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 Nov 19. [Epub ahead of print]

Recurrence of macular edema in eyes with branch retinal vein occlusion changes
the diameter of unaffected retinal vessels.

Yolcu U(1), Ilhan A(2).

Author information: 
(1)Ankara Mevki Military Hospital, Ophthalmology Service, Ankara, Turkey, 06100. 
umit_yolcu@hotmail.com. (2)Ankara Mevki Military Hospital, Ophthalmology Service,
Ankara, Turkey, 06100.

PMID: 26582163   [PubMed - as supplied by publisher]


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

Responding to a rebuttal letter concerning the BERVOLT study.

Kornhauser T(1), Barak A(2).

Author information: 
(1)The Soroka University Medical Center, Ben Gurion University of the Negev, Beer
Sheva, Israel. tomchook@gmail.com. (2)Tel Aviv Sourasky Medical Center and the
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 26582162   [PubMed - as supplied by publisher]


3. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 18. [Epub ahead of print]

Influence of optic disc leakage on objective optic nerve head assessment in
patients with uveitis.

Heinz C(1,)(2), Kogelboom K(3), Heiligenhaus A(3,)(4).

Author information: 
(1)Department of Ophthalmology, St. Franziskus-Hospital Muenster,
Hohenzollernring 74, 48145, Muenster, Germany. carsten.heinz@uveitis-zentrum.de. 
(2)Department of Ophthalmology, University of Duisburg- Essen, Essen, Germany.
carsten.heinz@uveitis-zentrum.de. (3)Department of Ophthalmology, St.
Franziskus-Hospital Muenster, Hohenzollernring 74, 48145, Muenster, Germany.
(4)Department of Ophthalmology, University of Duisburg- Essen, Essen, Germany.

PURPOSE: Secondary glaucoma is a common complication in patients with uveitis.
Heidelberg Retina Tomography (HRT) and retinal nerve fiber layer (RNFL) thickness
on optical coherence tomography (OCT) are widely used for examining optic nerve
head changes. We evaluated these parameters in patients with uveitis and
secondary glaucoma and with inflammatory papillary leakage on fluorescein
angiography.
METHODS: Prospective single-center analysis of patients with uveitis, evaluating 
the impact of optic disc leakage on objective optic disc imaging parameters.
RESULTS: Overall, 96 eyes of 59 patients were included. Papillary leakage was
found in 42 eyes (43.8 %), and secondary glaucoma was found in 41 eyes (42.7 %). 
Glaucoma and papillary leakage were present in 12 (29 %) eyes with leakage and in
29 (54 %) eyes without leakage (p = 0.023). Neuroretinal rim area (p = 0.004),
rim volume on HRT (p = 0.004), and RNFL thickness on OCT (p = 0.0008) were
significantly increased in eyes with papillary leakage, while RNFL on HRT was
unchanged (p = 0.255). When only eyes with normal IOP were examined, all
objective parameters on OCT and HRT were significantly increased, whereas in eyes
with secondary glaucoma, there was only a trend in the same direction, which did 
not reach significance. A comparison of eyes with secondary glaucoma and optic
disc leakage to normal eyes with no glaucoma or leakage revealed no difference in
any of the parameters.
CONCLUSIONS: The objective parameters of optic nerve head imaging tools are
significantly influenced by papillary leakage. In patients with secondary
glaucoma and papillary leakage, these techniques are unable to detect and monitor
glaucomatous damage.

PMID: 26582161   [PubMed - as supplied by publisher]


4. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 18. [Epub ahead of print]

Structural dissociation of optic disc margin components with optic disc tilting: 
a spectral domain optical coherence tomography study.

Hasegawa T(1), Akagi T(2), Hangai M(1,)(3), Yamada H(1), Suda K(1), Kimura Y(1), 
Nakanishi H(1), Ikeda HO(1,)(4), Yoshimura N(1).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, Kyoto University Graduate
School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
(2)Department of Ophthalmology and Visual Sciences, Kyoto University Graduate
School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
akagi@kuhp.kyoto-u.ac.jp. (3)Department of Ophthalmology, Saitama Medical
University, Saitama, Japan. (4)Institute for Advancement of Clinical and
Translational Science, Kyoto University Hospital, Kyoto, Japan.

PURPOSE: To investigate the dissociation of the Bruch's membrane opening (BMO)
from the scleral canal opening (SO) of the optic disc.
METHODS: In this prospective, cross-sectional, observational study, 101 eyes from
101 patients or suspected subjects of primary open angle glaucoma were included. 
Enhanced depth imaging spectral domain optical coherence tomography images along 
the long axis of the optic disc were used to visualize better the deep structures
around the optic disc on both the temporal and nasal sides. The distances between
the BMO and SO were measured at the temporal and nasal sides of the optic disc,
and their correlations with age, axial length, intraocular pressure, disc size,
disc ovality index, disc torsion degree, and visual field mean deviation were
investigated.
RESULTS: The temporal and nasal distances of BMO from SO correlated significantly
with each other (R = 0.632, P < 0.0001). By multiple linear regression analysis, 
significant correlations were found for disc ovality index (temporal: β = -0.691,
P < 0.0001; nasal: β = -0.420, P < 0.0001) and axial length (temporal: β = 0.224,
P = 0.002; nasal: β = 0.310, P = 0.001). The other factors did not show any
significant correlation.
CONCLUSION: Locations of the SO at not only the temporal, but also the nasal side
of the optic disc are nasally shifted from the BMO with optic disc tilting and
axial length elongation in glaucomatous eyes, and are significantly correlated to
each other. The nasal shift of the deep structures of the optic disc should be
considered especially when assessing myopic eyes with optic disc tilt.

PMID: 26582160   [PubMed - as supplied by publisher]


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

Bevacizumab treatment of macular edema in CRVO and BRVO: long-term follow-up
(BERVOLT study: bevacizumab for RVO long-term follow-up).

Călugăru D(1), Călugăru M(2).

Author information: 
(1)Department of Ophthalmology, University of Medicine Cluj-Napoca, Cluj-Napoca, 
Romania. dan.calugaru@ymail.com. (2)Department of Ophthalmology, University of
Medicine Cluj-Napoca, Cluj-Napoca, Romania. mihai.calugaru@mail.dntcj.ro.

PMID: 26573391   [PubMed - as supplied by publisher]


6. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 14. [Epub ahead of print]

Anterior lens epithelium in intumescent white cataracts - scanning and
transmission electron microscopy study.

Andjelic S(1), Drašlar K(2), Hvala A(3), Hawlina M(4).

