Journal Contents

Am Jour Ophthalmol
Br J Ophthalmol
Can J Ophthalmol
J Cat Ref Surg
Curr Eye Res
Eur J Ophthalmol
J Glaucoma
JAMA Ophthalmol
Graefes Ophthalmol
Indian J Ophthalmol
Int Ophthalmol Clin
Invest Ophth Vis Sci
Jpn J Ophthalmol
Korean J Ophthal
J Neuroophthalmol
Ophthalmic Epidemiol
Ophthalmic Genet
Ophthal Plast Rec Surg
Ophthalmic Res
Surv Ophthalmol
Ophthalmology Review Journal
Graefes Arch Clin Exp Ophthalmol[JOUR] Established 1995
1. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 30. [Epub ahead of print]

CCL20/MIP-3 alpha mRNA expression in the conjunctival epithelium of normal
individuals and patients with vernal keratoconjunctivitis.

Inada N(1), Ishimori A, Shoji J.

Author information: 
(1)Division of Ophthalmology, Department of Visual Sciences, Nihon University School
of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-ku, Tokyo, 173-8610, Japan,

BACKGROUND: CCL20, the single chemokine ligand for CCR6, contributes to
recruiting CCR6-expressing memory B cells, memory T cells, Th17 cells and
dendritic cells, and is involved in regulating immune responses, homeostasis, and
inflammation in mucosal tissues.
METHODS: CCL20 messenger RNA (mRNA) expression was analyzed in the conjunctival
epithelium in an in vivo study of patients with vernal keratoconjunctivitis (VKC 
group) and healthy volunteers (control group) using impression cytology. In vitro
analysis of CCL20 mRNA was performed using cultured conjunctival epithelial cells
(CECs). Real-time polymerase chain reaction was used to assess IL-8 and eotaxin-2
mRNA expression for comparison with CCL20 mRNA expression.
RESULTS: In the control group, CCL20 mRNA expression was present in all
conjunctival locations. However, CCL20 mRNA expression was significantly higher
in the upper palpebral conjunctiva in the severe VKC group than in the mild VKC
and control groups (p < 0.05, Steel test). In vitro stimulation of CECs with
lipopolysaccharide (LPS) significantly increased CCL20 expression in a
concentration-dependent manner that was significantly correlated with expression 
of IL-8 (p < 0.001, Spearman's rank correlation coefficient), but not eotaxin-2.
CONCLUSION: We conclude that CCL 20 mRNA expression in the conjunctival
epithelium plays a crucial role in regulating homeostasis at the ocular surface
and in exacerbation of VKC.

PMID: 25172034   [PubMed - as supplied by publisher]

2. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 28. [Epub ahead of print]

Structures affecting recovery of macular function in patients with age-related
macular degeneration after intravitreal ranibizumab.

Nishimura T(1), Machida S, Hashizume K, Kurosaka D.

Author information: 
(1)Department of Ophthalmology, Iwate Medical University School of Medicine, 19-1
Uchimaru, Morioka, Iwate, 020-8505, Japan.

PURPOSE: To determine the retinal structures affecting the recovery of macular
function in patients with exudative age-related macular degeneration (AMD)
treated with intravitreal ranibizumab (IVR).
METHOD: Thirty eyes of 30 patients with exudative AMD who were treated with IVR
at monthly intervals for 3 months were studied. Focal macular electroretinograms 
(fmERGs) and spectral-domain optical coherence tomography (SD-OCT) were performed
before and 3 months after beginning the IVR injections. The fmERGs were elicited 
by a 15° white stimulus spot centered on the fovea. The thickness of different
retinal layers, presence of a serous retinal detachment (SRD), and presence of a 
pigment epithelial detachment (PED) at the fovea was determined in the SD-OCT
images. Measurements were made of the inner, middle, and outer layers of the
retina and also of the SRD and PED in the horizontal and vertical meridians at
1.2 mm from the fovea (parafoveal regions). The significance of the correlations 
between these structural parameters and the a-wave amplitude of the fmERG was
RESULTS: There was no significant correlation between the structural parameters
of the fovea and the a-wave amplitude. In the parafoveal regions, the thickness
of the outer retinal layer was significantly correlated with an increase of the
a-wave amplitude (R = 0.56, P = 0.001). In addition, the SRD thickness was
negatively and significantly correlated with the a-wave amplitude (R = -0.54,
P = 0.002). The change in the parafoveal SRD thickness after IVRs was the only
independent determinant of recovery of the a-wave amplitude after the treatments 
(P < 0.05).
CONCLUSIONS: The macular function measured by the fmERGs was determined by the
parafoveal outer layer and SRD thickness in patients with exudative AMD. Of
these, changes in the SRD thickness by IVRs most strongly affected the recovery
of macular function.

PMID: 25163415   [PubMed - as supplied by publisher]

3. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 27. [Epub ahead of print]

Cytotoxic activity and degradation patterns of structural proteins by corneal
isolates of Acanthamoeba spp.

Sant'ana VP(1), Carrijo-Carvalho LC, Foronda AS, Chudzinski-Tavassi AM, de
Freitas D, de Carvalho FR.

Author information: 
(1)Department of Ophthalmology and Visual Sciences, Paulista School of Medicine,
Federal University of Sao Paulo, São Paulo, Brazil.

BACKGROUND: Proteolytic enzymes secreted by trophozoites (amoebic secretome) are 
suggested as the main virulence factor involved in the severity of Acanthamoeba
keratitis. The degradation profile of the main glycoprotein components of
anterior and posterior portions of the cornea and the cytopathic effect of
secretomes on endothelial cells by contact-independent mechanism were evaluated.
METHODS: Trophozoites were isolated primarily from corneal tissue samples
(n = 11) and extracellular proteins were collected from axenic cell culture
supernatants. The molecular weights of proteolytic enzymes were estimated by
zymography. Enzymatic cleavage of laminin and fibronectin substrates by amoebic
secretome was investigated and cluster analysis was applied to the proteolysis
profiles. Primary cultures of endothelial cells were used in both qualitative and
quantitative assays of cytophatogenicity.
RESULTS: Differential patterns of proteolysis were observed among the
Acanthamoeba secretomes that were analysed. The uniformity of laminin degradation
contrasted with the diversity of the proteolysis profiles observed in the
fibronectin substrate. Acanthamoeba secretome extracted from four clinical
isolates was shown to be toxic when in contact with the endothelial cell
monolayer (p < 0.01). Induction of apoptosis and membrane permeability, at
different percentual values, were suggested as the main mechanisms that could
induce endothelial cell death when in contact with amoebic secretome.
CONCLUSIONS: Our results provide evidence that virulence factors secreted by
Acanthamoeba trophozoites can be related to an increased pathogenicity pattern by
an independent contact-trophozoite mechanism, through induction of endothelial
cell death by apoptosis at a higher percentage than providing the lack of cell
viability by the membrane-associated pore-forming toxin activity.

PMID: 25161076   [PubMed - as supplied by publisher]

4. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 27. [Epub ahead of print]

Factors affecting laser power in retinal Navilas laser treatment.

Hoeh AE(1), Pollithy S, Dithmar S.

