bluuebunny/crossref_metadata_2025 huggingface dataset:
Could vision prognose cerebral palsy children’s development ?
Authors: TIGANITA S , KOZEIS N , KOKKINOU D , LAKE S , GEORGIADIS N
Published: October 2007

Purpose: To investigate the role of vision as a prognostic factor of the general developmental process in children with cerebral palsy (CP).

Methods: 80 CP children (age range 24‐96 months), participated in the study. Anamnestic data was collected, evaluation of Developmental Quotient (DQ), assessment of visual function (VFA‐K test), Visual Evoked Potentials (VEPs) and brain magnetic resonance imaging (MRI), were performed in all. VFA‐K test assesses the visual function in a global way (sensory, oculomotor, eye body coordination).

Results: 53 CP children (66.25%) appeared with affected visual function and reduced DQ. 75.55% of the CP children with moderate to severe PVL and 93.75% with combined brain damage, appeared with affected visual function. Statistical analysis showed a significant relationship between visual function, DQ and the severity of brain damage. (p<0,001) On the contrary, only 63.63% of the cases with affected visual function, appeared with abnormal flash VEPs.

Conclusions: Since visual function shows a statistically significant relationship with the developmental quotient of these children, visual function could play a prognostic role in these children’s general development.
Surgical outcome following iris related intraoperative difficulties in patients on tamsulosin (Flomax) undergoing phacoemulsification
Authors: KANG CY , KHAN‐LIM D , UNG T , LOCKWOOD A , FARNWORTH D
Published: October 2007

Purpose: To determine whether iris related intraoperative difficulties during phacoemulsification in patients on tamsulosin (Flomax) affects surgical outcome.

Methods: A retrospective case control study of consecutive patients undergoing phacoemulsification at Queen Alexandra Hospital, Portsmouth, UK. Pre‐operative pupil size, iris and non‐iris related intraoperative complications, and post‐operative best corrected Snellen visual acuity (BCVA) were examined. Two‐tailed Fisher exact test was used.

Results: Data from 9605 eyes of 6763 consecutive patients were analysed. 108 eyes were of male patients on tamsulosin (TG). The remaining 2862 eyes of male patients formed the control group (NT). The use of tamsulosin was 1.3% amongst all patients. ‘Small’ pre‐operative pupil size occurred with increased statistical significance in patients on tamsulosin (TG: 14.8%, NT: 2.5%, p<0.0001). Iris related intraoperative difficulties also occurred with increased frequency (TG: 36.1%, NT: 2.7%, p<0.0001), however vision‐threatening complications did not occur significantly in this group (TG: 2.8%, NT: 1.5% P = 0.22). At one month follow up, BCVA of 6/12 or better was achieved in 94% of cases on tamsulosin and 92% of controls. (P = 0.37)

Conclusions: A higher prevalence of intraoperative iris‐related difficulties was found in patients taking tamsulosin. However, this was not associated with increased prevalence of vision threatening complications or adverse visual outcome post‐operatively
The pentadecapeptide BPC 157 antagonizes the effect of atropine effect in the rats` eyes
Authors: MASNEC‐PASKVALIN S , IVEKOVIC R , RADIC B , KLICEK R , BRCIC L , SEIWERTH S , SIKIRIC P , MANDIC Z
Published: October 2007

Purpose: The goal of this study was to analyze the effect of the pentadecapeptide BPC 157 on midriasis caused by atropine dropped into the rats` eyes.

Methods: 24 male Wistar Albino rats were used. All the experiments were performed according to the rules brought by the Local Ethical Committee. The animals were randomly assigned into two groups. The first received the two drops of pentadecapeptide BPC 157 (10μg/kg) and two drops of the atropine (2%). The other group received the two drops of atropine only. The animals were macroscopically assessed every hour.

Results: The total midriasis developed during 30‐60 minutes after the application of atropine in both groups. The midriasis reduction started 7 hours after the atropine application in animals treated with the pentadecapeptide BPC 157. On the other hand the reduction of the midriasis in control animals started among 10‐13 hours following the atropine application. The pentadecapeptide BPC 157 continuously accelerated the reduction of the midriasis from hour to hour. The complete reduction to normal width of pupil was achieved 30 hours after the application of atropine in animals treated with the pentadecapeptide BPC 157, while in control animals the pupils width normalised 10 hours later.

Conclusions: The pentadecapeptide BPC 157 has brought to earlier pupil width normalization after the single atropine application. It suggests the possibility of functional antagonism of the pentadecapeptide BPC 157 onto the atropine and its agonists.
Long term outcome of bleb needling revisions following mitomycin C trabeculectomy in Afro‐Caribbean eyes
Authors: WILLIAMS TA , CROSBY N , SII F , CHIANG M , LOCKWOOD A , SHAH P
Published: October 2007

Purpose: To assess the frequency, risk factors and outcome of patients requiring bleb needling revisions (BNR)following Mitomycin‐C (MMC) augmented trabeculectomies in Afro‐Caribbean eyes in Birmingham, United Kingdom.

