bluuebunny/crossref_metadata_2025 huggingface dataset:
Age‐related changes in flicker sensitivity with rod‐ and cone‐enhanced stimuli
Authors: Hathibelagal Amithavikram R. , Bharadwaj Shrikant R. , Subramanian Ahalya , Sadler James , Barbur John L.
Published: December 2019

Purpose

Cone and rod photoreceptors are usually isolated using high light levels for cone vision and full dark‐adaptation, when only rods respond to light. Such methods are not ideal for clinical use. A new rod/cone flicker test has been designed to isolate and measure rod‐ and cone‐mediated signals in the absence of colour signals with one minute adaptation.

Methods

118 healthy adults (Mean age ± standard deviation: 40 ± 15 years), were investigated. None of the participants had a history of or exhibited signs of ocular disease. Rod and cone thresholds were measured monocularly in central vision and in each of the four quadrants (superonasal, superotemporal, inferonasal and inferotemporal) at an eccentricity of 5°. Temporal frequencies, stimulus sizes, background luminances and spectral composition were adjusted appropriately to achieve approximately equal thresholds with ~ 10‐fold separation in sensitivity between the rod‐ and cone‐enhanced stimuli. Flicker thresholds were measured using five adaptive (two‐down, one‐up), interleaved staircases. Spectrally calibrated, ‘neutral density’ glasses were used to enable adequate control of display luminance at low levels.

Results

The superotemporal quadrant had the lowest mean rod and cone thresholds compared to other tested quadrants. For participants, above 50 years of age, the central rod thresholds increased 0.53% per year, whereas cone thresholds increased 0.29% per year and this decline was faster than other respective quadrants. Overall, among the locations tested, the central rod (ρ = 0.547; p < 0.005) and cone (ρ = 0.504, p < 0.005) thresholds demonstrated the strongest correlation with age.

Conclusions

The new test isolates rod and cone signals sufficiently well to detect selective loss of photoreceptor function in normal ageing. The potential use of rod‐ and cone‐enhanced tests in patients with selective loss of photoreceptors and other retinal diseases (e.g., AMD, glaucoma, diabetes) remains to be explored.
Distribution of nanoparticles in the anterior chamber of porcine eyes
Authors: Sonntag Tobias , Froemel Franziska , Guter Michaela , Dillinger Andrea , Fuchshofer Rudolph , Breunig Miriam
Published: December 2019

Purpose

Decisive events of primary open angle glaucoma (POAG) onset and progression are located in the anterior chamber of the eye. Here, the outflow of aqueous humor through the trabecular meshwork (TM) and Schlemm´s canal (SC) is severely impeded.1 Conventional therapy suffers from poor compliance, low bioavailability of drugs, and does not treat the root cause of the disease. In the past few years, targets molecules and structures were identified that are associated with pathological changes of POAG and that could potentially be exploited for causative treatment.2 To efficiently address these novel targets and bring dug molecules to the TM and SC, the development of innovative and tailor‐made drug delivery systems is a prerequisite. Therefore, the goal of this study to exploit nanoparticles of different size and surface modification regarding their efficacy to accumulate in the TM after intracameral injection.

Methods

Polymer nanoparticles decorated with either hyaluronan or poly(ethylene imine) (PEI; about 250 nm) or gold nanoparticles of 5 nm were injected into the anterior chamber of enucleated porcine eyes. After 5 hr the anterior chamber was dissected and the iris, cornea, lens, the ciliary body and trabecular meshwork were analyzed either by fluorescence microscopy for polymer nanoparticles or inductively coupled plasma mass spectroscopy (ICP‐MS) for gold content.

Results

Nanoparticles decorated with hyaluronan demonstrated a favorable mobility in the extracellular matrix and excellent accumulation in the TM.3 Gold nanoparticles of 5 nm were detected in the TM at higher amounts compared to other tissues of the anterior chamber.

Conclusion

Nanoparticles depending on their size and surface modification are promising carriers for therapy of POAG to deliver drugs with high specificity to the TM and SC.
Novel corneal crosslinking technique with eosin‐Y and visible light
Authors: Yildiz Erdost , Anwaar Nazeer Muhammad , Bayraktutar Betul , Zibandeh Noushin , Kizilel Seda , Sahin Afsun
Published: December 2019

Purpose

Keratoconus is a progressive disease which results thinning of the cornea and increase in the forward curvature of the cornea until corneal rupture. The first choice in clinical management of keratoconus is Ultraviolet‐A(UV‐A) crosslinking procedure with riboflavin. This procedure is painful, prolonged and has many side effects on the patient. Eosin‐y is well known molecule and it has been used as crosslinker with visible light on hydrogels with various cells.

Methods

Firstly, we have examined effects of sequential concentrations of eosin‐y on proliferation and apoptosis of human corneal epithelial cells (HCECs). We have used MTT cytotoxicity assay, Xcelligence real‐time cell analysis, Ki67 and Caspase‐3 immunofluorescence staining. After these tests, visible light (525 nm) induced crosslinking has performed with Eosin‐Y in fresh bovine corneas at selected doses. Corneas which applied eosin‐y or riboflavin, or saline are observed under scanning electron microscopy for topographic, cross‐sectional and elemental analysis. Their young moduli measured with hybrid rheometer. Lastly, resistance to osmotic stress and chemical digestion of the corneas compared with water swelling test and enzymatic digestion test, respectively.

Results

We have demonstrated non‐toxic doses of eosin‐y with cytotoxicity and immunofluorescence experiments on HCECs. We determined LD50 concentration of eosin‐y for HCECs. After that, we have showed significant crosslinking with eosin‐y in fresh bovine corneas. Eosin‐y and visible light procedure has created faster and stronger corneal crosslinking reaction on bovine corneas compared to riboflavin and UV‐A procedure.

