bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of posterior subtenon injection of triamcinolone acetonide for diabetic macular edema refractory to intravitreal bevacizumab injection
Authors: SOO GEUN JOE , MOON HAEIN , CHAE JB
Published: November 2013

Purpose To evaluate posterior subtenon injection of triamcinolone acetonide (stTA) for diabetic macular edema (DME) refractory to intravitreal bevacizumab injection.

Methods Patients with DME involving fovea who revealed central foveal thickness (CFT) over than 300μm continuously and did not respond to intravitreal bevacizumab injection (IVB) were included. When CFT increased after 1 or 2 IVB or CFT did not decreased more than 50μm after 3 consecutive IVB, we classified these group of patients as DME refractory to IVB. Other diseases which can cause macular edema including macular degeneration, vein occlusion and epiretinal membrane were also excluded. 40mg TA was injected in to the posterior subtenon space by one clinician. All patients received ophthalmic examination including Snellen visual acuity, intraocular pressure (IOP), spectral domain optical coherence tomography at the time of posterior stTA injection, 2‐month, 4‐month and 6‐month follow up period.

Results 41 eyes of 35 patients were included. Average CFT reduced from 474μm to 377μm at 2‐month, to 352μm at 4‐month and 401μm at 6‐month (p<0.001, p=0.001, p=0.035 respectively; paired T‐test). Average IOP were increased from 15.5mmHg to 16.9mmHg at 2‐month but it reduced to 16.2 at 4‐month and to 15.8 at 6‐month. Visual acuity in logMAR scale increased from 0.55 to 0.50 at 2‐month, to 0.49 at 4‐month and to 0.50 at 6‐month (p=0.001, p<0.001, p<0.001 respectively; paired T‐test). No complications such as glaucoma and cataract were detected.

Conclusion Posterior stTA is effective treatment for DME refractory to IVB. But the effect did not continue over 6 months.
Mechanism of fluid accumulation
Authors: WOLFENSBERGER TJ
Published: November 2013

Purpose: To characterise the cellular mechanisms of fluid flow in the retina in view of its clinical implications. Background: Retinal fluid homeostasis is effected by a whole host of mechanisms that reside both in the retinal pigement epithelium, in the choroid and in the retina. In a physiological state there is a constant flow of fluid out of the intraretinal and subretinal space into the choroid, of which about 70% is effected via active transport mechanisms within in the retinal pigment epithelium. In case these Results: This presentation will summarise the latest data on how fluid homeostasis is maintained within the retina and how these mechanisms underly the evolving phramacological treatment modalities for exudative maculopathies. Conclusion: The understanding of the cellular mechanisms that govern retinal fluid flow is crucial to the cinical application of medical treatments against exudative maculopathies. .
Retinal ganglion cell degeneration: events in the human retina
Authors: THANOS S
Published: November 2013

Abstract not provided
Retinal ganglion cell degeneration and dysfunction in glaucoma
Authors: LEUNG C
Published: November 2013

Both dendritic shrinkage and dendritic outgrowth have been reported after chronic elevation of intraocular pressure and the longitudinal profile of retinal ganglion cell degeneration in glaucoma remains largely obscured. Monitoring dendritic and axonal degeneration requires long‐term, in vivo examination of axon and dendritic arborization. While clinical imaging only permits visualization of the ganglion cell layer and the nerve fiber layer, animal models have been established to track axonal and dendritic changes. Using a confocal scanning laser ophthalmoscope to image the retinae of transgenic mice (Thy‐1 YFP) that express fluorescent protein in neurons under the control of a Thy‐1 promoter, retinal ganglion cell degeneration has been shown to begin with progressive dendritic shrinkage, followed by loss of the axon and then the cell body after optic nerve crush. Although challenges remain to develop a glaucoma model with mildly to moderately elevated intraocular pressure lasting for a sufficiently long period of time with a clear optical media, it is promising that in vivo analysis of dendritic arborization would provide new insights into the neurobiology of retinal ganglion degeneration and neuroprotection in glaucoma.
Objectivity and reliability of the C‐Quant in a clinical setting
Authors: GICQUEL JJ
Published: November 2013

The fact that the (C‐quant) Straylight Meter measures the straylight as the subject actually sees it (and is disturbed by it) may be considered as a limitation of the technique, when used in a clinical environment. Because it is a psychophysical technique, reliability of individual measurements needs to be checked (as with visual field measurents). We decided to evaluate the objectivity and reliability in patients with cataract in a regular clinical environment. For this very purpose, we studied the reliability parameter (ESD), designed to predict the accuracy of an individual measurement. We also tried to simulate frauds.
Multiparameter cataract indication approach
Authors: REUS NJ
Published: November 2013

In the clinic, the indication for cataract surgery is often based on a visual impairment noted by the patient, the presence of cataract that accounts for the visual symptoms, and the likelihood of improved vision with surgery. The indication for cataract surgery is thus often based on subjective observations by the patient and the ophthalmologist. Visual acuity, especially when obtained through a pinhole, and straylight assessment may be more objective observations in the assessment for cataract surgery. This presentation will focus on the integration of these various subjective and objective parameters in the indication for cataract surgery.
A unilateral chronic conjunctivitis as onset of a systemic sarcoidosis
Authors: TARIGHT N , SMAIL A , SEVESTRE H , MILAZZO S , BREMOND‐GIGANC D
Published: November 2013

Purpose Introduction: Granulomatous conjonctivitis is unusual as a presenting symptom in patients suffering from Sarcoidosis. We report the case of a 48‐year‐old patient, presenting a chronic unilateral conjunctivitis and dyspnea for two years. The conjunctival biopsy led to the diagnosis of systemic sarcoidosis.

