bluuebunny/crossref_metadata_2025 huggingface dataset:
Regression of tumour cross‐sectional area after brachytherapy for uveal melanoma: relationship between tumour height, status of Bruch’s membrane, isotope and prescription dose
Authors: MAMUNUR RASHID M , KIVELÄ T
Published: November 2010

Purpose To describe regression of uveal melanoma by its cross‐sectional area rather than height in relation to characteristics of the tumour and parameters of radiotherapy.

Methods For this retrospective observational study, 287 consecutive patients with choroidal and ciliary body melanoma were enrolled. They were treated with iodine or ruthenium brachytherapy from January 2000 to March 2008 and imaged with Innovative Imaging I3 ultrasound using a standard procedure. Images taken at diagnosis and at 6 months, 1, 2 and 3 years were analysed. Tumour height and area were measured with Olympus DP‐Soft from original digitised images as traced by hand.

Results The reduction in the cross‐sectional area of the tumour was significantly greater if Bruch’s membrane was broken as compared to being unbroken (P=0.002 at 1 year), if the tumour involved the ciliary body (P=0.009) and, paradoxically, if the prescription dose to tumour apex was smaller (P=0.002). Use of iodine rather than ruthenium isotope (P=0.29) and tumour height were not significantly associated with regression. In a multivariate model, also the type of isotope became significant.

Conclusion Reduction in tumour cross‐sectional area depends on several tumour and radiotherapy parameters, which are partially interrelated.
Photodynamic therapy for selected, symptomatic choroidal metastases
Authors: PARROZZANI R , PILOTTO E , DARIO A , MIDENA E
Published: November 2010

Purpose To evaluate safety and efficacy of photodynamic therapy (PDT) for the treatment of choroidal metastases.

Methods Five cases of selected, symptomatic choroidal metastases were included in this prospective study. Each patient underwent a single‐spot standard‐fluence PDT with verteporfin (50 J/cm2, 83 sec.). BCVA, fundus photography and optical coherence tomography were performed at baseline and at each follow‐up examination (at 1 month and every 3 months thereafter). Fluorescein angiography and indocyanine green angiography were performed at baseline.

Results In two patients choroidal metastases were secondary to carcinoid tumors, in two cases to lung and in one case to breast adenocarcinoma. Mean follow‐up was 17±6 months. Mean PDT sessions were 1.6 (1‐3 sessions). Three patients (60%) showed clinical regression of the treated lesions and in two patients (40%) tumor size remained stable during follow‐up. Subretinal fluid resolved in al cases. BCVA increased in four patients (80%) and remained unchanged in one patient (20%).

Conclusion Photodynamic therapy appears as an effective and well‐tolerated treatment option for the management of selected choroidal metastasis
Bilateral choroidal melanoma a patient with bilateral melanocytosis
Authors: SALA‐PUIGDOLLERS A , GARCIA‐ALVAREZ C , CARRENO E , PORTERO A , SAORNIL MA , LOPEZ‐LARA F , FRUTOS‐BARAJA J , DIEZHANDINO P
Published: November 2010

Purpose Ocular melanocytosis, is a congenital condition characterized by hyperpigmentation of the episclera and uvea.. There is a clear association between this condition and uveal melanoma in Caucasian populations. We report a case of a patient affect of bilateral ocular malanocytosis whom has recently been diagnosticated of bilateral choroidal melanoma.

Methods Interventional Case report

Results A 65‐years‐old man affected of bilateral ocular melanocytosis diagnosed of bilateral choroidal melanoma without systemic affection. In his right eye presented a melanotic choroidal mass with orange‐pigment in the surface measuring 10,63 mm in basal diameter and 3,74 mm in height. In the left eye, there was another melanotic choroidal mass with subretinal hemorrhage measuring 12,69 x 8,7 mm. The left eye was treated with (125)I brachytherapy.

Conclusion Despite the fact that the uveal melanoma is the most frequent intraocular tumour, a bilateral choroidal melanoma is very uncommon. A few clinical conditions can predispose to or be associated with uveal melanoma, including ocular melanocytosis and oculodermal melanocytosis, neurofibromatosis type I, and familial atypical mole and melanoma syndrome. Patients with ocular melanocytosis and oculodermal melanocytosis sometimes do not have adequate follow‐up, which results in late diagnosis.
Giant orbital retinoblastoma: a case report
Authors: HADJISTILIANOU T , DE FRANCESCO S , BORRI M , MENICACCI F , GALLUZZI P , TOTI P , MENICACCI FL
Published: November 2010

Purpose The authors report a case of giant orbital Retinoblastoma following primary enucleation for intraocular tumor. The presence of worms was documented inside the necrotic tumoral mass.

Methods The child was diagnosed with unilateral advanced retinoblastoma at the age of one month and enucleated. Chemotherapy and/or radiotherapy had no been performed. 3 months later a mass started growing in the anophthalmic socket and when the child arrived to our referral center the mass was as big as the child’s head. Complete excision of the mass and exenteration have been performed and the presence of worms has been documented in the necrotic part of tumor. Diagnostic workup included computed tomography (CT) and magnetic resonance (MR) of the head and orbit, bone scintigraphy, lumbar puncture with cell count and examination of the cytocentrifugate and bone marrow aspiration.

Results The child died 6 months after.

