bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of oxygen in ocular blood flow regulation
Authors: GARHOFER G
Published: December 2011

The normal function of the retina is crucially dependent on an adequate perfusion and oxygenation of the tissue. Thus, it does not come as a surprise that ocular blood flow is very well autoregulated. It is known for a long time that the retinal circulation, and to some extent also the chorodial circulation can compensate for changes in ocular perfusion pressure in order to keep blood flow constant. This is usually referred to as an autoregulatory response of these vascular beds. However, the ocular circulation also responds to changes in oxygen tension. For example, breathing of pure oxygen leads to a pronounced vasoconstriction of the retinal vessel, indicating that the ocular circulation also adapts to changes in oxygen tension. This talk aims to summarize our current evidence of the role of oxygen in ocular blood flow regulation and how this may relate to ocular pathologies such as glaucoma or diabetic retinopathy.
Intravitreal Ranibizumab for retrofoveolar neovascular Age Related Macular Degeneration, in Pseudo vitelliform and/or Drusenoid pigment epithelium detachment shape
Authors: GONZALEZ C
Published: December 2011

Purpose To evaluate the functional, anatomical, vascular flow, effects of intravitreal Ranibizumab injections for retrofoveolar neovascular Pseudo vitelliform and/or Drusenoid pigment epithelium detachment (PED) Age Related Macular Degeneration (AMD), at 3 years 1/2 evolution.

Methods 48 eyes of 40 patients, 15 men, 25 women, with neovascular Pseudo vitelliform(35 eyes) and/or Drusenoid PED (13eyes) AMD. Patients received intravitreous Ranibizumab, 3 times, every 4 weeks in an inductive treatment, the next injections (IVT), depending on the follow‐up results, were done by series of 3 IVT. First and 2 months’ interval follow‐up exam included ETDRS visual acuity (VA), complete ophthalmic examination, fluorescein and infracyanine (ICG) angiography, and optical coherence tomography (OCT).VA and OCT were done before each IVT.

Results VA improved in 52% cases. Angiographic leakage disappeared in 78% cases, reduced about 75% in 40% cases. At ICG ,vascular flow, vessel’s diameter were 2/3 time less in 45% cases, low‐flow in 83% cases .Diffuse edema was normalized in 60% cases , pigment epithelial detachment(PED) was less dense in most of cases, by OCT. No ocular or systemic side effects observed.Better contrast Inductive treatment was sufficient in 24 cases, needed 2 IVT Series in 40% cases, failed in 1 case. In few cases, retinal and pigment epithelium atrophy was induced, Drusenoid PED disappeared.Discussion is open.

Conclusion The results, with generally improved visual function, lack of fluorescein leakage, low neovascularisation’s flow in ICG, reduction of exudation on OCT, suggest Series of 3 Ranibizumab IVT Protocol seems effective, in those usually poor resort considered cases.
Immune modulation in the next decade
Authors: DICK A
Published: December 2011

Purpose Moving away from the morbidity of steroid therapy for inflammatory disease or the overburdonsome adverse events of immunosuppressive therapy, the advent of understanding of immune response during non‐infectious uveitis alongside the explosion in biotechnology has facilitated the development of biologic therapy. This has generated a new era for increasing equisitely specific therapy.

Methods The review will highlight experimental evidence of targets of inhibiting T cell activation, B cell responses, Trafficking of cells, and cytokine inhibition. However, most importantly is the increasing abibility to predict and therefore target responses.

Results We will highlight the strength of predicting response to steroid and highlighting mechanisms of steroid refractiveness has generated avenues of approach for specific therapy. In addition the efficacy of regulating trafficking and inhibiting myeloid cell function shows promise in the future treatments of non‐infectious intraocular inflammatory disease.

Conclusion Biologic therapy has the opportunity to not only specifically and powerfully immunomodulate but also with the increase in understanding of individual immune response adapt to generate a more stratified and personalised approach to therapy.

Commercial interest
Immune modulation in uveitis:Biologicals ‐ [bdquo]Golden calf“ or [bdquo]Gold Standard“?
Authors: BODAGHI B
Published: December 2011

Uveitis is a sight‐threatening auto‐immune condition. Most of the cases require corticosteroids and conventional immunosuppressors. Until recently, safety issues limited the use of new therapeutic strategies such as biological agents. Anti‐TNF alpha and interferon alpha are the two major drugs, used for more than 12 years with well‐defined results and side‐effects. Behçet's disease is the principal indication of biologicals with a dramatic improvement of uveitis and a long‐lasting remission. Dosing and duration remain controversial. Anti‐TNF alpha are used in severe cases with a direct visual threat. The intravitreal use of the drug seems to be inefficient. Interestingly, other molecules such as anti‐IL1 molecules did not show a significant control of uveitis in a randomized multicentre clinical trial. Refractory cases of JIA‐associated uveitis are another indication of anti‐TNF alpha drugs. Even though, etanercept is highly effective on the rheumatological component of the disease, it is ineffective on uveitis. On the other hand, adalimumab is effective on uveitis but less commonly on arthritis. In the future, we will probably welcome new types of biologicals agents in the field of uveitis. However, it seems paramount to determine the best route and rhythm of administration, dosages and duration of therapy. Side effects are also important to consider before any further conclusions, especially in children.
Thyroid and ocular hypertension
Authors: BOSCHI A
Published: December 2011

Purpose To present and discuss the association between thyroid disorders and the development of glaucoma. Several population‐based cross‐sectional sample studies support the hypothesis that thyroid disorders may increase the risk of glaucoma. However, because the self‐report studies, data on specific type of glaucoma and /or thyroid disorders as well as severity and duration are not available. In Graves orbitopathy (GO), different mechanisms leading to intraocular pressure (IOP) increase are: eyeball compression by enlarged extra‐ocular muscles, and episcleral venous pressure elevation secondary to intraorbital content and pressure increase. But, the prevalence of glaucoma in GO patient doesn’t seem to be increased compared to the general population. However, most of the studies were retrospective and with a short‐term follow‐up.

