bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary results obtained by a new intraocular lens based on accommodative technology for the treatment of cataract and presbyopia
Authors: Martínez‐Abad Antonio , Alio Jorge , Yebana Pilar , Puche Ana Belen Plaza
Published: December 2022

Purpose: The aim of this study was to report the clinical results obtained by a new accommodative intraocular lens (AIOL) in terms of visual acuity, refraction, defocus curve, contrast sensitivity and complications incidence for multiple follow‐up phases.

Methods: This is a prospective and experimental study composed by patients interested in an AIOL implantation (Lumina, Akkolens) to improve their visual performance. An exhaustive postoperative follow‐up (1 week, 1 month, 3 months, 6 months, 1 year) was performed including the measurements of visual acuity for multiple distances in decimal notation, subjective refraction, accommodative evaluation by defocus curve, contrast sensitivity and a slit lamp and fundus exploration.

Results: The study included 42 eyes of 21 patients (mean age of 61.4 ± 10.9 years; 52% females, 48% males). The mean uncorrected distance visual acuity at week was 0.71 ± 0.28, but it improved to 0.85 ± 0.27 a year after the surgery. Similarly, the mean uncorrected near visual acuity improved for 0.48 ± 0.23 at 1 week to 0.60 ± 0.17 at 1 year. The mean equivalent sphere was −0.39 ± 0.60 diopters and the mean corrected distance visual acuity was 1.04 ± 0.16 at 1 year. For a defocus range comprised between 0.00 and −2.00 diopters the mean visual acuity was better than 0.50. The contrast sensitivity assessment showed values higher than 1.10 log units for all frequencies. Capsule opacification with YAG laser requirement was present in 21% of cases (N = 9). At the end of the follow‐up all minimal complications were resolved.

Conclusions: The AIOL Lumina Akkolens provided suitable distance vision and functional near vision improving its performance over time. Contrast sensitivity was good being comparable with a monofocal design, but the Lumina IOL shows better near visual performance as revealed in the defocus curve. Significant persistent complications were not observed. These results will be updated with more patients and will be compared with a control group.
Exacerbated mitochondrial fusion abrogates mitophagy and leads to pro‐inflammatory signalling in Müller glia during diabetic retinopathy
Authors: Anderson Aidan , Alfahad Nada , Ganley Ian G. , Rauz Saaeha , Wallace Graham , Curtis Tim M. , Romero Jose M.
Published: December 2022

Purpose: To determine how the dysregulated interplay between mitochondrial dynamics and mitophagy contribute to the progression of diabetic retinopathy [DR].

Methods: 3‐months and 9‐month‐old diabetic mitophagy reporter (MitoQC‐Ins2Akita) mice and their non‐diabetic siblings, were used to evaluate the interplay between mitochondrial dynamics and mitophagy by confocal morphometry. To model the dysregulation of mitochondrial quality control processes in vitro, mitochondrial fission was antagonized in retinal Müller cells (mouse primary and MIO‐M1 cell‐line) using a Drp1 inhibitor peptide (P110), under physiological (5.5 mM) and elevated glucose (30.5 mM) conditions. Mitochondrial fitness was assessed via metabolic flux (Seahorse) along with mitochondrial membrane potential (JC‐1), while the Müller glia inflammatory secretome was determined using Luminex.

Results: In contrast to younger ages, 9‐month‐old diabetic mice displayed exacerbated mitochondrial fusion at the outer retina (e.g., increased interconnectivity and mitochondrial aspect ratios), which was strongly associated with impaired mitophagy levels (r2 = 0.7, p < 0.001). P110 peptide inhibited mitochondrial fission/exacerbated fusion in retinal Müller cells, and abrogated mitophagy similarly to that found at advanced DR stages. Importantly, exacerbated mitochondrial fusion under hyperglycaemia (but not normoglycaemia) disrupted mitochondrial membrane potential (p < 0.05) in Müller cell cultures, further compromising mitochondrial fitness, as shown by decreased spare respiratory capacity and bioenergetic health index (p < 0.001 both). This was accompanied by significantly elevated secretion of key DR pro‐inflammatory factors, particularly CCL2 and VEGF‐A (p < 0.05 both).

Conclusions: Exacerbated mitochondrial fusion contributes to DR pathology by inhibiting mitophagy in Müller glia. Therapies aimed at facilitating mitochondrial fission/mitophagy in a controlled fashion may hold therapeutic potential for managing DR.
Orbital sarcoidosis. Case report
Authors: Martínez Julia Pérez , Prades Gemma Ortega , García Amparo Lanuza , Ibor Francisca García , Samper Antonio Miguel Duch
Published: December 2022

Purpose: Sarcoidosis is an autoimmune granulomatous disease that can affect any organ system in the body. Orbital manifestations are relatively uncommon. We present the clinical features and management in a case report with orbital sarcoidosis.

Methods: This case report study a 51 year‐old female patient being investigated for headache, blurred vision and diplopia of 7 days onset. She had proptosis of the left eye, diplopia and complete ophthalmoparesis on supraversion and abduction and partial on adduction. The magnetic resonance showed probable orbital inflammation (inflammatory pseudotumor)/Tolosa Hunt syndrome with predominant involvement of the left superior rectus muscle, cavernous sinus, and pachymeninges. Chest X‐ray showed no pathological findings and laboratory tests, thyroid profile, serology, IgG subclasses, angiotensin converting enzyme and autoantibodies were negative. The computed tomography (CT) showed pulmonary lesions compatible with stage III sarcoidosis. After the results of the imaging tests, it was decided to start treatment with a bolus of methylprednisolone for 5 days and then oral prednisone was started with clear clinical and radiological improvement. The mediastinal lymph node biopsy could not be performed due to the decrease in its size.

