bluuebunny/crossref_metadata_2025 huggingface dataset:
Tregs in corneal health and disease
Authors: Dana R.
Published: September 2015

This symposium will focus on the complex network of cells and molecular mechanisms that regulate immunity in the cornea and ocular surface. Talks will focus on the phenotype and function of corneal and ocular surface antigen‐presenting cells in heath and disease; the immunopathogenesis and regulation of allergic eye disease; the myriad functions of nerves in maintaining immune homeostasis in the ocular surface; and T cell regulatory mechanisms that maintain immune privilege and how they be subverted in chronic inflammation and autoimmunity. Those attending the symposium should achieve a greater in‐depth understanding of how immune cells, epithelial cells, and nerves interface to regulate immunity in the anterior segment of the eye.
Ultrasound biomicroscopy in diagnosis of anterior segment pathology
Authors: Ramazanova K. , Kiseleva T. , Lugovkina K.
Published: September 2015

Purpose

To demonstrate the role of ultrasound biomicroscopy (UBM) for the diagnosis of anterior segment pathology.

Methods

UBM was performed in 7 patients with corneal opacity (6 eyes) and with anterior chamber (AC) opacity (1 eye).

Results

In first case with total hyphema UBM demonstrated thickening of the iris. Second case with post‐contusional corneal edema and hyphema demonstrated signs of iridodialysis and cyclodialysis. Third patient with central corneal scar had a signs of intraocular epithelial proliferation. With UBM the epibulbar cyst extension into anterior chamber was confirmed in fourth clinical case. In patient with fungal corneal ulcer (fifth case) UBM demonstrated central corneal defect and anterior chamber opacities. Lipodermoid was found in sixth clinical case. UBM helped to confirm that the sclera was not involved. In seventh case with corneal nebula after ocular burns UBM demonstrated iridocorneal adhesion and retrocorneal fibrous membrane. UBM results in all clinical cases determined tactics of treatment.

Conclusions

UBM is a safe and effective diagnostic tool in the management of eyes with disorders of the anterior segment especially when visualisation is limited and multiple traumatic injures are involved.
Orbital and palpebral lymphomas
Authors: Robert P.Y. , Flausse R.
Published: September 2015

Extra nodal lymphomas may involve the ocular adnexae in 8% of cases. The mean age of onset is basically in the sixth decade. Lymphomas may present as a palpebral mass (39%), conjonctival infiltrate (39%) or proptosis (31%). It may involve orbital fat (47%), orbital muscles (26%), lacrymal gland (19%), preseptal tissues of eyelids (10%), or conjonctiva (60%). However, no specific location has been statistically associated to a better prognosis.Although MALT lymphoma (low grade with good prognosis) is the most common type (46%), other types such as follicular (20%), DLCB (11%), Mantel (5%), or other (17%) may occur. Lymphoma of ocular adnexae represent around 12% of all MALT lymphomas.

The incidence of Chlamydia Psittaci infection in lymphoma patients may vary according to the geographic area, for instance 0% in Florida and 80% in Italy.

The incidence of amyloïdosis in lymphoma patients arises from 0.85% to 7.5%. However amyloïd deposits are often not systematically looked for, and therefore may remain misdiagnosed.

The handling of orbito‐palpebral lymphomas requires the collaboration of a multidisciplinary team involving pathologists, biological and clinical haematologists, microbiologists and orbital surgeons.
Indications for scleral lenses
Authors: Leysen I.
Published: September 2015

In several cases of high irregular astigmatism such as advanced keratoconus, postkeratoplasty and pellucid marginal degeneration scleral lenses are the only nonsurgical solution to improve vision. In addition to correction of irregular astigmatism the large size and scleral bearing surface of these lenses can also be beneficial in the management of certain ocular surface disorders. They can prevent exposure keratitis and enhance epithelial healing.

In this part of the session the different indications for scleral lens fitting are discussed and demonstrated by several case reports. This will show the clinical success and many opportunities of these lenses.
Discussion, Questions and Answers
Authors: Dua H.S.
Published: September 2015

In this part of the course there will be an open discussion in which members of the audience will be encouraged to participate, to share their experience and anecdotes.

All the faculty of the course will be present to take questions and discuss or describe in further detail points they have made in their presentations.

The audience may be asked questions to assess if they had understood key aspects of the course.

Course participants will be requested to complete feedback forms.
Macular complication: from edema to ischemia
Authors: Midena E.
Published: September 2015

The pathophysiology of macular complications in diabetic retinopathy is multifactorial. Diabetic macular edema and ischemia (both macular and peripheral) are the major drivers of macular involvement in diabetes. Macular edema may be both intra and extra‐cellular and it is clinically characterized by different aspects, mainly detected by an accurate qualitative analysis of spectral domain OCT data. This approach allows to identify different phenotypes of diabetic macular edema, providing a track to a personalized treatment. Macular ischemia has always been considered a negative prognostic factor in the treatment of macular edema, and this aspect has been recently re‐confirmed. Peripheral retinal ischemia, easily documented by wide field retinal angiography, is emerging as a “new” driver of macular edema. All these new aspects, better defined by a multimodal imaging approach, are the essential to plan an adequate treatment.
Follow‐up and decision making on treatment choices of the patient with established pseudotumor cerebri syndrome
Authors: Parsa C.
Published: September 2015

