bluuebunny/crossref_metadata_2025 huggingface dataset:
Most readily usable methods to measure ocular blood flow
Authors: GUGLETA K
Published: September 2009

Purpose SIS Lecture.

Methods Literature search.

Results Ocular Blood Flow Research Association (OBFRA, recently merged with another organization ‐ ISOCO, into one single Association for Ocular CDirculation ‐ AOC) made a significant contribution to standardization of the blood flow measuring techniques in the field of ophthalmology. A consens was reached on the number of OBF measurements techniques that occured in the past decades. Particular emphasis was placed on the basic technology, specific parameters and interpretation, accuracy and reproducibility, field of clinical applications. Open questions were extensively discussed, limits of each technique clearly postulated. and a consensus statement put together for each of the technique involved. It encompassed techniques like color Doppler imaging, laser Doppler flowmetry (continuous as well as scanning LDF), laser Doppler velocimetry, Retinal Vessel Analyzer, combination of the vessel diameter measurement and the LDV, laser interferometry of the fundus pulsations amplitude, retinal oxymetry, measurements of the pulsatile component of the blood flow, blue field entoptic method and the newest ‐ Doppler OCT.

Conclusion There is no overwhelming measuring technique able to cover all the aspects of the research and the daily clinical routine. Various parameters and various vascular beds are involved, which makes the interpretation of the obtained results strenuous. Of particular importance is the capability of OBF measuring techniques to capture one dynamic feature of ocular circulation ‐ its ability to regulate and to response to various challenges. It is widely believed that not the constantly reduced blood flow, but rather the lack of regulation thereof, leads to prevalent ocular diseases.
Disease mechanisms leading to impaired blood flow in glaucoma
Authors: GHERGHEL D
Published: September 2009

Purpose SIS lecture

Methods Literature search

Results Although primary open‐angle glaucoma (POAG), is associated more closely with elevated intraocular pressure (IOP), other risk factors already implicated in the aetiology of this disease and especially in the aetiology of normal‐tension glaucoma are: abnormal ocular circulation, ocular and systemic vascular dysregulation, as well as systemic blood pressure (BP) alterations. Oxidative stress, which occurs as a result of an imbalance between generation of reactive oxygen species (ROS) and antioxidant defence mechanisms and is implicated in the pathogenesis of disorders ranging from atherosclerosis to neurodegenerative disorders, diabetes and aging, may also contribute to the general vascular disturbances observed in glaucoma. Moreover, increasing evidence shoes that oxidative stress plays a role in promoting endothelial dysfunction, which is a key factor in progression of vascular diseases. Indeed, glaucomatous optic nerve damage has been related to endothelial damage/dysfunction. This presentation explores the role of various ocular and systemic circulatory factors in the pathogenesis of glaucomatous neuropathy.
Recent developments in retinopathy of prematurity
Authors: MORTEMOUSQUE B
Published: September 2009

The retinopathy remains the principal severe ophthalmologic complication of neonates with a gestationalage of 32 weeks or less. It’s a major cause of lifelong blindness beginning in infancy. As many other ocular pathologies, including diabetic retinopathy, and age‐related macular degeneration, result in vision loss because of aberrant neoangiogenesis. A common feature of these conditions is the presenceof hypoxic areas and overexpression of the proangiogenic vascular endothelialgrowth factor (VEGF).Its prevantion can be made by a better management of the oxygenation of these children but also by a better knowledge of the other risk factors. The prevailing current treatment, laser ablation of the retina, is destructive and only partially effective. Preventive and less destructive therapies are much more desirable. So, Angiogenesis, or the formation of new retinal blood vessels is a key feature of many proliferative retinal diseases including diabetic retinopathy,retinal vein occlusions, and retinopathy of prematurity.
Glaucomatous optic neuropathy and oscillatory potentials in the ERG to long‐duration stimuli
Authors: KAZARYAN AA
Published: September 2009

Purpose To mark out OPs in the long‐duration flash ERG in primary open angle glaucoma (POAG) and to determine their role in diagnosis and monitoring of glaucomatous optic neuropathy (GON).

Methods 20 healthy subjects and 45 patients with different stages of glaucoma were investigated. Standard OPs and ERG to long‐duration stimuli (200 ms) were recorded. OPs for ON and OFF ERGs were isolated after mathematic filtration (80‐200 Hz). Optic discs of patients were evaluated by confocal scanning laser ophthalmoscopy HRT II. Index (mean) of early and late standard OPs were calculated separately.

Results Marked oscillations were determined in both ON and OFF ERG to long‐duration stimuli (3‐4 and 2‐3 waves respectively). Different decrease of amplitudes were detected depending on the stage of POAG. Subnormal OFF‐response of ERG to long‐duration stimulus and late standard OPs were observed in all stages of POAG. ON‐response of ERG to long‐duration stimulus and early standard OPs in the early stage of POAG were supernormal, whereas in the advanced and late stages they were subnormal. A statistically significant correlation was observed between standard OPs and OPs in the ERG to long‐duration stimuli.

Conclusion In POAG the OFF cone channels damage earlier. OPs of ERG to long‐duration stimulus are more sensitive indicator of ischemic processes in the retina. A strict correlation between different components of ERG may suppose that early waves of standard OPs are generated by ON‐components of cone and rod pathways, wile the origin of OFF‐OPs is related to OFF‐components of cone pathway.
EBO, ENET and accredited courses
Authors: TASSIGNON MJ
Published: September 2009

Abstract not provided
Effect of breathing a mixture of 92% O2 + 8% CO2 on flicker induced vasodilatation
Authors: LASTA M , PEMP B , GARHOFER G , SCHMETTERER L
Published: September 2009

Purpose It has been shown that increased neural activity evoked by stimulation with diffuse luminance flicker increases retinal and optic nerve head blood flow. Beside others, an increased oxygen demand has been attributed to evoke the flicker response. This study seeks to investigate whether the flicker light induced increase in retinal vessel diameters is different in subjects breathing 92% O2 + 8% CO2 compared to breathing room air.

