bluuebunny/crossref_metadata_2025 huggingface dataset:
The genetic pathophysiology of dominant optic atrophy
Authors: Lenaers G. , Charif M. , Amati‐Bonneau P. , Chao de la Barca J. , Procaccio V. , Gerber S. , Kaplan J. , Roubertie A. , Meunier I. , Reynier P. , Rozet J.M. , Hamel C. , Bonneau D.
Published: September 2016

Inherited Optic Neuropathies are blinding diseases related to mitochondrial dysfunctions jeopardizing retinal ganglion cell (RGC) survival. There are two main forms: the Leber Hereditary Optic Neuropathy (LHON) related to mutations in the mitochondrial genome, and the Kjer dominant optic atrophy (DOA) related to mutations in nuclear genes.

Since the initial discovery of the OPA1 gene in 2000 as the major gene causing DOA, the use of WES and re‐sequencing chips disclosed many novel genes responsible for DOA. Interestingly, most of them are involved in mitochondrial dynamics, suggesting that the equilibrium between fission and fusion is crucial for RGC physiology. In this respect, using fluorescence and electron microscopy, we showed that the structure of mitochondria is drastically different according to the myelination status of RGC axons, possibly correlating anterograde and retrograde mitochondrial transport to mitochondrial dynamics. Further metabolomics analysis of an Opa1 mouse model identified specific signatures in the plasma and optic nerve, emphasizing the consequence of mitochondrial shape on metabolic pathways, and revealing biomarkers of the disease.
How to tackle these difficult cases
Authors: Vandewalle E.
Published: September 2016

Real life cases will be presented. Their intraocular pressure is not sufficient controlled with topical eye drops alone. Each of the panel member will give their advice how to tackle those cases. This should give the audience guidance how to use the different new techniques in their clinical practice.
Transduction of corneal endothelial cells with AAV2 vectors
Authors: Gruenert A.
Published: September 2016

This talk deals with transduction of corneal endothelial cells with different kinds of AAV2 vectors. Data of a human corneal endothelial cell line as well as of human donor cornea endothelium will be presented. Furthermore, ways of optimizing transduction efficiency and feasibility of AAV2‐mediated gene therapy will be discussed.
Central keratoconus and bilateral asymmetry of keratoconus
Authors: Langenbucher A. , Szentmary N. , Eppig T.
Published: September 2016

Today, different measurement techniques are used in clinical routine for detection and monitoring of keratoconus and progression of the disease. In this talk we describe topo‐ and tomographical paramenters for centered or decentered corneal ectasia in terms of central and classical keratoconus. We demonstrate how to evaluate progression of keratoconus and side asymmetry in bilateral keratoconus. With the use of modern tomographical instruments, ophthalmologists are able to differentiate entities such as central or classical keratoconus.
How to calculate pseudophakic and phakic toric implants?
Authors: Langenbucher A. , Szentmary N. , Eppig T.
Published: September 2016

Different calculation modalities for pseudophakic and phakic toric lens implants are discussed: what are the benefits and drawbacks of formula‐based and raytracing techniques? How could we set‐up our own calculation sheet in a standard PC software package? A step‐by‐step calculation is shown in a clinical example. When do we need customized software? How can we evaluate residual refractive error after axis displacement of the toric lens implant? A list of commercial and non‐commercial online calculators for toric lenses is shown.
Evidence for apoptosis in the lens after in vivo exposure to ultraviolet radiation
Authors: Talebizadeh N. , Yu Z. , Kronschläger M. , Galichanin K. , Söderberg P.
Published: September 2016

The eye is exposed to ultraviolet radiation (UVR) in daylight. Epidemiological studies suggest a dose dependent association between UVR and cataract development. Experimental data confirm that UVR induces damage in the lens epithelium and trigger apoptosis. The time delay between exposure and onset of apoptosis in the lens varies depending on the dosage of UVR. The higher the in vivo UVR dose, the faster the onset of apoptosis and the development of lens opacification. Apoptotic events in the epithelium precede macroscopic cataractogenesis. Lens epithelium is a primary target for UVR exposure. Immunohistochemistry shows that the expression of apoptotic markers, caspase 3 and p53, increase in the lens epithelium after radiation. TUNEL‐labeling visualizes the transient increase of apoptosis products after UVR. After higher doses of UVR, apoptosis features are observed 1 h after radiation. Transmission electron microscopy shows the multi‐layered stack of epithelial cells, membrane infolds, nuclear fragmentation and chromatin condensation, phagosomes and apoptotic bodies, phagocytosis of apoptotic bodies and pyknosis. UVR causes apoptosis in the lens epithelial cells. The onset of apoptosis depends on the radiation dose.
Keratokonus – the killing application for most contact lenses is the prototypical job for sclerals
Authors: Nau C. , Schornack M.
Published: September 2016