Once a diagnosis of pseudotumor cerebri is established, the critical task becomes to protect the optic disc from excessive swelling potentially causing auto‐infarction. Assessing tolerable versus threshold levels for such swelling, and selecting a treatment plan based on the degree of disc swelling and findings from perimetry will be reviewed. Technical and procedural steps will be exposed to reduce the chances of auto‐infarction when large degrees of swelling are present using the principles of blood perfusion and regulation to the optic nerve head. Initiation of medical versus surgical treatment will be discussed. Precautions regarding intracranial pressure lowering techniques using lumbar puncture & drainage, optic nerve sheath fenestration, or shunt placement will be examined based on principles of blood perfusion as well as perineural sheath anatomy. Chronic long‐term effects of disc swelling will also be addressed.
Update in management of optic nerve glioma (part 2)
Authors: Parsa C.
Published: September 2015

Significant controversy exists in the treatment of optic nerve glioma because of the absence of evidenced‐based trials demonstrating efficacy for various treatments administered over the years, from radiation therapy to various chemotherapeutic regimens and combinations thereof. Elements of tumor biology will be discussed along with fundamental properties of anti‐mitotic regimens administered to date, as well as newer agents proposed targeting protein synthesis rather than DNA replication. Discussion of how tumor suppressor gene status (NF1) should be taken into consideration when deciding upon a treatment modality will also be discussed. Novel vision sparing surgical modalities applicable to NF1‐associated orbital gliomas in particular will be reviewed.
Diabetic maculopathy
Authors: Pournaras J.A.C.
Published: September 2015

Vitreoretinal macular interface plays an important role in the formation and progression of diabetic macular edema. Main vitreoretinal diseases as epiretinal membrane, vitreous traction and macular holes may occur in this condition. They are due to abnormal mechanical and biochemical interactions between posterior hyaloid and retinal surface. OCT has changed our understanding of the contribution of vitreoretinal interface disorders on the course of macular edema. Tractional elements contribution seems to be more obvious compared to untractional elements as epiretinal membranes. The management of vitreoretinal retinal disorders associated to diabetic macular edema will be discussed. Specific surgical approach will be detailled and compared to same conditions occuring in non diabetic patients.
Pre‐Descemets Endothelial Keratoplasty (PDEK)
Authors: Dua H.S.
Published: September 2015

The most popular endothelial keratoplasty (EK) technique is Descemets stripping endothelial keratoplasty (DSEK). Descemets membrane endothelial keratoplasty (DMEK) has advantages but is technically challenging. In 2013 Dua et al reported a pre‐Descemets layer (Dua's layer, DL) in the posterior cornea and suggested how this could be exploited for EK. This was later developed and performed as Pre‐Descemets endothelial keratoplasty (PDEK).

PDEK tissue is harvested by injecting air into the donor cornea and creating a type‐1 big bubble (BB). The posterior bubble wall composed of endothelial cells, DM and DL is excised and inserted in the recipient eye. This tissue rolls less than DMEK tissue and is more robust allowing easy handling and unrolling in the eye. It can also be physically centred in the anterior chamber. The limitations are that on occasions a type‐2 BB may form requiring a DMEK procedure. The PDEK graft size is smaller being limited by the size of the BB (around 8.5 mm). However, PDEK tissue can be taken form very young eyes with higher cell counts. Initial results, with regard to complications, visual acuity, refractive error and OCT changes are very encouraging making PDEK a viable option for EK.
Pathophysiology of macular hole formation
Authors: Stappler T.
Published: September 2015

Purpose

Our understanding of the pathophysiology of macular hole development has evolved in line with a novel classification system. As novel pharmacological treatments have been introduced previously unseen interactions with the pathophysiology have been observed.

Methods

Histopathological correlation studies as well as the effects of novel pharmacological agents on the pathogenesis of macular holes will be presented, including rare cases of macular hole formation.

Results

Perifoveal PVD with vitreomacular adhesion and vitreoschisis allow cortical vitreous to remain on the retinal surface and become a scaffold for cell proliferation and form epiretinal membranes. These alter the cleavage plane for the surgeon. Pharmacological vitreolysis leads to novel and challenging clinical scenarios. The Liverpool experience will be shared.

Conclusions

Histopathological correlation studies demonstrate a large proportion of additional epiretinal membrane components on peeled internal limiting membranes. In pharmacological vitreolysis novel strategies in the management of macular holes will be presented.
Subretinal implantation surgery and follow up in pig model
Authors: Kiilgaard J.F.
Published: September 2015

The dimension of the porcine eye is similar to the human eye. Combined with an almost identical anatomy to the human eye, the porcine eye makes an excellent model for surgical eye studies. Standard surgical instruments can be used in the pig model, and thereby can new surgical techniques be tested before they are introduced into the human.

Evaluation of the surgical outcome can be performed both in vivo, with fundus photo, OCT and mfERG, and ex vivo with histology, immunohistochemistry and molecular technologies.

Retinal pigment epithelium cells, biological membranes, artificial polymers and stem cells can be implanted in the pig, but the overall idea with subretinal implantation surgery is to regain function in diseased retina. There are transgenic porcine models of known retinal degenerative diseases and different iatrogenic traumas can simulate retinal disease, but there still need for development of new models.

