bluuebunny/crossref_metadata_2025 huggingface dataset:
FDT Matrix 24‐2 threshold strategy for the evaluation of glaucoma suspects and ocular hypertensive eyes
Authors: MICHELONE L , TROVARELLI S , MADONIA M , DA POZZO S , DI LAURO MT , SORCE G , RAVALICO G
Published: October 2007

Purpose: To evaluate FDT Matrix 24‐2 threshold strategy diagnostic performance in discriminating healthy subjects from glaucoma suspects (GS) and ocular hypertensives (OH) patients.

Methods: 23 healthy subjects, 27 OH, 21 GS and 20 EG patients were recruited. Classification was based on optic disc and Humphrey Field Analyzer (HFA) perimetry criteria (glaucoma if PSD<95% and/or GHT outside normal limits). A complete ophthalmologic evaluation, HFA (24‐2, SITA standard) and FDT perimetry (24‐2, ZEST strategy) were performed in all subjects. A severity score (from 1 for points with <5% probability up to 4 for probability <0.5%) was calculated from defective points on pattern deviation map and mean values (±SD) in the 4 groups were compared at Mann‐Whitney test. AUROC curves were created in order to assess MD, PSD and severity score diagnostic accuracy.

Results: MD and PSD displayed chance discriminating power in OHs (AUROC<0.6) on both instruments. For GSs, FDT‐MD and PSD have larger but not statistically significant AUROC than HFA. For EG, diagnostic performance of the two instruments is very similar with excellent AUROC (>0.9). Severity score on the 2 instruments are similar for OHs, whereas significance limit was nearly reached (p=0.057) for GSs and significant difference appeared (p=0.002) for EG eyes with higher score on FDT.

Conclusions: FDT Matrix 24‐2 threshold strategy apparently does not offer advantages over HFA in OH and EG. In GS, statistically significant improvement in diagnostic accuracy was not demonstrated, probably because of insufficient sample size. Thus, the role of FDT Matrix in clinical practice needs further investigation.
Changes in corneal surface aberrations after myopic INTRALASIK and LASEK: Comparison between Technolas and Esiris
Authors: CANADAS SUAREZ P , ARRANZ E , GARCIA‐RECIO C , VILLAFRANCA M , TEUS MA
Published: October 2007

Purpose: To compare high order corneal aberrations (HOCA) after myopic INTRALASIK and LASEK, using two different excimer lasers

Methods: This prospective study included 237 eyes of consecutive patients divided into 4 groups; group 1 LASEK with Technolas (LT) 61 eyes, group 2 LASEK with ESIRIS (LE) 73 eyes, group 3 INTRALASIK with Technolas (IT) 61 eyes, group 4 INTRALASIK with Esiris (IE) 42 eyes.

Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and manifest refraction were measured, in groups, before and 3 months after surgeries.

The topography data were used to calculate HOCA with 6 mm pupil size, before and 3 months after surgery.

Results: There were no significant differences concerning visual results 3 months after surgery in none of the 4 groups.

However, there was an increase in total RMS and high order in patients treated with Esiris laser. The aberrations with INTRALASIK (p< 0,01) were higher. With Technolas laser, there were significant differences in total RMS, spherical and coma aberrations. In this case, aberrations after LASEK (p< 0,01) were higher.

Conclusions: Our results suggest that both excimer lasers produce an increase in HOCA with equal visual results. Higer HOCA were found after INTRALASIK with Esiris and LASEK with Technolas.
Antimicrobial treatment of presumed ocular tuberculosis
Authors: KOUPRIANOFF S , CHIQUET C , BOUILLET L , ROMANET JP
Published: October 2007

Purpose: Uveitis secondary to a tuberculosis is rarely reported, even in a tertiary a care center. The prevalence of tuberculosis is low in Western Europe and its microbiological identification is difficult. However, anti tuberculosis treatment may be useful when the diagnosis of tuberculosis is presumed.

Methods: The clinical records of patients with suspected tuberculosis uveitis referred to the Ophthalmology Department of the Grenoble University, between January 2005 and January 2007 were retrospectively analyzed. Patients were included in this series if they received a specific antituberculosis treatment.

Results: This series included 10 patients (3M/7F, mean age 54.1). The clinical features of ocular inflammation were: bilateral panuveitis, episcleritis, bilateral posterior uveitis, and pars planitis. Tuberculin skin test, chest computerized tomography, BK sputum, and internal medicine consultation were performed for all patients. The diagnosis of presumed tuberculosis was based upon: history, thoracic imaging, and tuberculin skin test. None had extra‐ocular symptoms. Sputum cultures were negative, 2 adenopathy biopsies confirmed the diagnosis. Nine patients received specific antituberculosis therapy, without systemic steroid therapy. All of them improved; no relapse occurred after 1 to 2 years after the end of therapy. In one case, tuberculosis specific therapy allowed to taper the systemic steroid therapy.

Conclusions: The diagnosis of uveitis associated with tuberculosis is difficult since it depends on a spectrum of indirect signs. Bacteriological identification is rarely obtained. In presumed ocular tuberculosis, antituberculosis therapy may be useful to control intraocular inflammation, with or without steroid therapy.
Diagnostic coincidence of the technologies of analysis of image HRT, OCT and GDx‐VCC
Authors: ALIAS EG , BORQUE E , LARROSA JM , POLO V , FERRERAS A , HONRUBIA FM
Published: October 2007

Purpose: To value the diagnostic coincidence and specificity between different structural parameters of the topography papilar realized with the HRT3, the optic coherence tomography Stratus OCT 3000 and the laser polarimetry GDx‐VCC.

