bluuebunny/crossref_metadata_2025 huggingface dataset:
Separating physiological from pathological effects of drugs tested for retinal toxicity in animal models
Authors: PERLMAN I
Published: September 2009

Purpose Drugs tested for retinal toxicity in animal models frequently induce physiological effects with or without pathological effects. The physiological effects may be interpreted to reflect toxic action. Here, different experimental approaches and modes of data analysis are described to separate physiological from pathological effects of drugs on retinal function and structure in laboratory animals.

Methods The flash electroretinogram (ERG) and the visual evoked potential (VEP) were used to assess respectively the functional integrity of the distal and proximal parts of the retina following intravitreal administration of drugs. Histology at the light microscopic level and immunocytochemistry were used to evaluate structural damage and to localize the site/s of action of the drugs.

Results The ERG responses and the VEP were recorded at different time intervals after intravitreal injection of different drugs in order to assess short‐term and long‐term retinal effects. In some cases severe functional deficit was identified, but it was transient in nature, and partial or even complete recovery was observed during a follow‐up period of at least 4 weeks. Different modes of data analysis were applied in order to separate physiological effects from pathological ones.

Conclusion Drugs, used in the ophthalmic clinic, can be retinotoxic and induce permanent retinal damage, or may exert transient changes that can reflect drug interference with the normal physiological function of the retina. Data are analyzed to separate these possibilities in order to allow accurate assessment of drug toxicity. Furthermore, drugs exerting transient physiological effects can be used to study the normal mechanisms of visual information processing in the retina.
The mysterious a‐wave
Authors: LACHAPELLE P , GARON ML , POLOSA A , ZIMAK E
Published: September 2009

Purpose The electroretinogram (ERG) waveform usually consists of two major components, the a‐ and b‐waves. Exceptions to the above rule are scotopic ERGs evoked to dim flashes, where only b‐waves are recorded. The aim of this study was to examine if the no a‐wave ERG was a feature of scotopic ERG only and try to explain why it occurs.

Methods Photopic (background: 30 cd.s.m‐2; flash:‐1.81 to 2.84 log cd.s.m‐2 in 0.2 log unit steps) and scotopic (‐5.01 to ‐0.96 log cd.s.m‐2 in 0.4 log unit steps) ERG luminance‐response functions were obtained from normal human subjects (n=30) and Long‐Evans (n=8) and Sprague‐Dawley (n=8) rats (scotopic ERGs only).

Results Human photopic ERG waveform always included an a‐wave. With flash luminance, its peak time first increased, reached a maximal value and then decreased progressively and could be fitted to a fourth order polynomial function. In contrast, scotopic a‐waves appeared only in ERGs evoked to flashes equal to or brighter than ‐3.01 log cd.s.m‐2. With increasing intensity, the peak time of the a‐wave shortened following a linear model.On average, for each log‐unit of flash attenuation, the scotopic a‐wave shortened by more than 10 ms compared to 1.4 ms for the photopic one. Of interest, in rat scotopic ERGs evoked to the dimmest intensities the a‐wave appeared to be replaced by a group of short latency oscillations that were best seen in recordings where the low frequency cut‐off had been raised to 100 Hz.

Conclusion The a‐b‐wave rule seems to apply only to photopic ERGs where an a‐wave was still identifiable in ERGs smaller than 1% of maximal amplitude. One wonders if the submicrovolt oscillations occurring prior to the onset of the b‐wave of rat scotopic ERGs evoked to dim flashes could represent remnant of the original a‐wave. Funded by CIHR
Anterior segment OCT in corneal diseases and surgery
Authors: NUBILE M
Published: September 2009

Purpose Optical coherence tomography (OCT) after extended use in diagnosis of retinal diseases has now become a new cross‐sectional imaging approach useful for anterior segment (AS) imaging. The potential advantages and limits using AS‐OCT in corneal diseases and surgery are presented.

Methods Systematic literature review search and clinical examples focused in the fields of corneal ulcerations, opacities and corneal graft penetrating and lamellar surgery.

Results AS‐OCT technology, using 1310 nm wavelength, offers some advantages as compared to high frequency ultrasound system, the main being the absence of contact with the eye. It provides relatively accurate morphology and measurements of different structures of the AS and of the cornea. Corneal loss of transparency in general permits visualization of the deeper AS structures facilitating surgical choice in complex cases. In contrast ciliary bodies are barely visualized, in contrast to UBM, due to light absorption by pigmented iris layers. Morphometry of corneal structures is particularly useful in the preoperative evaluation of thinning disorders, corneal ulcerations, loss of transparency and after penetrating and lamellar surgery, including assessment of LASIK flaps and of deep anterior keratoplasty interfaces and endothelial keratoplasty lenticules adhesion.

