bluuebunny/crossref_metadata_2025_split huggingface dataset:
An algorithm combining two lesion‐detection methods of retinal microaneurysms for the reduction of human workload
Authors: Ometto G. , Bek T. , Al‐Diri B. , Hunter A. 
Published: September 2015

PurposeReduction of workload in the detection of microaneurysms (MA) from retinal photographs is crucial for the diagnosis and screening of diabetic retinopathy. Automatic algorithms for the detection of retinal lesions can help reduce human intervention especially when the lesions are present in large numbers.MethodsTwo methods for lesion detection were combined in a single algorithm, one based on the analyses of the contrast between dark peak‐points and surrounding circular regions, and a second one based on the correlation between the intensity values in the photographs and a MA‐template. The two individual methods and the two methods combined were tested separately to compare their performance on retinal images from 26 high‐risk patients.ResultsBoth individual lesion‐detection methods missed clustered MAs. With the exclusion of grouped lesions, the two methods combined showed higher sensitivity and precision than the contrast and template methods alone, identifying 22% and 13% more lesions respectively.ConclusionsThe combination of the two methods can provide repeatable detection of unclustered MAs in photographs from high‐risk patients. Manual intervention is only required to select grouped MAs and to adjust the automatic results, considerably reducing human workload.
The role of dendritic cells in non‐infectious anterior uveitis
Authors: O'Rourke M. , Canavan M. , Sweeney C. , Fletcher J. , Fearon U. , Murphy C. 
Published: September 2015

PurposeNoninfectious uveitis is characterised by influx of inflammatory cells into the immune‐privileged ocular microenvironment. Dendritic cells (DC) are powerful antigen presenting cells (APCs) and thereby initiate and perpetuate inflammation. Animal models of uveitis have suggested alterations in DC contribute to pathogenesis. Firstly, we examine the phenotype of circulating DC in anterior uveitis (AU). Secondly, we characterise the influxing inflammatory cells in the local micro‐environment of inflamed aqueous humor (AqH). Finally, the effect of this inflamed microenvironment on a DC model is examined.MethodsCirculating DC were defined as HLA‐DR+, Lineage‐ and CD11c+. CD40, CD80 and CD83 cell surface expression was used to assess activation and maturation of circulating DC. Cells isolated from AqH obtained from AU patients (n = 5) and HC were assessed by flow cytometry based on cell size, granularity and cell surface expression. 1:2 dilution of AqH supernatant was cultured with monocyte derived DC (moDC) model obtained from a healthy donor for 48 hours and activation and maturation markers on moDC assessed.ResultsThere is a decrease in circulating DC in AU patients compared to HC (p < 0.01). Circulating AU DC express higher CD40 (p < 0.05). Inflamed AqH contains >98% CD45+ cells. Populations of neutrophils (CD15+ HLA‐DR‐), T cells (CD3+ and either CD4+ or CD8+) and APCs (HLA‐DR+ CD11c+) were identified. HC AqH is devoid of CD45+ cells. AU AqH induces CD40 (p < 0.01) and CD80 (p < 0.01) expression on moDC compared to HC.ConclusionsThese results suggest that DC are recruited from the circulation to the eye during AU. AqH from AU patients can activate DC which will lead to initiation and propagation of inflammation. Current work examines functional effects on allogenic CD4+ T cell cocultures. These results suggest DC may be a useful therapeutic target in AU.
Reversal of ischemic retinopathy in ocular ischemic syndrome following carotid artery stenting
Authors: Esteban O. , Nuñez E. , Ascaso J. , Perez I. , Idoate A. , Sanchez J. , Cristobal J. 
Published: September 2015

PurposeOcular ischemic syndrome (OIS), also known as hypoperfusion retinopathy is a rare ocular disease determined by chronic arterial hypoperfusion. The risk factors include age between 50–80 years, male gender (M:F = 2:1), arterial hypertension, diabetes mellitus, coronary disease (5% of the cases develop ocular ischemic syndrome), vascular stroke, hemodialysis. The reported incidence is 7.5 cases per million persons every year and the five‐year mortality rate is 40%.MethodsInterventional case report showing the role of the early diagnosis and treatment with carotid artery stenting in a patient with OIS.ResultsA 58‐year‐old patient with primary arterial hypertension, hypercholesterolemia obstruction of right renal artery presented with multiple episodes of amaurosis fugax with a 5–10 min of duration since three months ago in right eye. Physical examination revealed uncorrected distant visual acuity of 20/20 in each eye. Fundus examination showed dilated retinal veins and multiples microhemorrhages in the right eye. Peripheral retinal ischemia was identified with fluorescein angiography. Doppler ultrasound examination revealed a more than 90% stenosis of the right internal carotid artery. Retinal signs of ischemia improved and amaurosis fugax episodes disappeared two months following internal carotid artery stentingConclusionsThe early diagnosis and treatment of patients with OIS have a major effect on their visual prognosis.
From devastation to restoration: trichosporon asahii can be beaten
Authors: Aydin Yaz Y. , Yildirim N. , Oz Y. , Sahin A. , Yaz Y. 
Published: September 2015

