bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of Confocal Microscopy in evaluation and treatment of infectious keratitis
Authors: ORSKI M , WYLEGALA E , TARNAWSKA D , WOJCIK L , SMEDOWSKI A , WOWRA B
Published: August 2012

Purpose To evaluate the role of in vivo confocal microscopy (IVCM) in the diagnosis and treatment of infectious keratitis.

Methods 24 patients with keratitis were examined by slit‐lamp biomicroscopy and IVCM (HRT). All IVCM examinations were assessed for inflammatory activity and potential etiology. After obtaining baseline cultures, patients were treated as bacterial (10), viral (5), fungal (8) or Acanthamoeba (1) related keratitis based on clinical findings and IVCM.

Results Primary outcome was clinical improvement, secondary outcome was correlation between IVCM findings and final culture. In 23 cases (9 bacterial, 5 viral, 8 fungal and 1 Acanthamoeba) clnical improvement was observed within 21 days whereas 1 patient worsened. In bacterial suspected group cultures were positive in 7 cases (70%), in viral none of the cultures were positive. Despite typical clinical image and IVCM findings and clinical improvement on adequate medication in fungal and Acanthamoeba suspected groups cultures remained negative.

Conclusion Our study suggests that IVCM along with clinical evaluation can be a useful tool in early diagnosis and guided treatment of patients with infectious keratitis, until definitive culture results are available. However, a prospective clinical study is recommended to further study the role of IVCM in infectious keratitis.
Corneal cross‐linking and Ferrara ® intracorneal rings for the treatment of progressive keratoconus : About 23 cases
Authors: LUSSATO M , DELBARRE M , BLAVIER B , LEDUC C , CREPY P , FROUSSAERT‐MAILLE F , RIGAL‐SASTOURNE JC
Published: August 2012

Purpose Keratoconus is a noninflammatory corneal ectasia which results in progressive visual loss due to the appearance of irregular astigmatism and myopia. We present the results obtained in patients treated with cross‐linking and intracorneal ring implantation.

Methods This prospective study involved 23 eyes of 17 patients with progressive keratoconus (stage 2 and 3). All patients underwent a combined treatment by cross‐linking. and intracorneal rings (Ferrara ®) implantation 3 months later. Uncorrected and corrected visual acuity, spherical equivalent, minimum, maximum and mean keratometry were measured preoperatively and 12 months after implantation.

Results At 12 months, improvement in uncorrected and best corrected visual acuity was found, with a gain of 1.6 lines . We found a statistically significant reduction in mean keratometry (1.21 D, P = 0.017) and maximum keratometry with a reduction of 1.969 diopters (P = 0.007). Reduction of minimum keratometry (‐2.58 D) and spherical equivalent (‐1.711 D) were also statistically significant (p<0.05).

Conclusion This new therapeutic approach seems attractive in the management of keratoconus to postpone the time of corneal transplant.
Postoperative astigmatism induction ‐ femtosecondlaser‐assisted penetrating keratoplasty vs penetrating keratoplasty
Authors: DOBROWOLSKI D , MILKA M , WYLEGALA E
Published: August 2012

Purpose To compare postoperative astigmatism outcomes of femtosecondlaser‐assisted 110°‐cut PK (FLPK) with conventional PK (PK)in keratoconus patients.

Methods 62 keratoconus patients were divided into 2 groups: FLPK‐32 patients, PK‐30 patients. Procedures were done with femtosecondlaser‐assisted 110°‐cut with outer diameter of donor's cornea 8.0 mm, in conventional PK donor's graft diameter was also 8.0 mm. Postoperative astigmatism, BCVA, endothelial cell loss were evaluated.

Results Follow‐up was at least 6 months. Postoperative astigmatism was lower in FLPK group (2,1±0,5D versus 4,19±1,7D in PK group, p<0.05). BCVA was respectively 0,59±0,1 and 0,55±0,1, endothelial cell loss 30,4±8,3% and 34,1±7,8% respectively.

Conclusion Femtosecondlaser‐assisted surgery results in lover astigmatism level
Improving DSAEK donor grafts cut using microkeratome motorization and pressure monitoring
Authors: BERNARD A , NEFZAOUI C , GRIOT O , CAMPOLMI N , ACQUART S , PEREIRA S , THEILLIERE C , PISELLI S , THURET G , GAIN P
Published: August 2012

Purpose in the world, most of the DSAEK donor corneas are prepared using the anterior chamber (AC) and manual microkeratome from Moria. Pressure within the AC, rapidity and regularity of the manual movement directly impact on the thickness and reproducibility of the cut. Our aim was to develop and validate a simple microkeratome motorization and pressure monitoring liable to improve cut quality

Methods we developed a turntable with programmable speed rotation and a sterilizable device to connect a digital pressure gauge (Ahlborn, Germany). After deswelling, organ cultured human corneas were cut with the Moria microkeratome. Cutting speeds from 3 to 10 sec were assessed. AC pressure of 90±5mmHg established by two methods (inflation with a syringe followed by clamping of the pipe, or using a passive high up infusion system without clamping) was continuously monitored and recorded. Central corneal thickness was measured before and after each cut with a US pachymeter (SP1000 Tomey). Endothelial viability was determined with the triple Hoechst/Ethidium/Calcein labeling coupled with image analysis of the whole endothelial surface immediately after the cut (IOVS 2011.52:6018)

Results during the cut, AC pressure slightly increased (+9%) with the passive infusion system whereas it strongly increased (+137%) with the clamping. Impact of pressure maintenance system and cutting speed on lamellar graft thickness and on endothelial viability will be presented

Conclusion automation of the mechanical Moria microkeratome and continuous pressure monitoring may be useful to improve reliability of lamellar grafts preparation and should help standardize the technique
One year stored corneas: is it possible?
Authors: HE Z , CAMPOLMI N , NEFZAOUI C , PISELLI S , PEOC'H M , DUMOLLARD JM , GAIN P , THURET G
Published: August 2012

Purpose To evaluate the endothelial characteristics after very long term organ culture (OC) of human corneas.

