bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental principles and indications of internal limiting membrane peeling
Authors: CREUZOT CP
Published: September 2008

Purpose The removal of the internal limiting membrane (ILM) has become a widely accepted option in macular surgery. We will present the fundamental and clinical features to assess the influence of this technique in the management of surgical macular diseases.

Methods The internal limiting membrane peeling is considered as an option to the commonly accepted treatment of macular hole surgery but its place remains under debate. Different studies were performed to assess the influence of ILM peeling on the outcome of macular hole, epiretinal membrane or macular edema. However they frequently combined different factors as well as different surgical techniques.

Results The ILM should constitute a scaffold for glial cell proliferation if not removed. It should increase the rate of success and decrease the rate of late opening of macular hole but it remains speculative and controversial at the moment. About all the studies assessing the efficacy of ILM peeling in macular hole surgery are retrospective. All the studies about ILM peeling in macular edema or epiretinal membrane are non randomized study. The peeling of ILM is possible without any staining. However, the difficulty to peel it without trauma of the retina and even more the putative toxic risk of the different dyes to facilitate its removal are of concern.

Conclusion The ILM peeling represents an interesting option in the treatment of macular hole surgery but its place needs to be defined more clearly. In the future, we have to define “individual” treatment considering all influencing factors (size, onset, stage of macular hole) to choose a “tailored” treatment.
Critical flicker fusion frequency in age‐related macular degeneration
Authors: MAIER MM , GRONEBERG T , SPECHT H , LOHMANN CP
Published: September 2008

Purpose To discuss the influence of AMD on critical flicker fusion frequency (CFF)

Methods CFF was measured centrally for red, green and blue signal and in 10° excentricity with a red signal. 33 patients with non exsudative AMD and a visual acuity (VA) of 20/100‐20/20, 12 patients with exsudative AMD (VA: 20/100‐20/25) and 45 age‐matched healthy eyes (VA: 20/32‐20/20) were included.

Results CFF decreased in eyes with non exsudative AMD (red 1,6Hz p=0,01, green 1,6 Hz p=0,04, blue 2,1 Hz p=0,01). The difference between central and peripher CFF increased (red‐red 10°, 1,0 Hz p=0,01). Differences between different colours were low and reached no significance. In eyes with exsudative AMD CFF showed lower values (red 2.2 Hz p=0.02, green 3.3 Hz p=0.001, blue 2,9 Hz p=0.02, but in spite of increased difference between central and peripher CFF had no statistical significance. (red‐red 10° , 1,3 Hz p=0,25). Eyes with exsudative AMD showed a 1.0 Hz (p=0.02) higher difference between CFF with a red and a green signal than healthy eyes. Sub‐group analysis of patients with non exsudative AMD and visual acuity better than 20/32 (n=20) and healthy eyes showed no difference. Patients with non exsudative (n=13) and eyes with exsudative AMD (n=7) and VA between 20/200 and 20/40 reached equal CFF values.

Conclusion CFF was decreased in non exsudative and exsudative AMD. The difference between central and peripher CFF increased in exsudative and nonexsudative AMD. Exsudative AMD has a stronger impact on a green than on a red signal. CFF is not able to distinguish between groups of equal visual acuity and therefore not applicable as a diagnostic test.
The spatial and neural deficit of human amblyopia
Authors: STEWART CE , MOSELEY MJ , FIELDER AR , MORLAND AB , MACRAE KL
Published: September 2008

Purpose Human functional imaging studies confirm deficits of V1 identified from animal models and suggest additional extrastriatal areas of dysfunction. This study aims to investigate spatial visual and neural deficits in human amblyopia.

Methods Participants were 6 adults (mean age=20±2 years) with amblyopia; anisometropia (n=2); mixed (n=4) and 3 normal adults (mean age=31±4 years). Cortical activation for each eye was measured using functional magnetic resonance imaging (fMRI) and psychophysical methods. Stimuli included four attributes of spatial vision known to be deficient in individuals with amblyopia: visual resolution, contrast sensitivity, vernier acuity and global motion. In each subject, retinotopic mapping experiments were also performed to establish locations of different visual areas and to act as regions of interest. All paradigms used a block design: 18 seconds stimulus ‘on’ alternated with 18s ‘control’, stimulus subtending 15x15 degrees and flickering at a temporal frequency of 8 Hz. The scans were performed on a Siemens Trio 3.0 Tesla System at Royal Holloway University.

Results All participants with amblyopia had residual amblyopia following treatment. Mean logMAR visual acuity was 0.24 (sd 0.06) and ‐0.08 (sd 0.06) for amblyopic and fellow eyes respectively. Mean visual acuity for the normals was ‐0.06 (sd 0.06). Global motion was reduced significantly in the amblyopic (p=0.04) and fellow eyes (p=0.05) of observers compared to the normals; amblyopic eye: 54%(25%); fellow eye: 41%(16%); normals: 25%(7%).

Conclusion Amblyopic observers show significant deficits of global motion for amblyopic and fellow eye stimulation. This is suggestive of extrastriatal deficits of amblyopia in addition to those in V1.
Contact lens wear in strabismic and non‐strabismic young patients: sensorial and oculomotor study and quality of life outcome
Authors: CARDON A , SULTANIM A , ARSENE S , GEORGET M , SANTALLIER M , NOCHEZ Y , PISELLA PJ
Published: September 2008

Purpose The main aim of the study was to compare sensorial and oculomotor examinations in a sample of strabismic young patients corrected with eyeglasses and secondarily fitted with contact lenses. The second aim was to evaluate the quality of life.

Methods Forty‐eight patients were included (8 to 19 years‐old) in Tours University Hospital from June 1st 2005 to May 31st 2007. Oculomotor and sensorial examinations were performed.

