bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic memory puzzle and progression of diabetic retinopathy
Authors: KOWLURU R 
Published: September 2008

Abstract Purpose Retinopathy is one of the most feared complications of diabetes. Good glycemic control can inhibit its development, but the effects of good glycemic control on the progression of retinopathy are not immediate. Diabetic patients may take years after re‐establishment of good glycemic control to show signs of arrest of its progression. Further, good glycemic control after a profound period of poor glycemic control does not immediately benefit the progression of retinopathy, and the imprinted effects of prior glycemic control produce the long lasting benefits of good glycemic control, thus suggesting a ‘metabolic memory’ phenomenon. Results Animal models of diabetic retinopathy, including dogs and rats, have duplicated this metabolic memory phenomenon. In rats, histopathology associated with diabetic retinopathy does not stop for at least six months when good glycemic control is initiated six months after induction of diabetes. Increase in retinal oxidative stress and peroxynitrite levels and activation of apoptosis execution enzyme‐caspase‐3 resist reversal after re‐institution of good glycemic control. Hyperglycemia‐induced inactivation of retinal glyceraldehyde dehydrogenase that is postulated to activate some of the key pathways associated with the development of diabetic complications remains inactive and covalently modified, and pro‐inflammatory markers elevated. Conclusion This suggests that the process of metabolic memory is complex, and multiple pathways contribute to this resistance of diabetic retinopathy to arrest. Understanding the mechanism responsible for the tendency of diabetic retinopathy to progress after reestablishment of good glycemic control should help reveal targets for therapies to prevent its progression.
Utility of retinal photography in the diagnosis of diabetic macular edema
Authors: IBANEZ J , MATEO OROBIA AJ , PEIRO C , PEREZ D , VALYI S , ROJO M , SAINZ A , CRISTOBAL JA 
Published: September 2008

Abstract Purpose To determine the validity of the simple photography and stereo photography in the diagnosis of diabetic macular edema. Methods Photographies were realized of 427 eyes of diabetic patients, previously dilated with tropicamide eye drops. The color and green filtered 45º and 30º photographies were centered on the posterior pole. Considering the difficulty of the detection of retinal thickenning on a flat photo, we decided to realize two photos to achieve stereopsis. This permits an easier perception of retinal thickening. Sensibility and specificity were compared of the photos to determine the validity in the diagnosis of diabetic macular edema. We used the optical coherence tomography (OCT) as the gold standard test. Results We obtained approximately an 80% sensibility for the detection of diabetic macular oedema (45 º color photos,45 º green photos, 45 º stereoscopic green photos, 30 º stereoscopic color photos and 30 º stereoscopic green photos ). With the 30 º stereoscopic green photos we achieved a sensibility of 94%. The specificity reached values close to 95%. The coefficients of interobserver agreement were at 80%. Conclusion The stereoscopic color photos, the 30 º green photos and both the 45 º and 30 º stereoscopic green photos offer sufficient sensibility and specificity to be used for the diagnosis of diabetic macular edema.
Modern exploration of choroidal inflammation
Authors: HERBORT C 
Published: September 2008

Abstract Purpose The choroid is the site of intraocular inflammation as often as the retina. Because choroidal structures were not accessible to sensitive and performing investigational procedures, analysis of inflammatory events lagged behind. This was at the origin of the inadequate appraisal of choroiditis and the use of imprecise or vague terminologies such as “White Dot Syndromes”. Thanks to indocyanine green angiography (ICGA), access to the choroidal compartment has been granted to the clinician and more precise information on inflammatory mechanisms has allowed to establish a classification based on disease behaviour as well as direct monitoring of disease evolution in the choroid. Methods With the help of ICGA, choroiditis could be subdivided into at least two inflammatory patterns touching 2 different choroidal structures are occuring. Firstly, inflammation of the choriocapillaris causing non perfusion is very well recognised by its typical ICGA features and constitutes a group of diseases that are called inflammatory choriocapillaropathies, including MEWDS, APMPPE or multifocal choroiditis. Results Secondly, there is a totally different type of choroiditis, with inflammation occurring in the choroidal stroma in form of a mostly granulomatous infiltration called stromal choroiditis. When the target is specifically in the choroid such as in VKH disease or Sympathetic Ophthalmia (SO) we speak of primary stromal choroiditis and when the choroid is just the structure where a systemic disease such as sarcoidosis elects to manifest itself we speak of secondary stromal choroiditis. Conclusion Beside the fact that ICGA has helped us classify choroiditis based on disease mechanism, it also allows proper monitoring of disease activity reaching a high degree of accuracy.
The role of TNF‐alpha blockers in uveitis therapy
Authors: ABU EL ASRAR AM 
Published: September 2008

