Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . 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. Computational Simulation of Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment: On the Effect of the Band Size on the Myopization Mon, 20 Jun 2016 06:41:56 +0000 A finite element model (FE) of the eye including cornea, sclera, crystalline lens, and ciliary body was created to analyze the influence of the silicone encircling bandwidth and the tightness degree on the myopia induced by scleral buckling (SB) procedure for rhegmatogenous retinal detachment. Intraocular pressure (IOP) was applied to the reference geometry of the FE model and then SB surgery was simulated with encircling bandwidths of 1, 2, and 2.5 mm. Different levels of tightening and three values of IOP were applied. The anterior segment resulted as unaffected by the surgery. The highest value of Cauchy stress appeared in the surroundings of the implant, whereas no increment of stress was observed either in anterior segment or in the optic nerve head. The initial IOP did not appear to play any role in the induced myopia. The wider the band, the greater the induced myopia: 0.44, 0.88, and 1.07 diopters (D) for the 1, 2, and 2.5 mm bandwidth, respectively. Therefore, patients become more myopic with a wider encircling element. The proposed simulations allow determining the effect of the bandwidth or the tightness degree on the axial lengthening, thus predicting the myopic increment caused by the encircling surgery. Elena Lanchares, María A. del Buey, José A. Cristóbal, Begoña Calvo, Francisco J. Ascaso, and Mauro Malvè Copyright © 2016 Elena Lanchares et al. All rights reserved. Evaluation of the Safety and Effectiveness of Intense Pulsed Light in the Treatment of Meibomian Gland Dysfunction Mon, 20 Jun 2016 06:30:35 +0000 Purpose. This study aims to explore the safety and efficacy of a novel treatment-intense pulsed light (IPL) in MGD eyes. Methods. This study is a prospective and open label study. Forty eyes of 40 MGD patients were recruited in the study and received 4 consecutive IPL treatments on day 1, day 15, day 45, and day 75. Ten ocular surface symptoms were evaluated with a subjective face score at every visit. Best spectacle corrected visual acuity, intraocular pressure (IOP), conjunctival injection, upper and lower tear meniscus height (TMH), tear break-up time (TBUT), corneal staining, lid margin and meibomian gland assessments, and meibography were also recorded at every visit, as well as the adverse effects on the eye and ocular surface. Results. Significant improvements were observed in single and total ocular surface symptom scores, TBUT, and conjunctival injection at all the visits after the initial IPL treatment (). Compared to baseline, the signs of eyelid margin, meibomian gland secretion quality, and expressibility were significantly improved at every visit after treatments. There was no regional and systemic threat observed in any patient. Conclusion. Intense pulsed light (IPL) therapy is a safe and efficient treatment in relieving symptoms and signs of MGD eyes. Xiaodan Jiang, Huibin Lv, Hang Song, Mingzhou Zhang, Yan Liu, Xiaodan Hu, Xuemin Li, and Wei Wang Copyright © 2016 Xiaodan Jiang et al. All rights reserved. Causative Microorganisms of Infectious Endophthalmitis: A 5-Year Retrospective Study Sun, 19 Jun 2016 08:03:29 +0000 This study aimed to identify the microbial etiology of infectious endophthalmitis and to determine the antibacterial susceptibilities of bacterial isolates at an eye hospital in South China. A retrospective analysis was carried out on 330 patients with clinically diagnosed infectious endophthalmitis who underwent microbiological evaluation from January 2010 to December 2014. Of the 330 patients, 193 patients (58.5%) had posttraumatic endophthalmitis, 67 patients (20.3%) had postoperative endophthalmitis, 61 patients (18.5%) had endogenous endophthalmitis, and 9 patients (2.7%) had postcorneal infective endophthalmitis. Of the 105 cases (31.8%) of culture-positive endophthalmitis, 79 cases (75.2%) had bacterial growth and 26 cases (24.8%) had fungal growth. In posttraumatic endophthalmitis, Gram-positive bacteria were the predominant species, followed by Gram-negative bacteria and fungi. In endogenous endophthalmitis, Gram-negative bacteria were the predominant species, followed by fungi and Gram-positive bacteria. In postsurgical endophthalmitis, all infections were bacterial. However, in postcorneal