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1.  Visual and Optical Performances of Multifocal Intraocular Lenses with Three Different Near Additions: 6-Month Follow-Up 
Purpose :
To compare the visual and optical outcomes of four multifocal intraocular lenses (IOLs) with three different near additions of +3.00 diopters (D), +3.75 D and +4.00 D.
Methods :
In this prospective study, 133 eyes of 88 patients were implanted with one of the following IOLs: AcrySof® ReSTOR® SN6AD1 (+3.00 D) for Group A, AcrivaUD Reviol BB MF 613 or BB MFM 611 (+3.75 D) for Group B, and AcrySof® ReSTOR® SN6AD3 (+4.00 D) for Group C. The visual acuity, refraction, intraocular pressure, tomography and corneal endothelial cell density (ECD) were compared between the three groups preoperatively and at 6 month postoperatively. Defocus curve, contrast sensitivity and higher order aberrations (HOAs) at 6 month postoperative visit were measured and compared.
Results :
There were no statistically significant differences in distance visual acuity, refraction, intraocular pressure or ECD among the three groups after 6 months (P > 0.05). The photopic contrast sensitivity in Group C was statistically better than in Group A (P < 0.05). The scotopic ocular aberration in Group B was statistically greater compared to that in Group A (P < 0.05). The highest near-visual peaks were -0.06 logMAR at a -2.50 D (40 cm) in Group A, -0.07 logMAR at -3.00D (33 cm) in Group B, and -0.06 logMAR at -3.50 D (29 cm) in Group C. Statistically significant differences in near and intermediate visual acuities were observed among the three groups at -2.00 D (50 cm), -2.50 D (40 cm), -3.50 D (29 cm) and -4.00 D (25 cm) (P < 0.01).
Conclusion :
AcrySof® ReSTOR® SN6AD1 IOLs (+3.00 D) and SN6AD3 (+4.00 D) IOLs provided the best intermediate and near vision, respectively. Both intermediate and near vision were comparatively better in the eyes with AcrivaUD Reviol BB MFM 611 IOLs or BB MF 613 IOLs (+3.75 D).
doi:10.2174/1874364101509010001
PMCID: PMC4321207
Cataract surgery; multifocal intraocular lens; near addition.
2.  Rail-Roading Technique Using 18 Gauge Intravenous Catheter and Silicon Rod for Frontalis Suspension in Blepharophimosis Syndrome 
Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod –needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.
doi:10.2174/1874364101509010008
PMCID: PMC4321230
Blepharophimosis syndrome; intravenous catheter; ptosis; silicon sling; technique.
3.  Fractured Anterior Chamber Intraocular Lens (ACIOL) Complicating Nd: YAG Laser for Peripheral Iridotomy 
Laser peripheral iridotomy is the procedure of choice for the treatment of angle-closure glaucoma caused by relative or absolute pupillary block. Nd: YAG laser iridotomy has been reported to have several complications such as Iris bleeding, hyphema, transient IOP elevation, intraocular inflammation, choroidal, retinal detachment and vitreous hemorrhage.
We report a case of a 74 year old lady on anticoagulant treatment who developed pupillary block and angle closure glaucoma after cataract surgery and anterior chamber intraocular lens (ACIOL) insertion complicated with intraoperative bleeding. The patient was treated with Nd: YAG laser iridotomy , however, the ACIOL was inadvertently fractured after a single shot of laser and it had to be replaced. Although the incidence is rare. Ophthalmologists and Opticians should be aware that an ACIOL may be fractured even after a single Nd:YAG laser shot and avoid to perform it close to the ACIOL. Pretreatment counseling should include this rare complication.
doi:10.2174/1874364101408010001
PMCID: PMC3942864  PMID: 24600484
Laser peripheral iridotomy; Anterior Chamber Intraocular Lens; Nd; Yag Laser; Complications.
4.  Clinical Risk Factors for Poor Anatomic Response to Ranibizumab in Neovascular Age-Related Macular Degeneration§ 
Purpose:
To identify OCT-based anatomical features and clinical characteristics for poor central retinal thickness (CRT) response to ranibizumab in neovascular age-related macular degeneration (AMD).
Patients and Methods:
Investigating our electronic patient records (Eyeswide), patients with neovascular AMD treated with intravitreal injections of 0.5mg/0.05ml ranibizumab were identified and their notes reviewed. Data collected included gender, age, initial best-corrected visual acuity (BCVA), prior photodynamic therapy, lesion type (classic versus occult), type of macular edema (intraretinal fluid, subretinal fluid, pigment epithelium detachment) and the total number of previous ranibizumab injections.
Results:
A total of 210 eyes of 182 patients with neovascular AMD were identified. Mean follow-up time was 1.34 years (SD ± 0.77). Central retinal thickness reduction in women was significantly inferior to that in men (p=0.05). Patients with cystoid type macular edema had significantly greater reduction in CRT compared to patients with subretinal fluid (p<0.001) or pigment epithelium detachment (p<0.001). The percentage drop of CRT was no longer statistically significant after the sixth injection. Age, initial BCVA, prior photodynamic therapy and lesion type had no statistically effect on CRT response.
