bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extended depth of focus versus trifocal for intraocular lens implantation: An updated systematic review and meta‐analysis
Authors: Karam Mohammad , AlKhowaiter Nahlaa , Alkhabbaz Ali , AlDubaikhi Ahmad , Alsaif Abdulmalik , Shareef Eiman , Alazaz Rand , Alotaibi Abdulaziz , Koaik Mona , Jabbour Samir 
Published: January 2024

Aims/Purpose: To compare the extended depth of focus (EDOF) versus trifocal intraocular lenses (IOLs) in patients undergoing IOL implantation.Methods: An electronic search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines to include studies comparing EDOF versus trifocal IOLs. Refraction and visual acuity were primary outcomes. Secondary outcomes included defocus curves, intraocular aberrations, contrast sensitivity (CS), quality of vision (QoV) questionnaire score, haloes and glare, spectacle independence and patient satisfaction.Results: A total of 22 studies enrolling 2200 eyes were identified. Trifocal IOL showed a significant improvement in sphere (mean difference [MD] = −0.23; p = 0.001) and spherical equivalence (MD = −0.11, p = 0.0001) compared to EDOF IOL. No difference was observed in cylinder (MD = −0.03, p = 0.25) or astigmatism. Trifocal IOL had superior near visual acuity outcomes, namely uncorrected near visual acuity (MD = 0.12, p < 0.00001) and distance‐corrected near visual acuity (MD = 0.12, p = 0.002). Post‐operative corrected distance visual acuity (MD = −0.01, p = 0.01) was significantly improved for the EDOF group, although no difference was noted in post‐operative uncorrected distance visual acuity (MD = 0.00, p = 0.84), uncorrected intermediate visual acuity (MD = 0.01, p = 0.68) or distance‐corrected intermediate visual acuity (MD = −0.01, p = 0.39). Defocus curve favoured trifocal IOLs at near vision and EDOF IOLs at intermediate vision. Ocular aberration, CS, haloes (odds ratio = 0.64, p = 0.10), glare and patient satisfaction were not statistically significant between the groups. The trifocal IOL was associated with an improved QoV questionnaire score (MD = 1.24, p = 0.03) and spectacle independence (odds ratio = 0.26, p = 0.02).Conclusions: Trifocal IOLs improved uncorrected near visual acuity compared to EDOF IOLs. Uncorrected distance and intermediate visual acuity, halos and glare were not statistically different between both groups.
Changes in peripheral visual field perception after intraocular lens implantation
Authors: Van Vught Luc , Luyten Gregorius , Beenakker Jan‐Willem 
Published: January 2024

Aims/Purpose: To assess whether the eccentricity of the perception of objects in the peripheral visual field changes when a crystalline lens is replaced by an intraocular lens (IOL).Methods: The effect of the IOL on the eccentricity at which peripheral objects are perceived was assessed using phakic and pseudophakic versions of the same eye model. Non‐sequential ray tracing simulations were used to determine the relation between the input eccentricity at which an object was positioned in the visual field and the corresponding eccentricity at which the object was perceived by the eye in every eye model. Two different IOL designs were evaluated in the pseudophakic eye model. For each IOL design five different axial positions and seven different intrinsic powers were tested. Subsequently, the results of the pseudophakic eye models were compared to the results of the phakic model.Results: For central vision, the perceived eccentricity differed less than 1 degree between the phakic and pseudophakic models. For peripheral vision, the light rays were refracted to a more central retinal location in pseudophakic eyes than in phakic eyes, therewith shifting perceived eccentricity. The amount of the perceived shift depended on the IOL design and its axial position. The maximal shift within the evaluated pseudophakic models was 5.4 degrees towards central vision.Conclusions: IOL implantation has a minor effect on how the central visual field is perceived, but it can alter the eccentricity at which objects in the peripheral visual field are perceived by over 5 degrees. Such a shift in eccentricity can, for instance, affect how peripheral visual complaints, such as negative dysphotopsia, are experienced.
Systemic effects of intracameral epinephrine during cataract surgery
Authors: Diez‐Montero Cecilia , Montero‐Moreno Javier , Iglesias‐Blanco Raquel , Sanchis Maria Eugenia , Urueña Clara Gonzalez , Hernandez‐Fernandez Rosario , Cañibano‐Pérez Elisabet 
Published: January 2024