Conclusions

We have observed, eosin‐y initiate faster and stronger crosslinking in corneal stroma at subtoxic doses than standard procedure. It could be new photo‐initiator agent for corneal crosslinking procedure in clinics. For next step, we will examine its toxicity on corneal stromal cells and corneal endothelial cells.
5‐Year progression of primary angle closure after treatment: the Primary Angle Closure Study (PACeS)
Authors: Venkatramani Iyer Jayant , Yean Kiew Sieh , Nongpiur Monisha , Aung Tin
Published: December 2019

Purpose

There is no recent evidence on progression rates of Primary Angle Closure (PAC) to Primary Angle Closure Glaucoma (PACG). We aimed to study the 5‐year progression rates of treated PAC to PACG or acute primary angle closure (APAC).

Methods

A retrospective cohort study of 50 PAC subjects was performed. PAC was defined as iridotrabecular contact of 180 degrees or more, in the presence of raised intraocular pressure or peripheral anterior synechiae, without evidence of glaucomatous optic neuropathy. Data on intraocular pressure (IOP), gonioscopy, treatment instituted and time of progression to PACG or APAC were analyzed. In subjects with bilateral PAC, one eye per subject was randomly chosen for analysis.

Results

Of the 50 PAC subjects, 33 (66%) subjects were female, 49 (98%) subjects were of Chinese descent and 1 Indian. All 50 eyes were treated ‐ 48 underwent initial laser peripheral iridotomy (LPI) and 2 primary phacoemulsification. During the follow‐up period, 17 were started on IOP‐lowering medications, and 26 (52%) underwent cataract extraction. None of the eyes developed APAC. Only 2 eyes progressed to PACG over 5 years of follow‐up. None of the eyes underwent glaucoma filtration surgery. Both the eyes that progressed were not noted to have synechial angle closure on diagnosis, and progressed to PACG at 1 year and 2.5 years from time of PAC diagnosis respectively.

Conclusions

These results suggest that the risk of progression of treated PAC to PACG is low. Our findings reveal lower rates of 5‐year progression compared to previously published data.1The low progression rate could be related to the majority of subjects having had lens extraction.

Reference

Thomas, R., Parikh, R., Muliyil, J. and Kumar, R. S. Five‐year risk of progression of primary angle closure to primary angle closure glaucoma: a population‐based study. Acta Ophthalmologica Scandinavica 2003; 81: 480‐485
Affection of neuroretina and ocular motility in patients affected by Thalidomide Embryopathy
Authors: Pérez‐Velilla Javier , Vicente María José , Palomar Elisa Vilades , Hospital Elvira Orduna , Ciordia Beatriz Cordón , Velilla Jose , Rodrigo Maria Jesús , Satué Maria , García‐Martín Elena
Published: December 2019

Introduction

Thalidomide embryopathy is a syndrome that associates abnormalities and congenital malformations as a result of intra‐uterine exposition to Thalidomide. The objective of this study is to evaluate the affection in neuro‐retina and ocular motility.

Clinical cases

We present 8 clinical cases that underwent the visual acuity measurement by ETDRS test, evaluation of tropia or phoria through the Cover Test, eye movements exam and macular and retinal fiber layer thicknesses by Triton SS‐OCT (Topcon Corporation, Japan). In half of the clinical cases, we observed low visual acuity and/or endophoria. Most of them have some decrease in retinal nerve fiber layer thickness. One of them has a restriction in eye movements.

Conclusion

There is retinal nerve fiber layer decrease and notable visual acuity reduction in patients with thalidomide embryopathy.
In vitro evaluation and transplantation of human corneal endothelial cells cultured on biocompatible carriers
Authors: Miron Alina , Spinozzi Daniele , Lie Jessica T. , Rafat Mehrdad , Lagali Neil , Melles Gerrit R.J. , Ni Dhubhghaill Sorcha , Dapena Isabel , Oellerich Silke
Published: December 2019

Purpose

To test in vitro the surgical potential of cultivated human corneal endothelial cells (hCEC) on human anterior lens capsule (HALC), bioengineered collagen sheets and denuded Descemet membrane (dDM) as tissue‐engineered grafts for Descemet membrane endothelial keratoplasty (DMEK).

Methods

Primary hCEC were seeded onto HALC, LinkCell™ bioengineered matrices of 20µm thickness (LK20), and dDM. Cell morphology, viability, and proliferation were assessed by light microscopy, cell viability assay, and immunohistochemistry. All hCEC‐carrier constructs were evaluated by simulating DMEK surgery in vitro using an artificial anterior chamber (AC) and a human donor cornea, without DM, with a regular DMEK graft as control.

Results

Primary hCEC cultured on all carriers formed a monolayer of tightly packed cells with a high cell viability rate (96±4%) and expression of ZO‐1 and Na+/K+‐ATPase. During the in vitro surgery, hCEC‐HALC constructs behaved most similar to the DMEK reference model during implantation and unfolding in the artificial AC, showing good adhesion to the bare stroma. On the other hand, hCEC‐LK20 and hCEC‐dDM constructs required some additional handling because of challenges related to the surgical procedure, although they were both successfully unfolded and implanted in the artificial AC. The hCEC‐dDM constructs showed similar graft adherence as hCEC‐HALC constructs, while adherence of hCEC‐LK20 constructs was less effective.

