Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Prognostic Factors of Early Morphological Response to Treatment with Ranibizumab in Patients with Wet Age-Related Macular Degeneration Wed, 04 Mar 2015 09:28:06 +0000 Aim. To assess the significance of age, gender, baseline best corrected visual acuity, baseline macula thickness, and type and size of choroidal neovascularization in early morphological therapeutic response to ranibizumab treatment in patients with the wet form of age-related macular degeneration. Methods. From 09/2008 to 06/2013 we evaluated 1153 newly diagnosed, treatment-naïve patients treated with ranibizumab. Based on the morphological findings in the macula following the initial 3 injections of ranibizumab, the patients were divided into two groups based on active and inactive choroidal neovascularization. Results. After the initial 3 injections of ranibizumab, we examined the sample of 841 eyes with active CNV and 312 eyes with inactive CNV. In the inactive group, we found a statistically higher proportion of occult CNV () and lower incidence of CNV greater than 5DA () compared with the active group. We found no statistically significant difference in age, gender, baseline best corrected visual acuity, or baseline macula thickness between the inactive and active groups. Conclusion. Occult CNV and CNV smaller than 5DA are optimistic factors for a better morphological therapeutic response at the beginning of ranibizumab treatment. Oldřich Chrapek, Jiří Jarkovský, Martin Šín, Jan Studnička, Petr Kolář, Barbora Jirková, Ladislav Dušek, Šárka Pitrová, and Jiří Řehák Copyright © 2015 Oldřich Chrapek et al. All rights reserved. Proteomic Study of Retinal Proteins Associated with Transcorneal Electric Stimulation in Rats Wed, 04 Mar 2015 09:12:07 +0000 Background. To investigate how transcorneal electric stimulation (TES) affects the retina, by identifying those proteins up- and downregulated by transcorneal electric stimulation (TES) in the retina of rats. Methods. Adult Wistar rats received TES on the left eyes at different electrical currents while the right eyes received no treatment and served as controls. After TES, the eye was enucleated and the retina was isolated. The retinas were analyzed by proteomics. Results. Proteomics showed that twenty-five proteins were upregulated by TES. The identified proteins included cellular signaling proteins, proteins associated with neuronal transmission, metabolic proteins, immunological factors, and structural proteins. Conclusions. TES induced changes in expression of various functional proteins in the retina. Takashi Kanamoto, Nazariy Souchelnytskyi, Takuji Kurimoto, Yasuhiro Ikeda, Hiroaki Sakaue, Yasunari Munemasa, and Yoshiaki Kiuchi Copyright © 2015 Takashi Kanamoto et al. All rights reserved. A Review of Current Management of Vitreomacular Traction and Macular Hole Tue, 03 Mar 2015 12:50:56 +0000 The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies. A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented. Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient’s clinical course. Alfredo García-Layana, José García-Arumí, José M. Ruiz-Moreno, Lluís Arias-Barquet, Francisco Cabrera-López, and Marta S. Figueroa Copyright © 2015 Alfredo García-Layana et al. All rights reserved. Blockade of Vascular Endothelial Growth Factor Receptor 1 Prevents Inflammation and Vascular Leakage in Diabetic Retinopathy Tue, 03 Mar 2015 09:15:25 +0000 Diabetic retinopathy (DR) is a leading cause of blindness in working age adults. The objective of this study is to investigate the effects of vascular endothelial growth factor receptor 1 (VEGFR1) blockade on the complications of DR. Experimental models of diabetes were induced with streptozotocin (STZ) treatment or Insulin2 gene mutation (Akita) in mice. Protein expression and localization were examined by western blots (WB) and immunofluorescence (IF). mRNA expression was quantified by PCR array and real-time PCR. The activity of VEGFR1 signaling was blocked by a neutralizing antibody called MF1. Vascular leakage was evaluated by measuring the leakage of [3H]-mannitol tracer into the retina and the IF staining of albumin. VEGFR1 blockade significantly inhibited diabetes-related vascular leakage, leukocytes-endothelial cell (EC) adhesion (or retinal leukostasis), expression of intercellular adhesion molecule- (ICAM-) 1 protein, abnormal localization and degeneration of the tight junction protein zonula occludens- (ZO-) 1, and the cell adhesion protein vascular endothelial (VE) cadherin. In addition, VEGFR1 blockade interfered with the gene expression of 10 new cytokines and chemokines: cxcl10, il10, ccl8, il1f6, cxcl15, ccl4, il13, ccl6, casp1, and ccr5. These results suggest that VEGFR1 mediates complications of DR and targeting this signaling pathway represents a potential therapeutic strategy for the prevention and treatment of DR. Jianbo He, Hong Wang, Ying Liu, Wen Li, Dorothy Kim, and Hu Huang Copyright © 2015 Jianbo He et al. All rights reserved. Gene Therapy with Endogenous Inhibitors of Angiogenesis for Neovascular Age-Related Macular Degeneration: Beyond