bluuebunny/crossref_metadata_2025 huggingface dataset:
Eccentric macular hole after pars plana vitrectomy for epiretinal membrane without internal limiting membrane peeling
Authors: Xirou T. , Kabanarou S. , Gkizis I. , Garnavou‐Xirou C. , Velissaris S. , Chatziralli I.
Published: September 2017

Purpose

Postoperative eccentric macular hole formation is an uncommon complication after pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling for epiretinal membrane (ERM). Herein, we present a case of eccentric macular hole formation after PPV for ERM without ILM peeling.

Methods

A 68‐year‐old male patient presented with ERM and visual acuity of 6/24 in his left eye. He underwent 23‐gauge PPV without ILM peeling for ERM treatment.

Results

One week postoperatively the retina was attached and the epiretinal membrane was successfully removed, while visual acuity was 6/9. One month after PPV, there was a single eccentric retinal hole below the macula, which was detected at the fundoscopy and was confirmed by optical coherence tomography (OCT). The visual acuity was 6/9 and the patient referred no symptoms. No further intervention was attempted and at the 6‐month follow‐up, the visual acuity and the size of the eccentric macular hole remained stable.

Conclusions

Eccentric macular holes can be developed after PPV even without ILM peeling and are usually managed conservatively by observation.
Evolution of foveal detachment in dome‐shaped macula after treatment by mineralocorticoids: report of three cases
Authors: Marco Monzon S. , Lopez Sangros I. , Bartolome Sese I. , Sanchez Marin I. , Idoate Domenech A. , Berniolles Alcalde J. , Ascaso Puyuelo J. , Pinilla Lozano I.
Published: September 2017

Purpose

To analyze three cases of visual acuity improvement after treatment with spironolactone in patients with dome‐shaped macular and related serous retinal detachment.

Methods

We evaluated four eyes of three patients of 38, 49 and 64 years old with serous retinal detachment associated with dome‐shaped macula. The patients were treated daily with oral spironolactone 50mg. Ophthalmic examination included best‐corrected visual acuity (BCVA) and central retinal thickness (CRT), determines by optical coherence tomography (OCT). They were evaluated on their first visit and on monthly follow‐up visits.

Results

The first patient's pretreatment BCVA was 20/80 in both eyes; after treatment BCVA improved to 20/50 in the right eye and 20/40 in left eye. Second patient's pretreatment right eye's BCVA was 20/100, and one month after treatment improved to 20/63. The patient stopped the treatment due to a secondary effect (asthenia) and two month later visual acuity declined to 20/80. The last patient's pretreatment BCVA in his right eye was 20/200 and four months after treatment was 20/63.

Conclusions

We evaluated a mineralocorticoid antagonist treatment for serous retinal detachment associated with dome‐shaped macula in myopic patients. One to six months after treatment with the mineralocorticoid antagonist spironolactone, the subretinal fluid and CRT were significantly reduced and there was an improvement in BCVA.
Involvement of peroxisome proliferator activator receptors in the photoprotective activity of the di‐apo‐carotenoid norbixin on RPE cells
Authors: Fontaine V. , Monteiro E. , Fournie M. , Bonnard B. , On S. , Serova M. , Balducci C. , Guibout L. , Sahel J.A. , Veillet S. , Dilda P. , Lafont R.
Published: September 2017

Purpose

There are increasing evidences for the involvement of peroxisome proliferator activator receptors (PPARs) in the development of ocular diseases, in particular AMD. PPAR receptors comprise three sub‐types of nuclear receptors: PPARα, PPARβ/δ and PPARγ. The mechanism by which norbixin (NBX), a di‐apo‐carotenoid exerts in vitro and in vivo protective effects on RPE was studied.

Methods

The affinity of NBX for the 3 PPAR subtypes was determined by binding studies. The photo‐protective properties of NBX were evaluated by an in vitro assay using primary cultures of porcine RPE cells challenged with A2E then blue light illumination. With the same assay, NBX protective activity was then characterized by a pharmacological approach employing different PPAR subtypes’ selective agonists and antagonists. The expression level of the PPARs was assessed by western blot.

Results

NBX bound PPARα and PPARγ with Ki values of 16.5 and 1.15 μM, respectively. In a non‐cellular PPARβ/δ receptor functional assay, NBX displayed a Kb value of 3.2 μM. Further, PPARγ (troglitazone) and PPARβ/δ (GW0742) agonists strongly and significantly protected RPE cells. NBX protective activity was partially reversed by PPARγ (T0070907) and PPARβ/δ (GSK3787) antagonists. We showed for the first time that PPARα protein expression was rapidly and strongly reduced upon A2E treatment. Most interestingly, its expression was maintained or restored when RPE cells were treated with NBX before or after A2E exposure, respectively. Interestingly, some PPARγ and β/δ agonists displayed similar patterns, and other compounds were unable to sustain PPARα protein expression.

Conclusions

Taken together, this study demonstrates that NBX photoprotective activity relies potentially on both PPARβ/δ and PPARγ activation and on a sustained expression level of PPARα.
Optimisation of potent topical SRPK1 inhibitors with improved retinal pharmacokinetics through ex vivo trans‐scleral permeability modelling
Authors: Liddell S. , Toop H. , Stewart E. , Daubney J. , Bourne J. , Batson J. , Morris J. , Bates D.
Published: September 2017

Purpose

Development of non‐invasive therapies for wAMD and DME has been unsuccessful to date. Delivery of potent small molecules to the retina as eye drops would be a treatment paradigm shift but remains an unmet need due to incomplete understanding of the physicochemical properties required. We hypothesised that trans‐scleral permeability modelling could identify these features and enable optimisation of inhibitors of the VEGF‐A splicing kinase SRPK1.

