bluuebunny/crossref_metadata_2025 huggingface dataset:
Recombinant Factor VIIa Concentrate versus Plasma-derived Concentrates for the Treatment of Acute Bleeding Episodes in Persons with Haemophilia and Inhibitors
Authors: Marchesini Emanuela , Prisco Domenico , Iorio Alfonso ,   Fellow, Haemophilia Centre, Perugia University,   Professor and Chair, Atherothrombotic Disease Unit, Department of Internal Medicine, University of Florence,   Associate Professor, Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University
Published: October 2015

The development of inhibitors remains the most challenging complication of treatment in persons with haemophilia, resulting in increased morbidity and a significant economic burden. The ultimate goal of treatment in patients with inhibitors is immune tolerance induction (ITI) therapy; however, during the induction phase of ITI, when ITI fails and where ITI is not affordable, the treatment of bleeding becomes a crucial issue. Recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrate (aPCC) have been developed to bypass the inhibitor antibody effect and have been tested in several randomised controlled trials, including two crossover head-to-head comparisons. Two systematic reviews of the literature have appraised and synthesised the available evidence. The recombinant drug seems to provide a more favourable benefitrisk ratio and may be easily administered as a single front-loaded bolus, making it a good candidate for the role of first-line treatment for bleeding in patients with inhibitors. Aggressive treatment of acute bleeds should be considered, including the use of higher and repeated-dose regimens until complete resolution of the bleed.
Allogeneic Haematopoietic Stem Cell Donation — Current Status with Regard to Safety
Authors: Bosi Alberto , Bartolozzi Benedetta ,   Full Professor of Haematology,   Fellow, Department of Haematology, Bone Marrow Transplantation Unit, University of Florence
Published: October 2015

Allogeneic haematopoietic stem cell transplantation (HSCT) represents the first choice of treatment or an important therapeutic option for numerous diseases. Several stem cell sources, such as bone marrow, mobilised peripheral blood stem cells and umbilical cord blood, are suitable for HSCT in clinical practice. However, this procedure is strongly related to availability of a histocompatible donor. In order to increase the probability of finding a histocompatible donor, national and international registries have been developed. Voluntary donation of bone marrow or peripheral blood stem cells for HSCT, both in the related or unrelated setting, is a well-established procedure with an invaluable ethical significance. Even if both procedures are safe, they are not risk free; therefore, the greatest attention has to be paid to the donor and to the donation process through a careful monitoring protocol for donor safety.
The End of Cytotoxics?
Authors: Utku Nalân ,   Private Lecturer, Institute for Medical Immunology, Charité University Hospital Berlin
Published: October 2015

Cytotoxic drugs were the first form of cancer chemotherapy to be established, but they can have quite severe side effects. Cytotoxics attack all rapidly dividing cells, including healthy cells and cancer cells. They can therefore cause side effects such as loss of hair, damage to the skin and mucosa, and damage to bone marrow, affecting the immune system. For this reason, the focus of some cancer research has moved from cytotoxics to targeted therapeutics, including monoclonal antibodies. Monoclonal antibodies can be very effective in patients who express the appropriate target; however, not all patients do, and some develop resistance. Monoclonal antibodies, like other biologicals, are also very costly. All is not lost for cytotoxics. Because they have been around for so long, there is an abundance of data on their modes of action. Based on these data, researchers have developed newer cytotoxics that are more effective and have fewer side effects, and approaches that deliver cytotoxics more safely or target them to tumours.
Current Standards and New Trends in Oesophageal Cancer
Authors: Lordick Florian ,   Director, Third Medical Department (Haematology and Oncology), Klinikum Braunschweig, Germany
Published: October 2015

Oesophageal squamous cell cancer has a constant or even decreasing incidence rate in many regions in Europe, while oesophageal adenocarcinoma and oesophagogastric junction (OGJ) cancer have shown an increasing incidence over the past three decades. If diagnosed at an early stage (stage I), which is rarely the case, these cancers have a good prognosis. Endoscopic resection can then be recommended in selected cases where the submucosal layer is not reached. In these cases, surgical resection is regarded as the standard of care. In contrast, in stages II and III, the prognosis is more critical. Local relapses and distant metastases occur frequently during post-surgical follow-up, leading to long-term survival being as poor as 2030 %. For locally advanced tumours, multimodal treatment has been established as the new standard of care. Neoadjuvant chemotherapy or chemoradiation have proven efficacy in adenocarcinoma of the oesophagus. Neoadjuvant chemoradiation (followed by surgery) and definitive chemoradiation are two proven and equivalent options with comparable outcomes in oesophageal squamous cell cancer. In metastatic disease, chemotherapy on the basis of cisplatin and 5-fluorouracil can be offered in order to achieve better symptom control, although prolongation of survival has not formally been proven due to a lack of randomised controlled clinical studies.
The Advanced Generation of Oral 5-Fluorouracil Available in Europe – Teysuno® (S-1)
Authors:   Proceedings of a Satellite Symposium Held at the European Society for Medical Oncology 15th World Congress of Gastrointestinal Cancer in Barcelona, 3 July 2013
Published: October 2015

