bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurotrophic Keratitis: Definition, clinical presentation and diagnosis
Authors: Said D. , Dua H. 
Published: September 2017

Neurotropic Keratitis is a non‐healing or repeated break down of corneal epithelium associated with degenerative changes resulting from impaired corneal innervation. Later complications such as infection scarring and perforation can follow. A reduced or absent corneal sensation is the hallmark of the disease.Patients present with dryness, photophobia and inability to read for prolonged duration hich is worse by computer work or air draft.Signs are divided into 2 parts: Signs related to the disease process such as corneal epithelial irregularity and clouding, reduced tear break up time and superficial punctate keratitis mostly inferior, Later persistent epithelial defect, corneal ulcers with rolled edges and loose epithelium surrounding the edges which can later develop infection, melting, scarring or perforation. Signs related to the underlying cause such as lagophthalmous and reduced blink reflex, signs of previous herpetic keratitis with scarring, vascularization and or patches of iris atrophy. Stromal dystrophy or beaded corneal nerves, advanced diabetic retinopathy or retinal laser marks.Diagnosis includes clinical presentation, duration of non‐healing epithelial defect and measuring corneal sensation with Coche‐Bonnet test.
Medical management of neurotrophic keratitis
Authors: RAMA P. 
Published: September 2017

SummaryConsiderations for the medical management of neurotrophic keratopathy (NK) depend upon the stage/ severity and pathology of the underlying disease process. Therapeutic approaches are broadly divided into strategic areas that encompass categories of treating the underlying disease process, treating any concurrent infections, preventing disease progression, promoting epithelialisation, providing tear replacement, reducing inflammation, preventing stromal tissue loss or perforation and avoiding complications.
Measurement of oculomotor parameters and visual processing times without eye‐tracking
Authors: Barbur J.L. , Llapashtica E. , Connolly D. , Sadler J. 
Published: September 2017

PurposeOculomotor parameters and visual processing times affect visual performance. In addition, mental health disorders and common drugs can also affect task completion times and the efficiency of visual search. Eye‐trackers are useful in such studies, but expensive equipment and careful calibration is needed. A new, simple method that does not require eye‐tracking is proposed. The EMAIL (Eye Movement and Intrinsic Latency) test captures parameters that describe both the time course of eye‐movement generation as well as the time needed to detect and process specific stimulus attributes at the end of each saccade.MethodsThe test relies on measuring the time needed to detect peripheral targets, carry out an appropriate eye‐movement and process some feature of the stimulus (such as colour, coherent motion, rapid flicker, spatial orientation or acuity). In this round of experiments, the stimulus was a Landolt ring flanked by distractors and presented at a randomly selected location on either side of fixation, 8o in the periphery. The measurement variable is the target presentation time, δT, needed to achieve ~71% correct response. The subject's task is to saccade to the peripheral target, to register the stimulus attribute of interest and to press one of four response buttons to indicate the correct orientation of the gap.ResultsThe results obtained so far show a significant effect of stimulus contrast, age and fatigue. The measured times vary systematically with age in the range 160 to 300 ms. Longer times are observed in schizophrenia and other mental health disorders.ConclusionsThe new EMAIL test provides a simple method to assess changes in oculomotor parameters and decision response times with potential applications in the study of fatigue and the evaluation of drug efficiency in the treatment of mental health disorders.
How to explain “flat” electroretinograms when patients with Leber's congenital amaurosis aren't blind
Authors: Parsa C. , Taylor A. 
Published: September 2017

