bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular surface findings in patients with congential aniridia
Authors: DE LA PAZ MF , BLANCO Z , ALVAREZ J
Published: September 2009

Purpose to study the Schirmer´s test, tear Break‐up time, ocular tear ferning pattern test and impression cytology results in patients with congenital aniridia

Methods 25 eyes of 25 patients with congenital aniridia underwent Schirmer´s test I, tear break‐up time, ocular ferning pattern test and impression cytology to study the ocular surface characteristics. Clinical findings were correlated with the results of the aforementioned tests.

Results Aniridia related keratopathy was Grade 0 in 12%, Grade 1‐A in 52%, 1‐B in 20% and Grade 2 in 16% of eyes studied. Schirmers Test I was normal in 96% of eyes. Tear break‐up time was abnormal in 75% of patients. Ocular ferning pattern tests were as follows: Grade 1 (20%), grade 2 (50%), Grade 3 (20%) and Grade 4 (10%). Conjunctival squamous metaplasia revealed: Grade 0 (23%), Grade 3 (35%), Grade 5 (4%). Conjunctival keratinization was mild in 35% and moderate in 15%. Significant correlation was found between conjunctival keratinization and the degree of Anirida‐related keratopathy. Significant correlation was also found between ocular ferning pattern test and conjunctival keratinization.

Conclusion Aniridia –related keratopathy is a muco‐deficient and lipo‐deficient, more than an aqueo‐deficient dry eye disease. Simple tests of the ocular surface must be done early on to direct the right kind of dry eye treatment in these difficult cases.
Compare optical with photometry measures of tear film lipid layer
Authors: NEPP J , BENZ P , NELL B , SCHAUERSBERGER J
Published: September 2009

Purpose Quantity of tear film lipids could be estimated optically by colours of interference By photometric evaluation it may be measured. Therefore we compared both measures.

Methods Patients with dry eyes were observed by Tearscope and Meibometer 550. For tearscope we used the 4‐parted scale of colours. Meibometry was performed with clean stripes, which have touched the tear film. >300 units are said to be normal. We observed the tear film by Schirmer I, Lissamin green and fluorescein staining, and the break up time. We correlated the measurements with Pearson Correlation.

Results 85 eyes of 53 patients were observed. Both measurements of the lipids showed positive correlations R=67. There was no Correlation between any lipid measurement and the watery and mucin Layer (R‐0,1 ‐ 0,3)

Conclusion The measurement of lipids is similar in both measurements. The optical evaluation needs longer experience, the Meibometry needs standards to find reproducible results. The lack of correlation between lipid layer results and the other results of the tear film observation may point at the special function of lipids independent of the other layers of the tear film.
Evaluation of spatial contrast sensitivity after the instillation of diclofenac eye drops
Authors: KARAMPATAKIS V , CHATZIMPALIS T , KORDALI P , KALPATSANIDIS A , STAMOULAS K
Published: September 2009

Purpose To evaluate if diclofenac eye drop instillation is related with spatial contrast sensitivity (CS) impairment.

Methods Thirty ophthalmologically healthy Caucasian individuals (‐‐male, ‐‐female), aged from 20 to 59 underwent CS testing. The examination was repeated 20 and 40 minutes after the instillation of diclofenac eye drops unilaterally. The fellow eye served as control.

Results All the examined individuals had normal visual acuity, color vision and CS before the diclofenac drop instillation. Four of them complained of a temporary glare at the eye in which diclofenac was instilled. These four individuals had decreased CS in low spatial frequencies (1.5 & 3 cycles/degree), in the examination performed 20 minutes after the instillation. The CS normalized again in the third CS evaluation performed 40 minutes after the instillation.

Conclusion The temporary glare that affects visual performance of some individuals after diclofenac eye drop instillation is related with a temporary decrease of spatial CS in low frequencies. Within this time period of 40 minutes after the instillation of diclofenac, individuals who experience visual disturbances should avoid activities that demand high visual efficacy or postpone the instillation for a more convenient time in relation to the duration of glare they have experienced.
Superior oblique myokymia
Authors: KAWASAKI A
Published: September 2009

Superior oblique myokymia (SOM) is an uncommon disorder characterized by episodic monocular oscillopsia. In most cases of SOM no specific etiology is found but occasional cases have been associated with intracranial tumors and head trauma. Recent radiologic evidence suggests that microvascular compression of the fourth cranial nerve may be a pathogenetic mechanism of SOM. This presentation will review the clinical presentation and course of SOM, including video examples, and discuss treatment options.

Commercial interest
Macrosquare wave jerks
Authors: EGGENBERGER E
Published: September 2009

Macro‐square wave jerks (MSWJ) are a specific saccadic intrusion. Both the more common square wave jerks (SWJ) and the rare macrosquare wave jerks are horizontal saccadic intrusions with a normal intersaccadic interval; these two saccadic intrusions differ from each other concerning their size: SWJ are less than 5 degrees, while macrosquare wave jerks are greater than 5 degrees. Occasional SWJ, especially in the older population, may be normal, while the presence of macrosquare wave jerks always indicates pathology (MS, multiple system atrophy have been reported).
Descement’s membrane detachment diagnosis using a very high frequency ultrasound scanning system (Artemis 2, Ultralink LLC)
Authors: STRATOS A , KYMIONIS G , BOUZOUKIS D , KROKIDIS M , TSILIMBARIS M , PALLIKARIS IG
Published: September 2009

Purpose To present a case report of Descement’s Membrane Detachment after cataract surgery diagnosed using a Very High Frequency ultrasound scanning system (Artemis 2, Ultralink LLC).