Anti-VEGF Therapy Tue, 03 Mar 2015 07:22:24 +0000 Age-related macular degeneration (AMD) is the leading cause of substantial and irreversible vision loss amongst elderly populations in industrialized countries. The advanced neovascular (or “wet”) form of the disease is responsible for severe and aggressive loss of central vision. Current treatments aim to seal off leaky blood vessels via laser therapy or to suppress vessel leakage and neovascular growth through intraocular injections of antibodies that target vascular endothelial growth factor (VEGF). However, the long-term success of anti-VEGF therapy can be hampered by limitations such as low or variable efficacy, high frequency of administration (usually monthly), potentially serious side effects, and, most importantly, loss of efficacy with prolonged treatment. Gene transfer of endogenous antiangiogenic proteins is an alternative approach that has the potential to provide long-term suppression of neovascularization and/or excessive vascular leakage in the eye. Preclinical studies of gene transfer in a large animal model have provided impressive preliminary results with a number of transgenes. In addition, a clinical trial in patients suffering from advanced neovascular AMD has provided proof-of-concept for successful gene transfer. In this mini review, we summarize current theories pertaining to the application of gene therapy for neovascular AMD and the potential benefits when used in conjunction with endogenous antiangiogenic proteins. Selwyn M. Prea, Elsa C. Chan, Gregory J. Dusting, Algis J. Vingrys, Bang V. Bui, and Guei-Sheung Liu Copyright © 2015 Selwyn M. Prea et al. All rights reserved. Retinal Neurodegeneration in db/db Mice at the Early Period of Diabetes Mon, 02 Mar 2015 14:32:07 +0000 Purpose. To describe both the functional and pathological alternations in neurosensory retina in a murine model of spontaneous type 2 diabetes (db/db mouse). Methods. db/db (BKS/DB−/−) mice and heterozygous littermates (as control group) at various ages (12, 16, 20, 24, and 28 weeks) were inspected with pattern electroretinogram (PERG), fundus fluorescein angiography (FFA), and optical coherence tomography (OCT). Histological markers of neuroinflammation (IBA-1 and F4/80) were evaluated by immunohistochemistry. In addition, levels of retinal ganglion cell death were measured by terminal dUTP nick-end labeling (TUNEL). Results. Significant alternations of PERG responses and increased retinal ganglion cells (RGCs) apoptosis were observed in diabetic db/db mice for 20-week period when compared with control group. IBA-1 and F4/80 expression in microglia/macrophages became evidently for 24-week period, thus supporting the PERG findings. Furthermore, obvious thinning of nasal and dorsal retina in 28-week-old db/db mice was also revealed by OCT. No visible retinal microvascular changes were detected by FFA throughout the experiments on db/db mice. Conclusions. Diabetic retina underwent neurodegenerative changes in db/db mice, which happened at retinal ganglion cell layer and inner nuclear layer. But there was no obvious abnormality in retinal vasculature on db/db mice. Qin Yang, Yidan Xu, Ping Xie, Haixia Cheng, Qinglu Song, Tu Su, Songtao Yuan, and Qinghuai Liu Copyright © 2015 Qin Yang et al. All rights reserved. Correlation of Papillomacular Nerve Fiber Bundle Thickness with Central Visual Function in Open-Angle Glaucoma Mon, 02 Mar 2015 11:57:14 +0000 Purpose. To determine the correlation of reduced retinal thickness in the central papillomacular bundle (CPB) to central visual function, including central retinal sensitivity and visual acuity, in glaucoma patients. Methods. This study enrolled 50 eyes of 50 patients with open-angle glaucoma who were carefully screened for comorbid conditions that can cause decreased central visual function, such as cataracts or macular diseases. We used a novel CPB analysis comprising a program for optical coherence tomography that measured RNFL thickness and GCC thickness in the CPB and divided lengthwise into three parts (upper, middle, and lower CPB). The relationship of these parameters, including conventional macular thickness, to visual field sensitivity in four central standard automated perimetry points (the central four thresholds) and BCVA was analyzed. Results. The two parameters most highly correlated with central four thresholds were macular GCCT and macular RNFLT. The two parameters most highly correlated with BCVA were middle CPB (mid-CPB) GCCT and mid-CPB RNFLT. A multiple regression analysis revealed that mid-CPB GCCT was an independent factor impacting central retinal thresholds and BCVA. Conclusions. Our results suggest that mid-CPB RNFLT and GCCT, parameters of a novel papillomacular bundle analysis, are candidate biomarkers of decreased central visual function in glaucomatous eyes. Wataru Kobayashi, Hiroshi Kunikata, Kazuko Omodaka, Kyousuke Togashi, Morin Ryu, Masahiro Akiba, Gaku Takeuchi, Tetsuya Yuasa, and Toru Nakazawa Copyright © 2015 Wataru Kobayashi et al. All rights reserved. Clinical Applications of Anterior Segment Optical Coherence Tomography Mon, 02 Mar 2015 09:31:37 +0000 Anterior segment optical coherence tomography (AS-OCT) was recently developed and has become a crucial tool in clinical practice. AS-OCT is a noncontact imaging device that provides the detailed structure of the anterior part of the eyes. In this review, the author will discuss the various clinical applications of AS-OCT, such as the normal findings, tear meniscus measurement, ocular surface disease (e.g., pterygium, pinguecula, and scleromalacia), architectural analysis after cataract surgery, post-LASIK keratectasia, Descemet’s membrane detachment, evaluation of corneal graft after keratoplasty, corneal deposits (corneal dystrophies and corneal verticillata), keratitis, anterior segment tumors, and glaucoma evaluation (angle assessment, morphological analysis of the filtering bleb after trabeculectomy, or glaucoma drainage device implantation surgery). The author also presents some interesting cases demonstrated via AS-OCT. Su-Ho Lim Copyright © 2015 Su-Ho Lim. All rights reserved. Sentinel Events in Ophthalmology: Experience from Hong Kong Mon, 02 Mar 2015 08:55:38 +0000 Purpose. To arouse ophthalmologists’ awareness in patient safety by reviewing sentinel events in Ophthalmology submitted to a web-based incident reporting system involving all public hospitals in Hong Kong. Methods. Sentinel events in Ophthalmology reported from November 2007 to October 2014 were identified and classified into different categories for further presentation and analysis. Key contributing factors attributing to the occurrence of the incidents were described. Suggestions aiming to prevent future occurrence of similar events were made. Relevant literature and case law were discussed. Results. Twelve sentinel events were included in this observational case series. They were classified into 4 main categories, namely “wrong eye” (5 cases, 41%), “wrong prescription” (3 cases, 25%), “wrong patient and surgery” (2 cases, 17%), and “retained surgical items” (2 cases, 17%). The key contributing factor leading to the occurrence of the incidents was largely human error. Increased staff awareness and proper time-out procedures were recommended to help prevent occurrence of these errors. Conclusion. Sentinel events in Ophthalmology do occur. Many of these incidents were attributed to human error. Surgeon’s awareness and willingness to prevent occurrence of sentinel events are warranted. Shiu Ting Mak Copyright © 2015 Shiu Ting Mak. All rights reserved. Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery Wed, 25 Feb 2015 08:35:40 +0000 Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery. Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one “head” (temporal or nasal) and MMC on the other “head.” All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study. Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (). Among eyes without recurrence, the conjunctival bed was graded higher in the MMC group than the CAU group (). Conclusion. The use of conjunctival autograft has a significantly lower long-term recurrence rate than mitomycin C in double-head pterygium surgery. Tommy C. Y. Chan, Raymond L. M. Wong, Emmy Y. M. Li, Hunter K. L. Yuen, Emily F. Y. Yeung, Vishal Jhanji, and Ian Y. H. Wong Copyright © 2015 Tommy C. Y. Chan et al. All rights reserved. The Long-Term Financial and Clinical Impact of an Electronic Health Record on an Academic Ophthalmology Practice Tue, 24 Feb 2015 12:14:55 +0000 Purpose. To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR). Methods. 191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume. Results. The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912) than before (mean = $411,420; SD = $39,366) (). Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05%) for all providers. Conclusions. This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world. Michele C. Lim, Roma P. Patel, Victor S. Lee, Patricia D. Weeks, Martha K. Barber, and Mitchell R. Watnik Copyright © 2015 Michele C. Lim et al. All rights reserved. Precision of Corneal Thickness Measurements Obtained Using the Scheimpflug-Placido Imaging and Agreement with Ultrasound Pachymetry Tue, 24 Feb 2015 09:06:31 +0000 Purpose. To assess the reliability and comparability of measuring central corneal thickness (CCT) and thinnest corneal thickness (TCT) using a new Scheimpflug-Placido analyzer (TMS-5, Japan) and ultrasound (US) pachymetry. Methods. Seventy-six healthy subjects were prospectively measured 3 times by 1 operator using the TMS-5, 3 additional consecutive scans were performed by a second operator, and ultrasound (US) pachymetry measurements were taken. The test-retest repeatability (TRT), coefficient of variation (CoV), and intraclass correlation coefficient (ICC) were calculated to evaluate intraoperator repeatability and interoperator reproducibility. Agreement among the devices was assessed using Bland-Altman plots and 95% limits of agreement (LoA). Results. The intraoperators TRT and CoV were <19 μm and 2.0%, respectively. The interoperators TRT and CoV were <12 μm and 1.0%, respectively, and ICC was >0.90. The mean CCT and TCT measurements using the TMS-5 were 15.97 μm (95% LoA from −26.42 to −5.52 μm) and 20.32 μm (95% LoA from −30.67 to −9.97 μm) smaller, respectively, than those using US pachymetry. Conclusions. The TMS-5 shows good repeatability and reproducibility for measuring CCT and TCT in normal subjects but only moderate agreement with US pachymetry results. Caution is warranted before using these techniques interchangeably. Jinhai Huang, Giacomo Savini, Chengfang Wang, Weicong Lu, Rongrong Gao, Yuanguang Li, Qinmei Wang, and Yune Zhao Copyright © 2015 Jinhai Huang et al. All rights reserved. Future Therapies of Wet Age-Related Macular Degeneration Tue, 24 Feb 2015 08:49:11 +0000 Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly population, and the prevalence of the disease increases exponentially with every decade after the age of 50 years. While VEGF inhibitors are promising drugs for treating patients with ocular neovascularization, there are limitations to their potential for improving vision in AMD patients. Thus, future therapies are required to have the potential to improve visual outcomes. This paper will summarize the future strategies and therapeutic targets that are aimed at enhancing the efficacy and duration of effect of antiangiogenic strategies. Makoto Ishikawa, Daisuke Jin, Yu Sawada, Sanae Abe, and Takeshi Yoshitomi Copyright © 2015 Makoto Ishikawa et al. All rights reserved. Update on Uveitis Management Mon, 23 Feb 2015 07:48:47 +0000 Vishali Gupta, Quan Dong Nguyen, Manfred Zierhut, and Ilknur Tugal-Tutkun Copyright © 2015 Vishali Gupta et al. All rights reserved. The Prevalence of Age-Related Eye Diseases and Cataract Surgery among Older Adults in the City of Lodz, Poland Thu, 19 Feb 2015 13:50:14 +0000 Purpose. To determine the prevalence of age-related eye diseases and cataract surgery among older adults in the city of Lodz, in central Poland. Material and Methods. The study design was cross-sectional and observational study. A total of 1107 women and men of predominantly Caucasian origin were successfully enumerated and recruited for the study. All selected subjects were interviewed and underwent detailed ophthalmic examinations. Results. Overall 8.04% (95% CI 6.44–9.64) subjects had cataract surgery in either eye. After excluding subjects with bilateral cataract surgery, the prevalence of cataract was 12.10% (95% CI 10.18–14.03). AMD was found in 4.33% (95% CI 3.14–5.54 ) of all subjects. Of them 3.25% (95% CI 2.21–4.30 ) had early AMD and 1.08% (95% CI 0.47–1.69) had late AMD. Various types of glaucoma were diagnosed in 5.51% (95% CI 4.17–6.85) of subjects and 2.62% (95% CI 1.68–3.56) had OHT. The prevalence rates of DR and myopic macular degeneration were 1.72% (95% CI 0.95–2.48) and 0.45% (95% CI 0.06–0.85), respectively. All multiple logistic regression models were only significantly associated with older age. The highest rate of visual impairment was observed among subjects with retinal diseases. Conclusions. The study revealed high prevalence of age-related eye diseases in this older population. Michal Szymon Nowak and Janusz Smigielski Copyright © 2015 Michal Szymon Nowak and Janusz Smigielski. All rights reserved. Clinical and Spectral-Domain Optical Coherence Tomography Findings of Patients with Incomplete Visual Recovery after Anatomically Successful Retinal Detachment Surgery Mon, 16 Feb 2015 14:04:32 +0000 Purpose. To identify causes of incomplete visual recovery in patients with anatomically successful retinal detachment surgery. Methods. This was a retrospective study of 61 eyes of 61 patients with at least 12-month follow-up and complete preoperative, intraoperative, and postoperative record. Postoperative visual acuity (VA) more than 0.18 logMAR was considered as incomplete visual recovery. Complete ophthalmic examination and Spectral-Domain OCT (SD-OCT) imaging were performed at last follow-up. Results. Twenty-nine eyes (47.5%) had a postoperative VA < 0.18 logMAR and 32 eyes (52.5%) had a postoperative VA ≥ 0.18 logMAR. Mean follow-up was 32.8 ± 17.3 months. Incomplete visual recovery was strongly correlated with presence of macular pathology (P = 0.002), a detached macula preoperatively (P = 0.02), retinotomy (P = 0.025), and pars plana vitrectomy and use of silicon oil as a tamponade agent (P = 0.009). Also, although there was a strong correlation between ellipsoid zone disruption and incomplete visual recovery, a distinct, more course pathology could be identified in all cases of poor visual recovery related to edema, thickening, or atrophy of the macula. Conclusion. The careful postoperative evaluation of the macula using biomicroscopy and SD-OCT can help in diagnosis of alterations that can be associated with incomplete visual recovery. Miltiadis K. Tsilimbaris, Aikaterini Chalkia, Chrysanthi Tsika, Anastasios Anastasakis, and Georgios A. Kontadakis Copyright © 2015 Miltiadis K. Tsilimbaris et al. All rights reserved. First Attempt to Implement Ophthalmia Neonatorum Prophylaxis in Angola: Microorganisms, Efficacy, and Obstacles Mon, 16 Feb 2015 06:44:17 +0000 Purpose. To determine the efficacy of povidone-iodine (P-I) prophylaxis for ophthalmia neonatorum (ON) in Angola and