bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetic retinopathy screening with nonmydriatic fundus camera(1 and 3 fields) vs ETDRS standard
Authors: MASSIGNAN F , VUJOSEVIC S , BENETTI E , PILOTTO E , MIDENA E
Published: October 2007

Purpose: To evaluate the ability to determine single lesions and to grade clinical levels of diabetic retinopathy (DR)using nonmydriatic(NM)digital color retinal images compared to Early Treatment Diabetic Retinopathy Study(ETDRS)7 standard 35‐mm stereoscopic color fundus photos.

Methods: 80 eyes of 42 diabetic patients with wide spectrum of DR lesions were enrolled.Nonsimultaneous 45°‐field non stereoscopic digital color images were taken from 1 central field(1F) and from 3 fields (3F) with a NM automatic fundus camera(Nidek Technologies, Italy).After dilatation standard 30° ETDRS photos were obtained with Topcon TRC50IA(Japan).The images obtained were analysed by 2 independent, masked readers evaluating lesion‐by‐lesion to assess the ETDRS grading and the clinical severity of the disease according the International proposed 5‐stage disease severity classification.

Results: Comparison of single lesions among 1F or 3F images and ETDRS fields revealed good agreement for hard exudates(k= 0.74 and k=0.75 respectively);moderate agreement for hemorrhages and/or microaneurysms(k=0.49, k= 0.60),cotton wool spots(k=0.41, K=0.49)and retinal new vessels(k=0.40, k=0.43).The agreement was fair for clinically significant macular edema(k=0.40, k=0.39).There was substantial agreement between 3F and ETDRS images for moderate non‐proliferative and proliferative DR(k=0.70 and k= 0.89 respectively),while it was moderate between 1F and ETDRS images.

Conclusions: The automatic non‐mydriatic 3 field system may be an effective tool to determine the level of DR and to identify the need for prompt referral to the ophthalmologist, even when applied as a telemedicine tool. It is still controversial if one 45° image is adequate for DR screening.
Comparison of corneal aberrations after myopic LASEK and LASIK surgeries using two different excimer lasers
Authors: CANADAS SUAREZ P , HERNANDEZ‐VERDEJO J , ROMAN‐GUINDO J , SANCHEZ‐PINA J , TEUS MA
Published: October 2007

Purpose: To compare changes in high order corneal aberrations (HOCA) after myopic LASEK and LASIK surgeries using two different excimer lasers.

Methods: This prospective study included 124 eyes of consecutive patients divided into 4 groups; group 1 LASEK with Technolas 24 eyes, group 2 LASIK with Technolas 26 eyes, group 3 LASIK with Esiris 37 eyes, group 4 LASEK with Esiris 37 eyes. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and manifest refraction were measured, in groups, before and 3 months after surgeries.

The topography data were used to calculate HOCA with 6 mm pupil size, before and 3 months after surgery.

Results: There were no significant differences, 3 months after surgery, in BCVA, UCVA and in manifest refraction between patients treated with LASEK and LASIK regardless of the laser used.

There was a significant increase in spherical, astigmatic, coma and total RMS aberrations in Technolas groups 3 months after surgery. They were lower in LASIK than in LASEK (p< 0,001). The same results were found in spherical and high order aberrations in Esiris groups (p: 0.001; p: 0.06). There were also higher in LASEK, 3 months after surgery.

Conclusions: : Our results suggest that both lasers produced an equal increase in HOCA. Therefore, it depends on the surgical technique used. HOCA after LASEK were higher than after LASIK 3 months after surgery.
Characterization within and around the Limbal Epithelial Crypt
Authors: YEUNG AM , SCHLOETZER SCHREHARDT U , KULKARNI B , HOPKINSON A , KRUSE FE , DUA HS
Published: October 2007

Purpose: The Limbal Epithelial Crypt (LEC) is an anatomical structure that is found between the junction of the cornea and sclera and is in a unique position to make it an ideal structure to examine further. Previous studies have demonstrated the LEC to have properties that suggest it may be a stem cell niche. Basal cells of the LEC are significantly smaller than basal cells found in adjacent rete pegs, and morphologically they have a higher nuclear:cytoplasmic ratio. We set out to examine LEC further by exploring the surrounding LEC matrix proteins, and with known differentiation markers.

Methods: Donated corneo‐sclero rims were cut into eight equal sized pieces and frozen. Each piece was cut into 7μm serial sections, and was examined by microscopy for LEC structures. Identified LEC was collected on slides and stored until they were fixed in acetone and processed by standard immunofluorescence techniques for each differentiation marker.

Results: Tenacin C was more positively taken up by the basement membrane of the LEC compared with the surrounding limbus. In addition, staining for desmoglein was negative against isolated small subpopulations of cells within the basal regions of the LEC.

Conclusions: The LEC structure demonstrates properties that may identify this as a possible stem cell niche. Further studies are necessary to determine the significance of the LEC in its role in stem cell maintenance.
Effects of moxaverine and placebo on ocular blood flow
Authors: GARHOFER G , RESCH H , WOLZT M , SCHMETTERER L
Published: October 2007

Purpose: A number of eye diseases are associated with perfusion abnormalities. Moxaverine, because of its known direct vasodilator effect, is used in the therapy of perfusion abnormalities in the brain, the heart and the extremities. The present study aimed to investigate whether moxaverine affects ocular blood flow.

Methods: 16 healthy volunteers were studied in this randomized, double masked, placebo‐controlled twoway crossover study. Moxaverine (Ursapharm, Saarbrücken, Germany, 150mg) was administered intravenously over 30 minutes. Ocular hemodynamic parameters were measured before and up to 90 minutes after drug administration. Retinal arterial and venous diameters were measured with a Retinal Vessel Analyzer. Retinal blood velocity (RBV) was assessed with laser Doppler velocimetry, choroidal (CF) and optic nerve head blood flow (ONF) were measured with laser Doppler flowmetry.

