Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Intraocular Pressure-Lowering Potential of Subthreshold Selective Laser Trabeculoplasty in Patients with Primary Open-Angle Glaucoma Wed, 27 Jul 2016 11:29:30 +0000 Purpose. To compare the efficacy of subthreshold and conventional selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in the patients with primary open-angle glaucoma (POAG). Methods. Fifty-two eyes from fifty-two POAG patients were randomized into two groups, one group treated with subthreshold SLT using two-thirds of the conventional energy and the other one treated with the conventional energy. IOP was measured with the Goldmann tonometer and the anterior chamber inflammation was determined using laser flare meter. Results. The initial energy dosage used in subthreshold SLT group was significantly lower than the amount of the energy used in conventional SLT group ( mJ versus  mJ, ). The total energy dosage was also significantly lower in subthreshold SLT group compared to the other group ( mJ versus  mJ, ). However, the level of inflammation in aqueous humor, amount of reduction in IOP, and the success rate in controlling IOP was the same in both groups. Conclusion. The efficacy of subthreshold SLT group in reducing IOP in POAG patients is comparable to the efficacy of conventional SLT group. Hong Yang Zhang, Yong Jie Qin, Yang Fan Yang, Jian Gang Xu, and Min Bin Yu Copyright © 2016 Hong Yang Zhang et al. All rights reserved. Comment on “Exotropia Is the Main Pattern of Childhood Strabismus Surgery in the South of China: A Six-Year Clinical Review” Mon, 25 Jul 2016 14:13:19 +0000 Onder Ayyildiz, Osman Melih Ceylan, and Fatih Mehmet Mutlu Copyright © 2016 Onder Ayyildiz et al. All rights reserved. The Application of a Contact Lens Sensor in Detecting 24-Hour Intraocular Pressure-Related Patterns Mon, 25 Jul 2016 07:30:06 +0000 Glaucoma is one of the leading causes of blindness worldwide. Recent studies suggest that intraocular pressure (IOP) fluctuations, peaks, and rhythm are important factors in disease advancement. Yet, current glaucoma management remains hinged on single IOP measurements during clinic hours. To overcome this limitation, 24-hour IOP monitoring devices have been employed and include self-tonometry, permanent IOP, and temporary IOP monitoring. This review discusses each IOP measuring strategy and focuses on the recently FDA-approved contact lens sensor (CLS). The CLS records IOP-related ocular patterns for 24 hours continuously. Using the CLS, IOP-related parameters have been found to be associated with the rate of visual field progression in primary open-angle glaucoma, disease progression in primary angle-closure glaucoma, and various clinical variables in ocular hypertension. The CLS has been used to quantify blink rate and limbal strain and measure the circadian rhythm in a variety of disease states including normal-tension glaucoma and thyroid eye disease. The effects of various IOP-lowering interventions were also characterized using the CLS. CLS provides a unique, safe, and well-tolerated way to study IOP-related patterns in a wide range of disease states. IOP-related patterns may help identify patients most at risk for disease progression and assist with the development of tailored treatments. Sarah C. Xu, Angela C. Gauthier, and Ji Liu Copyright © 2016 Sarah C. Xu et al. All rights reserved. Corneal Biomechanics Determination in Healthy Myopic Subjects Thu, 21 Jul 2016 14:33:20 +0000 Purpose. To determine the corneal biomechanical properties by using the Ocular Response Analyzer™ and to investigate potential factors associated with the corneal biomechanics in healthy myopic subjects. Methods. 135 eyes from 135 healthy myopic subjects were included in this cross-sectional observational study. Cornea hysteresis (CH), corneal resistance factor (CRF), cornea-compensated intraocular pressure (IOPcc), and Goldmann-correlated intraocular pressure (IOPg) were determined with the Reichert Ocular Response Analyzer (ORA). Univariate and multivariate regression analyses were performed to investigate factors associated with corneal biomechanics. Results. The mean CH and CRF were  mmHg and  mmHg, respectively. In univariate regression analysis, CH was significantly correlated with axial length, refraction, central corneal thickness (CCT), and IOPg (, 0.23, 0.45, and 0.21, resp.; all with ), but not with corneal curvature or age; CRF was significantly correlated with CCT and IOPg ( and 0.70, resp.; all with ), but not with axial length/refraction, corneal curvature, or age. In multivariate regression analysis, axial length, IOPcc, and CCT were found to be independently associated with CH, while CCT and IOPg were associated with CRF. Conclusions. Both CH and CRF were positively correlated with CCT. Lower CH but not CRF was associated with increasing degree of myopia. Evaluation of corneal biomechanical properties should take CCT and myopic status into consideration. Kunliang Qiu, Xuehui Lu, Riping Zhang, Geng Wang, and Mingzhi Zhang Copyright © 2016 Kunliang Qiu et al. All rights reserved. Innovations in Glaucoma Surgery: Improving the Results Thu, 21 Jul 2016 09:08:50 +0000 Michele Figus, Shlomo Melamed, Antonio Ferreras, Giorgio Marchini, and Vital P. Costa Copyright © 2016 Michele Figus et al. All rights reserved. Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O’odham Students Wed, 20 Jul 2016 07:53:51 +0000 Purpose. To determine rate of convergence insufficiency (CI) and accommodative insufficiency (AI) and assess the relation between CI, AI, visual symptoms, and astigmatism in school-age children. Methods. 3rd–8th-grade students completed the Convergence Insufficiency Symptom Survey (CISS) and binocular vision testing with correction if prescribed. Students were categorized by astigmatism magnitude (no/low: <1.00 D, moderate: 1.00 D to <3.00 D, and high: ≥3.00 D), presence/absence of clinical signs of CI and AI, and presence of symptoms. Analyses determine rate of clinical CI and AI and symptomatic CI and AI and assessed the relation between CI, AI, visual symptoms, and astigmatism. Results. In the sample of 484 students (11.67 ± 1.81 years of age), rate of symptomatic CI was 6.2% and symptomatic AI 18.2%. AI was more common in students with CI than without CI. Students with AI only () and with CI and AI () had higher symptom scores than students with neither CI nor AI. Moderate and high astigmats were not at increased risk for CI or AI. Conclusions. With-the-rule astigmats are not at increased risk for CI or AI. High comorbidity rates of CI and AI and higher symptoms scores with AI suggest that research is needed to determine symptomatology specific to CI. Amy L. Davis, Erin M. Harvey, J. Daniel Twelker, Joseph M. Miller, Tina Leonard-Green, and Irene Campus Copyright © 2016 Amy L. Davis et al. All rights reserved. Evaluation of Outflow Structures In Vivo after the Phacocanaloplasty Tue, 19 Jul 2016 12:57:47 +0000 Purpose. To evaluate the in vivo changes in Schlemm’s canal (SC) and the trabecular meshwork (TM) in patients with primary open-angle glaucoma (POAG) after phacocanaloplasty using anterior segment optical coherence tomography (AS-OCT). Methods. Ten eyes of nine patients with POAG (6 men and 3 women) who underwent phacocanaloplasty. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), and use of glaucoma medications were evaluated. The main outcome measures were the area of SC and TM thickness assessed using AS-OCT before and 12 months after surgery. Results. We found statistically significant reduction in IOP (from 26.4 (8.6) mmHg to 12.9 (2.5) () mmHg), increase in VA from 0.7 (0.4) to 0.9 (0.2), and decrease in glaucoma medication from 2.6 (1.2) to 1.1 (1.3) at 12 months postoperatively. There was a significant increase in the SC area (3081.7 (842.8) μm2 versus 5098.8 (1190.5) μm2, ) and a decrease in mean TM thickness (91.2 (18.6) μm versus 81.3 (15.1) μm, ) after surgery. We found negative correlations between SC area and IOP before surgery (, ) and also between SC area before and IOP reduction 12 months after the phacocanaloplasty (, ). Conclusions. Our results showed statistically significant dilation of SC area and reduction of TM thickness after phacocanaloplasty in POAG patients. The degree of SC expansion was related to the IOP decrease. Daiva Paulaviciute-Baikstiene, Renata Vaiciuliene, Vytautas Jasinskas, and Ingrida Januleviciene Copyright © 2016 Daiva Paulaviciute-Baikstiene et al. All rights reserved. The Predictability of Preoperative Pilocarpine-Induced Lens Shift on the Outcomes of Accommodating Intraocular Lenses Implanted in Senile Cataract Patients Tue, 19 Jul 2016 07:08:22 +0000 Purpose. To evaluate the predictability of lens shift induced by pilocarpine () on the outcomes of accommodating intraocular lens (Acc-IOL) implantation. Methods. Twenty-four eyes of 24 senile cataract patients who underwent phacoemulsification and Acc-IOL implantation were enrolled. was evaluated with anterior segment optical coherence tomography (AS-OCT). At 3 months postoperatively, the best corrected distance visual acuities (BCDVA), distance-corrected near visual acuities (DCNVA), and subjective and objective accommodations were measured. IOL shifts under accommodation stimulus () were evaluated with AS-OCT. Results. The mean was 112.29 ± 30.72 µm. was not associated with any preoperative parameters. The mean was 130.46 ± 42.71 µm. The mean subjective and objective accommodation were 1.54 ± 0.39 D and 1.27 ± 0.41 D, respectively. The mean postoperative BCDVA and DCNVA (log MAR value) were 0.22 ± 0.11 and 0.24 ± 0.12, respectively. positively correlated with (; ), subjective accommodation (; ), and objective accommodation (; ), respectively. Conclusion. is an independent preoperative parameter associated with the postoperative Acc-IOL mobility and pseudophakic accommodation. It may offer valuable information for ophthalmologists in determining the suitable candidates for Acc-IOL implantation. Jin Li, Qi Chen, Zhibo Lin, Lin Leng, Fang Huang, and Ding Chen Copyright © 2016 Jin Li et al. All rights reserved. The Effects of Scleral Collagen Cross-Linking Using Glyceraldehyde on the Progression of Form-Deprived Myopia in Guinea Pigs Mon, 18 Jul 2016 16:30:04 +0000 To investigate