bluuebunny/crossref_metadata_2025 huggingface dataset:
Adapting a dermatological multi‐laser fluorescent confocal microscope for ophthalmology applications
Authors: GRIOT O , GRIVET D , ESPINASSE M , PERROT JL , LABEILLE B , CAMBAZARD F , CAMPOLMI N , GAIN P , THURET G
Published: August 2012

Purpose To adapt for ophthalmology the only multi‐laser fluorescent confocal microscope available on the market and initially developed for dermatology (Vivascope 1500, MAVIG, GmbH). The arm that maintains the microscope in contact with the skin was too rigid and imprecise, and the disposable plastic window placed at the interface between the tissue and the microscope objective was too large. Both were not convenient for high quality corneal and ocular adnexa imaging

Methods We designed specific stands to create a take‐down interface between the confocal microscope, his dermatological arm support and an ophthalmology examination table comprising a 5 degrees of freedom stand (Zeiss, Germany). A male guide rail was machined in polyoxymethylene and permanently fixed on the confocal microscope to avoid repetition of assembly and disassembly. Two females guide rails machined in aluminium 7075 were fixed on the dermatological arm support on the one hand and on an ophthalmological stand on the other hand. Rails were blocked with simple screws. We also designed a new adapter to receive disposable caps already available for corneal confocal microscopy. A lateral camera allowed live visualization of the objective/eye contact

Results These new interfaces allowed easy and solid fastening of the confocal microscope on each arms of the two specialties providing optimal conditions for clinical examination. The new ophthalmology arm allowed a precise positioning of the contact objective on the patient eye

Conclusion Thanks to theses adaptations, the first multilaser fluorescent confocal microscope is now usable by ophthalmologists, and opens a completely innovative field of exploration
Revisiting corneal storage using a bioreactor: proof of concept
Authors: GAIN P , BERNARD A , NEFZAOUI C , CAMPOLMI N , GRIOT O , ACQUART S , PISELLI S , THURET G
Published: August 2012

Purpose Cold storage (CS) or organ culture (OC) for corneal storage, have not been dramatically improved since the 70’. Basically, they consist of immersion of the cornea in a sealed vial or viewing chamber filled with storage medium containing macromolecules for permanent (CS) or sequential (OC) deswelling. None respects the corneal physiology (higher pressure to the endothelial side associated with a retrocorneal fluid circulation), resulting more or less rapidly in endothelial cell (EC) death, stromal swelling and Descemet folding (for OC) that accentuate EC death. In the past, several artificial chambers were built or patented, mainly for toxicology experiments and never with a view to improve graft storage. We developed a corneal bioreactor (BR) that reconstitutes both pressure and continuous slow medium renewal in order to improve corneal storage

Methods The BR (patented) comprised sterile endothelial and epithelial chambers closed with transparent windows to allow easy controls (transparency, thickness, detection of interfaces, and EC count) from both sides. Adjustable fluid flow and pressure (15‐30 mmHg) in the endothelial side were maintained by a disposable infusion system connected to a microsolenoid valve controlled by a pressure sensor and a microcontroller. Furthermore, the height of the epithelial window could be adjusted to aplanate the cornea for femtosecond laser cut

Results The BR maintained a stable gradient of pressure during at least 5 weeks with a controlled flow. A few hours after insertion of the cornea in the BR, transparency improved and thickness and folding decreased and were maintained without deswelling molecules

Conclusion The BR could improve corneal storage in eye banks
Corneal ectasia after excimer surgery and the mandelbrot B. fractal theory in ophthalmology
Authors: KACHANOV ANDRE , NIKULIN SERGE , BAUER SVETA , ZIMIN BORIS
Published: August 2012

Purpose To investigate corneal ectasia after LASIK surgery by using the Mandelbrot B. fractal theory in ophthalmology.

Methods We reviewed our consecutive 55012 cases of excimer‐laser surgery including LASIK (48910 eyes) and PRK (6102 eyes). We used MEL‐60, MEL‐70 and MEL‐80 excimer laser (“Carl Zeiss Meditec”) and microkeratomes LSK‐Evolution 1, 2 and 3 (“Moria”) for LASIK. Follow‐up period was up to 14 years. The age of all patients was from 18 to 74 years. Some of them had hyperopia with sphere‐equivalence (SE) up to 6,5D, and the others had myopia with SE from –1,0D to –18,0D.

Results There was NO corneal ectasia in the PRK and the hyperopic LASIK groups. 38 eyes (0,08%) had corneal ectasia after myopic LASIK (46294 eyes). There were 8 eyes with previous radial keratotomy, 8 eyes with subclinical keratoconus and 22 eyes with normal cornea (0,048% of all myopic LASIK) among the eyes . Pre‐op parameters of these eyes were the followings: central K ‐ 44,37±1,09D, CCT ‐ 530,4±34,4 microns, SE – 5,90±3,36D. Fractal theory allows to explain post‐op corneal ectasia phenomenon.

Conclusion There are NO optical methods to predict corneal ectasia after LASIK surgery. But the risk factors of this complication were the followings: steep cornea (more than 44,0 D), corneal scars after previous corneal surgery (e.g. anterior radial keratotomy etc.), corneal topography irregularity and probably very thin residual corneal thickness. Myopic LASIK surgery can provoke post‐op corneal ectasia development in the long follow‐up period. We described post‐op myopic LASIK cornea as a “odd” (“curious”) attractor according to the Mandelbrot B. fractal theory.
Graft thickness and visual acuity after automated endothelial keratoplasty
Authors: RABOT A , SOLER V , FOURNIE P
Published: August 2012

Purpose Endothelial keratoplasty has become the standard of care for endothelial disease. Descemet Membrane Endothelial Keratoplasty (DMEK) gives superior visual results but poses several surgical challenges, compared to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Graft thickness was advanced as a reason for this difference. Ultrathin‐DSAEK, with a double microkeratome pass has been proposed to maintain the advantages of both DSAEK and DMEK. The purpose of this study was to evaluate the possible correlation between visual acuity (VA) and central graft thickness in DSAEK.

