bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a thiol antioxidant in various cataract models
Authors: Ercal N. , Maddirala Y. , Carey J. , Tobwala S.
Published: September 2016

Cataracts are the most common cause of treatable blindness worldwide, and result from loss of transparency of the lens. It has been demonstrated that oxidative stress plays an important role in cataract etiopathogenesis. Oxidative damage reduces solubility of crystallins, the main structural proteins of the lens, resulting in opacification. Cells have evolved to combat this damage with antioxidant enzymes and low molecular weight antioxidants such as glutathione (GSH). Our primary objective was to evaluate a GSH prodrug for cataract treatment because current surgical options are neither economical nor safe. Recent literature indicates that thiol compounds like N‐acetylcysteine (NAC) may ameliorate the risk for cataracts. Our data indicates that the analog of NAC, N‐acetylcysteine amide (NACA), is more effective than NAC due to its higher bioavailability. Therefore, the present study was performed to determine whether NACA is also effective in sodium selenite and L‐buthionine‐(S,R)‐sulfoxamine (BSO)‐induced cataracts. In both models, NACA significantly decreased lens opacity and improved redox balance. The data suggest that NACA has the potential to significantly improve both patient health and the clinical treatment of cataracts.
Presence of proteinase inhibitor‐9 and granzyme B in healthy and pathological human corneas
Authors: Jirsova K. , Reinstein Merjava S. , Chudickova M. , Holan V.
Published: September 2016

Aim: To determine whether proteinase inhibitor‐9 (PI‐9) and granzyme B (GrB) are expressed in normal and pathological corneas.

Methods: Cryosections and endothelial, epithelial and conjunctival imprints of 12 human cadaverous corneo‐scleral discs and 13 pathological corneas (corneal melting and herpes virus keratitis) were used. Protein localization was examined using fluorescent and enzymatic immunohistochemistry, and mRNA expression was determined by qRT‐PCR.

Results: PI‐9 is predominantly expressed in the superficial and suprabasal epithelial layers of the cornea and conjunctiva. The corneal endothelium showed positivity in about 50% of cells. GrB was weakly present in healthy corneal epithelium and endothelium. The expression of both proteins was confirmed using qRT‐PCR. Besides altered expression in pathological corneas, strong positivity for PI‐9 and GrB was present in stromal infiltrates and some stromal cells that were positive for HLA‐DR and CD45. A marker typical of keratocytes, CD34, was decreased or totally absent in pathological infiltrates.

Conclusions: The changes of PI‐9 and GrB expression in pathological tissue indicate that these proteins participate in the corneal immune response during the inflammatory process.
Controversies between lymphoma and uveitis – the point of view of the ophthalmologist
Authors: Touitou V.
Published: September 2016

Diagnosis of primary vitreoretinal lymphoma (PVRL) is often challenging. One of the reasons of this challenge relies on the absence of specificity of the clinical signs (masquerade syndrome mimicking uveitis), the low number of cells in the vitreous, and its fragility leading to rapid degradation of the cells during or after vitrectomy. Anterior chamber cytokine dosage provides important informations regarding the screening of patients suspect of PVRL. It also proved to be a valuable tool to detect early relapses of patients during the follow‐up. New molecular diagnostic tools or new biological scores based on intraocular cytokine dosage have been developed to increase the yield of cytokine level measurement and help in the decision to propose diagnostic vitrectomy. It may also be helpful to evaluate the ocular response to treatment in order to tailor the therapeutic strategy for each patient.
Nrf2‐ and PGC‐1α‐deficient mice: A novel animal model for disturbed proteostasis and RPE degeneration
Authors: Kaarniranta K.
Published: September 2016

Impaired autophagic and proteasomal cleansing have been documented in aged retinal pigment epithelial (RPE) cells and age‐related macular degeneration (AMD). Both of them participate in the regulation of proteostasis in the retina. Nrf2 and PGC‐1 transcription factors mediate cellular defence against oxidative stress. We describe a novel Nrf2 and PGC‐1 knock‐out mouse model that induces RPE degeneration. Aged Nrf2/PGC1 knock‐out mice developed RPE degeneration, associated with upregulation of lipid peroxidation marker 4‐HNE, ubiquitin protein aggregates, selective autophagy markers Beclin‐1, SQSTM1/p62 and LC3. These changes were accompanied by impaired visual function as assessed by ERG. Our findings suggest that combined Nrf2 and PGC‐1 deficiency increases oxidative stress and protein aggregation, and affects autophagy in RPE. Nrf2 and PGC‐1 knock‐out mouse model provides a novel tool to study role of proteostasis in the degeneration of RPE and autophagy as therapy target in the prevention of age‐related cellular damages.
Problems in the diagnosis of intraocular lymphoma
Authors: Cassoux N.
Published: September 2016

Intraocular lymphoma means different entities. Primary vitreoretinal lymphoma can mascarade a chronic uveitis. This lymphoma is a subset of primary cerebral lymphoma. The disease is a B cell non hodgking lymphoma, aggressive, with a survival rate of less than 2 years after the occurrence of cerebral localization. Clinical examination, fluorescein angiography, OCT can be highly suggestive combined with resistance to corticosteroids. Diagnosis is based on cytokines levels (IL10/IL6) in aqueous humor or vitreous and diagnostic vitrectomy. Uveal localization of MALT lymphoma is rare and much more difficult to diagnose. This affection can mimic choroidal metastasis or a posterior scleritis or achromic uveal melanoma. The diagnosis can be suspected clinically (unpainfull choroidal thickening), hypoechogenic choroidal infiltration, typical aspect on ocular MRI. The diagnosis is based on episcleral, or choroidal biopsy.
Inflammation the good and the bad
Authors: Calonge M. , Herreras J.M. , Stern M.E.
Published: September 2016

Inflammation at the ocular surface is the most commonly encountered pathology in Ophthalmology, irrespective of age, gender, race or geographical area. Inflammation in the form of primary keratitis of any origin represents a real threat for visual loss. The commonest way though to eventually have a vision‐threatening corneal problem is as a consequence of an inflammatory process initiated in the eyelid margin (i.e. meibomitis), in the conjunctiva (i.e. conjunctivitis that eventually develop into kerato‐conjunctivitis) or Dry Eye Disease (DED).

