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  • Metformin and rapamycin protect cells from vital dye–induced damage in retinal pigment epithelial cells and in vivo
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-14
    Chih-Wen Shu, Chui-Lien Tsen, Meng-Syuan Li, Youn-Shen Bee, Shi-Han Lin, Shwu-Jiuan Sheu

    Abstract Purpose To evaluate the effect of autophagy inducers on damage caused by vital dye in adult human RPE (ARPE) cells and in a rat model. Methods ARPE-19 cells were exposed to ICG or BBG (0.05 mg/ml) with rapamycin (200 nM) or metformin (2 mM) for 30 min and treated with or without 20 μM chloroquine (CQ) to identify the protein levels of LC3 and SQSTM1 by immunoblotting. In vivo study was performed by injecting 10 μl 0.05% ICG and 0.25% BBG into the subretinal space of the rat eyes, and/or co-treated them with metformin and rapamycin. The retinas were used to determine autophagy with the LC3-II level and apoptosis with terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) assay. Results In this study, both ICG and BBG inhibited autophagy flux in adult human retinal pigment epithelium cells (ARPE-19), whereas only ICG consistently reduced autophagy in the retina of rats. Moreover, rapamycin and metformin induced autophagic flux in ARPE-19 cells and increased the LC3-II level in retinal tissues exposed to vital dyes. Both ICG and BBG increased apoptosis in the retina of rats. However, both rapamycin and metformin induced autophagy and reduced the apoptosis caused by vital dyes. Conclusion Taken together, these results suggest that rapamycin and metformin may diminish vital dye–induced retinal damage in vivo through activation of autophagy.

    更新日期:2020-01-14
  • Multi-label classification of retinal lesions in diabetic retinopathy for automatic analysis of fundus fluorescein angiography based on deep learning
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-14
    Xiangji Pan, Kai Jin, Jing Cao, Zhifang Liu, Jian Wu, Kun You, Yifei Lu, Yufeng Xu, Zhaoan Su, Jiekai Jiang, Ke Yao, Juan Ye

    Abstract Purpose To automatically detect and classify the lesions of diabetic retinopathy (DR) in fundus fluorescein angiography (FFA) images using deep learning algorithm through comparing 3 convolutional neural networks (CNNs). Methods A total of 4067 FFA images from Eye Center at the Second Affiliated Hospital of Zhejiang University School of Medicine were annotated with 4 kinds of lesions of DR, including non-perfusion regions (NP), microaneurysms, leakages, and laser scars. Three CNNs including DenseNet, ResNet50, and VGG16 were trained to achieve multi-label classification, which means the algorithms could identify 4 retinal lesions above at the same time. Results The area under the curve (AUC) of DenseNet reached 0.8703, 0.9435, 0.9647, and 0.9653 for detecting NP, microaneurysms, leakages, and laser scars, respectively. For ResNet50, AUC was 0.8140 for NP, 0.9097 for microaneurysms, 0.9585 for leakages, and 0.9115 for laser scars. And for VGG16, AUC was 0.7125 for NP, 0.5569 for microaneurysms, 0.9177 for leakages, and 0.8537 for laser scars. Conclusions Experimental results demonstrate that DenseNet is a suitable model to automatically detect and distinguish retinal lesions in the FFA images with multi-label classification, which lies the foundation of automatic analysis for FFA images and comprehensive diagnosis and treatment decision-making for DR.

    更新日期:2020-01-14
  • The stability of horizontal ocular alignment of triad exotropia after one-step triple surgery
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-14
    Lianqun Wu, Weiyi Xia, Lei Li, Sida Xi, Xiying Wang, Wen Wen, Chao Jiang, Guohua Liu, Chen Zhao

    A-pattern exotropia, superior oblique muscle overaction, and dissociated vertical deviation may coexist and are referred to as triad exotropia. The present study evaluated the postoperative stability of horizontal ocular alignment of triad exotropia and possible prognostic factors.

    更新日期:2020-01-14
  • HCE-T cell line lacks cornea-specific differentiation markers compared to primary limbal epithelial cells and differentiated corneal epithelium
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-11
    Anna-Klara Rubelowski, Lorenz Latta, Priya Katiyar, Tanja Stachon, Barbara Käsmann-Kellner, Berthold Seitz, Nóra Szentmáry

    Human corneal epithelial cell-transformed (HCE-T) cell line is used as a widely accepted barrier model for pharmacological investigations in the context of eye application. The differentiation of (limbal) corneal epithelial into mature corneal epithelium coincides with the expression of established differentiation markers. If these differentiation mechanisms are disturbed, it will lead to ocular surface disease. In this study, we want to compare the expression of differentiation markers in the HCE-T cell line to differentiated primary epithelial cells (pCECs) and primary limbal epithelial cell (LEC) culture. This is necessary in order to decide whether HCE-T cells could be a tool to study the differentiation process and its regulatory networks in corneal epithelium.

    更新日期:2020-01-13
  • Comparison of postoperative refractive outcome in eyes undergoing combined phacovitrectomy vs cataract surgery following vitrectomy
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-10
    Paris G. Tranos, Bruce Allan, Miltiadis Balidis, Athanasios Vakalis, Solon Asteriades, George Anogeianakis, Magda Triantafilla, Nikolaos Kozeis, Panagiotis Stavrakas

    To investigate the accuracy of preoperative biometry in eyes undergoing combined phacovitrectomy and to compare it with eyes having cataract surgery at a later point in time following vitrectomy.

    更新日期:2020-01-11
  • Ophthalmological findings in children with autism spectrum disorder
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-09
    Raoul Kanav Khanna, Klara Kovarski, Sophie Arsene, Marine Siwiaszczyk, Pierre-Jean Pisella, Frédérique Bonnet-Brilhault, Magali Batty, Joëlle Malvy

    Eye pathology could be related to atypical visual behaviours and impaired social communication through visual cues in children with autism spectrum disorder (ASD). The main purpose of this prospective study was to assess ophthalmological disorders in children with ASD and to investigate the relationships with intellectual disability (ID) and ASD severity.