Conclusion AS‐OCT presents advantages in the clinical practice in the field of corneal disease and surgery. This technology alone should not substitute a comprehensive clinical examination but may offer valuable insights in the quantification and observation of fine details which can be obscured or not detectable during conventional slit‐lamp examination.
In vivo confocal microscopy of the cornea and conjunctiva
Authors: BAUDOUIN C
Published: September 2009

Abstract not provided
Anterior segment OCT versus UBM in the surgical management of pseudophakic bullous keratopathy
Authors: GICQUEL JJ
Published: September 2009

Anterior Segment‐OCT (AS‐OCT) is a non contact high Resolution Imaging system. It uses 1310 nm Coherent light and can scan up to 6 mm in Depth and thanks to a maximum scan width of 16 mm it can provide limbus to limbus cross sectional images even thru an opaque cornea. The acquisition is fast up to 8 Frames per second (almost video like). We decided to compare it to the Ultrasound Biomicroscopy (UBM), that is considered to be the gold standard of AS imaging. In a randomized comparative case series in patients with pseudophakic bullous keratopathy (PBK), we studied with AS‐OCT and UBM the anatomical modifications after a triple procedure involving: formerly implanted AC IOL removal followed by the fixation of a Verisyse Aphakic IOL either over or under the Iris. The AS anatomy was best respected in patients who had the Verisyze IOL implanted behind the iris. Measurements obtained with AS‐OCT and UBM were well correlated. AS‐OCT is a reliable and easy to use option for accurate AS imaging before and after surgery in patients with PBK.
Emergency keratoplasty
Authors: VALYI Z , PEREZ GARCíA D , IBANEZ J , ROJO ARNAO M , MINGUEZ MURO E , CRISTOBAL JA
Published: September 2009

Purpose Retrospective study about emergency keratoplasties made in our Service of Ophthalmology between 2006 and 2009.

Methods From the total number of 92 penetrating keratoplasties (PKP) 12 were done as an emergency. Of these, 66,7% were women and 33,3% men. Causes leading to surgery, donor and receptor cornea and eye, graft size, surgical technique, postoperative evolution, visual acuity and graft transparency were analysed.

Results Range of age was between 25 and 78 years. Corneal perforation was present in 8 cases. Corneal pathologies were: trophic and infectious corneal ulcers of bacterial, herpetic and fungal origin, bullous keratopathy and post‐LASIK hydrops. Best corrected visual acuity was between 0,1 y 0,7. Postoperatve complications were rejection of the graft (1 case), relapsed ulcer (3 cases), infections and calcium deposits. 9 grafts still remain transparent.

Conclusion Emergency keratoplasies have worse prognosis, as the corneas suffer from an active inflammation and/or infection, including a possible perforation. Alternatives for penetrating keratoplasty are corneal adhesives, lamellar keratoplasties and the use of amniotic membrane.
Straylight in function of wavelength and refraction
Authors: ROZEMA J , TASSIGNON MJ
Published: September 2009

Purpose To determine dependencies of straylight on ocular biometry.

Methods This prospective study includes 518 eyes of 277 volunteers with healthy eyes of various iris colors and ethnicities who had their retinal straylight tested using the psychophysical Oculus C‐Quant device. Ocular axial length and refraction were also measured, respectively using the Zeiss IOL master and the Nidek ARK‐700 autorefractometer.

Results The measured retinal straylight was validated by comparing our data with the age model described in the literature as log(s) = P1 + log(1+(Age/65)4). Our data was found to agree well, albeit that P1 was slightly higher (0.931 versus 0.87). Subtracting this model from the measured straylight values, a quadratic increase was found in function of axial length L. A similar model was defined for the spherical equivalent refraction SE and retinal image size I. This corresponds to an increasing straylight for increasing degrees of myopia. No correlation with keratometry or corneal astigmatism was found.

Conclusion Retinal straylight increases not only with age, but also with axial length. Further study is needed to identify the cause of this dependency.
Quality of life in cataract patients and the role of stray light
Authors: ASPINALL P
Published: September 2009

Purpose The aim of this study carried out at the Princess Alexandra Eye Pavilion in Edinburgh was to explore the similarities and differences in criteria for cataract surgery in current practice across 5 consultant teams at the hospital. In addition, a number of specific research questions were addressed. Among these, and the basis of this presentation, is the implication of using quality of life as a key referral criterion; and the relations between pre‐operative measures of stray light and quality of life indicators.

Methods 105 patients attending the cataract clinics at the hospital participated in the study. In addition to normal clinical practice, data was gathered on visual function (Snellen, LogMar,Pelli Robson contrast sensitivity); other clinical measures (Oxford cataract grading system and C‐quant); and quality of life indicators (VF‐14 and Vsq questionnaires).

Results Results will be presented in two parts. Firstly showing how the quality of life and the C‐quant measures relate to current practice. Secondly exploring inter‐relationships between the C‐quant and individual and aggregate quality of life scales as a basis for alternative referral criteria..

Conclusion General quality of life measures are loosely related to current referral practice for cataract surgery. On the other hand stray light (C‐quant) measures do seem more closely related to current practice
Women in ophthalmology: From bench to boardroom
Authors: GRAVES A
Published: September 2009

Dr. Adrienne Graves began her career as a visual scientist, with stops at Brown University, Harvard Medical School, University of Michigan, and University of Paris. Her passion for studying the visual system and the pathophysiology of disease processes led her to the pharmaceutical industry. After positions in R&D at Alcon, she is now President/CEO of Santen's US operations. Dr. Graves credits her time in Paris for expanding her horizons in many ways, including an appreciation for cultural diversity. This is especially important in her role as a Corporate Officer for Santen, a global ophthalmic pharmaceutical company based in Japan.
Oncocytic lesions of the ophthalmic region
Authors: HEEGAARD S , ØSTERGAARD J , PRAUSE JU
Published: September 2009

Purpose To make a nationwide clinicopathologic study of oncocytic lesions in the ophthalmic region and to characterize their cytokeratin(CK) expression.

