bluuebunny/crossref_metadata_2025 huggingface dataset:
Employability as a capacity for agency in the workplace: The implications for higher education of a collective perspective on work
Authors: Kahn Peter , Lundgren‐Resenterra Mariangela
Published: January 2021

Graduate employability is now typically conceptualised in terms of the extent to which the capacities of individual students match the available employment opportunities. As a result, higher education is increasingly seen as an investment in a project of the self for economic reward. This theoretical study draws on critical realist perspectives to problematise existing understandings of employability. It explores a collective perspective on work, analysing the institutional, social and reflexive basis for agency in workplaces. This exploration supports a conceptualisation in which graduate employability is understood as the capacity of a graduate to act as an agent within the workplace in ways that contribute to the maintenance and elaboration of collectives. It is argued that were higher education to treat collectives as an integral aspect of learning, then workplaces could be aligned more directly towards values that matter to society.
The rise, demise and replacement of the Bangladesh experiment in transnational labour regulation
Authors: KANG Youbin
Published: January 2021

Five years after the collapse of the Rana Plaza building in 2013 – a disaster that killed 1,133 garment workers – the Accord on Fire and Building Safety in Bangladesh, a multi‐stakeholder programme designed to set labour standards for the garment industry, was terminated by Bangladesh's highest court. Widely hailed as a promising example of transnational regulation, the Accord was never successfully institutionalized locally. On the basis of archival and ethnographic work in Bangladesh, the author suggests that, although the Accord successfully upgraded factory safety standards, its failure to build widespread support among local employers, workers and the Government led to its termination and replacement.
Managing eye conditions in primary care: a survey
Authors: Rahimzadeh Mana
Published: January 2021

Purpose

Patients with acute ophthalmic symptoms often present first to their general practitioner (GP). It is therefore essential that GPs are confident in managing eye conditions by the end of their training programme.

Methods

The survey was designed and emailed to practices across the country. There were 32 responses (12 GP registrars, 11 GPs with 0–10 years experience and 9 GPs with more than 10 years experience).

Results

50% (n = 16) of the GPs report feeling ‘not very comfortable’ and 50% (n = 16) ‘quite comfortable’ in managing eye conditions. Furthermore, in response to the questions ‘how comfortable do you feel using an ophthalmoscope’ and ‘how comfortable do you feel ruling out optic disc oedema’, average scores were 4.9 and 3.8 out of ten, respectively. When asked how the training programme prepared them for managing eye conditions, 31% (n = 10) report ‘not well at all’. Commonly suggested improvements to the current training programme included more time in eye casualty or clinics and training days delivered by ophthalmologists.

Conclusions

There is evidence that patients with acute eye conditions are poorly assessed in primary care, leading to treatment delays and reported cases of permanent sight loss. This survey supports existing evidence that there is insufficient confidence amongst GPs in managing eye conditions. More training is clearly required as part of the general training programme.
The top ten research priorities for rare mitochondrial diseases: results of a patient/health professional priority setting partnership
Authors: Votruba Marcela , Butterworth Lyndsey , Feeney Catherine , Graves Tracey , Holmes Sarah , Hunter Amy , Lowndes Jo , Rahman Shamima , Sharpe Jenny , Thomas Rhys , Upadhaya Sheela , Weaver Lindsay , Wheeler Russell
Published: January 2021

Purpose

The primary mitochondrial disorders encompass a wide‐reaching number of clinical presentations and a spectrum of severity. It is therefore vital to know that research that is designed by academics and competitively funded, meets the core needs of people with mitochondrial disorders and their clinicians.

Methods

The Priority Setting Partnerships (PSPs) are an established and collaborative methodology that brings patients, charity representatives and clinicians together to try to establish the most pressing and unanswered research priorities. After a scoping exercise to identify relevant partners, we chose to include questions relevant to children and adults (many people have life‐long conditions) and limit our focus to the primary mitochondrial disorders. We developed a web‐based questionnaire disseminated widely asking for all patients, carers and clinicians to pose their important research questions.

Results

This yielded 709 questions from 50 patients, 47 carers and 50 clinicians. These were grouped in to themes and were filtered for statements that were personal stories, for example, and not answerable questions. A literature search was undertaken to ensure that each question was unanswered from current evidence. This process resulted in a list of 42 discrete, answerable questions.

Conclusions

All patients and clinicians again were invited to prioritise these 42 questions using a web‐platform and a rank of ‘important’ to ‘less important’ questions was created. This identified 24 questions that were taken forward for a face‐to‐face workshop attended by a diverse range of patients, carers, charity representatives and clinicians where the relative merits and strengths of each question were debated to create a definitive ‘top 10 of unanswered research questions for mitochondrial disorders’. At every stage, we have actively sought to be inclusive of people who do not have English as a first language and people with visual impairment.
Epithelial alternate exposure to air and liquid further improves human corneas stored in the active storage machine
Authors: Garcin Thibaud , He Zhiguo , Herbepin Pascal , Forest Fabien , Thuret Gilles , Gain Philippe
Published: January 2021

Purpose

The standard version of our corneal active storage machine (ASM) maintains corneas viability much better than standard organ culture over 1 and 3 months (Am J Transplant 2019, Transplantation 2020). While it aims at recreating a physiologic environment (IOP and medium renewal), corneas were nevertheless immersed from both sides, probably contributing to slightly higher thickness than in vivo.

Aim

To assess whether epithelial alternate exposure to air and liquid (AirLifting, AL) could further improve quality of corneas stored into the ASM.

