bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful treatment of macular retinoblastoma with superselective ophthalmic artery infusion
Authors: HADJISTILIANOU T , CORIOLANI G , BRACCO S , GENNARI P , CAINI M , CERASE A , GALIMBERTI D , DE FRANCESCO S
Published: August 2012

Purpose To report our experience with superselective ophthalmic artery infusion of Melphalan (SOAIM) for macular retinoblastoma, in order to obtain tumor control while preserving as much as possible useful vision.

Methods This report concerns 5 cases with ‘naïve’ unilateral retinoblastoma involving the macula, selected from a group of patients scheduled for SOAIM as the primary treatment. Follow‐up ranged from a minimum of 6 months to a maximum of 30 months.

Results Each eye of each patient was treated with a cycle of three SOAIM procedures, made of 3‐5 mg of Melphalan per eye per treatment. SOAIM procedure was well tolerated in all 5 patients. One of the eyes was also treated with cryotherapy while all eyes underwent transpupillary thermo‐therapy and/or argon laser during or after the intra‐arterial treatment cycle. All patients are alive and free of metastatic spread. All the eyes achieved ophthalmoscopic remission of the tumor foci, showing types I to III regression, and no enucleation was necessary.Ultrasounds and fluorangiography were performed.

Conclusion SOAIM is effective for the treatment of macular retinoblastoma, when performed in adequate settings by operators with skills in angiographic diagnosis and treatment of intracranial vascular diseases. Moreover, Melphalan selectively delivered in the ophthalmic artery may allow the salvation of eyes which should otherwise be enucleated, showing a very low rate of complications due to local and systemic toxicity.
Indications for intraarterial chemotherapy in patients with advanced retinoblastoma
Authors: SAAKYAN S , JARWAH A , YAKOVLEV S , KOBYAKOV G
Published: August 2012

Purpose Despite the use of new methods of treatment for retinoblastoma their efficacy remains debatable and depends on different factors. Our aim was to determine the indications and efficacy of intraarterial chemotherapy in patients with different growth pattern in advanced retinoblastoma.

Methods For the period of last year 20 children (26 eyes) were treated for advanced and resistant retinoblastoma . 12 had monocular and 8 binocular RB. Age from 12 months to 6 years. 16 out of 20 children have had systemic chemotherapy. 13 patients have had exophytic growth and 7 – endophytic. All patients were treated with intraarterial chemotherapy with melfolan 7.5 mg (1‐3 injections).

Results We were able to preserve 21 eyes out of 26 eyes. The retrospective analysis has showed that the enucleated eyes had endophytic growth with massive seeding of tumour into the vitreous body. The best effect after chemotherapy has been observed in untreated patients with exophytic growth and juxtopapillary localization.

Conclusion Our experience shows that intraarterial chemotherapy in patients with endophytic growth of retinoblastoma has very low efficacy. The choice of method of treatment depends on tumour growth pattern, localization and duration of earlier done systemic chemotherapy.
Straylight as indication for cataract surgery
Authors: COCHENER B
Published: August 2012

We know that there are many sources of physiologic scatters such modified cornea (after refractive surgery, haze, dystrophies, ocular surface disease) , vitreous alterations and lens changes with the aging process inducing progressive cataract and impairing light diffusion. Nowadays, thanks to the access to scatter measurement, we might be able to assess tear film quality dynamics (with an increase in ocular surface desiccation commonly observed in old patients), but moreover we could detect early cataract at the stage of no induced visual acuity decrease but quality of vision degradation. We will present the preliminary results of a multicenter French study based on the use of the Double Pass Image Analyser (OQAS) for the potential diagnosis of cataract, on a standardized questionnaire of life and taking also account the integrity of ocular surface in addition to visual performances. The key parameter provided by this platform is the OSI (Ocular Surface that increases when scatters are in elevation (superior to 4). Our preliminary pilot results show a significant correlation between quality of life and OSI changes, suggesting that the objective measurement of light scatter might be of interest for detection of early cataract and that the consideration of quality of life (based on a basic questionnaire) should be considered in the modern new definition of cataract.
Clinical relevance of straylight in patients with retinitis pigmentosa
Authors: VAN BREE MCJ , VAN DEN BORN LI , VAN DEN BERG TJTP
Published: August 2012

Purpose The importance of straylight derives from the fact that it reduces retinal sensitivity. This may be particularly relevant in conditions with retinal dysfunction, such as Retinitis Pigmentosa (RP). Moreover in RP often early in life PSC cataract develops. The question of this study is whether straylight substantially contributes to visual disability in RP patients, potentially aggravated due to the combination of retinal degradation and increased straylight from cataract formation. In addition, straylight was used to predict possible benefit of (early) cataract surgery.

Methods Twenty‐five RP patients scheduled for cataract extraction (CE) participated. Before and after CE, best corrected visual acuity (BCVA) in logMAR, contrast sensitivity (CS) in log(CS), temporal contrast sensitivity (TCS) in log(TCS), and straylight (log of the straylight parameter s, log[s]) were tested. TCS, or flicker sensitivity, was tested with a new test, using the C‐Quant hardware. TCS measurement was performed to assess foveal function isolated from the eye’s optical quality.

Results Average pre CE log(s) value was 1.72, corresponding to a factor 6 straylight increase as compared to a healthy, young eye. Functionally significant improvement defined as >0.2 log, was only found for log(s). Only log(s) improvement was related to pre CE values. LogMAR and log(TCS) were correlated (pre CE r(19)= .57, p< .01; post CE ρ(19)= .47, p< .05). Pre and post CE log(TCS) values were similar (p= .14).

