bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetics and Diagnostics of Retinitis Pigmentosa
Authors: CREMERS FPM , NEVELING K , ESTRADA‐CUZCANO A , VELTMAN JA , SCHEFFER H , KLEVERING BJ , DEN HOLLANDER AI , COLLIN RWJ
Published: December 2011

Purpose To utilize next generation sequencing (NGS) and identity‐by‐descent mapping to identify mutations in known and new genes in patients with autosomal recessive (ar) or isolated (i) retinitis pigmentosa (RP).

Methods We employed Roche 454‐NGS to screen the exons of 111 inherited retinal disease (IRD) genes in 12 IRD patients with known compound heterozygous variants and 100 unsolved ar/i RP patients. We used identity‐by‐descent mapping and SOLiD‐NGS to identify novel genes for arRP. We carried out segration analysis in the relevant families using Sanger sequencing.

Results The NGS approach enabled us to robustly identify 21/24 known IRD‐associated variants. Taking into consideration that a proportion of the RP patients was previously screened for mutations in selected genes, we could solve 55 ar/i RP cases. Mutations were identified in arRP genes (n=45), X‐linked RP genes (n=4), and autosomal dominant RP genes (n=6). In at least 4 families de novo mutations were found. Targeted NGS of exons in selected chromosomal regions based on homozygosity mapping enabled us to identify at least one novel arRP gene. The interpretation of sequence variants derived from whole genome exon (exome) sequencing heavily depends on positional information (linkage analysis, homozygosity mapping).

Conclusion NGS can be used for comprehensive mutation scanning of known IRD genes and for the identification of novel IRD genes. The known RP genes contain 55% of the causative mutations. In a significant proportion of isolated patients, we identified X‐linked and de novo autosomal dominant mutations, which has important repercussions for genetic counselling.
Applications of anterior segment OCT to glaucoma surgery
Authors: GÜERRI N , OTIN S , FERRANDEZ ARENAS B , CALVO P , GIL‐ARRIBAS L
Published: December 2011

Purpose To assess the utility in clinical practice of anterior segment optical coherence tomography (OCT) in glaucoma surgery.

Methods Consecutive cases review of patients diagnosed of primary open angle glaucoma, closure angle glaucoma, pseudoexfoliative glaucoma. Anterior segment 5 Line Raster OCT protocol (Cirrus HD –Spectral Domain Technology) was performed to evaluate the follow‐up of glaucoma surgeries (trabeculectomy and drainage devices) of these patients.

Results Anterior segment OCT achieved a correct display of the angle anatomy after surgery. About glaucoma surgery images, it showed a correct display of structures in superficial sclera. However, it showed limitations at the evaluation of structures in deep sclera: space under sclera flap and exact location of the trabecular drainage.

Conclusion Anterior segment OCT is a tool of in vivo diagnostic, that achieves an objective anterior segment evaluation in glaucomatous eyes after surgery. This device shows limitations at the evaluation of deep sclera. However, anterior segment OCT provides clinical information about glaucoma post‐surgical anatomy and its functionality.
The Eye‐Associated Lymphoid Tissue (EALT) ‐ A basis of the anatomy and immunology at the ocular surface
Authors: KNOP E , KNOP N
Published: December 2011

Purpose Immune protection at the ocular surface is, similar to other mucosal surfaces, governed by mechanisms of the common mucosal immune system. At the ocular surface a local branch of the mucosal immune system, the Eye‐Associated Lymphoid Tissue (EALT), maintains the equilibrium between tolerance and immunity and prevents inflammatory diseases.

Methods Own results on the mucosal immune system of the human ocular surface are discussed together with results from the literature.

Results The Eye‐associated lymphoid tissue (EALT) is continuous from the ocular surface proper (cornea and conjunctiva) into the mucosal adnexa of the eye (lacrimal gland and lacrimal drainage system). In addition to innate immune factors, this system also contains lymphoid cells and accessory cells that have the task to favour immune tolerance and the secretion of anti‐inflammatory IgA antibodies. In inflammatory diseases, however, (as e.g. the dry eye syndrome, ocular allergy or autoimmune disease etc.) and also in certain types of infectious diseases, the mucosal tolerance is overridden and then own tissue constituents or non‐pathological antigens become antigenic. In such cases of deregulation, the mucosal immune system may become a promoter of an immune modulated, frequently T‐cell mediated, inflammatory disease process.

Conclusion The Eye‐Associated Lymphoid Tissue (EALT) formed by physiologic protective lymphocyte populations, accessory cells and protector mechanisms regulates the immunological homeostasis at the ocular surface but may become a player in inflammatory disease when the system is deregulated. Support DFG KN 317‐11
Overview of the spectrum and therapy of inflammatory ocular surface disease
Authors: PLEYER U
Published: December 2011

Abstract not provided
Inflammatory Events in Trachoma
Authors: HUGUET P
Published: December 2011

Purpose "Trachoma is not a disease of poverty, it is an immune disease – it is like chronic poison ivy” said H Taylor in 2005. Studies done on this topic suggest that inflammation rather than infection is responsible for blindness. This presentation will highlight the ocular surface inflammation induced by Chlamydia in infection and the effectiveness of azithromycin in reducing this inflammation.

Methods Review of the literature on the topic. Medline research with ocular AND inflammation AND azithromycin key words.

