BioMed Research International: Ophthalmology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Improvement of Amniotic Membrane Method for the Treatment of Corneal Perforation Mon, 23 May 2016 14:04:17 +0000 In our retrospective study we evaluated the efficacy of an improved amniotic membrane (AM) roll-in filling technique (AMR) combined with multilayer amniotic membrane cover to treat corneal perforation and included 46 cornea perforations ≤ 3 mm in diameter treated with AMR and 20% C3F8 mixed gas filling of the anterior chamber. Anterior chamber depth, aqueous leakage, bubble maintenance time, and cornea morphology were monitored after each operation. The mean diameter of corneal perforation was  mm (range 0.5–3) and the success rate of the AMR method for corneal perforation reconstruction was 100% after a single operation. Anterior chamber depth was normally reconstructed without AMR break-off, aqueous leak, or other complications. The mean time of the C3F8 gas bubble in the anterior chamber was days (range 4–12). At the last follow-up, all patients’ visual acuity was improved to varying degrees. The mean follow-up time was months (range 3–36). The AMR plugging combined with multilayer AM cover is a secure and easy intervention, which led to 100% success in our study. Various perforations ranging from trauma to infection can be treated with AMR, which is especially practical in those countries where donor cornea availability is limited. Junhua Fan, Meihua Wang, and Fulu Zhong Copyright © 2016 Junhua Fan et al. All rights reserved. Advances in Confocal Microscopy of the Eye Thu, 19 May 2016 08:49:55 +0000 Paolo Fogagnolo, Michele Iester, Hong Liang, and Dipika V. Patel Copyright © 2016 Paolo Fogagnolo et al. All rights reserved. Retinal Macroglial Responses in Health and Disease Wed, 18 May 2016 13:51:29 +0000 Due to their permanent and close proximity to neurons, glial cells perform essential tasks for the normal physiology of the retina. Astrocytes and Müller cells (retinal macroglia) provide physical support to neurons and supplement them with several metabolites and growth factors. Macroglia are involved in maintaining the homeostasis of extracellular ions and neurotransmitters, are essential for information processing in neural circuits, participate in retinal glucose metabolism and in removing metabolic waste products, regulate local blood flow, induce the blood-retinal barrier (BRB), play fundamental roles in local immune response, and protect neurons from oxidative damage. In response to polyetiological insults, glia cells react with a process called reactive gliosis, seeking to maintain retinal homeostasis. When malfunctioning, macroglial cells can become primary pathogenic elements. A reactive gliosis has been described in different retinal pathologies, including age-related macular degeneration (AMD), diabetes, glaucoma, retinal detachment, or retinitis pigmentosa. A better understanding of the dual, neuroprotective, or cytotoxic effect of macroglial involvement in retinal pathologies would help in treating the physiopathology of these diseases. The extensive participation of the macroglia in retinal diseases points to these cells as innovative targets for new drug therapies. Rosa de Hoz, Blanca Rojas, Ana I. Ramírez, Juan J. Salazar, Beatriz I. Gallego, Alberto Triviño, and José M. Ramírez Copyright © 2016 Rosa de Hoz et al. All rights reserved. The Effect of Autologous Platelet Lysate Eye Drops: An In Vivo Confocal Microscopy Study Wed, 20 Apr 2016 11:27:32 +0000 Purpose. To determine the effectiveness of autologous platelet lysate (APL) eye drops in patients with primary Sjögren syndrome (SS) dry eye, refractory to standard therapy, in comparison with patients treated with artificial tears. We focused on the effect of APL on cornea morphology with the in vivo confocal microscopy (IVCM). Methods. Patients were assigned to two groups: group A used autologous platelet lysate QID, and group B used preservative-free artificial tears QID, for 90 days. Ophthalmological assessments included ocular surface disease index (OSDI), best corrected visual acuity (BCVA), Schirmer test, fluorescein score, and breakup time (BUT). A subgroup of patients in group A underwent IVCM: corneal basal epithelium, subbasal nerves, Langerhans cells, anterior stroma activated keratocytes, and reflectivity were evaluated. Results. 60 eyes of 30 patients were enrolled; in group A ( patients) mean OSDI, fluorescein score, and BUT showed significant improvement compared with group B ( patients). The IVCM showed a significant increase in basal epithelium cells density and subbasal nerve plexus density and number and a decrease in Langerhans cells density (). Conclusion. APL was found effective in the treatment of SS dry eye. IVCM seems to be a useful tool to visualize cornea morphologic modifications. Antonio M. Fea, Vittoria Aragno, Valeria Testa, Federica Machetta, Simone Parisi, Sergio D’Antico, Roberta Spinetta, Enrico Fusaro, and Federico M. Grignolo Copyright © 2016 Antonio M. Fea et al. All rights reserved. Ocular Comorbidities and the Relationship between Eye Diseases and Systemic Disorders Tue, 29 Mar 2016 13:10:43 +0000 Maria D. Pinazo-Durán, J. Fernando Arévalo, José J. García-Medina, Vicente Zanón-Moreno, Roberto Gallego-Pinazo, and Carlo Nucci Copyright © 2016 Maria D. Pinazo-Durán et al. All rights reserved. Ocular Complications of Diabetes and Therapeutic Approaches Mon, 28 Mar 2016 14:13:42 +0000 Diabetes mellitus (DM) is a metabolic disease defined by elevated blood glucose (BG). DM is a global epidemic and the prevalence is anticipated to continue to increase. The ocular complications of DM negatively impact the quality of life and carry an extremely high economic burden. While systemic control of BG can slow the ocular complications they cannot stop them, especially if clinical symptoms are already present. With the advances in biodegradable polymers, implantable ocular devices can slowly release medication to stop, and in some cases reverse, diabetic complications in the eye. In this review we discuss the ocular complications associated with DM, the treatments available with a focus on localized treatments, and what promising treatments are on the horizon. Victoria J. Vieira-Potter, Dimitrios Karamichos, and Darren J. Lee Copyright © 2016 Victoria J. Vieira-Potter et al. All rights reserved. Eclectic Ocular Comorbidities and Systemic Diseases with Eye Involvement: A Review Mon, 14 Mar 2016 11:28:33 +0000 Coexistence of several ocular diseases is more frequent than suspected. In spite of the refractive errors, one or more of the following can be detected simultaneously: glaucoma, cataracts, uveitis, age-related macular degeneration, and dry eyes. In addition, as people age, ocular comorbidities are much more usually seen. Specific diseases are openly acknowledged to affect the eyes and vision, such as diabetes mellitus, hypertension blood pressure, arthritis, hyperthyroidism, neurodegenerative disorders, hematologic malignancies, and/or systemic infections. Recent advances in early diagnosis and therapy of the ophthalmic pathologies have reinforced patient options to prevent visual impairment and blindness. Because of this, it is essential not to overlook sight-threatening conditions such as the ocular comorbidities and/or the eye involvement in the context of systemic disorders. Moreover, the important role of the multidisciplinary cooperation to improve and sustain management of patients affected with eclectic ocular comorbidities and/or systemic disorders with eye repercussion is specifically addressed. This review intends to shed light on these topics to help in making opportune diagnosis and appropriately managing the affected patients. María D. Pinazo-Durán, Vicente Zanón-Moreno, José J. García-Medina, J. Fernando Arévalo, Roberto Gallego-Pinazo, and Carlo Nucci Copyright © 2016 María D. Pinazo-Durán et al. All rights reserved. In Vivo Laser Scanning Confocal Microscopy of Human Meibomian Glands in Aging and Ocular Surface Diseases Mon, 07 Mar 2016 14:13:49 +0000 Meibomian glands (MGs) play a crucial role in the ocular surface homeostasis by providing lipids to the superficial tear film. Their dysfunction destabilizes the tear film leading to a progressive loss of the ocular surface equilibrium and increasing the risk for dry eye. In fact, nowadays, the meibomian gland dysfunction is one of the leading causes of dry eye. Over the past decades, MGs have been mainly studied by using meibography, which, however, cannot image the glandular structure at a cellular level. The diffusion of the in vivo laser scanning confocal microscopy (LSCM) provided a new approach for the structural assessment of MGs permitting a major step in the noninvasive evaluation of these structures. LSCM is capable of showing MGs modifications during aging and in the most diffuse ocular surface diseases such as dry eye, allergy, and autoimmune conditions and in the drug-induced ocular surface disease. On the other hand, LSCM may help clinicians in monitoring the tissue response to therapy. In this review, we summarized the current knowledge about the role of in vivo LSCM in the assessment of MGs during aging and in the most diffuse ocular surface diseases. Vincenzo Fasanella, Luca Agnifili, Rodolfo Mastropasqua, Lorenza Brescia, Federico Di Staso, Marco Ciancaglini, and Leonardo Mastropasqua Copyright © 2016 Vincenzo Fasanella et al. All rights reserved. Laser Scanning In Vivo Confocal Microscopy of Clear Grafts after Penetrating Keratoplasty Mon, 29 Feb 2016 09:50:52 +0000 Purpose. To evaluate the changes of keratocytes and dendritic cells in the central clear graft by laser scanning in vivo confocal microscopy after penetrating keratoplasty (PK). Methods. Thirty adult subjects receiving PK at Shandong Eye Institute and with clear grafts and no sign of immune rejection after surgery were recruited into this study, and 10 healthy adults were controls. The keratocytes and dendritic cells in the central graft were evaluated by laser scanning confocal microscopy, as well as epithelium cells, keratocytes, corneal endothelium cells, and corneal nerves (especially subepithelial plexus nerves). Results. Median density of subepithelial plexus nerves, keratocyte density in each layer of the stroma, and density of corneal endothelium cells were all lower in clear grafts than in controls. The dendritic cells of five (16.7%) patients were active in Bowman’s membrane and stromal membrane of the graft after PK. Conclusions. Activated dendritic cells and Langerhans cells could be detected in some of the clear grafts, which indicated that the subclinical stress of immune reaction took part in the chronic injury of the clear graft after PK, even when there was no clinical rejection episode. Dai Wang, Peng Song, Shuting Wang, Dapeng Sun, Yuexin Wang, Yangyang Zhang, and Hua Gao Copyright © 2016 Dai Wang et al. All rights reserved. Quiescent and Active Tear Protein Profiles to Predict Vernal Keratoconjunctivitis Reactivation Wed, 17 Feb 2016 13:26:00 +0000 Objective. Vernal keratoconjunctivitis (VKC) is a chronic recurrent bilateral inflammation of the conjunctiva associated with atopy. Several inflammatory and tissue remodeling factors contribute to VKC disease. The aim is to provide a chip-based protein analysis in tears from patients suffering from quiescent or active VKC. Methods. This study cohort included 16 consecutive patients with VKC and 10 controls. Participants were subjected to clinical assessment of ocular surface and tear sampling. Total protein quantification, total protein sketch, and protein array (sixty protein candidates) were evaluated. Results. An overall increased Fluorescent Intensity expression was observed in VKC arrays. Particularly, IL1β, IL15, IL21, Eotaxin2, TACE, MIP1α, MIP3α, NCAM1, ICAM2, βNGF, NT4, BDNF, βFGF, SCF, MMP1, and MMP2 were increased in quiescent VKC. Of those candidates, only IL1β, IL15, IL21, βNGF, SCF, MMP2, Eotaxin2, TACE, MIP1α, MIP3α, NCAM1, and ICAM2 were increased in both active and quiescent VKC. Finally, NT4, βFGF, and MMP1 were highly increased in active VKC. Conclusion. A distinct “protein tear-print” characterizes VKC activity, confirming some previously reported factors and highlighting some new candidates common to quiescent and active states. Those candidates expressed in quiescent VKC might be considered as predictive indicators of VKC reactivation and/or exacerbation out-of-season. Alessandra Micera, Antonio Di Zazzo, Graziana Esposito, Roberto Sgrulletta, Virginia L. Calder, and Stefano Bonini Copyright © 2016 Alessandra Micera et al. All rights reserved. Corneal Dendritic Cell Density Is Associated with Subbasal Nerve Plexus Features, Ocular Surface Disease Index, and Serum Vitamin D in Evaporative Dry Eye Disease Sun, 24 Jan 2016 07:15:16 +0000 Dry eye disease (DED) has evolved into a major public health concern with ocular discomfort and pain being responsible for significant morbidity associated with DED. However, the etiopathological factors contributing to ocular pain associated with DED are not well understood. The current IVCM based study investigated the association between corneal dendritic cell density (DCD), corneal subbasal nerve plexus (SBNP) features, and serum vitamin D and symptoms of evaporative dry eye (EDE). The study included age and sex matched 52 EDE patients and 43 heathy controls. A significant increase in the OSDI scores (discomfort subscale) was observed between EDE (median, 20.8) and control (median, 4.2) cohorts . Similarly, an increase in DCD was observed between EDE (median, 48.1 cells/mm2) patients and controls (median, 5.6 cells/mm2) . A significant decrease in SBNP features (corneal nerve fiber length, fiber density, fiber width, total branch density, nerve branch density, and fiber area) was observed in EDE patients with OSDI score >23 . A positive correlation was observed between DCD and OSDI discomfort subscale (; ) and SBNP features. An inverse correlation was observed between vitamin D and OSDI scores (; ) and DCD with dendritic processes (; ). The findings implicate DCD, SBNP features, and vitamin D with EDE symptoms. Rohit Shetty, Swaminathan Sethu, Rashmi Deshmukh, Kalyani Deshpande, Arkasubhra Ghosh, Aarti Agrawal, and Rushad Shroff Copyright © 2016 Rohit Shetty et al. All rights reserved. An In Vivo Confocal Microscopic Study of Corneal Nerve Morphology in Unilateral Keratoconus Thu, 21 Jan 2016 13:52:07 +0000 Purpose. To study the corneal nerve morphology and its importance in unilateral keratoconus. Materials and Methods. In this prospective cross-sectional study, 33 eyes of 33 patients with keratoconus in one eye (Group 3) were compared with the other normal eye of the same patients (Group 2) and 30 eyes of healthy patients (Group 1). All patients underwent detailed ophthalmic examination followed by topography with Pentacam HR and in vivo confocal microscopy (IVCM). Five images obtained with IVCM were analyzed using an automated CCmetrics software version 1.0 for changes in subbasal plexus of nerves. Results. Intergroup comparison showed statistically significant reduction in corneal nerve fiber density (CNFD) and length (CNFL) in Group 3 as compared to Group 1 ( and , resp.) and Group 2 ( and , resp.). Though corneal nerve fiber length, diameter, area, width, corneal nerve branch density, and corneal total branch density were found to be higher in decentered cones, only the corneal nerve branch density (CNBD) was found to be statistically significant () as compared to centered cones. Conclusion. Quantitative changes in the corneal nerve morphology can be used as an imaging marker for the early diagnosis of keratoconus before the onset of refractive or topography changes. Natasha Kishore Pahuja, Rohit Shetty, Rudy M. M. A. Nuijts, Aarti Agrawal, Arkasubhra Ghosh, Chaitra Jayadev, and Harsha Nagaraja Copyright © 2016 Natasha Kishore Pahuja et al. All rights reserved. The Superficial Stromal Scar Formation Mechanism in Keratoconus: A Study Using Laser Scanning In Vivo Confocal Microscopy Mon, 18 Jan 2016 07:23:17 +0000 To investigate the mechanism of superficial stromal scarring in advanced keratoconus using confocal microscopy, the keratocyte density, distribution, micromorphology of corneal stroma, and SNP in three groups were observed. Eight corneal buttons of advanced keratoconus were examined by immunohistochemistry. The keratocyte densities in the sub-Bowman’s stroma, anterior stroma, and posterior stroma and the mean SNP density were significantly different among the three groups. In the mild-to-moderate keratoconus group, activated keratocyte nuclei and comparatively highly reflective ECM were seen in the sub-Bowman’s stroma, while fibrotic structures with comparatively high reflection were visible in the anterior stroma in advanced keratoconus. The alternating dark and light bands in the anterior stroma of the mild-to-moderate keratoconus group showed great variability in width and direction. The wide bands were localized mostly in the posterior stroma that corresponded to the Vogt striae in keratoconus and involved the anterior stroma only in advanced keratoconus. Histopathologically, high immunogenicity of α-SMA, vimentin, and FAP was expressed in the region of superficial stromal scarring. In vivo confocal microscopy revealed microstructural changes in the keratoconic cone. The activation of superficial keratocytes and abnormal remodeling of ECM may both play a key role in the superficial stromal scar formation in advanced keratoconus. Peng Song, Shuting Wang, Peicheng Zhang, Wenjie Sui, Yangyang Zhang, Ting Liu, and Hua Gao Copyright © 2016 Peng Song et al. All rights reserved. The Correlation of Age and Postoperative Visual Acuity for Age-Related Cataract Tue, 05 Jan 2016 06:55:02 +0000 Purpose. Clinically, what is the best time for age-related cataract (ARC) patients to receive surgeries and get the most benefits is important. We explored the relationship between age and presenting postoperative visual acuity (POVA) in patients from rural China. Methods. Three Lifeline Express Hospital Eye-Train missions of Peking University People’s Hospital were chosen. At the first day after surgery, 3452 ARC eyes with the presenting POVA 6/60 were enrolled. The relationship between age and POVA was analyzed statistically. Results. In these three missions, there were more female patients than males; the ratio of females to males was 1.71. The average age of females was older than males. Overall, the percentages of patients with good visual outcomes (6/18) were significantly decreased with aging. Different regions had variations, but the trends were the same. There was weak linear correlation between age and POVA. The correlations of females were stronger than males in Yuncheng and Sanmenxia and weaker than males in Zhoukou. Conclusion. The good visual outcomes of presenting POVA were significantly decreased with aging and there were weak linear correlations between age and POVA in rural China. The linear correlation might be influenced by the difference of gender and region. Xiaochun Li, Xiaoguang Cao, Xianru Hou, and Yongzhen Bao Copyright © 2016 Xiaochun Li et al. All rights reserved. Corrigendum to “Strategy for the Management of Diabetic Macular Edema: The European Vitreo-Retinal Society Macular Edema Study” Sun, 20 Dec 2015 09:07:54 +0000 Ron A. Adelman, Aaron J. Parnes, Zofia Michalewska, Barbara Parolini, Claude Boscher, Didier Ducournau, and EVRS Macular Edema Study Group Copyright © 2015 Ron A. Adelman et al. All rights reserved. In Vivo Confocal Microscopy of the Human Cornea in the Assessment of Peripheral Neuropathy and Systemic Diseases Mon, 07 Dec 2015 12:45:02 +0000 In vivo confocal microscopy (IVCM) of the living human cornea offers the ability to perform repeated imaging without tissue damage. Studies using corneal IVCM have led to significant contributions to scientific and clinical knowledge of the living cornea in health and pathological states. Recently the application of corneal IVCM beyond ophthalmology to wider clinical and research fields has been demonstrated. Abnormalities of the corneal subbasal nerve plexus have been associated with many forms of peripheral neuropathy and Langerhans cells correlate with systemic inflammatory states. There is a rapidly growing evidence base investigating the use of corneal IVCM in many systemic conditions and a well-established evidence base for IVCM imaging of the corneal subbasal plexus in diabetic peripheral neuropathy. This paper reviews the potential use of corneal IVCM in general clinical practice as a noninvasive method of assessing peripheral neuropathies, monitoring inflammatory states and clinical therapeutic response. Ellen F. Wang, Stuti L. Misra, and Dipika V. Patel Copyright © 2015 Ellen F. Wang et al. All rights reserved. Long-Term Outcomes of Cultivated Limbal Epithelial Transplantation: Evaluation and Comparison of Results in Children and Adults Thu, 03 Dec 2015 08:01:23 +0000 Purpose. To compare the long-term clinical outcomes of cultivated limbal epithelial transplantation (CLET) in children and adults with limbal stem cell deficiency. Design. Retrospective case series. Methods. Case records of patients with limbal stem cell deficiency (LSCD) who underwent CLET from April 2004 to December 2014 were studied. Outcome measures were compared in terms of anatomical success and visual improvement. Parameters for total anatomical success were avascular, epithelized, and clinically stable corneal surface without conjunctivalization, whereas partial anatomical success was considered when mild vascularization (sparing centre of cornea) and mild conjunctivalization were noted along with complete epithelization. Results. A total of 62 cases underwent the CLET procedure: 38 (61.3%) were children and 24 (38.7%) were adults. Patients with unilateral LSCD (33 children and 21 adults) had autografts and those with bilateral LSCD (5 children and 3 adults) had allografts. Amongst the 54 autografts partial and total anatomical success were noted in 21.2% and 66.6% children, respectively, and 19.0% and 80.9% in adults, respectively ( value 0.23). Visual improvement of 1 line and ≥2 lines was seen in 57.5% and 21.2% children, respectively, and 38% and 38% in adults, respectively ( value 0.31). Conclusion. Cultivated limbal epithelial transplantation gives good long-term results in patients with LSCD and the outcomes are comparable in children and adults. Anita Ganger, M. Vanathi, Sujata Mohanty, and Radhika Tandon Copyright © 2015 Anita Ganger et al. All rights reserved. Antiangiogenic and Neurogenic Activities of Sleeping Beauty-Mediated PEDF-Transfected RPE Cells In Vitro and In Vivo Tue, 01 Dec 2015 06:45:24 +0000 Pigment epithelium-derived factor (PEDF) is a potent multifunctional protein that inhibits angiogenesis and has neurogenic and neuroprotective properties. Since the wet form of age-related macular degeneration is characterized by choroidal neovascularization (CNV), PEDF would be an ideal candidate to inhibit CNV and support retinal pigment epithelial (RPE) cells. However, its short half-life has precluded its clinical use. To deliver PEDF to the subretinal space, we transfected RPE cells with the PEDF gene using the Sleeping Beauty transposon system. Transfected cells expressed and secreted biologically active recombinant PEDF (rPEDF). In cultures of human umbilical vein endothelial cells, rPEDF reduced VEGF-induced cumulative sprouting by ≥47%, decreased migration by 77%, and increased rate of apoptosis at least 3.4 times. rPEDF induced neurite outgrowth in neuroblastoma cells and protected ganglion and photoreceptor cells in organotypic retinal cultures. In a rat model of CNV, subretinal transplantation of PEDF-transfected cells led to a reduction of the CNV area by 48% 14 days after transplantation and decreased clinical significant lesions by 55% and 40% after 7 and 14 days, respectively. We showed that transplantation of pigment epithelial cells overexpressing PEDF can restore a permissive subretinal environment for RPE and photoreceptor maintenance, while inhibiting choroidal blood vessel growth. Sandra Johnen, Yassin Djalali-Talab, Olga Kazanskaya, Theresa Möller, Nina Harmening, Martina Kropp, Zsuzsanna Izsvák, Peter Walter, and Gabriele Thumann Copyright © 2015 Sandra Johnen et al. All rights reserved. Corrigendum to “Strategy for the Management of Macular Edema in Retinal Vein Occlusion: The European VitreoRetinal Society Macular Edema Study” Mon, 30 Nov 2015 06:54:00 +0000 Ron A. Adelman, Aaron J. Parnes, Silvia Bopp, Ihab Saad Othman, Didier Ducournau, and EVRS Macular Edema Study Group Copyright © 2015 Ron A. Adelman et al. All rights reserved. Segmentation of Retinal Blood Vessels Based on Cake Filter Mon, 09 Nov 2015 11:01:42 +0000 Segmentation of retinal blood vessels is significant to diagnosis and evaluation of ocular diseases like glaucoma and systemic diseases such as diabetes and hypertension. The retinal blood vessel segmentation for small and low contrast vessels is still a challenging problem. To solve this problem, a new method based on cake filter is proposed. Firstly, a quadrature filter band called cake filter band is made up in Fourier field. Then the real component fusion is used to separate the blood vessel from the background. Finally, the blood vessel network is got by a self-adaption threshold. The experiments implemented on the STARE database indicate that the new method has a better performance than the traditional ones on the small vessels extraction, average accuracy rate, and true and false positive rate. Xi-Rong Bao, Xin Ge, Li-Huang She, and Shi Zhang Copyright © 2015 Xi-Rong Bao et al. All rights reserved. Descemet’s Stripping Automated Endothelial Keratoplasty versus Descemet’s Membrane Endothelial Keratoplasty in the Fellow Eye for Fuchs Endothelial Dystrophy: A Retrospective Study Mon, 09 Nov 2015 08:22:19 +0000 Aim. To evaluate visual outcome and endothelial cell density (ECD) after Descemet’s Membrane Endothelial Keratoplasty (DMEK) in comparison with Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in the fellow eye for Fuchs endothelial dystrophy (FED). Design. Single-centre, retrospective case series. Methods. 30 eyes of 30 patients undergoing DMEK, who completed a 1-year follow-up, were compared with 30 fellow eyes which underwent DSAEK for bilateral FED. Main outcome measures studied included Best Corrected Visual Acuity (BCVA) and ECD during a 1-year follow-up period. Results. BCVA improved from 0.78 ± 0.35 logMAR, and 0.73 ± 0.31 logMAR before surgery to 0.22 ± 0.1 logMAR and 0.35 ± 0.12 logMAR 6 months after DMEK and DSEK, respectively (). At one year after surgery, the BCVA was maintained at 0.21 ± 0.12 logMAR and 0.34 ± 0.1 logMAR, respectively, after DMEK and DSAEK. A statistically better visual outcome was observed after DMEK compared to DSAEK () in fellow eyes. Conclusions. DMEK provided better visual rehabilitation when compared to DSAEK. Nevertheless, there were no significant differences with regard to the ECD within a 1-year follow-up. Vipul Bhandari, Jagdeesh K. Reddy, Kirti Relekar, and Vijayalakshmi Prabhu Copyright © 2015 Vipul Bhandari et al. All rights reserved. Enhanced Oxidative Stress and Other Potential Biomarkers for Retinopathy in Type 2 Diabetics: Beneficial Effects of the Nutraceutic Supplements Wed, 04 Nov 2015 09:14:20 +0000 We have studied the global risk of retinopathy in a Mediterranean population of type 2 diabetes mellitus (T2DM) patients, according to clinical, biochemical, and lifestyle biomarkers. The effects of the oral supplementation containing antioxidants/omega 3 fatty acids (A/ω3) were also evaluated. Suitable participants were distributed into two main groups: (1) T2DMG (with retinopathy (+DR) or without retinopathy (−DR)) and (2) controls (CG). Participants were randomly assigned (+A/ω3) or not (−A/ω3) to the oral supplementation with a daily pill of Nutrof Omega (R) for 18 months. Data collected including demographics, anthropometrics, characteristics/lifestyle, ophthalmic examination (best corrected visual acuity, ocular fundus photographs, and retinal thickness as assessed by optical coherence tomography), and blood parameters (glucose, glycosylated hemoglobin, triglycerides, malondialdehyde, and total antioxidant capacity) were registered, integrated, and statistically processed by the SPSS 15.0 program. Finally, 208 participants (130 diabetics (68 +DR/62 −DR) and 78 controls) completed the follow-up. Blood analyses confirmed that the T2DMG+DR patients had significantly higher oxidative stress , inflammatory , and vascular risk markers than the T2DMG−DR and the CG. Furthermore, the A/ω3 oral supplementation positively changed the baseline parameters, presumptively by inducing metabolic activation and ameliorating the ocular health after 18 months of supplementation. María J. Roig-Revert, Antonio Lleó-Pérez, Vicente Zanón-Moreno, Bárbara Vivar-Llopis, Juan Marín-Montiel, Rosa Dolz-Marco, Luis Alonso-Muñoz, Mara Albert-Fort, María I. López-Gálvez, David Galarreta-Mira, María F. García-Esparza, Carmen Galbis-Estrada, Carla Marco-Ramirez, Kian Shoaie-Nia, Silvia M. Sanz-González, Vicente Vila-Bou, Elena Bendala-Tufanisco, José J. García-Medina, Carlo Nucci, Roberto Gallego-Pinazo, J. Fernando Arévalo, Maria D. Pinazo-Durán, and Valencia Study on Diabetic Retinopathy (VSDR) Copyright © 2015 María J. Roig-Revert et al. All rights reserved. Myopia Control with a Novel Peripheral Gradient Soft Lens and Orthokeratology: A 2-Year Clinical Trial Wed, 28 Oct 2015 14:17:43 +0000 Objective. To evaluate the degree of axial elongation with soft radial refractive gradient (SRRG) contact lenses, orthokeratology (OK), and single vision (SV) spectacle lenses (control) during a period of 1 year before treatment and 2 years after treatment. Methods. This was a prospective, longitudinal, nonrandomized study. The study groups consisted of 30, 29, and 41 children, respectively. The axial length (AL) was measured during 2 years after recruitment and lens fitting. Results. The baseline refractive sphere was correlated significantly (Spearman’s Rho (ρ) correlation = 0.542; P < 0.0001) with the amount of myopia progression before baseline. After 2 years, the mean myopia progression values for the SRRG, OK, and SV groups were −0.56 ± 0.51, −0.32 ± 0.53, and −0.98 ± 0.58 diopter, respectively. The results represent reductions in myopic progression of 43% and 67% for the SRRG and OK groups, respectively, compared to the SV group. The AL increased 27% and 38% less in the SRRG and OK groups, respectively compared with the SV group at the 2-year visit (P < 0.05). Axial elongation was not significantly different between SRRG and OK (P = 0.430). Conclusion. The SRRG lens significantly decreased AL elongation compared to the SV control group. The SRRG lens was similarly effective to OK in preventing myopia progression in myopic children and adolescent. Jaime Pauné, Hari Morales, Jesús Armengol, Lluisa Quevedo, Miguel Faria-Ribeiro, and José M. González-Méijome Copyright © 2015 Jaime Pauné et al. All rights reserved. Ocular Blood Flow and Visual Function Mon, 19 Oct 2015 11:56:20 +0000 Goji Tomita, David Huang, Colm O’Brien, Ki Ho Park, and Toru Nakazawa Copyright © 2015 Goji Tomita et al. All rights reserved. No Evidence for Retinal Damage Evolving from Reduced Retinal Blood Flow in Carotid Artery Disease Mon, 19 Oct 2015 11:41:29 +0000 Introduction. Carotid artery disease (CAD) comprising high-grade internal carotid artery stenosis (CAS) or carotid artery occlusion (CAO) may lead to ipsilateral impaired cerebral blood flow and reduced retinal blood supply. Objective. To examine the influence of chronic CAD on retinal blood flow, retinal morphology, and visual function. Methods. Patients with unilateral CAS ≥ 50% (ECST criteria) or CAO were grouped according to the grade of the stenosis and to the flow direction of the ophthalmic artery (OA). Retinal perfusion was measured by transorbital duplex ultrasound, assessing central retinal artery (CRA) blood flow velocities. In addition, optic nerve and optic nerve sheath diameter were measured. Optical coherence tomography (OCT) was performed to study retinal morphology. Visual function was assessed using high- and low-contrast visual paradigms. Results. Twenty-seven patients were enrolled. Eyes with CAS ≥ 80%/CAO and retrograde OA blood flow showed a significant reduction in CRA peak systolic velocity (no-CAD side:  m/s, CAS/CAO side: ; ; ). OCT, optic nerve thicknesses, and visual functional parameters did not show a significant difference. Conclusion. Despite assessable hemodynamic effects, chronic high-grade CAD does not lead to gaugeable morphological or functional changes of the retina. Henning Heßler, Hanna Zimmermann, Timm Oberwahrenbrock, Ella Maria Kadas, Janine Mikolajczak, Alexander U. Brandt, Andreas Kauert, Friedemann Paul, and Stephan J. Schreiber Copyright © 2015 Henning Heßler et al. All rights reserved. Current Approach in the Diagnosis and Management of Uveitic Glaucoma Mon, 19 Oct 2015 09:07:59 +0000 Uveitic glaucoma (UG) typically is associated with very high intraocular pressure (IOP) and more intense optic nerve damage than other glaucoma types. This secondary glaucoma requires an early diagnosis and adequate management of both uveitis and glaucoma. It is mandatory to identify the mechanisms of IOP elevation that in many eyes have multiple combined mechanisms. Management of these patients commonly requires an interdisciplinary approach that includes a glaucoma specialist and rheumatologist to control the inflammation and IOP. Glaucoma surgery is required early in these patients due to the high IOP usually present and is less successful than in primary open-angle glaucoma. Recurrent uveitic episodes, multiple mechanism, and the complications associated with uveitis make surgical management of UG challenging. In this review, the management and treatment of UG are updated to clarify the pathogenesis and prevent optic nerve damage. Francisco J. Muñoz-Negrete, Javier Moreno-Montañés, Paula Hernández-Martínez, and Gema Rebolleda Copyright © 2015 Francisco J. Muñoz-Negrete et al. All rights reserved. A Clinical Picture of the Visual Outcome in Adamantiades-Behçet’s Disease Mon, 19 Oct 2015 08:56:06 +0000 Adamantiades-Behçet’s disease is a multisystemic vasculitis with multiorgan involvement. Ocular disorders occur often in this syndrome typically in the form of a relapsing-remitting panuveitis and vasculitis and can lead to blindness as one of its most disabling complications if left untreated. There are known risk factors related with the worst visual prognosis, which require early and intensive treatment in order to obtain a rapid suppression of inflammation and to prevent future relapses. The management strategy to avoid vision loss and blindness currently involves the use of local and systemic drugs including steroids and immunosuppressive and biologic agents. This review aims to demonstrate how the introduction and the use of biologic agents improves the visual outcome of patients with Adamantiades-Behçet’s disease. Michele Figus, Chiara Posarelli, Timothy G. Albert, Rosaria Talarico, and Marco Nardi Copyright © 2015 Michele Figus et al. All rights reserved. Ocular Manifestations and Therapeutic Options in Patients with Familial Amyloid Polyneuropathy: A Systematic Review Mon, 19 Oct 2015 08:21:17 +0000 Purpose. This paper aims to review the morphological and functional characteristics of patients affected by familial amyloid polyneuropathy (FAP), with greater focus on type I and its progression after liver transplantation. We also analyse therapeutic options for the ophthalmic manifestations. Methods. The literature from 2002 through 2015 was reviewed, with a total of 45 articles studied, using the key terms related to amyloidosis and its therapeutic approaches. Information was collated, evaluated, critically assessed, and then summarised in its present form. Pathophysiology and Treatment. FAP results from mutation of the transthyretin gene, with Val30Met being the most frequent substitution. The symptoms are those typical of a sensorimotor autonomic neuropathy and can be halted with liver transplantation. Nowadays there are new medical therapies that delay the progression of the systemic neuropathy. However, there are still no options to avoid ocular disease. Conclusion. The main ocular manifestations in patients with FAP type I are amyloid deposition in the vitreous, dry eye, and secondary glaucoma. Despite liver transplantation, eye synthesis of amyloid persists and is associated with progressive ocular manifestations, which require continued ophthalmologic follow-up. New therapeutic strategies are therefore needed, particularly to target the ocular synthesis of the abnormal protein. A. C. Martins, A. M. Rosa, E. Costa, C. Tavares, M. J. Quadrado, and J. N. Murta Copyright © 2015 A. C. Martins et al. All rights reserved. Ocular Blood Flow and Normal Tension Glaucoma Mon, 19 Oct 2015 08:14:12 +0000 Normal tension glaucoma (NTG) is known as a multifactorial optic neuropathy characterized by progressive retinal ganglion cell death and glaucomatous visual field loss, even though the intraocular pressure (IOP) does not exceed the normal range. The pathophysiology of NTG remains largely undetermined. It is hypothesized that the abnormal ocular blood flow is involved in the pathogenesis of this disease. A number of evidences suggested that the vascular factors played a significant role in the development of NTG. In recent years, the new imaging techniques, fluorescein angiography, color Doppler imaging (CDI), magnetic resonance imaging (MRI), and laser speckle flowgraphy (LSFG), have been used to evaluate the ocular blood flow and blood vessels, and the impaired vascular autoregulation was found in patients with NTG. Previous studies showed that NTG was associated with a variety of systemic diseases, including migraine, Alzheimer’s disease, primary vascular dysregulation, and Flammer syndrome. The vascular factors were involved in these diseases. The mechanisms underlying the abnormal ocular blood flow in NTG are still not clear, but the risk factors for glaucomatous optic neuropathy likely included oxidative stress, vasospasm, and endothelial dysfunction. Ning Fan, Pei Wang, Li Tang, and Xuyang Liu Copyright © 2015 Ning Fan et al. All rights reserved. Atrial Fibrillation and Coronary Artery Disease as Risk Factors of Retinal Artery Occlusion: A Nationwide Population-Based Study Mon, 19 Oct 2015 08:08:39 +0000 We use Taiwanese national health insurance research database (NHIRD) to investigate whether thrombolism (carotid artery disease (CAD) as a surrogate) or embolism (atrial fibrillation (AF) as a surrogate) plays roles in later retinal artery occlusion (RAO) development and examine their relative weights. The relative risks of RAO between AF and CAD patients and controls were compared by estimating the crude hazard ratio with logistic regression. Kaplan-Meier analysis was used to calculate the cumulative incidence rates of developing RAO, and a log-rank test was used to analyze the differences between the survival curves. Separate Cox proportional hazard regressions were done to compute the RAO-free rate after adjusting for possible confounding factors such as age and sex. The crude hazard ratios were 7.98 for the AF group and 5.27 for the CAD group, and the adjusted hazard ratios were 8.32 and 5.34 for the AF and CAD groups, respectively. The observation time with RAO-free was shorter for AF compared with CAD group (1490 versus 1819 days). AF and CAD were both risk factors for RAO with different hazard ratios. To tackle both AF and CAD is crucial for curbing RAO. Ju-Chuan Yen, Hsiu-Li Lin, Chia-An Hsu, Yu-Chuan (Jack) Li, and Min-Huei Hsu Copyright © 2015 Ju-Chuan Yen et al. All rights reserved. New Onset Diplopia in Patients with Nasopharyngeal Carcinoma following Concurrent Chemoradiotherapy: Clinical Features and Etiology Mon, 19 Oct 2015 07:29:52 +0000 Purpose. To investigate the clinical features and etiology of nasopharyngeal carcinoma (NPC) patients with new onset diplopia after concurrent chemoradiotherapy. Methods. We retrospectively reviewed the medical records of NPC patients with new onset diplopia after concurrent chemoradiotherapy from 1998 to 2012 in a cancer center. Their clinical manifestations of ocular motor dysfunction in relation to etiology were investigated. Results. Twenty-three NPC patients with diplopia after concurrent chemoradiotherapy were enrolled in this study. Unilateral cranial VI palsy (91%) was the most common ocular motor dysfunction in these patients. The new onset diplopia in these patients was secondary to tumor recurrence in 12 cases (52%), radiation neuropathy in 8 cases (35%), and skull base osteoradionecrosis in 3 cases (13%). Patients with tumor recurrence and skull base osteoradionecrosis tended to present a rapid progression of the nerve palsy or severe ocular duction deficit. Patients with radiation neuropathy were often manifested by incomplete nerve palsy with insidious onset and slow progression. Patients with osteoradionecrosis were associated with poor prognosis. Conclusions. A new onset diplopia in NPC patients could be caused by tumor recurrence or treatment complications such as radiation neuropathy and osteoradionecrosis, and they show diverse clinical symptoms, course, and outcome. Hui-Chuan Kau and Chieh-Chih Tsai Copyright © 2015 Hui-Chuan Kau and Chieh-Chih Tsai. All rights reserved. Retrobulbar Hemodynamics and Visual Field Progression in Normal Tension Glaucoma: A Long-Term Follow-Up Study Sun, 18 Oct 2015 13:36:15 +0000 Purpose. Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG). Patients and Methods. 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI) progression rate per year (in %). To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years. Results. Mean follow-up was 7.6 ± 4.1 years with an average of 10 ± 5 visual field tests. The mean MD (mean defect) at baseline was −7.61 ± 7.49 dB. The overall VFI progression was −1.14 ± 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found. Conclusion. Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters. D. Kuerten, M. Fuest, E. C. Koch, A. Koutsonas, and N. Plange Copyright © 2015 D. Kuerten et al. All rights reserved. Diagnostic Accuracy of Nonmydriatic Fundus Photography for the Detection of Glaucoma in Diabetic Patients Sun, 18 Oct 2015 12:24:32 +0000 Purpose. To determine the diagnostic accuracy for glaucoma of a set of criteria with nonmydriatic monoscopic fundus photography (NMFP) in diabetics. Methods. Diabetics recruited from a screening program for diabetic retinopathy and diabetic glaucoma patients recruited from our glaucoma unit were included. Any patient with evidence of diabetic retinopathy was excluded. Diabetic patients had to have no visual field defects to be included as controls. Glaucoma patients had to have a glaucomatous field defect in at least one eye to be included. One NMFP was taken per eye for all subjects. These photographs were evaluated by two masked glaucoma specialists for the presence of the following: bilateral cup to disc (C/D) ratio ≥0.6, notching or thinning of the neuroretinal rim, disc hemorrhages, and asymmetry in the C/D ratio between both eyes ≥0.2. This evaluation led to a dichotomous classification: if any of the above criteria was present, the patient was classified as glaucoma. If none were present, the patient was classified as normal. Results. 72 control subjects and 72 glaucoma patients were included. Evaluation of NMFP had a sensitivity of 79.17% and a specificity of 80.56% for specialist 1 and a sensitivity of 72.22% and a specificity of 88.88% for specialist 2 for the detection of glaucoma. The overall accuracy was 79.83% and 80.55%, respectively. Discussion. NMFP evaluation by a glaucoma specialist may be useful for the detection of glaucoma in diabetics. Francisco J. Muñoz-Negrete, Inés Contreras, Noelia Oblanca, M. Dolores Pinazo-Durán, and Gema Rebolleda Copyright © 2015 Francisco J. Muñoz-Negrete et al. All rights reserved. Systemic and Ocular Hemodynamic Risk Factors in Glaucoma Sun, 18 Oct 2015 12:17:27 +0000 Primary open angle glaucoma (POAG) is a multifactorial disease characterized by progressive retinal ganglion cell death and visual field loss. It is known that alterations in intraocular pressure (IOP), blood pressure (BP), and ocular perfusion pressure (OPP) can play a significant role in the pathogenesis of the disease. Impaired autoregulatory capacity of ocular blood vessels may render tissues vulnerable to OPP changes and potentially harmful tissue ischemia-reperfusion damage. Vascular risk factors should be considered more important in a subgroup of patients with POAG, and especially in patients with normal tension glaucoma (NTG) with evidence of unphysiological BP response. For example, reduction of BP during the nighttime has an influence on OPP, and increased circadian OPP fluctuation, which might stand for unstable ocular blood flow, has been found to be the consistent risk factor for NTG development and progression. Central visual field may be affected more severely than peripheral visual field in NTG patients with higher 24-hour fluctuation of OPP. This review will discuss the current understanding of allegedly major systemic and ocular hemodynamic risk factors for glaucoma including systemic hypertension, arterial stiffness, antihypertensive medication, exaggerated nocturnal hypotension, OPP, and autonomic dysregulation. Jaewan Choi and Michael S. Kook Copyright © 2015 Jaewan Choi and Michael S. Kook. All rights reserved. Ocular Surface and Tear Film Changes in Older Women Working with Computers Sun, 18 Oct 2015 12:14:01 +0000 The aim of this work is to investigate changes in the ocular surface (OS) and tear film (TF) by means of questionnaire-based subjective symptoms, TF break-up time, Schirmer test, and TF analysis in women working with computers and to analyze the effects of the oral supplementation with antioxidants/omega 3 fatty acids (A/ω3) in the OS outcomes. Women aged 40–65 years () were recruited at the Administrative Offices of Valencia (Spain) and distributed into two age groups, 40–52 years (AGE1; ) and 53–65 years (AGE2; ), and then subdivided according to being (or not) computer users (CUG; NCUG) during the workday. Homogeneous subgroups were randomly assigned (or not) to the daily intake of three pills of A/ω3 for three months. At baseline and at the end of follow-up, personalized interviews and ocular examination were done. Reflex tear samples were collected from the inferior meniscus and processed for a multiplexed particle-based flow cytometry assay to measure proinflammatory molecules. Statistics were performed using the SPSS 15.0 program. The OS pathology was clinically evident in the AGE1-CUG (33%) versus the AGE2-CUG (64%) of women. Significantly higher interleukins-1β and -6 tear levels were found in the AGE1 versus the AGE2 women employees ( and , resp.), as well as in the CUG versus the NCUG ( and , resp.). Supplementation with A/ω3 positively influenced the OS pathology as manifested by the amelioration of the clinical signs/symptoms related to computer uses. Strategies involving a safe environment and oral micronutrient supplements may be managed within eye-care standards in older women. Alfredo Ribelles, Carmen Galbis-Estrada, Maria A. Parras, Bárbara Vivar-Llopis, Carla Marco-Ramírez, and Manuel Diaz-Llopis Copyright © 2015 Alfredo Ribelles et al. All rights reserved. The Changes of Retinal Saturation after Long-Term Tamponade with Silicone Oil Sun, 18 Oct 2015 12:12:16 +0000 Purpose. To evaluate the effects of long-term tamponade with silicone oil on retinal saturation. Methods. A total of 49 eyes that received tamponade with silicone oil were included. The patients were divided into 3 groups (3–6 months, 6–9 months, and >9 months) according to the duration of silicone oil tamponade. Retinal oximetry was performed using the Oxymap system before and 2 months after silicone oil removal. Results. The mean retinal oxygen saturation before silicone oil removal was 107% ± 12% in the arterioles and 60% ± 10% in the venules, with an overall arteriovenous difference (AVD) of 47% ± 14%. The AVD in the >9-month group was significantly higher than that in the 3–6-month group (54% ± 16% versus 44% ± 11%, ). After silicone oil removal, the AVD in the >9-month group was significantly decreased (45% ± 9% versus 54% ± 16%, ); additionally, the arterioles were significantly wider than before surgery (10.8 ± 0.7 pixels versus 10.4 ± 0.9 pixels, ). Conclusions. The tamponade with silicone oil for more than 9 months will cause the alterations of retinal saturation and the narrowing of retinal arterioles, which may further interfere with the oxygen metabolism in the retina. Bingsheng Lou, Zhaohui Yuan, Liwen He, Lixia Lin, Qianying Gao, and Xiaofeng Lin Copyright © 2015 Bingsheng Lou et al. All rights reserved. Reproducibility of Neonate Ocular Circulation Measurements Using Laser Speckle Flowgraphy Sun, 18 Oct 2015 12:11:40 +0000 Measuring the ocular blood flow in neonates may clarify the relationships between eye diseases and ocular circulation abnormalities. However, no method for noninvasively measuring ocular circulation in neonates is established. We used laser speckle flowgraphy (LSFG) modified for neonates to measure their ocular circulation and investigated whether this method is reproducible. During their normal sleep, we studied 16 subjects (adjusted age of 34–48 weeks) whose blood flow could be measured three consecutive times. While the subjects slept in the supine position, three mean blur rate (MBR) values of the optic nerve head (ONH) were obtained: the MBR-A (mean of all values), MBR-V (vessel mean), and MBR-T (tissue mean), and nine blood flow pulse waveform parameters in the ONH were examined. We analyzed the coefficient of variation (COV) and the intraclass correlation coefficient (ICC) for each parameter. The COVs of the MBR values were all ≤10%. The ICCs of the MBR values were all >0.8. Good COVs were observed for the blowout score, blowout time, rising rate, falling rate, and acceleration time index. Although the measurement of ocular circulation in the neonates was difficult, our results exhibited reproducibility, suggesting that this method could be used in clinical research. Tadashi Matsumoto, Takashi Itokawa, Tomoaki Shiba, Yuji Katayama, Tetsushi Arimura, Norio Mizukaki, Hitoshi Yoda, and Yuichi Hori Copyright © 2015 Tadashi Matsumoto et al. All rights reserved. Femtosecond Laser Assisted Deep Anterior Lamellar Keratoplasty Outcomes and Healing Patterns Compared to Manual Technique Sun, 18 Oct 2015 12:10:59 +0000 The purpose of the study is to report the visual, refractive, and wound healing pattern outcomes of femtosecond assisted deep anterior lamellar keratoplasty (DALK) compared to the conventional manual technique. DALK was performed on 50 eyes of 47 advanced keratoconus patients. The patients were divided into two groups, 25 eyes each, depending on whether femtosecond assisted or manual DALK technique was performed for the side cut of the procedure only. Patients were followed up at 1 month, 6 months, and 1 year for visual acuity, clinical refraction, corneal cylinder, date of suture removal, and side cut corneal healing pattern according to new grading classification of the side cut scar (Grade 0 = transparent scar, 1 = faint healing opacity, 2 = evident healing opacity, 3 = significant opacity with some cosmetic imbalance, and 4 = highly significant opacity with very significant cosmetic imbalance). Outcomes are reported at one year. In conclusion, femtosecond assisted and manual DALK show comparable visual and refractive outcomes but femtosecond assisted DALK shows more evident corneal wound healing patterns at the side cut. This observation may indicate that an activated cornea wound healing might allow earlier suture removal when femtosecond technology is used to perform the side cut for DALK. Jorge L. Alio, Ahmed A. Abdelghany, Rafael Barraquer, Laila M. Hammouda, and Ahmed M. Sabry Copyright © 2015 Jorge L. Alio et al. All rights reserved. Analysis of Retinal Peripapillary Segmentation in Early Alzheimer’s Disease Patients Sun, 18 Oct 2015 12:09:59 +0000 Decreased thickness of the retinal nerve fiber layer (RNFL) may reflect retinal neuronal-ganglion cell death. A decrease in the RNFL has been demonstrated in Alzheimer’s disease (AD) in addition to aging by optical coherence tomography (OCT). Twenty-three mild-AD patients and 28 age-matched control subjects with mean Mini-Mental State Examination 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision, were considered for study. OCT peripapillary and macular segmentation thickness were examined in the right eye of each patient. Compared to controls, eyes of patients with mild-AD patients showed no statistical difference in peripapillary RNFL thickness (); however, sectors 2, 3, 4, 8, 9, and 11 of the papilla showed thinning, while in sectors 1, 5, 6, 7, and 10 there was thickening. Total macular volume and RNFL thickness of the fovea in all four inner quadrants and in the outer temporal quadrants proved to be significantly decreased (). Despite the fact that peripapillary RNFL thickness did not statistically differ in comparison to control eyes, the increase in peripapillary thickness in our mild-AD patients could correspond to an early neurodegeneration stage and may entail the existence of an inflammatory process that could lead to progressive peripapillary fiber damage. Elena Salobrar-Garcia, Irene Hoyas, Mercedes Leal, Rosa de Hoz, Blanca Rojas, Ana I. Ramirez, Juan J. Salazar, Raquel Yubero, Pedro Gil, Alberto Triviño, and José M. Ramirez Copyright © 2015 Elena Salobrar-Garcia et al. All rights reserved. The Role of Systemic Arterial Stiffness in Open-Angle Glaucoma with Diabetes Mellitus Sun, 18 Oct 2015 12:08:13 +0000 Purpose. To investigate the role of systemic arterial stiffness in glaucoma patients with diabetes mellitus (DM). Design. Retrospective, cross-sectional study. Participants. DM subjects who underwent brachial-ankle pulse wave velocity (baPWV) were recruited. Methods. Glaucoma patients () and age-matched control subjects () were enrolled. Systemic examination including BaPWV and detailed eye examination were performed. The glaucoma group was divided into subgroups of normal tension glaucoma (NTG, ) and primary open-angle glaucoma (POAG) based on an IOP of 21 mmHg. BaPWV was used to stratify the population into 4 groups based on the rate. Stepwise multiple logistic regression analysis by baPWV quartiles was used to compare the glaucoma group with the control group. Main Outcome Measures. BaPWV in glaucoma with DM patients. Results. Faster baPWV was positively associated with glaucoma (odds ratio: 3.74; 95% CI: 1.03–13.56, stepwise multiple logistic regression analysis) in patients with DM. Increasing baPWV was also positively associated with glaucoma ( for trend = 0.036). The NTG subgroup showed similar results to those of the glaucoma group. Conclusions. In this study, increased arterial stiffness was shown to be associated with glaucoma and may contribute to the pathogenesis of glaucoma in DM patients. Seong Hee Shim, Chan Yun Kim, Joon Mo Kim, Da Yeong Kim, Yang Jae Kim, Jeong Hun Bae, and Ki Chul Sung Copyright © 2015 Seong Hee Shim et al. All rights reserved. Comparison of Ocular Pulse Amplitude Lowering Effects of Preservative-Free Tafluprost and Preservative-Free Dorzolamide-Timolol Fixed Combination Eyedrops Sun, 18 Oct 2015 12:01:38 +0000 Purpose. To compare the ocular pulse amplitude (OPA) lowering effects of preservative-free tafluprost and dorzolamide-timolol fixed combination (DTFC) using dynamic contour tonometry. Methods. In total, 66 eyes of 66 patients with normal tension glaucoma (NTG) () or primary open angle glaucoma (POAG) () were included. Patients were divided into two groups: the preservative-free tafluprost-treated group () and the preservative-free DTFC-treated group (). Intraocular pressure (IOP) was measured using Goldmann applanation tonometry (GAT). OPA was measured using dynamic contour tonometry; corrected OPA (cOPA) was calculated at baseline and at 1 week and 1, 3, and 6 months after treatment. Results. After 6 months of treatment, tafluprost significantly reduced IOP (). The OPA lowering effects differed significantly between the two treatment groups (). The cOPA-lowering effect of tafluprost (1.09 mmHg) was significantly greater than that of DTFC (0.36 mmHg) after 6 months of treatment (). Conclusions. Tafluprost and DTFC glaucoma treatments provided marked OPA and IOP lowering effects. Tafluprost had a greater effect than DTFC; thus, this drug is recommended for patients at risk of glaucoma progression, due to the high OPA caused by large fluctuations in IOP. Du Ri Seo and Seung Joo Ha Copyright © 2015 Du Ri Seo and Seung Joo Ha. All rights reserved. The Association between Primary Open-Angle Glaucoma and Blood Pressure: Two Aspects of Hypertension and Hypotension Sun, 18 Oct 2015 11:40:01 +0000 Glaucoma is the second leading cause of blindness worldwide. Although the mechanism of the development of primary open-angle glaucoma (POAG) is not fully understood, elevated intraocular pressure (IOP) is considered the most important risk factor. Several vascular factors have also been identified as risk factors and can lead to hypoperfusion of the optic nerve head and thus may play an important role in the pathogenesis and progression of POAG. The results of the present study suggest that both high and low blood pressure (BP) are associated with an increased risk of POAG based on a comprehensive literature review. Elevated BP is associated with elevated IOP, leading to increased risk of glaucoma, but excessive BP lowering in glaucoma patients may cause a drop in ocular perfusion pressure (OPP) and subsequent ischemic injury. The relationship between IOP, OPP, and BP suggests that the relationship between BP and glaucoma progression is U-shaped. Hye Jin Chung, Hyung Bin Hwang, and Na Young Lee Copyright © 2015 Hye Jin Chung et al. All rights reserved. Evaluation of the Effect of Hypercapnia on Vascular Function in Normal Tension Glaucoma Sun, 18 Oct 2015 11:28:35 +0000 Introduction. Altered ocular perfusion and vascular dysregulation have been reported in glaucoma. The aim of this paper was to evaluate the vascular response to a hypercapnic stimulus. Methods. Twenty normal tension glaucoma (NTG) patients and eighteen age- and gender-matched controls had pulsatile ocular blood flow (POBF) measurements, systemic cardiovascular assessment, and laser Doppler digital blood flow (DBF) assessed. Measurements were taken at baseline, after 10-minutes rest, in the stable sitting and supine positions and following induction and stabilization of hypercapnia, which induced a 15% increase in end-tidal . The POBF response to hypercapnia was divided into high (>20%) and low responders (<20%). Results. 65% of NTG patients had a greater than 41% increase in POBF following rebreathing (high responders). These high responders had a lower baseline POBF, lower baseline DBF, and a greater DBF response to thermal stimulus. Conclusion. NTG patients that have a greater than 20% increase in POBF after a hypercapnic stimulus have lower baseline POBF and DBF values. This suggests that there is impaired regulation of blood flow in a significant subgroup of NTG patients. This observation may reflect a generalised dysfunction of the vascular endothelium. B. Quill, E. Henry, E. Simon, and C. J. O’Brien Copyright © 2015 B. Quill et al. All rights reserved. Ocular Manifestations of Ebola Virus Disease: An Ophthalmologist’s Guide to Prevent Infection and Panic Sun, 18 Oct 2015 09:46:02 +0000 Ebola virus disease (EVD—formerly known as Ebola hemorrhagic fever) is a severe hemorrhagic fever caused by lipid-enveloped, nonsegmented, negative-stranded RNA viruses belonging to the genus Ebolavirus. Case fatality rates may reach up to 76% of infected individuals, making this infection a deadly health problem in the sub-Saharan population. At the moment, there are still no indications on ophthalmological clinical signs and security suggestions for healthcare professionals (doctors and nurses or cooperative persons). This paper provides a short but complete guide to reduce infection risks. Enzo Maria Vingolo, Giuseppe Alessio Messano, Serena Fragiotta, Leopoldo Spadea, and Stefano Petti Copyright © 2015 Enzo Maria Vingolo et al. All rights reserved. Optical Coherence Tomography as a Tool for Ocular Dynamics Estimation Sun, 18 Oct 2015 09:24:27 +0000 Purpose. The aim of the study is to demonstrate that the ocular dynamics of the anterior chamber of the eye can be estimated quantitatively by means of optical coherence tomography (OCT). Methods. A commercial high speed, high resolution optical coherence tomographer was used. The sequences of tomographic images of the iridocorneal angle of three subjects were captured and each image from the sequence was processed in MATLAB environment in order to detect and identify the contours of the cornea and iris. The data on pulsatile displacements of the cornea and iris and the changes of the depth of the gap between them were retrieved from the sequences. Finally, the spectral analysis of the changes of these parameters was performed. Results. The results of the temporal and spectral analysis manifest the ocular microfluctuation that might be associated with breathing (manifested by 0.25 Hz peak in the power spectra), heart rate (1–1.5 Hz peak), and ocular hemodynamics (3.75–4.5 Hz peak). Conclusions. This paper shows that the optical coherence tomography can be used as a tool for noninvasive estimation of the ocular dynamics of the anterior segment of the eye, but its usability in diagnostics of the ocular hemodynamics needs further investigations. Damian Siedlecki, Waldemar Kowalik, and Henryk Kasprzak Copyright © 2015 Damian Siedlecki et al. All rights reserved. Detecting Blood Flow Response to Stimulation of the Human Eye Sun, 04 Oct 2015 14:41:09 +0000 Retinal blood supply is tightly regulated under a variety of hemodynamic considerations in order to satisfy a high metabolic need and maintain both vessel structure and function. Simulation of the human eye can induce hemodynamics alterations, and attempt to assess the vascular reactivity response has been well documented in the scientific literature. Advancements in noninvasive imaging technologies have led to the characterization of magnitude and time course in retinal blood flow response to stimuli. This allowed for a better understanding of the mechanism in which blood flow is regulated, as well as identifying functional impairments in the diseased eye. Clinically, the ability to detect retinal blood flow reactivity during stimulation of the eye offers potential for the detection, differentiation, and diagnosis of diseases. Alex D. Pechauer, David Huang, and Yali Jia Copyright © 2015 Alex D. Pechauer et al. All rights reserved. An Update on the Safety and Efficacy of Corneal Collagen Cross-Linking in Pediatric Keratoconus Tue, 29 Sep 2015 11:31:03 +0000 Keratoconus is a degenerative disease that affects adolescents and young adults and presents with variable thinning and conical deformation of the corneal apex. The resultant irregular astigmatism can progress to levels that can significantly affect everyday activities and overall quality of life. Therefore, stopping the progression of the disease is an essential part in managing patients with keratoconus. Corneal collagen cross-linking is a minimally invasive procedure that stiffens the anterior corneal stroma by creating strong covalent bonds between collagen fibrils. Over the past decade, many studies have proved its safety and efficacy in halting keratoconus progression in adults. This review of the literature highlights the growing trend towards using this treatment in pediatric keratoconic patients. In children, keratoconus tends to be more severe and fast progression is often encountered requiring closer follow-up intervals. Standard cross-linking shows comparable results in children with a good safety-efficacy profile during follow-up periods of up to three years. Further research is needed to standardize and evaluate transepithelial and accelerated cross-linking protocols as these could be of tremendous help in a population where cooperation and compliance are major issues. Hala El Rami, Elias Chelala, Ali Dirani, Ali Fadlallah, Henry Fakhoury, Carole Cherfan, George Cherfan, and Elias Jarade Copyright © 2015 Hala El Rami et al. All rights reserved. Rare Diseases of the Anterior Segment of the Eye: Update on Diagnosis and Management Sun, 27 Sep 2015 09:41:29 +0000 Alessandro Lambiase, Flavio Mantelli, Marta Sacchetti, Siavash Rahimi, and Giacomina Massaro-Giordano Copyright © 2015 Alessandro Lambiase et al. All rights reserved. Comparative Study of Anterior Eye Segment Measurements with Spectral Swept-Source and Time-Domain Optical Coherence Tomography in Eyes with Corneal Dystrophies Thu, 17 Sep 2015 11:56:46 +0000 Purpose. To compare anterior eye segment measurements and morphology obtained with two optical coherence tomography systems (TD OCT, SS OCT) in eyes with corneal dystrophies (CDs). Methods. Fifty healthy volunteers (50 eyes) and 54 patients (96 eyes) diagnosed with CD (epithelial basement membrane dystrophy, EBMD = 12 eyes; Thiel-Behnke CD = 6 eyes; lattice CD TGFBI type = 15 eyes; granular CD type 1 = 7 eyes, granular CD type 2 = 2 eyes; macular CD = 23 eyes; and Fuchs endothelial CD = 31 eyes) were recruited for the study. Automated and manual central corneal thickness (aCCT, mCCT), anterior chamber depth (ACD), and nasal and temporal trabecular iris angle (nTIA, tTIA) were measured and compared with Bland-Altman plots. Results. Good agreement between the TD and SS OCT measurements was demonstrated for mCCT and aCCT in normal individuals and for mCCT in the CDs group. The ACD, nTIA, and tTIA measurements differed significantly in both groups. TBCD, LCD, and FECD caused increased CCT. MCD caused significant corneal thinning. FECD affected all analyzed parameters. Conclusions. Better agreement between SS OCT and TD OCT measurements was demonstrated in normal individuals compared to the CDs group. OCT provides comprehensive corneal deposits analysis and demonstrates the association of CD with CCT, ACD, and TIA measurements. Anna K. Nowinska, Sławomir J. Teper, Dominika A. Janiszewska, Anita Lyssek-Boron, Dariusz Dobrowolski, Robert Koprowski, and Edward Wylegala Copyright © 2015 Anna K. Nowinska et al. All rights reserved. Rare Diseases Leading to Childhood Glaucoma: Epidemiology, Pathophysiogenesis, and Management Wed, 16 Sep 2015 13:16:36 +0000 Noteworthy heterogeneity exists in the rare diseases associated with childhood glaucoma. Primary congenital glaucoma is mostly sporadic; however, 10% to 40% of cases are familial. CYP1B1 gene mutations seem to account for 87% of familial cases and 27% of sporadic cases. Childhood glaucoma is classified in primary and secondary congenital glaucoma, further divided as glaucoma arising in dysgenesis associated with neural crest anomalies, phakomatoses, metabolic disorders, mitotic diseases, congenital disorders, and acquired conditions. Neural crest alterations lead to the wide spectrum of iridocorneal trabeculodysgenesis. Systemic diseases associated with childhood glaucoma include the heterogenous group of phakomatoses where glaucoma is frequently encountered in the Sturge-Weber syndrome and its variants, in phakomatosis pigmentovascularis associated with oculodermal melanocytosis, and more rarely in neurofibromatosis type 1. Childhood glaucoma is also described in systemic disorders of mitotic and metabolic activity. Acquired secondary glaucoma has been associated with uveitis, trauma, drugs, and neoplastic diseases. A database research revealed reports of childhood glaucoma in rare diseases, which do not include glaucoma in their manifestation. These are otopalatodigital syndrome, complete androgen insensitivity, pseudotrisomy 13, Brachmann-de Lange syndrome, acrofrontofacionasal dysostosis, caudal regression syndrome, and Wolf-Hirschhorn syndrome. Solmaz Abdolrahimzadeh, Valeria Fameli, Roberto Mollo, Maria Teresa Contestabile, Andrea Perdicchi, and Santi Maria Recupero Copyright © 2015 Solmaz Abdolrahimzadeh et al. All rights reserved. Ophthalmic Alterations in the Sturge-Weber Syndrome, Klippel-Trenaunay Syndrome, and the Phakomatosis Pigmentovascularis: An Independent Group of Conditions? Wed, 16 Sep 2015 11:13:42 +0000 The phakomatoses have been traditionally defined as a group of hereditary diseases with variable expressivity characterized by multisystem tumors with possible malignant transformation. The Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and the phakomatosis pigmentovascularis have the facial port-wine stain in common. Numerous pathophysiogenetic mechanisms have been suggested such as venous dysplasia of the emissary veins in the intracranial circulation, neural crest alterations leading to alterations of autonomic perivascular nerves, mutation of the GNAO gene in the Sturge-Weber syndrome, PIK3CA mutation in malformative/overgrowth syndromes such as the Klippel-Trenaunay syndrome, and the twin-spotting phenomenon in phakomatosis pigmentovascularis. Other features linked to the port-wine stain and typical to all of the three conditions are glaucoma and choroidal alterations. Glaucoma can be due to malformations of the anterior chamber or high episcleral venous pressure and in phakomatosis pigmentovascularis it can also be associated with angle hyperpigmentation. The choroid can be thickened in all diseases. Furthermore, choroidal melanocytosis in the phakomatosis pigmentovascularis can lead to malignant transformation. Although the multiple pathophysiological mechanisms still require clarification, similarities in ophthalmic manifestations make it reasonable to classify these diseases in an independent group. Solmaz Abdolrahimzadeh, Vittorio Scavella, Lorenzo Felli, Filippo Cruciani, Maria Teresa Contestabile, and Santi Maria Recupero Copyright © 2015 Solmaz Abdolrahimzadeh et al. All rights reserved. Diagnosis and Management of Iridocorneal Endothelial Syndrome Wed, 16 Sep 2015 09:43:08 +0000 The iridocorneal endothelial (ICE) syndrome is a rare ocular disorder that includes a group of conditions characterized by structural and proliferative abnormalities of the corneal endothelium, the anterior chamber angle, and the iris. Common clinical features include corneal edema, secondary glaucoma, iris atrophy, and pupillary anomalies, ranging from distortion to polycoria. The main subtypes of this syndrome are the progressive iris atrophy, the Cogan-Reese syndrome, and the Chandler syndrome. ICE syndrome is usually diagnosed in women in the adult age. Clinical history and complete eye examination including tonometry and gonioscopy are necessary to reach a diagnosis. Imaging techniques, such as in vivo confocal microscopy and ultrasound biomicroscopy, are used to confirm the diagnosis by revealing the presence of “ICE-cells” on the corneal endothelium and the structural changes of the anterior chamber angle. An early diagnosis is helpful to better manage the most challenging complications such as secondary glaucoma and corneal edema. Treatment of ICE-related glaucoma often requires glaucoma filtering surgery with antifibrotic agents and the use of glaucoma drainage implants should be considered early in the management of these patients. Visual impairment and pain associated with corneal edema can be successfully managed with endothelial keratoplasty. Marta Sacchetti, Flavio Mantelli, Marco Marenco, Ilaria Macchi, Oriella Ambrosio, and Paolo Rama Copyright © 2015 Marta Sacchetti et al. All rights reserved. Pediatric Glaucoma: A Literature’s Review and Analysis of Surgical Results Wed, 16 Sep 2015 09:41:14 +0000 The purpose of this paper is to review the surgical options available for the management of pediatric glaucoma, to evaluate their advantages and disadvantages together with their long-term efficacy, all with the intent to give guidelines to physicians on which elements are to be considered when taking a surgical decision. Currently there is a range of surgical procedures that are being used for the management of pediatric glaucoma. Within these, some are completely new approaches, while others are improvements of the more traditional procedures. Throughout this vast range of surgical options, angle surgery remains the first choice in mild cases and both