Use of blown glass shells, the precursors of scleral lenses, for management of keratoconus was first described in the late 1800's. Keratoconus has been a leading indication for scleral lenses throughout the history of the devices, both prior to and following the introduction of rigid gas permeable scleral lenses in 1983. Scleral lenses offer several benefits compared to corneal lenses for primary corneal ectasia. They do not require alignment with a highly irregular corneal surface, and are instead supported by the conjunctival tissue overlying the relatively regular sclera. They offer excellent comfort and lens stability. Scleral lenses do not touch the cornea, so may be less likely to lead to corneal epitheliopathy or scarring. Unlike corneal transplantation, scleral lenses can immediately provide improvement in the quality of vision, and are considerably less invasive. Furthermore, scleral lenses may provide improved ocular comfort for patients with concurrent keratoconus and atopic disease of the lids and adnexa. This presentation will review and summarize visual and ocular outcomes of scleral lens therapy for management of exposure keratopathy at the Mayo Clinic.
Agonistic β2 receptor autoantibodies in ocular hypertension and open‐angle glaucoma
Authors: Hohberger B.
Published: September 2016

Pathogenesis of glaucoma, a leading cause of blindness, is widely unknown till now. An involvement of immunological processes is discussed. Agonistic autoantibodies against β2‐adrenergic receptor autoantibodies (β2‐AABs) were found in a high rate of 69% in sera of glaucoma suspects and 78% in glaucoma patients, yet not in normals. β2‐AABs were of subclass type IgG3, interacting with the second extracellular loop of β2‐adrenergic receptor. Immunadsorption of AABs in 5 patients with primary open‐angle glaucoma resulted in a transient reduction of intraocular pressure. As β2‐AABs are involved in the regulation of aqueous humor dynamics and show a strong correlation with retinal capillary flow, a potential influence of β2‐AABs on retinal microcirculation and involvement in the pathogenesis of glaucoma is suggested.
Optical imaging properties of multifocal IOL
Authors: Millán M.S. , Vega F. , Alba‐Bueno F. , Ríos‐López I.
Published: September 2016

An increasing demand of spectacle independence after cataract surgery or clear lens extraction has greatly stimulated the development of multifocal intraocular lenses (MIOLs). Optical design has played an essential role in this progress. Based on the principle of simultaneous vision, MIOLs overcome the loss of accommodation by providing at least two primary powers intended for distance and near vision. Diffraction‐based MIOLs have proved better optical performance than multizonal refractive MIOLs and accommodative IOLs. Some new designs of diffractive MIOLs attempt to direct light either to an intermediate focus location or to an extended focal segment for an improved visual acuity at intermediate distances. Although the patient primarily perceives the focused image, they can also experience disturbing visual phenomena, such as halos and glare. The optical imaging performance of MIOLs, as referred to some quality metrics, is assessed using in‐vitro as well as in‐vivo testing methods. This work reviews the objective imaging quality of a variety of MIOLs measured in an optical bench and compares the experimental results with those obtained in the clinical practice.
Use of OPA in ocular blood flow studies
Authors: Willekens K. , Van Keer K. , Vandewalle E. , Molenberghs G. , Pinto L.A. , Barbosa‐Breda J. , Stalmans I.
Published: September 2016

The ocular pulse amplitude (OPA) measured by dynamic contour tonometry is one of the vascular parameters often used in glaucoma research. Probably measuring the pressure wave caused by the shifting volume of blood inside the eye in accordance to the cardiac cycle, this measurement gives information about extra‐ as well as intraocular hemodynamics. The Leuven Eye Study (LES) is one of the largest studies investigating ocular blood flow in glaucoma combining several non‐invasive investigations like color Doppler imaging, enhanced depth imaging optical coherence tomography, oximetry and OPA. Three groups (primary open angle glaucoma – POAG, normal tension glaucoma ‐ NTG and healthy subjects) were selected from the database of the LES. The relationship between the OPA, choroidal thickness and retrobulbar blood flow was assessed and results were compared with recent findings in the literature.
Controversies between how to handle uveitis and glaucoma. The point of view of the uveitis specialist
Authors: Kestelyn P.
Published: September 2016

Uveitic glaucoma is often associated with high pressures and may damage the optic nerve faster than other forms of glaucoma. Therefore, early diagnosis and adequate treatment are essential. The key to successful treatment is an understanding of the pathogenetic mechanisms (secondary open‐angle, secondary angle closure, forward rotation of the ciliary body, etc.) Moreover, one should realize that combined mechanisms are more common in uveitic glaucoma than in other forms of glaucoma.

Steroid‐induced pressure rise is common in uveitis patients and should be dealt with in a proper way: do not cut on steroids, but treat the glaucoma agressively. In those patients who have chronic uveitis and are steroid responders, surgery is a better option than medical treatment. Tubes are preferred over trabeculectomy with mitomycin in eyes with chronic inflammation.

