Journal of Ophthalmology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Differences in Surgical Management of Corneal Perforations, Measured over Six Years Thu, 23 Feb 2017 13:04:45 +0000 Purpose. To report the surgical approach, anatomical and functional results, and complications in the group of patients with corneal perforation. Materials and Methods. 247 eyes with corneal perforation were operated on between January 2010 and July 2016. The three surgical procedures, dependent on size and location of perforation, were performed: full-sized penetrating keratoplasty, corneoscleral patch graft, and anterior lamellar keratoplasty. The eyes underwent the minimum 6-month follow-up visit. Results. Between January 2010 and July 2016, 247 surgeries were performed: 116 penetrating keratoplasties, 117 corneoscleral patch grafts, and 14 anterior lamellar keratoplasties. More than one procedure was necessary in 32 eyes. Final improvement of the visual acuity, within a gain of 2 or more lines with the Snellen test, was achieved in 56 operated eyes. To achieve better final visual acuity, 75 eyes required successive surgical treatment. Complications of the surgery comprised persistent epithelial defect, glaucoma or ocular hypertension, corneal oedema, graft melting, loose corneal sutures, reinfection, anterior synechiae and fibrinoid membranes, and endophthalmitis. In 26 eyes, the treatment failure was reported. Conclusions. There is no one general-purpose surgical technique to treat corneal perforations. The complex nature of this pathology remains the individual, careful but also very distinct and multifactorial approach. Katarzyna Krysik, Dariusz Dobrowolski, Anita Lyssek-Boron, Judyta Jankowska-Szmul, and Edward A. Wylegala Copyright © 2017 Katarzyna Krysik et al. All rights reserved. Combination of Navigated Macular Laser Photocoagulation and Anti-VEGF Therapy: Precise Treatment for Macular Edema under Dry Retinal Conditions Mon, 20 Feb 2017 10:01:06 +0000 Purpose. To compare the controllability of navigated macular laser photocoagulation (MLP) in dry versus edematous retina and validate that pretreatment diagnostic images can be used as basis for navigated MLP after the macular edema (ME) has been resolved. Materials and Methods. Group 1 was divided into subgroup 1 (dry retina MLP) and subgroup 2 (MLP in ME) for comparisons of laser-burn diameters. In group 2, the areas and locations of ME before an intravitreal injection of anti-VEGF (IVAV) were compared with those of recurrent ME. Results. The average actual diameter as percentage of planned diameter of laser burn in subgroup 1 (11 DME eyes, 6 BRVO eyes) versus subgroup 2 (5 DME eyes, 8 BRVO eyes) was 115.1 ± 9.1% versus 167.2 ± 13.8% (based on retro-mode scanning laser ophthalmoscopy), and 118.1 ± 14.8% versus 176.1 ± 11.6% (based on OCT) (). In group 2 (6 DME eyes, 6 BRVO eyes), difference in mean ME area before IVAV and that in recurrent edema was insignificant (). Conclusion. The controllability of navigated MLP in dry retina is improved compared to edematous retina. This study validates that pretreatment diagnostic images can be used as basis for navigated MLP after the edema has been resolved. Ernest V. Boiko and Dmitrii S. Maltsev Copyright © 2017 Ernest V. Boiko and Dmitrii S. Maltsev. All rights reserved. Comparison of Progression Rate of Retinal Pigment Epithelium Loss in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab and Aflibercept Mon, 20 Feb 2017 09:58:05 +0000 Purpose. Retinal pigment epithelium (RPE) loss in neovascular age-related macular degeneration (nAMD) seem to have a linear progression but might be influenced by the treatment. The purpose of the study is the comparison of RPE loss over three years in patients treated with intravitreal ranibizumab to patients who were switched to aflibercept. Methods. A retrospective analysis with 96 eyes switched to aflibercept was conducted. The progression rate of RPE loss was evaluated in patients who showed atrophy one year prior to switch () or on switch date (). The RPE loss was evaluated by spectral domain optical coherence tomography (SD-OCT). Further, 22 eyes from patients treated with ranibizumab were compared. Results. The median yearly progression of RPE loss after square root transformation showed no significant difference in the year prior to switch compared to the year after switch (). In patients who received only ranibizumab, the median yearly progression of RPE loss was 0.15 mm/y, for aflibercept patients, 0.13 mm/y. This difference was not statistically significant (). Conclusions. There seems to be a linear progression rate of RPE loss in patients treated with ranibizumab as well as in patients with aflibercept. No significant increase of progression rate was found after switch to aflibercept. Juliana Wons, Magdalena A. Wirth, Nicole Graf, Matthias D. Becker, and Stephan Michels Copyright © 2017 Juliana Wons et al. All rights reserved. Correlation Analysis of Ocular Symptoms and Signs in Patients with Dry Eye Mon, 20 Feb 2017 07:17:34 +0000 Purpose. To analyze the correlations between the ocular surface signs and symptoms in patients with dry eye. Methods. In this observational study, 176 dry eye patients, including 60 males and 116 females, were enrolled and their dry eye symptoms and ocular signs were observed. Partial correlation analysis was conducted between OSDI score and each ocular surface sign, and the correlations were further discussed in different age groups. Then multiple linear regression analysis was used to further explore the influence of these signs on OSDI score. Results. Our correlation analyses showed that rounding of lid margins, notching of lid margins, vascularity of lid