ISRN Ophthalmology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Laser-Assisted Subepithelial Keratectomy versus Laser In Situ Keratomileusis in Myopia: A Systematic Review and Meta-Analysis Thu, 12 Jun 2014 13:10:20 +0000 This systematic review was to compare the clinical outcomes between laser-assisted subepithelial keratectomy (LASEK) and laser in situ keratomileusis (LASIK) for myopia. Primary parameters included mean manifest refraction spherical equivalent (MRSE), MRSE within ±0.50 diopters, uncorrected visual acuity (UCVA) ≥20/20, and loss of ≥1 line of best-corrected visual acuity (BCVA). Secondary parameters included flap complications and corneal haze. Twelve clinical controlled trials were identified and used for comparing LASEK (780 eyes) to LASIK (915 eyes). There were no significant differences in visual and refractive outcomes between the two surgeries for low to moderate myopia. The incidence of loss of ≥1 line of BCVA was significantly higher in moderate to high myopia treated by LASEK than LASIK in the mid-term and long-term followup. The efficacy (MRSE and UCVA) of LASEK appeared to be a significant worsening trend in the long-term followup. Corneal haze was more severe in moderate to high myopia treated by LASEK than LASIK in the mid-term and long-term followup. The flap-related complications still occurred in LASIK, but the incidence was not significantly higher than that in LASEK. LASEK and LASIK were safe and effective for low to moderate myopia. The advantage of LASEK was the absence of flap-related complications, and such procedure complication may occur in LASIK and affect the visual results. The increased incidence of stromal haze and regression in LASEK significantly affected the visual and refractive results for high myopia. Li-Quan Zhao, Huang Zhu, and Liang-Mao Li Copyright © 2014 Li-Quan Zhao et al. All rights reserved. A Physiological Neural Controller of a Muscle Fiber Oculomotor Plant in Horizontal Monkey Saccades Wed, 07 May 2014 08:26:38 +0000 A neural network model of biophysical neurons in the midbrain is presented to drive a muscle fiber oculomotor plant during horizontal monkey saccades. Neural circuitry, including omnipause neuron, premotor excitatory and inhibitory burst neurons, long lead burst neuron, tonic neuron, interneuron, abducens nucleus, and oculomotor nucleus, is developed to examine saccade dynamics. The time-optimal control strategy by realization of agonist and antagonist controller models is investigated. In consequence, each agonist muscle fiber is stimulated by an agonist neuron, while an antagonist muscle fiber is unstimulated by a pause and step from the antagonist neuron. It is concluded that the neural network is constrained by a minimum duration of the agonist pulse and that the most dominant factor in determining the saccade magnitude is the number of active neurons for the small saccades. For the large saccades, however, the duration of agonist burst firing significantly affects the control of saccades. The proposed saccadic circuitry establishes a complete model of saccade generation since it not only includes the neural circuits at both the premotor and motor stages of the saccade generator, but also uses a time-optimal controller to yield the desired saccade magnitude. Alireza Ghahari and John D. Enderle Copyright © 2014 Alireza Ghahari and John D. Enderle. All rights reserved. Present and Possible Therapies for Age-Related Macular Degeneration Wed, 16 Apr 2014 11:45:24 +0000 Age-related macular degeneration (AMD) is the most common cause of blindness in the elderly population worldwide and is defined as a chronic, progressive disorder characterized by changes occurring within the macula reflective of the ageing process. At present, the prevalence of AMD is currently rising and is estimated to increase by a third by 2020. Although our understanding of the several components underpinning the pathogenesis of this condition has increased significantly, the treatment options for this condition remain substantially limited. In this review, we outline the existing arsenal of therapies available for AMD and discuss the additional role of further novel therapies currently under investigation for this debilitating disease. Muhammad Khan, Ketan Agarwal, Mohamed Loutfi, and Ahmed Kamal Copyright © 2014 Muhammad Khan et al. All rights reserved. Orbital Volumetry in Graves' Orbitopathy: Muscle and Fat Involvement in relation to Dysthyroid Optic Neuropathy Wed, 02 Apr 2014 00:00:00 +0000 Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves’ orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression were retrospectively analyzed. Thirteen patients imaged for unilateral orbital fractures served as controls. Results. The retrobulbar muscle volume was 2.1 ± 0.5 cm3 (mean ± SD) in controls, 4.3 ± 1.5 cm3 in GO without DON, and 4.7 ± 1.7 cm3 in GO with DON. The retrobulbar fat volume was 5.4 ± 1.6 cm3 in controls, 8.7 ± 8.0 cm3 in GO without DON, and 9.4 ± 3.1 cm3 in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (), but the volumes in orbits with and without DON were not significantly different. The volume of the optic nerve were similar in the 3 groups. The number of apical, coronal 2 mm thick slices with no fat was 2.9 ± 0.9 in normal orbits, it was 4.1 ± 1.0 in GO orbits without DON and 5.3 ± 0.8 in GO orbits with DON (). Conclusion. Apical muscle enlargement may be more important than orbital fat enlargement in the development of DON. However, the fact that apical crowding