bluuebunny/crossref_metadata_2025 huggingface dataset:
Future plans: Exams in retina, paediatrics, cataract and cornea
Authors: Creuzot C.
Published: September 2015

Due to the heterogeity of ophthalmological practice all over Europe, there was currently no structured and standardised subspecialty training in the various fields of ophthalmology. Ophthalmologists who wish to pursue a more advanced training in the ophthalmological subspecialty of their choice mostly organize their own training and decide individually on their level of knowledge and capability. There was no formal process of assessment and recognition of their expertise. The goal of the EBO Subspecialty diploma is to award ophthalmologists who have completed an ophthalmological subspecialty training and achieved clearly defined prerequisites defined in collaboration with the different subspecialty societies. The first experiment has been organised this year with glaucoma with a close collaboration between EBO and EGS (European Glaucoma Society). In the future, EBO will act as an umbrella organization of the exam in close collaboration with the different European subspecialty societies. The assessment will be based on MCQs, clinical cases, oral examination, and discussion about published articles. If awarded, the candidates will be recognized as Fellow of the EBO in their field of expertise (ie retina, paediatrics, cataract …)
Steroids agents in the management of vitrectomized eyes with diabetic macular edema
Authors: Zambarakji H. , Papastefanou V. , Dooley I.
Published: September 2015

Steroid treatments for diabetic macular edema (DME) include intravitreal Triamcinolone Acetonide (IVTA) or subtenon Triamcinolone Acetonide (STTA), the Dexamethasone 0.7 mg implant (Ozurdex, Allergan) and the Fluocinolone 190 µg implant (Iluvien, Alimera). Most IVTA studies in vitrectomized eyes have too many confounders including additional treatments such as macular laser or anti‐VEG injections, variable outcome measures and follow up times. Furthermore, IVTA was usually given either at the time of pars plana vitrectomy (PPV) to better visualize the vitreous, or at the end of PPV and sometimes combined with an anti‐VEGF. STTA data are based on small non‐randomized studies with short‐term follow up. Whilst some studies have shown limited benefit, studies that compared vitrectomized and non‐vitrectomized eyes found no difference in VA. Current data based on the Ozurdex implant in vitrectomised eyes found short‐term benefit for both visual acuity (VA) and macular thickness. No data is available at the present time for the use of the Iluvien implant for DME in previously vitrectomized eyes. Randomized controlled data are lacking to evaluate the role of steroids for the management of DME in the vitrectomized eye.
Introduction and overview
Authors: Spalton D.
Published: September 2015

PCO remains the commonest complication of cataract surgery and is a particular problem with presbyopia correcting multifocal IOLs which are more sensitive to mild PCO and it remains the barrier to a truly accommodating IOL. This presentation reviews the current clinical status of PCO prevention and in particular the contribution of IOL material and design. Hydrophobic materials appear to induce less PCO than hydrophilic polymers and the reasons for this will be discussed. Square edge profile IOLs have reduced the incidence of PCO but delay rather than cure the problem, edge profile quality is however is very variable and this has clinical implications. Haptic design also affects PCO performance. New ‘open bag’ IOL designs appear to offer a significant improvement in PCO prevention.
Pathophysiology of uveitis
Authors: Dick A.
Published: September 2015

This talk will overview the pathophysiology of non‐infectious uveitis in relation to recent SUN (standardised uveitis nomenclature) disease classification. The experimental and translational human evidence of autoimmunity and activation of immunity will be discussed. In addition the talk will highlight the pathways and mechanisms of tissue damage that results in sight‐threatening disease. Traditionally, despite active immune regulatory mechanisms operative within the ocular environment, inflammation still occurs. Activated antigen and non‐antigen specific T cells are generated in uveitis. The interplay with innate immunity and in particular cells of myeloid lineage both systemically and within the local environment dictate the severity and extent of pathology we observe. The understanding of immune responses during the uveitis open many avenues to potential novel immunotherapies that not only suppress inflammation but attempt to redress immune balance, tolerance and local homeostasis within ocular tissues.
Neurodegeneration and vascular impairment in the eye of diabetic patients
Authors: Simó R. , Hernández C.
Published: September 2015

Diabetic retinopathy (DR), one of the leading causes of preventable blindness, has been considered a microcirculatory disease of the retina. However, there is emerging evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of DR, which participates in the development of microvascular abnormalities. Therefore, the study of the underlying mechanisms leading to neurodegeneration and the identification of the mediators in the crosstalk between neurodegeneration and microangiopathy will be essential for the development of new therapeutic strategies.

In my lecture, an updated discussion of the mechanisms involved in neurodegeneration, as well as the link between neurodegeneration and microangiopathy, will be presented. Finally, the therapeutic implications and new perspectives based on identifying those patients with retinal neurodegeneration will be given.
Monocarboxylate transporters and their functions in the retina
Authors: Osborne N.
Published: September 2015

Monocarboxylate transporters (MCTs) have important functions in healthy tissues, being involved in the transmembrane transport of lactate and other monocarboxylic acids. MCTs are a family of transporters which is presently composed by 14 members, but only MCT1–4 have been biochemically characterized. MCTs are located in the cornea, iris and ciliary body as well as the retina and pigment epithelium (RPE)/choroid. MCT1 is localized particularly to the apical and MCT3 to the basal membrane of the RPE. MCT1 is located to photoreceptor inner segments, Müller cells, retinal capillaries, and the two plexiform layers. In contrast MCT2 labelling is concentrated in the inner and outer plexiform layers with MCT4 being associated only in the inner nuclear retina and the plexiform layers.