Contrary to some recommendations, prostaglandins should not be avoided in uveitis patients for fear of cystoid mcular oedema. They should be avoided however in uveitis of herpetic origin.
Applied genetic testing in ocular tumors
Authors: Coupland S.
Published: September 2016

Increasingly molecular pathology tests are being applied to ocular specimens, to aid the establishment of definitive diagnoses, to predict therapeutic responses, and to determine the prognoses in ocular oncology patients. This presentation will provide an overview of the most commonly used molecular tests in ocular oncology, outlining their strengths and weaknesses, and indicating when they are of appropriate use. The speaker will also provide recommendations for sample transport to the processing laboratory, in order to achieve best results in these often very small samples, and will explain how the reports are to be interpreted – when combined with morphological and immunophenotypical studies – for subsequent patient management.
Update on epidemiological evidence for an association between sun exposure and cataract
Authors: Wegener A. , Meyer L.
Published: September 2016

There is currently substantial evidence for an epidemiological association between long‐term daily sub‐threshold exposure of the eye to mid wavelength ultraviolet radiation (UVR) from the sun and cortical cataract. Initial observation of a potential association between exposure of the eye to UVR from the sun were limited to case reports in regions with abundant sun hrs. In the late 1900 cataract incidence was correlated to meterological recordings of intense exposure of UVR direct to the surface of the earth and lack of use use of spectacles. It was subsequently pointed out that the ocular exposure to UVR from the sun substantially depends on exposure of the eye to indirect UVR from the sun rather than direct, indicating that only meterological observations is not sufficient to establish an epidemiological association. This triggered attempts to make personal dose estimations based on both meterological observations and concomitant interviews of use of sun‐glasses, hats and behavior. An appropriate cross‐sectional case–control study with personal dose estimation and graded cataract measurement demonstrated an association between cortical cataract and intermediate UVR‐dose comparing Chesapeake Bay bay fishermen with mainland inhabitants in the same area in USA. A similar approach was later used in Australia and found a similar association. A Japanese group, using detailed monitoring of the distribution of light scattering in the lens demonstrated an association between incidence of lower nasal opacity in the lens and latitude spanning from the equator to Island. Later, a large number of epidemiological studies have confirmed an association between exposure to intermediate UVR and cortical cataract.
The view of the EGS and the subspecialty exam
Authors: Sunaric Megevand G.
Published: September 2016

This part of the SIS will deal with the question: ‘how do we define a glaucoma specialist today’.

Since the creation in 1978, the EGS has been strongly involved in teaching and training glaucoma in Europe and worldwide. In order to implement the EGS mission statement for education: ‘Promotion of evidence‐based practice and life‐long learning through systematic, extensive and renewable training’ the EGS is constantly organizing and updating a large number of teaching‐learning activities; it hosts since 2007 a yearly 2‐day European Residents Glaucoma Course, gives travel support for 1‐year glaucoma fellowship program in leading European university hospitals, publishes and updates since 1998 the Terminology and Guidelines for Glaucoma, holds a biannual Glaucoma Congress and runs EBO‐accredited courses. While the EGS has not the authority to impose fellowship‐programs to different countries or institutions in Europe, it can set clear requirements and standards of knowledge that define a ‘glaucoma specialist’. Testing this knowledge by the EGS‐EBO subspecialty exam and providing the FEBOS diploma represents a logical continuation of the creation of sustainable education and glaucoma care within Europe.
Confocal microscopy findings in corneal dytrophies
Authors: Smedowski A. , Wylegala E.
Published: September 2016

Corneal confocal microscopy in vivo is a diagnostic method that uses 670 nm laser beam to visualize the structures of the cornea with an accuracy of 1 μm and visualization of single cells with 63× magnification. Proper diagnosis of corneal diseases is often difficult. The use of confocal microscopy for the in vivo analysis of the microarchitecture of the cornea can provide rapid and highly specific differentiation of corneal pathologies.

The aim of the course is to acquaint participants with the method – corneal confocal microscopy in vivo and to present its utility in diagnosis and management of corneal dystrophies. Course consists of description of epithelial‐basal membrane dystrophies, Bowman membrane dystrophies, stromal and endothelial dystrophies with respect to their typical histological features, differential diagnosis, evaluation and qualification for surgery and follow‐up with detection of possible recurrences and post‐surgical complications.
Retinal Oximetry and blood flow
Authors: Hudson C. , Rose K. , Kulasekara S. , Cheng R. , Wong B.
Published: September 2016

The retina has highest metabolic demand compared to any other tissue in the human body and regulation of the retinal blood flow, blood oxygen saturation (SO2) and thereby oxygen delivery (DO2) are crucial to preserve vision and function. The study reports inner retinal DO2 and consumption (VO2) during controlled and stable normoxia, hyperoxia and hypoxia in humans. Eleven subjects underwent measurement of total retinal blood flow (TRBF) and retinal blood oxygen saturation (SO2) using prototype methodologies of Doppler Spectral Domain Optical Coherence Tomography and Metabolic Hyperspectral Camera, respectively. TRBF decreased significantly (p = 0.010) from 43.17 μl/min (+12.7) to 36.23 μl/min (+4.6) during hyperoxia, conversely, TRBF increased significantly (p < 0.008) to 52.89 μl/min (+10.9) from baseline during hypoxia. The average inner retinal O2 delivery during normoxia was 8.48 mlO2/100 g/min and inner retinal consumption was 3.64 mlO2/100 g/min and these values changed during provocation to maintain a stable DO2 and VO2. Change in TRBF and SO2 reflect metabolic autoregulatory function of the retinal tissue indicating that retinal blood flow and SO2 are able to precisely compensate for changes in inspired oxygen.
Molecular genetics in ocular epidemiology
Authors: Den Hollander A.
Published: September 2016