Methods Human corneas with initial endothelial cell density (ECD) >2000 cells/mm2 were stored at 31°C in sealed flasks containing 100mL of a commercial medium with 2% foetal calf serum (CorneaMax, Eurobio, France): 6 for 3‐6 months (M), 7 for 6‐12 M and 5 for more than 12 M. The medium was renewed every 2 M. Transparency was quantified by analysis of modulation and contrast transfer functions. On one half of each cornea, ECD and EC morphology were analysed by image analysis (CellP‐Olympus, and SambaCornea‐TribVn) after alizarin red staining and flat mounting. On the other half of the cornea, EC differentiation status (NaK ATPase, ZO‐1, JAM‐1) and proliferative capacity (Ki67, Click‐it EdU) were studied by immunostaining in flat mounted corneas (He, MolVis2011;17:3494 and He, StemCells2012 in press). Epithelial cells and stroma were observed by histology on cross sections stained with Hematein/Eosin/Safran and by transmission electron microscopy

Results Corneal transparency and ECD decreased after very long‐term OC, but were partially preserved. ECD was about 1200, 800 and 400 cell/mm2 after respectively 3, 6 and 12 months. Morphology and differentiation of residual EC remained nevertheless almost preserved. The epithelium lost its multilayered organization

Conclusion Corneal cells, particularly EC, can survive for a very long time in the rustic environment of OC, suggesting that they are well equipped against environmental stress and cell death. The improvement of storage process and/or storage medium could potentially allow very long term storage without significant attrition of graft quality and therefore provide corneas suitable for graft
Efficacy of gas permeable scleral lenses in refractory severe dry eye syndrome
Authors: DOAN S , ELLUARD M , GABISON E , COCHEREAU I , DELCAMPE A
Published: August 2012

Purpose Modern scleral lenses have shown their efficacy in severe ocular surface diseases such as Stevens‐Johnson syndrome. Their geometry allows hydration and protection of the cornea and of the limbus. This study determined the efficacy of modern scleral contact lenses in severe eye dry syndrome.

Methods A retrospective single‐center study was conducted in patients with severe refractory dry eye syndrome, who were fitted with SPOT® scleral lenses (LAO, Thonon, France). At inclusion and after 3 months of daily wear, the following parameters were assessed: Ocular Surface Disease Index (OSDI) score, NEI Visual Function Questionnaire‐25 composite score (NEI VFQ‐25), best‐corrected visual acuity, slit lamp examination, number of associated drugs and tolerability.

Results The files of 10 patients (9 women and 1 man) with a mean age of 58.4 years (40‐80 years), were reviewed. Dry eye was related to Sjögren syndrome (6 patients), ocular cicatricial pemphigoid (3 patients) and graft versus host disease (1 patient). Lens fitting failed in 1 case. Improvement of quality of life scores (OSDI and NEI NFQ‐25) was remarkable in seven patients out of the nine fitted patients. Mean OSDI and NEI VFQ‐25 scores improved from 73.5±16.8 to 35±24.2 (p=0.002) and from 49.0±21.0 to 70.5±18.4 (p=0.045), respectively. Best corrected visual acuity improved by 3.2±4.3 Snellen lines. Mean follow‐up was 12.6±3.8 months. No serious adverse events attributable to the scleral lenses occurred.

Conclusion Scleral lenses are a promising therapeutic in patients with severe refractory dry eye syndrome. The results can be spectacular with a dramatic improvement of patients’ quality of life. Difficulties in manipulation represent the main disadvantage.
Laser subepithelial keratomileusis ( LASEK ) versus femtosecond sub‐Bowman keratomileusis ( FSBK ) to correct myopic astigmatism
Authors: CANADAS SUAREZ PILAR , IGLESIAS MLUZ , GARCIA‐GONZALEZ M , TEUS MA
Published: August 2012

Purpose to compare the safety and efficacy of LASEK versus FSBK to correct myopic astigmatism

Methods a retrospective pilot study of 846 consecutive eyes ( 427 FSBK and 419 LASEK + Mitomycin C ). Inclusion criteria was astigmatism ≥ ‐1.50 D. Uncorrected visual acuity ( UCVA ), best corrected visual acuity ( BCVA ), sphere and cilynder were examinated preoperatively and at 3 months after surgery. Enhancement rates were also evaluated.

