bluuebunny/crossref_metadata_2025 huggingface dataset:
Macular Infarction Following Intravitreal Triamcinolone Injection for Treatment of Central Retinal Vein Occlusion
Authors: Kim T.K. , Lee J.H. , Lee M.Y.
Published: September 2015

Purpose

To report a case of macular infarction following intravitreal triamcinolone injection for treatment of central retinal vein occlusion

Methods

A 75‐year‐old man visited our clinic for visual disturbance in his left eye, who had diagnosed with macular infarction in his right eye. The patient's best‐corrected visual acuity was 0.6 in his left eye. His medical history included type 2 diabetes, alcoholic liver cirrhosis, hepatocellular carcinoma. After fundus examination, the patient was diagnosed with central vein occlusion with macular edema, intravitreal triamcinolone was administered in an attempt to reduce edema.

Results

Within 1 week of treatment with intravitreal injection, the patient noted a significant decrease in visual acuity. Flurorescein angiogram demonstrated an enlargement of the foveal avascular zone following intravitreal triamcinolone, although optical coherence tomography (OCT) showed a decresed maculr edema. Despite normalization of macular thickness on OCT and cessation of leakage on angiography, visual acuity remained at the same level until 2 month of follow‐up.

Conclusions

Not only intravitreal anti‐VEGF injection, but also intravitreal triamcinolone injection can cause macular ischemia. This must be taken into consideration when the treatment regime is adopted for use in patients with ischemic risk factors.
Sterile corneal keratolysis in the rat at 300 nm
Authors: KronschlaGer M. , Talebizadeh N. , Yu Z. , Löfgren S. , Findl O.
Published: September 2015

Purpose

Ultraviolet radiation (UVR) today is widely used in anterior segment interventions. The purpose of the study was to evaluate toxicity of UVR at 3oo nm in the rat cornea.

Methods

16 Sprague Dawley rats were unilaterally exposed to 5 kJ/m2 UVR (λmax: 300 nm; λ0.5: 10 nm) for 15 min. Contralateral eyes were kept as control. The animals were divided into 4 latency groups and eyes were taken at 1, 5, 24 and 120 h post exposure. Apoptosis was detected with the TUNEL method and histopathological changes were visualized with H&E staining.

Results

At 5 h post exposure all 3 exposed corneal cell layers displayed apoptotic cells with a peak at 24 h. Corneal stromal thinning and stromal neutrophil infiltration were found at 120 h in exposed corneas.

Conclusions

In conclusion, sterile corneal keratolysis occurs in the post exposure time window 24 to 120 h and is probably induced by neutrophils. The potential danger of sterile corneal keratolysis is to be considered in the clinical applications of UVR.
Choroidal thickness changes in response to defocus in emmetropia and in myopia
Authors: Weber M. , Esmaeelpour M. , Drexler W. , Findl O.
Published: September 2015

Purpose

This prospective study aimed to investigate the effect of myopic defocus on choroidal thickness in emmetropic, in moderately myopic and in highly myopic subjects.

Methods

A 3‐dimensional spectral domain‐optical coherence tomography (SD‐OCT) system that operates at a wavelength of 1060 nm was used to measure choroidal thickness in the 9 sections according to the “early treatment diabetic retinopathy study” (ETDRS) grid before and after a period of 60 minutes of defocus with a +3.00 Dioptre (D) lens in one eye of 15 emmetropic (spherical equivalent‐SE: −0.75 to +0.75D; group A), 15 moderately myopic (SE: −6.00 to −2.50D; group B) and 15 highly myopic subjects (SE: ≥−6.25D; group C).

Results

Choroidal thickness was in all ETDRS fields significantly thicker in emmetropic than in moderately and in highly myopic subjects. Central field choroidal thickness before and after defocus was in group A 322 ± 59 μm and 321 ± 57 μm, in group B 259 ± 71 μm and 258 ± 65 µm and in group C 237 ± 64 µm and 237 ±65 µm. Choroidal thickness did not differ from before to after defocus in the central ETDRS field (group A: −1 ± 12 µm, p = 0.710; group B: −1 ± 8 µm, p = 0.660; group C: 0 ± 6 µm; p = 0.995; paired t‐test) and these differences did not differ significantly between the groups (p=0.940, ANOVA). In the peripheral ETDRS fields choroidal thickness changes from before to after defocus were neither found to be significant within the groups (p > 0.05, paired t‐test) nor between the groups (p > 0.05, ANOVA).

Conclusions

Myopic defocus does not influence the choroidal thickness in emmetropic, moderately myopic and in highly myopic subjects.
Effect of intravitreal dexamethasone implant (Ozurdex®) in the glycemic control of patients with diabetic macular edema
Authors: Agard E. , El Chehab H. , Malclès A. , Russo A. , Leberre J.P. , Mounier C. , Dot C.
Published: September 2015

Purpose

To evaluate the effect of intravitreal dexamethasone implant (Ozurdex®) in the glycemic control of patients with diabetic macular edema (DME).

Methods

Ten patients with DME received an intravitreal injection (IVI) of dexamethasone implant (DXE implant, Ozurdex®). The mean age of patients was 72 years ± 13.3 years (range, 54–78 years). Glycated haemoglobin (HbA1C) was analyzed before and three months after IVI. The real‐time glycemic readings, throughout the day and night, during at least one week, are provided by a new medical device (Dexcom G4® Dexcom, Fr). The primary outcome analysis was the comparison of HbA1C test before and after IVI. Other data included blood glucose average, the percentage of time spent higher, lower and in glycemic target, and standard deviation over the period.

