bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between saccadic parameter variations and clinical evidences in thyroid autoimmune ophthalmopathy (TAO) affected patients
Authors: VARANO L , CAMPAGNA F , BRUZZICHESSI D , CARNOVALE SCALZO G , PAOLA A , RUSSO C , SCORCIA V , PARISE S , ARTURI F , COSTANTE G , SCORCIA G
Published: October 2007

Purpose: Object of our study is to value correlation between saccadic parameters, estimated through EOMG exam, and several clinical symptoms/signs in subjects affected by TAO.

Methods: 80 eyes of 40 patients consecutive affected by TAO were examinated. All the patients were submitted to ocular motility exam, Hertel's exophthalmometry, clinical evaluation and saccadic movement analisys through Electroculomyography (EOMG; BM6000MOE system ‐ WinEOMG software ). CAS score was calculated in each subject.

Results: Most of observed patients showed at least a grade mild exophthalmos. In 40% of observed patients we found an increase of saccadic movement maximal speed; in 30% we found a decrease of movement medium speed. 25% of observed patients showed an increased latency. Almost all subjects with any saccadic alteration, showed exophthalmos.

Conclusions: In TAO affected patients seem not to be correlation between CAS score and saccadic alterations or exophthalmos entity. On the contrary, there seem to be a correlation between saccadic alterations and exophthalmos. Even if these data still need to be confirmed, analysis with EOMG could bring an ocular motility alteration predictive value.
Retinal oxygen saturation in humans in light and dark
Authors: HARDARSON SH , JONSDOTTIR TE , BASIT S , HALLDORSSON GH , KARLSSON RA , BEACH JM , EYSTEINSSON T , BENEDIKTSSON JA , STEFANSSON E
Published: October 2007

Purpose: To investigate the effect of light and dark on the retinal vessel oxygen saturation (SatO2) in healthy humans.

Methods: The oximeter consists of a fundus camera, a beam splitter, a digital camera and software, which calculates the SatO2 of the retinal vessels.

In the first experiment, 18 healthy individuals were first placed in the dark for 30 minutes, then alternatingly in light (80cd/m2) and dark. Each light or dark period lasted for 5 minutes.

In the second experiment, 23 volunteers were measured. The volunteers were placed in the dark for 30 minutes and then in light successively at 1, 10 and 100 cd/m2, each period lasting 5 minutes. Finally, the volunteers were adapted to dark for 5 minutes.

Oximetry was performed at the end of each period in both experiments. Three individuals were excluded from the first experiment and 4 from the second because of poor image quality. Paired t‐tests were used for analysis.

Results: In the first experiment, arterial SatO2 was 3‐4% higher in the dark than after subsequent adaptation to 80cd/m2 light (p<0.05) and similar results were seen in venules; 3‐7% higher SatO2 values in the dark (p<0.05). In the second experiment, arterial SatO2 was 3% higher in the dark than after adapatation to 100cd/m2 (p=0.01) and the corresponding difference in venules was 5% (higher in the dark, p=0.06). SatO2 was not significantly different between dark and 1 or 10cd/m2.

Conclusions: The results indicate that SatO2 is higher in dark than in light in both arterioles and venules. The higher SatO2 in dark may reflect the increased oxygen consumption in the dark, which has to be compensated for by increasing the oxygen gradient between the retinal vasculature and tissue.
Correlation between diagnostic tests guides the development and use of a dry eye diagnostic algorithm
Authors: MOORE JE , GRAHAM JE , GOODALL E , DARTT DA , LECCISOTTI A , DOWNES SC , MOORE CBT
Published: October 2007

Purpose: The existence of large variations in results of diagnostic tests for cases of mild to moderate dry eye is widely recognised. The purpose of this study was to assess if there was correlation between existing dry eye diagnostic tests and attempt to develop a diagnostic algorithm.

Methods: A total of 91 subjects were recruited to the study. The tear film and ocular surface were evaluated by measuring tear volume using the phenol red thread test, tear break up time using fluorescein, biomicroscopic examination of meibomian glands and impression cytological (IC) assessment of conjunctival goblet cells. Dry eye symptoms were assessed using McMonnies dry eye questionnaire and statistical correlations were assessed between all dry eye tests used.

Results: In this study cohort there were no severe aqueous deficient dry eye patients. Meibomian gland pathology, questionnaire (score of ≥14), IC and an altered tear break up time (reference ≤7 seconds) demonstrated correlation, while no other tests demonstrated evidence of correlation. A diagnostic algorithm was devised using these tests alone, with maximum weighting placed on questionnaire with decreasing weighting assigned to IC goblet cell grade, meibomian gland pathology and TBUT.

Conclusions: We propose this development of a flexible probabilistic algorithm as a rational approach when diagnosing mild/moderate dry eye in large study groups. Until further studies have demonstrated the true sensitivities and specificities of dry eye tests within the context of test sequences and particular patient cohorts are known, comparison of results between dry eye studies will remain questionable.
Quantitative fluorescein angiograms
Authors: SANTOS T , BERNARDES R , BAPTISTA P , SCHWARTZ A , CARTER W , CUNHA‐VAZ J
Published: October 2007

Purpose: Clinical assessment of quantitative fluorescein angiograms based on novel instrumentation adaptation.

