bluuebunny/crossref_metadata_2025 huggingface dataset:
Corneal imaging after treatment in dystrophic eyes (OCT, CM)
Authors: Dobrowolski D.
Published: September 2016

In late follow‐up after lamellar or penetrating keratoplasty dystrophic corneas can develop again changes in the stroma. Advanced analysis of corneal morphology and morphometry based on OCT devices can predict such pathology. More specific imaging for early deposits delivers confocal microscopy. Analysis of corneal collagen layers, stromal keratinocytes and extracellular matrix deposits shows natural recurrence of the disease in transplanted cornea.
Update in graves’ orbitopathy
Authors: Ludgate M.
Published: September 2016

Thyroid eye disease or Graves’ orbitopathy (GO) is an autoimmune condition most common in people with hyperthyroid Graves’ disease (GD). GD is caused by thyroid stimulating antibodies which bind the thyrotropin receptor (TSHR). The TSHR is probably also implicated in GO since it is expressed in orbital fat, particularly during adipogenesis. GO is the result of tissue remodelling, mainly overproduction of extra‐cellular matrix and excess adipogenesis, which together produce proptosis. In vitro models have increased understanding of the signalling cascades regulating these processes and identified possible novel treatments. However progress in identifying the triggers of the autoimmune response is lacking but a possible role for the microbiome has been proposed. Hopefully recent developments, including a TSHR induced model of GO in mice, will help to address these issues.
Is glutamate dehydrogenase in astrocytes one of the keys to control brain glutamate homeostasis?
Authors: Waagepetersen H.
Published: September 2016

Brain glutamate concentration needs to be balanced to avoid excitoxicity. Following glutamatergic neurotransmission astrocytes are responsible for clearance of the synaptic cleft via glutamate transporters. In the astrocyte the conversion of glutamate to glutamine is an essential part of the glutamate‐glutamine cycle. But, a substantial amount of glutamate is oxidatively metabolized in the mitochondria, which to a large extent may be dependent on glutamate dehydrogenase (GDH). Thus, astrocytes are likely the main regulator of the brain glutamate concentration, but how do they do it? We have investigated the role of GDH in astrocytes with focus on energy and glutamate neurotransmitter homeostasis. We have used cultured astrocytes originating from CNS‐specific GDH1 knock‐out mice and cultures of astrocytes treated with siRNA against GDH. We find that an impaired GDH activity force glutamate to be only partially oxidized via the truncated TCA cycle and formation of another excitatory amino acid, aspartate. Astrocytes totally lacking GDH exhibit an increased glycolysis and impaired glucose oxidation, supporting that astrocytes are in a need for glutamate oxidation to sustain energy metabolism.
Correlations Fleischer deposits with topographic parameters at different deformations of the cornea
Authors: Anisimov S. , Anisimova S. , Mistrukov A.
Published: September 2016

Purpose

Assessment of topographic and tensor topographic maps of the patients and the analysis of their compliance with deposits Fleischer.

Methods

28 patients with disorders of the biomechanics of cornea after RK, PRK, TKC, LASIK, IOL implantation, as well as using the orto‐contact lenses and degenerative changes various stages of keratoconus. All patients complemented by photos recording Fleischer corneatopography deposits and then calculating stress distribution map of the cornea –keratotenzotopogramm (KTT).

Results

The correlation position Fleischer deposits with zones of maximum mechanical stress gradient in corneas with disabilities form as a result of various causes. Most obviously there Fleischer pigment deposits in the form of rings – after hyperopic LASIK. Position of Fleischer ring correlated with the area of corneal mechanical stress maximum gradient according keratotenzotopogramm

Conclusions

We are inclined to the hypothesis that Fleischer deposits are natural markers of corneal zone, which are activated in the past or have been active processes caused by excessive mechanical stress in the
cornea's stroma.
Unilateral painful external ophthalmoplegia as the first manifestation of combined anterior and posterior scleritis
Authors: Esteban O. , Ascaso J. , Idoate A. , Sanchez J.I. , Berniolles J. , Bartolomé I. , Cristobal J.A.
Published: September 2016

Purpose

Posterior scleritis (PS) is a rare form of ocular inflammation. It can be idiopathic or associated with systemic disorders in 40%–50% of cases. PS is characterized by several different clinical manifestations like severe pain especially during eye movements and in some cases decreased vision. It can include changes in choroid, retina and optic nerve and associate anterior scleritis. We present a case of unilateral painful ophthalmoplegia as the first manifestation of combined anterior and posterior scleritis.

Methods

An otherwise healthy 55‐year‐old man complained with acute diplopia and painful ophthalmoplegia in his left eye. Findings on examination were conjunctival quemosis, moderate hyperemia and limitation of ocular movements in all directions. Best‐corrected visual acuity (BCVA) was 20/20 in both eyes. Goldmann applanation intraocular pressure was 18 mmHg in right eye and 28 mmHg in left eye. Fundus examination was normal. Contrast‐enhanced CT scan showed marked anterior and posterior scleral thickening of the left eye. In the systemic examination, routine blood tests, autoimmune and infectious markers were normal.

Results

Treatment was initiated with oral prednisolone 1 mg/kg/day. After 7 days, the patient′s signs and symptoms had improved. Following one month of treatment scleritis had disappeared. One year later, the patient is asymptomatic without any recurrences.