Results: RBV and ONF tended to increase by 13.6±13.3% and 11.8±12.7% respectively after administration of moxaverine, but this effect was not significant versus placebo. Moxaverine increased significantly CF by 22.6±27.9%. In retinal veins moxaverine induced vasodilation (2.6±2.8%), but this effect was not significant versus placebo. Retinal blood flow increased after infusion of moxaverine (19.6±16.5%), but again this effect did not reach the level of significance most likely due to the small numbers of subjects.

Conclusions: The present study indicates an increase in ocular blood flow after systemic infusion of a single dose of moxaverine in healthy subject. Further studies are warranted to investigate whether this effect can also be seen after repeated dose treatment in patients with ocular vascular disease.
To see or not to see
Authors: DALKE C , FAVOR J , PUK O , GRAW J
Published: October 2007

Purpose: “Sighted C3H” mice with a normal Pde6b gene, were compared to wild‐type C3H/HeH mice with the strain‐specific Pde6b(rd1) mutation causing retinal degeneration, BALB/c and C57BL/6 mice.

Methods: All mice were screened for morphological and visual alterations by funduscopy, slit lamp biomicroscopy, laser interference biometry, ERG and optokinetic drum.

Results: In “sighted C3H” mice the mutated Pde6b(rd1) allele of C3H/HeH mice was replaced by the normal Pde6b allele from BALB/c mice. The presence of the normal Pde6b gene was verified by PCR analysis.

Slit lamp biomicroscopy revealed no abnormalities in the anterior segments of the eye in all mice. In the fundus of C3H/HeH (Pde6b‐/‐) mice the typical pigment patches and vessel attenuation caused by the retinal degeneration were observed, while the “sighted C3H” (Pde6b+/+) mice showed a normal fundus appearance, comparable to C57BL/6 mice. The albino BALB/c mice had a red‐shining fundus, due to the lack of pigmentation. Scotopic ERG was performed with our screening setup for mice, where BALB/c and C57BL/6 mice showed good responses with well developed a‐ and b‐waves, while C3H/HeH (Pde6b‐/‐) mice showed no response. Unexpectedly, all “sighted C3H” (Pde6b+/+) mice did not show any b‐wave response in the scotopic ERG, but scored at least once within 6 trials in the optokinetic drum. As expected C3H/HeH (Pde6b‐/‐) mice did not respond to the moving stripes of the optokinetc drum, as did the BALB/c mice. A good response to the rotating drum was obtained from C57BL/6 mice.

Conclusions: "Sighted C3H" mice have a normal Pde6b gene and responded to the rotating stripes in the optokinetc drum, but do not have normal vision due to the lack of the b‐wave in the ERG.

This work is supported by the NGFN.
Refractive and biomechanical changes with intrastromal ring segments for keratoconus
Authors: MICHAEL R , DE LA PAZ MF , RIOS A , ROMO M , SALVADOR B , DELAS B , ALVAREZ DE TOLEDO JP , BARRAQUER RI
Published: October 2007

Purpose: To analyse the refractive changes by Power Vector Analysis and the changes in corneal elasticity with the Ocular Response Analyser [ORA].

Methods: Refraction data at one day and three months post‐op was available in 30 eyes (30 patients) and biomechanical data in 10 eyes (10 patients). Visual acuity and topography was analysed in all patients. The type of intrastromal ring segments used were 85% Ferrara and 15% Intacs. Spherical equivalent M, the astigmatism components J0 and J45, and the length of the Power Vector are calculated.

Results: The mean length of the Power Vector changed from 6.1 D (+/‐ 1.0 confidence interval [CI]) pre‐op to 3.1 D (+/‐ 0.6 CI) at one day post‐op and was 3.5 D (+/‐ 0.9 CI) at three months post‐op. ORA's Corneal Hysteresis Factor in keratoconus patients (mean 7.4 +/‐ 0.5 CI) was significantly lower than in controls (mean 11.2 +/‐ 0.8 CI) but did not change after intrastromal ring implantation.

Conclusions: Intrastromal ring segments for keratoconus reduced the spherical equivalent refraction and the amount of astigmatism at one day and three month post‐op, with some regression between 1 day and 3 month post‐op. Corneal hysteresis appeared not to be altered by the intrastromal ring segments.
Three‐dimensional high‐speed optical coherence tomography for the investigation of the cornea and anterior eye‐segments
Authors: YASUNO Y
Published: October 2007

Purpose: Optical coherence tomography (OCT) has a history of more than a decade for posterior eye investigations. This posterior OCT has been optimized for retinal investigation and is not suitable for anterior eye examinations, although interest for the application of OCT to the anterior eye exist. Recently, anterior‐segment OCT has been introduced and its application fields are rapidly extending. However, these anterior OCT systems are based on a time‐domain OCT configuration, which has relatively slow measurement speed; hence, it is difficult to have a full three‐dimensional (3‐D) tomographic dataset.

Methods: Our group recently demonstrated ultra‐high‐speed corneal & anterior eye segment OCT (CAS‐OCT). This OCT system is based on Fourier domain detection and provides 20,000 A‐lines/sec. This fast measurement speed enables a full 3‐D dataset of the anterior eye within 2 sec. This 3‐D dataset provides several useful applications : e.g. visualisation of the internal structure of the bleb of glaucoma surgery. An en‐face projection or en‐face OCT slices are available from the 3‐D dataset, which enables en‐face assessment of corneal diseases whose extension directly relates to the patient's visual acuity.

