bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal visual outcome 10 years after cataract surgery
Authors: MöNESTAM EI , LUNDQVIST B
Published: November 2010

Purpose This prospective, population‐based cohort study reports the longitudinal visual functional outcome of cataract surgery on a long‐term basis.

Methods 810 participants underwent cataract surgery during a 1‐year period. Before surgery, a few months after surgery, and 5 and 10 years after surgery, age and comorbidity were recorded, and BCVA was measured. At all occasions the patients also answered the same visual functional questionnaire (VF‐14). Ten years after surgery 335 (85% of survivors) participated with the questionnaire of whom 289 (73% of survivors) were re‐examined.

Results Ten years after surgery 76% of the patients examined had a BCVA of 20/40 or better, and 65% had a BCVA of 20/30 or better, which is a decline from 88% and 84% after surgery, respectively. Regarding each operated eye, 50% had unchanged or better VA, and an additional 19% had only lost less than 0.1 logMAR units, compared with postoperatively. Forty‐six patients (16%) had a decline in BCVA of more than 0.3 logMar units. The median VF‐14‐total score was 100 after surgery, declining to 96.7 5 years after surgery, and to 96.4 10 years after surgery. Ten years after surgery 49% of the patients had unchanged or better subjective visual function and 77% had less than 10 points in decline compared with preoperatively. Nine percent (31 of 335 patients) had a worsening of VF‐14 total score of 40 points or more. In this group age‐related macular degeneration (ARM) was the most common cause followed by bullous keratopathy.

Conclusion Longitudinal follow‐up of this older population confirms that subjective and objective visual function 10 years after cataract surgery remains stable in most surviving patients. Cataract surgery offers good long‐term visual rehabilitation for cataract.
Origin of the ERG omitted stimulus response: evidence from patients with congenital stationary night blindness
Authors: ANASTASAKIS A , MCANANY JJ , ALEXANDER KR , FISHMAN GA
Published: November 2010

Purpose Purpose: The omitted stimulus response (OSR) of the full‐field flicker ERG is an additional response component that follows stimulus termination. It has been attributed to a resonant oscillation in depolarizing (ON) bipolar cells. We evaluated this proposal by determining whether an OSR is present in the flicker ERG of patients with the complete type of congenital stationary night blindness (CSNB1) and presumed ON‐pathway dysfunction.

Methods Methods: Subjects included two patients with ERG findings typical of CSNB1 and 11 normally sighted individuals. Molecular genetic analysis confirmed a mutation in the NYX gene (Trp273Ter) of patient 1 and in the GRM6 gene (Arg621Ter) of patient 2. Monocular ERGs were recorded in response to full‐field sinusoidal flicker trains, ranging from 6.33 to 100 Hz, presented against a rod saturating background. The amplitude and relative delay of additional ERG responses following the offset of the flicker trains were analyzed.

Results Results: Across the frequency range of 39 to 63 Hz, the number of ERG responses exceeded the number of stimulus cycles for all control subjects. The delay between the additional response component and the last stimulus cycle was frequency dependent, consistent with an OSR. In the two patients with CSNB1, however, the number of ERG responses equaled the number of stimulus cycles at all frequencies.

Conclusion Conclusion: The absence of an OSR in these two CSNB1 patients supports the hypothesis that ON bipolar cells play a key role in the generation of this response.
Perceptual threshold and neuronal excitability as long‐term safety evaluation in retinal implants
Authors: VELIKAY‐PAREL M , IVASTINOVIC D , GEORGI T , HORNIG R
Published: November 2010

Purpose Despite the recent progress of retinal implants the effects of continuing stimulation still remains an open issue. Sofar the established safety limits are based on laboratory findings and clinical observations.This study examined the changes of perceptual threshold over time and its relation to longterm stimulation. The goal of the study was to establish stimulus induced depression of neuronal excitability (SIDNE) measurements as a method to gain further insight on the safety profile of epiretinal implants.

Methods As part of a clinical trial a prototype of an epiretinal implant ( IMI Intelligent medical implant) with 61 active platinum electrodes was implanted in a retinitis pigmentosa (RP) patient. The threshold was defined as the level of stimulation intensity at which the patient had a visual perception in a defined probability of 50% using the Best‐PEST method. SIDNE is measured by comparing the thresholds of two electrodes obtained at the beginning and at the end of a stimulation session. One electrode is actively used during the stimulation, the other remains passive. The stimulation is regarded as safe when the threshold raise of active electrodes is not significantly higher than of the inactive electrode.

Results The threshold remained stable over the observation period. The threshold raise of the active electrodes never exceeded that of the inactive electrode.

Conclusion SIDNE measurement is feasible in epiretinal implants. After prolonged stimulation the thresholds may increase by more than 16 % due to the patients fading concentration, however the stimulation was performed within the safety limits.
Seeing with subretinal electronic implants in blind volunteers requires direct link of image receiver to eye movement
Authors: ZRENNER E
Published: November 2010

Purpose To compare subretinal electrode‐generated percepts elicited by stationary stimulation with those elicited by light‐sensitive subretinal arrays during patient initiated natural eye movements.

Methods The Tuebingen subretinal implant consists of two arrays: a) 4 x 4 electrode field controlled externally for direct electrical stimulation (DS array), b) a light sensitive “CHIP” (3 x 3 x 0.1mm) with 1500 photodiodes, amplifiers and electrodes.

