Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Intravitreal Aflibercept Outcomes in Patients with Persistent Macular Exudate Previously Treated with Bevacizumab and/or Ranibizumab for Neovascular Age-Related Macular Degeneration Thu, 20 Nov 2014 10:59:14 +0000 Purpose. To assess whether intravitreal aflibercept (2.0 mg) can effectively reduce persistent macular exudate and enhance visual acuity in ranibizumab (0.5 mg) and/or bevacizumab (1.25 mg) treatment resistant patients with neovascular age-related macular degeneration. Methods. This retrospective study included 47 treatment resistant eyes from 47 patients switched to intravitreal aflibercept injections after receiving a minimum of 3 injections with either ranibizumab or bevacizumab. Snellen visual acuity and optical coherence tomography were assessed just prior to the first injection (baseline) and prior to the fourth injection (final). Additionally, anatomical regions of persistent macular exudate were tracked to determine if these areas yielded varying responses to aflibercept. Results. At baseline, patients had received an average of 11.3 injections with any prior anti-VEGF drug (SD 5.96). For whole group analysis, baseline and final central retinal thickness were 370.57 µm and 295.7 µm (), respectively. Baseline and final retinal fluid volumes were 4.81 mm3 and 4.37 mm3 (), respectively. Baseline and final logMAR were 0.56 and 0.53 (), respectively. Anatomic location of persistent exudate did not appreciably alter treatment outcome. Conclusion. Central retinal thickness and total retinal fluid volume were reduced in ranibizumab and/or bevacizumab treatment resistant patients following three aflibercept injections. No appreciable change in visual acuity was noted. David R. Griffin, Preston P. Richmond, and John C. Olson Copyright © 2014 David R. Griffin et al. All rights reserved. Analysis of Femtosecond Laser Assisted Capsulotomy Cutting Edges and Manual Capsulorhexis Using Environmental Scanning Electron Microscopy Thu, 20 Nov 2014 07:48:14 +0000 Purpose. To investigate the structure and irregularity of the capsulotomy cutting edges created by two femtosecond (FS) laser platforms in comparison with manual continuous circular capsulorhexis (CCC) using environmental scanning electron microscopy (eSEM). Methods. Ten anterior capsulotomies were obtained using two different FS laser cataract platforms (LenSx, , and Victus, ). In addition, five manual CCC () were obtained using a rhexis forceps. The specimens were imaged by eSEM (FEI Quanta 400, OR, USA). Objective metrics, which included the arithmetic mean deviation of the surface (Sa) and the root-mean-square deviation of the surface (Sq), were used to evaluate the irregularity of both the FS laser capsulotomies and the manual CCC cutting edges. Results. Several microirregularities were shown across the FS laser capsulotomy cutting edges. The edges of manually torn capsules were shown, by comparison of Sa and Sq values, to be smoother () than the FS laser capsulotomy edges. Conclusions. Work is needed to understand whether the FS laser capsulotomy edge microirregularities, not seen in manual CCC, may act as focal points for the concentration of stress that would increase the risk of capsular tear during phacoemulsification as recently reported in the literature. Sebastiano Serrao, Giuseppe Lombardo, Giovanni Desiderio, Lucio Buratto, Domenico Schiano-Lomoriello, Marco Pileri, and Marco Lombardo Copyright © 2014 Sebastiano Serrao et al. All rights reserved. Spectral Domain Optical Coherence Tomographic Findings of Bietti Crystalline Dystrophy Wed, 19 Nov 2014 12:57:55 +0000 We analyzed the OCT features of 24 eyes of 12 patients with Bietti crystalline dystrophy (BCD) with the Heidelberg HRA2-OCT. Seventeen of 24 eyes were in intermediate stage of the disease and seven in advanced stage of the disease at the time of latest OCT examination performed in 2014. Outer retinal tubulations and retinal hyperreflective dots were present in 20 of 24 eyes. The remaining four eyes had advanced disease with very thin retina. Appearance of bright plaque on top of RPE-Bruch membrane was present in all eyes. Choroidal hyperreflective spots were noted in 19 of 24 eyes. The remaining five eyes had advanced disease stage with very thin choroid. Mean central macular thickness was 163.08 μm ± 62.52 for all eyes (170.35 μm ± 56.46 in eyes with intermediate disease and 145.42 μm ± 77.2 in eyes with advanced disease). Mean subfoveal choroidal thickness was 95.37 μm ± 55.93 for the study eyes (116.47 ± 46.92 μm in eyes with intermediate disease and 44.14 μm ± 42.43 in eyes with advanced disease). Choroidal hyperreflective spots were noted in 21 of 24 eyes (87.5%). SD-OCT shows the disease progression in retinal and choroidal layers delicately in eyes with BCD and expands our knowledge about the ongoing disease process. Ali Osman Saatci, Hasan Can Doruk, Aylin Yaman, and Ferit Hakan Öner Copyright © 2014 Ali Osman Saatci et al. All rights reserved. Effect on Intraocular Pressure of Switching from Latanoprost and Travoprost Monotherapy to Timolol Fixed Combinations in Patients with Normal-Tension Glaucoma Wed, 19 Nov 2014 12:41:15 +0000 Purpose. To evaluate the effect on intraocular pressure (IOP) of switching from latanoprost and travoprost monotherapy to timolol fixed combinations in Japanese patients with normal-tension glaucoma (NTG). Methods. 