Methods 24 healthy volunteers were included in the study. Diameters of retinal vessels were recorded continuously with a Retinal Vessel Analyzer. During this measurement flicker stimulation was applied at a frequency of 8 Hz. Subjects were breathing a combination of 92% O2 + 8% CO2 and room air in a randomized, two way cross over design. Flicker responses were assessed during the two breathing periods. Blood gas values were determined from capillary blood samples.

Results Under room air conditions flicker stimulation significantly increased retinal venous diameters (p<0.05). Breathing of 92% O2 + 8% CO2 increased pO2 from 88±18 mmHg to 277±71 mmHg (p<0.05) and pCO2 from 37±3 mmHg to 46±6 mmHg (p<0.05). Breathing a combination of 92% O2 + 8% CO2 significantly increased flicker induced vasodilatation in retinal veins compared to room air (p<0.05).

Conclusion Breathing of a combination of 92% O2 + 8% CO2 increases the response of retinal venous diameters to stimulation with flicker light. The reason for this effect has, however, yet to be clarified.
In vitro transcorneal and transscleral diffusion of radiolabeled compounds in human and rabbit cornea and in human, monkey, dog, and rabbit sclera
Authors: STRUBLE CB , EDELHAUSER HF , HOLLEY GP , GROSSNIKLAUS HE
Published: September 2009

Purpose To determine the in vitro diffusion of selected compounds across the cornea or sclera of humans, monkeys, dogs, and rabbits.

Methods Human and NZW rabbit corneas were obtained and the epithelium was removed from one cornea of each pair. Corneas were mounted in chambers with 3H‐water or 3H‐dexamethasone on the epithelial side and BSS solution on the endothelial side. Serial aliquots were taken from each chamber and assayed by LSC. Scleral sections from human, NZW rabbit, dog, or monkey eyes were mounted in perfusion chambers. Adjacent sclera was used for H&E histology. 3H‐water, 3H‐dexamethasone, or 70kD‐14C‐dextran were added to the episcleral surface while perfusing BSS across the choroidal side. Serial aliquots were collected up to 5 hrs and assayed by LSC. Scleral permeability (ktrans) was calculated. H&E slides were used to determine scleral thickness.

Results 3H‐water diffused through cornea faster than 3H‐dexamethasone, especially with denuded epithelium. Scleral thickness and molecular weight were determinant of diffusion in sclera. Monkey sclera was thinnest, followed by dog, rabbit, and human. ktrans for 70kD‐14C‐Dextran and 3H‐dexamethasone were greatest in monkey, followed by dog, rabbit, and human. ktrans values for 3H‐water were similar in all species, and greater than values for 14C‐dextran and 3H‐dexamethasone.

Conclusion These studies demonstrate permeability of cornea and sclera in human and animal models with compounds of varied molecular weights representative of drugs being developed for treatment of ocular diseases. The results of this study indicate that these techniques are valuable as screening tools in the development of ocular drugs.
Visual function after cataract surgery in patients with an aspherical lens without spherical aberration
Authors: PISELLA PJ
Published: September 2009

Purpose To compare quality of vision in pseudophakic patients with customized‐asphericity intraocular lens (IOL) compared to patients with zero‐aberration IOL after a Micro‐Incision Cataract Surgery (MICS).

Methods 26 patients (41 eyes) were divided into two groups: 24 eyes received a customized‐aspheric IOL in both eyes and 17 eyes received zero‐aberration IOLs. IOL asphericity was customized according to the preoperative corneal spherical aberration (SA) in order to obtain a total ocular SA close to +0 µm. We implanted either aspherical AcriSmart 36A® generating a ‐0,18 µm SA (for a 6 mm pupil diameter), or zero‐aberration AcriSmart 46LC®. Postoperative evaluations were conducted 6 months after MICS: refraction, best‐corrected visual acuity (BCVA), contrast sensitivities, point spread function (PSF), Modulation Transfer Function (MTF), objective depth‐of‐focus and ocular wavefront aberrations were analyzed.

Results Postoperative BCVA was similar in both groups (‐0,021 ± 0,105 LogMAR for the custom group versus 0 ± 0,11 LogMAR, p=0,58). Mesopic contrast sensitivity was significantly better in the custom group at intermediate and high spatial frequencies (p<0.001). SA was significantly lower in the custom group (Z40 = 0,085 ± 0,07 µm vs 0,261 ± 0,09 µm, p<0.001) whereas no difference of preoperative corneal SA was noted. MTF cutoff frequency is lower in the reference group than in the custom group (p=0,008). The objective residual accommodative amplitude was lower in the custom group: 1,31 ± 0,54 D versus 2,25 ± 0,65 D (p=0,006).

Conclusion Individual selection of IOL asphericity with a preoperative corneal spherical aberration measurement allowed control of final total amount of spherical aberration. Such a customization improved mesopic contrast sensitivity, and leads to better objective quality of vision.
Colorimetric comparison between different filtered IOLs and human crystalline lenses at various ages
Authors: MENCUCCI R , MENCHINI U , ROMANO G , MONICI M , FUSI F , GUASTI A , MERCATELLI L
Published: September 2009

Purpose To perform the colorimetric characterization of two different blue light filtered IOLs (Intra Ocular Lenses, from Alcon, USA and Hoya Corporation, Japan) and one UV‐violet filtered IOL (Bausch & Lomb, USA) comparing them with standard UV filtered IOL (Alcon) and human crystalline lenses at various ages.