For long time studies mini pigs are essential as modern pigs have been refined to gain weight quickly. Spontaneous regenerative potential and a remarkable resistance to retinal trauma can also invalidate interpretation of the surgical outcome.
Clinical results and in vitro characterization of cornea limbal epithelial stem cells cultured in autologous serum
Authors: Moe M.
Published: September 2015

Slow‐cycling limbal epithelial stem cells (LESCs) are responsible for continuously renewing the entire corneal epithelium. Ocular burns, infectious and inflammatory diseases can all cause chronic scaring, decreased vision and severe pain due to limbal stem cell deficiency (LSCD) in the cornea. Center for Eye Research / Department of Ophthalmology, Oslo University Hospital is offering transplantation of autologous ex vivo expanded human corneal epithelial tissue to patients with LSCD. However, even though many of these patients gain significant life quality by means of increased vision and reduced pain by this treatment, in our recent published retrospective case series evaluating our surgical technique, only 56% of the patients had a persisting improvement in subjective symptoms/objective findings. Further clinical experience will reveal in which clinical situations this treatment modality is most likely to succeed – and fail. In parallel, we aim to develop a novel, improved protocol for enrichment of viable LESCs for clinical transplantation to further improve success rate of the treatment. Clinical results as well as results of translational research for improving graft quality will be presented.
Maging of DME in vitrectomized eyes
Authors: Pournaras J.A.C.
Published: September 2015

Imaging modalities have greatly improved our recognition and understanding of the pathophysiology of diabetic macular edema. Fluorescein angiogram have shown vascular leakage in the presence of macular edema. It permits early detection of intraretinal morphological changes, hemodynamic and inflammatory modifications. Macular perfusion is nicely identified by this exam. Furthermore, OCT have greatly improved the detection of intraretinal fluid, anatomical changes in all retinal layers. It offers comprehensive analysis of the vitreoretinal interface. Quantitative, non invasive and non mydriatic procedure may be performed. Additional recent developments in imaging systems will be discussed.
The On/OFF system pathway of the retina
Authors: Castelo‐Branco M.
Published: September 2015

The ON/OFF pathways in the retina represent parallel systems with asymmetric properties. Here we discuss the basic anatomy and function of these pathways in health and disease, from the point of view of luminance, contrast and motion perception. We will also highlight how receptive field properties are shaped within each of these pathways and how they cross‐talk within other parallel streams in the retina. Finally, we will address experimental and disease models that dissect the function of each of these pathways.
Novel mouse phenotypes identified in the eye screen of the German Mouse Clinic
Authors: Amarie O.V. , Fuchs H. , Gailus‐Durner V. , Hrabě de Angelis M. , Graw J.
Published: September 2015

The German Mouse Clinic (GMC) is a large‐scale mouse phenotyping facility that provides systematic analysis of all organ systems using a standardized workflow. The tests for the eye phenotyping include Scheimpflug imaging, Optical coherence tomography, Laser interference biometry, Virtual drum, ERG, and histology. It allows the identification of novel genetic models for human eye diseases. One example is the Meis1 mutant line, which have retinal and eye size deficits, and impaired visual acuity. Importantly, our results reveal that a single mutant Meis1 allele in the mouse is sufficient to elicit multiple phenotypic abnormalities, consistent with a dominant mode of inheritance in human patients being characterized by microphthalmia (and leukemia). These data provide a starting point for further investigation of several organ systems to dissect the underlying pathogenic mechanisms and to identify reliable phenotypic endpoints for therapeutic testing. Another example is the Ap4e1 mice that show retinal deficits, revealing a new phenotype for a mutation of this gene. The eye screen along with the GMC identifies new (and frequently pleiotropic) traits that bring progress in understanding the molecular mechanism in human eye diseases.
Signs and symptoms of uveitis
Authors: Neri P. , Arapi I. , Pirani V. , Gresti G.
Published: September 2015

Inflammation of uveal tract can be divided into: anterior, intermediate, posterior, and panuveitis. Uveitis can be a sight‐threatening disease. The commonest ocular symptoms are: blurred vision, ocular pain, photophobia and floaters, depending on the type of uveitis. The onset of uveitis can be either acute or insidious, involving one or both eyes. Posterior uveitis is usually associated with vitritis. Anterior chamber cells and flare should be graded according to standardized uveitis nomenclature (SUN) working group. Binocular indirect ophthalmoscopy (BIO) score is used to grade vitreous involvement. Vitreous changes may comprehend: vitreous hemorrhage, vitreous strands, and vitreous traction. A further classification of posterior uveitis depends on the primary site of inflammation, which can identify: retinitis, choroiditis, retinochoroiditis, and chorioretinitis. Posterior pole uveal involvement can be: focal, multifocal, and placoid. Retinal vasculitis can be associated with several sub‐types of posterior uveitis. Uveitis can present several complications such as, anterior and posterior synechiae, which can lead to uveitic glaucoma, cystoid macular oedema, retinal and choroidal neovascularizations, and retinal ischemia.
Regulation of cell‐based medicinal products
Authors: Lodge A.
Published: September 2015

The regulation of cell‐based medicinal products in the EU is governed by legislation for medicinal products in general plus dedicated regulations for advanced therapy medicinal products (ATMPs). In addition, the procurement and use of the tissues and cells used to manufacture these products are regulated by additional legislation. This presentation will focus on how a regulatory strategy for bringing a cell‐based ATMP under development into clinical trials and ultimately to marketing authorisation should be formulated around all relevant legislation and the guidelines used to implement it. A regulatory strategy should address the quality, safety and efficacy aspects of a medicinal product intended for human use, through defined strategies around CMC (chemistry, manufacturing and controls), nonclinical studies and clinical trials. In addition, regulatory routes to clinical trials and market authorisation that are appropriate to the ATMP under development should also be considered from an early stage, for example including orphan designation, paediatric investigation plans and accelerated approval schemes. Building a regulatory and product development strategy around these elements for a cell‐based ATMP will be outlined.
Mechanisms of Stromal Fibrosis
Authors: Beuerman R.
Published: September 2015

Purpose

This study was designed to uncover new drug targets to deal with the problems of fibrosis of the corneal stroma which can occur following an injury or infection, preventing the normal recovery of vision. Although, TGF‐β is clearly involved the detailed intracellular mechanisms necessary for a practical drug target are not available. The cellular target is the transition of the sessile keratocyte to a myofibroblast.