margins, hyperkeratinization, plugging of orifices, main duct dropout, and conjunctival congestion all had a positive correlation with OSDI score, while main duct number (central 1 cm) and BUT had a negative one. Further analysis suggested that these correlations varied in different age groups. Multiple linear regression analysis indicated that main duct number (central 1 cm), rounding of lid margins, and hyperkeratinization significantly affected OSDI score. Conclusions. Close attention should be paid to the morphology and structure of the eyelid margin and the function of meibomian gland in the diagnosis, treatment, and follow-up of dry eye diseases. Hang Song, Mingzhou Zhang, Xiaodan Hu, Kaixiu Li, Xiaodan Jiang, Yan Liu, Huibin Lv, and Xuemin Li Copyright © 2017 Hang Song et al. All rights reserved. Retinal Vessel Density in Optical Coherence Tomography Angiography in Optic Atrophy after Nonarteritic Anterior Ischemic Optic Neuropathy Sun, 19 Feb 2017 10:17:24 +0000 Aims. To compare optical coherence tomography angiography (OCT-A) retinal vasculature measurements between normal and optic atrophy after nonarteritic anterior ischemic optic neuropathy (NAION) subjects. Design. This prospective observational study was conducted between July 2015 and August 2016 at the ophthalmology outpatient department of a referral center in Taiwan. Peripapillary (4.5 × 4.5 mm) and parafoveal (6 × 6 mm) OCT-A scans were acquired. Measurements of the peripapillary region were obtained in two areas: (1) circumpapillary vessel density (cpVD) and (2) whole enface image vessel density (wiVD). Results. 13 participants with optic atrophy after NAION had lower peripapillary vessel density than the 18 age-matched participants in the healthy control (HC) group ( for both cpVD and wiVD). However, the parafoveal vessel density was not significantly different between the two groups (). The areas under the receiver operating characteristic curve for the HC and NAION eyes were 0.992 for cpVD and 0.970 for wiVD. cpVD and wiVD were significantly correlated with the average retinal nerve fiber layer thickness ( for both). Conclusion. Peripapillary retinal perfusion is significantly decreased in optic atrophy after NAION. OCT-A may aid in the understanding of structure-function-perfusion relationships in NAION. Chun-Hsiu Liu, Ling-Yuh Kao, Ming-Hui Sun, Wei-Chi Wu, and Henry Shen-Lih Chen Copyright © 2017 Chun-Hsiu Liu et al. All rights reserved. Clinical Characteristics of Patients with Newly Diagnosed Diabetic Macular Edema in Turkey: A Real-Life Registry Study—TURK-DEM Sun, 19 Feb 2017 10:09:45 +0000 Purpose. To evaluate the clinical and diagnostic characteristics of patients with newly diagnosed diabetic macular edema (DME) in Turkey in a real-life setting. Methods. A total of 945 consecutive patients (mean (SD) age: 61.3 (9.9) years, 55.2% male) with newly diagnosed DME were included. Data on patient demographics, comorbidities, ocular history, ophthalmic examination findings including type of DME, central macular thickness (CMT) via time domain (TD) and spectral domain (SD) optical coherence tomography (OCT), and planned treatments were recorded. Results. OCT (98.8%) and fundoscopy (92.9%) were the two most common diagnostic methods. Diffuse and focal DMEs were detected in 39.2% and 36.9% of cases, respectively. Laser photocoagulation (32.1%) and antivascular endothelial growth factors (anti-VEGF; 31.8%) were the most commonly planned treatments. The median CMT in the right eye was significantly greater in untreated than in treated patients [376.5 μm (range: 160–840) versus 342 μm (range: 146–999) ()] and in the left eye [370 μm (range: 201–780) versus 329 μm (range: 148–999) ()]. Conclusions. This study is the first large-scale real-life registry of DME patients in Turkey. SD-OCT and fundoscopy were the most common diagnostic methods. Laser photocoagulation and anti-VEGF therapy were the most common treatments. Bora Eldem, Sengul Ozdek, Ali Osman Saatci, Emin Ozmert, Esat Ulay, and Gulsah Nomak Copyright © 2017 Bora Eldem et al. All rights reserved. Visual Motor and Perceptual Task Performance in Astigmatic Students Wed, 15 Feb 2017 07:46:23 +0000 Purpose. To determine if spectacle corrected and uncorrected astigmats show reduced performance on visual motor and perceptual tasks. Methods. Third through 8th grade students were assigned to the low refractive error control group (astigmatism < 1.00 D, myopia < 0.75 D, hyperopia < 2.50 D, and anisometropia < 1.50 D) or bilateral astigmatism group (right and left eye ≥ 1.00 D) based on cycloplegic refraction. Students completed the Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) and Visual Perception (VMIp). Astigmats were randomly assigned to testing with/without correction and control group was tested uncorrected. Analyses compared VMI and VMIp scores for corrected and uncorrected astigmats to the control group. Results. The sample included 333 students (control group 170, astigmats tested with correction 75, and astigmats tested uncorrected 88). Mean VMI score in corrected astigmats did not differ from the control group (). Uncorrected astigmats had lower VMI scores than the control group () and corrected astigmats (). Mean VMIp scores for uncorrected () and corrected astigmats () did not differ from the control group. Uncorrected astigmats had lower mean scores than the corrected astigmats (). Conclusions. Uncorrected astigmatism influences visual motor and perceptual task performance. Previously spectacle treated astigmats do not show developmental deficits on visual motor or perceptual tasks when tested with correction. Erin M. Harvey, J. Daniel Twelker, Joseph M. Miller, Tina K. Leonard-Green, Kathleen