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Publisher: John Wiley and Sons   (Total: 1589 journals)

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Showing 1 - 200 of 1589 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 12, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 65, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 48, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 53, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 168, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 37, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 7, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 5)
Addiction     Hybrid Journal   (Followers: 36, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 14, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 26, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 295, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 11)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 16, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 3, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 32, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 33, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 152, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 93, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 29, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 35, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 13, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 16, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 37, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 290, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 16, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 18, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 138, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 9, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 20)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 179)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 229, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 41, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 7, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 48, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 8, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 13)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 25, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 17, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 91, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 50, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 8, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 70, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 209, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 50, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 14, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 32, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 36, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 29, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 26, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 3, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 13, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 274, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 54, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 326, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (Followers: 1, SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 6, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 12, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 3, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 47, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 6, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 31, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 15, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 419, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 5, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 72, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 23, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 36, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 11, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 5, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 24, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 10, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 16, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 5, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 41, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 44, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 152, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 7, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 247, SJR: 2.083, h-index: 125)

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Journal Cover Acta Ophthalmologica
  [SJR: 1.473]   [H-I: 38]   [6 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1755-375X - ISSN (Online) 1755-3768
   Published by John Wiley and Sons Homepage  [1589 journals]
  • Choroidal thickness and myopia in relation to physical activity –
           the CHAMPS Eye Study
    • Authors: Kristian Lundberg; Anders Højslet Vestergaard, Nina Jacobsen, Anne Suhr Thykjær, Rasmus Søgaard Hansen, Ernst Goldschmidt, Tunde Peto, Ulrich Halekoh, Niels Wedderkopp, Jakob Grauslund
      Abstract: PurposeTo describe the relationship between choroidal thickness (CT) and myopia in relation to physical activity (PA) in a population-based child cohort.MethodsIn a prospective study of 307 children from the CHAMPS Study Denmark, we used objective data from GT3X accelerometer worn at four periods between 2009 and 2015 to determine the amount and intensity of PA. Intensity was estimated as counts/minutes, and cut-off points were defined at four intensity levels. Eye examinations were performed in 2015 and included autorefraction in cycloplegia, axial length (AL) by biometric and fovea-centred enhanced depth imaging optical coherence tomography. By a semi-automated method, we measured the CT at 17 targets per eye representing anatomically different locations (subfoveal, 1 and 3 millimetre in each direction of fovea).ResultsMean age at the eye examination was 15.4 ± 0.7 years. The mean AL was 23.5 ± 0.9 mm, and the mean subfoveal CT was 369 ± 87 μm. Choroidal thickness (CT) was 331 ± 68 μm for the overall macula, 355 ± 78 μm for the 1-mm zone and 304 ± 60 μm for the 3-mm zone. All CT measurements were thinner in myopic eyes (p 
      PubDate: 2018-01-16T10:13:07.487615-05:
      DOI: 10.1111/aos.13640
  • Physical exercise and glaucoma: a review on the roles of physical exercise
           on intraocular pressure control, ocular blood flow regulation,
           neuroprotection and glaucoma-related mental health
    • Authors: Ming Ming Zhu; Jimmy Shiu Ming Lai, Bonnie Nga Kwan Choy, Jennifer Wei Huen Shum, Amy Cheuk Yin Lo, Alex Lap Ki Ng, Jonathan Cheuk Hung Chan, Kwok Fai So
      Abstract: The benefits of physical exercise on health and well-being have been studied in a wide range of systemic and ocular diseases, including glaucoma, a progressive optic neuropathy characterized by accelerated apoptosis of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP) and insufficient ocular perfusion have been postulated to be the two main theories in glaucoma development and progression. The effects of exercise in these two aspects have been demonstrated by numerous researches. A review in 2009 focusing on these two theories concluded that exercise results in transient IOP reduction but an inconsistent elevation in ocular perfusion. However, the majority of the studies had been conducted in healthy subjects. Over the past decade, technological advancement has brought forth new and more detailed evidence regarding the effects of exercise. Moreover, the neuroprotective effect of exercise by upregulation of neurotrophin and enhancement of mitochondrial function has been a focus of interest. Apart from visual impairment, the mental health issues in patients with glaucoma, which include anxiety and depression, should also be addressed. In this review, we mainly focus on publications from the recent years, so as to provide a comprehensive review on the impact of physical exercise on IOP, ocular perfusion, neuroprotection and mental health in patients with glaucoma.
      PubDate: 2018-01-16T10:12:50.567738-05:
      DOI: 10.1111/aos.13661
  • Three-dimensional visualization and volume quantification of pigment
           epithelium detachments
    • Authors: Yousif Subhi; Torben Lykke Sørensen
      PubDate: 2018-01-16T10:12:39.748002-05:
      DOI: 10.1111/aos.13687
  • Nestin expression in primary and metastatic uveal melanoma – possible
           biomarker for high-risk uveal melanoma
    • Authors: Luna Djirackor; Dilem Shakir, Helen Kalirai, Goran Petrovski, Sarah E. Coupland
      Abstract: PurposeNestin, a member of the intermediate filament protein family, has been described as a putative cancer stem cell marker (CSC) in uveal melanoma and poor prognostic factor in a variety of tumours, including cutaneous melanoma. In this study, we examined the expression of nestin in primary (PUM) and metastatic uveal melanoma (MUM) samples, and correlated the findings with histological, clinical and survival data.MethodsNestin expression was assessed by immunohistochemistry in 141 PUM and 26 MUM samples; 11 PUM cases were matched with their corresponding metastases. The percentage of tumour cells expressing nestin was scored by three independent observers. Statistical analysis of all data was performed with SPSS.ResultsNestin expression was identified in both the cytoplasm and membrane of UM cells. Increased expression of nestin in PUM samples was associated with known poor prognostic parameters, including epithelioid cell morphology (p 
      PubDate: 2018-01-16T10:12:30.000659-05:
      DOI: 10.1111/aos.13645
  • Tumour thickness, diameter, area or volume' The prognostic
           significance of conventional versus digital image analysis-based size
           estimation methods in uveal melanoma
    • Authors: Thorsteinn Snaebjörnsson Arnljots; Zaid Al-Sharbaty, Emma Lardner, Charlotta All-Eriksson, Stefan Seregard, Gustav Stålhammar
      Abstract: PurposeThe aim of this study was to compare conventional and novel size estimation methods’ ability to predict survival in uveal melanoma (UM).MethodsThe study was designed as a retrospective consecutive chart review of patients with UM, enucleated between the years 1984 and 1993. Area and volume were estimated based on the largest histopathological cross-section, the second centroid theorem of Pappus and digital image analysis, correlated to overall and relative survival.ResultsOf 168 patients analysed, 20 (12%) of tumours were categorized as T1, 47 (28%) as T2, 67 (40%) as T3 and 19 (11%) as T4 (15 N/a). A total of 91 tumours with complete survival and measurement data were included and recategorized into small, medium and large volume groups. Increased separation of overall survival was seen compared with current American Joint Committee on Cancer T categories. Difference between the large and small volume groups was 8.6 years (p = 0.001), compared to a difference of 5.6 years (p = 0.091) between T1 and T4. Hazard ratio for all-cause mortality in the large versus small volume group was 2.6 compared to 1.9 for T4 versus T1. Relative survival rates for small, medium and large volumes were 62, 44 and 31% at 10 years, versus 50, 45, 56 and 0% for T1, T2, T3 and T4.ConclusionThis study provides evidence that a novel UM volume estimation method might offer a practical and cost-efficient alternative to improve the prognostic value intrinsic to a tumour's size.
      PubDate: 2018-01-16T10:11:29.335989-05:
      DOI: 10.1111/aos.13668
  • Correlation between morphological characteristics in
           spectral-domain-optical coherence tomography, different functional tests
           and a patient's subjective handicap in acute central serous
    • Authors: Bianca S. Gerendas; Julia-Sophie Kroisamer, Wolf Buehl, Sandra M. Rezar-Dreindl, Katharina M. Eibenberger, Eleonore Pablik, Ursula Schmidt-Erfurth, Stefan Sacu
      Abstract: PurposeThe purpose of this study was to identify quantitatively measurable morphologic optical coherence tomography (OCT) characteristics in patients with an acute episode of central serous chorioretinopathy (CSC) and evaluate their correlation to functional and psychological variables for their use in daily clinical practice.MethodsRetinal thickness (RT), the height, area and volume of subretinal fluid (SRF)/pigment epithelium detachments were evaluated using the standardized procedures of the Vienna Reading Center. These morphologic characteristics were compared with functional variables [best-corrected visual acuity (BCVA), contrast sensitivity (CS), retinal sensitivity/microperimetry, fixation stability], and patients’ subjective handicap from CSC using the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25).ResultsData from 39 CSC patients were included in this analysis. Three different SRF height measures showed a high negative correlation (r = −0.7) to retinal sensitivity within the central 9°, which was also negatively correlated with SRF area and volume (r = −0.6). The CS score and fixation stability (fixation points within 2°) showed a moderate negative correlation (r = −0.4) with SRF height variables. Comparison of the subjective handicap with morphological characteristics in spectral-domain (SD)-OCT showed SRF height had the highest correlation (r = −0.4) with the subjective problems reported and overall NEI VFQ-25 score.ConclusionIn conclusion, SRF height measured in SD-OCT showed the best correlation with functional variables and patients’ subjective handicap caused by the disease and therefore seems to be the best variable to look at in daily clinical routine. Even though area and volume also show a correlation, these cannot be so easily measured as height and are therefore not suggested for daily clinical routine.
      PubDate: 2018-01-16T10:11:15.762774-05:
      DOI: 10.1111/aos.13665
  • Statin use and vitreoretinal surgery: Findings from a Finnish
           population-based cohort study
    • Authors: Sirpa Loukovaara; Sari Sahanne, Annika Takala, Jari Haukka
      Abstract: PurposeVitreoretinal (VR) surgery is the third most common intraocular surgery after refractive and cataract surgery. The impact of statin therapy on VR surgery outcomes remains unclear, despite a potentially beneficial effect. We explored the association of preoperative statin therapy and the need for revitrectomy after primary vitrectomy.MethodsOur historical, population-based, register-based, VR surgery cohort consisted of 5709 patients operated in a tertiary, academic referral hospital in Finland, during 2008–2014, covering 6.5 years.Subgroup analysis was performed as follows: eyes operated due to (i) rhegmatogenous retinal detachment (RRD), (ii) VR interface diseases (macular pucker/hole), (iii) diabetic maculopathy or proliferative retinopathy, (iv) vitreous haemorrhage, (v) lens subluxation, (vi) vitreous opacities or (vii) other VR indication.The primary end-point event was revitrectomy during a postoperative follow-up period of 1 year due to retinal redetachment, vitreous rehaemorrhage, postoperative endophthalmitis, recurrent pucker or unclosed macular hole.ResultsRhegmatogenous retinal detachment (RRD) was the second most frequent indication of VR surgery, including 1916 patients, with 305 re-operations with rate 0.20 (95% CI 0.18–0.23) per person-year. Statin treatment in time of operation was associated with lower risk of re-operation according to relative scale (incidence rate ratio 0.72, 95% CI 0.53–0.97), but not in absolute scale (incidence rate difference −0.58, 95% CI −4.30 to 3.15 for 100 person-years). No association with statin therapy and vitrectomy outcome was observed in the other VR subgroups.ConclusionUse of statin treatment was associated with a 28% lower risk of revitrectomy in patients operated due to RRD. Further randomized clinical trials are highly warranted.
      PubDate: 2018-01-16T10:11:12.015997-05:
      DOI: 10.1111/aos.13641
  • Pimasertib-associated ophthalmological adverse events
    • Authors: Elon H.C. Dijk; Wim H.J. Kruit, Martine J. Jager, Gregorius P.M. Luyten, Johannes R. Vingerling, Camiel J.F. Boon
      Abstract: PurposeTo analyse ophthalmological adverse events associated with mitogen-activated protein kinase kinase (MEK) inhibition with pimasertib treatment for metastatic cutaneous melanoma (CM).MethodsIn this prospective observational, cohort-based, cross-sectional study, eight patients treated with the MEK inhibitor pimasertib received a complete ophthalmic examination. This included Early Treatment of Diabetic Retinopathy Study best-corrected visual acuity, visual field testing, colour vision testing, slit-lamp examination, applanation tonometry, indirect ophthalmoscopy, digital colour fundus photography and optical coherence tomography (OCT). In selected cases, fluorescein angiography was performed.ResultsSerous subretinal fluid (SRF) developed in all patients, within a time frame of 9–27 days after the start of treatment. The fovea was involved in six of eight patients (75%). None of the patients with foveal SRF [excluding a patient who developed a bilateral retinal vein occlusion (RVO)] experienced visual symptoms. Subretinal fluid (SRF) decreased or resolved in all patients, despite continuation of study medication in six of eight patients (75%). Complaints in the CM patient (13%) consisted of experiencing a dark fleck in the inferior part of the visual field of the right eye 1 week after the start of treatment, due to an RVO. Subsequent intravitreal bevacizumab treatment resulted in functional and anatomical improvement.ConclusionPatients with metastatic CM who are treated with the MEK inhibitor pimasertib are at high risk of development of ocular adverse events including serous retinopathy and possibly RVO, stressing the need of adequate ophthalmological follow-up including OCT during administration of pimasertib, despite the fact that SRF generally does not lead to ophthalmological complaints.
      PubDate: 2018-01-16T10:11:07.812933-05:
      DOI: 10.1111/aos.13677
  • Retinal oximetry is affected in multiple sclerosis
    • Authors: Anna Bryndis Einarsdottir; Olof Birna Olafsdottir, Haukur Hjaltason, Sveinn Hakon Hardarson
      Abstract: PurposeStructural and physiological abnormalities have been reported in the retina in patients with multiple sclerosis (MS). Retinal oximetry has recently detected changes in retinal oxygen metabolism in Alzheimer′s disease and mild cognitive impairment. Our goal was to determine whether oxygen saturation in retinal blood vessels of patients with patients is different from that of a healthy population.MethodsOxygen saturation of haemoglobin was measured in retinal blood vessels, using imaging with spectrophotometric noninvasive retinal oximeter. Eight MS patients with history of optic neuritis were measured and compared to 22 healthy individuals matched in age and gender.ResultsVenular oxygen saturation was increased in patients with MS compared to healthy individuals (70.7 ± 3.4% versus 66.2 ± 4.7; p = 0.021, mean ± SD). The arteriovenous (AV) difference was lower in patients with MS compared to healthy (26.6 ± 3.6% versus 30.5 ± 4.8%; p = 0.049). There was no difference measured in arterioles when patients with MS (97.3 ± 1.7%) and healthy individuals (96.7 ± 2.8%) were compared.ConclusionIncreased venular oxygen saturation and lower AV difference in patients with MS may indicate reduced oxygen uptake. This may be due to less oxygen demand following atrophy and may be a useful objective biomarker for MS. Further studies are needed to confirm and expand these findings.
      PubDate: 2018-01-16T10:10:33.911232-05:
      DOI: 10.1111/aos.13682
  • Conservative therapy for chalazia: is it really effective'
    • Authors: Albert Y Wu; Kalla A Gervasio, Kellie N Gergoudis, Chen Wei, James H Oestreicher, John T Harvey
      Abstract: PurposeTo assess the within-treatment efficacy of hot compresses (HC), HC plus tobramycin (Tobrex) and HC plus tobramycin/dexamethasone (Tobradex) for chalazia treatment.MethodsDesign: Multicentre, randomized clinical trial ( identifier, NCT01230593). Setting: Two clinical sites in New York and two clinical sites in Ontario. Study Population: A total of 149 patients with one or more chalazia on separate eyelids randomly assigned to receive HC (n = 50), HC plus tobramycin (n = 50) or HC plus tobramycin/dexamethasone (n = 49). Intervention: 4–6 weeks of assigned treatment. Patients were measured for chalazion horizontal width and surveyed for pain and treatment satisfaction levels. Main outcome measures: Primary outcome was complete resolution (100% size reduction). Secondary outcomes were size change in millimetres and patient reported pre- and post-treatment pain and satisfaction levels.ResultsIn the intention-to-treat (ITT) population, complete resolution occurred in 36 (18%) lesions total, 13 (21%) treated with HC, 12 (16%) with HC plus tobramycin and 11 (18%) with HC plus tobramycin/dexamethasone, with no significant difference between them (p = .78). Individually by paired t-test, there were statistically significant post-treatment mean size differences: HC 1.20 mm (p 
      PubDate: 2018-01-16T10:10:32.256982-05:
      DOI: 10.1111/aos.13675
  • Axial length growth and the risk of developing myopia in European children
    • Authors: Jan Willem Lodewijk Tideman; Jan Roelof Polling, Johannes R. Vingerling, Vincent W. V. Jaddoe, Cathy Williams, Jeremy A. Guggenheim, Caroline C. W. Klaver
      Abstract: PurposeTo generate percentile curves of axial length (AL) for European children, which can be used to estimate the risk of myopia in adulthood.MethodsA total of 12 386 participants from the population-based studies Generation R (Dutch children measured at both 6 and 9 years of age; N = 6934), the Avon Longitudinal Study of Parents and Children (ALSPAC) (British children 15 years of age; N = 2495) and the Rotterdam Study III (RS-III) (Dutch adults 57 years of age; N = 2957) contributed to this study. Axial length (AL) and corneal curvature data were available for all participants; objective cycloplegic refractive error was available only for the Dutch participants. We calculated a percentile score for each Dutch child at 6 and 9 years of age.ResultsMean (SD) AL was 22.36 (0.75) mm at 6 years, 23.10 (0.84) mm at 9 years, 23.41 (0.86) mm at 15 years and 23.67 (1.26) at adulthood. Axial length (AL) differences after the age of 15 occurred only in the upper 50%, with the highest difference within the 95th percentile and above. A total of 354 children showed accelerated axial growth and increased by more than 10 percentiles from age 6 to 9 years; 162 of these children (45.8%) were myopic at 9 years of age, compared to 4.8% (85/1781) for the children whose AL did not increase by more than 10 percentiles.ConclusionThis study provides normative values for AL that can be used to monitor eye growth in European children. These results can help clinicians detect excessive eye growth at an early age, thereby facilitating decision-making with respect to interventions for preventing and/or controlling myopia.
