Journal Contents

Am Jour Ophthalmol
Br J Ophthalmol
Can J Ophthalmol
J Cat Ref Surg
Cornea
Curr Eye Res
Eur J Ophthalmol
Eye
J Glaucoma
JAMA Ophthalmol
Graefes Ophthalmol
Indian J Ophthalmol
Int Ophthalmol Clin
Invest Ophth Vis Sci
Jpn J Ophthalmol
JPOS
Korean J Ophthal
J Neuroophthalmol
Ophthalmic Epidemiol
Ophthalmic Genet
Ophthal Plast Rec Surg
Ophthalmic Res
Ophthalmologica
Ophthalmology
Retina
Surv Ophthalmol
Ophthalmology Review Journal
Graefes Arch Clin Exp Ophthalmol[JOUR] Established 1995
1. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 26. [Epub ahead of print]

Peripapillary retinal nerve fiber layer thickness in bipolar disorder.

Mehraban A(1), Samimi SM, Entezari M, Seifi MH, Nazari M, Yaseri M.

Author information: 
(1)Psychiatry Research Center, Department of Psychiatry, Imam Hossein Medical
Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

BACKGROUND: To compare peripapillary retinal nerve fiber layer thickness (RNFLT) 
between patients with bipolar disorder and a control group by optical coherence
tomography (OCT).
METHODS: This prospective comparative case series included 60 eyes of 30 patients
with bipolar disorder and 60 eyes of 30 age-matched healthy control subjects.
Using OCT, peripapillary RNFLT of the 4 quadrants and the mean of them was
compared between the two groups. Variables such as age of onset, duration,
smoking, psychosis, mania and depression episodes in the case group and their
relationships with RNFLT were evaluated by OCT.
RESULTS: Mean RNFLT was 99 ± 8 in the case group, significantly less than
the106 ± 8 mμ in the control group (p = 0.001). The inferior, superior, and nasal
quadrants in the case and control groups showed significant difference in RNFLT
(p < 0.001) (p = 0.040) (p = 0.005); however, the temporal quadrant was not
reduced significantly, compared to the control value (p = 0.907). Moreover, the
only variable showing significant relation with RNFLT was duration of bipolar
disorder (p = 0.040).
CONCLUSION: Reduction of peripapilary RNFLT occurs in patients with bipolar
disorder, and is related to the duration of disease. RNFLT can be a beneficial
value for studying neurodegenerative changes over time towards detecting the
severity and duration of disorder.

PMID: 25808660   [PubMed - as supplied by publisher]


2. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 25. [Epub ahead of print]

Applicability of the ISNT and IST rules on retinal nerve fiber layer measurement 
on spectral-domain optical coherence tomography in normal Indian children.

Dave P(1), Jethani J, Shah J.

Author information: 
(1)Dr. T V Patel Eye Institute, Vinoba Bhave Road, Salatwada, Vadodara, India,
390001, paaraj@gmail.com.

BACKGROUND: To determine the applicability of the ISNT
(inferior>superior>nasal>temporal) and IST (inferior>superior>temporal) rules on 
retinal nerve fiber layer (RNFL) measurement on spectral-domain optical coherence
tomography (SD-OCT) in normal children.
METHODS: A prospective, cross-sectional study including consecutive subjects
between the ages of 5-18 years who were born at term (≥37 weeks gestational age) 
and with a normal birth weight (≥2500 g) presenting to the out-patient department
for refractive error examination. RNFL measurement was done on Spectralis SD-OCT.
Exclusion criteria were best-corrected visual acuity less than 20/20, spherical
equivalent (SE) > ± 5 diopter (D), applanation IOP >21 mmHg, cup-to-disc (C/D)
ratio of >0.5, C/D ratio asymmetry of >0.2 between eyes and any retinal or optic 
disc anomaly as determined by mydriatic fundus examination. Subjects with
amblyopia, strabismus, or family history of optic nerve or retinal disease were
excluded. Poor cooperation for SDOCT imaging and lack of consent were other
exclusion criteria.
RESULTS: The ISNT rule on the RNFL was followed only by 30 eyes (23.8 %), while
the IST rule was followed by 66 eyes (52.4 %) (p < 0.001). The superior RNFL was 
thicker than the inferior in 57 eyes (45.2 %) while the temporal RNFL was thicker
than the nasal in 63 eyes (50 %). The age, gender, spherical equivalent, and disc
size did not predict the followability of the ISNT and IST rules (p > 0.05).
CONCLUSIONS: The ISNT and the IST rules for RNFL are not universally followed by 
all normal eyes in children. All deviations should therefore not be considered
pathological.

PMID: 25804995   [PubMed - as supplied by publisher]


3. Graefes Arch Clin Exp Ophthalmol. 2015 Apr;253(4):591-9. doi:
10.1007/s00417-015-2931-4. Epub 2015 Jan 21.

Canaloplasty versus non-penetrating deep sclerectomy - a prospective, randomised 
study of the safety and efficacy of combined cataract and glaucoma surgery;
12-month follow-up.

Rękas M(1), Byszewska A, Petz K, Wierzbowska J, Jünemann A.

Author information: 
(1)Department of Ophthalmology, Military Institute of Medicine, Szaserów 128
STR., 04-141, Warsaw, Poland, rekaspl@gmail.com.

PURPOSE: To compare outcomes of phaco-canaloplasty (PC) and phaco-non-penetrating
deep sclerectomy (PDS) with a viscoelastic compound.
METHODS: This study included 29 eyes after PC and 30 after PDS. Indications were 
uncontrolled primary open-angle glaucoma (POAG) and a cataract. Corrected
distance visual acuity (CDVA), intraocular pressure (IOP), and number of
medications were evaluated. Follow-up examinations were performed on days 1 and
7, and after 1, 3, 6, and 12 months. Complete and qualified success was an IOP ≤ 
18 mmHg.
RESULTS: At the 12-month follow-up, mean IOP decreased in the PC group from
19.0 ±6.9 mmHg to 12.6 ±2.7 mmHg, and in the PDS group, from 19.1 ±5.8 mmHg to
14.3 ±3.5 mmHg (P < 0.05). Both groups preoperatively and at 12 months showed no 
significant differences in IOP (P > 0.05). There was no statistically significant
difference between the number of medications used (P > 0.05). Complete and
qualified success rates for both groups were 79.0 % and 76.9 % (P = 0.701). The
most frequent postoperative PC complication was hyphema (58.0 %); for PDS, bleb
fibrosis was most frequent (26.7 %). No PC patients required postoperative
management. PDS patients required postoperative interventions 58.7 % of the time,
including a 5-fluorouracil (5-FU) injection (58.7 %), suture lysis (48.3 %), and 
needling (27.6 %).
CONCLUSIONS: Both PC and PDS lead to an effective decrease in IOP on a short-term
follow-up basis and demonstrate similar efficacy and safety profiles. PDS
patients required additional procedures including 5-FU injections, suture lysis, 
or needling. PC patients required no additional procedures.

