bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphofunctional changes of macular area in diabetic macular edema
Authors: SHAMSHINOVA AM , MANSURINA NB , ARAKELYAN MA
Published: September 2009

Purpose To investigate the electrogenesis in the L‐ and S‐cone system of the retina and their role in diagnosis of focal and diffuse macular edema (ME) in diabetic retinopathy (DR).

Methods 30 patients with diabetes mellitus type II were tested. All patients had ME: focal – 24 eyes, diffuse – 21. ISCEV Standard electroretinography (ERG) tests and additional chromatic macular ERG (M‐ERG) were used. Psychophysical test was presented by screening a topography of contrast and color sensitivity of the cone system. OCT was used to confirm macular edema that was found ophthalmoscopically.

Results In focal and diffuse ME a similar decrease of amplitude (?=6 mv; norm M=18 mv) and prolonged latency of b‐wave (M=58 ms; norm M=54 ms) to red stimuli were registered. M‐ERG to blue stimuli was subnormal in all cases: b‐wave amplitude in focal ME was M=23 mv, in diffuse M=26 mv (norm ?=62 mv). The b‐wave latency of M‐ERG to blue (norm ?=62 mv) was prolonged mostly in focal (M=80 ms) than in diffuse ME (M=76 ms). Campimetry for color sensitivity to red and blue stimuli revealed significant changes in all patients, dark channels affected earlier than light.

Conclusion In focal and diffuse ME similar changes of chromatic M‐ERG to red and blue stimuli are an evidence of cone function suppression. Prolonged b‐wave latency is due to excitation delay from photoreceptors to ganglion cells as a result of neuronal damage. Decreased sensitivity of dark and light channels with dominant localization of pathological process in macular area were found. The functionally revealed changes in focal ME may reflect the extensiveness and prevalence of retinal damage unlike the clinical picture.
Prophylaxis in ocular surgery
Authors: BRON AM
Published: September 2009

Abstract not provided
The prophylactic and therapeutic efficacy of a new eye drop for the treatment of murine dry eye induced by intelligently controlled environmental system
Authors: ZHANG X
Published: September 2009

Abstract not provided
Macular edema – With all the new data (BRAVO, SCORE and Posurdex) where to from here?
Authors: DE SMET M
Published: September 2009

Abstract not provided
Three years experience of Quantiferon®Gold testing
Authors: JAKOB E , MACKENSEN F , BECKER MD , MAX R , DALPKE A , ZIMMERMANN S
Published: September 2009

Purpose To give an overview of the results for Quantiferon® Gold (QFT) testing on uveitis patients in an interdisciplinary setting for a period of three years.

Methods Database search of all the patients tested for tuberculosis (Tb) with a full blood gamma interferon release essay, QFT, the result of the testing and analysis of uveitis subtypes involved.

Results From March 2006 until April 2009 294 patients have been tested, overall 62 (21.8%) were positive and 220 (74.8%) negative (in 2 the result was unclear). 101 patients were male, 193 female, age mean was 49 (13 – 86) years in the whole cohort and 50 (22‐80) years in the QFT+ group. Looking at anatomic localization they were distributed (in brackets % of QFT+ tests) as anterior n=46 (9%), intermediate n=68 (26%), posterior n=87 (26%), and pan n=38 (32%). In 26 QFT+ patients we presumed a diagnosis of Tb due to other clinical findings. In 14 patients a final diagnosis of Tb associated uveitis was postulated and treated with full therapy following WHO recommendations.

Conclusion QFT testing gives surprisingly high numbers of positives in uveitis patients, especially in the subgroup of intermediate, posterior and panuveitis. This is not sufficiently explained by immigrant status of the patients. The frequency of positives is a lot higher than in other cohorts as healthy hospital personel (4.8%, own data) or inflammatory arthritis patients (9.8%*). This opens important questions regarding treatment implications. *Martin J,et al.Ann Rheum Dis. 2009 Jan 30.
Which place for surgery for macular edema due to diabetic retinopathy ?
Authors: JONAS JB
Published: September 2009

Purpose To present treatment options for macular edema

Methods The various types of macular edema will briefly be discussed and available and potentially future treatment strategies will be presented.

Results The results of the current multicenter trials as well as the findings of previous studies using different medical agents for the treatment of diabetic macular edema will be compared.

Conclusion It may still be unclear which treatment strategy appears to be the best for which type of diabetic macular edema.

Commercial interest
Is there still a place for vitrectomy in the treatment of macular edema due to venous occlusion ?
Authors: POURNARAS CJ
Published: September 2009

Purpose Persistent macular edema (ME) is the main cause of poor visual outcome in either non‐ischemic BRVO or CRVO. Among multiples treatment approaches, vitreoretinal surgery with the goal to achieve the recanalisation of the occluded vessels and/or the resolution of ME, were proposed.

Methods Vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane,asociated to intravitreal (IVT) triamcinolone , neurotomy, sheathotomy, intravascular rtPA injection were studied in numerous nonrandomized cases series.

Results Pars plana vitrectomy has been shown to reduce macular oedema and restore the normal foveal contour without significant change in best corrected visual acuity. In contrast, visual improvement occurs after vitrectomy for vitreous haemorrhage, epiretinal membrane formation and retinal detachment complicating BRVO. Evidence to date does not support any therapeutic benefit from radial optic neurotomy, optic nerve decompression, arteriovenous crossing sheathotomy or intravascular rtPA. Vitrectomy combined with IVT triamcinolone, induces a ME decrease rapidly and durably, without any improvement in visual acuity.

