Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Joint Effect of CFH and ARMS2/HTRA1 Polymorphisms on Neovascular Age-Related Macular Degeneration in Chinese Population Wed, 25 Mar 2015 09:22:07 +0000 Purpose. The etiology of neovascular age-related macular degeneration (nAMD) cannot be completely explained by identified environmental risk factors or single-locus gene variants. This study was to explore the potential interactions among gene variants on nAMD in Chinese population. Methods. 43 SNPs located in different genes were genotyped in 932 Chinese individuals (464 nAMD patients and 468 controls). We explored the potential interactions among gene variants using generalized multifactor dimensionality reduction (GMDR) algorithm and the method to measure the departure from the additivity model. Results. The joint effect that involved CFH rs1061170 and HTRA1 rs3793917 was shown statistically significant (P < 0.001) with the highest cross-validation consistency (10/10) and the best testing balanced accuracy (64.50%). In addition, based on the method to measure the departure from the additivity model, the synergy index (S) was 2.63 (1.09–6.38) and the attributable proportion due to interaction (AP) was 55.7% (21.4%–89.9%), which suggested that a common pathway may exist for these genes for nAMD. Those who carried CC for rs3793917 and TC/CC for rs1061170 were at the highest risk of nAMD (OR: 9.76, 95% CI: 4.65–20.51). Conclusions. Evidence that the joint effect that involved CFH and ARMS2/HTRA1 may contribute to the risk of neovascular AMD in Chinese population was obtained. Kai Fang, Pei Gao, Jun Tian, Xueying Qin, Wenzhen Yu, Juan Li, Qing Chen, Lvzhen Huang, Dafang Chen, Yonghua Hu, and Xiaoxin Li Copyright © 2015 Kai Fang et al. All rights reserved. Comparative Analysis of Anterior Segment Parameters in Normal and Keratoconus Eyes Generated by Scheimpflug Tomography Tue, 24 Mar 2015 12:33:45 +0000 Purpose. To assess and compare the anterior and posterior corneal surface parameters, keratoconus indices, thickness profile data, and data from enhanced elevation maps of keratoconic and normal corneas with the Pentacam Scheimpflug corneal tomography and to determine the sensitivity and specificity of these parameters in discriminating keratoconus from normal eyes. Methods. The study included 656 keratoconus eyes and 515 healthy eyes with a mean age of and years, respectively. Forty parameters obtained from the Pentacam tomography were assessed by the receiver operating characteristic curve analysis for their efficiency. Results. Receiver operating characteristic curve analyses showed excellent predictive accuracy (area under the curve, ranging from 0.914 to 0.972) for 21 of the 40 parameters evaluated. Among all parameters indices of vertical asymmetry, keratoconus index, front elevation at thinnest location, back elevation at thinnest location, Ambrósio Relational Thickness (ARTmax), deviation of average pachymetric progression, deviation of ARTmax, and total deviation showed excellent (>90%) sensitivity and specificity in addition to excellent area under the receiver operating characteristic curve (AUROC). Conclusions. Parameters derived from the topometric and Belin-Ambrósio enhanced ectasia display maps very effectively discriminate keratoconus from normal corneas with excellent sensitivity and specificity. Faik Orucoglu and Ebru Toker Copyright © 2015 Faik Orucoglu and Ebru Toker. All rights reserved. Current Concepts and Future Developments of Corneal Cross-Linking Tue, 24 Mar 2015 11:59:23 +0000 Suphi Taneri, Elias Jarade, John A. Kanellopoulos, and David Muller Copyright © 2015 Suphi Taneri et al. All rights reserved. The Aging Eye Tue, 24 Mar 2015 09:06:15 +0000 Suddhasil Mookherjee, Ashima Bhattacharjee, and Mainak Sengupta Copyright © 2015 Suddhasil Mookherjee et al. All rights reserved. Comparison of Physiologic versus Pharmacologic Mydriasis on Anterior Chamber Angle Measurements Using Spectral Domain Optical Coherence Tomography Mon, 23 Mar 2015 11:26:06 +0000 Purpose. To compare the effects of physiologic versus pharmacologic pupil dilation on anterior chamber angle (ACA) measurements obtained with spectral domain optical coherence tomography (SD-OCT). Methods. Forty eyes from 20 healthy, phakic individuals with open angles underwent anterior segment OCT imaging under 3 pupillary states: (1) pupil constricted under standard room lighting, (2) physiologic mydriasis in a darkened room, and (3) postpharmacologic mydriasis. Inferior angle Schwalbe’s line-angle opening distance (SL-AOD) and SL-trabecular-iris-space area (SL-TISA) were computed for each eye and pupillary condition by masked, certified Reading Center graders using