bluuebunny/crossref_metadata_2025_split huggingface dataset:
The challenge of optimising topical ocular formulations
Authors: Clive Wilson Clive 
Published: December 2019

AbstractIn theory, introducing a drug directly into the eye should localise drug effects permitting efficient exchange of the drug between the vehicle and the cornea. Moreover since the blood supply to the eye represent such a small proportion of the output of the heart, the bystander effects should be greatly reduced by confining the dose, and other unwanted actions including metabolic clearance should be minimised. In practice, as appreciated by scientists and medical practitioners, topical ocular delivery is inefficient, the efficiency of dosing variable and compliance in the order patient questionable. The major factor contributing to pre‐corneal loss is the rapid drainage of the installed dose through the nasolacrimal duct to the sinuses and veins draining the face. The sensations and the immediate changes in visual acuity associated with ocular dosing, prompt blinking and in children rubbing of the eye. Many drugs such as cyclopentolate cause an uncomfortable stinging or after a period of use, a formulation may precipitate changes in tear structure associated with a measurable decrease in TBUT, conjunctival hyperaemia and reflex tearing. The development of better formulations which would be more acceptable to patients young and old, Is therefore of significance both in commercial and healthcare terms. The basic ingredients in a topical formulation designed for ocular use include a solution of the drug, buffering agents to optimise the pH permitting best absorption, tonicity adjusting agents (simple aqueous solutions with very low osmolality are uncomfortable as even slightly hypertonic formulations), wetting agents and preservatives. The formulation must be sterile on manufacture and remain with a low bioburden during use and where possible, packaging should assist maintenance of the medicine as designed. The drugs are Incorporated into the formulations are usually at a fairly low concentration and therefore there may be issues of stability or oxidation. The in life use is designed to be around one month although patients may hoard opened medicines for a much longer time. In my experience, this appears to particularly apply to ointments as patients assume that ointments do not contain water. This is not a safe assumption as although the water content may be very low in petrolatum‐based ointments, vegetable‐based ointments formulations usually contain more water. From these preliminary remarks, there are several elements to be considered in constructing a best‐in‐class formulation. There is no doubt that convenience and ease of use is an advantage in general medical device ergonomics. All elements of design need to be considered: bottle design, formulation, interval between dosing and preventing contamination whereas efficacy is not generally obvious to the patient except in treatment of acute conditions. The space for innovation is wide provided that the lowest cost option is not the only route available to the healthcare providers.
Fungal involvement (Pityrosporum) in ocular allergy
Authors: Chabane Habib 
Published: December 2019

AbstractAllergic conjunctivitis to atmospheric molds is well documented, Alternaria being by far the most common. However, the role of microbiota fungi in conjunctivitis is less documented. Several old reports until the seventies have underlined the implication of allergy to Candida albicans in some chronic conjunctivitis. Pityrosporum orbiculare allergy has been well documented in head and neck atopic dermatitis in adults, but there is no report showing the involvement of this fungi in chronic conjunctivitis, even if some authors suspected his involvement in blepharitis. Here we describe some case‐reports of atopic keratoconjunctivitis associated with IgE sensitization to Pityrosporum in adults with seborrheic dermatitis or head and neck dermatitis. Patients was initially treated by ciclosporin since no sensitization to aeroallergens have been highlighted. After local and systemic anti‐fungal treatment, ciclosporin was stopped and sustained improvement was observed under discontinuous treatment. When no sensitization to aeroallergens has been highlighted in atopic keratoconjunctivitis, we suggest to seek for sensitization to microbiota fungi particularly Pityrosporum spp. and Candida a. in patients with head skin lesions.
Simulation centers accreditation guidelines and good practice
Authors: Sachdeva Ajit 
Published: December 2019

AbstractIn 2005, the American College of Surgeons (ACS) launched an innovative program to accredit simulation centers based on rigorous standards and criteria. These standards and criteria were developed through an intense two‐year process that involved internationally‐renowned experts in the field of surgical simulation and individuals who were leading technical skills training centers in the US and Canada. We pilot‐tested the accreditation model, as well as the standards and criteria to ensure that they were robust and reliable. A few years ago we revised the accreditation model to one of continuing certification with longer accreditation cycles and detailed annual reports and targeted reviews as necessary. The accredited simulation centers are called ACS‐accredited Education Institutes given their broad scope of activities focusing on skills training, verification, and validation. The accreditation model includes two levels – comprehensive and basic, and there are different standards and criteria for each level of accreditation. The program has grown significantly and now includes 92 ACS‐accredited Education Institutes of which 82 are in the US and 10 in other regions of the world, including Canada, UK, Europe, Middle East, and Latin America. The program continues to grow and there is an annual meeting in Spring each year called the ACS Surgical Simulation Summit that provides opportunities to present scientific work, best practices, and latest advances in surgical simulation. In addition to the representatives from the ACS‐accredited Education Institutes, several other experts participate as well. The program continues to support the needs of practicing surgeons, surgery residents, medical students, and members of surgical teams. The ACS Division of Education looks forward to increasing international participation in this unique and one‐of‐a‐kind network.
Simulated ocular surgery
Authors: Gama Rita 
Published: December 2019

