bluuebunny/crossref_metadata_2025 huggingface dataset:
Localised loss of sheen in Optos pseudocolour images in Oguchi disease following prior short wavelength autofluorescence imaging
Authors: Akhtar Haseeb , Nicholson Luke , Ockrim Zoe , Neveu Magella , Webster Andrew R. , Michaelides Michel , Mahroo Omar
Published: January 2024

Aims/Purpose: Oguchi disease is characterized by night blindness and a striking golden retinal sheen in the light‐adapted state which disappears following prolonged dark adaptation (Mizuo‐Nakamura phenomenon). The sheen is observable clinically and on colour and pseudocolour (Optos plc) imaging. We observed a localized loss of sheen in a patient on colour/pseudocolour imaging in an area corresponding to the 30 degree square illuminated by short wavelength (488 nm) autofluorescence (AF) imaging (Heidelberg Spectralis). We explored whether other cases showed this phenomenon.

Methods: Patients in our service with Oguchi disease (diagnosed phenotypically and/or with genetic confirmation) who had undergone colour or pseudocolour imaging were identified. In these patients, note was made of whether prior 30 degree short wavelength autofluorescence images had been undertaken and whether a localized square‐shaped loss of sheen was observed.

Results: We identified 13 patients who had undergone colour or pseudocolour imaging. Of these, 4 patients (2 males, 2 females) had undergone prior 30 degree (and not 55 degree) short wavelength AF imaging at the same visit (ages ranging from 12 to 67). In 2 patients (a 12 year old, with variants in GRK1, and a 67 year old, not yet genotyped), a clear central square in which the sheen was absent was observed in the colour or pseudocolour images.

Conclusions: The phenomenon of disappearance of the sheen in Oguchi disease following prolonged darkness is well‐described. Paradoxically, we observed loss of the sheen in 2 patients in a defined area corresponding to the field of illumination by bright blue light in 30 degree AF imaging. The blue light is preferentially absorbed by rhodopsin, which becomes bleached. It is possible that the sheen (at least in some patients) is dependent on there being a large proportion of unbleached rhodopsin as well as deficient shut‐off of activated rhodopsin.
Vogt‐Koyanagi‐Harada‐like findings as the first manifestation of neuroleukaemia
Authors: García Laura Fernández , Fustel Paula Boned , Sánchez Anselmo Feliciano , Gil Romana García
Published: January 2024

Aims/Purpose: To report a well‐documented case of a 62‐year‐old woman presenting with VKH‐like findings as the first manifestation of neuroleukaemia.

Methods: Case study.

Results: A 52‐year‐old woman who had received a diagnosis of acute myeloid monoblastic leukaemia (AML) one month prior and was in remission after the induction phase presented with floaters and gradual visual loss in both eyes. Visual acuity was 20/200 and 20/25, respectively. Anterior segment exam was normal in both eyes. Funduscopy showed reduced foveal reflex. On spectral‐domain OCT, subretinal fluid was found in both eyes. Fluorescein angiography showed hypofluorescent areas compatible with multifocal serous retinal detachments and multiple hyperfluorescent dots surrounding the detached areas. Days after, the patient debuted with facial palsy and binocular diplopia due to bilateral VI cranial nerve (CN) palsy, left VII CN palsy and right complete III CN palsy. An MRI was performed with no signs of infiltration. A cerebrospinal fluid sample was drawn by lumbar puncture and its analysis denoted infiltration of AML cells with similar immunophenotype to that on initial bone marrow biopsy. Our patient presented with an atypical case of Vogt‐Koyanagi‐Harada (VKH) with multiple leakages along the periphery of the detached retinal area. This sparing of the macula should be considered a suspicious pattern, and combined with the finding of CN palsies was enough to suspect a relapse in the form of CSF infiltration, making the diagnosis of neuroleukaemia possible.

Conclusions: Exudative retinal detachment can be a primary presentation of AML or denote a relapse. VKH is a diagnosis of exclusion, as one of the main criteria for its diagnosis is the absence of other systemic diseases. This becomes especially important in atypical presentations and older patients. So as not to miss life‐threatening underlying conditions, leukaemia and lymphoma should be considered in the differential diagnosis of VKH.

References

1. Hassanpoor N, Niyousha MR. Acute Lymphoblastic Leukemia Presenting as Acute Vogt‐Koyanagi‐Harada Syndrome.

2. AlZamil WM. Lymphocytic leukemia presenting as acute Vogt‐Koyanagi‐Harada disease.

3. Chinta S, Rani PK, Manusani U. Bilateral exudative retinal detachment as a presenting sign of acute lymphoblastic leukemia.
The role of fluorescein angiography in incontinentia pigmenti: A case report
Authors: Monteiro Catarina , da Costa Tomás Reis , Dias Maria Teixeira , Almeida Júlio , Mota Mafalda , Pires Graça , Teixeira Susana , Prieto Isabel
Published: January 2024

Aims/Purpose: To present the angiographic findings in a case of a 6‐year‐old girl with incontinentia pigmenti.

Methods: We describe the case of a 6‐year‐old girl with a known diagnosis of incontinentia pigmenti that presented with retinal vascular changes in a routine ophthalmologic evaluation. Fundoscopic examination revealed a peripheral avascular area with adjacent vascular proliferation. In order to better evaluate these findings, a fluorescein angiography was performed.

Results: Angiography findings included abnormal vascular loops, capillary nonperfusion areas and vascular anastomoses. There were also leakage areas (corresponding to active neovascularization) and areas of staining (due to fibrosis). Laser photocoagulation of the peripheral avascular area was done.