Conclusions

All analyzed carriers were suitable substrates for cultivating hCEC. During in vitro DMEK surgery, hCEC‐HALC constructs behaved most similar to a standard DMEK‐graft, while graft adhesion and surgical handling, respectively, are parameters still requiring optimization for hCEC‐LK20 and hCEC‐dDM constructs.
A consensus dataset for the management of conjunctival melanoma in the multidisciplinary setting
Authors: Max Conway R. , Wegkamp Melissa , Joshua Anthony D. ,   The Kinghorn Cancer Centre Multi‐Institutional O.O. MDT Group, Cherepanoff Svetlana
Published: December 2019

Importance

A key tenet of best practice in modern oncology is multidisciplinary decision making. Currently there are no specific multidisciplinary guidelines for the management of conjunctival melanoma.

Background

Conjunctival melanoma is a rare disease which can be associated with significant morbidity and in some cases, mortality. Multidisciplinary care has been shown to improve outcomes for oncology patients. The aim of the current report is to determine a consensus dataset for the multidisciplinary management of conjunctival melanoma by surveying experts involved in the management of conjunctival melanoma.

Design and participants

Health professionals (n=86) who participate in a multi‐institutional ocular oncology multidisciplinary team (MDT) meetings at the Kinghorn Cancer Centre in Sydney, NSW were invited to participate in this study

Methods

A modified Delphi method with two rounds of online survey and one oral consensus round was carried out. Data fields relating to demographic, clinical, pathology and follow up information were collated from the American Joint Committees on Cancer TNM Staging Manual (8t edition) and Cancer Australia Government recommendations.

Main Outcome Measures

Fields for inclusion in a consensus dataset.

Results

In round one 43 of 86 participants (50%) responded. Nine out of 71 questions did not achieve 80% consensus and were added to round two. 32 professionals out of 43 (74%) responded to round two. None of the nine questions in this round achieved 80% consensus, and all nine were added to round three, the oral consensus round. 16 professionals out of 32 (50%) were present in this last round. The process generated a final dataset consisting of six demographic items), 31 clinical items, 32 pathology items and four items. In total, 75 fields were considered essential for multidisciplinary management of conjunctival melanoma.

Conclusions and Relevance

Using recognised methodology, this consensus dataset represents a working document and template for optimising patient care and multidisciplinary decision making for conjunctival melanoma. It can be used as a tool for evaluating and benchmarking MDT performance.
Neuro‐retinal alteration in dizygotic twins with multiple sclerosis
Authors: José Vicente María , Vilades Elisa , Orduna Elvira , Cordón Beatriz , Pérez‐Velilla Javier , Fernández‐Tirado Javier , Jesús Rodrigo María , Satué María , García‐Martín Elena
Published: December 2019

Purpose

The aim was to evaluate the retina and the optic nerve in two dizygotic twins suffering from multiple sclerosis (MS).

Method

The neuroretinal structures were analysed at diagnosis from only the right eyes of both two (A and B) dizygotic twins by the optical coherence tomography (OCT) device Heidelberguffered in her left eye. The protocol used was Posterior Pole (with an area of examin Spectralis®, in order to avoid bias due to a previous optic neuritis that the twin A sation 30° × 25°) that measured the thickness in microns (μm) of the whole retina, the ganglion cell layer (GCL) by segmentation in the macular area and the peripapilar retinal nerve fibre layer (RNFL). The functional situation of the disease was evaluated with the Expanded Disability Status Scale (EDSS) by neurologist.

Results

The onset of the disease of twin A was with an episode of left optic neuritis in 2017, whereas twin B with a cerebellar syndrome in 2013. Both twins were diagnosed of MS in 2018. At that moment, the twin B showed worse systemic functional status than twin A (EDSS: 3.5 versus 0 respectively), lower thickness in the peripapilar RNFL at temporal (54 versus 96 μm) and inferior temporal (109 versus 180 μm) sectors and also in GCL specifically at the inferior (31 versus 45 μm) and temporal (30 versus 40 μm) sectors.

Conclusions

The analysis of the posterior pole retinal thickness with segmentation could be a useful tool for the management of MS. The GCL showed an early and more intense damage than RNFL at the earliest years of the disease without previous episodes of optic neuritis in this case of two dizygotic twins.
Study of the functional integrity of the retinal pigment epithelium with a new technique in two models of inherited retinal degeneration
Authors: Di Pierdomenico Johnny , Soriano Francisco Javier Valiente , Navarro Manuel Salinas , García‐Ayuso Diego , Villegas‐Pérez María Paz , Vidal‐Sanz Manuel , Agudo‐Barriuso Marta
Published: December 2019

Introduction

Retinal pigment epithelium (RPE) is a cell layer located between the neurosensory retina and the choroid. RPE has many functions that are essential for photoreceptor nutrition and renewal, among others. To understand the pathogenesis of retinal degenerations, it is crucial to study the integrity, morphology and functionality of this layer.

Material and methods

Dystrophic young and old adult female albino P23H‐1 (rhodopsin mutation) and Royal College of Surgeon, (RCS, RPE mutation that impairs phagocytosis), rats were used in this experiment. Control strains were Sprague‐Dawley (SD) and Pievald Virol Glaxo (PVG). To label the RPE, 1.5 µl of 3% Fluorogold (FG) diluted in saline was administered intravitreally under general anaesthesia. RPE in‐vivo analysis were performed with SD‐OCT and by eye fundus observation; for ex‐vivo analysis flat mounted RPE and cryostat cross‐sections were used.

Results

In‐vivo analysis of the dystrophic strains showed an overexpression of lipofuscin in the RPE and a reduction of the retinal thickness, both pathological conditions increased with time. Ex‐vivo analysis in cross sections revealed that in control SD and PVG rats, RPE was labelled with FG showing its typical cubic morphology. The retinal structure and RPE morphology however, was altered in the dystrophic strains. In flat mounts we observed that FG accumulates inside the somas of RPE cells in SD, PVG and young P23H‐1 rats, indicating that the RPE has a correct function. However, in old P23H‐1 rats, FG was found inside and outside the RPE somas, which in addition were bigger and unstructured. When analysing RCS rats, we observed that FG accumulated outside the RPE somas, indicative of the phagocytosis malfunction that characterises this strain.

