Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. In Vivo Near-Infrared Fluorescence Imaging of Aqueous Humor Outflow Structures Tue, 24 May 2016 12:21:01 +0000 The aim of this study has been to visualize the aqueous outflow system in patients affected by primary open angle glaucoma. A solution of indocyanine green (ICG) plus high viscosity viscoelastic solution was injected into the Schlemm canal during surgery in 10 glaucomatous patients undergoing canaloplasty. Soon after injection of the dye the borders of the scleral flap were completely stained due to partial reflux caused by the intrachannel resistance; progression of the dye along the Schlemm canal starting from the site of injection was then visualized. The filling of the collector channels was observed only in the patent portions of the Schlemm canal. The only noticeable aqueous veins were located in correspondence of the quadrant in which both the Schlemm canal and the collectors were patent. Lastly, a retrograde filling, of glomerular-shaped structures, deepest to the Schlemm canal was observed in the quadrants where the pathway was functioning. Our findings show that injection of a mixture composed of ICG and viscoelastic solution into the Schlemm canal allows a clear visualization of the functioning portions of the conventional outflow pathway. In addition, a retrograde filling of structures presumably located into the iris was also recorded. Clinical Trial Registration. Our study is registered in ISRCTN registry, number 54005880, DOI 10.1186/ISRCTN54005880. L. Zeppa, L. Ambrosone, G. Guerra, M. Fortunato, and C. Costagliola Copyright © 2016 L. Zeppa et al. All rights reserved. Cationic Thiolated Poly(aspartamide) Polymer as a Potential Excipient for Artificial Tear Formulations Mon, 23 May 2016 11:19:19 +0000 Dry eye disease is a relatively common ocular problem, which causes eye discomfort and visual disorders leading to a decrease in the quality of life. The aim of this study was to find a possible excipient for eye drop formulations, which is able to stabilize the tear film. A cationic thiolated polyaspartamide polymer, poly[(N-mercaptoethylaspartamide)-co-(N-(N′,N′-dimethylaminoethyl)aspartamide)] (ThioPASP-DME), was used as a potential vehicle. Besides satisfying the basic requirements, the chemical structure of ThioPASP-DME is similar to those of ocular mucins as it is a protein-like polymer bearing a considerable number of thiol groups. The solution of the polymer is therefore able to mimic the physiological properties of the mucins and it can interact with the mucus layer via disulphide bond formation. The resultant mucoadhesion provides a prolonged residence time and ensures protective effect for the corneal/conjunctival epithelium. ThioPASP-DME also has an antioxidant effect due to the presence of the thiol groups. The applicability of ThioPASP-DME as a potential excipient in eye drops was determined by means of ocular compatibility tests and through examinations of the interactions with the mucosal surface. The results indicate that ThioPASP-DME can serve as a potential eye drop excipient for the therapy of dry eye disease. Mária Budai-Szűcs, Gabriella Horvát, Barnabás Áron Szilágyi, Benjámin Gyarmati, András Szilágyi, Szilvia Berkó, Piroska Szabó-Révész, Giuseppina Sandri, Maria Cristina Bonferoni, Carla Caramella, Judit Soós, Andrea Facskó, and Erzsébet Csányi Copyright © 2016 Mária Budai-Szűcs et al. All rights reserved. Assessment of Anterior Segment Changes in Pseudophakic Eyes, Using Ultrasonic Biomicroscopic Imaging, after Pars Plana Vitrectomy with Silicone Oil or Gas Tamponade Thu, 19 May 2016 11:25:07 +0000 Objective. To evaluate the morphological changes of the anterior segment using ultrasonic biomicroscopy (UBM) imaging in pseudophakic patients who underwent pars plana vitrectomy (PPV) with silicone oil or gas (C3F8) internal tamponade agent injection. Method. This prospective study included pseudophakic patients with planned PPV, divided into two groups according to internal tamponade agent: those in which silicone oil was used (, Group 1) and those in which gas (C3F8) was used (, Group 2). UBM measurements were performed in the supine position before and one week after surgery. Results. In patients of Group 1, postoperative trabecular meshwork-ciliary process distance (T-CPD) and iris-ciliary process distance (I-CPD), according to preoperative values, were found to be statistically significantly reduced, and postoperative mean value of scleral thickness (ST) and intraocular pressure (IOP), according to preoperative value, was found to be statistically significantly increased. In patients of Group 2, postoperative mean values of anterior chamber depth (ACD), ciliary body thickness (CBT), T-CPD, I-CPD, and IOP, according to preoperative values, were found to be statistically significantly reduced. Preoperatively, in Group 2 patients, according to Group 1 patients, TIA and IOP were found to be statistically significantly increased. Preoperative and postoperative IOP between the measured parameters with UBM showed no statistically significant correlation. Conclusions. Gases cause more morphological changes in the anterior segment structures. It is thought that complications such as increased intraocular pressure can be seen more frequently for this reason. Erkan Ünsal, Kadir Eltutar, Belma Karini, and Osman Kızılay Copyright © 2016 Erkan Ünsal et al. All rights reserved. Therapeutic Effect of Intrastromal Voriconazole, Topical Voriconazole, and Topical Natamycin on Fusarium Keratitis in Rabbit Thu, 19 May 2016 06:25:40 +0000 Purpose. Evaluating the therapeutic effect of topical and intrastromal voriconazole and topical natamycin on Fusarium keratitis. Methods. 