In an attempt to understand the role of pyruvate/lactate transport in the retina the influence of a specific MCT inhibitor (4‐cyano‐4‐hydroxycinnamate or 4‐CIN) was tested on ischemia/reperfusion in the rat. No evidence was found to support the view that blockade of lactate/pyruvate entry into mitochondria for oxidative metabolism has an influence on the outcome of retinal ischemia/ reperfusion.
Normal vision, strabismus and the corpus callosum in animals
Authors: Milleret C.
Published: September 2015

In the primary visual cortex of higher mammals, both the retino‐geniculo‐cortical (RGC) and the interhemispheric callosal pathways contribute to the unification of the visual hemifields that project separately within the two hemispheres. Anatomical and functional studies performed on animals reveal that each pathway complements each other both spatially and in terms of binocularity. They also reveal that this pattern emerges progressively with age during the critical period, proving however postnatal visual experience has been normal. In case of abnormal postnatal vision such as the one led by strabismus, both pathways develop abnormally. In particular, we have shown recently that asymmetrical callosal connections develop and this prevents the establishment of a unifying representation of the two visual hemifields. As a general rule, we suggest that crossed and uncrossed RGC pathways contribute successively to all this.

Reference

C. Milleret et al. Eur. J. Neurosci. 1994, 6:193; JC Houzel et al. 1994, Eur. J. Neurosci. 6: 898; C. Milleret & J.C. Houzel. Eur. J. Neurosci. 2001, 13:137; N. Rochefort et al. Neuroimage, 2007, 36:804; E. Bui Quoc et al. Frontiers in Neuroanat. 2011, 5: 1‐29; Ribot et al. J. Neurosci. 2013, 33:13326.
Matrix metalloproteinase in diabetic retinopathy
Authors: Opdenakker G.
Published: September 2015

The inflammatory processes in diabetic retinopathy (DR) are executed by leukocytes and their molecules. An important class of leukocyte effector molecules are the matrix metalloproteinases (MMPs), which are used by leukocytes to penetrate sites of inflammation. More than 20 MMPs are counteracted by 4 natural tissue inhibitors of metalloproteinases (TIMPs). By analysis of vitreous fluids of patients with diabetic retinopathy and ophthalmological controls, MMP‐9 has been detected as a disease marker of eye inflammations. MMP‐9 is a gelatinase and cleaves denatured and not intact collagens. For collagenolysis, one of the collagenases (MMP‐1, MMP‐8 and MMP‐13) need to be present. In DR, MMP‐1 levels are increased in the vitreous and may execute collagenolysis. In addition, MMP‐9 also cleaves the neuroprotective factor prominin‐1/CD133, abundantly present in photoreceptors. The fact that MMP‐9 gene knockout mice are resistant to the development of DR suggests MMP‐9 inhibition may be beneficial. The techniques to detect various forms of MMPs and the relevance of inhibitors will be discussed.

References

(1) PLoS One (2013) 8: e85857; (2) Progress in Retinal and Eye Research (2014) 43: 76–91; (3) Nature Methods (2013) 10: 211–220.
Virtual review‐ in glaucoma and beyond
Authors: Crawley L.
Published: September 2015

Virtual review clinics are becoming more common as a method of delivering consultant led care for patients with chronic conditions on a background of inexorable rise in service provision pressure. In this session we will look at glaucoma and other medical specialities using virtual clinics and explore the benefits and challenges of this new way of working.
Behçet's uveitis in Turkey, why is it still number one?
Authors: Tugal‐Tutkun I.
Published: September 2015

Pathogenetic mechanisms underlying Behçet's disease include complex interactions between genetic factors, environmental factors, and immunological aberrations. The strong association of Behçet's disease with the HLA‐B51 antigen has been known for more than 3 decades. Recent genome‐wide association studies have also shown several shared genetic factors throughout the old Silk Route. In contrast to the recent trend for lower disease prevalence and milder disease forms in Japan, Behçet's disease still accounts for around 25% of uveitis cases in Turkey. This suggests the strong role of environmental factors in disease onset and phenotype. Infections are suspected in the initial triggering of the disease as well as in relapses of its manifestations. It is thought that an aberrant immune response may be generated to different microorganisms recognized by pattern receptors in genetically susceptible individuals. An impaired microbial clearance and exuberant innate and adaptive immune responses to microbial products may have a major contribution to the pathogenesis. Better socioeconomic status with improved living conditions and personal hygiene in the Turkish population will hopefully lead to a lower disease prevalence and severity.
Ultrathin DSAEK: The Present Status
Authors: Busin M.
Published: September 2015

