Journal of Ophthalmology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Relationship among Corneal Biomechanics, Anterior Segment Parameters, and Geometric Corneal Parameters Tue, 25 Oct 2016 12:45:14 +0000 Purpose. To investigate the relationship between corneal biomechanical parameters, anterior segment parameters, and geometric corneal parameters in a healthy Caucasian group. Methods. This retrospective study included the healthy eyes with best corrected visual acuity of at least 20/40 of 122 Caucasian subjects. The anterior segment parameters and geometric corneal parameters such as corneal volume, central corneal thickness, horizontal and vertical corneal radii, anterior and posterior steep, and flat keratometric values were measured with a Scheimpflug camera. The biomechanical properties were measured with Ocular Response Analyzer. Results. One hundred and twenty-two healthy Caucasian subjects (67 males, 55 females) with a mean age of were enrolled. Both corneal hysteresis and corneal resistance factor were positively correlated with CCT (, ; , ) and CV (, ; , ) and negatively correlated with age (, ; , ). Both in age-gender and multivariate models, CH and CRF had statistically significant negative association with the posterior steep value. Conclusions. CH and CRF are negatively correlated with posterior steep and average posterior values. Sadık Görkem Çevik, Sertaç Argun Kıvanç, Berna Akova-Budak, and Mediha Tok-Çevik Copyright © 2016 Sadık Görkem Çevik et al. All rights reserved. Changing Clinical Presentation, Current Knowledge-Attitude-Practice, and Current Vision Related Quality of Life in Self-Reported Type 2 Diabetes Patients with Retinopathy in Eastern India: The LVPEI Eye and Diabetes Study Mon, 24 Oct 2016 09:16:23 +0000 Purpose. To document the changing clinical presentation of diabetic retinopathy (DR) over a decade, the current knowledge-attitude-practice (KAP) of known type 2 diabetes mellitus (DM) patients, and the current vision related quality of life (VR-QOL) of patients with DR in a tertiary eye care center in Eastern India. Methods. Two hundred and forty patients with known type-2 DM were evaluated. The evaluation included status of DR (), KAP (), and VR-QOL (). International classification of DR was used in the study. The DR status was compared with another cohort () examined a decade earlier, in year 2001. The KAP-25 questions were designed after literature review. The National Eye Institute Visual Function Questionnaire (NEI-VFQ; including optional items) was validated by Rasch analysis. Both KAP and VR-QOL were analyzed according to degree of DR, duration of known DM, and educational qualification. Results. Average age of the current cohort () was 57.16 ± 9.03 years; there were 205 (85.4%) male patients and 143 (59.6%) patients had received less than graduate qualification. The mean duration of DM since diagnosis was 10 ± 7.8 months (range 8 months to 30 years); 118 (49.16%) patients had DR. In a decade time, 2001 to 2011, there was a change of retinopathy status at presentation (more often nonproliferative diabetic retinopathy, NPDR). One-third of NPDR patients had poor vision and half of them were hypertensive. KAP was better in patients with higher education and those having DR. VFQ score was higher in better seeing patients. Conclusion. Patients currently presenting at earlier stage of retinopathy are probably related to poor vision. Early detection and treatment of DR is likely to preserve and/or improve vision. Taraprasad Das, Batriti Wallang, Preeti Semwal, Soumyava Basu, Tapas R. Padhi, and Mohd Hasnat Ali Copyright © 2016 Taraprasad Das et al. All rights reserved. Effect of Three-Dimensional Printed Personalized Moisture Chamber Spectacles on the Periocular Humidity Mon, 24 Oct 2016 07:42:40 +0000 Purpose. To assess the effect of three-dimensional (3D) printed personalized moisture chamber spectacles (PMCS) on the periocular humidity. Methods. Facial computed tomography (CT) scanning was conducted on 10 normal subjects. PMCS was designed based on volume rendered CT images and produced using a 3D printer. Periocular humidity of PMCS and commercially available uniformed moisture chamber spectacles (UMCS) were measured for 30 minutes via microhydrometer. Results. The mean ambient humidity was %. The mean periocular humidity was % in PMCS and % in UMCS. The difference was significant (). Additionally, PMCS always demonstrated lower humidity than dew points. Conclusion. PMCS made by 3D printer provides appropriate fitness for the semiclosed humid chamber. PMCS showed higher performance than UMCS. The wearing of PMCS would be an effective method to provide high enough periocular humidity in low humidity environment. Chan Hee Moon, Jae Yong Kim, Myoung Joon Kim, Hungwon Tchah, Byeong Gak Lim, and Jin Kwon Chung Copyright © 2016 Chan Hee Moon et al. All rights reserved. An Experimental Study on Botulinum Toxin Type A for the Treatment of Excessive Secretion after Submandibular Gland Transplantation in Rabbits Thu, 20 Oct 2016 14:02:27 +0000 Objectives. To investigate whether botulinum toxin type A (BTXA) could control excessive secretion after submandibular gland (SMG) transplantation in rabbits and its possible mechanisms. Methods. A new SMG transplantation model was established in rabbit. 