bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient behavior when prescribed non‐affordable glaucoma medication in the medical unit, National Research Center, Cairo, Egypt
Authors: SAEED IBRAHIM A
Published: November 2013

Purpose (1)Identify cost‐reducing strategies,including cost related non‐adherence(CRN),employed by primary open angle glaucoma (POAG)patients;(2)explore impact of doctor‐patient interaction(DPI)on CRN and(3)pinpoint best DPI methods that minimized CRN.

Methods A Cross‐sectional study was enrolled on consecutive adult patients attending the eye clinic of the National Research Center,Cairo,Egypt, diagnosed with POAG and on outpatient topical anti‐glaucoma drugs in the first 8 months of 2012.Data were collected via an interviewer‐administered questionnaire.The impact of factors as education,insurance and drug cost to income ratio were tested statistically.

Results Data gathered from 280 patients showed that 75% of patients employed at least 1 method of CRN(termed CRN+).Of those, up to 70% skip doses,64% postpone buying prescriptions and 28% ignore buying it altogether.We found significant relationships between lower CRN scores and better insurance coverage(p=0.002),higher education(p=0.002),lower values of “drug cost to monthly income” ratio(p=0.003),lower number of prescriptions(p=0.003)and better DPI regarding drug costs(p=0.004). 58% of CRN+ patients reported having DPI,(termed CRN+DPI).In CRN+DPI,the most common methods were doctors showing sympathy towards patients’ drug costs(72%),ensuring patients’affordability of drugs(65%)and change one to a cheaper alternative(62%).In those who did not have DPI,the most cited cause was “being embarrassed” to ask about drug costs(80%).

Conclusion Future policies should focus on improving DPI to lower CRN,mainly,ensuring patient education on drug costs, showing strong emotional support and reducing polypharmacy. Encouraging patients to ask for cheaper alternatives can also help.
Removal of preservative from Ganfort improves intraocular pressure (IOP) lowering in patients – A timolol dose‐response phenomenon
Authors: SHEN J , BEJANIAN M , SCHIFFMAN R
Published: November 2013

Purpose A benzalkonium chloride (BAK)‐free fixed‐combination formulation of bimatoprost and timolol (Ganfort) has been developed for patients who are sensitive to preservatives. A randomized controlled study in 561 patients compared the IOP‐lowering efficacy of the BAK‐free formulation versus the preserved Ganfort. At all timepoints, IOP lowering, numerically, consistently favoured the BAK‐free formulation. This finding contradicted expectations that the removal of BAK would result in lower ocular bioavailability of both bimatoprost and timolol, resulting in less efficacy. Research was conducted to explore possible explanation for the clinical observation.

Methods Literature search on timolol dose response was performed, focusing on IOP lowering following topical dosing of 0.1%, 0.25%, and 0.5% timolol ophthalmic solutions.

Results A U‐shaped dose‐response curve exists for timolol, and available data suggest that the dose that elicits maximal IOP lowering lies between 0.25% and 0.5%.

Conclusion Removal of BAK from the fixed combination product Ganfort, which contains 0.5% timolol, may have resulted in a lower, but optimal, ocular concentration of timolol, leading to improved IOP‐lowering efficacy with the preservative‐free formulation.

Commercial interest
Biomaterials for ophthalmic implants ‐ all for one and one for all?
Authors: STORSBERG J , SCHMIDT C , FUCHSLUGER T , WEBER A , SEL S
Published: November 2013

Having one biomaterial for a wide range of clinical applications may mean that the physico‐chemical properties of the material surface needs to be tailored to fulfill the allrequirements of the actual application. One example of tailoring surface properties of one and the same base material may include the definition of areas where cells attach to and deposit extracellular matrix. As for ophthalmological applications, this notion can be traced to de Quensgy's review, published in 1789. There, the author outlined basic features of the keratoprosthesis: a central optical cylinder and a haptic for firm positioning in the surrounding tissue. Incomplete biocompatibility of materials used, aside from issues of ethics and patient's acceptance, render problems. Using chemical, physical and nanotechnological methods, features of the material can be dramatically increased. There are different strategies to induce biomimetic cell‐tissue‐material interaction by modifying the surface on one base material – as well as the use of metallic biomaterials and drug‐containing particles. These findings aid the development of next‐generation biomaterials where surface‐effects are utilized in different therapeutic clinical applications.
Nanoparticles for drug delivery to the retina
Authors: STEFANSSON E
Published: November 2013

We have developed a drug delivery platform based on cyclodextrin nanoparticles in eye drop suspensions. The nanoparticles increase drug solubility, extend mucoadhesion and penetration into the eye. High concentrations of drug in the tear film for extended periods of time allow for greatly increased penetration into the eye and relatively less washing into the nasolacrimal apparatus. Dexamethasone nanoparticle eye drops are effective against diabetic macular edema and uveitis. Cyclodextrin nanoparticle eye drops allow drug treatment of retinal disease with eye drops.
Nanoparticles incorporated collagen hydrogels for sustained release of EGF
Authors: RAFAT M , MONDAL D , ISLAM M , LIEDBERG B , GRIFFITH M
Published: November 2013