24 rabbits were selected. The stroma of their corneas was inoculated with suspension of Fusarium solani species complex. Seven days after injection they were divided into 4 groups randomly: the first group was treated with topical voriconazole (TV) 1% for one week, the second one with one-time intrastromal injection of voriconazole (ISV) 50 microgram/0.1 mL, and the third group with topical gel of natamycin (TN) for one week, and the last one did not receive any antifungal treatment. Finally the eyes were enucleated and sclerocorneal buttons were sent for histological and microbiological examinations. Results. After treatment the ISV group and TN group showed significantly lower clinical score and colony forming units than the control group ( and , resp.), but there was statistically no significant difference between control and TV groups () or between ISV and TN groups (). In pathological evaluation, fewer chronic inflammations were reported in 2 of the 3 buttons from TV group and 3 of the 3 buttons from ISV and TN groups in comparison with the control group. Conclusion. Intrastromal injection of voriconazole seems to be effective in treatment of Fusarium keratitis as much as topical natamycin and these are more effective than topical voriconazole. Mahmood Nejabat, Nafiseh Yaqubi, Amir Khosravi, Kamiar Zomorodian, Mohammad Javad Ashraf, and Ramin Salouti Copyright © 2016 Mahmood Nejabat et al. All rights reserved. Peripapillary Choroidal Thickness and Open-Angle Glaucoma: A Meta-Analysis Thu, 19 May 2016 06:24:00 +0000 Purpose. To investigate the potential relationship between open-angle glaucoma (OAG) and peripapillary choroidal thickness (PPCT). Materials and Methods. Relevant publications were searched systematically through various databases from inception to January 2016. Studies comparing PPCT in OAG patients and healthy controls were retrieved. All qualified articles were analyzed using Stata 14.0 and Revman 5.3 software. Results. A total of 13 studies were identified for inclusion. There was a significant reduction of average PPCT in OAG patients compared to control participants (WMD = −24.07, 95% CI: −34.29, −13.85). Reduction of PPCT was significant in the superior (WMD = −28.87, 95% CI: −44.96, −12.78) and nasal (WMD = −21.75, 95% CI: −41.52, −1.98) sectors, but there was no significant reduction of PPCT in the inferior (WMD = −9.57, 95% CI: −36.55, 17.40) and temporal (WMD = −13.85, 95% CI: −35.40, 7.70) sectors. No obvious publication bias was detected. Conclusions. This meta-analysis suggests that open-angle glaucoma patients have significantly decreased peripapillary choroidal thickness compared to healthy individuals. Peripapillary choroidal thickness measured by optical coherence tomography may be an important parameter to consider in open-angle glaucoma. Zhongjing Lin, Shouyue Huang, Bing Xie, and Yisheng Zhong Copyright © 2016 Zhongjing Lin et al. All rights reserved. Ultrasound Biomicroscopy Comparison of Ab Interno and Ab Externo Intraocular Lens Scleral Fixation Wed, 18 May 2016 11:34:32 +0000 Purpose. To compare ab interno and ab externo scleral fixation of posterior chamber intraocular lenses (PCIOL) using ultrasound biomicroscopy (UBM). Methods. Randomized patients underwent ab externo or ab interno scleral fixation of a PCIOL. Ultrasound biomicroscopy was performed 3 to 6 months postoperatively, to determine PCIOL centration, IOL distance to the iris at 12, 3, 6, and 9 hours, and haptics placement in relation to the ciliary sulcus. Results. Fifteen patients were enrolled in the study. The ab externo technique was used in 7 eyes (46.6%) and the ab interno in 8 eyes (53.3%). In the ab externo technique, 14 haptics were located: 4 (28.57%) in the ciliary sulcus; 2 (14.28%) anterior to the sulcus; and 8 (57.14%) posterior to the sulcus, 6 in the ciliary body and 2 posterior to the ciliary body. In the ab interno group, 4 haptics (25.0%) were in the ciliary sulcus, 2 (12.50%) anterior to the sulcus, and 10 (75.0%) posterior to the sulcus, 4 in the ciliary body and 6 posterior to the ciliary body. Conclusions. Ab externo and ab interno scleral fixation techniques presented similar results in haptic placement. Ab externo technique presented higher vertical tilt when compared to the ab interno. Lie Horiguchi, Patricia Novita Garcia, Gustavo Ricci Malavazzi, Norma Allemann, and Rachel L. R. Gomes Copyright © 2016 Lie Horiguchi et al. All rights reserved. Efficacy and Safety of a Dexamethasone Implant in Patients with Diabetic Macular Edema at Tertiary Centers in Korea Tue, 17 May 2016 11:29:58 +0000 Purpose. To evaluate the real-world efficacy and safety of the dexamethasone implant (DEX implant) in patients with diabetic macular edema (DME). Methods. Retrospective, multicenter, and noncomparative study of DME patients who were treated with at least one DEX implant. A total of 186 eyes from 165 patients were included. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), complications, and number of retreatments were collected. Data at baseline and monthly for 6 months were analyzed. Results. The average baseline BCVA and CRT were 0.60 LogMAR and 491.6 μm, respectively. The mean BCVA improved until 3 months and then decreased up to 6 months of follow-up (0.53, 0.49, and 0.55 LogMAR at 1, 3, and 6 months; , <0.001, and 0.044, resp.). The change of mean CRT was similar to BCVA (345.0, 357.7, and 412.5 μm at 1, 3, and 6 months, , <0.001, and <0.001, resp.). 