AbstractBuilding cataract and vitreoretinal surgical skills can be challenging and stressful due to a steep learning curve and high stakes for the patient. In addition, most residents have limited exposure to microsurgery in medical school, which can create additional stress. Ophthalmic graduate medical programs have moved toward the integration of virtual simulation technology into resident cataract surgery training. The simulated ophthalmologic surgery courses are a group of three teaching programmes held in Lisbon: “Cataract beginners’ course”, “Video Symposium and Cataract advanced course” and “Vitreoretinal surgery basic course”. These 2 days courses included a group of lectures and “tips and tricks from experts” on the first day. On the second day a monitor was attributed to every trainee for the practical course. Different steps of surgery were trained in the Simulator, Wet‐lab surgery ont the Phillips® artificial eyes and Fluidics on the phacoemulsification system. Eyesi® indirect augmented reality simulator for indirect ophthalmoscopy is also included on these courses. Trainees completed an evaluation sheet before starting the course. A registration form indicating the specific surgical steps to be trained and the selected difficulty level was filled out. A similar evaluation sheet was completed by the monitor for each trainee, and discussion was held at the end of the day between the trainer and the trainee evaluating the day's session. The tool is useful to develop self‐awareness among trainees and to identify gaps, lead active continuous professional development plan, and eventually improve their surgical skills before ever operating on a live patient.
The latest on viral gene therapy
Authors: Arsenijevic Yvan 
Published: December 2019

AbstractIn this presentation, we will discuss the last developments of ocular gene therapy aiming to restore visual functions and protect the retina from different forms of inherited retinal dystrophies (IRD). The issue of disease models will also be addressed, especially for Usher syndrome, for which the vector should target the sensory cells of the cochlea and the retina. In addition to gene therapy for recessive and dominant forms of IRDs and the new perspectives to treat them with CRISPR/Cas9 technology, the development of optogenetic tools will be described. Different strategies to restore function of large mutated genes using minigenes or triple vectors to expand the capacity of AAV vectors will also be exposed. The state‐of‐the‐art of the new developing technologies should help to choose the best available tool to attempt to treat the disease of interest.
Dispelling myths and misconceptions in simulation based education
Authors: Ferris John 
Published: December 2019

AbstractImproving the safety of surgical training is the principle aim of simulation training. Barriers to the introduction of simulation techniques into training programs are the misconceptions that simulation training must be high‐tech and therefore expensive, that it is too time consuming for trainers and that it is only for cataract surgery. This talk will focus on dispelling these myths and misconceptions and to demonstrate how to deliver an affordable simulation training program for all ophthalmic surgical subspecialties. It will also describe how to use a “digital classroom” to deliver high fidelity surgical training without wet‐labs and how this approach is being used to provide remote mentoring of trainees who do not have access to experienced local trainers.
The academic‐industrial complexity
Authors: Levin Leonard A. 
Published: December 2019

AbstractThe transfer of findings from academic laboratories to industry laboratories is frequently difficult (Levin and Behar‐Cohen, Trend Pharmacol Sci 38:1052, 2017). We will discuss strategies to solve the problem, including (1) educating academic researchers and trainees to this issue, teaching them the procedures that are followed by industry laboratories in confirming results such as Good Laboratory Practices (GLP; (2) insuring that results are reproduced by researchers in other laboratories; (3) recognizing the importance of sufficient effect size to drive future development; (4) using a team approach so that the same person is not responsible for the experimental design, performing the experiments, and analyzing the results; (5) improving relations between academic laboratories and industry laboratories by arriving at common uses of positive and negative controls used in experiments between academic and industry laboratories; (7) obtaining financial support to perform the requisite experiments with sufficient numbers of animals and repeat experiments; (8) and incentivizing early partnerships between industry and academia.
Macular interface pathophysiology
Authors: BASTAKIS GEORGE 
Published: December 2019