Therapeutic biomolecules such as growth factors are essential for enhancing the regeneration of damaged tissues by inducing cell signaling activities such as cell migration, proliferation, and differentiation. Nevertheless, they have short half‐lives in physiological conditions due to fast deactivation and degradation by enzymes and other physical and chemical reactions. Therefore, there is a great need for the suitable target delivery of nanoparticles to improve the release kinetics of growth factors as well as their therapeutic effectiveness. The main objective of this study was to develope and characterize a sustained delivery system consisting of an EGF‐encapslated chitosan nanoparticles and collagen hydrogel carrier system to achieve a sustained release of EGF. In this study, we made EGF‐loaded chitosan nanoparticles, which could be incorporated into an engineered collagen hydrogel scaffold. The particles were spherical in the size range of 60–100 nm. The release kinetics of EGF showed the release of growth factors in a sustained manner. Live‐dead staining of human corneal epithelial (HCEC) cells was done to evaluate the cytotoxicity of the nanoparticles.
Intravitreal chemotherapy: Indications and results
Authors: MUNIER F , GAILLARD MC , BALMER A , BECK‐POPOVIC M
Published: November 2013

The presence of active vitreous seeding following state‐of‐the‐art conservative treatment of intraocular retinoblastoma leads in the vast majority of cases to either external beam irradiation (EBR) and/or enucleation. Intravitreal chemotherapy (IVC) is theoretically the best route for delivering the highest vitreous concentration of a chemotherapeutic drug, over intravenous, periocular and ophthalmic artery chemotherapy. This makes IVC the best candidate for treatment of diffuse vitreous disease in eyes with retinoblastoma, but it has remained highly controversial, as considered an invasive procedure associated with the risk of tumor exteriorization. We retrospectively reviewed all consecutive patients with vitreous disease found eligible and then treated by intravitreal injections of melphalan. IVC was performed every 7 to 10 days up to 8 injections of Melphalan (20‐30 g) per event, using a novel injection technique characterized by the prevention of vitreous reflux and sterilization of the needle track. The results appear promising in terms of safety (with no evidence of exteriorization), and efficacy with unprecedented salvage rate over 85%. Control of vitreous seeding was achieved without EBR in all cases.
Intraarterial chemotherapy: Indications and results
Authors: HADJISTILIANOU T
Published: November 2013

IA chemotherapy is a promising primary and salvage treatment for moderate and advanced RB particularly in eyes designed for enucleation. Indications include: Primary treatment of unilateral retinoblastoma Reese‐Ellsworth Stage II, III, IV, Va & Vb (ABC Stage B, C & D) ;adjunctive treatment after systemic chemotherapy, with or without focal therapy ;incomplete response to conservative therapy; local tumor recurrence after conservative therapy. Most of adverse side effects are transient, choroidal vasculopathy is permament and in some cases progressive. Intra‐arterial chemotherapy conserves many eyes with retinoblastoma that would otherwise require enucleation, at the same time avoiding the risks of radiotherapy and systemic chemotherapy.
Management of locally advanced retinoblastoma
Authors: LUMBROSO L
Published: November 2013

Abstract not provided
Case reports
Authors: DESJARDINS L , MUNIER F , HADJISTILIANOU T , LUMBROSO L
Published: November 2013

Abstract not provided
Cataract surgery up to the age of Daviel
Authors: DE LAEY JJ
Published: November 2013

The knowledge of ocular anatomy in the classical time was limited. Aristotle considered the lens as a post‐mortem artefact. For Celsus the lens was the essential organ of vision, a misconception which will remain till Vesalius, one of the first to consider its optical role. Platter recognized the role of the retina and Aquapendente will correct the position of the lens in the eye, which was thought to be in its centre. Cataract was considered an accumulation of "miasma" between the lens and the iris. It is not certain that the ancient Egyptians performed cataract surgery. It was first mentionned by Sushutra, the father of Indian surgery. His technique reached Rome probably via Alexandria. The description of couching by Celsus corresponds to 17th century descriptions of the procedure. Till the late 18th century this was often performed by itinerant cataract surgeons. One of the most notorious of these quacks was Chevalier Taylor who blinded Bach. Because Daviel, as others, experienced failures with couching, he introduced the corneal incision and expression of the lens by gentle pressure. This revolutionized cataract surgey although couching was still used in a number of centres till the middle of the 19th century.
Description of retinoblastoma by Pieter Pauw of Leiden in early 1600's
Authors: KIVELÄ T
Published: November 2013

In 1963, Edwin B. Dunphy of Boston credited the 16th century Dutch anatomist, Pieter Pauw (1564‐1617) of Leiden, with the first literary description of retinoblastoma made in 1597. Dunphy believed that the description referred to an advanced retinoblastoma that had broken into the orbit and temporal area. This opinion and credit is repeated often even in recent literature, in spite of the fact that a critical translation of the original Latin text of Pauw suggested in 2003 that another orbital tumor, such as embryonal rhabdomyosarcoma, would equally well, if not better, explain Pauw's observations. This presentation will review the evidence for and against retinoblastoma in the autopsy report. Retinoblastoma is likely to be as old as humankind, and exactly when this fascinating tumour first appeared in historic records will remain a matter of dispute.
Allergy and vernal keratoconjunctivitis: Results of a 251 children cohort
Authors: CHIAMBARETTA F
Published: November 2013