Results Thirty‐seven patients had a mean follow‐up of 17.6 months. Twenty‐six patients had strabismus. Contact lens wear was stopped in 22.9% cases. In esotropic patients, the decrease of horizontal deviation angle in distant vision with lens was significantly more important when the initial angle measured with eyeglasses was more than 8 dioptries. The contact lens spherical power was significantly higher than the eyeglasses power. We did not find significant difference of quality of life in strabismic young person and the control group. Those results show that contact lens wear can uncover residual accommodation and can decrease the horizontal deviation angle in distant vision when the initial angle is higher than 8 dioptries.

Conclusion Contact lens fitting has to take part in the global medical management of strabismus, especially in young patients willing to give up wearing eyeglasses.
The impact of common classes of topical antiglaucoma medications on central corneal thickness
Authors: WIERZBOWSKA J , FUKSINSKA B , MATUSIK R , STANKIEWICZ A , SIERDZINSKI J
Published: September 2008

Purpose Recent studies have shown that prostaglandin analogs (PGA) may induce biochemical (via FP receptor and MMP‐2 activation) and morphological (via collagen type I contraction) changes in corneal stroma thus affecting central corneal thickness (CCT). Beta‐blockers (BB) and topical carbonic anhydrase inhibitors (CAI) were found to have rather no effect on CCT. To investigate the influence of common classes of topical antiglaucoma medications used either in monotherapy or combined therapy on CCT.

Methods In a retrospective study 487 eyes from consecutive 260 patients (148F/112M) with open angle glaucoma were examined. Depending on the topical treatment they were classified into 7 groups: A/ PGA (n = 212), B/ BB (n = 54), C/ CAI (n = 36), D/ PGA + CAI (n = 25) E/ PGA + BB (n = 23) F/ BB + CAI (n = 54), G/ non‐treated (n = 83). The CCT was measured using ultrasound pachymetry Tomey AL‐2000. The central corneal power was measured with the Topcon keratometer. ANOVA analyses were used for statistical analysis.

Results There were no statistically significant differences between CCT of all groups (F=1,06, p=0,3931); the lowest values were in the eyes treated with PGA + BB (535,9 nm SD 31,4) and the highest in the eyes treated with PGA + CAI (571,3 nm SD 46,3). The mean CCT in group A was 550,4 (SD 40,8), group B 552,5 (SD 34,7), group C 562,6 (SD 40,2), group D 571,3 (SD 46,3), group E 535,9 (SD 31,4), group F 559,5 (SD 32,5), group F 557,5 (SD 42,2) nm.

Conclusion In this study CCT appears not to differ in eyes treated with different classes of antiglaucoma medications either in monotherapy or combined therapy. CCT of treated glaucoma eyes does not differ from CCT of untreated glaucoma eyes.
Cone mosaic imaging using an adaptive optics flood illumination camera system
Authors: GOCHO ‐ NAKASHIMA K , MASSAMBA N , ROCHE O , PARIER V , LE GARGASSON JF , LAMORY B , CHATEAU N , SOUBRANE G , DUFIER JL
Published: September 2008

Purpose The objective of this study was to develop an adaptive optics (AO) retinal imaging system and conduct in vivo pilot tests in a group of healthy eyes and in several pathological eyes. The experiments aimed at determining the device ability to image cone photoreceptors in presence of a variety of refractive errors.

Methods We examined 20 healthy eyes and 3 eyes with inherited maculopathy using the instrument. The AO system was based on a 52‐actuator electromagnetic deformable mirror and a 1024‐lenslet Shack‐Hartmann wavefront sensor (respectively mirao52e and haso32e, both Imagine Eyes, France). The device was completed with a modified Badal arrangement in order to compensate for possibly large defocus errors. A super luminescent diode operating at 750nm was focused at the retina and the wavefront sensor. Additionally the retina was illuminated by a 3°x3°produced by an electroluminescent diode at 850nm. The center of this field was located at 3° off the fovea. The images were detected using a low‐noise CCD camera (Ropper Scientific, USA).

Results Cone photoreceptor mosaics were imaged in the eyes with spherical refraction ranging between –7D and +4D and astigmatism up to 4.5D. The AO correction residual error ranged between 0.08 and 0.2µm in all tested eyes. The imaging resolution was estimated to be better than 5µm in all cases. The mosaic was visible over the entire 3°x3° field in several eyes.

Conclusion It appeared that the retinal isoaplanetic field width was at least 3° experimentally in several tested eyes. This study demonstrated the feasibility of cellular retinal imaging in eyes with relatively large refractive errors using a compact AO instrument.

Commercial interest
The incidence of glaucoma following paediatric cataract surgery
Authors: BHATT UK , TATHAM A , WOODRUFF GH
Published: September 2008

Purpose Aphakic glaucoma is a well‐recognised complication of surgery for congenital cataract, however there are wide variations in its reported prevalence. In this study, we investigated the incidence of glaucoma and the visual outcome following surgery in paediatric cataracts.

Methods A 10‐year retrospective case‐note review of children who had cataract surgery by the same surgeon for congenital or secondary cataract. The diagnosis of glaucoma was based on the clinician’s decision to initiate treatment for raised intraocular pressure.

