bluuebunny/crossref_metadata_2025 huggingface dataset:
Sebaceous carcinoma : diagnosis and therapeutic difficulties
Authors: GAVARD‐PERRET A , LAGIER J , CAUJOLLE JP
Published: August 2012

Purpose Sebaceous carcinoma is a malignant neoplasm that usually arises in the sebaceous glands of the eyelids (Meibomian and Zeiss glands). It can invasive the eyelid and the cunjunctiva and can metastasize to regional lymph nodes and distant organs. This tumor affects most frequently women after fifty years. The clinical diagnosis is difficult due to atypical presentations simulating benign lesions or other malignant tumors. Furthermore, its surgery is complicated because as we must perform large tumor excision with often difficult eyelid reconstruction. Through our small case series, we describe the clinical describe the clinical features and our management of this tumours.

Methods We report six patients presenting with eyelid sebaceous carcinomas: three nodular sebaceous carcinoma, one spreading sebaceous carcinoma and two cases with no safety margin after the initial surgery.

Results In all the cases , we completely removed the tumour with safety margin of at least five millimeters and then we reconstructed the eyelid. The diagnosis of sebaceous carcinoma was confirmed by the histological study . Afterward, all our patients benefited from an adjuvant radiotherapy.

Conclusion Due to its difficult diagnosis and the delay in treatment, the overall survival rate of sebaceous carcinoma is about 5 to 10 % and can reach 30% for infiltrative forms. The presence of yellowish material within tumour, which can simulate a chalazion, is highly suggestive of sebaceous carcinoma. The best management is the large tumoral excision. In our opinion, the adjuvant radiotherapy must be systematic due to the high grade of malignity. Moreover,the biological behavior of this kind of tumour requires long‐term oncologic following.
Amelanotic conjunctival melanoma: diagnosis and therapeutic management
Authors: SATUE M , BAMBO M , ARA M , EGEA MC , FERNANDEZ‐PEREZ S , HERRERO R , GARCIA‐MARTIN E , DE LA MATA G
Published: August 2012

Purpose To present a case report of a patient with atypical presentation of a conjunctival melanoma as an amelanotic tumor.

Methods A 82‐year‐old female presenting a large amelanotic tumor in inferior tarsal conjunctiva of the right eye was referred to our hospital. Previous histological analysis diagnosed intraepithelial carcinoma. Imaging digital analysis techniques showed infiltration of the extrinsic ocular muscles but not the scleral tissue. Excisional biopsy was obtained by removing the tumor with free margins and preserving as many unaffected tissue as possible. Amniotic membrane graft was used to cover the surgical injury.

Results Histopathological diagnosis confirmed amelanotic conjunctival melanoma. Systemic evaluation with imaging techniques (MRI, TC scan, Ecography…) revealed liver and kidney masses suggestive of metastasis and chemotherapy was prescribed to control the disease. Ophthalmological controls showed remission of tumor for 4 months, but new conjunctival masses appeared. At the present the patient is treated with palliative chemotherapy. Age and systemic status do not allow aggressive therapies in this patient.

Conclusion Amelanotic melanoma is an atypical subtype of melanoma lacking of pigmentation. Its macroscopic aspect makes it almost impossible to clinically distinguish this tumor from less aggressive tumors, such as intraepithelial carcinomas. The diagnosis delay makes early treatment difficult in this malignant tumors.
Iris tuberculous granuloma simulating medulloepithelioma
Authors: HADJISTILIANOU T , TOTI P , CORIOLANI G , CERASE A , DE FRANCESCO S , MICHELI L , MENICACCI F , DELUCA A
Published: August 2012

Purpose Pediatric ocular granuloma is a rare condition which may result from several causes including trauma, inflammatory diseases, or infectious agents such as fungi, viruses, or mycobacteria. The purpose of this case report is to increase the knowledge about the ophthalmic clinical picture, magnetic resonance imaging findings, histological pattern of a rare case of iris tubercular granuloma occurring in a 4‐year‐old boy.

Methods Case report

Results Inflammatory granulomas are usually the expression of systemic inflammatory diseases. Clinical picture may be that of an anterior or posterior uveitis and it may occur with uveal granulomas or episcleral nodules. Our case at diagnosis simulated a medulloepithelioma, both for ophthalmogic and neuroradiologic findings. Pathology following biopsy revealed a tuberculous granulomatous lesion.

Conclusion A complete systemic investigation confirmed tuberculous aetiology of this granulomatous lesion.
Never miss uveal lymphoma
Authors: LAVILLE MA , CASSOUX N , MOURIAUX F
Published: August 2012

Purpose Primary intraocular lymphomas can mimic many other diseases. The purpose of this presentation is to underline the crucial importance of biopsy.

Methods We described two cases of atypical primary uveal lymphomas.

Results The first case concerned a 35 year‐old man who presented a painful intraocular tumor with ciliary body infiltration. Enucleation was performed because of high suspicion of melanoma. Pathological findings revealed MALT lymphoma. No other localization was found and no further treatment was done. The second case concerned a 49 year‐old woman who presented blurred vision secondary to a choroidal mass associated with choroidal yellow infiltrates in right eye. An internal chorioretinal biopsy was performed, leading to the diagnosis of diffuse large B cell lymphoma. This high‐grade lymphoma was treated with chemotherapy associated with radiotherapy.

Conclusion These two cases illustrate the variety of clinical features of uveal lymphomas, which can mimic choroidal melanoma as in our first case. In our second case, histological findings were not typical and required an aggressive treatment. Biopsy and histological analysis remains the only way to diagnose a primary uveal lymphoma especially in cases of atypical presentation.
A new and standardised method to sample and analyse vitreous biopsies
Authors: VAN GINDERDEUREN R , VAN CALSTER J
Published: August 2012

Purpose To investigate and prepare a universal protocol for sampling and analysing vitreous material. Vitreous biopsies are difficult to handle because of the paucity of cells, the gelatinous formation and structure of the vitreous, the low frequency of biopsies and the burden of long‐during, delicate handwork by the technician.