Conclusions

Intraocular injection of FG is a reliable technique to label functional RPE. In both models of inhered retinal degeneration RPE functional integrity was affected by the evolution of degeneration.
Investigating basal cell carcinoma recurrence and outcomes following surgical excision at Broomfield hospital ophthalmology department, United Kingdom
Authors: Wong Caroline , Ghazi‐Nouri Seyed , Kesharaju V.
Published: December 2019

Purpose

Our current practice involves 2 years follow up after periocular BCC excision. This audit aims to investigate outcomes of: BCC recurrence rate while under follow up after histologically proven complete excision. Histological findings in cases of biopsy of suspected recurrent BCC

Methods

Retrospective identification of samples sent to histopathology by a single Oculoplastic consultant with suspected or confirmed BCC between 01/01/16–30/04/19. Clinic letters identified the duration from surgical excision to latest follow up and any suspicion of recurrence. Where initial surgery was incomplete, or recurrence suspected clinically, secondary surgery results were checked to determine whether residual BCC was reported. Initial diagnostic incising biopsy results were excluded.

Results

Of 115 samples, 51 were excluded as per criteria. Of the remaining 64 patients, 56 patients were reviewed post‐operatively with no suspicion of recurrence in timeframe seen (1–>24 months). Of 64 patients, 8 (12.5%) warranted secondary surgery within 2 years: 5 indicated by reported margin involvement (7.8%); 3 indicated by clinical suspicion (4.7%). This audit did not identify any cases of BCC recurrence. Residual BCC was identified on one deeper resection indicated by histopathology. Patients may continue to be risk assessed, and follow‐up preserved for: persistent marginal involvement; aggressive BCC sub‐type; pre‐disposition for BCC; immunosuppression; higher risk initial BCC site (e.g. medial canthus or orbital invasion).

Conclusions

No cases of BCC recurrence were identified within this cohort. Re‐excision of involved margin tends not to a show positive result. Minimal residual BCC may have been destroyed during the initial surgical cauterisation or by the immune system. We propose to discharge patients following complete excision of low risk BCCs from the periocular area with advice to seek referral with any new lesions following self‐examination.
Retinal vessel oximetry in children with inherited retinal diseases
Authors: della Volpe Waizel Maria , Scholl Hendrik P.N. , Valmaggia Christophe , Todorova Margarita G.
Published: December 2019

Background

Alterations in retinal oxygen metabolism have already been confirmed in eldery subjects with retinitis pigmentosa (RP). Hovewer, whether this is a also a feature in children affected by RP has not been studied yet. The aim of our study was to compare retinal oxymetry (RO) parameters whithin children with inherited retinal diseases (IRDs), as well as agains those of carriers and healthy controls.

Methods

A total of 68 children (136 eyes) of were examined: 16 with IRDs (32 eyes) were compared to those of 11 IRD carriers (22 eyes) and of 41 healthy children (82 eyes). RO was performed with the oxygen saturation tool of the Retinal Vessel Analyser (RVA; IMEDOS, Germany). The mean oxygen saturations, within 1.0–1.5 optic disc diameters from the disc margin, in the retinal arterioles (A‐SO2;%) and venules (V‐SO2;%) were estimated and their difference (A‐V SO2;%), was calculated. The corresponding arterioles (D‐A;μm) and venules (D‐V;μm) were evaluated, as well. For statistical evaluation ANOVA‐based linear mixed‐effects models were calculated with SPSS®.

Results

The V‐SO2 showed a statistically significant increase in RP eyes (67.00 ± 7.48%) when compared to healthy controls (59.07 ± 11.98%, p=0.03), but also to children with other IRDs and to carriers (p ≤ 0.03). The A‐V SO2 showed a statistically significant decrease in RP eyes (32.62 ± 4.03%), when compared to eyes suffering from macular dystrophies (MD, 44.35 ± 10.55%, p = 0.05) or cone‐rod‐dystrophies (CRD, 43.29 ± 10.55, p = 0.03). The D‐V, even if not reaching statistically significant level, showed a trend for RP to be slightly attenuated (102.31 ± 8.20 μm) when compared to controls (108.76 ± 20.87 μm; p = 0.07).

Conclusion

These data indicate that children suffering RP show early metabolic alterations. With aging and progression of RP the sign of vascular attenuation seems to be a secondary effect of neurovascular remodeling. Here, RO seems to be a useful screening tool for metabolic dysfunction within a family affected from RP.
Long‐term observation of the treatment of laser photocoagulation versus intravitreal bevacizumab in identical twins with aggressive posterior retinopathy of prematurity
Authors: Hee Jeon Seung , Jung Roh Young
Published: December 2019

Purpose

In recent years, a number of studies have been reported comparing the results of the treatment with intravitreal bevacizumab injection. We report a case of comparing effects of laser photocoagulation versus intravitreal bevacizumab injection in identical twins with AP‐ROP.

Methods

GA 28 + 2 weeks, identical twins were born with 0.97 and 1.02 kg. Twins were diagnosed as bilateral AP‐ROP and they were refered to different hospital due to the lack of hospital neonatal room, and they received different treatments. At the PMA 32 + 6 weeks, the older sister underwent bilateral intravitreal bevacizumab injection, younger sister underwent laser photocoagulation. Younger sister underwent bilateral laser photocoagulation at the PMA 34 + 4 weeks and received additional bilateral intravitreal bevacizumab injection after 1week. Older sister underwent second intravitreal bevacizumab injection at the PMA 42 + 2 weeks.