Methods A preliminary retrospective study was conducted on 42 patients who underwent DSAEK: 26 operated on with a single microkeratome pass with a 350 microns (µm) head, and 16 with a double pass using a 200 µm head. Pre‐ and post‐operative VA, and post‐operative central corneal graft thickness measured by OCT and Scheimpflug imaging were collected with at least 6 months follow‐up.

Results The overall mean of graft thickness was 127.25 ± 40µm. The overall mean VA was 0.16logMAR. 38% of patients had at least 0.1logMAR VA. Graft thickness was 136.8 ± 43.4µm with a single microkeratome pass compared to 111 ± 30µm with a double pass (p<0.05). Considering the overall cohort, we had a correlation between graft thickness and VA (p<0.05), but also between the pre and post‐operative VA (p<0.05). We had no correlation between graft thickness and VA in the double pass subgroup. No difference was found between the single and the double pass subgroups for VA.

Conclusion There is no clear correlation between graft thickness and visual acuity. Other factors may come into account such as scarring of the interface, or the stage of endothelial failure.Preoperative VA could be a prognosis factor.
Functional and biomechanical changes in keratoconic corneas after implantation of intracorneal ring segments 5 and 6mm in diameter
Authors: PERIS‐MARTINEZ C , ARGUDO M , ESPANA‐GREGORI E
Published: August 2012

Purpose To determinate biomechanical and functional changes in human keratoconic corneas after triangular section ring implantation in two designs.

Methods Retrospective study of biomechanical properties of 46 patients (60 eyes) with keratoconus undergoing surgery Keraring® intracorneal ring segments divided into two groups according to 5 or 6 mm of diameter. Surgical technique to made the channel was with IntraLase femtosecond laser. UCVA and BSCVA were measured and biomechanical factors provided by the device ORA before surgery and postoperatively one month, 3 months and 6 months.

Results After surgery, we obtained a significant increase (p<0.05) of the biomechanical parameters (CH and CRF) mean (0.87±2.59)mmHg for CH and (‐0.015±2.06)mmHg for CRF. This improvement is not homogeneous during the postoperative follow‐up in two groups in diameter. We found increased of CH top with rings of 6mm. The variations found in the CRF, are not significant at the descriptive level with any of the designs (p>0.05). At baseline‐ 6 months, the improvement in BSCVA (LogMAR) is 0.13 in 5mm diameter respect to 0.07 in 6mm in diameter. Among the changes in CH and BSCVA (LogMAR), there is a significant inverse correlation with 6mm rings at baseline‐ 1 month period (r=‐0.442) and 1 month‐ 3 month period 0.007 (r=‐0.511). No significant correlation was detected between CRF and BSCVA.

Conclusion Intracorneal rings improve corneal biomechanics. The CH undergoes improvement in postoperative follow up with any of the ring designs, while the CRF is not affected significantly with any of the types. 5mm rings further improve best corrected visual acuity. This improvement is not related to changes in the biomechanical properties.
Cis‐urocanic acid eye drops are safe and well tolerated in healthy adults – results from a randomised phase 1 clinical study
Authors: LEINO L , JAUHONEN HM , KARI E , PYLKKäNEN L , POUTANEN J , LAIHIA JK , KAARNIRANTA K
Published: August 2012

Purpose Cis‐urocanic acid (cis‐UCA) is an endogenous small molecule of the skin. Preclinical data suggest that topical cis‐UCA could be used as an anti‐inflammatory treatment in ophthalmology. We investigated the safety, tolerability and pharmacokinetics (PK) of cis‐UCA in healthy adults in a randomised, double‐blind and placebo‐controlled phase 1 study.

Methods The 37 subjects in 3 groups received either 0.5% or 2.5% cis‐UCA eye drops, or placebo. In part I, the eye drops were administered on one eye 3x in one day. In part II, the same subjects received the same eye drops on both eyes 3x a day for 14 days. Clinical evaluations included complete physical examination and safety laboratory tests, physical examination of the eyes, and ocular comfort rating by 5 parameters.

Results Both cis‐UCA eye drops were safe and well tolerated throughout the study. None of the ocular safety parameters differed between cis‐UCA and placebo. Of the ocular comfort rating, only burning of the eyes was significantly higher with cis‐UCA than with placebo; however, this reaction was mild, transient and infrequent in all cases. PK analysis showed that 2.5% cis‐UCA eye drops may be absorbed after repeated ocular dosing, as 7/12 subjects in this group had low cis‐UCA levels (< 10 µg/ml) in the urine. However, plasma cis‐UCA levels were negligible.

Conclusion The observed good local and systemic safety and tolerability of cis‐UCA eye drops warrants further clinical studies in patients with inflammatory ocular diseases.

Commercial interest
Monochromatic aberrations in children and youth in different cycloplegic conditions
Authors: MOCKO L , WYLEGALA E , ZAJAC M
Published: August 2012

Purpose The aim of the study was to quantify low and high order Zernike aberrations in children and youths as well as to investigate influence of fogging and cycloplegia on the refraction and aberrations measurement.