Aims/Purpose: The objective of this study has been to evaluate the systemic safety that the use of intracameral adrenaline in cataract surgery has on blood pressure and heart rate. This study aims to demonstrate that this procedure is safe for the patient.Methods: A cohort of 777 patients undergoing cataract surgery was studied. Two differentiated groups were prospectively established. Group I with 394 patients included those in whom only mydriatic eye drops were used to achieve adequate operative mydriasis. Group II with 383 patients in whom operative mydriasis was achieved by using the same mydriatic eye drops as in Group I, reinforced by the use of intracameral adrenaline at the beginning of the intervention. The pre‐anaesthetic evaluation was carried out by the anaesthesiology service. Systolic, diastolic and mean blood pressure was monitored non‐invasively at 5‐min intervals from the start of surgery using an automatically inflating cuff. The heart rate was recorded at the beginning of the intervention and every 5 min until the end of the surgery. Oxygen saturation was monitored by digital pulse oximetry.Results: A total of 496 patients presented cardiovascular pathology, being hypertension the most frequent with 417 patients. 65% of the patients with cardiovascular pathology and 54.3% of the hypertense were dilated with intracameral adrenaline, finding no statistically significant differences between being diagnosed with cardiovascular pathology and receiving or not intracameral adrenaline. In all degrees of anaesthetic risk, the number of patients dilated with adrenaline was similar to those dilated with topical mydriatics. There were not significant differences in the variables recorded during surgery between patients treated with intracameral adrenaline and those who were not.Conclusions: We can conclude that intracameral injection of adrenaline at the beginning of cataract surgery did not statistically increase the risk of side effects on blood pressure or heart rate, when compared to the group of patients who only received pre‐operative topical mydriatics. The use of intracameral adrenaline at the start of phacoemulsification does not imply changes in control actions, drug administration or monitoring by the anaesthesia service.
Hydroxytyrosol as a potential ocular antioxidant
Authors: Just Lucia Bernat , Ta Phuong Linh , Alambiaga‐Caravaca Adrián , Alarma Vicente Rodilla , Morell Francisco Bosch , Castellano Alicia López 
Published: January 2024

Aims/Purpose: The influence of antioxidants on ocular processes has gained increasing importance in recent years due to their impact on eye health. One of the most promising antioxidants is hydroxytyrosol (HT), a natural compound found in olive leaves and olive oil. The purpose of this study is to develop an ocular insert containing HT for administration to the eye. The study aims to verify the absence of ocular toxicity of HT and formulate inserts incorporating this antioxidant.Methods: To evaluate potential ocular irritation, the hen's egg‐chorioallantoic membrane test (HET‐CAM test) was carried out. HT solutions at concentrations of 0.1, 1 and 10 mg/mL were prepared in phosphate buffer solution (PBS) with a pH of 7.4. Solutions of 0.1 N NaOH and 0.9% NaCl were used as positive and negative controls, respectively (1).Different inserts were formulated using polyvinylalcohol (PVA), hyaluronic acid (HA) and polyvinylpyrrolidone (PVP) as polymers with film‐forming capabilities and propylene glycol (PGL) as a humectant agent. The components were added gradually and stirred until a homogeneous solution was obtained. Finally, the solution was poured into a Petri dish and allowed to dry.Results: The HET‐CAM test demonstrated that HT solutions exhibited behaviour similar to the negative control (0.9% NaCl) and did not show any signs of irritation in terms of haemorrhage, lysis, or coagulation.Four formulations were developed with the following compositions: F1: PVA 3%, PVP 1%, HA 0.2%, PGL 2% and HT 0.1%; F2: PVA 2%, PVP 2%, HA 0.2%, PGL 2% and HT 0.1%; F3: PVA 4%, PVP 1%, PGL 2% and HT 0.1%; and F4: PVA 2%, PVP 2%, PGL 2% and HT 0.1%.Conclusions: Hydroxytyrosol can be considered non‐irritating to the eye, and PVA‐PVP‐HA ocular inserts have been developed. Further studies are necessary to select the appropriate hydroxytyrosol insert for ocular administration.References1. Barile FA. Validating and troubleshooting ocular in vitro toxicology tests. J Pharmacol Toxicol Methods. 2010;61(2):136–45.
Characterization of the whole Advillin expressing retinal ganglion cell population in the rodent retina
Authors: Salinas‐Navarro Manuel , Sánchez José Antonio Gómez , Bernal‐Garro Jose M. , Vidal‐Sanz Manuel , Avilés‐Trigueros Marcelino 
Published: January 2024