Results both techniques showed similar safety and efficacy indexes ( efficacy in LASEK group was 0.9 ± 0.2 and in FSBK group was 0.88 ± 0.2, p= 0.3; safety in LASEK group was 1.0 ± 0.1 and in FSBK group was 1.02 ± 0.1, p= 0.8.Three months after surgery, astigmatism was similar in both groups: ‐0.52 ± 0.6 in LASEK group and ‐0.54 ± 0.6 in FSBK group ( p= 0.6 ). The sphere was higher in LASEK group than in FSBK group( 0.24 ± 0.7 D, LASEK group; 0.12 ± 0.5 D, FSBK group ) p= 0.005. BCVA and UCVA were slightly better in FSBK group ( BCVA in FSBK group: 1.02 ± 0.1. BCVA in LASEK group: 0.9 ± 0.2; p= 0.0001. UCVA in FSBK group was 0.9 ± 0.2. UCVA in LASEK group was 0.86 ± 0.2; p=0.03. Enhancement rates were higher in FSBK group, 97 eyes ( 22.62% ), than in LASEK group, 65 eyes ( 15.51% ), p= 0.01.

Conclusion LASEK and FSBK show similar safety and efficacy when used to correct myopic astigmatism ≥ ‐1.50 D. Postoperative BSCVA was slightly higher after FSBK, probably because it was also higher preoperatively, but the safety and efficacy indexes showed no significant differences between groups. Nevertheless there is a higher retreatment rate after FSBK . This might be due to the more comfortable post‐operative recovery of this technique.
Causes of intracorneal ring segments explantation
Authors: CANADAS SUAREZ P , ARRUABARRENA C , HERNANDEZ‐VERDEJO JL , GARCIA‐GONZALEZ M , TEUS MA
Published: August 2012

Purpose To illustrate the causes of intracorneal ring segments (ICRS) explantation in patients with ectatic corneal disease.

Methods We performed a retrospective of 92 eyes in which ICRS were implanted between 2007 and 2009. Two types of ICRS were implanted during this period: in 42 eyes (45.7%) INTACS ring segments were implanted, and in 50 eyes (54.3%) KERARING implants were used. In all cases a femtosecond laser was used to create the corneal channels where the implant was inserted. We analyzed the incidence of explantation of both types of ICRS and the causes

Results An explantation of the ICRS was needed in 10 cases (10.9%): 8 INTACS and 2 KERARINGS. In all cases the cause of the explantation was the segment extrusion. Interestingly, we found that the ICRS extrusion was related to the contact of the extremity of the segment with the vertical corneal incision in all cases.

Conclusion Based on our results, the main reason of ICRS explantation is the segment extrusion. The contact between the extremity of the segment and the corneal incision area seem to facilitate the segment extrusion. KERARINGS seem to be much better tolerated than INTACS.
Sub Bowman's keratomileusis for the correction of anisometropia after penetrating and lamellar corneal surgery
Authors: MENICACCI F , MENICACCI FL , MENICACCI C , BATISTI C , ESPOSTI G , FRUSCHELLI M
Published: August 2012

Purpose To report the use of Sub Bowman's Keratomileusis (SBK) in the treatment of anisometropia subsequent to Perforating Keratoplasty (PK) and Deep Anterior Lamellar Keratoplasty(DALK).

Methods Three patients with compound myopic and hyperopic astigmatism after PK and DALK were submitted to SBK. Treatments were conducted under topical anaesthesia. Femtosecond laser (IntraLase FS., AMO Inc, CA, USA) was used to create a superiorly hinged anterior lamellar flap at 100 microns in a 7.75/8 mm zone. The flap was lifted and a customized wavefront ablation was performed in two cases with the Star S4IR (CustomVue, AMO Inc., CA, USA), and in one case with Technolas z100 (Zyoptix Custom Wavefront, Bausch & Lomb Inc, NY, USA). The flap was then replaced, and the interface was irrigated. Minimum residual pachimetry value was estimated not inferior to 400µm.

Results Postoperative controls at 1 and 3 months showed a reduction of anisometropia up to 70% with residual spherical equivalent (SE) not superior to 2.50 diopters

Conclusion Sub Bowman's Keratomileusis has been shown to be safe and effective to reduce anisometropia in patients who have previously undergone to PK and DALK.
Corneal hystomorphology and myopic regression in patients after LASIK in the long follow‐up period
Authors: NIKULIN SERGE , KACHANOV ANDRE , CHURAKOV TIMUR , BAUER SVETA , ZIMIN BORIS
Published: August 2012

Purpose To estimate the ultrastructure of various layers of a cornea, refraction result and quality of visual functions at the patients after operation LASIK, in the long follow‐up period.

Methods The investigated group included 22 patients (44 eyes). Middle age was 31 year (from 23 to 39). The postoperative period ‐ from 4 to 10 years. Patients before operation had myopic refraction of various degrees. Standard methods of research including pachymetry with “Visante OCT”, keratotopography with “Pentacam”, “Atlas”, confocal microscopy with Confoscan 4 (Nidec Tech., Japan).

Results Visual acuity after operation without correction was 1,0 and more only in half of cases (22 eyes). In the presence of initial high myopia, the thickness of a cornea at patients in 10 years after LASIK has returned to preoperative values. The thickness of a corneal flap practically in all cases made the value planned before operation. Epithelial layer has increased no more than by 30 microns.

Conclusion In the remote postoperative period substantial growth of a thickness of a cornea in the central part is observed. Changes occur at all stoma levels. The increase in a thickness of a cornea first of all is connected with morphology of the interface between a flap and a corneal bed.
The current practice and researches of orthokeratology in China
Authors: LU F
Published: August 2012

Purpose Orthokeratology is account for 200,000 wearers in current China. In past ten years, orthorkeratology experienced “up‐down‐up” fortune. This article presents the evidence about what leads to the twists and turns of orthokeratology in China. And it sketches the update researches of orthokeratology in clinical safety and its on myopia retardation.