Conclusion:
Risk factors for poor central retinal thickness response to ranibizumab include female gender and patients with predominant subretinal fluid or pigment epithelium detachment. Furthermore, the anatomical response decreased after the sixth injection of ranibizumab.
doi:10.2174/1874364101408010003
PMCID: PMC4062930  PMID: 24949110
Age-related macular degeneration; Lucentis; poor-responder; ranibizumab; risk factors.
5.  Death by Water: Precautionary Water Submersion for Intravitreal Injection of Retinoblastoma Eyes 
There is growing interest in intravitreal injections of chemotherapy for retinoblastoma. However, concerns for potential tumor seeding through the needle track has prompted the use of risk-reducing precautionary methods. Presented here is a novel technique, which can be easily replicated, requires minimal sophisticated equipment and with laboratory data supporting its concept. Sterile distilled water submersion for 3 minutes renders retinoblastoma cells nonviable and can be employed as a precautionary method following intravitreal injection in the technique described here.
doi:10.2174/1874364101408010007
PMCID: PMC4062941  PMID: 24949111
Cancer; chemotherapy; distilled water; fine needle aspiration; intravitreal injection; melphalan; retinoblastoma; water.
6.  Traumatic Dislocation of Implanted Collamer Phakic Lens: A Case Report and Review of the Literature 
Purpose :
Present a case of dislocation of an Implantable Collamer Lens (ICL) that occurs after blunt trauma and review the published literature on this topic.
Methods :
Case report and literature review using PubMed.
Results :
A 44 year-old male presented to the emergency department with sudden onset of blurry vision after blunt trauma to the left eye. Three years prior, he had undergone bilateral ICL placement for high myopia. On examination, the superotemporal haptic was noted to be dislocated into the anterior chamber, but there was no endothelial touch by the dislocated lens. The patient had an associated hyphema that was medically managed, and 2 weeks after the injury, the patient underwent ICL repositioning. A review of the literature was performed and five previous cases of ICL dislocation were identified. Three of these occurred after blunt trauma. One of these cases was associated with endothelial touch and decompensation and eventually required a descement’s stripping endothelial keratoplasty (DSAEK).
Conclusion :
Dislocation of ICLs after blunt trauma is a rare but important potential sequela of the procedure and can lead to corneal decompensation if there is lens-endothelial touch. All patients who suffer blunt dislocation of ICL should be followed long-term after repositioning for signs of endothelial loss and dysfunction.
doi:10.2174/1874364101408010024
PMCID: PMC4066362  PMID: 24959305
Dislocation; high myopia; ICL; implantable collamer lens; IOL; lens dislocations; myopia; phakic IOL; PIOL; staar ICL; trauma; traumatic lens dislocation; vision.
7.  In Vitro Growth of Lens Epithelial Cells from Cataract Patients - Association with Possible Risk Factors for Posterior Capsule Opacification 
Aim :
Inter-individual differences in intrinsic proliferative capacity of lens epithelial cells may have importance for the risk of developing posterior capsule opacification (PCO) after cataract surgery. The purpose of the present study was to determine growth of human lens epithelial cells (HLEC) in culture and investigate possible associations with clinical characteristics of the donors, such as age, sex, pseudoexfoliation, uveitis and diabetes.
Methods :
Pieces of lens capsule and adhering lens epithelial cells were obtained through capsulorhexis at cataract surgery. Specimens were cultured in a humidified CO2-incubator using standard culture medium and 5% fetal calf serum for two weeks after which cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester. Image processing software was used to determine the area of the confluent epithelial cell layer in relation to the size of the original capsule specimen.
Results :
The increase in area of confluent HLEC showed a negative correlation with diabetes at the first week after surgery. Lower age and female sex showed border-line significant associations with a higher rate of cell proliferation. The presence of pseudoexfoliation in vivo did not significantly affect cell growth in culture postoperatively. Nor did installation of xylocain in the anterior chamber during surgery.
Conclusion :
Diabetes is associated with lower rate of proliferation of lens epithelial cells in culture. The lack of strong correlations between in vitro growth and known risk factors for PCO in the donors suggest that other factors than the proliferative capacity of the cells per se are important for PCO formation.
doi:10.2174/1874364101408010019
PMCID: PMC4066363  PMID: 24959304
Cataract; lens; posterior capsule opacification; primary cell culture; risk factors.
