Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Size of the Optic Nerve Head and Its Relationship with the Thickness of the Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer in Patients with Primary Open Angle Glaucoma Mon, 03 Aug 2015 16:24:51 +0000 Purpose. To evaluate the relationships among the optic nerve head (ONH) area, macular ganglion cell complex (mGCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and visual field defects in patients with primary open angle glaucoma (POAG). Methods. This retrospective study included 90 eyes of 90 patients with POAG. The ONH area, rim area, mGCC thickness, and cpRNFL thickness were measured using optical coherence tomography. Mean deviation (MD) was measured using standard automated perimetry. The relationships among clinical factors including age, refraction, the ONH area, the rim area, the mGCC thickness, the cpRNFL thickness, and MD were evaluated using correlation coefficients and multiple regression analyses. Results. The significant correlation of the ONH area with refraction (, ), the mGCC thickness (, ), and the cpRNFL thickness (, ) was found. Multiple regression analysis showed that the ONH area, rim area, and MD were selected as significant contributing factors to explain the mGCC thickness and cpRNFL thickness. No factor was selected to explain MD. Conclusions. The ONH area, in other words, the disc size itself may affect the mGCC thickness and cpRNFL thickness in POAG patients. Nobuko Enomoto, Ayako Anraku, Kyoko Ishida, Asuka Takeyama, Fumihiko Yagi, and Goji Tomita Copyright © 2015 Nobuko Enomoto et al. All rights reserved. Systematic Review of Randomized Clinical Trials on Safety and Efficacy of Pharmacological and Nonpharmacological Treatments for Retinitis Pigmentosa Mon, 03 Aug 2015 09:37:55 +0000 Aims. Several treatments have been proposed to slow down progression of Retinitis pigmentosa (RP), a hereditary retinal degenerative condition leading to severe visual impairment. The aim of this study is to systematically review data from randomized clinical trials (RCTs) evaluating safety and efficacy of medical interventions for the treatment of RP. Methods. Randomized clinical trials on medical treatments for syndromic and nonsyndromic RP published up to December 2014 were included in the review. Visual acuity, visual field, electroretinogram, and adverse events were used as outcome measures. Results. The 19 RCTs included in this systematic review included trials on hyperbaric oxygen delivery, topical brimonidine tartrate, vitamins, docosahexaenoic acid, gangliosides, lutein, oral nilvadipine, ciliary neurotrophic factor, and valproic acid. All treatments proved safe but did not show significant benefit on visual function. Long term supplementation with vitamin A showed a significantly slower decline rate in electroretinogram amplitude. Conclusions. Although all medical treatments for RP appear safe, evidence emerging from RCTs is limited since they do not present comparable results suitable for quantitative statistical analysis. The limited number of RCTs, the poor clinical results, and the heterogeneity among studies negatively influence the strength of recommendations for the long term management of RP patients. Marta Sacchetti, Flavio Mantelli, Daniela Merlo, and Alessandro Lambiase Copyright © 2015 Marta Sacchetti et al. All rights reserved. Spectral-Domain Optical Coherence Tomography of Preclinical Chloroquine Maculopathy in Egyptian Rheumatoid Arthritis Patients Sun, 02 Aug 2015 13:46:43 +0000 Purpose. To evaluate the role of spectral-domain optical coherence tomography (SD-OCT) in early detection of Chloroquine maculopathy in rheumatoid arthritis (RA) patients. Methods. 40 left eyes of 40 female rheumatoid arthritis patients who received treatment chloroquine for more than one year were recruited in the study. All patients had no symptoms or signs of Chloroquine retinopathy. They were evaluated using SD-OCT, where the Central Foveal Thickness (CFT), parafoveal thickness and perifoveal thickness, average Retinal Nerve Fiber Layer (RNFL) thickness, and Ganglion Cell Complex (GCC) measurements were measured and compared to 40 left eyes of 40 normal females. Results. The mean CFT was found to be thinner in the Chloroquine group (238.15 µm ± 22.49) than the normal controls (248.2 µm ± 19.04), which was statistically significant ( value = 0.034). The mean parafoveal thickness was lesser in the Chloroquine group than the control group in all quadrants ( value ). The perifoveal thickness in both groups showed no statistically significant difference ( value ) in all quadrants. No significant difference was detected between the two groups regarding RNFL, GCC, or IS/OS junction. Conclusions. Preclinical Chloroquine toxicity can lead to early thinning in