Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Repeatability of Perimacular Ganglion Cell Complex Analysis with Spectral-Domain Optical Coherence Tomography Wed, 01 Jul 2015 09:00:23 +0000 Purpose. To assess the repeatability of spectral-domain optical coherence tomography to measure macular and perimacular ganglion cell complex thicknesses and compare retinal ganglion cell parameters between algorithms. Methods. Ninety-two nonglaucomatous eyes from 92 participants underwent macular and perimacular ganglion cell complex thickness measurement using OCT-HS100 Glaucoma 3D algorithm and these measurements were repeated for 34 subjects. All subjects also had macular ganglion cell-inner plexiform layer thickness measured by Cirrus HD-OCT Ganglion Cell Analysis algorithm. Intraclass correlation coefficient and Pearson’s correlation analyses were performed. Results. Subfields of both macular and perimacular ganglion cell complex thicknesses had high intraclass correlation coefficient values between 0.979 (95% confidence interval [CI]: 0.958–0.989) and 0.981 (95% CI: 0.963, 0.991) and between 0.70 (95% CI: 0.481–0.838) and 0.987 (95% CI: 0.956–0.989), respectively. The overall average ganglion cell complex and macular average ganglion cell-inner plexiform layer thicknesses were strongly correlated .  Conclusions. The assessment of macular and perimacular retinal ganglion cell parameters by OCT-HS100 Glaucoma 3D algorithm is highly repeatable, and strongly correlates to retinal ganglion cell parameters assessed by Ganglion Cell Analysis algorithm. A comprehensive evaluation of retinal ganglion cells may be possible with OCT-HS100. Dorothy S. K. Ng, Preeti Gupta, Yih Chung Tham, Chye Fong Peck, Tien Yin Wong, Mohammad Kamran Ikram, and Carol Y. Cheung Copyright © 2015 Dorothy S. K. Ng et al. All rights reserved. Clinical Outcomes of Small Incision Lenticule Extraction with Accelerated Cross-Linking (ReLEx SMILE Xtra) in Patients with Thin Corneas and Borderline Topography Sun, 28 Jun 2015 09:28:34 +0000 Purpose. To study the safety and clinical outcomes of ReLEx SMILE with accelerated cross-linking in individuals with thinner corneas, borderline topography, and higher refractive errors. Methods. Eligible patients first underwent SMILE procedure for correction of myopic refractive error. Following the removal of lenticule, 0.25% riboflavin in saline was injected into the interface and allowed to diffuse for 60 seconds. Finally, eye was exposed to UV-A radiation of 45 mW/cm2 for 75 seconds through the cap. Total energy delivered was 3.4 J/cm2. Results. 40 eyes of 20 patients with mean age of 26.75 ± 5.99 years were treated. Mean follow-up was 12 months ± 28.12 days. Mean spherical equivalent (SE) was −5.02 ± 2.06 D preoperatively and −0.24 ± 0.18 D postoperatively. The mean central corneal thickness (CCT) and keratometry changed from 501 ± 25.90 µm to 415 ± 42.26 µm and 45.40 ± 1.40 D to 41.2 ± 2.75 D, respectively. Mean uncorrected visual acuity (UCVA) was 20/25 or better in all eyes. No eyes lost lines of corrected distant visual acuity (CDVA). There were no complications like haze, keratitis, ectasia, or regression. Conclusion. Based on the initial clinical outcome it appears that SMILE Xtra may be a safe and feasible modality to prevent corneal ectasia in susceptible individuals. Sri Ganesh and Sheetal Brar Copyright © 2015 Sri Ganesh and Sheetal Brar. All rights reserved. Factors Influencing Efficacy of Peripheral Corneal Relaxing Incisions during Cataract Surgery Thu, 25 Jun 2015 11:29:31 +0000 Purpose. To evaluate influencing factors on the residual astigmatism after performing peripheral corneal relaxing incisions (PCRIs) during cataract surgery. Methods. This prospective study included patients who were scheduled for cataract surgery with PCRIs. Optical biometry (IOLMaster 500, Carl Zeiss Meditec AG, Germany) was taken preoperatively, 1 week, 4 months, and 1 year postoperatively. Additionally, corneal topography (Atlas model 9000, Carl Zeiss Meditec AG, Germany), ORA (Ocular Response Analyzer, Reichert Ophthalmic Instruments, USA), and autorefraction (Autorefractometer RM 8800 Topcon) were performed postoperatively. Results. Mean age of the study population was 73.5 years (±9.3; range: 53 to 90) and mean corneal astigmatism preoperatively was −1.82 D (±0.59; 1.00 to 4.50). Mean corneal astigmatism was reduced to 1.14 D (±0.67; 0.11 to 3.89) 4 months postoperatively. A partial least squares regression showed that a high eccentricity of the cornea, a large deviation between keratometry and topography, and a high preoperative astigmatism resulted in a larger postoperative error concerning astigmatism. Conclusions. PCRI causes a reduction of preoperative astigmatism, though the prediction is difficult but several factors were found to be a relevant source of error. Nino Hirnschall, Jörg Wiesinger, Petra Draschl, and Oliver Findl Copyright © 2015 Nino Hirnschall et al. All rights reserved. Comparison of Fourier-Domain and Time-Domain Optical Coherence Tomography in the Measurement of Thinnest Corneal Thickness in Keratoconus Thu, 25 Jun 2015 11:04:01 +0000 Objective. To compare fourier-domain optical coherence tomography (FD-OCT) and time-domain OCT (TD-OCT) in the determination of thinnest corneal thickness (TCT). Methods. This study included 55 keratoconus patients and 50 healthy volunteers. The RTVue-OCT (FD-OCT) and Visante-OCT (TD-OCT) were used for the measurement of the TCT. Three consecutive scans were performed. The comparison and agreement between the two modalities