Results: The patient was treated with decreasing doses of corticosteroids until the disappearance of the orbital and pulmonary radiological symptoms. It has been followed for 2 years without recurrence.

Conclusions: The presentation of sarcoidosis simulating a pseudotumor is uncommon. Despite this, we must take it into account in the differential diagnosis. In our case, the presentation of CT showing a pulmonary lesion compatible with sarcoidosis and the improvement with corticoid treatment made us reinforce the suspicion of a diagnosis of sarcoidosis. In any case, the definitive diagnosis of this pathology is biopsy and pathological analysis.
Genetic findings in over 600 individuals with inherited retinal disorders in Finland
Authors: Krootila Julia , Kaukonen Maria , Sankila Eeva‐Marja , Paavo Maarjaliis , Seitsonen Sanna , Repo Pauliina , Backlund Michael P. , Majander Anna , Lindahl Päivi , Vasara Kristiina , Avela Kristiina , Salminen Eveliina , MacLaren Robert E. , Kivelä Tero T. , Turunen Joni A.
Published: December 2022

Purpose: To report genetic findings in patients with suspected inherited retinal disorders (IRD) in a large Finnish cohort.

Methods: The study was conducted retrospectively on IRD‐patients treated at the Department of Ophthalmology, Helsinki University Hospital between January 1, 2012, and December 31, 2020. Eligibility criteria were met by 786 patients. Clinical diagnosis, genetic testing method and result, relevant family history, and mode of inheritance were drawn from the electronic health registries.

Results: Of the 638 patients who underwent genetic testing, 79% received a genetic diagnosis. The genetic findings corresponded to autosomal recessive (AR) inheritance in 242 patients, X‐linked in 158, and autosomal dominant (AD) in 94, whereas pathogenic variants in mitochondrial genes were found in 22 patients. The most common genetic diagnosis was a pathogenic variant in RS1 causing X‐linked retinoschisis (n = 86, 17% of all patients with a positive genetic finding). Of retinitis pigmentosa ‐associated genes, causative variants were most commonly found in CERKL (n = 43, 8.5%), RPGR (n = 31, 6.1%), and EYS (n = 25, 5.0%). CERKL variant c.375C > G, p.(Cys125Trp) and EYS variant c.1155 T > A, p.(Cys385Ter), both with known founder effects in the Finnish population, were frequently discovered (n = 69 and 53, respectively). Variants in the ABCA4 gene explained IRD in 24 patients. Pathogenic variants were also found in CHM (n = 26), OPA1 (n = 16), and CLRN1 (n = 16).

Conclusions: The genetic causes of IRDs in Finland differ from other countries because of its isolated population history. Compared to similar studies in other countries, the percentage of patients with a positive genetic finding was higher (79%), which can partly be explained by the enriched founder mutations in the population. About 20% of the patients still lack a genetic diagnosis. These patients might have causative variants that are difficult to detect with current testing methods (such as complex structural variants) or the variants are in genes not yet associated with IRD.
Successful treatment of corneal perforation due to gonococcal keratoconjunctivitis with a combinations amniotic membrane transplantation and antibiotics
Authors: Perdana Dicky Putra , Sofia Ovi
Published: December 2022

Purpose: To present a case of gonococcal keratoconjunctivitis with corneal perforation as a rare case and its management.

Methods: Case was reported from an outpatient clinic patient at Ophthalmology Department of Dr. Saiful Anwar General Hospital. The diagnosis was based on history taking, ophthalmological examinations and microbiological examination result.

Results: A 19‐year‐old man complained of red, swollen, and painful eyes with sticky and copious discharge. The patient experienced clinical deterioration despite antibiotic treatment received at the previous eye clinic. There was a history of promiscuity and genital discharge 2 weeks before the eye symptoms. On eye examination, the visual acuity of the right eye was 1/60, and the left eye was 6/24. Both eyes showed conjunctival hyperemia and edema with purulent discharge. There was corneal perforation on the right eye sized 2.4 mm × 1.8 mm. Corneal erosion were noted on the left eye. Gram examination from conjunctiva swab of both eyes revealed intracellular Gram‐negative diplococci. The patient was hospitalized and received systemic antibiotics intravenous ceftriaxone, single dose oral azithromycin and topical moxifloxacin 0.5%. Patient also underwent amniotic membrane transplantation (AMT) in right eye due to small perforation. Improvement was noted as no discharge, closure of perforation, visual acuity of the right eye became 6/48, and the left eye became 6/6 at 1‐month follow‐up.

Conclusions: Systemic and topical antibiotics with AMT effectively manage gonococcal keratoconjunctivitis with small corneal perforation.
Assessing the impact of long‐term idebenone treatment on various visual acuity outcomes in Leber's hereditary optic neuropathy (LHON): Results, according to disease stage, from the prospective, natural history‐controlled LEROS study
Authors: Tomasso Livia , Carelli Valerio , Yu‐Wai‐Man Patrick , Klopstock Thomas ,   the LEROS Study Group
Published: December 2022

Purpose: For patients with LHON, preservation of functional visual acuity (VA) and/or recovery of lost VA are desirable outcomes. Beyond this, prevention of further VA worsening is also important. In LEROS, VA outcomes following 24 months of idebenone treatment were compared to an external, matched, natural history (NH) cohort. Here, we report results from a cumulative frequency analysis to understand the impact of idebenone across the range of possible VA outcomes.