Methods After a standardised 23gauge vitrectomy, 50 consecutive vitreous samples were analysed with the Cellient® tissue processor (Hologic). This machine is a fully automatic processor from a specified container with PreservCyt® (fixative fluid) with cells to paraffin. Cytology was compared with fixatives Cytolyt® ( contains a mucolyticum) and Preservcyt®.

Results In 96% (48 of 50 cases) sufficient material was found for diagnosis. Cytolyt® wash was necessary in 15% of cases to prevent clotting of the delicate tubes in the Cellient®, this procedure causes a loss of cellular material. Immuno‐histovhemical stainings were equal in quality with both preservatives. Labour hours of processing by technician was diminished by 4, compared with former, not‐standardised techniques.

Conclusion A standardised protocol for sampling and handling viteous biopsies by a 23G vitrectomy, fixing in PreservCyt® and processing by the Cellient® gives a superior result in morphology, number of cells, possibility of immuno‐histochemical stainings and technician labour hours.
A case of spontaneously regressed uveal melanoma
Authors: AMIRYAN AG , SAAKYAN S , TATSKOV RA
Published: August 2012

Purpose To present a case report of spontaneously regressed uveal melanoma.

Methods Complex clinical and instrumental diagnostics was done.

Results A patient, 62 y.o. complained of right eye vision absence during last 10 years. Several months ago appeared pain in the eye and this was the cause to visit to the ophthalmologist. The investigation revealed the eye subatrophy, deviation about 20º, moderate conjunctiva injection, corneal edema and dystrophy. Anterior chamber was deep. The iris was infiltrated with heterogeneous pigmented mass. Pupil had irregular form and complicated cataract was present. Eye fundus was not able to visualize. Vision OD=0, OS=1,0. The right eye pressure was decreased. CT‐scanning demonstrated the intraocular mass with calcification spreading into the orbit along the optic nerve sheets. Enucleation with orbitotomy was performed. During the operation the defect of sclera with black mass infiltration around the optic nerve was revealed. The pathomorphologic examination confirmed the spindle cell uveal melanoma with massive zones of calcification in intraocular lesion forming extraocular extension.

Conclusion All subatrophy eyes must be examined in details to exclude the intraocular tumors.
Treatment of macular oedema following proton beam therapy for choroidal melanoma with dexamethasone 700µg intravitreal implant
Authors: BAILLIF S , GASTAUD P , CAUJOLLE JP
Published: August 2012

Purpose To report the treatment of radiation macular edema following proton beam therapy for choroidal melanoma with dexamethasone 700µg intravitreal implant.

Methods Retrospective cases report

Results Five patients were treated with a single injection of intravitreal dexamethasone 700 µg. These patients presented with an uveal melanoma (mean thickness: 4.44 mm, mean highest diameter: 11.14mm) located at 2.58mm (range 0 to 3.5mm) from the macula. Patients were treated with proton beam irradiation (60 Gy cobalt relative biological effectiveness in 4 fractions) 26.75 months (range 16‐43 months) before the occurrence of radiation macular edema. The intravitreal injection of dexamethasone700 µg was performed 5.5 months (1‐14) after the diagnosis of macular edema. Best corrected visual acuity improved for 4 patients (5; 7; 9 and 10 letters), and remained unchanged for 1 patient, over a 5 months follow‐up period. Central retinal thickness decreased for 3 patients (231; 151 and 97 µm) and remained unchanged for 2 patients. Intraocular pressure increased for 1 patient (IOP>25 mmHg at month 3). No other ocular or systemic side effects were noted.

Conclusion Radiation macular edema is a common vision threatening complication following proton beam therapy. The available therapeutic options are limited. Intravitreal injections of dexamethasone implant can be of benefit in selected cases.
Identification of mRNAs and proteins specifically associated with transformation in ocular malignant melanoma cells
Authors: COSTAGLIOLA C , SEMERARO F , ROMANO MR , CAPUTO M , DE ROSA MC , TECCE MF
Published: August 2012

Purpose Ocular malignant melanoma has several morphological specificity when compared to melanoma tissues from other body regions. To assess and evaluate specific molecular factors of ocular melanoma we decided to screen clinical specimens from patients with melanoma from different tissue and organs, including eye.

Methods To identify a number of factors to be analyzed in clinical samples, we selected mRNAs specifically associated with the transformation state of cultured human melanoma cell line A375 This cell line was used as typical reference status of melanoma cells. These cells were then compared to similar cells in which Bag3 mRNA was silenced by transfection with specific siRNA (small interfering for Bag3). This mRNA encodes a protein which has a potent anti‐apoptotic effect and is generally expressed in melanoma cells, being part of the molecular mechanism of their transformation status.

Results Microarray techniques took advantage to compare the whole pattern of cellular mRNAs in the two conditions of A375 cells: untreated neoplastic and Bag3 silenced cells. Several mRNA species resulted differentially expressed between the two conditions both as induced or as decreased when comparing the more transformed condition vs. Bag3 silenced cells. We then tested the expression of some of these mRNA and of their encoded proteins within the clinical samples of ocular and non‐ocular melanoma tissues.

Conclusion Preliminary results indicated the expression of nephroblastoma overexpressed gene (NOV) as typical of melanoma transformation and of a small pattern of proteins as selectively modulated in ocular melanoma.
Bilateral choroidal metastases as presentation of dissemination of cutaneous malignant melanoma
Authors: FERNANDEZ‐PEREZ S , SATUE M , GARCIA‐MARTIN E , BAMBO M , PRIETO E , DE LA MATA G , PUEYO V , RUIZ‐MORENO O
Published: August 2012

Purpose To report the case of a patient with bilateral choroidal mestastases as the first sign of dissemination of cutaneous malignant melanoma.