The aim of our study was to follow the evolution of phenotype for children with lattice corneal dystrophy type I and granular corneal dystrophy type I. Mean age was 8,84 ± 4,20 years and 17,78 ± 3,76 years respectively. Corneal parameters were analysed from Scheimpflug photographs: number of opacities, location, thickness, depth and percentage of corneal transparency. Peripheral opacities in LCDI children continued to increase when the number of central deposits tended to stagnate after a mean age of 12 ± 1 years. GCDI children presented a continuous increase in number of opacities. Our results show a phenotypic heterogeneity, especially in early ages, which can lead to misdiagnosis.
Introduction ‐ The challenges to drug approval: Going from an idea, early data onto registration
Authors: DE SMET MD
Published: November 2013

Purpose: Gain a better appreciation of the steps involved in drug/device development and registration. Specific aim of this segment: The first challenge is to decide whether or not a drug or device is worth investigating further. Obtaining sufficient data and keep the process attractive to potential investors is a challenge as academics face a need to publish, thereby securing additional funding, while investors want to preserve intellectual property. One year after publication or presentation, data referring to a specific compound, process or device is considered to be part of public domain and cannot be patented. Prior to approval, a well defined package of efficacy, safety, and purification/production characteristics are required under good laboratory practice (GLP) guidelines. The clinical trial phase presents its own challenges. The desire to establish rapidly proof of concept, dose and frequency of administration often leading to premature costly choices, or overly complex study designs. The need to recruit within short timelines, increases the risk of inappropriate patient selection criteria. This lecture and others in this symposium, an insight into drug development and its intricacies will be presented.
Pre‐clinical testing: Good laboratory practice and the requirements imposed by the agencies
Authors: VEZINA M
Published: November 2013

In all countries, preclinical (nonclinical) studies are required to support testing of novel therapeutics in humans. For ocular therapeutics there is no defined guideline available from the major regulatory authorities. This combined with a wide variety of compound types and delivery systems can make it challenging to determine what nonclinical studies should be conducted to support the human clinical trials. The therapeutic indication, class of compound, species specificity and suitability, dose route, systemic exposure, whether the compound is a new molecular entity or an already approved product and the intended clinical protocol, all have an impact on the nonclinical ocular program design. This presentation will outline the types of nonclinical studies that are typically appropriate for ocular therapeutics in the context of the previously mentioned considerations and the role of Good Laboratory Practice (GLP) and regulatory agencies in the design and acceptance of these studies.

Commercial interest
Facing the regulators ‐ Partnership or opponent
Authors: GRANZER U
Published: November 2013

Abstract not provided
Glaucoma surgery outcome in Rwanda
Authors: DE SMEDT S , FONTEYNE Y
Published: November 2013

Purpose To assess long term intraocular pressure (IOP) outcome after adult trabeculectomy surgery in Africa.

Methods All adult glaucoma patients who underwent trabeculectomy surgery in the Kabgayi Eye Unit, Rwanda between August 2003 and March 2008 were invited for a follow‐up visit. Surgical and clinical data were collected from medical records. At the study visit best corrected visual acuity was measured and Goldmann applanation tonometry and biomicroscopy were done. Good IOP outcome was defined as both an intraocular pressure ≤ 15mmHg and achieving ≥ 30% reduction from the preoperative IOP. Odds ratios for good IOP outcome were calculated for potential predictors. For the first eyes multivariable analysis was done using logistic regression, as well as Kaplan–Meier survival curve analysis.

Results Participation rate was 74.2% (118 patients, 161 eyes). Preoperatively, the mean IOP was 31.2mmHg (SD 10.7, range 12‐60). Anti‐metabolites were applied during the operation in 79.5% of eyes. At the time of the follow‐up study visit the mean postoperative IOP was 13.0 mmHg (SD= 5.1, range 4‐35). A good IOP outcome was achieved in 66.9% (n=105) of eyes. Trabeculectomies using mitomycine C were 3 times as likely to have good IOP outcome than without (OR=3.0, CI= 1.2‐7.1, P=0.008). The cumulative probability to maintain good IOP outcome reduced from 75% at a follow‐up of 2 years to 25% after 5 years. At multivariable analysis long duration of follow‐up (OR= 0.31, CI= 0.11‐ 0.7, P= 0.009) and the presence of an elevated bleb (OR= 3.2, CI= 1.3‐ 8.1, P= 0.012) remained significant predictors.

Conclusion Trabeculectomy with mitomycine C is effective in lowering IOP in Central Africa. However, the IOP control reduced at a follow‐up duration beyond 2 years, highlighting the importance of regular long‐term follow‐up.
Refractive and axial length changes after trabeculectomy for open angle glaucoma
Authors: POPA CHERECHEANU A , CORBU C , COMAN C , IANCU R
Published: November 2013

Purpose Predicting refractive and axial changes that might occur after glaucoma surgery should be taken into account when managing the patients that have had cataract surgery previously or at the time of trabeculectomy (combined procedures). The aim of our study is to provide data regarding the changes in refraction and axial length (AL) at one year follow‐up after trabeculectomy for open angle glaucoma.

Methods This is a retrospective study assessing 48 patients that underwent trabeculectomy; 27 patients underwent cataract surgery at minimum 12 months after glaucoma surgery. Refractive status was analyzed using auto‐refractometry and axial length was measured using non‐contact biometry prior to the surgery and at one year follow‐up. Primary outcomes were axial length, refractive status and intraocular pressure (IOP).