    更新日期:2020-01-09
  • Assessment of corneal topographic, tomographic, densitometric, and biomechanical properties of Fabry patients with ocular manifestations
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-08
    Veysel Cankurtaran, Kemal Tekin, Ayse Idil Cakmak, Merve Inanc, Faruk Hilmi Turgut

    Abstract Purpose To investigate whether cornea verticillata affects corneal topography, tomography, densitometry, or biomechanics of Fabry patients with ocular manifestations and to compare these results with those obtained from healthy subjects. Methods This prospective, cross-sectional study included 23 Fabry patients (Fabry group) with cornea verticillata and the 37 age- and sex-matched healthy subjects (control group). After comprehensive ophthalmological examinations, corneal topography, tomography, and densitometry measurements were taken using Pentacam HR and corneal biomechanics were captured via Corvis ST for all participants. Results All the investigated topographic and tomographic values were similar in the eyes with Fabry disease (FD) and the controls (P > 0.05). The corneal densitometry values of patients with FD were statistically significantly higher in all the concentric zones and layers, except posterior 0–2 mm and posterior 2–6 mm zones, compared to the controls (P < 0.05). The mean values of A1 velocity, A2 velocity, deformation amplitude ratio, Corvis biomechanical index, tomographic and biomechanical index, and Stiffness parameter at the first applanation in the Fabry group were statistically significantly different compared to control group (P < 0.05). However, the mean values of A1 length, A2 length, and the biomechanically corrected intraocular pressure were similar between the groups (P = 0.317, P = 0.819, and P = 0.468; respectively). Conclusion Although cornea verticillata associated with FD is not considered to affect vision, it is associated with increased light backscattering and reduced corneal transparency as well as altered corneal biomechanical properties.

    更新日期:2020-01-08
  • Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year results
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-08
    Anıl Kubaloglu, Esin Sogutlu Sari, Arif Koytak

    To evaluate the 3-year results of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in keratoconus patients with previous corneal collagen crosslinking (CXL) treatment.

    更新日期:2020-01-08
  • Retinopathy of prematurity in discordant twins: is the small twin at increased risk?
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-08
    Ofira Zloto, Moran Goldfinger Lerner, Ram Mazkereth, Abraham Spierer, Yoav Yinon

    To examine the effect of birth weight (BW) independent of gestational age (GA) on Retinopathy of prematurity (ROP) in preterm discordant twins.

    更新日期:2020-01-08
  • Presence or absence of choroidal hyper-transmission by SD-OCT imaging distinguishes inflammatory from neovascular lesions in myopic eyes
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-06
    Xuan Shi, Yi Cai, Xiangdong Luo, Shuting Liang, Philip J. Rosenfeld, Xiaoxin Li

    Abstract Purpose To compare the characteristics of choroidal transmission in punctate inner choroidopathy (PIC) with or without choroidal neovascularization (CNV) and myopic CNV (mCNV) using spectral domain optical coherence tomography (SD-OCT). Methods This retrospective observational case series includes 22 consecutive myopic patients (22 eyes) recruited from April 2016 until April 2018 who complained of acute blurring of vision and showed evidence of hyper-reflective material on SD-OCT imaging. Each patient underwent a comprehensive eye examination and imaging with fundus fluorescein angiography (FFA), SD-OCT, and SD-OCT angiography (SD-OCTA). Based on the results of SD-OCTA imaging and the color fundus imaging, the patients were divided into 2 groups: a group with myopic choroidal neovascularization (mCNV group, n = 10 eyes) and a group with PIC and no evidence of CNV at baseline (PIC group, n = 12 eyes). Four eyes diagnosed with PIC developed secondary PIC-CNV during follow-up. The characteristics of choroidal transmission in these eyes using SD-OCT imaging were compared. Results At baseline, none of the PIC lesions showed any evidence of blood flow within the lesions on OCTA imaging. However, all of the eyes with mCNV showed flow signals within the subretinal neovascularization on SD-OCTA and subretinal or intra-retinal fluid on SD-OCT imaging. These eyes with mCNV showed subretinal hyper-reflectivity associated with choroidal hypo-transmission accompanied by retinal pigment epithelium (RPE) and ellipsoid zone (EZ) disruption. In eyes with PIC inflammatory lesions, disruption of both the RPE and EZ were observed in 33% of the inflammatory lesions, and disruption of the EZ alone was observed in 67% of the lesions at the baseline. They all showed a hyper-reflective subretinal lesion located above RPE. Three cases (25%) showed evidence of choroidal hyper-transmission at the baseline, while the remaining had normal transmission within the first month after onset. Hyper-transmission then developed in all the lesions as the disease progressed. Four cases of PIC (33%) developed PIC-related CNV that showed choroidal hypo-transmission along with hyper-transmission with disruption of the RPE and EZ. In cases with PIC-related CNV, evidences of neovascularization on SD-OCTA imaging were all detected afterwards. No intra-retinal fluid was detected before secondary CNV occurred. Conclusion SD-OCT imaging can noninvasively differentiate and track the progression of inflammatory lesions and myopic CNV by using the presence of choroidal hyper-transmission as a sign of just an inflammatory lesion and the presence hypo-transmission as a sign of a secondary CNV, which provides a convenient strategy for diagnosis and treatment of these lesions.

    更新日期:2020-01-06
  • Lens-induced uveitis: an update
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-06
    Eleanor Ngwe Nche, Radgonde Amer

    Abstract Ocular inflammation resulting from a lens pathology is rare in the absence of a cataract or lens trauma because of the lens’ immune privilege. The lens can be a source of ocular inflammation when the capsule is broken or when lens proteins leak out through an intact capsule. These uveitides are termed lens-induced uveitis (LIU) and are often associated with advanced cataracts. Cataracts are part of the normal aging process, and in today’s world, cataract surgery is a safe and affordable means of vision restoration in the developed world. In patients with neglected cataracts and in the developing world where cataract surgery rates are lower, LIU rates are higher together with the associated complications. In this literature review, we intend to equip the armamentarium of the practicing ophthalmologist with an updated knowledge on the demographic features, clinical characteristics, treatment options, and outcomes of LIU. This is to highlight the need for timely management of cataracts before the development of advanced cataracts and LIU.