Methods

Porcine eye tissue was clamped into a scaffold with drug formulations for 24 h. Compound levels were analysed by LCMS. For PK, Hy79b pigmented rabbits received a single eye drop for successive timepoints or tri‐daily eye drops for 6 days. Compound levels in eye tissues and plasma were analysed by LCMS. Efficacy was evaluated in vivo in C57/Bl6 mice.

Results

We identified potent and selective SRPK1 inhibitors with improved permeability ex vivo (ranging to 8.154x10‐6 cm/s compared to 0.07x10‐6 cm/s for pazopanib). Multiple regression analysis generated predicted permeability values which correlated with ex vivo permeability and in vivo retinal PK. SRPK1 inhibitors were equally distributed across the retina at 4 h at significantly higher concentrations than pazopanib and at significantly lower concentrations in plasma. SRPK1 inhibitors potently inhibited laser‐CNV following eye drop administration in mice (EC50s<0.5 μM, n = 6‐8, P < 0.05).

Conclusions

Ex vivo permeability screening enabled modelling and design of novel compounds with improved permeability and optimisation for in vivo retinal delivery. Increased potency and ocular permeability of the novel SRPK1 inhibitors show potential to reach therapeutic levels in the retina following eye drop administration and improve treatment for patients with wAMD and DME.
Aerobic exercise causes changes in choroidal thickness in young adults
Authors: Perdices L. , Orduna E. , Insa G. , Segura F.J. , Idoate A. , Sánchez A.I. , Pinilla I.
Published: September 2017

Purpose

In this study we evaluate the changes of choroidal thickness after doing physical aerobic exercise in healthy young adults using spectral‐domain optical coherence tomography (SD‐OCT), with Enhanced Depth Imaging (EDI) protocol, and manual segmentation. This is a modified technique which allows us to obtain an improved image of the choroidal layer.

Methods

Thirty eyes of 15 volunteers between 18 and 31 years old were prospectively and consecutively enrolled, with ±6.50 D maximum ametropia and 3.00 D of astigmatism, with neither systemic nor ocular pathology as inclusion criteria. All the subjects were examined in the same conditions and by the same investigator. Measures from autorefractometer, ocular biometry and SD‐OCT were taken. The SD‐OCT images were taken at basal measurement, after doing 10 minutes of physical exercise and then two more measures after the exercise (3 and 10 minutes after finalization). The choroidal layer was manually segmented, valuing thicknesses and volumes in the different areas from the ETDRS (Early Treatment Diabetic Retinopathy Study).

Results

In all the areas the average thickness increased 3 minutes after exercise compared to basal. We found significant differences (p < 0.05) by means of the test of ranks with signs of Wilcoxon in the areas: 3 mm temporal, 3 mm nasal, 6 mm superior, 3 mm superior and in the subfoveal choroidal thickness. After 10 minutes, this value decreased, finding only statistical values (p < 0.05) in the subfoveal choroidal thickness. Volumes measures showed the same pattern.

Conclusions

In healthy young people 3 minutes after finishing physical exercise the choroidal thickness increases. Ten minutes after the finish, the choroidal thickness decreases.
Comparison between over‐glasses patching and conventional patching for children with moderate amblyopia: a prospective randomized clinical trial
Authors: Kim S.J. , Lee S.U. , Lee J.E.
Published: September 2017

Purpose

To investigate the clinical effects of orthokeratology lens wear on inhibition of the myopic progression and axial length elongation in Korean children with myopia.

Methods

The authors reviewed out‐patient records of 37 eyes of 19 patients wearing orthokeratology lenses. The 46 eyes of 23 patients wearing spectacles were included into the control group. We evaluated the relationship between orthokeratology lens wear and control group according to age, initial myopia, initial astigmatism, axial length elongation.

Results

There were no significant differences between two groups as for age, initial myopia, astigmatism, spherical equivalent, and axial length at baseline (t‐test, p > 0.05). Significant reduction of refraction was shown in patients with wearing lenses after 1 year (t‐test, p < 0.001). The mean axial length before and after 1 year was 24.62 ± 1.39 mm and 24.73 ± 1.28 mm respectively after lens wearing, and 24.59 ± 0.74 mm and 24.80 ± 0.71 mm respectively after wearing glasses. The axial length elongation was 0.11 ± 0.12 mm, and 0.21 ± 0.07 mm in patients with wearing lenses and glasses, respectively, which showed statistically significant difference (t‐test, p < 0.0001).

Conclusions

The orthokeratology lens was found to be effective in suppression of myopic progression through less axial length elongation, compared with the glasses.
Evaluation of visual quality parameters after Descemet membrane endotelial keratoplasty (DMEK)
Authors: Gavin Sancho A. , Romero Sanz M. , Idoipe Corta M. , Mateo Orobia A. , Sanchez Perez A. , Garcia‐Martin E. , Satue Palacian M.
Published: September 2017

Purpose and Objectives

To evaluate progressive changes in visual quality parameters in patients who underwent DMEK for Fuchs endotelial dystrophy (FED), and to compare the visual quality results with healthy controls without corneal pathology.

Methods

Fourteen eyes with FED who underwent DMEK were evaluated for corneal topographic changes using Pentacam (OCULUS, Iberia SL), preoperatively, at 1 month and at 6 months after surgery. Mean keratometry (Km), corneal density (1‐2 mm, central and total), high order aberrations (HOA), low order aberrations (LOA) and total aberrations (total RMS) were analyzed in the anterior and posterior cornea. Fourteen healthy subjects were evaluated using the same protocol and compared with the patient's final evaluation data.

