Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Ophthalmologic Psychophysical Tests Support OCT Findings in Mild Alzheimer’s Disease Wed, 27 May 2015 14:22:57 +0000 Purpose. To analyze in mild Alzheimer’s disease (MAD) patients, GDS-4 (Reisberg Scale), whether or not some psychophysical tests (PTs) support OCT macular findings in the same group of MAD patients reported previously. Methods. Twenty-three MAD patients and 28 age-matched control subjects with mean Mini Mental State Examination of 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision were included. Best-corrected visual acuity (VA), contrast sensitivity (CS) (3, 6, 12, and 18 cpds), color perception (CP), and perception digital test (PDT) were tested in one eye of each patient. Results. In comparison with the controls, MAD patients presented (i) a significant decrease in VA, PDT, and CS for all spatial frequencies analyzed, especially the higher ones, and (ii) a significant increase in unspecific errors on the blue axis ( in all instances). In MAD patients, a wide aROC curve was plotted in all PTs. Conclusions. In MAD, CS, VA, and the tritan axis in CP were impaired. The PTs with the greatest predictive value are the higher spatial frequencies in CS and tritan unspecific errors in CP. PT abnormalities are consistent with the structural findings reported in the same MAD patients using OCT. Elena Salobrar-Garcia, Rosa de Hoz, Blanca Rojas, Ana I. Ramirez, Juan J. Salazar, Raquel Yubero, Pedro Gil, Alberto Triviño, and José M. Ramirez Copyright © 2015 Elena Salobrar-Garcia et al. All rights reserved. Corneal Segmentation Analysis Increases Glaucoma Diagnostic Ability of Optic Nerve Head Examination, Heidelberg Retina Tomograph’s Moorfield’s Regression Analysis, and Glaucoma Probability Score Wed, 27 May 2015 13:35:04 +0000 Purpose. To study whether a corneal thickness segmentation model, consisting in a central circular zone of 1 mm radius centered at the corneal apex (zone I) and five concentric rings of 1 mm width (moving outwards: zones II to VI), could boost the diagnostic accuracy of Heidelberg Retina Tomograph’s (HRT’s) MRA and GPS. Material and Methods. Cross-sectional study. 121 healthy volunteers and 125 patients with primary open-angle glaucoma. Six binary multivariate logistic regression models were constructed (MOD-A1, MOD-A2, MOD-B1, MOD-B2, MOD-C1, and MOD-C2). The dependent variable was the presence of glaucoma. In MOD-A1, the predictor was the result (presence of glaucoma) of the analysis of the stereophotography of the optic nerve head (ONH). In MOD-B1 and MOD-C1, the predictor was the result of the MRA and GPS, respectively. In MOD-B2 and MOD-C2, the predictors were the same along with corneal variables: central, overall, and zones I to VI thicknesses. This scheme was reproduced for model MOD-A2 (stereophotography along with corneal variables). Models were compared using the area under the receiver operator characteristic curve (AUC). Results. MOD-A1-AUC: 0.771; MOD-A2-AUC: 0.88; MOD-B1-AUC: 0.736; MOD-B2-AUC: 0.845; MOD-C1-AUC: 0.712; MOD-C2-AUC: 0.838. Conclusion. Corneal thickness variables enhance ONH assessment and HRT’s MRA and GPS diagnostic capacity. F. Saenz-Frances, L. Jañez, C. Berrozpe-Villabona, L. Borrego-Sanz, L. Morales-Fernández, A. Acebal-Montero, C. D. Mendez-Hernandez, J. M. Martinez-de-la-Casa, E. Santos-Bueso, J. Garcia-Sanchez, and J. Garcia-Feijoo Copyright © 2015 F. Saenz-Frances et al. All rights reserved. Critical Appraisal of Clinical Practice Guidelines for Age-Related Macular Degeneration Mon, 25 May 2015 12:36:34 +0000 Purpose. To evaluate the methodological quality of age-related macular degeneration (AMD) clinical practice guidelines (CPGs). Methods. AMD CPGs published by the American Academy of Ophthalmology (AAO) and Royal College of Ophthalmologists (RCO) were appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which comprises six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence), and an Overall Assessment score summarizing methodological quality across all domains. Results. Average domain scores ranged from 35% to 83% for the AAO CPG and from 17% to 83% for the RCO CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO and RCO CPGs were 0.74 and 0.88, respectively. The strongest domains were Scope and Purpose and Clarity of Presentation. The weakest were Stakeholder Involvement (AAO) and Editorial Independence (RCO). Conclusions. Future AMD CPGs can be improved by involving all relevant stakeholders in guideline development, ensuring transparency of guideline development and review methodology, improving guideline applicability with respect to economic considerations, and addressing potential conflict of interests within the development group. Annie M. Wu, Connie M. Wu, Benjamin K. Young, Dominic J. Wu, Curtis E. Margo, and Paul B. Greenberg Copyright © 2015 Annie M. Wu et al. All rights reserved. Pharmacological Isolation of Cognitive Components Influencing the Pupillary Light Reflex Sun, 24 May 2015 11:36:56 +0000 Cognitive operations can be detected by reduction of the pupillary light response. Neurophysiological pathways mediating this reduction have not been distinguished. We utilized selective blockade of pupillary sphincter or dilator muscles to isolate parasympathetic or sympathetic activity during cognition, without modifying central processes. Pupil diameter was measured during the light reaction in 29 normal adults under three processing levels: No Task, during an easy task (Add 1), or a difficult task (Subtract 7). At three separate sessions, the pupil was treated with placebo, tropicamide (blocking the muscarinic sphincter receptor), or dapiprazole (blocking the