AbstractTumor necrosis factor (TNF)‐α has been implicated as an important mediator in autoimmune ocular inflammatory disease pathogenesis as shown by animal studies and its detection in the ocular fluids of patients with uveitis. Blockade of TNF‐α has emerged as one of the most promising therapies in autoimmune diseases including uveitis. Currently, there are three TNF‐α antagonists: two monoclonal antibodies (infliximab and adalimumab) and a soluble receptor that binds soluble TNF‐α (etanercept). Infliximab is a chimeric monoclonal antibody directed against TNF‐α. It binds with high affinity to both the soluble and the membrane‐bound TNF‐α and inhibits a broad range of biologic activities of TNF‐α. Several studies reported that infliximab therapy was rapidly effective and safe treatment for refractory noninfectious uveitis including childhood uveitis and is indicated as rescue therapy for relapses of ocular inflammation or as maintenance therapy when conventional immunosuppression fails. It also allowed a reduction of corticosteroids and immunosuppressive drugs required to control the disease. However, repeated infusions are required to maintain long‐term remission. Moreover, infliximab administration is costly and requires hospital admission. Recently, adalimumab, fully humanized monoclonal anti‐ TNF‐α antibody, was also found to be effective and safe therapy for the management of refractory noninfectious uveitis. Several studies reported that infliximab was more effective than etanercept in the treatment of refractory uveitis. Perhaps infliximab’s ability to target membrane‐bound TNF‐α in addition to the soluble form may contribute to its increased efficacy in comparison with etanercept for uveitis.
Structural and optical changes in the eye after soft contact lens wear
Authors: MIRANDA MA , O'DONNELL C , RADHAKRISHNAN H 
Published: September 2008

Abstract Purpose To investigate the magnitude and aetiology of structural and optical changes in the cornea after short‐term hydrogel contact lens wear and to explore the effect of these changes on visual performance. Methods Sixteen healthy subjects were fitted with a low‐Dk hydrogel contact lens (CH) in one eye and a silicone hydrogel (SH) lens in the contralateral eye. Subjects wore the lenses for 1 month in daily wear (DW) and 1 week in extended wear (EW), with at least 1 week ‘wash out’ in between. All lenses were plano powered and were manufactured in matched designs with the same specifications. Measurements of corneal topography, corneal pachymetry (apical and peripheral), and corneal and ocular aberrations were performed at baseline and after lens wear using a Scheimpflug imaging system (Oculus Pentacam) and a Hartmann‐Shack aberrometer (IRX3). Best corrected visual acuity (BCVA, logMAR) and contrast sensitivity measurements (CS, Pelli‐Robson) were also performed. Results The optical and structural changes in the cornea after 1 month of DW and 1 week of EW for both the CH and SH materials were of low magnitude. The topographic and pachymetric changes observed were not found to be significant (p>0.05, repeated measures ANOVA). After 1 month of DW, however, the corneal root mean square of quatrefoil aberrations was found to be significantly different after CH contact lens wear (mean difference ‐0.021 µm; 95% confidence interval for difference: ‐0.037 to ‐0.06 µm; p=0.003). BCVA and CS did not change significantly after lens wear. Conclusion Our data showed that the CH and SH lenses tested do not significantly alter the structure or the optical performance of the cornea after one month of daily wear and 1 week of extended contact lens wear.
Re‐treatment after LASIK for correction of myopia and myopic astigmatism
Authors: FARES U , BRAGHEETH MA , DUA HS 
Published: September 2008