    更新日期:2020-01-06
  • Novel biomarker of sphericity and cylindricity indices in volume-rendering optical coherence tomography angiography in normal and diabetic eyes: a preliminary study
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-06
    Peter M. Maloca, Richard F. Spaide, Emanuel Ramos de Carvalho, Harald P. Studer, Pascal W Hasler, Hendrik P. N. Scholl, Tjebo F. C. Heeren, Julia Schottenhamml, Konstantinos Balaskas, Adnan Tufail, Catherine Egan, IOB study group

    Preliminary to evaluate geometric indices (vessel sphericity and cylindricity) for volume-rendered optical coherence tomography angiography (OCTA) in healthy and diabetic eyes.

    更新日期:2020-01-06
  • Tailored internal limiting membrane flap technique for primary macular hole
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-04
    Jia-Horung Hung, Yu-Harn Horng, Hui-Chen Chu, Meng-Syuan Li, Shwu-Jiuan Sheu

    Abstract Purpose To investigate the outcomes of primary full-thickness macular hole (MH) after surgical intervention with tailored internal limiting membrane (ILM) flap technique. Methods Patients were reviewed for their clinical characteristics and surgical outcomes. The technique included incomplete circular peeling of the perifoveal ILM which was then trimmed according to the size of the MH. Fluid-gas exchange was done without further manipulation. Results Nineteen eyes of 19 patients were included. The patients were in average 61 years old (range 41–83) and had an average follow-up period of 11.0 months. At baseline visit, minimal linear diameter of the MH was 311.6 μm (range 80–768). After a single surgery, the MH closed in all cases with improvement of mean visual acuity (from 0.9 to 0.4 logarithm of the minimum angle of resolution units, p < 0.0001, Wilcoxon signed-rank test). At the final visit, 15 (78.9%) eyes achieved a visual acuity ≥ 20/40. Outer retinal gliosis was found to be associated with less favorable postoperative visual acuity. Factors related to the formation of outer retinal gliosis were worse preoperative visual acuity and a large MH with a diameter > 400 μm. Conclusion Tailored ILM flap technique is an effective method for favorable anatomical and visual outcomes for treatment of primary MH.

    更新日期:2020-01-04
  • SIRT1 is required for the neuroprotection of resveratrol on retinal ganglion cells after retinal ischemia-reperfusion injury in mice
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Jinyuan Luo, Tao He, Jiayi Yang, Ning Yang, Zongyuan Li, Yiqiao Xing

    Retinal ganglion cells (RGCs) loss is closely related to visual impairment in glaucoma, so the neuroprotection on RGCs is important and novel for glaucoma research. SIRT1, a family member of sirtuins, is implicated in many crucial processes of eye diseases. The purpose of this study is to determine the neuroprotection of SIRT1 on RGCs and to investigate the underlying mechanisms of these effects in an experimental model for acute glaucoma.

    更新日期:2020-01-04
  • Comparison of the accuracy of four Pentacam corneal astigmatism values in non-toric pseudophakic eyes
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Tianyu Zheng, Jie Xu, Yi Lu

    Abstract Purpose To compare the accuracy of different corneal astigmatism values measured by Scheimpflug keratometry (Pentacam), including Simulated Keratometry (SimK) and three total corneal astigmatism values, equivalent K reading (EKR), true net power (TNP), and total corneal refractive power (TCRP). Methods We enrolled 168 eyes of 168 patients with non-toric IOL implantation. Pentacam examination and subjective refraction were performed 3 months after surgery. The agreement, arithmetic difference, and vector difference between refractive astigmatism (RA) and different corneal astigmatism values were compared. Results Differences in astigmatism magnitude were significant between SimK and RA in the against-the-rule (ATR) and with-the-rule (WTR) groups but not in total corneal measurements. The meridians of SimK and RA differed significantly in the oblique astigmatism group. The correlations between total corneal astigmatism values and RA were stronger than that between SimK and RA in the total, WTR, and oblique astigmatism groups in Pearson’s correlation test. Bland-Altman plots revealed more data points exceeding the limits of agreement (LoA) in SimK measurement in total and WTR subjects. In the ATR group, fewer data points exceeded LoA in EKR. The mean difference vector between SimK and RA was larger than that of other measurements in each astigmatism group. The arithmetic mean of difference vector was significantly smaller in EKR in the total, WTR, and oblique groups. Conclusions Among different Pentacam readings, corneal astigmatism measurements considering anterior and posterior corneal surfaces were more representative of total ocular astigmatism than SimK, and EKR showed markedly better performance in astigmatism estimation.

    更新日期:2020-01-04
  • Foveal vasculature changes and nonperfusion in patients with diabetes types I and II with no evidence of diabetic retinopathy
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Efrat Fleissig, Mehreen Adhi, Douglas K. Sigford, Charles C. Barr

    Abstract Purpose To analyze the foveal avascular zone (FAZ) in patients with diabetes and no retinopathy vs. controls using OCT angiography (OCT-A). Methods Prospective, observational clinical study. Type I and II diabetics with no retinopathy and healthy control patients underwent OCT-A. The FAZ size and capillary density were calculated using Image J and Adobe Photoshop CS8. Statistical analysis was performed using one-way ANOVA with Tukey’s multiple comparison test and the Pearson correlation test. Results Fifty-two eyes of 28 diabetic patients and 28 eyes of 16 healthy controls were enrolled. Type I diabetes patients had a longer disease duration than type II (30.3 ± 10.3 vs. 12.3 ± 9.7 years). The mean superficial capillary plexus (SCP) of the FAZ area was 0.27 ± 0.1, 0.36 ± 0.14, and 0.27 ± 0.12 mm2, for the type I, type II, and controls (p = 0.0058) and was significantly larger in type II diabetics (p < 0.05). The mean DCP (deep capillary plexus) FAZ was significantly larger in type II diabetics vs. controls (0.67 ± 0.2 and 0.52 ± 0.16 mm2 respectively) (p < 0.05). Both type I and type II SCP capillary density were significantly lower than the controls (p < 0.05, p < 0.005), and DCP capillary density was significantly lower in type II vs. controls (p < 0.005). Conclusions Type I patients showed fewer changes in the FAZ than the type II group, although their duration of diabetes was longer. Larger studies are needed to better analyze the differences between type I and type II diabetics.