Methods: Fluorescein angiograms were simultaneously performed on patient’s retinas and on standard cells composed of two sets of five standard fluorescein solutions mimicking the environmental conditions of the plasma and vitreous, respectively. Regular gray‐scale fluorescein angiograms were converted into absolute concentration image maps, after a deconvolution step for the separation of plasma and vitreous fluorescence contributions, taking into account the respective fluorescein quantum efficiencies. Diabetic retinopathy eyes, eyes before and 3 days after laser photocoagulation, and fellow‐eyes from patients with choroidal neovascularization were imaged using this new technique.

Results: Repetitive measurements over patients clearly show the advantage of correcting for instrumentation setup. Comparison of scans taken before and after laser photocoagulation demonstrates background values within the same range and the expected increase over laser spots.

Conclusions: Quantitative fluorescein angiograms compare favorably with conventional fluorescein angiograms by removing instrumentation setup bias and by allowing absolute concentration image maps to be built and comparable. Furthermore, the use of a non‐linear color‐coded map allows the detection of subtle differences not visible on regular fluorescein angiograms. It is realized that this first step needs to be complemented by other standardization procedures, e.g., by fundus reflectance.
Densitometry of meibometer samples from normal and dry eye subjects
Authors: TIFFANY JM , LAVRIC A
Published: October 2007

Purpose: To compare the original and modified techniques of meibometry, and scanning/densitometry of lipid blots, on normal and dry‐eye subjects.

Methods: A hand‐held loop of plastic meibometry tape was pressed on the lower lid margin (10sec contact at 15g load), or fixed in the prism‐holder of the Goldmann tonometer arm (3sec contact at zero load) to obtain meibomian blots from right and left eyes of the same subject. The tape blot was scanned with the IRIS‐Pen hand‐held scanner to obtain digital images of the blot area and background (unblotted) tape. Mean pixel density of the blot area was found with the NIH ImageJ software and mean background density subtracted. Some blots were measured with both the original Meibometer instrument and by scanning.

Results: Comparison of blot densities by the Meibometer and scanning/densitometry on 25 normals showed no significant difference, irrespective of background levels, making the Meibometer unnecessary. A good correlation was also seen between the original and the modified application techniques despite the lower pick‐up of the latter. This is also preferred where patients cannot tolerate the 10sec application without blinking, as in many dry‐eye cases. Mean pixel density was lower in 14 meibomian gland dysfunction patients (6 with, 8 without aqueous tear deficiency) than in normals, although the difference was not significant; readings were not always reproducible due to scanning errors, possibly indicating local tape saturation or composition‐dependent effects.

Conclusions: IRIS Pen densitometry gives comparable results to the original Meibometer, so the Pen and a laptop computer can be used in the clinic or in field studies. More work is needed on scanning reproducibility and the effect of other environmental factors.
Gene expression profile of Limbal Epithelial Stem Cell niche
Authors: KULKARNI B , YEUNG AM , HOPKINSON A , DUA HS
Published: October 2007

Purpose: It is established by laboratory and clinical evidence that corneal stem cells are localised at limbus but are not isolated as yet due to the lack of stem cell markers. Recently we had discovered a novel anatomical structure at limbus, termed as the Limbal epithelial crypt (LEC), which have the potential of a stem cell niche as determined from previous anatomical and immunohistological studies. We aim to characterise the differential gene expression of the LEC by comparing with other regions of the ocular surface epithelium by 30,000 genes human oligonucleotide microarray analysis with the view to find putative stem cell marker.

Methods: On the frozen cryostat sections of the corneoscleral epithelium from cadaver donor tissue, Laser Capture Microdissection (LCM) by PALM® Microbeam systems was done. From the LMD tissue the RNA was extracted, amplified and hybridised to human oligonucleotide array chip. Raw data was obtained with Genepix Pro 6 software and uploaded on BASE where filtration and normalisation was done. Further analysis was done on TMev software by SAM and T Test.

Results: Microarray analysis was performed on BASE and with Significance Analysis of Microarray (SAM) on TMev. The analysis showed significant gene expression indicative of stem cells such as specific and differentiation markers.Transcription factors, cell adhesion molecules, genes involved in cell metabolism and respiration showed up regulation in the LEC.

Conclusions: The microarray analysis data supports our hypothesis that LEC harbours stem cells along with neighbouring niche cells and hence represents a Limbal Stem Cell niche.This is being confirmed with real time PCR.
First experience with corneal collagen UV cross‐linking treatment in keratoconus patients
Authors: MIKEK K , MORELA V
Published: October 2007

Purpose: Corneal collagen cross‐linking by UVA/riboflavin represents a new method for the treatment of progressive keratoconus.

Methods: In the presentation we will present our first 10 cases of keratoconic eyes (maximum K value, 45‐51 diopters) with the follow up time from 4 to 7 months. A complete ophthalmologic examination with uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were performed. Listed examinations were performed before surgery and at 1,2,3 and 7 months after surgery: corneal computerized topographic examination, pentacam examination, endothelial cell count and intraocular pressure (IOP) evaluation.

Results: Comparative preoperative and postoperative results showed increases of 1.4 lines for UCVA (P = .000021) and 1.66 lines for BCVA (P = .00051). Topographic analysis showed a mean K reduction of 1.9 +/‐ 0.15 diopters (D) in the central 3.0 mm. Statistical analysis of IOP, corneal thicknes and endothelial cell count did not show significant differences. Corneal and lens transparency remained unchanged. Topographic analysis findings of corneal symmetry showed a trend toward increasing corneal symmetry with a major reduction in asymmetry between vertical hemimeridians.