Results: Using this 3‐D CAS‐OCT, we have examined 46 eyes with several types of pathologies including granular, Avellino and lattice corneal dystrophy, post LASIK corneal changes, keratoplasty, keratoconus, iris nodules, anterior synechiae, angle recession, ciliary body detachment, scleritis, and several types of glaucoma surgery; trabeculectomy, trabeculotomy, and laser iridotomy.

Conclusions: In the presentation, we introduce our CAS‐OCT and show clinical outcomes form the above‐mentioned examinations.
Spectral domain OCT at 850 nm and OFDI at 1050 nm for retinal imaging in glaucoma and AMD patients
Authors: DEN BOER J
Published: October 2007

Purpose: We have realized a 150 fold improvement of the sensitivity over conventional time domain OCT technology allowing video rate in vivo retinal imaging

without compromising image quality.

Methods: Two different but similar technologies (SD‐OCT and OFDI) provide high speed imaging at a wavelength of 850 nm and 1050 nm, respectively. An overview of the latest system developments will be presented. Data processing techniques to extract and quantify features such as retinal nerve fiber layer thickness, drusen volume, CNV size and volume, and subretinal fluid volume will be presented for a number of glaucoma and AMD patients.

Results: Ultra‐high‐resolution video rate SD‐OCT at 850 nm and OFDI at 1050 nm offers many advantages in retinal imaging, maintaining high signal to noise while operating at a safe ocular exposure level.

Conclusions: The unprecedented speed eliminates motion artifacts and the need to re‐align A‐lines, enabling accurate 3‐D mapping of the retinal topography, and provides a shift from two‐dimensional imaging to three‐dimensional screening of large retinal volumes.
TNF‐alpha and Interferon‐gamma upregulate AQP4 protein expression in ARPE‐19, a human retinal pigmented epithelial cell line.
Authors: JANSSENS S , CASPERS L , WILLERMAIN F , DELPORTE C
Published: October 2007

Purpose: Under physiological conditions, the outer retina is dehydrated by water movements through retinal pigmented epithelial (RPE) cells. However, during intraocular inflammation, water accumulation into the retina leads to the formation of retinal oedema. Accordingly, the knowledge of the type of aquaporins (AQPs) expressed by RPE cells and its regulation by cytokines is of crucial importance. Therefore, we studied the expression of AQP4 on the retinal epithelial ARPE‐19 cell line and its regulation by cytokines.

Methods: ARPE‐19 cells were grown for 24h in the presence or absence of 100 ng/ml interferon gamma (IFN gamma) or 30 ng/ml tumor necrosis factor alpha (TNF alpha). AQP4 expression was evaluated by semi‐quantitative Western blot analysis and by immunofluorescence.

Results: Protein immunoblots of membranes from ARPE‐19 cells were probed with an affinity purified anti‐AQP4 antibody and an anti‐glucose transporter 1. The immunoblots revealed the presence of a ± 30 kDa band, corresponding to the expected molecular weight of AQP4 observed in kidney membranes used as positive control. Immunofluorescence revealed a strong AQP4 labeling. AQP4 protein expression after 24 h treatment of ARPE‐19 cells with 100 ng/ml IFN gamma or 30 ng/ml TNF alpha were respectively of 158 ± 23 % (mean ± S.E.M, n = 3, p<0.05) and 171 ± 10 % (mean ± S.E.M, n = 3, p<0.05) compared to untreated cells.

Conclusions: ARPE‐19 cells constitutively express AQP4. In addition, AQP4 expression was significantly increased in response to IFN gamma and TNF alpha.
Failure of topical Cyclosporine A 2% in patients with severe ocular rosacea after penetrating keratoplasty
Authors: GICQUEL JJ , BOURGES JL , LANGMAN ME , BONNERIC JG , RENARD G , DIGHIERO PL
Published: October 2007

Purpose: To evaluate cyclosporine A (CsA) 2% eye‐drops in the prevention of acute rejection after penetrating keratoplasty (PKP) in patients with severe ocular rosacea.

Methods: IRB approval (Poitiers School of Medicine) was given an Informed Consent was obtained from all patients according to French Regulations. 35 patients with severe Rosacea that underwent a PKP from 2000 to 2003 for pseudophakic bullous keratopathy were topically treated with CsA. The patient’s charts, the level of rejection risk, the IOP and the graft outcome were analyzed.

Results: No systemic effect was detected. 21 rejections developed after a median of 18.5 months. Ten rejections under CsA treatment were reversible.

Conclusions: CsA 2% eye‐drops failed in being an effective treatment in the prevention of acute rejection in patients with severe ocular rosacea.
Quantification of light scattering and cataract development using the Scheimpflug’s principle
Authors: WEGENER AR
Published: October 2007

Purpose: Light entering the eye is scattered in a forward and backward direction in the cornea and lens due to their cellular architecture and the high protein content. Short wave optical radiation, UV, ionizing radiation, other internal and external risk factors and ageing increase light scattering especially in the lens finally leading to cataract development.

Methods: Back scattered light can be reproducibly measured with the Scheimpflug principle generating time and space resolved lens density data. Scheimpflug’s principle minimalises imaging distortion, but cornea and lens themselves distort the images, so that mathematical corrections are needed for true biometrical data. Quantification of scattering data requires standardization and correction. Standardization is necessary because each recording medium has non linear components. External standards have been evaluated, e.g. Ulbricht spheres and a diacepam solution. Correction is necessary because scattering changes in any layer of the transparent tissues in the anterior eye segment affects the data from underlying tissues, meaning that an internal standard is necessary as well.