the effects of collagen cross-linking using glyceraldehyde on the biomechanical properties of the sclera and the axial elongation of form-deprived myopia in the guinea pig. Thirty-six guinea pigs were randomly assigned to four groups: FDM (form-deprived myopia); FDMG (form-deprived myopia treated with glyceraldehyde); FDMS (form-deprived myopia treated with 0.9% isotonic sodium chloride); and normal control (free of form-deprivation). FDM was achieved in the right eye using a latex facemask. The right eye in FDMG was treated with a posterior subtenon injection of 0.5 M glyceraldehyde; 0.9% isotonic sodium chloride was administered to the right eye in FDMS group using the same method. Axial length, refraction, and stress-strain of the sclera were measured at scheduled time points. The treated eyes were also examined histologically by light microscopy. It was found that glyceraldehyde treatment significantly increased the stiffness of the sclera in the FDM eyes and abnormalities have not been observed in the retina and optic nerve of the treated eyes. But the development of myopia was not affected. Yanhua Chu, Zhaohui Cheng, Jing Liu, Ying Wang, Haixia Guo, and Quanhong Han Copyright © 2016 Yanhua Chu et al. All rights reserved. Expression of TSLP and Downstream Molecules IL-4, IL-5, and IL-13 on the Eye Surface of Patients with Various Types of Allergic Conjunctivitis Mon, 18 Jul 2016 13:18:45 +0000 Background. The pathogenesis of allergic conjunctivitis has not been clearly established. Moreover, previous studies fail to consider human models of allergic conjunctivitis. This study investigated the expression of thymic stromal lymphopoiet in TSLP and its downstream molecules in conjunctival scrappings and tear. Methods. This cross-sectional study compares patients with vernal keratoconjunctivitis (VKC), seasonal allergic conjunctivitis (SAC), and perennial allergic conjunctivitis (PAC) with normal controls. There are 80 people recorded in Shanxi Eye Hospital. Increasingly, 20 are with VKC, 20 are with SAC, 20 are with PAC, and the remaining 20 are normal controls. Conjunctiva were harvested for total RNA extraction and gene expression by real-time polymerase chain reaction. Epithelial cells were collected to make pathological sections for immunohistochemical staining. Human tears were evaluated by Luminex microbead assay. A value less than 0.05 from Dunnett’s post hoc test in SPSS means a statistical significant distinction. Results. Positive expression in conjunctival cells of patients with allergic conjunctivitis. The expression of TSLP and IL-4, IL-5, and IL-13 mRNA shows a statistically significant difference (). TSLP and IL-4, IL-5, and IL-13 concentrations show a statistically significant difference (). Conclusions. This study suggests that TSLP and downstream molecules are expressed in patients with various types of allergic conjunctivitis. Xiaofen Zheng, Juan Yao, and Bing Li Copyright © 2016 Xiaofen Zheng et al. All rights reserved. An Update on the Ophthalmologic Features in the Phakomatoses Sun, 17 Jul 2016 13:31:35 +0000 Neurofibromatosis type 1, tuberous sclerosis complex, and Von Hippel-Lindau disease, historically classified as the phakomatoses, are hereditary multisystem disorders characterized by the presence of hamartoma, which carry the risk of malignant transformation. The alteration of tumor suppressor genes seems to be at the basis of their pathophysiogenetic mechanism. Lisch and choroidal nodules in neurofibromatosis type 1, retinal astrocytomas in tuberous sclerosis complex, and retinal capillary hemangioma in Von Hippel-Lindau disease are the principal ophthalmic hamartomatous manifestations. The advent of novel imaging techniques such as near infrared reflectance and optical coherence tomography has provided unprecedented insight on the choroidal and retinal features of these diseases. These methods have improved early diagnosis and the ongoing surveillance in these conditions. Among an array of treatment modalities, antivascular endothelial growth factor therapy has been used in the management of retinal hamartomas but results have been varied. This review is an update on the pathophysiogenetic mechanisms, ophthalmic manifestations, and novel treatment strategies in the phakomatoses with emphasis on the role of imaging techniques. Solmaz Abdolrahimzadeh, Andrea Maria Plateroti, Santi Maria Recupero, and Alessandro Lambiase Copyright © 2016 Solmaz Abdolrahimzadeh et al. All rights reserved. Optic Disc, Macula, and Retinal Nerve Fiber Layer Measurements Obtained by OCT in Thyroid-Associated Ophthalmopathy Sun, 17 Jul 2016 11:25:26 +0000 Aim. To compare the measurements of retinal nerve fiber layer (RNFL), macula and optic disc parameters obtained by optical coherence tomography (OCT), and intraocular pressure (IOP) between the patients with thyroid-associated ophthalmopathy (TAO) and healthy controls. Methods. One hundred and thirty-two eyes of 66 patients with TAO and 72 eyes of 36 healthy controls were included in the study. Proptosis level was determined by Hertel exophthalmometer. Optic disc, peripapillary retinal nerve fiber layer, and