Aims/Purpose: We have quantified and examined the topography of the total population of retinal ganglion cells (RGC) expressing Advillin (Advillin+RGCs), an actin‐binding protein expressed in somatic sensory neurons, in the retinas, as well as their projections to the brain, in control adult Advillin‐Cretg/+ mice (Zurborg et al. Mol Pain 2011, 7:66).Methods: Retinas from adult Advillin‐Cretg/+ Ai14fl/fl C57BL/6J mice (Frutos‐Rincón et al., Int J Mol Sci 2022, 23:2997) expressing tdTomato were prepared as whole‐mounts, labelled with antibodies recognizing Brn3a and melanopsin. The entire Advillin+RGC population was quantified and its retinal distribution analysed by nearest neighbour maps. The brains were serial coronal crysectioned and the axonal Advillin+RGC projections in the brain were anatomically analysed.Results: Advillin protein was mainly located in the somas and axons of a subset of RGCs. Total number of Advillin+RGCs was 1947 ± 157 (mean ± SD; n = 7), which constitutes 5% of the total RGC population. Approximately 17.5% (340 ± 76) and 0% (3 ± 1) of the Advillin+RGC population co‐expressed Brn3a or melanopsin proteins, respectively. The Advillin+RGC population was distributed across the entire retina, with a higher concentration in the temporal region. The axons of this RGC subpopulation project to the main retinal recipient regions in the brain, such as the lateral geniculate nucleus (LGN) and superior colliculus (SC). However, none of these axons project to the suprachiasmatic nucleus. These data indicates that Advillin+RGCs is not a subpopulation of ipRGCs.Conclusions: The Advillin protein, which is characteristic of sensory neurons, is also expressed in a specific RGC subpopulation of the adult mouse retina. A small percentage of Advillin+RGCs expressed the Brn3a transcription factor, while none expressed melanopsin. The axons of Advillin+RGCs project to the typical retino‐recipient areas in the brain, excluding the suprachiasmatic nucleus.
Monocytic involvement in the neuroinflammatory response after retinal injury
Authors: Avilés‐Trigueros Marcelino , López‐Olivares Irene , Albero‐Ros Elsa , David Samuel , Vidal‐Sanz Manuel 
Published: January 2024

Aims/Purpose: Inflammation and disease lead to the recruitment of blood monocyte‐derived macrophages (MDM) to the central nervous system. The role of MDMs following a neuroinflammatory process after a lesion remains elusive because MDMs that enter the neural parenchyma are difficult to distinguish from microglia. The aim of this study is to elucidate the response of recruited MDMs after selective retinal ganglion cell (RGC) injury.Methods: Unilateral complete intra‐orbital optic nerve (ON) crush was performed in adult C57BL/6J LysM‐GFP mice carrying the selective marker green fluorescent protein (GFP) in myeloid MDM but not microglia, 1 week after retrograde labelling of RGCs with the neuronal tracer hydroxystilbamidine (OHSt) from the superior colliculi. This injury model allows to investigate how the retinal mononuclear phagocytic system responds to a neurodegenerative process via the phagocytic activity of its main cellular components, resident microglia and recruited MDM, both in the injured retina and its contralateral uninjured fellow retina, at 5‐, 7‐ or 10‐days post‐lesion.Results: At all‐time points after injury, microglial phagocytic activity was statistically significant in the injured retina compared to the uninjured fellow retina. In comparison to naïve retinas, the number of MDMs increases significantly after injury in both injured and uninjured retinas. In injured retinas the increase is statistically higher. However, only a subset of the recruited MDMs shows phagocytic activity in the injured retinas 10 days after the lesion but not before. In contrast, the population of MDMs in the contralateral uninjured retina shows no signs of phagocytic activity after the lesion.Conclusions: In the injured retina, recruited MDMs show an initial quiescent stage, with no phagocytic activity compatible with a neuroprotective state, followed by a delayed phase with detrimental behaviour for RGC survival. In the uninjured fellow retinas however, MDMs retain a quiescent stage. It is tempting to suggest that following ON injury, recruited MDMs adopt an initial neuroprotective stage followed by a detrimental phagocytic activity in the injured retina, whereas in the uninjured retina MDMs remain in the initial stage.
Intraocular pressure change during and after core strength isometric exercise
Authors: Lanzl ines , Aghayeva Fidan , Assaf Abdelrahman 
Published: January 2024