The lecture will present a complete review of Descemet Stripping Automated Endothelial Keratoplasty (DSEK), focussing in particular on the development of the technique for the dissection of ultrathin (UT) donor tissue. History as well as basic principles necessary to understand the mechanisms of UT DSAEK will be introduced to the attendees. In setting the indication to UT DSAEK, the author will discuss the role of recipient corneal status, type of endothelial disease, concomitant eye disease (i.e. glaucoma), presence of clear lens and other preoperative factors. The different techniques of conventional DSEK, UT DSAEK and Descemet membrane endothelial keratoplasty (DMEK) will be compared, pointing out the single steps, which are instrumental in facilitating surgery, while improving the final outcome. In case of multiple intervention, combined versus sequential procedures (e.g. phacoemulsification, IOL surgery, vitrectomy, etc.) will be discussed. The authors will highlight advantages and disadvantages of different surgical approaches. Possible implications for eye banking will also be addressed, with particular emphasis on preparation and storage of tissue for UT DSAEK and DMEK. Slides and videos of case studies will illustrate the most common complications (i.e. graft detachment, dislocation, failure, rejection etc.) as well as the appropriate solutions.
Classification of diabetic retinopathy: from screening to diagnosis
Authors: Wiedemann P.
Published: September 2015

The global incidence and prevalence of diabetes mellitus have reached epidemic proportions. Estimates indicate that more than 350 million people will be affected by diabetes mellitus by 2030. All of these individuals will be at risk of developing diabetic retinopathy (DR). It is necessary to categorize, classify and stage the severity of DR in order to provide adequate therapy. With proper management more than 90% of cases of visual loss can be prevented. The purpose of this presentation is to review the classification of DR with a special emphasis on the International Clinical Disease Severity Scale for DR. This new classification is simple to use, easy to remember and based on scientific evidence. It is based on clinical examination and applying the Early Treatment of Diabetic Retinopathy Study 4:2:1 rule. Together with general medical information it allows a risk based assessment. Specialized examinations such as optical coherence tomography or fluorescein angiography support treatment decisions.
Risk of visual impairment from glaucoma
Authors: Crabb D.
Published: September 2015

Monitoring diagnosed glaucoma patients represents a significant burden on clinical services, with an estimated one million visits annually in the UK alone. Visual field (VF) tests are routinely used for detecting worsening of vision. We modelled VF loss during patient's predicted lifetime by examining more than 400,000 VFs from four regionally different glaucoma clinics/services in England. Levels of VF loss were summarised using the Mean Deviation (MD) index from each test. MD at diagnosis and MD loss during predicted remaining lifetime, using a linear rate of MD deterioration (dB/year) and residual life expectancy tables, were calculated and plotted on motion graphs. Most patients followed in clinics have stable disease. Five percent (95% confidence interval: 4–6%) of patients were predicted to be at risk of statutory blindness in their lifetime [1]. Likelihood of a patient suffering serious visual impairment in their lifetime is linked to level of VF loss at presentation. These findings, from retrospective analysis of ‘big data’ residing in clinics, could help inform planning of follow‐up in glaucoma and also illuminate the importance of detecting the disease before it becomes advanced ([1] Saunders et al 2014. IOVS).
Opacification of intraocular lens
Authors: Matsushima H.
Published: September 2015

Soft hydrophobic acrylic intraocular lenses (IOLs) are increasingly being used because they can be implanted through small incisions, provide good postoperative vision. However, long‐term postoperative follow‐up has identified various problems, including calcification, glistening and whitening.

Calcium deposit on surface of IOLs are sometimes reported about hydrophilic acrylic materials. Calcification reduces the transmission of light and renders the fundus virtually invisible and decrease visual function easily.

Glistening has been attributed to water retention in voids of hydrophobic acrylic materials and nonuniformity of polymer network structures. Whitening refers to the clinical appearance from sub surface nano glistenings (SSNG) of reflected white light due to light scattering as light encounters nano sized fluid filled vacuoles that occur at the anterior and posterior IOL surface. With a hydrophobic IOL, the fundus remains visible despite opacification and less effect of visual function. As a result, removal and replacement of IOLs is indicated in only a few cases. However, sever glistening and whitening increased glare and decreased contrast sensitivity.
Behçet's disease, VKH, sarcoidosis
Authors: Khairallah M. , Kahloun R. , Ksiaa I.
Published: September 2015

Ocular involvement associated with Behçet disease is characterized by a relapsing remitting panuveitis with diffuse vitritis, retinal infiltrates, and occlusive vasculitis. Proper management relies on the early use of immunosuppressive drugs in combination with corticosteroids and administration of biologic agent in resistant and severe posterior segment involvement. VKH disease is a bilateral panuveitis that may be associated with extraocular manifestations. Exudative retinal detachment, associated with typical imaging findings, is the most specific feature to acute VKH disease. Sunset glow fundus is typical to chronic VKH disease. Complications are more likely to occur in the chronic recurrent phase. The mainstay of treatment for acute VKH disease relies on systemic corticosteroid therapy for at least 6 months. Immunosuppressive therapy is mainly used in chronic recurrent disease. Main ocular features of sarcoidosis include bilateral granulomatous anterior uveitis, vitritis with snowballs, multifocal chorioretinitis, and segmental periphlebitis. Diagnosis may be challenging in the absence of apparent systemic involvement. Treatment of ocular sarcoidosis relies on corticosteroids and immunosuppressive agents, in severe cases.
Safety and effectiveness of intravitreal injections in the silicone oil‐filled eye
Authors: Ascaso F.
Published: September 2015

