bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Royal College of Ophthalmologists and surgical training evolution in the UK
Authors: Spencer F. 
Published: September 2017

SummaryThe Royal College of Ophthalmologists (RCOphth) sets the curriculum and standards for surgical training in the UK; this receives approval from the General Medical Council. The evolution of surgical training will be presented.A microsurgical skills course, in simulation, prior to commencing live surgery has been mandatory for more than 7 years. A new strategy to increase simulation in all surgical subspecialties was initiated in 2014. This included the development of a curriculum for simulation with recommendations and resources published since 2015.Increasing availability of inexpensive options for simulation has allowed this to be available in all UK regions and to be considered mandatory in the required surgical competencies in the curriculum.Recent developments have included the introduction of Entrustable Professional Activities, or EPAs, to demonstrate the ability to manage an entire surgical list, demonstrating planning, teamwork and communication in addition to surgical technique. This also highlights the importance of considering simulation in communication skills or immersive simulation techniques.
Traditional immunesuppressive therapy: is there something we should know further?
Authors: Pichi F. 
Published: September 2017

SummaryThe cornerstone of management of ocular inflammatory disease historically has been corticosteroids, which are invaluable in the immediate control of inflammation; however, corticosteroids are inappropriate for long‐term use as they are associated with a wide array of toxic side effects. As we continue to learn more about the various etiologies and elucidate the basic science pathways and mechanisms of action that cause intraocular inflammation, new therapeutic approaches have evolved. They include employment of immunomodulatory agents (corticosteroid‐sparing therapies) that have expanded our treatment options for these vision‐threatening diseases. These pharmacologics provide therapy for ocular and systemic inflammation in an individualized, patient‐tailored, stepladder approach with the ultimate goal of durable, corticosteroid‐free remission.
The role of electrophysiology
Authors: Holder G. 
Published: September 2017

PurposeTo demonstrate the role of electrophysiological assessment in the investigation and management of the patient with photophobia, or whose vision is worse under bright lighting conditions.MethodsStandardised (ISCEV standard) techniques for electrophysiological assessment will be described, as will any necessary non‐standard protocol additions.ResultsSelected cases will be used to illustrate the value of the objective data provided by electrophysiology. The electrophysiological data will be discussed in association with the results of relevant imaging modalities.ConclusionElectrophysiological assessment provides objective functional data important to the diagnosis and management of this group of patients.
LHON: A look into nuclear and environmental factors; What is “sufficient”?
Authors: Sadun A. , Ross‐Cisneros F. , Tian J. , Anderson K. , Irvine A. , Karanjia R. , La Morgia C. , McManus M. , Wallace D. , Carelli V. 
Published: September 2017

PurposeIn Leber's Hereditary Optic Neuropathy (LHON) mutations of the mtDNA, are necessary but not sufficient for visual loss. We studied nuclear/environmental interactions in patients and in the Wallace LHON mouse model, to consider what is “sufficient”. The LHON mutation causes a modest decrease in ATP production, but a large increase in ROS production. Nuclear genetic and environmental factors may play upon these factorsMethodsWe noted in the data of Kirkman et al (Brain 2009) that heavy smoking mitigated visual loss by delaying disease onset. We reproduced these peculiar results (Carelli et al, Brain 2013). We also studied the ND6 mutant Wallace mouse model of LHON. 30 mice of 12 groups were sacrificed at 23 months including ND6 mutant vs ND6 wildtype and nicotinamide nucleotide transhydrogenase‐NNT +/+ vs ‐/‐ (NNT deletion), under different environments of air and smoke. 10 experiments compared the axonal nerve fiber spectrums.ResultsIn our patient pedigrees, heavy smoking also mitigated visual loss, but we saw in this, the existence of two subtypes of LHON. Type I, with an abrupt and severe loss of vision in the teens, was characterized by severe losses of both structure and function. Type II occured decades later with a more insidious onset, with less structural than functional loss. Type II patients were more likely to smoke. In the mice, we found the predominant loss of small fibers in NNT −/− mice carrying the ND6 mutation which were exposed to smoke.ConclusionsBoth nuclear modifiers and environmental factors in combination with LHON mutations can lead to vision loss. NNT is a transhydrogenase that couples hydride transfer from NAD(H) to NADP(+) and proton translocation across the inner mitochondrial membrane. NNT is potentially an important nuclear modifying gene for LHON.
Adaptive optics retinal imaging in patients with GNAT2 mutations
Authors: Georgiou M. , Kalitzeos A. , Michaelides M. 
Published: September 2017