Methods Clinical features of GO and risk factors associated with high IOP and glaucoma in GO pat will be discuss, as well as management recommendations
Limitations of 'hard' Keratoprosthesis in Clinical Practice ‐ can 'soft' KPs lead the way out?
Authors: LIU CS , AVADHANAM V
Published: December 2011

Two winners have emerged among dozens of keratoprostheses (KPros) which have come and gone. The Osteo‐odonto‐keratoprosthesis is the device of choice for end stage inflammatory ocular surface disease associated with a dry eye, such as Stevens Johnson syndrome and ocular cicatricial pemphigoid. The Boston Type 1 keratoprosthesis is successful for wet blinking eyes and can be considered as an alternative to high risk keratoplasty in highly vascularised corneae or in multiple previous graft failure. The main advantage of these "hard" KPros is optical clarity. Whilst the field of view may be somewhat limited, there is no astigmatism and the optical surface is usually bare and clear. Hard KPros depend mostly on bio‐inertness as opposed to biointegration. Soft KPros have the theoretical advantages of the possibility of having the same mechanical moduli as the host tissue thus reducing stress at the interface when the eye is subjected to minor trauma, intraocular pressure measurement by applanation, and drug penetration. However, much effort has to be directed towards adequate integration (healing), and either total and smooth epithelialisation or no epithelialisation whatsoever. Partial epithelialisation, tear meniscus, and buckling of a soft optic contribute to poor optical performance and thus poor vision.
Autologous versus Allogeneic Limbal Stem Cell Therapy ‐ Challenges and Pitfalls
Authors: DUA H
Published: December 2011

Abstract not provided
Mesechymal Stem Cell Properties in the Endothelium ‐ bioengineered EC for lamellar Keratoplasty?
Authors: FUCHSLUGER T
Published: December 2011

Purpose Corneal endothelium (EC) is crucial to maintain corneal transparency. Loss of EC finally results in blindness with the need of corneal transplantation. As lamellar grafting is globally spreading, engineering EC sheets are rational. However, in‐depth knowledge of precursor or stem cell‐like properties in EC and the precise anatomical locations are not yet clearly identified. These progenitor cells might serve as basis for tissue engineering. This study aims to identify the distribution and localization of EC with mesenchymal stem‐cell (MSC) and progenitor characteristics.

Methods To study the distribution of putative MSC in the cornea and in the anterior chamber, typical MSC markers (CD44, CD73, CD90, CD105,stro‐1) were studied by immunohisto‐ and immunocytochemistry in sections of eyes, corneas and whole mount staining (Balb/C and C57BL6 mice, human tissue).

Results CD44 expression was identified in the periphery of the lens epithelium, in single cells located in the peripheral parts of EC and in the limbus, but not in central parts of cornea. Moreover, CD44 was detected on cell borders of specific cell clusters throughout the endothelium (7%).

Conclusion To our knowledge, we identified for the first time CD44+ cells with potential stem cell properties in the cornea. This was localized in the peripheral part of the EC and the limbus. Therefore, the peripheral cornea might be a potential source for future tissue engineering approaches for corneal endothelium.
Premacular haemorrhage in patient with leukaemia
Authors: PRIETO CALVO E , EGEA ESTOPINAN C , IDOIPE CORTA M , DE LA MATA G , ABECIA MARTINEZ E , FERNANDEZ LARRIPA S , GARCIA MARTIN E
Published: December 2011

Purpose Blood dyscrasia has been associated with premacular haemorrhages. The combination of severe anaemia and thrombocytopenia has been hypothesised to cause reduced coagulability and loss of endothelial cell integrity, allowing blood leakages through the jeopardised endothelial barrier.

Methods Prospective, interventional, single case report. A 20‐year‐old man, treated with chemotherapy for acute lymphoid leukaemia, is referred with a sudden loss of vision in his left eye (LE). Funduscopic examination revealed a sharply demarcated, dome‐shaped premacular haemorrhage, with approximately one diameter‐disk of size. The spectral‐domain OCT(SD‐OCT) scan showed that the cleavage plane of blood accumulation was located under the internal limiting membrane (sub‐ILM). Considering the location and the size of the haemorrhage we decided to perform a conservative management with periodic checks.

Results Four months later, the macular haemorrhage had been reabsorbed and vision had improved. The SD‐OCT scan revealed the total absorption of blood, with signs of thickening of the internal limiting membrane.

Conclusion Therapeutic options in premacular haemorrhages (conservative management, laser membranotomy or vitrectomy) should be established on an individual basis, considering in each case, the underlying disease, bilaterality of the process, duration and severity of bleeding, lens transparency, age and general condition of the patient.
Proliferative diabetic retinopathy: from screening to treatment
Authors: TADROS C , MANSOUR T , PETO T
Published: December 2011

Purpose To assess if the guidelines for referral and treatment of proliferative diabetic retinopathy (PDR) in the English National Screening Programme are being followed in Tower Hamlets Diabetic Retinopathy Screening Service(THDRSS). The guidelines mandate that all patients with PDR must be seen within 2 weeks in an eye clinic and should be treated within 4 weeks if needed. This can potentially decrease blindness related to PDR in the underprivileged population of Tower Hamlets of East London, UK.

