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
Ophthal Plast Rec Surg
Ophthalmic Res
Surv Ophthalmol
Ophthalmology Review Journal
Eye[JOUR] Established 1995
1. Eye (Lond). 2015 May 1. doi: 10.1038/eye.2015.60. [Epub ahead of print]

The Eye Phone Study: reliability and accuracy of assessing Snellen visual acuity 
using smartphone technology.

Perera C(1), Chakrabarti R(2), Islam FM(3), Crowston J(4).

Author information: 
(1)1] Journal of Mobile Technology in Medicine [2] Department of Ophthalmology,
Fremantle Hospital, Western Australia, Australia. (2)1] Journal of Mobile
Technology in Medicine [2] Department of Ophthalmology, Centre for Eye Research
Australia, University of Melbourne, Victoria, Australia. (3)1] Department of
Ophthalmology, Centre for Eye Research Australia, University of Melbourne,
Victoria, Australia [2] Department of Psychological Sciences and Statistics,
Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria,
Australia. (4)Department of Ophthalmology, Centre for Eye Research Australia,
University of Melbourne, Victoria, Australia.

PurposeSmartphone-based Snellen visual acuity charts has become popularized;
however, their accuracy has not been established. This study aimed to evaluate
the equivalence of a smartphone-based visual acuity chart with a standard 6-m
Snellen visual acuity (6SVA) chart.MethodsFirst, a review of available Snellen
chart applications on iPhone was performed to determine the most accurate
application based on optotype size. Subsequently, a prospective comparative study
was performed by measuring conventional 6SVA and then iPhone visual acuity using 
the 'Snellen' application on an Apple iPhone 4.ResultsEleven applications were
identified, with accuracy of optotype size ranging from 4.4-39.9%. Eighty-eight
patients from general medical and surgical wards in a tertiary hospital took part
in the second part of the study. The mean difference in logMAR visual acuity
between the two charts was 0.02 logMAR (95% limit of agreement -0.332, 0.372
logMAR). The largest mean difference in logMAR acuity was noted in the subgroup
of patients with 6SVA worse than 6/18 (n=5), who had a mean difference of two
Snellen visual acuity lines between the charts (0.276 logMAR).ConclusionWe did
not identify a Snellen visual acuity app at the time of study, which could
predict a patients standard Snellen visual acuity within one line. There was
considerable variability in the optotype accuracy of apps. Further validation is 
required for assessment of acuity in patients with severe vision impairment.Eye
advance online publication, 1 May 2015; doi:10.1038/eye.2015.60.

PMID: 25931170   [PubMed - as supplied by publisher]

2. Eye (Lond). 2015 May 1. doi: 10.1038/eye.2015.45. [Epub ahead of print]

Topiramate maculopathy secondary to dose titration: first reported case.

Severn PS(1), Symes R(1), Rajendram R(1), Pal B(1).

Author information: 
(1)Department of Medical Retina, Moorfields Eye Hospital, London, UK.

PMID: 25931169   [PubMed - as supplied by publisher]

3. Eye (Lond). 2015 May 1. doi: 10.1038/eye.2015.56. [Epub ahead of print]

Chorio-retinal thickness measurements in patients with acromegaly.

Cheong KX(1), Tan CS(2).

Author information: 
(1)National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore,
Singapore. (2)1] National Healthcare Group Eye Institute, Tan Tock Seng Hospital,
Singapore, Singapore [2] Fundus Image Reading Center, National Healthcare Group
Eye Institute, Singapore, Singapore.

PMID: 25931168   [PubMed - as supplied by publisher]

4. Eye (Lond). 2015 May 1. doi: 10.1038/eye.2015.46. [Epub ahead of print]

Vitreoretinal surgery for shotgun eye injuries: outcomes and complications.

Khoueir Z(1), Cherfan G(1), Assi A(2).

Author information: 
(1)Beirut Eye Specialist Hospital, Beirut, Lebanon. (2)1] Beirut Eye Specialist
Hospital, Beirut, Lebanon [2] Beirut Eye Clinic, Beirut, Lebanon.

PurposeTo analyse the postoperative anatomic and functional outcomes in addition 
to complications after vitreoretinal surgery for patients with shotgun eye
injuries related to hunting accidents.MaterialsRetrospective review of the
clinical records of all cases of shotgun eye injuries presented between January
2000 and January 2011 and with a minimum follow-up of 1 year. Collection of
demographics, type of injury, choice of management, complications and final
surgical success with final visual acuity is reported.ResultsTwenty eyes of 19
patients (all male) with a mean age of 36.1 years (range 16-60 years) were
included in the study. Mean postoperative follow-up was 47.5 months (range 15-118
months). Best corrected visual acuity (BCVA) at presentation ranged from
perception of light to 20/200. Ten eyes had a penetrating injury and 10 others
had a perforating injury. All the eyes underwent an initial vitrectomy and the
intraocular pellet was removed in all the 10 penetrating injuries. Concurrent
cataract surgery was performed in 12 cases, internal tamponade was used in 15
cases and a supplemental encircling scleral buckle was inserted in 12 cases. One 
additional vitreoretinal surgery was required in seven cases (35%) and two
additional surgeries required in two other cases (10%). At last follow-up BCVA
ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients 
had a flat retina except for two cases (10%) that developed severe proliferative 
vitreoretinopathy.ConclusionThese results suggest that vitreoretinal surgery can 
offer good visual rehabilitation in patients with shotgun eye injuries.Eye
advance online publication, 1 May 2015; doi:10.1038/eye.2015.46.

PMID: 25931167   [PubMed - as supplied by publisher]

5. Eye (Lond). 2015 May 1. doi: 10.1038/eye.2015.63. [Epub ahead of print]

Keratoconus: an inflammatory disorder?

Galvis V(1), Sherwin T(2), Tello A(1), Merayo J(3), Barrera R(4), Acera A(5).

Author information: 
(1)1] Centro Oftalmologico Virgilio Galvis, Floridablanca, Colombia [2] Faculty
of Health Sciences, Universidad Autonoma de Bucaramanga, Floridablanca, Colombia.
(2)Faculty of Medical and Health Sciences, Department of Ophthalmology, New
Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
(3)Instituto Oftalmologico Fernandez-Vega, Oviedo, Spain. (4)Centro Oftalmologico
Virgilio Galvis, Floridablanca, Colombia. (5)Bioftalmik Applied Research, Derio, 

Keratoconus has been classically defined as a progressive, non-inflammatory
condition, which produces a thinning and steepening of the cornea. Its
pathophysiological mechanisms have been investigated for a long time. Both
genetic and environmental factors have been associated with the disease. Recent
studies have shown a significant role of proteolytic enzymes, cytokines, and free
radicals; therefore, although keratoconus does not meet all the classic criteria 
for an inflammatory disease, the lack of inflammation has been questioned. The
majority of studies in the tears of patients with keratoconus have found
increased levels of interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), and
matrix metalloproteinase (MMP)-9. Eye rubbing, a proven risk factor for
keratoconus, has been also shown recently to increase the tear levels of MMP-13, 
IL-6, and TNF-α. In the tear fluid of patients with ocular rosacea, IL-1α and
MMP-9 have been reported to be significantly elevated, and cases of inferior
corneal thinning, resembling keratoconus, have been reported. We performed a
literature review of published biochemical changes in keratoconus that would
support that this could be, at least in part, an inflammatory condition.Eye
advance online publication, 1 May 2015; doi:10.1038/eye.2015.63.