Results Sixty‐six eyes of 49 patients were identified, comprising; 57.1% (28/49,40 eyes) with congenital cataract, 26.5% (13/49,18 eyes) with cataract secondary to uveitis, and 10.2% (5/49) with traumatic cataract. 12.1% (8/66) of eyes had an intraocular lens inserted at the time of surgery. Of those with congenital cataract, surgery was performed at a median age of 101 days (range 5‐5089). 7.5% (3/40) of these eyes developed glaucoma. The mean interval from surgery to the diagnosis of glaucoma was 3519 days.The age of the patient at surgery was not found to be a significant risk factor for glaucoma (student‐t test, p=0.18). There was a mean follow‐up of 2108 days with no significant difference in the length of follow‐up between the groups. Of the patients with uveitis, 53.8% (7/13) developed glaucoma in the operated eye, with two eventually requiring aqueous shunt devices.

Conclusion We found a lower prevalence of glaucoma following surgery for congenital cataract than previously reported. However, glaucoma is significantly more likely following surgery for secondary cataract, particularly that associated with uveitis.
Susac's syndrome
Authors: BORRUAT FX
Published: September 2008

Susac's syndrome is a primary vasculitis of the central nervous system. It is a microangiopathy affecting the brain, the inner ear and the retina. Its clinical presentation usually consists in behavior and memory disturbances, hearing loss and visual loss due to multiple branch arteries occlusions. It affects mostly women between 18 and 40 years of age. There are no specific radiological or laboratory abnormalities. Lumbar puncture reveals non specific minimal pleocytosis and elevation of proteins. The differential diagnosis includes granulomatous angiitis of the central nervous system and Cogan's syndrome. The pathogenesis is unknown but immune complex and antibody‐mediated endothelial damage are possible mechanisms. There is no universally recognized therapy, but immunosuppressants are frequently used.
Primary intraocular and CNS lymphoma
Authors: CASSOUX N
Published: September 2008

Abstract not provided
Compliance and knowledge about glaucoma in austrian patients
Authors: MANSOURI K , RIGAL K
Published: September 2008

Purpose To document the rate of non‐compliance and patients’ attitude towards and knowledge of glaucoma in Austrian patients.

Methods Prospective observational case series. One‐ hundred consecutive glaucoma patients of an Austrian outpatient glaucoma department were included in the study. Patients were already under medical treatment for glaucoma. Personal characteristics, presence of systemic disease, compliance with glaucoma medication, and glaucoma‐related attitudes were ascertained by means of a predetermined questionnaire with 40 questions. Patients were subsequently assessed for the ability to correctly instil placebo eye drops. Non‐compliance was defined as omitting glaucoma medication more than once a week. Univariate and logistic regression was used to examine how patient characteristics and knowledge were related to reported compliance

Results Average age was 63.6 years (range 19‐88). Overall, 89% (n= 89) of patients reported to be compliant. Knowledge about the disease was associated with higher compliance (RR 3.05, 95% CI 1.7‐9.6). Forgetfulness was the most frequently cited reason for non‐compliance (20%). Although 84% patients believed glaucoma medication to be efficient, only 26% could give a simple correct definition of glaucoma. 29% had a positive family history for glaucoma.

Conclusion Despite the comparatively high compliance rate of Austrian patients with their glaucoma medication, knowledge of glaucoma remains poor in long term glaucoma sufferers.Patient compliance to glaucoma treatment could be improved mainly by increasing patient knowledge of the disease.
The characteristics of corneal biomechanics and their correlations with other biophysical parameters
Authors: POURJAVAN S , DETRY‐MOREL M
Published: September 2008

Purpose To assess the characteristics of corneal biomechanics; corneal hysteresis (CH) and corneal resistant factor (CRF) and their correlations with other biophysical parameters in healthy subjects.

Methods 150 healthy subjects had an IOP measurement with ORA. CH and CRF were analyzed based on age, race, sex, refractive error, corneal thickness and visual field parameters. Diurnal variability and short time variability were also examined. Patients with corneal pathologies were excluded. Regression analysis and Pearson correlation were used to assess the correlation between different parameters. Student test was used to assess the difference. Anova test was also applied to examine the differences in diurnal and short time variability.

Results CH was lower in advanced age. CRF was higher in the elderly. There was no difference in corneal biomechanics between males and females. CH and CRF seemed lower in black race then Caucasian. There was a positive correlation between CH, CRF and CCT. We couldn’t show any diurnal variability.

Conclusion The characteristics of CH and CRF in healthy subjects will be discussed.
Conjunctiva‐associated lymphoid tissue (CALT) – the physiological protective MALT of the conjunctiva
Authors: KNOP N , KNOP E
Published: September 2008

Purpose Conjunctiva‐associated lymphoid tissue (CALT) is a part of the mucosal immune system – the local MALT of the conjuncitva. The presence of lymphatic cells in the conjunctiva is known for about a century but had remained controversial for a long time.

Methods Complete conjunctival sacs in a large number of rabbits and humans were investigated in combined studies of whole‐mount observation together with histology, scanning and transmission electron microscopy and immunohistochemistry.

Results A diffuse lymphoid tissue composed of lymphocytes and plasma cells along with accessory cells of the immune system occurs in the sub‐epithelial lamina propria with intraepithelial lymphocytes. Lymphoid follicles are regularly interspersed. These are less frequent and flat in elderly humans, but prominent in the rabbit. They show a typical structure, are composed of B‐cells with parafollicular T‐cells and high endothelial venules, and are covered by a specialised follicle‐associated epithelium (FAE) devoid of goblet cells. This has specialised M‐cells that contain groups of lymphocytes for uptake of antigens. Follicles frequently have a bright germinal center which indicates that antigens were in fact taken up and lymphocyte proliferation and differentiation was induced.