Results Patterns presented via DS electrodes repeatedly to the same retinal position disappear after seconds. With the light sensitive subretinal CHIP, however, objects like grating patterns, tableware or letters can be perceived continuously (repeated at 7 Hz for 1 ms. Clearly objects scanned with natural eye movements via light sensitive retinal CHIP activate a range of adjacent pixels on the CHIP, i.e. eye movements and microsaccades continuously shift the “electrical image” on the retina, thus preventing mechanisms of image fading

Conclusion The results clearly support the feasibility of light sensitive subretinal multi‐electrode devices for restoration of useful visual percepts in blind patients. Continuous stimulation of fixed electrodes can provide only quickly fading percepts (similar to the Troxler effect). In contrast, percepts of images constantly moving across the subretinal light‐sensitive chip – due to saccadic and fixational eye movement ‐‐ remain visible without measurable temporal limitation. We conclude that real‐time information of eye movements (an efference copy) is required by the brain to generate stable percepts. This is only available if the light sensitive part of the implant moves exactly with the eye, as presently realized only in the subretinal Tuebingen CHIP

Commercial interest
Specific deficits in visual electrophysiology without retinal cellular apoptosis in a mouse model of dominant optic atrophy
Authors: BARNARD AR , PIECHOTA M , SEKARAN S , POWELL K , MACLAREN RE , DAVIES V , VOTRUBA M
Published: November 2010

Purpose Autosomal dominant optic atrophy (ADOA) due to mutations in OPA1 is a slowly progressive optic neuropathy. OPA1 is ubiquitously expressed and plays a key role in mitochondrial fusion. Heterozygous Opa1 mutant mice (B6;C3‐Opa1Q285STOP), with previously reported visual defects and optic nerve changes, were assessed for retinal sequelae.

Methods ERGs and VEPs were recorded in 12 month old B6;C3‐Opa1Q285STOP mice (n=4) and age/sex matched wildtype littermate controls. Full scotopic and photopic intensity series were recorded in response to brief (4 ms) single flash stimuli delivered in a ganzfeld dome. End‐organ evidence for apoptosis was explored on TUNEL stained retinal sections.

Results Quantification of the major ERG components (a‐wave and b‐wave) confirmed no detectable difference in the amplitude or implicit time of scotopic ERGs across the full intensity range tested. This was also true for the VEP components. Quantification of the photopic ERG responses revealed a significant reduction in the PhNR amplitude in Opa1+/‐ animals relative to wildtypes at the brightest intensity tested. The photopic VEP was also abnormal in mutant mice. There was no increased apoptosis in retinal sections from mutant animals.

Conclusion Opa1+/‐ mice display a functional deficit on electrophysiology that is indicative of specific ganglion cell dysfunction. Despite a 50% reduction in Opa1 protein there does not appear to be a significant increase in apoptosis in the retina. This suggests that the protein truncating mutation in this model may lead to RGC dysfunction without triggering RGC death.
How do we recognize objects? An intracranial study
Authors: BERTRAND JA , ROBERT M , NGUYEN DK , BOUTHILLIER A , LASSONDE M , LEPORE F
Published: November 2010

Purpose How the brain recognizes visual stimuli has been extensively studied using scalp surface electrodes and magnetic resonance imaging. Complex visual stimuli such as objects and faces have been shown to strongly activate the ventral visual stream in humans. The link between this pathway of activation (bottom‐up processes) and the memory (top‐down processes) still has to be described.

Methods In the present experiment, intracranial electroencephalography was carried out in epileptic patients implanted with subdural electrodes to localize the epileptic focus so as to directly assess brain activations evoked by visual stimuli. Fragmented pictures of objects with eight levels of coherence were used whereby at level 1 the stimulus was unrecognizable and at level 8, it constituted the complete picture. We measured the evoked potentials at four levels of recognition: threshold (T‐0), two levels before threshold (T‐1 and T‐2) and one post threshold (T+1).

Results Activations were found in V1, V2, LOC, orbito‐frontal cortex (OF) and hippocampus. In V1 and V2, the early visual response suggested a higher level of treatment when trying to integrate the information to recognize the stimulus. The higher order structures, such as LOC and OF, gave their largest responses mainly at longer latencies.

Conclusion This intracranial study permits precise localization coupled with high temporal resolution, which allows for a better understanding of the different mechanisms involved in a fast and accurate visual recognition of objects.
Cataract surgery in ambulatory surgery unit: our experience in 14 years
Authors: PEREZ GARCIA D , IBANEZ ALPERTE J , CRISTOBAL BESCOS JA , MINGUEZ MURO E , JIMENEZ A , JIMENEZ DEL RIO B , CASAS P , RAMIRO MILLAN P , CRUZ N
Published: November 2010

Purpose To evaluate the outcomes of cataract surgery in the Ambulatory Surgery Unit in our hospital from 1995 to 2009.

Methods Retrospective and descriptive study including 5087 cataract surgeries performed in our hospital between 1995 and 2009. We have analysed several indicators(substitution, suspension),variables(gender, age, anesthesia, surgical technique, morbidity, pre‐and postoperative medication required as the degree of patient satisfaction after passage through the unit)and complications after surgery. The data analysis program used was StatView.

Results During the period studied, cataract surgery was the most common surgery in the unit, representing a 30.4% of the total, and the most common eye surgery (77.8%). The 54.94% of the patients were women, average age 73.11 years. Retrobulbar anesthesia was the most common with 74.03% of the surgeries, and the the preferred surgical technique was phacoemulsification and intraocular lens implantation(91.74%). Twenty one patients had severe complications(arterial hypertension, nausea, vomiting, vasovagal syncope...) that required admission to hospital.

