Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Effect of Flat Cornea on Visual Outcome after LASIK Sun, 29 Nov 2015 07:11:30 +0000 Purpose. To evaluate the effect of preoperative and postoperative keratometry on the refractive outcome after laser in situ keratomileusis (LASIK) for moderate and high myopia. Methods. Records of 812 eyes (420 patients) with myopia ≥−6 D who had LASIK at Sohag Laser Center, Egypt, from January 2010 to November 2013, were retrospectively analyzed. Main outcome measures were postoperative corrected distance visual acuity (CDVA), postoperative spherical equivalence, and postoperative factor. Results. LASIK was performed in 812 eyes (mean age years). Patients were grouped according to the degree of preoperative myopia into three groups: Group 1, −6 D to −7.9 D; Group 2, −8 to −9.9 D; and Group 3, −10 to −12 D. The refractive outcome among the different myopia groups was stratified by pre- and postoperative keratometry. A trend toward greater undercorrection was noted in eyes with preoperative keratometry <43.5 D compared with those with steeper keratometry >46 D in all myopia groups. The undercorrection was also noted in postoperative keratometry groups <35 D. Conclusions. Preoperative and postoperative keratometry appeared to influence the refractive outcome especially in high myopic eyes. Engy Mohamed Mostafa Copyright © 2015 Engy Mohamed Mostafa. All rights reserved. The Prevalence and Distribution of Vitreoretinal Interface Abnormalities among Urban Community Population in China Thu, 26 Nov 2015 14:31:24 +0000 The aim of this research was to identify the prevalence and distribution of vitreoretinal interface abnormalities (VIAs) among urban community population in Shenyang, China. According to the WHO criteria, a cross-sectional study was carried out among 304 Type 2 diabetes (T2D) patients and 304 people without diabetes as control over 45 years old. The presence of VIAs was determined by standardized grading of macular optical coherence tomography (Optovue OCT; Optovue, Inc., Fremont, CA) scans and two-field fundus photographs in at least one eye. For both men and women, high prevalence of VIAs (70.79%) was observed among over 65-years-old T2D patients. Prevalence of VIAs was observed to be high among T2D patients in all age groups compared to normal subjects. Prevalence of VIAs increased with age in all subjects. Prevalence of components of VIAs was epiretinal membrane (ERM) 11.43%, posterior vitreous detachment (PVD) 17.76%, vitreomacular traction syndrome (VMT) 5.67%, macular cysts/macular edema (MC/ME) 4.61%, full-thickness macular hole (FTMH) 0.82%, and partial thickness macular hole (PTMH) 0.74% in any eye, respectively. ERM and MC/ME were more prevalent in T2D in both males and females. The results highlight the need for early detection using OCT and approaches for the prevention of VIAs of diabetes in urban community. Lei Liu, Song Yue, Jingyang Wu, Jiahua Zhang, Jie Lian, Desheng Huang, Weiping Teng, and Lei Chen Copyright © 2015 Lei Liu et al. All rights reserved. Comparison of the Effectiveness of Pars Plana Vitrectomy with and without Internal Limiting Membrane Peeling for Idiopathic Retinal Membrane Removal: A Meta-Analysis Thu, 26 Nov 2015 13:46:07 +0000 We conducted a meta-analysis of published retrospective studies and compared the effectiveness of pars plana vitrectomy with and without internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (IERM). The results revealed that patients in the IERM+ILM peeling group had better BCVA after surgery within 12 months than those in IERM peeling group. But patients in the IERM peeling group showed better BCVA in the 18th month. More retrospective studies or randomized controlled trials are required to investigate and compare the long-term effect of IERM removal with and without ILM peeling. Hanhan Liu, Shanru Zuo, Chun Ding, Xunzhang Dai, and Xiaohua Zhu Copyright © 2015 Hanhan Liu et al. All rights reserved. Optic Disc and Optic Cup Segmentation Methodologies for Glaucoma Image Detection: A Survey Wed, 25 Nov 2015 08:46:59 +0000 Glaucoma is the second leading cause of loss of vision in the world. Examining the head of optic nerve (cup-to-disc ratio) is very important for diagnosing glaucoma and for patient monitoring after diagnosis. Images of optic disc and optic cup are acquired by fundus camera as well as Optical Coherence Tomography. The optic disc and optic cup segmentation techniques are used to isolate the relevant parts of the retinal image and to calculate the cup-to-disc ratio. The main objective of this paper is to review segmentation methodologies and techniques for the disc and cup boundaries which are utilized to calculate the disc and cup geometrical parameters automatically and accurately to help the professionals in the glaucoma to have a wide view and more details about the optic nerve head structure using retinal fundus images. We provide a brief description of each technique, highlighting its classification and performance metrics. The current and future research directions are summarized and discussed. Ahmed Almazroa, Ritambhar Burman, Kaamran Raahemifar, and Vasudevan Lakshminarayanan Copyright © 2015 Ahmed Almazroa