Results

Significant improvement was observed in patients at 1 month after surgery in the posterior Km (p=0.005), central posterior density (p=0.034), 1‐2 mm posterior density (p=0.006) and central anterior density (p=0.045), and anterior LOA (p=0.026) and total aberrations (p=0.020). After 6 months all densities (anterior and posterior) had improved compared to preoperative results (p<0.05) as well as all posterior aberrations (total, HOA and LOA, p<0.05). Posterior and anterior Km values and corneal densities did not show significant differences compared to healthy subjects (p>0.05). Corneal aberrations (anterior and posterior)remained significantly higher in DMEK subjects (p>0.05)

Conclusions

DMEK surgery improves corneal visual quality parameters in FED patients after the first month postoperatively. Corneal density and mean keratometry values are not different from healthy corneas at 6 months after DMEK. However, despite corneal aberrations decrease after surgery they remain higher than those values found in healthy corneas.
Femtolaser‐assisted vs manual anterior lamellar keratoplasty in patients with keratoconus
Authors: Kazakbaev R. , Bikbov M. , Usubov E. , Kazakbaeva G.
Published: September 2017

Purpose

To evaluate anatomic and functional results of ALK using different technics for end‐stage keratoconus.

Methods

Anterior lamellar keratoplasty was performed in 21 eyes with progressive keratoconus of IV stage of disease according to the Amsler classification. In 1st group (12 cases) keratoplasty was performed using a femtosecond laser LDV8. Removed corneal disc diameter ‐ 7.5‐8.0 mm, thickness ‐ 250‐300 mc. In 2nd group (9 cases) manual dissection of anterior stroma was performed. Partial trepanation without penetration of anterior chamber (diameter 7.5‐8.0 mm) was done at depth 250 mc using Barron trephine. Corneal graft was fixated by 10/0 sutures. The follow‐up was 6 months.

Results

Significant improvements of UCVA and CVA was up to 0.2 and 0.5, respectively, in 1st group. In 2nd group UCVA and CVA improved up to 0.08 and 0.3 in early postop period. Mean corneal astigmatism was 4.6±1.2 D in 1st group and 7.7±2.4 D in 2nd, respectively. In 1 case after manual technic (2nd group) hazing and graft rejection was observed in 2 months after surgery.

Conclusions

The use of femtosecond technologies in anterior lamellar keratoplasty increases the efficiency of the operation due to the greater predictability and accuracy of the procedure and the optimal donor‐recipient juxtaposition. This leads to better visual and refractive outcomes by reduction of corneal astigmatism due to good wound apposition, biomechanical stable incision.
Ocular cicatricial pemphigoid secondary to intravitreal implant of ranibizumab: a case report
Authors: López Sangrós I. , Marco Monzón S. , Bartolomé Sensé I. , Berniolles Alcalde J. , Sanchez Marin J.I. , Idoate Domenech A. , Ascaso Puyuelo J. , Del Buey Sallas M.A.
Published: September 2017

Purpose

Mucous membrane pemphigoid is a systemic disorder that primarily affects mucous membranes. When localized to conjunctiva, it is know as ocular cicatricial pemphigoid (OCP), a potentially blinding desease resulting in progressive conjunctival fibrosis and ocular surface failure.Women are affected more than men by a ratio of 8:1. Age on onset is usually age 60 to 80 and rarely younger than 30. We describe the case of a patient with OCP secondary to intravitreal implant of ranibizumab.

Methods

We describe the case of a patient with OCP secondary to intravitreal implant of ranibizumab.

Results

A 85 years old woman with bilateral macular degeneration, treated with intravitreal implants of ranibizumab in the right eye, began with a non specific queratoconjunctivitis in the right eye after the second administration of intravitreal ranibizumab. In numerous ophthalmology follow‐ up appointments the patient presented red right eye and increased amount of tears. Six months later, after another intravitreal implant of ranibizumab, the patient presented a subepithelial fibrosis, as fine gray‐white striae in the inferior fornix. The patient was treated with topic corticosteroid, cyclosporin 0,2%, autologous serum eye 20% with a significant improvement. A systemic treatment with 15 mg methotrexate once a week and the suspension of intravitreal implants of ranibizumab was necessary to control the progression of the OCP.

Conclusions

In some patients, systemic drugs (practolol, D penicilamine…), have triggered the onset of OCP. The term pseudopemphigoid or drug‐induced pemphigoid may be used to describe these cases. There are not cases of POC secondary to ranibizumab described on the literature.
Softacort®, preservative‐free hydrocortisone 0.335% drops: A new anti‐inflammatory drop with minimal effects on intraocular pressure
Authors: Shortt A. , Rolando M.
Published: September 2017

Purpose

The aim of this study was to compare the changes in intraocular pressure (IOP) after instillation of a new preservative‐free hydrocortisone 0.335%(Softacort®), prednisolone 1% (Inflanefrane® Forte), loteprednol etabonate 0.5% (Lotemax®) and rimexolone 1% (Vexol®) in comparison with dexamethasone 0.1% (Maxidex®) in a rat model of glucocorticoid‐induced ocular hypertension

Methods

Sixty albino female rats were divided into 5 treatment groups and drops administered twice daily from Day 1 to Day 36. Clinical examination, body weight, and IOP measurements were assessed once weekly during 5 weeks.

Results

Animals treated with Softacort®, Lotemax® or Vexol® had a similar body weight gain. Inflanefran® Forte‐treated animals showed a lower body weight gain. Maxidex®‐treated animals gained weight up to 7 days but there after lost weight as expected. Animals treated with Softacort®, Lotemax®, Inflanefran® Forte or Vexol® had a similar IOP profile with a slow increase in the mean IOP up until Day 15, and then stabilization at +2 mmHg above baseline throughout the remainder of the study Maxidex®‐treated animals showed, as expected, an increase of the mean IOP until Day 36 reaching +4.4 mmHg and progressively increasing.