were analyzed by paired t-test, the Pearson correlation, intraclass correlation coefficient (ICC), and Bland-Altman plots. intraobserver repeatability was analyzed by the intraobserver within-subject standard deviation (), coefficient of variation (), and ICC. Results. The TCT value of normal corneas was higher by RTVue-OCT (530.4 ± 19.7 μm) than Visante-OCT (521.5 ± 18.3 μm) (). For keratoconus eyes, the TCT was 425.0 ± 58.2 μm and 424.4 ± 55.7 μm (difference being 0.6 ± 10.2 μm, ). Strong correlation (r = 0.938∼0.985) (ICC = 0.915–0.984) was observed between the two OCTs, and each OCT exhibited excellent repeatability in determining the TCT in all subjects (ICC = 0.984–0.994). Conclusions. The values of TCT obtained from RTVue-OCT and Visante-OCT were highly correlated; however, the two values were different. Both OCT instruments exhibited good intraobserver reliability. The existence of systematic differences suggested that the two instruments cannot be used interchangeably. Chunxiao Wang, Xueying Xia, Bishan Tian, and Shiyou Zhou Copyright © 2015 Chunxiao Wang et al. All rights reserved. Deep Sclerectomy with Goniosynechiolysis Ab Interno for Chronic Glaucoma Associated with Peripheral Anterior Synechiae Tue, 23 Jun 2015 08:56:12 +0000 Purpose. To report one-year results of phacoemulsification combined with deep sclerectomy and goniosynechiolysis ab interno for chronic glaucoma associated with peripheral anterior synechiae (PAS). Methods. We retrospectively analyzed medical charts of 16 patients (20 eyes) treated by one-site combined phacoemulsification and deep sclerectomy with goniosynechiolysis ab interno. PAS were transected by a spatula introduced into the anterior chamber through a paracentesis. To account for the correlation of right and left eyes a linear mixed model with unstructured covariance structure was calculated. Results. The mean preoperative intraocular pressure (IOP) was  mmHg with medications. One year postoperatively, the mean IOP was  mmHg (, paired -test) with medications. A postoperative IOP of ≤21 mmHg without medication was achieved in 17 of 19 eyes (89.5%) and in 12/19 eyes (63.2%) at 3 and 12 months after surgery, respectively. In the remaining eyes (10.5% at 3 months and 36.8% at 12 months), additional medication led to an IOP ≤21 mmHg or the target pressure. No case required further glaucoma surgery. In one eye, conversion of the surgery to trabeculectomy was necessary due to Descemet’s window rupture. Conclusions. With goniosynechiolysis ab interno, effective and safe nonpenetrating glaucoma surgery is possible in presence of PAS. Alireza Mirshahi, Peter Raak, Katharina Ponto, Bernhard Stoffelns, Katrin Lorenz, and Gábor B. Scharioth Copyright © 2015 Alireza Mirshahi et al. All rights reserved. Predisposing Factors, Microbial Characteristics, and Clinical Outcome of Microbial Keratitis in a Tertiary Centre in Hong Kong: A 10-Year Experience Thu, 18 Jun 2015 11:53:54 +0000 Purpose. To study the risk factors, microbial profile, antibiotic susceptibility pattern, and outcome for microbial keratitis over the past 10 years in a tertiary center in Hong Kong. Methods. All cases with corneal scraping performed in Queen Mary Hospital, Hong Kong from January 2004 to December 2013 were included. Clinical outcome was defined as poor if the final visual acuity (VA) was abnormal or worse than presenting VA, a major complication occurred, or therapeutic keratoplasty was required. Results. 347 scrapes were performed in the 10-year period growing 130 microorganisms (32.3% culture positive rate). Contact lens use was the commonest risk factor. The commonest isolates were coagulase-negative Staphylococcus and Pseudomonas aeruginosa. Fluoroquinolone susceptibility was tested in 47 Gram-negative bacteria with 93.6% susceptibility (100% for Pseudomonas). 90.7% of cases had good visual outcome. Multivariate logistic regression showed age (), trauma (), and ulcer size >3 mm () to be independently associated with poor outcome. Conclusion. There was no shifting trend in the isolate distribution or emergence of resistant strains in our study. Contact lens wear was the commonest risk factor, with Pseudomonas being the most frequent isolate in this group. It remained 100% susceptible to fluoroquinolones and 97% cases had good visual outcome. Alex Lap-Ki Ng, Kelvin Kai-Wang To, Chile Chi-Lai Choi, Leonard Hsu Yuen, Suk-Ming Yim, Keith Shun-Kit Chan, Jimmy Shiu-Ming Lai, and Ian Yat-Hin Wong Copyright © 2015 Alex Lap-Ki Ng et al. All rights reserved. Ultrastructure Organization of Collagen Fibrils and Proteoglycans of Stingray and Shark Corneal Stroma Wed, 17 Jun 2015 13:34:11 +0000 We report here the ultrastructural organization of collagen fibrils (CF) and proteoglycans (PGs) of the corneal stroma of both the stingray and the shark. Three corneas from three stingrays and three corneas from three sharks were processed for electron microscopy. Tissues were embedded in TAAB 031 resin. The corneal stroma of both the stingray and shark consisted of parallel running lamellae of CFs which were decorated with PGs. In the stingray, the mean area of PGs in the posterior stroma was significantly larger than the PGs of the anterior and middle stroma, whereas, in the shark, the mean area of PGs was similar throughout the stroma. The mean area of PGs of the stingray was significantly larger compared to the PGs, mean area of the shark corneal stroma. The CF diameter of the stingray was significantly smaller compared to the CF diameter in the shark. The ultrastructural features