27 NTG patients (54 eyes) were compared IOP, superficial punctuate keratitis (SPK) scores, and conjunctival injection scores in eyes treated with prostaglandin (PG) or PG analog/beta-blocker (PG/b) fixed-combination 6 months after the change in therapy. Results. The mean baseline intraocular pressure was  mmHg in eyes receiving PG therapy only and  mmHg in eyes switched to PG/b. Switching to fixed combination therapy from PG monotherapy, the mean IOP was  mmHg   % reduction from baseline) at 6 months. The mean conjunctival injection score was 0.69 for eyes on PG monotherapy and 0.56 for eyes on fixed combination therapy . The mean SPK scores were 0.46 and 0.53. This difference was not statistically significant . Conclusions. Switching from PG monotherapy to PG/b fixed combination therapy for NTG resulted in a greater intraocular pressure reduction than PG alone without increasing the number of instillations. Ryoko Igarashi, Tetsuya Togano, Yuta Sakaue, Takaiko Yoshino, Jun Ueda, and Takeo Fukuchi Copyright © 2014 Ryoko Igarashi et al. All rights reserved. Vitreous Hemorrhage in Pediatric Age Group Wed, 19 Nov 2014 00:00:00 +0000 Purpose. To identify and study causes of vitreous hemorrhage (VH) in pediatric age group and to investigate factors predicting visual and anatomical outcomes. Procedure. A retrospective review of patients aged 16 years or less with the diagnosis of vitreous hemorrhage from January 2005 until December 2010. Results. A total number of 230 patients (240 eyes) were identified. Traumatic vitreous hemorrhage accounted for 82.5%. In cases of accidental trauma, final visual acuity of 20/200 was significantly associated with visual acuity of ≥20/200 at presentation and the absence of retinal detachment at last follow-up. Patients with nontraumatic vitreous hemorrhage were significantly younger with higher rates of enucleation/evisceration/exenteration and retinal detachment at last follow-up compared to traumatic cases. Conclusion. Trauma is the most common cause of VH in pediatric age group. In this group, initial visual acuity was the most important predictor for visual outcome, and the presence of retinal detachment is a negative predictor for final good visual outcome. The outcome is significantly worse in nontraumatic cases compared to traumatic cases. Dora H. AlHarkan, Eman S. Kahtani, Priscilla W. Gikandi, and Ahmed M. Abu El-Asrar Copyright © 2014 Dora H. AlHarkan et al. All rights reserved. Evaluation of Corneal Stromal Demarcation Line after Two Different Protocols of Accelerated Corneal Collagen Cross-Linking Procedures Using Anterior Segment Optical Coherence Tomography and Confocal Microscopy Tue, 18 Nov 2014 11:05:21 +0000 Purpose. To evaluate the depth of corneal stromal demarcation line using AS-OCT and confocal microscopy after two different protocols of accelerated corneal collagen cross-linking procedures (CXL). Methods. Patients with keratoconus were divided into two groups. Peschke CXL device (Peschke CCL-VARIO Meditrade GmbH) applied UVA light with an intended irradiance of 18.0 mW/cm2 for 5 minutes after applying riboflavin for 20 minutes (group 1) and 30 minutes (group 2). One month postoperatively, corneal stromal demarcation line was measured using AS-OCT and confocal microscopy. Results. This study enrolled 34 eyes of 34 patients (17 eyes in group 1 and 17 eyes in group 2). The mean depth of the corneal stromal demarcation line was  μm in group 1 and  μm in group 2 measured with AS OCT, while it was  μm in group 1 and  μm in group 2 measured with confocal microscopy. Corneal stromal demarcation line depth measured with AS OCT or confocal microscopy was significantly deeper in group 2 than group 1 . Conclusion. The group in which riboflavin was applied for 30 minutes showed significantly deeper corneal stromal demarcation line than the group in which riboflavin was applied for 20 minutes. Engin Bilge Ozgurhan, Betul Ilkay Sezgin Akcay, Yusuf Yildirim, Gonul Karatas, Tugba Kurt, and Ahmet Demirok Copyright © 2014 Engin Bilge Ozgurhan et al. All rights reserved. A Comparison of Topical or Retrobulbar Anesthesia for 23-Gauge Posterior Vitrectomy Tue, 18 Nov 2014 07:52:31 +0000 Background. To compare the efficacy and safety of topical anesthesia versus retrobulbar anesthesia in 23-gauge vitreoretinal surgery. Materials and Methods. A total of 63 patients scheduled for 23 G posterior vitrectomy without scleral buckling procedures were included in the study. The patients were randomly assigned to receive either topical (Group 1, ) or retrobulbar anesthesia (Group 2, ). Postoperatively, patients were shown a visual analogue pain scale (VAPS) from 1 (no pain or discomfort) to 4 (severe pain or discomfort) to rate the levels of pain. Results. There was more discomfort in patients in Group 2 while anesthetic was administered (Group 1:  , Group 2: , ). Between the two groups the level of pain during surgery (Group 1: , Group 2: ; ) was noted. There was also no significant difference between two groups postoperatively (Group 1: , Group 2: ; ). There were no complications in either group related to the anesthetic technique. No patient needed sedation or anesthesia supplement during the surgery or postoperative period. Conclusion. Topical anesthesia in posterior vitrectomy procedures is an effective and safe method that is alternative to retrobulbar anesthesia. Hande Celiker, Levent Karabas, and Ozlem Sahin Copyright © 2014 Hande Celiker et al. All rights reserved. The Association between Dry Eye Disease and Physical Activity as well as Sedentary Behavior: Results from the Osaka Study Mon, 17 Nov 2014 00:00:00 +0000 Purpose. To assess the association of dry eye disease (DED) with physical activity and sedentary behavior. Methods. The cross-sectional survey conducted included Japanese office workers who use visual display terminals (). DED was assessed according to the Japanese Dry Eye Diagnostic Criteria, and participants were categorized into “definite DED,” “probable DED,” or “non-DED” groups based on the results