      PubDate: 2017-12-19T09:55:25.71201-05:0
      DOI: 10.1111/aos.13603
  • Early visual outcomes and optical quality after femtosecond laser
           small-incision lenticule extraction for myopia and myopic astigmatism
           correction of over −10 dioptres
    • Authors: Bing Qin; Meiyan Li, Xun Chen, Walter Sekundo, Xingtao Zhou
      Abstract: PurposeTo investigate early visual and refractive outcomes, corneal stability and optical quality after femtosecond laser small-incision lenticule extraction (SMILE) for treating myopia and myopic astigmatism over −10 D.MethodsThirty eyes (30 patients) with myopia and myopic astigmatism of over −10 D were treated with VisuMax® femtosecond laser (version 3.0; Carl Zeiss Meditec AG, Jena, Germany). Six months postoperative safety, efficacy and predictability were evaluated. Corneal Scheimpflug topography was measured preoperatively, 1 day, 3 months and 6 months postoperatively. Wavefront aberrations were measured preoperatively, 3 months and 6 months postoperatively.ResultsSix months postoperatively, LogMAR uncorrected and corrected distance visual acuity (CDVA) were −0.013 ± 0.086 and −0.073 ± 0.069, respectively. 73% (97%) of eyes were within 0.5 (1) D of target refraction. No eyes lost CDVA, 43% (13 eyes) gained one line and 7% (two eyes) gained two lines. Mean corneal back curvature (KMB) and posterior central elevation (PCE) did not change significantly comparing preoperative and 6 months postoperative data (p = 0.91 and 0.77, respectively). Comparing 1 day with 6 months postoperative data, central corneal thickness (CCT), mean corneal front curvature (KMF), KMB and PCE did not change significantly (p = 0.27, 0.07, 0.52, 0.71, respectively). Total higher-order aberration (HOA), spherical aberration and coma increased significantly (p 
      PubDate: 2017-12-18T10:25:45.800494-05:
      DOI: 10.1111/aos.13609
  • Diabetic macular edema, innovative technologies and economic impact: New
           opportunities for the Lombardy Region healthcare system'
    • Authors: Emanuela Foglia; Lucrezia Ferrario, Francesco Bandello, Camilla Ferri, Innocente Figini, Michela Franzin, Gianpiera Gambaro, Ugo Introini, Massimo Medaglia, Giovanni Staurenghi, Patrizia Tadini, Andrea Fomiatti, Davide Croce
      Abstract: PurposeDiabetic macular edema (DME) is a leading cause of vision loss and blindness. The aim of this study was to evaluate the economic benefits of introducing additional alternative technologies (Dexamethasone intravitreal implant – DEX – and Aflibercept injections), compared with the historical scenario of Ranibizumab intravitreal injections.MethodsA 3-year budget impact model was developed, taking into consideration the perspective of the Lombardy Region Healthcare Service (LRHS). Total administration costs (real-life data retrieved from clinical practice at three Departments of Ophthalmology) as well as costs related to the management of potential adverse events (information collected from the literature) were analysed.ResultsOver a 36-month horizon, the results showed that a higher consumption of DEX could lead to significant economic savings for the Regional Healthcare Service, ranging from a minimum of −4.35% (if DEX were used only in the second-line of treatment) to a maximum of −12.97% (if DEX were used in both the first-line and second-line), including the potential impact of adverse events. Therapy costs with Aflibercept and Ranibizumab were similar.ConclusionsThis study demonstrates that concentrating all eligible patients within the Ranibizumab regimen is unlikely to represent a cost-effective strategy. Indeed, significant economic advantages would be achieved by introducing the other licensed alternatives, Dexamethasone implant and Aflibercept, thus optimising DME Italian healthcare expenditure. The results demonstrate DEX as an advantageous technological alternative for the target population affected by DME, both as a first- and second-line treatment option, reducing the economic burden of the pathology for the Regional/National Health Service.
      PubDate: 2017-12-14T08:45:59.775094-05:
      DOI: 10.1111/aos.13620
  • The effect of haemopoietic stem cell transplantation on the ocular
           phenotype in mucopolysaccharidosis type I (Hurler)
    • Authors: Ahmed Javed; Tariq Aslam, Simon A. Jones, Jean Mercer, Karen Tyler, Heather Church, Arunabha Ghosh, Robert Wynn, Krishanthy Sornalingam, Jane Ashworth
      Abstract: PurposeTo determine whether the ocular phenotype in patients with mucopolysaccharidosis type I (MPSI) Hurler is affected by the efficacy of previous haemopoietic stem cell transplantation (HSCT).DesignA retrospective cohort study of patients with MPSI who had undergone treatment with HSCT.MethodsOcular phenotype was documented for each patient and compared to levels of biomarkers representing efficacy of previous transplantation. Main outcome measures: Assessment of visual acuity (VA), severity of corneal clouding and the presence of optic neuropathy or retinopathy. Biomarker assessment included dermatan sulphate/chondroitin sulphate (DS/CS) ratio and iduronidase enzyme level.ResultsSevere corneal clouding was significantly greater in patients with lower iduronidase levels (p = 0.023) and raised DS/CS ratio (R2 = 0.28 p = 0.043). Better VA was related to a higher iduronidase levels (R2 = 0.15, p = 0.004) and lower DS/CS ratio (R2 = 0.38, p = 0.001).ConclusionImproved ocular phenotypes in MPSI are associated with markers signifying efficacy of prior transplant. Early and effective HSCT may result in a better visual prognosis and reduction in ocular complications for patients with MPSI.
      PubDate: 2017-12-14T08:45:56.631069-05:
      DOI: 10.1111/aos.13627
  • Diabetic macular oedema treated with intravitreal anti-vascular
           endothelial growth factor – 2–4 years follow-up of visual acuity and
           retinal thickness in 566 patients following Danish national guidelines
    • Authors: Delila Hodzic-Hadzibegovic; Birgit Agnes Sander, Tine Juul Monberg, Michael Larsen, Henrik Lund-Andersen
      Abstract: PurposeTo investigate long-term functional and anatomical outcomes, discontinuation patterns, drug switching and rates of nonimprovement in patients treated with ranibizumab pro re nata (PRN) regimen for diabetic macular oedema (DME) according to the Danish national guidelines.MethodsRetrospective cohort study of 566 eyes in 566 patients with centre-involved DME who started intravitreal treatment with ranibizumab between January 2011 and December 2013 in the Greater Copenhagen region. Data were retrieved from a database and patient records between January 2011 and March 2016 and analysed using mixed-model statistics.ResultsAt the conclusion of follow-up, 24.6% were in active ranibizumab follow-up, 25.4% had switched to other intravitreal pharmacotherapy, 31.6% had been discontinued because of disease stability, 13.8% had been lost to follow-up, 1.4% had been discontinued because of low visual acuity (VA), and 3.2% had died. At baseline, mean best-corrected visual acuity (BCVA) and mean central subfield thickness (CST) were 64.9 (±15.0) letters and 400.2 (±120.3) μm. Mean change in BCVA and mean change in CST from baseline to 3, 12, 24, 36 and 48 months of follow-up were +3.9, +3.5, +2.7, +1.8, +2.3 letters and −97.4, −102.6, −106.9, −105.9, −131.6 μm, respectively. Mean number of injections was 6.1 in year 1 and 1.8 in year 4. In 93 patients, drug switching to aflibercept showed no difference between the two drugs on BCVA or CST. In 79 patients, CST decreased
      PubDate: 2017-12-14T08:45:36.456518-05:
      DOI: 10.1111/aos.13638
  • 3D printing of the choroidal vessels and tumours based on optical
           coherence tomography
    • Authors: Peter M. Maloca; Adnan Tufail, Pascal W. Hasler, Simon Rothenbuehler, Catherine Egan, J. Emanuel Ramos de Carvalho, Richard F. Spaide
      PubDate: 2017-12-14T08:41:38.963003-05:
      DOI: 10.1111/aos.13637
  • Automated refraction is stable 1 week after uncomplicated cataract
    • Authors: Christoffer Ostri; Stig K. Holfort, Marianne S. Fich, Per Riise
      Abstract: PurposeTo compare automated refraction 1 week and 1 month after uncomplicated cataract surgery.MethodsIn this prospective cohort study, we recruited patients in a 2-month period and included consecutive patients scheduled for bilateral small-incision phacoemulsification cataract surgery. The exclusion criteria were (i) corneal and/or retinal pathology that could lead to automated refraction miscalculation and (ii) surgery complications. Automated refraction was measured 1 week and 1 month after surgery.ResultsNinety-five patients met the in- and exclusion criteria and completed follow-up. The mean refractive shift in spherical equivalent was −0.02 dioptre (D) between 1 week and 1 month after surgery and not statistical significant (p = 0.78, paired t-test). The magnitude of refractive shift in either myopic or hyperopic direction was neither correlated to age, preoperative corneal astigmatism, axial length nor phacoemulsification energy used during surgery (p > 0.05 for all variables, regression analysis). The refractive target was missed with 1.0 D or more in 11 (12%) patients. In this subgroup, the mean refractive shift in spherical equivalent was 0.49 D between 1 week and 1 month after surgery with a trend towards statistical significance (p = 0.07, paired t-test). There was no difference in age, preoperative corneal astigmatism, axial length or phacoemulsification energy used during surgery compared to the remainder of the patients (p > 0.05 for all variables, unpaired t-test).ConclusionAutomated refraction is stabile 1 week after uncomplicated cataract surgery, but there is a trend towards instability, if the refractive target is missed with 1.0 D or more.
      PubDate: 2017-12-13T00:50:32.139674-05:
      DOI: 10.1111/aos.13545
  • Corrugated Bruch′s membrane in high myopia
    • Authors: Jost B. Jonas; Rahul A. Jonas, Kyoko Ohno-Matsui, Leonard Holbach, Songhomitra Panda-Jonas
      Abstract: PurposeTo assess the appearance of Bruch′s membrane (BM) in axially elongated eyes.MethodsThe light-microscopical investigation included histological anterior–posterior sections of human eyes. Using a light microscope, we assessed whether BM in the posterior segment was straight or locally corrugated. Corrugation of BM was defined as an elevation of BM with a height>20 μm over a basis of 50 μm without collateral proliferations of retinal pigment epithelium or choroidal swelling.ResultsThe investigation included 85 eyes (age: 62.0 ± 14.1 years; axial length: 26.7 ± 3.5 mm). In multivariate analysis, the presence of a corrugated BM, detected in eight eyes (9.4%), was strongly associated with the presence of macular BM defects [p = 0.001; odds ratio (OR): 418; 95% confidence interval (CI): 1 215 000], but not with axial length (p = 0.54). Bruch′s membrane (BM) corrugation was detected in seven (54%) of 13 eyes with macular BM defects. The single eye with BM corrugation and without macular BM defect showed the corrugated BM located in the parapapillary region at the peripheral end of a large parapapillary gamma zone.ConclusionBruch′s membrane (BM) corrugation can be present in the vicinity of macular BM defects in highly myopic eyes, perhaps due to differences in the tension within BM in various regions at the margin of the BM defect. Bruch′s membrane (BM) corrugation may also develop at the papillary end of BM in eyes with a large parapapillary gamma zone, potentially due to a disinsertion of BM at the end of the peripapillary choroidal border tissue of Jacoby. The observation of BM corrugation may help elucidating the aetiology of axial myopia.
      PubDate: 2017-12-13T00:45:59.284287-05:
      DOI: 10.1111/aos.13537
  • A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic
           surgery following the administration of epinephrine together with local
    • Authors: Jenny Hult; Rafi Sheikh, Cu Dinh Nguyen, Kajsa Tenland, Ulf Dahlstrand, Malin Malmsjö
      Abstract: ObjectiveThe time taken to reach maximal haemostatic effect following local anaesthesia with epinephrine is generally believed to be
      PubDate: 2017-12-13T00:41:32.110603-05:
      DOI: 10.1111/aos.13616
  • Treat-and-extend versus every-other-month regimens with aflibercept in
           age-related macular degeneration
    • Authors: Akira Haga; Takahiro Kawaji, Ryuichi Ideta, Yasuya Inomata, Hidenobu Tanihara
      Abstract: PurposeTo compare the 1-year outcomes of treat-and-extend (TAE) and every-other-month (2M) regimens with intravitreal aflibercept in Japanese wet age-related macular degeneration (AMD) patients.MethodsProspective, multicenter, randomized clinical trial. The primary outcome measure was the proportion of eyes in which the best-corrected visual acuity (BCVA) was maintained at week 52 [with a loss of
      PubDate: 2017-12-08T09:15:38.552503-05:
      DOI: 10.1111/aos.13607
  • Multispectral image analysis in Vogt–Koyanagi–Harada disease
    • Authors: Guo Huang; Junchao Peng, Zi Ye, Aize Kijlstra, Donglei Zhang, Peizeng Yang
      Abstract: PurposeTo investigate fundus abnormalities in Vogt–Koyanagi–Harada (VKH) disease by a noninvasive tool, multispectral imaging (MSI).MethodsA total of 77 patients with VKH and 163 healthy controls were enrolled between January and April 2015. The MSI findings were evaluated in combination with fundus fluorescein angiography (FFA), optical coherent tomography (OCT) and fundus photography (FP). Additionally, we compared extent of exposure of choroidal blood vessels between patients with VKH and healthy controls to evaluate retinal transmission function.ResultsA number of features could be recognized by MSI which included (i) general depigmentation, (ii) clumping of pigment and (iii) macular depigmentation and/or hyperpigmentation. The percentages of these three abnormalities discovered by MSI in 52 inactive VKH patients with a duration of more than 2 months in VKH were 67.3%, 75% and 84.6% respectively, which were all significantly higher than those detected by FFA, OCT or FP (p = 0.0398, p 
      PubDate: 2017-12-08T09:11:16.987337-05:
      DOI: 10.1111/aos.13606
  • Anterior surface breakdown and implant extrusion following secondary
           alloplastic orbital implantation surgery
    • Authors: Shadi Axmann; Dion Paridaens
      Abstract: BackgroundSecondary orbital implantation surgery can be complex due to scarring of the orbital tissues and can be complicated by implant exposure and extrusion.PurposeTo evaluate the incidence and risk factors of implant exposure and extrusion following secondary alloplastic orbital implantation surgery in anophthalmic patients.MethodsRetrospective analysis of a consecutive series of patients who underwent secondary placement of an alloplastic orbital implant by one surgeon between 2001 and 2016 in the Rotterdam Eye Hospital. Outcome parameters: implant exposure or extrusion. Other complications.ResultsSixty-three patients underwent secondary orbital placement of scleral-wrapped acrylic (60) or silicone (three) spherical implants. A subset of 25 patients had undergone earlier secondary orbital implant placement (by other surgeons) with exposure/extrusion necessitating additional implant surgery. Two patients were excluded due to lack of follow-up (
      PubDate: 2017-12-08T09:10:41.52635-05:0
      DOI: 10.1111/aos.13611
  • Effect of dexamethasone intravitreal implant on blood glucose,
           hypothalamic–pituitary–adrenal axis function and vascular endothelial
           growth factor serum levels in patients with diabetic macular oedema
    • Authors: Laura Posch-Pertl; Verena Schwetz, Monja Michelitsch, Jasmin Rabensteiner, Vera Höller, Vanessa Gasser-Steiner, Martin Weger, Harald Sourij
      PubDate: 2017-12-08T09:10:40.162118-05:
      DOI: 10.1111/aos.13615
  • Evaluation of efficacy and safety of dexamethasone intravitreal implants
           before and after vitrectomy in a real-life study
    • Authors: Amina Rezkallah; Ariane Malclès, Corinne Dot, Nicolas Voirin, Émilie Agard, Anne-Laure Vié, Philippe Denis, Thibaud Mathis, Laurent Kodjikian
      PubDate: 2017-12-07T03:45:34.64897-05:0
      DOI: 10.1111/aos.13608
  • A prospective multicentre randomized placebo-controlled superiority trial
           in patients with suspected bacterial endophthalmitis after cataract
           surgery on the adjuvant use of intravitreal dexamethasone to intravitreal
    • Authors: Sonia Manning; Luana C. Ugahary, Eric W. Lindstedt, René J. Wubbels, Jaap T. Dissel, Jan T.G. Jansen, Ivan Gan, Arnoud T. Goor, Carlien A. Bennebroek, Dymph J. Werf, Annette Ossewaarde-van Norel, Chris C. Mayland Nielsen, Mauk Tilanus, Pieter R. Biesen, Peter A. Schellekens, Ellen La Heij, Koorosh Faridpooya, Koen Overdam, Marc Veckeneer, Jan C. Meurs
      Abstract: PurposeWe aimed to determine whether intravitreal dexamethasone as an adjuvant to intravitreal antibiotics is beneficial in the treatment of suspected bacterial endophthalmitis after cataract surgery.MethodsRandomized, placebo-controlled superiority trial in three tertiary referral centres in the Netherlands. Patients with suspected bacterial endophthalmitis within 6 weeks after cataract surgery were eligible. A diagnostic vitreous biopsy was taken for culture, and patients received intravitreal injections of 400 μg dexamethasone (without preservatives) or placebo, in addition to 0.2 mg vancomycin and 0.05 mg gentamicin. The vancomycin and dexamethasone or placebo injections were repeated once at day 3 or 4. Primary outcome measure was best-corrected visual acuity (BCVA) at 1 year.ResultsBetween 1 November 2004 and 1 March 2014 (excluding two interruptions totalling 20 months), 324 eligible patients presented. A total of 167 patients (81 dexamethasone, 86 placebo) were available for the intention-to-treat analysis. Biopsies of 114 patients (68%) were culture-positive. Final BCVA did not differ between the dexamethasone and the placebo group (logMAR 0.31 ± 0.58 versus 0.27 ± 0.50; p = 0.90), nor did the number of patients with final vision of no light perception (LP, 7 versus 13). Pain, corneal oedema, the absence of a red fundus reflex on presentation, LP on presentation and culture of virulent pathogens from biopsy were statistically significantly associated with an unfavourable visual outcome.ConclusionIntravitreal dexamethasone without preservatives as an adjuvant to intravitreal antibiotics does not improve visual acuity (VA) in patients treated for suspected bacterial endophthalmitis after cataract surgery.
