bluuebunny/crossref_metadata_2025 huggingface dataset:
MEKi‐related retinopathy
Authors: Jager M.J. , van Dijk E.H.C. , van Herpen C.M.L. , Marinkovic M. , Luyten G.P. , Kapiteijn E.H. , Boon C.J.
Published: September 2017

Patients that are being treated for different types of malignancies may develop eye problems, which may be due to their treatment. We studied patients that received treatment with the MEK inhibitor binimetinib prospectively: 23% of 30 patients with metastatic cutaneous melanoma and 5 patients with metastatic uveal melanoma reported visual complaints during treatment. These complaints were time‐dependent, mild, and reversible. OCT revealed serous subretinal fluid in 74% of patients. Moreover, a persistent profoundly abnormal electro‐oculogram was found, indicating a panretinal dysfunction of the retinal pigment epithelium. Since no other abnormalities could be detected on multimodal imaging, this clinical entity is referred to as MEK‐associated serous retinopathy.

Ophthalmological monitoring is warranted in patients using MEK inhibitors; however, discontinuation of administration generally does not seem necessary because of the relatively low visual impact and transient nature of the associated serous retinopathy. Possible pathogenetic mechanisms of this retinopathy include anti‐RPE and anti‐retinal autoantibodies and/or direct RPE toxicity of MEK inhibitors.

Ophthalmology. 2015 Sep;122(9):1907‐16. https://doi.org/10.1016/j.ophtha.2015.05.027
The epidemiology of refraction
Authors: Ohlendorf A.
Published: September 2017

Both, ophthalmologist and vision researcher are aware that refractive errors are a major risk factor for the development of ocular diseases and therefore, their epidemiology is not only of interest for academia. The refractive state of an eye is determined by the distance between the position of the focal plane and the photoreceptor plane, when accommodation is relaxed. When focal plane and photoreceptor plane coincide, the refractive state is zero, a condition called emmetropia. If refractive errors develop, typical visual functions such as visual acuity or contrast sensitivity are affected, which results in blurry distance vision in the case of myopia. As myopia has become a major concern worldwide due to its increasing prevalence especially in Asian countries and with its known major implications on ocular health that also considerably affect the economy, epidemiological studies are especially focused on the elongation of the eye. This talk will summarize epidemiological findings regarding the development of all the ocular components that influence the refractive state (cornea, crystalline lens, axial length) and geographic (environmental) influences.
What do we really mean by emmetropisation
Authors: Morgan I.
Published: September 2017

One of the distinctive features of refractive development is the establishment of a tight distribution of refraction by the age of 2. This can be explained by work on animal models showing that hyperopic defocus promotes, while myopic defocus slows, axial elongation, with precise compensation for the imposed refractive error. It has therefore been assumed that the end‐point of human refractive development is tightly defined emmetropia, with an active mechanism for maintaining emmetropia. But in fact, human refractions generally stabilize in the mildly hyperopic range – a state which can be maintained until adult life. With educational pressures, many children become transiently emmetropic, but then progress to myopia, consistent with evidence that early emmetropia is a major risk factor for myopia. Recent work has demonstrated another control over axial elongation, based on increased release of dopamine by bright light which slows axial elongation. Refractive development in humans can be better explained if myopic defocus signals weaken after the age of 2, and once loss of lens power has slowed, the only process able to counter axial elongation associated with education is provided by the light‐dopamine pathway.
Choosing your fellowship and getting the most out of it – advice from Fellows
Authors: Sousa C. , Breda J.
Published: September 2017

Choosing a place for fellowship can be challenging. Every young ophthalmologist looks for a rewarding experience, trying to improve his/her knowledge in a specific area. Achieving this might be dependent on multiple factors. First, it's important to do some research about places where our area of interest can be mastered. After this, comes the “geographic” decision. Time away from family and friends is important for most people, and so is being able to visit them. Besides this, it's crucial to have at least a basic knowledge of the main language that will be spoken. English is widely spoken in most fellowship opportunities, but in my case it was of master importance to be fluent in the local language. Another factor to consider is the size of the hospital/clinic. Is it better to choose a big center with a lot of other residents or is it worth to choose a one‐on‐one experience, where you can sit side by side in an everyday basis with your tutor? For me, this second option worked perfectly and I will explain why. According to my expectations and personality, all the objectives were achieved. I'll try to explain this experience in every important detail and will also discuss some pros and cons of different types of opportunities.
Tips and tricks in macula surgery
Authors: Michalewska Z. , Nawrocki J.
Published: September 2017

The presentation will focus on the following macula diseases: epiretinal membranes, lamellar macular hole, full thickness macular hole, haemorrhagic AMD, diabetic macular oedema.

All presented cases will be illustrated with spectral domain or swept source OCT or swept source OCT angiography.

In epiretinal membranes and lamellar macular holes a guide to select proper cases for surgery will be presented. In full thickness macular holes the inverted ILM flap technique will be discussed. In this technique the ILM is not completely peeled, but a small fragment is left in order to cover the macular hole. Repeated surgery with autologous ILM flap transplants will follow.

In haemorrhagic AMD subretinal rTPA injections will be presented with results of following long‐term anti‐VEGF treatment.

