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
Graefes Arch Clin Exp Ophthalmol[JOUR] Established 1995
1. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 28. [Epub ahead of print]

Causes that influence the detachment rate after Descemet membrane endothelial

Röck T(1), Bramkamp M, Bartz-Schmidt KU, Röck D, Yörük E.

Author information: 
(1)Centre for Ophthalmology, University of Tübingen, Tübingen, Germany,

PURPOSE: To investigate Descemet graft (DG) detachment rate after Descemet
membrane endothelial keratoplasty (DMEK) in relation to DG position.
METHODS: A total of 175 consecutive pseudophakic eyes that underwent DMEK (175
eyes for Fuchs endothelial dystrophy) from September 2009 through February 2014
at the Tübingen Eye Hospital DG position were studied retrospectively by surgical
video at the end of an operation. A group of 45 eyes showed a decentration of the
DG with a stromal gap of ≥1.5 mm over at least 3 clock hours between the
descematorhexis edge and the DG. DG detachment was documented at a mean follow-up
of 13.9 ± 3.7 months after surgery. DG detachment was defined as a detachment of 
20 % or more of the DG surface area. Various donor characteristics and patient
characteristics were analyzed.
RESULTS: The best spectacle-corrected visual acuity (BCVA) in the group of eyes
with central well-positioned DG differed significantly from those of eyes with
decentered DG. The preoperative BCVA in the central well-positioned DG group was 
0.63 ± 0.40 logMAR, and in the decentered DG group 0.91 ± 0.51 logMAR
(P < 0.001). The postoperative BCVA in the group of eyes with central
well-positioned DG was 0.12 ± 0.11 logMAR, and in the group with decentered DG
0.23 ± 0.29 logMAR (P < 0.001). Endothelial cell density and patient
characteristics such as age, gender, and intraocular pressure did not differ
significantly between the two groups. The group of eyes with central
well-positioned DG showed DG detachment in 12 %; the group with decentered DG
findings had DG detachment in 87 % (P < 0.001) at the 12 month follow up.
CONCLUSION: The present findings demonstrate the importance of central
well-positioned DG and the relation of disease severity. Central well-positioned 
DG may reduce the incidence of DG detachment. Overlapping of the donor DG and the
host Descemet membrane seems to be responsible for DG detachment. One possible
way to enhance graft adhesion could be a larger descematorhexis, which avoids an 
overlapping. The second possible way could be not waiting too long for surgery to
reduce disease severity.

PMID: 26216795   [PubMed - as supplied by publisher]

2. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 24. [Epub ahead of print]

Trabeculectomy ab interno with the Trabectome® as a therapeutic option for
uveitic secondary glaucoma.

Anton A(1), Heinzelmann S, Neß T, Lübke J, Neuburger M, Jordan JF, Wecker T.

Author information: 
(1)Eye Center, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany,

PURPOSE: Treatment of secondary glaucoma in uveitis patients is challenging.
Owing to the young age of these patients, sufficient lowering of the intraocular 
pressure (IOP) is essential to prevent progression of visual field loss. However,
because of the chronic inflammatory stimulus, filtration surgery has an increased
risk of failure, especially in patients who have previously undergone surgery.
Therefore, minimally invasive glaucoma surgery is a valuable alternative.
METHODS: The clinical records of 24 consecutive patients with uveitic secondary
glaucoma who underwent trabeculectomy ab interno with the Trabectome® at the Eye 
Center of the Albert-Ludwigs University of Freiburg between June 2009 and June
2014 (registered in the Freiburg trabectome database) were retrospectively
analyzed. The general baseline information for each patient included age, gender,
glaucoma type, ocular medication and current IOP. The postoperative IOP and
number of antiglaucomatous medications were recorded at each visit. Statistical
analyses were performed using the Kaplan-Meier estimator and Dunnett's t-test.
RESULTS: The mean IOP before surgery was 31 ± 6.7 mmHg (median 32 mmHg). Both the
IOP and the number of medications significantly decreased over the various
follow-up intervals after trabeculectomy ab interno with the Trabectome®.
Patients with follow-ups continuing past one year showed an IOP-reduction of
approximately 40 % and a medication number reduction from 2 to 0.67. The failure 
rate (necessitating further glaucoma surgery) was N = 3 (12.5 %) patients.
CONCLUSIONS: Trabeculectomy ab interno with the Trabectome® is a minimally
invasive and effective method for controlling IOP in uveitic secondary glaucoma.

PMID: 26205735   [PubMed - as supplied by publisher]

3. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 23. [Epub ahead of print]

Retinal histopathology in eyes from patients with autosomal dominant retinitis
pigmentosa caused by rhodopsin mutations.