Methods

Twenty paired human corneas (initial ECD > 2000 cells/mm2 and <10% difference between right and left) were randomized to be stored for 1 month in the ASM either fully immersed or with AL. All other parameters were similar: IOP (21 mmHg), endothelial medium flow (2.6 μL/min) and nature (CMax, Eurobio). AL was done with CMax (6 cycles air‐liquid/min). Specular microscopy ECD, OCT thickness, transparency were monitored at Day (D)2, D26, D28. Pancorneal viable ECD (Hoechst/Ethidium/Calcein‐AM), histology, immunostaining, western blot for epithelial cells and endothelial cells (ECs) structure/functions proteins were done at D28.

Results

At D2, ECD was 2412 ± 222 versus 2385 ± 251 cells/mm2 (p = 0.349) respectively with and without AL and 2109 ± 165 versus 2119 ± 199 cells/mm2 (p = 0.621) at D26. The viable ECD at D28 was 2170 ± 321 versus 2185 ± 275cells/mm2 (p = 0.794). All corneas remained thin transparent during storage and at D28 only, corneas were thinner with AL: 667 ± 60μm versus 695 ± 55μm without (p = 0.048). Epithelial quality was similar, but the epithelium was thicker with AL (49 ± 20) than without (23 ± 7μm) (p = 0.001) and had more cell layers. Endothelial cells structure/functions were similar.

Conclusions

By mimicking blinking, AL enhances epithelium structure during storage into the ASM. It may also slightly help controlling corneal thickness. ASM with AL may be useful for penetrating and anterior keratoplasty as well as for research works.
Systematic review on the current state of simulation training in glaucoma surgery
Authors: Naveed Hasan , Scantling‐Birch Yarrow , Bin Lee Han , Lindfield Dan
Published: January 2021

Purpose

Simulation provides a realistic environment to learn technical and non‐technical skills for surgical trainees, without compromising patient safety. Glaucoma surgery is intricate and complex, demanding the highest order of manual dexterity and skill. Mastering the array of glaucoma procedures takes time and practice. High‐fidelity simulation offers a solution to learn this effectively in an artificial environment before operating on patients. The purpose of this study was to summarise the literature and identify simulation training models available to learn glaucoma surgery.

Methods

PubMed, Embase, Medline and Cochrane Library were systematically searched using keywords and MeSH terms: simulation, training, education, learning, glaucoma surgery, filtering surgery, shunting surgery and MIGS. The search yielded 148 articles, these were filtered by abstract and/or title by two independent reviewers.

Results

A total of 6 articles published in English with full text available were identified. All studies used high‐fidelity simulators, a trainee cohort and tested technical skills. No study examined non‐technical skills. Three studies described wet‐lab simulators for MIGS and three studies described a mix of wet and dry‐lab simulators for trabeculectomy surgery. Three studies used human cadaveric eyes, two studies adopted pig eyes and one study employed fruit. Only one study used a validated instrument in assessing technical skills of trainees.

Conclusions

Simulation provides an immersive scenario for both trainees and seniors to practice procedural techniques that increase expertise, reduce cognitive load and improve patient safety. There is a limited number of models for simulation training in glaucoma surgery, impeding the ability of trainees to learn evolving surgical techniques. Further work is required in producing high‐fidelity, but cost‐effective simulators in glaucoma surgery to train technical and non‐technical skills.
Ocular surface heat flux density in healthy subjects
Authors: Anatychuk Lukyan , Pasyechnikova Nataliya , Naumenko Volodimir , Kobylianskyi Roman , Zadorozhnyy Oleg
Published: January 2021

Purpose

To investigate the heat flux (HF) density from the ocular surface in healthy individuals.

Methods

This pilot study included 32 healthy individuals (64 eyes). Participants were divided into three age groups. They underwent a bilateral eye examination which included measurements of intraocular pressure, temperature of the external corneal surface, rheoophthalmography (ROG), and heat flux density from the eye. The thermoelectric device for the measurement of HF density from the eye has been developed.

Results

Mean room temperature during examination sessions was 21.3 ± 0.8°C. In addition, mean temperature of the external ocular surface and mean HF density from the human eye were 34.6 ± 0.7°C and 7.7 ± 1.3 mW/cm2, respectively. We found that the HF density from the eye decreased with age in healthy subjects. HF density from the eye was positively correlated with the ocular blood volume coefficient as assessed by ROG.

Conclusions

Thermoelectric device for real‐time measuring of the HF density from the human eye was developed. The developed device was used to show the relationships of the HF density from the ocular surface with the temperature of the external ocular surface, ocular blood flow and subject age.
Oxygen demand in glaucoma patients: influence of age, vascular dysregulation and oxidative stress
Authors: Türksever Cengiz , Todorova Margarita G.
Published: January 2021

Purpose

To evaluate the relationship between vascular dysregulation and retinal oxygen consumption in glaucoma patients.

Methods

Retinal vessel oxygen saturation was measured in 46 eyes of 34 Caucasian individuals with primary open‐angle glaucoma and in 21 eyes of 17 age‐matched controls using the oximetry tool of Retinal Vessel Analyser (RVA: IMEDOS Systems UG, Jena, Germany). The mean oxygen saturation of the major arterioles (A‐SO2) and venules (V‐SO2), as well as the corresponding A‐V SO2 difference, were calculated. Within glaucoma patients, retinal vascular responsiveness to flicker light (RVA) was measured, as well. Glaucoma patients were grouped according to their median arteriolar and venular vascular responsiveness, as well as to their median age (68y) and gender. In addition, we calculated the mean retinal oxygen consumption (O2‐C) per micron of nerve fibre layer thickness, O2‐C [%/µm] by dividing the mean AV SO2 with the mean RNFL thickness.