Results: Based on these correction procedures the actual amount of data is depending on the number of optical sections recorded per eye. For evaluation of normal age‐related changes in light scattering and homogenous opacities like nuclear cataracts about 4 meridians are sufficient whereas asymmetric opacities like most cortical cataracts require a higher number of meridians.

Conclusions: Densitometric analysis of a large number of images including all the corrections mentioned above should be performed with custom‐designed image analytical software in order to maximize the information output from the Scheimpflug recording.
Sigma‐1 receptor: a pivotal role in lens cell survival
Authors: WANG L , DUNCAN G
Published: October 2007

Purpose: Sigma‐1 receptor (Sig‐1R) has no known homology with any other receptors. Natural ligands are yet to be identified. Sig‐1R appears to play a critical role in controlling cell proliferation. The human lens grows throughout life and uncontrolled growth after cataract surgery is responsible for Posterior Capsule Opacification (PCO). We have therefore investigated a possible role for Sig‐1R antagonists in controlling PCO.

Methods: The human lens cell line FHL124 expresses the Sig‐1R and was employed for this study. Cells were maintained in EMEM or EMEM supplemented with 5% Serum (FCS) at 35°C in 5% CO2. Sig‐1R siRNA and scrambled siRNA were purchased from Ambion. Cell growth was assessed by measuring total protein and cell death by quantifying LDH leakage. mRNA level was assayed by RT‐PCR. Protein level was measured by western blotting.

Results: A dose‐dependent effect of Sig‐1R antagonist (rimcazole or BD1047) on cell growth was observed. 72 hours of transfection with siRNAs directed against Sig‐1R reduced mRNA and protein levels by over 70 and 60% respectively. Subsequent incubation for 96 hours in 5%FCS gave a partial recovery of mRNA, but no significant increase in protein expression. LDH leakage assays showed that significant cell death occurred and was accompanied by an increased level of Caspase‐3. The increases of pERK and pAkt stimulated with 10nM thrombin were inhibited by silencing Sig‐1R, but not in cells exposed to scrambled siRNA. The recycling level of EGF receptor was significantly reduced by Sig‐1R antagonists compared with controls.

Conclusions: This study establishes a central role for the Sig‐1R in lens cell survival through modulating the activity of growth factor receptor mediated cell signalling and growth factor receptor trafficking.
Ten‐year follow‐up of drusen like lesions in mesangiocapillary glomerulonephritis II
Authors: D'SOUZA Y , BONSHEK RE , SHORT D
Published: October 2007

Purpose: This study aims to assess the outcome of drusen‐like lesions in patients with mesangiocapillary glomerulonephritis –II (MCGN II) and to compare their progression to that of drusen in age‐related maculopathy

Methods: After obtaining consent and ethics approval, 4 patients with biopsy proven MCGN‐II were re‐examined clinically and on fluorescein angiography 10 years after their initial fundus examination. Three patients had undergone renal transplant in the past.

Results: All four patients had bilateral, fairly symmetrical drusen at the posterior pole which extended to the periphery. There was no blood, fluid nor cystoid change at the macula in either eye of any patient. No patient showed signs of choroidal neovascularisation (CNV). There was no progression in retinopathy over 10 years. This is in contrast to age‐related maculopathy where 33% patients develop CNV over 7 years. Renal transplant did not affect the risk of progression of retinopathy.

Conclusions: We therefore suggest that factors other than drusen alone may contribute to the developement of CNV
The presence of an active ETB1 receptor is essencial for ETB2 induced relaxation of the iris sphincter muscle
Authors: ROCHA DE SOUSA A , ALVES‐FARIA P , SARAIVA J , AMARAL M , FALCAO‐REIS F , LEITE‐MOREIRA A
Published: October 2007

Purpose: There are two subtypes of ETB receptors: ETB1 and ETB2. Stimulation of the latter relaxes iris sphincter. We investigated the interaction of the two ETB receptor subtypes in the iris sphincter muscle.

Methods: Rabbit iris sphincter muscles (n=55) were dissected, mounted on a vertical organ attached to a force transducer and precontracted. The effects of ETB stimulation through (i) Endothelin‐1 (ET‐1;10e‐10–10e‐7M), in the presence of an ETA receptor antagonist (BQ‐123;10e‐5 M; n=7) (ii) sarafotoxin sc6 (SRTX‐c; [10e‐10–10e‐6M]; n=6) (iii) IRL‐1620 (ETB1 agonist; [10e‐10–10e‐7M; n=7) were evaluated. The effect of ETB stimulation was also evaluated in the presence of i) an ETA/ETB receptor antagonist, (PD145065;10e‐5M;n=4) ii) an ETB1 receptor antagonist, (RES‐701;10e‐6M;n=7) iii) an ETB2 receptor antagonist, (BQ‐788;10e‐5M;n=6) iv) a NOS inhibitor, (L‐nitro‐L‐arginine;L‐NA;10e‐5M;n=7); v) a COX inhibitor (indomethacin; indo;10e‐5M; n=10).

Results: ETB stimulation by SRTX‐c or by ET‐1 in the presence of BQ‐123 promoted a concentration‐dependent relaxation of the rabbit sphincter muscles maximal at 10‐7M, averaging 10.8±2.03% and 9.35±1.79%, respectively. IRL‐1620 did not relax the iris sphincter muscle (0.91±5.45 %). The former was inhibited by RES‐701(‐0.09±2.23%) and BQ‐788 (‐2,30±2.04%). The effect was attenuated by PD145065 (5,71±0.98%) and by L‐NA (4.46±2.28%) or Indo (2.34±2.93%).