Conclusion Straylight effects of cataract may substantially aggravate visual disability in RP patients, whereas BCVA may (not yet) be affected. Loss of BCVA may reflect foveal function rather than cataract. For proper CE referral straylight must be assessed.
Indications and contraindications
Authors: THEOCHARIS IP
Published: August 2012

The modern vitrectomy procedures have replaced the conventional buckle operation in the treatment of rhegmatogenous retinal detachment (RRD) in the majority of cases. The present indications of buckle surgery depend on surgeon’s skills, patient to doctor communication and the availability of specialised personnel. On the other hand the contraindications such as proliferative vitreoretinopathy, thin bluish sclera, are more clear and delineate the grey zone of the preoperative dilemma ‘vitrectomy or buckle’. The presentation will try to answer why buckle surgery may be beneficial in special cases and when a modern surgeon must avoid this procedure for the treatment of a patient with RRD
Severity of colour vision loss in diabetes
Authors: ABDEL‐HAY A , SIVAPRASAD S , KONSTANTAKOPOULOU E , EDGAR DF , BARBUR JL
Published: August 2012

Purpose Vascular and structural changes in the retina are used to grade progression in diabetic retinopathy (DR) and this is often taken as an indicator of the severity of vision loss. Changes in visual function may, however, precede detectable structural damage. Red‐green (RG) and yellow‐blue (YB) thresholds were measured in patients with DR and related to their clinical grading classification.

Methods 66 patients diagnosed with diabetes were examined. DR was graded according to ETDRS severity scale as no retinopathy, mild, moderate, severe DR and presence/absence of macular oedema. Colour thresholds were measured using the CAD test (Expert Rev.Ophthalmol. 6:409‐420, 2011) together with other patient‐specific information: VA, duration of diabetes, HbA1c and central subfield (CSF) thickness, and response of macular oedema to Ozurdex intravitreal implant injection.

Results All diabetic patients showed loss of chromatic sensitivity (with mean RG and YB thresholds exceeding six times normal values). The clinical grading of disease progression showed negligible correlation with either RG (r2=‐0.0004) or YB thresholds (r2=0.052). Patients with no DR often exhibited normal visual acuity (~ 1 min arc), but showed significant loss of colour vision. Ozurdex treatment was associated with significant initial improvement in colour thresholds.

Conclusion RG and YB colour thresholds provide a sensitive measure of functional change in diabetics that does not relate well to observed vascular and structural changes. These preliminary findings also suggest that measurement of colour thresholds can be used to monitor the efficacy of treatment in diabetic macular oedema.
A novel co‐culture model of the blood‐retinal barrier based on primary retinal endothelial cells, pericytes and astrocytes
Authors: SCHLINGEMANN RO , WISNIEWSKA‐KRUK J , VOGELS IM , VAN NOORDEN CJF , KLAASSEN I
Published: August 2012

Purpose Loss of blood‐retinal barrier (BRB) is an important cause of diabetic macular edema (DME), but cellular mechanisms underlying BRB dysfunction are poorly understood. Therefore, we developed and characterized a novel in vitro BRB model.

Methods The model is based on primary bovine retinal endothelial cells(BRECs).These cells were shown to maintain specific in vivo BRB properties by expressing high levels of endothelial junction proteins and specific BRB transporters. To investigate the influence of pericytes and astrocytes on BRB maintenance in vitro, we compared five different co‐culture BRB models, based on BRECs, bovine retinal pericytes (BRPCs) and rat glial cells.

Results Co‐cultures of BRECs with BRPCs and glial cells showed the highest trans‐endothelial resistance (TEER) as well as decreased permeability of tracers, even after vascular endothelial growth factor (VEGF) stimulation, suggesting a major role for these cell types in maintaining barrier properties. To mimic the in vivo situation of DME, we stimulated BRECs with VEGF, which downregulated MDR1 and GLUT1 mRNA levels, transiently reduced expression levels of endothelial junctional proteins and altered their organization, increased the number of intercellular gaps in BRECs monolayers and influence the permeability of the model to differently‐sized molecular tracers. Moreover, as has been shown in vivo, expression of plasmalemma vesicle‐associated protein (PLVAP) was increased in endothelial cells in the presence of VEGF.

Conclusion This in vitro model is the first co‐culture model of the BRB that mimicks in vivo VEGF‐dependent changes occurring in DME.
Subthreshold micropulse photocoagulation with true yellow 577nm diode laser for macular oedema
Authors: FRUSCHELLI M , SPARAGNA MC , DENARO R , MENICACCI F , ESPOSTI G , ESPOSTI PL
Published: August 2012

Purpose Subthreshold, or tissue sparing, Diode Micropulse Photocoagualtion (SDM) is a treatment used to produce a therapeutic effect without inducing detectable intraretinal damage. Actually treatment options are available for diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), central serous chorioretinopathy (CSR), macular edema secondary to branch retinal vein occlusion (BRVO), and even glaucoma.

Methods We used micropulse technology with 577nm yellow diode laser to produce a therapeutic effect without inducing intraretinal damage detectable on clinical examination during or after the treatment. All patients were affected by clinically significative macular edema (CSME) due to diabetic retinopathy, venous branch retinal occlusion and central serous retinopathy.

Results Controls prefomed at 1, 3 and 6 months showed no detectable retinal scars in any case. Foveal thickness decreased in all patients, visual acuity remained stable (<10 ETDRS letters) or improved (≥10 ETDRS letters).

Conclusion The results of our study indicate that, in the treatment of CSME due to PDR, BRVO and CSR,SDM photocoagulation is at least as effective as conventional photocoagulation without any clinically discernible evidence of laser‐induced iatrogenic damage.
Is a synthetic lamina the ultimate goal for osteo‐odonto‐keratoprosthesis (OOKP) surgery? Options for the edentulous patient who require OOKP surgery
Authors: LLOYD A , AVADHANAM V , SANDEMAN S , LIU C
Published: August 2012

Purpose To list the options for an edentulous patient requiring OOKP surgery for rehabilitating corneal blindness.