Bonilha VL(1), Rayborn ME, Bell BA, Marino MJ, Beight CD, Pauer GJ, Traboulsi EI,
Hollyfield JG, Hagstrom SA.

Author information: 
(1)Cole Eye Institute, Cleveland Clinic, Ophthalmic Research - i31, 9500 Euclid
Avenue, Cleveland, OH, 44195, USA,

PURPOSE: To evaluate the histopathology in donor eyes from patients with
autosomal dominant retinitis pigmentosa (ADRP) caused by p.P23H, p.P347T and
p.P347L rhodopsin ( RHO ) gene mutations.
METHODS: Eyes from a 72-year-old male (donor 1), an 83-year-old female (donor 2),
an 80-year-old female (donor 3), and three age-similar normal eyes were examined 
macroscopically, by scanning laser ophthalmoscopy and optical coherence
tomography imaging. Perifoveal and peripheral pieces were processed for
microscopy and immunocytochemistry with markers for photoreceptor cells.
RESULTS: DNA analysis revealed RHO mutations c.68C>A (p.P23H) in donor 1,
c.1040C>T (p.P347L) in donor 2 and c.1039C>A (p.P347T) in donor 3. Histology of
the ADRP eyes showed retinas with little evidence of stratified nuclear layers in
the periphery and a prominent inner nuclear layer present in the perifoveal
region in the p.P23H and p.P347T eyes, while it was severely atrophic in the
p.P347L eye. The p.P23H and p.P347T mutations cause a profound loss of rods in
both the periphery and perifovea, while the p.P347L mutation displays near
complete absence of rods in both regions. All three rhodopsin mutations caused a 
profound loss of cones in the periphery. The p.P23H and p.P347T mutations led to 
the presence of highly disorganized cones in the perifovea. However, the p.P347L 
mutation led to near complete absence of cones also in the perifovea.
CONCLUSIONS: Our results support clinical findings indicating that mutations
affecting residue P347 develop more severe phenotypes than those affecting P23.
Furthermore, our results indicate a more severe phenotype in the p.P347L retina
as compared to the p.P347T retina.

PMID: 26202387   [PubMed - as supplied by publisher]

4. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 22. [Epub ahead of print]

Science and art in retinopathy of prematurity diagnosis.

Chiang MF(1), Chan RV, Vinekar A, Woo R.

Author information: 
(1)Departments of Ophthalmology and Medical Informatics & Clinical Epidemiology, 
Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger
Boulevard, Portland, OR, 97239, USA,

PMID: 26198712   [PubMed - as supplied by publisher]

5. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 21. [Epub ahead of print]

Experts contradict established classification.

Shapiro MJ(1), Blair MP, Garcia-Gonzalez JM.

Author information: 
(1)Retina Consultants, Ltd, 2454 E. Dempster St., Suite 400, Des Plaines,
Illinois, 60016, USA,

PMID: 26194405   [PubMed - as supplied by publisher]

6. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 21. [Epub ahead of print]

Surgical feasibility and biocompatibility of wide-field dual-array
suprachoroidal-transretinal stimulation prosthesis in middle-sized animals.

Lohmann TK(1), Kanda H, Morimoto T, Endo T, Miyoshi T, Nishida K, Kamei M, Walter
P, Fujikado T.

Author information: 
(1)Department of Applied Visual Science, Osaka University Graduate School of
Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.

PURPOSE: To investigate the safety and efficacy of a newly-developed wide-field
dual-array suprachoroidal-transretinal stimulation (STS) prosthesis in
middle-sized animals.
METHODS: The prosthesis consisted of two arrays with 50 to 74 electrodes. To test
the feasibility of implanting the prosthesis and its efficacy, the prosthesis was
implanted for 14 days into two rabbits. Optical coherence tomography (OCT) and
ophthalmoscopy were performed 7 and 14 days after the implantation. Then the
rabbits were euthanized, eyes were enucleated, and the posterior segment of the
eye was examined histologically. In a second experiment, the arrays were
implanted into two cats, and their ability to elicit neural responses was
determined by electrically evoked potentials (EEPs) at the chiasm and by optical 
imaging of the retina.
RESULTS: All arrays were successfully implanted, and no major complications
occurred during the surgery or during the 2-week postoperative period. Neither
OCT nor ophthalmoscopy showed any major complications or instability of the
arrays. Histological evaluations showed only mild cellular infiltration and
overall good retinal preservation. Stimulation of the retina by the arrays evoked
EEPs recorded from the chiasm. Retinal imaging showed that the electrical pulses 
from the arrays altered the retinal images indicating an activation of retinal
neurons. The thresholds were as low as 100 μA for a chiasm response and 300 μA
for the retinal imaging.
CONCLUSION: Implantation of a newly-developed dual-array STS prosthesis for
2 weeks in rabbits was feasible surgically, and safe. The results of retinal
imaging showed that the dual-array system was able to activate retinal neurons.
We conclude that the dual-array design can be implanted without complication and 
is able to activate retinal neurons and optic nerve axons.