goniotomy and trabeculotomy have good success rates. Trabeculectomy with or without mitomycin C (MMC) is preferred in refractory cases, in aphakic eyes, and in older children. GDIs have a good success rate in aphakic eyes. Nonpenetrating deep sclerectomy is still rarely used; nevertheless the results of ongoing studies are encouraging. The different clinical situations should always be weighed against the risks associated with the procedures for the individual patients. Glaucomatous progression can occur many years after its stabilization and at any time during the follow-up period; for this reason life-long assessment is necessary. Gianluca Scuderi, Daniela Iacovello, Federica Pranno, Pasquale Plateroti, and Luca Scuderi Copyright © 2015 Gianluca Scuderi et al. All rights reserved. Congenital Corneal Anesthesia and Neurotrophic Keratitis: Diagnosis and Management Wed, 16 Sep 2015 09:27:30 +0000 Neurotrophic keratitis (NK) is a rare degenerative disease of the cornea caused by an impairment of corneal sensory innervation, characterized by decreased or absent corneal sensitivity resulting in epithelial keratopathy, ulceration, and perforation. The aetiopathogenesis of corneal sensory innervation impairment in children recognizes the same range of causes as adults, although they are much less frequent in the pediatric population. Some extremely rare congenital diseases could be considered in the aetiopathogenesis of NK in children. Congenital corneal anesthesia is an extremely rare condition that carries considerable diagnostic and therapeutic problems. Typically the onset is up to 3 years of age and the cornea may be affected in isolation or the sensory deficit may exist as a component of a congenital syndrome, or it may be associated with systemic somatic anomalies. Accurate diagnosis and recognition of risk factors is important for lessening long-term sequelae of this condition. Treatment should include frequent topical lubrication and bandage corneal or scleral contact lenses. Surgery may be needed in refractory cases. The purpose of this review is to summarize and update data available on congenital causes and treatment of corneal hypo/anesthesia and, in turn, on congenital NK. Flavio Mantelli, Chiara Nardella, Eloisa Tiberi, Marta Sacchetti, Alice Bruscolini, and Alessandro Lambiase Copyright © 2015 Flavio Mantelli et al. All rights reserved. Climatic Droplet Keratopathy in Argentina: Involvement of Environmental Agents in Its Genesis Which Would Open the Prospect for New Therapeutic Interventions Wed, 16 Sep 2015 09:25:45 +0000 Climatic droplet keratopathy (CDK) is a degenerative corneal disease of unknown etiology. We described CDK for the first time in Latin America in the Argentinean Patagonia (El Cuy). A deeper knowledge of CDK pathogenic mechanisms will provide new therapeutic strategies. For that reason we investigated the prevalence of CDK in El Cuy and its existence in other 3 provinces with similar climate. Patients eyes were examined, habits throughout lives were inquired about, and serum ascorbate (sAA) was determined. All individuals work outdoors for most of the day. All regions had normal O3 levels. Individuals from regions 1, 2, and 3 had very low consumption of vegetables/fruits and low sAA levels. Conversely, region 4 individuals had balanced diet and higher sAA concentrations. CDK was only found in region 3 where individuals had partial deficiency of sAA and did not use eye protection. No CDK was found in regions 1 and 2 where individuals had similar work activities and dietary habits to those in region 3 but wear eye protection. No disease was found in region 4 where individuals work outdoors, have balanced diet, and use eye protection. To summarize, the CDK existence was related not only to climate but also to the dietary habits and lack of protection from sunlight. María Fernanda Suárez, Leandro Correa, Nicolás Crim, Evangelina Espósito, Rodolfo Monti, Julio Alberto Urrets-Zavalía, and Horacio Marcelo Serra Copyright © 2015 María Fernanda Suárez et al. All rights reserved. Stem Cell Therapy for Corneal Epithelium Regeneration following Good Manufacturing and Clinical Procedures Wed, 16 Sep 2015 09:06:31 +0000 Objective. To evaluate outcomes of cultivated limbal epithelial transplantation (CLET) for management of ocular surface failure due to limbal stem cell deficiency (LSCD). Design. Prospective, noncomparative, interventional case series and extensive comparison with recent similar studies. Participants. Twenty eyes with LSCD underwent CLET (11 autologous; 9 allogeneic) and were followed up for 3 years. Etiologies were divided into 3 prognostic categories: Group 1, chemical injuries (7 eyes); Group 2, immune-based inflammation (4 eyes); and Group 3, noninflammatory diseases (9 eyes). Intervention. Autologous and allogeneic limbal epithelial cells were cultivated on amniotic membranes and transplanted. Evaluations were based on clinical parameters, survival analysis, and in vivo confocal microscopy (IVCM). European Union Tissues/Cells Directive and good manufacturing procedures were followed. Main Outcome Measures. Improved clinical parameters, absence of epithelial defects, and improved central corneal epithelial phenotype. Results. Success rate was 80% at 1-2 years and 75% at 3 years. Autografts and allografts had similar survival. Success rate was significantly lower in prognostic Group 1 (42.9%) than in Groups 2-3 (100% each). All clinical parameters improved substantially. By IVCM, 80% of cases improved in epithelial status. Conclusions. CLET improved corneal epithelium quality, with subsequent improvement in symptoms, quality of life, and vision. These results confirm that CLET is a valid therapy for ocular surface failure. Beatriz E. Ramírez, Ana Sánchez, José M. Herreras, Itziar Fernández, Javier García-Sancho, Teresa Nieto-Miguel, and Margarita Calonge Copyright © 2015 Beatriz E. Ramírez et al. All rights reserved. The Genetics and the Genomics of Primary Congenital Glaucoma Wed, 16 Sep 2015 08:58:18 +0000 The sight is one of the five senses allowing an autonomous and high-quality life, so that alterations of any ocular component may result in several clinical phenotypes (from conjunctivitis to severe vision loss and irreversible blindness). Most parts of clinical phenotypes have been significantly associated with mutations in genes regulating the normal formation and maturation of the anterior segments of the eye. Among the eye anterior segment disorders, special attention is given to Glaucoma as it represents one of the major causes of bilateral blindness in the world, with an onset due to Mendelian or multifactorial genetic-causative traits. This review will point out the attention on the Primary Congenital Glaucoma (PCG), which is usually transmitted according to an autosomal-recessive inheritance pattern. Taking into consideration the genetic component of the PCG, it is possible to observe a strong heterogeneity concerning the disease-associated loci (GLC3), penetrance defects, and expressivity of the disease. Given the strong PGC heterogeneity, pre- and posttest genetic counseling plays an essential role in the achievement of an appropriate management of PCG, in terms of medical, social, and psychological impact of the disease. Raffaella Cascella, Claudia Strafella, Chiara Germani, Giuseppe Novelli, Federico Ricci, Stefania Zampatti, and Emiliano Giardina Copyright © 2015 Raffaella Cascella et al. All rights reserved. Fuchs Endothelial Corneal Dystrophy: Strong Association with rs613872 Not Paralleled by Changes in Corneal Endothelial TCF4 mRNA Level Wed, 16 Sep 2015 08:58:04 +0000 Fuchs endothelial corneal dystrophy (FECD) is a common corneal endotheliopathy with a complex and heterogeneous genetic background. Different variants in the TCF4 gene have been strongly associated with the development of FECD. TCF4 encodes the E2-2 transcription factor but the link between the strong susceptibility locus and disease mechanism remains elusive. Here, we confirm a strong positive association between TCF4 single nucleotide polymorphism rs613872 and FECD in Polish patients (OR = 12.95, 95% CI: 8.63–19.42, , ). We show that TCF4 expression at the mRNA level in corneal endothelium () does not differ significantly between individuals with a particular TCF4 genotype. It is also not altered in FECD patients as compared to control samples. The data suggest that changes in the transcript level containing constitutive TCF4 exon encoding the amino-terminal part of the protein seem not to contribute to disease pathogenesis. However, considering the strong association of TCF4 allelic variants with FECD, genotyping of TCF4 risk alleles may be important in the clinical practice. Monika Ołdak, Ewelina Ruszkowska, Monika Udziela, Dominika Oziębło, Ewelina Bińczyk, Aneta Ścieżyńska, Rafał Płoski, and Jacek P. Szaflik Copyright © 2015 Monika Ołdak et al. All rights reserved. SLC4A11 and the Pathophysiology of Congenital Hereditary Endothelial Dystrophy Wed, 16 Sep 2015 08:45:21 +0000 Congenital hereditary endothelial dystrophy (CHED) is a rare autosomal recessive disorder of the corneal endothelium characterized by nonprogressive bilateral corneal edema and opacification present at birth. Here we review the current knowledge on the role of the SLC4A11 gene, protein, and its mutations in the pathophysiology and clinical presentation of CHED. Individuals with CHED have mutations in SLC4A11 which encodes a transmembrane protein in the SLC4 family of bicarbonate transporters. The expression of SLC4A11 in the corneal endothelium and inner ear patterns the deficits seen in CHED with corneal edema and hearing loss (Harboyan syndrome). slc4a11-null-mouse models recapitulate the CHED disease phenotype, thus establishing a functional role for SLC4A11 in CHED. However, the transport function of SLC4A11 remains unsettled. Some of the roles that have been attributed to SLC4A11 include H+ and permeation, electrogenic Na+-H+ exchange, and water transport. Future studies of the consequences of SLC4A11 dysfunction as well as further understanding of corneal endothelial ion transport will help clarify the involvement of SLC4A11 in the pathophysiology of CHED. Sangita P. Patel and Mark D. Parker Copyright © 2015 Sangita P. Patel and Mark D. Parker. All rights reserved. Cultivated Oral Mucosa Epithelium in Ocular Surface Reconstruction in Aniridia Patients Wed, 16 Sep 2015 07:05:58 +0000 Purpose. Efficacy of cultivated oral mucosa epithelial transplantation (COMET) procedure in corneal epithelium restoration of aniridia patients. Methods. Study subjects were aniridia patients (13 patients; 17 eyes) with irregular, vascular conjunctival pannus involving visual axis who underwent autologous transplantation of cultivated epithelium. For the procedure oral mucosa epithelial cells were obtained from buccal mucosa with further enzymatic treatment. Suspension of single cells was seeded on previously prepared denuded amniotic membrane. Cultures were carried on culture dishes inserts in the presence of the inactivated with Mitomycin C monolayer of 3T3 fibroblasts. Cultures were carried for seven days. Stratified oral mucosa epithelium with its amniotic membrane carrier was transplanted on the surgically denuded corneal surface of aniridia patients with total or subtotal limbal stem cell deficiency. Outcome Measures. Corneal surface, epithelial regularity, and visual acuity improvement were evaluated. Results. At the end of the observation period, 76.4% of the eyes had regular transparent epithelium and 23.5% had developed epithelial defects or central corneal haze; in 88.2% of cases visual acuity had increased. VA range was from HM 0.05 before the surgery to HM up to 0.1 after surgery. Conclusion. Application of cultivated oral mucosa epithelium restores regular epithelium on the corneal surface with moderate improvement in quality of vision. Dariusz Dobrowolski, Boguslawa Orzechowska-Wylegala, Bogumil Wowra, Ewa Wroblewska-Czajka, Maria Grolik, Krzysztof Szczubialka, Maria Nowakowska, Domenico Puzzolo, Edward A. Wylegala, Antonio Micali, and Pasquale Aragona Copyright © 2015 Dariusz Dobrowolski et al. All rights reserved. Screening of the Seed Region of MIR184 in Keratoconus Patients from Saudi Arabia Mon, 24 Aug 2015 06:51:02 +0000 Micro-RNAs (miRNAs) are regulators of gene expression that control various biological processes. The role of many identified miRNAs is not yet resolved. Recent evidence suggests that miRNA mutations and/or misexpression may contribute to genetic disorders. Point mutations in the seed region of MIR184 have been recently identified in Keratoconus (KC) patients with or without other corneal and lens abnormalities. We investigated mutations within MIR184 in KC patients from Saudi Arabia and examined the relative expression of miR-184 and miR-205 in human cornea. Ethnically matched KC cases () were recruited and sequencing was performed using PCR-based Sanger sequencing and analyzed using the Sequencher 5.2 software. Expression of miR-184 and miR-205 was profiled in postmortem unaffected ocular tissues obtained from donors with no history of ocular diseases. miR-184 expression was 15-fold higher than that of miR-205 in cornea samples. No mutation(s) within the screened genomic region of MIR184 in KC cases was detected. This suggests that mutation in MIR184 is a rare cause of KC alone and may be more relevant to cases of KC associated with other ocular abnormalities. The increased expression of miR-184 versus miR-205 in normal cornea samples implies a possible role of miR184 in cornea development and/or corneal diseases. Khaled K. Abu-Amero, Inas Helwa, Abdulrahman Al-Muammar, Shelby Strickland, Michael A. Hauser, R. Rand Allingham, and Yutao Liu Copyright © 2015 Khaled K. Abu-Amero et al. All rights reserved. Corrigendum to “Short-Term Changes in Light Distortion in Orthokeratology Subjects” Sun, 02 Aug 2015 08:33:56 +0000 Elena Santolaria Sanz, Alejandro Cerviño, Antonio Queiros, Cesar Villa-Collar, Daniela Lopes-Ferreira, and Jose Manuel González-Méijome Copyright © 2015 Elena Santolaria Sanz et al. All rights reserved. Effect of Intraoperative Corneal Stromal Pocket Irrigation in Small Incision Lenticule Extraction Mon, 27 Jul 2015 13:30:14 +0000 This study aimed at evaluating the effect of intraoperative corneal pocket irrigation in small incision lenticule extraction (SMILE) and compares it to that in femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Sixteen rabbit eyes underwent a SMILE procedure, with 8 eyes having corneal pocket irrigation, while the other 8 eyes were without irrigation. Another 16 eyes underwent a FS-LASIK procedure for comparison, with 8 eyes having flap irrigation, while the other 8 eyes were without irrigation. The results showed that the changes in the total corneal thickness, anterior and posterior lamellar thickness, measured by the anterior segment optical coherence tomography, were comparable between the SMILE with and without irrigation groups, suggesting that the irrigation did not lead to significant changes in the corneal thickness. However, at postoperative 8 hours, in vivo confocal microscopy showed that the interface reflectivity in the SMILE with irrigation group was significantly higher than that in other three groups. The presence of interface fluid was further confirmed by the identification of fluid pockets with undulated collagen shown on histological section in the post-SMILE with irrigation eyes. Our findings might contribute to the occurrence of post-SMILE delayed immediate visual quality recovery and further clinical study is required. Yu-Chi Liu, Lasitha Jayasinghe, Heng Pei Ang, Nyein Chan Lwin, Gary Hin Fai Yam, and Jodhbir S. Mehta Copyright © 2015 Yu-Chi Liu et al. All rights reserved. Demodex sp. as a Potential Cause of the Abandonment of Soft Contact Lenses by Their Existing Users Tue, 21 Jul 2015 13:13:04 +0000 Demodex mites may be a potential etiological factor in the development of various eye and skin disorders. The aim of the study was to investigate the presence of Demodex in the hair follicles of eyelashes and their potential influence on abandoning soft contact lenses which had been previously well tolerated by their users. A group of 62 users of contact lenses (28 with emerging discomfort and 34 without discomfort) were examined. There is a need to check the existence of a relationship between D. folliculorum or/and D. brevis infestation and the emergence of intolerance to the presence of soft contact lenses. The removed lashes were examined under light microscopy, applying standard parasitological methods if demodicosis is suspected. A positive result was assumed if at least one adult stage, larva, protonymph/nymph, or egg of D. folliculorum and/or D. brevis was present. A positive correlation was observed between the presence of Demodex and intolerance to contact lenses by their existing users , and Demodex sp. infections were observed in 92.86% of patients with intolerance to contact lenses. Our results provide further evidence for the pathogenic role played by the mites in the development of eye diseases. Witold Tarkowski, Joanna Moneta-Wielgoś, and Daniel Młocicki Copyright © 2015 Witold Tarkowski et al. All rights reserved. Enhancing Image Characteristics of Retinal Images of Aggressive Posterior Retinopathy of Prematurity Using a Novel Software, (RetiView) Thu, 09 Jul 2015 06:21:37 +0000 Purpose. To report pilot data from a novel image analysis software “RetiView,” to highlight clinically relevant information in RetCam images of infants with aggressive posterior retinopathy of prematurity (APROP). Methods. Twenty-three imaging sessions of consecutive infants of Asian Indian origin with clinically diagnosed APROP underwent three protocols (Grey Enhanced (GE), Color Enhanced (CE), and “Vesselness Measure” (VNM)) of the software. The postprocessed images were compared to baseline data from the archived unprocessed images and clinical exam by the retinopathy of prematurity (ROP) specialist for anterior extent of the vessels, capillary nonperfusion zones (CNP), loops, hemorrhages, and flat neovascularization. Results. There was better visualization of tortuous loops in the GE protocol (56.5%); “bald” zones within the CNP zones (26.1%), hemorrhages (13%), and edge of the disease (34.8%) in the CE images; neovascularization on both GE and CE protocols (13% each); clinically relevant information in cases with poor pupillary dilatation (8.7%); anterior extent of vessels on the VNM protocol (13%) effecting a “reclassification” from zone 1 to zone 2 posterior. Conclusions. RetiView is a noninvasive and inexpensive method of customized image enhancement to detect clinically difficult characteristics in a subset of APROP images with a potential to influence treatment planning. Chaitra Jayadev, Anand Vinekar, Poornima Mohanachandra, Samit Desai, Amit Suveer, Shwetha Mangalesh, Noel Bauer, and Bhujang Shetty Copyright © 2015 Chaitra Jayadev et al. All rights reserved. Retinal Imaging of Infants on Spectral Domain Optical Coherence Tomography Mon, 06 Jul 2015 09:16:22 +0000 Spectral domain coherence tomography (SD OCT) has become an important tool in the management of pediatric retinal diseases. It is a noncontact imaging device that provides detailed assessment of the microanatomy and pathology of the infant retina with a short acquisition time allowing office examination without the requirement of anesthesia. Our understanding of the development and maturation of the infant fovea has been enhanced by SD OCT allowing an in vivo assessment that correlates with histopathology. This has helped us understand the critical correlation of foveal development with visual potential in the first year of life and beyond. In this review, we summarize the recent literature on the clinical applications of SD OCT in studying the pathoanatomy of the infant macula, its ability to detect subclinical features, and its correlation with disease and vision. Retinopathy of prematurity and macular edema have been discussed in detail. The review also summarizes the current status of SD OCT in other infant retinal conditions, imaging the optic nerve, the choroid, and the retinal nerve fibre in infants and children, and suggests future areas of research. Anand Vinekar, Shwetha Mangalesh, Chaitra Jayadev, Ramiro S. Maldonado, Noel Bauer, and Cynthia A. Toth Copyright © 2015 Anand Vinekar et al. All rights reserved. Advances in Diagnostic Imaging Technologies to Evaluate the Retina and the Optic Disc Mon, 29 Jun 2015 08:47:31 +0000 Antonio Ferreras, Michele Figus, Paolo Frezzotti, and Michele Iester Copyright © 2015 Antonio Ferreras et al. All rights reserved. Repeatability and Reproducibility of Retinal Nerve Fiber Layer Parameters Measured by Scanning Laser Polarimetry with Enhanced Corneal Compensation in Normal and Glaucomatous Eyes Mon, 22 Jun 2015 08:39:57 +0000 Objective. To assess the intrasession repeatability and intersession reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness parameters measured by scanning laser polarimetry (SLP) with enhanced corneal compensation (ECC) in healthy and glaucomatous eyes. Methods. One randomly selected eye of 82 healthy individuals and 60 glaucoma subjects was evaluated. Three scans were acquired during the first visit to evaluate intravisit repeatability. A different operator obtained two additional scans within 2 months after the first session to determine intervisit reproducibility. The intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRT) were calculated for all SLP parameters in both groups. Results. ICCs ranged from 0.920 to 0.982 for intravisit measurements and from 0.910 to 0.978 for intervisit measurements. The temporal-superior-nasal-inferior-temporal (TSNIT) average was the highest (0.967 and 0.946) in normal eyes, while nerve fiber indicator (NFI; 0.982) and inferior average (0.978) yielded the best ICC in glaucomatous eyes for intravisit and intervisit measurements, respectively. All COVs were under 10% in both groups, except NFI. TSNIT average had the lowest COV (2.43%) in either type of measurement. Intervisit TRT ranged from 6.48 to 12.84. Conclusions. The reproducibility of peripapillary RNFL measurements obtained with SLP-ECC was excellent, indicating that SLP-ECC is sufficiently accurate for monitoring glaucoma progression. Mirian Ara, Antonio Ferreras, Ana B. Pajarin, Pilar Calvo, Michele Figus, and Paolo Frezzotti Copyright © 2015 Mirian Ara et al. All rights reserved. Macular Development in Aggressive Posterior Retinopathy of Prematurity Thu, 18 Jun 2015 07:29:11 +0000 Purpose. To report anatomic outcomes after early and confluent laser photocoagulation of the entire avascular retina, including areas in close proximity to the fovea, in patients with APROP. We aspire to demonstrate fundoscopic evidence of transverse growth and macular development following laser treatment in APROP. Methods. Retrospective review of 6 eyes with APROP that underwent confluent laser photocoagulation of the entire avascular retina. Photographic fundoscopic imaging was performed using the RetCam to compare outcomes after treatment. Results. Mean birth weight and gestational age were 704.8 g and 24.33 weeks, respectively. There were 2 females and 1 male. The average time to laser was 9.3 weeks after birth, with the mean postmenstrual age of 34 weeks. Two eyes had zone 1 and 4 eyes had posterior zone 2 disease. Three eyes developed 4A detachments, which were successfully treated. All 6 eyes experienced transverse growth, with expansion of the posterior pole and anterior displacement of the laser treatment. Conclusion. Confluent photocoagulation of the entire avascular retina, regardless of foveal proximity, should be the mainstay for treating APROP. Examination should be conducted within 5–10 days to examine areas previously hidden by neovascularization to ensure prudent therapy. Macular development involves both transverse and anterior-posterior growth. Hemang K. Pandya, Lisa J. Faia, Joshua Robinson, and Kimberly A. Drenser Copyright © 2015 Hemang K. Pandya et al. All rights reserved. Limitations in ROP Programs in 32 Neonatal Intensive Care Units in Five States in Mexico Wed, 17 Jun 2015 12:03:49 +0000 Retinopathy of prematurity (ROP) is the main cause of avoidable blindness in children in Mexico despite National ROP Guidelines and examination of preterm infants being a legal requirement. Objective. To assess coverage of ROP programs and their compliance with national guidelines. Study Design. Thirty-two neonatal intensive care units (NICUs) in five of the largest states were visited. Staff were interviewed to collect information on their ROP programs which were defined as (1) compliant, if National Guidelines for screening and treatment were followed, (2) noncompliant, if other approaches were used, or (3) no program. Results. Only 10 (31.2%) had fully compliant programs and 11 (34.4%) had no program. In the remaining 11 (34.4%) different screening criteria were used (7 units): screening was undertaken by an ophthalmologist in unsalaried time (4), was not undertaken in the NICU (2), and was undertaken by a neonatologist (1) and/or Avastin was used as first-line treatment (7). Poorer states had poorer programs. Conclusions. Despite legislation mandating eye examination of preterm births, many ROP programs in the largest cities in Mexico require improvement or need to be established. Prevention of blindness due to ROP needs to be prioritized in Mexico to control the epidemic of ROP blindness. L. Consuelo Zepeda-Romero and Clare Gilbert Copyright © 2015 L. Consuelo Zepeda-Romero and Clare Gilbert. All rights reserved. Repeatability, Reproducibility, and Comparability of Subjective and Objective Measurements of Intraocular Forward Scattering in Healthy Subjects Sun, 14 Jun 2015 11:37:14 +0000 Purpose. To assess the repeatability, reproducibility, and comparability of measurements of subjective and objective forward scattering in healthy subjects. Methods. We prospectively examined twenty eyes of 20 healthy volunteers (7 men and 13 women; ages, 28.4 ± 4.1 years). The logarithmic straylight value (log(s)) and the objective scattering index (OSI) were measured with a straylight meter (C-Quant) and a point-spread function meter (OQAS), respectively. Results. The 95% limits of agreement (LoA) between first and second measurements ranged from −0.211 to 0.207 for the C-Quant and from −0.302 to 0.477 for the OQAS. The intraclass correlation coefficients for the repeatability of the log(s) and OSI measurements were 0.815 and 0.926, respectively. The mean difference between examiners was −0.051 ± 0.133 (95% LoA; −0.311 to 0.209) for the C-Quant and 0.080 ± 0.307 (−0.522 to 0.682) for the OQAS. There was a modest, but significant, correlation between the log(s) and the OSI (Spearman correlation coefficient , ). Conclusions. The C-Quant and the OQAS provide good repeatability and reproducibility, although the OQAS measurement provides a slightly higher ICC than the C-Quant measurement. The subjective forward scattering may be to some extent expressed in the objective forward scattering in healthy subjects. Ayaka Iijima, Kimiya Shimizu, Hidenaga Kobashi, Aya Saito, and Kazutaka Kamiya Copyright © 2015 Ayaka Iijima et al. All rights reserved. Central Macular Thickness in Children with Myopia, Emmetropia, and Hyperopia: An Optical Coherence Tomography Study Mon, 08 Jun 2015 09:35:55 +0000 Purpose. To investigate the central macular thickness (CMT) in myopic, emmetropic, and hyperopic Chinese children using Optical Coherence Tomography. Methods. 168 right eyes of Chinese subjects aged 4–18 were divided into 3 groups based on their postcycloplegic spherical equivalent: myopes (<−1.0 D); emmetropes (≥−1.0 to ≤+1.0 D); and hyperopes (>+1.0 D) and the CMT was compared before/after age adjustment. The CMT was correlated with age, axial length, and peripapillary retinal nerve fibre layer (RNFL). Results. The mean CMT was  μm and the mean population age was years. The CMT was thickest in the myopes ( μm, ), followed by the hyperopes ( μm, ) and then emmetropes ( μm, ) (all ). When adjusted for age, myopes had a thicker CMT than the other 2 groups (all ) but there was no CMT difference between the emmetropes and hyperopes (). There was no significant correlation between CMT with age, axial length, or peripapillary RNFL (all ). Conclusion. Chinese children with myopia had a thicker CMT than those with emmetropia or hyperopia. There was no correlation of the CMT with age, axial length, or peripapillary RNFL thickness. Gordon S. K. Yau, Jacky W. Y. Lee, Tiffany T. Y. Woo, Raymond L. M. Wong, and Ian Y. H. Wong Copyright © 2015 Gordon S. K. Yau et al. All rights reserved. Ganglion Cell Complex Evaluation in Exudative Age-Related Macular Degeneration after Repeated Intravitreal Injections of Ranibizumab Mon, 08 Jun 2015 08:26:04 +0000 Purpose. To detect the effects of intravitreal ranibizumab injections on GCC in patients with wet AMD. Methods. 32 wet AMD eyes were selected and submitted at three ranibizumab injections. RTVue-OCT GCC and MM5 protocol were performed before treatment and twenty days after each injection. Results. At baseline mean GCC thickness was 93.9 ± 18.5 μm. Twenty days after each intravitreal injection it was, respectively, 85.8 ± 10.1, 86.5 ± 9.3, and 91.1 ± 11.5 μm, without statistical significance. A significant improvement in visual acuity (P = 0.031) and a reduction of mean foveal (P = 0.001) and macular thickness (P = 0.001) were observed. Conclusion. The clinical results confirm therapeutic efficacy of intravitreal injections of ranibizumab in wet AMD. A contemporary not statistically significant reduction of GCC thickness suggests that the loading phase of ranibizumab does not have any toxic effects on ganglion cell complex. Andrea Perdicchi, Giacomo Peluso, Daniela Iacovello, Marco Balestrieri, Martina Delle Fave, Solmaz Abdolrahimzadeh, Gian Luca Scuderi, Vito Fenicia, and Santi Maria Recupero Copyright © 2015 Andrea Perdicchi et al. All rights reserved. Correlation between Visual Acuity, Inner Segment/Outer Segment Junction, and Cone Outer Segment Tips Line Integrity in Uveitic Macular Edema Mon, 08 Jun 2015 08:23:49 +0000 Purpose. To investigate the correlation between best-corrected visual acuity (BCVA), the foveal inner segment/outer segment (IS/OS) junction or ellipsoid portion of inner segment (EPIS/ellipsoid zone), and the cone outer segment tips (COST) line or interdigitation zone integrity in eyes with uveitic macular edema (ME). Method. A retrospective observational study involving all patients from January 2012 to December 2013 with uveitic ME was performed. All patients underwent BCVA using Snellen charts spectral-domain optical coherence tomography (SD-OCT) examination using Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). Results. Fifty-two eyes from 45 patients were included in this study. Multivariate analysis showed a negative correlation between BCVA and the central retinal subfield thickness (CST), the cystoid pattern of edema, and the interdigitation zone interruption. Univariate logistic analysis showed a strong correlation between the ellipsoid zone and the interdigitation zone integrity. Conclusions. The ellipsoid zone defect, the interdigitation zone interruption, and the CST are correlated with poor vision. Visual acuity is also strongly affected by the cystoid pattern. The interdigitation zone integrity appears to be the most important factor in the visual prognosis of uveitic ME. Paolo Tortorella, Enzo D’Ambrosio, Ludovico Iannetti, Federica De Marco, and Maurizio La Cava Copyright © 2015 Paolo Tortorella et al. All rights reserved. Does Posterior Capsule Opacification Affect the Results of Diagnostic Technologies to Evaluate the Retina and the Optic Disc? Mon, 08 Jun 2015 08:00:59 +0000 The visual outcome obtained after cataract removal may progressively decline because of posterior capsular opacification (PCO). This condition can be treated by creating an opening in the posterior lens capsule by Nd:YAG laser capsulotomy. PCO optical imperfections cause several light reflection, refraction, and diffraction phenomena, which may interfere with the functional and structural tests performed in different ocular locations for the diagnosis and follow-up of ocular disease, like macular and optic nerve diseases. Some parameters measured by visual field examinations, scanning laser polarimetry, and optical coherence tomography (OCT) have changed after PCO removal. Imaging quality also changes following capsulotomy. Consequently, the results of ancillary tests in pseudophakic eyes for studying ocular diseases like glaucoma or maculopathies should be correlated with other clinical examinations, for example, slit-lamp biomicroscopy or funduscopy. If PCO is clinically significant, a new baseline should be set for future comparisons following capsulotomy when using automated perimetry and scanning laser polarimetry. To perform OCT in the presence of PCO, reliable examinations (considering signal strength) apparently guarantee that measurements are not influenced by PCO. Jose Javier Garcia-Medina, Monica del Rio-Vellosillo, Vicente Zanon-Moreno, Enrique Santos-Bueso, Roberto Gallego-Pinazo, Antonio Ferreras, and Maria Dolores Pinazo-Duran Copyright © 2015 Jose Javier Garcia-Medina et al. All rights reserved. Functional and Structural Abnormalities in Deferoxamine Retinopathy: A Review of the Literature Mon, 08 Jun 2015 07:57:52 +0000 Deferoxamine mesylate (DFO) is the most commonly used iron-chelating agent to treat transfusion-related hemosiderosis. Despite the clear advantages for the use of DFO, numerous DFO-related systemic toxicities have been reported in the literature, as well as sight-threatening ocular toxicity involving the retinal pigment epithelium (RPE). The damage to the RPE can lead to visual field defects, color-vision defects, abnormal electrophysiological tests, and permanent visual deterioration. The purpose of this review is to provide an updated summary of the ocular findings, including both functional and structural abnormalities, in DFO-treated patients. In particular, we pay particular attention to analyzing results of multimodal technologies for retinal imaging, which help ophthalmologists in the early diagnosis and correct management of DFO retinopathy. Fundus autofluorescence, for example, is not only useful for screening patients at high-risk of DFO retinopathy, but is also a prerequisite for identify specific high-risk patterns of RPE changes that are relevant for the prognosis of the disease. In addition, optical coherence tomography may have a clinical usefulness in detecting extent and location of different retinal changes in DFO retinopathy. Finally, this review wants to underline the need for universally approved guidelines for screening and followup of this particular disease. Maura Di Nicola, Giulio Barteselli, Laura Dell’Arti, Roberto Ratiglia, and Francesco Viola Copyright © 2015 Maura Di Nicola et al. All rights reserved. Relationship between Outer Retinal Layers Thickness and Visual Acuity in Diabetic Macular Edema Mon, 08 Jun 2015 07:39:43 +0000 Purpose. To investigate the correlation of outer retinal layers (ORL) thickness and visual acuity (VA) in patients with diabetic macular edema (DME). Methods. Consecutive DME patients seen at the Retina Clinic of The University of Hong Kong were recruited for OCT assessment. The ORL thickness was defined as the distance between external limiting membrane (ELM) and retinal pigment epithelium (RPE) at the foveal center. The correlation between total retinal thickness, ORL thickness, and vision was calculated. Results. 