In diabetic macular oedema the surgical tip would be ILM peeling followed by subretinal fluid injection.
Automatic tool for quantification of nerve fibres in corneal confocal microscopy images
Authors: Malik R.
Published: September 2017

Failure after failure of phase 3 clinical trials in diabetic neuropathy has led to the realisation that potentially effective treatments have failed because of inadequate end‐points in clinical trials. Our pioneering studies showed that corneal confocal microscopy (CCM) had excellent diagnostic potential in diabetic somatic and autonomic neuropathy. We and others subsequently used CCM to diagnose peripheral neuropathies in obesity, impaired glucose tolerance, hereditary neuropathy (CMT1A, Friedreich's ataxia), Fabry's disease, amyloid neuropathy, CIDP, HIV etc. Of significant potential as a surrogate end‐point, we have shown that CCM detects nerve fibre regeneration within 6 months of pancreas transplantation in diabetic patients and after 24 months of an improvement in glycaemic control, blood pressure and lipids, continuous subcutaneous insulin infusion and after bariatric surgery. We have shown nerve repair in several phase 2b trials of ARA290, a peptide derivative of erythropoietin, in patients with sarcoid neuropathy and diabetic neuropathy. We have also shown that CCM detects axonal pathology which relates to the severity of neurological deficits in patients with Parkinson's disease, multiple sclerosis and dementia.
The corneal nerves in glaucoma and ocular surface diseases
Authors: Labbe A. , Liang H. , Baudouin C.
Published: September 2017

In addition to their important sensory function, corneal nerves provide protective and trophic functions and also regulate corneal epithelial integrity, proliferation and wound healing. The well‐defined in vivo confocal microscopy (IVCM) appearance of the subbasal corneal nerves has facilitated their quantitative in vivo analysis in ocular surface diseases. Although patients with dry eyes and patients treated for glaucoma experience similar ocular surface signs and symptoms, different correlations between corneal sensation and nerve morphology were observed in these two groups of patients. The relationship between corneal nerve function and structure remains complex, and nerve alteration and/or dysfunction could be different among different ocular surface diseases. Improvements in IVCM image acquisition and analysis will be an important step to further evaluate the role of corneal nerves in physiological and pathological ocular surface conditions.
OCT and OCTA: new technology, new terminology
Authors: Ambresin A.
Published: September 2017

This topic will introduce the course “current contribution of OCT angiography in clinical practice”. OCT angiography is a recent device that has already reached a wide acceptance among ophthalmologists in real life practice. Nevertheless, the images interpretation often remains a challenge for practioners. A overview about the OCT angiography technology will be given and the new terminology to interpret an OCTA will be exposed. Clinical examples will be presented using the suitable terminology.
The role of OCT algorithms and OCT A in glaucoma care
Authors: Mansouri K.
Published: September 2017

Background

The role of blood flow in the pathogenesis of glaucoma is not well understood.

Objective

To discuss applications of OCTA in glaucoma diagnosis and management.

Methods

Review of literature and presentation of ongoing clinical trials.

Results

More than 50 peer‐reviewed publications on OCTA in glaucoma are available. Data demonstrate good reproducibility and repeatability of OCTA measurements in glaucoma patients. Good correlation to structural and functional measures of glaucoma have also been found. Preliminary data have not found a demonstrated effect of IOP‐reduction of OCTA‐derived vessel density measurements. At present, studies on the long‐term role of OCTA in glaucoma evaluation are ongoing.

Conclusions

OCTA measurements of vessel density in glaucoma are reliable. Good correlation to structure‐function has been demonstrated. Available data suggest a role of OCTA for better understanding of the pathophysiological processes in glaucoma. It is unclear, at present, how this technology can be integrated into the long‐term management of glaucoma patients.
Ocular surface inflammation, nerves and brain: dangerous interactions?
Authors: Ferrari G. , Bignami F. , Rama P.
Published: September 2017

Sensory nerves have been typically studied for their sensory functions. It is now clear, however, that in the cornea they are relevant inflammatory modulators. Specifically, functional activation, or, on the other hand, disruption of corneal nerves is associated with highly prevalent ocular disorders, including infectious keratitis, and dry eye disease. Although the modulatory activity of nerves on inflammation has been demonstrated in peripheral tissues, it is not clear whether peripheral disruption of nerves in the cornea could induce modifications also in the central nervous system. In order to test this hypothesis, we have used a well‐known animal model of ocular surface injury. Then, we have quantified the inflammatory response, with in vivo magnetic resonance imaging and ex vivo, in the cornea and in the trigeminal ganglion. As a result, we observed increased leukocyte infiltration following ocular surface injury. Pro‐inflammatory cytokines IL1‐beta, TNF‐alpha and VEGF were also increased. Interestingly, inflammatory cytokine expression were also augmented in the trigeminal ganglion contralateral to the damaged cornea. Our findings support involvement of central nervous system following acute injury to the ocular surface.
An introduction to the tests and clinical interpretation
Authors: Holder G.
Published: September 2017

This lecture will introduce the standard tests used in routine electrophysiological practice, namely full‐field, pattern and multifocal electroretinography, and electro‐oculography. Although the Course will concentrate on disorders of retinal function, the cortical visual evoked potential will also be briefly addressed. The origins of the signals will be discussed and common disorders used to illustrate the principles of clinical interpretation ie the separation of rod and cone system function; localisation of disease either to photoreceptors or inner retina; and the distinction between localised macular disease and generalised retinal dysfunction, always relating the nature of the electrophysiological abnormalities to the underlying pathophysiology.
How to handle the posterior lens capsule in children
Authors: Barraquer R.I.
Published: September 2017

One of the multiple challenges posed by pediatric cataract surgery relates to the special management of the posterior capsule (PC).