Conclusion Vitrectomy with IVT triamcinolne seems to have a more durable effect than IVT triamcinolone alone.Vitrectomy, A‐V sheathotomy combined with intravenous t‐PA may offer benefits in BRVO. Despite uncertainty and open questions, surgical interventions are likely to be a therapeutic option for RVO in the future. Randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease.
Ultrastructure of anterior lens capsule in uveitic cataract
Authors: STUNF S , HVALA A , VIDOVIC VALENTINCIC N , KRAUT A , HAWLINA M
Published: September 2009

Purpose To evaluate the ultrastructure changes of anterior lens capsule in patients with different forms of uveitis, who underwent cataract surgery at the University Eye Clinic Ljubljana, Slovenia between years 2001 and 2007.

Methods Anterior lens capsules were obtained during cataract surgery, fixated and prepared for semi‐thin sections technique and transmission electron microscopy.

Results 22 uveitic cataract were studied (idiopathic anterior uveitis‐9, Fuchs‐5, panuveitis‐5, HSV‐1, toxoplasmosis‐1, uveitis in RA‐1). The cataract was mature‐1, cortical‐14, fibrotic‐1 or nuclear‐6. The anterior capsule thickness showed irregularity in and between the cases spanning from 8,8 to 25,2 μm (average 16,33, SD 4,85μm). In 12 samples intrusions of capsule at the capsule‐epithelial border embedding cellular material were found. Capsule itself showed ultrastructure changes in 18 samples, including: filaments, rarefication of capsule or its anterior chamber boarder, and lamellae. In 5 samples the amorphous material at the anterior chamber boarder was seen. Epithelial changes were observed in all 22 samples, including: vacuolisation, multilayered epithelium, detached epithelium, intercellular space, star‐shaped nuclei, necrotic cells, lipofucsin granules. In 4 samples the epithelium was unrecognizable due to extensive fibrosis or necrosis.

Conclusion All studied uveitic cataracts showed epithelial and most also capsular changes. Some capsules showed extensive changes with unrecognizable structures. The findings did not correlate to clinical appearance or diagnosis and most probably resulted from nonspecific response to inflammation. Amorphous depositions could be inflammatory debris. Further studies need to be done to explain the underlying processes.
The first keratoprosthesis implantation 1n 1955
Authors: DE LA PAZ MF , BARRAQUER J
Published: September 2009

Purpose to describe the Barcelona experience with the different types of keratoprosthesis for end‐stage cicatricial corneal disease.

Methods We present 6 cases showing various types of keratoprosthesis which we have used at the Barraquer Eye Center from the 1950´s up to the present.

Results We describe the first keratoprosthesis ever implanted in Spain, on a case of severe chemical burn on a young lady. We implanted a Dorzee acrylic keratoprosthesis in 1955. 5 years later she had extrusion of the prosthesis and superior retinal detachment. The second case describes the Dorzee‐Barraquer‐Cardona acrylic implant implanted in 1958 on a patient with end‐stage glaucoma. Patient had good anatomical retention until his death in 1970. The third case describes the use of the Cardona keratoprosthesis in 1960. Patient had good anatomical and functional results for 8 years until suffering from an acute endophthalmitis. The fourth case demonstrates the expulsion of a Teflon‐supported keratoprosthesis designed by Girard. The fifth case describes the first implantation of an osteo‐odontokeratoprosthesis designed by Strampelli on a blast injury showing good results for 10 years. The last case shows our experience on the Boston keratoprosthesis which we started using in 2006. Finally, we present our technique of the osteo‐odontokeratoprosthesis and a summary of our clinical results from 1970´s to the present.

Conclusion Our clinical experience for more than 50 years on the use of keratoprosthesis shows that while the surgical technique, design and post‐operative treatment of both biological and non‐biological keratoprosthesis have improved thru the years, the anatomical and functional success remains a challenge for the KPro surgeon.
Wiskott‐Aldrich syndrome: A case with scleritis
Authors: KARAMPATAKIS V , HATZISTILIANOU M , KORDALI P , BISMPAS I
Published: September 2009

Purpose To present a case of scleritis in a patient with Wiskott‐Aldrich primary immunodeficiency.

Methods An 18 year old male presented with red left eye. The patient received immunoglobulins for his immunodeficiency regularly. Dexamethasone eye drops were prescribed. In two days the redness increased and the eye became painful mainly nasally with a slight diminution of visual acuity(VA).

Results Aqueous flare and cells were detected. Intraocular pressure (IOP) was 12 mmHg. Steroid eye drops (dexamethasone) in frequent instillation and diclofenac eye drops were administered. Acyclovir (per os 800mgrx5) was added. Seven days later the redness increased and gradually the eye became more painful (nasally). Prednisolone 2, 5 % (1x1 at night) was added and also naproxen tablets (250mgrx3). Within 2 days the aqueous flare and cells ameliorated. Four days later a marginal corneal infiltration appeared nasally. Within the next week an increase of the lateral scleral involvement appeared (the nasal part was obviously better) and this lateral scleral area became painful. The fundus examination revealed chorioretinal involvement corresponding to the lateral scleral painful area. The visual acuity and the IOP remained normal. The patient was instructed to continue his therapy. He also received gamma globulins regularly (100mg/Kg/week). Only after the lateral deterioration of scleritis an additional dose was added in the middle of the week. The laboratory findings were indicative of inflammation.

Conclusion The topical treatment with dexamethasone, diclofenac and prednisolone in conjuction with acyclovir and naproxen per os was proved adequate treatment for this particular patient who also received gammaglobulins.
Recent findings and perspectives of the vision screen in the German Mouse Clinic
Authors: PUK O , FAVOR J , SUN M , DALKE C , GRAW J
Published: September 2009

Purpose The purpose of this study was the large‐scale screening of different mouse models for eye disorders.

