bluuebunny/crossref_metadata_2025 huggingface dataset:
Severity of type 2 diabetes in Seine St Denis among patients with diabetic macular edema treated by antiVEGF
Authors: STEPHAN S , FAJNKUCHEN F , GIOCANTI‐AUREGAN A
Published: August 2014

Purpose Diabetic macular edema (DME) is the main cause of loss of vision over the course of diabetes. In this study we sought to know whether DME was more severe in Seine st Denis, a french area, where the poverty is higher than in other french plac

Methods We enrolled all patients suffering from DME and treated by ranibizumab intravitreal injections between November 2012 and April 2013. In order to evaluate the severity of DME and the medical management of diabetes of these patients, we collected the following parameters: central macular thickness measured by SD‐OCT, the best corrected visual acuity, diabetic retinopathy severity, HbA1c, diabetes duration, and associated diseases.

Results We included 25 type 2 diabetic patients (8 women and 17 men), the mean age was 64± 8,1 years. Mean central macular thickness was 523 ± 145 μm. The best corrected visual acuity was 51 letters at baseline (counting fingers‐ 70 letters). 22 patients (88%) had a severe non proliferative diabetic retinopathy or a proliferative diabetic retinopathy. Mean HbA1c was 7,8% (+/‐ 2,3%). For 23 cases (92%), diabetes was associated with high blood pressure, and the average was 14,5±2 /8,5 ± 1,3 mmHg. Diabetes lasted for 13,1 years at baseline.

Conclusion Diabetic patients, in this case series, had a more severe DME regarding macular thickness and visual acuity than patients from large randomized studies found in the literature. This severity could be due to a sub optimal management of their diabetes. DME may become a tool to witness a limited access to good medical cares.
Use of bromfenac eye drops in the treatment of diabetic macular edema: a pilot study
Authors: BLASETTI F , CASU G , D'AMICO RICCI G , BOSCIA F , PINNA A
Published: August 2014

Purpose To evaluate the effect of bromfenac eye drops on diabetic macular edema (DME).

Methods In this pilot study, 20 eyes of 20 patients with monocular DME were analyzed. Topical bromfenac was administered in the affected eye twice daily for 30 days. Visual acuity (VA) and macular thickness, determined by optical coherence tomography (OCT), were evaluated initially and after 30 days' therapy. Statistical analysis was performed by Student’s t test.

Results Pre‐treatment mean VA was 0.38±0.2 logMAR and final mean VA was 0.41±0.18 logMAR, a not statistically significant result (p=0.21). Initial mean macular thickness was 476.15±130.16 μm and post‐treatment macular thickness was 413.8±161.13 μm, a statistically significant difference (p=0.04).

Conclusion The results of this pilot study suggest that topical bromfenac twice daily may play a role in the reduction of DME. This preliminary finding is interesting; however, further larger multi‐centre studies are necessary to establish whether, or not, topical bromfenac may be beneficial in the treatment of DME.
The efficacy of dexamethasone implant (Ozurdex 700 μg) in refractory diabetic macular oedema
Authors: KARTTUNEN T , KAARNIRANTA K , KINNUNEN K
Published: August 2014

Purpose The efficacy of dexamethasone implant in refractory diabetic macular oedema (DMO).

Methods 24 eyes of 22 patients having single dexamethasone implant for refractory DMO were included in the study. Patients with another retinal disease causing macular oedema were excluded. The patient data was collected and analyzed retrospectively. As a demographic data, age, gender and the type of diabetes and duration of DMO were collected. Morphology of the retina and changes in foveal thickness were analyzed with Heidelberg SD‐OCT. Furthermore improvement in the best‐corrected visual acuity (BCVA) and changes in the intraocular pressure (IOP) were observed.

Results The mean age of patients was 65,6 (±10,6) years. 36,4% were female and 63,6% were male. 22,7% had type 1 (DM1) and 77,3% had type 2 diabetes (DM2). The mean duration of DMO was 26,1 (±23,8) months. 90,9% of the eyes had had previous argon laser treatment to macula and/or periphery. Panphotocoagulation was made in 29,2% of the eyes, 87,5% of the eyes were treated with intravitreal bevacizumab (4,3 ±3,0 injections) and 37,5% were treated with triamcinolone before. The mean BCVA at baseline was 0,34 (±0,17) in Snellen. Best improvement in visual acuity was seen 120,5 (±78,8) days after dexamethasone implant. Best achieved VA was 0,53 (±0,19). Baseline foveal thickness was 413,4 (±120,2) μm and at the point of best achieved VA 333,5 (±46,5) μm. Vitrectomy was performed in 20,8% before. 45,8% of the eyes were phakic and cataract developed in 72,7% of these eyes. The highest increase in IOP was 4,9 (±6,5) mmHg. 8,3% of the eyes needed IOP lowering medication.

Conclusion We suggest that dexamethasone implant is a useful treatment in DMO even in relatively poor eyes.

Commercial interest
Tissue plasminogen activator as an anti‐angiogenic agent in experimental laser‐induced choroidal neovascularization
Authors: OZONE D , NOZAKI M , OHBAYASHI M , HASEGAWA N , KATO A , YASUKAWA T , OGURA Y
Published: August 2014

Purpose Tissue plasminogen activator (tPA) is a fibrinolytic compound, utilized originally to treat embolic or thrombotic stroke and as an adjuvant for displacement of submacular hemorrhage. The purpose of this study is to investigate anti‐angiogenic effects of tPA on experimental laser‐induced choroidal neovascularization (CNV) in mice.