Conclusion The conjunctiva of the rabbit and human have typical components of a physiologically protective mucosal immune system in the form of diffuse lymphoid tissue and lymphoid follicles that form the efferent and the afferent limb, respectively, of an immune answer. CALT can hence detect antigens from the ocular surface, pre‐sent them to lymphoid cells and generate protective effector cells and hence repre‐sents a part of the mucosal immune system at the conjunctiva. (DFG KN 317/11)
G‐probe: results of use on eyes with visual functions with patients in Armenia
Authors: BUNIATYAN IY , VARDANYAN AH , VOSKANYAN LA
Published: September 2008

Purpose G‐probe cyclophotocoagulation(IRIDEX laser systems) on blind eyes has allowed us to develop differentiated approaches to the treatment considering the etiology and optimum dosages.The objective we had defined was to utilize the accumulated experience and apply the given technique also on eyes with visual acuity.

Methods During 3 years there were 10 eyes under our supervision with neovascular glaucoma after diabetic retinopathy or vein thromboses.IOP was 45.4 mmHg.In 9 cases visual acuity as light perception;1 patient had account of fingers on distance 50cm without correction.2 patients had undergone vitrectomy.Technique:position‐supine; anaesthesia retrobulbar injection Sol.Lidocaine 2%‐3.0;optimum dosages (power‐duration‐number of coagulants):NVG after vein thromboses:1000‐1750mW(inclusive)‐1000msec‐minimum 24;NVG after diabetic retinopathy:1750‐2500mW‐2000msec‐minimum 25.After TSCPC subconjunctival steroids injection was done.

Results Visual acuity after TSCPC at 8 patients increased to account of fingers on distance 1m;1 case‐account of fingers on distance 2m;1 case‐account of fingers on distance 2m with correction (+4.0D)20/200.In 3 cases ? year after the condition had stabilized, we performed glaucoma surgery,in 1 case combined operation‐cataract and glaucoma surgery,in 1 case‐panretinal photocoagulation.All patients were under dynamic supervision.IOP after 3 years was 23.5 mmHg.1 patient after TSCPC and glaucoma surgery is preparing to keratoplasty.

Conclusion The results received by us are quite encouraging in terms of stabilization of intraocular pressure, painful syndrome, and also preservation of vision acuity.The given technique can be recommended as preparatory for the subsequent interventions for "refractory" patients.
Contact transcleral ciliary body photodynamic treatment with verteporfin in cases of refractory glaucoma
Authors: CHARISIS SK , VITANOVA VS , DETORAKIS E , TSILIMBARIS MK
Published: September 2008

Purpose Previous animal studies showed that contact transcleral ciliary body photodynamic treatment with verteporfin is a safe procedure for temporarily reducing IOP. The purpose of this study is to investigate safety and efficacy in cases of refractory or absolute glaucoma.

Methods 8 patients, 8 blind painful eyes of with absolute glaucoma (6 neovascular, 1 Sil Oil, 1 refractory), with mean IOP 37±12 mmHg, were treated. Verteporfin bolus infusion of 6 mg/m^2 body surface area over 1 minute was done prior to irradiation, realized with a triple optic fiber connected to a 689nm diode laser. Energy at each fiber’s tip was 80mW and irradiation time 3min per spot. 12 spots over 360 degrees (12min) were done. Eye drops with dexamethasone and tobramycin qd for 4 days were prescribed. Follow up consisted of daily slit lamp examination and IOP measurements with Goldman Tonometer during the first week, then weekly during the first month, then monthly. Photography was used to document clinical findings.

Results Significant mean IOP reduction of 25% for 2 weeks was observed in all cases. IOP returned to pre‐treatment values during the third week in 4 cases, during the 2nd month in 2 cases and 3rd month in 2 cases. Conjunctival oedema and anterior chamber reaction were mild and lasted 24‐48 hours. No serious adverse events were observed and patient’s discomfort was limited.

Conclusion Our findings suggest that contact transcleral ciliary body photodynamic treatment with verteporfin with the above mentioned settings is safe and efficient in short term in cases of refractory or absolute glaucoma.
Dynamic vessel analysis for assessing endothel dysfunction of microcirculatory vessels – method, model and results
Authors: VILSER W , SEIFERT B
Published: September 2008

Purpose To access the endothel function (flow induced autoregulation) provide a unique potential for vascular risk stratification,early recognition, diagnosis and treatment of big vascular heart and brain diseases by using the eye as a diagnostic window.It is assumed that Dynamic Vessel Analysis by DVA (Dynamic Vessel Analyzer Imedos GmgH Jena,Germany) is a practical and easy test for endothel dysfunction.

Methods DVA can access vessel functions by use of flickering light.Online measurements of the diameter enable a highly reproducible observation of local and temporal changes of big retinal vessels with high accuracy.For functional analysis the retina is stimulated by a 12.5 Hz monochromatic flicker light.The stimulation period amounts 20s.The vessel response before, during an after stimulöation is recorded.Vessel dialation is estimated.To understand and for clinical interpretation of the flickering vessel response model of vessel response to flickering light was developed.

Results In normal subjects flickering light induces an increase in vessel diameter.Reduced diameter dilatation is caused by exhausted regulative reserve (hypotonics) or by vascular dysfunction.The interpretation of the vascular dysfunction based on the following model:Flickering light is activating the neurovascular coupling, leading to a dilation of the capillaries and small arterioles.This causes an increase in flow leading to increased velocity in the bigger vessels indirectly.The flow induced autoregulation dilates the diameter of the big vessels by increasing nitric oxid NO via eNOS.Different experimental results support this model thesis.

Conclusion The vessel dilatation can be explained by eNOS.Endothel dysfunction reduces the flicker dilatation.