Conclusions: Incontinentia pigmenti often presents with neovascularization and other vascular changes that are more pronounced in the retinal periphery. Therefore, fluorescein angiography is very valuable in the documentation and study of vascular lesions associated with this condition.
Cultural differences in perceived social support in patients with retinal diseases
Authors: Nilsson Ida , Moreno Laura Hernández , Baskaran Karthikeyan , Mohlin Camilla , Senra Hugo , Macedo Antonio Filipe
Published: January 2024

Aims/Purpose: To compare the perceived social support in patients with retinal diseases living in Sweden or in Portugal.

Methods: Participants from Sweden were patients diagnosed with neovascular age‐related macular degeneration (nAMD). Participants from Portugal were patients diagnosed with AMD or diabetic retinopathy. Participants completed the Swedish or Portuguese version of the Multidimensional Perceived Social Support (MSPSS) scale. Visual acuity was measured using an ETDRS scale.

Results: The final sample was formed of 269 patients comprising two groups, one group with 198 from Sweden and a second group with 71 from Portugal. The median age was 77 years (IQR = 11) and the median visual acuity was 0.22 logMAR (IQR = 0.44). There was no statistically significant difference in age nor in acuity between the groups. The Swedish group had higher proportion of women (67%) compared to the Portuguese (52%). For the MSPSS there was a higher median score of 6.08 (IQR = 1.60) in the Swedish group compared with the median of 5.33 (IQR = 0.75) in the Portuguese group (p < 0.001). The Swedish group reported higher scores in the family (p < 0.001) and significant other (p < 0.001) subscales compared to the Portuguese.

Conclusions: Patients with retinal diseases from Sweden perceived better social support than patients from Portugal. Better perceived social support is expected to improve coping and adherence to treatments among patients with eye diseases. This aspect seems open for improvement in the Portuguese group.

References

1. Hernández‐Moreno L, et al. Is perceived social support more important than visual acuity for clinical depression and anxiety in patients with age‐related macular degeneration and diabetic retinopathy? Clin Rehabil 2021 Sep; 35(9): 1341–1347.

2. Okada M, et al. Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age‐Related Macular Degeneration: A Mixed‐Methods Systematic Review. Ophthalmology 2021 Feb; 128(2): 234–247.
Four years follow‐up OCTA changes in long‐term type 1 diabetic patients without diabetic retinopathy
Authors: Sopeña‐Pinilla Maria , Fernández‐Espinosa Guisela , Álvarez Marta Arias , Alonso Sofia Bielsa , Hospital Elvira Orduna , Tomas‐Grasa Cristina , Boned‐Murillo Ana , Díaz‐Barreda Mª Dolores , Acha Javier , Pinilla Isabel
Published: January 2024

Aims/Purpose: To assess changes in retinal capillary plexuses and choriocapillaris over 4 years' time in long‐term Type 1 diabetic patients (DM1) without diabetic retinopathy (DR).

Methods: Twenty‐four eyes of 24 long‐term DM1 patients with no DR lesions were examined by optical coherence tomography angiography (OCTA) over a 4 year follow‐up period. Vascular density (VD) of both superficial and deep retinal capillary plexuses (SCP, DCP) and choriocapillaris (CC) were compared, as well as foveal avascular zone (FAZ) area and diameters.

Results: Mean age was 46.84 ± 11.28 years and the average DM1 evolution time was 28.88 ± 8.04 years. Mean HbA1c level was 7.34 ± 0.94% at the last examination. SCP showed a statistically significant increase in VD in all areas except the inferior quadrant. There were no changes in the area or diameters of the FAZ in the SCP. In the DCP, there was a significant increase in VD in the temporal quadrant and a decrease in the inferior quadrant, along with a decrease in the horizontal diameter of the FAZ. The nasal area of the CC showed a significant increase in VD.

Conclusions: DM1 patients present changes in the inner retina microvascularization after a follow‐up period of 4 years before displaying any signs of DR, mainly an increase in VD the SCP of the retina, along with a decrease in VD in the inferior quadrant of the DCP.
Optical coherence tomography angiography of the foveal avascular zone after successful macula‐off rhegmatogenous retinal detachment repair
Authors: Mahjoub Anis , Abroug Nesrine , Rahma Chaabene , Arij Jouini , Wijdene Nabi , Khairallah Moncef
Published: January 2024

Aims/Purpose: To investigate the size and shape of the foveal avascular zone (FAZ) after successful macula‐off rhegmatogenous retinal detachment (RRD) repair using swept source OCT angiography (SS OCTA).

Methods: A prospective comparative cross‐sectional study including 21 eyes of 21 patients with macula‐off RRD that were successfully repaired. The size of the superficial FAZ was assessed by its area, length of perimeter, and Feret's diameter, and the shape by the circularity, axial ratio, roundness and solidity. The correlations between each parameter and the clinical and OCT findings were statistically determined. The unaffected fellow eyes were used as controls.