Methods Based on survey of twelve orthokeratology clinics and consulting work for government, it illustrated both the healthy part and illness part of fitting, wearing and related vision care service administration in the past tens years. Through summary of the research work, the clinical safety of orthokeratology and its on myopia retardation research both laboratories based or clinic based were presented.

Results Orthokeratology was first released in China in late 1990s. It quickly spread over China. But very soon, reports of high rate of complications began appeared, and the safety of Orthokeratology was questioned by both ophthalmologists and the public, and dropped to dead margin. After ten years researches and cautious monitoring from safety administration, the ortho‐K practice is backing up. The data from ten ortho‐K clinics proved its safety and efficacy. The author showed their clinical and laboratories study around corneal contour and relative peripheral refractive status in myopia retardation.

Conclusion The Orthokeratology not only brings backs to life but in very fast growing trend in current China. The key for its success in clinical safety and efficacy comes from the qualified fitters and scientific monitoring. Although evidence showed myopia retardation with ortho‐k among young myopes, whether its mechanism comes from relative peripheral refractive hyperopic changes is still under debate.
Comparison of decellularization methods for human corneal lenticules
Authors: HE Z , PERRIER E , CARA G , CAMPOLMI N , FOREST F , PEOC'H M , DUMOLLARD JM , GAIN P , THURET G
Published: August 2012

Purpose Human or animal thin corneal lenticules (L) have been used as biological carrier to experimentally reconstitute tissue‐engineered grafts. Decellularization of the stroma proved to reduce immune rejection after allografts in animals. Aim: to assess different decellularization methods of human corneal L.

Methods Stromal L were prepared with a Moria microkeratome on human organ cultured corneas mounted on an artificial anterior chamber. After desepithelialization, an anterior L was obtained with a 90 μm head and a posterior one with a 110 μm head. Four physical methods (sonification at 37 kHz for 45 minutes (min), 3 freeze/thaw cycles in liquid nitrogen, heating at 50°C for 60 min, and hypoxia) and four chemical methods (75% ethanol for 2x10 min, 0,1% sodium Dodecyl sulphate for 24 hours (h), 4M urea for 4h, and 29% NaCl for 24h) were tested. Efficiency and safety were assessed by determining: 1/mortality of the keratocytes using the Hoechst‐Ethidium‐Calcein triple labelling (Pipparelli, IOVS2011;52:6018), 2/alteration of the stroma using transparency measurement (analysis of modulation and contrast transfer functions), and collagen fibres analysis by transmitted electron microscopy (TEM), and 3/elimination of the cell debris using a staining of cell cytoplasm (Dioc 6) and TEM.

Results 75% ethanol and hypoxia triggered complete keratocytes mortality with minimal alterations of the stroma. None of the methods eliminated dead cells debris. Combination with the sonification helped fragmenting cells

Conclusion Two simple and rapid methods allow complete decellularization of human corneal L. The ability of these Lt to promote endothelial cells adhesion and proliferation is under investigation.
Epithelial thickness and structure in patients with congenital aniridia after COMET procedure
Authors: WOWRA B , WYLEGALA E , DOBROWOLSKI D , ORZECHOWSKA‐WYLEGALA B , ORSKI M , SMEDOWSKI A , WOJCIK L
Published: August 2012

Purpose To evaluate epithelial structure after COMET procedure in patients with congenital aniridia.

Methods 17 patients (20 eyes) with congenital aniridia underwent COMET procedure. Subjects were 13 women and 4 men, in 4 patients surgery was bilateral. Indication was aniridia related Limbal Stem Cell Deficiency (LSCD).Mean follow‐up was 13 months (6 to 26). Analyzed data included OCT assisted epithelial thickness measurement and structure assessment by confocal microscopy

Results Mean epithelial thickness performed in 5 different points was 52,2±14,3 µm in successful cases, 88,1±42,4 µm in failed cases with recurrent conjunctival ingrowth

Conclusion Analysis of epithelial structure and thickness could be useful in postoperative care in patients with congenital aniridia after COMET procedure
Use of wide field digital retinal imaging (RET CAM II) in paediatric retinal diseases
Authors: PINELLO L , MAZZAROLO M
Published: August 2012

Purpose To report our experience using the RetCam II to evaluate retinal pathology and morphology in children who did not cooperate for standard examination and to follow them by monitoring changes and development of the diseases

Methods We reviewed charts of 107 consecutive uncooperative children with fundus abnormalities that were photographed using the RetCam as a routine part of patient care.Since 2004 detailed diagnostic examination with use of RetCam II was performed in children with ocular tumors, vitreo‐retinal dysplasia, hereditary retinal dystrophies, ROP, congenital abnormalities of optic disc, retinal haemorrhages in shaking injury, neuroretinitis. All eyes were dilated with 1% tropicamide. 0.4% oxibuprocaine drops were used prior image acquisition. A blefarostat was used to keep the eye lids wide apart during the examination.The children were directed to lie supine, under sedation.