infective endophthalmitis, all infections were fungal. Overall, levofloxacin showed the highest activity against bacterial isolates. There was a significant difference in the susceptibility to tobramycin between the isolates from posttraumatic and postoperative endophthalmitis (). The results of this study identify the microbial spectrum of infectious endophthalmitis in this clinical setting. Fang Duan, Kaili Wu, Jingyu Liao, Yongxin Zheng, Zhaohui Yuan, Junlian Tan, and Xiaofeng Lin Copyright © 2016 Fang Duan et al. All rights reserved. Relationship between Peeled Internal Limiting Membrane Area and Anatomic Outcomes following Macular Hole Surgery: A Quantitative Analysis Thu, 16 Jun 2016 14:21:54 +0000 Purpose. To quantitatively evaluate the effects of peeled internal limiting membrane (ILM) area and anatomic outcomes following macular hole surgery using spectral domain optical coherence tomography (SD-OCT). Methods. Forty-one eyes in 37 consecutive patients with idiopathic, Gass stage 3-4 macular hole (MH) were enrolled in this retrospective comparative study. All patients were divided into 2 groups according to anatomic success or failure. Basal MH diameter, peeled ILM area, and MH height were calculated using SD-OCT. Other prognostic parameters, including age, stage, preoperative BCVA, and symptom duration were also assessed. Results. Thirty-two cases were classified as anatomic success, and 9 cases were classified as anatomic failure. Peeled ILM area was significantly wider and MH basal diameter was significantly less in the anatomic success group ( and 0.032, resp.). Other parameters did not demonstrate statistical significance. Conclusion. The findings of the present study show that the peeled ILM area can affect the anatomic outcomes of MH surgery. Yasin Sakir Goker, Mustafa Koc, Kemal Yuksel, Ahmet Taylan Yazici, Abdulvahit Demir, Hasan Gunes, and Yavuz Ozpinar Copyright © 2016 Yasin Sakir Goker et al. All rights reserved. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy Thu, 16 Jun 2016 12:57:20 +0000 Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40) who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT), total macular volume (TMV), and retinal ganglion cell layer (RGCL) were measured by spectral-domain optical coherence tomography (SD-OCT). Subfoveal choroidal thickness (SFCT) was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT). Results. The mean CMT was  μm,  μm, and  μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (). The mean TMV was  mm3,  mm3, and  mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (). The mean RGCL was  μm,  μm, and  μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (). The mean SFCT was μm,  μm, and  μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (). No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (), disc area (), vertical cup/disc ratio (), cup volume (), or retinal nerve fiber layer (). Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery. Berna Dogan, Ugur Dogan, Muhammet Kazim Erol, Mani Habibi, and Nurullah Bulbuller Copyright © 2016 Berna Dogan et al. All rights reserved. Evaluation of Choroidal Thickness in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma Tue, 14 Jun 2016 09:36:11 +0000 Purpose. To compare the macular and peripapillary choroidal thickness in eyes with pseudoexfoliation (PEX) syndrome and PEX glaucoma with the normal eyes of healthy controls. Materials and Methods. In this prospective study, 30 eyes of 30 patients with PEX syndrome, 28 eyes of 28 patients with PEX glaucoma, and 30 eyes of 30 age-matched healthy subjects were enrolled. Choroidal thicknesses in the macular and peripapillary areas were measured by using spectral domain optical coherence tomography. Results. Gender, age, and axial length did not significantly differ between the groups (all, ). The mean values of choroidal thickness in the macular and peripapillary areas (except the superior quadrant) in the patients with PEX syndrome and PEX glaucoma were lower compared with controls (all ). The mean values of the macular and peripapillary choroidal thickness in the PEX glaucoma group were lower compared with PEX syndrome group; however this difference was not significant. Conclusions. The findings of this study revealed that macular and peripapillary choroidal thicknesses were decreased in PEX syndrome and PEX glaucoma cases. The role of choroid in the development of glaucomatous damage in patients with PEX syndrome remains unclear. Ayhan