Methods All histologically diagnosed oncocytic lesions in the ophthalmic region registered in Denmark over a 25‐year period were collected and re‐evaluated using a monoclonal antimitochondrial antibody (MU213‐UC). Clinical data were registered. Immunohistochemical characterization was performed with a panel of anticytokeratin antibodies.

Results A total of 34 oncocytic lesions were identified. The incidence that required surgical intervention in the Danish population could be approximated to 0.3 lesions per million capita per year. The age of the patients ranged from 45 to 89 years with a peak incidence in the 8th decade. Female gender was twice as common as male. Lesions were typically described as red‐brown, cystic and slow growing. The antimitochondrial antibody MU213‐UC produced a distinct and intense immunostaining. 26 of the lesions originated from the caruncle, three in the conjunctiva, two in the lacrimal sac, one at the semilunar plica, one on the eyelid margin and one peripunctal. Lesions were histologically classified as adenoma(oncocytoma) (26), hyperplasia (4) and metaplasia (4). Basal‐type oncocytic cells reacted with antibodies against CK5/6, CK7, CK8, CK13, CK14, CK 17, CK18, CK19 and suprabasal cells with CK4, CK7, CK8, CK18 and CK19. Antibodies against CK1+10 and CK20 showed no reaction.

Conclusion Oncocytic lesions of the ophthalmic region most frequently present as a caruncular oncocytoma. The cytokeratin profile is similar to the lacrimal ‐ and accessory lacrimal gland duct elements and supports the theory that these lesions originate from lacrimal – and accessory lacrimal glands.
A Western blot analysis of P‐glycoprotein in retinoblastoma
Authors: SETHI S , GHOSE S , PUSHKER N , BAJAJ MS , KAUR J , KASHYAP S , MEHTA M , SAXENA P , CHAWLA B , CHANDRA M
Published: September 2009

Purpose Literature regarding role of P‐glycoprotein (P‐gp), a multi‐drug resistance (MDR) protein, in retinoblastoma (Rb) is scanty and research has mainly concentrated upon immunohistochemistry. We analyzed P‐gp expression in Rb by Western blotting (WB) and correlated with histopathology (HP).

Methods Prospective analysis of P‐gp was done between May 2008‐May 2009 on 15 human Rb tissue specimens after enucleation, either as primary treatment [Group I;n=10] or secondary to chemotherapy (vincristine, etoposide and carboplatin) [Group II;n:5]. Samples collected immediately after enucleation in RPMI‐1640 supplemented with 10% fetal bovine serum, were subjected to WB. HP details (routine H & E) were considered for tumour differentiation and invasion of optic nerve/ocular coats. P‐gp expression was graded semi‐quantitatively as negative, low or high.

Results By WB, P‐gp expression was found in 30% of patients in group I (3/10) and 80% of patients in group II (4/5). All expressions in group II were high expression. On HP, in Group I: 70% poorly differentiated (PD) and 30% well differentiated (WD) tumours; 5/10 had involvement of optic nerve/ocular coats/others. In Group II: 60% PD and 40% WD tumors. 1/5 had involvement of optic nerve/ocular coats. 2/5 chemo‐treated eyes were phthisical.

Conclusion By WB analysis, P‐gp was expressed more frequently in Rbs treated by chemotherapy. No significant relation between tumor differentiation, tumor invasion and P‐gp expression was found. Though this may be the first study of its kind with promising results, similar studies could be done in more patients with further parameters, especially while managing chemoresistant cases of Rb in the only remaining eye of a child.
Granular cell tumour of the lacrimal gland
Authors: VON HOLSTEIN SL , ØSTERGAARD J , DAUGAARD S , TOFT PB , HEEGAARD S
Published: September 2009

Purpose To report the clinical and histopathological characteristics of a patient with a granular cell tumour (GCT) of the lacrimal gland.

Methods Surgical excision and histological examination.

Results A 38‐year old male presented with a painful swelling located temporally in the right upper eyelid. Clinical examination revealed proptosis and displacement of the right eye and a tumour was palpated at the site of the lacrimal gland. MRI scan revealed a solid tumour in the lacrimal fossa. The tumour was excised. Microscopically the tumour was composed of tumour cells with coarsely granular cytoplasm. The tumour cells were arranged in clusters and ribbons separated by collagen bundles and no necrosis or mitosis were present. The granules were PAS positive, diastase resistant and the tumour cells expressed focal staining for S100. Electron microscopy showed numerous secondary lysosomes. The diagnosis is consistent with a GCT.

Conclusion This case presents for the first time a GCT of the lacrimal gland.
Combined intravitreal bevacizumab and triamcinolone for exudative age‐related macular degeneration
Authors: LIBONDI T , JONAS JB , GOLUPKINA L , SPANDAU UH , SCHLICHTENBREDE F , RENSCH F
Published: September 2009

Purpose To report on the combined application of intravitreal bevacizumab with triamcinolone acetonide for treatment of exudative age‐related macular degeneration.

Methods The clinical interventional case‐series study included 16 patients (16 eyes) with exudative age‐related macular degeneration who had previously received 3.5±1.8 mono‐injections of bevacizumab (1.5 mg) without significant improvement in visual acuity or reduction in macular exudation. All patients underwent a combined intravitreal injection of bevacizumab (1.5 mg) and triamcinolone acetonide (about 20 mg). Main outcome measures were visual acuity and macular thickness as determined by optical coherence tomography. All patients were re‐examined at 2 to 3 months after the intervention.