PMID: 25931166   [PubMed - as supplied by publisher]

6. Eye (Lond). 2015 Apr 24. doi: 10.1038/eye.2015.59. [Epub ahead of print]

Effect of cooling proparacaine 0.5% eye drops on patient's comfort during

Hu Youwei J(1), Chang B(1).

Author information: 
(1)Department of Ophthalmology, Khoo Teck Puat Hospital, Singapore, Singapore.

PMID: 25907208   [PubMed - as supplied by publisher]

7. Eye (Lond). 2015 Apr 24. doi: 10.1038/eye.2015.57. [Epub ahead of print]

Prevalence of gonococcal conjunctivitis in adults and neonates.

McAnena L(1), Knowles SJ(2), Curry A(3), Cassidy L(1).

Author information: 
(1)Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin,
Ireland. (2)Department of Microbiology, Royal Victoria Eye and Ear Hospital,
National Maternity Hospital, Dublin, Ireland. (3)Department of Microbiology,
National Maternity Hospital, Holles St, Dublin, Ireland.

PurposeTo report the prevalence of gonococcal conjunctivitis (GC) presenting to a
tertiary referral maternity hospital (NMH) and a tertiary referral ophthalmic
hospital (RVEEH) from 2011 to 2013 and describe the demographics, clinical
presentation, and antibiotic susceptibility of Neisseria gonorrhoeae ocular
infections.MethodsDemographic, clinical, and microbiological data were collected 
from patients with laboratory confirmed GC.ResultsThere were 27 556 live births
at NMH during the study period, and no case of neonatal GC was identified.
Fourteen cases of GC were identified at RVEEH in this period, representing a
prevalence of 0.19 cases per 1000 eye emergency attendees. Antibiotic
susceptibility data were available on nine cases, of which, all were ceftriaxone-
and ciprofloxacin sensitive. 64.3% of patients were male, with a mean age of 18
years. The mean duration of symptoms was 3 days. All patients presented with
unilateral conjunctival injection and purulent discharge. Eight cases had visual 
impairment at presentation and their mean visual acuity was 6/15. Corneal
involvement was present in 25% of patients. Uveitis was not detected. On receipt 
of positive culture and/or PCR results, treatment was altered in two thirds of
patients. All patients were referred for full STI screening and all patients
showed a full clinical recovery 1 week posttreatment.ConclusionWe observed that
GC presented in young adults with a male predominance and was rare in neonates.
In cases of unilateral purulent conjunctivitis, there should be a high clinical
suspicion of GC, early swab for PCR and culture, and knowledge of current
CDC-recommended antibiotic guidelines.Eye advance online publication, 24 April
2015; doi:10.1038/eye.2015.57.

PMID: 25907207   [PubMed - as supplied by publisher]

8. Eye (Lond). 2015 Apr 24. doi: 10.1038/eye.2015.44. [Epub ahead of print]

The diagnostic accuracy of spectral-domain optical coherence tomography for
neovascular age-related macular degeneration: a comparison with fundus
fluorescein angiography.

Wilde C(1), Patel M(2), Lakshmanan A(3), Amankwah R(3), Dhar-Munshi S(3), Amoaku 
W(1); Medscape.

Author information: 
(1)Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B
Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham,
UK. (2)Ophthalmology, Derby Hospitals NHS Foundation Trust, Derby, UK. (3)Eye
Clinic, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.

PurposeTo evaluate the diagnostic accuracy of spectral-domain optical coherence
tomography (SD-OCT) for neovascular age-related macular degeneration (nAMD): a
comparison against fundus fluorescein angiography (FFA).MethodsA retrospective
review of SD-OCT, colour fundus photographs (FP), and FFA of 411 consecutive
patients referred to a rapid access Macular Clinic over a 4-year period was
performed. FFA images were reviewed nonstereoscopically. SD-OCT images were
acquired using the Topcon 3D OCT-1000 instrument. All FFA and OCT images were
graded by at least two ophthalmologists independently. Side-by-side grading took 
place with immediate open discussion and adjudication. If there was disagreement 
between the two grading ophthalmologists or they were not 90% confident of their 
assigned grade, then adjudication by a third ophthalmologist was
performed.ResultsA total of 278 eyes were graded as having choroidal
neovascularisation (CNV) with SD-OCT and 231 diagnosed with FFA. The main
diagnostic CNV classifications on FFA were: classic no occult in 27 eyes,
predominantly classic in 16, minimally classic in 50, occult in 129, and 9
peripapillary membranes. There were a total of 47 false positives with SD-OCT: a 
rate of 16.9%. The sensitivity and specificity of SD-OCT alone for detecting CNV 
was 100 and 80.8%, respectively.ConclusionOur study confirms SD-OCT in comparison
to the reference standard of nonstereoscopic FFA is highly sensitive at detecting
newly presenting nAMD in the setting of a specialist AMD clinic where the
investigations are interpreted by trained specialists. However, it does not seem 
accurate enough to replace FFA in the diagnosis on nAMD in current practice.Eye
advance online publication, 24 April 2015; doi:10.1038/eye.2015.44.

PMID: 25907206   [PubMed - as supplied by publisher]

9. Eye (Lond). 2015 Apr 17. doi: 10.1038/eye.2015.48. [Epub ahead of print]

Defining response to anti-VEGF therapies in neovascular AMD.

Amoaku WM(1), Chakravarthy U(2), Gale R(3), Gavin M(4), Ghanchi F(5), Gibson
J(6), Harding S(7), Johnston RL(8), Kelly S(9), Lotery A(10), Mahmood S(11),
Menon G(12), Sivaprasad S(13), Talks J(14), Tufail A(15), Yang Y(16).

Author information: 
(1)Division of Clinical Neurosciences, Department of Ophthalmology, Academic
Ophthalmology, University of Nottingham, Nottingham University Hospitals NHS
Trust, Nottingham, UK. (2)Department of Ophthalmology, Queen's University of
Belfast, and the Royal Victoria Hospitals Trust, Belfast, UK. (3)Department of
Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK.
(4)Department of Ophthalmology, Gartnavel Hospital, NHSGG, Glasgow, UK.
(5)Department of Ophthalmology, Bradford Teaching Hospitals Foundation Trust,
Bradford, UK. (6)Department of Ophthalmology, School of Life and Health Sciences,
Aston University and Heart of England NHS Foundation Trust, and Birmingham and
Midland Eye Centre Birmingham, Birmingham, UK. (7)Department of Ophthalmology,
University of Liverpool and Royal Liverpool University Hospital, Liverpool, UK.
(8)Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust,
Gloucester, UK. (9)Department of Ophthalmology, Royal Bolton Hospital, Bolton,
UK. (10)Department of Ophthalmology, Clinical and Experimental Sciences, Faculty 
of Medicine, University of Southampton, Southampton, UK. (11)Department of
Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Hospitals
Foundation Trust, Manchester, UK. (12)Department of Ophthalmology, Frimley Park
Hospital NHS Foundation Trust, Frimley, UK. (13)Department of Ophthalmology, NIHR
Moorfields Biomedical Research Centre, King's College Hospital NHS Foundation
Trust, London, UK. (14)Department of Ophthalmology, Newcastle University
Hospirtals NHS Trust, Newcastle, UK. (15)Department of Ophthalmology, Moorfields 
Hospital NHS Trust, London, UK. (16)Department of Ophthalmology, New Cross
Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.