    更新日期:2020-01-04
  • Can a contact lens sensor predict the success of trabectome surgery?
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Naoki Tojo, Atsushi Hayashi

    Abstract Purpose We examined whether a contact lens sensor (CLS) is useful for the postoperative evaluation of trabectome surgery. We investigated the correlations between the outcomes of trabectome surgery and the output of a CLS. Methods We examined 24 consecutive eyes of patients with pseudo-exfoliation glaucoma. In each eye, the intraocular pressure (IOP) fluctuations over 24 h were measured with the SENSIMED Triggerfish CLS before and at 3 months after the trabectome surgery. We divided the patients into success (n = 12 eyes) and failure (n = 12 eyes) groups; success was defined as a postoperative IOP level ≤ 21 mmHg plus an IOP reduction ≥ 20% relative to the preoperative IOP value with or without anti-glaucoma medications. We investigated CLS parameters that correlate with surgical outcomes by performing a Cox hazard regression analysis. We determined the maximum value, minimum value, and range of IOP fluctuation as CLS parameters. Results The mean follow-up period was 38.0 ± 3.0 months. The success rate was 50%. The postoperative range of IOP fluctuation during the nocturnal period with the CLS was significantly correlated with the surgical results (p = 0.024). Conclusions A smaller range of IOP fluctuation was significantly correlated with better surgical outcomes. We were able to predict the surgical success after trabectome surgery at 3 months using the CLS. Thus, CLS results could be a new surgical evaluation parameter.

    更新日期:2020-01-04
  • Comparison between standard and transepithelial corneal crosslinking using a theranostic UV-A device
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Giuseppe Lombardo, Sebastiano Serrao, Marco Lombardo

    To assess corneal concentration of riboflavin in two different corneal crosslinking protocols performed by a novel image-guided therapeutic (or “theranostic”) UV-A device.

    更新日期:2020-01-04
  • Impact of optical coherence tomography angiography on the non-invasive diagnosis of neovascular age-related macular degeneration
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Audrey Giocanti-Auregan, Lise Dubois, Pauline Dourmad, Salomon Y. Cohen

    To investigate the changes in imaging tool practice for the diagnosis of neovascular age-related macular degeneration (nAMD).

    更新日期:2020-01-04
  • Multimodal imaging characterization of peripheral drusen
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Eleonora Corbelli, Enrico Borrelli, Mariacristina Parravano, Riccardo Sacconi, Marta Gilardi, Eliana Costanzo, Michele Cavalleri, Lea Querques, Francesco Bandello, Giuseppe Querques

    Abstract Purpose To provide an integrate multimodal imaging characterization of peripheral drusen in the eyes with and without macular signs of age-related macular degeneration (AMD) and to analyze their association with macular findings. Methods In this retrospective, cross-sectional study, subjects with peripheral drusen were imaged with the Optos (Optos PLC, Dunfermline, Scotland, UK) and Spectralis devices to obtain referenced spectral domain optical coherence tomography (SD-OCT) images. Two experienced graders independently graded the ultra-widefield (UWF) pseudocolor and fundus autofluorescence (FAF) images for the presence of peripheral drusen and analyzed peripheral druse features using OCT. Main outcome measures included quantitative and qualitative assessment of peripheral drusen. Results Fifty-seven eyes (30 subjects) were included in the analysis. Mean ± SD age was 77.6 ± 9.2 years (range 54–97 years). On pseudocolor images, graders identified the presence of drusen in all the enrolled eyes (Cohen’s kappa was 1.0). On FAF images, Cohen’s kappa was 0.71. In the topographical assessment, peripheral drusen were detected in 23 cases in the temporal region, in 40 cases in the nasal region, in 40 cases in the inferior region, and in 42 cases in the superior region. On SD-OCT images, peripheral drusen had a high reflective core in 97.1% of cases, while remaining drusen were characterized by a low reflective core. The macula was affected by early/intermediate AMD in 23 eyes (43.5%) and late AMD in 6 eyes (10.5%). Conclusions We provided an integrate multimodal imaging assessment of peripheral drusen in the eyes with and without AMD. Peripheral drusen were characterized by distinguished features that may suggest that these lesions constitute a distinct disease, rather than representing an expansion of AMD.

    更新日期:2020-01-04
  • Multifocal electroretinography in amblyopia
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Christiane Al-Haddad, Alaa Bou Ghannam, Zeinab El Moussawi, Elza Rachid, Karine Ismail, Marwan Atallah, Larissa Smeets, Hasan Chahine

    To identify whether there are functional abnormalities in the retina of amblyopic eyes using multifocal electroretinography (mfERG).

    更新日期:2020-01-04
  • Number, frequency and time interval of examinations under anesthesia in bilateral retinoblastoma
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Ido Didi Fabian, Vishal Shah, Noa Kapelushnik, Zishan Naeem, Zerrin Onadim, Elizabeth A Price, Catriona Duncan, David Stansfield, Mandeep S Sagoo, M. Ashwin Reddy

    Abstract Purpose Current practice in retinoblastoma (Rb) has transformed this malignancy into a curable disease. More attention should therefore be given to quality of life considerations, including measures related to examinations under anesthesia (EUAs). We aimed to investigate EUA measures in bilateral Rb patients and compare the findings to EUAs in unilateral Rb. Methods A retrospective analysis of bilateral Rb patients that presented to the London Rb service from 2006 to 2013, were treated and had long-term follow-up. Results A total of 62 Rb patients, 15 (24.2%) of which had International Intraocular Retinoblastoma Classification (IIRC) group A/B/no Rb at presentation, 26 (41.9%) C/D, and 21 (33.9%) were E in at least one eye. The mean number of EUAs was 35.8 ± 21.5, mean time from first to last EUA was 50.6 ± 19.9 months, and mean EUA frequency was 0.715 ± 0.293 EUAs/month. IIRC group was found not to correlate with any of the EUA measures. Age at presentation inversely correlated with time interval from first to last EUA and to EUA frequency (p ≤ 0.029). Rb family history correlated with the latter measure (p = 0.005) and intraophthalmic artery chemotherapy and brachytherapy correlated with all EUA measures (p ≤ 0.029). Mean follow-up time was 80.1 ± 24.3 months. When compared with a previously reported cohort of unilateral Rb, the present group underwent 3× more EUAs (p < 0.001) over nearly double the time (p < 0.001). Conclusions Families should be counselled on anticipated EUA burden associated with bilateral Rb. In this respect, age at presentation and family history were found to have a predictive role, whereas IIRC group did not.