Dursun, Ayse Vural Ozec, Oznur Dogan, Feyza Gulac Dursun, Mustafa Ilker Toker, Aysen Topalkara, Mustafa Kemal Arici, and Haydar Erdogan Copyright © 2016 Ayhan Dursun et al. All rights reserved. Comparison between a New Optical Biometry Device and an Anterior Segment Optical Coherence Tomographer for Measuring Central Corneal Thickness and Anterior Chamber Depth Tue, 14 Jun 2016 08:51:00 +0000 Purpose. To compare between a new optical biometer (AL-Scan, Nidek Co., Aichi, Japan) and an anterior segment optical coherence tomographer (Visante AS-OCT, Carl Zeiss Meditec, Dublin, USA) for measuring central corneal thickness (CCT), anterior chamber depth (ACD), and aqueous depth (AD). Methods. Sixty-three eyes of 63 normal subjects were examined with AL-Scan and Visante AS-OCT in this prospective study. One eye per subject was measured three times with both devices to record their CCT, ACD, and AD. All procedures were performed by the same operator. Agreement between the two devices was assessed using paired t-tests, Bland-Altman plots, and 95% limits of agreement (LoA). Results. The mean CCT, ACD, and AD measured by AL-Scan were  μm,  mm, and  mm, respectively. The mean values obtained by the Visante OCT were  μm for CCT,  mm for ACD, and  mm for AD. The mean CCT by the AL-Scan was higher than that obtained by the Visante AS-OCT (difference =  μm, ). The differences in ACD and AD measurements were not statistically significant. The 95% LoA of CCT, ACD, and AD were between −9.44 and 14.35 μm, −0.15 and 0.12 mm, and −0.15 and 0.12 mm, respectively. Conclusions. Since these two devices were comparable for measuring CCT, ACD, and AD, their results can be interchangeably used in the clinic. Jinhai Huang, Weicong Lu, Giacomo Savini, Hao Chen, Chengfang Wang, Xinxin Yu, Fangjun Bao, and Qinmei Wang Copyright © 2016 Jinhai Huang et al. All rights reserved. A Prospective Study of the Incidence of Retinopathy of Prematurity in China: Evaluation of Different Screening Criteria Mon, 13 Jun 2016 12:29:49 +0000 To investigate the incidence of Retinopathy of Prematurity (ROP) in Beijing, North China, and to evaluate the effectiveness of different ROP screening criteria, we conducted a prospective cohort study in a single-neonatal intensive care unit (NICU). A total of 2997 premature infants with birth weight (BW) ≤ 2000 g and/or gestational age (GA) ≤ 34 weeks had completed ROP screening. ROP was diagnosed in 356 (11.9%) infants. The mean GA was 30.46 ± 1.98 weeks and the mean BW was 1477.35 ± 371.29 g. Of the 59 (2.0%) infants receiving treatment, the mean GA was 29.37 ± 2.10 weeks, and the mean BW was 1240.80 ± 330.71 g. The incidence of ROP declined from 14.7% in 2009 and 11.1% in 2010 to 9.5% in 2011. The United Kingdom (UK) criteria could reduce the screening number by 40.8%, and 3 infants with type I ROP needing treatment were missed, but none in 2011. The United States (US) criteria could reduce the screening number by 66.5%, and 10 infants with type I ROP needing treatment were missed, including one in 2011. So the UK criteria may be appropriate for screening of ROP in our NICU in 2011. Future multisite epidemiologic studies are required to establish suitable ROP screening criteria in China. Qiuping Li, Zonghua Wang, Ruijuan Wang, Hongyi Tang, Haihua Chen, and Zhichun Feng Copyright © 2016 Qiuping Li et al. All rights reserved. Keratorefractive Effect of High Intensity Focused Ultrasound Keratoplasty on Rabbit Eyes Mon, 13 Jun 2016 09:45:17 +0000 Purpose. To evaluate high intensity focused ultrasound (HIFU) as an innovation and noninvasive technique to correct presbyopia by altering corneal curvature in the rabbit eye. Methods. Eighteen enucleated rabbit eyes were treated with a prototype HIFU keratoplasty. According to the therapy power, these eyes were divided three groups: group 1 (1 W), group 2 (2 W), and group 3 (3 W). The change in corneal power was quantified by a Sirius Scheimpflug camera. Light microscopy (LM) and transmission electron microscopy (TEM) were performed to determine the effect on the corneal stroma. Results. In the treated eyes, the corneal curvature increases from 49.42 ± 0.30 diopters (D) and 48.00 ± 1.95 D before procedure to 51.37 ± 1.11 D and 57.00 ± 1.84 D after HIFU keratoplasty application in groups 1 and 3, respectively. The major axis and minor axis of the focal region got longer when the powers of the HIFU got increased; the difference was statistically significant (). LM and TEM showed HIFU-induced