The European Society for Medical Oncology 15th World Congress of Gastrointestinal Cancer satellite symposium was held in Barcelona to discuss the oral fluoropyrimidine S-1. S-1 is a combination of three pharmacological compounds: tegafur, gimeracil and oteracil potassium. Tegafur is a prodrug of 5-fluorouracil (5-FU), an oral fluoropyrimidine, and has been developed as a replacement for infusional 5-FU therapy. S-1-based chemotherapy has become first-line treatment for unresectable advanced gastric cancer in Japan. It has also shown efficacy in the treatment of colorectal cancer, and a recent Japanese phase III clinical trial in pancreatic cancer showed that adjuvant treatment with S-1 substantially increases overall survival rates compared with treatment with the standard post-operative drug gemcitabin. Following a clinical trial in Western patients, S-1 has been approved in Europe and offers a tolerable and convenient treatment regimen with a tolerable safety profile.
Primary Penile Kaposi Sarcoma in an HIV-negative 21-year-old Male
Authors: Momen Sophie , Corbishley Cathy , Pettengell Ruth , Ayres Ben , Samol Jens ,   Senior House Officer in Medical Oncology, St George’s Hospital, London,   Consultant Histopathologist, Department of Histopathology, St George’s Hospital, London,   Consultant Medical Oncologist, Department of Medical Oncology, St George’s Hospital, London,   Consultant Urologist, Department of Urology, St George’s Hospital, London,   Senior Consultant Medical Oncology, Department of Medical Oncology, Johns Hopkins Singapore, Singapore
Published: October 2015

We present a 21-year-old HIV-negative Somalian male who was diagnosed with an immunohistochemically proven human herpes virus 8 (HHV8)-positive primary penile Karposi’s Sarcoma (KS). He was treated with local surgery and remained in complete clinical remission for 18 months. This is the first case of a heterosexual teenage and young adult (TYA) patient diagnosed with a primary penile KS without a history of sexual intercourse. This case provides clinical evidence that KS may be transmitted through routes other than sexual transmission.
Fertility Preservation After Breast Cancer
Authors: Brauten-Smith Grete ,   Clinical Nurse Specialist, Breast Cancer Care, London, UK
Published: October 2015

Around 5,000 younger women with breast cancer are missing out on fertility care, despite treatment potentially leaving them infertile in the future. This stark statistic was revealed through two surveys by Breast Cancer Care, the only UK-wide charity providing specialist support and tailored information for anyone affected by breast cancer.
Single Case of a Complete Response in a Metastatic Urothelial Carcinoma Patient Treated with Zoptarelin Doxorubicin
Authors: Castro Gustavo Fernandez , Schally Andrew V , Koru-Sengul Tulay , Jorda Merce , Merchan Jaime R , Flores Aurea M , Restrepo Maria , Block Norman L ,   Assistant Professor of Medicine, Department of Medicine,   Professor, Veterans Affairs Medical Center, Miami, Florida, US,   Assistant Professor, Department of Epidemiology and Public Health,   Professor, Department of Pathology, Sylvester Comprehensive Cancer Center of University of Miami Miller School of Medicine, Miami, Florida, US,   Associate Professor of Medicine, Department of Medicine,   PhD, ClinRes Experts, Miami, Florida, US,   Assistant Professor of Medicine, Department of Medicine,   Professor, Department of Pathology, Sylvester Comprehensive Cancer Center of University of Miami Miller School of Medicine, Miami, Florida, US,   Professor, Veterans Affairs Medical Center, Miami, Florida, US
Published: October 2015

Background: Zoptarelin doxorubicin (AEZS-108, AN-152) is an luteinising hormone-releasing hormone (LHRH)-cytotoxic hybrid drug consisting of an agonist coupled to the cytotoxic radical, doxorubicin. Methods: This is a single case report of a 66-year-old male who was diagnosed in May 2009 with metastatic urothelial carcinoma (UC) of the prostatic urethra. He presented with pelvic and retroperitoneal lymph nodes (LNs). Initially he was treated with cisplatin and gemzar, followed by radical cystoprostatectomy in October 2009. He relapsed in December 2009 and he received two more lines of chemotherapy with no response. The patient entered a phase I clinical trial with zoptarelin doxorubicin, in 2011. He received zoptarelin doxorubicin every 3 weeks for nine cycles from May to October 2011. Results: After two cycles of the investigational drug, all pain and palpable lymph neck nodes disappeared. A computed tomography (CT) scan 20 months post-treatment showed a complete response. Thirty months after treatment started, the patient is symptom free with no evidence of disease. Conclusions: This is the first case of a patient with LHRH-receptor (LHRH-R) positive UC treated with zoptarelin doxorubicin that has been reported. Considering the generally poor outcome of progressive UC and the short survival of these patients, the effect of this drug in this patient has been remarkable.
Atlas-based Auto-contouring – Balancing Accuracy with Efficiency in OnQ rts®
Authors: Barley Susan , Antoine Clare , Webster Gareth , Tiffany Marie , Nundlall Navinah , Simmons Rosemary , Hartley Andrew ,   Lead Clinical Scientist, Oncology Systems Limited, Shrewsbury, UK,   Medical Physicist,   Medical Physicist,   Medical Physicist,   Medical Physicist,   Specialist Radiographer,   Clinical Oncologist, Queen Elizabeth Hospital, Birmingham, UK
Published: October 2015