Results

In glaucoma patients, A‐SO2 and V‐SO2 were significantly increased and their difference decreased, when compared to controls (p = 0.017; linear mixed‐effects model). Whereas V‐SO2 (p = 0.697) and A‐V SO2 (p = 0.674) were not influenced by age, A‐SO2 was severely reduced (94.70 ± 4.01%) and the O2‐C significantly increased (0.50%/µ; ±0.08) in elderly glaucoma patients, than in younger glaucoma patients (98.17 ± 2.8% (p = 0.007), correspondingly 0.43 ± 0.04%/µm (p = 0.004)). Patients with reduced venular vascular responses (≤2.90%) had significantly higher O2‐C (0.49 ± 0.08%/µm, respectively 0.43 ± 0.06%/µ; p = 0.027). Higher O2‐C in glaucoma patients correlated negatively with the neuroretinal rim area (p < 0.001) and with the RNFL thickness (p = 0.017), and positively with the mean defect of the visual field (p = 0.011).

Conclusions

Reduced venular vascular responsiveness and increased age in glaucoma were associated with increased O2‐C, whereas the mean SO2 values were not related to age‐ and flicker responses. Thus, ganglion cells axons in glaucomatous eyes with vascular dysregulation are prone to consume more O2 (O2‐C [%/µm]), than eyes with normal flicker responsiveness. Furthermore, the increase in oxidative stress seems to contribute to progression of glaucomatous damage.
New stroboscopic system improves accuracy of deformation measurement of crystallin lens submitted to high rotational speed
Authors: Papillon Jean‐Marie , Youssof David , Poinard Sylvain , Ben Moussa Olfa , Maurer Aurélien , Enfrun David , Thuret Gilles , Gain Philippe
Published: January 2021

Purpose

Lens elasticity can be calculated from the deformation observed when it is submitted to different rotational speed in a specific device called lens spinner. Up to now, the accuracy of this technique is limited by dynamic blur due to small movements of the lens during rotation and requires expensive high‐speed cameras and intense light sources that can be harmful to the lens. Aim: to assess whether a stroboscopic system could overcome this limit.

Methods

The critical parameter was the synchronization of the light source with the position of the lens on the rotative plate. We thus designed a digital control system combined with a stepper motor that allowed reaching more than 2000 rpm while maintaining an angular accuracy of 0.2 degrees with respect to position of the illumination source. This allowed obtaining sharp 8‐megapixel images with a standard commercially available camera. We analyzed fresh lenses from 6‐month‐ and 3‐year‐old pigs and lenses from human donors (specific retrieval authorization for scientific purpose during corneal donation, from the Agence de la Biomédecine).

Results

Lens imaging was obtained by overlaying images of several short flashes: images referenced by their angular position allowed a 360‐degree reconstruction of the geometry of the lens (one image every 45 degrees). The light flux remained moderate with 10 flashes of 100 microseconds with a 20W white LED source. The maximal rotational speed for imaging was 2000 rpm allowing a wide range of investigation as the limit of the resistance of the porcine lens capsule was observed at much higher speeds.

Conclusions

Compared to pre‐existing lens spinner systems designed to essentially maintain a stable rotational speed, the fine angular position control combined with the stroboscopic lighting lens spinner strongly improves the reading of the lens’ geometry by an order of magnitude of 10 and will be a very useful device for research in lens biomechanics.
Development and characterization of a mechanical compression device for quantifying the elasticity of the porcine and human crystalline lens
Authors: Papillon Jean‐Marie , Youssof David , Poinard Sylvain , Ben Moussa Olfa , Maurer Aurélien , Enfrun David , Thuret Gilles , Gain Philippe
Published: January 2021

Purpose

We present the development and characterization of an electromechanical device that quantifies the elasticity of the crystalline lens ex vivo by measuring its reaction force when it is compressed by a rod moved step by step. Our specifications required a robust system, fast to allow serial analysis, capable of measurements on an immersed lens, and highly resolved to detect small changes in elasticity.

Methods

A first simple manual device was constructed to dimension the measuring system. The lenses (human and porcine) immersed in a buffer solution were placed on a precision weighing balance and compressed from top to bottom by a rod mounted on a micrometer screw. This system made it possible to define, among other things, the resolution of the balance (1 mg, 0.01 milli‐Newton). In a second device, the rod system was motorized with a resolution of 0.625 µm pitch in order to automate the measurement, and the balance data were integrated in real time into software executable on a desktop computer. A control camera (30 µm/pixel) was added to facilitate the approach of the rod in contact with the lens and to document the deformation experienced.

Results

The built‐in calibration of the balance allows direct measurement in Newton. The device allowed determining the very homogeneous behavior of the lens (elastic reaction versus displacement) as well as the breaking point of the capsule which is much higher than the elastic deformation (at about 100 times the weight of the lens). Automation also allows the measurement of lens relaxation times during pulsed stimulation, for example by compression/decompression of 1 mm on a porcine lens.