Methods: Patients with LHON onset ≤5 years prior were enrolled and stratified by time since onset: subacute/dynamic (≤1 year) and chronic (>1 year). Data from 181 patients treated up to 24 months were compared to retrospective data from an external natural history (NH) cohort (372 patients), matched by time since onset. In a cumulative frequency analysis, VA change was assessed from baseline to month 24. A change of ≥0.2 logMAR was considered a clinically relevant recovery or worsening, depending on the direction of change.

Results: In subacute/dynamic eyes treated with idebenone for 24 months, 47.9% (58/121) experienced a recovery of VA, and 25.8% (24/93) experienced VA worsening. This compared to 33.3% (25/75), and 51.0% (25/49) of untreated subacute/dynamic eyes displaying a recovery or worsening, respectively. In chronic eyes, recovery was observed in 31.9% (37/116) that had undergone treatment versus 16.1% (15/93) when untreated. A VA worsening was observed for 2.9% (2/68) of treated chronic eyes versus 20.0% (12/60) of untreated. The majority of treatment emergent adverse events were considered of mild to moderate intensity, with only 11.3% considered to be related to idebenone treatment.

Conclusions: In both the subacute/dynamic and chronic stages of LHON, idebenone treatment was able to boost VA recovery and prevent further VA deterioration. Consistent with previous findings, idebenone was well tolerated with no new safety concerns observed.
Cataract surgery with toric lens. Assessment through tomography and intraoperative aberrometry ORA
Authors: del Buey Sayas María Ángeles , Pascual Paula Casas , Alonso Sofia Bielsa , Rodriguez Nuria López , Monzon Sara Marco , Fernández Miguel Castillo , Álvarez Constanza Caramello , Ascaso Javier
Published: December 2022

Purpose: Nowadays, cataract surgery not only aims at the extraction of the opacified lens. Promoted by advances in the last decade, this medical procedure has evolved into a refractive technique whose purpose is emmetropia. The current intention, from an optical point of view, is to obtain a residual refractive error within ±0.50 diopters of spherical equivalent, and <0.75 diopters in the residual cylinder. Consequently, a prospective single‐center cross‐sectional study was performed at the Ophthalmology Department of the Lozano Blesa University Hospital of Zaragoza, which was conducted from July 2021 to February 2022.

Methods: Including a total of 42 eyes of 34 patients (38% male, 62% female), with astigmatism greater than 2.00 keratometric diopters undergo cataract surgery. The surgical procedure is carried out using FLACS femtosecond laser‐assisted surgery, altogether with implantation of toric intraocular lenses (Alcon SN6AT2‐9). Inclusion criteria pursued uncomplicated interventions, performed by a single surgeon and with a NRR (No Rotation Recommended) outcome.

Results: The mean ages were 69.5 ± 11.89 years (39–90), the mean axial length was 23.61 ± 2.38 mm. The corneal dioptric power was 3.10 ± 1.22 D anterior surface contribution, and 0.58 ± 0.40 D posterior surface contribution. It is worth highlighting that the contribution or the posterior surface in ATR eyes (against the rule) was only 0.21 ± 0.15 D. Using vector analysis, mean (standard deviation) and median (interquartile range) from a vector of astigmatism we obtained the following results: ORA's IOL recommendation and the preoperative prediction coincided in 50% of the cases (final astigmatism mean 0.76D ± 0.47 D). In the 50% remaining cases where they did not match, the biometer‐recommended IOL was inserted (final astigmatism mean 0.84 D ± 0.77 D).

Conclusions: To sum up, compared with standard methods, we show that the use of ORA intraoperative aberrometry system increases predictability and safety during the intervention, improving efficacy and giving better outcomes. The use of FLACS femtosecond laser‐assisted surgery and intraoperative guidance systems make phacoemulsification surgery a more reproducible technique.
A rare case of a combined retinal artery and vein occlusion in a young patient
Authors: Goh Eunice , Yeo Tun Hang , Hah Yan Yee
Published: December 2022

Purpose: To report a case of combined retinal artery and vein occlusion in a young patient.

Methods: A case report.

Results: A 37‐year‐old gentleman presented to the Emergency Department with a central scotoma in his right eye for 1 day. He was known to have right amblyopia but had no known past medical illness. He was a chronic smoker. Best corrected visual acuity was 6/45 in the right eye and 6/7.5 in the left eye. His intraocular pressure was 19 (right) and 18 (left) mmHg. Anterior segment examination was normal. His right eye fundus examination revealed retinal ischaemia and edema in the macula area supplied by cilioretinal artery. The inferotemporal vessels were also tortuous, with flame and dot haemorrhages. His left eye was normal. Optical coherence tomography showed inner retinal hyperreflectivity and edema. Fundus fluorescein angiography showed delayed filling of the cilioretinal artery and inferotemporal retinal vein corresponding to the clinical findings. He was diagnosed with a right eye combined cilioretinal artery and inferotemporal branch retinal vein occlusion. An anterior chamber tap was performed immediately to lower intraocular pressure and improve perfusion. The next day, he reported that his vision was clearer (visual acuity 6/20) and the scotoma was smaller in size. Given his young age, we performed a full systemic young‐stroke workup to evaluate his vascular risk factors and rule out thrombophilia. He was found to have newly diagnosed diabetes and hyperlipidemia. His coagulopathy screen was negative. A primary care referral was made for management of his chronic diseases and for smoking cessation support.