and muscle enlargement also occur in orbits without DON suggests that other factors also play a role in the development of DON. Moug Al-Bakri, Åse Krogh Rasmussen, Carsten Thomsen, and Peter Bjerre Toft Copyright © 2014 Moug Al-Bakri et al. All rights reserved. Aspheric Intraocular Lenses Implantation for Cataract Patients with Extreme Myopia Wed, 19 Mar 2014 13:59:49 +0000 Objective. To evaluate the postoperative visual quality of cataract patients with extreme myopia after implantation of aspheric intraocular lenses (IOLs). Methods. Thirty-three eyes were enrolled in this prospectivestudy. Eighteen eyes with an axial length longer than 28 mm were included in the extreme myopia group, and the other 15 eyes were included in the nonextreme myopia group. Phacoemulsification and aspheric IOL implantation were performed. Six months after cataract surgery, best-corrected visual acuity (BCVA), contrast sensitivity, and wavefront aberrations were measured, and subjective visual quality was assessed. Results. The BCVA improved significantly after surgery for both groups, and patients in the nonextreme myopia group achieved better postoperative BCVA due to better retinal status of the eyes. The evaluation of contrast sensitivity without glare was the same in both groups, whereas patients in the nonextreme myopia group performed better at intermediate spatial frequencies under glare conditions. The two groups did not show a significant difference in high-order aberrations. With regard to subjective visual quality, the composite scores of both groups did not differ significantly. Conclusions. Aspheric IOLs provided good visual outcomes in cataract patients with extreme myopia. These patients should undergo careful evaluation to determine the maculopathy severity level before surgery. Yanwen Fang, Yi Lu, Aizhu Miao, and Yi Luo Copyright © 2014 Yanwen Fang et al. All rights reserved. Outcomes and Control Rates for I-125 Plaque Brachytherapy for Uveal Melanoma: A Community-Based Institutional Experience Sun, 09 Mar 2014 11:40:55 +0000 Purpose. To evaluate our community-based institutional experience with plaque brachytherapy for uveal melanomas with a focus on local control rates, factors impacting disease progression, and dosimetric parameters impacting treatment toxicity. Methods and Materials. Our institution was retrospectively reviewed from 1996 to 2011; all patients who underwent plaque brachytherapy for uveal melanoma were included. Follow-up data were collected regarding local control, distant metastases, and side effects from treatment. Analysis was performed on factors impacting treatment outcomes and treatment toxicity. Results. A total of 107 patients underwent plaque brachytherapy, of which 88 had follow-up data available. Local control at 10 years was 94%. Freedom from progression (FFP) and overall survival at 10 years were 83% and 79%, respectively. On univariate analysis, there were no tumor or dosimetric treatment characteristics that were found to have a prognostic impact on FFP. Brachytherapy treatment was well tolerated, with clinically useful vision (20/200) maintained in 64% of patients. Statistically significant dosimetric relationships were established with cataract, glaucoma, and retinopathy development (greatest ). Conclusions. Treatment with plaque brachytherapy demonstrates excellent outcomes in a community-based setting. It is well tolerated and should remain a standard of care for COMS medium sized tumors. Aaron Wagner, Andy Chen, Taylor Cook, David Faber, Kirk Winward, and William Sause Copyright © 2014 Aaron Wagner et al. All rights reserved. Effects of Ocular Dominance on Contrast Sensitivity in Middle-Aged People Sun, 09 Mar 2014 09:59:02 +0000 Purpose. Our aim was to compare contrast sensitivity values of the dominant and nondominant eyes of healthy middle-aged subjects. Material and Methods. Ninety eyes of 45 healthy middle-aged subjects (30 males and 15 females) were included in this study. Patients were aged between 40 and 60 years, having uncorrected visual acuity (UCVA) of 20/25 or better (Snellen chart). Ocular dominance was determined by hole-in-the-card test. Functional acuity contrast testing (F.A.C.T.) was measured using the Optec 6500 vision testing system (Stereo Optical Co. Inc., Chicago, IL, USA) under both photopic and mesopic conditions. Results. At all spatial frequencies (1.5, 3, 6, 12, and 18 cpd), under mesopic conditions, the contrast sensitivity values of the dominant eyes were slightly greater than those of the nondominant eyes; but only 18 cpd spatial frequency measurements’ difference was statistically significant . Under photopic conditions, the contrast sensitivity values of the dominant eyes and non-dominant eyes were similar at all spatial frequencies . Conclusions. The photopic and mesopic contrast sensitivity values of dominant and nondominant eyes of healthy middle-aged people were similar at all spatial frequencies, except at mesopic 18 cpd spatial frequency. Gökhan Pekel, Neşe Alagöz, Evre Pekel, Cengiz Alagöz, and Ömer Faruk Yılmaz Copyright © 2014 Gökhan Pekel et al. All rights reserved. Optic Disc Hemorrhage after Phacoemulsification in Patients with Glaucoma Wed, 05 Mar 2014 06:49:14 +0000 Background. Optic disk hemorrhage is known to be a risk factor for glaucoma progression. Cataract surgery by phacoemulsification results in large intraocular pressure fluctuations. We aim to investigate whether phacoemulsification is associated with optic disc hemorrhage in patients with glaucoma. Methods. This