PurposeTo investigate the retinal structure in three subjects, from two pedigrees, with molecularly confirmed GNAT2 gene mutations with heterogeneous phenotype.MethodsSpectral Domain OCT (SD‐OCT) scans and custom‐built Adaptive Optics Scanning Laser Ophthalmoscope (AOS0LO) sequences were acquired after full ophthalmological examination, ERG and colour vision testing twice, 1‐2 years apart. The foveal outer nuclear layer (ONL) retinal thickness was measured using Bioptigen SD‐OCT; 120 B‐scans were acquired with a 7mm nominal scan width, aligned, registered and averaged in ImageJ. A 5‐pixel wide longitudinal reflectivity profile provided the distance between the internal and external limiting membrane. Peak cone density and inter‐cone spacing were measured at 0.5 degree from the fovea using confocal AOS0LO images. Voronoi analysis was also performed.ResultsHardy‐Rittler‐Rand plates suggested normal colour vision in one of our subjects. Conversely, the colour vision test for the other two subjects (from the other pedigree) suggested colour blindness. All three subjects had non‐detectable cone ERG. The peak para‐foveal density varied from 30 543 to 50 943 cones/mm2 and was significantly lower than previously reported values for unaffected subjects at 168 162 ± 23 529 cones/mm2 (mean ± SD). Voronoi diagrams revealed the heterogeneity of the cone mosaic with only 44% ‐ 53% of photoreceptors having six neighbouring cells. The ONL thickness was variable and due to the small sample size no conclusion could be drawn.ConclusionsMicroscopic retinal imaging allowed photoreceptor visualisation and quantification. It can play a significant role in a multimodal investigation, including functional and structural measurements for an in depth phenotyping of GNAT2 gene, implicated in achromatopsia and other inherited retinal diseases.
Pathophysiology of macular interface
Authors: Kalemaki M. 
Published: September 2017

PurposeTo study the pathophysiology of the vitreomacular interface disorders (epiretinal membrane, macular hole, vitreomacular traction syndrome).MethodsRetrospective review of published articles concerning the above entities.ResultsPosterior Vitrous Detachement (PVD) variations have been considered to be the initial event leading to vitreomacular interface abnormalities. Depending on the level of PVD (eg schisis, partial or complete), different pathophysiological cataracts may occur involving a number of cells and growth factors at the vitreomacular interface.ConclusionsThe pathophysiology of the vitreomacular interface includes a sequence of events such as cellular migration, proliferation and modulation of the extracellular matrix. The quality and quantity of the involved cells and growth factors vary between different vitromacular interface disorders.
The particularities of corneal infectious diseases in children
Authors: Bremond‐Gignac D. 
Published: September 2017

SummaryCorneal infections in children can affect subjects of all ages with a high frequency in newborns and infants. In infant, children and teenagers the most common ocular pathogens, that differ from the adult, are Haemophilus Influenzae, Staphylococcus aureus, Streptococcus pneumonia and also Moraxella species. These infections could lead to ulcers and sight‐threatening complications. Infectious keratitis in children is not common but can cause a severe visual impairment if late diagnosed with delayed treatment established or with weak efficacy. In children corneal infections can be difficult to diagnose because the pathology can develop without pain. In addition, the examination may be difficult to perform. Identification of the pathogen must be performed as far as possible. The treatment should be provided earlier and aims to eliminate the bacteria, virus or fungus pathogens. Specific epidemiology of pathogens will be detailed according to age. Risks of visual impairment and amblyopia must be integrated. An update on topical antibiotics and current options will be reviewed with practical aspects, diverse clinical cases and considering quality of life of children and parents.
Inflammatory biomarkers of the tear proteome in anterior segment disease
Authors: Beuerman R. , Zhou L. 
Published: September 2017