Methods A 74‐ year‐old female was referred to our institute due to persistent corneal edema after cataract surgery. Slit lamp examination revealed severe total corneal edema (obscuring anterior chamber and iris). Using a very high frequency (VHF) ultrasound scanning system (Artemis 2, Ultralink LLC) Descement’s Membrane Detachment (DMD) was diagnosed.

Results The patient was treated with anterior chamber air tamponade using a 27 gauge cannula attached to a syringe with a filter riled under topical anesthesia. Descement's membrane was successfully reattached and corneal edema resolved after two weeks.

Conclusion This case report demonstrates that the VHF ultrasound scanning system (Artemis 2, Ultralink LLC) could be a useful instrument for the early recognition and possible management of DMD after cataract surgery, especially in patients in which diagnosis is difficult due to significant corneal clouding.
Hereditary vitreoretinopathies
Authors: SNEAD M
Published: September 2009

Abstract not provided
Electrophysiological assessment of optic neuropathies in neuro‐ophthalmological practice
Authors: HAWLINA M , BRECELJ J
Published: September 2009

Purpose Clinical challenge in diagnosis of optic neuropathies are atypical cases of either unknown visual loss or clinical cases in which the cause is identified, however, assessment of the visual function by psychophysical and morphological methods is not sufficiently accurate to assess the damage caused by lesion, or when functional follow‐up is needed to assess the course. Such cases include inflammatory, compressive, paraneoplastic, infiltrative, toxic/nutritive or atypical demyelinating optic neuropathies.

Methods Electrophysiological methods will be interpreted with clinical history and presentation of clinical cases. Psychophysical methods and morphological presentation will be discussed in the context of why electrophysiology was needed either to clarify the diagnosis or to assess the functional status of the visual system.

Results Electrophysiological methods were informative in either dissociating the retinal involvement from that of optic nerve and to asses the functional preservation of the visual pathway. It is of importance that mfERG and pattern ERG can add to the diagnosis on macular disfunction where visual evoked potentials alone would be diagnostic for optic neuropathy.

Conclusion In neuroophthalmology, electrophysiological testing has its value especially in atypical cases and in situations where additional characterisation or functional assessment is needed. It is of importance to be able to dissociate functional characteristics of different components of visual pathway to assess the correct diagnosis and to asses whether the optic nerve may be endangered by progressive process, not readily discernible by other methods.
Wavefront analysis in unilateral herpetic keratitis
Authors: KASWIN G , DE MONCHY I , POGORZALEK N , GENDRON G , OFFRET H , LABETOULLE M
Published: September 2009

Purpose To assess optical aberrations using wavefront analysis in the affected eye of patients with unilateral herpetic keratitis with no apparent visual disturbance (visual acuity : 20/20), and to compare these results with those of the non‐affected eye

Methods Corneal optical aberrations from 5 patients with unilateral herpetic keratitis and normal visual acuity (20/20 OU) have been assessed using dynamic skiascopy with OPD Scan II® (Nidek™). Both eyes in all patients were apparently normal using slit‐lamp examination, and wavefront analysis was performed in a quiescent period of the herpetic disease. The fellow eye was used as control. Data were retrospectively analyzed by a blinded examiner.

Results Zernike’s polynoms and MTF curve analysis showed bilateral abnormalities in 4 patients, with no specific difference between the two eyes. In contrast, one patient had wavefront disturbances in the affected eye, whereas the non‐affected eye was normal.

Conclusion Moderate herpetic keratitis may induce wavefront abnormalities in some patients despite a normal visual acuity and an apparently normal cornea. This could explain visual discomfort that is sometimes described in such patients. . Further studies are needed to unerstand waevfront aberrations induced by herpetic keratitis with normal examination.
Anterior segment OCT in glaucoma
Authors: CIANCAGLINI M
Published: September 2009

Abstract not provided
Revisiting the value of assessing the mitotic rate of choroidal melanoma
Authors: COUPLAND SE , DAMATO B
Published: September 2009

Purpose To re‐evaluate mitotic rate (MR) as an indicator of malignancy grade in uveal melanoma (UM) and as a predictor for UM‐related mortality.

Methods UM patients treated 1993‐2006 by local resection or enucleation were included. Data on largest basal diameter (LBD), ciliary body involvement, extraocular extension, cell type, closed loops, MR per 40/HPF, cytogenetics were collected. Mortality data were obtained from NHS Cancer Registry.

Results 918 patients (520 M; 398 F) had median age of 64.6 yrs with a median follow‐up of 3.46 yrs (range 0.02‐13). The UM had mean diameter of 14.9 mm with ciliary body involvement in 43.0%, epithelioid cells in 63.3%, closed loops in 41.2%, extraocular spread in 11.3%. Cytogenetics in 337 patients showed disomy 3 and 8 in 27%, monosomy 3 in 10.7%, chromosome 8 gains in 24.0%, both these abnormalities in 38.3%. The median MR was 3(range 0‐61, SD 6). High MR correlated with ciliary body involvement (p = 0.001), epithelioid cells(p = 0.009), closed loops(p<0.0001), extraocular spread(p=0.027) & monosomy 3(p<0.0001;Mann‐Whitney). MR also correlated with LBD(p=0.0001; t‐test). Metastatic death occurred in 243 patients (26.7%). Kaplan‐Meier analysis showed MR >4/40 HPF to be associated with increased 10‐year metastatic mortality from 32.5 (95% confidence intervals [CI] 25.7‐39.3) to 65.5 (95% CI 55‐7‐75.4; log rank statistic 53.28, p<0.0001). Cox multivariate analysis showed MR to be an independent predictive factor for metastatic death (p<0.0001). MR was predictive of metastatic death also in patients without detectable monosomy 3 (Log rank statistic 10.38, p = 0.002).

