bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost‐effectiveness of the Boston keratoprosthesis
Authors: AMENT JD , STRYJEWSKI TP , DOHLMAN CH
Published: September 2009

Purpose Blindness due to corneal disease accounts for approximately 8 million of the 37 million blind in the world. A 2007 study confirmed the global cost‐effectiveness (CE) of cataract surgery and penetrating keratoplasty (PK). We sought to determine the CE of the Boston Keratoprosthesis.

Methods In a retrospective chart review, patients who underwent KPro type I surgery in the United States over the last 5 years were identified. Patients had to have a minimum of 2 years of visual acuity follow‐up data. Patients with autoimmune diseases and chemical burns were excluded. Eighty‐three patients were included. CE was determined by cost‐utility analysis (CUA). Complications and additional procedures were incorporated into a weighted cost decision tree. A conservative retention estimate of 85% was assumed at 5 years. Visual acuity values were converted to utilities and determined to be normally distributed per Shapiro‐Wilk testing.

Results The mean preoperative utility value was 0.449 increasing to 0.630 postoperatively. The mean incremental utility was 0.182. Amongst our cohort, 65 patients experienced improvement in their BSCVA at 2 years, 13 experienced no improvement, and 5 deteriorated. A total discounted incremental QALY gain of 0.763 was obtained. The total discounted cost associated with this utility equaled $11250 (USD). The cost‐utility of the KPro was $13106 per QALY. The model was assessed using both univariate and multivariate sensitivity analyses.

Conclusion The KPro is becoming an established procedure in the US for complex ophthalmic patients, often with numerous comorbidities. The cost effectiveness of KPro was determined in this study to be $13106 USD per QALY. This is comparable to PK, which has been reported in the range of $12000‐16000 USD per QALY.
Macular thickness alterations after cataract surgery determined by optical coherence tomography
Authors: ELEFTHERIADOU M , FRAGISKOU S , KYMIONIS G , PAPADAKI T , PANTELEONTIDIS V , PALLIKARIS IG , TSILIMBARIS M
Published: September 2009

Purpose To evaluate macular thickness alterations with optical coherence tomography after phacoemulsification and posterior champer intraocular lens implantation.

Methods In this prospective study,201 patients who underwent phacoemulsication(102 men and 99 women)with mean age 65±8years were included.Best corrected visual acuity,complete slit lamp examination with lens and OCT examination were performed in all patients before surgery and at one,three and six months postoperatively.Patients were divided into five groups:Group 1(control group‐100 eyes):patients without any predisponding factors for cystoid macular edema,Group 2(15 eyes):patients with complicated surgery,Group 3(27 eyes):patients with epiretinal membrane,Group 4(35 eyes):patients with diabetes and Group 5(24 eyes):patients with glaucoma.

Results The preoperative mean minimal foveal thickness(MMFT)in groups 1 and 2 was 204±24μm and 213±47μm respectively and had no significant changes throughout the follow up period(p>0,05).In groups 3,4 and 5 a significant increase of macular thickness was detected.In group 3 the preoperative MMTF was 248±72μm and at 1,3 and 6 months it was 263±86μm(p=0,01),240±30μm(p=0,18)and 270±64μm(p<0,01)respectively.In group 4 the preoperative MMTF was 219±39μm,after 1month the MMTF increased at 257±78μm(p=0,002),at 3months it was 231±46μm(p=0,005)and at the last examination at 6 months it was 236±49μm(p=0,005).In group 5 the initially MMTF(206±21μm)had significant increase in the first[213±30μm(p=0,07)]and in the third month[223±24μm(p=0,03)].

Conclusion Diabetic retinopathy, epiretinal membranes and glaucoma may predispose to increase in macular thickness after cataract surgery.
Slitlamp integrated OCT, what you can see, is what you can scan
Authors: VERBRAAK FD , STEHOUWER M , DEVRIES H , VANLEEUWEN TG
Published: September 2009

Purpose To present results of OCT images captured of the posterior and anterior segment of the eye using the SLSCAN‐1, a new FD‐OCT device integrated into a slit lamp.

Methods Patients, seen in the outpatient clinic of the Academic Medical Center, were scanned with the SLSCAN‐1, a newly developed OCT scanning device, integrated into a common slit lamp (figure 1). The OCT is a Fourier Domain OCT system (SLD light source, central wavelength 830 nm, bandwidth 30 nm, 1024 pixel CCD camera, scan speed 5k A‐scans per second, 1024 A‐scans per B‐scan). The posterior segment scans have been captured using a standard indirect ophthalmic lens (Volk). A color fundus photography of the observed area is made at the same time (Topcon camera DC1, resolution = 3.24 Mp).

Results For posterior segment imaging, the flexible optical arrangement of the slit lamp and the hand‐held lens (Volk), allows the user to scan large areas of the retina (>45 degrees), depending on the pupil size of the patient. In all patients the macula and optic disk could be visualized without any difficulty. In the anterior segment mode, the SLSCAN‐1 allows imaging of the cornea, anterior chamber, iris and parts of the lens.

Conclusion The images made by the SLSCAN‐, new slit lamp integrated FD‐OCT, could be very useful to examine patients directly, both posterior and anterior, during regular slit lamp examinations.

Commercial interest
Optical coherence tomography and biomicroscopical analysis in macular holes
Authors: FRUSCHELLI M , MOTOLESE I , MOTOLESE PA , FREZZOTTI P , MOTOLESE E
Published: September 2009

Purpose To assess the usefulness of optical coherence tomography (OCT) for better differential diagnosis of macular holes in comparison with biomicroscopical fundus analysis.