of the corneal stroma of both the stingray and the shark were similar to each other except for the CFs and PGs. The PGs in the stingray and shark might be composed of chondroitin sulfate (CS)/dermatan sulfate (DS) PGs and these PGs with sutures might contribute to the nonswelling properties of the cornea of the stingray and shark. Saud A. Alanazi, Turki Almubrad, Ahmad I. A. AlIbrahim, Adnan A. Khan, and Saeed Akhtar Copyright © 2015 Saud A. Alanazi et al. All rights reserved. Analysis of Factors Affecting Patients’ Compliance to Topical Antiglaucoma Medications in Egypt as a Developing Country Model Wed, 17 Jun 2015 06:56:11 +0000 Purpose. To study factors affecting patients’ compliance to antiglaucoma medications in Egypt where there are unique factors as a developing country. Patients and Methods. A cross-sectional descriptive study on 440 Egyptian patients with open angle glaucoma (OAG) recruited for over two years. The patients were thoroughly interviewed about their age, education level, duration of glaucoma, difficulty in instilling the drops, medication regimens, a family history of glaucoma, knowledge of the disease, and the presence of medical insurance. Results. 236 (53.6%) were noncompliant compared to 204 (46.4%) who were compliant. Females had a tendency for higher compliance . Patient age above 50 years and low level of education and negative family history of glaucoma were factors significantly associated with poor compliance . Polytherapy and lack of medical insurance could be contributing factors. Conclusion. Egyptian patients have a high rate of noncompliance compared to the average in literature. Great effort is needed in educating patients about the importance of medications and the risk and the prognosis of this disease. Economic factors must also be taken into consideration in developing countries with large number of poor patients. We recommend simplifying drug regimens, incorporating electronic dose monitors, and creating reminders for follow-up visits of glaucoma patients. Nahla B. Abu Hussein, Iman M. Eissa, and Ahmed A. Abdel-Kader Copyright © 2015 Nahla B. Abu Hussein et al. All rights reserved. Retinitis Pigmentosa with EYS Mutations Is the Most Prevalent Inherited Retinal Dystrophy in Japanese Populations Tue, 16 Jun 2015 09:41:54 +0000 The aim of this study was to gain information about disease prevalence and to identify the responsible genes for inherited retinal dystrophies (IRD) in Japanese populations. Clinical and molecular evaluations were performed on 349 patients with IRD. For segregation analyses, 63 of their family members were employed. Bioinformatics data from 1,208 Japanese individuals were used as controls. Molecular diagnosis was obtained by direct sequencing in a stepwise fashion utilizing one or two panels of 15 and 27 genes for retinitis pigmentosa patients. If a specific clinical diagnosis was suspected, direct sequencing of disease-specific genes, that is, ABCA4 for Stargardt disease, was conducted. Limited availability of intrafamily information and decreasing family size hampered identifying inherited patterns. Differential disease profiles with lower prevalence of Stargardt disease from European and North American populations were obtained. We found 205 sequence variants in 159 of 349 probands with an identification rate of 45.6%. This study found 43 novel sequence variants. In silico analysis suggests that 20 of 25 novel missense variants are pathogenic. EYS mutations had the highest prevalence at 23.5%. c.4957_4958insA and c.8868C>A were the two major EYS mutations identified in this cohort. EYS mutations are the most prevalent among Japanese patients with IRD. Yuuki Arai, Akiko Maeda, Yasuhiko Hirami, Chie Ishigami, Shinji Kosugi, Michiko Mandai, Yasuo Kurimoto, and Masayo Takahashi Copyright © 2015 Yuuki Arai et al. All rights reserved. The Influence of a Vitrectomy on the Diurnal Intraocular Pressure Mon, 15 Jun 2015 13:23:42 +0000 Purpose. To evaluate the diurnal intraocular pressure (IOP) in eyes after vitrectomy compared to that of healthy eyes. Methods. Twenty-one patients who had undergone vitrectomy and 21 age- and gender-matched normal controls were enrolled during the same period. We measured the diurnal IOP every two hours between 9 a.m. and 11 p.m. in all patients who were admitted for cataract surgery. Patients with a history of eye surgery (not including vitrectomy) or use of a medication that is associated with IOP were excluded. The IOP and ocular parameters of patients were compared with the same patients’ fellow healthy eyes and with normal eyes of age- and gender-matched controls. Results. There were no significant differences between vitrectomized eyes and normal fellow eyes with regard to all IOP parameters including the maximum, minimum, and IOP fluctuation values. Diurnal fluctuation of IOP (or the difference between the maximum and minimum IOP) was larger in vitrectomized eyes than it was in age- and gender-matched control eyes. Conclusions. Vitrectomy did not markedly affect the IOP. Although there were no severe complications after vitrectomy, the IOP fluctuation was wider in vitrectomized eyes than it was in normal eyes. Yong Woo Lee, Joon Mo Kim, Seong Hee Shim, Da Yeong Kim, Jeong Hun Bae, and Ki Ho Park Copyright © 2015 Yong Woo Lee et al. All rights reserved. Action Planning Mediates Guidance of Visual Attention from Working Memory Mon, 15 Jun 2015 06:55:42 +0000 Visual search is impaired when a salient task-irrelevant stimulus is presented together with the target. Recent research