91 eyes (48.9%) received additional treatment with anti-VEGF or DEX implant. The average treatment-free interval was 4.4 months. In group analyses, the DEX implant was more effective in pseudophakic eyes, DME with subretinal fluid (SRF), or diffuse type. Conclusions. Intravitreal dexamethasone implants are an effective treatment for patients with DME, most notably in pseudophakic eyes, DME with SRF, or diffuse type. A half of these patients require additional treatment within 6 months. Byung Gil Moon, Joo Yong Lee, Hyeong Gon Yu, Ji Hun Song, Young-Hoon Park, Hyun Woong Kim, Yong-Sok Ji, Woohyok Chang, Joo Eun Lee, Jaeryung Oh, and Inyoung Chung Copyright © 2016 Byung Gil Moon et al. All rights reserved. Intravitreal Ranibizumab Injection as an Adjuvant in the Treatment of Neovascular Glaucoma Accompanied by Vitreous Hemorrhage after Diabetic Vitrectomy Mon, 16 May 2016 13:03:07 +0000 Purpose. To determine the efficacy of intravitreal ranibizumab injection as adjuvant therapy in the treatment of neovascular glaucoma (NVG) accompanied by postvitrectomy diabetic vitreous hemorrhage (PDVH). Methods. Eighteen NVG patients (18 eyes) accompanied by PDVH were enrolled in this prospective, monocenter, 12-month, interventional case series. The consecutive 18 patients with an IOP ≥ 25 mmHg despite being treated with the maximum medical therapy were treated with intravitreal ranibizumab injections. Vitreous surgery or/with Ahmed valve implantation were indicated if no clinical improvement in vitreous haemorrhage and uncontrolled IOP was shown. Results. Ten patients got clear vitreous and controlled IOP only with injections of ranibizumab without additional surgery. Vitrectomy or/with Ahmed valve implantation was administered in the other 8 eyes due to uncontrolled VH and IOP. At follow-up month 12, all the 18 eyes gained clear vitreous. At month 12 BCVA improved significantly compared to baseline. The baseline and follow-up at month 12 IOP/medication usage were  mmHg on medications and  mmHg on medications, respectively. Conclusions. The findings suggest that intravitreal ranibizumab injection as adjuvant therapy for treatment of NVG accompanied by PDVH may be safe and potentially effective. This clinical trial is registered with NCT02647515. Xi Shen, Yanwei Chen, Yanuo Wang, Lu Yang, and Yisheng Zhong Copyright © 2016 Xi Shen et al. All rights reserved. Diagnostic Performance of McMonnies Questionnaire as a Screening Survey for Dry Eye: A Multicenter Analysis Sun, 15 May 2016 09:20:40 +0000 Purpose. To evaluate the diagnostic performance of the McMonnies questionnaire as a screening survey for dry eye in Chinese outpatients. Methods. The questionnaire was self-administered by 27,999 patients with dry eye symptoms. A thorough ophthalmic examination including tear break-up time (TBUT), fluorescein staining, and Schirmer I test was completed to make a clinical diagnosis of dry eye. Reliability, validity, and accuracy of the McMonnies questionnaire were assessed. Results. The McMonnies questionnaire showed poor internal consistency (Cronbach ), but excellent validity as the scores correlated with TBUT (Spearman test, , ) and Schirmer I test (Spearman’s test, , ), and significantly differed between the dry eye and control groups (2-sample t-test, , ). The area under the receiver-operating characteristics (ROC) curve (AUC) was 0.729, suggesting moderate accuracy in identifying dry eye and non-dry eye patients. However, the AUCs varied significantly in different gender and age subgroups (z test, ), as the discriminating ability declined with age. Analysis of the ROC curves also revealed that different cut-off points should be employed for each subgroup to achieve the same level of accuracy. Conclusions. The McMonnies questionnaire demonstrates moderate diagnostic value, and different cut-off points should be selected for various study populations. Yuxin Guo, Rongmei Peng, Kang Feng, and Jing Hong Copyright © 2016 Yuxin Guo et al. All rights reserved. Optical Quality and Related Factors in Ocular Hypertension: Preliminary Study Thu, 12 May 2016 17:18:55 +0000 Background. To evaluate the optical quality and related factors in patients with ocular hypertension (OHT). Methods. This was a prospective case-control study. A total of 12 eyes with OHT and 20 control eyes underwent testing with Optical Quality Analysis System II (OQAS II) to evaluate the modulation transfer function cut off frequency (MTF cutoff), the Strehl 2D ratio (SR), objective scatter index (OSI), tear-film mean OSI (TFOSI), and the OQAS values (OV100%,OV20%, and OV9%). Results. The optical quality of patients with OHT declined, with lower MTF cutoff (OHT 36.86 ± 7.11 cpd , controls 48.50 ± 4.04 cpd, , ), lower SR (OHT 0.22 ± 0.04, controls 0.27 ± 0.05, , ), lower OV100% (OHT 1.26 ± 0.25, controls 1.61 ± 0.14, , ), lower OV20% (OHT 1.27 ± 0.27, controls 1.72 ± 0.20, , ), and lower OV9% (OHT 1.30 ± 0.25, controls 1.69 ± 0.32, , ). There were not any statistically significant differences in OSI and TFOSI. The MTF cutoff in patients with OHT was correlated significantly with age (, ). Conclusions. Optical quality of patients with OHT is reduced, with lower MTF cutoff, SR, OV100%, OV20%, and OV9%. MTF cutoff is negatively related to age. Yu-jing Wang, Yan-ning Yang, Lin-ying Huang, Bo Wang, Yu-can Han, and Jiang-bo Yan Copyright © 2016 Yu-jing Wang et al. All rights reserved. Use of Mechanical Turk as a MapReduce Framework for Macular OCT Segmentation Wed, 11 May 2016 10:07:01 +0000 Purpose. To evaluate the feasibility of using Mechanical Turk as a massively parallel platform to perform manual segmentations of macular spectral domain optical coherence tomography (SD-OCT) images using a MapReduce framework. Methods. A macular SD-OCT volume of 61 slice images was map-distributed to Amazon Mechanical Turk. Each Human Intelligence Task was set to 0.01 and required the user to draw five lines to outline the sublayers of the retinal OCT image after being shown example images. Each image was submitted twice for segmentation, and interrater reliability was calculated. The interface was created using custom HTML5 and JavaScript code, and data analysis was performed using R. An automated pipeline was developed to handle the map and reduce steps of the framework. Results. More than 93,500 data points were collected using this framework for the 61 images submitted. Pearson’s correlation of interrater reliability was 0.995 () and coefficient of determination was 0.991. The cost of segmenting the macular volume was 1.21. A total of 22 individual Mechanical Turk users provided segmentations, each completing