8.  Enduring Influence of Elizabethan Ophthalmic Texts of the 1580s: Bailey, Grassus, and Guillemeau 
Three English ophthalmic texts of the 1580s were frequently republished: 1) Walter Bailey’s A Briefe Treatise Touching the Preseruation of the Eie Sight, 2) The Method of Phisicke, an adaptation of the medieval treatise of Benevenutus Grassus, and 3) A Worthy Treatise of the Eyes, a translation of Jacques Guillemeau’s treatise. Their history is intertwined through composite publications, some of which lacked clear attribution. At least 21 editions incorporated these texts. Although not previously realized, major elements of all 3 works are found in Two Treatises Concerning the Preseruation of Eie-sight, first published in 1616. To preserve eyesight, Bailey recommended eyebright (Euphrasia officinalis), fennel (Fæniculum vulgare), and a moderate lifestyle incorporating wine. In the works of Grassus and Guillemeau, cataracts were believed to lie anterior to the ‘crystalline humor,’ and were treated by the ‘art of the needle,’ or couching. Links are found between Grassus, Guillemeau, and eighteenth century glaucoma concepts. Although one of his students has traditionally received credit, it was English oculist John Thomas Woolhouse who first combined the early concepts and used the term glaucoma to describe the palpably hard eye in the early eighteenth century. The three primary ophthalmic texts of 1580s England influenced ophthalmic thought for over a century.
doi:10.2174/1874364101408010012
PMCID: PMC4066364  PMID: 24959303
Alcohol; cataract; couching; eyebright; glaucoma; ophthalmology.
9.  Laser Cyclophotocoagulation Enhances the Regulative Capacity of Retinal Vessels in Glaucoma 
Purpose:
To determine the effects of laser surgical IOP reduction by means of transscleral cyclophotocoagulation (CPC) on retinal blood flow parameters in glaucoma patients using Dynamic Vessel Analysis (DVA).
Materials and Methodology:
26 patients (average age: 70 years) with a long history of primary open angle glaucoma underwent CPC. The effect on the reactive capacity of retinal vessels was assessed before and 6-8 weeks after CPC by means of the Dynamic Vessel Analyzer (DVA) using flicker light provocation.
Results:
In our group of POAG patients, IOP was significantly reduced about approximately 20% by CPC while systemic blood pressure and heart rate were not changed.
The most obvious differences between the pre- and postoperative DVA measurements could be observed in the maximal dilation of the retinal arteries which increased from 0.75 % (+/- 0.6) to 3.17 % (+/- 0.5) with an average increase of 2.4 % (p<0.01). In addition, the ability of the arteries for constriction improved significantly (p<0.05) while the dynamic responses of the veins and the initial baseline values (MU) of the vessel diameters did not change.
Conclusions:
Our results of DVA measurements after an IOP-lowering laser surgical intervention (CPC) reveal a significant recovery of the regulative capacity of retinal arteries in glaucoma patients that has up to now neither been properly documented nor appreciated. Future studies with long-term follow-up must determine the clinical importance of these findings for the treatment of glaucoma patients.
doi:10.2174/1874364101408010027
PMCID: PMC4110390  PMID: 25067978
Cyclophotocoagulation (CPC); glaucoma; IOP; retinal vessel autoregulation; dynamic vessel analyzer (DVA); vascular dysregulation.
10.  Classical Pathology of Sympathetic Ophthalmia Presented in a Unique Case 
The ocular pathology of sympathetic ophthalmia is demonstrated in a 10 year-old boy who sustained a penetrating left globe injury and subsequently developed sympathetic ophthalmia in the right eye two months later. Two and a half weeks following extensive surgical repair of the left ruptured globe, he developed endophthalmitis and was treated with oral and topical fortified antibiotics. One month after the initial injury, a progressive corneal ulcer of the left eye led to perforation and the need for emergent corneal transplantation. The surgical specimen revealed fungus, Scedosporium dehoogii. The boy received systemic and topical anti-fungal therapy. Two months following the penetrating globe injury of the left eye, a granulomatous uveitis developed in the right eye. Sympathetic ophthalmia was suspected and the patient began treatment with topical and oral corticosteroids. Given the concern of vision loss secondary to sympathetic ophthalmia in the right eye, as well as poor vision and hypotony in the injured eye, the left eye was enucleated. Microscopically, granulomatous inflammation with giant cells was noted within a cyclitic membrane which filled the anterior and posterior chamber of the left globe. Other classic features including Dalen-Fuchs nodules were identified. Small, choroidal, ill-defined granulomas and relative sparing of the choriocapillaris were present. Molecular analysis did not identify evidence of remaining fungal infection. The pathology findings were consistent with previously described features of sympathetic ophthalmia. The present case is unique in that co-existing fungal infection may have potentiated the risk for developing sympathetic ophthalmia in the fellow eye.
doi:10.2174/1874364101408010032
PMCID: PMC4110402  PMID: 25067979
Infection; injury; pathology; sympathetic ophthalmia.