Results The difference between the mean final refraction and mean preoperative refraction in the study group (‐0.68±1.05 D vs ‐0.47±0.86 D) was not statistically significant (P=0.215). At one year follow‐up, IOP was significantly reduced after trabeculectomy with a mean of 8.95 +/‐ 2.93 mmHg (p = 7.82x10‐13). AL was determined at six months and one year follow‐up; the mean AL was significantly reduced at all time points (0.10 and 0.08 respectively; p value 0.015).

Conclusion The axial length reduction after trabeculectomy is small though still statistically significant. The decrease in axial length postoperatively was also correlated with the degree of IOP reduction. Following trabeculectomy the refractive status of the eye remained unchanged.
"No‐touch" DMEK: Learning curve and outcomes
Authors: DROUTSAS K
Published: November 2013

Descemet Membrane Endothelial Keratoplasty (DMEK), as described by Gerrit Melles in 2002, is currently the most targeted technique of endothelial replacement, as only Descemet membrane and the endothelial monolayer are transplanted. Therefore, the postoperative anatomy of the cornea is not altered as in earlier techniques (DLEK, DSAEK) and visual rehabilitation is fast and frequently complete. In the present lecture, surgical videos of graft preparation and DMEK surgery with the standardized “no touch” techniques as described by Melles will be presented along with clinical outcomes with regards to corrected visual acuity, refraction, endothelial cell density, complications and secondary procedures.
Silica‐collagen hybrid artificial cornea
Authors: PATEL SV , DIVITO MD , RUDISILL SG , STEIN A , MCLAREN JW , HUBEL A
Published: November 2013

Tissue‐engineered artificial corneas could eventually replace cadaveric corneal transplantation, enabling sight‐restoring procedures to many who do not have access to eye banking facilities. We investigated compositions of silica–collagen hybrid materials as potential artificial corneal substitutes. Hybrid materials were created from different proportions of collagen and silica precursors and manufactured to specific dimensions. Materials were implanted into animal corneas to determine if they supported epithelialization of their surface. The refractive indices of the hybrid materials ranged from 1.33 to 1.40 depending upon the composition and manufacturing characteristics. Transmissibility of 3:1 (silica:collagen ratio by weight) and 9:1 rehydrated xerogels was similar to that of normal rabbit corneas. Re‐epithelialization of 5‐ to 6‐mm‐wide rabbit corneal epithelial defects was complete in 5.5 ± 2.4 days (n = 6), with evidence of epithelial stratification. Silica–collagen hybrid materials have properties that are promising for use as an artificial corneal substitute. Additional studies are required to determine long‐term outcomes in vivo.
Family relationships of recent familial uveal melanomas in Finland
Authors: KIVELÄ T , TÄLL M , RAIVIO V , TUOMINEN J , LEHESJOKI AE
Published: November 2013

Purpose Attention has recently focused on hereditary predisposition in uveal melanoma. We describe relationships between patients with familial uveal melanomas prospectively diagnosed in Finland during the last five years.

Methods Prospective ascertainment of uveal melanoma patients with a positive family history between 2008 and 2012 in a national ocular oncology center managing essentially all uveal melanomas in Finland, a high risk region for developing this rare cancer.

Results Of 311 new patients with uveal melanoma, 8 (2.6%; 95% confidence interval, 1.1‐5.0) eventually gave a positive family history upon specific questioning and encouragement to query among relatives. The index cases were 40‐83 years old when the diagnosis was made (mean, 61) and 2 of them came from the same family. The previous cases in these families had been 26‐82 years old at the time of diagnosis, which had been made 3‐21 years earlier. The earlier patients had the following relationship to the index case: 1 son, 1 father, 1 mother, 1 grandmother, 2 aunts, 1 uncle, and 1 cousin. Of them, 5 had died of uveal melanoma and 2 were alive. On the other hand, none of the index patients have so far developed metastases or died.

Conclusion Mutations of BAP1 so far have explained some but not all familial cases of uveal melanoma. Identification and further analysis of familial uveal melanomas will help to understand the emerging genetic diversity of uveal melanoma.
Quantitative proteomic analysis of uveal melanoma reveals potential therapeutic targets
Authors: ANGI M , KALIRAI H , DAMATO BE , COUPLAND SE
Published: November 2013

Purpose To identify potential therapeutic targets in uveal melanoma by global proteomic analysis of tumours with high‐ (HR) or low‐ (LR) risk of developing metastatic disease.

Methods Proteins were extracted from fresh‐frozen tissues from 10 HR and 10 LR UM and from 22 normal choroid samples, subjected to isobaric tagging for relative quantification (iTRAQ) and analysed by nanoLC‐MS/MS. Peptide identification was performed using Protein Pilot with a False Discovery Rate set at 5%. Differential expression of proteins and their relative abundance between the groups was investigated by supervised and unsupervised hierarchical clustering and outlier analyses.

Results We identified 2651 unique proteins. Compared to normal choroid, the tumours showed 672 proteins up‐regulated more than 1.5‐fold and 459 down‐regulated more than 1.5‐fold. Of these, 18 proteins with known functions in tumour development/progression were identified and shown to be differentially expressed between HR and LR samples. Four of these have been further validated by immunohistochemistry in a larger cohort of patient samples.