Results Visual acuity improved significantly (P=0.03) from 0.80±0.40 logMAR prior to the combined injection to 0.65±0.42 log MAR at 3 months after the injection. An improvement by at least one Snellen line was found for 8 subjects, an increase by at least 2 lines for 5 subjects, and an improvement of 3 or more lines for 2 subjects. One patient lost one line, and one patient lost 3 lines. The central retinal thickness decreased significantly from 272±62 to 220±47 micrometer (P=0.03). At the 6 months follow‐up examination, the central retinal thickness increased again to 319± 142 micrometer, which was not significantly (P=0.30) different from the baseline measurements. measurements.

Conclusion The combined intravitreal application of bevacizumab and triamcinolone may temporarily be helpful in the treatment of exudative age‐related macular degeneration if previous intravitreal bevacizumab mono‐injections failed to improve vision and reduce macular edema
Prospective evaluation of macular and parapapillary morphology and their association with cognition in childhood and old age
Authors: LAUDE A , HENDERSON RD , GOW AJ , DHILLON B , STARR JM , DEARY IJ
Published: September 2009

Purpose We investigated the potential association between cognitive function and retinal morphology based on shared age‐related changes in a cohort of older people.

Methods Participants (n=250) from the Scottish Mental Survey 1947 undertook the Moray House Test (MHT) of general cognitive ability (IQ) at age 11 and 70. All were born in 1936. Fundus photographs were assessed by an ophthalmologist masked to the results of these tests.

Results Univariate analyses of variance were computed to compare the effects of retinal morphological features on cognitive test scores. Presence of retinal drusen was associated with lower age 70 IQ scores when compared to those without this abnormality. This difference approached statistical significance (F (1,166)=3.77, p=0.054, η2=0.22). Scores on the same cognitive test administered at age 11 were significantly lower in those with retinal drusen when compared to IQ scores from a group without this abnormality. This difference was statistically significant (F (1,158)=4.03, p=0.046, η2=0.025), though the effect size was small. But when age 11 IQ was included as a covariate in the earlier model, age 70 IQ scores were no longer significantly different by retinal drusen grouping (F (1,155)=1.47, p=0.228, η2=0.009). Similar analyses using parapapillary atrophy yielded null findings.

Conclusion Initial analysis of the age 70 IQ data implied that macular drusen could serve as a potential bio‐marker of cognitive decline. But the added information from the age 11 IQ data raises the possibility of reverse causation: rather than late‐life retinal damage being a marker of cognitive decline, early‐life cognitive ability might account for this retinal change in late‐life.
Extensive macular atrophy with pseudodrusen‐like appearance (EMAP), a new clinical entity
Authors: HAMEL C , MEUNIER I , ARNDT C , BEN SALAH S , LOPEZ S , BAZALGETTE C , ZANLONGHI X , ARNAUD B , DEFOORT‐DELLHEMMES S , PUECH B
Published: September 2009

Purpose To describe a previously unreported clinical entity of progressive extensive macular atrophy and pseudo‐drusen appearance in middle age patients.

Methods The database of the outpatient clinic for genetic sensory diseases was screened for patients over 40 years with uncharacterized macular dystrophy. Patients with extensive macular atrophy and pseudodrusen‐like appearance were included. Clinical investigations included visual acuity, eye examination, color fundus imaging, OCT scan, autofluorescence, Farnsworth 15‐HUE color testing, Goldman perimetry and ISCEV full‐field ERG.

Results Eighteen patients of 45 screened records matched the inclusion criteria. Bilateral polycyclic well‐delineated chorioretinal atrophy extending to the temporal vascular arcades, with a larger vertical axis and without sparing of the fovea featured the macular lesion. The pseudodrusen‐like appearance was widespread thoughout the posterior pole and the peripheral retina. In the extreme periphery, paving stone lesions were mostly located in the inferior quadrants. In contrast to age‐related macular degeneration, a rapid progression of the atrophy was observed with an early involvement of the foveal zone, thus leading to a severe visual loss. All the patients except two were legally blind at the end of the follow‐up. In all patients, the scotopic and photopic ERG responses were reduced.

Conclusion The cause of Extensive Macular Atrophy with Pseudodrusen (EMAP) remains unknown. Extensive Macular Atrophy with pseudodrusen (EMAP) should be considered as a possible pattern of severe macular dystrophy occurring in the middle‐aged adult.
Prevalence of myopia in preschool Singapore Chinese children
Authors: SAW SM , DIRANI M , GAZZARD G , MITCHELL P , VARMA R , WONG TY
Published: September 2009

Purpose To determine the prevalence of refractive error types in Singaporean Chinese children aged 6 to 72 months.

Methods The Strabismus, Amblyopia and Refractive error in Singaporean Children (STARS) is a population‐based study conducted in southwest Singapore. Door‐to‐door recruited participants were selected using a disproportionate random sampling in 6 month increments. Eye examinations included LogMAR visual acuity, cycloplegic autorefraction, and IOL Master biometry. Overall and age‐specific prevalences of myopia (spherical equivalence [SE] < ‐0.50 diopters [D]), high myopia (SE < ‐6.00 D), hyperopia (SE >+3.00 D), astigmatism (cylinder >+1.50 D), and anisometropia (SE difference between each eye >2.00D) were calculated.