Silicone oil (SiO) use has gained acceptance in providing an effective long‐term tamponade in retinal detachments complicated with proliferative vitreorretinopathy. As the use of injectable therapeutics grows and their indications broaden, it is important to know the safety and effectiveness of intravitreal injections in eyes containing SiO as a vitreous substitute. Thus, whereas intrasilicone injection of bevacizumab is safe and effective to treat patients with iris neovascularization after vitrectomy for advanced proliferative diabetic retinopathy, triamcinolone injection into the SiO‐filled eye is inadequate given that it might significantly increase the IOP due to volume expansion. Furthermore, triamcinolone may not dissolve in SiO, preventing its diffusion to the macula surface, and its whitish crystals might opacify the visual axis. Unlike intravitreal triamcinolone, the DEX implant causes minimal volume expansion and no media opacity. It is biodegradable and injected without surgery and thus also advantageous over the fluocinolone implant. Additional studies are necessary to better understand the pharmacodynamics of sustained‐release drugs from devices implanted or inserted into eyes filled with SiO as vitreous substitute.
The changes of the retinal layers in diabetic patients without retinopathy
Authors: Ferreira J. , Costa L. , Proença R. , Vicente A. , Cunha J.P. , Abegão Pinto L.
Published: September 2015

Diabetic retinopathy is considered to be a neurovascular disease. But in fact, retinal neurodegeneration is present before any microcirculatory abnormalities can be detected in ophthalmoscopic examination. We know this from functional studies documenting electroretinogram abnormalities, loss of dark adaptation, contrast sensitivity and color vision and abnormal microperimetry occur before any vascular abnormality is detected. Novel imaging devices have allowed this pre‐vascular damage to be quantified in a non‐invasive and reproducible way using spectral domain optical coherence tomography (SD‐OCT) that allows in vivo retinal layer thickness measurement. The extent to which this new technology can be used in the clinical setting for early screening in diabetic retinopathy will be the focus of this lecture. The review of the state of the art in this exciting new field of study may prove valuable in the management of this condition.
Sensory and motor fusion
Authors: Houtman A.C.
Published: September 2015

The basis of our understanding of binocular vision and amblyopia in clinical practice has not changed much since Claud Worth formulated three grades of binocular vision in 1903 – well over a century ago. Despite many scientific advances in the neuroanatomical and neurophysiological aspects of binocular vision it may – or may not – come as a surprise that the treatment of strabismus and amblyopia has not fundamentally changed since.

This part of the Special Interest Symposium “contains nothing new” [p.1 Squint: its causes, pathology and treatment. Worth C. London, John Bale, Sons & Danielsson Ltd, 1903], to an extent, but is intended as a refresher of the anatomical and physiological basis of binocular vision and to prime the attendants for the symposium's subject: the presentation of recent advances in the research of the corpus callosum and its role in binocular vision.
Stromal choroiditis in East (VKH) and West (birdshot)
Authors: Herbort C.P.
Published: September 2015

Background and aim

Both Vogt‐Koyanagi‐Harada (VKH) disease and birdshot retinochoroiditis (BRC) are primary stromal choroiditis entities, meaning that the initial inflammatory process necessarily starts in the choroidal stroma. The aim here was to point out similarities and differences between these two stromal choroiditis entities and to show that early treatment is able to modify the phenotypes of both conditions.

Patients and methods

Two groups of patients respectively of VKH and BRC cases were analyzed and followed clinically and angiographically using dual fluorescein (FA) and indocyanine green (ICGA) angiography.Results: 13 of 28 BRC patients and 11 of 24 VKH patients had enough follow‐up data to be included in the study. Early diagnosis and treatment in both VKH (9/11) and BRC (6/13), allowed to avoid sunset glow fundus in the former and BRC fundus lesions in the latter. The main similarities and differenced will be pointed out.

Conclusion

VKH and BRC differ substantially from each other. However choroidal stromal inflammation is characterized by a similar process and responds equally to therapy.
Can ophthalmic technicians be used to deliver glaucoma care?
Authors: Kotecha A.
Published: September 2015

The presentation will describe the development of a technician‐delivered glaucoma screening and monitoring service introduced to help improve capacity and the patient experience within glaucoma outpatient clinics in a London hospital. The service involves the use of ophthalmic technicians to collect clinical data from patients, with a specialist reviewing these data remotely; thus, it removes the face‐to‐face doctor consultation. The nature of glaucoma detection and monitoring lends itself to a ‘remote review’ care model. The patient journey time in this clinic averages at around 50 minutes, compared with 163 minutes in the glaucoma outpatients department. The overall first visit discharge rate for the new patient screening service is 58%; the proportion of patients attending the Stable Monitoring Service who have been rebooked into the service is now 83%. Patient satisfaction with the new service is high. Early analysis suggests that there exists a discrepancy between consultant reviewer management decisions for stable patients, suggesting some may be more risk‐averse than others when managing patients seen within this model.
Prevention of herpes simplex stromal keratitis by a glycoprotein B‐specific monoclonal
Authors: Bauer D. , Dirks M. , Kasper M. , Buch A. , Dittmer U. , Giebel B. , Wildschütz L. , Busch M. , Goergens A. , Schneweis K.E. , Eis‐Hübinger A.M. , Sodeik B. , Heiligenhaus A. , Roggendorf M. , Krawczyk A.
Published: September 2015