Results

After 9 years, older sister’s BCVA was checked 0.8 in the right eye, 0.25 in the left eye. Both eyes showed good angiogenesis to the periphery of the retina and fovea showed normal development on the OCT. And younger sister’s BCVA was checked 0.5 in the right eye, FC 50cm in the left eye. Laser was well applied at the periphery, but the retinal vessels didn’t grow even in the zone 1 main arcade, and the fovea on the OCT was irregular and undeveloped.

Conclusions

In this case, the intravitreal bevacizumab injection in the same twin with all the same conditions supports the efficacy of bevacizumab injections because of better long‐term outcome of anatomical and functional retinal vessel development. There is no reported case of different initial treatment in Identical twin, so it can be a meaningful case to compare long term results of two treatments.
Regulation of the glutamate release by pH and GABA at the axon terminal of rod photoreceptors
Authors: Gallego‐Ortega Alejandro , Liao Fei , Vidal‐Sanz Manuel , De la Villa Pedro
Published: December 2019

Purpose

Regulation of synaptic transmission at the rod synaptic terminal, between rods and rod bipolar cells (RBC) and horizontal cells (HC) is not well understood. The RBC depolarize as a consequence of the decrease in the calcium regulated glutamate release by the rod axon terminal. This effect is mediated by mGluR6 receptors coupled to Gi‐TRPM1 expressed in the RBC. We propose to investigate, in living animals, the modulatory effect by GABAergic HC on this synaptic transmission by means of electroretinogram (ERG) recordings.

Methods

Binocular ERG were obtained from C57BL6/J adult mice in response to low intensity full field light stimuli (0.01 cd·s·m−2) (rod response). The right eye of each animal was injected with 1 μl of phosphate buffer solution (PBS) containing either GABA (100 mm), Glutamate (100 mm), Bicuculline (10 mm), DNQX (30 mm), APB (25 mm), Hepes (100 mm) or a combination of these drugs. The left eye of each animal was injected with 1 μl of PBS. Burian‐Allen corneal electrodes were used and responses from both eyes were compared.

Results

The intraocular injection of APB produces the abolition of the rod response, which is explained by continued activation of mGluR6 receptors by APB. Stimulation by GABA and/or glutamate of membrane receptors expressed in HC produces a significant increase in the rod response (p < 0.05), while their antagonists (Bicuculline and DNQX) produce a significant response decrease (p < 0.05). These effects can only be explained by changes in the pH of the synaptic cleft, since the acidification of the synaptic space produces the blockage of the calcium channels expressed in the axon terminal of the rods. The acidification mechanism is justified since the intraocular injection of Hepes produces the same effect as the inhibition of HC.

Conclusion

Regulation of the pH in the triad of rod terminal synaptic cleft by GABA receptors seems to be an effective mechanism to control signal transmission from the photoreceptors to RBC.
Post‐DMEK bacterial interface keratitis treated with intrastromal and intracameral antibiotics
Authors: Lucas Janeschitz‐Kriegl Lucas , Dimacali Victoria , Sagri Despoina , Scholl Hendrik , Gatzioufas Zisis , Balidis Miltos
Published: December 2019

Case Report

A 61–year old woman presented in our clinic complaining of blurred vision in the right eye (OD). Best‐corrected visual acuity (BCVA) OD was 0.05. Central corneal thickness was 794μm. She had undergone complicated phacoemulsification with sulcus‐placed intraocular lens in the affected eye six months ago, so we set the diagnosis of pseudophakic bullous keratopathy and decided to proceed with Descemet Membrane Endothial Keratoplasty (DMEK). DMEK with 20% SF6 gas was performed uneventfully on the right eye. On first postoperative day, slitlamp examination revealed a paracentral corneal infiltrate in the interface with intact overlying epithelium. We injected 0.1 mL of 0.5% vancomycin and 0.1 mL of 0.8% amikacin, adjacent to the infiltrate into the mid‐stroma. Intracameral injection of 0.1 mL of 0.5% vancomycin was also performed. Topical 5% vancomycin and 2.5% amikacin eyedrops were administered hourly in addition to moxifloxacin eyedrops four times a day and preservative‐free dexamethasone eyedrops two times a day. We observed complete resolution of the infection by the twelfth day after injection.

In Summary

Intrastromal and intracameral antibiotic injection is an effective and safe treatment modality for post‐DMEK interface keratitis, which physicians should consider when managing such cases.
Evaluation of the results and techniques of cataract phacoemulsification in uncomplicated and complicated cases on various femtolaser installations
Authors: Malgin Konstantin
Published: December 2019

Purpose

To compare results and techniques of cataract phacoemulsification in uncomplicated and complicated cases on various femtolaser installations.

Material and methods

560 patients (876 eyes) aged from 20 to 85 were observed. Visual acuity before surgery: UCVA ‐ 0.1 ± 0.05, BCVA ‐ 0.3 ± 0.1. Patients were divided into 3 groups. The first group included patients who underwent cataract phacoemulsification with IOL implantation with femtosecond assistance on multi‐function mobile low‐energy high‐speed femtolaser system ‐ Femto1 (Ziemer FEMTO LDV Z8). The second group ‐ patients with similar surgical intervention on stationary femto‐installation with built‐in intraoperative optical coherent tomograph and video microscope ‐ Femto2 (LenSx Laser System). The third (control) group ‐ patients who had their lens removed and replaced with IOL with phacoemulsification, but without prior femto stage.