the central fovea as well as the parafoveal regions that is detected by SD-OCT. Riham S. H. M. Allam, Mai N. Abd-Elmohsen, Mohamed M. Khafagy, Karim A. Raafat, and Sherif M. Sheta Copyright © 2015 Riham S. H. M. Allam et al. All rights reserved. Correlation between Retinal Changes and Visual Function in Late-Stage Vogt-Koyanagi-Harada Disease: An Optical Coherence Tomography Study Sun, 02 Aug 2015 12:55:26 +0000 Purpose. To characterize the optical coherence tomography (OCT) findings in late-stage Vogt-Koyanagi-Harada (VKH) disease and its correlation with visual function. Methods. The records of patients with late-stage VKH disease (defined as ≥12 months from disease onset) were retrospectively reviewed. The analysis focused on the OCT findings and microperimetry, in addition to the possible correlation between morphology and functional findings. Results. Twenty-nine patients (58 eyes) were included. Mean age at onset was 34.24 ± 10.67 years. The OCT revealed that the outer retina and retinal pigment epithelium (RPE) were mainly affected. These effects included RPE thickening and breakage or disappearance of the cone outer segment tip (COST) line and/or inner segment/outer segment (IS/OS) junction. The COST line and IS/OS results were related to macular function and the interval between symptom onset and initiation of high-dose corticosteroid treatment (all ). Eyes with intact COST lines demonstrated intact IS/OS and normal RPE layers as well as better visual function and normal retinal sensitivity. Conclusions. The OCT findings are strongly correlated with macular function, as well as other clinical findings in late-stage VKH. With respect to the COST line and retinal sensitivity especially, the OCT and microperimetry findings may be useful for evaluating later-stage VKH. Min Zhou, Chunhui Jiang, Ruiping Gu, Zhongcui Sun, Nancy Huynh, and Qing Chang Copyright © 2015 Min Zhou et al. All rights reserved. Clinical Outcomes after Binocular Implantation of a New Trifocal Diffractive Intraocular Lens Sun, 02 Aug 2015 09:01:52 +0000 Purpose. To evaluate visual, refractive, and contrast sensitivity outcomes, as well as the incidence of pseudophakic photic phenomena and patient satisfaction after bilateral diffractive trifocal intraocular lens (IOL) implantation. Methods. This prospective nonrandomized study included consecutive patients undergoing cataract surgery with bilateral implantation of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec). Distance, intermediate, and near visual outcomes were evaluated as well as the defocus curve and the refractive outcomes 3 months after surgery. Photopic and mesopic contrast sensitivity, patient satisfaction, and halo perception were also evaluated. Results. Seventy-six eyes of 38 patients were included; 90% of eyes showed a spherical equivalent within ±0.50 diopters 3 months after surgery. All patients had a binocular uncorrected distance visual acuity of 0.00 LogMAR or better and a binocular uncorrected intermediate visual acuity of 0.10 LogMAR or better, 3 months after surgery. Furthermore, 85% of patients achieved a binocular uncorrected near visual acuity of 0.10 LogMAR or better. Conclusions. Trifocal diffractive IOL implantation seems to provide an effective restoration of visual function for far, intermediate, and near distances, providing high levels of visual quality and patient satisfaction. Florian T. A. Kretz, Detlev Breyer, Vasilios F. Diakonis, Karsten Klabe, Franziska Henke, Gerd U. Auffarth, and Hakan Kaymak Copyright © 2015 Florian T. A. Kretz et al. All rights reserved. Consensus on Severity for Ocular Emergency: The BAsic SEverity Score for Common OculaR Emergencies [BaSe SCOrE] Thu, 30 Jul 2015 17:07:02 +0000 Purpose. To weigh ocular emergency events according to their severity. Methods. A group of ophthalmologists and researchers rated the severity of 86 common ocular emergencies using a Delphi consensus method. The ratings were attributed on a 7-point scale throughout a first-round survey. Then, the experts were provided with the median and quartiles of the ratings of each item to reevaluate the severity levels being aware of the group’s first-round responses. The final severity rating for each item corresponded to the median rating provided by the last Delphi round. Results. We invited 398 experts, and 80 (20%) of them, from 18 different countries, agreed to participate. A consensus was reached in the second round, completed by 24 experts (43%). The severity ranged from subconjunctival hemorrhages (median = 1, Q1 = 0; Q3 = 1) to penetrating eye injuries collapsing the eyeball with intraocular foreign body or panophthalmitis with infection following surgery (median = 5, Q1 = 5; Q3 = 6). The ratings did not differ according to the practice of the experts. Conclusion. These