Author information: 
(1)Department of Ophthalmology, University Hospital Heidelberg, Im Neuenheimer Feld 
400, 69120, Heidelberg, Germany,

PURPOSE: To evaluate the effect of patient-associated factors on the minimum
laser power needed for a mild visible burn in focal laser treatments using the
532 nm Navilas laser system.
METHODS: We conducted a monocentric prospective pilot study of 58 eyes of 40
patients with diabetic macular edema. The following parameters were analysed:
axial length, refraction, iris pigmentation, lens status, lens grading and
densitometry, retinal and choroidal thickness and focus setting during treatment.
Laser power was adjusted to produce mild, barely visible burns. Retinal laser
burn size was measured 30 min after treatment.
RESULTS: Focus setting is significantly correlated with retinal lesion size
(r = 0.50, p = 0.001) and laser power (r = 0.44, p < 0.001). Axial length only
correlated with laser power when the effect of focus was controlled. Phakic eyes 
needed more laser power than pseudophakic eyes (78.3 versus 67.2 mW, p = 0.051). 
No correlation of laser power with any other factor could be found.
CONCLUSIONS: Among the examined parameters, focus setting had the strongest
effect on the laser power needed to produce a mild visible burn. The association 
of focus with laser power can be explained by the focus-dependent change of
retinal spot size. Lens status (phakic versus pseudophakic patients) seems to
influence laser light transmission in the examined age group.

PMID: 25161075   [PubMed - as supplied by publisher]

5. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 23. [Epub ahead of print]

Pharmacokinetics of intravenously administered tigecycline in eye compartments:
an experimental study.

Ozcimen M(1), Sakarya Y, Ozcimen S, Goktas S, Sakarya R, Alpfidan I, Erdogan E.

Author information: 
(1)Department of Ophthalmology, Konya Training and Research Hospital, Konya, 42090, 

PURPOSE: The purpose of this study was to evaluate the ocular distribution of
intravenously administered tigecycline in a rabbit uveitis model.
METHODS: Tigecycline, which has a broad spectrum of activity against many
gram-positive, gram-negative, and anaerobic organisms, was given intravenously to
rabbits at 7 mg/kg of body weight starting 24 h after induction of uveitis by
intravitreal endotoxin injection. Tigecycline concentrations were determined by
high performance liquid chromatography-mass spectrometry (LC-MS/MS) assay in the 
aqueous humor, vitreous humor, and plasma 1, 3, 6, and 24 h after administration 
of a single dose.
RESULTS: The maximum concentrations were found within 1 h after the end of the
intravenously given tigecycline, and were 1,308.60 ± 301.76 ng/mL in plasma,
181.40 ± 51.32 ng/mL in vitreous humor and 145.00 ± 55.29 ng/mL in aqueous humor 
of the inflamed eye. After 24 h, no drug was detectable in the aqueous and
vitreous of the normal eyes, whereas small amounts of drug were detectable in
inflamed eyes and in plasma.
CONCLUSIONS: Tigecycline did not reach therapeutically significant levels in the 
aqueous and the vitreous humor of rabbit eyes. The findings suggest a limited
role for intravenously administered tigecycline in the treatment of bacterial

PMID: 25150050   [PubMed - as supplied by publisher]

6. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 23. [Epub ahead of print]

Comparison of Wavelight Allegretto Eye-Q and Schwind Amaris 750S excimer laser in
treatment of high astigmatism.

Bohac M(1), Biscevic A, Koncarevic M, Anticic M, Gabric N, Patel S.

Author information: 
(1)Specialty Eye Hospital "Svjetlost", Heinzelova 39, 10000, Zagreb, Croatia,

PURPOSE: To compare functional outcomes of Wavelight Allegretto Eye-Q 400Hz and
Schwind Amaris 750S excimer laser for astigmatism between 2 and 7 diopters(D).
METHODS: Prospective comparative non-randomized case series of 480 eyes assigned 
in two laser groups and further divided into myopic and mixed astigmatism
subgroups. All treatments were centered on corneal vertex. One-year results were 
compared between the groups. Statistical analysis was performed using z-test.
RESULTS: Both Allegretto and Amaris postoperative uncorrected distance visual
acuity (UDVA) improved in comparison to preoperative corrected distance visual
acuity (CDVA). The difference was significant in the Allegretto group for myopic 
astigmatism (p = 0.017). There was no difference in postoperative UDVA between
lasers. Average sphere decreased in all groups for both lasers (p < 0.001)
without difference in effectiveness of spherical correction between lasers for
both groups. In Allegretto, average cylinder decreased from -3.30D to -0.55D in
myopic astigmatism (p < 0.001) and from -3.84D to -0.85D in mixed astigmatism
(p < 0.001). In Amaris average cylinder decreased from -3.21D to -0.43D in myopic
astigmatism (p < 0.001) and from -3.66D to -0.58D in mixed astigmatism
(p < 0.001). Amaris group had less residual astigmatism (myopic astigmatism
p = 0.023, mixed astigmatism p < 0.001). Mean spherical aberration shifted from
positive to negative in mixed astigmatism for both lasers.
CONCLUSION: Both lasers are effective in terms of UDVA, CDVA, spherical
correction, and preservation of high-order aberrations. However, Amaris was more 
effective in cylinder correction.

PMID: 25150049   [PubMed - as supplied by publisher]

7. Graefes Arch Clin Exp Ophthalmol. 2014 Mar;252(3):375-81.

Branch retinal vein occlusion and vitreovascular traction: a preliminary spectral
domain OCT case-control study.

Ascaso FJ, Padgett E, Núñez E, Villén L, Grzybowski A, Cristóbal JA.

OBJECTIVE: Branch retinal vein occlusion (BRVO) typically occurs at an
arteriovenous (AV) crossing site. Although the pathogenesis is unclear,
vitreovascular traction might have a significant role in some BRVO cases. The
purpose of present study was to determine the incidence of vitreoretinal traction
at the obstruction site in patients diagnosed with BRVO.
METHODS: In this prospective observational case–control study, 32 consecutive
BRVO patients were studied with spectral-domain optical coherence tomography
(SD-OCT) to detect the presence of vitreovascular traction or vitreous adherence 
at the occlusion site.
RESULTS: SD-OCT directed to the occlusion site revealed a vitreovascular traction
at this point in eight eyes (25 %). Fourteen eyes (43.75 %) were associated with 
an adherence of posterior hyaloids without signs of retinal traction, whereas ten
eyes (31.25 %) had neither vitreoretinal adherence nor vitreous traction.
Regarding either the same vessel segment of the fellow eye, none of the cases
revealed vitreovascular traction in the correspondent AV crossing site; 12 cases 
(37.5 %) presented vitreoretinal adherence; and the remaining 20 cases (62.5 %)
showed neither traction nor adhesion. Thus, vitreovascular traction in the
occlusion site was significantly associated with BRVO (p = 0.024, chi-squared
test). B-scan ultrasonography showed that the posterior vitreous cortex remains
more frequently attached in eyes with BRVO compared to unaffected fellow eyes
(p = 0.041, chi-squared test).
CONCLUSIONS: A common firm vitreous adhesion at the obstruction site is reported 
herein, pointing out the possible role of vitreovascular traction in the etiology
of some cases of BRVO. Likewise, although not all BRVO cases can be explained by 
this pathogenic mechanism, an attached posterior vitreous cortex might be a
cofactor in the origin of this entity.

PMID: 25147879   [PubMed - indexed for MEDLINE]

8. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 21. [Epub ahead of print]

Comparison of retinal detachment surgery outcome among patients undergoing pars
plana vitrectomy with and without relaxing retinotomy.