to document maternal prevalence and mother-to-child transmission rates. Methods. Endocervical samples from mothers and newborn conjunctival smears were analysed by multiplex polymerase chain reaction (PCR) for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG). Newborns were randomized into a noninterventional group and an interventional group that received a drop of P-I 2.5% bilaterally after conjunctival smear collection. Mothers were trained to identify signs of ON and attend a follow-up visit. Results. Forty-two newborns had ocular pathology, and 11 (4.4%) had clinical signs of ON at the time of delivery. Maternal PCR was positive for MG , CT , and NG . Six newborns were positive for CT , MG , and NG . Mother-to-child transmission rates were 50% for CT and NG and 10.5% for MG. Only 16 newborns returned for follow-up. Conclusions. Lack of maternal compliance prevented successful testing of prophylactic P-I efficacy in ON prevention. Nevertheless, we documented the prevalence and mother-to-child transmission rates for CT, NG, and MG. These results emphasize the need to develop an effective Angolan educational and prophylactic ON program. Isabel Alexandre, Mar Justel, Prudencio Martinez, Raul Ortiz de Lejarazu, and J. Carlos Pastor Copyright © 2015 Isabel Alexandre et al. All rights reserved. The Impact of Migraine on Posterior Ocular Structures Thu, 12 Feb 2015 12:16:56 +0000 Purpose. To investigate the thickness of the retinal nerve fiber layer (RNFL) and choroid in patients who have migraines in comparison to healthy controls. Methods. This study included 76 eyes and patients in the migraine group, 36 with aura (MWA group) and 40 without (MWoA group), and 38 eyes as control subjects. The RNFL and macular thicknesses were analysed with standard OCT protocol while choroidal thickness was analysed with EDI protocol in all subjects. Choroidal thickness was measured at the fovea, 1500 µm nasal and 1500 µm temporal to the fovea in a horizontal section. Results. The mean RNFL thickness for nasal and nasal inferior sectors was significantly thinner () in the migraineurs’ eyes than in those of the controls, as was the mean choroid thickness at the fovea and measured points (). However, the mean macular thickness was not significantly different between the groups. Conclusions. This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms and these findings are considered supportive of the relationship between glaucoma and migraine. Süleyman Demircan, Mustafa Ataş, Sevgi Arık Yüksel, Melek D. Ulusoy, İsa Yuvacı, Hasan Basri Arifoğlu, Burhan Başkan, and Gökmen Zararsız Copyright © 2015 Süleyman Demircan et al. All rights reserved. Polycystic Ovary Syndrome: Aggressive or Protective Factor for the Retina? Evaluation of Macular Thickness and Retinal Nerve Fiber Layers Using High-Definition Optical Coherence Tomography Wed, 11 Feb 2015 14:02:17 +0000 Objective. To compare macular thickness (MT) and retinal nerve fiber layers (RNFL) between women with polycystic ovary syndrome (PCOS) and healthy women. Materials and Methods. The study included 45 women with PCOS and 47 ovulatory women undergoing clinical-gynecological and ophthalmic evaluations, including measurement of MT, RNFL, and optic disc parameters using optical coherence tomography. Results. The superior RNFL around the optic nerve was significantly thicker in PCOS than in healthy volunteers (). After stratification according to insulin resistance, the temporal inner macula (TIM), the inferior inner macula (IIM), the nasal inner macula (NIM), and the nasal outer macula (NOM) were significantly thicker in PCOS group than in control group (). Both the presence of obesity associated with insulin resistance () and glucose intolerance () were associated with significant increase in the PC1 mean score, relative to MT. A significant increase in the PC2 mean score occurred when considering the presence of metabolic syndrome (). There was a significant interaction between obesity and inflammation in a decreasing mean PC2 score relative to macular RNFL thickness (). Conclusion. Decreased macular RNFL thickness and increased total MT are associated with metabolic abnormalities, while increased RNFL thickness around the optic nerve is associated with hormonal changes inherent in PCOS. José Edvan de Souza-Júnior, Carlos Alexandre de Amorim Garcia, Elvira Maria Mafaldo Soares, Técia Maria Oliveira Maranhão, Telma Maria Araújo Moura Lemos, and George Dantas Azevedo Copyright © 2015 José Edvan de Souza-Júnior et al. All rights reserved. Full-Thickness Retinochoroidal Incision in the Management of Central Retinal Vein Occlusion Thu, 05 Feb 2015 07:33:59 +0000 Purpose. To evaluate the clinical outcomes in patients with central retinal vein occlusion (CRVO) treated with full-thickness retinochoroidal incisions and to compare whether there is difference in treatment response in ischemic and nonischemic CRVO. Methods. Retrospective study of patients of CRVO receiving full-thickness retinochoroidal incisions in Changhua Christian Hospital. Fluorescein angiography (FA), slit-lamp biomicroscopy, indirect funduscopy, best corrected visual acuity, and