Conclusions: ETB receptor stimulation relaxes the iris sphincter muscle, an effect that is mediated by the ETB2 subtype, through NO and prostaglandins release. However the presence of an active ETB1 receptor is essential for the activation of ETB2 receptor by sarafotoxin.
Long‐term results of LASIK in the correction of high myopia
Authors: LINDBOHM NM , TUISKU IS , TERVO TM
Published: October 2007

Purpose: LASIK is widely used in the correction of moderate and high myopia, even though reports on long‐term results are few. We carried out this study to evaluate long‐term results, stability and patient satisfaction after LASIK for high myopia.

Methods: The study included 77 eyes of 47 patients who underwent LASIK for myopia of over ‐10 D in our hospital in the years 1999 to 2003. Preoperative and early postoperative data, including uncorrected and best corrected visual acuity and refraction, were collected retrospectively from hospital files. An additional examination with satisfaction query was performed 2 to 5 years after the operation.

Results: After a follow‐up of 2 to 5 years, 40% of the patients were within 1.0 D from the original intended refraction, 70% within 2.0 D, and 91% within 3.0 D. Only one eye lost 2 Snellen lines of visual acuity, while 3 eyes gained two lines and the rest had no significant change. Regression was mild but statistically significant in long term, with mean spherical equivalent being ‐1.2 D at one month, ‐1.8 D at 6 months, and ‐1.9 D at two to five years. Nine eyes had mild postoperative complications which all resolved without permanent consequences, and none developed keratectasia. All except one patient were very satisfied with the results, and would have chosen the operation again.

Conclusions: In conclusion, with careful patient selection and safety precautions, LASIK is a safe and relatively predictable alternative in the treatment of myopia of ‐10 to ‐17 D.
Treatment of epiphora in infants
Authors: STIRN KRANJC B
Published: October 2007

Purpose: To discuss the reasons of epiphora in infants and the natural history, treatment of lacrimal drainage system obstruction. In excluded excessive tear production epiphora means watery eyes in drainage failure. All parts of the lacrimal passages can be obstructed or anomalous, including lid malposition, skeletal, sinus malformation.

Methods: Clinical practice with retrospective interventional case series in children (0‐60 months) with epiphora. Descriptive analysis of a five year period, over 500 children.

Complete resolution of symptoms counted as a patent tear outlow system.

Results: Systemic associations were rare, a few children with Down sydrome had nasolacrimal duct obstruction.

Only 7 of over 500 children who had undergone lacrimal duct probing needed dacryocystorhinostomy and intubation. All these children have presented recurrent dacryocystitis without orbital celulitis. The microbial profile of the positive cultures consisted of Gram‐positive and or Gram‐ negative bacteria, mostly of Staph. aureus, Str. pneumoniae, Haemophilus influenzae, all sensitive to chloramphenicol and ofloxacin and to at least 5 other out of 8‐10 tested antibiotics. No complications of probing or surgery were seen.

Conclusions: Probing and irrigation of lacrimal ducts is highly effective, safe and simple procedure even after the first year of age, though so far not determined whether probing really shortens the duration of epiphora. Spontaneous improvement is possible at any age. On the other hand early probing in dacryocystocele can reduce the incidence of dacryocystitis.
Autosomal dominant recurrent erosions – from non‐existing to being everywhere
Authors: HAMMAR B , FAGERHOLM P
Published: October 2007

Purpose: To describe phenotypes of autosomal dominantly inherited corneal dystrophies characterized by recurrent corneal erosions in Sweden.

Methods: We have presented data about families with autosomal dominantly inherited recurrent erosions at national meetings in Sweden for 5 years and urged colleagues to report their existence to us. Their reports have led us to investigate several families. Interviews and clinical examinations were made to establish a pedigree and the specific phenotype for each family.

Results: Five families with more than fifty members have been found. The largest was a seven‐generation family with 342 members. Another 12 smaller families have been identified. Altogether 870 family members of whom 202 were affected were included. The families originated from all parts of Sweden and one also included members in Finland.

The phenotypes vary. For example, the onset were usually at the age of 4‐6 years, but in one family before 12 months of age. Also corneal opacifications of varying type and degree were found. In one family opacifications were first noted at the age of about 7 years, but usually first seen at the age of 20‐40 years.

Vitamin B complex treatment was effectively employed to reduce symptoms and number of recurrences in a family with 175 members. In another family phototherapeutic keratectomy (PTK) cured the recurrent erosions. In yet other families neither vitamin B supplementation nor PTK has been the cure when tried.

Conclusions: It seems that inherited recurrent erosions are more common in Sweden than was first believed. Phenotypically it appears to be several different corneal diseases.

The ongoing molecular genetic work‐up will disclose if several genes are involved and/or several mutations in one or more genes.
Congenital aniridia
Authors: POPPER M , BAUSZ M , TURI E , SENYI K , KNEZY K , SUVEGES I
Published: October 2007

Purpose: Our purpose was to analyze the various ocular manifestations, treatment options, and the possible outcome of congenital aniridia (CA) a rare and severe developmental disorder.

Methods: 52 eyes of 26 patients were regularly checked with full eye examination including anterior segment photography. Electrophysiology, OCT, UBM, and glaucoma testing was done if appropriate. The mean age at the last examination was 17.6 years (range: 2 months – 72 years).

Results: The best corrected visual acuity was: 0.2 (ranging from no light perception to 0.6). 20 cases were sporadic and 6 cases showed autosomal dominant inheritance in 3 families. A deletion including band p13 of the short arm of chromosome 11 was found in one familial and one sporadic case.