Frenkel T(1), Moisseiev E, Neudorfer M, Loewenstein A, Barak A.

Author information: 
(1)Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

The purpose of this four year retrospective study was to compare the anatomical
and functional outcomes of complicated retinal detachment (RD) surgery by pars
plana vitrectomy (PPV) with and without retinotomy. The main outcome measures
were primary anatomical success (defined as retinal re-attachment at the final
follow-up after a single operation, with or without silicone in situ), final
anatomical success, final best-corrected visual acuity (BCVA) and postoperative
complications. Baseline characteristics did not differ between the groups,
although there was a borderline significant trend for the retinotomy group to be 
associated with worse pre-surgical ocular pathology. With a mean follow-up of 18 
(±7.8) months, primary anatomical success was achieved in 76.7% (33 of 43) of the
retinotomy group eyes vs. 67.8% (40 of 59) of the eyes in the group without
retinotomy. Final anatomical success rates for the retinotomy group and no
retinotomy group were 100 and 93.2% respectively. The final BCVA was 1.57 LogMAR 
with retinotomy and 1.38 without retinotomy, an improvement in both groups. The
incidence of postoperative complications was similar in the two groups, while the
frequency of macular holes was higher in the retinotomy group. A similar degree
of improvement in BCVA following both surgeries indicates their similar efficacy 
and justifies their performance even in complicated eyes in order to improve the 
patients' quality of life. With neither approach superior to the other, the
choice of method should be left to the surgeon.

PMID: 25142375   [PubMed - as supplied by publisher]

9. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 22. [Epub ahead of print]

Acute anterior uveitis and undiagnosed spondyloarthritis: usefulness of Berlin

Wach J(1), Maucort-Boulch D, Kodjikian L, Iwaz J, Broussolle C, Sève P.

Author information: 
(1)Université Claude Bernard Lyon I, Lyon, France.

PURPOSE: Inflammatory back pain, the main symptom in spondyloarthritis, is
defined by the presence of two or more positive responses among the four items of
Berlin Criteria. This study assesses the value of these criteria in detecting
previously undiagnosed spondyloarthritis after an episode of acute anterior
METHODS: Records of patients addressed for etiological diagnosis after an acute
anterior uveitis (April 2006 to November 2013) were retrospectively analysed.
Patient characteristics, the presence of back pain, Berlin Criteria, the final
diagnosis, and the ASAS classification criteria for spondyloarthritis were
collected and analysed.
RESULTS: The study included 102 patients (59.8 % women). The mean age was
44.5 years. Uveitis cases were mainly unilateral (73.5 %) and recurrent (58.8 %).
Twenty-one patients had some type of spondyloarthritis, 20 fulfilling
retrospectively the ASAS criteria. Back pain with at least two positive items
from Berlin Criteria was 61.9 % sensitive and 97.5 % specific in diagnosing
spondyloarthritis. Considering only one positive item increased the sensitivity
(90.5 %) but decreased the specificity (91.4 %).
CONCLUSIONS: Acute anterior uveitis may be the key symptom that reveals a
formerly undiagnosed spondyloarthritis. A referral to a rheumatologist should be 
considered in presence of back pain, even without fulfilment of the classical
definition with Berlin Criteria.

PMID: 25142374   [PubMed - as supplied by publisher]

10. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 22. [Epub ahead of print]

Bevacizumab and ranibizumab for neovascular age-related macular degeneration: an 
updated meta-analysis of randomised clinical trials.

Kodjikian L(1), Decullier E, Souied EH, Girmens JF, Durand EE, Chapuis FR, Huot

Author information: 
(1)Service d'ophtalmologie, Hospices Civils de Lyon, Groupement Hospitalier Nord,
Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, F-69317, Lyon
Cedex 04, France,

PURPOSE: Neovascular age-related macular degeneration (AMD) is the main cause of 
central vision loss among individuals aged 50 years or older in developed
countries. The aim of this study was to review systematically the effect of
bevacizumab compared to ranibizumab in patients with AMD at 1 year.
METHODS: A systematic review was performed on Medline, Embase, and the Cochrane
Library and Trial registers to October 2013. Eligibility criteria for selecting
studies were randomised controlled trials (RCT) comparing bevacizumab with
ranibizumab in patients with neovascular AMD. Odds ratio (OR) and mean difference
(MD) estimates were synthesized under fixed- and random-effects models.
Heterogeneity was assessed using the Q statistic and I(2).
RESULTS: Five RCTs were included, representing 2,686 randomised patients. The
meta-analysis confirmed the non-inferiority of bevacizumab compared to
ranibizumab for change in visual acuity at 1 year (MD 0.57 letters, -1.80 to
0.66, p = 0.37, I(2) = 0 %). Better anatomical results were found for
ranibizumab. Bevacizumab was associated with a 34 % increase in the number of
patients with at least one serious systemic adverse event (OR 1.34, 1.08 to 1.66,
p = 0.01, I(2) = 0 %).
CONCLUSIONS: The pooled evidence confirmed that, compared with ranibizumab,
bevacizumab was associated with equivalent effects on visual acuity at 1 year and
with a higher risk of systemic serious adverse events. The current available data
do not show which types of adverse events occur more frequently. In practice,
bevacizumab should be used under a risk-management plan until further studies
have been carried out to assess accurately the increased risk of systemic adverse

PMID: 25142373   [PubMed - as supplied by publisher]

11. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 20. [Epub ahead of print]

Cytomegalovirus anterior uveitis: long-term follow-up of immunocompetent

Accorinti M(1), Gilardi M, Pirraglia MP, Amorelli GM, Nardella C, Abicca I, Pesci

Author information: 
(1)Servizio di Immunovirologia Oculare, Sapienza Università di Roma, Viale del
Policlinico 155, 00167, Rome, Italy,

BACKGROUND: We aimed to report on the clinical findings and long-term prognosis
of patients with cytomegalovirus (CMV) anterior uveitis.
METHODS: This was a retrospective observational study on 15 immunocompetent
patients with CMV anterior uveitis and a follow-up longer than 24 months (mean:
62.1 ± 28.5 months).
RESULTS: Uveitis was unilateral and hypertensive in all cases, with acute
relapsing having the characteristics of Posner-Schlossman syndrome in nine (60 %)
and chronic in nine patients (40 %), three of whom were clinically classified as 
Fuchs' heterocromic iridocyclitis (20 %). All patients received topical antiviral
and corticosteroid therapy, with six patients also receiving systemic therapy
with valganciclovir or acyclovir. The mean number of uveitis relapses
significantly decreased, before and after anti-CMV therapy, from 0.23 ± 0.17 to
0.03 ± 0.03 (p < 0.001), without significant differences among patients treated
with topical therapy alone or combined topical and systemic therapy. Cataracts
developed in nine out of 13 patients (69.2 %). A chronic raise in intraocular
pressure (IOP) was found in 13 patients (86.6 %), with nine requiring surgery
(60 %). At the end of the follow-up, all patients had a quiescent uveitis, with
ten of them requiring topical low dose steroid therapy (66.6 %) and combined with
systemic acyclovir in four cases. Eight patients (53.3 %) were on
antiglaucomatous therapy. The last mean IOP value was 14.9 ± 3.6 mmHg (range
8-21 mmHg), and visual acuity was 0.89 ± 0.21.
CONCLUSIONS: CMV-associated anterior uveitis has a fairly good long-term visual
prognosis. Antiviral therapy can reduce the frequency of relapses, but cataracts 
and a chronic raise in IOP are frequent complications often requiring a surgical 

PMID: 25138606   [PubMed - as supplied by publisher]

12. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 20. [Epub ahead of print]

Spironolactone in the treatment of central serous chorioretinopathy - a case

Herold TR(1), Prause K, Wolf A, Mayer WJ, Ulbig MW.