Conclusion MR correlates with other known risk factors for metastatic death and independently predicts mortality even when cytogenetics show disomy 3.
Immunohistochemical findings and proliferation markers in uveal melanomas after gamma‐knife radiosurgery
Authors: WACKERNAGEL W , MAYER CF , LACKNER EM , SCHNEIDER MR , LANGMANN G , UNGER F , KLEINERT R
Published: September 2009

Purpose We describe immunohistochemical characteristics and tumor cell proliferation in 12 eyes with uveal melanoma enucleated after Gamma‐Knife radiosurgery (GKR) with different treatment doses.

Methods Tumors were stained for the specific melanocytic markers S‐100, HMB‐45 and Melan A. The immunoreactive score (IRS, Remmele‐score) was calculated from percentage of positive cells and staining intensity. Proliferating cells were identified with PC‐10 and MIB‐1 staining and counted. All markers were evaluated at the tumor apex, center, base and margins. Results were compared between eyes enucleated for tumor recurrence or treatment related side effects. Influence of treatment dose and time to enucleation were analyzed.

Results Only 1 of 12 melanomas stained positive for S‐100 (median IRS 0). HMB‐45 and Melan A were both positive in 11 of 12 cases (median IRS 9 and 10.5, respectively). Staining intensity was higher at the tumor apex, base and margins than in the tumor center, which frequently showed necrosis. PC‐10 and MIB‐1 showed proliferating cells in all melanomas, without relation to tumor recurrence (n=5), radiation dose (25‐50 Gy) or time between GKR and enucleation (1‐47 months). We found markedly more proliferating cells at the tumor margins.

Conclusion Proliferating cells were found even in cases with clinically stable disease. The finding of cycling cells at the tumor margins and necrosis in the tumor center might reflect the inhomogenous dose distribution used for GKR, with the tumor center receiving almost twice the dose of the surface and margins. It might also be an indicator for an intrinsically higher proliferation rate at the margins of the melanoma.
Ophthalmologic outcome of 40 spheno‐orbital meningioma resections: 15 years long‐term results
Authors: NOCHEZ Y , FRANCOIS P , VELUT S , CARDON A , MAJZOUB S , JAN M , PISELLA PJ
Published: September 2009

Purpose To evaluate the operative results of spheno‐orbital meningiomas regarding resectability, recurrence and ophthalmological outcome.

Methods Retrospective study of 40 patients who underwent surgical resection of spheno‐orbital meningiomas followed by bony reconstruction between 1992 and 2008.

Results Mean age of 50 years and sex ratio of 37 women and 3 men. The most common preoperative sign was proptosis (90%), visual acuity (VA) and visual field deficits (55%). Periorbital tumor infiltration is a predictive factor of decreased VA in case of initial VA deficit. Optic canal invasion and resection don’t influence VA recovery. Postoperatively, 10 patients showed severe permanent visual field deficits, versus 17 patients showed no visual field deficits. After surgery, proptosis improved for all patients with a preoperative mean proptosis of 5,6 +/‐ 3,6 mm versus 2,2 +/‐ 2,7 mm postoperatively (p<0,001). Lateral orbital wall resection and bony reconstruction are the two major factors which are efficient in reducing proptosis. Mean follow‐up period was 7 years. Clinical tumor recurrence was observed in 10 patients (27 %), radiological tumor recurrence without clinical signs was observed in 7 patients. 4 patients underwent re‐operation and 3 patients were treated by radiation. Resection quality is the only predictive factor of a clinical recurrence.

Conclusion Periorbital tumor infiltration is a predictive factor of non‐improvement of visual deficits (VA or visual field deficits). Peri‐orbital resection leads to a better esthetic result with a better proptosis reduction. Complete and subtotal (> 90%) tumor resection gives a long‐term survival free of clinical recurrence for 80 % of our patients.
Retinal angiomatous proliferation: is intravitreal ranibizumab therapy enough?
Authors: MARJANOVIC B , GEORGOUDIS P , MANDAL K , PATRA S
Published: September 2009

Purpose To report the use of Ranibizumab monotherapy versus Ranibizumab combined with additional photodynamic therapy (PDT) in the management of retinal angiomatous proliferation (RAP).

Methods The data from a non‐randomised series of 25 patients with RAP lesions attending the Bristol Eye Hospital age‐related macular degeneration (AMD) treatment clinic from April to October 2008 was analysed. The RAP lesions were classified according to Yannuzzi’s system as stage 1, 2 or 3 based on clinical, ocular coherence tomogram and angiographic features. Two treatment regimes were identified (1) Lucentis monotherapy and (2) Lucentis monotherapy with additional photodynamic therapy (PDT). The main outcome measures were the % of eyes losing < 15 letters, % of eyes gaining ≥ 15 letters and the mean change in visual acuity.

Results Mean LogMAR visual acuity was 52.8 letters before treatment. Mean follow‐up time is 9.5 months. Fourteen eyes had been treated with PDT before or after the use of Ranibizumab. Two eyes received PDT+IVT only (Stage 2 patients). 77% of eyes had an improvement in visual acuity. 18.5 % of eyes have had improvement of 15 or more letters. Mean change in visual acuity was +7.2 letters. 57% and 60% of patients with stage 1 & 2 disease respectively, received PDT.

Conclusion Combined therapy is effective in improving visual acuity and reducing central retinal thickness (CRT) in all patients with stage 1 lesions and most of patients with stage 2 lesions. Combined therapy offered greater gain in visual acuity in all treated patients. Stage 1 and 2 patients benefit more from the treatment if the condition is recognised and treated early.
Findings in electrooculography and multifocal electroretinography in patients after bevacizumab treatment for age‐related macular degeneration
Authors: MANKOWSKI W
Published: September 2009

Purpose To assess usefulness of electrooculography (EOG) and multifocal electroretinography (mfERG) in monitoring electrophysiological changes in patients after bevacizumab treatment.

