Purpose:  To describe the study design and baseline factors of the Heidelberg Retina Tomograph ancillary study within the EGPS. Furthermore, to examine the relationship between HRT optic disc topographic measurements and baseline demographic and ocular factors.

Methods:  Four hundred and eighty-nine ocular hypertensive participants were included. Each participant completed HRT imaging at least annually. The associations between HRT measurements and IOP, central corneal thickness (CCT), baseline photographic estimates of vertical CDR ratio (CDR), asymmetry between the two eyes in CDR ratio and baseline visual field indices were assessed using regression analysis.

Results:  Associations between HRT measurements and vertical CDR by photographs were found for almost all stereometric optic disc parameters in both univariate and multivariate analysis. The strongest association was found between vertical CDR measurements and disc, cup and rim area; cup and rim volume, CDR area, linear CDR, mean and maximum cup depth and cup shape measure (all p < 0.0001). In multivariate analysis, pattern standard deviation (PSD) and HRT disc area had significant associations with several HRT optic disc measurements. Furthermore, CCT was significantly associated with reference height and the glaucoma probability score (GPS, outside normal limits).

Conclusions:  The EGPS is the first multicentre, placebo-controlled randomized clinical trial to use HRT for monitoring optic disc changes in participants with ocular hypertension. We found strong associations between stereophotographic vertical CDR estimates, HRT disc area, PSD and several HRT parameters. We found, furthermore, that the parameters reference height and GPS were significantly related to central corneal thickness.

2012 marks the 100th year of death of Gerhard Henrik Armauer Hansen (1841–1912), who discovered Mycobacterium leprae, but also gave the first systematic scientific work on the leprosy of the eye. The article reviews his life and scientific achievements with special regard to eye and ophthalmology.

Purpose:  To analyse the indocyanine green angiography (ICGA) patterns of hypofluorescence that are compatible with choriocapillaritis that occur secondarily to toxoplasmic retinochoroiditis (ToRC), ocular tuberculosis (including tuberculous choroiditis, TuCR and multifocal serpiginoid choroiditis, TMSC) and syphilitic chorioretinitis (SyCR).

Methods:  This was a single centre, retrospective case review study. Patients with a diagnosis of ToRC, TuCR, TMSC or SyCR were identified, their charts were reviewed and fundus photographs, fluorescein angiography (FA) and ICGA pictures were assessed.

Results:  Indocyanine green angiography was performed at the initial presentation in 63 of the 105 patients with ToRC, in 37 of the 38 patients with TuCR, in six of six patients with TMSC and in two of four patients with SyCR. The following four ICGA patterns indicated choriocapillaritis: extension of hypofluorescence beyond the hypofluorescence of the actual infectious focus as seen on fundus photography or FA (seen only in ToRC and TuCR); small dark dots around the infectious focus (seen only in ToRC); multiple ‘confetti-like’ hypofluorescent areas or hypofluorescent geographical confluent areas (seen only in TMSC); and widespread areas of nonperfusion visible only in ICGA (seen only in SyCR).

Conclusions:  Patients with secondary choriocapillaritis have distinct typical ICGA findings. ICGA is thus an important diagnostic tool that can provide an explanation for otherwise obscure visual loss and that might have diagnostic value for specific conditions like ToRC and SyCR.

Purpose:  The aim of this study was to assess (i) whether pupil dilation with tropicamide influences subfoveal choroidal blood flow, as assessed by continuous laser Doppler flowmetry (LDF) and (ii) if this is the case, whether the effect is due to a haemodynamic response of the drug-induced dilation.

Methods:  Following the instillation of one drop of 1% tropicamide in one eye of 18 healthy, nonsmoking volunteers (age 20–25 years), the subfoveal choroidal LDF parameters (Vel, Vol and ChBF) were recorded during 30 min, at 3-min intervals under two paradigms: through an artificial pupil (4 mm diameter) placed in front of the cornea (P1) and without this artificial pupil (P2).

Results:  Tropicamide increased the pupil diameter from 3.3 ± 0.4 mm (mean ± SD) to 8.3 ± 0.4 mm. Full dilation was reached at ∼24 min. During this period of time, linear regression analysis demonstrated that none of the LDF parameters varied significantly (p > 0.05), either under P1 or P2. Based on a group of 12 subjects, the smallest (%) change in the mean value of ChBF (ChBF_m) that would be detectable (sensitivity of the method, S) was found to be 2% for P1 and 6% for P2. The average coefficient of variation of ChBF_m based on eight measurements during dilation was greater for P2 than for P1 by a factor of approximately 2.

Conclusion:  Tropicamide had no significant influence on the subfoveal choroidal LDF parameters measured by continuous LDF during pupil dilation. Furthermore, pupil dilation did not affect ChBF_m by more than the calculated minimum percentage change of 6% detectable with our method.

Purpose:  To compare axonal loss in ganglion cells detected with spectral-domain optical coherence tomography (OCT) in eyes of patients with multiple sclerosis (MS) versus healthy control subjects using an artificial neural network (ANN). To analyse the capability of the ANN technique to improve the detection of retinal nerve fibre layer (RNFL) damage in patients with multiple sclerosis.

Methods:  Patients with multiple sclerosis (n = 106) and age-matched healthy subjects (n = 115) were enrolled. The Spectralis OCT system was used to obtain the circumpapillary RNFL thickness in both eyes. The 768 RNFL thickness measurements provided by the Spectralis OCT were performed to obtain thickness measurements from 24 uniformly divided locations around the peripapillary RNFL. The performance of the ANN technique for identifying RNFL loss in patients with multiple sclerosis was evaluated. Receiver-operating characteristic (ROC) curves were used to display the ability of the test to discriminate between MS and healthy eyes in our population. ROC curves obtained using ANN and parameters provided by OCT (mean and 6 sector thicknesses) were compared.

Results:  The capability of the ANN technique to detect RNFL loss in patients with multiple sclerosis compared with healthy subjects was good. The area under the ROC curve was 0.945. Compared with the OCT-provided parameters, the ANN had the largest area under the ROC curve.

Conclusions:  Measurements of RNFL thickness obtained with Spectralis OCT have a good ability to differentiate between healthy and individuals with multiple sclerosis. Based on the area under the ROC curve, the ANN performed better than any single OCT parameter.

Purpose:  To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti-vascular endothelial growth factor (VEGF) treatment with Ranibizumab.

Methods:  A consecutive series of 39 study eyes with centre-involving DME were included in this study. In all subjects, best-corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD-OCT) cross-sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross-sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained.

Results:  Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = −1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = −3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = −4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = −1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = −0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = −2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment.

Conclusions:  ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti-VEGF therapy with Ranibizumab in patients with DME.

Purpose:  To determine the optimal distribution of refractions in monofocal, pseudophakic monovision.

Methods:  A previously reported mathematical method for describing defocus for a single eye (Acta Ophthalmol, 89, 2011, 111) is expanded to the binocular situation. The binocular distribution of refractions yielding the least defocus over the most extended fixation intervals is identified by mathematical optimization. The results are tested in a group of 22 pseudophakic patients.

Results:  For the fixation interval 0.25–6.0 m, the optimal refractions are pure spheres of −0.27 D for the distance eye and −1.15 D for near eye. The mathematically derived defocus structure is confirmed in the clinical series.

Conclusions:  The reported mathematical method enables identification of the optimal distribution of refractions over any fixation interval. Monovision with refractions of approximately −0.25 and −1.25 D may lead to spectacle independence for distance and intermediate vision. Binocular problems – such as monovision suppression, reduced stereoacuity and binocular inhibition – are likely to be minimal with the suggested anisometropia of 1.0 D. This moderate monovision is fully reversible with spectacle correction, as the induced aniseikonia is minimal and it therefore represents a safe alternative to multifocal intraocular lenses (IOLs).

Purpose:  The retinal blood flow depends on the diameter of retinal arterioles, but diameter changes in these vessels have hitherto only been assessed in vessels larger than approximately 100 μm. Therefore, a new method was developed for studying diameter changes along the vascular tree of arterioles in whole perfused segments of porcine retinas, and the effect of known vasoconstrictors on the diameter of retinal arterioles at different branching levels were studied.

Methods:  Thirty-four whole-mounted porcine retinas were placed in a specially designed tissue chamber. On the basis of video recordings through an inverted microscope, the diameter of retinal arterioles was measured at five different branching levels before and after addition of a high potassium concentration, or increasing concentrations of endothelin-1, the prostaglandin analogue U46619, noradrenaline or none (time controls).

Results:  The baseline diameter ranged from 136 μm (95% CI 132–140 μm) for 1st order arterioles to 33 μm (95% CI 21–44 μm) for 5th order arterioles. In 1st order arterioles, endothelin produced 56.6% (95% CI 47.6–64.0) and U46619 14.6% (95% CI 5.7–22.6) relative constriction compared with baseline, which for both compounds decreased significantly with increasing branching level (p < 0.0001 and p < 0.0001, respectively). The change in diameter during addition of noradrenaline did not differ significantly from the time controls (p = 0.07).

Conclusions:  The effect of retinal vasoconstrictors differs among larger and smaller arterioles. The study highlights the need for investigating diameter regulation in smaller retinal arterioles as a basis for understanding normal and pathological changes in retinal blood flow.

Purpose:  Fanconi anaemia (FA) is a multisystemic disorder with ocular implications. This study aims to describe visual function, ocular characteristics and visual processing skills in patients with FA after haematopoietic stem cell transplantation.

Methods:  Ten patients with FA, ages 8–17 years, underwent ophthalmological examinations, corneal, periocular and fundus photography, visual evoked potentials (VEPs), visual fields and ocular motor and visual processing information tests.

Results:  Best-corrected decimal visual acuity was ≥0.65 in all 20 eyes. Microcornea was present in 18 of 18 eyes, short axial lengths in six of six eyes, steep corneal curvatures in four of six eyes, ptosis in 14 of 16 eyes, short palpebral fissures in 15 of 16 eyes and hypotelorism in three of seven patients. Optic disc areas were smaller in patients with FA compared to controls (p = 0.0003 right, p = 0.0003 left eye). Visual fields were abnormal in 4 of 18 eyes, while VEP was abnormal in 1 of 20 eyes. Eight patients had ocular motor dysfunction, while nine of 10 patients showed delay in visual processing skills.

Conclusion:  Patients with FA can present with microcornea, microphthalmia, ptosis, steep corneal curvatures, small optic discs, ptosis and delay in visual processing skills. Detailed ophthalmological and visual processing skills assessments and developmental investigations are important to detect impairments and facilitate appropriate support.

Purpose:  To investigate the apoptosis in retinal ganglion cells (RGCs) and insulin-like growth factor 1 receptor (IGF-1R) in the retina following optic nerve crush.

Methods:  Healthy Wistar rats (N = 70) were divided into two groups: a normal control group and an optic nerve injury group. Immunohistochemistry and flow cytometry were performed to detect the expression of IGF-1R and to measure the apoptosis of RGCs, respectively.

Results:  Immunohistochemistry revealed that at 1 hr after optic nerve injury, IGF-1R immunoreactivity began to increase and reached a maximal level at 24 hr (p < 0.05), where it remained elevated up to 14 days after injury. RGC apoptosis in the normal control group was 0.53%, while the apoptosis rate in the optic nerve injury group increased over time. The apoptosis rate in the optic nerve injury group was 1.4% at 1 hr, 4.4% at 6 hr, 5.2% at 12 hr and reached a maximal level (8.5%) at 24 hr. Subsequently, the rate declined to 1.9% 7 days after injury and 0.9% 2 weeks after injury.

Conclusion:  The IGF-1R immunereactivity in the retina increased after optic nerve injury. IGF-1R may regulate the apoptosis and regeneration of RGCs at different stages after optic nerve injury.

Purpose:  Our purpose was to evaluate the surgical outcome after intra-ocular lens exchange in patients who presented impairing visual complaints after primary multifocal intra-ocular lens (MIOL) implantation. In particular, the study was undertaken to look at the number of eyes that could be equipped with the bag-in-the-lens (BIL) IOL after MIOL exchange.

Methods:  This series consisted of 30 eyes of 21 consecutive patients scheduled for MIOL exchange. In 15 out of the 30 eyes, IOL misalignment was measured on slit lamp anterior segment photo’s after defining the mathematical centres of the IOL optic, pupil and limbus.

Results:  Diffractive MIOL was more frequently explanted (25; 83%) when compared with refractive MIOL (4; 13%) and progressive optic IOL (1; 4%). In 21 out of the 30 eyes (70%) a bag-in-the-lens could be implanted. In 7 out of the 30 eyes (23%), the capsule was not considered sufficiently stable to accommodate an IOL. An iris-fixated IOL or a sulcus-fixated IOL was then implanted. In 2 out of the 30 eyes (6%) the remaining capsular bag could accommodate a traditional lens-in-the-bag only. Eyes that underwent Nd:YAG laser capsulotomy prior to the MIOL exchange needed anterior vitrectomy peroperatively (11 eyes; 37%). Visual acuity improved postoperatively in 13 out of the 30 eyes and remained stable in 17 out of the 30 eyes.

Conclusions:  Since the BIL technique requires a very well-preserved capsular bag for the purpose of the IOL implantation, the success rate of BIL implantation after MIOL is a good indicator to evaluate the degree of difficulty to exchange MIOL.

Purpose:  To measure the hyporeflective lumen in the choroid of patients with central serous choroidopathy (CSC) and to compare the diameter with that of a control group.

Methods:  The prospective comparative observational clinical study included patients with unilateral CSC and a control group of normal subjects, matched in age, gender and refractive error with the study group. Subfoveal choroidal thickness (SFCT) and the largest diameter of choroidal hyporeflective lumen as surrogates for the choroidal vessels were measured by enhanced depth imaging optical coherence tomography (OCT).

Results:  The study group included 15 Chinese patients and the control group 15 control subjects. Mean SFCT was significantly (p = 0.04) larger in the affected eyes (455 ± 73 μm) than in the contralateral unaffected eyes (387 ± 94 μm), in which it was significantly (p = 0.005) larger than in the control group (289 ± 71 μm). In a parallel manner, the mean diameter of the largest hyporeflective lumen was larger, but not significantly larger (p = 0.18) in the affected eyes (305 ± 101 μm) than in the in the contralateral unaffected eyes (251 ± 98 μm), in which it was significantly (p = 0.001) larger than in the control group (140 ± 40 μm). Largest vessel diameter was significantly (p < 0.001; correlation coefficient: 0.73) correlated with the thickness of the total choroid.

Conclusions:  In patients with CSC, the affected eyes show larger hyporeflective lumen than the contralateral clinically unaffected eyes and significantly larger than normal control eyes. Assuming these hyporeflective lumens to be choroidal vessels, macular swelling in CSC is markedly associated with vascular engorgement. As also the clinically unaffected eyes showed macular choroidal significant swelling, CSC may have a systemic component with usually asymmetric ocular involvement.

Purpose:  To evaluate the effect of early vitreoretinal surgery on vascularly active stage 4 ROP through the preoperative use of intravitreal bevacizumab.

Methods:  This was a retrospective study. Eighteen patients with vascularly active stage 4 ROP who underwent primary vitrectomy from April 2007 to March 2010 were enrolled. Twelve eyes from eight patients received one-time intravitreal injection of 0.625 mg bevacizumab 7 days prior to vitrectomy (bevacizumab group), and 11 eyes from 10 patients underwent the surgical procedure without bevacizumab (control group). Demographical information of all patients was recorded. The patients were followed up for 12–36 months after the surgery. The postmenstrual age at vitrectomy, surgical procedure, anatomical and visual outcome, adverse effects and surgical complications were compared.

Results:  There was no statistically significant difference between the two groups in gender, birthweight and gestational age. The bevacizumab group showed remarkable regression of vascular activity after the injection. The mean postmenstrual age at the time of vitrectomy was significantly earlier in the bevacizumab group (40 versus 47 weeks, p = 0.002) compared with the controls. The mean surgery time was shorter in the bevacizumab group (74.81 versus 101.70 min, bevacizumab group versus control, p = 0.002). At the final follow-up, all patients in the bevacizumab group achieved anatomical retinal attachment, compared with 70% in the control group. Eighty-eight per cent patients in the bevacizumab group obtained pattern vision, while it was 30% in the control group (p = 0.015).

Conclusion:  Intravitreal bevacizumab administrated prior to vitrectomy effectively reduced active neovascularization in vascularly active stage 4 ROP patients, thus advancing the timing of vitrectomy and facilitating pars plicata vitrectomy (PPV).

Purpose:  To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study.

Methods:  The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina.

Results:  In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit.

Conclusions:  Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.

Purpose:  To describe the association between retinal vascular calibres and cardiovascular risk factors.

Methods:  Population-based cross-sectional study including 6353 participants of the Tromsø Eye Study in Norway aged 38–87 years. Retinal arteriolar calibre (central retinal artery equivalent) and retinal venular calibre (central retinal vein equivalent) were measured computer-assisted on retinal photographs. Data on blood pressure, body mass index (BMI), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, glycosylated haemoglobin (HbA1c) and smoking were collected. Association between retinal vessel calibre and the cardiovascular risk factors was assessed by multivariable linear and logistic regression analyses.

Results:  Retinal arteriolar calibre was independently associated with age, blood pressure, HbA1c and smoking in women and men, and with HDL cholesterol in men only. Blood pressure had the strongest effect on arteriolar calibre, with a decrease in calibre of 3.6 μm (women)/4.1 μm (men) per standard deviation increase in mean arterial blood pressure. Retinal venular calibre was independently associated with age, blood pressure, BMI, HDL and LDL cholesterol and smoking in men and women. The effect of BMI and HDL cholesterol on venular calibre was significantly stronger in men than in women. Current smoking was the most important factor for venular calibre, where smokers had 13.2 μm (women)/15.2 μm (men) wider calibre than nonsmokers.

Conclusion:  All the explored cardiovascular risk factors were independently associated with retinal vascular calibre, with stronger effect of HDL cholesterol and BMI in men than in women. Blood pressure and smoking contributed most to the explained variance.

Purpose:  To determine the mutation in a Swedish family with Best disease (vitelliform macular dystrophy; VMD) and to investigate the short- and long-term effects of photodynamic treatment (PDT) on subretinal neovascularization in a young boy.

Methods:  The five members of three generations of a family with VMD underwent a thorough ophthalmological examination, including best-corrected visual acuity (VA), visual field, colour vision, biomicroscopy of the posterior segment (dilated), fundus photography and electro-oculography (EOG). For the proband, an eleven-year-old boy, his father and grandfather, dark adaptation test, angiography and electroretinography (ERG) were also performed. After PCR amplification, the genotype was determined by cleavage with restriction enzyme, specific for the W93C allele.

Results:  Four family members had an abnormal EOG response. All showed the W93C mutation in the VMD2 gene. Visual acuity ranged from 20/20 to 20/250. The fundus manifestations varied from minor pigmentary changes over egg yolk-like lesions to chorioretinal atrophy, and fluorescein angiography showed corresponding pathology. In the proband, VA decreased during follow-up from 0.5 (20/40) to 0.08 (20/250) due to a subfoveal neovascularization with haemorrhage, and PDT with visudyne was begun. The haemorrhage resolved within 2 months, and after three treatments, VA had increased to 0.25 (20/80). One year later, acuity had improved to 0.5 (20/40), and this result was stable throughout the 7 years of the follow-up.

Conclusion:  The mutation was determined to be W93C, the most common mutation in VMD in Sweden. In an eleven-year-old boy with subretinal neovascularization, PDT seemed to be beneficial also in a long-term follow-up.

Purpose:  The purpose of this study was to assess the incidence of intraoperative floppy iris syndrome (IFIS) and the morphology of the corneal endothelium after cataract extraction in Caucasian male patients exposed to the α-1_a adrenergic receptor antagonist tamsulosin.

Methods:  In a clinical prospective study, 23 male patients (23 eyes) treated with tamsulosin due to benign prostatic hyperplasia and 25 male patients (25 eyes) with no tamsulosin treatment had cataract surgery. The divide-and-conquer technique was used with the Infinity OZil^® machine. A combination of Healon and Healon5 was used in all patients, but the use of additional Vision Blue, iris retractors or intracameral phenylephrine in the tamsulosin group was at the discretion of the surgeon. The endothelial cell density, variation in endothelial cell size (CV), percentage of hexagonal cells and central corneal thickness (CCT) were recorded at baseline and at 3 months postoperatively.

Results:  In the tamsulosin-treated group, 19 of 23 eyes (83%) developed IFIS, compared with no IFIS in the control group. Compared with the control group, the tamsulosin group showed significantly less dilatation at the start of the operation, significant miosis during surgery and significantly greater corneal endothelial cell loss 3 months postoperatively (12% versus 3%; p < 0.001).

Conclusion:  Intraoperative floppy iris syndrome during cataract surgery is significantly associated with tamsulosin-treated male patients. Patients on tamsulosin showed less preoperative dilatation, significant miosis during surgery, and had significantly greater postoperative endothelial cell loss compared with nontreated patients despite recommended precautions.

Purpose:  To evaluate the effect of aminoacid enriched artificial tears on the ocular surface of patients with dysfunctional tear syndrome (DTS).

Methods:  Forty patients were divided into two groups: group 1 treated for 90 days with sodium hyaluronate (SH) 0.15% 1 drop × 5 times/day; group 2 treated for 90 days with SH 0.15% + aminoacids mixture 1 drop × 5 times/day. Symptom score questionnaire, tear break-up time (TBUT), corneal fluorescein stain, Shirmer’s I test and confocal microscopy were performed at baseline and after 30 and 90 days. Confocal images underwent morphometric analysis.

Results:  Both treatments improved symptoms after 1 month. Group 2 patients showed at 1 month an improvement of TBUT and corneal stain, maintained throughout the study. Also Shirmer’s I test improved after 3 months. In group 1, an improvement of TBUT and corneal stain was observed after 3 months. The morphometric analysis of confocal images demonstrated at month 1 an improvement of nerve tortuosity in group 2; after 3 months both groups showed a significant improvement versus baseline. The epithelium showed, in both groups, a reduction in hyperreflective large cells starting from 1 month; the area of the cells was significantly reduced after 3 months, with a significant higher reduction in group 2. The perineural stromal opacity was significantly increased after 3 months, particularly in group 2.

Conclusion:  This is the first study addressing corneal changes after amino acids administration in a DTS population. The treatment with amino acids enriched SH can be considered a useful tool in the treatment of DTS.

Retinopathy of prematurity (ROP) is a disease that can cause blindness in very low birthweight infants. The incidence of ROP is closely correlated with the weight and the gestational age at birth. Despite current therapies, ROP continues to be a highly debilitating disease. Our advancing knowledge of the pathogenesis of ROP has encouraged investigations into new antivasculogenic therapies. The purpose of this article is to review the findings on the pathophysiological mechanisms that contribute to the transition between the first and second phases of ROP and to investigate new potential therapies. Oxygen has been well characterized for the key role that it plays in retinal neoangiogenesis. Low or high levels of pO₂ regulate the normal or abnormal production of hypoxia-inducible factor 1 and vascular endothelial growth factors (VEGF), which are the predominant regulators of retinal angiogenesis. Although low oxygen saturation appears to reduce the risk of severe ROP when carefully controlled within the first few weeks of life, the optimal level of saturation still remains uncertain. IGF-1 and Epo are fundamentally required during both phases of ROP, as alterations in their protein levels can modulate disease progression. Therefore, rhIGF-1 and rhEpo were tested for their abilities to prevent the loss of vasculature during the first phase of ROP, whereas anti-VEGF drugs were tested during the second phase. At present, previous hypotheses concerning ROP should be amended with new pathogenetic theories. Studies on the role of genetic components, nitric oxide, adenosine, apelin and β-adrenergic receptor have revealed new possibilities for the treatment of ROP. The genetic hypothesis that single-nucleotide polymorphisms within the β-ARs play an active role in the pathogenesis of ROP suggests the concept of disease prevention using β-blockers. In conclusion, all factors that can mediate the progression from the avascular to the proliferative phase might have significant implications for the further understanding and treatment of ROP.

Purpose:  To evaluate the amount of intraocular pressure (IOP) change in the eye against the pillow in the lateral decubitus position (LDP).

Methods:  Thirty eyes from 15 healthy volunteers (12 men and three women) aged 29 ± 3 (range 25–37) years participated in this study. Using the rebound tonometer (Icare PRO, Icare Finland Oy, Helsinki, Finland), the IOP of both eyes was checked in sitting, supine, right and left LDPs. In the LDP, the additional IOP measurements were taken with the lower eyeball against the latex pillow.

Results:  Baseline IOP in the sitting position was 12.7 ± 1.9 mmHg in the right eye and 12.8 ± 2.2 mmHg in the left eye. Ten minutes after shifting from the sitting to the supine position, IOP increased significantly (right eye: +1.4 ± 1.4 mmHg, p = 0.006; left eye: +1.8 ± 1.5 mmHg, p = 0.001). Changing from the supine to the right and left LDP increased significantly the IOP of dependent eye (right eye: +2.3 ± 1.8 mmHg, p = 0.001; left eye: +1.5 ± 1.8 mmHg, p = 0.011). When the dependent eye was compressed against the pillow in the LDP, the IOP of the dependent eyes increased significantly after 10 min (right eye in the right LDP: +4.1 ± 4.9 mmHg, p = 0.011; left eye in the left LDP: +3.4 ± 3.7 mmHg, p = 0.006).

Conclusion:  The IOP was significantly elevated when the eyeball was against the pillow in the LDP.

Purpose:  To evaluate the precision of techniques for measuring intraocular pressure (IOP) in corneas with presumably altered biomechanical properties.

Methods:  Intraocular pressure was measured with a Goldmann applanation tonometer (GAT), ocular response analyzer (ORA) and dynamic contour tonometer (DCT) in 70 eyes. Thirty-five eyes were normal corneas, 18 eyes had Fuchs’ endothelial dystrophy, and 17 eyes had undergone Descemet’s stripping automated endothelial keratoplasty (DSAEK) surgery. Corneal hysteresis (CH), corneal resistance factor (CRF) as well as central corneal thickness (CCT) were recorded with the ORA.

Results:  The measured cornea-corrected IOP using ORA was significantly higher than GAT in all three groups (p < 0.001). The DCT differed significantly from the Goldmann only in the Fuchs’ group (p = 0.04). The Goldmann and DCT showed no significant between-group differences, whereas IOP measured with the ORA was different between groups (p < 0.001). CH in the DSEAK group differed significantly from the controls (p < 0.001), but there was no significant difference between the DSEAK and Fuchs’ groups (p = 0.21). CCT did not differ significantly between the DSAEK and Fuchs’ group (p = 0.47). However, both these groups differed significantly from the controls (p < 0.001).

Conclusion:  Corneal hysteresis and CRF are reduced in Fuchs’ endothelial dystrophy as well as after posterior lamellar keratoplasty. GAT and DCT seem to measure IOP correctly in patients with Fuchs’ endothelial dystrophy as well as after posterior lamellar keratoplasty. Corneal-corrected IOP as measured with the ORA appears to overestimate IOP in patients with Fuchs’ endothelial dystrophy as well as after posterior lamellar keratoplasty.

Purpose:  To examine the relationship between vision impairment and driving exposure (amount of driving one does) in a population-based sample of older drivers and to examine to what extent cognitive status impacts this relationship.

Methods:  Enrollees consisted of a population-based sample of older adults from Alabama who were ≥70 years old, held a current driver’s license, and had driven within the last 3 months. Three aspects of visual function were measured under binocular conditions – habitual distance visual acuity, contrast sensitivity and visual processing speed. General cognitive status was assessed with the mini-mental status examination. Driving exposure was estimated by the Driving Habits Questionnaire that asked about the number of miles, places, trips and days driven per week.

Results:  Drivers with impaired contrast sensitivity exhibited reduced annual mileage, and a decreased number of places and trips driven per week compared to those with normal contrast sensitivity, even after adjustment for other factors. Slowed visual processing speed was associated with reduced number of days driven per week after adjustment. Visual acuity deficit was not associated with changes in driving exposure. Cognitive status did not impact any of the associations between vision impairment and driving exposure.

Conclusion:  Older drivers with contrast sensitivity impairment exhibit reduced driving exposure in terms of number of trips and places they drive per week, as well as decreased annual mileage. These apparent self-regulatory practices should be viewed as adaptive because contrast sensitivity impairment elevates motor vehicle collision (MVC) risk and reduction in driving exposure can reduce MVC risk.

Purpose:  To determine the influence of ocular complications on quality of life (QoL) 3 years after allogeneic stem cell transplantation (allo-SCT).

Methods:  All 54 adult patients that underwent and survived allo-SCT in 2006/2007 in our centre received two questionnaires (VFQ-25: visual function questionnaire-25 and OSDI: ocular surface disease index). In addition, the following data were included: gender, age, underlying disease, presence of chronic and/or ocular graft-versus-host disease (GVHD), number of visits to an ophthalmologist, manifestations of dry eye disease, the duration of follow-up and treatment for ocular GVHD.

Results:  Ocular GVHD developed in 26% (14 of 54) of patients and 71% (10 of 14) received treatment for ocular GVHD. The presence of ocular GVHD correlated with the severity of systemic GVHD (correlation coefficient: 0.52, p = 0.00). The Karnofsky scores were significantly lower in the patients with ocular GVHD compared to the patients with no ocular GVHD (p = 0.001). Karnofsky scores were weakly correlated with the severity of systemic GVHD (correlation coefficient: 0.25, p = 0.03. Three years after the all-SCT, OSDI and VFQ-25 scores were significantly impaired in patients with ocular GVHD [mean: 76.5; range (46.1–100) and mean: 31.1; range (0–72.9)] compared to patients with no ocular GVHD [mean: 89.4; range (45.2–100) and mean: 12.9; range (0–58.3); p = 0.02]. The scores of the VFQ-25 were significantly lower in the domains of general health, ocular pain, social functioning and role difficulties.