Methods KR‐1W Topcon aberrometer was used to measure aberrations in refractometer and aberrometer mode. Children were examined three times. First examination in whole group was performed after fogging stimulus used once ‐ in first of three continuous measurements, second after fogging stimulus performed for each measurement and third after pharmacological cycloplegia with 1% Tropicamid. Second and third measurements were performed in selected group of children. Totally 556 schoolchildren and 74 young sportsmen aged from 6‐to‐18 years were investigated. Average age was 13.87, SD 2.29 in large group and 11.33 years, SD 2.7 in smaller group.

Results We found significant differences in spherical refraction measured after pharmacological cycloplegia compared to that after fogging. Refraction after cycloplegia was more hyperopic. There were higher differences in high hyperopic children. There were no differences between fogging and cycloplegic measurements in myopes higher then ‐2.00 D.. Aberrometry has given more myopic results then refractometry. Cylinder values were almost the same. Keratometer readings were the same in all measurements conditions. We found similar levels of high order aberrations in myopic, emmetropic and hyperopic children. There was no noticeable symmetry in high order aberrations between right and left eye.

Conclusion Both methods of low order aberrations measurement are similar. Optical parameters of cornea do not depend on the cycloplegic status. Low order Zernike aberrations strictly correspond to the refraction error.
We don’t graft as many endothelial cells as we think (Part 1): what early post‐operative endothelial cell counts tell us
Authors: NEFZAOUI C , TRONE M , CAMPOLMI N , ACQUART S , THEILLIERE C , THURET G , GAIN P
Published: August 2012

Purpose The decrease of endothelial cells density (ECD) after penetrating keratoplasty (PK), is calculated form ECD given by eye banks (ebECD) and post‐operative specular counts. To better understand the difference between both counts, usually considered caused by EC mortality, we have introduced a new concept of viable ECD (vECD) experimentally determined with a triple staining of viable and dead EC. We demonstrated that vECD just before graft was lower than the ebECD by 12+/‐9% (IOVS 2011.52:6018). The aim of this prospective study was to measure post PK ECD as early as possible in order to compare it with vECD and deduce the true post op EC mortality

Methods Standard ebECD were determined 48h before graft with a validated analyzer (Samba cornea) on a minimum of 300 EC. Postoperative central ECD were determined by a non‐contact specular microscope (Topcon SP2000P) with manual determination of contours of the maximum of EC. Thirty‐four PK done by the same surgeon (>1000 PK) were analysed at D5, D15, and M1. Non‐parametric tests for paired data were used

Results All PK were uneventful. ebECD (n=40) was 2585(482) cells/mm² (mean(SD)). Postoperative ECD at D5 (n=22), D15 (n=29), and M1 (n=33) were respectively 1850(386), 1655(285) and 1650 (408) cells/mm² and were lower than ebECD (P<0,05). They corresponded to apparent EC loss of respectively 28%, 36% and 36% compared to ebECD

Conclusion ECD at D5 is dramatically lower than ebECD but subsequent decrease seems low. Results are consistent with the vECD that we previously noticed and suggest that EC mortality triggered by surgery and perioperative events may only minimally contribute to the decrease of ECD
We don’t graft as many endothelial cells as we think (part 2): comparison of cell loss after autograft and organ cultured allograft in the same patient
Authors: TRONE M , NEFZAOUI C , ALDOSSARY M , CAMPOLMI N , ACQUART S , GARRAUD O , THURET G , GAIN P
Published: August 2012

Purpose Reasons for endothelial cell density (ECD) decrease after corneal grafts remain unclear. We recently demonstrated that eye bank ECD (ebECD) overestimates the pool of viable EC really grafted to patients (Pipparelli.IOVS2011;52:6018) because standard ebECD cannot take account of acellular areas or area covered by dying EC. Autograft is a very rare situation where ECD can be easily determined by specular microscopy just before graft and almost all grafted EC are living. Aim: to compare EC decrease after simultaneous autograft and organ cultured (OC) allograft in the same patient

Methods A 71 year‐old woman presented with pseudophakic corneal edema in left eye and amblyopic right eye with a normal cornea. She underwent two penetrating keratoplasties (PK): autograft of the left eye and allograft of the right eye with an OC cornea. Follow‐up at day (D)1, 5, 15, 20 and 30 comprised slit lamp examination and non‐contact central specular microscopy (Topcon SP2000P)

Results Both grafts were uneventful. For the allograft, ebECD 48h before graft was 2787 cells/mm² and postop ECD decreased of 39%, 40%, 40% and 43% at D5, 15, 20 and 30. For the autograft, pregraft specular ECD was 2017 cells/mm² and postop ECD were 1941, 1934, 1924, 1909 and 1900 cells/mm² respectively at D1, 5, 15, 20 and 30

Conclusion This exceptional case confirms a dramatic discrepancy between ebECD and very early postop ECD, likely to be explained mainly by an overestimation of the true EC pool of viable cells by standard eye banks count, rather than by overmortality due to peri‐operative events, since almost no early cell loss is observed during autograft
Influence of culture time on maintenance of limbal epithelial progenitors in the explant culture system
Authors: GHOUBAY D , SANDALI O , GOLDSCHMIDT P , BULLET J , LAROCHE L , BORDERIE V
Published: August 2012

Purpose To assess the influence of culture time on maintenance of limbal epithelial progenitors in the explant culture system.

Methods Limbal epithelial cells were cultured from 2‐mm2 human limbal explants in cholera toxin‐free medium with no feeders for 9‐21 days. Expression of differentiation and progenitor markers was assessed by immunochemestry and RT‐PCR. The clonal growth ability of cultured epithelial cells at each time of culture and with murine 3T3 feeders or human corneal stromal feeders was evaluated by determining colony forming efficiency (CFE).