M. Mohan, Amy L. Davis, and Irene Campus Copyright © 2017 Erin M. Harvey et al. All rights reserved. Eye-Tracking as a Tool to Evaluate Functional Ability in Everyday Tasks in Glaucoma Wed, 15 Feb 2017 00:00:00 +0000 To date, few studies have investigated the eye movement patterns of individuals with glaucoma while they undertake everyday tasks in real-world settings. While some of these studies have reported possible compensatory gaze patterns in those with glaucoma who demonstrated good task performance despite their visual field loss, little is known about the complex interaction between field loss and visual scanning strategies and the impact on task performance and, consequently, on quality of life. We review existing approaches that have quantified the effect of glaucomatous visual field defects on the ability to undertake everyday activities through the use of eye movement analysis. Furthermore, we discuss current developments in eye-tracking technology and the potential for combining eye-tracking with virtual reality and advanced analytical approaches. Recent technological developments suggest that systems based on eye-tracking have the potential to assist individuals with glaucomatous loss to maintain or even improve their performance on everyday tasks and hence enhance their long-term quality of life. We discuss novel approaches for studying the visual search behavior of individuals with glaucoma that have the potential to assist individuals with glaucoma, through the use of personalized programs that take into consideration the individual characteristics of their remaining visual field and visual search behavior. Enkelejda Kasneci, Alex A. Black, and Joanne M. Wood Copyright © 2017 Enkelejda Kasneci et al. All rights reserved. The Effect of High Intensity Focused Ultrasound Keratoplasty on Rabbit Anterior Segment Thu, 09 Feb 2017 00:00:00 +0000 Purpose. To evaluate the safety of high-intensity focused ultrasound keratoplasty as a treatment for presbyopia by examining its effect on the rabbit anterior segment. Methods. The right corneas of 36 New Zealand rabbits were treated with HIFU keratoplasty. The animals were sacrificed at 1, 7, 15, 30, 60, and 90 days after operation. Collagen type I, MMP-2, and MMP-9 were evaluated using immunohistochemistry. For the detection of apoptosis, the TUNEL method was applied. The SOD and MDA levels were analyzed with assay kits. Results. Collagen type I, MMP-2, and MMP-9 levels were altered after the operation but returned to normal within 90 days. The apoptotic index (AI) of the corneal cells decreased from 1 to 30 days gradually. No apoptosis was observed in the epithelial cells of the lens, and the SOD and MDA levels were normal at any time point. Conclusion. After HIFU keratoplasty, the histomorphology of the cornea changed, the corneal collagen type I levels decreased, the corneal MMP-2 and MMP-9 levels increased, and the corneal cells underwent apoptosis for a period of time. Ninety days after the operation, the levels returned to normal, and the lenses were not affected. Thus, HIFU presents good biological safety for eyes. Menglei Wang, Meixuan Li, Pisong Yan, Qiang Luo, Yu Zhang, and Zhiyu Du Copyright © 2017 Menglei Wang et al. All rights reserved. Influence of Tear Protein Deposition on the Oxygen Permeability of Soft Contact Lenses Thu, 09 Feb 2017 00:00:00 +0000 Purpose. To investigate the effect of tear protein deposition on the change in oxygen permeability (Dk) of soft contact lenses (SCL). Methods. Three hydrogel lenses (polymacon, nelfilcon A, and etafilcon A) and two silicon hydrogel lenses (lotrafilcon A and balafilcon A) were investigated. Etafilcon A lenses were incubated in artificial tear solution for 1, 6, 12, and 48 h, whereas the other SCL were incubated for 1, 3, 7, and 14 days. Oxygen permeability was measured using the polarographic method, and lenses were stacked in four layers to correct the boundary effect. Results. The Dk of all investigated SCL was decreased by the protein deposition. Silicone hydrogel lenses showed a smaller deposition of artificial tear proteins than conventional hydrogel lenses. However, their Dk was reduced twofold than those of 3 conventional hydrogel lenses when compared at the same level of protein deposition. Despite a large amount of total deposited protein in etafilcon A lenses, their Dk was more stable than other SCL. Conclusions. From the results, it was revealed that the Dk of SCL is different from the value provided by manufacturers because of the tear protein deposition on surface and/or in pore of SCL; however, the degree of Dk change in SCL was not simply correlated with the amount of tear protein deposition. Thus, it is considered that the correlation between tear protein deposition and properties of lens materials affects Dk change. Se Eun Lee, So Ra Kim, and Mijung Park Copyright © 2017 Se Eun Lee et al. All rights reserved. Safety and Efficacy of Two Trabecular Micro-Bypass Stents as the Sole Procedure in Japanese Patients with Medically Uncontrolled Primary Open-Angle Glaucoma: A Pilot Case Series Tue, 07 Feb 2017 00:00:00 +0000 Purpose. To evaluate efficacy and safety of a trabecular micro-bypass stent system when used as the sole procedure in Japanese patients with medically uncontrolled primary open-angle glaucoma (POAG). Design. Prospective nonrandomized interventional pilot study. Methods. Ten eyes of 10 Japanese patients with medically uncontrolled POAG taking three ocular hypotensive medications were treated using only the implantation of two iStent trabecular micro-bypass stents. Each patient continued to take the same ocular hypotensive medications used preoperatively throughout the study. Intraocular pressure (IOP) and endothelial cell density (ECD) were determined at baseline and at 1, 3, and 6 months postoperatively. Best-corrected visual acuity (BCVA) was measured at baseline and 6 months after surgery. Results. Mean IOP was  mmHg at baseline and  mmHg at 6 months, which represented a mean reduction of 5.1 mmHg or 23.2%. No significant changes were observed in the ECD and BCVA. Complications that occurred during the early postoperative period included hyphema, peripheral anterior synechiae, and occlusion of the stent by the iris. Conclusion. Implantation of two trabecular micro-bypass stents as the sole procedure in Japanese POAG patients effectively reduced IOP and exhibited a favorable safety profile. Clinical Trials Registration number is UMIN000004002. Daisuke Shiba, Shingo Hosoda, Saori Yaguchi, Naoki Ozeki, Kenya Yuki, and Kazuo Tsubota Copyright © 2017 Daisuke Shiba et al. All rights reserved. Comprehensive Evaluation of Anterior Corneal Change in Asphericity Calculated by the Tangential Radius of Curvature after LASIK Mon, 06 Feb 2017 00:00:00 +0000 To evaluate the change in the anterior corneal asphericity (Δ) comprehensively calculated using the tangential radius () after LASIK. Forty-two right eyes were evaluated using the Orbscan II corneal topographer. The pre- and postoperative -values of the flat principal semimeridians calculated by the sagittal radius were compared to those by the tangential radius. The -value of each semimeridian in the horizontal region was calculated by . Fourier fitting was used to model the 360-semimeridional variation of -values and to fit the -values in the vertical region before and after surgery. There were significant differences in -values between the two methods before () and after surgery (). A significant increase in postoperative -value was detected compared to preoperative -value () calculated by . The 360-semimeridional variation of the -values was well fitted with a third- and fourth-degree Fourier function before and after surgery. The Δ-value distribution presented double valley variation, with the amount of Δ being lowest in the near-vertical regions and highest in the near-horizontal regions. Calculating the -value with combined with Fourier fitting, we evaluated 360 Δ-values’ variation of semimeridians of the entire anterior corneal surface and then displayed true and complete anterior corneal shape after LASIK. Jinglu Ying, Jianqiu Cai, Leru Zhu, and Yi Zha Copyright © 2017 Jinglu Ying et al. All rights reserved. Keraring Intrastromal Segment Depth Measured by Spectral-Domain Optical Coherence Tomography in Eyes with Keratoconus Thu, 02 Feb 2017 07:54:54 +0000 Purpose. To evaluate agreement between measured and intended distance of Keraring (Mediphacos, Belo Horizonte, Brazil) intracorneal ring segments from the anterior and posterior corneal surfaces. Methods. Twenty-six Keraring ICRS implanted in 24 keratoconic eyes were examined. The distance from the Keraring apex to the anterior corneal surface and the distance from the inner and the outer corners to the posterior corneal surface were measured 3 months postoperatively using spectral-domain optical coherence tomography. Agreement between measured distance and intended distance was assessed by calculating the absolute differences and 95% limits of agreement (95% LoA). Results. The mean absolute difference was significantly lower () for the measurements taken at the inner corner ( μm) than that for those taken at the apex ( μm) and the outer corner ( μm). The measurements taken at the inner corner were within ±25 and ±50 μm of the intended distance in 15/26 (57.7%) and 24/26 (92.3%) cases, respectively, and showed the narrowest 95% LoA with the intended distance (−57.61 to 55.15 μm). Conclusions. The distance of the inner corner from the posterior corneal surface showed the best agreement with the intended distance. This measurement is suitable for determining whether the actual Keraring depth matches the intended depth. Ugo de Sanctis, Carlo Lavia, Marco Nassisi, and Savino D’Amelio Copyright © 2017 Ugo de Sanctis et al. All rights reserved. Quantitative Assessment of the Impact of Blood Pulsation on Intraocular Pressure Measurement Results in Healthy Subjects Mon, 30 Jan 2017 06:49:31 +0000 Background. Blood pulsation affects the results obtained using various medical devices in many different ways. Method. The paper proves the effect of blood pulsation on intraocular pressure measurements. Six measurements for each of the 10 healthy subjects were performed in various phases of blood pulsation. A total of 8400 corneal deformation images were recorded. The results of intraocular pressure measurements were related to the results of heartbeat phases measured with a pulse oximeter placed on the index finger of the subject’s left hand. Results. The correlation between the heartbeat phase measured with a pulse oximeter and intraocular pressure is (). The phase shift calculated for the maximum correlation is equal to ° (). When the moment of measuring intraocular pressure with an air-puff tonometer is not synchronized, the changes in IOP for the analysed group of subjects can vary in the range of ±2.31 mmHg (). Conclusions. Blood pulsation has a statistically significant effect on the results of intraocular pressure measurement. For this reason, in modern ophthalmic devices, the measurement should be synchronized with the heartbeat phases. The paper proposes an additional method for synchronizing the time of pressure measurement with the blood pulsation phase. Robert Koprowski and Lei Tian Copyright © 2017 Robert Koprowski and Lei Tian. All rights reserved. Efficacy and Tolerability of Travoprost 0.004/Timolol 0.5 Fixed-Dose