Conclusion:  The long-term vision-related QoL measured by the OSDI and VFQ-25 was impaired in patients with ocular GVHD.

Purpose:  To evaluate the density of conjunctival goblet cells (GCs) in glaucomatous patients treated with preservative-free (PF) tafluprost, using laser scanning confocal microscopy (LSCM) and impression cytology (IC).

Methods:  Thirty glaucomatous patients (30 eyes) naive for therapy and thirty healthy subjects (30 eyes) were enrolled. Conjunctiva was examined by means of Heidelberg Retina Tomography/Rostock cornea module. Afterwards, the specimens for IC were obtained. Patients were randomized to PF-tafluprost (Group 1) or preserved latanoprost (Group 2) and controls to the vehicle of latanoprost (Group 3) or physiological buffered saline solution (Group 4). Both LSCM and IC were performed at baseline, and after the 1st and 6th months of therapy, GC density (GCD) (cells/mm²) was the main outcome measurement.

Results:  Baseline. Mean GCD was 240.69 ± 25.43 and 232.65 ± 23.52, for LSCM, and 162.10 ± 23.44 and 164.71 ± 21.03 for IC in Group 1 and 2, respectively. GC density values were not significantly different in Group 3 and 4 (p > 0.05%). Month one. Mean GCD increased to 284.16 ± 43.88 and 230.62 ± 48.32 in Group 1 (p < 0.001) and to 297.86 ± 26.87 and 221.78 ± 43.02 in Group 2 (p < 0.05), measured with LSCM and IC, respectively. In Group 3, GCD decreased to 205.88 ± 25.04 and 139.54 ± 17.37 measured with LSCM and IC, respectively (p < 0.05). Month six. Mean GCD did not change in Group 1 (p > 0.05) whereas it decreased in Group 2 (p < 0.05), compared to month 1. In Group 3, GCD further decreased to 166.32 ± 22.31 and 120.76 ± 11.66, measured with LSCM and IC, respectively (p < 0.05); in Group 4, mean GCD did not change during the study period (p > 0.05).

Conclusions:  Treatment with PF tafluprost was associated with an increase in conjunctival GCD in glaucomatous eyes naïve for therapy. Further studies are mandatory to verify this finding because its validation may have important consequences in the medical management of glaucoma.

Purpose:  To assess quantitatively the biometric optic components and its relationship with refractive status in preterm school children with diode laser-treated threshold retinopathy of prematurity (ROP).

Methods:  A prospective, cross-sectional study in which ultrasound biometric measurement of optic components and cycloplegic refraction were performed on 24 consecutive preterm children with diode laser-treated threshold ROP at the age of 9 years. The study results were compared with 1021 age-matched full-term control children from a national survey.

Results:  The eyes with laser-treated ROP showed statistically significantly thicker lens (3.94 versus 3.39 mm), steeper vertical corneal curvature (7.47 versus 7.67 mm) and shallower anterior chamber depth (ACD) (2.91 versus 3.58 mm) than age-matched full-term controls, but no difference in axial length (23.32 versus 23.24 mm). The laser-treated eyes had a mean spherical equivalent (SE) of −4.49 D compared with mean SE of −0.44 D in controls. Of 46 eyes studied, 93% of eyes were myopic and 28.3% with high myopia (<−6.0 D) compared with the 32% prevalence of myopia in controls. In preterm children, younger gestational age tended to correlate with shallower ACD (r = 0.352) and thicker lens (r = −0.298); lower birth weight tended to correlate with shallower ACD (r = 0.372) and steeper cornea (r = 0.360).

Conclusions:  There were higher prevalence and greater magnitude of myopia in preterm children. The significantly thicker lens, steeper corneal curvature and shallower anterior chamber depth are the major factors contributing to the development of myopia in preterm school children with laser-treated threshold ROP.

Purpose:  To investigate the presence and distribution of l-kynurenine aminotransferases immunoreactivity in human and animal lenses during cataract formation.

Methods:  Immunohistochemistry was conducted using polyclonal antibodies against KAT I, KAT II and KAT III on sections of 26 anterior capsules from patients undergoing surgical treatment of anterior subcapsular cataract (ASC) and 22 cataractous lenses from human eyes enucleated because of choroidal malignant melanoma. Additionally, the eyes of 11-month-old DBA/2J mice (6 eyes) were investigated (with KAT I and II). Ten clear human lenses and four BL6 mice lenses were used as controls. Spatial immunoreactivity patterns of enzymes were compared with Periodic Acid – Schiff (PAS)-stained sections.

Results:  Immunohistochemical analysis revealed presence of KAT I, KAT II and KAT III in extracellular structures of all studied types of cataract in human eyes showing specific pattern of the stain. In cortical cataract, immunoreactivity was observed on cortical lens fibres. In nuclear cataract, KAT II revealed stronger and diffused staining than KAT I. Additionally, both KAT showed more pronounced staining at the edge of small clefts. In normal human lenses, KAT I, II and III, immunoreactivity was not observed. Presence of KAT I and KAT II in the intercellular substance of DBA/2J mice cataract was observed. In BL6 mice lenses without cataract, only weak KAT I and KAT II staining was observed.

Conclusions:  Presence of l-kynurenine aminotransferases in extracellular matrix (ECM) during human cataract formation suggests that products of l-kynurenine pathway might be involved in mechanisms of cataractogenesis.

Purpose:  Cataract is the leading cause of reversible blindness worldwide, and the incidence of cataract surgery is projected to increase as the population ages. Gaining an understanding of the effects of cataract surgery on a range of health outcomes is important for maintaining the health and safety of older adults.

Methods:  A before and after cohort study was conducted using the Western Australian Hospital Morbidity Data System, Mental Health Information System and the Western Australian Death Registry.

Results:  Of the 21 110 patients who underwent cataract surgery in one eye only, 295 had mental health contacts for depression and/or anxiety 1 year before (n = 158) or 1 year after (n = 137) surgery. Results from Poisson generalized estimating equations showed a significant decrease of 18.80% (p ≤ 0.001) in the number of mental health contacts for depression and/or anxiety the year after cataract surgery after accounting for potential confounding factors. A 27.46% increase in mental health contacts the year after cataract surgery was reported by women compared with men (95% CI: 1.08–1.50). Those living in remote areas had less contact with mental health services compared with those living in metropolitan areas (adjusted risk ratio 0.62, 95% CI: 0.46–0.84). The corresponding reduction in health care costs for treatment of depression and/or anxiety was 28%.

Conclusion:  Further research should be conducted to collect information on the utilization of health care resources not captured in this study, namely community-based services, visits to general practitioners and/or emergency departments as well as medication usage such as antidepressants.

Purpose:  To evaluate the precision of the IcareONE rebound tonometer, which was developed for self-measuring intraocular pressure (IOP) and to compare IcareONE measurement with Goldmann applanation tonometry (GAT).

Methods:  Twenty-four healthy eyes and 81 glaucomatous eyes were enrolled. IOP measurements (three times per session) with IcareONE were made in a random order by an ophthalmologist (Icare(O)) and by the subject (Icare(S)). Intraclass correlation coefficients (CCs), kappa values and mean values of IOP were compared among the two types of Icare recordings and GAT. Bland–Altman analysis was used to assess agreement between methods. Multiple regression analysis was performed to identify the subject factors that influenced the discordant measurements between IcareONE and GAT.

Results:  The mean value of Icare(O) and Icare(S) measurements was 13.5 ± 5.2 and 13.5 ± 5.4 mmHg, respectively, neither of which was significantly different from GAT (13.8 ± 4.4). The intrarater CC of Icare(O) and Icare(S) was 0.968 and 0.885, respectively. The intermethod CC and weighted kappa between Icare(O) and Icare(S) were 0.907 and 0.684, respectively. All pairwise correlations between the two types of IOP measurement showed coefficients of determination >0.8. Bland–Altman analysis did not show any proportional biases. Multiple regression analysis revealed that the differences between GAT and Icare(O) or Icare(S) were positively correlated with central corneal thickness (CCT) and negatively correlated with age.

Conclusions:  Intraocular pressure measurements with IcareONE by a physician and by the subject showed excellent agreement with GAT measurements; IcareONE measurements between a physician and the subject had high intrarater reliability, and good agreement thicker CCT led IcareONE measurement to overestimate IOP, while higher age caused it to underestimate IOP compared with GAT.

Purpose:  To study the impact of eye motion on visual field extent.

Methods:  Visual fields were tested in 15 healthy volunteers with the Goldmann perimeter using a V4 test object, from seen to unseen, first in primary position of gaze, then allowing eye motion. Temporal points falling out of the cupola were tested again after a controlled nasal head rotation using a headband prototype fitted with a line-laser level having two orthogonal vial levels. Visual field surface areas (cm²) were calculated as projections on a 30-cm virtual Goldmann cupola, whose extent would have been large enough to include all points. Reproducibility error of the method assessed by calculation of the relative difference between surface areas of 12 visual field tests and 12 visual field retests was estimated at 14%. Hertel exophthalmometry was recorded to study the influence of globe position on visual field extent.

Results:  Binocular visual field surface area increased by 37% with eye motion (p-value = 1.20·10⁻⁹). This increase was highest (46%; p-value = 1.2·10⁻²⁴) in the temporal quadrant. Median maximal visual field temporal eccentricity with eye motion was 128.3° (minimum: 109.5°; maximum: 137.7°) and more than 135° in four eyes of three subjects. Hertel exophthalmometry was positively linked to visual field temporal surface area with eye motion (p-value = 0.013).

Conclusions:  Eye motion greatly expands the temporal visual field. This peculiarity is likely an adaptation to terrestrial life with upright bipedal locomotion and may save head movements through horizontal eyeball scanning.

Purpose:  Today the extent to which MP impacts visual function in early AMD remains unclear. This study examines the relationship between macular pigment optical density (MPOD) and high-contrast visual acuity (HC-VA) and low-contrast visual acuity (LC-VA) in eyes with early age-related macular degeneration (AMD).

Methods:  Measurements were made in 22 subjects with early AMD and 27 healthy control subjects. Distance best-corrected VA was measured using HC (96%) and LC (10%) Bailey-Lovie logMAR letter charts under photopic luminance conditions. MPOD was determined at the fovea through apparent motion photometry using the cathode ray tube-based Metropsis psychophysical vision test (Cambridge Research Systems).

Results:  No significant differences in foveal MPOD were detected between the control eyes (0.30 ± 0.24 log units) and eyes with early AMD (0.27 ± 0.15 log units). Neither were differences detected between the two groups in mean HC- and LC-VA. Foveal MPOD showed significant correlation with both photopic HC-VA (r = −0.47, p = 0.0008) and LC-VA (r = −0.46, p = 0.0008) such that as MPOD increased, photopic HC-VA and LC-VA improved (lower logMAR values).

Conclusions:  Low MP levels were related to worse visual function in both healthy eyes and eyes with early AMD. Our findings provide direction for future studies designed to improve retinal function through the use of oral supplements known to increase MP levels, especially in eyes with AMD and a low MPOD.

Purpose:  To test Sorsby’s classical statement of axial eye growth as completed at the age of 13 years, with a view also to differentiating between basic eye growth and juvenile elongation associated with eventual refractive change towards myopia.

Methods:  (i) A total of 160 healthy eyes close to emmetropia were included in a cross-sectional set-up (age 4–20 years, 91 males, 69 females), and (ii) 78 longitudinal data sets (67 male and 11 female annual repeat exams over 2–7 years, n = 30; age span 4–19 years) were available for evaluating individual axial elongation. The IOL-Master equipment was preferred for conventional ultrasound oculometry due to its extreme repeatability of measuring values, thus making it well fitted for evaluating very small differences. In particular, this had bearing for the decelerating end phase of growth in the longitudinal investigation.

Results:  Sorby’s statement about age 13 as general limit found support from the cross-sectional data, which suggested stable emmetropic eye size from about 11–12 years, with an average apparently outgrown male emmetropic value of 23.5 mm versus females’ 22.9 mm. The longitudinal data, however, showed emmetropic growth also beyond this age, with individual data to establish continued axial elongation also at age 13–18 years. The final basic teenage growth is however minute and without practical implications.

Conclusions:  Individual ocular growth curves have indicated axial elongation to occur also after the age of 13 years. With regard to the – mainly academic – discrepancy between cross-sectional and longitudinal results, bigger samples are needed, and the juvenile myopic trend has to be acknowledged.

Purpose:  To determine prognostic factors in patients with Vogt–Koyanagi–Harada (VKH) disease who were treated with high-dose corticosteroids.

Methods:  Retrospective analysis of 87 patients (174 eyes).

Results:  At presentation, there were 53 patients with initial-onset acute VKH disease and 34 patients with chronic recurrent VKH disease. Chronic recurrent presentation was significantly associated with more severe anterior segment inflammation at presentation as indicated by presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, iris nodules and posterior synechiae (p < 0.001 for all comparisons), less exudative retinal detachment at presentation (p < 0.001), more complications during the follow-up period (p < 0.001) and a worse visual outcome (p < 0.001). The use of immunomodulatory therapy (cyclosporine and mycophenolate mofetil) as first-line therapy significantly reduced the development of complications in the whole study group (p = 0.006) and in initial-onset acute group (p = 0.024) and improved visual outcome in the whole study group (p = 0.004) and in chronic recurrent group (p = 0.024). In the whole study group, final visual acuity of 20/20 was significantly associated with good initial visual acuity of >20/200 [odds ratio = 4.25; 95% Confidence interval (CI) = 1.53–11.89] and age older than 16 years was significantly associated with the development of complications (odds ratio = 3.15; 95% CI = 1.04–9.48).

Conclusions:  Chronic recurrent VKH disease is significantly associated with more severe anterior segment inflammation and less exudative retinal detachment at presentation, more ocular complications and a worse visual outcome than initial-onset acute VKH disease. Use of immunomodulatory therapy significantly improved the clinical outcomes.

Purpose:  To study the associations between serum 25-hydroxy-vitamin D (25(OH)D) levels, vitamin D administration and intraocular pressure (IOP).

Methods:  The design of the study included a nested case–control study and a randomized controlled intervention trial. In the first part, healthy Caucasians with high or low serum 25(OH)D levels were recruited from a population-based study. IOP of the right eye was measured by the use of a rebound tonometer. In the second part, those with low serum 25(OH)D levels were randomized to receive either capsules of vitamin D₃ 20 000 IU twice per week or placebo for 6 months before IOP was measured again.

Results:  Intraocular pressure in the 87 participants with low serum 25(OH)D levels (mean 40.1 ± 12.9 nm) did not differ from IOP in the 42 participants with high serum 25(OH)D levels (mean 85.1 ± 14.0 nm) (15.9 ± 3.3 mmHg versus 15.6 ± 3.1 mmHg, p = 0.56, independent t-test). After intervention, IOP decreased by −0.8 ± 2.1 mmHg (p = 0.017, paired t-test) in the vitamin D group (n = 39) and −0.8 ± 2.5 mmHg (p = 0.059) in the placebo group (n = 39), but the change was not significantly different between the groups (p = 0.92, independent t-test).

Conclusion:  This study in healthy participants revealed no associations between serum 25(OH)D levels and IOP, and administration of vitamin D₃ to participants with low levels of 25(OH)D did not affect IOP. These results do not support a role of vitamin D in the regulation of IOP.

Purpose:  To study healing of retinal laser lesions in patients undergoing PRP using SD-OCT.

Methods:  Moderate, light and barely visible retinal burns were produced in patients with proliferative diabetic retinopathy scheduled for PRP using 100-, 20- and 10-ms pulses of 532-nm laser, with retinal spot sizes of 100, 200 and 400 μm. Lesions were measured with OCT at 1 hr, 1 week, 1, 2, 4, 6, 9 and 12 months. OCT imaging was correlated with histology in a separate study in rabbits.

Results:  Lesions produced by the standard 100-ms exposures exhibited steady scarring, with the damage zone stabilized after 2 months. For 400- and 200-μm spots and 100-ms pulses, the residual scar area at 12 months was approximately 50% of the initial lesion size for moderate, light and barely visible burns. In contrast, lesions produced by shorter exposures demonstrated enhanced restoration of the photoreceptor layer, especially in smaller burns. With 20-ms pulses, the damage zone decreased to 32%, 24% and 20% for moderate, light and barely visible burns of 400 μm, respectively, and down to 12% for barely visible burns of 200 μm. In the 100-μm spots, the residual scar area of the moderate 100-ms burns was 41% of the initial lesion, while barely visible 10-ms burns contracted to 6% of the initial size. Histological observations in rabbits were useful for proper interpretation of the damage zone boundaries in OCT.

Conclusions:  Traditional photocoagulation parameters (400 μm, 100 ms and moderate burn) result in a stable scar similar in size to the beam diameter. Restoration of the damaged photoreceptor layer in lighter lesions produced by shorter pulses should allow reducing the common side-effects of photocoagulation such as scotomata and scarring.

Purpose:   To evaluate the diagnostic capacity of the Ocular Response Analyser’s keratoconus match index (KMI) and keratoconus match probability (KMP) classification in a sample of keratoconus (KC) patients.

Methods:  Keratoconus match index and KMP from 114 KC eyes, randomly selected from 114 patients with bilateral keratoconus (KCG), were compared with the corresponding ones from 109 normal eyes (CG). Keratoconus match index’s predictive accuracy was assessed by receiver operating curves (ROC). Keratoconus match probability level of agreement was evaluated at the different KC stages of the Amsler–Krumeich classification. Correlations were estimated with topographic keratoconus classification (TKC), keratoconus index (KI), index of surface variance (ISV), vertical asymmetry (IVA), height asymmetry (IHA), height decentration (IHD), minimal radius (Rmin), central corneal thickness (CCT), thinnest corneal thickness (TCT) mean keratometry (Km) and intraocular pressure (IOPg).

Results:  Mean KMI in KCG and CG was 0.20 ± 0.38 and 0.98 ± 0.25, respectively (p < 0.01). Significant KMI differences (p < 0.01) were detected in different KC groups [range: 0.62 ± 0.38 (KC 1), −0.62 ± 0.04 (KC 4)]. Significant correlation was detected between KC staging and KMI (r = −0.56, p < 0.0001). Keratoconus match probability identified 22.03% of the CG eyes as suspect. Moreover, KMP identified 7.01% and 23.68% of the KCG eyes as normal and suspect, respectively. Receiver operating curves analysis for KMI parameter indicated a predictive accuracy of 97.7% (cut-off point: 0.512, sensitivity: 91.18%, specificity: 94.34%).

Conclusions:  Keratoconus match index seems to be a reliable index in keratoconus diagnosis and staging. Keratoconus match probability identifies a significant percentage of topographically defined KC and CG eyes as suspect. Diagnostic capacity of these novel indexes needs to be further explored.

Purpose:  To examine retinal and choroidal blood vessels using spectral-domain optical coherence tomography (SD-OCT).

Methods:  Retrospective case series.

Results:  Scans through retinal blood vessels in healthy subjects demonstrated vessel wall reflexes and a tri-layer profile of the blood column on longitudinal scans and a figure-of-eight configuration on cross-sectional scans. Intravascular reflectivity decreased with increasingly oblique angles of observation and was absent when blood flow was parallel to the line of sight. The high blood flow in the choroidal vessels in healthy subjects and the low flow in the retinal vessels in patients with ocular ischaemic syndrome and central retinal artery occlusion were both associated with lower reflectivity of the blood and an unstructured intravascular SD-OCT profile.

Discussion:  This qualitative in vivo study found a characteristically structured SD-OCT profile of the blood column in retinal vessels with normal blood flow. Both structure and total reflectivity faded when blood flow was lower or higher than normal or at oblique angles to the line of sight. In conclusion, SD-OCT scans of the vessels in the posterior pole of the eye may assist the clinical assessment of gross abnormalities of ocular blood flow, e.g. in carotid artery stenosis.

Purpose:  To compare the rates of change in the visual field (VF) in patients with glaucoma before and after trabeculectomy.

Methods:  Of 52 eyes of 52 patients with different types of chronic glaucoma who underwent first trabeculectomy were evaluated retrospectively. Pre- and postoperative-automated visual fields measured by the same technique were compared to detect differences in rates of change. Rates of VF loss before and after trabeculectomy were calculated using mean deviation (MD). Linear mixed models were used to compare the rates of change in the VF before and after trabeculectomy.

Results:  The mean follow-up period pre- and post-trabeculectomy was 3.9 years (min 0.9, max 10.7) and 3.8 years (min 2.0, max 8.0), respectively. The intraocular pressure (IOP) decreased from 18.1 mmHg (SD = 4.7) before trabeculectomy to 11.1 mmHg (SD = 2.9) at the last follow-up after trabeculectomy. The rate of MD loss was reduced with 56% on average, from −0.36 dB/year before surgery to −0.16 dB/year after surgery (p = 0.15).

Conclusion:  Trabeculectomy considerably decreased the rates of change in the glaucomatous visual field.

Purpose:  The Gloucestershire Diabetic Eye Screening Programme offers annual digital photographic screening for diabetic retinopathy to a countywide population of people with diabetes. This study was designed to investigate progression of diabetic retinopathy in this programme of the English NHS Diabetic Eye Screening Programme.

Methods:  Mydriatic digital retinal photographs of people with diabetes screened on at least 2 occasions between 2005 and 2010 were graded and included in this study if the classification at first screening was no DR (R0), background DR in one (R1a) or both eyes (R1b). Times to detection of referable diabetic retinopathy (RDR) comprising maculopathy (M1), preproliferative (R2) or proliferative retinopathy (R3) were analysed using survival models.

Results:  Data were available on 19 044 patients, 56% men, age at screening 66 (57–74) years (median, 25th, 75th centile). A total of 8.3% of those with R1a and 28.2% of those with R1b progressed to any RDR, hazard ratios 2.9 [2.5–3.3] and 11.3 [10.0–12.8]. Similarly 7.1% and 0.11% of those with R1a progressed to M1 and R3, hazard ratios 2.7 [2.3–3.2] and 1.6 [0.5–5.0], compared to 21.8% and 1.07% of those with R1b, hazard ratio 9.1 [7.8–10.4] and 15.0 [7.1–31.5].

Conclusions:  The risk of progression is significantly higher for those with background DR in both eyes than those with background retinopathy in only one or in neither eye.

Purpose:  To evaluate the clinical usefulness of a new rebound tonometer, Icare^® PRO (Icare PRO), by comparison with Goldmann applanation tonometry (GAT) in a study on patients with glaucoma.

Methods:  One hundred and seventy-two eyes of 86 subjects were enrolled in this study. All of the subjects were examined with an autorefractometer, Icare PRO, slit-lamp biomicroscope, GAT, ultrasound A-scan and pachymeter. Three intraocular pressure (IOP) measurements were obtained by Icare PRO and GAT. The intraobserver reliabilities were established by calculating the intraclass correlation coefficients. The Bland–Altman plot was used to compare the Icare PRO and GAT.

Results:  There was a good correlation between the IOP measurement by GAT and that by Icare PRO (r = 0.6995, p < 0.001). The intraclass correlation coefficients of Icare PRO and GAT were 0.778 and 0.955, respectively. The IOP differences between Icare PRO and GAT (mean: 1.92 mmHg; SD: 3.29 mmHg; 95% limit of agreement: −4.52 to 8.37 mmHg) did not vary over the wide range of central corneal thickness (p = 0.498), age (p = 0.248), axial length (p = 0.277) or spherical equivalent (p = 0.075).

Conclusions:  Although IOP with Icare PRO was higher than that with GAT, especially at lower GAT IOP value, Icare PRO was found to be a reliable method and showed a good correlation with GAT. The IOP difference between Icare PRO and GAT was not affected by the central corneal thickness, age, axial length or spherical equivalent. Icare PRO can be expected not only to be a good screening tool but also to be a good substitute for GAT.

Purpose:  To determine whether tear osmolarity contributes to the assessment of the ocular surface in soft contact lens (CL) wearers.

Methods:  Prospective, case–control series in 44 CL wearers (28 tolerant and 16 intolerant) and 34 healthy subjects. Every patient underwent a thorough ophthalmic examination with a tear osmolarity test (TearLab System), conjunctival impression cytology and meibomian lipid sampling. Symptoms, break-up time (BUT), tear osmolarity, conjunctival expression of HLA-DR and meibomian fatty acid composition were evaluated.

Results:  Tear osmolarity did not differ between controls and CL wearers (p = 0.23). Flow cytometry results expressed in antibody-binding capacity (ABC) units and percentage of positive cells revealed a significant difference between the intolerant CL wearer group and the control group (p < 0.0001). Comparisons between tolerant and intolerant CL wearers showed only a significant difference for mean fluorescence levels expressed in ABC units (p < 0.0001). The BUT was significantly shorter in intolerant and tolerant CL wearers subjects than in healthy subjects (p < 0.0001), whereas there was no significant difference in meibomian fatty acid composition (p = 0.99) between the two groups.

Conclusion:  Contact lens wear is responsible for ocular surface alterations whose patterns are very similar to those reported in early dry-eye syndrome. However, tear osmolarity was not modified in these selected CL wearers. The yield of tear osmolarity with TearLab™ in assessing ocular surface disorders in CL wearers deserves further investigation.

Purpose:  To evaluate the reproducibility of measurements of area of β-zone parapapillary atrophy (β-PPA) using blue laser fundus autofluorescence (FAF) and confocal scanning laser ophthalmoscopy reflectance (CSLO) measurements and to assess agreement between the two imaging modalities.

Methods:  Sixty-five eyes of 45 patients (mean age, 68.2 ± 11.3 years) with established or suspected glaucoma from the Diagnostic Innovations in Glaucoma Study (DIGS) were prospectively included. FAF scans were obtained with the Spectralis HRA+OCT and CSLO reflectance images with the HRTII (both from Heidelberg Engineering, Heidelberg, Germany). Two masked graders independently measured β-PPA area on 3 consecutive scans using the semi-automated BluePeak RegionFinder software (BPRF) and on CSLO reflectance images using the optic disc contour line. Reproducibility of β-PPA area measurements was assessed using intraclass correlation coefficients (ICC).

Results:  Intragrader reproducibility was 0.997 (95% CI, 0.996–0.998) and 0.995 (95% CI, 0.992–0.996) for grader 1 and 2, respectively, using FAF-BPRF, and by CSLO, it was 0.991 (95% CI, 0.986–0.994) and 0.988 (95% CI, 0.982–0.992). Intergrader agreement (ICC) was 0.53 (95% CI, 0.331–0.685) for FAF-BPRF and 0.404 (95% CI, 0.149–0.601) for CSLO (comparison between ICC, p = 0.368). Agreement (ICC) between the two devices was worse for grader 1 (0.356; 95% CI, 0.129–0.549) than grader 2 (0.856; 95% CI, 0.774–0.910) (p < 0.001).

Conclusions:  Despite excellent intragrader reproducibility for β-PPA measurements with FAF-BPRF and CSLO, intergrader reproducibility is low to moderate. Measurements of β-PPA area obtained with the two instruments are of moderate agreement and, therefore, are not interchangeable.

Purpose:  To evaluate ocular surface characteristics and tear film function following modified Hughes flap for eyelid reconstruction.

Methods:  This is an institutional study including 18 patients (6 male, 12 female) who underwent a tarsoconjunctival flap for reconstructing the lower eyelid’s posterior lamella in one eye between 2005 and 2010. The median age of the patients was 72 (49–93) years at the time of surgery and 77 (51–97) years at the time of evaluation. The median follow-up time was 34 (9–69) months. All patients had large malignant or semi-malignant lid tumours. Data for subjective symptoms (OSDI questionnaire), lid margin morphology, tear break-up time (BUT), vital staining, Schirmer test, impression cytology, tear film osmolarity, lipid layer interference patterns, meibography and the size of the tumour and flap were recorded and compared with the contralateral side.

Results:  Statistical analysis of the data revealed a significant difference between the surgically treated lid and the untreated side in meibomian gland loss, more lid margin abnormalities in the upper and lower eyelid (p < 0.001) and increased fluorescein staining of the cornea (p = 0.031). For the operated side, the median OSDI score was higher (17.2 versus 14.7), and the median BUT value was shorter (4.2 versus 5.6 seconds) compared with the median values of the contralateral side.

Conclusion:  Despite the favourable cosmetic and functional results of the Hughes tarsoconjunctival flap, our results indicate that this procedure does affect the ocular surface health in the treated eyes.

It is generally accepted that Jacques Daviel introduced in the 18th century the extracapsular technique of extraction of the lens while the couching method of cataract operation had already been practiced since ancient times. Present study analyses the first known cataract surgery description in three translations into English from the original Sanskrit Sushruta textbook and all the available literature on the subject. We found evidences that some sort of extraocular expulsion of lens material through a limbal puncture (paracentesis) was described by the Indian surgeon. Nevertheless, this incision cannot be considered as a classic extracapsular procedure because it was not large enough to allow the extraction of the entire lens.

Purpose:  To evaluate the prevalence of and risk factors for, retinopathy in a geographically defined population with type 2 diabetes mellitus compared with a control group of subjects without diabetes, matched by age, sex and residence in order to find the retinopathy attributable to type 2 diabetes.

Methods:  The study populations are, on one hand, a prevalence cohort of subjects with type 2 diabetes resident in the community of Laxå, Sweden, and on the other a control group, matched by age, gender and residence with those with a diagnosis of type 2 diabetes mellitus. Retinopathy was graded from fundus photographs using a modification of the Early Treatment Retinopathy Study (ETDRS) adaptation of the modified Airlie House classification of diabetic retinopathy (DR).

Results:  Any retinopathy was found in 34.6% in the type 2 diabetes cohort and in 8.8% in the control group without diabetes. Among the diabetic patients, any retinopathy was significantly associated with duration of diabetes (p = 0.0001), HbA1c (p = 0.0056), systolic blood pressure (p = 0.0091) and lower serum cholesterol (p = 0.0197) in multivariate logistic regression analyses. Having retinopathy in the control group was associated only with systolic blood pressure (p = 0.0014) in logistic regression analysis.