      PubDate: 2017-12-07T03:30:40.648942-05:
      DOI: 10.1111/aos.13610
  • The treatment of postoperative endophthalmitis: should we still follow the
           endophthalmitis vitrectomy study more than two decades after its
    • Authors: Andrzej Grzybowski; Magdalena Turczynowska, Ferenc Kuhn
      Abstract: Conducted in the early 1990s Endophthalmitis Vitrectomy Study (EVS) have helped in establishing reasonable guidelines for the management of infectious postoperative endophthalmitis. However at present, more than 20 years after its publication, tremendous progress has been introduced in vitrectomy technology, which now permits the vitreoretinal surgeon to perform surgery more safely, and with better outcomes. Moerover, performing a complete vitreous removal, along with the moving up of the surgical intervention to as early as possible allows the prevention of complications that would limit the functional improvement postoperatively. Thus, it is now highly needed to re-evaluate the conclusions of the EVS study.
      PubDate: 2017-12-02T03:05:27.804284-05:
      DOI: 10.1111/aos.13623
  • Intra-ocular diathermy forceps
    • Authors: Koen A. van Overdam; Emine Kilic, Robert M. Verdijk, Sonia Manning
      Abstract: PurposeThe purpose of this study was to develop intra-ocular diathermy forceps and test them on perfused porcine cadaver eyes.MethodsWe designed two types of 23-gauge intra-ocular bipolar diathermy forceps by modifying commercially available membrane peeling forceps. In the first type, the emitting electrode is connected to one-half of the core and the return electrode to the other half, with one jaw of the forceps attached to each half. In the second type, the emitting electrode is attached to the core and both jaws of the forceps, and the return electrode to the surrounding tube. We compared the new diathermy forceps to conventional intra-ocular diathermy, on perfused porcine cadaver eyes. First-order retinal artery and vein closure was confirmed both by a perfusion study and by histology of the treated vessels.ResultsType 1 diathermy forceps closed retinal arteries and veins more successfully (five of five and five of five successful treatments, respectively) than Type 2 diathermy forceps (five of five and four of five, respectively) and conventional diathermy (three of five and four of five, respectively). Less energy was used with Type 1 compared to Type 2 and conventional for artery closure (1.5 ± 0.0 versus 4.6 ± 3.3 versus 2.1 ± 0.8 joules, respectively) and vein closure (1.5 ± 0.0 versus 5.4 ± 4.6 versus 2.4 ± 0.8 joules, respectively). Histology of the treated vessels confirmed the perfusion study results.ConclusionWe designed two types of a new multifunctional intra-ocular instrument with the ability to peel membranes and to grasp, compress and coagulate retinal blood vessels. Both types pose operational advantages compared to current conventional intra-ocular diathermy.
      PubDate: 2017-12-02T02:57:00.115366-05:
      DOI: 10.1111/aos.13619
  • Epidemiology and morphology of full-thickness macular holes
    • Authors: Vegard Asgeir Forsaa; Birger Lindtjørn, Jan Terje Kvaløy, Torbjørn Frøystein, Jørgen Krohn
      Abstract: PurposeTo investigate the incidence of full-thickness macular holes (FTMHs) and their morphological features according to the International Vitreomacular Traction Study (IVTS) classification.MethodsThe clinical records of all new patients with FTMH, referred between 2008 and 2014, were reviewed for demographics, cause of the FTMH, age at diagnosis, symptom duration, laterality, visual acuity (VA), axial length and lens status. A detailed analysis of the patients’ spectral domain optical coherence tomography (SD-OCT) images was performed, and the primary FTMHs were classified in clinical stages according to the IVTS classification. From the SD-OCT, accurate macula drawings were made by means of a computer-drawing software. By merging these drawings and displaying them as colour-coded maps, the morphology and shape of the FTMH were visualized.ResultsThe study included 177 eyes (152 primary and 25 secondary FTMH) in 166 patients. In primary FTMH, the male-to-female ratio was 1:2.2. The age- and gender-adjusted annual incidences of primary FTMH were 7.9 eyes and 7.4 individuals per 100 000 inhabitants. Mean primary FTMH minimum linear diameter (MLD) and basal diameter (BD) were 435 μm and 872 μm, respectively, and 13% were classified as small, 31% as medium and 55% as large. Vitreomacular traction (VMT) and epiretinal membrane (ERM) were present in 34% and 36% of the eyes, respectively.ConclusionThis study provides data on the incidence rates of FTMH adjusted to different standard populations. The morphological analysis and novel computational visualization technique offer new insight into the structural complexity of FTMH and how VMT and ERM significantly influence FTMH configuration.
      PubDate: 2017-12-02T02:40:28.693758-05:
      DOI: 10.1111/aos.13618
  • Application of the ISNT rules on retinal nerve fibre layer thickness and
           neuroretinal rim area in healthy myopic eyes
    • Authors: Kunliang Qiu; Geng Wang, Xuehui Lu, Riping Zhang, Lixia Sun, Mingzhi Zhang
      Abstract: PurposeWe determined the applicability of inferior > superior > nasal > temporal (ISNT) rules on retinal nerve fibre layer (RNFL) thickness and rim area and evaluated the impact of various ocular factors on the performance of the ISNT rules in healthy myopic eyes.MethodsA total of 138 eyes from 138 healthy myopic subjects were included in this cross-sectional observational study. The peripapillary RNFL and optic disc in each eye were imaged with Cirrus HD optical coherence tomography (OCT) and Heidelberg Retina Tomograph II (HRT2), respectively. The performance of the inferior > superior (IS), inferior > superior > nasal > temporal (IST) and ISNT rules on RNFL thickness and rim area was determined and compared between low-to-moderate myopia and high myopia. The effects of ocular factors [including axial length, disc area, disc tilt, disc torsion, disc-fovea angle (DFA) and retina artery angle] on the performance of ISNT rules were evaluated with logistic regression analysis.ResultsThe mean axial length and refractive error were 25.57 ± 1.09 mm (range, 22.52–28.77 mm) and −5.12 ± 2.30 D [range, −9.63 to −0.50 dioptres (D)], respectively. Sixty-three per cent of the healthy eyes were compliant with the ISNT rule on rim area, while ISNT rule on RNFL thickness was followed in only 11.6% of the included eyes. For rim area, smaller disc area was significantly associated with increased compliance of the IS rule (odds ratio: 0.46, p = 0.039), IST rule (odds ratio: 0.46, p = 0.037) and ISNT rule (odds ratio: 0.44, p = 0.030). For RNFL thickness, greater DFA was significantly associated with increased compliance of the IS and IST rules (odds ratio: 1.30, p 
      PubDate: 2017-12-02T02:30:37.047118-05:
      DOI: 10.1111/aos.13586
  • Clinical and ex vivo laboratory comparison of the self-sealing properties
           and dimensional stability between the femtosecond laser and manual clear
           corneal incisions
    • Authors: Takashi Kojima; Mari Takagi, Kei Ichikawa, Rie Horai, Yukihiro Sakai, Yoshiki Tanaka, Akeno Tamaoki, Kazuo Ichikawa
      Abstract: PurposeTo compare the self-sealing features and dimensional stability between the femtosecond laser (FL) and manual knife corneal incision.MethodsFor the clinical study, 29 consecutive eyes from 29 patients and 28 eyes from 28 patients who underwent cataract surgery with FL corneal incision and manual knife incision, respectively, were enrolled. Immediately after cataract surgery, the self-sealing features of the corneal incisions were evaluated. Scanning electron microscopy (SEM) images were obtained. For the experimental study, clear corneal incisions with a knife or FL with different energy settings (3, 6 and 9 μJ) were created in fresh porcine eyes, followed by a stress test. The incision width was measured before and after the stress test.ResultsIn the clinical study, the knife group had a higher self-sealing score (0.60 ± 0.49 points) than the FL group (0.17 ± 0.38 points). In the experimental study, the deformation rate in the knife incision (5.04 ± 1.93) was significantly lower than that in the FL with any energy. The deformation rate in the 9 μJ (12.98 ± 2.76) was significantly higher than in the 3 μJ (8.54 ± 2.38) and 6 μJ (8.82 ± 2.85) FL energies. Scanning electron microscopy (SEM) images revealed that the corneal stromal surface of the knife incision was smoother than that of the FL. Higher energy FL showed more irregular surfaces.ConclusionHigher FL energy tended to widen a clear corneal incision when mechanical stress was applied. The histological differences at the inner tunnel surface may cause differences in wound stability of the corneal incision.
      PubDate: 2017-11-30T02:30:36.674318-05:
      DOI: 10.1111/aos.13634
  • Evaluating refraction and visual acuity with the Nidek autorefractometer
           AR-360A in a randomized population-based screening study
    • Authors: Katri Stoor; Elina Karvonen, Johanna Liinamaa, Ville Saarela
      Abstract: PurposeThe evaluation of visual acuity (VA) and refraction in the Northern Finland Birth Cohort Eye study was performed using the Nidek AR-360A autorefractometer. The accuracy of the method for this population-based screening study was assessed.MethodsMeasurements of the refractive error were obtained from the right eyes of 1238 subjects (mean age 47), first objectively with the AR-360A and then subjectively by an optometrist. Agreement with the subjective refraction was calculated for sphere, cylinder, mean spherical equivalent (MSE), cylindrical vectors J45 and J0 and presbyopic correction (add). Visual acuity (VA) was measured using an ETDRS chart and the autorefractometer.ResultsThe refractive error measured with the AR-360A was higher than the subjective refraction performed by the optometrist for sphere (0.007 D ± 0.24 D p = 0.30) and also for cylinder (−0.16 D ± 0.20 D p 
      PubDate: 2017-11-30T02:20:45.242202-05:
      DOI: 10.1111/aos.13636
  • Plastic compressed collagen transplantation – a new option for corneal
           surface reconstruction'
    • Authors: Stefan Schrader; Joana Witt, Gerd Geerling
      PubDate: 2017-11-30T02:05:37.301672-05:
      DOI: 10.1111/aos.13649
  • Presenting characteristics and prevalence of polypoidal choroidal
           vasculopathy in Scandinavian patients with treatment-naïve exudative
           age-related macular degeneration
    • Authors: Thomas Dam Lorentzen; Yousif Subhi, Torben Lykke Sørensen
      Abstract: PurposeTo study presenting characteristics and prevalence of polypoidal choroidal vasculopathy (PCV) in Scandinavian Caucasians with treatment-naïve exudative age-related macular degeneration (AMD).MethodsWe reviewed all patients referred in year 2014 and diagnosed using fundus examination, optical coherence tomography, and fluorescein and indocyanine green angiography (ICGA). Details of found PCVs and its subtypes (clinical and angiographical) were correlated to the baseline best-corrected visual acuity (BCVA).ResultsOf 299 Caucasian patients with a tentative diagnosis of exudative AMD, 18 eyes of 17 patients (5.7%, CI 95%: 3.5–9.1%) had PCV. Patients with PCV were 75.8 (SD: 7.5) years old and 11 (65%) were females. Lesions were predominantly extramacular. Most eyes (56%) had subretinal haemorrhage, 39% had the exudative type and one (6%) eye had the quiescent type. Larger lesion area and disruption of the foveal inner-segment/outer-segment layer correlated with worse baseline BCVA. Polypoidal choroidal vasculopathy (PCV) type 1 was present in 50% and PCV type 2 in the other 50%. Polypoidal choroidal vasculopathy (PCV) type 1 was associated with a worse baseline BCVA and greater lesion size.ConclusionPolypoidal choroidal vasculopathy (PCV) is not a rare condition in Danes with exudative AMD and presents often extramacular and with haemorrhage. This study underscores the importance of ICGA as a part of the diagnostic repertoire in AMD and suggests its routine use in Scandinavian populations.
      PubDate: 2017-11-30T01:40:30.011988-05:
      DOI: 10.1111/aos.13646
  • Ophthalmic features of cone-rod dystrophy caused by pathogenic variants in
           the ALMS1 gene
    • Authors: Fadi Nasser; Nicole Weisschuh, Pietro Maffei, Gabriella Milan, Corina Heller, Eberhart Zrenner, Susanne Kohl, Laura Kuehlewein
      Abstract: PurposeWe aim to describe ophthalmic characteristics and systemic findings in a cohort of seven patients with cone-rod retinal dystrophy (CORD) caused by pathogenic variants in the ALMS1 gene.MethodsSeven patients with Alström syndrome (ALMS) were included in the study. A comprehensive ophthalmological examination was performed, including best-corrected visual acuity (BCVA), a semiautomated kinetic visual field exam, colour vision testing, full-field electroretinography testing according to International Society for Clinical Electrophysiology of Vision (ISCEV) standards, spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) imaging, and slit lamp and dilated fundus examination. DNA samples were analysed using Sanger sequencing or exome sequencing.ResultsIn our cohort, the ocular phenotype presented with a wide variability in retinal function and disease severity. However, age of symptom onset (i.e. nystagmus and photophobia) was at 6–9 months in all patients. These symptoms mostly mislead to the diagnosis of congenital achromatopsia (ACHM), Leber congenital amaurosis (LCA), isolated CORD or Bardet–Biedl syndrome. The systemic manifestations in our cohort were highly variable.ConclusionIn summary, we can report that most of our ALMS patients primarily presented with nystagmus and severe photophobia since early childhood interestingly without night blindness in the absence of systemic symptoms. Only genetic testing analysing both nonsyndromic retinal disease (RD) genes and syndromic ciliopathy genes by comprehensive panel sequencing can result in the correct diagnosis, genetically and clinically, with important implication for the physical health of the individual.
      PubDate: 2017-11-30T01:31:02.550268-05:
      DOI: 10.1111/aos.13612
  • Preferential atrophy of the central retinal ganglion cells in homonymous
           hemianopia due to acquired retrogeniculate lesions demonstrated using
           swept-source optical coherence tomography
    • Authors: Tsutomu Yamashita; Atsushi Miki, Katsutoshi Goto, Syunsuke Araki, Go Takizawa, Yoshiaki Ieki, Junichi Kiryu, Akio Tabuchi, Yasuyuki Iguchi, Kazumi Kimura, Yoshiki Yagita
      PubDate: 2017-11-30T01:25:27.032653-05:
      DOI: 10.1111/aos.13644
  • Dabigatran inhibits intravitreal thrombin activity
    • Authors: Jeroen Bastiaans; Verena C. Mulder, Jan C. Meurs, Marja Smits - te Nijenhuis, Conny Holten - Neelen, P. Martin Hagen, Willem A. Dik
      Abstract: PurposeProliferative vitreoretinopathy (PVR) is a vitreoretinal disorder in which retinal pigment epithelial (RPE) cell activation contributes to both formation of fibrotic retinal membranes and inflammation. Vitreous of patients with PVR contains increased thrombin activity which induces profibrotic and proinflammatory programs in RPE cells. Inhibition of intravitreal thrombin activity may thus represent a therapeutic option for PVR. In this study, we examined the capacity of the clinically available direct thrombin inhibitor dabigatran to inhibit thrombin activity in vitreous fluids.MethodsARPE-19 cells were cultured with the following: (i) thrombin, (ii) vitreous without thrombin activity and (iii) vitreous with elevated thrombin activity (PVR samples and thrombin spiked vitreous) either in the presence or absence of dabigatran (range: 10−5 to 10−7 M). Subsequently, CCL2, CXCL8, GMCSF, IL6 and PDGFB mRNA expression levels were determined by RQ-PCR and protein levels of 27 cytokines, chemokines and growth factors were detected in culture supernatants using a multiplex approach. In addition, the capacity of vitreous fluids obtained from patients after oral dabigatran intake was tested in an in vitro thrombin activity assay.ResultsThrombin and vitreous fluids containing thrombin activity induced CCL2, CXCL8, GM-CSF, IL-6 and PDGF-BB expression by ARPE-19 cells, which was inhibited by dabigatran. In addition, dabigatran that reached the vitreous after repeated oral intake did inhibit thrombin activity in the in vitro activity assay.ConclusionProliferative vitreoretinopathy (PVR) is associated with increased intravitreal thrombin activity that activates profibrotic and proinflammatory pathways in RPE cells. Our findings provide evidence that this activation pathway can potentially be inhibited by dabigatran.