Methods Case Report : A 49‐year‐old woman, came for an asymmetric bilateral eye discomfort for almost 6 months treated for a mislabeled allergic conjunctivits, with no effect. She reported an effort dyspnea for almost 2 years, with no other signs. Visual acuity was 20/20 P2. At slit lamp we found a low break up time at 4s with meibomian gland dysfunction and normal Shirmer test. A thickening of the lower conjunctival fornix at OR, with the presence of granuloma was noted, without pre‐auricular lymph node. Anterior segment examination was completely normal as intra‐ocular pressure and fundus.

Results A conjunctival biopsy was performed and pathologic examination showed the presence of epithelioid granuloma and giant cell without caseous necrosis. All culture including mycobacteria, were negative. A medical check‐up confrimed systemic sarcoidosis. The patient was treated topically by steroïds. Systemic steroïds with methotrexate relay were established

Conclusion Conclusion: Sarcoidosis can be, life threatening, especially by a heart affection that must be systematically tested. This clinical case shows the interest of a rigorous etiological investigation when a patient present a chronic unilateral or bilateral granulomatous conjunctivitis. The diagnosis of the sarcoidosis must be evoked and must motivate a general check‐up, especially if respiratory symptoms are associated. A biopsy may be performed to confirm the diagnosis.
Orthotopic xenografts in ocular tumors
Authors: CASSOUX N
Published: November 2013

In order to allow pharmacological assessment of innovative intraocular treatments in more relevant and predictive models, we have developed preclinical orthotopic xenografts of both primary human uveal melanoma (UM) and retinoblastoma (Rb) into immunodeficient mice. Orthotopic models of human UM and Rb have been developed from subcutaneous xenografts previously established and characterized in the laboratory. Mice bearing xenografts were sacrificed and tumors were dissected and injected into the subretinal space of SCID mice. After sub‐retinal injection, ophthalmic examination of the mice was performed weekly. When tumor cells invaded vitreal cavity and anterior chamber, the mice were sacrificed for ophthalmological pathological analyses. The RB200 model, was used for preclinical trial validation.After orthotopic transplantation, pathological analyses confirmed the conservation of histological sub‐type of the primary tumor, i.e. epithelioid and/or spindle cell, than in corresponding patient’s tumors and subcutaneous xenografts.For retinoblastoma, the orthotopic xenograft showed similar clinical and pathological similarities to human tumors. Theses models are suitable for preclinical trial.
miRNA and conjunctival melanoma migration
Authors: MOULIN A , NICOLAS M
Published: November 2013

Purpose : In cutaneous melanoma, downregulation of miR‐211 has been implicated in migration and invasion. As we have previously demonstrated the downregulation of miR‐211 in conjunctival melanoma in vivo, we evaluated in vitro the role of miR‐211 in the migration of 4 conjunctival melanoma cell lines compared to a cutaneous melanoma cell line. Methods : Migration assays were performed using a cutaneous melanoma cell line and 4 conjunctival melanoma cell lines. Taqman RT‐PCR was performed to evaluate the level of miR‐211 in each cell line. Results : Compared to the cutaneous melanoma cell line with a high migration potential, 2 conjunctival melanoma cell lines demonstrated moderate migration abilities while 2 others no migration. The migration potential of the cell lines was significantly inversely correlated with Taqman evaluation of miR‐211 expression (p=0,0239). Conclusions : The migration ability of conjunctival melanoma cell lines is lower than a cutaneous melanoma cell line. The level of miR‐211 expression in conjunctival melanoma appears in vitro to inversely correlate with the migration potential of the cell lines, confirming the downregulation of miR‐211 observed in vivo in conjunctival melanoma.
Retinal Oximetry – Metabolic Imaging of the Retina
Authors: STEFANSSON E , HARDARSON SK , GEIRSDOTTIR A , KRISTJANSDOTTIR JV , SCHEVING T , OLAFSDOTTIR OB
Published: November 2013

Diagnostic imaging of retinal disease has been limited to structural analysis, angiography and testing of visual function. Until the advent of retinal oximetry, no metabolic retinal imaging has been available in the clinic. Metabolic imaging has obvious relevance to metabolic disease such as diabetic retinopathy and oxygen imaging is particularly appropriate for ischemic disease such as retinal vein and artery occlusion. Fundus camera based spectrophotometric retinal oximeters have allowed clinical studies over the last several years. Remarkably, abnormalities in retinal oxygen metabolism have been discovered in most major retinal diseases, including diabetic retinopathy, retinal vein occlusions, glaucoma and age related macular degeneration. These results open a new window into the pathophysiology of these diseases and may help evaluate severity and progression.
DARC, Sick and Dying Cells
Authors: CORDEIRO M
Published: November 2013

DARC (Detection of apoptosing retinal cells) is currently being taken to clinical trial as a new diagnostic and screening imaging technique of retinal abnormalities. Initially it will involve patients with primary open angle glaucoma, where apoptosis of retinal ganglion cells (RGCs) is an early in event. Early detection of RGC apoptosis and its prevention of this process holds promise as a novel and effective treatment for glaucoma, especially as recent evidence has suggested a reversible element.
Antioxidant delivery to the lens nucleus: A strategy to delay age related nuclear cataract
Authors: DONALDSON PJ , VAGHEFI E , GREY AC , LIM JC
Published: November 2013