Methods 33 patients with age‐related macular degeneration underwent ophthalmic examination including visual acuity, EOG, mfERG (Vision Monitor, Metrovision, France). Visual acuity test, sensory EOG protocol and mfERG with 61 scaled hexagons for low vision protocol were used during electrophysiological exams before and 1 month after each bevacizumab injection.

Results before bevacizumab injection mean visual acuity was 0,181±0,160, mean Arden’s coefficient was 199,692±54,785%, mean P1 wave amplitude <2 deg was 29,062±14,89 nV/deg2, mean P1 wave <2 deg implicit time was 47,015±12,832 ms. 1 month afer bevacizumab injection we observed no statistically significant mean visual acuity decrease (0,181±0,160 vs. 0,162±0,140 p=0,757), no statistically significant mean P1 wave amplitude <2 deg decrease (29,062±14,89 vs 25,077±17,996 nV/deg2 p=0,544) and no statistically significant mean P1 wave <2 deg implicit time decrease (47,015±12,832 vs. 46,115±10,313 ms p=0,845). We observed positive correlation between visual aciuty and P1 wave amplitude <2 deg (r=0,540, p<0,05).

Conclusion Electrooculography and multifocal electroretinography are useful exams in monitoring electrophysiological changes in patients during bevacizumab treatment.
Crosslinking by riboflavin and UVA. An electron transmission microscopy study in rabbits. Preliminary results
Authors: MANGIORIS G , NATSIS K , NIKOLOUSI A , PAPADOPOULOU DN , KOMNENOU A , KAROUTIS A , KARAMPATAKIS V
Published: September 2009

Purpose Collagen crosslinking of the cornea (CXL) has been developed recently as a promising treatment of keratoconus. In vitro measurements have demonstrated a significant increase in biomechanical stiffness of the crosslinked cornea. The aim of the present study was to evaluate the effect of this procedure on the collagen fiber diameter of the rabbit cornea over time.

Methods The corneas of 10 New Zealand White albino rabbits were crosslinked by application of the photosensitizer riboflavin and exposure to UVA light (365 nm, 3 mW/cm2) for 30 minutes. The fellow control eyes were left untreated. On ultrathin sections of samples from the central and peripheral cornea, the collagen fiber diameter were measured with the help of morphometric computer software.

Results In the anterior stroma, 48 hours after the CXL the collagen fiber diameter in the treated corneas was significantly increased by 10% compared with the control fellow eyes. Four months after the CXL, the mean collagen fiber diameters were decreased as compared to the 48 h specimens. In the 6 month specimens the diameter of the collagen fibers was further decreased as compared to the control fellow eyes up to ‐8%.

Conclusion CXL leads to a significant increase in corneal collagen diameter 48 hours after the procedure. Interestingly, 4 months after the CXL, there is a decrease in the mean diameter of the collagen fiber and at 6 months, there is a further decrease up to 8% compared to the fellow eye. We can assume that the rigidity and the biomechanical stability of the cornea after CXL is increased because of the new intercollagen connections and collagen fiber diameter has little or no role in this procedure.
A pocket slitlamp
Authors: ARMOUR R
Published: September 2009

Purpose I here describe a prototype pocket slitlamp for students and non‐specialists. It might help bridge the growing gap between ophthalmology (and optometry) and other specialties.

Methods MATERIAL Pocket microscopes, condensing lenses, modified pentorch and a platform. PILOT TESTS Evaluation and photographs of optical sections of 1)Anterior segment and lens of the eyes of the author and four volunteers. 2)Wrist watch crystals. Is a wristwatch a suitable model eye?

Results The prototype weighs 100g, costs EUR35 (£30)and can be carried in a pocket. The magnification was 0‐30X, and the slits of light were 0.5‐2mm wide. The digital camera cost EUR85 (£79.99). PILOT TEST RESULTS 1) Clinically adequate optical sections of the cornea, anterior chamber and lens were seen and photographed. 2) The outer and inner surfaces of the wristwatch crystal, watch face and the space in between were clearly seen. They simulated the corneal epithelium and endothelium, the iris and the anterior chamber. LIMITATIONS The view is monocular, there is no zoom and the light is less intense than the maximum of a conventional slitlamp.

Conclusion When developed this miniature slitlamp could help both in the instruction of students and in the clinical practice of non‐specialists. Students could practice on each other and on wristwatches, which make good model eyes.

Commercial interest
Simultaneous topo‐guided photorefractive keratectomy (PRK) followed by collagen cross‐linking (CXL) for the treatment of keratoconus
Authors: KONTADAKIS GA , KYMIONIS G , PORTALIOU D , KOUNIS G , KARAVITAKI A , PALLIKARIS IG
Published: September 2009

Purpose To present the results after simultaneous topoguided Photorefractive Keratectomy (PRK) followed by corneal collagen cross linking with Riboflavin/Ultraviolet – A irradiation (CXL) for the treatment of keratoconus.

Methods In this prospective case series, 22 patients (27 eyes) with progressive keratoconus participated. All patients underwent customized topography guided photorefractive keratectomy (PRK) immediately followed by corneal collagen cross linking with the use of riboflavin and ultraviolet – A irradiation.