Author information: 
(1)Eye Hospital, University Medical Centre, Grablovičeva 46, 1000, Ljubljana,
Slovenia. (2)Department of Biology, Biotechnical Faculty, University of
Ljubljana, Ljubljana, Slovenia. (3)Institute of Pathology, Medical Faculty,
University of Ljubljana, Ljubljana, Slovenia. (4)Eye Hospital, University Medical
Centre, Grablovičeva 46, 1000, Ljubljana, Slovenia. marko.hawlina@mf.uni-lj.si.

PURPOSE: Our purpose was to study the structure of the lens epithelial cells
(LECs) of intumescent white cataracts (IC) in comparison with nuclear cataracts
(NC) in order to investigate possible structural reasons for development of IC.
METHODS: The anterior lens capsule (aLC: basement membrane and associated LECs)
were obtained from cataract surgery and prepared for scanning electron microscopy
(SEM) and transmission electron microscopy (TEM).
RESULTS: We observed by SEM that in IC, LEC swelling was pronounced with the
clefts surrounding the groups of LECs. Another structural feature was spherical
formations, that were observed on the apical side of LEC's, towards the fibre
cell layer, both by SEM and TEM. Development of these structures, bulging out
from the apical cell membrane of the LEC's and disrupting it, could be followed
in steps towards the sphere formation. The degeneration of the lens epithelium
and the structures of the aLC in IC similar to Morgagnian globules were also
observed. None of these structural changes were observed in NC.
CONCLUSIONS: We show by SEM and TEM that, in IC, LECs have pronounced structural 
features not observed in NC. This supports the hypothesis that the disturbed
structure of LECs plays a role in water accumulation in the IC lens. We also
suggest that, in IC, LECs produce bulging spheres that represent unique
structures of degenerated material, extruded from the LEC.

PMID: 26573390   [PubMed - as supplied by publisher]


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

Qualitiy of life in the follow-up of uveal melanoma patients after enucleation in
comparison to CyberKnife treatment.

Klingenstein A(1), Fürweger C(2), Mühlhofer AK(3), Leicht SF(3), Schaller UC(3), 
Muacevic A(2), Wowra B(2), Hintschich C(3), Eibl KH(3).

Author information: 
(1)Department of Ophthalmology, Klinikum der Universität München Campus
Innenstadt, Ludwig-Maximilians-University, Mathildenstraße 8, D-80336, Munich,
Germany. Annemarie.Klingenstein@med.uni-muenchen.de. (2)European CyberKnife®
Center, Munich, Germany. (3)Department of Ophthalmology, Klinikum der Universität
München Campus Innenstadt, Ludwig-Maximilians-University, Mathildenstraße 8,
D-80336, Munich, Germany.

PURPOSE: To compare quality of life (QoL) in patients with uveal melanoma after
enucleation and stereotactic radiosurgery to that in an age-matched patient
collective.
METHODS: QoL was assessed in a cross-sectional survey and compared among 32 uveal
melanoma patients after enucleation, 48 patients after stereotactic radiosurgery 
(CyberKnife(®); Accuray(®) Incorporated, Sunnyvale, CA, USA), and an age-matched 
control group of 35 patients, using the SF-12 Health Survey. Statistical analysis
was performed with Fisher's exact test, Student's t test, one-way ANOVA analysis,
Wilcoxon rank-sum (Mann-Whitney test), and ordered logistic regression for
multivariate analysis.
RESULTS: There was no significant difference in QoL between patients treated by
stereotactic radiosurgery and the age-matched control group. After enucleation,
patients presented significantly lower values in Physical Functioning (PF), Role 
Physical (RP), and Role Emotional (RE) compared to the radiosurgery and control
group. To control for the overall QoL lowering effect of visual loss, the QoL of 
the patients who underwent enucleation was compared with the QoL of patients
suffering severe functional loss after CyberKnife radiosurgery in a subgroup
analysis, which showed no statistically significant difference. The number of
comorbidities had a significant impact on QoL in multivariate analysis.
CONCLUSIONS: Superior performance in PF, RP, and RE suggests that CyberKnife
represents a suitable first-line therapy for uveal melanoma. In cases with
painful amaurosis or vast tumor recurrence, enucleation can be performed with an 
acceptable QoL outcome.

PMID: 26573389   [PubMed - as supplied by publisher]


8. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 4. [Epub ahead of print]

Severe cranial neuropathies caused by falls from heights in children.

Zahavi A(1,)(2), Luckman J(3), Yassur I(4), Michowiz S(5,)(6), Goldenberg-Cohen
N(7,)(8,)(9).

Author information: 
(1)Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach 
Tikva, lsrael. alonzahavi@gmail.com. (2)Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel. alonzahavi@gmail.com. (3)Department of Radiology,
Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. judluc@msn.com.
(4)Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach 
Tikva, lsrael. yassurdoc@gmail.com. (5)Pediatric Neurosurgery, Schneider
Children's Medical Center of Israel, Petach Tikva, Israel. michowiz@013.net.
(6)Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
michowiz@013.net. (7)Department of Pediatric Ophthalmology, Schneider Children's 
Medical Center of Israel, Petach Tikva, 49202, Israel. ncohen1@gmail.com.
(8)Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
ncohen1@gmail.com. (9)The Krieger Eye Research Laboratory, Felsenstein Medical
Research Center, Petach Tikva, Israel. ncohen1@gmail.com.

PURPOSE: Falls from heights are the most common traumatic event associated with
emergency department visits in children. This study investigated the incidence
and clinical course of cranial neuropathies caused by falls from heights in
children.
METHODS: The computerized records of a tertiary pediatric medical center were
searched for all patients admitted to the emergency department in 2004-2014 with 
a head injury caused by falling from a height. Those with cranial neuropathies
involving optic and eye-motility disturbances were identified, and their
clinical, imaging, and outcome data were evaluated.
RESULTS: Of the estimated 61,968 patients who presented to the emergency
department during the study period because of a fall, 18,758 (30.3 %) had head
trauma. Only 12 (seven boys, five girls, average age 6.7 years) had a visual
disturbance. Eight were diagnosed with traumatic optic neuropathy, one after a
6-month delay, including two with accompanying cranial nerve (CN) III injuries.
Five patients had anisocoria or an abnormal pupillary response to light at
presentation, one patient had CN VI paralysis and temporary vision loss, and one 
patient had an isolated CN III injury diagnosed on follow-up. Visual improvement 
varied among the patients.
CONCLUSION: Cranial neuropathies due to falls from heights are rare in children
and are associated with high visual morbidity. Vision or ocular motility
impairment, especially monocular vision loss, may be missed during acute intake
to the emergency department, and a high index of suspicion is needed. Assessment 
of the pupillary response to light is essential.

PMID: 26553199   [PubMed - as supplied by publisher]


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

Steady-state multifocal visual evoked potential (ssmfVEP) using dartboard
stimulation as a possible tool for objective visual field assessment.

Horn FK(1), Selle F(2), Hohberger B(2), Kremers J(2).