shrinkage of corneal stromal collagen with little disturbance to the underlying epithelium. Conclusions. We have preliminarily exploited HIFU to establish a new technique for correcting presbyopia. HIFU keratoplasty will be a good application prospect for treating presbyopia. Zhiyu Du, Pisong Yan, Qiang Luo, Dan Zhang, and Yu Zhang Copyright © 2016 Zhiyu Du et al. All rights reserved. Identification of the First De Novo UBIAD1 Gene Mutation Associated with Schnyder Corneal Dystrophy Sun, 12 Jun 2016 09:47:42 +0000 Purpose. To report the identification of the first de novo UBIAD1 missense mutation in an individual with Schnyder corneal dystrophy (SCD). Methods. A slit lamp examination was performed on a 47-year-old woman without a family history of corneal disorders. The proband’s parents, two sisters, and son were also examined and genomic DNA from all six individuals was collected. The exons and exon-intron boundaries of UBIAD1 were screened using Sanger sequencing. Identified mutations were screened for in 200 control chromosomes. In silico analysis predicted the impact of identified mutations on protein function and structure. Results. Slit lamp examination of the proband revealed findings consistent with SCD. Corneas of the family members appeared unaffected. Screening of UBIAD1 in the proband identified a novel heterozygous c.308C>T mutation, predicted to encode the missense amino acid substitution p.(Thr103Ile). This mutation was not identified in any of the family members or in 200 control chromosomes and was predicted to be damaging to normal protein function and structure. Conclusions. We present a novel heterozygous de novo missense mutation in UBIAD1, p.(Thr103Ile), identified in a patient with classic clinical features of SCD. This highlights the value of genetic testing in clinical diagnostic settings, even in the absence of a positive family history. Benjamin R. Lin, Ricardo F. Frausto, Rosalind C. Vo, Stephan Y. Chiu, Judy L. Chen, and Anthony J. Aldave Copyright © 2016 Benjamin R. Lin et al. All rights reserved. Assessment of Corneal Epithelial Thickness in Asymmetric Keratoconic Eyes and Normal Eyes Using Fourier Domain Optical Coherence Tomography Thu, 09 Jun 2016 08:18:00 +0000 Purpose. To compare the characteristics of asymmetric keratoconic eyes and normal eyes by Fourier domain optical coherence tomography (OCT) corneal mapping. Methods. Retrospective corneal and epithelial thickness OCT data for 74 patients were compared in three groups of eyes: keratoconic () and normal fellow eyes () in patients with asymmetric keratoconus and normal eyes () in healthy subjects. Areas under the curve (AUC) of receiver operator characteristic (ROC) curves for each variable were compared across groups to indicate their discrimination capacity. Results. Three variables were found to differ significantly between fellow eyes and normal eyes (all ): minimum corneal thickness, thinnest corneal point, and central corneal thickness. These variables combined showed a high discrimination power to differentiate fellow eyes from normal eyes indicated by an AUC of 0.840 (95% CI: 0.762–0.918). Conclusions. Our findings indicate that topographically normal fellow eyes in patients with very asymmetric keratoconus differ from the eyes of healthy individuals in terms of their corneal epithelial and pachymetry maps. This type of information could be useful for an early diagnosis of keratoconus in topographically normal eyes. S. Catalan, L. Cadarso, F. Esteves, J. Salgado-Borges, M. Lopez, and C. Cadarso Copyright © 2016 S. Catalan et al. All rights reserved. Differences in Central Corneal Thickness between Spectral Domain-Optical Coherence Tomography and Ultrasound Pachymetry in Patients with Dry Eye Disease Wed, 08 Jun 2016 06:15:48 +0000 Purpose. To compare central corneal thickness (CCT) values via Spectral Domain-Optical Coherence Tomography (SD-OCT) and ultrasonic pachymetry in patients with severe dry eye disease (DED) to determine the level of agreement between these 2 methods. Methods. The paired samples -test was used to compare CCT values in severe DED patients. Matching analysis between methods was performed using intraclass correlation coefficient (ICC). Intrasession reliability of the measurement methods was calculated via the concordance correlation coefficient (CCC), variation equivalent, and Pearson’s correlation coefficient. The Bland-Altman procedure was used to graphically represent the differences between CCT