Conclusion We describe an extraordinary case of a giant orbital Retinoblastoma following enucleation.
Switching to small gauge surgery: risk‐benefit assessment
Authors: RIZZO S
Published: November 2010

Abstract not provided
Managing diabetic retinopathy with 25G
Authors: MURA M
Published: November 2010

Abstract not provided
Retinal detachment management using 25G
Authors: NIKOLAKOPOULOS A
Published: November 2010

Abstract not provided
Transconjunctival sutureless 20G
Authors: POURNARAS CJ
Published: November 2010

Purpose To evaluate a trocar system that allows the use of the regular 20‐gauge vitrectomy instruments for a transconjunctival sutureless surgery for the treatment of various surgically treated vitreo‐retinal pathologies.

Methods The 20‐gauge trocar system uses a 10° self‐sealing tunneled incision made with trocars introduced with a inserter blade of 0.9 mm diameter. Incisions are radially made at 3.5 mm from the limbus and tunnels are made limbus‐parallel. Evaluation of the surgical procedure, sclerotomies closure by OCT, anatomical and visual outcomes in various vitreoretinal pathologies treated in current vitreoretinal practice.

Results Postoperative patient comfort and less eye inflammation are provided by the sutureless technique, allthough small conjunctival hemorrhage caused by the grasping forceps used to hold the eye during the insertion of the trocars may occur. The 20‐gauge trocar system using 10° self‐sealing tunneled incision remains very stable in the eye even during peripheral vitrectomy with indentation and they also decrease the surgical induced trauma at the entry sites. The use of nonflexible instruments, the same as in 20‐gauge conventional vitrectomy, provides easy access to the entire periphery.thus the system can be used in almost all vitreoretinal surgeries. It allows the use of phragmatome and is easy to work even with 5,000 centistokes silicone oil.

Conclusion In the era of sutureless surgeries, the 20‐gauge trocar system is a safe, comfortable, convinient with current instrumentation and less expensive alternative to 25‐ and 23‐gauge vitrectomy.
Robotics in VR surgery: maximizing the benefit of small gauge
Authors: DE SMET M
Published: November 2010

Abstract not provided
Neural contrast sensitivity calculated from measured total contrast sensitivity and modulation transfer function
Authors: MICHAEL R , GUEVARA O , BARRAQUER RI
Published: November 2010

Purpose To test the feasibility of calculating neural contrast sensitivity function (neural CSF) from conventionally measured total contrast sensitivity function (total CSF) and measured modulation transfer function (MTF). Neural CSF considers the retina and the brain, whereas total CSF considers the optical eye media, the retina and the brain together.

Methods Three groups with 9 eyes each, one group with normal ocular optics but with retinal alterations (mild diabetic retinopathy), another with altered ocular optics and normal retina (keratoconus) and a normal control group were studied.

Results Total CSF in the keratoconus and retinopathy group was significantly lower as compared with the control group. MTF for keratoconus was lower and in the retinopathy group was similar to the control group. Calculated neural CSF in the diabetes mellitus group was lower than in the control group whereas in the keratoconus group it was similar to the control group, with overestimations for some keratoconus cases.

Conclusion It is possible to calculate a meaningful neural CSF from measured total CSF and MTF data. The neural CSF represents a CSF adjusted for optical aberrations. This would allow comparing the neural component of visual function in eyes with different optical aberrations.
Patterns of vision loss predisposing to charles bonnet illusions
Authors: KRASTEL H , GOLUBKINA L , BEUTELSPACHER SC , JONAS JB , KOLLING G , FRISCH I
Published: November 2010

Purpose To find out criteria of visual impairment predisposing to Charles Bonnet illusions (CBI)

Methods In a retrospective study, exemplary cases of retinal, optic nerve, and visual pathway diseases are analyzed for common criteria likely to predispose for CBI experienced by these patients.

Results AMD: OD disciform macular scar ; OS exudative macuolpathy, recent hemorrhage. Wallpaper‐ and landscape‐ like illusions Serpiginous choroidopathy: OU atrophic lesions extending from the peripapillary region into the macula. Flower‐bed illusions Retinitis pigmentosa: widespread involvement of retinal midperiphery OU. Transitory illusions of human beings and furniture Ethambutole ‐ opticopathy: Central scotoma OU, VA FC. Illusions of coloured diamonds History of recurrent TIA episodes: normal visual field OU; transitory illusions of coloured and moving lanterns Right parietal ischemic focus: Lower left quadrantanopia OU. Distorted and alienated objects Bilateral carotid stenosis, left vertrebralis hypoplasia, bilateral ischemic occipital foci: Cortical blindness and Anton’s syndrome. The patient reports on skimming through an illustrated book.

Conclusion CBI’s arise if severe failures in photoreception or signal conduction affect congruent areas within both visual fields. Out of these regions, no visual information from the outside world comes to conscience. CBI’s tend to fill in binocular deep scotomas. These filing‐ins are not specific to particular diseases or distinct regions of the optic pathways. They are cerebral substitutes for real vision, coming from visual memory.
Tissue adhesives in corneal lesions
Authors: PAPADOPOULOU DN , MANGIORIS G , KALPATSANIDIS A , KARAMPATAKIS V
Published: November 2010

Purpose To evaluate the use of fibrin and cyanoacrylate glues in corneal wounds.