11.  Glycolysis in Patients with Age-Related Macular Degeneration 
Purpose:
Retinal adenosine triphosphate is mainly produced via glycolysis, so inhibition of glycolysis may promote the onset and progression of age-related macular degeneration (AMD). When glycolysis is inhibited, pyruvate is metabolized by lactic acid fermentation instead of entering the mitochondrial tricarboxylic acid (TCA) cycle. We measured urinary pyruvate and lactate levels in patients with AMD.
Methods:
Eight patients with typical AMD (tAMD group) and 9 patients with polypoidal choroidal vasculopathy (PCV group) were enrolled. Urinary levels of pyruvate, lactate, α-hydroxybutyrate, and β-hydroxybutyrate were measured in all patients.
Results:
The mean urinary levels of pyruvate and lactate were 8.0 ± 2.8 and 7.5 ± 8.3 μg/mg creatinine (reference values: 0.5-6.6 and 0.0-1.6), respectively, with the mean increase over the reference value being 83.6 ± 51.1% and 426.5 ± 527.8%, respectively. In 12 patients (70.6%), the lactate/pyruvate ratio was above the reference range. Urinary levels of α-hydroxybutyrate and β-hydroxybutyrate were decreased by -31.9 ± 15.2% and -33.1 ± 17.5% compared with the mean reference values. There were no significant differences of any of these glycolysis metabolites between the tAMD and PCV groups. Multivariate analysis revealed that none of the variables tested, including patient background factors (age, hypertension, diabetes, hyperlipidemia, cerebrovascular disease, alcohol, smoking, visual acuity, and AMD phenotype), were significantly associated with the lactate/pyruvate ratio.
Conclusion:
A high lactate/pyruvate ratio is a well-known marker of mitochondrial impairment, and it indicates poor oxidative function in AMD. Our results suggest that increased lactate levels may be implicated in the pathogenesis of AMD.
doi:10.2174/1874364101408010039
PMCID: PMC4150380  PMID: 25191529
Age-related macular degeneration; glycolysis; ketone body; lactate; pyruvate.
12.  Intraocular Lens Subluxation in Marfan Syndrome 
Purpose :
Ectopia lentis (EL) is a major criteria for the diagnosis of Marfan syndrome, it may vary from an asymptomatic mild displacement to a significant subluxation that places the equator of the lens in the pupillary axis. The purpose of this work is to present the case of a patient with Marfan syndrome who received treatment for subluxation at our institution.
Case Report :
A 51-year-old female diagnosed with Marfan syndrome presented to the emergency department with bilateral eye redness, foreign body sensation and crusting around the eyes on awakening. She had the following history of cardiac and ophthalmologic complications, including: 1. Lens subluxation 2. High myopia 3. Aortic root dilation, 4. Mitral valve prolapse and 5. Tricuspid insufficiency.
Conclusion :
The ophthalmological management of Marfan patients is challenging and periodical follow-up is needed. Surgical versus conservative management is controversial, each case needs to be evaluated individually to analyze the risks and benefits of the procedures.
doi:10.2174/1874364101408010048
PMCID: PMC4181168  PMID: 25279020
Capsular tension ring; intraocular lens subluxation; zonular dyalisis; zonular instability.
13.  Ocular Surface Alterations and Topical Antiglaucomatous Therapy: A Review 
Ocular Surface Disease (OSD) is prevalent among medically treated patients with glaucoma. This is basically related to three key-points: OSD and glaucoma are both prevalent in elderly and are common comorbidities in the same patient; the role of the active ingredient of the medical antiglaucomatous therapy; the role of the preservative agent of this medical therapy.
Considering the actual state of literature we can state that the active glaucoma agent have a role in OSD, but the main cause seems to be the preservative agent, in particular referring to benzalkonium chloride, BAK.
In the clinical evaluation of dry eye patients there is no actually established gold standard. Since the ocular surface injury not only causes dry eye, red eye, eye itching, photophobia and other discomforts, but also increases the risk of failure of glaucoma surgery in patients, it becomes fundamental a complete and good clinical evaluation of OSD (considering Schirmer’s test, tear breakup time, corneal and conjunctival staining) together with a good evaluation of patients’ quality of life (with validated questionnaires).
Development of complex preparations, preservative-free and/or novel preservative preparations for glaucoma therapy could provide a promising approach in the prevention of ocular surface injuries.
doi:10.2174/1874364101408010067
PMCID: PMC4192829  PMID: 25317218
Benzalkonium chloride (BAK); dry eye; glaucoma; ocular surface disease (OSD); quality of life (QoL).
14.  LETTER TO THE EDITOR Screening for Fingolimod Associated Macular Oedema: Experience Versus Guidelines 
We report adherence to United Kingdom national guidelines on surveillance for Fingolimod associated macular oedema (FAME) and the impact on clinical services at our unit. We conducted a 9-month study, measuring referral interval, visual function and performing OCT scans for all patients referred for FAME surveillance. 38 patients in total were seen, representing 9% of all new ophthalmic referrals during the study period. 26% were seen between 2 and 4 months after starting Fingolimod treatment, 74% between 3 and 4 months after starting Fingolimod treatment. The impact on clinical services is discussed.
doi:10.2174/1874364101408010073
PMCID: PMC4192831  PMID: 25317219
Fingolimod; guidelines; macular oedema; screening.