Methods We reviewed the files of 25 eyes of 24 patients who were diagnosed as having a macular hole on OCT examination and biomicroscopical fundus analysis. Each eye underwent six radial 3‐mm OCT scans centered on the macula, one 6‐mm vertical and one 6‐mm horizontal scan. Retinal thickness was measured at the foveal center and 750 μm from the center, vertically, and horizontally. The diameter of the macular contour was also measured on vertical and horizontal scans.

Results On biomicroscopy only 8 eyes (32%) were diagnosed as having macular hole, while in the remaining 17 eyes (68%) diagnosis of macular hole was possible only performing an OCT examination.

Conclusion Optical coherence tomography is very useful in the diagnosis of macular holes compared with classic biomicroscopical analysis.
Does internal longitudinal microstructure of retinal veins change with age in medically healthy persons?
Authors: KOTLIAR KE , KHAROUBI A , SCHMIDT‐TRUCKSÄSS A , HALLE M , LANZL IM
Published: September 2009

Purpose We demonstrated previously that roughness of the retinal arterial blood column measured along the vessel axis, termed longitudinal arterial profile (LAP) increases significantly in anamnesticly healthy volunteers with increasing age. Recently we have demonstrated age related changes in LAP of medically healthy persons. Whether longitudinal retinal venous profiles (LVP) are altered with age in this group is investigated.

Methods 83 medically healthy volunteers were examined by Dynamic Vessel Analyzer (IMEDOS, Jena, Germany) using stimulation with flickering light. 3 age groups were formed: young (N=28, 30,2±4,3 years), middle age (N=28, 42,3±3,3 years) and seniors (N=27, 64,0±5,0 years). Included in the analysis were volunteers without medical vascular risk factors defined as: blood pressure < 140/90 mmHg, HDL > 35 mg/dl, LDL < 190 mg/dl and glucose levels < 110 mg/dl. Retinal venous diameters were measured along 1 mm vessel segments to obtain LVP. Differences were analyzed using Fourier transformation.

Results In all age groups power spectra of LVP do not change during all stages of the venous response to the stimulation. There were no significant differences in LVP between the age groups. Venous diameters in middle‐age group were reduced in comparison to the young group at all stages of vessel reaction (p<0,05).

Conclusion Our results indicate that in contrast to retinal arteries retinal veins of validated healthy volunteers do not undergo age related microstructural changes. Hence previously reported age related decrease of retinal venous diameter might have physiologic origin due to reduced blood flow in retinal microcirculation with age, not because of structural changes of venous wall.
Lornoxicam pharmacokinetics in the vitreous humor of albino rabbits
Authors: TSIKA C , TSOURDOU A , TZATZARAKIS M , TSILIMBARIS M , PALLIKARIS IG
Published: September 2009

Purpose To assess the elimination half‐life of intravitreal lornoxicam, a non‐steroidal anti‐inflammatory drug (NSAID).

Methods Both eyes of 15 rabbits were intravitreally injected with 250 μg of commercially available lornoxicam (for intravenous/intramuscular use, Xefo® 8 IV/IM Injection, Nycomed Hellas S.A.). Six eyes were enucleated at time points 0, 1, 2, 6 and 24 hours after the injection was performed. The eyes were immediately frozen at ‐80°C. The vitreous was eviscerated from the eye and the drug was liquid‐liquid extracted from a 0.4 ml sample. Lornoxicam was isolated by a reversed‐phase High Performance Liquid Chromatography (HPLC) method at retention time 10.7 min and detected at 372 nm. The data were statistically analyzed in order to evaluate the pharmacokinetic parameters of the drug.

Results The recovery of lornoxicam after liquid‐liquid extraction was calculated at 69.6% and the limit of determination was 0.1 μg/ml. Statistical analysis revealed that lornoxicam concentrations followed first‐order kinetics with an elimination rate constant of 0.235h‐1 and a half‐life of 3.0 h.

Conclusion The determination of the pharmacokinetic characteristics of intravitreal lornoxicam allows the possibility for further investigation of the drug's intraocular behaviour and therapeutic potential.
Subconjunctival injection of bevacizumab (Avastin®) for corneal neovascularization
Authors: DE LA PAZ MF , DE SOUSA F , PONCE C , ALVAREZ J , BARRAQUER RI
Published: September 2009

Purpose to study the effects of subconjunctival injection of Bevacizumab on corneal neovascularization.

Methods Prospective interventional case series on 7 eyes of 7 patients who underwent subconjunctival injection with Bevacizumab. The following parameters were studied pre‐op, at 1 week, 30, 60 and 90 days post‐op: UCVA, BCVA, pachymetry with OCT, slit lamp examination and photographic imaging. Conjunctival impression cytology pre‐op at 1 week and 9o days was done and complications were also noted.

Results Pre‐op diagnoses were: herpetic leucoma (4 eyes), chemical burn (2 eyes), neurotrofic keratopathy (1 eye). An informed off‐label consent form prior to procedure was signed. 1.25 mg of subconjunctival Bevacizumab was injected nearest the area affected. Mean preoperative UCVA and BCVA were 0.86 and 0.44 LogMar units, improved to 0.61 and 0.26 LogMar units at 90 days post‐op, respectively. Central and peripheral pachymetry improved from 532 and 623 microns pre‐op, to 529 and 619 microns at 90 days post‐op, respectively. All slit lamp findings and photographic imaging showed a clear regression of superficial and deep stromal corneal vascularization, with clearing of lipid deposits around the affected areas. No toxic effects were noted on conjunctival impression cytology.