customized grading software. Results. SL-AOD and SL-TISA under pupillary constriction to room light were  mm and  mm2, respectively; decreased to  mm and  mm2  , respectively, under physiologic mydriasis; and increased to  mm and  mm2   under pharmacologic mydriasis compared to baseline. Conclusions. Using SD-OCT imaging, pharmacologic mydriasis yielded the widest angle opening, whereas physiologic mydriasis yielded the most angle narrowing in normal individuals with open iridocorneal angles. Accounting for the state of the pupil and standardizing the lighting condition would appear to be of importance for future studies of the angle. Anna I. Dastiridou, Xiaojing Pan, ZhouYuan Zhang, Kenneth M. Marion, Brian A. Francis, Srinivas R. Sadda, and Vikas Chopra Copyright © 2015 Anna I. Dastiridou et al. All rights reserved. The Impact of Unilateral or Bilateral Cataract Surgery on Visual Acuity and Life Quality of Elderly Patients Sun, 22 Mar 2015 11:00:51 +0000 In the current study, the CLVQOL was used to assess VRQOL before unilateral or bilateral cataract surgery and at the end of the follow-up period in order to determine the greater beneficial mode of surgery for patients, if one of the two surgical methods is more beneficial over the other. The patients were classified as receiving unilateral (group A) and bilateral cataract surgery (group B). There were no significant differences between groups A and B before the operation in terms of life quality scores, binocular weighted average LogMAR BCVA, age, educational level, gender, systematic and ocular comorbidities, and the complications of the operation. It was shown that visual acuity improved more significantly with bilateral cataract surgery than with unilateral surgery in elderly patients with a high preoperative disease burden in Shanghai city. However, the improvement in life quality was not different in patients receiving either bilateral or unilateral cataract surgery. Lei Zuo, Haidong Zou, Xinfeng Fei, Weiqi Xu, and Jianhong Zhang Copyright © 2015 Lei Zuo et al. All rights reserved. Association between Ophthalmic Timolol and Hospitalisation for Bradycardia Sun, 22 Mar 2015 08:53:05 +0000 Introduction. Ophthalmic timolol, a topical nonselective beta-blocker, has the potential to be absorbed systemically which may cause adverse cardiovascular effects. This study was conducted to determine whether initiation of ophthalmic timolol was associated with an increased risk of hospitalisation for bradycardia. Materials and Methods. A self-controlled case-series study was undertaken in patients who were hospitalised for bradycardia and were exposed to timolol. Person-time after timolol initiation was partitioned into risk periods: 1–30 days, 31–180 days, and >180 days. A 30-day risk period prior to initiating timolol was also included. All remaining time was considered unexposed. Results. There were 6,373 patients with at least one hospitalisation for bradycardia during the study period; 267 were exposed to timolol. Risk of bradycardia was significantly increased in the 31–180 days after timolol initiation (incidence rate ratio (IRR) = 1.93; 95% confidence interval (CI) 1.00–1.87). No increased risk was observed in the first 30 days or beyond 180 days of continuous exposure (IRR = 1.40; 95% CI 0.87–2.26 and IRR = 1.21; 95% CI 0.64–2.31, resp.). Conclusion. Bradycardia is a potential adverse event following timolol initiation. Practitioners should consider patient history before choosing a glaucoma regime and closely monitor patients after treatment initiation with topical nonselective beta-blocker eye drops. Nicole L. Pratt, Emmae N. Ramsay, Lisa M. Kalisch Ellett, Tuan A. Nguyen, and Elizabeth E. Roughead Copyright © 2015 Nicole L. Pratt et al. All rights reserved. Safety and Visual Outcome of Visian Toric ICL Implantation after Corneal Collagen Cross-Linking in Keratoconus: Up to 2 Years of Follow-Up Thu, 19 Mar 2015 09:20:48 +0000 Purpose. To evaluate the long-term safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. Methods. This was a retrospective study of 30 eyes (19 patients), with progressive keratoconus, who underwent sequential CXL followed by Visian toric ICL implantation after 6 months. Results. At baseline, 6 eyes had stage I, 14 eyes stage II, and 10 eyes stage III keratoconus graded by Amsler-Krumeich classification. At 6 months after CXL, only K (steep) and K (max) decreased significantly from baseline, with no change in visual acuity or refraction. Flattening in keratometric readings was stable thereafter. There was significant improvement in mean uncorrected distance visual acuity (1.57 ± 0.56 to 0.17 ± 0.06 logMAR, ) and mean corrected distance visual acuity (0.17 ± 0.08 