bluuebunny/crossref_metadata_2025_split huggingface dataset:
More than 50 years of experience with keratoprostheses
Authors: BARRAQUER J 
Published: September 2008

AbstractWe started to use acrylic corneal prostheses experimentally in 1955, principally in eyes considered functionally lost or after several attempts of other keratoplastic procedures had failed. In our first 15 cases a Dorzee prosthesis or a modified Dorzee prosthesis (Barraquer‐Cardona) had been used, in three cases some useful vision was obtained for several months or even up to 4 years. However, the expulsion rate was high, mainly due to the lysis of the corneal borders around the prosthesis. The communication of Strampelli’s first technique of osteo‐odonto‐keratoprosthesis, using a “live” support encouraged us to continue our experimentation. A case of bilateral blindness in a 50 year old patient, due to mine explosion in 1941 (Second World War) was first seen in 1965, 25 years after the accident. The right eye was lost due to retinal detachment, the left eye was aphakic, with opaque cornea due to explosion impacts and anterior synechiae due to old perforations. In 1965 osteo‐odonto‐keratoprosthesis, using Strampelli’s first technique, was performed with good recuperation of vision (0.4) for 10 years. Different aspects and details of the case are presented and commented. Unfortunately in 1975 necrosis of the bone support developed and reconstructive keratoplasty had to be performed. The patient remained with very low visual acuity (0.03) and a very reduced visual field. The author considers that this result, obtained with the very limited facilities available more than 40 years ago, confirms and justifies that experimentation in this field must continue, making use of all technological, surgical, pharmacological and research facilities available today.
Association between flicker‐induced vasodilatation and flow mediated vasodilatation in patients with diabetes, systemic hypertension and hypercholesterolemia
Authors: GARHOFER G , PEMP B , PETZL U , WOLZT M , SCHMETTERER L 
Published: September 2008

Abstract Purpose Flicker induced vasodilatation is reduced in patients with vascular related diseases. However, the reason for this diminished response is unclear, but may be related to endothelial dysfunction. Currently, the standard method to assess endothelial function in vivo is flow mediated vasodilatation (FMD). Thus, the present study was performed to investigate whether a correlation exists between flicker induced vasodilatation and FMD in patients with diabetes and patients with mild systemic hypertension and/or hypercholesteremia. Methods In the present study 20 patients with insulin dependent diabetes, 40 patients with systemic hypertension (systolic blood pressure:140‐159 mmHg; diastolic blood pressure 90‐99 mmHg) and/or serum cholesterol plasma levels > 250 mg/dl and 20 healthy control subjects were included. The flicker response was measured using the Dynamic Retinal Vessel Analyzer. FMD was determined using a high resolution ultrasound system, measuring brachial artery diameter reactivity during reperfusion after arterial occlusion. Results The flicker response of both retinal arteries and veins was significantly reduced in the two patients groups. Likewise, FMD was significantly reduced in patients as compared to healthy controls. However, only a weak correlation between flicker induced vasodilatation and FMD was observed. Conclusion The study confirms evidence that flicker responses and FMD is reduced in the selected patients groups. Whether the weak correlation between FMD and flicker is due to the different stimulation type, the different vascular beds measured or other mechanisms has yet to be investigated.
Retinal arteriolar vascular reactivity to incremental changes in hyperoxic stimuli during isocapnia
Authors: HUDSON C , TONG A , HAN J , MARDIMAE A , WONG T , FISHER J 
Published: September 2008