30 successfully constructed models were randomly assigned to five groups including control group and four experimental groups. Secretion outputs were used to analyze the effect of BTXA injection on excessive secretion. Hematoxylin and eosin (HE) staining, transmission electron microscopy (TEM), Western blot, and immunofluorescence were performed to analyze its possible mechanisms. Results. After BTXA injection, a significant decrease of excessive secretion after SMG transplantation was found in 2 and 4 weeks groups, but no significant effect on 12 and 24 weeks groups. HE and TEM results showed that BTXA led to morphological and ultrastructural changes of acinar cells of transplanted SMG. Western blot results suggested that BTXA decreased the aquaporin-5 (AQP5) protein expression after BTXA injection for 2 and 4 weeks. Immunofluorescence results showed that AQP5 protein was mainly expressed in the cytoplasm after BTXA injection for 2 and 4 weeks, which might indicate that BTXA promoted AQP5 expression from the cell membrane to cytoplasm. Conclusion. BTXA could effectively control excessive secretion after SMG transplantation in rabbits. Shang Xie, Hui Xu, Bo Lin, Kan Wang, Xiao-Feng Shan, and Zhi-Gang Cai Copyright © 2016 Shang Xie et al. All rights reserved. Optical Coherence Tomography as a Biomarker for Diagnosis, Progression, and Prognosis of Neurodegenerative Diseases Thu, 20 Oct 2016 12:06:13 +0000 Neurodegenerative diseases present a current challenge for accurate diagnosis and for providing precise prognostic information. Developing imaging biomarkers for multiple sclerosis (MS), Parkinson disease (PD), and Alzheimer’s disease (AD) will improve the clinical management of these patients and may be useful for monitoring treatment effectiveness. Recent research using optical coherence tomography (OCT) has demonstrated that parameters provided by this technology may be used as potential biomarkers for MS, PD, and AD. Retinal thinning has been observed in these patients and new segmentation software for the analysis of the different retinal layers may provide accurate information on disease progression and prognosis. In this review we analyze the application of retinal evaluation using OCT technology to provide better understanding of the possible role of the retinal layers thickness as biomarker for the detection of these neurodegenerative pathologies. Current OCT analysis of the retinal nerve fiber layer and, specially, the ganglion cell layer thickness may be considered as a good biomarker for disease diagnosis, severity, and progression. Maria Satue, Javier Obis, Maria J. Rodrigo, Sofia Otin, Maria I. Fuertes, Elisa Vilades, Hector Gracia, Jose R. Ara, Raquel Alarcia, Vicente Polo, Jose M. Larrosa, Luis E. Pablo, and Elena Garcia-Martin Copyright © 2016 Maria Satue et al. All rights reserved. Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study Tue, 18 Oct 2016 14:05:37 +0000 Purpose. To investigate whether patients with age-related macular degeneration (AMD) run a potentially higher risk of developing visual, musculoskeletal, and balance complaints than age-matched controls with normal vision. Methods. Visual assessments, self-rated visual function, self-rated visual, musculoskeletal, and balance complaints, and perceived general health were obtained in 37 AMD patients and 18 controls, at baseline and after an average of 3.8 years later. Results. At follow-up both groups reported decreased visual acuity (VA) and visual function, but only AMD patients reported significantly increased visual, musculoskeletal, and balance complaints. Decreased VA, need for larger font size when reading, need for larger magnification, and decreased self-rated visual function were identified as risk markers for increased complaints in AMD patients. These complaints were also identified as risk markers for decreased health. For controls, decreased VA and self-reported visual function were associated with increased visual and balance complaints. Conclusions. Visual deterioration was a risk marker for increased visual, musculoskeletal, balance, and health complaints in AMD patients. Specifically, magnifying visual aids, such as CCTV, were a risk marker for increased complaints in AMD patients. This calls for early and coordinated actions to treat and prevent visual, musculoskeletal, balance, and health complaints in AMD patients. Christina Zetterlund, Hans Olof Richter, and Lars-Olov Lundqvist Copyright © 2016 Christina Zetterlund et al. All rights reserved. Response to: Comment on “Choroidal Thickness in Patients with Mild Cognitive Impairment and Alzheimer’s Type Dementia” Mon, 17 Oct 2016 09:57:25 +0000 Mehmet Bulut, Aylin Yaman, Muhammet Kazim Erol, Fatma Kurtuluş, Devrim Toslak, Berna Doğan, Deniz Turgut Çoban, and Ebru Kaya Başar Copyright © 2016 Mehmet Bulut et al. All rights reserved. Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers Mon, 17 Oct 2016 06:46:15 +0000 Introduction. The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT) in treating nonhealing corneal ulcers. Material and Methods. Eleven patients (11 eyes) with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded. Corneal status was inspected by the laser scanning confocal microscopy and anterior segment optical coherence tomography (AS-OCT). Results. The primary diseases were herpes simplex keratitis (8 eyes), corneal graft ulcer (2 eyes), and Stevens-Johnson syndrome (1 eye). All epithelial flaps were intact following surgery, without shedding or displacement. Mean ulcer healing time was days, with a healing rate of 91%. Vision significantly improved from 1.70 to 0.82 log MAR (). A significant decrease in inflammatory cell infiltration and corneal stromal edema was revealed 2 months postoperatively by confocal microscopy and AS-OCT. Corneal ulcer recurred in 1 eye. None of the patients developed major complications. Conclusion. Active pedicle epithelial flap transposition combined with AMT is a simple and effective treatment for nonhealing corneal ulcers. Ting Zhang, Yuexin Wang, Yanni Jia, Dongle Liu, Suxia Li, Weiyun Shi, and Hua Gao Copyright © 2016 Ting Zhang et al. All rights reserved. SMILE and Wavefront-Guided LASIK Out-Compete Other Refractive Surgeries in Ameliorating the Induction of High-Order Aberrations in Anterior Corneal Surface Thu, 13 Oct 2016 13:02:14 +0000 Purpose. To compare the change of anterior corneal