Methods The eyes of the mouse mutants were analyzed by slit lamp biomicroscopy, funduscopy, and laser interference biometry. Cataracts were quantified by Scheimpflug imaging.

Results In the past 15 months, 36 mouse mutant lines were screened in the German Mouse Clinic. Two of them, Ali030 and Fra2, were affected in eye development. Funduscopy and histology of Ali030 indicated an optic nerve head dysplasia due to an alternative splicing of the serine/threonine‐protein kinase gene Bmpr1b. Fra2 is characterized by an H2‐Kb promoter induced ectopic expression of the transcription factor gene Fosl‐2. Laser interference biometric eye size measurements revealed a significantly reduced mean lens thickness in transgenic mice, indicating a putative role of Fosl‐2 in lens development. We further tested the clinically well established Scheimpflug imaging technique as a putative tool for cataract quantification in the vision screen. Measurements with the O377‐crybB2 mouse mutant line successfully imaged even faint zonular opacifications. Furthermore, a core density of 40% and a peripherical opacification between 10% and 14% was calculable. Our results demonstrated that Scheimpflug imaging is an improved quantitative alternative to subjective slit lamp investigations.

Conclusion Two novel mouse models for optic nerve head dysplasia and microphakia were detected in the vision screen. Scheimpflug imaging was demonstrated to be suitable for cataract quantification in the mouse lens.
Primary photodynamic therapy of choroidal melanoma
Authors: HEIMANN H , COUPLAND SE , DAMATO B
Published: September 2009

Purpose To review our initial experience with photodynamic therapy of choroidal melanoma at the Ocular Oncology Service in Liverpool.

Methods Patients were included in the study if they underwent primary photodynamic therapy for choroidal melanoma. The treatment was administered using the same protocol as for choroidal neovascularization.

Results The patients (12 male and 5 female) had a mean age of 62.2 years. The melanomas were located in the right eye in 11 patients and the left eye in 6 patients. The tumour margin extended anteriorly to pre‐equatorial choroid in one patient and posteriorly to include optic disc in 7 patients. The melanomas had a mean diameter of 7.6 mm and a mean thickness of 2.0mm. The initial visual acuity was 6/12 or better in 13 patients and 6/18‐6/60 in 4 patients. Biopsy showed the tumour to be of spindle cell type in two patients and to contain epithelioid cells in three patients. One patient was found to have monosomy 3 so that the tumour was treated with proton beam radiotherapy. The follow‐up ranged to 622 days with a median of 101 days. Four patients subsequently underwent proton beam radiotherapy and one patient was treated by endoresection. The last known visual acuity was 6/12 or better in 11 patients, 6/18 to 6/60 in 4 patients and 3/60 to Counting Fingers in 2 patients.

Conclusion Photodynamic therapy may be worth attempting in patients with a small choroidal melanoma when other methods are likely to cause visual loss. Many patients subsequently require more aggressive treatment to achieve local tumour control.
Outcome following ranibizimab therapy for neovascular age related macular degeneration in patients with poor, intermediate and good vision
Authors: ADEPEGBA O , JYOTHI S , GUPTA B , SIVAPRASAD S
Published: September 2009

Purpose To assess the visual outcome following intravitreal ranibizumab in eyes with wet age related macular degeneration(AMD) in patients with three different baseline vision viz; <35, 35‐54 and >54 ETDRS letters.

Methods This study assessed the ETDRS visual acuity at diferent time points in a total of 98 patients.Optical coherent tomography and fundus fluorescein angiography FFA was carried out at baseline and thereafter when required. Intravitreal ranibizumab was administered monthly for 3 months and when necessary as guided by vision and OCT. Follow up period was 6 months.

Results In the 27 patients with baseline vision < 35 letters, the mean change in vision at 6 months from baseline is +8 (p=0.04). None of the patients lost more than 15 letters (floor effect) and 35% gained more than 15 letters. In 43 patients with baseline vision 35‐54 letters the mean change in vision at 6 months is +10 letters(p=0.0003). None of the patients lost more than 15 letters or gained more than 15 letters.Twenty‐eight patients baseline vision > 54 letters had a mean change in vision at 6 months of +6 (p=0.4). Only 16% gained more than 15 letters(ceiling effect). All the three groups were observed to have improvement of vision in the 3rd month which was sustained in the 6 month.Patients with baseline vision more than 54 letters receive an average of 3.52 injections over the 6 month period. Those with vision 35‐54 and <35 received an average of 3.42 and 3.56 injections respectively over the same period.

Conclusion Response to ranibizumab in patients with good and intermediate and poor vision at baseline was similar to the ANCHOR and MARINA studies up to 6 months.
Validation of a predictive model for diabetic retinopathy progression in type‐2 diabetic patients with mild nonproliferative diabetic retinopathy.
Authors: NUNES S , BERNARDES R , LOBO C , CUNHA‐VAZ J
Published: September 2009

Purpose To validate a predictive model for diabetic retinopathy progression in type‐2 diabetic patients with mild nonproliferative diabetic retinopathy (NPDR) using non‐invasive examinations, previously reported by Lobo et al. [Arch Ophthalmol. 2004; 122(2):211‐7].

Methods Four‐hundred type‐2 diabetic patients with mild NPDR were included in this 2‐years observational and prospective study. Sixty‐three patients performed the baseline and the 6‐month visits underwenting: color fundus photography, retinal thickness (RT) measurements and blood tests. Microaneurysm formation rate (MAFR) was computed from color fundus photographs using a new method that assists graders on earmarking MAs (MA‐Tracker). Increased RT maps (Stratus OCT – Carl Zeiss Meditec, Dublin, CA, USA) were computed using proprietary software. Patients were classified into one of the 3 different phenotypes of DR progression characterized by: Phenotype 1 – eyes with low MAFR and normal RT; Phenotype 2 – eyes with increased RT and; Phenotype 3 – eyes with high MAFR.

