bluuebunny/crossref_metadata_2025 huggingface dataset:
Is there any place for relaxing incisions in cataract surgery?
Authors: COCHENER B
Published: November 2013

The advent of toric IOls has certainly reduced the place of relaxing incisions. On the other hand, the use of femtosecond has significantly improved the easiness, the predictability and safety of the incisional procedure. Moreover the recent innovation of the "femtocataract" offers on some platforms the opportunity to combined relaxing incisions at the time of the crystalline lens removal. We will remind the different modalities for performing these incisions and will focus on disparities concerning the popularity of this surgery from one country to the other. The review of literature will provide the demonstration of the efficacy of incisions for correction of astigmatism especially in case of large cylindrical component such secondary astigmatism after triple procedure graft and cataract removal. We will also underline the interest of femtosecond laser in the refinement of the final outcome and will compare transepithelial versus intrastromal incisions. Of course the debate will be opened with toric IOls and photablation, that in some cases can be more complementary rather than competitive.
Pentacam nuclear staging versus LOCS III grading for cataract classification
Authors: WEGENER A
Published: November 2013

Cataract classification systems have been developed by several groups with different targets. Merriam and Focht for example aimed at classifying radiation damage, Eckerskorn and Hockwin included the aspect of multifactorial influences on cataract morphology, WHO wanted to develop a simple to use universal classification system for epidemiological studies and Chylack and coworkers tried to integrate morphology and colour. The Pentacam nuclear staging tries to correlate density to nuclear hardness which is yet another aspect. However, the stack of 50 Scheimpflug images provided by the Pentacam allows developing software which could objectively classify all cataract types by using 3D shape recognition. The development and application of such corresponding software will be discussed.
Is preoperative antibiotic use justified by evidence based medicine?
Authors: GRZYBOWSKI A
Published: November 2013

Endophthalmitis is one of the most serious complications of the ocular surgery leading in most cases to a significant decrease in vision. The use of preoperative antibiotics and / or povidone‐iodine has been advocated as an effective measure to prevent endophthalmitis, although it was never proved in a prospective trial. The additional benefit of topical preoperative antibiotics to povidone‐iodine alone is controversial, and should be balanced with the risk of producing antibacterial resistance, the increasing problem of modern medicine. It was shown that 3 days preoperative use of major antibiotics is as effective as 1 hr preoperative use; povidone‐iodine is as effective as antibiotic; single 5% povidone‐iodine use is less effective than twice irrigation with the same solution; 10% povidone–iodine is more effective than 1% poviodone‐iodine. Moreover, preoperative antibiotic use did not lower the endophthalmitis rate. In conclusion, adding the antibiotic to povidone‐iodine brings no clear benefit. The antimicrobial resistance is known to be produced by repeated, overused and extended use of antibiotics, and might lead to development of treatment resistant infections, including severe forms of endophthalmitis.
ELAVL1/HuR‐mediated accumulation of SQSTM1/p62 during proteasomal inhibition in human ARPE‐19 cells
Authors: AMADIO M
Published: November 2013

Purpose Impaired protein degradation in retinal pigment epithelial (RPE) cells contributes to age‐related macular degeneration (AMD) pathogenesis. SQSTM1/p62 protein is involved in autophagy and proteasome‐mediated proteolysis, and expressed strongly under toxic stimuli. ELAVL1/HuR is a RNA‐binding protein which, in response to various stressors, regulates gene expression, finally affecting key cellular functions. Main aims of our study were to investigate whether p62 mRNA would be a target of HuR protein, and whether a link between these two proteins exists in RPE cells. Finally, the effects of proteasome inhibition and autophagy induction on p62 and HuR levels in RPE cells were also evaluated.

Methods AlphaScreen technology and immunoprecipitation coupled with real‐time qPCR were used to study the binding between HuR protein and p62 mRNA. ARPE‐19 cells were treated with MG‐132 (proteasome inhibitor; 5µM) and/or AICAR (AICA ribonucleotide, 5‐aminoimidazole‐4‐carboxamide‐1‐β‐D‐ribofuranoside; 2mM). P62 and HuR levels were analyzed by real‐time qPCR and Western blotting. HuR silenced ARPE‐19 cells and negative control cells were also employed.

Results MG‐132 treatment up‐regulates HuR, which binds p62 mRNA thus contributing, at post‐transcriptional level, to the increase of p62 protein level in ARPE‐19 cells. The addition of AICAR promoted cleansing by autophagy of p62, but not HuR.

Conclusion p62, whose mRNA represents a novel target of HuR, is positively regulated as a cellular response to proteasome inhibition. P62 is degraded by autophagy‐mediated pathway, while HuR through proteasome. These findings may be relevant for AMD.
Early dietary therapy in preventing progression of retinopathy in long‐chain 3‐hydroxyacyl‐CoA dehydrogenase (LCHAD) deficiency caused by the homozygous G1528C mutation
Authors: ROOMETS E , KIVELÄ T , TYNI T
Published: November 2013

Purpose To evaluate the efficacy of the early start of a low fat, high carbohydrate diet in preventing progression of pigmentary retinopathy, a characteristic feature of long‐chain 3‐hydroxy‐acyl‐CoA dehydrogenase (LCHAD) deficiency, a mitochondrial long‐chain fatty acid β‐oxidation defect.

Methods 13 Finnish patients with early diagnosis of LCHAD deficiency caused by the homozygous G1528C/Q510Q common mutation, were followed up to 20 years (median 6 y). An ophthalmic examination was performed every 1‐2 years including BCVA, colour vision, axial length, fundus colour photography, OCT, and ERG.