Conclusions

With a measured effective fidelity of 5 µm and 0.01 mN, this direct compression system allows the mechanical elastrometry of the lens. The measurement of a large series of human and porcine lenses of different ages is in progress to determine its accuracy and repeatability. It will be useful for any research on lens biomechanics.
Deswelling kinetics in CorneaJet of organ cultured human corneas
Authors: Peyret Benjamin , Crouzet Emmanuel , Poinard Sylvain , Garcin Thibaud , Perrache Chantal , Ninotta Sandrine , Gain Philippe , Thuret Gilles
Published: January 2021

Purpose

The deswelling of a corneal graft at the end of storage in the eye bank is essential before perforating or deep anterior lamellar keratoplasty to allow good donor/recipient congruence and to accelerate visual recovery. In France, CorneaJet (Eurobio, France) containing 5% Dextran T500 is the most commonly used medium, but its deswelling kinetics is not referenced and the duration of 48 or 72 hr is chosen purely by habit while the increase in endothelial toxicity over time is documented.

Aim

To determine the corneal deswelling kinetics in CorneaJet.

Methods

12 corneas discarded by our eye bank were used. They had an endothelial cell density at reception (day 2 to day 4) of 1713 ± 389 cell/mm2 (mean ± SD). All had been stored in organoculture in CorneaMax medium at 31°C for at least 1 week. The corneas were immersed in 50 ml vials of CorneaJet (same batch) and were stored at 31°C. Central corneal thickness (CCT in µm) and central corneal volume (on an 8mm disc, CCV8 in mm3) were measured by optical coherence tomography (OCT, Casia I, Tomey, Japan). Transparency was evaluated on a prototype measuring contrast transmission (relative scale in %). Measurements were performed before immersion in CorneaJet and repeated at hour (H)3, H6, H9, H12, H18, H24, H30, H36 and H48.

Results

All data were expressed as mean ± SD respectively at the different times. CCT: 1284 ± 249; 1031 ± 233; 897 ± 22; 773 ± 160; 741 ± 123; 673 ± 75; 626 ± 27; 638 ± 41; 645 ± 49; 652 ± 55. CCV8: 73 ± 9; 61 ± 9; 53 ± 9; 47 ± 8; 44 ± 6; 40 ± 4; 38 ± 3; 37 ± 3; 37 ± 3 and 37 ± 3. Transparency: 13 ± 4; 19 ± 5; 24 ± 6; 29 ± 6; 33 ± 7; 40 ± 7 41 ± 7; 44 ± 9; 45 ± 8 and 44 ± 11.

Conclusions

Corneal deswelling in CorneaJet is rapid during the first 12 hr and reaches a plateau at 20 hr. After 20 hr, transparency and thickness are ideal for surgery.
Objective assessment with LACRYDIAG of the efficacy of polychromatic intense pulsed light LACRYSTIM for the treatment of meibomian gland dysfunction after a 6‐month follow‐up
Authors: Caroline Trone Marie , Caroline Ronin , Lise Lanfant , Collomb Nicolas Perrillat , Thibault Garcin , Gilles Thuret , Philippe Gain
Published: January 2021

Purpose

Meibomian gland dysfunction (MGD) is the most common etiology of dry eye disease (DED) worldwide. Polychromatic Intense Pulsed Light (IPL) is a recent and promising therapy for DED treatment aiming at improving the quality of the tear film. The LACRYSTIM (Quantel Medical, Clermont‐Ferrand, France) is a new IPL device. The LACRYDIAG (Quantel Medical) is another device useful in clinical practice but also in clinical research as it allows an objective assessment of the ocular surface before and after treatment.

Aim

To objectively assess with LACRYSTIM the efficacy of IPL therapy by LACRYSTIM in MGD.

Methods

Design retrospective and observational study with a 6‐month follow‐up. Patients presenting a dry eye disease (DED) with stable mild to moderate MGD and having received LACRYSTIM treatment between June 2019 and February 2020, were included. The treatment consisted of 3 sessions of IPL at Day (D) 0, D15 and D45, patients received 4 pulses applied just below each lower eyelid at a fluence of 8 mJ/cm2. Clinical evaluation of the DED at D0, D15, D45, month (M)3 and M6: Oxford scale and break‐up time, Schirmer's test and Ocular Surface Disease Index (OSDI) questionnaire. LACRYDIAG examination: interferometry, meibography, tear meniscus height and non‐invasive break up time (NIBUT). The primary endpoint was the evolution in NIBUT between the first visit (D0) and 3 months (M3). A mixed‐effect linear regression was used for the statistical analysis.

Results

The medical record of 50 consecutive patients was examined. There was a significant difference in NIBUT values between D0 and M3 (Δ = 2.3 seconds, 95% CI (0.7‐3.9) p < 0.05). Significant results were also founded on oxford scale and OSDI. There was no significant change on other measured criteria. No adverse event was reported.

Conclusions

IPL therapy with LACRYSTIM appears to be effective and safe to treat MGD.
Light‐Field imaging of the human optic nerve head at different wavelengths—a case study
Authors: Schramm Stefan , Dietzel Alexander , Blum Maren‐Christina , Link Dietmar , Klee Sascha
Published: January 2021

Purpose

One strong risk factor for glaucoma is a suspicious optic nerve head appearance with an abnormal cupping or an increase in the cup‐to‐disc ratio. To measure such geometric characteristics, typically scanning systems like OCT or SLO are used. We present that one‐shot 3D retinal imaging and measuring with a commercial fundus camera using an industrial light‐field camera is possible and works best in the green spectrum.