Results

The mean HbA1C test is 7.2% before IVI and 7.5% after IVI (p = 0.83). Recording of blood glucose was performed on an average of 10 days ± 3. There is no statistical difference for the mean blood glycemic levels before and after IVI. It was 155.4 ± 2323.1 mg/dl before IVI and 163.3 ± 32.8 mg/dl after IVI (p = 0.25). No significant difference was found between extreme values of blood glucose: the mean highest values was 321.1 mg/dl versus 349 mg/dl (p = 0.35), the mean lowest values was 54 mg/dl versus 64.57 mg/dl (p = 0.40).Conclusions

This new continuous glucose monitoring system is indicated for detecting trends and tracking patterns in patients with diabetes. To our knowledge, this is the first study that analyses the glycemic control in human after DXE implant IVI with a daily continuous glucose monitoring. In this study, the use of intravitreal steroids in diabetic patients doesnâ€™t alter glycemic control or increase blood glucose levels. These preliminary results must be confirmed by further studies with a larger cohort.
Tolerance of Dexamethasone intravitreal implant in GAO patients according to their initial treatment and repeated intravitreal injections
Authors: Vié A.L. , Kodjikian L. , Malcles A. , Agard E. , El Chehab H. , Russo A. , Dot C.
Published: September 2015

Purpose

To evaluate the tolerance of dexamethasone intravitreal implant (DEX implant) in patients with history of open‐angle glaucoma (OAG) or ocular hypertension (OHT) according to their initial treatment and the repetition of intravitreal injections (IVI).

Methods

We performed a retrospective two‐center clinical study which included 100 patients treated by DEX implants, divided into one group with OAG or OHT patients (n = 50 patients), and one control group (n = 50 patients) including patients with no history of OHT or GAO, matched by age and pathology. IOP was measured and hypotensive treatments were gathered in all patients respectively at baseline, one week, and each month during six months.

Results

Mean age was 71.77 (SD +/‐ 10.5) years old in GAO/OHT group and 70.4 (SD +/‐ 10.7) years old in control group and mean number IVI was respectively 2.2 (1–7) and 2.8 (1–11). After the first injection, 50% of OAG/OHT patients and 42% of the control group increased their IOP more than 6 mmHg (p = 0.42). There was no difference between the IOP responses of patients initially treated with monotherapy and the control group but there was significantly more high responders (+>15 mmHg) in patients initially treated with bi and triple therapy. The proportion of responders increased when patient had more than one injection (64 and 56% respectively in OAG and control group, p = 0.22) and the number of high responders doubled (16% at the first IVI, 32% of multi‐IVI). An increased of hypotensive therapy was required in 54% of OAG/OHT patients versus 38% in control group (p = 0.1).

Conclusions

DEX implant is well tolerated for the patients under monotherapy. In contrast Patient under bi or triple therapy were at risk of ocular hypertension and filtering surgery. Repeated IVI increased the risk of ocular hypertension.
Normal tension glaucoma associated with lamina cribrosa defects and complicated of maculopathy: A case report
Authors: Besombes G. , Bachetti P. , Labalette P. , Rouland J.F.
Published: September 2015

Purpose

Eyes with glaucoma often present modification of the lamina cribrosa, including posterior displacement, thinning, defects and pore deformities.

Methods

A 40‐year‐old woman with no past medical history have been seen for an acute blurred vision of her left eye 5 days ago. Anamnesis didn't find any family history of glaucoma, but she described a Raynaud phenomenon. Complete ophthalmoscopic examination was performed, with biomicroscopy, fundus imaging, visual field test (Humphrey field analysis 30‐2), optical coherence tomography (OCT) assessment with both Spectralis (Heidelberg) and Cirrus OCT (Carl Zeiss), ultrasonography and fluorescein/infracyanin angiography.

Results

The maculopathy was characterized by schisis‐like thickening and serous detachment. The presence of lamina cribrosa defects permits anomalous communications between intraocular and extraocular spaces. OCT showed a schisis cavity between the inner and outer retina and a larger outer‐layer retinal detachment. The two were connected by a hole in the outer layer near the fovea. The associated subretinal and intraretinal fluid may derive from cerebrospinal fluid that passes through the opening created by the discontinuity of the lamina cribrosa into the subarachnoidal space. This complication usually occurs in case of congenital optic pit.

Conclusions

We describe the case of a patient with a recent diagnosis of normal tension glaucoma, showing a pit‐like structure within the ONH. We observed focal areas of laminar holes in the superior pole of the optic disc. This location differs from the congenital and acquired optic pits mostly temporally or inferiorly located. Enhanced Depth Imaging OCT of the ONH enables microstructural evaluation of lamina cribrosa defects, especially helpful in case of normal tension glaucoma.
Orbital T‐cell lymphoblastic lymphoma
Authors: Heegaard S. , Stenman L.
Published: September 2015

Purpose

To present the clinical, pathological and genetic characteristics of a case of primary T‐cell lymphoblastic lymphoma of the orbit.

Methods

Clinical work‐up and morphological – and immunohistochemical study. Genetic analyses using FISH, DNA sequencing and arrayCGH analysis.

Results

A 22‐year‐old man presented with a 3‐week period of headache, reduced visual acuity and restricted eye movements of the left eye, unresponsive to antibiotic treatment. MRI scan showed large thickening of the extraocular muscles. Biopsies showed infiltration of lymphoma cells in the medial and superior rectus muscle as well as the superior oblique muscle of the left eye.

Morphological and immunohistochemical studies of the biopsies showed T‐cell lymphoblastic lymphoma. No major genomic imbalances were detected by high‐resolution arrayCGH. FISH analysis revealed no evidence of chromosomal translocation involving the ETV6 and MLL genes.

The patient received chemotherapy according to the high‐risk NOPHO‐protocol as well as a myeloablative allogenic bone marrow transplantation. The patient remains free of lymphoma nine months after the diagnosis, but with loss of visual acuity on his left eye.