et al. All rights reserved. Safety and Biocompatibility of a New High-Density Polyethylene-Based Spherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits Tue, 24 Nov 2015 06:32:02 +0000 Purpose. To evaluate clinically and histologically the safety and biocompatibility of a new HDPE-based spherical porous orbital implants in rabbits. Methods. MEDPOR (Porex Surgical, Inc., Fairburn, GA, USA), OCULFIT I, and OCULFIT II (AJL Ophthalmic S.A., Vitoria, Spain) implants were implanted in eviscerated rabbis. Animals were randomly divided into 6 groups ( each) according to the 3 implant materials tested and 2 follow-up times of 90 or 180 days. Signs of regional pain and presence of eyelid swelling, conjunctival hyperemia, and amount of exudate were semiquantitatively evaluated. After animals sacrifice, the implants and surrounding ocular tissues were processed for histological staining and polarized light evaluation. Statistical study was performed by ANOVA and Kaplan-Meier analysis. Results. No statistically significant differences in regional pain, eyelid swelling, or conjunctival hyperemia were shown between implants and/or time points evaluated. However, amount of exudate differed, with OCULFIT I causing the smallest amount. No remarkable clinical complications were observed. Histological findings were similar in all three types of implants and agree with minor inflammatory response. Conclusions. OCULFIT ophthalmic tolerance and biocompatibility in rabbits were comparable to the clinically used MEDPOR. Clinical studies are needed to determine if OCULFIT is superior to the orbital implants commercially available. Ivan Fernandez-Bueno, Salvatore Di Lauro, Ivan Alvarez, Jose Carlos Lopez, Maria Teresa Garcia-Gutierrez, Itziar Fernandez, Eva Larra, and Jose Carlos Pastor Copyright © 2015 Ivan Fernandez-Bueno et al. All rights reserved. Effects of Zeaxanthin on Growth and Invasion of Human Uveal Melanoma in Nude Mouse Model Sun, 22 Nov 2015 09:57:16 +0000 Uveal melanoma cells were inoculated into the choroid of nude mice and treated with or without intraocular injection of zeaxanthin. After 21 days, mice were sacrificed and the eyes enucleated. Histopathological analysis was performed in hematoxylin and eosin stained frozen sections. Melanoma developed rapidly in the control group (without treatment of zeaxanthin). Tumor-bearing eye mass and tumor mass in the control group were significantly greater than those in zeaxanthin treated group. Melanoma in the controlled eyes occupied a large part of the eye, was epithelioid in morphology, and was with numerous mitotic figures. Scleral perforation and extraocular extension were observed in half of the eyes. Melanomas in zeaxanthin treated eyes were significantly smaller with many necrosis and apoptosis areas and no extraocular extension could be found. Quantitative image analysis revealed that the tumor size was reduced by 56% in eyes treated with low dosages of zeaxanthin and 92% in eyes treatment with high dosages of zeaxanthin, as compared to the controls. This study demonstrated that zeaxanthin significantly inhibits the growth and invasion of human uveal melanoma in nude mice, suggesting that zeaxanthin may be a promising agent to be explored for the prevention and treatment of uveal melanoma. Xiaoliang L. Xu, Dan-Ning Hu, Codrin Iacob, Adrienne Jordan, Sandipkumar Gandhi, Dennis L. Gierhart, and Richard Rosen Copyright © 2015 Xiaoliang L. Xu et al. All rights reserved. The Polymorphisms with Cataract Susceptibility Impair the EPHA2 Receptor Stability and Its Cytoprotective Function Thu, 19 Nov 2015 11:12:32 +0000 Despite accumulating evidence revealing susceptibility genes for age-related cataract, its pathophysiology leading to visual impairment at the cellular and molecular level remains poorly understood. Recent bioinformatic studies uncovered the association of two single nucleotide polymorphisms in human EPHA2, rs2291806 and rs1058371, with age-related cataract. Here we investigated the role of EPHA2 in counteracting oxidative stress-induced apoptosis of lens epithelial cells. The cataract-associated missense mutations resulted in the destabilization of EPHA2 receptor without altering the mRNA transcription. The cytoprotective and antiapoptotic function of EPHA2 in lens epithelial cells was abolished by the functional polymorphisms. Furthermore, our results suggest that the downstream signaling of activated EPHA2 promotes the antioxidative capacity of lens epithelial cells to eradicate the overproduction of reactive oxygen species. In contrast, the overexpression of EPHA2 with nonsynonymous mutations in the lens epithelial cells offered limited antioxidative protection against oxidative stress. Thus, our study not only sheds the light on the potential cytoprotective function of EPHA2 signaling in lens but also provides the cellular mechanisms underlying the pathogenesis of age-related cataract. Jin Yang, Dan Li, Qi Fan, Lei Cai, Xiaodi Qiu, Peng Zhou, and Yi Lu Copyright © 2015 Jin Yang et al. All rights reserved. Proteomic Analysis of the Vitreous following Experimental Retinal Detachment in Rabbits Wed, 18 Nov 2015 12:55:38 +0000 Purpose. The pathogenesis of rhegmatogenous retinal