Conclusion The model of Ambulatory Surgery in cataract surgery has proved, through their results in time and in properly selected patients, safe, efficient and effective, establishing as a consolidated unit in ophthalmologic patients.
How does scleral buckling affect the anterior segment of the eye?
Authors: ASCASO FJ , RUIZ DE GOPEGUI E , DEL BUEY MA , LAVILLA L , CRISTOBAL BESCOS JA
Published: November 2010

Purpose To describe the modifications produced in the anterior segment of the eye after placing an encircling scleral buckling (SB) in terms of corneal morphology, biomechanics and intraocular pressure.

Methods A prospective study of 15 eyes with rhegmatogenous retinal detachment who underwent pars plana vitrectomy combined with a scleral buckle (PPV/SB), and 12 eyes with vitreous hemorrhage treated with PPV alone. We measured preoperatively and 1‐month after surgery the corneal biomechanical properties using the Ocular Response Analyzer (ORA), including corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure (IOPg), and corneal compensated IOP (IOPcc). Moreover, we defined the corneal morphology by 4 parameters provided by the topographer Orbscan IIz: mean corneal power (dioptres), standard deviation, thinnest point (µm), and anterior chamber depth (ACD) (mm).

Results Mean CH values were significantly diminished following PPV/SB (p=0.003). We found no significant changes in CRF. IOPg and IOPcc mean values were significantly increased only in the PPV/SB group (p=0.019 and p=0.010, respectively) but not in PPV group (p=0.715 and p=0.273, respectively). In PPV/SB group, IOPcc mean values were significantly higher than IOPg before (p=0.001) and after surgery (p=0.003), but not in the other group. None of the morphological parameters were modified after surgery in any of the two study groups (p>0.05)

Conclusion Anterior segment morphology was not modified after placing a SB. Corneal biomechanical properties showed a reduction in CH, probably due to a vascular constriction and reduction of the eye compliance. PPV might be considered a less invasive approach for the repair of noncomplex retinal detachments than PPV/SB.
Acute mechanical effect of riboflavin corneal cross‐linking
Authors: PENNOS A , KARYOTAKIS N , KONTADAKIS G , PENTARI IG , PALLIKARIS IG , GINIS HS
Published: November 2010

Purpose To study the acute mechanical effect of corneal cross‐linking in vitro.

Methods Twenty porcine eyes were harvested from a local abattoire. The epithelium was removed using a rotating brush and corneal buttons having diameter of 8 mm were excised using a Barron’s PKP trephine. The buttons were left immersed for four hours in Dextran solution (20%W/V) in order to regulate their hydration. The buttons were immersed in riboflafin 0.1% in dextran 20% and separated in two groups (10 buttons each) where one group was irradiated for 30 minutes with UV light while the other group was not irradiated and served as control. After treatment mechanical measurements were performed by means of a purposely‐developed device featuring a stepping motor and a load cell. The motor shaft has a spherical tip that compresses the corneal button against a flat surface mounted on the load cell. The slope of force versus normalized deformation was recorded for each specimen.

Results The control group had an average slope of 3.55 (± 1.81) while the irradiated group had 4.47 (±1.80). This difference was not statistically significant. (p=0.27)

Conclusion This compressibility test did not reveal statistically significant changes between the two groups immediately after UV corneal cross‐linking. It remains to be elucidated whether different tests (e.g. elongation) may yield different results.
Three cases of reverse pupillary block after suturing of intraocular lens to the ciliary sulcus in avitreous eyes
Authors: KIMURA M , TSUDA M , MATSUYAMA K , ANDO A , NISHIMURA T , TAKAHASHI K
Published: November 2010

Purpose To report three cases of reverse pupillary block after suture of intraocular lens(IOL) to the ciliary sulcus in avitreous eyes.

Methods Visual impairment occurred in three eyes of three patients with past surgical history of vitrectomy and suture of IOL to the ciliary sulcus. Their findings of anterior segment showed deep anterior chamber (6000μm~4330μm) with concavity of the intermediate and peripheral iris, compression bonding of the pupil and IOL, and pigmentation of the trabecular meshwork. The diagnosis of a reverse pupillary block was made by opthalmological examinations and additional tests, e.g., ultrasonography and Pentacam®. In all eyes, laser iridotomy(LI) was performed in the superior peripheral iris to eliminate reverse pupillary block.

Results As a result, reverse pupillary block was eliminated and the depth of anterior chamber returned to normal (4018μm~3700μm), furthermore, concavity of the iris and compression bonding of the pupil and IOL were disappeared in all eyes.

Conclusion In the eyes with past surgical history of vitrectomy and suture of IOL to the ciliary sulcus, reverse pupillary block might occur and LI can be effective.
Are visual evoked potentials and pattern ERG useful in neuro‐ophthalmology?
Authors: HOLDER GE
Published: November 2010

Purpose To describe the roles of VEP and PERG in clinical neuroophthalmology.

Methods Case based examples.

Results Objective visual system testing with electrophysiology allows the distinction between optic nerve and macular dysfunction, often difficult in clinical practice. Examples will be shown of the types of VEP abnormality that can occur in different disorders of optic nerve function. PERG should also be performed in the patient with visual symptoms; if the PERG suggests macular dysfunction, full‐field ERG is indicated in order to determine whether that macular dysfunction is part of a generalised retinal process or is dysfunction localised to the macula. Electrophysiology further allows the diagnosis of non‐organic visual loss and the quantification of visual system dysfunction.

Conclusion The objective functional assessment with electrophysiology is an important part of the diagnostic armamentarium available to neuroophthalmologists.
Tobacco‐alcohol amblyopia: does it really exist?
Authors: GRZYBOWSKI A
Published: November 2010

Purpose Each textbook on ophthalmology in the 19th and the 20th centuries included a description of “tobacco‐alcohol amblyopia”. In the last 200 years several thousand cases of “tobacco‐alcohol amblyopia” were described, but the occurrence of the disorder has considerably decreased in modern times.