Results Twenty‐six patients (41.6%) were classified as being of Phenotype 1; 17 (27.0%) as Phenotype 2 and; 20 (31.7%) as Phenotype 3. This distribution of patients in each phenotype is similar to the one previously found when establishing the predictive model.

Conclusion Preliminary data confirms the existence of 3 different phenotypes of DR progression.
Evaluation and inter‐observer analysis of retinography existing clinical classification system to categorize moderate retinopathies
Authors: SANCHEZ RAMOS C , WASFI M , BONNIN‐ARIAS C , VINAS‐PENA M , FORLAN A , MOLINA‐GOMEZ M , CHAMORRO E
Published: September 2009

Purpose To evaluate existing validated systems to classify retinopathies, to determine the inter‐observer agreement level

Methods 55 retinographies (both gender, >60 years old) were categorized following 3 established criteria: the International Classification and Grading System for ARM and AMD (BIRD), the Wisconsin Age‐related Maculophathy Grading System (WISCONSIN) and the Clinical Age‐Related Maculophathy Staging System (CARMS). The categorizing was made by 2 experts in a blind, independent way. The goal of the doubled‐classification‐method, with changing order no randomised, was to reject the influence of the Velo effect. Inter‐observer’s repeatability was checked as an agreement parameter between both Experts

Results CARMS system was chosen, since allows a global pathology classification. CARMS concordance obtained was 81.89% (expected=57.39% Kappa index=0.57).Drusen concordance obtained was 87.27% (expected=60.31% Kappa index=0.68).Pigmentation concordance obtained was 76.36% (expected=54.46% Kappa index=0.48).The reliability measured by Kappa index followed the rule: 0.80‐1.00 (Excellent),0.60‐0.80 (Good) y 0.40‐0.60 (Moderate),0.20‐0.40 (Low),<0.20 (Bad)

Conclusion Existing Retinopathies classification systems can be improved, to solve the huge subjective level that they present. Kappa index obtained, shown medium concordance for the inter‐observer analysis, except in Drusen case, dichotomy’s variable, which presented a good reliability. The worse behaviour of the Pigmentation’s variable respect to Drusen variable has to be noted. This has an important influence in the global CARMS reliability, so it makes this influence to fall down
Animal models for the treatment of bacterial keratitis
Authors: KOWALSKI RP
Published: September 2009

Rabbit models of bacterial keratitis have been used to evaluate the efficacy of anti‐infectives in the clinical treatment of bacterial keratitis. These models can determine: 1) ocular toxicity and tolerance of anti‐infectives to ocular tissue, 2) penetration of anti‐infectives into the cornea, and 3) anti‐bacterial efficacy of the anti‐infectives to corneal bacterial pathogens. The current presentation will cover the structure and limitations of rabbit bacterial keratitis modeling using published data. Topics will include statistical design, the choice of bacterial pathogens, and positive aspects for possible systemic anti‐infective development.
Limiting the sequelae of irradiation in retinoblastoma patients by using globe and orbital brachytherapy with iodine 125
Authors: STANNARD C
Published: September 2009

Abstract not provided
Clearance of dying cells in the retina ‐ relevance to age‐related macula degeneration
Authors: PETROVSKI G , BERENYI E , VAJAS A , FESUS L , FACSKO A , BERTA A
Published: September 2009

Purpose The retina is the place with the highest daily phagocytic turnover in the whole human body. Besides photoreceptor outer segments, retinal pigment epithelial (RPE) cells can engulf other dying cells as well (epithelial, neural, etc.). Failure to do so may result in accumulation of debris that could lead to development of age‐related macula degeneration (AMD). The in vitro dynamics of this clearance process can be modelled using human ARPE‐19 cells and macrophages.

Methods Different death patterns were induced in vitro in ARPE‐19 cells: death through detachment from the extracellular matrix on polyHEMA coated surfaces known as anoikis, UV induced apoptosis and Argon‐laser induced necrosis. Two‐colored phagocytic assays were carried out where different phagocytes (living ARPE‐19 cells or human macrophages) engulfed different dying cells. Flow cytometry (FACS Calibur), fluorescent and time‐lapse microscopy (the later not shown) were used to quantify and visualize the phagocytic process.

Results The clearance of the anoikic ARPE‐19 cells by the living ARPE‐19 cells (serving as a model for dry AMD) over 8 hours of co‐incubation proved efficient and increasing over time (at 8 hours, over 50% of the phagocytes contained engulfed anoikic ARPE‐19 cells inside). The human macrophages could also engulf the anoikic ARPE‐19 cells (serving as a model for wet AMD), although less efficiently at five times lower rate over the same period.

Conclusion The clearance of the different dying ARPE‐19 cells can serve as a good in vitro model for studying AMD, both dry and wet type, as well as for testing different immunological and pharmacological aspects affecting this process.
Relationship between VEGF expression and the retina following light‐damage
Authors: CACHAFEIRO M , BEMELMANS AP , WENZEL A , ARSENIJEVIC Y
Published: September 2009

Purpose In the retina, the balance between pro‐ and anti‐angiogenic factors is critical for angiogenesis and is also involved in cell survival and maintenance. We previously reported an upregulation of VEGF following light‐damage (LD). Furthermore, systemic delivery of PEDF, as well as lentiviral gene transfer of an anti‐VEGF antibody rescued photoreceptors from cell death. Thus, we investigated the effect of high levels of VEGF on the neural retina and retinal pigmented epithelium (RPE) after LD.