      PubDate: 2017-11-30T01:15:40.947421-05:
      DOI: 10.1111/aos.13630
  • A novel NR2E3 gene mutation in autosomal recessive retinitis pigmentosa
           with cystic maculopathy
    • Authors: Deepti Mahajan; Marcela Votruba
      PubDate: 2017-11-29T04:01:18.112516-05:
      DOI: 10.1111/aos.13629
  • Exophiala phaeomuriformis keratitis in a subarctic climate region: a case
    • Authors: André Vicente; Fátima Pedrosa Domellöf, Berit Byström
      Abstract: PurposeTo report a case of Exophiala phaeomuriformis mycotic keratitis in a patient from a subarctic climate region. Dematiaceous fungi (black yeasts) have been gaining importance as corneal keratitis and ulcer causative agents in certain regions, but no cases have been described in Scandinavia.MethodsCase report of a patient with a persistent corneal erosion that eventually presented a brown-pigmented infiltrate. The patient had a history of several months of topical therapy comprising medication for glaucoma, corticosteroids and antibiotics. A therapeutic contact lens was used, and amniotic membrane transplantation was performed before the development of the pigmented infiltrate.ResultsExophiala phaeomuriformis was identified on the microbiological cultures from the surgically obtained infiltrate scrapes. The patient responded to topical amphotericin and fluconazole, the erosion was cured and a stromal scar subsided. During follow-up, sequential slit-lamp images and anterior segment optical coherence tomography (OCT) scans were obtained.ConclusionThis is the first described case of keratitis caused by E. phaeomuriformis in a subarctic region, the first in Europe and, to our knowledge, the second reported case in the literature. It is important to remember that superficial corneal brown-pigmented infiltrates should raise the suspicion of an unusual fungal infection even in this climate. This is particularly important in patients with ocular surface disease treated with steroids and antibiotics for a long time.
      PubDate: 2017-11-29T03:30:48.772393-05:
      DOI: 10.1111/aos.13624
  • Survival of corneal nerve/sheath structures in organ-cultured donor
    • Authors: Virinder K. Dhillon; Mohamed S. Elalfy, Marco Messina, Mouhamed Al-Aqaba, Harminder S. Dua
      Abstract: PurposeTo study the morphology of human corneal nerves in eye bank organ-cultured corneas and in corneal grafts post-transplantation.MethodsThirty-seven organ-cultured corneas were divided into: Group-A, anterior 300–400 μm of 20 corneas used for Descemets stripping endothelial keratoplasty, and Group-B, 17 full-thickness corneas unsuitable for transplantation. Corneas whole mounts were stained for nerves using acetylcholinesterase technique and examined by NanoZoomer digital pathology microscope. Central and sub-Bowman's stromal nerves and the sub-basal nerve plexus including perforation sites and terminal bulbs were studied. Ten eyes were imaged following penetrating keratoplasty using in-vivo confocal microscopy (IVCM) for the presence of sub-basal and stromal nerves at 1, 4–5 and 7–8 weeks postoperatively (five eyes) and in all the other five eyes, the final follow-up was at 12 weeks.ResultsFifteen of twenty (75%) corneas had stromal nerves in Group-A and 15 of 17 (88.2%) in Group-B. Average number of stromal nerves entering peripherally were 9.1 (range: 1–36). 7.5 in Group-A and 10.8 in Group-B. Central stromal nerves were seen in eight samples in Group-A and nine in Group-B. Many stromal nerves terminated abruptly without demonstrable continuity through Bowman's membrane. No terminal bulbs or sub-basal nerves were detected. In-vivo confocal microscopy (IVCM) showed 4 of 5 in 9 of 10 (90%) donor corneas had stromal nerves 1 week postoperatively, which remained present in 8 of 10 (80%) corneas at 4–5 weeks and in 9 of 10 (90%) at 7–8 weeks postoperatively. All 5 corneas analysed at 12 weeks showed the same stromal nerves from 1 to 12 weeks postoperatively. Sub-basal nerves were absent in all corneas over the 12-week study period.ConclusionThis study provides further insight into the behaviour of corneal nerves in transplanted corneas. Corneal stromal nerves/nerve–sheaths are preserved in organ-cultured eye bank eyes and persist post-transplantation up to 3 months. These could provide directional guidance to regenerating nerves from host stroma.
      PubDate: 2017-11-29T02:40:47.417702-05:
      DOI: 10.1111/aos.13614
  • Exploring literature-based definitions of hypotony following glaucoma
           filtration surgery and the impact on clinical outcomes
    • Authors: Ali Abbas; Pavi Agrawal, Anthony J. King
      Abstract: PurposeTo highlight the variations in published definitions of hypotony and their impact on reported clinical outcomes. To propose a revised definition, focusing on clinically significant hypotony (CH).MethodsLiterature review of hypotony definitions published between January 2010 and December 2015 was carried out. Numerical definitions for hypotony, its onset, duration and associated clinical signs were recorded. Each definition was applied to surgical outcomes data collected prospectively from a cohort of 300 glaucoma patients treated at a single centre. The sensitivity and specificity of each definition in identifying CH [defined as low intraocular pressure (IOP) with signs of maculopathy hypotony and choroidal detachment] were calculated.ResultsA total of 128 eligible papers were identified, and 14 different definitions for hypotony were extracted. In 53 (41.4%), hypotony was not defined. In the remaining 75 (58.6%), the numerical definitions varied between 4 and 8 mmHg, and of these, 24 (32%) included the onset and duration of hypotony as part of the definition. Definition-dependent hypotony rates within the cohort varied between 1% and 59.3%. No statistical differences were found between the groups based on corneal thickness or axial length. Clinically significant hypotony (CH) was identified in 37 (12.3%), with large differences in the sensitivity and specificity among published definition.ConclusionVariations in defining postoperative hypotony can have a large impact on the reported success and failure rates among studies. There is a need for a more robust universal definition, focusing on clinically important signs, to allow better comparison between different treatment modalities.
      PubDate: 2017-11-29T02:23:36.588449-05:
      DOI: 10.1111/aos.13601
  • Temporal changes in retinal vascular parameters associated with successful
           panretinal photocoagulation in proliferative diabetic retinopathy: A
           prospective clinical interventional study
    • Authors: Thomas Lee Torp; Ryo Kawasaki, Tien Yin Wong, Tunde Peto, Jakob Grauslund
      Abstract: PurposeWe aimed to investigate changes in retinal vascular geometry over time after panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR).MethodsThirty-seven eyes with PDR were included. Wide-field fluorescein angiography (Optomap, Optos PLC., Dunfermline, Scotland, UK) was used to diagnose PDR at baseline and to assess activity at follow-up month three and six. At each time-point, a trained grader measured retinal vessel geometry on optic disc (OD) centred images using semiautomated software (SIVA, Singapore I Vessel Assessment, National University of Singapore, Singapore) according to a standardized protocol.ResultsAt baseline, the mean age and duration of diabetes were 52.8 and 22.3 years, and 65% were male. Mean HbA1c was 69.9 mmol/mol, and blood pressure was 155/84 mmHg. Of the 37 eyes with PDR, eight (22%) eyes had progression at month three and 13 (35%) progressed over six months. Baseline characteristics, including age, sex, duration of diabetes, HbA1c, blood pressure, vessel geometric variables and total amount of laser energy delivered did not differ by progression status. However, compared to patients with progression of PDR, patients with favourable treatment outcome had alterations in the retinal arteriolar structures from baseline to month six (calibre, 154.3 μm versus 159.5 μm, p = 0.04, tortuosity 1.12 versus 1.10, p = 0.04) and in venular structures from baseline to month three (fractal dimension 1.490 versus 1.499, p = 0.04, branching coefficient (BC) 1.32 versus 1.37, p = 0.01).ConclusionIn patients with PDR, successful PRP leads to alterations in the retinal vascular structure. However, baseline retinal vascular geometry characteristics did not predict treatment outcome.
      PubDate: 2017-11-29T01:15:52.195969-05:
      DOI: 10.1111/aos.13617
  • Validation of automated screening for referable diabetic retinopathy with
           the IDx-DR device in the Hoorn Diabetes Care System
    • Authors: Amber A van der Heijden; Michael D Abramoff, Frank Verbraak, Manon V Hecke, Albert Liem, Giel Nijpels
      Abstract: PurposeTo increase the efficiency of retinal image grading, algorithms for automated grading have been developed, such as the IDx-DR 2.0 device. We aimed to determine the ability of this device, incorporated in clinical work flow, to detect retinopathy in persons with type 2 diabetes.MethodsRetinal images of persons treated by the Hoorn Diabetes Care System (DCS) were graded by the IDx-DR device and independently by three retinal specialists using the International Clinical Diabetic Retinopathy severity scale (ICDR) and EURODIAB criteria. Agreement between specialists was calculated. Results of the IDx-DR device and experts were compared using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), distinguishing between referable diabetic retinopathy (RDR) and vision-threatening retinopathy (VTDR). Area under the receiver operating characteristic curve (AUC) was calculated.ResultsOf the included 1415 persons, 898 (63.5%) had images of sufficient quality according to the experts and the IDx-DR device. Referable diabetic retinopathy (RDR) was diagnosed in 22 persons (2.4%) using EURODIAB and 73 persons (8.1%) using ICDR classification. Specific intergrader agreement ranged from 40% to 61%. Sensitivity, specificity, PPV and NPV of IDx-DR to detect RDR were 91% (95% CI: 0.69–0.98), 84% (95% CI: 0.81–0.86), 12% (95% CI: 0.08–0.18) and 100% (95% CI: 0.99–1.00; EURODIAB) and 68% (95% CI: 0.56–0.79), 86% (95% CI: 0.84–0.88), 30% (95% CI: 0.24–0.38) and 97% (95% CI: 0.95–0.98; ICDR). The AUC was 0.94 (95% CI: 0.88–1.00; EURODIAB) and 0.87 (95% CI: 0.83–0.92; ICDR). For detection of VTDR, sensitivity was lower and specificity was higher compared to RDR. AUC's were comparable.ConclusionAutomated grading using the IDx-DR device for RDR detection is a valid method and can be used in primary care, decreasing the demand on ophthalmologists.
      PubDate: 2017-11-27T08:26:56.845679-05:
      DOI: 10.1111/aos.13613
  • Factors associated with deep circulation in the peripapillary
           chorioretinal atrophy zone in normal-tension glaucoma with myopic disc
    • Authors: Naoki Kiyota; Hiroshi Kunikata, Seri Takahashi, Yukihiro Shiga, Kazuko Omodaka, Toru Nakazawa
      Abstract: PurposeTo investigate factors associated with choroidal microcirculation in the peripapillary chorioretinal atrophy (PPA) zone in eyes with normal-tension glaucoma (NTG) and myopic disc.MethodsIn 100 eyes of 100 NTG patients with myopic disc and 20 eyes of 20 age-matched myopic controls, 4.5 × 4.5 mm scans were made of the optic nerve head with optical coherence tomography angiography (OCTA). Peripapillary chorioretinal atrophy (PPA) area and PPA superficial choroidal image intensity (PPA-CI) were calculated with image j software. Clinical characteristics, laser speckle flowgraphy-measured mean blur rate in the temporal tissue area (temporal MT), the central thresholds (the averaged standard automated perimetry-measured visual field thresholds in the four paracentral points) and 3D-OCT-measured ganglion cell complex thickness in the papillomacular bundle (PMB-GCCT) were recorded.ResultsThe NTG patients had significantly lower intraocular pressure, PMB-GCCT and central threshold values, and a larger PPA area, than the controls. The area under the receiver operating characteristics curve to differentiate NTG with parafoveal scotoma (PFS) from controls was 0.76 for temporal MT, 0.85 for PPA-CI and 0.87 for PMB-GCCT. Univariate and multivariate analyses revealed that PPA-CI was negatively correlated with age, pulse rate, best-corrected visual acuity, axial length and PPA area, and positively correlated with temporal MT, PMB-GCCT and the central thresholds.ConclusionPeripapillary chorioretinal atrophy (PPA)-CI was associated with temporal MT, ageing, bradycardia, axial length elongation and changes in central retinal structure and visual function in patients with NTG and myopic disc. Thus, microcirculation deep within the PPA zone might be a clinically useful biomarker of PFS in NTG.
      PubDate: 2017-11-24T07:55:49.862979-05:
      DOI: 10.1111/aos.13621
  • Paravascular abnormalities observed by spectral domain optical coherence
           tomography are risk factors for retinoschisis in eyes with high myopia
    • Authors: Tong Li; Xiaohan Wang, Yanping Zhou, Tonghui Feng, Meichun Xiao, Fenghua Wang, Xiaodong Sun
      Abstract: PurposeTo investigate the retinal features and distribution of paravascular abnormalities (PVAs) and their relationship with retinoschisis in eyes with high myopia.MethodsOne hundred and fifty-two eyes of 88 patients with high myopia [refractive error greater than −6 dioptres (D) or axial length (AL) ≥26.5 mm] who had undergone comprehensive ophthalmic examinations were evaluated in this cross-sectional study. Multiple optical coherence tomography (OCT) scans were performed to study the microstructural alterations adjacent to the retinal vascular arcades and the entire macular area. The presence and distribution patterns of various PVAs, retinoschisis and the association between these parameters were analysed.ResultsOf the 152 highly myopic eyes, PVAs were detected by OCT in 126 eyes (82.9%), including paravascular microfolds in all 126 eyes, paravascular cysts in 109 eyes (71.7%) and paravascular lamellar holes in 44 eyes (28.9%). All three types of PVAs were observed more frequently along the temporal vascular arcades than along the nasal vascular arcades (p 
      PubDate: 2017-11-24T07:51:31.044434-05:
      DOI: 10.1111/aos.13628
  • Children with blindness – major causes, developmental outcomes and
           implications for habilitation and educational support: a two-decade,
           Swedish population-based study
    • Authors: Kim Verdier; Ek Ulla, Stefan Löfgren, Elisabeth Fernell
      Abstract: PurposeThe aim was to describe the population of children with congenital or early infancy blindness in Sweden, with regard to causes of blindness and prevalence of neurodevelopmental impairments.MethodsMedical, psychological and pedagogical records of Swedish children with congenital or early infancy blindness (total blindness or light perception at the most) born in 1988–2008 were analysed regarding year of birth, gender, cause of blindness, gestational age, associated neurological disorders/syndromes, associated neurodevelopmental impairments, cognitive level and type of school placement.ResultsA total of 150 individuals, 80 girls and 70 boys, were identified, corresponding to a prevalence of 7/100 000. Five causes of blindness dominated, constituting 76% of all represented aetiologies: retinopathy of prematurity (ROP), optic nerve hypoplasia (ONH), Leber congenital amaurosis (LCA), optic nerve atrophy (ONA) and microphthalmia/anophthalmia. Nearly three of four children in the study population had at least one additional disability besides blindness; the most common being intellectual disability (ID) and autism spectrum disorder (ASD). More than half of the population had more than one additional disability. Autism spectrum disorder (ASD) was most common in children with ONH, ROP, LCA and microphthalmia/anophthalmia.ConclusionIn children born within the last decades, isolated blindness is uncommon and the rate of multidisabilities is high. Autism spectrum disorder (ASD) seems to be more strongly associated with specific aetiological subgroups. Further development of the support to families and schools should be based on knowledge about the considerable heterogeneity of the population of children with blindness, and the common occurrence of coexisting neurodevelopmental disorders, especially ID and ASD.