Conclusions: Combined retinal and venous occlusions are rare and are often associated with significant systemic comorbidities. In a young, healthy patient, it is particularly important to perform detailed investigations to work up its cause, as this could be a harbinger of future ischaemic events.
“The glaucoma NO‐ctail” the use of vasodilators and OCT‐A in ischemic optic‐nerve: Case report
Authors: Tsigkos Dimitris , Theodorou Chrisanthi , Gkogkou Konstantina , Zouzoulas Euthimios , Tsigkos Vasileios
Published: December 2022

Purpose: To highlight the value of enhancing the microcirculation of the optic nerve head, with a combination (cocktail) of vasodilators and at the same time the avoidance of vasoconstrictors (eg timolol). As well as, to point out the key contribution of OCT‐Angiography (OCT‐A) in the early diagnosis and monitoring of pathological microcirculation.

Methods: A 68‐year‐old patient with ischemic optic nerve (OD) without stable antiglaucomatic treatment due to asthma, under Acetazolamide ¼ ×1 and vasodilator supplements (CoQ10, Bilberry extract/Pinus Pinaster), is presented with a significantly pale optic disc and incipient VF defects.

BCVA OU: Logmar 0.1.

IOP: 18/10 mmHg.

RNFL: OD 74 μm OS 103 μmΑ large decrease in the peripapillary vascular density is detected in OCT‐A (peripapillary RPC density 37.3%).

Ginkgo Biloba supplement is added and transcleral diode cyclophotocoagulation 180 ° is performed.

Results: The following 6 months the IOP(OD) ranges from 11 to 14 mmHg. VF is stable and RNFL (OD) is slightly improved (78‐80 μm), while significant improvement in the peripapillary vascular density is shown in follow‐up OCT‐A after 5 months (peripapillary RPC density 44.4%).

Conclusions: As OCT‐A shows, in patients with poor optic nerve microcirculation, the combination of early IOP reduction and the use of substances with vasodilating action, may have quite beneficial effects, possibly even stabilizing (if not reversing) RNFL thinning.
Changes in choroidal and retinal thickness assessed by optical coherence tomography in type 2 diabetes mellitus patients with moderate diabetic retinopathy
Authors: Fernández‐Espinosa Guisela , Orduna‐Hospital Elvira , Boned‐Murillo Ana , Díaz‐Barreda María Dolores , Bielsa‐Alonso Sofía , Sopeña‐Pinilla María , Sánchez‐Cano Ana , Pinilla Isabel
Published: December 2022

Purpose: To study choroidal thickness (CT) in type 2 diabetes mellitus (DM2) patients with moderate diabetic retinopathy (DR) without diabetic macular edema (DME) and to correlate with changes in retinal thickness (RT) with swept source OCT (SS‐OCT)) compared to healthy subjects.

Methods: Fifty‐four DM2 patients with moderate DR without DME and 73 age‐matched healthy subjects were evaluated using SS‐OCT to measure changes in total RT and the CT in the nine areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid.

Results: The mean ages were 64.06 ± 11.98 years and 60.79 ± 8.62 years in the diabetic and control groups, respectively. Visual acuity (VA) with ETDRS 100% was lower in the DM2 patients (p < 0.001). In the total RT, statistically significant differences were found in the temporal inner area being thicker thickness in the DM2 group (260.70 ± 19.22 μm vs. 271.90 ± 37.61 μm with p = 0.010, in control and DM2 group, respectively). The CT did not show significant differences between both groups (p > 0.05) in any ETDRS area. There was a significant negative correlation between RT and age in all of the external ETDRS areas and a positive significant correlation in the central area for DM2 group. There was also a negative significant correlation between CT and age in all ETDRS areas except for the inferior inner area. In the DM2 group, a negative correlation was observed between RT and CT in the central area (p = 0.039) and in both horizontal parafoveal areas (temporal inner: p = 0.028, central: p = 0.039 and nasal inner: p = 0.003).

Conclusions: DM2 patients with moderate DR have no changes in CT. CT and RT decrease with age and show a negative correlation with RT in the central and horizontal parafoveal areas of the ETDRS grid.
Prevalence of dry eye disease based on body mass index in Islamic boarding school population in rural Malang area
Authors: Putri Mutiara Kristiani , Putranto Herwindo Dicky , Aldina Rosy
Published: December 2022

Purpose: To investigate the prevalence of Dry Eye Disease (DED) based on body mass index (BMI) in Islamic boarding school population in the rural Malang area.

Methods: A cross‐sectional study was conducted from October to November 2021. Samples were selected using consecutive sampling in Nurul Mutaqina Al‐Barokah Islamic boarding school Malang, East Java, Indonesia. 359 students and employees were enrolled in this cross‐sectional study. Ocular Surface Disease Index (OSDI) score and Tear Break Up Time (TBUT) test were used to assess dry eye disease. Body mass index was calculated using anthropometric measurements that included height and weight. BMI in adults is measured by dividing the body weight in kilograms by height in meters squared (kg/m2) In paediatrics, gender‐specific BMI‐for‐age percentile curves are used to define the BMI category.

Results: Of 359 participants, 90 participants had abnormal TBUT and 19 participants had an OSDI score of (13. 13 of them were diagnosed with DED, none was underweight, 38.5% were normoweight, 41.7% were overweight and 8.3% were obese p = 0.011 (OR 2232, CI 95%, 1207–4130).