Methods

To demonstrate 3D imaging at the human optic nerve head (ONH), we examined one eye with suspected glaucoma (patient:37 years, male). ONH centered 30° images of the right eye were taken after pupil dilatation with Tropicamid with a Zeiss FF450 fundus camera (Carl Zeiss Meditec AG, Germany), to which an industrial light‐field camera (Raytrix GmbH, Germany) was attached. The images were taken at 450 nm, 520 nm, 600 nm and 650 nm centroid wavelengths, 40 nm bandwidth each. The maximum depth of the papilla was determined in virtual depth (VD) using the Raytrix software (RxLive, Raytrix GmbH, Germany). The results were compared among each other concerning the vessel contrast, quantity of measurement points and subjectively where they were found.

Results

The light‐field images showed clearly the ONH in 3D. The highest image contrast was found at 450 nm, whereby the contrast decreases with increasing illumination wavelengths. Most measurement points around the papilla were found at 520 nm followed by 450 nm with a slightly lower number. At 600 nm, the number of measurement points was significantly reduced. Worst results were found at 650 nm. Plausible measurement points were only found in image regions with high contrast. Those regions were vessel borders and the papilla border.

Conclusions

Using the light‐field technique in fundus photography, it is possible to image and to measure the ONH in 3D. Screening for glaucoma and glaucoma diagnosis can be much improved taking into account that, in principle, classical fundus imaging offer only 2D data.
Topical Insulin—A possible treatment in Refractory Neurotrophic Keratopathy—Quasi‐Experimental Study
Authors: Machado Soares Ricardo , Arêde Carlos , Braga Joana , Da Silva Fernandes Joana , Ferreira Catarina , Sequeira Joaquim
Published: January 2021

Purpose

To evaluate the clinical progression of patients with refractory Neurotrophic Keratopathy (NK) treated with topical insulin eye drops and its efficacy in treating NK in stages 2 and 3.

Methods

Quasi‐Experimental, randomized study, from October 2018 to December 2019, of 10 patients (11 eyes—13 to 92 years) with NK in stages 2 and 3. Patients included were refractory to standard medical and/or surgical treatment. Drops were applied 3‐4 times a day and a bandage contact lens was applied. Close follow‐up of patients was assured (daily in week one and weekly thereafter) and anterior segment photos were taken on each visit. Insulin eye drops were continued until the NK persistent epithelial defect or ulcer resolved. Treatment would be discontinued if the condition did not improve or worsened.

Results

Ten out of eleven eyes had complete resolution of the NK persistent epithelial defect and/or ulcer within 12‐45 days of follow‐up. One of the patients’ epithelial defect improved significantly although the wound did not fully heal within 42 days of treatment. No side‐effects were reported during the full extent of the treatment.

Conclusions

Although we recognize some limitations to our study (uncontrolled series of patients), our results suggest that topical insulin drops could be an effective treatment in refractory NK. Furthermore, this therapy may prove extremely useful due to its low cost and high accessibility. However, more studies are needed to evaluate the efficacy, posology, duration and side‐effects of this treatment.
Presenting features, management, and long‐term visual outcome of nanophthalmos patients in King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Authors: Almazyad Enmar , Malik Rizwan , Khabir Ahmad Syed , Aljadaan Ibrahim
Published: January 2021

Purpose

The purpose of this study was to describe the presenting features of patients with nanophthalmos who presented to King Khaled Eye Specialist tertiary Hospital and their subsequent management.

Methods

We conducted a retrospective case series of nanophthalmos patients who presented to our institute from 1984 to 2019. Baseline features, including presenting symptoms, best‐corrected visual acuity (BCVA), intraocular pressure (IOP), associated clinical features, axial length, and refraction, were documented. Complications from the condition itself and as a result of surgery were also documented. The main outcome measures were the number of eyes that deteriorated by two lines or more and IOP at final follow‐up.

Results

In total, there were 19 patients with bilateral nanophthalmos (38 eyes), 8 were males (42%), and 11 were females (57.9%), with a mean age of 38.8 ± 16 years (range 8‐61 years). The mean follow‐up was 10 ± 16 years (range 1–32 years). The mean ± SD IOP at presentation was 20.3 ± 7.4 mmHg (range 10–45 mmHg). Fourteen eyes had BCVA 20/20‐20/100 (36.8%), 12 had BCVA 20/125‐20/400 (31.5%), and 12 eyes had BCVA of worse than 20/400 (31.5%). The mean axial length was 16.5 ± 1.6 mm (range 14.1–20.0 mm). Over the course of follow‐up, 14 eyes had deteriorated by two or more lines (36.8%), while the majority (24 eyes) remained the same or improved (63.2%). Final IOP was within the normal range (5‐21 mmHg) in 29 eyes (76.3%), while nine eyes had IOP more than 21 mmHg (23.7%).

Conclusions

More than a third (36.8%) of eyes lost two or more lines of visual acuity by the last follow‐up, with a quarter of eyes having IOP >21 mmHg. The present study represents the largest study with long‐term follow‐up and end visual outcome of patients with nanophthalmos in Saudi Arabia.
Epidemiological analysis of choroidal melanoma: a population‐based analysis, 2000‐2017
Authors: Mikhael Sandra , Tadrosse Abanoob , Yassa Arsany , Mikhael Mina , Eloy Jean‐Anderson
Published: January 2021

Purpose

Uveal melanoma is the most common adult ocular malignancy, and the choroid is the most common location where it presents. In this study, we perform an epidemiological analysis of uveal melanomas arising from the choroid.