Results 3009 children were examined (participation rate 72.3%). Right eye (OD) cycloplegia data were available for 1375 boys and 1264 girls. Mean OD SE was +0.69D (SD 1.15D). Overall myopia prevalence was 11.0% with no gender variance (p = 0.91). High myopia prevalence was 0.2%. Prevalences of hyperopia, astigmatism and anisometropia were 1.4%, 8.6%, and 0.6%, respectively. Myopia was present in 15.8%, 14.9%, 20.2%, 8.6%, 7.6%, and 6.4% of children aged 6‐11, 12‐23, 24‐35, 36‐47, 48‐59, and 60‐72 months, respectively. Astigmatism prevalence increased with age (p<0.001), but hyperopia and anisometropia did not, p= 0.55 and p= 0.37, respectively.

Conclusion Prevalences of myopia and astigmatism in Singaporean Chinese preschoolers are high, and low for hyperopia. Age effects were observed for each refractive error category.
Validation and use of simulated corneal endothelium specular microscopy images
Authors: BUCHT C , SÖDERBERG PG , MANNEBERG G
Published: September 2009

Purpose The aim of the current study was to develop simulation software capable of producing life like images of the corneal endothelium (CE) captured by clinical specular microscopy (CSM). Exact morphological data would come with each image. Once evaluated for authenticity, simulated images would be used for evaluation of the precision of methods of morphometry of corneal endothelium density (CED).

Methods Software for simulation of images of the CE captured by CSM was developed. Several unique images of the CE were created, spanning a range of CED. 12 images, evenly spread over a CED range of 1959‐3838cells/mm2 were selected. The images were uploaded to a PC with border tracing software for CE morphometry. The semi‐automated morphometry software was used to analyze the CED of the 12 images. The CED results given by the analysis and the CED given from the creation of the images were analyzed by linear regression.

Results An expected correlation between CED given from the creation of the simulated images and the CED given from the semi‐automated analysis was found. Assuming CED given by the model were exact, the standard deviation of the residual variance of the analyzed CED was estimated as a 95% confidence interval to 15.8‐91.0cells/mm2, corresponding to a variation coefficient of 0.5‐3.1%. Average CED of the 12 samples was 2899cells/mm2.

Conclusion A simulator capable of realistic CE structures is a useful tool. Not only can it be used to estimate the accuracy of current methods of CE morphometry – it can also be used for development of new methods of morphometry, due to the virtually unlimited access to unique realistic images that come with exact and pre‐defined morphological data.
Intraocular pressure measurements values in patients who have had uneventful deep anterior lamellar keratoplasty
Authors: DOMINIKA J , WYLEGALA E
Published: September 2009

Purpose To effect of central corneal thickness (CCT) and graft site thickness ( GS) in patients who have had uneventful deep anterior lamellar keratoplasty (DALK) using “ big bubble” technique, on intraocular pressure (IOP) measurements, investigated using two different techniquesRetrospective cross sectional study from May 2008 to April 2009 on Ophthalmology Department of District Railway Hospital in Katowice, Poland.

Methods Patients 40 after DALK, at least 12 months prior to testing. Control group: 30 patients. IOP was determined by Goldman applanation tonometer (GAT) and iCARE (IC) rebound tonometer. CCT and GS were assessed by Anterior Segment OCT (Visante OCT). Mean GAT and IC IOP were calculated for: DALK and control. Agreement between results from IC and GAT were assessed using the Bland‐Altman method. The deviations of IC readings from GAT, corrected for CCT were calculated using a linear regression model.

Results In DALK mean CCT was 470.6 +/‐ 39 µm and in control 550.9 +/‐ 29 µm. Mean IOP +/‐ SD in DALK 16.5 +/‐11.1mmHg in control 16.7 +/‐ 4.2mmHg for IC. Mean IOP using GAT for studied group was 15.7 +/‐ 2.4mmHg and for control 13.2 +/‐ 2.6 mmHg. IC IOP was significant higher than GAT (P < .005). Difference between IOP and CCT and GS were not statistically significant (P = .53). Correlations between IOP and CCT were not significant in these cohorts (P > .09). Agreement between IC and GAT was assessed.

Conclusion IOP measured by IC was consistently higher when compared with GAT, this difference was greatest with thicker CCT but not with thicker GS. Falsely underrated IOP in DALK was not demonstrated.
Technical standardisation to measure the ocular surface lipid layer with Meibometer 550
Authors: NEPP J , BENZ P , SCHAUERSBERGER J , NELL B
Published: September 2009

Purpose Evaluation of measuring errors in usage of the meibometer550.

Methods Measurements of lipid layer of the ocular surface tear film were done by Meibometer 550. For exact measurement we observed possible disruptions, the calibration, hygienically standards, different sampling, alteration after topical treatment.Before each measurement there must be a calibration by clean lipid ‐free stripes.We observed the adjustment with two clean stripes by double measurement of each other.Both results must be 0. Hygienically influence is presumed by incorrect handling if objects are touched. Stripes were pressed on objects and measured.Those objects were the table surface, the hand of the observer, the gloves and the disinfectant used.We observed different pressure sampling as pressure may extract more lipids from the lid with touch of the lid and no touch, with pressure and without For the influence of topical treatments we dropped several artificial tears directly on the stripes, watery artificial tears, gels, ointments and drops with lipid portions.

