication for primary vitrectomy were randomized to IVB group (20 eyes) or control group (20 eyes). Intravitreal bevacizumab group received intravitreal injection of 1.25 mg/0.05 mL bevacizumab, 1 week before vitrectomy

Results

The frequency of postoperative recurrent vitreous hemorrhage (5%, 1/20 vs. 40%, 8/20, P = 0.017) were significantly lower in IVB group than in control group .The number of intraoperative endodiathermy spots (0.63 ± 1.0 vs. 1.3 ± 1.4, P = 0.028) were also significantly lower in IVB group than in control group while mean bleeding frequency in IVB group was 0.7 ± 0.78 times/case with range between 0 and 2 bleeding attacks/case and mean bleeding frequency in control group was 3.12 ± 1.31 times/case with range between 3 and 6 bleeding attacks/case and the difference was statistically significant as (p < 0.001). The frequency of reoperation due to recurrent vitreous hemorrhage within 4 weeks after surgery was significantly lower (P = 0.022) in IVB group (5%, 1 patient) than in control group (35%, 7/20)

Conclusions

Intravitreal injection of 1.25 mg/0.05 mL bevacizumab 1 week before vitrectomy blocked vascular endothelial growth factor production in vitreous and significantly reduced the incidence of reoperation due to early postoperative recurrent vitreous hemorrhage.