Journal of Ophthalmology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Enhanced Depth Imaging Optical Coherence Tomography: A New Way Measuring Choroidal Thickness in Pregnant Women Thu, 25 May 2017 08:06:20 +0000 The body changes markedly during pregnancy; each system behaves differently from a nonpregnant state. As the eyes are the only windows to see directly what is going on in the internal environment, more and more researches have been done to explain the association between ocular changes and the physiological and pathological changes during pregnancy. The choroid is one of the critical parts of the eye, providing nutrition. And abnormal choroid may result in ocular dysfunction and visual problems. As the optical coherence tomography develops, a rapid, direct, noninvasive, and nontoxic way is available to obtain the choroid situation of pregnant women, which may explain the mechanism of pregnancy-related eye diseases. This review would summarize relevant original articles published from January 1, 2008 to December 1, 2016 to assess the changes of choroidal thickness (CT) with enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy. And the relationship between choroidal thickness changes and pregnancy remains uncertain. To our knowledge, this is the first review of EDI-OCT in assessing the choroidal thickness of the pregnant women. Jun Zhang, Huiyun Wang, Qiubo Yu, Qihu Tong, and Qinkang Lu Copyright © 2017 Jun Zhang et al. All rights reserved. Corneal Endothelial Characteristics, Central Corneal Thickness, and Intraocular Pressure in a Population of Chinese Age-Related Cataract Patients Thu, 25 May 2017 00:00:00 +0000 Purpose. To describe corneal endothelial characteristics, central corneal thickness, and intraocular pressure in a population of Chinese age-related cataract patients and to determine the effects of age, gender, hypertension, and body mass index (BMI). Methods. 1551 eyes were examined preoperatively. The parameters measured were endothelial cell density (CD), average cell area (CA), coefficient of variation (CV), cell hexagonality (HEX), central corneal thickness (CCT), intraocular pressure (IOP), and axial length (AL). Results. There were significant differences in CV and BMI between genders. There was a significant decrease in CD, CCT, and IOP and, conversely, an increase in CA and BMI with increasing age. The patients who suffered from hypertension had bigger CA, less CD, and lower HEX than the patients who did not suffer from hypertension. CD has a negative correlation with age and CV and a positive correlation with CCT, CCT has a positive association with CD and IOP, and IOP had a negative relationship with age and a positive relationship with CCT, CA, and HEX. Conclusions. Normative data for the corneal endothelium, central corneal thickness, and intraocular pressure in the normal age-related cataract patients are reported which will serve as a baseline for comparative studies about cataract. Yingmei Li, Zhentao Fu, Jian Liu, Miao Li, Yuguang Zhang, and Xinyi Wu Copyright © 2017 Yingmei Li et al. All rights reserved. Impact of B-Scan Averaging on Spectralis Optical Coherence Tomography Image Quality before and after Cataract Surgery Tue, 23 May 2017 00:00:00 +0000 Background and Objective. To determine optimal image averaging settings for Spectralis optical coherence tomography (OCT) in patients with and without cataract. Study Design/Material and Methods. In a prospective study, the eyes were imaged before and after cataract surgery using seven different image averaging settings. Image quality was quantitatively evaluated using signal-to-noise ratio, distinction between retinal layer image intensity distributions, and retinal layer segmentation performance. Measures were compared pre- and postoperatively across different degrees of averaging. Results. 13 eyes of 13 patients were included and 1092 layer boundaries analyzed. Preoperatively, increasing image averaging led to a logarithmic growth in all image quality measures up to 96 frames. Postoperatively, increasing averaging beyond 16 images resulted in a plateau without further benefits to image quality. Averaging 16 frames postoperatively provided comparable image quality to 96 frames preoperatively. Conclusion. In patients with clear media, averaging 16 images provided optimal signal quality. A further increase in averaging was only beneficial in the eyes with senile cataract. However, prolonged acquisition time and possible loss of details have to be taken into account. Dominika Podkowinski, Ehsan Sharian Varnousfaderani, Christian Simader, Hrvoje Bogunovic, Ana-Maria Philip, Bianca S. Gerendas, Ursula Schmidt-Erfurth, and Sebastian M. Waldstein Copyright © 2017 Dominika Podkowinski et al. All rights reserved. Dark Signals in the Choroidal Vasculature on Optical Coherence Tomography Angiography: An Artefact or Not? Sun, 21 May 2017 00:00:00 +0000 Optical coherence tomography angiography (OCTA) based on mathematical processing of sequentially acquired structural OCT images has been applied widely in both retinal and choroidal research and may have advantages over traditional angiography. Images obtained by OCTA are rendered under the assumption that the only moving entity in the retina is blood flow. Optical phenomena and image processing algorithms may create imaging artefacts. Therefore, OCTA images require careful interpretation. This review discusses the dark signals seen in the choroidal vasculature on OCTA using multiple factor analysis. For accurate and comprehensive