adrenergic dilator receptor). With placebo, pupil diameter increased with increasing task difficulty. The light reaction was reduced only in the Subtract 7 condition. Dapiprazole (which decreased overall diameter) showed similar task-related changes in diameter and light reflex as for placebo. Following tropicamide (which increased overall diameter), there was a further increase in diameter only in the difficult task. Findings suggest two separate inhibitory components at the parasympathetic oculomotor center. Changes in baseline diameter are likely related to reticular activation. Inhibition of the light reaction in the difficult task is likely associated with cortical afferents. Sustained sympathetic activity also was present during the difficult task. Stuart R. Steinhauer, Ruth Condray, and Misha L. Pless Copyright © 2015 Stuart R. Steinhauer et al. All rights reserved. Evaluation of the Lower Punctum Parameters and Morphology Using Spectral Domain Anterior Segment Optical Coherence Tomography Thu, 21 May 2015 11:20:34 +0000 Purpose. To study features of the lower punctum in normal subjects using spectral domain anterior segment optical coherence tomography (SD AS-OCT). Methods. Observational cross-sectional study that included 147 punctae (76 subjects). Punctae were evaluated clinically for appearance, position, and size. AS-OCT was used to evaluate the punctal shape, contents, and junction with the vertical canaliculus. Inner and outer diameters as well as depth were measured. Results. 24 males and 52 females (mean age  y) were included. Lower punctum was perceived by OCT to be an area with an outer diameter (mean  μm), inner diameter (mean  μm), and depth (mean  μm). The OCT measured outer punctum diameter was significantly less than that measured clinically (: 0.000). Seven major shapes were identified. The junction with the vertical canaliculus was detectable in 44%. Fluid was detected in 34%, one of which had an air bubble; however, 63% of punctae showed no contents and 4% had debris. Conclusions. AS-OCT can be a useful tool in understanding the anatomy of the punctum and distal lacrimal system as well as tear drainage physiology. Measuring the punctum size may play a role in plugs fitting. Riham S. H. M. Allam and Rania A. Ahmed Copyright © 2015 Riham S. H. M. Allam and Rania A. Ahmed. All rights reserved. The Effect of Cataract on Eye Movement Perimetry Wed, 20 May 2015 11:24:32 +0000 Purpose. To determine how different grades of cataract affect sensitivity threshold and saccadic reaction time (SRT) in eye movement perimetry (EMP). Methods. In EMP, the visual field is tested by assessing the saccades that a subject makes towards peripheral stimuli using an eye tracker. Forty-eight cataract patients underwent pre- and postoperative EMP examination in both eyes. The subjects had to fix a central stimulus presented on the eye tracker monitor and to look at any detected peripheral stimulus upon its appearance. A multilevel mixed model was used to determine the factors that affected the sensitivity threshold and the SRT as a function of cataract grade. Results. We found no effect of cataract severity (LOCS III grades I through IV) on SRT and the sensitivity thresholds. In cataract of LOCS III grade V, however, we found an increase by 27% and 21% (), respectively, compared to the SRT and the sensitivity threshold in LOCS III grade I. Eyes that underwent cataract surgery showed no change in mean SRTs and sensitivity thresholds after surgery in LOCS III grade IV and lower. Conclusion. The present study shows that EMP can be readily used in patients with cataract with LOCS III grade IV and below. G. Thepass, J. J. M. Pel, K. A. Vermeer, O. Creten, S. R. Bryan, H. G. Lemij, and J. van der Steen Copyright © 2015 G. Thepass et al. All rights reserved. Suture Distension of Schlemm’s Canal in Canaloplasty: An Anterior Segment Imaging Study Tue, 19 May 2015 13:27:02 +0000 Purpose. The object of this study was to investigate the role of the suture stent regarding its impact on reduction of intraocular pressure (IOP) in canaloplasty based on the distension of the inner wall of Schlemm’s canal. Methods. Nineteen glaucoma patients who underwent canaloplasty with successful positioning of the tensioning suture were included. The measurements were analyzed using linear mixed models, with the means adjusted to IOP, age, cup-to-disc ratio, and time of follow-up. Results. Mean follow-up time was 27.6 months (SD 10.5). Mean intraocular pressure (IOP) was 24.6 mmHg (SD 5.29), 13.8 (SD 2.65), and 14.5 (SD 0.71) before surgery, at 12 months, and at 36 months after surgery, respectively. 57.9% of patients had no medication at last evaluation. Differences and variations of measurements between the devices over a time of 12 months were not significant (p = 0.15 to 0.98). Some angles of distension associated with the suture stent inside SC were predictive for IOP reduction (p < 0.03 to < 0.001), but not for final IOP (p = 0.64 to 0.96). Conclusion. The angles of the inner wall of Schlemm’s canal generated by the suture stent were comparable between OCT and UBM and did not change significantly over time. There was a tendency towards a greater distension of Schlemm’s canal, when the difference was larger between pre- and postoperative IOP, suggesting the tensioning suture may contribute to IOP reduction. Livia M. Brandao, Andreas Schötzau, and Matthias C. Grieshaber Copyright © 2015 Livia M. Brandao et al. All rights reserved. Biodegradable 3D-Porous Collagen Matrix (Ologen) Compared with Mitomycin C for Treatment of Primary Open-Angle Glaucoma: Results at 5 Years Tue, 19 May 2015 13:11:14 +0000 Purpose. To evaluate the effectiveness