Results The average number of cultured cells obtained after 7, 14, and 21 days was, respectively, 500, 60489, and 195949. Expression of broad spectrum cytokeratins, CK3, CK19, vimentin, p63, and ABCG‐2 was observed at all culture time points by immunocytochemistry and RT‐PCR. Epithelial colonies were observed at 9, 11, 14 and 18 of culture but not at 21 days, both with murine 3T3 feeders and human corneal stromal feeders. Higher number of colonies was obtained when limbal epithelial cells were cultured with murine 3T3 feeders than with human corneal stromal feeders. The highest number of colonies was obtained at 14 days of culture with murine 3T3 feeders. The average cell Feret diameter (µm)/circularity for clones obtained from 11‐, 14‐, and 18‐day primary cultures were, respectively, 38.4/0.76, 34.2/0.80, and 45.7/0.72 (p<0.0001). The average percentage of p63+ small cells was, respectively 2.6%, 4.7%, and 1.3% in clones obtained from 11‐, 14‐, and 18‐day primary cultures (p=0.002).

Conclusion In the explant culture system, limbal epithelial progenitors are better preserved after 2 versus 3 weeks of culture.
Targeting host kinases for the treatment of herpes keratitis
Authors: ALEKSEEV O , JENNINGS S , AZIZKHAN‐CLIFFORD J
Published: August 2012

Purpose Herpes keratitis (HK) is a common cause of blindness in the developed world. A large number of HK cases are refractory to antiviral agents and ultimately result in permanent corneal damage. The purpose of this study is to identify new therapeutic targets against HSV and to assess their antiviral potential in tissue culture experiments, as well as in more sophisticated models of HK. Specifically, we focused on the involvement of ataxia telangiectasia mutated (ATM) and its downstream target Chk2 in facilitating productive HSV infection in corneal epithelium.

Methods We used human corneal epithelial cell lines – hTCEpi and HCE – as in vitro models of corneal HSV infection, and also developed an ex vivo model of acute corneal epithelial infection, where explanted human and rabbit corneoscleral buttons were infected and maintained in organ culture. We are currently utilizing an in vivo mouse model of ocular herpes to further validate our findings. Small molecule inhibitors of ATM (KU‐55933, wortmannin, caffeine) and Chk2 (Chk2 inhibitor II), as well as RNAi against ATM and Chk2, were used to inhibit these two kinases. We used plaque assays and qPCR to assess the infectious particle production, genome replication, and transcriptional activity of HSV in corneal epithelium.

Results Small molecule or RNAi‐mediated inhibition of ATM or Chk2 greatly suppressed the replication and transcription of the viral genome, as well as the infectious particle production. This was observed in the tissue culture models and, importantly, in organotypically explanted human and rabbit corneas. Results of the animal studies will also be presented.

Conclusion This study identifies two host kinases – ATM and Chk2 – as potential novel therapeutic targets against herpes keratitis.
Biocompatible of human acellular cornea matrix
Authors: NASINNYK I , PASYECHNIKOVA N , LEUS M
Published: August 2012

Purpose The aim of this study was to construct a rabbit anterior cornea replacement with an acellular human cornea matrix (AHCM) as a scaffold

Methods Cornea was taken from the enucleated eye from patient with melanoma of choroidea. Before the decellularization process, human corneas were washed 3 times in sterile phosphate buffered saline. To remove the hereditary materials, the cornea discs were immersed in a Triton X 100 solution and Ammonium Hydroxide with a solvent/tissue mass ratio of 20:1 (vol./wt.). AHCMs were transplanted into the right corneas of 9 Chinchilla rabbits. The superficial corneas of the right eye of the rabbits were excised with a 6‐mm punch. AHCM lamellas (150 mm, 6 mm diameter) were made using a microkeratome. AHCM were transplanted and fixed with 10‐0 nylon into rabbit corneas. All rabbits received topical levofloxacin eye. The non‐operated, contralateral eye was used as a positive control. Follow‐up clinical examinations included slit‐lamp examination to assess corneal optical clarity, neo‐vascularization and degradation of grafts. After post‐operative 8 weeks, rabbits were euthanized respectively and the corneal specimens were examined by H&E staining

Results After lamellar implantation of the AHCM, all animals survived without infections or other complications during the follow‐up period. The transplanted AHCM could be recognized in the rabbit corneas at 8 weeks after operation, with no neo‐vascularization and inﬂammation or any other rejection signs in or around the transplanted disks, as demonstrated by H&E staining. H&E staining showed that the implants were well integrated within the host corneas, with cells inﬁltrating the transplanted disks.

Conclusion Acellular human cornea matrix has a good biocompatible properties after lamellar keratoplasty
Treatment of ligneous conjunctivits with subconjunctival fresh frozen plasma (ffp): about three severe cases
Authors: GABISON E , DOAN S , AJZENBERG N , COCHEREAU I
Published: August 2012

Purpose Ligneous conjunctivitis is a rare type of chronic membranous conjunctivitis. It is inherited as an autosomal recessive disorder, with low plasminogen levels reported in both homozygous and heterozygous individuals

Methods we describe the clinical features and response to subconjunctival FRESH FROZEN PLASMA (FFP) in three patients with severe ligneous conjunctivitis with a mean follow‐up of 12 months, among 15 patients followed in our department for the past 10 years.

Results All our cases had bilateral ocular involvement except. They were all treated with subconjunctival injection of FFP after resection of the membranes. Topical heparin and rimexolone application was continued 1 month after surgery. As the case 2 presented a corneal perforation during the course of the disease, he was also treated with multiple inlay amniotic membrane graft.

