bluuebunny/crossref_metadata_2025 huggingface dataset:
The reviewer: friend or foe?
Authors: PLEYER U
Published: December 2011

Abstract not provided
Cataract and glaucoma surgery, combined or consecutive, where do we stand?
Authors: SUNARIC MEGEVAND G
Published: December 2011

The surgical management of concomitant cataract and glaucoma, uncontrolled despite maximum tolerated medical therapy, may be consecutive or combined during the same surgical session. Combined procedures are more demanding techniques with potentially more complication but decrease durably the IOP and allow longer preservation of the visual field. However results in various studies using different surgical techniques give contradictory results and recommendations. During the course an analysis of the actual state of knowledge from the literature will be discussed in details covering the aspect of surgical techniques, efficacy in IOP lowering, visual function, quality of life as well as cost of these two different surgical approaches.
Combined approach, the yield of micro incisions for cataract surgery
Authors: BRON AM
Published: December 2011

Cataract extraction combined with glaucoma surgery remains controversial. Some authors advocate consecutive surgeries arguing that the expected lower inflammation will allow a better outcome of the filtering surgery. However it is well known that cataract extraction after a filter may impair the long term efficacy of glaucoma surgery. Conversely the combined approach is more convenient for the patient with one operation and generally a better visual result. However it is generally considered that the IOP‐lowering effect is less effective in combined procedures. Rather than opposing these two approaches, it is probable than according to the characteristics of the patient and the type and the stage of glaucoma, a consecutive or a combined surgery is more appropriate. Therefore the surgeon must be prepared to perform the two types of surgery. Micro incisions for cataract surgery (MICS) offer some substantial advantages vs conventional corneal incisions; a better tightness of the surgical wound allows a better control of IOP during the surgery. Therefore glaucoma surgeries (penetrating or not) are much easier to perform without changing your technique. In this presentation some surgical tips will be given in order to facilitate your combined procedures.
Staging: glaucoma first or cataract first?
Authors: ZEYEN T
Published: December 2011

A combined Phaco‐Trabeculectomy will often not have the same result as both procedures separately. The IOP lowering effect of a combined procedure is usually less than that of Trabeculectomy alone. Likewise, post‐operative fluctuations of the anterior chamber depth after a combined procedure will influence the post‐operative refraction, especially in the early post‐operative period and/or if additional procedures (e.g. needling) are necessary to rescue a failing bleb. Therefore, most surgeons will prefer to stage both procedures. Since cataract surgery might compromise an existing filtering bleb, it is recommended to perform Phaco first if the IOP is not too elevated. If the glaucoma is at risk to deteriorate in the short term, filtering surgery should be performed first. It is advisable to wait 6 months between the cataract and glaucoma surgery.
Role of 3.0 Tesla MRI in diagnosis and treatment planning of iridocilairy and choroidal melanocytic tumors
Authors: DE KEIZER RJW , RAZZAQ L , MARINKOVIC M , VERBIST B , VERSLUIS M , VAN DUINEN SG , LUYTEN GPM
Published: December 2011

Purpose To evaluate the role of 3 Tesla MRI in the diagnosis, measurement and treatment planning of choroidal and iridociliary melanoma and comparison of results with Ultrasound and histology to measure the accuracy of MRI.

Methods : Prospective analyses of consecutive 12 patients, four with iridociliary and eight having choroidal melanocytic tumors. All these patients had ultrasound (10MHz) or UBM (50MHz), 3 Tesla MRI and underwent primary enucleation. The enucleated eyes were examined for gross measurements and histopathology was done.

Results Iris/iridociliary melanocytic tumors showed that MRI was positive in two cases and comparable to UBM. In one case tumor was identifiable only on saggital sections while in one case of Leiomyoma MRI gave much details and enhancement patterns. For posterior tumors MRI was positive in all the eight cases and results were comparable to ultrasound and macroscopic pathology in six cases.

Conclusion 3 Tesla MRI showed comparable results to UBM /USG and macroscopic pathology in 80% of patients. MRI should be performed if clinical and USG are in doubt to get additional information for diagnosis of other melanocytic tumors. An important finding was that for iris‐iridociliary melanomas MRI saggital images should be used for interpretation.
Percentage of aberrant cells in uveal melanoma correlates with the patient’s prognosis
Authors: VAN DEN BOSCH T , VAN BEEK J , VAARWATER J , VERDIJK R , NAUS N , PARIDAENS D , DE KLEIN A , KILIC E
Published: December 2011

Purpose Uveal melanoma (UM) is the most common type of intra‐ocular malignancy in adults with an annual incidence of 5‐7 cases per million. Almost half of all patients with UM eventually die due to often late appearing metastases. Several clinical, pathological, and genetic factors have been identified as prognostic markers in UM. Non‐random chromosomal alterations for instance are present in over 80% of cases and complete loss of chromosome 3, (seen in 50% of all UM) relates to a 4‐year overall survival rate of only 30%.

Methods Fluorescence in situ hybridisation (FISH) can be used to evaluate aneuploidy in the tumour cells. This FISH technique enables an in situ analysis of exact number/ percentage of tumour cells displaying that particular chromosomal aberration. Tumour heterogeneity has been observed in UM and an obvious question is whether lower percentages of abnormal cells are related to a change in patient’s outcome or prognosis.

Results In this study, we assessed the percentages of aberrant tumour cells with FISH for each tumour (N=221) using chromosome 3 and 8 probes.