Results Trachoma infection usually evolves in two major phases: active or inflammatory trachoma and cicatricial or late trachoma. Active trachoma is characterized by an inflammatory response associated with the variable presence of demonstrable infection (PCR test). Trachoma is considered as a chronic, delayed‐type hypersensitivity reaction with subsequent fibrosis. Topical or systemic administration of azithromycin reduces the effects of acute inflammation such as mucus secretion and macrophage infiltration. Azithromycin inhibits inflammatory cytokines gene and protein expressions such as IL‐6, MMP‐2 activity and NFƘ B. In chronic or cicatricial trachoma a new concept is emmerging: a neglected ocular surface disease.

Conclusion The role of induced chronic inflammation in trachoma is more and more important to be taken in count. These results suggest that azithromycin is not only effective on Chlamydia trachomatis infection but also appears as a promising agent for preventing and treating ocular trachoma surface inflammation in this immuno‐inflammatory disease.

Commercial interest
Differential control and selective down regulation of cytokines but not chemokines in the normal and pathological tear fluid
Authors: SACK RA , ISEROVICH P , SATHE S , BEATON A
Published: December 2011

Purpose Overnight eye closure results in a near cessation in tear turnover and the induction of a sub‐clinical inflammation as evidenced by PMN cell recruitment and degranulation and the accumulation of pro‐inflammatory cytokines and chemokines. What prevents cytokine induced damage to the cornea was investigated.

Methods Methods: Open (O) and Closed (C) tears from Ns were subjected to multiple micro well array assays to obtain quantitative data on the distribution of >80 low abundance proteins. Samples were also separated by molecular sieve HPLC and the eluent profiled for the presences of chemokines, cytokines and interactive proteins. Cytokine‐protein complexes were identified using a laboratory‐developed multiplex assays.

Results Micro‐well array assay reveal a marked increase in the concentrations of a wide range of inflammatory and immune modulating cytokines as well as chemokines in the closed eye tears. This was accompanied by increased levels of s‐receptors at concentrations greatly exceeding that of the targeted proteins along with the accumulation of α2‐M. Protein‐protein binding studies and analysis of the HPLC eluent reveals that most inflammatory, angiogenic and immune cytokines eluent in the form of macromolecular complexes bound to s‐receptor and α2‐M. This serves to inactivate these entities and tags them for up take by macrophages and other cells that express the α2‐M receptor. In contrast chemokines which lack s‐receptors remain free and bioactive.

Conclusion s‐receptors and α2‐M co‐operatively function in the down–regulation of cytokine and growth factor induced inflammation. Data will also be presented showing its functional role in the control of inflammation elsewhere.
Pros of steroids use in optic neuritis
Authors: LEE A
Published: December 2011

Purpose To define indications for steroids in optic neuritis

Methods Case based learning Evidence based practice

Results Steroids have a biologically plausible mechanism for improving the speed of visual recovery and for the treatment of possible multiple sclerosis in patients with optic neuritis

Conclusion Intravenous steroids should be considered in the treatment of suspected demyelinating optic neuritis
Anterior‐to‐posterior "tour" of ocular disease processes
Authors: LOEFFLER K
Published: December 2011

Abstract not provided
Comparative ocular pathology
Authors: HEEGAARD S
Published: December 2011

Abstract not provided
Near distance vision with aspherical intraocular lenses in a model eye
Authors: LANGENBUCHER A , JANUNTS E , GILLNER M , EPPIG T
Published: December 2011

Purpose To determine the image performance of aberration free (AF) and aberration correcting (AC) aspherical IOLs for objects located at near distance in a model eye.

Methods For our simulation we considered 2 AF IOLs (1: Bausch&Lomb SOFPORT, 2: Dr. Schmidt MC6125 AS), 2 AC IOLs 3: Alcon Z9000, 4: Zeiss Invent ZO) and for reference a spherical IOL (5: Dr. Schmidt MC5812). All lenses (nominal refractive power: 22 D) were optimized for objects at far distance at a pupil of 3.0mm and all simulations were done for a pupil of 4.5mm. Image performance was assessed with Strehl ratio and geometrical RMS spot size using optical design software OSLO. The object vergence was increased from 0D:0.5D:3.5D to simulate the capabilities for near distance vision. The Liou Brennan (LBME) and the Gullstrand (GME) model eye were used for simulation.

Results With the LBME for far distant objects the Strehl ratio/RMS spot size was 0.1768/0.0157, 0.2613/0.0131, 0.8978/0.0008, 0.3577/0.0066 and 0.0159/0.0261 for lenses 1 to 5, respectively. For near distant objects (vergence 3D) it was 0.0018/0.0730, 0.0011/0.0579, 0.0004/0.0855, 0.0007/0.0801 and 0.0029/0.0669. With the GME for far distant objects (vergence 0D) the Strehl ratio/RMS spot size was 0.1698/0.0159, 0.2442/0.0134, 0.8651/0.0008, 0.3257/0.0069 and 0.0117/0.0246 for lenses 1 to 5, respectively. For near distant objects (vergence 3D) it was 0.0018/0.0718, 0.0013/0.0747, 0.0003/0.0861, 0.0007/0.0789 and 0.0066/0.0656.