Methods CNV was induced by laser injury in C57BL/6J mice, and intravitreal injection of tPA (4 or 40 IU/µl) or PBS was performed immediately after laser injury. Fluorescein angiography was performed 7 days after laser treatment to grade fluorescein leakage. And CNV volumes were measured by confocal evaluation of Isolectin B4 staining of RPE‐choroid flatmounts. The expression of fibrin on day 3 was observed by immunostaining.

Results Fluorescein leakage was inhibited by tPA in a dose‐dependent manner, and a significant difference was found with tPA (40 IU/ µl) compared with PBS (p=0.02). A dose‐dependent suppression of CNV volume was also observed by tPA, and there was a significant differences between tPA (40 IU/µl) (208988  52456 µm3) and PBS (386902  103060 µm3, p<0.01). The expression of fibrin was reduced in eyes treated with tPA.

Conclusion Intravitreal injection of tPA reduced the expression of fibrin and significantly suppressed laser‐induced CNV in mice. These findings suggested that tPA might be anti‐angiogenic and have a potential as an adjuvant to anti‐vascular endothelial growth factor therapy.
Major American dietary patterns are related to age‐related macular degeneration
Authors: CHIU CJ , CHANG ML , ZHANG FF , LI T , GENSLER G , SCHLEICHER M , TAYLOR A
Published: August 2014

Purpose We hypothesized that major American dietary patterns are associated with age‐related macular degeneration (AMD) risk.

Methods 8,103 eyes from 4,088 eligible participants in the baseline Age‐Related Eye Disease Study (AREDS) were classified into control (n=2,739), early AMD (n=4,599), and advanced AMD (n=765) by AREDS AMD Classification System. Food consumption data were collected by a 90‐item food frequency questionnaire.

Results Two major dietary patterns were identified by factor (principle component) analysis based on 37 food groups and named Oriental and Western patterns. The Oriental pattern was characterized by higher intake of vegetables, legumes, fruit, whole grains, tomatoes, and seafood. The Western pattern was characterized by higher intake of red meat, processed meat, high‐fat dairy products, French fries, refined grains, and eggs. We ranked our participants according to how closely their diets line up with the two patterns by calculating the two factor scores for each participant. For early AMD, multivariate‐adjusted odds ratio (OR) from generalized estimating equation logistic analysis comparing the highest to lowest quintile of the Oriental pattern score was ORE5O=0.74 (95% confidence interval (CI): 0.59‐0.91; Ptrend=0.01), and the OR comparing the highest to lowest quintile of the Western pattern score was ORE5W=1.56 (1.18‐2.06; Ptrend=0.01). For advanced AMD, the ORA5O was 0.38 (0.27‐0.54; Ptrend<0.0001), and the ORA5W was 3.70 (2.31‐5.92; Ptrend<0.0001).

Conclusion Our data indicate that overall diet is significantly associated with the odds of AMD and that dietary management as an AMD prevention strategy warrants further study.
Predictive value of outer retina Enface OCT imaging in geographic atrophy progression
Authors: GIOCANTI‐AUREGAN A , TADAYONI R , DOURMAD P , MAGAZZINI S , COHEN SY
Published: August 2014

Purpose To determine wether there was a correlation between hypo reflective area in Enface OCT of outer retina at baseline, and geographic atrophy (GA) area 1 year later in dry age‐related macular degeneration (AMD)

Methods Retrospective study. We included all patients who underwent a clinical examination for dry AMD from July to November 2013 and who had macular captured Enface OCT. Eyes with previously treated wet AMD were excluded. We analysed hypo reflectivity on Enface SD‐OCT extraction (Cirrus 2, Carl Zeiss Meditec,Dublin) of the outer retina 20 µm above retinal pigmented epithelium (RPE), corresponding to the disruption of ellipsoid line (EZ), and extraction below RPE corresponding to GA, the speed of progression of these 2 parameters, the pattern of these areas, best corrected visual acuity (BCVA) on ETDRS scale, and foveal involvement in GA. Our endpoint was the correlation between the difference area EZ‐GA and GA enlargement over 1 year on Enface OCT. Our secondary endpoint was the pattern similarities between both of these parameters.

Results We included 38 eyes of 31 patients with dry AMD, mean age was 84,9 years. At baseline, mean size of GA area was 7.1 mm2, mean size of hypo reflectivity was 9.28 mm2, fovea was involved in GA in 49% of cases, BCVA was 64.2 letters. One year later, mean size of GA area was 9.2 mm2, fovea was involved in 54% of cases, BCVA was 58.8 letters. The rate of progression of GA was 2.04 mm2 per year. The difference EZ‐GA at baseline and GA enlargement were not strongly correlated. The pattern of EZ disruption on Enface OCT was correlated in more than 2/3rd of cases with the pattern of GA 1 year later.

Conclusion EZ disruption and GA 1 year later are not constantly correlated
Five‐year results of ICG‐Guided Photodynamic Therapy combined with intravitreal Ranibizumab for juxtapapillary polypoidal choroidal vasculopathy with macular involvement
Authors: PETROPOULOS IK , MATTER MA , DESMANGLES PM
Published: August 2014

Purpose Long‐term results of the treatment of 3 patients with juxtapapillary polypoidal choroidal vasculopathy complicated by a serous macular pigment epithelium detachment (PED) are presented.

Methods Two women and one man (70, 77, and 84 years of age, respectively) presented with recent vision decrease in one eye. Decimal visual acuity (VA) of the affected eye was 0.2, 0.6, and 0.3, respectively. Fluorescein and ICG angiography as well as optical coherence tomography revealed juxtapapillary polypoidal choroidal vasculopathy and a large, dome‐shaped, serous macular PED.