Combination for the Treatment of Primary Open-Angle Glaucoma or Ocular Hypertension Inadequately Controlled with Beta-Blocker Monotherapy Mon, 23 Jan 2017 05:58:40 +0000 Objective. To evaluate the efficacy and tolerability of travoprost 0.004%/timolol 0.5% fixed-dose combination (TTFC) in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) inadequately controlled on beta-blocker monotherapy. Methods. In this phase IV, open-label study, 156 patients on beta-blocker monotherapy with mean intraocular pressure (IOP) between 18 and 32 mmHg were randomized (no washout period) to receive TTFC for 8 weeks (TTFC group) or to continue beta-blocker monotherapy for 4 weeks followed by TTFC for the remaining 4 weeks (beta-blocker group). Results. The mean IOP (±standard deviation) at baseline in the TTFC and beta-blocker groups was  mmHg and  mmHg, respectively, and at weeks 4 and 8, was  mmHg and  mmHg, respectively, in TTFC group and  mmHg and  mmHg, respectively, in the beta-blocker group. There was a significant least squares mean difference between TTFC and beta-blocker in 8 a.m. IOP at week 4 (−4.6 mmHg; one-sided 95% confidence interval [−inf, −3.9]; [primary endpoint]); the upper bound of the 95% confidence interval was within the prespecified limit (<0). Both treatments were well tolerated. Conclusion. Superior IOP control was achieved with TTFC in patients with OAG or OHT previously uncontrolled with beta-blockers. No new safety findings were identified. This trial is registered with NCT02003391. Simon Fabian Lerner, Ki Ho Park, Douglas A. Hubatsch, Valeriy Erichev, Jose A. Paczka, and Timothy V. Roberts Copyright © 2017 Simon Fabian Lerner et al. All rights reserved. Current Management of Traumatic Macular Holes Mon, 23 Jan 2017 00:00:00 +0000 Traumatic macular hole (TMH) is not a rare clinical condition, especially in young population. Its prognosis is of complexity and uncertainty, with a relatively high rate of spontaneous closure in some cases. Modern vitrectomy surgery plays an important role in the treatment of TMH, although the functional outcomes may be compromised by the concomitant retinal pathologies. Decision-making about the time of vitrectomy, especially in pediatric patients, remains to be clarified further. Wu Liu and Andrzej Grzybowski Copyright © 2017 Wu Liu and Andrzej Grzybowski. All rights reserved. Comparison of Maximum Stretch Forces between Femtosecond Laser-Assisted Capsulotomy and Continuous Curvilinear Capsulorhexis Sun, 22 Jan 2017 00:00:00 +0000 The current study reports comparing the postoperative mechanical properties of the anterior capsule between femtosecond laser capsulotomy (FLC) and continuous curvilinear capsulorhexis (CCC) of variable size and shape in porcine eyes. All CCCs were created using capsule forceps. Irregular or eccentric CCCs were also created to simulate real cataract surgery. For FLC, capsulotomies 5.3 mm in diameter were created using the LenSx® (Alcon) platform. Fresh porcine eyes were used in all experiments. The edges of the capsule openings were pulled at a constant speed using two L-shaped jigs. Stretch force and distance were recorded over time, and the maximum values in this regard were defined as those that were recorded when the capsule broke. There was no difference in maximum stretch force between CCC and FLC. There were no differences in circularity between FLC and same-sized CCC. However, same-sized CCC did show significantly higher maximum stretch forces than FLC. Teardrop-shaped CCC showed lower maximum stretch forces than same-sized CCC and FLC. Heart-shaped CCC showed lower maximum stretch forces than same-sized CCC. Conclusively, while capsule edge strength after CCC varied depending on size or irregularities, FLC had the advantage of stable maximum stretch forces. Mari Takagi, Takashi Kojima, Kei Ichikawa, Yoshiki Tanaka, Yukihito Kato, Rie Horai, Akeno Tamaoki, and Kazuo Ichikawa Copyright © 2017 Mari Takagi et al. All rights reserved. Refractive, Topographic, and Aberrometric Results at 2-Year Follow-Up for Accelerated Corneal Cross-Link for Progressive Keratoconus Wed, 18 Jan 2017 09:10:27 +0000 Purpose. To report the visual, refractive, and corneal topography and wavefront aberration results of accelerated corneal cross-linking (CXL) during a 24-month follow-up. Methods. Forty-seven eyes underwent riboflavin-ultraviolet A-induced accelerated CXL treatment (30 mW/cm2 with a total dose of 7.2 joules/cm2). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical values, keratometry () measurements (, , , and ), central corneal thickness, and anterior corneal aberrometric analyses including total wavefront error (WFE), total high order aberration (HOA), astigmatism, trefoil, coma, quadrafoil, secondary astigmatism, and spherical aberration were evaluated. Results. The mean UDVA and CDVA were significantly improved at 1 ( and , resp.) and 2 years after treatment ( and , resp.). The mean , , , and values were significantly lower than baseline at 12 months (, , , and , resp.) and 24 months (, , , and , resp.). Corneal thickness showed a significant decrease at 1 month. Total HOA and coma decreased significantly at the 12-month ( and , resp.) and 24-month visits ( and , resp.). Conclusion. Accelerated CXL (30 mW/cm2) was found to be effective in improving UDVA, CDVA, corneal topography readings, total HOA, and coma aberrations during the 24-month follow-up. Ercüment Bozkurt, Engin Bilge Ozgurhan, Betul Ilkay Sezgin Akcay, Tugba Kurt, Yusuf Yildirim, Zehra Karaagaç Günaydin, and Ahmet Demirok Copyright © 2017 Ercüment Bozkurt et al. All rights reserved. Vision Loss and Recovery after Baerveldt Aqueous Tube Shunt Implantation Wed, 18 Jan 2017 06:17:52 +0000 This study