Results: The mean initial BCVA was 1.92 ± 0.41 Log MAR (20/2000 Snellen's equivalent). The mean BCVA at OCTA acquisition (3 months) was 0.78 ± 0.39 Log MAR (20/100 Snellen's equivalent) (p < 0.001). FAZ was significantly larger (323.09 ± 129.03 μm2 vs. 245.27 ± 93.15 μm2; p = 0.038), with longer perimeter (2.31 ± 0.35 mm vs. 2.07 ± 0.31 mm; p = 0.048), and irregular shaped (mean circularity: 0.73 ± 0.72 vs. 0.78 ± 0.5; p = 0.019 and mean solidity: 0.90 ± 0.02 vs. 0.93 ± 0.02; p = 0.002) in operated eyes than in the control group. The average Feret's diameter was 0.77 ± 0.10 mm versus 0.71 ± 0.88 mm (p = 0.076). The average axial ratio was 1.25 ± 0.20 versus 1.22 ± 0.22 (p = 0.531), and the average roundness was 0.81 ± 0.11 versus 0.83 ± 0.11 (p = 0.531). Mean central foveal thickness (CFT) was significantly lower in operated eyes than in control eyes (178.23 ± 40.59 μm vs. 247.44 ± 38.2 μm (p < 0.001)). There was a significant inverse correlation between FAZ area and post‐operative outer nuclear layer thickness (r = −0.520, p = 0.016) and CFT (r = −0.571, p = 0.007) in operated eyes. There was no significant correlation between the post‐operative visual acuity and FAZ parameters.

Conclusions: Enlargement and irregularities of FAZ after successful macula‐off RRD repair, as demonstrated by SS OCTA, might suggest an ischaemic macular damage caused by RRD that may affect post‐operative functional outcome.
Clinical‐grade hPSC‐derived RPE grafts for the treatment of age‐related macular degeneration
Authors: Reyes Alvaro Plaza , Sánchez Lourdes Valdés , Mesa Rocio , Moshtaghion Mehdi , Infantes Estefania Caballano , Garcia‐Delgado Ana Belen , Arribas Blanca , Muñoz Beatriz Fernandez , Tsurkan Mikhail , Sanchez‐Pernaute Rosario , de la Cerda Berta , Diaz‐Corrales Francisco
Published: January 2024

Aims/Purpose: Age‐related Macular Degeneration (AMD), a prevalent global cause of vision loss in the elderly, necessitates the development of efficacious treatments. Existing therapies do not cure AMD due to its complexity and the irreversible loss of photoreceptors and Retinal Pigment Epithelium (RPE). Cell replacement therapies targeting faulty RPE cells offer potential for slowing AMD progression, but the immunocompatibility of such therapies is challenging. We aim to develop a cell therapy strategy to minimize immune rejection.

Methods: Our strategy entailed establishing a Good Manufacturing Practice (GMP)‐compatible induced Pluripotent Stem Cell (iPSC) cell bank representing the most frequent homozygous human leukocyte antigen (HLA) haplotypes in the Andalusian population, facilitating derivation of immunocompatible RPE cells. We utilized and refined existing RPE differentiation protocols for generating clinically compliant RPE cells. Furthermore, we tested three bioscaffolds for RPE growth and maturation and compared the physical properties of the resulting RPE cell‐bioscaffold biopatch for transplantability.

Results: We successfully established three GMP‐compatible iPSC lines featuring common homozygous HLA profiles. Through our refined differentiation protocols, these iPSCs were converted into functional, high‐purity and safe RPE cells. Comparative analysis of different bioscaffolds revealed variable capabilities for RPE growth, maturation and transplantability, thereby informing the final bioscaffold selection for RPE biopatch generation.

Conclusions: Our study underscores the feasibility of generating clinical‐grade, immunocompatible iPSC‐derived RPE grafts using GMP‐compliant procedures for AMD treatment. This innovative approach addresses a critical unmet medical need and suggests potential for similar strategies in other cell replacement therapies. The selection of an optimal bioscaffold for RPE growth and maturation is critical for effective RPE biopatch development. Further pre‐clinical and clinical studies are required to evaluate the safety and efficacy of these RPE grafts in AMD treatment.
OCT angiography findings in posterior persistent fetal vasculature
Authors: Hachicha Ines , Braham Imene Zhioua , Slim Haddar , Manel Mokrani , Ilhem Mili , Raja Gmar Zhioua
Published: January 2024

Aims/Purpose: To report optical coherence tomography angiography findings in a patient presenting unilateral posterior persistent fetal vasculature (PVF).

Methods: We report the case of a 19‐year‐old female patient with longstanding visual impairment of the left eye (LE). Patient was assessed with multimodal imaging including color fundus photography, swept source optical coherence tomography (SS‐OCT) and SS‐OCT angiography (SS‐OCTA) of the macula and the optic disc.

Results: The patient had a history of unilateral visual impairment of unknown aetiology and consulted for a routine examination. Best corrected visual acuity was 10/10 in the right eye (RE) and limited to counting fingers in the LE. Ophthalmological examination of the LE revealed a mild exophoria, a quiet anterior segment, a vestigial capsular bag and an inferonasal whitish spot at the posterior lens capsule corresponding to Mittendorf's dot. Dilated fundus examination of the LE showed a lack of foveal reflex, retinal vessel contraction associated to the presence of a fibrovascular stalk extending from the OD to the crystalline lens via the vitreous humour, corresponding to fibrovascular contraction of the persistent and hyperplastic Cloquet's canal. No associated retinal detachment was noted. The clinical diagnosis of posterior PVF was confirmed. Macular SS‐OCT revealed retinal thinning with absence of foveal pit. Optic disc SS‐OCT highlighted a hyporeflective tubular structure overlying a Bergmeister'papilla. Cross‐sectional SS‐OCTA detected a flow signal at the level of Bergmeister's papilla, but no confirmed flow signal was identified at the level of the fibrovascular stalk.