Conclusion Using quantitative proteomic analysis and immunohistochemistry we have identified novel potential therapeutic targets in UM. One of these in particular is a tumour suppressor associated with chemosensitivity in other cancers, but not yet described in UM. This opens a novel therapeutic avenue that is being further investigated.
Harmlessness of 1 mg cefuroxime intracameral injection at the end of cataract surgery
Authors: BARREAU G , BOURMAULT L , DOST L , ADENIS JP , ROBERT PY
Published: November 2013

Purpose Intracameral 1mg cefuroxime injection at the end of cataract surgery is included in the good practice in France and a lot of countries. Few studies have shown a macular toxicity for high doses of cefuroxime in particular in a case of dilution error for exemple.

Methods We propose a study on 18, of simple cataract operated, eyes : by phakoemulsification, the same surgeon, without particular surgical complications, and no posterior capsule rupture. Only patients with medium cataract and a normal macula were included in the study. A time‐domain macular OCT was pre‐operatively made, and then at 7 and 30 post‐operative days. The principal criterion of judgement was the central macular thickness at 30 post‐operative days.

Results The average pre‐operative central macular thickness was 209,11 +/‐ 29,44 microns (143‐279), at 7 post‐operative days the average was 214,44 +/‐ 28,42 microns (145‐267), and at 30 post‐operative days was 219,44 +/‐ 27,41 microns (145‐253). The differences observed between the pre and post‐operative values were not significant.

Conclusion These results show that at a dose of 1 mg, as an intracameral injection, and without posterior capsular rupture, cefuroxime does not significativly increase the central macular thickness. A study with a larger pool of patients would certainly confirm what the actual clinical practice lets us foresee.
Optimizing number of postoperative visits after cataract surgery – a safety perspective
Authors: WESTBORG INGER , MöNESTAM EVA
Published: November 2013

Purpose To evaluate safety perspectives, when the standard routine after cataract surgery is no planned postoperative visit.

Methods A prospective, observational cohort study was performed on all cases of cataract surgery during a 1‐year period, at one institution (n=1249). The study group was all patients following the standard procedure of the clinic. As a control group all patients having surgery during one month (March) was chosen. All these patients had a planned postoperative visit. The standard routine is no planned postoperative visit. A postoperative visit is planned if there are other significant eye diseases, for instance glaucoma, wet AMD and diabetic retinopathy. Outcome measures were; any planned postoperative visit, any complications and/or adverse events, postoperative visual acuity and any postoperative control/contact initiated by the patient.

Results There were no differences in age, sex, complications/adverse events and postoperative visual acuity between the study group and control group. 9 percent of the patients initiated a postoperative contact. 26% of the patients who initiated postoperative contact had also a scheduled visit. Reasons for unplanned contacts were visual disturbance, redness and/or chafing, pain and anxiety. Most unplanned contacts (68%) initiated by the patients were first eye surgery.

Conclusion It is possible refraining from planned postoperative visits in cases of uncomplicated cataract surgery. Before surgery patients with comorbidities need individual planning of their postoperative care. Preoperative information is important and the clinic should have resources to answer questions from patients and be prepared for the need of unplanned additional postoperative visits.
Halo size after implantation of a multifocal intraocular lens
Authors: PEREZ CARRASCO MJ , ÁLVAREZ‐REMENTERíA L , HURTADO‐CEÑA FJ , HEREDIA‐TEJADO L , DORADO‐PALACIOS FI , PUELL MC
Published: November 2013

Purpose To determine the size of a halo in the visual field induced by bright light after cataract surgery and implantation of an aspheric apodized diffractive multifocal intraocular lens (IOL) or aspheric monofocal IOL.

Methods This prospective observational study comprised 54 healthy eyes (mean age 72.6 ± 10.4) of 54 subjects having cataract surgery with bilateral implantation of an AcrySof ReSTOR SN6AD1 IOL (32 eyes, multifocal group) or AcrySof SN60WF IOL (22 eyes, monofocal group). Six months postoperatively, halo size was measured using the Vision monitor. Optotypes of low luminance (5cd/m2) were presented at a distance of 2.5 m. The visual angle subtended by the radius of the halo was calculated in minutes of arc (arc min). Best‐corrected distance logMAR visual acuity (VA) was evaluated with high‐contrast (HC‐96%) and low‐contrast (LC‐10%) logMAR Bailey‐Lovie letter charts.

Results The mean radius of the halo was 219.3 ± 42.1 and 194.0 ± 55.3 arc min (p > 0.05) in the multifocal and the monofocal groups respectively. The HC and LC VA means showed significant differences between the two groups, being worse in the multifocal group. Also, the HC and LC‐VA exhibited a significant correlation with halo size (r= 0.52 y r= 0.57 respectively).

Conclusion Mean halo size was not significantly different between the multifocal ReSTOR SN6AD1 and the monofocal AcrySof SN60WF IOLs. Worse HC and LC‐VA values were related to higher halo size measurements in the IOLs groups.
Fast fully‐automated multimodal image co‐registration (optical coherence tomography, colour fundus photography, red‐free, fluorescein angiography)
Authors: GUIMARAES P , RODRIGUES P , LOBO C , SERRANHO P , BERNARDES R
Published: November 2013

Purpose To automatically co‐register optical coherence tomography (OCT), colour fundus photography (CFP), red‐free (RF) and fluorescein angiography (FA).