Conclusion As both AC IOLs show the best imaging performance mostly for the LBME as well as the GME for far distance objects, the performance is strongly degraded for near distant objects and even worse than the respective values for AF and spherical IOLs both, for the LBME as well as the GME.
Simulation platform for evaluation of geometrical and positional changes of lenses during accommodation
Authors: GILLNER M , EPPIG T , ZORIC K , BRÜNNER H , LANGENBUCHER A
Published: December 2011

Purpose To build‐up an optomechanical eye model to reproduce physiological accommodation as a test environment for assessment of accommodative intraocular lenses (AIOL).

Methods Freshly enucleated porcine eyes were cleaned and glued into an expansion unit at ciliary body level. The cornea was removed using a trephine. After extraction of the crystalline lens with circular capsulorhexis an AIOL was implanted into the capsular bag. Finally, the posterior part of the globe was cut off and a vitrectomy was performed. The expansion unit with the dissected eye was placed in a temperature stabilized cuvette with BSS (35°C) simulating physiological conditions. The ciliary body is expanded to stretch or relax the zonula fibers effectuating pseudophakic accommodation. For a dynamic measurement of accommodation we used: 1) A Shack‐Hartmann‐Sensor for measuring optical performance. 2) An optical coherence tomograph (OCT) to measure the shape and relative lens position during accommodation.

Results The setup allows measurement of curvature, relative lens position, optical power and image quality of the IOL for different states of accommodation. Due to optical constraints, simultaneous measurement of 1) and 2) was not possible. Therefore, the cuvette was shifted between both beam paths for each measurement. Within the measurement area (5.5 x 5.5 x 1.6 mm in air) the OCT resolution is limited to 12 µm.

Conclusion The presented setup was considered to analyze the behavior of AIOL during accommodation in terms of change in curvature, position and optical performance. After experimental evaluation of the setup we will standardize and automate the measurement procedure, with the goal of a new AIOL design.
Benign concentric annular macular dystrophy. Diagnosis in a pediatric case
Authors: DE LA MATA G , FERNANDEZ‐PEREZ S , SATUE M , HERRERO LATORRE R , RUIZ O
Published: December 2011

Purpose We report a case of a benign concentric annular macular dystrophy diagnosed in childhood during a routine examination. We describe all the ophtlamologic features, complementary tests and the differential diagnosis.

Methods A 5 year old female patient who went to her first ophthalmological examination; her visual acuity (VA) was normal, but we found in the funduiscopy of her right eye an image of annular pigment epithelial atrophy in the macula zone with mottled pigment in the lesion. We appreciated in the left eye funduscopy a less marked alteration of the macular pigment epithelium.

Results The electrophysiological parameters were completely normal, appreciating a bilateral foveal atrophy in the macular optical coherence tomography. We didn’t perform perimetry and fluorescein angiography due to early age of the patient. The patient had no relevant family history. This suggests the diagnosis of benign concentric annular macular dystrophy.

Conclusion This is a pattern dystrophy described by Deutman in 1974, with few cases in the literature so far. Inheritance is autosomal dominant and characterized by an hypopigmented ring with respected foveal center. Usually diagnosed in adulthood and initially has a respected VA, so it is important to make a differential diagnosis with other entities to submit a bull's‐eye maculopathy, as malarial retinopathy, cone dystrophy and Stargardt disease. May evolve toward greater loss of VA and electroretinogram abnormalities, it is therefore necessary routine checks in these patients.
Electrophysiologic findings in Greek patients with Stargardt disease
Authors: ANASTASAKIS A , PLAINIS S , KAMAKARI S , TSIKA C , DOUKA C , TSILIMBARIS MK
Published: December 2011

Purpose To characterize the clinical and electroretinographic features of Greek patients with Stargardt disease exhibiting mutations in the ABCA4 gene.

Methods We retrospectively reviewed the charts of the patients with the clinical diagnosis of Stargardt disease seen at the department of ophthalmology of the University Hospital of Crete. The diagnosis of Stargardt disease was established based on clinical examination (fundoscopic evidence of retinal flecks) and genetic testing. Parameters evaluated included BCVA, age of onset, findings from fundus photographs, but also findings from the ISCEV standard full field ERG.

Results Twelve patients were included in our study. Median age was 29 years (range: 11‐59)and BCVA ranged from 2.0 τ[omicron] 0.2 logMAR. Fundoscopic findings included mild, mottled hypopigmentary changes in one patient, a bull’s‐eye‐appearing macular lesion in four patients and an atrophic macular lesion in seven patients. Of the 12 patients , four patients showed normal scotopic and photopic retinal responses while, eight patients showed abnormal photopic and scotopic function.

Conclusion This is the first report of the electrophysiologic findings of Greek patients with Stargardt disease. Our cohort exhibited a wide range of Electrophysiologic abnormalities. These results provides useful baseline data for the longitudinal monitoring of disease progression.
Relationship between optical coherence tomography and visual evoked potentials in patients with parasellar tumors without chiasmal compression
Authors: WASIK M , PILECKI W
Published: December 2011

Purpose To evaluate the relationship between retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and visual evoked potentials (VEP) in patients with parasellar tumors without chiasmal compression on MRI examination.

Methods 32 eyes of 16 patients suffering from tumor of sella turcica without any chiasmal compression were included to the study and compared to 59 eyes of 30 healthy patients. Exclusion criteria were any other ophthalmic or general condition that can affect both VEP and OCT measurements. All patients underwent MRI of the head to confirm the diagnosis, retinal nerve fiber thickness measurements with OCT and visual evoked potentials.