Common ocular diseases, such age‐related macular degeneration (AMD), are often caused by a combination of genetic and environmental factors. Genome‐wide association studies (GWAS) can shed light on the disease pathogenesis and provide clues for treatment. GWAS have identified genetic variants at more than 40 genomic regions to be involved in AMD. The currently known risk factors have a moderate‐to‐high predictive value for AMD, with an area‐under‐the‐curve of 0.8–0.9. Based on the genes that have been identified, we now know that three main pathways are involved in AMD pathogenesis: the complement system, the lipid metabolism and the extracellular matrix. Higher levels of systemic complement activation have been detected in AMD patients compared to controls, which can partly be attributed to genetic variants in the complement system. Several antibodies targeting the complement pathway are currently in the clinical trial phase for AMD. In conclusion, AMD is a successful example of how genetic studies can lead to the development of new treatments, and such studies will also be valuable for understanding the disease mechanisms of other common ocular diseases.
Animal models for ocular gene therapies
Authors: Arsenijevic Y. , Kostic C.
Published: September 2016

Disease‐causing variants of a large number of genes trigger inherited retinal degeneration leading to photoreceptor loss. Because cones are essential for daylight and central vision such as reading, mobility and face recognition, the presentation will focus on a variety of animal models for cone diseases. The pertinence of using these models to reveal genotype/phenotype correlations and to evaluate new therapeutic strategies will bediscussed. Interestingly, several large animal models recapitulate human diseases and can serve as a strong base to study the disease biology and to assess the scale‐up of new therapies. Examples of innovative approaches will be presented such as lentiviral‐based transgenesis in pigs. The models we will discuss permit to explore common mechanisms existing between different species and to highlight the pathways that may be specific to primates, including human.
Age‐related changes of cystatin C and effects on protein turnover in RPE cells
Authors: Paraoan L.
Published: September 2016

Essential functions of the retinal pigment epithelium (RPE) rely on specific proteolysis processes that require efficient regulation both intra‐ and extracellularly. One of the most potent regulators of proteolysis, the cysteine proteinase inhibitor cystatin C, is among the top 2% abundantly expressed genes by RPE. The secretion profile of cystatin C in RPE cells suggests a role in relation to maintaining the structure and function of Bruch's membrane/choroid. Variant B cystatin C is associated with increased risk of developing exudative age‐related macular degeneration (AMD) and presents leader sequence‐related altered intracellular trafficking, leading to reduced efficiency of processing through the secretory pathway. The abundance of cystatin C is reduced with ageing in the macula region of the RPE/choroid and cystatin C expression and secretion are significantly decreased in response to the accumulation of advanced glycation end‐products (AGEs). Together the data point out to a likely role for the wild type cystatin C in regulating the proteolytic homeostasis in the retina/choroid, which is declining with age and the decline is accelerated in homozygous carriers of AMD‐associated variant B.
Lifetime Study in mice: 24 months follow up after low doses of ionizing radiation with Scheimpflug imaging and OCT
Authors: Dalke C. , Rößler U. , Neff F. , Greiter M. , Gomolka M. , Hornhardt S. , Garrett L. , Kunze S. , Unger K. , Rosemann M. , Kempf S.J. , Azimzadeh O. , Wurst W. , Aubele M. , Zitzelsberger H. , Hölter S.M. , Tapio S. , Hoeschen C. , Kulka U. , Atkinson M. , Graw J.
Published: September 2016

At the adult age of 10 weeks male and female hybrid mice (C57BL/6 × C3H F1) were acutely whole‐body irradiated with low doses of ionising radiation (0, 0.063, 0.125 and 0.5 Gy) using a 60Co source. Over the following 24 months the mice were examined monthly for lens opacities by Scheimpflug imaging and every four months for retinal effects by OCT (optical coherence tomography). To estimate the contribution of genetic effects, virtually healthy mice heterozygous for an Ercc2 mutation were compared to wild‐type mice of the same strain background.

Additional groups of mice were sacrificed at various time points (4 and 24 h, 12, 18 and 24 months after irradiation) to investigate the underlying mechanisms of radiation‐induced effects on the eye and other organs. Histological and immunohistochemical analysis of the eyes are done.

Even at the highest dose of 0.5 Gy, analysis of the Scheimpflug examinations in irradiated wild‐type mice did not show significant differences in lens opacity compared to the unirradiated control group or the heterozygous mutants up to 24 months after irradiation. OCT data showed a reduction of the retinal thickness in irradiated heterozygous mutants, but not in wild‐type mice.
Regulating gene expression towards solving ocular surface diseases
Authors: Moore T. , Atkinson S. , Maurizi E. , Schiroli D. , Mairs L. , Christie K. , McLean I. , Allen E. , Pedrioli D.L. , Moore J. , Nesbit A.
Published: September 2016