Author information: 
(1)Department of Ophthalmology, University Eye Hospital - LMU, Campus Innenstadt,
Klinikum der Universität München, Mathildenstrasse 8, D-80336, Munich, Germany,

BACKGROUND: The pathogenesis of central serous chorioretinopathy (CSC) is still
poorly understood. An animal model of CSC proved that the mineralocorticoid
receptor [1] of the choroid also plays a role in CSC. Since there is still no
evidence-based therapy for non-self-limiting CSC, this case series evaluates the 
effect of oral spironolactone in CSC patients.
METHODS: In this interventional, uncontrolled, prospective case series, we
present 18 consecutive CSC patients. Patients were treated with spironolactone
25 mg twice daily (Spironolacton AL® 50 mg, ALIUD PHARMA) for up to 12 weeks.
Follow-up examinations with BCVA, OCT, and EDI-OCT were performed at 1, 2, and
3 months after starting the treatment. Main outcome measure was a change of
subretinal fluid (SRF) (in micrometers) measured by optical coherence tomography.
Secondary outcome was a change in central retinal thickness (CRT) (in
micrometers) measured by OCT and a change in BCVA.
RESULTS: The subretinal fluid (SRF; mean) decreased from 219 μm (baseline) to
100 μm (visit 3) (difference 119 μm). Total central retinal thickness (CRT; mean)
decreased from 405 μm before treatment (baseline) to 287 μm after treatment
(difference 118 μm). The BCVA (in logMAR; mean) increased from 0.32 at baseline
to 0.20 at visit 3.
CONCLUSION: Our case series could confirm a positive influence of spironolactone 
on the course CSC. Longer follow-up with a larger number of cases could provide
more data about the long-term efficiency, recurrences, and safety of this
well-tolerated and non-invasive treatment option of CSC.

PMID: 25138605   [PubMed - as supplied by publisher]

13. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 17. [Epub ahead of print]

Measurement of retinal nerve fiber layer and macular ganglion cell-inner
plexiform layer with spectral-domain optical coherence tomography in patients
with optic nerve head drusen.

Casado A(1), Rebolleda G, Guerrero L, Leal M, Contreras I, Oblanca N,
Muñoz-Negrete FJ.

Author information: 
(1)Department of Ophthalmology, Hospital Universitario Ramón y Cajal. IRYCIS,
Carretera de Colmenar Km 9,100, 28034, Madrid, Spain,

PURPOSE: To evaluate the effect of optic nerve head drusen (ONHD) on the retinal 
nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) 
using Cirrus optical coherence tomography (OCT).
METHODS: Fifty-seven eyes of thirty patients with ONHD and thirty-eight eyes of
twenty age-matched and sex-matched control subjects underwent circumpapillary and
macular scanning using Cirrus OCT. The percentages of eyes with abnormal GCIPL
and RNFL values according to the Cirrus normative data were analysed and
RESULTS: Overall, eyes with ONHD showed abnormally reduced values for average and
minimum GCIPL thicknesses in 35 % and 45 % of cases compared to 2 % for both
values in control eyes (P < 0.001). Average RNFL thickness comparison between
eyes with ONHD and normal eyes revealed abnormal thinning in 33 % vs. 0 %,
respectively (p = 0.002). The percentage of abnormal thinning increased with
higher grades of ONHD for all the parameters evaluated, so that in grade III
drusen, values were abnormally reduced in 80 % of eyes in all three analyses.
Regarding buried ONHD, 30 % and 4 % of eyes had an abnormally reduced minimum
GCIPL and average RNFL thickness, respectively. Furthermore, 26 % of these eyes
had abnormal GCIPL exams with a normal or increased RNFL thickness.
CONCLUSIONS: Both RNFL and GCIPL analysis reveal significant thinning in eyes
with ONHD directly correlated with drusen severity. In buried ONHD, the
abnormality rate was significantly higher with GCIPL compared to RNFL evaluation,
suggesting that GCIPL analysis might be an early structural indicator of neuronal
loss in the setting of thickened RNFL.

PMID: 25128962   [PubMed - as supplied by publisher]

14. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 17. [Epub ahead of print]

Results of long-term monitoring of normal-tension glaucoma patients receiving
medical therapy: results of an 18-year follow-up.

Komori S(1), Ishida K, Yamamoto T.

Author information: 
(1)Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1
Yanagido, Gifu-shi, Japan, 501-1194.

PURPOSE: To conduct a ≥15-year follow-up assessment of the visual field (VF) in
normal-tension glaucoma (NTG) patients receiving medical therapy and to identify 
risk factors for VF progression.
DESIGN: A retrospective clinical study.
METHODS: Medical records of 78 eyes of 78 NTG patients monitored for ≥15 years
were reviewed. VF progression was defined by a mean deviation (MD) deteriorated
twice by 3.00 dB from baseline (MD criterion) and an annual decrease in the MD
slope exceeding -0.5 dB/year (MD slope criterion). Logistic regression analysis
was employed to identify risk factors for VF progression.
RESULTS: The mean follow-up period was 18.3 years. The average intraocular
pressure (IOP) before treatment was 15.1 ±1.9 mmHg and the average treated IOP
was 13.5 ±1.5 mmHg with 2.0 medications. Forty-two eyes (53.8%) showed VF
progression using the MD criterion and 15 eyes (19.2%) showed a negative MD slope
less than -0.5 dB/year. Disc hemorrhage (DH) was observed in 30 eyes (38.5%). The
mean VF progression rate was -0.38 ±0.30 dB/year in the DH group and
-0.24 ±0.28 dB/year in the non-DH group (P = 0.012). Multiple logistic regression
analysis identified DH [relative risk (RR) 4.28; P = 0.028] as a risk factor for 
VF progression using the MD criterion. DH (RR 8.77; P = 0.007) and IOP
fluctuation during follow-up (RR 5.03; P = 0.048) were detected as risk factors
using the MD slope criterion.
CONCLUSIONS: DH and IOP fluctuation were associated with VF progression in NTG
during long-term therapy.

PMID: 25128961   [PubMed - as supplied by publisher]

15. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 17. [Epub ahead of print]

Retinal vessel diameter measurements by spectral domain optical coherence

Ouyang Y(1), Shao Q, Scharf D, Joussen AM, Heussen FM.

Author information: 
(1)Department of Ophthalmology, Charité-University Medicine Berlin, Augustenburger
Platz 1, 13353, Berlin, Germany.