Results The authors report cases series: 7 cases of Ret Cam imaging (2 siblings with gyrate atrophy of the choroid and retina after reduction of plasma ornithine with diet; 1 Pedler’s coloboma with overlay of the peripapillary retina,2 cases with retinal haemorrhages in shaking injury in the acute phase and until the bleeding reabsorption,1 infant with early onset autosomal dominant hereditary rod‐cone dystrophy , 1 optic nerve glioma extending to the retina, 1 case with chorioretinal dysplasia in systemic disease.

Conclusion In this study analysis of RetCam digital images allowed to evaluate objectively, to determine exactly the areas of the disease, and to estimate changes and worsening.In our cases series the wide‐field digital ophthalmic camera provided a new tool for the evaluation and precise documentation in paediatric retinal disease.
Lyme borreiosis with ocular manifestations during childhood period
Authors: SAUER A , HANSMANN Y , JAULHAC B , BOURCIER T , SPEEG‐SCHATZ C
Published: August 2012

Purpose Lyme borreliosis (LB) is the most common human tick‐borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood period are discussed in this study.

Methods Six children with LB‐associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia as well as exclusion of other causes were diagnosis criteria.

Results Two uveitis, Two abducens palsies, one optical neuropathy and one orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained about severe knee arthritis. Determination of antibodies was positive in all patients. All patients were treated by antibiotics adjusted to individual circumstances and some of them (two uveitis and one optic neuropathy) also had anti‐inflammatory treatment. Resolution of ocular signs, without any relapse, was observed in all patients within two to twelve weeks.

Conclusion For any unexplained ocular symptom, even for children, LB should be taken into account especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during childhood period, even following long‐term manifestation at an early age.
Three‐dimensional geometries representing the retinal nerve fiber layer in multiple sclerosis, optic neuritis, and healthy eyes
Authors: GARCIA MARTIN E , DE LA MATA G , SATUE M , BAMBO M , ARA M , EGEA MC , FERNANDEZ‐PEREZ S , HERRERO R , IDOIPE M , OTIN S , LARROSA JM , POLO V , GONZALEZ‐GARCIA C , GARCIA‐FEIJOO J , PABLO L
Published: August 2012

Purpose To represent and interpret the three‐dimensional geometry and distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON).

Methods MS patients (n=122) and age‐matched healthy subjects (n=108) were enrolled in this observational cross‐sectional study. The Spectralis OCT system (Heidelberg Engineering) was used to determine the circumpapillary RNFL thickness in both eyes of each participant. The 768 RNFL thickness measurements provided by the Spectralis OCT were used to evaluate thickness measurements in MS patients with or without antecedent ON and to design a three‐dimensional reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes.

Results RNFL thickness was decreased in MS patients, and higher in the MS group with previous ON. Statistical analysis and three‐dimensional RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area in MS eyes (101.77 µm in MS vs 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in healthy eyes vs. 149.26 previous‐ON MS eyes) in MS eyes with previous ON.

Conclusion The three‐dimensional representation of RNFL thickness based on measurements provided by the Spectralis OCT allows physicians to better observe damage in the temporal areas, especially in patients with previous ON.
Extraocular blood flow in multiple sclerosis (MS) patients
Authors: JANKOWSKA‐LECH I
Published: August 2012

Purpose Buckground: Multiple sclerosis is autoimmune disease which is often associated with vascular dysregulation syndrome (VDS), mediated by endothelin‐1 (ET‐1). Vascular dysregulation syndrome can lead to diminished blood flow in eyeball arteries. The aim of this study is evaluation of retrobulbar hemodynamics in multiple sclerosis (MS) patients.

Methods Material of this study consisted of 76 eyes of 38 MS patients (8 males and 30 females, mean age 39,38 years, range : 22‐56 years, SD: 10.02 ) which were recruited from Neurology and Epileptology Department. The healthy controls consisted of 52 eyes of 26 patients ( 3 males and 23 females, mean age: 36.26 years, range: 19‐55 years, SD: 10.88). No patients in the active stage of the disesses. The peak systolic (PSV) and‐ diastolic (EDV) blood flow velocities, indicators of peripheral vascular resistance such as Gosling Index (PI) and Pourcelot Index (RI) of the ophthalmic artery (OA), lateral short posterior ciliary arteries (LSPCA) and central retinal artery (CRA) were measured in each eye, using color Doppler imaging (CDI). In order to compare examined eyes between two groups we used analyze of variance (Unianowa). Additionaly, we analyzed the obtained values of blood flow in patients who received immunomodulation therapy and in patients who passed neuritis optica in history.

Results Statistically significant disturbances in the examined eyeball arteries were found in CRA and OA. The affected parameters were: diminished PSV velocity in CRA and OA; EDV in CRA (border of statistical significance); PI, RI in OA and increased EDV in OA.

Conclusion This study suggests that in MS eyes may exists of retrobulbar hemodynamics impairment.
A new technique of noninvasive evaluation of the intracranial pressure with retinal vessel analyzer
Authors: GENEVOIS O , MURAINE M , PAQUES M
Published: August 2012

Purpose One of the clinical signs observed at the funduscopic examination of the eye of the intracranial hypertension patients, apart from the papillary edema is the reduction, even the disappearance of the spontaneous pulsatility of the retinal vessels..A new device, Retinal Vessel Analyzer (Imedos) now makes it possible to measure negligible variations of the vascular diameter (arteriolar and venular) . We thus measured the retinal vascular pulsatility found among patients having a benign intracranial hypertension (BIH) which we compared with a control population.

