bluuebunny/crossref_metadata_2025 huggingface dataset:
Optical coherence tomography in the differential diagnosis of true edema versus pseudoedema of the optic disc
Authors: Gozzi F. , Aldigeri R. , Mora P. , Bianchi‐Marzoli S. , Barboni P. , Gandolfi S. , Farci R. , Fossarello M. , Incerti M. , Carta A.
Published: September 2017

Purpose

To assess the predictive value of Spectral Domain OCT (SD‐OCT) to discriminate between pathological true optic disc edema (ODE) and mimickers responsible for pseudoedema (PODE).

Methods

We carried out an observational cross‐sectional study of subjects consecutively referred from 2011 to 2017 to the Neuro‐Ophthalmology service of 4 different hospitals for presumed acute ODE. Among a total of 155 eyes, 95 were identified as ODE and 60 as PODE. Patients underwent the optic nerve OCT evaluation using Zeiss Cirrus Optic Disc Cube 200x200 analysis. Average and four principal quadrants RNFL values were compared between ODE and PODE groups and then with age‐matched controls. ROC curve and AUC were calculated to determine optimal cut‐off values. Mann‐Whitney and chi‐square tests were used to compare groups. Statistical correlation was tested by Spearman's rho test. All tests were two sided with p<.05 being considered statistically significant. Statistical analysis was performed with IBM SPSS Statistics 24.

Results

Average and RNFL thickness of each optic nerve quadrants resulted significantly higher in ODE compared to control and PODE; among quadrants, the highest correlation was reported for the inferior one. Combining the appropriate cut‐off value for average and inferior quadrant, we found a negative predictive value of 91% for ODE when compared to PODE. No statistically significant differences were seen between control and PODE.

Conclusions

Our data show the usefulness of SD‐OCT in the management of acute optic disc elevation of uncertain causes. In particular, the results herein reported provide high negative predictive value in differentiating benign mimickers from true edema of the optic disc, thus avoiding misdiagnosis and invasive procedures not necessary for such patients.
Gene therapy targeting of choroidal disease and AAV transcytosis through the outer blood retina barrier epithelium
Authors: Layton C. , Dhungel B. , Andrzejewski S. , Jayachandran A. , Murali A. , Ramlogan‐Steel C. , Steel J.
Published: September 2017

Purpose

The retinal pigment epithelium (RPE) forms the relatively impermeable outer blood‐retinal barrier, which, when intact, prevents intraocular gene therapy vectors from effectively targeting choroidal diseases such as choroidal melanoma or choroiditis. This study hypotheses that AAV vector optimisation may effectively penetrate this ocular barrier.

Methods

Monolayers of aRPE‐19 and primary human RPE were established on 24 well plate transwell inserts and integrity confirmed with stable transepithelial resistance (TEER) of 35±5 Ω/cm2 and resistance to passage of FITC‐Dextran (400 kDa) at 4 weeks. 10^8±1 vgs of AAV serotypes 1, 2, 3, 4, 5, 6, and 8 were added to the apical surface and media collected from the basal surface at various time points. Viral concentrations were measured by qPCR.

Results

AAV serotype 6 moved through the intact monolayer of both aRPE‐19 and primary human RPE. 41.5%. 47.4% and 60.4% of AAV‐6 viral particles moved through the monolayer at 30 minutes, 3 hours and 5 hours respectively. Blocking RPE exocytosis with tannic acid prevented movement of AAV6 through the monolayer. All other serotypes were unable to penetrate the RPE monolayer, with less than 10% penetrance at 24 hours.

Conclusions

These results indicate that AAV6 passes through a model of the outer blood retina barrier by active intracellular transport. Additionally, this is the first report of AAV‐6 transcytosis across any barrier epithelium. AAV6 may be a promising tool to deliver therapeutic genes for ocular diseases which lay beneath the retinal epithelium.
Characteristics, socioeconomic status and ethnic variations of primary idiopathic macular hole repair in vitreoretinal centers in the United Kingdom
Authors: Velissaris S. , Papavasileiou E. , Garnavou‐Xirou C. , Theodorou O. , Zakir R. , Duguid G. , Sandinha T. , Steel D. , Jackson T.L.
Published: September 2017

Purpose

The purpose of this multicentre retrospective study was to investigate the characteristics and role of ethnicity and socioeconomic status amongst patients with idiopathic macular holes (IMH) and the surgical outcome.

Methods

Consecutive patients undergoing primary IMH surgery at three vitreoretinal units in the UK (King's College Hospital, London, UK, Western Eye Hospital, London, UK, Sunderland Eye Infirmary, Sunderland, UK) between January 2007 and May 2017 were included. The main outcome measure was anatomical closure of IMH.

Results

Two hundred and thirty three primary IMH surgeries were included. All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. 69.10% of patients were European Caucasian, 6.44% were Asian, and 24.46% were Afro‐Caribbean. The mean base macular hole diameter (BD) was 475.5 mcm. Mean BD was 432.2 mcm in European Caucasian patients, 481.3 mcm in Asians (P=0.005), and 505.61 mcm in Afro‐Caribbeans (P=0.006). Regression analysis demonstrated that BD and Afro‐Caribbean ethnicity were independent significant risk factors for surgical failure. Those who have longer duration of symptoms (Afro‐Caribbeans) and leave in more deprived places (Afro‐Caribbeans) in England where found to have lower success rate on macular hole closure.