detachment (RRD) remains incompletely understood, with no clinically effective treatment for potentially severe complications such as photoreceptor cell death and proliferative vitreoretinopathy. Here we investigate the protein profile of the vitreous following experimental retinal detachment using a comparative proteomic based approach. Materials and Methods. Retinal detachment was created in the right eyes of six New Zealand red pigmented rabbits. Sham surgery was undertaken in five other rabbits that were used as controls. After seven days the eyes were enucleated and the vitreous was removed. The vitreous samples were evaluated with two-dimensional polyacrylamide gel electrophoresis and the differentially expressed proteins were identified with tandem mass spectrometry. Results. Ten protein spots were found to be at least twofold differentially expressed when comparing the vitreous samples of the sham and retinal detachment surgery groups. Protein spots that were upregulated in the vitreous following retinal detachment were identified as albumin fragments, and those downregulated were found to be peroxiredoxin 2, collagen-Iα1 fragment, and α-1-antiproteinase F. Conclusions. Proteomic investigation of the rabbit vitreous has identified a set of proteins that help further our understanding of the pathogenesis of rhegmatogenous retinal detachment and its complications. Nakul Mandal, Geoffrey P. Lewis, Steven K. Fisher, Steffen Heegaard, Jan U. Prause, Morten la Cour, Henrik Vorum, and Bent Honoré Copyright © 2015 Nakul Mandal et al. All rights reserved. Palmitoylethanolamide, a Natural Retinoprotectant: Its Putative Relevance for the Treatment of Glaucoma and Diabetic Retinopathy Wed, 18 Nov 2015 07:26:24 +0000 Retinopathy is a threat to the eyesight, and glaucoma and diabetes are the main causes for the damage of retinal cells. Recent insights pointed out a common pathogenetic pathway for both disorders, based on chronic inflammation. Palmitoylethanolamide (PEA) is an endogenous cell protective lipid. Since its discovery in 1957 as a biologically active component in foods and in many living organisms, around 500 scientific papers have been published on PEA’s anti-inflammatory and neuron-protective properties. PEA has been evaluated for glaucoma, diabetic retinopathy, and uveitis, pathological states based on chronic inflammation, respiratory disorders, and various pain syndromes in a number of clinical trials since the 70s of 20th century. PEA is available as a food supplement (PeaPure) and as diet food for medical purposes in Italy (Normast, PeaVera, and Visimast). These products are notified in Italy for the nutritional support in glaucoma and neuroinflammation. PEA has been tested in at least 9 double blind placebo controlled studies, among which two studies were in glaucoma, and found to be safe and effective up to 1.8 g/day, with excellent tolerability. PEA therefore holds a promise in the treatment of a number of retinopathies. We discuss PEA as a putative anti-inflammatory and retinoprotectant compound in the treatment of retinopathies, especially related to glaucoma and diabetes. Jan M. Keppel Hesselink, Ciro Costagliola, Josiane Fakhry, and David J. Kopsky Copyright © 2015 Jan M. Keppel Hesselink et al. All rights reserved. The Effect of Hormone Replacement Therapy on Dry Eye Syndrome Evaluated with Schirmer Test and Break-Up Time Wed, 18 Nov 2015 06:58:01 +0000 Hormone replacement therapy (HRT) for dry eye syndrome (DES) is controversial in clinical practice. The goal of this study was to review relevant studies and analyze the pooled data to determine whether HRT is effective for DES. In this study, a literature search of PubMed, Embase, and Cochrane databases up to May 2015 was performed, with the search restricted to English language publications. The studies were screened after reading the abstract and full text. Only studies related to the effect of HRT on DES were included in the meta-analysis. Results of Schirmer tests with and without anesthetics and tear break-up time (BUT) values data were extracted and entered into RevMan software to meta-analyze the overall effect of HRT on DES. A total of 43 studies were identified, and 21 of these studies were found to be related to the effect of HRT on DES. Ultimately, 5 studies were included in the final meta-analysis. The pooled results revealed that HRT can affect Schirmer test results without anesthetics but does not affect Schirmer test results with anesthetics and BUT. The results indicate that HRT might improve DES symptoms when measuring basal tear production without anesthesia. Yanhong Feng, Gang Feng, Shuli Peng, and Hui Li Copyright © 2015 Yanhong Feng et al. All rights reserved. A Comparison of Endothelial Cell Loss in Combined Cataract and MIGS (Hydrus) Procedure to Phacoemulsification Alone: 6-Month Results Tue, 17 Nov 2015 12:37:12 +0000 Purpose. To compare the corneal endothelial cell loss after phacoemulsification, alone or combined with microinvasive glaucoma surgery (MIGS), in nonglaucomatous versus primary open angle glaucoma (POAG) eyes affected by age-related cataract. Methods. 