PMID: 26194404   [PubMed - as supplied by publisher]

7. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 15. [Epub ahead of print]

Intra-session repeatability of iridocorneal angle measurements provided by a
Scheimpflug photography-based system in healthy eyes.

Ruiz-Belda C(1), Piñero DP, Ruiz-Fortes P, Soto-Negro R, Moya M, Pérez-Cambrodí
RJ, Artola A.

Author information: 
(1)Department of Ophthalmology (OFTALMAR), Vithas Medimar International Hospital,
C/Padre Arrupe, 20, 1st floor, 03016, Alicante, Spain.

PURPOSE: The purpose of this study was to evaluate intra-session repeatability of
measurements of the iridocorneal angle at different meridians in the nasal and
temporal areas in healthy eyes using the Sirius Scheimpflug photography-based
system in glaucoma analysis mode.
METHODS: A total of 43 eyes of 43 patients ranging in age from 36 to 79 years
were enrolled in the study. All eyes received a comprehensive ophthalmologic
examination including a complete anterior segment analysis with the Costruzione
Strumenti Oftalmici [CSO] Sirius system. Three consecutive measurements of nasal 
and temporal angles at 0°, ±10°, ±20°, and ±30° meridians were obtained in order 
to assess the intra-session repeatability of iridocorneal angle measurements
provided by the device using the glaucoma analysis mode. Within-subject standard 
deviation (Sw), coefficient of variation (CV), and intraclass correlation
coefficient (ICC) values were calculated.
RESULTS: The mean Sw was 1.07 ± 1.09°, 1.22 ± 1.53°, 0.66 ± 0.51°, 0.86 ± 0.57°, 
0.68 ± 0.65°, 0.84 ± 0.68°, and 0.91 ± 0.70° at the temporal 30°, 20°, 10°, 0°,
-10°, -20°, and -30° positions, respectively. Mean Sw was 3.13 ± 3.15°,
3.43 ± 3.63°, 2.75 ± 2.29°, 2.19 ± 1.55°, 1.90 ± 1.49°, 2.14 ± 1.74°, and
2.24 ± 2.06° at the temporal -30°, -20°, -10°, 0°, 10°, 20°, and 30° positions,
respectively. Mean CV ranged from 1.36 ± 1.05 % (nasal 0° position) to
10.92 ± 13.95 % (nasal -20° position). ICC values ranged from 0.778 to 0.972.
CONCLUSIONS: The glaucoma analysis mode of the Sirius system provides consistent 
measurements of the iridocorneal angle at different meridians in healthy eyes,
with slightly less consistency for nasal measurements. It may be considered a
clinically useful non-invasive technique for the detection of potentially
occludable angles.

PMID: 26174969   [PubMed - as supplied by publisher]

8. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 14. [Epub ahead of print]

The pattern of early corneal endothelial cell recovery following cataract
surgery: cellular migration or enlargement?

Kim DH(1), Wee WR, Hyon JY.

Author information: 
(1)Department of Ophthalmology, Gil Medical Center, Gachon University, Incheon,

PURPOSE: To evaluate whether cellular migration or enlargement is the main
mechanism of initial endothelial cell recovery following cataract surgery.
METHODS: A prospective observational study, of 24 patients aged 50-80 years who
were diagnosed with moderate cataract and received uncomplicated cataract surgery
with a 2.75 mm temporal clear corneal incision, was performed in Seoul National
University Bundang Hospital. Endothelial cell density (ECD) and area (ECA) were
obtained in central and four paracentral (superior, inferior, nasal, and
temporal) areas using non-contact specular microscopy. ECD, ECA, ECD% (ECD% = ECD
in each area/the sum total of ECD in five areas), and the coefficient of
variation of ECA (CV) in each location were investigated pre- and 1 day, 1 week, 
and 4 weeks postoperatively.
RESULTS: ECD significantly decreased 1 day, 1 week, and 4 weeks postoperatively
(p = 0.010, 0.015, and 0.003 respectively), and ECA increased (p = 0.008, 0.013, 
and 0.002 respectively) in only the temporal area. Postoperative ECD% decreased, 
and CV increased in only the temporal area significantly, when compared to
preoperative values. There were no significant postoperative changes of ECD, ECA,
ECD%, and CV in other areas.
CONCLUSIONS: Postoperative changes of ECD, ECA, ECD%, and CV were limited to the 
temporal area adjacent to the primary corneal incision. Cellular enlargement,
rather than migration, may have the major effect on early endothelial cell
recovery after cataract surgery.