aims to determine the course of vision loss after Baerveldt aqueous tube shunt placement and identify risk factors associated with unexplained severe long-term vision loss, or snuff-out. We retrospectively reviewed 247 eyes of 222 patients who underwent Baerveldt implantations at one of two academic institutions. Postoperative vision loss at 6 months following surgery was categorized as mild-to-moderate versus severe and long-term versus transient. Long-term vision loss, defined as 3 or more lines of Snellen visual acuity (VA) loss compared with preoperative VA, occurred in 63 of 247 eyes (25.5%), and 39 had mild-to-moderate and 24 had severe loss. Of these 63 eyes, 18 had no identifiable cause of vision loss. On multivariate analysis, poorer Snellen VA on postoperative day 1 (POD1) was found to be a significant risk factor for long-term vision loss (). In addition, the negative change in preoperative versus POD1 Snellen VA () and the presence of split fixation involving the inferonasal quadrant on preoperative Humphrey visual field () were significant risk factors for snuff-out. Transient vision loss occurred in 76 of 242 eyes (30.8%). In conclusion, vision loss is not uncommon after Baerveldt surgery, with snuff-out occurring in 2.4% of cases in this study. Esther Lee Kim, Jeffrey Tran, Marc Töteberg-Harms, Jasdeep Chahal, Douglas Rhee, Vikas Chopra, and Brian Francis Copyright © 2017 Esther Lee Kim et al. All rights reserved. Video-Assisted Informed Consent for Cataract Surgery: A Randomized Controlled Trial Mon, 16 Jan 2017 07:16:15 +0000 Purpose. To investigate whether adding video assistance to traditional verbal informed consent advisement improved satisfaction among cataract surgery patients. Methods. This trial enrolled 80 Chinese patients with age-related cataracts scheduled to undergo unilateral phacoemulsification surgery. Patients were randomized into two groups: the video group watched video explaining cataract-related consent information and rewatched specific segments of the video at their own discretion, before receiving traditional verbal consent advisement; the control group did not watch the video. Outcomes included patient satisfaction, refusal to consent, time to complete the consent process, and comprehension measured by a ten-item questionnaire. Results. All 80 enrolled patients signed informed consent forms. Compared with the control group, members of the video group exhibited greater satisfaction (65% versus 86%, ) and required less time to complete the consent process ( min versus  min, ), while also evincing levels of comprehension commensurate with those reported for patients who did not watch the video (accuracy rate, 77.5% versus 80.2%, ). Conclusion. The video-assisted informed consent process had a positive impact on patients’ cataract surgery experiences. Additional research is needed to optimize patients’ comprehension of the video. Yuehong Zhang, Xiangcai Ruan, Haoying Tang, Weizhong Yang, Zhuanhua Xian, and Min Lu Copyright © 2017 Yuehong Zhang et al. All rights reserved. Pediatric Posttraumatic Endophthalmitis in China for Twenty Years Mon, 16 Jan 2017 00:00:00 +0000 Pediatric posttraumatic endophthalmitis (PTE) is a rare but serious disease that frequently has a poor visual prognosis. To date, only a few English studies have focused on this disease. We perform a systematic review of the Chinese literature on pediatric PTE and describe the epidemiology, management, causative organisms, and visual acuity outcomes of reported cases in twenty years. We found that Staphylococcus epidermidis was the most common isolated organism and the use of a disposable syringe needle was the most common cause of ocular injuries in pediatric PTE in China. In the last ten years, the time from injury to first presentation for treatment has shortened, the proportion of cases resulting from a disposable syringe needle has decreased, the use of intravitreal antibiotics as the initial treatment has increased, and the use of palliative treatment has decreased. Although these favorable changes have occurred in the last ten years, the visual prognosis of pediatric PTE is still poor. Yan Sheng, Wen Sun, Yangshun Gu, and Andrzej Grzybowski Copyright © 2017 Yan Sheng et al. All rights reserved. Refractive Changes Induced by Strabismus Corrective Surgery in Adults Mon, 16 Jan 2017 00:00:00 +0000 Purpose. To investigate refractive changes after strabismus correction procedures among adults. Methods. Retrospective chart review of adult patients who had horizontal recti muscles surgery with preoperative and postoperative cycloplegic refraction measurements. The preoperative refraction was mathematically subtracted from the postoperative refraction, and the induced refractive changes were statistically analyzed. Vector analysis was used to examine the magnitude of the toric change. The proportion of clinically significant refractive change was evaluated as well. Results. Thirty-one eyes from 22 subjects met the criteria and were included in the final analysis. A significant postoperative refractive change of the spherical equivalent towards myopia and a change of the astigmatism in the with-the-rule direction were observed. In a subset of 9 cases a third cycloplegic refraction measurement demonstrated stable refraction compared to the 1-month postoperative measurement. In 10 cases of single eye surgery, significant refractive changes were observed only in the operated side when compared to the sound eye. The induced surgical refractive change was of clinical significance (≥0.5 D) in 11 eyes of 9 patients (40.9% of patients). Conclusions. Refractive changes are a significant side effect of horizontal strabismus corrective surgery among adults. Therefore, patients should be informed about it prior to surgery and should be rerefracted in the postoperative period. Daphna Mezad-Koursh, Ari Leshno, Tomer Ziv-Baran, and Chaim Stolovitch Copyright © 2017 Daphna Mezad-Koursh et al. All rights reserved. Translational Devices, Technologies, and Medicines in Clinical Ophthalmology Sun, 15 Jan 2017 11:46:54 +0000 George M. Saleh, M. Reza Vagefi, and Ioannis Athanasiadis Copyright © 2017 George M. Saleh et al. All rights reserved. Deep Sclerectomy with Nonabsorbable Implant (T-Flux) in Patients with Pseudoexfoliation Glaucoma Sun, 15 Jan 2017 00:00:00 +0000 Purpose. To evaluate the effectiveness of deep sclerectomy with T-flux implant (DS T-flux) in patients with pseudoexfoliation glaucoma (PExG). Methods. 