Associated ocular signs were nystagmus (88.5%), congenital cataract (61.5%), and ectopia lentis (3.8%). 14 eyes of 10 cases needed cataract surgery. Secondary glaucoma occurred in 24 eyes of 12 patients, with severe outcome in 15 eyes of 8 patients despite treatment. Aniridic keratopathy occurred in 23 eyes of 12 patients; in 3 cases keratoplasty was performed. One patient had aniridia on one eye, and iris coloboma on the fellow eye confirming the common origin of the two diseases. Interestingly, no Wilms tumor occurred in our series, but mental deficits were found in 4 patients.

Conclusions: Secondary glaucoma is the most severe complication of CA. It can appear in relatively young age, is relatively resistant to treatment, and the earlier the onset, the worse the prognosis. Risk factors for vision loss included eye surgeries at young age. Moreover, the outcome of cataract‐surgery is limited by foveal hypoplasia and the progression of glaucoma.
Wedge resection for high astigmatism in penetrating keratoplasty for keratoconus: refractive and histopathologic changes
Authors: DE LA PAZ MF
Published: October 2007

Purpose: to analyze the refractive, topographic, keratometric and histopathologic changes in wedge resection to correct high astigmatism in penetrating keratoplasty for keratoconus.

Methods: A retrospective study was done analysing the following parameters pre‐operatively, at 1 and 3 years post‐operatively: UCVA, BCVA, spherical equivalent, refractive, topographic and keratometric cylinder. We also studied the index of efficacy and safety, as well as the histopathologic results of tissues submitted for analysis.

Results: A total of 22 eyes of 21 patients who underwent PKP for advanced keratoconus and wedge resection for high astigmatism 18 years following PKP were included in the study. Mean follow‐up time was 3.2 years. All refractive, topographic and keratometric data showed the lowest degree of astigmatism at three years post‐op with a tendency towards regression towards five years post‐op. Safety index was 1.6 while efficacy index was 0.4. The corrected refractive cylinder at 3 years follow‐up was 55,2% while the corrected topographic cylinder was 53% at 3 years. All histopathologic sections of resected tissue were consistent with keratoconus.

Conclusions: Wedge resection is safe and moderately efficacious in the correction of high astigmatism post PKP for keratoconus. As previously published by the same authors, our study corroborates that there is a tendency towards regression of the desired cylindrical correction thru time. Keratoconus may be a disease that affects the entire cornea and surgical resection does not treat the disease.
Foundations of lens ion transport
Authors: DELAMERE NA
Published: October 2007

Purpose: Prof. George Duncan began work on the lens almost 40 years ago. His studies laid the foundation for our understanding of the mechanisms that regulate lens electrolyte content.

Methods: In the late 1960s Prof. Duncan conducted microelectrode and tracer flux studies that illustrated a link between ion transport, osmotic balance and lens transparency.

Results: His work defined the permeability properties of lens membranes and the requirement for equilibrium between passive ion movement and active ion transport. Later, Prof. Duncan and his colleagues at the University of East Anglia carried out an analysis of human cataractous lenses that revealed abnormal sodium, potassium, calcium and water levels in lenses with cortical opacification. Prof. Duncan presented the argument that the lens swells, calcium rises and cellular organization is disrupted if active sodium‐potassium transport fails to balance cation leakage. Over the course of several years, the University of East Anglia group discovered evidence for a high degree of cooperativity between fiber and epithelial cells. Prof. Duncan’s discoveries became the foundation for later studies by his group and others that showed certain lens cells are specialized for active ion transport and shift ions for the entire lens.

Conclusions: In recent years more has been learned regarding expression and regulation of Na,K‐ATPase in lens epithelium and fibers. Recent studies by Tamiya, Okafor and Delamere (Am. J. Physiol. 2007 In Press) point to alterations of Na,K‐ATPase activity subsequent to stimulation of purinergic receptors. It is interesting that one of the earliest reports on functional purinergic receptors in lens epithelium came from Prof. Duncan and the University of East Anglia group.
Effect of Travoprost and Brinzolamide on ocular hemodynamics
Authors: STALMANS I , VANDEWALLE E , VANBELLINGHEN V , ZEYEN T
Published: October 2007

Purpose: To investigate the effect of topical travoprost and brinzolamide on retrobulbar flow velocities and ocular pulse amplitude in glaucoma patients.

Methods: Twenty patients with glaucoma underwent color doppler imaging of the central retinal, temporal and nasal short posterior ciliary and ophthalmic artery, as well as Pascal dynamic contour tonometry and ocular pulse amplitude (OPA) measurement at baseline without treatment (timepoint 1, T1), after 1 month of travoprost (T2) and subsequently after 3 months of travoprost and brinzolamide (T3). A multivariate model was used to evaluate the changes in retrobulbar flow velocities and OPA.

Results: In the temporal posterior ciliary artery, the flow velocities remained unchanged after administration of travoprost (7.9 at T1 versus 7.7 cm/s at T2, p=0.55 and 2.6 versus 2.7 cm/s, p=0.36 for peak systolic and end diastolic velocity respectively). Peak systolic velocity significantly increased after addition of brinzolamide compared to travoprost alone (8.7 cm/s at T3, p=0.003), which was a borderline increase as compared to baseline (p=0.05), whereas end diastolic velocity significantly increased as compared to baseline (2.9 cm/s, p=0.001). Ocular pulse amplitude did not change after administration of travoprost (p=0.19), but decreased markedly after addition of brinzolamide (p=0.005) despite a more important intra‐ocular pressure reduction with travoprost than after addition of brinzolamide.