    更新日期:2020-01-04
  • 4-Methylumbelliferone suppresses hyaluronan and adipogenesis in primary cultured orbital fibroblasts from Graves’ orbitopathy
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-03
    Yeonjung Yoon, Min Kyung Chae, Eun Jig Lee, Jin Sook Yoon

    In Graves’ orbitopathy (GO), hyaluronan secreted by orbital fibroblasts contributes to orbital tissue expansion. The goal of this research was to evaluate the potential benefit of 4-methylumbelliferone (4-MU), a hyaluronan synthase (HAS) inhibitor, in primary cultured orbital fibroblasts from Graves’ orbitopathy.

    更新日期:2020-01-04
  • Real-world outcomes following 12 months of intravitreal aflibercept monotherapy in patients with diabetic macular edema in France: results from the APOLLON study
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-02
    Jean-François Korobelnik, Vincent Daien, Céline Faure, Ramin Tadayoni, Audrey Giocanti-Auregan, Corinne Dot, Laurent Kodjikian, Pascale Massin

    Abstract Purpose To report the effectiveness of intravitreal aflibercept (IVT-AFL) treatment for diabetic macular edema (DME) in French clinical practice. Methods APOLLON (NCT02924311) was a prospective, observational cohort study of patients with DME. Effectiveness was evaluated by change from baseline in best-corrected visual acuity (BCVA) at 12 months in treatment-naïve patients (i.e., had not received any anti-vascular endothelial growth factor [anti-VEGF] agent, laser, or steroid at IVT-AFL treatment start) and previously treated patients (i.e., previously treated with anti-VEGF agents other than IVT-AFL, laser, or steroids at IVT-AFL treatment start). Secondary endpoints included change in central retinal thickness (CRT) over 12 months, frequency of injections, and proportion of patients with safety events. Results Of the 147 patients followed for at least 12 months and included in the effectiveness analysis, 52.4% (n = 77) were treatment-naïve and 47.6% (n = 70) were previously treated. Mean (standard deviation [SD]) BCVA score at baseline was 62.7 (14.3) Early Treatment Diabetic Retinopathy Study (ETDRS) letters in treatment-naïve patients and 60.0 (13.7) ETDRS letters in previously treated patients. At month 12, mean (SD) change in BCVA was + 7.8 (12.3) letters in treatment-naïve patients and + 5.0 (11.3) letters in previously treated patients. Mean CRT decreased in both patient cohorts. The mean (SD) number of IVT-AFL injections at month 12 was 7.6 (2.5) for treatment-naïve patients and 7.6 (2.3) for previously treated patients. Of 388 patients included in the safety analysis, ocular treatment-emergent adverse events occurred in 54.1% (n = 210) of patients. Conclusion IVT-AFL treatment was associated with improvements in functional and anatomic outcomes in both treatment-naïve and previously treated patients with DME in France.

    更新日期:2020-01-04
  • Microvascular retinal changes in pre-clinical diabetic retinopathy as detected by optical coherence tomographic angiography
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-02
    Jing Yan Yang, Qian Wang, Yan Ni Yan, Wen Jia Zhou, Ya Xing Wang, Shou Ling Wu, Ming Xia Yuan, Wen Bin Wei, Jost B. Jonas

    Abstract Purpose To investigate microvascular abnormalities in diabetic patients without conventional clinical signs of diabetic retinopathy (DR). Methods In this cross-sectional observational cohort study, the study group included randomly chosen participants of a community-based cohort with diabetes type 2 without DR, and the control group consisted of non-diabetic individuals from a population-based study. All participants underwent optical coherence tomographic angiography (OCTA). Results Upon OCTA, 118 (40.4%) eyes of the study group (n = 292 eyes) showed microvascular abnormalities including foveal avascular zone erosion (95 (32.5%) eyes), non-perfusion areas in the superficial and deep retinal layers (39 (13.4%) eyes and 19 (6.5%) eyes, respectively), and microaneurysms in the superficial and deep retinal layers (22 (7.5%) eyes and 31 (10.6%) eyes, resp.). None of these abnormalities was detected in the control group (n = 80). The study group showed a lower vessel density in the superficial retinal vascular layer in all regions except for the foveal region (P < 0.001), and higher vessel density in the parafoveal region in the deep retinal vascular layer (P = 0.01). Higher diabetes prevalence was associated with lower superficial retinal vascular density (P = 0.005) in multivariable analysis. A lower radial peripapillary capillary flow density was correlated (regression coefficient r, 0.62) with higher fasting blood concentration of glucose (P < 0.001) in multivariable analysis. Conclusions OCTA revealed microvascular abnormalities in 40% of eyes of diabetic patients without ophthalmoscopically detectable diabetic fundus changes in a community-based population. The early stage of DR may be re-defined upon OCTA.

    更新日期:2020-01-04
  • Evaluation of the ocular surface by impression cytology in patients with endometriosis
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-02
    Meydan Turan, Gulay Turan, Akin Usta

    Abstract Objective The aim of this study was to investigate the effect of endometriosis on the ocular surface. Methods A total of 50 patients were included in the study and divided into two groups. Group 1 consisted of 25 patients with endometriosis. Group 2 had 25 control patients. All patients underwent complete ophthalmic examination, and the right eyes were included in the study. To evaluate the ocular surface, both groups were tested with the following: the Schirmer I test, tear breakup time (TBUT), the conjunctival impression cytology (CIC), and the Ocular Surface Disease Index (OSDI). The results were subsequently compared. Results The average Schirmer I test results were 8.40 ± 2.74 mm in group 1 and were significantly lower in patients with endometriosis (P < 0.001). The average TBUT test results were 9.04 ± 3.61 s in group 1 and were significantly lower in patients with endometriosis (P < 0.001). The average OSDI results were 24.04 ± 9.29 in group 1 and were significantly higher in patients with endometriosis (P < 0.001). The average CIC results were 1.76 ± 0.88 in group 1 and were significantly higher in patients with endometriosis (P < 0.001). Conclusions Ocular surface changes, including squamous metaplasia, may be observed in the conjunctiva of patients with endometriosis.