macula parameters were measured by OCT. All measurements of the patients were compared with those of age- and sex-matched healthy controls. Results. No statistically significant difference was found between the patients with TAO and control group in terms of demographic characteristics (). Exophthalmometer measurements and IOP were higher in TAO group (). Mean macula thicknesses in TAO and control groups were  μm and  μm, respectively, and the difference between the groups was statistically significant (). TAO group had thinner inferior RNFL thickness and macular thicknesses (superior, inferior, temporal, and nasal) and higher disc area and C/D ratio when compared with the control group (). Conclusion. IOP, disc area, and C/D area ratio were higher in the patients with TAO and the thicknesses of macula and inferior RNFL were thinner when compared with healthy controls. This trial is registered with registration number at NCT02766660. Osman Sayın, Volkan Yeter, and Nurşen Arıtürk Copyright © 2016 Osman Sayın et al. All rights reserved. Comparison of Perioperative Ranibizumab Injections for Diabetic Macular Edema in Patients Undergoing Cataract Surgery Thu, 14 Jul 2016 14:16:31 +0000 Purpose. To compare the efficacy of perioperative ranibizumab injections on diabetic macular edema (DME) in patients undergoing cataract surgery. Methods. This study included 59 eyes of 59 patients. All patients had advanced cataract with DME and underwent an uneventful phacoemulsification surgery. There were 3 subgroups. The first group received intravitreal ranibizumab injection 2 weeks preoperatively, the second group received intraoperatively, and the third group received 2 weeks postoperatively. Follow-up examinations were performed at 1 week as well as at 1 and 3 months. Results. Baseline visual acuity showed a significant increase in all groups at 1 month. In group 1, compared to baseline value, foveal thickness (FT) increased significantly at 1 month and showed a significant decrease up to month 3. In group 2, FT increased at month 1 and this continued up to month 3. In group 3, FT increased at month 1 and was almost stable up to month 3. There were not any significant differences for visual acuity and FT between the groups. Conclusions. Although intrapostoperative ranibizumab injection for DME seems to be more effective than preoperative injections in patients undergoing cataract surgery, the treatment still needs to be continued following surgery. Erhan Yumuşak and Kemal Örnek Copyright © 2016 Erhan Yumuşak and Kemal Örnek. All rights reserved. Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment Wed, 13 Jul 2016 11:34:35 +0000 Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD). Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60). Results. This study evaluated 422 eyes of 411 patients with a mean age of years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean = ). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments () and the presence of multiple tears (). Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%. Yasser Helmy Mohamed, Kozue Ono, Hirofumi Kinoshita, Masafumi Uematsu, Eiko Tsuiki, Azusa Fujikawa, and Takashi Kitaoka Copyright © 2016 Yasser Helmy Mohamed et al. All rights reserved. Impact of Indocyanine Green Concentration, Exposure Time, and Degree of Dissolution in Creating Toxic Anterior Segment Syndrome: Evaluation in a Rabbit Model Tue, 12 Jul 2016 13:20:29 +0000 Purpose. To investigate the role of indocyanine green (ICG) dye as a causative material of toxic anterior segment syndrome (TASS) in an experimental rabbit model. Method. Eight eyes of four rabbits were allocated to this study. Capsular staining was performed using ICG dye, after which the anterior chamber was irrigated with a balanced salt solution. The effects of different concentrations (control, 0.25, 0.5, and 1.0%), exposure times (10 and 60 seconds), and the degree of dissolution (differently vortexed) were investigated. The analysis involved anterior segment photography, ultrasound pachymetry, prostaglandin assay (PGE2 Parameter Assay, R&D systems, Inc.), and scanning electron microscopy of each iris. Result. There was no reaction in the control eye. A higher aqueous level of PGE2 and more severe inflammatory reaction were observed in cases of eyes with higher concentration, longer exposure time, and poorly dissolved dye. Additionally, scanning electron microscopy revealed larger and coarser ICG particles. Conclusion. TASS occurrence may be associated with the concentration, exposure time, and degree of dissolution of ICG dye during cataract surgery. Tamer Tandogan, Ramin Khoramnia, Gerd Uwe Auffarth, Michael Janusz Koss, and Chul Young Choi Copyright © 2016 Tamer Tandogan et al. All rights reserved. Long-Term Follow-Up of the Fellow Eye in Patients Undergoing Surgery on One Eye for Treating Myopic Traction Maculopathy Tue, 12 Jul 2016 07:30:14 +0000 Objective. To observe the fellow eye in patients undergoing surgery on one eye for treating myopic traction maculopathy. Methods. 