Conclusions: Refractive results showed a reduction of about 1.5 D in the mean spherical equivalent, topographically confirmed by the reduction in mean K. Results of surface topographic analysis showed improvement in morphologic symmetry. Long‐term results are necessary to evaluate the duration of the stiffening effect and to exclude long term side‐effects.
How to watch ganglion cells in the DARC?
Authors: CORDEIRO MF
Published: October 2007

Purpose: Assessment of neuroprotection in vivo is difficult. DARC (Detection of Apoptosing Retinal Cells) is a newly devised, non‐invasive real‐time imaging technique using confocal laser scanning ophthalmoscopy to visualise single retinal nerve cell apoptosis in vivo.

Methods: DARC allows longitudinal study of disease processes, which has not previously been possible. The implications of this novel technique include its application to glaucoma as a powerful new clinical tool with which to diagnose and identify patients with early disease, before they lose vision. Furthermore it may serve as a surrogate biomarker, providing real‐time information that could dramatically reduce the duration of glaucoma clinical studies, which currently have to use visual field status as a key endpoint and determinant of outcome.

Results: We have been able for the first time to image changes occurring in neuronal cell apoptosis over hours, days and months, and show effects depending on the magnitude of the initial apoptotic inducer in several experimental models of neurodegeneration.

Conclusions: More importantly, by using the eye as a “window” onto the brain, DARC opens the door to directly observing effects of therapeutic strategies in neurodegenerative disorders, by allowing for the study of potential neuroprotective drugs using meaningful endpoints that are based on the direct assessment of neuronal death in vivo. We have already assessed several neuroprotective agents using DARC including neuropeptide approaches.
Diagnosis and follow‐up of retinal detachment using a wide field scanning laser ophthalmoscope.
Authors: ARNDT CF , NABHOLZ N , BAZALGETTE C , NGUYEN N
Published: October 2007

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

Methods: All patients referred for retinal detachment from November 2006 to April 2007 were examined by one retinal surgeon who also performed the fundus drawing. An SLO image was taken by an orthoptist in training and interpreted by a resident, who were both unaware of the details of the retinal examination. The number of breaks and the extent of the detachment on the drawing were compared with the findings detected on the SLO image.

Results: 56 eyes with retinal detachment were documented. In 40 out of 56 eyes the retinal breaks could be detected on the SLO images obtained. The retinal breaks situated superiorly between 11 and 1 o’clock and inferiorly between 5 and 7 o’clock were missed on the SLO images. Two retinal detachments, one superior and one inferior, were missed on the SLO images.

Conclusions: SLO image analysis enabled correct diagnosis of a retinal breaks and related retinal detachments in more than 7 out of 10 cases. The retinal detachment was detected on the SLO image in more than 9/10 cases. The wide field SLO imaging system is thus not suitable as a diagnostic tool of retinal detachment replacing the fundus examination, however it represents a potential tool for patient education and training of vision professionals.
Genotype/phenotype features of the Slovenian patients with Stargardt disease: four novel mutations in ABCA4 gene and three novel complex alleles identified
Authors: HAWLINA M , JARC‐VIDMAR M , POPOVIC P , BRECELJ J , ALLIKMETS D , ZUPAN A , GLAVAC D
Published: October 2007

Purpose: To evaluate efficiency of recently developed genotyping microarray, the ABCR400‐chip, in combination with the denaturing high performance liquid chromatography (DHPLC) method sequencing to search for known ABCA4 mutations and to associate the findings with phenotype.

Methods: 36 Slovenian patients with phenotype of STGD1 were analysed for a population‐specific survey on the sequence variations in the ABCA4 gene. In the first step we used the ABCR400 microarray to identify the known mutations. Patients with one or no mutation on ABCR400 microarray were subsequently screened by DHPLC and sequencing. Phenotype was assessed by autofluorescence imaging, psychophysical methods and electrophysiology.

Results: By ABCR400 microarray, 25 potential disease‐associated alleles were identified resulting in a detection rate of 69.4%. With DHPLC, additional 8 mutations were found: four were novel ABCA4 mutations (two frameshift mutations 5977delT, 5716insG and two missense P597S and P640S). Three novel complex alleles were also identified. Mutation in both alleles were found in 9 patients, and in one allele in 14 cases. In the remaining 3 patients no mutations were found. Different phenotypes were characterised by different patterns of autofluorescence imaging. Electrophysiology,in general, showed normal flash ERG with abnormal PERG and multifocal ERG.

Conclusions: Combined approach using ABCR400‐chip and DHPLC/sequencing was efficient in detecting over 90% of potential disease‐causing mutations in Slovenian Stargardt patients, 4 of which were novel and show distinct genotype/phenotype patterns.
The phenotype of retinal dystrophy in patients with CERKL mutations
Authors: WILKE R , AVILA‐FERNáNDEZ A , TAPIA I , GARCIA‐SANDOVAL B , CANTALAPIEDRA D , VALLESPIN E , AYUSO C
Published: October 2007

Purpose: Recently a new gene encoding for a ceramide kinase like protein (CERKL) has been identified in a Spanish population and described to be associated with RP26. CERKL is assumed to be involved in sphingolipid‐mediated apoptosis in the retina. Here we present a phenotypic study of patients carrying CERKL mutations.

Methods: 210 unrelated Spanish families with autosomal recessive RP were screened using the ASPER arRP chip. Seven of these families presented a change in the CERKL sequence. Affected individuals of that families were investigated clinically including fundus examination, visual field testing and electroretinograhy.