an average of 5.5 HITs. Each HIT was completed in an average of 4.43 minutes. Conclusions. Amazon Mechanical Turk provides a cost-effective, scalable, high-availability infrastructure for manual segmentation of OCT images. Aaron Y. Lee, Cecilia S. Lee, Pearse A. Keane, and Adnan Tufail Copyright © 2016 Aaron Y. Lee et al. All rights reserved. An Important Cause of Blindness in Children: Open Globe Injuries Tue, 10 May 2016 12:05:44 +0000 Objective. Our aim was to present and evaluate the predictive factors of visual impairment and blindness according to WHO criteria in pediatric open globe injuries. Methods. The medical records of 94 patients younger than 18 years who underwent primary repair surgery were reviewed retrospectively. The initial and final visual acuity, anterior and posterior segment findings, and zone of injury were noted. The patients were classified as blindness in one eye or visual impairment in one eye. Results. Of 412 patients who presented with open globe injury, 94 (23%) were under 18 years old. Fifty-four (16 females, 38 males) children were included. The mean age of the children was 7.1 ± 4.1 years. According to WHO criteria, 19 of 54 patients (35%) had unilateral blindness and 8 had unilateral visual impairment (15%). There was no significant relationship between final visual acuity and gender and injured eye. In visually impaired and blind patients, presence of preoperative hyphema, retinal detachment, and zone 2 and zone 3 injuries was significantly higher. Conclusion. Presence of hyphema and zone 2 and zone 3 injuries and retinal detachment may end up with visual impairment and/or blindness in children. Meral Yildiz, Sertaç Argun Kıvanç, Berna Akova-Budak, Ahmet Tuncer Ozmen, and Sadık Gorkem Çevik Copyright © 2016 Meral Yildiz et al. All rights reserved. Expression of Wnt/β-Catenin Signaling Pathway and Its Regulatory Role in Type I Collagen with TGF-β1 in Scleral Fibroblasts from an Experimentally Induced Myopia Guinea Pig Model Tue, 10 May 2016 08:40:50 +0000 Background. To investigate Wnt/β-catenin signaling pathway expression and its regulation of type I collagen by TGF-β1 in scleral fibroblasts from form-deprivation myopia (FDM) guinea pig model. Methods. Wnt isoforms were examined using genome microarrays. Scleral fibroblasts from FDM group and self-control (SC) group were cultured. Wnt isoforms, β-catenin, TGF-β1, and type I collagen expression levels were examined in the two groups with or without DKK-1 or TGF-β1 neutralizing antibody. Results. For genome microarrays, the expression of Wnt3 in FDM group was significantly greater as confirmed in retinal and scleral tissue. The expression of Wnt3 and β-catenin significantly increased in FDM group and decreased significantly with DKK-1. TGF-β1 expression level decreased significantly in FDM group and increased significantly with DKK-1. Along with morphological misalignment inside and outside cells, the amount of type I collagen decreased in FDM group. Furthermore, type I collagen increased and became regular in DKK-1 intervention group, whereas it decreased and rearranged more disorder in TGF-β1 neutralizing antibody intervention group. Conclusions. The activation of Wnt3/β-catenin signaling pathway was demonstrated in primary scleral fibroblasts in FDM. This pathway further reduced the expression of type I collagen by TGF-β1, which ultimately played a role in scleral remodeling during myopia development. Min Li, Ying Yuan, Qingzhong Chen, Rao Me, Qing Gu, Yunjie Yu, Minjie Sheng, and Bilian Ke Copyright © 2016 Min Li et al. All rights reserved. A Meta-Analysis for Association of Maternal Smoking with Childhood Refractive Error and Amblyopia Mon, 09 May 2016 11:55:27 +0000 Background. We aimed to evaluate the association between maternal smoking and the occurrence of childhood refractive error and amblyopia. Methods. Relevant articles were identified from PubMed and EMBASE up to May 2015. Combined odds ratio (OR) corresponding with its 95% confidence interval (CI) was calculated to evaluate the influence of maternal smoking on childhood refractive error and amblyopia. The heterogeneity was evaluated with the Chi-square-based statistic and the test. Potential publication bias was finally examined by Egger’s test. Results. A total of 9 articles were included in this meta-analysis. The pooled OR showed that there was no significant association between maternal smoking and childhood refractive error. However, children whose mother smoked during pregnancy were 1.47 (95% CI: 1.12–1.93) times and 1.43 (95% CI: 1.23-1.66) times more likely to suffer from amblyopia and hyperopia, respectively, compared with children whose mother did not smoke, and the difference was significant. Significant heterogeneity was only found among studies involving the influence of maternal smoking on children’s refractive error (; %). No potential publication bias was detected by Egger’s test. Conclusion. The meta-analysis suggests that maternal smoking is a risk factor for childhood hyperopia and amblyopia. Li Li, Ya Qi, Wei Shi, Yuan Wang, Wen Liu, and Man Hu Copyright © 2016 Li Li et al. All rights reserved. Estimated Prevalence of Glaucoma in South Korea Using the National Claims Database Mon, 09 May 2016 11:31:41 +0000 Purpose. To estimate the prevalence of glaucoma and costs associated with glaucoma care in South Korea between 2008 and 2013 using the Korean national claims database. Design. Retrospective cross-sectional study from a national claims database. Methods. Patients who were diagnosed with glaucoma between 2008 and 2013 were retrospectively identified in the national claims database using glaucoma diagnostic codes. For each year, the prevalence of glaucoma and direct medical costs associated with glaucoma care were estimated. Result. The prevalence of glaucoma in patients ≥40 years of age increased from 0.79% in 2008 to 1.05% in 2013. The number of patients with glaucoma increased by 