Methods During the period from 01/04/2010‐31/03/2011, 34 patients were diagnosed with retinal changes characteristic of PDR at THDRSS. All patients were referred to Moorfields Eye Hospital (MEH). The times between screening and referral and referral to treatment were measured. Images were reviewed if there was a discrepancy between screening and clinical diagnosis.

Results All patients were referred to MEH on the same day of screening. Five patients did not attend any appointments given and were referred back to THDRSS and education on eye health. The remaining 29 patients were examined at MEH within 6 weeks from screening but only five (17.24%) were examined within the recommended 2 weeks. Half of those requiring laser for PDR were treated on the day of the first consultation and the other half within 4 weeks. Three patients had asymmetrical disease and these were confirmed to be retinal vein occlusions.

Conclusion Referral guidelines were followed by THDRSS with 100% of the patients referred on time. Guidelines for timely treatment of PDR patients were followed at MEH. This may contribute to the prevention of severe complications from PDR in this population. The delay between screening and first appointment will warrant further investigation.
C[omicron]mbined cataract surgery with anti‐VEFG agents in patients with quiescent proliferative diabetic retinopathy with no macular edema
Authors: SOKOLAKIS THOMA , SPAI SOFIA , GOURGOULI IOANA
Published: December 2011

Purpose The study of visual acuity and the course of diabetic retinopathy after combined cataract surgery and injection of ANTI‐VEGF agents in diabetic patients with quiescent proliferative diabetic retinopathy without macular edema.

Methods The study included 22 patients with quiescent proliferative diabetic retinopathy with no macular edema aged 62‐75 years of both sexes (15 men and 7 women). The preoperative visual acuity was of 1/10 to 4/10 and the time monitoring the patients after cataract surgery was 18 months.

Results The visual acuity improved in all patients and follow up of 18 months showed that only one patient developed macular edema after 6 months who was treated with subsequent monthly infusions of Anti‐VEGF (4.5%). At a percentage of 72.7% (16 patients), visual acuity improved and at a rate of 22.8% (5 patients), visual acuity remained unchanged

Conclusion The combination of cataract surgery and Anti‐VEGF helps in the greater improvement of visual acuity and of proliferative diabetic retinopathy.
Pivotal role for SD‐OCT in the diagnosis of acute zonal occult outer retinopathy
Authors: DE ZAEYTIJD J , KESTELYN P , LEROY BP
Published: December 2011

Purpose Acute Zonal Occult Outer Retinopathy (AZOOR) is characterized by an acute partial loss of outer retinal function with corresponding visual field defects and electroretinographic (ERG) abnormalities in one or both eyes. Spectral domain optical coherence tomography (SD‐OCT) findings are described as a key to the early diagnosis of AZOOR in a patient.

Methods A 25 ‐year‐old man developed acute painless central vision loss together with photopsia in the right eye (RE). He underwent a full ophthalmological work‐up including fluorescein and ICG‐angiography, SD‐OCT, specialized imaging, visual field testing (VFs) and electrophysiological testing.

Results On initial evaluation visual acuity was 15/10 in both eyes. Fundoscopy revealed a subtle loss of the foveal reflex with very limited foveal mottling in the RE. Fluorescein and ICG‐angiography were unremarkable. Static and kinetic perimetry showed an absolute scotoma inferotemporal of fixation and a slightly enlarged blind spot in the RE. Most remarkable were the inner/outer segment boundary defects visible on SD‐OCT. One month later, small changes were observed on infrared imaging and reduced responses were seen on multifocal ERG corresponding to the scotoma on VFs. A full‐field ERG and EOG were normal. The unilateral scotoma stabilized over the next 2 months.

Conclusion AZOOR is a rare condition with subtle and often vague signs and symptoms, which makes diagnosing it quite a challenge. The added value of SD‐OCT is that it allows identification of specific inner segment/outer segment boundary defects at presentation.
Diabetic retinopathy and type 2 macular telangiectasia
Authors: TADROS C , MANSOUR T , LEUNG I , SALLO F , CLEMONS T , PETO T , MACTEL GROUP
Published: December 2011

Purpose To establish the severity and progression of diabetic retinopathy (DR) and maculopathy (DMac) in patients with both Type 2 macular telangiectasia (MacTel) and diabetes mellitus (DM) and relate these to characteristics of MacTel.

Methods MacTel is a bilateral retinal disease affecting central vision. The MacTel Project enrols from 27 sites around the world; those in the study have multiple imaging performed yearly. Colour fundus, fluorescein angiographic, OCT and autofluorescence images were graded at the Reading Centre of Moorfields Eye Hospital, UK for characteristics of MacTel, DR and DMac; diabetes status and clinical data were obtained from the co‐ordinating centre (EMMES). Grading for DR and DMac was on 7‐field stereo images for baseline, and 3‐fields for follow‐ups using ETDRS standards.