Results: The mutation p.Arg257ter was identified in homozygous state in all seven families. The 9 affected individuals presented a common phenotype with characteristic macular and peripheral lesions, the later resembling those found with Gyrate Atrophy. In fact, one of the affected individuals has initially been diagnosed as Gyrate Atrophy.

Conclusions: This study presents the first genotype/phenotype correlation for persons carrying CERKL mutations From this initial study it seems likely that the p.Arg257ter mutation has a characteristic phenotype distinct from other arRP phenotypes.
The Uveitis subtype associated with Spondylarthropathies varies regarding to gender and the type of Spondylarthropathy involved
Authors: MACKENSEN F , BECKER MD , MAX R
Published: October 2007

Purpose: Inflammatory bowel disease (IBD) and Spondyarthropathies (SpA) are said to be associated with distinct types of Uveitis. We compared Uveitis subtypes in patients with IBD and SpA, as well as in different SpA subtypes.

Methods: We identified 162 patients with SpA (AMOR classification): 93 Ankylosing Spondylitis (AS), 43 with undifferenciated (u)Spa, 10 reactive Arthritis, 12 Psoriasis Arthropathy (PsA), and 5 enteropathy associated (eSpA) and their Uveitis (SUN classification).

Results: Patients with AS were male (67%) and HLA‐B27+ (84%) showing typical unilateral or alternating anterior Uveitis with sudden onset in 77%. Still, 23% (21) showed bilateral anterior Uveitis. In this subgroup females predominated with 55% . They were HLA‐B27+ in 80%.

Patients with uSpA were male (60 %) and HLA‐B27+ (82%), but only showed typical Uveitis in 58%. A higher number of other Uveitis subtypes was found: 27% showed bilateral anterior and 15% other Uveitis subtypes. Again there was a female predominance, without change in HLA‐B27 positivity (79%).

A different pattern was found in the PsA cohort, which was female (58%) and HLA‐B27 was infrequent. Here 25% of the patients had typical Uveitis, whereas 17% showed bilateral anterior and 58% other subtypes of Uveitis.

Patients with eSpA were female in 80%, and HLA B27 was less frequent (40%). None of the eSpA group had typical Uveitis, 80% a bilateral anterior and 20% other Uveitis subtypes.

Conclusions: The frequency of a “typical” Uveitis associated with SpA in our cohort varied from 77% to 0 %, decreasing from AS to eSpA. We saw a high number of other Uveitis subtypes, with a female predominance. Maybe women with SpA have a higher risk for atypical Uveitis.
Central corneal thickness and glaucoma in adult chinese. The Beijing eye study
Authors: JONAS JB , XU L , ZHANG H , WANG Y
Published: October 2007

Purpose: To evaluate whether glaucoma is related to central corneal thickness (CCT).

Methods: The Beijing Eye Study 2006 is a population‐based study including 3251 (73.3%) subjects (aged 45+ years) out of 4439 subjects who participated in the survey 2001 and who returned for re‐examination.

Results: Measurements of CCT were available for 3100 (95.4%) subjects. Glaucomatous optic nerve damage was detected in 77 (2.5%) subjects (“Optic Disc Glaucoma”), and 33 (1.1%) subjects showed “perimetric glaucoma”. CCT did not vary significantly (P>0.10) between “Optic Disc Glaucoma” (551.1±35.4μm), “Perimetric Glaucoma” (547.4±32.2μm), and the normal group (556.3±33.1μm). CCT was not significantly associated with neuroretinal rim area (P=0.30) or mean visual field defect as measured by frequency doubling perimetry (P=0.66). In multiple regression analysis, CCT was significantly associated with male gender (P<0.001; Odds ratio (OR): 5.67; 95% confidence intervals (CI): 3.44, 7.90), urban region (P<0.001; OR: 4.70; 95%CI:2,40,7.00) and intraocular pressure measurements (P<0.001; OR:4.31;95%CI:3.94, 4.69), while it was not significantly (P=0.17) associated with chronic pen‐angle glaucoma. In 126 (4.1%) ocular hypertensive subjects without glaucomatous optic disc abnormalities, mean CCT (582.1±34.4 μm) was significantly higher than in the normal group (P<0.001) and than in the glaucoma groups (P<0.001). During follow‐up from 2001 to 2006, 42 subjects showed a progression of, or development of glaucomatous abnormalities of the optic nerve head. The progressive subjects had slightly, not significantly (P=0.36;95%CI:‐27.4, 10.1), thicker corneas (554±35μm) than the stable subjects (545±36μm).

Conclusions: CCT may not be markedly different between glaucomatous eyes and normal eyes.
Calcium, the Universe and Everything
Authors: SANDERSON J
Published: October 2007

Calcium plays a pivotal role in lens physiology and pathophysiology. I will review research from the Norwich Eye Lab, which has been fundamental in establishing calcium and its function in the lens.

Human cortical cataract is associated with a loss of ionic homeostasis, with calcium overload a hallmark of this disease. Free calcium has also been found to increase in non‐cataractous human lenses as a result of aging, suggesting that it may be an early event in cataractogenesis. Lens organ culture experiments, using bovine and human lenses, have shown that calcium overload is indeed fundamental in loss of lens transparency. Raised intracellular calcium initiated proteolytic events both in the soluble (crystallin) fraction and the cytoskeletal fraction, supporting a role for the calcium‐activated protease calpain in the opacification process. In order to understand mechanisms of calcium overload, it is also important to understand the mechanisms of normal calcium homeostasis in the lens. This has been extensively studied, mainly in lens epithelial cells, with a particular emphasis on the role of the endoplasmic reticulum calcium store. Investigation of calcium signaling has, in addition to this, shown the lens to have a remarkable and diverse pharmacology, with functional expression of a plethora of receptors which signal via calcium including muscarinic receptors, purinoceptors and EGF receptors. Recent work in the lab has also extended this interest in calcium in the lens to other ocular cells types, where calcium signaling could have a role to play in other eye diseases such as retinal detachment and glaucoma.

