Journal Contents

Am Jour Ophthalmol
Br J Ophthalmol
Can J Ophthalmol
J Cat Ref Surg
Cornea
Curr Eye Res
Eur J Ophthalmol
Eye
J Glaucoma
JAMA Ophthalmol
Graefes Ophthalmol
Indian J Ophthalmol
Int Ophthalmol Clin
Invest Ophth Vis Sci
Jpn J Ophthalmol
JPOS
Korean J Ophthal
J Neuroophthalmol
Ophthalmic Epidemiol
Ophthalmic Genet
Ophthal Plast Rec Surg
Ophthalmic Res
Ophthalmologica
Ophthalmology
Retina
Surv Ophthalmol
Ophthalmology Review Journal
Br J Ophthalmol[JOUR] Established 1995
1. Br J Ophthalmol. 2015 Nov 18. pii: bjophthalmol-2015-306823. doi:
10.1136/bjophthalmol-2015-306823. [Epub ahead of print]

Anatomical effects of dexamethasone intravitreal implant in diabetic macular
oedema: a pooled analysis of 3-year phase III trials.

Danis RP(1), Sadda S(2), Li XY(3), Cui H(3), Hashad Y(3), Whitcup SM(3).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, University of
Wisconsin-Madison, Madison, Wisconsin, USA. (2)Doheny Image Reading Center,
Doheny Eye Institute, Los Angeles, California, USA. (3)Allergan, Inc., Irvine,
California, USA.

BACKGROUND/AIM: To assess long-term effects of dexamethasone intravitreal implant
(DEX implant) monotherapy on retinal morphology in diabetic macular oedema (DME).
METHODS: Two multicentre, masked, phase III studies with identical protocols
randomised patients with DME, best-corrected visual acuity of 34-68 Early
Treatment Diabetic Retinopathy Study letters and central subfield retinal
thickness (CSRT) ≥300 µm to DEX implant 0.7, 0.35 mg or sham procedure. Patients 
were followed up for 3 years (39 months if treated at month 36), with retreatment
allowed at ≥6-month intervals. Patients needing other macular oedema (ME) therapy
exited the study. Changes from baseline in CSRT, macular volume and ME grade,
area of retinal thickening, macular leakage, macular capillary loss and diabetic 
retinopathy severity were assessed.
RESULTS: After 3 years, more eyes treated with DEX implant 0.7 and 0.35 mg than
sham showed improvement (although small) in ME grade (p<0.05 vs sham). DEX
implant 0.7 mg delayed time to onset of two-step progression in diabetic
retinopathy severity by ∼12 months. DEX implant 0.7 and 0.35 mg produced small,
non-sustained reductions in macular leakage but had no significant effect on
macular capillary loss.
CONCLUSIONS: DEX implant 0.7 or 0.35 mg, administered at ≥6-month intervals over 
3 years, produced sustained retinal structural improvement in DME.
TRIAL REGISTRATION NUMBER: NCT00168337 and NCT00168389.

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PMID: 26581718   [PubMed - as supplied by publisher]


2. Br J Ophthalmol. 2015 Nov 13. pii: bjophthalmol-2015-306871. doi:
10.1136/bjophthalmol-2015-306871. [Epub ahead of print]

The impact of donor age and endothelial cell density on graft survival following 
penetrating keratoplasty.

Wakefield MJ(1), Armitage WJ(2), Jones MN(3), Kaye SB(4), Larkin DF(5), Tole
D(6), Prydal J(1); National Health Service Blood and Transplant Ocular Tissue
Advisory Group (OTAG Audit Study 19).

Author information: 
(1)Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK.
(2)National Health Service Blood and Transplant, Bristol Eye Bank, Bristol, UK
School of Clinical Sciences, University of Bristol, Bristol, UK. (3)National
Health Service Blood and Transplant, Bristol, UK. (4)St. Paul's Eye Unit, Royal
Liverpool University Hospital, Liverpool, UK. (5)Moorfields Eye Hospital, London,
UK. (6)National Health Service Blood and Transplant, Bristol, UK Bristol Eye
Hospital, Bristol, UK.

PURPOSE: To determine if donor age and preoperative endothelial cell density
(ECD) affect corneal endothelial failure following penetrating keratoplasty (PK).
METHODS: Preoperative and postoperative data for PKs performed in the UK between 
April 1999 and March 2012 were analysed. Donor age was split into three groups
(0-60, 61-75 and >75 years) and donor ECD was split into three groups (≤2400,
2401-2600 and >2600 cells/mm(2)). Cox proportional hazards regression was used to
determine whether the selected subgroups of donor age and donor ECD have an
impact on endothelial failure and a systematic analysis of the interaction
between donor ECD and donor age was conducted. The analysis was stratified for
primary corneal diagnosis (Fuchs endothelial dystrophy (FED), pseudophakic
bullous keratopathy (PBK) and other) and corrected for potentially confounding
factors (human leukocyte antigen matching, donor trephine diameter, deep
vascularisation, the occurrence of reversible rejection episodes and receipt of
systemic antiviral medication, long-term steroids or other immunosuppressive
agents).
RESULTS: A total of 9415 patients, from the National Health Service Blood and
Transplant UK Transplant Registry, who received their first PK for visual reasons
were included in this study. The overall 5-year graft survival rate due to
endothelial failure was 89%. Survival rates in recipients with FED, PBK and 'all 
other indications' were 95%, 83% and 89%, respectively. Our analysis shows that
donor ECD did not affect outcome following corneal graft within the preselected
categories, irrespective of diagnosis and after allowing for any potential
confounding factors. Furthermore, HRs for each level of donor ECD, relative to
>2600 cells/mm(2), for each combination of age group and indication, were not
statistically significant.
CONCLUSIONS: We were unable to detect a significant effect of donor age, up to
90 years, and preoperative donor ECD, above the lower limit of 2200 cells/mm(2), 
on endothelial failure at 5 years following PK.

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PMID: 26567026   [PubMed - as supplied by publisher]


3. Br J Ophthalmol. 2015 Nov 13. pii: bjophthalmol-2015-306749. doi:
10.1136/bjophthalmol-2015-306749. [Epub ahead of print]

Corynebacterium spp as causative agents of microbial keratitis.

Das S(1), Rao AS(1), Sahu SK(1), Sharma S(2).

Author information: 
(1)Cornea and Anterior Segment Service, LV Prasad Eye Institute, Bhubaneswar,
Odisha, India. (2)Ocular Microbiology Service, LV Prasad Eye Institute,
Bhubaneswar, Odisha, India.

PURPOSE: To report the clinical and microbiological profile of keratitis caused
by Corynebacterium spp.
METHODS: The medical and microbiology records of 22 patients, who had presented
at the L V Prasad Eye Institute, Bhubaneswar, between June 2009 and December
2012, and whose corneal scrapings had yielded significant growth of
Corynebacterium spp, were retrospectively reviewed. A detailed ocular examination
was performed before the respective corneal scraping was sent for a
microbiological work-up. The data collected from each record included age,
gender, predisposing factors (ocular and systemic), clinical presentation,
management and outcome of treatment.
RESULTS: The mean age of the patients was 43.8±24.4 years. Ocular predisposing
factor was present in 14 (63.6%) eyes. Surgical intervention was required in 12
(54.5%) patients. In vitro susceptibility (Kirby-Bauer disc diffusion method)
results of Corynebacterium spp to vancomycin (17/19, 89.5%), cefazolin (16/20,
80%), chloramphenicol (11/20, 55%), ofloxacin (13/19, 68.4%), ciprofloxacin
(10/20, 50%) and gatifloxacin (10/19, 52.6%) were variable. Drug resistance (more
than one drug) was seen in nine (40.9%) Corynebacterium isolates, of which, two
(22.2%) showed multidrug resistance to three or more classes of antibiotics.
CONCLUSIONS: Corynebacteria can cause severe corneal infection requiring surgical
intervention.

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PMID: 26567025   [PubMed - as supplied by publisher]


4. Br J Ophthalmol. 2015 Nov 13. pii: bjophthalmol-2015-307399. doi:
10.1136/bjophthalmol-2015-307399. [Epub ahead of print]

Pathogenesis of thyroid eye disease: review and update on molecular mechanisms.

Khong JJ(1), McNab AA(2), Ebeling PR(3), Craig JE(4), Selva D(5).

Author information: 
(1)North West Academic Centre, The University of Melbourne, Western Hospital, St 
Albans, Victoria, Australia Orbital Plastics and Lacrimal Unit, Royal Victorian
Eye and Ear Hospital, East Melbourne, Victoria, Australia Austin Health,
Department of Surgery, University of Melbourne, Heidelberg, Victoria, Australia. 
(2)Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East
Melbourne, Victoria, Australia Centre of Eye Research Australia, University of
Melbourne, East Melbourne, Victoria, Australia. (3)North West Academic Centre,
The University of Melbourne, Western Hospital, St Albans, Victoria, Australia
Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 
Victoria, Australia. (4)Department of Ophthalmology, Flinders University,
Flinders Medical Centre, Adelaide, South Australia, Australia. (5)South
Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South
Australia, Australia.