15.  Influence of Latanoprost on Retinal Microcirculation in Glaucoma 
Purpose :
To test whether latanoprost has an influence on ocular haemodynamics, considering the general reputation of prostaglandins which is frequently associated with vasoconstriction. The effect of latanoprost on the retinal blood supply of treatment-naïve glaucoma patients was tested.
Materials and Methodology :
13 patients (7 male, 6 female) who had just recently been diagnosed with primary open-angle glaucoma (POAG) were treated with latanoprost (0.005%). The average age of our study group was 63.8 years (+/- 2.9 years).
The drug’s effect on retinal autoregulation was assessed by flicker test using the Dynamic Vessel Analyzer (DVA). Examinations took place before initializing treatment, after 4 weeks and once again after 4 to 6 months.
Results :
In our group of POAG patients, the IOP under treatment was significantly reduced about 25%. No intraindividual differences in systemic blood pressure and heart rate were observed. In DVA measurements of glaucoma patients, the maximum flicker dilation of the arteries was significantly lower than reported for healthy volunteers. Beyond that, POAG patients did not show significant differences in vessel diameters, peak amplitudes as well as maximum dilations of retinal arteries and veins before and under treatment with latanoprost (0.005%).
Conclusion :
Latanoprost markedly lowered the IOP but it did not exert a significant effect on retinal haemodynamics. There was neither a tendency towards vasoconstriction nor towards vasodilation. Sustaining reperfusion damage after topical latanoprost therapy thus seems to be highly unlikely. Further studies must show if sole IOP lowering or a dual positive effect – IOP lowering and improvement of retinal vessel autoregulation – have a more positive impact on the long term follow-up of glaucoma patients.
doi:10.2174/1874364101408010060
PMCID: PMC4195175  PMID: 25317217
Autoregulation; dynamic vessel analyzer (DVA); glaucoma; haemodynamics; latanoprost; vascular dysregulation.
16.  In Vivo Confocal Microscopic Evaluation of Corneal Langerhans Cells in Dry Eye Patients§ 
Purpose.
To assess inflammatory involvement of cornea in dry eye by means of confocal microscopy, evaluating the presence and distribution of Langherans cells (LCs).
Methods:
98 eyes of 49 subjects were enrolled: 18 subjects affected by Sjögren Syndrome Dry Eye (SSDE), 17 with Non-Sjögren Syndrome Dry Eye (NSSDE), 14 healthy volunteeers. Dry eye symptoms, tear film, ocular surface damage and corneal confocal microscopy were analized.
Results:
A significant increase of LCs density was observed at sub-basal nerve plexus (SSDE = 79 cells/mm2 andNDE = 22 cells/mm2; p = 0,0031) and sub-epithelial nerve plexus (SSDE = 38 cells/mm2 and NDE = 3 cells/mm2; p = 0,0169) in central cornea of SSDE group. An increased number of LCs from the center to the periphery of the cornea was observed, significant only in healthy volunteers group. In dry eye patients there was an increase in LCs density in both peripheral and central cornea with a significant difference between NDE (14,66 cells/mm2) and SSDE (56,66 cells/mm2) only in central cornea (p = 0,0028). In SSDE group, mean density of LCs in central cornea results also superior to NSSDE group (29,33 cells/mm2).
There was no correlation between LCs density and dry eye symptoms, tear film deficiency and ocular surface damage.
Conclusion:
This study demonstrates the activation of an inflammatory and immunological reaction in cornea of NSSDE and SSDE patients. Confocal microscopy can be an important diagnostic tool in evaluation and follow-up of dry eye disease.
doi:10.2174/1874364101408010051
PMCID: PMC4195179  PMID: 25317216
Confocal microscopy; cornea; dry eye; langherans cells; sj gren.
17.  Trabeculectomy Improves Vessel Response Measured by Dynamic Vessel Analysis (DVA) in Glaucoma Patients 
Purpose :
To determine the effects of surgical IOP reduction (trabeculectomy) on retinal blood flow parameters in glaucoma patients using Dynamic Vessel Analysis (DVA).
Methods :
26 eyes of 26 patients with progressive primary open-angle glaucoma (POAG) despite maximal topical therapy were examined before and after trabeculectomy. The responses of the retinal vessels to flickering light provocation were measured with DVA the day before surgery and 4 to 6 weeks after trabeculectomy. Between 3 and 4 weeks before surgery all local therapies were stopped and a systemic therapy with acetazolamide and conservative free topic steroidal eye drops was started.