Author information: 
(1)Department of Ophthalmology and University Eye Hospital, Friedrich-Alexander
University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
folkert.horn@uk-erlangen.de. (2)Department of Ophthalmology and University Eye
Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Schwabachanlage 6,
91054, Erlangen, Germany.

PURPOSE: To investigate whether a conventional, monitor-based multifocal visual
evoked potential (mfVEP) system can be used to record steady-state mfVEP
(ssmfVEP) in healthy subjects and to study the effects of temporal frequency,
electrode configuration and alpha waves.
METHODS: Multifocal pattern reversal VEP measurements were performed at 58
dartboard fields using VEP recording equipment. The responses were measured using
m-sequences with four pattern reversals per m-step. Temporal frequencies were
varied between 6 and 15 Hz. Recordings were obtained from nine normal subjects
with a cross-shaped, four-electrode device (two additional channels were
derived). Spectral analyses were performed on the responses at all locations. The
signal to noise ratio (SNR) was computed for each response using the signal
amplitude at the reversal frequency and the noise at the neighbouring
frequencies.
RESULTS: Most responses in the ssmfVEP were significantly above noise. The SNR
was largest for an 8.6-Hz reversal frequency. The individual alpha
electroencephalogram (EEG) did not strongly influence the results. The percentage
of the records in which each of the 6 channels had the largest SNR was between
10.0 and 25.2 %.
CONCLUSION: Our results in normal subjects indicate that reliable mfVEP responses
can be achieved by steady-state stimulation using a conventional dartboard
stimulator and multi-channel electrode device. The ssmfVEP may be useful for
objective visual field assessment as spectrum analysis can be used for automated 
evaluation of responses. The optimal reversal frequency is 8.6 Hz. Alpha waves
have only a minor influence on the analysis. Future studies must include
comparisons with conventional mfVEP and psychophysical visual field tests.

PMID: 26553198   [PubMed - as supplied by publisher]


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

Systemic immunosuppression with mycophenolate mofetil to prevent corneal graft
rejection after high-risk penetrating keratoplasty: a 2-year follow-up study.

Szaflik JP(1,)(2), Major J(3,)(4), Izdebska J(3,)(4), Lao M(3,)(4), Szaflik
J(3,)(4).

Author information: 
(1)Department of Ophthalmology, Medical University of Warsaw, Warszawa, Poland.
szaflik@ophthalmology.pl. (2)Independent Public University Eye Hospital, ul. J.
Sierakowskiego 13, 03-709, Warszawa, Poland. szaflik@ophthalmology.pl.
(3)Department of Ophthalmology, Medical University of Warsaw, Warszawa, Poland.
(4)Independent Public University Eye Hospital, ul. J. Sierakowskiego 13, 03-709, 
Warszawa, Poland.

PURPOSE: In this study, we aimed to evaluate the efficacy and safety of systemic 
immunosuppression with mycophenolate mofetil (MMF) to prevent corneal graft
rejection after high-risk penetrating keratoplasty.
METHODS: One hundred and ninety-six consecutive patients who underwent high-risk 
penetrating keratoplasty defined as the presence of deep vascularization in more 
than two quadrants, keratouveitis, emergency keratoplasties, and
retransplantations were enrolled in the study. Ninety-eight prospectively
followed up patients were treated with MMF [with dose adjustment based on
mycophenolic acid (MPA) serum concentration], and 98 patients were in the
non-MMF-treated retrospectively assessed control group.
RESULTS: During a mean of 24 months of observation, immune reactions occurred in 
eight cases (8 %) and graft rejection with subsequent graft failure occurred in
three cases (3 %) in the MMF group. In the control group, graft rejection
occurred in 76 cases (78 %) and failure due to graft rejection occurred in 30
cases (31 %). Kaplan-Meier analysis demonstrated that 93 % of the grafts in the
MMF-treated group and 47 % in the control group showed no immune rejection
(p < 0.01, log-rank test) after a year. Cox regression analysis proved that MMF
treatment decreased the risk of graft rejection 11 times (RR = 11, 95.0 % CI
4.8-25, p < 0.0001). Among 98 MMF-treated patients, 13 had gastric discomfort,
three developed leucopenia, and two had anemia that resolved after MMF dose
reduction.
CONCLUSIONS: MMF treatment after high risk penetrating keratoplasty is safe and
reduces the incidence of immune graft rejection and graft failure. Side effects
were rare and reversible in all but one case.

PMID: 26553197   [PubMed - as supplied by publisher]


11. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 9. [Epub ahead of print]

Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone
patients.

Armarnik S(1), Mimouni M(2), Rosen E(1), Assia EI(1), Segev F(3).

Author information: 
(1)Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky St., Kfar 
Sava, 44410, Israel. (2)Department of Ophthalmology, Rambam Health Care Campus,
Haifa, Israel. (3)Department of Ophthalmology, Meir Medical Center, 59
Tchernichovsky St., Kfar Sava, 44410, Israel. fsegev@netvision.net.il.

BACKGROUND: We aimed to report a simple technique that involves modified anterior
(to the limbus) elongated corneal incisions in order to reduce the incidence and 
severity of intraoperative floppy iris syndrome (IFIS) and related complications.
METHODS: This was a retrospective study of phacoemulsification cataract surgeries
performed by a single surgeon on patients receiving tamsulosin or alfuzosin
between 1 January 2009 and 31 July 2012 at Meir Medical Center, Kfar-Sava,
Israel. We recorded preoperative gender, age, α-antagonist medication, coexisting
pseudoexfoliation (PXF), and intraoperative use of ophthalmic viscosurgical
devices (OVDs), pupil size, complications, IFIS grading and the need for
additional operative strategies to manage IFIS. Elongated corneal incisions were 
performed approximately 1 mm anterior to the limbus.
RESULTS: Ninety-three eyes of 81 men were included. Mean age was 76.5 years
(range 55 to 96 years). Forty-seven eyes (40 patients) had documented use of
alfuzosin and 45 eyes (40 patients) of tamsulosin. One patient received both. The
overall rate of IFIS was 22.6 % (n = 21). Eyes of patients who were treated with 
alfuzosin had a milder grading (p < 0.001) and an overall lower percentage of
IFIS compared to tamsulosin (4.26 % versus 42.22 % respectively, p < 0.001). No
additional strategies were used to manage IFIS during surgery. No intraoperative 
complications occurred.
CONCLUSION: Anterior elongated incisions are simple and efficient in preventing
IFIS, exempting the surgeon from the use of additional expensive devices or
materials in most cases. They do not limit the surgeon to one strategy, and
therefore, if necessary, another may be applied at any given time.

PMID: 26553196   [PubMed - as supplied by publisher]


12. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 9. [Epub ahead of print]

Effect of a topical nonsteroidal anti-inflammatory agent (0.1 % pranoprofen) on
acute central serous chorioretinopathy.