of DED examinations. Physical activity and sedentary behavior of participants were assessed using the International Physical Activity Questionnaire (IPAQ), and physical activity level was calculated in metabolic equivalent units per week (MET, min/week). Participants were classified as having a high, moderate, or low level of physical activity. Results. Participants with abnormal tear break-up time (BUT) (≤5 s) were involved in sedentary behavior for significantly longer duration than those with normal BUT (). Non-DED participants (14.5%) tended to have higher levels of physical activity than definite DED participants (2.5%). Participants with definite DED had significantly lower MET scores than those with non-DED (). Conclusions. Our findings suggest that a lower level of physical activity and sedentary behavior are associated with DED; however, longitudinal/intervention studies with large groups of participants are needed to validate these findings. Motoko Kawashima, Miki Uchino, Norihiko Yokoi, Yuichi Uchino, Murat Dogru, Aoi Komuro, Yukiko Sonomura, Hiroaki Kato, Yuji Nishiwaki, Shigeru Kinoshita, and Kazuo Tsubota Copyright © 2014 Motoko Kawashima et al. All rights reserved. RHO Mutations (p.W126L and p.A346P) in Two Japanese Families with Autosomal Dominant Retinitis Pigmentosa Sun, 16 Nov 2014 12:28:07 +0000 Purpose. To investigate genetic and clinical features of patients with rhodopsin (RHO) mutations in two Japanese families with autosomal dominant retinitis pigmentosa (adRP). Methods. Whole-exome sequence analysis was performed in ten adRP families. Identified RHO mutations for the cosegregation analysis were confirmed by Sanger sequencing. Ophthalmic examinations were performed to evaluate the RP phenotypes. The impact of the RHO mutation on the rhodopsin conformation was examined by molecular modeling analysis. Results. In two adRP families, we identified two RHO mutations (c.377G>T (p.W126L) and c.1036G>C (p.A346P)), one of which was novel. Complete cosegregation was confirmed for each mutation exhibiting the RP phenotype in both families. Molecular modeling predicted that the novel mutation (p.W126L) might impair rhodopsin function by affecting its conformational transition in the light-adapted form. Clinical phenotypes showed that patients with p.W126L exhibited sector RP, whereas patients with p.A346P exhibited classic RP. Conclusions. Our findings demonstrated that the novel mutation (p.W126L) may be associated with the phenotype of sector RP. Identification of RHO mutations is a very useful tool for predicting disease severity and providing precise genetic counseling. Satoshi Katagiri, Takaaki Hayashi, Masakazu Akahori, Takeshi Itabashi, Jo Nishino, Kazutoshi Yoshitake, Masaaki Furuno, Kazuho Ikeo, Tetsuji Okada, Hiroshi Tsuneoka, and Takeshi Iwata Copyright © 2014 Satoshi Katagiri et al. All rights reserved. Regional Reduction of Ganglion Cell Complex after Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Macular Hole Sun, 16 Nov 2014 00:00:00 +0000 Purpose. To determine whether the reduction of ganglion cell complex (GCC) thickness is uniform in the parafoveal region after vitrectomy with internal limiting membrane (ILM) peeling for idiopathic macular hole (MH). Methods. Thirty-nine consecutive eyes were studied. Vitrectomy was performed with ILM peeling with brilliant blue G (BBG) staining, and room air was used for an intraocular tamponade. The GCC thickness and retinal sensitivity were measured at the superior, inferior, nasal, and temporal quadrants around the fovea using spectral domain-optical coherence tomography (SD-OCT) and microperimetry (MP-1). The measurements were made at baseline, and at 3 and 6 months postoperatively. Results. In 38 of the 39 eyes, the MH was closed after the initial surgery. At three and six months, the percentage of eyes with significantly thinner GCC areas was higher at the temporal quadrant (40.5% at 3 months and 46.0% at 6 months) than that at the other quadrants (, resp.). The retinal sensitivity was also significantly lower in the temporal area than in the other areas (15.7 dB at 3 months, ; 15.4 dB at 6 months, ). Conclusion. These findings indicate that the inner retina in the temporal area may be more vulnerable to surgical manipulations than the other areas. Takayuki Baba, Eiju Sato, Toshiyuki Oshitari, and Shuichi Yamamoto Copyright © 2014 Takayuki Baba et al. All rights reserved. The Anti-Acetylcholine Receptor Antibody Test in Suspected Ocular Myasthenia Gravis Thu, 13 Nov 2014 10:24:57 +0000 Aim. To estimate the clinical significance of anti-acetylcholine receptor antibody (anti-AChR-Ab) levels in suspected ocular myasthenia gravis. Methods. In total, 144 patients complaining of fluctuating diplopia and ptosis were evaluated for serum levels of anti-acetylcholine receptor antibody and their medical charts were retrospectively reviewed. Subjects were classified into three groups: variable diplopia only, ptosis only, and both variable diplopia and ptosis. We investigated serum anti-AChR-Ab titer levels and performed thyroid autoantibody tests. Results. Patients’ chief complaints were diplopia (), ptosis (), and their concurrence (). Abnormal anti-AChR-Ab was observed in 21 of 144 patients (14.1%). Between the three groups, mean age, number of seropositive patients, and mean anti-AChR-Ab level were not significantly different (, 0.073, and 0.062, resp.). Overall, 27.5% of patients had abnormal thyroid autoantibodies. Conclusion. The sensitivity of anti-AChR-Ab was 14.1% in suspected ocular myasthenia gravis and seropositivity in myasthenia gravis patients showed a high correlation with the presence of thyroid autoantibodies. Jung Jin Lee, Kyung Min Koh, and Ungsoo Samuel