interpretation of the choroidal vasculature, we recommend simultaneous consideration of the laser light penetration depth and masking effect of retinal pigment epithelium, the orientation of vessels in relation to the scanning lasers and blood flow, the range of regional detectable velocity of blood flow, atrophic tissues in the periphery, and absorption of superior vessels on the scanning laser. Rui Hua and Hailin Wang Copyright © 2017 Rui Hua and Hailin Wang. All rights reserved. Detailed Distribution of Corneal Epithelial Thickness and Correlated Characteristics Measured with SD-OCT in Myopic Eyes Sun, 21 May 2017 00:00:00 +0000 Purpose. To investigate the detailed distribution of corneal epithelial thickness in single sectors and its correlated characteristics in myopic eyes. Methods. SD-OCT was used to measure the corneal epithelial thickness distribution profile. Differences of corneal epithelial thickness between different parameters and some correlations of characteristics were calculated. Results. The thickest and thinnest part of epithelium were found at the nasal-inferior sector () and at the superior side (), respectively. Subjects in the low and moderate myopia groups have thicker epithelial thickness than those in the high myopia group (). Epithelial thickness was 1.39 μm thicker in male subjects than in female subjects (). There was a slight negative correlation between corneal epithelial thickness and age (, ). Weak positive correlations were found between corneal epithelial thickness and corneal thickness (, ). No correlations were found between corneal epithelial thickness, astigmatism axis, corneal front curvature, and IOP. Conclusions. The epithelial thickness is not evenly distributed across the cornea. The thickest location of the corneal epithelium is at the nasal-inferior sector. People with high myopia tend to have thinner corneal epithelium than low–moderate myopic patients. The corneal epithelial thickness is likely to be affected by some parameters, such as age, gender, and corneal thickness. Yanan Wu and Yan Wang Copyright © 2017 Yanan Wu and Yan Wang. All rights reserved. Retrospective Study of Vitreous Tap Technique Using Needle Aspiration for Management of Shallow Anterior Chamber during Phacoemulsification Thu, 18 May 2017 06:15:50 +0000 Purpose. To evaluate the technique of vitreous tap using needle aspiration for management of anterior chamber shallowness during phacoemulsification. Methods. A retrospective study included 26 eyes of 17 patients who underwent phacoemulsification in which vitreous tap was performed using a 27-gauge needle attached to a 5 ml syringe, inserted 3.5 mm from the limbus to aspirate 0.2 ml of liquefied vitreous if a cohesive (OVD) failed to sufficiently deepen the anterior chamber. Results. Preoperative anterior chamber depth was 2.31 ± 0.26 mm, axial length was 21.7 ± 0.67 mm, lens thickness was 4.5 ± .19 mm, and cataract grade was 3.77 ± 1.4. Preoperative CDVA in LogMAR units was 0.98 ± 0.75. Coexisting angle closure glaucoma was present in 7 patients (26.92%) preoperatively. Vitreous needle tap was successful in vitreous removal on the first attempt in 26 eyes (100%). Postoperative follow-up period was 22.88 ± 10.24 (4–39) months. The final postoperative CDVA in LogMAR units was 0.07 ± 0.1, while the final postoperative IOP was 16.54 ± 1.45 mmHg. No complications related to vitreous tap were noted. Conclusion. Vitreous needle tap is a simple, cost-effective, and safe technique for management of shallow anterior chamber in phacoemulsification. Ashraf Ahmed Nossair, Wael Ahmed Ewais, and Lamia Samy Ali Copyright © 2017 Ashraf Ahmed Nossair et al. All rights reserved. Rho-Kinase/ROCK as a Potential Drug Target for Vitreoretinal Diseases Wed, 17 May 2017 06:54:02 +0000 Rho-associated kinase (Rho-kinase/ROCK) was originally identified as an effector protein of the G protein Rho. Its involvement in various diseases, particularly cancer and cardiovascular disease, has been elucidated, and ROCK inhibitors have already been applied clinically for cerebral vasospasm and glaucoma. Vitreoretinal diseases including diabetic retinopathy, age-related macular degeneration, and proliferative vitreoretinoapthy are still a major cause of blindness. While anti-VEGF therapy has recently been widely used for vitreoretinal disorders due to its efficacy, attention has been drawn to new unmet needs. The importance of ROCK in pathological vitreoretinal conditions has also been elucidated and is attracting attention as a potential therapeutic target. ROCK is involved in angiogenesis and hyperpermeability and also in the pathogenesis of various pathologies such as inflammation and fibrosis. It has been expected that ROCK inhibitors will become new molecular target drugs for vitreoretinal diseases. This review summarizes the recent progress on the mechanisms of action of ROCK and their applications in disease treatment. Muneo Yamaguchi, Shintaro Nakao, Mitsuru Arima, Iori Wada, Yoshihiro Kaizu, Feng Hao, Shigeo Yoshida, and Koh-hei Sonoda Copyright © 2017 Muneo Yamaguchi et al. All rights reserved. Assessment of Vascular Change Using Swept-Source Optical Coherence Tomography Angiography: A New Theory Explains Central Visual Loss in Behcet’s Disease Wed, 17 May 2017 06:28:25 +0000 Objective. To evaluate retinal vascular structural change in ocular Behcet’s using optical coherence tomography angiography (OCTA) and fluorescein angiography (FA). Methods. An analytic cross-sectional study of 37 eyes of 21 Behcet’s uveitic