An SH(1), Kwon YH(2).

Author information: 
(1)Department of Ophthalmology, Dong-A University Hospital, 3-1.
Dongdaeshin-Dong, Seo-gu, Busan, 602-715, Republic of Korea. (2)Department of
Ophthalmology, Dong-A University Hospital, 3-1. Dongdaeshin-Dong, Seo-gu, Busan, 
602-715, Republic of Korea. yhkwon@dau.ac.kr.

PURPOSE: To investigate the effects of topical pranoprofen 0.1 % on acute central
serous chorioretinopathy (CSC).
METHODS: The medical records of 52 cases (52 patients) of CSC were
retrospectively reviewed. Twenty-six patients were treated with topical
pranoprofen 0.1 % (treatment group) and 26 patients did not receive treatment
(control group). Baseline and follow-up values for visual acuity, subfoveal
choroidal thickness (SCT), subretinal fluid (SRF) maximum height, and central
macular thickness (CMT) were examined and compared between groups.
RESULTS: In the treatment group, mean SCT decreased from 365.5 ± 52.9 μm at
baseline to 288.9 ± 36.1 μm at 6 months after initiation of treatment
(p = 0.005). Both SRF maximum height and CMT were also decreased from baseline at
1 month (SRF maximum height, baseline: 221.5 ± 108.4, 1 month: 97.7 ± 54.3 μm,
p = 0.002; CMT, baseline: 403.9 ± 114.6, 1 month: 270.1 ± 37.9 μm, p = 0.003). In
the control group, SCT decreased throughout the follow-up period, but the change 
was not significant. Subretinal fluid maximum height and CMT were significantly
decreased after 3 months in the control group (SRF, baseline: 265.4 ± 112.4 μm,
6 months: 64.8 ± 116.9 μm, p = 0.005; CMT, baseline: 459.1 ± 104.9 μm, 6 months: 
304.6 ± 92.8 μm, p < 0.001). Visual acuity was improved from baseline in both
groups after 6 months, but the improvement was only significant in the treatment 
group (p = 0.002). The rate of disease recurrence was lower in the treatment
group (23 %) than in the control group (38 %), but this difference between groups
was not statistically significant (p = 0.229, chi-square test).
CONCLUSIONS: Topical pranoprofen 0.1 % was effective in treating acute CSC, as
demonstrated by an increase in visual acuity and a decrease in SRF, SCT, and CMT 
after treatment. These results suggest that topical pranoprofen 0.1 % may be
useful in treating patients with acute CSC.

PMID: 26553195   [PubMed - as supplied by publisher]


13. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 5. [Epub ahead of print]

Impaired systemic vascular endothelial function in patients with non-arteritic
anterior ischaemic optic neuropathy.

Yao F(1), Wan P(2), Su Y(2), Liao R(2), Zhu W(3).

Author information: 
(1)Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen
University, Guangzhou, China, 510080. (2)Department of Ophthalmology, The First
Affiliated Hospital of Sun Yat-sen University, #58 Zhongshan Second Road,
Guangzhou, Guangdong, China, 510080. (3)Department of Ophthalmology, The First
Affiliated Hospital of Sun Yat-sen University, #58 Zhongshan Second Road,
Guangzhou, Guangdong, China, 510080. dctzwh@139.com.

PURPOSE: The purpose of this study was to evaluate systemic endothelial function 
in elderly hypertension patients with non-arteritic anterior ischaemic optic
neuropathy (NAION) by using a noninvasive physiological method:
endothelium-dependent, flow-mediated vasodilation (FMD).
METHODS: Forty-two systemic hypertension patients with NAION (NAION group), 64
age- and sex-matched patients with systemic hypertension and no other ocular
disease (hypertension group), and 100 age- and sex-matched healthy volunteers
(normal group) were enrolled. FMD was evaluated using a high-resolution
ultrasonography. Traditional cardiovascular risk factors and vascular parameters 
were measured.
RESULTS: Systolic blood pressure and diastolic blood pressure were significantly 
higher in patients with NAION compared with the control groups (p < 0.001). The
FMD decreased significantly in the NAION group (6.02 ± 1.87 %) compared to in the
hypertension group (7.86 ± 2.94 %, p < 0.001) and the normal group
(8.99 ± 2.44 %, p < 0.001). By multivariable logistic regression analysis, FMD
was significantly associated with NAION (OR, 1.79; 95%CI, 1.67-2.01).
CONCLUSIONS: NAION may be associated with systemic vascular endothelial
dysfunction. FMD might be useful in the treatment monitoring of NAION.

PMID: 26542122   [PubMed - as supplied by publisher]


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

Spectral-domain optical coherence tomography findings of tractional retinal
elevation in patients with diabetic retinopathy.

Kim YC(1), Shin JP(2).

Author information: 
(1)Department of Ophthalmology, Keimyung University School of Medicine Dongsan
Medical Center, 56, Dalseong-ro, Jung-gu, Daegu, 41931, Korea. eyedr@dsmc.or.kr. 
(2)Department of Ophthalmology, School of Medicine, Kyungpook National
University, Daegu, Korea.

PURPOSE: To evaluate the clinical and morphological characteristics as well as
the surgical outcomes of tractional retinal elevation (TRE) in patients with
proliferative diabetic retinopathy (PDR) by analyzing spectral-domain optical
coherence tomography (SD-OCT).
METHODS: SD-OCT images of 26 eyes (24 patients) who visited our clinic because of
TRE and PDR from August 2011 to August 2014 were reviewed. According to the
presence or absence of tractional retinal detachment (TRD), patients were
classified into group 1 (without TRD) or group 2 (with TRD), and the clinical
characteristics and surgical outcomes of the two groups were compared.
Furthermore, we categorized the SD-OCT morphological components into sponge,
cystoid, saw tooth, bridging columnar, and TRD and compared the characteristics
among patients who had different components.
RESULTS: Group 1 had 18 eyes and group 2 had eight eyes. No differences in age,
best corrected visual acuity (BCVA), or spherical equivalent were observed
between the two groups, but group 2 had longer axial length than that of group 1 
(p = 0.02). A large variety of combined OCT findings was found in group 1
compared to that in group 2. TRD was the least combined form with the other
morphological components. Although 92 % of eyes with the bridging columnar
component had the cystoid component, TRD and tractional retinoschisis (TRS,
bridging columnar morphology) were combined in only one eye.
CONCLUSION: Diabetic TRE may progress to TRD or TRS, which are mutually
exclusive. They may progress to TRD in eyes with a long axial length, and cystoid
macular edema seems to develop into TRS.

PMID: 26542121   [PubMed - as supplied by publisher]


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

A new principle for the standardization of long paragraphs for reading speed
analysis.