DED serves as an example which explains the role of the lacrimal functional unit (LFU). The LFU, initially defined in 1988 and later expanded, comprises the ocular surface (cornea, conjunctiva, limbus, and tear film), all tear‐producing glands and cells (lacrimal glands, mucus producing system and Meibomian glands) and all the neuro‐hormonal controlling interactions. Thus, the LFU is a crucial concept to understand how inflammation in a tissue not belonging to the optic system (i.e. eyelids or conjunctiva) may end up causing visual disability by involving the visual axis in the cornea. Examples of inflammation in the LFU as well as their deleterious consequences will be presented.
The firsts in ophthalmic echography
Authors: Kivelä T.
Published: September 2016

Clinical ophthalmic ultrasound began with the A‐scan. The most recognized early pioneer in this field was a Finnish ophthalmologist Dr. Arvo Oksala (1920–1993), later Professor and Chair of the Turku University Eye Clinic. He began to explore ultrasound with the physicist Antti Lehtinen in 1957, a year after the first paper on this topic written by Mundt and Hughes. Oksala and Lehtinen used an industrial ultrasound from a large metal company. The same year they published their first results: detection of non‐metallic foreign bodies, retinal detachments and tumors in the eye. Further work allowed differentiation between a subretinal haemorrhage and a choroidal tumor. Together these two investigators published 23 papers on ophthalmic ultrasound within the first 5 years. From 1968 to 1971, prof. Oksala was the President of the Societas Internationalis pro Diagnostica Ultrasonica in Ophthalmologia (SIDUO) that had been founded in 1964, and in 1971 he became its Honorary Member and in 1984 he received its Pioneer Award. The second recipient of the Pioneer Award in 1984 was Dr. Gilbert Baum (1922–2002) from the Albert Einstein College of Medicine, New York. He was the primary developer of the B‐scan technique to examine the human eye.
When and why proteomic approach is needed?
Authors: Uusitalo H.
Published: September 2016

Ocular surfaces are delicate structures of the anterior segment of the eye protected, nourished and lubricated by tear fluid. The system has it's own regulatory mechanisms. Ocular surfaces are exposed environmental factors, topical ophthalmic drugs and affected by various ocular and systemic diseases. Inflammation and wound healing are vital processes involved in the defense mechanisms of the human body and pathogenesis of many eye diseases. It is also one of the most important factors in many ocular surgeries e.g. corneal, refractive and glaucoma surgery. It consists of many overlapping processes like inflammation, fibroblast activation, ECM production and remodeling of the ECM and there are many mechanisms and mediators involved in it. Tear proteomics is a powerful tool to diagnose and detect mechanisms and drugable targets of the ophthalmic and systemic diseases. This course is focusing in the proteomics and biomarkers of the tears and anterior surface of the eye in relation these diseases. The idea is to give practical instructions and advice when and how proteomic analysis is relevant to perform in research.
OCT‐A in neovascular age related macular degeneration
Authors: Lumbroso B.
Published: September 2016

The author reports regression and progression of CNV after treatment. Normal cycle lasts about 70 days. Abnormal recurrences are reported.
Adaptive optics – basic optical principles
Authors: Irsch K.
Published: September 2016

Adaptive Optics (AO) refers to a technique to compensate for distortions caused by optical aberrations in the media between the camera and the object being imaged. It was originally developed for use in astronomical telescopes to compensate for optical distortions induced by the inhomogeneous earth atmosphere. It has since evolved to become a powerful clinical tool in ophthalmology. In the eye, a ‘wavefront sensor’ (aberrometer) measures the distortion of incoming light induced by inhomogeneities within the cornea and crystalline lens, which is then ‘undistorted’ via reflection by a deformable mirror. AO thus enables imaging of the human retina with unprecedented resolution in vivo, such as revealing individual photoreceptors or the walls of blood vessels. One should note that AO by itself does not provide an image; rather an AO subsystem is incorporated into an existing imaging device. AO subsystems have thus far been successfully integrated into three ophthalmic imaging devices: fundus cameras, scanning laser ophthalmoscopes, and the OCT device. This lecture will introduce the basic principles of AO, illustrate its value with state‐of‐the‐art clinical examples, and discuss potential future applications in ophthalmology.
Treatment of hard exudates in CSME in PDR using Micropulse mode
Authors: Saksonov S. , Teslenko A. , Vitovska O.
Published: September 2016

Hard exudates are common in Diabetic Maculopathy. Quite often, it overlies the central part of the fovea causing severe visual loss. Some of the exudates may resorb while anti‐VEGF treating is performed or while normalizing diabetic control. Some of exudates remain in the fovea preventing visual function increase. Focal conventional laser coagulation as a DME treatment can speed up the proses of lipid resorption but it is associated with potential iatrogenic visual loss, especially in fovea region. Micropulse mode suggested to be safe and macular‐friendly treatment. This mode of laser energy delivery, if accurately titrated, do not left any signs of laser burns seen no on FA no on OCT. Micropulse 577 nm laser influence on lipids and surrounding RPE can stimulate hard exudates resorption and macular clearance. This potentially can be useful in case of visual loss due to hard exudates persisting in macular and especially foveal region.
Sclear embedded iol
Authors: Pappas G.
Published: September 2016

Aim

To evaluate if the embedding of an Intraocular lens in the sclera is an easy, safe and beneficial for the patients with aphakia surgical procedure.