Age related nuclear (ARN) cataract is associated with the accumulative effects of oxidative damage to proteins in the lens nucleus. Since it is preceded by a loss of the key lens antioxidant GSH specifically in the lens centre, but not the lens periphery or cortex, ARN cataract is thought to be due to a failure to deliver GSH to the nucleus. Due to its large size, the avascular lens cannot rely on passive diffusion alone to deliver GSH to deeper lying fiber cells. Instead it has been proposed that the lens operates an internal microcirculation system which delivers nutrients to the lens nucleus faster than would occur by passive diffusion alone. Consistent with this model, our group has used MRI and confocal microscopy to visualize this microcirculation and have revealed that the lens sutures serve as an extracellular pathway to deliver molecules to the lens nucleus. Furthermore, we have shown that cells in the nucleus express transporters that are potentially capable of accumulating the GSH and glucose convected to them via the microcirculation system. These results suggest that harnessing the circulation system to deliver antioxidants to the lens nucleus is a potential strategy to delay the onset of ARN cataract.
In vivo quantitative measurement of antioxidant effects in the lens
Authors: SÖDERBERG P , KRONSCHLäGER M , TALEBIZADEH N , YU Z , WANG J , XIAO Y
Published: November 2013

To evaluate the protective effect of antioxidants on experimental cataract induced by ultraviolet radiation (UVR). The protective effect of the antioxidants alpha‐tocopherol and caffeine and the antioxidant gene Grx‐1 were investigated. For investigation of the antioxidants, albino Sprague Dawley rats were used and for the Grx‐1 gene, a Grx‐1 knockout C57BL/6 mouse and its inbred wild type were used. As an oxidation insult, all animals were exposed to around threshold dose UVR in the 300 nm wavelength region, delivered during 15 min. The UVR was generated with a high pressure mercury arc lamp and the waveband was limited to around 300 nm. Dosimetry was assured with a calibrated thermopile. The rats and mice were sacrificed at 1 week and 48 hrs after exposure, respectively. Then, the lenses were extracted for forward light scattering measurement. In all three experiments, the animals were grouped at five different dose levels centered around the expected threshold dose. The Maximum Tolerable Dose‐2.3;16 (MTD‐2.3;16) was used as threshold estimate. The protection factor (PF) was calculated as the ratio between the threshold dose with protective factor and the threshold without the protective factor. The threshold dose for alpha‐tocopherol was with and without 3.0 and 2.7 kJ/m^2, respectively (PF= 1.1). The threshold dose for caffeine was with and without 5.7 and 4.6 kJ/m^2, respectively (PF= 1.2). The threshold dose for Grx‐1 was with and without 3.8 and 3.0 kJ/m^2, respectively (PF= 1.3). As measured in vivo, caffeine has a more potent antioxidant effect after topical application than alpha‐tocopherol administered parenterally. The Grx‐1 gene provides the most potent antioxidant effect in vivo.
Macular nerve‐fiber‐layer measurement in early stage Alzheimer’s disease using optical coherence tomography
Authors: GARCIA MARTIN ES , DE HOZ R , ROJAS B , GIL P , YUBERO R , RAMIREZ JM
Published: November 2013

Purpose Alzheimer’s disease (AD) is characterized by brain neuronal loss resulting in brain atrophy. Post‐mortem studies show a loss of retinal ganglion cells in this neurodegenerative disease. The purpose of this study was to compare thicknesses of the macular nerve‐fiber layer (MNFL) by Optical Coherence Tomography (OCT) between early AD patients and control.

Methods Twenty GDS 4 AD patients and 25 controls were examined at Hospital Clínico San Carlos in Madrid (Spain). Patients underwent a complete ophthalmologic exam (visual acuity, refraction, color test, biomicroscopy, IOP, dilated fundoscopy, and OCT). OCT macular measurements were made by dividing the macula into 9 areas: i) a central area of 1mm radius (fovea); ii) two concentric areas of 3 mm and 6 mm each were subdivided in 4 regions: nasal, temporal, upper and lower.

Results In comparison with the control group, patients with early‐stage AD presented a significant MNFL decrease (p <0.05) in the central area and in the 3 mm paracentral area. In the 6mm paracentral area statistically significant differences were restricted to the temporal region.

Conclusion In early‐stage AD (GDS4), the MNFL was decreased. The measurement of macular thickness by OCT could be a complementary tool for early diagnosis and control progression of AD.
MR imaging in posterior ischemic optic neuropathy
Authors: DEMAEREL P , VAN DEN EYNDE K , CASSIMAN C
Published: November 2013

Purpose To present and explain the pathognomonic magnetic resonance (MR) findings in posterior ischemic optic neuropathy (PION).

Methods Three patients with the suspicion of PION underwent a MR examination of the anterior visual pathway.

Results There was a rapidly progressive unilateral (n=2) and bilateral (n=1) decline in visual function with deterioration of central visual acuity and an altitudinal visual field defect (n=2). Fundoscopy showed optic disc pallor after 6 weeks in all patients at the affected side. A relative afferent pupillary defect was seen in the patients with unilateral disease. The MR imaging findings revealed a central high signal in the chiasm (n=3) and intracranial portion of the both optic nerves (n=1)/ one optic nerve (n=2) with normal signal of the outer part of the chiasm/optic nerve.

