Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Pilot Study on Visual Function and Fundus Autofluorescence Assessment in Diabetic Patients Wed, 10 Feb 2016 14:03:39 +0000 Purpose. Evaluate optimized fundus autofluorescence (FAF) imaging in early stages of diabetic retinopathy (DR) and relate findings with conventional colour fundus imaging and visual function in diabetic patients and control subjects. Materials and Methods. FAF and colour images were obtained using the CR-2 Plus digital nonmydriatic retinal camera in seven diabetic patients and thirteen control subjects. Visual-Functioning Questionnaire-25 (VFQ-25) and Diabetes Self-Management Questionnaire (DSMQ) were used to assess the quality of life and diabetes self-care. Contrast sensitivity function (CSF) was evaluated with the Vistech 6500 chart. Results. FAF and optimized-FAF imaging showed more retinal alterations related to DR than colour imaging. In diabetic patients, compatible signs with microaneurysms, capillary dilations, and haemorrhages were less numerous in colour imaging than optimized-FAF and FAF imaging in areas analysed. Control subjects at risk of developing DM showed more retinal pigment epithelium defects than those without risk in all retinal areas. Significant differences were not found in VFQ-25 and CSF between diabetic patients and control subjects. Conclusions. FAF and optimized-FAF imaging showed significant alterations related to DR not observed in colour imaging. FAF and optimized-FAF images could be a useful complementary tool for detecting early alterations associated with the development and progression of DR. Ana M. Calvo-Maroto, José J. Esteve-Taboada, Rafael J. Pérez-Cambrodí, David Madrid-Costa, and Alejandro Cerviño Copyright © 2016 Ana M. Calvo-Maroto et al. All rights reserved. Intravitreal Melphalan for Vitreous Seeds: Initial Experience in China Mon, 08 Feb 2016 12:08:29 +0000 Purpose. To evaluate the efficacy of intravitreal melphalan for vitreous seeds from retinoblastoma in Chinese patients. Methods. This is a retrospective review of 17 consecutive Chinese patients (19 eyes) with viable vitreous seeds from retinoblastoma. The patients received multiple intravitreal injections of 20 ug melphalan. Results. The International Classification of Retinoblastoma groups were B in 1 eye, C in 5 eyes, D in 11 eyes, and E in 2 eyes. On average, 6 injections (range: 1–15) were given to each eye at the interval of 2–4 weeks. Successful control of vitreous seeds was achieved in 16 of 19 eyes (84.21%). Globe retention was achieved in 73.68% (14/19) eyes. The patients were followed up for 27 months on average (median: 26; range: 17–42 months). There is a significant difference in response to intravitreal melphalan for cloud, spheres, and dust seeds with a median number of injections of 9, 6, and 3, respectively (). Complications related to intravitreal melphalan included vitreous hemorrhage, cataract, salt-and-pepper retinopathy, and pupil posterior synechia. There was no case of epibulbar extension or systemic metastasis within the period of follow-up. Conclusion. Intravitreal melphalan achieved a high local control rate for vitreous seeds without extraocular extension and with acceptable toxicity in Chinese retinoblastoma patients. Xunda Ji, Peiyan Hua, Jing Li, Jiakai Li, Junyang Zhao, and Peiquan Zhao Copyright © 2016 Xunda Ji et al. All rights reserved. Surgical and Functional Results of Hybrid 25-27-Gauge Vitrectomy Combined with Coaxial 2.2 mm Small Incision Cataract Surgery Thu, 04 Feb 2016 13:33:39 +0000 Purpose. To investigate outcomes after coaxial 2.2 mm small incision cataract surgery combined with hybrid 25-27-gauge vitrectomy in eyes with vitreoretinal disease and age-related cataract. Methods. A single-center, retrospective case series study of 55 subjects (55 eyes) with a mean age of 70 years who underwent combined small incision phacoemulsification, intraocular lens (IOL) implantation, and hybrid 25-27-gauge vitrectomy during the 12-month period to December 2014. Intraoperative and postoperative complications and visual results were the main outcome measures. Results. The mean follow-up period was 6 months (range: 2–18 months). Intraoperative findings were 3 retinal breaks (5.5%). No cases required corneal or scleral suture or conversion to larger-gauge vitrectomy. Postoperative complications consisted of posterior capsule opacification (12.7%), elevated intraocular pressure >30 mmHg (1.8%), and fibrin reaction (5.5%). There were no cases of hypotony (<7 mmHg), IOL decentration, or postoperative endophthalmitis. Visual acuity (mean ± SD) improved from logMAR preoperatively to logMAR at final postoperative visit (). Conclusion. Surgical and visual outcomes suggest hybrid 25-27-gauge vitrectomy combined with small incision phacoemulsification and IOL implantation is feasible, safe, and effective as a one-step surgical procedure for the management of vitreoretinal pathologies and concurrent cataract. Fabian Höhn, Florian Kretz, and Mitrofanis Pavlidis Copyright © 2016 Fabian Höhn et al. All rights reserved. Mean Platelet Volume in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy Thu, 04 Feb 2016 11:36:17 +0000 Objective. We aimed to investigate the mean platelet volume (MPV) of the patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods. The medical records of 46 patients with the diagnosis of NAION and 90 control subjects were retrospectively evaluated. All participants underwent complete ocular examination including intraocular pressure (IOP) measurement. Hematocrit, MPV, hemoglobin, and platelet levels of the patients with NAION were compared with those of control subjects. Results. There was no significant difference between the groups in platelet counts (). NAION group had significantly higher MPV values ( fL) than that of control subjects ( fL) (). Multivariate logistic regression analysis showed that MPV is an independent predictor of NAION (odds ratio = 1.61; 95% confidence interval (CI) = 1.13–2.28; ). The mean IOP was significantly higher in NAION group (). IOP was also found as an independent predictor of NAION according to the regression analysis (OR = 1.27; 95% CI = 1.08–1.48; ). Conclusion. Our results demonstrated that the MPV values were significantly higher in NAION patients, suggesting that larger platelets may contribute to the pathogenesis of the NAION. Muhammed Şahin, Alparslan Şahin, Bilal Elbey, Harun Yüksel, Fatih Mehmet Türkcü, and Abdullah Kürşat Cingü Copyright © 2016 Muhammed Şahin et al. All rights reserved. Comparison of Two Different OCT Systems: Retina Layer Segmentation and Impact on Structure-Function Analysis in Glaucoma Thu, 04 Feb 2016 09:44:53 +0000 Purpose. To compare two different spectral-domain optical coherence tomography (OCT) systems in regard to full macular thickness (MT) and ganglion cell layer-inner plexiform layer (GCIPL) measures and in regard to structure-function correlation when compared to standard automated perimetry (SAP). Methods. Seventeen primary open angle glaucoma patients and 16 controls (one eye per subject) were enrolled. MT and GCIPL thicknesses were measured by Cirrus and Spectralis OCTs. Octopus Perimeter 101 (G2 protocol) reports sensitivity in mean defect (dB). Differences between measurements were assessed with Student’s -test and Bland Altman. Diagnostic performance was also compared between each parameter calculating the areas under the operator receiver (ROC). Linear models were used to investigate structure-function association between OCT and SAP. Results. Disagreement between OCTs in both MT and GCIPL values was significant. Spectralis values were thicker than Cirrus. Average difference between OCTs was 21.64 μm (SD 4.5) for MT and 9.8 μm (SD 5.4) for GCIPL (). Patients differed significantly from controls in both OCTs, in both measurements. MT and GCIPL were negatively associated with MD (). Conclusions. Although OCT values were not interchangeable, both machines differentiated patients from controls with statistical significance. Structure-function analysis results were comparable, when either OCT was compared to SAP. Livia M. Brandao, Anna A. Ledolter, Andreas Schötzau, and Anja M. Palmowski-Wolfe Copyright © 2016 Livia M. Brandao et al. All rights reserved. Relationship between Daytime Sleepiness and Intrinsically Photosensitive Retinal Ganglion Cells in Glaucomatous Disease Wed, 03 Feb 2016 12:21:45 +0000 Patients with glaucoma showed to have higher daytime sleepiness measured by Epworth sleepiness scale. In addition, this symptom was associated with pupillary reflex and polysomnography parameters. These ipRGC functions might be impaired in patients with glaucoma, leading to worse quality of life. Carolina P. B. Gracitelli, Gloria Liliana Duque-Chica, Ana Laura de Araújo Moura, Marina Roizenblatt, Balazs V. Nagy, Geraldine Ragot de Melo, Paula Delegrego Borba, Sérgio H. Teixeira, Sergio Tufik, Dora Fix Ventura, and Augusto Paranhos Jr. Copyright © 2016 Carolina P. B. Gracitelli et al. All rights reserved. High MMP-9 Expression May Contribute to Retroprosthetic Membrane Formation after KPro Implantation in Rabbit Corneal Alkali Burn Model Mon, 01 Feb 2016 06:48:32 +0000 Purpose. To evaluate aqueous humor MMP-9 levels in alkali-burned rabbit cornea following KPr implantation and their roles in RPMs formation. Methods. Left eyes of 36 rabbits received a deep corneal alkali wound. 12 corneas were implanted with KPro and the other 24 control corneas were either penetrating keratoplasty or left without keratoplasty. Aqueous humor MMP-9 and TIMP-1 levels were determined and RPMs were obtained for histopathological and ultrastructural examination. Results. Alkali exposure induced significant increase in aqueous humor MMP-9 level and the data were further enhanced by KPro implantation. By contrast, TMIP-1 levels in aqueous humor showed a decreased trend following corneal alkali burn and KPro surgery. RPMs were developed in 5 out of 10 cases of KPro successfully implanted eyes. Histopathology showed the presence of a large number of fibroblasts and collagen fibers arranged irregularly with inflammatory cells infiltration, and an ingrowth of new blood vessels in this retrokeratoprosthesis fibrous tissue. Immunohistochemical analysis showed positive stain of RPMs for both MMP-9 and TIMP-1. Aqueous humor MMP-9 levels were significantly higher in RPM group postoperatively, while TIMP-1 levels were comparatively lower than that of No-RPM group. Conclusions. Our study evidenced the potential pathophysiological role of MMP-9 expression in RPM formation following KPro implantation. Minghong Gao, Wei Sang, Fuying Liu, Hai Yu, Runhai Zhou, Michael Wellington Belin, Peter Zloty, and Yingxin Chen Copyright © 2016 Minghong Gao et al. All rights reserved. Conjunctival Lymphangiogenesis Was Associated with the Degree of Aggression in Substantial Recurrent Pterygia Thu, 28 Jan 2016 15:42:18 +0000 Objective. To examine conjunctival lymphatic vessels and to analyze the relationship between lymphangiogenesis and aggressive recurrent pterygia. Methods. Tissues from 60 excised recurrent (including 19 of Grade 1, 28 of Grade 2, and 13 of Grade 3) pterygia were used in the study. Tissues from 9 nasal epibulbar conjunctivae segments were used as controls. Pterygium slices from each patient were immunostained with LYVE-1 monoclonal antibodies to identify lymphatic microvessels in order to calculate the lymphovascular area (LVA), the lymphatic microvessel density (LMD), and the lymphovascular luminal diameter (LVL). The relationship between lymphangiogenesis (LVA, LMD, and LVL) and pterygium aggression (width, extension, and area) was clarified. Results. Few LYVE-1 positive lymphatic vessels were found in the normal epibulbar conjunctiva segments. Lymphatic vessels were slightly increased in Grades 1 and 2 and were dramatically increased in Grade 3 recurrent