    更新日期:2020-01-04
  • Simultaneous intravitreal dexamethasone and aflibercept for refractory macular edema secondary to retinal vein occlusion
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-02
    Chiara Giuffrè, Maria Vittoria Cicinelli, Alessandro Marchese, Michele Coppola, Maurizio Battaglia Parodi, Francesco Bandello

    Abstract Purpose To assess the functional and anatomical outcomes of concurrent administration of aflibercept injection and dexamethasone (DEX) implant in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), refractory to each of the two drugs previously administered as monotherapy. Secondary outcomes included the number of retreatments required in a 12-month follow-up and safety. Methods This is a prospective, interventional case series of consecutive patients with refractory ME secondary to RVO, followed over a year. One injection of aflibercept was followed by a DEX implant on the same day; retreatment was driven by the persistence of ME on SD-OCT at least 4 months after the previous combined therapy. Central retinal thickness (CRT), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected at 1 month and then every 2 months until the end of follow-up. Results Thirty eyes of 30 Caucasian patients were enrolled; mean duration of RVO before the first combined treatment was 25 ± 5 months (range 11 ± 30). Baseline BCVA was 0.73 ± 0.5 LogMAR, with no significant changes at 12 months (0.77 ± 0.51 μm, p = 0.2). Baseline CRT was 578.3 ± 161 μm, reducing to 352.5 ± 81 μm at 12 months (p = 0.003). Thirteen eyes (43.3%) required a second treatment. Twenty eyes (66.6%) showed no ME at the end of follow-up. One patient (3.3%) required topical IOP-lowering therapy during the study. Conclusion In eyes with ME secondary to RVO unresponsive to either aflibercept or DEX administered singularly, a combination therapy with simultaneous administration of aflibercept and DEX was effective in resolving ME, despite the absence of visual improvement. Earlier combined treatment in the course of the disease might lead to better functional outcomes.

    更新日期:2020-01-04
  • Clinical features and optical coherence tomography findings of retinal astrocytic hamartomas in Chinese patients with tuberous sclerosis complex
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-02
    Chenxi Zhang, Kaifeng Xu, Qin Long, Zhikun Yang, Rongping Dai, Hong Du, Donghui Li, Zhiqiao Zhang

    To investigate the clinical features and spectral-domain optical coherence tomography (SD-OCT) findings of retinal astrocytic hamartoma (RAH) in Chinese patients with tuberous sclerosis complex (TSC).

    更新日期:2020-01-04
  • Effect of light and diurnal variation on macular thickness in X-linked retinoschisis: a case series
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2020-01-02
    Yair Rubinstein, Chen Weiner, Noa Chetrit, Hadas Newman, Idan Hecht, Nadav Shoshany, Eran Pras

    Diurnal variations in foveal thickness have been reported in several ocular pathologies including X-linked retinoschisis (XLRS), but its underlying mechanism is poorly understood. Rods are active under scotopic conditions with high metabolic demand, and its decrease may have positive effect on metabolic activity and macular thickness. The purpose of this study is to evaluate whether exposure to light and diurnal variation influence macular thickness in XLRS patients.

    更新日期:2020-01-04
  • Correction to: Retinal oximetry and fractal analysis of capillary maps in sickle cell disease patients and matched healthy volunteers
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-11-19
    W. A. J. Birkhoff, L. van Manen, J. Dijkstra, M. L. De Kam, J. C. van Meurs, A. F. Cohen

    In the published online PDF version, Figure 3 was incorrectly captured the same as Figure 1.

    更新日期:2020-01-04
  • Correction to: Lack of netrin-4 alters vascular remodeling in the retina
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-11-15
    Sergio Crespo-Garcia, Nadine Reichhart, Jeffrey Wigdahl, Sergej Skosyrski, Norbert Kociok, Olaf Strauß, Antonia M. Joussen

    The article “Lack of netrin-4 alters vascular remodeling in the retina”

    更新日期:2020-01-04
  • Viscocanalostomy combined with nearly 360-degree suture trabeculotomy for the treatment of primary congenital glaucoma: a preliminary report of a novel technique for trabeculotomy.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-12-02
    Ya Liang,Qiuli Yu,Fangfang Ji,Hong Sun,Zhilan Yuan

    PURPOSE The aim of this study was to determine the preliminary efficacy and safety of a novel technique for trabeculotomy for the treatment of primary congenital glaucoma (PCG). METHODS This retrospective interventional study was conducted on patients with PCG. Pliability test was performed among 5/0 and 6/0 polypropylene sutures and the flexible illuminated microcatheter. Viscocanalostomy was first performed and the Schlemm's canal was identified. Then, suture trabeculotomy was completed except the region for viscocanalostomy. The preoperative and follow-up data were recorded and analyzed. Success criteria were defined as intraocular pressure (IOP) ≤ 21 mmHg without (complete success) or with medications (qualified success). RESULTS 5/0 polypropylene suture was an appropriate option for cannulation of Schlemm's canal. A total of 33 eyes from 23 consecutive patients were included with a mean follow-up of 9.3 ± 3.6 months (range 6-18 months). Circumferential cannulation by suture was successfully performed in 28 eyes (84.8%) of 18 patients. Mean IOP decreased from 33.9 ± 9.4 mmHg preoperatively to 10.5 ± 3.5 mmHg at 6 months (p < 0.001) and 11.3 ± 4.1 mmHg at 9 months (p < 0.001). Complete success rate was 92.9% [95% confidence interval (CI:0.83-1.03)] and 87.5% (CI:0.69-1.06) at 6 months and 9 months, respectively. Hyphema was found in 5 eyes (17.9%), all of which were absorbed within 1 week. No other complications were observed. CONCLUSIONS Viscocanalostomy combined with nearly 360-degree suture trabeculotomy as a novel technique controls IOP in patients with PCG without any severe complications. It is suitable for extended applications because of accurate identification of Schlemm's canal and low cost.