Conclusions

Primary T‐cell lymphoblastic lymphoma in the eye region is very rare. It is important to recognize these patients early and think of lymphoma as a differential diagnosis in patients with involvement of the extraocular muscles. This is the first reported case of a T‐cell lymphoblastic lymphoma in the orbit.
Long term outcomes in a real life setting treatment by anti‐vascular endothelial growth factor for wet age‐related macular degeneration
Authors: Haouas M. , Girmens J.F. , Thuret G. , Gain P. , Paques M. , Sahel J.A.
Published: September 2015

Purpose

To report long‐term visual outcomes for patients receiving a real life setting treatment by anti‐vascular endothelial growth factor (VEGF) for neovascular age‐related macular degeneration (AMD).

Methods

Retrospective chart review of 500 patients who received a first anti‐VEGF injection for wet AMD from January 1, 2006 to January 1, 2010 at the Quinze‐Vingts National Hospital (Paris). Patients clinical characteristics, ETDRS letter score at baseline, every years and at the last follow‐up were recorded. The number of injections and the date of the first and last injection were also recorded. The main outcome measure was mean change in letter score at 5, 6 and 7 years from baseline.

Results

150 eyes of 120 patients with at least 5 years of follow‐up were identified. The eyes non‐selected had an insufficient follow‐up or another macular disease treated by anti‐VEGF. The mean follow‐up was of 77 months. Mean change in letter score at 5, 6 and 7 years was respectively + 2 letters, ‐1 letters and ‐ 4 letters. A vision of 20/40 or better was achieved in 20% of treated eyes. Seventy percent of eyes was untreated since 6 months or more at the last follow‐up. Patients received an average of 4 injections per year.

Conclusions

Real life setting treatment of neovascular AMD by anti‐VEGF results in a stabilization of vision at 5 and 6 years of treatment. At the seventh years of follow‐up, visual outcomes tend to be worse. Mean duration of treatment was 46 months, with 70% patient no longer requiring reinjection after a mean of 34 months after initiation. Evolution of treatment settings suggests that visual outcomes would be better for recently diagnosed and treated patients.
Radiation complications, Toxic Tumor Syndrome prevention
Authors: Romanowska Dixon B. , Kubicka‐Trzaska A. , Morawski K. , Bogdali A. , Markiewicz A.
Published: September 2015

Purpose

After large melanomas radiotherapy (I‐125, Ru‐106 brachytherapy or proton‐beam) tumor is damaged, which can cause the development of radiation‐induced complications. Large tumor resection under the scleral flap (egzoresection) or during pars plana vitrectomy (endoresection) can prevent Toxic Tumor Syndrome.

Aim

To present choroidal melanoma endoresections results. Tumors were resected in the Department of Ophthalmology and Ocular Oncology at the University Hospital in Krakow.

Methods

The study included 10 patients with large melanoma located in the posterior pole after the proton beam irradiation. Patients were stratified for resection because of the risk of Toxic Tumor Syndrome. Pars plana vitrectomy  and tumor endoresection was performed in all cases with endophotocoagulation and silicone oil endotamponade.  

Results

Removed melanomas were localized predominantly in the posterior pole of the eye, tumor base diameter ranged from 11.3 to 15.2 mm, tumor thickness ranged 5.2 to 9.1 mm. Endoresection was performed 1 to 3 months after proton beam irradiation. Intraoperative complications include minor bleeding occurred in all patients, postoperatively in 1 patient intraocular inflammation (treated with good effect intravitreal injections of steroids) and in 1 case of PVR. There was no recurrence of the neoplasm during the observation period. 

Conclusions

Choroidal melanoma endoresection should be used in some cases of large tumors localized back to the equator of the eye, mainly in the posterior pole of the eye. This prevents Toxic Tumor Syndrome and tumor recurrence.
Clinical outcome of YAG laser vitreolysis (Ultra Q Reflex®) for the treatment of floaters
Authors: Kim E. , Kim H.K. , Yoo T.Y.
Published: September 2015

Purpose

Floaters are localized vitreous opacities that are products of vitreous degeneration or posterior vitreous detachment (PVD). Usually, observation was the only solution, however some patients are suffered from floaters. This study reports the clinical results of YAG laser vitreolysis for the treatment of floaters.

Methods

The patients with floaters were involved who visited Pureun eye hospital between January and March 2015. The patients were involved who met the following criteria; the floaters caused by localized vitreous opacities or PVD; patients suffered from floaters and strong desire for cure. The patients with diabetic retinopathy, retinal detachment, severe media opacity and young age were excluded. Patients had pre and postoperative examinations including visual acuity, tonometry, wide fundus photography, slit lamp and fundus examination. Patients were examined 1, 4 and 8 weeks after treatment. The floater scores were measured with survey paper for the evaluation of subjective change. The wide fundus photography was used for the objective change.

Results

The 47 eyes were involved (27 cases:male and 20 cases:female). The mean age was 69.5 ± 14.3. Informed consent was obtained in all cases. The floater scores were significantly improved after treatment (preoperative: 73.6 ± 10.5, postoperative: 8.2 ± 4.6, P < 0.001). The visible floaters disappeared in 43/47 cases (91.5%) in wide fundus photography. There were no significant changes in VA and IOP. Other side effects such as retinal detachment or hemorrhage and cataract were not developed during follow up period.

Conclusions

The clinical outcome of YAG laser vitreolysis using Ultra Q Reflex showed favorable results in subjective and objective measurement. There were no significant complications after procedure. We think YAG laser vitreolysis could be the excellent treatment option for the floaters.
Thermal cataract induced by near infrared radiation (IRR)
Authors: Yu Z. , Schulmeister K. , Talebizadeh N. , Kronschläger M. , Söderberg P.
Published: September 2015

Purpose

To estimate the threshold radiant exposure for 1090 nm IRR and the time evolution of lens damage; To determine the temperature time evolution in the eye during the previously found threshold exposure, and the associated heat diffusion; To investigate if 1090 nm IRR induces cataract photochemically considering irradiance exposure time reciprocity.