and safety of the Ologen as an aid for trabeculectomy performed for primary open-angle glaucoma compared with mitomycin C. Methods. In this prospective, randomized, parallel assignment, comparative study, 31 eyes of 21 primary open-angle glaucoma patients were allocated for trabeculectomy with the Ologen implant; another 32 eyes of 23 patients were treated with trabeculectomy augmented with mitomycin C. The patients were followed up for 5 years and evaluated for intraocular pressure, rate of success, status of the bleb, and adverse events. Result. The mean postoperative intraocular pressure was statistically different at 3 m, 6 m, 1 y, 3 y, and 5 y follow-up. The rates of both complete success and overall success in the Ologen group were significantly higher than those in the mitomycin C group. The difference of the bleb extent and vascularity was statistically significant in both groups. There was no significant difference in postoperative complication. Conclusions. Ologen provides higher rates of surgical success compared with mitomycin C for patients with primary open-angle glaucoma undergoing trabeculectomy. It may be a new, safe, simple, and effective therapeutic approach for treating primary open-angle glaucoma. Fei Yuan, Lei Li, Xiuping Chen, Xiang Yan, and Liyang Wang Copyright © 2015 Fei Yuan et al. All rights reserved. Uveitis in the Aging Eye: Incidence, Patterns, and Differential Diagnosis Mon, 18 May 2015 07:09:04 +0000 Uveitis is a vision threatening inflammation of the eye that carries considerable morbidity. It is responsible for 10% of legal blindness in the United States and up to 25% in the developing world. Uveitis in patients more than 60 years of age is less common. The aging body has a changing response of the immune system, which might reflect a different pattern of uveitis in the elderly population. In this paper we review the incidence and patterns of uveitis in the elderly as reported in the literature and discuss changes with time. We also delineate a thorough differential diagnosis of de novo uveitis in the elderly. Marwan R. Abdulaal, Bachir H. Abiad, and Rola N. Hamam Copyright © 2015 Marwan R. Abdulaal et al. All rights reserved. Evidence for the Role of Blue Light in the Development of Uveal Melanoma Sun, 17 May 2015 08:57:42 +0000 Uveal melanoma is the most common malignancy of the adult eye. Although it is a relatively infrequent tumor, clinical prognosis is often poor owing to a high incidence of aggressive metastatic disease, for which there are limited treatment options. Little is known about the etiology of this condition, although several risk factors have been identified. Unlike cutaneous melanoma, however, ultraviolet radiation does not figure prominently among these risk factors. In this review, we focus on an associated form of visible electromagnetic radiation, high-energy short-wave (blue) light, a causative agent in various forms of age-related retina damage, as a previously overlooked risk factor in uveal melanoma development and progression. Finally, we discuss the impact of these data on contemporary ocular therapy, particularly the debate surrounding the filtering capabilities of intraocular lenses used to replace dysfunctional crystalline lenses during cataract surgery. Patrick Logan, Miguel Bernabeu, Alberto Ferreira, and Miguel N. Burnier Jr. Copyright © 2015 Patrick Logan et al. All rights reserved. Choroidal Thickness Analysis in Patients with Usher Syndrome Type 2 Using EDI OCT Sun, 17 May 2015 06:43:45 +0000 To portray Usher Syndrome type 2, analyzing choroidal thickness and comparing data reported in published literature on RP and healthy subjects. Methods. 20 eyes of 10 patients with clinical signs and genetic diagnosis of Usher Syndrome type 2. Each patient underwent a complete ophthalmologic examination including Best Corrected Visual Acuity (BCVA), intraocular pressure (IOP), axial length (AL), automated visual field (VF), and EDI OCT. Both retinal and choroidal measures were measured. Statistical analysis was performed to correlate choroidal thickness with age, BCVA, IOP, AL, VF, and RT. Comparison with data about healthy people and nonsyndromic RP patients was performed. Results. Mean subfoveal choroidal thickness (SFCT) was microns. SFCT was statistically significant correlated with age (correlation coefficient −0.7248179, ). No statistically significant correlation was found between SFCT and BCVA, IOP, AL, VF, and RT. SFCT was reduced if compared to healthy subjects (). No difference was found when compared to choroidal thickness from nonsyndromic RP patients (). Conclusions. Our study demonstrated in vivo choroidal thickness reduction in patients with Usher Syndrome type 2. These data are important for the comprehension of mechanisms of disease and for the evaluation of therapeutic approaches. L. Colombo, B. Sala, G. Montesano, C. Pierrottet, S. De Cillà, P. Maltese, M. Bertelli, and L. Rossetti Copyright © 2015 L. Colombo et al. All rights reserved. Training of Resident Ophthalmologists in Cataract Surgery: A Comparative Study of Two Approaches Thu, 14 May 2015 09:11:50 +0000 Purpose. To evaluate and compare the efficacy of two different training methods in resident-performed phacoemulsification surgery. Methods. 