Conclusions: PVF is a rare condition characterized by fetal remnant from developmental vascular system defects, clinically recognized in its three forms (anterior, posterior and combined). OCT‐angiography is a useful non‐invasive tool to confirm of persistent hyaloid artery patency and assess risk of vascular complications. Contraction of the fibrovascular mass is prone to tractional retinal detachment and repeated episodes of intravitreal or intracapsular haemorrhage. Monitoring is therefore recommended even in adulthood.
Correlations between optic nerve OCT and macular functional alterations in patients who undergone successful RRD surgery
Authors: Díaz‐Barreda Mª Dolores , Boned‐Murillo Ana , Hospital Elvira Orduna , Fernández‐Espinosa Guisela , Álvarez Marta Arias , Sopña‐Pinilla Maria , Pinilla Isabel
Published: January 2024

Purpose: The aim is to study the correlation between macular function measured by macular integrity assessment (MAIA) microperimetry and optic nerve (ON) evaluated by ON optical coherence tomography (OCT) in patients undergoing surgery after RRD.

Methods: Cross‐sectional unicentric study including 64 eyes with RRD surgically treated compared with 136 healthy eyes. All underwent an ophthalmological examination including MAIA and ON OCT according to the total retina (TR) protocol and the retinal nerve fibre layer (RNFL) protocol.

Results: Significant decrease in sensitivity and Macular Average Threshold were achieved in RRD group while macular integrity was higher. Temporal (T) sector of the TR protocol and superior (S) and inferior (I) sectors of the RNFL protocol showed greater thickness in the RRD group. Positive correlations were achieved between S sector of the OCT in both protocols and fixation stability P1; nasal (N) sector in the TR protocol and MAIA inferior outer (IO) sector; I sector in the TR protocol and MAIA IO and inferior inner (II) sectors while in the RNFL protocol with MAIA IO sector; T sector in the TR protocol and Macular Average Threshold; C (central) sector in the TR protocol and MAIA IO and II sectors. Negative correlations were showed between S sector in the RNFL protocol and MAIA C sector while in the TR protocol with BCEA 63% area; N sector in the RNFL protocol and MAIA central nasal (CN) sector; I sector in the RNFL protocol and MAIA IO sector and Macular Integrity; T sector in the RNFL protocol and MAIA C sector while in the TR protocol with BCEA 63% and 95% angles; C sector in the RNFL protocol and MAIA C and CN sectors.

Conclusions: RRD causes loss of macular sensitivity together with anatomical changes in the ON. Inferior sectors of MAIA showed more correlations with the OCT TR protocol while C sectors correlated with the RNFL protocol.
Real‐world experience with brolucizumab in pro re nata regimen in patients with neovascular age‐related macular degeneration previously treated with ranibizumab and aflibercept and without control of subretinal fluid
Authors: Di Lauro Salvatore , Millas Sara Crespo , LeaL Lucia Manzanas , Galvez Maria Isabel Lopez , Galarreta‐Mira David
Published: January 2024

Aims/Purpose: to report real‐world outcomes in patients with neovascular age‐related macular degeneration (AMD) previously treated with ranibizumab and/or aflibercept and without control of subretinal fluid (SRF) receiving switch treatment to Brolucizumab in Pro Re Nata (PRN) regimen.

Methods: Retrospective study including 11 patients with neovascular AMD previously treated with ranibizumab and/or aflibercept and without control of SRF were included. They received intravitreal treatment with standard 6‐mg intravitreal injections of brolucizumab between April 2022 and March 2023 in PRN regimen.

Results: The mean follow‐up after the first injection of brolucizumab was 7.25 months (SD 2.18). The mean number of injections per month (IPM) of ranibizumab and/or aflibercept previous to switch treatment to brolucizumab was 0.81 with standard deviation (SD) of 9.81. The mean number of IPM after starting the treatment with brolucizumab was 0.49 (SD: 0.95). Therefore, the amount of IPM was significatively lower when switching to brolucizumab (p‐value = 0.0003). SRF control was achieved in 9/11 of patients (81.82%). The mean VA increased from was 0.59/1 (SD 0.273) before switch to brolucizumab to 0.64/1 (SD 0.253) (p > 0.05). No cases of intraocular inflammation were described.

Conclusions: Brolucizumab in PRN regimen was effective in achieving SRF control in patients with neovascular AMD previously treated with ranibizumab and aflibercept and without control of SRF. Furthermore, the amount of IPM was significatively lower when switching to brolucizumab compared to ranibizumab and/or aflibercept.
Metabolic effect of the retina in a murine model of AD
Authors: Bermudez Mariana Yolotzin Garcia , Vohra Rupali , Freude Kristine Karla , Thomsen Maj Schneider , Aldana Blanca Irene , Kolko Miriam
Published: January 2024

Aims/Purpose: The aim of the study is to evaluate energy metabolism and retinal tissue survival in retinal explants in a murine model of AD (TgSwDI) during aging.

Methods: The 7‐, 12‐ and 24‐month‐old TgSwDI mouse model was compared with age‐matched wild‐type (WT) mice. Characterization of the mouse model was assessed by Aβ plaques staining. Cell viability was evaluated by lactate dehydrogenase (LDH) assay of retinal explants at 4 and 24 h of incubation with culture media. Retinal ganglion cell (RGC) survival was quantified by RBPMS staining in 7‐month‐old mice. Glucose metabolism was analysed by gas chromatography mass spectrometry (GC–MS) using uniformly labelled glucose by incubating whole retinas for 30 min with glucose in 7‐month‐old mice. And lactate, produced by glycolysis, was evaluated by the lactate assay in 7‐month‐old mice.

Results: The presence of Aβ plaques and vascularization was detected in the retinas of TgSwDI mice, whereas they were not found in the retinas of control mice. At 7 months, the viability of retinal explants was reduced in the TgSwDI model compared to the age‐matched WT model using the LDH assay. Compared to controls, RGC survival in the TgSwDI model tended to decrease. We performed GC–MS to evaluate glucose metabolism and observed no difference between the TgSwDI and WT groups. Lactate production showed no significant differences between the groups.