Results

On the first day after surgery UCVA in all the groups averaged 0.4‐0.6, BCVA ‐ 0.7‐1.0. Corneal incisions on Femto1 did not cause difficulties when opened. In some cases, paracenteses were immediately opened with cannula. In cataracts complicated by lens subluxation, both lasers showed greater efficiency of capsulorhexis and phacofractionation compared to the manual method. The integrity of ligaments in groups 1 and 2 was higher than in group 3. With pupil rigidity in the first group, in 5 cases, iris retractors were previously used to achieve 5.0 mm pupil diameter. Endothelial cell loss percentage remained fairly low (from 300 to 500 cells/mm2) in groups with femto assistance.

Conclusions

Phacoemulsification method with femtolaser assistance on Femto1 and Femto2 devices proved effective and safe in surgical treatment of low and medium density cataracts, and with weak lens ligaments. Mobile and compact Femto1 is better than Femto2 in interface and for corneal incisions. Femto2 is slightly faster in the automatic stage OCT.
Ultrasound biomicroscopy of the anterior segment of the eyeball after implantation of a phakic IOL in patients with different refractive errors
Authors: Malgin Konstantin
Published: December 2019

Purpose

To study the changes in of the anterior segment of the eyeball in the early and late postoperative periods after implantation of a phakic intraocular lens (PhIOL) in patients with different refractive errors using ultrasound biomicroscopy data.

Material and methods

32 patients (64 eyes) with moderate and high degree myopia (56 eyes) and hyperopia (8 eyes) without concomitant pathology were operated. The average age of the patients was 30 ± 5 years. Observation period: 1 day, 1 and 6 months after surgery. Complementary to standard diagnostic examination, ultrasound biomicroscopy was performed in all patients before and after surgery. The following parameters were estimated: anterior chamber depth (ACD), anterior chamber angle (ACA); iris profile; the position of the PhIOL, the distance between the PhIOL and the lens, the state of the Zinn’s zonules, the ciliary apparatus and the lens. Bilateral implantation of PhIOL was performed through 2.2 mm incision.

Results

On day 1, in 31 patients (96.8%): ACD decreased by 0.67 ± 0.1 mm, ACA was open, iris profile–straight, PhIOL position‐in ciliary sulcus, distance between PhIOL and the lens‐0.57 ± 0.2 mm, Zinn’s zonules were saved, ciliary body‐within normal limits, lens‐transparent; in 1 patient with high hyperopia (preoperative data: ACD‐open, ACA‐3.17 mm (OD), 3.23 mm (OS)) anterior chamber was shallow (1.05 mm), ACA was covered with iris, 1/3 of the iris root was in contact with corneal endothelium, PhIOL dislocated in the frontal plane, distance between PhIOL and the lens was uneven. After 1 and 6 months in 31 patients, the state of anterior and posterior chambers’ structures remained satisfactory.

Conclusion

Ultrasound biomicroscopy data of the anterior segment of the eyeball showed that implantation of PhIOL in patients with different refractive errors in early and late postoperative periods changes ACA, slightly decreases ACD, does not have contact with the anterior lens capsule.
Anti‐apoptotic properties of mesenchymal stem cells in mouse model of corneal injury
Authors: Kössl Jan , Bohacova Pavla , Hermankova Barbora , Zajicova Alena , Holan Vladimir
Published: December 2019

Limbal stem cell deficiency (LSCD) is associated with the break of immune privilege of the cornea, a harmful local inflammatory reaction and a loss of corneal epithelium cells caused not only by damage after injury but also by the apoptosis in later phase. Apoptosis is caused by various factors including damaging of cell structures and chronic inflammation and may be one of the main causes of the failure of corneal regenerative mechanisms. Mesenchymal stem cells (MSCs) turned out to be a suitable source of stem cells for the therapy of bilateral LSCD. MSCs are well known for their anti‐inflammatory, anti‐apoptotic, regenerative, migration and differentiation properties. Antiapoptotic mechanisms are still not well described but their recognition could help for a long‐term regeneration of corneal epithelium after the injury or after the corneal transplantation in cases like LSCD.

MSCs were obtained from murine bone marrow. Flow cytometry was used to characterize phenotypic markers of purified MSCs. For in vitro experiments, MSCs were cultured in plates for 24 hours. Excised corneas were added to the culture alone or in inserts and were stimulated by pro inflammatory cytokines. After a 48‐hour co‐cultivation the expression of genes for pro apoptotic and anti‐apoptotic molecules in corneas was detected using qPCR. Flow cytometry was used to detect phosphatidylserine on the surface of apoptotic cells by annexin V. In in vivo experiments, MSCs were seeded onto nanofiber scaffolds (allowed to adhere for 24 hours) and transplanted on the injured cornea (alkali burn)

MSCs significantly decreased the number of apoptotic cells in the cornea with simulated inflammation in vitro or in injured corneas in vivo. MSCs also supressed the expression of the pro‐apoptotic molecules Bax and p53 and change the ratio of Bcl‐2 Bax expression in the cornea.

Autologous MSCs suppressed apoptosis in in vitro and in vivo models of corneal injury and inflammation.
Retinal hemangioblastomas in Von Hippel‐Lindau germline mutation carriers: progression, complications and treatment outcome
Authors: Hajjaj Anass , van Overdam Koen , Oldenburg Rogier , Koopmans Anna , van den Ouweland Ans , Brosens Erwin , de Klein Annelies , Kiliç Emine
Published: December 2019

Purpose

Evaluating the phenotype, complications and treatment outcome of retinal hemangioblastomas (RH) and correlating this features with the genotype of Von Hippel‐Lindau (VHL) germline mutation carriers.