Methods Eight albino rabbits were used (16 eyes) for the comparison of different types of adhesions. After the creation of corneal wounds, the fibrin glue (Beriplast) was used in the right eyes of the rabbits, while the cyanoacrylate glue (Gluebran) was applied in the left eyes. Follow up examinations, under the microscope, were performed in 1, 3 and 10 months, for the evaluation of the wound and the surrounding corneal tissue.

Results The cyanocrylate glue was polymerized almost immediately after the application on the tissue, thus deteriorating the ability of the surgeon to reconstruct the wound appropriately. Neovascularization and clouding of the corneal tissue around the wound was present in all the follow up examinations. The fibrin glue was polymerized more gradually giving to the surgeon enough time for manipulations to reconstruct the wound properly. Less neovascularization and clouding were observed especially if the two components of the fibrin glue were mixed before the application on the wound. Both glues were easier to manipulate and apply in cases of corneal tunnels so as to seal the entrance of the tunnel with very satisfactory results.

Conclusion The use of the fibrin glue for the reconstruction of corneal wounds is easier than the use of the cyanoacrylate glue, with less tissue reaction postoperatively.
The clinical spectrum of corneal dystrophies
Authors: KESTELYN P
Published: November 2010

Purpose To review the most common corneal dystrophies from the clinician's standpoint.

Methods A systematic overview of the natural history and the clinical characteristics of the most common corneal dystrophies will be presented following the anatomic classification: epithelial and anterior stromal dystrophies, stromal dystrophies, and Descemet and endothelial dystrophies. Abundant use of slitlamp images will help to illustrate the most salient clinical features.

Conclusion Despite the fact that the knowledge about the genetic mutations responsible for the different corneal dystrophies has led to a better understanding of their basic defect and to molecular tests for their precise diagnosis, in most patients the careful examination at the slitlamp combined with personal and family history will remain the cornerstone for diagnosis, counseling and treatment.
Cataract frequency and light scattering profiles in retired members of light protected communities ‐ The Irish Nun Eye Study (INES)
Authors: WEGENER AR , SILVESTRI V , HEYMER P , MOORE E , SMYTH P , SLINEY D , SILVESTRI G
Published: November 2010

Purpose Investigation of cataract frequencies, yellow discoloration and light scattering profiles in the lenses of a subset of nuns from the Irish Nun Eye Study (INES) correlated to age and outdoor activity.

Methods After obtaining informed consent, the anterior eye segment of 144 retired nuns from contemplative and missionary convents in Northern Ireland and the Republic of Ireland were monitored with a Scheimpflug camera (Pentacam HR®, Oculus, Wetzlar, Germany). Images of the cornea and lens were recorded automatically in 25 meridians in mydriasis, using the recording algorithm of the camera. In addition retro‐images of the lenses were recorded using the Neitz Cataract screener and lens discoloration was recorded using a manual slitlamp and the LOCS III grading system. Image analysis was performed using special analytical software (BIOM®) and cataract classification was done using the Bonn cataract classification system.

Results Age‐related light scattering increase is most pronounced in the anterior deep cortex and the anterior nuclear shell of the lenses and is generally lowest in the posterior nuclear shell. Cortical cataracts were the most frequent type in this study, the highest frequency found in the lower nasal quadrant followed by the lower temporal quadrant. Pure subcapsular cataracts have not been found in this study. The increase in yellow discoloration correlated to the increase in nuclear light scattering. Nuns with cortical cataracts had less discoloration, but were also younger.

Conclusion The frequency of nuclear cataracts was lower in the INES cohort was lower, but the amount of cortical cataracts was similar to other studies like Beaver Dam Eye Study. The increases in nuclear light scattering and discoloration correlated with age and exposure index. The data from the INES study support the hypothesis that light protection has a positive effect on the frequencies of nuclear and subcapsular cataracts as well as on lens discoloration. The Pentacam HR® provided better documentation of lens transmission characteristics than the Neitz cataract scanner.
Proliferation of cultured lens epithelial cells and association with possible risk factors for posterior capsular opacification
Authors: ZETTERBERG M , PETERSEN A , KARLSSON JO , SUNDELIN K
Published: November 2010

Purpose To determine the proliferative capacity of human lens epithelial cells (HLEC) in culture and investigate possible associations with clinical characteristics of the donors, such as age, gender, pseudoexfoliations, uveitis and diabetes.

Methods Pieces of lens capsule and adhering lens epithelial cells were obtained through capsulorhexis at routine cataract surgery using phacoemulsification technique, with informed consent from the patients. These human lens epithelium specimens were cultured in a humidified CO2 incubator using standard culture medium and 5% fetal calf serum for two weeks. After one and two weeks respectively, cultured cells were stained with carboxy‐fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent epithelial cell layer in relation to the size of the original capsule specimen.

Results The increase in the area of confluent HLEC showed a negative correlation with age at the second week of growth and with diabetes at the first week after surgery. Female gender was associated with higher rate of cell proliferation when considering the whole culture period. The presence of pseudoexfoliations in vivo or a history of uveitis did not significantly affect cell growth in culture postoperatively. Nor did installation of xylocain, trypan blue or phenylephrine in the anterior chamber during surgery affect cell proliferation.