Methods We included 6 patients presenting a benign intracranial hypertension. For each participant, an examination with RVA was carried out right before the lumbar puncture (J0) then at 1 month (M1) and 3 months intervals (3M). We compared these results with a control population (n=76).

Results The mean venous pulsatility found at the 76 controls was 5,07m ± 1,57. Our 6 patients presenting a BIH, had a venous pulsatility that was lower than 0,5m at D0 (p < 0,05), lower than 0,8m± 0,52 at M1 (p < 0,05) and between 0,5 and 3m at m3. All the 6 patients had an abnormal measurement of the intracranial pressure . It was not found a correlation between the value of pulsatility and the value of the intracranial pressure

Conclusion The variation of the vascular diameter, measured by RVA, is an indirect reflection of the vascular transmural pressure.Our results show that even in the case of a moderate BIH it exist an early, identifiable repercussion at the level of the retinal vascular network quantifiable by RVA.This reduction in the venous pulsatility can be explained by an increase in the intravascular pressure and/or by a parietal remodeling, especially at the later stage.
Persistence of treatment effect of idebenone in Leber's Hereditary Optic Neuropathy
Authors: FSADNI MG , KLOPSTOCK T , METZ G , YU‐WAI‐MAN P , BüCHNER B , GALLENMüLLER C , BAILIE M , NWALI N , GRIFFITHS PG , RUDOLPH G , KORTüM K , ROULEAU J , COPPARD N , MEIER T , CHINNERY PF
Published: August 2012

Purpose To establish the long term benefit of oral idebenone 900mg/day in the treatment of Leber's Hereditary Optic Neuropathy (LHON).

Methods Patients who participated in a 24‐week, multi‐centre (3 sites), double‐masked, randomized, placebo controlled trial (RHODOS) were re‐assessed at a single visit by means of Visual Acuity (VA) using ETDRS charts.

Results Eighty‐five patients were enrolled in the RHODOS study: 55 treated with idebenone (900mg/day) and 30 with placebo. At the end of the 24 week treatment period, the VA for patients randomized to placebo deteriorated. In contrast, in patients treated with 900mg/day idebenone, VA was preserved. In addition, in severely affected patients with off‐chart vision at Baseline, only idebenone treated patients improved sufficiently to read at least 1 full line on the ETDRS chart (Klopstock et al., 2011). VA was repeated at a follow‐up visit conducted 2.5 years (median) after treatment discontinuation. The difference in VA between placebo and idebenone treated patients was maintained. Specifically, in patients who during RHODOS received idebenone and who on average were protected from vision loss, VA did not deteriorate upon discontinuation of treatment.

Conclusion These findings support the original conclusion that in selected patients with LHON, idebenone has significant therapeutic potential in preventing further vision loss and facilitating vision recovery.

Commercial interest
Dyslexia and eye movements
Authors: VAGGE A , CAVANNA M , IESTER M , PARISIO A , BURTOLO C , TRAVERSO CE
Published: August 2012

Purpose To analyze the relationship between dyslexia and eye movements. 

Methods 22 patients were included in the study, 11 patients have a diagnosis of dyslexia and 11 subjects were used as a control group (normal readers). The age of patients enrolled ranged from 8 to 13 years. All patients underwent careful orthoptic and ophthalmological visit; eye movements were quantified by Ober‐2 system. Ocular motility was divided into three phases: stability analysis to while fizating a still target; analysis of fixation pauses, analysis of tracking saccades (left and right horizontal axis); speed reading, saccades and regressions through the reading of a text.

Results The stability analysis on fixating a still target showed a significant (p<0.001) difference between dyslexic and control group, outlining an increased amount of loss of fixation in dyslexic subjects (5.36 +/‐ 2.5 and 0.82 +/‐ 2.1, respectively). Only two patients in the control group presented a fixation loss while none in the study group presented this defect. Also tracking saccades (left and right horizontal axis) and loss of fixation after saccades did not show significant difference. When the reading time was analyzed, a significant (p<0.001) difference was found between the dyslexic subjects and the control group (90+/‐ 52.0 second and 42 +/‐ 17.3, respectively). When the regression saccades were analyzed, a significant (p<0.001) difference was found between the dyslexic subjects and the control group (52+/‐ 33.4 seconds and 20.3 +/‐ 11.3, respectively).

Conclusion This is the first report of some ocular movement difference between dyslexic and healthy subjects detected by using the Ober‐2 system. Should our findings be confirmed, this analysis could be added to the work‐up of dyslexic.
Aicardi syndrome with macrocrania
Authors: DEGOUMOIS A , LUX AL , RYSANEK B , PONTE K , EMERY E , DENION E
Published: August 2012

Purpose to report a case of Aicardi syndrome associated with macrocrania.

Methods Aicardi syndrome is a very rare X‐linked congenital disorder. It is characterised by a typical triad of chorioretinal lacunae, agenesis of the corpus callosum and early‐onset infantile spasm.

Results A five‐month‐old girl presented with macrocrania and abnormal visual behavior. She was born in Abidjan (Côte d'Ivoire) and suffered from hydrocephalus. She underwent first ventriculo‐peritoneal derivation when she was one‐month‐old. This derivation was not efficient and her intracranial hypertension worsened. She suffered from local seizures during the two first months of life. Her brain CT scan showed tri‐ventricular hydrocephalus and agenesis of the corpus collosum. She was referred to Caen university hospital neurosurgery department in order to have a new derivation. She presented with no ocular pursuit and no light perception. The papillary light reflexes were present. Fundus examination showed bilateral chorioretinal lacunae involving both maculas with clear cut margins.