Conclusion FFP shortens the treatment period, reduces the probability of mid‐term recurrences and is a good alternative to a long‐term topical treatment with Heparin and steroid.
Cultivating oral mucosa epithelial transplantation (COMET) followed by penetrating keratoplasty (PK) in ocular surface reconstruction
Authors: DOBROWOLSKI D , WOWRA B , ORZECHOWSKA‐WYLEGALA B , WYLEGALA E
Published: August 2012

Purpose Efficacy of COMET and subsequent PK in patients with limbal insufficiency combined with stromal corneal haze after corneal burns

Methods 15 patients (16 eyes)who underwent corneal burns with vascular conjuctival pannus and stromal involvement underwent autologous cultivated oral mucosa epithelial transplantation. Cellular material was obtained from buccal mucosa, tripsinized, and settled on the previously prepared culture dishes. Cultures was carried on denuded amniotic membrane in presence of inactivated with mitomycin C 3T3 fibroblasts. At least 12 month after epithelium restoration patients underwent PK. Corneal surface stability and visual acuity were evaluated.

Results 6 month after last step of the surgery 68,7% of eyes had transparent cornea without reccurent revascularization, 31,2 % of eyes developed vascular pannus again with vascular ingrowth on the transplanted cornea ( in 2 cases visual axis was involved), in 62,5 % of eyes visual acuity increased from mean 0,01 to 0,3.

Conclusion COMET combined with PK effectively improves ocular surface stability and quality of vision.
Comparative study of three exophthalmometers and computed tomographic biometry
Authors: DELMAS J , MARTIN S , LOUSTAU JM , BOURMAULT L , ADENIS JP , ROBERT PY
Published: August 2012

Purpose Accurate and reproducible exophthalmometry is recognized as having a great importance in the clinical setting. However many variations are described among the different commercially available exophthalmometers.

Methods In this prospective study, 3 exophthalmometers (Luedde’s, 2 mirrors Hertel’s, and 1 prism Mourits’ exophthalmometers) were compared to tomodensitometric biometry by 2 observers, for 60 patients. Data recorded were the external prebicanthal segment (EPBCS), the inter‐orbital distance (IOD) and the axial length of the globe (AL). Intraobservers and interobservers reproducibility were evaluated, using intraclass correlation coefficient (ICC) and Bland and Altman method.

Results Concerning agreement between EPBCS measurements and CT‐scan biometry, ICC for Luedde’s instrument was 0.59 and 0.64 respectively for the 2 observers, for Hertel’s exophthalmometer: 0.63 and 0.72 and for Mourits’exophthalmometer: 0.94 and 0.87. Intraobserver and interobservers reproduciblities were high, particularly for Mourits’ exophthalmometer, concerning EPBCS and IOD measurements. Moreover, Bland and Altman charts showed that Luedde’s instrument induced underestimation of the readings, Hertel’s exophthalmometer overestimated small values and underestimated high values, and Mourits’ exophthalmometer slightly underestimated the readings compared to CT‐scan biometry.

Conclusion We showed a greater accuracy with 1 prism Mourits’ exophthalmometer, whereas Luedde’s instrument has a moderate agreement with CT‐scan biometry and Hertel’s exophthalmometer intermediate results. Intra‐ and interobservers reliability were good. International selection of reliable exophthalmometers should be defined for clinical practice and studies.
Vincristine‐induced unilateral ptosis
Authors: BATTA B , TRECHOT F , GEORGE JL , ANGIOI K
Published: August 2012

Purpose To report the ocurrence of an unilateral ptosis in a 2‐year‐old girl treated by vincristine for a vaginal rhabdomyosarcoma.

Methods Our young patient developed a vaginal rhabdomyosarcoma and had been treated by chemotherapy (Ifosfamide‐Vincristine‐Actinomycine) when an unilateral ptosis occurred 7 days after the fifth vincristine dose (1.5 mg/m2). At that time, cumulative vincristine dose was 4.50 mg. Neither oculomotor dysfunction nor anisocoria were present. Neurological and systemic examinations were otherwise unremarkable. Laboratory testing and thoracic‐cervical‐cranial scan were normal. Other causes of ptosis were excluded. Despite vincristine dose was reduced by a third, ptosis slightly increased after the 2 subsequent injections but decreased between cures. Ptosis disappeared at day 78 and no recurrence was noticed after the treatment continuation at the same dose.

Results Neurotoxicity is a well‐known complication of vincaalkaloids. Bilateral ptosis is relatively common but reported cases of vincristine‐induced unilateral ptosis are infrequent. In our young patient, occurrence of the ptosis during treatment, increase during new infusions of vincristine and exclusion of other aetiologies are forceful arguments to consider the role of vincristine in this side effect. The use of pyridoxine or pyridostigmine were suggested to treat vincristine‐induced cranial neuropathies but to date, the benefit remains unproved. Adaptation of treatment regimen must be done. In our case dose reduction allowed disappearance of the ptosis.

Conclusion Even if unilateral ptosis is rare among vincristine‐induced neurological complications, ophthalmologists must be aware of this diagnosis.
Jugular venous thrombosis secondary to idiopathic myelofibrosis: a rare cause of bilateral papilledema
Authors: MATEO J , JIMENEZ B , ASCASO F , LAVILLA L , PEIRO C , IBANEZ J
Published: August 2012

Purpose Idiopathic myelofibrosis is a chronic myeloproliferative disorder in which the bone marrow is progressively substituted by connective fibrous tissue.This is due to an increase of the fibroblast growth factor, produced by the megakaryocytes.Among its signs and symptoms, we can find extramedullary hematopoiesis with hepatosplenomegally, anemia, weight loss, bone pain, infections or coagulopathy.Bone marrow biopsy shows different degrees of fibrosis and nests of megakaryocytes.Patients receive mainly symptomatic treatment and,sometimes,chemotherapy.