Conclusions: The presence of Aβ plaques was detected in the retinas of the TgSwDI model, indicating that it is a good model for studying the retina in AD. Retinal tissue viability was altered at different ages in the TgSwDI model, and RGC survival was also reduced in the AD model, substantiating that AD affect the retina. We did not detect any differences between WT and TgSwDI groups in energy metabolism, implying that alterations in retinal tissue and cell survival may be related to other pathways. Further studies are needed to explore this, ultimately providing novel insight to address visual function affected by AD.
Safety, biocompatibility, and potential functionality of a new accommodative intraocular lens: An experimental study in rabitts
Authors: Olcina Luis Ignacio , Bueno Ivan Fernandez , Iglesias Cristina Andres , Iglesias Kevin Puertas , Martinez Itziar Fernandez , Martin Ricardo Usategui , Lopez Miguel Jose Maldonado
Published: January 2024

Aims/Purpose: This study aims to evaluate the safety, biocompatibility and functionality of a new accommodative intraocular lens (IOL) (LUZ, Lens Undergone Zonula Global S.L., Valencia, Spain) that, after implantation in rabbit eyes, is compared with a control lens (EyeCee®) and a capsular ring, both present on the market.

Methods: LUZ is an accommodative IOL with two parts: one IOL of hydrophobic acrylic material and polymethylmethacrylate (PMMA) and one ring of silicone and PMMA. LUZ (Study) and EyeCee® plus a capsular ring (Control) were implanted in rabbits (𝑛 = 8 each) after lens surgery by phacoemulsification technique to randomly. Intraoperative and long‐term clinical follow‐up, based on complete ophthalmic examination, and functional tests were performed periodically until 180 days post‐implantation. Finally, ocular samples were collected and histologically evaluated. All data was statistically analysed.

Results: During macroscopic clinical follow‐up we did not observed significant changes between both groups. The lens studied (LUZ) remained centered and without severe clinical complications. The functional study showed no significant differences between both groups. LUZ showed better centering, few adhesions, and kept the capsular bag open compared to Control IOL. Biological effects of LUZ lens implantation were low and comparable to the control lens.

Conclusions: LUZ IOL, has shown safety after being implanted in the rabbit eye, just like the control lens. It has not shown clinical or histological signs that refer to an adverse reaction to the material. Although LUZ functionality has not been observed in the rabbit eye, this possibility should be studied in other animal species with greater and better accommodation. The LUZ lens keeps the capsular bag open, preventing its fibrosis and lens adherence, thus theoretically favouring its potential accommodation.
Exposure to subthreshold dose of UVR‐B does not induce increase in caspase 3 mRNA expression in the rat lens in vivo within first 24 hours
Authors: Yu Zhaohua , Galichanin Konstantin
Published: January 2024

Aims/Purpose: The aim of this study is to investigate the time evolution of caspase 3 mRNA expression within first 24 h in the rat lens after in vivo exposure to subthreshold dose of UVR‐B.

Methods: Twelve six‐week‐old female albino Sprague–Dawley rats were exposed to subthreshold dose (1 kJ/m2) of UVR‐B unilaterally and sacrificed at 1, 8, 16 and 24 h after exposure. Lenses were enucleated and caspase 3 mRNA expression was detected by qRT‐PCR. The time evolution of caspase 3 mRNA expression was then plotted as a function of mean ratios in caspase 3 mRNA expression between exposed and contralateral nonexposed lenses.

Results: There is no difference in mean ratios in caspase 3 mRNA expression between exposed and nonexposed lenses in all four postexposure groups.

Conclusions: Exposure to subthreshold dose of UVR‐B does not induce increase in caspase 3 mRNA expression in the rat lens in vivo within first 24 h.
Hyperreflective material boundary remodelling: A new morphological biomarker of good functional outcomes in neovascular age‐related macular degeneration
Authors: Yu Siqing , Bachmeier Isabel , Hernandez‐Sanchez Jules , Armendariz Beatriz , Ebneter Andreas , Pauleikhoff Daniel , Chakravarthy Usha , Fauser Sascha
Published: January 2024

Aims/Purpose: To characterize the hyperreflective material (HRM) change over 9‐month follow‐up in treatment‐naïve neovascular age‐related macular degeneration (nAMD) eyes who underwent antiangiogenic treatment.

Methods: Spectral‐domain optical coherence tomography images of 207 study eyes enrolled in AVENUE trial were included to analyse HRM features including location, evolvement and boundaries. We looked for the development of a highly hyperreflective band with continuity to the adjacent unaffected retinal pigment epithelium on the inner aspect of persistent HRM, which we termed complete HRM‐BR, if more than 90% of HRM was covered by this feature. Other HRM evolution patterns included complete resolution of subretinal HRM (SHRM) and partial/no remodelling of persistent SHRM. We analysed associations of HRM morphological patterns with vision and intralesional hypertransmission into the choroid (HTC), a proxy for HRM‐associated macular atrophy, at Month 9. Predictive features for complete HRM‐BR were explored.

Results: At Month 9, persistent SHRM was present in 57% of the 207 included eyes. Of these, complete HRM‐BR developed in 44.9%, which was associated with greater visual outcome (+4.2 letters vs. −6.1 letter) and less intralesional HTC (20.8% vs. 69.2%) compared to partial/no HRM‐BR at Month 9. These eyes with complete HRM‐BR had similar visual outcome and intralesional HTC development to eyes with resolved SHRM (+2.2 letters; 26.8%). Presence of intralesional HTC (baseline OR 0.06, month 1 OR 0.18, p ≤ 0.01) was associated with lower odds of complete HRM‐BR development by month 9.