Conclusion We diagnosed this Aicardi syndrome thanks to the clinical triad. However, Aicardi syndrome is rarely associated with macrocrania. We rewiewed the literature to discuss the wide nosological status of this syndrome and its described associations.
Postural control in children with early strabismus without amblyopia
Authors: ORSSAUD C , GAERTNER C , CREUX C , ESPINASSE‐BERROD MA , ROCHE O , DUFIER JL , KAPOULA Z
Published: August 2012

Purpose In healthy subjects, the postural stability in orthostatic position is better when fixating at near than at far distance; increased convergence angle contributes to such effect. Children with strabismus present a deficit in vergence movements. The goal of this study was to evaluate the postural control in children in relation with the vergence angle while fixating at different depths, and also while making active vergence movements.

Methods A TechnoConcept platform (Céreste, France) was used to record postural stability of 11 subjects (M= 11.18 years) with convergent strabismus and 13 (M=11.31 years) with divergent strabismus in 3 conditions: fixation at 40cm, at 2m and active vergence movement between two target at 20cm and 50cm.

Results As for the controls, the standard deviation of medio‐lateral body sway decreased with proximity for convergent strabismus but increased for divergent strabismus. Relative to fixation, vergence eye movements caused an increase of medio‐lateral body sway for convergent strabismus but decrease for divergent strabismus. Yet, vergence eye movements were associated with the least variance of speed, indicating that less energy is needed to control body sway.

Conclusion We conclude that the fixation depth at which postural stability is best in strabismus is that for which the appropriate vergence angle correspond to the strabismus angle. It might be mediated by preponderant eye movement signals related to the angle of strabismus. Reduction of variance of speed in the active vergence eye movement condition corroborates further such interpretation.
Comparison of latency of P100 wave in children demonstrating some pathological disorders
Authors: PILECKI W , RUSIECKI L , KALKA D , SZAWROWICZ T
Published: August 2012

Purpose A goal of the present paper was an assessment of usefulness of latency of P100 wave in describing few pathological disorders in children. The study group comprised 268 children, including 68 with cytomegaly (CM), 59 with myelomeningocele (MM) , 69 with purulent meningitis(PM) and 73 with Down’s syndrome (DS). The control group consisted of 592 healthy children.

Methods Registrations were performed using Visual Evoked Potentials for each patient, stored on data bank and evaluated automatically with manual correction. Collected values of P100 wave’s latency were analyzed using typical statistical tools (t‐test contained in STATISTICA‐data analysis software system. StatSoft, Inc. 2011, version 10. www.statsoft.com).

Results The comparison performed in regard to the group‐mean latencies of the analyzed P100 wave between the control group and the four studied groups revealed statistically significant differences (p<0.0001). There were also statistically significant differences in the mean P100 latency between DS group and CM and PM groups (p<0.0001). Evaluation of the mean latencies in three groups (CM, MM and PM) did not reveal statistically significant differences (p>0.05).

Conclusion The results show the differences in mean latency of P100 wave between normal subjects and children with pathological disorders. In children with Down’s syndrome observed abnormalities were smaller than in other 3 groups.
Implementation of Medicare Part D and statin use among the elderly population with diabetes
Authors: Vaidya Varun , Blazejewski Lucas , Pinto Sharrel
Published: August 2012

Objective

The American Diabetes Association treatment guidelines recommend that patients with diabetes over 40 years of age with one or more risk factors for cardiovascular disease be prescribed statin medication. Despite the guideline, use of statins among elderly patients with diabetes is low. Medicare Part D was implemented in 2006 to increase affordability and access to prescription medications for Medicare enrollees. The main objective of this study was to analyse trend in statin users with diabetes before and after implementation of Part D.

Methods

Data were obtained from the Medical Expenditure Panel Survey for 2004–2008. Patients who were diabetic (ICD-9 code 250) and either elderly (≥65 years) or near elderly (57–64 years) were included in the analysis. Chi-square analysis was used to compare statin users before and after Part D for both the elderly and near-elderly populations. For elderly patients, trends in statin users were analysed for subpopulations based on gender, race/ethnicity, income, education level and perceived health status. A logistic regression analysis was conducted to identify factors that predicted use of statin.

Key findings

Between 2004 and 2008 patients who reported using statins increased from 55.05 to 61.25% for the elderly and from 54.99 to 55.89% for the near elderly. The elderly population had a significant increase in the percentage of patients reporting use of statins after the implementation of Part D (P = 0.002). Logistic regression identified post-Part D period (0.75, 95% confidence interval (CI) 0.60–0.94; P = 0.013), female gender (1.28, 95% CI 1.05–1.57; P = 0.013) and African-American race/ethnicity (1.53, 95% CI 1.19–1.96; P < 0.00) as significant predictors of reporting statin use among study population.

Conclusion

The study results imply that Part D may have influenced an increase in prescriptions of statins to elderly patients with diabetes. Logistic regression and trend analysis indicate that Part D was unable to reduce disparities in prescriptions for racial and gender subgroups.
Characterization of two polymorphs of lornoxicam
Authors: Zhang Jianjun , Tan Xin , Gao Jing , Fan Weiming , Gao Yuan , Qian Shuai
Published: August 2012

Objectives

The aim of the study was to prepare and to characterize two polymorphs of lornoxicam, a water-insoluble non-steroidal anti-inflammatory drug, which has thus far received no exploration of its polymorphs.