Radner W(1), Radner S(2), Diendorfer G(3).

Author information: 
(1)Austrian Academy of Ophthalmology, Mollgasse 11, A-1180, Vienna, Austria.
wolfgang.radner@inode.at. (2)Austrian Academy of Ophthalmology, Mollgasse 11,
A-1180, Vienna, Austria. stephan.radner@gmx.net. (3)Department of Phoniatrics,
Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
gabriela.diendorfer@meduniwien.ac.at.

PURPOSE: To investigate the reliability, validity, and statistical comparability 
of long paragraphs that were developed to be equivalent in construction and
difficulty.
METHODS: Seven long paragraphs were developed that were equal in syntax,
morphology, and number and position of words (111), with the same number of
syllables (179) and number of characters (660). For validity analyses, the
paragraphs were compared with the mean reading speed of a set of seven sentence
optotypes of the RADNER Reading Charts (mean of 7 × 14 = 98 words read).
Reliability analyses were performed by calculating the Cronbach's alpha value and
the corrected total item correlation. Sixty participants (aged 20-77 years) read 
the paragraphs and the sentences (distance 40 cm; font: Times New Roman 12 pt).
Test items were presented randomly; reading length was measured with a stopwatch.
RESULTS: Reliability analysis yielded a Cronbach's alpha value of 0.988. When the
long paragraphs were compared in pairwise fashion, significant differences were
found in 13 of the 21 pairs (p < 0.05). In two sequences of three paragraphs each
and in eight pairs of paragraphs, the paragraphs did not differ significantly,
and these paragraph combinations are therefore suitable for comparative research 
studies. The mean reading speed was 173.34 ± 24.01 words per minute (wpm) for the
long paragraphs and 198.26 ± 28.60 wpm for the sentence optotypes. The maximum
difference in reading speed was 5.55 % for the long paragraphs and 2.95 % for the
short sentence optotypes. The correlation between long paragraphs and sentence
optotypes was high (r = 0.9243).
CONCLUSIONS: Despite good reliability and equivalence in construction and degree 
of difficulty, a statistically significant difference in reading speed can occur 
between long paragraphs. Since statistical significance should be dependent only 
on the persons tested, either standardizing long paragraphs for statistical
equality of reading speed measurements or increasing the number of presented
paragraphs is recommended for comparative investigations.

PMID: 26542120   [PubMed - as supplied by publisher]


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

Inter-device size variation of small choroidal nevi measured using stereographic 
projection ultra-widefield imaging and optical coherence tomography.

Maloca P(1), Gyger C(2), Schoetzau A(2), Hasler PW(2).

Author information: 
(1)Department of Ophthalmology, OCTlab, University of Basel, Mittlere Strasse 91,
CH-4056, Basel, Switzerland. info@dr-maloca.ch. (2)Department of Ophthalmology,
OCTlab, University of Basel, Mittlere Strasse 91, CH-4056, Basel, Switzerland.

PURPOSE: Our purpose was to compare the tumor sizes of small choroidal nevi using
ultra-widefield imaging (UWF) and different optical coherence tomography systems.
METHODS: Thirteen choroidal nevi were measured using automatic and manual
segmentation techniques, including enhanced depth imaging spectral-domain optical
coherence tomography (EDI-SDOCT) and 1050 nm swept source OCT (SSOCT), to compare
to measurements obtained using the Optos projection ultra-widefield fundus (UWF) 
imaging technique. Segmentation artifacts were evaluated for all 13 cases,
alongside an additional 12 choroidal nevi, using SSOCT.
RESULTS: In tumor eyes, segmentation artifacts for the choroid-sclera interface
were found in 42 % of SSOCT scans. EDI-SDOCT can underestimate tumor dimensions
and differs up to -8.41 % compared to UWF imaging and by 1.25 % compared to SSOCT
cases. The horizontal length of the nevi showed an average difference between
EDI-SDOCT and SSOCT of ± 9.38 %. Measured markers showed an average difference in
length of ± 12.51 %. The average tumor thickness showed a difference
of ± 11.47 %. Comparisons between EDI-SDOCT/UWF, SSOCT/EDI-SDOCT, and marker
EDI-SDOCT/SSOCT showed significant mean differences of -122 μm (CI: -212 to
-31 μm, p = 0.013), 134 μm (CI: 65-203 μm, p = 0.0012), and -193 μm (CI: -345 to 
-41 μm, p = 0.017), whereas SSOCT/UWF showed no significant difference with a
measurement of 13 μm (CI: -69-95 μm, p = 0.74).
CONCLUSIONS: Automatic segmentation of nevi requires much caution, because a
choroidal tumor can trigger many artifacts. It would be beneficial to monitor
choroidal nevi using the same type of OCT technology, because a tumor is
displayed differently.

PMID: 26537123   [PubMed - as supplied by publisher]


17. Graefes Arch Clin Exp Ophthalmol. 2015 Nov 4. [Epub ahead of print]

Extensively and pan-drug resistant Pseudomonas aeruginosa keratitis: clinical
features, risk factors, and outcome.

Fernandes M(1), Vira D(2), Medikonda R(2), Kumar N(3).

Author information: 
(1)Cornea and Anterior Segment Services, L. V. Prasad Eye Institute,
Visakhapatnam, Andhra Pradesh, 530040, India. merle@lvpei.org. (2)Cornea and
Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, Andhra
Pradesh, 530040, India. (3)Ocular Microbiology Department, L. V. Prasad Eye
Institute, Visakhapatnam, Andhra Pradesh, 530040, India.

BACKGROUND: Emergence of multi-drug resistant (MDR), extensively drug resistant
(XDR), and pan-drug resistant (PDR) strains of Pseudomonas aeruginosa pose a
significant therapeutic challenge. Managing XDR and PDR Pseudomonas aeruginosa
keratitis would be extremely difficult due to paucity of safe and effective
topical medications. We aim to describe the clinical features, risk factors, and 
outcome of XDR and PDR Pseudomonas aeruginosa keratitis.
METHODS: A retrospective chart review of consecutive cases of XDR and PDR
Pseudomonas aeruginosa keratitis were identified from Ocular Microbiology
Department. XDR and PDR were defined based on criteria established by Centers for
Disease Control and European Centre for Disease Prevention and Control. The
following data was collected: age, gender, occupation, symptom duration, systemic
and ocular risk factors, infiltrate characteristics, antimicrobial
susceptibility, complications, surgical interventions, presenting, and final
visual acuity and final outcome. Complete success was defined as resolution of
the infiltrate with scar formation on medical treatment alone. Partial success
was the resolution following tissue adhesive application. Failure was an
inadequate response to medical therapy with progressive increase in infiltrate,
corneal melting, and/or perforation necessitating one or more therapeutic
penetrating keratoplasties or evisceration.
RESULTS: Fifteen eyes of 13 patients were included. Seven (53.8 %) were male with
left eye involvement in nine (60 %) cases. Most common risk factors were bandage 
contact lens (6, 40 %), topical steroids (5, 33.3 %), previous therapeutic graft 
(4, 26.6 %), and ocular surface disorder (OSD) following Stevens Johnson Syndrome
(SJS) (4, 26.6 %). Of 15 isolates, six (40 %) were sensitive only to imipenem,
three (20 %) to colistin, two (13.3 %) to neomycin, one (6.7 %) each to imipenem 
and colistin, imipenem and ceftazidime, and azithromycin respectively. One
isolate was resistant to all antibiotics. Complete success was noted in two
(16.67 %), partial success in three (25 %) and failure in seven (58.33 %) eyes.
Five (33.3 %) eyes healed on imipenem (three eyes), azithromycin (one eye), and
imipenem and colistin (one eye).
CONCLUSION: XDR and PDR Pseudomonas aeruginosa keratitis are extremely difficult 
to treat. Globe salvage was possible in all cases; however, more than half
required therapeutic grafts. Close monitoring of patients with known ocular and
systemic factors is warranted.