Results Mean follow up was 10.72+5.98 months (range from 3 to 19 months). Mean preoperative spherical equivalent (SE) (diopters, D) and defocus were –3.03 ± 3.23D and 4.67±3.29D while at the last follow up examination were significantly reduced to ‐1.29 ± 2.05D and 3.04±2.53D, respectively. Preoperative mean (LogMAR) Uncorrected Visual Acuity (UCVA) and Best Spectacle Corrected Visual Acuity (BSCVA) were 0.99±0.81 and 0.21±0.19 while at the last follow up examination were improved to 0.16±0.15 and 0.11±0.15 respectively. Mean preoperative steepest meridian keratometry from 48.2±3.4D was reduced to 45.13±1.8D at the last follow up examination.

Conclusion Simultaneous PRK followed by CXL seems to be a promising treatment capable of offering patients a functional vision and halting progression of the ectatic disorder. Longer follow up and larger case series are necessary in order to fully evaluate this new innovative combined procedure.
Protective effect of the thioltransferase gene on in vivo UVR‐300 nm induced cataract
Authors: KRONSCHLäGER M , YU Z , GALICHANIN K , MEYER L , LÖFGREN S , SÖDERBERG PG
Published: September 2009

Purpose To determine the protective effect of the thioltransferase glutaredoxin 1 (Grx1), a critical protein‐thiol repair enzyme, on in vivo UVR‐induced cataract. Further, to estimate the MTD(2.3:16) for Grx1+/+ and Grx1‐/‐ mice and to calculate the protection factor for the thioltransferase gene on UVR‐induced cataract.

Methods 20 Grx1+/+ and 20 Grx1‐/‐ mice were unilaterally exposed in vivo to UVR‐300 nm for 15 min. Altogether, 5 groups of 4 animals received 0.0, 2.1, 2.9, 3.6 or 4.1 kJ/m2 each. At 48 h post UVR exposure, light scattering in the exposed and contralateral not exposed lens was measured quantitatively. Macroscopic lens changes were documented with dark field illumination photography.

Results Subcapsular and cortical opacities were observed in both the Grx1+/+ and Grx1‐/‐ mice. Forward light scattering in the lenses from the Grx1+/+ group was lower than in the lenses from the Grx1‐/‐ group and increased with increasing radiant exposure. The MTD(2.3:16) was for the Grx1+/+ group 3.81 (CI(0.95) = [2.82;6.37]) and for the Grx1‐/‐ group 2.99 (CI(0.95)= [2.33;4.00]) resulting in a protection factor of 1.28.

Conclusion Deficiency of the Grx1 gene makes the lens 28 % more sensitive to early onset UVR‐300 nm induced cataract, indicating the important role of the Grx1 gene in the oxidation defense of the lens.
Face down posturing for macular hole surgery. Is it really required?
Authors: TRANOS P
Published: September 2009

Purpose Background: In macular hole surgery pars plana vitrectomy and intravitreal gas injection with or without inner limiting membrane peel, is considered the mainstay of treatment. The requirement for face down posturing is generally regarded as part of the traditional postoperative routine. Several mechanisms have been postulated to explain the action of the gas bubble including exertion of a large floatation force on the macula and prevention of the macular hole exposure to vitreous fluid. Recently the need to face down has been chalenged since this regime compromises patients’ postoperative quality of life and it makes macular hole surgery almost impossible for individuals with mental or physical limitations.

Methods Review of personal data and systermatic literature review of studies investigating macular hole surgery with shortened or eliminated face down posturing.

Results There is considerable body of evidence suggesting successful anatomical and functional outcome in patients with shorter duration of posturing or no posturing at all following macular hole surgery. The pros and cons of each technique will be presented in detail.

Conclusion Prone posturing following macular hole surgery provides no functional or anatomic benefit but it is associated with slower progression of cataract. Combined phacovitrectomy without face down positioning may be considered for phakic patients undergoing macular hole surgery.
Orally active multi‐functional antioxidants for the treatment of cataracts and AMD
Authors: KADOR PF , RANDAZZO J , ZHANG P , BLESSING K
Published: September 2009

Age‐related cataract and neurodegeneration has been linked to oxidative stress and increased lenticular levels of Fe and Cu, which can contribute to ROS generated through the Fenton Reaction. Since both antioxidants and chelating agents have both been reported to reduce experimental cataracts, we have synthesized a new class of antioxidants (JHX‐4 and its dimethoxy analog JHX‐8) containing a novel 2‐amino‐4‐hydroxylpyrimidine ring system that selectively chelates Fe and Cu. In vitro studies in human lens epithelial cells and retinal pigment epithelial cells demonstrate that these compounds can reduce ROS generated by H2O2, endoplasmic reticulum (ER) stress, or Fenton’s reaction. In vivo studies demonstrate that these compounds accumulate in the lens and retina after oral administration. In Long‐Evans rats receiving whole head irradiation, these compounds delayed cataract formation proportional to the tissue levels of drug achieved. Compared to untreated rats, treatment with JHX‐4 and ‐8 delayed the formation of PSC punctuate opacities in 50% of animals by 53 and 58 days, respectively and lens PSC opacities by 38 and 47 days, respectively. In vivo neuroprotection studies are currently in progress. Supported by NIH EY016460‐01.
Gene therapy for corneal transplantation
Authors: PLEYER U
Published: September 2009

Abstract not provided
Thyroid eye disease and the internet
Authors: ZAIDI F , JONES C
Published: September 2009

Purpose Thyroid eye disease (TED) is influenced by modifiable risk factors yet has received little attention in terms of how the internet influences patient behaviour. We assessed the quality of information accessed by sufferers using the internet.

Methods The word ‘thyroid eye disease’ was subjected to an advanced keyword search. This analyses average monthly search volumes over a 12 month period using the Google search engine. The most popular search term was then inputted into Google and the first 5 pages of websites studied using a validated instrument. The 4 criteria published in the Journal of the American Medical Association (JAMA) for qualifying information from the internet were used in the analysis, yielding a possible score of between 0 and 4.