Methods Three IOLs of each model with different dioptric power (16, 21 and 26 D) were analyzed. The colorimetric coordinates of the IOLs were calculated by measuring their transmission spectra by a spectrophotometric technique. Consequently, we defined a parameter (ΔE) proportional to the perceived color differences. A comparison was then performed between the various IOLs and human crystalline lenses of different ages (4, 22, 41, 53 and 72 years) considered from the literature. The CIE (Commission Internationale de l'Éclairage) standards were adopted for the colorimetric analysis.

Results The color distance ΔE was calculated for the 4 IOL models considered, respect to human lenses at different ages between 4 and 72 years. The maximum ΔE value was found respect to the standard UV filtered IOL for any other crystalline lens age and greatest for a human 72 year old lens. The minimum value for ΔE was obtained for both blue‐filtered IOLs respect to middle‐aged human lenses.

Conclusion None of the analyzed IOLs has the same colorimetric performance of the human crystalline lens. The two blue‐filtered IOLs reproduce at best the human lens yellowing of 20 to 50 years, among all the tested IOLs.
Screening history in those requiring fast track referral for proliferative diabetic retinopathy (PDR) in the ni diabetic retinopathy screening programme
Authors: HART PM , SAXENA R , JOHNSTON SE , FLYNN C , MCELDUFF P
Published: September 2009

Purpose If PDR is detected at screening, an urgent referral to an ophthalmologist ensues. This outcome can be stressful for patients and for the ophthalmologists who may need to treat very quickly. Aim: To examine the screening history of those deemed to require an urgent referral, with a view to identifying missed cases of referable diabetic retinopathy in previous screening encounters; and risk factors for interval cases.

Methods Fast tracked urgent referrals were identified from the NI DRSP database. Demographic factors and previous screening history were analysed.

Results In 2006‐7 18,887 attended for screening. 5.6% required referral to an eye clinic of which 0.3% were deemed urgent referrals (52 cases) 47 showed PDR; 5 had advanced NPDR in an only eye. 47% had Type 1 Diabetes; 52% had been diabetic for 20 years or more; 8% had been diabetic for 5 years or less. On feedback 98% were found to be appropriate referrals. At time of screening, 6 people had been lost to follow up from previous eye clinics. PDR was identified at the first screening event in the other 46 (88%). No cases were found where referral at a previous screening encounter would have been appropriate.

Conclusion Especially during the early years, screening programmes are very likely to encounter sight threatening retinopathy not previously identified. Over time, the balance between referral early in the disease process, and late, will hopefully be achieved but until then clinics must be prepared to manage the unpredictable urgent referral.

Commercial interest
Frequency of pterygium in indigenous Kadiweu
Authors: VERONESE RODRIGUES ML , SALUM TG
Published: September 2009

Purpose Study carried out in Amazonas, north of Brazil, reported that river indigenous people have much higher rates of pterygium than indigenous living in forest. Exposure to the sun was the major risk factor for pterygium . The objective of this study was to verify the frequency of pterygium in indigenous with different ethnic and cultural background, and living in another region of the country, with different geographic characteristics (Kadiwéu indigenous).

Methods Ocular examination was performed in 10% of the total population of Kadiwéu indigenous (90 subjects), living in two small villages, in “Serra Boquena” region, State of Mato Grosso do Sul, in center‐west Brazil.

Results The frequency of pterigyum in all participants was 15%. Considering only individuals over 20 years the rate was 20%.

Conclusion The frequency of pterygium in indigenous Kadiwéu is lower than the rate in river indigenous and higher than in forest people.
Sympathetic variability of intraocular pressure of glaucoma patients evaluated by wavelets
Authors: MARQUES‐NEVES C , GONçALVES C , LARANJO S , SANTOS M , FIGUEIREDO A , ROCHA I
Published: September 2009

Purpose We had showed the usefulness of wavelets in the detection of sympathetic activity in intraocular pressure(IOP).With we intend to evaluate sympathetic activity in glaucoma patients with and without topical therapeutics through the same methodology

Methods 3 groups of individuals of both sexes:1)a healthy individuals(HI,n=11);2)two groups of glaucoma patients with Primary Open‐Angle Glaucoma, one under treatment(GT,n=25) and another without(GNT,n=10).In a autonomic Lab. Continuous recording of IOP with Pascal‐DCT,in day before,individuals were told not to smoke and to avoid xanthines or other stimulants ingestion.Glaucoma patients were diagnosed by visual fields defects and optic disc analysis.For GT patients a wash‐out time of 1‐3 weeks was required depending on therapeutics.Individuals under medication or any other pathology that could affect the autonomic nervous system were excluded. Data analysis of systolicIOP in the time‐scale domain with wavelets(Db12)was performed during one minute.Statistical analysis using t‐Student, Welch corrected(Ducla‐Soares et al,2007)was used.LFIOP was calculated for the 3 groups and differenc.were consid. significant where p<0.05.Data(mean±SEM)

Results Mean age 49(40‐70),64(45‐67)and 61(36‐61) for HI,GT and GNT groups, respectively.The quantization of sympathetic variability of SIOP by wavelets was 0.4±0.17;0.122±0.075 and 0.118±0.067 for HI,GT and GNT groups respectively.Values were significantly different between HI and GT(p<0.05)and GNT(p<0.05)but not between the two groups of glaucoma patients

Conclusion Our data show that glaucoma patients have a significant decrease in sympathetic activity that could be due to an extraocular mechanism that persists with therapeutics
Retinal photocoagulation and oxygenation
Authors: POURNARAS CJ
Published: September 2009

Purpose The clinical role of photocoagulation for the treatment of hypoxia related complications of retinal ischemic microangiopathies is well established.