Kim Copyright © 2014 Jung Jin Lee et al. All rights reserved. Age-Related Macular Degeneration: Insights into Inflammatory Genes Wed, 12 Nov 2014 09:59:42 +0000 Age-related macular degeneration (AMD) is a progressive neurodegenerative disease that affects approximately 8.7% of elderly people worldwide (>55 years old). AMD is characterized by a multifactorial aetiology that involves several genetic and environmental risk factors (genes, ageing, smoking, family history, dietary habits, oxidative stress, and hypertension). In particular, ageing and cigarette smoking (including oxidative compounds and reactive oxygen species) have been shown to significantly increase susceptibility to the disease. Furthermore, different genes (CFH, CFI, C2, C3, IL-6, IL-8, and ARMS2) that play a crucial role in the inflammatory pathway have been associated with AMD risk. Several genetic and molecular studies have indicated the participation of inflammatory molecules (cytokines and chemokines), immune cells (macrophages), and complement proteins in the development and progression of the disease. Taking into consideration the genetic and molecular background, this review highlights the genetic role of inflammatory genes involved in AMD pathogenesis and progression. Raffaella Cascella, Michele Ragazzo, Claudia Strafella, Filippo Missiroli, Paola Borgiani, Francesco Angelucci, Luigi Tonino Marsella, Andrea Cusumano, Giuseppe Novelli, Federico Ricci, and Emiliano Giardina Copyright © 2014 Raffaella Cascella et al. All rights reserved. Ocular Surface Temperature in Age-Related Macular Degeneration Tue, 11 Nov 2014 12:39:56 +0000 Background. The aim of this study is to investigate the ocular thermographic profiles in age-related macular degeneration (AMD) eyes and age-matched controls to detect possible hemodynamic abnormalities, which could be involved in the pathogenesis of the disease. Methods. 32 eyes with early AMD, 37 eyes with atrophic AMD, 30 eyes affected by untreated neovascular AMD, and 43 eyes with fibrotic AMD were included. The control group consisted of 44 healthy eyes. Exclusion criteria were represented by any other ocular diseases other than AMD, tear film abnormalities, systemic cardiovascular abnormalities, diabetes mellitus, and a body temperature higher than 37.5°C. A total of 186 eyes without pupil dilation were investigated by infrared thermography (FLIR A320). The ocular surface temperature (OST) of three ocular points was calculated by means of an image processing technique from the infrared images. Two-sample -test and one-way analysis of variance (ANOVA) test were used for statistical analyses. Results. ANOVA analyses showed no significant differences among AMD groups ( value ). OST in AMD patients was significantly lower than in controls (). Conclusions. Considering the possible relationship between ocular blood flow and OST, these findings might support the central role of ischemia in the pathogenesis of AMD. Andrea Sodi, Sara Matteoli, Giovanni Giacomelli, Lucia Finocchio, Andrea Corvi, and Ugo Menchini Copyright © 2014 Andrea Sodi et al. All rights reserved. Psychophysiology of Refractive Accommodative Esotropia Mon, 10 Nov 2014 12:08:51 +0000 Purpose. To investigate the psychophysiologic aspects of refractive accommodative esotropia (RAE). Methods. I prospectively recruited patients aged 3–6 years with more than 3.0 diopters of hyperopia who presented at Kim’s Eye Hospital from January 2011 to March 2013. I compared Korean Child Behavior Checklist (K-CBCL) which consists of internalizing factors (social withdrawal, somatic complaints, anxiety, and depression) and externalizing factors (social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior) between RAE group and control group. Results. Two out of three internalizing indexes were significantly different between groups (somatic complaints: RAE children and controls ; depression/anxiety: RAE children and controls . Although there was no significant difference, RAE children scored slightly higher on the externalizing behavior index. In the RAE group, the far angle of esodeviation showed a moderate correlation with withdrawn behaviors. Conclusion. Hypermetropic children with high scores on the somatic complaint and depression/anxiety subscales of the CBCL could be at high risk for developing RAE. Psychosocial problems might be related to the pathogenesis of refractive accommodative esotropia. Ungsoo Samuel Kim Copyright © 2014 Ungsoo Samuel Kim. All rights reserved. The Relationship between Visual Field Global Indices and Retinal Nerve Fiber Layer Thickness in Healthy Myopes Mon, 10 Nov 2014 00:00:00 +0000 The aim of the current study was to investigate the association between the thickness of the retinal nerve fiber layer (RNFL) and central visual field indices in otherwise healthy myopes. In total, 57 otherwise healthy subjects were cross-sectionally studied. General ophthalmic examinations, refractive measurements, RNFL thickness by spectral domain optical coherence tomography (OCT), and central visual fields were examined. Linear models were used to assess the associations. In this young and mid-aged population, the mean spherical equivalent was −4.79 (SD 1.66) and −4.59 (SD 1.88) diopters in the right and left eyes, respectively. Approximately 7% to 14% of the eyes showed the average RNFL thickness out of the normal range. The temporal RNFL was remarkably thicker, whereas the nasal RNFL was thinner. The higher the refractive error, the thinner the RNFL thickness. A thicker overall RNFL was significantly associated with decreased mean sensitivity and increased mean defect, and further adjustments for age, sex, refractive error, optic disk area, or ocular magnification did not