higher-order aberrations (HOAs) after laser in situ keratomileusis (LASIK), wavefront-guided LASIK with iris registration (WF-LASIK), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), and small incision lenticule extraction (SMILE). Methods. In a prospective study, 82 eyes underwent LASIK, 119 eyes underwent WF-LASIK, 88 eyes underwent FS-LASIK, and 170 eyes underwent SMILE surgery. HOAs were measured with Pentacam device preoperatively and 6 months after surgery. The aberrations were described as Zernike polynomials, and analysis focused on total HOAs, spherical aberration (SA), horizontal coma, and vertical coma over 6 mm diameter central corneal zone. Results. Six months postoperatively, all procedures result in increase of anterior corneal total HOAs and SA. There were no significant differences in the induced HOAs between LASIK and FS-LASIK, while SMILE induced fewer total HOAs and SA compared with LASIK and FS-LASIK. Similarly, WF-LASIK also induced less total HOAs than LASIK and FS-LASIK, but only fewer SA than FS-LASIK (). No significant difference could be detected in the induced total HOAs and SA between SMILE and WF-LASIK, whereas SMILE induced more horizontal coma and vertical coma compared with WF-LASIK (). Conclusion. FS-LASIK and LASIK induced comparable anterior corneal HOAs. Compared to LASIK and FS-LASIK, both SMILE and WF-LASIK showed advantages in inducing less total HOAs. In addition, SMILE also possesses better ability to reduce the induction of SA in comparison with LASIK and FS-LASIK. However, SMILE induced more horizontal coma and vertical coma compared with WF-LASIK, indicating that the centration of SMILE procedure is probably less precise than WF-LASIK. Min-jie Ye, Cai-yuan Liu, Rong-feng Liao, Zheng-yu Gu, Bing-ying Zhao, and Yi Liao Copyright © 2016 Min-jie Ye et al. All rights reserved. Transient Increase of Retinal Nerve Fiber Layer Thickness after Vitrectomy with ILM Peeling for Idiopathic Macular Hole Mon, 10 Oct 2016 09:14:26 +0000 Purpose. The purpose of this study was to determine the long-term changes in the circumpapillary retinal nerve fiber layer (RNFL) thickness following macular hole surgery with internal limiting membrane (ILM) peeling combined with phacoemulsification. Methods. Thirty-eight eyes of 37 patients who had pars plana vitrectomy () between 2010 and 2014 were studied. The average thicknesses of the global and the six sectors of the RNFL were determined before and at 1, 3, 6, 12, and 24 () months (M) after the surgery by spectral-domain optical coherent tomography. The postoperative mean RNFL thickness at each time was compared to that before the surgery by paired t-tests. Results. The RNFL of the operated eyes was significantly thicker at 1 month (1 M) and 3 M in all but the inferior-nasal sectors. The significant increase remained until 12 M in the superior-temporal and superior-nasal sectors. In addition, the RNFL was also significantly thicker in the temporal-inferior sector at 12 M based on the findings in 38 eyes. Conclusions. The postoperative RNFL was thicker in all but the nasal-inferior sector for at least 12 M after surgery. This prolonged increase of the RNFL thickness may indicate damage and mild edema of the RNFL. Kouichi Ohta, Atsuko Sato, Nami Senda, and Emi Fukui Copyright © 2016 Kouichi Ohta et al. All rights reserved. Autorefraction, Retinoscopy, Javal’s Rule, and Grosvenor’s Modified Javal’s Rule: The Best Predictor of Refractive Astigmatism Mon, 10 Oct 2016 08:09:46 +0000 The aim of the study was to determine the level of agreement between Javal’s rule, autorefraction, retinoscopy, and refractive astigmatism and to determine which technique is the most suitable substitute when subjective refraction is not applicable using a clinical sample. A total of 36 subjects, 14 males and 22 females, were involved in this study. The intraclass correlation coefficients between subjective refraction, autorefraction, and retinoscopy were 0.895 and 0.989, respectively, for the spherical equivalent. The Bland-Altman 95% limits of agreement between subjective refraction and autorefraction; subjective refraction and retinoscopy; and autorefraction and retinoscopy were −2.84 to 3.58, −0.88 to 1.12, and −3.01 to 3.53, respectively, for the spherical equivalent. The intraclass correlation coefficients between spectacle total astigmatism and the following techniques were as follows: retinoscopy (0.85); autorefraction (0.92); Javal’s rule (0.82); and Grosvenor et al. version (0.85). The Bland-Altman 95% limits of agreement between subjective refraction and autorefraction; subjective refraction and retinoscopy; subjective refraction and Javal’s rule; and subjective refraction and Grosvenor et al. version were −0.87 to 1.25, −1.49 to 1.99, −0.73 to 1.93, and −0.89 to 1.7, respectively, for the total astigmatism. The study showed that autorefraction and Javal’s rule may provide a starting point for subjective refraction cylinder power determination but only retinoscopy may satisfactorily replace subjective refraction total astigmatism when subjective refraction is not applicable. Kofi Asiedu, Samuel Kyei, and Emmanuel Ekow Ampiah Copyright © 2016 Kofi Asiedu et al. All rights reserved. Anterior Segment Imaging in Ocular Surface Squamous Neoplasia Wed, 05 Oct 2016 14:35:13 +0000 Recent advances in anterior segment imaging have transformed the way ocular surface squamous neoplasia (OSSN) is diagnosed and monitored. Ultrasound biomicroscopy (UBM) has been reported to be useful primarily in the assessment of intraocular invasion and metastasis. In vivo confocal microscopy (IVCM) shows enlarged and irregular nuclei with hyperreflective cells in OSSN lesions and this has been found to correlate with histopathology findings. Anterior segment optical coherence tomography (AS-OCT) demonstrates thickened hyperreflective