78 patients with DME were recruited. The mean age was 58.1 years (±11.5 years) and their mean visual acuity measured with Snellen chart was 0.51 (±0.18). The correlation coefficient between total retinal thickness and visual acuity was 0.34 (P < 0.001) whereas the correlation coefficient was 0.65 between ORL thickness and visual acuity (P < 0.001). Conclusion. ORL thickness correlates better with vision than the total retinal thickness. It is a novel OCT parameter in the assessment of DME. Moreover, it could be a potential long term visual prognostic factor for patients with DME. Raymond L. M. Wong, Jacky W. Y. Lee, Gordon S. K. Yau, and Ian Y. H. Wong Copyright © 2015 Raymond L. M. Wong et al. All rights reserved. Novel Method for Automated Analysis of Retinal Images: Results in Subjects with Hypertensive Retinopathy and CADASIL Mon, 08 Jun 2015 07:14:58 +0000 Morphological analysis of the retinal vessels by fundoscopy provides noninvasive means for detecting and staging systemic microvascular damage. However, full exploitation of fundoscopy in clinical settings is limited by paucity of quantitative, objective information obtainable through the observer-driven evaluations currently employed in routine practice. Here, we report on the development of a semiautomated, computer-based method to assess retinal vessel morphology. The method allows simultaneous and operator-independent quantitative assessment of arteriole-to-venule ratio, tortuosity index, and mean fractal dimension. The method was implemented in two conditions known for being associated with retinal vessel changes: hypertensive retinopathy and Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). The results showed that our approach is effective in detecting and quantifying the retinal vessel abnormalities. Arteriole-to-venule ratio, tortuosity index, and mean fractal dimension were altered in the subjects with hypertensive retinopathy or CADASIL with respect to age- and gender-matched controls. The interrater reliability was excellent for all the three indices (intraclass correlation coefficient ≥ 85%). The method represents simple and highly reproducible means for discriminating pathological conditions characterized by morphological changes of retinal vessels. The advantages of our method include simultaneous and operator-independent assessment of different parameters and improved reliability of the measurements. Michele Cavallari, Claudio Stamile, Renato Umeton, Francesco Calimeri, and Francesco Orzi Copyright © 2015 Michele Cavallari et al. All rights reserved. Advanced Morphological and Functional Magnetic Resonance Techniques in Glaucoma Mon, 08 Jun 2015 07:14:51 +0000 Glaucoma is a multifactorial disease that is the leading cause of irreversible blindness. Recent data documented that glaucoma is not limited to the retinal ganglion cells but that it also extends to the posterior visual pathway. The diagnosis is based on the presence of signs of glaucomatous optic neuropathy and consistent functional visual field alterations. Unfortunately these functional alterations often become evident when a significant amount of the nerve fibers that compose the optic nerve has been irreversibly lost. Advanced morphological and functional magnetic resonance (MR) techniques (morphometry, diffusion tensor imaging, arterial spin labeling, and functional connectivity) may provide a means for observing modifications induced by this fiber loss, within the optic nerve and the visual cortex, in an earlier stage. The aim of this systematic review was to determine if the use of these advanced MR techniques could offer the possibility of diagnosing glaucoma at an earlier stage than that currently possible. Rodolfo Mastropasqua, Luca Agnifili, Peter A. Mattei, Massimo Caulo, Vincenzo Fasanella, Riccardo Navarra, Leonardo Mastropasqua, and Giorgio Marchini Copyright © 2015 Rodolfo Mastropasqua et al. All rights reserved. Can Variability of Pattern ERG Signal Help to Detect Retinal Ganglion Cells Dysfunction in Glaucomatous Eyes? Mon, 08 Jun 2015 06:23:15 +0000 Objective. To evaluate variability of steady-state pattern electroretinogram (SS-PERG) signal in normal, suspected, and glaucomatous eyes. Methods. Twenty-one subjects with suspected glaucoma due to disc abnormalities (GS), 37 patients with early glaucoma (EG), and 24 normal control (NC) were tested with spectral-domain optical coherence tomography (SD-OCT), standard automated perimetry (SAP), and SS-PERG. Mean deviation (MD), pattern standard deviation (PSD), retinal nerve fiber layer (RNFL), and ganglionar complex cells (GCC) were evaluated. The SS-PERG was recorded five consecutive times and the amplitude and phase of second harmonic were measured. PERG amplitude and coefficient of variation of phase (CVphase) were recorded, and correlation with structural and functional parameters of disease, by means of one-way ANOVA and Pearson’s correlation, was analysed. Results. PERG amplitude was reduced, as expression of retinal ganglion cells (RGCs) dysfunction, in EG patients and GS subjects compared to NC patients (). CVphase was significantly increased in EG patients and GS subjects, compared to healthy (), and it was also correlated with PSD (), GCC (), and RNFL () only in EG patients. Conclusions. Increased intrasession variability of phase in suspected glaucomatous eyes may be a sign of RGCs dysfunction. Alberto Mavilio, Francesca Scrimieri, and Donato Errico Copyright © 2015 Alberto Mavilio et al. All rights reserved. Structural and Function Correlation of Cone Packing Utilizing Adaptive Optics and Microperimetry Mon, 08 Jun 2015 06:21:45 +0000 Aim. To assess the functional aspects of cone mosaic and correlate cone packing with retinal sensitivity utilizing microperimetry in emmetropes at different eccentricities. Methods. Twenty-four healthy volunteers underwent microperimetry (MAIA Centervue, Italy) and assessment of photoreceptors using adaptive optics retinal camera, rtx1 (Imagine Eyes, Orsay, France), at 2 and 3 degrees from the foveal centre in 4 quadrants: superior, inferior, temporal, and nasal. Data was analyzed using SPSS version 17 (IBM). Spearman’s correlation tests were used to establish correlation between mean cone packing density and retinal sensitivity at different quadrants. Results. Thirteen females and 11 males (age range 20–40 years) were included. The cone density was found to be significantly different among all quadrants (temporal = 25786.68/mm2 ± 4367.07/mm2, superior = 23009.35/mm2 ± 5415.81/mm2, nasal = 22838.09/mm2 ± 4166.22/mm2, and inferior = 21097.53/mm2 ± 4235.84/mm2). A statistical significance was found between orthogonal meridians, that is, temporal, nasal superior, inferior (44106.88/mm2). A drop in retinal sensitivity was observed as the eccentricity increased . It was also found that as cone packing density decreased retinal sensitivity also decreased in all quadrants. This was observed at both 2 and 3 degrees. Conclusion. It is of crucial importance to establish normative variations in cone structure-function correlation. This may help in detection of subtle pathology and its early intervention. Dabir Supriya, Mangalesh Shwetha, Kumar Kiran Anupama, Kurian Kummelil Mathew, Tos T. J. M. Berendschot, Jan S. A. G. Schouten, Roopa Bharamshetter, Yadav K. Naresh, Shetty Rohit, and Bharath Hegde Copyright © 2015 Dabir Supriya et al. All rights reserved. Comparison of Macular Thickness in Patients with Keratoconus and Control Subjects Using the Cirrus HD-OCT Mon, 08 Jun 2015 06:19:44 +0000 Purpose. The aim of the present study was to compare macular thickness in patients with keratoconus (KC) with macular thickness in healthy subjects. Subjects and Methods. Twenty-six patients with KC and 52 control subjects were included. The macular structure was evaluated using a Zeiss Cirrus HD-OCT. The scan pattern used was 512 × 128, which covers an area of approximately 6 × 6 mm of the retina. The cube volume was assessed as well as macular thickness in each of the 9 sectors defined by the software. Results. The mean signal strength was significantly lower in the KC group (mean 8.4, range 6–10) compared with the control group (mean 9.7, range 7–10), (unpaired -test). There were no significant differences in cube volume (unpaired -test), cube average thickness, or macular thickness between the KC group and the control subjects in any of the retinal locations (one-way ANOVA). Conclusion. Macular structure as measured by OCT in KC subjects should be expected to lie within the range of age and sex matched controls. R. L. Brautaset, R. Rosén, A. Cerviño, W. L. Miller, J. Bergmanson, and M. Nilsson Copyright © 2015 R. L. Brautaset et al. All rights reserved. Altered Expression Levels of MMP1, MMP9, MMP12, TIMP1, and IL-1 as a Risk Factor for the Elevated IOP and Optic Nerve Head Damage in the Primary Open-Angle Glaucoma Patients Mon, 11 May 2015 13:23:01 +0000 The aim of presented work was to analyze the impact of particular polymorphic changes in the promoter regions of the -1607 1G/2G MMP1, -1562 C/T MMP9, -82 A/G MMP12, -511 C/T IL-1β, and 372 T/C TIMP1 genes on their expression level in POAG patients. Blood and aqueous humor samples acquired from 50 patients with POAG and 50 control subjects were used for QPCR and protein levels analysis by ELISA. In vivo promoter activity assays were carried on HTM cells using dual luciferase assay. All studied subjects underwent ophthalmic examination, including BCVA, intraocular pressure, slit-lamp examination, gonioscopy, HRT, and OCT scans. Patients with POAG are characterized by an increased mRNA expression of MMP1, MMP9, MMP12, and IL-1β genes as compared to the control group (). Aqueous humor acquired from patients with POAG displayed increased protein expression of MMP1, MMP9, MMP12, and IL-1β compared to the control group (). Allele -1607 1G of MMP1 gene possesses only 42,91% of the -1607 2G allele transcriptional activity and allele -1562 C of MMP9 gene possesses only 21,86% of the -1562 T allele. Increased expression levels of metalloproteinases can be considered as a risk factor for the development of POAG. Lukasz Markiewicz, Dariusz Pytel, Bartosz Mucha, Katarzyna Szymanek, Jerzy Szaflik, Jacek P. Szaflik, and Ireneusz Majsterek Copyright © 2015 Lukasz Markiewicz et al. All rights reserved. Ophthalmic Metastasis of Breast Cancer and Ocular Side Effects from Breast Cancer Treatment and Management: Mini Review Mon, 11 May 2015 05:57:28 +0000 Breast cancer is one of the most common malignant diseases occurring in women, and its incidence increases over the years. It is the main site of origin in ocular metastatic disease in women, and, due to its hematogenous nature of metastatic spread, it affects mainly the uveal tissue. The purpose of this paper is to summarize the clinical manifestations of the breast cancer ocular metastatic disease, alongside the side effects of the available treatment options for the management and regression of the systematic and ophthalmic disease. Ilias Georgalas, Theodore Paraskevopoulos, Chryssanthi Koutsandrea, Evgenia Kardara, Panagiotis Malamos, Dimitrios Ladas, and Dimitris Papaconstantinou Copyright © 2015 Ilias Georgalas et al. All rights reserved. Study on the Protective Effect of a New Manganese Superoxide Dismutase on the Microvilli of Rabbit Eyes Exposed to UV Radiation Wed, 29 Apr 2015 15:26:50 +0000 We present a study on the protective effects against UV radiation of a gel formulation containing a new recombinant form of manganese superoxide dismutase on the conjunctiva and corneal epithelia of rabbit eyes. The integrity of the microvilli of both ocular tissues has been considered as an indicator of the health of the tissues. Samples, collected by impression cytology technique, were added of 80 µL of a gel formulation containing superoxide dismutase (2.0 µg/mL) and irradiated with UV rays for 30 minutes and were evaluated with scanning electron microscopy. Wilcoxon test was used to verify the possible occurrence of statistically significant differences between damage for treated and nontreated tissues. Application of gel produces a significant reduction of damage by UV irradiation of ocular epithelia; both epithelia present a significant reduction of damaged microvilli number if treated with the superoxide dismutase gel formulation: the p values (differences between damage found for treated and nontreated both ocular tissues) for conjunctiva and cornea samples were and , respectively, at confidence level of 95%. The administration of this gel formulation before UV exposure plays a considerable protective role in ocular tissues of rabbit eye with a significant reduction of the damage. Lucia Grumetto, Antonio Del Prete, Giovanni Ortosecco, Francesco Barbato, Salvatore Del Prete, Antonella Borrelli, Antonella Schiattarella, Roberto Mancini, and Aldo Mancini Copyright © 2015 Lucia Grumetto et al. All rights reserved. Comparative Orbital Volumes between a Single Incisional Approach and a Double Incisional Approach in Patients with Combined Blowout Fracture Thu, 16 Apr 2015 06:59:29 +0000 Purpose. Blowout fracture characterized by concurrent floor and medial wall fractures is a rare entity. We compared surgical outcomes between a single approach and a double approach in patients with orbital fracture by measuring the postoperative orbital volume. Methods. We confirmed that 21 (8.5%) of a total of 246 patients with orbital fractures had fractures of the medial wall and floor through a retrospective chart review. Of these, 10 patients underwent the single approach and the remaining 11 patients had the double approach. We performed a statistical analysis of changes between the preoperative and postoperative orbital volumes at a 6-month follow-up. Results. Compared with the contralateral, nonaffected side, the orbital volume was 115.3 (±6.09)% preoperatively and 106.5 (±6.15)% postoperatively in the single approach group and 118.2 (±11.16)% preoperatively and 108.6 (±13.96)% postoperatively in the double approach. These results indicated that there was a significant difference between the preoperative and postoperative orbital volumes in each group (). However there was no significant difference between the single approach and the double approach (). Conclusions. Our results showed that there were no significant differences in surgical outcomes between the two modalities. The treatment modality may be selected based on the surgeons’ preference, as well as the fracture type. Hyun Ho Han, Sang Wook Park, Suk-Ho Moon, Bommie F. Seo, Jong Won Rhie, Sang Tae Ahn, and Deuk Young Oh Copyright © 2015 Hyun Ho Han et al. All rights reserved. SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary? Sun, 12 Apr 2015 12:07:25 +0000 Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus. Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR) and lateral rectus (LR) with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed. Results. There is significant overall improvement both in postoperative angle of esodeviation () and postoperative range of movement (). Comparing between the sclera fixation group (11 eyes) versus nonscleral fixation group (21 eyes), the postoperative horizontal deviation, the postoperative vertical deviation, successful outcome, and the change in horizontal deviation were not significantly different (). Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome. Carol P. S. Lam, Jason C. S. Yam, Flora H. S. Lau, Dorothy S. P. Fan, C. Y. Wong, Christopher B. O. Yu, and Winnie W. Y. Lau Copyright © 2015 Carol P. S. Lam et al. All rights reserved. Cross-Linking and Corneal Imaging Advances Wed, 08 Apr 2015 07:13:53 +0000 A. John Kanellopoulos, Ronald R. Krueger, and George Asimellis Copyright © 2015 A. John Kanellopoulos et al. All rights reserved. Understanding the Correlation between Tomographic and Biomechanical Severity of Keratoconic Corneas Mon, 06 Apr 2015 09:22:05 +0000 Purpose. To evaluate correlation between tomographic gradation of keratoconus (KC) and its corresponding air-puff induced biomechanical response. Methods. Corneal tomography and biomechanics were measured with Scheimpflug imaging in 44 normal and 92 KC corneas. Deformation waveform was also analyzed with Fourier series. A custom KC severity scale was used from 1 to 3 with 3 as the most severe grade. Tomographic and biomechanical variables were assessed among the grades. Sensitivity and specificity of the variables were assessed using receiver operating characteristics (ROC). Results. Curvature variables were significantly different between normal and disease () and among grades (). Biomechanical variables were significantly different between normal and disease () but similar among grades 1 and 2 (). All variables had an area under the ROC curve greater than 0.5. The root mean square of the Fourier cosine coefficients had the best ROC (0.92, cut-off: 0.027, sensitivity: 83%, specificity: 88.6%). Spearman correlation coefficient was significant between most variables (). However, tomographic segregation of keratoconus did not result in concomitant biomechanical segregation of the grades. Conclusions. There was lack of significant biomechanical difference between mild disease grades, despite progressive corneal thinning. Mathematical models that estimate corneal modulus from air-puff deformation may be more useful. Rohit Shetty, Rudy M. M. A. Nuijts, Purnima Srivatsa, Chaitra Jayadev, Natasha Pahuja, Mukunda C. Akkali, and Abhijit Sinha Roy Copyright © 2015 Rohit Shetty et al. All rights reserved. Intraoperative Optical Coherence Tomography Using the RESCAN 700: Preliminary Results in Collagen Crosslinking Mon, 06 Apr 2015 08:40:40 +0000 Purpose. To compare the penetration of riboflavin using a microscope-integrated real time spectral domain optical coherence tomography (ZEISS OPMI LUMERA 700 and ZEISS RESCAN 700) in keratoconus patients undergoing accelerated collagen crosslinking (ACXL) between epithelium on (epi-on) and epithelium off (epi-off). Methods. Intraoperative images were obtained during each of the procedures. Seven keratoconus patients underwent epi-on ACXL and four underwent epi-off ACXL. A software tool was developed using Microsoft.NET and Open Computer Vision (OpenCV) libraries for image analysis. Pre- and postprocedure images were analyzed for changes in the corneal hyperreflectance pattern as a measure of the depth of riboflavin penetration. Results. The mean corneal hyperreflectance in the epi-on group was 12.97 ± 1.49 gray scale units (GSU) before instillation of riboflavin and 14.46 ± 2.09 GSU after AXCL (P = 0.019) while in the epi-off group it was 11.43 ± 2.68 GSU and 16.98 ± 8.49 GSU, respectively (P = 0.002). The average depth of the band of hyperreflectance in the epi-on group was 149.39 ± 15.63 microns and in the epi-off group it was 191.04 ± 32.18 microns. Conclusion. This novel in vivo, real time imaging study demonstrates riboflavin penetration during epi-on and epi-off ACXL. Natasha Pahuja, Rohit Shetty, Chaitra Jayadev, Rudy Nuijts, Bharath Hedge, and Vishal Arora Copyright © 2015 Natasha Pahuja et al. All rights reserved. Performance of Three Multipurpose Disinfecting Solutions with a Silicone Hydrogel Contact Lens Tue, 31 Mar 2015 13:41:16 +0000 Purpose. To evaluate the clinical performance of a silicone hydrogel (Si-Hy) soft contact lens (CL) in combination with three different multipurpose disinfecting solutions (MPDSs). Methods. This was a prospective, randomized, single-masked, crossover, and comparative study in which 31 habitual soft CL wearers were randomly assigned to one of the three MPDSs (Synergi, COMPLETE RevitaLens, and OPTI-FREE PureMoist) for 1 month with a 1-week wash-out period between each exposure. All subjects were successfully refitted with a Si-Hy CL (Biofinity). Subjects were then scheduled for follow-up visits after 1 month of lens wear, being evaluated at 2 and 8 hours after lens insertion. Visual Analogue Scales (VAS) were used to gauge comfort rating. Results. The tarsal conjunctiva showed a significantly different degree of lid redness between the MPDSs at the 2-hour visit (, Kruskal-Wallis test), being lower for COMPLETE RevitaLens compared to the other two MPDSs (Mann-Whitney test). Furthermore, a significantly different degree of lid roughness at the 8-hour visit was seen (, Kruskal-Wallis test), being higher for Synergi (Mann-Whitney test). The subjective comfort was similar with the three MPDSs. Conclusion. Tarsal conjunctival response should be also considered in the context of the clinical performance of MPDs at the ocular surface. Nery García-Porta, Laura Rico-del-Viejo, Helena Ferreira-Neves, Sofia C. Peixoto-de-Matos, Antonio Queirós, and José M. González-Méijome Copyright © 2015 Nery García-Porta et al. All rights reserved. Diabetic Retinopathy: Mechanism, Diagnosis, Prevention, and Treatment Thu, 19 Mar 2015 07:54:55 +0000 Mohamed Al-Shabrawey, Wenbo Zhang, and Denise McDonald Copyright © 2015 Mohamed Al-Shabrawey et al. All rights reserved. Imbalance of the Nerve Growth Factor and Its Precursor as a Potential Biomarker for Diabetic Retinopathy Tue, 17 Mar 2015 07:16:39 +0000 Our previous studies have demonstrated that diabetes-induced oxidative stress alters homeostasis of retinal nerve growth factor (NGF) resulting in accumulation of its precursor, proNGF, at the expense of NGF which plays a critical role in preserving neuronal and retinal function. This imbalance coincided with retinal damage in experimental diabetes. Here we test the hypothesis that alteration of proNGF and NGF levels observed in retina and vitreous will be mirrored in serum of diabetic patients. Blood and vitreous samples were collected from patients (diabetic and nondiabetic) undergoing vitrectomy at Georgia Regents University under approved IRB. Levels of proNGF, NGF, and shedding were detected using Western blot analysis. MMP-7 activity was also assayed. Diabetes-induced proNGF expression and impaired NGF expression were observed in vitreous and serum. Vitreous and sera from diabetic patients showed significant 40.8-fold and 3.6-fold increases, respectively, compared to nondiabetics . In contrast, vitreous and sera from diabetic patients showed significant 44% and 64% reductions in NGF levels, respectively, compared to nondiabetics. ProNGF to NGF ratios showed significant correlation between vitreous and serum. Further characterization of diabetes-induced imbalance in the proNGF to NGF ratio will facilitate its utility as an early biomarker for diabetic complications. B. A. Mysona, S. Matragoon, M. Stephens, I. N. Mohamed, A. Farooq, M. L. Bartasis, A. Y. Fouda, A. Y. Shanab, D. G. Espinosa-Heidmann, and A. B. El-Remessy Copyright © 2015 B. A. Mysona et al. All rights reserved. TNF-Related Apoptosis Inducing Ligand in Ocular Cancers and Ocular Diabetic Complications Thu, 05 Mar 2015 10:50:17 +0000 TNF-related apoptosis inducing ligand (TRAIL) is an intensively studied cytokine, in particular for its anticancer activity. The discovery that conjunctival sac fluid contains extremely high levels of soluble TRAIL as compared to other body fluids suggested important implications in the context of the immunological surveillance of the eye, in particular of the anterior surface. In this review, we discuss the potential physiopathologic and therapeutic role of the TRAIL/TRAIL receptor system in a variety of ocular cancers. Moreover, since an increasing amount of data has indicated the important biological activities of the TRAIL/TRAIL receptor systems also in a completely different pathologic context such as diabetes mellitus, in the second part of this review we summarize the currently available data on the involvement of TRAIL in the ocular complications of diabetes mellitus as modulator of the inflammatory and angiogenic response in the eye. Paolo Perri, Giorgio Zauli, Arianna Gonelli, Daniela Milani, Claudio Celeghini, Giuseppe Lamberti, and Paola Secchiero Copyright © 2015 Paolo Perri et al. All rights reserved. Effectiveness of the Lower Eyelid Suspension Using Fascia Lata Graft for the Treatment of Lagophthalmos due to Facial Paralysis Wed, 04 Mar 2015 14:24:14 +0000 Purpose. To evaluate of functional and cosmetic effectiveness of lower eyelid sling technique with fascia lata graft in patients with lagophthalmos due to facial paralysis. Material and Method. Ten patients with a mean age of years who underwent lower eyelid sling surgery with a fascia lata graft between September 2011 and January 2014 were included in this prospective study. Preoperatively and postoperatively patients were evaluated in terms of corneal epithelial defects, Schirmer’s test, and tear break-up time (TBUT). Cosmetically, vertical eyelid aperture, margin reflex distances 1 and 2 (MRD1 and MRD2) and scleral show were evaluated preoperatively and postoperatively. Results. One patient had facial paralysis on the right side whereas the other 9 patients had facial paralysis on the left side. Preoperatively, 3 patients were detected with corneal ulcer, whereas 7 patients were detected with persistent corneal epithelial defects localized in the lower half of the cornea. In the 3 patients with preoperative corneal ulcer, the ulcer recovered with corneal opacity, whereas in the 7 patients with punctate epitheliopathy, postoperative corneal transparency was obtained. Discussion. Lower eyelid sling technique with fascia lata graft is an effective technique for the repositioning of the lower eyelid and preventing the corneal complications. Selam Yekta Sendul, Halil Huseyin Cagatay, Burcu Dirim, Mehmet Demir, Zeynep Acar, Ali Olgun, Efe Can, and Dilek Guven Copyright © 2015 Selam Yekta Sendul et al. All rights reserved. MicroRNA-146b-3p Regulates Retinal Inflammation by Suppressing Adenosine Deaminase-2 in Diabetes Sun, 01 Mar 2015 07:30:25 +0000 Hyperglycemia- (HG-) Amadori-glycated albumin- (AGA-) induced activation of microglia and monocytes and their adherence to retinal vascular endothelial cells contribute to retinal inflammation leading to diabetic retinopathy (DR). There is a great need for early detection of DR before demonstrable tissue damages become irreversible. Extracellular adenosine, required for endogenous anti-inflammation, is regulated by the interplay of equilibrative nucleoside transporter with adenosine deaminase (ADA) and adenosine kinase. ADA, including ADA1 and ADA2, exists in all organisms. However, because ADA2 gene has not been identified in mouse genome, how diabetes alters adenosine-dependent anti-inflammation remains unclear. Studies of pig retinal microglia and human macrophages revealed a causal role of ADA2 in inflammation. Database search suggested miR-146b-3p recognition sites in the 3′-UTR of ADA2 mRNA. Coexpression of miR-146b-3p, but not miR-146-5p or nontargeting miRNA, with 3′-UTR of the ADA2 gene was necessary to suppress a linked reporter gene. In the vitreous of diabetic patients, decreased miR-146b-3p is associated with increased ADA2 activity. Ectopic expression of miR-146b-3p suppressed ADA2 expression, activity, and TNF-α release in the AGA-treated human macrophages. These results suggest a regulatory role of miR-146b-3p in diabetes related retinal inflammation by suppressing ADA2. Sadanand Fulzele, Ahmed El-Sherbini, Saif Ahmad, Rajnikumar Sangani, Suraporn Matragoon, Azza El-Remessy, Reshmitha Radhakrishnan, and Gregory I. Liou Copyright © 2015 Sadanand Fulzele et al. All rights reserved. Aqueous Cytokines as Predictors of Macular Edema in Patients with Diabetes following Uncomplicated Phacoemulsification Cataract Surgery Wed, 25 Feb 2015 07:57:07 +0000 This study aims to ascertain whether cytokines in the aqueous humor can predict macular edema (ME) in diabetic patients following uncomplicated phacoemulsification cataract surgery. Undiluted aqueous humor samples were obtained from 136 consecutive type 2 diabetic patients who underwent cataract surgery. The concentrations of 27 cytokines were measured in aqueous humor using the multiplex bead immunoassay. At the final follow-up examination, 116 patients completed 4 weeks of follow-up, and the incidence of macular edema was 29.31% (34 patients) 4 weeks after cataract surgery. Compared to the ME (−) patients, the concentrations of interleukin-1β (IL-1β) (), IL-6 (), IL-8 (), interferon-induced protein-10 (IP-10) (), monocyte chemotactic protein-1 (MCP-1) (), and vascular endothelial growth factor (VEGF) () in the ME (+) patients were significantly higher. In addition, the aqueous levels of IL-1β (), IL-6 (), IL-8 (), IP-10 (), MCP-1 (), and VEGF () were positively correlated with the postoperative foveal center point thickness (FCPT). However, the aqueous levels of IL-10 () and IL-12 () were significantly lower in patients with ME. These results suggest IL-1β, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, and VEGF may be potential predictors of postoperative macular thickness in patients with diabetes following uncomplicated phacoemulsification cataract surgery. Ning Dong, Bing Xu, Bingsong Wang, Liqun Chu, and Xin Tang Copyright © 2015 Ning Dong et al. All rights reserved. Optical Coherence Tomography in Patients with Chiari I Malformation Sun, 22 Feb 2015 10:04:18 +0000 Background/Aims. To evaluate optic nerve head with spectral domain optical coherence tomography (OCT) in patients with Chiari I malformation (CMI) compared to healthy controls. Methods. Cross-sectional study. OCT of the optic nerve head of 22 patients with CMI and 22 healthy controls was quantitatively analyzed. The healthy controls were matched for age and sex with the study population. Mean retinal nerve fiber layer (RNFL) thickness was calculated for both eyes; the mean thickness value was also registered for each quadrant and for each subfield of the four quadrants. Results. CMI patients showed a reduction of the RNFL thickness in both eyes. This reduction was more statistically significant () for the inferior quadrant in the right eye and in each quadrant than nasal one in the left eye. Conclusion. A distress of the retinal nerve fibers could explain the observed reduction of the RNFL thickness in patients with CMI; in our series the reduction of the RNFL thickness seems lower when CMI is associated with syringomyelia. Michele Figus, Chiara Posarelli, Francesco Nasini, Paolo Perrini, Mario Miccoli, Angelo Baggiani, Antonio Ferreras, and Marco Nardi Copyright © 2015 Michele Figus et al. All rights reserved. Clinical Characteristics, Treatment Patterns, and Outcomes of Primary Canaliculitis among Patients in Beijing, China Tue, 17 Feb 2015 12:31:36 +0000 Background. Canaliculitis may cause punctal or canalicular swelling, discharge, erythema, and sometimes concretions. This study examined the clinical characteristics, treatment patterns, and outcomes of primary canaliculitis from patients at a top-rated hospital in Beijing, China. Methods. Medical records of 16 patients (retrospective case series) were studied. Results. This study included four males and twelve females with a median age of 72.5 years. The mean and the median follow-up time were 10.4 months and 6 months, respectively. The mostly observed clinical symptoms were epiphora with discharge (94%), while the mostly observed signs included pouting punctum (75%) and punctal regurgitation of concretions under syringing (75%). Only the symptoms of one patient among those with conservative therapy completely resolved within two-year follow-up. Curettage therapy was found to partly resolve the clinical symptoms and signs within the follow-up of four weeks. Fifteen patients finally received curettage with punctoplasty, and symptoms completely resolved in fourteen patients after one surgery. Conclusions. Syringing with pressing of lacrimal sac area may help better diagnosis of canaliculitis. Additionally, curettage with punctoplasty is recommended for thorough removal of concretions and complete resolution of canaliculitis. Qin Zhang, Beibei Xu, Xiao-Xin Li, and Ming-Wu Li Copyright © 2015 Qin Zhang et al. All rights reserved. The Use of an IL-1 Receptor Antagonist Peptide to Control Inflammation in the Treatment of Corneal Limbal Epithelial Stem Cell Deficiency Sun, 01 Feb 2015 13:43:34 +0000 Corneal limbal stem cell deficiency (LSCD) may be treated using ex vivo limbal epithelial stem cells (LESCs) derived from cadaveric donor tissue. However, continuing challenges exist around tissue availability, inflammation, and transplant rejection. Lipopolysaccharide (LPS) or recombinant human IL-1β stimulated primary human keratocyte and LESC models were used to investigate the anti-inflammatory properties of a short chain, IL-1 receptor antagonist peptide for use in LESC sheet growth to control inflammation. The peptide was characterized using mass spectroscopy and high performance liquid chromatography. Peptide cytotoxicity, patterns of cell cytokine expression in response to LPS or IL-1β stimulation, and peptide suppression of this response were investigated by MTS/LDH assays, ELISA, and q-PCR. Cell differences in LPS stimulated toll-like receptor 4 expression were investigated using immunocytochemistry. A significant reduction in rIL-1β stimulated inflammatory cytokine production occurred following LESC and keratocyte incubation with anti-inflammatory peptide and in LPS stimulated IL-6 and IL-8 production following keratocyte incubation with peptide (1 mg/mL) . LESCs produced no cytokine response to LPS stimulation and showed no TLR4 expression. The peptide supported LESC growth when adhered to a silicone hydrogel contact lens indicating potential use in improved LESC grafting through suppression of inflammation. E. Fok, S. R. Sandeman, A. L. Guildford, and Y. H. Martin Copyright © 2015 E. Fok et al. All rights reserved. New Approaches, Findings, and Diagnostics in Medical and Surgical Retina Thu, 29 Jan 2015 10:21:07 +0000 Jerzy Nawrocki, Ron Adelman, and Didier Ducournau Copyright © 2015 Jerzy Nawrocki et al. All rights reserved. Strategy for the Management of Macular Edema in Retinal Vein Occlusion: The European VitreoRetinal Society Macular Edema Study Thu, 29 Jan 2015 07:12:54 +0000 Objective. To compare the efficacy of different therapies in the treatment of macular edema associated with retinal vein occlusion (RVO). Design. This is a nonrandomized, multicenter collaborative study. Participants. 86 retina specialists from 29 countries provided clinical information, including choice of treatment and outcome, on 2,603 patients with macular edema including 738 cases of RVO. Methods. Reported data included the type and number of treatments performed, visual acuities, and other clinical and diagnostic findings. Main Outcome Measures. The mean increase in visual acuity and mean number of treatments performed. Results. 358 cases of central retinal vein occlusion (CRVO) and 380 cases of branch retinal vein occlusion (BRVO) were included in this investigation. Taking all RVO cases together, pars plana vitrectomy with internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than other therapies. Those treated with intravitreal antivascular endothelial growth factor (anti-VEGF) injection alone showed the second greatest improvement in vision. Dexamethasone intravitreal implant alone and intravitreal triamcinolone alone both resulted in modest visual gains. Conclusions. In the treatment of macular edema in RVO, vitrectomy with ILM peeling may achieve visual improvement and may be a good option for certain cases. Anti-VEGF injection is the most effective of the nonsurgical treatments. Ron A. Adelman, Aaron J. Parnes, Silvia Bopp, Ihab Saad Othman, and Didier Ducournau Copyright © 2015 Ron A. Adelman et al. All rights reserved. Strategy for the Management of Diabetic Macular Edema: The European Vitreo-Retinal Society Macular Edema Study Wed, 28 Jan 2015 14:17:07 +0000 Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME). Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s) performed, the pre- and posttreatment visual acuities, and other clinical findings. The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies). Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results. The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatment with threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies. Ron Adelman, Aaron Parnes, Zofia Michalewska, Barbara Parolini, Claude Boscher, and Didier Ducournau Copyright © 2015 Ron Adelman et al. All rights reserved. The Role of Fundus Autofluorescence Imaging in the Study of the Course of Posterior Uveitis Disorders Wed, 28 Jan 2015 12:32:54 +0000 Background. To evaluate the correlation of fundus autofluorescence (FAF) with indocyanine green angiography (ICGA) in patients with various posterior uveitis disorders. Methods. Interventional case series including 23 eyes of 15 patients with diagnosis of a specific type of retinochoroiditis, such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous-like choroiditis, multifocal choroiditis (MFC), Harada disease, and syphilitic retinochoroiditis. Also, some cases with undefined retinochoroiditis were included. FAF and ICGA were performed and correlated at baseline and during follow-up after treatment. Results. In ICGA, early hypofluorescence was found to be the hallmark of acute choroidal inflammation, resolving in later stages and remaining in the late phase in areas with retinal pigment epithelium (RPE) damage. Poorly defined hyperautofluorescent areas correlated with acute choroidal lesions. Hypoautofluorescent delineation suggested the initiation of RPE healing processes, correlating well with the late phase of ICGA and delineating the RPE damage. Early hyperautofluorescence with late hypofluorescence in ICGA indicated the presence of primary RPE involvement. Conclusion. FAF contributes to the interpretation of RPE disease and may be a useful tool for the follow-up of progressive inflammatory disorders. Comparative evaluation of FAF and ICGA allows a characterization of the sequence of inflammatory events and the level of tissue affected. Panagiotis Malamos, Panos Masaoutis, Ilias Georgalas, Stelios Maselos, Konstantinos Andrianopoulos, Chryssanthi Koutsandrea, and Nikos N. Markomichelakis Copyright © 2015 Panagiotis Malamos et al. All rights reserved. Short-Term Changes in Light Distortion in Orthokeratology Subjects Wed, 28 Jan 2015 07:00:31 +0000 Purpose. Quantifying adaptation to light distortion of subjects undergoing orthokeratology (OK) for myopia during the first month of treatment. Methods. Twenty-nine healthy volunteers (age: 22.34 ± 8.08 years) with mean spherical equivalent refractive error −2.10 ± 0.93D were evaluated at baseline and days 1, 7, 15, and 30 of OK treatment. Light distortion was determined using an experimental prototype. Corneal aberrations were derived from corneal topography for different pupil sizes. Contrast sensitivity function (CSF) was analyzed for frequencies of 1.50, 2.12, 3.00, 4.24, 6.00, 8.49, 12.00, 16.97, and 24.00 cpd under photopic conditions. Results. Average monocular values of all light distortion parameters measured increased significantly on day 1, returning to baseline after 1 week ( in all cases). Spherical-like aberration stabilized on day 7 for all pupil diameters, while coma-like for smaller pupils only. CSF was significantly reduced on day 1 for all spatial frequencies except for 1.5 cpd, returning to baseline afterwards. Significant correlation was found between light distortion and contrast sensitivity for middle and high frequencies () after 15 days. Conclusion. Despite consistently increased levels of corneal aberrations, light distortion tends to return to baseline after one week of treatment, suggesting that neural adaptation is capable of overcoming optical quality degradation. Elena Santolaria Sanz, Alejandro Cerviño, Antonio Queiros, Cesar Villa-Collar, Daniela Lopes-Ferreira, and Jose Manuel González-Méijome Copyright © 2015 Elena Santolaria Sanz et al. All rights reserved. Viability, Apoptosis, Proliferation, Activation, and Cytokine Secretion of Human Keratoconus Keratocytes after Cross-Linking Wed, 28 Jan 2015 06:20:19 +0000 Purpose. The purpose of this study was to determine the impact of cross-linking (CXL) on viability, apoptosis, proliferation, activation, and cytokine secretion of human keratoconus (KC) keratocytes, in vitro. Methods. Primary KC keratocytes were cultured in DMEM/Ham’s F12 medium supplemented with 10% FCS and underwent UVA illumination (370 nm, 2 J/cm2) during exposure to 0.1% riboflavin and 20% Dextran in PBS. Twenty-four hours after CXL, viability was assessed using Alamar blue assay; apoptosis using APO-DIRECT Kit; proliferation using ELISA-BrdU kit; and CD34 and alpha-smooth muscle actin (α-SMA) expression using flow cytometry. Five and 24 hours after CXL, FGFb, HGF, TGFβ1, VEGF, KGF, IL-1β, IL-6, and IL-8 secretion was measured using enzyme-linked-immunoabsorbent assay (ELISA). Results. Following CXL, cell viability and proliferation decreased (; ), the percentage of apoptotic keratocytes increased () significantly, and CD34 and α-SMA expression remained unchanged (). Five hours after CXL, FGFb secretion increased significantly (); however no other cytokine secretion differed significantly from controls after 5 or 24 hours (). Conclusions. Cross-linking decreases viability, triggers apoptosis, and inhibits proliferation, without an impact on multipotent hematopoietic stem cell transformation and myofibroblastic transformation of KC keratocytes. CXL triggers FGFb secretion of KC keratocytes transiently (5 hours), normalizing after 24 hours. Xuefei Song, Tanja Stachon, Jiong Wang, Achim Langenbucher, Berthold Seitz, and Nóra Szentmáry Copyright © 2015 Xuefei Song et al. All rights reserved. Cone Dystrophy in Patient with Homozygous RP1L1 Mutation Tue, 27 Jan 2015 08:53:27 +0000 The purpose of this study was to determine whether an autosomal recessive cone dystrophy was caused by a homozygous RP1L1 mutation. A family including one subject affected with cone dystrophy and four unaffected members without evidence of consanguinity underwent detailed ophthalmic evaluations. The ellipsoid and interdigitation zones on the spectral-domain optical coherence tomography images were disorganized in the proband. The proband had a reduced amplitude of cone and flicker full-field electroretinograms (ERGs). Focal macular ERGs and multifocal ERGs were severely reduced in the proband. A homozygous RP1L1 mutation (c.3628T>C, p.S1210P) was identified in the proband. Family members who were heterozygous for the p.S1210P mutation had normal visual acuity and normal results of clinical evaluations. To investigate other putative pathogenic variant(s), a next-generation sequencing (NGS) approach was applied to the proband. NGS identified missense changes in the heterozygous state of the PCDH15, RPGRIP1, and GPR98 genes. None of these variants cosegregated with the phenotype and were predicted to be benign reinforcing the putative pathogenicity of the RP1L1 homozygous mutation. The AO images showed a severe reduction of the cone density in the proband. Our findings indicate that a homozygous p.S1210P exchange in the RP1L1 gene can cause cone dystrophy. Sachiko Kikuchi, Shuhei Kameya, Kiyoko Gocho, Said El Shamieh, Keiichiro Akeo, Yuko Sugawara, Kunihiko Yamaki, Christina Zeitz, Isabelle Audo, and Hiroshi Takahashi Copyright © 2015 Sachiko Kikuchi et al. All rights reserved. Primary Retinal Cultures as a Tool for Modeling Diabetic Retinopathy: An Overview Mon, 19 Jan 2015 12:20:07 +0000 Experimental models of diabetic retinopathy (DR) have had a crucial role in the comprehension of the pathophysiology of the disease and the identification of new therapeutic strategies. Most of these studies have been conducted in vivo, in animal models. However, a significant contribution has also been provided by studies on retinal cultures, especially regarding the effects of the potentially toxic components of the diabetic milieu on retinal cell homeostasis, the characterization of the mechanisms on the basis of retinal damage, and the identification of potentially protective molecules. In this review, we highlight the contribution given by primary retinal cultures to the study of DR, focusing on early neuroglial impairment. We also speculate on possible themes into which studies based on retinal cell cultures could provide deeper insight. Andrea Matteucci, Monica Varano, Cinzia Mallozzi, Lucia Gaddini, Marika Villa, Sara Gabrielli, Giuseppe Formisano, Flavia Pricci, and Fiorella Malchiodi-Albedi Copyright © 2015 Andrea Matteucci et al. All rights reserved. GABAB Receptor Antagonist CGP46381 Inhibits Form-Deprivation Myopia Development in Guinea Pigs Sun, 11 Jan 2015 09:06:50 +0000 The aim was to investigate the effects of the receptor antagonist, CGP46381, on form-deprivation myopia (FDM) in guinea pigs. Twenty-four guinea pigs had monocular visual deprivation induced using a diffuser for 11 days (day 14 to 25). The deprived eyes were treated with daily subconjunctival injections (100 μl) of either 2% CGP46381, 0.2% CGP46381, or saline or received no injection. The fellow eyes were left untreated. Another six animals received no treatment. At the start and end of the treatment period, ocular refractions were measured using retinoscopy and vitreous chamber depth (VCD) and axial length (AL) using A-scan ultrasound. All of the deprived eyes developed relative myopia (treated versus untreated eyes, ). The amount of myopia was significantly affected by the drug treatment (one-way ANOVA, ). The highest dose tested, 2% CGP46381, significantly inhibited myopia development compared to saline (2% CGP46381: −1.08 ± 0.40 D, saline: −4.33 ± 0.67 D, ). The majority of these effects were due to less AL (2% CGP46381: 0.03 ± 0.01 mm, saline: 0.13 ± 0.02 mm, ) and VCD (2% CGP46381: 0.02 ± 0.01 mm, saline: 0.08 ± 0.01 mm, ) elongation. The lower dose tested, 0.2% CGP46381, did not significantly inhibit FDM (). Subconjunctival injections of CGP46381 inhibit FDM development in guinea pigs in a dose-dependent manner. Zhen-Ying Cheng, Xu-Ping Wang, Katrina L. Schmid, Yu-Fei Han, Xu-Guang Han, Hong-Wei Tang, and Xin Tang Copyright © 2015 Zhen-Ying Cheng et al. All rights reserved. Two-Year Accelerated Corneal Cross-Linking Outcome in Patients with Progressive Keratoconus Tue, 06 Jan 2015 06:45:39 +0000 Purpose. To evaluate the long-term results of accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. Methods. Sixteen patients underwent accelerated CXL at 6 mW/cm2 for 15 minutes in one eye. The follow-up visits were scheduled on 7 days, 14 days, and 3, 12, and 24 months after the treatment. Results. There were no significant differences () between preoperative and 2-year postoperative mean values, respectively, in terms of uncorrected visual acuity, best spectacle-corrected visual acuity, maximum keratometry , minimum keratometry , corneal astigmatism, and corneal eccentricity index. We noted a significant flattening of the cornea in 18.7% of patients with a higher preoperative value (>50 D) and its steepening in patients with a lower value (<50 D) (6.25%). There was no significant difference in the central corneal thickness and the apical corneal thickness preoperatively and 2 years postoperatively. The mean demarcation line depth was  μm. Persistent corneal haze was noted in 25% of patients. Conclusions. Accelerated CXL appears to be a relatively effective procedure for the treatment of keratoconus in 2-year follow-up. Arleta Waszczykowska and Piotr Jurowski Copyright © 2015 Arleta Waszczykowska and Piotr Jurowski. All rights reserved. Latest Treatment Option and Technology Advancement in Corneal and Ocular Surface Disease Sun, 28 Dec 2014 06:41:57 +0000 Ciro Costagliola, Mark Batterbury, Harminder Singh Dua, and Leonardo Mastropasqua Copyright © 2014 Ciro Costagliola et al. All rights reserved. Scotopic Microperimetry in the Early Diagnosis of Age-Related Macular Degeneration: Preliminary Study Tue, 09 Dec 2014 00:10:30 +0000 Background. Recent clinical studies have shown that, in some degenerative retinal diseases, like age-related macular degeneration (AMD), the sensitivity of the rods decreases more rapidly than the sensitivity of the cones. The aim of this study was to evaluate if there is a correlation between the presence of hard drusen at the macular level and the rod damage responsible for the reduction in scotopic retinal sensitivity in subjects at risk for AMD. Methods. The authors selected 24 subjects (14 men and 10 women) with an average age of 67.25 ± 5.7 years. Macular hard drusen were present in 50% of the subjects at the fundus oculi exam. The researchers evaluated the retinal sensitivity to light in mesopic and scotopic conditions of each subject with an MP-1 scotopic microperimeter (MP-1S). Results. In subjects with hard drusen in the fundus oculi examination, there was a statistically significant reduction in scotopic retinal sensitivity, while the mesopic retinal sensitivity was not compromised. Conclusion. This study revealed how the presence of hard drusen at the macular level is associated with a reduction in scotopic retinal sensitivity compared to a control group of healthy subjects. Retinal functionality in a scotopic setting examined with MP-1S could be useful in early diagnosis of AMD. Marcella Nebbioso, Andrea Barbato, and Nicola Pescosolido Copyright © 2014 Marcella Nebbioso et al. All rights reserved. Identification of Chemokines and Growth Factors in Proliferative Diabetic Retinopathy Vitreous Mon, 27 Oct 2014 06:53:24 +0000 Associations were investigated between levels of chemokines and growth factors in the vitreous and proliferative diabetic retinopathy (PDR). Enrolled were 58 patients (58 eyes) requiring pars plana vitrectomy (PPV), with PDR (, none with traction retinal detachment) or not (non-PDR). In the latter, 16 had macular hole (MH) and 10 had epiretinal membrane (ERM). With a multiplex bead immunoassay, levels of 11 chemokines and growth factors were measured from the undiluted vitreous sample from each patient. In the non-PDR eyes, the levels of the 11 chemokines and growth factors tested were similar between patients with MH and those with ERM. However, the levels of all 11 were significantly higher in the PDR eyes relative to the non-PDR; CCL17, CCL19, and TGFβ3 were markedly upregulated and have not been investigated in PDR previously. The significantly higher levels of CCL4 and CCL11 in PDR contradict the results of previous reports. Based on Spearman’s nonparametric test, moderate-to-strong correlations were found between VEGF and other mediators. Our results indicate that these chemokines and growth factors could be candidates for research into targeted therapies applied either singly or in combination with anti-VEGF drugs for the treatment of PDR. Ying Dai, Zhifeng Wu, Feng Wang, Zhengwei Zhang, and Mengxi Yu Copyright © 2014 Ying Dai et al. All rights reserved. Comparative Diagnostic Accuracy of Ganglion Cell-Inner Plexiform and Retinal Nerve Fiber Layer Thickness Measures by Cirrus and Spectralis Optical Coherence Tomography in Relapsing-Remitting Multiple Sclerosis Thu, 18 Sep 2014 00:00:00 +0000 Objective. To estimate sensitivity and specificity of several optical coherence tomography (OCT) measurements for detecting retinal thickness changes in patients with relapsing-remitting multiple sclerosis (RRMS), such as macular ganglion cell-inner plexiform layer (GCIPL) thickness measured with Cirrus (OCT) and peripapillary retinal nerve fiber layer (pRNFL) thickness measured with Cirrus and Spectralis OCT. Methods. Seventy patients (140 eyes) with RRMS and seventy matched healthy subjects underwent pRNFL and GCIPL thickness analysis using Cirrus OCT and pRNFL using Spectralis OCT. A prospective, cross-sectional evaluation of sensitivities and specificities was performed using latent class analysis due to the absence of a gold standard. Results. GCIPL measures had higher sensitivity and specificity than temporal pRNFL measures obtained with both OCT devices. Average GCIPL thickness was significantly more sensitive than temporal pRNFL by Cirrus (96.34% versus 58.41%) and minimum GCIPL thickness was significantly more sensitive than temporal pRNFL by Spectralis (96.41% versus 69.69%). Generalised estimating equation analysis revealed that age (), optic neuritis antecedent (), and disease duration () were significantly associated with abnormal results in average GCIPL thickness. Conclusion. Average and minimum GCIPL measurements had significantly better sensitivity to detect retinal thickness changes in RRMS than temporal pRNFL thickness measured by Cirrus and Spectralis OCT, respectively. Julio J. González-López, Gema Rebolleda, Marina Leal, Noelia Oblanca, Francisco J. Muñoz-Negrete, Lucienne Costa-Frossard, and José C. Álvarez-Cermeño Copyright © 2014 Julio J. González-López et al. All rights reserved. Profile of Microbial Keratitis after Corneal Collagen Cross-Linking Thu, 11 Sep 2014 06:35:59 +0000 Purpose. To report the profile of microbial keratitis occurring after corneal collagen cross-linking (CXL) in keratoconus patients. Methods. A retrospective analysis of 2350 patients (1715 conventional CXL, 310 transepithelial CXL, and 325 accelerated CXL) over 7 years (from January 2007 to January 2014) of progressive keratoconus, who underwent CXL at a tertiary eye care centre, was performed. Clinical findings, treatment, and course of disease of four eyes that developed postprocedural moxifloxacin resistant Staphylococcus aureus (MXRSA) infectious keratitis are highlighted. Results. Four eyes that underwent CXL (0.0017%) had corneal infiltrates. All eyes that developed keratitis had conventional CXL. Corneal infiltrates were noted on the third postoperative day. Gram’s stain as well as culture reported MXRSA as the causative agent in all cases. Polymerase chain reaction (PCR) in each case was positive for eubacterial genome. All patients were treated with fortified antibiotic eye drops, following which keratitis resolved over a 6-week period with scarring. All these patients were on long-term preoperative oral/topical steroids for chronic disorders (chronic vernal keratoconjunctivitis, bronchial asthma, and chronic eczema). Conclusion. The incidence of infectious keratitis after CXL is a rare complication (0.0017%). MXRSA is a potential organism for causing post-CXL keratitis and should be identified early and treated aggressively with fortified antibiotics. Rohit Shetty, Luci Kaweri, Rudy M. M. A. Nuijts, Harsha Nagaraja, Vishal Arora, and Rajesh S. Kumar Copyright © 2014 Rohit Shetty et al. All rights reserved. Accelerated Corneal Collagen Cross-Linking in Pediatric Patients: Two-Year Follow-Up Results Thu, 11 Sep 2014 00:00:00 +0000 Purpose. To evaluate the effectiveness and safety of accelerated corneal collagen cross-linking (ACXL) in patients below 14 years of age with progressive keratoconus. Materials and Methods. Thirty eyes of 18 patients with established progressive keratoconus underwent preoperative and postoperative visual acuity assessment, topography, and specular microscopy prior to ACXL and were followed up for 24 months. Results. Mean age of the patients was 12.7 years with ten males and eight females. There was an improvement in the mean postoperative uncorrected distant visual acuity (from to ; ), mean corrected distant visual acuity (from to ; ), mean spherical refraction (from to ; ), mean cylinder (from to ; ), and spherical equivalent (from to ; ). Three eyes of two patients with vernal keratoconjunctivitis (VKC) showed progression. There were no intra- or postoperative complications. Conclusion. In pediatric patients ACXL is an effective and safe procedure for the management of keratoconus. Optimal management of VKC is important to arrest the progression of keratoconus. Rohit Shetty, Harsha Nagaraja, Chaitra Jayadev, Natasha Kishore Pahuja, Mathew Kurian Kummelil, and Rudy M. M. A. Nuijts Copyright © 2014 Rohit Shetty et al. All rights reserved. Hyperautofluorescence in Outer Retinal Layers Thinning Tue, 09 Sep 2014 13:31:46 +0000 Purpose. To evaluate if paracentral hyperautofluorescence (HAF) retinal regions, which can be occasionally found and analyzed by optical coherence tomography (OCT), were related to retinal layer changes and to detect which layer was involved. Methods. This is a cross-sectional and retrospective study. 648 OCT files were revised. OCTs that showed a paracentral HAF area by using the fundus autofluorescence imaging in Heidelberg Spectralis (Heidelberg Engineering, Germany) were selected. Then retinal layer morphology was analyzed observing OCT scans and a retinal thickness was measured. Results. 31 patients were selected: 20 patients had chronic serous epitheliopathy (CSE), 8 patients had resolved central serous chorioretinopathy (CSC), and 3 patients wet age related macular degeneration (ARMD). The HAF zones corresponded to areas of thickness reduction of the external hyporeflective band. In all these areas the retinal pigment epithelium was not atrophic and the neuroepithelium was more or less dystrophic. In particular the retinal thickness was 264 um, 232 um, and 243 um in wet ARMD, CSE, and CSC, respectively; the reduction was significant () compared to the same area of the other eye. Discussion. The presence of HAF imaging might be mostly due to a “window effect” rather than an accumulation of lipofuscin. Marina Bertolotto, Luigi Borgia, and Michele Iester Copyright © 2014 Marina Bertolotto et al. All rights reserved. Imaging Mass Spectrometry by Matrix-Assisted Laser Desorption/Ionization and Stress-Strain Measurements in Iontophoresis Transepithelial Corneal Collagen Cross-Linking Tue, 02 Sep 2014 12:25:25 +0000 Purpose. To compare biomechanical effect, riboflavin penetration and distribution in transepithelial corneal collagen cross-linking with iontophoresis (I-CXL), with standard cross linking (S-CXL) and current transepithelial protocol (TE-CXL). Materials and Methods. The study was divided into two different sections, considering, respectively, rabbit and human cadaver corneas. In both sections corneas were divided according to imbibition protocols and irradiation power. Imaging mass spectrometry by matrix-assisted laser desorption/ionization (MALDI-IMS) and stress-strain measurements were used. Forty-eight rabbit and twelve human cadaver corneas were evaluated. Results. MALDI-IMS showed a deep riboflavin penetration throughout the corneal layers with I-CXL, with a roughly lower concentration in the deepest layers when compared to S-CXL, whereas with TE-CXL penetration was considerably less. In rabbits, there was a significant increase (by 71.9% and ) in corneal rigidity after I-CXL, when compared to controls. In humans, corneal rigidity increase was not significantly different among the subgroups. Conclusions. In rabbits, I-CXL induced a significant increase in corneal stiffness as well as better riboflavin penetration when compared to controls and TE-CXL but not to S-CXL. Stress-strain in human corneas did not show significant differences among techniques, possibly because of the small sample size of groups. In conclusion, I-CXL could be a valid alternative to S-CXL for riboflavin delivery in CXL, preserving the epithelium. Paolo Vinciguerra, Rita Mencucci, Vito Romano, Eberhard Spoerl, Fabrizio I. Camesasca, Eleonora Favuzza, Claudio Azzolini, Rodolfo Mastropasqua, and Riccardo Vinciguerra Copyright © 2014 Paolo Vinciguerra et al. All rights reserved. Etiopathogenesis and Therapy of Epithelial Ingrowth after Descemet’s Stripping Automated Endothelial Keratoplasty Tue, 02 Sep 2014 06:03:52 +0000 Descemet’s stripping endothelial keratoplasty is an emerging technique finalized to treat endothelial dysfunction replacing only the pathological portion of cornea. The advent of any new technique puts us in front of new complications. The epithelial ingrowth is a well-known complication already studied in case of ocular trauma and more recently in refractive surgery. This job analyzed the potential etiopathogenesis of epithelial ingrowth after DSAEK, reviewing the cases described in literature, and suggests the potential therapy. Francesco Semeraro, Attilio Di Salvatore, Alessandro Bova, and Eliana Forbice Copyright © 2014 Francesco Semeraro et al. All rights reserved. Vitreous Substitutes: From Tamponade Effect to Intraocular Inflammation Mon, 01 Sep 2014 09:57:14 +0000 Mario R. Romano, Xun Xu, and Kenneth K. W. Li Copyright © 2014 Mario R. Romano et al. All rights reserved. Evaluation of Corneal Biomechanical Properties Modification after Small Incision Lenticule Extraction Using Scheimpflug-Based Noncontact Tonometer Sun, 31 Aug 2014 00:00:00 +0000 Purpose. To quantify the effect of small incision lenticule extraction (SMILE) on the corneal biomechanics using Scheimpflug noncontact tonometer (Corvis ST). Methods. Twenty eyes of twenty patients, evaluated as eligible for surgery, with high myopia and/or moderate myopic astigmatism, underwent small incision lenticule extraction (SMILE). All patients underwent Corvis ST preoperatively and postoperatively after 1 week, and 1 and 3 months to observe alterations of corneal biomechanical properties. The main outcome measures were Deformation Amplitude, 1st-AT, and 2nd-AT. The relationship between the amount of stroma removed and the percentage variation of the measured parameters from baseline was evaluated with generalized linear model from each time point. For completeness also intraocular pressure (IOP), central corneal thickness (CCT), and their variations after surgery were evaluated. Results. The ratio between the amount of removed refractive error and, respectively, changes of Deformation Amplitude, 1st-AT, and 2nd-AT were significantly modified at the 1st week after surgery . At 1 and 3 months these values did not show statistically significant alterations. Intraocular pressure and central corneal thickness showed statistically significant changes during follow-up. Conclusions. No significant modifications in biomechanical properties were observed after SMILE so this procedure could induce only minimal transient alterations of corneal biomechanics. Leonardo Mastropasqua, Roberta Calienno, Manuela Lanzini, Martina Colasante, Alessandra Mastropasqua, Peter A. Mattei, and Mario Nubile Copyright © 2014 Leonardo Mastropasqua et al. All rights reserved. Descemetic and Predescemetic DALK in Keratoconus Patients: A Clinical and Confocal Perspective Study Tue, 26 Aug 2014 12:35:22 +0000 Purpose. To evaluate the clinical outcomes and in vivo confocal microscopy (IVCM) features of keratoconus patients who underwent deep anterior lamellar keratoplasty (DALK). Methods. DALK was performed using the big bubble technique in all the patients. If the bubble was not successful to bare the descemet membrane, a manual dissection layer-by layer was performed to expose a deep stromal plane close to the DM. The patients were divided in two groups depending on the intraoperative baring of the descemet membrane: predescemetic DALK (PD-DALK) and descemetic DALK (D-DALK) group. Results. One month after surgery the D-DALK patients show an increase of mean BCVA. In the PD-DALK group mean BCVA did not show significant improvement as compared to preoperative values. At 6 months after surgery mean BCVA was found to be similar in both groups. At 1 month IVCM the peak of reflectivity of the interface was lower in D-DALK group compared to PD-DALK. At 6 months the values of reflectivity were comparable. Conclusions. At 1 month D-DALK seems to lead to a minor interface reflectivity and to a better BCVA; these differences disappear after 6 months and the values of interface reflectivity and BCVA are comparable between D-DALK and PD-DALK. Domenico Schiano-Lomoriello, Rossella Annamaria Colabelli-Gisoldi, Mario Nubile, Francesco Oddone, Giorgio Ducoli, Carlo Maria Villani, Leonardo Mastropasqua, and Augusto Pocobelli Copyright © 2014 Domenico Schiano-Lomoriello et al. All rights reserved. Corneal Collagen Cross-Linking with Hypoosmolar Riboflavin Solution in Keratoconic Corneas Thu, 14 Aug 2014 11:12:56 +0000 Purpose. To report the 12-month outcomes of corneal collagen cross-linking (CXL) with a hypoosmolar riboflavin and ultraviolet-A (UVA) irradiation in thin corneas. Methods. Eight eyes underwent CXL using a hypoosmolar riboflavin solution after epithelial removal. The corrected distance visual acuity (CDVA), manifest refraction, the mean thinnest corneal thickness (MTCT), and the endothelial cell density (ECD) were evaluated before and 6 and 12 months after CXL. Results. The MTCT was 413.9 ± 12.4 μm before treatment and reduced to 381.1 ± 7.3 μm after the removal of the epithelium. After CXL, the thickness decreased to 410.3 ± 14.5 μm at the last follow-up. Before treatment, the mean K-value of the apex of the keratoconus corneas was 58.7 ± 3.5 diopters and slightly decreased (57.7 ± 4.9 diopters) at 12 months. The mean CDVA was 0.54 ± 0.23 logarithm of the minimal angle of resolution before treatment and increased to 0.51 ± 0.21 logarithm at the last follow-up. The ECD was 2731.4 ± 191.8 cells/mm2 before treatment and was 2733.4 ± 222.6 cells/mm2 at 12 months after treatment. Conclusions. CXL with a hypoosmolar riboflavin in thin corneas seems to be a promising method for keratoconic eyes with the mean thinnest corneal thickness less than 400 μm without epithelium. Shaofeng Gu, Zhaoshan Fan, Lihua Wang, Xiangchen Tao, Yong Zhang, and Guoying Mu Copyright © 2014 Shaofeng Gu et al. All rights reserved. Pattern Visual Evoked Potentials Elicited by Organic Electroluminescence Screen Thu, 14 Aug 2014 00:00:00 +0000 Purpose. To determine whether organic electroluminescence (OLED) screens can be used as visual stimulators to elicit pattern-reversal visual evoked potentials (p-VEPs). Method. Checkerboard patterns were generated on a conventional cathode-ray tube (S710, Compaq Computer Co., USA) screen and on an OLED (17 inches, 320 × 230 mm, PVM-1741, Sony, Tokyo, Japan) screen. The time course of the luminance changes of each monitor was measured with a photodiode. The p-VEPs elicited by these two screens were recorded from 15 eyes of 9 healthy volunteers (22.0 ± 0.8 years). Results. The OLED screen had a constant time delay from the onset of the trigger signal to the start of the luminescence change. The delay during the reversal phase from black to white for the pattern was 1.0 msec on the cathode-ray tube (CRT) screen and 0.5 msec on the OLED screen. No significant differences in the amplitudes of P100 and the implicit times of N75 and P100 were observed in the p-VEPs elicited by the CRT and the OLED screens. Conclusion. The OLED screen can be used as a visual stimulator to elicit p-VEPs; however the time delay and the specific properties in the luminance change must be taken into account. Celso Soiti Matsumoto, Kei Shinoda, Harue Matsumoto, Hideaki Funada, Kakeru Sasaki, Haruka Minoda, Takeshi Iwata, and Atsushi Mizota Copyright © 2014 Celso Soiti Matsumoto et al. All rights reserved. Corneal Epithelial Wound Healing Promoted by Verbascoside-Based Liposomal Eyedrops Wed, 06 Aug 2014 09:36:40 +0000 Different liposomal formulations were prepared to identify those capable of forming eyedrops for corneal diseases. Liposomes with neutral or slightly positive surface charge interact very well with the cornea. Then these formulations were loaded with verbascoside to heal a burn of corneal epithelium induced by alkali. The cornea surface affected involved in wound was monitored as a function of time. Experimental results were modeled by balance equation between the rate of healing, due to the flow of phenylpropanoid, and growth of the wound. The results indicate a latency time of only three hours and furthermore the corneal epithelium heals in 48 hours. Thus, the topical administration of verbascoside appears to reduce the action time of cells, as verified by histochemical and immunofluorescence assays. Luigi Ambrosone, Germano Guerra, Mariapia Cinelli, Mariaelena Filippelli, Monica Mosca, Francesco Vizzarri, Dario Giorgio, and Ciro Costagliola Copyright © 2014 Luigi Ambrosone et al. All rights reserved. Oxidative Stress Induces Endothelial Cell Senescence via Downregulation of Sirt6 Tue, 05 Aug 2014 11:02:45 +0000 Accumulating evidence has shown that diabetes accelerates aging and endothelial cell senescence is involved in the pathogenesis of diabetic vascular complications, including diabetic retinopathy. Oxidative stress is recognized as a key factor in the induction of endothelial senescence and diabetic retinopathy. However, specific mechanisms involved in oxidative stress-induced endothelial senescence have not been elucidated. We hypothesized that Sirt6, which is a nuclear, chromatin-bound protein critically involved in many pathophysiologic processes such as aging and inflammation, may have a role in oxidative stress-induced vascular cell senescence. Measurement of Sirt6 expression in human endothelial cells revealed that H2O2 treatment significantly reduced Sirt6 protein. The loss of Sirt6 was associated with an induction of a senescence phenotype in endothelial cells, including decreased cell growth, proliferation and angiogenic ability, and increased expression of senescence-associated -galactosidase activity. Additionally, H2O2 treatment reduced eNOS expression, enhanced p21 expression, and dephosphorylated (activated) retinoblastoma (Rb) protein. All of these alternations were attenuated by overexpression of Sirt6, while partial knockdown of Sirt6 expression by siRNA mimicked the effect of H2O2. In conclusion, these results suggest that Sirt6 is a critical regulator of endothelial senescence and oxidative stress-induced downregulation of Sirt6 is likely involved in the pathogenesis of diabetic retinopathy. Rong Liu, Hua Liu, Yonju Ha, Ronald G. Tilton, and Wenbo Zhang Copyright © 2014 Rong Liu et al. All rights reserved. Mechanical Models of the Dynamics of Vitreous Substitutes Thu, 24 Jul 2014 10:05:40 +0000 We discuss some aspects of the fluid dynamics of vitreous substitutes in the vitreous chamber, focussing on the flow induced by rotations of the eye bulb. We use simple, yet not trivial, theoretical models to highlight mechanical concepts that are relevant to understand the dynamics of vitreous substitutes and also to identify ideal properties for vitreous replacement fluids. We first recall results by previous authors, showing that the maximum shear stress on the retina grows with increasing viscosity of the fluid up to a saturation value. We then investigate how the wall shear stress changes if a thin layer of aqueous humour is present in the vitreous chamber, separating the retina from the vitreous replacement fluid. The theoretical predictions show that the existence of a thin layer of aqueous is sufficient to substantially decrease the shear stress on the retina. We finally discuss a theoretical model that predicts the stability conditions of the interface between the aqueous and a vitreous substitute. We discuss the implications of this model to understand the mechanisms leading to the formation of emulsion in the vitreous chamber, showing that instability of the interface is possible in a range of parameters relevant for the human eye. Krystyna Isakova, Jan O. Pralits, Rodolfo Repetto, and Mario R. Romano Copyright © 2014 Krystyna Isakova et al. All rights reserved. Evaluation of the Efficacy of 50% Autologous Serum Eye Drops in Different Ocular Surface Pathologies Tue, 22 Jul 2014 11:19:38 +0000 Purpose. This study evaluated the efficacy of 50% autologous serum eye drops in ocular surface diseases not improved by conventional therapy. Methods. We analyzed two groups: (1) acute eye pathologies (e.g., chemical burns) and (2) chronic eye pathologies (e.g., recurrent corneal erosion, neurotropic keratitis, and keratoconjunctivitis sicca). The patients were treated for surface instability after conventional therapy. The patients received therapy 5 times a day until stabilization of the framework; they then reduced therapy to 3 times a day for at least 3 months. We analyzed the best corrected visual acuity, epithelial defects, inflammation, corneal opacity, and corneal neovascularization. We also analyzed symptoms such as tearing, burning, sense of foreign body or sand, photophobia, blurred vision, and difficulty opening the eyelids. Results. We enrolled 15 eyes in group 1 and 11 eyes in group 2. The average therapy period was 16 ± 5.86 weeks in group 1 and 30.54 ± 20.33 weeks in group 2. The epithelial defects all resolved. Signs and symptoms improved in both groups. In group 2, the defect recurred after the suspension of therapy in 2 (18%) patients; in group 1, no defects recurred. Conclusions. Autologous serum eye drops effectively stabilize and improve signs and symptoms in eyes previously treated with conventional therapy. Francesco Semeraro, Eliana Forbice, Osvaldo Braga, Alessandro Bova, Attilio Di Salvatore, and Claudio Azzolini Copyright © 2014 Francesco Semeraro et al. All rights reserved. IOL Power Calculation after Corneal Refractive Surgery Mon, 21 Jul 2014 07:11:06 +0000 Purpose. To describe the different formulas that try to overcome the problem of calculating the intraocular lens (IOL) power in patients that underwent corneal refractive surgery (CRS). Methods. A Pubmed literature search review of all published articles, on keyword associated with IOL power calculation and corneal refractive surgery, as well as the reference lists of retrieved