Conclusions:  The prevalence of retinopathy among patients with type 2 diabetes in Laxå, Sweden, was similar or somewhat lower compared with other studies in the Nordic countries. The prevalence of retinopathy in a control group without diabetes equalled numbers from population studies worldwide. Our study indicates that the retinopathy that can be attributed to hyperglycaemia in the diabetic state is less common than is usually accounted for. A considerable fraction of retinopathy in subjects with diabetes may instead be due to other factors such as hypertension and should thus be treated correspondingly.

Purpose:  To determine whether glycemic control of patients with diabetic retinopathy (DR) due to type 2 diabetes was related to VEGF plasma levels.

Methods:  The prospective study included 30 patients with DR due to type 2 diabetes. Retinopathy was classified according to the international clinical DR disease severity scale. The concentrations of VEGF in the blood plasma were measured by ELISA. Glycosylated hemoglobin (HbA1c) was assessed all patients. Results were reported as DCCT/NGSP-HbA1c (%) values.

Results:  The median plasma level of VEGF was 34.5 (range 15–217) pg/ml. Median HbA1c was 7.5 (range 5.3–10.6). The highest individual plasma VEGF measurements were found in patients with severe non-proliferative DR. HbA1c levels revealed a significant correlation with plasma VEGF concentrations (r = 0.573, p = 0.001). Age (r = 0.097, p = 0.611), gender (r = −0.315, p = 0.09) and severity of DR (r = 0.256, p = 0.172) were with no significant relationship to the VEGF measurements.

Conclusion:  Poor glycemic control is positively correlated with increased levels of plasma VEGF in patients with type 2 diabetes. As normalization of HbA1c is one of the most effective ways to prevent progression of DR and VEGF has been to shown to be clearly implicated in the development of DR, it affirms the importance of glycemic control in patients with DR.

Purpose:  To analyse a 3-year clinical patient cohort of ranibizumab treatment of exudative age-related macular degeneration (AMD), to investigate the impact on visual outcome of carrying forward the last acuity observation in drop-outs and to explore possible differences between the early and the late phase of the study.

Methods:  A retrospective study of 312 eyes with neovascular AMD. The patients were followed up monthly, received three initial monthly injections of 0.5 mg ranibizumab and were re-treated pro re nata (PRN). Time-domain optical coherence tomography (TD-OCT) was used until spectral-domain (SD)-OCT was introduced during the last year of enrolment. Sixty-five patients were discontinued from the study. Primary outcome: change in best corrected visual acuity (BCVA).

Results:  Best corrected visual acuity was 58.4 (CI 56.9–59.9) ETDRS (Early Treatment Diabetic Retinopathy Study) letters. At three months, it had increased by 4.1 letters (p = 0.0004), at 12 months by 1.8 letters, at 24 months by 1.0 letter and at 36 months by 0.1 letter. However, if the last available acuity of drop-outs was carried forward one step and included, acuity had increased by 3.9 letters at 3 months (p < 0.0001) and by 1.0 letter at 12 months but had decreased by 3.8 letters at 24 months (p = 0.019) and by 4.1 letters (p = 0.003) at 36 months. At 24 months, the result was significantly (p = 0.030) less favourable when drop-outs were included. In patients enrolled during the late phase, BCVA was 59.3 (CI 56.7–62.0). It had increased by 5.7 letters (p < 0.0001) at three months and by 5.8 letters at 12 months (p = 0.0016). In patients enrolled during the early phase, BCVA was 57.9 (CI 55.0–60.8). At three months, it had increased by 3.5 letters (p = 0.0008), but at 12 months, it had decreased by 2.3 letters (ns). The result at 12 months was significantly (p = 0.0033) better for the late than for the early phase. The number of injections was also significantly (p = 0.011) higher in the late phase. Adverse events were similar to those in earlier clinical trials.

Conclusions:  The results of this 3-year cohort showed that the initial average acuity could be maintained over 36 months, which was comparable to those of many other clinical cohorts. However, if the last available acuity of drop-outs was carried forward one step and included, the acuity figures would have fallen significantly. The results in patients enrolled during the late phase of the study were fairly similar to those in clinical trials.

Purpose:  To assess the relation between retinal vascular caliber and renal function.

Patients and methods:  Eighty apparently healthy subjects screened for cardiovascular risk factors (mean age 47 years, 51% female, 36% hypertensive, without diabetes or renal dysfunction) were recruited. Retinal vascular calibers were measured from fundus photographs and expressed as central retinal artery and venular equivalent. Renal function was assessed by measurement of glomerular filtration rate (urinary clearance of 99mTc-DTPA) and urinary albumin/creatinine ratio.

Results:  Mean glomerular filtration rate was 117 ml/min/1.73m². Overall, central retinal artery and venular equivalent were positively correlated with glomerular filtration rate (r = +0.31, p = 0.005 and r = +0.30, p = 0.006, respectively). In addition, central retinal artery equivalent was negatively correlated with urinary albumin/creatinine ratio (r = −0.34, p = 0.002). No significant relationship was found between central retinal venular equivalent and urinary albumin/creatinine ratio (r = +0.12, p = 0.32). The observed relations between retinal vascular calibers and renal function parameters remained significant after adjusting for potential confounding factors.

Conclusion:  In apparently healthy subjects with normal renal function, retinal arteriolar and venular calibers were negatively correlated with kidney function, suggesting common determinants of these preclinical target organ damages.

Purpose:  To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries.

Methods:  This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients’ ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures.

Results:  A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow-up period was 25.7 ± 10.8 months. Preoperative best-corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant.

Conclusion:  The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.

Purpose:  To investigate whether the amount of intraocular pressure (IOP) reduction with topical medications is associated with the progression of normal-tension glaucoma (NTG) and to identify risk factors for NTG progression.

Methods:  The medical records of 121 eyes of 121 NTG patients, who were treated with topical medications for more than 7 years, were reviewed. NTG progression was defined by either structural (optic disc or retinal nerve fibre layer) or functional (visual field) deterioration. Patients were divided into tertile groups according to the percentage IOP reduction from baseline, and the cumulative probability of NTG progression between upper and lower tertile group was compared using Kaplan–Meier survival analysis. Multivariate analysis with Cox’s proportional hazard model was performed to identify the hazard ratio (HR) of clinical factors for NTG progression.

Results:  The average follow-up period was 12.2 years, and 56 of 121 eyes (46.3%) showed the NTG progression. Kaplan–Meier analysis revealed that upper tertile group (percentage IOP reduction >22.1%) showed a greater cumulative probability of non-progression than lower tertile group (percentage IOP reduction < 13.3%; p = 0.012). Multivariate Cox’s proportional hazard model indicated that percentage reduction of IOP (HR = 0.964; p = 0.007) and the occurrence of disc haemorrhage (HR = 2.410; p = 0.008) were significantly associated with NTG progression.

Conclusions:  The amount of IOP reduction using topical medications was related to NTG progression, and lower percentage reduction in IOP was a consistent risk factor for progression.

Purpose:  To describe the long-term efficacy of transconjunctival excision of subconjunctival orbital fat prolapse.

Methods:  Retrospective study of consecutive cases of orbital fat prolapse treated with transconjunctival resection between December 2002 and December 2011.

Results:  Thirty-two eyes of 23 patients (19 males and four females) were included. The lesion was unilateral in 14 and bilateral in nine cases. It was located superotemporally in a majority of cases. Excision was performed by opening the conjunctiva and excising the prolapsing orbital fat. The conjunctival wound was closed with 1–2 interrupted sutures. With an average follow-up of 29 months (range 4–108), a recurrence was seen in three cases. The average time to recurrence was 46 months (range 40–52 months).

Conclusion:  Transconjunctival excision is a simple, safe and effective primary surgical procedure to treat subconjunctival fat prolapse. In our series, the recurrence rate was 9%, but no additional surgery was required. As the average time to recurrence was longer than our average follow-up, more patients may develop a recurrence in future.

Purpose:  To study the ocular characteristics in patients with Marfan syndrome (MFS).

Methods:  One hundred and two eyes of 51 participants with MFS were included in this descriptive study. Ocular characteristics, visual acuity (VA) and biometric values were studied.

Results:  The mean patient age was 39.0 years (range, 12.7–71.6). Seventy-seven eyes were phakic, five aphakic and 20 pseudophakic. Thirty-one eyes had ectopia lentis (EL), 12 eyes cataract, nine eyes strabismus, five eyes glaucoma and four eyes had undergone surgery for a retinal detachment (RD). Ninety-four eyes (92%) had a best spectacle-corrected VA of 0.3 logarithm of the minimum angle of resolution (logMAR) or better. In the 77 phakic eyes, myopia exceeding −3 D was seen in 12/31 eyes (39%) with EL, and in 12/46 eyes (26%) without EL. The mean axial length (AL) was 24.73 mm (range, 21.59–32.75); 39 eyes (51%) had abnormally increased AL (≥24.5 mm). The mean K_med (mean value of K_min and K_max) was 42.2 D (38.7–46.9 D). No significant difference was found in refraction, AL or corneal curvature between eyes with and without EL. Lens-related astigmatism was seen in 15 (48%) eyes with EL versus four (12%) eyes without EL. Seventeen of the pseudophakic eyes underwent surgery for EL, with history of postoperative RD in one eye.

Conclusion:  Despite increased AL, high myopia is not as common in MFS as expected because of a flat cornea. Biometry should be considered in suspected cases of MFS when EL is not present.

Purpose:  To investigate corneal endothelial cell density and morphology in type II diabetic and non-diabetic patients and to relate potential differences to the glycaemic status.

Methods:  A prospective clinical study including 107 patients with type II diabetes and 128 non-diabetic patients. Sample size was based on a power calculation (power = 0.90; p = 0.05). The diabetic patients had on average more than four HbA1c tests performed (mean 4.1; range 2–14) with intervals of at least 3 months as a reflection of the long-term glycaemic status. The controls had no diabetes confirmed by two causal blood tests. The endothelial cell density, the variation in endothelial cell size (CV), the percentage of hexagonal cells, and the central corneal thickness (CCT) were recorded.

Results:  Type II diabetic subjects did not differ from the non-diabetic control subjects with regards to endothelial cell density, hexagonality or variation in CV, but showed a significant increase in CCT (538 versus 546 μm, p < 0.05). In the diabetic group, lower cell counts were associated with higher HbA1_c values (p < 0.05). The HbA1c did not, however, have any impact on the CCT.

Conclusion:  Type II diabetes has no impact on corneal cell density or morphology in subjects with good glycaemic status. However, higher HbA1c was associated with lower endothelial cell density. CCT was significantly increased in the diabetic group_.

Purpose:  To investigate the clinical features of all patients with acute–onset diplopia presenting to the ophthalmology department.

Methods:  The notes of every patient who presented with acute onset (<4-week duration) diplopia to the ophthalmology clinic over a 2-year period were reviewed. Data regarding clinical features, underlying aetiology, past medical history, investigations and outcomes were extracted.

Results:  One hundred and forty-nine patients presented with 53.7% having an isolated third, fourth or sixth nerve palsy, 10.7% a mechanical cause, 10.1% a dysfunction of higher control, 8.1% decompensation of a pre-existing heterophoria, 6.7% idiopathic, 5.4% causes of monocular diplopia and 5.3% another diagnosis. Neuroradiological investigation identified that <5% of patients had a serious underlying pathology, which required immediate management; 80.5% had a diagnosis and underlying aetiology, which were obvious at presentation based only on clinical information and evaluation.

Conclusions:  Acute onset diplopia is an uncommon and challenging presentation for the ophthalmologist to manage. These results demonstrate that the aetiology is commonly identifiable at the first presentation based on clinical evaluation, only a small percentage require urgent radiological investigation and a small minority of cases are likely to have serious emergent pathology.

Purpose:  To compare visual field (VF) and nerve fibre loss in patients with normal-tension (NTG) and high-tension glaucoma (HTG) at an equal level of glaucomatous structural damage of the optic nerve head (ONH).

Methods:  In a retrospective, pair-matched, comparative study, 126 eyes with NTG and 126 eyes with HTG were matched according to the same glaucomatous ONH damage based on rim volume, rim area and disc size measured by the Heidelberg Retina Tomograph (HRT III). Visual field by Humphrey perimetry and nerve fibre layer thickness measured by scanning laser polarimetry (GdxVCC) were compared between both groups.

Results:  Based on the HRT, NTG and HTG displayed comparable structural damage of the ONH without a statistically significant difference between both groups (mean, NTG/HTG: disc area 2.32/2.32 mm², p =0.342; rim area 1.03/1.00 mm², p = 0.279; rim volume 0.2/0.19 mm³; p = 0.274). Eyes with NTG had significantly less VF damage than eyes with HTG (mean, NTG/HTG: mean deviation (MD) −3.69/−9.77 dB, p = 0.0001; pattern standard deviation (PSD) 4.80/7.17 dB, p = 0.0001). The nerve fibre layer of NTG patients was thicker than that of HTG patients (mean, NTG/HTG: GDx total: 46.9/44.0 μm, p = 0.073; GDx superior: 57.2/49.9 μm, p = 0.0001; GDx inferior: 54.9/49.7 μm, p = 0.001).

Conclusions:  At an equal level of glaucomatous structural damage of the ONH indicated by cupping, rim area and rim volume, NTG patients seem to have a less affected visual field and a better preserved nerve fibre layer than HTG patients.

Purpose:  Hyperglycaemia has been identified as major risk factor for diabetic retinopathy (DR). It is widely accepted that the progression of DR is mainly due to a local imbalance of pro- versus anti-angiogenic factors in the retina. In this study, we investigated whether retinal pigment epithelial (RPE) cells produced pro-angiogenic factors under high glucose (HG) conditions in vitro.

Methods:  Cultured human retinal endothelial (RE) cells were exposed to conditioned medium from retinal pigment epithelium cells (ARPE-19) grown in HG medium and assessed for tube formation. Based on the expression profiles of ARPE-19, we investigated whether ANGPTL4 was a major angiogenic factor released from ARPE-19 under HG conditions using cultured human RE cells as the test system for experiments with recombinant protein, conditioned medium from ARPE-19 and RNA interference (RNAi).

Results:  The conditioned medium from ARPE-19 cultured under HG conditions promoted tube formation of cultured human RE cells. GeneChip analysis showed that ANGPTL4 was one of the highest upregulated genes under HG conditions. In addition, recombinant ANGPTL4 promoted all of the elements of angiogenesis in human RE cells in vitro. The results of experiments using conditioned medium from ARPE-19 combined with RNAi demonstrated that ANGPTL4 was a major angiogenic factor released from ARPE-19 under HG conditions.

Conclusions:  ANGPTL4 was induced by high glucose in RPE cells and exhibited potent angiogenic activity on RE cells. Our results are unique and may potentially add a new candidate to the long list of molecules involved in diabetic retinopathy.

Purpose:  Macular pigment (MP) deficit has been described in macular teleangiectasia type 2 (MTA; acquired MP loss) and in Sjögren–Larsson syndrome (SLS; hereditary MP deficiency). Central blue light-induced fundus autofluorescence (FAF) and blue light fundus reflectance (BLR) are thought to reflect MP distribution. This study was performed to describe the macular morphology in SLS and MTA by multimodal imaging to further investigate the causes of FAF and BLR changes in these disorders.

Methods:  This was a single-centre, cross-sectional, retrospective, observational study on SLS and MTA patients treated at our institution. In a multimodal retinal imaging dataset, patterns of BLR and FAF changes were compared with the optical coherence tomography (OCT) and clinical appearance of the patients’ retinas.

Results:  Multimodal image sets of seven eyes of four patients with SLS and of 25 eyes of 15 patients with MTA were included in this study. In MTA, areas of focal FAF increase were mainly associated with retinal pseudocysts and photoreceptor loss and were co-located with regions of increased BLR. In SLS, areas of focally decreased FAF correlated with the typical intraretinal glistening dots. Frequently, a spot of focally increased FAF was visible at the fovea of SLS patients, often independent of the presence of pseudocysts or photoreceptor loss on OCT.

Conclusion:  In MTA and SLS different patterns of FAF alterations could be observed. The areas of increased BLR, which are thought to correlate with MP loss, appeared to have only restricted correlation with FAF appearance.

Purpose:  To describe a modified graft-over-host (MGOH) surgical technique which was used to prevent serious complications in cases of positive vitreal pressure during penetrating keratoplasty (PKP) and to compare the endothelial cell density (ECD) loss and clinical outcome between eyes undergoing MGOH or standard PKP.

Methods:  In the proposed MGOH technique, the donor graft is sutured over the recipient cornea as soon as signs of positive pressure are noticed, even before cutting the recipient cornea, and the surgery is continued by consecutive cutting of the recipient and continuous suturing of the donor cornea, quadrant by quadrant. Donor grafts were prospectively followed up for the graft clarity, ECD loss and the amount of astigmatism.

Results:  Of 220 cases scheduled for standard PKP in years 2009–2011, eight were operated by MGOH technique. Despite the fact that the donor cornea is situated over the recipient almost throughout the whole MGOH procedure, the ECD loss is equal between eyes operated on by MGOH technique and standard PKP, and none of the grafts had primary graft failure. The only disadvantage was an increased amount of astigmatism that was not as significant once the sutures were taken out.

Conclusion:  Modified graft-over-host technique seems to be a safe and effective method to prevent complications during PKP complicated by positive vitreal pressure.

Purpose:  To explore the inhibitory effects of doxycycline on allograft rejection in alkali-burned cornea beds.

Methods:  The corneas of BALB/c mice were injured using a 1 mol/l NaOH solution. Following the injury, the corneas from C57BL/6 mice were transplanted into the eyes of BALB/c mice after being randomized into three groups: allogeneic corneal transplantation (group A), topical use of doxycycline after allogeneic corneal transplantation (group B) and syngeneic corneal transplantation (group C). Corneal angiogenesis was examined using whole-mount immunofluorescence, and corneal inflammation was evaluated using inflammation index scoring. The immune rejection of the grafts was examined using a slit lamp. In addition, the expression of vascular endothelial growth factor A and interleukin-1β in the transplanted corneas was examined using a real-time polymerase chain reaction, immunohistochemistry and an enzyme-linked immunosorbent assay.

Results:  The outgrowth of the corneal blood vessels in the group A mice was faster than that in the group B and group C mice. The inflammation index levels were highest in the group A mice, intermediate in the group B mice and lowest in the group C mice. Vascular endothelial growth factor and the interleukin-1β protein and mRNA levels decreased dramatically in the group B mice compared with the group A mice (all p-values < 0.01). In addition, the mean survival time in the group B mice (27.00 ± 2.00 days) was significantly longer than that in the group A mice (11.67 ± 1.51 days; p < 0.05).

Conclusions:  Doxycycline may have had a significant role in preventing corneal angiogenesis and inflammation in alkali-burned corneal beds, which resulted in higher allograft survival rates.

Purpose:  The aim of the study was to compare the diameter of the central retinal artery (CRA) between patients with diabetes mellitus and healthy subjects in vivo. CRA diameters were calculated from retinal haemodynamic parameters measured with noninvasive measurement techniques.

Methods:  Sixteen patients with type 1 diabetes with no or mild diabetic retinopathy and 16 age-matched healthy controls were included in this study. Total retinal blood flow was assessed by combining bidirectional laser Doppler velocimetry in all veins entering the optic disc with measurements of retinal vessel diameters using a Dynamic Vessel Analyser. Blood flow velocity in the CRA was measured with colour Doppler imaging (CDI). The diameter of the CRA in the optic nerve was then calculated for each subject using the individual ocular haemodynamic data.

Results:  Calculated CRA diameters were significantly larger in patients with diabetes (180 ± 13 μm) compared with healthy controls (166 ± 10 μm, p =  0.001). No significant differences were found in retinal blood flow, retinal artery or vein diameters or mean flow velocity of the CRA.

Conclusion:  The data of the present study show increased calculated CRA diameter in patients with type 1 diabetes with no or mild retinopathy. Blood flow velocity measurements in retrobulbar vessels using CDI need to be interpreted with caution in terms of retinal blood flow, because no information about vessel diameters is obtained by this technique.

Purpose:  Patients with epiretinal membrane sometimes complain of impaired central visual function, despite good best corrected visual acuity (BCVA), as measured by visual acuity (VA) charts. Here, we evaluate early epiretinal membrane–induced changes in central VA.

Methods:  Subjects were 72 eyes of 36 patients with epiretinal membrane in only one eye and a BCVA in each eye better than 1.0, as measured by conventional Landolt C chart, at the Retina Division Clinic of the Department of Ophthalmology, Keio University Hospital, between December 2010 and November 2011. The conventional Landolt VA, functional VA (FVA) and contrast VA measurements were taken after a general eye examination. For the FVA, Landolt optotypes were sequentially displayed every 2 seconds, which size was changed according to the correctness of the answer. To exclude the influence of other diseases, a standard Schirmer test was performed to diagnose dry eye, and corneal and lens densities were evaluated.

Results:  Average BCVA measured by Landolt C chart was not changed between affected and unaffected fellow eyes. However, the affected eyes showed a poorer FVA score (0.21 ± 0.12, affected; 0.09 ± 0.12, fellow) and visual maintenance ratio (VMR) (0.90 ± 0.04, affected; 0.94 ± 0.04, fellow), measured by the FVA system, and contrast VA score (0.35 ± 0.11, affected; 0.25 ± 0.14, fellow) than fellow eyes. The FVA and contrast VA values were correlated with the presence of epiretinal membrane, but not with the presence of dry eye, cataract and corneal densities.

Conclusion:  FVA and contrast VA results reflected early changes in central visual function caused by epiretinal membrane, which were not detected by conventional Landolt BCVA.

Purpose:  To investigate the effects of repeated measurements of intraocular pressure (IOP) using Goldmann applanation tonometry (GAT) and applanation resonance tonometry (ART) to identify mechanisms contributing to the expected IOP reduction.

Methods:  A prospective, single-centre study with six healthy volunteers. Consecutive repeated series (six measurements/serie/method) were made alternately on both eyes for 1 hr with oxybuprocaine/fluorescein in the right eye and tetracaine in the left. The left eye was Pentacam^® photographed before and repeatedly for 20 min after the IOP measurements. On a separate occasion, the same volunteers received the same amount of anaesthetic drops for 1 hr but without repeated IOP measurements.

Results:  A significant IOP reduction occurred with both ART and GAT in the oxybuprocaine-treated eye, −4.4 mmHg and −3.8 mmHg, respectively and with ART in the tetracaine eye, −2.1 mmHg. There was a significant difference in IOP reduction between the oxybuprocaine and tetracaine eyes with ART. There was a significant drop in anterior chamber volume (ACV) immediately after the IOP measurements, −12.6 μl that returned to pretrial level after 2 min. After 1 hr of receiving anaesthetic eye drops (without IOP measurements), the IOP decreased significantly in the oxybuprocaine eye for both ART and GAT, −3.1 and −1.7 mmHg, respectively, but not in the tetracaine eye (p = 0.72).

Conclusion:  The IOP reduction cannot be explained solely by aqueous humor being pressed out of the anterior chamber. While significant IOP reduction occurred with both tetracaine and oxybuprocaine after repeated mechanical applanation, the IOP reduction was significantly greater with oxybuprocaine.

Purpose:  To investigate the clinical value of assessment of peripapillary retinal nerve fibre layer (RNFL) thickness with OCT in addition to the evaluation of retinal function measured by full-field electroretinography (ff-ERG) in patients with suspected vigabatrin (VGB)-attributed visual field defects.

Methods:  Visual fields from adult patients in our clinical follow-up program for VGB medication were analysed. Twelve patients with suspected VGB-attributed visual field defects were selected for the study. They were re-examined with computerized kinetic perimetry, ff-ERG and OCT (2D circle scan).

Results:  Constricted visual fields were found in all patients. Comparative analysis of ff-ERG parameters showed reduced b-wave amplitudes for the isolated and the combined rod and cone responses (p < 0.0001). The a-wave, reflecting photoreceptor activity, was reduced (p = 0.001), as well as the summed amplitude of oscillatory potentials (p = 0.029), corresponding to inner retinal function. OCT measurements demonstrated attenuation of the RNFL in nine of 12 patients, most frequently superiorly and/or inferiorly. No temporal attenuation was found. Significant positive correlations were found between the total averaged RNFL thickness, superior and inferior RNFL thickness and reduced ff-ERG parameters. Positive correlations were also found between RNFL thickness and isopter areas.

Conclusion:  OCT measurements can detect attenuation of the RNFL in patients exposed to VGB medication. RNFL thickness correlates with reduced ff-ERG parameters and isopter areas of constricted visual fields, indicating that VGB is retino-toxic on several levels, from photoreceptors to ganglion cells. The study also supports previous studies, suggesting that OCT measurement of the RNFL thickness may be of clinical value in monitoring patients on vigabatrin therapy.

Purpose:  To evaluate the efficacy of keratectomy in treating irregular astigmatism caused by peripheral hypertrophic subepithelial corneal degeneration (PHSD) and to study the possible underlying immunological risk factors.

Materials and methods:  Patients (14 eyes) with diagnosed PHSD were treated with superficial keratectomy with or without the assistance of phototherapeutic keratectomy (VisX S4; VisX Inc., Santa Ana, CA, USA). Thirteen patients were subjected to analysis of human leucocyte antigen (HLA) genes, complement C4 gene numbers and total plasma immunoglobulin levels. Immunological risk factors between patients and a control group comprising 150 individuals were compared.

Results:  The mean preoperative best spectacle corrected visual acuity (BCVA) improved from 0.16 ± 0.22 (LogMAR scale range 0–0.7) to 0.06 ± 0.13 (−0.1–0.4) (p < 0.01). The mean preoperative astigmatism decreased significantly from 3.8 ± 2.1 D (range 1.2–8.2) to 2.1 ± 1.4 (range 0.6–5.0, p = 0.02) based on corneal topography. The HLA-B*44 allele and the ancestral haplotype (AH) 8.1 were found significantly more often in PHSD patients than in controls (both p = 0.03). No differences in the C4 genes were found.

Conclusions:  Astigmatism secondary to PHSD can be effectively treated with keratectomy. Peeling of the fibrotic tissue reduced astigmatism and improved visual performance. We suggest that HLA-B*44 allele and AH 8.1 haplotype are immunological factors predisposing to the development of PHSD. The consequent disruption/alteration of the limbal barrier may lead to corneal peripheral fibrous formation inducing astigmatism.

Purpose:  To explore eye laterality (higher refractive error in one eye) and its association with refractive state, spherical/astigmatic anisometropia, age and sex in refractive surgery candidates.

Methods:  Medical records of 12 493 consecutive refractive surgery candidates were filtered. Refractive error (subjective and cycloplegic) was measured in each subject and correlated with eye laterality. Only subjects with corrected distance visual acuity (CDVA) of >20/22 in each eye were enrolled to exclude amblyopia. Associations between eye laterality and refractive state were analysed by means of t-test, chi-squared test, Spearman’s correlation and multivariate logistic regression analysis, respectively.

Results:  There was no statistically significant difference in spherical equivalent between right (−3.47 ± 2.76 D) and left eyes (−3.47 ± 2.76 D, p = 0.510; Pearson’s r = 0.948, p < 0.001). Subgroup analysis revealed (I) right eye laterality for anisometropia >2.5 D in myopic (−5.64 ± 2.5 D versus −4.92 ± 2.6 D; p = 0.001) and in hyperopic (4.44 ± 1.69 D versus 3.04 ± 1.79 D; p = 0.025) subjects, (II) a tendency for left eye cylindrical laterality in myopic subjects, and (III) myopic male subjects had a higher prevalence of left eye laterality. (IV) Age did not show any significant impact on laterality.

Conclusions:  Over the full refractive spectrum, this study confirmed previously described strong interocular refractive correlation but revealed a statistically significant higher rate of right eye laterality for anisometropia >2.5 D. In general, our results support the use of data from one eye only in studies of ocular refraction.

Purpose:  To report the results of Descemet’s stripping endothelial keratoplasty (DSEK) for failed therapeutic penetrating keratoplasty (PK).

Methods:  Twenty-seven eyes of 27 patients undergoing DSEK for failed therapeutic PK were analysed.

Results:  The mean age of the patients was 36 ± 13.9 years (range: 14–70 years). The median size of the therapeutic graft was 10 mm (inter-quartile range; IQR 9.5–11 mm). Descemet’s membrane stripping was performed in all eyes. Graft clarity was achieved in 20/27 eyes. Six eyes had primary graft failure, and one had interface keratitis in the early postoperative period. In all eyes with primary graft failure, there was progressive stromal vascularization, which led to haziness in the graft. Late postoperative complications were rejection in four eyes, infection in two eyes, secondary graft failure in one eye and vortex keratopathy in one eye. Graft size was found to be a significant risk factor for graft rejection in this series. At the last follow-up visit, the best-corrected visual acuity was ≥20/40 in 5/27 eyes (18.5%), 20/60–20/40 in 12/27 eyes (44.4%), 20/100–20/60 in 3/27 eyes (1.5%) and ≤20/200 in 7/27 eyes (25.9%).

Conclusions:  Considering the limited success of repeat PK in failed large therapeutic keratoplasty, DSEK is a viable option for visual rehabilitation in these eyes, however; visual acuity may be limited due to sub-epithelial/stromal or interface scarring.

Purpose:  To compare the optic nerve head appearance in glaucomatous eyes before and after marked reduction of intraocular pressure (IOP).

Methods:  The hospital-based observational case-series study included selected glaucoma patients for whom optic disc photographs taken before and 1 week to 5 months after surgical reduction of IOP were morphometrically examined.