62 eyes of 62 patients were divided into group 1 (, affected by age-related cataract) and group 2 (, affected by age-related cataract and POAG). All patients underwent cataract surgery. Group 2 was divided into subgroups A (, cataract surgery alone) and B (, cataract surgery and MIGS). Prior to and 6 months after surgery the patients’ endothelium was studied. Main outcomes were CD (cell density), SD (standard deviation), CV (coefficient of variation), and 6A (hexagonality coefficient) variations after surgeries. Results. There were no significant differences among the groups concerning preoperative endothelial parameters. The differences in CD before and after surgery were significant in all groups: 9.1% in group 1, 17.24% in group 2A, and 11.71% in group 2B. All endothelial parameters did not significantly change after surgery. Conclusions. Phacoemulsification determined a loss of endothelial cells in all groups. After surgery the change in endothelial parameters after MIGS was comparable to the ones of patients who underwent cataract surgery alone. Antonio M. Fea, Giulia Consolandi, Giulia Pignata, Paola Maria Loredana Cannizzo, Carlo Lavia, Filippo Billia, Teresa Rolle, and Federico M. Grignolo Copyright © 2015 Antonio M. Fea et al. All rights reserved. Correlation of Vitreous Vascular Endothelial Growth Factor and Uric Acid Concentration Using Optical Coherence Tomography in Diabetic Macular Edema Tue, 17 Nov 2015 10:28:10 +0000 Purpose. We investigated two factors linked to diabetic macular edema (DME), vitreous and serum levels of vascular endothelial growth factor (VEGF) and uric acid (UA) in patients with DME, and compared the results with changes in optical coherence tomography (OCT) and visual acuity (VA). Methods. A prospective study of 29 eyes, 16 cystoid DME and nonproliferative diabetic retinopathy (DR) and 13 nondiabetic controls. Biochemical analysis of vitreous and serum samples was performed and OCT scans were graded according to central retinal thickness (CRT), cube volume (CV), cube average thickness (CAT), and serous retinal detachment (SRD). Results. In DME group, intravitreal concentrations of VEGF (), UA (), and total protein () were significantly higher than in control group. In DME subjects, intravitreal UA correlated significantly with intravitreal VEGF (ƍ = 0.559, ) but not with total vitreous protein and serum UA. Increased intravitreal VEGF in DME group correlated with increase in CV (ƍ = 0.515/). None of the OCT parameters correlated with the VA. Conclusions. The results suggest that the CV might be assessor of anti-VEGF therapy efficacy. Second, apart from VEGF, the role of UA in the pathogenesis and progression of DR should be considered. Libuse Krizova, Marta Kalousova, Ales Antonin Kubena, Oldrich Chrapek, Barbora Chrapkova, Martin Sin, and Tomas Zima Copyright © 2015 Libuse Krizova et al. All rights reserved. Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell Complex in Patients with Optic Neuritis or Neuromyelitis Optica Spectrum Disorders Using Optical Coherence Tomography in a Chinese Cohort Sun, 15 Nov 2015 13:26:18 +0000 We evaluate a cohort of optic neuritis and neuromyelitis optica (NMO) spectrum disorders patients in a territory hospital in China. The peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were measured using spectral-domain OCT after 6 months of acute onset. The results showed that both the peripapillary RNFL and macular GCC were significantly thinner in all optic neuritis subtypes compared to controls. In addition, the recurrent optic neuritis and NMO groups showed more severe damage on the RNFL and GCC pattern. Guohong Tian, Zhenxin Li, Guixian Zhao, Chaoyi Feng, Mengwei Li, Yongheng Huang, and Xinghuai Sun Copyright © 2015 Guohong Tian et al. All rights reserved. Dry Eye Disease following Refractive Surgery: A 12-Month Follow-Up of SMILE versus FS-LASIK in High Myopia Sun, 15 Nov 2015 11:49:06 +0000 Purpose. To compare dry eye disease following SMILE versus FS-LASIK. Design. Prospective, nonrandomised, observational study. Patients. 90 patients undergoing refractive surgery for myopia were included. 47 eyes underwent SMILE and 43 eyes underwent FS-LASIK. Methods. Evaluation of dry eye disease was conducted preoperatively and at 1, 3, 6, and 12 months postoperatively, using the Salisbury Eye Evaluation Questionnaire (SEEQ) and TBUT. Results. TBUT reduced following SMILE at 1 and 3 months () and at 1, 3, and 6 months following FS-LASIK (). TBUT was greater following SMILE than FS-LASIK at 3, 6, and 12 months (, , and , resp.). SEEQ scores increased (greater symptoms) following SMILE at 1 month () and 3 months () and at 1, 3, and 6 months following FS-LASIK (). SMILE produced lower SEEQ scores (fewer symptoms) than FS-LASIK at 1, 3, and 6 months (). Conclusion. SMILE produces less dry eye disease than FS-LASIK at 6 months postoperatively but demonstrates similar degrees of dry eye disease at 12 months. Bingjie Wang, Rajeev K. Naidu, Renyuan Chu, Jinhui Dai, Xiaomei Qu, and Hao Zhou Copyright © 2015 Bingjie Wang et al. All rights reserved. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study Thu, 12 Nov 2015 08:52:17 +0000 Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (); (2) macula-on patients with visual loss at the third month of follow-up () which were further subdivided in (3) phakic eyes (); and (4) pseudophakic eyes (). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery ( phakic eyes; pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures). Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis. Salvatore Di Lauro, Melissa Castrejón, Itziar Fernández, Jimena Rojas, Rosa M. Coco, María R. Sanabria, Enrique Rodríguez de la Rua, and J. Carlos Pastor Copyright © 2015 Salvatore Di Lauro et al. All rights reserved. Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy Wed, 11 Nov 2015 08:48:30 +0000 Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14–45 years) were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD) (interquartile range [IQR] 57.5–70) and vertical deviation was 13.5 PD (IQR 10–20). The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16), and the vertical deviation was 0 PD (IQR 0–4). The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16). All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy. Muhsin Eraslan, Eren Cerman, Sumru Onal, and Mehdi Suha Ogut Copyright © 2015 Muhsin Eraslan et al. All rights reserved. The Effects of Hemodialysis on Tear Osmolarity Tue, 10 Nov 2015 11:50:49 +0000 Aim. To determine the effects of hemodialysis (HD) on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD). Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males) with a mean age of years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis ( versus  mOsm/L, ). In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (,  ). Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (  ). Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (,  ; ,  ; and , , resp.). There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration. Muhittin Taskapili, Kubra Serefoglu Cabuk, Rukiye Aydin, Kursat Atalay, Ahmet Kirgiz, Dede Sit, and Hasan Kayabasi Copyright © 2015 Muhittin Taskapili et al. All rights reserved. Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy Sun, 08 Nov 2015 13:38:01 +0000 Purpose. To analyze optical coherence tomography angiography (OCTA) findings in eyes with central serous chorioretinopathy (CSC) and to compare them with those obtained with multimodal imaging. Methods. A series of consecutive patients diagnosed with CSC, underwent OCTA and multimodal imaging, including spectral domain OCT, fluorescein, and indocyanine green angiography. OCTA images were performed at three main depth intervals: automatically segmented outer retina, manually adjusted outer retina, and automatically segmented choriocapillaris. Results. Thirty-three eyes of 32 consecutive patients were analyzed. OCTA showed 3 main anomalies at the choriocapillaris: the presence of dark areas (19/33 eyes) which were frequently associated with serous retinal detachment, presence of dark spots (7/33 eyes) which were frequently associated with retinal pigment epithelium detachment, and presence of abnormal vessels (12/33 eyes) which were frequently, but not systematically, associated with choroidal neovascularization, as confirmed by multimodal imaging. Conclusions. OCTA revealed dark areas and dark spots, which were commonly observed. An abnormal choroidal pattern was also observed in one-third of cases, even when multimodal imaging did not evidence any choroidal neovascularization. Abnormal choroidal vessels should be interpreted with caution, and we could assume that this pathological choroidal vascular pattern observed in many CSC cases could be distinct from CNV. Eliana Costanzo, Salomon Yves Cohen, Alexandra Miere, Giuseppe Querques, Vittorio Capuano, Oudy Semoun, Ala’a El Ameen, Hassiba Oubraham, and Eric H. Souied Copyright © 2015 Eliana Costanzo et al. All rights reserved. Assessment of Corneal Biomechanical Properties by CorVis ST in Patients with Dry Eye and in Healthy Subjects Sun, 08 Nov 2015 07:50:32 +0000 Purpose. To investigate corneal biomechanical properties in patients with dry eye and in healthy subjects using Corneal Visualization Scheimpflug Technology (CorVis ST). Methods. Biomechanical parameters were measured using CorVis ST in 28 eyes of 28 patients with dry eye (dry eye group) and 26 normal subjects (control group). The Schirmer I test value, tear film break-up time (TBUT), and corneal staining score (CSS) were recorded for each eye. Biomechanical properties were compared between the two groups and bivariate correlation analysis was used to assess the relationship between biomechanical parameters and dry eye signs. Results. Only one of the ten biomechanical parameters was significantly different between the two groups. Patients in the dry eye group had significantly lower highest concavity time (HC-time) () than the control group. Correlation analysis showed a significant negative correlation between HC-time and CSS with marginal value (, ) in the dry eye group. Conclusions. The corneal biomechanical parameter of HC-time is reduced in dry eyes compared to normal eyes. There was also a very weak but significant negative correlation between HC-time and CSS in the dry eye group, indicating that ocular surface damage can give rise to a more compliant cornea in dry eyes. Qin Long, Jingyi Wang, Xue Yang, Yumei Jin, Fengrong Ai, and Ying