Methods

The 6‐weeks‐old albino rats were anesthetized intraperitoneally, ten min before exposure. The pupils of both eyes were dilated with tropicamide. Five min after pupil dilation, the animals were unilaterally exposed to 1090 nm IRR within the pupil area. Temperature was recorded with thermocouples placed in the selected positions of the eye. At the planned post‐exposure time, the animal was sacrificed and the lenses were extracted for measurements of forward light scattering and macroscopic imaging.

Results

The in vivo exposure to 197 W/cm2 1090 nm IRR required a minimum 8 s for cataract induction with a delayed onset of approx 16 h. The same radiant exposure was found to cause a temperature increase of 10°C at the limbus and 26°C close to the retina. The in vivo exposure to 96 W/cm2 1090 nm IRR with exposure time up to 1 h resulted in an average temperature elevation of 7°C at the limbus with the cornea humidified and no significant light scattering was induced one week after exposure.

Conclusions

An in vivo exposure to 197 W/cm2 IRR at 1090 nm within the pupil for 8 s induces cataract with a time delay. This threshold exposure causes a temperature rise of 10°C at the anterior segment of the rat eye. IRR at 1090 nm produces thermal cataract, probably by indirect heat conduction from absorption in tissues surrounding the lens. There is no cataract development given that the limbal temperature increase is below 8ºC.
Intra‐ocular pressure spike after Aflibercept and Ranibizumab intravitreal injections
Authors: El Chehab H. , Agard E. , Russo A. , Malcles A. , Dot C.
Published: September 2015

Purpose

Since anti‐VEGFsapproval, intra vitreous injections (IVI) represent a booming therapeutic delivery mode. Immediate ocular hypertension (OHT) induced is known after these IVIs. The purpose of this study is to compare the OHT after Aflibercept and Ranibizumab IVI.

Methods

In this prospective study, we compared 30 patients who received an Aflibercept IVI (0.05 mL) to 30 patients who received Ranibizumab for wet AMD. IVI were performed with a 30G needle pushed to the hilt with an anti‐reflux system. We measured intraocular pressure (IOP) using a portable aplanation tonometer PERKINS MK2 (Haag‐Streit, Koeniz, Switzerland) before injection (T0), immediately after IVI (T1), 5 minutes (T5), 15 minutes (T15) and 45 minutes (T45) after the IVI. IOP were compared by a t‐test.

Results

In Aflibercept group, at T0, IOP was 13.4 mmHg+1.5. All patients had a significant increase in IOP at T1 (42.7 mmHg+3, p < 0.001). At T5, IOP decreased but was still statistically higher than baseline IOP (23.6 mmHg+3.1, p < 0.001). At T15, IOP returned to normal values but was higher than T0 (16.2mmHG + 2.1, p = 0.009). At T45, IOP was 13 mmHg + 1.2, with no significant difference from baseline (p = 0.65). In Ranibizumab group, baseline IOP was 13.8 mmHg + 1.1. IOP increased at T1 (45.6 mmHg + 2.2, p < 0.001). At T5 and T15, IOP were still higher than baseline (24.6 mmHg + 2.2, p < 0.001 and 17.9 + 1.5, p < 0.001). At T45, IOP was 12.7 mmHg + 1.5, with no significant difference from baseline (p = 0.12). At each time measure, there is no statistically difference between two groups.

Conclusions

Aflibercept and Ranibizumab IVI induce an IOP spike for a short time. It seems to be equal between the two drugs and essentially related to the injected volume.
Comparison of effective group and refractory group to alternative patch treatment in overcorrected intermittent exotropia
Authors: Lee S.J. , Kim J.Y. , Park J.M.
Published: September 2015

Purpose

To compare effective group with refractory group to alternative patching alone in patients with overcorrection after surgery for intermittent exotropia (IXT).

Methods

Medical records of 53 patients with overcorrection after surgery for IXT were reviewed. Alternative patching was prescribed from postoperative day 1 for patients who had esodeviation ≥18 PD, or esodeviation ≥10 PD after postoperative day 2 weeks. Refractory group was defined as remaining esodeviation ≥10 PD at least 3 months of treatment. Presumed risk factors were investigated.

Results

Of total 53 patients, 30 patients (56.6%) were in effective group and 23 patients (43.4%) were in refractory group. Significant differences were found in gender (Female, Refractory 78.3% vs Effective 46.7%) and preoperative exodeviation at distance (Refractory 27.6 ± 6.5 PD vs Effective 25.8 ± 4.5 PD). Mean starting time of alternative patching in refractory group was later (22.4 ± 25.4 days) than in effective group (10.2 ± 9.6 days). The mean angle of postoperative maximal esodeviation at near was larger in refractory group (−20.0 ± 6.9PD vs −14.7 ± 8.5PD). The mean time of postoperative maximal esodeviation was later in refractory group than in effective group (at distance: 2.3 ± 2.1 months vs 0.3 ± 0.2 months, P < 0.01, at near: 3.4 ± 4.1 months vs 0.4 ± 0.3 months.

Conclusions

Female, large preoperative exodeviation at distance were predisposing factors for refractory to alternative patch treatment in overcorrected IXT. Prescription of alternative patching was late in refractory group. The mean angle of postoperative maximal esodeviation was larger and the mean time of postoperative maximal esodeviation was later in refractory group. Postoperative changes in angle of deviation was significantly larger in refractory group since 1 month.
Spontaneous oscillations in the diameter of retinal arterioles from normal persons decrease with age
Authors: Ragunathan S. , Taborsky J. , Bek T.
Published: September 2015

Purpose

The retinal vascular system is devoid of autonomic nervous supply, and consequently retinal blood flow is autoregulated. This includes pressure autoregulation, metabolic autoregulation and spontaneous oscillations in the diameter of retinal arterioles, so called vasomotion. It has been shown that vasomotion is impaired in diabetic patients, but it is unknown to what extent vasomotion results in retinal vascular disease should be corrected for age.