Results 11 out of 13 patients had mild pigmentary changes already in their first ocular exam (median age of 6 mos), while 2 had pale newborn retina. The initial fundus changes were most often pigment granularity in the posterior pole, hyperpigmented macula and pale fundus. In 12 patients, with good compliance of the dietary therapy, the pigmentary changes progressed only mildly or not at all, re‐maining at stage II of retinopathy with no atrophy and visual compromise. The only patient with an overall poor outcome, had progression of the chorioretinopathy to stage III, presenting atrophy in the posterior pole with relative sparing of the macula and far periphery.

Conclusion Our long‐term ocular follow‐up data are promising and suggest that the low‐fat, high‐carbohydrate diet started during the first months of life may delay or even halt the progression of the pigmentary retinopathy and possibly prevents the visual handicap in LCHAD deficiency.
Macular choroidal thickness profile in healthy population measured by swept‐source optical coherence tomography
Authors: RUIZ MORENO JM , RUIZ‐MEDRANO J , FLORES‐MORENO I , PEñA‐GARCíA P , MONTERO JA
Published: November 2013

Purpose To determine choroidal thickness (CT) profile in healthy population by swept‐source longer‐wavelength optical coherence tomography (SS‐OCT).

Methods Cross‐sectional, non‐interventional study. The macular area of 276 eyes, from 154 healthy patients was studied with an SS‐OCT prototype system. A horizontal CT profile of the macula was created by manually measuring subfoveal CT (SFCT, from the posterior edge of retinal pigment epithelium to the choroid/sclera junction). Three further determinations were performed every 1000 μm nasal to the fovea and five more every 1000 μm temporal to the fovea. CT was independently determined by two observers.

Results SS‐OCT allowed visualization of CT in all cases (100%). Mean SFCT was 301.89±80.53 μm (95% confidence interval: 292.34 to 311.43). Mean horizontal macular CT (MCT) was 258.69±64.59μm (95% confidence interval: 251.04 to 266.35). Mean SFCT was 325.6±51.1 μm in 0 to 10 years, 316.7±90.1 μm in 11 to 20 years, 313.9±80.3 μm in 21 to 40 years, 264.6±79.3 μm in 41 to 60 years and 276.3±88.8 μm in more than 60 years (P<0.001; Anova test). Mean horizontal MCT was 286.0±43.5 μm, 277.7±68.2 μm, 264.0±61.9 μm, 223.4±62.2 μm and 229.7±66.1 μm for 0 to 10, 11 to 20, 21 to 40, 41 to 60 and > 60 years respectively (P<0.001; Anova test). The CT profile was different for each age group.

Conclusion Macular CT profile in healthy population is similar between different age groups with thicker CT in young people.
Direct versus indirect ophthalmoscopy: Medical student assessment of retinal pathology
Authors: ZIELICKA Z , HULL S , DAVIES N
Published: November 2013

Purpose Fundoscopy by non Ophthalmic specialists is typically performed by direct ophthalmoscopy. This challenging skill gives a magnified, monocular image. In contrast, indirect ophthalmoscopy as regularly used by Ophthalmologists allows a wide field, binocular view. The aim of the study was to test the hypothesis that compared to direct ophthalmoscopy, indirect ophthalmoscopy is an easier technique to learn and that the correct diagnosis of fundus pathology is more readily achieved.

Methods The design was a prospective cohort study, conducted on 50 third year medical students, at a large inner city hospital. Participants attended a practical teaching session on both techniques. Students were then randomly allocated to either ophthalmoscopy technique and scored on their ability to recognise common fundus pathology in a group of patients. Student perception of the technique was also ascertained.

Results The number of surveys filled out for first and second session was 98% and 86% respectively. After the initial teaching session, the majority of students reported being ‘moderately’ confident in using both techniques (direct 52%; indirect 35%), but overall 59% preferred direct ophthalmoscopy. When asked to identify common retinal pathology, it was found that students allocated to direct ophthalmoscopy were more likely to correctly identify the pathology although not statistically significant (U value 9.5, p≤0.05).

Conclusion Although indirect ophthalmoscopy provides better views of the retina, students are more confident using direct ophthalmoscopy. Furthermore, there is no significant difference in ability to diagnosis retinal pathology between either techniques.
Viscocanalostomy and canaloplasty : Technique and results
Authors: SUNARIC MEGEVAND G
Published: November 2013

Non penetrating surgical procedures involving Schlemm canal represent a new challenge in glaucoma surgery. While allowing good IOP control this technics avoids major complications known with Trabeculectomy and avoids the need for a subconjunctival filtering bleb which shunts aqueous to nonphysiological routes. Viscocanalostomy is characterized by the enlargement of Schlemm’s canal with viscoelastic near the surgical margins, in order to enhance aqueous egress through the ostia of the canal and then out of the eye via aqueous collector channels. Since the first description of Viscocanalostomy by Stegman several improvements have been made in the technic of the procedure resulting finally in the 360 ° catheterization of the Schlemm’s canal, a procedure called Canaloplasty. The technic, personal and published results, advantages and disadvantages of these procedures will be discussed.
UK National Ophthalmology database: optimising surgical safety
Authors: JOHNSTON R
Published: November 2013