Atlas-based auto segmentation with OnQ rts® has been shown to deliver time-savings for the delineation of organs at risk in head and neck patients being treated with intensity-modulated radiotherapy. However, as the initial time to set up atlases can be high in busy departments the optimal number of atlas cases needed for auto-contouring was investigated. Using conformity index and mean distance to conformity to compare automatically generated with gold standard clinical contours, it was found that the majority of contours were unaffected by reducing the number of atlas cases from 30 to 10. The optimum number of atlas cases, however, was considered to be 20 due to the reduction in accuracy of the mandible, larynx and brain, below this level.
Precision Medicine in Europe – Forging a Common Vision
Authors: Martin-Moreno Jose M ,   Professor, Department of Preventive Medicine and Public Health of the Medical School and INCLIVA Clinical Hospital Biomedical Research Institute, University of Valencia, Spain,   Senior Associate, Johns Hopkins Bloomberg School of Public Health, Baltimore, US
Published: October 2015

The prospect of achieving truly personalised medicine (or precision medicine) has raised patients’ hopes and piqued researchers’ curiosity, prompting the development of new -omics fields and attracting interest from the health technology industry. However, to ensure that new advances are incorporated equitably without diverting scarce resources from essential services and underserved populations, European institutions must forge a common policy that balances investments with returns and competition with coordination.
Long-term Survival after Cerebellar Metastasis Resection from Her2 3+ Locally Advanced Breast Cancer
Authors: Tomasevic Zorica I , Tomasevic Zoran M , Kovac Zeljko , Milovanovic Zorka , Grujicic Dana , Dzodic Radan ,   Medical Oncologist, Institute for Oncology and Radiology of Serbia, Daily Chemotherapy Hospital, Belgrade, Serbia,   Medical Oncologist, Institute for Oncology and Radiology of Serbia, Daily Chemotherapy Hospital, Belgrade, Serbia,   Radiotherapist, Department of Radiotherapy, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia,   Director of Pathology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia,   Professor of Neurosurgery, Medicine Faculty, Belgrade University, and Head of Neuro-Oncology Department, Institute for Neurosurgery, Serbian Clinical Center, Belgrade, Serbia,   Professor of Surgery, Medicine Faculty, Belgrade University and Director of Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
Published: October 2015

We present a patient who first developed a distant metastatic site in the cerebellum during treatment for Her2 3+ locally advanced breast cancer (LABC). LABC was in complete remission at that time and isolated cerebellar metastasis was resected. The patient is still alive more than 135 months after LABC diagnosis, and more than 99 months after neurosurgery, and is still receiving trastuzumab without further progression or any toxicity. To the best of our knowledge, this is first report of such exceptional disease course for a patient with a predicted grave prognosis according to all prognostic parameters.
Breast Cancer Patients Continue to Struggle for Years After Diagnosis
Authors: Pennery Emma ,   Clinical Director, Breast Cancer Care, London, UK
Published: October 2015

One in six (17 %) breast cancer patients calling Breast Cancer Care’s Helpline in 2014 still needed information and support more than two years after diagnosis. This emphasises the necessity for ongoing care long after routine check-ups have ended.
Penetration of Bevacizumab into the Iris, Anterior Chamber Angle and Ciliary Body After Intravitreal Injection
Authors: Peters Swaantje , Heiduschka Peter , Bartz-Schmidt Karl-Ulrich , Schraermeyer Ulrich ,   University Eye Hospital, Tübingen,   University Eye Hospital, Lübeck,   University Eye Hospital, Tübingen,   University Eye Hospital, Tübingen,   University Eye Hospital, Tübingen
Published: October 2015

Recently, it was suggested that the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab could be used in the treatment of rubeosis iridis. Therefore, we aimed to trace the penetration of bevacizumab into the anterior chamber after intravitreal injection of the drug. We found that intravitreally injected bevacizumab penetrates well and quickly into the anterior chamber angle, iris and ciliary body. The highest concentration of bevacizumab is present on days one to four after injection, with penetration into the iris appearing to be faster than that into the anterior chamber angle and ciliary body. These findings are consistent with the clinically described regression of iris neovascularisation one to three days after injection. Furthermore, we demonstrated progressive penetration through the tissues of the anterior chamber towards the sclera. Our study showed that the intravitreal application mode is suitable for obtaining an accumulation of bevacizumab throughout the vascularised tissues of the anterior segment. Intravitreal bevacizumab may be used as a supplementary treatment for rubeosis iridis and neovascular glaucoma.
Comparing Retrobulbar and Topical Anaesthesia in Cataract Surgery by Phacoemulsification – How Can Patient Comfort During Surgery by Phacoemulsification Be Improved?
Authors: Gombos Katalin , Németh János ,   Assistant Professor,   Professor and Director, Department of Ophthalmology, Semmelweis University, Budapest
Published: October 2015