Methods

Forty‐eight normal persons consisting of at least 8 persons within each of the age groups (in years): 20–29, 30–39, 40–49, 50–59 and 60–69 were included. The patients had been examined by video recording of the retinal vessels using the Dynamic Vessel Analyzer, and diameter changes at five different locations on both arterioles and venules were analyzed by Fourier analysis. The power of the oscillations was calculated in five frequency bands defined as: (1) <0.04 Hz the very low frequency (VLF), (2) ≥0.04 and <0.15 Hz as the low frequency (LF), (3) ≥0.15 Hz and <0.4 Hz as high frequency (HF), (4) ≥0.4 and <2 Hz (VHF) normally containing the heart rate, and (5) 2‐12.5 Hz as a ultra high frequency (UHF).

Results

In all arteriolar segments the power of spontaneous diameter oscillations with high frequencies showed a negative correlation with age, and the correlation was also found for low frequencies 1½ disk diameter from the optic disk (R2 = 0.0038 ± , p < 0.003 for all comparisons).

Conclusions

Power analysis of spontaneous diameter changes in retinal arterioles should be corrected for age before results from different patient groups can be compared.
Characteristics of Artifacts Associated with Ultra‐Wide Field Fundus Image
Authors: Oh J.R. , Lee B. , Ahn J. , Kim Y.H. , Kim S.W.
Published: September 2015

Purpose

To evaluate characteristic of artifacts associated with ultra‐wide field fundus image.

Methods

The retrospective study included 139 eyes of 139 patients who had artifacts in color images using Optomap 200Tx (Optos, DunFermline, UK). The artifact means hyperreflective or hyporeflective shadow due to anterior segment of the eye or vitreous except retina. Types and characteristic of red laser separation, green laser separation and autofluorescence image artifacts within each image were evaluated.

Results

All image artifacts were categorized into two groups according to the location of artifacts. There were corneal opacity, cataract and posterior capsular opacity in the anterior artifacts group. And there were asteroid hyalosis, posterior vitreous detachment, vitreous opacity and vitreous hemorrhage in the posterior artifacts group. Anterior artifacts were more often hyporeflective in red and green laser separation images (p < 0.001). Posterior artifacts were more often hyperreflective in green laser separation images and hyporeflective in red laser separation images (p < 0.001).

Conclusions

Ultra‐wide field scanning laser ophthalmoscope images can frequently have various shadows from anterior or posterior lesion of eye. These shadows show a difference in reflectivity depending on their origins. To understand the difference helps interpretation of the fundus images.
Toxoplasma chorioretinitis: value of polymerase chain reaction and intraocular antibody production in a patient with negative anti‐Toxoplasma gondii serology
Authors: Roels D. , Nerinckx F. , Leroy B.P. , Padalko E. , De Schryver I.
Published: September 2015

Purpose

report a case of panuveitis with negative anti‐Toxoplasma gondiiserology, and serologic and PCR analysis of intraocular fluids positive for Toxoplasmosis.

Methods

A 29‐year‐old male presented with left panuveitis and no view of the fundus, underwent a diagnostic vitreous biopsy. Work‐up included serology, vitreous PCR and measurement of local antibody production in aqueous humour.

Results

At presentation, BCVA in the LE was CF at 1 m. The patient described a progressive decline of vision in the LE since 6 months. Examination showed panuveitis with dense vitritis obscuring the fundus. IOP was 29 mmHg. The RE showed a chorioretinal scar located superonasally to the optic disc. Toxoplasma chorioretinitis was suspected, but serology was negative. PCR on a diagnostic vitreous biopsy was positive for T. gondii DNA and negative for Herpes viruses. Treatment with clindamycin and trimethoprim/sulfamethoxazole was initiated. The anti‐T. gondii serology remained negative. The Goldmann‐Witmer coefficient was positive. Also, efficacy of treatment was supportive of a diagnosis of ocular toxoplasmosis.

Conclusions

Although clinical presentation was suggestive of ocular toxoplasmosis, anti‐T. gondii serology remained negative. In cases with high clinical suspicion of ocular toxoplasmosis, superior diagnostic efficacy is achieved by a combination of serology, PCR techniques and GWC.
Lens status and macular pigment optical density in an old French population (MONTRACHET's study: Maculopathy, Optic Nerve, nuTRition, neurovAsCular and HEarT diseases)
Authors: Fleck O. , Koehrer P. , Alassane S. , Binquet C. , Bretillon L. , Acar N. , Tzourio C. , Bron A.M. , Creuzot C.
Published: September 2015

Purpose

The aim of our study was to compare macular pigment optical density between pkakic and pseudophakic eyes in a population‐based study in the elderly.

Methods

The hree city study (3C) included 9294 participants aged 65 years or more from three cities (Bordeaux, Dijon and Montpellier) in 1999. After a 10‐year follow‐up, Dijon's cohort had a complete ophthalmic examination in the MONTRACHET study; 1153 participants older than 75 years were included. Every participant had fundus photographs, macular pigment optical density measured by two‐wavelength autofluorescence. We retained only one eye for each subject, the one with the best image quality. An experimented investigator recorded macular pigment optical density at 0.5, 1, 2, and 6° eccentricity and classified images into one of the three patterns: no ring, ringlike or intermediate. Subjects with age‐related macular degeneration were excluded.

