bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous corneal perforation in a young patient with vernal keratoconjunctivitis
Authors: Reinhold Aja , Baston Arthur , Della Volpe Maria , Janeschitz‐Kriegl Lucas , Traber Ghislaine , Scholl Hendrik , Gkatzioufas Zisis 
Published: January 2021

AbstractPurposeSpontaneous corneal perforation is a rare complication of systemic diseases with ocular involvement such as Sjögren's syndrome, rheumatoid arthritis, graft‐versus‐host disease or ocular rosacea. There are few cases of spontaneous perforations in adult patients described in the literature associated with keratoconus (KC) or pellucid marginal degeneration (PMD). This case describes a spontaneous corneal perforation in a young patient with vernal keratoconjunctivitis.MethodsCase report.ResultsA 14‐year‐old male patient presented at the Department of Ophthalmology accompanied by his parents due to one day existing redness and hazy vision of the left eye (OS). Additionally, he noticed a sudden “water outflow from the left eye.” The patient's medical history includes vernal keratoconjunctivitis, systemic prediabetes, obesity and steatohepatitis. Slit‐lamp examination of the left eye revealed a spontaneous corneal perforation of 1.4 × 1.8 mm inferonasal with iris tamponade and a surrounding corneal melting of 4 mm. The anterior chamber had been totally flattened. The right eye was diagnosed by slit‐lamp examination with central corneal thinning and inferior peripheral vascularization. The corneal perforation was primarily treated with histoacrylic tissue glue. Antibiotic treatment with Ceftazidime and Moxifloxacin eye drops alternating every hour has been established. After one week, a progressive corneal melting in the area of the primary corneal perforation was observed. Therefore, a patch “keratoplasty à chaud” had to be performed. The postoperative course was devoid of complications. The patient was initially treated with Pred forte eye drops 4 times daily. An optical penetrating keratoplasty is planned.ConclusionsSpontaneous corneal perforation is an extremely rare but severe complication of vernal keratoconjunctivitis, which can also occur in young patients. Ophthalmologists should be aware of this rare complication and inform and treat their patients accordingly.
Assessing clinical evidence for idebenone in the treatment of chronic Leber Hereditary Optic Neuropathy: a systematic literature review
Authors: Carlot Sara , Amadasi Alessio , Bianchi Francesco , Lloria Xavier 
Published: January 2021

AbstractPurposeLeber Hereditary Optic Neuropathy (LHON) is a mitochondrial genetic disorder causing severe, bilateral loss of visual acuity (VA). Idebenone is the only treatment for LHON currently approved in Europe. Due to the rarity of the disease, information about outcome in patients starting treatment >12 months since disease onset in the most recent eye (chronic LHON) is scarce.MethodsThe search for clinical evidence included any published study or conference abstract evaluating oral idebenone at the approved dose of 900 mg/day, in patients with confirmed diagnosis of LHON starting treatment >12 months since disease onset in the most recent eye. Literature search was carried out on Medline, Embase, InsightMeme and Cochrane Libraries up to March 2020.ResultsEvidence for idebenone treatment of chronic LHON is based on four uncontrolled, retrospective case series and one post‐hoc analysis of a randomized controlled study. All studies included patients (n = 4–53) with confirmed primary LHON mutations and evaluated changes in VA with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The post‐hoc analysis (n = 53, idebenone:34; placebo:19) assessed efficacy as rate of clinically relevant recovery (CRR; defined as improvement from off‐chart to reading five letters, or improvement of 10 letters) from baseline (BL) after 6‐month therapy. 35.3% of idebenone‐treated versus 10.5% of placebo patients achieved CRR (p = 0.059); by eyes: 23.5% versus 5.3% (p = 0.016). All 4 retrospective studies (n = 4–16) assessed efficacy as average VA improvement (all eyes) from BL after 9 to 12 months of therapy. Improvements ranged from −0.20 to −0.31 logMAR (2–3 ETDRS lines). One retrospective study compared the effect of idebenone in two subgroups according to time from LHON onset (1–5 years, n = 7; >5 years, n = 8) showing no difference between groups.ConclusionsData presented indicates a potential therapeutic effect of idebenone in chronic LHON patients, which may be explained by the reactivation of dysfunctional retinal ganglion cells and deserved further investigation.
Light‐field imaging for glaucoma diagnosis—reproducibility on one patient
Authors: Dietzel Alexander , Schramm Stefan , Link Dietmar , Klee Sascha 
Published: January 2021