54% between 2008 and 2013 (9% average annual increase). The prevalence of glaucoma increased with age and was higher in males than in females. The cost to care for glaucoma patients increased from $16.5 million in 2008 to $29.2 million in 2013, which translated into an 81% increase over the 6 years examined (12.7% average annual increase). Conclusion. The estimated prevalence and socioeconomic burden of glaucoma have steadily increased each year in South Korea. Nevertheless, many glaucoma patients remain undiagnosed in the present study using national claims database. Sang Jin Seo, Yun Ha Lee, Sang Yeop Lee, Hyoung Won Bae, Samin Hong, Gong Je Seong, and Chan Yun Kim Copyright © 2016 Sang Jin Seo et al. All rights reserved. In Vivo and Cadaver Studies of the Canalicular/Lacrimal Sac Mucosal Folds Sun, 08 May 2016 12:29:54 +0000 Purpose. The study aimed to investigate canalicular/lacrimal sac mucosal folds (CLS-MFs) in vivo and in cadavers in order to explore their functional roles in the lacrimal drainage system. Method. The observations of CLS-MFs in vivo were performed on 16 patients with chronic dacryocystitis after undergoing an endonasal endoscopic dacryocystorhinostomy (EE-DCR). The lacrimal sacs and common canaliculi of 19 adult cadavers were dissected. The opening/closing of an orifice and mucosal fold was recorded. All of the specimens were subjected to a histological examination. Results. The upper and lower lacrimal canaliculi in all of the samples united to form a common canaliculus that opened to the lacrimal sac. CLS-MFs were observed in 10 of the 16 patients (62.5%) and 9 of the 19 cadavers (47.4%). The orifices or mucosal folds could be opened or closed when related muscles contracted or relaxed. Histological sections showed a mucosal fold at one side of an orifice. Conclusion. Common canaliculus is the most common type that the canaliculus opens to lacrimal sac. CLS-MFs exist in a certain ratio that can be opened/closed with the movement of the orifices. They may be involved in the drainage of tears or the pathogenesis of acute dacryocystitis or lacrimal sac mucocele. Yongsheng You, Jing Cao, Xiaogang Zhang, Wencan Wu, Tianlin Xiao, and Yunhai Tu Copyright © 2016 Yongsheng You et al. All rights reserved. Association of Common Variants in eNOS Gene with Primary Open Angle Glaucoma: A Meta-Analysis Sun, 08 May 2016 12:00:21 +0000 Purpose. To clarify the association of endothelial nitric oxide synthase (eNOS) polymorphisms and primary open angle glaucoma (POAG). Methods. After a systematic literature search in the MEDLINE, EMBASE, and ISI Web of Science databases, all relevant studies evaluating the association between the polymorphisms (rs2070744 and rs1799983) of eNOS gene and POAG were screened and included. The pooled odds ratios (ORs) and the 95% confidence interval (CI) of each single-nucleotide polymorphism (SNP) in five genetic models were estimated using fixed-effect model if in the test for heterogeneity; otherwise the random-effects model was used. Results. Thirty-one records were obtained, with five being suitable for meta-analysis. The overall results showed that both TT genotype in rs2070744 and GG genotype in rs1799983 are associated with decreased risk of POAG susceptibility. Stratified analysis based on ethnicity showed that the association of rs2070744 with POAG remained only in Caucasians. Results of subgroup analysis by sex indicated association between both polymorphisms and POAG in female group, but not in male group. Conclusions. TT genotype and/or T-allele in rs2070744, as well as GG genotype and/or G-allele in rs1799983, was associated with decreased risk for POAG overall and in female group. Yang Xiang, Yi Dong, Xuan Li, and Xin Tang Copyright © 2016 Yang Xiang et al. All rights reserved. Propolis, a Constituent of Honey, Inhibits the Development of Sugar Cataracts and High-Glucose-Induced Reactive Oxygen Species in Rat Lenses Sun, 08 May 2016 06:38:55 +0000 Purpose. This study investigated the effects of oral propolis on the progression of galactose-induced sugar cataracts in rats and the in vitro effects of propolis on high-glucose-induced reactive oxygen species (ROS) and cell death in cultured rat lens cells (RLECs). Methods. Galactose-fed rats and RLECs cultured in high glucose (55 mM) medium were treated with propolis or vehicle control. Relative lens opacity was assessed by densitometry and changes in lens morphology by histochemical analysis. Intracellular ROS levels and cell viability were measured. Results. Oral administration of propolis significantly inhibited the onset and progression of cataract in 15% and 25% of galactose-fed rats, respectively. RLECs cultured with high glucose showed a significant increase in ROS expression with reduced cell viability. Treatment of these RLECs with 5 and 50 μg/mL propolis cultured significantly reduced ROS levels and increased cell viability, indicating that the antioxidant activity of propolis protected cells against ROS-induced damage. Conclusion. Propolis significantly inhibited the onset and progression of sugar cataract in rats and mitigated high-glucose-induced ROS production and cell death. These effects may be associated with the ability of propolis to inhibit hyperglycemia-evoked oxidative or osmotic stress-induced cellular insults. Teppei Shibata, Shinsuke Shibata, Naoko Shibata, Etsuko Kiyokawa, Hiroshi Sasaki, Dhirendra P. Singh, and Eri Kubo Copyright © 2016 Teppei Shibata et al. All rights reserved. Daily Optical Coherence Tomography Examinations after First Antivascular Endothelial Growth Factor Injections: An Interventional Case Series Thu, 05 May 2016 12:04:22 +0000 Purpose. To evaluate daily spectral-domain optical coherence tomography (SD-OCT) changes in naive-treatment patients with diagnosis of exudative age-related macular degeneration (AMD) treated with intravitreous bevacizumab (1.25 mg), during a 30-day follow-up period. Methods. In