bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retinal astrocytic hamartomas: 2 cases of atypical clinical presentation
Authors: Bouteleux V. , Tick S. , El Chehab H. , Mendes M. , Agard E. , Russo A. , Dot C. 
Published: September 2016

PurposeRetinal astrocytic hamartomas (RAH) are rare benign tumors found mainly in patients with phacomatosis. In these cases, RAH is a major diagnosis criteria.MethodsWe report the cases of two patients with 2 different clinical presentations.ResultsThe case 1 is an asymptomatic man without medical history. A voluminous white retinal lesion is discovered incidentally. The ultrasound shows intratumoral calcifications and autofluorescence imaging shows hyperautofluorescent calcified beads. Characteristic moth‐eaten spaces are seen on the SD‐OCT. The final diagnosis is isolated RAH.The case 2 is a 56 year old woman suspected of neurofibromatosis (NF) type 2. The fundoscopy found in both eyes a peripapillary whitish flat retinal lesion with blurred edges located on the surface of the retina. There is no autofluorescence nor hyperfluorescence. The diagnosis of plane RAH (= type 1) is made given the context.ConclusionsRAH must be known because of the impact on phacomatosis diagnosis. RAH are associated with Tuberous Sclerosis Complex in about 55% of cases and with NF type 1 and type 2 in 15% of cases. Nevertheless in 1/3 of cases it occurs in healthy subjects. Three types of RAH have been described (plan (case 1), multinodular (case 2) and intermediate). Classical appearance (=type II) is a yellowish nodular ‘mulberry‐like’ tumor. It is autofluorescent and hyperfluorescent in late frames of angiography. However, there are less typical presentations which is reported in case 2 and which makes discuss differential diagnosis.RAH can be a difficult diagnosis for which the clinical history and the multimodal imaging are essential. Neurological opinion and cerebral imaging should complete the investigation to search other diagnosis criteria of phacomatosis before concluding in an isolated form.
Evaluation of monotherapy of intravitreal Bevacizumab in retinopathy of prematurity stage 3 plus
Authors: Shirzadeh S. 
Published: September 2016

PurposeEvaluation of monotherapy of Bevacizumab intravitreal effect in Retinopathy Of Prematurity stage 3 plus treatmentMethods158 eyes of 89 premature infants with threshold ROP 3 plus disease which 86 (51.2%) in zone I and 82 (48.8%) in zone II, were treated with intravitreal injection of 0.625 mg in 0.025 cc bevacizumab that 11eyes (7%) were treated with second injection. No prior laser or other intravitreal therapy was done. Fundus examination was performed prior to the intervention and at each follow‐up visit. Changes in various mean vital parameters 1 week post intervention compared to pre‐intervention were assessed.ResultsAny infant wasn't any problem post intravitreal bevacizumab injection. After 4–161 days (mean 17.62), all eyes showed complete traet the puls disease and after 4–278 days (mean: 44.39) all eyes showed complete retinal vascularisation without any signs of disease recurrence.ConclusionsTreatment of ROP stage III puls disease with intravitreal Bevacizumab was effective in all cases and should be considered for treatment. Any side effect of Bevacizumab was seen. More patients with longer follow‐up duration are mandatory to confirm the safety and efficacy of this treatment.
Early hydroxychloroquine retinal toxicity enhanced by multifocal electroretinogram and laser flare‐cell meter
Authors: Cellini M. , Sebastiani S. , Campos E. 
Published: September 2016