Conclusions

This study shows significant differences in the IOP rise and therefore greater safety of this new preservative‐free hydrocortisone and other soft corticoids when compared to Maxidex. Twice daily instillation of Softacort® induced a slight IOP elevation which stabilized after 2‐weeks whilst dexamethasone treatment led to a significant continuing IOP increase and drastically reduced body weight gain. Thus, Softacort®, a preservative free hydrocortisone 0.335%, shows a good balance between efficacy and minimal side effects and has just obtained the Marketing Authorization in Europe.
Association of incidental epithelialization of corneal endothelium with endothelial barrier impairment
Authors: Smedowski A. , Mazur R. , Tarnawska D. , Wylegala E.
Published: September 2017

Purpose

To identify patients with incidental epithelialization of corneal endothelium (IECE) detected in in vivo confocal microscopy (IVCM) and analyze its association with corneal decompensation.

Methods

We performed a retrospective analysis of IVCM (Rostock Cornea Module, HRT III) scans of 327 patients treated in outpatients clinic for various corneal diseases. After identification of cases with IECE, visual acuity (VA), central corneal thickness (CCT) data, endothelial cell density, as well as slit‐lamp photographs were collected. CCT measurements were obtained using Pentacam (Oculus).

Results

From among of 327 IVCM examinations, IECE was visible in 8 patients associated with Posterior Polymorphous Corneal Dystrophy (PPCD) in 3 out of 6 patients with an IVCM diagnosis of PPCD; Fuch's Endothelial Dystrophy (FED) in 3 out of 12 FED patients with available IVCM scans. One patient was diagnosed with unilateral IECE after the incident of facial UV‐light burn (tanning salon) with the unilateral mild burn of the ocular surface. One patient presented unilateral IECE in superior half of the cornea due to epithelial ingrowth after cataract surgery. PPCD patients with presence of IECE developed corneal edema and greater endothelial cell loss, in contrast to age‐matching PPCD patients without IECE. Patients with FCD or cornea guttata developed corneal decompensation and visual impairment at the earlier age (before 50 y.o.) than FCD patients without IECE. Advanced IECE observed in the patient with ingrowth syndrome, as well as epithelial metaplasia after UV‐light burn resulted in severe visual impairment.

Conclusions

Diagnosis of corneal diseases should be supplemented by IVCM examination. IECE observed in IVCM could be considered as a prognosis factor of visual impairment in corneal endothelial diseases, however it requires more research.
Recombinant human heat shock protein 27 can inhibit ultraviolet B‐induced differentiation in pterygial‐derived fibroblast
Authors: Kim J.Y. , Moon C.H. , Shin J.A. , Kang S.S. , Kim E.S. , Tchah H.
Published: September 2017

Purpose

To investigate the effect of recombinant human heat shock protein 27 (rhHSP27) on the differentiation of human pterygial‐derived fibroblast.

Methods

Human conjunctival and pterygial fibroblasts were isolated and cultured from specimens of normal conjunctiva and pterygium head, which were donated during pterygium excision. Cultured conjunctival and pterygial fibroblasts were exposed to 20 mJ/cm2 of ultraviolet‐B (UVB) irradiation with and without 4 ug/mL rhHSP27 pre‐treatment. Western blot analyses of α‐smooth muscle actin (α‐SMA), a marker for myofibroblast, were performed in each group and quantified using Image Gauge 4.0 software. The ratios of α‐SMA / GAPDH and phosphorylated HSP27 / GAPDH were compared.

Results

The α‐SMA level in Pterygial fibroblasts showed 2.85 ± 0.11 fold greater than that of normal conjunctival fibroblasts (P < 0.001). The level of α‐SMA was increased by 1.92 ± 0.02 times (P < 0.001), when normal conjunctival fibroblasts were exposed to UVB irradiation without rhHSP27 pre‐treatment. However, when normal conjunctival fibroblasts were exposed to UVB irradiation with rhHSP27 pre‐treatment, the fibroblasts demonstrated 0.82 ± 0.04 fold smaller α‐SMA level than control did (P = 0.04).

Conclusions

The rhHSP27 revealed inhibitory effects on the UVB irradiation‐induced differentiation from normal conjunctival fibroblasts to pterygial myofibroblast. The rhHSP27 can be a preventive treatment against pterygium growth.
Trabeculectomy: evaluation of the area exposed to mitomycin C
Authors: Pinto Ferreira N. , Sousa D. , Mano S. , Medeiros Pinto J. , Barata A. , Abegão Pinto L.
Published: September 2017

Purpose

Mitomycin C (MMC) is used to increase the durability of filtering procedures in glaucoma. However, the ideal time and area of exposure, as well as the associated side effects remain to be fully understood. This study aims to analyse the association of the MMC‐exposed area in trabeculectomy with safety and efficacy outcomes.

Methods

Prospective, interventional pilot study of 25 eyes of 25 open‐angle glaucoma patients enrolled for a primary trabeculectomy with MMC 0.4 mg/ml. The antimetabolite solution was visually highlighted by mixing it with a vital dye (trypan blue 0.1%). The area of MMC application was evaluated using a software analysis program (ImageJ). The primary outcome was the association of surgical intraocular pressure (IOP) lowering efficiency with the area of MMC application. Absolute success was defined as 30% IOP reduction and less than 18 mmHg, with no further medication. Relative success was similarly defined but IOP‐lowering medication was used.