Methods: ReGAE (Research in Glaucoma and Ethinicity) is a UK based multidisciplinary based research group whose research is aimed at preventing glaucomatous blindness in the diverse ethnic population of the West Midlands. A prospective study of consecutive Afro‐Caribbean patients with refractory advanced glaucoma who had undergone Mitomycin C augmented trabeculectomy (modified Cairns type trabeculectomy with fornix based conjunctival flap mitomycin C 0.1‐0.4mg/ml) was completed. Bleb needling revisions in the operating theatre with subconjunctival 5 fluro‐uracil (5FU) 0.1ml 25mg/ml) were required in a subset of eyes. The frequency, timing, complications and outcome of BNRs was studied.

Results: 38 eyes (35 patients) were included in the study; mean age 52 years (range 11‐77 years); male:female 21:14. 9 of 38 eyes (24%)required BNR. Aetiology of glaucoma POAG 44%; JOAG 23%; traumatic 11%; fuchs 11%; pseudoexfoliation 11%. Of the patients requring BNR 6 eyes required BNR within 1 month of MMC‐ trabeculectomy. BNRs were performed 1‐48 months postopereratively. Number of BNRs required 1.7 per eye (range 1‐4) over a 2 year post operative follow up period. No complications occurred during BNR.

Conclusions: Afro‐Caribbean patients have a significant risk of requiring BNR following MMC trabeculectomy. Although such bleb manipulations are most commonly required during the early postoperative period, late subtenon's fibrosis may necessitate late BNR in this ethnic group.
Non Hodgkin orbital lymphoma
Authors: KNEZEVIC T , IVEKOVIC R , MANDIC Z
Published: October 2007

Purpose: To present three cases of orbital lymphoma

Methods: Detailed ophthalmological exam, laboratory, neuroimaging ( the orbital echoscan and MR of the brain and orbit ), patohistology and immunohistochemistry of tumor tissue biopsy “ex tempore“ and postoperatively and of the extirpated lymph node tissue, were done to have a final diagnosis of non‐Hodgkin lymphoma.

REAL/WHO classification was used.

Results: RESULTS:Anatomical localizations were as follows: extraocular muscles ( m.rectus superior and m.levator palpebrae) in two of three patients and inferior eyelid in one patient.

Ptosis and a reccurent "chalazion like" eyelid tumor mass were main clinical features.

Patohistological and immunohistochemic analysis showed in all of three cases diffuse B‐lymphocyte lymphoma, with CD20,CD22,CD34+ at first, CD 19+, 20+, 22, 23+ at second, and CD19, CD23+ tumour antigens at third patient.

All the patients had unilateral lesions of the orbit. One of three patients had an orbitothomia with total extirpation of the tumour mass. One patient had a systemic dissemination of the disease Ann Arbor, stage II and two patients had Ann Arbor grade IV.

All three patients were treated with chemotherapy and two of them received monoclonal antibodies. 0ne patient underwent autological bone marrow transplantation of the peripheral blood stem cells.

Conclusions: All of three patients had orbital lymphomas which were a consequence of the dissemination of the primary disease and all were diffuse B‐lymphocytic non‐Hodgkin lymphomas. Clinical signs were nonspecific and only complete diagnostic evaluation provide us final diagnosis.
Ocular and systemic factors associated with diabetes mellitus in the adult population in rural and urban China. The Beijing eye study
Authors: JONAS JB , XU L , XIE X , WANG Y
Published: October 2007

Purpose: To assess ocular and systemic factors associated with diabetes mellitus in the adult population in rural and urban China.

Methods: The Beijing Eye Study 2006, a population‐based, cross‐sectional cohort study, included 3251 subjects (participation rate: 73.2%). Blood samples were available for 2773 (85.3%) subjects. Diabetes mellitus was defined by a fasting plasma glucose concentration ≥7.0 mmol/L or by a self‐reported history diagnosis of diabetes.

Results: Diabetes mellitus was found in 334 (12.0%) subjects. In binary regression analysis, presence of diabetes mellitus was significantly associated with higher age, body mass index, systolic blood pressure, triglyceride concentrations, and intraocular pressure, and lower high‐density lipoprotein level. It was not statistically associated with cortical or and subcapsular cataract, size of the optic disc, rim and alpha zone and beta zone of peripapillary atrophy, retinal artery and vein diameters, retinal microvascular abnormalities, refractive error, and prevalence of glaucoma and early or late stage of age‐related macular degeneration.

Conclusions: In a population‐based setting, diabetes mellitus was not associated with optic disc, rim and peripapillary atrophy measurements, retinal vessel diameters and microvascular abnormalities, and prevalence of age‐related macular degeneration. Although diabetes mellitus was significantly correlated with higher intraocular pressure, it was not associated with glaucoma.
Report on research in dry eye
Authors: GIPSON IK
Published: October 2007

Purpose: Members of the DEWS research Subcommittee reviewed published research to determine if there is sufficient evidence to define the basic mechanisms underlying dry eye disease.

Methods: Evidence‐based research was evaluated concerning the changes in the tear film, lacrimal gland and accessory lacrimal glands, ocular surface epithelia (including cornea and conjunctiva), meibomian glands, lacrimal duct system and the immune system in dry eye. Consideration was given to both human and animal research data.

Results: Results are presented as a series of information matrices, identifying what has been learned about dry eye since the previous Dry Eye Workshop, providing supporting references. Areas for further investigation are identified.