Methods: There were included 41 eyes of 41 normal subjects ( intraocular pressure <21mmHg, normal optic nerve head morphology and standard automated perimetry ), and, 312 eyes of 312 consecutive patients sent by the ophtalmologist of zone for suspicion to be able to suffer glaucoma. An analysis was realized to each of them by means of HRT, OCT and GDx‐VCC and there was valued the diagnostic opposing coincidence. Considered to be criteria of damage a Moorfields Regresión Analysis ‐ MRA ‐> 95 % and a Glaucoma Probability Score ‐ GPS ‐> 0.51 to level of the HRT, a NFI> 30 in the GDx and an average thickness or in a quadrant of the cap of retinal nerve fiver layer thickness with a value of p <5 % by OCT.

Results: The specificities of MRA and GPS were 85 % and 80 %, in the GDx‐VCC of 78 % and in the OCT of 71 %. Between the suspects they found 113 positive cases by means of MRA, 153 by GPS, 101 by OCT and 64 by GDx‐VCC.

Conclusions: It is necessary to possess the analyzers of image in the screening of the glaucoma since they contribute a high specificity, being major the contributed one for the HRT. The opposing specificity is not associated with a low number of positive cases and the diagnostic coincidence of the different analyzers is high.

Key words: glaucoma, diagnosis, HRT, OCT, GDx‐VCC.
Role of EGFR in corneal remodelling in diabetes
Authors: AKHTAR S , BRON AJ , YOUSIF MHM , BENTER IF , AKHTAR S
Published: October 2007

Purpose: To examine the role of epidermal growth factor receptor (EGFR) signalling on ultrastructural organisation and remodelling of stromal corneal collagen fibrils (CF) and proteoglycans (PG) in the diabetic rat.

Methods: Diabetes was induced in female Wistar rats (n=5) by streptozotocin (STZ) injection (55mg/kg). Treatment with a selective inhibitor of EGFR tyrosine kinase, AG1478, was started on the same day as the induction of diabetes and administered every other day for four weeks. The corneas were fixed in 4% PFA at 4ºC to analyse the collagen fibril diameter. To study the distribution of proteoglycans the corneas were fixed in 2.5% glutaraldehyde in sodium acetate buffer containing cuprolinic blue. The analySIS soft imaging program was used to analyse CF and PG.

Results: In addition to a reduction in the epithelial thickness in the diabetic cornea, the median diameter and area fraction of CF in the stroma was decreased in diabetic rats compared to normal rats (p<0.001). In contrast, the median PG area and area fractions in diabetic rat corneas were significantly increased (p<0.001) compared to normal. Treatment with AG1478 prevented diameter and area fraction changes in CF and PG and restored corneas to a normal appearance.

Conclusions: These data show that the distribution of stromal CF and PG is altered in corneas after 4‐weeks of diabetes. Furthermore, treatment with an inhibitor of EGFR signalling normalized these abnormalities. Thus our data suggest that the EGFR plays an important role in the development of diabetes‐induced corneal remodelling.
Oncocytic adenocarcinoma of lacrimal gland with GCDFP15 positivity
Authors: TOSOUNIDIS IH , BONSHEK RE , LEATHERBARROW B , LANE C
Published: October 2007

Purpose: We present a very rare case of an oncocytic adenocarcinoma of the lacrimal gland. In our case it seems to arise from an oncocytoma and there is an interesting immunophenotype of this tumour, since it appears positive for the GCDFP 15 protein, which has not been described before.

Methods: A 77‐year‐old woman presented to the ophthalmologist, complaining of a six‐month history of pains at the left canthus. Incisional biopsy showed an epithelial oncocytic neoplasm which was reviewed in a tertiary ophthalmic pathology centre, where a immunohistochemistry revealed positivity for CK7 and GCDFP15 (PIP), with negativity for OR(ER), CK20, HepPar1, AFP, CA19‐9, TTF, S100, chromogranin and synaptophysin.

Results: After excluding the possibility of metastasis from a non‐ocular/adnexal primary neoplasm, she underwent left orbital exenteration. Pathological examination showed an aggressive oncocytic adenocarcinoma involving the lacrimal gland and containing a small focus of what appeared to be oncocytoma. The immunophenotype was similar to the original biopsy. Electron microscopy confirmed large numbers of mitochondria present within the tumour cells.

Conclusions: We reviewed the ophthalmic literature for previous reported oncocytic adenocarcinomas. Our case is different in that there is a very interesting immunohistochemical profile with a strong positivity for gross cystic disease fluid protein 15 (GCDFP15), which has never been described before in oncocytic lesions of the lacrimal gland. An interesting theory would correlate the fact that both organs (breast and lacrimal gland) derive from ectoderm, but this correlation needs to be thoroughly investigated.
Functional characteristic of the retina in glaucoma
Authors: KAZARYAN AA
Published: October 2007

Purpose: Purpose: To investigate bioelectrical activity of the retina in normal subjects and patients with primary open angle glaucoma (POAG).

Methods: Methods: 40 eyes of 20 normal subjects and 80 eyes of 45 patients with different stages of glaucoma were examined with electroretinogram (full‐field, flicker, pattern, multifocal ERG, ERG to long duration stimulus and chromatic ERG to red, green and blue stimulus). Intraocular pressure was 21 mm Hg or less in all patients. All patients were also tested on HRT II.

Results: Full‐field ERG recordings showed a decrease of b‐wave amplitude and an increase of implicit time in advanced and late stages of POAG. Macular chromatic ERG to red stimulus of 15° area was subnormal in all stages of POAG (p<0,01). The density of retinal responses of multifocal ERG was progressively decreased in all stages. An amplitude of P50 component of pattern ERG in initial stage of glaucoma was decreased (p<0,05). In advanced stage of glaucoma a significant decrease of amplitudes of P50 and N95 components and prolonged implicit time of N95 component were observed.

The off‐component of long duration stimulus flash ERG in all stages was subnormal. The on‐component in early stage was supernormal, whereas in advanced and late stages was subnormal. A damage of off‐cone system of the retina was the first symptom of retinal changes in glaucoma. In initial stage of glaucoma ERG symptoms of glaucomatous neuropathy were first detected even before changes on HRT test.