Results

The mean MMC‐exposed area was 122.6 ± 40.0 mm² (median 116 mm²). The mean time of follow‐up was 7.2 ± 4.8 months. Mean IOP reduction after trabeculectomy was 12.5 ± 8.0 mmHg with absolute and relative success rates of 60% and 76%, respectively. Overall, no relationship between the MMC‐exposed area and parameters of efficacy nor safety were observed (p = 0.40). Interestingly, all patients with a MMC exposure area >150 mm² had a 100% absolute success rate. All failed trabeculectomies (6 eyes, 24% of the total) had a MMC‐exposed area <150 mm². Lastly, only (but one) patients with MMC‐exposed area <150 mm² needed more than on laser suture lysis.

Conclusions

Our study gives an approximate absolute value of the MMC‐exposed area during trabeculectomy and suggests it may be related to the hypotensive efficacy, with exposed MMC areas >150 mm² being associated with better IOP‐lowering outcomes.
First real‐life data of use of the new PF‐MD glaucoma device (EasyGrip®): results of the ISY study from Spain and France
Authors: Denis P. , Duch S.
Published: September 2017

Purpose

Preserved eye drops can cause local side effects, some of which appear more rapidly, that can impact the patients’ quality of life. The new availability of the first Preservative‐Free (PF) Dorzolamide/Timolol (DT) Fixed Combination (FC) in a new MD bottle (EasyGrip®) could improve patient satisfaction, treatment compliance and ultimately treatment efficacy.

Methods

ISY is an international, multicentre, observational and cross‐sectional study. It is still ongoing to recruit a total of 1880 glaucoma patients from DK, FI, FR, DE, NO, ES and SE. The patients were treated and stabilised for at least 28 days with the PF‐MD DTFC (Duokopt®/Dualkopt® ‐ Laboratoires Théa‐France). The questionnaire is divided in two parts to be completed independently by the ophthalmologist and the patient during one routine visit. The primary endpoint is the prevalence of patients satisfied with the new PF‐MD bottle. Other parameters: medical history; intraocular pressure (IOP); use of the new PF‐MD bottle; ophthalmologist satisfaction; assessment of compliance and persistence; and visual acuity.

Results

The results of the first 268 patients (188 Spain, 80 France) are presented here for the first time. 97.5% of ophthalmologists are satisfied or very satisfied to prescribe the new PF‐MD device with DTFC. 79.0% of patients, who were previously using a preserved MD bottle, are satisfied enough to continue with the new PF‐MD device. 44.5% of patients declared the new PF‐MD bottle better or much better than the previous preserved MD eye drop.

Conclusions

The first results of ISY study confirm the interest of switching from a preserved MD glaucoma treatment to a PF‐MD device EasyGrip® whilst keeping the efficacy.
Persistent pupillary membrane associated with cataract
Authors:  IDOATE A. ,  Sanchez Marín J.I. ,  Bartolome Sese I. ,  Berniolles Alcalde J. ,  Marco Monzon S. ,  Lopez Sangros I. ,  Ascaso Puyuelo J. ,  Ibañez Alperte J.
Published: September 2017

Purpose

Persistent pupillary membranes represent remnants of the tunica vasculosa lentis. In general, it does not affect vision, although cases of deprivation ambliopia have been described. There are few reported cases of associations with other ocular pathologies.

Methods

Interventional case report showing bilateral Persistent Pupillary Membrane associated with cataract.

Results

A 17‐year‐old male underwent routine ophthalmologic examination. Best corrected visual acuity (BCVA) was 0.2 (+4.25, −4.50ª 90º) in the right (RE) and 1.0 (−0.50, 0.75 to 40°) in the left eye (LE). Slit‐lamp biomicroscopy examination demonstrated a bilateral persistent pupillary membrane associated to cataract in the RE. Goldmann applanation intraocular pressure (IOP) and fundoscopy were normal. In order to improve visual acuity we performed a membranectomy with cataract extraction. Nevertheless, BCVA following surgery showed no changes.

Conclusions

We describe the association of bilateral persistent pupillary membrane to unilateral cataract, as well as to hyperopia and anisometropic amblyopia. Conservative management should be considered in patients whose visual development has concluded. Surgery entails risks and visual gain may not be significant.
Case of IgG4‐related eye disease requiring differentiation from carotid‐cavernous fistula
Authors: Yamagishi A. , Oshitari T. , Tawada A. , Yamamoto S.
Published: September 2017

Purpose

We report our findings in a case of IgG4‐related eye disease that was confused with carotid‐cavernous fistula (CCF).

Methods

Case report: A 61‐year‐old man visited to our department for exophthalmos with dilated conjunctival vessels in both eyes. He had hyperthyroidism. At the first visit, his ocular movements were disturbed, and MRI showed funicular‐like appearance of the superior ophthalmic veins. However, enlargements of the extraocular muscles were not detected, and thyroid ophthalmopathy was excluded. Cerebral angiography showed no flow from either internal carotid arteries to the cavernous sinus, and CCF was also excluded. Blood tests showed high level of IgG4 (281 mg/dl) and a IgG4‐related eye disease was considered. Systemic examinations showed no other lesions. Although histological examinations could not be performed, we treated the patient with 30 mg prednisolone as a possible IgG4‐related eye disease. However, the reduced vision and critical fusion frequency did not improve. Then we switched to steroid pulse therapy, and all findings including the MR images were improved. A biopsy could not be performed because of the high risk of bleeding. Thus, malignant lymphoma could not be completely excluded. The patient is being followed continuously to detect any recurrences.

Results

Conclusions

We report our findings in a very rare case of IgG4‐related eye disease with funicular‐like appearance along the superior ophthalmic veins requiring differentiation from CCF. Ophthalmologists should consider IgG4‐related eye diseases in cases with signs and symptoms of CCF and thyroid ophthalmopathy.
Human ex vivo model of iris angiogenesis
Authors: Andre H. , Pesce N. , Plastino F. , Kvanta A.
Published: September 2017

Purpose

To assess iris angiogenesis using human explants and determine the role of hypoxia during iris neovascularization.