The risk of PC opacification is much higher in children, nearing 100% in the course of a few months with the standard techniques and intraocular lenses (IOL), even with a thorough capsular bag polishing. As the performance of a Nd:YAG laser capsulotomy can be impractical in children, an intraoperative solution is advisable. This normally involves a posterior capsulorhexis, with or without anterior vitrectomy, and either with a standard IOL or a special design such as the bag‐in‐the‐lens concept or using techniques as posterior capture of the optic.

Pediatric cataracts frequently include special features as in opacities a the PC level, which can range from cellular to fibrotic, with different degrees in the maturity of fibrous membranes. In some cases as with posterior polar cataracts there may be an extreme weakness or absence of the central PC. Other situations may involve additional materials as in persistence of anterior hyperplastic primary vitreous.

This presentation reviews the decision process, surgical options, and possible risks involved in dealing with the PC in pediatric cataract surgery.
Genetic anomalies in congenital cataract
Authors: Bremond‐Gignac D. , Burin des Roziers C. , Beugnet C. , Fourrage C. , Moriniere V. , Robert M. , Valleix S.
Published: September 2017

Developmental anomalies of the anterior segment of the eye encompasse a spectrum of disorders affecting the cornea, iris, lens, ciliary body, and/or the trabecular meshwork. Besides, nonsyndromic congenital cataract (CC) is a common cause of visual disability in children. All these genetic disorders are highly clinically and genetically heterogeneous, making challenging a proper diagnosis based solely on a phenotype‐based approach. We develop a genotype‐based approach by using a targeted Next‐Generation Sequencing panel including 50 known genes. A cohort of 150 French index patients were recruited after detailed ophthalmic examination. All exons of the 50 genes were amplified using the kit TrueSeq Custom Amplicon (TSCA, Illumina). The subsequent amplified libraries were sequenced using a MiSeq (Illumina, Inc, San Diego, CA, USA) sequencer. All pathogenic variants were confirmed by Sanger sequencing, and familial analyses were performed. A large spectrum of molecular defects were identified with numerous novel variants. This NGS approach is an efficient tool to improve molecular diagnosis, and provides insight into the genotype‐phenotype correlation of all these ocular disorders in a cost‐effective way.
Normal and abnormal corneal innervation
Authors: Dua H.S. , Al‐Aqaba M.
Published: September 2017

The objective of this talk is to provide an understanding of the latest view on corneal innervation and the changes that occur during disease processes and their possible role in corneal pathology. The cornea is innervated essentially by the 5th cranial nerve. The nerves enter the limbus equally all around the circumference, travel as stromal nerves and undergo dichotomous branching to form sub Bowman's nerves that penetrate the Bowman's zone and end in terminal bulbs. From these, the neuritis of the subasal plexus arise. There is also a signifiant sympathetic innervation of the cornea. There is very little knowledge on the histological changes in corneal nerves during disease process to IVCM studies are many. Recent studies have shown remarkable changes that occur in the stroma, and epithelila nerves in conditions such as bullous keratopahty, corneal grafts, keratoconus, and following refractive surgery. This indicates that corneal nerves are not passive bystanders but contribute actively to corneal pathology.
Changes in axial length in adult eyes
Authors: Rozema J. , Zakaria N. , ní Dhubhghaill S.
Published: September 2017

Purpose

It is generally assumed that axial length remains constant in adults, although there have been reports of gradual axial length decreases with age. These findings are often considered with scepticism by the authors themselves, however. This work investigates the cause for this apparent decrease and looks into any other factors that may influence axial length measurements.

Methods

The analysis reviews the literature on non‐myopic axial length changes with age in adults and correlates these changes against year of birth and average level of education obtained from United Nations reports. Furthermore a series of calculations were performed to assess how optical biometry methods respond to the thickening of the crystalline lens, while its equivalent refractive index decreases, as well as how they respond to refractive index increases due to cataract.

Results

The literature analysis shows that axial length does not significantly decrease with age (linear regression, p = 0.071 for the linear term). Axial length does increase with the year of birth, especially in Western countries that all saw similar economic developments during the 20th Century. In non‐Western countries, where the economic development was more diverse, the changes were less pronounced. The correlation of the axial length increase with the increasing education level that occurred in all countries on the other hand was very high (r² = 0.681; p < 0.001). Optical axial length measurements appear to increase by 0.07 mm between 20‐80 years of age due to internal media changes, even if the actual length remains constant. Apparent increases due to cataract are of the same order of magnitude.

Conclusions

The reported axial length decrease with age is an artefact caused by the gradual myopization of the population. Optical artefacts due to changes in the optical media have very little effect.
Micro‐CT study of Bomirski melanoma growing in hamster eye
Authors: Leszczyński B. , Śniegocka M. , Elas M. , Wróbel A. , Sojka‐Leszczyńska P. , Urbańska K. , Pędrys R. , Romanowska‐Dixon B.
Published: September 2017

Purpose

The Bomirski Hamster Melanoma (BHM) cell line has been successfully used as an eye tumor animal model in the studies on tumor vascular network, metastasis and radiation treatment. Visualization and modeling of neoangiogenesis is crucial for further ocular tumor research. This work presents visualization and image analysis of BHM eyeballs using X‐ray microtomography (micro‐CT).