articles, was performed. Results. A total of 33 peer reviewed articles dealing with methods that try to overcome the problem of calculating the IOL power in patients that underwent CRS were found. According to the information needed to try to overcome this problem, the methods were divided in two main categories: 18 methods were based on the knowledge of the patient clinical history and 15 methods that do not require such knowledge. The first group was further divided into five subgroups based on the parameters needed to make such calculation. Conclusion. In the light of our findings, to avoid postoperative nasty surprises, we suggest using only those methods that have shown good results in a large number of patients, possibly by averaging the results obtained with these methods. Maddalena De Bernardo, Luigi Capasso, Luisa Caliendo, Francesco Paolercio, and Nicola Rosa Copyright © 2014 Maddalena De Bernardo et al. All rights reserved. Anterior Segment Optical Coherence Tomography Imaging of Conjunctival Filtering Blebs after Glaucoma Surgery Sun, 20 Jul 2014 09:09:07 +0000 Time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) are cross-sectional, noncontact, high-resolution diagnostic modalities for posterior and anterior segment (AS) imaging. The AS-OCT provides tomographic imaging of the cornea, iris, lens, and anterior chamber (AC) angle in several ophthalmic diseases. In glaucoma, AS-OCT is utilized to evaluate the morphology of AS structures involved in the pathogenesis of the disease, to obtain morphometric measures of the AC, to evaluate the suitability for laser or surgical approaches, and to assess modifications after treatment. In patients undergoing surgery, AS-OCT is crucial in the evaluation of the filtering bleb functionality, permitting a combined qualitative and quantitative analysis. In this field, AS-OCT may help clinicians in distinguishing between functioning and nonfunctioning blebs by classifying their macroscopic morphology, describing bleb-wall features, bleb cavity, and scleral opening. This information is critical in recognizing signs of filtration failure earlier than the clinical approach and in planning the appropriate timing for management procedures in failing blebs. In this review, we summarize the applications of AS-OCT in the conjunctival bleb assessment. Rodolfo Mastropasqua, Vincenzo Fasanella, Luca Agnifili, Claudia Curcio, Marco Ciancaglini, and Leonardo Mastropasqua Copyright © 2014 Rodolfo Mastropasqua et al. All rights reserved. Cystic Fibrosis and New Trends by Ophthalmological Evaluation: A Pilot Study Tue, 15 Jul 2014 12:54:40 +0000 Background. Cystic fibrosis (CF) is characterized by hypoxia that affects several organic tissues. Retinal ganglion cells may suffer from the hypoxic status, and this may lead to alterations of retinal nerve fiber. Methods. Twenty-two eyes in CF patients were analyzed. A complete ocular evaluation and visual field exams of the 30 central degrees were performed using the frequency doubling technology (FDT). Forced expiratory volume in one second (FEV1%), forced vital capacity (FVC%), oxyhaemoglobin saturation (SpO2%), and hematocrit (Ht%) have been calculated. FDT analyzed parameters were mean deviation (MD) and pattern standard deviation (PSD). Pearson’s correlation was chosen as statistical analysis. Results. Data showed statistically significant relationship between MD and Ht% ( value −0.18; ), MD and FEV1% ( value −0.68; ), and MD and FVC% ( value −0.45; ). Moreover, there were correlations between PSD and Ht% ( value 0.29; ), PSD and SpO2% ( value −0.31; ), PSD and FEV1% ( value 0.71; ), and PSD and FVC% ( value 0.63; ). Conclusions. The oxygen supply alterations might determine hypoxia of the ganglion cells causing a decrease of receptive optic nerve fiber activity. This method could be also useful to evaluate indirectly pulmonary activity of the CF disease. Marcella Nebbioso, Serena Quattrucci, Emanuela Leggieri, Leopoldo Spadea, and Enzo Maria Vingolo Copyright © 2014 Marcella Nebbioso et al. All rights reserved. Some Physicochemical Remarks on Spontaneous Emulsification of Vitreal Tamponades Tue, 15 Jul 2014 07:07:15 +0000 The importance of gravitational instability in determining the emulsification of vitreal tamponades is discussed. Theoretical results and numerical simulations indicate that the spontaneous formation of water-silicon oil is a rare event and that the very low concentration of surface active agents cannot justify the systematic formation of emulsions. The gravitational instabilities seem to play the main role. Our theoretical results seem in agreement with the experimental evidences; furthermore they indicate a future research line for the improvement of endotamponades. Indeed, the use of biodegradable antifoam may avoid the formation of bubbles and delay the formation of emulsions. Ciro Costagliola, Francesco Semeraro, Roberto dell’Omo, Lucio Zeppa, Gennaro Bufalo, Michele Cardone, Mario Romano, and Luigi Ambrosone Copyright © 2014 Ciro Costagliola et al. All rights reserved. Comparative Study of Corneal Endothelial Cell Damage after Femtosecond Laser Assisted Deep Stromal Dissection Thu, 10 Jul 2014 07:36:46 +0000 Purpose. To find a relatively safe designed stromal bed thickness to avoid endothelial damage for lamellar keratoplasty with an Allegretto Wavelight FS200 femtosecond laser. Methods. Twelve rabbits were randomly divided into 50 μm and 150 μm groups according to the anticipated residue stromal bed thickness preparation with a femtosecond laser. Six rabbits without laser cutting were used as a control group. Central endothelial images were analyzed with in vivo confocal microscopy and scanning electron microscopy. The apoptosis of endothelium was evaluated with Hoechst 33342 staining and a TUNEL assay. Results. The endothelium of the 50 μm group had extensive injuries upon in vivo confocal and scanning electron microscopic observation, and minor injuries were observed in the 150 μm group. Moreover, more apoptotic cells were observed in the 50 μm group. Conclusions. When using a FS200 femtosecond laser assisted anterior lamellar keratoplasty, there was minor endothelium damage with a 150 μm stromal bed, and a more than 150 μm thickness stromal bed design may prevent the damage of corneal endothelium. Ting Liu, Jingjing Zhang, Dapeng Sun, Wenjie Sui, Yangyang Zhang, Dongfang Li, Zhaoli Chen, and Hua Gao Copyright © 2014 Ting Liu et al. All rights reserved. Caspase-14 Expression Impairs Retinal Pigment Epithelium Barrier Function: Potential Role in Diabetic Macular Edema Wed, 09 Jul 2014 11:14:33 +0000 We recently showed that caspase-14 is a novel molecule in retina with potential role in accelerated vascular cell death during diabetic retinopathy (DR). Here, we evaluated whether caspase-14 is implicated in retinal pigment epithelial cells (RPE) dysfunction under hyperglycemia. The impact of high glucose (HG, 30 mM D-glucose) on caspase-14 expression in human RPE (ARPE-19) cells was tested, which showed significant increase in caspase-14 expression compared with normal glucose (5 mM D-glucose + 25 mM L-glucose). We also evaluated the impact of modulating caspase-14 expression on RPE cells barrier function, phagocytosis, and activation of other caspases using ARPE-19 cells transfected with caspase-14 plasmid or caspase-14 siRNA. We used FITC-dextran flux assay and electric cell substrate impedance sensing (ECIS) to test the changes in RPE cell barrier function. Similar to HG, caspase-14 expression in ARPE-19 cells increased FITC-dextran leakage through the confluent monolayer and decreased the transcellular electrical resistance (TER). These effects of HG were prevented by caspase-14 knockdown. Furthermore, caspase-14 knockdown prevented the HG-induced activation of caspase-1 and caspase-9, the only activated caspases by HG. Phagocytic activity was unaffected by caspase-14 expression. Our results suggest that caspase-14 contributes to RPE cell barrier disruption under hyperglycemic conditions and thus plays a role in the development of diabetic macular edema. Selina Beasley, Mohamed El-Sherbiny, Sylvia Megyerdi, Sally El-Shafey, Karishma Choksi, Ismail Kaddour-Djebbar, Nader Sheibani, Stephen Hsu, and Mohamed Al-Shabrawey Copyright © 2014 Selina Beasley et al. All rights reserved. Heavy Silicone Oil and Intraocular Inflammation Tue, 08 Jul 2014 05:53:54 +0000 In the past two decades, many advances have been made in vitrectomy instrumentation, surgical techniques, and the use of different tamponade agents. These agents serve close retinal breaks, confine eventual retinal redetachment, and prevent proliferative vitreoretinopathy (PVR). Long-acting gases and silicone oil are effective internal tamponade agents; however, because their specific gravity is lower than that of the vitreous fluid, they may provide adequate support for the superior retina but lack efficacy for the inferior retina, especially when the fill is subtotal. Thus, a specific role may exist for an internal tamponade agent with a higher specific gravity, such as heavy silicone oils (HSOs), Densiron 68, Oxane HD, HWS 45-300, HWS 46-3000, and HeavySil. Some clinical evidence seems to presume that heavy tamponades are more prone to intraocular inflammation than standard silicone if they remain in the eye for several months. In this review, we discuss the fundamental clinical and biochemical/molecular mechanisms involved in the inflammatory response after the use of heavy tamponade: toxicity due to impurities or instability of the agent, direct toxicity and immunogenicity, oil emulsification, and mechanical injury due to gravity. The physical and chemical properties of various HSOs and their efficacy and safety profiles are also described. Francesco Morescalchi, Ciro Costagliola, Sarah Duse, Elena Gambicorti, Barbara Parolini, Barbara Arcidiacono, Mario R. Romano, and Francesco Semeraro Copyright © 2014 Francesco Morescalchi et al. All rights reserved. Evaluation of Macular Retinal Ganglion Cell-Inner Plexiform Layer Thickness after Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Macular Holes Mon, 07 Jul 2014 09:05:28 +0000 Purpose. To evaluate macular retinal ganglion cell-inner plexiform layer (GCIPL) thickness changes after Brilliant Blue G-assisted internal limiting membrane peeling for idiopathic macular hole repair using a high-resolution spectral-domain optical coherence tomography (SD-OCT). Methods. 32 eyes from 32 patients with idiopathic macular holes who underwent vitrectomy with internal limiting membrane peeling between January 2011 and July 2012 were retrospectively analyzed. GCIPL thickness was measured before surgery, and at one month and at six months after surgery. Values obtained from automated and semimanual SD-OCT segmentation analysis were compared (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA). Results. No significant differences were found between average GCIPL thickness values between preoperative and postoperative analysis. However, statistical significant differences were found in GCIPL thickness at the temporal macular quadrants at six months after surgery. Quality measurement analysis performed by automated segmentation revealed a significant number of segmentation errors. Semimanual segmentation slightly improved the quality of the results. Conclusion. SD-OCT analysis of GCIPL thickness found a significant reduction at the temporal macular quadrants at 6 months after Brilliant Blue G-assisted internal limiting membrane peeling for idiopathic macular hole. Alfonso L. Sabater, Álvaro Velázquez-Villoria, Miguel A. Zapata, Marta S. Figueroa, Marta Suárez-Leoz, Luis Arrevola, María-Ángeles Teijeiro, and Alfredo García-Layana Copyright © 2014 Alfonso L. Sabater et al. All rights reserved. Comparison of Reaction Response Time between Hand and Foot Controlled Devices in Simulated Microsurgical Testing Sun, 06 Jul 2014 08:15:12 +0000 Purpose. We hypothesized that reaction times (RTs) for a switch release are faster for hand-controlled than for foot-controlled switches for physiological and anatomical reasons (e.g., nerve conduction speed). The risk of accidental trauma could be reduced if the surgeon reacted quicker and therefore improve the surgical outcome. Method. We included 47 medical professionals at USC. Demographics and handedness were recorded. Under a microscope, a simple reaction time test was performed, testing all extremities multiple times in a random order. Additionally, a subjective questionnaire was administered. Results. The mean RTs for hands are 318.24 ms 51.13 and feet . The comparison of hand versus foot showed significant shorter RTs for the hand (). Partially significant differences between and within the experience level groups could be demonstrated by level of education (LE) and microscopic surgeries/week (MSW) (). In the subjective questionnaire, 91.5% () of test subjects prefer to use hand controls. Conclusion. Our data show that the RT for hands is faster than feet. Similarly the subjective questionnaire showed a greater preference for hand actuation. This data suggest a hand-controlled ophthalmic instrument might have distinct advantages; however, clinical correlation is required. Marcel Pfister, Jaw-Chyng L. Lue, Francisco R. Stefanini, Paulo Falabella, Laurie Dustin, Michael J. Koss, and Mark S. Humayun Copyright © 2014 Marcel Pfister et al. All rights reserved. Assessment of the Optic Disc Morphology Using Spectral-Domain Optical Coherence Tomography and Scanning Laser Ophthalmoscopy Sun, 06 Jul 2014 06:11:08 +0000 Objective. To compare the equivalent optic nerve head (OHN) parameters obtained with confocal scanning laser ophthalmoscopy (HRT3) and spectral-domain optical coherence tomography (OCT) in healthy and glaucoma patients. Methods. One hundred and eighty-two consecutive healthy subjects and 156 patients with open-angle glaucoma were divided into 2 groups according to intraocular pressure and visual field outcomes. All participants underwent imaging of the ONH with the HRT3 and the Cirrus OCT. The ONH parameters and the receiver operating characteristic (ROC) curves were compared between both groups. Results. Mean age did not differ between the normal and glaucoma groups (59.55 ± 9.7 years and 61.05 ± 9.4 years, resp.; ). Rim area, average cup-to-disc (C/D) ratio, vertical C/D ratio, and cup volume were different between both instruments (). All equivalent ONH parameters, except disc area, were different between both groups (). The best areas under the ROC curve were observed for vertical C/D ratio (0.980 for OCT and 0.942 for HRT3; ). Sensitivities at 95% fixed-specificities of OCT parameters were higher than those of HRT3. Conclusions. Equivalent ONH parameters of Cirrus OCT and HRT3 are different and cannot be used interchangeably. ONH parameters measured with OCT yielded a slightly better diagnostic performance. Pilar Calvo, Antonio Ferreras, Beatriz Abadia, Mirian Ara, Michele Figus, Luis E. Pablo, and Paolo Frezzotti Copyright © 2014 Pilar Calvo et al. All rights reserved. Molecular Mechanisms of Diabetic Retinopathy, General Preventive Strategies, and Novel Therapeutic Targets Sun, 06 Jul 2014 00:00:00 +0000 The growing number of people with diabetes worldwide suggests that diabetic retinopathy (DR) and diabetic macular edema (DME) will continue to be sight threatening factors. The pathogenesis of diabetic retinopathy is a widespread cause of visual impairment in the world and a range of hyperglycemia-linked pathways have been implicated in the initiation and progression of this condition. Despite understanding the polyol pathway flux, activation of protein kinase C (KPC) isoforms, increased hexosamine pathway flux, and increased advanced glycation end-product (AGE) formation, pathogenic mechanisms underlying diabetes induced vision loss are not fully understood. The purpose of this paper is to review molecular mechanisms that regulate cell survival and apoptosis of retinal cells and discuss new and exciting therapeutic targets with comparison to the old and inefficient preventive strategies. This review highlights the recent advancements in understanding hyperglycemia-induced biochemical and molecular alterations, systemic metabolic factors, and aberrant activation of signaling cascades that ultimately lead to activation of a number of transcription factors causing functional and structural damage to retinal cells. It also reviews the established interventions and emerging molecular targets to avert diabetic retinopathy and its associated risk factors. Sher Zaman Safi, Rajes Qvist, Selva Kumar, Kalaivani Batumalaie, and Ikram Shah Bin Ismail Copyright © 2014 Sher Zaman Safi et al. All rights reserved. Nutritional Risk Factors for Age-Related Macular Degeneration Thu, 03 Jul 2014 00:00:00 +0000 Purpose. To evaluate the role of nutritional factors, serum lipids, and lipoproteins in late age-related macular degeneration (late AMD). Methods. Intake of red meat, fruit, fish, vegetables, and alcohol, smoking status, and body mass index (BMI) were ascertained questionnaire-based in 1147 late AMD cases and 1773 controls from the European Genetic Database. Serum levels of lipids and lipoproteins were determined. The relationship between nutritional factors and late AMD was assessed using logistic regression. Based on multivariate analysis, area-under-the-curve (AUC) was calculated by receiver-operating-characteristics (ROC). Results. In a multivariate analysis, besides age and smoking, obesity (odds ratio (OR): 1.44, ) and red meat intake (daily: OR: 2.34, ; 2–6x/week: OR: 1.67, ) were identified as risk factors for developing late AMD. Fruit intake showed a protective effect (daily: OR: 0.52, ; 2–6x/week: OR: 0.58, ). Serum lipid and lipoprotein levels showed no significant association with late AMD. ROC for nutritional factors, smoking, age, and BMI revealed an AUC of 0.781. Conclusion. Red meat intake and obesity were independently associated with increased risk for late AMD, whereas fruit intake was protective. A better understanding of nutritional risk factors is necessary for the prevention of AMD. Lebriz Ersoy, Tina Ristau, Yara T. Lechanteur, Moritz Hahn, Carel B. Hoyng, Bernd Kirchhof, Anneke I. den Hollander, and Sascha Fauser Copyright © 2014 Lebriz Ersoy et al. All rights reserved. Tamponade or Filling Effect: Changes of Forces in Myopic Eyes Wed, 02 Jul 2014 07:41:45 +0000 Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye. Francesco Semeraro, Francesco Morescalchi, Andrea Russo, Mario R. Romano, and Ciro Costagliola Copyright © 2014 Francesco Semeraro et al. All rights reserved. Predictive Factors Affecting the Short Term and Long Term Exodrift in Patients with Intermittent Exotropia after Bilateral Rectus Muscle Recession and Its Effect on Surgical Outcome Wed, 02 Jul 2014 00:00:00 +0000 Purpose. To determine the predictive factors that affect short term and long term postoperative drift in intermittent exotropia after bilateral lateral rectus recession and to evaluate its effect on surgical outcome. Methods. Retrospective review of 203 patients with diagnosis of intermittent exotropia, who had surgical corrections with more than 3 years of followup. Different preoperative parameters were obtained and evaluated using Pearson’s correlation analysis. Results. The proportion of exodrift increased from 62% at 6 weeks to 84% at 3 years postoperatively. The postoperative drift was  PD at 6 weeks,  PD at 6 months,  PD at 1 year,  PD at 2 years, and  PD at 3 years. Preoperative deviation and initial overcorrection were significant factors affecting the postoperative drift at 3 years (, , , and , resp.). Conclusions. Postoperative exodrift along three years occurs in a majority of patients after bilateral lateral rectus recession for intermittent exotropia. The long term surgical success is significantly affected by this postoperative exodrift. A larger preoperative deviation and a larger initial overcorrection are associated with a larger early and late postoperative exodrift. Jason C. S. Yam, Gabriela S. L. Chong, Patrick K. W. Wu, Ursula S. F. Wong, Clement W. N. Chan, and Simon T. C. Ko Copyright © 2014 Jason C. S. Yam et al. All rights reserved. Advance in ERG Analysis: From Peak Time and Amplitude to Frequency, Power, and Energy Tue, 01 Jul 2014 10:22:04 +0000 Purpose. To compare time domain (TD: peak time and amplitude) analysis of the human photopic electroretinogram (ERG) with measures obtained in the frequency domain (Fourier analysis: FA) and in the time-frequency domain (continuous (CWT) and discrete (DWT) wavelet transforms). Methods. Normal ERGs were analyzed using traditional peak time and amplitude measurements of the a- and b-waves in the TD and descriptors extracted from FA, CWT, and DWT. Selected descriptors were also compared in their ability to monitor the long-term consequences of disease process. Results. Each method extracted relevant information but had distinct limitations (i.e., temporal and frequency resolutions). The DWT offered the best compromise by allowing us to extract more relevant descriptors of the ERG signal at the cost of lesser temporal and frequency resolutions. Follow-ups of disease progression were more prolonged with the DWT (max 29 years compared to 13 with TD). Conclusions. Standardized time domain analysis of retinal function should be complemented with advanced DWT descriptors of the ERG. This method should allow more sensitive/specific quantifications of ERG responses, facilitate follow-up of disease progression, and identify diagnostically significant changes of ERG waveforms that are not resolved when the analysis is only limited to time domain measurements. Mathieu Gauvin, Jean-Marc Lina, and Pierre Lachapelle Copyright © 2014 Mathieu Gauvin et al. All rights reserved. Dose-Response-Relationship between Number of Laser Burns and IOP Reduction in Cyclophotocoagulation: An Animal Study Sun, 29 Jun 2014 00:00:00 +0000 Purpose. The relationship between number of laser burns of cyclophotocoagulation (CPC) and intraocular pressure (IOP) reduction is unknown. This animal model was established to reveal a possible dose-response-relationship between the number of applied laser burns and the IOP lowering effect. Methods. 30 chinchilla bastard rabbits were divided into 5 groups and treated with either 1, 5, 10, 20, or 30 CPC burns, respectively. IOP was followed up for 1 week. IOP reduction of a single 30-burn treatment was compared with a fractionated treatment (three sessions; one week in between; 10 burns/session). Results. IOP reduction increases nonlinearly with the number of CPC burns (max.  mmHg). Fractionated treatment shows similar IOP reduction with less complications and more constant results compared to single session treatment. Conclusions. The study reveals a complex relationship between IOP reduction and the number of CPC burns. Fractionated CPC gives comparable IOP reduction at a higher degree of safety. Lars Wagenfeld, Hendrik Schwarzer, Gernot Roessler, Maren Klemm, Christos Skevas, Gisbert Richard, and Oliver Zeitz Copyright © 2014 Lars Wagenfeld et al. All rights reserved. Evaluation of Corneal Deformation Analyzed with Scheimpflug Based Device in Healthy Eyes and Diseased Ones Mon, 23 Jun 2014 12:55:04 +0000 This study was designed to evaluate the correlation between corneal biomechanical and morphological data in healthy eyes, eyes that underwent myopic photorefractive keratectomy (PRK), keratoconus affected eyes, and keratoconus affected eyes that underwent corneal collagen crosslinking (CCC). Complete clinical eye examination of all eyes was followed by tomographic (Pentacam, Oculus, Wetzlar, Germany) and biomechanical (Corvis ST, Oculus, Wetzlar, Germany) evaluation. Differences among Corvis ST (CST) parameters in the different groups have been performed. Linear regression between central corneal thickness (CCT), intraocular pressure (IOP), and anterior corneal curvature measured with Sim’K (KM), versus corneal deformation parameters measured with Corvis ST in the different groups, has been run using SPSS software version 18.0. We evaluated 64 healthy eyes of 64 patients with a mean refractive error of  D (measured as spherical equivalent), 17 eyes of 17 patients that underwent myopic PRK for a mean refractive defect of  D (measured as spherical equivalent), 16 eyes of 16 patients affected by keratconus (stage 2-3 of Amsler Classification), and 13 eyes of 13 patients affected by keratoconus that underwent CCC. Our data suggest that corneal curvature would have a greater influence on corneal deformation than CCT; in fact KM values are more strongly associated with more CST parameters both about corneal change in shape and both about the corneal ability to come back at original shape. Michele Lanza, Michela Cennamo, Stefania Iaccarino, Carlo Irregolare, Miguel Rechichi, Mario Bifani, and Ugo Antonello Gironi Carnevale Copyright © 2014 Michele Lanza et al. All rights reserved. Testing of Visual Field with Virtual Reality Goggles in Manual and Visual Grasp Modes Mon, 23 Jun 2014 07:57:19 +0000 Automated perimetry is used for the assessment of visual function in a variety of ophthalmic and neurologic diseases. We report development and clinical testing of a compact, head-mounted, and eye-tracking perimeter (VirtualEye) that provides a more comfortable test environment than the standard instrumentation. VirtualEye performs the equivalent of a full threshold 24-2 visual field in two modes: (1) manual, with patient response registered with a mouse click, and (2) visual grasp, where the eye tracker senses change in gaze direction as evidence of target acquisition. 59 patients successfully completed the test in manual mode and 40 in visual grasp mode, with 59 undergoing the standard Humphrey field analyzer (HFA) testing. Large visual field defects were reliably detected by VirtualEye. Point-by-point comparison between the results obtained with the different modalities indicates: (1) minimal systematic differences between measurements taken in visual grasp and manual modes, (2) the average standard deviation of the difference distributions of about 5 dB, and (3) a systematic shift (of 4–6 dB) to lower sensitivities for VirtualEye device, observed mostly in high dB range. The usability survey suggested patients’ acceptance of the head-mounted device. The study appears to validate the concepts of a head-mounted perimeter and the visual grasp mode. Dariusz Wroblewski, Brian A. Francis, Alfredo Sadun, Ghazal Vakili, and Vikas Chopra Copyright © 2014 Dariusz Wroblewski et al. All rights reserved. Corneal Collagen Cross-Linking with and without Epithelial Removal: A Contralateral Study with 0.5% Hypotonic Riboflavin Solution Sun, 22 Jun 2014 13:15:55 +0000 Purpose. Our main purpose was to compare safety and efficacy in the treatment of progressive keratoconus with “epithelium-on” and “epithelium-off” corneal collagen cross-linking (CXL). Our secondary purpose was to evaluate efficacy of CXL when hypotonic 0.5% riboflavin is used as photosensitizer. Methods. One eye of 20 patients with bilateral progressive keratoconus was randomly treated for “epithelium-on” CXL (group 1) while the fellow eye underwent “epithelium-off” CXL (group 2). Hypotonic 0.5% riboflavin was used in both groups. Visual acuity, refraction, corneal topography, and wavefront aberrometry were evaluated at baseline and after 1, 6, and 12 months. Specular microscopy was performed on 10 patients preoperatively and after 12 months. Postoperative pain was evaluated using a patient questionnaire. Results. Uncorrected and corrected distance visual acuity improved significantly in both groups. Refraction, topography, and aberrometry showed nonsignificant changes from the preoperative status throughout the 12-month follow-up in both groups. Moreover, the outcomes between the groups were comparable at all follow-up points. Endothelial cell-count was stable. Postoperative pain length was shorter in group 1 . Conclusion. “Epithelium-on” and “epithelium-off” CXL using hypotonic 0.5% riboflavin were equally safe and effective in stabilization of keratoconus. Topography and aberrometry outcomes in both groups failed to show any significant improvements. This study is registered at NCT01181219. Aleksandar Stojanovic, Wen Zhou, and Tor Paaske Utheim Copyright © 2014 Aleksandar Stojanovic et al. All rights reserved. The Outcomes of Primary Scleral Buckling during Repair of Posterior Segment Open-Globe Injuries Sun, 22 Jun 2014 13:14:41 +0000 Objective. To compare visual outcomes of eyes which underwent primary scleral buckling (PSB) treatment during posterior segment open-globe injury (OGI) repair with eyes not treated with PSB. Methods. We retrospectively reviewed 38 eyes which underwent a posterior segment OGI repair with no preoperative evidence of retinal detachment (RD) at Soroka University Medical Center (1995–2010). 19 (50%) underwent scleral repair alone (control group) and the other 19 eyes were treated with PSB also (PSB group). We compared visual outcomes in these two groups and rates of subsequent postoperative complications. Results. Baseline characteristics of the groups were similar. Compared with the control group, the PSB group had statistically significant lower rates of proliferative vitreoretinopathy (PVR) (5.3% versus 38.4%, ) and a trend towards lower rates of RD (15.8% versus 41.1%, ). PSB group eyes had a statistically significant improvement of their best distance visual acuity (BDVA) with lower means of final BDVA-grade () and logMAR vision (). Eyes in the control group had no improvement in these parameters. Conclusion. PSB procedure during posterior segment OGI repair may decrease the risk of subsequent retinal complications and improve final visual outcome. Dan Cohen, Jaime Levy, Tova Lifshitz, Nadav Belfair, Itamar Klemperer, Noam Yanculovich, and Boris Knyazer Copyright © 2014 Dan Cohen et al. All rights reserved. Silibinin Inhibits ICAM-1 Expression via Regulation of N-Linked and O-Linked Glycosylation in ARPE-19 Cells Tue, 17 Jun 2014 07:42:26 +0000 To evaluate the effects of silibinin on intercellular adhesion molecule-1 (ICAM-1) expression, we used ARPE-19 cells as a model in which tumor necrosis factor (TNF-α) and interferon (IFN-γ) enhanced ICAM-1 expression. This upregulation was inhibited by silibinin. In an adherence assay using ARPE-19 and THP-1 cells, silibinin inhibited the cell adhesion function of ICAM-1. The inhibitory effects of silibinin on ICAM-1 expression were mediated via the blockage of nuclear translocation of p65 proteins in TNF-α and phosphorylation of STAT1 in IFN-γ-stimulated cells. In addition, silibinin altered the degree of N-linked glycosylation posttranslationally in ARPE-19 cells by significantly enhancing MGAT3 gene expression. Silibinin can increase the O-GlcNAc levels of glycoproteins in ARPE-19 cells. In a reporter gene assay, PUGNAc, which can also increase O-GlcNAc levels, inhibited NF-κB reporter activity in TNF-α-induced ARPE-19 cells and this process was augmented by silibinin treatment. Overexpression of OGT gene was associated with reduced TNF-α-induced ICAM-1 levels, which is consistent with that induced by silibinin treatment. Taken together, silibinin inhibits ICAM-1 expression and its function through altered O-linked glycosylation in NF-κB and STAT1 signaling pathways and decreases the N-linked glycosylation of ICAM-1 transmembrane protein in proinflammatory cytokine-stimulated ARPE-19 cells. Yi-Hao Chen, Ching-Long Chen, Chang-Min Liang, Jy-Been Liang, Ming-Cheng Tai, Yun-Hsiang Chang, Da-Wen Lu, and Jiann-Torng Chen Copyright © 2014 Yi-Hao Chen et al. All rights reserved. Relationship between Spectral-Domain Optical Coherence Tomography and Standard Automated Perimetry in Healthy and Glaucoma Patients Mon, 16 Jun 2014 09:40:40 +0000 Objective. To evaluate the relationship between spectral-domain optical coherence tomography (OCT) and standard automated perimetry (SAP) in healthy and glaucoma individuals. Methods. The sample comprised 338 individuals divided into 2 groups according to intraocular pressure and visual field outcomes. All participants underwent a reliable SAP and imaging of the optic nerve head with the Cirrus OCT. Pearson correlations were calculated between threshold sensitivity values of SAP (converted to linear scale) and OCT parameters. Results. Mean age did not differ between the control and glaucoma groups (59.55 ± 9.7 years and 61.05 ± 9.4 years, resp.; ). Significant differences were found for the threshold sensitivities at each of the 52 points evaluated with SAP () and the peripapillary retinal nerve fiber layer (RNFL) thicknesses, except at 3 and 9 clock-hour positions between both groups. Mild to moderate correlations (ranging between 0.286 and 0.593; ) were observed between SAP and most OCT parameters in the glaucoma group. The strongest correlations were found between the inferior RNFL thickness and the superior hemifield points. The healthy group showed lower and weaker correlations than the glaucoma group. Conclusions. Peripapillary RNFL thickness measured with Cirrus OCT showed mild to moderate correlations with SAP in glaucoma patients. Beatriz Abadia, Antonio Ferreras, Pilar Calvo, Mirian Ara, Blanca Ferrandez, Sofia Otin, Paolo Frezzotti, Luis E. Pablo, and Michele Figus Copyright © 2014 Beatriz Abadia et al. All rights reserved. Correlation of Choroidal Thickness and Volume Measurements with Axial Length and Age Using Swept Source Optical Coherence Tomography and Optical Low-Coherence Reflectometry Thu, 12 Jun 2014 11:20:14 +0000 Purpose. To report choroidal thickness and volume in healthy eyes using swept source optical coherence tomography (SS-OCT). Methods. A prospective observational study of 122 patients examined with swept source OCT (DRI-OCT, Topcon, Japan). In each eye, we performed 256 horizontal scans, 12 mm in length and centered on the fovea. We calculated choroidal thickness manually with a built-in caliper and automatically using DRI-OCT mapping software. Choroidal volume was also automatically calculated. We measured axial length with optical low-coherence reflectometry (Lenstar LS 900, Haag-Streit, Switzerland). Results. The choroid has focally increased thickness under the fovea. Choroid was thinnest in the outer nasal quadrant. In stepwise regression analysis, age was estimated as the most significant factor correlating with decreased choroidal thickness followed by axial length . Refractive error was not statistically significant . Conclusions. SS-OCT is the first commercially available system that can automatically create choroidal thickness and volume maps. Choroidal thickness is increased at the fovea and is thinnest nasally. Age and axial length are critical for the estimation of choroidal thickness and volume. Choroidal measurements derived from SS-OCT images have potential value for objectively documenting disease-related choroidal thickness abnormalities and monitoring progressive changes over time. Janusz Michalewski, Zofia Michalewska, Zofia Nawrocka, Maciej Bednarski, and Jerzy Nawrocki Copyright © 2014 Janusz Michalewski et al. All rights reserved. Outcome of Corneal Collagen Crosslinking for Progressive Keratoconus in Paediatric Patients Wed, 11 Jun 2014 10:03:10 +0000 Purpose. To evaluate the efficacy of corneal collagen crosslinking for progressive keratoconus in paediatric patients. Methods. This prospective study included 25 eyes of 18 patients (aged 18 years or younger) who underwent collagen crosslinking performed using riboflavin and ultraviolet-A irradiation (370 nm, 3 mW/cm2, 30 min). Results. The mean patient age was 14.3 ± 2.4 years (range 8–17) and mean followup duration was 20.1 ± 14.25 months (range 6–48). Crosslinked eyes demonstrated a significant reduction of keratometry values. The mean baseline simulated keratometry values were 46.34 dioptres (D) in the flattest meridian and 50.06 D in the steepest meridian. At 20 months after crosslinking, the values were 45.67 D () and 49.34 D (), respectively. The best spectacle corrected visual acuity (BSCVA) and topometric astigmatism improved after crosslinking. Mean logarithm of the minimum angle of resolution (logMAR) BSCVA decreased from 0.24 to 0.21 () and topometric astigmatism reduced from mean 3.50 D to 3.25 D (). Conclusions. Collagen crosslinking using riboflavin and ultraviolet-A is an effective treatment option for