Results :
In 19 patients (73%), an inadequate response to the flicker stimulation was measured preoperatively. In these patients, the maximum dilation of arteries and veins was reduced significantly as compared to healthy eyes. In this group, the maximum dilation of the arteries following the flicker provocation improved from 1.4% before to 3.8% following trabeculectomy (p<0.01). In retinal veins, this parameter increased from 3.1% to 4.6% (p<0.05). In the 7 patients whose arterial and venous reactions to flickering light provocation preoperatively did not differ from healthy eyes, there was no significant change after surgery. The initial baseline values of arteries and veins (MU) did not deviate significantly in both groups.
Conclusion :
POAG patients with progressive disease and impaired vascular regulation profit from IOP lowering trabeculectomy concerning vascular reactivity and dilative reserve, indicating a possible improvement of retinal perfusion following effective IOP control. Future studies with long-term follow-up must determine the clinical importance of these findings for the treatment of glaucoma patients.
doi:10.2174/1874364101408010075
PMCID: PMC4209500  PMID: 25352934
Dynamic vessel analyzer (DVA); glaucoma; IOP; retinal autoregulation; trabeculectomy; vascular dysregulation.
18.  Indications for Intravitreal Bevacizumab in Ibadan, Sub-Saharan Africa 
Background :
Angiogenesis is a contributing factor in some retinal diseases, hence the role of vascular endothelial growth factor (VEGF) as a common pathway in proliferative retinopathies. Bevacizumab has been found to be effective in the treatment of these diseases.
The aim of this study was to review all cases of intravitreal bevacizumab given in the retinal unit of the University College Hospital, Ibadan from July, 2010 to June 2012, pointing out the common indications.
Methods :
After obtaining ethical approval from the University College Hospital/University of Ibadan Review Board for the study, all cases of intravitreal injections of bevacizumab recorded in the retinal register during the study period (July 2010 to June 2012) were retrieved. Age, sex, diagnoses and indication for injection were recorded in the data sheet prepared for the study. Results were analyzed using proportions and percentages.
Results :
A total of one hundred and thirty four injections of bevacizumab were given in the study period. The most common indication was cystoid macular edema from retinal vein occlusion ([26(19.4%)] followed by wet age related maculopathy [23(17.1%)] and sickle cell retinopathy [(22(16.4)]. Emerging indications included idiopathic polypoidal choroidal vasculopathy [8(6%) and retinal macroaneurism with macular edema [6(4.5%)].
Conclusion :
Cystoid macular edema from vascular occlusion and wet age related macular degeneration are the major indications for intravitreal bevacizumab injection in Ibadan.
doi:10.2174/1874364101408010087
PMCID: PMC4258700  PMID: 25493104
Cystoid macular edema; intravitreal bevacizumab; retinal vein occlusion; sickle cell retinopathy.
19.  Retinal Nerve Fiber Layer Alterations After Photocoagulation: A Prospective Spectral-Domain OCT Study 
Purpose :
To evaluate the effect of panretinal photocoagulation (PRP) on retinal nerve fiber layer thickness (RNFLT) in treatment-naive patients with proliferative diabetic retinopathy (PDR).
Methods :
Fifty eight previously untreated eyes of 30 patients with PDR who underwent PRP treatment were enrolled prospectively. All patients had at least six months of follow-up. Detailed ophthalmologic examinations including macular thickness and RNFLT assessments with spectral-domain type optic coherence tomography were performed at baseline as well as the third and sixth posttreatment months. Initial RNFLT and macular thickness of laser administered patients were compared with two separate control groups that were consisted of either nondiabetic patients or diabetics without PDR.
Results :
The mean age of study patients was 52.4±7.1 years (Range, 32-66 years) and 16 of them (53.3%) were female. At the sixth post-PRP month, visual stabilization or improvement was achieved in 54 eyes (93.1%). No significant difference was demonstrated in initial RNFLT measurements between the study patients and two control groups (p=0.478). Mean RNFLT was measured as 108.5±17.5µm, 115.8±17.6µm, and 103.0±16.4µm at baseline, third and sixth months of the follow-up, respectively. Although RNFLT increase noted at the third post-laser month was statistically significant compared to its baseline values (p<0.001), there was a significant reduction in RNFLT at the sixth post-laser month compared to its baseline values (p<0.001).
Conclusion :
RNFLT increase in the third month of follow-up may be related to ensuing axonal edema. Significant RNLFT decrease at the sixth month of follow-up may be attributed to axonal loss secondary to the laser treatment.
doi:10.2174/1874364101408010082
PMCID: PMC4258701  PMID: 25493103
Diabetic retinopathy; panretinal photocoagulation; retinal nerve fiber layer.
20.  Population-Based Age Group Specific Annual Incidence Rates of Symptomatic Age-Related Macular Degeneration 
Purpose
To study the population-based annual incidence rates of exudative, dry and all cases of symptomatic age-related macular degeneration (AMD) in different age and sex groups.
Methods.