is a retrospective review of consecutive university clinic based glaucoma patients undergoing phacoemulsification alone, with at least 3 visits in the year before and at least 5 visits in the year following phacoemulsification. The presence of optic disk hemorrhage was evaluated with slit lamp biomicroscopy at each clinic visit prior to and following phacoemulsification. Results. We evaluated 158 eyes of 158 subjects; 15 (9.5%) had ODH noted at least once during the 2-year study period. Four eyes had ODH identified on postoperative day 1, for a cross-sectional prevalence of 2.5%. Fourteen ODH episodes were noted preoperatively versus 12 episodes postoperatively (). Aspirin use was associated with ODH (). Conclusions. Our cross-sectional study found a prevalence of ODH immediately after CE that was similar to other published rates, and our longitudinal study did not find an increase in ODH in the year after phacoemulsification when compared to the year prior to surgery. Karine D. Bojikian, Daniel B. Moore, Philip P. Chen, and Mark A. Slabaugh Copyright © 2014 Karine D. Bojikian et al. All rights reserved. Corneal Biomechanical Properties in Different Ocular Conditions and New Measurement Techniques Tue, 04 Mar 2014 08:20:13 +0000 Several refractive and therapeutic treatments as well as several ocular or systemic diseases might induce changes in the mechanical resistance of the cornea. Furthermore, intraocular pressure measurement, one of the most used clinical tools, is also highly dependent on this characteristic. Corneal biomechanical properties can be measured now in the clinical setting with different instruments. In the present work, we review the potential role of the biomechanical properties of the cornea in different fields of ophthalmology and visual science in light of the definitions of the fundamental properties of matter and the results obtained from the different instruments available. The body of literature published so far provides an insight into how the corneal mechanical properties change in different sight-threatening ocular conditions and after different surgical procedures. The future in this field is very promising with several new technologies being applied to the analysis of the corneal biomechanical properties. Nery Garcia-Porta, Paulo Fernandes, Antonio Queiros, Jose Salgado-Borges, Manuel Parafita-Mato, and Jose Manuel González-Méijome Copyright © 2014 Nery Garcia-Porta et al. All rights reserved. Retinopathy of Prematurity in Port Harcourt, Nigeria Tue, 04 Feb 2014 11:01:51 +0000 Purpose. With many preterm babies now surviving as a result of improvement in neonatal care in Nigeria, the incidence of visual impairment/blindness as a result of retinopathy of prematurity (ROP) may rise. We describe our findings after screening starts for the first time in a 15-year-old special care baby unit so as to establish the incidence and risk factors for developing ROP. Methods. A prospective study carried out at the Special Care Baby Unit (SCBU) and Pediatric Outpatient Clinics of the University of Port Harcourt Teaching Hospital between January 1 and October 31, 2012. Fifty-three preterm babies (of 550 neonates admitted within the study period) delivered before 32 completed weeks and weighing less than 1500 g were included in the study following informed consent and the main outcome measure was the development of any stage of ROP. Results. Mean gestational age at birth was weeks. Mean birth weight was  g. Out of 550 babies admitted at SCBU, 87 of 100 preterms survived with 53 included in study. Twenty-five (47.2%) had different degrees of ROP with prevalence found to be 47.2%. Prevalence was higher (75%) in babies weighing 1300 g and those delivered before 30-week gestation (58%). Twenty-one (84%) had stage 1 no plus disease and 3 (12%) had stage 2 no plus disease. Only 1 (4%) had threshold disease in Zone 1. None had disease at stage 4 or 5 or AP-ROP. Receiving supplemental oxygen (; ), presence of sepsis (; ), multiple blood transfusions (; ), and delivery by caesarian section (; ) were significantly associated with development of ROP. There were no significant differences with gender, apneic spells, jaundice, or phototherapy. Conclusions and Relevance. All live infants with ROP were noted to regress spontaneously in this study. Though it may not be cost effective to acquire treatment facilities at the moment (the only child with treatable disease died), facilities for screening preterm infants displaying high risk features may be essential as smaller babies are saved. Adedayo O. Adio, Rosemary O. Ugwu, Chidi G. Nwokocha, and Augusta U. Eneh Copyright © 2014 Adedayo O. Adio et al. All rights reserved. Efficacy of Intraoperative Anterior Segment Optical Coherence Tomography during Descemet's Stripping Automated Endothelial Keratoplasty Sun, 02 Feb 2014 13:29:29 +0000 Purpose. To examine the graft-host interface during Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery with optical coherence tomography (OCT). Design. Prospective, interventional case series. Patients and Methods. Eight patients who underwent a DSAEK were included. A handheld OCT was used intraoperatively to examine the presence of interface fluid between the host cornea and the graft. Results. In 3 patients, no interface fluid was detected between the host cornea and the graft after the graft was attached by air injection. In 4 patients, interface fluid was detected after the graft was attached by air injection. The remaining interface fluid was drained