Orbital changes in thyroid orbitopathy (TO) result from de novo adipogenesis,
hyaluronan synthesis, interstitial oedema and enlargement of extraocular muscles.
Cellular immunity, with predominantly CD4+ T cells expressing Th1 cytokines, and 
overexpression of macrophage-derived cytokines, perpetuate orbital inflammation. 
Orbital fibroblasts appear to be the major effector cells. Orbital fibroblasts
express both thyrotropin receptor (TSHR) and insulin-like growth factor-1
receptor (IGF-1R) at higher levels than normal fibroblasts. TSHR expression
increases in adipogenesis; TSHR agonism enhances hyaluronan production. IGF-1R
stimulation leads to adipogenesis, hyaluronan synthesis and production of the
chemokines, interleukin (IL)-16 and Regulated on Activation, Normal T Cell
Expression and Secreted, which facilitate lymphocyte trafficking into the orbit. 
Immune activation uses a specific CD40:CD154 molecular bridge to activate orbital
fibroblasts, which secrete pro-inflammatory cytokines including IL-1β, IL-1α,
IL-6, IL-8, macrophage chemoattractant protein-1 and transforming growth
factor-β, to perpetuate orbital inflammation. Molecular pathways including
adenylyl cyclase/cyclic adenosine monophosphate, phophoinositide 3
kinase/AKT/mammalian target of rapamycin, mitogen-activated protein kinase are
involved in TO. The emergence of a TO animal model and a new generation of TSHR
antibody assays increasingly point towards TSHR as the primary autoantigen for
extrathyroidal orbital involvement. Oxidative stress in TO resulting from
imbalances of the oxidation-reduction state provides a framework of understanding
for smoking prevention, achieving euthyroidism and the use of antioxidants such
as selenium. Progress has been made in the understanding of the pathogenesis of
TO, which should advance development of novel therapies targeting cellular
immunity, specifically the CD40:CD40 ligand interaction, antibody-producing B
cells, cytokines, TSHR and IGF-1R and its signalling pathways. Further studies in
signalling networks and molecular triggers leading to burnout of TO will further 
our understanding of TO.

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PMID: 26567024   [PubMed - as supplied by publisher]


5. Br J Ophthalmol. 2015 Nov 13. pii: bjophthalmol-2015-307184. doi:
10.1136/bjophthalmol-2015-307184. [Epub ahead of print]

Spontaneous rupture of the lens capsule in hypermature cataract: presentations
and outcomes.

Goel N(1), Nagar M(1).

Author information: 
(1)ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India.

AIM: To describe the occurrence of spontaneous rupture of the lens capsule in
patients with hypermature cataract.
STUDY DESIGN: Consecutive case series.
METHODS: The records of patients with hypermature cataract and spontaneous
capsular dehiscence seen and managed at a tertiary eye care centre between August
2012 and August 2014 were reviewed retrospectively.
RESULTS: 10 eyes of 10 patients were identified. Best-corrected visual acuity
(BCVA) was limited to light perception in all patients. Three eyes had anterior
dislocation of the nucleus, two had posterior dislocation and in five the nucleus
was presumed to have absorbed. Eight eyes (80%) demonstrated both anterior and
posterior capsular tears and five eyes (50%) showed calcification spots in the
capsule remnants. Other features at presentation included corneal oedema (two
eyes), vitritis (four eyes), raised intraocular pressure (one eye) and hypopyon
(one eye). Removal of the nucleus through anterior (three eyes) or posterior
route (two eyes) was carried out in all patients with dislocated nucleus.
Intraocular lens could be implanted in seven eyes (70%) and they had a final BCVA
ranging from 6/18 to 6/36.
CONCLUSION: Spontaneous lens capsule rupture can occur in hypermature senile
cataract (HMSC) and result in anterior or posterior dislocation of the nucleus or
spontaneous resorption with or without an accompanying inflammatory reaction of
varying severity. An acceptable visual outcome can be obtained, except in the
presence of associated glaucoma or corneal decompensation.

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PMID: 26567023   [PubMed - as supplied by publisher]


6. Br J Ophthalmol. 2015 Nov 13. pii: bjophthalmol-2015-307460. doi:
10.1136/bjophthalmol-2015-307460. [Epub ahead of print]

Scleritis in patients with granulomatosis with polyangiitis (Wegener).

Cocho L(1), Gonzalez-Gonzalez LA(1), Molina-Prat N(2), Doctor P(1),
Sainz-de-la-Maza M(3), Foster CS(4).

Author information: 
(1)Massachusetts Eye Research and Surgery Institution (MERSI), Waltham,
Massachusetts, USA Ocular Immunology and Uveitis Foundation, Waltham,
Massachusetts, USA. (2)Instituto Oftalmológico Integral, Santiago de Chile,
Chile. (3)Ophthalmology Service, Institute Clinic of Ophthalmology, Hospital
Clinic of Barcelona, Barcelona, Spain. (4)Massachusetts Eye Research and Surgery 
Institution (MERSI), Waltham, Massachusetts, USA Ocular Immunology and Uveitis
Foundation, Waltham, Massachusetts, USA Department of Ophthalmology, Harvard
Medical School, Boston, Massachusetts, USA.

AIMS: To describe and compare clinical features, complications and outcomes in
patients with granulomatosis with polyangiitis (GPA)-associated scleritis with
those seen in idiopathic and other autoimmune-associated scleritis, and to
further describe the features that may serve as an indicator of life-threatening 
systemic disease.
METHODS: We retrospectively reviewed electronic health records of all patients
with scleritis seen at two tertiary care centres. Of 500 patients, 14 had
GPA-associated scleritis and were included in this analysis. Measures included
were age, gender, laterality, visual acuity and underlying systemic or ocular
diseases. Clinical features (location, pain, inflammation) and ocular
complications of these patients (decrease of vision, concomitant anterior uveitis
and ocular hypertension) were studied and correlated.
RESULTS: Fourteen of 500 patients with scleritis were GPA associated. Most of the
patients with GPA-associated scleritis presented with sudden onset, bilateral,
diffuse anterior scleral inflammation, with moderate-or-severe pain. Vision loss 
was not significantly different, and pain was more severe in these patients than 
in those with idiopathic scleritis. When compared with patients with other
underlying autoimmune diseases, there were no significant differences found in
epidemiological or clinical signs. Necrotising scleritis and corneal involvement 
were more commonly observed in GPA than in idiopathic scleritis and other
autoimmune diseases and are often the presenting feature of the disease.
CONCLUSIONS: The presence of necrotising changes or corneal involvement in the
setting of scleral inflammation is highly suggestive of an underlying systemic
vasculitis, of which GPA is the most common. These features should alert the
doctor/optometrist and prompt a thorough diagnostic approach and an aggressive
treatment given that it could reveal a life-threatening disease.

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PMID: 26567022   [PubMed - as supplied by publisher]


7. Br J Ophthalmol. 2015 Nov 13. pii: bjophthalmol-2015-306701. doi:
10.1136/bjophthalmol-2015-306701. [Epub ahead of print]

Mycophenolate sodium for the treatment of chronic non-infectious uveitis of
childhood.

Doycheva D(1), Zierhut M(1), Blumenstock G(2), Sobolewska B(1), Voykov B(1),
Hohmann J(1), Spitzer MS(1), Deuter C(1).

Author information: 
(1)Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany.
(2)Department of Clinical Epidemiology and Applied Biometry, University of
Tuebingen, Tuebingen, Germany.

AIM: To assess the efficacy and tolerability of mycophenolate sodium (MPS) in the
therapy of children with chronic non-infectious uveitis.
METHODS: Retrospective analysis of 23 children with chronic uveitis, treated with
MPS, with a follow-up of at least 6 months. The main outcome measures were time
to uveitis reactivation and corticosteroid-sparing effect under MPS treatment.
The secondary outcome measures were best-corrected visual acuity (BCVA) and
treatment-related side effects.
RESULTS: From 23 patients included in the study, 2 patients had anterior uveitis,
19 had intermediate uveitis and 2 had panuveitis. The probability of
reactivation-free survival after MPS initiation was estimated as 65% at both 1
and 2 years. The probability of discontinuing systemic corticosteroids after
1 year of treatment was 39% and after 2 years 51%. The probability to taper
corticosteroids to a daily dosage of ≤0.1 mg/kg after 1 and 2 years was 62% and
85%, respectively. BCVA improved or remained stable in 96% of eyes after 1 year
of therapy. Treatment-related side effects were found in nine children (rate:
0.17/patient-year). No therapy discontinuation because of side effects was
needed.
CONCLUSION: Our data suggest that MPS is useful and well tolerated in children
with chronic uveitis. MPS seems to be an effective drug for the treatment of
chronic non-infectious uveitis of childhood and may be preferred as a first-line 
steroid-sparing agent in this form of uveitis.