Conclusion The pattern of the lesions can be explained by the blood supply of the optic chiasm which occurs through arterioles arising from the circle of Willis entering the chiasm and forming capillaries. In vitro research revealed a poorer capillary distribution in the central parts. The central high signal represents ischaemia due to the vulnerability of the central part of the chiasm/optic nerve. These findings are important as they are almost pathognomonic for ischemic changes in the anterior visual pathway. These findings are different from those reported in inflammatory/demyelinating disorders affecting the anterior visual pathway. PION should be differentiated from stroke in the posterior cerebral circulation territory because of the possible treatment with rt‐PA in the latter. A dedicated imaging approach is necessary in patients with visual field loss of unknown origin in order to confirm or exclude ischemic changes of the anterior visual pathway.
Nanoparticles for delivery of therapeutical nucleic acids to corneal endothelium
Authors: CZUGALA M , MYKHAYLYK O , SINGER BB , STEUHL KP , ERGÜN S , WESSELBORG S , EPPLE M , PLANK C , FUCHSLUGER TA
Published: November 2013

Corneal endothelium is as crucial for maintenance of corneal function as difficult it is to be accessed with any treatment that doesn’t involve invasive surgical procedures. Hovewer it is possible to administer therapeutic agents by topical application, their effect on deeper corneal layers and further fate remains of our control. This study has been designed to employ nanoparticles in order to improve our chances in therapy of corneal dystrophies as well as to prevent endothelial cell loss after transplantation of the cornea. Variety of nanoparticles serves a potential solution to problem of targeting the corneal endothelium, when properly functionalized to assure precise targeting. Widely proven as efficient carrier for nucleic acids may enable any gene therapy or gene silencing to be conducted with minimized risk of uncontrolled transfection. When to concern both growing need for corneal transplantations and shortage of tissue, efficient therapy to protect graft from failure or even to protect patient’s own cornea becomes essential.
Lens slitlamp image grading and nuclear hardness
Authors: BARRAQUER R
Published: November 2013

Lens slitlamp image grading and nuclear hardness Purpose: To develop a lens nuclear grading system able to predict the hardness or surgical difficulty during cataract surgery. Methods: A 1 to 10 (plus 0) grading of the lens nuclear "density", thus called BCN‐10 was developed based on standardized clinical slit lamp photographs, from complete transparency (0) to a totally black cataract (10). The BCN‐10 scale was tested for intra‐observer and inter‐observer repeatibility, for correlation with forward scattering measurement (C‐Quant) and surgical difficulty (ultrasound time). Results: BCN‐10 grading shows good intraobserver and interobserver repeatibility, good correlation with surgical ultrasound times and fair correlation with forward scattering (glare) measurements. Discussion: Available lens grading systems as the LOCS III do not include the harder grades of cataract, precisely where prediction would help the surgeons. BCN‐10 is a novel and consistent lens nuclear grading system useful to predict the hardness and difficulty that will be encountered during cataract surgery, and to some extent correlates with cataract‐induced glare disability.
Controversies in the history of glaucoma
Authors: GRZYBOWSKI A
Published: November 2013

There are several interesting controversies in the history of glaucoma. The first corresponds to the origin of its name. It was argued that the ancient Greek word glaukos meant: 1. ‘‘to glow’’ or ‘‘to shine’’; 2. ‘‘blue‐white’’ or ‘‘blue‐green’’; 3. dull sheen or [bdquo]glaze” of blindness; 4. owl: ‘‘glaucomati’’ meaning ‘‘having the eyes of an owl’’; 5. a mortal fisherman who was transformed into a sea‐god after eating a magical herb. The second controversy corresponds to the meaning of the word glaucoma. Several ancient authors, including Celsus, Roufos of Ephesus and Galen, described glaucoma as a disease of the crystalline, which was transformed to glaucos because of moisture. This understanding was continued in the 18th century by Banister, Platner and Boerhaave, who argued that glaucoma was a malignant form of cataract that begins with acute pain and terminates in amaurosis. The third controversy corresponds to the different concepts of glaucoma etiology in the 19th century, including gouty iritis, serous choroiditis, thickening of the sclera, irritation of the secretory nerves of the eye, a disease of the vitreous, and [bdquo]secretory neurosis” (the primary cause of is the rise in pressure).
Trichromasy versus colour opponency: The controversy in 19th and 20th century’s colour science and its solution
Authors: KRASTEL H , UDODOV E , GRüTZNER P
Published: November 2013

Purpose: To recall in mind one of the most dedicatedly fought discussions in visual science: that about trichromatic versus colour opponent organization of human colour vision. Methods: Literature survey, personal communication Results: In 19th and early 20th century, the community of colour scientists was divided into followers of Young’s & Helmholtz’s trichromatic theory, and followers of Hering’s colour antagonistic concept. Both parties disposed on convincing arguments. Both confessions (as one is tempted to call them) felt that their particular belief necessarily had to be the truth. Both, in fact, contained truth. The controversy eventually found its solution in the zone theory of v. Kries which subsequently has received overwhelming experimental proof.: trichromasy at receptoral level, colour opponency throughout the postreceptoral network. Conclusion: Browsing through early colour science discloses surprising ad captivating developments. One is in particular satisfying: the controversy concerning trichromatic versus colour antagonistic organization of colour vision. Eventually both antitheses were proven true and combined to the synthesis of zonal organization of colour visison.
Intracameral bevacizumab as an adjunct to trabeculectomy: A one year prospective, randomized study
Authors: VANDEWALLE E , A PINTO L , VAN BERGEN T , SPIELBERG L , SPILEERS W , ZEYEN T , STALMANS I
Published: November 2013

Purpose To investigate the efficacy and safety of a single intracameral administration of bevacizumab to improve the outcome of trabeculectomy.