Treatment of genetic eye disease poses significant medical and surgical challenges. We used a bioluminescent corneal reporter gene mouse model to assess efficacy and potency of a number of gene therapy approaches for corneal dystrophy. Various modalities were assessed for delivery of short interfering RNA (siRNA) targeting one of five mutant alleles present in the corneal bioluminescent mouse model enabling assessment of topical, subconjunctival and intrastromal delivery. Potent and sustained in vivo gene silencing >50% for up to 7 days was observed. This siRNA therapy only provides a transient silencing of the mutant allele, however, Type II Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR‐associated nuclease 9 (Cas9) holds great promise to provide ‘one off’ permanent gene editing. Gene‐specific cleavage of the mutant allele, with DNA repair and frameshift mutations resulted in mutant allele knockout sustained over many weeks. Optimal delivery of our CRISPR system to all layers of the cornea was assessed. This gene editing treatment offers exciting potential for translation into clinical treatment for a wide range of genetic diseases of the eye.
Controversies between lymphoma and uveitis – the point of view of the neuro‐oncologist
Authors: Touitou V. , Houillier C.
Published: September 2016

It has been shown that elevated level of IL10 with an IL10/IL6 ratio greater than 1 is very evocative of Primary Vitreo Retinal Lymphoma (PVRL). However, other causes of uveitis can be accompanied with increased IL10 level, and on the other hand some pateints with PVRL may be characterized by normal levels of intraocular IL10 ((intraocular T‐cell lymphoma or subretinal lymphoma without vitreous infiltration). Currently, the decision to treat the patients cannot be based on the sole basis of increased IL10 level in aqueous humor. Systemic chemotherapy or radiation therapy can be associated with severe side effects, especially in elderly patients. In patients with a negative cytological analysis of the vietrous, the role of increased intraocular cytokines in the aqueous humor for the therapeutic decision is very debated and is currently not sufficient in order to confirm the diagnostic. However, the role of intraocular cytokine dosage in the aqueous humor to follow‐patients during and after treatment has to be discussed.
What limits normal visual performance in the dark?
Authors: Fitzke F.W.
Published: September 2016

When patients describe difficulties in seeing in the dark we need to consider whether this refers to rod photoreceptor dysfunction and how this affects our vision. How can we reliably measure scotopic (rod mediated night) vision and what functional consequences would we expect from losses of scotopic vision? Are visual losses attributable to cell death of rod photoreceptors or to dysfunction of the Retinal Pigment Epithelium (RPE)? Since there are no rods in the central fovea we must consider the spatial distribution of rods, the contribution of the RPE and other factors on difficulties in seeing in the dark.
Mistakes in the diagnosis of children intraocular tumors
Authors: Cassoux N.
Published: September 2016

The first mistake is to consider normal a unilateral strabismus or a leucocoria in a baby or a child and don't performed a dilated funduscopy. Retinoblastoma is the first ocular tumor in childhood and often late diagnosed because professionals (pediatrician, GPs, or ophthalmologists) didn't believe parents that notice a white reflect in their kid's pupil. Clinically, on dilated fundus, one or more white tumors can be associated with exudative retinal detachment or subretinal or vitreal seedings. The disease can be unilateral or bilateral. Several forms can be more difficult to diagnosed (infiltrative retinoblastoma, inflammatory cellulitis associated with advanced retinoblastoma, neovascular glaucoma with buphtalmia associated with advanced retinoblastoma. The more frequent disorder that can stimulate retinoblastoma is coats disease especially in advanced forms, persistent hyperplastic primary vitreous, and other rare tumors (medulloepitheloima, leiomyoma or melanoma). The proper diagnosis can be done in referral centers with team trained to deal with these diseases and sometime with the help of US echography or MRI of the eye. In case of suspicion of ocular tumor, the child must be referred in emergency in a specialized center.
Intravitreal chemotherapy for intraocular lymphomas
Authors: Cassoux N.
Published: September 2016

The treatment of intra ocular lymphoma with methotrexate is currently used since a decade. The local treatment is effective but often suspensive. The most common dosage is 400 microg/0.1 ml twice a week for 4 weeks then once a week for 4 weeks then once a month. This treatment is not easy to monitor since there is no measurable mass into the eye. One option is to monitor the tumor response with the help of IL10 dosage in the anterior chamber regularly. The IL10 decrease is very well correlated to the decrease of tumoral cells into the eye. The controversy that remains is when to use this local treatment? Is it sufficient if the lymphoma is restricted to the eye? Or should we need to treat systemically the ocular involvement before the occurrence of cerebral tumor? If the patient is treated systemically but relapse only in the eye, the local treatment is a good option. To date there is no evidence based studies demonstrating that ocular lymphoma is better treated systemically or locally and this point remains controversial.
Fine needle aspiration biospy or not?
Authors: Cassoux N.
Published: September 2016

Thanks to the dramatic progress in the field of ophthalmic surgery (mini invasive surgery), sampling an eye is more and more used in ocular tumors. A biopsy can be done via a transcleral or transvitreal route to diagnosed difficult cases especially achromic ocular tumors. However, fine needle aspiration biopsy or biopsy with a vitrector handpiece is more and more used to stratified uveal melanoma patients into low risk, intermediate risk, and high risk of metastasis using genomic (using a‐CGA or MLPA) or gene expression profile (GEP). The biopsy can be done before irradiation or the last day of irradiation or after irradiation (during an endoresection of the tumor). Large series have shown that the procedure is safe and efficient. The main issue is to deal with the results since we don't have to date an effective treatment for metastatic patients. However, tumor prognostication is important to develop because there is a learning curve for surgeon and to establish a good collaboration with the histopathology or genetic laboratories and new molecules are in the pipe (targeted therapies, immunotherapies) to treat metastatic patients in a close future.
Treat and extend versus PRN in diabetic retinopathy
Authors: Pournaras C.
Published: September 2016

Vascular endothelial growth factor (VEGF) plays a key role in the pathogenesis of the neo‐vascular age related macular degeneration (nAMD) and the ischemic retinal microangiopathies. Targeting VEGF in retinal diseases became an effective therapeutic option.