pterygia. The LMD was correlated with the pterygium area in Grade 1 and 2 pterygia. In Grade 3, both LVA and LMD were significantly correlated with the pterygium area. Conclusions. Lymphangiogenesis was associated with the degree of aggression in recurrent pterygia, particularly in substantial Grade 3 recurrent pterygia. Wei Zhao, Tao Wang, Juan Deng, Lei Zhong, Weilan Huang, and Shiqi Ling Copyright © 2016 Wei Zhao et al. All rights reserved. Elevated Transforming Growth Factor-β2 in the Aqueous Humor: A Possible Explanation for High Rate of Capsular Contraction Syndrome in High Myopia Thu, 28 Jan 2016 15:35:38 +0000 Purpose. The purpose of the study was to elucidate the role of transforming growth factor-beta 2 (TGF-β2) in the development of high myopic capsular contraction syndrome. Methods. Nineteen cases of capsular contraction syndrome, including 14 with high myopia, were collected, and their clinical data were reviewed. Aqueous humor and anterior capsular membranes were obtained during capsulotomy. Hematoxylin-eosin and immunohistochemical staining with anti-TGF-β2 antibody were performed on capsular membranes. TGF-β2 levels in aqueous humor were assayed using ELISA and western blot. Results. High myopia was significantly associated with the incidence of capsular contraction syndrome (odds ratio: 14.74, , 95% CI: 5.29–41.05). Histopathological analysis revealed proliferation of fibroblast-like lens epithelial cells on the shrunken anterior capsule, labeled with TGF-β2 antibodies. ELISA and Western blot showed higher levels of TGF-β2 in aqueous humor of patients with capsular contraction syndrome and high myopia. Conclusions. High myopia is a risk factor for capsular contraction syndrome. Elevated TGF-β2 levels in high myopic cataract patients may play an important role in the pathogenesis of capsular contraction syndrome. Keke Zhang, Xiangjia Zhu, Minjie Chen, Xinghuai Sun, Jin Yang, Peng Zhou, and Yi Lu Copyright © 2016 Keke Zhang et al. All rights reserved. Assessment of Optical Quality at Different Contrast Levels in Pseudophakic Eyes Thu, 28 Jan 2016 13:47:16 +0000 Purpose. To assess visual function using Optical Quality Analysis System (OQAS) at varying levels of contrast in pseudophakic eyes. Methods. The study included patients admitted to Seoul St. Mary’s Hospital between January and February 2012: 143 pseudophakic eyes with one of five intraocular lens types, examined 2–6 months after cataract surgery, and 93 normal eyes (enhanced visual acuity (VA) < 0.1 logMAR) in age-matched controls. Subjects were examined at three contrast levels using the OQAS. Results. At 100%, 20%, and 9% contrast, simulated mean VA was  logMAR,  logMAR, and  logMAR, in normal eyes, and  logMAR,  logMAR, and  logMAR, respectively, in pseudophakic eyes. Simulated VA decreased significantly when contrast was reduced, regardless of ocular status, age group, and lens type (). There were no significant differences between normal and pseudophakic eyes among subjects aged 50–69 (). Among subjects aged 70–79, pseudophakic eyes showed improved simulated VA () and objective scattering index values (). Conclusions. Patients with intraocular lenses have similar or superior visual function when compared to those with normal eyes at 2–6 months after cataract surgery, even under low-contrast conditions. Chang Won Park, Hyojin Kim, and Choun-Ki Joo Copyright © 2016 Chang Won Park et al. All rights reserved. Evaluation of LATS1 and LATS2 Promoter Methylation with the Risk of Pterygium Formation Thu, 28 Jan 2016 13:05:35 +0000 Purpose. Pterygium is a serious eye problem in countries with high exposure to UV. However, despite numerous studies, the molecular etiology of pterygium is unclear. Recent studies have indicated that LATS1 and LATS2 genes are involved in DDR signaling pathways against continuous UV exposure. Our aim was to evaluate the LATS1 and LATS2 promoter methylation with the risk of pterygium formation. Methods. We evaluated the promoter methylation status of LATS1 and LATS2 using methylation-specific PCR technique. Also, mRNA expression of LATS1 and LATS2 was assessed in 14 cases of pterygium and 14 normal specimens by real-time PCR. Results. Promoter methylation of LATS1 and LATS2 was detected significantly between pterygium tissues and normal tissues [LATS1; OR = 4.9; 95% CI: 1.54 to 15.48, ; LATS2; OR = 7.1; 95% CI: 1.53 to 33.19, ]. The gene expression analysis showed a statistically significant difference between pterygium tissues and healthy controls for both LATS1 and LATS2 (). Conclusions. The data of this study is the first report regarding the effect of promoter methylation of the LATS1 and LATS2 in the pterygium. To confirm these data, doing further studies in various genetic populations with large sample sizes using advanced molecular techniques is proposed. Maryam Najafi, Dor Mohammad Kordi-Tamandani, and Mohammad Arish Copyright © 2016 Maryam Najafi et al. All rights reserved. Serous Retinal Detachment Associated with Dome-Shaped Macula and Staphyloma Edge in Myopic Patients before and after Treatment with Spironolactone Thu, 28 Jan 2016 12:30:00 +0000 Objective. Serous retinal detachment (SRD) is a common anatomical complication associated with dome-shaped macula (DSM) and staphyloma margin in myopic patients. Here we described the anatomical and functional outcomes obtained with the use of oral spironolactone, a mineralocorticoid antagonist, in the management of myopic patients with SRD associated with DSM and staphyloma margin. Methods. We evaluated both eyes of twelve myopic patients with long-standing SRD associated with DSM or staphyloma margin. The patients were treated daily for six months with oral spironolactone 50 mg. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT), determined by optical coherence tomography, were evaluated on the first day and on monthly follow-up visits. Results. Pretreatment BCVA (mean ± standard deviation) was 0.406 ± 0.324 LogMAR, and posttreatment BCVA was 0.421 ± 0.354 LogMAR (). Pretreatment CRT was 323.9 ± 78.6 μm, and after six months of treatment it was significantly lower, 291.2 ± 74.5 μm (). There were no treatment-related complications. Conclusions. We evaluated a novel treatment for SRD associated with DSM and staphyloma margin in myopic patients. After six months of treatment with the mineralocorticoid antagonist spironolactone, the subretinal fluid and CRT were significantly reduced; however, there was no improvement in BCVA. Álvaro Fernández-Vega Sanz, Carlos Mario Rangel, Eva Villota Deleu, Beatriz Fernández-Vega Sanz, and Ronald Mauricio Sánchez-Ávila Copyright © 2016 Álvaro Fernández-Vega Sanz et al. All rights reserved. Ocular Surface Disorders in a Group of Egyptian Children with End Stage Renal Failure on Dialysis: A Cross-Sectional Study Thu, 28 Jan 2016 11:29:29 +0000 Purpose. To investigate tear function, ocular manifestations, and squamous metaplasia of the conjunctival epithelium (SMCE) in children with end stage renal failure (ESRF) on dialysis. Methods. Thirty children with ESRF and 20 age and sex matched controls during the period from January 2014 to May 2015 underwent full ophthalmologic examination and the tear function was investigated by the Schirmer and tear film break-up time (TBUT) tests. SMCE was evaluated by impression cytology and immunocytochemistry. The correlations of tear function status with ESRF-related clinical and biochemical variables were measured statistically. Results. Dry eye symptoms were detected in 26% of children with ESRF, compared with none of the controls () and SMCE was almost absent. Values of the Schirmer and TBUT tests were significantly lower in children with ESRF for right eye (, , and , , resp.) and left eye (, , and , , resp.). TBUT and the Schirmer test values were correlated inversely with the duration of ESRF (, , and , , resp.) and with the duration of dialysis (, , and , , resp.). None of the following parameters was associated with distorted tear function including serum creatinine, electrolytes, parathyroid hormone, total protein, albumin, CBC parameters, and systolic or diastolic blood pressure. Conclusion. The basal tear secretion and tear film stability were lower while the dry eye symptoms such as itching and redness were more common among children with ESRF. The duration of ESRF and dialysis duration seem to be related to the disturbances in tear secretion and tear film stability. However, SMCE is very rare. Mohamed Anbar, Ahmed R. H. Ahmed, Abdel-Azeem M. El-Mazary, and Ramadan A. Mahmoud Copyright © 2016 Mohamed Anbar et al. All rights reserved. Nonlethal Levels of Zeaxanthin Inhibit Cell Migration, Invasion, and Secretion of MMP-2 via NF-κB Pathway in Cultured Human Uveal Melanoma Cells Thu, 28 Jan 2016 08:53:39 +0000 Zeaxanthin at nonlethal dosages (3–10 μM) significantly inhibited the cell migration of cultured uveal melanoma cells (C918 cell line) as determined by wound healing assay and Boyden chamber assay. Matrigel invasion assay showed that cell invasion of uveal melanoma cells could be significantly inhibited by zeaxanthin. Secretion of MMP-2 by melanoma cells was significantly inhibited by zeaxanthin in a dose-dependent manner as measured by ELISA kit. Zeaxanthin also significantly inhibited the NF-κB levels in nuclear extracts of the UM cells, which is the upstream of the MMP-2 secretion. These results suggest that zeaxanthin might be a potentially therapeutic approach in the prevention of metastasis in uveal melanoma. Ming-Chao Bi, Nicole Hose, Cai-Lian Xu, Chen Zhang, Jodi Sassoon, and E. Song Copyright © 2016 Ming-Chao Bi et al. All rights reserved. Restoration of the Ellipsoid Zone and Visual Prognosis at 1 Year after Surgical Macular Hole Closure Thu, 28 Jan 2016 08:13:05 +0000 Purpose. To evaluate the restoration of the ellipsoid zone (EZ) and its influence on visual prognosis 1 year after surgical macular hole (MH) closure. Method. Subjects were patients with stage 2, 3, or 4 idiopathic MH who underwent primary vitrectomy that resulted in successful hole closure. Nineteen eyes with both EZ disruption with foveal detachment and a continuous external limiting membrane on optical coherence tomography during the early postoperative period were included in this study. Result. EZ disruption was restored in 10 eyes (53%, Group A) and remained in 9 eyes (47%, Group B) at 1 year after surgery. In Group B, the diameter of the residual EZ disruption was  μm. LogMAR visual acuity (VA) 1 year after surgery was significantly better than preoperative VA in each group (Group A: ; ; Group B: ; ), but there was no significant difference between the 2 groups (). There was no significant correlation between logMAR VA and EZ disruption diameter at 1 year after surgery. Conclusion. EZ was restored in 53% of eyes at 1 year after surgical closure of idiopathic MH. Mean residual EZ disruption diameter was  μm. Neither resolved nor residual EZ disruption influenced postoperative VA. Hiruma Hasebe, Naoki Matsuoka, Hiroko Terashima, Ryo Sasaki, Eriko Ueda, and Takeo Fukuchi Copyright © 2016 Hiruma Hasebe et al. All rights reserved. Ocular Surface Epithelial Thickness Evaluation in Dry Eye Patients: Clinical Correlations Tue, 26 Jan 2016 15:17:59 +0000 Purpose. To evaluate the relationship between corneal and conjunctival epithelium thickness and ocular surface clinical tests in dry eye disease (DED) patients. Patients and Methods. Fifty-four patients with DED and 32 control subjects were included. Each patient underwent an ocular surface evaluation using the ocular surface disease index (OSDI), tear film break-up time (TBUT), corneal and conjunctival staining, tear film lipid layer analysis, and Schirmer test. The central corneal (CET), limbal (LET), and bulbar conjunctival epithelium thickness (BET) were acquired using spectral-domain optical coherence tomography (SD-OCT). Results. Compared to control