99 fellow eyes of consecutive patients who underwent unilateral surgery to treat MTM were retrospectively evaluated. All patients underwent thorough ophthalmologic examinations, including age, gender, duration of follow-up, refraction, axial length, intraocular pressure, lens status, presence/absence of a staphyloma, and best-corrected visual acuity (BCVA). Fundus photographs and SD-OCT images were obtained. When feasible, MP-1 microperimetry was performed to evaluate macular sensitivity and fixation stability. Results. At an average follow-up time of 24.7 months, 7% fellow eyes exhibited partial or complete MTM resolution, 68% stabilized, and 25% exhibited progression of MTM. Of the 38 eyes with “normal” macular structure on initial examination, 11% exhibited disease progression. The difference in progression rates in Groups 2, 3, and 4 was statistically significant. Refraction, axial length, the frequency of a posterior staphyloma, chorioretinal atrophy, initial BCVA, final BCVA, and retinal sensitivity all differed significantly among Groups 1–4. Conclusions. Long axial length, chorioretinal atrophy, a posterior staphyloma, and anterior traction contribute to MTM development. Patients with high myopia and unilateral MTM require regular OCT monitoring of the fellow eye to assess progression to myopic pre-MTM. For cases exhibiting one or more potential risk factors, early surgical intervention may maximize the visual outcomes. Hui-Juan Xia, Wei-Jun Wang, Feng’E Chen, Ying Wu, Zhen-Yuan Cai, Wei Chen, Su-Qin Yu, and Ying Fan Copyright © 2016 Hui-Juan Xia et al. All rights reserved. The Application of OCTA in Assessment of Anti-VEGF Therapy for Idiopathic Choroidal Neovascularization Mon, 04 Jul 2016 11:19:17 +0000 Purpose. To assess the morphology of idiopathic choroidal neovascularization (ICNV) by optical coherence tomography angiography (OCTA) and determine the therapeutic effects of intravitreal antivascular endothelial growth factor (anti-VEGF). Method. Patients with naive ICNV were assessed by spectral domain optical coherence tomography (SD-OCT) and OCTA in this observational study. The timing of observation was before treatment, 1 day after treatment with intravitreal anti-VEGF injection, and 1 month after the treatment. The central retina thickness (CRT) on SD-OCT, selected CNV area, and flow area on OCTA were measured. Results. A total of 17 eyes from 17 patients with ICNV were included in this study. OCTA showed visible irregular choroidal neovascularization with “tree-in-bud” form on outer retinal layer. After treatment, as well as in the 1-day follow-up, CNV decreased in size from the periphery, and the vessel density was reduced. As shown on OCTA, the selected CNV area and flow area were significantly reduced compared to pretreatment. The rate of CNV vessel area changes was higher on OCTA than the changes in CRT on SD-OCT at 1-day and 1-month follow-up. Conclusion. Intravitreal injection of anti-VEGF is effective for idiopathic choroidal neovascularization, and the treatment outcomes are observable after 1 day. OCTA provides a useful approach for monitoring and evaluating the treatment of intravitreal anti-VEGF for CNV. Qin Chen, Xiaobing Yu, Zihan Sun, and Hong Dai Copyright © 2016 Qin Chen et al. All rights reserved. Biomechanical Measurement of Rabbit Cornea by a Modified Scheimpflug Device Sun, 03 Jul 2016 09:34:59 +0000 Purpose. To explore the probability and variation in biomechanical measurements of rabbit cornea by a modified Scheimpflug device. Methods. A modified Scheimpflug device was developed by imaging anterior segment of the model imitating the intact eye at various posterior pressures. The eight isolated rabbit corneas were mounted on the Barron artificial chamber and images of the anterior segment were taken at posterior pressures of 15, 30, 45, 60, and 75 mmHg by the device. The repeatability and reliability of the parameters including CCT, ACD, ACV, and CV were evaluated at each posterior pressure. All the variations of the parameters at the different posterior pressures were calculated. Results. All parameters showed good intraobserver reliability (Cronbach’s alpha; intraclass correlation coefficient, α, ICC > 0.96) and repeatability in the modified Scheimpflug device. With the increase of posterior pressures, the ratio of CCT decreased linearly and the bulk modulus gradually reduced to a platform. The increase of ACD was almost linear with the posterior pressures elevated. Conclusions. The modified Scheimpflug device was a valuable tool to investigate the biomechanics of the cornea. The posterior pressure 15–75 mmHg range produced small viscoelastic deformations and nearly linear pressure-deformation response in the rabbit cornea. Bo Zhang, Jianjun Gu, Xiaoxiao Zhang, Bin Yang, Zheng Wang, and Danying Zheng Copyright © 2016 Bo Zhang et al. All rights reserved. Comparative Analysis of KnockOut™ Serum with Fetal Bovine Serum for the In Vitro Long-Term Culture of Human Limbal Epithelial Cells Thu, 30 Jun 2016 12:36:16 +0000 The limbal epithelial cells can be maintained on 3T3 feeder layer with fetal bovine serum supplemented culture medium, and these cells have been used to successfully treat limbal stem cell deficiency. However, fetal