Methods To study the action of VEGF in the retina after LD, we exposed adult Balb/c mice to 5’000 lux for 1h, and we collected neural retinas and eye‐cups (containing RPE) at different time points after LD. We analysed protein expression, RPE cell permeability and then, we studied the action of VEGF and oxydative stress on ARPE19 cells.

Results In the neural retina, results indicate that high levels of VEGF induce an upregulation of VEGF‐R2 and increase the src phosphorylation, whereas VEGF‐R1 expression is decreased. Concomitantly with VEGF upregulation, in the RPE we observed a downregulation of PEDF expression and the β‐catenin translocates into the cytoplasm of RPE cells, indicating an increase on permeability. We observe that VEGF treatment did not alter ARPE19 cell junctions in normal conditions, whereas under oxidative stress, VEGF contributes to the disruption of cells junctions.

Conclusion This study involves VEGF in LD and highlights the prime importance of angiogenic factor balance for PR survival. Our results suggest that PR apoptosis is augmented by RPE cell permeability, and could contribute indirectly to the deleterious effect of VEGF observed during light‐induced PR apoptosis.
Encouraging results of a VEGF kinoid against experimental choroidal neovascularization
Authors: ABITBOL B , PROVOST A , GROUART‐VOGEL G , BERNIER S , ADAM‐BUCZKOWSKI E , ZAGURY D , ABITBOL M
Published: September 2009

Purpose The goal of this preliminary study was to evaluate the preventive and curative antiangiogenic properties of a VEGF KINOID vaccine produced by NEOVACS againt experimentally laser induced murine choroidal neovessels

Methods 3 groups of 12 adult mice (30g) were submitted to laser impacts breaking slightly the Bruch's membrane and initiating the development of subretinal choroidal neovessels. These laser impacts did not create immediately obvious choroidal lesions leading to blood hemorrhages.One Group of mice was submitted to repeated immunizations up to 5 immunizations by the VEGF Kinoid vaccine associated to a modified freund's adjuvant solution. One group of mice received only the mofified Freund's adjuvant and one group of mice sham injections of PBS in the same conditions.

Results We were able to observe a decrease or even the disappearance of the abnormal choroidal neovessels even in animals that had been immunized but had not reached adequate levels of neutralizing antibodies against VEGF. Transient adverse effects were observed in some mice in all the groups of mice.

Conclusion Obviously The modified freund's adjuvant solution utilized in this first set of experiments must be avoided or modified in order to avoid adverse effects. The chemistry for the production of the VEGF kinoid production must be improved in order to obtain a better immunizing vaccine.

Commercial interest
Ocular toxoplasmosis recurrences: a single center case report
Authors: SERRA U , JULIAN K , AKNIN C , CASSOUX N , FARDEAU C , BODAGHI B
Published: September 2009

Purpose To describe recurrence patterns in a cohort of patients with aqueous humor proven ocular toxoplasmosis, followed during 3 years, at a single referral center.

Methods Retrospective, observational, non comparative case series including 43 patients who suffered from an active episode of toxoplasmic retinochoroiditis during 2005, confirmed by aqueous humour polymerase chain reaction (PCR) positivity and assisted at the Ophthalmology Department of the Pitié‐Salpêtrière Hospital in Paris, France. Clinical files were analyzed in terms of signs of intraocular inflammation, number, size and location of retinochoroidal active lesions and scars, presence of ocular complications related to toxoplasmic retinochoroiditis, angiographic and visual field findings and therapeutic management.

Results 20 males and 23 females (mean age 37 year‐old) were followed after an episode of toxoplasmic retinochoroiditis confirmed by analysis of ocular fluids. Five of them were immunocompromised and twelve have already experienced at least a previous episode of active toxoplasmic retinochoroiditis. Recurrences occurred in 13 patients (28%) with a mean age of 48 years. These episodes were noted during the first year of follow‐up, between 12 and 24 months and between 24 and 36 months in 4, 5 and 3 patients respectively.

Conclusion Recurrences seem to be more frequent if they occur during the first year after the initial episode of retinochoroiditis, especially in older patients. Prospective studies are needed in order to confirm these preliminary data.
Ophthalmic microsporidiosis: the Manchester experience
Authors: BONSHEK R , CURRY A , IRION L
Published: September 2009

Purpose We report cases of ocular and adnexal microsporidiosis diagnosed in Manchester, UK, and review the literature.

Methods The archives of the National Specialist Ophthalmic Pathology (NSOPS) Manchester Laboratory and Health Protection Agency Laboratory (HPA)at Manchester Royal Infirmary were reviewed for cases of microsporidiosis between 1990 and 2009.

Results 8 cases of ocular and adnexal microsporidiosis were identified. Organisms were Encephalitozoon hellem, Encephalitozoon sp., Vittaforma corneae, Trachipleistophora hominis, Nosema sp. with infection of ocular surface, cornea, nasolacrimal apparatus and nasal sinuses, and eyelid; a historical case of Microsporidium ceylonensis keratitis, first reported by Norman Ashton in 1973 was also reviewed. Ages ranged from 11 years (Ashton’s case) to 50 years. One case was from an HIV +ve patient, the others were immunocompetent. At least 4 infections were contracted whilst the patient was outside the UK.