Methods Measurements of the partial pressure of oxygen (PO2) distribution within the the retina in various animal species using oxygen sensitive microelectrodes and evaluation of the retinal vessels reactivity by laser doppler velocimetry gave additional insights concerning photocoagulation mechanisms.

Results The PO2 within the vitreo‐retinal interface is heterogeneous. Preretinal and trans‐retinal PO2 profiles indicate that the preretinal PO2 far away from vessels remain constant in all retinal areas. Intervascular intraretinal PO2 gradually decreases from both the vitreo‐retinal interface and the choroid towards the mid‐retina. Close to the pigment epithelium, it is significantly higher than at the vitreoretinal interface due to the much higher O2 supply provided by choroidal compaires to retinal circulation. Laser photocoagulation reduces the outer retina O2 consumption and allows O2 diffusion into the inner retina from the choroid raising the PO2 in the inner healthy retinal layers and in the preretinal intervascular normal areas. In this way laser treatment relieves retinal hypoxia in experimental branch vein occlusion (BRVO). In patients with diabetic retinopathy (DR), the retinal PO2 is higher in areas previously treated with laser. Following photocoagulation, the resulting reversal of hypoxia, the retinal vasculature constriction and the improvement of the regulatory response to hyperoxia all affect favorably both the retinal neovascularisation and macular edema.

Conclusion Photocoagulation induces an increase of the inner retinal oxygenation reversing the retinal hypoxia and improving the regulatory response of the retinal vessels
Retinal and optic nerve oxygenation and carbonic anhydrase inhibition
Authors: LA COUR M , STEFANSSON E
Published: September 2009

Purpose To study the effects of carbonic anhydrase inhibition on porcine retinal and optic nerve oxygenation under physiological conditions and in experimental models of ischemia.

Methods Polarographic oxygen electrodes were used to measure the oxygen tension in the vitreous 500 microns in front of the optic nerve and retina. Retinal ischemia was produced by diathermia of the superior arcade vein, producing a branch retinal vein occlusion, BRVO. Optic nerve ischemia was produced by intravenous administration of 100 mg Indomethacin intravenously.

Results One week after induction of BRVO, the oxygen tension over BRVO affected retina was significantly decreased by 29%. Administration of the carbonic anhydrase inhibitor dorzolamide (500 mg) caused a significant increase in the oxygen tension over BRVO affected retina, and in effect restored this tension to normal values (n=5). Intravenous administration of 300 mg Indomethacin caused a decrease of optic nerve oxygen tension by 41%. Subsequent administration of 500 mg dorzolamide increased the optic nerve oxygen tension, albeit not to normal levels (n=6).

Conclusion Carbonic anhydrase inhibition increases the oxygen tension in the retina and optic nerve. In BRVO affected retina, carbonic anhydrase inhibition restores oxygen tension to normal levels.
Noninvasive oximetry and glaucoma
Authors: OLAFSDOTTIR OB , HARDARSON SH , GOTTFREDSDOTTIR MS , HARRIS A , STEFANSSON E
Published: September 2009

Purpose To investigate retinal vessel oxygen saturation in relation to glaucomatous visual field damage. Specifically, we examined whether oxygen saturation in retinal blood vessels differs between regions corresponding to glaucomatous visual field defects compared to regions without visual field defects.

Methods A spectrophotometric retinal oximeter (Oxymap ehf, Reykjavík, Iceland) was used to measure oxygen saturation in retinal arterioles and venules. The oximeter consists of a fundus camera, beam splitter, light filters and software that evaluate the oxygen saturation. The glaucomatous defect was estimated from a visual field test using the Octopus 1‐2‐3 perimeter. One eye in 13 individuals with open angle glaucoma with or without pseudoexfoliation syndrome was examined.

Results In retinal areas with no visual field defect, the mean oxygen saturation in arterioles was 102±6% and 65±9%, (mean±SD) in venules. The arteriovenous difference was 37±10%. In retinal areas corresponding to visual field defects, the mean oxygen saturation in arterioles was significantly lower; 98±5% (p=0.04, paired t‐test, n=13). The venules were at 68±7% (p=0.3) and the arteriovenous difference was also significantly lower; 30±10% (p=0.04).

Conclusion Arteriolar oxygen saturation and arteriovenous difference is statistically lower in areas with visual field defects compared to areas without visual field defects. This data suggests that visual field defects are associated with a reduction in retinal oxygen delivery and metabolism.
Retinal vessel oximetry using sequential and 'snapshot' hyperspectral imaging
Authors: MCNAUGHT A , HARVEY A , MUYO G , MORDANT D , ALLABOUD I , RITCHIE P
Published: September 2009

Purpose Use of sequential, and 'snapshot' hyperspectral imagers to measure oxygen saturation in retinal vessels in normals, and examples of eye disease, eg glaucoma, and retinovascular diseases. Validation of estimated oximetry values using a model eye.

Methods A sequential hyperspectral imager was constructed using a fundus camera with built‐in liquid‐crystal tuneable filter. Images of normals,and ocular disease are presented. A novel 'snapshot' hyperspectral imager is also described: this produces images in a single exposure. Validation of both devices using an artificial eye with capillary tubes containing human blood of known oxygen saturation, placed in front of an 'artificial retina' is described. The image analysis used to detect retinal vessels, and generate oximetric values is detailed.