Methods Literature review, personal experience, and theoretical considerations.

Results Options include an OOKP allograft from a living (related or unrelated) donor which necessitate systemic immunosuppression, a tibial bone allograft (depends on good bone density), and a Pintucci (Dacron) keratoprosthesis. None of these has the longevity of an OOKP proper. Other options, as yet not properly studied, include cadaveric OOKP allografting, and synthetic OOKP analogues. The latter has the advantage of the possibility of mass manufacture, no risk of transmission of blood‐borne infections, and no size constraints limiting optical cylinder design.

Conclusion Options do exist for the edentulous patient requring OOKP surgery for rehabilitation of corneal blindness. In the long term, the synthetic OOKP analogue holds the best promise.
Plastic compressed collagen as a biomimetic substrate for human limbal epithelial culture
Authors: DANIELS JT
Published: August 2012

Abstract not provided
Choroidal blood flow in central serous chorioretinopathy (CSC)
Authors: FUCHSJAGER‐MAYRL G , PALKOVITS S , BOLTZ A , WERKMEISTER R , TOLD R , SCHMETTERER L
Published: August 2012

Purpose Central serous chorioretinopathy (CSC) has been linked to alterations in perfusion and metabolism. In the present study we investigated arterial and venous oxygen saturation in patients with active CSC and compared it to the data in healthy subjects.

Methods A total of 13 subjects with active CSC and 13 healthy age‐ and sex‐matched control subjects were included in this study. Retinal arterial and venous oxygen saturation was measured in an annular area centered at the optic disk using the Imedos Oxygen Module for the Retinal Vessel Analyzer (RVA).

Results No significant difference was observed between the patients with CCS and healthy control subjects. This was the case for retinal arterial oxygen saturation (95.0 ± 4.5 % in patients with CCS, 96.2 ± 4.2 %; p = 0.463) and for retinal venous oxygen saturation (66.6 ± 5.5 % in patients with CCS, 63.7 ± 6.1 %; p = 0.392).

Conclusion Previous studies have shown that CSC is associated with abnormalities in choroidal blood flow regulation. Our data indicate, however, that retinal oxygenation is normal in CSC patients during the active phase.
Volumetric flow rate of ophthalmic artery in healthy individuals using a new magnetic resonance imaging technique
Authors: JóHANNESSON G , AMBARKI K , HALLBERG P , LINDéN C , ZARRINKOOB L , WåHLIN A , BIRGANDER R , MALM J , EKLUND A
Published: August 2012

Purpose To measure the volume flow rate of the ophthalmic artery (OA). A phase contrast magnetic resonance imaging (PCMRI) protocol was developed to assess volume flow rate of OA in healthy young (HY) and elderly (HE).

Methods The study was performed with a 3‐Tesla scanner on HY (n=51,28females,age=64‐80ys) and HE (n=51,28females,age=21‐30ys). The OA were localized by a 3D time of flight (3DTOF) sequence. To measure the volume flow rate, a 2D PCMRI sequence was optimized to reach a spatial resolution of 0.35mm/pixel. Based on 3DTOF data, the flow measurement was perpendicular to OA. Mean volume flow rate (Qmean), resistive index (RI), arterial volume change (ΔV) and symmetry index (SI) were computed from the volume flow rate curve. Accuracy of MRI measures was studied using a vessel‐phantom (Ø=1.4mm). Six constant flow rates (5.54‐34.41mL/min) were used as reference.

Results Phantom investigation showed good agreement between the reference and MRI measurements with a percentage error <7%. The mean and SD of RI (HE:0.68±0.08; HY:0.63±0.09), ΔV (HE:26.35±14.03uL; HY:18.51±7.23uL) and SI (HE:0.58±0.03; HY:0.63±0.03) of OAs volume flow rate curve were significantly higher in the elderly group compared to the young group (RI,p<0.05; ΔV,p<0.001; SI:p<0.001). No statistical difference was found in Qmean between HE(10.91±5.44mL/min) and HY (10.27±4.46mL/min) individuals (p>0.05).

Conclusion Volume flow rate measurement of OA vessels using PCMRI is possible. Contrary to color Doppler imaging, PCMRI technique does not alter IOP during the measurements. This method may provide a precise description of the dynamics of the volume flow rate of OA during the cardiac cycle.
Retinal vascular caliber is associated with renal function in normotensive and never‐treated hypertensive subjects
Authors: DAIEN V , KAWASAKI R , VILLAIN M , FESLER P
Published: August 2012

Purpose The aim of this study was to assess the relation between retinal vascular caliber and renal function in normotensive (systolic/diastolic blood pressure <140/90 mmHg) and never‐treated uncomplicated hypertensive subjects.

Methods Eighty subjects (51 normotensive and 29 hypertensive , mean age 47 yrs and 51% female) with serum creatinine < 1.2 mg/dL and without diabetes were recruited. Retinal vascular calibers were measured from fundus photographs and expressed as central retinal artery and venular equivalent (CRAE and CRVE, respectively). Renal function was assessed by measurement of glomerular filtration rate (GFR, urinary clearance of 99mTc‐DTPA) and urinary albumin/creatinine ratio (UACR).

Results Mean GFR was 117 ml/min/1.73m². The adjusted mean CRAE was smaller in the hypertensive group as compared to the normotensive group (mean±standard error: 135±24µm vs. 142±18µm; P=0.03); whereas adjusted mean CRVE was similar. In all participants, CRAE and CRVE were positively correlated to GFR (r²=0.09, P=0.005 and r²=0.09, P=0.006, respectively). In addition, CRAE was negatively correlated to UACR (r²=0.12, P=0.02) and no significant relationship between CRVE and UACR was found (r²=0.01, P=0.31). The observed relations between retinal vascular calibers (CRAE and CRVE) and renal function parameters (GFR and UACR) remained significant after adjusting for age, gender, mean blood pressure, smoking, glycemia, body mass index and lipid profile.