Methods Between April 2009 and November 2010, 144 consecutive, medically uncontrolled glaucoma patients who were scheduled for primary trabeculectomy were included in this prospective, randomized, double‐blinded and placebo‐controlled study. Patients were randomized to receive 50 µl of either bevacizumab (1.25 mg) or placebo (balanced salt solution) in the anterior chamber peroperatively. Normal tension glaucoma patients also received mitomycin C application. Absolute success was defined as intraocular pressure (IOP) ≤ 18 mmHg and > 5 mmHg with at least 30% reduction from baseline and no loss of light perception. The achievement of these criteria through the use of additional medical and/or surgical IOP‐lowering treatments was defined as qualified success.

Results 138 patients completed a 12‐month follow‐up, 69 of whom had received a bevacizumab injection. IOP at 1 year postoperatively was significantly lower than baseline (placebo: 25.6±9.9 vs. 11.9±3.9, p<0.01; bevacizumab: 24.8±8.1 vs. 11.9±3.9, p<0.01), with no difference between bevacizumab‐ and placebo‐treated patients (p=0.69). However, absolute success was higher in the bevacizumab group (71% vs. 51%, p=0.02), with the number of IOP‐lowering interventions (needlings) being significantly lower in this group (13% vs. 36%, p=0.003). Complication rates were low and comparable in both groups.

Conclusion Peroperative administration of intracameral bevacizumab significantly reduces the need for additional interventions during the follow‐up of patients undergoing trabeculectomy.
What is the most optimal administration route of bevacizumab after glaucoma filtration surgery in mice?
Authors: HOLLANDERS K , VAN BERGEN T , SIJNAVE D , VAN DE VELDE S , VANDEWALLE E , STALMANS I
Published: November 2013

Purpose Glaucoma filtration surgery (GFS) frequently leads to surgical failure due to excessive postoperative wound healing. The current study was designed to investigate the effect on postoperative scarring of a single subconjunctival (SC), intracameral (IC) or intravitreal (IV) injection of bevacizumab.

Methods The effect of bevacizumab (AvastinTM, Genentech) was investigated in a model of GFS in C75Bl/6 mice. Immediately after surgery, mice were divided in 3 groups (n=10 per group) and received a SC, IC or IV injection. In all groups, one eye was injected with bevacizumab (1 µl; 25 µg) and the other eye was used as a control and received an injection of NaCl (1 µl; 0.9%). Treatment outcome was studied by clinical investigation of bleb area and bleb survival every other day. Mice were killed on postoperative day 14 and immunohistological analysis of angiogenesis and collagen deposition were performed.

Results In the mouse model of GFS, treatment using a SC, IC, IV injection of bevacizumab significantly improved surgical outcome by increasing bleb area with 53%; with 45% and with 49%, respectively, compared to negative control. Bleb survival significantly improved only after SC injection with 37,5%. In all groups, blood vessel density was significantly reduced after bevacizumab treatment with 36%; with 31% and with 34%, respectively. All administration routes of bevacizumab significantly diminished collagen deposition with 27%, compared to negative control.

Conclusion This study shows that a subconjunctival injection of bevacizumab had the largest effect on surgical outcome compared to intracameral and intravitreal injection.
Cataract surgery and retinal vein occlusion: Is there an association?
Authors: TING DSJ , HEGDE V
Published: November 2013

Purpose To describe and characterise patients who were noted to have developed postoperative retinal vein occlusion (RVO) soon after cataract surgery and to hypothesise the underlying mechanism of such manifestation

Methods All the patients who developed post‐operative retinal vein occlusion (RVO) soon after cataract surgery between April 2012 and April 2013 in Cumberland Infirmary, Carlisle, United Kingdom, were consecutively recruited. All cataract surgeries were performed under topical anaesthesia. All the patients were assessed pre‐operatively and 4 weeks after the cataract surgery.

Results A total of 3 patients were included in this study. All 3 patients were male and mean age of the cohort was 82 ± 10 years. The mean preoperative best‐corrected visual acuity (BCVA) of the cohort was 78.3 ETDRS letters. Vasculopathic risk factors were identified in all patients, including previous RVO (66%), hypertension (100%), diabetes (33%) ischemic heart disease (33%) and smoking (66%). All patients underwent phacoemulsification with IOL implantation without any complication. Time interval between surgery and diagnosis of RVO was 73.3 ± 39.7 days. Postoperative BCVA of the cohort was 50 ETDRS letters. Two patients required 0.7mg intravitreal dexamethasone implant (Ozurdex).

Conclusion Vasculopathic risk factors were identified in all the patients who were noted to develop RVO following cataract surgery. We hypothesise that the fluctuation of intraocular pressure during cataract surgery predisposes to the development of intra‐operative retinal vein occlusion in our cohort. Preoperative counselling regarding the risk of RVO before the cataract surgery may be indicated.
Ranibizumab versus bevacizumab for neovascular age‐related macular degeneration: Results from the GEFAL noninferiority randomized trial
Authors: KODJIKIAN L , SOUIED EH , MIMOUN G , DECULLIER E , HUOT L , AULAGNER G
Published: November 2013

Purpose To evaluate the relative efficacy and safety profile of bevacizumab versus ranibizumab intravitreal injections for treatment of neovascular age‐related macular degeneration (AMD)

Methods Multicenter, prospective, non‐inferiority, double‐masked, randomized clinical trial, performed in 38 French ophthalmology centers. Patients were randomly assigned to intravitreal administration of bevacizumab (1.25 mg) or ranibizumab (0.50 mg). Patients were followed for one year, with a loading dose of three monthly intravitreal injections, followed by an as‐needed regimen (one injection in case of active disease) for the remaining nine months with monthly follow‐up.