Results After double calibration new stripes showed values of nearly 0, elder stripes 10‐18 u. Hygienically: in clean tables we measured <28u, even clean hand < 60 u, gloves < 5u. Disinfectant fluids decreased measured lipids from 500 to 100 u. There was a difference in sampling with pressure to samplings without pressure between 50 and 80%. Topical treatments changed different after use of watery drops: 0‐15u, lipid spray: change 370 u average, fatty ointments: change of 557u to 751 u.

Conclusion It is important to notice the careful handling during measuring the lipid layer with MB 550 to obtain valid measuring data.

Commercial interest
Cell death in lens epithelial cells after stimulation of the sigma‐2 receptor
Authors: KARLSSON JO , JONHEDE S , PETERSEN A , ZETTERBERG M
Published: September 2009

Purpose The aim was to investigate the mechanisms of cell death in lens epithelial cells after administration of siramesine, a sigma‐2 receptor agonist.

Methods Human lens epithelial cells in culture were exposed to siramesine and examined for morphological changes using DIC or calcein as a cytoplasmic marker. Lysosomes were studied using acridine orange and MagicRed. Proteolytic activity of the proteasome, calpain, caspases and cathepsins in living cells or cell extracts were studied using different fluorogenic substrates.

Results Siramesine at low concentrations increased the cytoplasmic proteolytic activity of the proteasome and the calpain system. Early effects was also observed with respect to lysosomal morphology, acidity and function. Activation of caspase‐3 and the appearance of nuclei with an apoptotic morphology were also found.

Conclusion Siramesine at very low concentrations affects lens epithelial cells with perturbation of the major proteolytic systems, lysosomal morphology and results in caspase activation and cell death. Siramesine may be a promising substance for clinical studies concerning the treatment of PCO.
The crystalline lens higher fatty acids influence on the lens physical characteristics
Authors: KUDRYAVTSEVA Y , CHUPROV A
Published: September 2009

Purpose To study influence lipids of a crystalline lens on its physical characteristics.

Methods 114 patients at the age from 55 till 78 years, with a cataract of various degree of a maturity are selected. Researches of a lens nucleus in vitro included: definition of mechanical hardness on the original device for research of mechanical hardness of a crystalline lens, research of composition of the higher fatty acids on the gas‐liquid chromatograph.

Results Influence of the higher fatty acids composition on mechanical hardness of a lens nucleus is revealed. Strong direct dependence between polyunsaturated fatty acids contents and hardness of a crystalline lens is found out. The correlation factor is equal 0.7 (? <0.05). Pentadecanic and stearic acids ‐ the saturated fat acids have average correlation with hardness of lens ‐ the correlation factor is accordingly equal ‐0.6 (? <0.05) and ‐0.6 (? <0.05), in spite of low contents in the lens. The palmitic acid contains in the cataract lens in concentration comparable to level polyunsaturated fatty acids, however, essential correlation with hardness has no ‐ the correlation factor is equal 0.21 (p >0.05). The oleic, linolic and linolenic acids are contained in the cataract lens in low concentration and have average (v and linolic acids) ‐ the correlation factor is accordingly equal ‐0.5 (? <0.05) and ‐0.57 (? <0.05) and weak correlation (linolenic acid) with hardness of a crystalline lens ‐ the correlation factor is equal ‐0.22 (p> 0.05).

Conclusion The polyunsaturated higher fatty acids which are a basis of membranes of a crystalline lens have the maximal influence on mechanical characteristics of the lens.
Evaluation of quality of life, and priorities in people with glaucoma
Authors: ASPINALL P
Published: September 2009

Purpose Quality of life appears to be of increasing importance as a criterion for clinical intervention. However its meaning can be complex and its assessment varied. In social science the term has broad definitions which include terms such as autonomy, wellbeing; self esteem; sense of control etc. On the other hand within ophthalmology a narrower operational definition is mainly used which is the degree to which someone’s vision impacts on a range of necessary and desirable daily tasks a person wishes to carry out. The purpose of the presentation is to compare alternative methods of quality of life assessment.

Methods The assessment approaches taken in the study range from conventional questionnaire rating scales, (something NICE has questioned) and time trade off comparisons, to more recent methods of scaling generated by for example Rasch or Hierarchical Bayesian analysis.

Results Data will be presented from two studies (one in Edinburgh and one in Aberdeen) on quality of life in people with glaucoma. One of the new recommended discrete choice methods (Choice based conjoint analysis with Hierarchical Bayesian estimates) will be used. The results will include quality of life outcomes and their stability; related visual factors; comparisons across methods and more general implications for quality of life assessment.

Conclusion Different methods for the assessment of quality of life produce different results with relatively low correlations between them although conjoint analysis has revealed stable priorities across two independent studies. These discrepancies in quality of life assessment require further study and evaluation.
Measuring visual diasability in glaucoma
Authors: KOTECHA A
Published: September 2009

Quantification of the visual disability experienced by the glaucoma patient is currently limited to the use of clinician‐based measures of disease status; that is, measurement of retinal nerve fibre layer thickness, visual field sensitivity and intraocular pressure. However, whilst these tests provide information to the clinician regarding patient management requirements, they provide very little information about the patient’s ability to function on a day‐to‐day basis. There have been attempts to measure the glaucoma patient’s experience using vision‐specific ‘quality of life’ questionnaires. However, it is apparent that no two patients with the same disease status will report the same quality of life experience. The purpose of this talk is to present new work examining how glaucoma patients perform specific, day‐to‐day tasks in the presence of the disease, with a view to understanding what specific visual factors might explain the difficulties they encounter at different stages of the disease.
Fitness to drive in glaucoma patients‐ Preliminary study results
Authors: STEVENS AM , LELOUP E , ZEYEN T
Published: September 2009

Purpose To develop a useful binocular 30° visual field criterion to predict safe driving behaviour in glaucoma patients by comparing perimetric data with an actual driving test on the road.