Conclusions

Opthalmologist should be aware of the possibility of a misdiagnosed posterior scleritis in a patient with clinical settings of anterior scleritis like diplopia or ophthalmoplegia.
The immunohistochemical identification and localization of homocysteine in the human retina with the features of age related macular degeneration
Authors: Ozimek M. , Chorągiewicz T. , Junemann A. , Rejdak R.
Published: September 2016

Purpose

The purpose of this study was to determine the presence of homocysteine within the human retina with the features of age related macular degeneration.

Methods

Immunohistochemistry was performed using anti‐homocysteine rabbit polyclonal antibodies on sections of 7 human eyes enucleated because of the choroidal malignant melanoma.

Results

Homocysteine immunoreactivity was found in humane retina. It was present in soft drusen, basal deposits and RPE presenting abnormal morphology. Hard drusen presented no staining.

Conclusions

The presence of homocysteine in the human retina with the features of age related macular degeneration suggest that it may be involved in the pathogenesis of this eye disease.
Melissa officials L. extracts protect human retinal pigment epithelial cells against oxidative stress‐induced apoptosis.
Authors: Kang S. , Shin J.A. , Oh J. , Rho C.R.
Published: September 2016

Purpose

We evaluated the protective effect of ALS‐L1023, an extract of Melissa officinalis L. (Labiatae; lemon balm) against oxidative stress‐induced apoptosis in human retinal pigment epithelial cells (ARPE‐19 cells).

Methods

ARPE‐19 cells were incubated with ALS‐L1023 for 24 h and then treated with hydrogen peroxide (H2O2). Oxidative stress‐induced apoptosis and intracellular generation of reactive oxygen species (ROS) were assessed by flow cytometry. Caspase‐3/7 activation and cleaved poly ADP‐ribose polymerase (PARP) were measured to investigate the protective role of ALS‐L1023 against apoptosis. The protective effect of ALS‐L1023 against oxidative stress through activation of the phosphatidylinositol 3‐kinase/protein kinase B (PI3K/Akt) was evaluated by Western blot analysis.

Results

ALS‐L1023 clearly reduced H2O2‐induced cell apoptosis and intracellular production of ROS. H2O2‐induced oxidative stress increased caspase‐3/7 activity and apoptotic PARP cleavage, which were significantly inhibited by ALS‐L1023. Activation of the PI3K/Akt pathway was associated with the protective effect of ALS‐L1023 on ARPE‐19 cells.

Conclusions

ALS‐L1023 protected human RPE cells against oxidative damage. This suggests that ALS‐L1023 has therapeutic potential for the prevention of dry age‐related macular degeneration.
Effects of histone acetylation on superoxide dismutase 1 gene expression in the pathogenesis of senile cataract
Authors: Qiu X. , Rong X. , Jiang Y. , Li D. , Lu Y.
Published: September 2016

Purpose

Histone acetylation plays key roles in gene expression, but its effects on superoxide dismutase 1 (SOD1) expression in senile cataract remains unknown. To address this problem, the study was to investigate the influence of histone acetylation on SOD1 expression and its effects in the pathogenesis of senile cataract.

Methods

Senile cataract was classified into three types – nuclear cataract (NC), cortical cataract (CC), and posterior subcapsular cataract (SC) – using the Lens Opacities Classification System III. Anterior lens capsule samples of cataract patients were obtained by continuous curvilinear capsulorhexis during cataract surgery. The intact lenses of normal New Zealand rabbits and B‐3 HLECs were also cultured for intervene experiment. Western blot assay, quantitative real‐time PCR, chromatin immunoprecipitation (CHIP)‐PCR assay, immunofluorescence, CCK‐8 and flow cytometry were applied to investigate the influence of histone acetylation on SOD1 expression.

Results

In senile cataracts, SOD1 expression decreased significantly. Both H3 and H4 were deacetylated at −600 bp of the SOD1 promoter of cataract lenses, and hypoacetylated at −1,500, −1,200, and −900 bp. In hypoacetylated histones, the hypoacetylation pattern differed among the cataracts. In vitro, anacardic acid (AA) significantly reduced H3 and H4 acetylation at the SOD1 promoter, decreased protein expression, and induced cataract formation in rabbits. AA also inhibited HLEC viability and increased cell apoptosis. In contrast, trichostatin A (TSA) was able to efficaciously stop AA's effects on both rabbit lenses and HLECs. Decreased histone acetylation at the SOD1 promoter is associated with declined SOD1 expression in senile cataracts.

Conclusions

Histone acetylation plays an essential role in the regulation of SOD1 expression and in the pathogenesis of senile cataracts.
Anti‐VEGF therapies for retinal vein occlusion: real‐world outcomes of a Portuguese multi‐center study
Authors: Sousa Neves F. , Ribeiro L. , Barata A. , Ruão M. , Matos R. , Vaz‐Pereira S. , Flores R.
Published: September 2016

Purpose

We aim to characterize real‐world treatment patterns in patients with retinal vein occlusion (RVO) treated with anti‐VEGF in Portugal and evaluate the visual acuity and tomographic outcomes.

Methods

Retrospective, observational multicenter study of Portuguese patients with center‐involving macular edema secondary to RVO treated with anti‐VEGF as primary treatment and with a follow‐up of 12‐months. Hemiretinal vein occlusion was analyzed within the BRVO group.

