Journal of Ophthalmology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. The Effect of CM082, an Oral Tyrosine Kinase Inhibitor, on Experimental Choroidal Neovascularization in Rats Sun, 22 Oct 2017 00:00:00 +0000 The aims of this study were to evaluate the effects of CM082 on the development of choroidal neovascularization (CNV) in a laser-induced CNV rat model and to determine the drug concentration in the ocular tissues. After the laser-induced CNV model was established in rats, CM082 was orally administered. The effects of CM082 on the CNV lesions were assessed using fundus fluorescein angiography (FFA), CNV histology, and retinal pigment epithelium- (RPE-) choroid-sclera eyecup analysis. The concentrations of CM082 in the plasma and eye tissues were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results of FFA, histology, and RPE-choroid-sclera eyecup analysis demonstrated that the CM082-treated (10 mg/kg/d or 30 mg/kg/d) rats exhibited significantly less neovascularization than did the control group. The total concentration of CM082 in the eyes (172.86 ± 57.11 ng/g) was similar to that in the plasma (196.87 ± 73.13 ng/ml). Within the eye, the concentrations of CM082 and its metabolites were highest in the retina-sclera. The orally administered CM082 thus effectively passed through the blood-retina barrier (BRB) to reach the retina in the Brown Norway rats. Therefore, at both 10 mg/kg/d and 30 mg/kg/d, CM082 was able to reduce CNV lesions in the laser-induced CNV rat model. Chengda Ren, Hui Shi, Juanjuan Jiang, Qingyu Liu, Yaru Du, Mengmei He, Wenting Cai, Qingquan Wei, and Jing Yu Copyright © 2017 Chengda Ren et al. All rights reserved. Algorithm for Correcting the Keratometric Error in the Estimation of the Corneal Power in Keratoconus Eyes after Accelerated Corneal Collagen Crosslinking Sun, 22 Oct 2017 00:00:00 +0000 Purpose. To analyze the errors associated to corneal power calculation using the keratometric approach in keratoconus eyes after accelerated corneal collagen crosslinking (CXL) surgery and to obtain a model for the estimation of an adjusted corneal refractive index minimizing such errors. Methods. Potential differences () among keratometric () and Gaussian corneal power () were simulated. Three algorithms based on the use of for the estimation of an adjusted keratometric corneal power () were developed. The agreement between (keratometric power using the keratometric index of 1.3375), , and was evaluated. The validity of the algorithm developed was investigated in 21 keratoconus eyes undergoing accelerated CXL. Results. overestimated corneal power between 0.3 and 3.2 D in theoretical simulations and between 0.8 and 2.9 D in the clinical study (). Three linear equations were defined for to be used for different ranges of r1c. In the clinical study, differences between and did not exceed ±0.8 D . No statistically significant differences were found between and () and and (). Conclusions. The use of the keratometric approach in keratoconus eyes after accelerated CXL can lead to significant clinical errors. These errors can be minimized with an adjusted keratometric approach. David P. Piñero, Vicente J. Camps, Esteban Caravaca-Arens, Dolores de Fez, and Francisco J. Blanes-Mompó Copyright © 2017 David P. Piñero et al. All rights reserved. Switch to Aflibercept in the Treatment of Neovascular AMD: Long-Term Results Thu, 19 Oct 2017 00:00:00 +0000 Purpose. To report the long-term clinical outcomes after switching from intravitreal bevacizumab or ranibizumab to aflibercept therapy in eyes with AMD. Methods. Retrospective analysis of changes in BCVA, SD-OCT image, and frequency of injections after 1, 2, and 3 years of follow-up. Results. 164 eyes were analyzed, 101 eyes switched from bevacizumab (group 1) and 63 from ranibizumab (group 2). One year after the switch, there was an overall nonsignificant mean decrease of 2 ETDRS letters in BCVA. Three years after, there was an overall mean decrease of 7 ETDRS letters, which was statistically significant. A significant improvement in the mean CRT was found at 1, 2, and 3 years. There was a significant decrease in the mean number of injections per year (7.8 to 6.5, ) between the first and third year. Conclusion. Aflibercept can be useful in the management of refractory neovascular AMD, with a good morphological response. However, in the long-term, BCVA stabilization was not achieved. Pedro Neves Cardoso, Ana Fernanda Pinheiro, Jorge Meira, Ana Catarina Pedrosa, Manuel S. Falcão, João Pinheiro-Costa, Fernando Falcão-Reis, and Ângela M. Carneiro Copyright © 2017 Pedro Neves Cardoso et al. All rights reserved. Use of OCT Angiography in Choroidal Melanocytic Tumors Thu, 19 Oct 2017 00:00:00 +0000 Objective. To describe OCTA findings in choroidal melanocytic tumors, especially the microcirculation patterns, and to try to correlate with the histopathological studies. Methods. Cross-sectional, comparative, observational study. 