Methods

Corneas of 8 week old C57BL6 mice underwent either an anterior keratectomy (AK) wound or infection with Pseudomonas aeruginosa (PA), and animals were sacrificed at 2 and 7 days, as well as 2 and 4 weeks after the procedures. The isolated stroma was used to monitor the expression and location of moesin, phospho‐moesin, TGF‐β1 and α‐SMA.

Results

TGF‐β1 and phospho‐moesin were not detected in normal corneal stromas. However, after either treatment, TGF‐β1 expression increased, along with phospho‐moesin and moesin in the wounded corneal stroma from day 2 to 7, and decreased after 2 weeks. No expression of TGF‐β1 and phospho‐moesin was found at PO week 4. Myofibroblasts positive for α‐SMA associated with either treatment were detected from day 2 to week 4 and peaked at week 2.

Conclusion

These studies show that moesin interactions with actin fiber growth may be a focus drug development in fibrosis decreases; however, it remains to determine the exact details of that interaction.
Patient‐focused glaucoma care delivery, maintaing quality despite cost limitation
Authors: Pourjavan S.
Published: September 2015

To assess the degree of patient satisfaction in a Glaucoma Outpatient centre and its correlation with the subjective scoring of the Ophthalmologist for the quality of provided care using a short not‐validated questionnaire. The practice of medicine has evolved in the latest decade. Disruptive innovation in healthcare causes a shift away from traditional health care venues like hospitals into clinic settings and outpatient's facility. There is also transference of skills from highly trained sub‐specialist to more accessible specialist. The outpatient offices, especially in Belgium provide accessible and fast services in a convenient location. In order to remain competitive the outpatient offices have to provide high level of healthcare quality. In the published report Crossing the Quality Chasm, the Institute of Medicine (IOM) set forth six aims for a quality health care system: safe, equitable, evidence based, timely, efficient and patient centered. The latter three factors directly influence patient satisfaction. The patient satisfaction on the other hand has been commonly used as an indicator for measuring the quality of care given by the health professionals. In this lecture we explain patient's motivations for their satisfaction degree during an outpatient Glaucoma clinic.
There is still a place for Penetrating Keratoplasty (PK)
Authors: Said D.
Published: September 2015

With new emerging lamellar keratoplasty techniques, the number of penetrating keratoplasty has reduced, yet it is still the most commonly performed technique for corneal grafting.

For many indications penetrating keratoplasty (PKP) is the best option such as keratoconus with previous hydrops and central scarring, therapeutic corneal graft and long standing bullous keratopathy with stromal scarring. Other situations such as presence of peripheral anterior synaechia, aphakia, shallow phakic eyes, DSEK and DMEK have greater risk and more loss of tissue through wastage.

Advantages over other lamellar techniques are shorter learning curve, comparable or better visual outcome and in some centers better survival rate when performed for the same indication as lamellar grafts. Post‐operative astigmatism and weak graft host junction remain to be major disadvantages of this technique.

Newer evolving cutting techniques of donor and recipient corneas using the femtosecond laser are being developed to address these issues, however, to date results do not justify the increase in cost.
Role of chemokines in diabetic retinopathy
Authors: Struyf S. , Mohammad G. , Imtiaz Nawaz M. , Van Raemdonck K. , De Hertogh G. , Van Damme J. , Abu El Asrar A.
Published: September 2015

We have detected altered expression of chemokines in the vitreous fluid of patients with proliferative diabetic retinopathy (PDR). In the early phase of disease chemokines (CXCL8, CCL2) are involved in leukocyte attraction. Later, CXCL12 may attract progenitor cells (endothelial cell precursors and fibrocytes) involved in establishment of neovessels and in formation of fibrovascular membranes. The myofibroblasts producing ECM in the fibrovascular membranes of the diabetic patients can originate from endothelial (precursor) cells via endoMT, from fibrocytes or from leukocyte‐like precursors. During the active disease stage also angiostatic chemokines (CXCL4, CXCL4L1 and CXCL10) are upregulated, probably in an attempt to counteract the stimulatory effects (angiogenesis and increased vascular permeability) of VEGF. Finally, CCL2 and CXCL10 have been reported to induce fibrosis and might play a role in the later stages of the pathology. Recently, we have demonstrated that CXCL4L1, a most potent angiostatic chemokine can be applied therapeutically as VEGF‐inhibitor in diabetic rats. Indeed, intraocular injections of CXCL4L1 early after the onset of diabetes protected animals against diabetes‐induced blood‐retinal barrier breakdown.
Cases
Authors: Hamel C.
Published: September 2015

Case reports will be presented.
Cases
Authors: Holder G.
Published: September 2015

Case reports will be presented.
Is it becoming or coming of age
Authors: Cordeiro M.F.
Published: September 2015