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PMID: 26567021   [PubMed - as supplied by publisher]


8. Br J Ophthalmol. 2015 Nov 13. pii: bjophthalmol-2015-307600. doi:
10.1136/bjophthalmol-2015-307600. [Epub ahead of print]

Surgical management of temple-related problems following lateral wall rim-sparing
orbital decompression for thyroid-related orbitopathy.

Siah WF(1), Patel BC(2), Malhotra R(1).

Author information: 
(1)Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK.
(2)Division of Facial and Orbital Cosmetic & Reconstructive Surgery, Moran Eye
Center, University of Utah, Salt Lake City, Utah, USA.

AIM: To report a case series of patients with persistent temple-related problems 
following lateral wall rim-sparing (LWRS) orbital decompression for
thyroid-related orbitopathy and to discuss their management.
METHODS: Retrospective review of medical records of patients referred to two
oculoplastic centres (Corneoplastic Unit, Queen Victoria Hospital, East
Grinstead, UK and Moran Eye Center, University of Utah, Salt Lake City, USA) for 
intervention to improve/alleviate temple-related problems. All patients were
seeking treatment for their persistent, temple-related problems of minimum
3 years' duration post decompression. The main outcome measure was the resolution
or improvement of temple-related problems.
RESULTS: Eleven orbits of six patients (five females) with a median age of
57 years (range 23-65) were included in this study. Temple-related problems
consisted of cosmetically bothersome temple hollowness (n=11; 100%), masticatory 
oscillopsia (n=8; 73%), temple tenderness (n=4; 36%), 'clicking' sensation (n=4; 
36%) and gaze-evoked ocular pain (n=4; 36%). Nine orbits were also complicated by
proptosis and exposure keratopathy. Preoperative imaging studies showed the
absence of lateral wall in all 11 orbits and evidence of prolapsed lacrimal gland
into the wall defect in four orbits. Intervention included the repair of the
lateral wall defect with a sheet implant, orbital decompression involving fat,
the medial wall or orbital floor and autologous fat transfer or synthetic filler 
for temple hollowness. Postoperatively, there was full resolution of masticatory 
oscillation, temple tenderness, 'clicking' sensation and gaze-evoked ocular pain,
and an improvement in temple hollowness. Pre-existing diplopia in one patient
resolved after surgery while two patients developed new-onset diplopia
necessitating strabismus surgery.
CONCLUSIONS: This is the first paper to show that persistent, troublesome
temple-related problems following LWRS orbital decompression can be surgically
corrected. Patients should be counselled about the potential risk of these
complications when considering LWRS orbital decompression.

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PMID: 26567020   [PubMed - as supplied by publisher]


9. Br J Ophthalmol. 2015 Nov 16. pii: bjophthalmol-2015-307024. doi:
10.1136/bjophthalmol-2015-307024. [Epub ahead of print]

Intravital imaging of the cellular dynamics of LysM-positive cells in a murine
corneal suture model.

Ueta M(1), Koga A(2), Kikuta J(3), Yamada K(2), Kojima S(4), Shinomiya K(2),
Ishii M(3), Kinoshita S(5).

Author information: 
(1)Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto
Prefectural University of Medicine, Kyoto, Japan Department of Ophthalmology,
Kyoto Prefectural University of Medicine, Kyoto, Japan. (2)Department of
Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
(3)Department of Immunology and Cell Biology, Graduate School of Medicine and
Frontier Bioscience, Osaka University, Osaka, Japan. (4)Department of
Ophthalmology, Faculty of Life Science, Kumamoto University, Kumamoto, Japan.
(5)Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto
Prefectural University of Medicine, Kyoto, Japan.

BACKGROUND: Corneal suturing is a surgical procedure used in patients with
corneal trauma or transplants. It was reported that endogenous neutrophils are
brightly labelled in gene-targeted mice expressing enhanced green fluorescent
protein (eGFP) under the control of the endogenous lysozyme M promoter (LysM-eGFP
mice).
METHODS: We applied intravital imaging methods to analyse in vivo the dynamics of
LysM-positive granulocytes (neutrophils) in LysM-eGFP mice with corneal sutures
and examined their role in the elicitation of neutrophil infiltration.
RESULTS: We found that in the presuturing state, neutrophils strongly positive
for LysM were located in the periphery of the corneal stromal layer; none were
present in the centre of the cornea. After introducing a corneal suture,
neutrophils accumulated in limbal vessels and then migrated to the corneal side
and the conjunctival side, suggesting that they derived from limbal vessels.
Thereafter they accumulated towards the central corneal area, arriving at the
suture about 7 h after its placement. Although corneal sutures may elicit the
continuous infiltration of neutrophils, their number was markedly decreased by
day 1 after suture removal and continued to decrease thereafter.
CONCLUSIONS: Our results showed that corneal sutures may elicit the continuous
infiltration of neutrophils.

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PMID: 26574604   [PubMed - as supplied by publisher]


10. Br J Ophthalmol. 2015 Nov 14. pii: bjophthalmol-2015-307035. doi:
10.1136/bjophthalmol-2015-307035. [Epub ahead of print]

Assessment of estimated retinal atrophy progression in Stargardt macular
dystrophy using spectral-domain optical coherence tomography.

Strauss RW(1), Muñoz B(2), Wolfson Y(2), Sophie R(2), Fletcher E(3), Bittencourt 
MG(2), Scholl HP(2).

Author information: 
(1)The Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA Department 
of Ophthalmology, Medical University Graz, Graz, Austria Department of
Ophthalmology, General Hospital Linz, Linz, Austria. (2)The Wilmer Eye Institute,
Johns Hopkins University, Baltimore, USA. (3)The Wilmer Eye Institute, Johns
Hopkins University, Baltimore, USA Department of Ophthalmology, Cheltenham
General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.

AIMS: To estimate disease progression based on analysis of macular volume
measured by spectral-domain optical coherence tomography (SD-OCT) in patients
affected by Stargardt macular dystrophy (STGD1) and to evaluate the influence of 
software errors on these measurements.
METHODS: 58 eyes of 29 STGD1 patients were included. Numbers and types of
algorithm errors were recorded and manually corrected. In a subgroup of 36 eyes
of 18 patients with at least two examinations over time, total macular volume
(TMV) and volumes of all nine Early Treatment of Diabetic Retinopathy Study
(ETDRS) subfields were obtained. Random effects models were used to estimate the 
rate of change per year for the population, and empirical Bayes slopes were used 
to estimate yearly decline in TMV for individual eyes.
RESULTS: 6958 single B-scans from 190 macular cube scans were analysed. 2360
(33.9%) showed algorithm errors. Mean observation period for follow-up data was
15 months (range 3-40). The median (IQR) change in TMV using the empirical Bayes 
estimates for the individual eyes was -0.103 (-0.145, -0.059) mm(3) per year. The
mean (±SD) TMV was 6.321±1.000 mm(3) at baseline, and rate of decline was
-0.118 mm(3) per year (p=0.003). Yearly mean volume change was -0.004 mm(3) in
the central subfield (mean baseline=0.128 mm(3)), -0.032 mm(3) in the inner (mean
baseline=1.484 mm(3)) and -0.079 mm(3) in the outer ETDRS subfields (mean
baseline=5.206 mm(3)).
CONCLUSIONS: SD-OCT measurements allow monitoring the decline in retinal volume
in STGD1; however, they require significant manual correction of software errors.

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PMID: 26568636   [PubMed - as supplied by publisher]


11. Br J Ophthalmol. 2015 Nov 9. pii: bjophthalmol-2015-307541. doi:
10.1136/bjophthalmol-2015-307541. [Epub ahead of print]

Comparison of macular choroidal thicknesses from swept source and spectral domain
optical coherence tomography.

Tan CS(1), Cheong KX(2), Lim LW(2), Sadda SR(3).

Author information: 
(1)National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore,
Singapore Fundus Image Reading Center, National Healthcare Group Eye Institute,
Singapore, Singapore. (2)National Healthcare Group Eye Institute, Tan Tock Seng
Hospital, Singapore, Singapore. (3)Doheny Eye Institute, University of California
Los Angeles, Los Angeles, California, USA.