PurposeTo report the first case of fungal keratitis caused by T. asahii which is treated succesfully with penetran keratoplasty.MethodsA 79‐year‐old woman was attended to our clinic with pain and hyperemia in her left eye. The patient had undergone phacoemulsification and intraocular lens implantation surgery from her left eye 9 months ago, and after the surgery visual acuity had been reported 0,8. 4 months after the surgery bullous keratopathy was occurred and treated with bandage contact lens and topical steroids. When she was evaluated visual acuity was light perception and slit lamp examination showed in anterior segment a large keratitis area, central of keratitis area was melted, anterior chamber was shallow and hypopyon was occurred. In direct examination hyphae formation was seen.ResultsFluconazole 200 mg 2 × 1, Cefazolin 50 mg/ml gtt per hour, Voriconazole %1 gtt per hour, Cyclopentolate %1 3 × 1, Phenilephrin %2.5 3 × 1, Tropicamide %1 3 × 1, Acetozolamide 250 mg 2 × 1 treatment were started empirical until the culture and antibiograme were resulted. Culture was resulted and Trichosporon asahii was isolated. The microorganism was sensitive for voriconazole and fluconazole, resistant for amphotericin B. According to the antibiograme results, systemic fluconazole and topical voriconazole treatment were continued. The keratitis area was healed with medical treatment but cornea was spontaneously perforated in 15th day of treatment and penetrating keratoplasty was performed immediately. After penetrating keratoplasty visual acuity was reached 0.1 and corneal graft was clear.ConclusionsFungal keratitis is vision threatening corneal disease causing by corneal ulceration. Trichosporon is one of the uncommon agent for fungal keratitis. This is the first case reported as a fungal keratitis caused by T. asahii treated successfully with penetrating keratoplasty.
Systemic IL‐1β production as a consequence of corneal HSV‐1 infection – contribution to the development of Herpes Simplex Keratitis
Authors: Murphy C. , de Chaumont C. , Shahnazaryan D. , Malone C. , Jefferies C. , Smith S. , Ni Gabhann J. 
Published: September 2015

PurposeHerpes Simplex Virus type‐1 (HSV‐1) infection can result in keratitis, a sight‐threatening disease that is the leading cause of infectious corneal blindness in the western world. HSV‐1 can invade the cornea and remain latent after treatment in the trigeminal ganglia. The pathogenesis of HSK involves a complex interaction between cytokines, chemokines and growth factors, either brought in by inflammatory cells or produced locally. Avoidance of these innate anti‐viral responses can cause lifelong recurrent infection, which in turn can cause progressive corneal scarring, vascularisation, thinning and the need for corneal transplantation to recover vision, often with poor long‐term outcome. This study aimed to investigate peripheral cytokine production in HSK patients with active and inactive infection to identify potential therapeutic targets.MethodsPeripheral blood mononuclear cells and serum were prepared from whole blood taken from both healthy controls and HSK patients during active infection or following treatment. Protein expression levels were analysed by Western Blot. Cytokine levels were determined by multiplex ELISA.ResultsActive corneal HSV‐1 infection resulted in significantly elevated peripheral levels of the pro‐inflammatory cytokine IL‐1b in patients compared to healthy controls. IL‐1β levels remained significantly increased in these patients following treatment. Impaired production of pro‐inflammatory cytokines (including IL‐6, IL‐8 and TNF‐a) and anti‐viral factors (including IL‐12 and IFN‐g) was associated with significantly reduced expression of the transcription factors IRF3 and STAT1 in active patients compared to inactive patients.ConclusionsOur data suggest that dysregulated peripheral production of pro‐inflammatory cytokines and anti‐viral factors may have implications for HSV‐1 viral clearance and recurrent keratitis.
Correlation of hyperreflective foci, status of photoreceptor layer, and visual acuity in diabetic macular edema
Authors: Chebil A. , Ben Abdallah M. , Kort F. , Hassairi A. , Maamouri R. , El Matri L. 
Published: September 2015