Conclusion For both anomalies we could demonstrate that a high percentage aberrant tumour cells correlate well with a significantly worse prognosis for the patient.

Commercial interest
Genetic and histological heterogeneity in uveal melanoma: a peculiar case
Authors: ANGI M , KALIRAI H , BAUDO MM , BIDDOLPH S , COUPLAND SE , DAMATO BE
Published: December 2011

Purpose Intratumour heterogeneity of uveal melanoma (UM) has become a relevant issue in the era of sampling for prognostication purposes. We present the case of a UM consisting of two very distinct components.

Methods A 53‐year‐old man was referred for an infero‐nasal, collar‐stud UM with associated retinal detachment in the right eye. On ultrasonography, the tumour measured 14 x 16mm, with a thickness of 11mm. The patient chose enucleation over other treatment options. The eye was examined morphologically, immunohistochemically and using multiplex ligation‐dependent probe amplification (MLPA).

Results Histological sections demonstrated two distinct components: a pale basal part consisting of amelanotic epithelioid melanoma cells with extensive diffuse involvement of the ocular structures. In contrast, the apical part was heavily pigmented comprised only of spindle B cells. Interestingly, MLPA demonstrated complete chromosome 3 loss in the apical (spindle) region but only partial chromosome 3 deletion in the basal (epithelioid) part. Both areas showed polysomy 8. Conversely, immunohistochemistry showed more aggressive features in the basal part rather than in the apical part.

Conclusion This case provides further evidence that there is heterogeneity in UM, and that a single intraocular biopsy may not be reliable for prognostication purposes.
An update on the use of the Boston Type 1 KPro outside the USA
Authors: LAKE D , ALDAVE T , BELIN M
Published: December 2011

Abstract not provided
An update on the collagen construct artificial cornea
Authors: MEHRDAD R , GRIFFITH M , FAGERHOLM P
Published: December 2011

Abstract not provided
Effect of SOCS1 overexpression on RPE cells activated by cytokines
Authors: BAZEWICZ M , MAKHOUL M , DRAGANOVA D , CHTARTO A , TENENBAUM L , EL MALEH V , CASPERS L , BRUYNS C , WILLERMAIN F
Published: December 2011

Purpose Retinal pigmented epithelium (RPE) cell activation by cytokines plays an important role in autoimmune uveitis development. The aim of this study was to investigate if Suppressors of Cytokine Signaling (SOCS1) overexpression in RPE cells can modulate this activation.

Methods SOCS clone and control clone were isolated after stable transfection of APRE‐19 with plasmids containing or not the SOCS1 gene. qRT‐PCR was used to measure SOCS1 mRNA expression. Clones were stimulated by IFNγ or/and TNFα. Membrane expression of MHCII and CD54 was measured by flow cytometry, IL‐8 secretion by ELISA and (P‐)STAT‐1 and IκBα expression by Western Blot.

Results We found a stable high expression of SOCS1 in the SOCS clone as compared to the control clone or native ARPE cells. This SOCS1 overexpression strongly decreased IFNγ‐mediated STAT‐1 phosphorylation, MHCII induction and CD54 upregulation. On the contrary, SOCS1 overexpression had no effect on TNFα‐mediated IκBα degradation, IL‐8 upregulation, but weakly inhibited CD54 upregulation. During simultaneous IFNγ and TNFα stimulation, SOCS1 overexpression canceled the inhibitory effect of IFNγ on TNFα‐induction of IL‐8 secretion.

Conclusion SOCS1 overexpression can block IFNγ but have almost no effect on TNFα activation of retinal pigmented epithelium cells. Those data suggest that SOCS1 overexpression might only affect certain cytokine pathways important in autoimmune uveitis development.
Demodex infestation in the normal population, blepharitis patients and among people who work with microscopes
Authors: UDZIELA M , SZAFLIK JP , GARBACEWICZ A , GRYTNER‐ZIECINA B , SZAFLIK J
Published: December 2011

Purpose Aim of the study was to estimate the prevalence of Demodex spp. infections of lid margin in Polish population

Methods 264 individuals were enrolled in the study. Patients were divided into four groups. First two groups consisted of young people (mean age 22 years) and seniors (mean age 66 years). The third group was made up of people who work with microscopes. Forth group consisted of patients with diagnosed blepharitis. From every individual 3‐4 lashes were epilated from upper and lower lid margin of each eye and examined under the microscope for Demodex mites.

Results The lowest number of infected individuals was observed in the young group‐ only 5%, the highest in blepharitis patients‐ 74% infected. Among microscope users (mean age 44 years) 30% were infected, in senior group (mean age 66 years) also 30% were infected.

