Journal Contents

Am Jour Ophthalmol
Br J Ophthalmol
Can J Ophthalmol
J Cat Ref Surg
Curr Eye Res
Eur J Ophthalmol
J Glaucoma
JAMA Ophthalmol
Graefes Ophthalmol
Indian J Ophthalmol
Int Ophthalmol Clin
Invest Ophth Vis Sci
Jpn J Ophthalmol
Korean J Ophthal
J Neuroophthalmol
Ophthalmic Epidemiol
Ophthalmic Genet
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Ophthalmic Res
Surv Ophthalmol
Ophthalmology Review Journal
Eye[JOUR] Established 1995
1. Eye (Lond). 2014 Oct 24. doi: 10.1038/eye.2014.247. [Epub ahead of print]

Testing vision testing: quantifying the effect of movement on visual acuity

Tidbury LP(1), O'Connor AR(2).

Author information: 
(1)1] Directorate of Orthoptics and Vision Science, University of Liverpool,
Liverpool, UK [2] Department of Psychological Sciences, University of Liverpool, 
Liverpool, UK.
(2)Directorate of Orthoptics and Vision Science, University of Liverpool, Liverpool,

PurposeAssessment of visual acuity (VA) has been shown to vary between tests,
which may be attributable in part to test inaccuracies, such as a change in the
distance between the chart and subject. Therefore, the study aim was to quantify 
changes in chart/patient separation during near and distance VA testing, and to
analyse the relationship between VA and movement observed.MethodsVolunteer
orthoptists and subjects were filmed during near and distance VA testing, with
the amount of movement determined from the recording. Controlling for movement
using chin rests and chart stands, VA was retested. Actual changes in VA due to a
change in subject or chart movement were compared with theoretical
predictions.ResultsFifty-one subjects (18-73 years) were assessed. Median
(interquartile) movements of 0.06 m (0.07) towards and 0.11 m (0.08) away from
the chart were measured (maximum 0.17 m towards and 0.24 m away). Significant
differences in VA score were measured when movement was restricted, at near and
distance (P<0.05). VA score change agreed with predicted values in 67% of the
cases, however, reduced test distance during near vision testing resulted in a
degradation of VA, opposite to the improvement expected.ConclusionThere were
significant variations in subject/chart separation during testing, which could
have affected VA values. While this movement is associated with a change in VA,
additional factors to movement appear to influence the score achieved during near
testing. Procedures to minimise variation, by eliminating movement of test chart 
or subject, will improve VA test accuracy.Eye advance online publication, 24
October 2014; doi:10.1038/eye.2014.247.

PMID: 25341437   [PubMed - as supplied by publisher]

2. Eye (Lond). 2014 Oct 24. doi: 10.1038/eye.2014.252. [Epub ahead of print]

Poppers maculopathy or retinopathy?

Clemens CR, Alten F, Loos D, Uhlig CE, Heiduschka P, Eter N.

Author information: 
Department of Ophthalmology, University of Muenster Medical Centre, Muenster,

PMID: 25341436   [PubMed - as supplied by publisher]

3. Eye (Lond). 2014 Oct 24. doi: 10.1038/eye.2014.251. [Epub ahead of print]

Rituximab for the treatment of IgG4-related orbital disease: experience from five

Wu A(1), Andrew NH(1), Tsirbas A(2), Tan P(3), Gajdatsy A(3), Selva D(1).

Author information: 
(1)South Australian Institute of Ophthalmology, University of Adelaide, Adelaide,
South Australia, Australia.
(2)Sydney Eye Hospital, Sydney, New South Wales, Australia.
(3)Lions Eye Institute, Perth, Western Australia, Australia.

PurposeTo review the clinical efficacy and safety of rituximab for treatment of
IgG4-related orbital disease (IgG4-ROD).DesignRetrospective multicentre
interventional case series.MethodsChart review for five cases of biopsy-confirmed
IgG4-ROD (IgG4+>10/HPF, ratio of IgG4+/IgG+>40%) treated with rituximab.
Information retrieved included the dosing schedule, adverse events and the
magnitude, temporality, and duration of the clinical response.ResultsAll cases of
IgG4-ROD were either steroid dependent or steroid resistant. Rituximab doses for 
induction therapy included two doses of 1000 mg at 2-weekly intervals, and four
doses at 375 mg/m(2) at weekly intervals. Two months after starting rituximab,
three cases achieved complete clinical resolution and two cases achieved partial 
clinical resolution. Complete radiological resolution occurred in one case, and
partial radiological resolution in three cases. Three cases received rituximab
maintenance therapy and one case was commenced on mycophenolate. No relapse
occurred during a mean follow-up of 33 months (range: 7-65 months). One disease
relapse occurred when the dosing interval of rituximab maintenance therapy was
extended to 6-monthly intervals; remission was swiftly achieved with rituximab
reinduction therapy. The only adverse effects reported were one episode of
fatigue lasting 1 week and two episodes of orbital discomfort.ConclusionRituximab
may be an effective treatment option for IgG4-ROD that is steroid dependent or
steroid intolerant. Rituximab therapy resulted in swift clinical and radiological
improvement, many months free of relapse, and few side effects.Eye advance online
publication, 24 October 2014; doi:10.1038/eye.2014.251.

PMID: 25341435   [PubMed - as supplied by publisher]

4. Eye (Lond). 2014 Oct 24. doi: 10.1038/eye.2014.246. [Epub ahead of print]

Compartmentalization of extraocular muscle function.

Demer JL.

Author information: 
Departments of Ophthalmology and Neurology, Stein Eye Institute, David Geffen
Medical School, University of California, Los Angeles, CA, USA.