Abstract Purpose To determine the relationship between the magnitude of retinal arteriolar vascular reactivity and incremental changes in hyperoxic stimuli whilst maintaining isocapnia. Methods Twelve healthy, young adults (mean age 27 years, SD 4) participated in a gas protocol consisting of 4 phases at varying fractional expired oxygen levels (FeO2): baseline (15%), hyperoxia I (40%), hyperoxia II (65%), and recovery (15%). End‐tidal carbon dioxide (ETCO2) was maintained at isocapnia throughout the experiment. Retinal arteriolar diameter, blood velocity, and blood flow were assessed non‐invasively using the Canon Laser Blood Flowmeter during each of these phases. Results Repeated measures ANOVA showed that there were significant influences of incremental changes in FeO2 on retinal arteriolar diameter (p<0.0001), blood velocity (p<0.0001), and blood flow (p<0.0001). Paired t‐tests of these retinal hemodynamic parameters during each phase in the gas sequence showed they were significantly different (p<0.05) from each other, with the exception of baseline and recovery values. Incremental increases in FeO2 caused a linear decrease in group mean arteriolar diameter (R2 = 1, p = 0.002), group mean blood velocity (R2 = 0.9968, p = 0.04), and group mean blood flow (R2 = 0.9982, p= 0.03). Conclusion Isocapnic hyperoxia elicits vasoconstriction and the reduction of retinal arteriolar diameter, velocity and blood flow in a dose‐dependent manner over the range of FeO2 explored in this study.
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DNA profile strongly associated with exudative age‐related macular degeneration
Authors: CARTER JG , ARISTODEMOU P , CHERRY J , CHURCHILL AJ 
Published: September 2008

Abstract Purpose The genetics of age‐related macular degeneration (AMD) is slowly unfolding with the recent discovery that single nucleotide polymorphisms (SNPs) in 4 genes, Complement Factor H (CFH), ARMS2/LOC387715, HTRA1 and Vascular endothelial growth factor (VEGF) independently confer a greater risk of disease. We have taken this further and analyzed a combined DNA profile for the SNPs in these 4 genes. Methods Patients with exudative AMD (n=45) and age‐matched controls (n=94) were genotyped for the CFH Y402H (rs1061170), ARMS2 A69S (rs10490924), HTRA1 ‐512 (rs11200638), and the VEGF +674 (rs1413711) polymorphisms, by RFLP, AS‐PCR and randomized sequencing. Statistical analysis was carried out for each individual loci and into a combined DNA profile using the PHASE program. Results Association of the VEGF +674CC genotype with AMD has been previously reported. We observed strong associations with AMD and the CFH‐CC [OR=11.9 (4.5,31.3), p=0.0000000184], ARMS2‐TT [OR=4.7 (1.6, 13.8), p=0.0023] and HTRA1‐AA [OR=3.6 (1.3,10.1), p=0.0128] genotypes respectively. We also observed strong linkage disequilibrium between rs10490924 and rs11200638 (r2=0.9138), as seen in previous studies. However, possession of the 4 SNP DNA profile: CTAC (CFH/ARMS2/HTRA1/VEGF) is strongly associated with AMD [OR=63.0 (8.3, 475.4), p<0.00001]. Conclusion Past associations between CFH, ARMS2 & HTRA1 have already been reported, and this data further supports this. However, the possession of the CTAC ‘at risk’ DNA profile shows the potential combined effects of these three genes, and their strong association with AMD. It is now possible to identify those most at risk in the general population allowing lifestyle choices to be made that could reduce the overall risk of AMD.
The role of factor h macular degeneration secondary to pathologic myopia
Authors: BARBAZETTO I , YANNUZZI L , ALLIKMETS R 
Published: September 2008

Abstract Purpose To compare the frequency of genes associated with age‐related macular degeneration (AMD), specifically the complement factor H alleles in patients with choroidal neovascularization (CNV) secondary to pathologic myopia (CNV). Methods Patients with pathologic myopia (defined as axial length > 25.50mm or ‐ 6.00 dpt) were examined. The presence of choroidal neovascularization was confirmed by clinical examination and fundus photography; fluorescein angiography and autofluorescence images were analyzed when available. DNA samples from all study subjects were screened for variants in the CFH genes, commonly associated with age‐related macular degeneration. Results Seventy‐three patients (47 female and 36 male; age 23 – 90 years; average: 59 years) were included into the study. Visual acuity ranged from 20/25 to count fingers in 1 meter. The frequency of the CFH Y402H as well as other common CFH polymorphisms in this cohort corresponded to that detected in the general population. Conclusion Factor h variants commonly associated with AMD and other forms of CNV may not play a causal role in neovascular complications of pathologic myopia.
Phenotyping parallel visual pathways in autosomal dominant optic atrophy
Authors: REIS AA , VIEGAS T , MATEUS CD , SILVA ED , CASTELO‐BRANCO M 
Published: September 2008