Conclusion Demodex mites are etiological factors of blepharitis. There is a significant correlation between Demodex spp. infection and the age of the examined individual. People who work with microscopes are in a risk group for Demodex infection of lid margins.
General Pathophysiology
Authors: AUGUSTIN A
Published: December 2011

Macular edema represents a common final pathway of many intraocular and systemic diseases, which usually involve the retinal vessels. It typically occurs with painless impairment of visual acuity in one eye, but can also be bilateral, depending on the etiology. A macular edema is a nonspecific sign of many ocular disorders. Usually the symptoms progress slowly. Nevertheless, patients often may notice this entity suddenly – this is the case when they examine one eye separately. The appearance can differ with several subtypes existing, depending on the etiology. In this presentation the following mechanisms and problems of this non‐specific disease entity will be discussed: Unique construction of the blood‐retinal‐barrier und general possibilities of alteration. Inflammatory mediators with major focus on Angiotensin II, VEGF and Prostaglandins. Other cytokines and Chemokines as well as Matrix metalloproteinases. Sorbitol pathway and oxidation (Diabetes) – relation to inflammation. Mechanical issues (venous diseases). In addition it will be mentioned how this knowledge on pathophysiology translates into clinical praxis when we design treatment strategies for our patients.
Retinal Vein Occlusion
Authors: COSCAS G
Published: December 2011

Macular edema is a major complication of both ischemic and non ischemic Retinal vein occlusions (RVO). Fluorescein angiography (FA) is the most effective method to determine the presence of macular cystoid edema (CME), its extension, persistence, regression, the degree of ischemia (perfused or non‐perfused RVO). Spectral domain OCT (SD‐OCT) helps to quantify the changes in retinal thickness, the amount of CME, the presence of sub retinal fluid accumulation and precise analysis of the outer retinal layers, useful as a guide for treatment. According to the recent results of the SCORE Trial, Grid Laser photocoagulation remains the reference treatment for macular edema due to branch retinal vein occlusion (BRVO) but not recommended in Central RVO Recent prospective randomized trials strongly suggest an anti‐edematous effect of intravitreal steroids (particularly dexamethasone in a slow release device) and intravitreal anti‐VEGF drugs, that may at least temporarily reduce foveal edema and improve visual function. Surgical treatment modalities have been reported for RVOs with a positive action of vitrectomy; the combination with intravitreal steroids and/or tissue plasminogen activator could permit a more rapid and lasting action. Taking into consideration the recent advances in diagnostic tools and management options, recent European practical recommendations and Guidelines, prepared by a collaborative group of retina specialists, are presented to provide the ophthalmologists with guidelines for the clinical approach of RVO.
Macular edema of choroidal origin
Authors: SOUBRANE G
Published: December 2011

Age‐related macular degeneration (AMD) is the result of an advanced alteration of the choriocapillaris and/or the retinal pigment epithelium (RPE), and/or the photoreceptor (PR) layers. The neural retina is only partially involved, and additional pathways are required for the development of edema within the retina. The exudative form of AMD is due to choroidal neovascularization (CNV) that causes a serous detachment of the neurosensory retina which development and importance depends on the activity of the new vessels. Edema involving the outer and ultimately the inner retina develops progressively. The presence of cystoid macular edema is more likely if the retinal serous detachment is long‐standing and if the choroidal neovascular membrane has involved most of the subfoveal region. The classic clinical definition of macular edema is an accumulation of serous fluid within the neuro sensory retina increasing thickness of the central retina. However in exudative AMD, the leakage of fluid from the choroidal new vessels may be the origin of fluid collection underneath and within the neuro sensory retina. The normal choriocapillaris leaks on the side facing the RPE in order to assure the nutrition of the photoreceptors. CNV being of choroidal origin presents the same structure histologically as the choriocapillaris. In AMD, the associated inflammatory reactions induce the rupture of the external retinal blood barrier and leads to an exudation within the subretinal space. In addition, after prolonged detachment, the retinal capillaries may become damaged and contribute to the leakage of dye into the extracellular compartment of the retina. The consequent damage of the outer retinal layers determines alterations of the overlying (and underlying) tissues. Several inflammatory mediators and inflammatory cells are likely the key signals, that initiate secretion of numerous cytokines one being vascular permeability factor, referred to as vascular endothelial growth factor (VEGF), present at the site of the angiogenic stimulus. All these factors interact in a complex chain reaction, which is not yet completely understood.
Postsurgical cystoid macular edema
Authors: LOEWENSTEIN A
Published: December 2011

Purpose Cystoid macular edema (CME) is a major cause of reduced vision following cataract and vitreoretinal surgery, with a reported incidence of 0.1‐ 2.35%. Intraretinal accumulation of fluid determines the formation of perifoveal cysts, which may combine and give rise to lamellar holes. The etiology of CME is not completely clarified. Risk factors, among which preexisting ocular (uveitis, retinal vein occlusion, epiretinal membrane) and systemic conditions (diabetes mellitus, systemic hypertension) as well as intraoperative complications can raise the risk of developing CME postoperatively. Modern surgical techniques have reduced the incidence of CME.

Methods Pseudophakic CME is characterized by poor postoperative visual acuity. Onset of clinically significant CME is generally 4‐12 weeks after surgery (peak at 4‐6 weeks). Fluorescein angiography (FA) is indispensable in the workup of CME, showing the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography (OCT) reveals cystic spaces in the outer nuclear layer. Differential diagnosis with FA and biomicroscopy is crucial for postsurgical CME management.

Results Most cases of pseudophakic CME resolve spontaneously. Available therapeutic interventions, for both prophylaxis and treatment of CME, are based on pathogenesis theories. The value of prophylactic treatment is doubtful, especially long‐term postoperatively. First‐line treatment should include topical nonsteroidal anti‐inflammatory drugs (NSAIDs ) and corticosteroids, with best results for acute postsurgical CME. In cases of resistant CME, periocular or intraocular corticosteroids represent an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options such as laser vitreolysis or vitrectomy should be reserved for special cases.
Quantifying end‐stage electrophysiological function in progressive retinal degenerative disorders (PRDD)
Authors: LACHAPELLE P , GAUVIN M , TRANG N , LINA JM , RACINE J
Published: December 2011

Purpose PRDD, such as Retinitis Pigmentosa, are accompanied with a gradual reduction of ERG signal to non‐measurable amplitudes. We compared alternative means of quantifying normal and pathological ERGs.