Conclusion High age, male gender and diabetes are associated with lower rate of proliferation of lens epithelial cells in culture and may hence be protective against posterior capsular opacification.
Sigma‐2 receptor agonists kill lens epithelial cells
Authors: KARLSSON JO , JONHEDE S , PETERSEN A , ZETTERBERG M
Published: November 2010

Purpose The aim of the present study was to examine the effects of the sigma‐2 receptor agonist, siramesine, on morphology, growth, cell death, lysosomal function, and effects on extra‐lysosomal proteolytic systems in human lens epithelial cells. In addition we compared the effects to that obtained in other human cells in primary culture.

Methods Human lens epithelial cells in culture were exposed to siramesine and examined for morphological changes using Nomarski optics or calcein. Lysosomes were evaluated using acridine orange and Magic Red (RR‐cresyl violet). Nuclear morphology was studied using Hoechst 33342 and propidium iodide. Enzymatic activities in living cells or cell lysates were studied using fluorogenic substrates.

Results Siramesine at low concentrations increased the cytoplasmic proteolytic activity of the proteasome and the calpain system. Effects were also observed with respect to lysosomal morphology, acidity and function. In addition, activation of caspase‐3 and the appearance of nuclei with an apoptotic morphology was found. Lens epithelial cells appeared to be more sensitive to siramesine than other cells.

Conclusion Siramesine at low concentrations affects lens epithelial cells with perturbations of the major proteolytic systems and lysosomal morphology, resulting in caspase activation and cell death. Siramesine may be a possible substance for the treatment or prevention of posterior capsular opacification (PCO).
Postoperative wavefront analysis and contrast sensitivity of the multifocal RestorTM IOL versus the AcrylisaTM IOL
Authors: GICQUEL JJ , NOCHEZ Y , PISELLA PJ
Published: November 2010

Purpose To compare visual acuity, total and high order wavefront aberrations (coma, spherical aberration, and other terms of high order aberration), and contrast sensitivity in eyes implanted with the multifocal Restore IOL versus the multifocal Acrylisa IOL.

Methods Patients were divided in two groups: group 1 (8 patients, 16 eyes implanted with Restor) and group 2 (15 patients / 30 eyes implanted with Acrylisa). All eyes were targeted for emmetropia. Complete ophthalmological examination, including uncorrected visual acuity (UCVA), best spectacle‐corrected visual acuity (BSCVA) was performed. Contrast sensitivity evaluation,and wavefront analysis, were performed with the Imagine Eyes IRX3 wavefront aberrometer. Measurements with the IRX3 were performed in triplicate in order to verify the robustness of the data.

Results All eyes in all groups had BSCVA > or = 20/20 postoperatively. Measurements with the IRX3 were easily obtained. The triplicate measurements confirmed the robustness of the data. Mean total aberration root‐mean‐square (RMS) values and higher order aberrations (HOA) value were not significantly different between the two groups. Residual spherical aberration values were comparable in both groups and appeared inferior if to the ones previously obtained with non aspheric standard monofocal IOLs. Mean contrast sensitivity values were comparable in both groups.

Conclusion The measurement of higher order aberrations in patients implanted with multifocal IOLs is easy and reproducible with the IRX3. There is no statistical difference between the values obtained in the 2 groups regarding RMS and HOA. Contrast sensitivity revealed similar values in both groups.
Objective measurement of the accommodative amplitude after implantation of the CrystalensTM intraocular lens (IOL)
Authors: GICQUEL JJ
Published: November 2010

Purpose To evaluate and compare the quality of vision and accommodative amplitude after implantation of the Crystalens AT45 intraocular lens (IOL) versus standard monofocal IOLs.

Methods Sixteen patients (32 eyes) were divided into 2 groups depending on which IOL was implanted. Accommodation was measured using the IRX3 wavefront aberrometer and vision quality evaluated by the OQAS system. Visual acuity measurements were performed under the same conditions with standard visual acuity charts.

Results Uncorrected monocular near vision was significantly better in the accommodative IOL group than in the standard monofocal group. Measures of accommodation were higher in Crystalens patients than in the monofocal IOL patients, however the accommodation amplitude remained limited. There was no significant difference in the quality of vision measurements with OQAS in both groups.

Conclusion The AT 45 IOL provided better uncorrected near and distance visual outcomes than standard monofocal IOLs. However the objectively measured accommodative response was limited.
Posterior chamber iris‐claw lens combined with vitrectomy: surgical technique and refractive analysis
Authors: PARIKAKIS E , MOUSTAKA L , AMARIOTAKIS G , KARAGIANNIS D , HALKIADAKIS S , METAXAKI I , MITROPOULOS P
Published: November 2010

Purpose To present a new surgical technique of vitrectomy and implantation of posterior chamber iris‐supported IOL and to evaluate the safety in eyes with inadequate zonular support and lens dislocation. Also, to study the refractive result and select the proper A constant ‐ formula for IOL power calculation.

Methods 27 eyes (23 patients) having IOL‐capsule vitreous dislocation were included. Pseudoexfoliative glaucoma was present in 11 cases. The procedure involved pars plana vitrectomy, extraction of the dislocated IOL‐capsule, Artisan–Verysise IOL insertion in the posterior chamber and iris enclavation without peripheral iridectomy. Measurements were performed by IOL Master and scanning endothelial microscope. The refractive outcome and any complications were evaluated.

Results The follow‐up period was 8‐24 months. Improvement in visual acuity was found in all 27 eyes. Postoperative refractive errors were within 1,5 D and the induced astigmatism was within 2 D. Complications such as retinal detachment,keratopathy, visual instabilities, or glaucoma progression were not found. The IOL was slightly eccentric in 4 cases. In 2 eyes single haptic subluxation was noticed and was relocated with second procedure. Temporary cystoid macular edema was observed in 4 eyes.