Conclusion In normotensive and never‐treated hypertensive subjects with normal renal function, the decrease in retinal arteriolar and venular calibers was associated with reduced kidney function, suggesting common determinants of these preclinical target organ damages.
Role of nitric oxide in optic nerve head blood flow regulation during experimental increase of intraocular pressure in healthy humans
Authors: SCHMIDL D , BOLTZ A , KAYA S , PALKOVITS S , TOLD R , FUCHSJAEGER‐MAYRL G , WERKMEISTER R , GARHOFER G , SCHMETTERER L
Published: August 2012

Purpose Several studies have indicated that the choroid shows some regulatory potential during changes in ocular perfusion pressure (OPP). For the optic nerve head (ONH) only few data are available. The present study set out to investigate the behavior of ONH blood flow (ONHBF) during an experimental decrease in OPP and to explore whether inhibition of Nitric Oxide Synthase (NOS) alters this response.

Methods Twelve healthy subjects participated in this randomized, double‐masked, placebo‐controlled three‐way crossover study. For each subject, three study days were scheduled, on which they either received intravenous infusions of NG‐monomethyl‐ L‐arginine (L‐NMMA), phenylephrine, or placebo. OPP was increased stepwise by the suction cup method. ONHBF was assessed continuously with laser Doppler flowmetry and OPP was calculated as 2/3*mean arterial pressure‐intraocular pressure.

Results Administration of L‐NMMA and phenylephrine significantly increased resting OPP compared to placebo (p<0.001 and p=0.016, respectively). As expected, L‐NMMA decreased resting ONHBF compared to phenylephrine (p=0.04). The relative decrease in OPP during suction cup application was comparable with all drugs administered (between ‐69% and ‐72%, p=0.19). In all three groups, the decrease in ONHBF was less pronounced than the decrease in OPP, but not significantly different between groups.

Conclusion The present data indicate that NO plays an important role in the regulation of basal ONHBF, but not in ONHBF autoregulation.
Eye motion increases temporal visual field extent
Authors: DENION E , DUGUE AE , COFFIN‐PICHONNET S , AUGY S , MOURIAUX F
Published: August 2012

Purpose To study the impact of eye motion on visual field extent.

Methods Visual fields were tested in 15 healthy volunteers with the Goldmann perimeter using a V4 test‐object, from seen to unseen, first in primary position of gaze, then allowing eye motion. Temporal points falling out of the cupola were tested again after a controlled nasal head rotation using a headband prototype fitted with a line‐laser level having two orthogonal vial levels. Visual field surface areas (cm2) were calculated as projections on a 30 cm virtual Goldmann cupola whose extent would have been large enough to include all points. Reproducibility error of the method assessed by calculation of the relative difference between surface areas of 12 visual field tests and 12 visual field retests was estimated at 14%. Hertel exophthalmometry was recorded to study the influence of globe position on visual field extent.

Results Binocular visual field surface area increased by 37% with eye motion (p‐value = 1.20.10‐9). This increase was highest (46%; p‐value = 1.2.10‐24) in the temporal quadrant. Median maximal visual field temporal excentration with eye motion was 128.3° (minimum: 109.5°; maximum: 137.7°) and more than 135° in 4 eyes of three subjects. Hertel exophthalmometry was positively linked to visual field temporal surface area with eye motion (p‐value = 0.013).

Conclusion Eye motion greatly expands the temporal visual field. This peculiarity is likely an adaptation to terrestrial life with upright bipedal locomotion, and may save head movements through horizontal eyeball scanning.
How to get your work published ?
Authors: DUA H
Published: August 2012

Abstract not provided
Cataract surgery in uveitis
Authors: MONNET D , BREZIN A
Published: August 2012

Abstract not provided
Vitreo‐retinal surgery in uveitis
Authors: BEHAR‐COHEN F
Published: August 2012

Abstract not provided
Heritage of Ophthalmology: a Philatelic view
Authors: ZEYEN T
Published: August 2012

Stamp collecting is one of the world’s most popular hobbies. Many collectors limit their scope to particular countries or themes. For obvious reasons I chose to collect stamps related to ophthalmology. Searching for them and learning about their back story has been a pleasant way to discover parts of the heritage of ophthalmology. I will present photographs of a selection of my stamps introducing our forerunners, showing famous ophthalmologists, ophthalmologists who chose a different path and well‐known blind people, representing eye diseases and aids for blind, and commemorating important congresses.
Comparison of intraocular pressure measurements with the reichert pt100, the keeler pulsair intellipuff portable non‐contact tonometers and goldmann applanation tonometry
Authors: APTEL F , HUBANOVA R , ZHOU T , ARNOL N , CHIQUET C , ROMANET JP
Published: August 2012

Purpose To compare the intraocular pressure (IOP) measurements by two portable tonometers, the Keeler Pulsair Intellipuff™ and the Reichert PT100™, with Goldmann applanation tonometry (GAT).

Methods Prospective cross‐sectional study conducted on normotensive and hypertensive patients. IOP was measured by the two portable non‐contact tonometers and GAT in one eye of each patient in a random order. The Wilcoxon test was used to compare the differences between tonometers, the Spearman correlation test to evaluate the correlation among the methods, and Bland–Altman plots and intra‐class Correlation Coefficient (ICC) to evaluate the agreement among the methods.

Results 137 eyes of 137 patients were included. We found an excellent agreement (ICC > 0.75) between PT100™ and GAT and between Intellipuff™ and GAT in normotensive patients. We found a fair to good agreement (ICC 0.67) between PT100™ and GAT in hypertensive patients. The agreement we found between Intellipuff™ and GAT was also excellent in hypertensive patients (ICC 0.83). The differences between the measurements of the two non‐contact tonometers and the GAT were significantly correlated to the central CCT.