Methods A 47‐year‐old Caucasian male presented to our emergency department with rapid‐onset blurred vision in his right eye (RE). Ophthalmoscopic examination revealed multiple pigmented placoid lesions located in the posterior pole and half periphery of the retina of both eyes and a serous macular detachment in RE. Optical coherence tomography confirmed the macular neurosensory detachment in the RE Since clinical suspicion of choroidal metastases, we referred the patient to the Oncology Department for systematic study. After an exhaustive study, they concluded that it was a dissemination of a cutaneous malignant melanoma with bilateral choroidal metastases, liver and spleen metastases.

Results The patient underwent palliative treatment with chemotherapy with improvement of the visual acuity and reduction of the macular neurosensory detachment in the RE. Nevertheless the patient died months later of the diagnosis of cutaneous melanoma dissemination.

Conclusion Dissemination of cutaneous melanoma to the choroid is rare and is a major prognostic factor. In general the treatment of ocular metastases is palliative, because the presence of metastases indicates hematogenous spread of tumor. The objectives are therefore to maximize the quality of life and restore or preserve vision.
Massive anterior chamber involvement in advanced retinoblastoma following intra‐arterial chemotherapy
Authors: DE FRANCESCO S , MASTRANGELO D , DE LUCA MC , MENICACCI F , TOTI P , MICHELI L , HADJISTILIANOU T
Published: August 2012

Purpose to describe retinoblastoma massive anterior chamber involvement after treatment with intra‐arterial chemotherapy. This condition represents an extremely poor prognostic sign for ocular preservation in patients with retinoblastoma. Therefore, anterior chamber retinoblastoma should be considered an absolute indication for enucleation.

Methods Ultrasound biomicroscopy (UBM) was used to document tumour pseudohypopion, cells in the aqueous humor, implanted clusters of cells on the corneal endothelium, iris nodules and lens capsule deposits.

Results The UBM data were compared with the histopathologic analysis after enucleation and revealed a significant concordance.

Conclusion UBM may represent an important diagnostic tool in retinoblastoma, particularly when the decision about enucleation of the eye, must be made in the absence of histopathologic data.
Posttraumatic periorbital necrotizing fasciitis
Authors: FERNANDEZ‐PEREZ S , HERRERO R , GARCIA‐MARTIN E , DE LA MATA G , SATUE M , BAMBO M , ARA M , EGEA MC , FERNANDEZ‐TIRADO FJ
Published: August 2012

Purpose To present the case report of a patient who developed periorbital necrotizing fasciitis following trauma with favorable response.

Methods 73 year‐old‐female came to the emergency department after downfall with a trauma in facial region. At the initial examination the patient had a large eyelid swelling in both eyes and a wound that required stitches on the left superciliary region. 5 days later the patient presented to our clinic with general discomfort, fever of 39°C and with slurring, crusty necrotic in the right eyelid, redness and heat in both upper eyelids and in frontal area.

Results Because of clinical suspicion of periorbital necrotizing fasciitis, we performed a debridement of the wound in the right upper eyelid, draining the purulent in frontal area, sampling for culture and intravenous treatment with amoxicillin‐clavulanate. In the culture Steptococcus pyogenes isolates. After 15 days of intravenous antibiotic treatment and local cures, the patient was discharged from hospital. One month later, the patient had complete resolution of the lesions with a mild ptosis in the right eye.

Conclusion Although this is a disease with a low incidence, it has a high morbidity and mortality if appropriate treatment is not performed. Treatment consists in an immediate and extensive debridement of the affected area with broad‐spectrum antibiotic.
Topography of the human Henle Fiber Layer (HFL) as revealed by imaging and histology
Authors: SJÖSTRAND J , POPOVIC Z
Published: August 2012

Purpose To create a model of the topography of the Henle Fibers (HF) connecting photoreceptor cell bodies of the human fovea to the inner retina based on information available in recent imaging and histological studies. Detailed knowledge of the HF is of importance for analysis of connectivity between the outer and inner retina and for evaluation of radial displacement of retinal neurons from their synaptically connected photoreceptors.

Methods Reported data of the Henle Fiber Layer (HFL) thickness (HFLt) at different eccentricities along the horizontal meridian of the human fovea from studies with optical coherence tomography (OCT) and histology was used. The radial displacement caused by HF was calculated from data of total displacement within the retina, corrected by data of other displacements obtained from Sjöstrand et al( unpublished).

Results A comparison of OCT and histology data showed a similar profile of HFLt vs eccentricity and similar HF topography. The angle of the Henle fibers vs. the external limiting membrane (ELM) was low centrally ranging from a few degrees (deg) to approximately 6 deg at a cone eccentricity of 0.9 mm.Thereafter the angle slowly increased with increasing eccentricity to an angle of 9‐10 deg at cone eccentricity of 1.8 mm . The locations of the maxima of HFLt and projected HF length were at a cone eccentricity of approximately 0.5 mm. A model was constructed displaying the characteristics of the topography of HFL.

Conclusion Published data of the topography of HFL fits with a model where the the maximal HFLt is attained at a cone eccentricity where the fiber angle vs ELM still is of low degree and the HF length reaches a maximum.
Stage 1 macular holes of Gass classification illustrated by Optical Coherence Tomography scans: a review of 4 cases
Authors: BENTALEB Z , DENIS P , KODJIKIAN L
Published: August 2012

Purpose Gaudric classification, stage 1 corresponds to intraretinal pseudocyst in the inner part of the foveola. The prolongation of the cyst laterally results in a split between the inner retina and the photoreceptor layer and a disruption of the outer retinal layers.