Results VEP of patients with parasellar tumors without any chiasmal compression showed no P100 latency prolongation (OD=101,9 ± 6,3ms, OS= 101,2 ± 6,3 ms) in comparison to control group (102,1 ± 4,5ms and 102,5 ± 4,2ms). There was noticed a reduced P100 amplitude in examined patients (OD=10,9 ± 4,8µV, OS=11,6 ± 5,6µV) comparing to healthy subjects (12,3±6,5 µV and 12,1±6,3 µV respectively), however it was not statistically significant (p=0,5 and p=0,8 respectively). Average RNFL thickness in our patients was lower (OD=102,2±8,9µm, OS=101,8 ± 11,5µm) than in control group (104,7 ± 10µm and 104,5 ± 15µm respectively), but the difference was not statistically significant (p=0,8 and p=0,95 respectively).

Conclusion In patients with parasellar tumors without any chiasmal compression both visual evoked potentials and RNFL thickness measurements in OCT showed no significant differences in comparison to healthy subjects.
Anti‐VEGF for the treatment of CNV secondary to angiod streaks
Authors: ROUVAS A
Published: December 2011

Purpose The purpose of this report is to evaluate the safety and efficacy of intravitreal antivascular endothelial growth factors (anti‐VEGF) in eyes with macular choroidal neovascularization ( CNV) secondary to angioid streaks.

Methods From the present evidence in the literature it may be concluded that anti‐VEGF therapy with ranibizumab or bevacizumab, based on the strategy to 'according to need' , is beneficial for the treatment of CNV secondary to angioid streaks.

Results Visual acuity can be maintained or even improved over a prolonged period of time, even with a low number of injections, at high rates ranging from 85.7 to 100% , especially in the early stages of the disease. Later when more widespread atrophic changes of pigment epithelium have occurred ,especially if they related the foveola, the visual prognosis was not favorable. Although at present there are not definite proofs with safety problems of anti‐VEGF agents in the treatment of CNV secondary to angioid streaks, patients need to be aware of the off‐label nature of the treatment with anti‐VEGF..

Conclusion Overall, based on the evidence available, intravitreal treatment with anti‐VEGF seems to be the best choice at present to treat patients with CNV secondary to angioid streaks .
Degeneration of retinal nerve fiber layer in patients with multiple sclerosis. Prospective study with three years follow‐up
Authors: HERRERO LATORRE R , GARCIA MARTIN E , SATUE M , SANCHO MORO E , FERNANDEZ TIRADO J
Published: December 2011

Purpose To quantify changes over three years in the retinal nerve fiber layer (RNFL) of patients with multiple sclerosis (MS) and to evaluate if treatments are a protector factor of CFNR degeneration.

Methods One hundred and eighty‐eight eyes of 94 MS patients were followed‐up during 3 years. All patients underwent a complete ophthalmic examination that included assessment of visual acuity (Snellen chart), colour vision (Ishihara pseudoisochromatic plates), visual field examination, optical coherence tomography (OCT) and visual evoked potentials (VEP). All patients were re‐evaluated in a period of 12, 24 and 36 months in order to quantify the changes in the retinal nerve fiber layer (RNFL).

Results Changes were obtained in the RNFL thickness with a 36‐month follow‐up. There were significant decreases (P<0,05 , t test) in the mean, superior, inferior , nasal and temporal RNFL thickness and macular volume provided by OCT, and in P100 latency of VEP. The greater differences were obtained in the superior and inferior RNFL thickness. Differences were not found between treatments, but untreated patients showed higher degeneration during follow‐up in the mean and superior RNFL thickness (p= 0,045 y p=0,024 respectively).

Conclusion Progressive axonal loss can be detected in the optic nerve of MS patients. The analysis of RNFL in OCT can be useful to evaluate MS progression and efficacy of treatments in reduction of axonal degeneration.
The discordance between objective signs and giant papillae improvement in patients with vernal keratoconjunctivitis (VKC) participating in a randomized, controlled, clinical trial
Authors: AMRANE M , BREMOND‐GIGNAC D , LEONARDI A , ISMAIL D , BUGGAGE R , DENIAUD M , BAUDOUIN C
Published: December 2011

Purpose Resolution of papillae is a desirable objective in the management of tarsal VKC. The effect of Vekacia®, an unpreserved cyclosporine cationic emulsion, was evaluated in children with active VKC presenting with giant papillae and keratitis at enrollment.

Methods 118 VKC patients were randomized to Vekacia® 0.05%, 0.1%, or vehicle QID. The primary criterion was subjective symptom improvement. Objective signs (giant papillae, conjunctival hyperemia, discharge, chemosis, limbal infiltrates and corneal epithelial disease) were assessed as secondary endpoint.

Results At Day 28, patient subjective symptoms improved in all groups without statistically significant difference between groups. Among the objective signs, except for papillae, clinically significant improvements were observed: absence of the sign ranged from 20.5% to 72% in both active groups and from 16.7% to 41.2% for vehicle group, depending of the sign. For papillae, only 4 patients experienced total clearing (2.8%, 2.6% and 6.6% in vehicle, 0.05% and 0.1% CsA groups respectively). Clinically and statistically significant differences in keratitis (CFS mean change) over vehicle were observed at Day 28 in Vekacia® treated patients (0.05%, p=0.003; 0.1% p=0.014).

Conclusion Corneal involvement in VKC is a sight‐threatening complication. Improvement in keratitis, a key element in the management of the active VKC was not associated with complete resolution of the papillae. Therefore, among the signs of the disease, papillae appear to be the least helpful sign to follow VKC improvement.