Ocular motor diversity exceeds capabilities of only six extraocular muscles
(EOMs), but this deficiency is overcome by the plethora of fibers within
individual EOMs surpassing requirements of homogeneous actuators. This paper
reviews emerging evidence that regions of individual EOMs can be differentially
innervated to exert independent oculorotary torques, broadening the oculomotor
repertoire, and potentially explaining diverse strabismus pathophysiology.
Parallel structure characterizes EOM and tendon fibers, with little transverse
coupling of experimentally imposed or actively generated tension. This
arrangement enables arbitrary groupings of tendon and muscle fibers to act
relatively independently. Coordinated force generation among EOM fibers occurs
only upon potentially mutable coordination of innervational commands, whose
central basis is suggested by preliminary findings of apparent compartmental
segregation of abducens motor neuron pools. Humans, monkeys, and other mammals
demonstrate separate, nonoverlapping intramuscular nerve arborizations in the
superior vs inferior compartments of the medial rectus (MR) and lateral rectus
(LR) EOMs that could apply force at the superior vs inferior portions of scleral 
insertions, and in the medial vs lateral compartments of the superior oblique
that act at the equatorial vs posterior scleral insertions that might
preferentially implement incycloduction vs infraduction. Magnetic resonance
imaging of the MR during several physiological ocular motor behaviors indicates
differential compartmental function. Differential compartmental pathology can
influence clinical strabismus. Partial abducens palsy commonly affects the
superior LR compartment more than the inferior, inducing vertical strabismus that
might erroneously be attributed to cyclovertical EOM pathology. Surgery may
selectively manipulate EOM compartments.Eye advance online publication, 24
October 2014; doi:10.1038/eye.2014.246.

PMID: 25341434   [PubMed - as supplied by publisher]

5. Eye (Lond). 2014 Oct 24. doi: 10.1038/eye.2014.241. [Epub ahead of print]

Periocular necrotising soft tissue infections-three cases of mistaken identity.

Pollock J, Hassan A, Smith M.

Author information: 
Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary,
Leicester, UK.

PMID: 25341433   [PubMed - as supplied by publisher]

6. Eye (Lond). 2014 Oct 24. doi: 10.1038/eye.2014.244. [Epub ahead of print]

Wavefront aberration changes caused by a gradient of increasing accommodation

Zhou XY(1), Wang L(1), Zhou XT(2), Yu ZQ(2).

Author information: 
(1)Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai,
(2)1] Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai,
China [2] Key Laboratory of Myopia, Ministry of Health, Shanghai, China.

PurposeThe aim of this study was to investigate the wavefront aberration changes 
in human eyes caused by a gradient of increasing accommodation stimuli.DesignThis
is a prospective, single-site study.MethodsHealthy volunteers (n=22) aged 18-28
years whose refraction states were emmetropia or mild myopia, with astigmatism
<1 diopter (D), were included in this study. After dilating the right pupil with 
0.5% phenylephrine drops, the wavefront aberration of the right eye was measured 
continuously either without or with 1, 2, 3, 4, 5, or 6D accommodation stimuli
(WFA1000B psychophysical aberrometer). The root mean square (RMS) values of the
total wavefront aberrations, higher-order aberrations, and 35 individual Zernike 
aberrations under different accommodation stimuli were calculated and
compared.ResultsThe average induced accommodations using 1, 2, 3, 4, 5, or 6D
accommodation stimuli were 0.848, 1.626, 2.375, 3.249, 4.181, or 5.085 D,
respectively. The RMS of total wavefront aberrations, as well as higher-order
aberrations, showed no significant effects with 1-3 D accommodation stimuli, but 
increased significantly under 4, 5, and 6 D accommodation stimuli compared with
relaxed accommodation. Zernike coefficients of significantly decreased with
increasing levels of accommodation.ConclusionHigher-order wavefront aberrations
in human eyes changed with increased accommodation. These results are consistent 
with Schachar's accommodation theory.Eye advance online publication, 24 October
2014; doi:10.1038/eye.2014.244.

PMID: 25341432   [PubMed - as supplied by publisher]

7. Eye (Lond). 2014 Oct 17. doi: 10.1038/eye.2014.248. [Epub ahead of print]

Quantification of allospecific and nonspecific corneal endothelial cell damage
after corneal transplantation.

Chauhan SK, Jurkunas U, Funaki T, Dastjerdi M, Dana R.

Author information: 
Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary,
Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.

PurposeTo investigate the effect of host immunity (allospecific) and surgical
manipulation (non-allospecific) on corneal endothelial cells (CECs) in corneal
transplantation.MethodsDraining lymph nodes and grafted C57BL/6 corneas were
harvested from syngeneic recipients, allograft acceptors, and allograft rejectors
(BALB/c) 1, 3, and 8 weeks after transplantation. We analyzed CEC apoptosis using
an ex vivo cornea-in-the-cup assay, and visualized cell-to-cell junctions using
immunohistochemical staining (ZO-1). Automatic cell analysis using Confoscan
software was used to measure CEC density as well as changes in CEC morphology by 
quantifying the coefficient of variation in cell size (polymegethism) and shape
(pleomorphism).ResultsThe cornea-in-the-cup assay showed that allogeneic acceptor
T cells and to an even greater extent rejector T cells (but not syngeneic T
cells) induced CEC apoptosis. CEC density after corneal transplantation was
significantly reduced in allogeneic acceptors compared with syngeneic grafts
(P<0.001), and CEC density was even further reduced in the allo-rejector group
compared with the allo-acceptor group. Allogeneic grafts showed a greater
increase in the coefficient of variation in cell size (polymegethism) when
compared with syngeneic grafts 1 week after transplantation (P=P<0.001). However,
pleomorphism was not significantly different between syngeneic and allo-acceptor 
grafts, indicating that polymegethism (but not pleomorphism or cell density) is a
sensitive indicator of the effect of alloimmunity on CECs.ConclusionsOur data
demonstrate that host alloimmunity rather than surgical manipulation alone is the
major cause of CEC damage in corneal transplantation, and such morphologic
changes of CECs can be detected before the clinically visible onset of allograft 
rejection.Eye advance online publication, 17 October 2014;

PMID: 25323855   [PubMed - as supplied by publisher]

8. Eye (Lond). 2014 Oct 17. doi: 10.1038/eye.2014.243. [Epub ahead of print]

New understanding on the contribution of the central otolithic system to eye
movement and skew deviation.