PurposeA suspicious optic nerve head appearance with abnormal cupping or increased cup‐to‐disc ratio is considered as a strong risk factor for glaucoma. Typical systems to measure this deformation are optical coherence tomography or scanning laser ophthalmoscopy. We show that the needed depth information for glaucoma diagnosis can be obtained reliably with a commercial fundus camera using an adapted light‐field camera providing a one‐shot 3d retinal image.MethodsWe examined the left eye of a glaucoma suspect (male, 39 years) 11 times in compliance with the Declaration of Helsinki. For each examination, the glaucoma suspect repositioned himself and the device was readjusted. The images were taken with a fundus camera (FF450, Carl Zeiss Meditec AG) combined with a modified light‐field camera (Raytrix R12, Raytrix GmbH). The eye was illuminated with a wavelength of 520 nm (±20 nm). The absolute virtual depth (VD) values were exported from the Raytrix software (RxLive 5.0, Raytrix GmbH) and further processed in Matlab R2018. All data were aligned to each other to measure at similar locations. The maximum VD on a vessel segment above the rim and the minimum above the root of the vessel inside the optic nerve head was determined to calculate the depth difference.ResultsAll images showed a clearly identifiable optic nerve head structure and allowed a successful and reliable determination of the depth information. The average relative depth difference over all examinations was 6.1 ± 0.34VD. The 95% confidence interval was between 5.86 and 6.34VD. Besides the depth values also the lateral values are virtual because of an aperture mismatch between fundus camera and light‐field camera. A successful depth estimations of the Raytrix software require high contrast images with textures. Caused by the objective of the fundus camera image distortions existed.ConclusionsThe presented results from our preliminary system show the potential of the light‐field technique to be used for glaucoma diagnostics and progression analysis based on the optic nerve head in 3D. Reliable and reproducible measurements of this technique can enhance the informative value of the classical fundus photography.
Clinical outcomes of trabecular microbypass stent (iStent®) implantation in medically controlled open‐angle glaucoma in the Korean population
Authors: Lim Suho 
Published: January 2021

PurposeTo evaluate the safety and efficacy [intraocular pressure (IOP)‐lowering effect and medication use] of a single trabecular microbypass stent (iStent®; Glaukos Corp., San Clemente, CA, USA) for medically controlled open‐angle glaucoma.MethodsThis retrospective case‐series included 42 eyes of 34 patients with medically controlled open‐angle glaucoma with IOP less than 21 mmHg. Clinical outcomes analyzed were IOP, medication use, corrected distance visual acuity (CDVA), and surgical complications. Surgical success was defined according to three criteria: (A) IOP <21 mmHg without medication; (B) IOP <18 mmHg without medication; and (C) IOP <18 mmHg with or without medication. Patients were followed for a minimum of six months postoperatively.ResultsMean IOP was reduced from 15.8 ± 2.8 mmHg to 14.5 ± 2.8 mmHg (p < 0.001), while mean number of medications decreased from 2.2 ± 1.2 to 0.8 ± 1.1 at final visit (p < 0.001). Surgical success rates were 78.6%, 61.9%, and 97.6% at six months and 78.6%, 59.5%, and 95.2% at final visits according to criteria A, B, and C. Meanwhile, 59.5% of patients were medication‐free at their final visit. The relative risk of surgical failure by Criterion B was 4.337 (95% confidence interval:1.799–10.454) times greater in the higher‐medication group (three or more preoperative medications). CDVA was significantly improved from 0.41 ± 0.10 to 0.09 ± 0.07 LogMAR in the combined phacoemulsification and iStent® implantation group (p < 0.001). There was no case whose vision was threatened (vision loss of two or more lines) or who showed severe complications after surgery.ConclusionsSingle trabecular microbypass stent implantation was effective in reducing IOP and medication usage in patients with open‐angle glaucoma with a low preoperative IOP. Our results imply that it is more difficult to achieve low target IOP control in eyes with higher numbers of preoperative medications.
Fight the silent thief of sight: glaucoma incidence in citizens of Sassari
Authors: Murgia Umberto , Brunoro Andrea 
Published: January 2021