PurposeTo investigate the correlation ofhyperreflective foci, photoreceptor integrity and visual acuity (VA) in patients with diabetic macular edema (DME).MethodsSeventy‐eight patients (114 eyes) with DME were analyzed retrospectively with Spectral‐domain optical coherence tomography (SD‐OCT).ResultsSD‐OCT showed that 28 eyes (24.5%) had hyperreflective foci in the inner retinal layers, and 66 eyes (57.9%) had hyperreflective foci in the outer retinal layers. The logMAR VA was significantly (P < .0001) worse in eyes with hyperreflective foci in the outer retinal layers than in eyes without them (0.478 ± 0.241 vs 0.133 ± 0.233, respectively). Disruption of the ellipsoid zone and ELM line on OCT were significantly (respectively P < .0001 and P < .0001) associated with both hyperreflective foci in the outer retinal layers and poor logMAR VA.ConclusionsThe presence of hyperreflective foci in the outer retina is closely associated with a disrupted ELM and ellipsoid zone on SD‐OCT images and decreased VA in DME.
Prognostics factors of poor functionally response in ranibizumab treatment for diabetic macular edema
Authors: Jullien M. , Deken‐Delannoy V. , Labalette P. 
Published: September 2015

PurposePurpose was to identify prognostics factors of poor functional response to anti‐ VEGF (ranibizumab) in diabetic macular edema (DME).MethodsThis retrospective study enrolled 36 eyes with DME treated with intravitral ranibizumab injections. The main outcome measures where the change in best corrected visual acuity (BCVA) after 12 months of treatment and its correlations with clinical findings.ResultsBCVA at baseline examination was 61 +/‐ 16 letters. In the final control after 12 months following injection, the median value of BCVA increased to 67 +/‐ 18 letters. Two groups were analyzed: the responder group (22 eyes or 61%) corresponding to patients with an increase in visual acuity at 12 months and non‐responders (39%). Sex, age, number of IVT, the focal laser history, blood pressure and diabetes duration evolution were similar in both groups. The median HbA1c was not significantly different between the 2 groups (p = 0.80). Patients who have received prior treatment (over 3 months before the first injection of ranibizumab) i.e. intravitreal injections of bevacizumab or intravitreal or sub‐Tenon triamcinolone acetonide injections were significantly more numerous in the non‐responder group (71.43% versus 27.3%, p = 0.0093). Best visual acuity was significantly different between the 2 groups at 3 months and 6 months compared to baseline (10.4 versus 2 letters, p = 0.02 at 3 months and 5 letters versus −2, p = 0.0004 at 6 months). Nine of the 19 eyes with available pictures of the fundus (47%) had extra‐foveal exudates. 89% of these patients were responders but the small number of patients did not allow statistical analysis.ConclusionsIn our study, the presence of previous treatments and the lack of response at 3 and 6 months are associated with poor functional response that could justify a management change.
Blepharitis and thin corneal thickness: An unexpected association
Authors: Trechot F. , Conaert J.B. , Perone J.M. , Angioi K. 
Published: September 2015

PurposeThe aim of this study is to measure central corneal thickness in patients with blepharitis associated with meibomian gland dysfunction. Local inflammation and alteration of the tears film might result to corneal thinning.MethodsAll consecutive patients seen in consultation with blepharitis in our Department of Ophthalmology in November 2014 were included. Blepharitis clinic criteria were those reported by MGD workshop. Meanwhile a control group was set up. Patients with ophthalmic associated pathology, or recent history of ophthalmic surgery were excluded. The central corneal thickness was measured with a non contact pachymeter (NT 530P, Nidek, Jp).ResultsThe study group was made of 40 eyes of 20 patients (11 men) with blepharitis, mean age was 58.5 ± 14.4. Forty eyes of 20 healthy patients (9 men) were used as a control group, mean age was 56.75 ± 13.39. The study group and the control group were comparable in gender and in age. In the study group, the mean central thickness was 527.5 μm ± 29.8 and in the control group mean central corneal thickness was 554.9 μm ± 24.7. There was statistically significant difference between the two groups using a Z normal distribution test.ConclusionsBlepharitis may be associated with a thinner corneal thickness. Increased of osmolarity in the tear fluid and ocular surface inflammation are likely to be the cause of this decrease.
Standardising the Schirmer Test by Enclosing the Strip in a Waterproof Sheath
Authors: Willshire C. , Buckley R. , Bron A.J. 
Published: September 2015