Conclusion The two non‐contact tonometers agree well with GAT in normotensive patients. The Pulsair Intellipuff™ agrees also well with GAT in hypertensive patients.
Comparation between Keeler and ORA IOP measurements
Authors: LOPEZ DE LA FUENTE C , SANCHEZ‐CANO A , PINILLA I , FUENTES BROTO L , SEGURA CLAVO F
Published: August 2012

Purpose To evaluate the relationship between intraocular pressure (IOP) measurements obtained with Pulsair EasyEye (PEE) and Ocular Response Analyser (ORA) in healthy subjects.

Methods Sixty‐five eyes from 65 healthy subjects were prospective and consecutively evaluated. All of them underwent a full optometric examination, including central corneal thickness (CCT), and IOP measured with both PEE and ORA devices. Differences between IOP measurements between both tonometers were analyzed.

Results Statistically differences were found between IOP measurements of PEE (IOPk) and ORA Goldmann‐corrected IOP (IOPg; p=0.001). IOPk and ORA corneal resistance‐corrected IOP (IOPcc) were also statistically different (p=0.025). However, no differences between IOPg and IOPcc were found (p=0.952). Mean differences between IOPg‐IOPk, IOPcc‐IOPk and IOPg‐IOPcc (±SD) were 0.71±1.66, 0.70±2.46 and 0.01±1.54 mmHg respectively. Pearson correlation coefficients showed that IOPk, IOPg, IOPcc were significantly correlated (p<0.001): r=0.816 for IOPk‐IOPg, r=0.826 for IOPcc‐IOPg and r=0.587 IOPcc‐IOPk.

Conclusion There are statistically differences between mean IOP values measured with PEE and ORA. ORA tonometer provides higher IOP values than PEE in most of the cases. IOPk, IOPcc and IOPg have, at least, moderate positive linear correlations between them.
Persistent ocular hypertension following intravitreal injections of anti‐VEGF agents or dexamethasone intravitreal implant
Authors: AGARD E , ELCHEHAB H , RUSSO A , RACT MADOUX G , SWALDUZ B , DUSSART C , DOT C
Published: August 2012

Purpose To report the rate of intraocular pressure elevation following repeated intravitreal injections (IVI) of anti‐VEGF agents or dexamethasone intravitreal implant and to determine the risk factors.

Methods A prospective study of 166 eyes undergoing IVI of ranibizumab (n=126), bevacizumab (n=19), or dexamethasone implant (n=12) was carried out. A total of 886 IVI were performed. The development of ocular hypertension (OHT) following these injections was investigated with respect to number of injections, pre‐existing glaucoma, diabetes and YAG capsulotomy.

Results After a mean of 5.34 +/‐ 5.1 IVI (range, 1‐30), 8.4% (n=14) had IOP elevation above 25 mmHg and required medical treatment (3% of them peaked above 30mmHg).Patients with pre‐existing glaucoma experienced highter rates of OHT were compared to patients without pre‐existing glaucoma (21.7mmHg +/‐12.4 versus 17.23mmHg +/‐4.5, p=0.06). No significant difference was found in diabetes subgroup (n=40, p=0.32), nor in YAG capsulotomy subgroup (n=12, p=0.8) compared to the control group. The peak of IOP was significatively correlated with the total number of IVI (p=0.01, R=0.19).The mean highest IOP was 17.2mmHg in ranibizumab group, 18.8mmHg in bevacizumab group and 19.9mmHg in dexamethasone intravitreal implant. No difference was found between these molecule subgroups (Kruskal‐Wallis p=0.38).

Conclusion Serial intravitreal injections may lead to persistent IOP elevations that require IOP lowering therapies. This risk is correlated with the number of injections and must be checked during the follow‐up. Pre‐existing glaucoma could be a risk factor but larger prospective studies are needed to verify these results.
Reproducibility of retinal nerve fiber layer parameters measured with scanning laser polarimetry in healthy eyes
Authors: BAMBO M , PRIETO E , DE LA MATA G , FERNANDEZ‐PEREZ S , SATUE M , GARCIA‐MARTIN E , FERRERAS A
Published: August 2012

Purpose To determine the variability of retinal nerve fiber layer (RNFL) parameters measured with scanning laser polarimetry (SLP) with enhanced corneal compensator (GDx ECC) in healthy eyes.

Methods Eighty‐two healthy individuals were prospectively selected. Only one eye per subject was randomly included in the study. All participants had intraocular pressure less than 21 mmHg and normal standard automated perimetry (Humphrey 24‐2 SITA Standard). Peripapillary RNFL parameters were measured using the GDxPRO (Carl Zeiss Meditec, Dublin, CA) 3 consecutive times on the same session. Left eye data were converted to a right eye format. The same operator performed all acquisitions with the same device. Intraclass correlation coefficient (ICC), coefficient of variation (COV), and test‐retest variability were calculated for all SLP parameters: TSNIT average, superior average, inferior average, TSNIT standard deviation and the nerve fiber indicator (NFI).

Results Mean age was 56.08 ± 9.4 years. The ICC was higher than 0.928 for all SLP parameters. The TSNIT average had the highest ICC (0.967), while the TSNIT standard deviation showed the lowest ICC (0.928). The COVs ranged from 2.4% (TSNIT average) to 21.8% (NFI). Test‐retest variability was 6.55 for the NFI and 2.51 for the TSNIT average.