The increasing incidence of acyclovir (ACV) and multidrug‐resistant strains in patients with Herpetic Stromal Keratitis (HSK) is a major health problem and often results in blindness. In the study we examined the effectivity of mAb 2c in preventing experimental HSK in BALB/c mice. Mice were infected with HSV‐1 (KOS) and subsequently either systemically or topically treated with mAb 2c. Systemic treatment was performed by intravenous administration of mAb 2c 24 h prior to infection (pre‐exposure prophylaxis) or 24, 40, and 56 hours after infection (post‐exposure immunotherapy). For topical treatment antibody‐containing eye drops or PBS as control was administered (5 times per day). Systemic antibody treatment markedly reduced viral loads and completely protected mice from developing HSK. The administration of antibody prior or post infection was equally effective. Topical treatment had no improving effect on the severity of HSK. In conclusion, our data demonstrate that mAb 2c proved to be effective for the treatment of corneal HSV‐infections and for prevention of HSK and blindness. Moreover, the humanized counterpart (mAb hu2c) was equally potent in protecting mice from HSV‐induced HSK when compared to the parental mouse antibody.
New software for an old problem
Authors: Diamond J.
Published: September 2015

There are huge benefits to be won by switching from old fashioned medical notes to paperless medical records: as a consequence, use of electronic patient records (EPRs) for glaucoma management has become more widespread in recent years.

There are a number of different EPR systems in use in the glaucoma clinic, each of which has strengths and weaknesses. Before selecting a system, clinicians need to consider how and where the system will be used, paying particular attention to venue (hospital or community), primary user (ophthalmologist, optometrist, nurse or technician), compatibility with other equipment (visual fields and disc imaging), ability to archive older medical records and accessibility for virtual review.

It is also of great importance to consider speed of data entry: most EPR systems are slower to use than old‐fashioned paper notes and if that differential is significant, the economics of switching to an EPR will be poor and uptake will suffer as a consequence.

In his presentation Jeremy Diamond will consider these issues in more detail, providing helpful insights to those who wish to switch from paper to paperless working.
Radiation‐induced cataracts: governmental safety aspects
Authors: Ainsbury E.
Published: September 2015

Despite relative ease of treatment, radiation induced cataracts are still the most frequent cause of blindness worldwide. Recent advances have demonstrated that the lens is more radiosensitive than was previously thought and that occupational radiation exposure leads to a small but genuine increase in the risk of radiation cataract for workers, for instance hospital based interventional radiologists and cardiologists. As a result of this and other work, the ICRP recommended to reduce the dose limit from 150 to 20 mSv/year (averaged over 5 years with no single year exceeding 50 mSv). This recommendation has recently been incorporated in the EU Basic Safety Standards in full, with member states required to comply from February 2018.

This presentation will outline the epidemiological and mechanistic research upon which the new limits are based; consider the implications for radiation protection in terms of who will be affected, what will need to be measured and how individuals can be protected and, finally, discuss the specific scientific gaps and research needs in order for the relevant authorities to ensure individual radiation workers and members of the public are adequately protected against radiation induced cataracts.
Dominant Optic Atrophy plus phenotype caused by a deep intronic mutation and a modifier variant in the OPA1 gene
Authors: Wissinger B. , Bonifert T. , Gonzalez‐Menendez I. , Theurer Y. , Synofzik M. , Schoels L.
Published: September 2015

Mutations in OPA1 are a common cause of dominant optic neuropathy (DOA). Recent studies suggest that ~20% of patients carrying OPA1 mutations have additional neurological deficits (DOAplus phenotype). Such patients frequently carry missense mutations in the GTPase domain of OPA1 suggesting a gain‐of‐function effect as a major mechanism. We and others recently reported a series of DOAplus patients with biallelic OPA1 mutations as an alternative disease mechanism. Notably most cases were compound heterozygous for a null allele and the Ile382Met variant. The latter is not per se pathogenic but rather acts as a hypomorphic modifier allele that reinforces phenotypic expression in patients with null mutations on the opposite allele. In one biallelic DOAplus family we identified a deep intronic mutation (DIM) that causes a constitutive activation and inclusion of a cryptic frameshift‐inducing exon into OPA1 mRNA. Consistent with the DIM representing a null allele we observed reduced OPA1 protein amounts to about 50% of normal. Applying antisense oligonucleotides targeting the splice acceptor site of the DIM in patient fibroblasts we could efficiently rescue splicing of the mutant mRNA and re‐establish intermediate OPA1 protein levels.
The CD4/CD8 ratio in vitreous fluids is of high diagnostic value in sarcoisosis
Authors: Maruyhama K.
Published: September 2015

Sarcoidosis is an idiopathic inflammatory disorder involving multiple organs, and ocular manifestation is one of the common features. A well‐known immunological feature in sarcoidosis is an increased CD4+ helper T cell type 1 lymphocyte subset in BALF. In this study, we investigated the vitreous lymphocyte subsets of sarcoidosis to elucidate the immunological features of this disorder in the eye. Our study enrolled 86 sarcoidosis patients. Diagnoses included 53 eyes with definitive sarcoidosis (D‐S) of 41 patients, 60 eyes with suspected sarcoidosis (S‐S) of 45 patients. Vitreous samples from the uveitis patients were analyzed with flow cytometry. Our result presented that the CD4/CD8 ratio was high in the D‐S/S‐S in the vitreous samples. Moreover, a high CD4+ population indicated sarcoidosis uveitis. Therefore, diagnostic vitrectomy using flow cytometric analysis may be a useful adjunct for the diagnosis of sarcoidosis, particularly in complex cases.
Atropine treatment
Authors: Grzybowski A.
Published: September 2015