PMID: 26170045   [PubMed - as supplied by publisher]

9. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 10. [Epub ahead of print]

Venting incisions in DSAEK: implications for astigmatism, aberrations, visual
acuity, and graft detachment.

Hovlykke M(1), Ivarsen A, Hjortdal J.

Author information: 
(1)Department of Ophthalmology, Aarhus University Hospital, Noerrebrogade 44,
10th Building, 2nd floor, DK - 8000, Aarhus C, Denmark,

PURPOSE: To evaluate the impact of venting incisions on the best corrected visual
acuity (BCVA), astigmatism, aberrations, and risk of graft detachment in Descemet
stripping automated keratoplasty (DSAEK).
METHODS: This was a retrospective, comparative, consecutive case series of DSAEK 
procedures performed with (n = 266) and without (n = 110) venting incisions.
Patients were treated with DSAEK for Fuchs' endothelial dystrophy at Aarhus
University Hospital between 2011 and 2013. Data included preoperative keratometry
and postoperative BCVA, subjective astigmatism, and Pentacam® HR tomography with 
corneal front surface (CFS) aberrations at 1 to 2 years of follow-up. Numbers of 
triple procedures (concurrent cataract surgery) and post-operative graft
detachments were also noted. The venting and non-venting groups were compared by 
the data-means. Unpaired t-tests and Mann-Whitney tests were used for normally
and non-normally distributed data, respectively. Differences in graft detachments
were analyzed with Fisher's exact and Chi square test.
RESULTS: There was no significant difference in any parameter, except the numbers
of triple procedures. BCVA (logMAR) was 0.25 ± 0.18 in the venting group and 0.25
± 0.19 in the non-venting group (p = 0.92), subjective astigmatism was -1.53 ±
0.99 diopters and -1.33 ± 0.78 diopters (p = 0.15), respectively. CFS astigmatism
and higher order aberrations were statistically uniform. The relative risk (RR)
of graft detachment was also uniform between the venting versus non-venting group
(RR 0.72, p = 0.40), and between triple versus non-triple procedures (RR 0.71,
p = 0.43). The preoperative corneal curvature had no impact on the risk of graft 
detachment (p = 0.74).
CONCLUSION: Venting incisions in DSAEK do not significantly alter BCVA,
astigmatism, CFS aberrations or reduce the risk of graft detachment in triple or 
non-triple procedures.

PMID: 26156682   [PubMed - as supplied by publisher]

10. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 10. [Epub ahead of print]

Aesthetic assessment in periciliary "v-incision" versus conventional external
dacryocystorhinostomy in Asians.

Ng DS(1), Chan E, Yu DK, Ko ST.

Author information: 
(1)Department of Ophthalmology, Tung Wah Eastern Hospital, 19 Eastern Hospital
Road, Causeway Bay, Hong Kong, Hong Kong.

PURPOSE: To determine the functional and aesthetic outcomes of periciliary
"v-incision" external dacryocystorhinostomy (DCR) and to compare with
conventional approach.
METHOD: Charts review of consecutive cases of "v-incision" (VDCR) or conventional
DCR performed in a single institute, between January 2007 and March 2014. All
procedures were performed or supervised by a single surgeon. Two periciliary
incisions were made near the skin-mucosal junction at the upper and lower eyelid 
margins medial to the punctum joining at the medial canthal angle to form a "v"
shape. Subcutaneous dissection was carried out inferomedially to reach the
anterior lacrimal crest. DCR was then performed in the usual manner. Functional
success was defined as no persistent or recurrent epiphora and patency on
irrigation of the lacrimal drainage system at least 6 months post-surgery. A
cross-sectional aesthetic survey was conducted by asking the patients to rate
their scar appearance satisfaction on a visual analogue scale (VAS). External
photographs were graded by two independent, masked physicians using VAS as well
as the Stony Brook scar evaluation scale (SBSES).
RESULTS: Sixty-one patients with median age of 64 years met the inclusion
criteria, with median follow-up duration of 28 months. Thirty-eight eyes
underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR
was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for
conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without
statistically significant difference (p = 0.38). VDCR patients rated higher
aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On
the SBSES, both observers gave higher aesthetic scores to the VDCR group
(observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p < 0.01) than conventional DCR
(observer #1 3.1 ± 2.8 and #2 2.8 ± 2.1, p < 0.01). More patients reported that
they could wear spectacles within 1 week post-VDCR (44.7 vs 4.3 %, p < 0.01).
CONCLUSION: "V-incision" external DCR has a similar functional success rate to
that of the conventional approach and has superior aesthetic outcomes as reported
by surgeons and patients. However, a higher proportion of trainees under
supervision performed conventional DCR, and it is uncertain whether the outcomes 
were also influenced by the level of surgeon's expertise.