Results

We included 534 participants with good image quality. The age was 82.3 ± 3.7 years. There were 247 (46.3%) phakic and 287 (53.7%) pseudophakic. Mean macular pigment optical density was significantly higher in pseudophakic eyes at 0.5° (0.66 ± 0.25 vs 0.44 ± 0.23 density units) at 1° (0.56 ± 0.21 vs 0.39 ± 0.19 density units) at 2° (0.35 ± 0.14 vs 0.25 ± 0.13 density units) and at 6° (0.08 ± 0.04 vs 0.06 ± 0.04 density units), p < 0,0001. There were no significant differences of macular pigment pattern between whatever the lens status (p = 0.64).

Conclusions

Macular pigment optical density measurement by two‐wavelength autofluorescence is dependent on the lens status so that it should be taken into account when used in elderly where cataractarct surgery is common.
Subretinal drusenoid deposits in an elderly population with age‐related macular degeneration (MONTRACHET study: Maculopathy, Optic Nerve, nuTRition, neurovasCular and HEarT diseases)
Authors: Gabrielle P.H. , DeLazzer A. , Koehrer P. , Devilliers H. , Arnoult L. , Danielle S. , Binquet C. , Tzourio C. , Bron A.M. , Creuzot C.
Published: September 2015

Purpose

To determine the frequency of subretinal drusenoid deposits (SDD) in a French population of elderly patients presenting an age‐related macular degeneration (AMD) in the MONTRACHET study.

Methods

The three‐city study (3C) was a population‐based study including 9294 patients older than 65 years from three French cities (Dijon, Bordeaux and Montpellier) at baseline in 1999. After 10 years, the cohort of Dijon benefited from a complete ophthalmologic examination as part of the MONTRACHET study. Each patient underwent a non‐mydriatic retinophotography associated with a spectral‐domain OCT examination (SD‐OCT) of the macula. AMD classification was established according to the classification of the Multi‐Ethnic study of Atherosclerosis (MESA) for the retinophotography analysis and with the E3 CONSORTIUM classification for the SD‐OCT analysis. Patients with uninterpretable images of both eyes were excluded from statistical analysis.

Results

One thousand one hundred fifty three subjects were included. 62.7% were female and the mean age was 82.2 ± 3.8 years. With retinophotography analysis, the frequency of SDD was 1.9% (n = 38 eyes). With the SD‐OCT macular analysis, the frequency of SDD was 14.8% (n = 342). In patients presenting with SDD, 68.8% (n = 137) had a bilateral involvement. The relative risk (RR) of presenting SDD lesions in patients older than 80 years old was 2.6 (p < 0.001) and in women at 1.3 (p < 0.045). An interruption of the ellipsoide line and an alteration of the retinal pigment epithelium were statistically associated with the presence of SDD: RR = 5.9 (p < 0.001) and RR = 2.8 (p < 0.001), respectively. The average thickness of the subfoveal choroid was thinner in subjects presenting SDD (174.9 μm with SDD vs 209.8 μm without SDD, p < 0.001).

Conclusions

Few population‐based studies have established the frequency of SDD in an elderly population.
Clinical aspects of Autosomic Recessive Retinitis Pigmentosa Caused by USH2A Mutations in Consanguineous Tunisian Families
Authors: Chebil A. , Largueche l. , Kort F. , Hassairi A. , Habibi I. , Munier F. , El Matri l.
Published: September 2015

Purpose

To assess the clinical phenotype in consanguineous Tunisian families with non syndromic autosomic recessive retinitis Pigmentosa (arRP) caused by an USH2A mutation.

Methods

All accessible members of families were included and underwent full ophthalmic examination with best corrected Snellen visual acuity, kinetic visual field testing, fundus photography, optical coherence tomography and full field electroretinography. Haplotype analyses were used to test linkage in the families to 20 arRP loci, including ABCA4, LRAT, USH2A, RP29, CERKL, CNGA1, CNGB1, CRB1, EYS, RP28, MERTK, NR2E3, PDE6A, PDE6B, RGR, RHO, RLBP1, TULP1.

Results

Thirty‐four patients from five families were ascertained for the study. Twelve of the 34 members were clinically affected with arRP without hearing loss. Age range at baseline was 27–68 years (mean age was 42.5 years). For all affected members, night blindness appeared during the second decade. Visual acuity at baseline ranged from 20/40 to 20/32. Kinetic visual field was severely constricted. Fundus examination revealed typical RP changes with bone spicule‐shaped pigment deposits in the mid periphery along with atrophy of the retina, narrowing of the vessels and waxy optic discs. Tomograms showed a thinning and even loss the outer nuclear layer of the fovea. ERG was unrecordable in scotopic conditions and the cone responses were markedly hypovolted.

Conclusions

For these families, changes were typical of those that have been described in patients with moderate to severe forms of non syndromic recessive RP. Our findings support the need to consider possible involvement of USH2A not only in patients with Usher syndrome but also in patients with non syndromc arRP. Despite consanguinity, the presence of non‐homozygous mutants illustrates the complexity of molecular analysis.
Light‐Induced Retinopathy in neonatal rats: A new retinal degeneration slow model
Authors: Lachapelle P. , Polosa A. , Ait Igrine W. , Chevrolat L.A. , Bessaklia B.
Published: September 2015

Purpose

We showed that compared to adult rats (AR), the retina of neonatal rats (NR) is significantly more resistant to light damage. The purpose of this study was to determine the minimum exposure time that the neonatal retina requires to cause an adult‐like retinopathy at long term.

Methods

Starting at postnatal age 14 days (P14), NR were exposed to 10,000 lux for various lengths of time [1, 2, 3, 6, 9, 12 and 16 consecutive days (d)]. ERGs and retinal histology were performed at predetermined time points.

Results

Maximal effect was obtained after 3 days of exposure [50% control ONL thickness (p < .05) compared to 97% and 75% for 1 and 2 days] beyond which no further significant (p > 0.05) thinning of the ONL was observed. In contrast, a significant (p < 0.05) dose‐dependent decrease of all ERG components is observed immediately following the cessation of light exposure. Athough non‐significant structural damage could be documented immediately following 1 day of exposure, when re‐examined at P70, the photoreceptor loss was almost identical (p > 0.05) to the damage produced following a 14 day long exposure.