Conclusions

Asian and Afro‐Caribbean patients present with larger IMH than European Caucasians. In addition to IMH base diameter, black origin and lower socioeconomic status are independent risk factors for surgical failure. This study presents a large population‐based data analysis on ethnic variation in macular holes and may assist in the management and predicting the surgical outcome.
Partial thickness Macular holes and pharmaceutical treatment of FTMH
Authors: Pournaras J.A.
Published: September 2017

The pathophysiology of full thickness macular hole and lamellar macular hole aredifferent and will be discussed. Oct characteristics will be repeated according to newclassification. Taking in account the natural history, indication of treatment will bedetailled according to each stage of those diseases. Recently, ocriplasmin has beenintroduced as an alternative treatment to vitrectomy. Favorable Prognostic factorshave been recognized as age inferior to 65 years old, full thickness macular hole < 400microns, the absence of epiretinal membrane, vitreous adhesion < 1500 microns andphakic status. While management of full thickness macular hole shows good visualprognosis for the patients, the visual result of lamelar macular hole is not so obvious.
What to do? Management recommendations
Authors: Damato E. M.
Published: September 2017

Patients on targeted oncology treatments, such as MEK inhibitors, may develop visual symptoms and can present to either their oncologist, general ophthalmologist or retinal specialist. This talk aims to describe the ophthalmic findings and main differential diagnoses, and to provide an approach to the general investigation of such patients. The significance of ocular findings is highlighted and a stepwise management strategy suggested. Close collaboration between the oncologist and ophthalmologist is recommended in these cases, which are likely to become more common in the face of ongoing advancements in the field of oncology.
Proteomics as a tool for stem cell research in the anterior segment of eye
Authors: Mikhailova A.
Published: September 2017

Limbal epithelial stem cells (LESCs) are essential for corneal transparency and normal vision, as they are responsible for renewing the corneal epithelium. Damage or loss of LESCs may cause the ocular surface to become opaque and vascularized. Patients suffering from such severe ocular surface disorders do not benefit from corneal transplantation alone, because it does not replace the damaged stem cells.

LESCs derived from human pluripotent stem cells (hPSCs) offer a novel cell‐based approach for ocular surface reconstruction. However, critical evaluation of these cells is crucial before considering clinical applications. Proteomics can help verify the authenticity of hPSC‐derived cells on a large scale.

This talk will discuss proteomics as a tool for stem cell research, focusing on the ocular surface. As an example, a study using proteomics to compare native corneal cells at different maturity levels and LESCs derived from hPSCs in feeder‐free and serum‐free conditions will be presented.
Mutation in the Crybb1 gene encoding beta‐B1‐crystallin leads to recessive cataracts in the mouse
Authors: Graw J. , Amarie O. , Kumar D. , Scheideler A. , Hrabé de Angelis M. , Przemeck G. , Sabrautzki S.
Published: September 2017

Purpose

Congenital cataracts are caused by mutations in various genes, and CRYBB1 is one of them. Aim of the study was to create a corresponding mouse model for a cataract‐causing mutation in Crybb1.

Methods

The ENU‐sperm archive of F1 mouse mutants (https://www.helmholtz-muenchen.de/ieg/services/scientific-resources/index.html) was searched for mutations in Crybb1. After selection of an appropriate mutation the corresponding mouse mutant was recovered after in‐vitro fertilization.

Results

We recently identified a mutation in exon 6 of CRYBB1 (c.613delC; p.Q205Sfs4*) as causative for congenital dominant cataracts in an Indian family. Correspondingly, we established a mouse mutant line, which affects the exon 5 of the Crybb1 gene (c.500A–>T; p.D167V). The mouse mutation affects the 3rd Greek Key motif; correspondingly, the size of the alpha‐helical region and the size of several beta‐sheets might be modified in the mutant protein. PolyPhen‐2 predicted this mutation as “possibly damaging” with a score of 0.731. This mutation leads to a recessive form of cataracts with clear lenses in heterozygotes, although Crybb1 is expressed in mouse lenses from E12.5 onwards. Similar to other beta‐crystallins, Crybb1 is also expressed in the brain, which might lead to additional neuronal changes and might explain the involvement of Crybb1 in association with schizophrenia and stress (Spadaro PA et al., Biol. Psychiatr. 2015;78: 848‐859).

Conclusions

In humans, several cataract‐causing mutations have been identified ‐ most of them leading to dominant cataracts, and only a few of these mutations have been shown to cause a recessive way of inheritance. Here we present the first Crybb1 mouse mutant line suffering from a recessive congenital cataract.
Genetic evidence for the role of ultraviolet radiation in the pathogenesis of uveal melanoma
Authors: Goh A. , Ramlogan‐Steel C. , Jayachandran A. , Steel J. , Layton C.
Published: September 2017

Purpose

Recent advances in the understanding and treatments of metastatic cutaneous melanoma (CM) have not led to parallel improvements in the care of metastatic uveal melanoma (UM), and consequently, the two conditions are now often viewed as separate entities. One possible difference is the aetiological role of ultraviolet (UV) radiation, which although well‐established in CM, remains uncertain in UM. This study hypothesised that UV radiation is a pathogenic factor in UM development, evidenced by genetic changes consistent with UV‐related damage in UM.

Methods

We analysed data from 993 UM patient samples and 11803 CM patient samples available from the Catalogue of Somatic Mutations in Cancer (COSMIC) as well as 80 UM patient samples and 343 CM patient samples from the Broad Institute GDAC FireBrowse. UM samples were probed to identify the most frequently mutated genes, mutation types and specific nucleotide substitutions. Somatic mutation data was then cross‐correlated with CM samples from COSMIC and Broad Institute GDAC FireBrowse.