Abstract Purpose To characterize different phenotypes of Kjer optic atrophy along different visual pathways. Methods Novel computerized psychophysical assessment methods (CCT ‐ Cambridge Colour Test and CSF ‐ Metropsis Contrast Sensitivity Function Test) were used to evaluate visual function in a population of 13 subjects (26 eyes) from 8 families with Autosomal Dominant Optic Atrophy (ADOA). This evaluation was completed with electrophysiological assessment (Pattern ERG, Pattern and Multifocal VEP) and Automated Static Perimetry (ASP). Results CCT shows evidence for severe damage of all cone populations (p<<0.0001), and of similar magnitude, implying concomitant damage of parvo and koniocellular pathways. Achromatic contrast sensitivity is severely impaired for all six spatial frequency channels studied (p<0.002), suggesting mixed magno/parvocellular impairment. A decrease of both P‐50 and N‐95 amplitudes of PERG is found (p<<0.001), while implicit times are normal. MfVEP results show significant impairment in amplitudes of the most central rings (1, 2 ‐ p<0.001), with concomitant local increased implicit times, no significant changes being found at most eccentric rings. Pattern VEP impairment is consistent with these results. Amplitude values of MfVEP in visual quadrants are significantly correlated with the decreased retinal sensitivity obtained in the 4 quadrants by ASP. Conclusion Our results suggest that all functional types of nerve fibers are damaged in ADOA, with a predominance of the parvocellular ones. Multimodal psychophysical and electrophysiological methods are good quantitative markers to understand the pathophysiology of damage of central and peripheral pathways in this condition.
Modified enucleation for choroidal melanoma with large extrascleral extension
Authors: PARROZZANI R , URBAN F , GURABARDHI M , MIDENA E 
Published: September 2008

Abstract Purpose To describe the technique and results of modified (enlarged) enucleation via lateral orbitotomy for choroidal melanomas with macroscopic periopticposterior extrascleral extension. Methods 5 cases of choroidal melanoma with macroscopic periopticposterior entrascleral extension underwent modified enucleation via lateral orbitotomy. After lateral orbitotomy and orbital mass exposure with direct tumor visualization, a long optic nerve stump was cut and the orbital component of the tumor was completely (macroscopically) removed along with the globe in all cases. After haemostasis and orbital reconstruction an orbital implant was than placed. Follow up was longer than 12 months Results After pathologic examination, the tumor result completely removed in 5 patients (100%). Excellent cosmetic outcome was achieved in all cases (100%) without operative or postoperative complications. Conclusion Modified (enlarged) enucleation via lateral orbitotomy for choroidal melanomas with macroscopic perioptic/posterior extrascleral extension allows placement of an orbital implant avoiding the long healing process of orbital exenteration with excellent clinical and cosmetic outcome.
Small, fatal choroidal melanoma: a retrospective study of patients treated in Liverpool
Authors: DAMATO B , COUPLAND S 
Published: September 2008

Abstract Purpose To review the Liverpool experience of small, fatal uveal melanomas. Methods We searched the database of the Liverpool Ocular Oncology Service for British patients dying from metastatic disease after treatment of a uveal melanoma having a basal diameter less than 10.0mm (i.e., ‘small melanoma’). The cause of death was obtained from death certificates provided by the National Health Service Cancer Registry. Results Of the 3186 patients first treated for uveal melanoma in Liverpool between January 1993 and July 2008, there were 994 (31%) with a small melanoma. In 803 of these patients residing in mainland Britain, the 15‐year actuarial survival was 88.4%. The 35 patients dying of melanoma (19 female, 16 male) had a median age of 72 years at primary treatment (range 43‐88). The tumours had a median diameter of 7.6mm (range 3.2‐9.9) with nine measuring less than 7.0mm. The posterior tumour margin was located in iris in 1 patient, ciliary body in 6 patients and choroid in 29 patients. The initial management consisted of brachytherapy (14 patients), proton beam radiotherapy (9), enucleation (5), local resection (2), transpupillary thermotherapy (3) and observation (2). Histological studies had been performed in 11 tumours, 9 of which contained epithelioid cells. Cytogenetic data were available for four tumours, two of which showed monosomy 3. Three patients had developed local tumour recurrence after their initial treatment. The median time to death was 4.8 years (range 0.1 – 13.7). This survival time was longer than in fatal cases with a medium‐sized or large tumour (Log rank, p<0.001). Conclusion Multicentre studies are indicated to understand the metastatic process and how this is influenced by ocular treatment.
Ten smallest melanomas that killed the patient – a very long‐term analysis
Authors: KIVELÄ T , KUJALA E , TOIVONEN P 
Published: September 2008