subjects, mean BET was significantly thicker and mean LET was significantly lower in the DED group. There was no significant difference in mean CET between the two groups. The mean LET was correlated with OSDI and TBUT. The inferior LET was correlated with OSDI, Schirmer I test, TBUT, Oxford score, and corneal sensitivity. Mean BET was correlated with OSDI and TBUT, but not with Schirmer I test and Oxford score. Conclusions. In dry eye patients, a thinner limbal epithelium and a thicker bulbar conjunctival epithelium were observed. These changes were correlated to the severity of dry eye symptoms and tear film alterations. Qingfeng Liang, Hong Liang, Hanruo Liu, Zhiqiang Pan, Christophe Baudouin, and Antoine Labbé Copyright © 2016 Qingfeng Liang et al. All rights reserved. Influence of Endothelin-1 in Aqueous Humor on Intermediate-Term Trabeculectomy Outcomes Thu, 21 Jan 2016 06:50:59 +0000 Purpose. To investigate whether increased concentrations of ET-1 in aqueous humor of glaucoma patients influences surgical outcome of standard trabeculectomy with Mitomycin C. Methods. Retrospective chart review of 36 glaucoma patients with known ET-1 concentrations who had undergone trabeculectomy with Mitomycin C. Patients were divided into two groups based on their aqueous ET-1 concentration, a below-median (low ET-1) and an above-median (high ET-1) group. Postoperative IOP development, necessity of glaucoma medication, surgical success and complications, postoperative use of antifibrotics (5-FU), and number of additional glaucoma surgeries were compared between the groups. Results. Overall surgical success of trabeculectomy was comparable to published literature (90%, 81%, 76%, and 68% absolute success at 12, 24, 36, and 48 months after surgery). There was no difference between high and low ET-1 group in the postsurgical development of IOP, surgical success rate, or complication rate. There was no difference in postoperative scarring or indirect indicators thereof (e.g., number of 5-FU injections, needlings, suture lyses, or IOP lowering medications). Conclusion. In this set of patients, ET-1 in aqueous humor does not appear to have influenced surgical outcome of trabeculectomy with Mitomycin C. There is no indication of an increased likelihood of bleb fibrosis in patients with increased ET-1 concentrations. Lars Choritz, Benjamin Mahmoodi, and Hagen Thieme Copyright © 2016 Lars Choritz et al. All rights reserved. Relationship between Corneal Temperature and Intraocular Pressure in Healthy Individuals: A Clinical Thermographic Analysis Wed, 20 Jan 2016 17:07:16 +0000 Purpose. To study the geographical distribution of corneal temperature (CT) and its influence on the intraocular pressure (IOP) of healthy human volunteers. Materials and Methods. Fifteen subjects (7 M, 8 F), years old, were enrolled in this pilot, cross-sectional study. Measurements of CT were taken after one hour with closed eyelids (CET) or closed eyelids with a cooling mask (cm-CET) and compared to baseline. Results. If compared to baseline, after CET, average CT significantly increased by 0.56°C in the RE and by 0.48°C in the LE () and IOP concomitantly significantly increased by 1.13 mmHg and 1.46 mmHg, respectively, in each eye (). After cm-CET, average CT significantly decreased by 0.11°C and 0.20°C, respectively, in the RE and LE (RE ; LE ), followed by a significant IOP decrease of 2.19 mmHg and 1.54 mmHg, respectively, in each eye (RE ; LE ). Conclusion. Significant variations of CT occurred after CET and cm-CET and were directly correlated with significant differences of IOP. It can be speculated that both oxidative stress and sympathetic nerve fiber stimulation by temperature oscillations may affect the regulation of AH vortex flow and turnover, thus influencing IOP values. Claudia Fabiani, Roberto Li Voti, Dario Rusciano, Maria Giulia Mutolo, and Nicola Pescosolido Copyright © 2016 Claudia Fabiani et al. All rights reserved. Pupil Dilation with Intracameral Epinephrine Hydrochloride during Phacoemulsification and Intraocular Lens Implantation Wed, 20 Jan 2016 11:09:28 +0000 Objective. To investigate mydriatic effect of intracamerally injected epinephrine hydrochloride during phacoemulsification and intraocular lens (IOL) implantation. Methods. Eighteen cataract patients for bilateral phacoemulsification were enrolled. To dilate pupil, one eye was randomly selected to receive intracamerally 1 mL epinephrine hydrochloride 0.001% for 1 minute after corneal incision (intracameral group), and the contralateral eye received 3 drops of compound tropicamide 0.5% and phenylephrine 0.5% at 5-minute intervals 30 minutes before surgery (topical group). Pupil diameters were measured before corneal incision, before ophthalmic viscoelastic device (OVD) injection, after OVD injection, before IOL implantation, and at the end of surgery. Results. At each time point, the mean pupil diameter in the intracameral group was , , , , and  mm, respectively, and in the topical group it was , , , , and  mm, respectively. The topical group consistently had larger mydriatic effects than the intracameral group (). The onset of mydriatic effect was rapid in the intracameral group. There was no difference in surgical performance or other parameters between groups. Conclusions. Intracameral epinephrine hydrochloride appears to be an alternative to the mydriatic modalities for phacoemulsification and IOL implantation. In comparison with topical mydriatics, intracameral epinephrine hydrochloride offers easier preoperative preparation, more rapid pupil dilation, and comparable surgical performance. A-Yong Yu, Hua Guo, Qin-Mei Wang, Fang-Jun Bao, and Jing-Hai Huang Copyright © 2016 A-Yong Yu et al. All rights reserved. High Levels of 17β-Estradiol Are Associated with Increased Matrix Metalloproteinase-2 and Metalloproteinase-9 Activity in Tears of Postmenopausal Women with Dry Eye Tue, 19 Jan 2016 12:26:43 +0000 Purpose. To determine