Conclusions: The retinal pathology presented in ERG symptoms may probably reflect some pathogenetic mechanisms of development of glaucomatous damage, including excitotoxcic factors and ischemia.
Comamonas: a not so comon agent in hydrogel contact lens wearers
Authors: LANGMAN ME , DIGHIERO PL , GICQUEL JJ
Published: October 2007

Purpose: To present an unusual agent responsable for a case of keratitis in a hydrogel contact lens wearer.

Methods: A 16 year old patient, hydrogel contact lenses wearer, presented with red eye. The patient reported red eye with blurred vision and pain for 1 day. In the central cornea, two stromal lesions were found surrounded by an infiltrate. The contact lenses, the lenses box and lenses cleansing products were sent to analyse and Comamonas acidovorans was found.

Results: The agent isolated was Comamonas acidovorans, a species of Pseudomonas.The patient was treated with local ciprofloxacin, tobramycine and hexamidine diisetionate 0, 1% with remission of the case.

Conclusions: Cultures and sensitivity studies should be performed in contact lenses wearers. Comamonas acidovorans should be considered as a possible keratitis agent.
Outcome and risk factors for failure of primary trabeculectomy
Authors: MEDVED N , CVENKEL B
Published: October 2007

Purpose: To evaluate the outcome and risk factors for failure in primary trabeculectomy in glaucoma patients.

Methods: Medical record review of 59 patients (66 eyes) who underwent primary trabeculectomy from 2002 to 2006 at the Eye Hospital Ljubljana. Complete success was defined as intraocular pressure (IOP)≤18 mmHg without glaucoma medications, and failure as IOP>18 mmHg with or without medications.

Results: The mean preoperative IOP was 31,4 mmHg (±9,7) on an average of 2,5 glaucoma medications, and the mean postoperative IOP after 20 months was 16,8 mmHg (±6,4) on an average of 0,6 medications. Twenty months after trabeculectomy 51 of 66 eyes (77,3%) had an IOP≤18 mmHg without medical treatment. Ten of 15 eyes (66%) experienced failure within the 6 months after trabeculectomy. Using Kaplan‐Meier life table analysis the 3 and 5 year probability of an IOP≤18 mmHg without medication was 70%. After 3 years, the cumulative survival rates for eyes after trabeculectomy with mitomycin C (22 eyes), 5‐fluorouracil (31 eyes)and trabeculectomy without antimetabolite (13 eyes) were 78%, 77%, and 57%, respectively. Postoperative interventions (needling of filtering blebs and subconjuntival injections of 5‐fluorouracil) were associated with a higher rate of failure with the hazard ratio of 2,9 (P=0,04). Patients' age, number of preoperative medications, and cataract surgery were not significant predictive factors for failure.

Conclusions: The outcome of primary trabeculectomy in our patients is comparable with that reported in other populations using the same criteria for success. More pronounced healing response after surgery necessitating needling of filtering blebs and subconjuctival injections of antimetabolite are associated with a higher risk for trabeculectomy failure.
Nycthemeral rhythm of intraocular pressure in normal tension glaucoma
Authors: RENARD E , PALOMBI K , CHIQUET C , PEPIN JL , NOEL C , ROMANET JP
Published: October 2007

Purpose: To characterize the circadian variations of intraocular pressure (IOP) in the normal tension glaucoma (NTG).

Methods: Fourteen patients with NTG were studied. The age range was from 45 to 87 years old. All patients underwent a complete ophthalmologic examination (including corneal thickness) and visual field (Humphrey type). Then, IOP measurements were hourly controlled by Tonopen TM*, during a 24 hour cycle associated with sleep monitoring. The sleep study included a polysomnography (to exclude a sleep apnoea syndrome) and was associated with 24 hour measurements of blood pressure and heart rate. The nycthemeral rhythm was defined according to the cosinor technique.

Results: Sixty percent of the patients exhibited an absence of circadian rhythm of IOP among 24 hours. Twenty one percent of the patients had a nocturnal rise of IOP and 21% of the patients had a diurnal rise of IOP (< 21 mmHg). A sleep apnoea syndrome was diagnosed in 71% of the patients, abnormal nocturnal dips of arterial pressure were present in 78%, a vasospastic syndrome was present in 41.6% with and 40% of the patients exhibited an systemic hypertension.

Conclusions: In our study, most of the patients shown an absence of nycthemeral rhythm of IOP. In this population, a high prevalence of sleep apnoea syndrome, of abnormal nocturnal dips of blood pressure, and of vasospastic syndrome was found.
High Order Aberrations of the eye implanted the Verisyse® iris‐claw intraocular lens
Authors: GICQUEL JJ , LANGMAN ME , NGUYEN KHOA JL , MERCIE M , DIGHIERO PL
Published: October 2007

Purpose: To investigate the influence of the secondary implantation site of the Verisyse® iris‐claw intraocular lens (IOL) on high order aberrations (HOAs) using wavefront analysis in aphakic patients.

Methods: Twenty aphakic patients (20 eyes) who had complicated phacoemulsification, leaving no capsular support, but good iris support and clear unwounded cornea implantated with the aphakic Verisyse®(AMO) intraocular lens site either implanted retropupilarely or over the iris. Wavefront aberrations were measured using the IRX3 Hartmann‐Shack aberrometer at 4 mm pupil aperture diameter.

Results: Nine patients were implanted in the anterior chamber versus 11 who had the IOL clipped behind the iris. Best corrected visual acuity was significantly higher and HOAs were significantly lower in the retropupilarely implanted group.