Methods Photopic ERGs (DTL electrode, background 30 cd.m‐2; flash stimuli: ‐2.62 to 0.64 log cd.sec.m‐2 in 17 steps of ~ ‐0.2 log‐unit) were recorded from 85 normal subjects and 55 patients with PRDD. In a subset of 6 normal subjects, focal ERGs (fERGs) were obtained with the use of a eye patch to restrict the stimulus centrally and at 20o or 40o nasally. ERG descriptors, obtained with Direct Wavelet Transform D(WT) of the ERGs, were compared to the traditional amplitude measurements.

Results In normal, the ERG amplitude gradually decreased from 131.42±31.27µV (Vmax) to 0.71±0.12 µV (dimmest flash used) in two distinct pseudo‐asymptotical steps of ‐15.2±2.0µV.s (step 1) and ‐0.42±0.1µV.s per decrement respectively (9 steps each). Pathological ERGs as well as normal focal ERGs could always be fitted to this model. Furthermore, while the traditional measurements frequently failed to quantify residual ERGs, including the normal fERGs, the DWT was always able to extract quantifiable and comparable information from the residual response, thus permitting a more favourable prognosis.

Conclusion Analysis of the ERG response in the time and frequency domain (such as DWT) allows for a more precise quantification of the ERG signal especially when it reaches residual amplitudes such as that observed in end‐stage PRDD. Our results suggest that modeling ERG attenuation with the DWT improves the staging and prognosis of patients affected with severe PRDD. Supported by FFB (USA).
Clinical significance of red target increment perimetry
Authors: KRASTEL H , BEUTELSPACHER SC , ENGLER CH , KAHLERT CH , JONAS JB , JAGLE H
Published: December 2011

Purpose To elucidate the significance of red target increment perimetry in diagnostic and occupational assessment

Methods Red target increment perimetry does not rely on color discrimination but merely on red target detection on a white background. In a retrospective study, ten exemplary cases of congenital and acquired color vision deficiencies are evaluated by kinetic, static and microperimetric techniques

Results Daltonism: Red brightness loss is common to protan observers. In marked protanomaly and protanopia severe constriction of red target field is a rule; i.e. within the peripheral visual field of protan observers red objects may remain entirely undetected. Female carriers of protan defects: Red target fields may show constriction to variable extent, but less pronounced than in male protan observers. Rod monochromacy: Since rhodopsin is virtually unable to absorb red light, red target fields are entirely lacking. Stargardt’s disease and cone dystrophies: Red target fields are affected earlier and more pronounced than standard white fields. Central serous retinopathy: Red desaturation and red brightness loss are common findings on confrontation testing. Scotomas are detected on microperimetry by red targets while white stimuli still fail to pick up pathology. CAR: Cancer associated retinopathy: Compared to RP, in CAR the cone system shows more involvement. CAR scotomas show up more distinctly in red than in white perimetry.

Conclusion In congenital protan defects, red target increment fields have a significant bearing on occupational demands. In various retinal diseases, field defects for red target increments exceed those for white targets and so, may contribute to early diagnosis.
The Optical Integration technique for the measurement of light scatter in the human eye
Authors: GINIS H , PEREZ G , BUENO J , ARTAL P
Published: December 2011

Purpose To develop and demonstrate a new optical technique for the measurement of light scatter in the human eye based on extended source imaging in a double pass configuration.

Methods The experimental setup is based on a double‐pass (DP) configuration. Series of disks of uniform radiance having angular dimensions ranging from 0 to 9.1 degrees (radius) are projected on to the eye's retina and DP images are recorded by a cooled electron‐multiplied CCD camera. Two spatially separated sub‐apertures at the pupil are used for stimulus projection and imaging to minimise back‐scatter and reflections. The derivative of the intensity of each recorded disk with respect to disk radius (in angular units) was fitted to a mathematical model of the wide‐angle double pass point‐spread function (PSF) and from that the underlying single‐pass PSF was computed. The setup was first validated using artificial eyes with known scattering properties and used in a group of normal human eyes.

Results The derivative of central disk intensity with respect to disk radius was measurable up to the complete range of the angular dimensions of the projected disks (9.1 degrees of visual field). Different features can be obtained from the estimated PSF to characterize not only the amount of scatter but also its angular dependence.

Conclusion A new optical method to measure scatter in the eye was developed and demonstrated. The procedure is sensitive enough to consistently detect differences in the light scatter intensity between normal healthy eyes and can be a significant step towards the complete optical characterization of the eye.
Intracorneal lenses using femtosecond laser for the treatment of presbyopia
Authors: PALLIKARIS IG , BOUZOUKIS D , LIMNOPOULOU A , PANAGOPOULOU S , PALLIKARIS AI , KYMIONIS G
Published: December 2011

Purpose To investigate the visual outcomes and safety of an Intracorneal lens (Presbia, Presbitech, CA, USA) for the treatment of presbyopia using femtosecond laser (Intralase, AMO, Irvine, CA,160 KHz).