Wong AM.

Author information: 
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 
University of Toronto, and the Toronto Western Hospital, Toronto, Canada.

The otolith organs consist of the utricle and saccule. The utricle mediates the
utriculo-ocular reflex by detecting horizontal head translation and static head
tilt. Skew deviation is a vertical strabismus caused by imbalance of the
utriculo-ocular reflex pathway and is commonly caused by lesions in the brainstem
or cerebellum. It is associated with abnormal utriculo-ocular reflexes including 
asymmetric reduction of the translational vestibulo-ocular and ocular counterroll
responses. Skew deviation is also associated with head position-dependent changes
in ocular torsion and vertical strabismus. The reduction in ocular torsion and
vertical strabismus when changing from an upright to supine position in skew
deviation allows us to devise a new bedside 'upright-supine test' to
differentiate skew deviation from fourth nerve palsy and other causes of vertical
strabismus.Eye advance online publication, 17 October 2014;

PMID: 25323854   [PubMed - as supplied by publisher]

9. Eye (Lond). 2014 Oct 17. doi: 10.1038/eye.2014.237. [Epub ahead of print]

Monitoring propranolol treatment in periocular infantile haemangioma.

Burne R(1), Taylor R(2); Medscape.

Author information: 
(1)Hull York Medical School, Heslington, York, UK.
(2)Ophthalmology Department, York Hospital, York, UK.

ObjectiveTo develop a tool for assessing amblyopic risk and monitoring the
treatment effect of propranolol in periocular haemangioma management.MethodsWe
present a study of nine children with periocular haemangioma who underwent
propranolol treatment at York Hospital between 2009 and 2013.A proposed measure
of amblyogenic risk based on the induced anisometropia resulting from a
periocular haemangioma was calculated in the form of a single quantitative value,
measured in dioptres. This calculation used published work and developed it to
produce a new function, termed the delta defocus equivalent (DFE-∂).Refraction
measurements were retrospectively collected from patients' notes in order to
measure the trend of DFE-∂ over the treatment period with propranolol.ResultsThe 
average DFE-∂ at commencement of propranolol was 1.54 (±0.62) D. The average at
the end of treatment was 0.39 (±0.38) D.ConclusionThis work presents a possible
tool for assessing amblyopic risk in cases of periocular infantile haemangioma.
The DFE-∂ gives a measure in dioptres, which may represent the true amblyopic
risk, and so be useful in supporting treatment decisions in paediatric
ophthalmology.Eye advance online publication, 17 October 2014;

PMID: 25323853   [PubMed - as supplied by publisher]

10. Eye (Lond). 2014 Oct 17. doi: 10.1038/eye.2014.245. [Epub ahead of print]

Gas tamponade combined with laser photocoagulation therapy for congenital optic
disc pit maculopathy.

Lei L(1), Li T(1), Ding X(1), Ma W(1), Zhu X(1), Atik A(2), Hu Y(1), Tang S(3).

Author information: 
(1)State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen
University, Guangzhou, China.
(2)Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
(3)1] State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun
Yat-sen University, Guangzhou, China [2] Aier School of Ophthalmology, Central
South University, Changsha, China.

PurposeTo evaluate the long-term clinical efficacy and safety of gas tamponade
combined with laser photocoagulation for optic disc pit maculopathy.MethodsSeven 
consecutive patients with unilateral maculopathy associated with optic disc pit
and one patient with bilateral optic disc pit maculopathy were given
octafluoropropane (C3F8) tamponade combined with focal laser photocoagulation
treatment. Patients were followed up for 21-62 months after treatment. Main
outcomes were determined by optical coherence tomography (OCT) and best-corrected
visual acuity (BCVA).ResultsTreatment with C3F8 tamponade followed by laser
photocoagulation in ODP maculopathy patients resulted in resolution of
sub-retinal and/or intra-retinal fluid in six out of eight patients. The
remaining two patients had significant reduction in fluid, as determined by OCT, 
and funduscopy, as well as an improvement in anatomical architecture. Visual
acuity improved obviously in seven eyes and remained stable in two eyes. Central 
visual field loss after photocoagulation was not clinically appreciable by visual
field examination. No post-operative complications of maculopathy occurred during
the follow-up period.ConclusionsAlthough repeated treatment was needed in some
patients, C3F8 tamponade combined with laser photocoagulation is still a simple, 
effective, minimally invasive, and economic therapy for optic disc pit
maculopathy.Eye advance online publication, 17 October 2014;

PMID: 25323852   [PubMed - as supplied by publisher]

11. Eye (Lond). 2014 Oct 17. doi: 10.1038/eye.2014.70. [Epub ahead of print]

Familial exudative vitreoretinopathy and related retinopathies.

Gilmour DF.

Author information: 
1] Section of Ophthalmology and Neuroscience, Leeds Institute of Molecular
Medicine, University of Leeds, Leeds, UK [2] Glasgow Centre for Ophthalmic
Research, Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde,
Glasgow, UK.