values. Results. The study included 56 eyes of 24 female and 4 male patients. Mean age of the patients was years. Mean CCT via Cirrus SD-OCT was  μm versus  μm via ultrasonic pachymetry (paired samples -test, ). The Bland-Altman plot showed good agreement between the examiners. The ICC for repeatability was 0.974. The CCC between the 2 methods’ CCT values was 0.973. The variation equivalent was 0.976 and Pearson’s correlation coefficient was 99.3%, which also indicated high correlation between the 2 methods’ measurements. Conclusions. The present findings show that in patients with severe DED Cirrus SD-OCT provides reliable intraobserver CCT values. Ali Riza Cenk Celebi and G. Ertugrul Mirza Copyright © 2016 Ali Riza Cenk Celebi and G. Ertugrul Mirza. All rights reserved. Is Floppy Eyelid Syndrome More Prevalent in Obstructive Sleep Apnea Syndrome Patients? Sun, 05 Jun 2016 09:21:54 +0000 Controversial findings are reported about the relationship between floppy eyelid syndrome (FES) and obstructive sleep apnea syndrome (OSAS). The main goal of this study was to evaluate whether FES is more prevalent in OSAS patients by performing a meta-analysis. A comprehensive literature search of Pubmed, Embase, and Cochrane databases was performed. Only studies related to the prevalence of FES in OSAS were included in the meta-analysis. We estimated a pooled odds ratio (OR) for the prevalence of FES in OSAS. In total, 6 studies with 767 participants met the inclusion criteria. Using a fixed-effects model, the pooled OR was 4.12. The test for the overall effect revealed that FES was statistically prevalent in OSAS patients when compared with that in non-OSAS subjects (, ). In the subgroup analysis by OSAS severity, the incidence of FES in OSAS increased with severity of OSAS as indicated with increased OR values (OR = 2.56, 4.62, and 7.64 for mild, moderate, and severe OSAS). In conclusion, the results indicate that FES is more prevalent in OSAS patients. However, this result was based only on unadjusted estimates. Prospective cohort studies are needed to determine whether OSAS is an independent risk factor for FES. Ping Wang, Dao-Jiang Yu, Gang Feng, Zhen-Hai Long, Chang-Jiang Liu, Hui Li, and Tian-Lan Zhao Copyright © 2016 Ping Wang et al. All rights reserved. Fascicular Visual Field Defects in Open-Angle Glaucoma: Evaluation with Microperimetry Sun, 05 Jun 2016 06:07:22 +0000 Purpose. Use of microperimetry (Mp-1), correlating with Humphrey perimetry (30-2 program), in patients affected by primary open-angle glaucoma (POAG) with perimetric defects, in order to obtain an evaluation of the accuracy of the results obtained by Mp-1. Materials and Methods. In this study 40 eyes of 25 patients affected by POAG with perimetric defects were included. All patients underwent microperimetry test by Nidek Mp-1 (NAVIS software version 1.7.2, Nidek Technologies). Mean sensitivity values expressed in decibel (dB) of all tested dots and mean values for each quadrant obtained by microperimetric test were correlated with corresponding quadrants obtained by static perimetry analysis. Data were analyzed by Pearson’s correlation and Bland-Altman analysis. Results. Interpolated data showed that mean sensitivity values in all spots tested by Mp-1 (11.98 dB, SD 4.31) may be significantly correlated with mean total values obtained by Humphrey 30-2 perimetry (17.95, SD 4.32), with correlation coefficient of 0.556. Conclusions. Topographic visualization of the perimetric alteration by microperimetry allows retesting areas with reduced sensitivity which are topographically visualized and displayable on the ocular fundus examination, avoiding worsening of the functional defect by better modulation of the antiglaucoma therapy and therefore it allows better monitoring of the pathologic functional damage. Loredana Arrico, Rossella Giannotti, Manuela Fratipietro, and Romualdo Malagola Copyright © 2016 Loredana Arrico et al. All rights reserved. Central Corneal Thickness in Spectral-Domain OCT and Associations with Ocular and Systemic Parameters Thu, 02 Jun 2016 06:13:57 +0000 Background. Optical coherence tomography (OCT) allows quantitative analysis of the anterior segment of the eye with a noncontact examination. The aim of this study is to analyze associations of central corneal thickness (CCT) as measured by OCT with ocular and systemic cardiovascular parameters. Methods. A cross-sectional study of 734 persons was performed in a working age population. Only healthy eyes were