The UK National Ophthalmology Database was established under the auspices of The Royal College of Ophthalmologists to collate anonymised patient data from electronic medical record systems that collect nationally agreed datasets for the purposes of national audit, research and revalidation of doctors. Following appropriate permissions data conforming to nationally agreed datasets were remotely extracted and anonymised. In 2011 data were extracted from 31 centres on a total of 382,275 patients including trabeculectomy operations. National audits and inter‐surgeon and inter‐institutional comparisons can be automated and allow surgeons to view their performance in the context of their anonymised peers.
Microbiological, Chemical, and Mathematical Analysis of Alexidine‐Polyethylene Interaction: Implications for the Fusarium Keratitis Epidemic of 2004‐2006
Authors: BULLOCK J
Published: November 2013

Our previous studies indicated that alexidine permeates into the walls of heated ReNu plastic bottles, thereby diminishing its concentration within the solution, thus allowing Fusarium growth. Using liquid chromatography‐mass spectroscopy (LCMS), alexidine levels were measured in heated/unheated ReNu bottles stored for various time periods. These data were plotted as decreasing alexidine concentrations vs. time; ratios of the areas under the curves were calculated and compared with data derived from Fourier transform infrared (FTIR) spectroscopy absorptions of methanol extract evaporate residues of formerly alexidine‐exposed bottle walls. FTIR studies showed that there was approximately 3.1 times more alexidine in the wall of the heated than the room temperature‐stored bottle. The LCMS study showed that there was approximately 3.2 times more alexidine in the walls of heated bottles. Alexidine levels correlated closely with timed and dilution microbiological studies. Decreasing alexidine levels with time and heat strongly suggest alexidine‐polyethylene interaction as the pharmaceutical failure mechanism of the worldwide Fusarium keratitis epidemic of 2004‐2006.
Nanofibrous scaffolds for corneal tissue engineering
Authors: FUCHSLUGER T , BAHNERS T , CZUGALA M , GUTMANN J , SALEHI S
Published: November 2013

This contribution will report on nanofibrous scaffolds for corneal tissue engineering. By electrospinning, biodegradable nanofibers can be created that form a semitransparent layer. This can be used as a substrate for further cell seeding procedures. It is the goal to use this scaffold in ocular surface reconstruction.
Femtosecond cataract surgery: The basic procedure and surgical details
Authors: BARRAQUER R , NAGY Z , ALVAREZ DE TOELDO J
Published: November 2013

Femtosecond lasers (FsL) have already proven to be a useful tool to improve efficacy ans safety in cataract surgery. This section of the course will review the basic steps of FsL‐assisted cataract surgery, the learning curve and transition, as well as the different variants and maneuvers of the procedure as compared to traditional phaco.
Complications & special cases of femtosecond laser cataract surgery
Authors: BARRAQUER R , NAGY Z , ALVAREZ DE TOELDO J
Published: November 2013

This section of the course will review the specific aspects of FsL‐assisted cataract surgery, including the evidences on the increased efficacy, precision and safety, the possible complications, and a number of special cases and situations as described by video presentations.
Ultrastructural 3D imaging of collagen fibrils and proteoglycans of macular dystrophy cornea
Authors: AKHTAR S , KHAN A , KIRAT O , ALKATAN H , ALMUBRAD T
Published: November 2013

Purpose Macular cornea dystrophy (MCD) is an autosomal, recessive, genetic disorder, involving a gene on chromosome 6 that leads to aberrant keratan sulphate synthesis. Here we report ultrastructural 3D image analysis of collagen fibrils (CF) and proteoglycans (PGs) macular corneal dystrophy (MCD) corneas.

Methods Three normal and three macular dystrophy (MCD) corneas were used for the study. The corneas were fixed in the 2.5% glutaraldehyde containing cuprolinic blue and processed for electron microscopy. 120 images were taken and used to construct 3D images of CF and PGs.

Results 3D image analysis showed that the PGs were embedded within the collagen fibrils of the stroma. There were less electron dense particles within the CF of the MCD cornea compared to within the normal CF. The diameter of the CF in the anterior stroma was larger compared to the CF diameter in the posterior stroma. The PGs area in the anterior stroma was significantly larger compared to the PGs area in the middle and posterior stroma. The PGs around the degenerated keratocytes were much larger. PGs areas in the MCD cornea were significantly larger than the PGs areas of the normal cornea.

Conclusion Ultrastructural 3D imaging provides detailed ultrastructural features of CF and PGs. A large aggregation of the PGs in the anterior stroma suggests that the degeneration of the anterior stroma was more severe compared to the degeneration of the middle and posterior stroma.
Integrin alphavbeta5 identifies human corneal epithelial stem cells
Authors: DI GIROLAMO N , ORDONEZ P , CHOW S
Published: November 2013

Purpose Stem cell (SC) therapy is the main treatment modality to restore vision in patients with limbal stem cell deficiency. If corneolimbal epithelial stem cells (LESC) can be readily identified, isolated and maintained ex vivo, better quality grafts can be generated for patients with this debilitating disease. With prior knowledge that the extracellular matrix protein vitronectin (VN) is present within the LESC niche and that it supports SC in vitro, we postulated that the VN receptor αvβ5 is expressed by, and can be used to identify and isolate SC within the cornea.

Methods Epithelial cells were isolate and expand from cadaveric human corneas and αvβ5 expression determined by flow cytometry and immunofluorescence. Integrin expressing cells were isolated by magnetic‐activated cell sorting then assessed by immunocytology, colony forming efficiency, RT‐PCR and microarray analysis.

Results Integrin αvβ5+ cells co‐localized to N‐cadherin+/CK‐15+ putative LESC. αvβ5 was restricted to 3% of the total epithelial cells, which expressed more SC markers and formed more colonies compared to αvβ5‐ cells. Transcriptional profiling of αvβ5+/‐ cells by global gene array identified several interferon‐inducible genes, including the chemokine IP‐10, which localized to LESC. The role of IP‐10 in these cells is yet to be elucidated, but may be involved in immunoprotection by attracting mesenchymal SC into the corneal stroma.