Conclusion Subconjunctival injection of Bevacizumab is a safe and effective procedure for the regression of superficial and deep corneal neovascularization. It may be a good alternative for patients prior to performing an optical keratoplasty or for those who are poor candidates for the same.
The neuromuscular junction microenvironment in extraocular and limb muscles
Authors: PEDROSA DOMELLOF F , BRäNNSTRöM T , ANDERSEN PM , MARKLUND SL , LIU J
Published: September 2009

Purpose To characterise the components of the neuromuscular junction (NMJ) in normal and pathological extraocular muscles (EOMs) and to assess the dynamics of progressive denervation.

Methods Limb and EOM samples from 11 controls,8 ALS patients and from transgenic mice with SOD1 mutations (D90A, G93A) paralleling familiar ALS were processed for immunocytochemistry with antibodies against Schwann cell markers (S‐100, p75, GFAP), gangliosides GD1b and GQ1b/GT1a, neurotrophic factors (BDNF, GDNF, NT‐3, NT‐4) and their receptors, parvalbulmin, nestin, desmin and laminin chains.

Results The NMJs of normal EOMs had a different cytoskeleton composition. Differences in the expression of gangliosides GD1b and GQ1b/GT1a, Schwann cell marker S‐100, agrin and nestin at the NMJs were noted in the human ALS EOMs. Parvalbumin was absent or scarce in EOM nerve trunks of ALS patients. The analysis of the time aspects of denervation in the animal models is ongoing.

Conclusion The human EOMs in late stages of ALS and the EOMs of the transgenic mice show signs of denervation, although these muscles appear remarkably well preserved. High levels of parvalbumin, proposed to be protective for oculomotor neurons in ALS, are not apparent in advanced stages of the disease. The identification of similar endpoints in the EOMs of patients with D90A mutation and the ALS transgenic mice carrying the same mutation indicates that this is a useful model to study the temporal aspects of progressive denervation in the EOMs, to explore aspects of muscle‐nerve interplay that protect the EOMs in motoneuron disease and to gain further knowledge useful for the development of selective tools to modulate eye muscle function in the treatment of strabismus.
Splicing defect in Calpain12 cDNA of a recessive cataract mutation in rats (cat)
Authors: GRAW J
Published: September 2009

Purpose The recessive cataract mutation cat was identified among F2 offspring of Wistar rats having been treated with X irradiation; a corresponding mutant line was established (Léonard & Maisin, Nature 205, 1965, 615‐6). Aim of the study is the identification of the underlying mutation.

Methods Homozygous cat rats have been outcrossed to wild‐type Brown Norway rats; heterozygous F1 offspring (without cataracts) have been backcrossed to parental homozygous cat rats.

Results Among 461 F2 offspring, we observed in total 223 cataracts (48.5%) at the age of 10 weeks; however, 2/3 of these cataracts were discovered at the age of 3 weeks, and most of the remaining third at the age of 7‐8 weeks. Linkage analysis located the mutation on rat chromosome 1 between the markers D1Got76 (76.2 MB) and D1Rat410 (87.6MB). This large interval contains candidate genes like Six5 and Opa3, which have been excluded by sequence analysis of cDNA from rat lenses. Recently, we identified a major splicing error in lens‐derived cDNA of the gene Capn12 encoding Calpain‐12. Besides exon 1, the transcript contains the complete intron 1; in exon 2 it keeps just a few bases to go to the end of intron 4 and than to exon 5; from there no further deviation from the wild‐type sequence was yet observed. It is predicted that the sequence of the first intron leads to a premature stop codon after 10 new amino acids, which might result in a loss of Calpain‐12 activity.

Conclusion Calpains has been proposed for a long time to be involved in cataractogenesis. Here we present for the first time a mutation in a calpain‐encoding gene (Capn12), which is very likely to be responsible for cataract formation.
Genomic (epigenetic) DNA methylation in patients with open‐angle glaucoma
Authors: JÜNEMANN A , LENZ B , REULBACH U , SCHLöTZER‐SCHREHARDT U , REJDAK R , KORNHUBER J , KRUSE F , BLEICH S
Published: September 2009

Purpose DNA methylation occurs by transfer of a methyl group to cytosine residues in the CpG1 islands. The extent of DNA methylation positively correlates with the extent of gene inactivation. The present study was performed to investigate whether there is an altered global DNA methylation in patients with open‐angle glaucoma.

Methods This prospectice case control study included 59 patients with primary open‐angle glaucoma (POAG, age: 68 (SD 8) years), 54 patients with secondary open‐angle glaucoma due to pseudoexfoliation syndrome (PEXG, age: 72 (SD 8) years), and 53 patients with cataract as controls (age: 69 (SD 11) years). Total DNA was extracted from frozen EDTA‐blood using QIAmp DNA Blood Mini Kit (Qiagen). Global methylation status [DNA methylation in %, 1‐(HpaII/MspI)] was measured with a modified non‐radioactive assay. Statistics: Mann‐Whitney‐Test (2‐tailed), the results are presented as means (SD), significance level p<0.05.

Results There was a significantly elevated genomic DNA methylation (in %) 1‐(HpaII/MspI) in peripheral mononuclear cells in patients with POAG (68%, SD 18; U=868, Z = ‐2.79, p=0.005), but not in PEXG (55%, SD 17; U=1049, Z=‐0.57, p=0.57) when compared with healthy controls (55%, SD 24). Thus, the difference between POAG and PEXG was exactly 13% of methylated HpaII/MspI restriction sites.