Results:  The study included 23 eyes of 16 patients (mean age: 28.7 ± 6.0 years). Mean preoperative IOP was 31.6 ± 7.7 mmHg (22–52 mmHg), and mean IOP drop was 21.5 ± 8.4 mmHg (11–45 mmHg). The horizontal disc diameter decreased significantly (p < 0.001) after surgery, while the vertical disc diameter did not change markedly (p = 0.54). The width of the neuroretinal rim increased significantly in all disc quadrants (all p-values ≤ 0.01), optic cup depth decreased (p < 0.001), and reflectivity of the inner retinal surface increased significantly (p < 0.001). Some eyes showed a pronounced reduction in beta zone of parapapillary atrophy parallel to an increase in horizontal disc diameter, and some eyes showed an enlargement of beta zone parallel to a reduction in horizontal disc diameter.

Conclusions:  After marked reduction of high IOP, some eyes of young adult patients with glaucoma can show a horizontal shrinkage of the optic nerve head, in addition to a partial restoration of the neuroretinal rim and a flattening of the optic cup. In addition, beta zone of parapapillary atrophy can decrease or increase, complementarily to changes in the horizontal disc diameter. These findings may be of interest for the biomechanics of the optic nerve head and the precision of imaging techniques.

Purpose:  Intraocular pressure (IOP) measured using Goldmann Applanation Tonometry (GAT) changes with individual’s corneal properties, but the method to measure the in vivo corneal material properties to account for individual variation in GAT IOP is not available. In this study, a new method to measure the IOP-dependent corneal tangent modulus in vivo is developed to address this research gap.

Methods:  Instrumented indentation and analysis were developed to measure the corneal tangent modulus. The validity of the method and procedure was verified using model silicone eye pressurized to different IOP. In addition, 15 porcine eyes and 3 rabbit eyes were tested using the corneal indentation at different set intraocular pressure and different indentation rates.

Results:  The results from silicone eye showed that the measured tangent modulus is in good agreement with the standard silicone rubber modulus. The results on the porcine eyes and rabbit eyes showed that the method can be used to measure corneal tangent modulus in vivo in the human range of intraocular pressure from 10 to 40 mmHg.

Conclusions:  An indentation method to measure the corneal tangent modulus in vivo was developed, and the IOP dependence of the corneal tangent modulus was characterized. The developed indentation method provides a new means to measure the in vivo corneal tangent modulus to account for individual and pressure variations in measurement of intraocular pressure.

Purpose:  Experimental data have demonstrated a relevant role for IL-6 in the modulation of acute ocular toxoplasmosis. Therefore, we aim to investigate the possible association between the IL-6 gene polymorphism at position -174 and toxoplasmic retinochoroiditis (TR) in humans.

Methods:  Ninety-seven patients with diagnosed TR were recruited from the Uveitis Section, Federal University of Minas Gerais. For comparison, 83 healthy blood donors with positive serology for toxoplasmosis and without retinal signs of previous TR were included in the study. Genomic DNA was obtained from oral swabs of individuals and amplified using polymerase chain reaction (PCR) with specific primers flanking the locus −174 of IL-6 (−174G/C). PCR products were submitted to restriction endonuclease digestion and analysed by polyacrylamide gel electrophoresis to distinguish allele G and C of the IL-6 gene, allowing the detection of the polymorphism and determination of genotypes.

Results:  There was a significant difference in the genotype (χ² = 12.9, p = 0.001) and allele (χ² = 6.62, p = 0.01) distribution between TR patients and control subjects. In a subgroup analysis, there was no significant difference in genotypes and allele frequencies regarding TR recurrence.

Conclusions:  This study suggests that the genotypes related with a lower production of IL-6 may be associated with the occurrence of TR.

Purpose:  To determine whether retinal vessel oxygen saturation in patients with glaucoma is associated with structural optic disc and retinal nerve fibre layer (RNFL) changes and visual field (VF) defects.

Methods:  Fifty-nine patients with confirmed glaucoma were recruited at University Hospitals Leuven. Retinal oxygen saturation in patients with glaucoma was measured with a noninvasive spectrophotometric retinal oximeter (Oxymap ehf, Reykjavik, Iceland). VF and Heidelberg retinal tomographies (HRTs) were performed on the same day. Statistical analysis was performed using Student’s t-test and Pearson’s or Spearman correlation coefficient.

Results:  The mean oxygen saturation in venules was higher in patients with severe VF defects compared to those patients with mild VF defects (69 ± 3% versus 65 ± 6% respectively; p = 0.0003; n = 59). Accordingly, the arteriovenous (AV) difference in oxygen saturation was lower in patients with worse VF compared to those with better VF (29 ± 3% versus 33 ± 6% respectively; p = 0.002). The oxygen saturation in venules correlated with the VF mean defects (r = −0.42; p = 0.001; n = 59) as well as with the structural HRT parameters rim area and RNFL thickness (r = −0.39; p = 0.008 and r = −0.26; p = 0.05 respectively; n = 53). The AV difference decreased significantly as the VF defect worsened (r = 0.38; p = 0.003), as the rim area diminished (r = 0.29; p = 0.03) and as the RNFL thickness decreased (r = 0.27; p = 0.05). No correlation was found between the oxygen saturation in retinal arterioles and either of these parameters.

Conclusion:  Severe glaucomatous damage is associated with increased oxygen saturation in retinal venules and decreased AV difference in oxygen saturation. These data suggest that in eyes with severe glaucomatous damage, reduced retinal oxygen consumption is consistent with tissue loss.

Purpose:  To compare the influence of aerobic and resistance exercise on intraocular pressure (IOP).

Methods:  Twenty-one healthy subjects participated. Aerobic exercise was performed using a cycle ergometer, and resistance exercise was performed with a leg curl and a butterfly machine. Intraocular pressure was measured at baseline, during exercise and 10 min after. During resistance exercise, a Valsalva manoeuvre was prevented.

Results:  Before aerobic exercise, the mean IOP was 18.8 ± 2.7 mmHg. It was 16.5 ± 2.8 after 10, 17.1 ± 2.6 after 20 and 16.7 ± 3.3 mmHg after 30 min of exercise. After 10 min, the IOP returned to baseline (18.8 ± 2.7 mmHg). The mean IOP before resistance exercise with the leg curl machine was 17.0 (15.6–18.4; 65%W_max) and 16.8 (15.3–18.3) mmHg; 75%W_max) and did not change significantly during the experiment. The mean IOP before resistance exercise with the butterfly machine (65%W_max) was 16.4 (15.2–17.6) and increased to 17.2 (16.0–18.4) mmHg (p < 0.05). After 10 min of recreation, it recovered to 16.3 (15.0–17.5) mmHg. At 75%W_max, the mean baseline IOP was 16.3 (15.2–17.4) mmHg, and there were no significant changes.

Conclusions:  Aerobic exercise leads to a significant decrease of IOP. There was no influence of resistance exercise on IOP as long as a Valsalva manoeuvre was prevented.

Purpose:  To assess preoperative features, frequency, surgical approaches and outcomes of late in-the-bag dislocation of posterior chamber intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome.

Methods:  Seventy-seven patients (81 eyes) were enrolled. Inclusion criteria were patients with pre-existing pseudoexfoliation syndrome who underwent surgery for late in-the-bag IOL dislocation between March 2004 and April 2010. Medical records were reviewed. Data from before and after secondary surgery were analysed.

Results:  Mean time between cataract extraction and secondary surgery for late in-the-bag dislocation of posterior chamber IOLs was 8.5 years. The increase in frequency within the reviewed period was statistically significant, ranging from six patients in the first year to 25 patients in the final year (p = 0.004). When surgical correction was performed within 1 month of referral, deterioration of the dislocation occurred in only one of 23 patients (4.3%). Complications, especially vitreous loss, occurred significantly more frequently during exchange surgery (n = 23) when compared with scleral suturing (n = 50) (p < 0.0001). After surgery, however, no differences in complications (p = 0.98) or best-corrected visual acuity (p = 0.74) was found. In general, following secondary surgery, there was a statistically significant improvement in best-corrected visual acuity (p < 0.0001).

Conclusion:  The frequency of late in-the-bag dislocation of posterior chamber IOLs in eyes with pseudoexfoliation syndrome increased during the observation period. Our study suggests that surgical repair should not be delayed beyond 1 month and that scleral suturing is preferable to exchange surgery, because of less intraoperative complications.

Purpose:  To assess long-term positioning of posterior chamber intraocular lenses within the capsular bag in eyes with pseudoexfoliation syndrome.

Methods:  The study includes 44 patients with pseudoexfoliation syndrome and 85 age-matched controls, who underwent cataract surgery in 2001 and 2002 at the Eye Department, Oslo University Hospital. In 2008, all patients were re-examined. A comparison of the extent of possible decentration in eyes with and without pseudoexfoliation syndrome was made by evaluating Scheimpflug images (Pentacam) of the anterior segment.

Results:  It was found that, 6–7 years following cataract surgery, posterior chamber intraocular lenses were positioned lower in eyes with pseudoexfoliation syndrome than in control eyes. The difference was statistically significant (p = 0.01). Downward shift was associated with presence of glaucoma only in eyes with pseudoexfoliation syndrome (p = 0.01). No patients had visual disturbances related to displacement of the intraocular lens. Three of the patients with pseudoexfoliation syndrome (6.8%) had observable pseudophacodonesis by slit-lamp examination, compared to one in the control group (1.2%). The study demonstrated that Pentacam is an appropriate instrument to measure decentration of intraocular lenses.

Conclusion:  The study suggests that, 6–7 years after cataract surgery, the intraocular lenses within the capsular bag are more prone to decentration in pseudoexfoliation syndrome eyes, compared to controls.

Purpose:  To evaluate the posterior capsule opacification (PCO) rates in three different modern standard intraocular lenses (IOL) and analyse the related cost.

Methods:  Retrospective study of medical records from 1527 patients who underwent uneventful cataract surgery by phacoemulsification with posterior chamber implantation of either AcrySof SN60 (n = 375), Akreos Adapt (n = 350) or Tecnis Acryl IOL (n = 801). All surgeries were performed by the same surgeon using the same surgical technique and equipment. Primary end-point was neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy for visual impairment secondary to PCO. Cost of IOL material and Nd:YAG capsulotomy for PCO was then evaluated and compared between the IOLs.

Results:  Mean follow-up was 41.5 months, and the only statistically significant variable of developing PCO was IOL type and individual follow-up time. Nd:YAG capsulotomy was performed in 7.47% in the AcrySof group, 17.71% in the Akreos group and 3.75% in the Tecnis group. Average cost for Nd:YAG capsulotomy per surgery was €18.75 in the AcrySof SN60 group, €44.25 in the Akreos Adapt group and €9.25 in the Tecnis Acryl group. The combined cost of cataract surgery and PCO treatment was €9.81 higher in for the Akreos Adapt group than the other two combined.

Conclusions:  This retrospective study shows that the risk of PCO and Nd:YAG capsulotomy is significantly higher in hydrophilic Akreos IOL compared with both AcrySof and Tecnis hydrophobic IOLs. The increased risk of PCO in the hydrophilic IOL is related to higher total average costs for cataract surgery.

Purpose:  To evaluate the relationship between signs and symptoms of dry eye disease (DED) in a clinic-based population.

Methods:  In a retrospective analysis, clinical signs and symptoms were evaluated for 344 subjects (n = 82, normal; n = 263, dry eye), across 11 sites from the EU and United States. Pearson correlations between signs and symptoms (r²) and an independent components analysis (ICA) mixing matrix were derived from the data set. Similar analysis was performed on an independent data set from 200 subjects in a previous study in Munich, Germany.

Results:  No correlations above r² = 0.17 were found between any signs and symptoms, except for corneal and conjunctival staining, which reported an r² = 0.36. In the multisite study, the average r² for osmolarity (0.07), tear breakup time (0.12), Schirmer test (0.09), corneal (0.16) and conjunctival staining (0.17), meibomian grading (0.11) and Ocular Surface Disease Index^® (0.11) were consistently low. Among patients who showed evidence of DED by consensus of clinical signs, only 57% reported symptoms consistent with a diagnosis of DED. Similar results were observed in the Munich-based study data set. Each component of the ICA mixing matrix exhibited minimal residual information.

Conclusions:  No consistent relationship was found between common signs and symptoms of DED. Each type of measurement provides distinct information about the condition of the ocular surface. These results also demonstrate that symptoms alone are insufficient for the diagnosis and management of DED and argue for a consensus of clinical signs that better reflect all aspects of the disease.

Purpose:  To evaluate the efficacy and safety of new moist cool air device (MCAD) for ocular symptoms, tear film stability and ocular surface status in office workers with dry eye disease (DED).

Methods:  In this prospective single-centre clinical trial, 40 eyes of 20 patients with DED were recruited and randomly divided into two groups (group with MCAD exposure and group without MCAD). All subjects are visual display terminals (VDTs) workers spending at least 4 h/day in front of VDTs. Patients using MCAD underwent moist air applications for 4 h/day for a total of five working weekdays during VDT works at their offices. The other group of patients performed their VDT work without moist cool air device exposure. The change in symptoms of ocular surface (OS) dryness, fatigue and discomfort was evaluated using visual analogue scale (VAS) scores. Changes in visual function, tear functions and ocular surface status were evaluated using best-corrected visual acuity (BCVA), the functional visual acuity (FVA) test, blink rate, BUT measurements, strip meniscometry (SM), tear evaporation rate, fluorescein staining and rose bengal staining scores. Tear film lipid layer interferometry was also performed to assess the status of the lipid layer over the tear film. In addition, adverse events were recorded.

Results:  In group with MCAD, symptoms of OS dryness during VDTs work, and FVA and BUT were significantly improved. SM and tear evaporation rate were significantly improved. There were no statistically significant differences on lipid layer stability and corneal staining scores in both groups. Blink rate was significantly increased in group without MCAD. No adverse events were reported during this trial.

Conclusion:  Moist cool air device use provided symptomatic relief of ocular dryness and improvement on tear stability in office workers with DED. This new device seems to be a safe and promising alternative in the treatment of DED.

Purpose:  To assess the prevalence of end-of-life visual impairment in patients followed for glaucoma.

Methods:  Data of 122 patients followed for glaucoma who had died between July 2008 and July 2010 and who had visited the ophthalmology outpatient department of a large non-academic Dutch hospital were collected from the medical files. Sixty-one patients had open-angle glaucoma (OAG), and 61 patients were suspect for glaucoma or had ocular hypertension (OHT). Visual impairment was defined as a mean deviation value <−15 dB or a Snellen visual acuity <0.3 (20/60) of the better eye. We determined the number of patients with visual impairment on the last patient visit before death and investigated its main explanations.

Results:  Overall, the mean age at death was 81.8 years after a mean follow-up period of 9.2 years. Seventy-three per cent of all patients had their last visit in the year preceding death. In OAG, 16 patients (26%) had an end-of-life visual impairment. In nine patients (15%), this was caused by glaucoma. Eight of them had substantial visual loss at the initial visit. Six (10%) impaired OAG cases were mainly explained by ocular comorbidity, and there was an equal contribution of comorbidity and glaucoma in one case. Five glaucoma suspects or patients with OHT (8%) were visually impaired at death and these were all caused by ocular comorbidity.

Conclusion:  The prevalence of end-of-life visual impairment is considerable in patients with OAG. Substantial visual loss at baseline is an important contributing factor. In glaucoma suspects or patients with OHT, the prevalence is lower and can be attributed to ocular comorbidity.

Purpose:  To evaluate the efficacy and safety of deep sclerectomy in childhood glaucoma.

Methods:  A prospective cohort of 120 children presenting with glaucoma to King Abdul Aziz University Hospital (KAUH) was subjected to nonpenetrating deep sclerectomy surgery (NPDS). Eventually, 57 patients had macro perforation and converted to penetrating deep sclerectomy (PDS). Intra-operative mitomycin C (MMC) 0.2 mg/ml was used in all patients. Pre- and postintervention glaucoma indices were assessed. Complete success rate (CSR) was identified as achieving an end-point of intraocular pressure <21 without any antiglaucoma medications. Data were analysed to compare pre- and postintervention changes and to compare both procedures.

Results:  After follow-up of 35.8 (34.5) months, NPDS procedure went smooth in 74 eyes of 63 patients. The complete success rate was 79.7%, whereas the overall success rate was 82.4%. Thirteen cases failed. The probability to survive was 74.6% after the 12th month. The mean intraocular pressure (IOP) went down to 11.5 ± 3.0 mmHg compared to 31.9 mmHg preoperatively. Comparing cases with NPDS to those with PDS, the magnitude of IOP reduction (15.8) was higher than that of the PDS (14.8); however, this difference was not statistically significant (p = 0.259). Apart from involuntary perforation of trabeculodescemetic window (TDW), neither intra-operative nor early postoperative complications were observed.

Conclusions:  Deep sclerectomy in childhood glaucoma can effectively reduce the IOP, without the occurrence of serious complications that are commonly seen after trabeculotomy or combined trabeculotomy trabeculectomy.

Purpose:  To evaluate effectiveness, tolerability and safety of repeated intravitreal injections of 0.5 mg ranibizumab for the treatment of neovascular age-related macular degeneration in routine medical practice in Germany.

Methods:  A noninterventional study with 3470 patients treated in 274 medical centres according to German guidelines, with monthly intravitreal injections of 0.5 mg ranibizumab during upload (3 months) followed by a maintenance phase (9 months) with reinjections if medically indicated.

Results:  Mean injection rate was 4.34 (SE = 0.05; median = 3.0). Best-corrected visual acuity (BCVA) remained stable (mean change 0.02 LogMAR, SE = 0.01, p = 0.0169) and central retinal thickness (CRT) decreased (by −78.9 μm, SE = 2.95 μm, p < 0.0001). The NEI-VFQ 25 summary score showed a positive stabilization with a mean change of 0.73 (SE = 0.37, p = 0.0501) compared with baseline. Adverse events were documented for 6.5% of the patients with 3.9% of these events being classified as serious.

Conclusions:  The number of administered intravitreal injections of ranibizumab over the first year of treatment was very low but still achieved a stabilization of BCVA, a reduction in CRT and maintained vision-related quality of life. The management of patients with neovascular AMD in Germany needs to be improved to achieve better treatment results.

Purpose:  To determine the incidence rate as well as causative diagnoses and surgical indications of enucleation in Iceland during the years 1992–2004.

Methods:  A retrospective population-based incidence study involving the entire population of Iceland. Medical records of all patients who underwent enucleation in Iceland from January 1992 through December 2004 were reviewed. The annually updated Icelandic census was used as a denominator data.

Results:  Fifty-six eyes were enucleated during 1992–2004. No eviscerations were done, and the three exenterations performed were not included in the study. The mean annual age-adjusted incidence rate of enucleation in Iceland was 1.48 enucleations per 100 000 population in comparison with 2.66 enucleations per 100 000 for the time period 1964–1991. With advancing age, a significant increasing linear trend existed (p < 0.001). The median age at enucleation was 51 years (SD 22; mean 55 years; 16–91 years). The three most common surgical indications for enucleation were blind painful eye, suspected ocular malignancy and acute trauma. The most common causative diagnosis for enucleation was traumatic lesion (39%). The annual incidence was 2.00 enucleations per 100 000 for men and 0.95 for women. There were significantly more men in the traumatic lesion group (p < 0.001), but no gender predominance was found in the other groups of causative diagnoses (p = 0.8).

Conclusion:  The overall mean annual incidence of enucleation in Iceland is continually decreasing, although the incidence of severe ocular trauma and ocular malignancy is fairly stable.

Purpose:  Angiogenesis in diabetic retinopathy (DR) is a multifactorial process regulated by hypoxia-induced growth factors and inflammatory cytokines. In addition to the angiogenic switch, the proteolytic processing and altered synthesis of the extracellular matrix are critical steps in this disease. This study was performed to evaluate the levels of matrix metalloproteinase-2 and matrix metalloproteinase-9 (MMP-2 and MMP-9), angiopoietin-1 and angiopoietin-2 (Ang-1 and Ang-2), vascular endothelial growth factor (VEGF), erythropoietin (EPO) and transforming growth factor-β1 (totalTGFβ1) in the vitreous of diabetic eyes undergoing vitrectomy compared with control eyes operated because of macular hole or pucker.

Methods:  Prospective consecutive controlled observational study performed in the unit of vitreoretinal surgery in Finland during the years 2006–2008. Vitreous samples were collected before the start of the conventional 3-ppp vitrectomy. Vitreous MMP-2 and MMP-9, Ang-1 and Ang-2, VEGF, EPO and TGFβ1 concentrations were measured from 69 patients with Type 1 or 2 diabetes and 40 controls.

Results:  Comparison of eyes with DR with controls revealed that the mean vitreous concentrations of proMMP-2 (p = 0.0015), totalMMP-2 (p = 0.0011), proMMP-9 (p = 0.00001), totalMMP-9 (p < 0.00001), Ang-2 (p < 0.00001), VEGF (p < 0.00001), EPO (p < 0.00001) and totalTGFβ1 (p = 0.000026) were significantly higher in the former group. A multivariate logistic regression analysis suggested intravitreal Ang-2 concentration being the key marker of PDR (p = 0.00025) (OR = 1507.9).

Conclusion:  The main new finding is that the intravitreal concentrations of Ang-2 correlated significantly with MMP-9, VEGF, EPO and TGFβ1 levels in diabetic eyes undergoing vitrectomy. Thus, these factors could promote retinal angiogenesis synergistically.

Purpose:  The purpose of this study was to model the influence of cataract on Spectral Domain Optical Coherence Tomography (SDOCT) image quality and Retinal Nerve Fibre Layer (RNFL) thickness measurements.

Methods:  SDOCT images, made with two different devices (3DOCT-1000, Topcon and Cirrus HD-OCT), before and after cataract surgery were compared and judged against measurements from normal subjects using artificial filters simulating the effects of cataract. Optical density of the images was calculated based on a mathematical model described previously.

Results:  In total, forty-eight eyes were included for pre- and postoperative cataract extraction measurements. OCT image quality significantly (p < 0.001) improved postoperative and postoperative RNFL thickness was significantly (p < 0.001) thicker in both groups of patients. The measurements using artificial filters showed a rather precise linear relation between change in filter induced optical density and change in RNFL thickness (R = 0.941, p < 0.001 for 3DOCT-1000 and R = 0.785, p < 0.001 for Cirrus HD-OCT). For the patient groups, the relation was less marked, 3DOCT-1000 R_s = 0.697, p < 0.03 and Cirrus HD-OCT R_s = 0.444, p < 0.03. The predictive potential based on the found linear relationship between OCT-effective optical density of cataract and the cataract-induced underestimation was however limited, and mean difference ± SD between predicted and measured RNFL thickness were 1.68 ± 7.55 (3DOCT-1000) and 3.71 ± 2.97 (Cirrus HD-OCT) micron.

Conclusions:  A linear relationship exists between OCT-effective optical density of cataract and underestimation of RNFL thickness measured with OCT. This finding holds promise to correct for cataract-induced changes in RNFL measurements, but will differ for each type of OCT device.

Purpose:  To investigate rates of visual field progression and factors associated with progression rate in open-angle glaucoma in clinical glaucoma care.

Methods:  We performed a retrospective chart review of all patients with manifest primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) followed ≥ 5 years with ≥5 SITA Standard fields. Exclusion criteria were minimal. Demographics, intraocular pressure values (IOP), treatment and treatment changes, and visual field (VF) data were recorded. VF progression rates were calculated as slopes of mean deviation (MD) over time.

Results:  Five hundred and eighty-three patients were eligible. Three hundred and sixty-seven (62%) had POAG and 221 (38%) PEXG. Median MD at study start was −10.0 dB. Mean follow-up time was 7.8 years (SD ± 1.2); mean number of VF tests was 8.9 (SD ± 2.8). Progression rates varied very much among patients with a mean of −0.80 dB/year (SD ± 0.82; median rate, −0.62), and 5.6% of patients progressed at rates worse than −2.5 dB per year A negative slope of MD values was observed in 89% of patients. Mean IOP of all visits decreased over the study period from 20.15 to 18.10 mmHg. Higher age and mean IOP, and more intensive treatment were associated with more rapid progression, while PEXG and IOP variation were not, if treatment intensity was taken into account.

Conclusion:  Rates of visual field progression in manifest glaucoma with field loss in ordinary clinical care were highly variable. Progression rates rapid enough to influence quality of life were common.

Purpose:  To examine the basis of previous findings of an association between indices of driving safety and visual motion sensitivity and to examine whether this association could be explained by low-level changes in visual function.

Methods:  A total of 36 visually normal participants (aged 19–80 years) completed a battery of standard vision tests including visual acuity, contrast sensitivity and automated visual fields and two tests of motion perception including sensitivity for movement of a drifting Gabor stimulus and sensitivity for displacement in a random dot kinematogram (D_min). Participants also completed a hazard perception test (HPT), which measured participants’ response times to hazards embedded in video recordings of real-world driving, which has been shown to be linked to crash risk.

Results:  D _min for the random dot stimulus ranged from −0.88 to −0.12 log minutes of arc, and the minimum drift rate for the Gabor stimulus ranged from 0.01 to 0.35 cycles per second. Both measures of motion sensitivity significantly predicted response times on the HPT. In addition, while the relationship involving the HPT and motion sensitivity for the random dot kinematogram was partially explained by the other visual function measures, the relationship with sensitivity for detection of the drifting Gabor stimulus remained significant even after controlling for these variables.

Conclusion:  These findings suggest that motion perception plays an important role in the visual perception of driving-relevant hazards independent of other areas of visual function and should be further explored as a predictive test of driving safety. Future research should explore the causes of reduced motion perception to develop better interventions to improve road safety.

Purpose:  To study the effect of patient education and the TravAlert^®-Eyot^® drop guider on intraocular pressure (IOP) and adherence in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT) monitored with the TravAlert^® dosing aid.

Methods:  Multicentre, randomized, controlled clinical trial among 18 Dutch hospitals. Patients were randomized to one of the four study arms: (1) use of the dosing aid, (2) use of the dosing aid with the drop guider, (3) use of the dosing aid together with patient education or (4) use of the dosing aid and drop guider together with patient education. IOP was recorded at baseline and after 3 and 6 months. Data on adherence generated by the dosing aid were collected and studied at the end of the study.

Results:  Mean IOP dropped from 20.3 ± 5.7 mmHg at baseline to 16.3 ± 4.0 mmHg (right eye) after 6 months and from 20.2 ± 5.9 mmHg to 16.4 ± 4.1 mmHg (left eye). The mean adherence rate was 0.91 ± 0.1. IOP and adherence rate were not statistically different between the study arms. Patients with ‘drug holidays’ had a significantly higher mean IOP after 6 months. Patients who used the drop guider were less adherent. A lower adherence level was also associated with new patients with glaucoma and patients with a lower level of knowledge on glaucoma.

Conclusion:  Patient education is especially useful for new patients with glaucoma. The use of a drop guider does not improve adherence. Especially patients with ‘drug holidays’ are at risk for developing uncontrolled IOP levels.

Purpose:  Microplasmin is known to alter the structure of the vitreous gel. The current experiments were designed to assess its ability to enhance clearance of an experimentally induced vitreous haemorrhage, and to compare it to ovine hyaluronidase.

Methods:  Twenty-five rabbits were used for this experiment, divided into five groups; groups 1–3 are microplasmin-treated eyes with 25, 75 and 125 μg, respectively. Group 4 treated with 55 IU of hyaluronidase, while group 5 was treated with normal saline (control). Eyes were injected in the mid-vitreous with 0.05 ml of autologous blood obtained from the marginal ear vein. One week later, all the groups were injected with the test solution injected in mid-vitreous as stated above. Clearance of the vitreous haemorrhage was assessed weekly indirect ophthalmoscopy for 8 weeks.

Results:  Microplasmin-treated eyes showed a significant clearance of the vitreous haemorrhage in a dose-dependent fashion, where group 3 (125 μg) had the highest clearance rate in comparison with control eyes. Hyaluronidase-treated eyes showed a similar clearance rate as group 3. In addition, group 3 showed a complete posterior vitreous detachment, which did not develop in hyaluronidase-treated eyes.

Conclusion:  Microplasmin may be a useful agent to accelerate the clearance of vitreous haemorrhage.

Purpose:  To presents results after 18 months of follow-up of a longitudinal study aiming at exploring the correlation between diabetic retinal vascular lesions and functional change.

Methods:  Patients were consecutively recruited from attendees to the screening program for diabetic retinopathy. Subjects are followed every sixth month for the first 3 years and thereafter annually up to 5 years. Progression of diabetic retinopathy is evaluated using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale and improvement/deterioration in visual fields by predefined significance limits for change.

Results:  Of 81 subjects, with no/mild/moderate diabetic retinopathy included, 76 have passed the 18-month visit. At that time, retinal progression by two steps according to the ETDRS scale had occurred in two subjects. Visual acuity was −0.14 logMAR and had decreased with two letters (0.04 logMAR) (p < 0.001) from baseline. The global visual field index mean deviation was almost unchanged with a negligible improvement of 0.03 dB (p = 0.79). In 21 subjects, repeated significant deterioration was seen in ≥10% of all points tested in the field, while almost no improved points were noted. The two subjects with retinal progression were not among those 21 with indication of perimetric progression.

Conclusions:  This is, to our knowledge, the first longitudinal study evaluating change of visual fields in a representative diabetic cohort with no or mild/moderate retinopathy. In this interim report, we demonstrate deteriorated perimetric sensitivity in subjects already at 18 months of follow-up. The results will have implications for evaluating change in visual function in future clinical trials.

Purpose:  To test whether adding topical phenylephrine 5% to tropicamide 0.5% eye drops in the protocol for pupil dilation affects the retinal vessel oximeter measurements in patients with glaucoma. To test whether phenylephrine 5% has an influence as a vasoconstrictor on the retinal vessel width and can improve the proportion of high-quality retinal images in patients with glaucoma.