Methods Four patients presented with a history of blurred vision and metamorphopsia. OCT examination showed a foveolar serous detachment between pigment epithelium and photoreceptor layer. Six months later, two patients presented lamellar holes and two patients evolved into stage 3 macular holes. In all cases we reported a complete resolution of the foveolar serous detachment . A surgical treatment was performed for three patients.

Results OCT scans performed one month after surgery showed a total closure of the macular holes, an increase of visual acuity and a disappearance of the metamorphopsia. The main physiopathological theory formulated about macular holes formation concerns vitreo retinal tractions. As the posterior hyaloid remained attached to the center of the foveola and to the optic disc, displaying a convexity that may indicate the exertion of anteroposterior traction on its vitreous side, Gaudric admits that stage 1a macular hole is the result of antero posterior vitreo retinal tractions. Stage 1 as described by Gass is characterized by a serous foveolar detachment and is a consequence of tangential tractions of the pre foveolar vitreous cortex.

Conclusion Our cases seem to be the tomographic illustration of the anatomic description of the stage 1 macular hole proposed by Gass and not mentioned in the tomographic classification proposed by Gaudric suggesting the implicationof tangential traction in macular holes formation.
Dexamethasone intravitreal implant in patients with macular oedema related to branch or central retinal vein occlusion, a retrospective study
Authors: BENZERROUG M , SERRERO M , BREMOND‐GIGNAC D , MILAZZO S
Published: August 2012

Purpose To evaluate the anatomic and visual outcomes of one treatment with dexamethasone intravitreal implant (Ozurdex®) in eyes with macular edema secondary to branch or central vein occlusion (BRVO or CRVO) during the first six months.

Methods The safety and efficacy of the dexamethasone intravitreal implant (Dex. implant) were evaluated retrospectively from January 2011 to May 2012 in a tertiary referral hospital. CRVO or BRVO diagnosis was confirmed with fluorescein angiography. At baseline, patients received a 0.7 mg dex. implant. They were evaluated at one, three and six months. Best corrected visual acuity (BCVA), optical coherence tomography (OCT) and intraocular pressure (IOP) were collected.

Results We included twenty one eyes: 28.5% had a CRVO and 71.5% a BRVO. At baseline, the mean BCVA was 47 letters (ETDRS) (52 in the BRVO group, 22 in the CRVO group). All patients had a macular edema involving the fovea. The mean central retinal thickness (CRT) was 513 micrometer [255‐780]. At one month, 47.5% of eyes had more than three line gains and the mean CRT was 286 µm. Only two eyes had an IOP increase (>25 mmHg). However, at six months, only 17% of eyes had more than three line gains and the mean CRT was 380 µm. IOP remained uncontrolled with medication in one eye.

Conclusion The dexamethasone intravitreal implant reduces macular edema and improves visual acuity in patients with either branch retinal vein occlusions or central retinal vein occlusions. However, this efficacy remains transient. A retreament with a dex. implant is necessary for most of the patients.
Changes in macular thickness measurements repeatability with age using Cirrus Fourier‐domain optical coherence
Authors: PINILLA I , GARCIA‐MARTIN E , IDOIPE M , FUENTES L , SANCHEZ‐CANO A , LOPEZ DE LA FUENTE C , FUERTES MI
Published: August 2012

Purpose To test the intrassession reproducibility of retinal thickness measurements using Cirrus Fourier‐domain optical coherence tomography (OCT). To evaluate if there is any relation between macular measurements repeatability and age of the studied subject.

Methods Two hundred and nine of 209 healthy subjects underwent three macular 512x128 volume cube centered on the fovea done by the same experienced examiner using Cirrus HD OCT (Carl Zeiss, USA). Descriptive statistics, analysis of variance, intraclass correlation coefficients (ICC), and coefficients of variation (COV) were calculated for the 9 macular areas described by the Early Treatment Diabetic Retinopathy Study (ETDRS) in the macular protocol. Values were analysed related to other subject factors like age and VA.

Results All measurements were highly reproducible. The ICCs ranged from 0.823 to 0.992 using macular volume cube. Mean COV was 1.4 ±1.09% (ranged from 0.7 to 1.9%) for the nine ETDRS areas. COV values increased with age; a significant correlation was found between them (r=0.300, p≤0.001). COVs were also related to VA.

Conclusion Retinal thickness measurements obtained using Cirrus Fourier‐domain OCT show good reproducibility for healthy eyes. Repeatability is related to the subject age.
Improving diabetic retinal clinics in a district general hospital to conform to UK national screening committee guidelines
Authors: MALIK A , MOORE SJ , PAUL B , ISLAM N
Published: August 2012

Purpose To determine if new diabetic retinopathy patients, with either ‘urgent’ (R3M0, R3M1) or ‘routine’ (R2M1, R1M1) grading, are lasered within the appropriate national guidelines timeframe for: Time between listing (clinic) and first laser treatment following screening (OBJECTIVE 11) ‐ Urgent: Minimum standard 90% of patients<2 wks ‐ Routine: Minimum standard 70% of patients<10 wks Time between screening encounter and first laser treatment (OBJECTIVE 12) ‐ Urgent: Minimum standard 70% of patients<6 wks ‐ Routine: Minimum standard 70% of patients<15 wks

Methods A retrospective audit of new patients (n=121) whom have undergone diabetic retinal laser for either R3 (proliferative retinopathy) or M1 (maculopathy), over a 6 month period (from 1st feb 2011 to 31st July 2011). Data collection method: ‐ Laser logbook ‐ Patient computer archives system ‐ Systematic review of patient’s notes Patients were excluded if: ‐ CRVO diagnosis ‐ already under Hospital eye services ‐ repeat laser attenders ‐ no data ‐ ungradeable