Conclusion Integrin αvβ5 is a candidate SC marker since its expression is restricted and αvβ5+ limbal epithelial cells have properties of LESC. Knowledge of the niche’s composition and the genes expressed by its SC will facilitate isolation and maintenance of these cells in culture for therapeutic purposes.
Predictive value of optical coherence tomography in graft attachment after Descemet membrane endothelial keratoplasty
Authors: YEH RY , QUILENDRINO R , MUSA F , LIARAKOS V , DAPENA I , MELLES GJ
Published: November 2013

Purpose To evaluate the predictive value of early anterior segment optical coherence tomography (AS‐OCT) on graft adherence or detachment after Descemet membrane endothelial keratoplasty (DMEK).

Methods Retrospective study of prospectively collected data at a tertiary referral center. 87 eyes of 87 patients out of a consecutive series of 142 DMEK surgeries were included in the study AS‐OCT was performed within the first hour after DMEK, and at 1‐ week, 1‐month, 3‐months and 6‐months, and for each time interval detachments were classified as ‘none’, ≤1/3 detachment, >1/3 detachment of the total graft surface area, or ‘complete’ detachment. Throughout the study no re‐bubbling procedures were performed. The main outcome measure was graft adherence at various postoperative time intervals.

Results 1‐hour AS‐OCT scans were more accurate at predicting the final 6‐month graft adherence status than those at 1‐week or 1‐month. Grafts showing complete attachment or <1/3 detachment at 1‐hour, remained stable or improved in 73% of the cases at 1‐week, 82% at 1‐month, 86% at 3‐months, and 90% at 6‐months, respectively. All grafts attached at 1‐week, remained attached at 6‐months. Graft detachments of >1/3 at 1‐hour showed re‐attachment at 6 months in 25% of the cases, while 67.5% of the cases showed a persistent detachment of >1/3 at 6 months and 12.5% a complete detachment.

Conclusion The 1‐hour AS‐OCT showed best predictive value on 6‐month graft adherence status. The combined information of the 1‐hour and 1‐week AS‐OCT may facilitate decision making on surgical re‐intervention after DMEK.
Cultivation and characterisation of human peripheral cornea derived endothelial cells
Authors: ALBERT R , FARAJ L , YEUNG A , BRANCH M , SIDNEY L , WILSON S , MCINTOSH O , HOPKINSON A , PETROVSKI G , DUA HS
Published: November 2013

To confirm that human corneal rims left over from DALK/DSEK/PK surgeries could be useful sources for ex vivo endothelial cell expansion. Human corneal rims remaining from DALK/DSEK/PK surgeries were utilized (1:1 sex ratio, age 63+20 years, endothelial cell density >2,500 cells/mm2). The time from death to use varied between 3 days and 1.5 months. Endothelial cells isolated using a two‐step, peel‐and‐digest method, whereby the Descemet’s membrane and endothelial cells were peeled off under a dissecting microscope, followed by digestion in collagenase. The isolated cells were suspended in TrypLE prior to plating onto FNC‐coated tissue culture plates. The cells were then cultured in Ham’s F12:M199 (1:1) media supplemented with, ascorbic acid, transferrin, sodium selenite and bFGF. Characterisation of the cultured cells was performed by RT‐qPCR and immunofluorescence staining accordingly. The number of isolated endothelial cells was repeatedly low (< 20,000 cells). However, improved techniques allowed to reduce stromal cell contamination. It was observed that endothelial cell proliferation was improved when the culture surface area was reduced. Furthermore, typical endothelial cobble stone morphology was observed when the cell density was high. Cell morphology and growth showed notable difference related to donor age and preservation time. ZO‐1, Na/K‐ATPase and PITX2 were used to confirm the endothelial phenotype. Preserved human corneal rims can be utilized for ex vivo expansion of corneal endothelial cells but further optimization is needed.
Hepatocyte growth factor in neovascular age related macular degeneration: In vitro study of its effects on choroidal endothelial cells
Authors: STEWART EA , SAMARANAYAKE GJ , AMOAKU WM
Published: November 2013

Purpose Intraocular angiogenesis is associated with a number of common blinding conditions including neovascular age‐related macular degeneration (nAMD). The growth factor vascular endothelial growth factor (VEGF) is reported as being central in driving choroidal neovascularisation in nAMD. Many clinical nAMD therapies target VEGF with anti‐VEGF drugs such as ranibizumab, bevacizumab and Aflibercept. These however have limited efficacy and require repeated, prolonged treatment. Other cytokines are known to be involved in nAMD including hepatocyte growth factor (HGF) which has been shown to have a role in the early stages of nAMD. Our aim was to elucidate the effect of HGF and its cooperation with VEGF on human choroidal endothelial cells (CEC).

Methods The expression of HGF and related molecules in CEC was investigated using western blotting and flow cytometry. In vitro assays for proliferation, tubule formation and transendothelial permeability were used to assess the role of HGF in nAMD.

Results Expression of HGF, VEGF and their receptors c‐met and VEGFR2 and co‐receptor CD44v6 was found in primary human CEC. Stimulation with HGF increased CEC proliferation and tube formation but did not increase permeability, the increased proliferation was additive with VEGF.

Conclusion This study provides insight into the interactions or cross‐talk in CEC signalling and indicates that a more efficient approach to regulate intraocular angiogenesis would aim to simultaneously block the actions of multiple growth factors, or the common downstream site in the angiogenesis pathway and this may provide a more sustained treatment response in order to enhance treatment protocols in nAMD.