prospective, interventional study, SD-OCT was performed daily for 30 days after the first intravitreal injection. The baseline, initial-decrease, minimal, and final central retinal thicknesses (CRTs) were assessed. Results. Nine eyes of nine patients with neovascular AMD were enrolled. The mean baseline CRT was  μm, and the mean final CRT was  μm (mean difference,  μm), a difference that reached significance (). After the first injection, the initial decrease in the CRT was seen as an average of one day after injection (mean CRT,  μm; ). The speed of the reduction in the CRT tended to decrease by day 17. The mean CRT was  μm and the mean minimal CRT on day 30 was  μm. Conclusion. The CRT decreased early after the first injection. We observed a tendency for reductions in the speed with which the CRT decreased by day 17 after the first injection, which may affect retreatment regime. Eduardo A. Novais, Emmerson Badaró, Flavio E. Hirai, Felipe Abdo Jorge, Paula Leal, Michel Eid Farah, and Eduardo B. Rodrigues Copyright © 2016 Eduardo A. Novais et al. All rights reserved. Retinal Ganglion Cell Atrophy in Homonymous Hemianopia due to Acquired Occipital Lesions Observed Using Cirrus High-Definition-OCT Wed, 04 May 2016 12:29:58 +0000 Purpose. To report a reduction in macular ganglion cell layer and inner plexiform layer (GCL+IPL) thickness and circumpapillary retinal nerve fiber layer (cpRNFL) thickness using spectral-domain optical coherence tomography in patients with homonymous hemianopia due to posterior cerebral artery (PCA) stroke. Methods. Seven patients with PCA stroke were examined using Cirrus high-definition-OCT. The GCL+IPL thicknesses were divided into the hemianopic and unaffected sides. The relationship between the time after stroke and the GCL+IPL thicknesses in the hemianopic side was evaluated. Results. The average thicknesses of the GCL+IPL were 64.6 and 82.0 μm on the hemianopic and unaffected sides, respectively, and the measurement was significantly thinner on the former side (). A regression analysis revealed a negative linear relationship (, ) between the time after stoke and the GCL+IPL thicknesses on the hemianopic side. The supratemporal and inferotemporal cpRNFL thicknesses in the eyes ipsilateral to the stroke showed a significant reduction. Conclusion. Our findings confirmed our previous observations that the degeneration of retinal ganglion cells can occur after PCA stroke. GCL+IPL thinning was demonstrated in the hemiretinae corresponding to the affected hemifields. Also, it is suggested that the retinal changes observed are progressive. Tsutomu Yamashita, Atsushi Miki, Katsutoshi Goto, Syunsuke Araki, Go Takizawa, Yoshiaki Ieki, Junichi Kiryu, Akio Tabuchi, Yasuyuki Iguchi, Kazumi Kimura, and Yoshiki Yagita Copyright © 2016 Tsutomu Yamashita et al. All rights reserved. Canaloplasty: Current Value in the Management of Glaucoma Sat, 30 Apr 2016 14:35:20 +0000 Canaloplasty is a nonpenetrating blebless surgical technique for open-angle glaucoma, in which a flexible microcatheter is inserted within Schlemm’s canal for the entire 360 degrees. When the microcatheter exits the opposite end, a 10-0 prolene suture is tied and it is then withdrawn, by pulling microcatheter back through the canal in the opposite direction. Ligation of prolene suture provides tension on the canal and facilitates aqueous outflow. The main advantage of canaloplasty is that this technique avoids the major complications of fistulating surgery related to blebs and hypotony. Currently, canaloplasty is performed in glaucoma patients with early to moderate disease and combination with cataract surgery is a suitable option in patients with clinically significant lens opacities. Carlo Cagini, Claudia Peruzzi, Tito Fiore, Leopoldo Spadea, Myrta Lippera, and Stefano Lippera Copyright © 2016 Carlo Cagini et al. All rights reserved. Retinal Electrophysiology Is a Viable Preclinical Biomarker for Drug Penetrance into the Central Nervous System Wed, 27 Apr 2016 14:23:32 +0000 Objective. To examine whether retinal electrophysiology is a useful surrogate marker of drug penetrance into the central nervous system (CNS). Materials and Methods. Brain and retinal electrophysiology were assessed with full-field visually evoked potentials and electroretinograms in conscious and anaesthetised rats following systemic or local administrations of centrally penetrant (muscimol) or nonpenetrant (isoguvacine) compounds. Results. Local injections into the eye/brain bypassed the blood neural barriers and produced changes in retinal/brain responses for both drugs. In conscious animals, systemic administration of muscimol resulted in retinal and brain biopotential changes, whereas systemic delivery of isoguvacine did not. General anaesthesia confounded these outcomes. Conclusions. Retinal electrophysiology, when recorded in conscious animals, shows promise as a viable biomarker of drug penetration into the CNS. In contrast, when conducted under anaesthetised conditions confounds can be induced in both cortical and retinal electrophysiological recordings. Jason Charng, Zheng He, Algis J. Vingrys, Rebecca L. Fish, Rachel Gurrell, Bang V. Bui, and Christine T. Nguyen Copyright © 2016 Jason Charng et al. All rights reserved. Loop Myopexy Surgery for Strabismus Associated with High Myopia Wed, 27 Apr 2016 13:10:52 +0000 Strabismus associated with high myopia is a rare abnormality of ocular motility, leading to the impairment of abduction and supraduction. Loop myopexy of the superior rectus (SR) and lateral rectus (LR) muscles is now the most preferred surgery for restoring the dislocated eye globe back into the muscle cone. Various procedural modifications have been made based on this concept, and satisfactory outcomes have been reached in most cases. In this paper, we review various surgical modifications published in the literature that are based on the loop myopexy surgery in patients with high myopic