502 eyes of 467 patients who underwent resident-performed phacoemulsification were included in the study by reviewing their medical records. Residents were allocated into two groups according to the method applied during their training in cataract surgery; Group A included residents that were trained with the “step-by-step” method and Group B those trained with the “one-step” method. Primary outcome was the incidence of main complications, defined as posterior capsular ruptures and/or zonular dehiscence with vitreous loss. Results. Each resident performed a median of 63 phacoemulsification surgeries. A statistically significant difference () was noted in the main complications rate between the two groups, yielding a mean of 17.3% in Group A and 7.25% in Group B. Other intraoperative complications were not shown to differ statistically significantly between study groups (). Among the first 40 surgeries of each resident, main complications rate differed also statistically significantly () between Group A (21.67%) and Group B (8.5%), while a better surgical performance-yielding statistical significance in Group A () was indicated in both groups between the 20th and the 30th procedure. Conclusions. Training in cataract surgery using the “one-step” method may lead to an improvement in surgical competency, when measured by complications rates and, therefore, to significantly better quality of training for resident ophthalmologists. Argyrios Tzamalis, Lampros Lamprogiannis, Nikolaos Chalvatzis, Chrysanthos Symeonidis, Stavros Dimitrakos, and Ioannis Tsinopoulos Copyright © 2015 Argyrios Tzamalis et al. All rights reserved. Multivariate Analysis of the Ocular Response Analyzer’s Corneal Deformation Response Curve for Early Keratoconus Detection Thu, 14 May 2015 08:27:41 +0000 Purpose. To thoroughly analyze corneal deformation responses curves obtained by Ocular Response Analyzer (ORA) testing in order to improve subclinical keratoconus detection. Methods. Observational case series of 87 control and 73 subclinical keratoconus eyes. Examination included corneal topography, tomography, and biomechanical testing with ORA. Factor analysis, logistic regression, and receiver operating characteristic curves were used to extract combinations of 45 corneal waveform descriptors. Main outcome measures were corneal-thickness-corrected corneal resistance factor (ccCRF), combinations of corneal descriptors, and their diagnostic performance. Results. Thirty-seven descriptors differed significantly in means between groups, and among them ccCRF afforded the highest individual diagnostic performance. Factor analysis identified first- and second-peak related descriptors as the most variable one. However, conventional biomechanical descriptors corneal resistance factor and hysteresis differed the most between control and keratoconic eyes. A combination of three factors including several corneal descriptors did not show better diagnostic performance than a combination of conventional indices. Conclusion. Multivariate analysis of ORA signals did not surpass simpler models in subclinical keratoconus detection, and there is considerable overlap between normal and ectatic eyes irrespective of the analysis model. Conventional biomechanical indices seem to already provide the best performance when appropriately considered. Jonatán D. Galletti, Pablo R. Ruiseñor Vázquez, Fernando Fuentes Bonthoux, Tomás Pförtner, and Jeremías G. Galletti Copyright © 2015 Jonatán D. Galletti et al. All rights reserved. Novel GUCY2D Gene Mutations in Japanese Male Twins with Leber Congenital Amaurosis Wed, 13 May 2015 09:13:14 +0000 Purpose. Leber congenital amaurosis (LCA), a genetically and clinically heterogeneous disease, is the earliest onset retinitis pigmentosa (RP) and is the most severe of hereditary retinal dystrophies. This study was conducted to investigate genetic and clinical features of LCA in a set of Japanese male twins with LCA. Methods. To identify causative mutations, 74 genes known to cause RP or LCA were examined by targeted-next generation sequencing (NGS). Targeted-NGS was performed using a custom designed Agilent HaloPlex target enrichment kit with Illumina Miseq sequencer. Identified potential pathogenic mutations were confirmed using Sanger sequencing. Clinical analyses were based on ophthalmic examination, fundus photography, and electroretinography (ERG). Results. Compound heterozygous GUCY2D mutations of novel splicing mutation c.2113+2_2113+3insT and novel missense mutation p.L905P were detected in both twins. Their father and mother were heterozygous for c.2113+2_2113+3insT and p.L905P, respectively. The twins had phenotypic features similar to those previously reported in patients with GUCY2D mutations. This included early childhood onset of visual loss, nystagmus, unrecordable ERG, photophobia, and hyperopia. Conclusions. To the best of our knowledge, this is the first report of genetic and clinical features of Japanese LCA twins with GUCY2D mutation, which were detected using targeted-NGS. Katsuhiro Hosono, Yuko Harada, Kentaro Kurata, Akiko Hikoya, Miho Sato, Shinsei Minoshima, and Yoshihiro Hotta Copyright © 2015 Katsuhiro Hosono et al. All rights reserved. Serum Uric Acid, Alanine Aminotransferase, Hemoglobin and Red Blood Cell Count Levels in Pseudoexfoliation Syndrome Wed, 13 May 2015 08:38:13 +0000 Purpose. The pathogenesis of pseudoexfoliation (PEX), the most common cause of secondary glaucoma, has not been clearly identified, but there is increasing evidence that points out the role of oxidative stress. The aim of this study is to evaluate some of the most commonly used blood parameters, hemoglobin (Hb), red blood cell count (RBC), alanine aminotransferase (ALT), and uric acid (UA) levels, in subjects with PEX. Materials and Methods. This study is performed in a state hospital between November 2011 and December 2012. Retrospective chart review of subjects who underwent cataract surgery was performed. Thirty-one healthy subjects with PEX and 34 healthy subjects without PEX were evaluated. Hb, RBC, ALT, and UA levels were recorded. Student’s t-test was used