BACKGROUND: Choroidal thickness (CT) measurements differ between swept source
optical coherence tomography (SS-OCT) and spectral domain OCT (SD-OCT) devices
for point thickness measurements. We aimed to assess the comparability of mean
macular CT measurements between SS-OCT and SD-OCT devices.
METHODS: In a prospective cohort study of 25 healthy volunteers, OCT scans were
performed sequentially with the deep range imaging (DRI) OCT-1 and Spectralis OCT
using standardised imaging protocols. These OCT scans were independently graded
by reading centre-certified graders to obtain mean CT in the various Early
Treatment Diabetic Retinopathy Study (ETDRS) subfields. Paired t tests and
intraclass correlation coefficients (ICCs) were used to compare the measurements.
RESULTS: The difference in mean central subfield CT between DRI OCT-1 and
Spectralis was 49.3 µm (p<0.001), while differences in CT in various ETDRS
subfields varied from 42.1 to 67.2 µm. After manual adjustment of the
segmentation boundaries for the central subfield in the DRI OCT-1, the mean
central subfield CT for DRI OCT-1 increased from 263.1 to 293.3 µm (p<0.001), and
the resultant difference between DRI OCT-1 and Spectralis decreased from 49.3 to 
19.1 µm (a decrease of 61.3%; p<0.001). CT between the three-dimensional and
radial scanning protocols of the DRI OCT-1 were highly comparable, with
differences generally under 10 µm and ICC of 0.888 for the central subfield.
CONCLUSIONS: CT measurements between automated segmentations from the DRI OCT-1
and manual segmentations on the Spectralis OCT may differ by more than 50 µm.
This difference can be reduced, but not eliminated, by manual adjustment of
segmentation boundaries by trained graders, and should be accounted for when
comparing results between the two devices.

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PMID: 26553923   [PubMed - as supplied by publisher]


12. Br J Ophthalmol. 2015 Nov 9. pii: bjophthalmol-2015-306972. doi:
10.1136/bjophthalmol-2015-306972. [Epub ahead of print]

Current therapeutic development for atrophic age-related macular degeneration.

Hanus J(1), Zhao F(2), Wang S(3).

Author information: 
(1)Department of Cell and Molecular Biology, Tulane University, New Orleans,
Louisiana, USA. (2)Department of Cell and Molecular Biology, Tulane University,
New Orleans, Louisiana, USA Fourth Affiliated Hospital of China Medical
University, Shenyang, Liaoning, P. R. China. (3)Department of Cell and Molecular 
Biology, Tulane University, New Orleans, Louisiana, USA Department of
Ophthalmology, Tulane University, New Orleans, Louisiana, USA.

Age-related macular degeneration (AMD), a degenerative disorder of the central
retina, is the leading cause of irreversible blindness in the elderly. The
underlying mechanism of the advanced form of dry AMD, also named geographic
atrophy (GA) or atrophic AMD, remains unclear. Consequently, no cure is available
for dry AMD or GA. The only prevention option currently available is the
Age-Related Eye Disease Study (AREDS) formulation, which has been demonstrated to
slow down the progression of dry AMD. This review summarises recent advances in
therapy for dry AMD and GA. Building on the new understanding of the disease and 
recent technological breakthroughs, numerous ongoing clinical trials have the
goal of meeting the need to cure AMD. Therapeutic agents are being developed to
target the key features of the disease, including inhibiting the complement
pathway and other inflammatory pathways, reducing oxidative stress and protecting
retinal pigment epithelial (RPE) cells, inhibiting lipofuscin and visual cycle,
regenerating RPE cells from stem cells and restoring choroidal blood flow. Some
of these therapeutic options, especially the stem cell-based therapy, hold great 
promise, which brings great hope for this devastating blinding disease.

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PMID: 26553922   [PubMed - as supplied by publisher]


13. Br J Ophthalmol. 2015 Nov 9. pii: bjophthalmol-2015-307362. doi:
10.1136/bjophthalmol-2015-307362. [Epub ahead of print]

Behçet's disease ocular attack score 24 and visual outcome in patients with
Behçet's disease.

Tanaka R(1), Murata H(1), Takamoto M(1), Ohtomo K(1), Okinaga K(1), Yoshida A(2),
Kawashima H(2), Nakahara H(1), Fujino Y(3), Kaburaki T(1).

Author information: 
(1)Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku,
Tokyo, Japan. (2)Department of Ophthalmology, Jichi Medical University,
Shimotsuke, Tochigi, Japan. (3)Department of Ophthalmology, Japan Community
Health Care Organization Tokyo Shinjuku Medical Center, Shinjyuku-ku, Tokyo,
Japan.

AIMS: To investigate the ability of the Behçet's disease ocular attack score 24
(BOS24) scoring system to predict visual acuity (VA) in patients with ocular
Behçet's disease.
DESIGN: This is a retrospective study.
METHODS: We included 91 eyes of 50 patients with ocular Behçet's disease (33
males, 17 females) who were referred to our hospital between 1986 and 2008 with
>5 years follow-up. Total BOS24 scores over a 5-year period, BOS24-5Y, were
calculated as the sum of BOS24 scores for each attack over the 5-year study
period for each eye. Change in VA was defined as change in best-corrected visual 
acuity (BCVA) from the first remission to the last remission at the end of the
target period. Factors related to change in VA (age, gender, BCVA at the first
remission, total number of immunosuppressive medications and total number of
ocular attacks during the 5-year period and BOS24-5Y) were evaluated using a
linear mixed model.
RESULTS: BCVA (logarithm of the minimal angle resolution) deteriorated from
0.16±0.30 (mean±SD) to 0.21±0.37 over the 5-year study period, but there was no
statistical difference. The total number of ocular attacks during the 5-year
period and BOS24-5Y scores were 10.0±7.9 and 36.8±40.8, respectively. Linear
mixed-model analysis revealed that BOS24-5Y was the most important index for VA
deterioration, followed by BCVA at the first remission.
CONCLUSIONS: BOS24-5Y was found to be a significant positive prognostic index for
VA deterioration in patients with ocular Behçet's disease.

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PMID: 26553921   [PubMed - as supplied by publisher]


14. Br J Ophthalmol. 2015 Nov 9. pii: bjophthalmol-2012-301504corr1. doi:
10.1136/bjophthalmol-2012-301504corr1. [Epub ahead of print]

Correction.

[No authors listed]

Erratum for
    Br J Ophthalmol. 2013 Mar;97(3):278-84. doi: 10.1136/bjophthalmol-2012-301504.
Epub 2013 Jan 7..

PMID: 26553920   [PubMed - as supplied by publisher]


15. Br J Ophthalmol. 2015 Nov 9. pii: bjophthalmol-2015-307350. doi:
10.1136/bjophthalmol-2015-307350. [Epub ahead of print]

Efficacy of conjunctival resection with cyanoacrylate glue application in
preventing recurrences of Mooren's ulcer.

Lal I(1), Shivanagari SB(2), Ali MH(1), Vazirani J(1).

Author information: 
(1)Cornea and Anterior Segment Services, LV Prasad Eye Institute, GMRV Campus,
Visakhapatnam, Andhra Pradesh, India. (2)Department of Clinical Epidemiology and 
Bio-Statistics, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad,
Telangana, India.

AIM: To evaluate the role of conjunctival resection along with cyanoacrylate glue
and bandage contact lens application in preventing recurrences and arresting
progression in cases of Mooren's ulcer.
METHOD: This retrospective interventional case series included cases of Mooren's 
ulcer that underwent conjunctival resection with cyanoacrylate glue and bandage
contact lens application between 2011 and 2014. Systemic immunosuppression was
initiated depending on the laterality and severity of disease. The primary
outcome measures were clinical quiescence and recurrence-free survival.
Kaplan-Meier plots were constructed and survival analysis done using the R
software environment for statistical analysis. Secondary outcome measures were
needed for systemic immunosuppression, change in best-corrected visual acuity and
complications encountered.
RESULTS: We evaluated 16 eyes of 12 patients who presented to us during the study
period. The mean follow-up duration was 9.6 months. All eyes achieved clinical
quiescence with a median recurrence-free survival of 141 days. The Kaplan-Meier
survival curve showed probability of recurrence-free survival to be 42.5% at
1 year, which further dropped down to 21.3% at 2 years. All patients with
recurrence (seven eyes of four patients) required systemic immunosuppression.
CONCLUSIONS: Conjunctival resection and cyanoacrylate glue application are not
effective in avoiding recurrences and halting the disease progression in cases of
Mooren's ulcer. Systemic immunosuppression remains the mainstay of therapy.

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PMID: 26553919   [PubMed - as supplied by publisher]


16. Br J Ophthalmol. 2015 Nov 9. pii: bjophthalmol-2013-304002corr1. doi:
10.1136/bjophthalmol-2013-304002corr1. [Epub ahead of print]

Corrections.

[No authors listed]

Erratum for
    Br J Ophthalmol. 2014 Feb;98(2):256-8. doi: 10.1136/bjophthalmol-2013-304002.
Epub 2013 Nov 13..

PMID: 26553918   [PubMed - as supplied by publisher]


17. Br J Ophthalmol. 2015 Nov 9. pii: bjophthalmol-2015-306934. doi:
10.1136/bjophthalmol-2015-306934. [Epub ahead of print]

In vivo confocal microscopic corneal images in health and disease with an
emphasis on extracting features and visual signatures for corneal diseases: a
review study.

Alzubaidi R(1), Sharif MS(1), Qahwaji R(1), Ipson S(1), Brahma A(2).

Author information: 
(1)School of Electrical Engineering and Computer Science, University of Bradford,
Bradford, UK. (2)Manchester Royal Eye Hospital, Central Manchester University
Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, UK.