PMID: 25795059   [PubMed - in process]


4. Graefes Arch Clin Exp Ophthalmol. 2015 Apr;253(4):583-9. doi:
10.1007/s00417-014-2895-9. Epub 2015 Jan 21.

Retinal vascular caliber between eyes with asymmetric glaucoma.

De Leon JM(1), Cheung CY, Wong TY, Li X, Hamzah H, Aung T, Su DH.

Author information: 
(1)Singapore Eye Research Institute, Singapore, Singapore.

PURPOSE: To compare differences in retinal arterial and venular caliber (RAC and 
RVC respectively) between fellow eyes with glaucoma of asymmetric severity.
METHODS: We included subjects with bilateral primary glaucoma that had vertical
cup-disc ratios (VCDR) >0.2 between both eyes, or visual field (VF) mean
deviation (MD) >6.0 decibels (dB) between both eyes.
RESULTS: Among 158 subjects, the average RAC in glaucoma eyes was 131.5 ± 17.8 μm
vs 141.6 ± 18.8 μm in fellow eyes with mild disease (p < 0.001). RVCs in glaucoma
eyes were 201.0 ± 21.4 μm vs 211.7 ± 25.3 μm in fellow eyes with mild disease
(p < 0.001). This relationship held in clustered linear regression models
adjusted for age, gender, vascular risk factors, visual acuity, axial length, and
intraocular pressure, with RVCs narrower in eyes with worse disease vs mild
disease. Eyes with worse disease had greater VCDR (0.9 ± 0.1 vs 0.7 ± 0.1,
p < 0.001), and worse VF MD (-18.5 ± 8.6 vs -6.6 ± 5.6, p < 0.001).
CONCLUSION: In glaucoma with asymmetric severity between fellow eyes, retinal
vascular caliber is less in the eye with more severe disease.

PMID: 25795058   [PubMed - in process]


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

Oral Rifampin treatment for longstanding chronic central serous
chorioretinopathy.

Shulman S(1), Goldenberg D, Schwartz R, Habot-Wilner Z, Barak A, Ehrlich N,
Loewenstein A, Goldstein M.

Author information: 
(1)Department of Ophthalmology, Tel-Aviv Medical Center, 6 Weizman Street, Tel
Aviv, 64239, Israel, shulmanshiri@gmail.com.

PURPOSE: To investigate the effect of oral Rifampin in patients with chronic
central serous chorioretinoapthy (CSCR).
METHODS: This was a prospective pilot study of patients with chronic CSCR with
persistent subretinal fluid (SRF) for at least 3 months, who were treated with
oral Rifampin 300 mg twice per day for 3 months and had 6 months of follow-up.
All patients underwent a complete ocular examination and a spectral domain
optical coherence tomography (SD-OCT) scan monthly from baseline until month 4,
and then at month 6. Fluorescein angiography (FA) was performed at baseline and
at the end of the study.
RESULTS: Fourteen eyes of 12 patients were included in the study, nine men and
three women. Mean age was 58.5 years (range 32-80). Mean duration of SRF prior to
study entry was 28.4 months. Forty-two percent of eyes were treated previously
for CSR with thermal laser, PDT, or intravitreal bevacizumab. Mean best corrected
visual acuity (BCVA) at presentation was 20/60 and improved to a mean of 20/50 at
month 3 (P > 0.05). Retinal thickness was reduced by 25.3 %, 21.2 %, and 21 % on 
months 1, 2, 3, respectively (P < 0.05). Mean choroidal thickness at presentation
was 476 μ (SD 188 μ) decreasing to 427 μ (SD 125 μ) after 3 months of treatment
(P > 0.05). SRF was reduced in nine eyes (64 %) and completely resolved in six
eyes (42.8 %) at month 3 following 3 months of treatment, and four out of these
six eyes remained fluid free at month 6. Two patients stopped the treatment after
2 months due to adverse events.
CONCLUSIONS: Oral Rifampin may be a therapeutic option in patients with
longstanding chronic CSCR.

PMID: 25794988   [PubMed - as supplied by publisher]


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

Treatment of stage 3 Coats' disease by endolaser photocoagulation via a two-port 
pars plana nonvitrectomy approach.

Cai X(1), Zhao P, Zhang Q, Jin H.

Author information: 
(1)Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiaotong
University School of Medicine, No. 1665, Kongjiang Road, Shanghai, China, 200092.

BACKGROUND: To evaluate the effectiveness of endolaser photocoagulation by a
two-port pars plana nonvitrectomy approach for treating Coats' disease with
shallow exudative retinal detachment.
METHODS: This study included 24 patients (23 boys with an age range of
2-17 years, and one girl, age 6 years) with stage 3 Coats' disease (25 eyes) from
December 2012 and May 2014 at a single center. All of the 25 eyes were
complicated with serous or total retinal detachment and received
none-vitrectomized endolaser: two (23- or 25-gauge) incisions were routinely made
3 mm posterior to the corneal limbus and a laser was applied directly on the
abnormal blood vessels. Additional treatments included subretinal fluid drainage 
(five eyes), intravitreal triamcinolone injection (seven eyes), and intravitreal 
anti-vascular endothelial growth factor (VEGF) injection (17 eyes).
Best-corrected visual acuity, intraocular pressure, and fundus and abnormal
vascular changes were recorded to determine therapeutic effects.
RESULTS: Twenty-four out of the 25 treated eyes (96 %) had retina reattached. The
number of treatment sessions differed case by case (1-5 sessions, average 1.96)
and the time to full treatment of retinal reattachment was 4 months in average.
One patient (4 %) presented with retinal redetachment. Five (20 %) eyes received 
further laser treatment with indirect ophthalmoscope and four eyes (16 %)
presented with total retinal detachment at their first visits received
consecutive treatments. At the end of the follow-up period (mean, 10.08 months), 
telangiectasias of 24 (96 %) eyes were resolved and no severe complications
occurred.
CONCLUSIONS: Endolaser photocoagulation by a two-port pars plana nonvitrectomy
approach is an effective treatment for advanced Coats' disease with serous
retinal detachment. The long-term safety of the approach needs further
investigation.