Methods Review of the literature and described cases of the entity.

Results By the end of the 20th century, a paradox had become apparent: the population of tobacco and alcohol users in some areas of the world continued to be very high, but there was a marked decrease in the incidence of the disease. Some believe that the disease never existed, some argue that it was a mismatch – or / and overdiagnosed.

Conclusion The presentation is going to cover the present status of knowledge about “tobacco‐alcohol amblyopia” and to finally give the answer whether such entity exists.
What next when the biopsy is negative in suspected giant cell arteritis (GCA)?
Authors: BOSCHI A
Published: November 2010

Purpose To present and discuss the approach of GCA when temporal artery biopsy (TAB) is negative. Recommendations for reducing the rate of negative TAB

Methods GCA is the commonest vasculitis. Visual loss occurs in up to one‐fifth of patients, which may be preventable by prompt recognition and treatment. Features predictive of ischaemic neuro‐ophthalmic complications are: jaw claudication, diplopia, and temporal artery abnormalities on physical examination. These manifestations and particularly blindness and jaw claudication seems to be more commonly associated with positive TAB.

Results Despite visual symptoms TAB may result negative. Rate of negative TAB varies from 7% to 40% in pat suspected of GCA. TAB should be done 2 to 6 weeks after commencement of treatment, and at least 1 cm. Contralateral biopsy is controversies, usually it increases the rate of GCA diagnosis of only 5%.

Conclusion If TAB is still however negative, but clinical suspicion high or Ultra‐Sound suggests GCA or complications typical of GCA, like anterior ischemic optic neuropathy, patient should be treat as biopsy‐positive GCA patient. If the clinical suspicion is low, features considered atypical or alternative explanations available, rapid glucocorticoid therapy should be tapered.
Sixth nerve palsy: who needs a workup, who needs a scan?
Authors: PURVIN V
Published: November 2010

Purpose To aid the clinician in the management of patients with sixth nerve palsy.

Methods The yield of various diagnostic for sixth nerve and other cranial nerve palsies will be reviewed. Attention will focus on risk factors that predict a positive result on diagnostic testing, particularly neuroimaging.

Results Most patients can be assigned a relative risk of harboring an underlying disease as the cause of their sixth nerve palsy but some will be missed. In most cases, a delayed diagnosis does not alter the outcome.

Conclusion The decision whether to image a patient with a sixth nerve palsy remains controversial and must be individualized.
Confusion and controversies in diagnosis and treatment of myasthenia
Authors: EGGENBERGER E
Published: November 2010

Myasthenia gravis is an afferent ocular motor mimic. The disease may appear with any pattern of pupil‐sparing, painless ocular misalignment with or without ptosis; accordingly, common mistaken diagnoses included CN3 palsy or internuclear ophthalmoplegia. Variability adds to diagnostic confusion, as patients may be asymptomatic and have a normal exam at certain stages in the disease. Clinical context remains the first diagnostic key, however, lab and electrophysiology are very helpful. Acetylcholine receptor antibodies are present in approximately 50% of ocular MG, but are highly specific. Single fiber EMG is perhaps the most sensitive test, being abnormal in approximately 90% of cases. Treatment is symptom dependent; pyridostigmine is often used as initial therapy and quite effective for ptosis and dysphagia, while additional immunosuppressives are often required for diplopia. We often initiate therapy with low dose every other day prednisone, and have a low threshold to add mycophenolate mofetil.
Primary intraocular lens implantation for bilateral congenital cataracts in infants 0‐1 year old: long‐term anatomic and visual outcome
Authors: LIANG F , DUREAU P , EDELSON C , METGE F , DE LAAGE DE MEUX P , CAPUTO G
Published: November 2010

Purpose To assess the long‐term anatomic and visual outcome of cataract extraction with primary intraocular lens(IOL) implantation in infants <1 year old

Methods We retrospectively reviewed 86 eyes of 43 infants operated for bilateral congenital cataract from 1999 to 2006. The surgical procedure was anterior capsulorhexis, phacoaspiration, posterior capsulotomy and anterior vitrectomy, with implantation of a PMMA or hydrophobic acrylic IOL in the bag or the sulcus.The following data were analyzed: age at the time of surgery, type of cataract, associated abnormalities, complications, final anatomic and refractive status, final best‐corrected visual acuity

Results The mean age at the time of surgery was 4.3±2.7 months. The morphology of cataract was total(45%), nuclear(42%), zonular(9%) and posterior subcapsular(6%).There was a family history of congenital cataract in 16 infants.Two infants suffered psychomotor delay. The most common postoperative complications were posterior proliferation, requiring anterior vitrectomy in 31% of the eyes, ocular hypertension (16%) and posterior synechia (14%). After a mean follow‐up of 3.7±1.5 years, the final spherical equivalent refraction was ‐2.2±4.1 diopters. 59% of eyes achieved final BCVA ≥ 20/70, 23% had BCVA ≥ 20/25,18% had BCVA ≤ 20/20. Visual outcome is significantly better in the group of infants older >6 months.