The first section of this article is a summary of the development of cataract surgery and the anaesthetic methods used in cataract surgery. When comparing the effectiveness of retrobulbar anaesthesia (RBA) and topical anaesthesia (TA), we found that more patients in the TA group indicated pain during the procedure (p<0.001). After analysing pre-operative data, we could predict which patients would report intraoperative pain with 93% certainty. The type of anaesthesia and the skills of the surgeon are robust factors, while higher levels of stress hormones before surgery are also significant, especially in younger patients. The possible origin of pain and the role of positive verbal communication around the procedure are discussed. In order to prevent unexpected surgical situations, it is better to offer patients the most appropriate method of anaesthesia rather than using a ‘one size fits all’ solution.
Corneal Collagen Cross-linking in Keratectasia
Authors: Hafezi Farhad ,   Associate Professor of Ophthalmology, University of Zurich, and Partner, Institute for Refractive and Ophthalmic Surgery, Zurich
Published: October 2015

In recent years, increased attention has been paid to the biomechanical properties of the cornea. Corneal biomechanics are altered not only in inherited and acquired corneal conditions, such as ectatic disorders or melting processes, but also by refractive surgical procedures. Therefore, a therapeutic approach to increase the biomechanical and biochemical resistance of the cornea would address important issues in a variety of corneal disorders. Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A (UVA) is an innovative clinical technique that fulfils these criteria. To assist researchers and clinicians interested in the field, this article provides a comprehensive overview of the current state of CXL, its basic principles, the technique and clinical indications, but also safety issues and potential complications.
Nanotechnology for Gene Delivery to the Eye
Authors: Singh Swita R , Kompella Uday B ,   Formulation Scientist, Wyeth Pharmaceuticals,   Professor of Pharmaceutical Sciences and Ophthalmology, University of Colorado, Denver
Published: October 2015

The relatively immune-privileged status of the eye makes it an interesting target for gene delivery. Gene delivery to the eye using viral vectors via subretinal and intravitreal injections has been extensively investigated. Recently, the safety of recombinant adeno-associated virus vector expressing RPE65 complementary DNA (cDNA) in a limited clinical trial of three patients has also been reported. Nanotechnology-based non-viral vectors offer the advantages of safety and flexibility in terms of loading capacity and delivery system design compared with viral vectors. An ideal non-viral vector should be non-toxic, efficiently taken up into the target cells and conducive to gene expression, and should protect the gene against enzymatic degradation. Multiple kinds of nanotechnology-based non-viral vectors have been investigated for potential applications for gene delivery to the eye, namely nanoplexes, dendrimers, micelles, nanoparticles and liposomes. This article summarises and discusses key advances in the application of nanotechnology for gene delivery to the eye.
The Blood–Retinal Barrier in Retinal Disease
Authors: Cunha-Vaz José ,   President, Association for Innovation and Biomedical Research on Light and Image
Published: October 2015

The blood–ocular barrier system is formed by two main barriers: the blood–aqueous barrier and the blood–retinal barrier (BRB). The BRB is particularly tight and restrictive and is a physiological barrier that regulates ion, protein and water flux into and out of the retina. The BRB consists of inner and outer components, the inner BRB being formed of tight junctions between retinal capillary endothelial cells and the outer BRB of tight junctions between retinal pigment epithelial cells. The BRB is essential to maintaining the eye as a privileged site and is essential for normal visual function. Alterations of the BRB play a crucial role in the development of retinal diseases. The two most frequent and relevant retinal diseases, diabetic retinopathy and age-related macular degeneration (AMD), are directly associated with alterations of the BRB. Diabetic retinopathy is initiated by an alteration of the inner BRB and neovascular AMD is a result of an alteration of the outer BRB. Treatment of retinal diseases must also deal with the BRB either by using its specific transport mechanisms or by circumventing it through intravitreal injections
Structural Changes Observed with Clinical Progression of Glaucoma
Authors: Topouzis Fotis , Founti Panayiota ,   Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki,   Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki
Published: October 2015

Glaucoma progression can be assessed based on the worsening of functional and/or structural damage. The importance of assessing structural changes relies on the fact that these usually precede visual field defects in the course of glaucoma. Changes in specific optic disc features denoting glaucoma progression can be clinically observed, while the occurrence of disc haemorrhages is considered to be a risk factor for glaucoma progression. To date, colour photography of the optic disc is the standard method for documenting and monitoring glaucoma in clinical practice and research studies. However, there are several limitations related to the use of colour photography. These mainly involve moderate to poor reproducibility in assessing glaucoma progression and limited information provided on the amount of glaucomatous damage progression.
Edge Profiles of Currently Available Intraocular Lenses and Recent Improvements
Authors: Werner Liliana , Tetz Manfred ,   Berlin Eye Research Institute (BERI),   John A Moran Eye Center, University of Utah, Salt Lake City,   John A Moran Eye Center, University of Utah, Salt Lake City
Published: October 2015