Results Selective ICG‐guided photodynamic therapy (PDT) with verteporfin directed to the juxtapapillary polyps was performed, followed by 3 monthly intravitreal injections of ranibizumab (Lucentis®), resulting in complete regression of the serous macular PED and in sustained VA increase. One month after the third injection, VA of the affected eye was 0.6, 0.9, and 1.0, respectively. One year later, VA of the affected eye was 0.7, 1.0, and 0.9, respectively. During 5 years of follow‐up, no recurrence of exudation was observed and VA remained the same.

Conclusion The association of selective ICG‐guided juxtapapillary PDT with intravitreal injections of ranibizumab apparently led to scarring of the source of subretinal fluid, to protection of the adjacent normal choriocapillary network, and to protection against the VEGF spike described after PDT, thus enabling significant vision improvement. Combined treatment with ICG‐guided PDT and intravitreal ranibizumab is beneficial for juxtapapillary polypoidal choroidal vasculopathy with macular involvement, offering excellent long‐term results.
Neovascular amd: multimodal criteria of neovascular activity
Authors: GONZALEZ C
Published: August 2014

Purpose To evaluate the multimodal criteria and the best evaluation of neovascular activity to indicate recurrence and so treatment indication

Methods 218 eyes of 170 patients, 50 men, 120 women, with subretinal neovascularization complicating AMD. First and 2 months’ interval follow‐up exam included ETDRS visual acuity (VA), complete ophthalmic examination with fundus exam, optical coherence tomography (HRA spectral domain OCT), fluorescein (FA) and infracyanine (ICG) angiography. VA and OCT were done before each IVT

Results Each exam was analyzed, evaluation was given, and compared to previous one. A score was established for each data, so exam, using cross. Every score was added to each other, the value of final score determine the degree of activity. The cross grading scale was: for VA: impaired = ++, same = +, improved = 0; for OCT: increased (inflammation, diffuse edema, MCO, SRD, Neovascularization thickness) = ++, same = +, reduced = 0; for FA: increased (diffusion, occults, PED, MCO, Neovascularization density) = ++ (according to increased intensity : ++++ (intense), +++ (moderate), ++ (mild)), same = +, decreased = 0; for ICG: High Flow NeoVx = ++++, Middle Flow NeoVx = +++, Low Flow NeoVx = ++. Score superior or equal to 8 mean Neovascular activity and so treatment indication. Using those criteria, Neovascular activity definition is more discriminating and efficient. Treatment indications are more precise and discerning. With those Neovascular activity and indication treatment criteria, this so called Proreactive protocol was defined and applied

Conclusion The multimodal criteria of Neovascular activity allow us to improve Neovascularization definition, then treatment indications, therefore to propose Proreactive protocol treatment ,optimization of antiVEGF IVT treatment
Influence of lornoxicam and triamcinolone on the dynamics of eye remodeling in concanavalin model of inflammation
Authors: ERDIAKOV A , GAVRILOVA S
Published: August 2014

Purpose To compare the effects of NSAID lornoxicam and corticosteroid triamcinolone on the dynamics of eye remodeling in concanavalin model of inflammation.

Methods Eye of Wistar rat was injected with 0,5 mcg (2,5 mcl) concanavalin A (ConA) in vitreous cavity. After 20 min rats received a saline, 16 mcg lornoxicam or 80 mcg triamcinolone intravitreal injection (2 mcl). On 1 and 2 day after that the medication was administered systemically. Histological evaluation of retinas was made on 7, 14, 28 and 56 days after inravitreal injection of ConA.

Results The total frequency of cararactogenesis after the injection of ConA was 72%. Lornoxicam and triamcinolone suppressed the development of cataracts. Lornoxicam 6 times decreased the total frequency of eye hemorrhage. After 7 days following ConA injection lornoxicam decreased thickness of more retina layers than triamcinolone. After 14 days triamcinolone increased the thickness of the outer plexiform, inner nuclear, inner plexiform layers as compared with the control group. At day 14 lornoxicam but not triamcinolone reduced the thickness of ganglion cell layer (GCL). At day 28 both drugs reduced the thickness of GCL. Phospholipase A2 and cyclooxygenase (COX) blocking reduced structural abnormalities of the retina, but its thickness increased on 56 day after triamcinolone administration.

Conclusion Lornoxicam prevented the development of proliferative vitreoretinopathy (PVR), reduced the severity of symptoms typical for proliferative diseases of the eye. It also inhibited the proliferation of retinal cells. Triamcinolone impaired the overall health of animals, less prevented the development of PVR compared to lornoxicam. Its effect on the proliferation of retinal cells was ambiguous.
Multifocal choroïditis: is it a granulomatosis close to sarcoidosis?
Authors: BENLAHBIB M , HAJJI Z , BENCHERIFA F , BOULANOUAR A , BERRAHO A
Published: August 2014

Purpose Multifocal choroiditis is an idiopathic posterior uveitis. It combines small white spots in fundus of eye and recurrent intraocular inflammation. Some biological or radiological manifestations of sarcoidosis may be found in these patients.

Methods We report a case of severe multifocal choroiditis associated with systemic granulomatosis. The aim of our study was to describe the clinical and therapeutic aspects, and discuss the etiopathogenic approach of this rare entity.

Results A 45 years old women who consults for blurred vision. Visual acuity is reduced at 1/20 P8 in right eye and 3/10 P5 in the left. There is a hyalite + bilaterally. Peri papillary atrophy, hemorrhage around the macula, multiple white and pigmentis small spots was found in fundus of eyes. Retinal thickening and involvements of the pigment epithelium and choroid are revealed by macular OCT in the right eye. The fluorescein angiography show hypofluorescence of chorioretinal spots in early time, a window effect scarring and bilateral papillitis. The ECA is 74 UECA. Chest scan reveal a non specific parenchymal micronodules. The patient received systemic corticosteroids. Control OCT show a subretinal fibrosis explaining the introduction of immunosuppressant treatment. The final visual acuity is 1/10 right and 12/10 left with a decline of 3 years.