Li Copyright © 2015 Qin Long et al. All rights reserved. Management of Ocular Diseases Using Lutein and Zeaxanthin: What Have We Learned from Experimental Animal Studies? Thu, 05 Nov 2015 13:33:32 +0000 Zeaxanthin and lutein are two carotenoid pigments that concentrated in the retina, especially in the macula. The effects of lutein and zeaxanthin on the prevention and treatment of various eye diseases, including age-related macular degeneration, diabetic retinopathy and cataract, ischemic/hypoxia induced retinopathy, light damage of the retina, retinitis pigmentosa, retinal detachment, and uveitis, have been studied in different experimental animal models. In these animal models, lutein and zeaxanthin have been reported to have beneficial effects in protecting ocular tissues and cells (especially the retinal neurons) against damage caused by different etiological factors. The mechanisms responsible for these effects of lutein and zeaxanthin include prevention of phototoxic damage by absorption of blue light, reduction of oxidative stress through antioxidant activity and free radical scavenging, and their anti-inflammatory and antiangiogenic properties. The results of these experimental animal studies may provide new preventive and therapeutic procedures for clinical management of various vision-threatening diseases. Chunyan Xue, Richard Rosen, Adrienne Jordan, and Dan-Ning Hu Copyright © 2015 Chunyan Xue et al. All rights reserved. The Safety and Efficacy of Routine Administration of Intracameral Vancomycin during Cataract Surgery Wed, 04 Nov 2015 12:11:05 +0000 Purpose. To evaluate the safety and efficacy of intracameral vancomycin during cataract surgery using a standardized dosage and delivery technique. Methods. The charts of 20,719 consecutive eyes that underwent phacoemulsification with intraocular lens implantation in a single ambulatory surgery center were retrospectively reviewed over a 5-year period. Results. The first 11,333 consecutive cases did not receive intracameral vancomycin, whereas the next 9,386 consecutive cases all received intracameral vancomycin. There were no significant differences in the baseline characteristics between the cohort of subjects who received intracameral vancomycin and the cohort of subjects that did not. There were a total of 11 subjects (0.97 cases per 1,000) that developed postoperative endophthalmitis in the group that did not receive intracameral vancomycin, whereas there were no cases of postoperative endophthalmitis in the group that received intracameral vancomycin (p = 0.0015). The overall rate of intraoperative and postoperative complications and the final postoperative visual acuities were similar among cohorts. There were no cases of toxic anterior segment syndrome occurring in either group during the study period. Conclusions. Routine administration of intracameral vancomycin during cataract surgery significantly decreased the incidence of postoperative endophthalmitis and was not associated with an increased incidence of postoperative adverse events. Sloan W. Rush, Duy Vu, and Ryan B. Rush Copyright © 2015 Sloan W. Rush et al. All rights reserved. Wide-Field Landers Temporary Keratoprosthesis in Severe Ocular Trauma: Functional and Anatomical Results after One Year Wed, 04 Nov 2015 11:53:51 +0000 Purpose. To evaluate longitudinal functional and anatomical results after combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP) using a wide-field Landers intraoperative temporary keratoprosthesis (TKP) in patients with vitreoretinal pathology and corneal opacity due to severe ocular trauma. Material and Methods. Medical records of 12 patients who had undergone PPV/PKP/KP due to severe eye trauma were analyzed. Functional (best-corrected visual acuity) and anatomic outcomes (clarity of the corneal graft, retinal attachment, and intraocular pressure) were assessed during the follow-up (mean 16 months). Results. Final visual acuities varied from NLP to CF to 2 m. Visual acuity improved in 7 cases, was unchanged in 4 eyes, and worsened in 1 eye. The corneal graft was transparent during the follow-up in 3 cases and graft failure was observed in 9 eyes. Silicone oil was used as a tamponade in all cases and retina was reattached in 92% of cases. Conclusions. Combined PPV and PKP with the use of wide-field Landers TKP allowed for surgical intervention in patients with vitreoretinal pathology coexisting with corneal wound. Although retina was attached in most of the cases, corneal graft survived only in one-fourth of patients and final visual acuities were poor. Katarzyna Nowomiejska, Dariusz Haszcz, Cesare Forlini, Matteo Forlini, Joanna Moneta-Wielgos, Ryszard Maciejewski, Tomasz Zarnowski, Anselm G. Juenemann, and Robert Rejdak Copyright © 2015 Katarzyna Nowomiejska et al. All rights reserved. The Role of the Endothelin System in the Vascular Dysregulation Involved in Retinitis Pigmentosa Tue, 03 Nov 2015 09:33:10 +0000 Retinitis pigmentosa is a clinical and genetic group of inherited retinal disorders characterized by alterations of photoreceptors and retinal pigment epithelium leading to a progressive concentric visual field restriction, which may bring about severe central vision