patients was performed. Foveal retinal thickness (FRT), perifoveal hypoperfusion areas in superficial capillary plexus (SCP), and deep capillary plexus (DCP) were measured with swept-source optical coherence tomography and OCTA. FA images were used for assessing the vascular features and correlation. Results. Twenty-one patients were enrolled (52.4% males). The average age at onset was 36.7 ± 12.93 years. The median of disease duration was 5 years (1–25). FRT was 118.1 ± 52.35 μm, which correlated with visual acuity (95% CI −60.47, −13.92). Using OCTA, the area of hypoperfusion in SCP (0.47 ± 0.17 mm2) was smaller than that in DCP (1.94 ± 3.87 mm2) (). Superficial to deep capillary plexus nonperfusion (SCP : DCP) ratio was 0.57 ± 0.27 which had the positive coefficient correlation with visual acuity (95% CI −0.644, −0.015). Conclusions. OCTA is an alternative noninvasive method to monitor macular ischemia in Behcet. Behcet’s uveitis affects DCP more than SCP. Decreasing SCP : DCP ratio and decrease FRT correlates with poor visual acuity. Macular ischemia and DCP loss can be found early and can explain vision loss in Behcet. Thanapong Somkijrungroj, Sritatath Vongkulsiri, Wijak Kongwattananon, Peranut Chotcomwongse, Sasivarin Luangpitakchumpol, and Korrawan Jaisuekul Copyright © 2017 Thanapong Somkijrungroj et al. All rights reserved. Physical Activity and Quality of Life in Retinitis Pigmentosa Wed, 17 May 2017 00:00:00 +0000 Purpose. Aerobic exercise has been found to be neuroprotective in animal models of retinal degeneration. This study aims to report physical activity levels in patients with RP and investigate the relationship between physical activity and vision-related quality-of-life (QOL). Materials and Methods. A retrospective study of adult patients with RP examined in 2005–2014. Physical activity levels were assessed using the Godin Exercise Questionnaire. The NEI-Visual Function Questionaire-25 (VFQ-25), SF-36 General Health survey, and Pepper Assessment Tool for Disability (PAT-D) were administered. Results. 143 patients participated. 81 (56.6%) patients were classified as “active” and 62 (43.4%) as “insufficiently active” by Godin score. VFQ-25 revealed statistically significant differences between the active and insufficiently active patients, including overall visual function (53.3 versus 45.1, ), color vision (73.8 versus 52.9, ), and peripheral vision (34.3 versus 23.8, ). The physical component of the SF-36 and the PAT-D survey also demonstrated statistically significant differences (47.2 versus 52.9, ; 24.3 versus 30.0, ). Active patients had a higher initial Goldmann visual field (GVF) score (74.8 versus 60.1 degrees, ) and final GVF score (78.7 versus 47.1 degrees, ) but did not reach statistical significance. Conclusions. In RP, increased physical activity is associated with greater self-reported visual function and QOL. Joshua D. Levinson, Ethan Joseph, Laura A. Ward, Joe R. Nocera, Machelle T. Pardue, Beau B. Bruce, and Jiong Yan Copyright © 2017 Joshua D. Levinson et al. All rights reserved. Meibomian Gland Dysfunction in Type 2 Diabetic Patients Tue, 16 May 2017 08:08:58 +0000 Purpose. To investigate meibomian gland and tear film function in patients with type 2 diabetes. Methods. This prospective study compared changes in meibomian gland and tear film function in type 2 diabetic patients with nondiabetic patients. Meibomian gland function was evaluated by measuring lipid layer thickness (LLT), grading of meibomian gland loss, lid margin abnormalities, and expression of meibum. Tear film function was assessed by measuring tear breakup time (TBUT), the Schirmer I test, noninvasive breakup time (NIBUT), tear meniscus height (TMH), and corneal fluorescein staining. Results. Meibography scores were significantly higher in the diabetic group compared with the nondiabetic group (). The number of expressible glands was significantly lower in the diabetic group in temporal, central, and nasal third of the lower eyelid (nasal: ; central: ; and temporal: ). The lid margin abnormality score was significantly higher in the diabetic group than in the nondiabetic group (). There was no statistically significant difference in the tear film function parameters between the two groups. Conclusions. Meibomian gland dysfunction (MGD) in type 2 diabetic patients is more severe compared with nondiabetic patients. Overall, most of the diabetic patients manifest as having asymptomatic MGD. Xiaolei Lin, Binbin Xu, Yuxi Zheng, Terry G. Coursey, Yinying Zhao, Junhua Li, Yana Fu, Xuewen Chen, and Yun-e Zhao Copyright © 2017 Xiaolei Lin et al. All rights reserved. A Surgical Cryoprobe for Targeted Transcorneal Freezing and Endothelial Cell Removal Tue, 16 May 2017 00:00:00 +0000 Purpose. To examine the effects of transcorneal freezing using a new cryoprobe designed for corneal endothelial surgery. Methods. A freezing console employing nitrous oxide as a cryogen was used to cool a series of different cryoprobe tip designs made of silver for high thermal conductivity. In vitro studies were conducted on 426 porcine corneas, followed by preliminary in vivo investigations on three rabbit corneas. Results. The corneal epithelium was destroyed by transcorneal freezing, as expected; however, the epithelial basement membrane remained intact. Reproducible endothelial damage was optimally achieved using a 3.4 mm diameter cryoprobe with a concave tip profile. Stromal edema was seen in the pre-Descemet’s area 24 hrs postfreeze injury, but this had been resolved by 10 days