PURPOSE: To describe a spectral domain optical coherence (OCT)-assisted method of
measuring retinal vessel diameters.
METHODS: All Patients with an OCT circle scan centered at the optic nerve head
using a Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) were
retrospectively reviewed. Individual retinal vessels were identified on infrared 
reflectance (IR) images and given unique labels both on IR and spectral domain
OCT (SD-OCT). Vessel width and vessel types obtained by IR were documented as
ground truth. From OCT, measurements of each vessel, including horizontal vessel 
contour diameter, vertical vessel contour diameter, horizontal hyperreflective
core diameter, and reflectance shadowing width, were assessed.
RESULTS: A total of 220 vessels from 13 eyes of 12 patients were labeled, among
which, 194 vessels (88 arteries and 65 veins confirmed from IR) larger than 40
microns were included in the study. The mean vessel width obtained from IR was
107.9 ± 36.1 microns. A mean vertical vessel contour diameter of 119.6 ± 29.9
microns and a mean horizontal vessel contour diameter of 124.1 ± 31.1 microns
were measured by SD-OCT. Vertical vessel contour diameter did not differ from
vessel width in all subgroup analysis. Horizontal vessel contour diameter was not
significantly different from vessel width for arteries and had strong or very
strong correlation with vessel width for veins.
CONCLUSION: In our study, vertical vessel contour diameter measured by current
commercially available SD-OCT was consistent with vessel width obtained by IR
with good reproducibility. This SD-OCT based method could potentially be used as 
a standard measurement procedure to evaluate retinal vessel diameters and their
changes in ocular and systemic disorders.

PMID: 25128960   [PubMed - as supplied by publisher]

16. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 15. [Epub ahead of print]

Inhibition of form-deprivation myopia by a GABAAOr receptor antagonist,
(1,2,5,6-tetrahydropyridin-4-yl) methylphosphinic acid (TPMPA), in guinea pigs.

Cheng ZY(1), Wang XP, Schmid KL, Han XG.

Author information: 
(1)Department of Ophthalmology, Qilu Hospital, Shandong University, 107 Wenhuaxi
Road, Jinan, Shandong, 250012, China,

PURPOSE: To investigate the effects of the relatively selective GABAAOr receptor 
antagonist (1,2,5,6-tetrahydropyridin-4-yl) methylphosphinic acid (TPMPA) on
form-deprivation myopia (FDM) in guinea pigs.
METHODS: A diffuser was applied monocularly to 30 guinea pigs from day 10 to 21. 
The animals were randomized to one of five treatment groups. The deprived eye
received daily sub-conjunctival injections of 100 μl TPMPA at a concentration of 
(i) 0.03 %, ( ii) 0.3 %, or (iii) 1 %, a fourth group (iv) received saline
injections, and another (v) no injections. The fellow eye was left untreated. An 
additional group received no treatment to either eye. Prior to and at the end of 
the treatment period, refraction and ocular biometry were performed.
RESULTS: Visual deprivation produced relative myopia in all groups (treated
versus untreated eyes, P < 0.05). The amount of myopia was significantly affected
by the drug treatment (one-way ANOVA, P < 0.0001); myopia was less in deprived
eyes receiving either 0.3 % or 1 % TPMPA (saline = -4.38 ± 0.57D, 0.3 %
TPMPA = -3.00 ± 0.48D, P < 0.01; 1 % TPMPA = -0.88 ± 0.51D, P < 0.001). The
degree of axial elongation was correspondingly less (saline = 0.13 ± 0.02 mm,
0.3 % TPMPA = 0.09 ± 0.01 mm, P < 0.01, 1 % TPMPA = 0.02 ± 0.01 mm, P < 0.001) as
was the VC elongation (saline = 0.08 ± 0.01 mm, 0.3 % TPMPA = 0.05 ± 0.01 mm,
P < 0.01, 1 % TPMPA = 0.01 ± 0.01 mm; P < 0.001). ACD and LT were not affected
(one-way ANOVA, P > 0.05). One percent TPMPA was more effective at inhibiting
myopia than 0.3 % (P < 0.01), and 0.03 % did not appreciably inhibit the myopia
(0.03 % TPMPA versus saline, P > 0.05).
CONCLUSIONS: Sub-conjunctival injections of TPMPA inhibit FDM in guinea pig
models in a dose-dependent manner.

PMID: 25120102   [PubMed - as supplied by publisher]

17. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 13. [Epub ahead of print]

Associated morbidity of pediatric ptosis - a large, community based case-control 

Nemet AY(1), Segal O, Mimouni M, Vinker S.

Author information: 
(1)Department of Ophthalmology, Meir Medical Center, Kfar Saba, 4428164, Israel,

PURPOSE: To report the incidence, demographics, and associations of various
conditions among patients with pediatric ptosis.
METHODS: A retrospective, observational case-control study of patients
(birth-18 years; n = 2,408) diagnosed with pediatric ptosis in 1/2003-12/2012.
Age- and gender-matched control patients (n = 9,632) were randomly selected from 
the district members. Medical and socio-demographic information were extracted
from electronic medical records.
RESULTS: The average age of diagnosis was 5.6 years, and 1,325 (54 %) were male, 
with an incidence of 19.9/100,000. Systemic conditions significantly associated
with pediatric ptosis include myasthenia gravis, congenital anomalies, deafness, 
mental retardation, muscular dystrophy, neurological diseases, epilepsy,
schizophrenia, and malignancy. Ophthalmic conditions associated with pediatric
ptosis include exotropia, progressive external ophthalmoplegia, hypotropia,
esotropia, hyperopia, vertical heterophoria, intermitent esotropia, astigmatism, 
retinopathy, internuclear ophthalmoplegia, and myopia. Symptoms of diplopia,
blurred vision, and aniseikonia were significantly more common.
CONCLUSION: Pediatric ptosis is associated with various systemic and ophthalmic
conditions, and many are diagnosed after the age of 5 years. Clinicians should
maintain a high degree of suspicion and thoroughly evaluate all patients with
pediatric ptosis to properly assess underlying systemic associations. A better
understanding of the patho-physiological association between these factors and
pediatric ptosis may help its prevention and treatment.

PMID: 25115411   [PubMed - as supplied by publisher]

18. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 13. [Epub ahead of print]

Changes of TGF-β2, MMP-2, and TIMP-2 levels in the vitreous of patients with high

Zhuang H(1), Zhang R, Shu Q, Jiang R, Chang Q, Huang X, Jiang C, Xu G.

Author information: 
(1)Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College,
Fudan University, 83 Fenyang Road, Shanghai, 200031, China.

PURPOSE: To investigate the concentrations of transforming growth factor
(TGF)-β2, matrix metalloproteinase (MMP)-2, and tissue inhibitor of
metalloproteinase (TIMP)-2 in the vitreous of patients with high myopia.
METHODS: Twenty-six patients with high myopia (HM) who received vitrectomy for
macular retinoschisis or macular hole were enrolled in this prospective study.
Twenty-six patients with idiopathic macular hole or macular epiretinal membrane
were chosen as a control group. Vitreous samples were obtained during the
vitrectomy surgery. The levels of TGF-β2、MMP-2、TIMP-2 in the vitreous samples
were measured by enzyme-linked immunosorbent assay. The MMP activity was
determined by a fluorometric assay.
RESULTS: There was no significant difference in the vitreous level of TGF-β2
between HM (1.64 ± 0.38 ng/ml) and the control group (1.56 ± 0.32 ng/ml,
p = 0.56). The vitreous levels of MMP-2 in HM (32.40 ± 14.90 ng/ml) were
significantly higher than in the control group (21.42 ± 6.74 ng/ml, p < 0.01).
The ratio of MMP-2/TIMP-2 was significantly elevated in the vitreous samples from
HM (0.61 ± 0.19), compared to the control group (0.48 ± 0.11, p < 0.05). The MMP 
activity was also significantly elevated in the vitreous samples from HM
(4,030.8 ± 1,257.3 FIU), compared to the control group (3,245.8 ± 835.6 FIU,
p < 0.05).
CONCLUSIONS: The elevated MMP/TIMP ratio and MMP activity may play a role in the 
pathogenesis of human high myopia. Large prospective studies are needed to
further investigate the effect of MMPs in the pathogenesis of human high myopia.