Results ‐ No. eyes lasered in time /No. eyes seen (%) OBJECTIVE 11 (clinic to laser): Urgent ‐ 17/31 (55%) Routine ‐ 117/135 (87%) OBJECTIVE 12 (screening to laser): Urgent ‐ 12/32 (38%) Routine ‐ 90/135 (70%)

Conclusion Standards achieved for routine but not urgent referrals for Objective 11 (clinic to laser time) and Objective 12 (screening to laser time). The appointment of a diabetic co‐ordinator helps to greatly improve flow of diabetic patient care pathway. Implementing the use of a medisoft connector would aid stream‐lining data transfer directly to the screening service, thus improving the quality of patient care.
Visual acuity and central macular thickness comparison between posterior sub‐Tenon's capsule triamcinolone injection and vitrectomy for diffuse diabetic macular oedema
Authors: NONOMURA S , OSHITARI T , YAMAMOTO S
Published: August 2012

Purpose To compare the effect of posterior sub‐Tenon's capsule triamcinolone acetonide injection (STTA) with the surgical outcomes of pars plana vitrectomy (PPV) for diffuse diabetic macular edema (DME).

Methods The medical records of 52 patients (52 eyes) with diffuse DME were reviewed. 26 eyes underwent STTA (20mg) and other 26 eyes – vitrectomy combined with cataract surgery. The central macular thickness (CMT) measured by OCT and best‐corrected visual acuity (BCVA) were examined before and 1, 3, and 6 months after treatment. Statistical analysis was performed with student t‐test, Mann‐Whitney U‐test and repeated measured ANOVA.

Results Preop BCVA was 0.65±0.4 logMAR units in the STTA group and 0.77±0.3 logMAR units in the PPV group. One, 3 and 6 months postop BCVA were 0.59±0.4, 0.53±0.5 and 0.47±0.4 in the STTA group and 0.77±0.3, 0.59±0.4, and 0.59±0.4 in the PPV group. Preop CMT were 608.1±220μm in the STTA group and 534.4±157μm in the PPV group. One, 3 and 6 months postop CMT were 392.1±193μm, 284.4±101.7μm and 331.4±121μm in the STTA group and 386.8±175μm, 354.2±101.7μm and 354.2±156.4μm in the PPV group. The differences in the BCVA and the CMT between two groups were not significant at any periods before and after treatment.

Conclusion Although STTA and PPV can significantly improve the BCVA and reduce the CMT in patients with diffuse DME, the differences in the BCVA and the CMT were not significant. Considering the minor invasion, STTA can be the first choice for the treatment of diffuse DME.
Multimarkers for diabetic retinopathy screening
Authors: CSUTAK A , TOROK ZS , TUKACS E , MAROS‐SZABO ZS , CSOSZ E , BERTA A , MOLNAR AM , TOZSER J , NAGY V , DOMOKOS B , HAJDU A
Published: August 2012

Purpose The aim of the project was to develop a methodology for diabetic retinopathy (DR) screening based on the examination of tear fluid biomarker changes. To evaluate the usability of protein biomarkers for pre‐screening purposes different approaches and machine learning algorithms were used.

Methods All persons involved in the study had diabetes. DR was diagnosed by capturing 7‐field fundus images. 165 eyes were examined, 55 were diagnosed healthy and 110 images showed signs of DR. Tears were taken from all eyes and state‐of‐the‐art nano‐HPLC coupled ESI‐MS/MS mass spectrometry protein identification was performed on them. Applicability of protein biomarkers was evaluated by six different optimal parameterized machine learning algorithms.

Results Out of the six identified machine learning algorithms, result of the Recursive Partitioning proved to be the most accurate. The performance indicators of the system applying the above algorithm indicated 74 % sensitivity and 48% specificity.

Conclusion Neither protein biomarkers nor machine learning algorithms are recommended alone for screening purposes because of low specificity and sensitivity values. This tool can be preferably used to improve the results of image processing methods as a complementary tool in automatic or semiautomatic systems.
Prognostic implication of choroidal thickness in ranibizumab‐treated eyes with neovascular age‐related macular degeneration (nvAMD)
Authors: YI JH , KWON HJ , LEE CS , LEE SC
Published: August 2012

Purpose To evaluate prognostic factors in newly diagnosed nvAMD.

Methods Forty eyes of 37 patients with nvAMD received 0.5mg of intravitreal ranibizumab (IVR) monthly. One month after the third IVR, responders were defined as patients having improved visual acuity without retinal fluid.

Results 22 eyes (55%) were responders. Multivariate logistic regression identified thicker subfoveal choroidal thickness (SFCT) (p=0.049) and smaller choroidal neovascularization (p=0.043) as predictive factor for responder. SFCT were significantly thicker in responders (257 vs. 167 μm) even after adjusting for age and spherical equivalent. (p=0.024)

Conclusion Thinner choroidal thickness is negative prognostic factor for response to IVR in nvAMD.
The ring like distribution profile of macular pigment appears highly heritable: a twin study
Authors: VAN KUIJK E , LIEW M , BEATTY S , GILBERT C , HAMMOND C
Published: August 2012

Purpose Macular pigment (MP) protects the retina from damage due to blue light and other oxidative stress. Genetic factors determine the distribution profile of MP, which may also be important in protection from oxidative stress. In addition it has been suggested that the ring pattern (with a “shoulder” in the profile at ~0.5 degrees from the fovea) may be protective of AMD .