Purpose: Physical exercise is advocated to achieve and maintain coordinated movements and good posture throughout life. Core strength, involving main muscle groups that support the spine, pelvis, upper and lower limbs, is considered crucial for this objective. An isometric core strength exercise often performed in this regard is the ‘plank’. The plank is taught to individuals of all age groups in fitness centers, online media and even rehabilitation programs. However no intraocular pressure (IOP) measurements during or after plank exercise have been reported so far.Methods: 21 healthy volunteers aged 25–60 years performed 1‐min plank exercise. IOP was measured in the right eye before the exercise (t0), at 1 min after commencing the plank (t1), 30 s (t2), 1 min (t3) and 5 min after the exercise (t4) using the Tonopen rebound tonometer. To ensure proper breathing the volunteers were engaged in conversation during exercise.Results: Mean age of the volunteers was 32 years, 57% of them being female. Median IOP before exercise was 15 (12.5–16.5) mmHg. At t1 it increased to 22 (17.5–24.5) mmHg, at t2 the IOP fell to 12 (10.5–15) mmHg, while it was 15 (11–17) mmHg at t3 and 12 (9–16) mmHg at t4, respectively. The IOP significantly increased at 1 min after starting the plank and decreased significantly below the initial value at t2. At 1 min there was no significant difference compared to the pre‐exercise value; however, at 5 min after exercising, the IOP was significantly lower than the initially. Wilcoxon test yielded significant results at time points t1, t2 and t4, with p‐value <0.001 for each time point.Conclusions: A significant increase in IOP was observed at the end of a 1‐min plank exercise in every volunteer and the entire group. Immediately after the exercise IOP levels dropped below the initial value and even after 5 min did not reach baseline. We suggest that during isometric core strength exercises IOP levels rise significantly, even using proper breathing techniques. The regulatory mechanisms involved in IOP control in healthy eyes seem to face challenges during a ‘normal’ isometric exercise. This finding should be taken into account when recommending isometric core strength exercises, particularly for patients with glaucoma, as their IOP regulatory mechanisms are likely compromised.
The effect of S‐allyl L‐cysteine on retinal ischaemia: The role of MCP‐1 and PKM2
Authors: Chao Windsor Wen‐Jin , Chao Hsiao‐Ming 
Published: January 2024

Aims/Purpose: Retinal ischaemia plays an important role in vision threatening retinal ischaemic disorders, such as central/branch RAO, nvAMD and normal tension glaucoma. The aim of this study was to determine the effects of S‐allyl L‐cysteine (SAC) and its underlying mechanism.Methods: Porcine RPE (pRPE) cells were extracted from adult pig eyes and maintained in DMEM containing 10% FBS, 100 U/mL penicillin and 100 mg/mL streptomycin in a humidified atmosphere of 95% air and 5% CO2 at 37°C. Cell viability was evaluated by via a haemocytometre under an optical microscope. H2O2 (500 μM) was added for 24 h to stimulate an oxidative stress and SAC or vehicle was added to some groups of the cultured pRPE cells 15 min before adding H2O2.Besides, high intraocular pressure (HIOP)‐induced retinal ischaemia was established by raising IOP to 120 mmHg for 60 min in a Wistar rat eye. This ischaemic insult is followed by 7 days of reperfusion. Whether and how ‘SAC’ is able to prevent retinal ischaemic injury were assessed by electrophysiology, fluorogold‐labeling and ELISA/western blot.Results: H2O2 (500 μM) stimulated free radical formation in cultured pRPE cells and significantly reduced the cell viability. This harmful effect was dose‐dependently (25/50 μM) and significantly (100 μM) ameliorated by pretreatment with SAC. Moreover, post‐administration of mega‐dose SAC (I/R + SAC 9 μg/kg/day ≈ 0.18 mg/0.2 Kg rat) counteracted the ischaemia‐induced decrease in the ERG b‐wave and reduction in the RGC cell number in the rat retina. This study supports an antioxidative role for SAC. Through the ELISA/western blot, SAC (100 μM) appears to protect against H2O2‐induced oxidative stress via the downregulation of ischaemia‐related factor PKM2 and inflammatory biomarker MCP‐1.Conclusions: SAC might protect against retinal ischaemia by antioxidation, anti‐ischaemia and anti‐inflammation (downregulating PKM2 and MCP‐1).References1. Chao, et al. S‐Allyl L‐Cysteine Protects the Retina against Kainate Excitotoxicity in the Rat. The Am J Chin Med, 42:693–708, 2014.2. Chao, et al. Fortified S‐Allyl L‐Cysteine: Animal Safety, Effect on Retinal Ischemia, and Role of Wnt in the Underlying Therapeutic Mechanism. Evid Based Complement Alternat Med, 2020:1–12, 2020.
Optimizing criterion to reduce the variability between observers in the delimitation of the foveal avascular zone in diabetic patients
Authors: Fernández‐Espinosa Guisela , Ruíz‐Tabuenca Carlos , Orduna‐Hospital Elvira , Arcas‐Carbonell María , Sánchez‐Cano Ana , Pinilla Isabel , Salgado‐Remacha Francisco J. 
Published: January 2024