Methods An intracorneal tunnel was created in the non‐dominant eye of 15 patients using femtosecond laser. Mean age was 51, 32 ± 3,1. Follow‐up was 6 months.

Results Mean uncorrected visual acuity for distance preoperatively, one day, 1 week, 1 month, 3 months, and 6 months after surgery was 20/20, 20/40, 20/40, 20/32, 20/32,20/30 respectively, whereas for near was 20/50, 20/32, 20/30, 20/25, 20/25, 20/25. No intra‐ or post‐operative complications were found.

Conclusion Intracorneal lenses for presbyopia seem to be a safe and effective method in patients aged between 45 to 60 years old.

Commercial interest
ElVisWeb: An interactive web‐application for the visualzation of ERG recordings based on the Electrophysiology of Vision Markup Language
Authors: STRASSER T , GOLDINA A , LANG S , LOTTER M , ODER M , OSTERTAG T , ULRICH M , WALTER M , YILDIZ D , PETERS T , ZRENNER E
Published: December 2011

Purpose Recently, we proposed a standard for the exchange of electrophysiological recordings of vision, called Electrophysiology of Vision Markup Language (ElVisML). Here we present a Web 2.0 application, ElVisWeb, for visualizing data encoded in ElVisML. It intends to facilitate the exchange of recordings on mailing lists like CEVNet in a standardized way and to allow for sharing of data along with published articles.

Methods Main goals of ElVisWeb were easy usage and deployment. It is developed completely in JavaScript and as web application it does not require any installation on the client. It uses the single‐page‐interface paradigm (SPI): An ElVisML‐file can be pasted into a text‐field and a graphical representation of it is compiled. ElVisWeb can be deployed on any web‐server or executed locally. For convenience, there is an upload functionality, which requires PHP on the server, however. ElVisWeb leverages open source JavaScript libraries for XML‐processing (http://dev.abiss.gr/sarissa) and charts generation (http://www.jqplot.com).

Results A Web 2.0 application for visualization of electrophysiological recordings of vision, ElVisWeb, was successfully implemented. It is designed for easy usage and deployment. Recordings encoded in ElVisML can be visualized with no additional software installation.

Conclusion ElVisML is a standardized way for exchanging electrophysiological data. ElVisWeb is a first step towards an open ecosystem around ElVisML. It provides chart generation for recordings and may be used in mailing lists like CEVNet or for sharing data along with published articles. It is also ready to be used on mobile devices.
Accommodative IOL' s and Pseudo Accommodation
Authors: PALLIKARIS IG
Published: December 2011

Purpose To analyze the existing lenses designs, properties as well as the new intraocular lens technology in the field of accommodative IOLs.Moreover, to distinguish the difference between accommodation and pseudoaccommodation.

Methods The restoration of near vision in elder individuals that have entered the presbyopic age is considered one of the major challenges in refractive surgery during the last decade. Accommodative IOLs offer to patients satisfactory near vision by restoring to some degree the dynamic component of the ocular ability for near vision. By implementing several designs of the haptic and the optic part of the IOL, the target is to take advantage of the movement of the ciliary muscle and of the vitreous in order to change position and shape. This offers a change of the overall dioptric power of the eye and the facilitation of near vision.

Results Pseudophakic patients’ ability for good distance and near visual acuity without correction has been characterized as apparent accommodation, or pseudoaccommodation. It has been attributed to several factors such as the pupil size, total and corneal aberrations, degrees and axis of astigmatism, potential of visual perception and axial movement of the intraocular lens.the i‐Trace technology has an important role in the evaluation of accommodation and pseudoaccommodation in pseudophakic eyes not only subjectively but optically.

Conclusion Accommodative IOLs represent the future in the battle for the correction of presbyopia and restoration of near vision.
Experimental femtosecond laser lens surgery
Authors: BARRAQUER RI , LOZA‐ALVAREZ P , OLARTE OE , MERINO D , MONTENEGRO G , MICHAEL R
Published: December 2011

Purpose To review the current developments and new experimental applications of femtosecond lasers (FsL) in lens surgery, including cataract and the treatment of presbyopia. FsL lentotomy has been shown effective to soften the lens matter easing cataract extraction. Because the main cause for presbyopia is the stiffening of the lens nucleus with age, FsL lentotomy could be applied to treat it, provided the cuts inside the lens do not induce a significant opacity.

Methods Commercial FsL lasers systems for cataract surgery are already available, using repetition rates of 100 kHz at 1041 nm, similar to those of corneal FsL. We have developed a custom build multimodal non‐linear microscopy platform modified to work as a nano‐surgery scalpel using a FsL with a repetition rate of 80 MHz at 860 nm. This allows cutting inside the lens matter at a much smaller scale than the current lens surgical FsL systems.

Results Using a single FsL system, we imprinted complex patterns in 2D and 3D configurations inside human donor lenses. These results were analyzed through transmitted infrared light and Two‐Photon Excitation Fluorescence (TPEF) microscopy. We observed an increase of the TPEF signal on the targeted regions. In addition, we found that the caused damage is highly confined without any apparent effect on the surrounding tissue.