Conclusions

Our findings suggest that in NR, a one day long light exposure is sufficient to produce, at long term, a significant retinal degeneration that will significantly impact the retinal structure and function and that in spite of the fact that no measurable structural and functional retinal anomalies could be demonstrated immediately following this 1‐day exposure (i.e. at P15). Our light‐induced slow retinal degeneration model thus represents an attractive (especially its dose‐dependent nature) alternative (to other more genetic models) to study the pathophysiology of photoreceptor‐induced retinal degeneration and therapeutic strategies to counteract it. Funding: CIHR and FRQ‐S, under the frame of E‐Rare‐2, the ERA‐Net for Research on Rare Diseases.
Association of microRNA DGCR8 and XPO5 gene polymorphisms with the risk of primary open angle glaucoma occurrence
Authors: Szaflik J.P. , Majsterek I. , Molasy M. , Walczak A. , Przybylowska‐Sygut K. , Szymanek K. , Szaflik J.
Published: September 2015

Purpose

Many reports suggest the correlation between altered microRNA level and the pathogenesis of glaucoma. It is suspected that disruption in microRNA processing machinery may influence microRNAs action. The single nucleotide polymorphisms in genes DGCR8 and XPO5, which are involved in microRNA biogenesis may be the key factor in this process.

Methods

The blood samples of 80 patients affected by primary open angle glaucoma and 250 age matched controls were enrolled to this study. The DNA was isolated from the peripheral blood lymphocytes. The polymorphic variant frequencies of DGCR8 (rs 3757) and XPO5 (rs 1107) genes were determined using TaqMan® SNP Genotyping Assays.

Results

The statistical analysis revealed that the polymorphism of DGCR8 gene did not affect to the risk of primary open angle glaucoma. While, the TT genotype of XPO5 was found to be present mainly in patients not affected by glaucoma (P=0.049746).

Conclusions

In conclusion, it was evaluated that the TT genotype of XPO5 gene might have protective effect on the risk of primary open angle glaucoma. Therefore, future analysis of polymorphic variants of genes involved in microRNA biogenesis could be used for patient's diagnosis according to glaucoma occurence.
Optic coherence tomography in analyzes of optic nerve and macula in neuro‐ophthalmological patients
Authors: Costa L. , Vicente A. , Anjos R. , Santos A. , Ferreira J. , Amado D. , Cunha J.P.
Published: September 2015

Purpose

Historically, is made the distinction between optic neuropathies and macular diseases. Although, in our practical experience we believe that optic nerve (ON) damage, such as nerve edema or atrophy, at certain point will affect the macula. We have analyzed the scientific/structural impact of this clinical impression. The authors studied the correlation between Retinal Nerve Fiber Layer (RNFL) thickness and total macular/ganglionic cell layer (GCL) thicknesses using Optic Coherence Tomography (Heidelberg Spectralis®).

Methods

This retrospective study, evaluate 114 patients with the initial diagnose of optic neuropathy. First, was measured the average thickness of RNFL in 4 quadrants and the central macula and GCL thicknesses in 1º, 2º and 3º mm in fovea. We studied it in 3 groups: ON pathology (1º – n: 68), chiasmal compressive lesions (2º – n: 8) and retro‐chiasmal pathology (3º – n: 38). The layer's thickness was correlated in 3 groups.

Results

The 1º and 3º group had a significant impairment in all measures (RNFL, total central macula and GCL). There is a moderate correlation between RNFL and total central macular thicknesses (r: 0,354 and r: 0,314) and the correlation is strong comparing RNFL and GCL in 2º mm (r: 0,653 and r: 0.775) and 3º mm (r: 0,674 and r: 0, 839) thicknesses. Although, we didn't find any correlation between the RNFL and GCL thicknesses in 1º mm of fovea. In 2º group the results wasn't statistically significant, possible because the sample is short (n: 8).

Conclusions

In both groups, there is a correlation between the RNFL and total macula thicknesses. The impairment of total macula thickness is strongly correlated with the decreased thickness in GCL of foveae's 2º and 3º mm. This study shows in that pré‐chiasmal and retrochiasmal lesions, the impairment RNFL co‐exists with affection of macula thickness.
Systemic immunosuppression with mycophenolate mofetil to prevent corneal graft rejection after high risk penetrating keratoplasty: a 2‐year follow‐up study
Authors: Szaflik J.P. , Major J. , Izdebska J. , Lao M. , Szaflik J.
Published: September 2015

Purpose

The study aimed to evaluate the efficacy and safety of systemic immunosuppression with mycophenolate mofetil (MMF) to prevent corneal graft rejection after high risk penetrating keratoplasty.

Methods

One hundred ninety‐six consecutive patients who underwent high risk penetrating keratoplasty defined as the presence of deep vascularization in more than two quadrants, keratouveitis, emergency keratoplasties, and retransplantations were enrolled in the study. Ninety‐eight prospectively followed‐up patients were treated with MMF (with dose adjustment based on mycophenolic acid [MPA] serum concentration), and 98 patients were in the non‐MMF‐treated retrospectively assessed control group.

Results

During a mean of 24 months’ observation, immune reactions occurred in 8 cases (8%) and graft rejection with subsequent graft failure occurred in 3 cases (3%) in the MMF group. In the control group, graft rejection occurred in 76 cases (78%) and failure due to graft rejection occurred in 30 cases (31%). Kaplan‐Meier analysis showed that after a year 93% of the grafts in the MMF‐treated group and 47% in the control group showed no immune rejection (p < 0.01, log‐rank test). Cox regression analysis showed that MMF treatment decreased the risk of graft rejection 11 times (RR = 11, 95.0% CI 4.8–25, p < 0.0001). Among 98 MMF‐treated patients, 13 had gastric discomfort, 3 developed leucopenia, and 2 had anemia that resolved after MMF dose reduction.