      PubDate: 2017-11-23T02:41:10.305018-05:
      DOI: 10.1111/aos.13631
  • Elevated plasma and vitreous levels of leucine-rich-α2-glycoprotein are
           associated with diabetic retinopathy progression
    • Authors: Chong Chen; Xia Chen, Hengye Huang, Changjing Han, Yuan Qu, Huiyi Jin, Tian Niu, Yuan Zhang, Kun Liu, Xun Xu
      Abstract: PurposeTo investigate the association of plasma and vitreous leucine-rich-α2-glycoprotein (LRG1) with diabetic retinopathy (DR) progression.MethodsA total of 86 outpatients and 33 inpatients were recruited. Outpatients with type 2 diabetes mellitus (T2DM) were classified as T2DM without DR (n = 22), nonproliferative DR (NPDR) (n = 20) and proliferative DR (PDR) (n = 22) based on international clinical DR severity scales. A total of 86 plasma and 33 vitreous samples were collected and subjected to enzyme-linked immunosorbent assay. The diagnostic value of plasma LRG1 was tested using receiver operating characteristic (ROC) curves.ResultsPlasma LRG1 in PDR patients (9025 ± 1870 pg/ml) was significantly increased as compared with controls (5975 ± 2022 pg/ml), T2DM without DR (6550 ± 2359 pg/ml) and NPDR patients (6550 ± 2359 pg/ml) (p 
      PubDate: 2017-11-23T02:30:25.548842-05:
      DOI: 10.1111/aos.13633
  • Photobiomodulation in dry age-related macular degeneration
    • Authors: Mahesh Uparkar; Shalini Kaul, Pritam Rajput, Rahul Baile
      PubDate: 2017-11-22T01:21:04.829311-05:
      DOI: 10.1111/aos.13433
  • Hypoxia challenge test and retinal circulation changes – a study using
           ocular coherence tomography angiography
    • Authors: David Cordeiro Sousa; Inês Leal, Susana Moreira, Patrícia Dionísio, Luís Abegão Pinto, Carlos Marques-Neves
      Abstract: PurposePrevious studies report that the response of retinal vessels to a decrease in oxygen (hypoxia) is vasodilation, thus increasing blood flow. We aimed to characterize the changes in retinal microvasculature induced by a mild hypoxia stress test in a healthy population, using ocular coherence tomography angiography (OCT-A) technology.MethodsInterventional repeated-measures study. The standardized hypoxia challenge test (HCT) was performed to all volunteers, according to the British Thoracic Society protocol. Ocular coherence tomography angiography (OCT-A) was performed at three time-points (baseline, during HCT and 30′ posthypoxia). Macular and peripapillary vessel densities were assessed using the built-in software. To minimize bias, analysis was performed separately in right (OD) and left (OS) eyes. Repeated-measures anova and mean comparison analysis were used as statistical tests (stata v13).ResultsStudied population included 30 healthy subjects (14 women), with a mean age of 28.8 ± 4.2 [range 22–37] years. Baseline vessel density increased in hypoxic conditions and subsequently decreased to near-baseline values in posthypoxia conditions. This pattern was observed for both eyes in both parafovea (OD: 55.3 ± 2.3 to 56.7 ± 1.9 to 55.8 ± 1.9, p 
      PubDate: 2017-11-21T02:11:10.421232-05:
      DOI: 10.1111/aos.13622
  • Treating amblyopia in adults with prosthetic occluding contact lenses
    • Authors: Esperanza Garcia-Romo; Consuelo Perez-Rico, Isabel Roldán-Díaz, Juan Arévalo-Serrano, Román Blanco
      Abstract: PurposeTo investigate the feasibility, effectiveness and acceptability of using prosthetic occluding contact lenses (OCLs) to treat moderate amblyopia in adults and of the role of the multifocal visual evoked potential (mfVEP) as a predictor of postamblyopic therapy.MethodsA comparative, prospective, interventional, case series pilot study with amblyopic adults (mean age: 40 years, range 20–50 years) allocated into two intervention groups: eye patching and OCL. The primary outcome variable was logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and secondary outcomes were mfVEP amplitude and latency and patients’ health-related quality of life National Eye Institute Visual Function Questionnaire (NEI VFQ-25).ResultsSignificant improvements in pre- to postamblyopic therapy BCVA were seen at 1.5 months in the OCL group [0.29 logMAR, 95% confidence interval (CI): 0.10–0.47 versus 0.11 logMAR, 95% CI: 0.02–0.19; p 
      PubDate: 2017-11-20T04:30:37.958606-05:
      DOI: 10.1111/aos.13585
  • Efficacy and safety of different regimens for primary open-angle glaucoma
           or ocular hypertension: a systematic review and network meta-analysis
    • Authors: Fei Li; Wenbin Huang, Xiulan Zhang
      Abstract: PurposeTo assess the efficacy and safety of different regimens, including monotherapy and double therapy, for primary open-angle glaucoma (POAG) or ocular hypertension.MethodsWe searched PubMed, EMBASE and for studies that fit our inclusion criteria in this network meta-analysis. Randomized controlled trials that report data on efficacy and safety of medications for POAG or ocular hypertension are included. Data on intra-ocular pressure (IOP) lowering effect and incidence of adverse events including hyperaemia and ocular discomfort were extracted and used in mixed-comparison analysis.ResultsThis study includes 72 randomized trials. Data were available on 12 medical treatments of POAG or ocular hypertension. Of 66 possible comparisons of outcome efficacy, 15 treatments were compared directly. Compared to prostaglandin analogues (PGA), beta-blockers (BB) showed relatively weaker ability to lower IOP, followed by α2-adrenergic agonists (AA) and carbonic anhydrase inhibitors (CAI). For dual therapy, regimens composed of a combination of PGA with another treatment demonstrated more powerful IOP lowering efficacy, while the combination of two non-PGA drugs had lower efficacy in controlling IOP than PGA alone. There was no statistical significance in combinations that did not include PGA on efficacy of IOP control. In terms of tolerance, PGA alone leads to more severe hyperaemia than any other monotherapy regimen, while BBs have the lowest effect on the incidence of hyperaemia. Most dual therapy regimens containing PGA also lead to serious hyperaemia, with the exception of PGA + AA. Compared to regimens containing PGA, those with BB are less likely to cause hyperaemia.ConclusionOur network meta-analysis showed that PGAs provide best IOP lowering effect among all the monotherapy regimen. Combination of PGA and other category of drugs leads to better IOP decrease. Combination of BB and another non-PGA drug may have less ocular side-effects than PGA alone.
      PubDate: 2017-11-16T05:20:31.249721-05:
      DOI: 10.1111/aos.13568
  • Comparison of self-made cryopreservative fibrin glue and commercial fibrin
           glue kit in pterygium surgery: 1-year follow-up
    • Authors: Jingwen Gong; Jiaqi Fan, Ting Shen, Jin Jiang
      Abstract: PurposeTo assess long-term efficacy and safety of self-made cryopreservative fibrin glue (SMC) applied in pterygium surgery.MethodsProspective, comparative, interventional case series. Forty eyes of 40 patients with nasal primary pterygium, 24 male and 16 female, were enrolled. The patients were assigned to two groups and each contained 12 male and eight female based on the pterygium area encroaching onto the cornea. In one group, the conjunctival autograft was attached to the sclera with SMC stored for 2 months, and in the other group, commercial fibrin glue kit (CK) was applied after the pterygium was removed. All the patients were followed up postoperatively on days 1, 3, 7 and 14 then at months 1, 3, 6, 12. The main outcome measures included operating time, postoperative discomfort, recurrence rate and complications.ResultsThere were no significant differences in surgery time (p = 0.713) and postoperative discomfort (day 1, 3, 7; p = 0.747, p = 0.766, p = 0.983, respectively) between the two groups. By the end of 1-year follow-up, the recurrence rate was 0% in the SMC group and 5% in the CK group (p = 1.000). There were no infections and severe visual acuity (VA) threatening complications in either group.ConclusionSelf-made cryopreservative fibrin glue (SMC) is as effective as standard CK for autograft fixation in pterygium surgery and it also has good safety after long-term follow-up. For its convenience and low cost, this new methods should be popularized, especially in underdeveloped area.
      PubDate: 2017-11-13T02:40:58.830176-05:
      DOI: 10.1111/aos.13478
  • Enhanced resolution and speckle-free three-dimensional printing of macular
           optical coherence tomography angiography
    • Authors: Peter M. Maloca; Richard F. Spaide, Simon Rothenbuehler, Hendrik P. N. Scholl, Tjebo Heeren, João E. Ramos de Carvalho, Mali Okada, Pascal W. Hasler, Catherine Egan, Adnan Tufail
      PubDate: 2017-11-13T02:33:48.655705-05:
      DOI: 10.1111/aos.13567
  • Randomized controlled trial of electro-stimulation therapies to modulate
           retinal blood flow and visual function in retinitis pigmentosa
    • Authors: Ava K. Bittner; Kenneth Seger, Rachel Salveson, Samantha Kayser, Natalia Morrison, Patricia Vargas, Deborah Mendelsohn, Jorge Han, Hua Bi, Gislin Dagnelie, Alexandra Benavente, Jessica Ramella-Roman
      Abstract: PurposeWe examined changes in visual function and ocular and retinal blood flow (RBF) among retinitis pigmentosa (RP) participants in a randomized controlled trial of electro-stimulation therapies.MethodsTwenty-one RP participants were randomized (1:1:1) to transcorneal electrical stimulation (TES) at 6 weekly half-hour sessions, electro-acupuncture or inactive laser acupuncture (sham control) at 10 half-hour sessions over 2 weeks. Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity (VA), quick contrast sensitivity function, Goldmann visual fields, AdaptDx scotopic sensitivity, spectral flow and colour Doppler imaging of the central retinal artery (CRA), and RBF in macular capillaries were measured twice pre-treatment, after 2 TES sessions, within a week and a month after intervention completion.ResultsWe measured a significant improvement in retrobulbar CRA mean flow velocity for both the TES (p = 0.038) and electro-acupuncture groups (p = 0.001) on average after 2 weeks of treatment when compared to sham controls. Transcorneal electrical simulation (TES) and electro-acupuncture subjects had significant 55% and 34% greater increases, respectively, in RBF in the macular vessels when compared to sham controls (p 
      PubDate: 2017-11-11T07:54:16.65443-05:0
      DOI: 10.1111/aos.13581
  • Age-related macular degeneration: using morphological predictors to modify
           current treatment protocols
    • Authors: Mohammed Ashraf; Ahmed Souka, Ron A. Adelman
      Abstract: To assess predictors of treatment response in neovascular age-related macular degeneration (AMD) in an attempt to develop a patient-centric treatment algorithm. We conducted a systematic search using PubMed, EMBASE and Web of Science for prognostic indicators/predictive factors with the key words: ‘age related macular degeneration’, ‘neovascular AMD’, ‘choroidal neovascular membrane (CNV)’, ‘anti-vascular endothelial growth factor (anti-VEGF)’, ‘aflibercept’, ‘ranibizumab’, ‘bevacizumab’, ‘randomized clinical trials’, ‘post-hoc’, ‘prognostic’, ‘predictive’, ‘response’ ‘injection frequency, ‘treat and extend (TAE), ‘pro re nata (PRN)’, ‘bi-monthly’ and ‘quarterly’. We only included studies that had an adequate period of follow-up (>1 year), a single predefined treatment regimen with a predetermined re-injection criteria, an adequate number of patients, specific morphological [optical coherence tomography (OCT)] criteria that predicted final visual outcomes and injection frequency and did not include switching from one drug to the other. We were able to identify seven prospective studies and 16 retrospective studies meeting our inclusion criteria. There are several morphological and demographic prognostic indicators that can predict response to therapy in wet AMD. Smaller CNV size, subretinal fluid (SRF), retinal angiomatous proliferation (RAP) and response to therapy at 12 weeks (visual, angiographic or OCT) can all predict good visual outcomes in patients receiving anti-VEGF therapy. Patients with larger CNV, older age, pigment epithelial detachment (PED), intraretinal cysts (IRC) and vitreomacular adhesion (VMA) achieved less visual gains. Patients having VMA/VMT required more intensive treatment with increased treatment frequency. Patients with both posterior vitreous detachment (PVD) and SRF require infrequent injections. Patients with PED are prone to recurrences of fluid activity with a reduction in visual acuity (VA). A regimen that involves less intensive therapy and extended follow-up intervals (4 weekly) can be suggested for patients who show adequate visual response and have both SRF and PVD at baseline. In addition, patients with poor prognostic indicators such as IRC, VMA, large CNV size, older age and poor response at 12 weeks should be extended very cautiously with the possibility of fixed monthly/bimonthly (every 2 months) treatments if they fail to achieve dryness. Patients with PED at baseline should receive monthly/bimonthly injections of anti-VEGF therapy or can be extended very cautiously (two weekly intervals) using a TAE protocol.
      PubDate: 2017-11-11T07:52:02.610587-05:
      DOI: 10.1111/aos.13565
  • Efficacy of predetermined therapeutic measures against bleb-related
           infection in the Collaborative Bleb-related Infection Incidence and
           Treatment Study
    • Authors: Nobuyuki Shoji; Yoshikuni Arakaki, Kenji Nakamoto, Tetsuya Yamamoto, Yasuaki Kuwayama,
      Abstract: PurposeTo report the efficacy of the predetermined treatment protocol of the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS) for bleb-related infection (BRI) patients.MethodsA prospective, observational cohort study was conducted at 34 clinical centres in Japan. Nineteen eyes from 19 patients that developed BRI were treated using the CBIITS protocol at 34 clinical centres. The visual acuity (VA) and intraocular pressure (IOP) were monitored for 6 and 12 months after treatment with the predetermined protocol.ResultsThe logMAR was 0.623 ± 0.748 (mean ± standard deviation) before the infection developed. It was 1.054 ± 1.156 and 0.950 ± 1.168 at 6 months and 12 months post-infection, respectively. However, in subgroup analyses, there was no significant decrease in post-infection logMAR in stages I and II. In contrast, decimal VA was decreased ≥2 lines in all four cases in stage III. The IOP did not change after infection. It was 10.2 ± 5.0 mmHg (range, 3–22 mmHg) before the infection developed, and 12.9 ± 5.2 mmHg (5–24 mmHg) and 10.7 ± 4.7 mmHg (3–18 mmHg) at 6 months and 12 months after infection, respectively.ConclusionBecause of the small number of BRI patients, the superiority of the treatment was not definitively determined. However, VA was almost maintained in stages I and II, and the IOP did not change after infection. Although further study is necessary, the treatment protocol shown in the study might be a valuable treatment regime.
      PubDate: 2017-11-08T07:50:51.3202-05:00
      DOI: 10.1111/aos.13523
  • Monitoring foveal sparing in geographic atrophy with fluorescence lifetime
           imaging ophthalmoscopy – a novel approach
    • Authors: Lydia Sauer; Matthias Klemm, Sven Peters, Dietrich Schweitzer, Johanna Schmidt, Lukas Kreilkamp, Lisa Ramm, Daniel Meller, Martin Hammer
      Abstract: PurposeTo investigate fundus autofluorescence (FAF) lifetimes in geographic atrophy (GA) with a focus on macular pigment (MP) and foveal sparing.MethodsThe study included 35 eyes from 28 patients (mean age 79.2 ± 8.0 years) with GA. A 30° retinal field, centred at the macula, was investigated using fluorescence lifetime imaging ophthalmoscopy (FLIO). The FLIO technology is based on a Heidelberg Engineering Spectralis system. Decays of FAF were detected in a short (498–560 nm, SSC) and long (560–720 nm, LSC) spectral channel. The mean fluorescence lifetime, τm, was calculated from a three-exponential approximation of the FAF decays. Macular optical coherence tomography (OCT) scans as well as fundus photography were recorded.ResultsReview of FLIO data reveals specific patterns of significantly prolonged τm in regions of GA (SSC 616 ± 343 ps, LSC 615 ± 154 ps) as compared to non-atrophic regions. Large τm differences between the fovea and atrophic areas correlate with better visual acuity (VA). Shorter τm at the fovea than within other non-atrophic regions indicates sparing, which was identified in 16 eyes. Seventy per cent of patients treated with lutein supplementation showed foveal sparing, whereas the rate among non-supplemented patients was 22%.ConclusionUsing FLIO, we present a novel way to detect foveal sparing, investigate MP, and analyse variability of τm in different foveal regions (including the prognostic valuable border region) in GA. These findings support the potential utility of FLIO in monitoring disease progression. The findings also highlight the possibly protective effect of lutein supplementation, with implication in recording the presence and distributional pattern of MP.
      PubDate: 2017-11-04T01:00:50.506555-05:
      DOI: 10.1111/aos.13587
  • Genetic prognostication in uveal melanoma
    • Authors: Mehmet Dogrusöz; Martine J. Jager
      Abstract: Uveal melanoma (UM) is a rare tumour with a high propensity to metastasize. Although no effective treatment for metastases yet exists, prognostication in UM is relevant for patient counselling, planning of follow-up and stratification in clinical trials. Besides conventional clinicopathologic characteristics, genetic tumour features with prognostic significance have been identified. Non-random chromosome aberrations such as monosomy 3 and gain of chromosome 8q are strongly correlated with metastatic risk, while gain of chromosome 6p indicates a low risk. Recently, mutations in genes such as BAP1, SF3B1 and EIF1AX have been shown to be related to patient outcome. Genetics of UM is a rapidly advancing field, which not only contributes to the understanding of the pathogenesis of this cancer, but also results in further refinement of prognostication. Concomitantly, advances have been made in the use of genetic tests. New methods for genetic typing of UM have been developed. Despite the considerable progress made recently, many questions remain, such as those relating to the reliability of prognostic genetic tests, and the use of biopsied or previously irradiated tumour tissue for prognostication by genetic testing. In this article, we review genetic prognostic indicators in UM, also comparing available genetic tests, addressing the clinical application of genetic prognostication and discussing future perspectives for improving genetic prognostication in UM.