Abstract Purpose To characterise the nature and course of smallest uveal melanomas that were fatal in a very long‐term follow‐up study. Methods Charts of 289 consecutive patients with choroidal and ciliary body melanoma treated in the Helsinki University Central Hospital district in 1962‐1981 were used to identify and those ten patients who died from the smallest tumours during the subsequent 30‐40 years. In this period, enucleation was the only treatment available. Results Altogether 41 (14%) melanomas were <10 mm in diameter, and 10 (25%) of these were fatal long‐term. For this size of tumour, the 5‐, 10‐, 15‐, 20‐ and 30‐year actuarial survival, which cancels the effect of other causes of death, was 90%, 85%, 80%, 80% and 70%, respectively. The 10 patients who died of melanoma were a median of 54 y (compared with 54 y for those who survived) old at treatment (range 33‐73 vs. 30‐74). The median tumour diameter was 7.5 vs. 8 mm (range 6‐9 vs. 3‐9), with 2 of 10 (20%) vs. 5 of 31 (16%) tumours measuring <7 mm. The median tumour height was 4 vs. 4.5 mm (range 2‐8 vs. 1‐11), with 2 of 10 (20%) vs. 7 of 31 (23%) tumours measuring less than 3 mm; thus, not all were “small” melanomas. 1 (10%) vs. 3 (10%) tumours extended to ciliary body and 0 vs. 1 extended extrasclerally; none of the patients developed local tumour recurrence. The median time to death was 6.7 y (range 1.2‐33). The two smallest fatal tumors were 6 and 7 mm in diameter and 2 mm in height. Conclusion The smallest ciliochoroidal melanomas that are fatal do not differ clinically at diagnosis from nonfatal melanomas in the same size range. A multicenter histopathologic and tumor cytogenetic analysis is necessary to characterise small melanomas as close to the time point when they acquire metastatic potential as possible.
Mapping of photoreceptor dysfunction using high resolution, three‐dimensional spectral optical coherence tomography
Authors: SIKORSKI BL , SZKULMOWSKI M , KALUZNY JJ , SZKULMOWSKA A , KOWALCZYK A , WOJTKOWSKI M 
Published: September 2008

Abstract Purpose To introduce a novel method of 3‐D Spectral Optical Coherence Tomography (SOCT) data analysis called reflectivity maps. Methods We introduced new software to perform segmentation of the junction between photoreceptor inner and outer segments (IS/OS) at 2‐D tomograms. After segmentation, each cross‐sectional image is transformed in such a fashion that posterior contour of the retina becomes a straight line but all radial distances within each cross section are preserved. It enables us to display the distribution of a back‐reflected intensity taken only from individual retinal layers located at specific distance from the reference plane and create reflectivity maps. We analysed the reflectivity maps of the IS/OS layer of 56 patients with photoreceptor dysfunction in course of age‐related macular degeneration, central serous chorioretinopathy, macular holes, retinal detachment, acute zonal occult outer retinopathy, multiple evanescent white dot syndrome, acute posterior multifocal placoid pigment epitheliopathy, drug‐induced retinopathy and congenital disorders. Results The reflectivity maps of the IS/OS layer displayed the areas of photoreceptor dysfunction. Conclusion Subtle changes in the IS/OS reflectivity can be detected and presented as SOCT reflectivity maps. The maps reveal the areas of photoreceptor dysfunction and can be correlated with standard techniques like fluorescein angiography and electrophysiological examination. We believe that the use of 3‐D analysis of segmented IS/OS layer in larger number of retinal pathologies may help in better understanding of photoreceptor dysfunction and allow for more accurate interpretation of the IS/OS layer on SOCT images.
Use of intravitreal Ketorolac tromethamine for postoperative cystoid macular edema
Authors: TSILIMBARIS MK , TSIKA CI , PANDELEONDIDIS V , PANAGIOTOGLOU T , KYMIONIS G 
Published: September 2008