Familial exudative vitreoretinopathy (FEVR) is a rare inherited disorder of
retinal angiogenesis. Cases can be autosomal dominant, autosomal recessive, or
X-linked. FEVR patients have an avascular peripheral retina which, depending on
the degree of ischaemia, causes the secondary complications of the disease.
Expressivity may be asymmetric and is highly variable. Five genes have been
identified that when mutated, cause FEVR; NDP (X-linked), FZD4 (autosomal
dominant and recessive), LRP5 (autosomal dominant and recessive), TSPAN12
(autosomal dominant and recessive), and ZNF408 (autosomal dominant). Four of
these genes have been shown to have a central role in Norrin/Frizzled4
signalling, suggesting a critical role for this pathway in retinal angiogenesis. 
In addition to the ocular features, LRP5 mutations can cause osteopenia and
osteoporosis. All FEVR patients in whom molecular testing is not easily
accessible should have dual energy X-ray absorptiometry (DEXA) scans to assess
bone mineral density, as treatment can be initiated to reduce the risk of bone
fractures.Eye advance online publication, 17 October 2014;

PMID: 25323851   [PubMed - as supplied by publisher]

12. Eye (Lond). 2014 Oct 17. doi: 10.1038/eye.2014.242. [Epub ahead of print]

Effect of pupil size on higher-order aberrations in high-myopic pseudophakic eyes
with posterior staphyloma.

Zhu X, Ye H, Yang J, Lu Y.

Author information: 
Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan
University, Shanghai, People's Republic of China.

PurposeTo evaluate the effect of pupil size on higher-order aberrations (HOAs) in
high-myopic pseudophakic eyes with posterior staphyloma using KR-1W
aberrometer.MethodsForty eyes of 40 high-myopic cataract patients with posterior 
staphyloma and 20 eyes of 20 age-related cataract patients with normal axial
length were recruited. At 1 month after phacoemulsification and intraocular lens 
implantation, ocular and internal HOAs as well as the visual quality data in the 
two groups were evaluated with KR-1W analyzer before and after
mydriasis.ResultsCompared with normal axial length eyes, high-myopic pseudophakic
eyes with posterior staphyloma had significantly lower values of internal coma
both under 4-mm and 6-mm pupil sizes (P<0.001 and 0.020), as well as internal
total HOAs (P<0.001) and third-order aberrations at 6-mm pupil size (P=0.018).
Statistically significant differences were also found in the variation from 4- to
6-mm pupil sizes for internal coma (P=0.001), internal third-order aberrations
(P=0.009), internal total HOAs (P=0.007), and ocular coma aberrations (P=0.006)
between two groups. After mydriasis, Strehl ratio increased significantly in
high-myopic eyes, whereas decreased slightly in normal axial length eyes (P=0.032
when compared with the variation between the two groups). Statistically
significant differences were also found for the variation of modulation transfer 
functions (MTFs) at frequencies of 15, 30, 45, and 60 cycles/degree between the
two groups (P=0.002, 0.002, 0.004, and 0.010,
respectively).ConclusionsHigh-myopic pseudophakic eyes with posterior staphyloma 
had significantly lower internal coma and less coma variations during
mydriasis.Eye advance online publication, 17 October 2014;

PMID: 25323850   [PubMed - as supplied by publisher]

13. Eye (Lond). 2014 Oct 10. doi: 10.1038/eye.2014.158. [Epub ahead of print]

Rapid and cost-effective molecular diagnosis using exome sequencing of one
proband with autosomal dominant congenital cataract.

Chen JH(1), Qiu J(2), Chen H(1), Pang CP(1), Zhang M(2).

Author information: 
(1)1] Joint Shantou International Eye Center, Shantou University and the Chinese
University of Hong Kong, Shantou, China [2] Department of Ophthalmology and
Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China.
(2)Joint Shantou International Eye Center, Shantou University and the Chinese
University of Hong Kong, Shantou, China.

PurposeDue to high genetic heterogeneity, to exclude known mutations and map
novel mutations in autosomal dominant congenital cataract (ADCC) using
conventional candidate gene screening requires laborious laboratory work. We
attempted to use a cost-effective exome sequencing strategy to identify
disease-causing mutations in an ADCC pedigree.MethodsAn ADCC pedigree affected by
nuclear cataract and 200 unrelated senile cataract controls were recruited and
given comprehensive ophthalmic examination. Whole exome of the proband of the
family was captured by the Illumina TruSeq Exome Enrichment Kit, followed by
sequencing using Illumina HiSeq 2000 sequencer. Validation was performed by
direct sequencing.ResultsThe whole exome, including all exons of known ADCC
disease-causing genes, was screened for possible disease-causing mutations. A
recurrent missense mutation c.773C>T (p.S258F) in exon 2 of the gap junction
protein alpha 8 gene (GJA8) was identified in the proband with nuclear cataract. 
The result was confirmed by direct sequencing. The mutation showed complete
co-segregation with the disease phenotype in the family but was not observed in
unrelated unaffected controls.ConclusionBy successfully sequencing whole exome of
only one proband and identifying a GJA8 mutation in one ADCC pedigree, the
current study demonstrated that exome sequencing could serve as a rapid, robust, 
and cost-effective approach in clinical diagnosis and disease-causing gene
discovery for ADCC.Eye advance online publication, 10 October 2014;

PMID: 25301372   [PubMed - as supplied by publisher]

14. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.229. [Epub ahead of print]

Variations in the cone packing density with eccentricity in emmetropes.

Dabir S(1), Mangalesh S(1), Kumar KA(1), Kummelil MK(2), Roy SA(3), Shetty R(4).

Author information: 
(1)Department of Retina, Narayana Nethralaya, Bangalore, India.
(2)Department of Cataract & Refractive Surgery, Narayana Nethralaya, Bangalore,
(3)Department of Imaging & Biomechanics, Narayana Nethralaya, Bangalore, India.
(4)Department of Cornea & Refractive Surgery, Narayana Nethralaya, Bangalore, India.