Results Both the sequential, and 'snapshot' retinal imagers produced accurate estimations of retinal vessel oxygen saturation, when compared with the model eye. Imaging of a small group of glaucoma eyes showed abnormally elevated venous oxygen saturation. In proliferative diabetic retinopathy, abnormally elevated venular saturation was found in areas of capillary loss on FFA. In vein occlusion, elevated venous saturation was found in eyes with ischaemic FFAs.

Conclusion Both the sequential and 'snapshot' hyperspectral imagers deliver useful oximetric maps of the retina. The 'snapshot' device allows more rapid imaging. The elevated venular oxygen saturation seen in both glaucoma, and retinovascular disease, is perhaps evidence of reduced oxygen consumption in damaged inner retina in glaucoma, and/or vascular 'shunting' in retinovascular disease.
Need for training the trainers programme in harmonisation of education
Authors: HAWLINA M
Published: September 2009

Purpose Brief introduction to this session will be given to outline the need for structured teaching activities that would focus on the contents (i.e. what to teach) and the teaching methodologies (i.e. how to teach) and methodologies of assessment of knowledge.

Methods The mission of European Board of Ophthalmology is to harmonise training in Europe and the traditional scope of its activities include curriculum development, assessments (EBO Diploma examination), accreditation of training centers, exchange of residents an staff members and CME.

Results "Training the trainers" programmes are recognised as one of important and rapidly developing disciplines, needed to optimise and harmonise the teaching processes, both in medical and surgical domains as well as in improving professionalism.

Conclusion EBO has recognised the potential of TTT courses to advance and harmonise training in ophthalmology and will continue to foster and implement this knowledge to everyday teaching practices.
EBO curriculum development
Authors: CREUZOT C
Published: September 2009

Purpose To explain the aim of a curriculum development in European Board of Ophthalmology (EBO)

Methods The aim of the European Board of Ophthalmology Diploma (EBOD) is to define a test of excellence in Ophthalmology designed to assess the knowledge and clinical skills requisite to the delivery of homogenous and high standard of Ophthalmology care in hospital. The curriculum workgroup belonging to the Education committee of the EBO aims to define a curriculum to help students during their training. It should provide students with a comprehensive uniformed list of topics of knowledge to stimulate students according to their different levels of training to follow their acquisition. It should be a guide for the students to share their time between different topics. Finally it should define good resources in relation with the curriculum considered as a “European dreamy library” designed for all ophthalmologists.

Results Two steps were defined: one syllabus made of an exhaustive list of items with a list of resources to help the student to find good references. It should be useful for written exam to help students to define the topics to be known with an exhaustive point of view. The second one based on more detailed objectives is based on 3 different levels of objectives: the first one will define the pure knowledge (it is mainly dedicated to epidemiology, pathology, signs, risk factors, genetics …), the second one will be more advanced as it is dedicated to know how the student will… do something, interpret an exam, explain to the patient...The third one will provide the student with an appropriated list of references in relation with this specific topic.

Conclusion The development of curriculum is a key role of EBO to define the objectives of learning and acquisition during training.
How to conduct a good viva voce?
Authors: ACLIMANDOS W
Published: September 2009

The Viva Voce exam is a very useful way of assessing candidates applied knowledge and their decision making process. It is crucial that examiners maximize the use of the limited time allocated in order to be able to make a fair assessment. Guidance will be given on exam conduction, time utilization and questioning technique. Advise will be given on fair marking and the importance of comprehensive completion of the score sheets.
How to teach residents to teach and to select proper residents for this goal
Authors: VASSILEVA P
Published: September 2009

Purpose It is very important to promote the development of the academic ophthalmologist. Part of the curriculum of residency program should be designed for training in the academic sphere.

Methods Some residents demonstrate verbal and personal characteristics which show an ability to teach. Apart from professional knowledge and skills they possess the aptitude to communicate and emotionally involve the listener. The ophthalmic educators should actively seek out such trainees, focus on them, analyze and improve their case presentations and clinical reports.

Results It is advisable to include these individuals in medical student education from the beginning of their residency. In the late phase of their education the level of responsibility can gradually be increased to teaching new residents and taking part in post‐graduate programs. Throughout their ophthalmic residency they have to be continuously encouraged to pursue academic realization. An important aspect of this stimulation should be regular participation in various ophthalmologic events – both nationally and abroad.

Conclusion It is essential to motivate the selected trainees to read journals so as to keep track of new developments in ophthalmology, medicine and public health. The next most important step is active involvement in the process of manuscript creation and publication. Exposure to excellency in education through short visits to accredited training centers and participation in “training for trainers” symposia would be beneficial for understanding the value of good teaching.
Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency and proliferative diabetic retinopathy in a Sardinian male population, Italy
Authors: PINNA A , CONTINI E , GIACOBONI M , CARTA A , SOLINAS G
Published: September 2009

Purpose Purpose: The reported incidence of G6PD deficiency in Sardina, Italy, ranges from 10% to 15%. Hemizygous males have totally deficient erythrocytes. Evidence indicates that patients with G6PD deficiency are protected against ischemic heart and cerebrovascular disease, retinal vein occlusion, and nonarteritic anterior ischemic optic neuropathy. The purpose of this study was to assess the incidence of G6PD deficiency in Sardinian men with proliferative diabetic retinopathy (PDR) and ascertain whether G6PD deficiency may have a protective effect against this vascular disorder.

Methods Methods: G6PD blood levels were measured in 524 men with PDR. 1262 non‐diabetic men undergoing cataract surgery served as controls. The Z test was used to assess differences in G6PD deficiency prevalence rates between groups. The odds ratio (OR) was used to evaluate the association between G6PD deficiency and PDR.