Results

The most common overlapping mutated genes were BRAF, PTEN, CDKN2A, TERT, NRAS, TP53 and ARID2, with four shared point mutations in BRAF (V600E (1799T>A)), NRAS (Q61R (182A>G)) and TP53 (R273C (817C>T)), R248Q (743G>A)). These gene mutations were found to be strongly associated with UV‐related damage in previous scientific reports. The proportion of samples with C>T substitutions (a marker of UV‐related damage) were similar between UM and CM on both DNA strands (20.35% vs 20.05%) and coding strand (11.3% vs 15.7%).

Conclusions

These findings support the hypothesis that the pathogenesis of UM is more dependent on UV radiation than previously thought.
Retinectomy and silicone oil in PVR surgery‐pearls and tricks
Authors: Acar N.
Published: September 2017

Appropriate surgical technique is the most important factor for the anatomical success in the management of retinal detachment (RD) with PVR. Retinectomies are frequently required in detached eyes complicated by severe PVR. Knowing when and how to perform a retinectomy is necessary for a vitreoretinal surgeon and this talk will cover important steps in this surgical maneuver.

Silicone oil endotamponade is also frequently preferred in PVR surgery. How to handle silicone oil during injection and its removal is important to avoid its major complications. Pearls related to these steps as well as some important properties of silicone oils will be discussed in this talk.
Mosaicking the subbasal nerve plexus
Authors: Allgeier S. , Reichert K.M. , Stachs O. , Köhler B.
Published: September 2017

Corneal confocal microscopy (CCM) has been established as a noninvasive, in vivo imaging technology that provides high‐resolution images of the corneal tissue layers at a cellular level. In particular, several research groups focus on the nerve fiber bundles constituting the subbasal nerve plexus (SNP). The ability to visualize ‐ and quantify ‐ morphological alterations of the SNP provides a new and potentially sensitive diagnostic approach for peripheral neuropathies, e.g. associated with diabetes. However, because of the small field of view of current CCM systems (approx. 0.16 mm²) and the locally inhomogeneous distribution of the subbasal nerve structures, a single image does not reliably reflect the condition of the SNP. To address this issue, we present a highly automated and integrated system that facilitates the imaging of an extended contiguous SNP area in a short recording time by guiding the gaze direction of the patient with a computer‐controlled moving fixation target. The system achieves growth rates of the scanned area of approximately 0.16 mm² per second. Following the image acquisition process, a high‐quality mosaic image of the scanned area is computed using specialized image processing software.
Cracking the nuclear‐mitochondrial code in Leber hereditary optic neuropathy
Authors: Carelli V.
Published: September 2017

Leber hereditary optic neuropathy (LHON) is primarily determined by mtDNA pathogenic mutations affecting complex I that are necessary but not sufficient to express the disease. In fact, there remain incomplete penetrance and male prevalence for which it is assumed that further complex genetic, anatomical and environmental interactions are necessary to trigger the neurodegenerative process. On the genetic ground, besides the primary mtDNA mutations there are further determinants, like the mtDNA copy number and the mtDNA background variability (haplotype) that are certainly relevant. However, variability of the nuclear genome is also assumed to play a relevant modifying role. Currently, multi‐layered strategies are employed to crack this nuclear‐mitochondrial code to finally reach a complete understanding of the genetic basis of LHON. The combination of next generation sequencing approaches, expression and metabolic profiles, and functional studies of neuronal tissue generated from patient‐derived reprogrammed stem cells casts hope to shed light on the genetic basis and pathogenic mechanisms in LHON, ultimately leading to the development of targeted therapeutic strategies.
Antisense oligonucleotide therapy for splicing defects in OPA1‐related dominant optic atrophy
Authors: Wissinger B. , Synofzik M. , Schöls L. , Bonifert T.
Published: September 2017

Mutations in OPA1 are the main cause of dominant optic atrophy (DOA) and have also been implicated in a variety of syndromic neuropathies such as DOAplus or Behr‐like syndrome. We have recently discovered a disease‐causing deep intronic mutation (DIM) in OPA1 that induces a constitutive inclusion of a cryptic exon into OPA1 transcripts. As a potential therapeutic strategy we sought to correct mis‐splicing of the mutant pre‐mRNA by using antisense oligonucleotides targeting the cryptic acceptor splice site and the novel branch point created by the DIM, respectively. Transfection of patient‐derived primary dermal fibroblasts with AONs resulted in splice correction of the mutant pre‐mRNA in a time and concentration dependent manner. Maximal rescue efficacy of up ~55% was obtained with the cryptic acceptor splice site targeting AON. Peak efficacy of splice correction was observed at 4 days after treatment. However, significant effects were still seen 14 days post‐transfection in the proliferating cell culture. Western blot analysis revealed increased amounts of OPA1 protein with maximum amounts at ~3 days post‐treatment. In summary, we provide the first mutation‐specific rescue strategy for OPA1 deficiency using synthetic AONs.
Surgical management of Acute Retinal Necrosis (ARN): timing and outcomes
Authors: Mora P. , Tagliavini V. , Tedesco S. , Forlini M. , Carta A. , Gandolfi S.
Published: September 2017

Purpose

To evaluate the demographics, etiology, clinical and surgical management, and functional outcomes of an Acute Retinal Necrosis (ARN) series from a referral Italian Centre. Both clinical characteristics and treatment strategies of ARN are valid and debated issues. Several dedicated articles appear every year in highly impacted medical journals.