In the last years, there has been a marked increase in the prevalence of high myopia in younger generations in developed countries in East and Southeast Asia, and there are signs of similar, but less pronounced increases in North America and Europe. In some parts of the world, 70–90% of children completing high schools are now myopic, and as many as 20% may be highly myopic. Topical Atropine have been quite extensively used in clinical practice in Asian countries, and recent reports suggest that low concentrated atropine, which has less severe side‐effects, is also effective. The beginning of an invasive treatment such as atropine drops, even at low doses, requires careful consideration of the risk of myopic progression. The current literature relevant to the prevention of myopic progression with atropine drops is reviewed.
Lifetime study in mice for radiation‐induced cataracts
Authors: Dalke C. , Rößler U. , Neff F. , Greiter M. , Gomolka M. , Hornhardt S. , Unger K. , Garrett L. , Rosemann M. , Kempf S. , Azimzadeh O. , Wurst W. , Aubele M. , Zitzelsberger H. , Hölter S. , Tapio S. , Hoeschen C. , Kulka U. , Atkinson M. , Graw J.
Published: September 2015

We initiated a lifetime study in mice focusing on non‐cancer effects after exposure to middle and low doses of ionizing radiation, particularly radiation‐induced cataracts and retinal disorders.

Mice (males and females) were irradiated (0, 0.063, 0.125 and 0.5 Gy) and received in vivo examinations for lens opacities by Scheimpflug imaging monthly and for retinal effects by OCT every four months. To investigate the underlying mechanisms of radiation‐induced effects mice are sacrificed at different time points (4 and 24 hours, 12, 18 and 24 months after irradiation) for pathological and histological examinations.

Beside wild‐type mice, heterozygous Ercc2/Xpd mutants are included in the study to estimate the risk of genetic susceptibility in virtually healthy mutant mice, while homozygous Ercc2 mutants develop cortical cataracts at early age. The ERCC2 protein has DNA helicase activity and is involved in general transcription and DNA repair.

First analyses of the Scheimpflug examinations did not show significant changes within the groups up to 20 months after irradiation with 0 and 0.5 Gy, while OCT data showed a reduction of the retinal thickness in irradiated heterozygous mutants. This study is still in progress.
Myopic macular holes
Authors: Mura M.
Published: September 2015

Myopic traction maculopathy is common in highly myopic patients and characterized by different stages: macular schisis (MS),macular detachment (MD) without macular hole (MH), and MD with MH. MH‐related retinal detachment is an uncommon complication associated with posterior staphyloma. Surgical management is based on transvitreal approach and posterior scleral procedure. Since the introduction of pars plana vitrectomy (PPV),retinal detachments with MH in highly myopic eyes were mostly treated with the transvitreal surgery. However,vitrectomy alone does not address the major risk factor of the macular schisis, which is the posterior staphyloma. To give a new shape and support to the posterior scleral wall by means of macular buckling has the advantage of releasing both the traction caused by the posterior staphyloma and the anteroposterior traction caused by the vitreous cortex. A more recent T‐shaped scleral buckle has been proposed by Devin et al.

We performed this macular buckling combined or not with PPV as a primary surgery or with a previous failed surgical approach in patients affected by MH with MD and MH with or without MS.

In our opinion a combined surgical approach could be the most effective way to treat this disease.
Congenital forms of nystagmus
Authors: Kaeser P.F.
Published: September 2015

Congenital benign forms of nystagmus have to be recognized and distinguished from acquired forms caused by neurologic lesions, in order to avoid unnecessary investigations. This distinction can usually be made on clinical grounds. Congenital forms of nystagmus include idiopathic infantile, ocular (most commonly associated with albinism, macular or optic nerve hypoplasia, and congenital retinal dystrophies) and latent nystagmus of the congenital esotropia. At the end of the session, participants should be able to identify these specific forms of nystagmus.
Blood flow and oxygenation in atrophic diseases
Authors: Todorova M.
Published: September 2015

There is increasing evidence that alterations in retinal‐choroidal blood flow play a role in the pathogenesis of atrophic diseases. Studying the oxygen saturation of retinal vessels on patients affected by glaucoma and inherited diseases of the retina, suggest the oxygen metabolism to be altered. To which extend the role of the oxygen saturation contributes to the blood flow fluctuations and thus, to the progression of atrophic disease will be discussed in this presentation.
Epidemiology and the protective effects of time outdoors
Authors: Morgan I. , Rose K.
Published: September 2015