postfreeze. A normal collagen fibril structure was seen 1 month postfreeze, concurrent with endothelial cell repopulation. Conclusions. Transcorneal freezing induces transient posterior stromal edema and some residual deep stromal haze but leaves the epithelial basement membrane intact, which is likely to be important for corneal re-epithelialization. Localized destruction of the endothelial monolayer was achieved in a consistent manner with a 3.4 mm diameter/concave profile cryoprobe and represents a potentially useful approach to remove dysfunctional corneal endothelial cells from corneas with endothelial dysfunction. Alina Akhbanbetova, Shinichiro Nakano, Stacy L. Littlechild, Robert D. Young, Madara Zvirgzdina, Nigel J. Fullwood, Ian Weston, Philip Weston, Shigeru Kinoshita, Naoki Okumura, Noriko Koizumi, and Andrew J. Quantock Copyright © 2017 Alina Akhbanbetova et al. All rights reserved. Review of Small Gauge Vitrectomy: Progress and Innovations Mon, 15 May 2017 00:00:00 +0000 Purpose. To summarise the surgical advances and evolution of small gauge vitrectomy and discuss its principles and application in modern vitreoretinal surgery. The advent of microincisional vitrectomy systems (MIVS) has created a paradigm shift away from twenty-gauge vitrectomy systems, which have been the gold standard in the surgical management of vitreoretinal diseases for over thirty years. Advances in biomedical engineering and surgical techniques have overcome the technical hurdles of shifting to smaller gauge instrumentation and sutureless surgery, improving surgical capabilities and expanding the indications for MIVS. Shaheeda Mohamed, Carl Claes, and Chi Wai Tsang Copyright © 2017 Shaheeda Mohamed et al. All rights reserved. Multimodal Imaging in an Unusual Cluster of Multiple Evanescent White Dot Syndrome Thu, 11 May 2017 00:00:00 +0000 Objective. To describe an unusual cluster of multiple evanescent white dot syndrome (MEWDS) encountered within a 3-month period. Methods. This retrospective observation study is comprised of seven patients who presented with MEWDS in a 3-month period in central Israel. Data were collected from patients’ medical records on clinical, multimodal imaging, and viral serology findings. Results. Six women and one man of mean age 31.5 ± 7.2 years. Three reported a precedent viral infection. All had unilateral decreased vision. Funduscopy revealed foveal granularity. Main Imaging Findings. Hyperfluorescent spots on blue autofluorescence (BAF), hypofluorescent spots on indocyanine green angiography, dark lesions on infrared photos, and ellipsoid zone irregularities on spectral domain optical coherence tomography (SD-OCT). Resolution of the spots on BAF correlated with anatomic (SD-OCT) and visual recovery. OCT angiography performed following the convalescence stage demonstrated intact retinal and choroidal flow. Serologic findings were inconclusive. Conclusion. We report a unique cluster of MEWDS patients presented in a short period of time. SD-OCT findings of ellipsoid zone disruption in combination with other multimodal imaging modalities are outlined meticulously. Recognizing these imaging features along with high index of clinical suspicion is important for the diagnosis of MEWDS. Serologic testing might be considered in future patients. Orly Gal-Or, Ethan Priel, Irit Rosenblatt, Shiri Shulman, and Michal Kramer Copyright © 2017 Orly Gal-Or et al. All rights reserved. A Review of Innovations in Rhegmatogenous Retinal Detachment Surgical Techniques Thu, 11 May 2017 00:00:00 +0000 Rhegmatogenous retinal detachment (RRD) requires surgical intervention for its repair. There are variable techniques used for this purpose, and they are all being continuously refined. In this review, we detail the recent innovations in surgical management of RRD and proliferative vitreoretinopathy (PVR). Achia Nemet, Ala Moshiri, Glenn Yiu, Anat Loewenstein, and Elad Moisseiev Copyright © 2017 Achia Nemet et al. All rights reserved. Simultaneous Fluorescein Angiography and Spectral Domain Optical Coherence Tomography Correlate Retinal Thickness Changes to Vascular Abnormalities in an In Vivo Mouse Model of Retinopathy of Prematurity Wed, 10 May 2017 00:00:00 +0000 Background. Retinopathy of prematurity (ROP) is a condition of abnormal retinal vascular development (RVD) in premature infants. Fluorescein angiography (FA) has depicted phases (early, mid, late, and mature) of RVD in oxygen-induced retinopathy (OIR) mice. We sought to establish the relationship between retinal structural and vascular changes using simultaneous FA and spectral domain optical coherence tomography (SD-OCT). Method. 63 mice were exposed to 77% oxygen at postnatal day 7 (P7) for 5 days, while 63 mice remained in room air (RA). Total retinal thickness (TRT), inner retinal thickness (IRT), and outer retinal thickness (ORT) were calculated at early (P19), mid (P24), late (P32), and mature (P47) phases of RVD. Results. TRT was reduced in OIR (162.66 ± 17.75 μm, ) compared to RA mice at P19 (197.57 ± 3.49 μm, ), P24, P32, and P49 (). ORT was similar in RA and OIR mice at all ages (). IRT was reduced in OIR (71.60 ± 17.14 μm) compared to RA (103.07 ± 3.47 μm) mice at P19 and all ages (). Conclusion. We have shown the spatial and temporal relationship between retinal structure and vascular development in OIR. Significant inner retinal thinning in OIR mice persisted despite revascularization of the capillary network; further studies will elucidate its functional implications in ROP. Olachi J. Mezu-Ndubuisi, Lauren