We evaluated the microstructure of the edges of currently available foldable intraocular lenses (IOLs). The methodology used assisted an IOL manufacturer (Hoya, Japan) to optimise the edge profile of its lenses. Ten designs of hydrophobic acrylic, six designs of silicone and 24 designs of hydrophilic acrylic IOLs were imaged under scanning electron microscopy (SEM), and the photographs were imported to a digital computer program. The area above the posterior–lateral edge, representing the deviation from a perfect square, was measured in square microns. There was a large variation of the area values measured in currently available foldable IOLs labelled as square-edged lenses. As a group, the edges of hydrophilic acrylic lenses were less square than those of hydrophobic acrylic and silicone lenses. Hydrophobic acrylic AF-1 Hoya lenses had a high area value (329.7μ2). Through manufacturing changes, the edges of the lenses were then optimised to a value down to 39.1μ2, which represents the most square hydrophobic acrylic edge currently available.
Imaging of the Retinal Nerve Fibre Layer with Spectral-domain Optical Coherence Tomography in Patients with Glaucoma
Authors: Ferreras Antonio , Pablo Luis E ,   Associate Professor of Health Services, University of Zaragoza, and Consultant Surgeon (Ophthalmology), Miguel Servet University Hospital,   Professor of Ophthalmology and Optics, University of Zaragoza, and Chairman, Department of Ophthalmology, Miguel Servet University Hospita
Published: October 2015

Evaluation of the retinal nerve fibre layer (RNFL) is key to diagnosing and monitoring changes in glaucoma. Optical coherence tomography (OCT) is a non-invasive, objective, quantitative method that provides realtimein vivoimages of the retina. The new spectral-domain OCTs have increased resolution and acquisition speed compared with earlier time-domain OCTs, enabling the generation of highly detailed 3D images. Axial resolution has also been improved from 10 to 3–5μm. Thus, spectral-domain OCT is a promising new clinical tool for evaluating the RNFL in glaucoma and other retinal diseases. Recent studies report that spectral-domain OCT provides peri-papillary RNFL measurements with excellent repeatability and reproducibility. The reduced variability compared with time-domain OCT may improve detection of disease progression in glaucoma patients. In cross-sectional studies, most authors suggest that the two OCT systems have similar diagnostic potential to discriminate between healthy and glaucoma patients. Nevertheless, the Cirrus HD-OCT (spectral-domain) tends to yield a slightly higher sensitivity at fixed specificities than the Stratus OCT (time-domain) for glaucoma diagnosis. In healthy subjects and patients with glaucoma, RNFL thickness measurements acquired with the two OCT systems correlated well, but their values cannot be used interchangeably.
Are Digital Imaging Devices Better than General Ophthalmologists at Diagnosing Glaucoma?
Authors: Vessani Roberto M , Susanna Remo ,   Assistant Professor, Glaucoma Service,   Head, Ophthalmology Department, University of São Paulo
Published: October 2015

Evaluation of the optic nerve head (ONH) and retinal nerve fibre layer (RNFL) is fundamental for glaucoma diagnosis. Limitations in clinical assessment of this structure may be related to normal anatomical variability and level of experience. Computerised imaging technologies such as scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography have been proposed as alternative methods to help the clinician in glaucoma diagnosis. Recent case–control studies suggest that these instruments do not provide better ability to discriminate normal from glaucomatous eyes compared with glaucoma experts, but that the reverse may be true for examiners with lower levels of experience in this disease. Increasing evidence suggests that the combination of information provided by subjective and objective analysis of ONH and RNFL could be useful to improve diagnostic certainty.
Innovations in Femtosecond Laser Technology – The Use of the WaveLight® FS200 Laser for Flap Cutting during LASIK Surgery
Authors: Kanellopoulos Anastasios John ,   Clinical Professor, Department of Ophthalmology, New York University Medical School, and Medical Director, Laservision Institute, Athens
Published: October 2015

Laser-assistedin situkeratomileusis (LASIK) involves the creation of a corneal flap and remodelling of the corneal stroma. This conventionally used a mechanical microkeratome but these devices are associated with variations in the flaps produced. The development of femtosecond excimer laser technology over the past 10 years has markedly improved the safety and efficiency of flap cutting during LASIK and provides superior performance. The Wavelight® FS200 laser is a recent development in femtosecond laser systems. This instrument is calibrated when switched on and prior to application of the applanation cone to the cornea surface, ensuring consistency in flap cutting. The Wavelight FS200 laser has a rapid firing speed that reduces the energy requirement, makes flap lifting easier, reduces procedure time and improves patient comfort. The system also provides consistency of flap diameter and thickness and allows for individualisation of flap morphology based on the patient’s condition. This article discusses clinical experience with the Wavelight FS200 laser for flap cutting in LASIK surgery.
Continuous Intraocular Pressure Monitoring by Means of the Sensimed Triggerfish® System
Authors: Michele Vetrugno , Margherita Apruzzese , Lindell Jeanette , Tiziana Sensimed AG ,   Glaucoma Research Center, Department of Ophthalmology and Otolaryngology, University of Bari,   Glaucoma Research Center, Department of Ophthalmology and Otolaryngology, University of Bari,   Sensimed AG,   Glaucoma Research Center, Department of Ophthalmology and Otolaryngology, University of Bari
Published: October 2015