There is a major epidemic of myopia in developed countries in East and Southeast Asia, where the prevalence of myopia is now 80–90% in those completing secondary school. More importantly, the prevalence of high myopia is now 15–20%, exposing the future adult population to a much increased risk of pathological myopia and vision loss. In Europe and North America, the prevalence of myopia is also increasing, and now appears to be of the order of 40–60%. Genetic change cannot provide an explanation of these increases, which must involve changes in environmental exposures. The two key factors appear to be increasingly intensive education, with study pressures extending to increased homework loads and extensive use of tutorial colleges after school hours. The other environmental factor at work is the amount of time that children spend outdoors, with increasing amounts of time outdoors protecting from the onset of myopia. The time spent outdoors by children is particularly low in East and Southeast Asia, and two clinical trials have now shown significant delays to the onset of myopia by increasing the amount of time that children spend outside at school. Similar interventions could help to control myopia in other parts of the world.
New developments in DMEK and endothelial cell therapy
Authors: Fuchsluger T.
Published: September 2015

This presentation provides an overview of current and future developments in endothelial transplantation. Aspects of clinical innovation, pharmacological options and developments in the pipeline are presented.
Fundus autofluorescence and Photobleaching : Definitions
Authors: Mathis T. , De Bats F. , Cahuzac A. , Wolff B. , Scemama Timsit C. , Uzzan J. , Kodjikian L. , Mauget‐Faÿsse M.
Published: September 2015

Fundus autofluorescence (AF) imaging is a non‐invasivemethod for detection of fundus fluorophores. The 488 nm blue (short wavelength: SW) or the 787 nm near‐infrared (NIR) wavelenght are usually used to induce AF of fluorophores located in the retinal pigment epithelium (RPE). In case of excitation with SW light, the resulting AF comes predominantly from A2E located in the lipofuscin granules of the RPE. On the other hand, excitation with NIR light seems to highlight the melanin. Regardless of the type of fluorophore in the RPE, the exciting light has to pass first through the retina and especially through the photoreceptor layer. The photopigment absorbs a part of the light, which will not be transmitted to the RPE. Therefore, RPE fluorophores will be less AF. In the same time, photo‐isomerization of the 11‐cis‐retinal to 11‐trans‐retinal by the photon absorbance will be the beginning of the visual signal. Thereby, retinal photopigment loose its absorption property and the light will be easily distributed to the RPE fluorophores. This photoreceptor bleaching phenomenon could be used to better understand the origin of the hyper‐AF pattern: hyper‐AF of the RPE or lack of absorbance of signal due to photopigment loss
Human pluripotent stem cells as a source of corneal epithelium
Authors: Skottman H.
Published: September 2015

In healthy cornea, epithelium is renewed by limbal stem cells (LSCs) and LSCs transplantation has been used to treat limbal stem cell deficiency (LSCD). However, this is only possible if enough healthy limbal tissue is available. Thus, novel cell sources are needed. Human pluripotent stem cells (hPSC) including embryonic stem cells (hESC) and induced pluripotent stem cells (hiPSCs) provide unique opportunities for differentiation of limbal and corneal epithelial cells.

We have previously developed an efficient method for differentiating hPSC towards corneal epithelial progenitor cells capable of terminal differentiation towards mature corneal epithelial‐like cells. With the protocolprotein expression of the corneal epithelial progenitor marker ΔNp63 was greatly enhanced, with up to 95% of cells being ΔNp63‐positive. Finally, after a total of six weeks in differentiation culture, the two markers specific to differentiated corneal epithelium, cytokeratins 3 and 12, were expressed in an average of 35% and 71% of cells, respectively. In recent studies we have continued the molecular and functional characterization of these cells providing more support that those could potentially be used for treating LSCD in the future.
Introduction to the stem cell derived transplants
Authors: Skottman H.
Published: September 2015

Stem cell therapy is a potential approach for the replacement of degenerated cells of the eye. For retinal diseases such as age related macular degradation (AMD), the usability of human pluripotent stem cells (hPSC) are widely studied. Several groups have demonstrated that hPSC‐ derived retinal pigment epithelial cells (RPE) display typical RPE characteristics and the first clinical trials using human embryonic stem cell (hESC) derived RPE are ongoing.

For therapeutic use, the culture of transplantable cells needs to be performed in a culture environment fulfilling quality requirements. For example, the use of xeno‐products in cell production should be avoided as this bears the danger of interspecies transfer of viruses and incorporation of immunogenic molecules. In addition, a supporting extracellular matrix or combined artificial scaffold promotes the stem cell differentiation and acquisition of the correct cell characteristics and function. This is especially important for highly polarized RPE cells possible improving cell survival and function after transplantations.
Retinal innate immune activation in health and disease
Authors: Xu H.
Published: September 2015

Retina is considered as an immune privileged tissue, yet many inflammatory retinal diseases occur. Circulating immune cells are not able to freely migrate into the healthy retina due to the blood retina barrier. Retina is protected by its own innate immune system, including microglia, perivascular macrophages, a small number of dendritic cells and the complement system. When retina suffers from exogenous/endogenous insults, a well‐controlled innate immune response is initiated to maintain homeostasis and restore functionality, such response is therefore beneficial. Dysregulation or malfunction of the innate immune response may result in excessive production of inflammatory mediators that may contribute to retinal pathology. The presentation will discuss how innate immune response is controlled in the retina, and the potential contribution of uncontrolled or dysregulated innate immune activation to retinal lesion development in common sight‐threatening diseases such as age‐related retinal degeneration.
Immune cell activation in diabetic retinopathy
Authors: Xu H. , Chen M.
Published: September 2015