PMID: 26156681   [PubMed - as supplied by publisher]

11. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 10. [Epub ahead of print]

One year outcome of hemi-Descemet membrane endothelial keratoplasty.

Lam FC(1), Baydoun L, Satué M, Dirisamer M, Ham L, Melles GR.

Author information: 
(1)Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The

PURPOSE: To evaluate the 1-year clinical outcome after semi-circular Descemet
membrane endothelial keratoplasty (hemi-DMEK) in a first case series.
METHODS: In three eyes of three patients with Fuchs endothelial dystrophy, best
corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and
intra- and postoperative complications were evaluated after transplantation of a 
semi-circular ~12 mm diameter Descemet graft (hemi-DMEK graft).
RESULTS: All corneas cleared within 6 months and showed a stable pachymetry
thereafter (527, 535, and 490 μm, respectively). Compared to preoperative
measurements, average central ECDs dropped by 51 % (56, 39, and 59 %,
respectively) at 3 months, 53 % (57, 38, and 63 %, respectively) at 6 months, and
59 % (60, 47, and 71 %, respectively) at 12 months. Denuded stromal areas
adjacent to the hemi-DMEK graft cleared and at 12 months peripheral ECD counts
ranged from 724 to 1051 cells/mm(2). At 12 months, BCVA was 20/22 (0.9), 20/40
(0.5, amblyopic eye) and 20/17 (1.2). No postoperative complications occurred
throughout the study period.
CONCLUSIONS: Hemi-DMEK may provide visual outcomes similar to those in standard
DMEK at the 1-year postoperative mark. If also graft survival and complication
rates prove to be similar, hemi-DMEK could become the next step in endothelial
keratoplasty, owing to its potential to double the yield of transplants from the 
same donor pool (two hemi-DMEK grafts can be prepared from one donor cornea).

PMID: 26156680   [PubMed - as supplied by publisher]

12. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 7. [Epub ahead of print]

Anti-VEGF therapy in symptomatic peripheral exudative hemorrhagic
chorioretinopathy (PEHCR) involving the macula.

Seibel I(1), Hager A, Duncker T, Riechardt AI, Nürnberg D, Klein JP, Rehak M,
Joussen AM.

Author information: 
(1)Department of Ophthalmology, Charité Universitätsmedizin Berlin, Campus
Benjamin Franklin, Berlin, Germany,

INTRODUCTION: The purpose of this study was to describe the anatomical and
functional outcome of vascular endothelial growth factor inhibitor (anti-VEGF)
treatment in symptomatic peripheral exudative hemorrhagic chorioretinopathy
(PEHCR) involving the macula.
METHODS: Clinical records from patients seen between 2012 and 2013 at a single
academic center were reviewed to identify PEHCR patients receiving anti-VEGF
therapy due to disease-associated changes involving the macula. Affected eyes
were either treated with consecutive intravitreal injections of anti-VEGF or
vitrectomy combined with anti-VEGF followed by pro re nata injections.
RESULTS: The mean age of the patients was 76 years (range 70-89 years). In all
nine eyes, visual acuity was reduced due to central subretinal fluid. On average,
three anti-VEGF injections (range 2-5 injections) were required initially to
achieve complete resolution of macular subretinal fluid. In three eyes,
subretinal fluid reappeared after an average of 10 months (range 5-16 months),
and an average of 2.5 anti-VEGF injections (range 2-3 injections) were necessary 
to attain complete resolution of macular subretinal fluid a second time. Median
visual acuity at the visit before the first injection was 1.0 logMAR (range
2.1-0.4 logMAR) and increased to 0.8 logMAR (range 2-0.1 logMAR) at the last
CONCLUSION: Results of this study show that for cases in which PEHCR becomes
symptomatic due to macular involvement, anti-VEGF treatment may have drying
potential. Although vision was improved in some patients, it remained limited in 
cases with long-term macular involvement, precluding any definitive functional
conclusion. However, we believe that the use of anti-VEGF agents should be
recommended in PEHCR that threatens the macula. Due to its often self-limiting
course, peripheral lesions should be closely observed. Larger studies are needed 
in order to provide clear evidence of the efficacy of anti-VEGF therapy in PEHCR.