Results 100 websites were studied. All 4 criteria were satisfied by 10% of sites; 3 criteria were met by 17%; 2 criteria by 7%; 1 criterion by 20%. 46% of sites scored zero for objective quality. Superior scores were achieved by peer‐reviewed journals, online abstracts, book chapters and medipedias (online medical encyclopedias). Counter‐intuitively websites of professional bodies including academic institutions scored poorly. Lowest mean scores were obtained by private clinics and hospitals’ websites. This is different from the quality of information available in other fields such as retinopathy of prematurity that have been studied.

Conclusion The quality of information on TED is poor and this is particularly of relevance as good patient information such as advice against smoking would improve patient outcomes. These findings are of specific relevance to how scientists and clinicians inform patients in this age where a wealth of information and misinformation is available on the internet.
Corneal surface regeneration: epithelial sheets to epithelial crypts
Authors: DUA HS
Published: September 2009

The corneal surface is the most important 123 square millimetres of the body’s surface. Its health is paramount for sight. Due to its exposed nature it is vulnerable to environmental insults causing minor to excessive epithelial cell loss. Large epithelial defects, with an intact limbus heal by the formation of 3 to 6 convex sheets that migrate centripetally, meet adjacent sheets and undergo contact inhibition to form geometric shapes. These finally close by the formation of ‘Y’ shaped contact lines (Rule 1). When the limbus is partially involved, there is a preferential healing of the limbus by circumferential migration of tongue shaped sheets from the remaining intact limbus. These meet to cover the limbus (Rule 2) and subsequent healing occurs as in rule 1. On occasions conjunctival epithelium migrates across the limbus resulting in partial limbal deficiency. When the entire limbus is affected, total conjunctivalisation of the cornea occurs (Rule 3). Within sheets, individual cells migrate in a predominantly clockwise whorl pattern (Rule 4). Physiological and wound healing related cell turnover is believed to occur from stem cells (SC) located at the limbus. Specialised anatomical structures, termed Limbal Epithelial Crypts (LEC) are associated with some limbal palisades and present all the hallmarks of a SC niche. SC characteristics are also seen in the peripheral cornea adjacent to a palisade with a LEC. Recent evidence suggests that the limbal SC play a critical role in wound healing but may have only a marginal role physiological corneal epithelial homeostasis.
Age‐related macular degeneration; an Alzheimer’s disease in the eye?
Authors: OHNO‐MATSUI K
Published: September 2009

Purpose One of the earliest signs of age‐related macular degeneration (AMD) is the formation of drusen beneath the retinal pigmented epithelium (RPE). Recent proteome analysis demonstrated that amyloid β (Aβ), which is a major component of senile plaques in the brains of patients with Alzheimer’s disease. The purpose of our study was to clarify the role of Aβ on the pathogenesis of AMD.

Methods The effect of Aβ on the expression of angiogenesis‐related factors, cytokines, and the modulators of complement pathway in cultured human RPE cells was investigated. Ocular findings in neprilysin gene‐disrupted mice, which lead to an increased deposition of Aβ, were evaluated.

Results Aβ treatment induced a marked increase in VEGF as well as a marked decrease in pigment epithelium‐derived factor (PEDF) in RPE cells. Electron microscopy of the senescent neprilysin gene‐disrupted mice revealed the degenerated RPE cells with vacuoles and basal deposits formation. Aβ did not directly affect the expression of modulators of complement pathway in RPE cells, but increased the production of MCP‐1. Co‐cultures of RPE cells and macrophage/microglia in the presence of Aβ significantly increased the expression of the activator of complement alternative pathway; factor B by RPE cells through IL‐1β/TNF‐α secreted by macrophages/microglia. Aβ binds to the inhibitor of alternative pathway; factor I and inhibited its ability to cleave C3b to inactivated iC3b.

Conclusion Aβ has a critical role in the pathogenesis AMD. Combined mechanism exists for Aβ‐induced activation of the complement alternative pathway in subretinal space; cytokine‐induced up‐regulation of activator factor B and dysfunction of the inhibitor factor I. Un‐regulated complement activation leads to a low‐grade, chronic inflammation in subretinal tissue, which could cause AMD development.
New developments in treating Macular Edema, Posurdex RVO Phase III results
Authors: SOUBRANE S
Published: September 2009

Abstract not provided
Ophthalmic Research Lecture ‐ Role of the vascular endothelial cell in uveitis
Authors: SMITH J
Published: September 2009

Of all the forms of inflammatory eye disease, posterior uveitis is the most likely to result in irreversible loss of vision. This disease results from: autoimmune disease; infection, most commonly toxoplasmosis; and in rare cases, B cell lymphoma. Patients with posterior uveitis frequently demonstrate clinical involvement of the retinal vasculature. Studies of rodent experimental autoimmune uveoretinitis conducted by other groups show that the lymphocytes that control this disease model access the retina via the retinal blood vessels. We have developed methods to isolate vascular endothelial cells from the retina of human cadaver donors; lymphocytes migrate readily across monolayers of these cells. In separate studies, we have observed that in comparison to other endothelial cell subtypes, retinal endothelial cells are relatively susceptible to infection with Toxoplasma gondii tachyzoites; increased binding of tachyzoites to the retinal endothelium may contribute to this susceptibility. We have also detected the expression of B cell lymphoid chemokines by vascular endothelial cells, as well as malignant lymphocytes, in primary central nervous system B cell lymphoma. Profiling analyses of the human retinal vascular endothelial cell, using gene expression microarray and shotgun proteomics, may help to clarify the molecular mechanisms that mediate interactions between the retinal vascular endothelium and lymphocytes or microbes in posterior uveitis. As the “gate” of the retina in posterior uveitis, the retinal endothelial cell holds much promise as a target for highly specific therapies of this disease.
Intracameral amphotericin B in the management of Candida glabrata anterior uveitis after penetrating keratoplasty
Authors: SCHOLLMAYER P , KRAUT A , GLOBOCNIK‐PETROVIC M , PFEIFER V
Published: September 2009

Purpose To report management of Candida glabrata anterior uveitis after penetrating keratoplasty with intracameral amphotericin B.