Methods We present the case of a 65‐year‐old woman diagnosed with idiopathic myelofibrosis.She complained of bilateral loss of vision after suffering a right internal jugular vein thrombosis.Her best corrected visual acuity was 20/40 in the right eye and 20/200 in the left eye.She developed a severe bilateral papilledema and macular edema, as well as retinal hemorrhages and peripapillary cotton wool spots.

Results The patient was treated with systemic steroids and anti‐platelet therapy, showing great improvement, with a final visual acuity of 20/25 in the right eye and 20/30 in the left eye.The macular edema was recovered, along with the visual fields.The papilledema was significantly reduced after the treatment.She is now being treated with heparin and her visual acuity remains stable.

Conclusion Jugular thrombosis is an uncommon cause of papilledema. Idiopathic myelofibrosis often causes platelet disorders which may lead either to thrombosis or easy bleeding.Ophthalmologists should be aware of internal jugular vein thrombosis as a possible cause of bilateral papilledema in patients suffering from diseases that can cause blood coagulation abnormalities.
Contribution of MRI in cases of isolated mydriasis: description of neurovascular conflicts.
Authors: TRECHOT F , BRAUN M , CLOCHE V , ANGIOI K
Published: August 2012

Purpose To study the contribution of MRI (sequence FIESTA) in the analysis of isolated and persistant mydriasis.

Methods Prospective single center study (November 2010 to March 2012) including patients with unilateral mydriasis (pure intrinsic Cranial Nerve III palsy) without life‐threatening pathology. Complete ophthalmological, systemic and neurological examinations were performed. All patients with any symptoms of extrinsic CN III palsy (diplopia, ptosis or ophthalmoplegia), with tonic pupil (pilocarpine diluted test positive), use of toxic or drug taking, sign of focus at neurological examination have been excluded. Our patients underwent cerebral MRI: images acquisition were performed on a GE 3T MRI, protocol included FIESTA and 3D TOF sequences.

Results Five patients were included (20 to 41 years), 2 women. They presented with a single non reactive, isolated and persistent mydriasis with a pilocarpine diluted‐test negative. For all, an obvious relationship between CN III and its adjacent Posterior Comunicating Artery (PCA) was demonstrated through FIESTA sequences with MPR images (3 real neurovascular conflicts in Root Entry Zone, 1 before cavernous sinus, 1 compression between PCA and dorsum selae). No saccular aneuvrysm or tumors were found.

Conclusion Thanks to MRI, we explained the symptoms for all the five patients, because of anatomical features, including neurovascular conflicts. If it has been described previously for facial and trigeminal nerves, no neurovascular conflict between CN III and PCA has been demonstrated before. The contribution of MRI in the study of anisocoria seems to be considered, and could help for diagnostic of a pathology tagged idiopathic.
Retina thickness measurements provide a sensitive and specific diagnostic tool in Parkinson’s disease
Authors: GARCIA MARTIN E , BAMBO M , PRIETO E , DE LA MATA G , FERNANDEZ‐PEREZ S , SATUE M , IDOIPE M , FUERTES I , OTIN S , ALARCIA R , ROCHE JC , SERAL M , POLO V , LARROSA JM , PABLO L
Published: August 2012

Purpose To test the diagnostic ability of optical coherence tomography (OCT) for the detection of Parkinson’s disease (PD). Retinal thickness depends in part on the retinal pigment epithelium, one of the principal tissues producing levodopa.

Methods PD patients (n=111) and healthy subjects (n=200) were enrolled. The Axonal application of the Spectralis OCT was used to obtain the circumpapillary RNFL thickness and retinal measurements in each participant. Two linear discriminant functions (LDF) were developed, one using RNFL parameters and another LDF using retinal thickness. A validating set (120 eyes from healthy individuals and 66 eyes from PD patients) was used to test the performance of both LDFs in an independent population. Receiver operating characteristic (ROC) curves were plotted and compared between both LDFs and with the standard parameters provided by OCT. Sensitivity and specificity were used to evaluate diagnostic performance.

Results The Retinal LDF combines only retinal parameters and provided the best performance: 31.1 + 0.02 x Temporal Outer ‐ 0.2 x Superior Outer + 0.16 x Nasal Outer ‐ 0.2 x Inferior Outer ‐ 0.06 x Superior Inner + 0.05 x Foveal thickness. The largest areas under ROC curve were 0.902 for Retinal LDF and 0.845 for RNFL LDF. At 95% fixed specificity, the Retinal LDF yielded the highest sensitivity values.

Conclusion Measurements of retinal thickness obtained with Spectralis OCT had a very good ability to differentiate between healthy and PD individuals. Based on the area under the ROC curve, the Retinal LDF performed better than any single parameter or diagnostic test used for PD.
Retinal circulation and intracranial pressure in idiopathic intracranial hypertension
Authors: PIERRU A , VIGNAL C , GENEVOIS O , PAQUES M
Published: August 2012

Purpose Idiopathic Intracranial Hypertension (IIH) is associated with moderate to severe papilledema (PE). Cases of central retinal vein oclusion identified in IIH suggest that PE can obstruct venous flow. The aim of this study was to evaluate the effect of intracranial hypertension on venous circulation and to determine the correlation between vascular caliber and intracranial pressure level.

Methods In this retrospective multicenter study, we included 8 patients with newly diagnosed IIH. Fundus photography were performed before and after lumbar puncture at various time points. The images were aligned with i2k pro© software. Arterio‐veinous ratio (AVR) was measured by a dedicated software.