strabismus and summarize the applicable scope of different surgical procedures for patients with different degrees of strabismus. Three major surgical procedures are identified and different modifications have been applied based on their concept. Most of these modifications have been proven to be safe and effective and result in good ocular alignments. The selection of such modifications is of great importance in different patients. Careful evaluation before surgery should be made not only to make the correct diagnosis but also to choose an appropriate surgical procedure and offer individualized modifications in the surgery. Yun Su, Qin Shen, and Xianqun Fan Copyright © 2016 Yun Su et al. All rights reserved. Comparison of the Early Clinical Outcomes between Combined Small-Incision Lenticule Extraction and Collagen Cross-Linking versus SMILE for Myopia Wed, 27 Apr 2016 09:31:33 +0000 Background. To compare the early outcome of combined SMILE and collagen crosslinking (SMILE Xtra) with SMILE. Method. Prospective, comparative interventional study of 21 eyes receiving SMILE Xtra using a low energy protocol and 32 control eyes receiving SMILE only. The outcomes were compared at 1, 3, and 6 months postoperatively. Results. Both groups had myopia with spherical equivalent refraction (SEQ) > 4.00 D. The SMILE Xtra group had thinner preoperative central corneal thickness and residual stromal bed thickness (). At 6 months, no eyes lost more than 1 line in corrected distance visual acuity. The safety index was and in SMILE Xtra and control, respectively (). 89% and 94% of eyes were within ±0.50 D of target refraction, respectively, with the mean error in SEQ correction being  D for SMILE Xtra and  D for control (). The efficacy index was and , respectively (). Conclusion. SMILE Xtra had good overall safety profile and predictability at 6 months. However, when compared with control, the safety index and efficacy index were statistically significantly lower in the early postoperative period. Alex L. K. Ng, Tommy C. Y. Chan, George P. M. Cheng, Vishal Jhanji, Cong Ye, Victor C. P. Woo, and Jimmy S. M. Lai Copyright © 2016 Alex L. K. Ng et al. All rights reserved. Comparison between Subjective Sensations during First and Second Phacoemulsification Eye Surgeries in Patients with Bilateral Cataract Wed, 27 Apr 2016 08:39:45 +0000 Purpose. To evaluate and compare the subjective sensations reported by patients during first and second cataract extractions. Methods. Consecutive patients undergoing bilateral sequential cataract extraction using phacoemulsification were recruited. Following cataract surgery, patients completed questionnaires designed to evaluate subjective sensations, including anxiety, eye bulges, pain, and light sensitivity. Changes in painful sensations experienced by patients between the two surgeries were also recorded. Comparisons were also performed for each subjective sensation between different age groups (<50, 50–59, 60–69, 70–79, and >79 years). Results. A total of 127 patients were included in the final evaluation. Statistical comparison of the results showed that there were significant differences in perception of anxiety, eye bulges, and pain scores between the first and second cataract surgeries (). However, there was no statistically significant difference for light sensitivity scores between the two surgeries (). The differences in anxiety, perception of eye bulges, pain, and light sensitivity scores between both the surgeries showed no correlation with age ( for all). Conclusions. Our research confirms the common observation that patients with bilateral cataracts often report more ocular discomfort during the second surgery. There are, therefore, additional factors that should be considered upon treating patients with bilateral cataracts, and the provision of preoperative counseling could play an important role in providing adequate patient care. Ji-guo Yu, Ting Ye, Qing Huang, Yi-fan Feng, Jue Wang, Xun-an Fu, and Yi Xiang Copyright © 2016 Ji-guo Yu et al. All rights reserved. Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics Tue, 26 Apr 2016 16:46:50 +0000 There has been substantial progress in our understanding of the ocular surface system/lacrimal function unit in the past 15 years. Keratoconjunctivitis sicca, more commonly referred to as dry eye syndrome (DES), is the most frequently encountered condition and diabetes mellitus (DM) has been identified as one of the leading causes of DES. Poor glycemic control affects both the anterior and the posterior segments of the eye and increasing prevalence of diabetes-associated DES (DMDES) has been reported in recent years. The pathogenesis and specific features of DMDES remain uncertain and interventions are limited to those used in DES. This review outlines the pathogenesis, clinical manifestations, and the current preventive and treatment strategies for diabetes-related DES. Xinyuan Zhang, Lin Zhao, Shijing Deng, Xuguang Sun, and Ningli Wang Copyright © 2016 Xinyuan Zhang et al. All rights reserved. Spectrum and Sensitivity of Bacterial Keratitis Isolates in Auckland Tue, 26 Apr 2016 13:45:25 +0000 Background. The bacteria isolated from severe cases of keratitis and their antibiotic sensitivity are recognised to vary geographically and over time. Objectives. To identify the most commonly isolated bacteria in keratitis cases admitted over a 24-month period to a public hospital in Auckland, New Zealand, and to investigate in vitro sensitivity to antibiotics. Methods. Hospital admissions for culture-proven bacterial keratitis between January 2013 and December 2014 were identified. Laboratory records of 89 culture positive cases were retrospectively reviewed and antibiotic sensitivity patterns compared with previous studies from other NZ centres. Results. From 126 positive cultures, 35 species were identified. Staphylococcus was identified to be the most common isolate (38.2%), followed