Conclusions: Given insufficient evidence to define the basic mechanisms giving rise to dry eye disease, a hypothesis for the mechanisms underlying the disease is presented.
In vivo confocal microscopy of the cornea
Authors: GUTHOFF RF
Published: October 2007

Confocal in‐vivo microscopy so far has not found its place in routine diagnostic of anterior segment disease. But progress has been made with recent developments mainly based on Laser scanning technology. This allows an optical sectioning of less than 5 μm thickness of high contrast and in well defined distances from the corneal surface as well as the examination of conjunctiva, sclera and the lid region.

Information is given how to differentiate subpopulations of the epithelium (superficial, intermedial, basal cells) as well as overall epithelial thickness measurements. This is exemplified in normal individuals, contact lens wearers and patients with various kinds of ocular surface disease.

Stromal keratocytes are displayed and quantified in different corneal layers. Information on keratocyte activation by higher densities of scatterers in the cytoplasm is possible, indicating increased metabolic activity.

A more wide spread use of in‐vivo confocal microscopy will allow to judge on woundhealing in all kind of corneal disease and repair mechanisms such as corneal re‐innovation following refractive corneal surgery.

Cell populations such as Langerhans cells are displayed and quantified allowing information on immunological corneal activity in‐vivo. Woundhealing modulation in Glaucoma filtering surgery can be displayed on a cellular level and microcyst formation depending on the influence of Mitomicin C and 5 FU are demonstrated at various stages after surgery. This information may influence the postoperative management considerably.

In‐vivo confocal microscopy recently has become easy to handle with improved imaging quality and possibilities of quantitative evaluation of ocular surface structures.
Fixed combinations and adherence
Authors: HOLLO G
Published: October 2007

Purpose: To summarise information on adherence of glaucoma patients using fixed combinations of IOP lowering medications.

Methods: Literary search.

Results: Clinical experience as well as published studies clearly show that like compliance, adherence to prescribed medication is far not optimal in glaucoma patients. When using prostaglandin analogue eye drops QD adherence is better to the prescribed medication than in treatment periods on BID medication or in patients treated with BID topical medication. Combined prostaglandin/beta‐receptor blocker medication is similar to prostaglandin analogue monotherapy in terms of number of application per day, and can substitute unfixed combinations consisting of a prostaglandin analogue plus a beta‐blocker. Thus, improved adherence to the combined medication given once daily is supposed to be similarly good as it is with prostaglandin analogues. However, little published data is available on this field.

Conclusions: Combined prostaglandin analogue/beta‐receptor blocker medication has a promise of good adherence because of the ease of administration and powerful IOP lowering, but for exact figures further adherence studies are necessary.
Blood flow changes in exfoliation
Authors: DAYANIR V , TOPALOGLU A , OZSUNAR Y , KECELI M , OKYAY P , HARRIS A
Published: October 2007

Purpose: Evaluation of orbital blood flow parameters by using color Doppler imaging in patients with unilateral exfoliation syndrome (XFS).

Methods: This prospective, comparative case series included 33 unilateral XFS patients, and 33 age‐sex matched control subjects. Color Doppler imaging was used to evaluate the XFS affected (Group 1), and unaffected (Group 2) eyes that were matched with the corresponding side (Groups 3, and 4) of control subjects. A masked radiologist obtained peak systolic velocity (PSV), and end diastolic velocity (EDV) of ophthalmic (OA), central retinal (CRA), nasal posterior ciliary (NPCA) and temporal posterior ciliary arteries (TPCA) as well as mean velocity of central retinal vein (CRV). Resistive indices (RI) were calculated.

Results: Orbital blood flow parameters had no statistically significant difference between Group 1, and 2 (p>0.05). OA of Group 1 had significantly low PSV and EDV, and high RI compared to Group 3. OA PSV, EDV, and RI for Groups 1, and 3 were 25.3+/‐9.2 cm/sec (p=0.000), 5.8+/‐2.5cm/sec (p=0.000), 0.74+/‐0.04 (p=0.009), and 35.1+/‐11.0 cm/sec, 9.7+/‐3.5 cm/sec, 0.69+/‐0.07 respectively. The RI had a cut‐off value of 0.72 between Group 1 (95% Confidence Interval [CI] for mean, 0.72‐0.75) and Group 2 (95% CI, 0.66‐0.72). In Group 2, OA PSV and EDV also were lower than Group 4 while the RI value did not differ significantly. Blood flow values for CRA, NPCA, TPCA, and CRV did not show any significant difference between the groups (p>0.05).

Conclusions: Ophthalmic artery hemodynamic parameters change in both eyes of unilateral XFS patients pointing out the systemic nature of the disease. The decrease in blood flow might be due to decreased vascular compliance through progressive buildup of exfoliative material in blood vessels.
Management of co‐existing cataract and exfoliation
Authors: TEUS MA , DE BENITO‐LLOPIS L
Published: October 2007

Purpose: To describe the way to manage coexisting cataract and pseudoexfoliative glaucoam (PEXG)

Methods: Several videos will be shown, together with a step‐wise approach to the possible problems theses eys usually have

Results: We will show several useful surgical maneuvers to achive success in theses potentially complex cases

Conclusions: When managed properly, the outcomes of surgery in eyes with coexisting cataract and PEXG can be improved
Diurnal IOP curve versus 24‐hour IOP curve: when and how to do it in practice
Authors: KONSTAS AGP
Published: October 2007

Purpose: To review the role and utility of 24‐hour, or diurnal IOP monitoring in the management of glaucoma

Methods: Current glaucoma practice generally involves single IOP readings at each visit owing to time, convenience and cost considerations. A single IOP measurement however, gives data for only one minute of the day and does not reflect the dynamic equilibrium of IOP during the 24‐hour cycle. There is significant unpredictability of single IOP measurements and poor correlation between single IOP readings and peak, or fluctuation of 24‐hour IOP. 24‐hour or diurnal IOP monitoring can provide valuable information for the diagnosis and management of glaucoma.

