bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathogen interactions in the pathogenesis of endophthalmitis
Authors: GILMORE MS
Published: September 2009

Endophthalmitis is an often blinding complication of penetrating globe injury, and an unfortunate consequence of common ocular surgeries, which requires immediate intervention. Although penetrating injuries are more likely to be associated with infectious complications, because of the number of ocular surgeries performed, postoperative endophthalmitis is its most common form. Given the challenge of maintaining a sterile field in ocular surgery, the fact that many surgeries are sutureless leaving a potential portal of entry, and the reported rates of bacterial contamination of irrigation fluid, it is perhaps surprising that the rate of infection in most centers is between 1 and 3 per 1000 surgeries. Although postoperative endophthalmitis rates are low, they appear to be increasing in the US and potentially elsewhere. This may relate to increased age of patient at the time of surgical intervention, increased rates of underlying illness, especially adult‐onset diabetes, and other factors. The development of new knowledge in several key areas is setting the stage for new and better strategies for infection treatment and prevention. It is now appreciated that the immune privilege of the posterior segment creates a highly permissive environment for the growth of microbes of even low virulence, such as coagulase negative staphylococci – a leading cause of postoperative endophthalmitis. The widespread use of antibiotic has selected for resistant strains of these and other organisms with increased virulence, including the ability to form tenacious and antibiotic refractory biofilms. We are beginning to understand the molecular basis for immune privilege in the posterior segment as it relates to the ability of innate immunity to contend with infecting microbes. We are also beginning to understand basic principles of the physiology of bacterial biofilms. The posterior capsule represents an important anatomical barrier to endophthalmitis, but many cases occur without known intraoperative breach. Studies now are attempting to identify bacterial properties, such as the production of tissue‐destructive proteases, that promote translocation of the microbes through an intact capsule and into the posterior segment. The contribution of innate immune privilege of the posterior segment, microbial virulence, and biofilm formation to endophthalmitis will be presented.
Unravelling the mysteries of ocular lymphomas
Authors: COUPLAND SE
Published: September 2009

Purpose There has been a bewildering evolution in the nomenclature of lymphomas, including ocular lymphomas. Confusing as this may seem, this is a reflection of impressive advances in our understanding of lymphoma pathogenesis, mainly as a result of immunohistology and molecular biological research. This overview will summarise the main successes of ocular lymphoma research and its translation into clinical practice.

Methods The WHO lymphoma classification is based on the morphology, immunophenotype and genotype of tumour cells and their relationship to a putative cell of origin. Most ocular adnexal lymphomas (OAL) are low‐grade B‐cell lymphomas (EMZL), thought to arise from marginal zones of lymphoid follicles. Their development is associated with chromosomal abnormalities, autoimmune disease & microorganisms. Traditionally, OAL have clinically been staged using the Ann Arbor system, which has many shortcomings. The novel TNM‐based staging system defines disease extent more precisely and allows for analysis of site‐specific factors.

Results Retinal lymphoma has been vaguely subsumed under the term "primary intraocular lymphoma": it is a high‐grade B‐cell malignancy, associated with a poor prognosis as a result of CNS disease. Immunophenotyping and genetic analysis suggest that retinal lymphomas arise from early post‐germinal centre cells. Other less common intraocular lymphomas include primary choroidal lymphomas (a low‐grade EMZL), primary iridal and ciliary body lymphomas, and secondary uveal lymphomas.

Conclusion Ocular lymphomas are heterogenous tumours with differing subtypes and varying clinical courses. Precise nomenclature together with exact subtyping and clinical staging is essential, to understand ocular lymphoma histiogenesis and to facilitate studies improving prognostication and therapy.
Meibomian gland dysfunction: management and treatment
Authors: DOAN S
Published: September 2009

Abstract not provided
Aqueous humor heparin‐binding epidermal growth factor‐like levels in patients with acute anterior uveitis.
Authors: FRANCES‐MUNOZ E , GALLEGO‐PINAZO R , DIAZ‐LLOPIS M , SALOM D , GARCIA‐DELPECH S , UDAONDO‐MIRETE P , SANZ E
Published: September 2009

Purpose Heparin‐binding epidermal growth factor‐like growth factor (HB‐EGF) is a potent antiapoptotic protein that enables cells and tissues exposed to different apoptotic stimuli to survive hypoxic, oxidative, and inflammatory stresses. The aim of this study was to evaluate the levels of HBEGF (HBEGF) in the aqueous humor in eyes with acute anterior uveitis (AAU).

Methods A prospective, comparative control study. Aqueous humor was collected from 16 eyes of 16 patients with AAU. The level of HBEGF was determined with a commercially available enzyme‐linked immunoabsorbent assay kit. The control group comprised 16 aqueous samples from 16 patients about to undergo cataract surgery and without any other ocular or systemic diseases.

Results The concentration of HBEGF in aqueous humor was markedly higher in patients with UUA than in control subjects (Mann‐Withney U test, P< 0.001). The level of HBEGF was 45.18 ± 54.58 (mean ± SD) pg/ml in eyes with UUA and 8.15 ± 5.71 pg/ml in the eyes of the control group.