epithelium with an abrupt transition between abnormal and normal epithelium in OSSN lesions and this has also been shown to mimic histopathology findings. Although there are limitations to each of these imaging modalities, they can be useful adjunctive tools in the diagnosis of OSSN and could greatly assist the clinician in the management of OSSN patients. Nevertheless, anterior segment imaging has not replaced histopathology’s role as the gold standard in confirming diagnosis. Sally S. Ong, Gargi K. Vora, and Preeya K. Gupta Copyright © 2016 Sally S. Ong et al. All rights reserved. Epidemiological Features of Pediatric Ocular Trauma in Egypt Wed, 05 Oct 2016 13:25:32 +0000 Purpose. To review the epidemiology of serious pediatric ocular trauma presenting to Kasr El Aini Hospital, Cairo University. Methods. Children with serious ocular trauma during a six-month period were examined and their data was analyzed. Results. Eighty eyes of 75 patients were included in this study, with 64% males () and average age of 5 years (5 months–15 years). There were 67 (83.75%) open globe injuries, 11 (13.75%) closed globe injuries, and 2 (2.5%) chemical injuries. Of the open globe injuries, 24 (30%) were ruptured globes and 43 (53.75%) were lacerations (31 penetrating injuries (38.75%), 6 IOFBs (7.5%), and 6 perforating injuries (7.5%)). Of the closed globe injuries, 3 had hyphema (3.75%), 5 had traumatic cataracts (6.25%), and 3 had vitreous hemorrhage with retinal detachment (3.75%). Forty-two patients (56%) presented within 24 hours, 28 patients (37.33%) presented between 24 hours and 1 week, and 5 patients (6.6%) presented after one week from the time of trauma. Seven eyes developed posttraumatic endophthalmitis (10% of open globe injuries). On leaving the hospital, 55 (68.75%) eyes had poor vision, 13 (16.25%) had moderate vision, and 12 (15%) had good vision. Conclusion. Children at a higher risk of trauma are males, >5 years, unsupervised, and involved in street activities. Immediate comprehensive primary management and secondary rehabilitation are mandatory in these cases. Ebrahim Abdullah Yehia Al Wadeai, Amr Abdellatif Osman, Tamer A. Macky, and Mahmoud M. Soliman Copyright © 2016 Ebrahim Abdullah Yehia Al Wadeai et al. All rights reserved. Assessment of Anterior Segment Measurements with Swept Source Optical Coherence Tomography before and after Ab Interno Trabeculotomy (Trabectome) Surgery Mon, 03 Oct 2016 13:42:28 +0000 Purpose. To compare the changes of anterior segment parameters, assessed by swept source anterior segment optical coherence tomography (AS-OCT) after combined Trabectome-cataract surgery and Trabectome-only surgery in open angle glaucoma patients. Methods. Thirty-eight eyes of 24 patients with open angle glaucoma were scanned with swept source AS-OCT before and 4 weeks after combined Trabectome-cataract or Trabectome-only surgery. Intraocular pressure, number of medications, and AS-OCT parameters, such as angle opening distance at 500 and 750 μm from the scleral spur (AOD500 and AOD750), trabecular-iris space area at 500 and 750 mm2 (TISA500, TISA750), angle recess area at 500 and 750 mm2 (ARA500, ARA750), trabecular iris angle (TIA), anterior chamber depth (ACD), anterior chamber width (ACW), and anterior chamber volume (ACV), were obtained before the surgery. These parameters were compared to evaluate whether the outcome of the surgery differed among the patients after the surgery. The width of the trabecular cleft was also measured for both groups. Results. The reduction of IOP and number of medications was found to be statistically significant in both groups (). ACD, ACV, and angle parameters such as AOD 500/750, TISA 500/750, ARA 500/750, and TIA500 showed significantly greater changes from the preoperative values to postoperative 1st month values in combined Trabectome-cataract surgery group (), whereas Trabectome-only group did not show statistically significant difference (). There was no statistically significant difference between two groups for the width of the trabecular cleft (). Conclusion. Anterior chamber angle parameters measured with swept source AS-OCT may be useful for evaluating glaucoma patients before and after Trabectome surgery with or without cataract surgery. Handan Akil, Ping Huang, Vikas Chopra, and Brian Francis Copyright © 2016 Handan Akil et al. All rights reserved. Timing of Pars Plana Vitrectomy in Management of Gunshot Perforating Eye Injury: Observational Study Mon, 03 Oct 2016 12:16:48 +0000 The aim of this study is to report the difference in either anatomical or functional outcome of vitreoretinal intervention in cases of gunshot perforating eye injury if done 2–4 weeks or after the 4th week after the original trauma. Patients were treated with pars plana vitrectomy and silicon oil. Surgeries were performed in the period from February 2011 until the end of December 2014. 253 eyes of 237 patients were reviewed. 46 eyes were excluded. 207 eyes of 197 patients were analyzed. The included eyes were classified based on the timing of vitrectomy in relation to the initial trauma into two groups: 149 eyes (the first group) operated on between the 3rd and the 4th week and 58 eyes (the second group) operated on after the 4th week after the trauma. Following one surgical intervention, in the first group, attached retina was achieved in 93.28% of patients. In the second group, attached retina was achieved in 96.55% of patients. All RD cases could be attached by a second surgery. Visual acuity improved in 81.21% of patients, did not change in 15.43% of patients, and declined in 3.35% of patients. In the second group, visual acuity improved in 81.03% of patients, did not change in 12.06% of patients, and worsened in 6.89% of patients. There was no statistically significant difference between the two groups in either anatomical