Conclusions: In addition to being atraumatic, the Verisyse® intraocular lens implanted behind the iris may restore vision in the absence of capsular support in a more physiological way than when fixated over the iris.
Diagnosis and follow‐up in patients with optic neuritis by means of optical coherence tomography (OCT) and scanning laser polarimetry (GDx)
Authors: EGEA ESTOPINAN MC , PUEYO ROYO V , GUERRI N , SANCHEZ CANO A , FERNANDEZ TIRADO FJ , RABINAL ARBUES F , HONRUBIA FM
Published: October 2007

Purpose: To evaluate the accuracy of ocular imaging technologies, such as Optical coherence tomography (OCT) and Scanning laser ophthalmoscopy (GDx) in the diagnosis and follow‐up of optic neuritis.

Methods: A total of 13 patients with optic neuritis and 13 age‐ and sex‐matched healthy controls were included in this prospective, clinical study and followed up for six months. All of them underwent neurologic assessment and a complete ophthalmic examination that included visual acuity, colour vision (Ishihara pseudoisochromatic plates), visual field, OCT and GDx.

Results: In acute episode, there were significant differences in visual acuity, Ishihara colour test, visual field mean deviation (MD), either in anterior or posterior optic neuritis, compared with healthy eyes. Eyes with acute papillitis showed increased RNFL thickness measured by OCT in every retinal quadrant compared with healthy eyes, but differences were not statistically significant. Six months after the acute episode, visual acuity, colour test and visual field had improved but we observed RNFL thinning in eyes with optic neuritis compared with control eyes. Both the OCT and the GDx detected significant differences between the groups six months after the acute episode

Conclusions: Structural analysis of the RNFL by means of OCT and GDx is useful in optic neuritis diagnosis and follow‐up. Optic neuritis, either anterior or posterior, causes a decrease in the RNFL thickness, which can be detected by OCT and GDx
Corneal backscatter after penetrating keratoplasty
Authors: PATEL SV , MCLAREN JW , BOURNE WM
Published: October 2007

Purpose: To determine changes in corneal backscatter in clear grafts after penetrating keratoplasty (PK) and in grafts that had failed from late endothelial failure (LEF).

Methods: Sixty‐one grafts, deemed clear by slit‐lamp examination, in 46 patients and 12 grafts with LEF in 11 patients were examined at 1 to 30 years after PK. Backscatter was measured from the anterior, middle and posterior thirds of the cornea from a digitized image of a high magnification slit‐beam through the center of the cornea. Clear grafts were compared to grafts with LEF and to 41 normal (unoperated) corneas of 41 subjects by using unpaired t‐tests. Photopic low contrast visual acuity (LCVA) was measured in 32 of the clear grafts. Generalized estimating equation models were used to account for correlation between fellow eyes of the same patient.

Results: Backscatter was increased by 80%, 49% and 34% in grafts with LEF compared to clear grafts in the anterior (P< 0.001), middle (P< 0.001) and posterior (P= 0.01) thirds of the cornea, respectively. Backscatter was increased by 16%, 18% and 29% in clear grafts compared to normal corneas in the anterior (P< 0.001), middle (P< 0.001) and posterior (P< 0.001) thirds of the cornea, respectively. Backscatter from clear grafts correlated with time after keratoplasty in the anterior (r= 0.23, P= 0.005), middle (r=0.21, P= 0.006) and posterior (r=0.32, P= 0.003) thirds of the cornea. LCVA correlated with backscatter in the anterior (r= ‐0.63, P< 0.001), middle (r= ‐0.56, P< 0.001) and posterior (r= ‐0.51, P= 0.003) thirds of the cornea.

Conclusions: Backscatter from penetrating corneal grafts is higher than normal, and substantially higher in grafts with LEF. Backscatter increases with time after keratoplasty, and increased backscatter is associated with decreased LCVA.
Secondary IOL implantation without capsular support. A laser flare cell‐meter study
Authors: BRAVETTI GO , LEONETTI P , MANDRIOLI M , STROBBE E , CELLINI M , CAMPOS EC
Published: October 2007

Purpose: The cataract surgery consist in phacoemulsification of the lens and implant of an intraocular lens (IOL). In some cases when the capsular support is absent we must use an anterior‐chamber IOL (ACIOL’s) or a posterior‐chamber IOL (PCIOL’s) transclerally sutured. We studied the intraocular inflammation after secondary implant of iris‐fixated ACIOL, angle‐supported anterior‐chamber (AC)IOL and transcleral‐fixated PCIOL.

Methods: We enrolled 60 patients with post‐surgery aphakia, for a total of 60 eyes. Twenty patients received an ACIOL (Artisan), in twenty patients was implanted PCIOL.

(PC 279Y) and in the last twenty patients was implanted an (AC)IOL. Twenty patients with PCIOL in the bag were used as control group. We performed an evaluation of anterior chamber cellularity with a laser flare‐cell meter (Kowa 500) 30 and 90 days after secondary implants.

Results: The anterior chamber flare‐cell, after 30 days, was 15,442 ± 10,435 photon/ms in ACIOL group, 22,716 ± 6,634 photon/ms in PCIOL group and 14,11 ± 7,087 photon/ms in the (AC)IOL group. (ACIOL vs PCIOL p<0.004; PCIOL vs (AC)IOL p<0.001; ACIOL vs (AC)IOL p<0.376) After 90 days the flare was 10,937 ± 7,393 ACIOL group, 18,311 ± 6,033 in PCIOL group and 10,605 ± 3,959 in (AC)IOL group. (ACIOL vs PCIOL p<0.003; PCIOL vs (AC)IOL p<0.001; ACIOL vs (AC)IOL p<0.507).

Conclusions: Our study shows chronic subclinical inflammation after 30 and 90 days from implantation of all IOL types but the flare is less in the ACIOL’s and (AC)IOL groups than in the PCIOL group. So we think that in without capsular support it is better to implant an anterior‐chamber iris‐fixated or an angle‐supported anterior chamber IOL's .
The grey fovea sign of foveal edema or serous detachment on non‐stereoscopic digital red‐free fundus photographs
Authors: PASCAL HASLER , SOLIMAN WS , SANDERS BS , HAAMANN PH , LARSEN ML
Published: October 2007

Purpose: To describe a simple, visually recognizable sign of foveal fluid accumulation on non‐stereoscopic fundus photographs recorded in red‐free illumination and displayed as a grey‐scale image.