Conclusions: The prevalence of dry eye disease according to body mass index was 3.6% which tends to be low. DED was commonly found in groups with higher BMI. Further investigation to determine the prevalence of DED with a proportional amount of each BMI category is highly recommended for future research.
Hairline cracks in osteo‐odonto‐keratoprosthesis: An Achilles' heel
Authors: Liu George , Naveed Hasan , Liu Christopher
Published: December 2022

Purpose: Background: The osteo‐odonto‐keratoprosthesis (OOKP) is the device of choice for restoring sight in end‐stage corneal blindness not amenable to conventional corneal transplantation. A bio‐integrable lamina created from an autologous single‐rooted tooth is used to frame a PMMA optical cylinder. The lamina is sealed by an overlying buccal mucous membrane graft. An OOKP has a survival rate of 80% over 18 years. The lamina is subject to resorption over time. Clinical and radiological observation are essential for detecting impending laminar failure.

Aims: Case report and literature review to illustrate the limits of clinical and radiological observation of an OOKP.

Methods: Retrospective case study of a 40‐year‐old male with bilateral corneal blindness from Stevens Johnson Syndrome, first presenting in 1996 with light perception vision, underwent left Stage 1 (March 1997) and Stage 2 OOKP (June 1997) surgery. Post‐operatively, his visual acuity was 6/5+ (1.2, 20/15).

Results: Regular CT imaging revealed no loss of volume or impending failure. He presented with severe eye pain on 11.12.2016, having had a normal quarterly review 5 days beforehand. He underwent endoscopic vitrectomy, biopsy and intravitreal antibiotics on 12.12.2016 for endophthalmitis (Group B Streptococcus). Despite efforts to treat his infection, his left eye was eviscerated on 16.12.2016. Later study of the lamina revealed a hairline crack not visible on CT imaging.

Conclusions: We discuss an unforeseen case of a failed OOKP lamina due to a hairline crack despite limited laminar resorption. Current management options for failing laminae include insertion of a new lamina, bone morphogenetic protein ± bone graft, an alternative device, and removal of device and closure of the corneal opening with a small full thickness corneal graft. Hairline cracks remain an Achilles' heel. There should be a high index of suspicion of endophthalmitis even in the presence of good laminar bulk.
An analysis of posterior capsule rupture (PCR) rate and risk stratification within the National Health Services (NHS)
Authors: Mak Sammie , Noor Maha , Almuhtaseb Hussein
Published: December 2022

Purpose: Posterior capsule rupture (PCR) is a serious complication of cataract surgery, which can lead to other complications such as cystoid macular oedema, retinal detachment and endophthalmitis1,2. The aim of our study was to firstly, ascertain the rate of PCR in patients undergoing phacoemulsification and intraocular lens implant (IOL) surgery at Rochdale Eye Unit, UK. Secondly, to identify the factors contributing to increased risk of PCR. Thirdly, to establish whether patients are being appropriately screened for risk factors for PCR.

Methods: A retrospective study of patients that underwent phacoemulsification and IOL surgery between 1st September 2021 and 1st April 2022 was performed. A total of 1179 patients were obtained using electronic records (OpenEyes™https://openeyes.apperta.org/).

Results: Of the 1179 patients, 18 patients (1.52%) experienced PCR with or without vitreous loss. Pre‐procedure PCR risk was not calculated for any of them. 11 (61%) cases were carried out by consultants, 6 (33%) by registrars, and 1 (6%) by an associate specialist. Increasing age (above 70 years), excess movement, and co‐morbidities were associated with an increased risk of PCR. Only 7 (0.6%) of the 1179 patients had the PCR risk estimated (using OpenEyes™ calculator) prior to booking of procedure. The calculator considers presence of glaucoma, diabetes, the density of the cataract, and experience of the surgeon, among other factors. The risk was not calculated in 1109 (94%) patients.

Conclusions: The risk of PCR during phacoemulsification and IOL surgery rises with increasing patient age, presence of co‐morbidities, and procedure undertaken by junior surgeons. Through greater utilization of PCR risk calculation, encouraged with electronic prompts and educational posters, this risk can be further reduced. The method may also be adapted by other National Health Service (NHS) Trusts in their cataract listing proforma.

References

1. Thevi T, Sahoo S, Kyaw Soe HH. Posterior Capsule Rupture during Phacoemulsification among Patients with Pseudoexfoliation – Is There A correlation? The Malaysian Journal of Medical Sciences. 2014;21(4):51–53.

2. Chakrabarti A, Nazm N. Posterior Capsular Rent: Prevention and Management. Indian Journal of Ophthalmology. 2017;65(12):1359–1369.
Bilateral uveitis following nivolumab and ipilimumab treatment for mesothelioma
Authors: Stavropoulou Theodora , Theodorakis Andreas , Papazacharia Areti , Papadedes Konstantinos
Published: December 2022

Purpose: Case report of a patient presenting with sudden onset of painful decreased vision in both eyes, diagnosed with Intermediate uveitis and keratitis. We will review the diagnostic pathway and the management of this case, as well as the correlation with the systemic treatment of that time.

Results: A 63‐year‐old male presented in the Emergency department with bilateral red painful eyes and blurred vision. The patient had a past ophthalmic history of keratouveitis in RE and medical history of mesothelioma for which he had recently started treatment with Nivolumab and Ipilimumab. The visual acuity on presentation was 6/9 in the RE and 6/6 in the LE. Upon examination BE were hyperaemic, there was a past corneal scar in the RE and bilateral KPs. RE had +1 AC inflammation and LE traces of AC inflammation. No signs of posterior segment inflammation were seen in both eyes. The patient was treated initially with oral Aciclovir 400 mg BD and Pred Forte 1% in BE QDS. One week after initiation of treatment symptoms improved and a tapering regime of the local steroid treatment was given. Four weeks later the visual acuity in the RE was 6/12 and 6/9 in the LE. Upon examination there was +1 AC activity in BE and +1 vitreous activity. OCT demonstrated bilateral macular oedema. An FFA revealed bilateral optic disc hyperfluorescence. Upon further discussion of the patient's medical history it was revealed that both episodes of intraocular activity coincided with his infusions of Nivolumab and Ipilimumab. The patient was advised to discontinue the oral Aciclovir treatment and was initiated on intensive regime of local steroids which was tapered on improvement of the vision and the inflammation. Our ocular findings were communicated the patient's oncology team that decided to discontinue the above treatment.