PMID: 25794987   [PubMed - as supplied by publisher]


7. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 22. [Epub ahead of print]

Correlation between depth and area of retinal nerve fiber layer defect as
measured by spectral domain optical coherence tomography.

Suh MH(1), Yoo BW, Park KH, Kim JY, Kim H, Kim HC.

Author information: 
(1)Department of Ophthalmology, Haeundae Paik Hospital, Inje University College
of Medicine, 1435 Jwa-dong, Haeundae-gu, Busan, 612-030, Korea,
crishuna0@hanmail.net.

BACKGROUND: To evaluate the correlation between the depth and area of retinal
nerve fiber layer (RNFL) defect, as measured on an RNFL map of spectral-domain
optical coherence tomography (SD-OCT).
METHODS: The RNFL of 472 glaucoma subjects and of 217 healthy subjects was imaged
by an SD-OCT. RNFL defect depth and area on the RNFL map were expressed as an
RNFL defect depth percentage index (RDPI) and an RNFL defect area index (RDAI),
respectively, according to the following two formulas: 100×[1-{summation of
thicknesses of RNFL defects/summation of thicknesses of upper 95th percentile
range of age-matched healthy subjects in areas corresponding to defects}];
100×[number of superpixels of RNFL defects/(46 × 46-superpixels inside optic disc
or β zone parapapillary atrophy)]. The best-fitting model describing the
relationship between the two parameters was derived by fractional polynomial
analysis.
RESULTS: Logarithmic fit was determined to be the best-fitting model in
describing the relationship of the RDPI against the RDAI (y = 53.4 + 3.7 ln(x)
and y = 50.9 + 5.9 ln(x) in superior and inferior hemifields, respectively). The 
expected RDAIs at the point where the RDPI and RDAI rates of change were the same
were 3.7 and 5.9 %; the corresponding upper 95 % confidence interval limits of
the RDPI 59.0 and 61.8 % in the superior and inferior hemifields, respectively.
CONCLUSIONS: The correlation between the RNFL defect depth and area, as derived
from the RNFL map, was best described by the logarithmic fit. Changes were more
marked in depth than in area, especially for mild localized defects.

PMID: 25794986   [PubMed - as supplied by publisher]


8. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 20. [Epub ahead of print]

Choroidal involvement in Rosai-Dorfman syndrome may be depicted and followed
using enhanced depth imaging optical coherence tomography (EDI-OCT).

Fassbender J(1), Schaal S.

Author information: 
(1)Department of Ophthalmology and Visual Sciences, University of Louisville, 301
E. Muhammad Ali Boulevard, Louisville, KY, 40202, USA.

PMID: 25791357   [PubMed - as supplied by publisher]


9. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 20. [Epub ahead of print]

RhoA/mDia-1/profilin-1 signaling targets microvascular endothelial dysfunction in
diabetic retinopathy.

Lu Q(1), Lu L, Chen W, Chen H, Xu X, Zheng Z.

Author information: 
(1)Department of Ophthalmology, Shanghai First People's Hospital, School of
Medicine, Shanghai Jiaotong University, No.100 Haining Road, Shanghai, 200080,
China.

BACKGROUND: Diabetic retinopathy (DR) is a major cause of blindness in the
working-age populations of developed countries, and effective treatments and
prevention measures have long been the foci of study. Patients with DR invariably
demonstrate impairments of the retinal microvascular endothelium. Many
observational and preclinical studies have shown that angiogenesis and apoptosis 
play crucial roles in the pathogenesis of DR. Increasing evidence suggests that
in DR, the small guanosine-5'-triphosphate-binding protein RhoA activates its
downstream targets mammalian Diaphanous homolog 1 (mDia-1) and profilin-1, thus
affecting important cellular functions, including cell morphology, motility,
secretion, proliferation, and gene expression. However, the specific underlying
mechanism of disease remains unclear.
CONCLUSION: This review focuses on the RhoA/mDia-1/profilin-1 signaling pathway
that specifically triggers endothelial dysfunction in diabetic patients.
Recently, RhoA and profilin-1 signaling has attracted a great deal of attention
in the context of diabetes-related research. However, the precise molecular
mechanism by which the RhoA/mDia-1/profilin-1 pathway is involved in progression 
of microvascular endothelial dysfunction (MVED) during DR has not been
determined. This review briefly describes each feature of the cascade before
exploring the most recent findings on how the pathway may trigger endothelial
dysfunction in DR. When the underlying mechanisms are understood, novel therapies
seeking to restore the endothelial homeostasis comprised in DR will become
possible.

PMID: 25791356   [PubMed - as supplied by publisher]


10. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 17. [Epub ahead of print]

Multifocal VEP provide electrophysiological evidence of predominant dysfunction
of the optic nerve fibers derived from the central retina in Leber's hereditary
optic neuropathy.

Ziccardi L(1), Parisi V, Giannini D, Sadun F, De Negri AM, Barboni P, La Morgia
C, Sadun AA, Carelli V.

Author information: 
(1)Neurophthalmology Unit, Fondazione G.B. Bietti- IRCCS, Via Livenza 3, 00198,
Rome, Italy, luxzic@hotmail.com.