This is a one year, prospective, population-based study on all consecutive new patients with AMD in the hospital district of Central Finland. The diagnosis was confirmed in all patients with slit lamp biomicroscopy, optical coherence tomography (OCT) using a Spectralis HRA + OCT device, and the Heidelberg Eye Explorer 1.6.2.0 program. Fluorescein angiograms were taken when needed.
Results.
The population-based annual incidence rates of all cases of symptomatic AMD increased from 0.03% (95% CI, 0.01-0.05%) in the age group 50-59 years to 0.82% (95% CI, 0.55-1.09%) in the age group 85-89 years and were 0.2% (95% CI, 0.17-0.24%) in exudative, 0.11% (95% CI, 0.09-0.14%) in dry, and 0.32% (95% CI, 0.28-0.36%) in all cases of AMD in the age group 60 years and older. During the next 20 years in Central Finland the population-based annual incidence rates can be estimated to increase to 0.27% (95% CI, 0.24-0.30%) in exudative, to 0.13% (95% CI, 0.11-0.15%) in dry, and to 0.41% (95% CI, 0.37-0.45%) in all cases of AMD in the age group 60 years and older. The population-based annual incidence of AMD did not show statistically significant differences between males and females (p>0.1).
Conclusion:
The population-based age-group specific annual incidence rates of symptomatic AMD of this study may help to plan health care provision for patients of AMD.
doi:10.2174/1874364101408010095
PMCID: PMC4319199
Age-related macular degeneration; incidence; macula; optical coherence tomography; retina.
21.  Economic Burden of Diabetes in Urban Indians 
Purpose :
To find out the average economic burden of medical care on a patient with diabetes in Pune, India
Methods :
A semi-open ended questionnaire followed by interview was conducted with patients attending diabetes and ophthalmic out-patient departments. They were asked regarding the duration of diabetes, methods undertaken for blood sugar control and the amount they spend on consultations, laboratory tests, medicines and procedures if any within past year. Expenditure was classified as direct cost (cost of medicines, doctor’s fees, investigations, lasers and surgery) and indirect cost (travel, diet control, health classes and loss of wages). Data was collected regarding the socioeconomic status according to Kuppaswamy classification.
Results :
219 patients participated of whom 129 were males (58.9%). Average annual direct cost of diabetes treatment was Rs 8,822 of which 52.1% was spend on medicines, 3.2% was spend on lasers, 12.6% was spend on surgical procedures, 11.6% spent on investigations and 10.4% was spend on clinician fees. Average annual indirect cost was Rs. 3949 of which 3.4% was spend on travelling purpose, 0.4% was spent on health classes, 4.9% was spent on diet control and 91.3% was loss of wages. Average expenditure done by lower middle class was 23.7% of their income. Average percentage of income for direct and indirect cost was 3.6% and 1.4% respectively. The cost of the treatment formed1.3% of the annual income for those in Socio-economic class I, 1.7% in class II, 3.7% in class III and 23.7% in class IV.
Conclusion :
The cost of managing diabetes was a significant proportion of the patients’ income, especially for those on lower socio-economic scale (class IV).
doi:10.2174/1874364101408010091
PMCID: PMC4319201
Cost of treatment; diabetes; economic burden; India.
22.  Incidence of Retinal Pigment Epithelial Tears and Associated Risk Factors After Treatment of Age-Related Macular Degeneration with Intravitreal Anti-VEGF Injections§ 
Purpose :
To study the incidence and risk factors for retinal pigment epithelium tears following intravitreal anti-vascular endothelial growth factor (VEGF) injections.
Methods :
Retrospective longitudinal study. 4027 intravitreal anti-VEGF injections in 628 patients (676 eyes) for choroidal neovascularisation associated with age related macular degeneration in a period of 18 months were studied.
Results :
Seventeen patients (mean age 83.95±5.84) developed retinal pigment epithelium tears. The incidence rate was 0.4%. Fibrovascular pigment epithelium detachment (PED) was previously observed in all cases. In 88 % (15/17) of AMD patients that had a RPE tear, PED height was found to be less than 400 microns at presentation. In 5 of 7 patients with RPE tear grade <4, continuing of anti-VEGF treatment resulted to improvement of visual acuity.
Conclusion :
Critical risk factors for RPE tears are presence of PED as well as advanced age. Visual improvement appears to depend more on the extent and location of the RPE tear and less on the PED height.
doi:10.2174/1874364101408010101
PMCID: PMC4319202
Age-related macular degeneration; anti-vascular endothelial growth factor; intravitreal; retinal pigment epithelium tears.