Commercial interest
Optic nerve reflectance variations in the near‐infrared during neural function
Authors: RIVA CE , BONAIUTI M , ROVATI L
Published: September 2008

Purpose Diffuse luminance flicker induces optic nerve head (ONH) reflectance changes, ChRonh, in humans, when Ronh is measured at visible wavelengths (Crittin and Riva, 2004). Intrinsic signal imaging in macaque retina and ONH has revealed also flash‐induced infrared (840‐900 nm) reflectance changes (Hanazono et al., 2007). Our purpose was to determine a) whether flicker‐induced near‐infrared ChRonh are detectable from the human ONH; b) is there a spatial distribution of ChRonh.

Methods Ronh was measured at 770 nm with a fundus camera based reflectometer. Neural activity was evoked by 535‐nm diffuse (50 deg) flicker (various frequencies below 20Hz). 7 successive recordings were performed at 9 temporal sites, each consisting of a 20s baseline, a 60s flicker period and a 40s recovery. ChRonh (%) was defined as 100 x (Ronh,fl ‐ Ronh,bl)/Ronh,bl, where Ronh,bl is the average response during the baseline (no flicker) and Ronh,fl is the response, averaged over time slots of 2s, during flicker. ONH regions containing visible vessels were avoided.

Results Flicker induced significant decreases in Ronh at most sites. These decreases presented a strong oscillatory behavior (period of about 8s), reached a maximum in less than 40s of flicker and were more marked at the rim. ChRonh was found to be frequency‐dependent. Ronh during recovery also showed marked oscillations

Conclusion Flicker induces significant frequency‐dependent decreases in near‐infrared (770 nm) reflectance in the temporal region of the human ONH, confirming previous infrared optic nerve intrinsic signal reflectance findings in monkeys. Comparison with flicker‐induced blood flow increases in the ONH, these decreases are most probably due to changes in blood volume during neural activity.
Ocular adverse effects of the pneumatic trabeculoplasty in patients' treatment with open angle glaucoma
Authors: PESCE G , AHMETAJ M , ALESSIO T , SCANDALE M , SCORCIA G
Published: September 2008

Purpose To valuate the ocular adverse effects of the pneumatic trabeculoplasty in patient affected by open angle glaucoma. The subjective and objective troubles of the ocular surface have been valued during and after the execution of the procedure.

Methods 50 patients have been recruited (25 men and 25 women, inclusive age between 30 and 55 years) affected by open angle glaucoma in topical pharmacological treatment with beta‐blockers. The patients in treatment with prostaglandin have been excluded. The treatment has been performed on day 0 and 7 only on 1 eye while the other one has been used as check. The ocular surface has been observed before and after the treatment relatively to the reported symptoms (burning, pain, ocular disconfort, lacrimation, visual alteration during the treatment, itch) and the signs (conjuntival hyperaemia, haemorrhage). After the treatment the patients have continued to instill only the hypotensive therapy. All the patients were controlled for 30 days.

Results The following side effects have been reported: conjuntival hyperaemia (75%), pain (50%), ocular disconfort (90%), visual alteration (90%), hemorrahe (0,25%), lacrimation (20%), itch (20%)

Conclusion Modest and transitory simptoms and signs have shown the treatment to be safe, both during and after it. With the exception of a case of subconjuntival hemorrhage, spontaneously resolved after 7 days.
The role of leukocytes in ischemia‐driven neovascularisation
Authors: SHIMA DT , KRILLEKE D , NISHIJIMA K
Published: September 2008

Purpose Our research strategy has been to study VEGF‐A and the adaptive response to ischemia, with the aim of better understanding the benefit that VEGF‐A may bring to ischemic tissues, and to characterize the basis for the chaotic and poorly controlled neovascular response that usually accompanies ischemia in retinal diseases such as diabetic retinopathy.

Methods Mice genetically engineered with deletion of the VEGF164 isoform were examined during normal vascular development of the retina and following oxygen‐induced retinopathy. Abnormal vascular growth and leukostasis were quantified. To study determinants of VEGF‐A involved in leukostasis, VEGF‐A mutants and VEGF‐A signaling antagonists were injected intraocularly

Results Rather than focusing on the abolition of VEGF‐A signaling in ischemic retinal disease, we have tried to find ways to normalize the adaptive response. We previously demonstrated that inflammation was critical for the abnormal vascular response in OIR. Here we found that inflammation was driven by VEGF164, and that a cluster of residues in the heparin‐binding domain of VEGF164 were responsible for its heightened inflammatory activity compared to other VEGF‐A isoforms. This region of VEGF164 imparts high affinity binding to VEGFR1

Conclusion Data suggest that reducing VEGF‐VEGFR1 mediated inflammation, whilst preserving VEGF‐mediated angiogenesis, may be a strategy to help transform the unwanted pathological response to ischemia into a desirable outcome whereby new vessels sprout into the area of need and nurture the ischemic retina.

Commercial interest
The reasons of unsuccessful antiglaucoma operations
Authors: MILOJKO B
Published: September 2008

Purpose The study was to determinate the level excessive scarring in zone of antiglaucome operations.

Methods This study 48 eyes of 46 consecutive patients with medically uncontrolled glaucoma after filtration surgery underwent reconstruction of filtration zone. IOP decompensation happened between 6 mount and 6 years after filtration surgery. Mean preoperative IOP was 35.7± 8.4 mm Hg.

Results After reconstruction of filtration zone in 9 causes (18,7%) aqueous humor outflow started after revision filtration bleb, 23 causes (48%) after reconstruction scleral spit. In other causes we had to cut up zone of trabeculectomy hole. In 8 causes (16%) excessive scarring in zone of trebeculectomy hole was mean reason for IOP decompensation.