The realisation that lowering IOP is unable to prevent progressive vision loss in all glaucoma patients, has led to investigation of neuroprotection as an alternative or additional treatment option. Neuroprotection has gained renewed interest recently as a therapeutic approach to prevent neuronal degeneration and loss of function in glaucoma. Although confirmation of neuroprotective effects by randomized clinical trials is needed, there is now a demonstration of positive non‐IOP dependent effects in the LoGTS study. Furthermore, it has been proposed as a treatment strategy in other ocular diseases, such as AMD. Neuroprotection has been advocated for many years in neurodegeneration. Indeed, the therapies that have been suggested in Alzheimer's and Parkinson's Disease are similar to those investigated in ophthalmology. This talk will review the evidence for neuroprotection that led to our assessment of its role in glaucoma now and its application as treatment strategy.
Update on lymphoma diagnostic
Authors: Coupland S.
Published: September 2015

Lymphomas are classified according to the current WHO classification, which emphasizes an approach whereby the clinical characteristics are correlated with distinct morphological, immunophenotypical, and genotypical features of each neoplasm. The classification of lymphoid malignancies recognizes three major categories: B‐cell neoplasms, T‐/NK‐cell neoplasms, and Hodgkin lymphomas. B‐ and T‐cell lymphomas are further classified into precursor‐ and mature neoplasms, the latter being subdivided again according to their clinical manifestation: i.e. into disseminated/leukemic, extranodal and nodal malignancies. Hodgkin's disease, now more appropriately termed Hodgkin lymphoma, comprises nodular lymphocyte‐predominant Hodgkin lymphoma and classical Hodgkin lymphomas of nodular sclerosis, mixed cellularity, lymphocyte‐depleted and lymphocyte‐rich subtype. This talk will provide a summary of the major lymphoid malignancies affecting the eye, and an overview of the techniques used to diagnose them.
Limbal stem cell niche – New insights into structural and molecular composition
Authors: Schlotzer‐Schrehardt U.
Published: September 2015

Maintenance and regeneration of the corneal epithelium relies on unipotent progenitor cells at the corneoscleral limbus, which are regulated by extrinsic factors from their local microenvironment, the stem cell niche. The postulated limbal niche is an anatomically protected site of intimate epithelial‐mesenchymal interaction and is highly vascularised, innervated, pigmented due to intraepithelial melanocytes, infiltrated with immune cells, and supported by a specialized extracellular matrix as well as subepithelial mesenchymal cells emitting soluble signals. For ex vivo expansion and transplantation, limbal stem cells are unfavourably removed from their niche. This lecture outlines our current understanding and novel findings regarding the structural and molecular composition of the limbal niche including specific matrix components, cell‐matrix‐ and cell‐cell adhesion molecules, and niche cell populations, which are involved in stem cell regulation through multiple signalling pathways including the Hedgehog pathway. This lecture also provides an overview of current tissue‐engineering approaches for corneal surface regeneration that aim at incorporating specific niche components, such as matrix proteins, growth and signalling factors, or putative niche cells, into the culture systems in order to support maintenance of stemness and to improve the therapeutic use of limbal stem cell transplantation.
Inflammatory choroiditis
Authors: Herbort C.P.
Published: September 2015

White dot syndromes (WDS) is a term introduced around 1995 to describe posterior uveitis syndromes that were poorly understood such as MEWDS, APMPPE, multifocal choroiditis (MFC), serpiginous choroiditis (SC), birdshot retinochoroiditis (BRC) and many others depending on the extension with which the term is used. Unfortunatelly the term is of no utility as it is purely based on the the white dots most posterior uveitis exhibit and as it emcompasses entities that look alike but have nothing in common as far as mechanism is concerned. Thanks to indocyanine green angiography (ICGA) it became possible to get away from this pot‐pourri terminology and allowed to sort out choroiditis entities according to the pathophysiological mechanism subdividing choroiditis into diseases of the choriocapillaris (primary choriocapillaritis) including MEWDS, APMPPE, MFC, SC and atypical and overlapping entities on one side and stromal choroiditis on the other side including Vogt‐Koxanangi‐Harada disease (VKH), BRC, sarcoid and tubercular choroiditis. The appraisal of these diseases and the rationale of their new classification will be explained and examples will be given to illustrate this new comprehensive approach that should make WDS obsolete.
The Role of Antigen Presenting Cells in the Pathophysiology of Dry Eye
Authors: Stern M.E.
Published: September 2015

Purpose

Dry eye (DE) disease is perpetuated by self‐antigen driven autoimmune‐based inflammation. During the initiation of desiccating stress (DS)‐induced DE acute cytokine production and dendritic cell activation precedes autoreactive CD4 +  T cell activation, and CD4 +  T cells isolated from these DE mice are sufficient to mediate disease following adoptive transfer to T cell‐deficient nude recipient mice.

Methods

Flow cytometry, IHC, ELISA and ocular surface antigen presenting cell (APC)‐depletion were used to phenotype expression and function of dendritic cells and cytokines during DS‐DE (induced in C57BL/6 female mice exposed to sc scopolamine (0.5 mg/0.2 ml) TID, humidity <40%, and sustained airflow).

Results

In response to DS‐induced DE there is a significant increase (p ≤ 0.05) in the expression of CD11cloPDCA+ plasmacytoid dendritic cells (pDCs) and secretion of type I interferons (IFNa/b) in draining cervical lymph nodes (CLN) and ocular surface tissues compared to naïve controls. The higher frequency of pDCs within the CLN correlated with enhanced IFNa levels in both CLN and ocular surface tears (p ≤ 0.05). Furthermore, CD4 +  T cells isolated from APC‐depleted mice exposed to DS are not pathogenic; CD4 +  T cell infiltration was markedly (p < 0.05) reduced relative to controls, which was associated with an attenuated proinflammatory cytokine/chemokine response.