PurposeTo explain how a ‘flat” or ‘extinguished” electroretinogram (ERG) in a patient with Leber's congenital amaurosis may not necessarily be indicative of a corresponding loss of vision.MethodsBasic principles of ocular as well as auditory electrophysiology, wave physics, phototransduction metabolic pathways and ophthalmic genetics were reviewed and organized to reveal heretofore overlooked pathways. Correlations of ocular as well as auditory electrophysiology characteristics for Leber's congenital amaurosis and congenital auditory neuropathy/dys‐synchrony were made.ResultsVariably delayed individual photoreceptor cell signaling secondary to metabolic enzymatic deficiencies involved in phototransduction results in ERG a‐waves produced, and subsequent b‐waves, to interfere destructively with each other, rather than allow for averaging in‐phase summation to permit recordable ERG signals. Despite the delayed visual cycle, intraretinal synaptic transmission may proceed uninhibited to activate retinal ganglion cells and axonal pathways to the visual cortex.ConclusionsA ‘flat” or ‘extinguished” ERG need not indicate absent vision, but overall destructive interference of individual a‐waves and b‐waves averaged for the recorded ERG. Analogous auditory electrophysiologic findings are noted in corresponding so‐called congenital auditory neuropathy/dys‐synchrony. Such findings are of great diagnostic utility and may be considered pathognomonic. Theoretically, the stability or progression of a patient with Leber's congenital amaurosis, and their response to an interventional genetic or pharmacologic therapeutic regimen, could be followed in more sensitive and objective manner at the cellular level via electro‐oculography, prior to visual acuity, visual evoked potentials, or ERG testing revealing any changes in overall retinal function.
Limits for the indication of multifocal lenses based on the contrast sensitivity function
Authors: Grzybowski A. 
Published: September 2017

SummaryMultifocal IOLs are more often responsible for lower contrast sensitivity (CS) than monofocal IOLs, especially in mesopic light conditions. Thus, multifocal IOLs are contraindicated in many ocular diseases, which are characterized by decreased contrast sensitivity function. They included irregular astigmatism, Fuchs dystrophy, and many retinal diseases affecting macular function like retinitis pigmentosa, Stargardt disease, diabetic retinopathy, age‐related macular degeneration, epiretinal membrane, and many optic nerve disorders. IOL decentration and tilt lead to decreased contrast sensitivity, aberrations, and ultimately decreased visual acuity, thus zonular weakness, esp. when severe, should be regarded as absolute or relative contraindication to choosing a multifocal IOL. Since contrast sensitivity is found to be most affected in eyes with aberrations and implanted multifocal IOLs, increased aberrations are relative contraindications for multifocal IOL implantation. It was proved that patients with the aspheric multifocal IOL had significantly better contrast visual acuity than patients with the spherical multifocal IOL.
Endoocular OCT assisted epimacular surgery with preliminary vitreoretinal adhesions mapping
Authors: Stoliarenko G. , Doroshenko D. , Ledeneva M. , Salakhutdinov V. , Savostianova N. 
Published: September 2017

SummaryMembranectomy is critical and one difficult stages of macular surgery. The difficulty is caused by heterogeneity of the adhesion of epiretinal tissue to the retina, and if it is large, traumas of the retina appear that are the main cause of loss of visual fields in the central area. Also, that in the overwhelming majority of cases (more than 50%), the onset of membranectomy is accompanied by a trauma of the retina, which occurs when the epiretinal tissue is first captured with forceps. Selective surgery, in which the map of adhesion of epiretinal tissue to the retina is created with the help of OCT at the preoperative stage and membranectomy is carried out only in areas of low adhesion, significantly reduces the probability of traumas of the retina.In the process of vitrectomy and membranectomy, the redistribution of mechanical stress occurs in the epiretinal tissue. Because of this, the topology of the adhesion map changes. Dislocations of the boundaries of high adhesion zones in the process of membranectomy can reach 1.5 mm and with the probability greater than 0.7 are greater than 0.5 mm.Uses endoOCT allows to control these changes in process of surgery, allowing it is essential to increase its efficiency.
Changing the fate of retinal ganglion cells following retinal ischemia: is autophagy the way?
Authors: Russo R. , Varano G.P. , Adornetto A. , Nazio F. , Corasaniti M.T. , Nucci C. , Bagetta G. 
Published: September 2017