Results Between June 2009 and November 2011, 501 patients were randomized. In the per protocol analysis, bevacizumab was non‐inferior to ranibizumab (bevacizumab minus ranibizumab +1.89 letters, 95% confidence interval ‐1.16 to +4.93, p<0.0001). The intention‐to‐treat analysis was concordant. The mean numbers of injections were 6.8 in the bevacizumab group and 6.5 in the ranibizumab group (p=0.39). Both drugs reduced the central subfield macular thickness, with a mean decrease of 95 µm for bevacizumab and 107 µm for ranibizumab (p=0.27). There were no significant differences in anatomical secondary criteria. The proportion of patients with serious adverse events was 12.6% in the bevacizumab group and 12.1% in the ranibizumab group (p=0.88). The proportion of patients with serious systemic or ocular adverse events was similar in both groups.

Conclusion Bevacizumab was non‐inferior to ranibizumab for visual acuity at one year with similar safety profiles. The results are similar to previous head‐to‐head studies.
Non‐invasive discrimination between perfused and occluded vessels by optical coherence tomography
Authors: BERNARDES R , GUIMARAES P , RODRIGUES P , FIGUEIRA J , SERRANHO P
Published: November 2013

Purpose To noninvasively distinguish between perfused and occluded vessels from OCT scans of the human retina.

Methods Two specific signatures of the vascular tree of the human retina do exist, the hyper‐reflectivity from the top of the vessel, and the shadow due to light absorption by haemoglobin. This shadow effect is notorious on the retinal pigment epithelium (RPE) being responsible for the dark appearance of the perfused vascular network on OCT fundus images. While the hyper‐reflectivity (due to the vessel) is always present, the shadow effect on the RPE only exists for perfused vessels. Thus, this method allows the discrimination between perfused and occluded vessels by a non‐invasive OCT scan of the human retina.

Results The haemoglobin on perfused vessels act as a natural dye on optical coherence tomography data. By computing the integral of OCT A‐scan values over specific layers, it was demonstrated the possibility to discriminate between perfused and occluded vessels of the human retina noninvasively. In addition, the extent of the perfused vascular network possible to identify on OCT fundus reference is similar to that of colour fundus photography, and notably allows the identification of the non‐perfused vascular network which colour fundus photography do not.

Conclusion The presented method compares favourably to colour fundus photography in discriminating between normal and occluded vascular tree, within the same scan, and provides functional information noninvasively.
En face 3D‐SDOCT images and the saltmarshes sign
Authors: THEOCHARIS IP
Published: November 2013

Purpose To investigate the signal intensity obtained from the vitreoretinal interface using the spectral domain 3D OCT images.

Methods Review of spectral domain optical coherence tomography (OCT) examinations; mapping of the intensity of the tomographic signal over the posterior pole using the 3D reconstruction software; Retrospective study of the signs revealed. Chi‐square was used.

Results Mapping the signal intensity over the posterior pole was named as Vitreoretinal Interface Signal Topography (V.I.SI.T.); VISIT images offer views of the epicenters and retinal folds associated with epiretinal membranes, a tool to followup the progress of the disease and to investigate the direction of the tractional forces; VISIT images allow the visualization of the borders of internal limiting membrane peeling and the inner retinal defects after an ILM rhexis; VISIT images revealed white plaques at the vitreoretinal interface, which were named as saltmarshes (SAM); SAMs are reproducible, exhibit interocular symmetry, faint in older ages and they correlate with the epicenters of ERMs.

Conclusion En face VISIT images offers unique information about the vitreoretinal interface; the saltmarshes sign may indicate the areas of strong vitreoretinal adherence and strain and/or the cortex remnants after a posterior vitreous detachment.
Combined approach of inflammatory choroidal neovascularization indicates improved outcome
Authors: NERI P , PIRANI V , ARAPI I , CAPUANO V , GIOVANNINI A , MARIOTTI C
Published: November 2013

Inflammatory Choroidal Neovascularization (CNV) can be one of the most severe sequela in patients with uveitis. The outcome of subfoveal inflammatory CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. On the other hand, the better knowledge of CNV pathophysiology may suggest a suitable treatment strategy. The combination of steroids and immunosuppression represents an important aspect of inflammatory CNV treatment. This ensures suitable control of inflammation as well as the reduction concomitant steroids dose. Neverthless there are cases which do not show a fully satisfactory response. Recently, the role of intravitreal anti‐Vascular Endothelial Growth Factor (VEGF) has become primary in the treatment of neovascularizations. At this time, the combination of anti‐VEGF drugs and immunesuppressives seems to be the best option for the management of inflammatory CNV. In summary, CNV secondary to uveitis is a severe sequela, which can lead to significant visual impairment. Although no guideline is provided, the current medical literature can give the basis for a successful treatment strategy, suggesting that combination of immunesuppresives and anti‐VEGF is recommended.
Role of different imaging modalities in the differential diagnosis of inflammatory serous retinal detachments
Authors: KHAIRALLAH M , KAHLOUN R
Published: November 2013