or functional results. We recommend interfering before the 5th week after the trauma as retinal detachment is encountered more in cases operated on after the 4th week. The visual outcome depends on the site of entry and exit (the route of gunshot). Hammouda Hamdy Ghoraba, Mohamed Amin Heikal, Hosam Osman Mansour, Haithem Mamon Abdelfattah, Emad Mohamed Elgemai, and Adel Galal Zaky Copyright © 2016 Hammouda Hamdy Ghoraba et al. All rights reserved. Fuchs’ Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis Mon, 03 Oct 2016 09:51:13 +0000 Purpose. To study epidemiology, clinical findings and visual prognosis of patients with Fuchs’ Heterochromic Iridocyclitis (FHI). Methods. A retrospective analysis was performed on 158 patients with FHI. Thirty-five patients were observed only once; the remaining 123 had a mean follow-up of 30.7 months (50 of them had a mean follow-up of 63.5 months) and in those we assessed complications, medical and surgical treatment, and long-term visual prognosis. Results. Average age at uveitis diagnosis was 27.2 years and 18.3% of patients were children. Blurred vision (54.5%) and floaters (40.5%) were the most frequent presenting symptoms. Small to medium-sized keratic precipitates (95.6%), iris atrophy (86.8%), and vitreous opacities (91.2%) were the most common signs; the prevalence of cataract and IOP increase was 63.5% and 20.1%, respectively, and their incidence was 0.1 and 0.06 eye/year. Significant risk factor for visual loss was IOP increase at presentation (). At final examination 98% of the eye had a visual acuity ≥ 0.6, and topical () and systemic () corticosteroids therapy were used less frequently than before referral. Conclusions. FHI has a good visual prognosis, despite the significant incidence of cataract and glaucoma. A correct and prompt diagnosis might avoid unnecessary therapies and provide excellent visual outcomes. Massimo Accorinti, Giovanni Spinucci, Maria Pia Pirraglia, Simone Bruschi, Francesca Romana Pesci, and Ludovico Iannetti Copyright © 2016 Massimo Accorinti et al. All rights reserved. Polar Value Analysis of Corneal Astigmatism in Intrastromal Corneal Ring Segment Implantation Mon, 03 Oct 2016 09:10:51 +0000 Purpose. To evaluate surgically induced astigmatism (SIA) and the average corneal power change in symmetric intrastromal corneal ring segment (ICRS) implantation. Methods. The study included 34 eyes of 34 keratoconus patients who underwent symmetric Intacs SK ICRS implantation. The corneal pocket incision meridian was the preoperative steep meridian. Corneal power data were obtained before and 3 months after Intacs SK ICRS implantation using scanning-slit topography. Polar value analysis was used to evaluate the SIA. Hotelling’s trace test was used to compare intraindividual changes. Results. Three months postoperatively, the combined mean polar value for SIA changed significantly (Hotelling’s ; ). The SIA was 1.54 D at 99° and the average corneal power decreased significantly by 3.8 D. Conclusion. Intacs SK ICRS placement decreased the average corneal power and corneal astigmatism compared to the preoperative corneal power and astigmatism when the corneal pocket incision was made at the preoperative steep meridian. Chang Rae Rho, Min-Ji Kim, and Choun-Ki Joo Copyright © 2016 Chang Rae Rho et al. All rights reserved. The Role of E-Cadherin in Maintaining the Barrier Function of Corneal Epithelium after Treatment with Cultured Autologous Oral Mucosa Epithelial Cell Sheet Grafts for Limbal Stem Deficiency Thu, 29 Sep 2016 18:42:28 +0000 The role of E-cadherin in epithelial barrier function of cultured autologous oral mucosa epithelial cell sheet (CAOMECS) grafts was examined. CAOMECS were cultured on a temperature-responsive surface and grafted onto rabbit corneas with Limbal Stem Cell Deficiency (LSCD). E-cadherin levels were significantly higher in CAOMECS compared to normal and LSCD epithelium. Beta-catenin colocalized with E-cadherin in CAOMECS cell membranes while phosphorylated beta-catenin was significantly increased. ZO-1, occludin, and Cnx43 were also strongly expressed in CAOMECS. E-cadherin and beta-catenin localization at the cell membrane was reduced in LSCD corneas, while CAOMECS-grafted corneas showed a restoration of E-cadherin and beta-catenin expression. LSCD corneas did not show continuous staining for ZO-1 or for Cnx43, while CAOMECS-grafted corneas showed a positive expression of ZO-1 and Cnx43. Cascade Blue® hydrazide did not pass through CAOMECS. Because E-cadherin interactions are calcium-dependent, EGTA was used to chelate calcium and disrupt cell adhesion. EGTA-treated CAOMECS completely detached from cell culture surface, and E-cadherin levels were significantly decreased. In conclusion, E cadherin high expression contributed to CAOMECS tight and gap junction protein recruitment at the cell membrane, thus promoting cellular adhesion and a functional barrier to protect the ocular surface. Fawzia Bardag-Gorce, Richard H. Hoft, Andrew Wood, Joan Oliva, Hope Niihara, Andrew Makalinao, Jacquelyn Thropay, Derek Pan, Imara Meepe, Kumar Tiger, Julio Garcia, Amanda Laporte, Samuel W. French, and Yutaka Niihara Copyright © 2016 Fawzia Bardag-Gorce et al. All rights reserved. Intravitreal Conbercept Injection with and without Grid Laser Photocoagulation in the Treatment of Diffuse Diabetic Macular Edema in Real-Life Clinical Practice Thu, 29 Sep 2016 16:19:11 +0000 Purpose. To evaluate the efficacy of intravitreal conbercept (IVC) plus modified grid laser photocoagulation (MGP) versus IVC alone for treatment of diffuse diabetic macular edema (DDME). Methods. In this retrospective study, 51 DDME patients were treated with either IVC alone (IVC group) or IVC plus MGP (combined group) with 12 months of follow-up. The clinical records of those patients were reviewed. Results. 