Methods

We examined the notes of 42 patients who underwent surgery for aphakia and they had an scleral embedded IOL. All procedures performed by the same surgeon under the same settings at Venizeleio Hospital of Heraklion.

Results

Final visual acuity, stability, difficulty of the procedure, astigmatism produced, complications and patients satisfaction were recorded. We will also present videos with different techniques to stabilize an IOL in the sclera.

Conclusion

We will produce evidence that scleral embedded IOLs is a safe and easy procedure which produces very good results.
OCT angiography: evaluation of the macular perfusion
Authors: Pournaras C.
Published: September 2016

OCT angiography (OCT‐A) as a new non‐invasive imaging technology that enables the monitoring of the macular circulation. OCT‐A has a better rate of detection either of the macular capillaries plexus or the distribution of the macular cystoid spaces, than using fluoserseine angiography (FA), allowing the evaluation, of either superficial or deep perifoveal capillary layers.

During the evolution of the ischemic micro‐angiopathies, the appearance of the capillaries ischemic areas, the micro‐aneurysms, the capillaries segments dilations as well as the distributions and the evolution of the capillaries collaterals, can be monitored. The evaluation of the deep capillary plexus, appears to be more severely affected than the superficial capillary plexus, resulting to deep non perfused capillaries areas. The perifoveal capillary arcade disruption, observed on OCT‐A in eyes with retinal vein occlusions, was correlated with the presence of retinal peripheral ischemia.

OCT‐A progressively became a useful imaging modality in the evaluation and management of macular hemodynamic changes observed during the evolution of the retinal ischemic micro‐angiopathies allowing to evaluate the treatment effects on the capillary circulation.
Retinal toxicity following intra‐vitreal injections of melphalan
Authors: Munier F. , Gaillard M.C. , Stathopoulos C. , Beck‐Popovic M.
Published: September 2016

We report a retinal toxicity grading system as observed in a cohort of 110 retinoblastoma eyes treated by intra‐vitreal injections of melphalan to control vitreous seeding.

By definition grade 1 and 2 correspond to a salt and pepper retinopathy anterior to the equator of 2 quadrants and 2 quadrants respectively; grade 3 any extension behind the equator, grade 4 extension involving the macula and grade 5 diffuse retinopathy with optic nerve atrophy. In our series grade 4 and 5 toxicity could be avoided in 100% of the cases. We conclude that our injection technique is safe enough to prevent severe sight‐threatening toxicity.
Optimisation of RPE65 gene delivery for treatment of Leber congenital amaurosis patients
Authors: Georgiadis T.
Published: September 2016

Virally‐mediated gene therapy to treat inherited retinal disorders has proven to be safe and well tolerated through a number of phase I/II clinical trials. RPE65 deficiency is the cause of Leber congenital amaurosis type 2 and clinical trials, including our own, using recombinant AAV serotype 2 to deliver the human RPE65 gene into the patients’ RPE cells have shown moderate levels of efficacy. We aim to increase the potency and persistence of treatment effect by employing a range of optimisations to the recombinant AAV gene therapy vector. We assessed the preclinical efficacy of a novel gene therapy vector for RPE65 gene replacement in vitro and in vivo following optimisation of the viral serotype, transgene promoter and transgene sequence. We observed a 300‐fold increase in efficacy in a mouse model lacking Rpe65 when compared to the original AAV2 gene therapy vector. We aim to bring this vector forward for a new phase I/II clinical trial in patients with LCA2.
Light‐Adjustable Lens: A non‐invasive approach to adjust remaining refractive errors after cataract surgery
Authors: Hengerer F. , Conrad‐Hengerer I.
Published: September 2016

Yet, in spite of improvements in preoperative lens power calculation, many patients are in need of spectacle correction to achieve emmetropia and/or an optimal distance vision after cataract surgery.

One possibility to reduce this is to have the ability to adjust residual spherical and astigmatic errors postoperatively in a predictable and non‐invasive way.

Calhoun Vision's LAL is based upon the inclusion of a proprietary photoreactive silicone macromer within a silicone polymer matrix. Selective irradiation of the implanted LAL by targeted dosages of UV light (365 nm) produces modifications in the lens curvature resulting in a predictable spherical and/or cylindrical power change postoperatively. After achieving the desired refractive outcome, the LAL is irradiated to polymerize remaining photosensitive macromers and prevent additional change in lens power.