AbstractThe vitreous body occupies nearly 80% of the total ocular volume. It constitutes a dynamic structure that normally changes composition and formation through time. Vitreous characteristics can also change owing trauma, metabolic or oxidative factors. Physiologically, the process of gradual vitreous liquefaction (synchysis) comes along with the progressive vitreous collagen fibrils packing and aggregation (syneresis). Both synchysis and syneresis can lead to posterior vitreous detachment (PVD) after normal cortex dehiscence from the underlying retina tissue (vitreoretinal interface).In contrast, when the dehiscence process is abnormal (anomalous, incomplete or partial), various pathological conditions can be created on the retina. The pathologies formed specifically on the macular region from the above conditions are named vitreomacular interface diseases (VMID). In this presentation, we will analyse the pathophysiological mechanisms of different VMID like a macular hole (MH), vitreomacular traction syndrome (VTS) and epiretinal membrane (ERM). Moreover, we will present different molecular and cellular components mentioned in the literature and implicated in VMID formation, and we will try to highlight potential future treatment options for the diseases.
Bag‐in‐the‐lens cataract surgery in patients with uveitis
Authors: Van Os Luc 
Published: December 2019

AbstractThe bag‐in‐the‐lens technique involves opening of the posterior capsule and suspension of the implant in both the anterior and the posterior capsulorhexis. This results in a stable, well‐centered lens position and sequesters any remaining lens epithelial cells in a closed space. Postoperative complications such as PCO and capsular fibrosis are thus prevented and additional interventions such as Nd:YAG‐capsulotomy are avoided. This offers a big advantage in uveïtis patients, who are often at a younger age when presenting with cataract. We will describe the technique in detail and discuss the results of the use of the bag‐in‐the‐lens implant in patients with uveitis at the department of ophthalmology of the Antwerp University Hospital.
Artificial intelligence in glaucoma: Assisted diagnosis and risk assessment
Authors: Hemelings Ruben 
Published: December 2019

AbstractRecently, systems of automated or assisted analysis of retinal imaging have emerged for various pathologies, including glaucoma. The development of such deep learned systems (referred to as artificial intelligence) currently requires a large amount of labeled data. This talk will give example strategies on how to overcome this burden by selecting training and validation data in a smart manner. The second part of this presentation will elaborate on glaucoma risk estimation using fundus images.
Clinical pathological correlations in Meretoja corneal lattice amyloidosis
Authors: Mattila Jaakko , Kessel Klaus 
Published: December 2019

AbstractCorneal lattice amyloidosis, previously mis‐designated lattice corneal dystrophy, type II, is the earliest clinical manifestation of gelsolin amyloidosis (Agel), also known as Meretoja syndrome and Familial amyloidosis, Finnish. Agel results from one of two single nucleotide substitutions in gelsolin gene. Although most common in Finland, Agel is found in several countries in North America, Europe, and Asia. We analysed the outcome of penetrating keratoplasty (PK) and distribution of corneal amyloid in a retrospective series of 31 patients (median follow‐up, 32 months). At 2 years after PK, median BCVA was 20/280 versus 20/400 preoperatively; 3/18 eyes had a BCVA ≥20/63 and 13/18 grafts were clear. Graft failed in 16/31 eyes, which resulted from surface complications in 11/16 eyes; 7 eyes were re‐grafted. Corneal neovascularization predicted failure and poor BCVA. To correlate visual results with amyloid deposition, we stained PK specimens from 42 patients with Congo red, and digitally labelled amyloid deposits and stromal tissue on pixel level for training and validation of an automated algorithm to quantify relative amyloid deposition (RAD) and its association with BCVA. Areas of amyloid and stroma detected by the algorithms were displayed on whole slide images (WSI) with a red overlay. We had not enough evidence to either prove or exclude a correlation (Spearman's rank correlation, −0.264, p = 0.091) between RAD and BCVA. It may be that deposition of amyloid in an around Bowman layer rather than the total RAD in the cornea determines the outcome after PK. Because of the failure risk and guarded visual prognosis after PK in Agel, it is reasonable to limit PK to bilateral advanced disease and try to optimize ocular surface health to delay PK.
OCT and OCT‐A in pediatric ocular oncology
Authors: Stathopoulos Christina 
Published: December 2019

AbstractOver the last years, the use of optical coherence tomography in pediatric ocular oncology has become instrumental for the diagnosis and treatment of different tumors, by providing precise location of the lesions and documentation of growth or concomittant complications. In the specific case of retinoblastoma, the most common intraocular pediatric tumor, OCT allows (i) the early detection of new tumors or tumor recurrences, (ii) the monitoring of the treatment response, (iii) the evaluation of the retina and optic nerve status especially in cases of concomitant dense retrohyaloidal or epiretinal seeding and also (iv) the documentation of treatment‐related adverse effects affecting the macula or the choroid. Recently, the use of optical coherence tomography‐angiography has enabled to investigate changes in the foveal microvascular anatomy of different pediatric cases at diagnosis or after various treatments.
Pathophysiology of leakage and the special role of vascular abnormalities in DME
Authors: Schlingemann Reinier 
Published: December 2019