PMID: 26148802   [PubMed - as supplied by publisher]

13. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 7. [Epub ahead of print]

Abundance of infiltrating CD163+ cells in the retina of postmortem eyes with dry 
and neovascular age-related macular degeneration.

Lad EM(1), Cousins SW, Van Arnam JS, Proia AD.

Author information: 
(1)Department of Ophthalmology, Duke University Medical Center, DUMC 3802,
Durham, NC, 27710, USA,

PURPOSE: Prior research in animal models has suggested that retinal macrophages
play an important role in age-related macular degeneration (AMD), but studies
have insufficiently characterized the distribution of retinal macrophages in
various stages of human AMD.
METHODS: In this case series, we analyzed H&E, periodic acid-Schiff, and CD163
and CD68 immunostained slides from 56 formaldehyde-fixed, paraffin-embedded
autopsy eyes of patients over age 75: 11 age-matched, normal eyes, and 45 AMD
RESULTS: Qualitative analysis of the macula and retinal periphery revealed that
all eyes contained a significant number of CD163+ cells but a negligible number
of CD68+ cells. In normal eyes and eyes with thin or infrequent basal laminar
deposits, CD163+ cells were restricted to the inner retina. In contrast, in AMD
eyes with thick basal deposits, choroidal neovascular membranes, and geographic
atrophy, qualitatively there was a marked increase in the number and size of the 
CD163+ cells in the outer retina, sub-retinal, and sub-retinal pigment epithelium
space in the macula.
CONCLUSIONS: The changes in number and localization of retinal CD163+ cells in
eyes with intermediate-severe AMD support a key role for macrophages in the
pathogenesis and progression of the disease. A larger, quantitative study
evaluating the distribution of macrophage subpopulations in postmortem AMD eyes
is warranted.

PMID: 26148801   [PubMed - as supplied by publisher]

14. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 5. [Epub ahead of print]

Inhibition of p38 mitogen-activated protein kinase phosphorylation decreases H2O 
2-induced apoptosis in human lens epithelial cells.

Bai J(1), Zheng Y, Dong L, Cai X, Wang G, Liu P.

Author information: 
(1)Eye Hospital, First Affiliated Hospital, Harbin Medical University, 23
Youzheng Road, Harbin, People's Republic of China.

BACKGROUND: Oxidative damage resulting from ROS is a known causal factor for
cataractogenesis. The mitogen-activated protein kinases (MAPK) pathway plays an
important role in the apoptosis of HLE cells. The purpose of this study was to
investigate the role of phosphorylated p38 mitogen-activated protein kinase in
H2O2-induced apoptosis in cultured human lens epithelial (HLE) cells.
METHODS: The effect of SB203580 on HLE cells treated with H2O2 was determined by 
various assays. Cell viability was monitored by the MTT assay. The rates of
apoptosis and ROS generation were determined by flow cytometric analysis. The
numbers of mitotic and apoptotic cell nuclei were determined after staining with 
Hoechst 33342. The protein level of phospho-p38 was measured using western blot
RESULTS: SB203580 reduced H2O2-induced cellular apoptosis and inhibited the
generation of reactive oxygen species (ROS); it also delayed the progression of
H2O2-induced opacification of lenses. The level of p-p38 was increased when cells
were exposed to H2O2 and significantly SB203580-inhibited phosphorylation of p38.
The p38MAPK pathway plays an important role in H2O2-induced apoptosis of HLE
CONCLUSIONS: The study demonstrates that activation of p38MAPK plays an important
role in H2O2-induced apoptosis of HLE cells. SB203580 may potentially be
exploited as a useful tool for cataract prevention.

PMID: 26143291   [PubMed - as supplied by publisher]

15. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 5. [Epub ahead of print]

Pediatric open-globe injuries: clinical characteristics and factors associated
with poor visual and anatomical success.

Sul S(1), Gurelik G, Korkmaz S, Ozdek S, Hasanreisoglu B.

Author information: 
(1)Department of Ophthalmology, Muğla Sıtkı Koçman University School of Medicine,
Muğla, Turkey,

PURPOSE: We determine the clinical characteristics, visual and anatomical
outcomes, and factors associated with poor visual outcome and anatomical success 
in pediatric open-globe injuries (OGI).
METHODS: The records of patients aged 17 years and younger who had undergone
surgical intervention after OGI between January 2000 and June 2010 were reviewed 
RESULTS: In total, 182 patients were enrolled in the study (70.9 % males, 29.1 % 
females; mean age: 8.6 ± 4.5 years [range 1-17 years]). Injuries occurred mostly 
at home (45.1 %). Objects most often causing the ocular trauma were sharp objects
(74.1 %). Over one-third of the eyes (39.7 %) had final visual acuities of 20/200
or better. Anatomical success was achieved in 76.9 % of eyes. Time between
primary globe repair and secondary surgical intervention was 61.4 ± 144 days.
Visual outcomes were poor in eyes with initial visual acuity less than for
counting fingers, retinal detachment, proliferative vitreoretinopathy, and
endophthalmitis. Anatomical success rates were low with retinal detachment.
CONCLUSION: Visual outcomes seem to be poor in more than half of the patients
despite advanced microsurgical techniques.