Methods The burden of manually assisted co‐registration and the number of images taken per day prevent its widespread use. An algorithm able to co‐register images in between the major modalities in due time is herewith proposed. Typically, OCT fundus references translate into a poorly detailed vascular network, thus rendering difficult its co‐registration to other imaging modalities. A recently developed method (by our group) to compute the vascular network from OCT to the level of detail of CFP was used. A set of vessel features is computed and an iterative process estimates the transformation required to co‐register these locations. At each step the number of inliers is determined and the process repeats. Images of 20 eyes from 13 patients that underwent high‐definition OCT, CFP and FA, were co‐registered. These images were manually segmented by a grader. Two additional sets were co‐registered and evaluated by an expert: 102 OCT/CFP image pairs from 51 subjects, and 40 FA/RF image pairs from 20 patients.

Results A skeleton overlap metric was defined and computed based on the vessels skeleton (0–no overlap, 1‐full overlap) for the first set. An average overlap of 0.93±0.03 (N=60) is reported. From the expert evaluation, 91% of images were successfully co‐registered. For the registration of a given pair, the algorithm takes 1.68±0.38 seconds on an Intel Core i7‐2600k, 3.4 GHz computer.

Conclusion The achieved level of co‐registration, render this process an asset to the clinical daily practice and research.
Visualization of 3D retinal microcapillary network using OCT
Authors: SIKORSKI B , BUKOWSKA D , RUMINSKI D , GORCZYNSKA I , SZKULMOWSKI M , KRAWIEC K , MALUKIEWICZ G , WOJTKOWSKI M
Published: November 2013

Purpose To present a novel method for noninvasive visualization of 3D retinal microcapillary network (RMN) using optical coherence tomography (OCT) reflectivity maps and to validate its clinical usefulness in vascular retinal diseases.

Methods OCT imaging was applied to 43 patients with diabetic retinopathy, CRVO, BRVO and in 13 healthy subjects. OCT maps of RMN from different retinal layers were reconstructed and compared with fluorescein angiography.

Results OCT showed the RMN of 20 microns in diameter, revealed vascular nonperfusion and identified microexudates that were not visible on clinical examination and fundus photography.

Conclusion OCT is capable to precisely detect the RMN and can be used for noninvasive diagnosis and monitoring of early stages of retinal vascular diseases.
Swept source optical coherence tomographic findings in a case of bilateral macular coloboma
Authors: CHENG C , CHAN JH , CHEUNG G
Published: November 2013

Purpose To describe the findings of macular coloboma using swept‐source optical coherence tomography (SS‐OCT)

Methods Case report

Results A 35‐year‐old man was found to have bilateral deep excavation of the maculae and was diagnosed clinically with bilateral macular coloboma. SS‐OCT showed deep excavation of the sclera corresponding to the area of coloboma. There is loss of overlying retinal pigment epithelium (RPE), neurosensory retina and choroid within the area of excavation. A thin membranous structure is seen overlying the area bared sclera. At both edges of the coloboma, intraretinal cystic changes can be seen.

Conclusion The SS‐OCT is able to image the posterior border of the deep coloboma in this case. In addition, the detailed structure of the retinal layers can be studied. This membranous structure likely represents the remnants of degenerative neurosensory retina and internal limiting membrane. In addition, we also demonstrated intraretinal cysts, not previously reported, at the edges of the coloboma. The use of SS‐OCT technology has enabled the capturing of the retina, RPE and choroid at a much better resolution and this has served to provide greater understanding of the anatomical changes seen in macular coloboma.
Wide field imaging in Coat‘s disease
Authors: ARNDT C , BENISTY D , MASSE S , VARDI K , DUCASSE A , ZAMBROWSKI O
Published: November 2013

Purpose To report the usefulness of wide field imaging and angiography in patients with Coat’s disease.

Methods In 5 consecutive patients, wide field imaging using scanning laser ophthalmoscopy and angiography (Optomap) was performed before treatment. The laser was performed on the basis of the wide field images. When the ophthalmologist considered that the treatment was complete, the imaging was repeated. After reviewing the images, the ophthalmologist decided whether further treatment was required.

Results Among all patients, wide field imaging enabled to monitor the localization of laser treatment with respect to the vascular abnormalities and non perfusion areas displayed on angiography. In all cases, additional laser treatment was performed on the basis of image lecture although the treatment had been considered to be complete by the ophthalmologist.

Conclusion Wide field imaging and wide field angiography enables to target laser treatment in Coat’s disease.
Better monitoring of intraocular inflammation by laser flare photometry and diversified therapeutical approach could mean improved outcome for JIA
Authors: BODAGHI B
Published: November 2013

Slit lamp biomicroscopy is widely used to evaluate the importance of anterior segment flare and cells in children with anterior uveitis. However, different studies have clearly shown that other tools such as laser flare photometry may improve the monitoring during the follow‐up. Laser flare photometry showed for the first time that active ocular inflammation may be associated with a significant level of flare even in the absence of detectable cells. This is a major finding to start a therapeutic approach or change it for a more aggressive strategy and monitor the decrease of flare. Moreover, the level of flare decrease under therapy may predict further serious complications such as secondary glaucoma or cataract. Based on our modern monitoring tools, therapeutic strategies have been progressively modified, allowing a better control of chronic uveitis. Efficacy and tolerance of anti‐TNF alpha agents will be discussed and alternatives in severe and resistant cases will be discussed.
Vitrectomized patients: Are they at risk for glaucoma?
Authors: VANDEWALLE E
Published: November 2013