Serous retinal detachment (SRD) may complicate a number of non infectious or infectious uveitic entities, including VKH disease, sympathetic ophthalmia, posterior scleritis, multifocal choroiditis, sarcoidosis, tuberculosis, and toxoplasmosis. Accurate detection and evaluation of inflammatory SRD relies on clinical examination and a multimodal imaging approach, including optical coherence tomography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and ultrasonography, in selected cases. Moreover, mutimodal imaging is useful in monitoring response to treatment. It also plays an important role in differentiating inflammatory SRD from central serous chorioretinopathy that may be induced or exacerbated by corticosteroid therapy.
Preventing complications of OOKP surgery
Authors: AVADHANAM V , LIU C
Published: November 2013

Osteo‐odonto‐keratoprosthesis (OOKP) is the procedure of choice for end stage ocular surface disease with severe dryness and keratinisation, and in those eyes with structural and functional lid abnormalities. The device retention rates and visual outcomes of the OOKP are far superior than any other keratoprosthesis. However, this device can have complications at every step during surgery and unto many years afterwards. Complications after the Stage 1 include: mucosal thinning and ulceration, mouth related, resorption of the implanted lamina and infections. Complications after the Stage 2 include: mucosal thinning and ulceration, mucosal overgrowth onto the optic, lid malpositions, lamina problems like resorption, tilting, infection, posterior segment complications like retinal detachment and vitreous haemorrhage. Glaucoma is a major cause of visual loss in a successful OOKP eye. Social and psychological complications can arise after visual restoration or the preexisting problems can continue. In addition, operative complications, systemic morbidity and anesthetic related problems do occur. A majority of the complications can be sight threatening if not rectified appropriately in a good time. They may be preventable or reducible with correct patient selection, improvements in preoperative and postoperative patient care and education. A sound surgical technique, reflective learning, harnessing the medical technology and multidisciplinary team approach can effectively reduce and treat the complications of OOKP surgery. Multidisciplinary team approach, having an experienced anesthetist and psychologist on board, and a continuous social support will prevent patient morbidity and optimise good outcomes.
Biomimetic developments to improve the OOKP
Authors: AVADHANAM V , LIU C , LLOYD A , SANDERMAN S
Published: November 2013

While the alveo‐dental tissue provides an excellent source for the Osteo‐odonto‐keratoprosthesis (OOKP) skirt with highest biointegrability anteriorly and inertness posteriorly, it brings with itself a number of disadvantages like oral trauma, laminar resorption, complex surgical technique and multiple stages of the procedure. Additionally, edentulous patients and those with unsuitable teeth are left with the options of less successful allografts and tibial bone carriers for the KPro. Therefore, a synthetic skirt material which, could avoid the problems of tooth extraction, complications of allografts and immunosuppression will be advantageous. A lamina available off the shelf can drastically minimise the surgical procedure duration and stages, and has the potential for replacements. A number of materials have been proposed using Dacron skirts (Pintucci), ceramics, corals, bioactive glass and titanium. These materials have advantages and disadvantages. However, a synthetic material that mimics the alveo‐dental tissue in porosity, mineral composition and biostability may prove suitable as a substrate for synthetic lamina.
The treatment of bilaterally advanced retinoblastoma: The Institut Curie experience
Authors: DESJARDINS L , LUMBROSOLEROUIC L , LEVY‐GABRIEL C , CASSOUX N , AERTS I , SASTRE X , SAVIGNONI A
Published: November 2013

Purpose Since 2005 we have used more intensive chemotherapy, combined with intensive local treatment started at the third cycle in case of bilateral group D or group D+E bilateral retinoblastoma. We report the results

Methods All children identified with bilaterally advanced retinoblastoma were treated with 6 courses of 3 drugs. Local treatments including laser, cryotherapy and sometimes iodine plaque brachytherapy were started at the third cycle, synergistic with the chemotherapy. All tumors except the macular tumors were treated with laser during 5 to 20 minutes. The inferior periphery was treated with cryotherapy . After the end of the chemotherapy, close follow up was performed and additional local treatments were often necessary. Data concerning the initial findings, treatments and results were entered in the data base.

Results : the follow up ranges from 3 to 8 years with a mean follow up of five years. Between 2005 and 2010 23 group D eyes were treated in 16 children.17 eyes are preserved without external beam (73%) One eye is lost to follow up. Visual acuity is available in 11 children ranging from counting fingers to 20/20 with a mean visual acuity of 20/50.

Conclusion Intravenous chemotherapy associated with intensive local treatments allows preservation of the eye with usefull vision in a great pourcentage of group D eyes.
The effects of interleukin‐8, VEGF and CFH polymorphisms on the long‐term response to bevacizumab therapy in exudative age‐related macular degeneration
Authors: HAUTAMäKI A , KIVIOJA J , VAVULI S , KAKKO S , SAVOLAINEN ER , SAVOLAINEN MJ , LIINAMAA MJ , SEITSONEN S , ONKAMO P , JÄRVELÄ I , LUOMA A , IMMONEN I
Published: November 2013

Purpose To study the effects of IL‐8, VEGF, CFH, complement component C3 and LOC387715 single nucleotide polymorphisms and neovascular lesion characteristics on the response to intravitreal bevacizumab treatment in exudative age‐related macular degeneration (AMD).

Methods Fifty patients with treatment naïve exudative AMD were recruited to this two‐year prospective follow‐up study, and treated with bevacizumab on their once‐a‐month visits when sub‐ or intraretinal fluid in OCTs, or a new hemorrhage was detected. Visual acuities (VA) and contrast sensitivities (CS) were assessed on every visit, and fluorescein (FA) and indocyanine green (ICGA) angiographies recorded at baseline, and after one and two years of follow‐up. Blood samples were collected for genotyping.