Conclusion Primary IOL implantation appears effective and safe in the management of bilateral congenital cataract in infants. Favorable visual outcomes can be achieved in the majority of cases. Opacification of the visual axis is the most common complication and the risk of glaucoma requires a careful long‐term follow‐up.
Using the OHTS‐EGPS risk calculator with OctopusTM visual field testing
Authors: STEVENS AM , KESTELYN P
Published: November 2010

Purpose Assessing risk in ocular hypertensive (OHT)patients is not only of clinical importance for the patients with regard to their possible glaucomatous field damage but has major repercussions on their quality of life when making decisions about the use of eye drops for longer periods. Clinicians are not that good in estimating the risk hence the need for instruments to help them make a more evidence‐based decision. The EGPS group states that a methodological difference “ of using in a quarter of the patients another type of perimeter could explain the Hasard Ratio for the Pattern Standard Deviation (PSD) of 1.66 in EGPS and 1.27 in OHTS .Hence our interest to recalculate a conversion of the Octopus G1 program ( mostly used for glaucoma ) to the Humphrey 30‐2 in a Group of ocular hypertensives conform the inclusions of the OHTS thus providing a way to use the calculator more accurately.

Methods 50 OHT patients recruited using the OHTS criteria were tested both with the Humphrey 30‐2 program and the Octopus G1 program. The Humphrey PSD values were plotted against the square root of the Loss of Variance (sLV) and a conversion formula was calculated

Results Our data generated the following conversion formula: Y = 0.4X + 1.1

Conclusion Our conversion permits a proper use of the risk calculator in OHT patients. There has been an attempt to convert the values from Humphrey 30‐2 to Octopus 32 by Monhart based on the results of a study by Langerhorst. Another approach could be based on the algorithm described by Zeyen using HFA 24‐2 and G1 Octopus but proves difficult to use in daily practice. EGPS simply used "converted" indices by taking the square root of LV for PSD. Our formula is based on the same population as OHTS but yields different results
Comparison of diagnostic accuracy of Fourier‐domain optical coherence tomography and scanning laser polarimetery to detect glaucoma
Authors: HOLLO G , GARAS A , KÓTHY P
Published: November 2010

Purpose To compare diagnostic accuracy of retinal nerve fiber layer thickness (RNFLT) measurements made using RTVue‐100 Fourier‐domain optical coherence tomography (RTVue‐OCT) and scanning laser polarimetry with variable (GDx‐VCC) or enhanced compensation (GDx‐ECC).

Methods One eye of each of 177 consecutive patients was imaged. Healthy (n=50) and ocular hypertensive (n=28) eyes were defined as normal, preperimetric (n=33) perimetric (n=66) glaucoma eyes as diseased.

Results For average RNFLT sensitivity was higher (Chi‐square test, p=0.002) with RTVue‐OCT (65.7 %) than with GDx‐VCC (49.5 %). For superior and inferior RNFLT sensitivity was similar with all methods. For the different nerve fiber bundle parameters, sensitivity of RTVue‐OCT (64.6 to 84.8 %) was consistently, up to 35 % higher (p<0.001) than that of GDx‐VCC/ECC (28.3 to 72.7 %). Specificity ranged 84.6 to 98.7 % with RTVue‐OCT, 92.3 to 100 % with GDx‐VCC, and 94.9 to 100 % with GDx‐ECC, with no significant difference between the methods except for one nerve fiber bundle parameter, for which RTVue‐OCT was less specific than either GDx method (p≤0.004). Diagnostic accuracy of the GDx‐VCC/ECC nerve fiber indicator (NFI) and RTVue‐OCT average RNFLT were similar. Of the detected glaucoma cases 87.7 % was identified both by GDx‐VCC/ECC NFI and average RNFLT of RTVue‐OCT.

Conclusion In this clinical setting, all methods were similarly highly specific, but for localized RNFLT damage RTVue‐OCT was statistically and clinically significantly more sensitive than GDx‐VCC and GDx‐ECC. Most detected glaucoma cases were identified with all three methods.

Commercial interest
Relationship between flicker FDF perimetry and standard automated perimetry
Authors: CALVO PEREZ P , GIL‐ARRIBAS L , FERRERAS A , OTIN S , ALTEMIR I , FERNANDEZ S , PABLO JULVEZ L , FUERTES I
Published: November 2010

Purpose To compare the main indices of flicker FDF perimetry (FDF, Heidelberg Engineering, Germany) with standard automated perimetry (SAP).

Methods Twenty healthy subjects and twenty‐three glaucoma patients were prospectively and consecutively selected. Glaucomatous patients had an intraocular pressure higher than 21 mmHg and glaucomatous optic disc appearance. All of them underwent at least one reliable perimetry with each device. SAPs were performed with a FDF perimeter (24‐2 ASTA‐Standard test) and Humphrey perimeter (Carl Zeiss (24‐2 SITA standard algorithm). The Kolmogorov Smirnov test was applied to check that the data were normally distributed. Only one eye per subject was included in the study. Pearson correlations were calculated between both devices : mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI).

Results Mean age was 58.41±12,4 years. MD of SAP was ‐2.82 ± 4.8 dB, and MD of FDF was ‐4.47 ± 4.8 dB (p=0.123); PSD of SAP was 3.11 ± 3.1, and PSD of FDF was 3.14 ± 1.4 (p = 0.953). The correlations between MDs were 0.521 (p<0.001) and between PSDs were 0.350 (p<0.001)

Conclusion Moderate correlations were found between main visual field indices both devices. Altough no differences were found, FDF tends to present MD values lower than Humphrey.
Relationship between HEP perimetry and standard automated perimetry
Authors: GIL ARRIBAS L , CALVO P , FERRERAS A , ALTEMIR I , OTIN S , FERNANDEZ S , PABLO JULVEZ L , FUERTES I
Published: November 2010

Purpose To evaluate the relationship between Standard Automated Perimetry (SAP) performed with Humphrey perimeter (Carl Zeiss Meditec, EEUU) and a new white‐white perimetry tested with Heidelberg Edge Perimeter (HEP, Heidelberg Engineering, Alemania).