Conclusion Since methylation of DNA is an important epigenetic factor in regulation of gene expression these findings may have implications for a possible subsequent derangement of epigenetic control in patients with POAG. Further studies including gene‐specific analyses are needed to clarify the differences between POAG and PEXG.
Gene screening at the 13q32 keratoconus locus
Authors: GAJECKA M
Published: September 2009

Purpose Keratoconus (KTCN) is a non‐inflammatory thinning and anterior protrusion of the cornea that results in steepening and distortion of the cornea, altered refractive powers, and altered visual acuity. We ascertained eighteen autosomal dominant multigenerational KTCN families from Ecuador and identified a novel locus on 13q32.1‐q32.3 in the large family KTCN‐014. Here we present sequencing results of candidate keratoconus genes localized to 13q32.

Methods The keratoconus locus contains 23 known transcripts. Sixteen of the genes were chosen for the evaluation. Genes are screened by standard techniques using 48 genomic DNA samples from individuals from family KTCN‐014 and selected affected and unaffected individuals from other Ecuadorian families. Coding exons and intron‐exon boundaries of the genes are evaluated.

Results Sequencing analysis of genes MBNL2, FARP1, ZIC5, ZIC2, FGF14, EFNB2, RNF113B, DOCK9, PHGDHL1, VGCNL1, ERCG5 and ING1 have not revealed mutations segregated with the disease phenotype. Several novel single nucleotide polymorphisms were identified. Other candidate genes on 13q32.1‐q32.3 including COL4A1 and COL4A2 are currently being screened for a possible role in the pathogenesis of KTCN.

Conclusion To date, mutation analyses of candidate genes have not identified sequence alterations segregating with the keratoconus phenotype in this population.
Until what age should glaucoma be monitored and/or treated? A novel index that facilitates clinical decision making
Authors: JANSONIUS N , WESSELINK C , STOUTENBEEK R
Published: September 2009

Purpose To calculate for which combinations of age and perimetric disease stage (mean deviation [MD]) treated and untreated glaucoma patients are unlikely to become blind during lifetime.

Methods The probability of dying without blindness was calculated using the age and gender adjusted life expectancy values from the Statistics Netherlands and the progression rates of treated and untreated glaucoma patients from the Early Manifest Glaucoma Trial and the Groningen Longitudinal Glaucoma Study. Absence of blindness was defined as an MD better than ‐20 dB. Because it is difficult ‐ or even impossible – to determine someone's individual life expectancy and rate of progression accurately, patients were assumed to reach the 90th percentile of the adjusted life expectancy and to progress with the 90th percentile of the rate of progression, leaving an a priori probability of becoming blind during lifetime of 2.5%.

Results If MD+0.8*age, with MD in dB and age in years, is larger than 59, treated male patients were unlikely to become blind during lifetime. For untreated male patients the cut‐off value was 66, and for treated and untreated female patients 61 and 68 respectively.

Conclusion With this novel index, MD+0.8*age, the intensity of glaucoma monitoring and/or treatment can be reduced well‐founded in the ageing patient. The index can be applied to either the worse or the better eye, depending on what is considered acceptable or possible given limited resources.
RTVue Fourier‐domain OCT: reproducibility of RNFLT and macular thickness measurements
Authors: GARAS A , KOTHY P , HOLLO G
Published: September 2009

Purpose To evaluate the reproducibility of peripapillary retinal nerve fiber layer thickness (RNFLT) and macular thickness (MT) measurements with the RTVue‐100 Fourier‐domain optical coherence tomography, and to determine the influence of pupil dilation, patients’ experience in examinations and severity of glaucoma.

Methods One eye of 14 normal subjects, 11 patients with moderate, 12 patients with severe glaucoma and 40 screening trial participants were imaged 5 times on the same day. For the hospital‐based patients, the measurement series was repeated after pupil dilation and 3 months later.

Results For the RNFLT and the MT parameters, intrasession intraclass correlation coefficient (ICC) varied between 93.9 and 99.0%, intrasession coefficient of variation (CV) between 1.95 and 5.69 %, and intratest variability between 3.11 and 9.13 µm. Most thickness values, all intrasession CV and intratest variability values and the signal strength index remained unchanged after pupil dilation. Most intrasession CV values increased significantly with increasing disease severity. Patients’ experience in imaging examinations had no influence on intrasession CV. Intratest variability and intrasession CV represented 79.1 to 98.6 % and 77.1 to 95.0 % of test‐retest variability and intervisit CV, respectively.

Conclusion Reproducibility of RNFLT and MT measurement with the RTVue‐100 OCT are satisfactory for clinical purposes both in normals and glaucoma patients. Pupil dilation and patients’ experience in imaging examinations do not influence the reproducibility of the measurements clinically significantly.

Commercial interest
Retinal nerve fiber layer thickness and central corneal thickness in ocular hypertensive patients and healthy subjects
Authors: BRON AM , MUSELIER A , BEYNAT J , CREUZOT C
Published: September 2009

Purpose To establish the correlation between central corneal thickness (CCT) and retinal nerve fiber layer (RNFL) thickness in ocular hypertensive patients and healthy subjects.

Methods We prospectively collected charts of healthy subjects and ocular hypertensive (OHT) patients in one academic center between 2007 and 2008. OHT patients were defined by two measurements of intraocular pressure superior to 21mmHg without treatment, open angle in gonioscopy, normal appearing optic nerve head and normal visual field test Standard Automated Perimetry (SAP SITA) and Frequency Doubling Technique (FDT). Every patient underwent a standard clinical examination including optic nerve head examination, intraocular pressure, CCT measurement by ultrasonic (US) and anterior segment OCT pachymetry, visual field testing (SAP and FDT), RNFL thickness by scanning laser polarimetry (GDX‐VCC) and optical coherence tomography (OCT).