Methods: 100 selected digital fundus photographs from 100 eyes with diabetic retinopathy or central serous chorioretinopathy or from healthy volunteers were graded by 4 masked observers and the result compared using transfoveal optical coherence tomograms as the reference method for determining whether an abnormally thick fovea or subfoveal fluid was present. The photographs were graded for the presence of a darkly pigmented fovea, diffusely circumscribed toward the surrounding macula or the absence of this feature, as may be seen when foveal thickening or detachment is sufficient to increase light scatter in the neurosensory fovea, making it acquire a shade of grey comparable to the surrounding retina (the grey fovea sign).

Results: Mean foveal thickness, including subretinal fluid, was significantly higher in eyes graded as showing evidence of the grey fovea sign (309.3 ± 4.0 μm) than in eyes with a dark fovea (262.5±6.2 μm; p < 0.05).

Conclusions: The results support the hypothesis that visual grading of greyscale fundus photography in red‐free illumination enables detection of signs or foveal edema or detachment in the form of a generalized of localized replacement of the healthy dark fovea with a brighter shade of fundus reflection that is nearly identical to the surrounding macula
The impact of clinical variables on the visual field damage of patients with pseudoexfoliative glaucoma
Authors: MARTÍNEZ‐GARCÍA A , SANCHEZ‐SALORIO M
Published: October 2007

Purpose: To evaluate the relationship between the visual field global indices [Mean defect (MD), and Pattern Standard Deviation (PSD)] and different clinical characteristics in patients with pseudoexfoliative glaucoma (PEX).

Methods: 56 consecutive patients with newly diagnosed PEX were included in this prospective cross‐sectional study. Visual field was assessed using the 24‐2 Swedish Interactive Threshold Algorithm (SITA). Clinical variables assessed were: Age, intraocular pressure (IOP), systolic and diastolic blood pressure, ocular perfusion pressure, central corneal thickness (CCT), and Doppler measurements in ophthalmic artery and posterior ciliary arteries. For each patient, the eye with the worse PSD of the visual field test was considered as the study eye. The relationship among clinical variables and visual field indices were analyzed by linear regression analysis.

Results: The linear regression analyses showed that the age, IOP and CCT were correlated with both the MD (p=0.0001, p=0.0062, and p=0.0449, respectively) and the PSD (p=0.0013, p<0.0001, and p=0.0004, respectively).

Conclusions: In patients with pseudoexfoliative glaucoma the visual field damage seems to be correlated with the age, IOP and CCT.
Ghrelin expression in the iris and ciliary epithelium of fetal and newborn rats
Authors: ROCHA DE SOUSA A , MOURA RS , SARAIVA J , AMARAL M , CORREIA‐PINTO J , LEITE‐MOREIRA A
Published: October 2007

Purpose: The presence of ghrelin was previously identified in the posterior epithelium of the iris and in the non‐pigmented ciliary epithelium. Ghrelin is also a potent relaxator of the iris sphincter muscle.

Methods: Sprague‐Dawley rat fetuses were removed by caesarian section at 10.5, 11.5, 12.5, 13.5, 17.5, 20.5 dpc, and 15 day‐old animals (P15) were euthanized Specimens (heads or eyes) were paraffin embedded and processed for in situ hybridization (ISH). Digoxigenin‐labeled ghrelin probe was synthesized from a 247bp fragment of prepro‐ghrelin.

Results: Ghrelin’s mRNA was expressed in the posterior epithelium of the iris of 17.5, 20.5 dpc fetuses and P15 animals. Furthermore, in 20.5 dpc fetuses and P15 animals there was also ghrelin expression in the non‐pigmented ciliary epithelium.

Conclusions: Ghrelin is expressed during development of the rat’s eye from 17.5 dpc onward. Its expression is more evident in the posterior epithelium of the iris and ciliary epithelium. These findings could enrol a new function of ghrelin in the development of the anterior segment of the eye.
Validity of non‐mydriatic cameras for screening and follow‐up in diabetic retinopathy
Authors: IBANEZ J , MATEO A , FAURE E , CRISTOBAL JA , DEL BUEY MA , MINGUEZ E , NUNEZ E , ASCASO FJ
Published: October 2007

Purpose: To determine the validity of a non‐mydriatic camera for screening and grading diabetic retinopathy (DR). To establish the number of photographs and the field width needed for a correct DR follow‐up.

Methods: A cross‐sectional, observational study was carried out to assess the validity of the non‐mydriatic Topcon TRC‐NW6S retinograph. Validity proportions were calculated. Kappa analysis was made to determine the agreement with conventional fundoscopy exploration performed by indirect ophthalmoscopy and retinal biomicroscopy. One 45º single‐field non‐mydriatic digital photograph was taken in 82 eyes for DR screening. For DR grading, several combinations of retinal fields were photographed in 247 eyes, first without pupillary dilatation and later with mydriasis.

Results: In DR screening, 88.2% sensitivity and 96.9% specificity were obtained, where 9% of the tests were invalid. In DR grading diagnosis, the kappa analysis showed close agreement (k>0.8) based on at least two 45º photographs with mydriasis. However, when attempting to detect macular edema (ME), the maximum kappa statistic obtained did not go above 0.71, showing 67% maximum sensitivity. The sensitivity for detecting derivable DR was similar to that obtained with indirect ophthalmoscopy (94‐98%).