Conclusion Although intraocular manifestations of multifocal choroiditis, it most correspond to a systemic granulomatosis near sarcoidosis.
A review of acute posterior multifocal placoid epitheliopathy
Authors: PEREZ NAVARRO I , ALMENARA MICHELENA C , CARAMELLO C , HERRERA L , PEREZ GARCIA D , MARTINEZ M , ESTEBAN O
Published: August 2014

Purpose Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory disease, generally of unknown a etiology, affecting the choriocapillaris, the pigment epithelium and the outer retina. It predominantly affects young patients.

Methods Our patient was a 14‐year‐old female presented with rapid bilateral loss of vision She reported lu‐like symptoms and taking antibiotics therapy. Fundoscopy revealed yellow‐white subretinal lesions in the posterior pole with foveolar affectation of both eyes. Fluorescein angiography in acute stage of the disease demonstrated early hypofluorescence followed by later hyperfluorescence of the lesions. Indocyanine green angiography demonstrated hypofluorescence in all stages of the angiogram.

Results After a period of 7 days oral prednisone treatment she was completely recovered

Conclusion Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is characterized by rapid, but transient loss of visual acuity. Diagnosis is established in fluorescein angiography and prognosis for recovery is good, however in cases with poor visual acuity glicocorticosteroids might be beneficial. Usage of steroids is recommended for treating APMPPE in cases where macula is involved and in recurrent cases
Intravitreal dexamethasone implant in the treatment of postoperative cystoid macular edema (Irvine Gass syndrom): one year retrospective study
Authors: LANDRé C , GASTAUD P , BAILLIF S
Published: August 2014

Purpose To evaluate the efficacy of dexamethasone 0.7mg intravitreal implant in patients with chronic postoperative cystoid macular edema.

Methods Fourteen patients’ charts were retrospectively reviewed. Inclusion criteria comprised patients with postoperative cystoid macular edema. The main outcome measures were best corrected visual acuity (BCVA) and mean central retinal thickness (CRT).

Results Patients mean age was 72.1 years. All patients were pseudophakic. Six patients were diabetic. Four patients had received a previous treatment with intravitreal ranimizumab. The mean BCVA before intravitreal dexamethasone was 0.75 logmar. It improved to 0.56 at month 1 and was 0,45 at month 3. The pre injection mean CRT was 584.6 µm. It improved to 309 µm at month 1 and was 341,5 at month 3. Seven patients presented an elevated intraocular pressure during the follow up

Conclusion Intravitreal dexamethasone implant improved visual acuity and macular thickness at month 1 and month 3 in patients with postoperative cystoid macular edema. However its beneficial effect seemed to decrease at month 3.
Prognostic factors for epiretinal membrane surgery
Authors: PAPANDREOU I , FALLON T
Published: August 2014

Purpose To evaluate the outcome of epiretinal membrane surgery and to recognize potential prognostic factors.

Methods Case notes and SD‐OCT scans from all patients that were operated for epiretinal membranes between 01/2010 and 12/2013 were reviewed. All patients had received a standard 23G pars plana vitrectomy with epiretinal membrane peel by a single surgeon. Best corrected visual acuity (BCVA) on the logMAR chart was recorded before surgery and at the last visit. Central retina thickness (CRT) was measured manually on the corresponding OCT scans. OCT was performed with the Spectralis OCT device (Heidelberg Engineering, Heidelberg, Germany) using the standard protocol of the clinic. Statistical analysis involved the Wilcoxon signed rank test and Spearman correlation test.

Results 26 eyes of 26 patients were included in this study. The mean age was 76.2 years (range 36‐87). The follow up time was up to 41 months with a mean of 15. The mean BCVA was 0.89 before and 0.70 after surgery (p=0.01). The mean BCVA improvement of 2 lines remained among patients with idiopathic (p=0.02) and secondary membranes (p=0.29). Pre‐ and postoperative lens status, sex and the postoperative use of NSAIDs did not seem to affect the outcome. The postoperative BCVA correlated strongly with the preoperative one (ρ=0,789, p<0.001) but not with the preoperative CRT. There was no statistically significant difference in the postoperative BCVA between patients with intact or disrupted ellipsoid zone, external limiting membrane (ELM) or fovea contour. The preoperative existence of intraretinal cysts also did not seem to influence the BCVA after surgery.

Conclusion Preoperative BCVA seems to be the main prognostic factor for the outcome of epiretinal membrane surgery.
Severe inferior retinal folding after retinectomy: an uncommon form of posterior proliferative vitreoretinopathy
Authors: BARCATALI MG , DENION E
Published: August 2014

Purpose Relaxing retinectomy is a surgical procedure commonly used in the presence of a retinal shortening in retinal detachments with severe proliferative vitreoretinopathy (PVR. Severe inferior retinal folding (SIRF) is an uncommon form of posterior PVR observed after retinectomy. This rare complication has been described in a single publication so far.

Methods A 49‐year‐old woman presented with a 180° giant retinal tear with diffuse posterior PVR.

Results She was treated with pars plana vitrectomy, retinectomy, internal limiting membrane peeling, endolaser and silicone oil tamponnade. A week after the retina was completely attached. Visual acuity was counting fingers. Twenty seven days after the intervention, a recurrent PVR detachment involving the lower hemi‐retina was observed. The lower retinal edge had retracted upwards away from the retinopexy scar (SIRF). Six months after the patient underwent silicone oil removal, epi‐retinal membrane peeling, repeat inferior retinectomy, endolaser and C2F6 tamponnade. The spared retina remained attached. Visual acuity was “hand motion”.