PurposeThe aim of this study is the evaluation of the multifocal electroretinogram (mfERG) and the laser flare‐cell meter methodology (LFM) in early detection of hydroxychloroquine (HCQ) retinal toxicity.MethodsWe enrolled 10 patients mean age 64.8 years with rheumatoid arthritis in therapy with hydroxychloroquine (400 mg/day) and cumulative dose (CD) of 625.6 ± 167.44‐g with no signs of retinal toxicity. As control group we recruited 10 health subjects mean age 61.3 years. MfERG (Retimax Plus, CSO, Florence, Italy) and LFM (FM‐500, Kowa, Tokio, Japan) were performed in all patients and controls. The Wilcoxon signed‐rank test and Spearman's correlation test was performed considering p < 0.05 as positive.ResultsPatients treated with HCQ showed compared to controls a significant amplitude reduction 0.518 ± 0.348 μV vs. 0.745 ± 0.337 μV (p = 0.035) with equally significant increase in latency 38.611 ± 2.857 ms vs. 36.334 ± 2.212 ms (p = 0.024) P1 wave in ring 2 of mfERG. The alteration of dependent values of mfERG correlated to the HCQ‐CD. To evaluate the behavior of the flare we divided the patients into two groups according to the CD: a group with CD > 500‐g and one with CD < 500‐g. The CD Group > 500‐g had a significant increase in flare values than the CD group < 500‐g: 14.4 ± 6.266 pg/ms vs. 8.1 ± 2.828 pg/ms (p = 0.008). The increase in the flare on the CD group>500 g was found to be related to the drug CD (r = 0.899; p = 0.001).ConclusionsWe found that mfERG P1 wave implicit time in ring 2 and the flare is the more sensitive test for demonstrating retinal dysfunction from HCQ toxicity in the setting of a normal fundus with a normal authomated visual field 10.2 and normal visual acuity. The increase in the flare would indicate not only a damage to the iris and cliary body pigmented cells but also an enzyme‐based breakdown of the blood retinal barrier directly caused by HCQ.
Case‐finding for angle closure: the diagnostic value of simple tests for estimating limbal and central anterior chamber depth
Authors: Dabasia P. , Murdoch I. , Edgar D. , Lawrenson J. 
Published: September 2016

PurposeTo evaluate the diagnostic accuracy of limbal and central anterior chamber depth measurement for detecting gonioscopically narrow anterior chamber angles (ACAs).MethodsA total of 78 subjects with narrow or open ACAs underwent an assessment of anterior chamber depth at the temporal limbus by estimating depth as a percentage of peripheral corneal thickness (van Herick test) by one examiner and just‐touching‐slit‐length measurements of the central anterior chamber depth (Smith's test) by a second examiner. Diagnostic performance was compared with (a) a gonioscopy reference standard, performed by a third examiner using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) definition of primary angle closure and (b) a classification based on clinical opinion of occludability. All examiners were masked regarding each subject's clinical status and other test results. Sensitivity, specificity, and partial area under the receiver operating characteristic curve (AUROC) were generated.ResultsThe van Herick grading cutoff of 25% or less and ISGEO gonioscopic classification achieved 80% (95% CI 65–89) sensitivity and 92% specificity (95% CI 80–97) for narrow angle detection, with specificity reaching 97% (95% CI 87–100) for a cutoff of less than or equal to 15%. Notably, with a gonioscopic classification based on clinical opinion of occludability, van Herick (≤25%) together with Smith's test (≤2.50 mm) detected 100% of narrow angle subjects.ConclusionsThe van Herick test provides good discrimination between narrow and open angles both alone, and in combination with the measurement of central anterior chamber depth. These tests show good potential for identifying individuals who may benefit from further gonioscopic assessment in a case‐finding or screening setting.
Aberrations, accommodation and pseudoaccomodation in myopia and hyperopia
Authors: Tarutta E. , Harutyunyan S. , Khandzhyan A. , Khodzhabekyan N. 
Published: September 2016

PurposeA comparative study of accommodation, pseudoaccommodation and higher order optical aberrations (HOA) in young people with myopia and hyperopiaMethods39 myopic eyes (averagely −5.2 ± 1.5 D) and 53 hyperopic eyes (averagely +3.1 ± 1.15 D) of 46 patients aged 5–20 years (mean age 11.6 ± 0.6 years) were examined. Objective accommodative response (OAR) was measured on Grand Seiko Binocular Open Field Auto ref/keratometer WR‐5100K. Aberrometry was conducted on OPD‐Scan III (Nidek). Relative accommodation reserve (RAR) were measured. The amplitude of pseudoaccomodation was determined as the difference between the calculated additional plus lens of 3.0 D and the power of the minimum plus lens which allowed reading in cycloplegic conditions (1% cyclopentolate hydrochloride × 2) at the distance of 33 cm.ResultsOAR and RAR were significantly higher in hyperopic patients (−2.2 ± 0.07 D and −3.0 ± 0.17 D; respectively), as compared to myopic ones (−1.8 ± 0.09 D, p < 0.01, and −2.2 ± 0.11 D, p < 0.05; resp.). Total HOAs measured with a pupil 4 mm wide: root mean square, vertical coma, spherical aberrations, as well as pseudoaccomodation were significantly higher in myopic patients (0.5 ± 0.05 D; −0.05 ± 0.01 D; 0.15 ± 0.05 D; 0.9 ± 0.1 D resp.) in comparison with those in hyperopic patients (0.37 ± 0.03 D; −0.003 ± 0.01 D; 0.04 ± 0.01 D; 0.6 ± 0.1 D resp., p < 0.05). Corneal spherical aberrations were measured to be 0.1 ± 0.03 D in myopic and 0.03 ± 0.04 D in hyperopic patients (p < 0.05).ConclusionsOAR and RAR are lower in myopia compared with hyperopia. Root mean square and some HOAs are higher in myopia, which probably accounts for higher pseudoaccomodation values in myopic patients.
EDI‐OCT is less suited for close monitoring of primary stromal choroiditis when compared to Indocyanine green angiography
Authors: Herbort C.P. , Balci O. , Gasc A. , Jeannin B. 
Published: September 2016