SummaryAutophagy is a highly conserved catabolic pathway for cell components to be degraded through the lysosomes and recycled under normal and stressful circumstances. The involvement of autophagy has been proven in several models of neurodenegerative diseases; however, its role in the neurodegenerative process occurring in retinal ganglion cells (RGCs) exposed to glaucoma‐related stimuli is still controversial.Here we show that retinal ischemia induced by acute elevation of intraocular pressure (IOP) is associated with a dynamic, biphasic, modulation of the autophagic pathway, characterized by an initial upregulation of the process, which is followed by a reduced efficiency. Increased RGC death was reported in mice with partial genetic autophagy impairment (AMBRA1 +/‐) and subjected to retinal ischemia. Conversely, boosting basal autophagy, either by caloric restriction or pharmacological treatment, improved RGC survival suggesting that the catabolic pathway can be targeted to achieve neuroprotection.
Neurotrophins involved in neuroprotective antibody effect
Authors: Bell K. , Wilding C. , Beck S. , Pfeiffer N. , Grus F.H. 
Published: September 2017

SummaryLower levels of different antibodies (abs) can be detected in glaucoma. Several have neuroprotective effects on retinal ganglion cells. Indicated by up‐regulation of glutamine synthetase previous studies show that Müller cells (MC) participate in this effect and we aimed to analyse MC participation in more detail. Primary porcine MC incubated with different abs (0.5 μg/ml γ‐synuclein, 1 μg/ml 14‐3‐3 or GFAP abs for 3 h), a control ab (anti‐myoglobin) or without added abs. To win conditioned medium containing secreted proteins MC were incubated with serum‐reduced medium. BDNF, CTNF, IL6, glutathione, neurotrophin 3, ILG1 and bFGF levels were analysed. Organ cultures were incubated with the conditioned media, medium containing 10 ng/ml CNTF or control medium. MC incubated with 14‐3‐3 (p = 0.045) or GFAP (p = 0.031) abs showed increased CNTF secretion. In comparison to control explants (740 rgc/mm2) rgc/mm2 quantification showed a significant increase in explants incubated with GFAP abs (1014 rgc/mm2, p = 0.04) or 14‐3‐3 abs (910 rgc/mm2,p = 0.07) conditioned medium. Control abs had no effect. We conclude that the neuroprotective antibodies also have an indirect effect on rgcs by increasing CNTF secretion and GS in Müller cells.
Juxtapapillary tumors and pseudo‐tumors of the retinal pigmented epithelium
Authors: Kivelä T. 
Published: September 2017

SummaryThe most conspicuous retinal pigment epithelium (RPE)‐associated lesion, most of which typically occur in the peripapillary region, is known as the combined hamartoma of the retina and the RPE although not all of them extend to the level of the RPE. This congenital lesion, which also has a vascular and an epiretinal component, often will slowly evolve during observation, not infrequently leading to reduced vision from distortion of the macula. It appears as a greyish‐brown, slightly elevated fundus lesion. It may be associated with neurofibromatosis type 2, although most seem to be isolated. None of the other RPE lesions occurs predominantly in the peripapillary region, although congenital hypertrophy of the RPE, simple hamartoma of the RPE, adenomas and adenocarcinomas of the RPE, and acquired reactive proliferations leading to RPE hyperplasia can do so. Except for the first one, these are slightly to moderately elevated lesions. Finally, rare congenital pigmentary changes such as pigmented optic disk, thought to be of RPE origin, can sometimes be observed.
Vascular tumors and malformation of the optic disk
Authors: De Laey J.J. 
Published: September 2017

SummaryThree main types of angiomatous tumors of the optic disc may be considered: 1. Capillary angiomas associated or not with retinal angiomatosis are considered as a peculiar form of von Hippel or von Hippel‐Lindau disease. If they grow they may provoke extensive exudative response resulting ultimately in functional loss of the eye. However treatment is quite challenging. As long as vision is not threatened observation is advised. Direct laser photocoagulation of the tumor will result in severe nerve fiber damage and major loss of visual loss. PDT with or without intravitreal anti‐VEGF injections can be considered. The use of proton beam irradiation has been advocated in selected cases. 2. Cavernous angiomas of the optic disc are very rare. They may also be associated with a cavernous angioma of the retina. As most cases are non‐progressive, treatment is not advised. Neuro‐imaging has to be considered as cavernous angiomas of the retina can be associated with a cerebral angioma. 3. Angioma racemosum or congenital retinal AV malformations. In such cases the optic disc involvement is only part of the fundus lesion.If associated with cerebrovascular and dermatological anomalies the disease is called Wyburn‐Mason syndrome.
Efficacy and safety of the pars plana clip in the Ahmed valve device in patients with refractory glaucoma
Authors:  Ibanez J. ,  Perez Garcia D. ,  Martinez J. ,  Sanchez I. ,  Idoate A. ,  Berniolles J. ,  Bartolome I. ,  Lopez I. ,  Ascaso J. 
Published: September 2017