The purpose of this presentation will explain the LAL technology, as well as treatment options and expected future applications.
Cases
Authors: Hamel C.
Published: September 2016

Several cases of retinal dystrophies or optic neuropathies will be presented and the genotype phenotype correlation will be discussed.
Molecular mechanisms of immune privilege of the cornea – as a potential of Immune checkpoint therapy
Authors: Hori J.
Published: September 2016

The eye, which is endowed with immune privilege, is a rare organ that permits analysis of the regulatory mechanisms for inflammation in organs. In particular, studies using animal models of corneal transplantation have revealed the molecular mechanisms of corneal cell‐mediated immune privilege. Several molecules expressed in the cornea induce apoptosis of T cells and delete effector T cells in the cornea. Constitutive expression of Fas ligand and programed death ligand 1 (PD‐L1, B7‐H1) on corneal endothelial cells induce apoptosis of effector T cells via Fas and PD‐1, respectively. B7‐H3 is also constitutively expressed in the corneal endothelium and iris cilialy body and plays a role in the induction of anterior chamber associated immune deviation (ACAID). We have also found that constitutive expression of glucocorticoid‐induced TNF receptor family‐related protein ligand (GITRL) in the cornea mediates local expansion of CD25+CD4+T regulatory cells and suppresses conventional effector T cell function via GITR. These differently functioning molecules contribute to the local immune suppressive microenvironment in the cornea. The study for the roles of B7RP‐1 and Galectine‐9 expressed in the cornea are also introduced.
Relevance of the posterior corneal surface for detection of early keratoconus and post‐LASIK keratectasia
Authors: Wylegala E.
Published: September 2016

We present different display techniques for the anterior and posterior corneal surface such as axial or tangential power map, pachymetry map, height or enhanced height map or results of mathematical decomposition techniques such as Fourier or Zernike maps. We discuss the advantage and drawbacks of those maps for detection and evaluation of keratoconus severity. The variety of the output maps of different instruments such as the Orbscan IIz or TMS‐5, the Pentacam and the Casia‐1000 are shown and discussed in detail. Additional information of new parameters such as ratio of anterior to posterior surface curvature are introduced and the diagnostic value for evaluation of early forms of keratoconus will be tailored‐out.
Corneal tomographical changes following crosslinking
Authors: Zsolt Nagy Z.
Published: September 2016

We show the potential of Scheimpflug‐based tomographic indices for indication and postoperative monitoring of corneal collagen cross‐linking (CXL) performed in progressive keratoconus. The value of tomographic indices for validation of corneal flattening after CXL in the long term is being discussed. In addition, we will focus on keratoconus index (KI) and index of height asymmetry (IHA) provided by the Pentacam, which have been established in clinical routine for monitoring of the long‐term stabilization effect of CXL on the corneal architecture.
Surgical aspects of toric lens implantation and complication management
Authors: Barraquer R.I.
Published: September 2016

In this contribution we would like to give an overview in the spectrum of pseudophakic and phakic toric lenses currently on the market. The audience will be guided how to select the proper lens for the indivual patient. Perioperative marking, surgical technique, intraoperative positioning and validation of lens alignment will be addressed in detail. Techniques are shown how to prevent postoperative rotation, decentration or tilt of the lens. In a last step, we will demonstrate how and when to re‐position or re‐align (in axis) the pseudophakic or phakic toric lens implant in case of decentration, tilt or axis rotation. The add‐on value of modern intraoperative assistance / guidance functions for proper positioning of the toric lens implant or re‐positioning in terms of complication management is shown.
OCT angiography in Retinal Angiomatous Proliferation
Authors: Soubrane G.
Published: September 2016

Retinal Angiomatous Proliferations (RAP) have been described initially on ophthalmoscopy as a chorioretinal anastomosis in a late stage of AMD and of MACTEL. Fluorescein angiography evidences a dilated perimacular retinal capillary with late profuse leakage of dye. ICG angiography is instrumental to detect Retinal Angiomatous Proliferation at an early stage of development, especially in AMD. A localized effraction of the RPE on OCT evidences the communication between retinal and choroidal circulation with massive fluid infiltration of the retina. The basic idea of OCT angiography was to separate moving objects from static tissue. This new technic is suitable for 3D segmentation and reconstruction of the retinal capillary layers. There are a number of questions that OCTA may help to solve. What is the participation of the deep retinal capillary plexus to the clinically visible RAP? Is the portion perpendicular to the retinal plane a capillary of the intermediate layer? Does RAP involving only the deep retinal plexus exist? Is the PED part of the process? OCTA may be of great value to the understanding of the pathophysiology of the early stage of the disorder and may offer noninvasive monitoring of the disease progression and activity, aiding for each treatment assessment.
Learning curves for strabismus surgery in two ophthalmologists
Authors: Moosang K.
Published: September 2016

Purpose

To identify the average turning point by comparing the learning curves of two surgeons learningto perform strabismus surgery.

Methods

Patients who underwent procedures to correctexotropia between January 2010 and December 2014 followed for at least 3 months were retrospectivelyassessed. The first 70 patients on whom each of two ophthalmologists (A and B) performed surgery to treatstrabismus were divided into 7 cohorts comprising 10 patients each based on the chronological order ofthe surgery. Factors, including patient age, preoperative angle of deviation, operative time, and success orfailure of the operation, were compared between the two surgeons. Learning curves were calculated basedon changes in operative time and operation success rate. Operation success was determined by measuringthe angle of deviation at a distance of 5 m 3 months after the operation.

Results

A turning point wasobserved after 40 cases for Surgeon A and 50 cases for Surgeon B based on the operative time learning curve. No turning point was observed in the operation success rate learning curve based on the absence of a specifictrend. Success rate by cohort was not significantly different between the two surgeons (p > 0.05). Surgeon B had a significantly longer mean operative time than Surgeon A (p = 0.045).