Conclusion The management of cases having serious pseudoexfoliation and IOL dislocation with vitrectomy and posterior chamber iris‐claw IOL implantation seems to provide a safe alternative method with favorable outcome and satisfactory anatomic restoration combined with anterior segment protection. The power of Artisan–Verysise should be calculated with a new A constant (116,7–116,8), depending on the applied formula.
Dacryoliths in the lacrimal gland ductule
Authors: LOEFFLER KU , ALTEN F , HOLZ FG
Published: November 2010

Purpose Lacrimal duct obstruction can occasionally be associated with dacryolithiasis. Dacryoliths (DLs) have been found in the nasolacrimal sac, nasolacrimal duct, canaliculi, and rarely in the lacrimal gland ductules. Here, we would like to present the clinical, intra‐operative, and histologic findings in 4 cases of DLs in the lateral fornix

Methods All 4 patients were examined by slit lamp microscopy, and ultrasound (US) was performed in 3 patients; 1 patient underwent Magnetic resonance imaging (MRI). Following surgery, the excised tissue and concretions were fixed in formalin and embedded in paraffin. Ophthalmopathologic examination included routine staining with H&E and PAS as well as stains for microorganisms.

Results All patients presented with a short duration of symptoms with only little pain. Lesions were located at the lateral canthus and appeared slightly hyperemic and to a varying degree cystic. US showed hypo‐ and hyperreflective signals but did not demonstrate any concretions. The DLs were found intraoperatively during removal of the "tumour". Macroscopic characteristics varied between small multiple round whitish–yellow concretions of hard consistency (0.7mm in diameter) and bigger more irregular stones (up to 7mm). Histology revealed amorphous acellular material without any evidence of microorganisms. In one patient, a cilium was found. All symptoms resolved quickly after removal of the DLs.

Conclusion DLs of the lacrimal system can – albeit rarely – form in the excretory duct of the lacrimal gland. Possible agents responsible for stone formation in the lacrimal gland ductule include cilia and – less likely ‐ bacteria. Both US and MRI appear ineffective in reliably identifiying dacryoliths at this site but surgical intervention leads to rapid relief of all symptoms.
Influence of atmospheric pressureand temperature changes on the intraocular pressure.
Authors: VAN DE VEIRE S , GERMONPRE P , RENIER C , STALMANS I , ZEYEN T
Published: November 2010

Purpose Some patients questioned us whether diving and mountaineering can have an effect on their intraocular pressure (IOP). Since the results in the literature concerning mountaineering are often contradictory and the data concerning diving are very limited; we investigated if an increase in atmospheric pressure influences the IOP in a normal population. Since we clinically experienced higher pressures in the summer, we checked the temperature influence on the IOP simultaneously.

Methods Twenty‐seven healthy volunteers (aged 18 to 44) were placed in a hyperbaric chamber. Their IOP was measured with a Perkins tonometer at baseline (normal atmospheric pressure of 1 Bar and 24°C), after increasing the atmospheric pressure to 2 Bar both at 14°C and 28°C, and finally at baseline again. A multivariate regression analysis was used to evaluate the results of both eyes.

Results The IOP significantly decreased from 11.75mmHg to 10.50mmHg at 2 Bar. The IOP decrease remained constant during the atmospheric pressure rise (40 minutes) and was independent of the temperature change. The IOP returned back to the baseline value when exiting from the hyperbaric chamber.

Conclusion A small increase of atmospheric pressure to 2 Bar (= equal effect to diving at 10m below sea level) is sufficient to lead to a significant reduction in IOP independent of temperature changes in a healthy young population. The IOP decrease sustains for the whole hyperbaric chamber period.
Response of the human eye against oxidative stress at high altitudes
Authors: KARAKUCUK S , MUJDECI M , BASKOL G
Published: November 2010

Purpose To evaluate the response of the anterior segment of the eye against oxidative stress during acute exposure to high altitudes.

Methods Forty volunteers were examined and measurements performed at Erciyes University Medical Faculty,Ophthalmology Clinic, Kayseri,Turkey(1080m). On the following day, participants were transported to Mt. Erciyes Ski Center by bus(2200m); thereafter they climbed to an altitude of 2800m.with a moderate pace. Central corneal thickness, intraocular pressure,spheric equivalent of refraction, arterial oxygen pressure,blood pressure, pulse rate and body temperature were measured at both altitudes. Venous blood samples were taken from volunteers at both altitudes;total oxidant status (TOS),total antioxidant status(TAS),advanced oxidation protein products (AOPP), xanthine oxidase (XO), thiol, adenosine deaminase(ADA)levels were investigated at 1080m and 2800m.