to 0.11 ± 0.05 logMAR, ) at 12 months after ICL implantation that was maintained at the 2-year follow-up. Mean cylinder power and mean spherical equivalent (SE) also decreased significantly after ICL implantation. A small hyperopic shift in SE (+0.25 D) was observed at 2 years that did not alter visual outcomes. Conclusions. Visian toric ICL implantation following CXL is an effective option for improving visual acuity in patients with keratoconus up to 2 years. Rafic Antonios, Ali Dirani, Ali Fadlallah, Elias Chelala, Adib Hamade, Carole Cherfane, and Elias Jarade Copyright © 2015 Rafic Antonios et al. All rights reserved. Rate of Corneal Collagen Crosslinking Redo in Private Practice: Risk Factors and Safety Thu, 19 Mar 2015 09:03:59 +0000 Objective. To report the rate of progression of keratectasia after primary crosslinking (CXL) and evaluate the safety and efficiency of CXL redo. Materials and Methods. We conducted a retrospective analysis of the patients who underwent CXL between 2010 and 2013 at the Beirut Eye Specialist Hospital, Lebanon. Progression of keratectasia was based on the presence of an increase in maximum keratometry of 1.00 D, a change in the map difference between two consecutive topographies of 1.00 D, a deterioration of visual acuity, or any change in the refraction. Primary and redo CXL were done using the same protocol. Results. Among the 221 eyes of 130 patients who underwent CXL, 7 eyes (3.17%) of five patients met the criteria of progression. All patients reported a history of allergic conjunctivitis and eye rubbing and progressed within 9 to 48 months. No complications were noted and all patients were stable 1 year after CXL redo. Conclusion. Allergic conjunctivitis and eye rubbing were the only risk factors associated with keratoconus progression after CXL. A close followup is thus mandatory, even years after the procedure. CXL redo seems to be a safe and efficient technique to halt the progression after a primary CXL. Joelle Antoun, Elise Slim, Rami el Hachem, Elias Chelala, Elyse Jabbour, Georges Cherfan, and Elias F. Jarade Copyright © 2015 Joelle Antoun et al. All rights reserved. The Relationship between Estimated Glomerular Filtration Rate and Diabetic Retinopathy Wed, 18 Mar 2015 07:09:15 +0000 Diabetic retinopathy (DR) is the leading cause of visual impairment and blindness in working-aged people. Several studies have suggested that glomerular filtration rate (GFR) was correlated with DR. This is a hospital-based study and the aim of it was to examine the relationship between the GFR and DR in patients with type 2 diabetes mellitus (T2DM). We used CKD-EPI equation to estimate GFR and SPSS 19.0 and EmpowerStats software to assess their relationship. Among the 1613 participants (aged 54.75 ± 12.19 years), 550 (34.1%) patients suffered from DR. The multivariate analysis revealed that the risk factors for DR include age (, OR = 0.940), duration of diabetes (, OR = 1.163), hemoglobin A1c (, OR = 1.224), systolic blood pressure (, OR = 1.032), diastolic blood pressure (, OR = 0.953), high density lipoprotein cholesterol (, OR = 3.884), and eGFR (, OR = 0.973). Through stratified analysis and saturation effect analysis, our data suggests that eGFR of 99.4 mL/min or lower might imply the early stage of DR in diabetic patients. Thus, the evaluation of eGFR has clinical significance for the early diagnosis of DR. Jingyang Wu, Jin Geng, Limin Liu, Weiping Teng, Lei Liu, and Lei Chen Copyright © 2015 Jingyang Wu et al. All rights reserved. Surgical Outcome of Medial Rectus Resection in Recurrent Exotropia: A Novel Surgical Formula Tue, 17 Mar 2015 09:37:18 +0000 Purpose. To evaluate the surgical outcomes of unilateral or bilateral medial rectus (MR) muscle resection for recurrent exotropia after bilateral lateral rectus (BLR) muscle recession based on a novel surgical formula. Methods. Forty-one consecutive patients with unilateral or bilateral MR muscle resection for recurrent exotropia after BLR muscle recession were included in this retrospective study. All surgeries were performed according to the formula: 1.0 mm MR muscle resection for every 5 prism dioptres (PD) of exotropia, with an addition of 0.5 mm to each MR muscle operated on. Results. The mean recurrent exotropia distant deviation was 28 PD ± 11.2 (range 14 to 55 PD). Overall at postoperative 1 month, 36 (88%) achieved successful outcomes, 4 (10%) had undercorrection, and 1 (2%) had overcorrection. At postoperative 6 months, 29 (71%) achieved successful outcomes, 12 (29%) had undercorrection, and none had overcorrection. Subgroup analysis showed no statistically significant difference in success rates between unilateral and bilateral MR groups. Conclusion. Unilateral