To optimize the benefit of risk ratio and cost effectiveness of anti‐VEGF agents, a number of flexible dosing strategies have being used in clinical practice.

The treat and extend regiment (TE) is defined as an individualized proactive dosing regimen usually initiated by monthly injections until a maximal clinical response is observed, followed by increasing intervals between injections (and evaluations) depending on the disease activity. It appears as an effective approach to tailoring the dosing regimen and for reducing treatment visits and injections, compared with fixed monthly dosing or monthly visits with optical coherence tomography (PRN).

The individualised anti‐VEGF TE regimen can improve and stabilise patient outcomes in diabetic macular oedema and nAMD. The potential to reduce healthcare resource burden incurred from fixed monitoring requirements, will be of benefit to health care, in the management of retinal diseases.
OCT Angio imaging of the pathologic changes in PDR
Authors: Glittenberg C.
Published: September 2016

The presentation will give the audience an overview over swept source OCT angiography and it′s applications in imaging proliferative and non‐proliferative diabetic retinopathy. The presentation will give a basic understanding of how motion contrast is used to visualize erythrocyte movement inside vessels as well as how using exactly this method leads to reflection and shadowing artifacts that can be misleading during diagnosis. We will show how new methods of temporal despeckling and flicker noise reduction can increase the visibility of subtle vessel changes that are pivotal in diagnosing and monitoring diabetic retinopathy. Additionally we will show how three‐dimensional ray‐traced rendering of the OCT‐angiographic data sets increase the structural understanding of diabetic neovascularizations, micro‐aneurysms, and retinal ischemias. The presentation will also include a discussion on the benefits of using swept source technology as well as a 1,050 nm wavelength in order to perform superior OCT angiographic examinations.
How to keep your work published?
Authors: Kivelä T.
Published: September 2016

If you want to keep your papers published, please avoid at least the following five mortal academic sins. (i) Do not plagiarize either the work of someone else or your previous writings. Be original to succeed. (ii) Do not revert to sloppy, let alone dishonest research practice. Eventually you will be discovered. (iii) Do not manipulate any images. There are people specialized to discover and report this type of a problem. (iv) Do not meddle with authorship. Everyone involved is to be included and should know about it. (v) Do not fake peer review. Yes, it does happen. These and other great ways of getting your paper pulled out of the literature will be highlighted in this talk using recent life examples, several of them from the field of ophthalmic research. Moreover, the audience will be introduced to useful tools related to post‐publication review, an important emerging trend that you can be part of. Learn what problems are best to know before they will strike you either through your own action or through that of one of your co‐authors.
Results for the Synergy trial: use of iStent in open angle glaucoma
Authors: Garcia‐Feijoo J. , Voskanyan L. , Martinez de la Casa J.M.
Published: September 2016

iStent aim to improve access of aqueous to Schlemm's canal and to the collector channels. IStent surgery can be performed on topical and intracamerular anaesthesia. The G1 Glaukos® trabecular micro‐bypass is L‐shaped titanium implant. iStent inject is conic and smaller than the G1and also made of titanium. The Stents are pre‐loaded in the injector designed to deliver the stents into the Schlemm′s canal. For iStent inject Voskanyan et al (2014) conducted a multicenter study on 99 POAG patients uncontrolled on two or more topical medications. 66% of subjects achieved IOP ≤ 18 mmHg at 12 months without medication, and 81% of subjects achieved Month 12 IOP ≤ 18 mmHg with either a single medication or no medication. Mean baseline washout IOP values decreased by 10.2 mmHg or 39.7% from 26.3 (SD 3.5) mmHg to 15.7 (SD 3.7) mmHg at Month 12. Mean IOP at 12 months was 14.7 (SD 3.1) mmHg in subjects not using ocular hypotensive medications. The best indications for the trabecular stent are cases with primary open angle, pigmentary or PSX glaucoma. The ideal candidate for this surgery is a patient with early or moderate glaucoma, patients with compliance issues, bad tolerance to medical treatment or reluctant towards a chronic daily treatment.
The ocular surface anatomy under cover – its interaction with a scleral lens
Authors: Knop E. , Knop N.
Published: September 2016

Scleral Lenses represent the historic type of a large rigid ‘foreign body’ that rests on the sclera, vaults over the cornea thus keeps the main parts of the ocular surface ‘under cover’. However, in contrast to ordinary large soft CL that are in direct contact with cornea and conjunctiva, scleral lenses are in most parts physically separated from the ocular surface epithelia. Their lens vault forms a dome‐like region over the ocular surface. It is filled by tear fluid and thereby allows to constantly moisten the cornea within its own physiological bathing solution. This special ‘tear bandage’ has various advantages on ocular physiology and its natural healing capacities, that may be explained by a plethora of metabolically active ingredients in the tears. Modern lens materials and designs make sclerals an easy to use and versatile tool for daily practise with ideal wearing comfort and medical safety. Therefore, sclerals are a highly underestimated medical tool in an ‘under cover mission’ at the ocular surface.
Tear fluid biomarkers, conjunctival inflammation in glaucoma
Authors: Uusitalo H.
Published: September 2016