Conclusions: Nivolumab is an anti‐programmed cell death protein‐monoclonal. It is used for cancer treatment but case reports have emerged of uveitis and ocular surface disease. Ipilimumab is a humanized CLTA‐4 antibody and it can be associated with immune related adverse events such as uveitis. Our patient was switched to a different treatment protocol without further ocular inflammation and excellent visual outcome. Clinicians should raise their index of suspicion in side effects around the timing of treatment.
Optical coherence tomography angiography findings in patients with essential hypertension
Authors: Cheour Monia , Aoun Safa Ben , Nouri Slim , Mzoughi Khadija , Sassi Hela
Published: December 2022

Purpose: To study the variation of retinal and choroidal density in patients with essential hypertension using Swept Source Optical Coherence Tomography Angiography (SS‐OCT A).

Methods: Prospective cross‐sectional study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between June, 1st 2021 and March, 30th 2022. Fifteen volunteer healthy patients (30 eyes) were included. All patients underwent complete ophthalmic examination, measurements of resting systolic and diastolic blood pressure and 3 × 3 and 4.5 × 4.5 SS‐OCT A angiograms in both eyes. Perimeter of avascular central zone (ACZ), superficial retinal plexus density (SRPD), deep retinal plexus density (DRPC) and choriocapillaris capillary vessel density (CVD) were calculated on exported jpg format images using the Fiji Software. Comparative Mann Whitney and Spearman tests were performed using 21.0 SPSS.

Results: Eleven males and four females were eligible for the study. Mean age was 53.33 ± 9.73 years. Eight patients (53.3%) with chronic essential hypertension were compared to seven healthy volunteers (46.7%). Mean ACZ, SRPD, DRPD and CVD were respectively 2.62 ± 0.52 mm, 13.20 ± 2.10%, 17.14 ± 1.17% and 51.05 ± 0.85%. Mean systolic blood pressure was 13 ± 5 mmHg and mean diastolic blood pressure was 7.67 ± 5.16 mmHg. CVD was lower in patients with chronic hypertension than in the control group (50.59 vs 51.41, p = 0.047). There were no significant differences between hypertension group and normal group in ACZ, SRPD and DRPC measurements (p = 0.089, p = 0.90 and p = 0.70, respectively). No correlations were found between resting blood pressure values and ACZ measurements.

Conclusions: Chronic hypertension does not affect retinal vessels and capillaries quantitative parameters. However, it may alter choroidal vascular structures by decreasing choriocapillaris vessel density. Larger studies are needed to strengthen these results.
Paracentral acute middle maculopathy secondary to retinal artery macroaneurysm elucidates anatomy and physiology of retinal capillary plexus
Authors: Goh Eunice , Ngo Wei Kiong
Published: December 2022

Purpose: To report a novel case of Paracentral Acute Middle Maculopathy (PAMM) Secondary to Retinal Artery Macroaneurysm.

Methods: A case report.

Results: A 72‐year‐old lady presented with three‐month history of sudden onset left paracentral scotoma. Her medical history include hypertension and hyperlipidemia. Visual acuity was 6/7.5 and 6/45 in the right and left eye respectively. Anterior segment examination and intraocular pressures were unremarkable. A ruptured retinal arterial macroaneurysm (RAM) was seen along the second‐order artery along the inferotemporal arcade with a small area of deep‐retinal whitening along the distal branches of the artery. Corresponding optical coherence tomography showed a round superficial retinal hyperreflective lesion consistent with RAM and hyperreflective band involving the outer plexiform layer (OPL), inner nuclear layer (INL) and inner plexiform layer (IPL) consistent with PAMM. Confocal scanning laser ophthalmoscopy video fluorescein angiogram (FA) demonstrated a ruptured and hemorrhagic RAM with significantly delayed distal filling of the artery, with resultant PAMM in an area supplied by the tributary arterioles of the affected artery.

Conclusions: Oxygen consumption is highest at the metabolically active middle retinal layer. The inner and middle retinal layers are supplied by the superficial capillary plexus in the ganglion cell layer, intermediate capillary plexus (ICP) in the INL‐IPL boundary and deep capillary plexus (DCP) in the INL‐OPL boundary. Rupture and partial thrombosis of the RAM resulted in mechanical narrowing of the vessel lumen and severe flow limitation, which was further exacerbated by her history of hypertension and hyperlipidemia. This was consistent with the FA findings of delayed filling in the distal parts of the artery. Flow limitation results in decreased blood supply to the retinal capillary plexuses, further decreasing perfusion pressure, causing most disruption to the delicately balanced ICP and DCP blood supply of the middle retinal layer. Middle retinal infarction occurs most readily and presents as PAMM in our patient. In conclusion, we described a novel case of PAMM secondary to a ruptured and partially thrombosed RAM which clearly elucidates the anatomy and physiology of retinal capillary plexuses.
Optic disc pit macular serous detachment recurrence. A surgical approach using ILM autograph
Authors: Parikakis Efstratios , Diafa Aspasia , Kontomichos Loukas , Batsos Georgios , Gianni Theodora , Mpouratzis Nikolaos , Spanos Evangelos , Karagiannis Dimitrios
Published: December 2022

Purpose: We aim to present a surgical approach for optic disc pit macular serous detachment recurrence, using pars plana vitrectomy (PPV) and internal limiting membrane (ILM) autograft.