Results: Although 24‐hour monitoring is especially helpful in advanced or progressive glaucoma a simplified diurnal curve (IOP readings at 10:00, 14:00 and 18:00) can be successfully employed in most glaucoma cases.

Conclusions: A simplified diurnal curve can provide reasonable quality of IOP information and help us setting a better target pressure. Better understanding of the prognostic value of 24‐hour IOP characteristics and the ideal target 24‐hour IOP are needed in the future.
How to monitor visual field progression?
Authors: VISWANATHAN A
Published: October 2007

Purpose: Although the scientific merits of trend analysis (PROGRESSOR) are encouraging, its suitability for randomized, controlled trials (RCTs) has not been widely addressed. This study assesses the performance of this type of analysis in the setting of an RCT.

Methods: A collaboration between Moorfields Eye Hospital and the University of Parma attempted to determine the validity of trend analysis in measuring differences between glaucoma treatment interventions. Glaucoma patients with deteriorating vision, as indicated by negatively sloping trend lines, were randomly assigned to receive laser trabeculoplasty or anti‐glaucoma medication treatment—in this case, brimonidine—to determine whether trend lines flattened out (denoting stabilized vision) or continued to slope downward (showing exacerbated visual loss).

Results: Before and after treatment, the laser trabeculoplasty group demonstrated no discernable pattern, with pre‐ and postintervention graphs displaying negative slopes. With brimonidine, however, the trend reversed from negative before intervention to positive afterward, signifying an improvement in visual field status.

Conclusions: These results are as yet unpublished but indicate that rate‐based measures are indeed suitable for visual field outcome measurements in RCTs. Yet, further work is needed to assemble the optimal combination of summary, cluster, and pointwise methods for different trial conditions.
Prion disease
Authors: BODAGHI B
Published: October 2007

Prions are a new form of pathogens made by proteins and lacking genetic information such as DNA or RNA sequences. These proteins may transmit certain phenotypes that are inherited in a non‐Mendelian manner. Prions are possibly the primitive form of life, existing before or with self‐replicating RNA. The abnormal fom of prion proteins results in a misfolded molecule, becoming resistant to different major neutralizing agents. Prion protein (PrP) is expressed in many tissues and is required for susceptibility to scrapie and other prion diseases. Creutzfeldt‐Jakob disease (CJD), the most common form of prion diseases, is a rare and fatal neurodegenerative disorder with a worldwide incidence of 1‐1.5 per million. Different animal models have been developed in order to study the pathophysiology and transmission of prions. The presence of the pathologic isoform in the retina seems to be correlated with disease progression during the preclinical and clinical stages, perhaps using the inner plexiform layer as a first entry site and diffusing from the brain using a centrifugal model. On the other hand, prions may spread within the CNS via central axons of the visual pathways following intraocular inoculation. All these considerations are important for the better understanding of the disease and its variants in humans.
Making sense of immediately sequential bilateral phacoemulsification
Authors: LIU C
Published: October 2007

Immediately sequential bilateral cataract makes sense, both for patient convenience, rapid rehabilitation, and health economics. However, there is still a stigma attached to it. We open by reviewing the advantages and disadvantages of operating on both cataracts at the same sitting. We introduce the concept of conditional probability. We list the strategies available to reduce the risk of bilateral complications, including the option of not proceding with the second eye procedure should the first operation be complicated.
Basics of straylight in the human eye
Authors: VAN DEN BERG TJTP
Published: October 2007

Purpose: Large angle light scattering in the eye causes retinal straylight and as a consequence functional disturbances such as glare hindrance while driving at night, or contrast loss in counter light situations. Apart from small angle effects such as measured with wavefront approaches, this constitutes a second major optical deficit of the human eye. Straylight must be studied for clinical use.

Methods: A forced choice psychophysical assessment technique was developed ("Compensation Comparison"), that resulted in a commercial product (C‐Quant from Oculus). The task of the patient is to compare flicker strength in two half fields, and indicate with push buttons for 20 short presentations wich half field flickers most strongly. The straylight value is obtained including a reliability estimate. Added value in comparison to visual acuity was assessed in 2400 subjects in the European GLARE study. In 150 patients straylight data were collected before and after cataract procedures or YAG capsulotomy.

Results: Repeated measures standard deviation for the method is about 0.07 log units, to be compared with differences in the young normal population of 0.2 log units, and by 1.0 log units (a factor of ten) or more with (early) cataract or corneal disturbances. In healthy eyes a strong age effect occurs. Straylight doubles by the age of 65, and triples by the age of 77. In pseudophakia, straylight values could be very good, better even than in the non‐cataract group, but with much differences in the population. In age‐normal as well as cataractous eyes, visual acuity and straylight were found to vary quite independently.