Results The mean age of MacTel patients at diagnosis was 57±9 years. Diabetes was diagnosed in 188 out of 555 MacTel patients enrolled. MacTel patients with DM had an average HbA1c of 6.9±1.4%. Over 70% of patients had no DR at baseline. Only one patient developed mild and one moderate non‐proliferative DR during the over 3 years follow‐up. Only one patient developed DMac requiring laser treatment. MacTel patients with DM had significantly lower visual acuity at baseline (No DM 70.3±0.7 letters, DM 65.±1.6; p=0.02). MacTel patients with DM progressed significantly more on NEI‐VFQ and on OCT characteristics at the fovea, such as foveal empty cavities and neuroretinal changes (all p<0.05). Progression of the severity of MacTel was significantly modified by DM (p<0.05).

Conclusion DM has a clinically meaningful impact on visual functioning and progression of MacTel. Further study is required to understand the relationship between the two diseases.
Fluorescein angiography based classification of retinopathy of prematurity
Authors: SUZANI M , TRAVERSA E , BARILLà D , GUAGLIANO R , BERTONE C , ANSELMETTI G , BIANCHI PE
Published: December 2011

Purpose To select fluorescein angiography (FA) signs detected in Retinopathy of prematurity (ROP) in order to propose a new classification.

Methods From December 2009 to December 2010, 15 patients affected by ROP (stage 2 or 3, zone 2, no plus) were evaluated at San Matteo Hospital(Pavia) and Maria Vittoria Hospital (Torino) along with their FA exams by an expert in paediatric retina diseases. Among the multiple FA features in ROP, we considered: ischaemic area posterior to the shunt, leakage at the vascularised/avascularised junction (v/av j) and peripheral plus (vessel tortuosity just beyond the v/av).

Results Patient group characteristics were: Mean Gestational age: 25 weeks Mean Weight at Birth: 657 g Mean Age at ROP diagnosis: 30 weeks Considering the described criteria, we were able to detected a new class of ROP patients; they were all described as type 2 ROP on the basis of fundus examinations, while FA characteristics permitted to: ‐ Identify a more aggressive subtype of ROP type 2, in need of a sudden treatment ‐ Plan FA based laser administration which involved the ischaemic area near the shunt All the patients in the study received a laser treatment with favourable structural and visual outcome.

Conclusion FA classification allows to advance and/or improve laser administration in FA selected patients with retinopathy of prematurity.
Ocular surface and refractive surgery
Authors: COCHENER B
Published: December 2011

Purpose Dry eye represents nowadays the most common complication after PRK and even more frequent after lasik. Preoperative dry eye constitutes a risk factor for postoperative severe dryness; that it why it appears crucial to detect and treat surface disorder before the surgery.

Methods We will remind the list and hierarchy of tests available for the assessment of ocular surface. Unfortunately, values of the defined criteria are variable and there are a lot of variations in the methods. Moreover, the correlation between clinical symptoms and tests results is very poor. The access to tear osmolarity (TearLab©) could be an interesting new biomarker. A study will be presented showing that 44% of patients, candidates to Lasik have an asymptomatic dryness before surgery (mild to moderate stage.

Results Related to the principle of these two procedures, the cause of ocular surface deregulation lies on neurotrophic disturbances (secondary to nerves section) and inflammation ( wound healing process). In addition, changes in corneal shape can affect the tear dynamics with an increase in ocular surface dessication. All these phenomenon are systematically observed after photoablation for a transitory period of 1 to 3 months. But, sometimes, they do persist beyond one year (20%), becoming chronic and source of a great discomfort and dissatisfaction (10%). The strategy of treatment will be discussed, in graduating the medications according the growing severity.

Conclusion Is there a difference between surface PRK and Lasik ? Hinged flap induced transection of large number of afferent sensory nerve fibers during lamellar cut, that impacts the integrated lacrymal gland OS functional unit. Finally, Lasik is responsible of more dry eye syndrome that PRK, that should be prefered in case of preoperative Ocular surface disorder.
Technical and topographical variability in automatic retinal oximetry
Authors: PALSSON O , HARDARSON SH , STEFANSSON E
Published: December 2011

Purpose To assess if retinal vessel oxygen saturation measurements are affected by (1) which eye is measured (2) photographic flashes (3) image angle (4) location within the retina (quadrant).

Methods The Oxymap retinal oximeter simultaneously acquires fundus images at 570nm and 600nm and calculates relative oxygen saturation in retinal vessels. Oximetry images were obtained from 26 healthy individuals, 18‐30 years. Images were taken of one eye at different angles and at the same angle with at least two photographic flashes in between. In addition, one image from the other eye was obtained. Retinal vessel oxygen saturation was measured with the Oxymap analysis software.

Results (1) No difference was found between the left and right eyes (n=24, p>0.68). (2) Saturation increased by 0.5±1.0%, (p=0.028, mean±SD, hemoglobin saturation percentage) in arterioles and 0.9±1.9% (p=0.020) in venules after three or more photographic flashes. (3) Saturation was higher in both arterioles (1.3±1.7%, p=0.0004) and venules (1.9±2.4%, p=0.0007) when the subject gazed down than when looking straight. (4) Significant topographical variations were found within the retina, up to ‐3.1±2.4% difference from average saturation in arterioles and ‐5.4±4.0% in venules.

Conclusion The left and right eye are comparable in retinal vessel oxygen saturation measurements. A few photographic flashes have a small effect on the measurement. The difference in saturation by angle is significant when the subject is looking down and the topographical difference in saturation is notable between quadrants. It is important to standardise image acquistion and analysis.