the serum levels of sex steroids and tear matrix metalloproteinases (MMP) 2 and 9 concentrations in postmenopausal women with dry eye. Methods. Forty-four postmenopausal women with dry eye and 22 asymptomatic controls were enrolled. Blood was drawn and analyzed for serum levels of sex steroids and lipids. Then, the following tests were performed: tear collection, Ocular Surface Disease Index (OSDI) questionnaire, fluorescein tear film break-up time (TBUT), corneal fluorescein staining, Schirmer test, and conjunctival impression cytology. The conjunctival mRNA expression and tear concentrations of MMP-2 and MMP-9 were measured. Results. Serum 17β-estradiol levels were significantly higher in the dry eye subjects than in the controls (), whereas there were no significant differences in levels of testosterone, dehydroepiandrosterone sulfate (DHEA-S), and progesterone. Tear MMP-2 and MMP-9 concentrations (), as well as the MMP-9 mRNA expression in conjunctival samples (), were significantly higher in dry eye subjects than in controls. Serum 17β-estradiol levels were positively correlated with tear MMP-2 and MMP-9 concentrations and negatively correlated with Schirmer test values. Conclusions. High levels of 17β-estradiol are associated with increased matrix metalloproteinase-2 and metalloproteinase-9 activity in tears of postmenopausal women with dry eye. Guanglin Shen and Xiaoping Ma Copyright © 2016 Guanglin Shen and Xiaoping Ma. All rights reserved. A Head-Mounted Spectacle Frame for the Study of Mouse Lens-Induced Myopia Tue, 19 Jan 2016 08:56:11 +0000 The mouse model has been widely employed to explore the mysteries of myopia. For now, existing techniques for induction of experimental myopia in mice can be classified into three types: (1) devices directly glued to the fur; (2) devices attached using a combination of glue and sutures; (3) devices attached using a skull-mounted apparatus. These techniques each have its advantages, disadvantages when considering the devices stability, safety, complexity, effectiveness, and so forth. Thus, techniques for myopia induction in mice have yet to be further refined to popularize the applications. In this pilot study, we introduce a new head fixation device named the head-mounted spectacle frame apparatus for the study of mouse lens-induced myopia. Surgical procedures for device attachment were relatively simple and easy to learn in our study. Effective myopia induction was validated by retinoscopy refraction and axial length measurement using optical coherence tomography. In addition, it showed improved compliance and reliable safety when compared to the published methods. The head-mounted spectacle frame apparatus provides a new choice for the study of lens-induced myopia in mouse. It also allows for the use of form deprivation, making it attractive for future experimental mouse myopia trials. Yangshun Gu, Baisheng Xu, Chunfei Feng, Yang Ni, Qin Wu, Chixin Du, Nan Hong, Peng Li, Zhihua Ding, and Bo Jiang Copyright © 2016 Yangshun Gu et al. All rights reserved. Outcomes of 23-Gauge Vitrectomy Combined with Phacoemulsification, Panretinal Photocoagulation, and Trabeculectomy without Use of Anti-VEGF Agents for Neovascular Glaucoma with Vitreous Hemorrhage Sun, 17 Jan 2016 12:15:16 +0000 Purpose. To evaluate the outcomes of 23-gauge vitrectomy combined with phacoemulsification, PRP and trabeculectomy without use of anti-VEGF-agents for NVG. Methods. Eighteen eyes of 18 patients with NVG underwent 23-gauge vitrectomy combined with phacoemulsification, PRP and trabeculectomy without use of anti-VEGF agents. The preoperative BCVA ranged from light perception to 0.2. The preoperative IOP ranged from 38 mmHg to 64 mmHg with a mean of  mmHg. The average follow-up time was months with a range from 11 to 24 months. Results. The postoperative VA increased in 14 eyes and was stable in 4 eyes at the final follow-up. The mean IOP was  mmHg at postoperative day 1. The mean IOP was  mmHg,  mmHg,  mmHg,  mmHg,  mmHg,  mmHg, and  mmHg at postoperative days 2 and 3, 1, 2, 3, and 12 weeks, and 1 year postoperatively, respectively, with a range from 10 to 30 mmHg at the final follow-up time point of one year. The IOP was significantly lower than the preoperative one 12 weeks postoperatively (). Conclusion. 23-gauge vitrectomy combined with phacoemulsification, PRP, and trabeculectomy without use of anti-VEGF-agents is a safe and effective method in treating NVG. Hua Yan Copyright © 2016 Hua Yan. All rights reserved. Comparison of Two Botulinum Neurotoxin A Injection Patterns with or without the Medial Lower Eyelid in the Treatment of Blepharospasm Thu, 14 Jan 2016 09:08:39 +0000 The aim of this study was to evaluate the efficacy of two botulinum toxin A (BoNT-A) injection patterns with or without the medial lower eyelid (MLE) in treating benign essential blepharospasm (BEB) and influencing lacrimal drainage. Two different injection patterns of BoNT-A were randomly applied to 98 eyes of 49 BEB patients: MLE Group received a full injection pattern of 5 sites and non-MLE Group received a MLE waived injection pattern of 4 sites. Tear breakup time (BUT), Schirmer I test, lagophthalmos height, and lower lid tear meniscus height (TMH) were measured and Jankovic Rating Scale (JRS) was surveyed before injection and at 1 week, 1 month, and 3 months after injection. The symptom of BEB was relieved in both groups as suggested by JRS scores at all time points after injection, and MLE Group came up with a better JRS score at 3 months. The increases of Schirmer I test value and TMH in MLE Group were higher than those in non-MLE Group at 1 week after injection. This study shows that the MLE-involved full injection pattern is a better choice for patients with BEB. It has longer-lasting effects in relieving BEB symptoms and better efficacy in reducing lacrimal drainage. Clinical Trials registration number is NCT02327728. Hui Yang, Jing Lu, Xiujuan Zhao, Xiaohu