Methods

Observational series of biopsy‐proven ARN cases between January 2010 and March 2017. All the considered patients had the last visit in 2017. Soon after diagnosis patients had received systemic antiviral therapy according to the specific guidelines. No intravitreal injections or “early” (i.e. in the absence of retinal detachment, RD) pars plana vitrectomy (PPV) were adopted.

Results

Seven patients (5 men) were included with a mean age of 52 ± 18 years (range 31–78 years). HZV was detected in 4 cases, HSV in 2 cases, CMV in 1 case (the sole with positive serology for HIV). PPV was performed in 6/7 subjects, with a mean delay of 43±33 days since diagnosis. Only in 1 case silicone tamponade removal was successfully reached. A second PPV was required in 4/6 patients, because of RD recurrence or posterior bleeding. In one HSV case a complete healing was achieved with medical treatment. Visual acuity (VA) averagely improved in the whole cohort either between diagnosis (0.91 ± 0.25 logMAR) and the end of follow up (0.77±0.51 logMAR); or between preoperatively (1.15 ± 0.03 logMAR) and the end of follow up. In both cases, however, statistic was not significant (p > 0.05).

Conclusions

The efficacy of prophylactic laser in our series, as in the literature, remains unclear. VA improvement was achieved even without early PPV. This evidence, along with the possible adjuvant effect of intravitreal antivirals, warrant comparative discussion with literature data.
Case series and literature review: Is there a role for antiviral prophylaxis in patients who have had herpetic encephalitis?
Authors: Balendra S. , Sepetis A. , Rainsbury P. , Malem A. , Meredith P. , Farnworth D. , Lockwood A.
Published: September 2017

Purpose

To report a case series involving two cases of acute retinal necrosis (ARN) presenting after treatment and resolution of herpes simplex virus (HSV) encephalitis. In neither case was antiviral prophylaxis after initial episode of encephalitis used. Literature review is presented to evaluate the benefit of prophylaxis in such cases.

Methods

Two case reports are described and fundus photos presented of patients presenting to the Ophthalmology Department of Queen Alexandra Hospital, Portsmouth, UK within the last 3 years. PubMed was used to conduct the literature review.

Results

A 67‐year‐old female presented with rapid painful unilateral visual loss. She had had a history of HSV encephalitis 6 years before, treated successfully with no recurrences. Clinical assessment was in keeping with ARN. She was admitted for intravenous acyclovir for 8 days followed by long‐term oral antiviral treatment. Her vision remained poor with a best‐corrected visual acuity (BCVA) of 6/60 in the affected eye.

A 66 year‐old male presented with a 10‐day history of painful unilateral visual loss. He had had a history of HSV encephalitis 6 months before and a relapse 2 months later treated successfully with acyclovir. Clinical assessment demonstrated a panuveitis and retinitis in keeping with ARN. He was admitted for intravenous acyclovir then kept on long‐term oral treatment of 400 mg twice‐daily. The BCVA in his affected eye has remained at 5/60.

Conclusions

HSV encephalitis has been widely documented as a risk factor for ARN and has been reported to occur up to 20 years after initial illness. The virus may reach the eye via a trans‐axonal route and reside in a reservoir awaiting re‐activation within retinal neurons. We propose that prophylaxis with long‐term low‐dose antivirals is necessary after all cases of HSV encephalitis to reduce the risk of ARN.
3D visualization systems
Authors: Pournaras J.A.
Published: September 2017

Panoramic visualization systems offers new possibilities for all surgeons in the peroperative management of patients affected by vitreoretinal disorders. Ultradigital 3D heads up surgery offers enhanced 3D visualization with high‐definition resolution, image depth, clarity and color contrast while helping to minimize light exposure to the patient's eye. All surgical or patients advantages and inconvenients will be discussed.
Normal upper age‐limits for photopic and mesopic visual acuity and functional contrast sensitivity
Authors: Keuken A. , Subramanian A. , Barbur J.L.
Published: September 2017

Purpose

Normal, healthy aging causes a gradual worsening of vision with more pronounced effects at lower light levels (mesopic range). Normal spatial vision enables us to resolve fine spatial detail and to detect faint edges and boundaries that make up objects. Age‐related changes in the optics of the eye and diseases of the retina and / or systemic diseases that affect vision can also cause a loss of spatial vision. In order to separate the latter from the effects of normal aging, reliable, upper, normal limits of spatial vision are needed for both photopic and mesopic light levels. The purpose of this investigation was to measure visual acuity (VA) and functional contrast sensitivity (FCS) as a function of age in a large sample of normal subjects and to establish reliable, statistical limits to describe normal vision.

Methods

206 subjects (age range: 10‐77 years) have been investigated. A detailed medical and ocular history and eye examination were carried out. We measured photopic and mesopic VA and FCS in each subject under binocular and monocular viewing conditions with both positive and negative contrast using the Acuity‐Plus test (http://www.city.ac.uk/avot).

Results

The best visual performance corresponds to ~ 15 to 35 years. The gradual increase in thresholds with increasing age was surprisingly small under all stimulus conditions below the fifth decade with significant differences between photopic and mesopic conditions.