bovine serum contains unknown components and displays quantitative and qualitative lot-to-lot variations. To improve the culture condition, the defined KnockOut serum replacement was investigated to replace fetal bovine serum for culturing human limbal epithelial cell. Human primary limbal epithelial cells were cultured in KnockOut serum and fetal bovine serum supplemented medium, respectively. The cell growth rate, gene expression, and maintenance of limbal epithelial stem cells were studied and compared between these two groups. Human primary limbal epithelial cells were isolated and successfully serially cultivated in this novel KnockOut serum supplemented medium; the cell proliferation and stem cell maintenance were similar to those of cells grown in fetal bovine serum supplemented medium. These data suggests that this KnockOut serum supplemented medium is an efficient replacement to traditional fetal bovine serum supplemented medium for limbal epithelial cell culture, and this medium has great potential for long term maintenance of limbal epithelial cells, limbal epithelial stem cells transplantation, and tissue regeneration. Shaokun Zhang, Zaoxia Liu, Guanfang Su, and Hong Wu Copyright © 2016 Shaokun Zhang et al. All rights reserved. Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism Thu, 30 Jun 2016 10:28:03 +0000 Purpose. To evaluate the visual and refractive outcomes after small incision lenticule extraction (SMILE) for treating myopia and myopic astigmatism after penetrating keratoplasty (PKP). Design. Case-series. Methods. Ten eyes of 10 patients with previous PKP and residual myopic astigmatism for whom pentacam imaging and thickness measurements were acceptable for laser vision correction. Manifest refraction (MR), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained preoperatively and one day, one week, and one, 3, and 6 months postoperatively. Cases were operated on the VisuMax® femtosecond laser platform with 500 kHz repetition rate. Results. The mean correction ratio for spherical errors was  D and for the mean refractive spherical equivalent (MRSE) was  D. Vector analysis showed a mean astigmatism reduction at the intended axis of , a correction index of , and an overall mean percentage of success of astigmatism surgery of . The postoperative MRSE was stable throughout the 6-month follow-up period. The efficacy index was 0.93 and the safety index was 1.12. Conclusion. SMILE for correction of post-PKP myopia and astigmatism is effective, safe, and stable with moderate accuracy and predictability. Centration of the treatment within the grafts was easily performed. Tamer H. Massoud, Osama Ibrahim, Kitty Shehata, and Moones F. Abdalla Copyright © 2016 Tamer H. Massoud et al. All rights reserved. Multimodal Imaging Evaluations of Focal Choroidal Excavations in Eyes with Central Serous Chorioretinopathy Wed, 29 Jun 2016 15:02:49 +0000 Purpose. To investigate the prevalence and characteristics of focal choroidal excavation (FCE) concurrent with central serous chorioretinopathy (CSC) using multimodal imaging. Methods. This was a retrospective single-institution study. Clinical features and multimodal imaging findings were analyzed in eyes with CSC and FCEs, using imaging methods including optical coherence tomography (OCT), OCT angiography (OCTA), fluorescein angiography (FA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), and multispectral imaging. Results. Seventeen patients (4.8%) with 21 FCEs (19 eyes) were found among 351 consecutive Chinese patients with CSC. Chronic CSC represented 47.1% of those cases. Window defects in 12 lesions identified through FA and hypoautofluorescence in 13 lesions identified through FAF revealed retinal pigment epithelial attenuation. Choroidal hemodynamic disturbances characterized by localized filling defects at the excavation and circumferential hyperperfusion were validated by both ICGA and OCTA, which were similar to the angiographic features of normal chronic CSC. The hyperreflective tissue beneath FCE, observed on B-scan OCT, presented as intensive choroidal flow signals on OCTA. Conclusions. FCE is not uncommon in patients with CSC. Multimodal imaging suggested that the aberrant choroidal circulation might be a contribution factor for leakage from the dysfunctional retinal pigment epithelium at the area of excavation. Yao Wang, Zhi-Qing Chen, Wei Wang, and Xiao-Yun Fang Copyright © 2016 Yao Wang et al. All rights reserved. Static and Dynamic Measurement of Ocular Surface Temperature in Dry Eyes Tue, 28 Jun 2016 15:26:55 +0000 Purpose. To study ocular surface temperature (OST) in dry eyes by static and dynamic measures. Methods. OST was recorded on 62 dry eyes and 63 age- and sex-matched controls. Static measures were study of absolute OST at , 5, and 10 s after eye opening. Dynamic measures were study of mean change and net change in OST over 10 s of sustained eye opening. Ten OST indices studied were temperatures of the geometric center of the cornea (GCC), extreme temporal (T1) and nasal conjunctiva (T4), midtemporal (CT) and nasal conjunctiva (CN), temporal (LT) and nasal (LN) limbus, and