Conclusions

Collectively, these data further support the concept that DE is a localized self‐antigen‐driven autoimmune disease.
Genetic landscape of Leber's hereditary optic neuropathy: reflection on pathogenic mechanisms
Authors: Carelli V. , La Morgia C. , Caporali L. , Maresca A. , Giordano L. , Valentino M.L. , Barboni P.S.A.A. , Cantatore P. , d'Adamo P.
Published: September 2015

Leber's Hereditary Optic Neuropathy (LHON) is a mitochondrial disease due to homoplasmic mtDNA point mutations in complex I, affecting prevalently young males with incomplete penetrance. We recently documented that increase of mitochondrial biogenesis drives incomplete penetrance in LHON, further enhanced by estrogen protection in females. To shed light on nuclear genetic modifiers of LHON penetrance, we combined linkage analysis and association studies with tag and functional SNPs, MitoExome and microarray expression analysis. After computation of relevant co‐variates (age, sex, smoke and mtDNA copy number) we obtained a list of candidate genes, the most interesting being implicated in ROS detoxification, mitochondrial biogenesis and cell quality control. A prevalent role of tobacco smoking in penetrance also emerged from our studies, showing that tobacco toxicity triggers LHON by depressing mtDNA copy number and oxidative phosphorylation. Overall, our results indicate that penetrance in LHON is modulated by variants in different genes rather than by a single mutation, and that a complex interaction with environmental factors such as tobacco smoking plays also a major role, representing a confounder for genetic studies. Supported by Telethon‐Italy, grant #GGP11182 to VC.
The inhibitory effect of Itraconazole on Corneal neovascularization in Rabbits
Authors: Yang S. , Won J.Y. , Lee H.S. , Joo C.K. , Chung S.K.
Published: September 2015

Purpose

To evaluate the inhibitory effect of itraconazole on corneal neovascularization in rabbits.

Methods

Corneal neovascularization was induced in 36 eyes of 18 rabbits by suture placement in the corneal stroma. Seven days after suture placement, all rabbits were randomly divided into 4 groups and were treated four times daily with balanced salt solution (Group 1, 4 rabbits), topical 0.5% itraconazole (5 mg/mL , Group 2, 4 rabbits), topical 1% itraconazole (10 smg/mL , Group 3, 6 rabbits), and topical 2% itraconazole (20 mg/mL , Group 4, 4 rabbits). After one week, the surface area of corneal neovascularization was assessed on the digital photographs. In the corneal specimens, the concentration of VEGF A (vascular endothelial growth factor), VEGF R2, and PLGF (placental growth factor) mRNAs was measured by RT‐PCR, and the concentration of ERK, p‐ERK, Flk, and p‐Flk was measured by Western Blotting.

Results

The surface area of induced corneal neovascularization was significantly smaller in Groups 2, 3, and 4 compared to the control group on day 14 (p < 0.05). RT‐PCR analysis showed that the mean concentration of VEGF and PLGF in Groups 2, 3, and 4 was significantly lower than that in the control group after 7 days of treatment. Western Blotting analysis showed that the mean concentration of p‐ERK, Flk, and p‐Flk in Group 3 was significantly lower than that in the control group after 7 days of treatment.

Conclusions

Topical itraconazole application was useful for effective inhibition of experimental corneal neovascularization.
Indications and interpretations of various imaging techniques
Authors: Zografos L.
Published: September 2015

A large variety of imaging techniques are presently used in ocular oncology in order to document intraocular, epibulbar and iris tumors. The imaging of choroidal and retinal tumors is obtained either by digital or by scanning laser fundus cameras. Panoramic fundus pictures are obtained both with transpupillary and transscleral illumination. Imaging of epibulbar and iris tumors is obtained with split lamp photographies and gonio photographies. Standard fluoresceine angiography and ICG as well as panoramic angiography (102° – 150°) in ocular oncology are used according to the location and the extend of the tumors and the serous retinal detachment. Retinal thickness, retinal structure and the interface between retina and pigmented epithelium are studied by OCT. More recently, OCT en Face and Angio‐OCT provide useful informations on the extend of the retinal detachment and the retinal vascular changes of the macular area. The more appropriate technique has to be always used in order to obtain the best quality of imaging and avoid diagnostic errors.
How to keep your research published
Authors: Kivelä T.
Published: September 2015

A key criterion for publishing a paper is novelty. This extends from original data to the introduction and discussion of the results. No part of the manuscript can be cut and pasted, or cursorily adjusted, from published literature – not even from the author's previously published papers. Violation of this rule, if detected after publication, often results in retraction of the paper, something which can now happen even years after its publication. One must also be certain to submit only unaltered images and data. The advent of post‐publication peer review almost ensures that if images have been tampered with, this will be detected, again resulting in retraction. A third way of having one's paper retracted is to include authors who did not know about or did not approve the submission. These and certain other ways of getting a paper pulled out of the medical literature will be highlighted by recent examples, and the audience will be introduced to useful tools and web sites related to post‐publication review. It is best to know about them before they strike you.
DALK Techniques from manual to femtolaser
Authors: Nubile M. , Salgari N. , De Nicola C. , Mastropasqua L.
Published: September 2015