Methods Fourty‐three subjects (healthy and with different levels of glaucomatous damage subjects) were prospectively and consecutively selected. Only one eye per subject was included in the study. All of them underwent at least one reliable perimetry with each device. 24‐2 SITA standard was used with Humphrey perimeter and 24‐2 ASTA standard algorithm was tested with HEP in all subjects. After checking the normal values of variables by Kolmogorov‐Smirnov test, Pearson’s correlation coefficients were calculated between global indices of both devices: mean deviation (MD), pattern standard deviation (PSD) and visual field index (VFI).

Results Mean age was of 58.41±12.4 years. Subjects had mean IOP values of 18.24±3.6 mmHg. No differences were found in mean MD values (p=0.127): ‐2.82±4.8 dB and ‐1.54±2.6 dB between Humphrey and HEP, respectively. No differences were found in mean PSD values (p=0.290) between Humphrey (3.11±3.1) and HEP (2.52±1.9). The strongest correlations were observed between PSDs (0.788; p<0.001) and between PSD with HEP and VFI (‐0.711; p<0.001).

Conclusion Both perimetries showed a good correlation between their indices. HEP tends to present MD and PSD values lower than Humphrey. Further studies are required to assess the clinical usefulness of HEP.
Patient reported outcomes in glaucoma: associations between the NEI VFQ‐25 and the GQL‐15 and clinical measures of visual function
Authors: POURJAVAN S , SPRATT A , KOTECHA A
Published: November 2010

Purpose To examine associations between visual function measurements and patient‐reported outcomes as assessed by vision‐specific National Eye Institute Visual Function Questionnaire(NEI‐VFQ25) and glaucoma‐specific Glaucoma Quality of Life 15(GQL‐15)

Methods NEI‐VFQ25 & GQL‐15 were self administered. LogMAR visual acuity (VA), contrast sensitivity (CS), stereoacuity and visual field (VF) testing with Humphrey Field Analyzer were performed. To estimate the binocular VF defect severity, 2 scores were generated: the average Visual Field Index (mVFI) and the binocular integrated visual field (IVF). Correlations were examined using Spearman’s correlation coefficient.

Results To date, 54 glaucoma patients were included(mean age 65.1±12.9 yrs). The group mean mVFI index was 79.6 ±26 % and IVF score was 9 ±19.5. NEI VFQ composite scores were strongly associated with VF defect severity (mVFI rho = 0.61, p < 0.001; IVF rho = ‐ 0.55, p < 0.001), worse VA and CS (VA worse eye rho = ‐0.44, p = 0.01; CS worse eye rho = 0.55, p < 0.001) and poorer stereoacuity (rho = ‐0.35, p = 0.01). GQL scores were also associated with VF defect severity, worse eye VA, worse eye CS and stereoacuity, but to a lesser extent (mVFI: rho = ‐0.47, p < 0.01; IVF: rho = 0.38, p < 0.01; VA worse eye = 0.37, p = 0.05; CS worse eye rho = ‐0.43, p<0.01; stereoacuity rho = 0.31, p < 0.05).

Conclusion The perceived difficulties experienced by glaucoma patients appear to be related to many aspects of visual function. This interim analysis shows that clinical measures of visual ability are better correlated with the NEI VFQ than the GQL‐15. This suggests the former maybe more sensitive to the experiences reported by glaucoma patients.
Influence of hydrophilic aspheric IOL on quality of vision
Authors: CURATOLO MC , ZOLA P , SCUDERI AC
Published: November 2010

Purpose Quality of vision after a cataract surgery is influenced by several factors among which the optical IOL properties have to be considered. The aim of the study was to evaluate the influence of the optical property of a hydrophilic aspheric monofocal IOL on the quality of vision in pseudophakic patients.

Methods A retrospective clinical study was performed by evaluating patients undergone a cataract operation with phacoemulsification and IOL implant in a 12 months period. In each patient a hydrophilic aspheric monofocal IOL (MIRA 3, SIFI Italy) was implanted. In preclinical tests this IOL assures a very high MTF value. Clinical evaluation included: slit lamp examination, visual acuity, refraction and contrast sensitivity before and 3 months after surgery. Contrast sensitivity was analyzed by a computerized optotype ( YANG visual system, SIFI Italy)

Results An uneventful cataract operation was performed in 80 patients implanted with the above mentioned IOL. As the post–operative refraction is concerned, after 3 months, the refractive target was achieved in 90 % of cases. Moreover, 85% of patients showed a high post‐operative contrast sensitivity.

Conclusion The optical properties of the IOL resulted excellent. This is due to its design (assures centration and stability inside the capsular bag) and elasticity, as well as the refractive and optical quality of the IOL.

Commercial interest
Cytostatic and cytotoxic effects of 5‐fluorouracil on human corneal epithelial cells and keratocytes
Authors: MIDENA E , LAZZARINI D , PARROZZANI R , VIOLATO D , FREGONA I
Published: November 2010

Purpose To investigate the effects of different 5‐Fluorouracil (5‐FU) concentrations, exposure times and application techniques on in vitro cultured human corneal cells.

Methods Human corneal epithelial cells (HCEC) and human corneal keratocytes (HCK) cultures were exposed to different 5‐FU concentration (0.025% to 1%) and incubation times (single 5’ to 2 hrs). The cytostatic effect was evaluated as ratio of inhibition of migration towards controls. The cytotoxic effect evaluation included both contrast phase microscopic observations, and viability measures performed using a MTT[3‐(4,5‐dimethylthiazo‐2‐yl)‐2,5‐diphenyltetrazolium bromide; thiazolyl blue] colorimetric assay. The results were expressed as ratio of optical density (OD) reduction 24 hrs after exposures.