Commercial interest
Novel therapeutic strategies for the induction of tolerance in cornea transplantation
Authors: RITTER T , TREACY M , WILK M , MORCOS M , O'FLYNN L , RYAN A , NOSOV M
Published: December 2011

Purpose With more than 60,000 procedures per year, the cornea is the most commonly transplanted solid tissue. However, immunologic rejection is still the leading cause of corneal allograft failure, especially in high‐risk recipients with a history of previous graft rejection, inflammation or neovascularization. Therefore, novel treatment protocols are desirable.

Methods The genetic engineering of tissues prior to transplantation is an attractive approach to protect the graft from allogeneic rejection. Here the role of lentivirus mediated overexpression of Programmed Death‐Ligand 1 (PD‐L1) to prevent corneal graft rejection will be discussed. Moreover the injection of regulatory cell populations to modulate immune‐mediated rejection will be discussed in this presentation.

Results Overexpression of PD‐L1 in ex‐vivo cultured corneas prior to transplantation significantly prevents corneal allograft rejection by modulating both innate and adaptive intragraft allo‐immune responses. Moreover, injection of regulatory cells is able to prolong corneal allograft survival.

Conclusion Local overexpression of immunomodulatory molecules is a promising approach to prevent corneal graft rejection. In addition treatment of transplanted animals with regulatory cells also modulates graft rejection. These novel therapies may have the potential to be further developed towards a clinical application. [Supported by Science Foundation of Ireland (SFI 07/IN.1/B925). TR is supported by a Travel Grant from Millennium Research Funds, National University of Ireland, Galway]
Graft survival and cytokine production profile after limbal transplantation in the experimental mouse model
Authors: LENCOVA A , FILIPEC M , HOLAN V
Published: December 2011

Purpose To evaluate the immune response in the experimental model of orthotopic limbal allo‐ and xenotransplantation in the mouse.

Methods Allogeneic (C57BL/6 to BALB/c mouse), xenogeneic (Lewis rat to BALB/c mouse) and syngeneic (BALB/c to BALB/c mouse) limbal transplantations were performed. The rejection of limbal graft was scored according to the corneal opacity. The expression of IL‐2, IFN‐gamma, IL‐4, IL‐10 and inducible nitric oxide synthase (iNOS) were detected by Real‐time PCR in the graft. The donor cell survival was determined by Real‐time PCR after transplantation. The recipients were treated with systemic monoclonal antibodies (mAb) anti‐CD4 and anti‐CD8 and with saline in the control group.

Results The allografts were rejected in 9.0 ± 1.8 days and xenografts in 6.5 ± 1.1 days after transplantation, syngeneic limbal grafts survived permanently. Distinct pattern of Th1 and Th2 cytokine production and intragraft expression of the iNOS gene were detected during rejection. Limbal grafts were promptly rejected by Th1 (allogeneic group) or by Th2 (xenogeneic group) type of immune response involving CD4+ cells and iNOS expression. The mean survival time of allogeneic and xenogeneic grafts was prolonged by systemic treatment of mAb anti‐CD4. Treatment with mAb anti‐CD8 did not extend the graft survival.

Conclusion The experimental model of limbal transplantation is useful for testing various immunosuppressive approaches to treat rejection after transplantation. The anti‐CD4 mAb treatment presents promising immunosuppressive treatment after limbal transplantation.
What are the implications of the Straylight domain for the clinician
Authors: VAN DEN BERG TJTP
Published: December 2011

Purpose Straylight is an important source of patient complaints. They can be voiced like halos, glare, hazy vision and blinding at night. With visual acuity, contrast sensitivity and slit lamp examination little may be found. Yet increased large angle light scattering in the eye media not detected by common tests, may degrade the image projected on the retina, thus decreasing the quality of vision. Aging changes to the crystalline lens and cataract are the most common causes of increased straylight, but many corneal conditions including laser treatment have been reported to increase straylight as well.

Methods In order to evaluate the importance of straylight for clinical decision making, the quantity in which straylight is expressed must attain a meaningful value. Straylight is expressed logarithmically, as the logarithm of the straylight parameter s, which directly relates straylight to the (outer skirt) of the functional point‐spread‐function: s = θ^2 PSF. It was found earlier that expressed this way, the straylight value has functionally about equal importance as logMAR. The functional value of straylight was further corroborated by Aspinal et al., finding that straylight was the better predictor of clinical decisions on cataract surgery, as compared to visual acuity.

Results Implications for the clinician include a shift in targeting of patient care. On the basis of straylight elevation treatment can be offered in cases where visual acuity is good. In the case of optical malfunction of the eye, as simple model for functional severity of the condition, the linear average of visual acuity in logMAR and straylight in log(s) is proposed. Data from population study on >5000 eyes show significant retargeting of cataract surgery.

Conclusion Straylight retargets patient care.

Commercial interest
Strabismus and amblyopia in Iranian schoolchildren
Authors: OSTADIMOGHADDAM H , HERAVIAN J , YEKTA AA , AZIMI A , KHABAZKHOOB M , MOHAMMADIAN M
Published: December 2011

Purpose To determine the prevalence of amblyopia and strabismus among the population of school children mashahd, Iran

Methods In a cross‐sectional study with cluster sampling, 2510 school children were selected from schools of district one in Mashhad. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2‐line interocular optotype acuity differences in the absence of pathological causes.