Conclusion The aqueous humor HBEGF level is increased in eyes with AAU. These results imply that HBEGF is associated with the regulation of inflammation in patients with AAU
A case of intraocular dirofilaria in a dog: alarm bell for human beings?
Authors: DODI PL , ZANOTTI C
Published: September 2009

Purpose The genus Dirofilaria includes various species, in particular immitis and repens, that are natural parasites of dogs and other domestic and wild mammals. From those natural hosts microfilariae circulating in blood may accidentally be transmitted by mosquitoes to man. These microfilariae can be localized in the human beings' periorbital or subconjunctival tissues or in the intraocular region. This case report observed an increase of the ocular filariasis in dogs and it aims to put emphasis on the possible transmission of this parasite from animals to the human eye.

Methods A 2‐year‐old male, mixed breed living in the North of Italy, in the Emilia Romagna area, was presented to the author having pain to the right eye. Ocular esamination showed miosis, corneal edema and low intraocular pressure. Slit lamp examination revealed a lively motile worm in the anterior chamber.

Results It was not possible both to remove the parasite and to identify its species. At the same time no parasite was identified in the peripherial blood.

Conclusion The rise of weather temperatures of these last years caused an increase in the occurrence of “tropical disease”. This particuar case shows many similarities to the human parasite because the dog had no microfilariae in the blood. Many studies pointed out a remarkable incidence of microfilariae in the dogs' eyes living in the Mediterrenean area; this remark must be taken into serious consideration because it can be considered as an emerging zoonosis and as an alarm bell for human beings.
Macular edema and uveitis: may we find a place for surgery
Authors: DE SMET M
Published: September 2009

Abstract not provided
Evaluation of cerebrospinal fluid pressure in patients with Alzheimer’s disease as a possible cause of glaucoma
Authors: KIEKENS S , DE GROOT V , TASSIGNON MJ , DE DEYN PP
Published: September 2009

Purpose To investigate whether cerebrospinal fluid (CSF) pressure and trans‐lamina cribrosa pressure gradient play a role in the pathogenesis of glaucoma. Our hypothesis is that a low cerebrospinal fluid (CSF) pressure may be correlated with the presence of glaucoma. The first objective is to investigate whether the CSF pressure in Alzheimer’s disease (AD) patients with glaucoma is lower than in AD patients without glaucoma. The second goal is to evaluate an animal model with AD for the incidence and prevalence of glaucoma. If glaucoma is present histopathological analysis will be performed on retina and optic nerve, to search for Alzheimer‐type changes.

Methods Newly diagnosed AD suspects will undergo a lumbar puncture with CSF manometry, during neurological work‐up. Ophthalmological evaluation consists of best corrected visual acuity, slit lamp biomicroscopy, gonioscopy, fundoscopy and pachymetry. Diagnosis of glaucoma or ocular hypertension will be made on the basis of visual field examination, optic disc evaluation and IOP measurement. Correlation between CSF pressure, trans lamina cribrosa pressure gradient and the presence of glaucoma will be calculated. The prevalence of low tension glaucoma will be compared to the prevalence of chronic open angle glaucoma with elevated IOP. In the second part of the project a genetically modified strain of mice with AD will be examined and screened for the development of glaucoma. Opthalmological examination will consist of IOP measurement, corneal pachymetry, optic disc evaluation and visual evoked potentials with flash. Histopathological analysis will be performed by the team of Prof De Deyn PP.

Results will follow

Conclusion will follow
The role of VEGF in intermediate uveitis patients
Authors: VIDOVIC VALENTINCIC N , KRAUT A , KOROSEC P , HAWLINA M , ROTHOVA A
Published: September 2009

Purpose Intermediate uveitis (IU) represents a chronic type of uveitis which usually manifests at young adult age with the vitreous and peripheral retina as the major sites of the inflammation. The cause and pathogenesis of IU are not known. Cystoid macular edema (CME) is the main cause of permamnent visual loss in IU. Cytokines and chemokines play a major role in the pathogenesis and persistence of intraocular inflammation. The era of anti VEGF biologics opens the new possible way of treatment of uveitic macular edema of which scarce reports are found until now.

Methods Prospective cohort study. We compare the intraocular VEGF profiles in 30 patients with IU with various stages of inflammatory activity and 10 healthy controls with cataract and no uveitis in whom the AqH samples were collected during cataract surgery. Comparison was also made between the 7 IUpatients with and 23 IU patients without cystoid macular edema; for 10 IU patients with active and 20 with nonactive IU. Concentrations were measured by multiplex immunoassay method in the aqueous humor.

Results There were no statistically significant differences IU patients/control group (P= 0.293); for the IU with/without CME (P=0.666);for active/not active IU (P=0.502).

Conclusion Although there are many known and unknown factors influencing vascular permeability in macular edema there is a question of reasonableness of treating the CME with intravitreal anti VEGF in IU patients with CME.
The Sanger Institute mouse genetics programme: progress on the high throughput characterisation of knockout mice
Authors: GERDIN AK
Published: September 2009

Purpose Anna‐Karin Gerdin The Wellcome Trust Mouse Genetics Programme Group Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, England, UK. Email: mousegenetics@sanger.ac.uk The Sanger Institute Mouse Genetics Programme is committed to making a significant contribution to the functional annotation of the mammalian genome. We are utilising the growing knockout first conditional ready targeted ES cell resource currently being created by the EUCOMM and KOMP initiatives to generate, characterise and archive 250 lines of knockout mice per year, including 40 lines for the EUMODIC consortium. In addition to studying the role of each gene in normal development and function, the breadth and depth of our phenotyping platform ensures that phenotype information on a wide spectrum of disease conditions is obtained for each individual mouse line without the need for any prior assumptions about function. All phenotype data and biological resources generated by the programme are openly available to the scientific community.