The introduction of anti-vascular endothelial growth factor (anti-VEGF) has made 
significant impact on the reduction of the visual loss due to neovascular
age-related macular degeneration (n-AMD). There are significant inter-individual 
differences in response to an anti-VEGF agent, made more complex by the
availability of multiple anti-VEGF agents with different molecular
configurations. The response to anti-VEGF therapy have been found to be dependent
on a variety of factors including patient's age, lesion characteristics, lesion
duration, baseline visual acuity (VA) and the presence of particular genotype
risk alleles. Furthermore, a proportion of eyes with n-AMD show a decline in
acuity or morphology, despite therapy or require very frequent re-treatment.
There is currently no consensus as to how to classify optimal response, or lack
of it, with these therapies. There is, in particular, confusion over terms such
as 'responder status' after treatment for n-AMD, 'tachyphylaxis' and
'recalcitrant' n-AMD. This document aims to provide a consensus on
definition/categorisation of the response of n-AMD to anti-VEGF therapies and on 
the time points at which response to treatment should be determined. Primary
response is best determined at 1 month following the last initiation dose, while 
maintained treatment (secondary) response is determined any time after the 4th
visit. In a particular eye, secondary responses do not mirror and cannot be
predicted from that in the primary phase. Morphological and functional responses 
to anti-VEGF treatments, do not necessarily correlate, and may be dissociated in 
an individual eye. Furthermore, there is a ceiling effect that can negate the
currently used functional metrics such as >5 letters improvement when the
baseline VA is good (ETDRS>70 letters). It is therefore important to use a
combination of both the parameters in determining the response.The following are 
proposed definitions: optimal (good) response is defined as when there is
resolution of fluid (intraretinal fluid; IRF, subretinal fluid; SRF and retinal
thickening), and/or improvement of >5 letters, subject to the ceiling effect of
good starting VA. Poor response is defined as <25% reduction from the baseline in
the central retinal thickness (CRT), with persistent or new IRF, SRF or minimal
or change in VA (that is, change in VA of 0+4 letters). Non-response is defined
as an increase in fluid (IRF, SRF and CRT), or increasing haemorrhage compared
with the baseline and/or loss of >5 letters compared with the baseline or best
corrected vision subsequently. Poor or non-response to anti-VEGF may be due to
clinical factors including suboptimal dosing than that required by a particular
patient, increased dosing intervals, treatment initiation when disease is already
at an advanced or chronic stage), cellular mechanisms, lesion type, genetic
variation and potential tachyphylaxis); non-clinical factors including poor
access to clinics or delayed appointments may also result in poor treatment
outcomes. In eyes classified as good responders, treatment should be continued
with the same agent when disease activity is present or reactivation occurs
following temporary dose holding. In eyes that show partial response, treatment
may be continued, although re-evaluation with further imaging may be required to 
exclude confounding factors. Where there is persistent, unchanging accumulated
fluid following three consecutive injections at monthly intervals, treatment may 
be withheld temporarily, but recommenced with the same or alternative anti-VEGF
if the fluid subsequently increases (lesion considered active). Poor or
non-response to anti-VEGF treatments requires re-evaluation of diagnosis and if
necessary switch to alternative therapies including other anti-VEGF agents and/or
with photodynamic therapy (PDT). Idiopathic polypoidal choroidopathy may require 
treatment with PDT monotherapy or combination with anti-VEGF. A committee
comprised of retinal specialists with experience of managing patients with n-AMD 
similar to that which developed the Royal College of Ophthalmologists Guidelines 
to Ranibizumab was assembled. Individual aspects of the guidelines were proposed 
by the committee lead (WMA) based on relevant reference to published evidence
base following a search of Medline and circulated to all committee members for
discussion before approval or modification. Each draft was modified according to 
feedback from committee members until unanimous approval was obtained in the
final draft. A system for categorising the range of responsiveness of n-AMD
lesions to anti-VEGF therapy is proposed. The proposal is based primarily on
morphological criteria but functional criteria have been included.
Recommendations have been made on when to consider discontinuation of therapy
either because of success or futility. These guidelines should help clinical
decision-making and may prevent over and/or undertreatment with anti-VEGF
therapy.Eye advance online publication, 17 April 2015; doi:10.1038/eye.2015.48.

PMID: 25882328   [PubMed - as supplied by publisher]

10. Eye (Lond). 2015 Apr 17. doi: 10.1038/eye.2015.54. [Epub ahead of print]

Long term patient-reported benefit from ptosis surgery.

Maycock N(1), MacGregor C(1), Saunders DA(1), Parkin B(1).

Author information: 
(1)Eye Department, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK.

PurposeTo assess the long term impact of ptosis surgery on health-related
quality-of-life using the Glasgow Benefit Inventory (GBI) patient-reported
outcome measure.Patients and methodsA retrospective case note review was carried 
out on all patients who had undergone ptosis surgery (6 November 2008 to 5
December 2010) by one surgeon at Royal Bournemouth Hospital. Patient
demographics, surgical technique, and complications were recorded. The GBI
questionnaire data was obtained by telephone interview.ResultsA total of 62
ptosis operations (33 right, 29 left, of which 18 were bilateral) on 44 patients;
20 male, 24 female were included. Median age 77 years (range: 17-95 years). One
wound dehiscence occurred, but no redo ptosis procedures were required. GBI data 
was obtained on 32 patients (45 ptosis procedures) at a mean follow-up period of 
42.8 months postoperatively (range 31-67 months). The mean total GBI score for
ptosis surgery was +21.36 (range 0-58.33; 95% confidence interval: 17.28-25.43,
P<0.05).ConclusionPatients derived a highly significant benefit to their
health-related quality-of-life from ptosis surgery measured by the GBI that was
maintained for up to 5 years.Eye advance online publication, 17 April 2015;

PMID: 25882327   [PubMed - as supplied by publisher]

11. Eye (Lond). 2015 Apr 17. doi: 10.1038/eye.2015.38. [Epub ahead of print]

Vision standards for driving: what ophthalmologists need to know.

Rees GB(1).

Author information: 
(1)Drivers' Medical Group, DVLA, Swansea, UK.