through corneal stab incisions. One patient required a second surgery because the first surgery failed due to persistence of the interface fluid. All patients showed a complete attachment of the graft at one month after the DSAEK surgery. Conclusion. A handheld OCT is useful to detect the interface fluid between the host cornea and the graft during a DSAEK. Akio Miyakoshi, Hironori Ozaki, Mitsuya Otsuka, and Atsushi Hayashi Copyright © 2014 Akio Miyakoshi et al. All rights reserved. Phacoemulsification Surgery in Eyes with Neovascular Age-Related Macular Degeneration Wed, 22 Jan 2014 12:43:24 +0000 Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (−0.04 to 1.32) at 1 month, 0.52 (−0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (). Median CMT measured 203 μm preoperatively, which temporarily increased to 238 μm at 1 month after surgery () and then spontaneously returned to baseline, measuring 212.5 μm at 3 months postoperatively (). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively. Andre Grixti, Evangelia Papavasileiou, Dominic Cortis, Balakrishna Vineeth Kumar, and Som Prasad Copyright © 2014 Andre Grixti et al. All rights reserved. Comparison between Intravitreal Triamcinolone with Grid Laser Photocoagulation versus Bevacizumab with Grid Laser Photocoagulation Combinations for Branch Retinal Vein Occlusion Thu, 19 Dec 2013 11:34:22 +0000 Purpose. To compare the efficacy of intravitreal triamcinolone (IVT) and intravitreal bevacizumab (IVB), both combined with grid laser photocoagulation (GLP) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods. Retrospective, comparative study. The newly diagnosed patients with ME secondary to BRVO who were treated with IVT and GLP or IVB and GLP were included. The main outcome measures were changed in the best corrected visual acuity (BCVA) and central retinal thickness (CRT) from the baseline to month 24. Results. Ninety-nine eyes of 99 patients were included. The change in BCVA was not statistically different in any time points between the two groups (, for all). The change in CRT was not statistically different in any time points between the two groups (, for all). The mean number of injections at month 24 was in the IVT+GLP group and in the IVB+GLP group (). The need for cataract surgery () and secondary glaucoma () occurrence were more common in IVT group. Conclusion. Both treatment modalities were effective in the treatment of ME secondary to BRVO. The number of injections was significantly lower in the IVT group than in the IVB group; however cataract and secondary glaucoma were more frequent in the IVT+GLP group than in the IVB+GLP group. Abdullah Ozkaya, Ugur Celik, Zeynep Alkin, Miray Faiz Turan, Ahmet Taylan Yazici, and Ahmet Demirok Copyright © 2013 Abdullah Ozkaya et al. All rights reserved. Profile of Gaze Dysfunction following Cerebrovascular Accident Thu, 10 Oct 2013 09:21:34 +0000 Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud’s syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility. 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. Evaluation of Contrast Sensitivity after Single Intravitreal Triamcinolone Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion Thu, 03 Oct 2013 11:52:57 +0000 Purpose. To evaluate visual acuity (VA), contrast sensitivity (CS), and central retinal thickness (CRT) after intravitreal triamcinolone acetonide (IVT) injection for macular edema secondary to branch retinal vein occlusion (BRVO). Methods. In this prospective study, a total of 21 eyes of 21 patients were included. VA, CS, and CRT were assessed at baseline and at 1, 3, and 6 months after a single IVT injection. Results. Mean age was 64.57 ± 8.34 years. The mean baseline VA (LogMAR) increased from 1.11 ± 0.63 to 0.55 ± 0.39 (), 0.60 ± 0.40 (), and 0.78 ± 0.39 () at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 1 meter improved from 0.66 ± 0.49 to 1.11 ± 0.32 (), 0.99 ± 0.38 (), and 0.72 ± 0.37 () at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 3 meters improved from 0.34 ± 0.41 to 0.74 ± 0.41 (), 0.64 ± 0.44 (), and 0.46 ± 0.49 () at 1, 3, and 6 months, respectively. The mean baseline CRT decreased from 511 ± 146 m to 242 ± 119 m, 277 ± 131 m, and 402 ± 166 m at 1, 3, and 6 months after IVT ( for each). Conclusion. Single IVT injection improved VA and CS and reduced CRT at 1 and 3 months of treatment. VA and CS returned to baseline levels at 6 months. Tulin Aras Ogreden, Zeynep Alkin, Abdullah Ozkaya, Halil Ibrahim Demirkale, Irfan Perente, and Cengiz Aras Copyright © 2013 Tulin Aras Ogreden et al. All rights reserved. Photorefractive Keratectomy with Adjunctive Mitomycin C for Residual Error after Laser-Assisted In Situ Keratomileusis Using the Pulzar 213 nm Solid-State Laser: Early Results Sat, 28 Sep 2013 11:47:56 +0000 Purpose. To evaluate the accuracy, efficacy, stability, and safety of photorefractive keratectomy (PRK) enhancement using the Pulzar 213 nm solid-state laser (SSL) with adjunctive Mitomycin C in eyes previously treated with laser assisted in situ keratomileusis (LASIK) with residual error of refraction. Methods. This is a prospective noncomparative case series of 16 eyes of 12 patients who underwent PRK for residual refractive error after primary LASIK. Mitomycin C 0.02% was used after the PRK to prevent haze formation. Outcomes measured were pre- and postoperative manifest refraction spherical equivalent (MRSE), uncorrected (UDVA) and best-corrected distance visual acuity (CDVA), and slit lamp evidence of corneal complications. Results. The