Methods Eye morphology is routinely assessed using the Slit Lamp and Ophthalmoscope. Details are documented using a standardised checklist of observable characteristics. When abnormalities are identified, images are collected directly from the Slit Lamp or, for the retina, by using a topical endoscope (TEFI). Furthermore, we are in the process of assessing the Optokinetic Drum and its suitability in our high throughput phenotyping pipeline to measure visual perception and acuity. Here we report the progress on the Eye and Vision screens.

Results We present a summary of the phenotyping data available to date and examples of novel findings from a subset of interesting mutant lines.
Screening for mouse eye and vision defects at MRC Harwell
Authors: MULFORD C , JOYNSON R , CROSS S , WEST K , MCKIE L , JACKSON I
Published: September 2009

Purpose Characterisation of novel genes involved in vision and eye development from the Harwell EUMODIC screen and a recessive ENU mutagenesis screen.

Methods Mice have been generated through the EuComm and EuModic programmes that have knockout mutations in defined genes. In addition, mice with random, undefined, mutations have been produced by chemical mutagenesis. Cohorts of these mice have been subjected to slit lamp examination and indirect ophthalmoscopy, and are tested for visual function using a virtual optokinetic drum with a computer generated image displayed around the test animal. Further phenotypic characterisation involves histology and use of tissue markers. In order to preserve the three‐dimensional structure of the eye for examination of the vasculature, for example, we are exploring the use of Optical Projection Tomography which images the intact eye and allows reconstruction of eye structure.

Results We have identified a number of mouse lines defective in the visual system. These defects include microphthalmia, eyes open at birth, lens, cornea or iris defects, intraocular bleeding, and retinal degeneration. Furthermore, one line exhibits persistent fetal vasculature in the vitreous (PHPV) which normally regresses after birth through the action of resident macrophages. Determining the basis of this phenotype involves analysis of both the embryonic and adult eye, since mice with defective optic‐fissure closure have also been described with this phenotype.

Conclusion Characterisation of these mutant lines will enable us to contribute to a more comprehensive understanding of the genetic regulation of eye development and tissue maintenance within the visual system. Many of these mutants are valuable genetic models of human eye diseases.
Progress in the appraisal and management of inflammatory CNVs
Authors: NERI P
Published: September 2009

Purpose To review the current Literature and to describe the experience of a tertiary referral centre on the progress in the appraisal and the management of inflammatory choroidal neovascularization (CNV).

Methods The current literature is reviewed and the experience of a tertiary referral centre is reported.

Results CNV is a potentially severe sequela of posterior uveitis. The role of chronic inflammation has been described in experimental uveitis. For such reasons, even when biomicroscopy and fluorangiography (FA) cannot detect abnormalities, Indocyanine Green Angiography (ICGA) can show choridal anomalies. ICGA greatly improved the appraisal of the choroidal involvement, by providing reliable data for the diagnosis and for the management of inflammatory CNV. The new spectral domain optical coherence tomography (OCT) equipments can provide further informations that can be useful for a correct clinical assessment. The out‐come of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. Steroids, both local and systemic, are the first line therapy for non‐infectious choroidal inflammation, although their long‐term use can lead to unpleasant sequala, such as glaucoma and cataract. Immunesuppressive agents, lasers photocoagulation, photodynamic treatment, surgical removal and anti‐Vascular Endothelial Growth Fact (VEGF) are other options.

Conclusion CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant informations about the choroidal status. Several therapeutic options have been considered, but no guidelines are available at the moment.
Diffusion tensor magnetic resonance imaging and fiber tracking of trigeminal nerves in relapsing herpetic keratouveitis
Authors: LABETOULLE M , NASSER G , DE MONCHY I , GENDRON G , OFFRET H , DUCREUX D , BENOUDIBA F
Published: September 2009

Purpose To study the trigeminal fibres (TGFs) using diffusion tensor magnetic resonance imaging (DTMRI) in relapsing herpetic kerato‐uveitis.

Methods The TGFs of 11 patients (average age: 57+/‐9 years), addressed for relapsing unilateral kerato‐uveitis related to Herpes simplex virus (HSV) or varicelle‐zoster virus (VZV), were tested using DTMRI. The diagnosis of HSV‐ or VZV‐related disease was based on PCR or specific antibodies production within the aqueous humor, or on medical history (zoster). At the time of DTMRI, the kerato‐uveitis was in a quiescent period (no recent increase of inflammation). Data were retrospectively assessed by a blinded examiner to compare the affected‐side with the non‐affected one and with data from sex‐ and age‐matched normal subjects.

Results The DTRMI processing showed a significant difference in the mean isotropic fraction within trigeminal fibres innervating the affected side, compared to the non‐affected side (0.41 versus 0.49, p = 0,003). There also was a trend in difference between results of the affected side of patients and those of control subjects (0.41 versus 0.44, p =0,12), whereas it was not the case for DTRMI results of non‐affected sides (p=0.23).