Methods

Micro‐CT is a nondestructive preclinical imaging method with isotropic micron resolution suitable for small ex‐vivo samples. This technique provides 3D distribution of linear attenuation coefficient realized as a stack of cross‐sectional images. The micro‐CT scanning and analysis protocol was optimized for simultaneous visualization of normal ocular tissues, and pathological vasculature of BHM. Micro‐CT image contrast was enhanced using iodine (Lugol's solution) staining technique. In this investigation the Bruker SkyScan 1272 micro‐CT system was used.

Results

The iodine staining method provided well contrasted images presenting a globe anatomy in fine details. Advanced malignancy, with the tumor occupying the entire anterior chamber and the pathological disorganized irregular tumor vascular network was also visualized. Image analysis and processing allowed to distinguish grey level range corresponding to the particular globe and tumor structures. Quantitative analysis of BHM vessel size distribution and complexity level was performed.

Conclusions

Micro‐CT enhanced with Lugol solution staining method has a great potential in preclinical eye tumor research using small animal models.
Application of label‐free 2‐photon fluorescence lifetime imaging microscopy to measure endogenous melanin profiles in human eye melanocytes, naevus and melanoma cells
Authors: Sitiwin E. , Madigan M. , Jager M. , Conway R. , Cherepanoff S. , Macmillan A.
Published: September 2017

Purpose

The progression of choroidal melanoma (CM) is complex, involving genetic and immune‐related factors. Melanin/pigmentation genes and forms (eumelanin/dark and pheomelanin/light) can also impact on CM progression. In this study, an optimised 2‐photon fluorescence lifetime imaging microscopy (FLIM), with phasor analysis, was used to identify melanin fluorescence lifetime (FL) profiles in formalin‐fixed, label‐free paraffin sections of human melanoma and naevus, with surrounding heterogeneously pigmented melanocytes.

Methods

Sections of ‘light CM’ (n = 3) with ‘mixed surrounding melanocytes’ and ‘dark naevi’ (n = 3) with ‘dark surrounding melanocytes’ were imaged with FLIM (3 sampled regions). Fluorescence lifetimes were measured at every pixel of captured FLIM images, Fourier transformed and presented in a ‘fit‐free’ phasor plot. These plots were segmented by 7 phasor clusters of linearly increasing fluorescence lifetimes mapped to intracellular melanin in melanocytes, naevus and melanoma cells. The mean fraction of FLIM image pixels linked to each melanin‐mapped cluster was obtained for all sampled regions to form melanin FL profiles.

Results

The measured sampled regions displayed distinct intracellular melanin (eumelanin:pheomelanin) profiles with varying dominant melanin‐mapped clusters. The dominant ‘highest pixel fraction’ cluster measured in ‘light CM’ mapped to long FLs, implying a low eu:pheo ratio. The ‘mixed pigmented melanocytes around CM’ showed a mixed eu:pheo content based on the dominant mid‐valued FL cluster. The ‘dark naevi and surrounding melanocytes’ were mapped to mostly short FLs (high eu:pheo ratio).

Conclusions

Our FLIM‐phasor method provides a fast ‘model‐free’ way to unmix melanin fluorescence lifetimes in melanocytes, naevi and CM, and provides a basis for exploring the role of melanin forms in eye melanoma pathogenesis.
Idiopathic multifocal choroiditis
Authors: NERI P. , Pirani V. , Lassandro N. , Nicolai M.
Published: September 2017

Idiopathic multifocal choroiditis (IMFC) is an umbrella term used to describe a specific phenotype of uveitis, which presents multiple inflammatory foci in the retino‐choroidal tissue. In the past, such disease has been described with a number of different names, such as punctate inner choroidopathy, multifocal choroiditis with panuveitis and progressive subretinal fibrosis and uveitis syndrome. This chronic, progressive, bilateral inflammatory chorioretinopathy has been recently identified as a unique entity with a variable phenotype both in terms of clinical expression and severity. The sites which are affected most are the retinal pigment epithelium (RPE), outer retinal spaces and choriocapillaris, while the choroidal stroma has a marginal involvement. During the acute stage, choroidal neovascularization (CNV) can occur, representing the most severe complication in such disease. Albeit there is not general agreement for the treatment strategy, steroids and immunesuppressive agents, with or without intravitreal anti‐vascular endothelial growth factor (VEGF) drugs depending on the presence of CNV, represent effective methods for the control of IMFC.
Irradiation induced optic neuropathy
Authors: Zografos L.
Published: September 2017

Irradiation induced optic neuropathy is a major complication of conservative management of intra‐ocular tumors. An irradiation dose of 20 Gy or more delivered on the optic disk is the major risk factor. The final visual acuity in case of irradiation induced optic neuropathy is 0.2 or more only in 25% of the cases. Vascular damage can be located in the retrobulbar arteriovenous network, on the choroidal peripapillary network and on the central retinal artery or vein. In case of retinal ischemia, panretinal photocoagulation and intravitreal anti‐VEGF medication is currently used. The preventive use of anti‐VEGF and steroids is still controversal.
Corneal crosslinking in microbial keratitis
Authors: Szentmary N.
Published: September 2017