mean UDVA improved from 20/70 preoperatively to 20/30 postoperatively. The average gain in lines for the UDVA was 2.38. After six months of followup, the postoperative MRSE within 0.50 D in 56% (9) of eyes and 94% (15) eyes were within 1.0 diopters of the intended correction. No eyes developed haze all throughout the study. Conclusion. PRK enhancement with adjunctive use of Mitomycin C for the correction of residual error of refraction after LASIK using the Pulzar 213 nm solid-state laser is an accurate, effective, and safe procedure. Maya Fe Ng-Darjuan, Raymond P. Evangelista, and Archimedes Lee D. Agahan Copyright © 2013 Maya Fe Ng-Darjuan et al. All rights reserved. Incidence of Retinal Detachment after Fellow-Performed Primary Pars Plana Vitrectomy Thu, 19 Sep 2013 15:03:22 +0000 Background. Primary pars plana vitrectomy (PPV) is often performed by vitreoretinal fellows. We aimed to evaluate the incidence of retinal breaks and detachments (RD) after fellow-performed PPV. Methods. We reviewed 119 consecutive cases of standard 3-port primary PPVs on 115 patients at a teaching institution from 2003 to 2006. In all cases, the primary surgeon was a vitreoretinal fellow. Patients with previous RD were excluded. Cases were reviewed for postoperative retinal detachments, and all patients were followed for up to 1 year. Results. Intraoperative retinal breaks occurred in 5 of 119 eyes (4.2%). One break was associated with sclerotomy and 4 were not. Postoperative RD occurred in 8 of 119 eyes (6.7%). Two RDs were sclerotomy related, 5 were not, and 1 was of indeterminate origin. Conclusions. Incidence of retinal breaks and RD following primary PPV by vitreoretinal fellows is low and comparable to that of fellowship-trained surgeons. Justin T. Wilkinson, Amanda B. Richards, Dongseok Choi, Joseph E. Robertson Jr., and Christina J. Flaxel Copyright © 2013 Justin T. Wilkinson et al. All rights reserved. Lens Injury Has a Protective Effect on Photoreceptors in the RCS Rat Thu, 19 Sep 2013 13:30:34 +0000 Lens injury induced activation of retinal glia, and subsequent release of ciliary neurotrophic factor (CNTF) and leukaemia inhibitory factor (LIF) potently protect axotomised retinal ganglion cells from apoptosis and promotes axon regeneration in the injured optic nerve. The goal of the current study was to investigate if similar effects may also be applicable to rescue photoreceptors from degeneration in a model of retinitis pigmentosa. Lens injury was performed in the Royal College of Surgeons (RCS) rats at the age of one month. The survival of photoreceptors was evaluated histologically, and retinal function was analysed by electroretinography (ERG). Expression of CNTF was also analysed. Lens injury significantly enhanced the survival of photoreceptors 1 month after surgery compared to untreated controls, which was associated with an enhanced ERG response. In addition, lens injury significantly protected photoreceptors from degeneration in the contralateral eye, although to a much lesser extent. We could show that lens injury is sufficient to transiently delay the degeneration of photoreceptors in the RCS rat. The observed neuroprotective effects may be at least partially mediated by an upregulation of CNTF expression seen after lens injury. Peter Heiduschka, Daniel Renninger, Dietmar Fischer, Adrienne Müller, Sabine Hofmeister, and Ulrich Schraermeyer Copyright © 2013 Peter Heiduschka et al. All rights reserved. Postkeratoplasty Anterior and Posterior Corneal Surface Wavefront Analysis: Descemet’s Stripping Automated Endothelial Keratoplasty versus Penetrating Keratoplasty Thu, 12 Sep 2013 09:23:28 +0000 Purpose. To compare the higher-order aberrations (HOAs) due to the anterior and posterior corneal surfaces in patients that underwent either Descemet-stripping-automated-endothelial-keratoplasty (DSAEK) or penetrating keratoplasty (PK) for endothelial dysfunction and age-matched controls. Methods. This retrospective, observational, case series included 28 patients after PK, 30 patients after DSAEK, and 30 healthy controls. A Scheimpflug imaging system was used to assess the HOAs due to the anterior and posterior corneal surfaces at 4 mm and 6 mm optical zones. Total, 3rd and 4th order HOAs were considered. Intra- and intergroup differences were assessed using the Friedman and the Kruskal-Wallis tests, respectively; paired comparisons were performed using Duncan's multiple range test. Results. Total, 3rd and 4th order HOAs due to both corneal surfaces at 4 mm and 6 mm optical zones were significantly higher in the PK group, intermediate in the DSAEK group, and lower in controls (). The most important HOAs components in both PK and DSAEK groups were trefoil and coma from the anterior corneal surface () and trefoil from the posterior corneal surface (). Conclusions. The optical quality of both corneal surfaces appeared significantly higher after DSAEK than after PK, which can increase the postoperative patient's quality of vision and satisfaction. Maria L. Salvetat, Marco Zeppieri, Flavia Miani, and Paolo Brusini Copyright © 2013 Maria L. Salvetat et al. All rights reserved. Preoperative and Postoperative Optical Coherence Tomography Findings in Patients with Rhegmatogenous Retinal Detachment Involving the Macular Region Wed, 11 Sep 2013 08:56:00 +0000 Purpose. To evaluate morphologic changes of the macula, we observed eyes with rhegmatogenous retinal detachment (RRD) involving the macular region by optical coherence tomography (OCT). Subjects and