Methods Case report and literature review

Results We report a case of a 79‐year‐old woman that presented with anterior uveitis and a dense endothelial plaque at the graft‐host junction in her only eye six weeks after repeated penetrating keratoplasty with donor tissue that was culture‐positive for Candida glabrata. Anterior chamber tap was performed and 5 µg of amphotericin B was injected in the anterior chamber. Cultures of the anterior chamber were positive for the same pathogen as the corneosleral donor rim. She was also treated with topical 0,5% amphotericin B for the next month and topical corticosteroids. At the end of follow up after 16 months her SCVA was 0,6. There was no evidence of recurrent fungal intraocular infection and the graft remained clear with the endothelial cell density of 2286 cells/mm.

Conclusion In our opinion intracameral amphotericin B is effective and safe in the therapy of Candida glabrata anterior uveitis after penetrating keratoplasty.
Progress in monitoring inflammatory CMO
Authors: DE SMET M
Published: September 2009

Abstract not provided
Metastatic disease in small uveal melanomas : retrospective review of 368 patients
Authors: DESJARDINS L , LEVY GABRIEL C , LUMBROSO‐LEROUIC L , DENDALE R , PLANCHER C , ASSELAIN B
Published: September 2009

Purpose To determine the metastatic rate and survival curves of small uveal melanomas and find the smallest uveal melanoma associated with metastatic disease.

Methods We studied uveal melanomas patients treated with radiotherapy in Curie Institute between 1992 and 2004. We selected the tumors with a diameter inferior or equal to 12 mm and a thickness inferior or equal to 3 mm. All the datas concerning initial tumor findings, radiotherapy treatment and follow up were routinely entered in the data base. Retrospective review and statistical analysis were performed.

Results Among 2258 patients treated during this period, 368 had small tumors. Median tumor diameter was 9 mm and median tumor thickness was 2,5 mm. Retinal detachment was present in 32 patients. 282 patients were treated by proton beam therapy, 77 by iodine plaque and 9 by transpupillary thermotherapy. Median follow up is 109 months. 71 patients died and 20 patients developped metastatic disease. Local recurrence was observed in two cases. Overall survival at 5 years was 92%and at 10 years 78% survival without metastasis at 5 years was 96% and at 10 years 93%. According to our data the smallest tumor associated with metastatic death was 5mm in diameter and 1,5 mm in thickness and 14 of the tumors had a diameter of less than 10 mm develloped. Half of the metastatic patients developped metastasis 5 years or more after treatment.

Conclusion Very small uveal melanoma can be responsible for metastatic death.
Open‐sky biopsy of ciliary body or choroidal tumors of undetermined origin: utility and safety
Authors: SCHALENBOURG A , CHAMOT L , UFFER S , ZOGRAFOS L
Published: September 2009

Purpose In the presence of a ciliary body or choroidal tumor of undetermined origin, an open‐sky biopsy is performed in selected cases to establish a diagnosis and specify the therapeutic approach. We explored the frequency and reliability of this diagnostic procedure.

Methods Retrospective, consecutive, histopathologic case series of 30 biopsies since 1989 of ciliary body or choroidal tumors of undetermined origin.

Results Eighteen tumors originated from the ciliary body, 12 from the choroid. Diagnosis was respectively adenoma/adenocarcinoma (4;0), mesectodermal leiomyoma (4;1), metastatic tumor (2;0), melanocytic tumor (4;5), lymphoma (1;3); hemangioma (1;0) or posterior nodular scleritis (0;3). In 2 cases, there was insufficient material to make a diagnosis. There were no cases where the biopsy complicated local or systemic tumor control.

Conclusion Open‐sky biopsy is only performed in cases whose clinical appearance doesn’t permit to confidently establish a diagnosis; its goal is to guide the therapeutic approach.
Interest of QuantiFERON®‐TB (QT) Gold test (Cellestis) in patients with positive Tuberculin Skin Test (TST) in etiologic and therapeutic work‐up in uveitis
Authors: DE MONCHY I , GENDRON G , KASWIN G , POGORZALEK N , OFFRET H , LABETOULLE M
Published: September 2009

Purpose Define the interest of QuantiFERON®‐TB Gold test (Cellestis) in patients with positive Tuberculin Skin Test (TST) to improve etiologic and therapeutic work‐up in uveitis.

Methods All patients followed in the Ophthalmology Department of Bicêtre Hospital between April 2007 and March 2009 for uveitis had an extensive work‐up including Tuberculin Skin Test (TST). Among them, 14 patients had a very positive TST making suspect an active tuberculosis infection. Then all of these patients had systematically a quantiFERON®‐TB Gold test. Finally, charts from clinical exam and therapeutic management were retrospectively analysed.

Results The mean age at the time of presentation was 58 years (+/‐ 9) and sex ratio (F/M) was 43%. Uveitis was bilateral in 43% of cases, and the location of inflammation was anterior in 43% of the cases, intermediate (21.4%), posterior (21.4%) or total (7%). The average of PPD test was 21.75mm (+/‐ 4mm, 15‐65mm) and minimal delay between PPD and quantiFERON®‐TB Gold test was 3 days (mean: 42 days +/‐ 17). QuantiFERON®‐TB Gold test was positive in 9 patients (64.3%) enjoining introduction of a full anti‐tuberculosis therapeutic treatment in 8 patients (57.1%), that preceded oral steroids regimen in 42.8% of cases. Visual acuity increased dramatically (6 lines) in 4 patients and was unmodified for the others.