Conclusion DTMRI is an emerging technique that allows an accurate analysis of neuronal networks in patients. Our results suggest that multiple HSV or VZV reactivation episodes induce persistent trigeminal fibres injuries (as shown by reduction of the mean isotropic fraction), that probably reflects a significant decrease in the amount of nerve endings.
Uveal melanoma: management and outcome of patients with extraocular spread
Authors: CASSOUX N , BELLMANN C , LUMBROSO‐LE ROUIC L , LEVY‐GABRIEL C , PLANCHER C , ASSELIN B , DENDALE R , DESJARDINS L
Published: September 2009

Purpose Extraocular spread is thought to be a negative prognostic factor on survival of the patient with uveal melanoma. Depending on the size of the tumor and the type of extraocular extension conservative treatments can be employed.

Methods 2256 patients were treated between 2000 and 2007 at the Institut Curie, Paris, France for an uveal melanoma. 67 patients (3.0%) presented an extraocular extension. A retrospective study was performed to evaluate the patients outcome with regard to tumour recurrence and their survival.

Results Results: Eye‐conserving treatment was employed in 38 (52.8%) patients. An enucleation was performed in 29 (47.2%) patients. The median follow‐up was 38 (range 7 ‐ 79) months with an overall survival rate at 5‐years of 40.4% in enucleated patients and 79.3% in the eye‐ conserving treatment group (protons n=19, iodine‐125 plaque n = 19) (p = 0.01; Kaplan‐ Meier analysis). No tumor recurrence was observed in any group. Degree of extraocular spread as well as the clinical characteristics tumor location, retinal detachment, ciliary body involvement (p < 0.01; Chi‐square test) and tumor thickness (p = 0.04; Chi‐square test) influenced the choice of treatment. Age, tumor diameter, involving optic nerve, vitreous hemorrhage, achromic lesion was without any influence.

Conclusion Conclusion: No tumor recurrence and no lower survival rate were observed in patients receiving an eye‐conserving treatment. They may represent thus a therapeutic option in selected patients with extraocular spread.
Cytogenetic profile of locally invasive posterior uveal melanoma
Authors: PARROZZANI R , ALEMANY‐RUBIO E , PILOTTO E , URBAN F , BONALDI L , MIDENA E
Published: September 2009

Purpose To analyze cytogenetic profile of locally invasive posterior uveal melanoma (UM).

Methods Twenty consecutive cases of large posterior UM with histopathologically confirmed extrascleral extension were included in this non‐comparative cases series. Fine needle aspiration biopsy (FNAB) of the intraocular tumor portion was performed using 25‐gauge trans‐scleral approach, immediately after enucleation of the globe. FNAB of the extrascleral tumor portion was also performed when it was > 1mm in thickness. Sampled material underwent fluorescence in situ hybridization (FISH). Follow‐up was longer than 12 months.

Results Six tumors (30%) had both intraocular and extraocular tumor samplings, whereas 14 tumors (70%) showed extrascleral extension less than 1 mm in thickness. Monosomy 3 was found in 5 tumors (25%), whereas disomy 3 in 15 tumors (75%). Cytogenetic profile of the intraocular tumor portion appears to be maintained in the extrascleral extension in all cases (100%). Five patients (25%) developed metastatic disease during follow‐up (all had monosomy 3 tumors).

Conclusion Extrascleral extension appears more frequent in disomy 3 tumors. Cytogenetic profile of locally invasive posterior UM is maintained in the extrascleral tumor portion and must be considered the most important prognostic factor in locally invasive tumors.
Anti‐VEGF therapy and influence of vitreomacular traction in wet AMD
Authors: CORTES MORA N , LOPEZ GALVEZ MI , MANZANAS LEAL L , RODRIGUEZ DE LA RUA FRANCH E , GIRALDO ARGUELLO A
Published: September 2009

Purpose The aim of this study is to describe the results of anti Vascular Endothelial Growth Factor (VEGF) therapy in Wet Age Macular Degeneration (Wet‐AMD) and the posible rol of vitreomacular traction (VMT).

Methods Descriptive, retrospective, interventional case series study of Wet‐AMD patients diagnosed by angiography (AFG) and optical coherence tomography (OCT) and treated with anti‐VEG . All patients received an initial charge course of three doses, and consecutive new doses if required by monthly follow up. Vitreomacular status was evaluated by OCT. Inactivation was defined by the absense of new subretinal fluid on OCT and AFG. Minimun follow up of six months after the last dose.

Results Of 76 treated patients, 27 met the inclusion criteria, 12 men and 15 women with a mean age of 79,9 years (standar deviation of 6,2). 11 had VMT and 16 had not. 48% (13/27) of patients became inactive after initial charge course, 18% (5/27) after initial good response became active despite consecutive aditional doses and 33% (9/27) required more dosis but finally achieved inactivation, but did not improve visual acuity. Between patients with VMT there were more prevalence of patients who needed seven or more doses to stabilize the disease (p=0,003).

Conclusion Consecutive dosis of anti‐VEGF after inicial charge course are needed to inactivate one third of patients, but these patients have poorer funtional results. VMT seems to be a bad prognosis factor.
Long‐term result of intravitreal steroid for macular oedema: 2 to 5 year follow‐up of 92 eyes
Authors: ZAIDI F , ANSARI E
Published: September 2009

Purpose A topical area is how best to manage diabetic macular oedema (intravitreal steroid, laser, anti‐VEGF). However little or no long‐term data exists for steroids. We hence studied the 2 to 5‐year results of intravitreal triamcinolone (IVTA) in diabetic macular oedema.