PURPOSE: To differentiate the bioelectrical cortical responses driven by axons
from central and mid-peripheral retina in Leber's hereditary optic neuropathy
(LHON) by using multifocal visual evoked potentials (mfVEP).
METHODS: Seventeen genetically confirmed LHON patients (33.35 ± 8.4 years, 17
eyes) and 22 age-matched controls (C) (38.2 ± 6.0 years, 22 eyes) were studied by
mfVEP and optical coherence tomography. MfVEP P1 implicit time (P1 IT, ms) and
response amplitude density of the N1-P1 components (N1-P1 RAD, nV/deg(2)) of the 
second order binary kernel were measured for five concentric retinal areas
between the fovea and mid-periphery: 0-20 degrees (R1 to R5).
RESULTS: Mean mfVEP P1 ITs and N1-P1 RADs at all five foveal eccentricities were 
significantly different (p < 0.01) in LHON when compared to controls. In both
groups, mean mfVEP responses obtained from R1 to R5 showed a progressive
shortening of P1 ITs (linear fitting, LHON: r  = -0.95; C: r = -0.98) and
decrease of N1-P1 RADs (exponential fitting, LHON: r (2) = 0.94; C: r
(2) = 0.93). The slope of the linear fitting between mean mfVEP P1 ITs in the two
groups was about three times greater in LHON than in controls (LHON: y = -13.33x 
+182.03; C: y = -4.528x +108.1). MfVEP P1 ITs detected in R1 and R2 (0-5 degrees)
were significantly correlated (p < 0.01) with the reduction of retinal nerve
fiber layer thickness of the temporal quadrant.
CONCLUSIONS: MfVEP identifies abnormal neural conduction along the visual
pathways in LHON, discriminating a predominant involvement of axons driving
responses from the central retina when compared to those serving the
mid-peripheral retina.

PMID: 25773998   [PubMed - as supplied by publisher]


11. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 13. [Epub ahead of print]

Ocular adnexal (orbital) solitary fibrous tumor: nuclear STAT6 expression and
literature review.

Petrovic A(1), Obéric A, Moulin A, Hamedani M.

Author information: 
(1)Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital,
15 Avenue de France, 1004, Lausanne, Switzerland.

PURPOSE: To report the clinico-pathological features of solitary fibrous tumor
occurring in the ocular adnexa (OA) in a single center. To assess the presence of
NAB2-STAT6 genes fusion in OA solitary fibrous tumor detected by nuclear
overexpression of STAT6.
METHODS: Retrospective study including orbital and OA solitary fibrous tumors
treated between 2006 and 2014 in our center. The clinical, radiological, and
histopathological findings were evaluated. STAT6 expression was assessed by
immunohistochemistry.
RESULTS: Five patients were identified and presented with a chronic OA mass. The 
tumors were radiologically well delimited, highly vascularized and without bone
erosion. All the patients underwent complete surgical excision. Pathological
examination confirmed solitary fibrous tumor in all cases. All tumors
demonstrated a nuclear expression of STAT6. There were no recurrences, with a
mean follow-up of 5 years after surgery. Our review demonstrated that proptosis
was the most common presentation occurring in 60 % of the cases. In the ocular
adnexa, adverse histological criteria were found in 19.7 % of the tumors, and
recurrences were observed in 48 % of these cases. Thirty-six percent of patients 
presented at least one local recurrence, and metastastic spread was found in
2.4 % of the cases. Tumor-related death was described in two cases.
CONCLUSION: Ocular adnexal SFT are rare and usually present as a chronic orbital 
mass with proptosis. In the OA, solitary fibrous tumor demonstrates STAT6 nuclear
expression, as documented in other locations. Recurrences are unusual and
metastasis exceptional. Initial surgical resection should be complete in order to
avoid recurrence.

PMID: 25761539   [PubMed - as supplied by publisher]


12. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 8. [Epub ahead of print]

Change in vision after retinal pigment epithelium tear following the use of
anti-VEGF therapy for age-related macular degeneration.

Durkin SR(1), Farmer LD, Kulasekara S, Gilhotra J.

Author information: 
(1)Discipline of Ophthalmology and Visual Science, The University of Adelaide,
Level 8, East Wing, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000,
Australia.

PURPOSE: We investigated visual acuity outcomes and their associations in the
setting of retinal pigment epithelium tear (RPET) following the use of
anti-vascular endothelial growth factor (anti-VEGF) agents.
METHODS: This retrospective review included all patients treated for neovascular 
age-related macular degeneration (AMD) with an anti-VEGF agent who subsequently
developed an RPET. All patients who developed an RPET were identified and outcome
measures data were recorded and analysed. The main outcome measures were best
corrected visual acuity (BCVA) and spectral domain optical coherence tomography
characteristics.
RESULTS: Among the 14 participants identified, a subfoveal RPET was associated
with the loss of one or more lines of vision from baseline (p = 0.03). There was 
no association between the size of the RPET and BCVA at the time of the RPET or
final BCVA. The development of a disciform scar was associated both with a BCVA
at the time of the RPET of < 6/24 (p = 0.02) and a final BCVA of < 6/24
(p = 0.02). Ongoing treatment with an anti-VEGF agent following an RPET saw five 
patients (35.7 %) have an improvement in their BCVA and all patients maintained
their BCVA following the RPET with ongoing anti-VEGF treatment.
CONCLUSIONS: Visual decline following an RPET is associated with subfoveal
location of the RPET (p = 0.03) and later development of a disciform scar. These 
data also suggest that the ongoing use of an anti-VEGF agent may stabilise vision
in some patients following an RPET and for some patients there may be an
improvement in visual acuity despite the RPET, depending on its location.

PMID: 25749721   [PubMed - as supplied by publisher]


13. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 8. [Epub ahead of print]

Relationship between mean platelet volume and retinopathy of prematurity.

Tao Y(1), Dong Y, Lu CW, Yang W, Li Q.

Author information: 
(1)Department of Ophthalmology, the First Hospital of Jilin University, No.71 Xin
Min Road, Changchun, 130021, Jilin, China, taoyuanchn@163.com.

PURPOSE: We aimed to investigate the association between mean platelet volume
(MPV) and the occurrence of type 1 retinopathy of prematurity (ROP).
MATERIALS AND METHODS: This was a retrospective case-control study. Cases with
ROP required laser surgery; controls developed no ROP or stage 1 ROP. Most recent
peripheral blood platelet indices before laser (case) and matched age (control)
were abstracted. Student's t-test and multivariate logistic regression analysis
were used.
RESULTS: A significant difference was found in MPV values between infants with
ROP and control groups (10.76 ± 1.27 fl, 10.04 ± 0.91 fl, p = 0.0001). No
significant differences were found in the mean platelet counts or MPV/Platelet
counts between the two groups (p = 0.4151, p = 0.1460, respectively). There was a
1.94-fold increase in the risk of retinopathy of prematurity (OR:1.94; p = 0.005)
as the MPV value increased.
CONCLUSIONS: Elevated MPV is associated with the occurrence of type 1 ROP. A
hypothesis is presented concerning the role of platelets as sequester and
deliverer angiogenesis regulators during the neovascularization phase of ROP.