Conclusion QuantiFERON®‐TB Gold test seems usefull in systematic diagnostic strategy in uveitis; it stays negative in 35.7% of the case suggesting that positive results are significant. However, further studies are necessary to define its place in diagnostic procedure in uveitis.
Semi‐automated assessment of microaneurysm formation rate from color fundus photographs in patients with mild NPDR
Authors: BERNARDES R , NUNES S , PEREIRA I , LOBO C , CUNHA‐VAZ J
Published: September 2009

Purpose To assess the reliability of microaneurysm (MA) formation rate, computed from color fundus photographs, in type‐2 diabetic patients with mild NPDR.

Methods In a 2‐years observational and prospective study of 400 type‐2 diabetic patients with mild NPDR, MA formation rate (MAFR) was computed using a new method (MA‐Tracker). This method allows graders to earmark MAs location on color fundus photographs. By using image co‐registration, it became possible to track previously identified MAs and to identify newly earmarked ones. The reliability of the procedure, assessed using 3 independent graders and a total of 235 color fundus photographs from a previous dataset, demonstrated a very good agreement between graders for the number of MAs (ICC=0.964) and for the MAFR (ICC=0.981).

Results Sixty‐three of the 400 patients/eyes that completed the baseline and the 6‐month visits had MAFR computed using the MA‐Tracker. While the number of MAs earmarked at baseline (mean±SD: 2.0±2.5 MAs) and at 6‐months (2.7±3.7 MAs) showed no statistically significant increase (P=0.105), the MAFR, on the other hand, showed a high MA turnover (mean±SD: 2.7±3.7 new MAs for this 6‐months period of follow‐up).

Conclusion Microaneurysm formation rate obtained from color fundus photographs using the MA‐Tracker show a very good reliability between graders making it a new tool with potential to be used as a biomarker of DR progression.
AlphaCor, Pintucci, Supradescemetic
Authors: PROSDOCIMO G
Published: September 2009

Purpose To report the long term results of a supradescemetic corneal implant to restore vision

Methods A Keralia "soft" keratoprosthesis was implanted in one eye of a seventy years old woman bilaterally blind and affected by a bilateral limbal stem cells deficiency.

Results After four years the implant is still insite, well tolerated. Thi initial visual recovery has been compromized , during the last year, by a progressive opacification of the superficial layer of the device.

Conclusion The Keralia supradescemtic implant seems well tolerated in the long term by the human eye. Problems related to the stability of the material should be solved in future.
Immunimodulation of corneal epithelial cells following electroporation with mRNA encoding IL‐10 and FasL
Authors: ZAKARIA N
Published: September 2009

Purpose The aim of this project is to transfect corneal epithelial cells with mRNA encoding IL‐10 and FasL in order to evoke down modulation of allogenic T cell responses in an ex vivo model.

Methods The corneal epithelial cells (CECs) will be electroporated initially using a reporter gene, EGFP, in order to optimize the transfection efficiency of the cells which will be detected using flow cytometry. Following this, we intend to transfect the cells with mRNA encoding IL‐10 and FasL. The cells will then be labeled with antibodies against IL‐10 and FasL and checked for expression of these molecules using flow cytometry. Cytokine secretion will also be detected using ELISA. IL‐10 and FasL transfected cells will be co cultured with allogenic T cells and compared with control co cultures of allo‐T cells with mock‐electroporated CECs. After 5 days of culture, T cells will be analyzed for allogenic reactivity by ELISA for IFN‐γ production in the culture supernatant.

Results We intend to show that it is possible to electroporate corneal epithelial cells effectively ex vivo with a reporter gene as well as with IL‐10 and FasL. We hypothesize that this may induce tolerance in allogenic T cells and we intend to illustrate this in an ex vivo model using an epithelial‐allo T cell co‐culture.

Conclusion This project aims to illustrate, in an ex vivo model, how gene insertion into corneal epithelial cells could possibly lead to improved cultivated limbal stem cell graft acceptance in patients with vascularized corneas.
Retinal pigment epithelial tears following administration of intravitreal bevacizumab (3 case reports)
Authors: KUOLIENE K , CIMBALAS A , AUKSTIKALNIENE M , ASOKLIS R
Published: September 2009

Purpose To report three cases of retinal pigment epithelial (RPE) tears after repeated intravitreal injection of bevacizumab for the treatment of neovascular age‐related macular degeneration (AMD). To present fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) findings.

Methods Out of 433 patients treated with intravitreal bevacizumab injections for choroidal neovascularization, three patients with vascularized RPE detachment developed RPE tear. Case 1: the patient developed RPE tear shortly after the third intravitreal injection into the left eye; cases 2 and 3: the patients developed RPE tear after a single injection into the right eye and left eye, respectively. Visual acuity testing, fundus photography and OCT were performed for all patients monthly for over a year after the first injection.

Results The preoperative size of the RPE detachment was 9.14 sq. mm for case 1, 5.16 sq. mm for case 2 and 5.93 sq. mm for case 3. At diagnosis of RPE tear, the patients suffered vision loss of three lines in cases 1 and 2 and two lines in case 3. After further treatment with bevacizumab, visual acuity at 12‐month follow‐up improved by two lines in case 1 and one line in cases 2 and 3.

Conclusion 1. RPE tear can occur following treatment with intravitreal bevacizumab and is associated with significant visual loss. 2. Large RPE detachment may be a predictor for RPE tear. 3. Visual acuity improved in all three cases after further treatment with bevacizumab following RPE tear.