Methods:  Retinal images of 66 patients with chronic open-angle glaucoma were obtained before and after the administration of phenylephrine 5% eye drops to patients already dilated with tropicamide 0.5% with the Oxymap Retinal Oximeter (Oxymap ehf, Reykjavik, Iceland). Specialized software, Oxymap Analyzer, analysed the images and measured the oxygen saturation and vessel diameter. Oxygen saturation was measured in first- and second-degree vessels. A Mann–Whitney U-test was used to compare both groups. Quality of the images was assessed, and a Fisher’s exact test was used to compare the proportion of high- and poor-quality images.

Results:  There was no significant difference in arterial and venous oxygen saturation in patients with glaucoma whether dilated by tropicamide alone or a combination of tropicamide and phenylephrine (97 ± 6% versus 96 ± 5%, p = 0.88 for arterial saturation and 66 ± 6% versus 67 ± 6%, p = 0.78 for venous saturation, n = 27). There was no significant difference in vessel diameter between both conditions for the different vessels (p = 0.61 for arterial saturation and p = 0.51 for venous saturation, n = 27). The proportion of high-quality images was significantly higher after the combination regimen compared with tropicamide only (p = 0.0001).

Conclusion:  The addition of topical phenylephrine 5% after tropicamide 0.5% improved the proportion of high-quality retinal oximetry images without influencing the retinal oxygen saturation values or the retinal vessel diameter in patients with glaucoma.

Purpose:  To compare spectacles plus alternate-day patching for 8 hr or more with spectacles plus patching for 8 hr or more 6 days weekly to treat strabismic amblyopia 1 year after a 1-year randomized trial.

Methods:  Forty children (mean age, 4.3 years) participated. Refractive correction was provided. The children were assigned to alternate-day patching for 8 hr or more or patching for 8 hr or more daily 6 days weekly. VA, binocular function, and refractive errors were measured after 2 years. The main outcome measure was the median VA change in the amblyopic eye after 2 years.

Results:  The median VA change in the amblyopic eye at the 2-year visit was significantly (p = 0.0453) greater with alternate-day patching (0.8 log unit) versus patching daily 6 days weekly (0.6 log unit). The final median VA in the amblyopic eyes was 0.0 logMAR in the alternate-day patching group and 0.1 logMAR in the daily patching group. Binocular function improved with both treatments. The median spherical equivalent (SE) refractive error increased in the fellow eyes (alternate-day patching, p < 0.0001; patching daily 6 days weekly, p = 0.0033); no change was found in the amblyopic eyes in either group.

Conclusions:  The magnitude of the VA change 2 years after treatment with spectacles plus alternate-day patching for 8 hr or more was significantly greater than with spectacles plus daily patching for 8 hr or more 6 days weekly for strabismic amblyopia. However, the final median VA did not differ significantly between the two treatments.

Purpose:  To report the change in refraction in pseudophakic eyes following 23-gauge vitrectomy for epiretinal membrane (ERM), without use of silicone oil, intraocular gas or scleral buckling.

Methods:  Retrospective review of the records of 28 pseudophakic eyes in 28 patients undergoing 23-gauge pars plana vitrectomy for ERM. All 28 eyes had a measured preoperative refraction in their records and were seen minimum 2 months after vitrectomy for measuring their refraction. Fellow eyes (28 eyes) were used as controls.

Results:  The mean preoperative refraction was −0.15 ± 0.85 dioptre (D), and the mean postoperative refraction was −0.41 ± 0.93 D. Thus, a myopic shift was observed following vitrectomy with a mean change in refraction of −0.26 ± 0.60 D (range +0.75 to −2.13 D, p = 0.032). The postoperative change in refraction was within ±0.25, ±0.50 and ±1.00 D in 39%, 68% and 96% of the eyes, respectively. The mean absolute refractive error was 0.47 ± 0.44 D. The change in refraction in fellow eyes was +0.01 D (p = 0.82).

Conclusion:  The change in refraction following 23-gauge pars plana vitrectomy for ERM in pseudophakic eyes was −0.26 D.

Purpose:  To analyse lesion components determining retinal sensitivity in microperimetry in eyes with newly diagnosed exudative age-related macular degeneration (AMD).

Methods:  Visual acuity, contrast sensitivity, microperimetry, optical coherence tomography (OCT), and fluorescein (FA) and indocyanine green (ICGA) angiographies of 23 eyes of 23 patients were analysed. Central microperimetry grids with 28 test stimulus sites were automatically aligned with three-dimensional OCTs and manually aligned with angiographies. Thicknesses of the neuroretina, neuroepithelial detachment (NED), retinal pigment epithelial (RPE) elevation and subretinal tissue were measured under the 644 microperimetry stimulus sites. Areas of classic and occult choroidal neovascularizations (CNVs), subretinal and intraretinal haemorrhage, and late hyperfluorescence in ICGA were identified. The impact of the lesion components on retinal sensitivity was evaluated with correlation analysis and multivariate modelling.

Results:  Decreased retinal sensitivity correlated significantly with the presence of CNV, haemorrhage, subretinal tissue and RPE elevation. Out of the OCT parameters, the most important determinant of sensitivity was the thickness of RPE elevation (Spearman’s rho, r = −0.202, p < 0.0001). The thicknesses of subretinal tissue (r = −0.168, p < 0.0001) and NED had weaker effects (r = −0.147, p < 0.0001), and the neuroretinal thickness remained nonsignificant. In multivariate modelling, RPE elevation and subretinal tissue in OCT, CNV membranes in angiographies and haemorrhage had the strongest impacts on retinal sensitivity.

Conclusion:  The most important lesion components affecting retinal function were RPE elevation and subretinal tissue in OCT as well as neovascular membranes and haemorrhage in angiographies. NED and neuroretinal thickening remained less significant.

Purpose:  Central serous chorioretinopathy (CSCR) mostly affects middle-aged men and has been associated with stress and hypercortisolism. We hypothesized that some factors prone to inducing CSCR could also have a harmful effect on erectile function. This study aimed to investigate the risk of subsequent erectile dysfunction after CSCR using Taiwan National Health Insurance Research Database.

Methods:  The study cohort (n = 1220) consisted of newly diagnosed CSCR men aged 19–64 years between 1999 and 2007, and men matched for age, monthly income and time of enrolment were randomly selected as the control group (n = 10870). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of clinically diagnosed erectile dysfunction (including organic origin and/or psychogenic origin) for the two groups. Erectile dysfunction-free survival analysis was assessed using a Kaplan–Meier method.

Results:  Twenty-five patients (2.0%) from the CSCR cohort and 103 (0.9%) from the control group were diagnosed erectile dysfunction clinically during a mean observation period of 4.3 years. Patients with CSCR had a significantly higher incidence of erectile dysfunction diagnosis than those without CSCR (p < 0.001). After adjusting for age, geographic location, chronic comorbidities and medication habits, patients with CSCR were found to have a 2.22-fold [95% confidence interval (CI), 1.42–3.46] higher hazard ratio of a subsequent erectile dysfunction diagnosis than the matched controls. The adjusted HR for organic and psychogenic erectile dysfunction were 2.14 (95% CI: 1.34–3.44) and 3.83 (95% CI: 1.47–10.01), respectively.

Conclusions:  Central serous chorioretinopathy was independently associated with an increased risk of being diagnosed with erectile dysfunction.

Purpose:  To determine the prevalence of visual impairment, retinopathy and macular oedema, and assess risk factors for retinopathy in persons with diabetes.

Methods:  The present study included 514 participants with diabetes aged 46–87 years from the Tromsø Eye Study, a sub-study of the population-based Tromsø Study in Norway. Visual acuity was measured using an auto-refractor. Retinal images from both eyes were graded for retinopathy and macular oedema. We collected data on risk factor exposure from self-report questionnaires, clinical examinations, laboratory measurements and case note reviews. Regression models assessed the cross-sectional relationship between potential risk factors and diabetic retinopathy.

Results:  The prevalence of visual impairment (corrected Snellen visual acuity <20/60 in the better-seeing eye) was 1.6%. The prevalence of diabetic retinopathy was 26.8% and macular oedema 3.9%. In a multivariable logistic regression model, retinopathy was associated with longer diabetes duration (odds ratio, OR 1.07, 95% CI 1.03–1.11), insulin use (OR 2.14, 95% CI 1.19–3.85), nonfasting glucose (OR 1.07, 95% CI 1.00–1.15) and microalbuminuria (OR 1.89, 95% CI 1.28–2.81). Sub-group analyses showed association between retinopathy and even low levels of microalbuminuria (1.16 mg/mmol).

Conclusion:  The findings suggest that low levels of microalbuminuria may be a useful risk predictor for identifying individuals with diabetes at high risk of retinopathy. The study confirms previous findings that insulin use, longer diabetes duration and higher levels of blood glucose are associated with retinopathy in persons with diabetes. The prevalence of diabetic retinopathy was similar as reported in other studies.

Purpose:  Ranibizumab (Lucentis^®) is a Fab-Fragment of a recombinant, humanized, monoclonal VEGF (anti-vascular endothelial growth factor) antibody. This study analyzed the ability of topical Ranibizumab to inhibit lymphangiogenesis in addition to hemangiogenesis after acute corneal inflammation in vivo. In addition, the effect of Ranibizumab on the proliferation of human lymphatic endothelial cells (LECs) and blood endothelial cells (BECs) in vitro was studied.

Methods:  The inhibitory effect of Ranibizumab on LECs and BECs was studied in vitro using a proliferation enzyme-linked immunosorbent assay (ELISA) assay. To study the in vivo effects of Ranibizumab, the mouse model of suture induced inflammatory corneal neovascularization was used. Study mice received topical Ranibizumab as eye drops. After 1 week excised corneas were stained with LYVE-1 and CD31. Hemangiogenesis and lymphangiogenesis were analyzed morphometrically by using a semiautomatic method based on the image analyzing program Cell^F.

Results:  An antiproliferative effect of Ranibizumab was seen in vitro on both human BECs and LECs with a significance of p < 0.0001 and p < 0.0004, respectively. In vivo experiments showed that topical application of Ranibizumab significantly inhibits both hemangiogenesis (p = 0.0026) and lymphangiogenesis (p = 0.0026) in the cornea.

Conclusion:  Ranibizumab is a potent inhibitor of inflammatory corneal hemangiogenesis and lymphangiogenesis in vivo with a direct inhibitory effect on both endothelial cell types in vitro. This study for the first time demonstrates an inhibitory effect of Ranibizumab on lymphatic vessels which could have a wider range of clinical applications.

Purpose:  DNA damage has been described in the human cataractous lens epithelium, and oxidative stress generated by UV radiation and endogenous metabolic processes has been suggested to play a significant role in the pathogenesis of cataract. In this study, the aim was to explore the quality and relative quantity of DNA damage in lens epithelium of cataract patients in vivo and after incubation in a cell culture system.

Methods:  Capsulotomy specimens were analysed, before and after 1 week of ex vivo cultivation, using the comet assay to measure DNA strand breaks, oxidized purine and pyrimidine bases and UV-induced cyclobutane pyrimidine dimers.

Results:  DNA strand breaks were barely detectable, oxidized pyrimidines and pyrimidine dimers were present at low levels, whereas there was a relatively high level of oxidized purines, which further increased after cultivation.

Conclusion:  The observed levels of oxidized purines in cataractous lens epithelium may support a theory consistent with light damage and oxidative stress as mediators of molecular damage to the human lens epithelium. Damage commonly associated with UV-B irradiation was relatively low. The levels of oxidized purines increased further in a commonly used culture system. This is of interest considering the importance and versatility of ex vivo systems in studies exploring the pathogenesis of cataract.

Purpose:  The aim of the study was to evaluate the importance of immediate postoperative supine patient positioning after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods:  Forty eyes from 40 patients who underwent DSAEK were randomized into two groups: 20 patients sat in a chair for 2 hr postoperatively (group 1), and 20 patients were placed in a supine position (group 2) for the same time interval. At the end of surgery, the anterior chamber was fully filled with air, aiming at an intraocular pressure (IOP) of approximately 20 mmHg. The dislocation rate in the two groups was registered. IOP was measured 2 hr postoperatively and compared with endothelial cell loss at 6 months.

Results:  There was no statistically significant difference in the dislocation rate between the two groups (p = 0.548): two patients (10%) in group 1 and one patient (5%) in group 2. Endothelial cell loss at 6 months was 29.6% and 29.7% in group 1 and 2, respectively. There was no correlation between the IOP 2 hr after surgery and endothelial cell loss at 6 months (p = 0.741).

Conclusion:  Supine positioning does not seem to be of crucial importance in avoiding graft dislocation in DSAEK when the anterior chamber is fully filled with air for 2 hr postoperatively.

Purpose:  Aquaporins (AQPs) are widely expressed and have diverse distribution patterns in the eye. AQPs 0–5 have been localized at the cellular level in human eyes. We investigated the presence of the more recently discovered AQPs 6–12 in the human eye.

Methods:  RT-PCR was performed on fresh tissue from two human eyes divided into the cornea, corneal limbus, ciliary body and iris, lens, choroid, optic nerve, retina and sclera. Each structure was examined to detect the mRNA of AQPs 6–12. Twenty-one human eyes were examined using immunohistochemical and immunofluorescence techniques to determine the topographical localization of AQPs 6–12.

Results:  mRNA transcripts of AQP7, AQP9 and AQP11 were found in the ciliary body, corneo-limbal tissue, optic nerve, retina and sclera. AQP9 and AQP11 mRNA was also detected in the choroid. No mRNA of AQP6, AQP8, AQP10 or AQP12 was detected. Anti-AQP7 immunolabelling was detected in the corneal epithelium, corneal endothelium, trabecular meshwork endothelium, ciliary epithelia, lens epithelium, the inner and outer limiting membrane of the retina, the retinal pigment epithelium and the capillary endothelium of all parts of the eye. AQP9 immunolabelling was detected in the nonpigmented ciliary epithelium and retinal ganglion cells. AQP11 immunolabelling was detected in the corneo-limbal epithelium, nonpigmented ciliary epithelium and inner limiting membrane of the retina.

Conclusion:  Selective expression of AQP7, AQP9 and AQP11 was found within various structures of the human eye. The detection of these aquaporins in the eye implies a role that may be related not only to water transport but also to the transport of glycerol, lactate and ammonia, with importance for metabolism, especially in the retina.

Purpose:  To establish whether differences in the assessment of diabetic macular oedema (DME) with either optical coherence tomography (OCT) or stereoscopic biomicroscopy lead to variability in the photocoagulation treatment of DME.

Methods:  The differences in the assessment of DME with either OCT or stereoscopic biomicroscopy were analysed by calculating the surface areas and the overlap of retinal thickening. Photocoagulation treatment plans of retinal specialists were compared by evaluating the number and location of planned laser spots.

Results:  The threshold for and dosage of photocoagulation differ depending upon whether the basis of retinal thickness diagnosis is clinical observation or OCT. The overlap in laser spot location based on the assessment of DME with OCT or biomicroscopy averages 51%. Among retinal specialists, the treatment plans differed in the laser spot count by six- to 11-fold.

Conclusion:  Diabetic macular oedema photocoagulation treatment threshold and dosage of laser spots differ depending on whether thickness assessments are based on stereoscopic slit-lamp biomicroscopy or OCT. In addition, retinal specialists differed in the number and placement of planned laser spots even when given identical information concerning DME and treatable lesions. This variability in the photocoagulation treatment of DME could lead to differences in patient outcome and laser study results.

Purpose:  To investigate whether age at onset of type 1 diabetes is a risk factor for clinically significant macular oedema (CSME).

Methods:  A sample of 1354 patients with a mean duration of diabetes 24.6 ± 11.6 years was drawn from the FinnDiane Study population and divided into age at onset groups 0–4 (n = 184), 5–14 (n = 662) and 15–40 years (n = 508). Type 1 diabetes was defined as age at onset ≤40 years, C-peptide negativity and insulin treatment initiated within 1 year of diagnosis. Retinopathy status was assessed from fundus photographs and stereoscopic fundus examinations and graded with the ETDRS scale.

Results:  After 30 years of diabetes, the estimated cumulative incidences of CSME were 17% (95% CI 11–26) in age at onset group 0–4 years, 27% (95% CI 23–32) in age at onset group 5–14 years and 34% (95% CI 27–41) in age at onset group 15–40 years (p = 0.002, Gray’s test). In a competing risks regression model, adjusted for covariates selected with Bayesian information criteria, age at onset 5–14 years (HR 1.89 [95% CI 1.22–2.91], p = 0.004), and age at onset 15–40 years (HR 3.72 [95% CI 2.35–5.89], p < 0.0001), were significant overall risk factors for CSME (p < 0.0001). Higher ETDRS score (HR 1.04 ([95% CI 1.03–1.05], p < 0.0001), HbA_1c (HR 1.12 [95% CI 1.02–1.23], p = 0.016), and total cholesterol (HR 1.19 [95% CI 1.04–1.37], p = 0.013) also increased the risk of CSME.

Conclusions:  Higher age at onset of type 1 diabetes is a significant risk factor for macular oedema. This suggests that ageing may modify the risk of retinopathy in type 1 diabetes.

Purpose:  Leber hereditary optic neuropathy (LHON) is regarded as the most common mitochondrial disease. We have previously reported comprehensive population-based epidemiological data on common mitochondrial DNA (mtDNA) mutations including m.3243A>G, m.8344A>G and large-scale mtDNA deletions in Northern Finland. Our aim was to investigate the prevalence of primary LHON mutations and mutations in the four mtDNA genes considered hot spots for LHON in the same population.

Methods:  The study population consisted of 42 adult patients with an aetiologically undefined bilateral optic atrophy. The major LHON mutations m.3460G>A, m.11778G>A and m.14484T>C were analysed by restriction fragment length polymorphism (RFLP), and MTND1, MTND6 and MTATP6 genes were sequenced. MTND5 gene was analysed by conformation-sensitive gel electrophoresis (CSGE).

Results:  No major LHON mutations were found in the population of the province of Northern Ostrobothnia giving the prevalence of these mutations 0–1.36:100 000 (95% CI). However, two main mutations were found elsewhere in Northern Finland, homoplasmic m.11778G>A from Kainuu and heteroplasmic m.3460G>A from Central Ostrobothnia. Furthermore, tobacco-alcohol amblyopia was diagnosed in five patients in the study population and one of them had m.11778G>A.

Conclusion:  The prevalence of the three major LHON mutations is lower in Northern Finland than elsewhere in Finland or in Western Europe. As LHON and tobacco-alcohol amblyopia have a similar phenotype, we recommend analysing the known LHON-associated mutations before setting tobacco-alcohol amblyopia diagnosis.

Recently, there has been an increase in the use of targeted therapies for cancer treatments. Nevertheless, the ocular side-effects of the commonly used targeted agents are generally under-reported and not well studied in the literature. We conducted multiple searches in databases, including Medline, EMBASE, Cochrane Library and conference proceedings, using the following strings: ‘name of targeted therapeutic agent (both generic and commercial names)’ AND ‘eye OR ocular OR vision OR ophthalmological’. Various targeted agents have been found to be associated with ocular side-effects due to their specific targeting of activities in the eye. Imatinib commonly causes periorbital oedema, epiphora and occasionally conjunctival haemorrhage. Cetuximab causes corneal lesions, meibomian gland dysfunction, periorbital and lid dermatitis, blepharitis and conjunctivitis. Erlotinib is related to various ocular toxicities, mainly on the ocular surface, and perifosine has been reported to be associated with severe keratitis. Bevacizumab could potentially disrupt intrinsic ocular circulation and lead to the development of thromboembolic events; there are rare reported cases of optic neuritis or optic neuropathy. Other targeted agents, such as trastuzumab, sunitinib and crizotinib, also have specific ocular toxicities. In conclusion, ocular effects of targeted agents are not uncommon in cancer patients receiving targeted therapy. Ophthalmologists should have high indexes of suspicion to diagnose and treat these complications promptly.

Purpose:  To compare the mydriatic effect of intracameral mydriatics injected into the anterior or the posterior chamber in routine phacoemulsification cataract surgery.

Methods:  Forty-four patients planned for unilateral phacoemulsification surgery were included after informed consent. Mydriasis was achieved by injecting 150 μl of a mixture of phenylephrine 1.5% and lidocaine 1.0% at the beginning of the procedure. The patients were randomly assigned to injection into the anterior or the posterior chamber. The pupils were filmed during the procedures, and the mean pupil diameters were measured at predetermined intervals from the video recordings by an independent observer.

Results:  Immediately after the injection, the pupils were larger after posterior chamber injection (3.8 ± 0.8 versus 3.1 ± 0.7 mm; p = 0.004). A similar difference was seen after the phacoemulsification (6.4 ± 0.7 versus 5.9 ± 1.0 mm; p = 0.031). The mydriatic durability was also better after posterior injection (p = 0.004–0.041).

Conclusions:  Apart from immediately after the injection, the initial mydriatic response was similar with both injection techniques, but the durability of the mydriasis was slightly better after a posterior chamber injection of ICM.

IgG4-related orbital disease (IgG4-ROD) is a recently described condition that may account for a significant proportion of idiopathic lymphoplasmacytic or sclerotic orbital lesions. This study is the first meta-analysis of published cases and reveals several differences between IgG4-related disease affecting the orbit and that affecting the pancreas. IgG4-ROD affects a slightly younger group of patients, affects men and women approximately equally, is commonly associated with salivary gland lesions, is associated with a relatively higher serum IgG4 and may confer an increased risk of non-Hodgkin Lymphoma. Its pathogenesis may involve an immune response to antigen exposure in the upper aerodigestive tract.

Purpose:  To describe the study design and methodology of the Tromsø Eye Study (TES), and to describe visual acuity and refractive error in the study population.

Methods:  The Tromsø Eye Study is a sub-study of the Tromsø Study, a population-based multipurpose longitudinal study in the municipality of Tromsø, Norway. The Tromsø Eye Study was a part of the sixth survey of the Tromsø Study, conducted from October 2007 through December 2008. The eye examination included information on self-reported eye diseases, assessment of visual acuity and refractive errors, retinal photography and optical coherence tomography. Retinal images were graded for diabetic retinopathy and age-related macular degeneration, and with computer-assisted measurements of arteriolar and venular diameters. In addition, TES researchers have access to the large comprehensive Tromsø Study database including physical examination results, carotid artery ultrasound, electrocardiogram, bone densitometry, cognitive tests, questionnaires, DNA, blood and urine samples and more from the present and the five previous surveys.

Results:  Visual acuity was assessed in 6459 subjects and refraction in 6566 subjects aged 38–87 years. Snellen visual acuity <20/60 was found in 1.2% (95% CI 0.95–1.5) of the participants and there was no gender difference. Visual impairment increased with age, and in the age group 80–87 years, the overall visual acuity <20/60 was 7.3% (95% CI 3.3–11.2). Spherical equivalent showed an increasing trend with age and there was no clinically relevant difference between men and women. Retinal photography was performed in 6540 subjects.

Conclusion:  Prevalence of visual impairment was low but increased with age. There was a trend towards hyperopia with age and no clinically relevant difference in refraction between the sexes. TES aims to provide epidemiological research on several eye and eye-related diseases. Owing to a comprehensive data collection, it has the opportunity to explore issues related to environmental factors, cognition and their interaction with diseases in this community.

Purpose:  Ocular surface reconstruction with cultivated oral mucosal epithelial transplantation technique is a viable treatment option for severe ocular surface injuries and diseases with limbal stem cell deficiency. Currently, this technique is based on utilization of xenogenic, allogenic or undefined components such as murine 3T3 feeders, serum and amniotic membrane. In this study, we aimed to find a more defined culture method to generate stratified human oral mucosal epithelium.

Methods:  In this study, we have examined the formation of stratified cell sheets from human oral mucosal epithelial cells under serum-free culture environment both in the absence and presence of fibroblast-conditioned culture medium and elevated epidermal growth factor (EGF) concentration.

Results:  In all examined culture conditions, the cultivated oral epithelial cells formed a stratified tissue, which was positive for keratins K3/12, K4 and K13. The tissue-engineered oral epithelia also expressed proliferation and progenitor markers Ki67 and p63 in the basal layer of the cell sheets, suggesting that the epithelia still had regenerative capacity. The cultures presented expression of tight junction proteins ZO-1 and occludin and high transepithelial electrical resistance values.

Conclusion:  In this culture method, we have been able to produce stratified cell sheets successfully without serum, conditioning of the medium or increased EGF concentration. We provide a novel protocol to produce tight multi-layered epithelium with proliferative potential, which can be easily adapted for cultivated oral mucosal epithelial transplantation.

Purpose:  Presently, our clinic is the only centre in Scandinavia that offers patients with corneal surface pathology including limbal stem cell deficiency (LSCD) transplantation of ex vivo expanded limbal epithelial cells (LECs). We here present clinical data of the first nine patients with LSCD who were transplanted with autologous LECs expanded in medium completely free of any animal-derived products and non-human/recombinant growth factors (including Cholera Toxin), and with autologous human serum as the only growth supplement.

Methods:  We conducted a noncomparative retrospective study of patients with LSCD at our centre between 2009 and 2011. The diagnosis was based on history and clinical signs. A biopsy was taken from healthy limbus, and the epithelium was expanded on amniotic membrane (AM) in medium containing autologous serum and subsequently transplanted to the affected eye.

Results:  Successful outcome was defined as relief of pain and photophobia and/or improved best corrected visual acuity (BCVA) and/or reestablishment of a stable corneal epithelium and regression of corneal vascularization. Five of the nine transplanted patients (55.6%) had an improvement in either subjective symptoms or objective findings (11- to 28-month follow-up).

Conclusions:  Our clinical study shows that patients with LSCD can be treated successfully with transplantation of LECs expanded ex vivo in a medium with autologous serum as the only growth supplement. The use of this novel culture system, which is devoid of animal-derived products and non-human/recombinant growth factors (including Cholera Toxin), reduces the risks of inter-species disease transmission and host immune responses to xenogenic proteins, both obvious advantages for the patient.

Purpose:  To evaluate the positivity rate of temporal artery biopsies (TAB) performed in suspects of giant cell arteritis (GCA) and to study the epidemiological and clinical factors associated to the biopsy result.

Methods:  A retrospective, multicenter, case–control study was performed, including three hundred and thirty-five patients who underwent TAB for a suspicion of GCA from 2001 to 2010. Clinical, epidemiological and pathology data were recovered from the patients’ clinical records. Histologic diagnosis of GCA was made when active inflammation or giant cells were found in the arterial wall.

Results:  Eighty-one biopsies (24.2%) were considered positive for GCA. Clinical factors independently associated to TAB result in a logistic regression analysis were temporal cutaneous hyperalgesia (OR = 10.8; p < 0.001), jaw claudication (OR = 4.6; p = 0.001), recent-onset headache (OR = 4.4; p = 0.001), decreased temporal pulse (OR = 2.8; p = 0.02), pain and stiffness in neck and shoulders (OR = 2.3; p = 0.05), unintentional weight loss (OR = 1.33; p = 0.003) and age (OR = 1.085; p = 0.004). Other factors such as length of the surgical specimen (OR = 1.079; p = 0.028) and erythrocyte sedimentation rate (OR = 1.042; p < 0.001) were also statistically significant. The model was accurate (C-index = 0.921), reliable (p_{Hosmer–Lemeshow} = 0.733) and consistent in the bootstrap sensitivity analysis. No significant association was detected between TAB result and number of days of previous systemic corticosteroid treatment (p = 0.146). However, an association was observed between TAB result and the total accumulated dose of previous systemic corticotherapy (p = 0.043).

Conclusions:  Exhaustive anamnesis and clinical examination remain of paramount importance in the diagnosis of GCA. To improve the yield of TAB, it should be performed specially in older patients with GCA-compatible clinic. TAB could be avoided in patients with an isolated elevation of acute phase reactants, without GCA-compatible clinic.

Purpose:  To present clinical features and microbial data for bleb-related infections obtained by the 5-year-long Japan Glaucoma Society Survey of Bleb-related Infection (JGSSBI).

Methods:  This multicentre prospective observational study was conducted in 82 clinical centres in Japan. A total of 170 bleb-related infections developed in 157 eyes of 156 patients during a 5-year period. The ophthalmological and microbial data were analysed.

Results:  The patient age at first infection was 59.3 ± 17.7 years [mean ± standard deviation (SD)], and the period between the last glaucoma surgery and the first infection was 6.9 ± 5.8 years (mean ± SD; range: 0.3–41 years). Bleb leakage was noted significantly more frequently in eyes with repeated infections. The stage of infection at diagnosis was stage I in 91 infections (54%), stage II in 30 infections (18%), stage IIIa in 18 infections (11%), and stage IIIb in 31 infections (18%). Staphylococcus species were the most frequently isolated microbe (41%), followed by Streptococcus species (32%). Streptococcus species, coagulase-negative Staphylococcus, Haemophilus influenzae, and Enterococcus species were the major bacteria isolated in the late-stage infections.

Conclusions:  The JGSSBI project has revealed several characteristics of bleb-related infection in Japan, which include the significance of bleb leakage in the development of repeated infections and the distribution of bacterial isolates.

Purpose:  To prospectively study patients presenting with sight-threatening corneal ulcers with a view to identify the predisposing factors, causative organisms, clinical signs and treatment outcomes.

Methods:  Prospectively, over 3-year period, all cases with serious infective keratitis presenting to Queens Medical Hospital in Nottingham, UK, were recruited. Detailed information on the aetiology, culture results, signs & symptoms, the treatment given and the patient’s response was collected and statistically analysed.

Results:  One hundred and forty-three eyes of 129 patients were enrolled. Thirty-one patients were managed as out-patients, and 98 were treated as in-patients. The mean duration of admission was 9 ± 13 days but was significantly higher in older patients and in Acanthamoeba keratitis cases. The important risk factors were ocular surface disease (32%), contact lens wear (26%) and previous ocular surgery (20%). Old age, deep infiltration, steroid use and poor initial vision were risk factors for prolonged course of treatment in bacterial keratitis. Corneal scrapings were done in 89% of the cases, but positive results were obtained only in 41.7%. Staphylococcus aureus was the most common isolated bacteria (18.8%). Acanthamoeba and Pseudomonas aeruginosa were the second and third common causative organisms (16.6% and 15%, respectively). Overall, 8.3% needed corneal grafting, which survived in 83.3% and eradicated infection in 100%.