Conclusion Microsporidia, minute obligate intracellular parasites related to fungi, infect via a polar tube housed within a highly resistant spore. Microsporidial infection in HIV/AIDS, usually entereic, is the most reported. Antiretroviral treatment has lowered the incidence of enteric microsporidiosis and ocular infection is increasingly prevalent and often not HIV‐related. In our cases the majority were immunocompetent individuals. LM can be diagnostic if characteristic refractile ZN‐positive spores are seen, but LM does not permit speciation, which usually requires EM. Diligent searching for organisms may be necessary as distribution may be focal. Insufficient data exist for PCR‐based diagnosis of most microsporidial species.Sources and mechanisms of microsporidial infection remain speculative.
An epidemiologic analysis of staphylococcus aureus‐associated keratitis in Boston
Authors: BEHLAU I , HEIMER SR , LEONARD EM , MARTIN JN , DOHLMAN CH , GILMORE MS
Published: September 2009

Purpose S. aureus is a normal commensal of the human skin and nasopharynx. It is therefore of interest to determine whether S. aureus keratitis is caused by a subset of these organisms. In this study, the phenotypic and genotypic characteristics of S.aureus keratitis isolates were analyzed.

Methods All S. aureus clinical isolates were prospectively collected over a 24 month period at the MEEI (2006‐2008). The diagnosis of clinical keratitis and associated risk factors was by medical record review. Keratitis‐associated S. aureus strains were assessed for: 1) antibiotic susceptibility, 2) biofilm robustness by gentian violet staining using an in vitro microtiter plate assay, and 3) genetic lineage by multi‐locus sequence typing (MLST).

Results 26 cases of keratitis were identified from the 600 S. aureus clinical isolates. Risk factors associated with S.aureus keratitis included trauma, prior surgery, soft contact lens wear, and the presence of a foreign body. Ocular surface disease does not appear to be an independent risk factor. All 26 isolates were tetracycline‐ and trimethoprim‐sulfamethoxazole‐ sensitive. All the MRSA strains were found to be ciprofloxacin‐resistant (10/26). Nearly one‐half of all the S.aureus keratitis‐associated isolates were caused by a single clone, ST5. Both methicillin sensitive and resistant S. aureus strains were represented within ST5.

Conclusion These results suggest that there may be specific S.aureus lineages which possess phenotypic and genotypic characteristics that enable S. aureus to more effectively cause sight‐threatening keratitis. Future work will examine their virulence traits and a comparison to commensal S.aureus strains.
Uveal melanoma in a 12‐year old child
Authors: DESJARDINS L , LEVY‐GABRIEL C , SASTRE X , MICHON J
Published: September 2009

Abstract not provided
Irido‐cilio‐choroidal melanoma in a 5‐year old child
Authors: PE'ER J
Published: September 2009

Abstract not provided
A child with a melanocytic ciliary body tumour
Authors: KIVELÄ T
Published: September 2009

Abstract not provided
Large retinal hemangioma treated in second hand by betabrachytherapy, on a single eye of a young adult
Authors: GRANGE JD , KODJIKIAN L
Published: September 2009

Abstract not provided
Comparison of spectral‐domain cirrus optical coherence tomography (OCT) and time‐domain Stratus OCT for the evaluation of macular and peripapillar retinal nerve fiber layer thickness in patients with diabetes type 2
Authors: GIL ARRIBAS L , GARCIA MARTIN E , IDOIPE M , FUERTES I , PINILLA I
Published: September 2009

Purpose To compare Cirrus Fourier‐domain OCT with Stratus Time‐domain OCT for measuring the peripapillar retinal nerve fiber layer (RNFL) and macular thickness in patients with diabetes mellitus type 2 without diabetic retinopathy.

Methods Prospective study of 49 patients with diabetes type 2. Only one eye by each patient was randomly included in the study. All of them were underwent three optic disc cube 200x200 scans and three macular 512x128 volume cube scans with the Cirrus HD‐OCT system (Carl Zeiss Meditec, Inc.) and with the Stratus system. The average of all the scans was calculated. The RNFL thickness average, the RNFL thickness at each quadrant, and each 12 clock‐hours position were evaluated comparing the two devices. The macular values of the nine areas corresponding to ETDRS protocol were compared between both systems.

Results 21 men (42.9%) and 28 women (57.1%) were included in the study. Mean age was 60 (42‐72 years). The average of the macular thickness using Cirrus HD‐OCT was approximately 66.37 µm higher the average measured with Stratus (263.52 µm vs 197.15 µm; p=0.001). We did not find statistically significant differences between Cirrus and Stratus in RNFL average thickness measurements. Statistically differences were only found in one clock‐hour position.

Conclusion Macular measurements using Cirrus OCT are higher than those measured with Stratus OCT in patients with diabetes mellitus type 2. It doesn’t exist a clear difference in RNFL measurements between two devices. Our results are consistent with other previous studies obtained in healthy subjects in similar conditions.
Differences in macular thickness studied by time domain optical coherence tomography (OCT) and spectral domain OCT in healthy subjects
Authors: IDOIPE M , GIL ARRIBAS L , PINILLA I , GARCIA MARTIN E , FUERTES LAZARO M
Published: September 2009

Purpose To compare Stratus Time‐Domain optical coherence (OCT) with Spectralis Spectral‐domain OCT for measuring macular thickness in healthy patients.

Methods Prospective study. Fifty‐ five healthy subjects were studied. All them undewent 3 Time Domain Optical Coherence Tomograph (OCT) scanning (Stratus OCT, Carl Zeiss Meditec, Inc.), fast macular thickness scan strategy, and 3 Spectral Domain OCT (Spectralis OCT; Heidelberg Engineering, Heidelberg, Germany) with macular scan 512 x 128 volume cube. Mean values of macular thickness measurement of the nine areas corresponding with “Early Treatment Diabetic Retinopathy Study” (ETDRS) were compared between both tomographs.

Results We examined 55 healthy subjects, 43 women and 12 men, mean age was 35.64 ±13.73 years. Central thickness measured by Status OCT was 200.51 ± 17.98; central thickness obtained by Spectralis was 276.34 ± 20.71 microns. The t‐test assesses whether the means of all ETDRS macular areas measuremnts of the two tomographs are statistically different from each other, finding that Spectralis central thickness measuments was 75.83 microns higher than using the Stratus OCT.