mean (MOST), maximum (), and minimum () temperatures of the region of interest. Results. For static measures, dry eyes recorded significantly lower GCC, MOST, , , T4, CT, LT, LN, and CN. For dynamic measures, dry eyes had significantly steeper regression line of mean change (corresponding to greater net change) for 5 s onward and T4 at 3 s onward. Conclusions. Both static and dynamic measures of the OST were valuable and can be used as clinical tool to assess dry eye. Li Li Tan, Srinivasan Sanjay, and Philip B. Morgan Copyright © 2016 Li Li Tan et al. All rights reserved. Emerging Technology in Refractive Cataract Surgery Tue, 28 Jun 2016 10:47:39 +0000 Technology in cataract surgery is constantly evolving to meet the goals of both surgeons and patients. Recent major advances in refractive cataract surgery include innovations in preoperative and intraoperative diagnostics, femtosecond laser-assisted cataract surgery (FLACS), and a new generation of intraocular lenses (IOLs). This paper presents the latest technologies in each of these major categories and discusses how these contributions serve to improve cataract surgery outcomes in a safe, effective, and predictable manner. João Saraiva, Kristin Neatrour, and George O. Waring IV Copyright © 2016 João Saraiva et al. All rights reserved. Visualization of IOL Material-Induced Changes in Retinal Color Stimulus Tue, 28 Jun 2016 07:33:35 +0000 Purpose. Different IOL materials, particularly blue-light filtering materials, have different spectral transmittance characteristics. The color stimuli, which influence retinal receptors objectively, have consequently implications for color perception. We report on the quantitative determination of IOL-specific transmittance characteristics and present a method visualizing the resultant changes in color stimulus. Methods. A setup was realized to quantify IOL-absorption in a range of 390–780 nm. To visualize the influence of the different spectral transmittance characteristics an algorithm was developed, which converts RGB-pixel values of images into spectra, which performs the corresponding transmittance correction, reconverts to RGB, and reconstructs the image. IOLs of hydrophobic acrylate and hydrophilic acrylate with a hydrophobic surface in each case with/without blue-light filter were examined. Results. Assessment of the reference images verifies the suitability of the pipeline. Evaluation of the transmittance spectra reveals differences of material- and manufacturer-specifics, which are capable of inducing considerable changes in color perception, particularly in the blue color range and mixed colors involving blue. Conclusions. The developed technique provides an approach for determining IOL-specific transmittance behavior and subsequently its influence on the retinal color stimulus. Problems of altered color perception are occasionally reported after cataract surgery and these become obvious with the visualization procedure developed here. Stephan Reiss, Karsten Sperlich, Martin Kunert, Rudolf F. Guthoff, Heinrich Stolz, Anselm Jünemann, and Oliver Stachs Copyright © 2016 Stephan Reiss et al. All rights reserved. Comment on “Choroidal Thickness in Patients with Mild Cognitive Impairment and Alzheimer’s Type Dementia” Tue, 28 Jun 2016 07:09:32 +0000 Abdullah Ilhan, Umit Yolcu, and Fahrettin Akay Copyright © 2016 Abdullah Ilhan et al. All rights reserved. Corrigendum to “Local Relationship between Global-Flash Multifocal Electroretinogram Optic Nerve Head Components and Visual Field Defects in Patients with Glaucoma” Tue, 28 Jun 2016 05:53:42 +0000 Chan Hee Moon, Jungwoo Han, Young-Hoon Ohn, and Tae Kwann Park Copyright © 2016 Chan Hee Moon et al. All rights reserved. Comparison of In Vivo Gene Expression Profiling of RPE/Choroid following Intravitreal Injection of Dexamethasone and Triamcinolone Acetonide Mon, 27 Jun 2016 09:59:45 +0000 Purpose. To identify retinal pigment epithelium (RPE)/choroid genes and their relevant expression pathways affected by intravitreal injections of dexamethasone and triamcinolone acetonide in mice at clinically relevant time points for patient care. Methods. Differential gene expression of over 34,000 well-characterized mouse genes in the RPE/choroid of 6-week-old C57BL/6J mice was analyzed after intravitreal steroid injections at 1 week and 1 month postinjection, using Affymetrix Mouse Genome 430 2.0 microarrays. The data were analyzed using GeneSpring GX 12.5 and Ingenuity Pathway Analysis (IPA) microarray analysis software for biologically relevant changes. Results. Both triamcinolone and dexamethasone caused differential activation of genes involved in “Circadian Rhythm Signaling” pathway at both time points tested. Triamcinolone (TAA) uniquely induced significant changes in gene expression in “Calcium Signaling” (1 week) and “Glutamate Receptor Signaling” pathways (1 month). In contrast, dexamethasone (Dex) affected the “GABA Receptor Signaling” (1 week) and “Serotonin Receptor Signaling” (1 month) pathways. Understanding how intraocular steroids affect the gene expression of RPE/choroid is clinically relevant. Conclusions. This