The prevalence of glaucoma has been suggested to be higher in vitrectomized patients than in the overall population. The mechanisms behind this reported higher prevalence are largely unknown but literature suggests that overall ocular physiology would be impaired in vitrectomized patients. The current theories on the importance of the vitreous body in ocular oxidative stress will be discussed. Furthermore, a review of the underlying diseases needing a vitrectomy and their relationship to glaucoma will be reviewed. Practical aspects such as decision making of combining cataract surgery to vitrectomy, membrane peeling and post‐operative management of vitrectomized patients will be analyzed from the perspective of a glaucoma specialist.
Vitreous attachment to the optic disc: Strings pulling neurons?
Authors: JONAS J
Published: November 2013

The talk witll present and discuss the epidemiology of a posterior vitreous detachment and its associations with clincial conditions
Boston type 1 KPros in India ‐ Indications, contraindications and device modifications
Authors: SRINIVASAN B
Published: November 2013

Boston Keratoprosthesis is the most commonly used Keratoprosthesis worldwide. It is a collar button kind of Keratoprosthesis carried on a corneal graft. The prerequisites for a type 1 Boston Keratoprosthesis include the following 1) Bilateral corneal blindness 2) Reasonably healthy posterior segment 3) Well controlled Intraocular pressure or combine a shunt surgery with the Keratoprosthesis 4) Moist eye 5) Good blink 6) Well formed fornices 7) Committed to regular follow ups and Understands the potential risk involved in the surgery The current indications for Boston type 1 Keratoprosthesis are 1) Multiple failed grafts 2) Limbal stem cell deficiency 3) Ocular burns( chemical/thermal) 4) Aniridia 5) Pediatric corneal opacities 6) Silicone oil induced keratopathy Contraindications 1) Poor /Incomplete blink 2) Severely damaged lid apparatus post chemical injuries 3) Keratinized ocular surface (would be an indication for Boston type 2/MOOKP) Design modifications like addition of more holes in the back plate, the use of the titanium locking ring, Use of a bandage contact lens and prophylaxis with antibiotics with the present design have improved the outcome and retention rates of the Keratoprosthesis. Further research in the form of a titanium back plate to reduce the rates of retroprosthetic membrane formation is being tried.
Proteomic analysis of aqueous humor in retinoblastoma: Final results
Authors: MICHELI L , LANDI G , MORIGGI M , VANNONI D , VASSO M , MENICACCI F , GELFI C , LEONCINI R , HADJISTILIANOU T
Published: November 2013

Purpose Proteomics in ocular fluids is gaining rapidly relevance.Since 2009 we work on the analysis of proteic composition of the aqueous humor (AH) from retinoblastoma (RTB) patients and,in this work,we use the 2D‐DIGE coupled to mass spectrometer to find new RTB markers.

Methods We enrolled 22 RTB patients(Reese‐Ellsworth stage V or ABC classification group E)undergoing enucleation and 20 normal subjects undergoing cataract surgery(CTR).Five of 22 patients presented with associated secondary glaucoma whereas 17 had no secondary glaucoma;8 of 17 patients with no secondary glaucoma received chemotherapeutical treatment with melphalan.Pools were analyzed using 2D‐DIGE coupled to mass spectrometer.DIA and BVA were fully automated with 2D DeCyder® and statistical analysis was performed with EDA® module.Significant spots were In‐Gel digested and identified with Maldi‐TOF/TOF.

Results PCA analysis of the data underlines high distance between CTR pool and RTB pools.In particular the analysis of single protein shows that all the RTB pools are characterized by a high level of Crystallin and pro‐inflammatory proteins and CTR pool are characterized by a high level of Epithelium Growth Factor.

Conclusion This study is the last step for the clarification of AH protein pattern in patients with RTB.Although we learn from literature that the presence of inflammatory processes is widely documented in late stages of pathology,however the presence of crystalline proteins could be either a new marker or an active part of the late stage tumor‐induced panorama in RTB AH samples.Due to this,we think that several molecular biology studies are necessary to better understand involvement of this protein family in RTB pathological pathway.
Pigmented basal cell carcinoma of the eyelid
Authors: ROSNER M , PRIEL A , BEN SIMON1 G , ROSEN N
Published: November 2013

Purpose While Basal cell carcinoma (BCC) is the most common malignant lesion of the eyelid, pigmented basal cell carcinoma of the eyelid are only rarely seen. Thus it is usually misdiagnosed clinically. The purpose of this presentation is to describe three cases with pigmented periocular BCC and to discuss its clinical and histopathological characteristics.

Methods A retrospective review was performed, of the files and the histopathologic slides of patients with pigmented BCC of the eyelid, who were treated in the Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, during 2007‐2012.

Results Fifty three patients were found with eyelid BCC diagnosed between 2007 and 2012, and three of them had pigmented BCC. Two of the tumors were on the lower lid and one in the medial canthus. All were uniformly or almost uniformly darkly pigmented. All were nodular and treated by complete surgical excision. The clinical diagnosis of two of the lesions was nevus.