70 cases, including 55 choroidal nevi and 15 choroidal melanomas. Three different observers evaluated specific variables in the choriocapillaris layer on AOCT images and searched for images which described histopathologic vascular patterns, and also, a general description of the images was made. Complementary multi-imaging studies included EDI SD-OCT, color and autofluorescence fundus imaging, Doppler ultrasound, and indocyanine/fluorescein angiography. Main Results. Good quality studies were acquired in 80% of the cases, with kappa indexes 0.768–0.958. Nevus OCTA images were described mainly as hyperreflective (72.7%), whereas choroidal melanoma as iso/hyporeflective (62.5%). Avascular areas were found in 50.96% and in 33.3% of choroidal nevus and choroidal melanomas, respectively. A neovascular membrane was found only in cases of choroidal nevus (16.3%). Only in cases of choroidal melanomas, we found vascular loops (6.6%) or vascular networks (6.6%). Conclusion. OCTA is a promising new technology that can be used to study in vivo the differential characteristics of microcirculations between posterior segment melanocytic lesions. Today, larger studies are needed to corroborate these findings and to correlate it with malignancy. Juan J. Toledo, Mónica Asencio-Duran, Jesús R. García-Martinez, and Alejandro López-Gaona Copyright © 2017 Juan J. Toledo et al. All rights reserved. Axial Length and Ocular Development of Premature Infants without ROP Sun, 15 Oct 2017 06:46:26 +0000 Purpose. To investigate the ocular parameters of premature infants without ROP at gestational age (GA) more than 28 weeks and their relationship with growth parameters. Methods. 76 preterm infants without ROP and 65 term infants were involved to undergo portable slit lamp, RetCam3, ultrasonic A-scan biometry, and cycloplegic streak examination at their 40 weeks’ postconceptional ages (PCA). Ocular parameters of infants’ right eye and growth parameters were used for analysis. Results. All the infants were examined at 40 weeks’ PCA. No significant difference was found between male and female in axial length of preterm infants (p = 0.993) and term infants (). Significant differences were found in axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and vitreous depth (VD) between preterm and term infants. No significant correlation was found between AL and spherical equivalent in preterm infants’ group. In preterm group, AL was significantly correlated with gestational age (GA), birth weight (BW), and head circumference (HC). Conclusions. Preterm infants had shorter AL, shallow ACD, thicker LT, and thinner VD compared to term infants. Refractive error in preterm infants at GA between 28 to 37 weeks was not related to axial length. Among all the growth parameters of preterm infants, GA, BW, and HC had effect on axial length. Yi Zha, Guangdong Zhu, Jinfei Zhuang, Haihua Zheng, Jianqiu Cai, and Wangqiang Feng Copyright © 2017 Yi Zha et al. All rights reserved. Effect of MT3 on Retinal and Choroidal TGF-β2 and HAS2 Expressions in Form Deprivation Myopia of Guinea Pig Sun, 15 Oct 2017 00:00:00 +0000 Purpose. To confirm its dose-dependent effect on form deprivation myopia and evaluate the effect of MT3 at different tissue concentrations on changes in mRNA and protein expression for TGF-β2 and HAS2. Methods. MT3 was intravitreally injected into deprived eyes at two-day intervals. Refraction was measured by streak retinoscopy after cycloplegia. The axial dimensions were measured by A-scan ultrasound. The quantitative RT-PCR and Western blot were used to detect the changes of TGF-β2 and HAS2 expressions in the retina and choroid of guinea pigs. Results. MT3 treatment produced a significant dose-dependent reduction in relative myopia compared to FD group (both ). There were statistically significant increases in retinal and choroidal mRNA levels for both TGF-β2 and HAS2 after injections of 10 μM of MT3, when compared to the FD group. There were no significant differences in retinal and choroidal TGF-β2 protein expression levels between the MT3 treatment groups and FD group (all ). The injections of 10 μM of MT3 caused a marked decrease in retinal HAS2 protein expression level, when compared to the FD group (). Conclusion. MT3 can inhibit form deprivation myopia, and MT3 treatment can result in changes of retinal and choroidal TGF-β2 and HAS2 mRNA and protein expressions. Tao Li, Xiaodong Zhou, Bing Li, and Bo Jiang Copyright © 2017 Tao Li et al. All rights reserved. The Involvement of β-Catenin/COX-2/VEGF Axis in NMDA-Caused Retinopathy Thu, 12 Oct 2017 00:00:00 +0000 NMDA, a molecule that is capable of producing the loss of retinal ganglia cells (RGCs), has been widely studied; however, the detailed mechanism is not yet clarified. Previously, Wnt/β-catenin signaling has been suggested to be involved in the NMDA-induced retinopathy. In addition, previous investigations in our group demonstrated the presence of a Wnt/β-catenin/COX-2 axis in dorsal root ganglions (DRGs). Therefore, here in this paper, we tested whether there is an association of such axis with NMDA-induced RGC loss. Rat retinal damage models generated by intravitreal injection of NMDA were used to measure the expression levels of β-catenin, COX-2, and VEGF in retinas, and the neuron numbers of the retinal GCL of rats were counted. Then, pharmacological tools (MK801, a NMDA receptor inhibitor; Dickkopf homolog 1, a specific inhibitor of the Wnt pathway; NS-398, a COX-2 inhibitor; and bevacizumab, IVB, a VEGF inhibitor) were introduced to evaluate the detailed roles of Wnt/β-catenin, COX-2, and VEGF in retinopathy of rats. Results demonstrated that all three factors in sequence are positively regulated neuronal loss induced by NMDA. These observations indicated that the Wnt pathway/COX-2/VEGF axis plays a pathogenic role in retinopathy and represented novel therapeutic targets. Dan Ning, Wei Kevin Zhang, Han Tian, Xiao-Jun Li, Min Liu, Yu-Sang Li, and He-Bin Tang Copyright © 2017 Dan Ning et al. All rights reserved. Changes in Retinal and Choroidal Vascular Blood Flow after Oral Sildenafil: An Optical Coherence Tomography Angiography Study Mon, 09 Oct 2017 00:00:00 +0000 Purpose. To describe changes in the retina and choroidal flow by optical coherence tomography angiography (OCT-A) after a single dose of oral sildenafil. Method. A case-control study. Patients in the study group received 50 mg of oral sildenafil. Patients in the control group received a sham pill. Retinal and choroidal