PurposeTo identify the silent thief of sight in asymptomatic citizens of Sassari and assess the importance of the screening in glaucoma.MethodsSeven ophthalmologists performed free specialist examinations and included 322 asymptomatic subjects from 40 to 80 years. All volunteers attended the screening with assessment of intraocular pressure (IOP, air‐puff tonometer TX‐f Canon) and optic disc evaluation by fundus biomicroscopy. Subjects with optic nerve cupping underwent retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness examination (i‐Vue OptoVue OCT).ResultsSubjects with a diagnosis of hypertension or treated for glaucoma were excluded. Of the total 322 volunteers included, 23.6% had glaucoma familiarity, 8.7% declared that the screening was the first ophthalmological visit and 55,28% stated that they had never been examined with tonometry before. IOP was >21 mmHg in the 7% and optic disc showed abnormal cupping in 6.8% of the volunteers. The 2.48% of the subjects had both ocular hypertension (IOP>21 mmHg) and papillary abnormalities, and 7.4% of the 27 OCT performed showed anomalies.ConclusionsGlaucoma is one of the leading causes of irreversible blindness, but early detection and treatment could prevent severe vision loss. For these reasons, glaucoma screenings are fundamental even though they could have limited diagnostic power. In fact, subjects with OCT anomalies were directed to further examinations. The results of this screening are quite impressive, most of all the 8% of patients declaring that they had never underwent an ophthalmological visit and the 55% of patient that undertake a tonometry for the first time. The discrepancy between these data stresses the importance of a regular ophthalmological examination that is still confused with the visual acuity assessment made by opticians. Only a complete ophthalmological visit can diagnose conditions affecting irreversibly the vision, such as the silent thief of sight.
Geometric mapping of the eye lens and its epithelium reveals changes that accompany emmetropia
Authors: Quinlan Roy , Kalligeraki Alexia , Uwineza Alice , Jarrin Miguel 
Published: January 2021

PurposeTo investigate changes in both lens shape and the epithelial distribution as emmetropia is established in C57Bl6J mice between postnatal weeks 4 to 6.MethodsWe used a computational approach to produce geometrical maps of the mouse lens and its epithelium. Conveniently our approach ulitises data collected from intact lenses imaged using a conventional laser scanning confocal microscope. It delivers cartesian coordinates for every epithelial cell in the lens epithelium. We chose to investigate lenses during postnatal weeks 4 to 6, a time during lens development when emmetropia is established in this inbred strain of mice (Tkatchenko et al., 2010).ResultsGeometric mapping standardises the measurement and analysis of lens epithelial cell densities. Emmetropia is established in C57Bl6J inbred mice, but many other strains exhibit considerable refractive error (Tkatchenko et al., 2019). The eye lens plays its part in the development and establishment of emmetropia in mice (Tkatchenko et al., 2010; Pardue et al., 2013). We record a change in the shape of the eye lens from a spheroid to a lentoid shape between postnatal weeks 4 and 6. The distribution of the epithelial cells in the lens epithelium also changes from a non‐zonal to a zonal distribution, with characteristics that typify the epithelia of adult animals. We correlate these observations regarding lens geometry with genetic mutations in lens cytoskeletal proteins found in those strains that present with refractive error, but which are absent from C57Bl6J (Sandilands et al., 2004). We discuss the potential significance of these observations in the context of the mechanistic basis of the lens contribution to emmetropia.ConclusionsThe development of emmetropia in the C57Bl6J inbred strain of mice correlates with changes in epithelial cell organisation and changes in lens geometry, which when combined with strain‐specific genetic differences offer a mechanistic understanding involving the lintermediate filament cytoskeleton.Pardue, M. T., et al., (2013) Exp Eye Res, 114, 96–105.Sandilands, A., et al (2004). Eye Res. 78, 109–123.Tkatchenko, T. V. et al. (2019). BMC Medical Genomics, 12, 1–24.Tkatchenko, T. V., Shen, Y. and Tkatchenko, A. V. (2010) Invest Ophth Vis Sci, 51, 21–27. https://doi.org/10.1167/iovs.08‐2767
Treatment of complex macular holes using a large disc of trypan blue stained‐lyophilized amniotic membrane: a 10 cases series with 1‐year follow‐up
Authors: Garcin Thibaud , Gain Philippe , Thuret Gilles 
Published: January 2021