Conclusion While current FsL lentotomy systems can soften the lens nucleus to ease cataract extraction, optical quality at the optical axis is compromised. Experimental FsL with modified parameters is able to further confine the damage in order to preserve the lens clarity, a requirement for FsL lens presbyopia surgery.
Slowly progressive corneal opacification in a patient with known mucocutaneous Leishmaniasis and HIV
Authors: VAN OS L
Published: December 2011

Purpose To present a case of corneal opacification and anterior uveitis in a patient with systemic Leishmaniasis

Methods Case report

Results A 40‐year old HIV‐positive patient was already followed for conjunctival involvement in systemic Leishmaniasis. Treatment with Glucantime was effective, but had to be stopped because of acute pancreatitis. A switch to Ambisome was made, but did not result in complete resolution. Slow appearance of corneal stromal opacities was also noted at this time. In January 2011 the patient consulted in emergency and was diagnosed with bilateral acute anterior uveitis as well as manifest progression of the stromal opacification. Regarding the inflammation, a good initial response was obtained with topical prednisolone acetate. However, a slumbering reaction remained present in the anterior chamber and an increase of the keratic precipitates was noted. On tapering of the steroids, several relapses occurred. The intrastromal opacities were still increasing, resulting in worsening visual acuity. An in‐vivo confocal microscopy of the cornea was performed and showed presence of cystic structures in the stroma, possibly related to intracorneal presence of the parasite. Because of insufficient response of the anterior chamber reaction to topical steroids, anterior chamber tap was performed and PCR showed positive for Leishmania. A tentative treatment with intrastromal and intracameral injection of Amphotericin B was initiated.

Conclusion We report an atypical ocular presentation of Leishmaniasis, with proven presence of the organism in the aqueous humor, and presence of the cystic structures on in‐vivo confocal microscopy. A tentative treatment with intrastromal and intracameral injection of Amphotericin B was initiated.
Evaluation of the corneal pachymetry and biomechanical parameters changes in patients treated by prostaglandins topical medication
Authors: VANTOMME M , POURJAVAN S , DETRY‐MOREL M
Published: December 2011

Purpose To assess the possible corneal changes after topical prostoglandins treatment.

Methods Prospective study including 15 patients newly diagnosed with OHT or POAG needed to be treated. The patients had complete basic ophthalmological examination before treatment (D0). IOP was measured with Goldmann aplanation tonometer, Pascal contour tonometry and ocular response analysis (ORA). The corneal biomechanical parameters, CRF and CH were measured as well with ORA. Axiale length and the anterior chamber depth were measured using IOL master. The pachymetry was performed using an ultrasound pachymeter. These examinations were repeated on D42 and D90. Anova test for repeated measurements was used for statistical analysis

Results The mean CCT was 552.6 ± 30 µ on D0, 548.8 ± 32 µ on D42 and 542.6 ± 31µ on D90. There was a significant difference between the CCT measurements on D0 and D90 (p= 0.006). The mean CRF on D0, D42 and D90 was: 11.8 ± 2.3 mmHg, 10.6 ± 1.7 mmHg and 10.7 ± 1.8 mmHg respectively. There were no significant differences between these values. The mean CH on D0, D42 and D90 was: 8.8 ± 2.1 mmHg, 9.6 ± 1.6 mmHg and 10 ± 2 mmHg respectively. There were no significant differences between these values.

Conclusion In this study we found a significant decrease of CCT after topical prostaglandins treatment. We didn’t find any significant change in corneal biomechanic parameters after treatment.
Anterior segment optical coherence tomography changes post laser peripheral iridotomy in primary angle closure suspects in an Asian population
Authors: HOW A , AUNG T
Published: December 2011

Purpose Multiple modalities have been used to image the anterior chamber angle. We quantified changes in novel parameters associated with angle closure, namely anterior chamber area (ACA) and volume (ACV); anterior chamber width (ACW); lens vault (LV) and iris thickness, area and curvature using ASOCT, in a cohort of primary angle closure suspects (PACS) after laser peripheral iridotomy (LPI).

Methods A prospective study of primary angle closure suspects > 50 years of age after LPI. ASOCT images (Visante, Carl Zeiss Meditec, Dublin, CA) from 176 subjects were analyzed quantitatively using customized software, before and 1 week after LPI.

Results The mean age of the 176 participants was 63.0 ± 7.3 year and majority of the subjects were Chinese (95.5%) and women (76.7%). After LPI, the angle width opened significantly with increase in mean angle opening distance [AOD 500, 0.11 vs. 0.18 mm, p< 0.001), trabecular iris surface area (TISA500, 0.06 vs. 0.08 mm², p< 0.001) and angle recess area (ARA, 0.12 vs. 0.17 mm², p< 0.001). Mean ACA (14.9 vs. 16.0 mm², p< 0.001) and ACV (91.6 vs. 103.0 mm³, p< 0.001) increased significantly after LPI, but there was no change in ACW (11.21 vs. 11.24 mm, p = 0.3), anterior chamber depth (2.16 vs. 2.17 mm, p = 0.16) or LV (783.6 vs. 788.6µm, p = 0.72). Mean iris curvature was reduced (0.375 vs. 0.180 mm, p< 0.001) after LPI, but there was no significant change in iris thickness or area.

Conclusion LPI results in a significant increase in the angle width in subjects with narrow angles. ACA and ACV increased after LPI but there was no change in ACD, ACW, LV or iris thickness and area. The increase in ACA/ACV is attributed to be due to decreased iris curvature after LPI.
PCR‐based circulating melanoma cells detection in uveal melanoma
Authors: PARROZZANI R , PILOTTO E , DARIO A , MIGLIONICO G , MIDENA E
Published: December 2011

Purpose to investigate the presence of circulating melanoma cells (CMCs) in patients affected by posterior uveal melanoma in different stages of the disease and to determine their prognostic relevance.