Methods 300 healthy white female twin volunteers, aged 16‐50 years (mean age 40+/‐8.7 years) had macular pigment optical density (MPOD) measured by 2‐wave‐length fundus autofluorescence (AF), figure 1. The sample consisted of 76 monozygotic twin pairs, and 74 dizygotic twin pairs. Case‐wise concordance was calculated by the formula 2C/(2C+D) where C is the number of twin pairs concordant for a ring structure, D the number of pairs discordant

Results At baseline, mean MPOD by AF was 0.41 density units (SD 0.21; range 0.04 to 1.25) in the central half‐degree field, and exhibited a near‐ normal distribution. The ring like MP distribution profile was observed in 93 subjects (pre‐valence 0.31, 95% CI 0.26‐0.36). Concordance in monozygotic twins was 0.85 (95% CI 0.75‐0.95) compared to 0.43 in dizygotic twins (95% CI 0.23‐0.63), (p for diff<0.001).

Conclusion The finding that the monozygotic twin concordance is approximately double the dizygotic concordance, suggests that genetic factors are important in determining the MP distribution profile in the macula. This agrees with our previous findings of significant MP optical density heritability.
Five‐year follow‐up results of photodynamic therapy for polypoidal choroidal vasculopathy
Authors: KANG HM , KOH HJ
Published: August 2012

Purpose To evaluate the 5‐year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).

Methods Forty‐two eyes of 36 patients with PCV followed up for at least 60 months after PDT were retrospectively reviewed. The diagnosis of PCV was based on indocyanine green angiography (ICGA), showing branching vascular network with polypoidal components. All eyes were primarily treated with PDT, and retreated with PDT and anti‐vascular endothelial growth factor (VEGF) injection or with only anti‐VEGF injection. The recurrence of PCV was defined as the emergence of active polypoidal lesions observed with fluorescein angiography (FA) and ICGA. Retreatment was performed when leakage of fluorescein or subretinal fluid/intraretinal cyst on optical coherence tomography was noted during follow‐up examiinations.

Results During the mean follow‐up duration, 73.64±13.47 months, the mean number of PDT was 2.21±1.62 times, and the mean number of anti‐VEGF injection was 5.05±5.55 times. Recurrence was noted in 33 eyes (78.6%) during follow‐up. The mean baseline BCVA was 0.78±0.48 logarithm of the minimum angle of resolution (logMAR), and the final BCVA at 60‐month follow‐up was 0.68±0.54 logMAR. On the final evaluation at 60 months, the mean BCVA was improved in 14 eyes (33.3%) by at least 0.3 logMAR, stable (mean BCVA change within 0.2 logMAR from baseline) in 23 eyes (54.7%), and decreased in 5 eyes (11.9%) by at least 0.3 logMAR.

Conclusion After 5 years, 88.1% of patients showed stable or improved BCVA after PDT. Despite of high recurrence rate up to 78.6%, PDT was effective for 5 years, and seems to be a good option of treatment in PCV patients.
Two year follow‐up of low‐level laser therapy (LLLT) in patients with age‐related macular degeneration (AMD)
Authors: KOEV K , AVRAMOV L , BORISSOVA K
Published: August 2012

Purpose The objective of this study is to examine long‐term effects of low‐level laser therapy (LLLT) in patients with age‐related macular degeneration (AMD).

Methods The research was implemented for a period of two years. For LLLT, a He‐Ne Laser with continuous emission at 633 nm (01 mW/cm2) was used in patients with AMD of all stages (dry to wet exudative forms were included). In total, 54 patients (25 men and 29 women ‐ 108 eyes) with AMD of various stages and a mean age of 67.5 ±5.2 years were included in the study. Progressive, exudative AMD was diagnosed in 33 eyes. 75 eyes had drusen or were depigmented. Laser radiation was applied transpupillary 6 times for 3 min once in two days to the macula. 20 patients with AMD (40 eyes) were randomly selected to receive mock treatment (control group 9 men and 11 women with a mean age of 68.5± 4.2 years). Visual acuity was followed for a 2‐year period. The perimetry and Amsler test was used to screen central scotomas. Fluorescein angiogram of AMD and control groups was examined.

Results Visual acuity remained unchanged in all patients in the control group. There was a statistically significant increase in visual acuity (p<0.001, end of study versus baseline) for AMD patients for the period of 2 years after the treatment. The edema and hemorrhage in the patients with progressive, exudative AMD significantly decreased. No side effects were observed during the therapy. The prevalence of metamorphopsia, scotoma in AMD group was reduced.

Conclusion In conclusion, this study shows that LLLT may be a novel long‐lasting therapeutic option for both forms of AMD. This is highly effective treatment that improves visual acuity for a long tme.
Docosahexaenoic acid protects human RPE cells against oxidative stress via PI3K/Akt m‐TOR/p70‐p85S6K pathways
Authors: BABCHIA N , DE ARAUJO A , LECLERE L , BUTEAU B , GREGOIRE S , MARTINE L , BRETILLON L
Published: August 2012

Purpose Oxidative Stress (OS) plays a critical role in the pathogenesis of age‐related macular degeneration (AMD), especially by targeting the retinal pigment epithelium (RPE). Dietary habits with high consumption of docosahexaenoic acid (DHA) have been shown to prevent the development and evolution of AMD. Nevertheless, it is still unclear how DHA affects AMD. Our study aimed to investigate the involvement of the PI3K/Akt and m‐TOR/p70‐p85S6K pathways in human RPE cells after induction of OS, and then to assess the effect of DHA in the signaling pathways and in the protection against RPE cell death.

Methods For this purpose, we used ARPE‐19 cells exposed to the prooxidant agent, tert‐butyl hydroperoxide (t‐BHP).

Results We found that exposing cells to t‐BHP (400µM) showed complete inhibition of Akt and p70/p85S6K active forms. However in cells enriched with DHA (20µM) and then exposed to t‐BHP (400µM), we demonstrated that Akt and p85S6K, but not p70S6K, remained phosphorylated for a longer time after stress. In addition there was a 2.6‐fold decrease in the number of necrotic cells after 48hours of t‐BHP treatment, as assessed by flow cytometry.