Conclusions: In nAMD eyes undergoing antiangiogenic therapy, complete HRM‐BR developed frequently when SHRM persisted. It was associated with better visual outcome and less MA compared to eyes with partial/no HRM‐BR, and with similar outcomes compared to those with resolved SHRM. This morphological pattern can be predicted at an early stage by RPE‐related HRM features.
Swedish version of the Massof activity inventory to measure vision‐related activity difficulties among patients with nAMD
Authors: Baskaran Karthikeyan , Nilsson Ida , Ringbäck Klara , Ternehäll Michaela , Svanfeldt Cecilia , Melin Jeanette , Mohlin Camilla , Macedo Antonio Filipe
Published: January 2024

Aims/Purpose: The aim of this study was to assess vision‐related activity difficulties among patients with neovascular AMD using a Swedish version of the mass of activity inventory (MAI).

Methods: Participants were patients diagnosed with neovascular AMD receiving treatment for the disease in a hospital in southeast Sweden. Participants completed the Swedish version of the MAI questionnaire. MAI can be used to measure the overall visual ability and visual ability in 4 functional domains: reading, mobility, visual motor function and visual information processing. Best corrected distance and near visual acuity (VA) were also measured.

Results: Among the 196 participants (mean age = 78.5 years, SD = 7.67, 66% female) the median VA in the better seeing eye was 0.18 logMAR (IQR = 0.34), and in the worse eye was 0.54 logMAR (IQR = 0.98). The median visual ability for all participants was 1.92 logits (IQR = 2.69). There was a significant negative correlation between distance VA in the better eye and visual ability (rho = −0.4025, p < 0.01). Using ROC curves, we tested the capacity of the MAI to detect cases of any vision impairment (VA worse than 0.3 logMAR in the better seeing eye), the area under the curve (AUC) was 0.717 (95% CI = 0.643–0.791 p < 0.001). When we tested for detection of moderate vision impairment (VA worse than 0.5 logMAR in the better seeing eye) the AUC was 0.738 (95% CI = 0.648–0.829 p < 0.001).

Conclusions: The results indicate that the Swedish version of the MAI produce measures of visual ability that are consistent with clinical measures among patients with nAMD. The Swedish version of the MAI can be used as outcome measure in interventions for people with nAMD.

References

1. Macedo, A.F. et al. Predictors of problems reported on the EQ‐5D‐3L dimensions among people with impaired vision in northern Portugal. Health Qual Life Outcomes 2022; 20: 132.
The biomechanical e‐staging—In vivo assessment of corneal biomechanics in keratoconus
Authors: Flockerzi Elias , Vinciguerra Riccardo , Belin Michael W. , Vinciguerra Paolo , Ambrósio Renato , Seitz Berthold
Published: January 2024

Aims/Purpose: Keratoconus (KC) is biomechanically characterized by a decreased resistance to deformation when compared to healthy corneas. The aim of this presentation is to give an overview about the development and clinical application of the recently introduced Homburg Biomechanical E‐Staging (BEST) for KC.

Methods: The Corvis ST (Oculus, Germany) non‐contact pneumotonometer measures the corneal deformation after applying a standardized air puff. It calculates the quasi‐binary indices Corvis Biomechanical Index (CBI) and Tomographic Biomechanical Index (TBI) to separate healthy from ectatic corneas, without, however providing a biomechanical KC severity stage. The Homburg BEST based on the linearized CBI provides information about biomechanical KC severity in form of E‐stages 0 to 4, thus augmenting the existing tomographic ABCD KC classification by including corneal biomechanics. Several studies and results about the development and clinical application of the Homburg BEST are presented.

Results: The Homburg BEST was developed based on two independent KC datasets (Homburg: n = 448, Milano/Rio: n = 860). Since 2022, it has been integrated into the Corvis ST software, thus providing a biomechanical KC severity and progression assessment. The software based on several individual biomechanical parameters indicates KC progression like tomographic progression parameters. However, it is influenced by corneal thickness measurements, increases within the first postoperative months after corneal crosslinking (CXL) and indicates postoperative KC stabilization more than 1 year after CXL. Intracorneal ring segment implantation permanently affects corneal thickness in the midperiphery and contributes to slightly higher postoperative BEST values.

Conclusions: Although with limitations, the Homburg BEST enables a biomechanical staging and progression assessment in KC by considering several biomechanical parameters as an addition to the previously purely tomographic or even topographic analysis.
Analysis of corneal scrape outcomes in NHS Ayrshire and Arran
Authors: Blake Anna , Nairn Jonathan , Koshy Zachariah
Published: January 2024

Aims/Purpose: Corneal scrape is a key diagnostic procedure in the management of microbial keratitis. Safe technique for corneal scrape is a requirement of the Royal College of Ophthalmology (RCOphth) curriculum; national and international best practice guidelines exist (1, 2). The purpose of our project is to evaluate the local method of scraping in Ayrshire and Aran, Scotland. The primary aims of this project are to determine: the current method of corneal scraping, the yield of positive samples and impact on safe patient care.

Methods: The corneal scrape samples submitted to microbiology from Ayr Casualty Clinic were analysed between 1st November 2021–19th December 2022. An audit was taken of the equipment available in clinical areas of the Ophthalmology department and the technique used by on‐call clinicians. Through liaising with microbiology, a local poster was created with guidelines for performing corneal scrape and placed in the eye casualty department with appropriate equipment set up.