PMID: 25112847   [PubMed - as supplied by publisher]

19. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 12. [Epub ahead of print]

Investigation of blood flow regulation and oxygen saturation of the retinal
vessels in primary open-angle glaucoma.

Ramm L(1), Jentsch S, Peters S, Augsten R, Hammer M.

Author information: 
(1)Department of Ophthalmology, University Hospital Jena, Bachstr. 18, 07743, Jena, 

PURPOSE: To examine the supply of oxygen to the retina in primary open-angle
glaucoma (POAG).
METHODS: Forty-one patients with primary open-angle glaucoma (mean age
64.1 ± 12.9 years) and 40 healthy subjects (63.6 ± 14.1 years) were included.
Fundus images, centered at the optic disc, were taken using the Retinal Vessel
Analyzer (RVA). The vessel diameters were calculated as central retinal artery
(CRAE) and vein equivalent (CRVE) from diameter measurements in the peripapillary
vessels. The oxygen saturation of the arteries and veins was investigated
employing a two-wavelengths technique. After the measurement at baseline, the
vascular response to flicker light exposure was measured.
RESULTS: In glaucoma patients the mean oxygen saturation of the retinal veins at 
baseline was higher than in the healthy controls (64.36 ± 7.11 vs. 59.78 ± 8.47, 
p = 0.01), whereas the mean arteriovenous oxygen saturation difference was lower 
(33.07 ± 5.24 vs. 37.53 ± 6.95, p = 0.002). The arterial oxygen saturation as
well as the arterial and venous diameters showed no difference between the
groups. The increase of the CRVE during flicker light stimulation (3.72 ± 3.29 % 
vs. 5.43 ± 4.04, p = 0.039), as well as the change of the venous oxygen
saturation (2.08 ± 3.74 % vs. 4.18 ± 3.88 %, p = 0.016) and the arteriovenous
saturation difference (-2.1 ± 3.31 % vs. -4.43 ± 3.6 %, p = 0.003) were smaller
in POAG patients than in the healthy group.
CONCLUSIONS: The reduction in the arteriovenous difference in oxygen saturation
in POAG patients might show a decreased oxygen demand of the retina caused by the
glaucomatous loss of neuroretinal tissue. The lower extent of the flicker
light-induced change of the diameter of retinal veins and the venous oxygen
saturation could indicate an impairment of blood flow regulation.

PMID: 25112846   [PubMed - as supplied by publisher]

20. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 12. [Epub ahead of print]

Effect of sulodexide in patients with non-proliferative diabetic retinopathy:
diabetic retinopathy sulodexide study (DRESS).

Song JH(1), Chin HS, Kwon OW, Lim SJ, Kim HK; for the DRESS Research Group.

Author information: 
(1)Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea.

PURPOSE: To evaluate the effectiveness of sulodexide for the treatment of hard
exudates (HE) in non-proliferative diabetic retinopathy (NPDR).
METHODS: This was a randomized, placebo-controlled, multicenter trial involving
130 patients (65 for each group) who had mild-to-moderate NPDR with macular HE.
Participants were given a daily dose of either 50 mg sulodexide or a matching
dose of placebo orally for 12 months. Main outcome measure was an improvement in 
HE defined as a decrease in severity by at least two grades on a 10-grade
severity scale. This was evaluated by fundus photography over 12-month period.
RESULTS: The sulodexide group showed significantly greater improvement in HE
severity than that shown by the placebo group (39.0 % vs. 19.3 %; chi square,
P = 0.005). Logistic regression analysis yielded an odds ratio of 2.790 (95 %
confidence interval, 1.155-6.743; P = 0.023) for the effect of treatment once
adjustments were made for demographic, prognostic and disease confounders.
Intention to treat and per-protocol analysis yielded similar results.
Sulodexide's safety was comparable to that of the placebo.
CONCLUSIONS: Oral sulodexide therapy over 12 months improved macular HE in
patients with mild-to-moderate NPDR, without leading to detectable adverse
events. The study protocol was registered on under identifier

PMID: 25112845   [PubMed - as supplied by publisher]

21. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 12. [Epub ahead of print]

Retinal vessel diameter in normal-tension glaucoma patients with asymmetric

Lee TE(1), Kim YY, Yoo C.

Author information: 
(1)Department of Ophthalmology, Korea University College of Medicine, Seoul, South

PURPOSE: To investigate the longitudinal changes in the central retinal vessel
diameter in asymmetric progressive normal-tension glaucoma (NTG) patients.
METHODS: This study included 27 patients with bilateral NTG without any systemic 
vascular disease who showed glaucomatous progression in one eye at the mean
follow-up of 24.3 months (range, 18-29 months). Progression was determined by the
development of new retinal nerve fiber layer (RNFL) defects or widening of
pre-existing defects on red-free RNFL photographs. The central retinal arteriolar
equivalent (CRAE) and the central retinal venular equivalent (CRVE) were measured
at baseline and at the mean follow-up of 24.3 months. We classified the eyes of
each patient as either progressed or stable eyes, and compared the differences
and changes in the CRAE and CRVE.
RESULTS: No significant inter-eye difference was observed at baseline in the mean
CRAE (167.5 ± 22.2 μm vs. 168.2 ± 15.5 μm, p = 0.809) and in the mean CRVE
(276.3 ± 18.2 μm vs. 281.6 ± 21.9 μm, p = 0.267) between the progressed and
stable eyes. There were significant changes in CRAE in the progressed eyes
between baseline and 2 years after baseline (from 167.5 ± 22.2 μm to
146.9 ± 18.0 μm, p < 0.0001), but there were no significant changes in the stable
eyes (from 168.2 ± 15.5 μm to 167.5 ± 14.8 μm, p = 0.084).
CONCLUSIONS: In our series of NTG patients with asymmetric progression, central
retinal artery diameter decreased over time in the progressed eyes, whereas no
significant decrease in the central retinal artery diameter was seen in the
stable eyes.

PMID: 25109787   [PubMed - as supplied by publisher]

22. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 10. [Epub ahead of print]

A prospective multicenter randomized placebo-controlled trial of dexamethasone as
an adjuvant in the treatment of postoperative bacterial endophthalmitis: interim 
safety analysis of the study drug and analysis of overall treatment results.

Lindstedt EW(1), Bennebroek CA, van der Werf DJ, Veckeneer M, Norel AO, Nielsen
CC, Wubbels RJ, van Dissel JT, van Meurs JC.