Conclusion The reproducibility of RNFL measurements acquired with the GDxPRO was excellent. Variability was higher for NFI than for other SLP parameters.
Stereometric parameters change vs. HRT Topographic Change Analysis (TCA) agreement in early detection of glaucoma progression
Authors: POPA CHERECHEANU A , DASCALU AM , SERBAN D , STANA D
Published: August 2012

Purpose To investigate the sensitivity and specificity of the stereometric parameters change analyses vs. TCA in early detection of glaucoma progression.

Methods 81 patients with POAG were monitored for 4 years: GAT (monthly), SAP (every 6 months), optic disc photographs and HRT3 (yearly). The exclusion criteria were optic disc or retinal pathology that might interfere with the detection of glaucoma progression, TSD >30 and inter‐test variation of RH above 25 μm for all HRT exams. The criterion for structural progression was considered at least 20 adjacent super‐pixels with clinically significant decrease in height (>5%).

Results 16 patients of total 81 presented structural progression on TCA. The most useful stereometric parameters for early detection of glaucoma progression were: Rim Area change (sensitivity 100%, specificity 74.2% for a “cut off” value of ‐0.05), C/D Area change (sensitivity 85.7%, specificity 71.5% for a “cut off” value of 0.02), C/D linear change (sensitivity 85.7%, specificity 71.5% for a “cut off” value of 0.02), Rim Volume change (sensitivity 71.4%, specificity 88.8% for a “cut off” value of ‐0.04). RNFL Thickness change (<0) was highly sensitive (82%), but less specific for glaucoma progression (45,2%). The changes of the other stereometric parameters have a limited diagnostic value for early detection of glaucoma progression.

Conclusion TCA is a valuable tool for assessing structural progression in glaucoma patients and its inter‐test variability is low. On long‐term run quantitative analysis by stereometric parametres change is also very important. The present study shows that the most relevant parameters to detect progression are RA, C/D Area, Linear C/D and RV.
Efficacy and safety assessment of preservative‐free latanoprost (T2345) versus Xalatan™ in ocular hypertensive or glaucomatous patients
Authors: ROULAND JF
Published: August 2012

Purpose To assess the efficacy on intraocular pressure (IOP) and safety of preservative‐free latanoprost (T2345) versus BAK‐preserved latanoprost (Xalatan™) for the treatment of open‐angle glaucoma (POAG) and ocular hypertension (OHT), through 2 clinical trials (phase II and III).

Methods A pilot phase II, cross‐over, 6‐week study with plasma samples was conducted in (2x15) patients. In an international investigator‐masked, phase III study, 402 patients with POAG or OHT already controlled by Xalatan™ were randomized to receive either T2345 or Xalatan™ for 3 months, after a 5‐week run‐in period with brinzolamide and a 5‐day wash‐out period so as to achieve an IOP ≥ 22 mmHg at baseline. The main primary endpoint was the change in IOP at 9:00 am between D0 and D84 in the worse eye. Safety parameters were also assessed.

Results The mean IOP was reduced from baseline to D84 by 36% with T2345 (‐8.6 ± 2.6 mmHg) and 38% with Xalatan™ (‐9.0 ± 2.4 mmHg). These results met the limits set for non‐inferiority of T2345 to Xalatan™. Conjunctival hyperaemia was less frequent on T2345 at D42 and D84 (20% vs. 30% on Xalatan™). Upon instillation, the subjective ocular symptom score was lower on T2345 than on Xalatan™ (p=0.001). The phase II study showed comparable efficacy on IOP of both products during the whole day (8am, 12am, 4pm and 8pm). After instillation, AUC(0‐30) was 1086 ± 509 pg.min/mL on T2345 and 1379 ± 784 pg.min/mL on Xalatan™, suggestive of lower plasma concentrations of latanoprost on T2345 treatment (p=0.036).

Conclusion T2345 is the first preservative‐free formulation of latanoprost, stable at room temperature, showing a non‐inferior IOP lowering efficacy compared to Xalatan™, with improved local tolerance.
Angle closure glaucoma associated with venlafaxine treatment
Authors: TURCOTTE S , FREDETTE MJ
Published: August 2012

Purpose Despite its very weak anticholinergic profile, there are few case reports linking venlafaxine treatment with angle closure glaucoma. One of the principal pathophysiological mechanisms suggested is through supraciliary effusions.

Methods We report a case of an 86 year old patient who presented with progressive symptoms of angle closure glaucoma in her left eye. Venlafaxine treatment had been started one week prior to presentation. Intraocular pressures were initially 22 mmHg in the right eye and 59 mmHg in the left eye. Ultrasound biomicroscopy (UBM) and gonioscopic exams were performed to better identify the pathophysiologic mechanism of her glaucoma.

Results Gonioscopy demonstrated a closed angle in the left eye and a narrow angle in the right eye. Venlafaxine was discontinued and an anti‐glaucomatous treatment was started. There was bilateral resistance to 2% pilocarpine at presentation which subsided 48 hours after venlafaxine cessation. UBM demonstrated a plateau iris configuration with absence of supraciliary effusions.

Conclusion To our knowledge, this is the first case describing angle closure glaucoma associated with venlafaxine treatment, where there is a documented bilateral resistance to pilocarpine and an UBM demonstrating a plateau iris configuration with absence of ciliary body effusions. These findings suggest a mydriatic mechanism for our patient’s glaucoma. The weak anticholinergic properties and the noradrenergic effect associated with venlafaxine could precipitate angle closure glaucoma without supraciliary effusions in a patient who is at risk for this condition.
Ex‐press glaucoma shunt for the treatment of complex glaucoma
Authors: ANSARI E
Published: August 2012

Purpose To assess the safety and efficacy of Ex‐PRESS Mini glaucoma (EMG) shunt for the surgical treatment of complex glaucoma.