Conclusions: Flow velocities improved only in the temporal posterior ciliary artery after topical treatment with travoprost and brinzolamide in glaucoma patients. Ocular pulse amplitude decreased significantly with brinzolamide added to travoprost, but not with travoprost alone.
Is corneal hysteresis an additional risk factor for glaucoma?
Authors: POURJAVAN S , BERKOUK K , DETRY‐ MOREL M
Published: October 2007

Purpose: 1. To assess the correlation and agreement between Goldmann Applanation Tonometer (GAT) and Ocular Response Analyzer (ORA).

2. To investigate the corneal hysteresis (CH) and the Corneal Resistance factor (CRF) in normal subjects and glaucomatous patients.

Methods: Prospective controlled study including one eye at random of 41 normal subjects and 45 glaucoma patients with optic disc alteration and visual field defect.

The IOP was determined by GAT and ten minutes later by ORA followed by pachymetry.

Corneal‐Compensated Intraocular Pressure (IOPcc), Corneal Resistance Factor (CRF) and CH were considered for analysis. Pearson correlation coefficient and Bland‐Altman plots were used to evaluate the correlation and the agreement between the two devices.

Results: The mean CCT was 558±35 μm in normal subjects and 540±38 μm in glaucoma patients. The mean GAT was 17.0±2.5 mmHg for normals and 17.8±6.5 mmHg for glaucoma group. The mean IOPcc was 14.2±3.9 mmHg in normal subjects and 17.5±6.3 mmHg in glaucoma.

• The GAT and IOPcc values were correlated in both group (p<0.01).

• There was a significant correlation between CCT and CH in all patients (p<0.05).

•CH and CRF values were significantly lower in glaucoma group (p<0.05)

Conclusions: •The CH and CRF values are significantly lower in glaucoma patients comparing to normal subjects.
Reduced choroidal blood flow parameters play a role in the development of neovascular AMD
Authors: WEIGERT G , SCHMETTERER L , LUKSCH A , MAAR N , ERGUN E , WIMPISSINGER B , GARHOFER G , FUCHSJAEGER‐MAYRL G , STUR M
Published: October 2007

Purpose: The factors that trigger neovascular AMD are still not completely elucidated. We performed a study in order to investigate if reduced choroidal blood flow parameters are a risk factor for the development of neovascular AMD.

Methods: We performed an observational longitudinal 3‐years follow up study. 41 patients with unilateral CNV and non‐exudative AMD in the study eye were included. Choroidal blood flow (CBF) and fundus pulsation amplitude (FPA) were measured using a compact laser Doppler flowmeter and a laser interferometer, respectively. Patients were devided into two groups. Patients, who developed CNV were assigned group 1 and patients who did not, group 2. A non‐paired t‐test was used to compare choroidal hemodynamic parameters between the two study groups.

Results: 17 patients developed CNV, 20 patients did not develop CNV and 4 patients were lost for follow up. Patients in group 1 (16.2 ± 3.00 AU) showed lower CBF values as compared to patients in group 2 (18.9 ± 3.74 AU; p = 0.021 between groups). Correspondingly, group 1 (3.58 ± 1.05 μm) had lower FPA values than group 2 (2.96 ± 0.71 μm; p = 0.045 between groups).

Conclusions: The current study strengthens the hypothesis that choroidal hypoperfusion plays a role in the development of CNV in AMD.
Functional anatomy, innervation and immune regulation of the ocular surface
Authors: KNOP N , KNOP E
Published: October 2007

Purpose: The functional anatomy of the ocular surface prominently contributes to the visual function of the eye. It is aimed to describe the complexity of this system.

Methods: Own results on histological, immunohistological, ultrastructural and biochemical level in the human and the rabbit eye are discussed together with results from the literature.

Results: The ocular surface in a functional view consists of the mucosal surfaces of the globe and lid (cornea & conjunctiva) and of its mucosal adnexa (lacrimal gland & lacrimal drainage system) and it also includes the lid apparatus required for eye closure and blinking in order to provide lubrication. Different functional systems interact to produce the intact functional anatomy. These are e.g. epithelial differentiation, secretion, lid motion and immune defence that together lead to the higher order function of wetting and comfort. Ultimately they allow the preservation of corneal clarity and visual function at the ocular surface level. These systems are governed by similar underlying regulatory mechanisms as e.g. growth factors, cytokines, hormones, neuromodulatory molecules and innervation which are all shown to be involved in ocular surface function and also interact through common signalling molecules. An important functional system is the immunological defence system of the ocular surface that is known as the Eye‐Associated Lymphoid Tissue (EALT) and appears to have a central integrative role.

Conclusions: Different functional systems interact at the ocular surface by interactions based on common signalling molecules, which may also allow psycho‐neuro‐immunological regulation. An integrative understanding of the physiological state may also give insight into potential interventions under pathologic conditions.
Twelve hour variability of ocular blood flow parameters in healthy subjects and patients with primary open angle glaucoma
Authors: SCHMETTERER L , GEORGOPOULOS M , VASS C , LUKSCH A , FUCHSJAEGER‐MAYRL G , GARHOFER G
Published: October 2007

Purpose: Ocular perfusion abnormalities have been implicated in the pathogenesis of primary open angle glaucoma (POAG). More specifically it has been reported that POAG is associated with vascular dysregulation and ischemia/reperfusion phenomena. In the present study we compared the twelve hour variability of ocular blood flow parameters in healthy subjects and patients with POAG.

Methods: In 16 patients with POAG and 16 healthy age‐matched controls ocular and systemic blood flow parameters and intraocular pressure was measured every 2 hours over 12 hours. Ocular hemodynamic measurements included optic nerve head blood flow and choroidal blood flow assessed with laser Doppler flowmetry, fundus pulsation amplitude assessed with laser interferometry and retrobulbar blood velocities with color Doppler imaging. A repeated measures ANOVA model was used to compare variability among these measurements between the two groups of patients.