Methods

A retrospective, population‐based analysis was performed using patient data extracted from the Surveillance, Epidemiology, and End Results Registry US database from 2000 to 2017. Incidence (IR) was calculated in number of cases/million/year. Disease‐specific survival (DSS) was calculated using the Kaplan–Meier method.

Results

7122 cases of choroidal melanoma (CM) were identified, of whom 52.2% were males and 96.5% were white. The overall IR was 4.5. IR during 2000–2008 (4.37) was significantly lower than that during 2009‐2017 (4.63) [p = 0.017]. The annual percent change in IR during 2000–2017 was 2.04 (p < 0.001). IR in males (5.1) was significantly higher than that in females (4.0) [p < 0.001]. White patients displayed significantly higher IR (5.5) than black (0.4; p < 0.001) and Asian/Pacific Islander (0.6; p < 0.001) patients. IR in patients older than 65 years old (y/o) [17.4] was statistically higher than that in those 22‐64 y/o (4.1; p < 0.001) and those younger than 21 y/o (0.1; p < 0.001). Right and left laterality did not impact IR (p = 0.620). 90.5% of patients presented with a localized malignancy while 7.9% and 1.6% showed regional and distal spread, respectively. 5‐year DSS during 2000–2012 was 82.0%. Race and sex did not affect survival. 5‐year DSS was significantly higher during 2010‐2012 (83.3%) than during 2000‐2002 (75.9%; p < 0.001).

Conclusions

Incidence of choroidal melanoma is highest in the male, white and elderly populations. Incidence is increasing over the study’s timeframe. Most cases of CM are diagnosed at a localized stage. Overall 5‐year DSS for CM is 82.0% and has shown a substantial improvement comparing the two tail‐ends of the study. Race and sex do not affect survival.

Bibliography

Surveillance Research Program, National Cancer Institute SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.6.
Trabeculectomy with mitomycin C alone or with mitomycin C plus intracameral bevacizumab—A comparative study
Authors: José Patrícia , Teixeira Filipa , Sousa David , Esteves Marques Raquel , Diogo Barata André , Marques‐Neves Carlos , Pedro Silva José , Abegão Pinto Luis
Published: January 2021

Purpose

To compare the long‐term outcomes of trabeculectomy using mitomycin C (MMC) alone versus MMC plus intracameral bevacizumab.

Methods

Retrospective, comparative study (#ISRCTN93098069). Patients’ charts from two centers were reviewed for data between October 2015 and March 2019. Minimum follow‐up of 12 months was required. The main efficacy outcome was intraocular pressure (IOP) lowering at 12 and 24 months, with surgical success defined as IOP ≤18 mmHg and >5 mmHg with at least 30% reduction from baseline. Absolute success was achieved if no IOP‐lowering medication was needed and a qualified success considered otherwise. Safety outcomes were also analyzed.

Results

A total of 111eyes underwent trabeculectomy with MMC, 52 of them combined with intracameral bevacizumab. 78% were followed for at least two years. Baseline IOP was 24.5 ± 8.9 mmHg and 23.8 ± 8.3 mmHg for the MMC and the MMC+bevacizumab groups, respectively (p = 0.97). During the early post‐operative period (at 3 months), mean IOP was lower in the MMC+bevacizumab group (9.3 ± 2.3 mmHg versus 11.1 ± 5.5 mmHg, p = 0.03). At 24‐month visit, IOP was significantly reduced (MMC group: 10.6 ± 3.4 mmHg; MMC+bevacizumab group: 10.9 ± 4.1 mmHg, p < 0.01) with no difference between groups (p = 0.61). Absolute success was higher in the MMC+bevacizumab group at 12 months (86% versus 75%, p = 0.16) and at 24 months (83% versus 67%, p = 0.14), with the need for IOP‐lowering re‐interventions (needlings) being lower in this group (2% versus 17%, p = 0.01). Almost all patients (98%) of the MMC+bevacizumab group were drop‐free at 12 months and nearly half (44%) had an IOP in the single‐digit range (≤ 9 mmHg) at 24 months. Complication rates were low and similar between groups, with no systemic adverse events.

Conclusions

Adding perioperative intracameral bevacizumab to the standard of care use of MMC in trabeculectomy seems to allow for sustained low IOP outcomes. Furthermore, it seems to decrease the need for additional interventions during the early post‐operative period.
Μicrovascular foveal changes determined by optical coherence angiography following vitrectomy for idiopathic epiretinal membrane
Authors: Parikakis Efstratios , Kontomichos Loukas , Batsos Georgios , Christodoulou Eleni , Chatzirallis Alexandros , Peponis Vasileios , Karagiannis Dimitrios
Published: January 2021

Purpose

To present microvascular changes in fovea following pars plana vitrectomy for idiopathic epiretinal membrane (ERM). Optical coherence tomography angiography (OCTA) was performed preoperatively and postoperatively.

Methods

Eleven patients diagnosed with idiopathic epiretinal membrane were enrolled in the study. OCTA was conducted before and 6 months after internal limiting membrane (ILM) peeling and pars plana vitrectomy performed by the same vitreoretinal surgeon. Foveal avascular zone (FAZ) and foveal vessel density (VD) in superficial capillary plexus were estimated by OCTA preoperatively and 6 months postoperatively. Contralateral healthy eye of the same patient served as controls.