Investigation of calcium in the lens has demonstrated a central role in the pathophysiology of cortical cataract. By understanding the molecular mechanisms underlying cataractogenesis we move closer to the development of pharmacological strategies for the treatment of this disease.
Physiological effects of vitrectomy and retinal laser treatment explain their clinical effects: Vitrectomy and laser treatment both affect retinal oxygenation and benefit ischemic retinopathies
Authors: STEFANSSON E
Published: October 2007

Clinical studies have established that retinal laser photocoagulation on one hand and vitrectomy on the other have a positive clinical effect on the development of diabetic retinopathy and other ischemic retinopathies. Both reduce retinal neovascularization and macular edema. The clinical effect of laser and vitrectomy is related to the physiological effect of these treatment modalities. Both improve retinal oxygenation, but through different mechanisms. Laser treatment destroys some of the photoreceptors, reduces the oxygen consumption of the outer retina and allows oxygen to diffuse from the choroid to the inner retina.

In vitreous surgery the viscous vitreous gel is replaced by low viscosity water. According to the Stokes‐Einstein equation viscosity is inversely related to the diffusion coefficient. Diffusion (and convection) of any substance is many times higher in water than vitreous gel, and this includes oxygen, growth factors and drugs. In the vitrectomized eye, oxygen diffuses more easily from well perfused to hypoxic areas of the retina. At the same time growth factors are cleared from the retina more rapidly than before and may indeed be transported to the anterior segment and produce iris neovascularization.

Laser and vitrectomy reduce retinal hypoxia and thereby reduce the production of hypoxia induced growth factors such as VEGF. Vitrectomy also clears VEGF away from the retina at a more rapid rate than when the vitreous gel is in place. VEGF and other growth factors influence both neovascularization and capillary permeability, and the latter influences the osmotic balance between blood and tissue and the osmotic arm of Starling´s law. In addition, improved oxygenation reduces the hypoxia‐induced vasodilatation and this decreases capillary blood pressure and reduces edema formation according to the hydrostatic arm of Starling´s law.

By understanding the physiological effects of laser and vitrectomy, we can understand the mechanism of the clinical effect. Classical laws of physiology and physics help complete the picture and give us an understanding of the nature of these treatment modalities and how they may be combined with other agents.

For details and references please see Stefánsson E: Survey of Ophthalmology 2006.
UK experience and evolving strategies to improve results I ‐ clinical results
Authors: PERERA S , OKERA S , TANDON R , HEROLD J , HULL C , THORP S , LIU C
Published: October 2007

Purpose: To report the long term results of osteo‐odonto‐keratoprosthesis (OOKP) surgery in the visual rehabilitation of patients with corneal blindness from end stage inflammatory ocular surface disease.

Methods: A non‐comparative retrospective interventional case series.

36 consecutive patients treated at the National OOKP referral centre in Brighton, United Kingdom, between November 1996 and March 2006.

Osteo‐odonto‐keratoprosthesis surgery performed in line with the Rome‐Vienna protocol.

Anatomical retention, visual acuity, retention of best attained visual acuity, visual field, complications resulting in anatomical or visual failure, de novo glaucoma rate.

Results: A total of 36 patients, with age ranging from 19 to 87 years (mean 51 ± 19 years), were included in the analysis. The main preoperative diagnoses were Stevens Johnson syndrome (n=16, or 44%), severe thermal or chemical burns (n=6, or 17%), and mucous membrane pemphigoid (n=5, or 14%). The remainder of the cases comprised miscellaneous causes of dry eye (n=9, or 25%), which included one each of graft versus host disease, ectodermal dysplasia, ionising radiation damage, cicatrising conjunctivitis from topical medication, trachoma, congenital trigeminal nerve hypoplasia, linear IgA disease, Sjogren’s syndrome, and nutritional deficiency. Follow‐up ranged from 6 months to nine years (mean 3.86 ± 2.45 years). Anatomical retention during the entirety of the follow‐up period was seen in 72% of patients. The main factor resulting in anatomical failure was resorption of the OOKP lamina, which occurred in seven cases (or 19%). Predicted resorption in three cases resulted in successful planned exchange of the lamina, but two cases underwent emergency removal of the OOKP, and two cases developed endophthalmitis. HLA matched allografts suffered a higher rate of laminar resorption. Out of the entire cohort, thirty patients (or 83%) had some improvement in vision, twenty eight (or 78%) achieved vision of 6/60 or better, and nineteen (or 53%) achieved 6/12 or better. The best‐achieved vision was retained throughout the follow‐up period in 61% of cases. Survival analysis suggested that the probability of retaining vision >6/60 five years after surgery was 53%±10%. Vision threatening complications occurred in 9 cases (or 25%), and included endophthalmitis, retinal detachment, and glaucoma. De novo glaucoma occurred in six patients (or 24%) but was seen overall in seventeen patients (or 47%), ten of whom required surgical treatment.