images were obtained at baseline (before pill ingestion) and 1 hour after ingestion. Central macular and choroidal thickness, choroidal and outer retina flow, and the retinal and choroidal vascular density were compared using a Mann-Whitney U test. Results. Twenty eyes were enrolled into the study group and 10 eyes in the control group. There was a significant difference in central choroidal thickness and outer retina blood flow between groups after 1 hour of sildenafil ingestion (). There were no differences in central macular thickness, choroidal flow, and retinal vascular density among groups. Conclusions. A single dose of oral sildenafil increases choroidal thickness, probably due to sildenafil-induced vasodilation. David Berrones, Guillermo Salcedo-Villanueva, Virgilio Morales-Cantón, and Raul Velez-Montoya Copyright © 2017 David Berrones et al. All rights reserved. Comparison between the Correlations of Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography and Visual Field Defects in Standard Automated White-on-White Perimetry versus Pulsar Perimetry Sun, 08 Oct 2017 09:15:20 +0000 Purpose. To compare the structure-function relationships between retinal nerve fiber layer thickness (RNFLT) and visual field defects measured either by standard automated perimetry (SAP) or by Pulsar perimetry (PP). Materials and Methods. 263 eyes of 143 patients were prospectively included. Depending on the RNFLT, patients were assigned to the glaucoma group (group A: RNFL score 3–6) or the control group (group B: RNFL score 0–2). Structure-function relationships between RNFLT and mean sensitivity (MS) measured by SAP and PP were analyzed. Results. Throughout the entire group, the MS assessed by PP and SAP correlated significantly with RNFLT in all sectors. In the glaucoma group, there was no significant difference between the correlations RNFL-SAP and RNFL-PP, whereas a significant difference was found in the control group. Conclusions. In the control group, the correlation between structure and function based on the PP data was significantly stronger than that based on SAP. Maged Alnawaiseh, Lisann Hömberg, Nicole Eter, and Verena Prokosch Copyright © 2017 Maged Alnawaiseh et al. All rights reserved. OM-101 Decreases the Fibrotic Response Associated with Proliferative Vitreoretinopathy Wed, 04 Oct 2017 00:00:00 +0000 Purpose. This study aimed to investigate the effect of OM-101 on the fibrotic response occurring in proliferative vitreoretinopathy (PVR) in an animal model. Methods. Antifibrotic effect of OM-101 was investigated in vivo. As control, eight weeks old c57black mice underwent intravitreal injection with Hepes (group A) or dispase (0.3 units), to induce retinal detachment (RD) and PVR. The dispase-injected mice were randomly divided into two groups B and C ( mice); in group C, the eyes were treated with intravitreal injection of OM-101 (3 μl), and group B with PBS, as a control. After additional five days, mice were injected with the same initial treatment. Three days later, mice were euthanized, and the eyes were enucleated and processed for histological analysis. Results. Intravitreal injection of dispase caused RD in 64% of the mice in group B, and 93% of those mice had PVR. Only 32% of mice treated with OM-101 and dispase (group C) developed RD, and only 25% of those developed PVR. Conclusions. OM-101 was found effective in reducing the incidence of RD and PVR maintaining the normal architecture of the retina. This study suggests that OM-101 is a potentially effective and safe drug for the treatment of PVR patients. Zeev Dvashi, Keren Ben-Yaakov, Tamir Weinberg, Yoel Greenwald, and Ayala Pollack Copyright © 2017 Zeev Dvashi et al. All rights reserved. Correlation between Choroidal Neovascularization Shown by OCT Angiography and Choroidal Thickness in Patients with Chronic Central Serous Chorioretinopathy Wed, 04 Oct 2017 00:00:00 +0000 Purpose. To assess the occurrence of choroidal neovascularization (CNV) secondary to chronic central serous chorioretinopathy (CSCR) using optical coherence tomography angiography (OCTA) and correlate these findings with choroidal thickness (CT). Materials and Methods. This retrospective study included 25 consecutive patients (43 eyes), mean age 48.12 ± 7.8 years, diagnosed with persistent CSCR. All patients underwent a complete ophthalmic examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography, and OCTA. Results. CNV was confirmed in 18.6% of eyes using FA and ICGA and in 25.6% of eyes using OCTA. All cases of CNV were associated with irregular retinal pigment epithelial detachment. CT was increased in the affected eyes (mean 491.05 ± 91.98), but there were no statistically significant correlations between CT and CNV and PED occurrence ( and , resp.) and between CT and duration of the disease (). Conclusions. OCTA detected CNV more frequently than other imaging modalities. CNV coexisted with irregular PED in all cases. CT was increased in eyes with chronic CSCR, but without any correlation with CNV occurrence; therefore, CT cannot be considered as a predictor of CNV occurrence. Further studies with a larger number of patients are needed to confirm these findings. Joanna Gołębiewska, Joanna Brydak-Godowska, Joanna Moneta-Wielgoś, Monika Turczyńska, Dariusz Kęcik, and Wojciech Hautz Copyright © 2017 Joanna Gołębiewska et al. All rights reserved. Visual Quality Assessment of Posterior Capsule Opacification Using Optical Quality Analysis System (OQAS) Tue, 03 Oct 2017 05:52:00 +0000 Objective. To evaluate intraocular scattering in eyes with posterior capsule opacification by means of an objective scatter index (OSI) obtained from double-pass images of optical quality assessment system (OQAS TM II) and to