Results Of the 2510 selected population, 2150 school children participated (response rate of 85.6%). The prevalence of amblyopia was 1.9% (95% CI: 0.94 ‐ 2.90); 2.1% (95% CI: 0.10 ‐ 3.16) in girls and 1.7% (95% CI: 0.30 ‐ 3.12) in boys (P=0.620). Among myopic, hyperopic and astigmatic students, 3.7%, 27.8% and 6.5% had amblyopia respectively (p<0.001). the causes of amblyopia were 65.9%, 24.4% and 9.8% anisometropia, strabismus and Isoametropic respectively. The prevalence of strabismus was 3.1% (95% CI, 1.3% to 4.3%); 4.2% (95% CI, 3.05 to 5.7%) in girls, and 2.0% (1.3% to 2.9%) in boys(P=0.0011). Strabismus was significantly more prevalent among hyperopic students compared to myopic ones.

Conclusion Results of the present study indicate that, the prevalence rate of amblyopia was in the mid range and the prevalence of strabismus was relatively high. Since refractive errors, especially hyperopia, are responsible for some cases of strabismus, a timely diagnosis and treatment can prevent a high percentage of cases with amblyopia and strabismus in children.
Entropion as a complication of the frontalis muscle flap direct advancement
Authors: SATUE M , GARCIA‐MARTIN E , HERRERO LATORRE R , EGEA MC , FUENTES JL , FERNANDEZ FJ
Published: December 2011

Purpose The use of the frontalis muscle in a direct attachment is an alternative to the traditional techniques of frontalis muscle flap advancement. This new variant, which is considered the most physiological, shows better functional results, but it may associate entropion as adverse effect.

Methods Through a unique incision on the eyelid crease or making another incision on the superciliar area, a flap of frontalis muscle is created and attached to the tarsal plate with a non‐resorbable suture. It is important to attach the flap to the upper third of the tarsal plate for a correct elevation of the eyelid. A lower union otherwise could create long term complications principally residuary progressive entropion, which until now was only seen after traditional techniques of aponeurosis reinsertion of elevator muscle. We present two case reports showing severe ptosis after frontalis muscle flap direct suspension in which a medium third of the tarsal plate union was performed.

Results Both patients showed progressive entropion which needed correction through surgery.

Conclusion To prevent entropion in the frontalis muscle flap direct advancement, the muscle flap should be attached to the upper third of the tarsal plate, which allows physiological distribution of the tractional force in spite of maintaining the vertical vector, preventing the eyelid margin inversion.
Biomarkers and Proteomics in Corneal Cell Biology
Authors: BEUERMAN RW , ZHOU L
Published: December 2011

Purpose Developing a basis for personalized medicine requires instrumentation that has a high throughput and appropriate senstivity. To discover proteomic biomarkers of ocular surface diseases using quantitative mass spectrometry for discovery of molecular representatives within the tear film that can be used for clinical application and pharmacological development. Additionally, proteomics carried out by mass spectrometry provides a ready tool for use with quantitative biomarkers.

Methods Tear samples can be collected by several means, our lab usually uses type I Schirmer’s test from patients and has been used successfully with patients with dry eye, pterygium or on anti‐glaucoma medications as well as age‐matched healthy unmedicated controls. Tear proteins are analyzed using iTRAQ (Isobaric tags for relative and absolute quantification) based quantitative proteomics or SELDI mass spectrometry. ELISA is used for confirmation of proteomic findings.

Results In dry eye patients, over 200 tear proteins have been identified. Potential biomarkers include up‐regulated proteins, alpha‐enolase, alpha‐1‐acid glycoprotein 1, S100 A8, S100 A9, S100 A4 and S100. In chronic glaucoma patients, 128 tear proteins were identified with 99% confidence. We found 5 proteins whose iTRAQ ratios showed significant changes (p < 0.05) when comparing non‐medicated control group and medicated group. Levels of 4 tear proteins (S100 A8, S100 A9, mammaglobin B and 14‐3‐3 z/d protein) were elevated.

Conclusion Proteomic biomarkers provide new insights into the disease process as with the inflammatory S100 proteins found here and they are measurable end points for drug development, diagnosis and response to treatment. A biomarker panel for dry eye has been developed for patient use.
Foreign body granuloma's after fadenoperation : a review of seven cases
Authors: ROBIN A , GEORGE JL , MAALOUF T , ANGIOI K
Published: December 2011

Purpose To evaluate and to describe our series of foreign body granulomas and granulation tissue after fadenoperation.

Methods Retrospective monocentric study, from 1997 to 2010, conducted on all the patients who developed a foreign body granuloma or a foreign body granulation tissue histologically proven, after fadenoperation surgery.

Results Seven patients (3 to 10 years old) were included. Incidence of granuloma is evaluated at 1,95 ‰ among all our surgeries of strabismus. All the patients were children. All had been operated of fadenoperation surgery combined with medial rectus recession. Delay of granulomatous formation occurence ranged from 5 months to 5 years. All the patients underwent surgical treatment of granulomatous formations with pathological analysis. We have observed three cases of recurrence after initial surgical removal.