Results: Most of the outcome variables showed higher fluctuations in patients with PAOG than in healthy controls. These changes were not associated with ocular perfusion pressure or intraocular pressure. Changes over time were, however, correlated among the different ocular hemodynamic outcome measures in patients with POAG, but not in healthy controls.

Conclusions: Patients with POAG show an abnormal diurnial fluctuation of ocular blood flow parameters. Since we observed correlations between these fluctuations as assessed with different methods this does not appear to be related to statistical errors associated with the measurement techniques. These data support the hypothesis of vascular dysregulation in POAG.
Trabeculectomy with or without adjustable flap sutures and anterior chamber maintainer
Authors: ZEYEN T , VANDEWALLE E , RENIER C , VAN DE VEIRE S , STALMANS I
Published: October 2007

Purpose: To compare the efficacy and safety of trabeculectomy with or without adjustable flap sutures and anterior chamber (AC) maintainer.

Methods: 32 patients (64 eyes) were included in this prospective study. One eye of each patient was randomly assigned to a trabeculectomy with 2 adjustable and 2 releasable flap sutures + an AC maintainer (technique 1) while the other eye had a trabeculectomy with 2 releasable flap sutures + a viscoelastic (technique 2). The rest of the operation was similar in both eyes. Mitomycin‐C was used in 50% of the patients in each group. The postoperative management was equal in both groups except for the manipulation of the adjustable sutures. The main outcome measures were the intraocular pressure (IOP) and the frequency of early postoperative complications.

Results: 32 patients were included and had a follow‐up of at least 24 months. The mean pre‐ and postoperative IOP at 24 months was 22.1 ± 7.6 and 13.3 ± 2 mmHg for technique 1, and 22.7 ± 6.8 and 13.3 ± 3.4 for technique 2 (p=0.18). Early postoperative complications were infrequent and comparable in both techniques.

Conclusions: The efficacy and safety of both trabeculectomy techniques were comparable.
Calcium signalling can be bad for you: thapsigargin and PCO prevention
Authors: WORMSTONE IM , WANG L , DUNCAN G
Published: October 2007

Purpose: Posterior capsule opacification (PCO) remains a significant clinical problem after cataract surgery. The Perfect Capsule device (Milvella, Ltd) permits the introduction and subsequent removal of potentially toxic agents into the closed capsular bag. The present study aimed to determine the influence of thapsigargin (Tg) exposure on lens cell viability.

Methods: FHL124 cells were routinely cultured in Eagle’s minimum essential medium (EMEM). DNA and protein synthesis rates were quantified by measuring the incorporation of 3H‐thymidine and 35S‐methionine. Longer‐term growth was assessed by quantifying the increase in area over time of a circular patch of seeded cells. Human capsular bags were prepared from donor eyes and sealed with the Perfect Capsule device. 100uM Tg was introduced for 2 minutes. The bags were then perfused with EMEM and an IOL inserted before the bags were dissected and pinned to the base of plastic culture dishes and maintained in EMEM for 28 days.

Results: Continuous exposure of >100 nM Tg to FHL124 cells for 24 hours significantly inhibited both protein and DNA synthesis. A 2 minute exposure of Tg resulted in a complete loss of viable cells following 4 days of culture. A 2 minute application of 100uM Tg to the capsular bag using the perfect capsule system did not immediately eliminate the residual lens cell population, however, by 4 weeks there were no surviving cells in Tg treated bags while a confluent cover of the posterior capsule was observed in controls.

Conclusions: Thapsigargin inhibits cell proliferation and protein synthesis resulting in decreased survival rates. Application of thapsigargin at the time of cataract surgery for a 2 minute period using the Perfect Capsule system provides a promising means of preventing PCO.
Anatomy of ocular lymphatic tissue in confocal laser scanning microscopy
Authors: KNOP N , KNOP E
Published: October 2007

Purpose: A regular lymphatic tissue that belongs to the mucosal immune system of the body is present at the normal ocular surface. It is termed Eye‐Associated Lymphoid Tissue (EALT). Due to its location in the mucosal ocular surface and its high cellularity it appears very suitable for confocal microscopy as attempted here.

Methods: Confocal investigation with the digital Rostock laser scanning microscope (RLSM) based on the Heidelberg retina topograph (HRT II) was performed in human and rabbit EALT and compared to histology and electron microscopy.

Results: EALT extends from the lacrimal gland throughout the conjunctiva into the lacrimal drainage system and consists of diffusely interspersed lymphoid cells and solitary lymphoid follicles. In the human conjunctiva it can be associated with the tubes or furrow‐like epithelial crypt infoldings. RLSM showed frequent lymphocytes as bright roundish spots together with bright cells of dendritic morphology in the epithelium and in the lamina propria. Lymphoid follicles in the rabbit conjunctiva contained numerous lymphocytes within a meshwork of connective tissue fibres. Towards the surface the fibre‐meshwork increased in density and appeared finally continous with a bright layer conceivably representing the basement membrane. This contained numerous dark holes reflecting massive transmigration of lymphoid cells; sometimes bright roundish lymphocytes occured within the holes. Inside the epithelium M‐cells containing groups of lymphocytes could be clearly detected by RLSM.

Conclusions: Eye‐Associated Lymphoid Tissue (EALT) can be investigated by in‐vivo confocal microscopy (RLSM). With this technique, structural and topgraphical details of EALT are seen in a resolution that also allows the detection of single antigen transporting M‐cells.