Intraocular pressure (IOP), like other biological parameters, has a 24-hour rhythm with physiological oscillations around 5mmHg. Recently, it has been demonstrated that IOP fluctuations represent an independent parameter for progression of glaucoma. The most common clinical methods able to detect the diurnal state of IOP are the tonometric curve (with IOP measurements taken from 9:00 am to 20:00 pm) or two provocative tests, such as the water drinking test (WDT) and the ibopamine test. Recently introduced in clinical practice, the Sensimed Triggerfish® is a system enabling continuous IOP monitoring based on a disposable contact lens with a sensor linked to a telemetric microprocessor. The purpose of this project was to investigate the clinical applicability of the system as an additional tool, providing useful information for the management of glaucoma patients. Of eight evaluated patients, two cases are presented in detail in this report. The monitoring system that provides 24-hour continuous data appears to be very promising, as it captures clinically useful, real-life IOP fluctuations day and night while patients maintain normal activities, including undisturbed sleep.
Results Nine Months After Implantation of Crystalens HD
Authors: Tomalla Mark ,   Senior Physician and Head, Clinic for Refractive and Ophthalmic Surgery, Duisburg
Published: October 2015

The Crystalens HD is  according to our experience  a bifocal intraocular lens (IOL). In addition to treating cataracts, the Crystalens HD can be used to correct myopia, hyperopia, slight astigmatism and presbyopia. In this article we present our first results nine months post-operatively from an open, uncontrolled, prospective, observational study. The surgical procedure used differs considerably from standard cataract operations. Posterior capsule opacification was treated early  eight to 10 weeks post-operatively  using a specific YAG-capsulotomy. We have implanted over 70 IOLs and nine-month results are available for 30 eyes. Uncorrected visual acuity for distance vision was 0.67 in 82%, for intermediate vision 0.8 in 100% and for near vision 0.5 in 100%. Sixty-eight per cent of the patients no longer need reading glasses and 100% have no blinding sensitivity/halos and unchanged nightvision. After Crystalens HD implantation, the long-term post-operative clinical results were convincing. Subjective patient satisfaction was above average.
Diagnosing and Treating Vitreomacular Adhesion
Authors: Carpineto Paolo , Antonio Luca Di , Aharrh-Gnama Agbeanda , Ciciarelli Vincenzo , Mastropasqua Leonardo ,   Associate Professor,   Doctor of Philosophy,   Doctor of Philosophy,   Resident,   Professor and Chair, Ophthalmology Clinic, Department of Medicine and Aging Sciences, University G dAnnunzio Chieti-Pescara
Published: October 2015

Perifoveal vitreous detachment with residual vitreofoveal adhesion is considered as the first stage of posterior vitreous detachment. A key point is the transition from an innocuous vitreomacular adhesion (VMA) to a pathological vitreomacular traction (VMT). By using optical coherence tomography (OCT), VMA is defined as adhesion of the posterior hyaloid cortex involving the centre of the foveal region with or without a hyper-reflective signal on the inner surface of the retina. VMT is diagnosed when the inner macular surface slopes steeply, or sharp angulation and localised deformation of the retinal profile is detected at the VMA site. Otherwise, VMA is simply considered to be persistent adherence of the cortical vitreous. The tractional effects of perifoveal vitreous detachment cause a variety of macular pathologies determined by the size and the strength of the residual vitreoretinal adhesion. Vitreomacular adhesion plays a major role in the development of diseases such as vitreomacular traction syndrome (VMTS), macular hole, epiretinal membrane, tractional macular oedema and myopic macular retinoschisis. In addition, clinical evidence supports the theory that the course of diabetic retinopathy and age-related macular degeneration may be strongly influenced by an incomplete posterior vitreous separation. The current standard of care of vitreomacular interface pathologies is vitrectomy and membrane peeling  a procedure that is thought to relieve epiretinal traction  followed by regeneration of the retinal architecture and recovery of visual function. Over the last few years, with the introduction of 25-gauge (0.50mm) and 23-gauge (0.72mm) instruments, there has been another major shift toward transconjunctival microincisional vitrectomy surgery (MIVS). Pharmacological induction of posterior vitreous detachment (PVD) can become a further step toward a real minimally invasive vitreous surgery for VMTS.
White Dot Syndromes
Authors: Errera Marie-Hélène , Westcott Mark ,   Moorfields Eye Hospital, London,   Moorfields Eye Hospital, London
Published: October 2015

This article reviews the distinctive features of ‘white dot’ syndromes and related conditions. The investigations of choice for the proper diagnosis and monitoring of the diseases are indicated. A differential diagnosis is presented so that the clinician can confidently exclude other conditions such as infectious causes that can mimic white dot syndromes. This review is based upon our clinical experience in the uveitis service of Moorfields Eye Hospital, supported by an up-to-date literature review.
Computer-aided Analysis of Fundus Photographs
Authors: Ribeiro Luisa , Bernardes Rui , Cunha-Vaz José ,   Director of Clinical Trial Unit,   Director, Centre for New Technologies in Medicine,   Professor of Biophysics,   President, Association for Innovation and Biomedical Research on Light and Image, Coimbra,   Emeritus Professor of Ophthalmology, Faculty of Medicine, University of Coimbra
Published: October 2015