Results

Two hundred eyes were analyzed: 62% with BRVO and 38% with CRVO; 50% of patients were male and the mean age was 69 years. The median visual acuity (VA) gain was maximal at 6 months: −0.2 logMar (2‐line gain) and −0.1 logMar (1‐line gain) for the BRVO and CRVO groups respectively. This improvement was maintained throughout the follow‐up (p < 0.05 in 0–6 and 0–12 months period in both groups). The central macular thickness (CMT) decreased from 535 to 333 μm at 6 months in the BRVO group and from 693.5 to 404 μm in the CRVO group. At 12 months no further improvement was seen (p < 0.05 in 0–6 months period and in 0–12 months period in both groups). The mean change of CMT was not statistically different between groups in neither time point. The median number of injections was 3 in the first 6 months and 1 in the following six in both groups. A better VA outcome was associated with younger age, higher initial VA and a lower baseline CMT in both groups (p < 0.05).

Conclusions

Real‐world outcomes of anti‐VEGF treatment for RVOs are usually worse than those obtained in the landmark clinical trials in functional and morphological parameters. This could be due to less intense treatment but also because clinical trials usually exclude patients with poor baseline characteristics. Our results are in accordance with other real‐life studies and confirm a better prognosis of BRVO in comparison with CRVO.
Retinal microangiopathy as primary manifestation of systemic lupus erythematosus
Authors: Almenara C. , Núñez E. , Ascaso F. , Pérez I. , Martínez M. , Esteban O. , Sánchez J.I. , Idoate A. , Bartolomé I. , Berniolles J. , Cristóbal J.Á.
Published: September 2016

Purpose

Systemic lupus erythematosus (SLE) is a complex connective tissue disorder that involves multiple organs, including several opththalmic structures. The prevalence of retinopathy ranges from 3 to 29% and the autoimmune process affects the retina in two ways, directly by deposition of immune complexes and indirectly by arterial hypertension secondary to renal involvement. Although uncommon, ocular manifestations can precede systemic features, and their early diagnosis is the key to successful and better prognosis.

Methods

We present a case of retinal microangiopathy as primary manifestation of systemic lupus erythematosus (SLE). The patient is a 37‐years old woman, who presented at the Emergency department with a 24‐h history of floaters in her right eye (RE). Systemic review revealed arthralgias for the past 6 months. Best‐corrected visual acuity (BCVA) was 20/20 in both eyes. Pupillary reflexes, slit‐lamp biomicroscopy examination and Goldmann applanation intraocular pressure (IOP) were normal. Fundus examination showed bilateral dot haemorrhages and cotton wool spots. Spectral‐domain optical coherence tomography (SD‐OCT) and fluorescein angiography were also normal.

Results

Blood investigations revealed anemia, leucopenia and thrombocytopenia, without any affectation of renal function. Based on the clinical findings and serology results, a diagnosis of SLE was made. The patient was treated with intravenous methylprednisolone followed by oral prednisolone which was then gradually tapered. Retinal signs resolved two months following treatment.

Conclusions

This case illustrates that retinopathy can be a primary presenting manifestation in a SLE patient who is apparently healthy.
A review of intraocular foreign body injuries and their management in the Palestinian territories 2000–2009
Authors: Kanavati S. , Almuhtaseb H. , Sargent N. , Kanawati C.
Published: September 2016

Purpose

To review the causes, management and outcomes of intraocular foreign body (IOFB) injuries presenting to St. John's Eye Hospital in Jerusalem between January 2000‐ December 2004 and Dr Kanawati Eye Centre in the Palestinian Territories between May 2006–September 2009.

Methods

Retrospective review of medical records of patients who underwent surgical treatment for IOFB injuries. Rubber bullet injuries and enucleation/evisceration as a primary repair were excluded.

Results

51 eyes of 49 patients (46 males & 3 females) underwent surgical removal of IOFB. Mean age was 26 years (range 5–62). 33 eyes (65%) were due to Hammering without protective goggles and 88% were due to Metallic IOFB. 38 eyes (75%) underwent pars plana vitrectomy with 20 (39%) had lensectomy, intraocular lens 14 (27%), endolaser/indirect laser/cryotherapy 31 (61%), explant 10 (20%), internal tamponade 23 (45%), membrane peel 3 (6%) and intravitreal antibiotics and/or steroids 19 (37%). 8 eyes (16%) had IOFB removed from anterior chamber and transcleral approach in 2 eyes (4%). Visual acuity (VA) at presentation varied with (61%) having Snellen 6/60 or worse. Postoperatively, 35% had 6/6–6/9, 10% had 6/12–6/18, 8% had 6/24–6/36 and 29% had 6/60 or worse. Causes of poor visual outcome were due to retinal detachments (40%) and macular pathology (33%). The remaining 27% were due to endophthalmitis, phthisis, copper‐related panophthalmitis and suprachoroidal haemorrhage.

Conclusions

IOFB injuries are an important cause of blindness in the Palestinian Occupied Territories. Factors leading to poor visual outcome include IOFB material, poor presenting VA and the presence of vitreoretinal complications due to late presentation. Not only do these injuries affect manual labour workers, but also affect both adults and children as a result of military trauma.
Functional end‐arterial circulation of the choroid assessed by using fat embolism and electric circuit simulation
Authors: Lee J.E. , Ahn K.S. , Park G.H. , Kim H.J. , Kim H.W. , Chung I.Y. , Byon I.S. , Park S.W.
Published: September 2016

Purpose

To investigate the choroidal circulation using the fat embolism model and electric circuit simulation.