Conclusion SIRF consists in an inferior widespread epi‐retinal membrane whose massive retraction capacity overcomes retinopexy adhesion. The inferior retina ends up retracted upwards like a Venetian blind, away from the retinopexy scars. SIRF is rare. It has been described only in 5 of 254 patients after relaxing retinectomy over a 9‐year period in Gupta et al. study.
Glucose levels in the vitreous in patients with retinal detachment
Authors: ARNDT C , HUBAULT B , DUCASSE A , RAMONT L
Published: August 2014

Purpose In retinal detachment surgery when primary vitrectomy is performed , macular atrophy limits visual recovery. The physiopathological mechanism of this macular impairment remains unknown. The purpose of the present study is to evaluate whether the vitreous composition could be a prognostic factor for visual outcome and macular atrophy.

Methods In a prospective study on 51 non diabetic patients undergoing primary vitrectomy for rhegmateous retinal detachment, a biochemical analysis of Na,K, Cl, glucose was performed . Post‐operative visual acuity and macular thickness assessed with OCT was correlated with the biochemical analysis.

Results In the group with low glucose levels, macular thickness was higher than in the patients with higher glucose levels (p=0.0002 Mann‐Whitney). No difference in terms of post‐operative visual acuity was found between the 2 groups with high and low glucose levels in the vitreous. Na, K, Cl appeared to have no incidence on macular thickness or post operative visual acuity.

Conclusion Increased glucose levels appear to be assocated with macular atrophy. They may be reflect retinal glycation even in non diabetic patients.
Optic nerve oximetry mapping using a novel metabolic hyperspectral retinal camera
Authors: DESJARDINS M , SYLVESTRE JP , TRUSSART R , ARBOUR JD , LESAGE F
Published: August 2014

Purpose Oximetry measurement of the principal retinal vessels represents a first step towards understanding retinal metabolic state. Spectral imaging is expected to significantly enhance metabolic state evaluation via local fundus oximetry determination. In this preliminary study, we focus on the oximetry of the entire optic nerve head (ONH) microvasculature from datasets obtained with a novel metabolic hyperspectral retinal camera (MHRC).

Methods Five healthy volunteers had retinal images captured between 490‐650 nm in steps of 5 nm using a prototype MHRC (Optina Diagnostics, Montreal, Canada) based on a tunable laser source that permits the selection of a specific wavelength (2 nm bandwidth) from a supercontinuum source. Each subject's data was fit to a model where oxy‐ and deoxyhemoglobin are the main absorbers and scattering is modeled by a log(1/wavelength) term. The fitted parameters were used to extract an estimation of oxygen saturation and total hemoglobin content.

Results The local oximetry and hemoglobin content maps over the entire ONH microvasculature were extracted for all subjects from the spectral‐rich information. Physiologically plausible oxygen saturation values were obtained for all subjects over this region (mean 58 +/‐ 6 %).

Conclusion The oximetry and hemoglobin content maps of the ONH microvasculature obtained with the MHRC could ultimately contribute to the diagnostic and optimal management of diseases affecting the ONH such as glaucoma.
Embryology of extraocular muscles : A new vision
Authors: TRECHOT F , MICARD E , CENDRE R , TONNELET R , ANGIOI K , BRAUN M
Published: August 2014

Purpose To describe the embryology of extraocular muscles, through a 3D viewing algorithm, from Carnegie stage XVII to Carnegie stage XXIII (41st‐57th day of development).

Methods The work consisted of a scanning and a data processing reconstruction of embryonic histological material. Material came from anatomical universities collections. 12 embryos were selected, and 7 were dedicated to muscle study (from 14.5mm to 54.5mm). This data processing has allowed a study in three spatial planes.

Results From Carnegie stage XVII, all extraocular muscles are in place, including levator palpebrae. The study in 3 planes makes their individualization easier. Gilbert (Carnegie Institution) described the origin of inferior rectus and inferior oblique by a common primordium, however from the stage XVII the two muscles are clearly separated. The decussation of the superior oblique is seen from the stage XIX, the trochlea appears at stage XXII. Our work also demonstrates the nerves : optic, oculomotor, trochlear, trigeminal and abducens. The junctions between nerve and muscle are put in evidence, especially for the lower branch of the oculomotor nerve.

Conclusion This new study tool has resulted in explicit images of the development of extraocular muscles in the embryonic period. It helped to provide details with respect to the work already established by the Carnegie Institution.
Microglia activation in mice retina contralateral to experimental glaucoma: increased cell number and retraction of processes beyond GCL
Authors: RAMIREZ AI , GALLEGO B , ROJAS B , DE HOZ R , SALAZAR JJ , VALIENTE‐SORIANO FJ , AVILES‐TRIGUEROS M , VILLEGAS PEREZ MP , VIDAL‐SANZ M , TRIVINO A , RAMIREZ JM
Published: August 2014

Purpose To analyse quantitatively retinal microglia signs of activation after two weeks of laser‐induced ocular hypertension (OHT) in OHT‐eyes and their contralateral eyes

Methods Adult albino Swiss mice were assigned to two groups: naïve (n=6) and lasered (n=9). Anti‐Iba1 was used in retinal whole‐mounts to analyse microglial number and the area covered by each microglial cell (arbor area)