Conclusion:  Microbial keratitis is an important cause of ocular morbidity. Previous ocular disease is an important predisposing factor. Old age, steroid use and poor presenting visual acuity are important prognostic indicators. Corneal grafting is an effective option for managing recalcitrant corneal infections.

Purpose:  To investigate the prognosis and complications in patients with peripheral multifocal chorioretinitis (PMC). PMC is a posterior or panuveitis characterized by chronic bilateral vitritis and punched-out lesions in the peripheral retina which occurs commonly in elderly white women and is associated with sarcoidosis. Prognosis and complications are largely unknown.

Methods:  A structured literature search in PubMed, Embase and Cochrane was performed to identify relevant articles. Articles were screened, and the remaining articles were critically appraised based on relevance and validity.

Results:  The search yielded 267 articles. Eight relevant articles were retrieved. All studies reported on moderate visual impairment. Macular oedema occurred in 60% of the patients with PMC (range, 0–71%), glaucoma in 27% (range, 25–43%) and an epiretinal membrane in 21% (range, 0–28%). In total, 47% had proven or presumed sarcoidosis. Treatment usually comprised topical corticosteroids, periocular steroid injections and systemic corticosteroids regularly in combination with methotrexate.

Conclusion:  The prognosis of patients with PMC is characterized by a rather poor visual outcome and the relatively high prevalence of complications. PMC is strongly associated with sarcoidosis. Solid proof for the treatment efficacy of PMC is lacking.

Purpose:  Prostaglandin analogues are used to reduce the intraocular pressure (IOP) in glaucoma, but also affect the tone of the arteries supplying the ciliary body. Previously, the effect of prostaglandins has been studied on the extraocular ciliary arteries, whereas the effect on intraocular ciliary arteries has not been studied in detail.

Methods:  Intraocular long posterior porcine ciliary arteries were isolated and mounted in a myograph system for isometric tension recording, and the effects of PGF_2α, the prostaglandin analogue latanoprost, PGD₂, PGE₂, PGI₂ and the thromboxane analogue U46619 were studied in the presence and absence of selective receptor antagonists.

Results:  The prostaglandins PGD₂ and PGE₂ induced relaxation at low concentrations (10⁻⁹ – 3 × 10⁻⁷ m), which could be inhibited by blocking either the DP or the EP₄ receptor, whereas PGD₂, PGE₂, PGF_2α, latanoprost and U46619 induced contraction at high concentrations (10⁻⁶ – 10⁻⁵ m), which could be inhibited by blocking the TP receptor. Additionally, blocking of the FP receptor induced a right-shift of latanoprost-induced contraction.

Conclusions:  Prostaglandins with affinity to DP₁ and EP₄ receptors induce relaxation at low concentrations, and prostaglandins with affinity to TP and FP receptors induce contraction at high concentrations of intraocular porcine ciliary vessels in vitro. The findings may contribute to understanding the regulation of blood flow to the ciliary body.

Purpose:  To evaluate donor demographics, trends in donor tissue procurement and tissue storage over a long period.

Methods:  A retrospective, longitudinal, descriptive analysis was undertaken of data from the Hamburg Eye Bank Data Base (HEB-DB) that had been collected between 1981 and 2010. Data on 54 parameters of cornea donors [including clinical history, age, death cause, gender and death-to-explantation interval (DEI)] and of cultivated corneas (endothelial quality and development in culture, cultivation period, microbiological contamination) were retrieved. These data were analysed statistically, focusing on the historical development of the eye bank.

Results:  At the time of retrieval (June 2010), the HEB-DB contained data on 10 943 corneas (5503 donors). Most donors were men (65%) and had died from cardiopulmonary (n = 801)/cerebral (n = 261) failure or as the result of a polytraumatic accident/suicide (n = 602). Within these years, donor age, DEI and storage time increased. The percentage of stored corneas suitable for transplantation displayed a variable but increasing trend; in 2007, almost 75% of the stored corneas were transplanted. Between 1995 and June 2010, the median microbiological contamination rate was 5.3%. A change in the procurement procedure from enucleation to corneoscleral explantation in 2008 led to a briefly increased contamination rate.

Conclusion:  Donor demographic data run parallel to the general demographic development. Our analysis indicates a dynamic development of the eye bank over the last 30 years and emphasizes the need for an active quality management in coping with the challenges of modern eye banking.

Purpose:  To quantitate the effect of intravenous hypertonic saline (IVHTS) injection on elevated intraocular pressure (IOP).

Methods:  Nineteen patients (median age, 65 years; range, 41–84 years) with glaucoma and an IOP 30 mmHg or higher were recruited. A bolus of IVHTS (sodium chloride concentration 23.4%) was injected in an antecubital vein over 10–20 seconds. The IOP and systolic and diastolic blood pressure (BP) were measured frequently for 2 hr. The dosage was 0.5 mmol/kg sodium in 11 patients (Group 1) and 1.0 mmol/kg in eight patients (Group 2).

Results:  In both groups, a median absolute IOP reduction of 7 mmHg was achieved in 5 min. The maximum median reduction was 7 mmHg (range, 4–16) and 9 mmHg (range, 3–14) at 5 and 16 min after IVHTS in Group 1 and 2, respectively, at which point the median IOP had reduced from 38 and 35 mmHg to 31 and 27 mmHg (p < 0.001), respectively. In both groups, the IOP remained 7 mmHg reduced 2 hr after IVHTS. Systolic BP increased a median of 14.5 mmHg at 3 min and was comparable with baseline after 6 min.

Conclusion:  Intravenous hypertonic saline solution reduces IOP moderately within minutes for up to 2 hr.

Purpose:  The purpose of this study was to compare the efficacy of short-term non-supine positioning (NSP) and strict face-down positioning (FDP) in the repair of macular hole (MH).

Methods:  We retrospectively reviewed all MH repairs over a 27-month period (2008–2010). Inclusion criteria were idiopathic full thickness stage 2–4 MH treated by a single surgeon with 23-gauge pars plana vitrectomy, internal limiting membrane peeling and gas tamponade, followed by postoperative short-term NSP (for 5 days) or strict FDP (for 3–4 days). NSP was achieved by fastening a tennis ball to the back of the nightshirt. Outcome measures were anatomical MH closure verified by optical coherence tomography and postoperative visual acuity.

Results:  A total of 67 eyes (64 patients) met the inclusion criteria. The median follow-up period was 6.6 months (range, 4.7–19.8 months). The closure rates following a single operation were 30/33 (90.9%) in the FDP group, and 31/34 (91.2%) in the NSP group, respectively (p = 0.97). The FDP group improved 2.9 ETDRS lines, and 23 eyes (69.7%) gained two or more ETDRS lines. The NSP group improved 2.7 ETDRS lines (p = 1.00), and 25 eyes (73.5%) gained two or more ETDRS lines. The closure rates in the MH subgroup with diameters larger than 400 μm were 20/23 (87.0%) and 15/17 (88.2%) in the FDP group and the NSP group, respectively (p = 0.96).

Conclusion:  The study indicates that short-term NSP is equally effective as strict FDP in the repair of MH. Contrary to previous reports, even large MH did not seem to benefit from FDP.

Purpose:  Recently, the absence of spontaneous venous pulsation (SVP) has been suggested as a vascular risk factor for primary open-angle glaucoma (POAG). As the mechanism behind this phenomenon is still unknown, the authors have studied this vascular component using colour Doppler imaging (CDI).

Methods:  A total of 236 patients were divided into three diagnostic groups: healthy controls (81), POAG (86) and normal tension glaucoma (NTG; 69). All subjects were submitted to CDI studies of the retrobulbar circulation, intraocular pressure measurements and assessment of SVP existence. Mann–Whitney, chi-square contingency tables and Spearman correlations were used to explore differences and correlations between variables in the diagnostic groups.

Results:  Eighty-two percent of healthy controls had SVP (66/81), while a smaller numbers were registered in both glaucoma groups: POAG – 50% (43/86); NTG – 51% (35/69). In NTG patients, but not in POAG patients, the prevalence of the SVP phenomenon decreases with increased glaucoma damage (p = 0.04; p = 0.55, respectively). Overall glaucoma patients from both groups had lower central retinal vein (CRV) velocities than the healthy controls (p < 0.05). NTG patients with SVP had less severe visual field defects (mean defect −6.92 versus −11.1, p < 0.05), higher [correction added after online publication 21 September 2012; the word ‘higher’ has been inserted to replace the word ‘lower’] peak systolic and mean flow velocities in the central retinal artery (p < 0.01; p < 0.05, respectively) as well as higher [correction added after online publication 21 September 2012; the word higher has been inserted to replace the word lower] maximal velocities and RI of the CRV (p < 0.02; p < 0.05, respectively).

Conclusions:  Glaucoma patients have a decrease in CRV velocities. SVP is less prevalent in glaucoma patients than in healthy individuals. This phenomenon apparently reflects different hemodynamic patterns in the central retinal vessels. This variable may be of particular importance in NTG patients, where it may be associated with more advanced functional damage.

This literature review is aimed at the evaluation of the potential for cataract prevention in Europe. It was performed using PubMed with Mesh and free-text terms. Studies included were (i) performed on a population of Caucasian origin at an age range of 40–95 years, (ii) cataract was clinically verified, (iii) drug record of prescriptions, their indication, a record of every diagnosis, dosage and quantity of prescribed medicine were available, (iv) sample size >300 and (v) published between 1990 and 2009. The results of 29 articles were reviewed. Former [3.75 (2.26–6.21)] or current smoking [2.34 (1.07–5.15)], diabetes of duration >10 years [2.72 (1.72–4.28)], asthma or chronic bronchitis [2.04 (1.04–3.81)], and cardiovascular disease [1.96 (1.22–3.14)] increased the risk of cataract. Cataract was more common in patients taking chlorpromazine during ≥90 days with a dosage ≥300 mg [8.8 (3.1–25.1)] and corticosteroids >5 years [3.25 (1.39–7.58)] in a daily dose >1600 mg [1.69 (1.17–2.43)]. Intake of a multivitamin/mineral formulation [2.00 (1.35–2.98)] or corticosteroids [2.12 (1.93–2.33)] also increased the risk of cataract. Corticosteroids applied orally [3.25 (1.39–7.58)], parenteral [1.56 (1.34–1.82)] or inhalational [1.58 (1.46–1.71)] lead to cataract more frequently than those applied topically: nasal [1.33 (1.21–1.45)], ear [1.31 (1.19–1.45)] or skin [1.43 (1.36–1.50)]. Outpatient cataract surgery was negatively associated with total cataract surgery costs, and chlorpromazine, corticosteroids and multivitamin/mineral formation increase the risk of posterior subcapsular cataract dependent on dose, treatment application and duration. This review presented a comprehensive overview of specific and general cataract risk factors and an update on most recent experimental studies and randomized control trials directed at cataract prevention.

Purpose:  To evaluate 3-year follow-up treatment outcomes with ranibizumab (Lucentis^®) 0.5 mg administered either monthly or quarterly on a pro re nata (PRN) basis according to a disease activity–guided monitoring and treatment algorithm.

Methods:  A total of 316 treatment-naive eyes of 316 patients with exudative age-related macular degeneration met the criteria for inclusion in this retrospective, interventional case series. Patients were treated with ranibizumab 0.5 mg according to a disease activity–guided algorithm with monthly monitoring. Optical coherence tomography and fluorescein angiography were routinely used to assess disease activity: active lesions were treated with a series of three monthly injections, whereas inactive lesions were treated with quarterly injections.

Results:  Mean Early Treatment Diabetic Retinopathy Study best-corrected visual acuity improved from 52 letters at baseline to 59 letters at 12 months, achieved with a mean of 7.1 injections, 61 letters at 24 months with a mean of 5.0 injections administered in the second year and 60 letters at 36 months with a mean number of 5.2 injections.

Conclusions:  Monthly visits and a morphology-driven PRN regimen with 3 injections in case of recurrence plus quarterly injections in case of inactive CNV resulted in an average VA gain of 7–9 letters that could be maintained over 3 years.

Purpose:  To evaluate inferior oblique (IO) underaction related to orbital floor fracture and its management.

Methods:  We retrospectively assessed 137 patients with orbital floor fractures who had undergone surgical repair between July 2003 and August 2009. Review of clinical data, which included photographs and radiologic findings, was performed. IO underaction was diagnosed based on anomalous head position and which was confirmed with the Hess test and limitation of duction and version in the nine diagnostic positions of gaze.

Results:  Twelve patients demonstrated IO underaction pattern (8.8%); 3 patients presented preoperatively and 9 patients presented postoperatively. All the patients showed IO underaction pattern in the Hess test and head tilt position. The median age was 9.5 years (range, 6–24 years), and all the patients were male. Of 12 patients, 10 (85%) presented with nausea and vomiting symptoms, 2 (17%) infraorbital hypoesthesia, and 3 (25%) pupillary dilatation. On the basis of the CT scans, all patients had trap door fractures with soft tissue entrapment. The IO underaction recovered spontaneously within 2 months without any treatment.

Conclusion:  Head tilt towards the injured side can be a warning sign of IO underaction in orbital floor fracture, especially pre- or postoperatively in the paediatric population. Physicians managing paediatric orbital fracture should be aware of this transient complication.

Purpose:  To compare the anatomic success between repair of rhegmatogenous retinal detachment (RRD) with superior breaks and repair of RRD with inferior breaks, by performing primary vitrectomy and using similar techniques and the same gas.

Methods:  Eighty-two consecutive eyes of 80 patients with RRD were included in this retrospective comparative study. The eyes were divided into two groups according to the location of the breaks: superior (n = 62) and inferior (n = 20). All the patients underwent a standard, 3-port, 20-gauge pars plana vitrectomy with 20% sulphur hexafluoride gas tamponade performed by the same surgeon. The main outcome measured was the primary anatomic reattachment at 3 months after surgery.

Results:  The primary anatomic success rate in the inferior group was significantly lower than that in the superior group (80% versus 98%, p = 0.012). In the inferior group, the primary anatomic success rate in patients whose symptoms lasted for more than 2 weeks was significantly lower than that in others (5/9 versus 11/11, p = 0.026). Multivariate logistic regression analysis identified inferior break as the only independent risk factor for redetachment (odds ratio, 11.88; p = 0.034).

Conclusion:  The anatomic success of primary vitrectomy for RRD with inferior breaks is lower than that for RRD with superior breaks. In particular, the duration of symptoms longer than 2 weeks is associated with a worse outcome in patients who had RRD with inferior breaks.

The aim of the article is to assess the usefulness of Ludwik Fleck’s theory of thought-styles for the history of ophthalmology. On the basis of Fleck’s ideas, the authors attempt to analyse the development of concepts of vision. They enumerate three styles in the history of ophthalmology: humoral, iatromechanical and micro-tissue. In conclusion, they state that the history of evolution of the concept of vision should be considered not only from the perspective of achievements of individual scientists but also with the addition of the social ‘mood’ that prevailed in a given historical period.

Purpose:  The aim of the study was to investigate prevalence of visual impairment in rural central India.

Methods:  The population-based Central India Eye and Medical Study included 4711 subjects with an age of 30+ years. Presenting visual acuity (PRVA) and best-corrected visual acuity (BCVA) were recorded. Visual impairment and blindness were defined using the World Health Organization (WHO) standard and United States (US) standard.

Results:  On the basis of PRVA and using WHO and US standards, 1049 [22%; 95% confidence interval (CI): 21.1, 23.5] subjects and 1290 (27%; 95% CI: 26.1, 28.7) subjects, respectively, were visually impaired, and 35 (0.7%; 95% CI: 0.5, 1.0) subjects and 116 (2.5%; 95% CI: 2.0, 2.9) subjects, respectively, were blind. The corresponding age-standardized prevalence figures were 17%, 21%, 0.5% and 2%, respectively. Using best-correcting glasses could eliminate PRVA-visual impairment/blindness in 729 subjects (67% of all subjects with visual impairment/blindness). On the basis of BCVA and using WHO and US standards, 333 (7%; 95% CI: 6.3, 7.8) subjects and 473 (10%; 95% CI: 9.2, 10.9) subjects, respectively, had visual impairment, and 22 (0.5%; 95% CI: 0.3, 0.7) and 31 (0.7%; 95% CI: 0.4, 0.9) subjects, respectively, were blind. Corresponding age-standardized prevalence figures were 5%, 8%, 0.4% and 0.5%, respectively. Causes for BCVA-visual impairment/blindness were cataract (75%), postoperative posterior capsular opacification (4%), surgical complications (2%), corneal opacifications (2%), age-related macular degeneration (2%), other macular diseases (1%), and glaucoma (1%).

Conclusions:  Age-standardized prevalence of PRVA-visual impairment/blindness (WHO definition) in the adult population of rural central India was 17%. Most frequent cause was undercorrected refractive error. Supply of correct glasses is the most efficient way to improve vision in the rural central India.

Purpose:  This study aims to clarify the existence of and to map the localization of different proposed stem cell niches in the corneal limbal region.

Materials and methods:  One human eye was cut into 2200 consecutive sections. Every other section was stained with haematoxylin and eosin, digitized at low and high magnification, aligned, 3D reconstructed and visualized using interactive 3D visualization software. The visualization software has interactive tools that make free rotations in all directions possible and makes it possible to create virtual sections independent of the original cutting plan. In all, one low-magnification and 24 high-magnification interactive 3D models were created. Immunohistochemistry against stem cell markers p63 and ΔNp63α was performed as a supplement to the 3D models.

Results:  Using the interactive 3D models, we identified three types of stem cell niches in the limbal region: limbal epithelial crypts (LECs), limbal crypts (LCs) and focal stromal projections (FSPs). In all, eight LECs, 25 LCs and 105 FSPs were identified in the limbal region. The LECs, LCs and FSPs were predominantly located in the superior limbal region with seven LECs, 19 LCs and 93 FSPs in the superior limbal region and one LEC, six LCs and 12 FSPs in the inferior limbal region. Only few LECs, LCs and FSPs were localized nasally and temporally.

Conclusion:  Interactive 3D models are a powerful tool that may help to shed more light on the existence and spatial localization of the different stem cell niches (LECs, LCs and FSPs) in the corneal limbal region.

Purpose:  To examine retinal function in relation to retinal perfusion pressure in patients with carotid artery stenosis.

Methods:  Thirteen patients with carotid artery stenosis without clinical eye disease underwent assessment of ophthalmic artery systolic blood pressure (OSP) by ocular pneumoplethysmography, carotid artery obstructive disease by ultrasonography, intraocular pressure by applanation tonometry, retinal perfusion by fluorescein angiography and retinal function by multifocal electroretinography (mfERG). Data analysis compared the eye on the most stenotic side with the fellow eye in the same patient.

Results:  Ophthalmic systolic pressure was 95.8 ± 13.1 mmHg on the side with the highest degree of carotid artery stenosis (mean 94.0%) and 111.7 ± 10.3 mmHg in the fellow eyes on the side with the lesser degree of stenosis (mean 33.9%). Summed mfERG implicit times (N1 and P1) were 3.4% and 2.0% longer (p = 0.013 and 0.021), and N1 and P1 amplitudes were 18.0% and 16.0% (p = 0.0041 and 0.020) lower in eyes on the side with the higher stenosis compared with the contralateral eyes. Shorter implicit times and higher amplitudes were correlated with higher brachial systolic arterial blood pressure (p = 0.0028, 0.011, 0.041 for N1, P1, N2 implicit times, respectively, and p = 0.0086, 0.016, 0.040 for N1, P1, N2 for amplitudes, respectively, corrected for OSP).

Conclusion:  Cone function deviation was observed in clinically healthy eyes on the side with highest degree of carotid artery stenosis and was found correlated to arterial blood pressure.

Purpose:  The Finnish distribution of clinical Usher syndrome (USH) types is 40% USH3, 34% USH1 and 12% USH2. All patients with USH3 carry the founder mutation in clarin 1 (CLRN1), whereas we recently reported three novel myosin VIIA (MYO7A) mutations in two unrelated patients with USH1. This study was carried out to further investigate the USH mutation spectrum in Finnish patients.

Methods:  We analysed samples from nine unrelated USH patients/families without known mutations and two USH3 families with atypically severe phenotype. The Asper Ophthalmics USH mutation chip was used to screen for known mutations and to evaluate the chip in molecular diagnostics of Finnish patients.

Results:  The chip revealed a heterozygous usherin (USH2A) mutation, p.N346H, in one patient. Sequencing of MYO7A and/or USH2A in three index patients revealed two novel heterozygous mutations, p.R873W in MYO7A and c.14343+2T>C in USH2A. We did not identify definite pathogenic second mutations in the patients, but identified several probably nonpathogenic variations that may modify the disease phenotype. Possible digenism could not be excluded in two families segregating genomic variations in both MYO7A and USH2A, and two families with CLRN1 and USH2A.

Conclusion:  We conclude that there is considerable genetic heterogeneity of USH1 and USH2 in Finland, making molecular diagnostics and genetic counselling of patients and families challenging.

Purpose:  To describe sequential phacoemulsification–intraocular lens (IOL) implantation–posterior capsulorhexis–anterior vitrectomy in the management of phakic malignant glaucoma.

Methods:  Twenty consecutive patients (25 eyes) with phakic malignant glaucoma were enrolled at the Zhongshan Ophthalmic Center, Sun Yat-sen University. All patients underwent phacoemulsification, IOL implantation and posterior capsulorhexis together with anterior vitrectomy via a clear corneal paracentesis. Visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), surgical complications and medications required after the surgery were recorded.

Results:  After surgery, the mean LogMAR visual acuity and ACD increased significantly (visual acuity from −1.56 ± 1.17 to −0.54 ± 0.81, p < 0.001; ACD from 0.367 ± 0.397 mm to 2.390 ± 0.575 mm, p < 0.001), and mean IOP decreased significantly (from 39.6 ± 10.6 mm Hg to 14.5 ± 4.1 mmHg, p < 0.001). No serious perioperative complications occurred, and only five eyes required topical glaucoma medications after surgery.

Conclusion:  Combined phacoemulsification–IOL implantation–posterior capsulorhexis–anterior vitrectomy surgery is a safe and effective method for treating patients with phakic malignant glaucoma.

Purpose:  To investigate construct validity for modules hydromaneuvers and phaco on the Eyesi surgical simulator.

Methods:  Seven cataract surgeons and 17 medical students performed capsulorhexis, hydromaneuvers, phaco, navigation, forceps, cracking and chopping modules in a standardized manner. Three trials were performed on each module (two on phaco) in the above order. Performance parameters as calculated by the simulator for each trial were saved. Video recordings of the second trial of the modules capsulorhexis, hydromaneuvers and phaco were evaluated with the modified Objective Structured Assessment of Surgical Skill (OSATS) and Objective Structured Assessment of Cataract Surgical Skill (OSACSS) tools.

Results:  Cataract surgeons outperformed medical students with regard to overall score on capsulorhexis (p < 0.001, p = 0.035, p = 0.010 for the tree iterations, respectively), navigation (p = 0.024, p = 0.307, p = 0.007), forceps (p = 0.017, p = 0.03, p = 0.028). Less obvious differences in overall score were found for modules cracking and chopping (p = 0.266, p = 0.022, p = 0.324) and phaco (p = 0.011, p = 0.081 for the two iterations, respectively). No differences in overall score were found on hydromaneuvers (p = 0.588, p = 0.503, p = 0.773), but surgeons received better scores from the evaluations of the modified OSATS (p = 0.001) and OSACSS (capsulorhexis, p = 0.003; hydromaneuvers, p = 0.017; phaco, p = 0.001).

Conclusions:  Construct validity was found on several modules previously not investigated (phaco, hydromaneuvers, cracking and chopping, navigation), and our results confirm previously demonstrated construct validity for capsulorhexis and forceps modules. Interestingly, validation of the hydromaneuvers module required OSACSS video evaluation tool. A further development of the scoring system in the simulator for the hydromaneuvers module would be advantageous and make training and evaluation of progress more accessible and immediate.

Purpose:  Ocular motility disturbances are common in a number of neuropaediatric and neurometabolic disorders. Assessment of ocular motor function can be a source of information for diagnosis and follow-up of these patients.

Aim:  To evaluate a new clinical ocular motor function test: ocular motor score (OMS) and provide reference values in children and young adults without known ocular or neurological disorders.

Material and Methods:  A total of 233 children and young adults, 103 males and 130 females between the ages of 6 months and 19 years, were assessed according to a specific OMS protocol. They were divided into four different age groups: 0.5–3, 4–6, 7–10 and 11–19 years. The OMS protocol consists of 15 different subtests evaluating ocular motor function, and a total score of minimum 0 up to max 15 can be obtained: the minimum score, 0, is considered normal while 1 represents an abnormal function.

Results:  The median OMS in the whole reference group was 0.3 (range 0–4.8). The median OMS in the different age groups, starting with the youngest, was: 0.9 (range 0.3–4.8), 0.3 (range 0–3.4), 0.3 (range 0–2.3) and 0 (range 0–3.5), respectively. The youngest subjects, aged 0.5–3, showed a significantly higher total OMS compared with the other age groups (p < 0.001).

Conclusion:  This study provides reference values for the OMS test in a population aged 0.5–19 years. The test may be valuable as a screening tool for identification and follow-up of ocular motor dysfunction in children and young adults.

Purpose:  To examine size and frequency of parapapillary atrophy (beta zone) in patients with intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary optic disc region.

Methods:  Thirty-four Chinese subjects with intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary optic disc region and 129 age-matched subjects randomly selected from the population-based Beijing Eye Study were enrolled. Beta zone was measured on fundus photographs. Size and location of the tumours were assessed on neuroradiological images.

Results:  Beta zone was significantly more common (79 ± 7% versus 46 ± 4%; p = 0.001), and it was significantly larger in the tumour group than in the control group (circumferential extent: 135 ± 99 versus 57 ± 72; p < 0.001; relative area: 1856 ± 1923 versus 759 ± 1390; p = 0.002). The width of the intracerebral tumours was significantly associated with the circumferential extent of beta zone (r = 0.36, p = 0.039) and with the area of beta zone (r = 0.37, p = 0.032). Tumour width, height and depth were significantly (p = 0.001; p = 0.012; and p < 0.001, respectively) larger in the group of patients with beta zone than in the subgroup of patients without beta zone of parapapillary atrophy.

Conclusions:  Patients with large intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary region as compared with a population-based control group had a significantly larger and more frequently occurring beta zone of parapapillary atrophy. It suggests that large parasellar or suprasellar tumours can be associated with typical glaucomatous abnormalities in the parapapillary and intrapapillary region of the optic nerve head. It may give hints for the pathogenesis of glaucomatous optic neuropathy.

Purpose:  Approximately 50% of patients with uveal melanomas develop metastases. Thus, it is important to improve our understanding of how melanoma metastases develop.

Methods:  As part of a uveal melanoma micrometastasis study, we compared the detection rates of immunomagnetically selected (IMS) tumour cells in bone marrow (BM) with positively stained tumour cells using immunocytochemistry (ICC). Bone marrow mononuclear cells were isolated. Immunocytochemistry cytospin preparations were immunocytochemically stained in parallel with two different melanoma antibodies, 9.2.27 and HMB45. Using IMS, melanoma cells were selected from BM mononuclear cell fractions using immunomagnetic beads coated with the 9.2.27 antibody and identified by light microscopy.

Results:  In cytospin preparations from 226 patients, melanoma cells were detected in 24 (10.6%), 10 with 9.2.27 and 17 with the HMB45 antibody. In three cases, we found positive cells with both antibodies. Six of the 226 (2.6%) patients that stained positively with ICC died with metastatic disease, all also positive with IMS. Sixty-six (29.2%) patients had positive BM samples with IMS at the first examination. Immunomagnetic selection (IMS) was positive in 36.8% of the 57 patients who later developed clinical metastases. Twenty-one IMS-positive patients and 31 IMS-negative patients died of metastases, in total 52 of 226 patients (23.0%). The mortality rate of melanoma metastasis was 24% (6/24) after at least 4 ½ years in ICC-positive patients compared to 38.5% (20/52) in IMS-positive patients.

Conclusion:  The presence of melanoma cells in BM of patients with uveal melanoma is documented in our study with IMS and ICC. Immunomagnetically selected is more sensitive than ICC in detecting tumour cells in BM. However, statistically, we did not find any prognostic impact of the presence of melanoma cells in BM.

Purpose:  To compare clinicians and a trained artificial neural network (ANN) regarding accuracy and certainty of assessment of visual fields for the diagnosis of glaucoma.

Methods:  Thirty physicians with different levels of knowledge and experience in glaucoma management assessed 30-2 SITA Standard visual field printouts that included full Statpac information from 99 patients with glaucomatous optic neuropathy and 66 healthy subjects. Glaucomatous eyes with perimetric mean deviation values worsethan −10 dB were not eligible. The fields were graded on a scale of 1–10, where 1 indicated healthy with absolute certaintyand 10 signified glaucoma; 5.5 was the cut-off between healthy and glaucoma. The same fields were classified by a previously trained ANN. The ANN output was transformed into a linear scale that matched the scale used in the subjective assessments. Classification certainty was assessed using a classification error score.

Results:  Among the physicians, sensitivity ranged from 61% to 96% (mean 83%) and specificity from 59% to 100% (mean 90%). Our ANN achieved 93% sensitivity and 91% specificity, and it was significantly more sensitive than the physicians (p < 0.001) at a similar level of specificity. The ANN classification error score was equivalent to the top third scores of all physicians, and the ANN never indicated a high degree of certainty for any of its misclassified visual field tests.

Conclusion:  Our results indicate that a trained ANN performs at least as well as physicians in assessments of visual fields for the diagnosis of glaucoma.