Conclusions: Straylight assessment has added clinical value. It is quite independent from visual acuity. Lens extraction potentially reverses the strong age‐normal increase in straylight value.
Intraocular straylight and contrast sensitivity after LASIK
Authors: MICHAEL R , OSPINO A , GIOINO J , RECANCOF A , BARRAQUER RI
Published: October 2007

Purpose: To give a review about the effect of refractive surgery on glare, intraocular straylight and contrast sensitivity and to present the results of a study at the Centro de Oftalmología Barraquer.

Methods: Altogether 50 eyes of 33 patients (mean age 31 years; refractive error range 3.5 to ‐7.5 D) were treated for LASIK with Bausch & Lomb Technolas Z100 and studied pre‐op and two month post‐op. Intraocular straylight was measured with the Oculus C‐quant and contrast sensitivity with the CSV‐1000 (at 3, 6, 12, 18 cycles/degree).

Results: In our study at the Centro de Oftalmología Barraquer, pre‐op mean log(s) straylight parameter of 0.98 (+/‐0.06 confidence interval [CI]) did not change at two month post‐op 0.97 (+/‐0.05 CI). Only two eyes out of 50 had straylight values increased by more than 0.2 log units. There was no significant change in contrast sensitivity at all four spatial frequencies.

Conclusions: This and one earlier study by Beerthuizen showed no change of the mean values of intraocular straylight at one or two month post‐op after refractive surgery, but a few cases had a more than 0.2 log units increase. Results with regard to contrast sensitivity are not consistent in the literature, with improvement or decrease depending on post‐op time, illumination level and type of refractive procedure.
Redox regulation of the proteasome in human lens epithelial cells and intact mouse lens
Authors: PETERSEN A , CARLSSON T , KARLSSON JO , ZETTERBERG M
Published: October 2007

Purpose: This study examined the proteasome susceptibility to oxidative stress and changes in the redox system after proteasome inhibition.

Results: Oxidative stress by H2O2 significantly decreased all three main peptidase activities of the proteasome, the chymotrypsin‐like, the trypsin‐like and the peptidylglutamyl peptidase activities of the proteasome in human lens epithelial cells (HLEC). Oxidatively stressed mouse lenses showed trends of decreased chymotrypsin‐like proteasome activity as well as decreased GSH‐levels.

In HLEC lysate, the chymotrypsin‐like and the peptidylglutamyl peptidase activities were stimulated by GSH and all three peptidase activities were inhibited by GSSG addition.

Inhibition of the proteasome in HLEC by MG‐132 and lactacystin caused increased apoptosis as revealed by Hoechst 33342 staining and caspase‐3 determination. Proteasome inhibition increased superoxide and peroxide production, depolarised the mitochondria and decreased the level of glutathione. However apoptosis could be prevented by addition of GSH. Non‐stressed HLEC exposed to GSH, did not present any change in apoptotic respons.

Conclusions: The present data indicate that the protesasome may regulate apoptosis through oxidative mechanisms.
Enhanced diabetic cataract in mice lacking Cu‐Zn superoxide dismutase
Authors: OLOFSSON EM , MARKLUND SL , BEHNDIG A
Published: October 2007

Purpose: We have previously shown that lenses from mice lacking the antioxidant enzyme copper‐zinc superoxide dismutase (SOD1 null mice) develop cataract and show signs of cell damage when exposed to high levels of glucose in vitro. The superoxide radical, elevated in the SOD1 null lenses, is thought to contribute to the cataractogenesis in these lenses possibly through the reaction with nitric oxide, generating the highly toxic peroxynitrite. In this study, we aimed to evaluate the effect of diabetes mellitus on cataract formation and oxidative stress in SOD1 null mice in vivo.

Methods: SOD1 null and wild‐type mice were rendered diabetic by intraperitoneal streptozotocin injections for 5 consecutive days. Mice injected with citrate buffer were used as controls. After eight weeks of diabetes, the mice were sacrificed and the lenses removed and photographed in retro‐illumination. The cataract formation was quantified from the photographs using digital image analysis. Lens cell damage was assessed by analyzing the leakage of LDH from the lenses and markers of oxidative stress, such as glutathione (GSSG/GSH) and protein oxidation were measured in lens homogenates. The results were statistically analyzed using a general linear model.

Results: There was a strong relationship between glucose levels and cataract development, especially in the SOD1 null mice (p=0.003). The lenses showing increased cell damage also developed more cataract, an effect which also was more evident in the SOD1 null lenses (p=0.002). Also, with increasing markers of oxidative damage, the lenses showed increased cataract development (p≤0.03).

Conclusions: The study suggests that increased formation of superoxide radicals and derived oxidants might be the cause of diabetic cataract.
Retinal dystrophies & dysfunctions
Authors: LEROY BP
Published: October 2007

Purpose: To provide an overview of the current status of knowledge in inherited retinal dystrophies and dysfunctions.

Methods: A case presentation format will be used to illustrate an overview of current insights into genotypes and phenotypes of generalised dystrophies and dysfunctions of the retina.

Results: Much progress has been made in unravelling the molecular mysteries underlying generalised retinal dystrophies and dysfunctions, with a wide variety of functions attributed to proteins encoded by causative genes.

Conclusions: Rapid progress is being made in the field of generalised genetic retinal disease, with the first gene therapy trial for Leber congenital amaurosis currently underway.
Misinterpretation of common ophthalmic tests
Authors: BORRUAT FX
Published: October 2007

Purpose: In order to solve the case of a patient with a neuro‐ophthalmic disorder, paraclinical tests are frequently needed. They include evaluation of the visual fields, electroretinography, visual evoked cortical potentials to name a few.