PMID: 26537122   [PubMed - as supplied by publisher]


18. Graefes Arch Clin Exp Ophthalmol. 2015 Oct 31. [Epub ahead of print]

Long-term results of ab externo trabeculotomy for glaucoma secondary to chronic
uveitis.

Voykov B(1), Dimopoulos S(2), Leitritz MA(2), Doycheva D(2), William A(2).

Author information: 
(1)Centre for Ophthalmology, University of Tuebingen, Schleichstr. 12-16, 72076, 
Tuebingen, Germany. bogomil.voykov@med.uni-tuebingen.de. (2)Centre for
Ophthalmology, University of Tuebingen, Schleichstr. 12-16, 72076, Tuebingen,
Germany.

PURPOSE: To present the long-term results of ab externo trabeculotomy in the
management of glaucoma secondary to chronic uveitis.
METHODS: In this retrospective single-centre case series, medical records of
patients with glaucoma secondary to chronic uveitis, who underwent ab externo
trabeculotomy, were evaluated. Two definitions of success were used: intraocular 
pressure (IOP) 6 ≤ IOP ≤ 21 mmHg (success 1) or 6 ≤ IOP ≤ 21 mmHg and at least
25 % reduction from baseline (success 2). Success was complete when no additional
medication was required or qualified when additional medication or cycloablative 
procedures were required to achieve the specific IOP definition.
RESULTS: Twenty-two eyes of 18 patients were included. After 3 years, median IOP 
decreased from 27 mmHg [range 17-43 mmHg, mean 27.5 mmHg, 95 % confidence
interval of the mean (CI) 24.5-30.5 mmHg] to 15 mmHg (range 9-19 mmHg, mean
14.5 mmHg, CI 13-16.1 mmHg). Complete and qualified success 1 was 23 and 45 %
after 3 years, respectively. For success 2, the rates were 23 and 32 %,
respectively. Hyphema was the most common complication, which resolved completely
within 1 month after surgery without further intervention.
CONCLUSION: Trabeculotomy ab externo was moderately successful in glaucoma
secondary to chronic uveitis after 3 years. No sight-threatening complications
were observed during the follow-up period.

PMID: 26520445   [PubMed - as supplied by publisher]


19. Graefes Arch Clin Exp Ophthalmol. 2015 Oct 31. [Epub ahead of print]

Baerveldt tube implantation following failed deep sclerectomy versus repeat deep 
sclerectomy.

Bergin C(1), Petrovic A(1), Mermoud A(2), Ravinet E(2), Sharkawi E(3).

Author information: 
(1)Jules-Gonin Hôpital Ophtalmique, Avenue de France 15, Lausanne, 1004,
Switzerland. (2)Clinic Montchoisi, Lausanne, Switzerland. (3)Jules-Gonin Hôpital 
Ophtalmique, Avenue de France 15, Lausanne, 1004, Switzerland.
eamon.sharkawi@fa2.ch.

PURPOSE: To compare the surgical outcomes of repeat deep sclerectomy (DS) and the
Baerveldt glaucoma implant (BGI) in eyes with failed primary deep sclerectomy.
DESIGN: A retrospective comparative case-control study.
METHODS: Fifty-eight eyes of 56 glaucoma patients with previously failed DS
underwent BGI (group BGI) and 58 eyes of 55 patients underwent repeat DS (group
DS) at a tertiary referral centre. Visual acuity, intraocular pressure (IOP),
number of glaucoma medications, surgical failure rates and complication rates
were compared between groups. Surgical failure was defined as loss of IOP
control, loss of light perception, or need for further glaucoma surgery.
RESULTS: Baseline demographics were similar between groups. Preoperatively,
median IOP was lower in the DS than the BGI group (19 mmHg versus 21 mmHg,
p = 0.10). Postoperatively at year 1, median IOP was significantly higher in the 
DS than BGI group (14 mmHg versus 11 mmHg, p = 0.02). There were no differences
between the DS and BGI groups in mean number of medications preoperatively (2.3
versus 2.6) or postoperatively (1.3 versus 1.1). Complication rates were
significantly higher in the DS group [41 % (n = 24) versus 14 % (n = 8);
p = 0.01]. The failure rate at 1 year was higher in eyes with repeat DS than in
eyes with BGI (30 vs. 21 %, respectively; p = 0.07).
CONCLUSIONS: Baerveldt implants were more effective in lowering IOP and resulted 
in significantly fewer complications than repeat deep sclerectomy in eyes with
previously failed deep sclerectomy.

PMID: 26520444   [PubMed - as supplied by publisher]


20. Graefes Arch Clin Exp Ophthalmol. 2015 Oct 30. [Epub ahead of print]

The association between systemic oxidative stress and ocular blood flow in
patients with normal-tension glaucoma.

Himori N(1), Kunikata H(1,)(2), Shiga Y(1), Omodaka K(1), Maruyama K(1),
Takahashi H(1), Nakazawa T(3,)(4,)(5).

Author information: 
(1)Department of Ophthalmology, Tohoku University Graduate School of Medicine,
1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan. (2)Department of Retinal
Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.
(3)Department of Ophthalmology, Tohoku University Graduate School of Medicine,
1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan. ntoru@oph.med.tohoku.ac.jp.
(4)Department of Retinal Disease Control, Tohoku University Graduate School of
Medicine, Sendai, Japan. ntoru@oph.med.tohoku.ac.jp. (5)Department of Advanced
Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai,
Japan. ntoru@oph.med.tohoku.ac.jp.