Purpose:  To project the number of persons with late age-related macular degeneration (AMD) in Scandinavia through 2040.

Methods:  Age- and sex-specific prevalence rates of late AMD (choroidal neovascularization and geographic atrophy) from the European Eye Study and the Eye Diseases Prevalence Research Group were applied to the projected Danish, Norwegian and Swedish population from 2012 to 2040.

Results:  A total of 187 000 persons aged ≥65 years in Scandinavia are currently affected by late AMD: 47 000 in Denmark, 43 000 in Norway and 97 000 in Sweden. Owing to an ageing population, the number of persons affected by late AMD will increase 75% to 328 000 in 2040.

Conclusion:  The number of patients with late AMD in Scandinavia is expected to increase substantially over the next three decades, resulting in increased demand for ophthalmic health services.

Purpose:  To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo^®) used to close the conjunctiva in trabeculectomy.

Methods:  A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture (n = 29) or using the fibrin glue (n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self-reported discomfort and complications arising during and after surgery.

Results:  No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow-up. In the first 2 weeks of follow-up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo^® group. Two patients in the Tissucol Duo^® group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups.

Conclusion:  The use of Tissucol Duo^® seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period.

Purpose:  The European Board of Ophthalmology Diploma (EBOD) examination has evolved over the last few years, especially with the introduction of negative marking (−0.5 points) for incorrect or blank answers (0 points for don’t know option), which aimed to improve the quality and reliability of the examination.

Methods:  In 2010, negative marking at the written part of the EBOD examination has been introduced in an attempt to improve not only the reliability of the examination as entity but also the statistical performance parameters of the individual questions. As lower pass rates and discrimination of female candidates are feared by the general public when negative marking is concerned, these parameters have been explicitly investigated.

Results:  Introduction of negative marking has not only lead to improved reliability of the EBOD examination (increased Cronbach’s alpha value: ≤0.80 without and ≥0.90 with negative marking), but also to improved statistical performance parameters of the individual questions. The pass rate of the EBOD examination has proven to remain at the same high level as without negative marking (around 90%). Furthermore, although female candidates do seem to have different answering strategies (p < 0.01, use of don’t know option), no statistically significant difference has been found between total scores of male and female candidates (p > 0.05).

Conclusion:  Introduction of negative marking at the written EBOD examination has proven to be beneficial, not only for the organizers (improvement of the statistical performance of the examination and its questions), but also for candidates (better discrimination with borderline candidates). These results have been obtained without evidence of lower pass rates or discrimination of female candidates.

Purpose:  To evaluate phenotypes caused by different RLBP1 mutations in autosomal recessive retinitis pigmentosa of Bothnia type.

Methods:  Compound heterozygotes for mutations in the RLBP1 gene [c.677T>A]+[c.700C>T] (p.M226K+p.R234W), n = 10, aged 7–84 years, and homozygotes c.677T>A (p.M226K), n = 2, aged 63 and 73 years, were studied using visual acuity (VA), low-contrast VA, visual fields (VFs) and optical coherence tomography (OCT). Retrospective VA and VFs, standardized dark adaptation and full-field electroretinograms (ERGs) were analysed and prolonged dark adaptometry and ERG (at 24 hr) were performed.

Results:  Progressive decline of VA and VF areas was age-dependent. Retinal degenerative maculopathy, peripheral degenerative changes and retinitis punctata albescens (RPA) were present. Early retinal thinning in the central foveal, foveal (Ø 1 mm), and inner ring (Ø 3 mm) in the macular region, with homogenous, high-reflectance RPA changes, was visualized in and adjacent to the retinal pigment epithelium/choriocapillaris using OCT. Reduced dark adaptation and affected ERGs were present in all ages. Prolonged dark adaptation and ERG (at 24 hr), an increase in final threshold, and ERG rod and mixed rod/cone responses were found.

Conclusions:  The two RLBP1 genotypes presented a phenotypical and electrophysiological expression of progressive retinal disease similar to that previously described in homozygotes for the c.700C>T (p.R234W) RLBP1 mutation. The uniform phenotypical expression of RLBP1 mutations is relevant information for the disease and of importance in planning future treatment strategies.

Purpose:  To compare the clinical characteristics of eyes with childhood-onset to those with adult-onset optic disc pit maculopathy.

Methods:  Twenty-seven eyes of 25 patients with optic disc pit maculopathy were reviewed. The clinical characteristics, clinical history including a history of blunt trauma, ophthalmoscopic evaluations and intraoperative findings in the childhood-onset (age <15 years, four eyes of four patients) cases were compared with those in the adult-onset (≥15 years, 23 eyes of 21 patients) cases of optic disc pit maculopathy. The strength of the vitreous adhesions was graded by what was required to create a posterior vitreous detachment (PVD); grade 1 = with vitreous cutter, grade 2 = by microhook or forceps and grade 3 = by forceps with removal of remnants of Cloquet’s canal.

Results:  The incidence of visual impairments following blunt trauma was significantly higher in childhood-onset (three of four eyes) than that of adult-onset (0 of 23 eyes, p = 0.0014). Vitreous surgery with creation of a PVD was performed in the four childhood-onset eyes and 18 adult-onset eyes after an absence of a spontaneous resolution. The grade of the vitreous adhesions was significantly higher in childhood-onset than in adult-onset eyes (p = 0.0096).

Conclusions:  An ocular trauma may provide an opportunity to detect optic disc pits. However, childhood-onset optic disc pit maculopathy was noted most commonly following blunt ocular trauma in eyes with a strong vitreous adhesion to the optic disc margin.

Purpose:  To evaluate the association between telomere length and age-related macular degeneration (AMD).

Methods:  Circulating leucocyte telomere length and the proportion of telomeres <5 kb were analysed in blood DNA samples taken from 121 patients with exudative AMD (83%), large drusen (14%) or central geographic atrophy (3%). Controls consisted of 77 age-matched subjects without AMD. The AMD status was assessed by a masked analysis of fundus photographs or angiographs. Telomere length was measured by Southern blotting.

Results:  Mean (SD) telomere length was 7.76 kb (0.68) in AMD patients and 7.83 (0.69) in controls (p = 0.485). The corresponding proportions of telomeres <5 kb were 10.60 (2.76) and 10.05 (2.64) (p = 0.197). In this material, there was no correlation between telomere length and age, gender or smoking status. There were no differences between the major AMD risk single-nucleotide polymorphisms (SNPs) of the CFH, HTRA1 or C3 genes, expect for somewhat longer telomeres in controls with the C3 risk SNP. There were no differences in telomere length between patients with drusen or exudative AMD.

Conclusions:  Telomere length is not associated with exudative AMD or high-risk drusen.

Relapsing ocular involvement is one of the major manifestations in Behçet disease (BD). When ocular BD is left untreated, it often results in blindness in <5 years. Combining systemic corticosteroids with cyclosporine A and other conventional immune modulating agents has been the only choice for treatment. More recently, the introduction of ‘biologics’ seems to be an effective therapy in patients affected with BD, especially in those with ocular disease. Our purpose was to survey the current knowledge regarding the biological therapeutic approaches for Behçet uveitis. We focused on the most commonly used biological agents: ‘tumor necrosis factor-alpha antagonists’ and ‘interferon alpha’. We attempted to compare the effectiveness of these two biologicals and tried to balance on the pros and cons of these agents in clinical practice. The impressive efficacy of both approaches in sight-threatening BD argues for their expanding role. Earlier introduction of these agents in the course of disease may prevent irreversible structural damage and may result in improved long-term prognosis.

Purpose:  To assess and correlate the levels of inflammatory mediators in the eyes from non-diabetic and diabetic subjects without retinopathy (NDR), with non-proliferative diabetic retinopathy (NPDR) or with proliferative diabetic retinopathy (PDR) to corresponding erum levels.

Methods:  The levels of interleukin 1β, interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were analysed by an ELISA-mimicking technique in the vitreous from 26 diabetic subjects with active PDR and 27 non-diabetic subjects, or by a multiplex bead assay in the aqueous humour from 35 diabetic subjects with NDR/NPDR and 40 non-diabetic subjects. Intraocular protein production was estimated in vitreous specimens by calculating a vitreous/serum ratio.

Results:  In the vitreous, IL-6 was higher in diabetic [157.5 (25.0–1401.0) pg/ml; median (min–max)] than in non-diabetic subjects [44.0 (5.0–4425) pg/ml; p = 0.021]. The vitreous/serum ratio was high (55.5:1 and 16:1, respectively), suggesting intraocular production. TNF-α was lower in diabetic [18.0 (8.0–46.0) pg/ml] than in non-diabetic subjects [22.0 (13.0–47.0) pg/ml; p = 0.034], but the vitreous/serum ratio was elevated in both groups (2:1 and 3.4:1, respectively). TNF-α levels were higher in serum from diabetic subjects [9.0 (5.0–53.0) pg/ml versus 6.7 (3.0–11.0) pg/ml; p < 0.001]. Aqueous levels of inflammatory mediators did not differ between diabetic subjects with NDR/NPDR and non-diabetic subjects despite elevated TNF-α in serum [27.8 (6.8–153.7) pg/ml versus 16.4 (4.1–42.4) pg/ml; p = 0.021].

Conclusion:  Intraocular inflammation seems to be involved in PDR but does not seem to be prominent in early retinopathy stages, i.e. NDR or NPDR. Diabetic subjects have an overall increased inflammatory activity compared to non-diabetic subjects, as demonstrated by increased serum levels of TNF-α.

Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.

Purpose:  To present our initial clinical experience with ReLEx^® flex (ReLEx) for moderate to high myopia. We compare efficacy, safety and corneal higher-order aberrations after ReLEx with femtosecond laser in situ keratomileusis (FS-LASIK).

Methods:  Prospective study of ReLEx compared with a retrospective study of FS-LASIK. ReLEx is a new keratorefractive procedure, where a stromal lenticule is cut by a femtosecond laser and manually extracted. Forty patients were treated with ReLEx on both eyes. A comparable group of 41 FS-LASIK patients were retrospectively identified. Visual acuity, spherical equivalent (SE) and corneal tomography were measured before and 3 months after surgery.

Results:  Preoperative SE averaged −7.50 ± 1.16 D (ReLEx) and −7.32 ± 1.09 D (FS-LASIK). For all eyes, mean corrected distance visual acuity remained unchanged in both groups. For eyes with emmetropia as target refraction, 41% of ReLEx and 61% of FS-LASIK eyes had an uncorrected distance visual acuity of logMAR ≤ 0.10 at day 1 after surgery, increasing to, respectively, 88% and 69% at 3 months. Mean SE was −0.06 ± 0.35 D 3 months after ReLEx and −0.53 ± 0.60 D after FS-LASIK. The proportion of eyes within ±1.00 D after 3 months was 100% (ReLEx) and 85% (FS-LASIK). For a 6.0-mm pupil, corneal spherical aberrations increased significantly less in ReLEx than FS-LASIK eyes.

Conclusions:  ReLEx is an all-in-one femtosecond laser refractive procedure, and in this study, results were comparable to FS-LASIK. Refractive predictability and corneal aberrations at 3 months seemed better than or equal to FS-LASIK, whereas visual recovery after ReLEx was slower.

Purpose:  To evaluate the incidence rate, distribution, patient characteristics and indications for surgical intervention of lacrimal gland lesions in Denmark between 1974 and 2007.

Material and methods:  All biopsied/surgically removed lacrimal gland lesions in Denmark during the period 1974–2007 were identified by searching two population-based registries. Specimens were collected and re-evaluated. The following data were collected: age, gender, indications for surgical intervention and local recurrence.

Results:  A total of 232 lesions from 210 patients with a histologically verified lesion of the lacrimal gland were included. The incidence rate of lacrimal gland lesions was 1.3/1 000 000/year. The overall annual age- and gender-adjusted incidence rate more than doubled during the study period, owing to an increase in non-malignant lesions. Approximately half of the lesions were neoplasms (119) and 55% (66) of these were malignant. Dacryops constituted 10% (24), inflammatory lesions 27% (62), normal tissue 12% (27), benign tumours 23% (53) and malignant tumours 29% (66). Patients with malignant neoplasms were significantly older than patients with benign neoplasms (63 versus 48 years, p < 0.001). The indication for surgical intervention was suspicion of a tumour in more than 90% of the neoplastic lesions and in 30% of the non-neoplastic lesions.

Conclusion:  Lacrimal gland lesions that require surgical evaluation are rare in the Danish population and represent a wide spectrum of diagnoses, mostly benign. The overall incidence rate of biopsied lacrimal gland lesions is increasing.

Purpose:  To investigate the change in subfoveal choroidal blood flow in patients with glaucoma and to assess the effect of myopia, as one of the vascular risk factors for glaucoma on this flow.

Methods:  Subfoveal choroidal blood flow in groups of 12 myopic and glaucomatous eyes has been investigated by means of the laser Doppler flowmetry (LDF), comparing the results with those of 17 myopic eyes without glaucoma, 34 non-myopic glaucomatous eyes and of 50 control eyes. The subfoveal choroidal LDF parameters, that is, blood velocity (ChBVel), volume (ChBVol), and flow (ChBF), as well as the vascular resistance were studied in each group. Statistical analysis was performed by means of anova and t-test according to the Bonferroni procedure for multiple comparisons. Pearson correlation was used to establish the correlations between the hemodynamic parameters and the degree of myopia in dioptres.

Results:  All LDF parameters (ChBVel, ChBVol and ChBF) were significantly reduced in glaucomatous patients (1.3 ± 0.4, 0.14 ± 0.06 and 4 ± 2 respectively) and myopic patients with primary open-angle glaucoma (POAG) (1.3 ± 0.4, 0.08 ± 0.04 and 2 ± 0.7 respectively) and without POAG (1.2 ± 0.3, 0.11 ± 0.08 and 2 ± 1 respectively) in comparison with age-matched controls (1.5 ± 0.4, 0.27 ± 0.1 and 8 ± 2 respectively). On the other hand, the choroidal vascular resistance (Rm) was increased in the previously described studied patients groups (16 ± 7, 26 ± 9 and 24 ± 9 respectively) compared with controls (7 ± 2). The LDF parameters did not differ significantly between myopic subjects without and with POAG (p = 0.09, p = 0.09, p = 0.2, p = 0.08 and p = 0.9 respectively). Compared to patients with emmetropic glaucomatous, significant reduction in the ChBVol and ChBF and increased Rm were recorded in patients with glaucomatous myopia (p = 0.05, p = 0.04 and p = 0.04 respectively).

Pearson correlation demonstrated a significant correlation between the degree of myopia in dioptres and the ChBF (p = 0.012).

Conclusions:  The subfoveal choroidal LDF parameters were reduced in patients with POAG and myopia. Theses alterations are more in glaucomatous patients with myopia in comparison with age-matched glaucomatous patients without myopia. These data suggest that the impaired choroidal circulation caused by myopia might be an important additional risk factor involved in the glaucomatous damaging process.

Purpose:  To describe the age-related change in contrast sensitivity seen in 35- to 80-year-old men in an Australian population.

Methods:  The Florey Adelaide Male Ageing Study (FAMAS) is a prospective population-based study of men aged 35–80 years randomly selected from the north-west suburbs of Adelaide. We conducted a nested ophthalmic substudy of these men. Contrast sensitivity (CS) was measured at four spatial frequencies (3, 6, 12 and 18 cycles/degree [cpd]) using the Vectorvision CSV-1000 contrast sensitivity test chart (Vectorvision, Dayton, OH, USA), and results were statistically analysed relative to age and cataract type.

Results:  There were 2650 eligible subjects in the FAMAS and 1195 participated (45.1%); 472 of those participated in the ophthalmic substudy. A statistically significant decrease in contrast sensitivity was seen with advancing age at each spatial frequency tested [Generalized estimating equations (GEE) multiple linear regression: p ≤ 0.01]. The decline with age was greatest in the highest spatial frequency (18 cpd) and least in the lowest spatial frequency (3 cpd). Posterior subcapsular cataract caused the greatest reduction in contrast sensitivity at all spatial frequencies, while nuclear cataract caused significant reduction only in the intermediate (12 cpd) and high (18 cpd) spatial frequencies. Cortical cataract failed to reach statistical significance in contrast sensitivity reduction at all spatial frequencies tested.

Conclusion:  Contrast sensitivity declines with age in all spatial frequencies tested with a greater decline occurring in the higher spatial frequencies. Age and cataracts are independently associated with contrast sensitivity decline, and posterior subcapsular cataracts caused the greatest reduction at all spatial frequencies.

Purpose:  To evaluate the learning curve for the surgery of primary nasal pterygium with conjunctival autograft using fibrin adhesive (the Cut and Paste method).

Methods:  The outcomes of the first consecutive 120 primary pterygium surgery cases for two surgeons (groups A and B) were investigated retrospectively and compared with the first (group C) and second (group D) 120 cases of GK. A and B were previously inexperienced in pterygium surgery. Outcome variables were surgery time, complications, the number and the temporal distribution of the recurrences. The statistics used were moving averages of the recurrences, Scheffé’s test of means, learning curve analysis according to Wright and logarithmic curve fitting to operation time data. The impact of age and sex on recurrences was tested using t-tests and chi-square tests.

Results:  The mean surgery time was 17 min for A, 13 min for B and 13 min for GK. There was a certain learning curve slope in operation time in groups A and C. The postoperative complications were few and acceptable. There were ten (8.9%) recurrences in group A, eight (6.8%) in group B, six (5.5%) in group C and five (4.6%) in group D. The temporal distribution of the recurrences did not show any learning curve. Age and sex had no significant correlation with recurrence rate or surgery time (data not shown).

Conclusions:  Our study indicates that the Cut and Paste technique is easy to learn and master. We did not find a significant learning curve regarding surgery time, recurrences or complications. In a clinical setting, it is beneficial to let a few, otherwise experienced eye surgeons learn the technique.

Purpose:  To evaluate known and potential risk factors, including nutritional, lifestyle and environmental factors, differentiating patients with high-tension primary open-angle glaucoma (POAG) from control subjects with ocular hypertension (OHT).

Methods:  In 2006–2007, 111 French ophthalmologists prospectively enrolled 339 cases of POAG and 339 age-matched controls with OHT. After a clinical examination with assessment of ocular risk factors, the ophthalmologist filled, during face-to-face interview, a detailed questionnaire developed by nutritionists and epidemiologist on lifestyle and environmental risk factors, including socio-demographic variables, dietary habits related to omega-3 fatty acids intake, smoking and alcohol drinking and professional exposure to pesticides and other chemicals. Associations of POAG with risk factors were estimated using conditional logistic regression, with adjustment for age, gender and duration of disease.

Results:  In the final multivariate model, by comparison with OHT, POAG was significantly associated with more frequent use of pesticides during the professional life [OR = 2.65, 95% confidence interval (CI): 1.04–6.78, p = 0.04] and with low consumption of fatty fish (OR = 2.14, 95% CI: 1.10–4.17, p = 0.02) and walnuts (OR = 2.02, 95% CI: 1.18–3.47, p = 0.01). POAG was also associated with higher frequency of heavy smoking (40 pack-years or more, OR = 3.93, 95% CI: 1.12–13.80, p = 0.03) but not with moderate (20–40 pack-years) and light smoking (<20 pack-years).

Conclusions:  These exploratory observations suggest a protective effect of omega-3 fatty acids and a deleterious effect of heavy smoking and professional exposure to pesticides in POAG. This will need to be confirmed in future studies.

Although the work for which Emil von Behring (1854–1917) was awarded the first Nobel Prize Winner for Medicine or Physiology in 1901 was on serum therapy, not only was he trained and worked as an ophthalmologist but he also wrote his doctoral dissertation on a practical ophthalmological topic whilst in Berlin under Carl Schweigger (1830–1905). He later worked for 3 years as an assistant and co-worker with the famous Polish ophthalmologist Boleslaw Wicherkiewicz (1847–1915), in Poznan where he described an interesting ophthalmic case in a scientific journal. His life and work in other fields have been well studied, but his interests and relationship to ophthalmology that played an important role in, at least part of, Behring’s life have never previously been analysed thoroughly.

Purpose:  Study the clinical and microbiological characteristics and the prognostic factors of post-traumatic endophthalmitis.

Methods:  Seventeen eyes were included between 2004 and 2010, with clinical and microbiological data collected prospectively. Conventional cultures and panbacterial PCR were performed on aqueous and vitreous samples.

Results:  Clinical signs of endophthalmitis were observed soon after trauma (1.5 ± 2.5 days). Laceration with an intraocular foreign body (IOFB) was noted in 53% of the patients. At admission, all patients had aqueous humour (71%) and/or vitreous (53%) samples. Fifteen patients (88%) underwent a pars plana vitrectomy. Bacteria were identified in 77% of the cases: Staphylococcus epidermidis (n = 5), Streptococcus (n = 4), Bacillus (n = 2), Pseudomonas stuzeri (n = 1), and Streptococcus salivarius and Gemella haemolysans (multibacterial infection, n = 1). Progression toward phthisis was observed in 35% of the cases; 41% of the patients recuperated visual acuity (VA) ≥20/40. A good final visual prognosis (≥20/40) was significantly associated with initial VA better than light perception (0% versus 70%, p = 0.01) and absence of pupillary fibrin membrane (80% versus 20%, p = 0.05). There was no correlation between visual prognosis and age, the type of laceration (corneal or scleral) or presence of an IOFB. We found a statistical trend toward an association between bacterial virulence and poor final VA.

Conclusion:  This series showed that better final VA outcomes were associated with initial VA better than light perception, S. epidermidis or culture-negative cases and absence of retinal detachment during the clinical course.

Purpose:  To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma.

Methods:  From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission/relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6–27 months in 28 patients (30 eyes).

Results:  Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus/exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7/16 (43%) newly diagnosed retinoblastomas and 1/22 (4.5%) retinoblastomas undergoing partial remission/relapse. For all treated eyes, Kaplan–Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3–97.5%), 74.4% (95% CI, 57–91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission/relapse, and eyes at presentation, K–M at 2 years were 95.5% (95% CI, 86.9–100%) and 45.6% (95% CI, 16.6–74.6%), respectively.

Conclusion:  Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.

Purpose:  To investigate the association between conjunctival ultraviolet autofluorescence (UVAF), a biomarker of ocular ultraviolet radiation (UVR) exposure, and prevalent pterygium.

Methods:  We conducted a cross-sectional study on Norfolk Island, South Pacific. All permanent residents aged ≥15 were invited to participate. Participants completed a sun exposure questionnaire and underwent autorefraction and slit lamp biomicroscope examination. Area of conjunctival UVAF (sum of temporal/nasal area in right and left eyes) was determined using computerized methods. Multivariate logistic and linear regression models were used to estimate the associations with pterygia and UVAF, respectively.

Results:  Of 641 participants, 70 people (10.9%) had pterygium in one or both eyes, and prevalence was higher in males (15.0% versus 7.7%, p = 0.003). Significant independent associations with pterygium in any eye were UVAF (per 10 mm²) [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.16–1.28, p = 0.002], tanning skin phenotype (OR 2.17, 1.20–3.92, p = 0.010) and spending more than three-quarters of the day outside (OR 2.22, 1.20–4.09, p = 0.011). Increasing quartile of UVAF was associated with increased risk of pterygium following adjustment of age, sex and time outdoors (p_Trend = 0.002). Independent associations with increasing UVAF (per 10 mm²) were decreasing age, time outdoors, skin type and male gender (all p < 0.001). UVAF area correlated well with the duration of outdoor activity (p_Trend < 0.001).

Conclusion:  Pterygium occurs in approximately one-tenth of Norfolk Islanders. Increasing conjunctival UVAF is associated with prevalent pterygia, confirming earlier epidemiological, laboratory and ray-tracing studies that pterygia are associated with UVR. Protection from the sun should be encouraged to reduce the prevalence of pterygium in the community.

Purpose:  To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO).

Design:  Prospective, comparative, randomized, interventional clinical trial.

Methods:  Forty-three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4-mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25-mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months.

Results:  Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow-up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure–lowering medications.

Conclusion:  Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO.

Purpose:  To evaluate the diagnostic yield of optic nerve ultrasonography (US) in distinguishing between papilloedema (swollen discs owing to raised intracranial pressure) and pseudopapilloedema.

Methods:  We prospectively evaluated all patients with bilateral optic disc swelling who underwent a complete neuro-ophthalmological examination. Suitable patients were referred for neuroimaging (computerized tomography or magnetic resonance imaging) and lumbar puncture. They underwent optic nerve US (A-mode and B-mode), and the findings were compared with the final clinical assessment. Sensitivity, specificity and predictive values for US distinction between true papilloedema and pseudopapilloedema were calculated and compared with those of the other imaging tests.

Results:  Forty-four patients were enrolled. Ultrasonography detected papilloedema with a high degree of sensitivity (85%) when the normal optic nerve width (ONW) was set at ≤3.3 mm, and with an even higher degree of sensitivity (95%) when the normal ONW was set at ≤3.0 mm. Ultrasonography had a high negative predictive value for detecting papilloedema: 83% when the normal ONW was set at ≤3.3 mm and 93% when it was set at ≤3.0 mm. There was a significant correlation between the US findings and the final diagnosis (p < 0.001) when the upper limit of the normal ONW was set at 3.0 mm.

Conclusions:  Ultrasonography findings of the ONW correlated well with the final diagnosis of papilloedema or pseudopapilloedema, especially when the upper limit of the normal ONW was set at 3.0 mm. Ultrasonography could be a useful non-invasive technique for differentiating papilloedema from other causes for swollen discs, such as pseudopapilloedema.

Epithelial tumours of the lacrimal gland represent a large spectrum of lesions with similarities in clinical signs and symptoms but with different biological behaviour and prognosis. They are rare, but with aggressive malignant potential. Tumours of the lacrimal gland may present with swelling of the lacrimal gland, displacement of the eyeball, reduced eye motility and diplopia. Pain and symptoms of short duration before the first ophthalmic consultation are characteristic of malignant tumours. The histological diagnosis determines the subsequent treatment regimen and provides important clues regarding the prognosis. The purpose of this paper is to describe the various primary epithelial tumours of the lacrimal gland. In the first part of the review, the frequency, demographics, clinical presentation and diagnostic features are described. In the second part, primarily tumour-specific histological characteristics are given. Finally, treatment modalities including surgical procedures and medical oncology as well as prognosis are discussed.

To determine the efficacy of prisms used for redirection of incoming images towards the peripheral retina in cases with macular function loss. Meta-analysis of published work reporting outcomes from interventions using prisms was performed. The primary outcome measure selected for analysis was visual acuity (VA) used for viewing distance targets. Pooled data from 449 cases where prisms were prescribed for wearing in distance glasses were analysed. Visual acuity was better after using prisms (1.05 versus 0.89 logMAR units, p < 0.044). Mean effect size for improving VA was 79 bigger than the effect size calculated for the control group (0.158 versus 0.002). Most patients (76%) reported compliance with the therapy and also reported other benefits directly derived from the realized VA improvement. Published studies collectively offer positive evidence in support of using prisms for low vision rehabilitation after macular function loss. Further research is required to reach definitive binding conclusions.

Purpose:  To examine the corneal endothelium and establish the 7-year cumulative incidence of cornea guttata (CG).

Methods:  Population-based prospective cohort study with 573 participants (third wave of the Reykjavik Eye Study (RES) in 2008). Four hundred and thirty-seven subjects had either right or left eyes available for analysis after excluding confounding eye conditions. The baseline for eyes at risk for developing CG is the second wave of the RES in 2001. Participants underwent specular microscopy and a standardized eye examination.

Results:  The cumulative 7-year incidence of CG in either eye was estimated as a 95% confidence interval for the expected value for both genders combined (15–23%), for males (8–18%) and for females (19–29%). In right eye only, the 7-year cumulative incidence for both genders combined was estimated to be 6–11%. For genders combined and for males only, the data indicated no correlation between 7-year cumulated incidence and age at baseline. In women, however, the change of 7-year incidence for CG in at least one eye appeared to be correlated to age at baseline. Reduction of endothelial cell density for corneas with CG at baseline was found [CI (0.95)−132 ± 94].

Conclusion:  The cumulative 7-year incidence of primary central CG for a middle-aged and older Caucasian population without history of potentially confounding eye disease has been established. Women tend to have higher incidence if onset occurs at middle age. If CG is present, the cell density and the cell size variation decrease within a 7-year period.

Purpose:  Storage time for donor corneas in Optisol GS is limited compared to Eye Bank Organ Culture (EBOC). We here examine the epithelium on donor corneoscleral rims after primary storage in Optisol GS and subsequent incubation in EBOC.

Methods:  Morphology was monitored by light and electron microscopy, expression of phenotypic and genotypic markers by immunohistochemistry and RT-PCR and changes in oxidative lipid and DNA damage by ELISA and COMET assay.

Results:  A prominent loss of cells was observed after storage in Optisol GS. After maintenance in EBOC, spreading apical cells were Occludin⁺, while the staining for E-cadherin and Connexin-43 was less intense. There were an upregulation of Occludin and a downregulation of E-cadherin and Connexin-43. Eye Bank Organ Culture was associated with an ongoing proliferative activity and a downregulation of putative progenitor/stem cell marker ABCG2 and p63. Staining for 8-OHdG and Caspase-3 did not increase, while levels of malondialdehyde and number of DNA strand breaks and oxidized bases increased.

Conclusions:  This dual procedure should be pursued as an option to increase the storage time and the pool of available donor corneas. The observed downregulation of markers associated with stemness during EBOC is relevant considering the potential use of donor epithelium in the treatment of ocular surface disorders.

Purpose:  To the best of our knowledge, no large population-based studies on the relationship between conjunctival haemorrhage and stroke have been conducted to date. Using a nationwide population-based data set, this study investigated the relationship between conjunctival haemorrhage and the subsequent risk of stroke within a 3-year period following diagnosis.