Commercial interest
Daily skills performed by previously blind RP patients with subretinal electronic implant Alpha IMS
Authors: ZRENNER E , BARTZ‐SCHMIDT U , BESCH D , BRUCKMANN A , GREPPMAIER U , GEKELER F , KOITSCHEV A , SACHS H , SLIESORAITYTE I , STINGL K , WILHELM B
Published: December 2011

Purpose To investigate visual perception of previously blind retinitis pigmentosa (RP) patients using electronic subretinal implants.

Methods The new Alpha IMS chip (Retina Implant AG) with its 1500 photodiodes, amplifiers and electrodes powered wirelessly via a subdermal coil was implanted subretinally in 7 retinitis pigmentosa patients for indoor and outdoor use.

Results VA was up to 21/1000 within a field of 11° by 11° (see previous pilot study http://rspb.royalsocietypublishing.org/content/early/2010/11/01/rspb.2010.1747). A) Near vision: Localizing, cutlery and tableware, plates and content in 4AFC mode and in restaurants, facial characteristics of persons, items on working desk. B) Far vision: Recognizing clouds, clothes of people, borders of cars by metallic reflections, discerning smaller from larger persons. C) Spatial resolution: Position of clock hands, stripe patterns up to approx. 0.33 – 0.44 cpd, reading letters 4 to 8 cm high, localization and recognition of square, round or rectangular objects . D) Contrast: Differentiation of 7 to 10 shades of grey; increased sensitivity for infrared radiation. E) Motion: Hand movement, walking direction of a goose, circumvention of obstacles. F) Eye‐hand coordination: Pointing at objects and moving them.

Conclusion Subretinal Alpha IMS implants allow RP‐ patients within few days of exercising to localize objects and to perform visuomotor tasks for improved orientation and mobility. This device thereby can provide considerable support to blind RP patients in mastering tasks of daily life, indoor and outdoor, as shown in an ongoing clinical study.

Commercial interest
Blood‐retinal barrier function status from OCT data
Authors: BERNARDES R , SERRANHO P , RODRIGUES P , GONçALVES V , CUNHA‐VAZ J
Published: December 2011

Purpose To demonstrate the presence of blood‐retinal barrier (BRB) function information within OCT data.

Methods It was recently suggested that OCT data embeds functional information on BRB status. In this work a different approach was followed resorting to the use of support vector machines (SVM) to discriminate between healthy (N=31), ETDRS level 10 diabetic retinopathy (DR) (N=31) and diabetic macular edema (DME) eyes (N=31). Healthy volunteers and diabetic patients underwent Cirrus HD‐OCT (Carl Zeiss Meditec, Dublin, USA) using both the 512x128 and the 200x200 Macular Cube Protocols. Data was exported and the intensity distributions were computed for each eye, taking into consideration only the retina (between the inner limiting membrane ILM and the retinal pigment epithelium RPE), both on the logarithmic and linear spaces. A total of 43 parameters per eye were computed and labeled accordingly (healthy, DR and DME). A publicly available SVM toolbox (LIBSVM) was applied to assess the possibility of discriminating between each of these groups using a radial basis function (RBF) kernel and the leave‐one‐out approach for validation.

Results Achieved results allow to conclude on the possibility of discriminating between healthy and DR eyes (level 10 ETDRS and DME eyes). Of added value is the fact the system is able to discriminate between healthy and ETDRS level 10 DR eyes. This suggests that optical properties of the retina are modified and that this change cannot be currently detected using any other available technique.

Conclusion In this work, it was demonstrated the presence of early changes in the optical properties of the human retina related to diabetes, and that this information is embedded in OCT data. Support: FCT/PTDC/SAU‐BEB/103151/2008
Calculation of central retinal artery diameters in patients with type 1 diabetes using non‐invasive measurements
Authors: PEMP B , GARHOFER G , SCHMETTERER L
Published: December 2011

Purpose To compare the diameter of the central retinal artery between patients with type 1 diabetes and healthy control subjects in vivo. Central retinal artery diameters were calculated from results of non‐invasive measurements of ocular hemodynamics.

Methods 16 patients with type 1 diabetes with no or mild diabetic retinopathy and 16 age‐matched healthy controls were participated in this study. Total retinal blood flow was assessed by the use of laser Doppler velocimetry and measurement of retinal vessel diameters in all veins entering the optic disc using a Dynamic Vessel Analyzer. In addition blood flow velocity in the retrobulbar central retinal artery was measured using color Doppler imaging. The diameter of the central retinal artery was then calculated individually for each subject using the obtained ocular hemodynamic data.

Results Calculated central retinal artery diameters were significantly larger in patients with diabetes (180 ± 13 µm) compared to healthy controls (166 ± 10 µm, p = 0.001). There were no significant differences in retinal blood flow, retinal vessel diameters or mean flow velocity in the central retinal artery between the two groups.

Conclusion The present results indicate a dilation of the central retinal artery in patients with type 1 diabetes, whereas total retinal blood flow is unaltered compared to healthy controls. Results from blood flow velocity measurements using color Doppler imaging in retrobulbar vessels do not include information about vessel diameters and need to be interpreted with caution in terms of retinal blood flow.
Comparison of optic nerve head and choroidal blood flow regulation during isometric exercise
Authors: SCHMIDL D , BOLTZ A , LASTA M , PEMP B , KAYA S , GARHOFER G , SCHMETTERER L
Published: December 2011

Purpose In the recent years the response of choroidal blood flow (ChBF) to isometric exercise has been characterized in some details. Generally, the degree of blood flow increase is lower than the degree of ocular perfusion pressure (OPP) increase indicating for some regulatory capacity of the choroid during these conditions. In the present study we compared the response of optic nerve head (ONH) blood flow and ChBF in response to isometric exercise.