Methods: Case report – Description of the surgical technique and presentation of the outcome.

Results: A 55 year‐old female patient referred to our clinic's Vitreoretinal Department complained of reduced visual acuity at the right eye. On clinical examination, optic disc pit, cystic maculopathy and serous detachment were noted. The patient reported a history of vitrectomy for optic pit macular detachment on the same eye 25 years ago. To manage the recurrent macular detachment, she underwent a vitrectomy, during which the ILM was removed, and part of it used as an autograft on the optic disc pit. Mild endophotocoagulation on the area of the maculopapular bundle was performed, and gas endotamponade was utilized. On follow‐up examinations, a continuous improvement in serous detachment and visual acuity was noted.

Conclusions: In cases with recurrent macular serous detachment due to optic disc pit maculopathy, PPV combined with ILM autograft, endophotocoagulation and gas tamponade seems to be a promising technique with satisfactory anatomical and functional improvement.
Closure of large macular holes
Authors: Ilyuk Oksana
Published: December 2022

Purpose: Despite the variety of different techniques for large macular holes (LMH) closure, this task is still challenging, especially in patients with myopia. We compared closure rates of LMH achieved by conventional internal limiting membrane (ILM) peeling and inverted ILM flap.

Methods: Material and Methods. We represent single‐surgeon series of 42 consecutive treatment‐naive patients (pts) with LMH and myopia, for 21 pts retinal detachment (RD) was confirmed either before or during surgery. Initially we performed conventional ILM peeling (CP) – 17 pts, 8 with RD; starting from 2017 all patients were operated with inverted ILM flap (IF) technique – 25 pts, 13 with RD.

Results: Results. Conventional ILM peeling allowed us to attain LMH closures in 3 of 8 pts with RD (33%) and 4 of 9 pts without RD only. Again, we achieved closures of LMH in all patients (with and without RD), operated with IF technique. In one patient operated with inverted ILM flap technique, we observed gliotic changes along the line of overlapping, but without significant loss of vision.

Conclusions: Conclusion. Inverted ILM flap technique serves as a novel exceptionally effective approach for LMH closure in myopic patients. We found no influence of retinal detachment on the effectiveness of IF technique.
Optical coherence tomography angiography reveals retinal microvascular changes in patients with multiple sclerosis without optic neuritis
Authors: Popa‐Cherecheanu Alina , Bostan Mihai , Chua Jacqueline , Sim Yin Ci , Tan Bingyao , Bujor Inna , Garhofer Gerhard , Schmetterer Leopold
Published: December 2022

Purpose: Retinal imaging has attracted much interest as a non‐invasive low‐budget biomarker for neurological diseases such as multiple sclerosis (MS). Optical coherence tomography angiography (OCTA) is a functional extension of OCT and allows for the non‐invasive visualization of the retinal and choroidal microvasculature. We investigated retinal microvasculature changes in patients with relapsing–remitting MS (RRMS) without history of optic neuritis (ON) and compared them to a healthy control group.

Methods: The study was performed in a prospective, case–control design, including 58 participants (n = 100 eyes) with RRMS without ON and 78 age‐ and sex‐matched control participants (n = 136 eyes). OCTA images of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) were obtained using a commercial OCTA system (Zeiss Cirrus HD‐5000 Spectral‐Domain OCT with AngioPlex OCTA, Carl Zeiss Meditec, Dublin, CA). Perfusion density (PD) and foveal avascular zone (FAZ) features (area and circularity) in both the SCP and DCP, as well as flow deficit in the CC were used as outcome variables.

Results: MS patients showed significantly increased PD in SCP (p = 0.003) and decreased PD in DCP (p < 0.001) as compared to controls when data were corrected for confounders. A significant difference was also noted when large vessels (LV) in the SCP were removed from the PD calculation (p = 0.004). Deep FAZ was significantly larger (p = 0.005) and less circular (p < 0.001) in the eyes of MS patients compared to healthy controls. Neither LV, PD or FAZ features in the SCP, nor flow deficits in the CC showed any statistically significant differences between the MS patients and the controls (p > 0.186).

Conclusions: Our study shows that MS patients have microvascular changes in the macular parafoveal retina even without ON. They show increased PD in SCP and decreased PD in DCP. To which degree retinal biomarkers in MS are associated with the progression of MS remains to be studied.
Plasma rich in growth factors as an adjuvant agent in non‐penetrating deep sclerectomy
Authors: Rodriguez‐Calvo Pedro Pablo , Rodriguez‐Una Ignacio , García Montserrat , Gonzalez‐Iglesias Hector , Fernandez‐Vega‐Cueto Andres , Merayo‐Lloves Jesus
Published: December 2022

Purpose: To evaluate the utility and safety of plasma rich in growth factors (PRGF) eye drops in the postoperative treatment of non‐penetrating deep sclerectomy (NPDS).

Methods: Retrospective case–control study, including open‐angle glaucoma patients. Cases were consecutively recruited, and used topical PRGF for 4 months after NPDS. Historical controls were patients who had undergone the same technique immediately before the start of the study (without PRGF). Prior to surgery, intraocular pressure (IOP), the number of topical hypotensive medications, and visual field mean deviation (MD) were registered. Postoperatively (1 week, 3 and 6 months), those three variables were also analysed, as well as complications, manipulations and reinterventions.