Ding, Zhonghao Wang, Xiaoyu Cai, Yan Luo, and Lin Lu Copyright © 2016 Hui Yang et al. All rights reserved. Zeaxanthin: Review of Toxicological Data and Acceptable Daily Intake Wed, 13 Jan 2016 11:46:19 +0000 Zeaxanthin is a nutritional carotenoid with a considerable amount of safety data based on regulatory studies, which form the basis of its safety evaluation. Subchronic OECD guideline studies with mice and rats receiving beadlet formulations of high purity synthetic zeaxanthin in the diet at dosages up to 1000 mg/kg body weight (bw)/day, and in dogs at over 400 mg/kg bw/day, produced no adverse effects or histopathological changes. In developmental toxicity studies, there was no evidence of fetal toxicity or teratogenicity in rats or rabbits at dosages up to 1000 or 400 mg/kg bw/day, respectively. Formulated zeaxanthin was not mutagenic or clastogenic in a series of in vitro and in vivo tests for genotoxicity. A 52-week chronic oral study in Cynomolgus monkeys at doses of 0.2 and 20 mg/kg bw/day, mainly designed to assess accumulation and effects in primate eyes, showed no adverse effects. In a rat two-generation study, the NOAEL was 150 mg/kg bw/day. In 2012, this dosage was used by EFSA (NDA Panel), in association with a 200-fold safety factor, to propose an Acceptable Daily Intake equivalent to 53 mg/day for a 70 kg adult. The requested use level of 2 mg/day was ratified by the EU Commission. James A. Edwards Copyright © 2016 James A. Edwards. All rights reserved. Visual and Refractive Outcomes of a Toric Presbyopia-Correcting Intraocular Lens Wed, 13 Jan 2016 06:45:58 +0000 Purpose. To evaluate outcomes in astigmatic patients implanted with the Trulign (Bausch + Lomb) toric presbyopia-correcting intraocular lens (IOL) during cataract surgery in a clinical practice setting. Methods. Retrospective study in 40 eyes (31 patients) that underwent cataract extraction and IOL implantation in a procedure using intraoperative wavefront aberrometry guidance (ORA system). Endpoints included uncorrected visual acuity (VA), reduction in refractive cylinder, accuracy to target, axis orientation, and safety. Results. At postoperative month 1, refractive cylinder was ≤0.50 D in 97.5% of eyes (≤1.00 D in 100%), uncorrected distance VA was 20/25 or better in 95%, uncorrected intermediate VA was 20/25 or better in 95%, and uncorrected near VA was 20/40 (J3 equivalent) or better in 92.5%. Manifest refraction spherical equivalent was within 1.00 D of target in 95% of eyes and within 0.50 D in 82.5%. Lens rotation was <5° and best-corrected VA was 20/25 or better in all eyes. Conclusion. The IOL effectively reduced refractive cylinder and provided excellent uncorrected distance and intermediate vision and functional near vision. Refractive predictability and rotational stability were exceptional. Implantation of this toric presbyopia-correcting IOL using ORA intraoperative aberrometry provides excellent refractive and visual outcomes in a standard of care setting. Alice T. Epitropoulos Copyright © 2016 Alice T. Epitropoulos. All rights reserved. Intraoperative Corneal Thickness Changes during Pulsed Accelerated Corneal Cross-Linking Using Isotonic Riboflavin with HPMC Wed, 13 Jan 2016 06:38:54 +0000 Purpose. To evaluate corneal thickness changes during pulsed accelerated corneal cross-linking (CXL) for keratoconus using a new isotonic riboflavin formula. Methods. In this prospective, interventional, clinical study patients with grades 1-2 keratoconus (Amsler-Krumeich classification) underwent pulsed accelerated (30 mW/cm2) CXL after application of an isotonic riboflavin solution (0.1%) with HPMC for 10 minutes. Central corneal thickness (CCT) measurements were taken using ultrasound pachymetry before and after epithelial removal, after riboflavin soaking, and immediately after completion of UVA treatment. Results. Twenty eyes of 11 patients (4 males, 7 females) were enrolled. Mean patient age was (range from 18 to 30 years). No intraoperative or postoperative complications were observed in any of the patients. Mean CCT was  μm (range: 559–459 μm) before and  μm (range: 535–420 μm) after epithelial removal (). After 10 minutes of riboflavin instillation, there was a statistically significant decrease of CCT by 6.2% from  μm (range: 535–420 μm) to  μm (range: 508–400) (). There was no other statistically significant change of CCT during UVA irradiation. Conclusions. A significant decrease of corneal thickness was demonstrated during the isotonic riboflavin with HPMC application while there was no significant change during the pulsed accelerated UVA irradiation. Ahmed M. Sherif, Nihal A. El-Gheriany, Yehia M. Salah El-Din, Lamiaa S. Aly, Amr A. Osman, Michael A. Grentzelos, and George D. Kymionis Copyright © 2016 Ahmed M. Sherif et al. All rights reserved. Scheimpflug Imaging Parameters Associated with Tear Mediators and Bronchial Asthma in Keratoconus Tue, 12 Jan 2016 12:23:20 +0000 Purpose. To determine associations between mediators in tears in the whole spectrum of keratoconus (KC); to explore connections between mediators and Scheimpflug parameters; to examine correlations between Scheimpflug parameters and bronchial asthma. Methods. Tear samples were collected from 69 patients and 19 controls. Concentrations of mediators—IL-6, -10; CXCL8, CCL5; MMP-9, -13; TIMP-1; t-PA, PAI-1—were measured by Cytometric Bead Array. Measured Pentacam parameters include keratometry values (, , ), corneal thickness (Pachy Pupil, Apex, Min), and elevations and indices (including Belin-Ambrósio deviation (BAD-D)). Results. A number of significant positive associations were observed between pairs of mediator concentrations. Significant positive correlations were found between BAD-D and CXCL8/MMP-9 and and MMP-9. Significant negative associations were explored between Pachy Min and CXCL8/t-PA. Significant associations were found between pairs of mediators (IL-6 and CXCL8; CCL5 and