Methods Two study days were performed in 48 healthy young subjects. 24 subjects participated in the choroidal studies and 24 subjects in the ONH studies. The effect of a 6 minutes squatting period on ChBF and ONH blood flow was studied. ChBF and ONH blood flow were measured using laser Doppler flowmetry. OPP was calculated as 2/3*mean arterial pressure‐intraocular pressure.

Results ChBF and ONH blood flow increased during isometric exercise (p < 0.001 each). The increase was, however, in both vascular beds less pronounced than the increase in OPP indicating for some degree of blood flow regulation. The pressure/flow curves revealed that ChBF was constant until OPP of about 60% above baseline, whereas ONH blood flow was constant until OPP of about 40% above baseline.

Conclusion During isometric exercise ChBF regulates better than ONH blood flow. In some subjects an interesting phenomenon was found in the ONH blood flow experiments. During isometric exercise blood pressure temporarily decreased slightly, when subjects were exhausted from squatting. These periods were sometimes associated with a pronounced decrease in ONH blood flow (up to 30% below baseline values) although the OPP was still much higher than at baseline. The significance of this observation is unknown.
Complex regulation of optic nerve head blood flow during combined isometric exercise and elevation of intraocular pressure
Authors: BOLTZ A , SCHMIDL D , LASTA M , PALKOVITS S , KAYA S , GARHOFER G , SCHMETTERER L
Published: December 2011

Purpose For a long time it was assumed that ocular vascular beds are characterized by one specific pressure/flow curve. Recently we have, however, shown that this behavior is much more complex in the choroid, because alterations in arterial and venous pressure lead to different regulatory behaviors. In the present study we tested the hypothesis that this is also the case in the optic nerve head.

Methods Two study days were performed in 40 healthy subjects. On the 1st day the effect of isometric exercise and an elevation of IOP on optic nerve head blood flow (ONHBF) were studied separately. On the 2nd day the effect of combined IOP and mean arterial pressure (MAP) increase was investigated. IOP was increased in a stepwise way using the suction cup method. ONHBF was measured using laser Doppler flowmetry. For correlation analysis all values from all subjects were pooled according to IOP and MAP values.

Results When data were grouped according to MAP values a highly significant correlation was found between ONHBF and IOP (p<0.001). The regression lines at different MAP levels were almost equal. When data were pooled according to IOP levels a significant correlation was found between MAP and ONHBF for IOP values up to 25 mmHg (p<0.05) and the correlation lines were almost identical. At higher IOP values, however, no correlation between ONHBF and MAP was found.

Conclusion Our data are in agreement with previously published studies that ONHBF shows some autoregulatory capacity. The autoregulatory behavior appears to be complex and dependent on the site of perfusion pressure regulation (arterial vs venous). Compared to the choroid the ONH adapts its perfusion better to an increase in IOP
Clinical and ultrastructural feature of a cornea with pellucid marginal degeneration
Authors: AKHTAR S , KIRAT O , KATAN H , ALMUBRAD T
Published: December 2011

Purpose Pellucid marginal degeneration (PMD) of the cornea is a rare ectatic disorder which typically affects the inferior peripheral cornea in a crescentic fashion. We report clinical, histological and ultrastructural PMD cornea.

Methods A 57 year old female was diagnosed with PMD and keratoconus in the right eye, and PMD in the left eye. Uncorrected vision was: OD 5/200 with pinhole 20/400; OS 20/100 with the pinhole to 20/70. The patient underwent lamellar keratoplasty in the right eye and the excised cornea was processed for light and electron microscopiy.

Results Four months post‐operatively uncorrected vision in the right eye was 20/160 improving with the pinhole to 20/60. Ultrastructure of the peripheral and central parts of the cornea was similar to each other. The epithelium was irregular and most of the basal epithelial cells were vacuolated. Hemidesmosomes were broken at various places. Bowman’s layer was degenerated and absent or replaced by collagenous panus. Lamellae in the anterior and middle stroma were thin and undulating. Numerous microfilaments were aggregated at the inter‐lamellar junction. The collagen fibrils (CF) were running in random directions in the anterior and middle stroma.

Conclusion Our observation of disorganisation and degeneration of CF suggestes that PMD could be related to malfunctioning in the synthesis of CF due to a disorder in keratocan, a luecine rich proteoglycan. Cross linking treatment should be considered for treatment in early stages of the disease.
Ocular injuries
Authors: WYLEGALA E
Published: December 2011

Abstract not provided
Genetics and treatment of Stargardt disease
Authors: ALLIKMETS R
Published: December 2011

Purpose When the adenosine triphosphate (ATP)‐binding cassette (ABC) transporter gene, ABCA4 (originally named ABCR), was cloned and characterized in 1997 as the causal gene for autosomal recessive Stargardt disease (STGD) it seemed as if just another missing link was added to the extensive table of genetic determinants of rare monogenic retinal dystrophies. Now, 14 years later, the ABCA4 gene continues to emerge as the predominant determinant of a wide variety of retinal degeneration phenotypes, such as STGD, cone‐rod dystrophy, retinitis pigmentosa, and age‐related macular degeneration.

Methods A combination of genetic, molecular biology, gene‐ and small molecule therapy approaches.