K. Taylor, and Jamee A. Schoephoerster Copyright © 2017 Olachi J. Mezu-Ndubuisi et al. All rights reserved. Characterization of Ex Vivo Expanded Oral Mucosal Epithelium Cells on Acellular Porcine Corneal Stroma for Ocular Surface Reconstruction Mon, 08 May 2017 08:35:16 +0000 Purpose. To ex vivo expand oral mucosal epithelium cells (OMECs) on acellular porcine corneal stroma (APCS) without using feeder cells and serum and to compare the morphologic and phenotypic characteristics of cultured oral cells on APCS to those of cells on deluded human amniotic membrane (HAM). Methods. SD rat oral mucosal biopsies were cultured on APCS and HAM. Reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry were used to analyze the characterization of stem cells and epithelial differentiation of the outgrowth products. Results. Stratified and optimal transplantable OMECs were obtained after being cultured three to four weeks. Both RT-PCR and immunohistochemistry showed that cultured OMECs expressed markers of epithelial differentiation cytokeratin K3 and epithelial stem cell markers of p63 and ABCG2. Conclusions. OMECs can be successfully cultured on APCS without using xenobiotic feeder cells and serum. Characterization showed that these sheets retain the morphologic and phenotypic characteristics of OMECs within differentiated cells and stem cells. The optimal transplantable sheets can prove to be particularly beneficial to both bilateral limbal stem cell deficiency and deep corneal lesions. Jia-Song Wang, Hua-Tao Xie, and Ming-Chang Zhang Copyright © 2017 Jia-Song Wang et al. All rights reserved. Self-Monitoring Symptoms in Glaucoma: A Feasibility Study of a Web-Based Diary Tool Thu, 04 May 2017 00:00:00 +0000 Purpose. Glaucoma patients annually spend only a few hours in an eye clinic but spend more than 5000 waking hours engaged in everything else. We propose that patients could self-monitor changes in visual symptoms providing valuable between clinic information; we test the hypothesis that this is feasible using a web-based diary tool. Methods. Ten glaucoma patients with a range of visual field loss took part in an eight-week pilot study. After completing a series of baseline tests, volunteers were prompted to monitor symptoms every three days and complete a diary about their vision during daily life using a bespoke web-based diary tool. Response to an end of a study questionnaire about the usefulness of the exercise was a main outcome measure. Results. Eight of the 10 patients rated the monitoring scheme to be “valuable” or “very valuable.” Completion rate to items was excellent (96%). Themes from a qualitative synthesis of the diary entries related to behavioural aspects of glaucoma. One patient concluded that a constant focus on monitoring symptoms led to negative feelings. Conclusions. A web-based diary tool for monitoring self-reported glaucoma symptoms is practically feasible. The tool must be carefully designed to ensure participants are benefitting, and it is not increasing anxiety. Leanne McDonald, Fiona C. Glen, Deanna J. Taylor, and David P. Crabb Copyright © 2017 Leanne McDonald et al. All rights reserved. Twenty-Four-Hour Variation of Intraocular Pressure in Primary Open-Angle Glaucoma Treated with Triple Eye Drops Wed, 03 May 2017 09:15:11 +0000 Objectives. To evaluate 24-hour intraocular pressure (IOP) variation in patients with primary open-angle glaucoma (POAG) treated with triple eye drops. Subjects and Methods. The IOP was measured in 74 eyes in 74 POAG patients (seated) on triple therapy (PG analogue, β-blocker, carbonic anhydrase inhibitor) at about every 3 hours. Results. The peak IOP was 13.5 ± 3.1 at 1:00, and the trough IOP was at 12.6 ± 2.4 mmHg at 7:00. The IOP at 7:00 was significantly lower than that at 10:00, 1:00, and 3:00 (). Based on the time of the peak IOP, we classified the patients into two groups: diurnal (28 eyes) and nocturnal types (37 eyes). There was significant difference at the spherical equivalent between diurnal and nocturnal types (). To assess the influence of reflective error, we conducted subanalysis for two groups: high myopic (26 eyes, ≤−6D) and low/nonmyopic (24 eyes, ≥−2D) groups. In the low/nonmyopia group, the IOP was significantly higher at 1:00 and 3:00 than at 13:00, 16:00, and 7: 00 (). Conclusion. The mean of IOP elevated outside of clinic hour in the POAG patients on triple therapy. The low/nonmyopia patient should be carefully treated because the IOP of the patients at night elevated significantly. Yoshinori Itoh, Kenji Nakamoto, Hiroshi Horiguchi, Shumpei Ogawa, Takahiko Noro, Makoto Sato, Tadashi Nakano, Hiroshi Tsuneoka, and Noriko Yasuda Copyright © 2017 Yoshinori Itoh et al. All rights reserved. Potential Utility of a 4K Consumer Camera for Surgical Education in Ophthalmology Wed, 03 May 2017 00:00:00 +0000 Purpose. We evaluated the potential utility of a cost-effective 4K consumer video system for surgical education in ophthalmology. Setting. Tokai University Hachioji Hospital, Tokyo, Japan. Design. Experimental study. Methods. The eyes that underwent cataract surgery, glaucoma surgery, vitreoretinal surgery, or oculoplastic surgery between February 2016 and April 2016 were recorded with 17.2 million pixels using a high-definition digital video camera (LUMIX DMC-GH4, Panasonic, Japan) and with 0.41 million pixels using a conventional analog video camera (MKC-501, Ikegami, Japan). Motion pictures of two cases for each surgery type were evaluated and classified as having poor, normal, or excellent