Results Results: G6PD deficiency was found in 30 (5.7%) out of 524 patients with PDR and in 107 (8.5%) out of 1262 controls. Differences between PDR patients and controls were statistically significant (Z = 1.99, P<0.046). G6PD deficiency showed a statistically significant protective effect against PDR (OR: 0.66; 95% Confidence Interval: 0.43‐0.99).

Conclusion Conclusions: The prevalence of G6PD deficiency in Sardinian men with PDR was lower than expected. Results suggest that G6PD deficient men have a lower risk of developing PDR.
Phenotype‐genotype correlations of TGFBI in Asian patients
Authors: CHAI SM , VITHANA E , MEHTA J , TAN D , TIN A
Published: September 2009

Purpose Phenotypic‐genotype correlations of mutations in Tissue Growth factor beta‐inducible (TGFBI) responsive gene in Asian patients with Bowman’s membrane and stromal corneal dystrophies.

Methods Twenty families with Bowman’s membrane and stromal corneal dystrophies presenting to a tertiary referral centre underwent visual acuity testing, and ocular examination with slit lamp biomicroscopy. Blood was collected for genetic analysis and the TGFBI gene was screened for possible mutations.

Results There were 10 males and 10 females in this series, with10 Chinese, 4 Malays, 4 Indians and 2 Indonesians. The mean age was 48.9 years (range 9 ‐72). Five (out of 9) patients had the R555W mutation, while the other 4 had the R124H mutation. Of the 9 patients with lattice dystrophy, 2 had the H626R mutation while 5 had the R124C. One novel mutation Ala620Asp in a patient with lattice dystrophy was identified. Other mutations detected include R124L, R555Q and H572R .There was marked phenotypic variation amongst different TGFBI mutations.

Conclusion The most common mutation amongst our patients was R555W and R124C. We describe the clinical features of a previously unreported TGFBI mutation. There was marked phenotypic variability in TGFBI mutations in Asian patients.
A novel mitochondrial ND5 gene mutation m.13042G>A in Leber hereditary optic neuropathy
Authors: PAJTLER A , STIRN‐KRANJC B , BRECELJ J , HAWLINA M
Published: September 2009

Purpose To report clinical and genetic characterization of two related patients with Leber hereditary optic neuropathy (LHON).

Methods A 20‐year old man was referred in September 2004 for acute, painless and severe visual loss in his left eye, and then three weeks later in the other. Visual acuity (VA) on presentation was 0.2 in his right eye and HM in his left eye. His 11‐year old cousin was referred in December 2006 for acute and painless visual loss on both eyes with VA of CF in his right eye and 0,3 on his left eye. Fundus examination in both patients revealed engorged optic disc with telangectatic and tortuous vessels with no leakage on fluorescein angiography. MRI of brain was normal in both patients. There were loss of N95 vawe in PERG and abnormal VEP suggesting retinal ganglion cell loss and optic nerve disease. In first patient, VA decreased to HM on both eyes in few months and in 4,5 year follow up didn’t improve.In second patient, VA decreased to 0.001 on right eye and 0.04 on left eye in 2,5 year follow up.

Results Genetic tests of the mitochondrial(MT) DNA for three most common mutations (m.11778 G> A, m.3460 G>A, m.14484 T>C) responsible for LHON were negative in both patients. Use of Mito‐Chip 2 didn't reveal any mutations,whilst sequencing the entire MT‐genome in the first patient revealed mutation m.13042G>A (homoplasmy) in gene MT‐ND5; for second patient sequencing for this mutation is in process.

Conclusion This mutation has not been previously described in association with LHON and was not mentioned in mtDB or mtSNP (single nucleotide polymorphism) database (DB). The mutation is likely to be causative of the disease since no other mutations were found in MT‐genome in a patient with typical clinical presentation of LHON.
Severe ocular trauma cases: types and incidence
Authors: STOJANOVIC N , TSOLAKI F , TACHIAOS P
Published: September 2009

Purpose Presentation of severe traumatic ocular injuries during the year 2008 at Ophthalmology Department of Hippokration General Hospital in Thessaloniki

Methods The study included patients who came at our clinic with severe ocular trauma and needed admission for observation and/or surgical treatment (total number 26)

Results Included cases were: I) 9 (34,6%) cases of blunt trauma (4 with hemophthalmia and 5 with hyphaema), only 2 needed surgical evacuation. II) 6 (23,1%) corneal penetrating traumas with intraocular foreign body, all of which surgically treated, with mild visual impairment in 3 cases. III) 8 (30,7%) cases of corneal penetrating trauma without intraocular foreign body, 6 surgically treated, with good visual outcome in 6 cases, IV) 3 (11,6%) cases of scleral laceration without intraocular foreign body, all surgically treated, 1 of them with severe visual impairment

Conclusion Severe traumatic ocular injuries are frequent at Ophthalmology Department of Hippokration General Hospital (most frequent blunt trauma followed by corneal penetrating trauma) and with timely treatment the majority of cases had good visual outcome.
Ocular features and management in the mucopolysaccaridoses
Authors: PINELLO L , DE BELVIS V , MAZZAROLO M , SCARPA M
Published: September 2009

Purpose To evaluate the ocular findings and the visual outcome in a group of patients with mucopolysaccaridoses(MPS) followed and treated with new therapeutic options.