AbstractBreakdown of the inner endothelial blood‐retinal barrier (BRB) in diabetic retinopathy and retinal vein occlusions results in vasogenic edema and neural tissue damage, causing loss of vision. The understanding of the complex cellular and molecular processes involved in BRB leakage has grown rapidly in recent years. Altered BRB function is caused by a change in the permeability characteristics of retinal endothelial cells induced by growth factors such as vascular endothelial growth factor (VEGF) and cytokines. This leads to increased paracellular and transcellular transport across the retinal vascular wall via opening of endothelial intercellular junctions and qualitative and quantitative changes in endothelial caveolar transcellular transport, respectively. Functional changes in pericytes and astrocytes, as well as structural changes in the composition of the endothelial glycocalyx and the basal lamina around BRB endothelium further facilitate BRB leakage. As Starling's rules apply, active transcellular transport of plasma proteins by the BRB endothelial cells causing increased interstitial osmotic pressure is probably the main factor in the formation of macular edema. In addition to these active, regulated and reversible mechanisms of leakage, long standing retinal vascular disease such as diabetic macular edema and retinal vein occlusion may also lead to the formation of vascular abnormalities in the form of telangiectatic capillaries (TelCaps). These are characterized by chronic uncontrolled leakage associated with formation of hard exudates, which may be independent of VEGF and require other forms of treatment such as laser photocoagulation instead of VEGF inhibitors or corticosteroids.
Retinal vessels before and after carotid endarterectomy
Authors: Ala‐Kauhaluoma Marianne 
Published: December 2019

AbstractPurposeTo elucidate short term changes in retinal circulation following carotid endarterectomy (CEA).DesignProspective, non‐randomized, cohort study.Subjects and controlsNine patients were examined before and 5 weeks after CEA. Control group of nine medically healthy subjects was examined at baseline.MethodsAnalysis of clinical ocular findings and aspects of retinal and choroidal circulation included best‐corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment biomicroscopy, fundus photography and dynamic vessel analyzer (DVA) measurements. Central retinal arterial equivalent (CRAE), central retinal vein equivalent (CRVE) and arteriovenous ratio (AVR) were determined from 30° disc centered photographs using semi‐automated software, Vesselmap.Main outcome measuresRetinal circulation as expressed in CRAE, CRVE, AVR and DVA measurements.ResultsPreoperative ipsilateral CRVE was higher when compared to controls and to contralateral eyes: 235.8 μm (199.2–284.7) versus 205.9 μm (149.2–245.9) and versus 222.4 μm (200.7–259.4), p = 0.014 and p = 0.028, respectively. DVA flicker light‐induced venular vasodilatation increased postoperatively in ipsilateral eyes; 2.3% (0.3‐4.1) versus 2.6% (0.7‐5.1); p = 0.028. SFCT and IOP in ipsilateral eyes were comparable to contralateral eyes and controls preoperatively, and remained unchanged postoperatively.ConclusionsAfter CEA, retinal venules in ipsilateral eye appear less dilated indicating normalization in retinal circulation. Furthermore, flicker light‐induced vasodilatation increase, suggesting improved retinal endothelial function postoperatively.
Dynamic and static vessel analyses – background on technology and measurement principles
Authors: Vilser Walthart 
Published: December 2019

AbstractThe superficial retinal vasculature can be directly viewed and assessed by using non‐invasive technologies such as photography and video recording. While single image capture provides only a snapshot in time, video capture allows for observation of vessel dynamics at rest and during stimulation. Changes in the retinal micro‐circulation have been shown to be useful markers of both systemic and ocular vascular conditions. This talk will provide some background on the technology and measurement principles of static and dynamic vessel analysis.
Techniques for graft preparation in DMEK
Authors: Muraine Marc 
Published: December 2019

AbstractDMEK is a surgical technique that is now known by many surgeons and is gradually replacing other surgical techniques in the management of corneal endothelial pathologies. There are currently several different preparation techniques, the most famous and most widely used being the initial technique described by Guerrit Melles. During this procedure, the Descemet membrane is detached using one or two forceps from the periphery. The isolated graft rolls spontaneously with the endothelium outside. It is then aspirated into a glass cartridge before being injected into the anterior chamber. Another preparation technique we have described is to detach the Descemet membrane by hydrodissection after inverting the corneal curvature. It is then possible to roll the graft with the endothelium inside, and mark it easily before inserting it into an injection cartridge. The main advantages are the easier unfolding of the graft and the assurance of positioning it in the right position. A third technique consists in detaching the Descemet membrane by performing a Big Bubble technique but it is not always possible to isolate a graft larger than 7 mm. Whatever the technique, the most important thing for each surgeon is to train regularly in order to choose the procedure that best suits him. There does not seem to be any difference in terms of endothelial cell loss depending on each technique. It should also be kept in mind that the performance of a DMEK is accompanied by a greater number of post‐operative graft detachment and that other endothelial graft techniques should be proposed in case of specific surgical conditions. In addition, the precut techniques proposed by corneal banks are now making the surgical procedure even easier and faster.