Results

Superficial FAZ preoperatively was significantly smaller in eyes with ERM compared to that of healthy eyes. Six months postoperatively, a significant increase in FAZ was observed, without reaching the levels of the FAZ of fellow healthy eyes. Foveal VD was significantly increased in eyes with ERM, whereas 6 months postoperatively a decrease of VD was observed. Greater differences in FAZ between the eye with ERM and the healthy control eye of the same patient as well as smaller FAZ were associated with worse best‐corrected visual acuity (BCVA) postoperatively.

Conclusions

OCT angiography has been proven recently a noninvasive and useful tool for many foveal vascular lesions. In our case series, it showed foveal microvascular and morphological changes following surgical repair of epiretinal membrane with ILM peeling. There seems to be a significant association between these microvascular changes and visual prognosis.
Evaluation of ocular surface disease in elderly patients with glaucoma: expression of matrix metalloproteinase‐9 in tears
Authors: Lim Suho
Published: January 2021

Purpose

To evaluate the symptoms and signs of ocular surface disease (OSD) and tear film matrix metalloproteinase‐9 (MMP‐9) overexpression using point‐of‐care testing (InflammaDry test) in patients with primary open‐angle glaucoma (POAG).

Methods

This prospective, case‐control study included sixty‐seven patients diagnosed with POAG and forty‐seven healthy control subjects. The OSD assessment included Schirmer‐I test, the Oxford corneal stain scale, tear breakup time (TBUT), and the 5‐Item Dry Eye Questionnaire (DEQ‐5). Measurement of extracellular MMP‐9 was performed using the InflammaDry test. The OSD parameters and MMP‐9 expression levels were compared between the POAG and control groups. Additional subgroup analysis in the POAG group was performed according to the number of topical glaucoma medications (1, 2, or 3 bottles).

Results

There were significant differences between the control and POAG groups for all OSD parameters. MMP‐9 overexpression was observed in 71.6% of POAG group, whereas only 31.9% of control group showed MMP‐9 overexpression. The subgroup analysis revealed that DEQ‐5, Oxford stain score, Schirmer‐I, and MMP‐9 overexpression demonstrated no significant difference among the three groups. Abnormal TBUT (≤ 5sec) was observed in 37.5%, 59.1%, and 76.2% of each subgroup according to number of medications (1, 2, and 3), and strong MMP‐9 overexpression was detected in 25.0%, 40.9%, and 61.9%, respectively (p = 0.032, p = 0.043).

Conclusions

The use of preservative‐containing medications may affect the ocular surface in patients with POAG. Graded measurement of tear‐film MMP‐9 could provide more information on OSD and might be a more useful marker for inflammation than conventional results obtained using an MMP‐9 kit.
Combined cilioretinal artery and vein occlusion and glaucoma: genetics in two siblings
Authors: Ventura Abreu Nestor , Alforja Castiella Socorro , Pazos Marta , Carreras Castañer Xavier , Milla Elena
Published: January 2021

Purpose

Here we present two siblings with combined cilioretinal artery and vein occlusion (CLARVO), with genetic confirmation of glaucoma as the underlying etiology and discovering of two novel variants of CARD10 and OLFM2.

Methods

Ancillary tests were performed to rule out other etiologies, and genetic tests using next generation sequencing (NGS) were performed in the two siblings. An extensive literature research was performed of similar cases of CLARVO and glaucoma, as well as the genetics (NCBI Genes Database) found in our patients.

Results

In April 2016, a 39‐years‐old man and a 45‐year‐old woman came to the Emergency Room referring visual loss on their right eye, also both with an onset of the symptoms differing only two weeks. They denied any abnormalities, recent travels or drugs abuse. On the examination, both presented CLARVO in the right eye, a more severe condition in the female patient along with lower visual acuity. Both patients showed a pigmentary dispersion glaucoma with a higher cup‐to‐disc ratio in their right eye. IOP was controlled with medical treatment, and in the female peripheral iridotomies and selective trabeculoplasty were also needed. A genetic analysis with NGS showed variants of CARD10 (pThr436Met) in both siblings, and in OLFM2 (p.ARg460=) in the female. These genes have been related to a higher risk of increased IOP (CARD10) and normal development of the structures of the eye (OLFM2). Also, OLFM2 has been recently linked to vascular smooth muscle cells regulation.

Conclusions

CLARVO is a rare entity. As in other vascular retinal diseases, like in retinal vein occlusion, even in younger patients, classic predisposing factors like glaucoma should be considered. When available, genetic tests should be performed, especially in presumed familiar association. The combination of the genetic variants in our patients could be related to both a higher predisposition of high‐pressure glaucoma, along with an increased susceptibility of the retinal vasculature; however, further research is needed to confirm this association between CLARVO and glaucoma.
Inflammation‐related MiRNAs are associated with Monosomy 3 in Uveal Melanoma
Authors: Souri Zahra , Jochemsen Aart G. , Verdijk Robert , van der Velden Pieter A. , Luyten Gregorius , Jager Martine
Published: January 2021

Purpose

Inflammation is a bad prognostic sign in Uveal Melanoma (UM), but it is as yet unclear how it is regulated. We set out to investigate the relation between microRNA’s and inflammation in UM and their potential regulation by chromosome 3 and 8.

Methods

The expression of 125 microRNA’s was determined using an Illumina HT12V4 array in 64 primary UM. Similarly, the mRNA expression of HLA‐A, HLA‐B and markers of tumor‐infiltrating lymphocytes (TIL) such as CD3E, CD4, CD8, and tumor‐associated macrophages (TAM), such as CD68 and CD163, was obtained from the array.