Without a careful examination of the results, the clinician might be mislead in the diagnosis and the care of the patient might be inappropriate.

Methods: Illustrative cases will be presented in an interactive way.

Conclusions: At the end of the session, the participant will be aware of some of the "traps" that can be avoided with a thorough examination of such test results.
Using local carboplatin in the treatment of retinoblastoma
Authors: DESJARDINS L
Published: October 2007

Purpose: Introduction: Carboplatin is one of the most active chemotherapy in the treatment of retinoblastoma. Like other chemotherapeutic agents, it has potential mutagenic effects.

To avoid these mutagenic effects, local delivery of carboplatin was studied

Methods: Preliminary animal studies: Concentrations of carboplatin in the vitreous in mice proved to be higher after subconjunctival injections then after intraveinous injections and to have a dose dependent effect on retinoblastoma vitreous disease (Harbour 1996, Murray 1996 and 1997, Hayden 2000 and 2004 and Yan Ke xue Bao 2004).Coulomb controlled iontophoresis was also studied in mice by Hayden.

Results: Clinical results: a phase I/II study was performed by D Abramson on 13 eyes and reported in 1999: Vitreous and retinal tumor response were observed but no subretinal disease responded.

Two children were treated in Curie institute ; One child with recurrent disease after external beam radiation including vitreous seeding was treated with 3 subconjunctival injections of carboplatin and iodine plaque brachytherapy . He is free of disease 9 years later

Another child with recurrent vitreous disease after external beam radiation was treated with carboplatine iontophoresis ; no response was observed

Despite good initial response late recurrences can occur; Atrophy of optic nerve and severe orbital fibrosis have been reported and because of these severe side effects the use of subconjunctival injections cannot be recommended.

Conclusions: Local delivery of carboplatin may be one of the treatment modalities in the future if fibrin sealant ( Van Quill 2005 , Gorodetsky 2005)or iontophoresis delivery can achieve good concentrations of carboplatin in the eye with less orbital toxicity; further studies are needed.
Autofluorescence : additional value in clinical management of ARMD
Authors: VACLAVIK V , BIRD AC
Published: October 2007

Purpose: Autofluorescence is a noninvasive technique that allows the assessment of the viability of the RPE/photoreceptor complex. With the higher expectations of newer biological treatments in age related macular degeneration (ARMD), the assessment of the viability of retina and RPE at the beginning of treatment is a precious indication on the potential therapeutic results.

Methods: We studied 79 eyes with untreated early‐stage subfoveal neovascular AMD. Autofluorescence images were compared with digital fluorescein angiography and fundus color photographs. Autofluorescence at the macula was correlated with visual acuity, angiographic lesions characteristics, lesion size and length of symptoms.

Results: In 54 eyes, the autofluorescence was present, continuous at the macula and this correlated significantly with visual acuity, lesion size, length of symptoms, but not choroidal neovascularization type.

Conclusions: Intact autofluorescence at the macula correlating with visual acuity confirmed the hypothesis that visual outcome is determined by maintenance of RPE function. Autofluorescence assessment may allow a better identification of patients who would benefit substantially from ARMD treatment.
(Multifocal) ERG : additional functional information in research and clinical settings
Authors: TSANG SH , SANTOS R , GREENSTEIN VC
Published: October 2007

Purpose: To investigate the relationship between areas of hyper‐ and hypofluorescence and measures of visual function in patients with macular diseases.

Methods: Eight patients (8 eyes) with macular disease aged from 26‐80 yrs. were enrolled in the study. All tested eyes had best corrected visual acuities of at least 20/100 and areas of abnormal fundus autofluorescence (FAF) in the posterior pole. Retinal function was evaluated with the multifocal ERG (mfERG) VERIS system using a display of 61 hexagons. Fixation was continuously monitored. First order kernel responses were analyzed.

Results: The pattern of hyperfluorescence varied with the macular findings as well as the stage of disease. For all patients, MP‐1 and HVF fields showed decreased sensitivity in locations corresponding to and adjacent to hypofluorescent (atrophic) areas. Multifocal ERG response amplitudes were decreased and sometimes delayed in the same regions. Deficits extended into areas of normal FAF. Hyperfluorescent areas adjacent to normal appearing areas had normal visual function, whereas those adjacent to atrophic areas had decreased visual function. In patients with ABCA4 related maculopathy, flecks adjacent to normal FAF had normal visual function with the MP‐1. In contrast, flecks adjacent to atrophic areas had reduced visual sensitivity. Two patients with ABCA4 dystrophies had eccentric PRLs in superior retina.

Conclusions: The correlation of fundus hyperfluorescence with cone system function is related to the health of adjacent retinal pigment epithelium. There is a need to use functional techniques as well as FAF in monitoring macular disease progression.
Cellular responses to lysosomal dysfunction in RPE cells
Authors: KOPITZ J
Published: October 2007

Purpose: Several lines of evidence suggest that dysfunction of the retinal pigment epithelium (RPE) is a crucial event in triggering molecular pathways contributing to clinically relevant ARMD‐changes. Such dysfunction may be induced by phagocytosis of photoreceptor‐derived compounds conveying lysosomotropic effects. We therefore analysed cellular responses of cultured RPE cells to various lysosomotropic compounds.