Results TOS(7.02µmol H2O2 equiv/L, range:0.49‐22.07) and AOPP(220.74µmol/L,range:103.81‐667.35)significantly increased at high altitude, compared to low altitude levels (3.32µmol H2O2 equiv/L range:0.92‐18.41,and 195.58µmol/L,range:84.77‐663.16, resp; p<0.05).IOP significantly elevated at high altitude (14.45±3.54mmHg vs 13.22±2.74mmHg; p<0.05). There was a significant positive correlation between IOP and TAS levels(p<0.05).No significant correlation was found between spherical equivalent or central corneal thickness with the investigated oxidation parameters at both altitudes

Conclusion We conclude that oxidative stress markers, TOS and AOPP are increased along with IOP during acute exposure to hypoxic environment at high altitudes and that antioxidant system may have a limited capacity to counter balance this effect because of acute unacclimatized ascent.
Corneal endothelial decompensation: a novel ocular manifestation of multiple sclerosis
Authors: HILLENAAR T , MOOY CM , REMEIJER L
Published: November 2010

Purpose To report the in vivo and ex vivo histopathologic features of the cornea in a patient with endothelial decompensation within the scope of multiple sclerosis (MS).

Methods During a 2‐year period a 64‐year‐old male patient, suffering from multiple sclerosis and unilateral bullous keratopathy, was repeatedly examined by slit‐lamp and in vivo confocal microscopy (IVCM). Light microscopy with histochemical staining, transmission electron microscopy (TEM), and scanning electron microscopy (SEM) were performed on the corneal button obtained at penetrating keratoplasty.

Results Besides corneal decompensation on his left eye, slit‐lamp examination of both eyes showed a deposition of translucent vesicles on the iris and fine deposits on the corneal endothelium and anterior lens pole. Observation of the endothelium by IVCM confirmed fine precipitates in the right eye, and displayed larger deposits in the left eye. After further deterioration, the left eye showed endothelial denudation. Light microscopy of the corneal button showed periodic acid‐Shiff and Giemsa positive granular deposits in the epithelium and stroma. The same electron dense deposits displayed a fingerprint configuration with TEM. This finding corresponds with a deposition of neurodegenerative origin. SEM disclosed similar unique morphological changes of the endothelial cells as detected by IVCM. Lichen‐like deposits were observed on the endothelial cells.

Conclusion IVCM enabled us to obtain high resolution images of the endothelial layer in an obscured cornea. This resulted in the discovery of a new ocular manifestation of multiple sclerosis.
History of development of VEGF inhibitors
Authors: GRAGOUDAS E
Published: November 2010

Abstract not provided
Results of corneal collagen crosslinking with riboflavin and UV‐A radiation
Authors: KONTADAKIS G , KYMIONIS G , KOUNIS G , PORTALIOU D , GRENTZELOS M , LIMNOPOULOU A , DIAKONIS V , PALLIKARIS IG
Published: November 2010

Purpose To investigate outcomes after Corneal Collagen Cross Linking with riboflavin and UVA for the treatment of keratoconus.

Methods 40 patients, 56 eyes participated in this study. Mean age was 28.9 ± 6.1 (range from 18 to 45 years). All eyes underwent Corneal Cross Linking induced by riboflavin and UV‐A. Postoperative evaluation included Uncorrected Distance Visual Acuity (UDVA), Corrected Distance Visual Acuity (CDVA), mean Keratometric values, topography and confocal microscopy analysis.

Results Mean follow up was 18.35+3.12 months (range from 6 to 29 months). No intraoperative complications were observed in this series.UDVA (decimal scale) improved from 0.13±0.15 to 0.20±0.17. CDVA (decimal scale) improved from 0.45±0.24 to 0.54±0.54. No eye lost lines of CDVA. A flattening of the Mean K was observed. (From 48.84 ± 5.83D preoperatively to 47,30 ± 1,34D). Confocal microscopy analysis revealed that collagen fibres in the superior stroma after CXL were distributed unevenly similar to a net like formation.

Conclusion Corneal Collagen Cross Linking induced by riboflavin and UVA is a promising new therapeutic technique for the treatment of keratoconus. Longer follow up is necessary.
Treatment of keratoconus by intra‐corneal rings and cross‐linking: about 10 cases treated
Authors: LUSSATO M , DELBARRE M , BLAVIER B , LEDUC C , CREPY P , FROUSSART‐MAILLE F , RIGAL‐SASTOURNE JC
Published: November 2010

Purpose Keratoconus is a noninflammatory corneal ectasia resulting in a gradual loss of vision due to the appearance of irregular astigmatism and myopia. We present a prospective study on the treatment of 10 patients with keratoconus treated with cross‐linking and intracorneal rings (ICR).

Methods This is a monocentric and prospective study concerning thirteen eyes of ten patients, the average age is 29 years. The gender distribution is of eight men (80%) and two women (20%). Only four patients were treated in both eyes by this protocol and one patient had on his fellow eye a penetrating keratoplasty. The monitoring elements are: the best spectacle‐corrected visual acuity (BSCVA), the spherical equivalent, the average keratometry and the pachymetry. The follow up is six months. The treatment is done in two steps: first step the cross‐linking, second step three months later, insertion of Ferrara ICR, using a Femtosecond laser. The ICR strategy is established with Ferrara normogram achieved with the steeper meridian and design of the ectacic area in preoperative topography.

Results The results of this on going study show a stabilization of keratoconus after cross‐linking. Then, after ICR, there is an improvement in best spectacle‐corrected visual acuity with a decrease in spherical equivalent of about 1.8 diopters and an average decrease of two diopters of mean keratometry and ectasia apex recentration.

Conclusion The synergistic combination of both techniques seems to be effective in slowing the development and reshaping the cornea.
Update on physiopathology of cystoid macular edema
Authors: MORA P
Published: November 2010

Purpose To offer an overview on the historical and most recent acquisitions about the mechanisms that have been proposed to explain how cystoid macular edema (CME) develops.