There is an evolution in the demands of modern ophthalmology from descriptive
findings to assessment of cellular-level changes by using in vivo confocal
microscopy. Confocal microscopy, by producing greyscale images, enables a
microstructural insight into the in vivo cornea in both health and disease,
including epithelial changes, stromal degenerative or dystrophic diseases,
endothelial pathologies and corneal deposits and infections. Ophthalmologists use
acquired confocal corneal images to identify health and disease states and then
to diagnose which type of disease is affecting the cornea. This paper presents
the main features of the healthy confocal corneal layers and reviews the most
common corneal diseases. It identifies the visual signatures of each disease in
the affected layer and extracts the main features of this disease in terms of
intensity, certain regular shapes with both their size and diffusion, and some
specific region of interest. These features will lead towards the development of 
a complete automatic corneal diagnostic system that predicts abnormalities in the
confocal corneal data sets.

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already granted under a licence) please go to
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PMID: 26553917   [PubMed - as supplied by publisher]


18. Br J Ophthalmol. 2015 Nov 6. pii: bjophthalmol-2015-307347. doi:
10.1136/bjophthalmol-2015-307347. [Epub ahead of print]

Triamcinolone during pars plana vitrectomy for open globe trauma: a pilot
randomised controlled clinical trial.

Banerjee PJ(1), Xing W(1), Bunce C(1), Woodcock M(2), Chandra A(1), Scott RA(3), 
Charteris DG(1).

Author information: 
(1)Moorfields Eye Hospital, London, UK NIHR Clinical Research Facility at
Moorfields Eye Hospital, London, UK. (2)Royal Air force and Worcestershire Acute 
Hospitals NHS Trust, Worcester, UK. (3)Birmingham and Midland Eye Centre,
Birmingham, UK.

PURPOSE: To investigate the feasibility of conducting a randomised controlled
trial in patients undergoing pars plana vitrectomy surgery following open globe
trauma (OGT). Additionally, to investigate the treatment effect and toxicity of
intensive anti-inflammatory agents.
METHODS: A 2-year, pilot, single-centre prospective, participant and
surgeon-masked randomised controlled trial (RCT). Forty patients requiring
vitrectomy surgery following OGT were randomised to either standard (control) or 
study treatment (adjuncts) in a 1:1 allocation ratio. Perioperatively, the
adjunct group received intravitreal and subtenons triamcinolone acetonide, oral
flurbiprofen and guttae prednisolone acetate 1%. The control group received
standard care. Primary outcome was anatomical success at 6 months. Secondary
outcomes included final visual acuity, occurrence of proliferative
vitreoretinopathy, intraocular pressure rise, number of operations and
recruitment rate.
RESULTS: 40 patients were recruited within 21 months. Primary outcome assessment 
showed similar results in anatomical success with 50% (10/20) in the adjunct
group compared with 47% (9/19) in the standard group (OR 1.11, 95% CI 0.316 to
3.904). Visual outcomes were better in the adjunct group with a final median
visual acuity of 31 Early Treatment Diabetic Retinopathy Study (ETDRS) letters
compared with 25 ETDRS letters in the standard group. A higher proportion of
patients gained 10, 20 and 30 ETDRS letters in the adjunct group (80%, 65% and
50%, respectively) compared with the standard group (52.6%, 52.6% and 42.1%).
Fewer adjunct patients (15%, n=3) had poor visual outcomes (Zero ETDRS letters)
compared with 42.1%, (n=8).
CONCLUSIONS: An RCT in this population is deliverable and estimated recruitment
rates are realistic. Results and patient discussions determined that the
definitive study should have vision as a primary outcome. This pilot study is
supportive of there being a positive treatment effect of intensive
anti-inflammatory agents in OGT.
TRIAL REGISTRATION NUMBER: European Clinical Trials Database 2007-005138-35;
Results.

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PMID: 26546051   [PubMed - as supplied by publisher]


19. Br J Ophthalmol. 2015 Nov 5. pii: bjophthalmol-2015-307871. doi:
10.1136/bjophthalmol-2015-307871. [Epub ahead of print]

Cycloplegic autorefraction versus subjective refraction: the Tehran Eye Study.

Hashemi H(1), Khabazkhoob M(1), Asharlous A(2), Soroush S(2), Yekta A(3), Dadbin 
N(2), Fotouhi A(4).

Author information: 
(1)Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran,
Iran. (2)Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
(3)Department of Optometry, School of Paramedical Sciences, Mashhad University of
Medical Sciences, Mashhad, Iran. (4)Department of Epidemiology and Biostatistics,
School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

AIM: To compare cycloplegic autorefraction with non-cycloplegic subjective
refraction across all age and refractive error groups.
METHODS: In a cross-sectional study with random stratified cluster sampling, 160 
clusters were chosen from various districts proportionate to the population of
each district in Tehran. Following retinoscopy and autorefraction with the 0.25 D
bracketing (Topcon KR-8000, Topcon, Tokyo, Japan), all participants had a
subjective refraction. Then all participants underwent cycloplegic
autorefraction.
RESULTS: The final analysis was performed on 3482 participants with a mean age of
31.7 years (range 5-92 years). Based on cycloplegic and subjective refraction,
mean spherical equivalent (SE) was +0.31±1.80 and -0.32±1.61 D, respectively
(p<0.001). The 95% limits of agreement (LoA) between these two types of
refraction were from -0.40 to 1.70 D. The largest difference between these two
types of refraction was seen in the age group of 5-10 years (1.11±0.60 D), and
the smallest difference was in the age group of >70 years (0.34±0.45 D). The 95% 
LoA was -0.52 to 0.89 D in patients with myopia and -0.12 to 2.04 D in patients
with hyperopia. We found that female gender (coefficients=0.048), older age
(coefficients=-0.247), higher education (coefficients=-0.043) and cycloplegic SE 
(coefficients=-0.472) significantly correlated with lower intermethod
differences.
CONCLUSIONS: The cycloplegic refraction is more sensitive than the subjective one
to measure refractive error at all age groups especially in children and young
adults. The cyclorefraction technique is highly recommended to exactly measure
the refractive error in momentous conditions such as refractive surgery,
epidemiological researches and amblyopia therapy, especially in hypermetropic
eyes and paediatric cases.

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already granted under a licence) please go to
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PMID: 26541436   [PubMed - as supplied by publisher]


20. Br J Ophthalmol. 2015 Nov 5. pii: bjophthalmol-2015-307575. doi:
10.1136/bjophthalmol-2015-307575. [Epub ahead of print]

Predicting vision gains with anti-VEGF therapy in neovascular age-related macular
degeneration patients by using low-luminance vision.

Frenkel RE(1), Shapiro H(2), Stoilov I(2).

Author information: 
(1)Bascom Palmer Eye Institute, Miami, Florida, USA East Florida Eye Institute,
Stuart, Florida, USA Eye Research Foundation, Stuart, Florida, USA. (2)Genentech,
Inc, South San Francisco, California, USA.

BACKGROUND/AIMS: To evaluate baseline low-luminance visual acuity (LLVA) as a
predictor of visual acuity improvement in patients with neovascular (wet)
age-related macular degeneration (wAMD) receiving antivascular endothelial growth
factor A (anti-VEGF) therapy.
METHODS: In the HARBOR trial, 1084 treatment-naïve patients ≥50 years of age with
subfoveal wAMD received intravitreal ranibizumab 0.5 or 2.0 mg monthly or as
needed. To measure LLVA, patients read a normally illuminated ETDRS (Early
Treatment Diabetic Retinopathy Study) chart with a neutral density filter placed 
in front of the study eye. Patients were assigned into quartiles based on the
magnitude of the difference between best-corrected visual acuity under optimal
luminance (BCVA) and LLVA (BCVA-LLVA gap). The association between mean change in
BCVA from baseline and BCVA-LLVA gap at baseline was analysed using a general
linear model.
RESULTS: A smaller baseline BCVA-LLVA gap predicted significantly higher BCVA
gains over 24 months (p<0.0001 at each month; Pearson correlation), even after
controlling for baseline BCVA or stratifying by treatment arm. Patients in the
smallest baseline BCVA-LLVA gap quartile gained an average of +13.4 letters
compared with +2.4 letters for patients in the widest baseline BCVA-LLVA gap
quartile. At months 12 and 24, the smallest baseline BCVA-LLVA gap quartile had
the highest proportion of ≥15-≥30-letter gain, and the widest baseline BCVA-LLVA 
gap quartile had the highest proportion of ≥15-/≥30-letter loss (p<0.0001;
Fisher's exact test).
CONCLUSIONS: The baseline BCVA-LLVA gap is a significant predictor of visual
acuity response to anti-VEGF treatment in patients with wAMD.
TRIAL REGISTRATION NUMBER: NCT00891735; Post-results.