visibility. Results. The 4K video system was easily installed by reading the instructions without technical expertise. The details of the surgical picture in the 4K system were highly improved over those of the conventional pictures, and the visual effects for surgical education were significantly improved. Motion pictures were stored for approximately 11 h with 512 GB SD memory. The total price of this system was USD 8000, which is a very low price compared with a commercial system. Conclusion. This 4K consumer camera was able to record and play back with high-definition surgical field visibility on the 4K monitor and is a low-cost, high-performing alternative for surgical facilities. Tsunetomo Ichihashi, Yutaka Hirabayashi, and Miyuki Nagahara Copyright © 2017 Tsunetomo Ichihashi et al. All rights reserved. Changes in Anterior, Posterior, and Total Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty Tue, 02 May 2017 09:33:39 +0000 Purpose. To evaluate changes in anterior, posterior, and total corneal astigmatism in patients after Descemet membrane endothelial keratoplasty (DMEK). Methods. We retrospectively included 29 eyes of 23 patients (age 67.6 ± 9.8 years, 13 female, 10 male) after DMEK surgery. The magnitude and axis orientation of anterior, posterior, and total corneal astigmatism before and after DMEK were determined using a rotating Scheimpflug system (Pentacam HR, Oculus). Results. The magnitude of anterior, posterior, and total corneal astigmatism in the central cornea did not change significantly after surgery. Before surgery, we found a significant correlation between the magnitudes of anterior and posterior corneal astigmatism (Spearman’s correlation coefficient , ), while after surgery this correlation was no longer significant (, ). There was a significant correlation between the vector difference between preoperative and postoperative posterior astigmatism and the change in corneal pachymetry (, ). Conclusions. Posterior corneal astigmatism (especially the orientation) and therefore the relationship between anterior and total corneal astigmatism may change after DMEK. This should be considered to improve the accuracy of toric IOL power calculations following phakic DMEK or in combined procedures. Maged Alnawaiseh, Lars Zumhagen, André Rosentreter, and Nicole Eter Copyright © 2017 Maged Alnawaiseh et al. All rights reserved. Intraoperative Macula Protection by Perfluorocarbon Liquid for the Metallic Intraocular Foreign Body Removal during 23-Gauge Vitrectomy Tue, 02 May 2017 09:22:31 +0000 Purpose. To evaluate visual and safety outcomes of 23-gauge (G) pars plana vitrectomy (PPV) with application of perfluorocarbon liquid (PFCL) for intraoperative protection of the macula during intraocular foreign body (IOFB) removal. Methods. Retrospective study of 42 patients who underwent 23 G PPV for IOFB removal from posterior segment with intraoperative PFCL application for the macula shielding. Collected data included corrected distance visual acuity (CDVA), size of IOFB, and complication rate. The mean follow-up period was 12 months. Results. The mean preoperative CDVA was 0.54 logMAR (SD 0.46), and the final mean CDVA was 0.68 logMAR (SD 0.66). All IOFBs were metallic with mean dimensions of 4.6 mm × 2.1 mm. Twenty-two IOFBs were removed through the corneal tunnel and 20 IOFBs through the sclerotomy. No intraoperative iatrogenic lesion of the macula was observed. As a tamponade, silicon oil was applied in 31 eyes, SF6 gas in 5 eyes, air in 4 eyes, and 2 eyes required no tamponade. Secondary retinal detachment was observed in 17% of cases, but at the end of the follow-up, all the retinas were attached. Conclusion. PFCL application during PPV is a safe method of protecting the macula from unexpected falling of the metallic IOFB during its removal. Robert Rejdak, Tomasz Choragiewicz, Joanna Moneta-Wielgos, Dominika Wrzesinska, Dorota Borowicz, Matteo Forlini, Anselm G. Jünemann, and Katarzyna Nowomiejska Copyright © 2017 Robert Rejdak et al. All rights reserved. Glaucomatous Optic Nerve Changes and Thyroid Dysfunction in an Urban South Korean Population Tue, 02 May 2017 00:00:00 +0000 Purpose. This study was performed to evaluate the relationship between intraocular pressure (IOP) and glaucomatous optic nerve change and thyroid factors in Korean population. Materials and Methods. The study included subjects who underwent health screening in Kangbuk Samsung Hospital. Detailed history taking and systemic and ocular examination including fundus photography were performed for all participants. All fundus photographs were divided into two groups based on disc and RNFL appearance: nonglaucoma and glaucoma group. Subjects were also divided into quartiles of each thyroid function parameter, and the relationship with IOP and glaucoma were analysed. Results. In univariate analysis, free T4, T3, and TSH in normal subjects and T3 in thyroid disease group were associated with the IOP. After adjusting for age and sex, the IOP tended to slightly decrease according to the level of the quartile of free T4 and T3 in normal subjects. In terms of glaucoma, on multivariate analysis, it did not show a significant correlation with any thyroid function tests. Conclusions. In normal subjects, the IOP tended to be decreased according to the level of free T4 and T3 but the amounts were clinically insignificant. Thyroid factors are not an independent risk factor for the development of glaucoma. Yu Sam Won, Da Yeong Kim, and Joon Mo Kim Copyright © 2017 Yu Sam Won et al. All