Methods

Form I and form II of lornoxicam were prepared by recrystallization and characterized by X-ray powder diffractometry (XRPD), thermal analysis, Fourier transform infrared spectroscopy and scanning electron microscopy. The solubility and dissolution of both polymorphs were also determined and compared to provide the basis for polymorph selection in formulation.

Key findings

The crystal structures of the two polymorphs were established by the experimental XRPD patterns. Form I was demonstrated to be triclinic with two kinds of intermolecular hydrogen bonds, while form II was orthorhombic with two kinds of intramolecular hydrogen bonds. The morphologies of form I and form II were observed to be rectangle and approximately oval, respectively.

Conclusions

Form II had the significantly higher solubility and dissolution and would be the suitable polymorph for the preparation of oral and injectable dosage forms of lornoxicam.
An Experimental Study of Ammonia Receiver Geometries for Dish Concentrators
Authors: Dunn Rebecca , Lovegrove Keith , Burgess Greg , Pye John
Published: August 2012

This paper presents experimental evaluation of ammonia receiver geometries with a 9 m2 dish concentrator. The experiments involved varying the geometric arrangement of reactor tubes in a thermochemical reactor built from a series of tubes arranged in a conical shape inside a cavity receiver. Differences in conical arrangement were found to affect the efficiency of energy conversion. The solar-to-chemical efficiency gain obtained by varying the receiver geometry was up to 7% absolute. From this, it is apparent that geometric optimizations are worth pursuing since the resulting efficiency gains are achieved with no increase in costs of manufacture for receivers. The experimental results and methodology can be used when developing receivers for larger dish concentrators, such as the second generation 500 m2 dish concentrator developed at the Australian National University.
Effect of Variable Guide Vanes and Natural Gas Hybridization for Accommodating Fluctuations in Solar Input to a Gas Turbine
Authors: Kitzmiller Kyle , Miller Fletcher
Published: August 2012

In recent years, several prototype solar central receivers have been experimentally demonstrated to produce high temperature and high pressure gas capable of driving a gas turbine engine. While these prototype receivers are generally small (<1 MWth), advancements in this technology will allow for the development of solar powered gas turbine engines at a commercial level (sizes of at least several megawatts electric (MWe)). The current paper analyzes a recuperated solar powered gas turbine engine, and addresses engine considerations, such as material limitations, as well as the variable nature of solar input. In order to compensate for changes in solar input, two operational strategies are identified and analyzed. The first is hybridization, meaning the solar input is supplemented via the combustion of fossil fuels. Hybridization often allows for an increase in net power and efficiency by adding heat during periods of low solar thermal input. An alternative strategy is to make use of variable guide vanes on the compressor of the gas turbine engine, which schedule to change the air flow rate into the system. By altering the mass flow rate of air, and assuming a fixed level of heat addition, the operating temperature of the engine can be controlled to maximize power or efficiency. The paper examines how to combine hybridization with variable guide vane operation to optimize gas turbine performance over a wide range of solar thermal input, from zero solar input to solar-only operation. A large material constraint is posed by the combustor, and to address this concern two alternative strategies—one employing a bypass valve and the other a combustor modified to allow higher temperature inlet air—are presented. Combustor modifications could include new materials and/or increased cooling air. The two strategies (bypass versus no bypass) are compared on a thermodynamic basis. It is found that it is possible to operate the gas turbine across the entire range without a significant drop in performance in either design through judicious adjustment of the vanes, though both approaches yield different results for certain ranges of solar input. Finally, a yearly assessment of solar share and thermodynamic performance is presented for a 4.3 MWe gas turbine to identify the overall benefits of the operational strategies. The annualized thermodynamic performance is not appreciably different for the two strategies, so that other factors such as mechanical design, operational issues, economics, etc. must be used to decide the optimal approach.
Multiresponse Metamodeling in Simulation-Based Design Applications
Authors: Romero David A. , Amon Cristina H. , Finger Susan
Published: August 2012

The optimal design of complex systems in engineering requires the availability of mathematical models of system’s behavior as a function of a set of design variables; such models allow the designer to search for the best solution to the design problem. However, system models (e.g., computational fluid dynamics (CFD) analysis, physical prototypes) are usually time-consuming and expensive to evaluate, and thus unsuited for systematic use during design. Approximate models of system behavior based on limited data, also known as metamodels, allow significant savings by reducing the resources devoted to modeling during the design process. In this work in engineering design based on multiple performance criteria, we propose the use of multi-response Bayesian surrogate models (MR-BSM) to model several aspects of system behavior jointly, instead of modeling each individually. To this end, we formulated a family of multiresponse correlation functions, suitable for prediction of several response variables that are observed simultaneously from the same computer simulation. Using a set of test functions with varying degrees of correlation, we compared the performance of MR-BSM against metamodels built individually for each response. Our results indicate that MR-BSM outperforms individual metamodels in 53% to 75% of the test cases, though the relative performance depends on the sample size, sampling scheme and the actual correlation among the observed response values. In addition, the relative performance of MR-BSM versus individual metamodels was contingent upon the ability to select an appropriate covariance/correlation function for each application, a task for which a modified version of Akaike’s Information Criterion was observed to be inadequate.