Conclusion Pigmented BCC should be remembered among the differential diagnosis of pigmented lesions of the eyelid. It is interesting that our cases of pigmented BCC such as other cases described in the literature, were nodular or nodulo‐ulcerative and not cystic or sclerosing types.
Pro‐inflammatory cytokines induce apoptosis of human retinal capillary endothelial cells through downregulation of Hsp27
Authors: NAGARAJ R , NAHOMI R
Published: November 2013

Purpose Retinal capillary cells undergo apoptosis in diabetes, but the mechanism is not clear. Pro‐inflammatory cytokines are upregulated in the diabetic retina of humans and rodents. In this study, we have investigated the effect if pro‐inflammatory cytokines on a small heat shock protein, Hsp27 in human retinal endothelial cells (HREC)

Methods HREC were cultured in the presence of pro‐inflammatory cytokines, interferon ‐γ (IFN‐γ, 50 and 100 units/ml), interleukin‐1β (IL‐1β, 10 and 20 ng/ml) and tumor necrosis factor‐α (TNF‐α, 10 and 20 ng/ml) for 48 hrs and in the presence or absence of high glucose (25 mM, HG). The roles of the kynurenine pathway and NOS were determined by adding 20 μM 1‐methyl tryptophan (MT) and 500 μM L‐Nω‐nitroarginine methyl ester hydrochloride (L‐NAME), respectively to the culture medium.

Results HREC cultured in the presence of mixed cytokines showed a significant downregulation of Hsp27 at the protein and mRNA levels. This downregulation was not due to downregulation of the transcription factor, HSF‐1. Mixed cytokines activated indoleamine 2,3‐dioxygenase (IDO), enhanced kynurenine production and increased the ROS content in HREC. MT inhibited the effects of mixed cytokines on Hsp27. Mixed cytokines upregulated NOS2 and increased levels of NO. A peroxynitrite donor and exogenous peroxynitrite drastically reduced Hsp27. The cytokine and HG‐mediated downregulation of Hsp27 was accompanied by increased apoptosis of HREC

Conclusion Our data suggest that pro‐inflammatory cytokines induce ROS and NO formation, which through peroxynitrite production reduce Hsp27 and bring about apoptosis of HREC. These results suggest a novel mechanism for capillary cell death in diabetic retinopathy.
Characterization of rafts subtypes in monocytes of diabetic patients with and without neovascular complication
Authors: MATHIEU B , GAMBERT‐NICOT S , BRETILLON L , BRON AM , CREUZOT‐GARCHER C
Published: November 2013

Purpose Diabetic retinopathy is a chronic inflammatory disease where the infiltration of plasma and neovascularization of the retina cause blindness. This disease affects millions of people in developed countries and early biological markers would better manage these patients.

Methods For this purpose we purified monocytes, key players of inflammation, blood of healthy and sick people. On the surface of monocytes, there are dynamic structures called rafts membrane microdomains, which there are two subtypes: flat rafts and caveolae rafts. They correspond to dynamic assemblies and ordered cholesterol and sphingolipids. We isolated these rafts membranes of monocytes and studied protein AT2 (angiotensin receptor II) and gp91 (major membrane subunit of NADPH oxidase, producing enzyme superoxide anions), potential markers of the severity of diabetic retinopathy.

Results Our results have shown a switch of cholesterol and sphingomyelin flat rafts to caveolae rafts. The analysis of the constituent proteins (flotillin and caveolin) and functional (AT2, gp91 and p47phox) have shown that these are mobile in the membrane in an inflammatory context. Subunits of NADPH oxidase seem to gather in caveolae rafts and more precisely when the enzyme is activated.

Conclusion The proteins of interest and the switch composition of lipid rafts therefore would appear to be an indicator of the progression of diabetic retinopathy and it would be interesting to provide a mechanistic explanation for the evolution of this chronic vascular disease to consider potential therapeutic targets.
The UK Sight Loss and Vision Priority Setting Partnership (SLV‐PSP): Vision research questions prioritised by patients and health care professionals
Authors: VOTRUBA M , THE SLV‐PSP STEERING GROUP AT
Published: November 2013

Purpose The SLV‐PSP process aims to identify research priorities that can be used to inform decisions of funding bodies and enhance the case for additional research funding.

Methods People were asked to submit questions about prevention, diagnosis and treatment of sight loss and eye conditions that are most important to them. The survey was available online, by phone, post and alternative formats (Braille and audio). The partner organisations were Fight for Sight, the College of Optometrists, NIHR Biomedical Research Centre for Ophthalmology, The Royal College of Ophthalmologists and Vision 2020. Over 30 charitable and professional organisations promoted the survey.

Results 2,200 people responded generating 4,461 questions. 65% of respondents had sight loss or an eye condition. 17% were healthcare professionals (ophthalmologists, optometrists, orthoptists, ophthalmic nurses, opticians, social care/ rehabilitation). The questions were allocated to 12 eye disease categories before subsequent prioritisation of the top 10 at 12 workshops (questions at http://fightforsight.org.uk/sightlosspsp). The categories were ARMD, cataract, corneal and external, glaucoma, inherited retinal, neuro‐ophthalmology, ocular cancer, ocular inflammatory, refractive error and ocular motility and vitreoretinal/ocular trauma.

Conclusion Analysis of demographic data for respondents indicates that the sample is generally representative of the UK population. The number and diversity of conditions represented in responses is distributed across the major conditions and fits projected population incidence.