Results Eighty healthy subjects and 60 OHT patients were included. A correlation between US CCT and OCT CCT was found in both groups (r2=0.85 and r2= 0.87, p<0.001). There was no significant difference (p>0.15) in GDX‐VCC and OCT RNFL thickness in both groups. In controls there was no correlation of any RNFL thickness measurement with the CCT. In OHT patients, the US CCT was weakly correlated with the average TSNIT evaluated by GDX‐VCC (r2= 0.04, p<0.02).

Conclusion This study did not show any relevant correlation between the RNFL thickness evaluated by GDX‐VCC and the US CCT in healthy individuals and in OHT patients with a normal FDT.
Studying electrophysiological characteristics in children with congenital sensory nystagmus‐ case presentations
Authors: BRECELJ J , STIRN‐KRANJC B
Published: September 2009

Purpose In classification of sensory congenital nystagmus (CN) is important to recognize the underlying retinal or visual pathway dysfunction. The aim was to distinguish ERGs and VEPs charcteristics which may identify among variety of disorders associated with sensory CN.

Methods In infants and small children that were ophthalmologically classified as sensory CN were ERGs and VEPs recorded simultaneously in the same session. ERGs were detected without dilated pupils and with skin electrodes. Under darkened laboratory conditions were ERGs recorded to white (cone/rod mediated response) and dim blue (rod mediated response) flash and under lighten room were ERGs recorded to white, red and 30 Hz flicker flash (cone mediated responses). VEPs were recorded from three occipital electrodes to flash and onset stimulation.

Results Cases with abnormal ERGs showed: in Leber’s congenital amaurosis were undetectable both rod and cone mediated responses from early infancy; in cone‐rod retinal dystrophy abnormal cone and rod mediated responses progressed in time; in achromatopsia abnormal cone mediated responses did not progress in time; in congenital stationary night blindness a negative ERG did not progress in time. Cases with abnormal VEPs showed: in ocular albinism VEP contralateral asymmetry; in achiasmia VEP ipsilateral asymmetry; in severe optic nerve hypoplasia flash VEP was non‐recordable, while in moderate optic nerve hypoplasia flash and pattern onset VEP findings might not correlate with clinic findings.

Conclusion Sensory CN is associated with a variety of disorders affecting the retina, optic nerve, chiasm and electrophysiology may characterize retinal or postretinal pathway dysfunction and therefore help in early diagnosis.
Foveal serous detachment in juvenile idiopathic arthritis(JIA)‐associated uveitis
Authors: LIANG F , TERRADA C , DUCOS DE LAHITTE G , QUARTIER P , LEHOANG P , BODAGHI B
Published: September 2009

Purpose To characterize the foveal serous detachment(FSD) in JIA‐associated uveitis.To investigate the correlation with visual acuity (VA) and ocular inflammation.

Methods 9 children having FSD with JIA‐associated uveitis were identified between 2005‐2007.All were treated with periocular steroid injection and systemic anti‐TNF α antibody.Outcome measures included VA,ocular inflammation quantified by laser flare photometry and the macular profile analyzed by OCT.

Results All patients(8 female,1 male) had bilateral uveitis and 6 had bilateral SRD.All patients had risk factors to develop severe anterior uveitis.The mean age at the onset of uveitis and at the onset of FSD was 4.1±1.1years and 7.6±2.2years.At the onset of FSD 6 children were refractory to methotrexate and systemic corticosteroids.It had a high frequency of ocular complications:87% posterior synechiae, 80% cataract, 60% band keratopathy and 20% glaucoma.FSD appeared isolated in 21% of eyes,it was associated with diffuse macular edema in 46% and with cystoid macular edema in 12% of cases.Before therapeutic intensification,the mean VA was 0.46logMAR,the mean foveal thickness(FT) was 261μm.At 6 months follow‐up:VA increased to 0.22logMAR(p=0.017),the reduction of flare was 41%(p=0.003),the mean FT was 229μm(p=0.59).At 12 months follow‐up,the mean VA was 0.19logMAR(p=0.0029),the mean FT was 196μm(p=0.009),only 1 eye showed persistant SRD.

Conclusion FSD is a late‐stage complication of sustained and insufficiently treated anterior uveitis in JIA‐associated uveitis and must be considered for the long‐term visual outcome.An agressive immunomodulatory strategy is mandatory in order to achieve strict control of ocular inflammation and improve the visual function.
Correlation between Goldmann applanation tonometry and rebound tonometry in relation to central corneal thickness
Authors: BRANDTNER H , HITZL W , STROHMAIER C , ABRI S , WINTERSTELLER CH , HOHENSINN M , RUCKHOFER J , STOIBER J , GRABNER G , REITSAMER HA
Published: September 2009

Purpose To investigate the influence of central corneal thickness (CCT) on the ICare Rebound Tonometer (RBT) measurements and to verify the correlation of RBT and Goldmann applanation tonometry (GAT).

Methods The current study contains data from 230 eyes from a mixed population of the outpatient departments of the University Eye Clinic Salzburg. The mean‐age was 67.19 years (SD +/‐ 11.87). The study was explained to the patients and their informed consent was obtained. The IOP was measured with both the GAT and the ICare‐tonometer; in addition the CCT was determined with standard pachymetry.