PMID: 25882326   [PubMed - as supplied by publisher]

12. Eye (Lond). 2015 Apr 10. doi: 10.1038/eye.2015.55. [Epub ahead of print]

Regarding 'transient visual loss due to reversible 'pending' central retinal
artery occlusion in occult giant cell arteritis'.

Alwitry A(1).

Author information: 
(1)Loughborough Hospital, Epinal Way, Loughborough, UK.

PMID: 25857610   [PubMed - as supplied by publisher]

13. Eye (Lond). 2015 Apr 10. doi: 10.1038/eye.2015.40. [Epub ahead of print]

Topical cyclosporine to control ocular surface disease in patients with chronic
glaucoma after long-term usage of topical ocular hypotensive medications.

Saini M(1), Dhiman R(1), Dada T(2), Tandon R(1), Vanathi M(1).

Author information: 
(1)Cornea & Ocular Surface Services, Cataract & Refractive Services, Dr R P
Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New
Delhi, India. (2)Glaucoma Services, Dr R P Centre for Ophthalmic Sciences, All
India Institute of Medical Sciences, New Delhi, India.

PurposeTo evaluate changes in ocular surface and central corneal sub-basal nerve 
fiber layer (SBNFL) after topical cyclosporin therapy in chronic glaucoma
patients on long-term topical antiglaucoma therapy.MethodsA prospective
comparative study of ocular surface evaluation of chronic glaucoma patients on
long-term topical therapy treated concurrently with a topical cyclosporine 0.05% 
twice daily for 6 months and controls was done. The study parameters evaluated at
recruitment and at the 6-month follow-up included details of topical antiglaucoma
medications, visual acuity, intraocular pressure, ocular surface evaluation
parameters (TBUT, Schirmers I, ocular surface staining scores and ocular surface 
disease (OSD) index score (OSDI)), central corneal sensation (Cochet Bonnett
aesthesiometer), and central confocal microscopy to study the SBNFL density
(SBNFLD).ResultsThirty-two eyes of 16 patients with chronic glaucoma and 30 eyes 
of 15 normal subjects as controls were studied. Mean TBUT, pre/post CsA treatment
was 8.67±3.01/12.24±1.83 s (P=0.007). Mean conjunctival/corneal staining scores
pre/post CsA treatment were 3.38±1.93/1.50±0.718 (P=0.00) /5.19±1.82/1.81±0.78
(P=0.098), respectively. Mean OSDI pre/post CsA treatment scores were
30.63±14.61/14.76±6.06 (P=0.007). Mean corneal sensations scores pre/post CsA
treatment were 4.64±0.46/4.94±0.39 (P=0.002). Central corneal SBNFLD pre and post
CsA treatment was 8811.35±2985.29/10335.13±4092.064 μm/mm(2)
(P=0.0001).ConclusionsSchirmer's test, ocular surface staining scores, OSDI,
corneal sensations, and corneal SBNFLD showed a statistically significant
improvement following a 6-month concurrent topical CsA therapy.Eye advance online
publication, 10 April 2015; doi:10.1038/eye.2015.40.

PMID: 25857609   [PubMed - as supplied by publisher]

14. Eye (Lond). 2015 Apr 10. doi: 10.1038/eye.2015.50. [Epub ahead of print]

Reply to 'Intraocular lens calcification following endothelial keratoplasty: a
message for all cataract surgeons'.

De Cock R(1), Fajgenbaum MA(1).

Author information: 
(1)Kent and Canterbury Hospital, East Kent Hospitals University Trust, England,

PMID: 25857608   [PubMed - as supplied by publisher]

15. Eye (Lond). 2015 Apr 10. doi: 10.1038/eye.2015.49. [Epub ahead of print]

Intraocular lens calcification following endothelial keratoplasty: a message for 
all cataract surgeons.

Park JC(1), Habib NE(2), Moate RM(3).

Author information: 
(1)Royal Eye Infirmary, Derriford Hospital, Plymouth, UK. (2)1] Royal Eye
Infirmary, Derriford Hospital, Plymouth, UK [2] Peninsula Medical School,
Plymouth, UK. (3)Plymouth Electron Microscope Centre, University of Plymouth,
Plymouth, UK.

PMID: 25857607   [PubMed - as supplied by publisher]

16. Eye (Lond). 2015 Apr 10. doi: 10.1038/eye.2015.47. [Epub ahead of print]

Pupil dilation using drops vs gel: a comparative study.

Moisseiev E(1), Loberman D(1), Zunz E(1), Kesler A(1), Loewenstein A(1),
Mandelblum J(1).

Author information: 
(1)Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to
the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PurposeTo compare the efficacy in pupil dilation and degree of discomfort between
topical instillation of mydriatic drops and gel.MethodsThe study included 60
patients with no previous ocular history of trauma and surgery. One eye was
dilated with two drops (tropicamide 0.5% and phenylephrine 10%), and the other
with one drop of gel (tropicamide 0.5%+phenylephrine 5%). Pupil size was measured
by a Colvard pupillometer at baseline and 5, 15, 30, and 45 min following
instillation. Pain upon instillation was measured by visual analog scale
(VAS).ResultsThere was no difference in pupil size at baseline. Use of the gel
achieved greater mydriasis than drops (P=0.01), and was also associated with
lower pain scores (P=0.003). In diabetic patients, pupil size was smaller at
baseline and following instillation of drops and gel. Use of the gel achieved an 
even greater degree of pupil dilation in this subset of patients than drops
(P=0.019).ConclusionsGel formulation achieved significantly greater pupil
dilation than drops, despite a lower concentration of phenylephrine, and was also
associated with significantly lower patient discomfort. This study is the first
report of improved mydriatic efficacy in diabetic patients.Eye advance online
publication, 10 April 2015; doi:10.1038/eye.2015.47.

PMID: 25857606   [PubMed - as supplied by publisher]

17. Eye (Lond). 2015 Mar 20. doi: 10.1038/eye.2015.36. [Epub ahead of print]

Anatomical and functional recurrence after dexamethasone intravitreal implants: a
6-month prospective study.

Fortoul V(1), Denis P(1), Kodjikian L(1).

Author information: 
(1)Department of Ophthalmology, Croix-Rousse University Hospital, University of
Lyon 1, Lyon, France.