Methods

Experimental fat embolism was induced by infusing triolein emulsion into the internal carotid artery in cats. Video fluorescein angiography was recorded. The observations were interpreted by using a custom software developed to simulate the choriocapillaris as a schematic electric circuit; electric current for blood flow, voltage for intravascular pressure, and electric resistance for vascular resistance. A dual‐layered hexagon was designed to represent the choriocapillaris lobule. The anode and cathodes were connected to the center and periphery of each hexagon, representing the terminal arteriole and draining venules, respectively. Disconnecting the anode simulated choroidal embolism.

Results

Perfusion defects were observed in two categories. In the scatter perfusion defects suggesting an embolism at the terminal arterioles, fluorescein dye filled the non‐perfused lobule slowly from the adjacent perfused lobule. In the segmental perfusion defects suggesting occlusion of the posterior ciliary arteries, the hypofluorescent segment became perfused by spontaneous resolution of the embolism without subsequent smaller infarction. The findings could be simulated with an electric circuit. Although electric currents flowed to the disconnected hexagon, the level was very low compared with that of the connected ones.

Conclusions

The choroid appeared to be composed of multiple sectors with no anastomosis to other sectors, but to have its own anastomotic arterioles in each sector. Blood flows through the continuous choriocapillaris bed in an end‐arterial nature functionally to follow a pressure gradient due to the drainage through the collector venule.
The 1 year outcome of intravitreal dexamethasone implant for macular edema secondary to central retinal vein occlusion
Authors: Kim H.W. , Chung I.Y. , Lee J.E. , Kim K.
Published: September 2016

Purpose

To evaluate 1‐year outcome of intravitreal dexamethasone implant in macular edema secondary to central retinal vein occlusion (CRVO).

Methods

A medical records was reviewed retrospectively for 22 patients (22 eyes) with macular edema secondary to central retinal vein occlusion. All of them were treated with intravitreal dexamethasone implant twice a year and followed up at least 1‐year from the first dexamethasone implant injection. The best‐corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) was measured at every 2 months after the first injection. Adverse effects including cataract formation, elevation of IOP were analyzed.

Results

Mean age was 64.3 ± 9.5. Mean injection number was 2.4 ± 0.6 and interval between first and second injection was 22.0 ± 6.4 weeks. Additional treatments were performed with 11 patients (50%), bevacizumab in 9 and triamcinolone acetonide in 2. Mean BCVA (logMAR) was 0.79 ± 0.49 at pre‐injection and 0.72 ± 0.62 at 1 year. BCVA change was not significant (p = 0.638). But there was significant BCVA increase at 2, 4, 6 month after first injection (p < 0.001). The number of patients who improved in BCVA was 10 (45.5%) at 1 year. Mean CMT at baseline was 627.3 ± 149.7 μm and 458.4 ± 139.0 μm at 1 year, significant decrease compared to baseline (p < 0.001). In subgroup analysis, Hypertension (HTN) group showed significant improvement in BCVA and CMT compared to non‐HTN group (p = 0.044; BCVA, p = 0.005; CMT). Ischemic group represented significant decrease at CMT (p < 0.001). Elevated intraocular pressure was observed in 6 eyes (27.3%). Cataract formation was in 3 eyes (13.6%).

Conclusions

Intravitreal dexamethasone implant was effective in stabilizing visual acuity and reduction of macular edema in patients with macular edema secondary to central retinal vein occlusion.
Are Currently Available Tests Satisfactory for Color Vision Assessment?
Authors: Işık M. , Özcerit A.T. , Erdurmuş M. , İnam O.
Published: September 2016

Purpose

We aimed to investigate the ophthalmologists’ color vision test usage habits and thoughts on whether it meets the needs of their demands in clinical practice.

Methods

A 8‐item questionnaire was applied to ophthalmologists who have interested in color vision tests in daily practice. The questionnaire was applied to the participants through face to face fashion or by mail.

Results

A total of 70 participants (50 male, 20 female) with a mean age of 36.8 years were completed the questionnaire. Mean professional experience of the participants was 9.6 years. Almost all of the participants (97%) were using Ishihara pseudoisochromatic plates in daily clinical practice. The Farnsworth‐Munsell 100 hue test was preferred by only 2 (3%) ophthalmologist. However, 84.3% of the participants believe that Ishihara pseudoisochromatic plates do not meet their needs at least partially. Seventy four percent of ophthalmologist (n = 52) thought that there is a need for new color vision test providing more detailed data of the subjects.

Conclusions

Most of the ophthalmologists still use Ishihara pseudoisochromatic plates for color vision assessment in their routine practice. However, they thought that it does not meet their needs and believe that a new computer based color vision test is essential for the detailed examination of the patients with color vision deficiency.
Surgical outcome of minimal resection with full thickness rotating suture technique for lower lid epiblepharon
Authors: Jeong H.C. , Sohn E.J. , Kwon Y.H. , AHN H.
Published: September 2016

Purpose

To introduce the minimal skin & orbicularis oculi muscle resection with full thickness rotating suture technique for lower lid epiblepharon and its surgical outcome.

Methods

A retrospective review of The medical records was performed on lower lid epiblepharon patients who were followed for more than 6 month following surgical correction performed between January 2004 and December 2015 were retrospectively reviewed. All surgeries were performed by one surgeon using minimal skin & orbicularis oculi muscle resection and the full thickness rotating suture technique for the lower lid epiblepharon correction.