20 eyes of 18 patients with medically uncontrolled PExG have undergone DS T-flux implantation. Postoperatively we evaluated the IOP values and the frequency of complications. The minimum follow-up time was 12 months (20 eyes) and the maximum 24 months (10 eyes). Results. The mean preoperative IOP was  mmHg. The IOP significantly decreased throughout all postoperative periods () and reached 1 day after surgery  mmHg; 3 months  mmHg; 12 months  mmHg; and 24 months  mmHg. Complete success rate, defined as IOP ≤ 18 mmHg without medication, was 85% (17/20 eyes) at 12 months. Qualified success rate, defined as IOP ≤ 18 mmHg with or without medication, was 100% (20/20 eyes). The most frequent postoperative complications were mild hyphaema (9 patients, 45%), choroidal detachment (3 patients, 15%), and hypotony—IOP < 5 mmHg (2 patients, 10%). Conclusions. DS with T-flux implant is a safe and effective surgical treatment method for medically uncontrolled PExG. The number of complications is low. Pavel Studeny, Alina-Dana Baxant, Jana Vranova, Pavel Kuchynka, and Jitka Pokorna Copyright © 2017 Pavel Studeny et al. All rights reserved. The Degeneration and Apoptosis Patterns of Cone Photoreceptors in rd11 Mice Thu, 12 Jan 2017 13:24:55 +0000 The retinal degeneration 11 (rd11) mouse is a new animal model with rapid photoreceptor degeneration. The long-term efficacy of gene therapy has a direct relationship with the onset of photoreceptor degeneration or apoptosis, whereas the degeneration or apoptosis patterns of photoreceptors are still unclear in rd11 mice. The distribution patterns of cone function-related L- and S-opsin were examined by immunofluorescence staining, and the apoptosis was performed by TUNEL assay in rd11 mice. The expression pattern of L-opsin or S-opsin in rd11 retina at postnatal day (P) 14 was similar to the pattern observed in wildtype retina. With increasing age, the expression of L-opsin and S-opsin, especially S-opsin, decreased significantly in rd11 mice. The degeneration of L-opsin began around the optic nerve and expanded to the periphery of the retina, from the ventral/nasal to dorsal/temporal retina, whereas the expression of S-opsin gradually decreased from the dorsal/temporal to ventral/nasal retina. Apoptotic signal appeared at P14 and was strongest at P28 of rd11 mice. The key genes associated with apoptosis confirmed those changes. These indicated that the degeneration and apoptosis of cone photoreceptors began at P14 of rd11 mice, which was a key point for gene therapy. Hua Zhang, Xia Li, Xufeng Dai, Juanjuan Han, Yangyang Zhang, Yan Qi, Ying He, Yan Liu, Bo Chang, and Ji-jing Pang Copyright © 2017 Hua Zhang et al. All rights reserved. Anti-Inflammatory and Antioxidative Stress Effects of Oryzanol in Glaucomatous Rabbits Thu, 12 Jan 2017 12:49:37 +0000 Purpose. γ-Oryzanol works by anti-inflammatory and radical scavenging activity as a neuroprotective, anticancer, antiulcer, and immunosuppressive agent. The present study was conducted to investigate effect of oryzanol in acute and chronic experimental glaucoma in rabbits. Methods. Effect of oryzanol was evaluated in 5% dextrose induced acute model of ocular hypertension in rabbit eye. Chronic model of glaucoma was induced with subconjunctival injection of 5% of 0.3 ml phenol. Treatment with oryzanol was given for next two weeks after induction of glaucoma. From anterior chamber of rabbit eye aqueous humor was collected to assess various oxidative stress parameters like malondialdehyde, superoxide dismutase, glutathione peroxidase, catalase, nitric oxide, and inflammatory parameters like TNF-α and IL-6. Structural damage in eye was examined by histopathological studies. Results. In acute model of ocular hypertension oryzanol did not alter raised intraocular pressure. In chronic model of glaucoma oryzanol exhibited significant reduction in oxidative stress followed by reduction in intraocular pressure. Oryzanol treatment reduced level of TNF-α and IL-6. Histopathological studies revealed decreased structural damage of trabecular meshwork, lamina cribrosa, and retina with oryzanol treatment. Conclusions. Oryzanol showed protective effect against glaucoma by its antioxidative stress and anti-inflammatory property. Treatment with oryzanol can reduce optic nerve damage. Shital S. Panchal, Rajesh K. Patidar, Abhishek B. Jha, Ahmed A. Allam, Jamaan Ajarem, and Shital B. Butani Copyright © 2017 Shital S. Panchal et al. All rights reserved. A Possible Regression Equation for Predicting Visual Outcomes after Surgical Repair of Open Globe Injuries Thu, 12 Jan 2017 08:08:10 +0000 Background. To analyze the effects of factors other than the ocular trauma score parameters on visual outcomes in open globe injuries. Methods. Open globe injuries primarily repaired in our hospital were reviewed. The number of surgeries, performance of pars plana vitrectomy (PPV), lens status, affected tissues (corneal, scleral, or