Abstract Purpose To evaluate the results of LASIK re‐treatment for under‐correction or regression after primary LASIK procedures for myopia and myopic astigmatism. Methods Of 360 consecutive LASIK‐treated eyes, for myopia and/or myopic astigmatism, 32 eyes of 34 patients were retreated and followed at 3, 6 and 12 months post retreatment. Re‐treatment was performed by lifting the original flap after cutting the epithelium around the flap edge with a fine needle. Standard ablation was performed based on the patient’s residual refraction. Results 9.4% of eyes patients required retreatment. Prior to re‐treatment the mean manifest spherical equivalent (SE) was –0.99 D ± 1.48 D (range from ‐ 0.75 to ‐2.63). The mean sphere was ‐ 0.79 D ± 1.20 D (range from –2.50 to ‐0.50) and the mean cylinder was –0.90 D ± 1.14 D (from –2.75 to 1.25). At 1 year follow up 56% of the eyes were within ± 0.50 D SE and 78% were within ± 1.00 D SE. 78% percent of the eyes examined at one year post re‐treatment managed unaided vision of 6/9 or better. Peripheral epithelial ingrowth not requiring treatment, developed in two eyes. Second re‐treatment for regression was performed in one eye. Conclusion LASIK re‐treatment for residual myopia, by lifting the original flap is an effective option. Refractive results are fairly predictable and refraction stabilizes by 3 months after re‐treatment. Lifting the corneal flap after cutting the epithelium on the flap edges, is easy to perform and has a very low incidence of epithelial ingrowth.
Endothelial cell loss 9 years after PRK and LASIK and its importance for eye banks
Authors: BOURNE WM , PATEL SV 
Published: September 2008

Abstract Purpose To measure changes in the endothelium of corneas 9 years after myopic PRK and LASIK to determine if these corneas are suitable donor tissue for posterior lamellar transplantation. Methods Central endothelial photographs were taken before and at 9 years after PRK in 9 eyes of 6 patients and after LASIK in 20 eyes of 10 patients. Preoperative spheroequivalent refraction was ‐3.5 ± 1.7 D (range ‐1.25 to ‐5.75) in PRK eyes and ‐6.2 ± 1.4 D (range ‐4 to ‐9.25 D) in LASIK eyes with intended correction to emmetropia in all eyes. Endothelial cells were analyzed with the center method by the same masked investigator from the endothelial images after calibration for magnification. Comparisons were made by using generalized estimating equation models to account for any correlation between fellow eyes of the same subject. Results Endothelial cell density at 9 years after PRK (2559 ± 423 cells/mm2) was not significantly lower than before PRK (2641 ± 340 cells/mm2, P=0.45, n=9). Endothelial cell density at 9 years after LASIK (2741 ± 308 cells/mm2) was lower than before LASIK (2925 ± 303 cells/mm2; P<0.001, n=20), representing an annual exponential cell loss of 0.7 ± 0.8%. This cell loss was not significantly different from the annual exponential cell loss of 0.6 ± 0.5 % during a ten‐year period measured in 42 normal (unoperated) corneas of control subjects from a previous study (P=0.41, minimum detectable difference = 0.5%, α=0.05, ß=0.20). Conclusion We found no effect of PRK or LASIK on the corneal endothelium 9 years after the procedure. Eye banks and surgeons can use donor corneas from PRK eyes and from LASIK eyes for posterior lamellar keratoplasty procedures.
Retinal fiber layer measured by oct in patients with type I diabetes without retinopathy
Authors: PINILLA I , GARCIA‐MARTIN E , IDOIPE CORTA M , GIL ARRIBAS L , FERRERAS A , HONRUBIA FM 
Published: September 2008

Abstract Purpose To evaluate the changes in the peripapillary retinal nerve fiber layer (RNFL) thickness measured with optical coherence tomography (OCT) in patients with type I diabetes without retinopathy. Methods Comparative cross‐sectional study. Thirty eyes of 30 healthy subjects and 30 eyes of 30 patients with type I diabetes mellitus were studied. Ophthalmic examination of diabetic patients showed no retinopathy. One eye per patient was randomly selected for the study. All patients were examined by means of OCT. Results The control group was formed by 9 women, 21 men, aged 18‐38 yr (mean ± SD 28.7 ± 6.01). Diabetic patients were 9 women and 21 men, aged 25.02 yr (± 8.1). Mean period from the onset of diabetes was 14.2 years (SD 5.46). None of the diabetic group had changes at the fundus examination. The RNFL average thickness was 106.1 and 101.8 in the control and in the diabetic group respectively. A significant difference was found in the superior quadrant thickness where the measures were 136 vs 127 respectively (p=0.05). Conclusion Our results suggest that RNFL changes assessed by OCT can be detected early in the course of type I diabetes.
Clinical use of multifocal and focus shift IOLs
Authors: BARRAQUER RI , MICHAEL R 
Published: September 2008