Results

A total of 943 lower lid epiblepharon patient (403 male, 540 female) records were included in the analysies. The mean patient age was 6.7 ± 2.4 years, and the mean postoperative follow‐up was 12.9 ± 7.2 months. Eyelid shape and function were well maintained in 904 patients (95.9%), with no recurrence during the follow‐up. Among the recurrent cases (39 patients [4.1%]), 19 patients (2%) underwent a second correction surgery.

Conclusions

The minimal skin & orbicularis oculi muscle resection with full thickness rotating suture technique for lower lid epiblepharon showed good surgical outcome with few complications and high success rate.
Gene transfer of prolyl hydroxylase domain 2 inhibits hypoxia‐inducible angiogenesis in a model of choroidal neovascularization
Authors: Andre H. , Mammadzada P. , Tunik S. , Takei A. , Ekström M. , Yu M. , Aronsson M. , Kvanta A.
Published: September 2016

Purpose

Cellular responses to hypoxia are mediated by the hypoxia‐inducible factors (HIF). In normoxia, HIF‐α proteins are tightly regulated by a family of dioxygenases, both by proteasomal‐mediated degradation and transcriptional inactivation. In hypoxic conditions, the dioxygenases become inactive and allow formation of HIF transcription factor, responsible for the upregulation of a myriad of target genes. In ocular neoangiogenic diseases, such as neovascular age‐related macular degeneration (nAMD), the role of ischemia and hypoxia is associated with progression of choroidal neovascularization. Here, we investigate the effects of HIF‐regulating proteins on the hypoxia pathway in retinal pigment epithelium (RPE) cells, critically involved in nAMD pathogenesis.

Methods

ARPE‐19 cells were transfected with HIF‐regulating proteins. In vitro angiogenesis was assayed in human retinal and choroidal endothelial cells. In vivo analysis of the effects of HIF‐regulating proteins was determined in mouse models of iris and choroidal induced angiogenesis.

Results

Our previous results have associated HIF expression in RPE cells to CNV progression. Our data indicates that, in ARPE‐19 cells, prolyl hydroxylase domain (PHD)2 is the most potent negative‐regulator of the HIF pathway. Furthermore, the negative effects of PHD2 on the hypoxia pathway were associated with decreased HIF‐1a protein levels, and concomitant decrease in secreted VEGF by these cells. Consequently, ARPE‐19 cells stably expressing PHD2 impaired angiogenesis in endothelial cells, both in vitro and in vivo. Gene transfer of PHD2 in vivo resulted in mitigation of HIF‐mediated angiogenesis in a mouse model of nAMD.

Conclusions

These results may have implications for the clinical treatment, particularly regarding the use of gene therapy to negatively regulate neoangiogenesis present in nAMD patients.
Evolution of spectral‐domain optical coherence tomography images in an acute stage of Vogt‐Koyanagi‐Harada disease
Authors: Almenara Michelena C. , Ascaso F.J. , Núñez E. , Martínez M. , Pérez I. , Esteban O. , Idoate A. , Sánchez J.I. , Bartolomé I. , Berniolles J. , Cristóbal J.Á.
Published: September 2016

Purpose

Vogt‐Koyanagi‐Harada (VKH) disease is a rare granulomatous inflammatory disorder that affects pigmented structures, such as eye, inner ear, meninges, skin and hear. It is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA‐DRB1*0405 allele. The disease has an acute onset of bilateral blurred vision preceded by flu‐like symptoms. Prompt diagnosis followed by early, aggressive and long‐term treatment with high‐dose corticosteroids is critical for a good visual prognosis.

Methods

We present a case of a 55‐year‐old woman with a 12‐h history of bilateral central blurred vision accompanied with oppressive headache for the past 5 days. Best‐corrected visual acuity (BCVA) was counting fingers in both eyes. Slit‐lamp biomicroscopy evaluation and Goldmann applanation intraocular pressure (IOP) were normal.

Results

Funduscopic examination and spectral‐domain optical coherence tomography (SD‐OCT) revealed bilateral optic disc swealling and multiple focal areas of exudative retinal detachment, including macular detachment. Combined with cerebrospinal fluid pleocytosis, this patient was diagnosed with VKH disease and was treated with intravenous methylprednisolone followed by oral prednisolone which was then gradually tapered. SD‐OCT were performed upon initial presentation and at 5‐days and 1‐month follow‐up. Retinal signs resolved two months following treatment and BCVA was 20/25 in both eyes.

Conclusions

Focal areas of subretinal fluid are usually present at the beginning of VKH disease. SD‐OCT has a significantly importance in the early detection of these areas and follow‐up of the disease.
Spironolactone in the treatment of nonresolving central serous chorioretinopathy: a comparative analysis
Authors: Lee J.Y. , Kim D.Y. , Kim J.Y.
Published: September 2016

Purpose

To evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, for naïve and nonresolving central serous chorioretinopathy.

Methods

A retrospective chart review was conducted of all central serous chorioretinopathy patients at one center treated with spironolactone (50 mg once a day) or observation. Thirty eyes of 30 patients with central serous chorioretinopathy and persistent subretinal fluid (SRF) for at least 8 weeks were enrolled. Patients were followed at monthly intervals with examination and optical coherence tomography. The primary outcome measure was the changes in SRF thickness from baseline to the apex of the serous retinal detachment. Secondary outcome included the best‐corrected visual acuity (BCVA).