Methods: Cultured RPE cells were treated with 9‐hydroxynonenal, malondialdehyde, A2E, or leupeptin. Their action on intralysosomal degradative capacities and intracellular storage was monitored and the resulting effects on secretion of undegraded material, autophagic sequestration and cytokine production were analysed.

Results: When the cells were challenged by feeding with photoreceptor outer segments, all tested compounds severely impaired lysosomal degradative functions resulting in intracellular accumulation of undegraded macromolecules and formation of lipofuscin‐like material. In polarised RPE cells lysosomal dysfunction caused secretion of undegraded phagocytosis‐derived material at the basolateral side of the cell layer. Intracellular autophagic sequestration rates were strikingly reduced. Finally longterm lysosomal dysfunction caused increased production of stress‐related cytokines, including VEGF‐A.

Conclusions: Basolateral secretion of undegraded material observed in polarized cells suggests that an analogous pathomechanism may also in vivo contribute to deposition of undegraded material below the RPE layer. Autophagic sequestration is considered a cellular anti‐aging mechanism, therefore impaired autophagy may add to RPE aging and degeneration. Altered cytokine production induced by lysosomal dysfunction of the RPE should be further evaluated as a pathogenic factor in ARMD.
Regulation of complement activation in ocular and vascular inflammation
Authors: SEPPO M
Published: October 2007

The complement system keeps the body clear from invading microbes and accumulating debris. Its main regulator, factor H (FH), protects host tissues and limits excessive activation. Polymorphisms or mutations in FH and other complement proteins (C3, FB) predispose to age‐related macular degeneration (AMD) and other diseases with complement‐mediated tissue damage: membranoproliferative glomerulonephritis type II (MPGN II) and recurrent atypical hemolytic‐uremic syndrome (aHUS). AMD‐associated polymorphism in the middle part of FH influences the ability of FH to bind to C‐reactive protein (CRP). This would affect phagocytic clearance of debris (e.g. eye pigment) and cause local inflammation. Accumulation of pigment, protein aggregates and stress conditions in retinal pigment epithelial cells provide a challenge to complement‐mediated clearance. Excess cellular stress or regulatory complement disturbances sensitize tissues to complement attack and inflammation. An interplay between CRP and complement is seen also in atherosclerotic vasculitis. Loss of the ability of FH to recognize C3b molecules deposited of polyanion‐rich self structures predisposes to aHUS, where blood cells, platelets and endothelial cells, particularly in kidneys, become targets for repeated complement attacks. The pathogenetic mechanisms of these diseases are being increasingly understood, which will help in designing new therapies.
The first consultation & photophobia in anterior segment disease
Authors: HAWLINA M
Published: October 2007

Purpose: First consultation and anterior segment diseases associated with photophobia are described.Photophobia may be caused either by ocular or neurological disorders.

Methods: Principles of first consultation include differential diagnosis between ocular and neurological causes of photophobia. Detailed history for exposure to foreign bodies, allergens, systemic symptoms (e.g., arthritis) and physical exam should include a detailed ocular exam (including dilated fundoscopic and slit‐lamp exam if possible), eyelid eversion to rule out foreign bodies, fluorescein staining of the cornea to rule out abrasion, and intraocular pressure measurement is mandatory. In suspected neurological diseases, neurological workup is necessary.

Results: Almost any condition of the eye may cause photophobia, including dry eye, conjunctivitis, blepharitis, keratitis, corneal dystrophies, iritis, aniridia, albinism, glaucoma, optic nerve and retinal diseases. If anterior uveitis is suspected, targeted testing may include CBC, ESR, ANA, ACE level (sarcoidosis), RPR (syphilis), PPD, chest X‐ray (TB/sarcoidosis), Lyme titers, Chlamydia cultures (Reiter's syndrome), HLA‐B27 assay, sacroiliac spine films (ankylosing spondylitis), and colonoscopy (inflammatory bowel disease). If retinal dystrophy is suspected, electrophysiology is mandatory for the diagnosis. If optic neuritis is diagnosed, an MRI of the brain and orbits is indicated to evaluate for demyelination. Other neurological reasons include migraine, meningitis and SAH. A number of drugs can also cause photophobia.

Conclusions: Detailed history often gives good insight in differential diagnosis. However, differentiation between ocular and neurological disorders may be complex and should be based on detailed clinical examination and appropriate tests.
The potential of iontophoresis in introducing methotrexate and carboplatin into the eye
Authors: FRUCHT‐PERY J , PE'ER J , DOMB AJ , ELJARRAT‐BINSTOCK E
Published: October 2007

Purpose: Intraocular injections of methotrexate have been used recently in place of the systemic approach to treat intraocular lymphoma and, sometimes, intraocular inflammation. Subconjunctival/subtenon injections of carboplatin have been recently used lately in some centers to treat retinoblastoma. In the last few years we have investigated the potential of iontophoresis for introducing these two drugs into the eye.

Methods: Cylindrical agar gels served as a model resembling the eye for examining the transport of carboplatin in‐vitro. In‐vivo iontophoretic studies of methotrexate and carboplatin were performed on eyes of healthy rabbits, and the levels of the drugs were measured in different parts of the eye. The iontophoretic device we have employed is a portable, easy‐to‐use (Tonopen‐like) system, operated by battery. The drugs were loaded into hydrogels of different sizes and shapes, and varying electrical currents were tested.