to compare the two groups. Results. The mean age was years in PEX group and in control group . Hb, RBC, ALT, and UA levels did not show a statistically significant difference among PEX and control groups ( for all). Conclusion. Serum levels of Hb, RBC, ALT, and UA levels were similar in subjects with and without PEX. Further studies are needed to clarify the precise role of Hb, RBC, ALT, and UA in the pathogenesis of PEX. Hüseyin Simavlı, Yasin Yücel Bucak, Mehmet Tosun, and Mesut Erdurmuş Copyright © 2015 Hüseyin Simavlı et al. All rights reserved. The Different Characteristics of Cirrus Optical Coherence Tomography between Superior Segmental Optic Hypoplasia and Normal Tension Glaucoma with Superior Retinal Nerve Fiber Defect Wed, 13 May 2015 07:06:48 +0000 Purpose. To evaluate the different characteristics in superior segmental optic hypoplasia (SSOH) and normal tension glaucoma (NTG) with superior retinal nerve fiber layer (RNFL) defect (NTG-SRD) compared to normal control using cirrus optical coherence tomography (OCT). Methods. SSOH eyes and NTG-SRD eyes were reviewed. The peripapillary RNFL (pRNFL) and ganglion cell inner plexiform layer (GCIPL) of the two groups were compared to age-matched normal controls using cirrus OCT. Results. Included in this study were 31 SSOH eyes, 33 NTG patients, and 49 healthy normal controls. Compared to normal controls, pRNFL thickness in SSOH eyes was thinner except in the inferotemporal to the temporal segment. NTG-SRD eyes had thinner pRNFL except in the nasal to inferonasal segment. Meanwhile, GCIPL thickness in SSOH eyes was thinner in the global and sectoral segment, but not in the superonasal and inferonasal sectors compared to normal controls. NTG-SRD eyes showed thinner GCIPL in all sectors compared to normal controls. In case of comparison between SSOH and NTG-SRD, superonasal sector was thinner in NTG-SRD than in SSOH (). Conclusions. The different distributions of nerve fiber layer were shown in pRNFL and GCIPL between SSOH eyes and NTG-SRD eyes. Jong Chul Han, Da Ye Choi, and Changwon Kee Copyright © 2015 Jong Chul Han et al. All rights reserved. Assessment of Macular Parameter Changes in Patients with Keratoconus Using Optical Coherence Tomography Tue, 12 May 2015 13:53:37 +0000 Keratoconus is typically diagnosed through changes at the anterior ocular surface. However, we wished to assess if macular parameter changes might also occur in these patients. We assessed posterior changes through the use of optical coherence tomography and compared to a nonkeratoconus patient group. All subjects underwent clinical examination including macular thickness measurements. The generalized estimation equation model was used to estimate the means and compare the differences in various measurements between keratoconus and nonkeratoconus patients. A total of 129 keratoconus eyes of 67 cases and 174 nonkeratoconus eyes of 87 controls were analysed. Keratoconus individuals presented with a significantly greater mean retinal thickness in the central fovea, inner, and outer macula compared to the nonkeratoconus group (). In addition, individuals presenting with the early signs of keratoconus had significantly greater inner and outer macular volume compared to the nonkeratoconus group (). This study indicates the retina appears to thicken at the fovea and macula and had increased macular volume in keratoconus individuals compared to nonkeratoconus individuals. Thus we posit that structural retinal changes exist in keratoconus eyes that are additional to those typically seen in the anterior segment. Srujana Sahebjada, Fakir M. Amirul Islam, Sanj Wickremasinghe, Mark Daniell, and Paul N. Baird Copyright © 2015 Srujana Sahebjada et al. All rights reserved. Ultrastructural Changes in Human Trabecular Meshwork Tissue after Laser Trabeculoplasty Tue, 12 May 2015 13:29:41 +0000 Purpose. To compare morphologic changes in human trabecular meshwork (TM) after selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT). Design. Laboratory evaluation of ex vivo human eye TM after laser trabeculoplasty. Methods. Corneoscleral rims from human cadaver eyes were sectioned and treated with varying powers of either SLT or ALT. Specimens were examined using light microscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Results. TEM of SLT at all powers resulted in disrupted TM cells with cracked and extracellular pigment granules. SEM of SLT samples treated at high power revealed tissue destruction with scrolling of trabecular beams. SEM of ALT-treated tissue showed increasing destruction with exposure to higher power. The presence or absence of “champagne” bubbles during SLT did not alter the histologic findings. Conclusions. SLT-treated human TM revealed disruption of TM cells with cracked, extracellular pigment granules, particularly at higher treatment powers. Tissue scrolling was noted at very high SLT energy levels. ALT-treated tissue showed significant damage to both the superficial and deeper TM tissues in a dose-dependent fashion. Further studies are needed to guide titration of treatment power to maximize the IOP-lowering effect while minimizing both energy delivered and damage to target tissues. Jeffrey R. SooHoo, Leonard K. Seibold, David A. Ammar, and Malik Y. Kahook Copyright © 2015 Jeffrey R. SooHoo et al. All rights reserved. Anterior and Posterior Corneal Astigmatism after Refractive Lenticule Extraction for Myopic Astigmatism Tue, 12 May 2015 09:22:27 +0000 Purpose. To assess the amount and the axis orientation of anterior and posterior corneal astigmatism after refractive lenticule extraction (ReLEx) for myopic astigmatism. Methods. We retrospectively examined 53 eyes of 53 consecutive