Conclusion Time Domain OCT uses the joint of the inner and outer segments of the photoreceptors as outer reference for macular thickness calculation whereas Spectral Domain OCT bases its reference in the retinal pigment epithelium, so differences between both of them are predictable. With our study we obtain a measurement of useful conversion to extrapolate the results obtained with a tomograph to the other one, being of great utility in the clinical practice.
Choroidal blood flow and retinal ganglion cell function in early glaucoma
Authors: MARANGONI D , COLOTTO A , SALGARELLO T , STIFANO G , PARISI V , RIVA CE , CAMPOS EC , FALSINI B
Published: September 2009

Purpose To assess subfoveal choroidal blood flow in patients with early manifest glaucoma (EMG) and to compare blood flow with functional measures of retinal ganglion cell (RGC) integrity.

Methods Subfoveal choroidal blood flow was determined by confocal, real‐time laser Doppler flowmetry in 25 EMG patients (<‐6 dB Humphrey mean deviation, age range: 42‐64 years, visual acuity: 0.8‐1.0) and in 20 age‐matched controls. All patients had a therapeutically (topical beta‐blockers with or without a prostaglandin) controlled intraocular pressure (IOP <20 mmHg). Subfoveal choroidal blood volume (ChBVol), velocity (ChBVel) and flow (ChBF) were determined as the average of three 60 sec recordings with changes in the DC < 10% between the recordings (DC measures the intensity of the light scattered by the tissue and red blood cells in the illuminated volume). In all patients and controls pattern electroretinograms (PERGs) were recorded according to a standardized protocol.

Results In EMG patients, average ChBVel and ChBF were reduced by 31 and 35%, respectively (p <0.01) compared to control values. No significant difference in ChBVol was found between the two groups. PERG amplitudes were reduced by 40% (p <0.01) in EMG patients compared to controls. No correlation was found between anyone of the choroidal flow parameters and PERG data or IOP values.

Conclusion The results suggest a significant alteration of subfoveal choroidal hemodynamics in EMG patients, involving both ChBVel and ChBF. These changes do not appear to be associated with the severity of functional retinal ganglion cell loss. Our findings may have implications for the pathophysiology of early glaucomatous damage and its treatment.
Glaucoma treathment in MOOKP
Authors: TALONI M , FALCINELLI G
Published: September 2009

Abstract not provided
Intravitreal combination of triamcinolone acetonide – bevacizumab (Kenacort–Avastin) in diabetic macular edema
Authors: ELEFTHERIADOU M , FRAGISKOU S , PANTELEONTIDIS V , PAPADAKI T , TSILIMBARIS M , PALLIKARIS IG
Published: September 2009

Purpose To evaluate the effect of intravitreal injection of Triamcinolone Acetonide – Bevacizumab (Kenacort®)‐(Avastin®) in the treatment of diabetic macular edema

Methods Twenty seven eyes of 17 patients with diabetic macular edema participated in this study. Each patient received an intravitreal injection of 0,1 ml triamcinolone acetonide (Kenacort®) (0,2mg)combined with bevacizumab (Avastin®) (1,25mg). Mean age was 64years and mean duration of diabetes 15,5years. The primate outcome measures were changes in best corrected visual acuity and in central macular thickness measured by OCT. The follow up period was six months from the first intravitreal therapy.

Results During the follow up period 3 eyes(11%) received one, 18 eyes(67%) received two and 6 eyes(22%) received three intravitreal injections according to the monthly follow up examination. There were not observed any important complications of the intravitreal combination of Triamcinolone Acetonide – Bevacizumab either during or after the treatment. The mean visual acuity increased 0,12 (decimal) (p<0,0001) and the central macular thickness decreased 235μm (p=0,018).

Conclusion Intravitreal combination of Triamcinolone Acetonide – Bevacizumab seems to be effective in improving visual acuity and macular edema in patients with diabetes.
Ocular blood flow and visual field preservation?
Authors: MARTINEZ‐GARCIA A
Published: September 2009

Purpose The aetiology of primary open‐angle glaucoma (POAG) is almost certainly multifactorial. Elevated intraocular pressure (IOP) has been recognized as one of the most important risk factor for the progression of the glaucomatous damage. Nevertheless, other risk factors have been considered to be involved on the progression of the glaucomatous damage. Several population‐based studies have shown that low diastolic blood pressure and diastolic ocular perfusion pressure (OPP) are major risk factors for the genesis and progression of POAG. Additionally, there is increasing evidence that ocular ischemia is a primary and independent factor for the progression of the glaucomatous damage. Because OBF alterations are associated with the progression of the glaucomatous damage and dorzolamide seems to be capable of increasing OBF, it is conceivable that an increase of the OBF may protect against the glaucomatous visual field deterioration.

Methods This hypothesis has been suggested by a recently paper published by our group, which has shown that dorzolamide 2% added to timolol 0.5%, each given twice daily, may prevent the visual field deterioration over the course of 4 years in individuals with primary open‐angle glaucoma (POAG). Finally, in a prospective, randomized, evaluator‐masked, and parallel study we compared the impact of dorzolamide and brinzolamide, each added to timolol, on the progression of the glaucomatous damage. The results of our study suggested that the patients treated with dorzolamide/timolol had half of the progression risk of patients treated with brinzolamide/timolol.