Commercial interest
Does cyclodextrin affect penetration of diclofenac sodium through amniotic membrane?
Authors: RESCH M , MARSOVSZKY L , BUDAI‐SZUCS M , SOOS J , BERKO SZ , SIPOS P , NEMETH J , SZABO‐REVESZ P , CSANYI E
Published: November 2013

Purpose To investigate permeability of amniotic membrane (AM) to diclofenac sodium containing eye drops with or without cyclodextrin (CD)

Methods Cryopreserved AM pieces on cellulose acetate filter membranes were mounted in the previously established vertical Franz‐diffusion cell system equipped with autosampler. In vitro penetration of two commercially available eyedrops containing 0.1% diclofenac sodium was examined. Voltaren Ophtha CD (VO, with CD) and Uniclophen (UN, without CD) were compared. Drug release was determined by quantitative absorbance measurement carried out with a high performance liquid chromatography (HPLC).

Results The initial two hours, release of diclofenac from VO was lower than penetration of diclofenac from UN. At 30 minutes only 6.6% of diclofenac penetrated AM from VO vs 11.5% from UN. At 2 hours difference between two eyedrops was not siginificant (25.69% for VO and 27.39% for UN; p>0.05). After two hours, greater concentration of VO could be measured in the acceptor phase than that of UN and this difference remained significant over the study period. Seven and half hour after instillation we detected 56.26% for VO versus 35.62% for UN of baseline concentrations

Conclusion Drug penetration of diclofenac sodium was affected by CD. Until 120 minutes following instillation, CD decreased drug release from eyedrop containing CD compared to eyedrop without CD. After 2 hours, however drug penetration became significantly greater from solution with CD compared to solution without CD.
Circulating blood glutathione levels influence retinal microvascular function in healthy individuals
Authors: SESHADRI S , QIN L , MROCZKOWSKA S , PATEL S , GHERGHEL D
Published: November 2013

Purpose To assess the relationship between retinal vessel reactivity and oxidative stress markers in the systemic circulation.

Methods Two hundred and twenty four healthy volunteers (aged 20‐70 years) free of cardiovascular risk factors based on medical history, lipid profiles, blood pressure, and body mass index were included in this study. Measurements included plasma cholesterol, blood glucose, triglycerides, oxidized (GSSG) and reduced (GSH) forms of glutathione. Arterial and venous retinal vessel reactivity was assessed using the dynamic retinal vessel analyser (DVA, IMEDOS, Germany) according to an already established protocol.

Results A simple correlation model showed that arterial and venous dilation amplitude was inversely with correlated with age (r= ‐0.4041, p= 0.0001; r= ‐.4045, p= 0.0001, respectively). Forward step‐wise multiple linear regression analysis revealed that independent of age and other systemic influences, blood GSH levels were positively correlated with arterial and venous percent dilation (β= 0.158, p= 0.0133; β= 0.224, p= 0.0004, respectively), and overall dilation amplitude (β= 0.245, p = 0.0003; β= 0.230, p= 0.0006, respectively). In addition, blood GSH levels negatively influenced the arterial constriction response slope (SlopeAC: β= ‐1.722, p= 0.0024), while GSH and overall redox status (GSH/GSSG) influenced percent constriction in both the artery (β= ‐0.345, p=0.0002, β= ‐0.229, p= 0.0462, respectively) and vein (β= ‐0.253, p= 0.0001; β= ‐0.156, p= 0.0177, respectively).

Conclusion In otherwise healthy individuals, retinal microvascular function is influenced by systemic anti‐oxidative capacity.
Correlation between SD‐OCT, immunocytochemistry and functional findings in an animal model of retinal degeneration
Authors: PINILLA I , FERNANDEZ‐SANCHEZ L , SEGURA FJ , SANCHEZ‐CANO A , SAUVE Y , TAMARIT JM , LOPEZ DE LA FUENTE C , FUENTES‐BROTO L , HERRERA LX , CUENCA N
Published: November 2013

Purpose The P23H rhodopsin mutation is an extensively studied model of ADRP. We evaluated the anatomical changes using SD‐OCT and correlate the findings and retinal thickness values with immunocytochemistry. Functional changes were analyzed

Methods Heterozygous P23H pigmented transgenic rats aged from P18 to P180 were studied. LE rats bred with Sprague Dawley (SD) 1 month old served as wild type controls. Visual acuity and contrast sensitivity evaluation was performed every month. Corneal ERGs were recorded under scotopic and photopic conditions. Retinal thicknesses at different levels (total thickness, ONL + RPE, ONL and IPL), fundus autofluorescence (FAF) and fluorescein angiography was performed in 3 animals at P150 using Spectralis OCT and HRA (Heidelberg Engineering, Germany). Retinas were immunostained for ICC.

Results Retinal thicknesses diminution was seen in OCT sections, with a clear loss of ONL and morphological modifications. Statically differences were found between groups in all evaluated thicknesses. In the P23H rats, change in FAF was noted comparing to control group, as sparse autofluorescent dots. No relevant changes were observed in the angiography pattern. ICC showed a progressive decrease in ONL thickness. Functional changes were progressive with time.