central macular thickness (CMT) measured by optical coherence tomography were performed pre- and postoperatively. Patients were divided into an ischemic and nonischemic group according to the findings of FA. Patients were followed up for at least 1 year. Results. Twenty-eight eyes (14 ischemic and 14 nonischemic CRVO) were included. Functional retinochoroidal venous anastomosis (RCVA) was achieved in 48 of the 65 retinochoroidal incisions (73.8%). Central macular thickness (CMT) and retinal hemorrhage decreased significantly after the surgery. Significant visual gain was observed postoperatively in the nonischemic group, but not in the ischemic group. Postoperative complications included vitreous hemorrhage (17.8%), neovascular glaucoma (7.1%), and preretinal fibrovasular membrane (10.7%), all of which were in the ischemic group. Conclusions. RCVA formation induced by retinochoroidal incisions could improve venous flow, and decrease CMT and retinal hemorrhage. However, only eyes with nonischemic CRVO showed visual improvement. San-Ni Chen and Ya-Chi Huang Copyright © 2015 San-Ni Chen and Ya-Chi Huang. All rights reserved. The Balanced Two-String Technique for Sulcus Intraocular Lens Implantation in the Absence of Capsular Support Mon, 02 Feb 2015 08:01:49 +0000 Purpose. To describe and explore an alternative approach for sulcus intraocular lens (IOL) implantation in the absence of capsular support. Methods. The commonly available one-piece poly(methyl methacrylate) (PMMA) lens is stabilized in the sulcus by two intraocular horizontal strings of 10/0 polypropylene suture passed through the lens dialing holes in opposite directions to achieve a mechanical balance. The horizontal strings of 10/0 polypropylene work as a rail track for the IOL optics, allowing some side to side lens adjustment even following wound closure. The stability of the IOL was tested in vitro. Six aphakic patients underwent in-sulcus IOL secondary implantation using the balanced two-string technique. Patients were followed up for a minimum of six months. Best spectacle corrected vision was assessed. Lens centration and lens tilt were measured by anterior segment optical coherence tomography (AS-OCT). Results. All patients had successful lens insertion. Best spectacle corrected visual acuity (BSCVA) improved in all patients. Lens decentration ranged between 0.21 mm and 0.9 mm (average 0.53 mm). Lens tilt ranged between 1.2° and 2.8° (average 2.17°). Conclusion. The mechanically balanced two-string technique is an alternative option for sulcus IOL implantation in absence of capsular support, allowing lens centration adjustment with no additional risks. Hesham A. Ibrahim and Heba Nabil Sabry Copyright © 2015 Hesham A. Ibrahim and Heba Nabil Sabry. All rights reserved. Comment on “The Ocular Surface Chemical Burns” Sat, 31 Jan 2015 13:07:34 +0000 Abdullah Ilhan and Umit Yolcu Copyright © 2015 Abdullah Ilhan and Umit Yolcu. All rights reserved. An Eleven-Year Retrospective Study of Endogenous Bacterial Endophthalmitis Sat, 31 Jan 2015 07:53:51 +0000 Purpose. To determine the clinical features, microbial profiles, treatment outcomes, and prognostic factors for endogenous bacterial endophthalmitis (EBE). Methods. The medical records of 27 eyes of 21 patients diagnosed with EBE for 11 years were reviewed. Collected data included age, site of infection, visual acuities (VAs), microbial profiles, and treatment regimen. Results. The mean age was 68.5 years. Gram-positive organisms accounted for 76.2%, while gram-negative ones accounted for 19.0%. Staphylococcus aureus was the most common causative organism (52.3%) of which 72.7% was methicillin-resistant S. aureus. A final VA of ≥20/40 was achieved in 44% and 20/200 or better was in 64%. Eyes with initial VA of ≥20/200 ( = 0.003) and focal involvements ( = 0.011) had significantly better final VA. Initial VA ( = 0.001) and the interval between onset of ocular symptoms and intravitreal antibiotic injection ( = 0.097) were associated with final VA in eyes receiving intravitreal antibiotics. Conclusions. EBE is generally associated with poor visual outcome; however the prognosis may depend on initial VA, extent of ocular involvement, and an interval between onset of ocular symptoms and intravitreal antibiotic injection. Early diagnosis and early intravitreal injection supplement to systemic antibiotics might lead to a relatively good visual outcome. Takashi Nishida, Kyoko Ishida, Yoshiaki Niwa, Hideaki Kawakami, Kiyofumi Mochizuki, and Kiyofumi Ohkusu Copyright © 2015 Takashi Nishida et al. All rights reserved. Acute Effect of Cigarette Smoking on Pupil Size and Ocular Aberrations: A Pre- and Postsmoking Study Thu, 29 Jan 2015 16:48:23 +0000 Aim. To evaluate the acute effects of cigarette smoking on photopic and mesopic pupil sizes and wavefront aberrations. Methods. Cigarette smoker volunteers were recruited in the study. Photopic and mesopic pupil sizes and total ocular aberrations were measured before smoking and immediately after smoking. All volunteers were asked to smoke a single cigarette containing 1.0 mg nicotine. Pupil sizes and total ocular aberrations