progressive keratoconus in paediatric patients. Crosslinking stabilises the condition and, thus, reduces the need for corneal grafting in these young patients. Deepa Viswanathan, Nikhil L. Kumar, and John J. Males Copyright © 2014 Deepa Viswanathan et al. All rights reserved. Silicone Oil: Different Physical Proprieties and Clinical Applications Wed, 11 Jun 2014 09:27:13 +0000 Silicone oils are important tools in vitreoretinal surgery because they have the ability to displace aqueous humor from the retinal surface, maintaining the adhesion between retina and retinal pigment epithelium. To understand this capability, it is important to know the silicone oil characteristics. Herein, we report first on the main chemical-physical proprieties and then we review the clinical applications of the current silicone oil which is lighter than water with particular reference to their indications with small gauge vitrectomy. Finally, we describe the surgical techniques to inject and remove this type of silicone oil. In the summary of this paper, we explain why silicone oils are today increasingly used and why their introduction has improved the prognosis of several retinal diseases. In fact, having different types of silicone oils allows us to choose the appropriate endotamponade for every single case. Francesco Barca, Tomaso Caporossi, and Stanislao Rizzo Copyright © 2014 Francesco Barca et al. All rights reserved. Microincision Vitrectomy Surgery in Vitreomacular Traction Syndrome of Retinitis Pigmentosa Patients Mon, 09 Jun 2014 13:07:31 +0000 Purpose. To investigate long-term retinal changes after microincision pars plana vitrectomy surgery (MIVS) and internal limiting membrane (ILM) peeling outcome in retinitis pigmentosa (RP) patients affected by vitreomacular traction syndrome (VMT) with higher vitreous surface adhesion or coexisting epiretinal membrane (ERM). Methods. Eight RP patients suffering from VMT were evaluated by means of best corrected visual acuity (BCVA), anterior and posterior binocular examination, spectral-domain optical coherence tomography (SD-OCT), MP-1 microperimetry (MP-1), and full-field electroretinogram (ERG), before MIVS and ILM peeling and during the 36-month follow-up. Patients were hospitalized for two days after the surgery. Surgical procedure was performed following this schedule: surgical removal of crystalline lens (MICS), MIVS with 23-gauge sutureless system trocars, core vitreous body removal, and balanced-sterile-salin-solution- (BSS-) air-gas (SF6) exchange. Results. All patients presented visual acuity (VA) increase after MIVS. None of the patients developed ocular hypertension or vitreomacular adhesions during the 3-year follow-up. MP-1 bivariate contour ellipse area (BCEA) was reduced in its dimensions and improved in all patients demonstrating a better fixation. Conclusions. MIVS could be the gold standard therapy in RP patients with VMT and higher vitreous surface adhesion or coexisting ERM if medical therapy is not applicable or not effective. Enzo Maria Vingolo, Emanuele Gerace, Stefano Valente, Leopoldo Spadea, and Marcella Nebbioso Copyright © 2014 Enzo Maria Vingolo et al. All rights reserved. Trehalose-Based Eye Drops Preserve Viability and Functionality of Cultured Human Corneal Epithelial Cells during Desiccation Sun, 08 Jun 2014 00:00:00 +0000 This paper presents the evaluation of cytoprotective ability of trehalose-based eye drops in comparison with commercially available preparations during the experimental desiccation of cultured human corneal epithelial cells. Cultured human corneal epithelial cells (hCEC) underwent incubation with 7 different, commercially available medicaments used commonly in dry eye syndrome treatment, followed by desiccation trial performed on air under the flow hood for 5, 15, 30, and 45 minutes. Cell viability was quantified by live/dead fluorescent assay, while the presence of apoptotic cells was estimated by immunofluorescent staining for active caspase 3 protein. The preservation of membrane functions was evaluated using neutral red staining, while the preservation of proper morphology and phenotype was determined by fluorescent staining for actin filaments, nuclei, and p63 protein. The trehalose-based eye drops showed the highest efficiency in prevention of cell death from desiccation; moreover, this preparation preserved the normal cellular morphology, functions of cell membrane, and proliferative activity more effectively than other tested medicaments. Aneta Hill-Bator, Marta Misiuk-Hojło, Krzysztof Marycz, and Jakub Grzesiak Copyright © 2014 Aneta Hill-Bator et al. All rights reserved. Vitreous Tamponades in Highly Myopic Eyes Mon, 02 Jun 2014 11:05:24 +0000 The use of endotamponade agents has gained a major role in the management of macular complications of high myopia. Myopic foveoschisis and macular hole are the main macular complication of pathologic myopia, this growing condition that is a main cause of visual loss, especially in patients at a younger age. We discuss the physical properties and advantages and disadvantages of the main ocular tamponade agents used in the treatment of these diseases. X. Valldeperas and J. Lorenzo-Carrero Copyright © 2014 X. Valldeperas and J. Lorenzo-Carrero. All rights reserved. Comparison of Anterior Segment Measurements Obtained by Three Different Devices in Healthy Eyes Mon, 02 Jun 2014 06:35:43 +0000 Purpose. To assess the normal values and the repeatability of the Galilei Dual Scheimpflug Analyzer (GDSA), the biometer IOL Master, and the autokerato/refractometer WAM 5500 in anterior segment examinations. Methods. Eighty-eight eyes from 88 healthy volunteers were prospectively and consecutively recruited. The repeatability was assessed, calculating the intraclass correlation coefficient (ICC). Results. The correlations among the repeated measurements showed nearly perfect reliability (ICC > 0.81) for all of the parameters, except corneal astigmatism Galilei (0.79) and WAM (0.68). There were statistically significant differences () between the values of the flat simulated keratometry (SimK) and the steep SimK measured by GDSA and the other methods; however, there were no statistically significant differences for the values obtained with the IOL Master and WAM 5500 ( and , resp.) or between the values of the ACD () and WTW () measured by the IOL Master and GDSA. Conclusions. The anterior segment measurements from the IOL Master and WAM 5500 were highly repeatable, comparable, and well correlated. In healthy young persons, the evaluated parameters had very good repeatability, although significant differences were found between the GDSA and IOL Master and between the GDSA and WAM 5500. Carmen Lopez de la Fuente, Ana Sanchez-Cano, Francisco Segura, and Isabel Pinilla Copyright © 2014 Carmen Lopez de la Fuente et al. All rights reserved. Effect of Biometric Characteristics on the Change of Biomechanical Properties of the Human Cornea due to Cataract Surgery Thu, 29 May 2014 09:35:41 +0000 Purpose. To determine the impact of biometric characteristics on changes of biomechanical properties of the human cornea due to standard cataract surgery using biomechanical analysis. Patients and Methods. This prospective consecutive cross-sectional study comprised 54 eyes with cataract in stages I or II that underwent phacoemulsification and IOL implantation. CH, CRF, IOPg, and IOPcc intraocular pressure were measured by biomechanical analysis preoperatively and at 1 month postoperatively. Changes () were calculated as preoperative value versus postoperative value. Biometrical data were extracted from TMS-5 (CSI and SAI), IOLMaster (AL), and EM-3000 (CCT and ECC) preoperatively. Results. The average values of the changes were  mmHg,  mmHg,  mmHg, and  mmHg. The higher the CSI the smaller the decrease in CH (, ). The higher the CCT the larger the decrease in CRF (, ). The higher the AL the smaller the decrease in IOPg (, ). The higher the AL, SAI, and EEC the smaller the decrease in IOPcc (, ; , ; , ). Conclusions. Corneal biomechanical properties were affected by comprehensive factors after cataract surgery, including corneal endothelium properties, biometry, and geometrical characteristics. Xuefei Song, Achim Langenbucher, Zisis Gatzioufas, Berthold Seitz, and Moatasem El-Husseiny Copyright © 2014 Xuefei Song et al. All rights reserved. Differential Effects of Dry Eye Disorders on Metabolomic Profile by 1H Nuclear Magnetic Resonance Spectroscopy Wed, 21 May 2014 13:15:35 +0000 We used 1H NMR spectroscopy to analyze the metabolomic profile of reflex tears from patients with dry eye disorders (DEDs). 90 subjects were divided into 2 groups: (1) patients with DEDs (DEDG; ) and (2) healthy subjects (CG; ). Additionally, the DEDG was subdivided into 2 subgroups based on DED severity: mild-to-moderate and moderate ( and , resp.). Personal interviews and systematized ophthalmologic examinations were carried out. Reflex tears (20–30 μL) were collected by gently rubbing in the inferior meniscus of both eyelids with a microglass pipette and stored at −80°C until analysis. NMR spectra were acquired using a standard one-dimensional pulse sequence with water suppression. Data were processed and transferred to MATLAB for further chemometric analysis. Main differences in tear composition between DEDG and CG were found in cholesterol, N-acetylglucosamine, glutamate, creatine, amino-n-butyrate, choline, acetylcholine, arginine, phosphoethanolamine, glucose, and phenylalanine levels. This metabolic fingerprint helped also to discriminate between the three additional subgroups of DEDG. Our results suggest that tear metabolic differences between DEDG and CG identified by NMR could be useful in understanding ocular surface pathogenesis and improving biotherapy. Carmen Galbis-Estrada, Sebastián Martinez-Castillo, José M. Morales, Bárbara Vivar-Llopis, Daniel Monleón, Manuel Díaz-Llopis, and María Dolores Pinazo-Durán Copyright © 2014 Carmen Galbis-Estrada et al. All rights reserved. Human Aqueous Humor Levels of TGF-β2: Relationship with Axial Length Tue, 20 May 2014 00:00:00 +0000 Purpose. To analyze the relationship between transforming growth factor-beta 2 (TGF-β2) levels in the anterior chamber aqueous humor and axial length of patients with myopia. Methods. TGF-β2 was measured with the Luminex xMAP Technology by using commercially available Milliplex xMAP Kits. Sixty-five aqueous humor samples were collected during cataract or clear lens extraction surgery and TGF-β2 levels in these specimens were analyzed. According to the axial length, the samples were divided into three groups: A (AL  mm), B (24~29 mm), and C (AL ≥ 29 mm). Results. Aqueous humor samples were analyzed from subjects with an average age of 67.0 ± 11.7 years. Mean TGF-β2 concentration of all aqueous samples was 422.2 ± 258.8 pg/mL. TGF-β2 concentration in group C (543 ± 317 pg/mL) was significantly greater than that in group A (390 ± 212 pg/mL) and group B (337 ± 217 pg/mL). The concentration of TGF-β2 was positively correlated with axial length ( = 0.308, = 0.013). Conclusions. TGF-β2 is likely to be acting as a critical factor in axial elongation and development of myopia. Yan Jia, Dan-Ning Hu, and Jibo Zhou Copyright © 2014 Yan Jia et al. All rights reserved. Analysis of the Time and Location of the Silicone Oil Emulsification by Spectral-Domain Optical Coherence Tomography after Silicone Oil Tamponade Mon, 19 May 2014 00:00:00 +0000 Purpose. To estimate localization and the period up to the appearance of small hyperreflective round-shaped droplets using spectral-domain optical coherence tomography (SD-OCT) after pars plana vitrectomy with silicone oil tamponade. Methods. A retrospective observational study included 24 patients who had undergone pars plana vitrectomy with silicone oil tamponade for proliferative vitreoretinopathy (PVR) retinal detachment. SD-OCT analysis was performed 1, 3, and 6 months after surgery. We characterized the emulsified silicone oil in the SD-OCT as the small hyperreflective round-shaped droplets. Results. In SD-OCT examination, none of the patients had hyperreflective round-shaped droplets visible one month after vitrectomy with silicone oil tamponade. The hyperreflective droplets were found three months after surgery—in one patient above the optic nerve and in five patients intraretinally (in the cystoid spaces). Six months after vitrectomy, the hyperreflective round-shaped droplets were still present in the aforementioned patients' eyes and additionally in 3 eyes above the optic disc. Conclusions. Hyperreflective round-shaped droplets were found in a SD-OCT examination 3 months after silicone oil tamponade. The authors suggest that they are most likely the emulsified silicone oil droplets. The authors hypothesize that emulsification and migration of silicone oil begin within 3 months after surgery. Dominik Odrobina and Iwona Laudańska-Olszewska Copyright © 2014 Dominik Odrobina and Iwona Laudańska-Olszewska. All rights reserved. Comprehensive Detection, Grading, and Growth Behavior Evaluation of Subthreshold and Low Intensity Photocoagulation Lesions by Optical Coherence Tomographic and Infrared Image Analysis Mon, 12 May 2014 07:00:20 +0000 Purpose. To correlate the long-term clinical effect of photocoagulation lesions after 6 months, as measured by their retinal damage size, to exposure parameters. We used optical coherence tomographic (OCT)-based lesion classes in order to detect and assess clinically invisible and mild lesions. Methods. In this prospective study, 488 photocoagulation lesions were imaged in 20 patients. We varied irradiation diameters (100/300 µm), exposure-times (20–200 ms), and power. Intensities were classified in OCT images after one hour, and we evaluated OCT and infrared (IR) images over six months after exposure. Results. For six consecutive OCT-based lesion classes, the following parameters increased with the class: ophthalmoscopic, OCT and IR visibility rate, fundus and OCT diameter, and IR area, but not irradiation power. OCT diameters correlated with exposure-time, irradiation diameter, and OCT class. OCT classes discriminated the largest bandwidth of OCT diameters. Conclusion. OCT classes represent objective and valid endpoints of photocoagulation intensity even for “subthreshold” intensities. They are suitable to calculate the treated retinal area. As the area is critical for treatment efficacy, OCT classes are useful to define treatment intensity, calculate necessary lesion numbers, and universally categorize lesions in clinical studies. Stefan Koinzer, Amke Caliebe, Lea Portz, Mark Saeger, Yoko Miura, Kerstin Schlott, Ralf Brinkmann, and Johann Roider Copyright © 2014 Stefan Koinzer et al. All rights reserved. Visual and Anatomical Outcomes of Intravitreal Aflibercept for Treatment-Resistant Neovascular Age-Related Macular Degeneration Wed, 07 May 2014 14:42:37 +0000 A retrospective chart review of patients with persistent subretinal and/or intraretinal fluid, despite previous treatment with intravitreal ranibizumab (0.5 mg), who were switched to aflibercept injections, was performed. Treatment was three monthly aflibercept (2 mg) injections followed by dosing on pro re nata basis. Main outcome measures included changes in best corrected visual acuity (BCVA), 1 mm central subfield (CSF) retinal thickness, the height of the pigment epithelial detachment (PED), and subfoveal choroidal thickness on optical coherence tomography at 6 months. Thirty-one eyes of 30 patients were analyzed. The mean number of injections before aflibercept conversion was 34.4 ± 11.9. After an average of 4.5 aflibercept injections (range 3 to 6) over 6 months, no significant change in BCVA was observed (). Compared with baseline, there was a significant reduction of the CSF retinal thickness (449 ± 179 versus 269 ± 145 μm, ), maximum PED height (262 ± 134 versus 183 ± 100 μm, ), and choroidal thickness (192 ± 67 versus 167 ± 51 μm, ). Stable visual acuity and anatomical improvement were obtained for up to 6 months after aflibercept conversion. However, choroidal thinning related to treatment was observed. Magda Gharbiya, Ludovico Iannetti, Francesco Parisi, Umberto De Vico, Maria Laura Mungo, and Marco Marenco Copyright © 2014 Magda Gharbiya et al. All rights reserved. Vitreous Substitutes: The Present and the Future Sun, 04 May 2014 00:00:00 +0000 Vitreoretinal surgery has advanced in numerous directions during recent years. The removal of the vitreous body is one of the main characteristics of this surgical procedure. Several molecules have been tested in the past to fill the vitreous cavity and to mimic its functions. We here review the currently available vitreous substitutes, focusing on their molecular properties and functions, together with their adverse effects. Afterwards we describe the characteristics of the ideal vitreous substitute. The challenges facing every ophthalmology researcher are to reach a long-term intraocular permanence of vitreous substitute with total inertness of the molecule injected and the control of inflammatory reactions. We report new polymers with gelification characteristics and smart hydrogels representing the future of vitreoretinal surgery. Finally, we describe the current studies on vitreous regeneration and cell cultures to create new intraocular gels with optimal biocompatibility and rheological properties. Simone Donati, Simona Maria Caprani, Giulia Airaghi, Riccardo Vinciguerra, Luigi Bartalena, Francesco Testa, Cesare Mariotti, Giovanni Porta, Francesca Simonelli, and Claudio Azzolini Copyright © 2014 Simone Donati et al. All rights reserved. Repeatability of Ocular Measurements with a Dual-Scheimpflug Analyzer in Healthy Eyes Thu, 24 Apr 2014 09:42:58 +0000 Purpose. To assess the repeatability of the Galilei dual Scheimpflug analyzer (GDSA) in anterior segment examination. Methods. Fifty-two eyes from 52 healthy volunteers were prospectively and consecutively recruited. Anatomic, axial, refractive, and instantaneous parameters were measured with GDSA to provide a complete characterization of the anterior segment. Repeatability was assessed calculating intraclass correlation coefficient (ICC), and coefficient of variation (COV). Results. Correlation among repeated measurements showed almost perfect reliability (ICC > 0.81) for all parameters except thinnest central corneal thickness (CCT) (0.78), corneal thickness average out (0.79), and posterior axial curvature average out (0.60). Repeatability was excellent (COV 10%) for all parameters except anterior chamber volume and, superior iridocorneal angle and eccentricities. In these last three parameters, repeatability limits were excessively high compared to the mean. Conclusions. GDSA in healthy young persons had an almost perfect correlation in measuring anatomic, axial, instantaneous, and refractive parameters with greater variability for peripheral terms. Repeatability of anatomical parameters like pachymetry, anterior chamber, or iridocorneal angle and eccentricity were limited. In healthy young persons, the other evaluated parameters had very good repeatability and their limits of agreement showed excellent clinical results for this device. Carmen Lopez de la Fuente, Ana Sanchez-Cano, Francisco Segura, Lorena Fuentes-Broto, and Isabel Pinilla Copyright © 2014 Carmen Lopez de la Fuente et al. All rights reserved. Heavy Silicone Oil as a Long-Term Endotamponade Agent for Complicated Retinal Detachments Tue, 15 Apr 2014 12:48:20 +0000 We retrospectively evaluated a heavy silicone oil (HSO) as a long-term intraocular endotamponade agent to treat complicated RD by inferior PVR in 25 eyes of 25 patients. Patients underwent PPV and injection of Oxane HD as an internal tamponade agent. A comparison of preoperative and postoperative BCVA at month 1, month 6, and last visit was made in the group in which HSO was removed and in the group in which HSO was not removed. Statistical calculations were performed using the Wilcoxon test. The HSO was removed from 11 patients after a mean of 26.55 ± 21.38 months. The HSO remained inside the vitreous cavity in 14 eyes due to a high chance of PVR recurrence (mean follow-up period, 11.07 ± 7.44 months). Anatomic success was achieved in 92%. The BCVA in the group, in which HSO was not removed, improved significantly during the first 6 months. Among the patients who had the oil removed, there was improvement in BCVA after 1 month. Oil emulsification was the most common adverse effect in 52% of eyes. HSO is an effective tamponade in complex rhegmatogenous and tractional RD complicated by PVR. HSO can remain in the eye for long periods with relative tolerability and safety. Juliana Prazeres, Octaviano Magalhães Jr., Luiz F. A. Lucatto, Rodrigo Milan Navarro, Nilva S. Moraes, Michel E. Farah, André Maia, and Maurício Maia Copyright © 2014 Juliana Prazeres et al. All rights reserved. Clinical Observations and Occurrence of Complications following Heavy Silicone Oil Surgery Mon, 14 Apr 2014 17:19:30 +0000 Purpose. To demonstrate development and complications in heavy silicone oil (HSO) surgery in 100 eyes following primary vitreoretinal surgery. Methods. 100 eyes were included in this retrospective study that underwent vitreoretinal surgery using HSO as endotamponade. Indication diagnoses were retinal detachments , complicated macular holes (MH) , and others . HSO removal was performed after a mean period of 20.2 ± 19.0 weeks. In 18 eyes with poor functional prognosis the silicone oil remained permanently for stabilisation. Overall follow-up time was 35.9 ± 51.8 weeks. Results. The mean IOP before HSO surgery was 13.3 ± 5.6 mmHg and raised to an average maximum of 23.3 ± 8.5 mmHg postoperatively and decreased to 13.7 ± 7.2 mmHg after removal. Secondary IOP raise due to emulsification of the silicone oil endotamponade was seen in 29 eyes after 7.8 ± 4.5 weeks. Other complications being observed with HSO installed were persistent corneal erosion and prolonged anterior chamber inflammation . In 13 eyes recurrent retinal detachments occurred during followup. Conclusions. According to our analysis HSO surgery might deliver satisfying results in complicated cases of ophthalmological surgery. However, potential complications should always be taken into account when making the decision if to use and when to remove HSO in complicated retinal surgery. Hendrik Schwarzer, Babac Mazinani, Niklas Plange, Matthias Fuest, Peter Walter, and Gernot Roessler Copyright © 2014 Hendrik Schwarzer et al. All rights reserved. Selective Laser Trabeculoplasty for Glaucoma Secondary to Emulsified Silicone Oil after Pars Plana Vitrectomy: A Pilot Study Sun, 13 Apr 2014 17:06:33 +0000 Background. To investigate the efficacy of selective laser trabeculoplasty (SLT) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO). Methodology/Principal Findings. Prospective, interventional, consecutive case series of 11 eyes with sustained elevation of IOP after SO removal. The mean IOP at baseline, week 1, month 1, month 3, and month 6 was evaluated. The mean baseline IOP was significantly decreased from 25 ± 2.7 mmHg to 18.4 ± 5.5 mmHg at week 1 , 17.9 ± 3.1 mmHg at month 1 , 15.8 ± 3.9 mmHg at month 3 , and 16.2 ± 4.7 mmHg at month 6 . IOP < 21 mmHg was achieved in 91% of the eyes without a significant complication at month 6. Conclusion/Significance. SLT may be successful for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment. Zeynep Alkin, Banu Satana, Abdullah Ozkaya, Berna Basarir, Cigdem Altan, Ahmet Taylan Yazici, and Ahmet Demirok Copyright © 2014 Zeynep Alkin et al. All rights reserved. Reproducibility of the Optical Biometer OA-1000 (Tomey) Thu, 10 Apr 2014 14:09:57 +0000 Aim. The OA-1000 (Tomey, Japan) is a new optical biometer, which measures axial length (AL), anterior chamber depth (ACD), and central corneal thickness (CT) utilizing optical interference technology. The aim of this study was to prove the reproducibility which is considered fundamental for other clinical investigations. Methods. 55 healthy volunteers were enrolled in this study. For each measurement of AL, ACD, and CT the biometer is grabbing a sequence of 10 shots and mean value (mean) and standard deviation (SD) are displayed. Five consecutive measurements were performed and average and standard deviation were assessed. Cronbach’s was derived as a quality measure for reproducibility. Results. For AL measurement Cronbach’s was 1.000, for CT 0.999, and for ACD 0.979, respectively. Mean value for AL was  mm, for ACD it was  mm, and for CT it was  μm, respectively. Standard deviation for AL was  mm, for ACD  mm, and for CT  μm. One correlation was found between mean values for AL and ACD (, ); no other correlations were found between mean values or values of standard deviation of AL, ACD, or CT. Conclusion. The OA-1000 shows an excellent reproducibility for measurement of AL, ACD, and CT and can be used in clinical practice. Susanne Christiane Goebels, Berthold Seitz, and Achim Langenbucher Copyright © 2014 Susanne Christiane Goebels et al. All rights reserved. Perfluorocarbon Liquid: Its Application in Vitreoretinal Surgery and Related Ocular Inflammation Sun, 30 Mar 2014 10:59:33 +0000 The application of perfluorocarbon liquids has been well acclaimed in vitreoretinal surgery. Its unique physical properties make it an ideal intraoperative tool to improve the efficiency and safety of surgical procedures in complicated cases. The main functions of perfluorocarbon liquids in vitreoretinal surgery include relocating and fixing the detached retina, displacing the subretinal and subchoroidal to fluid anteriorly, revealing proliferative vitreous retinopathy (PVR) for further maneuvers, protecting the macula from exposure to chemicals with potential toxicity, and assisting the removal of foreign body. The related clinical applications include retinal detachment with severe proliferative vitreoretinopathy, giant tear, diabetic retinopathy (DR), retinopathy of prematurity (ROP), and posterior dislocated crystalline and intraocular lenses. The application of perfluorocarbon liquids has been expended over the past fewer years. Several PFCLs related ocular inflammations have been observed in in vitro studies, animal studies, and clinical follow-up. The complete removal of PFCLs is recommended at the end of the surgery in most cases. Qi Yu, Kun Liu, Li Su, Xin Xia, and Xun Xu Copyright © 2014 Qi Yu et al. All rights reserved. Effect of Intraocular Lens Diameter Implanted in Enucleated Porcine Eye on Intraocular Pressure Induced by Scleral Depression Thu, 27 Mar 2014 13:38:06 +0000 The effect of the diameter of an intraocular lens (IOL) implanted in enucleated porcine eyes on the intraocular pressure induced by scleral depression was investigated. Two IOLs of 6 mm and 7 mm optic diameter were implanted. The intraocular pressure (IOP) was monitored during scleral depression by a transducer placed in the midvitreous through a sclerotomy at 6 o’clock. The area under the curve (AUC) of the IOP changes from the beginning of the indentation to the point when the peripheral retinal surface was observed through the IOL optics was measured. The AUC was significantly larger in eyes with a 6 mm IOL than in eyes with a 7 mm IOL (). The IOP elevation at the endpoint was higher in eyes with the 6 mm IOL than in eyes with the 7 mm IOL. We conclude that the AUC may represent the degree of stress induced by scleral depression. The higher AUC value with the X-60 may be because of the longer distance from the peripheral retina to the edge of the IOL optics. Gaku Terauchi, Celso Soiti Matsumoto, Kei Shinoda, Harue Matsumoto, and Atsushi Mizota Copyright © 2014 Gaku Terauchi et al. All rights reserved. Using Surgical Microscope for Sclera Buckling and Transscleral Cryopexy: An Alternative Procedure of Treatment for Rhegmatogenous Retinal Detachment Thu, 27 Mar 2014 00:00:00 +0000 Purpose. To observe the long-term effectiveness of scleral buckling and transscleral cryopexy conducted under a surgical microscope in the treatment of uncomplicated rhegmatogenous retinal detachment. Methods. This was a retrospective analysis in a total of 227 consecutive patients (244 eyes) with uncomplicated rhegmatogenous retinal detachment (proliferative vitreoretinopathy ≤ C2). All patients underwent scleral buckling and transscleral cryopexy under a surgical microscope without using a binocular indirect ophthalmoscope or a contact lens. Results. After initial surgery, complete retinal reattachment was achieved in 226 eyes (92.6%), and retinal redetachment developed in 18 eyes (7.4%). The causes of retinal redetachment included presence of new breaks in eight eyes (44%), failure to completely seal the breaks in five eyes (28%), missed retinal breaks in four eyes (22%), and iatrogenic retinal breaks in one eye (6%). Scleral buckling surgery was performed again in 12 eyes (66%). Four eyes (22%) developed proliferative vitreoretinopathy and then were treated by vitrectomy. The sealing of retinal breaks and complete retinal reattachment were achieved in 241 eyes (98.8%). Conclusion. Probably because of clear visualization of retinal breaks and being controllable under a surgical microscope, the microsurgery of scleral buckling and transscleral cryopexy for uncomplicated retinal detachment exhibits advisable effectiveness. Liu-xue-ying Zhong, Yi Du, Wen Liu, Su-Ying Huang, and Shao-chong Zhang Copyright © 2014 Liu-xue-ying Zhong et al. All rights reserved. Inflammation Induced by Perfluorocarbon Liquid: Intra- and Postoperative Use Mon, 24 Mar 2014 16:29:08 +0000 Perfluorocarbon liquids (PFCLs) are useful and safe surgical tools in vitreoretinal surgery. The use of PFCL as a tamponade has been controversial due to the corneal toxicity, retinal infiltration, and inflammatory reaction in experimental studies. Several authors have studied in humans the anatomical and functional outcome and adverse effects of perfluorocarbon liquids used as short-, medium-, and long-term tamponade. PFCLs develop dispersion a few days after injection and droplets may move into the anterior chamber and cause corneal endothelial damage. When PFCLs are used as postoperative tamponades for more than one week, a foreign-body inflammatory reaction is observed in up to 30% of cases but such a reaction does not induce PVR, and it resolves after removal of PFCLs. Although most clinical studies have found no signs of retinal toxicity such as progressive visual acuity deterioration or macular anatomical changes, few performed ERG or retinal histological analysis. Marta S. Figueroa and Diego Ruiz Casas Copyright © 2014 Marta S. Figueroa and Diego Ruiz Casas. All rights reserved. Dynamics of Blood Count after Rheohemapheresis in Age-Related Macular Degeneration: Possible Association with Clinical Changes Thu, 06 Mar 2014 13:19:57 +0000 Background. Rheohemapheresis (RHF) is a method that can stop the activity of the dry form of age-related macular degeneration (AMD). The pathophysiologic mechanisms are not well understood, and the effects of the RHF procedures extend beyond the time of the individual procedures. Patients and Methods. We present the data for 46 patients with AMD treated with a series of 8 rheohemapheretic procedures. Blood count parameters were measured before the first and the last procedures. The clinical effect was judged by changes in the drusenoid pigment epithelium detachment (DPED) area before and after the rheopheretic sessions. Results. Rheopheresis caused a decrease in hemoglobin , a decrease in leukocytes , and an increase in platelets . We found a negative correlation between the amount of platelets and their volume (, Pearson correlation coefficient: −0.509). We identified the platelet/MPV ratio as a good predictor of the clinical outcome. Patients with a platelet/MPV ratio greater than 21.5 (before the last rheopheresis) had a significantly better outcome (, sensitivity of 76.9% and specificity of 80%). Conclusion. Several basic blood count parameters after RHF can be concluded to significantly change, with some of those changes correlating with the clinical results (reduction of the DPED area). Milan Košťál, Milan Bláha, Eva Rencová, Miriam Lánská, Pavel Rozsíval, Vera Kratochvilová, and Hana Langrová Copyright © 2014 Milan Košťál et al. All rights reserved. Erratum to “Topical 100% Serum Eye Drops for Treating Corneal Epithelial Defect after Ocular Surgery” Sun, 02 Feb 2014 13:03:38 +0000 Kaevalin Lekhanont, Passara Jongkhajornpong, Lulin Choubtum, and Varintorn Chuckpaiwong Copyright © 2014 Kaevalin Lekhanont et al. All rights reserved. Comparison of Diagnostic Accuracy between Octopus 900 and Goldmann Kinetic Visual Fields Thu, 23 Jan 2014 11:53:22 +0000 Purpose. To determine diagnostic accuracy of kinetic visual field assessment by Octopus 900 perimetry compared with Goldmann perimetry. Methods. Prospective cross section evaluation of 40 control subjects with full visual fields and 50 patients with known visual field loss. Comparison of test duration and area measurement of isopters for Octopus 3, 5, and 10°/sec stimulus speeds. Comparison of test duration and type of visual field classification for Octopus versus Goldmann perimetry. Results were independently graded for presence/absence of field defect and for type and location of defect. Statistical evaluation comprised of ANOVA and paired t test for evaluation of parametric data with Bonferroni adjustment. Bland Altman and Kappa tests were used for measurement of agreement between data. Results. Octopus 5°/sec perimetry had comparable test duration to Goldmann perimetry. Octopus perimetry reliably detected type and location of visual field loss with visual fields matched to Goldmann results in 88.8% of results . Conclusions. Kinetic perimetry requires individual tailoring to ensure accuracy. Octopus perimetry was reproducible for presence/absence of visual field defect. Our screening protocol when using Octopus perimetry is 5°/sec for determining boundaries of peripheral isopters and 3°/sec for blind spot mapping with further evaluation of area of field loss for defect depth and size. Fiona J. Rowe and Alison Rowlands Copyright © 2014 Fiona J. Rowe and Alison Rowlands. All rights reserved. Comparison of Riboflavin/Ultraviolet-A Cross-Linking in Porcine, Rabbit, and Human Sclera Thu, 02 Jan 2014 11:30:29 +0000 Purpose. To compare the biomechanical properties of porcine, rabbit, and human sclera before and after riboflavin/ultraviolet-A (UVA) collagen cross-linking (CXL). Methods. Eight rabbits, 8 porcine eyeballs, and 8 human eyeballs were included. One rabbit eye and half of each bisected human and porcine eyeball were treated with riboflavin/UVA CXL. Untreated fellow rabbit eyes and eyeball halves served as controls. A 10 mm × 20 mm scleral band was harvested from each specimen. From this band, two 3.5 mm × 15.0 mm strips were prepared for biomechanical testing. The biomechanical parameters were ultimate stress, stress and Young’s modulus. Results. Values of stress, and Young’s modulus showed that human sclera was 4 times stiffer than porcine sclera and 3 times stiffer than rabbit sclera. In rabbit sclera, both the stress and Young’s modulus were significantly increased by CXL (). In porcine sclera, only the ultimate stress was significantly increased by CXL (). The biomechanical properties of human sclera were not statistically affected by CXL (). Conclusions. Human sclera has higher biomechanical stiffness than porcine and rabbit sclera. With the same irradiation dose, riboflavin/UVA CXL increases the biomechanical stiffness of rabbit sclera but not porcine or human sclera. Yali Zhang, Zhiwei Li, Lei Liu, Xuguang Han, Xiaomin Zhao, and Guoying Mu Copyright © 2014 Yali Zhang et al. All rights reserved. High-Resolution En Face Images of Microcystic Macular Edema in Patients with Autosomal Dominant Optic Atrophy Thu, 28 Nov 2013 10:55:30 +0000 The purpose of this study was to investigate the characteristics of microcystic macular edema (MME) determined from the en face images obtained by an adaptive optics (AO) fundus camera in patients with autosomal dominant optic atrophy (ADOA) and to try to determine the mechanisms underlying the degeneration of the inner retinal cells and RNFL by using the advantage of AO. Six patients from 4 families with ADOA underwent detailed ophthalmic examinations including spectral domain optical coherence