23.  Diabetic Retinopathy and VEGF 
Diabetic retinopathy remains the leading vascular-associated cause of blindness throughout the world. Its treatment requires a multidisciplinary interventional approach at both systemic and local levels. Current management includes laser photocoagulation, intravitreal steroids, and anti-vascular endothelial growth factor (VEGF) treatment along with systemic blood sugar control. Anti-VEGF therapies, which are less destructive and safer than laser treatments, are being explored as primary therapy for the management of vision-threatening complications of diabetic retinopathy such as diabetic macular edema (DME). This review provides comprehensive information related to VEGF and describes its role in the pathogenesis of diabetic retinopathy, and in addition, examines the mechanisms of action for different antiangiogenic agents in relation to the management of this disease. Medline (Pubmed) searches were carried out with keywords “VEGF”, “diabetic retinopathy”, and “diabetes” without any year limitation to review relevant manuscripts used for this article.
doi:10.2174/1874364101307010004
PMCID: PMC3580758  PMID: 23459241
Diabetic retinopathy; VEGF; DME; diabetes; central retinal vein occlusion; PGF.
24.  Should Posterior Vitrectomy be Made a Priority in Ophthalmic Facilities of Sub Sahara Africa? 
Background:
Posterior vitrectomy facilities are lacking in Sub Sahara Africa due to paucity of trained personnel in vitreo retinal subspecialty. More cases are seen needing vitrectomy, especially cases with vitreous opacities and complications of cataract surgery as more residents are being trained. The review will aim to determine whether vitrectomy facility should be a priority as part of ophthalmic facility in the region.
Method:
A 3 year review was carried out. All cases of posterior vitrectomy performed at the retinal unit of the University College Hospital, Ibadan, Africa between 2008 and 20011 were retrieved. Indications, and visual outcome were documented. Proportions and percentages were used to analyse the data.
Results:
Sixty six posterior vitrectomies were performed during the period. The most common indication for vitrectomy was vitreous hemorrhage n=30 [45.5%].Complication of cataract surgery such as dropped intraocular lens 7 [10.7%], sclera fixated intra ocular lens 6 [9.2%], and dropped nucleus 5 [7.5%] were emerging indications. Other indications noted include complicated retinal detachments 4 (6.1%), membranectomy for posterior capsule opacity from pediatric cataract surgery 3 (4.5%) and congenital lens subluxation 2 (3.0%). Improved visual outcome was noted after surgery. Forty nine [75%] eyes were blind [visual acuity of < 3/60] before vitrectomy. This proportion dropped to 24 [37%] after vitrectomy with an additional 24% regaining navigational vision [visual acuity of 3/60 to Counting fingers at 1meter] .
Conclusion:
Vitrectomy should be an integral part of eye care and its availability should be made a priority in ophthalmic facilities of Sub Sahara Africa, especially those involved in ophthalmology training.
doi:10.2174/1874364101307010001
PMCID: PMC3582012  PMID: 23459116
Cataract surgery complications; posterior vitrectomy; retinal; sub Sahara Africa; vitreous opacities.
25.  Correlation from Undiluted Vitreous Cytokines of Untreated Central Retinal Vein Occlusion with Spectral Domain Optical Coherence Tomography 
Purpose:
To correlate inflammatory and proangiogenic key cytokines from undiluted vitreous of treatment-naïve central retinal vein occlusion (CRVO) patients with SD-OCT parameters.
Methods:
Thirty-five patients (age 71.1 years, 24 phakic, 30 nonischemic) underwent intravitreal combination therapy, including a single-site 23-gauge core vitrectomy. Twenty-eight samples from patients with idiopathic, non-uveitis floaterectomy served as controls. Interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF-A) levels were correlated with the visual acuity (logMar), category of CRVO (ischemic or nonischemic) and morphologic parameters, such as central macular thickness-CMT, thickness of neurosensory retina-TNeuro, extent of serous retinal detachment-SRT and disintegrity of the IS/OS and others.
Results:
The mean IL-6 was 64.7pg/ml (SD ± 115.8), MCP-1 1015.7 ( ± 970.1), and VEGF-A 278.4 ( ± 512.8), which was significantly higher than the control IL-6 6.2 ± 3.4pg/ml (P=0.06), MCP-1 253.2 ± 73.5 (P<0.0000001) and VEGF-A 7.0 ± 4.9 (P<0.0006). All cytokines correlated highly with one another (correlation coefficient r=0.82 for IL-6 and MCP-1; r=0.68 for Il-6 and VEGF-A; r=0.64 for MCP-1 and VEGF-A). IL-6 correlated significantly with CMT, TRT, SRT, dIS/OS, and dELM. MCP-1 correlated significantly with SRT, dIS/OS, and dELM. VEGF-A correlated not with changes in SD-OCT, while it had a trend to be higher in the ischemic versus the nonischemic CRVO group (P=0.09).
Conclusions:
The inflammatory cytokines were more often correlated with morphologic changes assessed by SD-OCT, whereas VEGF-A did not correlate with CRVO-associated changes in SD-OCT. VEGF inhibition alone may not be sufficient in decreasing the inflammatory response in CRVO therapy.
doi:10.2174/1874364101307010011
PMCID: PMC3613771  PMID: 23560031
Vitreous samples; CRVO; VEGF; MCP-1; IL-6; CBA; SD-OCT.

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