Conclusion Non resorbable suture, ischemia induced by fadenoperation and surgery traumatism may lead to development of subclinical granulomas. Suture extrusion, cause or consequence of granulomatous phenomenon could explain late delay of clinical expression. Granulomas occurred always when both of recession and fadenoperation were realized. This can be explained by increased local inflammation and maybe by the presence of two kinds of suture. Despite surgical treatment, 3 recurrences occured, probably linked to exogenous material persistence within the surgical site. To reduce and to prevent the occurrence of granulomas, using a resorbable suture may be interesting.
Clinical assessment of binocular vision with the “ZEISS Polatest”
Authors: CABEZA J
Published: December 2011

Purpose The “ZEISS Polatest”, introduced in 1958, was the first instrument to allow a complete and precise assessment of binocular vision, including heterophoria. In this talk we give an overview about the history of for binocular vision testing using Polatest and its clinical application. We will highlight how binocular vision testing can be incorporated into the routine visual acuity measurement for every patient. The information gained allows us to provide better eye care for our patients in their day‐to‐day vision needs.

Methods The ZEISS Polatest uses polarized light to separate the information sent to the right and the left eye. In this way, binocular fusion can be controlled and the rest position of each eye can be determined precisely. We will review the technology used in the ZEISS Polatest for binocular vision testing and its evolution in the last 50 years. We will also present a review of the clinical literature related.

Results Modern binocular vision testing based on polarisation separation provides a superior and eficient way to screen and measure binocular vision deficiencies.

Conclusion With the widespread use of 3D entertainment many patients become aware of their binocular vision deficiencies which may have been asymptomatic before. This is leading to a renewed interest in binocular vision testing in clinical practice. Incorporating binocular vision screening into the regular screening protocol increases the quality of vision care for our patients.

Commercial interest
Irradiation induced maculopathy and retinopathy. Diagnosis and Treatment
Authors: DAMATO BE , GROENEWALD C
Published: December 2011

Purpose To describe the pathology and clinical features of radiation‐induced maculopathy and retinopathy and to discuss treatment.

Methods Direct maculopathy occurs when the macula has received a high dose of radiation whereas indirect maculopathy occurs as a result of exudation from the irradiated tumour. Investigations include: fluorescein angiography, optical coherence tomography and visual acuity testing. Treatments include: photoablation of leaking retinal vessels as well as transpupillary thermotherapy or photodynamic therapy, endoresection or exoresection of the exudative tumour.

Results Direct radiation‐induced maculopathy is essentially untreatable but it is often possible to reverse visual loss occurring as a result of exudation from the 'toxic tumour'.

Conclusion It is important to differentiate direct from indirect radiation‐induced maculopathy so that the appropriate treatment can be administered.
Inflamation and scleral defect following ocular radiotherapy. Therapeutic appraoch
Authors: DESJARDINS L , LEVY C , LUMBROSO‐LE ROUIC L , CASSOUX N , DENDALE R , PLANCHER C , ASSELAIN B
Published: December 2011

Purpose to describe inflammation and scleral necrosis following irradiation for uveal melanoma, their risk factors and their therapeutic approach.

Methods retrospective review of patients treated in Curie Institute; all the data concerning the initial tumor, the treatment and the follow up are registered in the data base .Statistical analysis has been performed.

Results Twenty‐three patients treated with a single plaque therapy (cobalt‐60 (Co(60)) or iodine‐125 (I(125)) (1.5% of treated patients) or proton beam radiotherapy (0.45% of treated patients) for choroidal or ciliary body melanoma, presented scleral necrosis as a post‐radiation complication .In a retrospective series of 2413 patients treated with proton beam with a median follow up of 98 months 21% of patients have had inflammation and 3,3% of them have active inflammation. Risks factors were essentially tumour related and were correlated with larger lesions (height > 5 mm, diameter > 12 mm, volume > 0.4 cm Multivariate analysis identified initial tumour height and irradiation of a large volume of the eye as the two most important risk factors.

Conclusion Treatment options: Scleral necrosis usually requires only observation Ocular inflammation often consisted of mild anterior uveitis, resolving rapidly after topical steroids and cycloplegics. Nevertheless for large tumors, inflammation can be associated with neovascular glaucoma and can be more severe. The use of anti VEGF is useful to obtain regression of iris néovasculariastion. Preventive endorésection of the tumor scar if possible gives the best results.
Refractive and therapeutic applications of femtosecond laser corneal surgery
Authors: NUBILE M
Published: December 2011

Purpose Femtosecond laser (FSL) devices, based on the physical phenomena of ultrashort laser pulses in the sub‐picosecond range of duration, have gained significant interest in ophthalmology thanks to their potential for high‐precision microsurgery, particularly in applications involving the transparent tissue of the cornea that take the greatest advantage of these attributes. The potential advantages and limits in using FSL in the field of refractive corneal surgery and keratoplasty are presented.

Methods FSL is applied in performing LASIK flap, femtosecond laser lenticule extraction, deep lamellar (DALK), and DSEK lenticule preparation. Clinical and histological analysis was performed.

Results FSL LASIK procedures produced excellent clinical and morphological results, with great precision achieved in flap thickness and morphology. FSL refractive lenticule extraction enables the treatment of myopia and astigmatism without the use of the excimer laser. FSL technology enables multiple cut configurations and customized‐shaped lamellar keratoplasty techniques. Transmission electron microscopy revealed precise geometry and good quality of the cuts.