The effect of crosslinking (CXL) on microorganisms and on viral, bacterial, mycotic and acanthamoeba keratitis is summarized. Experimental studies have shown that herpes simplex virus will be reduced on a LogMar scale by 4‐5 lines, of Staphylococcus aureus, Pseudomonas aeruginosa or Candida albicans strains by 1‐2 lines. Previous clinical studies have shown that CXL may heal bacterial, mycotic or even acanthamoeba keratitis, but leads to corneal necrosis in herpetic keratitis. Acanthamoeba cysts also survive CXL therapy. Therefore, CXL may be used as an alternative treatment option in bacterial, mycotic and acanthamoeba keratitis, if they are therapy resistant.
High‐intensity focused ultrasound cyclo‐coagulation: a prospective study from a tertiary center
Authors: Sousa D.C. , Pinto Ferreira N. , Marques‐Neves C. , Abegão Pinto L.
Published: September 2017

Purpose

High‐intensity focused ultrasound (HIFU) technology aims to achieve selective coagulation of the cilliary body, thus reducing aqueous humor production and lowering intraocular pressure (IOP). This study evaluated safety and efficacy of HIFU cyclo‐coagulation using EyeOP‐1® device in 44 glaucoma patients.

Methods

Glaucoma patients with uncontrolled IOP despite optimal medication were scheduled for HIFU treatment and followed for 12 months. The primary efficacy and safety outcomes were IOP reduction and major adverse events, respectively. Statistical analyses were performed using STATA v14.1.

Results

Fourty‐four patients (23 male) with a mean age of 70 ± 15 years were studied. Mean preoperative IOP reduced from 26.6 ± 3.8 mmHg to 17.7 ± 4.3 mm Hg at month 6 and 17.4 ± 3.3 mm Hg after 12 months (P < 0.01). Mean number of medications also decreased from 3.1 ± 0.8 at baseline to 2.4 ± 0.9 after 6 months and 2.3 ± 0.5 at month 12 (P < 0.01). More than 80% of the patients achieved an IOP‐reduction of more than 20% compared to baseline, being almost all cases within the target IOP range. One serious adverse event (hypotonia) was registered.

Conclusions

This innovative device seems to be effective in decreasing IOP and to contribute to decrease the number of administered glaucoma drops, with a good safety profile.
Socioeconomic deprivation status of patients undergoing Trabeculectomy surgery. A 9‐year review at Queen Alexandra Hospital, Portsmouth
Authors: Sepetis A. , Balendra S. , Meredith P. , Kirwan J. , Lockwood A.
Published: September 2017

Purpose

To evaluate the socioeconomic status of patients undergoing Trabeculectomy surgery.

Methods

The study population consisted of all individuals who underwent Trabeculectomy surgery (TS) recorded on the Medisoft electronic database. Socioeconomic status was investigated by correlating each individual's postal address with the 2015 Index of Multiple Deprivation (IDM) decile from the UK national database. The IDM decile is a combination of seven indices; income, employment, education skills and training, barriers to housing services, crime, living environment, health and disability, where decile 1 is ranked as the most deprived. In order to account for the socioeconomic status of the population served by our unit, patients that underwent cataract surgery (CS) were used as controls.

Results

582 individuals that were recorded as having TS from Nov 2008 to Apr 2017; Male:Female 1.02:1, mean age 70.9 (SD 11.9) were compared to 39,805 individuals who underwent CS from Jul 2004 to Apr 2017; Male:Female 1:1.51, mean age 76.4 (SD 10.2). The percentage of the population of TS patients belonging to IDM decile 5 and below was 32.82% compared to 39.62% of CS patients. The percentage of TS patients belonging to IDM deciles 1 to 3 was lower than that of CS patients, but higher In IDM deciles 6 to 10. More specifically the percentage of TS patients belonging to decile 1(3.26%) and 2(4.64%) are significantly lower compared to CS patients of the decile 1(6.20%)*** and 2(6.85%)** (***p < 0.01, **p < 0.05, two‐tailed z‐test).

Conclusions

Our results show that more deprived patients are less likely to have a TS compared to CS. This might indicate either that the more deprived individuals present with glaucoma late and cannot be treated surgically, or that the less deprived patients are more concerned about their vision or both.
Three year results of iStent + phacoemulsification cataract surgery for glaucoma
Authors: Lewis A. , Ramanathan D. , Wong C. , Imonikhe R. , Ansari E.
Published: September 2017

Purpose

To evaluate long‐term safety and efficacy of iStent trabecular micro‐bypass stent implantation + cataract surgery (phaco) in glaucoma: A retrospective, interventional, open label study.

Methods

Cases of glaucoma who had phacoemulsification surgery planned, were included. Preoperative and postoperative evaluations included intra‐ocular pressure (IOP), topical ocular hypotensive agent use, best corrected visual acuity, perioperative complications and adverse events.

Results

A single trabecular micro‐bypass iStent was implanted at the time of phacoemulsification cataract surgery. A temporal incision approach was used in all cases. The results from 35 eyes in 25 patients were analysed for 3 years postoperatively. 49% (n = 17) were male. Mean age was 80 ± 7 (SD). 3 eyes had angle closure with previous peripheral iridotomies.