The continuous evolution of corneal transplantation has recently demonstrated that the surgical approach based on selective lamellar keratoplasty represents the gold‐standard for the treatment of corneal disease. The replacement of the diseased corneal layers with deep anterior lamellar (DALK) or endothelial keratoplasty clearly gives advantages to patients in terms of safety and outcomes. The introduction of femtosecond laser technology (FSL) into the clinical practice, after the wide use for refractive surgical corneal procedures, allowed a significant refinement in terms of precision and customization of both penetrating and lamellar keratoplasty (ALK and DALK). The main advantages of using FSLs are represented by the possibility of performing complex‐shaped trephination in both donor and recipient tissues (for example top‐hat or zig‐zag cut profiles) and the great precision of lamellar dissection. The concept of reducing or avoiding sutures (femtosecond laser suture‐less ALK) is still debated. However to date cut quality and interface smoothness represents critical points to be improved.
Angle evaluation after cataract operation using Swept‐Source OCT in elder Asian
Authors: Lee W. , Bae H. , Kim C.Y. , Seong G.J.
Published: September 2015

Purpose

To investigate the change of anterior angle morphology after phacoemulsification with intraocular lens implantation in eyes with cataract using Swept‐Source optical tomography (SS‐OCT) in elder Asian people

Methods

One eye of 31 patients with cataract was performed phacoemulsification with intraocular lens implantation. Before and after the operation, the postop 1 day and 1 month, the anterior chamber angles were evaluated by SS‐OCT(CASIA®, Tomey) under dark conditions using three‐dimensional angle analysis scan protocol. In order not to indent eyes, in naturally eye opening status, we obtained SS‐OCT scans and analyzed with nasal and temporal quadrant of eyes. AOD, TISA, TIA were calculated automatically by SS‐OCT after an observer marked the scleral spurs (AOD: Angle Open Distance, TISA: Trabecular‐Iris Space Area, TIA: Trabecular‐Iris Angle).

Results

Enrolled 31 patients were 18 men and 13 women. The mean age was 68.71 ± 9.82 years. Preoperative means of AOD, TISA, TIA were 0.51 ± 0.27 (mm), 0.21 ± 0.11 (mm), 28.83 ± 11.51 (°). Postop 1day and 1month, the means of AOD, TISA, TIA were 0.63 ± 0.19 (mm), 0.24 ± 0.08 (mm), 32.05 ± 7.54 (°), and 0.67 ± 0.24 (mm), 0.26 ± 0.1 (mm), 36.78 ± 8.4 (°). Longitudinal data analysis was conducted based on multilevel model framework. The changes of AOD, TISA, TIA were significantly increased linearly or quadradically after adjusting age and gender (p = 0.004, p = 0.002, p = 0.000).

Conclusions

The eyes that were performed cataract operation have greater improved anterior chamber angle parameters. It means that cataract surgery can improve aqueous humor dynamic in angle closure suspect or glaucoma patients.
Comparison of retinal and choroidal involvement in tuberculous chorioretinitis in a non‐endemic area
Authors: Massy R. , Herbort C.P.
Published: September 2015

Purpose

To assess the respective involvement of retina versus choroid in presumed ocular tuberculosis (POT) in a non‐endemic area using dual fluorescein (FA) and indocyanine green angiography (ICGA).

Methods

Retrospective study on patients with the diagnosis of POT seen in the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiography signs were quantified according to an established FA and ICGA scoring system for uveitis (Int Ophthalmol. 2010;30:539–52 and Ocul Immunol Inflamm 2010;18:385–9).

Results

Among the 1739 uveitis patients seen from 1995 to 2014, 53 patients were diagnosed as POT (3%) of which 28 had sufficient data to be included in the study. The choroid was predominantly involved in 22 patients and the retina in 6 patients. The mean angiographic score was 6.19/36 ± 4.11 for the retina versus 13.48/36 ± 7.06 for the choroid. For patients having sufficient angiographic follow‐up, the scores decreased from 6.19 to 2.40 ± 2.39 for FA and from 13.48 to 7.87 ± 5.37 for ICGA after combined antituberculous and inflammation suppressive therapy.

Conclusions

This study shows for the first time the respective involvement of retina and choroid in POT. Choroid is preferentially involved for which ICGA is the examination of choice. By looking only at FA, there is a risk of underestimating global ocular involvement and to miss the diagnosis. To evaluate correctly intraocular inflammation in POT and to have a better follow‐up, the use of dual FA & ICG angiography is recommended. On the other hand, in case of a compatible uveitis having a positive IGRA test, in a non‐endemic area, dual FA & ICGA should be performed to avert or help the diagnosis of ocular tuberculosis.
Subthreshold Micropulse Yellow Laser (577 nm) Photocoagulation for Subfoveal Serous Pigment Epithelium Detachment
Authors: Park H.
Published: September 2015

Purpose

To evaluate the efficacy of subthreshold micropulse yellow laser photocoagulation(SMYLP) for subfoveal serous pigment epithelial detachment(SPED).

Methods

We evaluated retrospectively 6 eyes of 5 patients with symptomatic subfoveal SPED treated with SMYLP. SMYLP was performed on the entire area of SPED with Supra 577Y Laser System(Quantel Medical). The SMYLP settings were 100 μm spot diameter, 20 ms duration, 15% duty cycle, 3 × 3 pattern. If SPED was not definitely restored, we applied laser again with more increased power at 1 or 2 months interval.