Conclusions

Thresholds of VA and FCS increase gradually in normal aging. These preliminary results reveal a more pronounced effect between the fifth and sixth decade of life. On completion of this study, statistically‐reliable, upper, normal limits for VA and FCS will be determined as a function of age. These data will make it possible to detect reliable significant loss of spatial vision that cannot be attributed to normal aging.
Retinal vascular fractal dimension and cerebral blood flow, the CRESCENDO study
Authors: Nadal J. , Deverdun J. , Menjot De Champfleur N. , Villain M. , Creuzot Garcher C. , Le Bars E. , Daien V.
Published: September 2017

Purpose

The retinal vascular fractal dimension (FD) is a marker of retinal complexity of vascular tree. It has been associated with neurodegenerative and cerebrovascular diseases. Arterial spin labelling is a non‐invasive technique to evaluate the cerebral blood flow (CBF). The purpose of this study was to explore the relationship between retinal vascular FD and CBF.

Methods

Cross sectional analysis comprising 29 individuals aged 65 years and over from the Cognitive REServe and Clinical ENDOphenotype (CRESCENDO) cohort of healthy older adults. Retinal vascular FD was measured from fundus photographs using semi‐automated standardized imaging software “Singapore Eye Vessel Assessment (SIVA)” system. CBF was estimated in various gray matter regions from a 2D Pulsed arterial spin labelling sequence from MRI.

Results

A higher venular FD was associated with higher CBF in all cerebral regions of interest (p < 0.01). No significant associations were found between CBF and other parameters derived from SIVA or the central retinal arterial or venular equivalent. This association was stronger for opposite eye to handedness (p = 0.03). No relationship was observed between arterial FD and CBF (p > 0.07).

Conclusions

Venular FD was the main parameter associated to cerebral perfusion whereas retinal vascular calibers were not. It may be evaluated in clinical studies for early and non‐invasive detection of subclinical cerebro‐vascular pathologies including dementia and stroke.
Proteinics study: Relevance and interest for screening, follow‐up, etiopathogenesis of AMD
Authors: Gonzalez C.
Published: September 2017

Purpose

To evaluate Proteinics study impact on AMD diagnosis, screening, follow‐up, etiopathogenesis.

Methods

AMD: 40 patients,16 men,24 women,30 with AMD.4 Groups A,B,C,T. A:10 first stage AMD patients,B:10 Atrophy AMD patients(predominant atrophic areas),C:10 patients with Neovascular AMD,T:10 normal patients,control group. Ophthalmologic exam included ETDRS visual acuity(VA),complete ophthalmic examination,Fundus examination,autofluorescence imaging(FAF),(RegionFinderSoftware),optical coherence tomography(HRA Spectral Domain OCT)(OCTenFace software, M‐S software),Fluorescein angiography(FA)and ICG when Neovascular complication. Proteinics Study: Blood tests and analysis, proteinics qualitative and quantitative analysis,all the same for all patients,whatever group. Blood test is done during ophthalmologic exam. Plasma congelation,then Elisa technic,3 stages(SimpleStep Elisa kits)for detection and quantification of IL1β,IL6,IL10,TNFα,tau protein. Classic Elisa technic,2stages,for Amyloid peptid Aß1‐40.Each sample quadruplicate; MicroBCA analysis.

Results

Analysis will determine proteinics quantitative values in each group of patients, and proportion, characterization, singularity of each of them: group A and C:similar results, higher for C; group T and B:similar results, lower for B. So, characterization, prevalence, specifics of and for each group, therefore a proteinics profile. Proteinics study'evaluation, identification, classification in AMD patients, and especially A, B, C groups allow AMD screening, follow‐up, particularly according to AMD type and stage. Proteinics study may have biomarker feature and let AMD prevention

Conclusions

Proteinics study enhance AMD characterization, allow better diagnosis, follow‐up, screening. Interrelations, correlations between AMD and Proteinics lead to better etiopathogenesis understanding and therapeutics prospects.
Molecular diagnostics of ocular allergy
Authors: Vitte J. , Baye A. , Batellier L. , Doan S. , Bury T.
Published: September 2017

Ocular allergies may severely impact on daily activities and overall quality of life. Conventional allergy testing with skin prick tests and circulating serum immunoglobulin E often falls short of identifying the culprit ocular allergens. On the other hand, targeting the ocular milieu may prove valuable for ocular allergy diagnostics. Conjunctival provocation testing and specific immunoglobulin E detection in tear fluid provide data on local ocular hypersensitivity. We focused on specific IgE testing by means of a commercial allergen microarray (ISAC® 112, Thermo Fisher Scientific). We report here the contribution of allergen microarray testing to identifying the culprit allergen in a 42‐year old woman presenting with perennial allergic conjunctivitis.
Seeing the light: A perspective from a junior scientist on her journey from psychology to physics to ophthalmic research
Authors: Irsch K.
Published: September 2017

While there is no magic formula or a single path to achieving independence in an academic research setting, apart from intellect and scientific ability, persistence, drive, and flexibility certainly belong to the mix of valuable skills. In a perspective from a junior scientist on her own journey to independence, this talk discusses some of the challenges and obstacles encountered along the way, and shares personal insights, in an attempt to aid the upcoming generation of early‐career scientists in their own journey.
Swept Source OCT Angiography after retinal detachment treatment with different techniques
Authors: Michalewska Z. , Nawrocki J.
Published: September 2017

Introduction

The aim of this study is to present Swept Source OCT Angiography images of eyes after retinal detachment treated with different techniques

Material and methods

100 eyes of 100 patients were treated with pneumatic retinopexy, segmental buckling, cerclage, primary vitrectomy or combined scleral buckling and vitrectomy. In all eyes swept source OCT angiography was performed one week, one and three and six months after surgery. ILM was peeled in all vitrectomized eyes. 3 × 3 and 9 × 9 Swept Source OCT Angiography images were obtained.