Mean preoperative IOP was 18.5 ± 3.2 mmHg; this was significantly reduced at 12 months (p = 0.008), 24 months (p=<0.001) and 36 months (p=<0.001). Mean IOP was 15.9 ± 4.5, 15.0 ± 4.5 and 15.6 ± 3.6 respectively. The mean number of preoperative IOP lowering agents was 2.3 ± 1.0 and 2.5 ± 1.0 at 36 months. This was not significantly reduced at any follow up time period. Secondary interventions were required in three eyes. Cyclodiode laser was required in 2 patients. ALT was carried out in 2 eyes. There were no significant intraoperative complications and no post‐operative hypotony. At 36 months, visual acuity was ≥6/12 in 29 eyes (83%).

Conclusions

Trabecular micro‐bypass stent implantation during cataract surgery is safe and effective for patients with glaucoma. We measured a sustained reduction in IOP over 36 months in the real world clinic setting.
Follow‐up of non‐complicated filtering surgeries under ambulatory care with no control at Day 1
Authors: Jeancolas A.L. , Conart J.B. , Trechot F. , Berrod J.P. , Angioi‐Duprez K. , Maalouf T.
Published: September 2017

Purpose

In most cases, filtering glaucoma surgery is performed as an outpatient procedure and recommendations suggest performing follow‐up at least at Day 1, Day 8, Day 15 and Day 30. As many of our patients have difficulties to come to follow‐up and because of the economical cost of medical transportations we decided to evaluate the results of a group of patients without clinical control at Day 1.

Methods

Retrospective monocentric study in the department of ophthalmology. All patients (naïve of surgical treatment for glaucoma) underwent of surgery of a primary open‐angle glaucoma in an ambulatory care unit between May 2014 and July 2016. A nurse made a phone call to the patients at Day 1. Clinical controls were due at Day 5 and Day 21. In case of problems detected during the phone call, patients were examined earlier.

Results

One hundred and forty‐four eyes (126 patients) were consecutively included in our study. The mean preoperative IOP was 20.4 ± 6.4 mmHg. After the phone call, only five patients were examined before the first planned control at Day 5. For 3 of them the examination revealed the presence of a hyphema and their topical treatment was changed. The others two patients had no medical modifications. At Day 5, the mean IOP was 10.6 ± 5.9 mmHg. Thirty‐two eyes (22.2%) needed a change in their treatment at Day 5. The mean IOP at Day 21 was 12.9 ± 4.6 mmHg. Our success rate (IOP < 21 mmHg with no topical) at day 21 was 95.6%.

Conclusions

We replaced the Day 1 control with a phone call. We didn't notice a substantial rate of complications. The criteria of success of a filtering glaucoma surgery vary according to the different articles in the literature. Our success rate seems to be similar to those we find in the literature and may suggest that the control at Day 1 is not necessary if the surgery is not complicated.
Results of the Scleral Lens in Current Ophthalmic Practice (SCOPE) survey
Authors: Nau A.
Published: September 2017

An IRB approved, internet based, 19 question survey was administered via email to 4633 eye care providers. A total of 989 responses were collected representing a total of 84,735 patients. 723 responses from individuals living in 14 countries who had fit at least 5 patients with scleral lenses were analyzed. A summary of findings from this survey will include descriptions of lens characteristics, recommendations for wear time, disinfection systems, types of solutions used for insertion, demographic characteristics of fitters and incidence of complications.
Emerging applications of adaptive optics retinal imaging
Authors: Vabre L. , Chateau N.
Published: September 2017

Adaptive optics (AO) is an optical technology used in astrophysics to compensate the turbulences of the atmosphere which alter the quality of the images.

That principle has been applied to various image modalities (OCT, SLO, Flood, etc) permitting the observation of the retina's finest structures at the microscopic scale. The rtx1 is the first, and until now, the only compact AO retinal imaging medical device available on the market. Based on an en‐face near infrared imaging approach, the rtx1 allows to observe the cone photoreceptors mosaic, the lumen and the walls of the retinal arterioles, and the pores of the lamina cribrosa. It is now possible to detect the early signs of diseases and to follow‐up the effect of a treatment.

Thanks to its ergonomy for the patient and the user, the rtx1 is more and more adopted by clinical research centers worldwide to investigate various medical fields. We will present here recent results in the field of ophthalmology but also in translational research using AO retinal imaging to investigate pathologies in cardio‐vascular and neurological diseases.
Small fatal choroidal melanomas: A survey by the European Ophthalmic Oncology Group
Authors: Jouhi S. , Jager M. , Desjardins L. , Eide N. , Rospond‐Kubiak I. , Caujolle J.P. , Grange J.D. , Kiilgaard J.F. , Scheen L. , Midena E. , Raffaele P. , Kivelä T.
Published: September 2017

Purpose

To assess retrospectively characteristics of smallest choroidal melanomas that metastasized.

Methods

Ten ocular oncology services submitted data anonymously through a secure website. Eligible were patients with a choroidal or ciliary body melanoma <3 mm in thickness and <9 mm in diameter that developed metastases. Of 57 patients submitted, 49 fulfilled all eligibility criteria.

Results

At treatment, median age was 57 years (range, 26–81), tumor thickness 2.3 mm (range, 0.4–3.0) and diameter 7.2 mm (range, 3.0–9.0). Fifteen tumors (31%) were observed before treatment, and 13 of them grew a median of 0.5 mm (range, 0.1–1.2) in thickness and 1.0 mm (range, 0–3.0) in diameter in a median of 7 months (range, 2.5 months–5.8 years). Fifty‐seven percent were >2 mm in thickness, 62% had subretinal fluid, 77% caused symptoms, 51% had orange pigment, and 79% a margin within 3 mm of the optic disk (25%) touched disk margin). The number of high risk characteristics was 0 for 10% of the tumours and ranged 1–5 for 12%, 29%, 31%, 14%, and 4%. Local recurrence developed in 18% of eyes. By study design, all developed metastatic melanoma. Cumulative incidence estimate for metastasis developing was 14% (95% CI, 6–25) by 2 years, 51% (95% CI, 36–64) by 5 years, and 86% (95% CI, 72–93) by 10 years after treatment. Median relapse‐free survival was 4.5 years.