Methods A retrospective cohort of 92 eyes was recruited, inclusion criteria subjects with diabetic macular oedema injected with 4mg / ml IVTA with regular follow‐up of 2 to 5 years. Exclusion criteria were subjects with non‐diabetic oedema (uveitis, vascular, post‐operative) and baseline foveal ischaemia at time of first injection. The following were recorded: visual acuity, central retinal thickness (OCT) prior, 1 month after (+/‐ 1 week) and 3 months post‐IVTA (+/‐ 2 weeks), complications, and angiograms pre‐ and post‐treatments. 88% had Type 2 diabetes. Mean duration of diagnosis of diabetes was 14 years, mean age 64 (29‐84).

Results At 2 to 5 years IVTA continued to be effective both in improving visual acuity and reducing macular thickness in 76% of subjects, including after multiple injections. In 24% of subjects foveal ischaemia limited outcome, usually 36 to 54 months post initial treatment. In 8% of subjects a repeat injection was associated with cessation of leakage for 2 to 3 years, or a persistent marked dimunition in leakage of in excess of 100 microns, thereafter vision dropping to 6/12 to 6/18 despite further injections. Intra‐ocular pressure rises were controlled topically, there was one case of sterile endophthalmitis.

Conclusion IVTA continues to offer significant visual benefit and reduction in macular thickness 2 to 5 years after initiation of therapy, including after multiple injections. Therapeutic potential is limited by ischaemia in 24% of subjects.
Assessment of retinal arteriolar hemodynamics in patients pre‐ and post‐cataract extraction
Authors: HUDSON C , AZIZI B , WAN J , WONG T , SINGER S
Published: September 2009

Purpose We have previously demonstrated that artificial light scatter results in the erroneous elevation of retinal vessel diameter and blood flow using densitometry based techniques. The aim of this study was to determine the impact of cataract on the quantitative, non‐invasive assessment of retinal arteriolar blood flow.

Methods Of the original 30 recruited patients who were scheduled for extra‐capsular cataract extraction using phacoemulsification and intraocular lens implantation, ten patients between the ages of 61 and 84 (mean 73 ± 8) successfully completed the study protocol. Two visits were required to complete the study, one prior to the surgery and one at least six weeks after the surgery. Cataract status was documented using the Lens Opacity Classification System (LOCS, III) on the first visit. Retinal arteriolar hemodynamics were measured using the high intensity laser setting of the Canon Laser Blood Flowmeter (CLBF) on each visit.

Results Group mean retinal arteriolar diameter and blood flow were significantly lower following extracapsular cataract extraction (Wilcoxon signed‐rank test, p=0.022 and p=0.028 respectively); however, centreline blood velocity was unchanged (Wilcoxon signed‐rank test, p=0.074). The primary reason for failure to complete the study protocol was due to poor retinal image quality impairing CLBF measurement.

Conclusion Densitometry assessment of vessel diameter is extraneously impacted by the presence of cataract. Care needs to be exercised in the interpretation of studies of retinal vessel diameter and blood flow that utilize densitometry techniques.
Effects of conventional argon panretinal laser photocoagulation on retinal nerve fibre layer and driving visual fields in diabetic retinopathy
Authors: MUQIT MMK , GHANCHI FD , WAKELY L , HENSON DB , STANGA PE
Published: September 2009

Purpose To determine the effects of argon green panretinal laser photocoagulation (AG‐PRP) on retinal nerve fibre layer thickness (RNFLT), threshold visual fields (VF), and Estermann full binocular VF over time.

Methods Prospective, pilot clinical study of patients with newly‐diagnosed proliferative diabetic retinopathy (PDR). Time‐Domain optical coherence tomography (TD‐OCT) of optic nerve head and 24‐2 SITA‐Fast Humphrey/Estermann VF (HVF, EVF) recorded at baseline, 10 weeks and 6 months post‐laser. Quantitative field analysis of central 10º, 24º, and binocular VF.

Results 10 eyes underwent uncomplicated multiple‐session 100ms AG‐PRP using 2000 burns, 400μm spot, and mean power 136 mW (SD 39.3). TD‐OCT detected and quantified an increase in mean RNFLT at 10 weeks (+8 μm; p<0.05) and progressive thinning at 6 months (‐4 μm; p<0.05) compared to baseline. Mean threshold sensitivities, 10° and 24°, improved at both time‐points in the majority (9/10 and 8/10) of patients. Masked grading of EVFs showed no significant change with treatment.