SummaryOcular surface inflammation is linked to a number of adverse outcomes which vary depending on adjunct factors such as recent surgery or presence of disease. Usually the level of inflammation is thought to be important in the evaluation. However, from a clinical point of view there are limited methods of evaluating inflammation. Proteomics allows the simultaneous accurate quantification of a large number of proteins associated with inflammation using just a few microliters of tears so that individual patients can be evaluated. For example, studies have shown several members of the S100 family of proteins which are contain 2 EF hand calcium binding motifs to be upregulated in dry eye and pterygium. The S100 proteins can bind to RAGE receptors on immune cells to stimulate further inflammation. Other proteins associated with inflammation include various heat shock proteins such as HSPA8, 70 kDa protein. YWHAZ is found which is associated with cell injury and may be directly related to the type of pathology. Thus, using proteomics a more complete picture of the ocular surface inflammation can be developed and used to predict clinical outcomes.
Cornea and lacrimal gland synergy, a corner stone for a healthy vision
Authors: Michon F. 
Published: September 2017

SummaryA disturbed tear film secretion results in an ocular dryness, which can induce a corneal opacification. Interestingly, few studies have correlated the cornea renewal to the LG secretion. Nonetheless, our preliminary data suggested that LG secretion changes from birth to the eyelid opening, happening two weeks after birth in mouse. We have investigated the transcriptomic signature of the LG and cornea in embryonic, postnatal (eyelid closed) and adult animals. This analysis confirmed that the LG secretes morphogenetic factors (IGF2, HGF, EGF, KGF), while not expressing the receptors. Interestingly, the cornea epithelium expresses the corresponding receptors, but not the ligands. Moreover, the secretion of these factors is peaking prior the eyelid opening, correlating to an intense proliferation in the cornea epithelium. Moreover, the changes of secreted factors shortly after cornea wounding demonstrate a direct regulatory loop between the two organs modulating the tear composition. Our data provide a new research avenue for the development of tear film biomimetic enhancing the corneal healing.
Tips and tricks in open globe injuries (management of intraocular foreign bodies)
Authors: Durukan H. 
Published: September 2017

SummaryTraumatic open globe injuries with intraocular foreign bodies (IOFBs) may result in severe visual loss depending on a number of factors including elevated risk for endophthalmitis, toxicity to the IOFB material, and postoperative proliferative vitreoretinopathy. Surgical removal of an IOFB is perhaps the most unpredictable surgery, especially in the presence of media haze, requiring intense preoperative workup and patient counseling. There is still significant controversy in the management of IOFBs, particularly the timing and method of surgery. The purpose of this topic is to familiarize clinicians with the recent advances in diagnosis and management of such injuries.
OCT and vitreomacular interface
Authors: Pournaras J.A. 
Published: September 2017

SummaryNowdays, OCT examination is currently available and offers many insights for the management of vitreomacular interface disorders. We will review carefully the natural history of these disorders nicely described by OCT images. Furthermore, mainly after surgery, this examination play an important role in the followup of those patients and will be presented. At the first visit, correct recognition of the alterations of vitreomacular disorders helps clinicians to predict the visual prognosis of the patients.
Acquired retinal disease
Authors: Holder G. 
Published: September 2017

SummaryThis lecture will address the role of electrophysiological testing in the diagnosis and management of acquired retinal disease. Topics will include toxic, vascular, inflammatory and autoimmune disorders. The functional data provided by electrophysiology will be combined with the structural data from various imaging modalities to show that the optimal management of the patient requires knowledge both of structure and function.
Paediatric applications
Authors: Thompson D. 
Published: September 2017

SummaryThe International Society for Clinical Visual Electrophysiology of Vision, [ISCEV], publishes standards for performing five clinical visual electrophysiology tests; ffERG, mfERG, PERG, VEP and EOG, (www.ISCEV.org/standards). Older and co‐operative children tolerate these adult standard protocols well. Less compliant, younger infants, children with systemic as well as ocular disease or those with learning difficulties can benefit from adaptations that account of visual system maturation, make the test time shorter and the test experience less stressful. This talk will describe the key maturational changes and their impact on ERGs and VEP waveforms. Ways of combining and modifying tests for alert infants will be described that account for visual pathway development and limited tolerance. These will include the effects of anaesthesia, choice of electrodes and stimulation techniques. Case examples will be presented to show how visual electrophysiology maybe used to diagnose retinal dysfunction and to monitor visual pathway dysfunction in children.
Novel pathophysiological mechanisms in dominant optic atrophy beyond the mitochondrial dynamics equilibrium
Authors: Lenaers G. , Charif M. , Amati‐Bonneau P. , de la Barca J. Chao , Procaccio V. , Chevrollier A. , Leruez S. , Bonneau D. , Reynier P. 
Published: September 2017