Results Immediately following lumbar puncture these was decrease of the diameter of the central retinal vein. In 4 patients, an associated decrease in venous tortuosity was observed. For all patients, AVR increased immediately after lumbar puncture. This was due to the combined effect of a decreased venous diameters and an increase of the arterial caliber.

Conclusion Venous diameters may be an interesting indicator of PE evolution. Fundus photography are a non‐invasive, convenient method to investigate and monitor IIH which may be useful in a variety of setting, including neurosurgery units. A prospective study is necessary to confirm these results.
Visual function improvement after idebenone therapy in Leber hereditary optic neuropathy
Authors: ORSSAUD C , ROBERT M , ROCHE O , DUFIER JL
Published: August 2012

Purpose There is still no therapy for patients with Leber hereditary optic neuropathy (LHON). Recent studies have confirmed the effectiveness of Idebenone for the treatment of specific groups of LHON patients. However, it is still unclear if this treatment can be interesting in all cases of LHON. We wanted to evaluate whether Idebenone therapy in association with vitamin B2 and vitamin C can modify the visual function in non selected LHON patients.

Methods A retrospective review of visual acuity and Goldmann visual field performed in patients referred to the ophthalmology clinic for LHON before and after a therapy with Idebenone (up to 270 mg/day), vitamin B2 and vitamin C.

Results Seventy five patients were included. Mean duration between LHON onset and inclusion was 36 months. Mean treatment duration was 25 months. Twenty seven per cent of patients presented visual improvement. A surface reduction of the central scotoma greater than 30 % was observed in 36.2 % of these patients.

Conclusion There is an effect of Idebenone therapy on visual function of LHON patients. Due to the delay between symptoms onset and beginning of the treatment, improvement does not seem to be due to habituation to low vision. However, Idebenone therapy is unable to correct visual disability in LHON population.
Analysis of changes in the macula and retinal nerve fiber layer by optical coherence tomography in patients with Alzheimer’s disease (AD)
Authors: CRUZ N , CASAS P , ASCASO F , CRISTOBAL JA , DEL BUEY MA , MINGUEZ E
Published: August 2012

Purpose To evaluate the usefulness of optical coherence tomography (OCT) in the diagnosis of Alzheimer’s disease(AD) Thickness is determined at the peripapillary RNFL and macular volume with OCT, in individuals suffering from AD and compared with a control group.

Methods Prospective study in 40 eyes of 20 patients with Alzheimer’s disease and 40 eyes of 20 controls, measuring the thickness of the peripapillary RNFL and macular volume with OCT.

Results The average thickness of RNFL in patients with Alzheimer’s disease was 65,28±11,55 microns (53,50 to 87,29), significantly decreased compared to control subjects, which was 107.1 ± 7, 2 microns (94.9 ‐128.8) (p = 0.0001. Mann‐Whitney U test.). Macular volume in patients with AD was 5.6 ± 0.3 mm 3 compared with control subjects: 7.0 ± 0.5 mm3. Peripapillary RNFL thickness evaluated in each of the separate quadrants (superior, inferior, nasal and temporal) is also statistically significantly decreased in patients with AD in connection with control subjects. However, the central foveal thickness (1 mm), thickness macular inner ring (3 mm) and macular volume were significantly higher in AD patients.

Conclusion The AD is the major cause of dementia in the world. Although the entorhinal cortex and hippocampal complex are best known as the sites of early pathology in AD, increasing evidence shows that the eye, particularly the retina, is also affected. The AD‐related changes in the retina are associated with degeneration and loss of neurons, reduction of the retinal nerve fibres, increase in optic disc cupping, retinal vascular tortusity and thinning, and visual functional impairment.
Neurotrophic keratopathy associated with congenital agenesis of the corpus callosum
Authors: HERRERO LATORRE R , GARCIA‐MARTIN E , DE LA MATA G , SATUE M , BAMBO MP , ARA M , EGEA MC , FERNANDEZ‐PEREZ S , PUEYO V
Published: August 2012

Purpose The corpus callosum (CC), with its central position in the cerebrum, has an essential role in relaying sensory, motor, and cognitive information from homologous brain regions across cerebral hemispheres. Corpus callosum agenesis (CCA) is a rare congenital malformation which is caused by an alteration in embryonic development.

Methods We report the case of a 3 year old child who was diagnosed of complete corpus callosum agenesis with a normal karyotype. The neurological findings were spastic tetraparesis with dystonia, several delayed psychomotor and epilepsy. In ophthalmology examination he presented esotropia, bilateral optic nerve hypoplasia, delayed visual evoked potential flash type and altered corneal sensibility in both eyes which is manifested clinically by recurrent corneal ulcers and epithelial disruption associated with stromal edema.

Results After Neurotrophic keratopathy suspected, treatment with autologous serum was decided and response to treatment was favorable in both eyes with closure of ulcers and good management of symptoms. CCA has also been described in association with other ocular abnormalities such as optic nerve hypoplasia, retinal detachments, cataracts, morning glory syndrome, iris and optic nerve colobomas, among many others.

Conclusion In all patients diagnosed with agenesis of the corpus callosum, the possible alteration of corneal sensitibility is a fact that will be suspected to perform early diagnosis and appropriate treatment and follow‐up.
Altered functional connectivity of primary visual cortex in adult comitant strabismus using resting‐functional mri
Authors: YAN X , LIN X , ZHOU Y , LIU Y , JIANG T
Published: August 2012

Purpose Strabismus is not only associated with an abnormal eye position, but also with abnormal eye movement and poor stereopsis, both of which may be associated with high brain function. The aim of this study was to examine the functional connectivity between primary visual cortex and other cortical areas during rest in normal subjects and patients with comitant strabismus using functional magnetic resonance imaging.