Results VEGF ‐2578A/C and CFH Y402H polymorphisms and baseline lesion size in ICGA associated with the number of needed reinjections during the follow‐up, and IL‐8 ‐251A/T associated with the disappearance of fluid in OCTs. The alleles A in IL‐8 ‐251A/T, A in VEGF ‐2578A/C, and C in CFH Y402H had a cumulative effect on the presence of fluid in OCTs. A marked difference existed between patients having 0 ‐ 2 risk alleles compared to those having 3 ‐ 6 risk alleles (P=0.00002). An association was also detected between the VEGF ‐2578A/C polymorphism and CS gain (P=0.014). During the first year VA change correlated negatively with the number of visits when cystic changes were detected in the OCTs (r=‐0.366, P=0.009), but the association did not persist during the second year.

Conclusion VEGF ‐2578A/C, IL‐8 ‐251A/T, and CFH Y402H seem to to affect the persistence of fluid in the macular area during bevacizumab therapy of exudative AMD.
Influence of refractive error and axial length on retinal vessel geometric characteristics
Authors: LIM LS , CHEUNG C , LIM X , MITCHELL P , WONG TY , SAW SM
Published: November 2013

Purpose To evaluate the influence of refractive error and axial length (AL) on retinal vascular network geometry measurements in an adult Asian population.

Methods This was a population‐based, cross‐sectional study on 2882 persons with diabetes in the Singapore Malay Eye Study (SiMES). Spherical equivalent refraction (SE) was assessed using an autokeratorefractometer and subjective refraction. AL was measured by IOL Master. Retinal vascular caliber, tortuosity, and branching characteristics were quantified from retinal fundus photographs using a semi‐automated computer‐assisted program according to a standardized protocol.

Results In multivariate analyses adjusting for age, gender, education, smoking, blood pressure, diabetes status, and anti‐hypertensive medication use, longer AL and more myopic refraction were associated with narrower retinal arterioles and venules,(p ≤ 0.001 for all) and less tortuous (straighter) arterioles,(p < 0.001 for both). Longer AL and more myopic refraction were also associated with increased branching coefficients in both arterioles (p < 0.001 for both) and venules.(p = 0.02 and p < 0.001 respectively). Longer AL and more myopic refraction were associated with more acute branching angles in arterioles (p < 0.001 for both) but not venules.

Conclusion Myopic refractive errors and longer AL are associated with narrower retinal arterioles and venules, less tortuous arterioles, and increased branching coefficients in both arterioles and venules. These findings provide insights into ocular blood flow in myopia, and also suggest that future studies evaluating these retinal parameters should account for the influence of AL and refractive error.
Combination of ranibizumab and navigated retinal photocoagulation in diabetic macular edema, compared to ranibizumab mono‐therapy: Twelve month results
Authors: KERNT M
Published: November 2013

Purpose To evaluate the number of anti‐VEGF injections needed in DME patients using a protocol with navigated laser

Methods A consecutive series of 76 eyes with DME were included and randomized into 3 groups: 1. Ranibizumab monotherapy (n=27; using an observation and retreatment paradigm for anti‐VEGF therapy that is compliant with the European Public Assessment Report (EPAR, European Medicines Agency) for ranibizumab), 2. Three consecutive monthly ranibizumab injections followed by navigated laser therapy, then application of the observation and retreatment paradigm as in group “1” (n=15), 3. Monthly ranibizumab injection until central retinal thickness (CRT) was reduced to 450µm (Spectralis OCT) then navigated laser therapy followed by the application of the observation and retreatment paradigm as in group “1” (n=34). Subjects were followed monthly (best corrected Visual acuity (BCVA), CRT) for 12month, to assess the number of anti‐VEGF injections required to maintain stable clinical improvement.

Results After 12 month BCVA increased and in all three investigated groups significantly (group 1: 6.3 ±6.77; group 2: 7.1 ±8.22; group 3: 7.4 ±7.53 letters). To achieve these results, after an upload of three consecutive monthly applied ranibizumab injections, ranibizumab mono‐therapy group (group 1) needed 5.2 ± 3.2 injections. In contrast, group 2 and 3 nedded significantly less ranibizumab injections (0.5 ± 0.8 and 0.8 ± 1.1, p<0.001).

Conclusion Combining anti‐VEGF with navigated laser showed similar visual improvements compared to anti‐VEGF monotherapy with significantly fewer injections.

Commercial interest
High doses fatty acids for improving vision in patients with dry and wet macular degeneration
Authors: GEORGIOU T , NICOLAOU D , NEOKLEOUS A , MICHAEL S , IKONOMU C
Published: November 2013

Purpose To evaluate the effect of high doses EPA/DHA for dry and wet macular degeneration

Methods 40 eyes with dry macular degeneration (6 months follow up) and 43 eyes with wet macular degeneration (1 year follow up) were treated with 5g/day of EPA/DHA. Results of the visual acuity and/or mfERG and/or OCT scans were noted.

Results Visual acuity for dry macular degeneration patients improved by one or more lines in 80% of eyes at 6/52, 88% at 3/12 and 100% of eyes at 4.5/12. The mean macular oedema for wet macular degeneration was reduced from 487 to 280um at 1 year and the mean visual acuity gain was 1.4 lines at 1 year. The average number of anti‐VEGF injections for wet macular degeneration injected was 0.77 over 1 year.

Conclusion Innovative therapy of using high doses fatty acids to improve vision in patients with dry and wet macular degeneration.