patients (mean age ± standard deviation, 33.2 ± 6.5 years) undergoing ReLEx to correct myopic astigmatism (manifest cylinder = 0.5 diopters (D)). Power vector analysis was performed with anterior and posterior corneal astigmatism measured with a rotating Scheimpflug system (Pentacam HR, Oculus) and refractive astigmatism preoperatively and 3 months postoperatively. Results. Anterior corneal astigmatism was significantly decreased, measuring 1.42 ± 0.73 diopters (D) preoperatively and 1.11 ± 0.53 D postoperatively (, Wilcoxon signed-rank test). Posterior corneal astigmatism showed no significant change, falling from 0.44 ± 0.12 D preoperatively to 0.42 ± 0.13 D postoperatively (). Refractive astigmatism decreased significantly, from 0.92 ± 0.51 D preoperatively to 0.27 ± 0.44 D postoperatively (). The anterior surface showed with-the-rule astigmatism in 51 eyes (96%) preoperatively and 48 eyes (91%) postoperatively. By contrast, the posterior surface showed against-the-rule astigmatism in all eyes preoperatively and postoperatively. Conclusions. The surgical effects were largely attributed to the astigmatic correction of the anterior corneal surface. Posterior corneal astigmatism remained unchanged even after ReLEx for myopic astigmatism. Kazutaka Kamiya, Kimiya Shimizu, Mayumi Yamagishi, Akihito Igarashi, and Hidenaga Kobashi Copyright © 2015 Kazutaka Kamiya et al. All rights reserved. Patients with Fuchs Endothelial Dystrophy and Cataract Undergoing Descemet Stripping Automated Endothelial Keratoplasty and Phacoemulsification with Intraocular Lens Implant: Staged versus Combined Procedure Outcomes Tue, 12 May 2015 05:45:36 +0000 Purpose. To compare the surgical outcomes of staged and combined phacoemulsification with intraocular lens implant (phaco+IOL) and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with Fuchs’ endothelial dystrophy and cataract. Setting. Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK. Methods. Retrospective study of patients who had combined phaco+IOL and DSAEK (group 1) or phaco+IOL followed within 2 months by DSAEK (group 2). Patients who had previous eye surgery or any other ocular comorbidities were excluded. Results. There were 28 eyes in group 1 and 31 in group 2. There were no significant differences in the demographics and corneal tissue characteristics of the two groups. The endothelial disc dislocation and rebubbling rate within 1 week in group 1 was 21.42% and in group 2 was 3.2% , while the endothelial cell density at 12 months was for group 1 and for group 2 . The mean 12-month logMAR visual acuity was for group 1 and for group 2 . Conclusions. Although the combined procedure seems to be associated with a higher complication rate the final outcomes seem to be similar to both methods. Evripidis Sykakis, Fook Chang Lam, Panagiotis Georgoudis, Samer Hamada, and Damian Lake Copyright © 2015 Evripidis Sykakis et al. All rights reserved. The Correlation between Aquaporin-4 Antibody and the Visual Function of Patients with Demyelinating Optic Neuritis at Onset Mon, 11 May 2015 08:17:41 +0000 ON patients with AQP4-Ab seropositivity tend to be predominantly female and young and have worse visual acuity and more severe damage to their visual fields compared with AQP4-Ab seronegativity. Hui Yang, Wei Qiu, Xiujuan Zhao, Wei Xiao, Shaofen Lin, Yan Luo, and Lin Lu Copyright © 2015 Hui Yang et al. All rights reserved. The Effect of Rebamipide on Ocular Surface Disorders Induced by Latanoprost and Timolol in Glaucoma Patients Sun, 10 May 2015 11:50:20 +0000 Purpose. To examine the efficacy of ophthalmic rebamipide suspensions on ocular surface disorders induced by antiglaucoma eye drops. Patients and Methods. Forty eyes of 40 patients receiving latanoprost (0.005%) and timolol (0.5%) were included in this randomized prospective study. The patients were randomly divided into two groups (n = 20): the rebamipide-treated group and control group. Changes in intraocular pressure, tear film break-up time (TBUT), and corneal epithelial barrier function were evaluated at baseline, 4 weeks, and 8 weeks after rebamipide administration. Furthermore, superficial punctate keratopathy severity was evaluated by scoring the lesion area and density. Results. There was no significant difference in intraocular pressure before and after rebamipide treatment. However, corneal epithelial barrier function improved significantly 4 and 8 weeks after rebamipide treatment. TBUT was partially, but significantly, increased (P = 0.02) 8 weeks after rebamipide treatment, whereas no significant change was observed at 4 weeks. Additionally, a significant decrease in area and density of keratopathy was observed 8 weeks after rebamipide treatment but not at 4 weeks. The control group showed no significant difference compared to baseline. Conclusions. Our data suggests that rebamipide treatment may reduce the occurrence of drug-induced ocular surface disorder. Naoto Tokuda, Yasushi Kitaoka, Akiko Matsuzawa, Junsuke Miyamoto, Shinsuke Sakae, Yasunari Munemasa, and Hitoshi Takagi Copyright © 2015 Naoto Tokuda et al. All rights reserved. Retinal Nerve Fibre Layer and Macular Thicknesses in Adults with Hyperopic Anisometropic Amblyopia Thu, 07 May 2015 09:29:50 +0000 Objectives. This study compared the macular and retinal nerve fibre layer (RNFL) thicknesses and optic nerves of eyes with reduced vision due to anisometropia with the contralateral healthy eyes in adults using optical coherence tomography (OCT). Methods. This cross-sectional study was conducted in Atatürk State Hospital, Sinop, Turkey. Macular and RNFL thicknesses, optic nerve disc area, cup area, and horizontal and vertical cup-to-disc ratios obtained