Results: There was large variation in the clinical technique used to perform the corneal scrapes. None of the on‐call clinicians were able to perform the technique to the published standard. There were no slides, agar plates or needles available for use. One third of clinicians described the correct technique but had no access to the correct equipment. Two‐thirds did not describe the correct technique. Twenty‐two samples were submitted between 01/11/2021–19/12/2022. All samples were cultured, however there were only two positive samples.

Conclusions: Uncertainty and clinical variation exist in the clinical technique used to perform this key diagnostic procedure. There are no guidelines available in the casualty clinic or on‐call room and the necessary equipment is unavailable. The next steps include the creation of a local protocol with correct equipment available to improve the diagnostic yield.

References

1. The Royal College of Ophthalmologists. Practical Skills PS10. https://curriculum.rcophth.ac.uk/learningoutcomes/ps10/

2. Fairbanks AM, Provencher LM, Greiner MA, Sindt C. The University of Iowa, Department of Ophthalmology and Visual Sciences. A Guide to the Corneal Culture. http://EyeRounds.org/tutorials/cornea-culture/index.htm
A biosynthetic alternative to human amniotic membrane for cornea repair—A comparative in‐vitro study
Authors: Sahay Prity , Behbehani Mehri , Filippini Perla , Bruti Gianpaolo , Townsend Melissa , Dua Harminder
Published: January 2024

Aims/Purpose: We hypothesize that the biosynthetic Symatix membrane (SM) can replace human amniotic membrane (HAM) in ocular surgical applications. Our aim was to test this hypothesis by comparing the performance of limbal epithelial cells (LECs) cultures on the membranes.

Methods: SM was manufactured by the Electrospinning Company Ltd using its proprietary Symatix® Technology platform. SM consists of degradable medical grade poly (lactic‐co‐glycolic acid) polymer fibres and sodium hyaluronan. The suturing and fibrin gluing of SM were tested ex‐vivo by simulation on human corneas. LECs from human limbal tissue were used for testing cellular properties namely cell proliferation (scratch wound and Ki‐67 assay), metabolic activity, limbal epithelial cell marker (cytokeratin‐19 (CK‐19)) tight junction formation (zonula occludens‐1 (ZO‐1)), cell‐ECM interaction (fibronectin (FN)), and basement membrane protein expression (laminin) on SM, plastic, HAM, and freeze‐dried amniotic membrane (FDAM).

Results: The surgical handleability of SM was equivalent to HAM. Histological studies demonstrated that epithelial cells on SM had the typical tightly apposed, polygonal, corneal epithelial cell morphology. Rapid wound healing occurred on SM within 3 days; Ki‐67 revealed increased progressive proliferation; and improved metabolic activity was found on SM compared to HAM and FDAM. Immunofluorescence studies showed positive expression of CK‐19, collagen‐1 (Col‐1), laminin, ZO‐1, and FN in SM, plastic, and FDAM compared to negative expression of CK‐19 and ZO‐1 and positive expression of collagen‐1 (Col‐1), laminin and FN in HAM. This could indicate that SM is a better substrate for epithelial cell migration, proliferation, and tight junction formation.

Conclusions: This data demonstrates that SM can provide a suitable alternative to HAM for surgical application in sight‐restoring operations.
Far‐red, high‐resolution, reflection‐free images of the anterior segment in retroillumination
Authors: Cortez Oliver Dorado , Ain Anthony , Poinard Sylvain , Trone Marie Caroline , He Zhiguo , Thomas Justin , Mascarelli Frederic , Gain Philippe , Thuret Gilles
Published: January 2024

Aims/Purpose: Retroillumination observation of the anterior segment is a routine examination method as old as the slit lamp, but capturing good quality images is difficult because of patient glare, the presence of corneal and or lens reflections, and limited resolution. We have modified a slit lamp to overcome these limitations and present the first series of images obtained.

Methods: On a Topcon SL‐D7 slit lamp, we replaced the light source with a far‐red LED (Thorlabs, M780L3, 200 mW, 800 mA at 780 nm) and added a monochrome camera with sufficient resolution (Baumer, VCXU‐123 M). Reflection suppression was achieved by modifying the optical path (patent pending). In a clinical trial validated by an ethics committee (IDRCB: 2021‐A01496‐35), we acquired images of 5 different diseases after pupillary dilation: cataract, posterior capsule opacification, hereditary stromal dystrophy, Fuchs' corneal endothelial dystrophy (FECD), Bowman's membrane dystrophy.

Results: Our innovative prototype device made it possible to obtain images of 3000 × 4096 pixels for 13.3 × 9.7 mm (×40 magnification). In 100% of the cases, one or more clear images on the area of interest were obtained without glare, and without disturbing reflections in 90% of the cases. Some pseudophakic patients showed minimal to moderate light reflection. The images were sufficiently resolved to allow precise analysis of disease areas, such as each guttae of the FECD.

Conclusions: Our retroilluminator prototype provides, for the first time to our knowledge, high‐resolution images of the different structures of the anterior segment, easy to acquire and likely to facilitate the diagnosis and follow‐up of patients. Improvements to the prototype are underway to remove some persistent reflections. One of the first applications will be the classification of the severity of endothelial damage in FECD.
Novel anti‐evaporative lipid‐based formulation for dry eye disease treatment
Authors: Jäntti Janika , Viitaja Tuomo , Sevón Julia , Lajunen Tatu , Puranen Jooseppi , Raitanen Jan‐Erik , Viljanen Mira , Paananen Riku , Moilanen Jukka , Ekholm Filip , Ruponen Marika
Published: January 2024

Purpose: The majority of dry eye disease (DED) patients suffer from the tear film lipid layer (TFLL) instability issues associated with increased evaporation of water from the ocular surface. Therefore, we developed a liposomal formulation based on selected TFLL lipid classes that would restore the tear film stability and retard the evaporation of the aqueous tear fluid.