Methods The sample will consist of 200 driving glaucoma patients, recruited in 2 university based glaucoma clinics (Ghent and Leuven, Belgium). Inclusion criteria are glaucomatous optic disc damage and/or glaucomatous field defects. Exclusion criteria are concomitant ocular disease, cataract > LOCS 2, systemic disease or medication affecting the visual field. Data collection will include demographic and medical data, driving habits, and Mini Mental Status. A complete ophthalmic examination wil be done including Goldmann, SAP and Esterman visual field testing. In addition, UFOV test, stereopsis and contrast sensitivity testing will be performed. All subjects will perform an on the road driving test with a driving expert of the Belgian Institute for Traffic Safety. Subjects can pass, fail, or pass the test with limitations. An attempt will be made to develop an algorithm of visual field abnormalities that predict as accurately as possible the outcome of the practical driving test.

Results Preliminary results of the first 50 included patients will be presented.
Impact on visual function from light scattering and glistenings in intraocular lenses
Authors: MöNESTAM E , BEHNDIG A
Published: September 2009

Purpose To investigate the impact on visual function from light scattering and glistenings in intraocular lenses (IOLs) in patients who had cataract surgery 10 years previously.

Methods 103 patients, who had phacoemulsification with implantation of Acrysof® MA60BM IOLs 10 years previously, were evaluated with best corrected visual acuity (VA), and low contrast visual acuity (LCVA) 10% and 2.5 %. The light scattering from the IOLs was measured by Scheimpflug photography. The degree of glistenings was also quantified at the slit‐lamp. Eyes with coexisting pathology that could affect VA and LCVA were excluded.

Results The patients were divided into various groups according to the degree of light scattering and grade of glistenings. In two subsets of patients paired data from the patients’ two eyes were analyzed. It was not possible to detect any significant impact on visual function, BCVA and LCVA 10% and 2.5% in eyes with a more pronounced light scattering or a higher grade of glistenings seen at the slit‐lamp. The correlation between IOL dioptric power and both the total light scattering of the IOL, and the subjective grading of the intensity of the glistenings at the slit‐lamp was statistically significant (r=0.25; p=0.012; rS=0.23; p=0.019, respectively).

Conclusion Most patients in this case series operated 10 years previously had severe glistenings and a high level of light scattering from their intraocular lenses. No detectable impact on BCVA, LCVA 10% and 2.5% was found.
How to tell dystrophies of Bowman's layer (Reis‐Bücklers and Thiel‐Behnke) from one another
Authors: KIVELÄ T
Published: September 2009

Purpose To discuss difficulties encountered in differentiating two classic dystrophies of the Bowman layer caused by mutations of the TGFBI gene: Thiel–Behnke corneal dystrophy (TBCD) and Reis–Bücklers corneal dystrophy (RBCD).

Methods Critical review of published data by the IC3D group and personal experience of the author as an ophthalmic pathologist and clinician.

Results It has traditionally been difficult to recognise and distinguish TBCD and RBCD, so much so that some early papers claimed to describe the ultrastructure of RBCD actually analysed tissue from patients with TBCD; the known entity of RBCD was described as an unusual variant of granular corneal dystrophy; and Waardenburg‐Jonkers dystrophy appeared for eyars in textbooks although their patients had TBCD. The main problem is that both dystrophies are fairly rare and clinicians seldom have personal prior experience or adequate literature knowledge of both when they encounter a patient; and the literature with its frequent errors in diagnoses has not been that helpful.

Conclusion TBCD and RBCD may be differentiated by careful clinical and ophthalmic pathologic examination if the clinician and pathologist are experienced; genetic or electron microscopic examination is needed for unequivocal confirmation.
Coenzyme Q10 prevents human lens epithelial cells from light‐induced apoptotic cell‐death by reducing oxidative stress and stabilizing BAX/Bcl‐2 ratio
Authors: KERNT M , HIRNEISS C , NEUBAUER AS , ULBIG MW , KAMPIK A
Published: September 2009

Purpose Cataract is one of the most prevalent eye disease and a major cause for legal blindness in the world. Beside others, cumulative light‐exposure and apoptotic cell death are significantly associated with cataract developement. In contrast, supplementation with antioxidants has been suggested to prevent premature cataractogenesis. This study investigates possible protective effects of Coenzyme Q10 (CoQ10) regarding light‐induced stress and apoptotic cell death in human lens epithelial cells (LEC).

Methods Human LEC were either pre‐incubated with CoQ10 or not and then exposed to white light. After 10 to 40 minutes of irradiation viability, induction of intracellular reactive oxygen species (ROS), apoptosis and cell death was determined. Expression of apoptotic BAX and anti‐apoptotic Bcl‐2 protein and their mRNA were determined by RT‐PCR and Western‐Blot analysis.