Methods Review of the literature and presentation of personal evidences and imagines.

Results CME represents an excessive presence of fluid within the layers of the retina. A breakdown in the blood‐retinal barrier normally is the causative event for fluid to accumulate in cystoid spaces within the retina. Several mechanisms have been proposed to explain the blood‐retinal barrier alteration and consequent CME formation. The intraocular diffusion of inflammatory mediators (eg, prostaglandins), following mechanical or biological insults, remains the most proven evidence. Another mechanism refers to the role of tractional forces on the macula from disruption of the normal vitreoretinal interface. According to this theory, a release of mediators that lead to a breakdown of the blood‐retinal barrier, would have triggered mainly by local forces. Photic injury, finally, has been implicated in the development of pseudophakic or post‐vitrectomy CME.

Conclusion A full comprehension of the pathogenesis of CME will significantly help in focussing and developing an effective treatment even for the chronic form of CME.
Anti‐VEGF and corticosteroids therapy in macular edema secondary to venous occlusions
Authors: POURNARAS JAC
Published: November 2010

Purpose To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema (ME) secondary to central (CRVO) and branch retinal vein occlusion (BRVO)

Methods Recent randomized studies have evaluated the safety and efficacy of corticosteroids (triamcinolone, dexamethasone) and anti‐VEGF therapies (ranibizumab). Score study evaluates preservative‐free intravitreal triamcinolone with standard care in BRVO and CRVO. In Geneva study, dexamethasone (DEX) intravitreal implant is compared with sham in BRVO and CRVO. BRAVO and Cruise studies evaluate intraocular injections of ranibizumab in patients with ME following BRVO and CRVO, respectively.

Results In SCORE study, there was no difference identified in visual acuity at 12 months for the standard care group compared with the triamcinolone groups in BRVO patients. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Improvements in BCVA with DEX implant were seen in patients with BRVO and CRVO, although the patterns of response differed. Intraocular injections of 0.3 mg or 0.5 mg ranibizumab provided rapid, effective treatment for ME following BRVO and CRVO

Conclusion Grid photocoagulation remains the standard care for patients with vision loss associated with ME secondary to BRVO. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO. Anti‐VEGF therapies represent new therapeutical option in the treatment of ME secondary to BRVO and CRVO. Further randomized studies are needed
Treatment options of macular edema in uveitis
Authors: GUEX‐CROSIER Y
Published: November 2010

Purpose To summarize current concepts on therapeutic approach in inflammatory cystoid macular edema (ICME).

Methods A review of relevant literature concerning treatment options of ICME was performed.

Results ICME is a major factor related to poor visual acuity in long term follow‐up of uveitis. Topical corticosteroids administration has a minor therapeutic effect on ICME. Local therapies consist mostly of posterior sub‐tenon's, intraocular corticosteroids injections or drug delivery systems. The effect of systemic corticosteroids, immunosuppressive agents or biological therapies will be discussed.

Conclusion The recent development of drug delivery systems and biological therapies has considerably improved the prognosis of ICME.
Macular edema in ocular oncology
Authors: ZOGRAFOS L
Published: November 2010

To present various causes of Macular edema before and after therapy of in occular tumours.
Treatment of postoperative macular edema
Authors: PETROPOULOS I
Published: November 2010

Purpose Cystoid macular edema (CME) is a frequent complication of a number of interventions in ophthalmology, such as cataract surgery (Irvine‐Gass syndrome), laser procedures, and trabeculectomy. The purpose of this talk is to present the latest bibliographic data regarding the appropriate treatment of postoperative CME.

Methods A review of the existing literature concerning the treatment of postoperative CME is performed. Characteristic personal cases are presented.

Results In more than two‐thirds of the cases, postoperative CME resolves spontaneously within weeks or months. Prophylactic topical treatment with indomethacin or flurbiprofen seems to reduce the frequency of clinical and angiographic CME, but its beneficial effect on final visual acuity is not established. Curative therapy includes topical corticosteroids; topical non‐steroidal anti‐inflammatory drugs (e.g. ketorolac); oral acetazolamide; sub‐Tenon or intravitreal injection of triamcinolone acetonide; intravitreal injection of anti‐VEGF drugs; and pars plana vitrectomy. The indications, role, and efficacy of each of the above treatment modalities are discussed, based on the latest bibliographic data.

Conclusion Most cases of postoperative CME are mild and resolve spontaneously. In refractory cases, sub‐Tenon or intravitreal injection of triamcinolone acetonide can be effective, but the risk of ocular hypertony is high. Intravitreal injection of anti‐VEGF drugs offers promising results, yet large‐scale randomized studies are necessary to validate their utility. Finally, pars plana vitrectomy is the treatment of choice when vitreomacular traction and/or epiretinal membrane is present.
Surgical therapy of macular edema
Authors: POURNARAS CJ
Published: November 2010

Purpose Persistent macular oedema (ME) is the main cause of poor visual outcome during the evolution of retinal ischemic microangiopathies and traction related macular distortion. Among multiples treatment approaches, vitreoretinal surgery is applied with the goal to achieve the release of a traction related component of macular oedema .

Methods Vitrectomy with peeling of the posterior hyaloid, epiretinal membranes, vitreoretinal tractions and/or internal limiting membrane removal, were studied in numerous nonrandomized cases series.