using a NIDEK RS-3000 SLO spectral domain OCT device were compared between the amblyopic and fellow eyes in 30 adults with anisometropic amblyopia 18–55 years old who were seen in our clinic with unilateral poor vision. Results. The mean macular thickness was 266.90 ± 23.22 µm in the amblyopic eyes and 263.90 ± 22.84 µm in the fellow eyes, and the mean RNFL thickness was 111.90 ± 12.9 and 109.70 ± 9.42 µm, respectively. The two thicknesses did not differ significantly between the amblyopic and fellow eyes. There were also no significant differences between the eyes in disc area, cup area, and horizontal-vertical cup/disc ratios. Conclusion. There does not seem to be a difference in macular thickness, peripapillary RNFL, or optic disc structures between the amblyopic and fellow eyes in adults. Konuralp Yakar, Emrah Kan, Aydın Alan, Mehmet Hanifi Alp, and Tolga Ceylan Copyright © 2015 Konuralp Yakar et al. All rights reserved. Effects of Lamellar Keratectomy and Intrastromal Injection of 0.2% Fluconazole on Fungal Keratitis Thu, 07 May 2015 09:12:15 +0000 Purpose. To evaluate effects of lamellar keratectomy and intrastromal injection of 0.2% fluconazole (LKIIF) on fungal keratitis. Methods. Data for 54 eyes of consecutive patients with fungal keratitis treated with LKIIF were retrospectively analyzed. The lesions in these eyes did not heal or were aggravated after antifungal chemotherapy for 7 days. The maximum lesion diameters were ≤5 mm and maximum depth was not more than half of full corneal thickness. Cases were followed up for at least 90 days. Results. Forty-six eyes were cured (85.2%). The wound healing times were 3–16 days and were less than 7 days in 28 cases (51.9%). In cured eyes, uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were both 20/250–20/20. The UCVA improved in 38 eyes and was unchanged in seven eyes. BCVA improved in 44 eyes and was unchanged in two eyes. When followed up for more than 90 days, 89% (41 of 46 eyes) showed improvement in UCVA and 11% were unchanged. Regarding BCVA, 98% improved and one eye was unchanged. No other complications were observed except neovascularization in one eye and thinner corneas. Conclusions. LKIIF was quick and effective for small fungal keratitis confined to half of the corneal thickness. Xinying You, Jun Li, Suxia Li, and Weiyun Shi Copyright © 2015 Xinying You et al. All rights reserved. Perceived Pain during Cataract Surgery with Topical Anesthesia: A Comparison between First-Eye and Second-Eye Surgery Mon, 04 May 2015 06:35:55 +0000 Purpose. To compare pain scores between first-eye and second-eye cataract surgery and to determine the affecting factors. Methods. 106 first-eye and 53 second-eye cataract surgery patients (mean age: 67 ± 13 and 69 ± 10 years, resp.) were enrolled. The patients completed simplified State-Trait Anxiety Inventory and visual analog scale (VAS) for anxiety questionnaires before surgery, and VAS for pain and Wong-Baker Faces Pain Rating Scale questionnaires after surgery. Blood pressure (BP) and heart rate (HR) were recorded perioperatively. Results. A greater proportion of patients who underwent second-eye surgery reported intraoperative pain compared with first-eye surgery patients (85% versus 35%, ). The pain scores were higher in second-eye surgery, while the VAS anxiety score was lower in second-eye surgery. Moreover, 31 patients reported greater pain during second-eye surgery than their first one, with higher pain scores than other 22 patients ( and 0.003, resp.). The VAS pain score of these 31 patients was positively correlated with the differences between the intraoperative and postoperative diastolic BP, mean arterial pressure, and HR. Conclusions. Cataract patients were likely to have more pain during second-eye surgery, which may be related to lower preoperative anxiety. Monitoring perioperative BP and HR may help to identify patients with intraoperative pain. Lin Jiang, Keke Zhang, Wenwen He, Xiangjia Zhu, Peng Zhou, and Yi Lu Copyright © 2015 Lin Jiang et al. All rights reserved. Dye-Free Porcine Model of Experimental Branch Retinal Vein Occlusion: A Suitable Approach for Retinal Proteomics Sun, 03 May 2015 13:00:52 +0000 Branch retinal vein occlusion induces complex biological processes in the retina that are generated by a multitude of interacting proteins. These proteins and their posttranslational modifications can effectively be studied using modern proteomic techniques. However, no method for studying large-scale protein changes following branch retinal vein occlusion has been available until now. Obtainment of retinal tissue exposed to branch retinal vein occlusion is only available through experimental animal models. Traditional models of experimental branch retinal vein occlusion require the use of Rose Bengal dye combined with argon laser photocoagulation. The use of Rose Bengal dye is problematic in proteomic studies as the dye can induce multiple protein modifications when irradiated. This paper presents a novel technique for proteomic analysis of porcine retinal tissue with branch retinal vein occlusion combining a dye-free experimental model with label-free liquid chromatography mass spectrometry based proteomics. Lasse Jørgensen Cehofski, Anders Kruse, Benedict Kjærgaard, Allan Stensballe, Bent Honoré, and Henrik Vorum Copyright © 2015 Lasse Jørgensen Cehofski et al. All rights reserved. Elevated Neutrophil Lymphocyte Ratio in Recurrent Optic Neuritis Tue, 28 Apr 2015 13:06:49 +0000 Purpose. To demonstrate the relation between optic neuritis (ON) and systemic inflammation markers as neutrophil lymphocyte ratio (N/L ratio), platelet count, mean platelet volume (MPV), and red cell distribution width (RDW) and furthermore to evaluate the utilization of these markers to predict the frequency of the ON episodes. Methods. Forty-two patients with acute ON and forty healthy subjects were enrolled into the study. The medical records were reviewed for age, sex, hemoglobin (Hb), Haematocrit (Htc), RDW, platelet count, MPV, white blood cell count (WBC), neutrophil and lymphocyte count, and neutrophil lymphocyte ratio (N/L ratio). Results. The mean N/L ratio, platelet counts, and RDW were significantly higher in ON group (, , and ). There was a significant relation between N/L ratio and number of episodes (, ). There was a statistically significant difference for MPV between one episode group and recurrent ON group (). Conclusions. Simple and inexpensive laboratory methods could help us show systemic inflammation and monitor ON patients. Higher N/L ratio can be a useful marker for predicting recurrent attacks. Hande Guclu, Sadık Altan Ozal, Vuslat Pelitli Gurlu, and Ramazan Birgul Copyright © 2015 Hande Guclu et al. All rights reserved. Corneal Epithelial Remodeling after LASIK Measured by Fourier-Domain Optical Coherence Tomography Tue, 28 Apr 2015 09:38:27 +0000 Purpose. To quantify corneal epithelial thickness changes after myopic LASIK by OCT. Methods. Epithelial thickness before and after myopic LASIK were measured by a Fourier-domain OCT system. Average central (within 1 mm diameter) and paracentral epithelial thickness (5~6 mm diameter) before and after LASIK were compared. Correlation between central epithelial thickness change and laser spherical equivalent setting was evaluated. An epithelial smoothing constant was estimated based on a mathematical model published previously. Results. Nineteen eyes from 11 subjects were included in the study. Eyes had myopic LASIK ranging from −1.69 D to −6.75 D spherical equivalent. The average central epithelial thickness was 52.6 ± 4.1 μm before LASIK and 56.2 ± 4.3 μm 3 months after LASIK (). The average paracentral epithelial thickness was 51.6 ± 6.6 μm before LASIK and 54.8 ± 4.3 μm 3 months after LASIK (). The change in average central epithelial thickness was correlated with laser spherical equivalent (R2 = 0.40, ). The epithelial smoothing constant was estimated to be 0.46 mm. Conclusions. Corneal epithelial thickens centrally and paracentrally after myopic LASIK. The extent of epithelial remodeling correlated with the amount of LASIK correction and could be predicted by a mathematical model. Maolong Tang, Yan Li, and David Huang Copyright © 2015 Maolong Tang et al. All rights reserved. Evaluation of Optical Low Coherence Reflectometry Parameters in Patients with Exfoliation Syndrome Tue, 28 Apr 2015 06:55:40 +0000 Purpose. To evaluate optical low coherence reflectometry (OLCR) parameters in patients with exfoliation syndrome (EXS) undergoing cataract surgery. Methods. Forty-seven eyes of 47 patients with EXS (Group 1), and 55 eyes of 55 healthy subjects (Group 2) were included in the study. Anterior chamber depth (ACD), lens thickness (LT), axial length (AL), central corneal thickness (CCT), horizontal corneal length (HCL), and pupil diameter (PD) parameters were measured by OLCR (Lenstar LS 900, Haag-Streit) and compared between groups. Shapiro-Wilk test and Mann Whitney U tests were used for statistical analyses. Results. The mean ACD, HCL, and PD values were significantly lower in EXS group than in healthy subjects (P = 0.01, P = 0.04, and , resp.). The mean LT was significantly higher in EXS group than in healthy subjects (P = 0.007). There was no significant difference between groups in means of AXL and CCT. Conclusions. According to OLCR measures, eyes with EXS have shallower ACD, smaller PD, thicker LT, shorter HCL, and no significantly different CCT levels. Emrullah Beyazyıldız, Özlem Beyazyıldız, Süleyman Günaydın, Emrah Kan, Mert Şimşek, Pelin Yılmazbaş, and Faruk Öztürk Copyright © 2015 Emrullah Beyazyıldız et al. All rights reserved. Predictors of HIV/AIDS Related Ocular Manifestations among HIV/AIDS Patients in Felege Hiwot Referral Hospital, Northwest Ethiopia Mon, 27 Apr 2015 09:49:17 +0000 Background. Ocular manifestations in people living with HIV/AIDS are varied and affect almost all the structures of eye leading to visual impairment or blindness. Therefore, the aim of this study was to identify the predictors of HIV related ocular manifestation among ART clinic clients. Methods. Institution based cross-sectional study was employed among ART clients at Felege Hiwot referral hospital, northwest Ethiopia. The study was conducted from 1 January 2013 to 30 January 2013. A total of 369 systematically and randomly selected clients were included in the study. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 16.0. Binary and multivariable logistic regression analyses were computed to identify independent predictors of HIV related ocular manifestation. Results. Twenty-five percent (25.7%) of HIV patients had ocular manifestations. The three most frequent signs were Squamoid Conjuctival growth (26.9%), ophthalmic herpes zoster (22.1%), and Bacterial Conjuctivitis (17.2%). History of eye problem, CD4 count, and visual acuity of the eye were the predictors of HIV related ocular manifestation. Conclusion. In this study, a higher proportion of ocular manifestations were detected in HIV/AIDS patients. Visual acuity and CD4 counts were the independent predictors of ocular manifestations. This finding gives an insight for policy makers and concerned body to integrate ophthalmic examination in ART clinics to improve the health condition of HIV/ADIS patients. Guadie Sharew and Muluken Azage Copyright © 2015 Guadie Sharew and Muluken Azage. All rights reserved.