Abstract Purpose To compare the clinical experience with multifocal and focus shift IOLs in Austria, Germany and Spain. Methods We give a summary of published and unpublished data, reviews and meta‐analyses. Main outcome measures are uncorrected distance and near visual acuity, and reading speed under different light conditions as well as subjective patient satisfaction and spectacle independence. The focus will be on ReStor, ReZoom and Technis IOLs in the multifocal group, and ICU, BioComFold, AT‐45 Crystalens in the focus shift group. Results Multifocal IOLs can provide functional intermediate vision in bright light; under dim light the results vary depending on the IOL design. Hybrid design of the refractive‐diffractive IOL can reduce the increased optical aberrations induced by purely refractive multifocal IOLs. Aspheric apodized diffractive IOLs can reduce stray light artefacts and can enhance distance vision performance for large pupils. Focus shift IOLs result in a moderate to no improvement for uncorrected near visual acuity and minor or no forward movement, on average corresponding to less than 0.5 diopters. Conclusion Multifocal IOLs provide pseudo‐accommodation and their optical quality has improved due to new design developments. Focus shift IOLs accommodate only by a minor amount abd give some pseudo‐accommodation by mechanisms not clearly understood.
Straylight effects in diffractive multifocal IOL compared to monofocal IOL
Authors: NUIJTS RMMA , FRANSSEN L , DE VRIES NE , TJIA KF , VAN DEN BERG TJTP 
Published: September 2008

Abstract Purpose To measure levels of intraocular straylight following cataract surgery and implantation of either the ReSTOR SA60D3 IOL or the SA60AT monofocal IOL. Methods A newly developed straylight meter was used to objectively measure straylight in a prospective open observational case series at 6 months postoperatively in 66 eyes with the diffractive ReSTOR SA60D3 IOL (Alcon Laboratories) and in a control group of 40 eyes with the monofocal SA60AT IOL. A comparison with straylight levels in an age‐matched population without cataract was performed. Results The straylight levels in the ReSTOR SA60D3 IOL and in the control group with the monofocal SA60AT IOL were 1.20±0.16 logunits and 1.10±0.19 logunits. When the difference in mean level of straylight was adjusted for age by multivariate analysis of the combined pseudophakic groups, mean straylight levels were 0.078 logunits lower for the monofocal SA60AT IOL group as compared to the multifocal ReSTOR SA60D3 IOL group (p=0.026). Straylight levels in both pseudophakic groups were lower than those of the normal age‐matched control group without cataract (p<0.0001). Conclusion Levels of intraocular straylight log(s) were significantly lower (p<0.0001) for both types of IOL as compared to age‐matched subjects from the normal population, with expected reduction of complaints of glare and halos and higher levels of contrast sensitivity.The mean level of intraocular straylight 6 months postoperatively was higher for subjects with a ReSTOR SA60D3 IOL as compared to subjects with a monofocal SA60AT IOL, with expected less gain in contrast sensitivity and less reduction of glare and halo complaints.
Molecular and functional genetics of inherited eye disorders in India
Authors: KANNABIRAN C 
Published: September 2008