included. A comprehensive ophthalmological examination including refraction, noncontact tonometry, and imaging of the anterior segment by SD-OCT was performed. In parallel, a broad range of systemic cardiovascular parameters were measured. Associations were analyzed using a generalized estimating equations’ model. Results. CCT measurements showed a significant association with corneal curvature and intraocular pressure: a thinner CCT was associated with a flatter cornea and with lower intraocular pressure (). Age was positively associated with CCT (); all other cardiovascular parameters were not associated. Conclusion. A thinner cornea is associated with a flatter surface and with lower intraocular pressure readings, while there are no independent associations with refraction and systemic cardiovascular parameters. Our findings highlight the value of SD-OCT CCT measurements as a standard tool in anterior segment analysis. Alexander Karl-Georg Schuster, Joachim Ernst Fischer, and Urs Vossmerbaeumer Copyright © 2016 Alexander Karl-Georg Schuster et al. All rights reserved. Inhibition of Zymosan-Induced Inflammatory Factors Expression by ATRA Nanostructured Lipid Carriers Wed, 01 Jun 2016 13:47:23 +0000 Purpose. The study aimed to evaluate the effect of all-trans retinoic acid-loaded nanostructured lipid carriers (ATRA-NLCs) on the zymosan-induced expression of the cytokines IL-4, IL-10, and IFN-γ and the matrix metalloproteinases/tissue inhibitor of metalloproteinases (MMPs/TIMPs) and TLR2 in rabbit corneal fibroblasts (RCFs). Methods. ATRA-NLCs were prepared by emulsification. RCFs were isolated and harvested after four to seven passages in monolayer culture. Cytokine release (IL-4, IL-10, and IFN-γ) induced by zymosan was analyzed by cytokine release assay, reverse transcription, and real-time polymerase chain reaction (RT-PCR) analysis detection. MMP-1, MMP-3, and MMP-13, TIMP-1 and TIMP-2, and TLR2 expression were analyzed by immunoblotting. Results. ATRA-NLCs were resistant to light and physically stable, and the average size of the ATRA-NLCs was 200 nm. ATRA-NLCs increased the zymosan-induced release of IL-4 and IL-10 and decreased the release of IFN-γ by RCFs. ATRA-NLCs decreased the levels of TLR2 and MMPs/TIMPs above. Conclusions. ATRA may be a potent anti-inflammatory agent for the therapy of fungal keratitis (FK). Hongyan Zhou, Wensong Zhang, Xunyi Gao, Hongguang Zhang, and Ning Kong Copyright © 2016 Hongyan Zhou et al. All rights reserved. Evaluation of Different Power of Near Addition in Two Different Multifocal Intraocular Lenses Wed, 01 Jun 2016 08:30:32 +0000 Purpose. To compare near, intermediate, and distance vision and quality of vision, when refractive rotational multifocal intraocular lenses with 3.0 diopters or diffractive multifocal intraocular lenses with 2.5 diopters near addition are implanted. Methods. 41 eyes of 41 patients in whom rotational +3.0 diopters near addition IOLs were implanted and 30 eyes of 30 patients in whom diffractive +2.5 diopters near addition IOLs were implanted after cataract surgery were reviewed. Uncorrected and corrected distance visual acuity, intermediate visual acuity, near visual acuity, and patient satisfaction were evaluated 6 months later. Results. The corrected and uncorrected distance visual acuity were the same between both groups ( and , resp.). The uncorrected intermediate and corrected intermediate and near vision acuities were better in the +2.5 near vision added intraocular lens implanted group (, , and , resp.) and the uncorrected near vision acuity was better in the +3.0 near vision added intraocular lens implanted group (). The patient satisfactions of both groups were similar. Conclusion. The +2.5 diopters near addition could be a better choice in younger patients with more distance and intermediate visual requirements (driving, outdoor activities), whereas the + 3.0 diopters should be considered for patients with more near vision correction (reading). Ugur Unsal and Gonen Baser Copyright © 2016 Ugur Unsal and Gonen Baser. All rights reserved. Lecithin-Bound Iodine Prevents Disruption of Tight Junctions of Retinal Pigment Epithelial Cells under Hypoxic Stress Tue, 31 May 2016 06:59:39 +0000 Aim. We investigated whether lecithin-bound iodine (LBI) can protect the integrity of tight junctions of retinal pigment epithelial cells from hypoxia. Method. Cultured human retinal pigment epithelial (ARPE-19) cells were pretreated with LBI. To mimic hypoxic