Ocular surfaces are protected, nourished and lubricated by tear fluid and are exposed environmental factors, topical ophthalmic drugs. Inflammation and wound healing are vital processes involved in the defense mechanisms and in the pathogenesis of many eye diseases. Chronic topical medication is known to affect ocular surface eliciting inflammation, activating wound healing and worsening the success of glaucoma surgery. We used proteomics as a powerful tool to diagnose ocular surface diseases and detect pathogenic mechanisms and biomarkers in glaucoma patients.

Tear fluid and conjunctival tissue specimens of glaucoma and control patients were analyzed by using proteomic and histological techniques. Proteomic analyses were performed with NanoLC‐TripleMSTOF MS using SWATH acquisition. For library generation UniProtKB/SwissProt database was used.

Proteomic analysis of conjunctiva demonstrates protein profile of >2,000 proteins. Pathway analysis allowed analysis of processes like inflammation and wound healing. It will also give an opportunity to further analyze the role of pathogenic mechanisms leading to failure in glaucoma surgery and to develop novel diagnostic tools, biomarkers and therapies for glaucoma patients.
Inflammatory choroiditis
Authors: Herbort C.P.
Published: September 2016

Non‐infectious choroiditis is classically subdivided into at least two main categories, including choriocapillaritis and stromal choroiditis. In the latter, the site of inflammation is situated in the choroidal stroma. When inflammation exclusively originates from the choroidal stroma which is the target of an immune reaction such as in Vogt‐Koyanag‐Harada disease (VKH), sympathetic Ophthalmia (SO) or birdshot retinochoroiditis (BRC), the term of primary stromal choroiditis is used. When the choroidal stroma is a chance and random location of a systemic disease such as sarcoidosis, the term of secondary stromal choroiditis is used. In the choriocapillaritis group the lesion process is an inflammatory non perfusion of the choriocapillaris, a mechanism occurring or suspected to occur in diseases such as multiple evanescent white dots syndrome (MEWDS), multifocal choroiditis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE). The difference of these two mechanism will be further presented with the help of practical examples presented in the same fashion as the ‘viva voce’ EBO examination.
Scanning laser ophthalmoscopy – basic optical principles
Authors: Irsch K.
Published: September 2016

Scanning Laser Ophthalmoscopy (SLO) produces an ocular fundus image by moving a focused laser beam via scanning mirrors over the retina in a grid pattern and registering the reflected light from each scanned point. In confocal SLO, a pinhole is placed in front of the detector to cut off scattered or defocused light coming from outside the point of interest, which otherwise can blur the image. This results in a focused, high‐contrast image of a single tissue layer located at the focal plane. Tomographic information can be extracted by moving the plane of the pinhole. The use of various wavelengths allows for different applications, such as fluorescein angiography, indocyanine green angiography, and autofluorescence imaging. This lecture will present the basic principles of SLO, as well as discuss notable applications and variants of the technology.
Optical coherence tomography – basic optical principles
Authors: Irsch K.
Published: September 2016

Optical Coherence Tomography (OCT) is an optical analogue to ultrasound imaging. The much higher speed of light compared with sound allows for finer cross‐sectional views of the retina and anterior segment. Since it is extremely difficult to directly detect the shorter ‘echo’ times it takes light to travel from different structures at axial distances within the eye, interferometry is used. Incident light is thus split into two beams, and the beam backscattered from the ocular tissue is then compared (‘interfered’) with the beam that has traveled a known time from the reference mirror. Broadband (i.e., low ‘coherence’) light sources are used, because they produce a wider band of wavelengths, and thereby enable greater sensitivity in comparing the travel time differences of the two beams. In time‐domain OCT, the reference mirror position is altered, so that interference patterns are generated whenever the two beams have traveled almost the same amount of time. In spectral‐domain OCT, the reference mirror position is fixed and the mixed interference patterns are separated via spectral wavelength analysis. This lecture will explain underlying concepts of OCT with a discussion of cutting‐edge technological developments.
The future of stem cell and cell therapy in ophthalmology
Authors: Ferrari S. , Moore T. , Shahdadfar A. , Petrovski G.
Published: September 2016

The anatomical and biological properties of stem cells in the eye have been the topic of indepth research over the last few decades. Enormous advances in the cell and tissue isolation and cultivation techniques, as well as molecular characterization of the different cell populations have been achieved, next to the major advances made in the bioscaffolds’ engineering for cell delivery and treatment of eye diseases. Advances in the cell and gene therapy have reached culmination with the human cornea being at the top and holding great promise in treating eye disorders. The eye is indeed a golden mine for stem cells. This session will include lectures from European experts in the field with high international recognition and large collaborative networks. Challenges in the clinical applications of cornea limbal stem cells will be described, along with advances in corneal endothelium engineering for future transplantation applications. In addition, examples of regulating the gene expression towards solving ocular surface diseases will be shown, as well as future directions hallmarking stem cell and cell therapy in ophthalmology.
Retinal detachment in ocular oncology
Authors: Pournaras J.A.
Published: September 2016

Retinal detachment may occur in advanced retinoblastoma or be induced by recent therapy as intra‐arterial chemotherapy.