AbstractPurposeTreatment of complex macular holes (MH) is challenging. The use of amniotic membrane (AM) has been described but is not yet codified, and we need to collect more cases.AimTo describe tips and tricks for the use of a large patch of lyophilized AM (lAM) in this indication.MethodsConsecutive 10 cases series: two patients with severe MH‐induced rhegmatogenous retinal detachment (RRD), three with recurring RRD + persistant MH, five with persistant MH after inner limitant flap. Our IRB approved the study and all patients signed an informed consent. lAM (Visio Amtrix, TBF) was chosen because of its availability, easy handling, thinness and transparency. A 3‐ to 4‐mm diameter disc was trephined with a disposable punch, stained with 0.06% Trypan Blue (after a first failure due to poor visualization of an unstained lAM) and rinsed with BSS. Stained lAM were inserted through a 23G sclerotomy using a standard perfusion catheter and unfolded on top of the MH using a forceps and a backflush needle. Tamponade was done with gas (17% C2F6, Arceole; n = 6) or heavy silicone (Densiron 68, Fluoron; n = 4) depending of the case. Routine follow‐up was done for 12 months, including SD‐OCT (Spectralis, Heidelberg) and color fundus photography (CR2‐AF, Canon).ResultsTen eyes of 10 patients of 62 ± 9 years with preoperative mean BCVA 1/80 (1.9 logMAR) and a mean minimal MH diameter of 942 ± 333 μm underwent surgery. The blue staining disappeared within 15 days. Anatomic success occurred for all patients: six/10 were closed, four/10 had reduced diameter. BCVA improved in all cases. The five RRD were reattached without recurrence. Apart one failure (lAM left unfolded) with migration at day 1 and MH closed with central scar, no secondary displacement of the patch occurred.ConclusionsA large patch of lAM seems a new method to cure complex MH in different situations. Trypan blue staining is, in our hand, absolutely necessary to allow correct positioning. Complete unfolding seems also required to allow good adherence over the MH.
Temperature monitoring in vitreoretinal surgery
Authors: Anatychuk Lukyan , Pasyechnikova Nataliya , Naumenko Volodimir , Kobylianskyi Roman , Nazaretyan Rudolf , Zadorozhnyy Oleg 
Published: January 2021

AbstractPurposeTo study the dynamics of epibulbar and intraocular temperature during vitreoretinal surgery.MethodsThis pilot study included 20 patients with rhegmatogenous retinal detachment (10 eyes) and proliferative diabetic retinopathy (10 eyes). All patients underwent vitreoretinal surgery with room temperature irrigation solution. In all cases, the ambient temperature, the patient's body temperature, the temperature of the irrigating solution, temperature in the anterior, mid‐ and posterior vitreous were recorded during surgery. Pre and post‐operative thermometry was also performed on the outer ocular surface.ResultsDuring vitreoretinal surgery with room temperature (24.2 ± 0.52°C) irrigation solution, a decrease in temperature (p < 0.001) versus the initial one was found in all segments of the vitreous cavity. In the absence of continuous irrigation, a rapid rewarming of the vitreous cavity was noted (an average of 0.18°C per minute). Our study also demonstrated the presence of regional hyperthermia of the operated eye in a number of patients (25%) in the post‐operative period.ConclusionsCurrent research shows that vitreoretinal surgery is performed under conditions of uncontrolled local ocular hypothermia is characterized by a rapid uncontrolled rewarming of the vitreous cavity after cessation of cooling, and in the post‐operative period, local hyperthermia of the operated eye is observed in a number of patients.
Leber's Hereditary Optic Neuropathy‐like syndrome in heteroplasmic mitochondrial mutations
Authors: Chan Jane , Sadun Alfredo 
Published: January 2021

AbstractPurposeLeber's Plus syndromes have been well described in the literature. Intriguingly, an opposite effect occurs when heteroplasmy with more severe mitochondrial mutations present with an Leber's Hereditary Optic Neuropathy (LHON)‐like visual loss at a later age of onset. The small, unmyelinated papillomacular bundle (PMB) fibers are selectively affected first in these heteroplasmic mitochondrial mutations.MethodsCase report.ResultsTwenty‐year‐old woman with subacute bilateral sequential visual loss (CF @2 feet OD; 20/400+1 OS, no RAPD; central scotoma OU; temporal disc pallor OU; superior, temporal, and inferior RNFL thinning OU; diffuse GCL/IPL thinning OU) presented with an LHON‐like syndrome with a non‐LHON mutation, a pathogenic variant in MT‐ND3 m.10197G>A (p. Ala47Thr) with 51% heteroplasmy. Idebenone and vitamin C resulted in mild visual improvement.ConclusionsWe hypothesize that an LHON‐like presentation can be a form fruste of more severe heteroplasmic pathogenic mitochondrial mutations at a later age of onset, irrespective of the mitochondrial DNA (mtDNA) mutation type. Other factors can play a role in the clinical phenotype, including DNA haplotype, nuclear genetic background, environmental factors, etc. Although the mtDNA 10197G>A mutation has been associated with Leigh syndrome (LS), LHON/dystonia (LDYT), and MELAS/LS overlap syndrome,1 our 20‐year‐old woman had only LHON‐like visual loss at the onset of presentation. In all cases, the PMB is most vulnerable to oxidative damage.2 Although these mtDNA mutations affect different ND subunits of complex I, some electrons seem to be transferred through a parallel pathway to complex II, as shown in cybrid studies.3References1. Leng Y, et al. The mitochondrial DNA 1019 G > A mutation causes MELAS/Leigh overlap syndrome presenting with acute auditory agnosia. Mitochondrial DNA. 2015; 208‐212.2. Pan BX, et al. Mathematically modeling involvement of axons in Leber's hereditary optic neuropathy. Invest Ophthalmol Vis Sci. 2012; 53: 7608–7617.3. Caporali L, et al. Cybrid studies establish the causal link between the mtDNA m.3890G>A/MT‐ND1 mutation and optic atrophy with bilateral brainstem lesions. Biochim Biophys Acta. 2013; 1832: 445–452.
Second primary neoplasms in patients with primary orbital lymphoma: a population‐based study 1992 to 2016
Authors: Tadrosse Abanoob , Mikhael Sandra , Tadrosse Marina , Tadrosse Mark , Langer Paul D. 
Published: January 2021