Methods. We studied 26 eyes with RRD before and after surgery, assessing visual acuity, the height of retinal detachment at the fovea (HRD), and morphologic changes of the macular region. The interval between the onset and surgery was also determined. We examined the external limiting membrane (ELM) after surgery and the continuity of the inner segment-outer segment junction (IS/OS junction) of the photoreceptor layer. Results. Impairment of visual acuity was observed when HRD was over 1,000 μm, when there was outer nuclear layer edema before surgery, and when there was IS/OS junction disruption 3 months after surgery. However, 67% of eyes with a continuous ELM and IS/OS junction disruption 3 months after surgery eventually showed restoration of the continuity of IS/OS junction at 6 months. Conclusions. Impairment of visual acuity was observed in eyes with HRD  μm, preoperative outer nuclear layer edema, and IS/OS junction disruption 3 months postoperatively. It is suggested that continuity of ELM might affect restoration of IS/OS junction after surgery for retinal detachment. Asaki Matsui, Hiroshi Toshida, Rio Honda, Takahiko Seto, Toshihiko Ohta, and Akira Murakami Copyright © 2013 Asaki Matsui et al. All rights reserved. Clinicopathological Features of Dacryolithiasis in Japanese Patients: Frequent Association with Infection in Aged Patients Mon, 02 Sep 2013 11:52:16 +0000 Purpose. The purpose of this study is to elucidate the clinicopathological features of dacryolithiasis and prevalence of associated infection in Japanese patients. Materials and Methods. Out of 13,471 outclinic patients from 2006 to 2011, 268 patients were scheduled to be performed dacryocystorhinostomy (DCR) due to dacryocystitis with nasolacrimal duct obstruction. Actually 266 patients underwent dacryocystorhinostomy (DCR) and two patients were cured by only ophthalmic examination. Dacryoliths were found in 17 cases (6.3%). Among 17 cases of dacryolithiasis, three patients were male, and 14 were female. The age of the patients ranged from 32 to 82 (mean 67) years, and 13 cases (76%) were more than 65 years of age. Pathological examination disclosed the infectious agents in 9 cases (53%), and all patients with infection were more than 65 years of age. Special stains revealed colonies of fungus, suspicious of Aspergillus, in 6 cases and gram-positive rods, and suspicious of Actinomyces, in 3 cases. Conclusions. The current study showed the frequent association of infection with dacryolithiasis in aged Japanese patients. This should be taken into the consideration for the treatment of dacryolithiasis. Masabumi Kubo, Tomoki Sakuraba, and Ryuichi Wada Copyright © 2013 Masabumi Kubo et al. All rights reserved. Effect of 60 kHz and 150 kHz Femtosecond Lasers on Corneal Stromal Bed Surfaces: A Comparative Study Thu, 29 Aug 2013 15:58:24 +0000 Purpose. To compare the effect of 60 kHz and 150 kHz femtosecond (FS) laser on the corneal stromal bed surfaces (SBS). Methods. Sixteen human donor corneal tissues unsuitable for transplantation were used. Anterior and posterior lamella was obtained using 60 kHz and 150 kHz FS laser. A standard depth of 400 μm was set for anterior lamellar keratoplasty (ALK) and endothelial lamellar keratoplasty (ELK). The quality and smoothness of the SBS post-FS laser dissection were graded for statistics. Results. No intraoperative complications were found. The side cuts were straight, and the SBS appeared smoother in cuts obtained using 150 kHz. The average values of the SBS quality of the anterior lamellar cut were found to be 2.25 (±0.28) for 60 kHz and 3.125 (±0.25) for 150 kHz (). Whereas, 2 (±0.4) for 60 kHz and 2.75 (±0.28) for 150 kHz () was the quality observed in endothelial cuts. No significant difference was found between anterior and posterior cuts performed using the same FS laser (60 kHz or 150 kHz) (). Conclusions. The 60 kHz and 150 kHz FS lasers are equally effective in performing lamellar dissection for ALK and ELK. 150 kHz FS laser allows a tighter spot and layer separation which creates a slightly smoother SBS. Cristina Monterosso, Alessandro Galan, Elisabetta Böhm, Alfonso Zampini, Mohit Parekh, and Luigi Caretti Copyright © 2013 Cristina Monterosso et al. All rights reserved. Bevacizumab versus Ranibizumab on As-Needed Treatment Regimen for Neovascular Age-Related Macular Degeneration in Turkish Patients Thu, 29 Aug 2013 08:30:59 +0000 Purpose. To compare the efficacy of intravitreal bevacizumab versus ranibizumab in the treatment of neovascular age-related macular degeneration (nAMD). Methods. Retrospective, comparative study. The newly diagnosed nAMD patients who were treated with intravitreal bevacizumab or ranibizumab on an as-needed treatment regimen were included in the study. Main outcome measures were the change in best corrected visual acuity (BCVA), and central retinal thickness (CRT). Secondary outcome measures were the number of injections, and complications. Results. A total of 154 patients were included in the study. Bevacizumab group consisted of 79 patients, and ranibizumab group consisted of 74 patients. Mean follow-up time was 18.9 months, and 18.3 months in the bevacizumab and ranibizumab groups, respectively. There was not a significant difference between the two groups regarding the change in BCVA and CRT at all time points ( for all). The mean number of injections at month 12 was 4.8 and 4.7 in bevacizumab and ranibizumab groups, respectively (). No serious complications were detected in any of the groups. Conclusion. Both