Conclusions

Approximately 50 cases are required for an ophthalmologist to reach a turning point in strabismus surgery. This outcomecan be used as a guideline when training surgeons to perform strabismus surgery.
Correlation between intraocular pressure and bottle heights during vitrectomy
Authors: Moosang K.
Published: September 2016

Purpose

To determine the correlation between intraocular pressure (IOP) and the bottle heights during vitrectomy usingTONO‐PEN®XL applanation tonometer and Icare® PRO rebound tonometer.

Methods

Twenty‐four eyes of 24 patients who underwent 23‐gauge sutureless vitrectomy were evaluated. After complete vitrectomy, the IOP was gradually increased by lifting the irrigation bottle height from the trocar insertion site by 40, 45, 50, and 55 cm. The distance between the floor and patient's eye was consistent in all cases (105.5 cm). Before the removal of 23‐gauge microcannulas, IOP was measured five times using each of the two methods, Tono‐Pen®XL and Icare® PRO.

Results

The mean IOPs were 8.25 ± 0.35 mmHg for TONO‐PEN®XL and 8.96 ± 0.32 mmHg for Icare® PRO at 40 cm bottleheight. As the bottle height increased, the differences in IOP was also increased, 10.71 ± 0.37 mmHg at 45 cm, 14.18 ± 0.39 mmHg at 50 cm and 17.93 ± 0.40 mmHg at 55 cm for TONO‐PEN®XL and 11.48 ± 0.31 mmHg at 45 cm, 14.64 ± 0.31 mmHg at 50 cm and 18.13 ± 0.38 mmHg at 55 cm for Icare® PRO. In TONO‐PEN®XL, the linear equation was Y = 0.65 X − 18.108 (R2 = 0.794, p = 0.000) and the quadratic equation was Y = 0.013 X2 − 0.569 X + 10.446 (R2 = 0.801, p = 0.000). In Icare® PRO, the linearequation was Y = 0.614 X − 15.842 (R2 = 0.820, p = 0.000) and the quadratic equation was Y = 0.010 X2 − 0.306 X + 5.688 (R2 = 0.825, p = 0.000). The results show correlation of the quadratic equation was stronger than the linear equation in bothtonometers.

Conclusions

The differences of IOP were positively correlated with bottle heights in the form of a curve during vitrectomy.Therefore, the patients who are susceptible to retina or optic nerve damage during vitrectomy should be closely monitored.
Patterned macular dystrophy as the first sign of maternally‐inherited diabetes and deafness (MIDD)
Authors: Esteban O. , Ascaso J. , Peiro B. , Martinez M. , Almenara C. , Perez I.
Published: September 2016

Purpose

Maternally inherited diabetes and deafness (MIDD) is a mitochondrial disorder characterized by the mutation of the mitocondrial DNA (mtDNA) at the 3,243 position. The prevalence accounts for 0.5–2.8% of all cases of diabetes. In more than 80% of cases it is associated with a good prognosis bilateral pattern macular dystrophy. We show the importance of ocular examination to diagnose MIDD.

Methods

We present a case report of MIDD.

Results

A 42 year‐old man was referred for a nonspecific blurred vision in both eyes since two months ago. Diabetes mellitus type 1 and migraine had been diagnosed at the age of 20. The patient wore a hearing aid because he had bilateral sensorineural hearing loss. Best‐corrected visual acuity (BCVA) was 20/20 in both eyes. Fundus examination revealed bilateral hyperpigmented lesions surrounding the macula combined with depigmented areas of retinal pigment epithelium (RPE). Spectral‐domain optical coherence tomography (SD‐OCT) showed hyperreflective dome‐shaped lesions corresponding to a hyperpigmented areas that seemed to originate from the RPE. Fundus autofluorescence (FAF) was characterized by a diffuse speckled appearance of the macula with decreased FAF signal in areas of RPE atrophy and irregular increased FAF signal between the areas of RPE atrophy. Results from automated static perimetry and magnetic resonance imaging (MRI) of the brain was unremarkable. We suspected MIDD and genetic testing of mtDNA confirmed a point mutation at the locus 3,243 with 85% heteroplasmy.

Conclusions

Ophthalmologists need to be aware in patients presenting patterned dystrophies of the RPE in the context of diabetes or deafness. It is possible that there are other family members with undiagnosed disorders related to mitochondrial mutation who would benefit from ophthalmic evaluation, auditory testing and screening for diabetes mellitus.
The long‐term effect of intravitreal bevacizumab injection in central serous chorioretinopathy
Authors: Mun S.J. , Choi C. , Jeong J.G.
Published: September 2016

Purpose

To study the effect of intravitreal bevacizumab injection in patients with idiopathic central serous chorioretinopathy.

Methods

We had performed retrospective review on the patients who had been diagnosed as idiopathic central serous chorioretinopathy and had regular follow‐up for at least 12 months from the first injection, either undergone intravitreal bevacizumab injection (107 eyes of 100 patients) or observed without injection (46 eyes of 40 patients). Changes in the visual acuity and the serous neurosensory retinal and retinal pigment epithelium detachment were evaluated through the results of best corrected visual acuity and optical coherence tomography measured at initial presentation, after 1, 3, 6, 9 and 12 months of the first injection.

Results

87 males and 13 females with mean age of 45.4 ± 7.6 years were recruited in the intravitreal bevacizumab injection (IVB) group, and 34 males and 6 females with mean age of 47.2 ± 9.8 years were recruited in the observation group. There was significant difference in the mean duration of retinal detachment to disappear between the IVB group (2.5 ± 0.2 months) and the observation group (4.3 ± 0.7 months). There was no significant difference in the best corrected visual acuity and the central macular thickness after 12 months follow‐up between the IVB group and the observation group.