Results: Preoperatively, the PRGF group (n = 37) and the control group (n = 49) were similar in age (70.9 ± 10.0 vs. 71.5 ± 10.7 years; p = 0.68), IOP (23.0 ± 9.0 vs. 20.6 ± 10.2 mmHg; p = 0.26), MD (−15.0 ± 8.8 vs. −15.9 ± 7.8 dB; p = 0.76) and the number of hypotensive medications (2.8 ± 0.9 vs. 2.7 ± 0.8; p = 0.40). IOP significantly decreased at all follow‐up visits in both groups, compared to preoperative values. That reduction was greater at 6 months with PRGF (p < 0.01): 10.9 ± 4.3 mmHg (−52.6%) versus 15.0 ± 8.0 mmHg (−27.2%). In the final analysis, the number of drugs similarly reduced in both groups (p = 0.32). MD showed no significant differences. Surgical complications were observed in 12 control eyes (25%) and 5 eyes (14%) treated with PRGF (p = 0.06). No complications related to the use of PRGF were identified. The needling rates were 9.4% and 5.9% in PRGF and controls, respectively (p = 0.58). Three eyes (6.3%) required further glaucoma surgery in the control group, and 1 (2.7%) in the PRGF‐group (p = 0.78). The final complete success rate was higher with PRGF: 83.8% vs 60.4%.

Conclusions: Postoperative PRGF reduced IOP and complications rate in the mid‐term after NPDS, thus it may be considered as a possible safe adjuvant agent to achieve surgical success.
BAP1 UCH‐domain enzymatic activity
Authors: Staskiewicz Aleksandra , Repo Pauliina , Backlund Michael , Kivelä Tero , Turunen Joni
Published: December 2022

Purpose: Pathogenic variants in BRCA‐associated protein 1 (BAP1) cause BAP1 tumour predisposition syndrome (BAP1‐TPDS) with an elevated risk of several cancers including uveal melanoma (UM). BAP1 is a deubiquitinating enzyme that needs to retain its enzymatic activity and be able to locate in the nucleus to function as a tumour suppressor. BAP1 loss of function variants are easily interpreted as pathogenic, but many missense variants remain as of unknown significance (VUS). We studied the effect of UCH domain missense variants on the enzymatic activity of BAP1.

Methods: We selected 22 rare missense variants within or near the UCH domain (aa1‐240). Nineteen have been identified in patients with UM (Walpole et al.) and three in the general population (according to gnomAD). The variants were cloned to a bacterial vector and expressed as a GST‐fusion protein. Finally, we assayed the purified fusion proteins for their ability to cleave ubiquitin.

Results: Nine variants significantly reduced the deubiquitinating activity of BAP1. Seven mutants with variants found in patients with familial BAP1‐TPDS, retained <20% of their activity. Three variants retained about 50% of activity, and the function of 12 variants was interpreted as normal (70%–120%).

Conclusions: Functional studies are needed for accurate classification of BAP1 missense variants. Although BAP1 variants are dominant, penetrance might be affected by variants effect on enzymatic activity and patients with pathogenic variants might not exhibit familial BAP1 ‐TPDS. Some pathogenic variants that have been suggested to be pathogenic retained enzymatic activity, casting doubt on their classification. If enzymatic activity is retained, re‐classification should be considered or, when found in a family with clear BAP1‐TPDS, further studies need to be conducted.

References.

1. Walpole S, Pritchard AL, Cebulla CM, et al. Comprehensive Study of the Clinical Phenotype of Germline BAP1 Variant‐Carrying Families Worldwide. JNCI: Journal of the National Cancer Institute 2018; 110(12): 1328–1341.
Gene expression in tears of patients with dry eye disease and meibomian gland dysfunction treated with intensive pulsed light
Authors: Vérges Carlos , Salgado‐Borges Jose Manuel
Published: December 2022

Purpose: To better understand the effect of IPL we have designed a study where we compared the signs and symptoms of patients with DED‐MGD and the changes in the genes found in the conjunctival cells after treatment with IPL (Thermaeye Plus) using a transcriptomic and multiplexed approach.

Methods: A prospective study of 60 consecutive subjects, 30 controls and 30 patients with DED‐MGD. These were treated with 4 IPL sessions (12 flashes of 8 J/cm2) on periocular area at day 1, 14, 28, and 49 and evaluated before and 1 month after last session. Tears were collected from the conjunctival fornix at the beginning and at the end, 1 month after the last session. They were amplified with nCounter® Low RNA Input Amplification Kit and the Human Immunology V2 Panel (NanoString Technologies) with 594 transcripts genes was performed to analyse the differentially expressed genes.

Results: 7 pathways' signatures upregulated in DED‐MGD were compared to controls: Type I and Type II Interferon, MHC class I and II antigen presentation, B cell Receptor signalling, Immunometabolism and T cell receptor signalling. A high correlation was observed between the clinical improvement after the IPL and the decrease in some of the upregulated genes (p < 0.01). Ten genes showed a positive significant correlation with OSDI (ADA, LTA, CD19, TLR9, IRF5, TGFB1, CD27, HLA‐DPB1, PTPN6 and MAP4K1) and IFITM1, showed inverse correlation. For osmolarity, CD19 and IRF5 were significantly and positively correlated, For TS1 parameter, we observe a positive correlation for NCR1, CEACAM8 and CCL8 genes and inverse correlation for TGFBI/SLC2A1 genes.

Conclusions: High correlation between clinical data and genetic analysis was present in patients with DED‐MGD comparing pre and post‐treatment with IPL. The presence of upregulated genes related to the inflammatory process reduced after IPL treatment suggests that part of the effect of IPL is due to the improvement of inflammation.