change the association. Although nonpathologic myopia does not significantly affect central visual field global indices, its effects on the RNFL may be linked with performance on the central visual field test. Yuan-zhi Yuan, Chen-li Feng, Bao-yue Li, Min-qian Shen, Xiu-ping Chen, Chen-hao Zhang, Chun-qiong Dong, and Fei Yuan Copyright © 2014 Yuan-zhi Yuan et al. All rights reserved. Variations in Eyeball Diameters of the Healthy Adults Wed, 05 Nov 2014 07:59:55 +0000 The purpose of the current research was to reevaluate the normative data on the eyeball diameters. Methods. In a prospective cohort study, the CT data of consecutive 250 adults with healthy eyes were collected and analyzed, and sagittal, transverse, and axial diameters of both eyeballs were measured. The data obtained from the left eye and from the right eye were compared. The correlation analysis was performed with the following variables: orbit size, gender, age, and ethnic background. Results. We did not find statistically significant differences correlated with gender of the patients and their age. The right eyeball was slightly smaller than the left one but this difference was statistically insignificant . We did not find statistically significant differences of the eyeball sizes among the ethnicities we dealt with. Strong correlation was found between the transverse diameter and the width of the orbit . Conclusion. The size of a human adult eye is approximately (axial) with no significant difference between sexes and age groups. In the transverse diameter, the eyeball size may vary from 21 mm to 27 mm. These data might be useful in ophthalmological, oculoplastic, and neurological practice. Inessa Bekerman, Paul Gottlieb, and Michael Vaiman Copyright © 2014 Inessa Bekerman et al. All rights reserved. Analysis of Current Status and Strategies of Retinopathy of Prematurity Screening during 6 Years in Local Regions of China: Implication and Caution Tue, 04 Nov 2014 09:48:32 +0000 Purpose. To understand the current status of retinopathy of prematurity (ROP) screening in a province of North China. Methods. We retrospectively analyzed 5651 cases with ROP screening in the Provincial Screening Center of Hebei Province from January 2008 to December 2013. Results. 14.98% of all ROP patients and 1.56% of severe ROP patients required treatment. All the severe ROP patients met the criteria of screening. Severe ROP patients were detected at recommended initial screening time (4–6 weeks after birth). The frequency of other ocular diseases was 8.03%, in which the main disease was fundus hemorrhage. In 2665 more mature and unqualified infants, only 2 retinoblastoma and 2 familial exudative vitreoretinopathy were detected, which indicates the advantage of early diagnosis and treatment based on fundus examination. Conclusions. It is suggested that the standard of GA < 32 weeks and/or BW < 1800 g could be served as the screening criteria in the local region for ROP screening. 4 weeks after birth is the most appropriate time for initial screening. Lu Chen, Ming Su, Sheng-gang Ren, Hui-lan Hua, Jian-cang Wang, and Wei Zheng Copyright © 2014 Lu Chen et al. All rights reserved. Comparison of Anterior Segment Measurements with Scheimpflug/Placido Photography-Based Topography System and IOLMaster Partial Coherence Interferometry in Patients with Cataracts Thu, 23 Oct 2014 07:35:13 +0000 Purpose. To assess the consistency of anterior segment measurements obtained using a Sirius Scheimpflug/Placido photography-based topography system (CSO, Italy) and IOLMaster partial coherence interferometry (Carl Zeiss Meditec, Germany) in eyes with cataracts. Methods. A total of 90 eyes of 90 patients were included in this prospective study. The anterior chamber depth (ACD), keratometry (K), corneal astigmatism axis, and white to white (WTW) values were randomly measured three times with Sirius and IOLMaster. Concordance between them was assessed by calculating 95% limits of agreement (LoA). Results. The ACD and K taken with the Sirius were statistically significantly higher than that taken with the IOLMaster; however, the Sirius significantly underestimated the WTW values compared with the IOLMaster. Good agreement was found for Km and ACD measurements, with 95% LoA of −0.20 to 0.54 mm and −0.16 to 0.34 mm, respectively. Poor agreement was observed for astigmatism axis and WTW measurements, as the 95% LoA was −23.96 to 23.36° and −1.15 to 0.37 mm, respectively. Conclusion. With the exception of astigmatism axis and WTW, anterior segment measurements taken by Sirius and IOLMaster devices showed good agreement and may be used interchangeably in patients with cataracts. Jinhai Huang, Na Liao, Giacomo Savini, Fangjun Bao, Ye Yu, Weicong Lu, Qingjie Hu, and Qinmei Wang Copyright © 2014 Jinhai Huang et al. All rights reserved. Effectiveness of Counseling Provided by Primary Care Doctors and Nurses in Increasing Glaucoma Screening Rates Sun, 19 Oct 2014 14:20:39 +0000 Introduction. An effective screening that can prevent glaucoma-related blindness largely depends on successful recruitment. This study was to assess the effectiveness of one-on-one counseling carried out by primary care doctors and nurses to increase glaucoma screening rates. Material and Methods. The study, carried out in an urban primary care center, involved 308 persons aged 35–87 years who were assigned to a doctor’s, nurse’s, or control group (, 110, and 89, resp.). Interventions by doctors and nurses included a brief one-on-one counseling session, while only a screening history was taken from controls. The number of people in each group with a positive screening status was assessed by telephone interview three months after the visit. Results. The