Colour fundus photography is the most frequently used imaging modality because it is non-invasive, well accepted by patients and above all, because it allows documentation and automated analysis of the ophthalmoscopic examination. Colour fundus photography is considered crucial for diabetic retinopathy management to identify disease and its progression in clinical practice. This article focuses on automated computer-aided analysis of fundus digital photographs with special emphasis on microaneurysm dynamics. Together with optical coherence tomography measurements of extracellular space and retinal thickness, both based on non-invasive procedures, this technique allows close follow-up of the main changes in the diabetic retina. Determination of the activity of the retinal disease and individual risk profiles using these non-invasive procedures contribute to personalised management of diabetic retinopathy by identifying eyes at risk from vision-threatening complications, such as macular oedema and proliferative retinopathy.
Ultrasound Circular Cyclo-Coagulation – Innovation in Glaucoma with High Intensity Focused Ultrasound
Authors: Cato Sharon , Aptel Florent , Denis Philippe , Haar Gail ter , Melamed Shlomo , Sellem Eric , Shaarawy Tarek , Wright David ,   Senior Medical Writer, Touch Medical Communications,   Edouard Herriot Hospital, Lyon,   Ophthalmology Department, Croix-Rousse University Hospital, Lyon,   Institute of Cancer Research, Royal Marsden Hospital, Sutton,   Sam Rothberg Glaucoma Centre and Tel Aviv University Medical School,   Glaucoma Department, Kléber Ophthalmology Centre, Lyon,   Glaucoma Unit, University Hospitals of Geneva,   International Glaucoma Association, London
Published: October 2015

Existing treatment modalities for glaucoma, including pharmacological therapy, lasers, surgery and shunts, are all associated with shortcomings. Ultrasonic coagulation of the ciliary body with pinpoint precision using high intensity focused ultrasound (HIFU) enables significant reduction of aqueous inflow and intraocular pressure (IOP). Energy is focused through non-optically transparent media with controlled energy absorption, reducing effects on adjacent tissues. Energy deposition and tissue heating at the focus site do not depend on tissue pigmentation, thus improving predictability. Currently, high-frequency miniaturised transducers create small focal zones for improved treatment area targeting, and ultrasound focusing provides enhanced control. The high operating frequency allows a sharp transition between the focal zone and the untreated area, reducing risks of heating adjacent healthy tissue. Such transducers are used extensively in malignant tumour treatments. Novel Ultrasound Circular Cyclo-Coagulation (UC3) with a miniaturised annular transducer uses HIFU technology. The circular geometry of the device allows precise, constant and reproducible positioning. Results from animal studies and from a clinical pilot study of patients with refractory glaucoma indicate that ultrasonic coagulation of the ciliary body using HIFU delivered by a circular miniaturised transducer is an effective and well-tolerated method of reducing IOP. The single-step procedure is short, easy to perform and accurate. Glaucoma impacts patients’ quality of life, including unpleasant treatment side effects and social and physical aspects. Gold-standard trabeculectomy shortcomings highlight the need for precise, focused surgical modalities. HIFU is a non-invasive, cost-effective innovation that, should the multicentre clinical trial demonstrate similar results to the preclinical and pilot studies, will be a useful addition to current glaucoma management techniques.
Medical Treatment of Open-angle Glaucoma in 2011
Authors: Holló Gábor ,   Professor and Head, Glaucoma and Perimetry Unit, Department of Ophthalmology, Semmelweis University, Budapest
Published: October 2015

Treatment possibilities for open-angle glaucoma have improved considerably in recent years. Fixed-dose combination eye drops and preservative-free preparations are used increasingly in routine clinical practice, and may reduce the frequency and severity of the medication-related ocular surface problems. Despite this progress, our knowledge of several aspects of the use of combined medication is suboptimal and in many cases treatment intensification or surgery is not introduced in time. To improve the quality of glaucoma care it is useful to review the problematic aspects of treatment.
Severe Ocular Burns
Authors: Merle Harold , Gerard Max , Schrage Norbert ,   Service d’Ophtalmologie, Martinique,   Service d’Ophtalmologie, Centre Hospitalier de Cayenne, Guyane,   University Hospital Aachen, Department of Ophthalmology, Cologne
Published: October 2015

The worst ocular lesions are chemical burns caused by strong bases and acids. Associated with the destruction of limbal stem cells (LSCs), there are repeated epithelial ulcerations, chronic stromal ulcers, deep stromal neovascularisation, conjunctival invasion and even corneal perforations. The initial clinical examination is difficult because the symptomatology is severe, but nevertheless it helps to classify the lesions, to establish a prognosis and to guide the therapeutic care. The classification system used most is that implemented by Hughes and modified by Roper-Hall. It is now completed neatly by those proposed by Dua and Wagoner, which are based on the importance of the deficit of LSCs. Prognosis of severe forms has progressed significantly thanks to a better knowledge of the physiology of the cornea’s epithelium. Surgical techniques to repair destroyed LSCs have changed the prognosis of severe corneal burns significantly. To limit the incidence of burns, prevention, especially in the industrialised world, is essential.
Macular Pigment Density Measurement in Patients with Age-related Macular Degeneration
Authors: Dawczynski Jens , Jentsch Susanne , Schweitzer Dietrich , Hammer Martin , Strobel Jürgen ,   Professor and Associate Director, Department of Ophthalmology, University Hospital Leipzig,   Research Fellow,   Research Fellow,   Research Fellow,   Professor and Head, Department of Ophthalmology, University Hospital Jena
Published: October 2015