Conclusions: The non‐mydriatic retinograph is a valid instrument for DR screening only when taking one 45º non‐mydriatic photograph per eye. However, given that the sensitivity for proliferative DR (PDR) was worse, when grading DR, we would recommend obtaining nine retinal photographs (mosaic) with mydriasis. Used in this way, the apparatus is extremely useful for detecting derivable DR cases.
AML with bilateral retinal detachment
Authors: SARKADY E , JONES NP , BONSHEK RE
Published: October 2007

Purpose: To present a case of thrombotic ocular and CNS involvement complicating acute myeloid leukaemia (AML).

Methods: A 42 year old woman developed blurred vision shortly after diagnosis and treatment of M6 AML. Investigations showed anterior orbital infiltration, retinal detachment and panuveitis. Iris biopsy and vitreous aspirate were negative. She developed right temporal lobe infarction and died following further CNS infarction two months after initial diagnosis.

Results: Post mortem examination showed cerebral oedema, multiple cerebral infarctions and hepatosplenomegaly; both eyes contained vitreous exudates, retinal detachment and uveal thickening. Microscopy showed exudative and haemorrhagic retinal detachment, without inflammatory or neoplastic infiltrate, and bilateral uveal leukaemic infiltration with infarction. Neoplastic cells infiltrated the leptomeninges and brain parenchyma with focal vascular occlusion. Lung vessels were occluded by neoplastic cells. The spleen and bone marrow were heavily infiltrated. Partial immunophenotyping suggested a diagnosis of acute promyelocytic leukaemia (APL).

Conclusions: Acute leukaemia involves the eye occurs in 39‐53% cases. Visual loss is uncommon. Retinal involvement most frequently occurs in the form of superficial haemorrhages, detachment is uncommon. Acute lymphoblastic leukaemia (ALL) treated with L‐asparaginase, acute promyelocytic leukaemia (APL) and non‐M3 AML may present with a prothrombotic state which may be catastrophic, as occurred in this fatal case.
Immune expression and inhibition of HSP90 in uveal melanoma
Authors: FAINGOLD D , MARSHALL JC , ANTECKA E , DI CESARE S , BAKALIAN S , BURNIER MN
Published: October 2007

Purpose: To examine the immunohistochemical profile of Hsp90 in uveal melanoma and the effects of Hsp90 inhibitor 17‐AAG, in uveal melanoma cell lines.

Methods: Hsp90 expression was studied in 44 sections of human uveal melanoma and in five uveal melanoma cell lines (92.1, OCM‐1, MKTBR, SP6.5 and UW‐1). Sulfurhodamine‐B based proliferation assay was assessed with a range of concentrations of 17‐AAG. Changes in cell migration and invasion were evaluated in vitro in the presence or absence of 17‐AAG. Cell cycle fractions were determined by flow cytometry and the caspase 3 protease activity was detected using the BD ApoAlertTM Caspase Colorimetric Assay. Expression of intracellular proteins was determined by Western blot analysis.

Results: Immunohistochemical expression of Hsp90 was identified in 68 % of the paraffin embedded sections and was significantly associated with largest tumor dimension. A statistically significant reduction on proliferation rate of uveal melanoma cell lines was observed with drug concentrations of 100 μM to 1 μM and also a reduction of their migratory and invasive capabilities. Exposure to 17‐AAG induced accumulations of cells in G1 and loss of cells in S phase and also a significant increase in Caspase 3 protease activity. The cytotoxic effect of 17‐AAG was associated with decreased levels of phospho‐AKT after 24 h exposure to the drug.

Conclusions: The immunohistochemical expression of Hsp90 in uveal melanoma indicates worse prognosis. Inhibition of HSP90 function by 17‐AAG had an effect on cell motility and invasive potential, inducing cell cycle arrest and promoting apoptosis. Further trials in uveal melanoma models should be undertaken to study the effect of 17 AAG to target Hsp90 in vivo.
Identification of a novel VMD2 mutation in Slovene family with best vitelliform dystrophy
Authors: JARC‐VIDMAR M , SLAJPAH M , POPOVIC P , GLAVAC D , HAWLINA M
Published: October 2007

Purpose: To report a clinical phenotype and a novel VMD2 gene mutation in a Slovene family with Best vitelliform dystrophy.

Methods: Father (51 yrs, VA: 0,1 ou) and his two sons (21 yrs, VA: 1,0 RE, 0,001LE; and 17 yrs, VA: 0,6 RE, 0,2 LE) with abnormal EOG and clinical features of Best distrophy were tested with static perimetry, pattern ERG and multifocal electroretinography. Autofluorescence imaging of the fundus was done by HRA. Screening for mutation was done by the non‐isotopic high resolution single stranded conformation analysis (SSCA) after amplification of each exon by the polymerase chain reaction (PCR). Primers for VMD2 were described by Petrukhin.

Results: A new mutation was found with G to C substitution at position 147 in VMD2 gene, altering nonpolar glycine to a bigger and positively charged arginine at codon 15. The change altered electric balance of the mutated protein. Four other changes in these family were observed as well (P341P, T470T, T536T, S519S), but have already been described by other groups and presumably did not alter the predicted amino acid sequence of bestrophin protein. AF imaging showed different patterns in each patient according to the stage of disease ‐ central hiperfluorescent lesions in early stages and central hypofluorescent regions being surrounded with hyperfluorescent rings in later stages of the disease. Electrophysiology testing showed reduction of pattern P50 and N95 amplitudes in those with lower VA. Reduction of P1 amplitude of mfERG was mostly observed in the inner three concentric rings already in the early stages of disease.

Conclusions: A novel disease‐causing mutation (G15R) was found in the exon 2 in VMD2 gene in a Slovene family with BVD.
Peculiarities of pupil reactions in patients with hyperopic amblyopia in dependence of monocular fixation
Authors: BUSHUYEVA NN , BOYCHUK IM , KHRAMENKO NI , SHAKIR DUHIRE MH
Published: October 2007

Purpose: Data of pupil reactions in patients with amblyopia revealed disturbances in pupillary afferent pathway in 9% ‐ 93% cases (Tychsen L., Hoyt W.F.,1985, Portnoy JZ, & al.,1983). and disorders of peripheral parts of retina in amblyopic eyes. The aim of the work was to study pupil reactions in patients with hyperopic amblyopia in dependence of monocular fixation and in comparison with emmetropic patients.