PurposeTo evaluate the efficacy and safety of the pars plana clip (PPC) in the Ahmed valve tube PC7 inserted via the pars plana in patients with secondary refractory glaucoma.MethodsProspective and interventional case series that included 8 patients with secondary refractory glaucoma. The pars plana vitrectomy and the implant of the modified tube were performed during the same surgery. Control of intraocular pressure (IOP) and the development of intra‐ and postoperative complications were evaluated during the follow‐up.ResultsFollow‐up time was twelve months in all the patients. Control of IOP was achieved in 85% of patients, and 75% needed no antiglaucoma treatment. The complications that occurred were transient hypotony in two cases, choroidal detachment in two cases, and one case of intraocular hemorrhage and one case of hyphema. No case of tube extrusion was observed.ConclusionsOur clinical experince suggests that implantation of the Ahmed tube modified with the PPC via the pars plana is safe and effective in patients with secondary refractory glaucomas.
Supracilliary Micro‐Stent (CyPass®) is associated with lack of disease progression and minimum usage of IOP lowering medications in patients with POAG 2‐years post‐implantation
Authors: Uzunov R. , Ianchulev T. , Dickerson J. 
Published: September 2017

PurposeGlaucoma is a progressive disease marked by deterioration in the visual field, optic nerve cupping and nerve fiber layer thinning. Glaucoma treatment is aimed at slowing disease progression through control of intraocular pressure (IOP). Minimally invasive glaucoma surgery (MIGS) has become available as a treatment modality offering effective IOP lowering without the high rate of complications associated with traditional glaucoma surgery or the reliance on strict patient adherence required for pharmacological intervention.MethodsOne such MIGS device, a supracilliary micro‐stent (MS), implanted during cataract surgery, has recently completed a large 2‐year trial in the US (COMPASS trial) ‐ 505 patients were randomized to MS (n = 374) or cataract surgery control (n = 131).ResultsMS showed sustained 24‐month efficacy > than phacoemulsification alone. Importantly, visual fields (VF) did not progress with MS treatment over control (baseline and 2‐year mean deviation [MD] ‐3.4, ‐3.2 MS; ‐3.7, ‐3.2 control) while the percent of patients requiring IOP lowering medications was 15.2% for CyPass group versus 40.9% for control. The percentage of patients with VF progression (≥2.5 dB MD decrease) was 6.7% for MS and 9.9% for control. There was a three‐fold lower incidence of disc hemorrhage for MS vs. control (0.5% vs.1.6%), fewer IOP spikes (≥10 mmHg) over the 30‐day post‐op period (6.4% vs. 20.6%), and fewer subsequent glaucoma surgeries (0.6% vs.3.8%).ConclusionsWhile these are post‐hoc descriptive observations, the data suggest that the benefits of reliable, effective, sustained IOP‐lowering through the use of a supracilliary micro‐stent implant may include limiting disease progression in patients with mild‐to moderate primary open‐angle glaucoma. Additional studies aimed at monitoring progression in patients with the micro‐stent are warranted.
Toric lens implantation in cataract surgery: risk factors of post‐operative lens rotation, analysis of 50 cases
Authors: Loria O. , Raucau M. , Agard E. , El Chehab H. , Lereuil T. , Dot C. 
Published: September 2017