PurposeInvestigate the performance, utility, and precision, of enhanced depth imaging optical coherence tomography thickness (EDI‐OCT‐T), versus indocyanine green angiography (ICGA), in tracking any fluctuation in the activity of primary stromal choroiditis (PSC) in response to therapy during long‐term follow‐up.MethodsPatients with a diagnosis of PSC; Vogt Koyanagi Harada (VKH) or birdshot retinochoroiditis (BRC), with untreated initial disease with long‐term follow‐up including both ICGA and EDI‐OCT, were recruited at the Centre for Ophthalmic Specialized care, Lausanne, Switzerland. Angiography signs were quantified according to established dual FA and ICGA scoring systems for uveitis. Changes in ICGA score, and EDI‐OCT‐T, in response to therapy, were assessed.ResultsAmong 1829 uveitis patients seen from 1995 to 2015, 59 patients (3.2%) were diagnosed with PSC of which 4 patients (2 BRC and 2 VKH) fulfilled the restrictive inclusion criteria. Mean EDI‐OCT‐T decreased from 672 ± 101 μm at entry to 358.5 ± 44.5 μm in a mean of 26.5 months at stabilization. Mean ICGA scores decreased from 28 ± 4.2 at entry, to 5 ± 7 at stabilization. Only ICGA was sufficiently sensitive and reactive to detect disease recurrencies and efficacy or absence of effect of successive treatment changes, detected in 7 instances during follow‐up, but not recorded by EDI‐OCT.ConclusionsThis pilot study showed that ICGA was the more sensitive methodology; able to promptly identify evolving subclinical and occult choroidal disease and flag occult recurrence and/or therapeutic responses that were otherwise missed by EDI‐OCT. Although EDI‐OCT‐T showed a linear decrease, these changes were too sluggish to be relied upon for close follow‐up and timely adjustment of therapy.
Eye position under general anesthesia in orthophoric children
Authors: Manoli P. , Auckburally M. , Jullienne R. , Thuret G. , Gain P. , Lebranchu P. , Pechereau A. 
Published: September 2016

PurposeThe aim of this study is to evaluate the effect of general anesthesia with muscle relaxant on the horizontal ocular deviation in orthophoric children.MethodsChildren aged 4–16 years requiring a non‐ophthalmological surgical procedure under general anesthesia with neuromuscular blockade were included. Prior ophthalmological examination excluded any oculomotor disorder. Horizontal ocular deviation was measured by the Hirschberg photographic method by comparing pictures taken in the awakened state to those taken under general anesthesia. Monitoring of anesthesia was performed by the Bispectral index (BIS) and muscle relaxation by the train of four (TOF).Results33 Patients were included. Mean age was 8(±4) years and 67.7% were male. The mean horizontal ocular deviation after general anesthesia with neuromuscular blockade was −0.2 diopters (SD 9.7). Median was −0.7 diopters. 72.7% of patients had an ocular deviation of less than 7.5 diopters with a normal distribution.ConclusionsOur results show that contrary to popular belief, eye position under general anesthesia in children without strabismus is not divergent but very close to orthophoria.
Selective retina therapy (SRT) for diabetes macular edema in Korean patients: 12‐months results
Authors: Park Y.G. , Roh Y.J. 
Published: September 2016