PurposeTo evaluate the efficacy, safety, and delay of anatomical and functional
recurrence after a first intravitreal injection of dexamethasone implant in eyes 
with cystoid macular edema (CME) secondary to retinal vein occlusion
(RVO).MethodsA 6-month prospective, monocentric and noncomparative case-series of
26 eyes of 26 patients. Best-corrected visual acuity (BCVA) and central subfield 
thickness (CST) were measured at baseline and each visit at 1 week, and months 1,
2, 3, 4, 5, and 6 after a first treatment. Primary efficacy outcome was the
proportion of eyes with a minimum three-line improvement from baseline BCVA at
each visit and at 6 months. We also defined different patterns of recurrence:
qualitative anatomical recurrence, quantitative anatomical recurrence and
functional recurrence. A P-value <5% was considered statistically
significant.ResultsMean population age was 69.3 years (SD=12.2; range=42-94
years). Mean ME duration before treatment was ~9.2 months (SD=11.43; range=0.4-40
months). Eighty eight percent of eyes achieved a three-line improvement from
baseline at 2 months (P=0.02). The mean delay from baseline until qualitative
anatomical, functional, or quantitative anatomical recurrence was 4.11 months
(±0.86), 4.31 months (±1.33), and 4.40 months (±1.14), respectively. Qualitative 
anatomical recurrence occurred on average 14.4 days (SD=42.18) before a minimum
of one-line BCVA impairment (functional recurrence).ConclusionDexamethasone
intravitreal treatment seems to be effective for ME after RVO even with
long-duration ME or poor visual acuity before treatment. Other longer studies
should assess the delay of recurrence after second and further treatments with
DEX implants or combined therapies for ME after RVO.Eye advance online
publication, 20 March 2015; doi:10.1038/eye.2015.36.

PMID: 25853447   [PubMed - as supplied by publisher]

18. Eye (Lond). 2015 Mar 20. doi: 10.1038/eye.2015.23. [Epub ahead of print]

Corneal collagen crosslinking for keratoconus or corneal ectasia without
epithelial debridement.

Hirji N(1), Sykakis E(2), Lam FC(3), Petrarca R(1), Hamada S(2), Lake D(2).

Author information: 
(1)1] The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East
Grinstead, UK [2] Department of Ophthalmology, East Surrey Hospital, Surrey, UK. 
(2)The Corneoplastic Unit, The Queen Victoria Hospital and Eye Bank, East
Grinstead, UK. (3)1] The Corneoplastic Unit, The Queen Victoria Hospital and Eye 
Bank, East Grinstead, UK [2] Ophthalmology Department, Worthing and St. Richards 
Hospital, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK.

PurposeCorneal collagen crosslinking (CXL) is a relatively new technique to
reduce the progression of keratoconus. The technique can be performed with or
without complete debridement of the corneal epithelium. We describe a novel
intermediate technique involving mechanical disruption of the epithelium, and
evaluate its safety and efficacy.MethodsThe case notes of 128 eyes with
progressive keratoconus or iatrogenic corneal ectasia who had undergone CXL using
the epithelial disruption technique were retrospectively reviewed. Thin corneas
were treated with hypotonic riboflavin. All others were treated with an isotonic 
solution. Note was made of preoperative and postoperative parameters, including
uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA),
refraction, endothelial cell count, and corneal tomography. Occurrence of
procedure-related complications was recorded. Statistical analyses were performed
using the paired sample t-test and Wilcoxon signed-rank test, with a level of
P<0.05 being accepted as statistically significant.ResultsAt 12 months, 41.8% of 
patients treated with isotonic riboflavin had improved UCVA and 29.7% had
improved BSCVA. Only 13.4% lost lines of UCVA and 14.9% lost BSCVA. Of the
patients treated with hypotonic riboflavin, at 12 months, 75% demonstrated
stability of BSCVA and 25% had stable Kmax. In addition, 25% showed improved
visual acuity at 12 months, and 58.3% showed regression of their Kmax. Our rate
of short-term complications was comparable to studies using complete epithelial
removal.ConclusionsCXL with epithelial disruption is a safe and effective
treatment for keratoconus or iatrogenic corneal ectasia, and may be better
tolerated by patients than the epithelium-off technique.Eye advance online
publication, 20 March 2015; doi:10.1038/eye.2015.23.

PMID: 25853446   [PubMed - as supplied by publisher]

19. Eye (Lond). 2015 Mar 20. doi: 10.1038/eye.2015.14. [Epub ahead of print]

The usefulness of the Retinomax autorefractor for childhood screening validated
against a Danish preterm cohort examined at the age of 4 years.

Fledelius HC(1), Bangsgaard R(1), Slidsborg C(1), laCour M(1).

Author information: 
(1)Copenhagen University Eye Department, Glostrup Hospital & Rigshospitalet,
Copenhagen, Denmark.

Background and purposeRefractometers have gained a foothold in childhood
screening for ophthalmic disorders. Given the results of an ophthalmic follow-up 
of an extremely preterm Danish cohort, the results of the Retinomax autorefractor
were further evaluated.Materials and methodsA nationwide cohort of infants born
before gestational age 28 weeks (n=178) and 56 term controls were examined at the
age of 4 years. Refraction was given as the cycloplegic Retinomax value. For this
study, we analysed the equipment's confidence value on the printout and
equipment-induced myopization (as the difference between refraction measured
before and after topical cyclopentholate 1%), both items hypothetical with a view
to having identified factual ophthalmic deviations.ResultsThirty-two of 42 eyes
with visual acuity ≤0.4 had high Retinomax confidence values (8-9); the Retinomax
values were also high in 10 of 12 children with strabismus and lack of
stereopsis. Low values (1-6) were recorded in 11 single eyes, 5 of which were
normal (false positives). Three children already known to have low vision were
unable to cooperate. The overall mean value for equipment-induced myopization was
1.9 D (range, 0-6.87 D). Myopization showed no correlation with visual acuity and
corneal curvature, and a weak positive correlation with refractive value
disappeared when the myopic outliers were excluded.ConclusionsThe hand-held
Retinomax seemed to be reliable for assessing refraction in 4-year-old children, 
provided a cycloplegic agent is applied; if used alone, the Retinomax would have 
missed several cases of ophthalmic deviation during screening. Equipment-induced 
myopization was not indicative.Eye advance online publication, 20 March 2015;

PMID: 25853445   [PubMed - as supplied by publisher]

20. Eye (Lond). 2015 Mar 20. doi: 10.1038/eye.2015.37. [Epub ahead of print]

Apolipoprotein B: novel indicator of elevated intraocular pressure.

Son JH(1), Chung YK(2), Son JS(3).

Author information: 
(1)Department of Ophthalmology, Yeungnam University College of Medicine, Daegu,
South Korea. (2)Department of Occupational and Environmental Health, Hallym
Sacred Heart Hospital, Hallym Medical University, Anyang, South Korea.
(3)Department of Occupational and Environmental Medicine, Samsung Changwon
Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.

PurposeMany studies have reported associations between elevated intraocular
pressure (IOP) and systemic health parameters, which suggest a common mechanism
links IOP elevation and various related cardiometabolic risk factors.
Furthermore, according to a recent study, serum apolipoprotein B (APO B) level is
a predictor of coronary artery disease. This study was undertaken to analyse the 
relationship between serum apolipoprotein levels and IOP.MethodsHealthy people
(28 852) who attended a community hospital for a health checkup between January
2011 and December 2013 were enroled in the study. We measured age, body mass
index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum
levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein
cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and
apolipoprotein A1 (APO A1) and APO B, APO B/APO A1 ratios, and
IOP.ResultsUnivariate regression analysis showed IOP was positively correlated
with BMI, SBP, DBP, TC, LDL-C, TG, APO B, and APO B/APO A1 (P<0.001), and
negatively correlated with HDL-C (P<0.001). On the other hand, multivariate
regression analysis adjusted for age, BMI, SBP, and DBP, revealed IOP was
positive correlated with TC, TG, LDL-C, APO B, and APO B/APO A1, and negatively
correlated with HDL-C (all <0.05).ConclusionsAmong the various lipid profiles
investigated, APO B was found to be most strongly correlated with IOP, regardless
of sex. Additional studies are required to confirm the validity of apolipoprotein
level as an index for predicting IOP.Eye advance online publication, 20 March
2015; doi:10.1038/eye.2015.37.