PMID: 25749720   [PubMed - as supplied by publisher]


14. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 7. [Epub ahead of print]

Pigment epithelial tears after ranibizumab injection in polypoidal choroidal
vasculopathy and typical age-related macular degeneration.

Shin JY(1), Choi M, Chung B, Byeon SH.

Author information: 
(1)The Institute of Vision Research, Severance Hospital, Department of
Ophthalmology, Yonsei University College of Medicine, 134 Shinchon-Dong,
Seodaemun-Gu, Seoul, Korea, 120-752.

PURPOSE: The purpose of the study was to compare the rates and characteristics of
retinal pigment epithelial (RPE) tears between typical exudative age-related
macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV) after
injection of intravitreal ranibizumab (IVR).
METHODS: In total, 836 eyes from 784 patients with exudative AMD treated with IVR
were analyzed. The presence, type, size, and height of pigment epithelial
detachment (PED) in OCT before injection were evaluated, and the occurrence rate 
of RPE tears within three months of injection between tAMD and PCV was compared.
RESULTS: In total, 515 eyes (61.6 %) had tAMD and 321 eyes (38.4 %) were
diagnosed as PCV. RPE tears developed in 18 eyes (3.5 %) in the tAMD group, while
only two eyes (0.62 %) were associated with PCV (p = 0.009, Chi-square test).
Eleven of the eighteen eyes with RPE tears in tAMD had fibrovascular PED with
contractile neovascular tissue under the surface of the RPE and a cleft at
baseline. Two eyes with RPE tears in PCV showed large hemorrhagic PED before
presenting with an RPE tear.
CONCLUSIONS: RPE tears after IVR were significantly less common in PCV than in
tAMD. The different characteristics of RPE tears between the two disease entities
suggest differences in the pathogenesis underlying the event.

PMID: 25744335   [PubMed - as supplied by publisher]


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

Multimodal assessment of choroideremia patients defines pre-treatment
characteristics.

Seitz IP(1), Zhour A, Kohl S, Llavona P, Peter T, Wilhelm B, Zrenner E, Ueffing
M, Bartz-Schmidt KU, Fischer MD.

Author information: 
(1)University Eye Hospital, University of Tübingen, Tübingen, Germany.

PURPOSE: Choroideremia (CHM) is a X-chromosomal disorder leading to blindness by 
progressive degeneration of choroid, retinal pigment epithelium (RPE), and
retinal neurons. A current clinical gene therapy trial (NCT01461213) showed
promising safety and efficacy data in a carefully selected patient population.
The present study was performed to shed light on pre-treatment characteristics of
a larger cohort of CHM patients using a high resolution multi-modal approach.
METHODS: In a retrospective cross-sectional study, data from 58 eyes of 29
patients with clinically confirmed CHM were analysed including best-corrected
visual acuity (BCVA), refractive error, spectral-domain optical coherence
tomography (SD-OCT), fundus autofluorescence (FAF), perimetry, and tonometry.
Residual retinal volume, area of residual RPE, and foveal thickness were
quantified to further define natural disease progression and assess symmetry.
RESULTS: We evaluated 98 data points of BCVA [0.34 ± 0.06 (logMAR); mean ± 95 %
confidence interval], 80 of IOP (14.6 ± 0.6 mmHg), and 98 of refraction
(-2.16 ± 1.08 spherical equivalent). Visual fields (n  = 76) demonstrated
variable degrees of concentric constriction (54 % <10°, 25 % 10-30°, 21 % >30°). 
Mean residual RPE area on FAF (n  = 64) measured 8.47 ± 1.91 mm(2) (range
0.30-38.5 mm(2)), while mean neuroretinal volume (n  = 42) was found to be
1.76 ± 0.12 mm(3). Age at examination was exponentially associated with BCVA,
while logarithmic functions best described progressive loss of retinal area and
volume. A high degree of left to right symmetry was found in all modalities with 
structural markers showing the best correlation (r (2) area = 0.83; r (2)
volume = 0.75).
CONCLUSION: Analysis of these widely available clinical data defines the natural 
disease characteristics of a relevant patient population eligible for gene
therapeutic intervention. In the wake of preliminary reports on safety and
efficacy of CHM gene therapy (NCT01461213), this multi-modal assessment of a
cohort of CHM patients provides important evidence of the natural rate of disease
progression and degree of symmetry between eyes.

PMID: 25744334   [PubMed - as supplied by publisher]


16. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 7. [Epub ahead of print]

Retinal sensitivity is a valuable complementary measurement to visual acuity - a 
microperimetry study in patients with maculopathies.

Liu H(1), Bittencourt MG, Wang J, Sepah YJ, Ibrahim-Ahmed M, Rentiya Z, Jang HS, 
Moradi A, Nguyen QD.

Author information: 
(1)Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.

PURPOSE: To evaluate changes in macular sensitivity, as measured with
microperimetry, among patients with maculopathy and stable visual acuity (VA).
METHODS: Macular sensitivity was assessed using the Spectral OCT/SLO™
microperimetry (OCT/SLO, Optos Plc., Dunfermline, UK) in 25 eyes (16 patients)
with maculopathy and stable VA (<5 letters change in ETDRS score) at two
consecutive clinic visits. To take the limits of the test-retest repeatability of
the OCT/SLO into account, coefficient of repeatability (CoR) was employed to
estimate the probability of the sensitivity changes being secondary to
measurement noise.
RESULTS: The point sensitivity changes were statistically significant (Wilcoxon
signed-rank test, P < 0.001). Seventy-seven points (11 %) out of a total of 700
sensitivity points had a genuine sensitivity change, with a mean increase of
8.6 ± 2.6 dB in 35 points and a mean decrease of 7.9 ± 2.2 dB in 42 points.
CONCLUSIONS: Point-to-point change in macular sensitivity can be used as a
biomarker of changes in disease activity in patients with maculopathy, and can be
more accurate than either mean sensitivity or BCVA in detection of changes in
macular function. The measurement variability should be considered when observing
the local sensitivity changes.

PMID: 25744333   [PubMed - as supplied by publisher]


17. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 7. [Epub ahead of print]

Corneal regeneration after femtosecond laser small-incision lenticule extraction:
a prospective study.