Results

Deep retinal vessels were intact only in eyes after pneumatic retinopexy and plombae. After cerclage the density of deep retina vessels was decreased. After vitrectomy deep retina vessels were irregular and had decreased density.

Conclusions

Retinal attachment might be obtained with all techniques when administered properly. Pneumatic retinopexy and segmental buckling are still the least invasive retinal detachment surgery, even in days of small gauge surgery. Vitrectomy was associated with most significant changes in retina vasculature, but it must be considered it was also chosen more often in eyes with more a severe disease.
Nanofibrous carrier for transplantation of retinal pigment epithelial cells
Authors: Ardan T. , Popelka Š. , Straňák Z. , Kozak I. , Lytvynchuk L. , Rais D. , Dušková M. , Motlík J.
Published: September 2017

The most common retinal degenerative diseases such as age‐related macular degeneration (AMD) and retinitis pigmentosa belong to serious eye diseases that cause dominant number of cases of impaired vision or even legal blindness. Because there is no treatment method to stop progression of these diseases or even treat them, it is supposable that cell therapy based on replacement of retinal pigment epithelial (RPE) cells can serve as an effective treatment for AMD and other degenerative diseases. The study was aimed at development of a new delivery technique for transplantation of RPE cells using two complementary delivery devices: a membraneous cell carrier and an injector as trans‐scleral implantation instrument. The design of the suggested nanofibrous carrier with a peripheral frame was optimized to provide a minimal diffusion barrier for the flow of nutrients in the subretinal space and at the same time to resist surgical handling. An implantation instrument together with the cell carrier ensured a safe transfer of an organized RPE cell monolayer into the subretinal space. Different designs of the carrier seeded with cultured RPE cells and the implantation instrument was assessed in both ex vivo and in vivo animal experiments.
Infectious keratitis: new concepts for old enemies
Authors: Pirani V. , Cesari C. , Carrozzi G. , Lassandro N. , Calamita R. , Neri P.
Published: September 2017

Microbial keratitis (MK) represents one of the main causes of blindness in the world due to corneal scarring, perforation and endophthalmitis. MK remains a challenging public health concern with the need for more effective treatments. Since resistance to therapies has developed over time to several pathogens, ophthalmologists should pay attention to diagnostic procedures. In order to achieve such goal, animal models and novel studies on disease signaling pathways and pathogenesis have given new therapeutic targets. The most common agents include bacteria (ie: Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae and Serratia species), fungi (ie: Fusarium, Aspergillus and Candida species), and protists, such as Acanthamoeba spp. Several innovative treatments have been proposed, such as lipid based therapy and microRNA based therapies. Corneal cross‐linking might become an alternative to standard antibiotic therapy for treatment of bacterial and fungal corneal infections, decreasing microbial resistance to antibiotics and other drugs. Moreover, deep anterior lamellar keratoplasty (DALK) seems to be more appropriate in herpetic infections than perforating keratoplasty (PK).
Ocular surface reconstruction in severe contact lens associated pathology
Authors: Wylegala E. , Dobrowolski D. , Wylegala A.
Published: September 2017

Limbal stem cells insufficiency (LSCI) can be primary (PLSCI) or secondary. (SLSCI). LSCI can be total or partial. Sings and symptoms of LSCI are: decreased visual acuity, photophobia, pain, and corneal epithelial defects leading to the loss of transparency. Conjunctivilzation of the cornea is a symptom sine qua non of total SLSCI. 5–15% cases of SLSCI are after contact lenses wearing. The LSCI in long term contact lens wearers is caused by oxygen level reduction, mechanical irritation and / or inflammatory etiology of corneal limbus. Treatment includes the use of topical corticosteroids, cyclosporin A application of preservative free artificial tears eye drops. Surgical treatment includes: the autologous or allograft limbal stem cell transplantation. Autologous cultured limbal stem cell transplantation is a new method with standardized number of transplanted limbal stem cells. All surgical options of treatment will be discussed.
Robotic surgery ‐ a new way to perform cataract surgery
Authors: Chammas J. , Sauer A. , Bourcier T.
Published: September 2017

Purpose

To demonstrate the feasibility of robot‐assisted simulated cataract surgery

Methods

We performed cataract surgeries on a Kitaro cataract wet lab training system using simultaneously the DaVinci Xi robotic surgical system and a phacoemulsification system. For each procedure, duration and successful completion of the surgery with or without ocular complications were assessed.

Results

Procedures were successfully performed on 27 lens nuclei. Feasibility of robot‐assisted simulated cataract surgery is confirmed. The DaVinci Xi system provided the intraocular dexterity and operative field visualization necessary to perform the main steps of the phacoemulsification procedure: corneal incisions, capsulorhexis, grooving, cracking, quadrant removal and infusion‐aspiration of the viscoelastic. The intervention of a second surgeon was required for the intraocular injections of viscoelastic, balanced salt solution and intraocular lenses. Mean operative time was 26 minutes. All lens nuclei were removed. Inadvertent enlargement of the main corneal incision caused by the phaco hand piece was observed in 2 cases.