Methods

Retrospective analysis of the medical and genetic records of 21 individuals with a VHL germline mutation and a diagnosis of RH. Germline mutation status was correlated to phenotype, complications, treatment methods and outcomes. Mutations were categorized in two genotypic categories: the truncating mutation (TM) group and the missense mutation (MM) group.

Results

From the 36 VHL germline mutation carriers, 21 VHL patients developed RH. Prevalence of RH in VHL disease was higher in TM carriers (15 of 21, 68.2%) vs. 40% of the MM carriers (6 of 15). The mean age of diagnosis of RH was 25.7 years. There was no significant difference in age of diagnosis of RH between genotypic categories (P = 0.931). Mean follow‐up duration was 16.3 years and did not differ significantly between the mutation groups (P = 0.383). Bilateral involvement was observed in 66.7% of the patients. Missense mutation (MM) carriers (n = 6) developed more RH (more than 5 RH: 50.0% vs. 38.5%), had a larger extent of peripheral retinal involvement of ocular VHL disease (66.7% vs. 35.7% all quadrants involved) and developed more progression‐related complications compared to TM carriers (n = 15) (100% vs. 46.7%). Complete tumor regression at last recorded visit was achieved in fifteen patients (71.4%). Moderate (VA 20/80 to 20/200) to severe (less than VA 20/200) visual impairment was observed in 53.3% of the eyes of MM carriers and 28.1% of the eyes of TM carriers at last recorded visit.

Conclusions

Germline mutation status might play a role in the course of progression of RH in VHL disease. In our observational study, VHL missense mutation carriers had a more complicated progression of RH than carriers of a truncating mutation.
Circadian Control and Pinosylvin Treatment in the Disease Model of Age‐related Macular Degeneration
Authors: Tamminen Toni , Koskela Ali , Toropainen Elisa , Pitkänen Marja , Viiri Johanna , Paterno Jussi , Seppänen Anne , Koskelainen Ari , Kaarniranta Kai
Published: December 2019

Purpose

Circadian clocks in the eye are critical for normal visual function and they relate to periodical renewal of photoreceptor outer segments as well as oxidative stress. Impaired rhythm can thus contribute to the pathogenesis of age‐related macular degeneration (AMD). Chronic oxidative stress leads eventually to protein aggregation in combination with impaired autophagy. We hypothesise that pinosylvin, a polyphenolic compound, slows down the progression of AMD through autophagy induction.

Methods

We investigated the relative change in electroretinogram (ERG) metrics of mice raised in 12:12 h light‐dark cycle and after a 24 h two‐week dark period in wild type (WT; n = 10), PGC1‐α knock‐out (KO; n = 7) and Nrf2 KO (n = 7) mice aged 9.7 ± 3.4 months. From these, 9 WT, 5 PGC1‐α and 7 Nrf2 KO mice continued to be raised to an age of 17.3 ± 3.8 months and assigned to a treatment and control group and fed for 2 months with pinosylvin‐feed or regular‐feed prior to recording ERG.

Results

The two‐week dark period resulted in significantly greater b‐wave amplitudes and shorter b‐wave latencies in WT mice in photopic ERG. Nrf2 KO and PGC1‐α/Nrf2 dKO mice exhibited b‐wave latency changes in the opposite. The dKO also had diminished b‐wave amplitudes. Scotopic ERG yielded no significant changes. Pinosylvin treatment in Nrf2 KO and PGC1‐α KO mice caused significantly increased b‐wave amplitudes in photopic ERG. In scotopic ERG, the pinosylvin treated mice had larger a‐ and b‐wave amplitudes in WT and Nrf2 KO mice, but not in PGC1‐α KO mice.

Conclusions

PGC1‐α KO and Nrf2 KO mice showed different circadian rhythmicity. Pinosylvin treatment showed improved ERG signalling in aged NRf2 KO and WT mice.
Gonococcal conjunctivitis: a case report
Authors: Lopez Sangros Isabel , Marco Monzón Sara , Karlsruher Riegel Gisela , Montes Rodriguez Paula , Dolores Diaz Barreda Maria , Boned Murillo Ana , de los Angeles Del Buey Sayas Maria , Minguez Muro Enrique , Ascaso Puyuelo Javier
Published: December 2019

Purpose

A case report of ocular perforation secondary to gonococal queratoconjunctivitis is presented.

Methods

A 49 year old man visited the Emergency Departement with redness, pain, and purulent secretion in his left eye of four days of evolution. He related a risky sexual relationship in the days before the clinic appeared, with direct inoculation of vaginal secretions in his left eye. At the slit lamp examination, he presented a significant corneal thining with ocular perforation in the upper part of the cornea. The direct microscopic examination of ocular secretions showed the presence of gram negative diplococci.Treatment with intravenous ceftriaxone, and topic ceftazidime was instaured. The patient underwent an urgent surgical intervention with a superior conjunctival covering of the upper of the cornea.

Results

The evolution of the patient was favorable with surgical treatment and antibiotic therapy. The results of the culture of ocular secretions confirmed the growth of Neisseria gonhorreae. One month later, the patient underwent a penetranting keratoplasty and a phacoemulsification with intraocular lens implant in the posterior chamber. At the moment, the patient is stable without corneal reject signs and a visual acuity of 1/10 with his left eye.

Conclusion

Gonococal queratoconjunctivitis is a serious infection that can cause significant corneal thining and ocular perforation. The incidence of this disease has increasead in the last years. For this reason it is important to make a differential diagnosis in presence of purulent queratoconjunctivitis asociated with risk factors.
Cyclodialysis cleft as a complication of cataract surgery: a case report
Authors: Lopez Sangros Isabel , Marco Monzón Sara , Karlsruher Riegel Gisela , Montes Rodriguez Paula , Dolores Diaz Barreda Maria , Boned Murillo Ana , Martinez Morales Juana , de los Angeles Del Buey Sayas Maria , Ascaso Puyuelo Javier
Published: December 2019

Purpose

We describe a case report of hypotonic maculopathy secondary to cataract surgery with phacoemulsification and intraocular lens implant (IOL).