Abstract Purpose To understand the genetics of ocular diseases in India by identification of the underlying genes, characterizing the functional effects of pathogenic or disease‐associated variants in suitable systems and to develop applications of genetics in patient screening and counseling. Methods Genetic analysis involves the screening of candidate genes, linkage and association studies on patients and families recruited for specific eye diseases including several Mendelian and complex diseases. Phenotypic correlations are drawn using clinical, histological and other data as applicable from medical records of patients. Results Over the last 10 yrs, we have carried out studies on retinal dystrophies, retinoblastoma, congenital cataract, corneal dystrophies, anterior segemnt dysgeneses, congenital glaucoma, POAG, age‐related macular degeneration and myopia. These studies have led to the identification of new genes and genetic associations, as well as delineation of mutational spectra for various Mendelian disorders. Functional and/or structural effects of disease‐associated mutations are another area of activity and questions in this realm have been investigated for some proteins such as crystallins and optineurin. Conclusion The challenge in the near future is to develop effective and relevant ways of translating genetic and molecular science towards the benefit of patients.
“Vision care at all levels: From bench to bedside to the community”‐ A working model by L. V. Prasad Eye Institute, Hyderabad, India
Authors: BALASUBRAMANIAN D , KANNABIRAN C , KHANNA R , RAO GN 
Published: September 2008

Abstract Purpose Of the 50 million blind people in the world, 60% live in developing countries. The three major causes of blindness here (cataract, infection, uncorrected refractive errors) are needless, since they are treatable or avoidable. In order to do so, we need a program of outreach to the countryside and village communities, involve them as partners in the endeavor, and thus make it successful and sustainable. Methods Over the last twenty years, the L. V. Prasad Eye Institute (LVPEI), a non‐profit, non‐governmental eye care centre at Hyderabad, India, has set up a multi‐tier pyramid model to address this problem of winning over needless blindness. This pyramid connects a centre of excellence at Hyderabad on the top with tertiary eye care centres in two other cities, secondary care centres in 15 towns‐ each of which is served by 10 vision centres in villages, thus taking care of about 20 million people. Prescription of eyeglasses, drugs against infection, and cataract surgical care are delivered on a large scale through this pyramid approach. This model of translation from bench to bedside to the community appears to be replicable in other places and for other aspects of healthcare. Results In basic and clinical research, LVPEI is involved in the molecular and functional genetics of some inherited forms of blindness, use of stem cells to reconstruct the damaged ocular outer surface, and biochemical aspects of cataract. Conclusion This model of translation from bench to bedside to the community appears to be replicable in other places and for other aspects of healthcare. It also appears suitable for the goals of Vision 2020: The Right to Sight.
Choroideal neovascularisation in age related maculopathy and high myopia. A Laser Flare‐Cell Meter study
Authors: CELLINI M , RICCETTI A , LEONETTI P , CAMPOS EC 
Published: September 2008

Abstract Purpose We studied the subclinical ocular inflammation by laser flare‐cell meter in patients with choroideal neovascularisation (CNV) in age related maculopathy (AMD) and in high myopia (HM). Methods We enrolled 22 patients (12 males and 10 females) without diabetes, systemic inflammatory disease or previous ocular surgery or laser therapy, aged between 65 and 89 years (mean 78,2±6,3) with macular CNV. Twelve of these patients have an age related maculopathy (AMD) and ten have an high myopia (HM). The myopia was mean ‐14,25 D. We made an indocyanine angiography and measured the extension of neovascularization with the Heidelberg Eye Explorer analysis program. The flare was measured with laser flare‐cell meter (FM‐500, Kowa, Tokio, Japan) in both eyes of the same patient. Subsequently we compared the flare data of AMD‐patients that had an CNV with an area similar of the CNV of the HM‐patients. Statistical analysis was performed considering significant a p<0.05. Results The flare in AMD and HM patients was 14,89±7,61 vs 8,00±0,86 photons/msec (p<0.013) and the CNV area was 4,03±2,236 vs 1,07±0,14 mm2 (p<0.001). We selected a sub‐group of AMD‐patients that had a CNV area similar to the CNV of HM‐patients: 1.13±0.18 vs 1,07±0,14 mm2 (p<0.192) and the flare was 13,48±3,08 vs. 8,00±0,86 photons/msec (p<0.001). Conclusion Our results show that sub‐clincal inflammation in AMD with CNV is higher than in HM with CNV. Furthermore in AMD the flare is correlated with CNV (p<0.021)but not in HM. These data could be explain with inflammatory pathogenesis of CNV in AMD. whereas in HM the CNV could be related to a spontaneous ruptures of the Bruch’s membrane.