Results Pars plana vitrectomy has been shown to reduce macular oedema with significant change in best corrected visual acuity, in epiretinal membranes, vitreoretinal traction syndrome and ischemic microangiopathies related macular thickening central, hemiretinal, branch retinal vein occlusion and diabetic macular edema). Evidence to date does not support any therapeutic benefit from radial optic neurotomy and arteriovenous crossing sheathotomy for BRVO and CRVO related macular oedema.

Conclusion In the era of intravitreal injection of steroids and anti VEGF substances, vitrectomy seems to have a beneficial effect in traction related, selected pathologies associated to chronic macular edema.
Straylight and vision
Authors: VAN DEN BERG TJTP , VAN DER MEULEN IJE
Published: November 2010

Purpose Straylight is considered an important source of patient complaints. They can be voiced like halos, glare, hazy vision and blinding at night. With visual acuity, contrast sensitivity and slit lamp examination little may be found. Yet increased large angle light scattering in the eye media not detected by common tests, may degrade the image projected on the retina, thus decreasing the quality of vision. Aging changes to the crystalline lens and cataract are the most common causes of increased straylight. This study aimed to quantify the importance of straylight for daily life on the basis of patient complaint scores.

Methods In a duocenter setting questionnaires were administered before and after cataract surgery. The 37 questions VFQ as well as a self developed 5 question straylight questionnaire were used. A comparison was made between the importance of visual acuity and of straylight to explain the questionnaire outcomes.

Results A total of 214 patients were included in the study. For the comparison correlation coefficients were calculated between a weighted average of the 2 functional measures visual acuity and straylight on the one hand, and the questionnaire outcomes on the other. In all 4 cases (2 questionnaires x 2 visits) correlation was lowest for both visual acuity and straylight used in isolation. When visual acuity and straylight were combined to one combined score, correlation improved. Maximum correlation was found when visual acuity and straylight were combined 1:1 (preop) to 2:1 (postop), for both questionnaires.

Conclusion For cataract patients, straylight is of about equal importance compared to visual acuity for their appreciation of daily function. In this comparison both were quantified as logarithms (logMAR and log(s)).
Sources of straylight in the human eye
Authors: DE BROUWERE D , GINIS HS
Published: November 2010

Purpose Besides refractive aberrations, ocular light scattering is a major parameter affecting image quality on the retina in healthy eyes. Several pathologies in the anterior segment such as corneal scarring and cataract cause significant increase of straylight in the eye. In this study, we link morphologic changes addressed to corneal scarring to a scattering function.

Methods Excised rabbit corneas with different grades of scarring following photorefractive keratectomy were optically evaluated for their forward light scattering distribution and consecutively prepared for histology. An absolute parameter for forward scattering was calculated based on the readings in the optical device. We compared this parameter to the relative thickness of the scar tissue observed in the histological data.

Results The histological data showed a wide variation of thickness a scar tissue layer in the anterior stroma. The scattering ratio measured using the optical device measuring forward light scattering correlated strongly with the relative thickness of the scar tissue layer with (0.63, Pearson’s coefficient), as well as a standard haze exam (measuring backscattered light) (0.51, Pearson’s coefficient). The light scattering distribution is narrowly forward peaked (FWHM 30 arcmin), suggesting this light scattering is caused by large particles such as myofibroblasts, oedema or irregular scar tissue in the ablated zone.

Conclusion Corneal light scattering associated with the increased amount of haze after excimer laser ablation has a narrowly forward distribution that can be attributed to the subepithelial structures observed in treated corneas.This is in contrast to the origin of scatterers linked to cataract, as small protein aggregates and multilamellar bodies that are scattering over wider angles.
Influence of cataract morphology on retinal straylight and straylight changes due to cataract surgery using the Morcher 89A Bag in the LensTM
Authors: TASSIGNON MJ
Published: November 2010

Purpose To evaluate straylight and contrast sensitivity (CS) in eyes with various cataract morphologies, to determine which type of cataract presents a higher impairment of visual function with respect to proposed norms car driver safety and to compare retinal straylight and CS before and after implantation of a Morcher 89A IOL.

Methods BCVA, CS and straylight were measured in 97 cataractous eyes using respectively a Snellen chart, a Pelli‐Robson chart and the C‐Quant. Cataracts were graded using the LOCS III scale and divided into four groups: nuclear, cortical, nuclear‐cortical and posterior subcapsular cataract. These results were compared to data from 38 cataract‐free control subjects. A separate group of 71 eyes had their straylight measured before and after cataract surgery.

Results CS was reduced and straylight increased in all cataract patients, most notably in posterior subcapsular and nuclear‐cortical cataract. CS and BCVA were correlated (r=0.44), whereas straylight and BCVA were not. Applying cut‐off values as proposed by European drivers studies of l.25 log CS and 1.4 log straylight as safe margins for driving, 31% would be considered unfit to drive on the basis of CS and 78% on the basis of straylight although their visual acuity was still above the current European visual acuity requirement for driving. Retinal straylight reduced significantly from 1.560.26 to 1.250.22logunits (P<0.001) after IOL implantation .

Conclusion Straylight and, to a lesser extent, CS are complementary to BCVA and should be taken into account when considering driving eligibility. After IOL implantation straylight reduces significantly, resulting in a significant increase in driving eligibility.