Conclusions: OOKP surgery can restore useful and lasting vision in patients suffering from end stage ocular surface disease, for whom conventional corneal surgery is not possible. The main problems seen in this study were laminar resorption, particularly in allografts, and glaucoma.
Advances in the Type I Boston Keratoprosthesis
Authors: COLBY K , DOHLMANN C
Published: October 2007

Purpose: To give an update on the Type I Boston keratoprosthesis (KPro).

Methods: We reviewed our recent experiences with the Type I Boston KPro with attention to design modifications, use in pediatric patients, post‐operative care and management of complications.

Results: The use of the Type I Boston KPro has increased dramatically since 2003, when only 57 of these devices were implanted. In 2006, more than 450 Type I Boston KPro’s were implanted worldwide. Recent modifications include a threadless front plate stem designed to reduce trauma to and maintain the health of the carrier corneal graft. The Type I Boston KPro appears to be a viable alternative to PK in children with corneal opacities and may simplify amblyopia management. Post‐operative care following Boston KPro placement remains critical, with availability of preserved vancomycin reducing the risk of endophthalmitis. Management of complications including cataract formation and retinal detachment following Boston KPro will be discussed.

Conclusions: The Type I Boston keratoprosthesis has shown continued acceptance among corneal surgeons throughout the world. Ongoing work at our institution aims to improve the utility of this device while minimizing complications from its use.
Boston KPro collaborative study results
Authors: BELIN MW
Published: October 2007

Purpose: To report the indications, practices, complications, and outcomes from the first multi‐center study on the Boston Type 1 Keratoprosthesis.

Methods: We analyzed 218 Boston Type 1 Keratoprosthesis surgical procedures, from 20 surgical sites, implanted from January 2003 through August 2007 in 210 eyes of 205 patients. Forms reporting seventy pre‐, intra‐, and post‐operative parameters were collected and analyzed at a central data collection site (Cornea Consultants of Albany, PLLC, Albany Medical College, Albany, NY). The main outcome measures were; Visual acuity and keratoprosthesis survival.

Results: Common preoperative diagnoses were graft rejection in 103 eyes (47%) (average prior grafts: 2.24), chemical injury (26 eyes, 12%), bullous keratopathy (34 eyes, 16%), and herpes simplex virus keratitis (12 eyes, 6%). Additionally, 100 eyes (46%) had preoperative glaucoma. Preoperative best‐corrected visual acuity ranged from 20/100 to light perception, and was less than 20/200 in 94% of eyes. At an average follow‐up of 9.4 months, postoperative vision improved to ≥ 20/200 in 63%. Among eyes at least 1 year postoperative (104 eyes), vision was ≥ 20/200 in 58% of eyes and ≥ 20/40 in 17%. At an average follow‐up of 9.4 months, graft retention was 96%. Severe visual loss or failure to improve from keratoprosthesis was usually secondary to comorbidities such as advanced glaucoma, macular degeneration, or retinal detachment.

Conclusions: The Boston Type 1 Keratoprosthesis seems to be a viable option after multiple failed corneal grafts or in some situations with a poor prognosis for primary penetrating keratoplasty.
Infection control in KPros
Authors: NOURI M
Published: October 2007

Purpose: To study Boston KPro‐related infections.

Methods: Retrospective review of case notes.

Results: Since 1990, 350 patients have undergone Boston Keratoprosthesis surgery. An analysis has been made of those affected by bacterial or fungal infections. The results will be presented.

Conclusions: Strategies to prevent and treat Boston KPro‐related ocular infections will be presented.
ACTA lecture: The retinal pigment epithelium, friend or foe?
Authors: LA COUR M
Published: October 2007

Purpose: To review the physiology and pathophysiology of the retinal pigment epithelium, RPE, with focus on some of the work of myself and my wonderful collaborators and students during the last 20 years.

Methods: In vitro studies of RPE preparations from frogs and of cultured human and porcine RPE cells. In vivo studies of experimental surgery in pigs using histopathology, immunohistochemistry and functional testing by multifocal electoretinograhpy.

Results: There are active fluid transport mechanisms in the RPE, which are capable of transporting water aganist an osmotic gradient. This has important bearings on the fundus appearance in states of macular oedema.

RPE cell physiology is dependent on the surface on which they grow, and the maturity of the cells. Older RPE cells are more stress resistant than younger RPE cells. This has important bearings on studies where cultured RPE cells are used to assess toxicity of substances used in the clinic.

In vivo RPE cells are non‐dividing under normal circumstances. Posterior injury to the epithelium induces proliferation of the peripheral, but not the posterior RPE. This indicates that a g zone of putative RPE stem cells might exist in the peripheral retina.

The functional consequences of experimental posterior RPE injury can be assessed by multifocal electroretinography

Conclusions: The RPE plays an important role in the normal physiology og the outer retina, as well as in the pathogenesis of retinal diseases. The development of animal models of RPE injury increase our understanding of the role of RPE in health and disease.
Intraperitoneal application of rituximab in refractory mantle cell lymphoma with massive ascites resulting in local and systemic response
Authors: Crysandt Martina , Neumann Britta , Das Marco , Engelbertz Vera , Bendel Michael , Galm Oliver , Osieka Rainhardt , Jost Edgar
Published: September 2007