Results Cytostatic effect is time and dose dependent. Minimal inhibiting dose (ID50) was 0,55% after 1 hour incubation for HCEC; ID50 was 0,5% after 2 hrs incubation for HCK . A 100% inhibitory effect was never observed at any concentration or incubation interval. No cytotoxic changes were observed at 5‐FU < 1%; 5‐FU 1% showed time‐dependent cytotoxic changes just in HCEC cultures. MTT analysis showed no OD reduction at 5‐FU concentration < 1%, whereas 1% 5‐FU showed OD reduction < 50% at any tested exposure time. HCEC showed higher reduction in OD than HCK.

Conclusion 5‐FU shows no definite signs of irreversible toxicity to normal cultured corneal epithelial and keratocyte cells at examined concentrations and exposure time.
The role of transpupillary thermotherapy in combined treatment of retinoblastoma
Authors: SAAKYAN SV
Published: November 2010

Purpose Retinoblastoma (RB) is one of the most serious ophthalmic pathology in childhood. Treatment options that provide eye preservation include chemotherapy, brachytherapy, external beam radiation, cryotherapy and laser treatment. The aim of our study is to evaluate efficiency of transpupillary thermotherapy (TTT) as a part of combined treatment of RB.

Methods Our group consists of 30 RB patients (34 eyes). All patients received systemic chemotherapy (Carboplatin and Vincristine). Tumor thickness before TTT varied from 0.9 to 2.6 mm, tumor base diameter varied from 2 to 10 mm. Seven patients had monolateral RB, others had bilateral lesion. Five patients were treated with brachytherapy before TTT. TTT was performed using infrared diode laser Nidec DC 3300. Exposure time was 60 seconds. Width of laser beam was from 1000 to 2000 nm. TTT power setting varied from 600 to 900 mW. Eleven patients had TTT more then once. Follow‐up period after TTT was up to 24 months.

Results Control examination after TTT showed good response to the treatment in 27 eyes (79.4%).After TTT we saw hyperpigmented scar on the eye fundus at the place of previous tumor location, on OCT it looked like hyper‐reflective stripe replacing all layers of a retina. Seven eyes (20.6%) were resistant to TTT, five of them were successfully treated by additional brachytherapy. Two eyes were enucleated because of uncontrolled tumor growth. Evaluation of metastatic disease in all patients revealed no signs of metastasis at the time of treatment or during follow‐up.

Conclusion TTT can be used in combined treatment of RB for small multifocal lesions. The method is rather simple and uncomplicated. Patients treated with TTT have better visual prognosis in comparison with brachytherapy.
Treatment of choroidal neovascularization associated with choroidal nevus
Authors: PILOTTO E , PARROZZANI R , MIDENA E
Published: November 2010

Purpose Purpose:To evaluate safety and efficacy of different treatments of choroidal neovascularization (CNV) associated with choroidal nevus at the posterior pole.

Methods Methods: Six patients affected by choriodal nevus complicated by CNV were treated with photodynamic therapy with verteporfin (PDT; 50 J/cm2, 83 seconds) (five cases), or intravitreal anti‐VEGF (bevacizumab, 1.25 mg) (one case). All patients underwent an ophthalmologic evaluation, including fluorescein and indocyanine green angiography, A‐and B scan ultrasonography and OCT at presentation and at each follow‐up examination. CNV was extrafoveal in all PDT treated cases, and a foveal serous detachment was detectable. CNV was subfoveal in the eye treated with anti‐VEGF.

Results Results: Mean follow‐up was 15.5 months (range: 6 – 24). Visual acuity improved in four of the PDT treated cases and in the anti‐VEGF treated eye, while it remained unchanged in the remaining PDT treated lesion. In all eyes resolution of the foveal serous detachment was detectable. In all PDT treated eyes a single treatment was performed with no recurrence during follow‐up. Meanwhile anti‐VEGF was repeated after three months for CNV recurrence.

Conclusion Conclusions: PDT and anti‐VEGF seem both effective in the treatment of CNV secondary to choroidal nevus but a larger study is required to evaluate long‐term efficacy and safety expecially of anti‐VEGF therapy.
Hypermethylation of tumour suppressor genes in ocular adnexal lymphoma
Authors: MA H , LAKE SL , LO A , WONG D , DAMATO BE , COUPLAND SE
Published: November 2010

Purpose Promoter hypermethylation occurs in various tumours, including ocular adnexal lymphomas (OAL), and is a mechanism by which tumour suppressor genes can be inactivated during tumourigenesis. This study aimed to investigate the levels of hypermethylation and specific genes that are hypermethylated in different subtypes of OAL using methylation‐specific multiplex ligation‐dependent probe amplification (MS‐MLPA) and pryrosequencing.

Methods DNA was extracted from formalin‐fixed, paraffin‐embedded tissues from 33 extra‐marginal zone B‐cell lymphomas (EMZL) and 37 non‐EMZL. Using two MS‐MLPA assays (MRC‐Holland) the methylation status and copy number of 36 genes was detected. MS‐MLPA results were validated using pyrosequencing.