SummaryInherited Optic Neuropathies are blinding diseases related to mitochondrial dysfunctions in retinal ganglion cell (RGC). There are two main forms: the Leber Hereditary Optic Neuropathy (LHON) related to mutations in the mitochondrial genome, and the Kjer dominant optic atrophy (DOA) related to mutations in nuclear genes. Since the initial discovery of the OPA1 gene in 2000 as the major gene causing DOA, the use of WES and re‐sequencing chips disclosed many novel genes responsible for DOA. Beyond genes recently identified involved in mitochondrial dynamics, we identified novel candidate genes crucial for RGC physiology. Using patient fibroblasts, we analyzed the consequences of their mutation on mitochondrial physiology and metabolism. Altogether, these data are shedding novel lights on DOA pathophysiology, beyond mitochondrial dynamics, as novel culprit mechanisms responsible for RGC degeneration, which should condition the design of future therapeutic approaches.
β‐catenin activation in conjunctival melanocytic proliferations
Authors: Larivé E. , Nicolas M. , Schalenbourg A. , Zografos L. , Moulin A. 
Published: September 2017

PurposeConjunctival and cutaneaous melanoma partially share similar genetic alterations. β‐catenin is a dual‐function protein that acts not only as a structural component of adherens junctions but also as an effector molecule involved in the Wnt pathway. In skin melanoma, in vitro activation of the Wnt pathway led to nuclear localization of β‐catenin and increased invasiveness. We investigated the expression and activation of β‐catenin in benign and malignant conjunctival melanocytic proliferations.Methodsβ‐catenin expression was assessed by immunohistochemistry in 43 conjunctival naevi, 48 PAM (including 23 PAM with atypia) and 44 conjunctival melanomas as well as in 4 conjunctival melanoma cell lines at various stages of confluence. Statistical analysis was performed with JUMP 8.0 software.ResultsIn the naevi, membranous expression of β‐Catenin was found in all the cases and nuclear expression in 14% of the cases. In the PAM, membranous expression of β‐catenin was identified in all the cases without nuclear expression. Membranous expression of β‐catenin in melanoma was found in 94% of the cases and nuclear expression in 15.9% of the cases. There were no significant differences in the nuclear expression of β‐catenin between conjunctival nevi and melanoma. In the melanoma group, there was a significant correlation between nuclear expression of β‐catenin and depth of invasion. In the 4 conjunctival melanoma cells lines, no significant nuclear expression of β‐catenin was identified at various stages of confluence.Conclusionsβ‐catenin activation and nuclear localization does not appear to be a major mechanism occurring in conjunctival melanoma. It is however possible that β‐catenin activation might occur at a late stage in tumor development.
Primary human choroidal melanocytes express functional Toll‐Like Receptors (TLRs)
Authors: Cioanca V.A. , McCluskey P.J. , Madigan M.C. 
Published: September 2017