PurposeToric lens implantation in cataract surgery has improved with the help of automatic alignment methods, which can determine the immediate postoperative angle with great precision. However, unpredictable misalignment sometimes occurs in the following days. The goal of our study is to identify risk factors of toric lens rotation within the first month of implantation.MethodsWe conducted a prospective, monocentric, descriptive study of 50 eyes in 26 patients operated for cataract by a surgeon experienced in toricity, and implanted a Zeiss Asphina709 implant, during September and October 2016. The intraoperative lens alignment was determined by conjunctival recognition with the Callisto system (Zeiss), coupled with the IOL Master 700 (Zeiss). Lens alignment at one month was determined by blinded double reading on slit lamp photographs using EyeSuite (Luneau). Axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and white to white (WTW) distance were measured with the IOL Master 700.ResultsAll implants were aligned as planned at the end of surgery. The average postoperative lens rotation at one month was 4.4° (+/‐4.85). There was no statistically significant correlation between implant rotation at one month and AL (p = 0.46), ACD (p = 0.18), LT (p = 0.75), WTW (p = 0.67), Age (p = 0.57), or Gender (p = 0.11).ConclusionsOur study was not able to identify significant risk factors for postoperative toric implant rotation. Our low average rotation and small sample size may explain why statistical significance was not reached. A larger prospective study is underway. Our study underlines the difficulty to predict which patients will show toric implant rotation and highlights the importance of viscoelastic management at the end of surgery. Understanding and controlling those risk factors may help achieve better refractive results in the future.
Visualization of the light field of multifocal intraocular lenses using a dual wavelength approach
Authors: Eppig T. , Rubly K. , Schröder S. , Rawer A. , Langenbucher A. 
Published: September 2017

PurposeTo implement a setup which allows simultaneous visualization of the far and near distance light field of multifocal intraocular lenses (MIOL) with two different wavelengths.MethodsWe used two different laser systems (532 nm and 405 nm) in junction with Powell lenses to create vertical laser lines. One laser line was collimated to simulate far distance imaging while the second laser line was diverging simulating near distance imaging at approximately 0.3 m distance. The MIOL was placed in a glass cuvette filled with balanced saline solution which was doped with two different fluorophores. The fluorophores were chosen to have a large Stokes shift and good separation between their excitation and emission bands. Image acquisition was performed with a slit lamp bio microscope and a digital single reflex camera. We investigated three different IOL types: a bifocal MIOL, a trifocal MIOL and an extended depth of focus IOL.ResultsWe found that Propidium iodide and Fluorescein were appropriate fluorophores. Propidium iodide was excited at 532 nm and showed a red fluorescence while Fluorescein was excited at 405 nm showing the green fluorescence. Both lasers required a high power of approximately 30 mW in order to create a visible fluorescent reaction in the cuvette. All three MIOL types provided a good separation between far and near distance light. The regions of overlapping light fields were visible as yellow fluorescence.ConclusionsIn contrast to the previously published setups using a single wavelength with collimated excitation light and axially separated far and near distance foci the current setup allows superposition of the far and near distance foci which is more realistic compared to the situation in the eye. The dual wavelength approach enables an easy optical separation of far and near distance light.
Contribution of microglia and complement activation to glaucoma progression
Authors: Vetter M. , Bosco A. , Anderson S. , Breen K. , Romero C. , Steele M. , Chiodo V. , Boye S. , Hauswirth W. , Tomlinson S. 
Published: September 2017

SummaryGlaucoma results in decline and loss of retinal ganglion cells (RGCs), and is associated with microglia and complement activation, with correlation between early microgliosis in the optic nerve head and later optic nerve pathology. Inhibiting microglia activation can protect RGC axons, implicating microglia in glaucoma pathogenesis. Thus, microglia and innate neuroimmune events are critical components of glaucoma. Since microglia express receptors for multiple complement factors, we have investigated how the complement pathway contributes to glaucoma and microglial responses. We tested the therapeutic effect of limiting complement C3 activation using ocular gene therapy. We utilized CR2‐Crry, which is the soluble rodent‐specific complement inhibitor (sCrry) linked to a complement receptor 2 (CR2) targeting moiety. This was packaged into an AAV2 vector and delivered to the eyes of DBA/2J mice by intravitreal injection. AAV2‐CR2‐Crry‐treatment was highly neuroprotective, with significant preservation of retinal ganglion cells and improved optic nerve integrity. Molecular analysis showed significant shifts in the gene expression profile of FACS‐sorted myeloid cells, including upregulation of several potentially protective cytokines.