PURPOSE: To evaluate the association between ocular blood flow and biomarkers of 
systemic oxidative stress, as well as the potential of these biomarkers to assess
normal-tension glaucoma (NTG).
METHODS: This study included 73 eyes of 73 patients with NTG. We assessed ocular 
blood flow by measuring mean blur rate (MBR) in the optic nerve head using laser 
speckle flowgraphy, both overall and separately in the vessel and tissue areas.
We also measured urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and skin
autofluorescence (SAF), and lastly, determined correlations between these
measurements and with other clinical parameters.
RESULTS: SAF was correlated with age, circumpapillary retinal nerve fiber layer
thickness (cpRNFLT), mean deviation (MD), and overall MBR (P = 0.003, P = 0.013, 
P = 0.015 and P = 0.006, respectively). SAF and 8-OHdG were both correlated with 
tissue-area MBR (P = 0.006 and P = 0.010, respectively). Visual acuity, cpRNFLT, 
mean deviation and tissue-area MBR had a significant tendency to change with NTG 
severity (P = 0.014, P < 0.001, P < 0.001 and P = 0.006, respectively). Multiple 
regression analysis revealed that cpRNFLT and 8-OHdG were independent
contributing factors to MD (P < 0.001 and P = 0.040, respectively), and that
cpRNFLT and 8-OHdG were independent contributing factors to tissue-area MBR
(P = 0.005 and P = 0.028, respectively).
CONCLUSIONS: We found a close relationship between cpRNFLT, MD, tissue MBR, SAF
and 8-OHdG, suggesting that systemic oxidative stress is associated with
decreased ocular blood flow and may be involved in the pathogenesis of NTG.

PMID: 26514963   [PubMed - as supplied by publisher]


21. Graefes Arch Clin Exp Ophthalmol. 2015 Oct 29. [Epub ahead of print]

Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy for
retinoblastoma with vitreous seeds.

Lee JH(1), Han JW(2), Hahn SM(2), Lyu CJ(2), Kim DJ(3), Lee SC(4).

Author information: 
(1)Department of Ophthalmology, The Institute of Vision Research, Yonsei
University College of Medicine, Seoul, Korea. (2)Department of Pediatric
Hematology and Oncology, Yonsei University College of Medicine, Seoul, Korea.
(3)Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. 
(4)Department of Ophthalmology, The Institute of Vision Research, Yonsei
University College of Medicine, Seoul, Korea. sunglee@yuhs.ac.

PURPOSE: We aimed to evaluate the therapeutic effect and complications of
combined intravitreal melphalan and intravenous/intra-arterial chemotherapy as a 
primary approach for retinoblastoma with vitreous seeds.
METHODS: In this retrospective case series, eight eyes from eight retinoblastoma 
patients with vitreous seeds were included. All eyes received 20-30 μg of
intravitreal melphalan accompanied by intravenous and intra-arterial
chemotherapy. Triple freeze-thaw cryotherapy was performed when withdrawing the
needle from the eye to prevent tumor dissemination.
RESULTS: Tumors and vitreous seeds regressed in all eyes. The mean number of
intravitreal melphalan injections was 3.25 (median 3.50, range 2-4). Globe
salvage was attained in seven of eight eyes (87.5 %). Enucleation was performed
in one case, in which the pathologic section showed no residual tumor and
tumor-free resection margins. Serous retinal detachment was observed in four eyes
(50 %), and vitreous hemorrhage developed in two (25 %). Retinal pigment
epithelium atrophy or mottling was found in three eyes (37.5 %). There were no
cases of extraocular tumor extension or remote metastasis.
CONCLUSIONS: Combined intravitreal melphalan and intravenous/intra-arterial
chemotherapy was effective for tumor and vitreous seeding control, but
vision-threatening complications such as vitreous hemorrhage or serous retinal
detachment occurred in half the cases.

PMID: 26511530   [PubMed - as supplied by publisher]


22. Graefes Arch Clin Exp Ophthalmol. 2015 Oct 27. [Epub ahead of print]

Minimally fibrotic stage 5 ROP: a clinical prognostic factor in eyes undergoing
vitrectomy for stage 5 retinopathy of prematurity.

Gadkari SS(1), Deshpande M(2), Kulkarni S(2).

Author information: 
(1)Department of Vitreoretina surgery, PBMA's H V Desai Eye Hospital, Hadapsar,
Pune, 411060, India. drgadkari@gmail.com. (2)Department of Vitreoretina surgery, 
PBMA's H V Desai Eye Hospital, Hadapsar, Pune, 411060, India.

TITLE: Minimally fibrotic Stage 5: A clinical prognostic factor in eyes
undergoing vitrectomy for stage 5 retinopathy of prematurity (ROP).
PURPOSE: To define minimally fibrotic stage 5 ROP and to demonstrate better
surgical outcomes in this subgroup.
METHODS: A cohort of eligible eyes with stage 5 ROP undergoing vitrectomy were
further divided into those with minimally fibrotic stage 5 and others. Minimally 
fibrotic stage 5 ROP was defined as those stage 5 eyes having a translucent
retrolental membrane with visibility of the underlying retinal vessels and
absence of anteriorly rotated ciliary processes. We reported on anatomic and
visual outcomes in eyes with defined characteristics of this subgroup identified 
before surgery and then observing them post vitrectomy over a period of time as
compared to others.
RESULTS: Minimally fibrotic stage 5 eyes had better visual (p = .0068) and
anatomical outcomes (p = .0001).
CONCLUSION: Minimally fibrotic stage 5 ROP shows ridge to ridge traction that has
resulted in a traction retinal detachment with a retrolental membrane, but
fibrotic change has just begun. This stage 5 ROP with limited fibrosis represents
a subset of this stage 5 ROP with a positive anatomic and visual prognosis.

PMID: 26507399   [PubMed - as supplied by publisher]


23. Graefes Arch Clin Exp Ophthalmol. 2015 Dec;253(12):2279-84. doi:
10.1007/s00417-015-3198-5. Epub 2015 Oct 27.

Rituximab in the treatment of refractory scleritis in patients with
granulomatosis with polyangiitis (Wegener's).

Recillas-Gispert C(1), Serna-Ojeda JC(2), Flores-Suárez LF(3).

Author information: 
(1)Ophthalmology, Instituto Nacional de Ciencias Medicas y Nutrición "Salvador
Zubirán", Mexico City, Mexico. (2)Instituto de Oftalmologia "Conde de
Valenciana", Mexico City, Mexico. (3)Primary Systemic Vasculitides Clinic,
Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502. Col.
Sección XVI, C.P. 14080, Mexico City, Mexico. felipe98@prodigy.net.mx.