AimTo describe the parafoveal cone arrangement in emmetropic subjects and its
variations with eccentricity, meridians and change in axial length in Indian
eyes.MethodsWe imaged 25 subjects using compact adaptive optics (AO) retinal
camera prototype, the rtx1. Imaging was done at 1, 2, and 3° eccentricity from
the fovea in four meridians: nasal, temporal, superior, and inferior.ResultsA
statistically significant drop in the cone packing density was observed from 2 to
3° (2° eccentricity=25 350/mm(2) (5300/mm(2), 8400-34 800/mm(2)) 3°
eccentricity=20 750/mm(2) (6000 mm(2), 9000-33 670/mm(2))) P<0.05. The spacing
correspondingly increased with increase in distance from the fovea (2°
eccentricity=6.9 μm (0.70 μm, 5.95-11.6 μm)) and 3°eccentricity=7.80 μm (1.00 μm,
6.5-13.5 μm) P<0.05. As the axial length increases, the cone density
significantly decreases. Interocular variations were noted.ConclusionWith the
advent of AO, visualization at the cellular level is now possible. Understanding 
the photoreceptor mosaic in the parafoveal space in terms of its density,
spacing, and arrangement is crucial so as to detect early pathology and intervene
appropriately. Newer therapeutic modalitites that are targeted at the cellular
level like yellow micropulse laser, stem cells, gene therapy and so on may be
better monitored in terms of safety and efficacy.Eye advance online publication, 
3 October 2014; doi:10.1038/eye.2014.229.

PMID: 25277309   [PubMed - as supplied by publisher]

15. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.226. [Epub ahead of print]

FPR1 interacts with CFH, HTRA1 and smoking in exudative age-related macular
degeneration and polypoidal choroidal vasculopathy.

Liang XY(1), Chen LJ(1), Ng TK(1), Tuo J(2), Gao JL(3), Tam PO(1), Lai TY(1),
Chan CC(2), Pang CP(1).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, The Chinese University of Hong
Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong.
(2)Laboratory of Immunology, National Eye Institute, National Institutes of Health, 
Bethesda, MD, USA.
(3)Laboratory of Molecular Immunology, National Institute of Allergy and Infectious 
Diseases, National Institutes of Health, Bethesda, MD, USA.

PurposeTo determine the genetic association of an inflammation-related gene,
formyl peptide receptor 1 (FPR1), in exudative age-related macular degeneration
(AMD) and polypoidal choroidal vasculopathy (PCV).MethodsThe coding region of
FPR1 gene was sequenced in 554 unrelated Chinese individuals: 155 exudative AMD
patients, 179 PCV patients, and 220 controls. Interactions and combined effects
of FPR1 with complement factor H (CFH), high temperature requirement factor A1
(HTRA1), and smoking were also investigated.ResultsA total of 28 polymorphisms in
FPR1 were identified. Single nucleotide polymorphisms (SNP) rs78488639 increased 
the risk to exudative AMD (P=0.043) and PCV (P=0.016), whereas SNP rs867229
decreased the risk to exudative AMD (P=0.0026), but not PCV. Homozygous G allele 
of rs1042229 was associated with exudative AMD (P=0.0394, odds ratio (OR)=2.27,
95% confident interval: 1.08-4.74), but not with PCV. Exudative AMD, but not PCV,
was associated with the heterozygous genotypes of rs2070746 (P=0.019, OR=0.57)
and rs867229 (P=0.0082, OR=0.54). Significantly, interactions were identified
among FPR1 rs78488639, CFH rs800292, and HTRA1 rs11200638 in both exudative AMD
and PCV. Combined heterozygous risk alleles of CFH rs800292 GA and FPR1
rs78488639 CA were posed to PCV (P=2.22 × 10(-4), OR=10.47), but not exudative
AMD. Furthermore, FPR1 rs78488639 CA combining with HTRA1 rs11200638 and smoking 
was also predisposed risks to exudative AMD and PCV.ConclusionFPR1 is associated 
with exudative AMD and PCV in a Hong Kong Chinese cohort. FPR1 rs78488639
interacted with CFH rs800292, HTRA1 rs11200638, and smoking, enhancing risk to
exudative AMD and PCV.Eye advance online publication, 3 October 2014;

PMID: 25277308   [PubMed - as supplied by publisher]

16. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.232. [Epub ahead of print]

Comment on 'The effect of erythropoietin on the severity of retinopathy of

Modi RR, Padhi TR.

Author information: 
L V Prasad Eye Institute, Bhubaneswar, India.

PMID: 25277307   [PubMed - as supplied by publisher]

17. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.236. [Epub ahead of print]

Peripheral hypertrophic subepithelial corneal degeneration presenting with
bilateral nasal and temporal corneal changes.

Schargus M(1), Kusserow C(2), Schlötzer-Schrehardt U(3), Hofmann-Rummelt C(3),
Schlunck G(4), Geerling G(5).

Author information: 
(1)1] Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany [2]
Department of Ophthalmology, University of Bochum, Bochum, Germany.
(2)Department of Ophthalmology, University of Luebeck, Lübeck, Germany.
(3)Department of Ophthalmology, University of Erlangen-Nuernberg, Erlangen, Germany.
(4)Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany.
(5)1] Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany [2]
Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany.