in vivo study has elucidated several genes and pathways that are potentially altering the circadian rhythms and several other neurotransmitter pathways in RPE/choroid during intravitreal steroid injections, which likely has consequences in the dysregulation of RPE function and neurodegeneration of the retina. Zeljka Smit-McBride, Elad Moisseiev, Sara P. Modjtahedi, David G. Telander, Leonard M. Hjelmeland, and Lawrence S. Morse Copyright © 2016 Zeljka Smit-McBride et al. All rights reserved. Classifications for Proliferative Vitreoretinopathy (PVR): An Analysis of Their Use in Publications over the Last 15 Years Mon, 27 Jun 2016 07:02:41 +0000 Purpose. To evaluate the current and suitable use of current proliferative vitreoretinopathy (PVR) classifications in clinical publications related to treatment. Methods. A PubMed search was undertaken using the term “proliferative vitreoretinopathy therapy”. Outcome parameters were the reported PVR classification and PVR grades. The way the classifications were used in comparison to the original description was analyzed. Classification errors were also included. It was also noted whether classifications were used for comparison before and after pharmacological or surgical treatment. Results. 138 papers were included. 35 of them (25.4%) presented no classification reference or did not use any one. 103 publications (74.6%) used a standardized classification. The updated Retina Society Classification, the first Retina Society Classification, and the Silicone Study Classification were cited in 56.3%, 33.9%, and 3.8% papers, respectively. Furthermore, 3 authors (2.9%) used modified-customized classifications and 4 (3.8%) classification errors were identified. When the updated Retina Society Classification was used, only 10.4% of authors used a full C grade description. Finally, only 2 authors reported PVR grade before and after treatment. Conclusions. Our findings suggest that current classifications are of limited value in clinical practice due to the inconsistent and limited use and that it may be of benefit to produce a revised classification. Salvatore Di Lauro, Mustafa R. Kadhim, David G. Charteris, and J. Carlos Pastor Copyright © 2016 Salvatore Di Lauro et al. All rights reserved. Passive Removal of Silicone Oil with Temporal Head Position through Two 23-Gauge Cannulas Wed, 22 Jun 2016 14:26:46 +0000 Purpose. To report a new approach for removal of silicone oil. Methods. All surgeries were performed using 23-gauge vitrectomy system with two transconjunctival sutureless cannulas. At the beginning, most of the silicone oil was removed by traditional microinvasive vitrectomy system through inferior-temporal cannula. Then, the blood transfusion tube is removed from the inferior-temporal cannula, and the fluid-air exchange is performed. A passive fluid-air exchange was performed to aspirate the residual silicone oil after gradually turning the patient’s head temporally by approximately 90° gradually. Results. After the surgery, all patients had a clear anterior chamber and vitreous cavity on slit lamp and B scan examination, respectively. The mean time taken for silicone oil removal and total surgery was minutes and minutes, respectively. The mean intraocular pressure 1 day, 3 days, 1 week, 1 month, and 3 months after surgery was  mmHg,  mmHg,  mmHg,  mmHg, and  mmHg, respectively. Conclusion. This new approach may provide a safe and fast method to remove the silicone oil. Zhong Lin, Zhi Sheng Ke, Qian Zheng, Zhen Quan Zhao, and Zong Ming Song Copyright © 2016 Zhong Lin et al. All rights reserved. iStent® Trabecular Microbypass Stent: An Update Mon, 20 Jun 2016 07:05:11 +0000 Due to the high rates of complications and failure experienced with current glaucoma procedures, there is a continuous search for a safer and more effective glaucoma surgery. A new class of procedures termed minimally invasive glaucoma surgeries (MIGS) aim to fill this void by offering an alternative method of IOP reduction associated with markedly reduced complication rates and shorter recovery times. The iStent, a trabecular microbypass stent, is a MIGS device that has quickly gained popularity. The device allows aqueous humor to directly drain from the anterior chamber into Schlemm’s canal by bypassing an obstructed trabecular meshwork. This review examines publications about the iStent, focusing on the device’s efficacy, safety, and cost when a single iStent or multiple iStents are implanted in combination with cataract surgery or as a solo procedure. Current data suggest that the iStent is a safe and effective tool in the management of mild-to-moderate glaucoma, notable for its limited complications and absence of serious adverse events following implantation. As valuable experience is gained performing ab interno MIGS, increasing familiarity with angle anatomy and iStent placement, and as newer stent designs are developed, there is promise of continual improvement in the surgical management of glaucoma. Arthur Fernandes Resende, Neal Sanjay Patel, Michael Waisbourd, and L. Jay Katz Copyright © 2016 Arthur Fernandes Resende et al. All rights reserved.