Aims/Purpose: To reduce the variability when performing manual segmentation of the foveal avascular zone (FAZ) on retinal optical coherence tomography angiography (OCTA) images, and to find a new accurate FAZ delimitation criterion.Methods: Seventy‐three eyes from healthy subjects, 40 eyes from Type 1 diabetes mellitus (DM1) patients without diabetic retinopathy (DR) and 54 eyes from Type 2 diabetes mellitus (DM2) patients with moderate DR and without diabetic macular oedema (DME) were evaluated using OCTA. A manual FAZ segmentation was performed by different observers of each OCTA image of the superficial (SCP) and deep capillary plexuses (DCP). After comparing the results, a new criterion was established to reduce the variability in the segmentations. The FAZ area and circularity were also studied.Results: The novel criterion produces smaller areas (closer to the real FAZ), as well as a diminution of the standard deviation values, with a factor of 0.5, with lower variability than the different criteria of the explorers in both plexuses for the three groups. This was particularly notorious for the DM2 group with damaged retinas, where it was very difficult to define the FAZ limits. The acircularity values were also slightly reduced with the final criterion in all groups. In the DM2 group a significant reduction in the acircularity mean value of both plexuses was obtained. Looking for a relationship between the FAZ area and the acircularity, we found slightly higher values of acircularity for smaller FAZ areas. The number of extremal values was much higher for the initial method, and when the DCP was evaluated.Conclusions: The implementation of a new criterion for FAZ segmentation produced more consistent results with less variability among observers.
Long‐term response to idebenone treatment in a patient with advanced Leber hereditary optic neuropathy
Authors: Kabanarou Stamatina , Sgourou Chrysoula , Bitzanakis Nikolaos , Bontzos Georgios , Gkizis Ilias , Xirou Vasiliki , Xirou Tina 
Published: January 2024

Aims/Purpose: To present a case with advanced LHON and its response to 2‐year‐treatment with idebenone, which was prescribed 13 years after the onset of the disease.Methods: A 40‐year‐old Caucasian male patient with a history of bilateral painless visual loss since the age of 28 was examined at our Ophthalmology department. His brother had also suffered similar visual loss. At presentation ETDRS best corrected visual acuity (BCVA) was counting fingers (CF) in both eyes (BE). Fundoscopy revealed pale optic discs bilaterally. Visual fields (30‐2) showed central scotomas in BE. During OCT/OCTA imaging of the optic disc RNFL and GCC thickness were decreased bilaterally. In electrophysiological assessment with flash visual evoked potentials a reduction in amplitude was recorded in BE but with normal latency. Full‐field ERG was within normal limits in BE. At the genetic test, a mitochondrial point mutation m. 3460 G>A at MT‐ND1 gene was detected, which was compatible with LHON. The patient was prescribed 300 mg idebenone per os three times/day for 24 months. Follow‐up visits were scheduled at 6, 12, 18 and 24 months.Results: At 6‐ and 12‐month follow‐up visits visual acuity, fundoscopic findings and OCT‐RNFL imaging remained unchanged. However, the patient reported subjective visual improvement bilaterally, with greater improvement in the visual field of the left eye. At 18 months following initiation of treatment an improvement of the visual field was documented in BE. No change of the GCC thickness was noted. At 2‐year follow‐up his condition remained improved.Conclusions: Delayed treatment with idebenone in advanced LHON can lead to subjective visual improvement. Moreover, an improvement in visual fields can also be documented even after 18 to 24 months of the initiation of the treatment.