PMID: 26143290   [PubMed - as supplied by publisher]

16. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 4. [Epub ahead of print]

Erratum to: Next generation sequencing uncovers a missense mutation in COL4A1 as 
the cause of familial retinal arteriolar tortuosity.

Zenteno JC(1), Crespí J, Buentello-Volante B, Buil JA, Bassaganyas F,
Vela-Segarra JI, Diaz-Cascajosa J, Marieges MT.

Author information: 
(1)Genetics Department and Research Unit, Institute of Ophthalmology "Conde de
Valenciana" and Biochemistry Department, Faculty of Medicine, National Autonomous
University of Mexico (UNAM), Chimalpopoca 14, Col. Obrera, Mexico City, CP,
06800, Mexico,

PMID: 26142150   [PubMed - as supplied by publisher]

17. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 3. [Epub ahead of print]

Anti-vascular endothelial growth factor monotherapy for polypoidal choroidal
vasculopathy with polyps resembling grape clusters.

Lee JH(1), Lee WK.

Author information: 
(1)Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine,
The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701,
Republic of Korea.

PURPOSE: The objective of this study was to investigate the 2-year outcomes of
treatment with anti-vascular endothelial growth factor (VEGF) in patients with
polypoidal choroidal vasculopathy (PCV) with polyps resembling grape clusters.
METHODS: Twenty eyes in 20 patients were included. All patients initially
received three consecutive anti-VEGF injections, followed by an as-needed
re-injection schedule. Patients were followed regularly at 1- to 3-month
intervals. The primary outcome was change in best-corrected visual acuity (BCVA).
RESULTS: The mean number of injections administered over the course of 24 months 
was 12.50 ± 2.77 (range, 9-18). The logarithm of the minimum angle of resolution 
(logMAR) BCVA improved from 0.61 ± 0.28 to 0.42 ± 0.27 at 12 months (P = 0.015), 
and 0.44 ± 0.31 at 24 months (P = 0.056). At 24 months, BCVA had improved in 6
(30.0 %) eyes by 0.3 logMAR or more, was stable in 11 (55.0 %) eyes, and had
decreased in 3 (15.0 %) eyes. Complete absorption of fluid was achieved with
anti-VEGF treatment in 18 (90 %) eyes at least once during the 2-year follow-up
period, and 10 (50 %) eyes revealed a dry macula at 24 months. Two eyes (10.0 %) 
received rescue photodynamic therapy because subfoveal fluid persisted despite
six and seven consecutive anti-VEGF injections. Of 18 eyes treated only with
anti-VEGF agents, 3 (16.7 %) revealed partial resolution of the polypoidal
lesions at 24 months.
CONCLUSIONS: A treatment regimen with anti-VEGF effectively improved or
maintained visual acuity over a 24-month period in patients with PCV with
clusters of grape-like polyps, and required frequent injections, comparable to
typical choroidal neovascularization in age-related macular degeneration.

PMID: 26138657   [PubMed - as supplied by publisher]

18. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 2. [Epub ahead of print]

Histopathologic features of a resolving orbital Langerhans cell histiocytosis.

van Zyl T(1), Stagner AM, Jakobiec FA, Yoon MK.

Author information: 
(1)Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard
Medical School, Boston, MA, USA.

PMID: 26134307   [PubMed - as supplied by publisher]

19. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 2. [Epub ahead of print]

Magnetic resonance imaging of bilateral split lateral rectus transposition to the
medial globe.

Chaudhuri Z(1), Demer JL.

Author information: 
(1)Stein Eye Institute, University of California Los Angeles (UCLA), 100 Stein
Plaza, Los Angeles, CA, 90095-7002, USA.