In the past decade, rituximab in combination with polychemotherapy has become the standard approach in most patients with advanced CD20‐positive B‐cell lymphoma. In mantle cell lymphoma (MCL), follicular lymphoma and diffuse large B‐cell lymphoma, rituximab has been used as monotherapy and in combination with various chemotherapy regimens in different treatment situations. Routinely, rituximab is given intravenously, but other routes of administration have also been described. Here, we report a 64‐yr‐old woman who was previously treated with three different chemotherapy regimens for stage IV MCL. No sustained clinical and radiological response could be achieved. The patient’s general status declined and she developed massive ascites as the dominant clinical problem. Local, intraperitoneal administration of rituximab was initiated as an experimental treatment approach. After 11 doses of rituximab, the general status of the patient improved significantly, ascites resolved completely and computed tomography (CT) scans demonstrated a partial remission of intra‐abdominal lymph nodes and splenomegaly. Furthermore, we observed a regression of mediastinal lymph nodes, pleural effusion and centrocytes in peripheral blood as well as improvement of anaemia. The response to the experimental treatment has maintained for more than 6 months. In summary, we observed a sustained local and systemic response to intraperitoneal administration of rituximab in a patient with heavily pretreated advanced MCL.
Scope of practice, referral patterns and lesion occurrence of an oral medicine service in Australia
Authors: Farah CS , Simanovic B , Savage NW
Published: September 2007

Aim:  The purpose of this study was to examine the scope of practice, lesion occurrence and utilisation of referral‐based hospital and private practice oral medicine and oral pathology (OMP) services in Australia.

Materials and methods:  Clinical records of patients referred to a hospital (n=500) and private (nbequals;1104) OMP clinic were audited. For each patient, the following parameters were recorded: age, gender, source of referral, reason for referral, site of lesion/condition if applicable, medical and drug history, diagnostic services utilised, clinical and histopathological diagnoses rendered, medications prescribed and further treatment required.

Results:  A majority of the referrals were generated by general dental practitioners. The most commonly seen problems were epithelial hyperplasia/hyperkeratosis, oral candidosis, oral lichen planus, xerostomia, recurrent aphthous ulcers and burning mouth syndrome. OMP specialists requested diagnostic imaging for 13% of hospital and 9.42% of private patients, diagnostic biopsies were required for 18.4% of hospital and 19.3% of private patients, blood tests were ordered for 14.4% of hospital and 12.13% of private patients, while medications were prescribed for approximately 36% of hospital and 51% of private patients.

Conclusions:  This study is the first to detail the scope of practice, lesion occurrence and utilisation of services offered by OMP specialists in Australia. The demand for OMP services is strong.
Water Quality Changes as a Result of Coalbed Methane Development in a Rocky mountain Watershed1
Authors: Wang Xixi , Melesse Assefa M. , McClain Michael E. , Yang Wanhong
Published: September 2007

Abstract:  Coalbed methane (CBM) development raises serious environmental concerns. In response, concerted efforts have been made to collect chemistry, salinity, and sodicity data on CBM produced water. However, little information on changes of stream water quality resulting from directly and/or indirectly received CBM produced water is available in the literature. The objective of this study was to examine changes instream water quality, particularly sodicity and salinity, due to CBM development in the Powder River watershed, which is located in the Rocky Mountain Region and traverses the states of Wyoming and Montana. To this end, a retrospective analysis of water quality trends and patterns was conducted using data collected from as early as 1946 up to and including 2002 at four U.S. Geological Survey gauging stations along the Powder River. Trend analysis was conducted using linear regression and Seasonal Kendall tests, whereas, Tukey’s test for multiple comparisons was used to detect changes in the spatial pattern. The results indicated that the CBM development adversely affected the water quality in the Powder River. First, the development elevated the stream sodicity, as indicated by a significant increase trend of the sodium adsorption ratio. Second, the development tended to shrink the water quality differences among the three downstream stations but to widen the differences between these stations and the farthest upstream station. In contrast, the development had only a minor influence on stream salinity, as indicated by that the stream electrical conductivity exhibited either no trend or a marginally significant positive trend. Hence, the CBM development is likely an important factor that can be managed to lower the stream sodicity. The management may need to take into account that the effects of the CBM development were different from one location to another along the Powder River.
In Vitro Evaluation of the Activities of Telavancin, Cefazolin, and Vancomycin against Methicillin-Susceptible and Methicillin-Resistant
Staphylococcus aureus
in Peritoneal Dialysate
Authors: Clouse Frances L. , Hovde Laurie B. , Rotschafer John C.
Published: October 2007

This study compared the ability of telavancin to the ability of cefazolin and vancomycin to eliminate staphylococci from peritoneal dialysis fluid by using a static in vitro model to simulate the conditions of peritoneal dialysis. The results showed that telavancin exhibited statistically significantly better kill (
P
< 0.05) against both methicillin-susceptible and methicillin-resistant
Staphylococcus aureus
.
Frequency of Development and Associated Physiological Cost of Azithromycin Resistance in
Chlamydia psittaci
6BC and
C. trachomatis
L2
Authors: Binet Rachel , Maurelli Anthony T.
Published: October 2007