were assessed by optical path difference scanning system (OPD-Scan II ARK-10000, NIDEK). Only the right eyes were considered for statistical analysis. The changes of pupil size and total ocular aberrations after smoking were tested for significance by Wilcoxon signed ranks test. Results. Mean photopic pupil size decreased from 3.52 ± 0.73 mm to 3.29 ± 0.58 mm after smoking. Mean mesopic pupil size was also decreased from 6.42 ± 0.75 mm to 6.14 ± 0.75 mm after smoking . There was a decrease in all the measured components of aberrations (total wavefront aberration, higher-order aberration, total coma, total trefoil, total tetrafoil, total spherical aberration and total higher-order aberration) after smoking; however the differences were insignificant for all . Conclusion. Our results indicate that pupil constricts after smoking. On the other hand, smoking does not alter ocular aberrations. Uzeyir Erdem, Fatih C. Gundogan, Umut Aslı Dinc, Umit Yolcu, Abdullah Ilhan, and Salih Altun Copyright © 2015 Uzeyir Erdem et al. All rights reserved. Changes in Central Macular Thickness following Single Session Multispot Panretinal Photocoagulation Wed, 28 Jan 2015 11:36:13 +0000 Purpose. To determine changes in central subfield (CSF) macular thickness and best corrected visual acuity (BCVA) following single session, multispot panretinal photocoagulation (PRP). Methods. Forty eyes of 33 patients with newly diagnosed proliferative diabetic retinopathy were treated with single session, 20-millisecond, multispot PRP. Changes in central macular thickness and BCVA at 4- and 12-week follow-up were compared to baseline measurements. Results. Each eye received a mean (SD) of 2,750 (686.7) laser spots. At 4-week follow-up, there was a statistically significant 24.0 μm increase in mean CSF thickness (), with a 17.4 μm increase from baseline at 12-week follow-up (). Mean logMAR BCVA increased by 0.05 logMAR units () at 4-week follow-up. At 12-week follow-up, BCVA had almost returned to normal with only an increase of 0.02 logMAR units compared to baseline (). Macular edema occurred in 2 eyes (5%) at 12-week follow-up. Conclusions. Macular thickening occurs following single session, 20-millisecond, multispot PRP, with a corresponding, mild change in BCVA. However, the incidence of macular edema appears to be low in these patients. Single session, 20-millisecond, multispot PRP appears to be a safe treatment for patients with proliferative diabetic retinopathy. Nawat Watanachai, Janejit Choovuthayakorn, Direk Patikulsila, and Nimitr Ittipunkul Copyright © 2015 Nawat Watanachai et al. All rights reserved. Comparison of the Changes in Corneal Endothelial Cells after Pars Plana and Anterior Chamber Ahmed Valve Implant Wed, 28 Jan 2015 08:56:11 +0000 Purpose. To compare the changes in corneal endothelial cells after pars plana Ahmed glaucoma valve (AGV) implantation with those after the anterior chamber AGV implantation for refractory glaucoma. Methods. The medical records of 18 eyes with pars plana implantation of AGV (ppAGV) were reviewed retrospectively and were compared with 18 eyes with the anterior chamber AGV (acAGV) implant. The preoperative and postoperative endothelial cells, intraocular pressure (IOP), and postoperative complications during the follow-up in both groups were compared. Results. The average follow-up was 18 months. The postoperative endothelial cells in the ppAGV and acAGV groups were 2044 ± 303 and 1904 ± 324, respectively . The average percentage decrease in the endothelial cells in the ppAGV and acAGV groups at 18 months was 12.5% and 18.4%, respectively, and showed significant difference between the 2 groups . No difference in IOP control and the number of postoperative glaucoma medications was observed between the 2 groups. Conclusions. Endothelial cell damage in the ppAGV group for refractory glaucoma appeared to be lower than that in the acAGV group. Therefore, pars plana implantation of AGV may be preferred as it may have lower level of endothelial cell damage while maintaining similar level of IOP control. Ji Won Seo, Jong Yeon Lee, Dong Heun Nam, and Dae Yeong Lee Copyright © 2015 Ji Won Seo et al. All rights reserved. Efficacy and Safety of Corneal Transplantation Using Corneas from Foreign Donors versus Domestic Donors: A Prospective, Randomized, Controlled Trial Wed, 28 Jan 2015 06:38:47 +0000 Purpose. To assess the efficacy and safety of corneal transplantation using corneas from foreign donors. Methods. One hundred and eight patients needing therapeutic penetrating keratoplasty were randomly divided into 2 groups (54 cases/group): foreign group using foreign donor corneas and domestic group using domestic donor corneas. Clinical outcome and incidence of postoperative complications were compared between groups. Results. No significant difference with respect to the therapeutic outcome and postoperative Best Corrected Visual Acuity (BCVA) and neovascularization by final follow-up was observed between the two groups. The graft thickness in the foreign group was statistically higher than the domestic group at 1 month postoperatively, but not at 3, 6, and 12 months