Methods: The liposomal formulation was prepared by the thin film hydration method and subsequently characterized intermittently by standard techniques for at least 6 months. The mitochondrial metabolic activity (MTT) assay with human corneal epithelial (HCE) cells was utilized to assess the formulation toxicity in vitro. The evaporation resistance properties of the formulation were determined in vitro by the Langmuir trough methods, while a DED cellular model engendered by exposing the HCE cells to benzalkonium chloride (BAC) enabled additional assessment of the in vitro efficacy. In vivo safety was evaluated in rats and rabbits in one‐week studies. The conditions of the animal eyes were assessed by a non‐invasive biomicroscope, an optical coherence tomography, and histological staining of the dissected eyes.

Results: The lipid‐based formulation with favourable pharmaceutical and functional properties (e.g., the evaporation resistance, and the promotion of HCE cell recovery after damage) was developed successfully, while also the physical stability of the formulation was found promising. No evidence of toxicity was observed during in vitro and in vivo experiments.

Conclusions: The results suggest that the developed formulation is well‐tolerated and possesses properties and a safety profile compatible with ocular administration. Utilized in vitro efficacy models imply that the developed formulation is a promising candidate towards more efficient DED treatment. In vivo efficacy remains to be clarified in future studies.
A novel AI‐powered IR‐Visible dual camera system for measuring and tracking ocular surface temperature
Authors: Bidaki Ehsan Zare , Wong Alexander , Shahsavari Navid , Murphy Paul
Published: January 2024

Aims/Purpose: To report the development of a novel artificial intelligence (AI) powered, dual camera (infrared (IR)/visible) system capable of measuring and tracking ocular surface temperature (OST) over any time period.

Methods: The system consists of an IR camera (Teledyne FLIR IR A655sc) and a visible (V) camera (FLIR BFS 51S5C‐C), co‐mounted on a slit‐lamp for simultaneous and overlapping fields of view (FOV); designed control algorithms; computer hardware and connecting cables. Novel algorithms are leveraged to synchronize IR and V video streams of exposed ocular surface and adnexa for image and video registration. Localisation of the cornea in V video stream obtained by deep learning (DL) AI algorithms designed for semantic segmentation of the cornea. Coordinates of V video stream segmented cornea are then used to extract corresponding OST data from the IR video stream in each video stream frame. Data analysis algorithms are used to extract OST data from IR video stream. Further image segmentation algorithms isolated specific areas of interest (AOI) for OST analysis.

Results: The DL algorithm was trained using V images captured using the V camera. Image registration and segmentation errors were calculated to determine accuracy of system. Mean square error for registration was 5.03 ± 1.82 (c.0.45 mm). Mean Intersection over Union (IoU) was 97.6%, representing accuracy in identifying corneal and scleral pixels in tracked eye segmentation. Analysis software extracted rate of OST change and relative OST change compared to baseline across cornea and selected AOI.

Conclusions: A novel AI‐powered system for measuring and tracking OST over time was developed. The system synchronously records IR and V video streams of the eye surface and automatically extracts OST over time. The system can track eye movements and remove artefact eyelid blink frames from the data. A consistent AOI, i.e., pupil, whole cornea, inferior half, superior half, or selected corneal region, can be selected for OST extraction and analysis over time. Experimental results show that the system can track and analyse OST change over time.
Artificial intelligence, anterior segment and refractive surgery: Which relationship and association?
Authors: Ettouri Sara , Ghizlane Daghouj , Mtalai Naoual , Zamzami Samia , Rami Ali , el Maaloum Loubna , Allali Bouchra , Asmaa El Kettani
Published: January 2024

Aims/Purpose: The goal of our work is to synthesize the different fields identified by AI in refractive surgery.

Methods: Research in the literature of the different manifestations of artificial intelligence related to refractive surgery.

Results: Several articles including reviews reported several studies done in this direction. Lops and al introduced the PRFI (Pentacam Random Forest Index) using data from 3 different countries. The PRFI has a sensitivity of 85.2% and specificity of 96.6%. Xie and Co developed PIRSS (Pentacam InceptionResNetV2 Screening) for refractive surgery with a little number of false positive in identifying normal cornea, suspected irregular and keratoconic cornea. AI has also been used in recommending the appropriate refractive surgery and nomograms used, Kamiya and al developed an ML‐based algorithm to predict the postoperative posterior chamber phakic intraocular lens (IOL) vault using preoperative AS‐OCT images of patients undergoing phakic IOL implantation to predict the achieved vault. These examples of studies and discoveries open new horizons in refractive surgery using AI.

Conclusions: AI has been successfully used in the prediction of diagnosis of various corneal disorders, including IK, keratoconus, pterygium, endothelial diseases, and corneal graft‐related complications but also in refractive surgery; certainly it has limits but next to telemedicine, 5G/6G networks, Quantum Communication Networks and Internet of Medical Things, AI is likely to form part of the new health care revolution.

References

1. Artificial intelligence in ophthalmology ‐ Machines think! Indian J Ophthalmol avr 2022.

2. Artificial intelligence in ophthalmology: A multidisciplinary approach. 2022.

3. Artificial Intelligence for Anterior Segment Diseases: A Review of Potential Developments and Clinical Applications mai 2023.