Conclusion Our study suggests that 1/ PI3K/Akt and m‐TOR/P70‐p85S6K pathways play an important role in OS, 2/DHA protects RPE cells from apoptosis and necrosis triggered by OS by enhancing the phosphorylation of Akt and p85S6K.
Prognostic factors for visual outcome after intravitreal bevacizumab injection for pigment epithelial detachment in AMD
Authors: BOULADI M , CHEBIL A , KORT F , BOURAOUI R , MGHAIETH F , EL MATRI L
Published: August 2012

Purpose To evaluate the prognostic factors for visual outcome after intravitreal bevacizumab injection in patients with pigment epithelial detachment (PED) in AMD

Methods Thirty eyes in 30 patients with CNV and PED in AMD who had received intravitreal bevacizumab injections were retrospectively reviewed. Initial visual acuity, pigment epithelial detachment size, retinal or subretinal fluid resolution and CNV location were evaluated at 12 months.

Results Initial visual acuity was not correlated with BCVA at 12 months (p=0.063). CNV at the edge of PED appears to respond more favorably at 12 months (p=0.033) than CNV within PED. Sub and intraretinal fluid initially resolved faster than the sub‐PED fluid (P = 0.041).The subretinal pigment epithelial fluid was highly resistant. Sub and intraretinal fluid response did not appear to be related to PED size. Visual acuity improvement was similar in both groups: large and minimal PED component.

Conclusion The location of CNV and the retinal or subretinal fluid resolution were the main prognostic factors for visual outcome. Bevacizumab was very effective in reducing more of the sub‐ and intraretinal fluid than the PED fluid in AMD with CNV.
Subfoveal perfluorocarbon liquid (SFCL) extraction: a report of three cases
Authors: CASTRO NAVARRO J , GARCÍA FERNÁNDEZ M , BAJO FUENTE A
Published: August 2012

Purpose To analyze the outcomes after subfoveal perfluorocarbon liquid (SFCL) extraction.

Methods Three eyes of three patients (all males and aged between 43 and 63 years old), with presence of subfoveal SFCL after retinal detachment (RD) with macular involvement surgery. After a variable period of time, which ranged from 1 to 12 months after vitreoretinal surgery, it was performed extraction of the SFCL by a retinotomy in the extrafoveal rim of the SFCL bubble and aspiration with a 38‐gauge cannula in one patient and with a 29‐gauge cannula in the other two. Full clinical ophthalmological examination, including determination of Best Corrected Visual Acuity (BCVA), funduscopy and Optical Coherence Tomography (OCT)examination was performed in all patients prior and after surgery.

Results BCVA prior surgery was 10/100 in the three patients. Funduscopy and OCT examination showed one SFCL bubble localizated under the fovea. Four months after surgery, it was achieved anatomic restoration, without rests of SFCL, but a severe defect in photoreceptors (PR) was appreciated by funduscopy and confirmed by OCT in all eyes. Visual acuity remained unchanged during the follow‐up period, being of 10/100 in the three eyes.

Conclusion Subfoveal SFCL extraction in patients with previous RD with macular involvement surgery may imply bad functional outcomes, probably due to a previous damage of pigment retinal epithelium and PR, aggravated by SFCL toxicity.
Age related macular degeneration in the algerian population and comparison with the italian one
Authors: LAZREG S , DELCOURT C , NOURI MT
Published: August 2012

Purpose To identify the risk factors for Age Related Macula changes (ARM and ARMD) in the Algerian population. The results will be compared, in a second time, to the results of a similar previous survey performed in Italy on Maghreb population. Finally, a predictive algorithm in order to detect the individual risk for developing AMD will be defined

Methods Multicenter epidemiological study has been carried out in Algeria by 23 ophthalmologists who aimed to include all the patients aged of 55 years or more. Data were collected by questionnaire: age, gender, BMI, ethnical origin, personal and family history, smoking, alcohol consumption, sun exposure, food habits (fruits, vegetables, fat fish), food supplements, iris color, cataract surgery, refraction, fundus

Results 1183 subjects included, 68 presented ARMD, 288 ARM and 82. People less than 65 years old were 37% and 40% were between 65 and 75 years old and most of them were Caucasian (90%) and 10% black. Factors significantly correlated to ARM and ARMD are: black‐African (OR: 9.25 and 19.04 for ARM and ARMD respectively), arthrosclerosis (OR: 3.28 and 1.94), family history of ARMD (OR: 4.48, significant for ARMD only), beer consumption (OR: 9.93 and 14.36), cataract surgery (OR: 1.71 and 2.71), myopia (OR: 3.74 and 5.61), hypermetropia (OR: 1.91)

Conclusion This study is in line with risk factors already described, including the most rfactors already described, including the most recently pointed out ‐refraction troubles‐ and shows relevant variations between North‐African Caucasian living in their country and those living in Italy. Nevertheless, these preliminary results must be validated by further studies in order to find why there is a difference.
Isolated juxtapapillary haemangioma
Authors: PEFKIANAKI M , MICHAELIDES M
Published: August 2012

Purpose To report a case of a juxtapapillary retinal capillary haemangioma

Methods A 21‐year‐old lady was referred from her optician with a six month history of blurred vision in her right eye. She was otherwise fit and well and did not take any regular medication. She had experienced occasional migraines in the last few years. She had no significant family history of note. On presentation, her visual acuity was 6/6 in both eyes. She had evidence of right optic disc swelling with some telangiectatic changes in a peripapillary distribution. In addition there were significant hard exudates temporal to the macula. A fundus fluorescein angiogram and OCT were undertaken which were consistent with a juxtapapillary capillary haemangioma. Although she had no systemic symptoms suggestive of Von Hippel‐Lindau (VHL) syndrome, we referred her to a clinical geneticist to initiate investigations to evaluate this, as retinal haemangiomas are a frequent presenting feature of VHL; although they can be an isolated disorder. She underwent an abdominal and pelvic USS which was reported as normal, MRI of the head was reported as revealing no features suggestive of VHL disease, FBC, U&Es were also normal, 24 hr urine collection was normal for adrenaline, nor‐adrenaline and dopamine.