Methods

A 68‐year‐old man, with medical history of prostatic hyperplasia, and surgical history of uneventful cataract surgery in his left eye (phacoemulsification and IOL implant), underwent cataract surgery in his right eye. Flopy iris syndrome was manifested, with the consequent traumatic manipulation of the iris. The surgery finished successfully with the IOL implantation in the posterior chamber. During the following postoperative visits, the patient presented a best‐corrected visual acuity (BCVA) lower than 1/10 in his right eye, and an intraocular pressure (IOP) of 4 mmHg. The slit‐lamp examination discarded the presence of leakage throught the corneal incisions. The funduscopic examination showed a macular hypotony with radial folds, wich was confirmed by optical coherence tomography. The examination with ultrasonic biomicroscopy, revealed the presence of a superior cyclodialysis of 180°. An anterior YAG laser capsulotomy was performed to release the anterior capsular fibrosis. Despite treatment with topical steroids and atropine for two months, hypotonic maculopathy remained unchanged. Finally, an encircling procedure was performed, 23 g pars plana posterior vitrectomy, an internal limiting membrane peeling, SF6 20% air‐gas exchange, and superior criopexy of the cilliary body at 3 mm of the corneal limbus.

Result

The postoperative evolution was favourable with resolution of the maculopathy, progressive elevation of IOP (12 mmHg), and resolution of the cyclodialysis cleft. The patient recovered a BCVA of 7/10 with his right eye.

Conclusion

Ocular hypotony is an infrequent, yet potentially vision‐threatening entity. The diferential diagnosis is extense, involving any condition that may compromise aqueous humor dynamics or the integrity of the globe and sometimes following medical treatments or procedures.
Uveitis‐glaucoma‐ hyphema syndrome (UGH) as complication in the long‐term cataract surgery
Authors: Dolores Diaz Maria , Boned Ana , Martínez Juana , Marco Sara , López Isabel , Karlsruher Gisela , Montes Paula , Javier Ascaso Francisco
Published: December 2019

Purpose

Although uveitis‐glaucoma‐hyphema (UGH) syndrome was described as a postoperative complication associated with intraocular lenses (IOL) in the anterior chamber, cases with IOL in the posterior chamber have also been described in both into capsular bag, in sulcus as well as lenses anchored to the iris. The physiopathology is not clear but it seems that the mechanical friction produced by the IOL haptics, in contact with different structures, produces erosion, pigment dispersion and consequently anterior uveitis accompanied by elevated intraocular pressure (IOP) and hyphema. Different treatments have been proposed: topical or systemic drugs, YAG laser iridectomies, capsular tension rings, anti‐VEGF or IOL explantion.

Methods

We present the case of a 40‐year‐old man who came to our emergency department with painful red left eye and blurred vision since several hours. He had a history of left congenital cataract surgery when he was 14. The patient presented uveitis with elevated IOP that did not yield with topical treatment with mydriatics, corticoids, antihypertensive drugs and oral diuretic agent. 24 hours later, he showed hyphema, deciding to enter the hospital IV for treatment. Symptomatic control was achieved, being discharged with topical treatment. 15 days later he returned to A&E at the same clinic. He was treated in the same way and ultrasonic biomicroscopy (UBM) was performed.

Results

UBM demostrated a poorly positioned IOL.Then, we diagnosed him with UGH syndrome. After presenting a third episode a week after discharge, explantation exchange was decided. Since then it is in follow‐up and has not submitted incidents.

Conclusion

The increase in cataract surgeries implies that a growth of the possible associated complications.UGH syndrome must be taken into account in all those patients who present their characteristic triad. Before suspicion a UBM should be performed.
Impact of preserved and preservative‐free 0.005% latanoprost ophthalmic formulations on human conjunctival goblet cell survival
Authors: Kolko Miriam , Ahmad Mouhammad Zaynab , Müllertz Olivia , Vohra Rupali , Heegaard Steffen , Petrovski Goran
Published: December 2019

Purpose

To compare the cell toxicity levels of preserved (P) and preservative‐free (PF) 0.005% latanoprost formulations used in glaucoma treatment, on pure cultures of human conjunctival goblet cells (GC), and to establish the physical properties of the various P and PF formulations, with respect to drop size distribution, pH, osmolarity, surface tension and the amount of latanoprost in each formulation.

Methods

The pureness of the cultured human conjunctival GC was established using PAS staining and immune‐staining specific for GC. The impact of the branded and generic P or PF latanoprost (Monoprost®). Latanoprost formulation on the GC survival was assessed using LDH cytotoxicity detection assay and MTT cell proliferation assay. Chemical properties of the ophthalmic formulations containing P or PF latanoprost was determined with respect to drop size distribution, pH, osmolarity, surface tension and the amount of latanoprost in each formulation.

Results

PAS and immuno‐staining showed the purity of the GC cultures. The GC survival was compromised when treating with P latanoprost, whereas when treating with PF latanoprost, the cells appeared not to be affected. Significant differences could be observed in regard to the pH, osmolality, surface tension, and drop size between the treatment modalities.

Conclusion

Viability of pure GC cultures was decreased by P latanoprost formulations, whereas PF latanoprost did not cause GC death. The loss of conjunctival GC will produce dry eye symptoms in patients, which is the most described discomfort by the patient. More emphasis should therefore be placed on physicochemical properties and on the toxicity from using P latanoprost formulations when treating glaucoma patients.