Results We were able to show a good linear correlation between GAT and RBT readings (r=0.9). Over the whole range of IOP we could observe a good correlation of both tonometers with the tendency of a slight overestimation of the IOP in RBT readings. CCT has a stronger impact on the results of RBT than on the results of GAT. In thin corneas RBT tends to underestimate the GAT readings, whereas in thick corneas RBT overestimates the GAT readings. Although the correlation factor between GAT and RBT is high, significant differences can be seen in the Bland‐Altman analysis. Only in 15% of all measurements no differences in results between the two methods were observed. In 26% the difference was 1 mmHg, in 23% 2 mmHg, in 19% 3 mmHg and in 16% 4 or more mmHg. The analysis also revealed a correlation of r=‐0.4 between CCT and the difference in results of the two methods.

Conclusion In cases where an exact measurement of the IOP is important RBT would not be the first choice. Also formulas to correct for the dependency of RBT on CCT would improve the results only marginally.
A new storage medium for pre‐cut donor tissue for DSAEK in eye bank
Authors: POCOBELLI A , AMATO D , DUCOLI P
Published: September 2009

Purpose To evaluate the efficacy of a new storage medium able to avoid swelling the donor cornea before the microkeratome cut in eye bank routine setting

Methods The Eusol‐C (Alchimia s.r.l.,Italy) storage medium and a modified storage medium (only for experimental use,Alchimia) were used to store two different sets of donor corneas (n=12).Before the microkeratome cut,corneas were stored in Eusol‐C (n=6) while the controlateral donor corneas were stored in the modified medium (M.M.) (n=6).Donor lenticules were created with a full pass of microkeratome blade which resulted in a posterior lamella and a free cap.Endothelial cell density,cellular viability and corneal thickness by AS‐OCT (VisanteTM,Carl Zeiss) were evaluated before dissection,4,24 and 48 hours after dissection.

Results Endothelial cell density and cellular viability were well preserved during the time course in both storage medium.Pachymetry values, after the microkeratome cut did not show significant variations during the time course.Conversely significant differences were found between the two groups (p<0,05).Average corneal thickness immediately before dissection was 659+/‐38,08 microns and 537,83+/‐24,78 microns in Eusol‐C and in M.M. respectively.Immediately after dissection, thickness of the residual posterior bed was 247,83+44,13 (Eusol‐C)and 143,6+24,96(M.M.)microns.After 4, 24 and 48 hours was 238,5+41; 238,83+42,73 and 232,83+39,01 microns respectively in Eusol‐C.Instead in M.M. after 4, 24 and 48 hours was 141,2+24,92;145,6+22,35 and 157,2+30,40 microns respectively.The M.M. was able to reduce,on the controlateral corneas,the thickness of 100 microns in average.

Conclusion The M.M.was capable of preventing corneal tissue swelling during storage of pre‐cut tissue for DSAEK.
Effect of corneal collagen crosslinking on corneal sensitivity, tear function and innervation: a clinical and confocal microscopic study
Authors: KONTADAKIS GA , KYMIONIS G , PORTALIOU D , DIAKONIS V , PALLIKARIS IG
Published: September 2009

Purpose To evaluate the effect of corneal collagen crosslinking (CXL) on corneal sensitivity, innervation and tear function.

Methods We conducted esthesiometry, Shirmer’s II test, tear break up time measurements and confocal microscopy to evaluate innervation in 32 eyes with keratoconus preoperatively, and one, three and six months post CXL.

Results Sensitivity decreased significantly the first postoperative month (p<0.05) with restoration until the sixth. Tear break up time and Shirmer’s II scores remained unaffected (p>0.05). Denervation appeared one month postoperatively and began retrieving by the third month.

Conclusion The main outcome of this study is that corneal innervation and sensitivity is significantly affected by crosslinking, but preoperative sensitivity is restored to the preoperative levels after six months.
On the dependence of outflow facility on Intraocular pressure in the living human eye.
Authors: KARYOTAKIS NG , GINIS H , LIMNOPOULOU A , DASTIRIDOU AI , TSILIMBARIS M , PALLIKARIS IG
Published: September 2009

Purpose The change of outflow facility is determined by the value of intraocular pressure (IOP) possibly due to changes in the angle of the anterior chamber, the trabecular meshwork and the Schlemm’s canal. The purpose of this study was to determine the relationship between outflow facility and IOP (especially for elevated values of IOPs) in living human eyes.

Methods Thirteen eyes from thirteen cataract patients (6 men and 7 women, aged 61 years, sd 15) were enrolled in the study. The study was approved by the Institutional Review Board. The measurements were performed before cataract surgery, using an intraoperative invasive manometric device. The pressure‐time decay was recorded in order to calculate the outflow facility at different values of IOP. An appropriate mathematical model was developed to calculate outflow facility based on the IOP‐time curve and the ocular rigidity of each eye under measurement.

Results The average outflow facility coefficient was 0.213 (SD 0.097) μl/min/mmHg. Our data suggest that outflow facility has a non‐linear relationship with IOP, especially in the range of higher IOPs. This non‐linear behavior of outflow facility was approximated with an exponential function. There was no significant statistical correlation (r=0.2377, p=0.4568) with outflow facility and ocular rigidity.