Methods EMG shunt was inserted in the following cases of complex glaucoma: Failed glaucoma drainage surgery Multiple co‐morbidity /high risk (proliferative diabetic retinopathy,neovascular glaucoma, vitreo‐retinal surgery, OSD). Surgical procedure was in accordance with published methods. 10 cases of complex glaucoma were reviewed retrospectively over aperiod at least 6 months following surgery. The end‐points were: intraocular pressure (IOP) number of glaucoma drops used visual acuity Unqualified success was defined as IOP < 19 mmHg without glaucoma drops, and qualified success was IOP < 19 mmHg with the use of drops. Complications were noted.

Results 7 cases (70%) were successful at a mean of 6 months post operatively without drops with a mean IOP of 11.6mmHg (sd 1.6mmHg). 3 cases required drops to achieve the target IOP, the mean IOP being 18.7mmHg (sd 0.8 mmHg) with a mean of 1.3 glaucoma medications required at 6 months post‐operatively. (3.7 pre‐op 1.3 post‐op, p<0.05) Cases requiring additional topical treatment had ocular co‐morbidity.

Conclusion EMG shunt was safe and effective in controlling IOP in complex cases of glaucoma EMG shunt was relatively easy to insert with a minimum of post‐operative manipulations The IOP was stable and predictable at 6 months; the IOP was reduced significantly at 6 months (p<0.05) with a significant reduction in medications (p<0.05) Multiple co‐morbidities were associated with less chance of unqualified success Although a small cohort, the experience so far in treating complex cases with EMG shunt has been very encouraging and the study is continuing with more data being collected
Changes in anterior segment after‐iridotomy with nd: yag laser for narrow angle measured with spectral domain OCT
Authors: IBANEZ J , PEREZ GARCIA D , JIMENEZ DEL RIO B , RAMIRO P , MATEO J , ASCASO F , CRISTOBAL JA
Published: August 2012

Purpose To evaluate the anterior chamber variations after‐iridotomy with Nd: Yag laser in eyes with narrow angle.

Methods Twenty one patients with shalow anterior chamber were studied. Spectral domain OCT (Heidelberg, Germany) was performed before and seven days after laser peripheral iridotomy treatment in all cases. Spetial attention was taken to evaluate angle changes. Main measures were: anterior chamber volumen, central anterior chamber depth and temporal angle wide.

Results Thirty two eyes of twenty one patients , 15 females and 6 males, age average 66.28 years old were measured. The preoperative angle wide at the temporal angle was 25.9 ± 4,8 degrees and postoperative was 27.1 ± 10 degrees. Morphological changes were evident with a deeper chamber and disruption in iris parenchyma.

Conclusion Spectral domain OCT is a potential tool to evaluate changes in anterior chamber in narrow angle someted to iridotomy with Nd: Yag laser. The procedure is effective to increase anterior chamber volumen, central anterior chamber depth and angle wide in all cases.
Experimental application of high‐frequency electric welding of biological tissues for iridoplasty and trabeculectomy
Authors: ZADOROZHNYY O , PASYECHNIKOVA N , NAUMENKO V , LAZAR Y
Published: August 2012

Purpose To estimate the possibility of using of high‐frequency electric welding of biological tissues for iridoplasty and trabeculectomy in the experiment.

Methods In experiment we used devices and instruments made by the original method in the E.O.Paton Electric Welding Institute. Experimental studies in vitro were performed on the isolated porcine eye. After dissection of the iris edges of the cut combined with a bipolar instrument. In the second phase studied the possibility of using the method of high‐frequency electric welding (frequency ‐ 66 kHz ‐ 440 kHz) for trabeculectomy with monopolar electrode, which was injected into the anterior chamber through the corneal incision. The second electrode was fixed to the sclera with special clip. For experiment in vivo we used 10 chinchilla rabbits. Morphological studies of the samples were performed.

Results We have observed the formation of solid welded connection of cut edges of the iris. In vitro trabecular tissue of the anterior chamber angle was removed using different settings. In vivo during iridoplasty observed minimal changes in the surrounding tissues in the area of electrical effects. It was also noted the formation of solid welded connection of iris edges. In vivo were removed structures of the anterior chamber angle of the rabbit without bleeding complications.

Conclusion These results indicate the possibility of using the method of high‐frequency electric welding of biological tissues for microsurgery of the eye trabecular apparatus and iris. Requires further study of the characteristics of the developed method for working out the optimal parameters of exposure.
Ultrasonic circular cyclo coagulation in patients with primary open‐angle glaucoma: preliminary results of a multicenter clinical trial
Authors: APTEL F , DENIS P , ROULAND JF , NORDMANN JP , LACHKAR Y , RENARD JP , SELLEM E , BAUDOUIN C , BRON A
Published: August 2012

Purpose To evaluate the efficacy and safety of the Ultrasonic Circular Cyclo Coagulation (UC3) procedure in patients with primary open‐angle glaucoma (POAG).

Methods Prospective multicenter clinical trial. 39 eyes of 39 patients with POAG, intraocular pressure (IOP) > 21 mmHg, an average of 1.65 failed previous surgeries and an average of 3.2 hypotensive medications were insonified with a probe comprising 6 piezoelectric transducers. 18 patients (group 1) were treated with a 4 seconds exposure time for each shot and 21 patients (group 2) with a 6 seconds exposure time. Follow‐up visits were performed at 1 day, 1 week, 1, 2, 3, 6 and 12 months after.

Results IOP was significantly reduced in both groups (p<0.05), from a mean preoperative value of 28.9 ± 6.8 mmHg in group 1 and 29.2 ± 6.9 mmHg in group 2 to a mean value of 18.1 ± 4.4 mmHg in group 1 and 16.1 ± 8,5 mmHg in group 2 at last follow‐up. Success (IOP reduction >20%) was achieved in 15 of 18 (83%) eyes of the group 1 with an average of IOP decrease of 42% and in 19 of 21 (90%) eyes of the group 2 with an average of IOP decrease of 49%. No major intra‐ or post‐operative complications occurred.