PURPOSE: Medial transposition of the split or intact lateral rectus (LR) muscle
in oculomotor palsy improves extreme exotropia. We studied rectus pulley
positions using high-resolution surface coil MRI before and after LR split with
medial transposition surgery in a patient with bilateral oculomotor and trochlear
nerve palsies.
METHODS: This is a report of a 14-year-old girl with 90Δ exotropia due to
bilateral oculomotor and trochlear nerve palsies following traumatic midbrain
infarction at age 6 years. Surgery comprised longitudinal division of each LR
into a superior and inferior, threading of both halves between the inferior
rectus (IR) and inferior oblique inferiorly, and inferior to the superior oblique
and the superior rectus superiorly, with suturing of each 10 mm posterior to the 
medial rectus (MR) insertion.
RESULTS: Pre-operative MRI of the orbit and extraocular muscles (EOMs) with thin,
2-mm slices revealed bilateral atrophy of all EOMs supplied by the oculomotor and
trochlear nerves. Post-operative MRI at 2 months demonstrated no significant
changes in rectus EOM pulley positions compared with pre-operative values.
CONCLUSIONS: The LR pulley does not change position even after split LR
transposition to the MR insertion, confirming the profound constraint of the
connective tissue pulley system on the LR path.

PMID: 26134306   [PubMed - as supplied by publisher]

20. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 2. [Epub ahead of print]

Macular structural characteristics in children with Down syndrome.

O'Brien S(1), Wang J, Smith HA, Donaldson DL, Haider KM, Roberts GJ, Sprunger DT,
Neely DE, Plager DA.

Author information: 
(1)Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana
University School of Medicine, 1160 W. Michigan St., Indianapolis, IN, 46202,

PURPOSE: This prospective study aimed to investigate macular structural
characteristics in children with Down syndrome compared to those in healthy
METHODS: Two groups of children (aged 6-16 years) were enrolled: children with
Down syndrome (Down syndrome group, N = 17) and age-matched healthy children who 
were full-term at birth (control group, N = 18). Eligible patients had visual
acuity of 20/100 or better and gestational age at birth of ≥ 36 weeks. Fourier
domain optical coherence tomography was used for imaging of the macular retinal
structure, and retinal volume scans centered on the macula were obtained. Central
subfield thickness (CST) and the thickness of the inner and outer retinal layer
regions were analyzed using the instrument's segmentation software. The analysis 
of data is provided for the right eye only, since there was no significant
difference between right and left eyes for either the Down syndrome or control
RESULTS: Children in the Down syndrome group generally had identifiable retinal
structure. The CST for the full retina and inner and outer retinal layers were
all significantly greater in the Down syndrome group than the control group
(independent t test, all p < 0.05). Despite the significantly thicker macula,
only about 29 % (5 of 17) of the right eyes of patients with Down syndrome had
macular thickness outside the normal range. Visual acuity in the Down syndrome
group was not directly correlated with increased CST (t = 1.288, r = 0.326,
p = 0.202).
CONCLUSIONS: On average, CST in the Down syndrome group was greater than that in 
the control group, suggesting abnormal macular development in children with Down 

PMID: 26126584   [PubMed - as supplied by publisher]

21. Graefes Arch Clin Exp Ophthalmol. 2015 Jul 2. [Epub ahead of print]

Visual and structural prognosis of the untreated fellow eyes of unilateral normal
tension glaucoma patients.

Cho HK(1), Suh W, Kee C.

Author information: 
(1)Department of Ophthalmology, Sungmo Eye Hospital, Busan, Republic of Korea.

PURPOSE: To investigate the visual and structural prognosis of untreated initial 
non-glaucomatous fellow eyes of unilateral normal tension glaucoma (NTG)
METHODS: In this retrospective observational cohort study, 50 NTG patients with
unilateral visual field (VF) loss and no VF defect, retinal nerve fiber layer
(RNFL) defect or neuroretinal rim (NRR) notching in the fellow eyes, and those
who had initial non-glaucomatous fellow eyes untreated were included. For the
fellow eyes, the development of VF defect, RNFL defect, and NRR notching was
inspected retrospectively by two observers. Baseline clinical characteristics
including initial intraocular pressure (IOP), central corneal thickness, and
spherical equivalent (SE) were compared between glaucomatous and fellow eyes.
RESULTS: During the mean follow-up period of 8.77 ± 2.92 years, five patients
(10 %) developed RNFL defect and four patients (8 %) developed NRR notching in
the fellow eye. Among six patients (12 %) who had developed either RNFL defect or
NRR notching, only three patients (6 %) developed VF loss in 1.81, 3.09, and
9.27 years respectively. The initial IOP was significantly higher (p = 0.031), SE
was more myopic (p = 0.025), and the occurrence of disc hemorrhage (p = 0.049)
was significantly higher in glaucomatous eyes than that in fellow eyes.
CONCLUSIONS: The incidence of glaucoma development in the fellow eye is rather
low. Therefore, the initial non-glaucomatous fellow eye of the unilateral NTG
patient may be observed without treatment until glaucoma develops.

PMID: 26126583   [PubMed - as supplied by publisher]