Conclusion Outflow facility depends on IOP in a non‐linear manner that indicates a complex relationship between IOP and the geometry of the outflow pathways. In this limited set of measurements, a relationship between the outflow facility (or its non‐linearity) with other parameters could not be established.
IOP evaluation in glaucoma patients after phacoemulsification
Authors: STOJANOVIC N , TSOLAKI F , GOGAKI E , SAKKIAS G , TACHIAOS P
Published: September 2009

Purpose To evaluate intraocular pressure in glaucoma patients after cataract surgery with phacoemulsification

Methods 107 glaucoma patients underwent phacoemulsification cataract extraction from June 2006 to May 2009. The follow up period was 6 months. No medication was discontinued preoperatively The mean value of preoperative IOP was16,33 mmHg (10‐28mmHg). 41 patients ( 38,3%) were under single medication treatment, 35 (32,7%) were under two medications, 23 (21,5%) were under three and 8 (7,5%) were under four medications. IOP was measured on the 1st day, 1 week, 1, 2, 3 and 6 months postoperatively. If IOP was <25mmHg, no additional medication was given, and if IOP was >25mmHg, acetazolamide was given during the first week and topical medication after that

Results Final IOP was <20mmHg without treatment in 50.8% of the patients, 27,6% were under single medication treatment, 17,9% were under two medications, 3,7% were under three medications and none was under four medications

Conclusion A reduction of at least one glaucoma medication was observed postoperatively. Cataract extraction with phacoemulsification has a positive influence in postoperative IOP in glaucoma patients and can delay or even avert a possible trabeculectomy.
Functional correlation between retinal sensitivity threshold values of standard automated perimetry in glaucoma
Authors: GUERRI MONCLUS N , PRIETO CALVO E , EGEA ESTOPINAN MC , FERRERAS A , PABLO LE
Published: September 2009

Purpose To study the interrelationship among the 52 retinal sensitivity threshold values of the Humphrey visual field analyzer with the 24‐2 Swedish interactive threshold algorithm (SITA) standard strategy in glaucoma patients.

Methods Prospective cross‐sectorial study. 104 eyes of 104 patients with diagnosed glaucoma by means of optic disc stereophotographs were evaluated. Each 52 threshold points of the SITA Standard 24.2 program in the standard automated perimetry (SAP) were obtained. The upper and the lower hemifield were studied separately. Pearson correlation coefficients were calculated between each of the mean threshold values at each point of the visual hemifield and the rest of the threshold points.

Results Perimetric correlation maps between threshold values in the same hemifield were obtained. Most of the points had moderate and high correlations (r ≥ 0,65) with neighboring points and distant points corresponding to the retinotopic distribution of the retinal nerve fibers.

Conclusion There is a functional relationship, in glaucoma patients SAP, between neighboring and distant threshold points in corresponding to the anatomical arrangement of ganglion cells axons. This enables to achieve perimetric patterns of glaucoma defects.
In vivo imaging of microglial cell trafficking
Authors: PAQUES M , SIMONUTTI M , SAHEL J
Published: September 2009

Purpose Microglial cells (MCs) are active sensors of neural tissues that are rapidly mobilized upon disruption of homeostasis. OUr goal was to observe in vivo the migration of MCs, which has not been done yet.

Methods Following acute laser damage, the behavior of MCs in the retina of adult Cx3cr1gfp/+ and gfp/gfp mice was observed noninvasively using time‐lapse confocal scanning laser ophthalmoscopy. Observation were done at various time‐points up to 8 days after laser damage.

Results Focal damage elicite prompt migratory response of MCs within 200 to 400 µm around laser burns. This migratory response was preceded in all case by dendritic reorientation. Convergent and nonconvergent migration were observed. Such migratory activity persisted several days after laser damage. At day 8, the microglia network was restored and microglial locomotion had ceased.

Conclusion To our knowledge, this is the first observation of microglial locomotion in vivo. A Morphological evidence of microglial activation starts with dendritic reorganization. Migrating cells were only of the dendritic type (i.e. not ameboid). There appears to be a notable heterogeneity in the locomotor response of MCs. MCs within and around scars remain highly motile and mobile several days after laser damage.
In vivo imaging of retinal inflammation in experimental autoimmune uveoretinitis
Authors: XU H
Published: September 2009

Purpose Experimental animal models are essential for us to understand the pathogenesis of human diseases. Posterior uveoretinitis can be modelled in mice with IRBP immunization (i.e. experimental autoimmune uveitis, EAU), whereas a number of mouse models are also available for age‐related macular degeneration (AMD). With the advancement in new technologies, it is now possible to image inflammatory retinal changes in experimental mice in vivo none invasively. The aim of the study is to clinical revisit the traditional retinal inflammation animal models with modern imaging techniques.

Methods EAU was induced in C57B/6 mice with IRBP peptide 1‐20. Aged CCL2 knockout mice were used as an AMD model. Retinal inflammatory changes were imaged in vivo non‐invasively using topical endoscopic fundus imaging system and the scanning laser ophthalmoscopy (SLO) system.

Results Inflammatory retinal changes in the early stages of EAU were characterised as retinal oedema, vascular sheathing, multiple small retinal infiltrates or large linear retinal infiltrates. “Snow‐ball”‐like vitreous infiltrates were observed in the inferior part of the fundus at the peak stage of EAU. Using SLO autofluorescent (AF)‐macrophages were detected at the peak stages of EAU and were located predominately around inflamed retinal venules. At the late stages of EAU, retinal scars and intraretinal neovascular membranes were observed. In the retina aged CCL2 KO mice, regional retinal atrophy and dursen‐like multiple lesions were observed. Dursen‐like changes were autofluorescent in SLO examination. Ex vivo confocal microscopy indicated that they were not dursen but subretinal lipofuscin‐loaded microglial cells.