of the bevacizumab and ranibizumab found to be effective in the treatment of nAMD in regards of functional and anatomical outcomes with similar number of treatments and similar side effects. Abdullah Ozkaya, Zeynep Alkin, Yalcin Karakucuk, Dilek Yasa, Ahmet Taylan Yazici, and Ahmet Demirok Copyright © 2013 Abdullah Ozkaya et al. All rights reserved. Ocular Risk Factors for Exudative AMD: A Novel Semiautomated Grading System Tue, 30 Jul 2013 08:11:44 +0000 Purpose. To evaluate the contribution of the ocular risk factors in the conversion of the fellow eye of patients with unilateral exudative AMD, using a novel semiautomated grading system. Materials and Methods. Single-center, retrospective study including 89 consecutive patients with unilateral exudative AMD and ≥3 years of followup. Baseline color fundus photographs were graded using an innovative grading software, RetmarkerAMD (Critical Health SA). Results. The follow-up period was months. The occurrence of CNV was confirmed in 42 eyes (47.2%). The cumulative incidence of CNV was 23.6% at 2 years, 33.7% at 3 years, 39.3% at 5 years, and 47.2% at 10 years, with a mean annual incidence of 12.0% (95%  0.088–0.162). The absolute number of drusen in the central 1000 and 3000 μm () and the absolute number of drusen ≥125 µm in the central 3000 and 6000 µm () proved to be significant risk factors for CNV. Conclusion. The use of quantitative variables in the determination of the OR of developing CNV allowed the establishment of significant risk factors for neovascularization. The long follow-up period and the innovative methodology reinforce the value of our results. This trial is registered with NCT00801541. João Pedro Marques, Miguel Costa, Pedro Melo, Carlos Manta Oliveira, Isabel Pires, Maria Luz Cachulo, João Figueira, and Rufino Silva Copyright © 2013 João Pedro Marques et al. All rights reserved. The Role of Lumican in Ocular Disease Wed, 24 Jul 2013 10:07:56 +0000 Lumican is keratan sulfate proteoglycan of the small leucine rich proteoglycan family. Through studies in animal models lumican has been found to be critical in maintaining corneal clarity. It maintains ordered collagen fibrils which are vital in keeping the cornea transparent. It may also be important in primary open angle glaucoma influencing aqueous outflow. Lumican deficiency in mice results in increased axial length with fibromodulin deficiency and thinner sclerae. There is evidence suggesting that this characteristic may be pertinent in humans and lumican gene polymorphisms could be related to high myopia. Lumican plays a fundamental role in inflammation and wound healing. It localises macrophages to the site of corneal injury and recruits neutrophils in lipopolysaccharide-induced keratitis in mice. It has also been shown to bind lipopolysaccharide which may be critical in inflammatory diseases such as uveitis. Lumican is also important in wound healing revealing decreased synthesis in scar tissue and mediating Fas-Fas ligand interactions. It is present in human placenta and amniotic membrane suggesting that it may ensure viable amniotic membrane grafts. Lumican may also be involved in the formation of posterior capsular opacification following cataract surgery. Research into the pivotal role of lumican in the pathogenesis of ocular disease has resulted in greater understanding of the key role which proteoglycans play in human disease. Shahriar Amjadi, Kelly Mai, Peter McCluskey, and Denis Wakefield Copyright © 2013 Shahriar Amjadi et al. All rights reserved. Comparison of Octopus Semi-Automated Kinetic Perimetry and Humphrey Peripheral Static Perimetry in Neuro-Ophthalmic Cases Mon, 15 Jul 2013 12:38:56 +0000 Aim. To compare semikinetic perimetry (SKP) on Octopus 900 perimetry to a peripheral static programme with Humphrey automated perimetry. Methods. Prospective cross-section study comparing Humphrey full field (FF) 120 two zone programme to a screening protocol for SKP on Octopus perimetry. Results were independently graded for presence/absence of field defect plus type and location of defect. Results. 64 patients (113 eyes) underwent dual perimetry assessment. Mean duration of assessment for SKP was 4.54 minutes ±0.18 and for FF120 (). 80% of results were correctly matched for normal or abnormal visual fields using the I4e target versus FF120, and 73.5% were correctly matched using the I2e target versus FF120. When comparing Octopus results with combined I4e and I2e isopters to the FF120 result, a match for normal or abnormal fields was recorded in 87%. Conclusions. Humphrey perimetry test duration was generally longer than Octopus SKP. In the absence of kinetic perimetry, peripheral static suprathreshold programme options such as FF120 may be useful for detection of visual field defects. However, statokinetic dissociation may occur. Octopus SKP utilising both I4e and I2e targets provides detailed information of both the defect depth and size and may provide a more representative view of the actual visual field defect. Fiona J. Rowe, Carmel Noonan, and Melanie Manuel Copyright © 2013 Fiona J. Rowe et al. All rights reserved. New Therapeutic Targets for Intraocular Pressure Lowering Sun, 07 Jul 2013 14:37:12 +0000 Primary open-angle glaucoma (POAG) is a leading cause of irreversible and preventable blindness and ocular hypertension is the strongest known risk factor. With current classes of drugs, management of the disease focuses on lowering intraocular pressure (IOP). Despite of their use to modify the course