postoperatively. Corneal endothelial cell density in the domestic group was statistically higher than in the foreign group at 3, 6, and 12 months postoperatively. Corneal epithelial abnormalities in the foreign group were significantly higher than that in domestic group. The primary graft failure, incidence of graft survival, and postoperative complications such as immunologic rejection, graft infection, and secondary glaucoma were not significantly different between the two groups. Conclusions. Corneal transplantations using foreign donor corneas are as effective and safe as those using domestic donor corneas. Yingxin Chen, Congling Liao, Minghong Gao, Michael Wellington Belin, Mingwu Wang, Hai Yu, and Jing Yu Copyright © 2015 Yingxin Chen et al. All rights reserved. An Updated Meta-Analysis: Risk Conferred by Glutathione S-Transferases (GSTM1 and GSTT1) Polymorphisms to Age-Related Cataract Tue, 27 Jan 2015 12:09:19 +0000 Purpose. To study the effects of glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) polymorphisms on age-related cataract (ARC). Methods. After a systematic literature search, all relevant studies evaluating the association between GSTs polymorphisms and ARC were included. Results. Fifteen studies on GSTM1 and nine studies on GSTT1 were included in this meta-analysis. In the pooled analysis, a significant association between null genotype of GSTT1 and ARC was found (OR = 1.229, 95% CI = 1.057–1.429, and ). In subgroup analysis, the association between cortical cataract (CC) and GSTM1 null genotype was statistically significant (OR = 0.713, 95% CI = 0.598–0.850, and ). In addition, GSTM1 null genotype was significantly associated with ARC causing risk to individuals working indoors and not individuals working outdoors. The association between GSTT1 null genotype and risk of ARC was statistically significant in Asians (OR = 1.442, 95% CI = 1.137–1.830, and ) but not in Caucasians. Conclusions. GSTM1 positive genotype is associated with increased risk of CC and loses the protective role in persons who work outdoors. Considering the ethnic variation, GSTT1 null genotype is found to be associated with increased risk of ARC in Asians but not in Caucasians. Rong-feng Liao, Min-jie Ye, Cai-yuan Liu, and Dong-qing Ye Copyright © 2015 Rong-feng Liao et al. All rights reserved. Early Results of Slanted Recession of the Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency Mon, 26 Jan 2015 11:10:31 +0000 The aim of this study was to evaluate the efficacy of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. This prospective study included 31 patients who underwent slanted lateral rectus recession for intermittent exotropia with convergence insufficiency between June 2010 and June 2012. Following parameters were recorded and analyzed: patient sex, age, preoperative and postoperative near and distance ocular alignment, and changes in stereopsis. The mean age of the patients was 9.2 years. The preoperative mean deviation angle was 32.4 PD at distance and 43.4 PD at near. After 6 months, slanted lateral rectus recession reduced the deviation angles to 2 PD at distance and 3.4 PD at near. In addition, the mean difference between distance and near deviation angles was significantly reduced from 11 PD to 1.4 PD at 6 months postoperatively. Slanted lateral rectus recession for intermittent exotropia with convergence insufficiency in children successfully reduced the distance and near exodeviations and the near-distance difference without increasing the risk of long-term postoperative esotropia or diplopia. Bo Young Chun and Kyung Min Kang Copyright © 2015 Bo Young Chun and Kyung Min Kang. All rights reserved. Alterations Induced by Bangerter Filters on the Visual Field: A Frequency Doubling Technology and Standard Automated Perimetry Study Tue, 20 Jan 2015 11:29:56 +0000 Purpose. To investigate the effects of Bangerter filters on the visual field in healthy and in amblyopic patients. Materials and Methods. Fifteen normal adults and fifteen anisometropic amblyopia patients were analysed with standard automated perimetry (SAP) and frequency doubling technology (FDT) at baseline and with filters 0.8 and 0.1. Results. With 0.1 filter in SAP there was an increase of MD compared with controls (−10.24 ± 1.09 dB) in either the amblyopic (−11.34 ± 2.06 dB; ) or sound eyes (−11.34 ± 1.66 dB; ). With filters 0.8 the PSD was increased in the amblyopic eyes (2.09 ± 0.70 dB; ) and in the sound eyes (1.92 ± 0.29 dB; ) compared with controls. The FDT-PSD values in the control group were increased with the interposition of the filters compared to baseline (0.8; and 0.1; ). We did not find significant differences of the baseline PSD between amblyopic eyes (3.80 ± 2.21 dB) and the sound eyes (4.33 ± 1.31 dB) and when comparing the filters 0.8 (4.55 ± 1.50 versus 4.53 ± 1.76 dB) and 0.1 (4.66 ± 1.80 versus 5.10 ± 2.04 dB). Conclusions. The use of Bangerter filters leads to a reduction of the functionality of the magno- and parvocellular pathway. Costantino Schiavi, Filippo Tassi, Alessandro Finzi, and Mauro Cellini Copyright © 2015 Costantino Schiavi et al. All rights reserved.