Azithromycin is a major drug used in the treatment and prophylaxis of chlamydial infections. Spontaneous azithromycin-resistant mutants of
Chlamydia psittaci
6BC were isolated in vitro in the plaque assay at a frequency of about 10
−8
. Isogenic clonal variants with A
2058
C, A
2059
G, or A
2059
C mutations in the unique 23S rRNA gene (
Escherichia coli
numbering system) displayed MICs for multiple macrolides (i.e., azithromycin, erythromycin, josamycin, and spiramycin) at least 100 times higher than those of the parent strain and were also more resistant to the lincosamide clindamycin.
Chlamydia trachomatis
L2 variants with a Gln-to-Lys substitution in ribosomal protein L4 at position 66 (
E. coli
numbering system), conferring an eightfold decrease in azithromycin and erythromycin sensitivities and a fourfold decrease in josamycin and spiramycin sensitivities, were isolated following serial passage in subinhibitory concentrations of azithromycin. Each mutation was stably maintained in the absence of selection but severely affected chlamydial infectivity, as determined by monitoring the development of each isolate over 46 h in the absence of selection, in pure culture or in 1:1 competition with the isogenic parent. Data in this study support the hypothesis that the mechanisms which confer high-level macrolide resistance in chlamydiae carry a prohibitive physiological cost and may thus limit the emergence of highly resistant clones of these important pathogens in vivo.
Diversity of
ndo
Genes in Mangrove Sediments Exposed to Different Sources of Polycyclic Aromatic Hydrocarbon Pollution
Authors: Gomes Newton C. Marcial , Borges Ludmila R. , Paranhos Rodolfo , Pinto Fernando N. , Krögerrecklenfort Ellen , Mendonça-Hagler Leda C. S. , Smalla Kornelia
Published: September 2007

Polycyclic aromatic hydrocarbon (PAH) pollutants originating from oil spills and wood and fuel combustion are pollutants which are among the major threats to mangrove ecosystems. In this study, the composition and relative abundance in the sediment bacterial communities of naphthalene dioxygenase (
ndo
) genes which are important for bacterial adaptation to environmental PAH contamination were investigated. Three urban mangrove sites which had characteristic compositions and levels of PAH compounds in the sediments were selected. The diversity and relative abundance of
ndo
genes in total community DNA were assessed by a newly developed
ndo
denaturing gradient gel electrophoresis (DGGE) approach and by PCR amplification with primers targeting
ndo
genes with subsequent Southern blot hybridization analyses. Bacterial populations inhabiting sediments of urban mangroves under the impact of different sources of PAH contamination harbor distinct
ndo
genotypes. Sequencing of cloned
ndo
amplicons comigrating with dominant DGGE bands revealed new
ndo
genotypes. PCR-Southern blot analysis and
ndo
DGGE showed that the frequently studied
nah
and
phn
genotypes were not detected as dominant
ndo
types in the mangrove sediments. However,
ndo
genotypes related to
nagAc
-like genes were detected, but only in oil-contaminated mangrove sediments. The long-term impact of PAH contamination, together with the specific environmental conditions at each site, may have affected the abundance and diversity of
ndo
genes in sediments of urban mangroves.
Sequential Aldol Condensation Catalyzed by Hyperthermophilic 2-Deoxy-
d
-Ribose-5-Phosphate Aldolase
Authors: Sakuraba Haruhiko , Yoneda Kazunari , Yoshihara Kumiko , Satoh Kyoko , Kawakami Ryushi , Uto Yoshihiro , Tsuge Hideaki , Takahashi Katsuyuki , Hori Hitoshi , Ohshima Toshihisa
Published: September 2007

Genes encoding 2-deoxy-
d
-ribose-5-phosphate aldolase (DERA) homologues from two hyperthermophiles, the archaeon
Pyrobaculum aerophilum
and the bacterium
Thermotoga maritima
, were expressed individually in
Escherichia coli
, after which the structures and activities of the enzymes produced were characterized and compared with those of
E. coli
DERA. To our surprise, the two hyperthermophilic DERAs showed much greater catalysis of sequential aldol condensation using three acetaldehydes as substrates than the
E. coli
enzyme, even at a low temperature (25°C), although both enzymes showed much less 2-deoxy-
d
-ribose-5-phosphate synthetic activity. Both the enzymes were highly resistant to high concentrations of acetaldehyde and retained about 50% of their initial activities after a 20-h exposure to 300 mM acetaldehyde at 25°C, whereas the
E. coli
DERA was almost completely inactivated after a 2-h exposure under the same conditions. The structure of the
P. aerophilum
DERA was determined by X-ray crystallography to a resolution of 2.0 Å. The main chain coordinate of the
P. aerophilum
enzyme monomer was quite similar to those of the
T. maritima
and
E. coli
enzymes, whose crystal structures have already been solved. However, the quaternary structure of the hyperthermophilic enzymes was totally different from that of the
E. coli
DERA. The areas of the subunit-subunit interface in the dimer of the hyperthermophilic enzymes are much larger than that of the
E. coli
enzyme. This promotes the formation of the unique dimeric structure and strengthens the hydrophobic intersubunit interactions. These structural features are considered responsible for the extremely high stability of the hyperthermophilic DERAs.
Evaluation of Postharvest-Processed Oysters by Using PCR-Based Most-Probable-Number Enumeration of
Vibrio vulnificus
Bacteria
Authors: Wright Anita C. , Garrido Victor , Debuex Georgia , Farrell-Evans Melissa , Mudbidri Archana A. , Otwell W. Steven
Published: September 2007

Postharvest processing (PHP) is used to reduce levels of
Vibrio vulnificus
in oysters, but process validation is labor-intensive and expensive. Therefore, quantitative PCR was evaluated as a rapid confirmation method for most-probable-number enumeration (QPCR-MPN) of
V. vulnificus
bacteria in PHP oysters. QPCR-MPN showed excellent correlation (
R
2
= 0.97) with standard MPN and increased assay sensitivity and efficiency.