First line intra‐arterial chemotherapy was proposed recently as a new conservative treatment for retinoblastoma patients. It offers good tumor control. Incidence of rhegmatogenous retinal detachment will be detailled as the evolution over time. Treatment options will be discussed, including scleral buckle surgery and surgical outcome.

In our recent serie, secondary retinal detachment occurred in 16/30 cases (50%). Scleral buckle surgery with anterior chamber ponction was performed without drainage of sub‐retinal fluid. Retinal reapplication was obtained with scleral buckling in all patients. The early treatment of this complication is important for salvage of the globe and visual function.
Iris claw
Authors: Pournaras J.A.
Published: September 2016

Iris claw has been proposed in the management of aphakia, as anterior chamber and scleral IOL fixation. Fixation of this PMMA lens is based on enclavation of a fold of iris tissue without sutures, centered over pupil without affecting mydriasis, iris vasculature and o fluorescein leakage) angle structuresangle structures.

Surgical procedure of anterior versus posterior implantation will be detailled. Per‐ and postoperative complications will be discussed.

The choice of surgical modality may be individualised for specific patients taking into consideration anatomical characteristics (anterior chamber depth, EC count), prexisting ophthalmic pathologies, and surgeon experience.isting ophthalmic pathologies.
Visual evoked potentials
Authors: Liasis A.
Published: September 2016

VEPs in neuro‐ophthalmology are important for diagnosis and surveillance of intracranial pathology. The VEP can indicate the impact of pathology along the afferent visual pathway to the striate cortex. The pathology may directly or indirectly affect the visual pathway. A VEP typically is largest and best defined on electrodes over the mid occiput. The VEP to pattern reversal stimulation has a main positive peak, p100. The latencyp100 has been used extensively in adult neurology to depict and monitor conduction delay consequent upon demyelination and optic neuritis associated with MS. The other characteristics of the VEP waveform are also informative including its size, shape and distribution over the occiput. An inter‐ocular comparison of the distribution of monocular VEPs over the occiput can signpost chiasmal dysfunction, e.g. compression, or chiasmal disproportion as seen in albinism or achiasmia, or indicate hemisphere dysfunction.

This talk will describe what a patient experiences during a VEP, what the results look like and how they are analysed.
Know your Bubbles
Authors: DUA H.S.
Published: September 2016

Deep anterior lamellar keratoplasty (DALK) is the gold standard for corneal transplantation in pathology that does not affect the Descemet's membrane (DM) and endothelium. Knowledge of the surgical micro anatomy of the posterior stroma is important in understanding the procedure and increasing the success rate.

Anwar's ‘Big Bubble’ technique is the most popular. Three types of big bubbles (BB) can form. The most common one is the Type‐1 where the BB forms between deep stroma and the pre‐Descemets layer [Dua's layer‐ DL]. This is the most desirable one and successful DALK can be carried out even if there is a micro or macro perforation of this layer. The less common ones are the Type‐2 BB where the BB forms between DL and DM; and the Mixed BB (combination of types 1 and 2). In Type‐2 BB there is risk of rupture or bursting of the BB. By careful handling and ensuring that the eye pressure is constantly kept low by releasing aqueous through the paracentesis, DALK can be successfully completed when both Type‐2 and mixed BB are formed. The surface of Type‐1 BB is rough looking and Type‐2 is very smooth. The former extends to no more than 8.5 mm while the latter and Mixed BB can extent to the periphery of the cornea.
Photorefractive keratectomy for corneal dystrophies
Authors: Dobrowolski D.
Published: September 2016

PTK is considered as one of many options in treatment of corneal dystrophies. Removal of pathologic tissue from the corneal surface or anterior stroma is sufficient to improve visual acuity. It can delay more invasive treatment for many years. In other cases PTK induces healing process of the cornea including restoration of epithelial basement membrane and renewal of the healthy multilayer epithelium. In cases which underwent keratoplasty for dystrophy, PTK may be offered as an early treatment in recurrence of the dystrophy in the donor tissue.
The montrachet study
Authors: Creuzot C. , Bron A. , Binquet C.
Published: September 2016

The Montrachet Study (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) is a population‐based derived from the 3C Study performed in Dijon. In 2009–2011, 1153 participants from the 3 Cities Study, aged 75 years or more, had an initial eye examination. Apart from the old age of this population, the main interest is that information on cardiovascular and neurologic diseases and a large comprehensive database (blood samples, genetic testing, cognitive tests, MRI) were available. Our first results showed us that despite the high prevalence of self‐reported eye diseases in this elderly population, visual impairment was low and increased with age. These results can improve our knowledge on the characteristics of ocular data in the elderly as well as the relations between eye and age‐related vascular and neurologic diseases.
The view of the doctor in training
Authors: Scott A.
Published: September 2016

The aspirations of a resident play an important aspect of the motivation during work. A comprehensive view of the type of training and which skill sets residents expect to gain, from surgical to medical expertise to opportunities in research will be explored during this lecture.