Conclusion This pilot study demonstrates that conventional AG‐PRP may increase the RNFL in the short‐term, presumably related to laser‐induced axonal injury, with progressive thinning of RNFL in the longer‐term. The sensitivity of both 10° and 24° VFs improved significantly following AG‐PRP, and this central functional improvement may be due to a reduction in oedema folowing AG‐PRP. Binocular standard driving VFs performed within 6 months of AG‐PRP may actually reflect pre‐existing VF abnormalities due to severe retinal ischaemia or non‐viable retina at presentation, rather than direct functional loss from laser.
How should we quantify the performance of KPro's? VATI
Authors: GRABNER G , STOIBER J , HITZL W
Published: September 2009

Purpose To report a method of standardized data collection and reporting and statistical assessment that can be used for all KPro´s available on the market. The database (will be presented) should be • Usable for different types of KPro´s • Easily adaptable to changes in technique • Allow for complete entry of relevant data

Methods Visual Acuity data should be reported in different international surgical centres in a standardized manner: Best spectacle corrected VA, unless BCVA only possible with CL (> useful time of wear). A complete entry of all relevant data is possible in this database. The statistical analysis should be agreed upon by all centres. For Survival Time = Retention of KPro > the Kaplan‐Meier method For Visual Acuity over the Course of Time > the Monte‐Carlo method

Results A database will be demonstrated that can be used free of charge by all KPro centres interested. The VISUAL ACUITY BY TIME‐ INDEX (VAT‐ Index) will also be presented, whose theoretical basis published in: Journal of Theoretical Medicine, 2002 / 4, 183‐190, W. Hitzl and G. Grabner [bdquo]Application of the Monte Carlo Method for the Assessment of Long‐term Success in Keratoprosthesis Surgery“. Example of its use will be give, based in data, courtesy Barraquer Eye Clinic, Barcelona.

Conclusion With the Kaplan‐Meier method: + analysis is done quickly, uses all data available, hypotheses tests are available for comparisons and mean and median survival time can be computed ‐ no information about relation between time and best corrected visual acuity and the definition of terminal event is arbitrary to a certain extent. Monte‐Carlo method (VAT‐index): + Method is based on a so‐called non‐parametric longitudinal model + Reliabel estimation of relation between time and best corrected visual acuity at any given time point (patient as well as surgeon is basically interested in this relation). + statistically valid analysis and better comparison of different KPro techniques + easy comparison of defined postoperative periods + comparison of different initial clinical findings and diseases possible + long‐time follow‐up of BCVA ‐ shorter follow‐up time as compared with Kaplan‐Meier method (e.g. with strict [bdquo]80%data complete” criteria)
Clinical decision paths in KPro Surgery
Authors: GRABNER G , STOIBER J , HITZL W
Published: September 2009

Purpose To analyse the currently available methods for treating very severe anterior segment disease, such as stem cell transplantation with amniotic membrane transplantation, lamellar and penetrating keratoplasty techniques, and the different Kpro´s currently available, in regard to the initial clinical findings, the potential complications encountered and the surgical requirements needed for the different techniques. Factors considered are: uni‐ or bilaterality, limbal stem cell status, dry eye status and availability of healthy teeth.

Methods A systematic analysis of surgical options available for different stages of a variety of anterior segment diseases and currently published results of VA and complications

Results With a systematic approach it becomes clear that some popular reconstructive surgical techniques should be avoided in cases where a very low chance of success is to be expected (e.g. amniotic membrane and stem cell transplantation and /or PKP in very dry eyes –> these would have to be treated with OOKP).

Conclusion Following a simple the clinical decision path the anterior segment surgeon will be presented with standardized guidelines for treating those patients where conventional surgical procedures have to be avoided and replaced by rather rarely performed KPro techniques.
Safety evaluation of intravitreal use of a beta2‐agonist in rabbit eyes
Authors: VAN CALSTER J , VERSTRAETEN S , STALMANS P
Published: September 2009

Purpose There is no known information on the use and safety of a long‐acting beta‐agonist, such as Clenbuterol when administered by intravitreal injection. Therefore, it is appropriate to perform this intravitreal injection in an animal model prior to start with a human experiment. The aim is to investigate the safety of an intravitreal injection of the beta2‐agonist Clenbuterol in rabbit eyes. This study is in preparation of using of this molecule in human eyes. That trial will be a monocentric, academic (investigator driven) trial to investigate the safety and efficacy of an intravitreal beta2‐agonist in patients with persistent subfoveal fluid after retinal detachment surgery. Approval of the ethics committee for the human trial has already been obtained, pending a re‐evaluation after the results of the animal study will be known.

Methods 5 rabbits will receive an injection of 0.1 ml solution containing 0.08µg Clenbuterol in one eye and an injection of 0.1ml NaCl 0.9% in the other eye. Since the volume of an adult rabbit eye is only one third of an adult human eye, the achieved concentration with be three time the concentration suggested for use in a human eye.
The role of lox and LOXL2 in inflammation and fibrosis in a laser induced mouse model
Authors: VAN DE VEIRE S
Published: September 2009

Purpose Lysyl oxidase (LOX) and lysyl oxidase‐like protein 2 (LOXL2) are involved in the cross‐linking of collagen and elastin in the extracellular space. The aim of this study was to investigate the expression LOX and LOXL2 in the eye (choroidea and retina) after laser‐induced chroidal neovascularization (CNV). We also want to check the anti‐angiogenic, anti‐inflammatory and anti‐fibrotic efficacy of anti‐LOX and anti‐LOXL2 antibody in a mouse model of age related macular degeneration (ARMD).

Methods CNV will be induced in 8 to 10 weeks old C75Bl/6 mice, by placing 3 laser spots at 9, 12 and 3 o’clock position (50µm, 0.05 s and 400mW). Two daily injection with LOX(L) antibodies or control solution (PBS‐Tween 20%) will be given intraperitoneally from day 0 after lasering until day 34. Immediately after death, both eyes will be enucleated. One eye will be used to check RNA‐expression of LOX and LOXL. The other eye will be used to perform different immunohistochemical stainings (HE, Sirius Red, Trichrome, CD31, CD45 and LOX(L)).