CXCL8/MMP-9; TIMP-1 and MMP-9/-13/t-PA; t-PA and CXCL8/CCL5/PAI-1) and the severity of KC. Significant positive correlation between asthma and the severity of KC was explored. Conclusion. Cooperation of different mediators in tears all taking part in the complex pathomechanism of keratoconus was revealed. Our research verifies that inflammation plays a crucial role in the pathogenesis of KC. Additionally this study confirms the effect of bronchial asthma on keratoconus. Dorottya Pásztor, Bence Lajos Kolozsvári, Adrienne Csutak, András Berta, Ziad Hassan, Beáta Andrea Kettesy, Péter Gogolák, and Mariann Fodor Copyright © 2016 Dorottya Pásztor et al. All rights reserved. Choroidal Thickness in Patients with Mild Cognitive Impairment and Alzheimer’s Type Dementia Mon, 11 Jan 2016 08:33:10 +0000 Aim. To asses both choroidal thickness differences among Alzheimer’s type dementia (ATD) patients, mild cognitive impairment (MCI) patients, and healthy control (C) subjects and choroidal thickness relationships with cognitive performance. Methods. A total of 246 eyes of 123 people (41 ATD, 38 MCI, and 44 healthy C subjects) were included in this study. Complete ophthalmological and neurological examination was performed in all subjects. Choroidal thicknesses (CT) were measured at seven locations: the fovea, 500-1500-3000 μm temporal and 500-1500-3000 μm nasal to the fovea by enhanced depth imaging optical coherence tomography (EDI-OCT). Detailed neurological examination including mini mental state examination (MMSE) test which evaluates the cognitive function was applied to all participants. Results. The ages and genders of all participants were similar in all groups. Compared with healthy C subjects, the CT measurements at all regions were significantly thinner both in patients with ATD and in patients with MCI than in healthy C subjects (). The MMSE scores were significantly different among ATD patients, MCI patients, and healthy C subjects. They were , , and in ATD, MCI, and healthy controls, respectively (). There were also significant correlation between MMSE score and choroidal thickness at each location (). Conclusions. CT was reduced in ATD patients and MCI patients. Since vascular structures were affected in ATD patients and MCI patients, they had thin CT. Besides CT was correlated with degree of cognitive impairment. Therefore CT may be a new biomarker in diagnosis and follow-up of MCI and ATD patients. Mehmet Bulut, Aylin Yaman, Muhammet Kazim Erol, Fatma Kurtuluş, Devrim Toslak, Berna Doğan, Deniz Turgut Çoban, and Ebru Kaya Başar Copyright © 2016 Mehmet Bulut et al. All rights reserved. Usefulness of Surgical Media Center as a Cataract Surgery Educational Tool Sun, 10 Jan 2016 09:18:33 +0000 Purpose. This study retrospectively analyzed cataract surgeries to examine the usefulness of Surgical Media Center (SMC) (Abbott Medical Optics Inc.), a new cataract surgery recording device, for training of cataract surgery. Methods. We studied five hundred cataract surgeries conducted with a phacoemulsification system connected to the SMC. After surgery, the surgical procedures were reviewed, with changes in aspiration rate, vacuum level, and phaco power displayed as graphs superimposed on the surgical video. We examined whether use of SMC is able to demonstrate the differences in technique between experienced and trainee operators, to identify inappropriate phacoemulsification techniques from analyzing the graphs, and to elucidate the cause of intraoperative complications. Results. Significant differences in the time taken to reach maximum vacuum and the speed of increase in vacuum during irrigation and aspiration were observed between experienced and trainee operators. Analysis of the graphs displayed by SMC detected inappropriate phacoemulsification techniques mostly in cases operated by trainee operators. Conclusions. Using SMC, it was possible to capture details of cataract surgery objectively. This recording device allows surgeons to review cataract surgery techniques and identify the cause of intraoperative complication and is a useful education tool for cataract surgery. Tomoichiro Ogawa, Takuya Shiba, and Hiroshi Tsuneoka Copyright © 2016 Tomoichiro Ogawa et al. All rights reserved. Novice Reviewers Retain High Sensitivity and Specificity of Posterior Segment Disease Identification with iWellnessExam Wed, 06 Jan 2016 13:11:21 +0000 Introduction. Four novices to Spectral Domain Optical Coherence Tomography (SD-OCT) image review were provided a brief lecture on the interpretation of iVue iWellnessExam findings (available on iVue SD-OCT, Optovue, Inc., Fremont, CA). For a cohort of 126 (Confirmed) Normal, 101 (Confirmed) Disease subjects, iWellnessExam OD, OS, and OU reports were provided. Each novice independently reviewed and sorted the subjects into one of four categories: normal, retinal disease, optic nerve (ON) disease, and retinal + ON disease. Their accuracy is compared between the novices and with an expert reviewer. Results. Posterior segment disease was properly detected by novices with sensitivities of 90.6%, any disease; 84.3%, retinal disease; 88.0%, ON disease; expert sensitivity: 96.0%, 95.5%, and 90.0%, respectively; specificity: 84.3%, novices; 99.2%, expert. Novice accuracy correlates best with clinical exposure and amount of time spent reviewing each image set. The novices’ negative predictive value was 92.0% (i.e., very few false negatives). Conclusions. Novices can be trained to screen for posterior segment disease efficiently and effectively using iWellnessExam data, with high sensitivity, while maintaining high specificity. Novice reviewer accuracy covaries with both clinical exposure and time spent per image set. These findings support exploration of training nonophthalmic technicians in a primary medical care setting. Samantha Slotnick, Catherine Awad, Sanjeev Nath, and Jerome Sherman Copyright © 2016 Samantha Slotnick et al. All rights reserved.