PurposeHolly et al. (1984) showed that the wetting length of the Schirmer strip is influenced by evaporation and may be affected by ambient humidity. This could explain poor reproducibility in different environmental conditions. We therefore studied how preventing evaporation affected wetting length in different conditions of relative humidity.MethodsA closed‐eye Schirmer test was performed bilaterally in 8 subjects with normal eyes (3 male; mean age 35.5 years SD ± 25), in a Weiss‐Gallenkamp controlled environmental chamber, at a temperature of 23°C and with a laminar airflow of 0.08 m/s. Tests were conducted at relative humidities (RH) of 25%, 15% and 5%, with a 10 min break between each test. Eyes received either a standard Schirmer paper (Whatman No. 41 – Biotech®), or a Schirmer paper clad in a waterproof sheath, on a random basis. Sheaths were constructed from a double layer of laminating plastic (Fellowes® ImageLast – outer layer: polyethylene terephthalate; inner layer: ethylene‐vinyl acetate), heat‐sealed to form a lightweight pouch. Papers were inserted, first on the right eye and then on the left. Wetting length was measured at 5 minutes. If full wetting occurred before this time, the time was noted.ResultsThe wetting length was greater on the sheathed side in 23/24 tests. At 25% RH the mean difference in wetting length was 39.3% SD ± 14.7 (n = 8), at 15% RH the mean difference was 44.3% SD ± 17.8 (n = 8) and at 5% RH the mean difference was 56.3% SD ± 17.7 (n = 7). However, no significant difference was found in % means at different RH, P (0.287) > α ± (0.05) using a repeated measures ANOVA test.ConclusionsSheathing of the Schirmer strip frees the test from a dependence on ambient conditions that can vary seasonally, geographically and locally from clinic to clinic. Such standardisation would improve the performance and utility of the test.
Nuclear factor‐erythroid 2‐related factor‐2 (Nrf2) and peroxisome proliferator‐activated receptor γ coactivator‐1α (PGC‐1α) regulates proteolysis in cornea
Authors: Smedowski A. , Paterno J.J. , Amadio M. , Levonen A.L. , Tavi P. , Kaarniranta K. , Wylegala E. 
Published: September 2015

PurposeThe cornea is exposed to constant oxidative stress that may lead to protein homeostasis imbalance and tissue damage during aging process. The ubiquitin‐proteasome pathway and the lysosomal pathway including autophagy are the major proteolytic systems to clean damaged proteins in cells. Our aim was to investigate the role of the Nrf2 and PGC‐1α, the central transcription factors of the regulation of cellular detoxification and defense against oxidative stress, in corneas of double knockout mice (Nrf2‐/PGC1α‐).MethodsAfter fixation in 4% PFA, eyeballs were embedded in paraffin and 5 μm cross sections were cut using microtome. Tissue sections were deparaffinized, rehydrated and processed for immunostaining with primary antibodies against Beclin, HuR, p62 and LC3. Results were compared with age matching wild type controls.ResultsDeficiency of Nrf2 and PGC‐1α evoked accumulation of proteasomal ubiquitin and autophagy markers p62, Beclin and LC3 in one year old animals. Moreover, HuR that regulates p62 expression was highly up‐regulated in the cornea epithelium.ConclusionsThese results suggest that Nrf2 and PGC‐1α deficiency associates with the impaired proteasomal and autophagy clearance in the corneal epithelium. This might be linked to corneal diseases, such as macular dystrophy (Kaarniranta et al., 2015).
Investigating the blue sclera in osteogenesis imperfecta by in vivo confocal microscopy
Authors: Jullienne R. , Brehon A. , Perrot J.L. , Forest F. , Cinotti E. , Labeille B. , Peoc'h M. , Thuret G. , Gain P. 
Published: September 2015