Results ABCA4 has caused exciting and sometimes intense discussions among ophthalmologists and geneticists, resulting in more than 300 publications during this time. In my presentation I will summarize our current knowledge of the role of ABCA4 in retinal disease and review the substantial progress in diagnostic and therapeutic applications for ABCA4‐associated disorders which most recently seemed impossible.

Conclusion Although ACBA4 has proven to be a complex and difficult research and therapeutic target, I hope to convince the audience that treatment of all ABCA4‐associated disorders, and especially STGD, should be possible in the near future.
Unexpected ectopic thyroid tissue in the orbit: a clinical case report
Authors: ASOKLIS R , RUZGYS R , PAJAUJIS M , PETROSKA D
Published: December 2011

Purpose To present clinical case report of the benign ectopic thyroid tissue in the orbit.

Methods 75‐year‐old woman with a slowly growing, painless, elastic tumor in the left inferior –lateral part of the orbit complained about diplopia, eye globe protrusion and dislocation medialy‐superiorly. Symptoms were progressing for two years. Head magnetic resonance imaging (MRI), tumor excision and histopathological examination of the obtained specimen were performed.

Results Head MRI showed 18x14 mm in size, non‐homogenic, contrast accumulating mass with well defined margins in the inferior –lateral part of the orbit. Gross examination of the excised mass revealed grey color, round tumor, covered by connective tissue. Histologicaly tumor was well circumscribed, composed of micro‐/ macrofolicules with colloid. Folicular epithelium had no atypical changes. These criteria support diagnosis of ectopic thyroid tissue with slight signs of goiter. In the National Pathology Registre it was found that one year before patient had thyroidectomy and histological diagnosis of nodular thyroid hyperplasia and follicular adenoma was established. Possibility of follicular carcinoma metastasis to the orbit was rejected reviewing both cases by three pathologists and only usual Hematoxylin/Eosin method was used for staining.

Conclusion There are rear case reports of ectopic thyroid tissue. To our knowledge this is the first description of thyroid tissue with signs of goiter in the orbit.
Efficacy of wet chamber warming goggles (Blephasteam®) in patients with posterior blepharitis
Authors: DOAN S , CHIAMBARETTA F , CORTEVAL F , SEMBEIL J , BAUDOUIN C
Published: December 2011

Purpose Posterior blepharitis is a main cause of dry eye. Lid hygiene is an important treatment, but compliance is often poor because of its complexity and lack of specific devices. The aim of this study is to assess the efficacy of wet chamber warming goggles (Blephasteam®) in patients with posterior blepharitis.

Methods In this interventional multicenter prospective uncontrolled study, patients with meibomian gland dysfunction were enrolled. Blephasteam® (Laboratoires Thea, Clermont‐Ferrand, France) was used once or twice a day during 10 minutes, with a following lid massage. Main outcome measures were assessed at baseline and after 3 weeks, including symptoms (ocular discomfort on a visual analogic scale‐primary endpoint, and separate symptoms), signs of blepharitis, Schirmer test, Break up time, corneal fluorescein vital staining, and tear osmolarity (measured with the Tearlab® system).

Results Thirty patients (16 women, 14 men), mean age 48 ± 22 years (4 to 82 years) were included. After 3 weeks of treatment, mean global visual analogic scale symptom score decreased by 15.2 ± 22 mm (range, +32 to ‐57 mm on a 100 mm scale)(p=0.004). Mean composite blepharitis score decreased by ‐3.5 points on the worst eye (range, +1 to ‐10 on a 20 points scale)(p<0,001). No change was observed for the other parameters among which BUT, IOP and tear osmolarity. Improvement rated by the patient was important in 48 % of cases, moderate in 36% and fair in 16%.

Conclusion Blephasteam® wet chamber warming goggles are a promising alternative to classical lid hygiene techniques. A multicenter extended study is ongoing.

Commercial interest
The first consultation
Authors: SPILEERS W
Published: December 2011

Purpose Patients with complaints of seeing badly in the dark need a full ophthalmological workup.

Methods Acquired versus congenital nightblindness has to be questioned in a full anamnesis. Visual acuity, biomicroscopy and fundus examination are essential followed by visual field testing and possibly visual electrophysiology (flash ERG)

Results Several causes of congenital and acquired nightblindness can be found. Not all patients complaining of seeing badly in the dark are "nightblind"

Conclusion A full clinical ophthalmological work up can identify adequately several causes of night blindness
Causes of night blindness
Authors: LEROY BP
Published: December 2011

Purpose To describe the causes of both genetically determined and acquired night blindness.

Methods A case presentation format will be used to illustrate different genetically determined and acquired conditions leading to night blindness. Both clinical and electrophysiological phenotypes as well as genotypes will be discussed.

Results Phenotypes and genotypes of genetically determined diseases leading to night blindness are very different. An important distinction to be made is the one between stationary and progressive diseases. Indeed, other than night blindness the visual outcome differs considerably between different conditions.