Methods: Pupil reactions (direct, sequence and accommodative) in patients with hyperopic amblyopia were studied with elaborated pupillograph in 72 children aged 5‐14 years old (50 with amblyopia and 22 with emmetropia). Amblyopia of high degree was in 22% of patients, medium and light degree was in 14% and 64% accordingly. Degree of hyperopia in both eyes was (2,14 ±0,49)dptr, astigmatism was below 2,0 dptr. Central fixation was in 27 and eccentric in 23 cases.

Results: It was established that values of pupil latency recovery after direct flash stimulation were larger than in healthy person, values of active constriction latencies, term of active constriction and recovery latencies during the consequent pupil reaction were different in healthy and amblyopic eyes and degree depends on monocular fixation of amblyopic eye in comparison with healthy persons who had equal values. During accommodative reaction average maximal pupil area values and term of pupil recovery were larger in amblyopic eyes than in eyes of healthy patients, the largest were in cases with eccentric fixation.

Conclusions: It is suggested that not only afferent pupil way function is disturbed as it was known before but also the efferent ways are involved in amblyopia especially in cases with eccentric fixation.
Risk factors for age related maculopathy in a Tunisian population
Authors: EL MATRI L , BOURAOUI R , BAKLOUTI K
Published: October 2007

Purpose: The aim of this study is to identify risk factors for AMD in the Tunisian population which is exposed to intense sunlight and have important seafood diet.

Methods: A prospective study was conducted including 2204 persons aged more than 50 years which came to our hospital as patient or as accompanying adult. Patients responded to a questionnaire asking about medical history, habits and behaviour, sun exposure, diet and smoking habits. A complete ophthalmic examination was undertaken in patients with AMD.The median age of patients was 66 ± 9.5 years old (range 50‐100). Lesions are classified in early and late stages of AMD. Statistical analysis was done.

Results: Prevalence of AMD in our studied population was 16.4 %. Age was a significant risk factor. Prevalence of AMD was 12.5% in group patient aged between 50 and 60 years and 31% in group patient aged more than 80 years (P=0.001). Males were more exposed to AMD than females (p=0,001).

Excessive sun exposure, lack of nutrients and antioxidants increased significantly the risk of AMD (P<10‐3). Smoking was the most important risk factor (P< 10‐3) and prevalence increased proportionally to the importance of cumulated annual consummation. Cardiovascular diseases, diabetes and dyslipimia were not significantly associated to a high prevalence of AMD. Cataract extraction did not increase the risk of AMD in our study and myopia was associated to a low risk of AMD.

Conclusions: AMD is a multifactoriel disease. Some preventive measure were effectives. Genetics’ studies of the disease could identify population at risk.
Structure‐function relationship in the process of primary open‐angle glaucoma ‐ an OCT study
Authors: AJTONY CS , BALLA ZS , KOVACS B
Published: October 2007

Purpose: To evaluate the strength and pattern of the relationship between visual field (VF) sensitivity and retinal nerve fiber layer (RNFL) thickness as measured by StratusOCT, and define the structural decay where glaucomatous VF defects appear.

Methods: Normal, preperimetric (PPG) and glaucomatous (POAG) subjects were enrolled in this cross‐sectional study. Linear and non‐linear regression models were used to define the relationship between average RNFL thickness (AVG) and VF sensitivity (mean deviation‐MD and mean sensitivity‐MS) on standard automated perimetry, coefficient of determination (R2) was calculated, their association was described by bivariate Pearson correlation.

Results: The correlation of AVG and MD/MS was significant only in POAG eyes (r 0.718/0.733), their relationship fit a curvilinear regression model (R2 0.723/0.694), in normal and PPG groups no correlation and a minimal degree of determination was detected. Receiver operating characteristic (ROC) curves describing the ability of all VF parameters and AVG were evaluated to differenciate PPG from POAG eyes. Repeated analysis with the best performing test parameter, PSD (AUROC=0.937) with cutoff value 1.9dB, showed that regression profiles only in the POAG group with PSD >1.9 dB maintained their strong curvilinear RNFL/VF relationship.

Conclusions: Evaluating structure/function relationship in our normal, PPG and POAG subjects, strong curvilinear regression was found in POAG eyes with PSD >1.9 dB and RNFL AVG thickness below 70 μm, which might represent a profound threshold value in glaucomatous structural changes, while no correlation was detectable above these values. This is comparable with histologic data, indicating that 25‐40% of RNFL is lost before VF defects arise.
Development of lentiviral vectors for gene therapy for Usher syndrome type 1B
Authors: HASHIMOTO T , GROISBERG R , ZHANG XM , GIBBS D , LILLO C , AZARIAN SM , WILLIAMS DS , YANG XJ
Published: October 2007

Purpose: Usher 1B, one of the major subtypes of a combined blindness and deafness disease, is caused by mutations in the MYO7A gene, which encodes a large unconventional myosin expressed in the retinal pigment epithelium (RPE) and photoreceptor (PR) cells. This study aims at developing viral vectors expressing the wild type human MYO7A at an adequate level in order to rescue cellular phenotypes of MYO7A mutation.

Methods: The full‐length (7 kb) human MYO7A cDNA was cloned into the third generation, self‐inactivating lentiviral vector under different promoters and enhancers. Human genomic 4‐kb DNA fragment including exon 1 through 2 was cloned by PCR. Activities of different promoters and enhancers were tested by reporter assays using ARPE‐19 cells. Previously identified Myo7a‐null phenotypes in shaker‐1 mouse were used to test the efficacy of various lentiviruses.