Inflammation plays an important role in the pathogenesis of diabetic retinopathy (DR), although the detailed pathways involved remain poorly defined. Inflammation may occur intravascularly at the early stages of DR in the form of leukocyte‐endothelial interaction (leukostasis). As the disease progresses, this intravascular inflammation damages the integrity of the blood retina barrier resulting in the infiltration of circulating immune cells and plasma proteins that are often toxic to various retinal cells, including the vascular cells as well as various neurons. The presentation will discuss how the phenotype and function of circulating immune cells is affected by diabetes and the contribution of systemic immune activation to retinal degeneration during diabetes.
Ultrasonography in the management of orbital diseases
Authors: Guthoff R.F.
Published: September 2015

Based on a 30 year experience in ophthalmic ultrasound a flowchart is presented dealing with orbital anatomical structures, their recognition and their possible pathological changes mainly based on B‐scan technology.

The following entities are of importance:

pseudo exophthalmus

myogenic exophthalmus

vascular‐exophthalmus

infiltrating legions

expanding legions

optic nerve legions

legions from surrounding structures (bones, sinusis).

This system helps to decide which diagnostic or therapeutic steps should follow in order to support a decision orientated straight forward patient management.
Ultrasound methods in the assessment of ocular blood flow
Authors: Kisseleva T. , Ramazanova K. , Gavrilenko A. , Kuklin A. , Adzhemyan N. , Chudin A.
Published: September 2015

Purpose

To investigate ocular blood flow in vascular diseases (VD) with use of ultrasonic Doppler methods

Methods

610 patients suffered from ischemic optic neuropathy (ION)‐180; the retinal vein occlusion (RVO)‐110; diabetic retinopathy (DR)‐80; age‐related macular degeneration (AMD)‐240 patients were observed. Color Doppler Imaging (CDI) and Power Doppler (PD), 3D‐mode were used to estimate blood‐flow of the ophthalmic artery (OA), the central retinal artery (CRA), the posterior cilliary arteries (PCA). The Doppler spectrum of blood flow and its main indices including the peak systolic velocity (PSV), end‐diastolic velocity (EDV) and resistance index (RI) were measured.

Results

Signs of disordered blood flow in the CRA were detected in RVO:diastolic flow was absent or markedly reduced, decreased PSV and an increase RI in comparison with the norm. CDI showed reduced flow velocities in PCA in patients with ION. The decrease of flow velocities in the OA, the CRA and the PCA in patients with dry AMD and significant increase of RI in the PCA in wet AMD were registered. Decreased PSV and EDV in the CRA and the PCA were determined in patients with DR.

Conclusion

CDI, PD and 3D‐mode are valuable methods for the clinical management of VD.
Eye diseases identified in the ENU‐Ageing Screen
Authors: Jackson I. , Starbuck B. , McKie L. , Banks G. , Blease A. , Simon M. , Wisby L. , Cross S. , Nolan P. , Brown S. , Potter P.
Published: September 2015

MRC Harwell is generating cohorts of mutagenized mice, bred to reveal recessive mutations. Cohorts are repeatedly screened for a range of phenotypes at different ages up to 18 months. Included among the screens is optokinetic response to test visual acuity, pupillometry and examination by slit lamp and indirect ophthalmoscopy. We identify both early and late onset disease models, and document disease progression over the lifetime of the mouse. The genetic design of the screen means that the mutant gene can be rapidly identified by mapping and next‐generation sequencing To date we have identified early onset phenotypes including retinal degeneration due to mutation of Rpgrip1, a model for Leber congenital amaurosis‐6, and abnormal pupil response due to mutation in Chrm3. Late onset phenotypes include corneal opacity, caused by mutation of Ikzf2, and progressive vision loss with retinal degeneration. We have identified a missense mutation in Idh3a that results in reduced visual acuity and retinal degeneration from 12 months. Idh3a encodes the α subunit of the mitochondrial enzyme, isocitrate dehydrogenase. This mouse is a model for retinitis pigmentosa 46, due to mutation in the β subunit of human mitochondrial IDH enzyme.
Fundus autofluorescence imaging in Toxic Retinopathies and in Gravitational descending atrophic retinal pigmented epithelial tracks
Authors: Cahuzac A. , Wolff B. , Lehmann M. , Scemama C. , Mauget‐Faÿsse M.
Published: September 2015

Fundus autofluorescence (FAF) was studied in toxic retinopathy due to synthetic antimalarial drugs (SAM). It was not a screening tool, however it was useful for non‐invasive follow up once retinal toxicity is established.

FAF was also studied in Central serous chorioretinopathy (CSC) and diffuse retinal pigment epitheliopathy (DRPE) where it showed abnormalities at both acute and late stage as well as gravitational descending atrophic retinal pigment epithelial tracks, with different caracteristics depending on the acute or chronic stage of the disease.

FAF was also studied in choroidal hemangioma where it showed various pattern of atrophic retinal pigment epithelial tracks, in chronic retinal detachment (RD) and in post‐traumatic retinal lesions.

Fundus autofluorescence is a major non‐invasive tool to monitor damaged retinal epithelium areas in various pathologies such as toxic retinopathy, CSC, DRPE, chroidal hemangioma and chronic retinal detachment.