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PMID: 26541435   [PubMed - as supplied by publisher]


21. Br J Ophthalmol. 2015 Nov 5. pii: bjophthalmol-2015-306924. doi:
10.1136/bjophthalmol-2015-306924. [Epub ahead of print]

MicroRNAs in retina during development of experimental autoimmune uveoretinitis
in rats.

Watanabe T(1), Keino H(1), Kudo A(2), Sato Y(3), Okada AA(1).

Author information: 
(1)Department of Ophthalmology, Kyorin University School of Medicine, Tokyo,
Japan. (2)Department of Anatomy, Kyorin University School of Medicine, Tokyo,
Japan. (3)Division of Radioisotope Research, Kyorin University School of
Medicine, Tokyo, Japan.

PURPOSE: To determine the changes in the expression profiles of microRNAs
(miRNAs) in retinas during the development of experimental autoimmune
uveoretinitis (EAU) in rats.
METHODS: The levels of interleukin-1β (IL-1β) and monocyte chemoattractant
protein-1 (MCP-1) were measured in aqueous humour samples and supernatants of
homogenised posterior eye cups obtained from Lewis rats immunised with
interphotoreceptor retinoid binding protein peptide (R14) and complete Freund's
adjuvant. Microarray analysis was performed to determine the miRNA profiles in
the retina of eyes with EAU on days 0 (baseline), 7, 14 and 21 after
immunisation.
RESULTS: The levels of IL-1β and MCP-1 in the aqueous humour and the supernatants
of posterior eye cups were significantly elevated in eyes with EAU, and the
levels corresponded with the stage of the EAU. On day 14 after immunisation, the 
expressions of nine miRNAs (miRNA-223, 142-5p, 142-3p, 21, 146a, 146b, 1949,
1188-3p and 193) were significantly elevated, and the expressions of four miRNAs 
(miRNA-181a, 183*, 124* and 331) were downregulated relative to the baseline.
Quantitative PCR analyses confirmed the elevation of miRNA-223 and miRNA-146 and 
the downregulation of miRNA-181a in retinas with EAU on day 14 after
immunisation. In situ hybridisation confirmed increased expression of miR-223 and
miR-146 in retinas with EAU.
CONCLUSIONS: Several miRNAs were significantly increased or decreased in retinas 
during the course of EAU. The expression of miR-223 and miR-146a corresponded
with the clinical score of the EAU and elevation of IL-1β/MCP-1 in the eye with
EAU. Further studies are required to clarify the role of miRNA in eyes with
autoimmune uveoretinitis.

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PMID: 26541434   [PubMed - as supplied by publisher]


22. Br J Ophthalmol. 2015 Nov 5. pii: bjophthalmol-2015-307313. doi:
10.1136/bjophthalmol-2015-307313. [Epub ahead of print]

Influence of epiretinal membrane on the measurement of peripapillary retinal
nerve fibre layer thickness using spectral-domain coherence tomography.

Lee YH(1), Bae HW(2), Seo SJ(3), Lee SY(2), Beon SH(2), Kang S(4), Kim CY(2).

Author information: 
(1)Tae Ophthalmic Clinic, Anyang, Korea. (2)Department of Ophthalmology,
Severance Hospital, Institute of Vision Research, Yonsei University College of
Medicine, Seoul, Korea. (3)Department of Ophthalmology, Maryknoll Medical Center,
Busan, Korea. (4)Department of Ophthalmology, Eyereum Ophthalmic Clinic, Seoul,
Korea.

BACKGROUND/AIMS: To investigate the effect of epiretinal membrane (ERM) on
peripapillary retinal nerve fibre layer (RNFL) thickness measurements using
spectral-domain optical coherence tomography (Spectralis; Heidelberg
Engineering).
METHODS: A total of 134 patients with idiopathic ERM and 63 healthy controls were
included in this observational comparative study. We categorised ERMs into three 
severity grades, based on retinal appearance in macular scans. All eyes with ERM 
were classified into two groups; those involving the peripapillary scan area
(ERM+pp, n=68 eyes) and not involving the peripapillary scan area (ERM-pp, n=66
eyes) using the macular disc scan. Peripapillary RNFL thickness was compared
between related subgroups as (ERM+pp) or (ERM-pp) group.
RESULTS: Temporal peripapillary RNFL thickness was significantly greater in the
ERM+pp group (109.44±22.91 μm), followed by the ERM-pp (82.60±11.77 μm, p<0.001) 
and control (75.42±10.49 μm, p<0.001) groups. Temporal peripapillary RNFL
thickness significantly increased with ERM grade in the ERM+pp and ERM-pp groups 
(both p<0.001). The peripapillary RNFL thickness was overestimated (exceeded 99th
percentile) in the temporal sector in 49 eyes (72.1%) in the ERM+pp group and in 
5 eyes (7.6%) in the ERM-pp group.
CONCLUSIONS: Temporal and global peripapillary RNFL thickness is significantly
higher in eyes with ERM, especially when the ERM extends into the peripapillary
area. However, some eyes with an ERM that does not involve the peripapillary scan
area still show peripapillary RNFL thickening. Measured peripapillary RNFL
thickness was significantly and positively correlated with ERM severity.

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PMID: 26541433   [PubMed - as supplied by publisher]


23. Br J Ophthalmol. 2015 Nov 5. pii: bjophthalmol-2015-307272. doi:
10.1136/bjophthalmol-2015-307272. [Epub ahead of print]

Influence of involuntary eyelid spasms on corneal topographic and eyelid
morphometric changes in patients with hemifacial spasm.

Osaki T(1), Osaki MH(1), Osaki TH(1), Hirai FE(1), Nallasamy N(2), Campos M(1).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, 
Federal University of São Paulo/UNIFESP, São Paulo, SP, Brazil. (2)Department of 
Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA.

BACKGROUND/AIMS: In patients with hemifacial spasm (HFS), treatment relieves
eyelid spasms on the affected side, thus changes in corneal topography and eyelid
morphometry may be observed after treatment. We aimed to evaluate these
parameters during a 4-month period in patients with HFS treated with botulinum
toxin A (BTX-A).
METHODS: This prospective study evaluated eyelid morphometric and corneal
topographic changes in patients with HFS before onabotulinum toxin A application,
and after 15 days and 2, 3 and 4 months.
RESULTS: 24 patients were treated with BTX-A. On the normal side, the mean
palpebral fissure height (PF), interpalpebral surface area (ISA), steep K and
astigmatism values were 8.7±1.98 mm, 122.09±39.37 mm(2), 44.99±1.45 D and
0.9±0.64 D, respectively, before treatment. A statistically significant
difference was not observed in these parameters after treatment (p>0.05). On the 
affected side, the mean PF, ISA, steep K and astigmatism were 5.5±1.77 mm,
67.68±28.49 mm(2), 46.91±3.57 D and 2.63±2.46 D, respectively, before treatment. 
We observed a statistically significant (p<0.05) increase in the mean PF and ISA 
on the affected side 15 days (8.36±1.91 mm and 115.92±34.44 mm(2), respectively),
2 months (8.18±1.80 mm and 112.22±33.57 mm(2), respectively) and 3 months
(7.27±1.65 mm and 95.48±27.80 mm(2), respectively) after treatment. A
statistically significant decrease in steep K and astigmatism was observed at 2
months (45.14±1.20 D and 1.01±0.58 D, respectively) and 3 months (45.64±1.77 D
and 1.36±1.31 D, respectively) after treatment.
CONCLUSIONS: The results suggest that treatment with BTX-A in patients with HFS
leads to eyelid and corneal changes on the affected eye that are significant
during the known period of action of the toxin. Thus, caution should be taken
when performing ophthalmological examination in patients with HFS, since it may
vary according to BTX-A period of action.

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PMID: 26541432   [PubMed - as supplied by publisher]


24. Br J Ophthalmol. 2015 Nov 5. pii: bjophthalmol-2015-307494. doi:
10.1136/bjophthalmol-2015-307494. [Epub ahead of print]

En face enhanced depth imaging optical coherence tomography of polypoidal
choroidal vasculopathy.

Semoun O(1), Coscas F(2), Coscas G(2), Lalloum F(1), Srour M(1), Souied EH(1).

Author information: 
(1)University Eye Clinic of Créteil, Centre Hospitalier Intercommunal de Créteil,
Paris, France. (2)University Eye Clinic of Créteil, Centre Hospitalier
Intercommunal de Créteil, Paris, France Centre d'exploration Ophtalmologique de
l'Odéon, Paris, France.