ratings could be used to assess the severity of ocular emergency events, to serve in composite algorithms for emergency triage and standardizing research in ocular emergencies. Jean-Louis Bourges, Isabelle Boutron, Dominique Monnet, and Antoine P. Brézin Copyright © 2015 Jean-Louis Bourges et al. All rights reserved. Ranibizumab for Visual Impairment due to Diabetic Macular Edema: Real-World Evidence in the Italian Population (PRIDE Study) Wed, 29 Jul 2015 14:51:46 +0000 Purpose. An expanded access program (PRIDE study) in Italy to provide ranibizumab 0.5 mg to diabetic macular edema (DME) patients, prior to reimbursement. Methods. Open-label, prospective, phase IIIb study. Majority of patients were not treatment-naïve before enrollment. Patients received ranibizumab as per the EU label (2011). Safety was assessed by incidences of ocular/systemic adverse events (AEs) and serious AEs (SAEs) and efficacy in terms of visual acuity (VA) change from baseline (decimal score or Snellen (20/value)). Results. Overall, 515 patients (83.5%) completed the study. In unilateral/bilateral patients, commonly observed AEs were cardiac disorders (1.3%/1.3%) and nervous system disorders (1.3%/1.1%); SAEs were reported in 4.5%/4.8% of patients. Acute renal failure, lung carcinoma, and cardiac arrest were the causes of death in one unilateral and two bilateral patients. Ranibizumab improved/maintained VA (Snellen (20/value)/decimal scores) in both unilateral (up to −16.7/1.5) and bilateral patients (up to −23.6/1.2) at Month 5, with a mean of 4.15 and 4.40 injections, respectively. Overall, no difference was observed in the VA outcomes and treatment exposure between unilateral/bilateral patients. Conclusions. The PRIDE study provided early ranibizumab access to >600 Italian patients. Ranibizumab was well-tolerated and improved/maintained VA in 40.2%–68.8% patients, with no differences in case of unilateral or bilateral pathology. The study is registered with EudraCT. Ugo Menchini, Francesco Bandello, Vincenzo De Angelis, Federico Ricci, Luigi Bonavia, Francesco Viola, Elisa Muscianisi, and Massimo Nicolò Copyright © 2015 Ugo Menchini et al. All rights reserved. Scleral Fixation of Posteriorly Dislocated Intraocular Lenses by 23-Gauge Vitrectomy without Anterior Segment Approach Wed, 29 Jul 2015 07:02:32 +0000 Background. To evaluate visual outcomes, corneal changes, intraocular lens (IOL) stability, and complications after repositioning posteriorly dislocated IOLs and sulcus fixation with polyester sutures. Design. Prospective consecutive case series. Setting. Institut Universitari Barraquer. Participants. 25 eyes of 25 patients with posteriorly dislocated IOL. Methods. The patients underwent 23-gauge vitrectomy via the sulcus to rescue dislocated IOLs and fix them to the scleral wall with a previously looped nonabsorbable polyester suture. Main Outcome Measures. Best corrected visual acuity (BCVA) LogMAR, corneal astigmatism, endothelial cell count, IOL stability, and postoperative complications. Results. Mean follow-up time was 18.8 ± 10.9 months. Mean surgery time was 33 ± 2 minutes. Mean BCVA improved from 0.30 ± 0.48 before surgery to 0.18 ± 0.60 at 1 month, which persisted to 12 months (0.18 ± 0.60). Neither corneal astigmatism nor endothelial cell count showed alterations 1 year after surgery. Complications included IOL subluxation in 1 eye (4%), vitreous hemorrhage in 2 eyes (8%), transient hypotony in 2 eyes (8%), and cystic macular edema in 1 eye (4%). No patients presented retinal detachment. Conclusion. This surgical technique proved successful in the management of dislocated IOL. Functional results were good and the complications were easily resolved. Jeroni Nadal, Bachar Kudsieh, and Ricardo P. Casaroli-Marano Copyright © 2015 Jeroni Nadal et al. All rights reserved. Comparison of Measurement of Central Corneal Thickness with Spectral Domain Optical Coherence Tomography and Standard Ultrasonic Pachymeter in Premature Infants Wed, 22 Jul 2015 06:42:54 +0000 Purpose. To evaluate the repeatability of measurement of central corneal thickness (CCT) by spectral domain optical coherence (SD-OCT) in premature infants and compare it to CCT measurement by ultrasonic pachymetry (USP). Methods. Three CCT measurements of the left eyes of 50 premature infants were obtained by SD-OCT using the iVue system. 