Liu M(1), Zhang T, Zhou Y, Sun Y, Wang D, Zheng H, Liu Q.

Author information: 
(1)State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun
Yat-sen University, 54 S. Xianlie Road, Guangzhou, 510060, China.

PURPOSE: To evaluate the morphologic changes of corneal after small incision
lenticule extraction (SMILE) using the Heidelberg Retina Tomograph III (HRT
III)/Rostock Cornea Module confocal microscope and three-dimensional optical
coherence tomography (3D-OCT).
METHODS: Thirty eyes of 30 patients who underwent SMILE for the correction of
myopia and myopic astigmatism in this study. Morphologic modifications of corneal
architecture and the density of corneal subbasal nerve were evaluated prior to
SMILE and 7 days, 1, 3, and 6 months after SMILE by in-vivo confocal microscopy
(IVCM) and 3D-OCT.
RESULTS: The corneal epithelium morphology showed no particular changes during
the entire 6-month examination period. Subbasal nerve density recovered to
preoperative levels within 3 months after SMILE (P > 0.05). On the interface
layer, intense keratocyte activity was noted in all eyes after SMILE. The corneal
fibrotic tissues on the interface layer diminished with time, but the persistence
of brightly reflective particles still existed. No particular change between
preoperative and postoperative corneal endothelium. The incision margin of SMILE 
had the appearance of a less clearly identified fibrotic scar with epithelial
plug.
CONCLUSIONS: IVCM and 3D-OCT analysis showed that there is a low-level corneal
wound-healing response after SMILE procedure in the early postoperative period.
Subbasal nerve regeneration is recovered at the third month, but the reflective
particles elevated up to the sixth month.

PMID: 25744332   [PubMed - as supplied by publisher]


18. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 7. [Epub ahead of print]

Plasma levels of amyloid beta and other proinflammatory mediators in patients
with age-related macular degeneration.

Guymer R(1), Cipriani T, Rittenhouse KD, Lim L, Robman LD, Li W, Wang W, Deng S, 
Banerjee P.

Author information: 
(1)Centre for Eye Research Australia, University of Melbourne, Royal Victorian
Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia,
rh.guymer@unimelb.edu.au.

PURPOSE: To investigate the plasma levels of amyloid beta (Aβ) and select
inflammatory mediators in patients with various stages of AMD compared to that of
age-matched controls, and discern a relationship to disease severity.
METHODS: Plasma samples were obtained from AMD subjects at various stages of
disease-early (drusen only), geographic atrophy (GA), neovascular AMD (CNV)-and
from controls of similar age without AMD. Samples were analyzed using a
commercially available ELISA kit (sixteen cytokines) or LC/MS/MS (Aβ isotypes).
Descriptive statistics were compiled on all analytes. Analysis of covariance
(ANCOVA) was conducted to compare each analyte across AMD groups while adjusting 
for sex and age of the patients, and in comparison to the control group. Receiver
operating characteristics plots were generated for the strongest predictor
variables.
RESULTS: Levels of alternative spliced CC3 proteins were significantly different 
between controls and CNV groups (p < 0.05), with median levels almost twice
higher in CNV than in controls. There was an increasing trend for plasma levels
of Αβ isotypes across AMD progressive stages (p values ranged from 0.052 to
0.0012) (ANCOVA). When adjusted for multiple comparisons analysis, plasma Aβ 1-42
levels, and its ratio with Aβ 1-40 were the most significantly associated with
late AMD stages. Consistently with the ANCOVA results for Αβ isotypes, the ROC
curve showed a moderate prediction (AUC = - ~ 0.78) of AMD vs control using the
Aβ 1-42 isotype.
CONCLUSION: Plasma Aβ 1-42 may have utility as a systemic biomarker for AMD.

PMID: 25744331   [PubMed - as supplied by publisher]


19. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 7. [Epub ahead of print]

Macular pigment optical density measurements by one-wavelength reflection
photometry-influence of cataract surgery on the measurement results.

Na KS(1), Paik JS, Park YG.

Author information: 
(1)Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital,
College of Medicine, The Catholic University of Korea, Seoul, South Korea.

PMID: 25744330   [PubMed - as supplied by publisher]


20. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 7. [Epub ahead of print]

Magnetic resonance imaging in congenital Brown syndrome.

Kim JH(1), Hwang JM.

Author information: 
(1)Department of Radiology, Seoul National University College of Medicine, Seoul 
National University Hospital, Seoul, Korea.

AIMS: Our aim was to elucidate the etiology of Brown syndrome by evaluating the
trochlea position, morphologic characteristics of the extraocular muscles
including superior oblique muscle/tendon complex, and the presence of the cranial
nerves (CN) III, IV, and VI using magnetic resonance imaging (MRI) in eight
patients with unilateral congenital Brown syndrome and one patient with bilateral
congenital Brown syndrome.
METHODS: Nine consecutive patients diagnosed with congenital Brown syndrome had a
comprehensive ocular examination and MRI for the CN III, CN VI, and the
extraocular muscles. Five of the nine patients underwent additional high
resolution MRI for CN IV. The distance from the annulus of Zinn to the trochlea
was measured.
RESULTS: Normal sized CN III, IV, and VI, as well as all extraocular muscles,
could be identified bilaterally in all patients with available MRI. The distance 
from the annulus of Zinn to the trochlea was the same in both eyes.
CONCLUSIONS: The findings for our patients, particularly in those who underwent
additional high resolution MRI, did not provide evidence of a lack of CN IV as a 
cause of Brown syndrome.

PMID: 25744329   [PubMed - as supplied by publisher]


21. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 7. [Epub ahead of print]

Tissue reaction after intrastromal corneal ring implantation in an experimental
animal model.

Ibares-Frías L(1), Gallego P, Cantalapiedra-Rodríguez R, Valsero MC, Mar S,
Merayo-Lloves J, Martínez-García MC.

Author information: 
(1)Group of Optical Diagnostic Techniques, Theorist, Atomic and Optical Physics
Department, Faculty of Science, University of Valladolid, Valladolid, Spain,
luciaibares@hotmail.com.