or bilateral MR muscle resection using our surgical formula is a safe and effective method for calculating the amount of MR resection in moderate to large angle recurrent exotropia, with a low overcorrection rate. Abbie Sheung-Wan Luk, Jason Cheuk-Sing Yam, Henry Hing-Wai Lau, Wilson Wai-Kuen Yip, and Alvin Lerrmann Young Copyright © 2015 Abbie Sheung-Wan Luk et al. All rights reserved. Intraocular Lens Opacification following Intracameral Injection of Recombinant Tissue Plasminogen Activator to Treat Inflammatory Membranes after Cataract Surgery Mon, 16 Mar 2015 08:58:41 +0000 Purpose. To report 7 cases of intraocular lens (IOL) opacification following treatment of postoperative anterior chamber fibrin with recombinant tissue plasminogen activator (rtPA) after cataract surgery. Methods. Retrospective case series of 7 eyes in 7 patients who developed IOL opacification after receiving rtPA for anterior chamber inflammatory membrane formation resulting from phacoemulsification cataract surgery. Three explanted IOLs were investigated with light microscopy, histochemical analysis, scanning electron microscopy, and X-ray spectrometry. Results. All patients underwent uncomplicated cataract surgery and posterior chamber hydrophilic IOL implantation. Anterior chamber inflammatory membranes developed between 1 and 4 weeks of surgery and were treated with intracameral rtPA. IOL opacification was noted between 4 weeks and 6 years after rtPA treatment with reduced visual acuity, and IOL exchange was carried out in 3 patients. Light microscopy evaluation revealed diffuse fine granular deposits on the anterior surface/subsurface of IOL optic that stained positive for calcium salts. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS) confirmed the presence of calcium and phosphate on the IOL. Conclusions. Intracameral rtPA, though rapidly effective in the treatment of anterior chamber inflammatory membranes following cataract surgery, may be associated with IOL opacification. Simon S. M. Fung, Evripidis Sykakis, Niaz M. Islam, Hadi J. Zambarakji, Ramin Khoramnia, Gerd U. Auffarth, and Dipak N. Parmar Copyright © 2015 Simon S. M. Fung et al. All rights reserved. Decreased Perifoveal Sensitivity Detected by Microperimetry in Patients Using Hydroxychloroquine and without Visual Field and Fundoscopic Anomalies Thu, 12 Mar 2015 13:57:28 +0000 Purpose. To evaluate the usefulness of microperimetry in the early detection of the ocular anomalies associated with the use of hydroxychloroquine. Methods. Prospective comparative case series study comprising 14 healthy eyes of 7 patients (group A) and 14 eyes of 7 patients under treatment with hydroxychloroquine for the treatment of rheumatologic diseases and without fundoscopic or perimetric anomalies (group B). A comprehensive ophthalmological examination including microperimetry (MP) and spectral-domain optical coherence tomography was performed in both groups. Results. No significant differences were found in mean MP foveal sensitivity between groups . However, mean MP overall sensitivity was significantly higher in group A ( dB versus group B,  dB; ). Significantly higher sensitivity values were obtained in group A in comparison to group B for the three eccentric loci evaluated . Conclusion. Microperimetry seems to be a useful tool for the early detection of retinal damage in patients treated with hydroxychloroquine. A. Molina-Martín, D. P. Piñero, and R. J. Pérez-Cambrodí Copyright © 2015 A. Molina-Martín et al. All rights reserved. Attenuating Photostress and Glare Disability in Pseudophakic Patients through the Addition of a Short-Wave Absorbing Filter Mon, 09 Mar 2015 12:46:47 +0000 To evaluate the effects of filtering short wavelength light on visual performance under intense light conditions among pseudophakic patients previously implanted with a clear intraocular lens (IOL). This was a patient-masked, randomized crossover study conducted at 6 clinical sites in the United States between September 2013 and January 2014. One hundred fifty-four bilaterally pseudophakic patients were recruited. Photostress recovery time and glare disability thresholds were measured with clip-on blue-light-filtering and placebo (clear; no blue-light filtration) glasses worn over patients’ habitual correction. Photostress recovery time was quantified as the time necessary to regain sight of a grating target after intense light exposure. Glare disability threshold was assessed as the intensity of a white-light annulus necessary to obscure a central target. The order of filter used and test eye were randomized across patients. Photostress recovery time and glare disability thresholds were significantly improved (both ) when patients used blue-light-filtering glasses compared with clear, nonfiltering glasses. Compared with a nonfiltering placebo, adding a clip-on blue-absorbing filter to the glasses of pseudophakic patients implanted with clear IOLs significantly increased their ability to cope with glare and to recover normal viewing after an intensive photostress. This result implies that IOL designs with blue-light-filtering characteristics may be beneficial under intense light conditions. Billy R. Hammond Copyright © 2015 Billy R. Hammond. All rights reserved. Advances in Retinal Therapeutics Mon, 09 Mar 2015 06:53:52 +0000 Petros E. Carvounis, Thomas A. Albini, Andrew J. Barkmeier, and Miltiadis Tsilimbaris Copyright © 2015 Petros E. Carvounis et al. All rights reserved. The Role of Eye Movement Driven Attention in Functional Strabismic Amblyopia Mon, 09 Mar 2015 06:40:40 +0000 Strabismic amblyopia “blunt vision” is a developmental anomaly that affects binocular vision and results in lowered visual acuity. Strabismus is a term for a misalignment of the visual axes and is usually characterized by impaired ability of the strabismic eye to take up fixation. Such impaired fixation is usually a function of the temporally and spatially impaired binocular eye movements that normally underlie binocular shifts in visual attention. In this review, we discuss how abnormal eye movement function in children with misaligned eyes influences the development of normal binocular visual attention and results in deficits in visual function such as depth perception. We also discuss how eye movement function deficits in adult amblyopia patients can also lead to other abnormalities in visual perception. Finally, we examine how the nonamblyopic eye of an amblyope is also affected in strabismic amblyopia. Hao Wang, Sheila Gillard Crewther, and Zheng Qin Yin Copyright © 2015 Hao Wang et al. All rights reserved. Prognostic Factors of Early Morphological Response to Treatment with Ranibizumab in Patients with Wet Age-Related Macular Degeneration Wed, 04 Mar 2015 09:28:06 +0000 Aim. To assess the significance of age, gender, baseline best corrected visual acuity, baseline macula thickness, and type and size of choroidal neovascularization in early morphological therapeutic response to ranibizumab treatment in patients with the wet form of age-related macular degeneration. Methods. From 09/2008 to 06/2013 we evaluated 1153 newly diagnosed, treatment-naïve patients treated with ranibizumab. Based on the morphological findings in the macula following the initial 3 injections of ranibizumab, the patients were divided into two groups based on active and inactive choroidal neovascularization. Results. After the initial 3 injections of ranibizumab, we examined the sample of 841 eyes with active CNV and 312 eyes with inactive CNV. In the inactive group, we found a statistically higher proportion of occult CNV () and lower incidence of CNV greater than 5DA () compared with the active group. We found no statistically significant difference in age, gender, baseline best corrected visual acuity, or baseline macula thickness between the inactive and active groups. Conclusion. Occult CNV and CNV smaller than 5DA are optimistic factors for a better morphological therapeutic response at the beginning of ranibizumab treatment. Oldřich Chrapek, Jiří Jarkovský, Martin Šín, Jan Studnička, Petr Kolář, Barbora Jirková, Ladislav Dušek, Šárka Pitrová, and Jiří Řehák Copyright © 2015 Oldřich Chrapek et al. All rights reserved. Proteomic Study of Retinal Proteins Associated with Transcorneal Electric Stimulation in Rats Wed, 04 Mar 2015 09:12:07 +0000 Background. To investigate how transcorneal electric stimulation (TES) affects the retina, by identifying those proteins up- and downregulated by transcorneal electric stimulation (TES) in the retina of rats. Methods. Adult Wistar rats received TES on the left eyes at different electrical currents while the right eyes received no treatment and served as controls. After TES, the eye was enucleated and the retina was isolated. The retinas were analyzed by proteomics. Results. Proteomics showed that twenty-five proteins were upregulated by TES. The identified proteins included cellular signaling proteins, proteins associated with neuronal transmission, metabolic proteins, immunological factors, and structural proteins. Conclusions. TES induced changes in expression of various functional proteins in the retina. Takashi Kanamoto, Nazariy Souchelnytskyi, Takuji Kurimoto, Yasuhiro Ikeda, Hiroaki Sakaue, Yasunari Munemasa, and Yoshiaki Kiuchi Copyright © 2015 Takashi Kanamoto et al. All rights reserved. A Review of Current Management of Vitreomacular Traction and Macular Hole Tue, 03 Mar 2015 12:50:56 +0000 The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies. A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented. Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient’s clinical course. Alfredo García-Layana, José García-Arumí, José M. Ruiz-Moreno, Lluís Arias-Barquet, Francisco Cabrera-López, and Marta S. Figueroa Copyright © 2015 Alfredo García-Layana et al. All rights reserved. Blockade of Vascular Endothelial Growth Factor Receptor 1 Prevents Inflammation and Vascular Leakage in Diabetic Retinopathy Tue, 03 Mar 2015 09:15:25 +0000 Diabetic retinopathy (DR) is a leading cause of blindness in working age adults. The objective of this study is to investigate the effects of vascular endothelial growth factor receptor 1 (VEGFR1) blockade on the complications of DR. Experimental models of diabetes were induced with streptozotocin (STZ) treatment or Insulin2 gene mutation (Akita) in mice. Protein expression and localization were examined by western blots (WB) and immunofluorescence (IF). mRNA expression was quantified by PCR array and real-time PCR. The activity of VEGFR1 signaling was blocked by a neutralizing antibody called MF1. Vascular leakage was evaluated by measuring the leakage of [3H]-mannitol tracer into the retina and the IF staining of albumin. VEGFR1 blockade significantly inhibited diabetes-related vascular leakage, leukocytes-endothelial cell (EC) adhesion (or retinal leukostasis), expression of intercellular adhesion molecule- (ICAM-) 1 protein, abnormal localization and degeneration of the tight junction protein zonula occludens- (ZO-) 1, and the cell adhesion protein vascular endothelial (VE) cadherin. In addition, VEGFR1 blockade interfered with the gene expression of 10 new cytokines and chemokines: cxcl10, il10, ccl8, il1f6, cxcl15, ccl4, il13, ccl6, casp1, and ccr5. These results suggest that VEGFR1 mediates complications of DR and targeting this signaling pathway represents a potential therapeutic strategy for the prevention and treatment of DR. Jianbo He, Hong Wang, Ying Liu, Wen Li, Dorothy Kim, and Hu Huang Copyright © 2015 Jianbo He et al. All rights reserved. Gene Therapy with Endogenous Inhibitors of Angiogenesis for Neovascular Age-Related Macular Degeneration: Beyond Anti-VEGF Therapy Tue, 03 Mar 2015 07:22:24 +0000 Age-related macular degeneration (AMD) is the leading cause of substantial and irreversible vision loss amongst elderly populations in industrialized countries. The advanced neovascular (or “wet”) form of the disease is responsible for severe and aggressive loss of central vision. Current treatments aim to seal off leaky blood vessels via laser therapy or to suppress vessel leakage and neovascular growth through intraocular injections of antibodies that target vascular endothelial growth factor (VEGF). However, the long-term success of anti-VEGF therapy can be hampered by limitations such as low or variable efficacy, high frequency of administration (usually monthly), potentially serious side effects, and, most importantly, loss of efficacy with prolonged treatment. Gene transfer of endogenous antiangiogenic proteins is an alternative approach that has the potential to provide long-term suppression of neovascularization and/or excessive vascular leakage in the eye. Preclinical studies of gene transfer in a large animal model have provided impressive preliminary results with a number of transgenes. In addition, a clinical trial in patients suffering from advanced neovascular AMD has provided proof-of-concept for successful gene transfer. In this mini review, we summarize current theories pertaining to the application of gene therapy for neovascular AMD and the potential benefits when used in conjunction with endogenous antiangiogenic proteins. Selwyn M. Prea, Elsa C. Chan, Gregory J. Dusting, Algis J. Vingrys, Bang V. Bui, and Guei-Sheung Liu Copyright © 2015 Selwyn M. Prea et al. All rights reserved. Retinal Neurodegeneration in db/db Mice at the Early Period of Diabetes Mon, 02 Mar 2015 14:32:07 +0000 Purpose. To describe both the functional and pathological alternations in neurosensory retina in a murine model of spontaneous type 2 diabetes (db/db mouse). Methods. db/db (BKS/DB−/−) mice and heterozygous littermates (as control group) at various ages (12, 16, 20, 24, and 28 weeks) were inspected with pattern electroretinogram (PERG), fundus fluorescein angiography (FFA), and optical coherence tomography (OCT). Histological markers of neuroinflammation (IBA-1 and F4/80) were evaluated by immunohistochemistry. In addition, levels of retinal ganglion cell death were measured by terminal dUTP nick-end labeling (TUNEL). Results. Significant alternations