Commercial interest
Spinal Cord Injury‐Induced Neurogenic Bladder
Authors: CHENG Chen‐Li
Published: September 2009

Spinal cord injury (SCI) is one of the most debilitating and devastating injuries to humans. Lower urinary tract dysfunction is of most concern in the management of SCI patients. Proper management depends on understanding the mechanisms underlying the development of neurogenic bladder. Suprasacral SCI induces detrusor areflexia and urine retention initially. The recovery of lower urinary tract function occurs several weeks later, but the voiding function deteriorates and manifests by hyperreflexia and incomplete voiding secondary to the simultaneous contraction of the detrusor and external urethral sphincter (detrusor–sphincter dyssynergia) during voiding. Electrophysiological and pharmacological studies of animals reveal that the recovery of lower urinary tract function relies on the plasticity of bladder afferent pathways. The Aδ afferents convey proprioception and initiate micturition reflex in intact cats and rats. Chronic SCI animals exhibit hyperreflexia during storage and incomplete expulsion during voiding. The Aδ afferent pathway is replaced by capsaicin‐sensitive C‐fiber afferents in chronic SCI cats. In chronic SCI rats, voiding is still mediated thru Aδ afferents. However, C‐fiber afferents modify bladder function and induce bladder hyperreflexia and detrusor–sphincter dyssynergia in chronic SCI rats. Thus, multiple factors have been implicated in the development of neurogenic bladder induced by SCI.
Bladder Botulinum Toxin
Authors: CHUANG Yao‐Chi , KUO Hann‐Chorng , CHANCELLOR Michael B
Published: September 2009

Botulinum neurotoxin (BoNT) is well–known for its ability to modulate neurotransmission and treat muscular hypercontractility. In addition, recent studies also suggest that BoNT affects the modulation of sensory function and inflammation. We hereby review the mechanism by which it modulates overactive bladder and interstitial cystitis.
Localized Effects of Antimuscarinics in the Bladder
Authors: KIM Yong‐Tae , CHANCELLOR Michale B. , TYAGI Pradeep , YOSHIMURA Naoki , MASUDA Hitoshi , KIM Dae Kyung , KWON Don Deuk , CHUANG Yao‐chi
Published: September 2009

Following oral administration, each antimuscarinic agent exerts a range of effects on the bladder urothelium due to a variety of pharmacological activity from the parent compound, inactive, or active metabolites following excretion into the bladder, as studied in a rat detrusor overactivity model. Differences in localized bladder effects exist among antimuscarinic agents, and the agents excreted into the urine with substantial activity might be more effective for treating bladder overactivity because of this localized effect, in addition to the systemic effects on muscarinic receptors in the bladder wall.
Significance of Nitric Oxide and its Modulation Mechanisms in Micturition Disorders
Authors: MASUDA Hitoshi , YANO Masataka , ICHIYANAGI Nobutaka , KIHARA Kazunori
Published: September 2009

Nitric oxide (NO) pathway is of critical importance in the physiological regulation of micturition reflex. NO released from urothelium and suburothelium depresses afferent micturition pathway, while in the central nervous system NO has dual effects on afferent pathway; i.e, excitatory effect in the spinal cord and brain stem and inhibitory effect in the forebrain. Elevated endogenous NO synthase (NOS) inhibitors and increased arginase activity in the lower urinary tracts contribute to NO deficiency, leading to impairement of NO‐mediated relaxations and excitation of different pathway. Therefore, manipulation of endogenous NOS inhibitors and arginase may be new targets of micturition disorders.
Interstitial Cystitis and the Therapeutic Effect of Suplatast Tosilate
Authors: HAYASHI Yukio , UEDA Tomohiro , KIRIMOTO Tsukasa , NAKANO Koushi , OKA Toshinori , KINIWA Mamoru , YOSHIMURA Naoki
Published: September 2009

Painful bladder syndrome (PBS)/interstitial cystitis (IC) can be a chronic and debilitating disease characterized by urinary urgency, frequency, and bladder pain, which are often very difficult to treat, regardless of currently‐proposed treatments. Suplatast tosilate (IPD‐1151T) is an immunoregulator that suppresses Th2 cytokine production, immunoglobulin E (IgE) synthesis, chemical mediator release from mast cells, and eosinophilic recruitment. In a preliminary, open‐label clinical study of IPD‐1151T in 14 women with IC, treatment with IPD‐1151T significantly increased bladder capacity and decreased urinary urgency, urinary frequency, and lower abdominal pain, as measured by the IC symptom index, in patients with non‐ulcerative IC. A concomitant reduction in immunological parameters (eosinophils, IgE, and urine T cells) was observed. Also, in basic experimental studies using hydrochloric acid‐induced chronic cystitis rats, the oral administration of IPD‐1151T (0.1–100 mg/kg/day) for 7 days after the induction of cystitis dose dependently increased the intercontraction intervals and micturition volume. In addition, the infiltration of mast cells and eosinophils into the bladder was suppressed by IPD‐1151T. These findings suggest that IPD‐1151T could be a new medicine for treating debilitating symptoms, such as bladder pain and urinary frequency in PBS/IC.
Solid Oxide Fuel Cell Design Optimization With Numerical Adjoint Techniques
Authors: Elliott L. , Anderson W. K. , Kapadia S.
Published: September 2009

In this paper analysis results for a 2D solid oxide fuel cell model are presented. The model is solved on an unstructured mesh with the finite-volume scheme using an iterative Newton’s method. A cost function is computed on the anode/electrolyte interface proportional to the ratio of the density of hydrogen to water. Sensitivity derivatives of the cost function are obtained with respect to the design variable, Psi, the ratio of porosity to tortuosity in the mean transport pore model with three methods: finite-difference, direct differentiation, and the adjoint technique. The results of the three methods are compared for accuracy. An optimization step is taken using the sensitivity derivative to improve the value of the cost function. The cost function is improved with the design step.