PurposeTo characterise the history, clinical and histopathological features of
patients with bilateral nasal and temporal peripheral hypertrophic subepithelial 
corneal degeneration in a German population.MethodsA detailed ophthalmological
and dermatological history and clinical findings were recorded of nine patients
with bilateral simultaneous nasal and temporal peripheral corneal degeneration
from two centers in Germany. Excised tissues were studied by histopathology,
immunohistochemistry, and transmission electron microscopy.ResultsForeign body
sensation and need of artificial tear substitutes were the only symptoms reported
regularly. Schirmer's and Jones-test were normal in all, but fluorescein break-up
time of >10 s was found in five eyes of four patients. Best corrected visual
acuity was reduced only under glare conditions. Corneal topography revealed
irregular astigmatism in 13 of 14 eyes. Follow-up median time was 35 months. Most
cases were stable within the follow-up period. Light and electron microscopy
revealed the findings of superficial vascularised corneal hypertrophic scars,
oxytatlan fibers, and discontinued Bowmans layer.ConclusionIn this series of
German patients with peripheral hypertrophic subepithelial corneal degeneration, 
the changes were predominantly located in the palpebral aperture and often
present in both eyes. No associated surface disease could be established in this 
study. Light and transmission electron microscopy showed histological features
that are similar to Salzmann's corneal changes without any inflammation. We
hypothesise that light exposure and a localised limbal insufficiency could be
involved in the pathogenesis.Eye advance online publication, 3 October 2014;

PMID: 25277306   [PubMed - as supplied by publisher]

18. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.233. [Epub ahead of print]

Earlier therapeutic effects associated with high dose (2.0 mg) Ranibizumab for
treatment of vascularized pigment epithelial detachments in age-related macular

Chan CK(1), Abraham P(2), Sarraf D(3), Nuthi AS(4), Lin SG(4), McCannel CA(4).

Author information: 
(1)1] Southern California Desert Retina Consultants, Palm Desert, CA, USA [2] Loma
Linda University, Department of Ophthalmology, Loma Linda, CA, USA.
(2)Black Hills Regional Eye Institute, Rapid City, SD, USA.
(3)Retinal Disorders and Ophthalmic Genetics, Jules Stein Eye Institute, UCLA, Los
Angeles, CA, USA.
(4)Southern California Desert Retina Consultants, Palm Desert, CA, USA.

Summary statementIntravitreal high dose (2 mg) ranibizumab may lead to quicker
resolution of choroidal neovascularization (CNV) and associated retinal pigment
epithelial detachment in eyes with exudative age-related macular degeneration,
although it may possibly correlate with RPE tears in certain cases.PurposeThis
prospective study compared the outcomes of 0.5 vs 2.0 mg intravitreal ranibizumab
injections (RI) for treating vascularized pigment epithelial detachment (vPED)
due to age-related macular degeneration.MethodsPatients with vPED were randomized
to receive 2.0 vs 0.5 mg RI monthly for 12 months or for 4 months and then
repeated on a pro-re nata basis. Optical coherence tomography, fundus
photography, and fluorescein and indocyanine-green angiography were obtained at
baseline and subsequent specific intervals. Outcome measures were best-corrected 
standardized visual acuities, central 1-mm thickness, surface area (SA), greatest
linear diameter (GLD), heights (PED and CNV), and amount of subretinal fluid
(SRF) and cystoid macular edema (CME).ResultsBoth groups yielded reductions of
the central 1-mm thickness, PED and CNV SA and PED height and GLD, SRF, and CME. 
Vision improvement and reduction in SRF and PED height occurred earlier for eyes 
receiving the 2.0 mg dose. Cataract progression was similar but RPE tears
developed more often with the 2.0 mg dose.ConclusionsThere were similar visual
and anatomical outcomes at the end of the study; however, the higher dose yielded
more rapid reductions and more complete resolution of the PED, although there was
possible increased tendency for an RPE tear with the higher dose.Eye advance
online publication, 3 October 2014; doi:10.1038/eye.2014.233.

PMID: 25277305   [PubMed - as supplied by publisher]

19. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.227. [Epub ahead of print]

Association of choroidal thickness with eye growth: a cross-sectional study of
individuals between 4 and 23 years.

Zengin MO(1), Karahan E(2), Yilmaz S(3), Cinar E(1), Tuncer I(2), Kucukerdonmez

Author information: 
(1)Department of Ophthalmology, Izmir University Faculty of Medicine, Izmir, Turkey.
(2)Alfagoz Eye Center, Izmir, Turkey.
(3)Retina Eye Hospital, Bursa, Turkey.

Background and aimsWe aimed to evaluate the association of subfoveal choroidal
thickness (SFCT) with age and to determine its relationship with axial length
(AL) and ocular biometric parameters, in children and young adults during growth 
period.MethodsOne hundred and sixty patients (80 male, 80 female) aged between 4 
and 23 years were included. Patients were classified into five groups according
to their ages as group 1 (4-7 years of age), group 2 (8-11 years), group 3 (12-15
years), group 4 (16-19 years), and group 5 (20-23 years). SFCT was assessed using
spectral-domain optical coherence tomography (3D OCT-2000). The measurements were
taken at the same daytime (1000-1200 hours) to avoid diurnal fluctuation. Ocular 
AL and anterior segment parameters were measured using optical biometry (Lenstar 
LS900)).ResultsThe average SFCT was 308.1±47.6 μm, ranging from 206 to 410 μm.
The mean SFCT values in group 1 to 5 were measured as 306.8±42.0, 297.8±48.1,
283.2±38.9, 326.9±57.4, and 325.8±35.9 μm, respectively. The mean CT of group 3
was significantly thinner than group 4 and 5 (P<0.05 for two groups), however,
there was no statistical significance compared with group 1 (P=0.227) and group 2
(P=0.693). On stepwise regression analysis, age exhibited a positive association 
with SFCT (B=2.8, P<0.001) and AL exhibited a negative association with choroidal
thickness (B=-16.7, P<0.001).ConclusionsWe found that SFCT shows no age-related
difference until age of 15, whereas 16-23-year old participants had thicker SFCT 
compared with the younger ones. In that aspect, a thicker choroid associated with
age in certain age groups suggests an age period of SFCT increase to a plateau in
young adulthood. Larger studies are warranted to elucidate the age-related
changes in SFCT in childhood, as improved evaluation of normal choroidal
thicknesses during eye growth should assist in the diagnosis of choroidal
abnormalities associated with eye disease.Eye advance online publication, 3
October 2014; doi:10.1038/eye.2014.227.