Conclusions

Ten percent of the smallest choroidal melanomas that metastasized had no high risk characteristic for growth. One third was followed for growth, which may or may not have influenced outcome. We found only 5 melanomas in 10 centres that were <4.5 mm (3 DD) in diameter and none that was <3 mm and metastasized.
Radiation‐induced cataracts
Authors: Quinlan R. , Kalligeraki A. , Uwineza A. , Jarrin M. , Pal R.
Published: September 2017

The eye lens is not only a radiosensitive tissue, but also one where the response to ionising radiation (IR) is cell location specific. Moreover this behaviour affects the emergent properties of the cells in the lens epithelium causing deregulation of the normally geometrically constrained epithelial cells as that transition from the germinative zone to the meridional rows at the very periphery of the lens. Epithelial cells in the germinative zone are, however, much slower than either the central epithelial cells or isolated blood lymphocytes from the same animals in their repair of double strand breaks (DSBs). Here we describe the emergent cell behavior of peripheral lens epithelial cells that affects the “roundness of the lens”. This is an example of a nonlinear biological response induced by low dose IR exposure. It is a consequence of a non‐uniform increase in cell proliferation in the lens epithelium. The measurement of epithelial cell density and cell proliferation rates in the lenses of IR exposed animals is a key underpinning technology. We present a rapid imaging method to measure cell proliferation and density in the IR exposed lens and determine how IR affects the emergent properties of cells in the lens epithelium.
Inflammatory changes in aqueous induced by diabetes in open angle glaucoma patients
Authors: Pantalon A. , Constantinescu D. , Feraru C.
Published: September 2017

Purpose

Comparative changes of inflammatory cytokines expression in open angle glaucoma and diabetes.

Methods

A cross‐sectional study: 87 eyes, from 87 patients, distributed in 4 groups: 24 eyes from healthy subjects, 26 eyes from diabetic patients, 16 POAG eyes and 21 eyes from diabetic glaucoma patients. Aqueous was collected during conventional cataract surgery. 21 inflammatory markers were quantified and compared between groups using a Luminex® Performance Assay multiplex kit based on flowcytometric methods. Data on patient demographics, duration of glaucoma/diabetes, intraocular pressure as well as duration of anti‐glaucoma therapy were collected for correlations and prediction models.

Results

Molecules like CXCL5 (p = 0.008), CXCL8 (p = 0.048), IL‐1α (p = 0.005), IL‐2 (p = 0.015) and TNFα (p = 0.041) were found significantly higher if diabetes was present in POAG patients. Based on the same pathogenic pathway (TNFα stimmulation, Th1 lymfocytes), a prediction model was created for each glaucoma group. As such, levels of CXCL5, CXCL8, IL‐1α and IL‐2 could highly predict TNFα level for the POAG patients (r2 = 0.842, p = 0.000), whereas for the diabetic glaucomatous patients the prediction level was inferior (r2 = 0.618, p = 0.034). Therefore, we tested a second inflammatory model for this category. Presence of diabetes induced collateral stimmulation of TNFα via elevated GM‐CSF expression (stimmulation via Th2 lymfocytes). Molecules like TNFα, G‐CSF and VEGF were significant predictors for a GM‐CSF augmented expression (r2 = 0.758, p = 0.018) in this group; moreover a lineary dependence between GM‐CSF and TNFα was noted. No other parameter was signifficant in these models.

Conclusions

Inflammatory reaction in glaucoma patients was based on TNFα overexpression, induced either directly (POAG) or indirectly via collateral pathways GM‐CSF mediated (diabetic POAG).
Deep Sclerectomy – what I learned from my first 20 cases
Authors: Mercieca K.
Published: September 2017

Deep Sclerectomy (DS) is a commonly performed procedure for many types of open angle glaucoma, particularly in mainland Europe. The procedure has also gained popularity throughout the UK over the last years, with more units and surgeons in different parts of Great Britain teaching and learning this technically challenging but very rewarding technique. Many glaucoma sub‐specialists undergo intense fellowship training before embarking on independent practice but no experience specifically prepares you for the first months of your solo career. Additionally, DS may not be ubiquitously performed and competition from more traditional surgeries (e.g. trabeculectomy) and Micro‐incisional Glaucoma Surgery (MIGS) can result in limited exposure (or none at all) to this type of procedure during the course of a fellowship and/or insecurity when performing the first few cases independently. This part of the SIS will provide expert tips and genuine advice from a newly appointed glaucoma consultants trained in DS and currently teaching the procedure within a large UK tertiary referral setting. The speaker will share videos and experiences from the first few cases as a solo glaucoma specialist. The course will include tips on preventing and handling complications, sharing of lessons and expected pitfalls, and pearls on how to properly and safely teach residents and fellows to perform this procedure.
The suppression of local cytokine production in experimental models of injured cornea after stem cell treatment
Authors: Kossl J. , Hermankova B. , Javorkova E. , Bohacova P. , Zajicova A. , Holan V.
Published: September 2017

Purpose

Limbal stem cell deficiency (LSCD) is associated with the break of immune privilege of the cornea, a harmful local inflammatory reaction, production of cytokines and a failure of corneal regeneration. The corneal transplantation is not sufficient treatment. In the case of bilateral LSCD the only therapeutic option is an allogenic transplantation of limbal tissue or cultured limbal stem cells (LSCs) with a systemic administration of immunosuppressive medication. As an alternative, mesenchymal stem cells (MSCs) turned out to be a suitable source of autologous stem cells (SCs).