Results

All patients were received 3 or 5 times bevacizumab or ranibizumab injections before SMYLP. The total follow‐up period was 26.5 (18–36) months, mean follow‐up period after laser application was 19.8 (15–32) months. Mean height of PED before treatment was 349.2 ± 53.22 μm. About 3 (2–4) sessions SMYLPs were performed. All eyes showed nearly complete resolutions of the PED for 5.6 (5–7) months, which were sustained during the follow‐up. Mean BCVA before treatment was 0.11 (0–0.22) logMAR and mean BCVA at final follow‐up was 0.07 (0–0.22) logMAR. After PED resolution, all patients had increased vision and metamorphopsia improvement. After PED resolution, usually there were seen in mild RPE atrophies in fundus and OCT image, and these atrophies were not aggravated.

Conclusions

SMYLP for subfoveal SPED induced the resolution of SPED and symptom improvement. But after SPED resolution, mild RPE atrophy was detected. We think this finding was related to subsequent epithelial atrophy after resolution of SPED or laser damage. Prospectively, the study about long‐term efficacy and safety of this treatment will be needed.
Objective assessment of cataract: Comparison between the Lens Opacities Classification System III and a Scheimpflug camera
Authors: Birkeldh U. , Domínguez‐Vicent A. , Laurell C.G. , Brautaset R. , Nilsson M.
Published: September 2015

Purpose

Develop an automatic system for cataract classification using the Sirius Scheimpflug for both nuclear and cortical cataract.

Methods

Scheimpflug images were taken using the Sirius system in 50 patients with nuclear and/or cortical cataract (mean age 69 ± 9.2 years). The nuclear opacity (NO) and cortical opacity was graded by an ophthalmologist according to the Lens Opacities Classification System (LOCSIII) by comparing the slit‐lamp image with the LOCS's standard nuclear images. A custom‐made MATLAB program was used to calculate the pixel intensity value within a region of interest (ROI) of the nucleus and to calculate the percentage of opaque pixels in the cortex.

Results

Eighty‐nine eyes with nuclear and 81 eyes with cortical cataract were analysed. Both average and maximum NO pixel intensity units obtained from the ROI had a significant correlation with LOCS III (r = 0.731; P < 0.01 and r = 0.738; P < 0.01). The mean average NO was 21.77 ± 11.59 pixel intensity units and the mean maximum NO was 38.94 ± 18.52. A significant and positive correlation with LOCS III (r = 0.812; P < 0.01) was found when the whole cortex area was analysed.

Conclusions

The results from this study indicate that the Sirius Scheimpflug has a good correlation with LOCS III for lens density measurements. The use of a Scheimpflug camera might be a valuable tool in clinical practice to grade nuclear and cortical cataracts automatically and objectively.
Pigment epithelium central limit ‐ Inner limit of the retina, Minimal Distance, PIMD, a morphometrical variable for glaucoma follow‐up
Authors: Sandberg Melin C. , Malmberg F. , Malmqvist L. , Talebizadeh N. , Yu Z. , Söderberg P.
Published: September 2015

Purpose

To establish the resolution of measurements of the minimal distance between the central limit of the pigment epithelium and the inner limit of the retina (PIMD) as measured with OCT.

Methods

The optic nerve head was topographically recorded with OCT (Topcon 3D, OCT‐2000, protocol: 6 × 6 mm 3D disc cube). The minimal distance between the inner limit of the retina and the central limit of the pigment epithelium was sampled 8 times resolved in 500 angles.

Results

The angular minimal distance was longer in the upper and the lower meridian and averaged 0.21 mm. An analysis of the consequence of the resolution demonstrated that the minimal relevant significant average difference at α = 0.05 and aiming for β = 0.02 was 0.11 change (mm)/Average (mm). Thus, a change of 0.024 mm integrated over 2π is the detection limit at the selected statistical parameters. This corresponds to a local average change within one quadrant of 0.006 mm.

Conclusions

PIMD has the potential to be a useful variable for follow‐up of nerve fiber loss in the optic nerve head.
Surgical outcomes of Ahmed gluacoma valve implantation in pseudoexfoliative glaucoma
Authors: Kim G.A. , Ko J. , Bae H. , Hong S. , Kim C.Y.
Published: September 2015

Purpose

Pseudoexfoliation is considered to be the most common identifiable cause of open angle glaucoma worldwide and pseudoexfoliative glaucoma (PEXG) patients often require surgical intervention. But no studies are available reporting surgical outcomes of Ahmed glaucoma valve (AGV) implantation in PEXG. This study aims to evaluate the efficacy and safety of AGV implantation in PEXG patients.

Methods

A retrospective chart review of 27 eyes of PEXG patients who underwent AGV implantation (n = 14) or trabeculectomy (n = 13) and 13 eyes of primary open angle glaucoma

(POAG) patients who underwent AGV implantation as a primary surgical option was conducted. Postoperative intraocular pressure, number of medications and complications were compared between 3 groups.

Results

At postoperative 1, 3, 6, 9 and 12 months, intraocular pressure and number of medications were similar between 3 groups. Rates of transient hypotony were significantly lower in PEXG eyes with AGV implantation (14.3%) in comparison with those with trabeculectomy (61.5%, p = 0.018).

Conclusions

AGV implantation as a primary surgical treatment in PEXG patients produced similar intraocular pressure reduction and numbers of medications compared with AGV implantation in POAG patients and trabeculectomy in PEXG patients. And It offers advantage of reduced rate of transient hypotony over trabeculectomy in PEXG. Therefore, AGV implantation may be promising alternative in surgical management of this type of glaucoma.