Macular pigment is key to the healthy eye. Direct determination of macular pigment optical density using single-wavelength reflectometry with a fundus camera has allowed to identify changes in macular pigmentation in patients with dry or exudative macular degeneration. This approach could be useful for individualised patient follow-up, particularly in those with age-related macular degeneration.
Suprachoroidal Drug Delivery – A New Approach for the Treatment of Severe Macular Diseases
Authors: Augustin Constanze , Augustin Albert , Tetz Manfred , Rizzo Stanislao ,   Medical student,   Professor and Chair,   Professor and Chair, Berlin Eye Research Institute,   Professor and Chair, UO Chirurgia Oftalmica, Azienda Ospedaliera-Universitaria Pisana
Published: October 2015

In this article, we review recent research in suprachoroidal drug administration for the treatment of advanced, refractory, retinal disease. A microcatheter (iTRACK 400) has been used to access and deliver drugs to the suprachoroidal space. This technology has been investigated in several animal models as well as in patients with advanced disease stages and/or who are unresponsive to conventional treatments. In groups with either age-related macular degeneration (AMD) and/or macular oedema resulting from other diseases, significant effects were achieved by using this technology to apply steroids and/or anti-vascular endothelial growth factor (VEGF) drugs, with no surgical or postoperative complications observed. Suprachoroidal drug administration directly adjacent to the choroid in the submacular region might therefore be a potential treatment for many retinal diseases. Human pilot studies in patients with advanced, refractory retinal disease that is unresponsive to conventional treatments showed some increase in residual vision and significant reduction of macular oedema, with few complications. Prospective trials are necessary to confirm the pilot results obtained by different research groups.
Safety and Efficacy of Ranibizumab and Bevacizumab for the Treatment of Neovascular Age-related Macular Degeneration
Authors: Chong Victor , Kaiser Peter K , Mitchell Paul ,   Consultant and Lead Clinician, Oxford Eye Hospital, University of Oxford,   Professor of Ophthalmology, Cole Eye Institute, Cleveland Clinic,   Professor of Ophthalmology, Centre for Vision Research, University of Sydney
Published: October 2015

Ocular anti-vascular endothelial growth factor (VEGF) therapy represents a major breakthrough in the treatment of patients with neovascular age-related macular degeneration (nvAMD). The anti-VEGF agents, ranibizumab and bevacizumab, are both widely used in the treatment of nvAMD although bevacizumab has not yet received regulatory approval for intraocular use. Bevacizumab costs considerably less than ranibizumab when administered as an intraocular injection, which has led to widespread use and studies comparing the efficacy and safety of the two drugs. Bevacizumab shares identical pharmacology with ranibizumab although structural differences result in differences in receptor affinity and rates of drug clearance. While estimates of the vitreous half-life of ranibizumab vary, it is shorter than that of bevacizumab. Furthermore, the serum half-life of bevacizumab is about 20 days, more than twice that of ranibizumab and this has led to speculation that it may present a greater risk of systemic adverse effects. Considerable clinical trial evidence exists relating to the efficacy and safety of ranibizumab. The Comparison of age-related macular degeneration treatments trials (CATT) study of the two drugs found efficacy to be equivalent for the as needed versus as needed and monthly versus monthly comparisons. Ranibizumab as needed was equivalent to monthly ranibizumab, though the bevacizumab as needed was not equivalent to monthly bevacizumab. A greater number of serious adverse events (SAEs) occurred with bevacizumab. However, the study was insufficiently powered to identify differences in drug-related adverse events. Intravitreal injection of bevacizumab is associated with a low but significant risk of acute intraocular inflammation, shown to result in significant visual loss in some patients. Finally, there are issues related to fractionating of bevacizumab that has lead to sporadic cases of blindness worldwide. The increased risk for both systemic and ocular adverse events may influence the cost-effectiveness ratio of the two drugs based on health economic models. Further comparative studies and continuous monitoring of safety data are required to examine the incidence of adverse events.
Management of Anti-vascular Endothelial Growth Factor Therapy – Diagnostic Pitfalls
Authors: Mauget-Faÿsse Martine , Wolff Benjamin , Basdekidou Chrysanthi ,   Centre Ophthalmologique Robelais, Lyon,   Foundation A de Rothschild, Paris,   Foundation A de Rothschild, Paris
Published: October 2015

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in adults aged over 50 years in developed countries. In 2006, the use of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs revolutionised the therapeutic approach to treating neovascular AMD. However, it is essential to detect the frequent diagnostic pitfalls encountered in this therapeutic domain to apply anti-VEGF therapy successfully and thereby avoid useless treatments. Classic pitfalls include  retinal pigmented epithelium-photoreceptor abnormalities mimicking choroidal neovascularisation; persistent serous retinal detachment; pseudocysts and cystoid cavities mimicking retinal oedema; and outer retinal tubulations. Current imaging technologies, such as colour fundus photography, autofluorescence (FAF) and infrared imaging, fluorescein (FA) and indocyanine green (ICGA) angiographies, spectral domain optical coherence tomography (SD-OCT) and enhanced depth imaging OCT (EDI-OCT), can help overcome these pitfalls. Even if anti-VEGF treatments are mostly based on SD-OCT data, the consolidation and correlational analysis of all the available patient data is essential for accurate diagnosis.