Conclusion The causes of night blindness are diverse. Taking a thorough history in combination with an extensive clinical examination and psychophysical and electrophysiological tests most often allows a to make a specific diagnosis. Acquired conditions are generally treatable, and should be differentiated from those that are inherited. For genetic disease, it is important to distinguish between progressive and stationary conditions.
Electrophysiology of patients with nyctalopia
Authors: HOLDER GE
Published: December 2011

The lecture will use a case‐based approach to demonstrate the value of electrophysiological testing in the diagnosis and management of patients with nyctalopia. The diagnostic features of various inherited and acquired diseases will be described, including photoreceptor dystrophies, congenital stationary night blindness, fundus albipunctatus, melanoma associated retinopathy, vitamin A deficiency and others.
Changes in expression of matrix metalloproteinases 12 and 19 in corneal epithelial cells after UV irradiation
Authors: ARDAN T , CEJKOVA J
Published: December 2011

Purpose Matrix metalloproteinases (MMPs) are zinc‐binding endopeptidases that degrade various components of extracellular matrix. MMP‐12 participates in macrophage migration and MMP‐19 is involved in regulation of angiogenesis. Based on our previous findings dealing with the coincidence of the concentration of proteolytic enzymes with the severity of corneal injury induced by UV irradiation, the aim of this study was to investigate the effects of UVA and UVB rays on expression of matrix metalloproteinases 12 and 19 in the corneal epithelium.

Methods In the first group of rabbits the corneas were irradiated with UVA lamp (365 nm, once a day during 4 days, and a dose per day 1.01 J/cm2). In the second group of rabbits the corneas were irradiated with UVB lamp (312 nm, once a day during 4 days, and a dose per day 1.01 J/cm2). Matrix metalloproteinases 12 and 19 were examined on cryostat sections immunohistochemically by using sheep polyclonal anti‐MMP‐12 and anti‐MMP‐19 antibodies.

Results Results show that as compared to normal corneas, UVA rays did not change the expression of MMPs studied in the corneal epithelium. In contrast, UVB rays induced overexpression of both MMPs in corneal epithelial cells. The expression of MMP‐12 was more pronounced in irradiated corneas than the expression of MMP‐19.

Conclusion In conclusion, UVB rays (not UVA rays) evoked increased expression of MMPs in irradiated corneas. Results point to the suggestion that overexpression of these MMPs due to UVB‐exposure might mediate previously found angiogenesis and neutrophil migration through the UVB‐irradiated cornea and thus contribute to the development of abundant inflammatory response.
Indocyanine green angiography in uveitis
Authors: HERBORT C
Published: December 2011

Abstract not provided
OCT in uveitis
Authors: NERI P , ARAPI I
Published: December 2011

Purpose To describe the role of optical coherence tomography (OCT) in uveitis.

Methods The current literature is reviewed and the experience of a tertiary referral centre is reported.

Results The involvement of the posterior pole during an active eye inflammatory disease can entail a reduction of visual acuity, which is sometimes difficult to treat. Albeit fluorescein angiography (FA) is still the gold standard for the detection of blood‐retinal barrier (BRB) disruption and has been the best option for the diagnosis of cystoid macular oedema (CMO), OCT represents an essential tool that can ameliorate the interpretation of FA findings. Epiretinal membrane (ERM) and tractional maculopathy may represent a sight‐threatening sequela of uveitis. OCT is extremely useful in documenting pathologies at the vitreo‐retinal interface, such as the formation of ERM, as well as it is also helpful in proving early infiltrates at the posterior vitreous interface. Although FA still remains the gold standard for the choroidal neovascularization (CNV) assessment, OCT is very helpful in documenting CNV nearby a chorioretinal scar. OCT has been used to study the type of CNV and to find its correlation to RPE.

Conclusion OCT may demonstrate a variety of morphological changes, that may point towards a specific uveitic disease: different forms of macular oedema may be described in uveitis as well as OCT features which can be peculiarly found in several diseases. In addition, OCT can be very useful in documenting both ERM and CNV.
CXC Chemokine Expression Profiles in Aqueous Humor of Patients with Different
Authors: ABU EL ASRAR A , AL‐OBEIDAN S , KANGAVE D , GEBOES K , OPDENAKKER G , VAN DAMME J , STRUYF S
Published: December 2011

Purpose To investigate the CXC chemokine expression profiles in the aqueous humor from patients with active uveitis associated with Behçet’s disease, VKH disease, and HLA‐B27‐related intraocular inflammation and to correlate.

Methods Aqueous humor (AH) samples from patients with Behçet’s disease (BD) (n=29), Vogt‐Koyanagi‐Harada (VKH) disease (n=21), and HLA‐B27‐associated uveitis (n=8), and 42 control patients were assayed for the neutrophil chemoattractants CXCL1/GRO‐α and CXCL8/IL‐8 and the lymphocyte chemoattractants CXCL9/MIG, CXCL10/IP‐10 and CXCL12/SDF‐1 with the use of a multiplex chemokine assay.

Results Chemokine levels except CXCL12/SDF‐1 were significantly higher in the 3 disease groups than in normal controls. Considering all patients, mean CXCL1/GRO‐α levels were 15‐fold higher than CXCL8/IL‐8 levels and mean CXCL10/IP‐10 levels were 22‐fold higher than CXCL9/MIG levels. In patients with the same disease activity, AH levels of CXCL1/GRO‐α and CXCL10/IP‐10 were significantly higher in patients with BD than in patients with VKH disease and HLA‐B27‐associated uveitis (p=0.0474; p<0.001, respectively).

Conclusion These data suggest that CXCL1/GRO‐α and CXCL10/IP‐10 are the predominant CXC chemokines involved in neutrophil and activated T lymphocyte chemoattraction in endogenous uveitis, particularly in BD.
Practical & quiz cases IV
Authors: PAPADIA M
Published: December 2011

Abstract not provided
What do we (authors, reader, publisher) need ?
Authors: DUA H
Published: December 2011

Abstract not provided
Characteristics of a good paper
Authors: WEGENER A
Published: December 2011

Abstract not provided