26 patients (31 eyes) received IVC alone and 25 patients (30 eyes) received combined therapy. At month 12, the mean best-corrected visual acuity (BCVA) letter score improvement was and in the IVC group and the combined group and the mean central retinal thickness (CRT) reduction was 145.1 ± 69.9 μm and  μm, respectively. There was no statistically significant difference of improvement in BCVA () and decrease in CRT () between the two groups. The mean number of injections delivered was significantly higher () in the IVC group (5.6 ± 0.8 per eye) than in the combined group ( per eye). Conclusions. IVC alone or combined with MGP appeared to be effective for treatment of DDME, achieving the similar clinical efficacy. Moreover, MGP helps to reduce the number of injections. Yule Xu, Ao Rong, Yanlong Bi, and Wei Xu Copyright © 2016 Yule Xu et al. All rights reserved. Visual Impairment among Older Adults in a Rural Community in Eastern China Thu, 29 Sep 2016 08:47:38 +0000 Purpose. To determine the prevalence, causes, and associations of visual impairment (VI) among participants aged 60 years or older in a rural community in China. Methods. A community-based survey was undertaken in a rural town located in Eastern China and 4579 people aged 60 years or older participated in the study. Presenting visual acuity was assessed using a Snellen chart with tumbling-E optotypes and anterior segment was examined using a slit-lamp. VI was defined as presenting VA <6/18 and it included moderate VI (<6/18 to 6/60) and blindness (<6/60). Results. The prevalence of VI was 5.4% (95% confidence interval [CI] 4.7–6.0). In multivariate analysis, the presence of VI was positively associated with increasing age (odds ratio [OR] = 1.12, 95% CI 1.10–1.16, per year increase), female gender (OR = 2.33, 95% CI 1.53–3.55), the presence of hypertension (OR = 1.31, 95% CI 1.001–1.85), living alone (OR = 1.52, 95% CI 1.08–2.62), and increased sleeping hours (OR = 1.10, 95% CI 1.001–1.22). Drinking 3 or more glasses of green tea per day was inversely associated with VI (OR = 0.79, 95% CI 0.63–0.98). Conclusion. VI was less prevalent in this community compared with previous report in other areas in China. Chen-Wei Pan, Deng-Juan Qian, Hong-Peng Sun, Qinghua Ma, Yong Xu, and E. Song Copyright © 2016 Chen-Wei Pan et al. All rights reserved. Repeatability and Reproducibility of Quantitative Corneal Shape Analysis after Orthokeratology Treatment Using Image-Pro Plus Software Wed, 28 Sep 2016 10:10:19 +0000 Purpose. To evaluate the repeatability and reproducibility of quantitative analysis of the morphological corneal changes after orthokeratology treatment using “Image-Pro Plus 6.0” software (IPP). Methods. Three sets of measurements were obtained: two sets by examiner 1 with 5 days apart and one set by examiner 2 on the same day. Parameters of the eccentric distance, eccentric angle, area, and roundness of the corneal treatment zone were measured using IPP. The intraclass correlation coefficient (ICC) and repetitive coefficient (COR) were used to calculate the repeatability and reproducibility of these three sets of measurements. Results. ICC analysis suggested “excellent” reliability of more than 0.885 for all variables, and COR values were less than 10% for all variables within the same examiner. ICC analysis suggested “excellent” reliability for all variables of more than 0.90, and COR values were less than 10% for all variables between different examiners. All extreme values of the eccentric distance and area of the treatment zone pointed to the same material number in three sets of measurements. Conclusions. IPP could be used to acquire the exact data of the characteristic morphological corneal changes after orthokeratology treatment with good repeatability and reproducibility. This trial is registered with trial registration number: ChiCTR-IPR-14005505. Ying Mei, Zhiping Tang, Zhouyue Li, and Xiao Yang Copyright © 2016 Ying Mei et al. All rights reserved. Possible Relation between Lack of Posterior Vitreous Detachment and Severe Endogenous Endophthalmitis Tue, 27 Sep 2016 15:41:50 +0000 Purpose. Endogenous endophthalmitis (EE) is a rare ocular disease caused by bacterial or fungal infection of intraocular spaces by hematogenous spread of pathogens from distant infectious loci in the body. We investigated the clinical characteristics and management of eyes with EE in ten consecutive patients. Methods. Ten patients (10 eyes) with EE treated at Tokyo Medical University Hospital in 2014 were reviewed. We retrospectively studied the causative organisms, systemic complications, pre/postoperative mean best-corrected visual acuity (BCVA), and status of posterior vitreous detachment (PVD). Results. The 10 patients comprised 8 males and 2 females, with mean age of 71.2 years. The causative organisms were bacteria in 6 eyes and fungi in 4 eyes. Systemic complications included septicemia or disseminated intravascular coagulation in 5 patients and diabetes mellitus in 4 patients. Postoperative BCVA was improved by or greater in 4 eyes and decreased in 4 eyes. Vitrectomy was performed in all eyes, and 4 required multiple surgeries. During vitrectomy, PVD was absent in 8 eyes, 4 of which showed retinal necrosis. The mean age of patients with no PVD was 71.2 years. Conclusion. Despite an advanced age, PVD was absent in the majority of patients with EE. PVD may be related to the pathogenesis and aggravation of EE. Kazuhiko Umazume, Jun Suzuki, Yoshihiko Usui, Yoshihiro Wakabayashi, and Hiroshi Goto Copyright © 2016 Kazuhiko Umazume et al. All rights reserved. Swept Source Optical Coherence Tomography Angiography for Contact Lens-Related Corneal Vascularization Mon, 26 Sep 2016 11:01:36 +0000 Purpose. To describe a novel technique of adapting a swept-source optical coherence tomography angiography (OCTA) to image corneal