Results

The mean duration of central serous chorioretinopathy before enrollment in study eyes was 11.13 ± 2.40 weeks. Spironolactone demonstrated statistically significant visual acuity improvement (0.12 ± 0.09) and SRF reduction (273.07 ± 71.16 μm) at 3 months compared to baseline (0.25 ± 0.17, p = 0.003; 432.57 ± 108.99 μm, p = 0.001, respectively). Eight of the 14 patients with spironolactone had complete resolution of SRF at 3 months, compared to six of the 16 patients under observation (p = 0.377). Data analysis showed a statistically significant improvement in SRF and visual acuity in spironolactone treated eyes as compared with the same eyes under observation (p = 0.043, p = 0.047, respectively). There were no complications related to treatment observed.

Conclusions

In naïve eyes with persistent SRF due to central serous chorioretinopathy, spironolactone had a positive effect in the reduction of SRF and recovery of visual acuity.
Surgical Effect of Medial Rectus Posterior pulley fixation in Esotropia greater at near fixation
Authors: Choi H.Y. , Jeon H.
Published: September 2016

Purpose

To determine the surgical effect of medial rectus posterior pulley fixation in esotropia greater at near fixation.

Methods

Medical records of consecutive patients who underwent medial rectus posterior pulley fixation for esotropia greater at near fixation and followed up at least 1 year were reviewed retrospectively. Surgical success was defined as orthotropic or ≤8 prism diopters (PD) esotropia at distance at 1 year after surgery. Preoperative and postoperative deviation, distance‐near disparity and the sensory status were evaluated. Stereoacuity was measured with Titmus test and normal stereoacuity was defined as ≤100 arc sec at one year after surgery.

Results

Sixteen patients were included the study. The mean age at surgery was 6.29 ± 2.17 years (range 3.00–9.92) and mean follow up period was 18.8 ± 4.79 months (range 12.00–27.00). Preoperative angle of deviation was 23.31 ± 12.37 PD at distance, 33.81 ± 10.95 PD at near and distance‐near disparity was 10.50 ± 4.77 PD. Twelve patients underwent bilateral medial rectus recession and 4 underwent unilateral medial rectus recession. Fourteen (85.8%) patients achieved surgical success and 2(14.2%) patients were undercorrected. The mean distance‐near discrepancy was 5.81 ± 4.48 PD at 1 year after surgery, which was significantly decreased (p = 0.018, Wilcoxon signed ranked test). Normal stereoacuity at near fixation was achieved in 10 (32.5%) patients at 1 year after surgery.

Conclusions

Medial rectus posterior pulley fixation may be the effective method in esotropia greater at near fixation.
Strabismus in Children with Periventricular leukomalacia: MRI correlation
Authors: Choi H.Y. , Jeon H.
Published: September 2016

Purpose

To investigate the correlation between strabismus and the severity of PVL based on magnetic resonance imaging (MRI) findings. Although strabismus is commonly associated with periventricular leukomalacia (PVL), its clinical features are not well established.

Methods

In this cross‐sectional study, 73 consecutive patients who visited the Department of Ophthalmology and were diagnosed with PVL were included. The severity of PVL was graded based on the MRI findings of the patients. All of the patients underwent complete ophthalmic examination, and strabismus was characterized in terms of direction, constancy, and angle of deviation. The prevalence and the characteristics of strabismus and their correlation with the grade of PVL were investigated.

Results

The perinatal characteristics did not differ between different grades of PVL. Refractive errors, found in 56 (76.7%) patients, did not differ between the grades of PVL either. Strabismus was observed in 38 (52.1%) patients, and its prevalence increased with the grade of the disorder; 20 patients had exotropia and 18 had esotropia. Constant strabismus was found more frequently in patients with higher grade PVL. However, the direction and angle of deviation did not differ depending on the grade of PVL.

Conclusions

The prevalence of strabismus was higher among patients with PVL than among healthy individuals and increased with the severity of PVL. The severity of PVL might be related to the presence and constancy of strabismus. Early ophthalmic evaluation is necessary in children with PVL, especially in those with higher grades of the disease.
Relationship between visual outcomes and initial optical coherence tomographic findings in macular edema secondary to branch retinal vein occlusion after bevacizumab treatment
Authors: Kwon Y.H. , Kim S.T. , Ahn H.
Published: September 2016

Purpose

To investigate the relationship between initial spectral‐domain optical coherence tomographic (SD‐OCT) features in macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and visual acuity (VA) at 1 year after intravitreal bevacizumab (IVB) treatment.

Methods

Patients diagnosed with ME secondary to BRVO and treated with IVB with 1 year follow up time were reviewed retrospectively. The presence of diffuse ME, cystic ME, disruption of the photoreceptor IS/OS junction (IS/OS disruption), serous retinal detachment (SRD) and epiretinal membrane (ERM) was evaluated and, central macular thickness (CMT), maximal central retinal height (MCRT) and sum of maximal retinal heights in five lines (5‐sum) were measured on initial SD‐OCT images. The patients were divided into two group; improved in visual acuity at 1 year after treatment (Group 1) and not improved (Group 2). Statistical analysis was done to evaluate the relationship between OCT findings and group division.

Results

49 patients (49 eyes) was enrolled in this study. 27 patients were in Group 1, 22 patients were in group 2. There was no significant difference of sex ratio, age and mean VA at initial visit between Group 1 and 2. It was found that the risk of being included in Group 2 increased approximately 5‐fold in the presence of diffuse ME, but IS/OS disruption, SRD, and ERM did not show a statistically significant relationship with improvement in VA. Initial VA and 5‐sum were significantly correlated with final VA. However, age, CMT, and MCRT had no statistically significance with final VA.