Conclusions

Intravitreal bevacizumab injection was more effective and faster treatment for resolution of sensory retinal detachment than observation during the 12 months of consecutive follow‐up. Therefore, intravitreal bevacizumab injection can be considered as a significant and safe treatment modality for central serous chorioretinopathy when the patients need prompt visual improvement, such as depending on the morbid eye or requiring binocular vision for occupational cause.
Long‐term results of up to 6 years of mitomycin‐c augmented non‐penetrating deep sclerectomy for pseudoexfoliation glaucoma
Authors: Yazgan S. , Ates H. , Guven Yilmaz S. , Celik T.
Published: September 2016

Purpose

To evaluate the long‐term efficacy of mitomycin‐c augmented non‐penetrating deep sclerectomy (NPDS) in patients with pseudoexfoliation glaucoma.

Methods

In this retrospective single‐center study a total of 72 eyes of 63 patients with pseudoexfoliation glaucoma were included. Perioperative and postoperative complications, additional procedures including laser goniopuncture, needling, selective laser trabeculoplasty (SLT) were recorded. Complete and partial surgical success were defined as an intraocular pressure (IOP) <18 mmHg and IOP between 18‐21 mmHg with or without medications, respectively.

Results

The follow‐up time was 26.40 ± 20.06 months (range 1–80). Preoperative and postoperative IOP were 26.53 ± 7.71 and 18.69 ± 6.58 mmHg, respectively (p < 0.001). Preoperative and postoperative last visit mean RNFL were 61.82 ± 17.54 and 62.55 ± 17.39 micrometers, respectively (p = 0.081). The success rate for the IOP of 18–21 and <18 after first year were 88 and 87%, respectively, and after second years were 88 and 71%, respectively. The success rate for the IOP < 18 after 3 years was 60%, after 4 years was 55%, after 5 years was 49%, and after 6 years was 37%. The success of NPDS is not affected by age, gender, preoperative application of SLT, cup/disc ratio, preoperative IOP and medication numbers (p > 0.05). Hypotony was observed in 19 eyes. There were no serious complications including hypotony induced maculopathy, choroidal detachment, blebitis, and endophthalmitis.

Conclusions

Mitomycin‐c augmented deep sclerectomy is almost as effective as trabeculectomy in long‐term management of intraocular pressure in patients with pseudoexfoliative glaucoma in addition with lower complication rates with its well‐known excellent safety profile.
Normal values for amplitude of accommodation among a population of high school students in Iran
Authors: Yekta A.A. , Hashemi H. , Khabazkhoob M. , Forouzesh S. , Ostadimoghaddam H. , Heravian J. , Azimi A. , Nabovati P. , Yazdani N. , Yekta R.
Published: September 2016

Purpose

To determine the normal values for amplitude of accommodation in a population of high school students in Iran.

Methods

In a cross‐sectional study, sampling was done from high school students in Kermanshah, Iran through a multi‐stage cluster sampling method. Eye examinations included ophthalmoscopy, refraction, visual acuity, amplitude of accommodation (AA) and cover test. Amplitude of accommodation was measured with Donder's push‐up method using Royal Air Force (RAF) near point rule. Examinations were performed on‐site at each sampled high school.

Results

Of the 1,070 selected students, 901 were included in the study. Mean age of the subjects was 14.4 ± 1.7 years and mean AA was 11.53 ± 3.02 diopters (D) (range, 5–28.5D). Mean AA was 15.33D in 11‐year‐olds and significantly decreased with age until it reached 10.40D in the 17‐year‐old age group. Mean AA in boys and girls were 10.09 ± 2.48D and 11.65 ± 3.03D, respectively. Based on the multiple linear regression model, younger age (coef = −0.774) and female gender (coef = 1.060) significantly associated with AA magnitude.

Conclusions

The results of this study indicated that the normal values of AA magnitude is lower in Iranian teenagers than that calculated with the Hofstetter's formula. It is important to take account of this point when making diagnostic and therapeutic decision.
The prevalence of refractive errors among underserved rural areas in Iran
Authors: Yekta A.A. , Hashemi H. , Khabazkhoob M. , Ostadimoghaddam H. , Malekifar A. , Nabovati P.
Published: September 2016

Purpose

To determine the prevalence of myopia and hyperopia and related factors in underserved rural areas in Iran.

Methods

In this cross‐sectional study, two rural regions of north and south in Iran were randomly selected through a multi‐stage cluster sampling. After selecting samples, participants had non‐cycloplegic refraction, cycloplegic refraction (<20 years old age) and measurement of uncorrected and corrected visual acuity.

Results

Of the 3,851 invitees participated, 3,271 of them were examined in this study. The prevalence of myopia and hyperopia was 23% (95%CI: 19.6–26.4) and 21.59% (95% CI: 17.92–25.26), respectively in total sample. In those subjects ≤20 years of age, the prevalence of myopia and hyperopia based on cycloplegic refraction was 5.69% (95% CI: 4.42–6.96) and 3.25% (95% CI: 1.49–5.02), respectively. In over 20‐year‐olds subjects, these values were 29.47% (95% CI: 26.26–32.68) and 28.44% (95% CI: 24.40–32.49), respectively. Multiple logistic regression models indicted that myopia prevalence significantly correlated with age, education level, cataracts, and region of residence, and hyperopia prevalence correlated with age and region of residence.