has shown that this attentional capture effect is enhanced when the salient stimulus matches working memory (WM) content, arguing in favor of attention guidance from WM. Visual attention was also shown to be closely coupled with action planning. Preparing a movement renders action-relevant perceptual dimensions more salient and thus increases search efficiency for stimuli sharing that dimension. The present study aimed at revealing common underlying mechanisms for selective attention, WM, and action planning. Participants both prepared a specific movement (grasping or pointing) and memorized a color hue. Before the movement was executed towards an object of the memorized color, a visual search task (additional singleton) was performed. Results showed that distraction from target was more pronounced when the additional singleton had a memorized color. This WM-guided attention deployment was more pronounced when participants prepared a grasping movement. We argue that preparing a grasping movement mediates attention guidance from WM content by enhancing representations of memory content that matches the distractor shape (i.e., circles), thus encouraging attentional capture by circle distractors of the memorized color. We conclude that templates for visual search, action planning, and WM compete for resources and thus cause interferences. Tobias Feldmann-Wüstefeld and Anna Schubö Copyright © 2015 Tobias Feldmann-Wüstefeld and Anna Schubö. All rights reserved. Effects of Long-Term Antiglaucoma Eye Drops on Conjunctival Structures: An In Vivo Confocal Microscopy Study Mon, 15 Jun 2015 06:40:08 +0000 Purpose. The study was aimed at comparing the long-term effects of different antiglaucoma eye drops on conjunctival structures using laser scanning confocal microscopy. Methods. Eighty patients diagnosed with primary open-angle glaucoma and twenty healthy volunteers were included in this study. The participants were divided into 5 groups according to the different medications. The lachrymal film break-up time, Schirmer’s I test, and Ocular Surface Disease Index Questionnaire were performed in all subjects. The confocal microscopy was used to observe the basal epithelial cell density (ECD), goblet cell density (GCD), dendritic cell density (DCD), and subepithelial collagen fiber diameter (SFD). Results. Statistically significant differences were found among the control group and the antiglaucoma therapy groups in the values of three clinical data (). The GCD, DCD, and SFD showed significant differences in all glaucoma groups when compared to the control (). Moreover, the prostaglandin group differed from the other antiglaucoma therapy groups in the GCD and SFD (). Conclusions. Our study confirmed the significant differences in the conjunctival structures based on the effects of antiglaucoma medications. Less pronounced changes were found in the patients treated with prostaglandin analogue than in the other kinds of antiglaucoma therapies. Wenqing Zhu, Xiangmei Kong, Jianjiang Xu, and Xinghuai Sun Copyright © 2015 Wenqing Zhu et al. All rights reserved. Ocular Complications in Cutaneous Lupus Erythematosus: A Systematic Review with a Meta-Analysis of Reported Cases Thu, 11 Jun 2015 16:51:19 +0000 Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease. L. Arrico, A. Abbouda, I. Abicca, and R. Malagola Copyright © 2015 L. Arrico et al. All rights reserved. Retinitis Pigmentosa: Disease Mechanisms, Diagnosis, and Therapies Thu, 11 Jun 2015 13:33:51 +0000 Xinhua Shu, Ji-jing Pang, Houbin Zhang, and David Mansfield Copyright © 2015 Xinhua Shu et al. All rights reserved. Trabeculectomy with Healaflow versus Trabeculectomy for the Treatment of Glaucoma: A Case-Control Study Thu, 11 Jun 2015 12:48:28 +0000 Purpose. To compare the outcomes of trabeculectomy with and without Healaflow (Anteis S.A, Geneva, Switzerland), a high molecular weight viscoelastic gel, in patients requiring glaucoma surgery. Methods. This was a retrospective, comparative, interventional case-control study. Forty patients formed two matched study groups and were analyzed (trabeculectomy alone (control) versus trabeculectomy with Healaflow (study)). Results. The postoperative levels of mean IOP were statistically significantly lower than preoperatively in both groups, for all time intervals. There was no statistical difference, at the end of the follow-up period, between the two groups in the mean values of the IOP (14.9 ± 3.2 mmHg for the study group versus 14.8 ± 3.3 mmHg for the control group). The number of antiglaucoma drugs used in the study group was reduced from a preoperative mean of 3.4 ± 0.75 to a 6-month postoperative mean of 0.6 ± 0.8 and in the control group from 3.6 ± 0.59 to 0.55 ± 0.9 . Conclusions. Although trabeculectomy with Healaflow appears to be a safe procedure, we failed to identify any significant advantages in the use of Healaflow when compared with trabeculectomy alone, at the end of the 6-month follow-up period. Dimitris Papaconstantinou, Andreas Diagourtas, Petros Petrou, Alexandros Rouvas, Athanasios Vergados, Chryssanthi Koutsandrea, and Ilias Georgalas Copyright © 2015 Dimitris Papaconstantinou et al. All rights reserved. Efficacy and Acceptability of Orthokeratology for Slowing Myopic Progression in Children: A Systematic Review and Meta-Analysis Mon, 08 Jun 2015 13:01:23 +0000 Background. To evaluate the efficacy and acceptability of orthokeratology for slowing myopic progression in children with a well conducted evidence-based analysis. Design. Meta-analysis. Participants. Children