Methods:  We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2000. The study cohort consisted of 17 349 patients with conjunctival haemorrhage and 86 745 comparison subjects. Each patient was individually tracked for a 3-year period from their index date to identify all those who had subsequently received a diagnosis of stroke.

Results:  The incidence rate of stroke was 2.44 (95% CI = 2.31–2.55) per 100 person-years in patients with conjunctival haemorrhage and 1.63 (95% CI = 1.59–1.68) per 100 person-years in comparison patients. After adjusting for patients’ monthly income and geographic location, as well as for hypertension, atrial fibrillation, diabetes, hyperlipidaemia and coronary heart disease, stratified Cox proportional hazards regressions revealed a statistically significant hazard ratio for stroke in patients with conjunctival haemorrhage (HR = 1.33; 95% CI = 1.24–1.42, p < 0.001).

Conclusions:  In this study, patients with conjunctival haemorrhage were found to be at a significant risk of stroke during a 3-year follow-up period after diagnosis.

Purpose:  To compare posterior capsular opacification in patients with and without pseudoexfoliation syndrome 6–7 years following surgery.

Methods:  Forty-four eyes of 44 patients with pseudoexfoliation syndrome who underwent cataract surgery with phacoemulsification in 2001 and 2002 were available for follow-up in 2008. These patients were compared to 86 age- and gender-matched patients (86 eyes) without pseudoexfoliation syndrome who had surgery during the same time period. Posterior capsule opacification was assessed using digital retroillumination photography. The images were analysed with a software program (POCOman) to determine the extent and severity of the capsular opacification.

Results:  Percentage and severity of posterior capsular opacification within the central 4.0 and 1.3 mm of the optical zone were compared in eyes with and without pseudoexfoliation syndrome. Neither of these results were statistically significant. Before the re-examination in 2008, neodymium:yttrium-aluminium-garnet laser posterior capsulotomy had been conducted in 16% (n = 7) of eyes with pseudoexfoliation syndrome, as well as in 16% (n = 14) of eyes without pseudoexfoliation syndrome.

Conclusion:  Our study indicates that, with phacoemulsification, development of long-term posterior capsular opacification is not increased in patients with pseudoexfoliation syndrome after uncomplicated cataract surgery.

Purpose:  To investigate whether unilateral in vivo UVR-B exposure of one eye affects the fellow eye in a co-cataractogenic, sympathetic reaction and to determine whether an inflammatory response could be involved in the pathogenesis.

Methods:  C57BL/6 mice were unilaterally exposed in vivo to UVR-B for 15 min. In the group of 24 animals each received 0×/2×/3×/or 4× cataract threshold equivalent dose. Following 48-hr UVR-B exposure, cataract morphology was documented in dark-field illumination photography, and light scattering was quantified, in both lenses in vitro. Serum levels of pro-inflammatory cytokines IL-1ß, IL-6 and TNF-α were analysed with ELISA. Immunohistochemistry was performed for inflammatory infiltration in exposed and contralateral eyes.

Results:  UVR-B exposure induced cataract in all exposed lenses. There was additionally a significant UVR dose–dependent increase in light scattering in the lenses of the non-exposed fellow eye. Inflammatory infiltration was detected immunohistochemically in the anterior segment of both eyes. IL-1β serum concentration increased with increasing UVR-B exposure dose. There was a similar trend for serum IL-6 but not for TNF-α.

Conclusion:  Unilateral UVR-B exposure to one eye is associated with intraocular inflammation and an increase in lens light scattering also in the unexposed, fellow eye. A resulting systemic inflammatory response might be mediated by IL-1β and possibly IL-6. The finding that an inflammatory response may play a role in UVR-B-induced cataract development might initiate new strategies in the prevention of the disease.

Purpose:  To evaluate the long-term safety of intracameral mydriatics (ICM) in phacoemulsification cataract surgery compared with conventional topical mydriatics (TM).

Methods:  A total of 45 patients were examined 6 years after phacoemulsification cataract surgery. The patients had previously participated in a prospective randomized double-blind study including 60 patients, operated with either ICM or TM. The follow-up included best-corrected visual acuity (BCVA), intraocular pressure (IOP), grade of posterior capsule opacification (PCO), YAG laser capsulotomy rate, pupil size, corneal thickness and endothelial morphology.

Results:  No differences in postoperative BCVA, IOP, pupil size, PCO or YAG rate were observed between the groups. Endothelial cell loss, endothelial morphology and corneal thickness were also equivalent.

Conclusions:  Intracameral mydriatics is a safe alternative to topical mydriatics in phacoemulsification cataract surgery with no long-term disadvantages at 6-year follow-up.

Purpose:  The main aim of the study was to determine whether intravenous sedation with midazolam reduces the ability of patients to see during cataract surgery performed under topical anaesthesia. We also sought to determine the effects of sedation on patient’s level of disturbance to the microscope light and visualization of surgical instruments and on the overall of experience of the patients during surgery.

Methods:  A total of 78 patients, aged 40–75 years, were randomly divided into two groups: Group S, (sedation) who received intravenous midazolam 0.015 mg/kg, and Group NS, (no sedation) who did not receive midazolam. Patients with history of anxiety, those with history of intraocular surgery and those with severe chronic obstructive pulmonary disease were excluded. Topical anaesthesia was achieved by the application of 2% xylocaine gel over the conjunctiva. A blinded observer interviewed all the patients 30 min after the surgery using a standard questionnaire.

Results:  Significant number of patients (25.6%) in Group NS was disturbed a lot because of the microscope light compared to Group S (5.1%), p = 0.021. Also, statistically significant number of patients in Group S (48.7%) compared to Group NS (20.5%) was not sure about the images perceived during surgery and were unable to recollect them after the surgery, p = 0.008, and 12.8% of the patients in Group NS reported the visual experience as frightening compared to 2.6% of patients in Group S, p = 0.239.

Conclusion:  Our study confirms that intravenous midazolam reduces both the ability to see and recall intraoperative visual images in patients undergoing cataract surgery under topical anaesthesia.

Purpose:  To investigate the clinical effects and safety of targeted pattern scan laser (Pascal) retinal photocoagulation (TRP) in proliferative diabetic retinopathy (PDR).

Methods:  Prospective and non-randomized study of 28 eyes with treatment-naive proliferative diabetic retinopathy (PDR). Single-session 20-ms-Pascal TRP strategy applied 1500 burns to zones of retinal capillary non-perfusion and intermediate retinal ischaemia guided by wide-field fluorescein angiography (Optos). Main outcome measures at 12 and 24 weeks included; PDR grade (assessed by two masked retina specialists); central retinal thickness (CRT); mean deviation (MD) using 24-2 Swedish interactive threshold algorithm (SITA)-standard visual fields (VF); and ETDRS visual acuity (VA).

Results:  Following primary TRP, there was PDR regression in 76% of patients at 12 weeks (κ = 0.70; p < 0.001). No laser re-treatment was required at 4 weeks, and 10 eyes underwent repeat TRP at 12 weeks. Wide-field Optos angiography at 24 weeks showed complete disease regression in 37% and partial regression in 33%. Additional panretinal laser photocoagulation (PRP) was planned for active PDR in 30%. There were significant reductions in CRT over time (10.4 μm at 12-weeks, p = 0.007; 12.1 μm at 24-weeks, p = 0.0003). The MD on VFs improved after 12 weeks (+1.25 dB; p = 0.015) and 24 weeks (+1.26 dB, p = 0.01). The VA increased by +3 letters at 24 weeks (95% CI, 1.74–5.01; p < 0.0001).

Conclusions:  This pilot study reports that Optos-guided Pascal 20-ms TRP using 1500 burns for treatment-naive PDR is a promising procedure with favourable safety profile.

Purpose:  To describe in detail the phenotype of CORD5 in two families segregating a mutation c.1878G>C (p.Q626H) in the PITPNM3 gene.

Methods:  The study included 35 individuals from two different families of Swedish origin, all heterozygous for a PITPNM3 p.Q626H mutation. All participants underwent ophthalmological examination including kinetic perimetry, and in selected cases adaptometry, colour vision tests and optical coherence tomography (OCT). Electrophysiological studies were also performed. In some cases, the data were obtained from medical records.

Results:  The majority of patients showed subnormal visual acuity and light sensitivity from childhood. Early signs of macular degeneration were also observed. There was a progressive decrease in visual acuity leading to legal blindness in early adulthood. Electrophysiological testing showed a progressive loss of photoreceptor function restricted mainly to the cones. OCT revealed decreased macular thickness with flattened and enlarged fovea.

Conclusion:  Our observations of the PITPNM3 p.Q626H mutation carriers confirm that CORD5 is a disease not to mix with other retinal degenerations mapped to 17p13. The results of our clinical evaluation so far indicate that CORD5 is characterized by predominant cone dysfunction without signs of general involvement of the retinal pigment epithelium. The rod system also seems to be unaffected. In this sense, CORD5 is different from other autosomal dominant CORDs where rod involvement is present to some degree in a late phase of the disease. Some intra- and inter-familial differences regarding the severity of the clinical picture were observed.

Purpose:  To evaluate the effects of intravitreal bevacizumab and ranibizumab treatments in retinal angiomatous proliferation (RAP).

Methods:  Fifty patients affected by RAP were randomly assigned either to intravitreal bevacizumab injection (IVBI) or intravitreal ranibizumab injection (IVRI). After a loading phase including three consecutive monthly injections, the retreatment was administered in cases of persistent RAP. The primary outcome measures were the mean changes in BCVA between the two treatment groups, and the proportion of eyes gaining 1 and 3 lines at the end of the follow-up. Secondary outcomes included central macular thickness (CMT) changes and progression to more advanced stages of RAP.

Results:  Fifty patients affected by stage 1 and 2 RAP were recruited. Twenty-six and 24 patients received IVBI and IVRI, respectively. At the baseline, mean best corrected visual acuity (BCVA) values were 0.59 ± 0.21 (LogMAR ± SD, approximately corresponding to 20/80 Snellen Equivalent-SE) in IVBI group and 0.66 ± 0.33 (approximately 20/90 SE) in IVRI group with no statistical difference. At 12-month examination, both groups showed a statistically significant improvement in the BCVA, with a final mean value of 0.43 ± 0.24 (approximately 20/54 SE) in IVBI group and 0.50 ± 0.32 (approximately 20/63 SE) in the IVRI group. A BCVA gain of 1 and 3 lines was registered in 20 and 8 eyes, respectively, in the IVBI group. Similarly, 17 and 7 eyes showed an improvement of 1 or 3 lines, respectively, in the IVRI group. The CMT reduced significantly from baseline to 12-month examination in both groups. A lower proportion of eyes with complete pigment epithelium detachment resolution was noted in the IVBI group than in the IVRI group (40% versus 90%).

Conclusions:  Our study shows that both IVBI and IVRI are equally effective in improving the BCVA over a 1-year follow-up in eyes affected by stage 1 and 2 RAP.

Purpose:  To report the 12 months efficacy of initial intravitreal bevacizumab or intravitreal recombinant tissue plasminogen activator (rtPA) combined with expansile gas in patients with subretinal haemorrhage caused by neovascular age-related macular degeneration (AMD).

Methods:  Forty-five eyes of 45 patients with subretinal haemorrhage (1–5 disc diameters) involving the fovea secondary to neovascular AMD were evaluated retrospectively consecutively. Thirty-two eyes underwent treatment with rtPA (50 μg/0.05 ml) combined with intravitreal sulphur hexafluoride (SF6). The other 13 eyes were treated with bevacizumab (1.25 mg/0.05 ml) and SF6. Thereafter, all patients received Vascular Endothelial Growth Factor (anti-VEGF) treatment according to modified PrONTO criteria. Main outcome was change of best-corrected visual acuity (VA) at 12 months as determined by Early Treatment Diabetic Retinopathy (ETDRS).

Results:  There was more improvement in patients initially treated with rtPA and gas (14 letters; bevacizumab and gas eight letters) and not suffering from adverse events. The incidence of vitreous haemorrhages was significantly higher in the rtPA group (nine of 32 versus one of 13, p < 0.01). In both groups, an average of 3.5 anti-VEGF injections were performed per patient during 12 months (no difference between both groups).

Conclusion:  Both initial treatment regimen lead to improved functional results after 1 year. However, patients, not suffering from adverse events, who underwent initial treatment with rtPA and gas showed better results. To maintain VA, controlling neovascular AMD by anti-VEGF treatment regime after initial treatment with rtPA+gas is important for all cases.

Purpose:  To evaluate the efficacy and the safety of uveal melanoma transretinal biopsy using 25-gauge vitrectomy system.

Methods:  At the patient’s request of a tissue diagnosis, nine posterior uveal melanomas treated by proton-beam therapy were biopsied during the insertion of tantalium markers.

Results:  The diagnosis was uveal melanoma, confirmed in all cases using cytological (7 of 9) and histological analysis (2 of 9). Immunocytochemistry was performed on all samples (9 of 9). In eight of nine patients, minor postoperative vitreous haemorrhages were seen, which resolved in 1 day. No other ocular complications were noticed.

Conclusion:  Uveal melanoma biopsy using 25-gauge vitrectomy system is a valuable procedure to confirm the diagnosis, with adequate sample and low ocular morbidity.

Purpose:  The ‘Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study’ (SPR study) is a randomized multicentre trial comparing primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). This subanalysis was conducted to identify risk factors associated with anatomical outcomes.

Methods:  Relating the anatomical success results at the 1-year follow-up visit to pre- and intraoperative findings using multivariate statistical methods.

Results:  In the phakic subtrial, anatomical success was negatively associated with the number of breaks (p < 0.0001), break extension > 1 clock hour (p = 0.0005) and intraoperative use of cryotherapy (p = 0.0484). It was positively associated with retinal breaks with irregular edges (p = 0.0353) and subretinal fluid drainage (p = 0.0155). In the pseudophakic/aphakic subtrial, anatomical success was negatively associated with the number of retinal breaks (p = 0.0004) and previous YAG capsulotomy (p = 0.0256), and the combined effect of the surgical procedure and intraoperative use of laser (p = 0.0229).

Conclusion:  Primary anatomical success is an important result for patients undergoing RRD surgery. Our data demonstrate that the final anatomical outcome is related to a higher preoperative number of breaks and cryotherapy in phakic eyes. Additional risk factors varied between phakic and pseudophakic subgroups. Our findings may be used to facilitate the prognosis of future patients with RRD.

Purpose:  To determine whether glaucoma subtype is an independent risk factor for visual field (VF) progression.

Methods:  We reviewed the charts of glaucoma suspects and glaucoma patients seen in a referral practice between 1999 and 2009. Automated pointwise linear regression analysis determined the rates of VF change. A progression endpoint was determined when two or more adjacent test locations in the same hemifield showed a threshold sensitivity decline at a rate of ≥1.0 dB/year with p < 0.01.

Results:  We included 841 eyes (841 patients; mean age, 64.1 ± 12.6 years; mean number of VF tests, 10.8 ± 2.8; mean follow-up, 6.4 ± 1.7 years). The glaucomatous group consisted of angle-closure glaucoma (76 eyes), juvenile primary open-angle glaucoma (37 eyes), normal-tension glaucoma (81 eyes), pigmentary glaucoma (34 eyes), primary open-angle glaucoma (275 eyes) and exfoliative glaucoma (XFG, 84 eyes). Normal-tension glaucoma eyes were more likely to present with beta-zone parapapillary atrophy and disc haemorrhage (p < 0.01). Exfoliative glaucoma eyes had the fastest rates of global VF change (−0.65 dB/year), as well as the highest mean, fluctuation, and peak intraocular pressure during follow-up (16.5, 3.0 and 22.0 mmHg, respectively) and reached a progression endpoint more frequently (40%). After adjusting for all covariates, including the glaucoma phenotype, there was no difference among groups regarding global rates of VF change and the risk of reaching a progression endpoint.

Conclusions:  Despite different clinical features, epidemiology and genetics, glaucoma phenotype is not an independent risk factor for VF progression. Rather, variations in well-known, reported risk factors remain important disease parameters that affect progression.

Purpose:  To determine the expression of the endogenous anti-angiogenic and pro-fibrotic matricellular protein thrombospondin (TSP)-2 and its receptors CD36 and CD47 in proliferative diabetic retinopathy (PDR). In addition, we examined the expression of TSP-2 in the retinas of diabetic rats.

Methods:  Epiretinal membranes from 14 patients with PDR and nine patients with proliferative vitreoretinopathy were studied by immunohistochemistry. Vitreous samples from 30 PDR and 25 nondiabetic patients were studied by enzyme-linked immunosorbent assay. Vitreous samples and retinas of rats were examined by Western blotting.

Results:  In epiretinal membranes, vascular endothelial cells and myofibroblasts expressed TSP-2, CD36 and CD47. In PDR membranes, significant correlations were observed between numbers of blood vessels expressing the panendothelial cell marker CD34 and numbers of blood vessels and stromal cells expressing TSP-2, CD36 and CD47. The numbers of blood vessels and stromal cells expressing CD34, TSP-2, CD36 and CD47 were significantly higher in membranes with active neovascularization when compared with those with quiescent disease. Thrombospondin-2 levels in vitreous samples from PDR patients were significantly higher than those in control patients without diabetes (p < 0.001). Western blot analysis revealed a significant increase in the expression of intact and cleaved TSP-2 in vitreous samples from PDR patients and in the retinas of diabetic rats compared to nondiabetic controls.

Conclusions:  Upregulation of TSP-2 may be a protective mechanism against inflammation and angiogenesis associated with PDR.

Purpose:  Modern therapy of neovascular age-related macular degeneration consists in intravitreal injections of inhibitors of the vascular endothelial growth factor. An increasing number of these injections is required not only in monthly but also in as-needed treatment regimen. In this study, it should be examined whether an additional administered photodynamic therapy (PDT) can considerably reduce the number of injection.

Methods:  In this prospective, randomized study carried out in three large hospitals of Vienna eyes with neovascular age-related macula degeneration were included. Patients were randomized to either Ranibizumab monotherapy or combined standard fluence PDT and Ranibizumab therapy. All patients received a loading dose of three intravitreal Ranibizumab injections and were thereafter treated in an as-needed regimen based on distance acuity and retinal thickness values. In the combined treatment group, PDT was administered 1 day after the first Ranibizumab injection.

Results:  Fifty-one patients were randomized, 44 were finally included (four screening failures and three withdrawals). Twenty-four patients were assigned to the monotherapy and 20 patients to the combined treatment group. Fewer injections were required in the combined treatment group (4.7 versus 6.3). Overall the patients lost 0.5 letters; in the combined treatment group, the patients lost mean 7.1 letters; in the monotherapy group, they gained mean 5.1 letters. Retinal thickness decreased significantly in both groups.

Conclusion:  A significant reduction of the number of required intravitreal injections could be achieved by the additional PDT treatment, but was accompanied by a worse functional outcome in this group.

Purpose:  To study the effect of intravitreal (IVT) ranibizumab on the retinal arteriolar diameter in patients with neovascular age-related macular degeneration (AMD).

Methods:  Ten eyes of 10 patients with previously untreated neovascular AMD were included. All eyes had three monthly IVT injections of ranibizumab and then were retreated as needed, based on visual acuity and optical coherence tomography (OCT) criteria. The diameter of the retinal arterioles was measured in vivo with a retinal vessel analyser (RVA) before the first IVT injection, 7 and 30 days after the first, the second and the third injection, and at month 12 of follow-up.

Results:  A significant vasoconstriction of the retinal arterioles was observed following each one of the first three IVT injections of ranibizumab. Thirty days following the first, second and third injection, there was a mean decrease of 8.4 ± 3.2%, 11.9 ± 4.5% and 18.5 ± 7.2%, respectively, of the retinal arteriolar diameter compared with baseline (p < 0.01). At month 12, the vasoconstriction was still present with a mean decrease of 19.1 ± 8.3% of the retinal arteriolar diameter compared with baseline (p < 0.01). Median number of ranibizumab injections was 4 (range 3–10). There was no correlation between the number of injections and percentage diameter decrease at month 12 (r = −0.54, p > 0.1). There was no significant change in mean arterial pressure (MAP) during the period of follow-up (p > 0.05).

Conclusions:  These results suggest that IVT ranibizumab induces sustained retinal arteriolar vasoconstriction in eyes with neovascular AMD.

Purpose:  To describe the ocular and electrophysiological phenotype of four patients with late-onset retinal degeneration (LORD).

Methods:  Clinical examination, fundus and anterior segment photography, fundus autofluorescence imaging and spectral domain optical coherence tomography (SD-OCT) were performed. Three patients underwent pattern and full-field electroretinography (ERG). Patient DNA was screened for the c.686C>G, p.Ser163Arg mutation in C1QTNF5.

Results:  All affected individuals had a family history suggestive of autosomal dominant inheritance with full penetrance. Molecular analysis identified a heterozygous c.686C>G, p.Ser163Arg mutation in C1QTNF5 in DNA from all four affected probands. All four patients presented in their 50s with nyctalopia and developed central visual loss in their 60s. Peripupillary iris atrophy and long anterior zonular insertions were present in three of four patients. Dilated fundus examination revealed scalloped areas of retinal pigment epithelium (RPE) atrophy in the mid-periphery and widespread atrophy in the posterior pole. Full-field ERGs were consistent with rod-cone dystrophy with pattern ERG evidence of severe macular involvement. SD-OCT revealed widespread loss of the photoreceptors with absence of the inner/outer segment junction line and concurrent thinning of the outer nuclear layer. Diffuse choroidal thinning, mainly affecting the inner choroid with loss of the choriocapillaris, was observed.

Conclusion:  C1QTNF5 retinopathy is an autosomal dominant LORD resulting in a complex ocular phenotype involving the RPE and ciliary epithelium. SD-OCT findings revealed widespread photoreceptor loss and diffuse choroidal thinning.

Purpose:  To compare the relationships of parapapillary retinal nerve fibre layer (RNFL) thickness among three spectral-domain optical coherence tomography (SD-OCT) instruments with visual field sensitivity (VFS).

Methods:  One hundred and thirteen eyes of 113 Japanese subjects with glaucoma (mean deviation in standard automated perimetry = −8.9 ± 6.7 dB) were imaged by Cirrus, RTVue and 3D OCT. The average hemi-superior and hemi-inferior RNFL thicknesses were obtained. In addition, the structure–function relationship using two retinotopic maps that consisted of six or nine sectors was also evaluated. Decibel (dB) scale and 1/Lamert (1/L) were used to express VFS. RNFL thickness correlation with corresponding VFS in visual field sectors was compared among the three instruments. Background RNFL thickness (non-neuronal tissue) for each instrument was estimated using a linear regression model at 1/L = 0.

Results:  The correlation between the average hemi-superior and hemi-inferior RNFL thickness in the three SD-OCT instruments with corresponding VFS was similar. In the analysis of retinotopic maps, 3D OCT showed a higher correlation in superotemporal sectors than RTVue, whereas RTVue had a stronger relationship in the nasal sector than Cirrus. The background RNFL thickness extrapolated was approximately 60% that of normal eyes in all the instruments.

Conclusions:  The three SD-OCT showed similar overall correspondence with VFS with a partially discordant retinotopic relationship. RNFL measured with any SD-OCT devices likely contains non-neuronal tissue, comprising 60% of its thickness.

Purpose:  To compare the 23-gauge (23-G) sutureless vitrectomy incision architecture in macular and non-macular surgery, using anterior segment spectral-domain optical coherence tomography (SD-OCT), and to evaluated its influence on clinical outcomes.

Methods:  A prospective, observational case series of 43 patients who underwent primary transconjunctival 23-G pars plana vitrectomy (PPV) for macular and non-macular diseases. All sclerotomy wounds were imaged 1 day after surgery using the anterior segment module of SD-OCT (OCT Spectralis; Heidelberg Engineering, Heidelberg, Germany). Sclerotomy architecture, including good wound apposition, presence of gaping and misalignment of the roof and floor of the incisions were evaluated. Preoperative, intraoperative and postoperative medical record data were also prospectively collected.

Results:  Incision gaping and misalignment of the roof and floor occurred more frequently in the superotemporal and superonasal quadrants than in the inferotemporal quadrant (p < 0.05) and was more frequent in the non-macular group than in the macular group (p < 0.05). The incidence of incision gaping increased significantly as the incision angle increased. In the macular group, the mean postoperative intraocular pressure (IOP) did not change from the preoperative value, whereas in the non-macular group, the mean IOP decreased significantly from 15.09 ± 2.58 mmHg preoperatively to 12.18 ± 3.25 mmHg on the first postoperative day (p < 0.005). The mean IOP did not differ significantly between the two groups of surgery at 1 week, and at 1 month postoperatively.

Conclusions:  In 23-G PPV, non-macular surgery is associated with a significant postoperative IOP decrease in comparison with macular surgery, which could be explained by the most remodelled wound architecture.

Purpose:  Toll-like receptor 3 (TLR3) is a receptor of the innate immune system, recognizing double-stranded RNA. TLR3 can lead to cytokine release or apoptosis and has recently been associated with the development of geographical atrophy via cytotoxic effects on the retinal pigment epithelium (RPE). The current study was conducted to elucidate the underlying pathways of TLR3 effects in the RPE.

Methods:  TLR3 activation via polyinosinic acid/polycytidylic acid (Poly I:C) was investigated in primary porcine RPE cells, focussing on cell death and vascular endothelial growth factor (VEGF) secretion. Primary cells were stimulated with different concentrations of Poly I:C. Cell death was investigated in trypan blue exclusion assay and cell death detection ELISA. VEGF and IFN-ß secretion were also detected in ELISA. As Mitogen-activated protein kinases (MAPK) play an important part in TLR3-mediated signal transduction, we investigated the influence of JNK, ERK1/2 and p38 on cell death and VEGF secretion, using commercially available inhibitors.

Results:  Activation of TLR3 by Poly I:C induced concentration-dependent cell death, partly mediated by JNK. ERK1/2 was activated and exerted some protection. Furthermore, higher concentrations of Poly I:C increased VEGF secretion after 4 and 24 hr, which was independent of MAPK.

Conclusion:  The induction of cell death in RPE cells by TLR3 activation confirms possible involvement of TLR3 activation in GA. As cell death is partly mediated by JNK, more studies should be conducted investigating the role of JNK in RPE cell death to evaluate whether its inhibition might be a new therapeutic opportunity for the treatment of geographical atrophy. Additionally, effects on VEGF secretion can be found.

Purpose:  A reduction in quality of life (QoL) during an active phase of disease has been shown for patients with uveitis of various age groups. Adult uveitis patients were shown to also have reduced QoL-values despite disease being quiescent, but adolescents have not been investigated in this respect.

Methods:  This clinic-based, cross-sectional pilot study assessed the overall health-related quality of life (HRQoL) in adolescents (11–18 years) with a history of inactive uveitis and good visual function. Two independent generic (non-disease-specific) instruments were applied, the Inventory for Assessing the Quality of Life and the German KINDL-R-questionnaire.

Results:  Thirty-seven adolescents, 20 females (54%) and 17 males with a mean age of 15 ± 3 years and diagnosis since 5 ± 2 years participated. Subgroups with a reduced HRQoL were those with anterior and intermediate localization of uveitis, bilateral disease, application of immunosuppressive therapy, a short time since diagnosis, and a high number of recurrences.

Conclusion:  Even despite quiescence of disease and good visual function, certain risk factors may result in a decreased HRQoL in juvenile uveitis patients. Our findings support the need of further evaluation of HRQoL in this patient group, the validation of specific psychometric inventories for this disease and the establishment of interdisciplinary collaboration including psychological counselling.

Purpose:  To identify the underlying molecular genetic cause in a Czech family with optic atrophy, deafness, ptosis, ophthalmoplegia, polyneuropathy and ataxia transmitted as an autosomal dominant trait.

Methods:  Ophthalmological and neurological examination followed by molecular genetic analyses.

Results:  Seven family members were clinically affected. There was a variable but progressive visual, hearing and neurological disability across the family as a whole. The majority of subjects presented with impairment of visual function and a variable degree of ptosis and/or ophthalmoplegia from the first to the third decade of life. Deafness, neuropathy and ataxia appeared later, in the third and fourth decade. Migraine, tachycardia, intention tremor, nystagmus and cervical dystonia were observed in isolated individuals. A significant overall feature was the high level of neurological disability leading to 3 of 4 members being unable to walk or stand unaided before the age of 60 years. A novel missense mutation c.1345A>C (p.Thr449Pro) in OPA1 segregating with the disease phenotype over three generations was detected. In silico analysis supported pathogenicity of the identified sequence variant.

Conclusion:  Our work expands the spectrum of mutation in OPA1, which may lead to severe multisystem neurological disorder. The molecular genetic cause of dominant optic atrophy in the Czech population is reported for the first time. We propose that regular cardiac follow-up in patients diagnosed with dominant optic atrophy and widespread neurological disease should be considered.

Purpose:  The aim of the study was to determine the prevalence and risk factors for pterygium in a population aged 40–74 years in Fukushima Prefecture, Japan.

Methods:  Of 4185 citizens of the towns of Minamiaizu-machi and Tadami-machi, 2312 (55.2%) gave consent to an ocular examination during a health examination. Pterygium was diagnosed when a radially oriented fibrovascular lesion growing over the limbus into the cornea was observed. Eyes with a history of pterygium excision were also diagnosed with pterygium. Prevalence and factors associated with pterygium were investigated.

Results:  Of the 2312 subjects, 101 (4.4%; 95% confidence interval, 3.6–5.3%) had pterygium in at least 1 eye. The average age (±SD) of the subjects was 64.3 ± 8.0 years. Gender, age, outdoor job history and smoking history were examined as possible associated factors, but only age was found to be significantly associated with pterygium in logistic regression analysis.

Conclusion:  The prevalence of pterygium was 4.4% in the study population. This low rate may be due to the northern latitude of these towns. Age was associated with a risk of pterygium, but gender and outdoor job history were not associated with onset of pterygium in this study.