    更新日期:2019-11-01
  • CD163+ macrophages infiltrate axon bundles of postmortem optic nerves with glaucoma.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2018-08-04
    Milica A Margeta,Eleonora M Lad,Alan D Proia

    PURPOSE Prior research in animal models has shown that macrophages and microglia play an important role in pathogenesis of glaucoma, but the phenotype and distribution of macrophages in human glaucomatous tissue have not been sufficiently characterized. METHODS We analyzed H&E, CD68-, and CD163-immunostained slides from 25 formaldehyde-fixed, paraffin-embedded autopsy eyes: 12 control eyes and 13 eyes with glaucoma. The diagnosis of glaucoma was made based on a history of glaucoma as reported in the medical record and histological changes characteristic of glaucoma. Glaucoma cases and controls were matched in terms of age, sex, and race. RESULTS Qualitative analysis of the conventional outflow pathway and the optic nerve revealed that all eyes contained CD163+ cells but a negligible number of CD68+ cells. CD163+ macrophages infiltrated the trabecular meshwork and surrounded Schlemm's canal of normal eyes and eyes with glaucoma, but the pattern was variable and qualitatively similar between groups. In optic nerves of control eyes, CD163+ macrophages were present at low levels and restricted to septa between axon bundles. In glaucomatous optic nerves, the number of CD163+ cells was increased both qualitatively and quantitatively (glaucoma 5.1 ± 0.6 CD163+ cells/mm2, control 2.5 ± 0.3 CD163+ cells/mm2, p < 0.001), with CD163+ cells infiltrating axon bundles in cases of both mild and severe diseases. CONCLUSIONS The increase in CD163+ cell number in eyes with mild and severe glaucoma is the first demonstration of macrophage infiltration in glaucomatous human optic nerves. This finding supports a role for macrophages in glaucoma pathogenesis and progression.

    更新日期:2019-11-01
  • Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Genjie Ke,Enliang Zhou,Kai Zhu,Yingying Wei,Zhiling Wang,Yangxue Jia,Shiying Wang,Yonghao Gu

    BACKGROUND Both ectopia lentis and retinal injury are common results of blunt ocular trauma. Here, we investigated the incidence and characteristics of retinal breaks associated with ectopia lentis caused by blunt ocular trauma. METHODS Patients who underwent pars plana vitrectomy to treat traumatic lens subluxation and dislocation were retrospectively reviewed. The incidence, characteristics, and outcomes of retinal breaks were analyzed. RESULTS Forty-five eyes from 45 patients were included in the study. Seventeen eyes (37.7%) were complicated by retinal breaks or detachment, but only four (8.9%) were identified pre-operation. Our study revealed that retinal breaks were more frequently located at the superior (72.7%) and peripheral (81.8%) retina. All patients achieved anatomic recovery post-surgery. The eyes with and without retinal breaks did not differ significantly with respect to initial or final visual acuity. The final visual outcomes were independently and significantly associated with visual acuity at presentation (P = 0.001). CONCLUSIONS Retinal breaks occurred in approximately one-third of patients with traumatic ectopia lentis and were difficult to observe pre-operation. Complete ophthalmic evaluation and timely intervention may help achieve favorable outcomes.

    更新日期:2019-11-01
  • The flicker response of venous oxygen saturation is significantly reduced in the early and late stages of age-related macular degeneration.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Emilia Donicova,L Ramm,R Augsten,M Hammer

    BACKGROUND Retinal oxygen saturation (SO2) during flicker light stimulation was measured non-invasively in humans with age-related macular degeneration (AMD). Furthermore, the differences between early and late stages of AMD were evaluated. METHODS In 60 eyes of 45 AMD patients (74 ± 8.3 years) and 23 eyes of 23 healthy controls (73.4 ± 7.4 years), the SO2 of arterioles and venules was measured with the oximetry module of the Retinal Vessel Analyzer. Arterial SO2, venous SO2 and arteriovenous SO2 difference at baseline and with the flicker were assessed and compared with controls. From the difference between the arteriovenous SO2 under flicker stimulation and at baseline, the parameter delta av. Diff was calculated. Subgroup analyses of non-exudative (dry) AMD, exudative (wet) AMD and their end stages, geographic atrophy (GA) and disciform scar (DS) were performed. RESULTS In comparison with healthy subjects (mean - 4.90, CI [- 6.32, - 3.43]), the parameter delta av. Diff was significantly reduced in all AMD patients (mean - 2.20, CI - 3.15, -1.23, p = 0.003), dry AMD (mean - 1.97, CI - 3.31, -0.63, p = 0.013) and wet AMD (mean - 2.35, CI - 3.50, - 1.19, p = 0.025). The comparison between wet and dry AMD revealed no significant results (p = 1). The comparison between AMD subgroups and healthy controls (median (IQR) - 4.29 (- 8.32; - 2.42) %) showed significant differences in non-neovascular (early dry AMD) (median (IQR) - 2.43 (- 4.59; - 0.74) %, p = 0.038), GA (median (IQR) 0.10 (- 4.02; 3.15) %, p = 0.019) and DS (median (IQR) - 1.67 (- 3.52; - 0.12) %, p = 0.03). A nearly significant reduction was observed in exudative (early wet) AMD (median (IQR) - 2.71 (- 5.84; - 0.2) %, p = 0.055). Minimal, not statistically significant differences of delta av. Diff were found between AMD subgroups. None of the baseline parameters was significantly different between patients and healthy controls, even after flicker light stimulation. CONCLUSIONS Non-invasive retinal oximetry with flicker light stimulation seems to be a suitable method to study the pathogenetic mechanisms of AMD. The mathematically derived parameter delta av. Diff appears to be more sensitive than arteriovenous SO2 difference. Results suggest that the regulation of retinal oxygen supply, oxygen consumption or both is impaired in AMD.