Abstract Purpose To investigate the effect of intravitreal ketorolac tromethamine in chronic post‐operative cystoid macular edema. Methods Six patients diagnosed with chronic post‐operative CME non responsive in conventional therapies, were enrolled. 2 patients received 2 intravitreal injections of 300 μg (0.05ml) of ketorolac tromethamine (Toradol) with a 3‐week interval, three patients received 4 consecutive injections of 500 μg (0.05ml) weekly and 3 patients received 4 consecutive injections of 500 μg (0.05ml) daily. Patients were followed by means of biomicroscopy, fluorescein angiography and optical coherent tomography. Follow‐up lasted up to six months. Results No adverse effect was noticed in any of the patients. A trend for visual acuity improvement and macular edema regression was noticed after initiation of the therapy. A rebound of the edema happened usually a week after the last injection. In the long follow‐up regression of the macular edema was noticed in three out of six patients. Conclusion This pilot study indicates a possible role of intravitreal injection of ketorolac tromethamine in patients with chronic postoperative cystoid macular edema. Further research is warranted in order to obtain conclusive results concerning doses and timing of injections.
Ophthalmic microsporidiosis: Emerging pathogens or emerging awareness?
Authors: BONSHEK RE , IRION LD , CURRY A 
Published: September 2008

Abstract Purpose We report and discuss an apparent increase in the number of ocular and adnexal microsporidial infections. Methods We present cases of ocular microsporidial infection which were diagnosed by light (LM) and electron microscopy (EM) at our departments and review the literature. Results Cases involved Encephalitozoon, Vittaforma, Trachipleistophora and Nosema sp. with infection of ocular surface, corneal stroma, canaliculi and nasolacrimal apparatus. Conclusion Microsporidia are minute obligate intracellular parasites which infect via a polar tube. Human microsporidiosis is normally HIV/AIDS related, most infections being enteric with few ocular cases. With the success of antiretrovirals, the incidence of enteric microsporidiosis is now much lower. Ocular infection is now more prevalent and not usually HIV‐associated. Our cases had infection of ocular surface, cornea and lacrimal canal/sac. The diagnosis was not initially considered clinically. LM may be diagnostic if characteristic refractile ZN‐positive microspores are seen. If they are few or are not identified, LM is not diagnostic. LM does not permit speciation which usually requires EM. Diligent search for organisms may be necessary as distribution may be focal. Insufficient data exist to allow PCR‐based diagnosis of most microsporidial species. Sources and mechanisms of infection remain speculative. Insect infection is abundant. Spores are present in water. Microsporidia are poikilothermic. Microsporidiosis occurs in animals. Does the eye's immune status and lower surface temperature favour opportunistic infection by organisms adapted to lower temperatures in insects? Are animals vectors? Is travel to "exotic" places a factor? Are microsporidia emerging pathogens or are they simply not recognised?
Lyme borreliosis: different ocular aspects of the same disease in North‐West of Italy
Authors: ALLEGRI P , MASTROMARINO A , RISSOTTO R , MURIALDO U 
Published: September 2008

Abstract Purpose To show different presentations of ocular Lyme disease in an endemic area (North‐West of Italy) Methods In last ten years, at Lavagna (Genova) uveitis referral centre, we examined about a hundred people affected by Lyme ocular disease (57 males and 45 females; mean age 42 +/‐ 3.2 years) and we were able to recognize some different ocular manifestations of this affection in 133 eyes. Diagnosis was made by means of ELISA or Western‐Blot tests;sometimes by PCR test. Different systemic symptoms were present: 53% of patients had inflammatory arthropathy, 24% erythema migrans, 13% neuro‐ophthalmologic findings. Results Five main groups of Lyme disease ocular involvement were detected from our long‐term study: 1 ‐ diplopia and periocular pain 2 ‐ diffuse or nodular episcleritis 3 ‐ acute anterior uveitis 4 ‐ retinal vasculitis and papillitis 5 ‐ retino‐choroiditis Group 4 and 5 were the more frequent bilateral presentation. Our study shows slit‐lamp, FA, ICG‐A and OCT pictures of these different Lyme disease presentations. Antibiotic treatment of early diagnosed infection allowed a complete recovery in 79 patients. Conclusion Lyme ocular disease, because of its peculiar characteristic of being able to mimic a lot of ocular inflammations, may be underdiagnosed by ophthalmologists; aim of our work is to show and to point out some different ocular presentations of this disease