10 CCT measurements of each 28 left eyes of 28 infants were obtained by USP using the Pacscan 300P system. Bland-Altman plots were developed and the limit of agreement (LoA) was determined to compare the mean of the SD-OCT and USP measurements. Results. No statistically significant difference was found among the 3 CCT measurements by SD-OCT. Both USP and SD-OCT have been performed for only left eyes of 28 of the 50 babies. Those results have been compared with each other. A statistically significant difference was found between the mean CCT measurements by SD-OCT and USP (). The LoA between the SD-OCT and USP measurements ranged from 11.4 to −64.1. Conclusions. CCT can be measured using the iVue SD-OCT system with a high level of repeatability. Although measurement of CCT by SD-OCT and USP is highly correlated, the 2 systems cannot be used interchangeably in premature infants. Emre Hekimoglu, Muhammet Kazım Erol, Devrim Toslak, Deniz Turgut Coban, Berna Doğan, and Ozgur Yucel Copyright © 2015 Emre Hekimoglu et al. All rights reserved. The Fundus Autofluorescence Spectrum of Punctate Inner Choroidopathy Wed, 22 Jul 2015 06:37:32 +0000 Purpose. To investigate the fundus autofluorescence (FAF) spectrum of punctate inner choroidopathy (PIC). Methods. This is a retrospective observational case series of 27 consecutive patients with PIC admitted from October 2013 to March 2015, who underwent short-wavelength- (SW-) and near-infrared- (NIR-) FAF imaging, spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA). Results. There were three primary findings on the FAF imaging of patients with PIC. First, active PIC lesions revealed hypoautofluorescent spots with hyperautofluorescent margin. After the lesions regressed, the hyperautoflurescent margin faded. Second, subclinical and most of the atrophic PIC lesions appeared to be hypoautofluorescent spots. But subclinical PIC lesions were more distinctive on NIR-FAF imaging than on SW-FAF imaging. Third, hypoautofluorescent spots of PIC lesions coexisted with hyperautofluorescent patches on SW-FAF imaging. These hyperautofluorescent patches were demonstrated to be multiple evanescent white dot syndrome (MEWDS) or acute zonal occult outer retinopathy (AZOOR) lesions by subsequent multimodal imaging and faded during follow-up examinations. Conclusion. FAF imaging helps in noninvasively tracking the evolution of PIC lesions and identifying the combined MEWDS or AZOOR lesions, complementary to SD-OCT and angiographic studies. Miaoling Li, Xiongze Zhang, and Feng Wen Copyright © 2015 Miaoling Li et al. All rights reserved. Short-Term Intraocular Pressure Elevations after Combined Phacoemulsification and Implantation of Two Trabecular Micro-Bypass Stents: Prednisolone versus Loteprednol Tue, 21 Jul 2015 09:10:01 +0000 Objective. To compare the effects of prednisolone and of loteprednol after combined phacoemulsification and trabecular micro-bypass stent implantation (phaco-iStent). Methods. Patients who underwent phaco-iStent between April 2013 and November 2014 were identified by retrospective chart review. Postoperatively, they received either prednisolone () or loteprednol (). Baseline data was compared. Primary outcomes including intraocular pressure (IOP) and number of glaucoma medications (NGM) were analyzed at preoperative visit, postoperative day 1, weeks 1-2, weeks 3-4, and months 2-3. Results. Both groups had similar preoperative parameters (). The mean IOP spike occurred at postoperative weeks 1-2 with an increase of 2.21 ± 7.30 mmHg in the loteprednol group and 2.54 ± 9.28 mmHg in the prednisolone group. It decreased by weeks 3-4 in both groups and continued to improve at months 2-3. NGM showed significant reduction () after the surgery and remained stable in both groups. No significant group effect or time-group interaction in IOP and NGM evolution was detected (). The proportions of patients needing paracentesis were similar between the two groups. Conclusion. Similar early IOP elevations after combined phaco-iStent occurred with both prednisolone and loteprednol. Facilitated glucocorticoid infusion, altered aqueous humor outflow, and local inflammation may be contributing factors. Qianqian Wang and Paul Harasymowycz Copyright © 2015 Qianqian Wang and Paul Harasymowycz. All rights reserved. Extraction of Iron from the Rabbit Anterior Chamber with Reverse Iontophoresis Wed, 15 Jul 2015 10:41:48 +0000 Ocular siderosis is a common eye disease caused by retention of an iron-containing intraocular foreign body in the eye. Iron-containing intraocular foreign bodies may cause severe inflammatory reaction and affect visual function. Currently the optimal treatment method of ocular siderosis is a moot point. This study used the reverse iontophoresis technique to noninvasively extract iron from the rabbit anterior chamber. By slit lamp observation and histological examination, reverse iontophoresis treatment has a good effect on ocular siderosis. Reverse iontophoresis seems to be a noninvasive and promising approach to extract iron from the anterior chamber to treat ocular siderosis. Shoubin Sun, Huijie Diao, Fali Zhao, Jianhai Bai, Yuan Zhou, Hao Cui, and Liqiong Zhang Copyright © 2015 Shoubin Sun et al. All rights