Results In naïve, contralateral and OHT‐eye microglia were distributed throughout the retina in the photoreceptor layer (PRL), outer plexiform layer (OPL), inner plexiform layer (IPL), nerve‐fibre layer (NFL) and ganglion‐cell layer (GCL). In comparison with naïve, contralateral eyes and OHT‐eyes showed a significant increase in the number of microglial (p<0.05 and p<0.001, respectively) and in the area of the retina occupied by microglial cells in the NFL GCL (p<0.01 and p<0.001 respectively). OHT eyes exhibited significantly higher values than did contralateral eyes for microglial number (p<0.001) and for the area of the retina occupied by microglial cells in the NFL‐GCL (p<0.001). In comparison with naïve, the microglial arbor area in the OPL and IPL was decreased in both OHT eyes (p<0.001 in both instances) and in contralateral untreated eyes (p<0.05 and p<0.001, respectively)

Conclusion Two weeks of laser‐induced OHT induce an increase of microglia number and retraction of processes beyond the GCL both in OHT eyes as well as in contralateral normotensive untreated eyes. Differences between the two groups could help to elucidate glaucoma pathophysiology. (OFTARED Grant RD12/0034/0002 and RD12/0034/0014)
A novel proteotoxic stress‐associated mechanism for macular corneal dystrophy
Authors: KAARNIRANTA K , SZALAI E , SMEDOWSKI A , WYLEGALA E , FELSZEGHY S
Published: August 2014

Purpose Macular corneal dystrophy is a rare autosomal recessive eye disease primarily affecting the corneal stroma. Abnormal deposits have been observed intra‐ and extracellularly in the stromal layer. In addition to the stromal keratocytes and corneal lamellae, deposits are also present in the basal epithelial cells, endothelial cells and Descemet's membrane. Misfolded proteins have a tendency to gather into aggregating deposits. We studied the interaction of molecular chaperones and proteasomal clearance in macular dystrophy human samples and in human corneal HCE‐2 epithelial cells in this disease.

Methods Seven cases of macular dystrophy and 5 normal human corneal buttons were collected during corneal transplantation. Fluorescent immunohistochemistry on human donor corneal button was used to verify the spatial distribution pattern of selected Hsp70, SQSTM1/p62 and ubiquitin molecules, respectively. The expression level of these proteins were analysed in HCE‐2 cells using western blotting and transmission electron microscopy, respectively.

Results Highly elevated Hsp70, SQSTM1/p62 and ubiquitin protein conjugates were observed in intracellular space of the epithelial cells in macular dystrophies. All the studied proteins were also highly elevated under proteasome inhibition in human corneal epithelial HCE‐2 cells in cell cultures.

Conclusion We report a novel proteostatic regulatory mechanism that connects the molecular chaperone and proteasomal clearance system with the pathogenesis of macular corneal dystrophy.
presbyopia and hyperopia treatment by Presbylasik using a central multifocal excimer laser profile with a micromonovision
Authors: SAIB N , ABRIEU N , BERGUIGA M , RAMBAUD C , FENOLLAND JR , BONNEL S , FROUSSART‐MAILLE F , RIGAL‐SASTOURNE JC
Published: August 2014

Purpose To analyze the efficacity and satisfaction of treatment by hyperopic presbyopia with a new in situ keratomileusis (LASIK) procedure, Supracor( Technolas Perfect Vision).

Methods This retrospective study included 58 eyes of 29 patients treated with a new central multifocal presbyLASIK with a micromonovision using the Technolas 217P excimer laser between september 2011 to september 2013. Mean patient age was 55 years (range 47 to 62 years). The mean preoperative spherical equivalent refraction was +1.3D. The main outcome measure were uncorrected distance visual acuity (UDVA) and uncorrected reading ability, aberrometry, the bump and the satisfaction of the patients.

Results The mean binocular UDVA was 0.09 logMAR‐/+0.15 for distance vision and 0.22 logMAR+/‐0.11 for near vision the day postoperatively , 0.04 logMAR+/‐0.14 for distance vision and 0.17 logMAR+/‐0.12 for near vision at 1 months , 0.15 logMAR+/‐0.23 and 0.19logMAR+/‐0.18 respectively at 3 months and ‐0.02 logMAR+/‐0.06 and 0.18 logMAR +/‐0.11 respectively at 6 months. The mean bump was 2.56+/‐0.9D. The median total RMS increased from 0.30µm +/‐0.07 preoperatively to 0.46µm+/‐0.14 postoperatively (p<0.01). 3 patients had a retreatment : 2 in the dominant eye to improve the UDVA of distance vision and 1 in the nondominant eye to improve near vision. 86% of patients report an independance of glasses for daily activities using near, intermediate and distance vision. 100% of patients would recommend these procedure to their friends.

Conclusion Central Presbylasik with micromonovision provided a high level of independance for near, intermediate and far vision.
Distribution of orbscan indices in a young population of Iran
Authors: YEKTA AA , HASHEMI H , KHABAZKHOOB M , YAZDANI N , OSTADIMOGHADDAM H , DERAKHSHAN A , MOUSAVI M , HERAVIAN J , NOROUZIRAD R , YEKTA R
Published: August 2014

Purpose To determine the distribution of keratometric indices, corneal thickness, anterior chamber depth, pupil diameter and corneal diameter by Orbscan in a young Iranian population.

Methods In this cross‐sectional study, samples were selected through multistage cluster sampling from among the students of Mashhad University of Medical Sciences, Iran. After performing refraction and retinoscopy, Orbscan was used for imaging.