PMID: 25853444   [PubMed - as supplied by publisher]

21. Eye (Lond). 2015 Mar 20. doi: 10.1038/eye.2015.20. [Epub ahead of print]

Incidence and indications for pars plana vitrectomy following the treatment of
posterior uveal melanomas in Scotland.

Chia SN(1), Smith HB(1), Hammer HM(1), Kemp EG(1).

Author information: 
(1)Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.

BackgroundGlobe-sparing treatments such as plaque brachytherapy, local or
endoresection, and proton beam therapy (PBT) are the treatments of choice for
posterior uveal melanoma. However, both early and late complications can arise
from these techniques, including vitreous haemorrhage (VH) and retinal detachment
(RD). Choroidal melanomas in Scotland are managed by a single unit, the Scottish 
Ocular Oncology Service (SOOS).MethodsIndications and outcomes from surgery were 
analysed for patients undergoing vitrectomy following treatment for uveal
melanoma in the SOOS between 1998 and 2013.ResultsSeventeen from 715 cases (2.4%)
required vitrectomy, of which 8/445 (1.8%) followed plaque brachytherapy, 7/43
(16.3%) combined local resection and brachytherapy, and 2/227 (0.9%) PBT.
Casenotes were reviewed for 16/17 cases, with surgery indicated for VH in 10
(63%), RD in 5 (31%), and combined VH/RD in 1 (6%). The median interval from
initial tumour treatment to vitrectomy was 5.8 months (range 10 days to 8.8
years). Ten (63%) required early vitrectomy (within 6 months), of which the
majority (70%) followed combined resection/brachytherapy. Six (37%) required late
vitrectomy (after 6 months), of which all were non-clearing VH following plaque
brachytherapy, with proliferative retinopathy in 4/6 (67%), and tumour recurrence
in 2/6 (33%). Overall vision improved in 8 eyes (50%), remained the same in 2
(12.5%), and deteriorated in 6 (37.5%).ConclusionsEarly vitrectomy was most
commonly indicated for RD following local resection, and late vitrectomy for VH
due to radiation retinopathy. The majority of patients undergoing vitrectomy
gained or maintained vision.Eye advance online publication, 20 March 2015;

PMID: 25853443   [PubMed - as supplied by publisher]

22. Eye (Lond). 2015 Mar 20. doi: 10.1038/eye.2015.29. [Epub ahead of print]

Association of histone acetylation at the ACTA2 promoter region with epithelial
mesenchymal transition of lens epithelial cells.

Ganatra DA(1), Rajkumar S(1), Patel AR(1), Gajjar DU(1), Johar K(1), Arora AI(1),
Kayastha FB(1), Vasavada AR(1).

Author information: 
(1)Cell and Molecular Biology, Iladevi Cataract and IOL Research Centre,
Ahmedabad, India.

PurposeEpithelial mesenchymal transition (EMT) plays a central role in the
development of fibrotic complications of the lens. The current study is designed 
to check whether EMT of lens epithelial cells (LECs) is regulated by epigenetic
modifications and to evaluate the effect of Trichostatin-A (TSA) on the
transforming growth factor-β (TGF-β)-induced EMT.MethodsFetal human LECs (FHL124)
were treated with TGF-β2 in the presence or absence of TSA. Levels of mRNA,
protein, as well as localization of α-smooth muscle actin (αSMA) were studied
along with migration of LECs. Acetylation of histone H4 was analyzed and
chromatin immunoprecipitation (ChIP) was carried out to study the level of
acetylated histone H4 at the promoter of αSMA gene (ACTA2). Student's t-test was 
used for statistical analysis.ResultsTGF-β2 treatment resulted in
myofibroblast-like changes and increased migratory capacity of FHL124. Protein
and mRNA expression of αSMA increased, and immunofluorescence revealed presence
of extensive stress fibers. TSA treatment preserved epithelial morphology,
retarded cell migration, and abrogated an increase in αSMA levels. TSA led to the
accumulation of acetylated histone H4 that was reduced on TGF-β2 treatment.
However, increased level of histone H4 acetylation was found at the ACTA2
promoter region during TGF-β treatment.ConclusionsThe increased level of αSMA, a 
hallmark of EMT in LECs, is associated with increased level of histone H4
acetylation at its promoter region, and TSA helps in suppressing EMT by
epigenetically reducing this level. TSA thus shows promising potential in
management of fibrotic conditions of the lens.Eye advance online publication, 20 
March 2015; doi:10.1038/eye.2015.29.

PMID: 25853442   [PubMed - as supplied by publisher]

23. Eye (Lond). 2015 Mar 20. doi: 10.1038/eye.2015.22. [Epub ahead of print]

Comparision of surgical outcomes of intraocular lens refixation and intraocular
lens exchange with perfluorocarbon liquid and fibrin glue-assisted sutureless
scleral fixation.

Oh SY(1), Lee SJ(2), Park JM(1).

Author information: 
(1)Department of Ophthalmology, Maryknoll Hospital, Busan, South Korea.
(2)Department of Ophthalmology, Haeundae Paek Hospital, Busan, South Korea.

AimThe purpose of this study was to compare the surgical outcomes of intraocular 
lens (IOL) refixation with intraocular lens exchange using perfluorocarbon liquid
(PFCL) and fibrin glue-assisted sutureless scleral fixation surgery in patients
with dislocation of the IOL.MethodsTwenty-five eyes of 25 patients who underwent 
surgery for dislocated IOLs with PFCL and fibrin glue-assisted scleral fixation
were studied; 13 eyes experienced IOL refixation (in-the-bag and out-of-the-bag),
and 12 eyes experienced IOL exchange. Preoperative and postoperative clinical
features from patient charts and 25 eyes with >6 months' follow-up information
were reviewed and analyzed.ResultsAt postoperative 6 months, best-corrected
visual acuity (BCVA) and spherical equivalent of IOL refixation and exchange were
significantly improved (P=0.042, P=0.001), and endothelial cell density was
significantly decreased in the two groups with no significant difference between 
them. Surgically induced astigmatism of IOL refixation improved from 0.90±0.47 to
0.61±0.37 (P=0.012), and IOL exchange improved from 1.17±0.64 to 0.73±0.37
(P=0.037) at postoperative 6 months, with no significant difference between the
two groups. Complications occurred in four eyes in the IOL refixation group and
in three eyes in the IOL exchange group.ConclusionPFCL and fibrin glue-assisted
IOL sutureless scleral refixation or exchanged fixation was an effective surgical
treatment for IOL dislocation. Also, because postoperative BCVA, surgical
outcomes, and complications did not differ significantly between IOL refixation
and exchange surgery, if IOL exchange surgery is not indicated, IOL refixation
surgical techniques should be considered.Eye advance online publication, 20 March
2015; doi:10.1038/eye.2015.22.