vascularization. Methods. In this pilot cross-sectional study, we obtained 3 × 3 mm scans, where 100,000 A-scans are acquired per second with optical axial resolution of 8 μm and lateral resolution of 20 μm. This was performed with manual “XYZ” focus without the anterior segment lens, until the focus of the corneoscleral surface was clearly seen and the vessels of interest were in focus on the corresponding red-free image. En face scans were evaluated based on image quality score and repeatability. Results. We analyzed scans from 10 eyes (10 patients) with corneal vascularization secondary to contact lens use in 4 quadrants, with substantial repeatability of scans in all quadrants (mean image quality score 2.7 ± 0.7; ). There was no significant difference in image quality scores comparing quadrants (superior temporal: 2.9 ± 0.6, superior nasal: 2.8 ± 0.4, inferior temporal: 2.5 ± 0.9, and inferior nasal: 2.4 ± 1.0; ) and able to differentiate deep and superficial corneal vascularization. Conclusion. This early clinical study suggests that the swept-source OCTA used may be useful for examining corneal vascularization, which may have potential for clinical applications such as detecting early limbal stem cell damage. Marcus Ang, Yijun Cai, and Anna C. S. Tan Copyright © 2016 Marcus Ang et al. All rights reserved. A Novel Technique for Conjunctivoplasty in a Rabbit Model: Platelet-Rich Fibrin Membrane Grafting Thu, 22 Sep 2016 16:12:09 +0000 Purpose. To investigate the effect of platelet-rich fibrin (PRF) membrane on wound healing. Methods. Twenty-four right eyes of 24 New Zealand rabbits equally divided into 2 groups for the study design. After the creation of 5 × 5 mm conjunctival damage, it was secured with PRF membrane, which was generated from the rabbit’s whole blood samples in PRF membrane group, whereas damage was left unsutured in the control group. Three animals were sacrificed in each group on the 1st, 3rd, 7th, and 28th postoperative days. Immunohistochemical (IHC) stainings and biomicroscopic evaluation were performed and compared between groups. Results. PRF membrane generated significant expressions of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-), and platelet-derived growth factor (PDGF) in the early postoperative period. However, the IHC evaluation allowed showing the excessive staining at day 28, in control group. Biomicroscopic evaluation revealed complete epithelialization in PRF membrane group, but none of the cases showed complete healing in the control group. Conclusions. This experimental study showed us the beneficial effects of the PRF membrane on conjunctival healing. Besides its chemical effects, it provides mechanical support as a scaffold for the migrating cells that are important for ocular surface regeneration. These overall results encourage us to apply autologous PRF membrane as a growth factor-enriched endogenous scaffold for ocular surface reconstruction. Mehmet Erol Can, Hasan Basri Çakmak, Gamze Dereli Can, Hatice Ünverdi, Yasin Toklu, and Sema Hücemenoğlu Copyright © 2016 Mehmet Erol Can et al. All rights reserved. Clinical Features and Visual Outcomes of Optic Neuritis in Chinese Children Tue, 20 Sep 2016 12:09:20 +0000 Purpose. Although optic neuritis (ON) in children is relatively common, visual outcomes and factors associated with the condition have not been well documented. The aim of this study was to evaluate the clinical features and visual outcomes of ON in Chinese children. Methods. Patients with a first episode of ON at a tertiary neuroophthalmic centre in China were assessed and followed up for at least three months. Visual outcomes and clinical, laboratory, and neuroimaging findings were reviewed. In patients with bilateral ON, only the eyes with worse visual acuity (VA) at presentation were used for statistical analysis. Results. Seventy-six children (76 eyes) with a first episode of ON were included. The mean age was 11.8 years, 60.5% were females, and 48.7% had bilateral involvement. The children were followed up for an average of 18.5 months (age range, 3–48 months). Vision loss at presentation was severe, with VA < 20/200 in 37 eyes (48.7%). At the final visit, 3 (3.9%) eyes had VA of at least 20/20, and 41 (53.9%) eyes had VA of at least 20/40. The final VA in 35 eyes (46.1%) was worse than 20/40. Children aged ≤ 10 years had better predicted visual outcomes when compared to children over 10 years (odds ratio = 2.73, 95% confidential interval: 1.05–7.07, and ). The other features of this cohort, such as sex, experienced bilateral attack, VA at presentation, presence of optic disc edema, systemic diseases, magnetic resonance imaging (MRI) findings, and aquaporin-4 (AQP-4) antibody status, were not significantly correlated with the final visual outcome. Conclusion. The data revealed the clinical characteristics and visual outcomes of ON in Chinese children. ON in children was associated with severe vision loss and relatively good visual recovery. The age at onset could predict the final visual function. Huanfen Zhou, Wei Wang, Quangang Xu, Shaoying Tan, Shuo Zhao, Mo Yang, Chunxia Peng, and Shihui Wei Copyright © 2016 Huanfen Zhou et al. All rights reserved. A Combination of Intrastromal and Intracameral Injections of Amphotericin B in the Treatment of Severe Fungal Keratitis Mon, 19 Sep 2016 13:44:54 +0000 Purpose. To evaluate the efficacy of a combination of intrastromal and intracameral injections of amphotericin B in the treatment of severe recalcitrant fungal keratitis. Methods. Patients with severe fungal keratitis who were resistant to conventional antifungal medical treatments and needed potential surgical intervention were recruited at the First Affiliated Hospital of Fujian Medical University between January 2012 and July 2013. The patients were treated with a combination of intrastromal and