Conclusion Anatomical changes in pigmented P23H can be observed using SD‐OCT and immunocytochemistry, with a good correlation between their values. SD‐OCT and FAF are important tools for research in retinal degenerations.
The frequency of idiopathic retinal detachment has seasonal variation and correlated with climate – A survey in Japan
Authors: TAKETANI Y , INAMOCHI K , MAYAMA C , ASAOKA R , MURATA H , NOMOTO Y
Published: November 2013

Purpose Several studies have reported that rhegmatogenous retinal detachment (RRD) has a high incidence in the summer season and it correlates with increased sunshine hours and the average temperature. However, there is no report in Japan where seasonal changes in climate are rather distinct. In this study, we examined the seasonal variation of the frequency of RRD and the influence of climate. Asahi General Hospital is located in Asahi city (Chiba, Japan) where there is only a small change of population and furthermore, there is no other hub hospital in the city.

Methods Medical records of consecutive 271 patients (>13‐year‐old) who had surgery for idiopathic RRD at Asahi General Hospital from January 2007 to December 2011 were retrospectively reviewed. The incidence of RRD was counted by months and seasons, and its seasonal variation and the correlation with the climate factors including the sunshine hours, temperature, humidity, and rainfall were examined. Result:

Results 271 RRD eyes of 271 patients (176 male and 95 female, 56.0±15.0 years old) were included in the study.The RRD occurred most frequently in early summer (May to June, 21%), and least frequently in winter (January to February, 14%). Its frequency was significantly correlated with increased sunshine hours (r=0.71, P<0.05).

Conclusion The incidence of RRD has an increasing trend in summer season in Japan, similarly to the previous reports in Asia, Middle East and Europe. It also positively correlated with increased sunshine hours and average temperature. These findings could suggest the influence of increased opportunity of outdoor‐activities and miosis by sunshine on the occurrence of RRD
Simultaneous SD‐OCT and fundus autofluorescence imaging of the macula after successful repair of rhegmatogenous retinal detachment
Authors: CHAKER N , MGHAIETH F , BOURAOUI R , GHRIBI H , EL MATRI L
Published: November 2013

Purpose To evaluate the ultrastructural changes in the macula after successful repair of rhegmatogenous retinal detachment (RRD) using spectral domain optical coherence tomography (sdOCT) and fundus autofluorescence (FAF) imaging

Methods Simultaneous sdOCT (Topcon 2000 FA plus) and FAF imaging were performed with a system for FAF imaging using a fundus camera that included Spaide Autofluorescence filters available on IMAGEnet.

Results 31 patients with macular‐off RRD and 2 with macular‐on RRD were recruited. Post operative visual acuity ranged from 20/400 to 20/20. SdOCT images were normal in 18 eyes (54.5%), revealed macular edema in 9 eyes (27.2%), macular hole in 2 eyes (6%), macular pucker in 3 eyes (9%), submacular fluid in 2 eyes (6%). Fundus autofluorescence imaging of the macula were normal in 13 eyes (39.3%).There were central abnormalities in 14 eyes. Patients with abnormal FAF were also associated with poor postoperative BCVA (p<0.001)

Conclusion The present study demonstrates the ultrastructural changes assessed with simultaneous FAF and sdOCT and their relation with visual outcome
Cytologic analysis in vitreo‐retinal surgery
Authors: BENISTY D , HAYATE F , BOULAGNON C , DUCASSE A , ARNDT C
Published: November 2013

Purpose Proliferative vitreoretinopathy (PVR) is the leading cause of failure in retinal detachment surgery. The migration of retinal pigment epithelial cells and the proliferation of the extracellular matrix has been associated with PVR. The purpose of this prospective study was to compare the cellular contents of the vitreous of patients undergoing retinal detachment surgery with patients scheduled for macular surgery.

Methods The vitreous samples of patients with epiretinal membrane and rhegmatogenous retinal detachment were obtained at the initial phase of surgery without previous intraocular infusion. A cytological analysis and Papanicolaou staining was performed in all cases. The concentration of vitreous cells in 62 patients with retinal detachment and 62 undergoing macular surgery (52 epiretinal membranes, 6 macular holes and 4 vitreomacular traction syndromes) were analyzed semi‐quantitatively.

Results An increased concentration of vitreous cells and free pigment was observed in a higher proportion in retinal detachment specimens compared with patients undergoing macular surgey. In the retinal detachment group, there was a higher amount of hyalocytes (p=0,017) and macrophages (p=0,00865). There was no correlation between any cell concentration and PVR induced recurrence of retinal detachment. Interestingly, in the vitreous of eyes with vitreomacular traction, no cells could be detected.

Conclusion Vitreous changes observed in patients with retinal detachment appear to involve vitreous cells particularly hyalocytes and macrophages, whereas in vitreomacular traction, syndromes no cellular reaction could be detected.
Purtscher‐like retinopathy associated with acute pancreatitis at Vilnius University Hospital Santariskiu Klinikos
Authors: PAULAVICIENE R , STRELKAUSKAITE E , ASOKLIS R , STRUPAITE R
Published: November 2013

Purpose To report two cases of Purtscher‐like retinopathy associated with acute pancreatitis.

Methods Retrospective analysis of two cases of Purtscher‐like retinopathy associated with acute pancreatitis. Fluorescein angiography (FAG), retinal photography, laboratory tests, computer tomography (CT) were analyzed.

Results 2 cases were identified in a period from 2007 to 2013. The first, 57 y.o patient with a history of recently treated acute pancreatitis, was referred to clinic 2 weeks after visual impairment. Visual acuity (VA) was 0,3 in the right eye and 0,25 in the left eye. FAG revealed prolonged arterio‐venous passage time, enlarged foveal avascular zone (FAZ), fluorescein blockage temporal to optic nerve disc due to soft exudates. Patient was treated with systemic steroids intravenously. VA improved to 1,0 after 9 days of treatment. The second, 39 years old patient was referred to our clinic 3 days after visual impairment. At the time of hospitalization despite patients normal vital signs, laboratory tests and CT revealed acute pancreatitis and reactive hepatitis. VA was hand motion in the right eye and 0,01 in the left eye. FAG showed large FAZ and evidence of leakage from vessels in the late phase. After treatment with intravenous steroids, VA improved to counting fingers at 30 cm in the right eye and 0,03 in the left eye.