Methods

Human irises were isolated post‐mortem from human research consented donnors. Explants were seeded onto extracellular matrix (ECM), and kept at normal oxygen concentrations (normoxia, 20% O2) or exposed to hypoxia (1% O2) in standard tissue culture conditions for 48 h. Iris angiogenesis was analyzed by quantifying the neovascular area. Furthermore, iris neovascular structures were characterized by immunofluorescence.

Results

Human iris ex vivo neoangiogenesis could be observed within 48 h after the explants were seeded onto ECM, and was defined as vascular sprouts and/or tufts. Vascular sprouts were more common in normoxia, while vascular tufts were mostly formed in hypoxia. A significant increase in vascular area was observed in irises exposed to hypoxia when compared to normoxia. Positive immunoreactivity to specific endothelial cell markers confirmed human iris neoangiogenesis ex vivo.

Conclusions

Our data shows the first human ex vivo neoangiogenesis assay, using iris. The method here presented could have potential use in testing pro‐ and anti‐angiogenic drugs in an human ocular context.
Can optical coherence tomography be used in lacrimal gland imaging?
Authors: Mrazovac D. , Juri Mandic J. , Ivkic P.K. , Mandic K. , Jukic T.
Published: September 2017

Purpose

Lacrimal gland is a serous gland, bi‐lobed in shape, situated superolateral to the eye. The gland continually secretes tears which moisten, lubricate and protect the surface of the eye. Excess tears drain into small ducts which empty into the nasal cavity. Even in healthy subjects, the palpebral lobe is seen through the conjunctiva when the upper eyelid is elevated. The structural features of lacrimal gland are usually analyzed with ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI). Purpose of this study was to explore the possibilities of the lacrimal gland imaging using optical coherence tomography.

Methods

Our study included 10 healthy subjects, aged between 25 and 30 years. Images of the palpebral portion of the lacrimal gland were made using optical coherence tomography, anterior segment module. We have obtained B‐scans of the lacrimal gland, longitudinally and transversely to the exposed palpebral lobe. With the obtained images we analyzed structures of the lacrimal gland.

Results

In this study we obtained photographs of the palpebral lobe of the lacrimal gland. We were able to identify conjunctiva, subconjunctival connective tissue, blood vessels, excretory ducts and glandular parenchyma.

Conclusions

Preliminary results of our study show that optical coherence tomography offers a possibility of structural differentiation in attempt to analyse morphology of the lacrimal gland. With the development of modern technologies, such as OCT, analysis in vivo of ocular adnexa is placed directly into the domain of ophthalmologists, which, in cases of patients with systemic diseases, facilitates diagnostic process and treatment.
Multifocal electroretinogram and optical coherence tomography to evaluate parafoveal fixation
Authors: Vilades Palomar E. , Orduna Hospital E. , Ciprés M. , Obis J. , Rodrigo SanJuan M.J. , Satué M. , Garcia‐Martin E.
Published: September 2017

Purpose

Spatial resolution of the human visual field changes depending on the distance from the fovea and fixation point. The visual field is divided in three areas: foveal, parafoveal and peripheral. The highest visual acuity (AV) is obtainded at the foveal area, covering approximately 2 °, then parafoveal area covers 2 ° to 5 °, and the peripheral vision from 5 ° to the edge of the visual field, but the AV decreases progressively in each area .

Methods

We analyzed two cases of parafoveal fixation by SD‐Spectralis OCT (Heidelberg Engineering), Triton Swept‐Source OCT (Topcon) and multifocal electroretinogram (mfERG) with RetiPort / Scan (Roland Consult). The structure and function of retinal cells have been correlated using OCT images and the three‐dimensional map of mfERG.

Results

Case 1: Patient with 100% ETDRS VA equal to 0,0 in both eyes (OU), contrast sensitivity (CS) Pelli Robson 1,35 in right eye (OD) and 1,20 in left eye (OS), presents Parafoveal fixation <1º.

Case 2: Patient with previous episode of optic neuritis in OD and parafoveal fixation of 3º in OS, which presents VA ETDRS 100% of 0.7 in OD and 0.1 in OS, CS PelliRobson of 1,05 in OD and 1,20 OS.

Both cases present a reduced macular peak seen at the mfERG, and a fixation point out of the foveal at the OCT.

Conclusions

We can see how VA and CS decreases as the fixation eccentricity increases, as can be clearly seen in the three‐dimensional mfERG map. CS seems to be the quickest parameter to be affected.
Magnetic resonance imaging features in moebius syndrome: a pilot study
Authors: Carta A. , Piccinini S. , Ormitti F. , Mora P. , Gandolfi S. , Ruoli F. , Simonelli M.B. , Incerti M. , Nicoletti P.
Published: September 2017

Purpose

To investigate with unconventional neuroimaging (UNI) the alterations of the brain structures in patients affected by Moebius Syndrome (MBS).

Methods

7 MBS patients underwent MRI evaluation of the brain and the brainstem with 3.0T MRI through volumetric sequences (FLAIR 3D, BRAVO, CUBE T2); high resolution T2 imaging (FIESTA) and Diffusion Tensor Imaging (75 directions, ST: 3 mm) were also performed to better evaluate all cranial nerves. Data analysis and full‐brain tractography were obtained using Functool software. We measured the dimensions of the brainstem in MBS patients and compared the obtained values with the AIRO's (Italian Association of Radiation Oncology) standard data.

Results

Brainstem resulted abnormal when compared to controls; in particular we found an hypoplasia of both the midbrain (6 cases) and the medulla (3 cases). In all the cases the VI and VII cranial nerves resulted hypo‐ or aplasic; fiber tracking and color coding in the DTI analysis showed a lack of uniformity in the brainstem and in the cerebellar peduncles. We also found a prevalence of abnormal transverse pontine fibers colonizing the cortical spinal tracts bilaterally (6 cases). We documented: thinner corpus callosum (4 cases), reduction of the internal auditory meatus and cisterna magna (1 case).