PurposeThe blue sclera appearance is a distinctive clinical sign for osteogenesis imperfecta (OI), a connective tissue disorder caused by an abnormality of type I collagen. It is a challenging diagnosis because multiple bone fractures, occurring in early childhood, can be the only sign of the non‐lethal forms of OI. In these situations, child abuse is a major concern for Paediatricians.AimTo investigate the in vivo confocal microscopy (IVCM) of the sclera and its characteristics as a diagnostic test for OI.MethodsA father and his daughter suffering from OI gave informed consent for non‐invasive ocular examination. The cornea and sclera were examined with a handheld dermatological IVCM (VivaScope 3000, MAVIG GmbH/Lucid), which we pioneered for ophthalmological examination. The examination of two age matched healthy volunteers and corneoscleral donor tissues served as a control.ResultsThe IVCM in OI shows a very specific and reproducible pattern where the collagen fibres have a well organised parallel alignment as would be expected within the clear corneal stroma. Collagen fibres were cross striated in the control.ConclusionsThese findings were consistent with the electron‐microscopic features previously described. The blue appearance results from the visualisation of the underlying choroid through the translucent sclera, which displays a specific parallel orientation of the collagen fibres. To the best of our knowledge, this is the first report of IVCM of the blue sclera. This rapid and non‐invasive imaging technique is an interesting diagnostic tool for challenging cases, especially in children, with multiple bone fractures.GRANT: GIRCI RAA
Choroidal Thickness in Diabetic Patients without Diabetic Retinopathy
Authors: Ferreira J. , Vicente A. , Proença R. , Dias‐Santos A. , Santos B. , Cunha J.P. , Abegão Pinto L. 
Published: September 2015

PurposeTo evaluate choroidal thickness (CT) in diabetic patients without diabetic retinopathy (DR) using enhanced depth imaging spectral‐domain optical coherence tomography (EDI SD‐OCT). To correlate CT with disease duration, systemic blood pressure (BP), glycemia, intraocular pressure (IOP) and ocular pulse amplitude (OPA).MethodsProspective, observational case‐control study. A complete ophthalmological examination was performed (visual acuity, refraction, Goldmann applanation and dynamic contour tonometries, fundoscopy and axial length). CT was assessed by a non‐invasive procedure using an EDI‐OCT (Spectralis Heidelberg) at 13 locations (subfoveal and 3 measurements 500 μm apart in all 4 directions – nasal, temporal, superior and inferior).Results180 patients were recruited: 130 diabetic patients with no DR and 50 healthy controls; one eye per patient included in the study. CT at 1500 μm above the fovea was significantly thicker in the diabetic group (239.9 ± 56 μm vs 268.2 ± 67.7 μm, p = 0.001). None of the other topographic region comparisons were statistically different (p > 0.05). In diabetic patients CT was not correlated with disease duration, BP, glycemia or IOP. CT was positively correlated with OPA in 12 points in diabetic patients (r between 0.19 and 0.27, p < 0.05) but not in the control group. CT variation coefficients in the diabetic group were statistically lower than in the control group (p < 0.01).ConclusionsThe thickening of the choroid at 1500 μm superior of the fovea in diabetic patients without DR may correspond to the diabetic choroidopathy in mid‐periphery presented before DR. Moreover, this tissue may be functionally different, as the pattern of correlations seems to differ between groups. Further studies are needed to explore these differences and the potential of the CT in the clinical setting.
A case report of eyelid basal cell carcinoma with orbital invasion: an alternative to exenteration
Authors: Jeancolas A.L. , Maalouf J. , Baudot A. , Ameloot F. , George J.L. , Angioi K. 
Published: September 2015

PurposeBasal cell carcinoma (BCC) is the most common periocular skin cancer affecting eyelids. Lateral canthus location is very rare. The gold standard treatment consists in an extensive surgery which allows the lowest recurrence rate. We report the case of a man suffering of a lateral canthus eyelid BCC with intraorbital invasion and who declined exenteration.MethodsA 78‐year old man consulted his ophthalmologist for a painless right ptosis associated with a tumefaction of the external orbital angle. He had neither oculomotor disorders nor decreased visual acuity. He was refered to our clinic 6 months later; we noticed a worsening of the ptosis up to visual axis and an abduction limitation. Visual acuity was steady. Pathological analysis revealed the diagnosis of BCC. Orbital tomography showed a location near the lacrimal gland with posterior invasion along the lateral rectus muscle. Multidisciplinary meeting suggested performing an exenteration. The patient refused this treatment. A conservative surgery was then suggested. The patient has been informed about risks of dissemination.ResultsWe performed a tumorectomy with large excision including the lateral part of upper and lower eyelids, the tumor itself, the lacrimal gland and the lateral orbital wall adjacent to the tumor. Pathological analysis revealed clear resection margins on all samples.The 4‐month control revealed no complications.ConclusionsExenteration is the gold standard treatment of orbital invasive BCC. In case of lateral canthus lesions, radiotherapy is not recommended because of major risks of orbital recurrences and side effects. Several authors showed that in case of bone‐adjacent tumors, bone resection is necessary, because tomography is not specific enough to rule out bone invasion. Despite a complete tumor resection, a long term follow‐up is mandatory patients with invasive BCC.