Methods

In this study MSCs were obtained from murine bone marrow. Flow cytometry was used to characterize the phenotypic markers of such MSCs. LSCs were isolated from limbal tissue by trypsin digestion. For in vitro experiments SCs were cultured in 48‐well plates for 24 hours. Excised murine corneas were added into cultures and stimulated by proinflammatory cytokines, interleukin‐1β (IL‐1β), interferon gamma and by lipopolysaccharide or were pretreated with 0.25M NaOH for 20 seconds. After 48 hours of cocultivation of corneas with SCs, the expression of genes for inflammation cytokines and growth factors in the cornea was detected using real‐time PCR. In in vivo experiments, SCs were seeded onto nanofiber scaffolds (allowed to adhere for 24 hours) and transplanted on the damaged (0.25M NaOH, 20 seconds) cornea.

Results

We showed that LSCs and MSCs have the ability to suppress the local expression of genes for IL‐1β, tumour necrosis factor‐α, vascular endothelial growth factor and inducible NO synthase in the damaged cornea in both in vitro and in vivo models and that transplantation of SCs supports corneal regeneration.

Conclusions

We suggest that MSCs can be a suitable substitute for ocular surface regeneration in cases when autologous LSCs are absent or difficult to obtain.
SS – OCT angiography in macular dystrophies
Authors: El Matri L. , Falfoul Y. , El Matri K. , Hassairi A. , Maamouri R. , Chebil A.
Published: September 2017

Purpose

To assess the ability of swept source optical coherence tomography angiography (SS – OCT‐A) to identify abnormalities of the retinal and choroidal vascular network in macular dystrophies.

Methods

Optical coherence tomography angiography and structural OCT were performed using a Swept‐source DRI OCT Triton (Topcon, Corporation, Japan) for patients with Stargardt disease, Best maculopathy, pseudo‐vitelliform dystrophy and progressive cone dystrophy. In our series, for every patient the clinical diagnosis was confirmed by the results of molecular genetic study.

Results

In Stargardt patients, we found alterations especially located at the level of the deep capillary plexus and choriocapillaris. There were different degrees of choriocapillaris impairment, with no residual choriocapillaris inside area of retinal epithelium pigment atrophy in advanced stages. Large choroidal vessels and borders of the atrophy were well visualized. In patients with Best maculopathy and pseudo‐vitelliform dystrophy, OCT‐A revealed neovascularisation in the outer retina and the choriocapillaris while traditional multimodal imaging wasn't conclusive. In progressive cone dystrophy, there was a retinal vasculature signal reduction in both superficial and deep plexus associated with window effect in the outer retina and the choriocapillaris due to the retinal and RPE atrophy.

Conclusions

In inherited macular distrophies, OCT‐A may provide information of great interest. In stargardt disease, OCT‐A findings were in agreement with the results suggesting primitive severe involvement of choriocapillaris. In Best maculopathy and pseudo‐witelliform dystrophies, OCT‐A helps diagnose choroidal neovascularization. In Progressive cone dystrophies, it could be useful for gaining deeper Knowledge of both the pathogenesis and therapeutic implications.
The important role of OCT in the diagnosis of Oculocutaneous albinism
Authors: Berniolles J. , Ascaso Puyuelo F.J. , Bartolomé Sesé M.I. , Martínez Vélez M. , Esteban Floria O. , Sánchez J.I. , Idoate Domench A. , Marco Monzón S. , López Sangrós I. , Ibáñez Alperte J.
Published: September 2017

Purpose

Oculocutaneous albinism (OCA) is a group of genetic diseases with an autosomal dominant pattern. It affects skin, hair and eyes, leading in an hypopigmentation of all these organs. In ophthalmology we can observe a low visual acuity, photophobia, nystagmus, foveal hypoplasia and retinal hypopigmentation. The hypopigmentation may also affect the iris with a characteristic iridian translucence. The disease is also associated with chiasm alterations.

Methodss

We present the case of a 40 year old patient that was referred to our service to confirm the diagnosis of oculocutaneous albinism. The patient presents a severe hypopigmentation of the skin and hair. She also referred a low visual acuity since birth. She didn't presented family antecedents, or personal ophthalmologic history.

Results

The best corrected visual acuity (BCVA) was 0.1 in both eyes. The patient presented horizontal nystagmus and iridian translucence. The fundus examination revealed an important retinal atrophy that showed the choroidal circulation.The optical coherence tomography (OCT) revealed a foveal hypoplasia, atrophy in the epithelial retinal epithelium.

Conclusions

In the patients that the diagnosis of oculocutaneous albinism is not clear, the use of an objective complementary test may be determinant before the genetic diagnosis. This case shows the utility of macular OCT to guide the molecular diagnosis.