Conclusions

Experimental robot‐assisted cataract surgery is technically feasible using the new DaVinci Xi robotic Surgical System combined with a phacoemulsification machine.
Contribution of microglia‐mediated neuroinflammation to retinal degenerative diseases
Authors: Boia R. , Madeira M.H. , Aires I.D. , Neves C.R. , Ambrósio A.F. , Santiago A.R.
Published: September 2017

Glaucoma is characterized by optic nerve damage and retinal ganglion cell (RGC) loss. The onset of the disease is accompanied by microglia reactivity and neuroinflammation. Hence, therapeutic strategies designed at reducing microglia reactivity may offer therapeutic benefits to manage glaucomatous damage. We have been evaluating the ability of adenosine A2A receptors (A2AR) blockade in the control of retinal neuroinflammation and neuroprotection in experimental models of glaucoma.

The pharmacological blockade or the genetic inactivation (siRNA in microglial cells or A2AR knockout animal) prevent microglia reactivity, retinal neuroinflammation, and RGC loss. Also, the treatment with a selective A2AR antagonist reverts inflammation and protects the retina. Furthermore, the intake of caffeine, a non‐selective antagonist of adenosine receptors, affords protection to the retina and prevents microglia reactivity.

Our results open the possibility for the use of A2AR antagonists as therapeutic options in glaucoma.

Funding

FCT (PTDC/BIM‐MEC/0913/2012, PEst‐C/SAU/UI3282/2011‐2013, UID/NEU/04539/2013), COMPETE‐FEDER (FCOMP‐01‐0124‐FEDER‐028417), Centro 2020 Regional Operational Programme (CENTRO‐01‐0145‐FEDER‐000008: BrainHealth 2020), AIBILI
Why should you buy a Shack‐Hartman aberrometer for your everyday practice?
Authors: Gicquel J.J.
Published: September 2017

Quality of vision is a new comprehensive set of measures that determines visual performance at near, far and in variable light conditions. Good vision is no longer defined by 20/20 vision. The necessity of evaluating vision beyond Snellen acuity has led clinicians and vision scientists to utilize contrast sensitivity, wavefront aberrometry and straylight measurement in most clinical trials related to vision.Recently,the advent of 3D movies and 3D TVs brought us new challenges regarding 3 3 Dimensional Quality of Vision.In this course, experts will share with you their experience on this new frontier of modern ophthalmology.
Nestin expression in primary and metastatic uveal melanoma
Authors: Djirackor L. , Shakir D. , Kalirai H. , Petrovksi G. , Coupland S.
Published: September 2017

Purpose

Nestin, a member of the intermediate filament protein family, has been described as a putative cancer stem cell marker (CSC) in a variety of tumours. In particular, increased Nestin expression is associated with an aggressive and primitive tumour phenotype as well as a poor prognosis in cutaneous melanoma. In this study, we examined the expression of nestin in primary (PUM) and metastatic uveal melanoma (MUM) samples, and correlated the findings with histological, clinical and survival data.

Methods

Nestin expression was assessed by immunohistochemistry in 141 PUM and 26 MUM samples; 11 of the PUM cases were matched with their corresponding metastases. The percentage of tumour cells staining positively for nestin was scored by three independent observers. Statistical analysis of all data was performed with SPSS

Results

Increased levels of nestin in PUM samples were associated with known poor prognostic parameters, including epithelioid cells (p < 0.001), closed loops (p = 0.001),increased mitotic count (p < 0.001), monosomy 3 (p = 0.007) and chromosome 8q gain (p < 0.001). Positive staining was identified in both the cytoplasm and membrane of tumour cells. PUM with nestin expression levels above a cut‐off value of 10% (as determined by ROC analysis) were associated with a significantly reduced survival time (Log rank, p = 0.002). In the MUM, a higher nestin percentage combined with poor prognostic markers led to a shorter survival time following the development of metastases.

Conclusions

In conclusion, increased nestin expression in PUM is an independent predictor of a tumour phenotype associated with metastatic progression and reduced survival time at metastasis.
OCT Angiography
Authors: Leitgeb R.A.
Published: September 2017

OCT has become already a standard diagnostic tool in ophthalmology. Despite its continuous improvement in performance, its tissue specificity is still limited, as the contrast mechanism relies on local backscattering changes only. Functional extensions of OCT, in particular Doppler OCT and angiography partially mitigate this limitation. Doppler OCT provides quantitative blood flow in a depth‐localized manner. Abnormal changes in total retinal blood flow have been related to major retinal diseases and their assessment might therefore be an early biomarker of disease onset. Recent developments overcome the necessity to determine the Doppler angle for flow quantification. Fast OCT sequences resolve the pulsatile blood flow in circumpapillary vessel cross sections, that allow to determine the total retinal perfusion in reliable manner. OCT Angiography (OCTA) has gained much attention, due to its easy operation, and impressive vascular detail. It operates in a fully non‐invasive manner, directly on OCT data, and as such as naturally co‐registered. Several examples are given to highlight recent developments to improve speed, field‐of‐view and penetration depth.
Multifunctional OCT for preclincial imaging
Authors: Baumann B.
Published: September 2017

Functional extensions of optical coherence tomography (OCT) expand image contrast and enable quantitative measurements of optical tissue properties, improved segmentation of tissue morphology and the assessment of physiological parameters. In this presentation, we will discuss applications of multifunctional OCT including high‐resolution polarization‐sensitive OCT and OCT angiography for preclinical studies of ocular disease models.
Photoacoustic imaging and its preclinical application in ophthalmology
Authors: Liu M.
Published: September 2017