Conclusions

This study suggests that initial SD‐OCT findings and the measurements of patients with ME secondary to BRVO can be useful for predicting the visual outcome after IVB treatment. Initial VA, presence of diffuse ME and sum of maximal retinal heights in five lines were related with visual outcome.
Comparison between Aflibercept, Ranibizumab intravitreal injection on Neovascular Age‐related macular degeneration patients
Authors: Kwon Y.H. , Min J.S. , Ahn H.
Published: September 2016

Purpose

To investigate the difference of optical coherence tomography (OCT) findings between aflibercept treatment group and ranibizumab treatment group.

Methods

This study include 63 patients (n = 63 eyes) diagnosed with treatment‐naïve neovascular AMD, and they were treated with aflibercept or ranibizumab monthly for 3 months. We compared the changes of the two groups between before the treatment and after the treatment with optical coherence tomography (OCT) findings such as serous pigment epithelium detachment, fibrovascular pigment epithelium detachment, subretinal fluid, intraretinal fluid, dense zone of outer retina, classic neovascularization, and hyper‐reflective dots. And we also compared the changes of BCVA and IS/OS length, ELM length, central foveal thickness with optical OCT between the two groups.

Results

There were no significant differences between two groups before each treatments. Serous pigment epithelium detachments were disappeared 36% in aflibercept group, 5% in ranibizumab group, and there was significant difference between the two groups (p = 0.021). There was no significant changes such as BCVA change, OCT finding changes except for serous pigment epithelium detachment between the two groups.

Conclusions

For treatment of neovascular AMD patients, aflibercept might be more effective in serous pigment epithelium detachment than ranibizumab. Because there was no significant visual acuity improvement in serous pigment detachment improvement group in both two treatments, it might be necessary to study further about relationship between visual acuity and serous pigment detachment improvement.
Comparison of perceptual eye positions among patients with different degrees of anisometropia
Authors: Zeng J. , Yang C. , Yang X. , Yan L.
Published: September 2016

Purpose

To compare the perceptual eye positions among patients with different degrees of anisometropia.

Methods

157 patients were recruited and devided into 3 groups according to the spherical equivalent (SE) difference between two eyes: group A with anisometropia>2.50D, group B with anisometropia>1.00D and ≤2.50D, group C with anisometropia ≤1.00D. The degree of refractive errors in presence of astigmatism was converted into the degree of spherical equivalent. We compared the vertical and horizontal perceptual eye positions among the three groups, using polarized monitor and three‐dimension (3D) polarized glasses. The results were recorded and statistically analyzed by SPSS19.0.

Results

Group A included 32 patients, aged (14.51 ± 9.50) years old; group B included 37 patients, aged (15.52 ± 9.61) years old; group C included 88 patients, aged (15.03 ± 9.73) years old. There was no significant difference in age among the three groups. The SE differences between two eyes were as follows: group A (5.04 ± 2.92) D, group B (1.48 ± 0.40) D, group C (0.31 ± 0.28) D. The average vertical perceptual eye position pixels were (13.84 ± 13.87) in group A, (6.51 ± 7.19) in group B and (7.60 ± 9.26) in group C. There were significant differences between group A and group B (p < 0.05), group A and group C (p < 0.05), while no significant difference between group B and group C (p > 0.05). The average horizontal perceptual eye position pixels were (62.78 ± 94.81) in group A, (42.37 ± 55.96) in group B and (47.90 ± 56.18) in group C. There was no significant difference among the three groups (p > 0.05).

Conclusions

There was obvious deviation in vertical perceptual eye position in patients with anisometropia>2.50D, indicating that the unstability of vertical perceptual eye position might be a critical factor for the development of anisometropia.
Cyberknife treatment in adenoid cystic carcinoma of the lacrimal gland
Authors: Tunc M. , Guney Y.
Published: September 2016

Purpose

To determine the effectiveness of Cyberknife radiotherapy in Adenoid Cystic Carcinoma of the lacrimal gland.

Methods

Five patients with pathologically proven adenoid cystic carcinoma of the orbit were included in our study. All received 1–2 sessions of Cyberknife treatement in between 1–5 fractions after surgical resection of the tumor. Clinical characteristics and outcome of treatment were discussed in depth.

Results

All patients except one case were under 25 years old at diagnosis. Bone involvement was present in four cases. Tumor was removed as much as possible in all cases. All patients received additional cyberknife radiotherapy for the residual tumor. Tumor recurrence was seen in four cases and additional surgical resection was required in all. Additional second session Cyberknife was applied in two cases. One of these two developed radiation induced keratopathty, none developed radiation retinopathy.

Conclusions

Cyberknife radiotherapy is an effective and repeatable method in adenoid cystic carcinoma of the orbit.
Orbital mucocele: Orbital Masquarading Syndrome
Authors: Tunc M.
Published: September 2016

Purpose

To discuss the clinical features and management in orbital mucucele.

Methods

Six patients who were presented with progressive proptosis and orbital mass were included in our analysis. One patient had a history of gastric cancer, one patient had a history of previous trauma. All patients underwent surgery and excisional biopsies for differential diagnosis. The pathological diagnosis was consistent with mucocele in all cases. Three patients were controlled well with the initial surgical procedure, whereas 3 patients needed additional surgeries with sinus drainage.

Results

All patients had inferior proptosis, as the tumor was involving superior and medial orbit. CT imaging demonstrated bone erosions in 4 cases. Surgically all cases represent cystic mass lesions without any solid component. Adding sinus drainage at the initial surgery may prevent recurrences in orbital mucocele.