determine the indication for laser capsulotomy when patients report visual disturbances without decreased visual acuity. Methods. In this prospective, observational, and nonconsecutive case series study, a total of 32 eyes of 29 patients are diagnosed with posterior capsule opacification after age-associated cataract were analyzed. Patient examination included age, the period after cataract surgery, logMAR best corrected visual acuity (BCVA), and OSI. Results. We found a significant decrease in the BCVA and increase in the OSI with the development of posterior capsule opacification. The decrease of BCVA was statistically correlated with the increase of OSI (, ). In patients who reported visual disturbances without decreased visual acuity, OSI decreased to <1.3 and subjective symptoms were resolved in all cases although there was no significant improvement in visual acuity after laser capsulotomy. Conclusions. The results of our study showed that OSI is also a useful parameter for objectively evaluating posterior capsule opacification. OSI may help predict laser capsulotomy in patients who report visual disturbances without decreased visual acuity. Hui Zhang and Jing Wang Copyright © 2017 Hui Zhang and Jing Wang. All rights reserved. Clinical Profile of Unilateral Proptosis in a Tertiary Care Centre Tue, 03 Oct 2017 00:00:00 +0000 Proptosis, the forward protrusion of the eyeball, is a common manifestation of a wide variety of diseases inside the orbit and its spaces. Its diagnosis is usually a combined effort of the ophthalmologist, otolaryngologist, neurosurgeon, and radiologist. A clinical study of twenty-five cases with unilateral proptosis were studied in different age groups over a period of about 3 years under different headings like distribution, clinical features, radiological features, histopathological aspects, management, and outcomes of diseases. Proptosis measurement was done by simple/plastic ruler exophthalmometry, and diagnosis was made after a detailed clinical examination and ancillary tests. Treatment modality was decided based on radiological and histopathological examination reports, which included medical surgery, radiotherapy, and chemotherapy or a combination of all. In our study, most of the patients were in the age group of more than 60 years. The M : F ratio is 3 : 1. One case had a large proptosis of 18 mm above normal and 2 cases were as small as 3 mm. Diagnosis was mainly done by clinical features and confirmed by radiological and histopathological features. Most of them were treated medically (13 cases, i.e., 52%) and the rest by surgery with a combination of radiotherapy/chemotherapy (12 cases, i.e., 48%). Susan Dsouza, Pooja Kandula, Gurudutt Kamath, and Manjunath Kamath Copyright © 2017 Susan Dsouza et al. All rights reserved. The Protective Effects of αB-Crystallin on Ischemia-Reperfusion Injury in the Rat Retina Mon, 02 Oct 2017 07:27:52 +0000 To investigate whether αB-crystallin protects against acute retinal ischemic reperfusion injury (I/R) and elucidate the potential antioxidant mechanisms. Retinal I/R injury was made by elevating the intraocular pressure (IOP) 110 mmHg for 60 min, and αB-crystallin (1 × 10−5 g/L) or vehicle solution was administered intravitreously immediately after I/R injury. The animal was sacrificed 24 h, 1 w, and 1 m after the I/R injury. The retina damage was detected by hematoxylin and eosin (HE) staining and electroretinography (ERG). The level of malondialdehyde (MDA), nitric oxide (NO), and the total superoxide dismutase (T-SOD) was determined. An immunohistochemical study was performed to detect the activation of inducible nitric oxide synthase (iNOS) and NF- (nuclear factor-) kappaB (NF-κB) p65. The decrease of retinal thickness and the number of retinal ganglion cells (RGCs) can be suppressed by αB-crystallin. And the amplitudes of a- and b-wave were remarkably greater without αB-crystallin. Similarly, αB-crystallin also significantly decreased the level of MDA and NO and enhanced the activities of T-SOD. The positive expression of iNOS and NF-kappaB p65 was obviously reduced while treated with αB-crystallin. αB-crystallin can inhibit the expression of NF-κB and its antioxidative effect to protect the retina from I/R injury. Huan Yan, Yanli Peng, Wei Huang, Liyan Gong, and Li Li Copyright © 2017 Huan Yan et al. All rights reserved. Bruch’s Membrane Opening Minimum Rim Width Measurement with SD-OCT: A Method to Correct for the Opening Size of Bruch’s Membrane Mon, 02 Oct 2017 05:42:39 +0000 A precise evaluation of the retinal nerve fiber layer thickness (RNFLT) is key for diagnosing and monitoring glaucoma. The Bruch’s membrane opening minimum rim width (BMO-MRW) has been proposed as a reproducible assessment of the optic nerve. The BMO-MRW measures the minimum distance from the BMO to the internal limiting membrane. We propose an approach to correct the BMO-MRW using the BMO size for increased accuracy in interindividual comparisons in future studies. Eighty-one healthy patients received SPECTRALIS spectral domain optical coherence tomography measurements for the peripapillary RNFLT and BMO-MRW. We calculated a BMO size-corrected BMO-MRW using the mean BMO size of our cohort. BMO size was defined using the manufacturer-provided BMO area and manually measured BMO perimeter. We observed that the BMO-MRW correlated highly with the perimeter (, ) and the area of the BMO (, ). Using these parameters, we provided a corrected BMO size-adjusted BMO-MRW which was better correlated with the RNFLT compared to the noncorrected one (, ). We demonstrated the dependency of the BMO-MRW on ONH size. Furthermore, we showed the superiority of the corrected BMO-MRW using either the manually measured optic nerve head perimeter or the automatically provided ONH for future studies. Robert Kromer and Martin Stephan Spitzer Copyright © 2017 Robert Kromer and Martin Stephan Spitzer. All rights reserved. Influence of Overnight Orthokeratology on Corneal Surface Shape and Optical Quality Sun, 01 Oct 2017 00:00:00 +0000 Purpose. To investigate the changes of corneal surface shape and optical quality during orthokeratology. Methods. 