Conclusion The mean reason of IOP decompensation after antiglaucoma operation is excessive scarring in zone of scleral spit (48%) and filtrations bleb (18,7%).
Long term results of Limbal stem cell transplantation in ocular surface disease
Authors: MIRI A , ALDEIRI B , MATHEW M
Published: September 2008

Purpose To evaluate results of limbal stem cell transplantation (LSCT) in patients with ocular surface (OS) disease.

Methods The case records of 26 eyes of 25 patients who underwent LSCT with at least one year follow up were retrospectively reviewed. Aetiology, type of transplant procedure, intra and post‐operative complications and final visual outcome were analysed. Surgical success of transplanted limbal epithelial stem cells was defined by the duration of maintenance of normal corneal epithelial phenotype after surgery. Failure was defined as the presence of abnormally high fluorescein permeability and late corneal epithelial staining, recurrence of conjunctivalisation, neovascularisation, and persistent epithelial defect. Functional success was assessed by National Eye Institute Visual Functioning Questionnaire 25(VFQ‐25).

Results Survival of ocular surface transplantation in this study was seen in 23 procedures (82%) after 6 months and in 22 procedures (79%) after one year. An increase in visual acuity was observed after 21 limbal stem cells transplantations (75%).VFQ‐25 results have showed remarkable improvement in terms of vision and daily activities of the patients.

Conclusion LSCT is an effective surgical procedure in the management of eyes prior to corneal graft surgery or as a combined procedure. Post‐operatively non healing defects and vascularisation of the cornea may contribute to the occurrence of surgical failure and the need for further procedures.
Quality of vision following penetrating keratoplasty and deep anterior lamellar keratoplasty for keratoconus
Authors: PARENTE G , FONTANA L , TASSINARI G
Published: September 2008

Purpose The authors purpose is to investigate whether quality of vision in keratoconus patients after deep anterior lamellar keratoplasty (DALK) with and without descemet’s membrane (DM) exposure, may be comparable with Penetrating Keratoplasty (PK).

Methods To investigate quality of vision after PK and DALK with and without DM exposure a files of 52 keratoconus patients were analysed. Patients were divided in 3 groups: group 1 (n = 16) DALK with DM exposure, group 2 (n = 22) DALK without DM exposure and group 3 (n = 14) PK. Visual function was assessed by Uncorrected Visual Acuity (UCVA) and Best Spectacle Corrected Visual Acuity (BSCVA), Low Contrast Visual Acuity (LCVA) and Pelli‐Robson Contrast Sensitivity (PRCS).

Results UCVA was comparable among groups. BCVA, LCVA and PRCS were better in group 1 than group 2 (p < 0.05) and comparable between groups 1 and 3 (p > 0.05).

Conclusion Quality of vision after DALK is comparable to PK if the DM is exposed.
Promotion of ER stress: a potential therapeutic approach for PCO
Authors: WANG L , DUNCAN G , NEILSON GJ , ZHANG H , WORMSTONE IM
Published: September 2008

Purpose Posterior Capsule Opacification (PCO) remains a significant clinical problem following cataract surgery. Endoplasmic Reticulum (ER) stress has been shown to play a critical role in cell death and apoptosis. The aim of this study was to determine the relative effectiveness of ER stressors, thapsigargin (Tg) and arsenic trioxide (As2O3) on induction of cell death in human capsular bags.

Methods FHL124 cell survival was assessed by Coomassie blue staining after 4 days. Induction of ER stress genes was detected using real‐time PCR and apoptosis assessed using the TUNEL assay. Human capsular bags were prepared from donor eyes and sealed with the Perfect Capsule device. The agents were again introduced to the bags for a 2 minute period prior to perfusion with EMEM alone. The bags were maintained in EMEM for 28 days and phase images were acquired throughout.

Results Tg and As2O3 application to FHL124 cells induced significant up‐regulation of ER stress genes Bip, EIF2α, IRE1 and ATF6. FHL124 cells exposed for 2 minutes to both Tg and As2O3 for 4 days demonstrated reduced cell survival in a dose‐dependent manner. Moreover, TUNEL assay data showed that both Tg and As2O3 could induce FHL124 cell death by apoptosis. Application of the 100uM Tg and 100mM As2O3 to capsular bags for a 2 minute period using the perfect capsule system resulted in a total loss of viable cells following the 4 week culture period.

Conclusion Thapsigargin and arsenic trioxide induce an ER stress in human lens epithelial cells, which is associated with a reduced cell survival and promotion of apoptosis. Using the perfect capsule system, a 2 minute exposure of either agent successfully killed all cells within the capsular bag and thus predicts putative therapeutic benefit in vivo.
Sealed capsule irrigation to prevent posterior capsule opacification: Results of long‐term clinical trials and laboratory studies
Authors: AUFFARTH GU , RABSILBER TM
Published: September 2008

Purpose We investigated long‐term safety and efficacy of sealed capsule irrigation (SCI) during cataract surgery to prevent posterior capsule opacification (PCO).

Methods One eye of each of 17 patients (mean age: 70.1+/‐9.7 years) who presented with bilateral cataracts was randomly chosen for SCI treatment. After phacoemulsification, the capsular bag was vacuum sealed with the PerfectCapsule device (Milvella) followed by SCI using distilled water for two minutes. No vacuum loss occurred during irrigation. Each patient's fellow eye served as a control. One hydrophilic acrylic intraocular lens model was implanted in all eyes. Five patients had to be excluded due to deep anterior chamber, small pupil or unilateral surgery. Follow‐up examinations took place one day and one, three, six, 12 and 24 months after surgery. We evaluated safety parameters, anterior capsule (AC) overlapping and PCO.

Results Postoperatively, mean best corrected visual acuity, pachymetry, endothelial cell count, intraocular pressure, AC overlapping and PCO showed no statistically significant difference between SCI and the control group (p>0.05, Wilcoxon test).