impairment. Haemodynamic studies in patients with retinitis pigmentosa have demonstrated ocular blood flow abnormalities both in retina-choroidal and in retroocular vascular system. Moreover, several investigations have studied the augmentation of endothelin-1 plasma levels systemically in the body and locally in the eye. This might account for vasoconstriction and ischemia, typical in vascular dysregulation syndrome, which can be considered an important factor of reduction of the ocular blood flow in subjects affected by retinitis pigmentosa. Francesco Saverio Sorrentino, Claudio Bonifazzi, and Paolo Perri Copyright © 2015 Francesco Saverio Sorrentino et al. All rights reserved. Effects of Lutein and Zeaxanthin on LPS-Induced Secretion of IL-8 by Uveal Melanocytes and Relevant Signal Pathways Mon, 02 Nov 2015 12:06:12 +0000 The effects of lutein and zeaxanthin on lipopolysaccharide- (LPS-) induced secretion of IL-8 by uveal melanocytes (UM) were tested in cultured human UM. MTT assay revealed that LPS (0.01–1 μg/mL) and lutein and zeaxanthin (1–10 μM) did not influence the cell viability of cultured UM. LPS caused a dose-dependent increase of secretion of IL-8 by cultured UM. Lutein and zeaxanthin did not affect the constitutive secretion of IL-8. However, lutein and zeaxanthin decreased LPS-induced secretion of IL-8 in cultured UM in a dose-dependent manner. LPS significantly increased NF-κB levels in cell nuclear extracts and p-JNK levels in the cell lysates from UM, but not p-p38 MAPK and p-ERG. Lutein or zeaxanthin significantly reduced LPS-induced increase of NF-κB and p-JNK levels, but not p38 MAPK and ERG levels. The present study demonstrated that lutein and zeaxanthin inhibited LPS-induced secretion of IL-8 in cultured UM via JNK and NF-κB signal pathways. The anti-inflammatory effects of lutein and zeaxanthin might be explored as a therapeutic approach in the management of uveitis and other inflammatory diseases of the eye. Shih-Chun Chao, Tommaso Vagaggini, Chan-Wei Nien, Sheng-Chieh Huang, and Hung-Yu Lin Copyright © 2015 Shih-Chun Chao et al. All rights reserved. Usefulness of Implantation of Diffractive Multifocal Intraocular Lens in Eyes with Long Axial Lengths Sun, 01 Nov 2015 14:29:19 +0000 Purpose. This study retrospectively analyzed the postoperative visual functions of myopic eyes implanted with multifocal intraocular lens (IOL) to evaluate the efficacy of multifocal IOL in highly myopic eyes. Methods. We studied 61 patients (96 eyes) who were implanted with multifocal IOL ZMA00 or ZMB00 (Abbott Medical Optics). The patients were stratified into two groups by axial length: 26 mm or above ( group) and below 26 mm ( group). Postoperative corrected and uncorrected distance (5 m) and near (30 cm) visual acuity (VA), contrast sensitivity, and depth of focus were compared between two groups. Results. In the group and the group, the mean ± standard deviation uncorrected distance logMAR VA at 12-month postoperative follow-up was and , respectively; and the corrected distance VA was and , with no significant differences between two groups ( and 0.101; Mann-Whitney test). For near VA, the corresponding uncorrected VA was and ; and distance-corrected VA was and , with no significant differences between two groups (, and 0.157; Mann-Whitney test). Conclusion. The present study demonstrates that it is possible to achieve good uncorrected near and distance VA following implantation of multifocal IOL in eyes with long axial lengths. Tomoichiro Ogawa, Takuya Shiba, and Hiroshi Tsuneoka Copyright © 2015 Tomoichiro Ogawa et al. All rights reserved. Macular Thickness Assessed with Optical Coherence Tomography in Young Chinese Myopic Patients Sun, 01 Nov 2015 13:23:49 +0000 Purpose. To evaluate the variations in macular thickness in young Chinese myopic persons and the association with axial length (AL), spherical equivalence refraction (SE), age, intraocular pressure, and sex. Methods. In total, 133 young Chinese myopic subjects between 18 and 30 years of age were selected. The macular thickness was assessed using third-generation optical coherence tomography. AL, intraocular pressure, and SE were also measured. Results. The mean central foveal thickness was  µm. The macula was consistently thinner in women than in men. Central foveal thickness had a significant positive correlation with AL and a negative correlation with SE. In the inner and outer regions, the macular thickness had a positive correlation with SE and negative correlation with AL. Conclusions. The retina was thinner in women than in men. Associated with myopic progression and AL extension, the central foveal thickness increased, while the retinal thickness of the inner and outer regions decreased. Minghui Zhao, Qiang Wu, Ping Hu, and Lili Jia Copyright © 2015 Minghui Zhao et al. All rights reserved. Color Doppler Imaging Analysis of Ocular Blood Flow Velocities in Normal Tension Glaucoma Patients: A Meta-Analysis Thu, 29 Oct 2015 10:11:24 +0000 Background. To evaluate the potential diagnostic value of CDI of retrobulbar hemodynamic changes in NTG patients. Methods. Relevant publications which included PSV, EDV, and RI of OA, CRA, NPCA, and TPCA in NTG patients and