      PubDate: 2017-11-04T00:35:28.649242-05:
      DOI: 10.1111/aos.13580
  • Fundus autofluorescence imaging in hereditary retinal diseases
    • Authors: Francesco Pichi; Emad B. Abboud, Nicola G. Ghazi, Arif O. Khan
      Abstract: Fundus autofluorescence (FAF) is a non-invasive retinal imaging modality used in clinical practice to non-invasively map changes at the level of the retinal pigment epithelium (RPE)/photoreceptor complex and alterations of macular pigment distribution. This imaging method is based on the visualization of intrinsic fluorophores and may be easily and rapidly used in routine patient care. Excessive accumulation of lipofuscin granules in the lysosomal compartment of RPE cells represents a common downstream pathogenic pathway in various hereditary and complex retinal diseases. The clinical applications of FAF continue to expand. It is now an essential tool for evaluating macular dystrophies and various hereditary retinal disorders. Fundus autofluorescence (FAF) may detect abnormalities beyond those detected on funduscopic examination, fluorescein angiography (FA) or optical coherence tomography (OCT). Fundus autofluorescence (FAF) imaging is particularly helpful for differential diagnosis, detection and extent delineation of involved retinal areas, genotype-phenotype correlations and monitoring of changes overtime. Given its ease of use, non-invasive nature and value in characterizing retinal disease, FAF enjoys increasing clinical relevance. This review summarizes basic principles and FAF findings in various hereditary retinal diseases.
      PubDate: 2017-11-02T22:06:59.615989-05:
      DOI: 10.1111/aos.13602
  • Agreement of phakic and pseudophakic anterior chamber depth measurements
           in IOLMaster and Pentacam
    • Authors: Hassan Hamoudi; Ulrik Correll Christensen, Morten la Cour
      PubDate: 2017-11-02T22:01:14.768098-05:
      DOI: 10.1111/aos.13599
  • Causes of intracapsular cataract extraction, explantation of intraocular
           lenses and suture scleral fixation of intraocular lenses in the modern era
    • Authors: Kazunobu Sugihara; Masaki Tanito, Yasuyuki Takai, Akihiro Ohira
      PubDate: 2017-11-02T22:01:07.987232-05:
      DOI: 10.1111/aos.13579
  • Prevalence and associations of epiretinal membranes in the Australian
           National Eye Health Survey
    • Authors: Stuart Keel; Jing Xie, Joshua Foreman, Peter Wijngaarden, Hugh R. Taylor, Mohamed Dirani
      PubDate: 2017-06-29T06:50:33.820521-05:
      DOI: 10.1111/aos.13386
  • Optical coherence tomography morphology and evolution in cblC
           disease-related maculopathy in a case series of very young patients
    • Authors: Giacomo M. Bacci; Maria A. Donati, Elisabetta Pasquini, Francis Munier, Catia Cavicchi, Amelia Morrone, Andrea Sodi, Vittoria Murro, Nuria Garcia Segarra, Claudio Defilippi, Leonardo Bussolin, Roberto Caputo
      Abstract: PurposeTo describe the retinal structure of a group of patients affected by methylmalonic aciduria with homocystinuria cblC type, caused by mutations in the MMACHC gene, using spectral domain optical coherence tomography (SD-OCT).MethodsYoung patients (n = 11, age 0–74 months) with cblC disease, detected by newborn screening or clinically diagnosed within 40 days of life, underwent molecular analysis and complete ophthalmic examination, including fundus photography and SD-OCT. In one case, we also performed fluorescein angiography (FA) and standard electroretinography (ERG).ResultsMolecular analysis of the MMACHC gene fully confirmed cblC disease in nine of 11 patients. Two patients harboured only a single heterozygous pathogenic MMACHC mutation and large unbalanced rearrangements were excluded by array-CGH analysis in both. All patients except two showed a bilateral maculopathy. In general, retinal changes were first observed before one year of age and progressed to a well-established maculopathy. Measurable visual acuities ranged from normal vision, in keeping with age, to bilateral, severe impairment of central vision. Nystagmus was present in six patients. Spectral domain optical coherence tomography (SD-OCT) showed macular thinning with severe alterations in outer, and partial sparing of inner, retinal layers.ConclusionPatients affected by cblC disease may frequently show an early onset maculopathy with variable ophthalmoscopic appearance. Spectral domain optical coherence tomography (SD-OCT) broadens the knowledge of subtle retinal alterations during the disease's progression and helps to shed light on the pathological mechanism of maculopathy development.
      PubDate: 2017-05-08T06:45:41.326963-05:
      DOI: 10.1111/aos.13441
  • Influence of scanning area on choroidal vascularity index measurement
           using optical coherence tomography
    • Authors: Rupesh Agrawal; Xin Wei, Abhilash Goud, Kiran Kumar Vupparaboina, Soumya Jana, Jay Chhablani
      Abstract: PurposeRecently, choroidal vascularity index (CVI) is proposed as a novel tool to evaluate the choroidal vasculature. In this study, we investigate the impact of scanning area on CVI measurement using spectral-domain optical coherence tomography (SD-OCT).MethodsSpectral-domain optical coherence tomography (SD-OCT) using enhanced depth imaging mode was performed in 30 eyes from 15 normal subjects. Three scanning areas were compared: dingle foveal scan; central macular scans [scan passing through central 1000 microns circle on Early Treatment Diabetic Retinopathy Study (ETDRS) grid, inner circle]; and total macular cube scans. Binarization of OCT B-scans and segmentation of the binarized choroid layer were achieved using a previously reported validated automated software. Choroidal vascularity index (CVI) percentage was calculated. Degree of agreement among foveal, central macular and total macular CVI was assessed using intraclass correlation coefficient (ICC) and was plotted using Bland–Altman plot.ResultsThe mean CVI in subfoveal, central macular and total macular scans was 49.95 ± 4.84%, 50.00 ± 4.68% and 51.10 ± 4.63%, respectively. Intraclass correlation coefficient (ICC) was more than 0.8 for all three comparisons [subfoveal versus central macular CVI, ICC = 0.92 (95% CI: 0.84–0.96); central macular versus total macular CVI, ICC = 0.90 (95% CI: 0.82–0.96); subfoveal versus total macular CVI, ICC = 0.92 (95% CI: 0.85–0.95)]. No significant differences in variance (all p > 0.05) were noted among CVI measured from the three scanning areas.ConclusionChoroidal vascularity index (CVI) measurements were highly reproducible using subfoveal, central and total macular scans in healthy individuals. Single foveal scan choroidal vascularity represents total macular choroidal vascularity in healthy population.
      PubDate: 2017-05-04T02:35:26.734447-05:
      DOI: 10.1111/aos.13442
  • Incidence of secondary glaucoma after treatment of uveal melanoma with
           robotic radiosurgery versus brachytherapy
    • Authors: Jakob Siedlecki; Veronika Reiterer, Simon Leicht, Paul Foerster, Karsten Kortüm, Ulrich Schaller, Siegfried Priglinger, Christoph Fuerweger, Alexander Muacevic, Kirsten Eibl-Lindner
      Abstract: PurposeDifferent modalities of radiation therapy nowadays allow for effective treatment of uveal melanoma combined with the advantage of eye preservation. However, this advantage can secondarily be impaired by radiation-related side effects. After local recurrence, secondary glaucoma (SG) has been described as second most frequent complication leading to need of enucleation. This study compares the incidence of SG after conventional Ruthenium (Ru)-106 brachytherapy (BT) versus CyberKnife robotic radiosurgery (RRS) which has been gaining importance lately as an efficient treatment option offering improved patient comfort.MethodsMedical records of all patients diagnosed with uveal melanoma in the Eye Clinic of the Ludwig-Maximilians-University Munich between 2007 and 2013 were reviewed. A total of 268 eyes of 268 patients treated with Ru-106 BT or CyberKnife-RRS as monotherapy were entered in this retrospective cohort study. Incidence of SG was correlated with treatment modality and baseline tumour characteristics.ResultsFifty-three patients (19.8%) developed SG. At 5 years, SG was significantly more frequent after RRS (46.7%) than BT (11.1%); however, tumour thickness (maximum apical height) as a marker of tumour progress was more pronounced in the RRS group. Subgroup analysis of 178 patients for tumours amenable to both BT and RRS (thickness ≤6 mm) revealed comparable results at 3 years (RRS: 13.8 versus BT: 11.2%), but a trend towards increased incidence after RRS beyond year three. However, this difference was not significant at 5 years (28.2% versus 11.2%, p = 0.138). Tumour thickness was significantly associated with incidence of SG.ConclusionIn tumours ≤6 mm thickness, RRS and BT seem to offer a comparable safety profile in terms of SG. Beyond year three, SG was tendentially, but not significantly more frequent after RRS. Increasing tumour thickness is associated with risk of SG.
      PubDate: 2017-04-07T05:13:27.756852-05:
      DOI: 10.1111/aos.13418
  • Additive effects and safety of fixed combination therapy with 1%
           brinzolamide and 0.5% timolol versus 1% dorzolamide and 0.5% timolol in
           prostaglandin-treated glaucoma patients
    • Authors: Makoto Aihara; Misato Adachi, Hiroshi Matsuo, Tetsuya Togano, Takeo Fukuchi, Noriyuki Sasaki,
      Abstract: PurposeTo compare the additive effects and safety of 1% brinzolamide/0.5% timolol fixed combination (BTFC) versus the low-dose regimen of 1% dorzolamide/0.5% timolol fixed combination (DTFC) in patients with open-angle glaucoma and ocular hypertension (OAG/OH) following treatment with prostaglandin analogues (PGAs).MethodsA prospective, randomized, double-masked, multicentre, parallel-group and active-controlled study included 201 Japanese OAG/OH patients who had been treated with PGA. Efficacy was assessed as the change in intra-ocular pressure (IOP) from baseline after weeks 4 and 8. Safety was assessed with adverse event rates, ocular discomfort score, blur scale, blood pressure and heart rates, best-corrected visual acuity (BCVA) and slit lamp examinations.ResultsIntra-ocular pressure (IOP) change from baseline at 9 AM/11 AM pooled over the 8 weeks was −3.3/−3.3 mmHg in the BTFC group and −2.9/−3.4 mmHg in the DTFC group, demonstrating non-inferiority of BTFC to DTFC. Ocular irritation was frequently seen in DTFC group. Although blurred vision was frequently seen in BTFC group, it was transient and blurring became the equivalent 3 min after instillation between two groups. No noteworthy issue was observed in other safety outcome.ConclusionNon-inferiority of BTFC to DTFC in IOP reduction was demonstrated after adding onto PGA therapy in Japanese OAG/OH patients. Although the score of blurred vision was transiently higher in BTFC than DTFC, treatment difference decreased and disappeared with time. Thus, BTFC can be considered as a safe and effective agent for glaucoma treatment.
      PubDate: 2017-04-03T00:05:24.557264-05:
      DOI: 10.1111/aos.13401
  • Visual impairment certification due to diabetic retinopathy in North and
           Eastern Devon
    • Authors: Siying Lin; Bhaskar Gupta, Natalee James, Roland H. Ling
      Abstract: PurposeTo determine certifications of visual impairment (CVIs) due to diabetic retinopathy (DR) in a region that has operated diabetic screening since 1992.MethodsA retrospective review of all CVIs due to DR was conducted, with mid-year population estimates and a diabetes prevalence model used to determine the annual incidence of certification from 2010 to 2013. For 2013, CVIs due to DR were also compared to all CVIs in the region.ResultsThe total number of certifications due to DR was 75; 52 were sight impaired (SI) and 23 severely sight impaired (SSI) certifications; 25% of patients had type 1, and 75% had type 2 diabetes mellitus. The mean age at time of CVI was 65.5 years. The mean duration of known diabetes was 22.0 years. The incidence of CVI due to DR ranged from 30.8 to 77.4 per million population per year between 2010 and 2013. The incidence of CVI in the diabetic population was estimated at 0.47 to 1.21 per 1000 patients per year with diabetes for 2010–2013. In 2013, DR was a main or contributing cause in 4.3% of all CVIs, but did not contribute to any SSI certifications in the working age population.ConclusionThe incidence of CVI due to DR was comparable to that reported in other regions. Nationwide, DR was the second most common cause of blindness in working age adults, but did not contribute to any SSI certifications in our population. Our results are consistent with the success of a long-standing retinal screening programme.
      PubDate: 2017-04-01T01:05:26.155893-05:
      DOI: 10.1111/aos.13400
  • Visual and health outcomes, measured with the activity inventory and the
           EQ-5D, in visual impairment
    • Authors: Antonio Filipe Macedo; Pedro Lima Ramos, Laura Hernandez-Moreno, Joana Cima, António M. G. Baptista, Ana Patricia Marques, Robert Massof, Rui Santana
      Abstract: PurposeGeneric instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition-specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ-5D-3L and the Activity Inventory (AI).MethodsParticipants were recruited in different hospitals during the PCVIP-study. A total of 134 patients with acuity 0.30 logMAR or less in the better eye were interviewed. The AI includes 46 goals split between three objectives: social functioning, recreation and daily living, and was used to measure visual ability. The EQ-5D consists of five questions covering one domain each and was used to provide a measure of health states. Responses to each domain were combined to produce a single individual index.ResultsThe AI and the EQ-5D-3L showed enough discriminatory power between VI levels (p 
      PubDate: 2017-03-30T06:00:40.721371-05:
      DOI: 10.1111/aos.13430
  • Efficacy of nutritional supplementation with omega-3 and omega-6 fatty
           acids in dry eye syndrome: a systematic review of randomized clinical
    • Authors: Ignacio Molina-Leyva; Alejandro Molina-Leyva, Aurora Bueno-Cavanillas
      Abstract: PurposeTo critically appraise scientific evidence regarding the efficacy of nutritional supplementation with omega-3 and omega-6 fatty acids for the treatment of dry eye syndrome (DES).MethodsA systematic review of randomized clinical trials was performed. Two independent reviewers selected and analysed the scientific papers that met inclusion and exclusion criteria. Objective and subjective efficacy outcomes were assessed.ResultsThe trials involved a total of 2591 patients in fifteen independent studies. All studies were published between 2005 and 2015. The supplements used were mostly omega-3 and omega-6 in different proportions. Subjective improvement was measured using mainly Ocular Surface Disease Index (OSDI) test and Dry Eye Severity Score (DESS) test: significant differences in favour of the experimental group were found in seven of the studies. The objective amelioration was assessed by lacrimal function parameters: Tear break-up time (TBUT) significantly increased in nine studies and Schirmer's test in four studies.ConclusionWe observed a discrete improvement in the parameters of tear function. Scientific evidence is not strong enough to systematically recommend the use of omega-3 and omega-6 fatty acids as a standalone treatment of DES independently from its aetiology. However, they could be considered as an effective alternative to topical treatment in patients with DES secondary to certain pathologies.
      PubDate: 2017-03-30T04:20:38.160798-05:
      DOI: 10.1111/aos.13428
  • Treatment of adenoviral keratoconjunctivitis with a combination of
           povidone-iodine 1.0% and dexamethasone 0.1% drops: a clinical prospective
           controlled randomized study
    • Authors: Natalya Kovalyuk; Igor Kaiserman, Michael Mimouni, Ornit Cohen, Shmuel Levartovsky, Hilda Sherbany, Michal Mandelboim
      Abstract: PurposeTo determine the efficacy of combination povidone-iodine (PVP-I) 1.0% eyedrops and dexamethasone 0.1% eyedrops in the treatment of adenoviral keratoconjunctivitis.Materials and methodsIn a prospective, randomized, controlled, double-blinded clinical trial patients with recent adenoviral keratoconjunctivitis (diagnosed clinically and confirmed by PCR), we randomly divided into three treatment groups: study group – received PVP-I 1.0% and dexamethasone 0.1%, control 1 group – received dexamethasone 0.1% and control 2 group – received lubricating eyedrops (hypromellose 0.3%). The treatment was administered four times a day in each group. All patients were examined and filled a questionnaire before treatment and on the 3rd, 5th and 7th days of treatment.ResultsWe included in the study 78 eyes (26 in each group). Adenovirus type 8 was the most common pathogen (83% of cases). The fastest improvement in patients red eyes, discharge, superficial punctate keratitis and pseudomembranes was observed in the study group (p 
      PubDate: 2017-03-25T00:20:35.819042-05:
      DOI: 10.1111/aos.13416
  • Factors influencing the contamination rate of human organ-cultured corneas
    • Authors: Daniel Röck; Johanna Wude, Karl U. Bartz-Schmidt, Efdal Yoeruek, Sebastian Thaler, Tobias Röck
      Abstract: PurposeTo assess the influence of donor, environment and storage factors on the contamination rate of organ-cultured corneas, to consider the microbiological species causing corneal contamination and to investigate the corresponding sensitivities.MethodsData from 1340 consecutive donor corneas were analysed retrospectively. Logistic regression analysis was used to assess the influence of different factors on the contamination rate of organ-cultured corneas for transplantation.ResultsThe mean annual contamination rate was 1.8 ± 0.4% (range: 1.3–2.1%); 50% contaminations were of fungal origin with exclusively Candida species, and 50% contaminations were of bacterial origin with Staphylococcus species being predominant. The cause of donor death including infection and multiple organ dysfunction syndrome increased the risk of bacterial or fungal contamination during organ culture (p = 0.007 and p = 0.014, respectively). Differentiating between septic and aseptic donors showed an increased risk of contamination for septic donors (p = 0.0020). Mean monthly temperature including warmer months increased the risk of contamination significantly (p = 0.0031). Sex, donor age, death to enucleation, death to corneoscleral disc excision and storage time did not increase the risk of contamination significantly.ConclusionThe genesis of microbial contamination in organ-cultured donor corneas seems to be multifactorial. The main source of fungal or bacterial contamination could be resident species from the skin flora. The rate of microbial contamination in organ-cultured donor corneas seems to be dependent on the cause of donor death and mean monthly temperature.