of PERG responses and increased retinal ganglion cells (RGCs) apoptosis were observed in diabetic db/db mice for 20-week period when compared with control group. IBA-1 and F4/80 expression in microglia/macrophages became evidently for 24-week period, thus supporting the PERG findings. Furthermore, obvious thinning of nasal and dorsal retina in 28-week-old db/db mice was also revealed by OCT. No visible retinal microvascular changes were detected by FFA throughout the experiments on db/db mice. Conclusions. Diabetic retina underwent neurodegenerative changes in db/db mice, which happened at retinal ganglion cell layer and inner nuclear layer. But there was no obvious abnormality in retinal vasculature on db/db mice. Qin Yang, Yidan Xu, Ping Xie, Haixia Cheng, Qinglu Song, Tu Su, Songtao Yuan, and Qinghuai Liu Copyright © 2015 Qin Yang et al. All rights reserved. Correlation of Papillomacular Nerve Fiber Bundle Thickness with Central Visual Function in Open-Angle Glaucoma Mon, 02 Mar 2015 11:57:14 +0000 Purpose. To determine the correlation of reduced retinal thickness in the central papillomacular bundle (CPB) to central visual function, including central retinal sensitivity and visual acuity, in glaucoma patients. Methods. This study enrolled 50 eyes of 50 patients with open-angle glaucoma who were carefully screened for comorbid conditions that can cause decreased central visual function, such as cataracts or macular diseases. We used a novel CPB analysis comprising a program for optical coherence tomography that measured RNFL thickness and GCC thickness in the CPB and divided lengthwise into three parts (upper, middle, and lower CPB). The relationship of these parameters, including conventional macular thickness, to visual field sensitivity in four central standard automated perimetry points (the central four thresholds) and BCVA was analyzed. Results. The two parameters most highly correlated with central four thresholds were macular GCCT and macular RNFLT. The two parameters most highly correlated with BCVA were middle CPB (mid-CPB) GCCT and mid-CPB RNFLT. A multiple regression analysis revealed that mid-CPB GCCT was an independent factor impacting central retinal thresholds and BCVA. Conclusions. Our results suggest that mid-CPB RNFLT and GCCT, parameters of a novel papillomacular bundle analysis, are candidate biomarkers of decreased central visual function in glaucomatous eyes. Wataru Kobayashi, Hiroshi Kunikata, Kazuko Omodaka, Kyousuke Togashi, Morin Ryu, Masahiro Akiba, Gaku Takeuchi, Tetsuya Yuasa, and Toru Nakazawa Copyright © 2015 Wataru Kobayashi et al. All rights reserved. Clinical Applications of Anterior Segment Optical Coherence Tomography Mon, 02 Mar 2015 09:31:37 +0000 Anterior segment optical coherence tomography (AS-OCT) was recently developed and has become a crucial tool in clinical practice. AS-OCT is a noncontact imaging device that provides the detailed structure of the anterior part of the eyes. In this review, the author will discuss the various clinical applications of AS-OCT, such as the normal findings, tear meniscus measurement, ocular surface disease (e.g., pterygium, pinguecula, and scleromalacia), architectural analysis after cataract surgery, post-LASIK keratectasia, Descemet’s membrane detachment, evaluation of corneal graft after keratoplasty, corneal deposits (corneal dystrophies and corneal verticillata), keratitis, anterior segment tumors, and glaucoma evaluation (angle assessment, morphological analysis of the filtering bleb after trabeculectomy, or glaucoma drainage device implantation surgery). The author also presents some interesting cases demonstrated via AS-OCT. Su-Ho Lim Copyright © 2015 Su-Ho Lim. All rights reserved. Sentinel Events in Ophthalmology: Experience from Hong Kong Mon, 02 Mar 2015 08:55:38 +0000 Purpose. To arouse ophthalmologists’ awareness in patient safety by reviewing sentinel events in Ophthalmology submitted to a web-based incident reporting system involving all public hospitals in Hong Kong. Methods. Sentinel events in Ophthalmology reported from November 2007 to October 2014 were identified and classified into different categories for further presentation and analysis. Key contributing factors attributing to the occurrence of the incidents were described. Suggestions aiming to prevent future occurrence of similar events were made. Relevant literature and case law were discussed. Results. Twelve sentinel events were included in this observational case series. They were classified into 4 main categories, namely “wrong eye” (5 cases, 41%), “wrong prescription” (3 cases, 25%), “wrong patient and surgery” (2 cases, 17%), and “retained surgical items” (2 cases, 17%). The key contributing factor leading to the occurrence of the incidents was largely human error. Increased staff awareness and proper time-out procedures were recommended to help prevent occurrence of these errors. Conclusion. Sentinel events in Ophthalmology do occur. Many of these incidents were attributed to human error. Surgeon’s awareness and willingness to prevent occurrence of sentinel events are warranted. Shiu Ting Mak Copyright © 2015 Shiu Ting Mak. All rights reserved. Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery Wed, 25 Feb 2015 08:35:40 +0000 Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery. Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one “head” (temporal or nasal) and MMC on the other “head.” All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study. Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (). Among eyes without recurrence, the conjunctival bed was graded higher in the MMC group than the CAU group (). Conclusion. The use of conjunctival autograft has a significantly lower long-term recurrence rate than mitomycin C in double-head pterygium surgery. Tommy C. Y. Chan, Raymond L. M. Wong, Emmy Y. M. Li, Hunter K. L. Yuen, Emily F. Y. Yeung, Vishal Jhanji, and Ian Y. H. Wong Copyright © 2015 Tommy C. Y. Chan et al. All rights reserved. The Long-Term Financial and Clinical Impact of an Electronic Health Record on an Academic Ophthalmology Practice Tue, 24 Feb 2015 12:14:55 +0000 Purpose. To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR). Methods. 191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume. Results. The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912) than before (mean = $411,420; SD = $39,366) (). Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05%) for all providers. Conclusions. This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world. Michele C. Lim, Roma P. Patel, Victor S. Lee, Patricia D. Weeks, Martha K. Barber, and Mitchell R. Watnik Copyright © 2015 Michele C. Lim et al. All rights reserved. Precision of Corneal Thickness Measurements Obtained Using the Scheimpflug-Placido Imaging and Agreement with Ultrasound Pachymetry Tue, 24 Feb 2015 09:06:31 +0000 Purpose. To assess the reliability and comparability of measuring central corneal thickness (CCT) and thinnest corneal thickness (TCT) using a new Scheimpflug-Placido analyzer (TMS-5, Japan) and ultrasound (US) pachymetry. Methods. Seventy-six healthy subjects were prospectively measured 3 times by 1 operator using the TMS-5, 3 additional consecutive scans were performed by a second operator, and ultrasound (US) pachymetry measurements were taken. The test-retest repeatability (TRT), coefficient of variation (CoV), and intraclass correlation coefficient (ICC) were calculated to evaluate intraoperator repeatability and interoperator reproducibility. Agreement among the devices was assessed using Bland-Altman plots and 95% limits of agreement (LoA). Results. The intraoperators TRT and CoV were <19 μm and 2.0%, respectively. The interoperators TRT and CoV were <12 μm and 1.0%, respectively, and ICC was >0.90. The mean CCT and TCT measurements using the TMS-5 were 15.97 μm (95% LoA from −26.42 to −5.52 μm) and 20.32 μm (95% LoA from −30.67 to −9.97 μm) smaller, respectively, than those using US pachymetry. Conclusions. The TMS-5 shows good repeatability and reproducibility for measuring CCT and TCT in normal subjects but only moderate agreement with US pachymetry results. Caution is warranted before using these techniques interchangeably. Jinhai Huang, Giacomo Savini, Chengfang Wang, Weicong Lu, Rongrong Gao, Yuanguang Li, Qinmei Wang, and Yune Zhao Copyright © 2015 Jinhai Huang et al. All rights reserved. Future Therapies of Wet Age-Related Macular Degeneration Tue, 24 Feb 2015 08:49:11 +0000 Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly population, and the prevalence of the disease increases exponentially with every decade after the age of 50 years. While VEGF inhibitors are promising drugs for treating patients with ocular neovascularization, there are limitations to their potential for improving vision in AMD patients. Thus, future therapies are required to have the potential to improve visual outcomes. This paper will summarize the future strategies and therapeutic targets that are aimed at enhancing the efficacy and duration of effect of antiangiogenic strategies. Makoto Ishikawa, Daisuke Jin, Yu Sawada, Sanae Abe, and Takeshi Yoshitomi Copyright © 2015 Makoto Ishikawa et al. All rights reserved. Update on Uveitis Management Mon, 23 Feb 2015 07:48:47 +0000 Vishali Gupta, Quan Dong Nguyen, Manfred Zierhut, and Ilknur Tugal-Tutkun Copyright © 2015 Vishali Gupta et al. All rights reserved.