PURPOSE: To evaluate corneal wound healing in the hen animal model after additive
surgery with an intracorneal ring segment (ICRS).
METHODS: We implanted one ICRS in each eye of 76 hens. In control group 1 (n = 22
hens), the stromal channel was prepared but no ICRS was inserted. In control
group 2 (n = 2 hens), no surgery was performed. Animals were randomly separated
into groups and euthanized after clinical follow-up of 4 and 12 hours, 1, 2, 3,
and 7 days, and 1, 2, 3, 4, and 6 months. Corneas were stained with
hematoxylin-eosin. Apoptosis was measured by terminal uridine nick end-labeling
assays. Cell proliferation and myofibroblast-like differentiation were assayed by
BrdU and α-smooth muscle actin immunofluorescence microscopy. Stromal matrix
changes were documented by electron microscopy.
RESULTS: Epithelial and stromal cell apoptosis around the ICRS-implanted and
control group 1 eyes peaked at 12 hours, but continued for 72 hours. In
ICRS-implanted eyes, epithelial and stromal proliferation was present at 12 and
24 hours, respectively, and peaked at 7 days and 72 hours, respectively. Some
proliferation in the ICRS-implanted group continued through the 6-month
follow-up, and myofibroblast-like cells differentiated one to three months after 
ICRS implantation. The segments rotated within the stroma as the limbal inferior 
angle approached the epithelium.
CONCLUSIONS: Wound healing after ICRS implantation in hen corneas was similar to 
that of other corneal surgical wounds in stages. However, there were some
specific features related to the small size of the epithelial wound and the
device permanently implanted inside the cornea.

PMID: 25744328   [PubMed - as supplied by publisher]


22. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 3. [Epub ahead of print]

Sutureless scleral fixation of intraocular lenses.

Karadag R(1), Bayramlar H, Cakici O.

Author information: 
(1)School of Medicine, Department of Ophthalmology, Istanbul Medeniyet
University, Goztepe, Istanbul, Turkey, drrkaradag@yahoo.com.

PMID: 25726755   [PubMed - as supplied by publisher]


23. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 1. [Epub ahead of print]

Carbamylated erythropoietin mediates retinal neuroprotection in
streptozotocin-induced early-stage diabetic rats.

Liu X(1), Zhu B, Zou H, Hu D, Gu Q, Liu K, Xu X.

Author information: 
(1)Department of Ophthalmology, Shanghai First People's Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai, China.

PURPOSE: The neuroprotective effect of carbamylated erythropoietin (CEPO), an
erythropoietin (EPO) derivative, in diabetic retinopathy (DR) has not been
clearly verified. We conducted this study to investigate the potential
neuroprotective role of CEPO in a streptozotocin-induced diabetic rat model.
METHODS: Streptozotocin-induced diabetic rats and blank controls were treated
with or without CEPO and EPO for 4 weeks. Retinal functional and histological
changes were quantified by electroretinogram, light microscopy, and terminal dUTP
nick end labeling assay. Gene and protein levels of colony-stimulating factor 2
receptor beta, low-affinity (CD131), EPO receptor (EPOR), THY1, glial fibrillary 
acidic protein (GFAP), and vascular endothelial growth factor (VEGF-A) in retinal
tissues were determined by real-time PCR and western blotting, respectively.
Vascular penetration was assessed by fluorescein retinal angiography.
RESULTS: Diabetic rats had decreased retinal thickness, decreased ganglion cells,
and increased retinal neuron apoptosis. CEPO increased CD131 and THY1 expression,
while EPO increased EPOR expression. High glucose increased GFAP expression in
the diabetic group, but both CEPO and EPO attenuated the trend for increase. CEPO
downregulated VEGF-A expression. The amplitudes of b-wave and oscillatory
potentials were decreased in the untreated diabetic group, whereas neither
parameter decreased in diabetic rats after CEPO or EPO treatment. Vascular
leakage and microaneurysms in the diabetic group were significantly improved
following CEPO treatment.
CONCLUSIONS: CEPO has similar anti-apoptotic effects to EPO in DR, but CEPO does 
not induce neovascularization. CEPO may exert neuroprotective effects via its
receptor CD131.

PMID: 25725621   [PubMed - as supplied by publisher]


24. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 1. [Epub ahead of print]

Clinical features of psoriatic uveitis in Japanese patients.

Tanaka R(1), Takamoto M, Komae K, Ohtomo K, Fujino Y, Kaburaki T.

Author information: 
(1)Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo,
Bunkyo-ku, Tokyo, 113-0033, Japan, rtanaka-ymn@umin.ac.jp.

PURPOSE: To investigate the clinical features of psoriatic uveitis in Japanese
patients.
METHODS: Clinical features of 13 consecutive patients with psoriatic uveitis
treated at our facility were retrospectively examined using medical records. In
this study, we collected data about psoriasis type, uveitis laterality, onset
type, HLA types, visual acuity, ocular inflammation localization, anterior
segment findings, funduscopy findings, complications, recurrence, and medical
treatments for uveitis and skin diseases.
RESULTS: The cohort comprised ten males and three females (43.6 ± 7.1 years old),
and types of psoriasis included psoriasis vulgaris (seven cases), psoriatic
arthritis (four cases), pustular psoriasis (three cases) and psoriatic
erythroderma (one case). Two cases represented complicated cases of pustular
psoriasis and psoriatic arthritis. Seven cases were unilateral, and six cases
were bilateral. All cases had acute non-granulomatous anterior uveitis, whereas
panuveitis occurred in one case. Furthermore, macular edema and vascular leakage 
on fluorescein angiography occurred in four cases, and hyperemic disc occurred in
two cases. Recurrence occurred in nine cases. In addition to topical
corticosteroid treatment, eight cases underwent oral immunosuppressive treatment 
or biologics. All six cases undergoing HLA typing were HLA-A2 positive.
CONCLUSIONS: Cases of psoriatic uveitis in Japan appear to present with acute
non-granulomatous uveitis; other symptoms may include macular edema, retinal
vasculitis, or hyperemic disc.

PMID: 25725620   [PubMed - as supplied by publisher]


25. Graefes Arch Clin Exp Ophthalmol. 2015 Mar 1. [Epub ahead of print]

Influence of anterior chamber depth, anterior chamber volume, axial length, and
lens density on postoperative endothelial cell loss.

Reuschel A(1), Bogatsch H, Oertel N, Wiedemann R.