from previously reported comparative studies were treated by orthokeratology versus control. Methods. A systematic literature retrieval was conducted in MEDLINE, EMBASE, Cochrane Library, World Health Organization International Clinical Trials Registry Platform, and The included studies were subjected to meta-analysis using Stata version 10.1. Main Outcome Measures. Axial length change (efficacy) and dropout rates (acceptability) during 2-year follow-up. Results. Eight studies involving 769 subjects were included. At 2-year follow-up, a statistically significant difference was observed in axial length change between the orthokeratology and control groups, with a weighted mean difference (WMD) of −0.25 mm (95% CI, −0.30 to −0.21). The pooled myopic control rate declined with time, with 55, 51, 51, and 41% obtained after 6, 12, 18, and 24 months of treatment, respectively. No statistically significant difference was obtained for dropout rates between the orthokeratology and control groups at 2-year follow-up (OR, 0.79; 95% CI, 0.52 to 1.22). Conclusions. Orthokeratology is effective and acceptable for slowing myopic progression in children with careful education and monitoring. Daizong Wen, Jinhai Huang, Hao Chen, Fangjun Bao, Giacomo Savini, Antonio Calossi, Haisi Chen, Xuexi Li, and Qinmei Wang Copyright © 2015 Daizong Wen et al. All rights reserved. Comparison of Intraocular Pressure before and after Laser In Situ Keratomileusis Refractive Surgery Measured with Perkins Tonometry, Noncontact Tonometry, and Transpalpebral Tonometry Mon, 08 Jun 2015 12:12:25 +0000 Purpose. To compare the intraocular pressure (IOP) before and after Laser In Situ Keratomileusis (LASIK), measured by Diaton, Perkins, and noncontact air pulse tonometers. Methods. Fifty-seven patients with a mean age of 34.88 were scheduled for myopia LASIK treatment. Spherical equivalent refraction (SER), corneal curvature (K), and central corneal thickness (CCT) and superior corneal thickness (SCT) were obtained before and after LASIK surgery. IOP values before and after surgery were measured using Diaton, Perkins, and noncontact air pulse tonometers. Results. The IOP values before and after LASIK surgery using Perkins tonometer and air tonometers were statistically significant (). However, no significant differences were found () for IOP values measured with Diaton tonometer. CCT decreases significantly after surgery () but no statistical differences were found in SCT (). Correlations between pre- and postsurgery were found for all tonometers used, with and for the air pulse tonometer, and for Perkins, and and for Diaton. Conclusion. Transpalpebral tonometry may be useful for measuring postsurgery IOP after myopic LASIK ablation because this technique is not influenced by the treatment. Isabel Cacho, Juan Sanchez-Naves, Laura Batres, Jesús Pintor, and Gonzalo Carracedo Copyright © 2015 Isabel Cacho et al. All rights reserved. Prospective Randomized Study Comparing Combined Phaco-ExPress and Phacotrabeculectomy in Open Angle Glaucoma Treatment: 12-Month Follow-Up Sun, 07 Jun 2015 15:53:27 +0000 Purpose of the Study. To compare the efficacy and safety of phacotrabeculectomy (P-Trab) and phacoemulsification with the ExPress (P-ExPress) mini glaucoma shunt implantation. Study Plan. Prospective randomized study. Material and Methods. 85 eyes with cataract and unregulated open angle glaucoma. There were 46 eyes in the P-ExPress and 39 the P-Trab group. Intraocular pressure (IOP), the number of antiglaucoma medications, qualified and complete surgical success (defined as IOP ≤ 18.0 mmHg), visual acuity (CDVA), the number of endothelial cells, and postoperative complications and additional procedures were assessed. Results. After 12 months of observation, the average IOP in the P-Express group went from 26.4 ± 9.3 down to 17.1 ± 5 mmHg () and from 27.9 ± 12.9 down to 15.9 ± 2.7 mmHg in the P-Trab group (). No significant differences in the amount of medications used after surgery and CDVA were discovered between the groups. In the P-ExPress group, greater loss of endothelial cells was noted , compared to the P-Trab group. Conclusions. Both P-ExPress and P-Trab have comparable efficacy and similar early postoperative complication profile. The presence of additional implant (as is the case of the ExPress mini glaucoma shunt implantation) may cause progressive loss of endothelial cells. Joanna Konopińska, Marta Deniziak, Emil Saeed, Agnieszka Bartczak, Renata Zalewska, Zofia Mariak, and Marek Rękas Copyright © 2015 Joanna Konopińska et al. All rights reserved. Role of Peroxisome Proliferator-Activated Receptor γ in Ocular Diseases Thu, 04 Jun 2015 07:24:30 +0000 Peroxisome proliferator-activated receptor γ (PPAR γ), a member of the nuclear receptor superfamily, is a ligand-activated transcription factor that plays an important role in the control of a variety of physiological processes. The last decade has witnessed an increasing interest for the role played by the agonists of PPAR γ in antiangiogenesis, antifibrosis, anti-inflammation effects and in controlling oxidative stress response in various organs. As the pathologic mechanisms of major blinding diseases, such as age-related macular degeneration (AMD), diabetic retinopathy (DR), keratitis, and optic neuropathy, often involve neoangiogenesis and inflammation- and oxidative stress-mediated cell death, evidences are accumulating on the potential benefits of PPAR γ to improve or prevent these vision threatening eye diseases. In this paper we describe what is