PURPOSE: To analyse retinal and choroidal changes associated with polypoidal
choroidal vasculopathy (PCV) using en face spectral-domain optical coherence
tomography (SD-OCT).
METHODS: In this retrospective and descriptive study, we collected imaging of
patients affected with PCV examined using enhanced depth imaging (EDI) SD-OCT,
fluorescein and indocyanine green angiography for a qualitative analysis. The
three-dimensional reconstruction of 197 transverse sections with EDI SD-OCT at
30 μm intervals provided a virtual macular brick through which 496 sections in
the coronal plane resulted in a C-scan or en face OCT image.
RESULTS: 30 eyes of 30 patients affected with PCV were studied. En face OCT
revealed polyps as roundish structures visible deeper than pigment epithelium
layer, attached to its posterior face, easily detected in all cases.
Hyper-reflective dots were visible on en face OCT in all cases within the retinal
layers, associated to a well-defined dark area suggesting serous exudation in 27 
eyes. The abnormal choroidal network was identified in four eyes. At the Bruch
membrane level, all polyps were associated with a localised back shadowing, and
were no more visible at the choriocapillaris layer level. Large choroidal vessels
were visible in all eyes, mainly at the polypoidal lesion periphery, not directly
behind.
CONCLUSIONS: En face OCT imaging using SD-OCT is an easy, reproducible,
non-invasive and effective tool to visualise and to understand retinal and
choroidal changes PCV. It provides complementary morphological information,
describes new semiological entities and might substitute other exams in the
future, without dye injection.

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PMID: 26541431   [PubMed - as supplied by publisher]


25. Br J Ophthalmol. 2015 Nov 4. pii: bjophthalmol-2015-307797. doi:
10.1136/bjophthalmol-2015-307797. [Epub ahead of print]

Efficacy of dexamethasone versus bevacizumab on regression of hard exudates in
diabetic maculopathy: data from the BEVORDEX randomised clinical trial.

Mehta H(1), Fraser-Bell S(2), Yeung A(2), Campain A(2), Lim LL(3), Quin GJ(4),
McAllister IL(5), Keane PA(6), Gillies MC(2).

Author information: 
(1)The Save Sight and Eye Health Institute, Sydney Medical School, University of 
Sydney, Sydney, Australia National Institute for Health Research Biomedical
Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust
and UCL Institute of Ophthalmology, London, UK. (2)The Save Sight and Eye Health 
Institute, Sydney Medical School, University of Sydney, Sydney, Australia.
(3)Centre for Eye Research Australia, University of Melbourne, Royal Victorian
Eye and Ear Hospital, East Melbourne, Victoria, Australia. (4)The Save Sight and 
Eye Health Institute, Sydney Medical School, University of Sydney, Sydney,
Australia Ophthalmology Department, Australian School of Advanced Medicine,
Macquarie University, Sydney, Australia. (5)Lions Eye Institute, Centre for
Ophthalmology and Visual Science, University of Western Australia, Perth, Western
Australia, Australia. (6)National Institute for Health Research Biomedical
Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust
and UCL Institute of Ophthalmology, London, UK.

OBJECTIVE: To report the effect of bevacizumab versus dexamethasone on hard
exudates (HEX) in diabetic macular oedema (DME).
DESIGN: Post hoc analysis of 24-month data from the Randomised clinical trial of 
BEVacizumab OR DEXamethasone for diabetic macular oedema (BEVORDEX) phase 2
multicentre randomised clinical trial. Eyes with centre-involving DME resistant
to or unlikely to benefit from macular laser therapy were included. Eyes were
randomly assigned to bevacizumab every 4 weeks or Ozurdex dexamethasone implant
(DEX) every 16 weeks, both as required. The 68 eyes from 48 patients that
completed 24-month follow-up were analysed. Two masked graders assessed extent
and location of HEX on baseline, 12-month and 24-month foveal-centred colour
fundus photographs using validated grading software.
RESULTS: Macular HEX was present in 60% of study eyes. Of these, 21 eyes were
treated with DEX and 20 eyes with bevacizumab. Both treatments led to reduction
in area of macular HEX at 12 months and 24 months. There was greater regression
of HEX from the foveal centre in DEX-treated eyes (median change +890 µm,
IQR=1040 µm) than bevacizumab-treated eyes (median change +7.0 µm, IQR=590 µm) at
12 months (p=0.04) but the difference was no longer statistically significant
(p=0.10) by 24 months (DEX +1400 µm, IQR=1590 µm; bevacizumab +20 µm,
IQR=2680 µm). Reassuringly, no study eye developed HEX at the foveal centre, a
visually devastating consequence of diabetic maculopathy.
CONCLUSIONS: Bevacizumab and DEX were effective in reducing area of HEX in eyes
with DME. DEX provided more rapid regression of HEX from the foveal centre
although bevacizumab-treated eyes started to catch up by 24 months. Distance from
the foveal centre as well as total area of macular HEX should be assessed when
evaluating treatments for foveal-threatening HEX.
TRIAL REGISTRATION NUMBER: NCT01298076; Post-results.

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PMID: 26537156   [PubMed - as supplied by publisher]


26. Br J Ophthalmol. 2015 Nov 3. pii: bjophthalmol-2015-307587. doi:
10.1136/bjophthalmol-2015-307587. [Epub ahead of print]

Evaluation of the efficacy and safety of a standardised intracameral combination 
of mydriatics and anaesthetics for cataract surgery.

Labetoulle M(1), Findl O(2), Malecaze F(3), Alió J(4), Cochener B(5), Lobo C(6), 
Lazreg S(7), Hartani D(8), Colin J(9), Tassignon MJ(10), Behndig A(11);
Intracameral Mydrane Study 2 Group.

Author information: 
(1)Hôpital Bicêtre, APHP, South Paris University, Ophtalmology, Le
Kremlin-Bicêtre, France Institute for Integrative Biology of the Cell (I2BC),
Département de Virologie, CNRS, Gif/Yvette, France. (2)Vienna Institute for
Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria. (3)Hôpital
Purpan, CHU de Toulouse, Toulouse, France. (4)Instituto Oftalmologico de
Alicante, Alicante, Spain. (5)CHU Morvan, Brest, France. (6)Association for
Innovation and Biomedical Research on Light and Image (AIBILI), Centro Hospitalar
e Universitário de Coimbra, Coimbra, Portugal. (7)Centre d'ophtalmologie, Lazreg,
Algeria. (8)CHU Mustapha, Alger, Algérie. (9)Hôpital Pellegrin Tripode, Bordeaux,
France. (10)Universitair Ziekenhuis Antwerpen, Edegem, Belgium. (11)Umeå
University Hospital, Umeå, Sweden.

BACKGROUND/AIMS: To compare the efficacy and safety of intracameral (IC)
administration at the beginning of cataract surgery, of Mydrane, a standardised
ophthalmic combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine
1%, to a standard topical regimen.
METHODS: In this international phase III, prospective, randomised study, the
selected eye of 555 patients undergoing phacoemulsification with intraocular lens
(IOL) implantation received 200 μL of Mydrane (Mydrane group) just after the
first incision or a topical regimen of one drop each of tropicamide 0.5% and
phenylephrine 10% repeated three times (reference group). The primary efficacy
variable was achievement of capsulorhexis without additional mydriatics. The
non-inferiority of Mydrane to the topical regimen was tested. The main outcome
measures were pupil size, patient perception of ocular discomfort and safety.
RESULTS: Capsulorhexis without additional mydriatics was performed in 98.9% of
patients and 94.7% in the Mydrane and reference groups, respectively. Both groups
achieved adequate mydriasis (>7 mm) during capsulorhexis, phacoemulsification and
IOL insertion. IOL insertion was classified as 'routine' in a statistically
greater number of eyes in the Mydrane group compared with the reference group
(p=0.047). Patients in the Mydrane group reported statistically greater comfort
than the reference group before IOL insertion (p=0.034). Safety data were similar
between groups.
CONCLUSIONS: Mydrane is an effective and safe alternative to standard eye drops
for initiating and maintaining intraoperative mydriasis and analgesia. Patients
who received IC Mydrane were significantly more comfortable before IOL insertion 
than the reference group. Surgeons found IOL insertion less technically
challenging with IC Mydrane.
TRIAL REGISTRATION NUMBER: NCT02101359; Results.

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PMID: 26531052   [PubMed - as supplied by publisher]


27. Br J Ophthalmol. 2015 Nov 3. pii: bjophthalmol-2015-306828. doi:
10.1136/bjophthalmol-2015-306828. [Epub ahead of print]

Risk factors for low vision related functioning in the Mycotic Ulcer Treatment
Trial: a randomised trial comparing natamycin with voriconazole.

Rose-Nussbaumer J(1), Prajna NV(2), Krishnan T(2), Mascarenhas J(2), Rajaraman
R(2), Srinivasan M(2), Raghavan A(2), Oldenburg CE(3), O'Brien KS(3), Ray KJ(3), 
Porco TC(4), McLeod SD(5), Acharya NR(6), Keenan JD(6), Lietman TM(7); Mycotic
Ulcer Treatment Trial Group.