Conclusions

The results of this study indicated that the prevalence of hyperopia and myopia were lower compared to the other studies in urban areas of Iran, but overall, hyperopia had a high prevalence in this study and other Iranian investigations. The prevalence of refractive errors significantly differs between northern and southern rural regions of Iran.
How to make better, safer and easier endothelial controls of long‐term stored corneas with Specular Microscopy?
Authors: Garcin T. , Bernard A. , Calyaka E. , Herbepin P. , Hor G. , He Z. , Gain P. , Thuret G.
Published: September 2016

Purpose

Unlike short term cold storage in which corneas remain clear and thin, long‐term organ cultured corneas cannot be rated by specular microscopy (SM) because of the storage‐induced stromal edema and deep endothelial folds. Aim: To present SM of corneas stored in our patented bioreactor (BR).

Methods

Human corneas were stored in our BR, with a commercial medium containing 2% foetal calf serum at 31°C. The BR restored the intraocular pressure while renewing the medium. By preventing from edema and folding, it improved endothelial cell (EC) viability in the long‐term. Two windows allowed easy multimodal corneal imaging. A new type of SM was developed (CMOS camera, ×10 objective, collimated LED, micrometric stage). For each cornea, 5 images (centre + 4 quadrants) were acquired at day 2 and 28 exactly in the same area, and treated with a custom‐made software and ImageJ to determine the EC density (ECD).

Results

All corneas remained thin and clear, allowing SM without deconditioning nor deswelling in specific media. The field of view of 935 × 748 μm was 3 times greater than those of both commercial eyebank SM. At D2 and 28, despite shallow residual endothelial folds, large areas of ECs were clearly visualized. ECD could be determined on most images easily. Epithelial cells could also be observed.

Conclusions

The BR combines the advantages of cold storage (closed system) and organ culture (long‐term). SM allowed endothelial assessment of long term‐stored corneas in our closed BR: it could make endothelial controls safer, easier and increase the cell count reliability especially thanks to a wider field of view.
Transpalpebral near‐infrared LED transillumination for anteriorly located intraocular tumors imaging
Authors: Zadorozhnyy O. , Korol A. , Kustryn T. , Nasinnyk I. , Pasyechnikova N.
Published: September 2016

Purpose

To study the possibilities of transpalpebral near‐infrared LED transillumination for intraocular tumors imaging.

Methods

This study was conducted on 35 people (35 eyes) with intraocular tumors of the ciliary body and iris. In all cases a color photo of the anterior eye segment, transpalpebral near‐infrared LED transillumination, ultrasound examination were made.

The device for transillumination consists of compact wireless near‐infrared LED‐probe, monochrome camera able to capture video and images in the near‐infrared range, slit lamp adaptor and a computer with software. For transpalpebral transillumination were used near‐infrared light sources with a wavelength of 940 nm. Examination was performed without local anesthesia.

Results

In all cases structures of the ciliary body were registered by transpalpebral near‐infrared LED transillumination. Monochrome images of the ciliary body structures of good diagnostic quality were captured during the infrared transillumination of the eye in all cases.

In patients with intraocular tumors transpalpebral near‐infrared transillumination made it possible to visualize ciliary body structures and tumor shadows on sclera and to outline their borders. In all cases anteriorly located intraocular tumor shadow was detected and tumor localization in relation to the ciliary body structures was estimated.

Conclusions

Transpalpebral near‐infrared LED transillumination provides imaging of the ciliary body and accurately estimates the projection of its structures to the sclera. Transpalpebral near‐infrared transillumination helps to visualize intraocular tumors and to determine their projection to the sclera and can be used for diagnostic purposes and during destruction of the tumor.
Experimental study of intraocular temperature distribution in the rabbit under various environmental conditions
Authors: Anatychuk L. , Pasyechnikova N. , Zadorozhnyy O. , Kobylianskyi R. , Nazaretyan R. , Myrnenko V.
Published: September 2016

Purpose

To study ocular temperature distribution in the rabbit in dependence on ambient temperature in experiment.

Methods

To measure ocular temperature a thermoelectric device was developed; the latter consisted of a temperature recording microprocessor module, polytetrafluoroethylene microprobes (diameter – 0.6 mm) with thermocouple sensors, computer software for visualization and registration of temperature parameters in real time. The device allows measurements in the temperature range from 10 to 120°C with ± 0.05°C accuracy. The experiment was conducted on 21 rabbits (42 eyes) which were divided into 3 groups. Group 1 consisted of 11 rabbits (22 eyes) ocular temperature measurements of which were made at ambient temperature with the range of 23–24.5°C while Group 2 and 3 consisted of 5 rabbits (10 eyes) each with ambient temperatures with the range of 14.5–15.5°C and 30–32°C, respectively.

Results

The lowest temperature was noted on the outer corneal surface, and then it increased gradually in the inner segments of the eye and reached its maximum in the retina and subtenon space. A temperature gradient between the outer corneal surface and the retina was 3.23, 4.68 and 3.85°C in Group I, II and III, respectively. No significant difference between temperatures in the left and right eyes of the experimental animals was observed. Data obtained in this study show the lowest correlation between temperatures of the anterior corneal surface and retina. The high correlation was observed between temperatures of inferior conjunctival fornix and retina.

Conclusions

Raising and lowering of the ambient temperature increases the temperature gradient between the external and internal structures of the rabbit eye.
Corneal perforation during laser assisted blepharoplasty
Authors: Lee S. , Moon D. , Kang H.
Published: September 2016

Purpose

Blepharoplasty is one of the most commonly performed oculoplastic prodecures. Laser‐assisted blepharoplasty has been performed for several years with some advantages but also it has many complications. We describe two cases of corneal perforation developed during laser assisted blepharoplasty.