Conclusions

Our data show new relevant alterations of the brainstem in MBS patients investigated with UNI; we suppose that this could be related to a misdirection of the axonal guidance paths during the embryogenesis secondary to the abnormal development of the VIthand VIIth cranial nerves nuclei. We also found anomalies in the supratentorial region which need further investigations. A correlation of the features herein observed with the ophthalmological pattern of MBS may provide further insight in the pathogenesis of this disease.
Slit lamp assessment of relative afferent pupillary defect
Authors: MEKKI M.B.
Published: September 2017

Purpose

To demonstrate the accuracy of slit lamp assessment of relative afferent pupillary defect (RAPD) in patients with asymetric optic neuropathy.

Methods

40 eyes of 20 patients with asymetric optic neuropathy and no obvious RAPD in swinging flashlight test were evaluated on slit lamp. The asymetric optic neuropathy was confirmed by fundus examination, retinal nerve fiber layer thikness on OCT, visual field examination, visual potentials and/or brain and orbit MRI.

The horizontal pupillary diameter in the affected (or more affeted) eye was measured and compared to the horizontal pupillary diameter of the fellow eye using the width of the slit lamp beam. Both diameters were measured in millimeters and compared.

Results

There was a quantified anisocoria and RAPD each time when asymetric optic neuropathy was present. In other words, with the same slit lamp beam width (the same light intensity) the affected (or more affected eye) had a larger pupillary horizontal diameter.

Conclusions

Slit lamp assessment of RAPD is simpler, quicker and more accurate than standard assessment using swinging flashlight test especially when anisocoria is not obvious.
Case of IgG4‐related eye disease accompanied by compressive optic neuropathy
Authors: Takeishi M. , Oshitari T. , Ota S. , Chiba A. , Yamamoto S.
Published: September 2017

Purpose

We report a case of IgG4‐related eye disease accompanied by a compressive optic neuropathy.

Methods

A 76‐year‐old woman had hypothyroidism with thyroid ophthalmopathy and was followed at the Kimitsu Central Hospital from July 2015. On October 2016, her right exophthalmos worsened, and a lago ophthalmic keratitis developed in the right eye on February 2017. MRI showed enlargements of the extraocular muscles, and blood tests showed high levels of serum IgG4 (446 mg/dl). On February 27, 2017, her visual acuity decreased to 0.01 OD, and she was referred to the Chiba University Hospital.

Results

At the first visit, her visual acuity was counting finger OD, and Goldmann perimetry showed a lower right visual field defect. Ocular movements in the right upper field was severely limited because of a lesion that occupied the upper orbit. She was diagnosed with IgG4‐related eye disease accompanied by compressive optic neuropathy.She underwent two cycles of steroid pulse therapy with intravenous antibiotics. Two months later, her decimal visual acuity improved to 0.4 OD, and the ocular movements and the visual field defect were markedly improved. The logo ophthamic keratitis also improved, and the oral prednisolone was tapered to 20 mg. No side effects of the steroid therapy was observed.

Conclusions

When thyroid ophthalmopathy is markedly exacerbated, ophthalmologists should consider IgG4‐related eye disease that can be masked by lesions associated with thyroid ophthalmopathy.
Spectral‐domain optical coherence tomography of optic nerve after closed eye injury
Authors: Ioyleva E. , Zelentsov K. , Zelentsov S. , Duginov A. , Ankundinov A.
Published: September 2017

Purpose

Purpose: to research optic nerve in the early period of closed eye injury by spectral‐domain optical coherence tomography.

Methods

32 patients with closed eye injury and transparent eye media were examined. The age of the patients was 41.5 + 2.7 years. The examination was performed 4.01 + 0.37 days after the injury. Visual acuity of the injured eye was 0.65 + 0.06. After examination by automated static perimetry 8 patients were diagnosed with paracentral scotoma, 4 – with scotomas in Bjerrum zone, 7 – with peripheral scotomas, 2 – with central scotomas. In 11 cases no scotomas were registered. Spectral‐domain optical coherence tomography (SD‐OCT) of both injured and healthy eyes was performed at the optical coherence tomograph RTVue‐100 OCT (Optovue, Fremont,USA). Optic nerve heads (ONH) and retinal nerve fiber layers (RNFL) were examined with estimated diameter of 3.45 mm around disc center.

Results

Statistical analysis of morphometric parameters of ONH and RNFL based on SD‐OCT data showed that in the early period in comparison with the healthy eye the injured eye has ONH edema resulting in ONH volume increase (0.43 + 0.02 and 0.29 + 0.02 mm3; p = 0.008), rim volume increase (0.21 + 0.01 and 0.17 + 0.01 mm3; p = 0.03), rim area increase (1.64 + 0.05 and 1.25 + 0.04 mm2; p = 0.03), ONH area increase (2.12 + 0.07 and 1.89 + 0.06 mm2; p = 0.01), cup volume decrease (0.08 + 0.01 and 0.13 + 0.02 mm3; p = 0.04) and cup area decrease (0.48 + 0.06 and 0.63 + 0.07 mm2; p = 0.03). In addition to this RNFL thickness increase (111.12 + 2.04 and 106.75 + 1.59; p = 0.007) was noted.

Conclusions

We detected a significant increase in the volume of the optic nerve head and an increase in the thickness of the nerve fiber layer of the retina on all 32 eyes in the early period after a closed eye injury.
The proportion of microsaccadic overshoot and the influence of accomodation on the quantitative measures of microsaccades in fourteen normal test persons
Authors: Visby E. , Møller F.
Published: September 2017

Purpose

In normal test persons to (1) quantify the proportion of microsacadic overshoot, and (2) to investigate if accomodation have an influence on the quantitative measure of microsaccades.