Results Sixteen months after her first visit, her vision dropped to 6/12. OCT imaging demonstrated increasing macular oedema and exudation over the fovea. It was decided that the best option for treatment was intravitreal avastin, in combination with photodynamic therapy.

Conclusion Combined anti‐VEGF therapy and PDT are a treatment option for juxtapapillary capillary haemangioma; although prognosis is often poor.
Intraocular pressure response to acetazolamide in patients with retinal detachment
Authors: ARNDT C , DUCASSE A , GHOUALI W
Published: August 2012

Purpose Besides the responsibility of vitreous traction, deficient photoreceptors adherence due to lower fluid transport of the retinal pigment epithelium (RPE) has been hypothezised to be involved in the occurrence of retinal detachment(RD). However this adherence remains difficult to evaluate in patients. Acetazolamide reduces aqueous secretion of the ciliairy body and stimulates fluid absorption by the RPE. Recording the intraocular pressure response to systemic acetazolamide could enable to indirectly evaluate the carbonic anhydrase activity of the RPE.

Methods The response to intraveineous acetazolamide was evaluated on the first postoperative day in 30 patients undergoing either RD surgery (n=15) or epiretinal membrane peeling (n=15). Intraocular pressure was measured with a handheld Perkins tonometer in suppine position before (t‐2 min) and after the administration of acetazolamide (t+2 min,t+6min ,t+10 min and t+30 min). The mean variation of the intraocular pressure was compared between the two groups.

Results Consecutively to the intraveineous injection of acetazolamide, a reduction of the intraocular pressure was observed in both groups (both n=15). This reduction was significantly lower in the group of patients who underwent RD surgery. The observed difference remained significant until 10 minutes (p<0,01 at t= 2, 6 and 10 min). At t=30 min, the intraocular pressure reduction was comparable in both groups.

Conclusion The response to acetazolamide is significantly lower in patients undergoing RD surgery. Further research should aim to confirm the value of the intraocular pressure response to acetazolamide for characterizing photoreceptor adherence.
Effect of Resvega in a model of choroidal neovascularization in mice
Authors: RECALDE S , GARCIA‐GARCIA L , FERNANDEZ‐ROBREDO P , IVANESCU A , REDONDO‐EXPOSITO A , MORENO‐ORDUñA M , FERNANDEZ‐GARCIA V , GARCIA‐LAYANA A
Published: August 2012

Purpose We aim to assess the effect of Resvega as a source of resveratrol and combined with an anti‐VEGF in a diode laser‐induced choroidal neovascularization (Li‐CNV) model in mice.

Methods Sixty C57BL6/J mice underwent a diode Li‐CNV model, and were divided into 4 groups (n=15): Control group: vehicle by oral gavage. NA group: daily oral Resvega (NA). C‐VEGF group: vehicle and intravitreal anti‐VEGF. NA‐VEGF group: NA and intravitreal anti‐VEGF. Oral treatments (100 µL) were administered 10 days before laser until 28 days post‐laser. Intravitreal injections (7 µl) were performed 48 hours after laser. CNV evolution was assessed weekly through fluorescein angiography (FA) for 4 weeks. CD‐31 immunofluorescence was assessed in choroidal flat mounts after sacrifice. Gene and protein expression of VEGF was analyzed with RT‐PCR and western‐blot, respectively. Results were analyzed with SPSS 15.0.

Results FA showed a significant decrease in fluorescein leakage from second week in NA and NA‐VEGF groups compared with their respective controls (p<0.05). The lowest CNV area measured by CD31 was observed in NA group compared with control group with statistically significant differences (p<0.05). RT‐PCR and western‐blot analysis showed a significant decrease in VEGF expression in NA and NA‐VEGF groups (p<0.05).

Conclusion Our data show that oral Resvega administration reduces CNV area and expression of proangiogenic VEGF expression. These results suggest that Resvega could be considered as potential preventive therapy against CNV. Supported in part by Thea Laboratoires and Grant RETICS RD 07/0062, Ministerio de Ciencia e Innovación.
Ocular effects of combined therapy with pegylated interferon (PegINF) and ribavirin (RBV) in hepatitis C
Authors: ORSKI M , WYLEGALA E , MANKOWSKI W , TARNAWSKA D , WOJCIK L , SMEDOWSKI A , WOWRA B , BLONSKA ‐ FAJFROWSKA B , MUSIALIK J
Published: August 2012

Purpose To evaluate ocular effects of combined therapy with pegylated interferon and ribavirin in hepatitis C.

Methods 18 patients (36 eyes) received combined therapy based on the presence of HCV antibodies in the serum and positive RT – PCR test results for HCV RNA. Patients were examined at baseline, months 1, 3, 6 after initiation and 6 months after completion of antiviral treatment. Primary outcome was best corrected visual acuity (BCVA) and secondary outcomes were slit lamp examination, intraocular pressure, foveal thickness, and P1 Multifocal Electroretinography( mfERG) amplitude.

Results 13 patients (26 eyes) completed the study. 2 of 13 (15%) patients had exacerbation of dry eye syndrome and 2 of 13 (15%) developed retinopathy. Therapy was discontinued in patients with retinopathy with remission of retinal changes after 3 months. No significant changes in other parameters were observed.

Conclusion Patients treated with PegINF‐RBV have a potential risk of ocular complications and require a regular ophthalmic examination. We suggest ocular examination and follow up protocol for patients treated with interferon‐ribavarin therapy to limit potential side effects.