Conclusion Prognosis of Purtscher‐like retinopathy may depend on systemic disease severity, VA in early stages and the presence of macular ischemia. Pancreatitis‐associated retinopathy is rare and there are no evidence‐based therapeutic recommendations.
Hypertensive retinopathy complicated with bilateral retinal neovascularization: PRP versus intravitreal anti‐VEGF treatment
Authors: XIROU T , BATSOS G , GEORGIADIS O , XIROU V , FERETIS E , KABANAROU SA
Published: November 2013

Purpose To report a case of hypertensive retinopathy with bilateral retinal neovascularization treated with anti‐VEGF intravitreal injection in one eye and panretinal photocoagulation (PRP) in the fellow eye.

Methods A 33‐year‐old male patient presented with gradual visual loss in both eyes for the last five months. From his medical history, idiopathic systematic hypertension was diagnosed five months ago. There was no other relevant medical or family history. Best corrected visual acuity (BCVA) was CF in the right eye and 8/10 in the left eye. Anterior segment examination was unremarkable on both eyes. Fundus examination showed abnormalities in both eyes compatible with hypertensive retinopathy and extensive areas of neovascularization. OCT examination showed no evidence of macular oedema. Fluorescein angiography (FFA) revealed macular ischaemia in the right eye and large areas of retinal ischemia and retinal neovascularization with vascular leakage, mainly across the temporal arcades, in both eyes. Indocyanine green angiography (ICG) showed no further pathology. Patient was treated with an anti‐VEGF (ranibizumab) intravitreal injection in the right eye and PRP laser in the left eye.

Results Follow up examination one and two months post‐operatively showed no change in BCVA in either eye. FFA documented regression of retinal neovascularization mainly in the right, while in the left eye there were still areas of vascular leakage across the temporal arcades.

Conclusion Hypertensive retinopathy can be rarely complicated with retinal neovascularization.
Response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age‐related macular degeneration refractory ranibizumab
Authors: OGATA N , HASEGAWA T , YAMASHITA M , OKAMOTO M
Published: November 2013

Purpose Recent reports demonstrated that large retinal pigment epithelial detachments (PED) associated with neovascular age‐related macular degeneration (AMD) was successfully treated with aflibercept. The aim of this study is to report unexpected short‐term response of aflibercept in the treatment of AMD with associated large PED which had been failed to ranibizumab treatment.

Methods The method comprised a retrospective review of the medical records of patients with PEDs associated neovascular AMD and recently treated with aflibercept and previously treated with ranibizumab.

Results Two eyes of male Japanese patients of ages 79 and 80 years old with large serous PEDs and subretinal fluid (SRF) associated with occult choroidal neovascularization and neovascular AMD were treated with aflibercept after intravitreal ranibizumab had failed to resolve the lesions. All had complete resolution of SRF and complete or near‐ complete resolution of the serous PEDs after aflibercept injections over a 2‐month period. However, after the second injection of aflibercep, all eyes displayed fibrovascular PED in the lesion where serous PED was observed. Moreover, one eye presented a sudden retinal hemorrhage and a recurrent PED just after the third injection of aflibercept, and the visual acuity decreased 10/20 to 2/20.

Conclusion Intravitreal aflibercept may be carefully applied for for serous PED in neovascular AMD patients after ranibizumab have previously failed. Larger studies with longer follow‐up are required to determine the role of aflibercept in treatment of serous PED in neovascular AMD.
Neovascular AMD with high recurrences and atrophic areas ‐ Potential relationship between neovascular complication and atrophy
Authors: GONZALEZ C
Published: November 2013

Purpose To evaluate the possible relationship between Neovascular complication and atrophy and each one characteristics input

Methods 144 eyes of 72 patients, 21 men, 51 women, 72 with retrofoveolar neovascularisation complicating AMD, high recurrences, and atrophic areas,72 controlateral eye with atrophic areas only. First and 2 months’ interval follow‐up exam included ETDRS visual acuity (VA), complete ophthalmic examination, fluorescein and infracyanine (ICG) angiography, optical coherence tomography (OCT), (HRA Spectralis‐OCT), Autofluorescence imaging (FAF),( region finder software,to evaluate Atrophic areas). Protocol treatment: Series of 3 monthly Ranibizumab IVT, in loading dose and as Neovascular activity needed. Atrophic areas characteristics, their growth way were studied. The impacts of atrophy on high recurrence Neovascular AMD, and vice versa are valuate, compared to own atrophy evolution and average Neovascular evolving way

Results VA improved in 34% cases, stabilized in 37%. Total Atrophic area surface was 0‐ 5mm2 in 65%, (4, 898 mm2average),with moderate(1,817 mm2average)and slow (1,481 mm2/year average) growth.14% more in Neovascular eye. 24% more than low recurrences Neovascular AMD. Little correlation between Atrophy growth and number of Neovascular recurrences. Both are different process. Being together increase Neovascular risk and lower treatment response. This protocol had good functional results, with less IVT needed even if frequent recurrences, and a little impact on the evolution of atrophic areas