Methods

Fourteen healthy adults (mean age 31.2 years, range 16–50 years) all with a visual acuity of 1.0 or better with no previous eye diseases were investigated. Mean ametropia was −1.0 diopter. Microsaccades were quantified binocularly using an infrared recording technique (Eye Link 1000) during fixation at a distance of 40 cm and 6 m. Accomodation was measured at 40 cm and 6 m using an open field autorefractor (Shin Nippon SRW‐5000).

Results

The mean proportion of microsaccadic overshoot during fixation at 40 cm and 6 m was 75.8% and 146.1% larger than the normal “classic” microsaccadic amplitude, respectively. The relation between the “classic” microsaccadic amplitude (x) and the proportion of overshoot (f) could be fitted to a negative exponential curve. The best curve fit at 40 cm (R2 = 0.88) was f = 3.02*exp(−6.00*x) and at 6 m f = 3.10*exp(−6.21*x) (R2=0.98). The mean “classic” microsaccadic amplitude (±SD) at 40 cm was 0.334 ± 0.140 and 0.256 ± 0.073° at 6 m. The microsaccadic amplitude ± SD including overshoot at 40 cm and 6 m was 0.486 ± 0.209 and 0.411 ± 0.101°, respectively. Accomodation (in diopters) at 40 centimeters was positively correlated to the mean “classic” microsaccadic amplitude.

Conclusions

The proportion of microsaccadic overshoot is larger for smaller microsaccades when fixating at both near and far targets. Microsaccades seems to be influenced by accomodation.
AMD drusenoid deposits “L”, lipid type: morphology, volume, evolution analysis with morphology‐structural software
Authors: Gonzalez C.
Published: September 2017

Purpose

To study AMD Drusenoid Deposits “L”, Lipid type, with morphology‐structural software and see all the input of this software on their morphology, volume, evolution knowledge and understanding

Methods

166 eyes of 83 patients, 30 men, 53 women, with AMD Drusenoid Deposits “L”, Lipid Type (soft Drusen, Drusenoid PED “L”). Deposits were evaluated by Autofluorescence, IR imaging, OCT (Spectralis HRA‐OCT, spectral domain OCT) and Morphology‐Structural software (M‐S software). ETDRS visual acuity (VA), complete ophthalmic examination with Fundus exam were added. M‐S software let: grading (semi‐automatized Drusenoid deposit volume and contours analyze, 3D deposit reconstruction); measurements (volume(in μm3), density (grey levels of deposits)(Statistic moments of pixel intensities: mean, median, minimum, maximum, average, standard deviation, skewness and kurtosis), structure (structural measures, texture parameters),(Haralick texture measurements for distances of 1 to 10 pixels), composition (differential density calculation). Grading, measurements (volume, density) let analyze Drusenoid Deposit “L”, their evolution, 4 years follow‐up

Results

M‐S software allows AMD Drusenoid Deposits “L”, Lipid Type (soft Drusen, Drusenoid PED) analyze, follow‐up: topography, volume, density, evolution, for each cut, layer, eye, patient, and patient to patient. Therefore M‐S software enable Drusenoid Deposits comparison, evolution for each patient and patient to patient. So M‐S let assay AMD progression, assess evolution Drusenoid deposits “L” to atrophy and its occurrence period and intensity

Conclusions

Morphology‐Structural Software contribute to and improve AMD Drusenoid deposits “L”, Lipid type, study and knowledge, therefore AMD understanding.
Unilateral retinal vasculopathy in systemic lupus erythematosus
Authors: Bartolomé I. , Berniolles Alcalde J. , Idoate Domench A. , Sanchez Marin J.I. , Lopez Sangrós I. , Marco Monzón S. , Esteban Floria O. , Martinez Velez M. , Lara Medina F.J. , Ispa Callen C. , Ibañez Alperte J. , Ascaso Puyuelo F.J.
Published: September 2017

Purpose

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder affecting multiple organ systems frequently with a relapsing and remitting clinical course. It may have ocular manifestations at posterior pole, cornea, conjunctiva, sclera, uveal tract and optic nerve.

SLE is a complex disease with dysregulation of the immune system with defects in the innate and adaptive immune systems.

Methods

A 40‐year‐old Spanish woman was diagnosed with SLE 5 years before. At the time she underwent treatment with a tapering dose of oral prednisone (currently 10 mg/day) and hydroxychloroquine because of a relapse only with cutaneous involvement. She came to the emergency department because she noticed a nasal visual field defect and flashes in her right eye. Her best corrected visual acuity (BCVA) was 20/20 in both eyes and slit‐lamp anterior segment examination was unremarkable. Right fundus showed multiple cotton wool spots along the vessels, and some intraretinal haemorrhages in the inferior temporal branch retinal.Right fundus fluorescein angiography revealed an active vasculitis with abnormal vessel permeability and leakage of the dye together with a branch retinal artery occlusion along the inferotemporal arcade without ischemic areas. Her left eye was normal. She was treated with high‐dose steroid (intravenous methylprednisolone 500 mg/day during 3 days). Then, she completed 2 doses of intravenous cyclophosphamide 400 mg and oral prednisone (45 mg/day) and hydroxychloroquine 400 mg/day.

Results

The following week the fundus examination demonstrated resolution of haemorrhages without neovascularization or cotton wool spots. BCVA remained 20/20 and visual field exam slightly improved.

Conclusions

SLE may lead to severe unilateral vasculitis. However, an early diagnosis and aggressive treatment allow the resolution of the disease without many sequelae.