Methods

Two patients were referred to our clinic for complaints about decreased visual acuity. They presented with decreased vision, pain and photophobia of their left eye after laser‐assisted blepharoplasty. Both patients had a visual acuity of 20/400 in the affected eye and showed intraocular pressure as low as 5 mmHg. Slit‐lamp examination revealed Seidel‐positive corneal perforation surrounding corneal opacity with corneal folding. The anterior chamber was shallow with mild intraocular inflammation. Application of cyanoacrylate glue to the perforations was done and therapeutic lenses were replaced. Patients were treated with topical antibiotics and artificial tears four times a day.

Results

One week after the injury, the IOP was elevated within normal range and intact epithelium without leaking was confirmed by slit‐lamp examination. One month later, the visual acuity was regained and subepithelial and stromal corneal opacity was found without inflammation or leaking. And anterior segment optical coherence tomography revealed deep stromal corneal opacity.

Conclusions

Corneal perforation during laser blepharoplasty seems probable with eyelid perforation by the laser beam. So during surgery, metal corneal protectors were placed, but corneal perforation could be developed because a Bell's phenomenon with elevation of the cornea superior to the corneal shields. Therefore, to prevent eyelid and corneal perforation, degree of laser power and exposure must be checked carefully.
Clinical manifestations of parasellar mass
Authors: Cho M.
Published: September 2016

Purpose

This study was purposed to make comparative analysis on various clinical findings of parasellar mass which was diagnosed by ophthalmologist.

Methods

For 51 patients diagnosed as parasellar mass (23 males, 28 females), we reviewed vision, clinical symptoms, visual fields, imaging study.

Results

At the first visit, the patient's most common chief complain was decreased visual acuity or blurred vision (41 patients) and other symptoms include visual field defect (7 patients) and diplopia (3 patients). Corrected visual acuity was varied from 1.0 to <0.01. Variable visual field defect pattern was noted (normal to complete defect). But usually bilateral temporal hemianopia was the most common finding in visual field test. In some cases, diplopia was the only symptom of mass.

Conclusions

When a patient complains visual field defects and shows unilateral or bilateral temporal visual field defect in visual field test, it was easy to suspect parasellar mass. But no visual field defect in patient with tumor is also exist. So in patients who complain unexplained visual discomfort with normal visual acuity or normal visual filed, we must suspect tumor and consider neurologic image study in order to rule out the tumor.
Racial differences in the extracellular matrix of the lamina cribrosa and the peripapillary sclera
Authors: Kim Y. , Park H.Y.L.
Published: September 2016

Purpose

To investigate the major extracellular matrix components (ECM) of the lamina cribrosa (LC) and peripapillary sclera (PPS) in human donor eyes and to determine the differences between Korean and Caucasian eyes.

Methods

Posterior segment tissues obtained from nonpathologic, age and axial length‐matched 24 Caucasian and 48 Korean donors were used. Protein and mRNA expression of major ECM components were assessed by quantitative polymerase chain reaction, immunohistochemitry, and light and electron microscopy. Biomechanical analysis was performed by obtaining stress‐strain curves of the PPS and LC.

Results

Collagen and elastin were significantly more abundant in Korean eyes as measured by quantitative polymerase chain reaction and immunohistochemical staining. ECM modulating enzyme, lysyl oxidase like‐2 expression was elevated in the PPS and LC of Korean eyes. The width of PPS around the LC region was larger in Korean eyes compared to Caucasian eyes. Collagen fibers had a greater preferred directionality and smaller fibril diameter in the PPS region in Korean eyes observed by electron microscopy. The mechanical properties of the LC and PPS produced greater strain in Korean eyes measured by strain‐stress relationship. Increased strain was more pronounced in the PPS region in Korean eyes.

Conclusions

The LC and PPS are more easily deformed by similar pressures in Korean eyes compared to Caucasian eyes. Racial differences in the ECM composition and microscopic architecture may contribute to the greater deformation of the LC and PPS and this could contribute to the susceptibility for glaucoma under normal intraocular pressure range in Korean eyes.
Characteristics of retinal vein occlusion (RVO) patients with macular edema who lasted remission more than 6 months after single injection of intravitreal bevacizumab
Authors: Lee M.Y.
Published: September 2016

Purpose

To evaluate clinical characteristics of retinal veiin occlusion (RVO) patients with macular edema who lasted remission more than 6 months after single injection of intravitreal bevacizumab.

Methods

We retrospectively reviewed sixty eight eyes of 67 patients who have macular edema due to RVO. Group 1 included eyes lasted remission more than 6 months after single injection of intravitreal bevacizumab. Group 2 included eyes lasted macular edema even after two injections of intravitreal bevacizumab and needed intravitreal triamcinolone or ozurdex. Clinical characteristics including initial visual acuity, initial CMT (Central macular thickness) were compared between two groups.

Results

44, 24, eyes were included in group 1, 2 respectively. Group 1 included 36 eyes of BRVO and 8 eyes of CRVO. Group 2 included 11 eyes of BRVO and 13 eyes of CRVO. Initial visual acuity was better in group 1 than group 2 (p = 0.023). Initial CMT was higher in group 2 (p = 0.006). Prevalence rate of diabetes were higher in group 2 (p = 0.002).

Conclusions

Our results suggest that weather the patient have a diabetes and initial visual acuity and CMT can be helpful in predicting the treatment response after intravitreal bevacizumab injection in these patients.