normal controls measured by CDI were retrieved from the Cochrane Central Register of Controlled Trials, PubMed, the ISI Web of Knowledge, and EMBASE from 1990 to 2014. Subgroup analyses were made based on IOP-lowering medications uses. Result. In OA, there was significant decrease of PSV with moderate heterogeneity (, %) and significant decrease of EDV with significant heterogeneity (, %) in NTG patients. In CRA, similar results of PSV (, %) and EDV (, %) were detected. Significant decrease of PSV and EDV with significant heterogeneity was also found in both NPCA (, %; , %; resp.) and TPCA (, %; , %; resp.). Statistically significant increases of RI were found in CRA (, %) and TPCA (, %) with significant heterogeneities, though RI in OA (, %) and in NPCA (, %) showed no statistical changes with significant heterogeneities. Conclusions. Ischemic change of retrobulbar hemodynamics is one of the important manifestations of NTG. Hemodynamic parameters measured by CDI might be potential diagnostic tools for NTG. Shuo Xu, Shouyue Huang, Zhongjing Lin, Wangmin Liu, and Yisheng Zhong Copyright © 2015 Shuo Xu et al. All rights reserved. Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management Thu, 29 Oct 2015 07:55:41 +0000 Pseudoexfoliation syndrome (PES) is a systemic disorder caused by progressive accumulation of extracellular material over various tissues. PES usually determines increased intraocular pressure, changes in the anatomical aspects of the optic nerve, and visual field alterations leading to the diagnosis of pseudoexfoliation glaucoma (PEG). Use of topical medical treatment usually leads to poor results in terms of long-term follow-up but many surgical techniques, such as Argon Laser or Selective Laser Trabeculoplasty, have been proposed for the management of PEG affected patients. The present paper is a review on the pseudoexfoliation syndrome and pseudoexfoliation glaucoma with an update on surgical management. Pasquale Plateroti, Andrea Maria Plateroti, Solmaz Abdolrahimzadeh, and Gianluca Scuderi Copyright © 2015 Pasquale Plateroti et al. All rights reserved. The Acute Effect of Hemodialysis on Choroidal Thickness Thu, 29 Oct 2015 06:37:47 +0000 Objective. To determine the effect of hemodialysis (HD) on choroidal thickness (CT). Methods. The right eyes of 41 patients with end-stage renal disease (ESRD) undergoing HD were included. All patients underwent an ophthalmic examination, including CT measurement via optical coherence tomography, intraocular pressure (IOP), blood pressure, and body weight measurement immediately before and after a HD session. Results. Mean subfoveal choroidal thickness (SFCT) after HD decreased significantly from 254.59 ± 84.66 µm to 229.34 ± 77.79 µm . CT at the temporal and nasal regions also decreased significantly after HD (both ). IOP changes after HD were insignificant . CT difference was insignificant in patients with diabetes mellitus (DM) and without DM before and after HD, respectively ( and ). Stepwise multivariate linear regression analysis showed that diastolic blood pressure was the best fitted factor to explain the changes in CT ( and ).  Conclusion. CT was decreased in the patients with ESRD following a HD session. This study suggested that the changes in CT may be related to the changes in systemic blood pressure. Osman Çelikay, Sinan Çalışkan, Tolga Biçer, Naciye Kabataş, and Canan Gürdal Copyright © 2015 Osman Çelikay et al. All rights reserved. Clear Corneal Phacovitrectomy with Posterior Capsulorhexis and IOL Implantation in Management of Selective Vitreoretinal Cases Mon, 26 Oct 2015 14:08:51 +0000 Purpose. To describe our technique, clear corneal phacovitrectomy with posterior capsulorhexis (CCPV), for the management of selected posterior segment intraocular foreign body (IOFB), posteriorly dislocated lens fragments (PDLF), and proliferative diabetic retinopathy (PDR) cases. Methods. This was a single-center retrospective interventional case series. In 21 patients (21 eyes) we performed phacovitrectomy through three clear corneal tunnel incisions (CCTI) and posterior capsulorhexis to remove IOFB (), PDLF from the vitreous cavity after complicated phacoemulsification (), and vitreous hemorrhage and epiretinal membranes in PDR (). The procedure was completed with implantation of a hydrophobic acrylic IOL through the CCTI. Results. The mean visual acuity (logMAR) was 0.90 preoperative and improved to 0.26 over a mean follow-up of 8.7 months (range, 6–12 months). The intraocular lens was implanted into the capsular bag () or onto the anterior capsule (). One PDR patient experienced an intraprocedural complication, hemorrhage from isolated fibrovascular adhesions. One IOFB patient developed apparent anterior proliferative vitreoretinopathy and required a repeat intervention. Conclusion. Selected vitreoretinal IOFB, PDLF, and PDR cases can be successfully managed by a combined surgical approach involving clear corneal phacovitrectomy with posterior capsulorhexis and implantation of an IOL, with good visual outcome and a low complication rate. Ernest V. Boiko, Sergey V. Churashov, Alexei N. Kulikov, and Dmitrii S. Maltsev Copyright © 2015 Ernest V. Boiko et al. All rights reserved.