PurposeSelective Retina Therapy can induce proliferation and migration of retinal pigment epithelium (RPE) cells at SRT‐irradiated areas without damaging photoreceptor cells. We demonstrate 1‐year clinical results of SRT for clinically significant diabetic macular edema (DME) in Korean patients.MethodsProspective nonrandomized interventional case series study. Twenty‐three eyes of 21 patients with clinically significant DME were treated with SRT and followed up for 12 months. After analysis of the correlation between the RM value and FFA visibility, the sensitivity and specificity of reflectometry was calculated. We measured best‐corrected ETDRS visual acuity (BCVA). Microperimetry was employed to measure the macular sensitivity within the central 10° visual field, and the central macular thickness (CMT) and maximum macular thickness (MMT) were measured at every 3 months. Patients were considered for retreatment at 3 months if there was no decrease in CMT.ResultsThirteen of 23 eyes were included for the analysis of 1‐year results. BCVA improved from 69.5 letters at baseline to 76.23 letters at 6 months and 71.3 letters at 1 year. Although change in CMT did not demonstrate a significant change at two‐time points, MMT were decreased from 446.7 ± 78.4 μm to 423.5 ± 76.5 μm, 408.5 ± 59.6 at 6 months, 12 months (all p < 0.05) and mean macular sensitivity were increased from 21.5 ± 3.1 dB to 22.9 ± 2.4 dB, 23.2 ± 2.5 dB respectively. (p = 0.009, p = 0.001). Additional SRT was performed for nine eyes (69.2%).ConclusionsIn 9 of 23 eyes (39.1%), BCVA was maintained or improved by SRT monotherapy during 1 year follow‐up period. The improvement in maximum macular thickness (MMT) and macular sensitivity support that SRT treatment could be effective and safe modality in Korean patients with clinically significant DME.
Effect of biochemical cues on proliferation, phenotype and migration of human corneal stromal cells
Authors: Fernández‐Pérez J. , Ahearne M. 
Published: September 2016

PurposeWith the increasing demand for corneal replacements and a shortage of suitable donors, tissue engineering and cell based therapies have emerged as a possible solution. Understanding the influence that biochemical factors have on corneal wound healing is needed to improve tissue regeneration. Our aim was to investigate the effect of several molecules on human corneal stromal cells.MethodsCorneal fibroblasts were serum‐starved for 72 h in DMEM/F12 and then exposed to specific reagents for 7–14 days. The reagents examined in this study were ascorbic acid (AA), retinoic acid (RA), FGF‐2, PDGF‐BB, IGF, TGF‐β1, TGF‐β3, IBMX and insulin‐transferrin‐selenium (ITS). Proliferation was assessed by AlamarBlue assay, general morphology was monitored by bright field microscopy and the expression of keratocan, ALDH3A1 and smooth muscle actin (α‐SMA) at the mRNA level was quantified by qPCR. Immunohistochemistry and western blotting were also performed to assess protein expression.ResultsAA, IGF‐1, RA and ITS increased the expression of keratocyte markers such as keratocan and ALDH3A1, while not increasing fibrotic/myofibroblast marker α‐SMA. FGF‐2 and PDGF‐BB decreased expression of keratocan and ALDH3A1 without up‐regulating α‐SMA, suggesting a fibroblastic phenotype. TGF‐β1 and TGF‐β3 were shown to up‐regulate α‐SMA expression but TGF‐β3 also up‐regulated keratocan. All reagents apart from AA resulted in an increase in cell proliferation by day 7.ConclusionsThis study demonstrates the influence different biochemical cues have on corneal stromal cells. These findings will be useful in developing the next generation of therapies for corneal diseases and injuries.
Influence of material compliance on human corneal stromal cell behaviour
Authors: Kelly C. , Ahearne M. 
Published: September 2016

PurposeDue to a shortage of healthy donor tissue, bioengineering strategies for corneal regeneration are drawing more attention. It is well established that substrate stiffness has an effect on the proliferation and phenotype of many cell types. In this study, we aim to investigate the influence of the mechanical environment on corneal cell behaviour, by demonstrating the effects of varying material stiffness on the growth and morphology of human corneal stromal cells.MethodsUsing blends of two commercially available polydimethylsiloxane (PDMS) elastomer kits, cured polymer substrates with elastic moduli ranging from 12 kPa to 3 MPa were achieved. Materials underwent tensile mechanical testing to 10% strain in order to determine elastic mechanical properties. Samples were coated with a thin layer of collagen I to promote cell adhesion.ResultsContact angle measurements were taken before and after protein coating, with a decrease in angle from 90.30 ± 0.47° to 73.26 ± 2.24°, indicating a significant increase in hydrophilicity of the PDMS. Phase contrast imaging was used to visualise differences in morphology of cells seeded onto the substrates, while actin and DAPI (4′,6‐diamidino‐2‐phenylindole) staining were employed to view differences in cytoskeletal structure under confocal microscopy. Cells on softer substrates displayed increased proliferation, as determined by AlamarBlue assay, with a notably spread and elongated fibroblastic morphology. Stiffer substrates induced increased cell aggregates, with a more dendritic shape visible. Gene expression of cells was also monitored by qPCR, with observed upregulation of collagen I, ALDH3A1 and keratocan, which was more pronounced in cells seeded on less compliant substrates.ConclusionsThese results will be useful in future biomaterial scaffold designs for corneal tissue regeneration.
Comparison of retinal and choroidal involvement in sarcoidosis chorioretinitis
Authors: El Ameen A. , Herbort C.P. 
Published: September 2016