Results

When looking at all 64 UM tumors, expression levels of seven of the 125 miRNA’s that were analysed correlated with the presence of tumor‐infiltrating lymphocytes (TIL), tumor‐associated macrophages (TAM) and HLA Class I expression. Increased levels of miRNA 22 and 155 were associated with increased HLA expression and high numbers of TIL and TAM, while expression of miRNAs 7, 98, 125, 302 and 599 was associated with less infiltrate and a lower HLA expression. MiRNAs 22 (p ≤ 0.001) and 155 (p = 0.005) were upregulated in monosomy 3 tumors and expression of miRNAs 7 (p = 0.35), 98 (p = 0.26), 125 (p = 0.91) and 599 (p = 0.80) was not related to monosomy 3, while miR‐302 (p = 0.02) was slightly higher in D3 tumors. MiR‐22 was positively associated to chromosome 8q gain (p = 0.01) but miRNA’s 7 (p = 0.004), 98 (p = 0.002), 125 (p = 0.005), 302 (p = 0.02), and 599 (p ≤ 0.001) were all decreased in tumours with 8q gain.

Conclusions

We identified a set of microRNA’s associated with inflammatory markers (HLA Class I, TIL’s and TAM’s) in UM. The microRNA’s that are positively associated with inflammation are highly expressed in tumors with one copy of chromosome 3 and 8q gain while this is the opposite for microRNA’s negatively associated with inflammation. We propose a regulatory role for chromosome 3 and 8q abnormality in the control of inflammation‐related microRNA’s and suggest a potential involvement of these microRNA’s in the development of inflammation in UM.
Proteomic analysis of tear film composition in diabetic dogs
Authors: Winiarczyk Dagmara , Winiarczyk Mateusz , Winiarczyk Stanisław , Adaszek Łukasz , Michalak Katarzyna
Published: January 2021

Purpose

Diabetes mellitus is becoming an increasing concern in veterinary practice and research. Not treated, it can lead to serious systemic complications and even animal death. The most common form of diabetes in dogs resembles type 1 diabetes in humans. Tear film is easily accessible fluid that can be collected during routine veterinary visit. Based on research conducted in humans, we propose that diabetes can reflect on tear film proteomic composition.

Methods

The study was conducted on 49 dogs. Enrollment was restricted to clinically stable diabetic dogs. Nineteen healthy age‐ and sex‐matched dogs were included as a control group. Tear film was collected with Schirmer strips from the diabetes and sex‐ and age‐matched control group. Two‐dimensional electrophoresis was performed followed by MALDI‐TOF mass spectrometry identification of differential proteins. Quantitative analysis of the differentiating electrophoretic spots was done with 2Delta software. Metabolic pathways associated with those proteins were identified with Panther GO software.

Results

Nine out of a total 489 proteins detected on all of the gels were identified as significantly differentially expressed (p ≤ 0.05) in tear film samples collected from diabetic patients. Eight of the nine proteins were assigned to downregulated, namely Phosphatydylinositol‐4 kinase, Pro‐melanin concentrating hormone, Flotillin‐1, Protein mono‐adp ribosyltransferase, ATP‐dependent RNA helicase, GRIP and coiled coil domain containing protein 2, Tetratricopeptide repeat protein 36, Myosin light chain 6B and Prelamin A/C. One of the nine proteins (SRC kinase signalling inhibitor 1) was assigned to upregulated.

Conclusions

Tear film obtained from dogs with diabetes differs from the healthy controls. Those findings correspond with research conducted in humans, and can add value to our understanding about the course of the disease in dogs. Also, dogs serve well as an animal model of various human diseases.
A rare cause of ophtalmoplegia: about a case
Authors: Abdi Rhizlane , Siham Chariba , Maadan Asmae , Sekhsoukh Rachid
Published: January 2021

Purpose

Wernicke's encephalopathy (WE) is an acute neurological disorder induced by a thiamine (vitamin b1) deficiency, secondary to undernutrition or malabsorption. It is a rare but serious complication requiring urgent treatment. Characterized by: mental confusion, ophthalmoplegia and ataxia. In the absence of treatment, the progression is towards Korsakov syndrome where the lesions become irreversible. The objective of our work is to alert clinicians to the seriousness of this pathology, which in our case, the revelation was ophthalmological.

Methods

We report the case of a patient who consults in ophthalmological emergencies for bilateral ophthalmoplegia sudden installation and whose etiological diagnosis was in favor of Wernicke encephalitis

Results

Fifty‐year‐old patient who presented to the ophthalmic emergency department for reduced visual acuity with eye pain. The general examination finds a patient confused, disoriented in time and space with an unbalanced gait.

The ophthalmological examination finds:

ODG total ophthalmoplegia

Lazy direct and consensual photomotor reflex.

Bilateral stage I papillary edema.The rest of the ophthalmological examination is unremarkable.

An MRI was requested which objectified a hyper signal of the thalamus in flair and T2 sequence. In front of this clinical and radiological picture, the diagnosis of gayet Wernicke's encephalitis was evoked and confirmed by the dosage of vitamin B1 which was lowered. She benefited from an injectable vitamin B1 treatment at a dose of 400 mg/day as soon as the diagnosis was suspected, followed by an oral relay (250 mg, twice a day). The evolution was favorable with improvement of consciousness after the 5th day, regression of visual disturbances and resumption of walking. The 6‐month follow‐up showed a normal fundus and a normal brain MRI.

Conclusions

Gayet Wernicke's encephalitis is a rare condition, which remains under diagnosed to this day. It is a diagnostic emergency requiring early treatment to prevent complications.