Conclusion UC3 seems to be an effective and well‐tolerated method to reduce intraocular pressure in patients with POAG.

Commercial interest
Efficacy of pneumatic trabeculoplasty in patients with primary open angle glaucoma and ocular hypertension in combination with prostaglandin monotherapy
Authors: MARTY A , BECCAT S , AMARI E , NORDMANN JP , DENIS P
Published: August 2012

Purpose To evaluate the safety and efficacy of pneumatic trabeculoplasty (PNT), a non invasive treatment to lower intraocular pressure (IOP), in patients with primary open angle glaucoma or ocular hypertension under prostaglandin monotherapy.

Methods 38 patients were enrolled from may 2009 to october 2010 to determine the IOP lowering effects of PNT. All the eyes had been diagnosed primary open angle glaucoma (87%) or ocular hypertension. PNT was performed in one or both eyes at day 0, 7, 90 and 180. Assessments were peformed at day 0,7, 45, 90 and 180 including visual acuity, IOP by goldmann tonometer, slit lamp examination and optic disc evaluation. Safety was adressed at all visits. A 15% reduction of IOP defined responder patients.

Results Mean IOP before PNT was 23.21 +/‐ 2,92 mmHg. 57 eyes were treated and analysed. All patients completed 6 months of follow up. After PNT, a statistically significant reduction of IOP occured at all visits: at days 7, 45, 90, 180, IOP was 19,92+/‐5,05, 19,32+/‐5,22, 18,89+/‐5,00, 17,76+/‐4,81 mmHg (p<0,05). The IOP decrease was up to 23,4% at day 180. The rate of responder patients was 54,4% after one week and 76,4% at day 180. After 6 months, 76% patients had IOP reduction more than 15%, 69% more than 20%, 51% more than 25% and 46% more than 30%. Side effects such as conjunctival hyperhaemia, subconjunctival hemorrhage and corneal epithelium disorder occured. No significant complications were observed.

Conclusion PNT seems to be a safe technique allowing a significant IOP reduction with prostaglandin monotherapy. It could be helpful especially in patients having troubles in following their local treatment correctly.
Experimental glaucoma model using polyurethane microbeads in rats
Authors: KIM C , RHO S , LEE N , LEE C , KIM N , PARK S , CHOI B
Published: August 2012

Purpose To establish a new experimental glaucoma model using intracameral injection with various microbeads of different sizes and materials.

Methods Chronic elevation of intraocular pressure (IOP) was induced by unilateral microbeads injection into the anterior chamber of Sprague‐Dawley (SD) rats. The effectiveness of different materials (polymethylmethacrylate (PMMA, 7 and 15 µm), polyurethane (PU, 7 and 17 µm), Silica (13 µm)) on IOP elevation was compared. Reinjection of the microbeads was performed at post‐injection day 7. Difference of IOP between both eyes was observed for 4 weeks. Axonal degeneration was assessed by the analysis of light microscopic and transmission electron microscopic photos.

Results Total 54 SD rats weighing 250~300g initially were included in this study. After a single injection, the ratio of increased IOPs (mean value) at post‐injection day 3 were 56.6 %, 24.1 %, 23.8 %, 98.1 %, and 153.0 % in PMMA 7 µm, PMMA 15 µm, PU 7 µm, PU 17 µm, and Silica 13 µm, respectively. Since inter‐animal variability of PU 17 µm injected group was smaller than others, so that it was more adequate to produce constant IOP elevation with good repeatability (whereas Silica injected eyes showed severe inflammation). Sustained elevation of IOP by twice of PU 17 µm injection for at least 4 weeks resulted in approximately a 25.5 % loss of axon density (p=0.023, Mann‐Whitney U test). No axonal damage was noted in safety study group.

Conclusion These data supports that the polyurethane microbeads injection is an applicable and versatile model for high tension glaucoma in rats. Among several biomaterials, PU showed more stable IOP elevation with safety. Future studies about suitable size and biomaterial of microbeads are more needed to secure this novel model.
Experimental glaucoma model in two lines of rats using polystyren microspheres (Bead Model)
Authors: SMEDOWSKI A , PIETRUCHA‐DUTCZAK M , WYLEGALA E , LEWIN‐KOWALIK J
Published: August 2012

Purpose The purpose of this study is to develop a method to get simple and reproducible rodent glaucoma model in rats of Wistar and Long‐Evans line. The intraocular pressure (IOP) and loss of number of retinal ganglion cells (RGCs) were measured to evaluate the success of model.

Methods 20 male rats were used in this study. 7 of them were excluded because of incidence of eye inflammation. Finally 13 rats (6 Wistar rats and 7 of Long‐Evans lines with a mass about 200 g) were included. IOP was elevated by injection of polystyrene microbeads into the anterior chamber and measured by Icare TonoLab. For each rat, the right eye was treated with different combinations of polystyrene microspheres with a diameter of 6 and 1 um separately and the left eye was treated as a control. RGCs were labeled retrogradely with a fluorescent marker “FluoroGold” 5 days before euthanasia and after harvested and made slices for a counting of surviving ganglion cells.

Results Mean intraocular pressure (IOP) of examined group was 24 mmHg ± 5,4. The highest IOP appeared after injection on 3rd day, and rose a bit lasting till 21st day. The mean IOP in contralateral eyes during experiment was 10,8 mmHg ± 0,5. Mean number of RGCs in eyes with elevated IOP was 3014±655 cells (semiquantitative method was used). In control group it was 4106±852 cells. In examined group values of IOP were significantly higher and number of RGCs was significantly lower according to control eyes.

Conclusion“Bead model” method could be used to create rat model of glaucoma with stable increasd IOP. The different size microspheres could provide the IOP with the desired values.