Conclusions

Orbital mucocele may masquarade lymphoid and cystoid orbital tumors, and all cases should be biopsied for differential diagnosis. In confirmed lesions drainage of the paranasal sinuses may prevent recurrences significantly.
Primary open angle glaucoma treated by high intensity focused ultrasound (HIFU): results at 18 months of a prospective pilot study on patients treated with the 2nd generation probe
Authors: Rouland J.F. , Aptel F.
Published: September 2016

Purpose

To assess the safety and efficacy of Ultrasound Ciliary Plasty (UCP procedure) using HIFU (high intensity focused ultrasound) with a second‐generation probe which increases the treatment surface area and the firing duration in patients with primary open angle glaucoma.

Methods

Prospective clinical series performed in two University Hospitals, on twenty eyes of twenty patients with primary open‐angle glaucoma, treated with the EyeOP1 medical device equipped with six miniaturized cylindrical piezoelectric transducers of a new generation with an increased lesion volume. All eyes were treated with an 8‐s exposure time per transducer. The main assessment criteria were safety and efficacy measured by the incidence of complications and IOP reduction. Ophthalmic examination and ultrasound biomicroscopy were performed before treatment and during clinical follow‐up at D7, M1, M3, M6, M12, M18 and M24.

Results

No major intra‐ or post‐operative complications were observed during follow‐up period. Clinical examination showed no lesions of ocular structures other than the ciliary body and no or few signs of intraocular inflammation after treatment. The mean intraocular pressure was significantly reduced from 29.1 ± 5.4 mmHg before treatment to 17.8 ± 6.2 mmHg at last follow‐up. Five patients have needed a second ultrasound procedure and two patients a third procedure. With a mean follow‐up of 18 months, success rate, as defined by an IOP reduction >20% after one or more UCP procedures was 67%. The mean IOP reduction achieved in responding patients was 44%.

Conclusions

Coagulation of the ciliary body using high intensity focused ultrasound carried out with the new‐generation of miniaturized transducers is a simple, well‐tolerated procedure which enables to significantly reduce the intraocular pressure in patients with Open Angle Glaucoma.
Retinal nerve fiber layer atrophy in patients with multiple sclerosis: Longitudinal 5 years study
Authors: Garcia Martin E. , Satue M. , Rodrigo M.J. , Obis J. , Cipres Alastuey M. , Vilades E. , Otin S. , Polo V. , Larrosa J.M. , Pablo L. , Gracia H.
Published: September 2016

Purpose

To evaluate changes in the retinal nerve fiber layer (RNFL) thicknesses in multilple sclerosis (MS) patients compared with healthy subjects during 5 years of follow up. To compare ability of optical coherence tomography (OCT) and visual field test to detect axonal damage.

Methods

Fifty eyes of 50 MS patients and 50 eyes of 50 healthy controls were included. All of them underwent measurements of best corrected visual acuity (BCVA) refractive defect, color vision, visual field, and OCT (Spectralis OCT). All of them were annual re‐evaluated during 5 years. Change in both groups (MS patients and healthy controls) were evaluated and compared using paired T Student′s test.

Results

We found decrease in all RNFL thicknesses during the 5 years follow‐up in both groups (patients and controls), and the changes were significant higher in MS group (T Student′s, p ≤ 0.05). No differences were found between patients and controls in visual functional tests (BCVA, color vision test and visual field). Higher change was found in inferior quadrant (113.67 in baseline and 105.39 μm in 5 years visit in MS group, p < 0.001). Correlations between structural and functional tests were found, but not between the changes in both tests during the 5 years follow up.

Conclusions

MS progression causes axonal damage that can be detected by OCT but not by visual functional tests.
Papilledema secondary to internal jugular veins thrombosis in a peritoneal dialysis patient
Authors: Braga J. , Loureiro M. , Barros P. , Gomes A.M. , Meira D.
Published: September 2016

Purpose

Intracranial hypertension secondary to internal jugular vein (IJV) thrombosis has been described in patients undergoing hemodialysis with peripheral hemodialysis shunts or repeated subclavian and jugular veins catheterizations. Pseudotumor cerebri, with no identified IJV thrombosis has also been reported in dialysis patients and has been associated with chronic or recurrent dialysis disequilibrium. We aim to report the case of a dialysis patient with papilledema secondary to bilateral IJV thrombosis.

Methods

Case report with fundus photography, optical coherence tomography, perimetry, brain imaging with venography, cerebrospinal fluid (CSF) analysis and neck eco Doppler.

Results

A 38‐year‐old man with end stage kidney disease undergoing peritoneal dialysis for 4 years presented with transient blurred vision, lasting a few minutes at a time, exacerbated by positional changes, with no vision loss or other symptoms. Physical examination revealed bilateral disc edema. No other ophthalmologic or neurological signs were found. Head CT with venography was unremarkable. Lumbar puncture CSF opening pressure was 23 cm H2O with normal CSF composition. Humphrey visual field were normal. Posterior neck eco Doppler showed absence of IJV bilaterally, which established the diagnosis.

Conclusions

Papilledema secondary to IJV thrombosis may occur in dialysis patients as a result of hemodynamic factors related to arteriovenous fistulas or chest/neck veins catheterization and also in patients undergoing peritoneal dialysis. End stage kidney disease is associated with higher risk of cardiovascular events and IJV thrombosis must be promptly ruled out in patients presenting with altered vision and papilledema.