Conclusion EAU mimics many aspects of human posterior uveoretinitis including retinal vasculitis, multifocal choroiditis. Late stage EAU could be a good model for inflammation induced retinal neovascularisation. CCL2 KO mouse is a model of dry‐AMD.
Relationship between frequency‐doubling perimetry indices and optic nerve head parameters measured with the Heidelberg retina tomograph 3
Authors: FERRERAS A , CALVO PEREZ P , PAJARIN AB , ABADIA B , FOGAGNOLO P , FIGUS M , PABLO LE
Published: September 2009

Purpose To determine the relationship between the indices of frequency‐doubling perimetry (FDT) and the optic disc parameters measured with the Heidelberg Retina Tomograph (HRT) 3 in glaucoma patients.

Methods 74 eyes of 74 glaucoma patients were prospective and consecutively selected. All of them had intraocular pressure higher than 21 mmHg, and reproducible glaucomatous visual field loss in standard automated perimetry. FDTs were performed with a Humphrey FDT perimeter using the C‐20‐5 full threshold strategy. Participants underwent imaging of the optic disc with the HRT3. The Kolmogorov Smirnov test was applied to check the data were normally distributed. Pearson correlations were calculated between FDT indices (mean deviation and pattern standard deviation) and global stereometric HRT3 parameters.

Results Mild to moderate significant correlations (p<0.05) were observed between the FDT indices and most HRT3 parameters. The strongest correlation was found between the mean deviation of FDT and FSM discriminant function of HRT3 (0.525). Pattern standard deviation had the strongest correlation with rim area (‐0.431).

Conclusion Optic nerve head parameters measured with HRT3 showed reasonable agreement with FDT indices in glaucoma patients.
Pathological alterations in Meibomian gland dysfunction as an important factor in ocular surface disease
Authors: BARABINO S
Published: September 2009

Purpose The purpose of this presentation is to synthesize a clinical description of Meibomian gland disease (MGD) diagnosis, classification, and treatments currently available and in development.

Methods The lipid content of Meibomian glands secretion varies with age and lid disease, and it contributes to the lipid component of the tear film by providing polar and nonpolar lipids. The lipids function as surfactant and barrier, provide structural support for the tear film, and are chiefly responsible for creating a smooth optical surface for the cornea. Meibomian gland disease (MGD) is one of the most common ocular disease characterized by an alteration of the lipids and therefore of all the ocular surface components, causing visual function changes and symptoms of discomfort.

Results The contribution of MGD to ocular surface disease includes contact‐lens associated MGD, Meibomian keratoconjunctivitis, evaporative dry eye. The relationship between MGD and ocular surface inflammation will be presented with the results of clinical studies published in the literature to treat the different forms of MGD.

Conclusion MGD is a common but often misdiagnosed disease of the ocular surface which should be treated according to specific protocols.
Individualised risk in AMD
Authors: MACKEY D
Published: September 2009

With the advent of direct to consumer DNA testing, several companies are offering testing to patients for genetic risk of AMD. This testing is provided with significant information about AMD and its genetics. However, patients and their families will ask their ophthalmologists about this and ophthalmologists will need to be aware of what is being provided.
An analysis of retinal nerve fiber layer with ImageJ program
Authors: KIM S , KIM H , SHON Y
Published: September 2009

Purpose So far retinal nerve fiber layer(RNFL)analysis in red‐free fundus photograph has been qualitative. The purpose of this study is to introduce the gray scale of imageJ program as quantitative tool for evaluation of RNFL in red‐free fundus photograph.

Methods Subjects were normal healthy 120 eyes of 120 patients aged 20‐50 years old. They were recruited from referred glaucoma suspected patients from March 2008 to December 2008 at Kim's eye hospital. Refractive error above 6.0Diopter, large peripapillary atrophy, previous other ocular disease subjects were excluded. Red‐free digital fundus photographs were taken by Kowa nonmyd7 funudus camera and Nikond70s digital camera by one experienced examiner with pupil dilatation. A circle was drawn around the optic disc nerve head(ONH)margin on Red‐free digital fundus photographs. The ONH divided into 12 clock‐hours's sectors. Sectors run clockwise in the right eye and counter clockwise in the ledt eye. The gray scales of RNFL adjacent to ONH were calculated by three observers.

Results The gray scale of observer1 were calculated from 78+/‐21.6 to 125+/‐15.2. The gray scales were lowest at 3o/c and highest at 11o/c. The gray scale of observer2 were calculated from 87.8+/‐20.7 to 128.6+/‐13.5.The gray scales were lowest at 3o/c and highest at 7o/c. The gray scale of observer3 were calculated from 86.7+/‐24.8 to 128.4+/‐16.4. The gray scales were lowest at 3o/c and highest at 11o/c. Interclass correlation coefficient was from 0.864 to 0.985.

Conclusion The gray scales of RNFL were high in superotemporal and inferotemporal area and low in nasal area. The gray scale of imageJ showed hith correlation between three observers. The gray scale of imageJ program can be objective tool for RNFL evaluation with red‐free fundus photograph.
Ocular blood flow autoregulation and the clinical implications of its alteration
Authors: GARHOFER G
Published: September 2009

Autoregulation is commonly defined as the ability of a vascular bed to adapt blood flow to changes in ocular perfusion pressure (pressure autoregulation) or to adapt to changes in metabolic need (metabolic autoregulation). Considering the high metabolic turnover of the eye, its intact function is strongly dependent on a stable blood supply, assured by an intact vascular autoregulation. However, it has been shown that in the recent years that several ocular diseases such as glaucoma, diabetic retinopathy or age related macula degeneration are associated with an impaired autoregulation. This vascular dysregulation may lead to an under‐ or overperfusion of the tissue and in turn to ischemia and/or oxidative stress. This talk seeks to summarize our current knowledge of autoregulation in the ocular vascular beds. Furthermore, the possible reasons of impaired autoregulation and how this may relate to ocular pathologies will be discussed.