tomography (SD-OCT). Mutational screening of all coding and flanking intron sequences of the OPA1 gene was performed by DNA sequencing. SD-OCT showed a severe reduction in the retinal nerve fiber layer (RNFL) thickness in all patients. A new splicing defect and two new frameshift mutations with premature termination of the Opa1 protein were identified in three families. A reported nonsense mutation was identified in one family. SD-OCT of one patient showed MME in the inner nuclear layer (INL) of the retina. AO images showed microcysts in the en face images of the INL. Our data indicate that AO is a useful method to identify MME in neurodegenerative diseases and may also help determine the mechanisms underlying the degeneration of the inner retinal cells and RNFL. Kiyoko Gocho, Sachiko Kikuchi, Takenori Kabuto, Shuhei Kameya, Kei Shinoda, Atsushi Mizota, Kunihiko Yamaki, and Hiroshi Takahashi Copyright © 2013 Kiyoko Gocho et al. All rights reserved. Vignetting and Field of View with the KAMRA Corneal Inlay Wed, 13 Nov 2013 08:24:02 +0000 Purpose. To evaluate the effect of the KAMRA corneal inlay on the retinal image brightness in the peripheral visual field. Methods. A KAMRA inlay was “implanted” into a theoretical eye model in a corneal depth of 200 microns. Corneal radius was varied to a steep, normal, and flat (7.37, 7.77, and 8.17 mm) version keeping the proportion of anterior to posterior radius constant. Pupil size was varied from 2.0 to 5.0 mm. Image brightness was determined for field angles from −70° to 70° with and without KAMRA and proportion of light attenuation was recorded. Results. In our parameter space, the attenuation in brightness ranges in between 0 and 60%. The attenuation in brightness is not affected by corneal shape. For large field angles where the incident ray bundle is passing through the peripheral cornea, brightness is not affected. For combinations of small pupil sizes (2.0 and 2.5 mm) and field angles of 20–40°, up to 60% of light may be blocked with the KAMRA. Conclusion. For combinations of pupil sizes and field angles, the attenuation of image brightness reaches levels up to 60%. Our theoretical findings have to be clinically validated with detailed investigation of this vignetting effect. Achim Langenbucher, Susanne Goebels, Nóra Szentmáry, Berthold Seitz, and Timo Eppig Copyright © 2013 Achim Langenbucher et al. All rights reserved. Long-Term Effects of Nilvadipine against Progression of the Central Visual Field Defect in Retinitis Pigmentosa: An Extended Study Tue, 12 Nov 2013 13:32:57 +0000 Purpose. To assess the long-term effects of nilvadipine on the progression of central visual field defect in retinitis pigmentosa (RP). Methods. Patients with RP were randomly divided into a treated group receiving oral nilvadipine and a control group. Progression of RP was evaluated with MD slope and the average sensitivity of the central 2° (ΔCENT4). Results. The mean MD slopes were −0.55/−0.39 (right/left eyes, ) dB/year in the treated group and −1.37/−1.15 (right/left eyes, ) dB/year in the control group (, resp.). In both eyes, however, no statistical difference was observed between the two groups for the ΔCENT4 values. Conclusion. Although we confirmed that nilvadipine significantly retarded the progression of the average of MD value defects in the central 10°, it was not specific for the central 2° of the visual field in RP. Mitsuru Nakazawa, Yukihiko Suzuki, Tadashi Ito, Tomomi Metoki, Takashi Kudo, and Hiroshi Ohguro Copyright © 2013 Mitsuru Nakazawa et al. All rights reserved. Changes in Frequency-Doubling Perimetry in Patients with Type I Diabetes prior to Retinopathy Mon, 11 Nov 2013 16:08:54 +0000 Purpose. To evaluate the ability of frequency-doubling technology (FDT) perimetry in detecting visual field defects in young adults with type I diabetes prior to retinopathy or with minor retinovascular changes. Methods. This comparative cross-sectional study included 30 healthy subjects and 73 age-matched patients with type I diabetes mellitus. All subjects underwent a full ocular examination including an FDT with the threshold C-20-5 strategy. Only one eye per subject was randomly included in the statistical analysis. FDT results and time to perform the test were compared between the groups. Results. The mean age was 27.1 years in the control group and 26.6 years in the diabetic group (). The mean period from the onset of diabetes was years, while minimal retinovascular changes were observed in 18 eyes. Mean deviation of FDT did not differ between the groups. Although global indices of FDT were within normal limits, pattern standard deviation of FDT was higher in the diabetic group (). The area under the receiver operating characteristic curve was 0.647 for pattern standard deviation of FDT (standard error = 0.052; ). Conclusion. FDT can detect retinal dysfunctions in diabetic patients prior to the onset of significant vascular complications. Isabel Pinilla, Antonio Ferreras, Miriam Idoipe, Ana I. Sanchez-Cano, Diana Perez-Garcia, Laura X. Herrera, Maria J. Pinilla, and Emilio Abecia Copyright © 2013 Isabel Pinilla et al. All rights reserved. Ocular Dominance and Visual Function Testing Mon, 11 Nov 2013 15:17:37 +0000 Purpose. To show the distribution of ocular dominance as measured with sensory and eye sighting methods and its potential relationship with high and low contrast LogMAR visual acuity in presbyopic subjects. Method. Forty-four presbyopes (48.5 ± 3.5 years) participated in this study. Ocular dominance was determined by eye sighting (hole-in-card) and sensorial (+1.50 D lens induced blur) methods. According to the dominance detected with each method (RE: right eye or LE: left eye), patients were classified in dominance type 1 (RE/RE), type 2 (RE/LE), type 3 (LE/RE) and type 4 (LE/LE). Results. Baseline refractive error (MSE) was RE:−0.36 ± 1.67 D and LE:−0.35 ± 1.85 D (). RE was the dominant eye in 61.4% and 70.5% of times as obtained from sensorial and sighting methods, respectively. Most frequent dominance was of type 1 (52.3%), in this case the RE showed statistically significant better distance low contrast LogMAR VA (0.04 LogMAR units) compared to the LE (). Conclusions. The dominance was more frequent in RE in this sample. The eye sighting and sensorial methods to define ocular dominance agreed in more than half of cases. Amount of MSE was not significantly different between dominant and non-dominant eye. But in case of right dominance, the RE presented better distance low contrast VA compared to the LE. D. Lopes-Ferreira, H. Neves, A. Queiros, M. Faria-Ribeiro, S. C. Peixoto-de-Matos, and J. M. González-Méijome Copyright © 2013 D. Lopes-Ferreira et al. All rights reserved. Epiretinal Membranes in Patients with Uveitis: Morphological and Functional Analysis with Spectral Domain Optical Coherence Tomography Tue, 05 Nov 2013 10:40:10 +0000 Purpose. To correlate the uveitic epiretinal membrane (ERM) features using spectral-domain optical coherence tomography (SD-OCT) with visual acuity (VA). Methods. Forty-one eyes of 32 patients were included in this retrospective study. SD-OCT was performed in all patients and data were collected at the time of ERM diagnosis and at the final visit. Both best corrected visual acuity (BCVA) and ERM thickness were correlated with the morphological and clinical features. Results. Final BCVA was positively correlated with male sex and the focal pattern of ERM attachment and negatively correlated with IS/OS photoreceptor junction disruption . BVCA change showed a positive correlation with the age of ERM onset but a negative correlation with IS/OS photoreceptor disruption at the ERM diagnosis and the increase of central subfield thickness (CST) . Final ERM thickness correlated with the duration of uveitis and the duration of ERM . During the follow-up, ERM thickening correlated with male sex , posterior uveitis , uveitis duration , and broad attachment pattern . Conclusions. In the uveitic ERM, VA negatively correlates with IS/OS photoreceptor junction disruption and the increase of CST. ERM thickness is influenced by longer duration of both uveitis and ERM. Ludovico Iannetti, Paolo Tortorella, Enzo D’Ambrosio, Rossela Spena, Roberta Zito, and Magda Gharbiya Copyright © 2013 Ludovico Iannetti et al. All rights reserved. Microscopic Evaluation, Molecular Identification, Antifungal Susceptibility, and Clinical Outcomes in Fusarium, Aspergillus and, Dematiaceous Keratitis Thu, 24 Oct 2013 09:39:46 +0000 Purpose. Fusarium, Aspergillus, and Dematiaceous are the most common fungal species causing keratitis in tropical countries. Herein we report a prospective study on fungal keratitis caused by these three fungal species. Methodology. A prospective investigation was undertaken to evaluate eyes with presumed fungal keratitis. All the fungal isolates () obtained from keratitis infections were identified using morphological and microscopic characters. Molecular identification using sequencing of the ITS region and antifungal susceptibility tests using microdilution method were done. The final clinical outcome was evaluated in terms of the time taken for resolution of keratitis and the final visual outcome. The results were analyzed after segregating the cases into three groups, namely, Fusarium, Aspergillus, and Dematiaceous keratitis. Results. Diagnosis of fungal keratitis was established in 73 (35.9%) cases out of 208 cases. The spectra of fungi isolated were Fusarium spp. (26.6%), Aspergillus spp. (21.6%), and Dematiaceous fungi (11.6%). The sequence of the ITS region could identify the Fusarium and Aspergillus species at the species complex level, and the Dematiaceous isolates were accurately identified. Using antifungal agents such as fluconazole, natamycin, amphotericin B, and itraconazole, the minimum inhibitory concentrations (MICs) for Fusarium spp. were >32 μg/mL, 4–8 μg/mL, 0.5–1 μg/mL, and >32 μg/mL, respectively. Antifungal susceptibility data showed that Curvularia spp. was highly resistant to all the antifungal agents. Overall, natamycin and amphotericin B were found to be the most effective antifungal agents. The comparative clinical outcomes in all cases showed that the healing response in terms of visual acuity of the Dematiaceous group was significantly good when compared with the Fusarium and Aspergillus groups (). The time required for healing in the Fusarium group was statistically significantly less when compared with the Aspergillus and Dematiaceous groups. Conclusion. This study demonstrates important differences in microscopic features of scraping material and antifungal susceptibility between the three groups. Early and accurate identification coupled with the MIC data, and thereby appropriate treatment is crucial for complete recovery. Devarshi U. Gajjar, Anuradha K. Pal, Bharat K. Ghodadra, and Abhay R. Vasavada Copyright © 2013 Devarshi U. Gajjar et al. All rights reserved. How Ocular Surface Disease Impacts the Glaucoma Treatment Outcome Wed, 09 Oct 2013 15:19:30 +0000 The treatment goals for glaucoma are lowering the intraocular pressure and preservation of vision. Topical hypotensive drops are the standard form of therapy which is often associated with some symptoms of toxicity, ocular inflammation, allergy, or ocular surface disease (OSD). OSD is a common comorbidity in glaucoma patients, and its prevalence with glaucoma increases with age. Use of topical treatment could additionally increase symptoms of OSD mostly due to preservatives added to multidose medication bottles used to reduce the risk of microbial contamination. This toxicity has been particularly associated with BAK, the most commonly used preservative which damages conjunctival and corneal epithelial cells and significantly aggravates OSD symptoms. OSD adversely affects patients’ quality of life causing discomfort and problems with vision which in turn may result in noncompliance, lack of adherence, and eventually visual impairment. In the management of glaucoma patients OSD symptoms should not be overlooked. If they are present, topical glaucoma treatment should be adapted by decreasing the amount of drops instilled daily, using BAK-free or preservative-free medication and lubricants if necessary. Awareness of the presence and importance of OSD will in turn improve patients' adherence and compliance and thus ultimately the preservation of long-term vision. Snježana Kaštelan, Martina Tomić, Kata Metež Soldo, and Jasminka Salopek-Rabatić Copyright © 2013 Snježana Kaštelan et al. All rights reserved. Repeatability and Reproducibility of Measurements Using a NT-530P Noncontact Tono/Pachymeter and Correlation of Central Corneal Thickness with Intraocular Pressure Tue, 08 Oct 2013 09:35:19 +0000 Purpose. To investigate the repeatability and reproducibility of intraocular pressure (IOP) and central corneal thickness (CCT) measurements using a noncontact tono/pachymeter (NT-530P) and to assess the correlation of CCT with IOP. Methods. Forty-six eyes of healthy volunteers were measured by two examiners. Three consecutive measurements per eye were performed. Repeatability was assessed using the coefficient of variation, and reproducibility was assessed using Bland-Altman plots. Linear correlations were used to determine agreement between CCT and noncorrected IOP and CCT and corrected IOP, which was calculated using a formula built into the NT-530P. Results. The coefficient of variation for IOP was 6.4% and for CCT was 0.4%. The 95% limits of agreement between examiners were  mmHg (range: to 2.61 mmHg) for IOP,  μm (range: to 7.64 μm) for CCT. The corrected IOP was significantly higher than the noncorrected IOP (). The noncorrected IOP significantly correlated with CCT (, ). The corrected IOP showed no significant correlation with CCT (, ). Conclusions. NT-530P offered repeatability and reproducibility in both IOP and CCT measurements. The corrected IOP calculated using the NT-530P was independent of the CCT, suggesting that this IOP may be less influenced by the central corneal thickness. Fusako Fujimura, Kazutaka Kamiya, Kazuko Fujiwara, Nobuyuki Shoji, and Kimiya Shimizu Copyright © 2013 Fusako Fujimura et al. All rights reserved. A Comparison between Tube Surgery, ND:YAG Laser and Diode Laser Cyclophotocoagulation in the Management of Refractory Glaucoma Mon, 07 Oct 2013 16:16:07 +0000 Purpose. To compare the results of intraocular pressure (IOP) reduction by 3 treatment modalities, (a) glaucoma tube implants, (b) noncontact YAG laser cyclophotocoagulation (cycloYAG), and (c) contact transscleral diode laser cyclophotocoagulation (cyclodiode), in cases of advanced glaucoma refractory to alternative treatments. Methods. A consecutive group of 45 eyes that received cycloYAG were matched against two control groups of patients who had received tube surgery or cyclodiode, each control group having been derived from a database of patients. Results. Mean pretreatment IOP improved from 41.3, 38.6, and 32.0 mmHg for the tube, cycloYAG, and cyclodiode groups, respectively, to 16.4, 22.1, and 19.3 mmHg, respectively. Treatment success was achieved in 78%, 69%, and 71% of the tube, cycloYAG, and cyclodiode groups, respectively. Visual acuity deteriorated 2 or more Snellen lines in 16%, 7%, and 9% of the patients in the tube, cycloYAG, and cyclodiode groups, respectively. Complications included retinal detachment, hypotony, and phthisis. Conclusions. All 3 methods provided acceptable IOP lowering in the short and medium term. Control of IOP was best in patients receiving tube surgery. Cyclodiode and cycloYAG treatments were similarly effective in lowering IOP. Tube surgery was associated with a greater incidence of sight threatening complications. Philip A. Bloom, Colin I. Clement, Anthony King, Baha Noureddin, Kamal Sharma, Roger A. Hitchings, and Peng T. Khaw Copyright © 2013 Philip A. Bloom et al. All rights reserved. Antioxidant Delivery Pathways in the Anterior Eye Thu, 26 Sep 2013 08:03:40 +0000 Tissues in the anterior segment of the eye are particular vulnerable to oxidative stress. To minimise oxidative stress, ocular tissues utilise a range of antioxidant defence systems which include nonenzymatic and enzymatic antioxidants in combination with repair and chaperone systems. However, as we age our antioxidant defence systems are overwhelmed resulting in increased oxidative stress and damage to tissues of the eye and the onset of various ocular pathologies such as corneal opacities, lens cataracts, and glaucoma. While it is well established that nonenzymatic antioxidants such as ascorbic acid and glutathione are important in protecting ocular tissues from oxidative stress, less is known about the delivery mechanisms used to accumulate these endogenous antioxidants in the different tissues of the eye. This review aims to summarise what is currently known about the antioxidant transport pathways in the anterior eye and how a deeper understanding of these transport systems with respect to ocular physiology could be used to increase antioxidant levels and delay the onset of eye diseases. Ankita Umapathy, Paul Donaldson, and Julie Lim Copyright © 2013 Ankita Umapathy et al. All rights reserved. Plasticity in the Human Visual Cortex: An Ophthalmology-Based Perspective Wed, 25 Sep 2013 16:26:48 +0000 Neuroplasticity refers to the ability of the brain to reorganize the function and structure of its connections in response to changes in the environment. Adult human visual cortex shows several manifestations of plasticity, such as perceptual learning and adaptation, working under the top-down influence of attention. Plasticity results from the interplay of several mechanisms, including the GABAergic system, epigenetic factors, mitochondrial activity, and structural remodeling of synaptic connectivity. There is also a downside of plasticity, that is, maladaptive plasticity, in which there are behavioral losses resulting from plasticity changes in the human brain. Understanding plasticity mechanisms could have major implications in the diagnosis and treatment of ocular diseases, such as retinal disorders, cataract and refractive surgery, amblyopia, and in the evaluation of surgical materials and techniques. Furthermore, eliciting plasticity could open new perspectives in the development of strategies that trigger plasticity for better medical and surgical outcomes. Andreia Martins Rosa, Maria Fátima Silva, Sónia Ferreira, Joaquim Murta, and Miguel Castelo-Branco Copyright © 2013 Andreia Martins Rosa et al. All rights reserved. Age-Related Changes in Trabecular Meshwork Imaging Thu, 19 Sep 2013 15:02:18 +0000 Purpose. To evaluate the normal aging effects on trabecular meshwork (TM) parameters using Fourier domain anterior segment optical coherence tomography (ASOCT) images. Patients and Methods. One eye from 45 participants with open angles was imaged. Two independent readers measured TM area, TM length, and area and length of the TM interface shadow from 3 age groups (18–40, 41–60, and 61–80). Measurements were compared using stepwise regression analysis. Results. The average TM parameters were 0.0487 () mm2 for TM area, 0.5502 () mm for TM length, 0.1623 () mm2 for TM interface shadow area, and 0.7755 () mm for TM interface shadow length. Interobserver reproducibility coefficients ranged from 0.45 (TM length) to 0.82 (TM area). TM area and length were not correlated with age. While the TM interface shadow length did not correlate with age, the TM interface shadow area increased with age. Race, sex, intraocular pressure, and gonioscopy score were not correlated with any TM parameters. Conclusion. Although the TM measurements were not correlated with age, the TM interface shadow area increased with age. Further study is required to determine whether there is any relationship between the age-related ASOCT findings of the TM interface shadow area and physiologic function. Mark E. Gold, Seema Kansara, Kundandeep S. Nagi, Nicholas P. Bell, Lauren S. Blieden, Alice Z. Chuang, Laura A. Baker, Kimberly A. Mankiewicz, and Robert M. Feldman Copyright © 2013 Mark E. Gold et al. All rights reserved. Role of Color Doppler Imaging in Early Diagnosis and Prediction of Progression in Glaucoma Tue, 17 Sep 2013 11:46:23 +0000 This longitudinal and prospective study analyzes the ability of orbital blood flow measured by color Doppler imaging (CDI) to predict glaucoma progression in patients with glaucoma risk factors. Patients with normal perimetry but having glaucoma risk factors and patients in the initial phase of glaucoma were prospectively included in the study and divided, after a five-year follow-up, into two groups: “Progression” and “No Progression” based on the changes in the Moorfields regression analysis (MRA) classification of Heidelberg retina tomograph (HRT). An orbital CDI was performed in all patients and the parameters obtained were correlated with changes in HRT. A logistic discrimination function (LDF) was calculated for ophthalmic artery (OA) and central retinal artery (CRA) parameters. Receiver operating characteristics curves (ROC) were used to assess the usefulness of LDFs to predict glaucomatous progression. A total of 71 eyes were included. End-diastolic velocity, time-averaged velocity, and resistive index in the OA and CRA were significantly different () between the Progression and No Progression groups. The area under the ROC curves calculated for both LDFs was of 0.695 (OA) and 0.624 (CRA). More studies are needed to evaluate the ability of CDI to perform early diagnosis and to predict progression in glaucoma in eyes. Fatima Jimenez-Aragon, Elena Garcia-Martin, Raquel Larrosa-Lopez, Jose M. Artigas-Martín, Pilar Seral-Moral, and Luis E. Pablo Copyright © 2013 Fatima Jimenez-Aragon et al. All rights reserved. Role of Rheum Polysaccharide in the Cytokines Produced by Peripheral Blood Monocytes in TLR4 Mediated HLA-B27 Associated AAU Mon, 16 Sep 2013 08:24:59 +0000 Purpose. To evaluate the effect of a traditional Chinese medicine, Rheum Polysaccharide (RP), on the in vitro production of tumor necrosis factor alpha (TNF-α) and interleukin-10 (IL-10) by lipopolysaccharide- (LPS-)stimulated human monocytes from HLA-B27 associated acute anterior uveitis patients of convalescence stage. Method. PBMC samples were isolated from 10 HLA-B27 associated acute anterior uveitis, incubated, respectively, and divided into 4 groups as follows: (1) controls, PBS was added in final concentration of 1 mg·L−1, (2) stimulated by LPS, LPS was added in final concentration of 1 mg·L−1, (3) stimulated by LPS + HTA125, 30 minutes before the adding of LPS in final concentration of 1 mg·L−1, the final concentration of 5 mg·L−1 of the HTA125 was added, and (4) stimulated by LPS + RP, 30 minutes before the adding of LPS in final concentration 1 mg·L−1, the final concentration 100 mg·L−1 of the RP was added. Supernatants were used to quantify the amounts of TNF-α and IL-10 released in time course using enzyme-linked immunosorbent assay (ELISA). Result. After stimulated by lps, the concentrations of TNF-α and IL-10 in culture supernatants of patients are significantly higher than control group at all time points (). Blockage of TLR-4 by HTA125 can decrease the production of TNF-α and IL-10 compared with lps group (, except at 4 h group of IL-10). Concentration of TNF-α and IL-10 also decreases in the LPS + RP group () but not so significantly as in the LPS + HTA125 group. Conclusion. As anti-TLR4 monoclonal antibodies, rheum Polysaccharide can also inhibit the secretion of cytokines produced by monocytes from HLA-B27 positive AAU patients of convalescence stage. Xuhui Liu, Xiaofeng Hu, Xiaosheng Zhang, Zhongqiu Li, and Hong Lu Copyright © 2013 Xuhui Liu et al. All rights reserved. A Prospective Profile of Visual Field Loss following Stroke: Prevalence, Type, Rehabilitation, and Outcome Mon, 09 Sep 2013 14:30:23 +0000 Aims. To profile site of stroke/cerebrovascular accident, type and extent of field loss, treatment options, and outcome. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol of visual parameters. Results. 915 patients were recruited with a mean age of 69 years (SD 14). 479 patients (52%) had visual field loss. 51 patients (10%) had no visual symptoms. Almost half of symptomatic patients () complained only of visual field loss: almost half () also had reading difficulty, blurred vision, diplopia, and perceptual difficulties. 31% () had visual field loss as their only visual impairment: 69% () had low vision, eye movement deficits, or visual perceptual difficulties. Occipital and parietal lobe strokes most commonly caused visual field loss. Treatment options included visual search training, visual awareness, typoscopes, substitutive prisms, low vision aids, refraction, and occlusive patches. At followup 15 patients (7.5%) had full recovery, 78 (39%) had improvement, and 104 (52%) had no recovery. Two patients (1%) had further decline of visual field. Patients with visual field loss had lower quality of life scores than stroke patients without visual impairment. Conclusions. Stroke survivors with visual field loss require assessment to accurately define type and extent of loss, diagnose coexistent visual impairments, and offer targeted treatment. Fiona J. Rowe, David Wright, Darren Brand, Carole Jackson, Shirley Harrison, Tallat Maan, Claire Scott, Linda Vogwell, Sarah Peel, Nicola Akerman, Caroline Dodridge, Claire Howard, Tracey Shipman, Una Sperring, Sonia MacDiarmid, and Cicely Freeman Copyright © 2013 Fiona J. Rowe et al. All rights reserved. Identifying Cell Class Specific Losses from Serially Generated Electroretinogram Components Mon, 09 Sep 2013 08:31:12 +0000 Purpose. Processing of information through the cellular layers of the retina occurs in a serial manner. In the electroretinogram (ERG), this complicates interpretation of inner retinal changes as dysfunction may arise from “upstream” neurons or may indicate a direct loss to that neural generator. We propose an approach that addresses this issue by defining ERG gain relationships. Methods. Regression analyses between two serial ERG parameters in a control cohort of rats are used to define gain relationships. These gains are then applied to two models of retinal disease. Results. The to gain is unity whereas the to and to gains are greater than unity, indicating “amplification” (). Timing relationships show amplification between to and compression for to and to , (). Application of these gains to -3-deficiency indicates that all timing changes are downstream of photoreceptor changes, but a direct pSTR amplitude loss occurs (). Application to diabetes indicates widespread inner retinal dysfunction which cannot be attributed to outer retinal changes (). Conclusions. This simple approach aids in the interpretation of inner retinal ERG changes by taking into account gain characteristics found between successive ERG components of normal animals. Christine T. O. Nguyen, Algis J. Vingrys, Vickie H. Y. Wong, and Bang V. Bui Copyright © 2013 Christine T. O. Nguyen et al. All rights reserved. Analysis of COCH and TNFA Variants in East Indian Primary Open-Angle Glaucoma Patients Mon, 26 Aug 2013 17:36:39 +0000 Glaucoma represents a heterogeneous group of optic neuropathies with a complex genetic basis. It is the second-largest cause of blindness in the world that reduces vision without warning and often without symptoms. Among 3 major subtypes of glaucoma, primary open-angle glaucoma (POAG) is the most common form. The focus of this study is to understand the molecular basis of the disease among Indian patients with respect to two genes, Cochlin (COCH) and tumor necrosis factor alpha (TNFA), selected based on reports of possible association with POAG. The genes were screened in patients and controls by PCR and direct sequencing. Although two novel changes (–450 C/T and –79 G/G) were identified in the 5′upstream region of COCH, no causal variant could be identified in either gene. –450 C/T was detected in 3 patients and 2 controls and –79 G/C in a single patient. Further, we did not observe significant association with the promoter SNPs of TNFA that had been previously reported to be associated with POAG pathogenesis. Thus, our study suggests lack of association of both COCH and TNFA with POAG pathogenesis. Subhadip Chakraborty, Suddhasil Mookherjee, Abhijit Sen, and Kunal Ray Copyright © 2013 Subhadip Chakraborty et al. All rights reserved. Spectrum of Bacterial Keratitis at a Tertiary Eye Care Centre in India Mon, 26 Aug 2013 15:35:08 +0000 Aim. To report the aetiological spectrum and susceptibility patterns of bacteria isolated from patients with corneal ulceration. Method. The microbiological data of all patients with suspected infectious corneal ulceration who presented to the ocular microbiology service at this centre between 2005 and 2012 were reviewed retrospectively. Result. Microorganisms were recovered from 1665 (77%) of the 2170 ulcers. Bacterial isolates accounted for 1205 of the organisms isolated. The most common bacterial pathogens isolated were various species of Staphylococcus, representing 777 (64.5%), followed by Staphylococcus spp. (148; 12.3%) and Pseudomonas aeruginosa (117; 9.7%). High percentages of Gram-positive bacteria were susceptible to gatifloxacin (>94%), followed by ofloxacin and moxifloxacin. Almost 90% of Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin and moxifloxacin. Sixty-two (44%) of 140 isolates of Streptococcus pneumoniae, 79 (14.8%) of 534 isolates of Staphylococcus epidermidis, and 33 (14%) of 234 isolates of Staphylococcus aureus were resistant to three or more antibiotics. Conclusion. Staphylococcus spp. were the most common bacterial pathogens isolated from patients with keratitis in this setting. High percentages of Gram-positive and Gram-negative bacteria were susceptible to gatifloxacin and moxifloxacin, respectively. Interestingly, a high percentage of Streptococcus pneumoniae isolates were found to be resistant to three or more antibiotics. Jayaraman Kaliamurthy, Catti Muniswamy Kalavathy, Pragya Parmar, Christadas Arul Nelson Jesudasan, and Philip A. Thomas Copyright © 2013 Jayaraman Kaliamurthy et al. All rights reserved. Initial Dose of Three Monthly Intravitreal Injections versus PRN Intravitreal Injections of Bevacizumab for Macular Edema Secondary to Branch Retinal Vein Occlusion Mon, 26 Aug 2013 13:24:00 +0000 Purpose. To compare visual and anatomic outcomes of intravitreal bevacizumab injections administered as needed (PRN group) and initial treatment with 3 monthly injections followed by as-needed injections (3 monthly initial dose group) in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods. This retrospective study included 69 and 26 patients in the PRN and 3 monthly initial dose groups, respectively. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared between the 2 groups 6 months after initial injection. Results. At month 6, BCVA change from baseline was (mean ± standard deviation) logMAR in the PRN group and  logMAR in the 3 monthly initial dose group. Mean CRT changes were in the PRN group and  μm in the 3 monthly initial dose group at month 6. There were no statistically significant differences in BCVA or CRT changes between groups at any time point. The number of intravitreal injections over 6 months was significantly lower in the PRN group ( injections) than in the 3 monthly initial dose group ( injections; ). Conclusions. Our results suggest that as-needed intravitreal bevacizumab injections are more tolerable for patients with ME secondary to BRVO. Seong Joon Ahn, Jeeyun Ahn, Se Joon Woo, and Kyu Hyung Park Copyright © 2013 Seong Joon Ahn et al. All rights reserved. Diagnostic Procedures and Management of Dry Eye Mon, 19 Aug 2013 08:19:41 +0000 Dry eye disease or dysfunctional tear syndrome is among the most frequent diagnoses in ophthalmology. It is a multifactorial disease of the ocular surface and tear film which results in ocular discomfort, visual disturbances, and tear instability with potential damage to the cornea and conjunctiva. Risk factors for dry eye syndrome include age, sex (female gender), race, contact lens wear, environment with low humidity, systemic medications, and autoimmune disorders. The aim of this paper is to present the systematic classification, epidemiology, diagnostic procedures, and advances in the management of dry eye disease. The recent improvements in comprehending the underlying etiologic factors will inevitably improve future classifications and diagnostic abilities leading to more effective therapeutic options. Treatment of this highly prevalent condition can drastically improve the quality of life of individuals and prevent damage to the ocular surface. Snježana Kaštelan, Martina Tomić, Jasminka Salopek-Rabatić, and Branko Novak Copyright © 2013 Snježana Kaštelan et al. All rights reserved. SDOCT Thickness Measurements of Various Retinal Layers in Patients with Autosomal Dominant Optic Atrophy due to OPA1 Mutations Mon, 19 Aug 2013 08:09:54 +0000 Purpose. To specify thickness values of various retinal layers on macular spectral domain Optical Coherence Tomography (SDOCT) scans in patients with autosomal dominant optic atrophy (ADOA) compared to healthy controls. Methods. SDOCT volume scans of 7 patients with ADOA (OPA-1 mutation) and 14 healthy controls were quantitatively analyzed using manual grading software. Mean thickness values for the ETDRS grid subfields 5–8 were calculated for the spaces neurosensory retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), a combined space of inner plexiform layer/outer plexiform layer/inner nuclear layer (IPL+INL+OPL), and a combined space of outer nuclear layer/photoreceptor layers (ONL+PL). Results. ADOA patients showed statistically significant lower retinal thickness values than controls (). RNFL () and GCL thicknesses () were significantly lower in ADOA patients. There was no difference in IPL+INL+OPL and in ONL+PL thickness. Conclusion. Manual subanalysis of macular SDOCT volume scans allowed detailed subanalysis of various retinal layers. Not only RNFL but also GCL thicknesses are reduced in the macular area of ADOA patients whereas subjacent layers are not involved. Together with clinical findings, macular SDOCT helps to identify patients with suspicion for hereditary optic neuropathy before genetic analysis confirms the diagnosis. Andrea M. Schild, Tina Ristau, Julia Fricke, Antje Neugebauer, Bernd Kirchhof, Srinivas R. Sadda, and Sandra Liakopoulos Copyright © 2013 Andrea M. Schild et al. All rights reserved. Novel GUCA1A Mutations Suggesting Possible Mechanisms of Pathogenesis in Cone, Cone-Rod, and Macular Dystrophy Patients Wed, 14 Aug 2013 09:17:24 +0000 Here, we report two novel GUCA1A (the gene for guanylate cyclase activating protein 1) mutations identified in unrelated Spanish families affected by autosomal dominant retinal degeneration (adRD) with cone and rod involvement. All patients from a three-generation adRD pedigree underwent detailed ophthalmic evaluation. Total genome scan using single-nucleotide polymorphisms and then the linkage analysis were undertaken on the pedigree. Haplotype analysis revealed a 55.37 Mb genomic interval cosegregating with the disease phenotype on chromosome 6p21.31-q15. Mutation screening of positional candidate genes found a heterozygous transition c.250C>T in exon 4 of GUCA1A, corresponding to a novel mutation p.L84F. A second missense mutation, c.320T>C (p.I107T), was detected by screening of the gene in a Spanish patients cohort. Using bioinformatics approach, we predicted that either haploinsufficiency or dominant-negative effect accompanied by creation of a novel function for the mutant protein is a possible mechanism of the disease due to c.250C>T and c.320T>C. Although additional functional studies are required, our data in relation to the c.250C>T mutation open the possibility that transacting factors binding to de novo created recognition site resulting in formation of aberrant splicing variant is a disease model which may be more widespread than previously recognized as a mechanism causing inherited RD. Kunka Kamenarova, Marta Corton, Blanca García-Sandoval, Patricia Fernández-San Jose, Valentin Panchev, Almudena Ávila-Fernández, Maria Isabel López-Molina, Christina Chakarova, Carmen Ayuso, and Shomi S. Bhattacharya Copyright © 2013 Kunka Kamenarova et al. All rights reserved.