Methods Blood samples from 14 healthy donors and 23 patients affected by posterior uveal melanoma were collected. Fourteen patients were included at the time of initial treatment without any evidence of metastatic disease using liver ultrasonography and Pet‐CT (non‐metastatic group). Nine patients were included at time of initial treatment of liver metastasis (metastatic group). mRNA expression of tyrosinase, MelanA/MART1 and GP100 as a surrogate marker for the presence of CMCs was analyzed by real‐time RT‐PCR and compared with patient characteristics.

Results There was no significant difference on tyrosinase, MelanA/MART1 and GP100 levels between healthy donors and uveal melanoma patients (p>0.05). There was also no significant difference between non‐metastatic vs metastatic group (p>0.05). High levels of tyrosinase, MelanA/MART1 and GP100 in non‐metastatic patients were not related to the development of metastasis in a median follow‐up time of 24 months (p>0.05).

Conclusion PCR‐based detection of tyrosinase, MelanA/MART1 and GP100 in uveal melanoma patients appear unrelated with presence/absence of the disease and with the disease stage.
Verteporfin photodynamic therapy of retinal optic disc haemangioma
Authors: HEIMANN H , KENAWY N , DAMATO BE
Published: December 2011

Purpose Retinal optic disc haemangioma are difficult to manage. Observation as well as therapeutical interventions may result in irreversible visual loss. We investigated verteporfin photodynamic therapy (PDT) as the initial treatment method for these tumours.

Methods Retrospective review of patients with optic disc haemangioma not associated with v. Hippel‐Lindau disease and a minimum follow‐up of 1 year.

Results Between January 2009 and June 2010, we treated three patients with PDT and standard parameters as the initial intervention. All patients presented with symptomatic visual loss caused by macular oedema. In a 67‐year‐old female patient, complete regression could be achieved with a single PDT after 14m follow‐up. Best corrected visual acuity (BCVA) improved from 6/60 to 6/18. In a 55‐year‐old male patient, no regression of the angioma could be induced despite 5 consecutive PDT sessions. After a 24m follow‐up, BCVA decreased from 6/9 to counting fingers. In a 24‐year‐old female patient, a single PDT induced complete regression and BCVA improved from 6/12 to 6/9 over 12m. The treatment was initially complicated by a shutdown of the choroidal perfusion with temporary visual loss immediately following the PDT.

Conclusion In this small series, treatment response of optic disc haemangioma to PDT varied significantly between cases. A complete regression of two angiomas as well as no visible reaction to PDT in a third case could be observed. Alternative treatment modalities should be employed if the haemangioma does not respond to the initial treatment cycles and is complicated by progression of the disease.
Meganuclease targeting herpes simplex virus protects against viral endothelitis : An organ culture model
Authors: CHAPELLIER BC , LABETOULLE M , ARNOULD S , SMITH J , SAHEL JA , GABISON EE
Published: December 2011

Purpose Despite advances in antiviral therapies, past history of HSV keratitis is associated with poor prognosis of subsequent penetrating keratoplasty.The aim of this study is to assess the antiviral property of a meganuclease targeting HSV in the prevention of HSV endothelitis.

Methods Normal rabbit corneas were placed in organ culture using an immersion method and transduced by a recombinant adeno‐associated virus (rAAV) allowing constitutive expression of meganucleases targeting HSV‐1 genome or containing the same expression cassette with a non‐coding sequence. These organs were then submitted to infection by recombinant HSV‐1 F(1) virus equipped with a LacZ expressing cassette at M.O.I. 0.001 to 0.1% in liquid or semi‐solid medium. Infection rates for plaques or cells in endothelium were established by immunostaining of envelope protein gD or X‐gal staining after the end of first or second lytic cycle.

Results Meganuclease targeting the ICP0 gene which encodes an E3 ubiquitin ligase involved in viral reactivation and replication did not change infection rates in the present organ culture model, but reduced the average size of plaques in endothelium with a decrease of 27‐46%. Conversely, the meganuclease directed against the major capsid protein UL19 lowered the number and size of plaques, both being reduced by half at M.O.I. 0.001%. Consequently, the expression of a meganuclease in endothelium, evidenced by RT‐PCR, could either reduce infectious particle production or induce cell resistance to HSV‐1.

Conclusion These meganucleases are currently checked for their anti‐infective properties in an in vivo model of endothelitis.
Cultivated oral mucosa epithelium transplantation (COMET) in bilateral limbal stem cell deficiency
Authors: DOBROWOLSKI D , WYLEGALA E , WOWRA B , ORZECHOWSKA‐WYLEGALA B
Published: December 2011

Purpose To present results of COMET technique in corneal surface reconstruction in bilateral limbal stem cell deficiency.

Methods Study group: 13 patients (17 eyes) suffering from limbal stem cell deficiency (LSCD) after chemical burns (7 eyes) or from aniridia related LSCD (10 eyes). Preoperative vision was ranged from hand movements to 0,05. Oral mucosa epithelium was collected and tripsinized. Single cells were seeded on denuded amniotic membrane. Cultures were carried in standard conditions in supplemented DMEM HAM/F12 mixture medium in presence of inactivated 3T3 fibroblasts for 8 days. Histologic examination and immunostaining for epithelial cytokeratins confirmed epithelial origin before transplantation. After superficial keratectomy carries with stratified epithelium were transplanted on the denuded corneas. Corneal surface stability was evaluated as well as visual outcomes.