      PubDate: 2017-03-21T02:01:24.864585-05:
      DOI: 10.1111/aos.13375
  • Plasma long-chain omega-3 polyunsaturated fatty acids and macular pigment
           in subjects with family history of age-related macular degeneration: the
           Limpia Study
    • Authors: Bénédicte M. J. Merle; Benjamin Buaud, Jean-François Korobelnik, Alain Bron, Marie-Noëlle Delyfer, Marie-Bénédicte Rougier, Hélène Savel, Carole Vaysse, Catherine Creuzot-Garcher, Cécile Delcourt
      Abstract: PurposeIn numerous epidemiological studies, omega-3 polyunsaturated fatty acids (PUFAs) have been associated with a decreased risk of age-related macular degeneration (AMD). Beyond their structural, functional and neuroprotective roles, omega-3 PUFAs may favour the retinal accumulation of lutein and zeaxanthin and thus increase macular pigment optical density (MPOD). We examined the associations of MPOD with plasma omega-3 PUFAs in subjects with family history of AMD.MethodsThe Limpia study is a double-blind, placebo-controlled, prospective randomized clinical trial performed in 120 subjects. Subjects with at least one parent treated for neovascular AMD, aged 40–70, with a best corrected visual acuity (BCVA)>20/25, free of late AMD and other major eye conditions and with no use of supplement containing lutein or zeaxanthin the preceding year were recruited in Bordeaux and Dijon, France. At baseline, MPOD within 1° of eccentricity was measured by modified Heidelberg retinal analyser (Heidelberg, Germany) and plasma omega-3 PUFAs by gas chromatography. Medical history and lifestyle data were collected from a standardized questionnaire. Associations of MPOD with plasma omega-3 PUFAs were assessed at the baseline examination, using mixed linear models adjusted for age, gender, centre, body mass index, smoking, plasma high-density lipoprotein (HDL) cholesterol and lutein+zeaxanthin.ResultsAfter multivariate adjustment, high MPOD was significantly associated with higher level of plasma docosapentaenoic acid (DPA) (β = 0.029, 95% CI: 0.003, 0.055; p = 0.03). Plasma alpha linolenic, eicosapentaenoic and docosahexaenoic acids were not significantly associated with MPOD.ConclusionIn the Limpia study, high MPOD within 1° was significantly associated with higher plasma levels of omega-3 DPA.
      PubDate: 2017-03-08T00:55:52.122862-05:
      DOI: 10.1111/aos.13408
  • Reduced number of relapses of human leucocyte antigen-B27-associated
           uveitis during pregnancy
    • Authors: Fleurieke H. Verhagen; Arthur M. Braakenburg, Tessa Kremer, Julia Drylewicz, Aniki Rothova, Joke H. Boer
      PubDate: 2017-03-07T07:10:37.694373-05:
      DOI: 10.1111/aos.13387
  • Two-year results of microcatheter-assisted trabeculotomy in paediatric
           glaucoma: a randomized controlled study
    • Authors: Yasmine El Sayed; Ghada Gawdat
      Abstract: PurposeTo compare the outcomes of microcatheter-assisted circumferential trabeculotomy to standard rigid probe trabeculotomy in childhood glaucomas.MethodsEyes of children requiring trabeculotomy for primary congenital or secondary paediatric glaucoma were randomized to undergo either trabeculotomy using the Glaucolight illuminated microcatheter, or a rigid probe trabeculotomy. Complete success was defined as an intraocular pressure (IOP) of
      PubDate: 2017-03-07T03:45:47.363045-05:
      DOI: 10.1111/aos.13414
  • Serum from plasma rich in growth factors regenerates rabbit corneas by
           promoting cell proliferation, migration, differentiation, adhesion and
           limbal stemness
    • Authors: Jaime Etxebarria; Sara Sanz-Lázaro, Raquel Hernáez-Moya, Vanesa Freire, Juan A. Durán, María–Celia Morales, Noelia Andollo
      Abstract: PurposeTo evaluate the regenerating potential and the mechanisms through which the autologous serum derived from plasma rich in growth factors (s-PRGF) favours corneal wound healing in vitro and in vivo.MethodsWe compared the effect of various concentrations of s-PRGF versus fetal bovine serum (FBS) and control treatment in rabbit primary corneal epithelial and stromal cells and wounded rabbit corneas. Cell proliferation was measured using an enzymatic colorimetric assay. In vitro and in vivo wound-healing progression was assessed by image-analysis software. Migration and invasion were evaluated using transfilter assays. Histological structure was analysed in stained sections. Protein expression was evaluated by immunohistochemistry.Resultss-PRGF promoted the robust proliferation of epithelial cultures at any concentration, similar to FBS. Likewise, s-PRGF and FBS produced similar re-epithelialization rates in in vitro wound-healing assays. In vivo, s-PRGF treatment accelerated corneal wound healing in comparison with control treatment. This difference was significant only for 100% s-PRGF treatment in our healthy rabbit model. Histological analysis confirmed normal epithelialization in all cases. Immunohistochemistry showed a higher expression of cytokeratins 3/76 and 15, zonula occludens-1 and alpha-smooth muscle actin proteins as a function of s-PRGF concentration. Notably, keratocyte density in the anterior third of the stroma increased with increase in s-PRGF concentration, suggesting an in vivo chemotactic effect of s-PRGF on keratocytes that was further confirmed in vitro.Conclusions-PRGF promotes proliferation and migration and influences limbal stemness, adhesion and fibrosis during corneal healing.
      PubDate: 2017-03-07T01:35:45.119128-05:
      DOI: 10.1111/aos.13371
  • Aqueous chlorhexidine is an effective alternative to povidone–iodine for
           intravitreal injection prophylaxis
    • Authors: Carmen L. Oakley; Brendan J. Vote
      PubDate: 2017-03-06T01:50:41.614694-05:
      DOI: 10.1111/aos.13340
  • IgG4-related disease as an emerging cause of scleritis
    • Authors: Faiz Karim; Joeri Hoog, Dion Paridaens, Rob Verdijk, Marco Schreurs, Aniki Rothova, Martin Hagen, Jan Laar
      PubDate: 2017-02-22T22:00:29.587296-05:
      DOI: 10.1111/aos.13376
  • Early microvascular retinal changes in optical coherence tomography
           angiography in patients with type 1 diabetes mellitus
    • Authors: Joseph M. Simonett; Fabio Scarinci, Fabiana Picconi, Paola Giorno, Daniele De Geronimo, Antonio Di Renzo, Monica Varano, Simona Frontoni, Mariacristina Parravano
      Abstract: PurposeDiabetic retinopathy (DR) can lead to significant vision loss and blindness and has a particularly high prevalence in patients with type 1 diabetes (DM1). In this study, we investigate quantitative differences in optical coherence tomography angiography (OCTA) data between DM1 patients with no or mild signs of retinopathy and non-diabetic subjects.MethodsOptical coherence tomography angiography (OCTA) imaging was performed on DM1 patients with no or mild nonproliferative diabetic retinopathy and healthy, age-matched controls. Parafoveal vessel density and foveal avascular zone (FAZ) area in the deep capillary plexus (DCP) and superficial capillary plexus (SCP) were calculated with automated quantification software and compared between patient cohorts.ResultsA significant decrease in parafoveal vessel density was seen in the DCP of DM1 patients compared to non-diabetic controls (57.0 ± 3.3% versus 60.7 ± 2.4%, p 
      PubDate: 2017-02-16T22:45:28.098338-05:
      DOI: 10.1111/aos.13404
  • Optic nerve head microcirculation in autosomal dominant optic atrophy and
           normal-tension glaucoma
    • Authors: Noriko Himori; Hiroshi Kunikata, Maki Inoue, Takayuki Takeshita, Koji M. Nishiguchi, Toru Nakazawa
      PubDate: 2017-01-30T06:35:35.130435-05:
      DOI: 10.1111/aos.13353
  • Visual function response to ocriplasmin for the treatment of vitreomacular
           traction and macular hole
    • Authors: Timothy L. Jackson; Thomas Verstraeten, Luc Duchateau, Benedicte Lescrauwaet
      Abstract: PurposeTo assess the effect of an intravitreal ocriplasmin injection on visual function, measured using visual acuity (VA) and vision-related quality of life.MethodsPost hoc analysis of prespecified secondary end-points in two multicentre, randomized, double-masked, phase 3 clinical trials. A total of 652 participants with symptomatic vitreomacular adhesion were enrolled, of whom 464 received a single intravitreal injection of 125 μg ocriplasmin and 188 received a single intravitreal placebo injection. Based on principal components analysis results, visual function response (VFR) was defined as either a VA improvement of ≥2 lines; or an improvement in the composite score of the National Eye Institute Visual Function Questionnaire (VFQ-25) exceeding the minimal clinically important difference (MCID), estimated using the standard error of measurement approach; or an improvement in the VFQ-25 driving subscale score exceeding the MCID. The main outcome measure was VFR at 6 months.ResultsA VFR occurred in 55.1% of the ocriplasmin group versus 34.2% of the placebo injection group (p 
      PubDate: 2017-01-30T04:50:32.05178-05:0
      DOI: 10.1111/aos.13369
  • The role of hypertension in retinal blood flow alterations in open-angle
           glaucoma patients
    • Authors: Lauren Ciulla; Alon Harris, June Geng, Colin Ip, Patrick Serrano, Joshua Gross, Brent Siesky
      PubDate: 2017-01-13T02:40:35.704612-05:
      DOI: 10.1111/aos.13365
  • Comparison between the short-term outcomes of bevacizumab and
           ziv-aflibercept in the treatment of primary diabetic macular oedema
    • Authors: Mohammed Ashraf; Hassan El Kayal, Ahmed A.R. Souka
      PubDate: 2017-01-13T01:46:03.307471-05:
      DOI: 10.1111/aos.13352
  • Issue Information
    • Pages: 751 - 754
      PubDate: 2017-12-08T09:16:23.49754-05:0
      DOI: 10.1111/aos.13267
  • This Issue of Acta
    • Authors: Einar Stefánsson
      Pages: 755 - 756
      PubDate: 2017-12-08T09:16:25.975327-05:
      DOI: 10.1111/aos.13660
  • Vascular endothelial growth factor inhibition for proliferative diabetic
           retinopathy: Et tu, Brute'
    • Authors: Jakob Grauslund
      Pages: 757 - 758
      PubDate: 2017-12-08T09:16:26.068302-05:
      DOI: 10.1111/aos.13562
  • The interrelation between hypothyroidism and glaucoma: a critical review
           and meta-analyses
    • Authors: Marianne Thvilum; Frans Brandt, Thomas Heiberg Brix, Laszlo Hegedüs
      Pages: 759 - 767
      Abstract: Data on the association between hypothyroidism and glaucoma are conflicting. We sought to shed light on this by conducting a critical review and meta-analyses. The meta-analyses were conducted in adherence with the widely accepted MOOSE guidelines. Using the Medical Subject Heading (MeSH) terms: hypothyroidism, myxoedema and glaucoma or intraocular pressure, case–control studies, cohort studies and cross-sectional studies were identified (PubMed) and reviewed. Using meta-analysis, the relative risk (RR) of coexistence of glaucoma and hypothyroidism was calculated. Based on the literature search, thirteen studies fulfilled the inclusion criteria and could be categorized into two groups based on the exposure. The designs of the studies varied considerably, and there was heterogeneity related to lack of power, weak phenotype classifications and length of follow-up. Eight studies had glaucoma (5757 patients) as exposure and hypothyroidism as outcome. Among these, we found a non-significantly increased risk of hypothyroidism associated with glaucoma (RR 1.65; 95% confidence interval [CI]: 0.97–2.82). Based on five studies (168 006 patients) with hypothyroidism as exposure and glaucoma as outcome, we found the risk of glaucoma to be significantly increased (RR 1.33; 95% CI: 1.13–1.58). Based on these meta-analyses, there seems to be an association between hypothyroidism and glaucoma, which does not seem to be the case between glaucoma and hypothyroidism. However, larger scale studies with better phenotype classification, longer follow-up and taking comorbidity and other biases into consideration are needed to address a potential causal relationship.
      PubDate: 2017-02-16T22:30:53.915088-05:
      DOI: 10.1111/aos.13412
  • Can the retina be used to diagnose and plot the progression of Alzheimer's
    • Authors: Deepti Mahajan; Marcela Votruba
      Pages: 768 - 777
      Abstract: Alzheimer's disease (AD) is a neurodegenerative disease and the most common cause of senile dementia. It impairs the quality of life of a person and their family, posing a serious economic and social threat in developed countries. The fact that the diagnosis can only be definitively made post-mortem, or when the disease is fairly advanced, presents a serious problem if novel therapeutic interventions are to be devised and used early in the course of the disease. There is therefore a pressing need for more sensitive and specific diagnostic tests with which we can detect AD in the preclinical stage. The tau proteins and beta-amyloid proteins start to accumulate 20 years before the symptoms begin to manifest. Detecting them in the preclinical stage would be a potential breakthrough in the management of AD. A high degree of clinical suspicion is needed to correlate problems in cognition with the changes in the eye, particularly the retina, pupil and ocular movements, so that the disease can be detected early and managed in the prodromal phase. In this systematic review, we ask the question whether the retina can be used to make a specific and early diagnosis of AD.
      PubDate: 2017-06-09T01:40:59.633058-05:
      DOI: 10.1111/aos.13472
  • Prevalence and risk factors for diabetic retinopathy in 17 152 patients
           from the island of Funen, Denmark
    • Authors: Morten B. Larsen; Jan Erik Henriksen, Jakob Grauslund, Tunde Peto
      Pages: 778 - 786
      Abstract: PurposeThis study aims to estimate the prevalence and risk factors of diabetic retinopathy (DR) in patients enrolled in a large Danish quality-assuring database for diabetes: the Funen Diabetes Database (FDDB).MethodsAll patients with type 1 (T1DM) and type 2 DM (T2DM) diabetes mellitus (DM) were included in a cross-sectional study. The level of DR per patient was determined based on the eye with highest level of DR. All ocular and non-ocular data were extracted at the latest examination that corresponded to the most recent DR-grading data.ResultsData from 17 152 patients were analysed; 83.1% had T2DM. Prevalence of DR was 23.8% (T1DM: 54.3%, T2DM: 21.2%). T1/T2DM patients were statistically significantly different regarding age, duration of diabetes, BMI, systolic blood pressure (BP), cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, s-creatinine and u-albumin (p 
      PubDate: 2017-04-26T02:16:44.250352-05:
      DOI: 10.1111/aos.13449
  • Treatment for neovascular age-related macular degeneration in Sweden:
           outcomes at seven years in the Swedish Macula Register
    • Authors: Inger Westborg; Elisabet Granstam, Aldana Rosso, Susanne Albrecht, Niklas Karlsson, Monica Lövestam-Adrian
      Pages: 787 - 795
      Abstract: PurposeTo present Swedish Macula Register (SMR) data regarding treatment of neovascular age-related macular degeneration (AMD) in clinical practice since 2008.MethodsA retrospective register-based study was conducted. Evaluation of baseline demographics, visual outcome and number of injections during this period is presented.ResultsMean age at diagnosis was 79 ± (SD) 8 years; 65% were female. The proportion of patients with
      PubDate: 2017-08-21T07:10:21.471605-05:
      DOI: 10.1111/aos.13539
  • An 8-year follow-up of anti-vascular endothelial growth factor treatment
           with a treat-and-extend modality for neovascular age-related macular
    • Authors: Karina Berg; Anca B. Roald, Jesintha Navaratnam, Ragnheiður Bragadóttir
      Pages: 796 - 802
      Abstract: PurposeTo investigate long-term visual results of treatment with anti-vascular endothelial growth factor (VEGF) agents for neovascular age-related macular degeneration (nAMD) following a treat-and-extend regimen.MethodsRetrospective review of 155 patients who initiated treatment with bevacizumab for nAMD in one eye. At the final 8-year visit, 40 patients (26%) remained for follow-up. Mean change in best-corrected visual acuity (BCVA) was calculated compared to baseline values.ResultsMean BCVA improved significantly from baseline during the first year of treatment, with −0.11 logMAR units equivalent to 6.1 approximate Early Treatment Diabetic Retinopathy Study (approxETDRS) letters (p = 
      PubDate: 2017-09-19T07:55:20.853516-05:
      DOI: 10.1111/aos.13522
  • NLRP3 inflammasome activation is associated with proliferative diabetic
    • Authors: Sirpa Loukovaara; Niina Piippo, Kati Kinnunen, Maria Hytti, Kai Kaarniranta, Anu Kauppinen
      Pages: 803 - 808
      Abstract: PurposeInnate immunity and dysregulation of inflammatory processes play a role in vascular diseases like atherosclerosis or diabetes. Nucleotide-binding domain and Leucine-rich repeat Receptor containing a Pyrin domain 3 (NLRP3) inflammasomes are pro-inflammatory signalling complexes that were found in 2002. In addition to pathogens and other extracellular threats, they can be activated by various endogenous danger signals. The purpose of this study was to find out whether NLRP3 activation occurs in patients with sight-threatening forms of diabetic retinopathy (DR).MethodsInflammasome components NLRP3 and caspase-1, inflammasome-related pro-inflammatory cytokines IL-1β and IL-18, vascular endothelial growth factor (VEGF), acute-phase cytokines TNF-α and IL-6, as well as adaptive immunity-related cytokine interferon gamma (IFN-γ) were measured from the vitreous samples of 15 non-proliferative diabetic retinopathy (non-PDR) and 23 proliferative diabetic retinopathy (PDR) patients using the enzyme-linked immunosorbent assay (ELISA) method. The adaptor protein apoptosis-associated speck-like protein containing a CARD (ASC) was determined using the Western blot technique.ResultsInflammasome components were present in the vitreous of DR patients. Along with VEGF, the levels of caspase-1 and IL-18 were significantly increased, especially in PDR eyes. Interestingly, clearly higher levels of NLRP3 were found in the PDR eyes with tractional retinal detachment (TRD) than from PDR eyes with fully attached retina. There were no significant differences in the amounts of IL-1β, TNF-α, IL-6, and IFN-γ that were detectable in the vitreous of both non-PDR and PDR patients.ConclusionOur results suggest that NLRP3 inflammasome activation can be associated especially with the pathogenesis of PDR. The lack of differences in TNF-α, IL-6, and IFN-γ also alludes that acute inflammation or T-cell-mediated responses do not dominate in PDR pathogenesis.