Author information: 
(1)Francis I. Proctor Foundation, University of California San Francisco, San
Francisco, California, USA Department of Ophthalmology, University of California 
San Francisco, San Francisco, California, USA Department of Optometry, University
of California Berkeley. (2)Aravind Eye Care System at Madurai, Pondicherry and
Coimbatore. (3)Francis I. Proctor Foundation, University of California San
Francisco, San Francisco, California, USA. (4)Department of Ophthalmology,
University of California San Francisco, San Francisco, California, USA
Epidemiology and Biostatistics, University of California San Francisco, San
Francisco, California, USA. (5)Department of Ophthalmology, University of
California San Francisco, San Francisco, California, USA. (6)Francis I. Proctor
Foundation, University of California San Francisco, San Francisco, California,
USA Department of Ophthalmology, University of California San Francisco, San
Francisco, California, USA. (7)Francis I. Proctor Foundation, University of
California San Francisco, San Francisco, California, USA Department of
Ophthalmology, University of California San Francisco, San Francisco, California,
USA Epidemiology and Biostatistics, University of California San Francisco, San
Francisco, California, USA.

BACKGROUND/AIMS: The Mycotic Ulcer Treatment Trial I (MUTT I) was a
double-masked, multicentre, randomised controlled trial, which found that topical
natamycin is superior to voriconazole for the treatment of filamentous fungal
corneal ulcers. In this study, we determine risk factors for low vision-related
quality of life in patients with fungal keratitis.
METHODS: The Indian visual function questionnaire (IND-VFQ) was administered to
MUTT I study participants at 3 months. Associations between patient and ulcer
characteristics and IND-VFQ subscale score were assessed using generalised
estimating equations.
RESULTS: 323 patients were enrolled in the trial, and 292 (90.4%) completed the
IND-VFQ at 3 months. Out of a total possible score of 100, the average VFQ score 
for all participants was 81.3 (range 0-100, SD 23.6). After correcting for
treatment arm, each logMAR line of worse baseline visual acuity in the affected
eye resulted in an average 1.2 points decrease on VFQ at 3 months (95% CI -1.8 to
0.6, p<0.001). Those who required therapeutic penetrating keratoplasty had an
average of 25.2 points decrease on VFQ after correcting for treatment arm (95% CI
-31.8 to -18.5, p<0.001). Study participants who were unemployed had on average
28.5 points decrease on VFQ (95% CI -46.9 to -10.2, p=0.002) after correcting for
treatment arm.
CONCLUSIONS: Monocular vision loss from corneal opacity due to fungal keratitis
reduced vision-related quality of life. Given the relatively high worldwide
burden of corneal opacity, improving treatment outcomes of corneal infections
should be a public health priority.
TRIAL REGISTRATION NUMBER: Clinicaltrials.gov Identifier: NCT00996736.

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PMID: 26531051   [PubMed - as supplied by publisher]


28. Br J Ophthalmol. 2015 Nov 3. pii: bjophthalmol-2015-307637. doi:
10.1136/bjophthalmol-2015-307637. [Epub ahead of print]

Metabolic syndrome and retinal microvascular calibre in a high cardiovascular
disease risk cohort.

Wang SB(1), Mitchell P(1), Plant AJ(1), Phan K(2), Liew G(1), Thiagalingam A(2), 
Burlutsky G(1), Gopinath B(1).

Author information: 
(1)Centre for Vision Research, Department of Ophthalmology and Westmead
Millennium Institute, University of Sydney, New South Wales, Australia. (2)Centre
for Heart Research, Westmead Millennium Institute, University of Sydney, Sydney, 
New South Wales, Australia.

AIMS: To investigate the independent associations between metabolic syndrome and 
retinal vessel calibre in a high cardiovascular risk cohort, and to determine
whether these associations also exist in patients without diabetes, hypertension 
or coronary artery disease (CAD).
METHODS: The Australian Heart Eye Study is an observational study that surveyed
1680 participants who presented to a tertiary referral hospital for the
evaluation of potential CAD by coronary angiography. Metabolic syndrome was
defined according to the Third Report of the National Cholesterol Education
Program. Retinal arteriolar calibre narrowing and retinal venular calibre
widening were measured from retinal photographs. CAD was quantified using
severity (Gensini) and extent scores. Diabetes and hypertension were defined from
clinical investigation (fasting plasma glucose >7.0 mmol/L and blood pressure
>130/85 mm Hg) or from self-reported clinical diagnosis, including the use of
medications.
RESULTS: A total of 979 participants had complete information on metabolic
syndrome components and were included in cross-sectional analyses. After
adjusting for age, sex, smoking status and fellow vessel calibre, persons with
metabolic syndrome (compared with persons without metabolic syndrome) had
narrower retinal arteriolar calibre (mean difference 4.3 µm, p<0.0001). No
significant difference in venular calibre was observed (p=0.05). This association
persisted in persons without diabetes (mean arteriolar calibre difference 4.4 µm,
p=0.0006) but not in participants without CAD and those without hypertension.
CONCLUSIONS: Metabolic syndrome is independently associated with narrower retinal
arterioles but not wider retinal venules among those at high risk of CAD. The
association between metabolic syndrome and narrower retinal arterioles is likely 
due to the presence of CAD or hypertension in individuals with this syndrome, as 
the association is not significant in individuals without hypertension or without
CAD.

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PMID: 26531050   [PubMed - as supplied by publisher]


29. Br J Ophthalmol. 2015 Oct 29. pii: bjophthalmol-2015-306987. doi:
10.1136/bjophthalmol-2015-306987. [Epub ahead of print]

A systematic review of as needed versus treat and extend ranibizumab or
bevacizumab treatment regimens for neovascular age-related macular degeneration.

Chin-Yee D(1), Eck T(1), Fowler S(2), Hardi A(2), Apte RS(1).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, Washington University School 
of Medicine, St Louis, Missouri, USA. (2)Becker Medical Library, Washington
University School of Medicine, St Louis, Missouri, USA.

PURPOSE: To evaluate the relative efficacy of as needed versus treat and extend
regimen for the treatment of neovascular age-related macular degeneration (AMD).
METHODS: We conducted a systematic review of studies that evaluated the efficacy 
of as needed or treat and extend regimen for neovascular AMD by searching
multiple databases up to December 2013. Included studies were selected based on
study duration of no less than 12 months, availability of outcome data, treatment
protocol for as needed groups or pro re nata (PRN) receiving bevacizumab or
ranibizumab, and all studies with treat extend protocols following the 'inject
and extend' regimen. The outcome data were pooled and analysed.
RESULTS: 1046 peer reviewed articles meeting our initial search criteria were
returned. After further review by two independent reviewers, 8 studies meeting
treat and extend protocol and 62 studies meeting PRN protocol were included. The 
mean improvement in visual acuity in the PRN group was 5.4 ETDRS letters compared
with 10.4 ETDRS letters in the treat and extend group. The PRN group received an 
average of 5.60 injections at 1 year compared with 8.09 in the treat and extend
group. Central retinal thickness improved on average by 100.32 µ in the PRN group
compared with 87.7 µ in the treat and extend group.
CONCLUSIONS: Though our study suggests superiority of the treat and extend
regimen to PRN treatment in a 12-month period, this review demonstrates the need 
for randomised clinical trials to confirm our findings and to evaluate long-term 
efficacy outcomes with these regimens compared with monthly therapy.

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PMID: 26516125   [PubMed - as supplied by publisher]


30. Br J Ophthalmol. 2015 Oct 29. pii: bjophthalmol-2015-306979. doi:
10.1136/bjophthalmol-2015-306979. [Epub ahead of print]

Outcomes of endothelial keratoplasty in pseudophakic corneal oedema: with or
without Descemet's membrane stripping.

Mohamed A(1), Ks AR(2), Chaurasia S(2), Ramappa M(2).

Author information: 
(1)Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad,
India. (2)Cornea and Anterior Segment Services, L V Prasad Eye Institute,
Hyderabad, India.

AIMS: To evaluate and compare outcomes of Descemet's stripping endothelial
keratoplasty (DSEK) with non-DSEK (nDSEK) in pseudophakic corneal oedema (PCE).
METHODS: The study was a prospective, non-consecutive, comparative,
interventional case series. Twenty-six patients with PCE were randomised into two
groups. Group 1 comprised of those cases that had undergone conventional DSEK,
and group 2 consisted of those that had nDSEK for PCE between 2010 and 2012. The 
data on demographics and clinical characteristics were collected from all
patients. Any intraoperative and early and late postoperative complications were 
also noted. The primary outcome measure was postoperative functional success.
Graft survival and complications were analysed as secondary outcomes.
RESULTS: The median best-corrected visual acuities at 6 months postoperatively in
groups 1 and 2 were 0.18 (IQR 0.10-0.30) and 0.44 (IQR 0.18-0.51), respectively
(p=0.11). Corneal oedema cleared in all patients. During the early postoperative 
period, a patient in group 2 had lenticule detachment managed by rebubbling.
CONCLUSIONS: nDSEK has outcomes similar to DSEK in PCE with advantages of
decreased surgical time and avoidance of inadvertent pull on the posterior
stromal fibres that may occur during Descemet's stripping.

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PMID: 26516124   [PubMed - as supplied by publisher]