reserved. Visual Electrodiagnostic Testing in Birdshot Chorioretinopathy Mon, 13 Jul 2015 12:31:23 +0000 Birdshot chorioretinopathy (BSCR) is a rare form of autoimmune posterior uveitis that can affect the visual function and, if left untreated, can lead to sight-threatening complications and loss of central vision. We performed a systematic search of the literature focused on visual electrophysiology studies, including electroretinography (ERG), electrooculography (EOG), and visual evoked potentials (VEP), used to monitor the progression of BSCR and estimate treatment efficacy. Many reports were identified, including using a variety of methodologies and patient populations, which makes a direct comparison of the results difficult, especially with some of the earlier studies using nonstandardized methodology. Several different electrophysiological parameters, like EOG Arden’s ratio and the multifocal ERG response densities, are reported to be widely affected. However, informal consensus emerged in the past decade that the full-field ERG light-adapted 30 Hz flicker peak time is one of the most sensitive electrophysiological parameters. As such, it has been used widely in clinical trials to evaluate drug safety and efficacy and to guide therapeutic decisions in clinical practice. Despite its wide use, a well-designed longitudinal multicenter study to systematically evaluate and compare different electrophysiological methods or parameters in BSCR is still lacking but would benefit both diagnostic and therapeutic decisions. Radouil Tzekov and Brian Madow Copyright © 2015 Radouil Tzekov and Brian Madow. All rights reserved. Traumatic Wound Dehiscence after Keratoplasty: Characteristics, Risk Factors, and Visual Outcome Thu, 09 Jul 2015 11:11:56 +0000 Purpose. The study aimed at evaluating the patients’ characteristics, risk factors, complications, and visual outcome of traumatic wound dehiscence after keratoplasty. Patients and Methods. A retrospective case series that included 20 eyes of 20 patients who had undergone a previous keratoplasty procedure followed by traumatic wound dehiscence. Records of the selected patients were reviewed. The mean duration of follow-up after repair was 21 months. Included patients were recalled for the final follow-up visit. Results. The procedure of corneal transplantation was penetrating (PKP) in 16 eyes and deep anterior lamellar keratoplasty (DALK) in 4 eyes. The associated anterior segment injuries included iris prolapse in 17 eyes and lens extrusion in 12 eyes. The associated posterior segment injuries included vitreous hemorrhage in 11 eyes and retinal detachment in 4 eyes. The final BSCVA was 0.1 or better in 5 cases (25 %) and was better than hand motions (HM) to less than 0.1 in 7 cases (35 %). Conclusion. Traumatic wound dehiscence following keratoplasty results in poor visual outcome. Cases following DALK may have less wound extent and better final visual outcome. The dehiscence seems most likely to occur during the first year. Mohamed Bahgat Goweida, Hany Ahmed Helaly, and Alaa Atef Ghaith Copyright © 2015 Mohamed Bahgat Goweida et al. All rights reserved. Optical Coherence Tomography Reveals New Insights into the Accommodation Mechanism Mon, 06 Jul 2015 08:41:53 +0000 Purpose. To evaluate the movement of the anterior and posterior lens poles during naturally stimulated accommodation in children using anterior segment optical coherence tomography (OCT). Methods. This is a prospective, observational, noncomparative case series including 18 eyes of nine children. Analysis of the anterior segment in the accommodated and unaccommodated state (with cycloplegia) was done using anterior segment OCT. The main outcome measures were the position of the anterior and posterior lens poles (in relation to the cornea) and lens thickness (LT). Results. A Statistically significant forward movement of the anterior lens pole and backward movement of the posterior lens pole with an increase in LT were found during accommodation (). There was no significant difference between the degree of movement of the anterior lens pole and the posterior lens pole during accommodation (). Conclusions. Anterior segment OCT provides a rapid noncontact method for studying accommodation in children. The backward movement of the posterior lens pole during accommodation nearly equals the forward movement of its anterior pole. These data minimize the theoretical hydraulic effect of the vitreous during accommodation, adding more support to the capsular theory of Helmholtz. Mahmoud Mohamed Farouk, Takeshi Naito, Kayo Shinomiya, Hiroshi Eguchi, Khulood Mohammed Sayed, Toshihiko Nagasawa, Takashi Katome, and Yoshinori Mitamura Copyright © 2015 Mahmoud Mohamed Farouk et al. 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.