Methods 18 pazients with MPS (9 males and 9 females) were examinated: 3 cases with MPS type I, 4 with MPS type II,7 with MPS type III, 1 with MPS type IV and 3 with MPS type VI. The patients underwent an ophthalmological assessment with : visual acuity (with Teller Acuity Cards, Lea Symbols o letter chart, depending on patient age or degree of cohoperation), slit‐lamp examination, fundus ophthalmoscopy, intraocular pressure, refractometry, electroretinography and eye echography.

Results The mean follow‐up was 48 months (ranged from 3 to 190 months).The mean age at first ophtalmologic evaluation was 6,9 years ( ranged from 1 to 20 years). 8 case presented progressive corneal clouding, 5 case retinal pigmentary degeneration, and 1 papilledema. Visual acuity worsened severely in 3 cases with MPS type I: 1 case from 10/10 to 5/10, 1 case from 5/10 to 1/10; in another case visual acuity decreased to 1/20 and underwent to corneal transplantation with good visual outcome (RE 5/10 and LE 7/10). The other cases showed slightly reduction of visual function. 3 patients had ocular hypertension and were treated with hypotensive eye drops. 8 patients underwent enzyme replacement therapy.

Conclusion The mucopolysaccaridoses(MPS) are rare systemic disorders caused by accumulation of glycosaminoglycans. Ophthalmological manifestations are frequent in MPS, particularly in MPS I, II and VI, characterized by corneal clouding, retinal distrophy and blindness.Regular ophthalmic monitoring to determine disease progression and management of complications are necessary as a part of multidisciplinary approach.
Butaprost, a prostaglandin EP2 receptor agonist, counteracts the negative effect of serum deprivation to retinal ganglion cells
Authors: KANG K , OSBORNE NN
Published: September 2009

Purpose To investigate the neuroprotective role of butaprost an EP2 receptor agonist.

Methods Cultures of transformed retinal ganglion cells (RGC‐5 cells) were maintained in normal medium or medium that lacked serum for 48 hours. During this period butaprost was added in some cases to the medium. The cultures were then subjected to various methodologies (MTT‐assay, WST‐assay, APOPercentage analysis, TUNEL, DHE staining, LDH assay, flow cytometric anaylsis and immunohistochemistry) so as to characterize their nature of survival. The level of cAMP was also measured in some cases by ELISA.

Results Functional EP2 receptors in RGC‐5 cells were demonstrated by immunohistochemistry, western blot and by the generation of cAMP caused by the presence of butaprost. Serum deprivation resulted in RGC‐ 5 cells dying by apoptosis, indicated by APOPercentage™, TUNEL and flow cytometric assays. Butaprost (1 or 10 μM) added 30 minutes after the onset of serum deprivation significantly reduced cell death caused by serum deprivation.

Conclusion The EP2 agonist butaprost significantly attenuates apoptosis caused by serum deprivation. This data supports the view that EP2 agonists might have a role to play in the treatment of glaucoma given that it is known to lower IOP significantly.
Choroidal blood flow regulation during a latanoprost‐induced decrease in intraocular pressure
Authors: BOLTZ A , FUCHSJAEGER‐MAYRL G , LASTA M , PEMP B , SCHMIDL D , GARHOFER G , SCHMETTERER L
Published: September 2009

Purpose Blood flow regulation in the human choroid appears to be complex. We have recently shown that choroidal blood flow is better regulated during exercise‐induced changes in choroidal blood flow than during a suction‐cup‐induced increase in intraocular pressure (IOP). In the present study we hypothesized that choroidal blood flow regulation may be altered during a latanoprost‐induced decrease in IOP.

Methods In this prospective, balanced, placebo‐controlled parallel group study, 18 healthy male volunteers were included. Choroidal blood flow regulation was assessed using laser Doppler flowmetry during an artificial increase in intraocular pressure using a suction cup and during a 6 minutes squatting period. Results were compared before drug administration and after 14 days of topical instillation of either latanoprost or placebo.

Results Neither systemic blood pressure nor choroidal blood flow at baseline was altered by latanoprost. As expected, latanoprost did, however, reduce IOP. The regulation of choroidal blood flow was altered by latanoprost with a wider range of regulation compared to placebo treatment (p < 0.05).

Conclusion The present data indicate that administration of latanoprost improves choroidal blood flow regulation. Since latanoprost did not alter baseline choroidal blood flow this effect may be related to the reduction in IOP.
Choroidal blood flow response to hyperoxia and hypercapnia in patients with obstructive sleep apnea syndrome
Authors: KHAYI H , TONINI M , PEPIN JL , RENARD E , BAGUET JP , ROMANET JP , GEISER MH , CHIQUET C
Published: September 2009

Purpose Obstructive sleep apnea syndrome (OSA) is associated with ischemic and glaucomatous optic neuropathy. The physiopathology of these diseases includes an abnormal regulation in the optic nerve head vasculature. The aim of our study was to characterize the choroidal vascular reactivity to hyperoxia and 8% CO2 breathing in OSA patients, as compared with matched healthy control subjects.

Methods Eighteen newly diagnosed OSA patients were included in this prospective study. Control subjects were matched with OSA patients for body mass index (BMI), gender and age. At the screening visit, each subject underwent a general exam, cardiovascular, neurologic and ophthalmological examinations, and underwent complete overnight polysomnography. The LDF instrument used in this study to measure subfoveal choroidal blood flow (ChBF) measured the following parameters: ChBVel (kHz); volume, ChBVol (in arbitrary units, AU) and the relative flow, ChBF = ChBVel ? ChBVol (in AU). Vascular choroidal reactivity was tested during hyperoxia and hypercapnia (8% CO2) inhalation.

Results OSA patients exhibited a similar choroidal reactivity during hyperoxia (stability of choroidal blood flow) and hypercapnia (1.5% increase in choroidal blood flow per 1 mmHg PtCO2) than controls.