PMID: 25853441   [PubMed - as supplied by publisher]

24. Eye (Lond). 2015 Apr;29(4):453-9. doi: 10.1038/eye.2015.31. Epub 2015 Mar 27.

Focal choroidal excavation in patients with central serous chorioretinopathy.

Luk FO(1), Fok AC(1), Lee A(1), Liu AT(1), Lai TY(2); Medscape.

Author information: 
(1)1] Hong Kong Eye Hospital, Hong Kong SAR, China [2] Department of
Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
SAR, China. (2)Department of Ophthalmology and Visual Sciences, The Chinese
University of Hong Kong, Hong Kong SAR, China.

PurposeTo evaluate the prevalence and clinical features of focal choroidal
excavation (FCE) in patients presenting with central serous chorioretinopathy
(CSC).MethodsThis is a retrospective consecutive case series of consecutive
patients with CSC who were referred for spectral domain optical coherence
tomography (SD-OCT) between January 2010 and December 2011. Medical records were 
reviewed and clinical features including presence of FCE in SD-OCT, fluorescence 
angiography (FA), and indocyanine green angiography (ICGA) were
studied.ResultsAmong the 116 CSC patients assessed, FCE was found in 11 eyes of 7
(6.0%) patients. FCE was associated with subretinal fluid in six eyes of six
patients and serous pigment epithelial detachment in three eyes of two patients. 
The mean central subfield retinal thickness of CSC eyes with FCE was 283.7 μm,
compared with 377.5 μm for CSC eyes without FCE (Mann-Whitney U-test, P=0.020).
Five FCE eyes of five patients had focal leakage on FA. Choroidal
hyperpermeability on ICGA was found in seven CSC eyes with FCE, with four eyes
showing hypofluorescent spot corresponding to the FCE. After a mean follow-up of 
16 months, visual acuity of all 11 eyes with FCE remained stable or improved at
the last follow-up.ConclusionFCE is not an uncommon feature in patients with CSC 
and might be associated with choroidal hemodynamic disturbances.

PMID: 25853402   [PubMed - in process]

25. Eye (Lond). 2015 Mar 27. doi: 10.1038/eye.2015.39. [Epub ahead of print]

The role of computerised tomography in predicting visual outcome in ocular trauma

Chaudhary R(1), Upendran M(1), Campion N(2), Yeung A(1), Blanch R(2),
Morgan-Warren P(2), Gibb I(3), Nelson T(4), Scott R(5).

Author information: 
(1)Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital 
NHS Trust, Birmingham, UK. (2)Section of Neurotrauma and Neurodegeneration,
School of Clinical and Experimental Medicine, University of Birmingham,
Birmingham, UK. (3)Fort Blockhouse, Defence Centre for Imaging, Gosport, UK.
(4)Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham,
UK. (5)1] Department of Ophthalmology, Birmingham and Midland Eye Centre, City
Hospital NHS Trust, Birmingham, UK [2] Royal Centre for Defence Medicine, New
Queen Elizabeth Hospital, Birmingham, UK.

PurposeOcular blast injuries in the military setting are particularly associated 
with significant maxillofacial trauma and/or brain injury. The opportunity to
perform a comprehensive ophthalmic evaluation is frequently limited in the acute 
multiple trauma scenario. We aim to describe the relationship between the
clinical effects of acute ocular and orbital blast trauma with the findings on
computerised tomography (CT).MethodsThis was a retrospective consecutive case
series of all soldiers with facial and/or suspected ocular injuries. A total of
80 eyes that had suffered blast injuries of varying severity were studied.
Assessment of orbital and ocular CT images were performed by military consultant 
radiologists. A comparison was made with actual clinical findings. Statistical
analysis was performed using Fisher's exact test.ResultsNo pathological findings 
were described in 37 of the 80 eyes imaged by orbital and ocular CT scans.
Clinically, these eyes and orbits were all found to be intact, or had minor
trauma. All foreign bodies and penetrating eye injuries were successfully
diagnosed by CT. Absence of an orbital fracture did not rule out a globe injury. 
However, a corneal or scleral defect was less likely when an orbital fracture was
absent.ConclusionThe eye is a delicate structure prone to injury that requires
urgent repair if breached. It is difficult to assess thoroughly in the
unconscious or distressed patient. In this context, CT imaging is invaluable to
be able to make a relatively confident prediction of clinical findings and decide
upon the necessity for acute ophthalmic surgical intervention.Eye advance online 
publication, 27 March 2015; doi:10.1038/eye.2015.39.

PMID: 25853401   [PubMed - as supplied by publisher]

26. Eye (Lond). 2015 Mar 27. doi: 10.1038/eye.2015.35. [Epub ahead of print]

Evaluation of the retinal nerve fibre layer and ganglion cell complex thickness
in pituitary macroadenomas without optic chiasmal compression.

Cennamo G(1), Auriemma RS(2), Cardone D(1), Grasso LF(3), Velotti N(1), Simeoli
C(3), Di Somma C(3), Pivonello R(3), Colao A(3), de Crecchio G(1).

Author information: 
(1)Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche,
University of Naples'Federico II', Naples, Italy. (2)Coleman-Ios Medicina Futura 
Medical Center, Naples, Italy. (3)Dipartimento di Medicina Clinica e Chirurgia,
Sezione di Endocrinologia, University of Naples'Federico II', Naples, Italy.

PurposeThe aim of this prospective study was to measure the thickness of the
circumpapillary retinal nerve fibre layer (cpRNFL) and the ganglion cell complex 
(GCC) using spectral domain optical coherence tomography (SD-OCT) in a cohort of 
consecutive de novo patients with pituitary macroadenomas without chiasmal
compression.Patients and methodsTwenty-two consecutive patients with pituitary
macroadenoma without chiasmal compression (16 men, 6 women, aged 45.2±14.6 years,
43 eyes) entered the study between September 2011 and June 2013. Among them,
31.8% harboured a growth hormone-secreting pituitary adenoma, 27.3% a
prolactin-secreting pituitary adenoma, 27.3% a corticotrophin-secreting pituitary
adenoma, and 13.6% a non-secreting pituitary tumour. Eighteen subjects (nine
females, nine males, mean age 36.47±6.37 years; 33 eyes) without pituitary
adenoma, with normal ophthalmic examination, served as controls. In both patients
and controls, cpRNFL and GCC thicknesses were measured by SD-OCT.ResultsPatients 
were significantly older (P=0.02) than controls. Best corrected visual acuity,
intraocular pressure, colour fundus photography, and automatic perimetry test
were within the normal range in patients and controls. Conversely, cpRNFL
(P=0.009) and GCC (P<0.0001) were significantly thinner in patients than in
controls. The average GCC (r=0.306, P=0.046) significantly correlated with the
presence of arterial hypertension. OCT parameters did not differ significantly
between patients with a tumour volume above the median and those with a tumour
volume below the median.ConclusionPituitary macroadenomas, even in the absence of
chiasmal compression, may induce GCC and retinal nerve fibre layer thinning.
SD-OCT may have a role in the early diagnosis and management of patients with
pituitary tumours.Eye advance online publication, 27 March 2015;

PMID: 25853400   [PubMed - as supplied by publisher]

27. Eye (Lond). 2015 Mar 27. doi: 10.1038/eye.2015.28. [Epub ahead of print]

Storage stability of bevacizumab in polycarbonate and polypropylene syringes.