Results: Lentiviral vectors could successfully transduce large genes (up to 7.6 kb) in vitro and in vivo for the purpose of gene therapy. Reporter assay indicated that regions with a suppressor activity and an enhancer activity existed within intron 1. The CMV promoter drove excessive MYO7A expression in the RPE, and thus caused cell death. A chimeric promoter that consists of partial CMV promoter with 160‐bp MYO7A enhancer could direct moderate levels of gene expression in RPE and PR in vivo, and rescued a number of phenotypes in the mutant mice.

Conclusions: These results illustrate the importance of regulating transgene expression levels in achieving therapeutic outcomes. They demonstrate the efficacy of lentivirus‐mediated expression of the large MYO7A cDNA as a gene therapy strategy for correcting the MYO7A deficiency underlying Usher 1B.
The analysis of fundus autofluorescence patterns in retinal diseases
Authors: POPOVIC P , JARC ‐ VIDMAR M , HAWLINA M
Published: October 2007

Purpose: Fundus autofluorescence (AF) imaging is a method that shows accumulation of lipofuscin in the retinal pigment epithelium cells in vivo. Fundus AF may be recorded in retinal diseases either by scanning laser ophthalmoscope or by fundus camera using the appropriate filter. The aim of this study was to analyze the AF pattern by both methods.

Methods: 20 patients with different retinal diseases including retinitis pigmentosa, cone‐rod dystrophy, Stargardt disease, Best macular dystrophy, central serous retinopathy and age‐related macular degeneration were included in the study. AF images were obtained from each subject using a confocal scanning laser ophthalmosope and digital fundus camera. The distribution and amount of AF were compared by the use of both systems.

Results: In all disease entities both instruments showed distinct pattern of AF typical for the disease. Areas of high intensity of AF recorded with HRA matched to areas of increased intensity of AF detected with fundus camera. The distribution of areas of low or absent AF also corresponded well in both systems. Images taken with conventional fundus camera were in general lower contrasted and therefore less sharp. This was particularly true for patients with even mild media opacity. The advantage of fundus camera was however a recording of AF of a greater field of view.

Conclusions: AF imaging is a very useful noninvasive method for detecting RPE abnormalities. In clinical practice, when scanning laser ophthalmoscope for recording of AF is not available, conventional digital fundus camera can be used for screening of patients suspected to have retinal disease. Care should be taken in patients with nuclear cataract, as the AF image is influenced by the AF of the crystalline lens by a great amount.
Is nonadherence with eye drop treatment associated with increased intra ocular pressure?
Authors: VANDENBROECK S , DOBBELS F , DE GEEST S , STALMANS I , ZEYEN T
Published: October 2007

Purpose: Effectiveness of clinical glaucoma treatment may be dependent on the patient’s adherence (A) with eye drop treatment. The relation between non‐adherence (NA) and intraocular pressure (IOP) is not yet well understood, due to methodological weaknesses in the studies performed so far. The goal of this study was to investigate the association between NA with eye drop treatment, IOP and degree of visual field (VF) defects in a large sample of glaucoma patients.

Methods: A multi‐center cross‐sectional survey was performed in 973 patients in 60 ophthalmologic centers in Belgium. NA was assessed by a written self‐report question asking patients how many times he/she had forgotten to administer eye drops during the past 2 weeks. Answer options ranged from never, seldom, once a week to daily. The patients indicating they had skipped 1 or more administrations were classified as NA. Current IOP (mmHg) and VF defects were measured with a Goldmann applanation tonometer and perimeter, respectively, at the same time as the NA assessment.

Results: 603 out of 937 (64%) questionnaires were available for analysis. 39.5% of the patients reported to be NA. NA patients showed a significant higher current IOP of the left eye than A patients (16.12 +/‐ 3.15 vs 15.58 +/‐ 2.83; p=0.030). No significant difference in IOP of the right eye was found between NA and A patients (16.13 +/‐ 3.53 vs 16.02 +/‐ 7.61; p=0.843). The degree of visual field defects was not significantly related to NA.

Conclusions: Because of the difference in IOP of the left eye between A and NA patients, NA should be carefully monitored as part of glaucoma management. Yet, prospective studies are needed to confirm the relationship between NA and poor outcomes.
Association of single nucleotide polymorphisms (SNPs) of VEGF gene with diabetic retinopathy
Authors: LIINAMAA MJ
Published: October 2007

Purpose: Vascular endothelial growth factor (VEGF) has an important role in the development of diabetic retinopathy. High concentration of vitreous VEGF and elevated VEGF expression has been found in diabetic retinopathy. Single nucleotide polymorphisms (SNPs) of VEGF gene have been shown to influence expression of VEGF. We studied the association of VEGF SNPs with severity of diabetic retinopathy.

Methods: The study population consisted of 129 diabetic (type 1 or type 2) patients with laser‐treated retinopathy, 99 diabetic patients with mild or no retinopathy and 524 non‐diabetic controls. SNPs were chosen on structural basis at three different haploblocks of the VEGF gene covering the whole VEGF gene and in addition, polymorphisms previously known to affect VEGF production were selected. VEGF SNPs rs699947, rs2010963, rs2146323, rs3025033 and rs3025039 were genotyped using the 5' nuclease assay for allelic discrimination (TaqMan). The allele and genotype frequencies were analyzed with chi‐square test in SPSS.

Results: Duration of diabetes was similar in patients with laser‐treated retinopathy and in patients with mild or no retinopathy (mean 22.8 vs. 22.7 years, respectively), but the laser‐treated diabetic group had somewhat poorer glycemic control (9.2 vs. 8.4 %). The distribution of genotypes and the allele frequencies did not differ significantly between the diabetics and controls, between patients with laser‐treated retinopathy and patients with mild or no retinopathy, or between patients with proliferative retinopathy and patients with non‐proliferative retinopathy.

Conclusions: In conclusion, these findings suggest that VEGF gene SNPs studied are not associated with the severity of diabetic retinopathy.