Results Light exposure decreased LEC viability and Bcl‐2 expression and increased intracellular ROS, apoptotic cell death, and BAX expression in a time‐of‐irradiation‐dependent manner. Phototoxic cell death and apoptosis, as well as decrease of Bcl‐2 and increase in BAX expression was significantly reduced, when cells were pre‐incubated with CoQ10.

Conclusion In this study CoQ10 significantly reduced light‐induced LEC‐damage and attenuated phototoxic effects on BAX and Bcl‐2 expression. Therefore, CoQ10 supplementation might also be useful in preventing LEC death and consecutive cataract formation in vivo.
23G versus 20G for macular hole surgery. Efficacy, safety and patient satisfaction
Authors: PAPPAS G
Published: September 2009

Purpose To compare the 20gauge and 23gauge vitreoretinal surgical system and equipment in macular hole surgery.

Methods We randomly assigned 38 patients in two different groups. Group 1. Used 20g surgical equipment and instrumentation. Group 2. Used 23g surgical equipment and instrumentation. All cases were operated by the same surgeon. The efficacy, the safety and the patient comfort were evaluated.

Results No statistically significant difference found between the two groups regarding efficacy and complications. Group 2 was superior to group 1 regarding patient satisfaction (p<0.005).

Conclusion 23g surgical equipment offers similar efficacy to the established 20g equipment for macular hole surgery. Though reduces the intraoperative time and patient overall satisfaction is greater.
The initial consultation
Authors: SPILEERS W
Published: September 2009

Purpose A patient reporting flashing lights, shimmering, positive scotoma, hallucinations, ...needs a full (neuro‐)ophthalmological work‐up.

Methods The ophthalmological work‐up includes visual acuity testing, biomicroscopy of the anterior segment, examination of the fundus. In selected cases, more specific ophthalmic testing such as visual electrophysiology is needed. Sometimes a general work up is indicated.

Conclusion The different neuro‐ophthalmological causes of reporting positive phenomena will be introduced.
Retinal causes
Authors: LEROY BP
Published: September 2009

Purpose To describe conditions which affect retinal function and can lead to seeing things which aren't there.

Methods A case presentation format will be used to illustrate different genetically and environmentally determined conditions leading to visual hallucinations. Both clinical and electrophysiological phenotypes as well as genotypes will be discussed.

Results Phenotypes of environmentally and genetically determined retinal diseases leading to visual hallucinations are very different. In some instances, the ophthalmologist can make a real difference when systemic treatment is indicated.

Conclusion Very diverse conditions may give rise to seeing things which aren't there. Clinical examination and electrophysiology allow making a correct diagnosis, with sometimes far reaching implications for therapy.
Beyond penetrating keratoplasty: the challenge of endothelial transplantation
Authors: BUSIN M
Published: September 2009

The paper will present a complete review of the technique of endothelial keratoplasty (EK). History as well as basic principles necessary to understand the mechanisms of EK will be introduced to the attendees. In setting the indication to EK, the author will discuss the role of recipient corneal status, type of endothelial disease, concomitant eye disease (i.e. glaucoma), presence of clear lens and other preoperative factors. The different techniques of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) will be presented, pointing out the single steps, which are instrumental in facilitating surgery, while improving the final outcome. In case of multiple intervention, combined versus sequential procedures (e.g. phacoemulsification, IOL surgery, vitrectomy, etc.) will be discussed. The authors will highlight advantages and disadvantages of different surgical approaches. Possible implications for eye banking will also be addressed, with particular emphasis on preparation and storage of tissue for DSAEK and DMEK. Slides and videos of case studies will illustrate the most common complications (i.e. graft detachment, dislocation, failure, rejection etc.) as well as the appropriate solutions.
Insights into regulation of the human corneal endothelial cell cycle
Authors: JOYCE N
Published: September 2009

Purpose Human corneal endothelial cells (HCEC) exhibit both an age‐ and position‐related decrease in proliferative capacity. HCEC are inhibited in G1‐phase of the cell cycle, but this not caused by critically short telomeres. The current studies explored whether oxidative stress and oxidative DNA damage could be responsible for this decreased proliferative capacity.

Methods Human donor corneas were divided into 2 age‐groups: Young=<30yo; Older=>50yo. Ex vivo corneas were used for some studies and, for others, HCEC were cultured according to published protocols. An ELISA assay quantified 8‐OHdG, a marker of oxidative DNA damage. ICC was used to localize 8‐OHdG. Treatment of HCEC from young donors with H2O2 was used to test the effect of oxidative stress on nuclear DNA damage and relative proliferative capacity.

Results Significant oxidative DNA damage was present in HCEC from older donors, particularly in central endothelium. 8‐OHdG staining was present in mitochondria in central and peripheral HCEC from young donors. In HCEC from older donors, intense 8‐OHdG staining was found in nuclei of central cells, indicating nuclear oxidative DNA damage. Age‐related differences in nuclear 8‐OHdG staining were also found in cultured HCEC. Treatment of HCEC from young donors with H2O2 caused a dose‐dependent increase in nuclear 8‐OHdG staining and a dose‐dependent decrease in proliferative capacity. Growth curves from H2O2‐treated young HCEC closely resembled those of untreated HCEC from older donors.

Conclusion The age‐ and position‐related decrease in proliferative capacity observed in HCEC is due to increased nuclear oxidative DNA damage, possibly caused by chronic light exposure and high metabolic activity.