PMID: 25277304   [PubMed - as supplied by publisher]

20. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.207. [Epub ahead of print]

Choroidal thickness in regressed retinopathy of prematurity.

Anderson MF, Ramasamy B, Lythgoe DT, Clark D.

Author information: 
Department of Ophthalmology, University Hospital Aintree, Liverpool, UK.

PurposeTo compare choroidal thickness in patients with regressed retinopathy of
prematurity (ROP) with healthy controls using enhanced depth imaging optical
coherence tomography (EDI OCT)MethodsTwenty-four children and young adults (41
eyes) with regressed ROP≥stage 3 had undergone EDI OCT with Spectralis FD-OCT as 
part of their clinical record. Their refraction, best-corrected visual acuity,
and ophthalmoscopic findings were recorded. Corresponding data was collected
prospectively from 33 healthy controls (58 eyes) who had been born at term.
Choroidal thickness was measured independently by two observers subfoveally and
at 1500 μm nasal and temporal to the fovea using EDI OCT.ResultsMean subfoveal
choroidal thickness, adjusted for refraction, was 271.1 μm (95% CI, 247.8-294.5) 
in the ex-ROP group, which was significantly thinner than 327.4 μm (95% CI,
293.8-360.9) in controls (P=0.008). Similarly, mean adjusted temporal choroidal
thickness was 257.2 μm (95% CI, 240.2-274.2) in ex-ROP's vs 320.5 μm (95% CI,
288.6-352.3) in controls (P=0.001). There was no statistically significant
difference in the nasal measurement. In the ex-ROP group, there was no
significant correlation between subfoveal choroidal thickness and gestational age
(rs=0.16, P=0.46) or birthweight (rs=0.03, P=0.90). In eyes without copathology
in addition to regressed ROP (29 eyes, 19 patients), there was no significant
correlation between subfoveal choroidal thickness and visual
acuity.ConclusionsOur findings of thinner subfoveal and temporal macular
choroidal thickness in regressed ROP support the case for choroidal involvement
in the pathogenesis of this condition.Eye advance online publication, 3 October
2014; doi:10.1038/eye.2014.207.

PMID: 25277303   [PubMed - as supplied by publisher]

21. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.231. [Epub ahead of print]

The incidence of serious complications associated with intravitreal therapy in a 
quaternary ARMD service (2008-2014).

Severn PS(1), Hamilton R(2).

Author information: 
(1)Department of Medical Retina, Moorfields Eye Hospital, London, UK.
(2)1] Department of Medical Retina, Moorfields Eye Hospital, London, UK [2] NIHR
Biomedical Eye Hospital NHS & UCL Institute of Ophthalmology, London, UK.

PMID: 25277302   [PubMed - as supplied by publisher]

22. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.235. [Epub ahead of print]

Reply to: 'Glaucoma prescribing trends in England 2000 to 2012'

Tiew S, Choudhary A.

Author information: 
Royal Liverpool University Hospital, Liverpool, UK.

PMID: 25277301   [PubMed - as supplied by publisher]

23. Eye (Lond). 2014 Oct 3. doi: 10.1038/eye.2014.230. [Epub ahead of print]

Safety and efficacy of epithelium removal and transepithelial corneal collagen
crosslinking for keratoconus.

Shalchi Z(1), Wang X(2), Nanavaty MA(3).

Author information: 
(1)Department of Ophthalmology, Queen Mary's Hospital, King's College Hospital NHS
Foundation Trust, London, UK.
(2)Cochrane Eyes and Vision Group, Department of Epidemiology, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA.
(3)Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust,
Brighton, UK.

This review aims to assess the efficacy and safety of epithelial removal (ER) and
transepithelial (TE) corneal collagen crosslinking (CXL) for the treatment of
keratoconus. We used MEDLINE to identify all ER and TE CXL studies on keratoconic
eyes (n≥20, follow-up ≥12 months). Ex vivo and studies for non-keratoconus
indications or in conjunction with other procedures were excluded. Data on
uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refractive
cylinder, maximum keratometry (Kmax), and adverse events were collected at the
latest follow-up and 1 year. Only one randomised controlled trial (RCT) qualified
inclusion. Forty-four ER and five TE studies were included. For logMAR UDVA,
CDVA, mean spherical equivalent, refractive cylinder and Kmax, at latest
follow-up 81, 85, 93, 62, and 93% ER studies vs 66.7, 80, 75, 33, and 40% TE
studies reported improvement, respectively. Whereas at 1 year, 90, 59, and 91% ER
studies vs 80, 50, and 25% TE studies reported improvement, respectively. The
majority of studies showed reduced pachymetry in both groups. Treatment failure, 
retreatment rates, and conversion to transplantation were reported to be up to
33, 8.6, and 6.25%, respectively, in ER studies only. Stromal oedema, haze,
keratitis, and scarring were only reported in ER studies, whereas endothelial
cell counts remained variable in both groups. Both ER and TE studies showed
improvement in visual acuity, refractive cylinder but Kmax worsened in most TE
studies. Adverse events were reported more with ER studies. This review calls for
more high quality ER and TE studies with comparable parameters for further
assessment of safety and efficacy.Eye advance online publication, 3 October 2014;

PMID: 25277300   [PubMed - as supplied by publisher]

24. Eye (Lond). 2014 Sep 26. doi: 10.1038/eye.2014.218. [Epub ahead of print]

Evaluation of choroidal thickness using spectral-domain optical coherence
tomography in migraine patients during acute migraine attacks: a comparative

Karalezli A(1), Simsek C(2), Celik G(3), Eroglu FC(1).