Conclusions

MMF treatment after high risk penetrating keratoplasty is safe and reduces the incidence of immune graft rejection and graft failure. Side effects were rare and reversible in all but one case.
Impact of a pre‐cut on clear cornea incision architecture in cataract surgery
Authors: Draschl P. , Hirnschall N. , Doeller B. , Nguyen P.M. , Findl O.
Published: September 2015

Purpose

To assess the influence of a 600 μm corneal pre‐cut on incision architecture compared to a stab‐incision in cataract surgery.

Methods

This randomised bilateral study included patients scheduled for cataract surgery in both eyes without any other relevant ophthalmological co‐morbidities. Pre‐operatively, optical biometry and topography were performed (IOL Master 500 and the Atlas; both CZM AG). The first eye to be operated randomly received a corneal pre‐cut, or a single‐plane stab incision and the second eye received the other incision technique. In the pre‐cut group, a vertical cut was performed using a 600 μm guided blade. Incision size was 2.4 mm in both groups. Incision architecture was assessed intra‐operatively using a continuous intraoperative‐OCT device (ReScan 700, Carl Zeiss Meditec AG, Germany) after the incision, after I/A and after IOL implantation. Additionally, OCT measurements were assessed (Spectralis, Heidelberg Engineering, Germany) one hour, one week and one month post‐operatively. Additionally, autorefraction and subjective refraction were performed at the one‐month‐follow‐up.

Results

In total, 40 eyes of 20 patients were included. The intra‐operative measurements were possible in all cases and details of the morphology of the incision was visible in nearly all cases. Intra‐operative findings of endothelial and epithelial gaping, as well as Descemet detachment correlated well with post‐operative findings at the 1 hour follow‐up. Correlations between wound architecture and residual astigmatism were found to be weak.

Conclusions

Intra‐operative OCT measurements using spectral‐dmoain technology were found to be useful to observe and document the incision architecture during cataract surgery.
A minimally invasive approach to sub‐conjunctival outflow: 1 year results of an ab‐interno gelatin stent in combination with preoperative MMC injection for the treatment of primary open angle glaucoma
Authors: Stalmans I. , Fea A. , Reitsamer H. , Lavin C.
Published: September 2015

Purpose

To establish the safety and efficacy of an ab‐interno gelatin stent, as a stand‐alone procedure, in combination with a preoperative mitomycin C injection in reducing IOP and anti‐glaucoma medications in patients presenting with primary open angle glaucoma. Mean IOP, IOP change, reduction in medications, and safety were recorded in 70 subjects through 12 months.

Methods

In this prospective, non‐randomized, multi‐center evaluation, safety and efficacy parameters were evaluated. As a stand‐alone glaucoma procedure, a trans‐scleral gelatin stent is placed through a clear corneal incision using a preloaded injector with a 27 gauge needle. Once in place, the permanent gelatin implant is designed to connect the anterior chamber to the non‐dissected Tenon's and subconjunctival space, thereby creating diffuse dispersion of aqueous while bypassing potential outflow obstructions. Effectiveness was assessed by comparing medicated baseline IOP and glaucomatous medications to postoperative values through 12 months. Safety was assessed by assessing complications at routinely scheduled exams through 12 months.

Results

No major adverse events were reported, and 2 patients were converted to a tube shunt at 6 months. The mean preoperative (best medicated) IOP was 23.6 mmHg. The mean postoperative IOPs were: 13.3 mmHg (44% reduction) at 9 months, and 12.6 mmHg (47% reduction) at 12 months. From the preoperative mean of 3.5 (patients not washed out pre‐surgery), 9 months medications were reduced by 69% and at 12 months medications were reduced by 66%. No infection, migration or erosion occurred in any patients.

Conclusions

This “hybrid system”, combining a minimally invasive ab‐interno approach with a subconjunctival drainage, provided very satisfactory intra‐ocular pressure control after one year with an excellent safety profile.
Clinical Efficacy of an Oil‐based Lubricant Eye Drop in Dry Eye Patients with Lipid Deficiency
Authors: Labetoulle M. , Maurino V. , Ogundele A. , Rossi G.C.M. , Van der Meulen I. , Mrukwa‐Kominek E. , Galarreta D. , Boehringer D. , Baudouin C.
Published: September 2015

Purpose

To demonstrate the superior efficacy of a propylene glycol‐based, micro‐emulsion eye drop (SYSB; Systane® Balance) over Preservative‐Free 0.9% Saline (PFS) Solution in patients with lipid‐deficient dry eye.

Methods

This was a multicenter, observer masked, parallel‐design study (powered to show superiority). Subjects were randomized to receive SYSB or PFS QID for 35 days (Phase 1) and then as needed for 55 days (Phase 2). Eligible subjects had lipid‐deficient dry eye with meibomian gland dysfunction.

Results

A total of 279 patients were enrolled, 214 were randomized and 210 received the assigned study treatment. Baseline and demographic characteristics were similar between SYSB (n = 110) and PFS (n = 100) groups. At the end of the study, the mean change from baseline (±SEM) in TFBUT at Day 35 was 1.5 (0.2) and 0.5 (0.2) for SYSB and PFS respectively, representing a difference of 1.0 (0.3), significantly in favor of SYSB (p = 0.0011). Twenty one (19.1%) patients receiving SYSB and 8 (8.0%) patients receiving PFS experienced ocular treatment‐emergent AEs.

Conclusions

SYSB demonstrated superior efficacy to PFS in patients with lipid‐deficient dry eye and was well tolerated over the 90 day of treatment.