      PubDate: 2017-03-08T04:15:25.641168-05:
      DOI: 10.1111/aos.13427
  • Choroideremia: melanopsin-mediated postillumination pupil relaxation is
           abnormally slow
    • Authors: Shakoor Ba-Ali; Søren Kirchhoff Christensen, Birgit Sander, Thomas Rosenberg, Michael Larsen, Henrik Lund-Andersen
      Pages: 809 - 814
      Abstract: PurposeTo investigate the rod–cone and melanopsin pupillary light response (PLR) pathways in choroideremia.MethodsEight patients with choroideremia and 18 healthy age-matched controls underwent chromatic pupillometry by applying blue (463 nm) and red light (643 nm) at 100 lux intensity to the right eye while recording pupil diameters. Absolute baseline pupil size (mm), normalized maximal pupil constriction and the early and late postillumination pupillary dilation, from 0 to 10 seconds and 10 to 30 seconds after the end of illumination, respectively, were determined. Postillumination responses to blue light were considered to be primarily driven by melanopsin activation of the intrinsic photosensitive retinal ganglion cells.ResultsBaseline pupil diameters were comparable in patients with choroideremia and control subjects (p = 0.48). The maximum pupil constriction in patients with choroideremia was severely weakened in red light but only mildly weakened in blue light (p 
      PubDate: 2017-03-08T04:35:27.782914-05:
      DOI: 10.1111/aos.13394
  • Levels of beta-trace protein in optic disc pit with macular detachment
    • Authors: Karim Makdoumi; Torbjörn K. Nilsson, Sven Crafoord
      Pages: 815 - 819
      Abstract: BackgroundTo report beta-trace protein (βTP) levels in the subretinal fluid (SRF) of four patients with a macular detachment associated with optic disc pit (ODP).MethodsFour patients with a serous retinal detachment involving the macula was operated by pars plana vitrectomy (PPV) with C2F6 gas tamponade and peeling of internal limiting membrane (ILM). Patients with a follow-up period exceeding one year postoperatively were included in the study. The SRF was drained using a fine cannula without laser photocoagulation, and the samples were analysed using particle-enhancing nephelometry. The levels of βTP were compared to 20 routine cerebrospinal fluid (CSF) samples.ResultsIn four of the five samples from SRF had relatively low βTP levels, with a mean concentration of 6.6 mg/l (range 2.0 to 23.1 mg/l) compared to 16.0 mg/l (range 6.3-26.8 mg/l) in CSF. The only SRF sample within the range corresponding to normal CSF was the first sample from patient 4, and the analysis of the renewed aspirate during the second operation was 2.8 mg/l. Postoperatively, the regression of SRF was slow, but regression of SRF in the foveal region took place in all cases; however, visual acuity (VA) was improved in only half of the patients.ConclusionThe results from the analysed SRF regarding βTP concentration in these patients indicate that the SRF in ODP is not identical to CSF, as the concentrations of βTP differ.
      PubDate: 2017-09-19T08:00:48.214303-05:
      DOI: 10.1111/aos.13527
  • Functional benefits and patient satisfaction with upper blepharoplasty –
           evaluated by objective and subjective outcome measures
    • Authors: Agnes Galbo Jacobsen; Brian Brost, Henrik Vorum, Janos Hargitai
      Pages: 820 - 825
      Abstract: PurposeTo investigate the functional benefits and patient satisfaction with upper blepharoplasty in patients meeting the Danish visitation guidelines for upper blepharoplasty from the Danish Health and Medicines Authority (Sundhedsstyrelsen).MethodsBefore and 3 months after upper blepharoplasty, the following investigations were made: (i) a standard eye examination, (ii) photographic documentation with a normal camera and the infrared camera of a Spectralis Optical Coherence Tomograph and (iii) measurements of the upper visual fields using the blepharoptosis test of Octopus 900. Along with the pre- and postoperative examinations, the patients completed a questionnaire concerning the functional and psychosocial impact of their eyelids.ResultsNinety eyelids of 45 patients were studied, 34 females and 11 males. The mean age was 56.9 years (SD: 12.8). The mean change in the distance between the upper eyelid skin fold and the visual axis or the marginal reflex distance (MRD), depending on which was lowest, was 1.6 mm (SD: 0.8 mm) for the right eyelids and 1.2 (SD: 0.9 mm) for the left eyelids. The mean improvement in the upper visual field was 31.3% points for the right eyelids (SD: 21.4% points) and 28.3% points for the left eyelids (SD: 24.9% points). A statistically significant correlation between the preoperative distance from skin fold to visual axis/MRD and the pre- and postoperative visual field was found. The patients reported an improvement in their symptoms postoperatively. All subjects were satisfied with the postoperative result and would undergo the surgery again if they had to make the choice again.ConclusionPatients meeting the Danish visitation guidelines for upper blepharoplasty experience a measurable improvement in function and alleviation of symptoms after blepharoplasty.
      PubDate: 2017-02-15T22:15:28.353754-05:
      DOI: 10.1111/aos.13385
  • Measurement centration and zone diameter in anterior, posterior and total
           corneal astigmatism in keratoconus
    • Authors: Anneli Fredriksson; Anders Behndig
      Pages: 826 - 833
      Abstract: PurposeTo investigate the central and paracentral astigmatism and the significance of centration and measurement zone diameter compared to a 3-mm pupil-centred measurement zone in keratoconus and in healthy eyes.MethodsTwenty-eight right eyes from 28 KC patients with an inferotemporal cone were selected according to specified criteria based on Oculus Pentacam HR® measurements and were matched with healthy control eyes. The flat (K1) and steep (K2) keratometry readings were registered from the ‘Total Corneal Refractive Power’ (TCRP) display as well as the anterior and posterior corneal astigmatism displays (ACA and PCA, respectively). Astigmatic power vectors KP0 and KP45 were calculated and analysed for a 6-mm and two 3-mm zones centred on the corneal apex and the pupil, and for 8 paracentral 3-mm zones.ResultsThe astigmatism was generally higher in KC. Many astigmatic values in KC differed between the 3-mm pupil-centred and the 3- and 6-mm apex-centred zones in KC. In the controls, no corresponding differences between measurement zones were seen, apart from PCA, which differed. The magnitude and direction of KP0 and KP45 varied greatly between the paracentral measurements in KC.ConclusionCentration and measurement zone diameter have great impacts on the astigmatic values in KC. A small pupil-centred measurement zone should be considered when evaluating the astigmatism in KC.
      PubDate: 2017-07-10T08:57:03.342677-05:
      DOI: 10.1111/aos.13517
  • Exposure to subthreshold dose of UVR-B induces apoptosis in the lens
           epithelial cells and does not in the lens cortical fibre cells
    • Authors: Konstantin Galichanin
      Pages: 834 - 838
      Abstract: PurposeThe aim of this study was to investigate in which part of the lens in vivo exposure to subthreshold dose of UVR-B radiation induces apoptosis.MethodsTwenty 6-week-old female albino Sprague-Dawley rats were exposed to subthreshold dose (1 kJ/m2) of UVR-B unilaterally and killed at 120 hr after exposure. Lenses were enucleated and dissected on three regions: the lens epithelium, the cortex and the nucleus. The lens nucleus then was removed. Apoptosis markers p53 and caspase 3 were used to study apoptosis in the lens regions. qRT-PCR and Western blot were utilized to analyse the lenses.ResultsTP53 and CASP3 mRNA expressions are increased in exposed lenses, both in the lens epithelium and in the cortex regions, in relation to non-exposed lenses. Expression of p53 protein is increased in exposed lens epithelium in relation to non-exposed lens epithelium. Caspase 3 protein is expressed in exposed lens epithelial cells, while it is not expressed in non-exposed lens epithelial cells. p53 and caspase 3 proteins are not expressed in either exposed nor non-exposed lens fibre cells.ConclusionExposure to UVR-B increases mRNA transcription of apoptosis marker p53 in vivo in both regions of the lens and of apoptosis marker caspase 3 in the lens cortex. Exposure to UVR-B increases p53 and caspase 3 proteins expression just in the lens epithelium. In vivo exposure to subthreshold dose of UVR-B induces apoptosis in the lens epithelial cells and does not in the lens fibre cells.
      PubDate: 2017-01-13T02:30:35.9118-05:00
      DOI: 10.1111/aos.13370
  • The effect of cataract surgery and IOL implantation on the magnification
           of a fundus photograph: a pilot study
    • Authors: Laura Knaapi; Tuomo Lehtonen, Eija Vesti
      Pages: 839 - 841
      Abstract: PurposeThe goal was to determine the effect of cataract surgery-induced change in ametropia and anterior chamber depth on the magnification of a fundus photograph.MethodsFundus photographs were taken from 11 subjects undergoing cataract surgery and intraocular lens (IOL) implantation before and after surgery with a telecentric Zeiss and Topcon fundus cameras. The distance between two distinct fundus landmarks, i.e. two crossings of retinal vessels, was measured before and after surgery, and the results were compared to axial length and surgery-induced change in ametropia and anterior chamber depth. In addition, the change in the conversion factor of Topcon fundus camera was calculated and its correlation to axial length, change in ametropia and anterior chamber depth was analysed. Further, the change in the mathematical location of P′, i.e. the second principal point of the eye in the formula of Bennett et al. (1994), was calculated.ResultsCataract surgery and IOL implantation did not significantly influence the magnification of a fundus photograph taken with a telecentric Zeiss or Topcon fundus camera even when ametropia changed markedly. Axial length and anterior chamber depth did not correlate with change in the magnification of a fundus photograph. The average change in the mathematical location P′ due to surgery was −39.4%, SD 0.33.ConclusionFundus photographs taken with a telecentric Zeiss or Topcon fundus camera can be reliably used to follow the size of fundus landmarks even if ametropia and anterior chamber depth are changed after cataract surgery and IOL implantation.
      PubDate: 2017-03-31T23:40:27.580756-05:
      DOI: 10.1111/aos.13435
  • Fundus imaging in newborn children with wide-field scanning laser
    • Authors: Vigdis Magnusdottir; Wouter B. Vehmeijer, Thorunn S. Eliasdottir, Sveinn H. Hardarson, Nicoline E. Schalij-Delfos, Einar Stefánsson
      Pages: 842 - 844
      Abstract: PurposeCurrent fundus imaging in newborn babies requires mydriatics, eye specula and corneal contact. We propose that a scanning laser ophthalmoscope (SLO) allows ultra wide-field imaging with reduced stress for the child.MethodsThis prospective observational single centre study was conducted in Landspítali, University Hospital, Reykjavik, Iceland. In this study, a noncontact wide-field SLO (Optomap 200Tx) was used to image the retina in healthy full-term newborns without the use of mydriatics or eye specula. The child was held by one of the parents, while one of the researchers supported the child's head in front of the SLO camera for alignment and opened the eye with either a finger or a cotton tip.ResultsFifty-nine participants were recruited (34 females). The mean age was 16 days, and the mean gestational age was 40 ± 1 weeks at the time of imaging. Ultra-wide-field (200°) images were obtained of 44 participants. Twenty-seven participants (61%) had at least one ultra wide-field image with the optic disc and vessel segments in all quadrants of the fundus visible and in focus. No retinal pathology was found in the participants with the exception of one participant with small retinal haemorrhages.ConclusionScanning laser ophthalmoscope (SLO) ultra-wide-field fundus imaging is feasible in healthy full-term newborns without corneal contact, eye speculum or mydriatics. This approach could be an improvement for retinal imaging in newborn infants. Eye movement of the infant, whether asleep or awake, influenced which part of the fundus was captured, but focus and image quality were generally good.
      PubDate: 2017-04-09T01:45:36.497041-05:
      DOI: 10.1111/aos.13453
  • Is there inter-procedural transfer of skills in intraocular surgery' A
           randomized controlled trial
    • Authors: Ann Sofia Skou Thomsen; Jens Folke Kiilgaard, Morten Cour, Ryan Brydges, Lars Konge
      Pages: 845 - 851
      Abstract: PurposeTo investigate how experience in simulated cataract surgery impacts and transfers to the learning curves for novices in vitreoretinal surgery.MethodsTwelve ophthalmology residents without previous experience in intraocular surgery were randomized to (1) intensive training in cataract surgery on a virtual-reality simulator until passing a test with predefined validity evidence (cataract trainees) or to (2) no cataract surgery training (novices). Possible skill transfer was assessed using a test consisting of all 11 vitreoretinal modules on the EyeSi virtual-reality simulator. All participants repeated the test of vitreoretinal surgical skills until their performance curve plateaued. Three experienced vitreoretinal surgeons also performed the test to establish validity evidence. Analysis with independent samples t-tests was performed.ResultsThe vitreoretinal test on the EyeSi simulator demonstrated evidence of validity, given statistically significant differences in mean test scores for the first repetition; experienced surgeons scored higher than novices (p = 0.023) and cataract trainees (p = 0.003). Internal consistency for the 11 modules of the test was acceptable (Cronbach's α = 0.73). Our findings did not indicate a transfer effect with no significant differences found between cataract trainees and novices in their starting scores (mean ± SD 381 ± 129 points versus 455 ± 82 points, p = 0.262), time to reach maximum performance level (10.7 ± 3.0 hr versus 8.7 ± 2.8 hr, p = 0.265), or maximum scores (785 ± 162 points versus 805 ± 73 points, p = 0.791).ConclusionPretraining in cataract surgery did not demonstrate any measurable effect on vitreoretinal procedural performance. The results of this study indicate that we should not anticipate extensive transfer of surgical skills when planning training programmes in intraocular surgery.
      PubDate: 2017-03-30T03:59:14.220734-05:
      DOI: 10.1111/aos.13434
  • Ophthalmologic wax models as an educational tool for 18th-century vision
    • Authors: Fabio Zampieri; Francesco Comacchio, Alberto Zanatta
      Pages: 852 - 857
      Abstract: The Medical Faculties of the University of Padua (Italy) and the University of Vienna (Austria) preserved two series of wax models, made by the Austrian Johann Nepomuk Hoffmayr at the beginning of the 19th century. These models were created in a period of evolution of both medical specialties and organ pathology, which brought morbid organs at the centre of medical investigation. Ceroplastic was considered a useful tool for didactic and research, as it provided a three-dimensional realistically coloured reproduction of organic lesions. The models represent the typical eye diseases of the period, in particular those affecting external parts, which could be investigated without the need for specific instruments devised for the observation of the inner and posterior anatomy of the eye, at that time not yet available. Even if the nosological categories then employed by Hoffmayr were different from those currently used, it has been possible to find a correspondence thanks to the ophthalmological literature of his period. Ceroplastic started to decline at the end of 19th century, substituted by the much less expensive method of preservation of morbid organs in formalin and by new techniques of investigation of the inner body, such as X-ray.
      PubDate: 2017-02-16T00:41:04.204521-05:
      DOI: 10.1111/aos.13383
  • Orbital lymphomas missed by first biopsies of orbital masses
    • Authors: Christine A.E. Eenhorst; Kamil G. Laban, Roos J. Leguit, Timothy R.D.J. Radstake, Rachel Kalmann
      Pages: 858 - 859
      PubDate: 2017-01-30T06:00:39.753537-05:
      DOI: 10.1111/aos.13350
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