Author information: 
(1)Department of Ophthalmology, Baskent University School of Medicine, Konya,
(2)Department of Ophthalmology, Baskent University School of Medicine, Ankara,
(3)Department of Neurology, Baskent University School of Medicine, Konya, Turkey.

PurposeThe purpose of this study was to assess choroidal thickness in migraine
patients during acute migraine attacks and compare them with healthy controls,
using spectral domain optical coherence tomography (OCT).Patients and methodsIn
this prospective case-control study, choroidal thicknesses of 46 migraine
patients during acute migraine attacks and 46 age- and sex-matched healthy
subjects were measured using a high-speed, high-resolution frequency domain-OCT
device. All patients underwent a complete ophthalmic examination before the
measurements. OCT measurements were taken at the same time of day (0900 hours),
in order to minimize the effects of diurnal variation.ResultsThere was a
statistically significant difference in mean choroidal thickness between the
migraine patients during acute migraine attacks (356.3±21.46 μm) and the controls
(302.3±18.34 μm; P=0.000). There were significant differences at all measurement 
points (P<0.001 for all).ConclusionThe increased choroidal thickness of the
migraine patients during acute migraine attacks might be related to the vascular 
pathology of the disease. Further studies are needed to evaluate the
etiopathologic relationship between choroidal thickness and acute migraine
attack.Eye advance online publication, 26 September 2014;

PMID: 25257772   [PubMed - as supplied by publisher]

25. Eye (Lond). 2014 Sep 26. doi: 10.1038/eye.2014.222. [Epub ahead of print]

Outcome of polypoidal choroidal vasculopathy at 1 year by combined therapy of
photodynamic therapy with ranibizumab and predictive factors governing the

Ho M, Lo EC, Young AL, Liu DT.

Author information: 
Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong,
Prince of Wales Hospital, Hong Kong SAR, Hong Kong.

AimTo report the visual outcome of polypoidal choroidal vasculopathy receiving
combined treatment with photodynamic therapy using Visudyne and intravitreal
ranibizumab injections, and to analyze the predictive factors of visual outcome
at 1 year post treatment.MethodsSeventy-four consecutive patients with newly
diagnosed polypoidal choroidal vasculopathy were treated with photodynamic
therapy using Visudyne and three loading doses of intravitreal ranibizumab. The
final visual outcome and polyp eradication rate at 1 year were reported. A
stepwise regression model was used to estimate the baseline clinical factors
predictive of better visual outcome and polyp eradication.ResultsVisual acuities 
at 12-months follow-up improved significantly compared with baseline from 0.828
logMAR to 0.728 logMAR (P=0.026). The mean foveal thickness decreased from
380±175 to 278±117 μm. In all 29.7% of eyes improved at least by 0.3 logMAR, and 
55.4% remained stable in visual acuity with less than 0.3 logMAR change. Overall,
85% of eyes achieved at least stable vision, 20.2% (15/74) cases achieved polyp
eradication on angiogram, and 60.8% (45/74) achieved polyp size reduction on
angiogram at 1 year. Regarding predictive factors, the baseline visual acuity
(P=0.003), no foveal involvement by abnormal choroidal vasculature (P<0.0001),
absence of hard exudates (0.001) or subretinal fluid (<0.0001) are important
clinical factors affecting the final visual outcome.ConclusionsCombination
therapy with photodynamic therapy using Visudyne and three loading doses of
intravitreal ranibizumab injections resulted in 85% success rate on visual
stabilization and 81% success rate in polypoidal lesion control.Eye advance
online publication, 26 September 2014; doi:10.1038/eye.2014.222.

PMID: 25257771   [PubMed - as supplied by publisher]

26. Eye (Lond). 2014 Sep 26. doi: 10.1038/eye.2014.220. [Epub ahead of print]

Subretinal fluid is common in experimental non-arteritic anterior ischemic optic 

Yu C, Ho JK, Liao YJ.

Author information: 
Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University
School of Medicine, Stanford, CA, USA.

PurposeAnterior ischemic optic neuropathy (AION) is an important cause of acute
vision loss for which several animal models exist. It has been associated with
subretinal fluid in a previous study on patients but not yet so in animal
models.Patients and MethodsA patient presented with acute non-arteritic AION
(NAION) and underwent ophthalmic evaluation and testing including fluorescein
angiography and spectral-domain optical coherence tomography (SD-OCT). On the
basis of the patient's findings, we used SD-OCT circular and volume scans to
analyze retinal changes in a murine model of NAION.ResultsOne week after left eye
vision loss, the patient had clinical and imaging findings consistent with NAION.
On SD-OCT, there was prominent peripapillary retinal thickening consistent with
intra-retinal edema and sub-foveolar fluid. Inspired by the findings in human
AION, we looked for similar changes in murine NAION using SD-OCT. The circular
scan did not adequately detect the presence of subretinal fluid. Using the
25-line scan, which covered a larger part of the posterior pole, we found that
100% of murine AION resulted in subretinal fluid at day 1. The subretinal fluid
resolved by week 1.ConclusionThis study detailed a case of clinical NAION
associated with intra-retinal and subretinal fluid. We also found that subretinal
fluid was common in murine photochemical thrombosis model of AION and could be
found far away from the optic disc.Eye advance online publication, 26 September
2014; doi:10.1038/eye.2014.220.

PMID: 25257770   [PubMed - as supplied by publisher]