Conclusion This prospective comparative study explored for the first time the choroidal blood flow of OSA patients and results showed that subfoveal ChBF reactivity to gas in OSA patients is similar to healthy control subjects. These preliminary results suggest that choroidal vasculature is protected against the inbalance between the vasodilation (NO) and vasoconstriction (endothelin) system.
Retrobulbar flow velocities in open angle glaucoma and their association with mean arterial blood pressure
Authors: KAYA S , FUCHSJAEGER‐MAYRL G , RESCH H , GARHOFER G , PEMP B , VASS C , SCHMETTERER L
Published: September 2009

Purpose Previous experiments indicate that vascular dysregulation may play an important role in the pathogenesis of primary open angle glaucoma (POAG). Furthermore, evidence has been provided that reduced flow velocities as assessed with color Doppler imaging (CDI) are a risk factor for the progression of the disease. In the present study the association between retrobulbar flow velocities as measured with color Doppler imaging and ocular perfusion pressure were compared in patients with POAG and healthy control subjects.

Methods 253 patients with POAG and 198 healthy subjects have been included in this study. Peak systolic (PSV), end diastolic (EDV) and mean blood flow velocity (MFV) in the ophthalmic artery, the central retinal artery and posterior ciliary arteries was assessed using Doppler ultrasound. Resistance Index was then calculated as (PSV‐EDV)/PSV. Ocular perfusion pressure (OPP) was assessed based on measurements of systemic blood pressure and intraocular pressure.

Results Intraocular pressure was higher in glaucoma patients than in healthy controls (p < 0.01). All flow velocities were significantly reduced in POAG patients as compared to healthy control subjects (p < 0.01 each), whereas resistance index was increased in POAG. An association between blood velocities was found between OPP and blood velocities in both groups. This association was, however, higher in POAG patients than in the healthy control group.

Conclusion The present study indicates that there is a more pronounced association between retrobulbar flow velocities and OPP in POAG patients than in healthy control subjects. This supports the hypothesis that vascular dysregulation is present in patients with POAG.
Cis‐urocanic acid suppresses UV‐B‐induced interleukin‐6 secretion and cytotoxicity in human corneal and conjunctival epithelial cells in vitro
Authors: VIIRI J , JAUHONEN HM , RYHäNEN T , PAIMELA T , SORRI I , LAIHIA JK , LEINO L , SALMINEN A , KAARNIRANTA K
Published: September 2009

Purpose Urocanic acid (UCA) is a major UV‐absorbing endogenous chromophore in the epidermis and is also an efficacious immunosuppressant. The anti‐inflammatory and cytoprotective effects of cis‐UCA were studied in ocular surface cell cultures exposed to UV‐B irradiation.

Methods Human corneal epithelial cells (HCE‐2) and human conjunctival epithelial cells (HCEC) were incubated with 10, 100, 1000, and 5000 µg/ml cis‐UCA with and without a single UV‐B irradiation dose. Cell viability was measured by the colorimetric MTT (3‐(4,5‐dimethyldiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide) assay.

Results The UV‐B irradiation elevated IL‐6 secretion by 7 to 9‐fold in HCE‐2 cells and by 2‐fold in HCEC cells as analyzed with ELISA., declined by 30 to 50 % in HCE‐2 cells and by 20 to 40 % in HCEC cells after UVB irradiation. Treatment with 100 µg/ml cis‐UCA completely prevented both the elevated IL‐6 secretion and the decrease in cell viability to the same level as nonirradiated control cells in both cell types, i.e. simultaneous anti‐inflammatory and cytoprotective effects against UV‐B radiation.No significant effects on IL‐6 secretion or viability of the nonirradiated cells were observed with 10 and 100 µg/ml cis‐UCA, while 1000 µg/ml cis‐UCA evoked secretion of IL‐6 in both cell types. The 5000 µg/ml concentration was toxic.

Conclusion Cis‐UCA may represent a promising anti‐inflammatory and cytoprotective treatment option to suppress UV‐B‐induced inflammation and cellular damage in human corneal and conjunctival epithelial cells.
Investigation of particular surgical steps in epiretinal prostheses implantation procedure in pigs
Authors: IVASTINOVIC D , GEORGI T , HORNIG R , WEDRICH A , VELIKAY‐PAREL M
Published: September 2009

Purpose Proliferative vitreoretinopathy (PVR) is known a known complication of implantation of epiretinal prostheses in porcine eyes using our combined surgical procedure of vitrectomy, lensectomy, large scleral incision and retinal tack insertion. The aim of the present experimental study is to investigate the intraocular reaction to particular parts of the epiretinal prostheses implantation procedure in pigs.

Methods 15 pigs were divided into 3 groups. Group 1 (n=6) underwent vitrectomy, lensectomy, insertion of inactive epiretinal prosthesis through a scleral incision and fixation to the posterior pole with a retinal tack. In group 2 (n=5) vitrectomy, scleral incision and retinal tack insertion were performed. Group 3 (n=4) received vitrectomy, scleral incision and insertion of a shortened prosthesis into the vitreous cavity. The follow up was 4 weeks.

Results PVR was observed in all eyes of group 1 and in one eye of the group 3 with unintentional perforation of the lens capsule by the shortened implant. In all other eyes funduscopy revealed no clinical pathology.

Conclusion Our results indicate that lensectomy is the key stimulus for PVR in porcine eyes while other steps of the implantation procedure are well tolerated. Though pigs do not seem to be a reactive animal model, lens manipulation should be avoided in the surgical procedure for the implantation of retinal prostheses.