by Pseudomonas (21.3%). Over the last decade, infection due to Pseudomonas species, in the same setting, has increased (). Aminoglycosides, cefazolin, ceftazidime, erythromycin, tetracycline, and doxycycline were 100% effective against tested isolates in vitro. Amoxicillin (41.6%), cefuroxime (33.3%), and chloramphenicol (94.7%) showed reduced efficacy against Gram-negative bacteria, whereas penicillin (51%) and ciprofloxacin (98.8%) showed reduced efficacy against Gram-positive bacteria. Conclusions. Despite a shift in the spectrum of bacterial keratitis isolates, antibiotic sensitivity patterns have generally remained stable and show comparability to results within the last decade from NZ centres. S. Marasini, S. Swift, S. J. Dean, S. E. Ormonde, and J. P. Craig Copyright © 2016 S. Marasini et al. All rights reserved. Usefulness of Discarded Vitreous Samples from Routine Vitrectomy Tue, 26 Apr 2016 13:04:39 +0000 Purpose. To describe the histopathological features of vitreous samples obtained after vitrectomy surgery from diabetic and nondiabetic patients. Methods. Vitreous specimens from 137 patients who underwent vitrectomy for different clinical conditions were analysed. All samples were centrifuged and each resulting pellet was fixed and processed as part of routine paraffin section histopathology. The histopathological features were categorized in a semiquantitative fashion. The samples from diabetic and nondiabetic patients were compared. Results. The 125 included patients (58 diabetic, 60% males) were aged years. The presence of hemorrhage, inflammatory cells, and histiocytes was significantly higher in the diabetic group (, , and , resp.), showing more vessels () and ghost vessels (). The presence of inflammatory cells was the feature with the highest sensitivity for detecting diabetes mellitus (98%) and also the highest negative predictive value (89%). In the multivariate analysis, three variables emerged as independent significant predictors of diabetes in vitrectomy samples: hemorrhage, endothelial-lined vessels, and age (, , and , resp.). Conclusions. Different histopathological features can be found in vitreous samples from diabetic patients. Analysis of vitrectomy samples may serve as a tool for diabetes management. Natàlia Vilà, Pablo Zoroquiain, Vasco Bravo-Filho, Emilia Antecka, Helena Dietrich, John C. Chen, I. John Galic, Michael A. Kapusta, and Miguel N. Burnier Jr. Copyright © 2016 Natàlia Vilà et al. All rights reserved. Properties of Retinal Precursor Cells Grown on Vertically Aligned Multiwalled Carbon Nanotubes Generated for the Modification of Retinal Implant-Embedded Microelectrode Arrays Thu, 21 Apr 2016 12:20:32 +0000 Background. To analyze the biocompatibility of vertically aligned multiwalled carbon nanotubes (MWCNT), used as nanomodification to optimize the properties of prostheses-embedded microelectrodes that induce electrical stimulation of surviving retinal cells. Methods. MWCNT were synthesized on silicon wafers. Their growth was achieved by iron particles (Fe) or mixtures of iron-platinum (Fe-Pt) and iron-titanium (Fe-Ti) acting as catalysts. Viability, growth, adhesion, and gene expression of L-929 and retinal precursor (R28) cells were analyzed after nondirect and direct contact. Results. Nondirect contact had almost no influence on cell growth, as measured in comparison to reference materials with defined levels of cytotoxicity. Both cell types exhibited good proliferation properties on each MWCNT-coated wafer. Viability ranged from 95.9 to 99.8%, in which better survival was observed for nonfunctionalized MWCNT generated with the Fe-Pt and Fe-Ti catalyst mixtures. R28 cells grown on the MWCNT-coated wafers showed a decreased gene expression associated with neural and glial properties. Expression of the cell cycle-related genes CCNC, MYC, and TP53 was slightly downregulated. Cultivation on plasma-treated MWCNT did not lead to additional changes. Conclusions. All tested MWCNT-covered slices showed good biocompatibility profiles, confirming that this nanotechnology is a promising tool to improve prostheses bearing electrodes which connect with retinal tissue. Sandra Johnen, Frank Meißner, Mario Krug, Thomas Baltz, Ingolf Endler, Wilfried Mokwa, and Peter Walter Copyright © 2016 Sandra Johnen et al. All rights reserved. Different Strategies for the Treatment of Age-Related Macular Degeneration in China: An Economic Evaluation Wed, 20 Apr 2016 10:14:58 +0000 Purpose. To assess the cost-effectiveness of bevacizumab compared to ranibizumab, verteporfin photodynamic therapy (PDT), and usual care for the treatment of age-related macular degeneration (AMD) in China. Methods. A Markov model was developed according to patient visual acuity (VA) in the better-seeing eye (Snellen scale). Four cohorts of patients were treated with one of the following therapies: bevacizumab, ranibizumab, PDT, or usual care. Clinical data related to treatments were obtained from published randomized clinical trials. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. Health and economic outcomes were evaluated over a lifetime horizon. Sensitivity analyses were performed. Results. Treatment with ranibizumab provided the greatest gains in quality-adjusted life-years (QALYs). The cost per marginal QALY gained with bevacizumab over usual care was $1,258, $3,803, and $2,066 for the predominantly classic, minimally classic, and occult lesions, respectively. One-way sensitivity analysis showed considerably influential factors, such as utility values and effectiveness data. Probabilistic sensitivity analysis indicated that, compared to usual care, PDT and ranibizumab most cases would be cost-effective in the bevacizumab arm at a threshold of $7,480/QALY. Conclusion. Bevacizumab can be a cost-effective option for the treatment of AMD in the Chinese setting. Bin Wu, Jin Li, Houwen Lin, and Haixiang Wu Copyright © 2016 Bin Wu et al. All rights reserved.