Author information: 
(1)The Rotterdam Eye Hospital, Schiedamsevest 180, 3011 BH, Rotterdam, The

PURPOSE: In an ongoing prospective multicenter randomised placebo-controlled
trial we study the adjuvant use of intravitreal dexamethasone in the treatment of
patients with suspected bacterial endophthalmitis after phacoemulsification. In
accordance with the study protocol, a mid-inclusion interim analysis of the
safety of the study drug was performed.
PATIENTS AND METHODS: Patients with suspected endophthalmitis after
phacoemulsification were asked to participate in this study. A diagnostic
vitreous biopsy was taken and the patients received intravitreal injections of
400 micrograms dexamethasone or a placebo, plus 0.2 mg vancomycin and 0.05 mg
gentamicin. Injections were repeated after 3 or 4 days. The safety analysis
included: the number of eyes with an evisceration; no light perception; or a
visual acuity of less than 5/200. Treatment outcome was evaluated in terms of:
the percentage of patients with a visual acuity of 20/40 or more and 20/100 or
RESULTS: The interim analysis included 81 patients with at least 1 year
follow-up. Sixty-three patients (65 %) were culture-positive. Safety analysis: 7 
eyes were eviscerated (3 dexamethasone, 4 placebo); 4 eyes had no light
perception (2 dexamethasone, 2 placebo); and 4 eyes had less than 5/200 vision (3
dexamethasone, 1 placebo). Treatment outcome: 70 % of patients had a visual
acuity of at least 20/40.
CONCLUSION: The safety analysis does not warrant premature discontinuation of the
study. So far, the overall outcome of our treatment regimen, consisting of merely
a diagnostic biopsy instead of a vitrectomy and an optimized antibiotic dosing,
compares favourably to published literature.

PMID: 25107542   [PubMed - as supplied by publisher]

23. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 10. [Epub ahead of print]

From where does "rete" in retina originate?

de Jong PT.

Author information: 
Retinal Signal Processing, NIN KNAW Meibergdreef 47, Amsterdam, BA, 1105, The

PMID: 25107541   [PubMed - as supplied by publisher]

24. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 10. [Epub ahead of print]

Early axonal damage detection by ganglion cell complex analysis with optical
coherence tomography in nonarteritic anterior ischaemic optic neuropathy.

Larrea BA(1), Iztueta MG, Indart LM, Alday NM.

Author information: 
(1)Department of Ophthalmology, Cruces University Hospital, Plaza de Cruces s/n,
Barakaldo, Vizcaya, 48903, Spain,

PURPOSE: To investigate the ability of ganglion cell complex (GCC) analysis by
optical coherence tomography (OCT) to detect early axonal damage in nonarteritic 
anterior ischaemic optic neuropathy (NAION), and to assess the relationship of
GCC measurements with visual field defects and function parameters.
METHODS: Twenty-two patients with NAION participated in this retrospective
case-series study. Patients underwent spectral-domain OCT measurement of retinal 
nerve fibre layer (RNFL) and GCC average and minimum thicknesses, best-corrected 
visual acuity, Ishihara test and Humphrey visual field (SITA Standard 24-2).
These measurements were recorded in the acute (2-6 weeks after the ischaemic
episode) and chronic (≥6 months later) phases. Spearman's coefficients were used 
to assess the relationship between GCC thickness and visual field defects.
RESULTS: In the acute phase, none of the patients showed atrophy of the optic
disc, while early damage was observed in the GCC average and minimum thickness in
54.54 % and 77.27 % of patients. At 6 months, the rate of patients with RNFL
below normal limits increased to 90 % in the RNFL, and 92.85 % and 100 % in the
GCC average and minimum GCC respectively. Spearman's coefficients indicated
significant relationships of GCC in the acute phase with visual field index and
mean deviation in both acute and chronic phases. A significant correlation was
also found with location of the defects.
CONCLUSIONS: GCC thickness measurement by OCT is capable of detecting early
axonal damage in NAION eyes in the acute phase that cannot be detected by RNFL.
GCC defects are significantly correlated with visual field globally and the
defect location.

PMID: 25107540   [PubMed - as supplied by publisher]

25. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 9. [Epub ahead of print]

Anterior segment ischemia following diode laser photocoagulation for aggressive
posterior retinopathy of prematurity.

Gunay M(1), Sekeroglu MA, Celik G, Gunay BO, Unlu C, Ovali F.

Author information: 
(1)Department Of Ophthalmology, Zeynep Kamil Maternity and Children's Disease
Training and Research Hospital, Istanbul, Turkey,

PURPOSE: To describe the clinical and demographical characteristics and treatment
outcomes of the premature infants who were presented with the signs of anterior
segment ischemia (ASI) following transpupillary diode laser photocoagulation for 
aggressive posterior retinopathy of prematurity (APROP).
METHODS: The records of the premature infants who developed ASI following
bilateral laser photocoagulation between November 2010 and December 2013 in a
single institution for the treatment of APROP were retrospectively reviewed. The 
clinical and demographical characteristics, laser parameters, anterior segment
complications, and structural outcomes were evaluated.
RESULTS: Nine eyes of five infants (three males, two females) were recruited for 
the study. Mean gestational age (GA), birth weight (BW), and postmenstrual age
(PMA) at the time of laser ablation were 28.2 ± 2.5 weeks, 1,287.0 ± 483.4 g and 
34.8 ± 2.2 weeks, respectively. All eyes were treated with a near-confluent
pattern of laser ablation. Several anterior segment complications were observed
including corneal edema (nine eyes), posterior synechia (nine eyes), pupillary
membranes (five eyes), shallow anterior chamber (three eyes), hyphema (three
eyes), and focal lens opacities (two eyes), of all resolved completely. Permanent
dense cataracts observed in two eyes of two infants who were scheduled for
lensectomy and anterior vitrectomy. None of the eyes progressed to phthisis
CONCLUSIONS: Anterior segment ischemia after laser treatment of APROP is a rarely
encountered clinical entity. Mild and transient cases may resolve without any
long-term sequelae but severe ones may progress to permanent cataract requiring
further surgery.

PMID: 25104466   [PubMed - as supplied by publisher]

26. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 8. [Epub ahead of print]

Detecting ultrasonographic hollowness in small choroidal melanocytic tumors using
10 MHz and 20 MHz ultrasonography: a comparative study.

Piñeiro-Ces A(1), Rodríguez Alvarez MJ, Santiago M, Bande M, Pardo M, Capeáns C, 
Blanco MJ.

Author information: 
(1)Surgical Retina and Ocular Oncology Unit, Servizo de Oftalmoloxía, Hospital de
Conxo, Complexo Hospitalario de Santiago, c/Ramón Baltar s/n, 15706, Santiago de 
Compostela, Spain,

BACKGROUND: The purpose of this work was to compare the detection of
ultrasonographic hollowness (UH), as a risk sign for evolution from small
choroidal melanocytic tumors (SCMT) to uveal melanoma (UM), between conventional 
ultrasonography (standardized 8 MHz ultrasonography and B-mode 10 MHz
ultrasonography) and high-resolution 20 MHz ultrasonography.
METHODS: Fifty SCMTs from 50 eyes were included in this work. In all cases,
ultrasonographic studies were performed using: 8 MHz standardized A-mode, 10 MHz 
B-mode, and posterior pole 20 MHz B-mode. Comparison between the presence and the
absence of UH were carried out between the ultrasonographic images.
RESULTS: There were no statistically significant differences between the SCMT
dimensions obtained using the 8-10 and 20 MHz techniques. UH was detected in 12
and 20 cases by means of ten and 20 MHz probes respectively. The difference
between these proportions was statistically different from zero (McNemar test,
p-value = 0.008). Cases without UH by 20 MHz have lower height values than cases 
with UH. However, these differences were not found by 10 MHz ultrasonography. By 
receiver operating characteristic (ROC) study, specificity was better by 20 MHz
than 10 MHz ultrasonography when the value of tumor height as marker for UH was
CONCLUSIONS: UH is easier to detect by 20 MHz than by 10 MHz ultrasonography.
This ultrasonographic sign appears to be correlated with the height of the tumor.
Thus, we believe UH estimation by 20 MHz ultrasonography could be used as a
significant predictive factor for SCMT growth.