corneoscleral), intravitreal hemorrhage, intraocular foreign body, glaucoma, anterior segment inflammation, loss of iris tissue, cutting of any prolapsed vitreous in the primary surgery, penetrating injury, and the time interval between the trauma and repair were the thirteen variables evaluated using linear regression analysis. Results. In total, 131 eyes with a mean follow-up of (12–36) months and a mean age of (4–88) years were included. The regression coefficients were 0.502, 0.960, 0.831, −0.385, and −0.506 for the performance of PPV, aphakia after the initial trauma, loss of iris tissue, penetrating injury, and cutting of any prolapsed vitreous in the primary surgery, respectively ( for these variables). Conclusions. The performance of PPV, aphakia after the initial trauma, and loss of iris tissue were associated with poor visual outcomes, whereas cutting any prolapsed vitreous in the primary repair and penetrating-type injury were associated with better visual outcomes. Huseyin Gursoy, Mustafa Deger Bilgec, Afsun Sahin, and Ertugrul Colak Copyright © 2017 Huseyin Gursoy et al. All rights reserved. Transient Peripapillary Retinoschisis in Glaucomatous Eyes Thu, 12 Jan 2017 07:23:54 +0000 Purpose. To investigate transient focal microcystic retinoschisis in glaucomatous eyes in images obtained with several imaging techniques used in daily glaucoma care. Methods. Images of 117 glaucoma patients and 91 healthy subjects participating in a large prospective follow-up study into glaucoma imaging were reviewed. Participants were measured with spectral domain optical coherence tomography (SD-OCT), scanning laser polarimetry (SLP), scanning laser tomography (SLT), and standard automated perimetry (SAP). The presence of a focal retinoschisis in SD-OCT was observed and correlated to SLP, SLT, and SAP measurements, both cross-sectionally and longitudinally. Results. Seven out of 117 glaucoma patients showed a transient, localised, peripapillary, heterogeneous microcystic schisis of the retinal nerve fiber layer (RNFL) and sometimes other retinal layers as well in SD-OCT. None of the healthy eyes showed this phenomenon nor did any of the other imaging techniques display it as detailed and consistently as did the SD-OCT. SAP showed a temporarily decreased focal retinal sensitivity during the retinoschisis and we found no signs of glaucomatous progression related to the retinoschisis. Conclusions. Transient microcystic retinoschisis appears to be associated with glaucomatous wedge defects in the RNFL. It was best observed with SD-OCT and it was absent in healthy eyes. We found no evidence that the retinoschisis predicted glaucomatous progression. Josine van der Schoot, Koenraad A. Vermeer, and Hans G. Lemij Copyright © 2017 Josine van der Schoot et al. All rights reserved. Photorefractive Keratectomy for Residual Myopia after Myopic Laser In Situ Keratomileusis Thu, 12 Jan 2017 00:00:00 +0000 Purpose. To evaluate the safety, efficacy, and predictability of photorefractive keratectomy (PRK) on the corneal flap for correction of residual myopia following myopic laser in situ keratomileusis (LASIK). Patients and Methods. A retrospective study on eyes retreated by PRK on the corneal flap for residual myopia after LASIK. All eyes had no enough stroma after LASIK sufficient for LASIK enhancement. Data included spherical equivalent (SE), uncorrected and best corrected visual acuity (UCVA and BCVA), central pachymetry, corneal higher order aberrations (HOAs), corneal hysteresis (CH), corneal resistance factor (CRF), and corneal haze. Results. The study included 64 eyes. Before PRK, the mean central pachymetry was  μm, the mean SE was − D, and the mean UCVA and BCVA were and , respectively. 12 months postoperatively, the mean central corneal thickness was  μm, the mean SE was − D (), and the mean UCVA and BCVA were () and (), respectively. The safety index was 1.01 and the efficacy index was 0.86. No significant change was observed in corneal HOAs. Conclusions. Residual myopia less than 3 D after LASIK could be safely and effectively treated by PRK and mitomycin C with a high predictability. This prevents postoperative ectasia and avoids the flap related complications but has no significant effect on HOAs. Kamal A. M. Solaiman, Sameh M. Fouda, Ashraf Bor’i, and Haitham Y. Al-Nashar Copyright © 2017 Kamal A. M. Solaiman et al. All rights reserved. Suppression of Human Tenon Fibroblast Cell Proliferation by Lentivirus-Mediated VEGF Small Hairpin RNA Wed, 11 Jan 2017 00:00:00 +0000 Purpose. The functions of vascular endothelial growth factor (VEGF) in scar formation after trabeculectomy were investigated in a human Tenon fibroblast cell line from glaucoma patients using lentivirus-mediated VEGF shRNA. Methods. Human Tenon fibroblast (HTF) cells were isolated from scar tissue of glaucoma patients during secondary surgery. Lentivirus-VEGF-shRNA was constructed and transfected into HTF cells. Subsequently, VEGF mRNA and protein expression were analyzed using quantitative RT-PCR and western blotting, respectively, and the effects of VEGF knockdown were analyzed. The inhibition of HTF proliferation was monitored according to total cell numbers using ScanArray. Results. Both mRNA and protein levels of VEGF were reduced by lentivirus-mediated VEGF-shRNA, and proliferation of HTF cells was inhibited. Conclusions. Primary cultures of human Tenon fibroblast (HTF) were established, and proliferation was decreased following inhibition of VEGF. VEGF may be a suitable therapeutic target for reducing scar tissue formation in glaucoma patients after filtration surgery. Zhongqiu Li, Wen Hua, Xuedong Li, and Wei Wang Copyright © 2017 Zhongqiu Li et al. All rights reserved.