known about the role of PPAR γ in the ocular pathophysiological processes and PPAR γ agonists as novel adjuvants in the treatment of eye diseases. Su Zhang, Hongwei Gu, and Nan Hu Copyright © 2015 Su Zhang et al. All rights reserved. Trends in Glaucoma Medication Expenditures under Universal Health Coverage: A National Population-Based Longitudinal Survey in Taiwan Tue, 02 Jun 2015 11:52:22 +0000 Medical care in Taiwan is well known for its low cost, high efficiency, high quality, excellent medical accessibility, and high equity. We investigate the trends in medication expenditures for glaucoma from 1997 to 2010. The results show that higher medical expenditures were incurred by patients who were aged ≥40 years, male patients, and patients in the highest salary population whereas lower medical expenditures were incurred by blue-collar workers. The medications with the most significant increases in expenditure were prostaglandin analogs (PGAs), α-agonists, and fixed combinations, whereas the medications with the most significant decreases in expenditure were β-blockers and cholinergic agonists. The number of trabeculectomies shows two downward break points in 1999 and 2000 when PGAs were listed and were reimbursed. These results suggest socioeconomic disparities in glaucoma care, as well as understanding of the changes in the expenditure of glaucoma medications under such universal health insurance coverage system. Shin-Lin Chiu, Chiao-Lee Chu, Chih-Hsin Muo, Chiu-Liang Chen, and Shou-Jen Lan Copyright © 2015 Shin-Lin Chiu et al. All rights reserved. Knocking Down Snrnp200 Initiates Demorphogenesis of Rod Photoreceptors in Zebrafish Tue, 02 Jun 2015 07:34:20 +0000 Purpose. The small nuclear ribonucleoprotein 200 kDa (SNRNP200) gene is a fundamental component for precursor message RNA (pre-mRNA) splicing and has been implicated in the etiology of autosomal dominant retinitis pigmentosa (adRP). This study aims to determine the consequences of knocking down Snrnp200 in zebrafish. Methods. Expression of the Snrnp200 transcript in zebrafish was determined via whole mount in situ hybridization. Morpholino oligonucleotide (MO) aiming to knock down the expression of Snrnp200 was injected into zebrafish embryos, followed by analyses of aberrant splicing and expression of the U4/U6-U5 tri-small nuclear ribonucleoproteins (snRNPs) components and retina-specific transcripts. Systemic changes and retinal phenotypes were further characterized by histological study and immunofluorescence staining. Results. Snrnp200 was ubiquitously expressed in zebrafish. Knocking down Snrnp200 in zebrafish triggered aberrant splicing of the cbln1 gene, upregulation of other U4/U6-U5 tri-snRNP components, and downregulation of a panel of retina-specific transcripts. Systemic defects were found correlated with knockdown of Snrnp200 in zebrafish. Only demorphogenesis of rod photoreceptors was detected in the initial stage, mimicking the disease characteristics of RP. Conclusions. We conclude that knocking down Snrnp200 in zebrafish could alter regular splicing and expression of a panel of genes, which may eventually trigger rod defects. Yuan Liu, Xue Chen, Bing Qin, Kanxing Zhao, Qingshun Zhao, Jonathan P. Staley, and Chen Zhao Copyright © 2015 Yuan Liu et al. All rights reserved. Histone Deacetylases Inhibitors in the Treatment of Retinal Degenerative Diseases: Overview and Perspectives Tue, 02 Jun 2015 07:10:20 +0000 Retinal degenerative diseases are one of the important refractory ophthalmic diseases, featured with apoptosis of photoreceptor cells. Histone acetylation and deacetylation can regulate chromosome assembly, gene transcription, and posttranslational modification, which are regulated by histone acetyltransferases (HATs) and histone deacetylases (HDACs), respectively. The histone deacetylase inhibitors (HDACis) have the ability to cause hyperacetylation of histone and nonhistone proteins, resulting in a variety of effects on cell proliferation, differentiation, anti-inflammation, and anti-apoptosis. Several HDACis have been approved for clinical trials to treat cancer. Studies have shown that HDACis have neuroprotective effects in nervous system damage. In this paper, we will summarize the neuroprotective effects of common HDACis in retinal degenerative diseases and make a prospect to the applications of HDACis in the treatment of retinal degenerative diseases in the future. Hua Zhang, Xufeng Dai, Yan Qi, Ying He, Wei Du, and Ji-jing Pang Copyright © 2015 Hua Zhang et al. All rights reserved. A Novel Device to Exploit the Smartphone Camera for Fundus Photography Tue, 02 Jun 2015 06:51:01 +0000 Purpose. To construct an inexpensive, convenient, and portable attachment for smartphones for the acquisition of still and live retinal images. Methods. A small optical device based on the principle of direct ophthalmoscopy was designed to be magnetically attached to a smartphone. Representative images of normal and pathological fundi were taken with the device. Results. A field-of-view up to ~20° was captured at a clinical resolution for each fundus image. The cross-polarization technique adopted in the optical design dramatically diminished corneal Purkinje reflections, making it possible to screen patients even through undilated pupils. Light emission proved to be well within safety limits. Conclusions. This optical attachment is a promising, inexpensive, and valuable alternative to the direct ophthalmoscope, potentially eliminating problems of poor exam skills and inexperienced observer bias. Its