Conclusion Femtosecond laser technology may offer further promising approaches towards all‐FSL refractive surgery, and dissection procedures in the field of corneal transplantation
A case of chronic relapsing inflammatory optic neuropathy (crion)
Authors: HERRERO LATORRE R , FERNANDEZ PEREZ S , DE LA MATA G , IDOIPE M , SATUE M , GARCIA MARTIN E
Published: December 2011

Purpose The chronic relapsing inflammatory optic neuropathy (CRION) is a recurrent optic neuropathy not associated with any demyelinating or systemic desease, characterized by the need for prolonged immunosuppressive therapy to prevent relapse.

Methods We report the case of a 32 year old man who presented three episodes of optic neuritis in the left eye over a period of 8 months. Each episode remitted quickly with intravenous steroids and resorted after gradual withdrawal thereof. The initial visual acuity in left eye was counting fingers, had relative afferent pupillary defect and diffuse edema of the optic nerve. All systemic examinations were normal (analytics, and serology tests, imaging studies, lupus anticoagulant, ECA and autoimmunity tests).

Results After CRION suspected, corticosteroid treatment was decided at a dose of 1mg/kg/day maintained in decreasing doses associated with azathioprine, and response to treatment was favorable, with no new episodes. Actually, visual acuity is 7/10 , there are palidness optic disc and inferior visual field lost in perimetry due to optic neuritis.

Conclusion CRION is a recurrent optic neuritis, corticoid dependent, not associated with any neurological deficit or autoimmune disease. Severe visual loss, associated with persistence of pain after onset of visual loss and frequent recurrences should make us suspect this entity.
Dysthyroid optic neuropathy: diagnosis and treatment
Authors: BORRUAT FX
Published: December 2011

Optic neuropathy is a rare complication of dysthyroid orbitopathy (incidence < 5%). Its onset is often insidious and progression is frequently slow. However it is mandatory to recognize it early as it is a potentially blinding but treatable condition. At the end of the presentation, participants will be able to recognize the various clinical features of dysthyroid optic neuropathy, decide which diagnostic procedures is necessary to establish the diagnosis, understand the underlying physiopathologic mechanisms, and choose amongst the therapeutic options.
ERK activation and monosomy 3 are associated with Src expression in uveal melanoma and may serve as biomarkers for Dasatinib treatment
Authors: VERSLUIS M , EL FILALI M , BRONKHORST IHG , BAGHAT A , LUYTEN GPM , JAGER MJ , VAN DER VELDEN PA
Published: December 2011

Purpose Uveal melanoma (UM) leads to metastasis in up to 50% of the patients. Patients at risk are readily identified using an array of prognostic markers but an effective treatment is lacking. We recently identified Src as an important tyrosine kinase that conveys MAPK activation in UM. GNAQ/GNA11 mutations are the common denominators of oncogene signalling in UM and Src is a likely downstream kinase. We describe the preclinical analysis of Dasatinib, a known inhibitor or Src kinase, in UM.

Methods Eight tumours were removed, cultured and exposed to Dasatinib treatment. proliferation and MAPK signalling were evaluated. Additionally, 36 UM samples were analyzed for Src/ERK signalling, GNAQ/GNA11 mutation status, chromosome 3 and known histological prognostic parameters.

Results Growth arrest was observed in 5 of 8 UM cultures and molecular analysis indicated that Dasatinib inhibited MAPK via Src. Treatment efficacy associated with MAPK and Src kinase activity as UM cells with the highest Src activity and MAPK activation displayed the strongest growth inhibition. Furthermore, treatment responses tended to be better in UM cultures with monosomy 3. In the cohort of primary UM, Src expression was highly correlated with MAPK activation and monosomy 3.

Conclusion We identified the Src family kinase inhibitor, Dasatinib, as a treatment option for UM. Dasatinib inhibits UM proliferation and may also inhibit UM progression as an association between Src and monosomy 3 was revealed. Consequently, monosomy 3 analysis in tumour tissue may suffice both the prognosis and choice of treatment.
Keratin Films for Ocular Surface Reconstruction
Authors: REICHL S , BORRELLI M , GEERLING G
Published: December 2011

Purpose Keratins are a group of cysteine‐rich structural proteins formed in the epithelial cells of higher vertebrates. Keratin from hair or wool has been proposed as an appropriate biomaterial for producing films or cell cultivation scaffolds. This study was performed to develop transparent, stable and transferable human hair keratin films that support cellular adhesion and proliferation.

Methods The films were engineered by a multi‐step procedure including reductive keratin extraction, aqueous dialysis, casting on hydrophobic membrane, drying and a final curing process. The influence of various process parameters on the ultrastructure, biomechanical properties, light transmission and cell growth behavior of corneal epithelial cells on keratin film in comparison to amniotic membrane (AM) were tested. Keratin films were investigated by SDS‐PAGE, SEM and X‐ray analyses. Furthermore, the tensile strength and light transmission of the films were studied. Finally, the growth behavior of human corneal epithelial cells on the keratin films and AM was estimated.

Results The film‐forming process resulted in transparent films composed of nanoparticulate keratin structures. The film characteristics could be varied by changing the protein composition, adding softening agent (glycerol) or varying the curing temperature and duration. Based on these findings, an optimized protocol was developed. The films showed improved light transmission and biomechanical strength in comparison to AM. Furthermore, cell behavior on the films was similar to that found on AM.

Conclusion Biopolymer films based on human hair keratin may represent a new, promising alternative for corneal surface reconstruction. Further investigations will have to describe the clinical usefulness in animals and humans.