Khalili H(1), Sharma G(1), Froome A(2), Khaw PT(3), Brocchini S(1).

Author information: 
(1)1] NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute 
of Ophthalmology, London, UK [2] UCL School of Pharmacy, London, UK.
(2)Moorfields Pharmaceuticals, Moorfields Eye Hospital, London, UK. (3)NIHR
Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of
Ophthalmology, London, UK.

PurposeTo compare and examine the storage stability of compounded bevacizumab in 
polycarbonate (PC) and polypropylene (PP) syringes over a 6-month period. PC
syringes have been used in a recent clinical study and bevacizumab stability has 
not been reported for this type of syringe.MethodsRepackaged bevacizumab was
obtained from Moorfields Pharmaceuticals in PC and PP syringes. Bevacizumab from 
the stored syringes was analysed at monthly time points for a 6-month period and 
compared with bevacizumab from a freshly opened vial at each time point. SDS-PAGE
electrophoresis and size-exclusion chromatography (SEC) was used to observe
aggregation and degradation. Dynamic light scattering (DLS) provided information 
about the hydrodynamic size and particle size distribution of bevacizumab in
solution. VEGF binding and the active concentration of bevacizumab was determined
by surface plasmon resonance (SPR) using Biacore.ResultsSDS-PAGE and SEC analysis
did not show any changes in the presence of higher molecular weight species
(HMWS) or degradation products in PC and PP syringes from T0 to T6 compared with 
bevacizumab sampled from a freshly opened vial. The hydrodynamic diameter of
bevacizumab in the PC syringe after 6 months of storage was not significantly
different to bevacizumab taken from a freshly opened vial. Using SPR, the VEGF
binding activity of bevacizumab in the PC syringe was comparable to bevacizumab
taken from a freshly opened vial.ConclusionNo significant difference over a
6-month period was observed in the quality of bevacizumab repackaged into
prefilled polycarbonate and polypropylene syringes when compared with bevacizumab
that is supplied from the vial.Eye advance online publication, 27 March 2015;

PMID: 25853399   [PubMed - as supplied by publisher]

28. Eye (Lond). 2015 Mar 27. doi: 10.1038/eye.2015.41. [Epub ahead of print]

Where is the junction of zone 2 and zone 3 temporal retina in RetCam images of
acute retinopathy of prematurity?

Fleck BW(1).

Author information: 
(1)Department of Ophthalmology, Princess Alexandra Eye Pavilion, Chalmers Street,
Edinburgh EH3 9HA, UK.

PMID: 25853398   [PubMed - as supplied by publisher]

29. Eye (Lond). 2015 Mar 27. doi: 10.1038/eye.2015.42. [Epub ahead of print]

Vitiligo iridis and glaucoma: a rare sequelae of small pox.

Kavitha S(1), Patel SR(1), Mohini P(1), Venkatesh R(1), Sengupta S(1).

Author information: 
(1)Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry,

PurposeVitiligo iridis refers to focal areas of iris atrophy as sequelae of small
pox infection. We report a series of patients with unilateral vitiligo iridis,
some of whom presented with secondary open-angle glaucoma.MethodsThree patients
with vitiligo iridis underwent a comprehensive ophthalmic examination including
intraocular pressure (IOP) measurement, slit lamp biomicroscopy, gonioscopy, and 
fundus evaluation. Patients' facial features were also documented and
photographed.ResultsAll patients were in their sixth decade. Two out the three
had elevated IOP (52 mm Hg and 36 mm Hg) in the same eye as vitiligo iridis, at
initial presentation. Gonioscopy showed patchy iris hyperpigmentation and fundus 
evaluation showed glaucomatous optic disc changes in the involved eye. One
patient responded favourably to topical antiglaucoma medications, whereas the
other was taken up for combined phacoemulsification-trabeculectomy with good
results. The third patient had normal IOP in the involved eye. All three patients
gave a history of small pox in childhood and had pitted facial scars typical of
previous small pox infection.ConclusionsVitiligo iridis may be associated with
the secondary glaucoma as a long-term sequelae of small pox. It may be prudent to
periodically follow-up such patients for development of raised IOP in the
future.Eye advance online publication, 27 March 2015; doi:10.1038/eye.2015.42.

PMID: 25853397   [PubMed - as supplied by publisher]

30. Eye (Lond). 2015 Mar 27. doi: 10.1038/eye.2015.34. [Epub ahead of print]

Evaluation of choroidal thickness using enhanced depth imaging by spectral-domain
optical coherence tomography in patients with pseudoexfoliation syndrome.

Eroglu FC(1), Asena L(2), Simsek C(2), Kal A(1), Yılmaz G(2).

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

PurposeTo investigate the choroidal thickness using optical coherence tomography 
in the eyes of patients with unilateral and bilateral pseudoexfoliation syndrome 
and to compare them with healthy controls.MethodsWe studied four groups: (1)
affected eyes from 30 patients with unilateral PEX syndrome affecting the right
eye of 17 patients and the left eye of 13 patients; (2) clinically unaffected
eyes of 30 patients with unilateral PEX syndrome; (3) the eyes of 30 patients
with bilateral PEX syndrome; and (4) the eyes of 30 normal healthy subjects.
Choroidal thickness was evaluated using high-speed, high-resolution enhanced
depth imaging by spectral-domain optical coherence tomography. Optical coherence 
tomography features were compared in all groups using the statistical package
SPSS v 15.0.ResultsThe mean subfoveal choroidal thicknesses were 237.35±58.01 μm 
in group 1; 330.75±47.84 μm in group 2; 206.3±86.75 μm in group 3; and
311.8±51.42 μm in group 4. Significant differences in the mean subfoveal
choroidal thickness were found between groups 1 and 2 (P<0.001), groups 1 and 4
(P=0.004), groups 2 and 3 (P<0.001), and groups 3 and 4 (P<0.001).ConclusionIn
this study, it was observed that clinically affected eyes of patients with PEX
syndrome have significantly thinner choroids compared with the clinically
unaffected eyes of patients with unilateral PEX syndrome and eyes of healthy
controls.Eye advance online publication, 27 March 2015; doi:10.1038/eye.2015.34.

PMID: 25853396   [PubMed - as supplied by publisher]