PMID: 25104465   [PubMed - as supplied by publisher]

27. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 9. [Epub ahead of print]

Macular ganglion cell-inner plexiform layer thinning in patients with visual
field defect that respects the vertical meridian.

Shin HY(1), Park HY, Choi JA, Park CK.

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

The aim of this work is to compare the thinning patterns of the ganglion cell
inner-plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL)
as measured using Cirrus high-definition optical coherence tomography (HD-OCT) in
patients with visual field (VF) defects that respect the vertical meridian.
Twenty eyes of 11 patients with VF defects that respect the vertical meridian
were enrolled retrospectively. The thicknesses of the macular GCIPL and pRNFL
were measured using Cirrus HD-OCT. The 5 and 1 % thinning area index (TAI) was
calculated as the proportion of abnormally thin sectors at the 5 and 1 %
probability level within the area corresponding to the affected VF. The 5 and 1 %
TAI were compared between the GCIPL and pRNFL measurements. The color-coded GCIPL
deviation map showed a characteristic vertical thinning pattern of the GCIPL,
which is also seen in the VF of patients with brain lesions. The 5 and 1 % TAI
were significantly higher in the GCIPL measurements than in the pRNFL
measurements (all p < 0.01). Macular GCIPL analysis clearly visualized a
characteristic topographic pattern of retinal ganglion cell (RGC) loss in
patients with VF defects that respect the vertical meridian, unlike pRNFL
measurements. Macular GCIPL measurements provide more valuable information than
pRNFL measurements for detecting the loss of RGCs in patients with retrograde
degeneration of the optic nerve fibers.

PMID: 25104464   [PubMed - as supplied by publisher]

28. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 7. [Epub ahead of print]

Intraocular pressure elevation and post-DMEK glaucoma following Descemet membrane
endothelial keratoplasty.

Maier AK(1), Wolf T, Gundlach E, Klamann MK, Gonnermann J, Bertelmann E, Joussen 
AM, Torun N.

Author information: 
(1)Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow
Klinikum Augustenburger Platz 1, 13353, Berlin, Germany,

PURPOSE: Intraocular pressure (IOP) elevation and post-keratoplasty glaucoma
occur commonly after penetrating keratoplasty (PK), but also after Descemet
stripping endothelial keratoplasty (DSEK). In this study, we evaluated the risk
after Descemet membrane endothelial keratoplasty (DMEK) to develop IOP elevation 
and post-DMEK glaucoma.
METHODS: The 12-month incidence of IOP elevation and post-DMEK glaucoma was
analyzed retrospectively in the first 117 consecutive eyes that underwent DMEK
between September 2011 and December 2012 at the Universitätsmedizin-Charité,
Berlin. IOP elevation was defined as IOP ≥ 22 mmHg, or ≥10 mmHg from preoperative
baseline. The assessment included the pre-operative history of corneal disease
and glaucoma. Furthermore, the response to anti-glaucoma treatment, the graft
failure, the IOP, the visual acuity, and the endothelial cell count were
RESULTS: The 12-month incidence of IOP elevation was 12.10 % [95 % confidence
interval (CI): 0.94 %, 18.37 %], post-DMEK glaucoma 2.7 % (95 % CI: -0.44 %,
5.84 %). The most frequent cause remained steroid-induced IOP elevation, with an 
12-month incidence of 8.0 % (95 % CI: 7.95 %, 8.05 %). In all cases, IOP
elevation was treated effectively by tapering down steroid medication and
initiating or increasing anti-glaucoma medication. The incidence of postoperative
postoperative pupillary block IOP elevation was 15.40 % (95 % CI: 8.93 %,
21.87 %). The number of eyes with iridocorneal contacts after surgery was low
(4.2 %). Only the preoperative increased IOP is a significant risk factor for IOP
elevation (p = 0.005). Visual acuity improved significantly after surgery
(p < 0.001), and clear grafts were achieved in all eyes. Mean endothelial cell
count did not differ between patients with and without IOP elevation.
CONCLUSION: Incidence of IOP elevation and post-keratoplasty glaucoma after DMEK 
were low, but regular IOP measurements, especially in eyes with pre-existing
glaucoma and bullous keratopathy, are necessary. Steroid-induced IOP elevation
was the most frequent reason, and could be treated effectively by tapering down
steroid medication or changing the steroid drug. Development of peripheral
anterior synechiae after DMEK occured rarely. Therefore, the risk for IOP
elevation and especially post-DMEK keratoplasty was reduced compared to PK and
DSEK. In all cases, successful management by medical treatment was possible, and 
resulted in good visual acuity.

PMID: 25099676   [PubMed - as supplied by publisher]

29. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 6. [Epub ahead of print]

Early peripheral laser photocoagulation of nonperfused retina improves vision in 
patients with central retinal vein occlusion. Results of a proof of concept

Tan CS(1), Lim LW, Singer M, Sadda SR.

Author information: 
(1)Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore,

PMID: 25095764   [PubMed - as supplied by publisher]

30. Graefes Arch Clin Exp Ophthalmol. 2014 Aug 5. [Epub ahead of print]

Soluble vascular endothelial growth factor receptor-3 suppresses
allosensitization and promotes corneal allograft survival.

Emami-Naeini P(1), Dohlman TH, Omoto M, Hattori T, Chen Y, Lee HS, Chauhan SK,
Dana R.

Author information: 
(1)Schepens Eye Research Institute, Massachusetts Eye & Ear Infirmary, Department of
Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114,

PURPOSE: To investigate the effect of VEGF-C and VEGF-D blockade via soluble
VEGFR-3 (sVEGFR-3) on T cell allosensitization, corneal neovascularization, and
transplant survival.
METHODS: Corneal intrastromal suture placement and allogeneic transplantation
were performed on BALB/c mice to evaluate the effect of sVEGFR-3 on corneal
neovascularization. Soluble VEGFR-3 trap was injected intraperitoneally to block 
VEGF-C/D (every other day starting the day of surgery). Immunohistochemical
staining of corneal whole mounts was performed using anti-CD31 (PECAM-1) and
anti-LYVE-1 antibodies to quantify the levels of hem- and lymphangiogenesis,
respectively. Mixed lymphocyte reaction (MLR) was performed to assess indirect
and direct host T cell allosensitization and the frequencies of IFN-γ-producing T
cells in the draining lymph nodes were assessed using flow cytometry. Graft
opacity and survival was evaluated by slit-lamp biomicroscopy.
RESULTS: Treatment with sVEGFR-3 resulted in a significant blockade of
lymphangiogenesis 2 weeks post-transplantation and significantly prolonged
corneal allograft survival compared to the control group at 8 weeks
post-transplantation (87.5 % vs. 50 %), and this was associated with significant 
reduction in the frequencies of allosensitized T cells and decreased frequencies 
of IFN-γ-producing CD4 T cells.
CONCLUSIONS: Soluble VEGFR-3 suppresses corneal lymphangiogenesis and allograft
rejection and may offer a viable therapeutic modality for corneal
neovascularization and corneal transplantation.

PMID: 25091513   [PubMed - as supplied by publisher]