PurposeTo assess the respective involvement of retina versus choroid in ocular sarcoidosis (OS) using dual fluorescein (FA) and indocyanine green angiography (ICGA).MethodsRetrospective study on patients with the diagnosis of OS seen in the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. The diagnosis of OS was based on a compatible uveitis associated with a positive biopsy, or positive broncho‐alveolar lavage, or bilateral hilar lymphadenopathies or 2 of the 3 following laboratory test including elevated lysozyme, elevated angiotensin converting enzyme or elevated polyclonal activation, together with a negative quantiferon‐TB Gold test. Angiography signs were quantified according to an established FA and ICGA scoring system for uveitis (Int Ophthalmol. 2010;30:539–52 and Ocul Immunol Inflamm 2010;18:385–9).ResultsAmong 1,325 uveitis patients seen from 2000 to 2015, 23 patients (4 men) fullfilled the diagnostic criteria and could be included in the study. The choroid was predominantly involved in 19 patients (82.6%) and the retina in 4 patients (17.4%). The mean angiographic score was 7.3 ± 4.6 for the retina versus 14.2 ± 5.1 for the choroid (p < 0.0001). In 3 of 23 patients (13%), FA did not show retinal inflammation while ICGA was strongly positive, showing occult choroidal lesions.ConclusionsThis study shows for the first time the respective involvement of retina and choroid in OS. Choroid is preferentially involved for which ICGA is the examination of choice. By looking only at FA, there is a risk of underestimating global ocular involvement and to miss choroidal involvement. To evaluate correctly intraocular inflammation in OS and to have a better follow‐up, the use of dual FA & ICG angiography is recommended.
Ocular candidiasis in intravenous drug misusers
Authors: Lam D. , Belazzougui R. , Fardeau C. , Touitou V. , Le Hoang P. , Edel Y. , Bodaghi B. 
Published: September 2016

PurposeTo study the characteristics, the management and evolution of Candida endophthalmitis among intravenous drug misusers in the era of new systemic antifungal agents.MethodsRetrospective, descriptive study of patients with ocular candidiasis performed at Pitié‐Salpêtrière hospital, Paris, France, from 2002 to 2015.Results12 patients (14 eyes) had fungal endophtalmitis associated with drug misuse. Mean age at diagnosis was 41.1 years old and 83% of patients were male. Misuse of buprenorphine and morphin sulfate were noted in 83 and 17% respectively. 50% had polymedications. The way of infection was 50% hand transmission and 50% salivary transmission. Many of them had systemic co‐infections: hepatitis B, C, D or Human Immunodeficiency Virus. Patients presented with chorioretinitis (50%), endophthalmitis (57%) or both (36%). The microbiological diagnosis was obtained from anterior chamber tap (50%), vitrectomy (57%), skin, hair or mouth sample (7% each). 36% of the samples were positive and gave a fungal identification (75% positive for Candida albicans; 25% positive for Candida tropicalis and dubliniensis). At diagnosis of endophtalmitis, mean visual acuity was 0.9 log MAR and 0.3 logMAR after resolution of endophthalmitis. Patients received fluconazole (50%), voriconazole (42%) or amphotericin B (8%), associated with intravitreal injections of amphotericin B (50%) or vitrectomy (50%). Mean time of treatment was 2 months.ConclusionsFungal endophthalmitis is a sight‐threatening disease most commonly caused by Candida species. It is important to maintain a high index of suspicion of Candida ocular infection, particularly among intravenous drug users, even if they have drug substitution. Infection is mostly due to the preparation process. An early treatment based on antifungal agents highly improve the visual prognosis.