Results Of 1330 selected students, 1121 participated in the study. After applying the exclusion criteria, final analysis was performed on 1051 subjects. The mean age of the subjects was 26.1±3.2 years (19‐34 years old). The mean and 95% confidence interval (CI) of maximum keratometry, minimum keratometry, pupil diameter corneal diameter, anterior chamber depth, and central corneal thickness were 44.5(44.4‐44.6), 43.1(43.0‐43.2), 4.3(4.3‐4.4), 11.7(11.7‐11.7), 3.7(3.6‐3.7) and 550.5 (548.4‐552.6), respectively. After adjusting with age and spherical equivalent (SE), the maximum and minimum keratometry, thinnest corneal thickness were higher in females while the corneal diameter and anterior chamber depth were more in males. Corneal diameter and anterior chamber depth showed significant changes with age. The SE was only correlated significantly with maximum keratometry and anterior chamber depth.

Conclusion The results of this study showed the normal ranges and averages of some Orbscan indices in a young Iranian population. The insignificant changes of the corneal diameter and anterior chamber depth with age and the differences between males and females in the evaluated indices should be considered in refractive surgery.
Structure of Collagen fibril and proteoglycans at different depth of corneal stroma of CXL treated rats
Authors: AKHTAR S , SMEDOWSKI A , KHAN A , KAARNIRANTA K , ALMUBRAD T
Published: August 2014

Purpose In the present study we assess the effects of collagen cross‐linking on ultrastructure organization of collagen fibrils (CF) and proteoglycans (PGs) in a rat model.

Methods The corneas were treated with a standard cross linking (CXL) method with isotonic riboflavin. Scelral‐corneal rings were removed one week after the treatment. All samples were fixed in 2.5% glutaraldehyde containing cuprolinic blue in sodium acetate buffer and processed for electron microscopy.

Results The CXL rat corneal stroma thickness increased compared to the normal rat corneal stromal thickness. The collagen fibril diameter (29.28±3.42nm) in the anterior stroma of CXL rats was larger compared to the CF diameter (27.76±3.77nm) of the anterior stroma of control rats. Within the CXL rat corneal stroma, the CF diameter (29.28±3.42nm) and the interfibrillar spacing (43.01±3.32nm) in the anterior stroma were larger compared to the diameter (26.07±2.8nm) and interfibrillar spacing (41.27±3.52nm) in the posterior stroma. The PGs mean area was larger in the posterior stroma (260.1±282.395nm2) than the PGs mean area in the anterior stroma (209.98±177.0nm2) within the corneal stroma of the CXL rat.

Conclusion The present study demonstrates that CXL leads to an increase in the CF diameter and interfibrilar spacing and reduces the PGs area in the anterior stroma of the CXL rats. The changes in the collagen fibril diameter could be due to an increase in the spacing between the microfibrils within the collagen fibrils. The increase in interfibrillar spacing could be due to an increase in hydration in the corneal stroma.
Treatment of alkali‐injured corneas by nanofibers seeded with mesenchymal stem cells or loaded with cyclosporine a
Authors: HOLAN V , CEJKOVA J , CEJKA C , TROSAN P , ZAJICOVA A
Published: August 2014

Purpose Purpose. To test a possibilty to treat the early corneal inflammation occuring after alkali injury by nanofiber scaffolds seeded with mesenchymal stem cells (MSCs) or loaded with cyclosporine A (CsA).

Methods Methods. The alkali was applied on the cornea of the rabbit eyes. The eyes were rinsed with the excess of physiological solution and covered with nanofiber scaffold seeded with rabbit bone marrow‐derived MSCs or with nanofibers loaded with CsA. At different time intervals after the injury the eyes were analyzed macroscopically, immunohistochemically and biochemically.

Results Results. Treatment of alkali‐injured eyes with MSCs or CsA significantly attenuated the local inflammatory reaction. The therapeutic effects were characterized clinically, according to a reduced infiltration with inflammatory cells, by a lower neovascularization and by decreased expression of genes for proinflammatory molecules IL‐1beta, IL‐2, IFN‐gamma and iNOS and for vascular endothelial growth factor. These anti‐inflammatory effects were accompanied by a more rapid regeneration of the corneal epithelium and by increased expression of gene for cytokeratin K12.

Conclusion Conclusion. The results demonstrate that MSC‐seeded or CsA‐loaded nanofiber scaffolds represent a promising therapeutic tool for the treatment of alkali‐induced ocular surface injuries
Diquafosol sodium ophthalmic solution for the treatment of dry eye in soft contact lens wearers
Authors: YAMADA M , SHIGEYASU C , FUKUI M
Published: August 2014

Purpose Ocular dryness, experienced by up to 75% of soft contact lens (SCL) wearers, is the main reason for its discontinuation. The aim of the study is to evaluate the efficacy of topical application of diquafosol sodium for the treatment of dry eye in SCL wearers. In addition to clinical tests, we used a wheat germ agglutinin conjugate of fluorescein (F‐WGA) and fluorophotometry to evaluate the glycocalyx in the ocular surface in vivo.

Methods Twelve SCL wearers with dry eye symptoms (31.3 ± 6.8 year‐old) were treated with 3% diquafosol eyedrops for 4 weeks. The clinical tests included tear break‐up time (BUT), Schirmer test, fluorescein staining score, and subjective symptoms evaluated by the Dry Eye Related Quality of Life Score (DEQS). Five minutes after a 5% F‐WGA solution was applied to the eye, fluorescent intensities in the central cornea were measured by fluorophotometry.

Results When comparing before and after diquafosol treatment for 4 weeks, BUT (3.6±2.2 sec to 5.0±2.1 sec, p=0.003), kerato‐conjunctival staining score (2.8±1.8 to 2.1±1.4, p=0.045) and DEQS score (19.2±12.7 to 10.6±12.5, p=0.0032) showed statistically significant improvements (Wilcoxon signed‐rank test). F‐WGA fluorescent intensities in the central cornea (571.8±227.8 to 794.6±219.4, p<0.0001) significantly increased, and had a significant correlation with BUT.