Author information: 
(1)Department of Ophthalmology, University of Leipzig, Liebigstraße 10-14, 04103,
Leipzig, Germany.

PURPOSE: To evaluate the influence of anterior chamber depth (ACD), anterior
chamber volume (ACV), lens density (LD), and axial length (AL) as risk factors on
endothelial cell loss 3 months after cataract surgery.
METHODS: We enrolled 47 patients with senile cataract who were operated between
July 2012 and March 2013 by the same surgeon using torsional phacoemulsification.
Preoperatively, we measured ACD, ACV, and LD using the Oculus Pentacam®. The AL
was determined using the IOL Master®. Primary outcomes were central endothelial
density (ECD) and corrected distance visual acuity (CDVA) 3 months after surgery 
We evaluated the effect of ACD, ACV, LD, and AL as possible risk factors of
postoperative percentage endothelial cell loss (ECL).
RESULTS: The median age was 72 years. The median CDVA before surgery was 0.5
improving to 1.0 postoperatively. The median ECL was 5.2 % (range 1.7 %-7.6 %).
These results are comparable to our previous study (median ECL 6.9 % after
3 months) [Reuschel et al. (2010) J Cataract Refract Surg]. The median ACD in our
study was 2.56 mm (range 2.26 mm-2.8 mm). Median ACV was 144 mm(3) (range
121 mm(3)-158 mm(3)]. The median LD was 12.4 (range 11.4-13.7). Median AL was
23.1 mm (range 22.7 mm-23.9 mm). Our correlation analysis showed no significant
correlation between ACD, ACV, LD, AL, and postoperative ECL.
CONCLUSION: ACD, ACV, AL, and LD were not identified as risk factors of
postoperative endothelial cell loss in our analysis.

PMID: 25725619   [PubMed - as supplied by publisher]


26. Graefes Arch Clin Exp Ophthalmol. 2015 Feb 26. [Epub ahead of print]

Short-term efficacy of subthreshold micropulse yellow laser (577-nm)
photocoagulation for chronic central serous chorioretinopathy.

Kim JY(1), Park HS, Kim SY.

Author information: 
(1)Nune Eye Hospital, 18-21F LIG Bldg, 2397, Dalgubeol-daero, Suseong-gu, Daegu, 
Republic of Korea.

PURPOSE: To investigate the short-term efficacy of subthreshold micropulse yellow
laser photocoagulation in the treatment of chronic central serous
chorioretinopathy (CSC).
METHODS: A retrospective case series study was performed from April 2012 to June 
2014 at Nune Eye Hospital. A total of ten eyes of ten chronic or chronic
recurrent CSC patients received subthreshold micropulse yellow laser
photocoagulation with a 15 % duty cycle at a reduced energy level from the
micropulse laser test burn. Laser exposure time was 20 ms, and the spot diameter 
was 100 μm. Patients were followed up at the authors' hospital for at least
3 months.
RESULTS: Mean age of patients was 43.9 years. The baseline best-corrected visual 
acuity was 0.21 ± 0.21 logarithm of the minimum angle of resolution (logMAR),
which was improved to 0.055 ± 0.093 logMAR (p = 0.020) at the  3-month follow-up 
and 0.035 ± 0.063 logMAR (p = 0.012) at final follow-up. Central macular
thickness at baseline was 349.2 ± 53.2 μm, which was changed to 250.7 ± 28.8 μm
(p = 0.009) at the 3-month follow-up and 261.2 ± 38.31 μm (p = 0.009) at final
follow-up.
CONCLUSIONS: Subthreshold micropulse yellow laser photocoagulation showed
short-term efficacy in treating chronic CSC without retinal damage. However,
prospective, randomized, and comparative large-scale studies are needed to
evaluate the efficacy and safety of this treatment.

PMID: 25717024   [PubMed - as supplied by publisher]


27. Graefes Arch Clin Exp Ophthalmol. 2015 Feb 25. [Epub ahead of print]

Association of rhinostomy shape and surgical outcome after endoscopic endonasal
dacryocystorhinostomy.

Lee J(1), Yang SW, Lee H, Chang M, Park M, Baek S.

Author information: 
(1)Department of Ophthalmology, Korea University College of Medicine, 80,
Guro-dong, Guro-gu, Seoul, South Korea, 152-703.

PURPOSE: The purpose of this study was to investigate surgical outcomes and
complications after endoscopic endonasal dacryocystorhinostomy (EDCR) in relation
to rhinostomy shape.
METHODS: A retrospective electronic medical record review of patients who
underwent EDCR for primary acquired nasolacrimal duct obstruction (PANDO) was
performed. Surgical success rates and postoperative complications were compared
among three groups of patients in relation to rhinostomy shape (alcove, cavern,
or concealed cavern).
RESULTS: A total of 280 patients (358 eyes) were included in the study. Of the
358 eyes, 194 rhinostomies were alcove-shaped, 157 were cavern-shaped, and 7 were
concealed cavern-shaped. There were no patients with flat-shaped rhinostomies.
The nasal cavity was wider in patients in the alcove group than those in the
cavern and concealed cavern groups (p = 0.012). The mean time to tube removal was
longest in the concealed cavern group (p = 0.029). There were no significant
differences in anatomical success rates among the three groups (p = 0.338). With 
regard to functional success for patients with anatomically patent DCR, the
cavern and concealed cavern groups had significantly poorer results than the
alcove group (p = 0.001). Functional success rates were 91.6 %, 84.8 %, and
57.1 % for the alcove, cavern, and concealed cavern groups, respectively.
Development of postoperative granuloma was more frequent in the concealed cavern 
group (85.7 %) than in the alcove (29.3 %) or cavern groups (26.1 %) (p= 0.003). 
Multiple logistic regression models for surgical outcome showed that rates of
functional failure after EDCR were influenced by patient age and rhinostomy shape
(odds ratio 1.824, p = 0.045 for age; odds ratio = 9.605, p = 0.000 for
rhinostomy shape) (Table 5).
CONCLUSIONS: The incidence rate of symptomatic epiphora after EDCR was
approximately 12 %, and this result may have been associated with cavernous and
concealed rhinostomy shapes. For patients with persistent epiphora and
anatomically patent DCR, it is important to identify rhinostomy shape by
endoscopy in order to differentiate causes of functional failure.

PMID: 25712630   [PubMed - as supplied by publisher]