Photoacoustic imaging is an emerging optical imaging technique featuring optical illumination and acoustic detection. Short laser pulses deposit their energy in optical absorbers where light energy is converted to acoustic energy. Therefore photoacoustic imaging is a direct way of absorption mapping in 3D. Since absorbers, or chromophores, have unique absorption spectra, spectrascopic photoacoustic imaging can distinguish different absorbers by wavelength unmixing. In preclinical and clinical settings, photoacoustic microscopy, one major modality in photoacoustic imaging, can be used for ophthalmic imaging. Without the use of contrast agents, two absorbers can be distinguished: melanin and hemoglobin. Even though the application of photoacoustic microscopy in ophthalmic imaging is relatively new and still in its primitive phase, here we can see how photoacoustic microscopy can reveal the details of blood vessels and melanin in the eye. We will also discuss the potentials of photoacoustic imaging for ophthalmology.
Radiation‐induced cataracts
Authors: Barnard S. , Moquet J. , Lloyd S. , Ellender M. , Ainsbury E. , Quinlan R.
Published: September 2017

The radiosensitive nature of the lens has been increasingly reported, although the exact mechanistic details of the radiation response pathways for cataractogenesis are unclear. Radiation‐induced DNA damage and the subsequent impairment of repair pathways within the lens epithelium are involved. Here, two distinct regions of the murine lens epithelium have been analysed for their differences in double strand break (DSB) repair responses to ionising radiation. The responses of epithelial cells located at the anterior pole (central region) have been compared to those in other locations, including the proliferative compartment, and including the very periphery of the monolayer (peripheral region). Described here are the responses between the two regions, across four strains, over a low dose (0–25 mGy) X‐irradiation range up to 24 hours. Damage visualised through biomarker 53BP1 staining was present across the epithelium, repair kinetics appear non‐uniform. Epithelial cells in the central region have significantly more 53BP1 positive foci. In this study, BALB/c were identified as the most suitable strain for low dose ionising radiation exposure investigation.
Ocriplasmin in the treatment of vitreomacular traction – for
Authors: Xirou T. , Chatziralli I.
Published: September 2017

Enzymatic vitreolysis for the treatment of vitreomacular traction (VMT) and small macular holes with traction instead of pars plana vitrectomy is a hot debate currently.

Ocriplasmin may give a fast and easy solution to the VMT and small macular holes with traction with minimal patient's discomfort and only trasient side effects.

Pars plana vitrectomy the only alternative management to the above mentioned retinal diseases it is an invasive procedure, may be traumatic to the macula, and carries a risk of post‐operatively complications such as an epiretinal membrane, nerve fiber layer defect and cataract formation.

Therefore enzymatic vitreolysis should be considered as a strong treatment option.
A review of orbital tumors in adult Portuguese population
Authors: Teixeira F. , Barata A. , Pinto‐Ferreira N. , Mano S. , Pinto F. , Fonseca A.
Published: September 2017

Purpose

To determine the types and frequency of orbital tumors from patients referred to the Orbital Department.

Methods

Retrospective consecutive case series. All cases of histopathologically or radiologically verified orbital tumors from a major tertiary referral hospital in Lisbon, were reviewed from a 9‐year period. The distribution of patient's age and sex; and tumor's pathology, origin and location in the orbit were determined.

Results

Consecutive series of 71 patients. Median age at tumor's diagnosis was 52y‐o (from 0 to 92 y‐o), and 65% of the patients were females. The most common clinical features at presentation included proptosis in 33 patients (33%), low vision in 24 (34%), a mass in 15 (21%) and pain in 12 (17%). The mean duration of symptoms was 3,3 years (from 1 month to 20 years) before referral. Orbital tumor were malignant in 37 patients (52%) and benign in 34 (48%). The most common tumors were in the extraconal area: malignant lymphoma in 8 patients (11%) and squamous cell carcinoma in 4 (5%); in the intraconal area: meningioma in 9 patients (12%), cavernous hemangioma in 8 (11%), metastases in 7 (10%); and in the lacrimal gland malignant lymphoma 7 (10%) were the most common.

Conclusions

A variety of tumors can involve the orbit. In our series 48% were benign and 52% were malignant. Regardless of the location the most common tumors were malignant lymphoma and cavernous hemangioma. Symptoms that are associated with orbital tumors include: proptosis, orbital mass, decreased vision and pain.
Trabeculectomy – what I learned from my first 20 cases
Authors: Abegao Pinto L.
Published: September 2017

Trabeculectomy has existed for 40 years now and remains not only the Gold Standard in filtering surgery but also the most commonly performed Glaucoma surgery worldwide. However, this highly effective intraocular pressure (IOP) lowering procedure is a time consuming, multi‐step surgery with a relatively steep learning curve. Accordingly, a begginer surgeon should be aware of the critical steps in pre‐operative, intra‐surgical and post‐operative management in order to maximize results with a low risk profile. In this lecture, we will cover the tips and tricks a surgeon may experience when first starting on this surgery. We will cover the topics concerning pre‐surgical assessment of the patient, type of anesthesia, wound construction, scleral flap and ostium design as well as wound closure and post‐operative management. Additionally, the most common results and complications in the early post‐operative period will be discussed.
XEN implant and UC3 ‐ what I learned from my first 20 cases
Authors: Vandewalle E.
Published: September 2017

Starting with new glaucoma techniques gives a beginning surgeon some extra stress. In this session, we will go into more detail how to perform those techniques and to select the right patient for the right technique. We will elaborate more how to avoid pitfalls and how to handle complications intra‐ and postoperatively.