Results MLPA and pyrosequencing results were comparable with 75‐100% concordancy. Ten common genes were hypermethylated in the EMZL and non‐EMZL, diffuse large B‐cell lymphomas (DLBCL) and mantle cell lymphomas (CDH13, DAPK1, ESR1, GATA5, IGSF4, PAX6, RARβ, THBS1, TIMP3, and WT1). In non‐EMZLs, a greater number of genes showed hypermethylation when diagnosed in the orbit and patients had a poorer prognosis. Deletion of the 9p21 region was seen in 7/13 DLBCLs including the p14ARF, p15 and p16 genes.

Conclusion Hypermethylation is a feature of OALs suggesting a role for epigenetic deregulation in OAL development. In non‐EMZLs greater epigenetic deregulation may be indicative of poorer patient prognosis. We hypothesise that EMZL, DLBCL and mantle cell lymphomas share a similar epigenetic aetiology and that genes in the 9p21 region may be important to DLBCL development. Correlation of hypermethylation and copy number data with clinical presentation and follow‐up could reveal biomarkers of diagnostic and prognostic value in OALs.
Low level of residual monomer and specific surface properties affect intraocular lens material biocompatibility
Authors: CURATOLO MC , SCUDERI AC , TORNETTA T , LICCIARDELLO A , LA ROSA C , MARLETTA G
Published: November 2010

Purpose Surface chemistry, roughness and adhesiveness properties of biomaterials can affect cell adhesion and protein mediation. Also release of inflammatory species from IOL material can promote foreign body reaction. Purpose of this study is of evaluating how the low quantity of residual monomer and specific surface properties of a hydrophilic IOL material can have efficacy in reducing release of species and controlling cell adhesion and protein mediation.

Methods A co‐polymer, material of a hydrophilic acrylic IOL (MIRA,SIFI Italy), was investigated by TG and TOF‐SIMS analysis. Surface roughness and adhesiveness properties were evaluated by AFM. For protein adhesion QCM‐D technique was employed. Cell Adherence (SIRC) and strength of interaction at the cell‐surface contact area (McCoy) were also observed and measured.

Results Thermal (TG) and chemical analysis (TOF‐SIMS) showed that low level of residual monomer affects thermal stability. AFM analysis showed low surface roughness and adhesive force values. QCM‐D analysis showed small values of thickness and mild viscoelastic behavior for protein layer. Cell adherence was not significant and strength of interaction did not show difference for bare and protein adsorbed substrate.

Conclusion Properties of hydrophilic materials are variable and not directly related to the hydrophilicity of their surface. The hydrophilic acrylic IOL polymer tested, pure of residual monomer content and with the investigated specific surface properties cannot promote foreign body reaction and can control protein adsorption and inhibit cell reaction.

Commercial interest
Management of a severe Graves’ orbitopathy
Authors: FERNANDEZ PEREZ S , PUEYO ROYO V , CALVO PEREZ P , EGEA ESTOPINAN MC , GIL ARRIBAS L , DE LA MATA PEREZ G , IDOIPE CORTA M , GUERRI MONCLUS N , FERNANDEZ TIRADO FJ
Published: November 2010

Purpose A case report of a 44‐year‐old woman with severe graves’ orbitopathy treated with high‐dose intravenous glucocorticoids, radiotherapy and bilateral orbital decompression by endoscopic surgery.

Methods In the initial examination the corrected visual acuity was 0.2 in the right eye and 0.1 in the left eye, exophthalmos of 25 mm in both eyes, ophthalmoplegia mild to moderate ,lower keratitis, ocular hypertension (23 mm Hg in the right eye and 28 mm Hg in the left eye) despite treatment. She was treated with intravenous boluses of methylprednisolone 1g/day/3 days with clinical improvement although there was reactivation of her graves’ orbitopathy. She received orbital radiotherapy using a cobalt‐60 radiation source (total dose 20 Gy) after which, the patient experienced clinical improvement. Due to the large corneal involvement (exposure keratitis) of both eyes and the patient's clinical deterioration, it was decided to carry out orbital decompression by endoscopic surgery urgently.

Results Ten months after surgery the patient has a corrected visual acuity of 0.7 in the right eye and 0.9 in the left eye. Proptosis, eyelid retraction and exposure keratopathy have disappeared, although walleye remain lower in both eyes.

Conclusion The treatment of choice for moderate‐to‐severe and active Graves’ orbitopathy is high‐dose intravenous glucocorticoids. When there is no response, orbital radiotherapy is an appropriate treatment option. Orbital decompression is a very successful surgery to correct exophthalmos and improve edema taking place in the not active orbitopathy as rehabilitative or active in cases not responding to any medical therapy.
Changes in the retinal nerve fiber layer in patients with multiple sclerosis
Authors: ASCASO FJ , RUIZ DE GOPEGUI E , IÑIGUEZ C , DEL BUEY MA , CRISTOBAL BESCOS JA
Published: November 2010

Purpose To evaluate by Optical Coherence Tomography (OCT) the presence of peripapillary retinal nerve fiber layer (RNFL) damage in patients suffering from multiple sclerosis (MS).

Methods Prospective study of the peripapillary RNFL measured by Stratus OCT in 116 eyes from 58 patients divided in four groups: non optic neuritis MS patients (non ON‐MS): 35 eyes; optic neuritis MS patients (ON‐MS): 20 eyes; fellow eye optic neuritis MS patients (FE‐ON‐MS): 29 eyes; healthy controls (HC): 32 eyes.

Results The peripapillary RNFL thickness is lowered not only in eyes from patients with MS and ON (81'6±20'6µm), but also in their fellow eye 92'9±13'6µm), and even in eyes from MS patients without previous history of ON (101'0±11'2µm). p< 0,05, ANOVA test.

Conclusion OCT proved to be a useful device in the diagnosis of axonal damage in patients with MS.