portability, together with the wireless connectivity of smartphones, presents a promising platform for screening and telemedicine in nonhospital settings. Translational Relevance. Smartphones have the potential to acquire retinal imaging for a portable ophthalmoscopy. Andrea Russo, Francesco Morescalchi, Ciro Costagliola, Luisa Delcassi, and Francesco Semeraro Copyright © 2015 Andrea Russo et al. All rights reserved. ET-1 Plasma Levels, Aqueous Flare, and Choroidal Thickness in Patients with Retinitis Pigmentosa Tue, 02 Jun 2015 06:42:46 +0000 Purpose. To assess endothelin-1 (ET-1) plasma levels, choroidal thickness, and aqueous flare in patients with early stage retinitis pigmentosa (RP) and to search for possible correlations. Methods. We compared 24 RP patients with 24 healthy controls. Choroidal thickness and aqueous flare were measured, respectively, by using a spectral domain optical coherence tomography and a laser flare-cell meter, whereas plasma samples were obtained from each patient to evaluate ET-1 plasma levels. Results. Notably, RP subjects showed significantly increased ET-1 plasma levels and reduced choroidal thickness compared with controls: versus  pg/mL, , and versus  μm, , respectively. Higher aqueous flare values were also demonstrated in RP compared to controls: in detail, versus photon counts/ms, . Spearman’s correlation test highlighted that the increase of ET-1 plasma levels was related with the decrease of choroidal thickness (; ) and the increase of aqueous flare (; ). Conclusions. Early stage RP patients show a breakdown of blood-ocular barrier and increased ET-1 plasma levels and these findings may contribute to the reduction of choroidal thickness. Ernesto Strobbe, Mauro Cellini, Michela Fresina, and Emilio C. Campos Copyright © 2015 Ernesto Strobbe et al. All rights reserved. Self-Testing of Vision in Age-Related Macula Degeneration: A Longitudinal Pilot Study Using a Smartphone-Based Rarebit Test Mon, 01 Jun 2015 12:46:49 +0000 Purpose. There is a need for efficient self-tests of vision in patients with neovascular age-related macula degeneration. A new tablet/smartphone application aiming to meet this need is described and its performance is assessed in a longitudinal pilot study. Materials and Methods. The new MultiBit Test (MBT) employs segmented digits defined by rarebits, that is, receptive field-size bright dots briefly presented against a dark background. The number of rarebits per digit segment was varied in a cyclic fashion, in preset steps. There were no fixation demands. Twenty-eight patients with neovascular AMD of varying severity were monitored for an average of 30 weeks. Test scores were evaluated on an individual basis, by contrasting observed trends with the clinical status recorded at independently scheduled clinical examinations. Results. Serial plots of MBT results revealed gradual improvement after successful antineovascular treatment. Recurrences were signalled by gradual deteriorations of results. Test results remained stable during clinically stable time intervals. MBT results agreed well with clinical assessments whereas an acuity test performed at chance level. The MBT was well accepted by all subjects. Conclusions. The MBT appears to have a good potential for effective self-testing of vision in AMD and merits large-scale studies. Exploration of MBT performance with other forms of macula conditions may be worthwhile. Christina Winther and Lars Frisén Copyright © 2015 Christina Winther and Lars Frisén. All rights reserved. iTRAQ-Based Proteomic Analysis of Visual Cycle-Associated Proteins in RPE of rd12 Mice before and after RPE65 Gene Delivery Mon, 01 Jun 2015 12:36:06 +0000 Purpose. To investigate the iTRAQ-based proteomic changes of visual cycle-associated proteins in RPE of rd12 mice before and after RPE65 gene delivery. Mehtods. The right eyes of rd12 mice underwent RPE65 gene delivery by subretinal injection at P14, leaving the left eyes as control. C57BL/6J mice were served as a wide-type control group. ERGs were recorded at P42, and RPE-choroid-sclera complex was collected to evaluate the proteomic changes in visual cycle-associated proteins by iTRAQ-based analysis. Western blot was used to confirm the changes in the differentially expressed proteins of interest. Results. ERG parameters improved dramatically at P42 after RPE65 delivery. The proteomics analysis identified a total 536 proteins with a global false discovery rate of 0.21%, out of which 7 were visual cycle-associated proteins. RALBP-1, RBP-1, and IRBP were reduced in the untreated rd12 eyes and the former two were improved after gene therapy, confirmed by Western blot analysis. Conclusions. RPE65 gene delivery restored retinal function at P42 and modified the expression of other functional proteins implicated in the visual cycle. The level of RALBP-1 was still below the normal level after gene therapy in rd12 mice, which may explain the delayed dark adaption in LCA patients undergoing similar therapy. Qinxiang Zheng, Yueping Ren, Radouil Tzekov, Shanshan Hua, Minghan Li, Jijing Pang, Jia Qu, and Wensheng Li Copyright © 2015 Qinxiang Zheng et al. All rights reserved. Histological Characterization of the Dicer1 Mutant Zebrafish Retina Mon, 01 Jun 2015 11:25:29 +0000 DICER1, a multidomain RNase III endoribonuclease, plays a critical role in microRNA (miRNA) and RNA-interference (RNAi) functional pathways. Loss of Dicer1 affects different developmental processes. Dicer1 is essential for retinal development and maintenance. DICER1 was recently shown