percentage of persons in the nurse’s counseling group who claimed being subjected to screening was more than four times higher than in the control group (20.9% versus 4.5%, ). The doctor’s interventions resulted in almost a tripled screening rate as compared to the control group (12.8% versus 4.5%, ). There was no significant difference between screening rates in doctor’s and nurse’s groups . Conclusions. In the studied population, counseling provided by nurses proved to be an efficacious method to encourage patients to undergo glaucoma screening. Witold Rezner, Anna Rezner, and Sławomir Dutkiewicz Copyright © 2014 Witold Rezner et al. All rights reserved. Prevalence of and Risk Factors for Dry Eye Symptom in Mainland China: A Systematic Review and Meta-Analysis Wed, 15 Oct 2014 07:29:51 +0000 Purpose. To evaluate the pooled prevalence rate and risk factors of dry eye symptoms (DES) in mainland China. Methods. All the published population-based studies investigating the prevalence of DES in China were searched and evaluated against inclusion criteria. A systematic review and meta-analysis were performed. Results. Twelve out of the 119 identified studies were included in the meta-analysis. The pooled prevalence of DES in China was 17.0%. Female individuals, subjects living in the Northern and Western China, and over 60 years of age had significantly higher prevalent rates (21.6%, 17.9%, 31.3%, and 34.4%, resp.) compared with their counterparts. Patients with diabetes were also found to be more vulnerable to DES. Conclusions. The pooled prevalence rate of DES in mainland China was lower than that in other Asian regions and countries. A remarkable discrepancy in the prevalence in different geographic regions was noted. Aging, female gender, and diabetes were found to be risk factors for DES in China. Ning-ning Liu, Lei Liu, Jun Li, and Yi-zhou Sun Copyright © 2014 Ning-ning Liu et al. All rights reserved. A Method for En Face OCT Imaging of Subretinal Fluid in Age-Related Macular Degeneration Mon, 13 Oct 2014 08:12:01 +0000 Purpose. The purpose of the study is to report a method for en face imaging of subretinal fluid (SRF) due to age-related macular degeneration (AMD) based on spectral domain optical coherence tomography (SDOCT). Methods. High density SDOCT imaging was performed at two visits in 4 subjects with neovascular AMD and one healthy subject. En face OCT images of a retinal layer anterior to the retinal pigment epithelium were generated. Validity, repeatability, and utility of the method were established. Results. En face OCT images generated by manual and automatic segmentation were nearly indistinguishable and displayed similar regions of SRF. En face OCT images displayed uniform intensities and similar retinal vascular patterns in a healthy subject, while the size and appearance of a hypopigmented fibrotic scar in an AMD subject were similar at 2 visits. In AMD subjects, dark regions on en face OCT images corresponded to reduced or absent light reflectance due to SRF. On en face OCT images, a decrease in SRF areas with treatment was demonstrated and this corresponded with a reduction in the central subfield retinal thickness. Conclusion. En face OCT imaging is a promising tool for visualization and monitoring of SRF area due to disease progression and treatment. Fatimah Mohammad, Justin Wanek, Ruth Zelkha, Jennifer I. Lim, Judy Chen, and Mahnaz Shahidi Copyright © 2014 Fatimah Mohammad et al. All rights reserved. Long-Term Outcome after Vitrectomy for Macular Edema with Retinal Vein Occlusion Dividing into the Occlusion Site Mon, 13 Oct 2014 07:53:50 +0000 Purpose. To investigate the efficacy of treatment for macular edema secondary to retinal vein occlusion (RVO) with vitrectomy. Methods. This retrospective study identified patients with macular edema associated with RVO between January 2004 and April 2006. Inclusion criteria were eyes with (1) preoperative visual acuity (VA) of 20/40 or worse, (2) a central foveal thickness (CFT) greater than 250 μm, and (3) vitrectomy with internal limiting membrane and intravitreal triamcinolone acetonide. Each patient had their RVO classified as a major or macular BRVO or hemispheric RVO (HSRVO). Results. Forty-six eyes with major BRVO, 18 eyes with macular BRVO, and 17 eyes with HSRVO were investigated. VA was significantly improved at 24 months after surgery for each group . Vision in the macular BRVO group 24 months after surgery was significantly better than that in other groups . For each group, a concomitant reduction of CFT was noted at every time point when compared to preoperative values . Conclusions. In macular BRVO, the postoperative vision 24 months after surgery was significantly better than the other groups. These findings suggest that additional and earlier treatments might be more important for patients with major BRVO and HSRVO than for those with macular BRVO. Takeshi Iwase and Brian C. Oveson Copyright © 2014 Takeshi Iwase and Brian C. Oveson. All rights reserved. Laser-Based Strategies to Treat Diabetic Macular Edema: History and New Promising Therapies Mon, 22 Sep 2014 08:52:06 +0000 Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. The management of DME is complex and often various treatment approaches are needed. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal pharmacologic therapies (e.g., corticosteroids and anti-VEGF drugs), laser photocoagulation still remains the current standard in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME and describe the developments in laser systems. And we will also discuss the new laser techniques and review the latest results including benefits of combined therapy. In this paper, we briefly summarize the major laser therapeutics for the treatment of diabetic macular edema and allude to some future promising laser therapies. Young Gun Park, Eun Yeong Kim, and Young Jung Roh Copyright © 2014 Young Gun Park et al. All rights reserved. Corneal Biomechanical Changes after Crosslinking for Progressive Keratoconus with the Corneal Visualization Scheimpflug Technology Mon, 22 Sep 2014 06:44:24 +0000 Purpose. To evaluate the effect of corneal crosslinking in progressive keratoconus by applying in vivo corneal visualization Scheimpflug technology. Design. Longitudinal retrospective study. Subjects and Controls. Seventeen eyes of patients treated with corneal crosslinking for progressive keratoconus. Methods. Corneal visualization Scheimpflug technology analyses (research software version 6.07r08) of subjects with progressive keratoconus before and 3 months after corneal crosslinking (CXL) were reviewed retrospectively. t-test (for normal distribution) and Wilcoxon matched-pairs test (if not normally distributed) were used to test for statistically significant differences between pre- and post-CXL analyses. Results. We demonstrated statistically significant differences for the intraocular pressure (median: +3 mmHg, ), the central corneal pachymetry (pachy; mean: −35 µm, ), the timespan between the air impulse release and the first applanation of the cornea (A1time; median: +0.12 ms, ), and the timespan between the air impulse release and the second applanation of the cornea (A2time; median: −37 ms, ). Conclusions. With the A1time and the A2time, we identified two parameters that demonstrated a statistically significant improvement of the biomechanical properties of the cornea after CXL. Despite the known initial decrease of the pachymetry after CXL, none of the analyzed parameters indicated a progression of the keratoconus. Johannes Steinberg, Toam Katz, Aiham Mousli, Andreas Frings, Maria K. Casagrande, Vasyl Druchkiv, Gisbert Richard, and Stephan J. Linke Copyright © 2014 Johannes Steinberg et al. All rights reserved. Posttraumatic Orbital Emphysema: A Numerical Model Tue, 16 Sep 2014 09:07:07 +0000 Orbital emphysema is a common symptom accompanying orbital fracture. The pathomechanism is still not recognized and the usually assumed cause, elevated pressure in the upper airways connected with sneezing or coughing, does not always contribute to the occurrence of this type of fracture. Observations based on the finite model (simulating blowout type fracture) of the deformations of the inferior orbital wall after a strike in its lower rim. Authors created a computer numeric model of the orbit with specified features—thickness and resilience modulus. During simulation an evenly spread 14400 N force was applied to the nodular points in the inferior rim (the maximal value not causing cracking of the outer rim, but only ruptures in the inferior wall). The observation was made from to second after a strike. Right after a strike dislocations of the inferior orbital wall toward the maxillary sinus were observed. Afterwards a retrograde wave of the dislocation of the inferior wall toward the orbit was noticed. Overall dislocation amplitude reached about 6 mm. Based on a numeric model of the orbit submitted to a strike in the inferior wall an existence of a retrograde shock wave causing orbital emphysema has been found. Andrzej Skorek, Paweł Kłosowski, Łukasz Plichta, Dorota Raczyńska, Marcin Zmuda Trzebiatowski, and Paweł Lemski Copyright © 2014 Andrzej Skorek et al. All rights reserved. Outcome and Prognostic Factors for Traumatic Endophthalmitis over a 5-Year Period Mon, 15 Sep 2014 05:45:15 +0000 Purpose. To evaluate the outcome and identify the prognostic factors of traumatic endophthalmitis over a 5-year period. Methods. We reviewed the medical records of all the traumatic endophthalmities that we treated in our department over the last 5 years (2009–2013). We extracted the following parameters: age, gender, wound anatomy, associated ocular lesions, treatment, and initial and final visual acuities. We used the program SPSS version 20.0.0. for the statistical analysis of our data. Results. During the last 5 years, we treated 14 traumatic endophthalmities, representing 46.66% of all types of endophthalmities. The infection rate in open globe injuries was 8.13% and 34.78%, if an intraocular foreign body (IOFB) was associated. All the patients were males with the median age of 37 years. Initial visual acuities varied between light perception and 0.4 and the timing of treatment from a few hours to 10 days. We administered antibiotic and anti-inflammatory drugs, systemically and intravitreally, in all cases. We performed pars plana vitrectomy in 64.28% of cases. In 57.14% of cases, the final visual acuity was 0.1 or more. Conclusions. IOFBs increased significantly the risk for endophthalmitis. The worse prognostic factors were retinal detachment at presentation and delayed treatment. This trial is registered with IRCT2014082918966N1. Simona Delia Nicoară, Iulian Irimescu, Tudor Călinici, and Cristina Cristian Copyright © 2014 Simona Delia Nicoară et al. All rights reserved. Effect of Hemodialysis on Retinal Thickness in Patients with Diabetic Retinopathy, with and without Macular Edema, Using Optical Coherence Tomography Mon, 15 Sep 2014 00:00:00 +0000 Background. Effects of hemodialysis (HD) treatment on retinal thickness and macular edema are unclear. Objective. To evaluate changes in retinal thickness using optical coherence tomography (OCT) in end stage renal disease (ESRD) patients with diabetic retinopathy (DR), with and without diabetic macular edema (DME), undergoing HD. Methods. Nonrandomized prospective study. Forty eyes of DR patients with ESRD treated with