Results Preliminary results showed a significant increase of LOX and LOXL2 in the choroid and retina after lasering compared to control.

Conclusion ARMD remains the most common cause of irreversible vision loss in people aged 50 years and older, due to (sub‐)retinal neovascularisation and scarring. It is already known that LOX and LOXL are playing a role in the cross linking of collagen and elastin, leading to an increase of fibrosis, and there is growing evidence that these molecules also play a role in neovascularisation. Therefore, a therapeutic potential of anti‐LOX and/or anti‐LOXL therapy can open new perspectives to treat CNV.
MICS and vitreo retinal surgeries
Authors: CREUZOT C
Published: September 2009

Purpose Cataract represents the main complication occuring after vitreoretinal surgery. The purpose is to present the main advantages and convenients due to combined procedures.

Methods Among the complications of vitrectomy, cataract represents the most common one as about 100% of patients will be operated within 5 years after initial surgery. However, surgeons have to face sometimes with severe complications when operating patient long time after vitreoretinal surgery. Combined procedures have become more and more popular especially for macular surgery.

Results The main pros and cons of combined surgery have to be considered: specific surgical complications, problems due to the internal tamponade, macular edema, cost… Combined procedures will probably become the standard procedure in vitreoretinal surgeries. The use of transconjunctival vitrectomy as well as MICS contributes to the easier post‐operative follow‐up of the patients.

Conclusion Combined surgery for vitreoretinal diseases will probably become the standard procedure due to the diffusion of transconjunctival surgery.
MICS and glaucoma
Authors: BRON AM
Published: September 2009

Purpose Anterior segment imaging devices have brought a better understanding of the role of the lens in angle‐closure glaucoma. The key‐role of the lens in theses presentations seems to be crucial in open‐angle glaucoma as well.

Methods With the growing evidence that the lens plays a more important role in glaucoma than previoulsy thought, it is expected that lens extraction will increase in the next coming years. Micro incision cataract surgery (MICS) offers a unique opportunity to achieve for these cases a safe and reliable procedure. We will focus on combined surgeries with lens extraction (either trabeculectomy or deep sclerectomy).The small size of the corneal incision allows a very good tightness of the incision. Therefore glaucoma surgery is performed on a hard globe with much ease.

Conclusion MICS although dedicated to the field of cataract, yields a valuable improvement in the surgical management of the glaucomas.
Prophylaxis of posttraumatic endophthalmitis
Authors: ABU EL ASRAR A
Published: September 2009

Infectious endophthalmitis is a devastating complication of open globe injuries. The incidence of culture‐positive endophthalmitis after open globe injuries varies between 0.5% and 17%. Several reports have demonstrated that delayed primary repair, dirty wound, breach of lens capsule, retained intraocular foreign body (IOFB), grade 4 injury (presenting visual acuity of worse than 5/200 to light perception), placement of primary intraocular lens, and rural setting are associated with an increased risk of posttraumatic endophthalmitis. Posttraumatic endophthalmitis is associated with its own microbiologic spectrum which is distinct from other subgroups of exogenous endophthalmitis. Posttraumatic endophthalmitis still carries a poor prognosis. Reasons for guarded prognosis include polymicrobial infection and the virulence of the infecting microorganisms. In addition, concomitant injuries may directly result in ocular damage that limits ultimate visual recovery. Because of the substantial incidence of endophthalmitis after open globe injuries, careful consideration should be given to the use of prophylactic antimicrobial therapy. The purpose of prophylaxis is to provide effective antibiotic levels as rapidly as possible against a broad range of organisms. Good coverage for most organisms is obtained with intravenous vancomycin coupled with a third generation cephalosporin, such as ceftazidime, which can penetrate the vitreous cavity in effective levels in inflamed aphakic experimental eyes. Recently, the use of prophylactic intravitreal antibiotic administration in high‐risk cases was recommended.
Animal studies for the prevention of endophthalmitis
Authors: KOWALSKI RP
Published: September 2009

Topical anti‐infectives are commonly used to prevent post‐surgical endophthalmitis. Animal models can be used for the development and selection of topical anti‐infectives for optimizing ocular surgical prophylaxis. The primary outcome measures for providing prophylactic efficiency are antibacterial efficacy and anti‐infective penetration into the anterior chamber. This curreent presentation will focus on a rabbit prevention of endophthalmitis model. Publish data will be presented detailing clinical correlation and limitations of the models.
Bacterial keratitis: the clinical problem
Authors: PLEYER U
Published: September 2009

Abstract not provided
Basic principles of radiotherapy in ophtalmic oncology
Authors: DENDALE R , FOURNIER ‐ BIDOZ N , CAMPITELLI M , CALUGARU V , LUMBROSO ‐ LE ROUIC L , LEVY C , PIERRAT N , MAZAL A , DESJARDINS L , FOURQUET A
Published: September 2009