to have another function of silencing the toxicity of Alu RNAs in retinal pigment epithelium (RPE) cells, which are involved in the pathogenesis of age related macular degeneration. In this study, we characterized a Dicer1 mutant fish line, which carries a nonsense mutation (W1457Ter) induced by N-ethyl-N-nitrosourea mutagenesis. Zebrafish DICER1 protein is highly conserved in the evolution. Zebrafish Dicer1 is expressed at the earliest stages of zebrafish development and persists into late developmental stages; it is widely expressed in adult tissues. Homozygous Dicer1 mutant fish (DICER) have an arrest in early growth with significantly smaller eyes and are dead at 14–18 dpf. Heterozygous Dicer1 mutant fish have similar retinal structure to that of control fish; the retinal pigment epithelium (RPE) cells are normal with no sign of degeneration at the age of 20 months. Saeed Akhtar, Sarita Rani Patnaik, Rakesh Kotapati Raghupathy, Turki M. Al-Mubrad, John A. Craft, and Xinhua Shu Copyright © 2015 Saeed Akhtar et al. All rights reserved. Exome Sequencing Identified a Recessive RDH12 Mutation in a Family with Severe Early-Onset Retinitis Pigmentosa Mon, 01 Jun 2015 11:23:41 +0000 Retinitis pigmentosa (RP) is the most important hereditary retinal disease caused by progressive degeneration of the photoreceptor cells. This study is to identify gene mutations responsible for autosomal recessive retinitis pigmentosa (arRP) in a Chinese family using next-generation sequencing technology. A Chinese family with 7 members including two individuals affected with severe early-onset RP was studied. All patients underwent a complete ophthalmic examination. Exome sequencing was performed on a single RP patient (the proband of this family) and direct Sanger sequencing on other family members and normal controls was followed to confirm the causal mutations. A homozygous mutation c.437T<A (p.V146D) in the retinol dehydrogenase 12 (RDH12) gene, which encodes an NADPH-dependent retinal reductase, was identified as being related to the phenotype of this arRP family. This homozygous mutation was detected in the two affected patients, but not present in other family members and 600 normal controls. Another three normal members in the family were found to carry this heterozygous missense mutation. Our results emphasize the importance of c.437T<A (p.V146D) substitution in RDH12 and provide further support for the causative role of this mutation in the pathogenesis and clinical diagnosis of RP. Bo Gong, Bo Wei, Lulin Huang, Jilong Hao, Xiulan Li, Yin Yang, Yu Zhou, Fang Hao, Zhihua Cui, Dingding Zhang, Le Wang, and Houbin Zhang Copyright © 2015 Bo Gong et al. All rights reserved. Retinitis Pigmentosa Treatment with Western Medicine and Traditional Chinese Medicine Therapies Mon, 01 Jun 2015 09:27:49 +0000 Current management of retinitis pigmentosa (RP) includes an attempt at slowing down the degenerative process through therapies that use either Western or traditional Chinese medicine (TCM). Novel therapies in Western medicine (WM) include use of tailor-made gene therapy, transplantation of stem cells, or neuroprotection treatment. TCM treatment includes two major approaches. These are orally applied herbal decoctions and acupuncture. In fact, all TCM treatments are based on the differentiation of a symptom-complex, which is the characteristic essence of TCM. Thus, diagnosed RP may be treated via the liver, the kidney, and the spleen. The principle behind these treatments is to invigorate the blood and brighten the eyes by toning up the liver and the kidney. Also treatments to cope with deficiencies in the two concepts that are unique and fundamental to TCM are considered: Qi or “vital energy” and Yin and Yang or the harmony of all the opposite elements and forces that make up existence. In particular, the Qi deficiency that results from blood stasis is addressed in these treatments. This paper also puts forward the existing problems and the prospect of the future development on integrating TCM with WM. Jian Xu and Qinghua Peng Copyright © 2015 Jian Xu and Qinghua Peng. All rights reserved. Eye Motility Alterations in Retinitis Pigmentosa Mon, 01 Jun 2015 09:05:56 +0000 Purpose. We evaluated a sample of individuals with retinitis pigmentosa (RP) with the aim of assessing the presence or absence of ocular motility (OM) disorders. Materials and Methods. We included 23 out of the 25 individuals from the sample (9 females and 14 males) with an average visual acuity of 6/10. Results. The cover test about the vertical deviation in near distance showed an r/l in 3.45% and an l/r in 6.9%. The assessment of OM showed that 39.1% of the sample had a severe hyperfunction of the IO of the right eye and a severe hyperfunction (34.5%) of the SO of the left eye; 21.8% had a moderate hypofunction of right SO with a moderate percentage of hypofunction of 17.5% for the SO of the left eye; 30.5%, however, showed a serious hypofunction of the SR of both eyes; 21.7% of the sample showed a hyperfunction in both eyes of the IR. Conclusion. This alteration, however, is not attributable to either a high refractive defect (medium-low myopia: −1 diopter  SD) or to a severely impaired binocular vision (visual acuity, motor fusion, and stereopsis are normal or within a range of values commonly accepted). Therefore, the disorders of OM lead to a genetic origin. Raffaele Migliorini, Anna Maria Comberiati, Giovanni Galeoto, Manuela Fratipietro, and Loredana Arrico Copyright © 2015 Raffaele Migliorini et al. All rights reserved.