PURPOSE: The purpose of this descriptive study was to evaluate the clinical
response to rituximab (RTX) in patients with scleritis due to granulomatosis with
polyangiitis (GPA), in patients who had proved refractory to treatment with
systemic glucocorticoids and immunosuppressive agents.
METHODS: Retrospective analysis of interventional case series. Single referral
center study. Eight patients (12 affected eyes) due to scleritis secondary to
GPA, refractory to conventional treatment were included to receive RTX as therapy
for remission induction. RTX was administered as a 1-g infusion every 2 weeks,
for a total of 2 g. Patient follow-up included clinical evaluation (systemic and 
ophthalmologic), B-cell subset (CD19, CD20, CD22) counts, proteinase-3
anti-neutrophil cytoplasmic antibody (PR-3 ANCA), and Birmingham Vasculitis
Activity Score for Wegener's granulomatosis (BVAS-WG). Outcomes were response to 
treatment and achievement of remission, as well as number of ocular relapses.
RESULTS: The main indication for treatment was refractory necrotising anterior
scleritis. Four weeks after completion of treatment with RTX, all patients showed
clear clinical improvement, with no further progression. In all patients, an
absolute depletion of B cells was confirmed in the first 6 weeks after treatment.
Seven patients (87.5 %) achieved remission of inflammatory activity in 7 months
or less. However, three patients experienced ocular relapse, which comprised
reactivation of the anterior scleritis, uveitis, and posterior scleritis, and two
patients required a second dose of RTX, with immediate improvement.
CONCLUSIONS: RTX is useful in the treatment of refractory necrotising scleritis
in patients with GPA. Of note, in those who relapse after remission, RTX can be
successfully used for retreatment.

PMID: 26507398   [PubMed - in process]


24. Graefes Arch Clin Exp Ophthalmol. 2015 Oct 21. [Epub ahead of print]

Investigating the ocular temperature rise during femtosecond laser lens
fragmentation: an in vitro study.

Mencucci R(1), Matteoli S(2), Corvi A(2), Terracciano L(3), Favuzza E(3),
Gherardini S(4), Caruso F(5), Bellucci R(6).

Author information: 
(1)Department of Surgery and Translational Medicine, Eye Clinic, University of
Florence, Largo Brambilla 3, 50134, Florence, Italy. rita.mencucci@unifi.it.
(2)Department of Industrial Engineering, University of Florence, Florence, Italy.
(3)Department of Surgery and Translational Medicine, Eye Clinic, University of
Florence, Largo Brambilla 3, 50134, Florence, Italy. (4)INFN, CSDC, Department of
Information Engineering, University of Florence, Florence, Italy. (5)QSTAR, LENS,
Department of Physics and Astronomy, University of Florence, Florence, Italy.
(6)Ophthalmic Unit, University Hospital, Verona, Italy.

PURPOSE: To investigate the trend of temperature variation during lens
fragmentation simulated by a femtosecond laser on an in vitro eye model.
METHODS: In our experimental study, a convex cylinder of gelatinous material,
usually employed in femtosecond laser calibration, was used to simulate both an
anterior segment and a crystalline lens during fragmentation performed with the
Victus femtosecond laser (Technolas Perfect Vision GmbH, Germany; Bausch + Lomb
Incorporated, USA). Two radiated energies (7000 nJ and 9000 nJ) and three cutting
patterns (crosses, circles and cross + circle) were applied. Trends of
temperature variation as a function of time were obtained using a T-type
thermocouple.
RESULTS: The maximum value of temperature rise during lens fragmentation ranged
from 3.53 to 5.13 °C; the rise was directly proportional to the intensity of the 
radiated energy (7000 nJ or 9000 nJ) and the cutting pattern performed. This
behavior was experimentally represented by an asymmetric function with a
characteristic bell curve shape, whereas it was mathematically described by a
transport diffusive model.
CONCLUSIONS: Since the temperature rise at the fragmentation volume base resulted
to be around 5 °C in our in vitro study, lens fragmentation performed using the
Victus femtosecond laser might be considered safe form a thermal point of view.

PMID: 26490374   [PubMed - as supplied by publisher]


25. Graefes Arch Clin Exp Ophthalmol. 2015 Oct 21. [Epub ahead of print]

Functional assessment of the fundus autofluorescence pattern in Best vitelliform 
macular dystrophy.

Parodi MB(1), Iacono P(2), Del Turco C(1), Triolo G(1), Bandello F(1).

Author information: 
(1)Department of Ophthalmology, Scientific Institute San Raffaele, University
Vita-Salute, Milano, Italy. (2)Fondazione G. B. Bietti per l'Oftalmologia, IRCCS 
(Istituto di Ricovero e Cura a Carattere Scientifico), Via Livenza 3, Rome,
Italy. pierluigi.iacono@libero.it.

PURPOSE: To identify the fundus autofluorescence (FAF) patterns in Best
vitelliform macular dystrophy (VMD).
METHODS: Patients affected by VMD in vitelliform, pseudohypopyon, and
vitelliruptive stages underwent a complete ophthalmological examination,
including best-corrected visual acuity (BCVA), short-wavelength FAF (SW-FAF),
near-infrared FAF (NIR-FAF) and microperimetry.
MAIN OUTCOME MEASURES: the identification of the correlation between SW-FAF and
NIR-FAF patterns of the foveal region with BCVA, and central retinal sensitivity 
in eyes affected by VMD. The secondary outcomes included the definition of the
frequency of foveal patterns on SW-FAF and NIR-FAF.
RESULTS: Thirty-seven of 64 (58 %), 8 of 64 (12.5 %) and 19 of 64 (29.5 %) eyes
showed vitelliform, pseudohypopyon, and vitelliruptive stages respectively. Three
main FAF patterns were identified on both techniques: hyper-autofluorescent
pattern, hypo-autofluorescent pattern, and patchy pattern. BCVA was significantly
different in eyes with hypo-autofluorescent and patchy patterns with respect to
eyes showing a hyper-autofluorescent pattern. Similar differences were registered
in the FS according to SW-FAF classification. However, the FS differed in each
subgroup in the NIR-FAF analysis. Subgroup analyses were performed on the patchy 
pattern, combining FAF and fundus abnormalities. Considering both FAF techniques,
the BCVA differed between the vitelliform and pseudohypopyon stages, and between 
the vitelliform and vitelliruptive stages. In the NIR-FAF classification, there
was a significant statistical difference in the FS between each subgroup; in the 
SW-FAF, there was a significant difference between the vitelliform and
pseudohypopyon stages and the vitelliform and vitelliruptive stages.
CONCLUSIONS: Three main FAF patterns can be identified in VMD. The patchy pattern
is the most frequent, accounting for 70 % of eyes on SW-FAF and 80 % of eyes on
NIR-FAF. A tighter correlation links the classification of NIR-FAF patterns and
FS. Longitudinal investigations are warranted to evaluate the course of FAF
patterns and their role in disease monitoring.

PMID: 26490373   [PubMed - as supplied by publisher]