Ophtalmologic Radiation Oncology concerns intra ocular tumors, orbital tumors and eyelid tumors. In these locations, tumors are often close to normal critical tissues, increasing the risk of radiation toxicities. Basic principles of ophthalmic radiotherapy are not really different from radiotherapy of others organs. They are based on a precise description of the tumor volume, knowledge of potential tumor local or regional extension, knowledge of tissue biological radiosensitivity for tumors and the surrounding normal tissues. Based on these features, treatment modalities (radiation treatment length and fractionation) are determined to fulfill the aims of medical curative intents: good local control with acceptable toxicities or the aims of medical palliative intents: to relief with minimal toxicities. Many types of radiation therapy can be used for ophthalmic tumors: brachytherapy, orthovoltage radiotherapy, conformal therapy with photons and electrons including intensity modulated radiation therapy, protontherapy, and the use of specific devices such as CyberKnife and Tomotherapy. All of these techniques have their advantages and their disadvantages, leading the radiation oncologist to make a choice depending on the tumor site and characteristics.
The treatment of uveal melanoma by ruthenium plaques
Authors: DAMATO B
Published: September 2009

Purpose Plaque radiotherapy is the first choice of treatment for choroidal melanomas. The standard practice is to position the plaque centrically in relation to the tumour, with a 2mm physical safety margin in all directions. The author has developed techniques for administering brachytherapy with plaques positioned eccentrically, with their posterior edge aligned with the posterior tumour margin. This allows a higher apex dose to be given while reducing the radiation delivered to optic nerve and fovea.

Methods The tumour is localized by transillumination and its anterior margin marked on the sclera with a pen. The 'plaque‐tumour difference' measurement is then marked on the sclera at the point where the anterior plaque margin should be. A transparent plaque template is sutured to the sclera. The position of the plaque is checked with a right‐angled fibre‐optic transilluminator, which is passed through a perforation near the posterior edge of the template. If the template is positioned correctly, then with binocular indirect ophthalmoscopy one should see the 'sunset sign', which occurs when the transilluminator is exactly at the posterior tumour margin.

Results Eccentric ruthenium plaque positioning has been practised in Liverpool for over a decade. The results have been published. Local tumour control rates have been good (partly because of case selection). Radiation maculopathy and optic neuropathy have been rare if the tumour has not extended within 1 mm of these structures. The main cause of visual loss has been maculopathy, caused by exudation from the irradiated tumour. Methods for treating such exudation are described.

Conclusion Plaque radiotherapy is effective for choroidal melanomas up to 5 mm in thickness. It achieves good local tumour control with preservation of vision in most cases.
Principle of adaptive optics
Authors: SÖDERBERG PG
Published: September 2009

Purpose To provide an overview of adaptive optics imaging of the retina.

Methods In ophthalmoscopical imaging, the two dimensional spatial radiance variation of the back scattered light from the retinal surface is measured. Perfect imaging would require that light backscattered from one point on the retina examined is refocused to one point on the detector. Due to diffraction, light scattering and aberrations, some of the light, injected into the eye examined and some of the light back scatted from the retina examined, are deviated. This leads to loss of contrast. Aberrations induced are, for each individual, specific to the optics of the eye examined. In AOSLO, in addition to confocal illumination and light detection, aberrations induced by the optics of the eye examined are individually measured by wave front sensing and corrected for.

Results In the AOSLO, a wave front sensor is introduced between the light source and the eye examined. The information from the wave front sensor is fed back to a deformable mirror, also placed in between the light source and the eye examined. The deformable mirror corrects the wave front aberrations induced by the optics of the eye examined. This allows the injected light to form a point on the retinal surface and simultaneously, the backscattered light from the retina of the eye examined to be focused to a point on a detector. An x‐y scanner in front of the eye allows sequential illumination and capturing of aberration minimized back scattered light from an x‐y matrix of the retinal surface of the eye examined. The relative radiances measured in the x‐y matrix represent the image.

Conclusion Adaptive optics in ophthalmoscopy improves contrast in the image of the retina examined by correcting for aberrations induced by the optics of the eye examined.
Telangiectasia evaluated with adaptive optics and HR‐OCT
Authors: ATMANI K , LEVEZIEL N , SOUBRANE G
Published: September 2009

Purpose Type 2 Macular Telangiectasia is a progressive disease starting in the fifth to seventh decade and characterized by a progressive damage of the neurosensory retina.. The purpose of this study is to compare the images obtained using two non‐invasive techniques, High‐Resolution Optical Coherence Tomography (HR‐OCT) and Adaptive Optics (AO), in Type 2 Macular Telangiectasia.

Methods Nine eyes of 5 patients affected by Type 2 Macular Telangiectasia underwent examination including visual acuity measurement with ETDRS (Early Treatment of Diabetic Retinopathy Study) chart, color photographs, monochromatic photographs, Spectral‐Domain Optical Coherence Tomography with Heidelberg Spectralis™ OCT and Adaptive Optics assessment with Imagine Eyes™ System. The neurosensory retina and the photoreceptor layer were analyzed using both HR‐OCT and AO imaging.

Results The disruptions of the photoreceptor layer on HR‐OCT correspond to a cellular loss on Adaptive Optics Imaging. On the other hand, Adaptive optics Imaging allows the measurement of cellular density in areas which have a normal aspect on HR‐OCT.

Conclusion The diagnosis of Macular Telangiecctasia is based on biomicroscopy and fluorescein angiography. Adaptive Optics Imaging is helpful to analyze the retinal damages, especially the cone abnormalities. This technique will certainly allow a better understanding of this rare disease. Author Disclosure Information: K. Atmani, None; N. Leveziel, None G. Soubrane, None.