Conclusion Fluorophotometric measurement of WGA staining appears to reflect the glycocalyx in the corneal epithelium, and therefore can be a good indicator of the ocular surface wettability. Topical application of diquafosol sodium improved subjective symptoms of SCL wearers with dry eye, possibly by enhancing tear film stability and reducing damage of ocular surface epithelia.
Evaluation of self‐report questionnaires as predictive tests for obtaining pathological schirmer i, tear film break‐up time and ocular protection index scores in dry eye disease patients
Authors: BADIAN R , UTHEIM TP , RÆDER S , UTHEIM Ø , CHEN X , EIDET JR
Published: August 2014

Purpose To assess if the ocular surface disease index (OSDI) and McMonnie’s self‐report questionnaires can be used as predictive tests for obtaining pathological Schirmer I, tear film break‐up time (TFBUT) and ocular protection index (OPI) scores in a Norwegian cohort of dry eye disease (DED) patients.

Methods Two hundred and fifty‐two patients with DED of mixed etiology were consecutively included in the study. Pathological Schirmer I, TFBUT, and OPI scores were defined as <10 mm, <10 s and <1, respectively. All patients received an extensive ophthalmological work‐up and completed the OSDI and the McMonnie’s questionnaires. Receiver‐operating characteristics (ROC) analysis was used to assess the ability of the OSDI and McMonnie’s questionnaires to predict pathological scores.

Results Maximal sensitivity (0.58) and specificity (0.67) for predicting a pathological OPI score was obtained by using 15.7 as OSDI cutoff value (area under the ROC curve 0.63; P=0.003). For Schirmer I, the maximal sensitivity (0.58) and specificity (0.60) for predicting a pathological score was obtained when using 13.6 as the OSDI cutoff value (area under the ROC curve 0.59; P=0.015). The McMonnies questionnaire could not predict either the pathological OPI or Schirmer I scores. Neither OSDI nor McMonnie’s questionnaires were able to predict pathological TFBUT scores.

Conclusion Cutoff values for the OSDI, but not the McMonnie’s questionnaire can be defined to predict pathological Schirmer I and OPI scores in DED patients with moderate sensitivity and specificity.
Clinical performance of preservative‐free, hypotonic solution of 0.15% sodium hyaluronate for mild to moderate dry eye
Authors: PURSLOW C
Published: August 2014

Purpose The viscoelastic and hydration properties of Hyaluronic Acid (HA) make it the ingredient of choice in modern topical formulations for relief of dry eye symptoms, but there are few that present it as a hypotonic preparation without preservatives, both properties known to be beneficial for dry eye management. This study was designed to investigate the patient satisfaction and clinical performance of Hyabak (R) (Laboratoires Thea, France) in a group of volunteers with mild to moderate dry eye symptoms.

Methods Thirty volunteers (8M, 22F; mean age 66.6 (SD 9.9) years) with mild to moderate dry eye symptoms, as assessed by the Ocular Surface Disease Index (OSDI) questionnaire), were recruited from an older population around Plymouth, UK. Participants were assessed at baseline and after 10 days of treatment with Hyabak (4 drops daily to each eye). The following was recorded at each visit: bulbar and limbal redness, corneal and conjunctival staining, tear film stability, ocular comfort using visual analogue scales (VAS) and OSDI scores.

Results Ocular comfort and OSDI scores showed significant improvements by day 10 (by 35% and 34% respectively; p<0.001). Average cornea and conjunctival staining decreased by 50% and 56% (both p<0.001), respectively. Improvements in bulbar and limbal redness were significant (p<0.001), and the improvement in tear film stability after 10 days was statistically significant (p<0.001) but clinically small (average increase +1.1 seconds)

Conclusion Statistically and clinically significant improvements in the key clinical indicators of success, including patient comfort, can be seen after only ten days using this preservative‐free, hypotonic formulation in mild to moderate dry eye.

Commercial interest
Decreased basal tear in aged mice is linked to morphological and functional changes in corneal sensory nerve fibers
Authors: IÑIGO PORTUGUÉS A , ALCALDE I , GONZÁLEZ‐GONZÁLEZ O , GALLAR J , BELMONTE C , MERAYO‐LLOVES J
Published: August 2014

Purpose To determine whether the effects of aging on density, morphology and functional activity of corneal cold sensory nerve fibers are associated with changes in basal tearing rate.

Methods TRPM8‐EYFP and TRPM8‐KO mice of different ages ranging from 90 to 720 postnatal days were studied. Basal tearing was measured in anesthetized animals, using phenol red threads. Corneal nerves expressing EYFP protein were identified in whole mount corneas using immunohistochemical techniques. Also, trigeminal ganglia (TG) were processed for immunofluorescence techniques against TrkA and CGRP. Extracellular electrical activity of single sensory nerve endings of the corneal surface was recorded in excised and superfused eyes.

Results The number of TRPM8+ fibers and nerve terminals decreased with age. Also, fibers of p90 mice were morphologically different from those of p720 TRPM8‐EYFP mice resembling those found in TRPM8‐KO mice. Basal tearing rate decreased in parallel with the reduction in number of TRPM8+ fibers. Two different populations of sensory nerve endings responding to cold were distinguished electrophysiologically: Low and High‐threshold cold terminals. With aging, the incidence of low‐threshold cold nerve endings decreased while more high‐threshold nerve endings were found. Also, a population of non‐peptidergic and another of peptidergic TRPM8+ neurons were distinguished in the TG.

Conclusion Corneal cold sensory fibers and terminals of TRPM8‐EYFP mice developed parallel changes in number and morphology, functional activity and basal tearing rate during aging, thus supporting the hypothesis that cold thermoreceptor activity and basal tearing are functionally associated.