rights reserved. Additive Intraocular Pressure-Lowering Effects of Ripasudil with Glaucoma Therapeutic Agents in Rabbits and Monkeys Sun, 30 Apr 2017 00:00:00 +0000 Ripasudil hydrochloride hydrate (K-115), a specific Rho-associated coiled-coil containing protein kinase (ROCK) inhibitor, is developed for the treatment of glaucoma and ocular hypertension. Topical administration of ripasudil decreases intraocular pressure (IOP) by increasing conventional outflow through the trabeculae to Schlemm’s canal, which is different from existing agents that suppress aqueous humor production or promote uveoscleral outflow. In this study, we demonstrated that ripasudil significantly lowered IOP in combined regimens with other glaucoma therapeutic agents in rabbits and monkeys. Ripasudil showed additional effects on maximum IOP lowering or prolonged the duration of IOP-lowering effects with combined administration of timolol, nipradilol, brimonidine, brinzolamide, latanoprost, latanoprost/timolol fixed combination, and dorzolamide/timolol fixed combination. These results indicate that facilitation of conventional outflow by ripasudil provides additive IOP-lowering effect with other classes of antiglaucoma agents. Ripasudil is expected to have substantial utility in combined regimens with existing agents for glaucoma treatment. Yoshio Kaneko, Masayuki Ohta, Tomoyuki Isobe, Yuto Nakamura, and Ken Mizuno Copyright © 2017 Yoshio Kaneko et al. All rights reserved. A Meta-Analysis Comparing Postoperative Complications and Outcomes of Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification for Cataract Sun, 30 Apr 2017 00:00:00 +0000 Objective. This meta-analysis aimed to compare the outcomes and postoperative complications between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). Methods. Bibliographic databases, including PubMed, Embase, and Cochrane library, were systematically searched for references on or before September 2015 regarding the outcomes and complications by FLACS or CPCS. Data on corneal endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive outcomes, and postoperative complications were retrieved. Results. A total of 9 trials were included in this analysis. Refractive outcomes (MD = −0.21, 95% CI: −0.39~0.03, ) were significantly improved after FLACS. Although corneal endothelial cell loss was not significantly reduced after FLACS, there was a trend towards lower corneal endothelial cell loss (mean difference (MD) = 197.82, 95% confidence interval (CI): 2.66~392.97, ) after FLACS. There was no significant difference in UDVA (MD = −0.01, 95% CI: −0.13~0.10, ) or CDVA (MD = −0.03, 95% CI: 0.07~0.00, ) between the two surgeries. Elevated intraocular pressure and macular edema were most commonly developed complications after cataract surgery, and the incidence of these complications associated with the two surgeries was similar. Conclusion. Compared with CPCS, FLACS might achieve higher refractive stability and corneal endothelial cell count. Nevertheless, further study is needed to validate our findings. Zi Ye, Zhaohui Li, and Shouzhi He Copyright © 2017 Zi Ye et al. All rights reserved. A System Review and Meta-Analysis of Canaloplasty Outcomes in Glaucoma Treatment in Comparison with Trabeculectomy Sun, 30 Apr 2017 00:00:00 +0000 Purpose. This system review studied the efficiency and safety of canaloplasty (CP) and compared the outcomes between CP and trabeculectomy (TE). Methods. Literatures were searched in PubMed and EMBASE. The meta-analysis was conducted on the postoperative outcomes in CP and then on the differences of outcomes between CP and TE. Results. In the meta-analysis, IOP decreased by 9.94 (95% CI 8.42 to 11.45) mmHg with an average AGM reduction of 2.11 (95% CI 1.80 to 2.42) one year after CP. The IOP reduction was significantly higher after TE than after CP, with an average difference of 3.61 (95% CI 1.69 to 5.53) mmHg at 12 months postoperationally. For complications, the incidence of hyphema was significantly higher in CP and the Descemet membrane detachment was just reported in CP, with an incidence of 3%. However, the incidence was significantly lower in CP of hypotony and of choroidal effusion/detachment. Meanwhile, suprachoroidal hemorrhage and bleb needling were only reported in TE. Conclusions. CP was less effective in IOP reduction than TE, but CP was able to achieve similar postoperative success rates and reduce the number of AGMs likewise. CP was also associated with lower incidence of complications. More high-quality researches are needed in the future to verify our findings in this system review. Bing Zhang, Jie Kang, and Xiaoming Chen Copyright © 2017 Bing Zhang et al. All rights reserved. Safety and Efficacy of Microinvasive Glaucoma Surgery Sun, 23 Apr 2017 00:00:00 +0000 Microinvasive glaucoma surgery (MIGS) is emerging as a new therapeutic option for glaucoma patients who wish to reduce their medication burden and avoid the postoperative complications of conventional glaucoma filtration surgery. These devices differ in terms of their efficacy and safety profile. Schlemm’s canal devices have the most favorable safety profile at the compromise of modest efficacy, while subconjunctival and suprachoroidal devices are potentially more effective at lowering the intraocular pressure at the expense of a higher rate of complications. This review consolidates the latest evidence on the efficacy and safety of the MIGS devices in clinical use and provides an overview on upcoming devices which would likely also become viable