intracameral injections of amphotericin B (25 μg/mL and 50 μg/mL, resp.). Selectively repeated injections were performed as necessary. The efficacy, complications, and outcome were evaluated. Results. Nine patients (9 eyes) were involved in this study. All 9 cases responded favorably, and the clinical appearance of serious corneal damage and intraocular extension was resolved after the treatment. Four eyes required only 1 injection, and 5 eyes required repeated injections. Seven corneal ulcers healed with leucoma, and 2 healed with adherent leucoma. All of our cases had a marked increase in the anterior chamber reaction and pain immediately after the injection. There was no obvious clinical evidence of corneal or lenticular toxicity in any patient. Conclusions. A combination of intrastromal and intracameral injections of amphotericin B may be safe and effective for the treatment of severe fungal keratitis that is resistant to conventional therapy. Jianzhang Hu, Jingjin Zhang, Yanling Li, Xiaoli Han, Weidong Zheng, Juan Yang, and Guoxing Xu Copyright © 2016 Jianzhang Hu et al. All rights reserved. Applications of Anterior Segment Optical Coherence Tomography in Cornea and Ocular Surface Diseases Mon, 19 Sep 2016 09:23:45 +0000 Optical coherence tomography (OCT) is a noncontact technology that produces high-resolution cross-sectional images of ocular tissues. Anterior segment OCT (AS-OCT) enables the precise visualization of anterior segment structure; thus, it can be used in various corneal and ocular surface disorders. In this review, the authors will discuss the application of AS-OCT for diagnosis and management of various corneal and ocular surface disorders. Use of AS-OCT for anterior segment surgery and postoperative management will also be discussed. In addition, application of the device for research using human data and animal models will be introduced. Sang Beom Han, Yu-Chi Liu, Karim Mohamed Noriega, and Jodhbir S. Mehta Copyright © 2016 Sang Beom Han et al. All rights reserved. Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes Sun, 18 Sep 2016 11:43:37 +0000 Purpose. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 () 12 months after one (), two (), and three () implants but not four implants (). The mean baseline CRT decreased significantly () from 463 to 254 microns after 12 months with one (), two (), and three () implants but not with four implants (). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%). Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes. Eduardo A. Novais, Mauricio Maia, Paulo Augusto de Arruda Mello Filho, João Rafael de Oliveira Dias, José Maurício B. B. Garcia, Gabriel C. de Andrade, Ricardo N. Louzada, Marcos Ávila, André Maia, J. Fernando Arevalo, Lihteh Wu, Maria Berrocal, Emmerson Badaró, and Michel Farah Copyright © 2016 Eduardo A. Novais et al. All rights reserved. Clinical Usefulness of Monitoring Expression Levels of CCL24 (Eotaxin-2) mRNA on the Ocular Surface in Patients with Vernal Keratoconjunctivitis and Atopic Keratoconjunctivitis Sun, 18 Sep 2016 09:44:31 +0000 Purpose. This study aimed to evaluate the clinical efficacy of using expression levels of CCL24 (eotaxin-2) mRNA on the ocular surface as a biomarker in patients with vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). Methods. Eighteen patients with VKC or AKC (VKC/AKC group) and 12 control subjects (control group) were enrolled in this study. The VKC/AKC clinical score was determined by objective findings in patients by using the 5-5-5 exacerbation grading scale. All subjects underwent modified impression cytology and specimens were obtained from the upper tarsal conjunctiva. Expression levels of CCL24 (eotaxin-2) mRNA on the ocular surface were determined using real-time reverse transcription polymerase chain reaction. Results. The VKC group was divided into two subgroups, depending on the clinical score: the active stage subgroup with 100 points or more of clinical scores and the stable stage subgroup with 100 points or less. CCL24 (eotaxin-2) mRNA expression levels in the active VKC/AKC stage subgroup were significantly higher than those in the stable VKC/AKC subgroup and the control group. Clinical scores correlated significantly with CCL24 (eotaxin-2) mRNA expression levels in the VKC group. Conclusions. CCL24 (eotaxin-2) mRNA expression levels on the ocular surface are a useful biomarker for clinical severity of VKC/AKC. Yukiko Shiraki, Jun Shoji, and Noriko Inada Copyright © 2016 Yukiko Shiraki et al. All rights reserved. Reliability of Using Retinal Vascular Fractal Dimension as a Biomarker in the Diabetic Retinopathy Detection Wed, 14 Sep 2016 10:00:39 +0000 The retinal fractal dimension (FD) is a measure of vasculature branching pattern complexity. FD has been considered as a potential biomarker for the detection of several diseases like diabetes and hypertension. However, conflicting findings were found in the reported literature regarding the association between this biomarker and diseases. In this paper, we examine the stability of the FD measurement with respect to (1) different vessel annotations obtained from human observers, (2) automatic segmentation methods, (3) various regions of interest, (4) accuracy of vessel segmentation methods, and (5) different imaging modalities. Our results demonstrate that the relative errors for the measurement of FD are significant and FD varies considerably according to the image quality, modality, and the technique used for measuring it. Automated and semiautomated methods for the measurement of FD are not stable enough, which makes FD a deceptive biomarker in quantitative clinical applications. Fan Huang, Behdad Dashtbozorg, Jiong Zhang, Erik Bekkers, Samaneh Abbasi-Sureshjani, Tos T. J. M. Berendschot, and Bart M. ter Haar Romeny Copyright © 2016 Fan Huang et al. All rights reserved.