HD were divided into two groups: patients with macular edema and patients without macular edema. Both eyes were analyzed. Patients underwent an ophthalmic examination including OCT measurements of retinal thickness, blood albumin and hemoglobin A1C levels, blood pressure, and body weight, 30 minutes before and after HD. Results. We found no significant effects of HD on retinal thickness among patients both with and without DME. The former showed a trend towards reduction in retinal thickness in foveal area following HD, while the latter showed an increase. There was no correlation between retinal thickness and mean blood pressure, weight, kinetic model value—, glycemic hemoglobin, or albumin levels before and after HD. Conclusions. HD has no significant effect on retinal thickness among patients with or without DME. Further studies on larger cohorts and repeated OCT examinations are needed to confirm the preliminary findings in this study. Nur Azem, Oriel Spierer, Meital Shaked, and Meira Neudorfer Copyright © 2014 Nur Azem et al. All rights reserved. The Clinical Characteristics and Surgical Outcomes of Epiblepharon in Korean Children: A 9-Year Experience Sun, 14 Sep 2014 09:17:58 +0000 Purpose. To examine the demographic characteristics, clinical features, surgical outcomes, and long-term prognoses of epiblepharon in Korean children. Methods. Epiblepharon patients who were followed for ≥ 6 month following surgical correction between January 2005 and December 2013. The patient demographics, clinical features, concomitant disorders, surgical outcomes, and complications were retrospectively reviewed. Results. A total of 768 epiblepharon records were included in the analysis. The mean patient age was years. At presentation, 712 patients (92.8%) complained of typical epiblepharon symptoms. The mean patient age at surgery was years, with 629 patients (81.9%) on the lower lid and 72 patients (9.4%) on the upper lid and 82 patients (10.7%) undergoing surgery on both lids. The eyelid was well everted with no recurrence in 740 patients (96.4%). Conclusion. Epiblepharon frequently occurs in Korean children and is correctable with a simple surgery. Recurrence and serious complications do not occur often, and any suspicions of epiblepharon should be investigated. A thorough ocular examination can lead to a correct diagnosis and timely corrective surgery. Most procedures are successful and prevent secondary complications that often occur with uncorrected epiblepharon. Jong Soo Kim, Sang Wook Jin, Mun Chong Hur, Yoon Hyung Kwon, Won Yeol Ryu, Woo Jin Jeong, and Hee Bae Ahn Copyright © 2014 Jong Soo Kim et al. All rights reserved. Orbital Epidermoid Cysts: A Diagnosis to Consider Mon, 08 Sep 2014 12:02:11 +0000 Background. Orbital epidermoids form a rare pathological entity that is separate from dermoid cysts. They have variable clinical and radiological presentations and they should be considered in the differential diagnosis of orbital cystic lesions. This work describes the various clinical and radiological presentations of 17 cases of epidermoid cysts and the surgical outcome. Method. A prospective interventional study was conducted on 17 patients diagnosed with epidermoid cysts. Patients’ symptoms and signs were recorded; CT scan was done for all patients. All lesions were removed through anterior orbitotomy and histopathological diagnosis confirmed. Results. Mean age of patients was 16.3 years . Main complaints were lid swelling, masses, ocular dissimilarity, chronic pain, and ocular protrusion. Clinical signs varied from lid swelling and masses in all cases to proptosis, globe displacement, limitation of ocular motility, and scars. Radiological findings ranged from homogenous hypodense masses (58.8%) to homogenous radiolucent (17.6%) and heterogenous masses (23.5%). No recurrences following surgeries were reported throughout the follow-up (mean 18.8 months ). Conclusion. Deep orbital epidemoid cysts are a separate entity that can behave like deep orbital epidermoid; however, they usually present at a relatively older age. They can be associated with increased orbital volume but not necessarily related to bony sutures. Rania A. Ahmed and Rasha M. Eltanamly Copyright © 2014 Rania A. Ahmed and Rasha M. Eltanamly. All rights reserved. Clinical Outcomes after Complete Intracorneal Ring Implantation and Corneal Collagen Cross-Linking in an Intrastromal Pocket in One Session for Keratoconus Mon, 08 Sep 2014 09:06:11 +0000 Purpose. The aim of this work was to evaluate the results after combined surgery implantation of full rings and CXL in one session in a group of patients with keratoconus during a 12-month follow-up. Material and Methods. The study included 22 eyes of 20 keratoconic patients, mean age of 28.41 (from 18 to 50) years. A full ring was inserted and afterwards 0.1% riboflavin solution was injected into the corneal pocket through the incision tunnel. The cornea was irradiated with UV-A light for 30 minutes. Postoperative visits were scheduled for the first week and months 1, 3, 6, 12, and 24 after surgery. Minimal follow-up time was 12 months. Results. The mean UDVA improved by 6 lines from before the operation to 1 year after the operation, the mean CDVA improved by approximately 2.5 lines, and the mean K improved by 3.94 D. Statistically significant reductions of sphere , cylinder , and spherical equivalents were found 1 month after surgery. Conclusion. The combined surgery MyoRing implantation and CXL seems to be a safe method in the treatment of keratoconus. We noticed an improvement of the refractive error in all of our patients. Pavel Studeny, Deli Krizova, and Zbynek Stranak Copyright © 2014 Pavel Studeny et al. All rights reserved.