AbstractPurposeTo investigate, in a population‐based study, the risk of developing second primary neoplasms (SPNs) after a diagnosis of primary orbital lymphoma (OL).MethodsData on a cohort of patients with a diagnosis of primary OL as their first malignancy were extracted from the Surveillance, Epidemiology, and End Results US registry from 1992 to 2016. Observed‐to‐expected ratio of developing SPNs was calculated to estimate relative risk (RR) and associated 95% confidence interval (CI), which were compared to a reference population (RP) matched for age, sex, race, and calendar year.ResultsA total of 1063 patients with primary OL were identified, 14% of whom developed SPNs. Mean age at OL diagnosis was 66 years old, while that at a SPN diagnosis was 74. There was a significant 20% excess risk of SPNs development in OL patients compared to the RP (p < 0.05). Two to 11 months after OL diagnosis, there was an increased risk of respiratory tract malignancies [RR: 3.2 (95% CI: 1.2–6.9); p < 0.05], while 10–15 years after diagnosis, there was an increased risk of colorectal cancer [RR: 3.0 (95% CI: 1.1–6.4); p < 0.05]. Stratification by sex revealed an increased risk of prostate cancer development in males [RR: 3.4 (95% CI: 1.1–8.0); p < 0.05]. Patients aged 40–59 years old experienced the greatest burden of SPNs with a significant 46% excess risk compared to the RP (p < 0.05). Radiotherapy‐treated patients were at a higher risk of thyroid SPNs [RR: 3.8 (95% CI: 1.04–9.6); p < 0.05].ConclusionsPatients with primary OL experience a 20% increased risk of SPNs compared to the RP. Two to 11 months and 10–15 years after OL diagnosis mark an increased risk of respiratory tract and colorectal SPNs, respectively. Male OL patients tend to more readily develop prostate malignancies than the RP. Patients 40–59 years old display the highest risk of SPNs. Radiotherapy is associated with an increased risk of developing thyroid neoplasms. Patients who are diagnosed with primary orbital lymphoma should be followed with these risks in mind.BibliographySurveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 8.3.6.1.
OCTA parameters of the peripapillary retina and optic disk in older age group
Authors: Ioyleva Elena , Safonenko Alexandra 
Published: January 2021

AbstractPurposeTo investigate the OCTA parameters of the peripapillary retina and optic disk in Caucasian people of an older age groupMethodsThirty‐four patients (68 eyes), 14 male and 20 female, mean age 57.1 ± 9.6 were examine. All patients underwent OCT and OCTA examination (RTVue‐XR, Optovue), by using protocol ‘HD Angio Disk’ 4.5*4.5 mm. OCT and OCTA were used to measure the radial peripapillary capillaries (RPC, %) and retinal nerve fiber layer thickness (RNFL, µm), rim area, disc area, cup volume.ResultsMean value of the RNFL thickness was 109.7 ± 11.1 µm. The lower value of the RNFL thickness was observed in ‘Tempo Inferior’ and ‘Tempo Superior’ segments. Rim area was 1.66 ± 0.33 mm2, disc area—1.87 ± 0.28 mm2. The mean value of RPC density in peripapillary retina was 52.2 ± 2.3%. The lower value of the RPC density was in ‘Nasal Inferior’ and ‘Superior Nasal’ segments, 48.9 ± 3.2% and 49.9 ± 3.1%, respectively.