49 eyes of 26 patients (10.63 ± 2.02 years old) who underwent overnight orthokeratology for myopia were prospectively examined. The corneal surface shape parameters, including surface regularity index (SRI) and surface asymmetry index (SAI), were attained with an OPD-III SCAN. The higher-order aberrations and higher-order Strehl ratios were calculated under a 3 mm pupil diameter before orthokeratology, 1 month, 3 months, and 6 months after orthokeratology. A value of less than 0.05 was statistically significant. Results. Months after orthokeratology, SRI and SAI were both showing a significant increase in comparison with those before orthokeratology (). After orthokeratology, for a 3 mm pupil, the higher-order Strehl ratio presented a reduction of 0.217 μm (), and the higher-order aberration root mean square (HOA RMS) showed a mean increase of 0.100 μm (). There were significant increases in spherical aberration () and coma () after orthokeratology. Trefoil showed a slight reduction at month 6 after orthokeratology, but there was no statistical significance (). Conclusion. Overnight orthokeratology for a correction of myopia resulted in a significant improvement in refractive error but increased corneal irregularity and ocular higher-order aberrations, especially in spherical aberration. Yuan Sun, Lin Wang, Jing Gao, Mei Yang, and Qi Zhao Copyright © 2017 Yuan Sun et al. All rights reserved. Reduced Expression of VAMP8 in Lacrimal Gland Affected by Chronic Graft-versus-Host Disease Sat, 30 Sep 2017 02:38:02 +0000 Purpose. To investigate whether the SNARE protein vesicle-associated membrane protein 8 (VAMP8) was implicated in the development of chronic ocular graft-versus-host disease (GVHD). Methods. Firstly, the chronic GVHD (cGVHD) and Sjögren’s syndrome (SS)-impaired lacrimal gland (LG) tissue sections from humans for diagnostic purpose were evaluated for VAMP8 expression by histopathology and immunohistochemistry. Next, serial changes of tear secretion and VAMP8 expression at both protein and mRNA level of LG in an animal cGVHD model compared with the syngeneic control. Results. Decreased VAMP 8 expression in the cGVHD-affected human LG was detected in comparison with SS-affected LG. Tear secretion in the murine cGVHD model was significantly reduced compared with that in the syngeneic controls 8 weeks after BMT. Protein expression of VAMP8 in the cGVHD-affected LG in murine cGVHD was decreased in comparison with that in the controls. Gene expression of VAMP8 in the cGVHD-affected murine LG was significantly less than that in the syngeneic control 3 weeks after BMT. Conclusions. Our results suggested that expression of VAMP8 in the cGVHD-affected LG was decreased and accordingly tear secretion in cGVHD was reduced. Collectively, the reduction of VAMP8 expression in the cGVHD-affected LG can be involved in the pathogenic processes of cGVHD-induced dry eye disease. Masaki Fukui, Yoko Ogawa, Shin Mukai, Mizuka Kamoi, Teru Asato, Yutaka Kawakami, and Kazuo Tsubota Copyright © 2017 Masaki Fukui et al. All rights reserved. An Analysis of 3-Year Outcomes Following Canaloplasty for the Treatment of Open-Angle Glaucoma Fri, 29 Sep 2017 03:22:04 +0000 Purpose. To report 3-year results investigating the safety and efficacy of canaloplasty for open-angle glaucoma. Setting. University of Oklahoma, Dean McGee Eye Institute, Oklahoma, United States of America. Design. Nonrandomized single-center retrospective chart review. Methods. Adult open-angle glaucoma eyes underwent canaloplasty or combined cataract-canaloplasty surgery. A tensioning suture was placed into Schlemm’s canal in all eyes. Primary endpoints included the mean IOP and mean number of glaucoma medications at each follow-up visit. Secondary endpoints included visual acuity and surgical/postsurgical complications. Results. The study cohort included 277 eyes (mean age, 72.8 years). Overall, the mean baseline IOP of 19.7 mmHg was reduced to 14.3 mmHg,14.0 mmHg, and 15.2 mmHg at 1, 2, and 3 years, respectively (). The average medicine use was reduced from 2.1 preoperatively to 0.4 at 12 months, and 0.5 and 0.6 at two and three years, respectively (). The frequency of surgical and postsurgical complications was low with no serious adverse events recorded. Conclusion. Canaloplasty was safe and effective in achieving long-term IOP reductions and reduced dependence on antiglaucoma medications. Mahmoud A. Khaimi, Justin D. Dvorak, and Kai Ding Copyright © 2017 Mahmoud A. Khaimi et al. All rights reserved. Phenotypic Description of the Spanish Multicentre Genetic Glaucoma Group Cohort Tue, 26 Sep 2017 00:00:00 +0000 Introduction. The aim of the study was to make a phenotypic description of the Spanish multicentre glaucoma group cohort of patients. Design. Retrospective, observational, multicentre, cohort study. Material and Methods. The clinical charts of 152 patients with hereditary glaucoma from18 Spanish eye centres were reviewed in order to make an epidemiologic description of the type of glaucoma and associated factors. True hereditary cases were compared with familiar cases according to the Gong et al. criteria. Results. 