Conclusion SCI is a safe procedure and enables the specific pharmacological targeting of lens epithelial cells inside the capsular bag. Using distilled water, however, it is not possible to reduce PCO development significantly. Thus, alternative substances should be evaluated.
Mechanism of PCO prevention in the bag‐in‐the‐lens technique
Authors: TASSIGNON MJ
Published: September 2008

Purpose Since the technique of the bag‐in‐the‐lens (BIL) implantation is based on performing a PCCC, the question can be raised whether we need the posterior capsule and in case it is removed whether this is safe for the eye.

Methods Fluorophotometry, review of the literature and retinal detachment rates after BIL implantation have shown that PCCC does preserve the anterior ocular barrier and probably even better than in case YAG capsulotomoy is needed as it is the case in the traditional lens‐in‐the‐bag implantation technique.

Results The risk for retinal detachment is comparable with the lens‐in‐the‐bag implantation at the short postoperative follow‐up. However, since no Nd:YAG laser capsulotomy is necessary after BIL technique, the risk for retinal detachment after BIL is lower with time.

Conclusion At the long run, the BIL technique may even be safer for the eye than the lens‐in‐the‐bag implantation.

Commercial interest
Long‐term results of combined cataract and non perforant sclerectomy surgery supplemented with antimitotics: prospective study
Authors: GUTIERREZ G , BLOVIAR G , MIGUEL T
Published: September 2008

Purpose Prospectively to evaluate the long‐term results of phacoemulsification plus non perforant sclerectomy (PNPS) supplemented with antimetabolites and without implant.

Methods Prospective, non‐randomized study that comprised all consecutive patients who underwent PNPS in our unit from January 2004 up to now. We analysed those patients with a minimum of follow‐up of one year.

Results 42 eyes of 42 patients suffering form open angle glaucoma were included. Mean follow up was 17.4 (SD: 5.6) months (range 12 to 24 months). 85.5% has best corrected visual acuity (BCVA) ≥ 0.5; 73.8% ≥ 0,7 and 28.5% , 1. After the first year or the follow‐up the intraocular pressure (IOP) decreased by 49.3% and after the second year by 45.4% with or without medication. The decrease of the number of medications was statistically significant in all follow‐up periods. The number of complications was low and they were no severe. Total success was higher when MMC was used than when 5‐Fluorouracil was applied.

Conclusion PNPS supplemented with antimetabolites reduces significatively the IOP in the long‐term, allows a rapid BCVA recovery, and has a low number rate of complications and they were no severe.
Increasing IOP decrease with sequential use of travoprost, travoprost/timolol fixed combination and travoprost/timolol fixed combination with adjunctive brinzolamide
Authors: HOLLO G , KOTHY P
Published: September 2008

Purpose To investigate if combined intraocular pressure (IOP) lowering medication with travoprost/timolol (travg/tim) fixed combination and a carbonic anhydrase inhibitor, brinzolamide is superior to both travoprost monotherapy and trav/tim fixed combination therapy in POAG and OHT.

Methods Following a four‐week wash‐out period and using four‐week treatment periods, 20 POAG or OHT patients were treated with evening travoprost 0.004%, then switched to evening travoprost 0.004%/timolol 0.5% fixed combination, and finally the treatment was combined with adjunctive twice‐daily brinzolamide 1% ophthalmic suspension. Both eyes were treated but only one eye per patient, (the eye with higher mean diurnal IOP at baseline), was evaluated. IOP was measured at 8 a.m., 12 noon and 4 p.m. at baseline and at the end of each treatment period.

Results Mean diurnal IOP (mean (SD)) at baseline was 28.5(7.3) mmHg which decreased to 22.3(6.3) mmHg on travoprost, 19.2(3.4) mmHg on trav/tim fixed combination and 17.3(3.4) mmHg when the brinzolamide was added to trav/tim (ANOVA, contrast test, p<0.003 for all comparisons). The individual time point IOP values showed similar and significant stepwise differences.

Conclusion Adjunctive brinzolamide medication provided a clinically and statistically significant further IOP decrease in patients receiving evening‐dosed trav/tim fixed combination. The trav/tim fixed combination was significantly more effective in IOP reduction than travoprost monotherapy. These results suggest that combined therapy with trav/tim fixed combination and brinzolamide is clinically useful for IOP lowering in primary open‐angle glaucoma and ocular hypertension.

Commercial interest
Safety of trabeculectomy with mitomycin C: The ReGAE (research into glaucoma and ethnicity) experience
Authors: GHAURI AJ , SHAH P , SII F , HUSSAIN A , CHIANG M
Published: September 2008

Purpose To describe the prevalence of surgical complications in patients undergoing trabeculectomy with mitomycin C (trab + MMC).

Methods A Review of an open consecutive prospective interventional case series performed by a single surgical team was undertaken. The case mix was a supra‐regional complex mixture of primary, secondary and paediatric glaucoma. Complete and qualified success rates, and the prevalence of complications were calculated.

Results 382 eyes of 298 patients were included in the study. Mean follow up was 3.08 years. Mean age was 57.4 years (range: 6‐87). At latest follow up qualified success (IOP ≤ 21mmhg with ≥1 ocular hypotensive agent) was 95.7% (360 eyes) and complete success (IOP ≤ 21mmhg without an ocular hypotensive agent) was 84.8% (319 eyes). Early postoperative complications ≤1 month of surgery were reported in 21 (5.5%) eyes. 7 (1.8%) eyes developed late surgery related complications >1 month of surgery. Clinically significant early hypotony (IOP <6 on 2 separate occasions and requiring surgical intervention) occurred in 17 (4.5%) eyes. 2 patients developed late hypotony including 1 case of hypotony maculopathy, and there was 1 case each of toxic anterior segment syndrome, corneal decompensation plus cystoid macular oedema (ICE syndrome patient), blebitis, endophthalmitis, aqueous misdirection, suprachoroidal haemorrhage, retinal tear, and epiretinal membrane. No patients developed choroidal neovascularisation or malignant glaucoma. 1 patient developed pulmonary oedema after general anaesthesia.