Conclusion Potential relationship between Neovascular and Atrophic process is a main question in the AMD follow –up, protocol treatments options,etiopathogenic knowledge and therapeutic prospects.
Clinical manifestation of retinal pigment epithelial tear after age‐related macular degeneration treatment
Authors: CHAE JB , JOE SG
Published: November 2013

Purpose To determine the risk factors for and responses of treatments after the development of retinal pigment epithelial (RPE) tears after treatment of exudative age‐related macular degeneration (AMD)

Methods A retrospective, consecutive chart review was performed for all patients with exudative AMD treated with intravitreal anti‐vascular endothelial growth factor (VEGF) antibody or photodynamic therapy (PDT) between March 2010 and January 2013. The main outcome measures were time from first injection until development of RPE tear, and pre‐RPE and post‐RPE tear visual acuity. The post‐RPE tear visual acuity conservational interval was defined between the time RPE tear occurred and the time visual acuity was decreased 0.1(decimal) from pre‐RPE tear visual acuity.

Results A total of 219 eyes were treated with intravitreal bevacizumab, ranibizumab or PDT. 10 eyes from 10 patients developed a RPE tear(4.6%). 3 of 10 eyes were polypoidal choroidal vasculopathy (PCV). The average RPE tear patients’ age was 75.4 years which is statistically greater than the others’(65.7 years)(p=0.001). 90%(9/10) of the RPE tears occurred within the first 12 weeks of treatment initiation. The number of patients conserving whose post‐RPE tear visual acuity was 5(50%) and their visual acuity was conserved until about 4 months. However, all 10 patients had poor visual acuity within 1 year follow‐up period.

Conclusion RPE tears can occur after treatments for exudative AMD in more elder patients. Visual acuity could be conserved at early period after RPE tear occurred. However, visual acuity finally decreased within 1 year in spite of continuous treatment.
Choroidal thickness in dry age‐related macular degeneration
Authors: ZABADANI K , ASCASO FJ , HERRERA L , PADGETT E , NUÑEZ E , CRISTOBAL JA
Published: November 2013

Purpose To compare the choroidal thickness (CT) in the macular area in eyes with nonexudative age‐related macular degeneration (AMD) with that of unaffected fellow eyes and eyes of healthy controls.

Methods Enhanced depth imaging (EDI) was obtained by spectral‐domain optical coherence tomography (SD‐OCT) (Spectralis, Heidelberg‐Engineering, Germany) in 47 eyes of 52 patients (78.7 ± 7.1 years) with AMD, 96 eyes of 96 healthy controls (74.0 ± 8.5 years) and in 5 unaffected contralateral eyes (68.6 ± 14.4 years). Eyes were divided into 3 groups: 47 eyes in group A (affected eyes with AMD), 5 eyes in group B (unaffected fellow eyes), and 96 eyes in group C (right eyes of age‐matched controls). Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid‐scleral junction in the subfoveal area (SCT) and 1 mm away from the fovea in the nasal (NCT) and temporal (TCT) regions. Statistical analysis was conducted to compare mean choroidal thicknesses.

Results In the AMD group the mean choroidal thicknesses were 164.9 ± 62.4 µm at the fovea (SCT), 150.7 ± 64.8 µm nasally (NCT), and 171.1 ± 63.3 µm temporally (TCT). In the unafected fellow eyes these measurements were 219.2 ± 143 µm, 215.8 ± 129.1 µm, and 226.2 ± 113 µm, respectively. Finally, the control group showed the following values: 234.9 ± 100.4 µm, 224.7± 96.4 µm, and 233.0 ± 95.5 µm, respectively. Choroidal thickness did not show any statistically significant differences among the three groups of eyes when age was counted as a confounding variable (p>0.05, ANOVA test).

Conclusion There were no significant differences between choroidal thickness of nonexudative age‐related macular degeneration with the contralateral unaffected eye or the control group.
Topographic distribution of vascular and neurodegenerative signs in type 2 idiopathic macular telangiectasia
Authors: SALLO F , LEUNG I , BALASKAS K , PAULEIKHOFF D , BIRD AC , PETO T
Published: November 2013

Purpose Idiopathic macular telangiectasia type 2 (MacTel) is associated with characteristic vascular signs including leakage/staining on fluorescein angiography (FA) as well as neurodegenerative signs including a progressive loss of luteal pigment. The distribution of luteal pigment can be assessed by dual‐wavelength autofluorescence (DWAF) imaging. Our aim was to investigate the relationship of vascular and neurodegenerative signs of type 2 MacTel in FA and DWAF images.

Methods FA and DWAF images were acquired using a Heidelberg Spectralis SLO and a HRA Classic SLO device respectively. Thirty eyes of 30 MacTel patients were examined. Images were aligned to attain exact correspondence. Staging of luteal pigment loss in DWAF images was performed according to the system developed by Zeimer et al. The extent of abnormalities in the two imaging modalities was compared.

Results According to severity of luteal pigment loss, 6 eyes were at stage 1, 14 at stage 2 and 10 at stage 3. At stages 2 and 3, the area with early FA changes was always smaller and contained within the area of luteal pigment loss. This also held true for stage 1 except in very early cases with minimal pigment loss. In these, FA changes, especially late staining appeared more extensive. Dense pigment plaques appeared as masking dark areas in both FA and DWAF images with hyperfluorescent spots in DWAF. Subretinal neovascularization broke up the pattern in 3 eyes.

Conclusion Our results indicate that in non‐neovascular type 2 MacTel, luteal pigment loss appears more extensive than vascular change. The relative time sequence of changes may provide clues to the primary underlying cause. Confirmation on a larger sample with follow‐up is indicated.