PurposeHuman choroidal melanocytes (HCMs) are an abundant heterogeneous, melanin‐containing population of cells within the vascular uveal tract. Toll‐like receptors (TLRs) are pattern recognition receptors involved in the innate immune response against phylogenetically conserved microbial components. Immune cells are established to express TLRs and more recent studies showed TLR expression on non‐immune cells including corneal and conjunctival epithelia, retinal microglia and RPE, iris pigment epithelium, and skin melanocytes. The expression of TLRs on uveal melanocytes however remains to be investigated.MethodsHCMs were isolated and cultured from donor human eyes. TLR1‐10 and MYD88 (a critical adaptor protein in the TLR signalling pathway) expression was investigated using RT‐PCR and confirmed by immunocytochemistry. The production of IL‐8 and CCL2 in response to TLR agonists was measured by ELISA.ResultsHCMs constitutively expressed TLR1‐6, TLR9, and MYD88. Stimulation of HCMs with bacterial‐derived TLR agonists [Pam3CSK4 (TLR1/2), HKLM (TLR2), LPS (TLR4), Flagellin (TLR5) and, FSL‐1 (TLR6/2)] and virus‐mimicking TLR agonists [Poly I:C (TLR3), Imiquimod (TLR7), ssRNA40 (TLR8) and ODN2006 (TLR9)] induced variable secretion of IL‐8 and CCL2 (MCP‐1). Control levels of IL8 (140 pg/ml) increased in response to Pam3CSK4 (2360 pg/ml), Poly I:C (3620 pg/ml), LPS (4100 pg/ml), Flagellin (1550 pg/ml) and FSL‐1 (2160 pg/ml). Virus‐mimicking agonists imiquimod, ssRNA40 and ODN2006, and intriguingly bacteria‐derived HKML, did not significantly affect secreted IL8. Secreted CCL2 showed a similar pattern of response following stimulation with TLR agonists. HCMs were immunoreactive for TLR2, TLR3 and TLR4 protein.ConclusionsThe findings suggest that HCMs are potentially involved in innate immune responses against bacterial and viral pathogens within the human choroid.
Tear sample collection in ocular allergy
Authors: Munk S.A.J. , Heegaard S. 
Published: September 2017

SummaryPurposeTo evaluate four different methods of tear collection in healthy participants.MethodsFour methods used for tear collection were evaluated in both eyes of 20 healthy participants. Methods tested: capillary tubes (CT), capillary tubes with instillation of saline (CT saline), Schirmer's Tear Test Strips (STTS) and Polyvinyl Alcohol sponges (PVA). Volume, duration of collection, participant‐reported discomfort, concentration and mass of histamine were evaluated.ResultsWith CT saline the largest volume was collected in the shortest time. A significantly higher concentration of histamine was found in samples collected with STTS compared to CT saline (p = 0.04) and PVA (p = 0.02). CT and CT saline were associated with no or mild discomfort in 95% and 90%, STTS and PVA with moderate or severe discomfort in 70% and 85%.ConclusionFor collection of tear fluid for the measurement of histamine the CT saline method was found to be a technically easy and quick method of obtaining sufficient volumes of tear fluid, with low discomfort for participants.
Vitreo‐retinal pathology and multifocal IOLs
Authors: ASCASO F.J. 
Published: September 2017

SummaryCataract surgery is the most common and successful surgical procedure performed today. Multifocal intraocular lenses (m‐IOLs) offer good uncorrected distance and near visual acuity. However, the reduction in contrast sensitivity attributed to m‐IOLs might manifest as compromised visual acuity, especially in eyes with macular disease. Because of this, not every currently available IOL is suitable for every patient. Furthermore, retinal visulization problems when performing vitrectomy with these lenses in place can be challenging. We will discuss the visual disturbances that m‐IOLs produce in a patient with vitreoretinal pathology; the need for an accurate preoperative evaluation to assess macular function, including the role of OCT for identifying occult macular disease preoperatively in patients with dense cataracts; the convenience or not of m‐IOLs in the presence of macular disease, which depends on the stability or the expected progression of the condition over time, and the availability of treatment. Finally, retinal surgeons need to be aware of the challenges of the impaired fundus visualization during vitrectomy following m‐IOL implantation and the recommended strategies to minimize intraoperative complications.
Ocular motility, do we know what is the dominant eye?
Authors: Shah S. 
Published: September 2017

SummaryOcular motility, do we know which is the dominant eye?Ocular dominance, is the tendency to prefer visual input from one eye to the other. It is somewhat analogous to the laterality of right‐ or left‐handedness; however, the side of the dominant eye and the dominant hand do not always match.Approximately two‐thirds of the population are right‐eye dominant and one‐third left‐eye dominant; however in a small portion of the population neither eye is dominant. Eye dominance has been categorized as “weak” or “strong” and highly profound cases are sometimes caused by amblyopia or strabismus.This talk will discuss

what is ocular dominance

different techniques for measuring dominance

what we have learnt from contact lens practice and monovision

whether it can change and what influences that change

surgical interventions relevant to ocular dominance

The relevance to multifocal intraocular lenses with comorbidity will be detailed.