Conclusion Trab + MMC in a complex supra‐regional case mix service is a highly effective and safe operation. Only 3 (0.8%) eyes developed irreversible vision loss > 2 lines Snellen.
Micropulse diode laser trabeculoplasty for secondary corticosteroid induced glaucoma
Authors: MELIS R , PILOTTO E , VUJOSEVIC S , DORIGO MT , MIDENA E
Published: September 2008

Purpose To evaluate the role of micropulse diode laser trabeculoplasty (MDLT) in the treatment of secondary glaucoma due to intravitreal injection of corticosteroid.

Methods Five consecutives patients previously treated with intravitreal triamcinolone (4mg) for refractory diabetic macular edema developed secondary glaucoma in the treated eye. Each eye underwent 360° micropulse diode laser trabeculoplasty (2000 mw power, 200 msec duration, 15% duty cicle, 300 µm diameter per spot). Patients were followed at 1, 7, 15, 28 days and monthly for 12 months.

Results Mean age of the patients was 56 ± 2 years. Mean baseline intraocular pressure (IOP) was 30 ± 3 mmHg. IOP significantly decreased at 7 days post operative (19 ± 4 mmHg; p < 0.001) and maintained at normal level in 3 of 5 eyes. After 28 days two eyes needed retreatment and IOP maintained normal in one eye during follow up. No pain or side effect was documented.

Conclusion Secondary glaucoma due to intravitreal injection of corticosteroid may be safely treated with micropulse diode laser trabeculoplasty.
Control of filtering bleb scarring trough tissue bioengineering
Authors: APTEL F , DUMAS S , BURILLON C , DENIS P
Published: September 2008

Purpose To evaluate the effects on intraocular pressure (IOP) reduction and bleb morphology of a new biodegradable collagen implant iGen TM, a porous matrix reducing scar formation after glaucoma surgery.

Methods We conducted a prospective interventional case series in 18 eyes of 18 patients with uncontrolled primary open‐angle glaucoma. We performed limbal‐based deep‐sclerectomy with implantion of the device in the scleral bed. We performed a complete ophtalmic examination, ultrasound biomicroscopy (UBM) and Visante anterior segment Optical Coherence Tomography (OCT) at each follow up visit, scheduled 1 day, 1 week, 4 and 12 weeks post‐operatively.

Results Postoperative IOP decreased significantly (p < 0.001) from a preoperative mean value of 25.1 ± 5.9 mm Hg (n = 2.73 glaucoma medications) to a postoperative mean value of 8.0 ± 1.1 (n = 0), 8.3 ± 1.2 (n = 0), 11.5 ± 3.0 (n = 0) and 14.1 ± 3.7 mm Hg (n = 0.28) at 1 day, 1week, 4 and 12 weeks respectively. Characteristic imaging parameters of successful bleb were frequently observed (14/18 patients): high and hypoechoic bleb with UBM; thin and hyporeflective bleb wall, multiple subconjunctival fluid spaces and hyporeflective deep bleb tissue with OCT. Bleb height and trabeculocorneal membrane thickness are correlated with low IOP (r = 0.91 p < 0.01, r = 0.90 p < 0.001) with UBM examination. Thin bleb wall, large subconjunctival fluid spaces and low reflectivity of bleb tissue are associated with lower IOP (r = 0.81 p < 0.01, p < 0.001 and p < 0.001) with OCT examination. No post‐operative complications were reported.

Conclusion In our series, deep‐sclerectomy with iGen TM implantation seems to be an effective and well‐tolerated method to lower IOP and avoid conjunctival scarring.
Different techniques to evaluate chromosome aberrations
Authors: COUPLAND SE , DAMATO BERTIL
Published: September 2008

Purpose To review the demonstration of chromosomal alterations in uveal melanomas

Methods Uveal melanomas (UM) have an incidence of 6 per million per year, with presentation peaking at 60 years. Treatment is by various combinations of radiotherapy, local resection and phototherapy in 70% of patients, and by enucleation in 30%. Despite successful ocular treatment, 50% of UM patients develop metastatic disease. This occurs haematogenously, usually involving the liver, and almost always causing death within a year of the onset of symptoms. Long‐term survival is rare. Clinical trials evaluating agents for systemic adjuvant therapy are difficult because of the rarity of UM & the reduced availability of molecular genetic testing.

Results In 1999 Prescher et al. reported that metastatic death occurs almost exclusively in patients with UM showing monosomy 3. Others also demonstrated a strong inverse relationship correlation between the presence of additional copies of 8q and survival. In contrast, patients with tumours having chromosome 6 abnormalities appear to have better prognosis. These analyses have been performed using FISH. Long‐term data suggests that FISH, however, is not highly specific, and that approx. 5‐10% of patients with disomy 3 UM develop metastatic disease. Newer methodologies are being tested on a research basis in the hope of using them as a diagnostic tool. These include multiplex ligation probe amplification (MLPA), array chromosome genomic hybridisation (aCGH), single nucleotide polymorphism (SNP) analysis and gene expression profiling.

Conclusion Newer methodologies will provide more details to chromosomal changes in uveal melanoma, and possibly molecular therapeutic targets to which new medications can be directed in adjuvant treatment of metastatic disease.