conditions, cells were incubated with CoCl2. We compared the integrity of the tight junctions (TJs) of control to cells with either LBI alone, CoCl2 alone, or LBI + CoCl2. The levels of cytokines in the conditioned media were also determined. Results. Significant decrease in the zonula occludens-1 (ZO-1) intensity in the CoCl2 group compared to the control (5787.7 ± 4126.4 in CoCl2 group versus 29244.6 ± 2981.2 in control; average ± standard deviation). But the decrease was not significant in the LBI + CoCl2 (27189.0 ± 11231.1). The levels of monocyte chemoattractant protein-1 (MCP-1) and Chemokine (C-C Motif) Ligand 11 (CCL-11) were significantly higher in the CoCl2 than in the control (340.8 ± 43.3 versus 279.7 ± 68.3 pg/mL for MCP-1, and 15.2 ± 12.9 versus 12.5 ± 6.1 pg/mL for CCL-11. With LBI pretreatment, the levels of both cytokines were decreased to 182.6 ± 23.8 (MCP-1) and 5.46 ± 1.9 pg/mL for CCL-11). Blockade of MCP-1 or CCL-11 also shows similar result representing TJ protection from hypoxic stress. Conclusions. LBI results in a protective action from hypoxia. Masahiko Sugimoto and Mineo Kondo Copyright © 2016 Masahiko Sugimoto and Mineo Kondo. All rights reserved. Shallow Inferior Conjunctival Fornix in Contracted Socket and Anophthalmic Socket Syndrome: A Novel Technique to Deepen the Fornix Using Fascia Lata Strips Mon, 30 May 2016 15:41:04 +0000 Purpose. To evaluate a new surgical technique using fascia lata to deepen the shallow inferior conjunctival fornix in contracted socket and anophthalmic socket syndrome. Methods. A prospective controlled study in which 24 sockets of 24 patients who were unable to wear and retain their ocular prosthesis due to shallow inferior fornix were enrolled and categorized into anophthalmic socket syndromes (9 patients) and contracted sockets (15 patients). Another 24 patients who underwent evisceration or enucleation with healthy sockets and can wear and retain their prosthesis comfortably were chosen as a control group. Deepening of the fornix was performed using fascia lata strips under general anesthesia. Central depth of the inferior fornix was measured preoperatively and postoperatively. Results. A statistically significant improvement of the postoperative central inferior fornix depth was reported which was marked in anophthalmic subgroup. 100% of anophthalmic sockets and 93.3% of contracted sockets achieved satisfactory results during the follow-up period with no postoperative lower eyelid malposition or obvious skin scar. Conclusion. Fascia lata technique is a new alternative and effective procedure to deepen the shallow inferior fornix that can be used in moderate to severe contracted sockets or anophthalmic socket syndrome with minimal lower eyelid or socket complications. Mohamed F. K. Ibrahiem and Sahar T. A. Abdelaziz Copyright © 2016 Mohamed F. K. Ibrahiem and Sahar T. A. Abdelaziz. All rights reserved. Refractive Results: Safety and Efficacy of Secondary Piggyback Sensar™ AR40 Intraocular Lens Implantation to Correct Pseudophakic Refractive Error Mon, 30 May 2016 14:55:04 +0000 In this study we evaluate the visual outcomes, safety, efficacy, and stability of implanting of second sulcus intraocular lens (IOL) to correct unsatisfied ametropic patients after phacoemulsification. Methods. Retrospective study of 15 eyes (15 patients) underwent secondary intraocular lens implanted into the ciliary sulcus. The IOL used was a Sensar IOL three-piece foldable hydrophobic acrylic IOL. The first IOL in all patients was acrylic intrabagal IOL implanted in uncomplicated phacoemulsification surgery. Results. Fifteen eyes (15 patients) were involved in this study. Preoperatively, mean UDVA and CDVA were 0.88 ± 0.22 and 0.19 ± 0.13, respectively, with a mean follow-up of 28 months (range: 24 to 36 months). At the end of the follow-up, all eyes achieved UDVA of 0.20 ± 0.12 with postoperative refraction ranging from 0.00 to −0.50 D of attempted emmetropia. Conclusions. Implantation of the second sulcus SensarAR40 IOL was found to be safe, easy, and simple technique for management of ametropia following uncomplicated phacoemulsification. Alahmady Hamad Alsmman Hassan, Khulood M. Sayed, Mohammed ElAgooz, and Ashraf Mostafa Elhawary Copyright © 2016 Alahmady Hamad Alsmman Hassan et al. All rights reserved. Comparison between Limbal and Pars Plana Approaches Using Microincision Vitrectomy for Removal of Congenital Cataracts with Primary Intraocular Lens Implantation Mon, 30 May 2016 14:34:00 +0000 Purpose. To compare the surgical outcomes of limbal versus pars plana vitrectomy using the 23-gauge microincision system for removal of congenital cataracts with primary intraocular lens implantation. Methods. We retrospectively reviewed all eyes that underwent cataract removal through limbal or pars plana incision. Main outcome measures included visual outcomes and complications. Results. We included 40 eyes (26 patients) in the limbal group and 41 eyes (30 patients) in the pars plana group. The mean age was 46 months. There was no significant difference in best-corrected visual acuity between the two groups (). Significantly, more eyes had at least one intraoperative complication in the limbal group than in the pars plana group () that were mainly distributed at 1.5–3 years of age (). The most common intraoperative complications were iris aspiration, iris prolapse, and iris injury. More eyes in the limbal group had postoperative complications and required additional intraocular surgery, but the difference was not significant (). Conclusions. The visual results were encouraging in both approaches. We recommend the pars plana approach for lower incidence of complications. The limbal approach should be reserved for children older than 3 years of age and caution should be exercised to minimize iris disturbance. Xin Liu, Tianyu Zheng, Xingtao Zhou, Yi Lu, Peng Zhou, Fan Fan, and Yi Luo Copyright © 2016 Xin Liu et al. All rights reserved. Morphometric Optic Nerve Head Analysis in Glaucoma Patients: A Comparison between the Simultaneous Nonmydriatic Stereoscopic Fundus Camera (Kowa Nonmyd WX3D) and the Heidelberg Scanning Laser Ophthalmoscope (HRT III) Mon, 30 May 2016 12:07:57 +0000 Purpose. To investigate the agreement between morphometric optic nerve head parameters assessed with the confocal laser ophthalmoscope HRT III and the stereoscopic fundus camera Kowa nonmyd WX3D retrospectively. Methods. Morphometric optic nerve head parameters of 40 eyes of 40 patients with primary open angle glaucoma were analyzed regarding their vertical cup-to-disc-ratio (CDR). Vertical CDR, disc area, cup volume, rim volume, and maximum cup depth were assessed with both devices by one examiner. Mean bias and limits of agreement (95% CI) were obtained using scatter plots and Bland-Altman analysis. Results. Overall vertical CDR comparison between HRT III and Kowa nonmyd WX3D measurements showed a mean difference (limits of agreement) of −0.06 (−0.36 to 0.24). For the CDR < 0.5 group () mean difference in vertical CDR was −0.14 (−0.34 to 0.06) and for the CDR ≥ 0.5 group () 0.06 (−0.21 to 0.34). Conclusion. This study showed a good agreement between Kowa nonmyd WX3D and HRT III with regard to widely used optic nerve head parameters in patients with glaucomatous optic neuropathy. However, data from Kowa nonmyd WX3D exhibited the tendency to measure larger CDR values than HRT III in the group with CDR < 0.5 group and lower CDR values in the group with CDR ≥ 0.5. Siegfried Mariacher, Stephanie Hipp, Robert Wirthky, Gunnar Blumenstock, Karl-Ulrich Bartz-Schmidt, Focke Ziemssen, Ulrich Schiefer, Bogomil Voykov, and Kai Januschowski Copyright © 2016 Siegfried Mariacher et al. All rights reserved. The Effect of Air Pollution on the Occurrence of Nonspecific Conjunctivitis Mon, 30 May 2016 06:38:18 +0000 Purpose. To investigate the short-term effect of air pollution on occurrence of nonspecific conjunctivitis. Methods. Data were collected from outpatient visits from cases with conjunctivitis over a period of one year. Regression analysis was performed to evaluate the relationship between the number of outpatient visits and the air quality and the lag effect of air quality on conjunctivitis occurrence. Results. The air quality index on the day of presentation (), one day before presentation (), and two days before presentation day () had a positive relation with outpatient visits for conjunctivitis. The air quality index () and outpatient visits number per day () in autumn and winter (October to March) were significantly higher than those in spring (April) and summer (September). Conclusions. The air quality index within two days before presentation affected the probability of attending the outpatient clinic for nonspecific conjunctivitis. High number of cases can be expected in colder season. Zhiwei Li, Xiaoyan Bian, Jianguang Yin, Xiaoli Zhang, and Guoying Mu Copyright © 2016 Zhiwei Li et al. 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.