treatment options in the near future. These clinical data would assist a glaucoma surgeon in selecting the most appropriate MIGS device for each patient based on the glaucoma severity and patient expectations. David Z. Chen and Chelvin C. A. Sng Copyright © 2017 David Z. Chen and Chelvin C. A. Sng. All rights reserved. High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction? Sun, 23 Apr 2017 00:00:00 +0000 The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC3), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC3 shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC3 was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC3, summarizing the current knowledge about this procedure and future possible developments. Rodolfo Mastropasqua, Vincenzo Fasanella, Alessandra Mastropasqua, Marco Ciancaglini, and Luca Agnifili Copyright © 2017 Rodolfo Mastropasqua et al. All rights reserved. A Comparative Study: The Use of Collagen Implant versus Mitomycin-C in Combined Trabeculotomy and Trabeculectomy for Treatment of Primary Congenital Glaucoma Sun, 23 Apr 2017 00:00:00 +0000 Purpose. To compare Ologen implant versus mitomycin-C (MMC) in combined trabeculotomy and trabeculectomy as a treatment of primary congenital glaucoma. Setting. Sohag University Hospital, Egypt. Design. A prospective comparative study. Methods. Thirty-four eyes of twenty-one patients with primary congenital glaucoma were included in this study. All patients were subjected to preoperative evaluation including complete anterior segment examination under general anesthesia. The patients were divided into two groups: patients of the first group (group A) underwent combined trabeculotomy and trabeculectomy with Ologen implantation while those of the second group (group B) underwent combined trabeculotomy and trabeculectomy with MMC application. Results. Postoperatively, the IOP in group A was as follows: 8 eyes developed IOP levels less than 14 mmHg (complete success), 3 eyes had levels between 14 and 16 mmHg (accepted result), 2 eyes had levels between 16 and 20 mmHg (guarded result), and only 2 eyes showed levels exceeding 20 mmHg (failed procedure), while in group B, 7 eyes showed complete success, 3 eyes had accepted result, 3 eyes had guarded result, and 2 eyes had failed procedure. Conclusion. Ologen is a safe and effective adjuvant in combined trabeculotomy and trabeculectomy for treatment of primary congenital glaucoma. Alaa Abdel Sadek Singab, Osama Ali Mohammed, Mohammed Iqbal Hafez Saleem, and Mortada Ahmed Abozaid Copyright © 2017 Alaa Abdel Sadek Singab et al. All rights reserved. Refractive Lens Exchange Combined with Primary Posterior Vitrectorhexis in Highly Myopic Patients Thu, 20 Apr 2017 00:00:00 +0000 Purpose. To evaluate efficacy and safety of primary vitrectorhexis for posterior capsulotomy in highly myopic patients undergoing refractive lens exchange. Methods. The study is a prospective nonrandomized interventional study. The study comprised 60 eyes of 60 myopic patients. All patients underwent refractive lens exchange (RLE) and foldable IOL implantation combined with primary posterior capsulotomy. We used a 23-gauge vitrectomy probe for the creation of the posterior capsule opening. We followed the patients for one year. Results. During surgery, the IOLs remained well centered in the capsular bag after creation of the capsulotomy. Postoperatively, we did not report any complications related to lens centration or changes in the posterior capsulotomy size. No eye required YAG laser posterior capsulotomy and no cases of retinal detachment (RD) occurred during the follow-up period. Conclusion. Primary posterior vitrectorhexis during RLE is an efficient method in preventing the occurrence of posterior capsular opacification (PCO) and the need for YAG laser posterior capsulotomy with its possible complications. Tarek A. Mohamed, Wael Soliman, Dalia M. EL Sebaity, and Ahmed M. Fathalla Copyright © 2017 Tarek A. Mohamed et al. All rights reserved. The Impact of Electronic Reading Devices on Reading Speed and Comfort in Patients with Decreased Vision Thu, 20 Apr 2017 00:00:00 +0000 Background/Aims. To evaluate the impact of back-illuminated and nonilluminated electronic reading devices on reading speed and comfort in patients with decreased vision. Methods. A prospective study involving a convenience sample of 167 patients at a single retina practice from January 2011 to December 2012. Participants were asked to read five different excerpts on five different media in a randomly assigned order. Media included a printed book at 12-point font (12PF), iPad2 at 12PF, iPad2 at 18-point font (18PF), Kindle2 at 12PF, and Kindle2 at 18PF. Reading speed in words per minute (WPM) and medium preference were recorded and stratified by visual acuity (VA). Results. Mean reading speeds in WPM: iPad2 at 18PF (217.0), iPad2 at 12PF (209.1), Kindle2 at 18PF (183.3), Kindle2 at 12PF (177.7), and printed book at 12PF (176.8). Reading speed was faster on back-illuminated media compared to nonilluminated media. Text magnification minimized losses in reading performance with worsening patient VA. The majority of participants preferred reading on the iPad2 at 18PF. Conclusions. Back-illuminated devices may increase reading speed and comfort relative to nonilluminated devices and printed text, particularly in patients with decreased VA. Henry L. Feng, Daniel B. Roth, Howard F. Fine, Jonathan L. Prenner, Kunjal K. Modi, and William J. Feuer Copyright © 2017 Henry L. Feng et al. All rights reserved.