Results: Iontophoresis increased significantly the levels of methotrexate in the various eye parts. In contrast, levels of carboplatin achieved by iontophoresis were not significantly different from our control mock iontophoresis.

Conclusions: A short, low‐current, non‐invasive iontophoresis treatment using methotrexate‐loaded hydrogels has potential clinical value in treating ocular inflammatory diseases and intraocular lymphoma. In contrast, carboplatin has high passive diffusion properties from the hydrogel into the ocular tissue, and iontophoretic application has no obvious advantage over local injection or application.
PKP versus LKP: rehabilitation speed, optical performance, endothelial cell loss
Authors: KESTELYN P , CLAERHOUT I
Published: October 2007

This presentation will provide a critical comparison between penetrating and lamellar keratoplasty as far as rehabilitation speed, optical performance, endothelial cell loss and immunological rejection rate is concerned.

Deep anterior lamellar keratoplasty has the advantage of retaining a stronger globe and no risk of late endothelial failure, implying patients might be able to keep their graft for the rest of their life. There is also a reduced risk of graft rejection, or at least the damage caused will not be directed towards the vital endothelial cells. This however seems to go at the expense of visual acuity and quality. High postoperative astigmatism remains an issue and interface haze ‐when dissection is not down to bare Descemets‐ limits the vision to 20/40 in some cases. The decrease in recipient endothelial cell loss mimics the physiological cell loss of non operated corneas except maybe in patients with macular dystrophy.

The results of deep endothelial keratoplasty (either DLEK of DSAEK) seem very promising as far as astigmatic control is concerned as there is virtually no astigmatic change induced. Vision outcome in the largest reported series of DLEK was a vision of 20/40 or better in 49% of eyes. This compared to a percentage of respectively 62% and 87% in patients with DSEK or DSAEK. Contrary to common belief endothelial rejection can still hapen in patients undergoing deep endothelial keratoplasty. DS(A)EK seems to induce more endothelial cell loss than DLEK which is probably a direct consequence of the current taco folding techniques. New insertion devices are currently developped to minimise this increased cell loss.
Non endoscopic endonasal DCR
Authors: MAVRIKAKIS I
Published: October 2007

Purpose: During this lecture we will describe a nonendoscopic endonasal DCR technique

Methods: It is based on the principles and concepts of the endoscopic approach using standard oculoplastic equipment without the need for an endoscope. Surgical loupes and a nasal speculum are used for direct visualization of the osteotomy site. A vitrectomy light pipe through the upper canaliculus into the lacrimal sac is providing transillumination trough the thin lacrimal bone within the nose. Formation of the osteotomy is performed using a Kerrison rongeur.

Results: overall success rate better than 90%.

Conclusions: Nonendoscopic endonasal DCR is a safe and effective method in treating epiphora with an overall success rate better than 90%.
Endoscopic endonasal dacryocystorhinostomy
Authors: ELOY P
Published: October 2007

Methods: With the advances of the endonasal endoscopic surgery, DCR performed through the nose becomes with the time a viable and highly effective alternative to the conventional DCR performed through an external approach.

The optimal indication is low obstruction of the lacrimal pathway. This requires a precise preoperative assessment of the lacrimal pathway including a complete ophthalmological examination, seringing and probing of the lacrimal pathway and an imaging (dacryocystography and in some cases, a scintigraphy of the lacrimal pathway).

The authors present the technique using the powered instrumentation. They emphasize the importance of the resection of the vertical part of the uncinate process and a large drilling of the frontal process of the maxilla in order to expose widely the nasolacrimal duct and the inferior part of the lacrimal sac. Stenting is not routinely necessary except when the epithelium of the canalicular system is damaged by the probing or when a high obstruction of the lacrimal pathway is associated to the low obstruction or in case of functional obstruction.

A review of their results and those published in the worldwide literature is exposed.

Results: With good selection of patient the success rate is around 90%.
Nasolacrimalduct interventions‐dacryocystoplasty (Ballooncatheter dilatation in pre‐and postsaccal obstructions)
Authors: WILHELM K , LACHMUND U
Published: October 2007

Purpose: To examine the clinical outcome of the ballon dilatation in stenosis and obstruction of the nasolacrimal duct.

Methods: Patients with epiphora and proven stenosis or radiologic short‐distance occlusions were successful treated with ballondilatation only, of the nasolacrimal duct were treated with ballon dilatation. The diagnosis was established by dacryocystography. The intervention with balloondilatation was followed by a one‐week period of additional treatment wirh antiinflammatory and antioedematous eye‐drops. Patientes were followed for clinical evaluation at 6 and 12 weeks and yearly thereafter.

Results: Technical success was obtained in 90% of cases with stenosis and in 100% of cases in occlusions.. Over a mean follow‐up of 6 months patency of the nasolacrimal duct system was achieved in 83 % in stenosis and 66 % in radiologic short‐distance occlusions.

Conclusions: Balloon dacryocystoplasty is a minimal‐invasive alternative, performed in local anesthesia that recover the normal anatomy of the nasolacrimal duct system. It is a good alternative in the treatment of epiphora caused by nasolacrimal duct obstructions.