Results Postoperative follow‐up ranged from 6 to 12 months. 6 months after surgery 76,4 % of eyes showed stabile epithelium. In 23,5 % of eyes corneas reminded cloudy due to recurrent conjuctival neovascularization or stromal haze. All failed grafts were from ocular burns patients group. Visual acuity ranged from hand movement to 0.4.

Conclusion COMET is a new method for bilateral corneal epithelial disorders offering the patient satisfactory stabilization of the corneal surface.
Topical application of autologous adipose‐derived mesenchymal stem cells (AdMSCs) for persistent sterile corneal epithelial defect
Authors: AGOROGIANNIS GI , KYMIONIS G , ALEXAKI VI , CASTANA O , CASTANAS E , PALLIKARIS IG
Published: December 2011

Purpose To report a patient with post‐traumatic persistent sterile corneal epithelial defect treated with topical application of autologous AdMSCs.

Methods A 35‐yr‐old man was referred to our clinic for treatment of post‐traumatic persistent corneal epithelial defect previously treated as infection. 1 yr before CxL was performed for keratoconus stabilization. Examination showed a central corneal epithelial defect with stromal opacification and thinning. Corneal sensitivity was decreased, while corneal scraping cultures were negative for bacterial or fungal infection. Despite conventional treatment (patching, artificial tears, soft contact lens & autologous serum) no corneal epithelial healing progress occurred 50 days after injury. A PKP was scheduled due to risk of corneal perforation. While waiting for graft, we proposed to the patient the alternative treatment of autologous AdMSCs. IRB was obtained and approved from the Hospital.

Results Corneal epithelial healing process was started 10 days after topical application of MSCs, isolated through liposuction. 1 month later, complete corneal epithelial healing was observed. 1 yr later, corneal epithelium remained intact with mild anterior stromal opacification. The patient’s current UCVA lies between 6‐7/10.

Conclusion Topical application of autologous adipose‐derived MSCs seems to promote corneal epithelial healing in a patient with persistent sterile corneal epithelial defect refractory to other treatments. Differentiation or trans‐differentiation of MSCs into corneal epithelial/stromal cells and/or production of trophic factors could be possible mechanisms behind the corneal healing process.
Optical coherence tomography in retinal detachment cases
Authors: KAMPANAROU SA
Published: December 2011

Purpose To report the contribution of optical coherence tomography (OCT) in the assessment of macular pathology following retinal detachment surgery.

Methods OCT imaging was employed to assess macular pathology following pars plana vitrectomy or scleral buckling for the management of retinal detachment cases.

Results The presence of persistent subretinal fluid, cystoid macular oedema and the formation of epiretinal membranes or macular holes were demonstrated during optical coherence tomography imaging postoperatively. In the era of spectral domain OCT greater attention has also been directed in the evaluation of any alteration, and/or disruption of the junction line between photoreceptor inner and outer segments and in the external limiting membrane. An attempt has also be made to correlate the anatomical results following surgery with visual recovery.

Conclusion OCT imaging enhances the visualization of macular anatomy following retinal detachment surgery. A correlation between anatomical and functional results can be established in some cases.
Macular holes after retinal detachment surgery
Authors: XIROU T
Published: December 2011

Purpose To study the incidence, characteristics and management of Macular Holes (M.H.) developing after retinal detachment repair.

Methods The records of 4 patients with M.H. following retinal detachment were reviwed. All patients underwent three‐port pars plana vitrectomy, internal limiting membrane removal, 14% C3F8 gas tamponade with post‐operative face down positioning for two days.

Results Macular holes were diagnosed from 1 to 9 months post‐operatively. Macular hole closure was achieved in all patients. Functional improvement was compromised by pre‐existing macular pathology.

Conclusion Macular holes may develop after retinal detachment repair and they can be managed with conventional M.H. surgery.
Glaucoma and Retinal Detachment
Authors: MAGURITSAS G
Published: December 2011

Abstract not provided
Pneumatic retinopexy complications
Authors: PARIKAKIS EA
Published: December 2011

Purpose To review the incidence of new and missed retinal breaks, the risk for PVR formation and the danger of other intraoperative or postoperative complications after pneumatic retinopexy (PR) for retinal detachment comparing with those after scleral buckling procedure and vitrectomy.

Methods All cases having undergone PR in our clinic during the last 8 years for primary retinal detachment or redetachment were reviewed for intraoperative or / and postoperative adverse events. The findings were compared with those from the literature which studied in any prospective or retrospective way the complications after PR, scleral buckling and vitrectomy for retinal detachments without PVR.

Results Improper gas entrapment (anteriorly, subretinal or subconjuctival) and high intraocular pressure were observed intraoperatively or soon after the procedure. New retinal breaks and PVR development were the most common findings in the late postoperative period.

Conclusion The relatively high incidence of new breaks suggests that proper case selection and close follow‐up are probably required. PR seems to be the method of choice after retinal redetachment due to missed retinal breaks after vitrectomy.
Silicone oil complications
Authors: PAPPAS G
Published: December 2011

Abstract not provided