Methods Functional magnetic resonance imaging (fMRI) was carried out on ten patients with comitant exotropia and eleven well‐matched healthy subjects while all were in a resting state. The primary visual cortex was selected as the region of interest and the resting‐state functional connectivities of this area were analyzed.

Results Compared with normal controls, strabismic patients showed that left BA17 had decreased functional connectivity with the right parietal lobe, left middle frontal gyrus, left superior frontal gyrus and right cerebellum, while the functional connectivity of the right BA17 was decreased at the middle frontal gyri bilaterally and the left inferior frontal gyrus. Enhanced connectivity of right BA17 to the bilateral middle occipital gyrus was also identified.

Conclusion These data suggest that functional dysconnectivity between primary visual cortex and other cortical areas may exist in patients with comitant strabismus, and the abnormal connectivity may be associated with abnormal eye movement and loss of stereopsis.
Enigmatic reticulated filaments in subsurface granite
Authors: Miller A. Z. , Hernández‐Mariné M. , Jurado V. , Dionísio A. , Barquinha P. , Fortunato E. , Afonso M. J. , Chaminé H. I. , Saiz‐Jimenez C.
Published: August 2012

In the last few years, geomicrobiologists have focused their researches on the nature and origin of enigmatic reticulated filaments reported in modern and fossil samples from limestone caves and basalt lava tubes. Researchers have posed questions on these filaments concerning their nature, origin, chemistry, morphology, mode of formation and growth. A tentative microbial origin has been elusive since these filaments are found as hollow tubular sheaths and could not be affiliated to any known microorganism. We describe the presence of similar structures in a 16th century granite tunnel in Porto, Northwest Portugal. The reticulated filaments we identify exhibit fine geometry surface ornamentation formed by cross‐linked Mn‐rich nanofibres, surrounded by a large amount of extracellular polymeric substances. Within these Mn‐rich filaments we report for the first time the occurrence of microbial cells.
Short‐term results of laparoscopic surgery after preoperative chemoradiation for clinically staged T3 and T4 rectal cancer
Authors: Hotchi Masanori , Shimada Mitsuo , Kurita Nobuhiro , Iwata Takashi , Sato Hirohiko , Morimoto Shinya , Yoshikawa Kozo , Higashijima Jun , Miyatani Tomohiko , Mikami Chie , Kashihara Hideya
Published: August 2012

Introduction

The feasibility of laparoscopic surgery for clinically staged T3 and T4 rectal cancer has not been clearly defined specifically in cases following preoperative chemoradiation therapy (CRT). Our aim was to investigate the feasibility of laparoscopic surgery after preoperative CRT for clinically staged T3 and T4 rectal cancer.

Methods

Between May 2003 and June 2009, 57 patients (T3: n = 50, T4: n = 7) who underwent preoperative CRT for rectal cancer were identified. Forty‐three patients with laparoscopic surgery (Lap group) were compared with 14 patients who underwent open surgery (Open group). Perioperative data including postoperative morbidity were assessed between the two groups.

Results

All patients underwent complete laparoscopic operations, and none was converted to laparotomy. Operating time was longer in the Open group (331 vs 375 min, P < 0.01). Blood loss was lower in the Lap group (160 vs 316 mL, P < 0.01). Lymph node harvest and morbidity rate were similar in both groups. The distal tumor margin was negative in all patients. No patients had perioperative mortality associated with surgery after CRT.

Conclusion

Laparoscopic surgery after preoperative CRT is a feasible and a safe option for T3 and T4 rectal cancer compared to conventional open surgery.
HIV and dentistry in Australia: clinical and legal issues impacting on dental care
Authors: McLean AT , Wheeler EK , Cameron S , Baker D
Published: August 2012

The number of people in Australia living with HIV is growing. This reflects a consistent rate of new HIV infections combined with an increased life expectancy of people with HIV. Dentists are ideally positioned to identify, manage and treat HIV‐associated oral manifestations and have a responsibility to themselves and to their patients to be up‐to‐date with the evolving area of HIV and related issues. Those issues include medico‐legal implications associated with HIV diagnosis and treatment. This article provides a review of the current clinical and medico‐legal aspects of HIV in Australia. The oral manifestations of HIV can be divided into five categories: microbiological infections (fungal, bacterial and viral); oral neoplasms; neurological conditions; other oral conditions that may be associated with HIV infection; and oral conditions associated with HIV treatment. Current treatment options in the scope of general dental practice are outlined. Medico‐legal issues related to the management of patients with HIV are explored, including rights of the patient regarding disclosure of HIV status; an algorithm for the management of a patient with signs or symptoms indicating possible HIV infection, including referral pathways; and an algorithm for dealing with patient management and referral issues.
The importance of a thorough medical and pharmacological history before dental implant placement
Authors: Zadik Y , Abu‐Tair J , Yarom N , Zaharia B , Elad S
Published: August 2012

The risk of osteonecrosis in patients treated with bisphosphonates is well known and guidelines intended to prevent this complication have been established and accepted. Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a unique condition in which even past administration of medication may be of current and future relevance. We present a case of BRONJ in the maxilla after dental implant placement. The patient suffered from osteoporosis and had been treated with oral alendronate sodium in the past. However, the medication was stopped two years before implant placement, and the treating dentist was unaware of the patient’s past bisphosphonate use. Prevention of BRONJ is based on identifying at‐risk patients, and then avoiding or modifying dentoalveolar surgical procedures in these individuals. Nevertheless, there seems to be some difficulties identifying patients at risk. We present some of the challenges that impede thorough assessment of a patient’s medical background (review of systems) in the dental office, and suggest possible solutions.