61% were true hereditary cases and 39% familiar cases. Ocular comorbidity, optic disc damage, and visual field mean defect were significantly more severe in hereditary patients, who required significantly more first-line hypotensive drugs and surgical interventions to control intraocular pressure than familiar patients. Conclusions. The strength of the hereditary component of glaucoma seems to worsen the clinical course, causing more structural and functional damage and requiring more intense glaucoma treatment. The family history of glaucoma should be carefully investigated and taken into consideration when making treatment decisions or intensifying previous treatment. Elena Milla, Maria José Gamundi, Susana Duch, Jose Rios, Miguel Carballo, and EMEIGG Study Group Copyright © 2017 Elena Milla et al. All rights reserved. Inherited Retinal Degeneration: Genetics, Disease Characterization, and Outcome Measures Mon, 25 Sep 2017 06:01:56 +0000 Naheed W. Khan, Benedetto Falsini, Mineo Kondo, and Anthony G. Robson Copyright © 2017 Naheed W. Khan et al. All rights reserved. Molecular Age-Related Changes in the Anterior Segment of the Eye Sun, 24 Sep 2017 00:00:00 +0000 Purpose. To examine the current knowledge about the age-related processes in the anterior segment of the eye at a biological, clinical, and molecular level. Methods. We reviewed the available published literature that addresses the aging process of the anterior segment of the eye and its associated molecular and physiological events. We performed a search on PubMed, CINAHL, and Embase using the MeSH terms “eye,” “anterior segment,” and “age.” We generated searches to account for synonyms of these keywords and MESH headings as follows: (1) “Eye” AND “ageing process” OR “anterior segment ageing” and (2) “Anterior segment” AND “ageing process” OR “anterior segment” AND “molecular changes” AND “age.” Results. Among the principal causes of age-dependent alterations in the anterior segment of the eye, we found the mutation of the TGF-β gene and loss of autophagy in addition to oxidative stress, which contributes to the pathogenesis of degenerative diseases. Conclusions. In this review, we summarize the current knowledge regarding some of the molecular mechanisms related to aging in the anterior segment of the eye. We also introduce and propose potential roles of autophagy, an important mechanism responsible for maintaining homeostasis and proteostasis under stress conditions in the anterior segment during aging. Luis Fernando Hernandez-Zimbron, Rosario Gulias-Cañizo, María F. Golzarri, Blanca Elizabeth Martínez-Báez, Hugo Quiroz-Mercado, and Roberto Gonzalez-Salinas Copyright © 2017 Luis Fernando Hernandez-Zimbron et al. All rights reserved. Analysis of Factors Associated with the Ocular Features of Congenital Cataract Children in the Shanghai Pediatric Cataract Study Wed, 20 Sep 2017 07:03:36 +0000 Purpose. To investigate the ocular features of children with congenital cataract in a tertiary referral eye center in East China. Methods. We retrospectively reviewed the clinical data of congenital cataract children who underwent cataract surgery between April 2009 and April 2014 at the Eye and ENT Hospital of Fudan University and identified factors associated with the axial length (AXL) and corneal curvature (K value). Results. We included 493 children, 210 with unilateral and 283 with bilateral cataract. The mean AXL was 22.03 ± 1.97 mm and the mean K value was 43.61 ± 1.86 D. Age showed a linear correlation with AXL in unilateral cataract eyes and a logarithmic correlation with AXL in bilateral cataract eyes (both ). AXL was longer and the K value was smaller (both ) in boys than in girls after adjusting for age and cataract laterality. AXL was longer in unilateral cataract eyes than in bilateral cataract eyes after adjusting for age and gender (). In children with unilateral cataract, AXL was significantly longer in the affected eye than in the contralateral eye (). Conclusion. Age, gender, and cataract laterality together contribute to the development of ocular features of congenital cataract children, especially for AXL. Wenwen He, Ting Sun, Jin Yang, Guoyou Qin, Zhenyu Wu, Xiangjia Zhu, and Yi Lu Copyright © 2017 Wenwen He et al. All rights reserved. New Objective Refraction Metric Based on Sphere Fitting to the Wavefront Wed, 20 Sep 2017 06:24:42 +0000 Purpose. To develop an objective refraction formula based on the ocular wavefront error (WFE) expressed in terms of Zernike coefficients and pupil radius, which would be an accurate predictor of subjective spherical equivalent (SE) for different pupil sizes. Methods. A sphere is fitted to the ocular wavefront at the center and at a variable distance, t. The optimal fitting distance, topt, is obtained empirically from a dataset of 308 eyes as a function of objective refraction pupil radius, r0, and used to define the formula of a new wavefront refraction metric (MTR). The metric is tested in another, independent dataset of 200 eyes. Results. For pupil radii , the new metric predicts the equivalent sphere with similar accuracy (<0.1D), however, for , the mean error of traditional metrics can increase beyond 0.25D, and the MTR remains accurate. The proposed metric allows clinicians to obtain an accurate clinical spherical equivalent value without rescaling/refitting of the wavefront coefficients. It has the potential to be developed into a metric which will be able to predict full spherocylindrical refraction for the desired illumination conditions and corresponding pupil size. Mateusz Jaskulski, Andreí Martínez-Finkelshtein, and Norberto López-Gil Copyright © 2017 Mateusz Jaskulski et al. All rights reserved. A Masked, Randomized, Phase 3 Comparison of Triple Fixed-Combination Bimatoprost/Brimonidine/Timolol versus Fixed-Combination Brimonidine/Timolol for Lowering Intraocular Pressure Tue, 19 Sep 2017 00:00:00 +0000 Objective. To evaluate the efficacy and safety of triple fixed-combination bimatoprost 0.01%/brimonidine 0.15%/timolol 0.5% (TFC) versus dual fixed-combination brimonidine 0.2%/timolol 0.5% (DFC) in primary open-angle glaucoma and ocular hypertension. Methods. Patients with intraocular pressure (IOP) ≥23 and ≤34 mmHg were randomized to twice-daily TFC or DFC. The primary variable is the change in worse eye mean IOP from baseline at week 12 (modified intent-to-treat (mITT) population). Secondary endpoints are mean IOP and mean change from baseline at weeks 1, 2, 4, 8, and 12 (mITT population). TFC superiority was demonstrated if the primary variable favored TFC (). Sensitivity analyses were conducted, and safety was assessed at all visits. Results. TFC () provided greater IOP reductions from baseline than DFC () at week 12 (treatment difference, 0.85 mmHg; ) and all other visits. TFC was also superior to DFC in patients with high baseline IOP (i.e., IOP ≥ 25 mmHg; ). Conjunctival hyperemia, ocular irritation, and dry eye were reported more often with TFC (); however, discontinuations for ocular adverse events were similar between treatments. Conclusions. TFC demonstrated IOP-lowering benefits that outweigh the risk of predominantly mild ocular side effects, which may be particularly relevant in patients who require greater IOP lowering to prevent/delay disease progression. This trial is registered with registry number: NCT01241240. Curt Hartleben, Juan Camilo Parra, Amy Batoosingh, Paula Bernstein, and Margot Goodkin Copyright © 2017 Curt Hartleben et al. All rights reserved. The Impact of Adherence and Instillation Proficiency of Topical Glaucoma Medications on Intraocular Pressure Thu, 14 Sep 2017 00:00:00 +0000 Background. The possible sequel of poorly controlled intraocular pressure (IOP) includes treatment failure, unnecessary medication use, and economic burden on patients with glaucoma. Objective. To assess the impact of adherence and instillation technique on IOP control. Methods. A cross-sectional study was conducted on 359 glaucoma patients in Menelik II Hospital from June 1 to July 31, 2015. After conducting a Q-Q analysis, multiple binary logistic analyses, linear regression analyses, and two-tailed paired t-test were conducted to compare IOP in the baseline versus current measurements. Results. Intraocular pressure was controlled in 59.6% of the patients and was relatively well controlled during the study period (mean (M) = 17.911 mmHg, standard deviation (S) = 0.323) compared to the baseline ( mmHg, , t (358) = −6.70, ). A unit increase in the administration technique score resulted in a 0.272 mmHg decrease in IOP (). Moreover, primary angle-closure glaucoma (adjusted odds ratio (AOR) = 0.347, 95% confidence interval (CI): 0.144–0.836) and two medications (AOR = 1.869, 95% CI: 1.259–9.379) were factors affecting IOP. Conclusion. Good instillation technique of the medications was correlated with a reduction in IOP. Consequently, regular assessment of the instillation technique and IOP should be done for better management of the disease. Tesfay Mehari Atey, Workineh Shibeshi, Abeba T. Giorgis, and Solomon Weldegebreal Asgedom Copyright © 2017 Tesfay Mehari Atey et al. All rights reserved. Two-Year Outcome of Aflibercept in Patients with Pigment Epithelial Detachment due to Neovascular Age-Related Macular Degeneration (nAMD) Refractory to Ranibizumab Wed, 13 Sep 2017 00:00:00 +0000 Purpose. To evaluate the response of intravitreal aflibercept injection (IAI) in eyes with detachment of retinal pigment epithelium (DEP) secondary to nAMD refractory to monthly ranibizumab. Patients and Methods. This is a retrospective, multicenter study. All patients received 3 IAI then treated as needed every 4 weeks for 12 months. During the second year, the eyes were treated with a treat- and-extend regimen. Results. Forty-four eyes were included. Best-corrected visual acuity improved significantly after the loading phase (3.1 ± 6.4 letters) and at 6 months (2.8 ± 6.4 letters), but change was not significant at 1 year and 2 years. The height of the DEP was significantly decreased at 3 months and 6 months, but the difference did not reach statistical difference at 1 and 2 years. Rate of eyes with complete resolution of exudation was 59% after the loading phase and 34.3% at 2 years. Mean interval of anti-VEGF injection was extended from 31 ± 2.6 days to 61 ± 5 days after conversion. Conclusions. Aflibercept intravitreal injection in patients with fibrovascular DEP due to nAMD who respond poorly to monthly ranibizumab led to short-term functional and anatomical improvement. Reduction of intravitreal injection frequency was obtained until 2 years of follow-up. Thi Ha Chau Tran, Stéphane Dumas, and Florence Coscas Copyright © 2017 Thi Ha Chau Tran et al. All rights reserved. Impact of Topically Administered Steroids, Antibiotics, and Sodium Hyaluronate on Bleb-Related Infection Onset: The Japan Glaucoma Society Survey of Bleb-Related Infection Report 4 Tue, 12 Sep 2017 07:40:53 +0000 Purpose. To investigate the impact of topically administered ophthalmic medications on the onset and severity of bleb-related infections. Methods. Data obtained from 104 eyes of 104 patients with bleb-related infections were analyzed. We assigned an infection stage to each eye (stage 1–4) and analyzed the onset severity. Results. Steroids and antibiotics were routinely administered to 13 (12.5%) and 42 (40.4%) eyes, respectively. The median stage of steroid-administered eyes was 3 versus 1 for eyes without steroid administration (). The median duration from surgery to infection for the steroid-administered eyes was 2.0 years versus 5.8 years for eyes without steroid administration (). The median duration from surgery to infection for the antibiotic-administered eyes was 6.4 years versus 3.9 years for eyes without antibiotic administration (). Multiple logistic regression analysis revealed that infections were severe in the steroid-administered eyes (odds ratio: 4.57). No infections developed within 16 weeks postoperatively. No relationship was detected between sodium hyaluronate and the analyzed factors. Conclusions. Topical steroid administration beyond the immediate postoperative period may affect severe and earlier onset bleb-related infections. Conversely, topical antibiotic administration may be effective in suppressing earlier onset bleb-related infections. Hideto Sagara, Tetsuya Yamamoto, Kimihiro Imaizumi, and Tetsuju Sekiryu Copyright © 2017 Hideto Sagara et al. All rights reserved. Steeper Iris Conicity Is Related to a Shallower Anterior Chamber: The Gutenberg Health Study Mon, 11 Sep 2017 07:12:22 +0000 Purpose. To report the distribution of iris conicity (steepness of the iris cone), investigate associated factors, and test whether pseudophakia allows the iris to sink back. Methods. A population-based cross-sectional study was carried out. Ophthalmological examination including objective refraction, biometry, noncontact tonometry, and Scheimpflug imaging (Pentacam®, Oculus) was performed including automated measurement of iris conicity. 3708 phakic subjects, 144 subjects with bilateral and 39 subjects with unilateral pseudophakia were included. Multivariable analyses were carried out to determine independently associated systemic and ocular factors for iris conicity in phakic eyes. Results. Mean iris conicity was 8.28° ± 3.29° (right eyes). Statistical analysis revealed associations between steeper iris conicity and shallower anterior chamber depth, thicker human lens and higher corneal power in multivariable analysis, while older age was related to a flatter iris conicity. Refraction, axial length, central corneal thickness, pupil diameter, and intraocular pressure were not associated with iris conicity. Pseudophakia resulted in a 5.82° flatter iris conicity than in the fellow phakic eyes. Conclusions. Associations indicate a correlation between iris conicity with risk factors for angle-closure, namely, shallower anterior chamber depth and thicker human lens. In pseudophakic eyes, iris conicity is significantly lower, indicating that cataract surgery flattens the iris. Alexander K. Schuster, Norbert Pfeiffer, Stefan Nickels, Andreas Schulz, Philipp S. Wild, Maria Blettner, Karl Lackner, Manfred E. Beutel, Thomas Münzel, and Urs Vossmerbaeumer Copyright © 2017 Alexander K. Schuster et al. All rights reserved. Accommodative Stimulus-Response Curve with Emoji Symbols Sun, 10 Sep 2017 00:00:00 +0000 Purpose. To evaluate the static measurement of the accommodative stimulus-response curve with emoji symbols. Methods. The accommodative stimulus-response curve was measured in 18 subjects using a Hartmann-Shack sensor to obtain the objective accommodative response from the Zernike defocus term. Measurements were acquired at different accommodative demands, from 0 to 3 D with a step of 0.5 D. Detailed and nondetailed emoji targets were used with two different sizes, corresponding to the two most common visual angles used in smartphones. Results. A regression analysis was performed to fit the mean results obtained for each target. The determination coefficient was for all targets. For the detailed targets, the slopes for the averaged stimulus-response curve were 0.65 and 0.66 for the bigger and smaller sizes, respectively. For the nondetailed targets, the slopes were 0.60 and 0.58 for the bigger and smaller sizes, respectively. values for these slopes were statistically significant for the two types of targets (). Conclusions. Our results reveal that the replacement of a word or several words by detailed or nondetailed emoji symbols seems not to provoke a different accommodative response in normal subjects and under standard viewing conditions in the use of smartphones. Robert Montés-Micó, José J. Esteve Taboada, Paula Bernal-Molina, and Teresa Ferrer-Blasco Copyright © 2017 Robert Montés-Micó et al. All rights reserved. Laser Peripheral Iridotomy versus Trabeculectomy as an Initial Treatment for Primary Angle-Closure Glaucoma Fri, 01 Sep 2017 00:00:00 +0000 Purpose. To compare laser peripheral iridotomy (LPI) with trabeculectomy as an initial treatment for primary angle-closure glaucoma (PACG) with peripheral anterior synechiae (PAS) ≥ 6 clock hours. Methods. Patients were drawn from two randomized controlled trials. 38 eyes of 38 patients (PAS ≥ 6 clock hours) were treated with LPI (group 1) while 111 eyes of 111 PACG patients (PAS ≥ 6 clock hours) underwent primary trabeculectomy (group 2). All patients underwent a comprehensive ophthalmic examination at baseline and at postoperative visits and were followed up for a minimum of one year. Results. Group 2 had higher baseline IOP (45.7 ± 14.8 mmHg versus 34.3 ± 14.3 mmHg) than group 1 and more clock hours of PAS (10.4 ± 1.9 versus 9.0 ± 2.2). IOPs at all postoperative visits were significantly lower in group 2 than in group 1 (). Five eyes in group 1 required trabeculectomy. 17 of the 38 eyes in group 1 (44.7%) required IOP-lowering medications as compared to seven of the 111 eyes in group 2 (6.3%). Cataract progression was documented in 2 eyes (5.3%) in group 1 and 16 eyes (14.4%) in group 2. Conclusions. Primary trabeculectomy for PACG (PAS ≥ 6 clock hours) is more effective than LPI in lowering IOP. Yan Yun Chen, Su Jie Fan, Yuan Bo Liang, Shi Song Rong, Hai Lin Meng, Xing Wang, Ravi Thomas, and Ning Li Wang Copyright © 2017 Yan Yun Chen et al. All rights reserved.