of the disease, none of the current medications for POAG is able to reduce the IOP by more than 25%–30%. Also, some glaucoma patients show disease progression despite of the therapeutics. This paper examines the new described physiological targets for reducing the IOP. The main cause of elevated IOP in POAG is thought to be an increased outflow resistance via the pressure-dependent trabecular outflow system, so there is a crescent interest in increasing trabecular meshwork outflow by extracellular matrix remodeling and/or by modulation of contractility/TM cytoskeleton disruption. Modulation of new agents that act mainly on trabecular meshwork outflow may be the future hypotensive treatment for glaucoma patients. There are also other agents in which modulation may decrease aqueous humour production or increase uveoscleral outflow by different mechanisms from those drugs available for glaucoma treatment. Recently, a role for the ghrelin-GHSR system in the pathophysiology modulation of the anterior segment, particularly regarding glaucoma, has been proposed. A. Rocha-Sousa, J. Rodrigues-Araújo, Petra Gouveia, João Barbosa-Breda, S. Azevedo-Pinto, P. Pereira-Silva, and A. Leite-Moreira Copyright © 2013 A. Rocha-Sousa et al. All rights reserved. Clinical Outcomes of Peripheral Iridotomy in Patients with the Spectrum of Chronic Primary Angle Closure Wed, 26 Jun 2013 15:19:28 +0000 Purpose. To evaluate outcomes of peripheral iridotomy (PI) for initial management of primary angle closure suspects (PACS), chronic primary angle closure (CPAC), and chronic primary angle closure glaucoma (CPACG). Patients and Methods. Seventy-nine eyes with PACS, CPAC, or CPACG and better than 20/50 visual acuity that underwent PI as initial management were included. Eyes with previous acute angle closure attacks, laser trabeculoplasties, surgeries, or intraocular injections were excluded. Additional treatments, glaucomatous progression, intraocular pressure, visual acuity, and the number of medications were evaluated. Results. The mean followup was months (range 13.8–150.6 months). Sixty-eight eyes (86.1%) underwent additional medical, laser, or surgical treatment. Forty eyes (50.6%) underwent lens extraction due to reduced visual acuity. The mean 10× logMAR visual acuity score for all patients significantly declined from at baseline to (, ) at the last followup. Conclusions. Most patients who undergo PI for CPAC spectrum will require additional intervention for either IOP lowering or improvement of visual acuity. This suggests that a procedure that not only deepens the angle but also lowers IOP and improves visual acuity would be desirable as further intervention could be avoided. Evaluation of techniques that achieve all 3 goals is warranted. Ricardo J. Cumba, Kundandeep S. Nagi, Nicholas P. Bell, Lauren S. Blieden, Alice Z. Chuang, Kimberly A. Mankiewicz, and Robert M. Feldman Copyright © 2013 Ricardo J. Cumba et al. All rights reserved. Lens-Induced Glaucoma: The Need to Spread Awareness about Early Management of Cataract among Rural Population Tue, 25 Jun 2013 15:15:42 +0000 Purpose. To determine the clinical profile of lens-induced glaucoma (LIG), reasons for late presentation, and outcome of current management. Methods. Retrospective analysis of 50 eyes with LIG over a 6-year period between 2005 and 2011 at a tertiary care centre in rural India. Visual acuity and intraocular pressure (IOP) were assessed preoperatively and postoperatively along with postoperative complications. Results. Fifty (2.4%) of 12,004 senile cataracts operated at Pravara Rural Hospital, Loni, presented with LIG. There were 39 (78%) phacomorphic cases and 11 (22%) phacolytic glaucoma. Following cataract surgery, 21 of 50 operated eyes (42%) had visual acuity 6/60 or worse. Conclusion. The results highlight the importance of early diagnosis and treatment of visually disabling cataract. There is a need to educate both the patient and the cataract surgeon about the dangers of lens-induced glaucoma and of about poor outcome if treatment is delayed. Raghunandan Kothari, Sandeep Tathe, Pratik Gogri, and Akshay Bhandari Copyright © 2013 Raghunandan Kothari et al. All rights reserved. Association of Reticular Pseudodrusen and Early Onset Drusen Thu, 16 May 2013 09:36:02 +0000 Purpose. To report an association between reticular pseudodrusen, located above the retinal pigment epithelium (RPE), and Early Onset Drusen (EOD) as described using Spectral-Domain Optical Coherence Tomography (SD-OCT). Methods. Eight patients (16 eyes) with EOD were examined. EOD were classified into three entities called Large Colloid Drusen (LCD), Malattia Leventinese (ML), and Cuticular Drusen (CD). Best-corrected visual acuity, fundus examination, color fundus photographs, fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and SD-OCT were performed in all study patients. Results. Four patients had LCD, 2 had ML, and 2 had CD. Reticular pseudodrusen were observed with SD-OCT in all study patients; all these patients had hyperreflective lesions above and below the RPE. Conclusion. Early Onset Drusen appear to be associated with reticular pseudodrusen. SD-OCT is helpful in distinguishing the location of the deposits that are above and below the RPE in EOD. Further studies are needed to understand the role of reticular pseudodrusen in the pathophysiology of EOD. Flore De Bats, Benjamin Wolff, Martine Mauget-Faÿsse, Isabelle Meunier, Philippe Denis, and Laurent Kodjikian Copyright © 2013 Flore De Bats et al. All rights reserved.