    更新日期:2019-11-01
  • Salvage of the retinal ganglion cells in transition phase in Alzheimer's disease with topical coenzyme Q10: is it possible?
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Refika Hande Karakahya,Tuba Şaziye Özcan

    PURPOSE The evaluation of the short-term effect of topically applied coenzyme Q10 (CoQ10) on retina and choroid in Alzheimer's disease (AD) was aimed in this study. METHODS Randomized controlled study included a total of 93 patients, 62 of whom with AD. Thirty (32.3%) AD patients received treatment (Group 1), 32 (34.4%) AD patients observed without treatment (Group 2), and Group 3 included 31 (33.3%) healthy controls (HC). Neurological and ophthalmological examinations including optical coherence tomography (OCT) were executed. RESULTS Retinal nerve fiber layer (RNFL) thickness in all quadrants increased following CoQ10 treatment in Group 1; however significant rise yielded in average and temporal quadrant RNFL thickness. Average and superonasal sector ganglion cell-inner plexiform layer (GCIPL) thickness increased significantly following CoQ10 treatment. The correlation analysis between difference in pre- and posttreatment OCT values in Group 1 revealed that rise in average RNFL thickness was inversely correlated with duration of the disease and rise in average GCIPL thickness and superonasal sector thickness was inversely correlated with severity of the disease. CONCLUSION Short-term topical CoQ10 resulted in improvement in AD related retinal ganglion cell (RGC) loss which may reflect the salvage of some RGCs in the reversible transitional phase. More bioavailability through intravitreal route of administration and longer duration of effect with sustained release forms may possibly help enhalting the RGC loss, especially incipience of neurodegenerative diseases.

    更新日期:2019-11-01
  • Correction to: Retinal oximetry and fractal analysis of capillary maps in sickle cell disease patients and matched healthy volunteers.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-11-21
    W A J Birkhoff,L van Manen,J Dijkstra,M L De Kam,J C van Meurs,A F Cohen

    In the published online PDF version, Figure 3 was incorrectly captured the same as Figure 1.

    更新日期:2019-11-01
  • Retinal oximetry and fractal analysis of capillary maps in sickle cell disease patients and matched healthy volunteers.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-09-19
    W A J Birkhoff,L van Manen,J Dijkstra,M L De Kam,J C van Meurs,A F Cohen

    PURPOSE Fractal analysis can be used to quantitatively analyze the retinal microvasculature and might be a suitable method to quantify retinal capillary changes in sickle cell disease (SCD) patients. Retinal oximetry measurements might function as a proxy for the pathophysiology of cerebrovascular diseases. Moreover, hypoxia has an important role in the pathophysiology of diabetic and other retinopathies. However, little is known about the oximetry around the macula in SCD patients. With this study, we explored the feasibility to perform these quantified measurements in SCD patients. METHODS Retinal microvascular and oximetry measurements were performed in eight SCD patients and eight healthy matched controls. Oximetry pictures and non-invasive capillary perfusion maps (nCPM) were obtained by the retinal function imager. Measurements were conducted twice on two different study days. Measured variables included monofractal dimension (Dbox), relative saturation, deoxygenated hemoglobin (deoxyHb), and oxygenated hemoglobin (oxyHb) concentration. RESULTS No statistically significant differences in vessel density were found in the different annular zones (large vessels, p = 0.66; small vessels, p = 0.66) and anatomical quadrants (large vessels, p = 0.74; small vessels, p = 0.72). Furthermore, no significant between-group differences were found in the other different anatomical quadrants and annular zones around the fovea for relative saturation levels and deoxygenated Hb. However, the oxyHb levels were significantly lower in SCD patients, compared with those in matched controls in the temporal quadrants (p = 0.04; p = 0.02) and the superior nasal quadrant (p = 0.05). CONCLUSIONS Our study demonstrated the feasibility of multispectral imaging to measure retinal changes in oxygenation in both SCD patients and matched volunteers. The results suggest that in SCD patients before any structural microvascular changes in the central retina are present, functional abnormalities can be observed with abnormal oximetry measurements.

    更新日期:2019-11-01
  • The delicate topic of mentorship.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Diana Epstein,Igor Kozak

    更新日期:2019-11-01
  • Optic nerve head microcirculation in congenital nasal optic disc hypoplasia.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Yuka Hasegawa,Yuki Hashimoto,Yasuhiro Shinmei,Susumu Ishida

    更新日期:2019-11-01
  • 360-degree intra-operative laser retinopexy for the prevention of retinal re-detachment in patients treated with primary pars plana vitrectomy.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Ali Dirani,Fares Antaki,Marc-André Rhéaume,Danny Gauthier,Louis Corriveau,Jean-Daniel Arbour,Karim Hammamji

    PURPOSE To investigate the effect of 360° intra-operative laser retinopexy (ILR) for the prevention of retinal re-detachment in patients treated with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). METHODS A retrospective single-institution cohort study was performed. Consecutive patients with primary uncomplicated RRD who underwent 23-gauge PPV with gas endotamponade between July 2013 and July 2016 were included in the study (n = 151). Two cohorts were compared: one which received laser retinopexy only around identified tears/holes/lattice zones (Control group, n = 86), and one which received additional 360° intra-operative laser retinopexy (360° ILR group, n = 65). RESULTS Retinal re-detachment was seen in 4/65 eyes (6%) in the 360° ILR group compared to 18/86 eyes (21%) in the control group. In multiple logistic regression, the 360° ILR was associated with a 75% reduction in the odds of retinal re-detachment compared to control (OR = 0.248, 95% CI [0.079-0.772], p = 0.016). There was no statistically significant difference in the incidence of epiretinal membrane formation between the two groups. CONCLUSIONS Intra-operative 360° laser retinopexy during PPV with gas endotamponade resulted in a significant reduction in the odds of postoperative retinal re-detachment in eyes with uncomplicated primary RRD.

    更新日期:2019-11-01
  • Small incision lenticule extraction (SMILE) lenticule thickness readout compared to change in axial length measurements with the IOLMaster.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Eugene Tay,Ram Bajpai

    PURPOSE To compare theoretical values from the small incision lenticule extraction (SMILE) lenticule thickness readout with change in axial length measurements taken with the IOLMaster. METHODS We prospectively studied 214 eyes from 107 patients undergoing bilateral SMILE surgery for myopia or myopic astigmatism between December 2014 and May 2017 at an ophthalmological practice in Singapore. All eyes were examined pre-operatively and 1 and 3 months post-operatively with the IOLMaster following SMILE surgery. Achieved lenticule thickness was taken as the change in axial length after surgery. A linear mixed-effects model was used to examine changes in axial length, spherical equivalent and acuity over time. The relationships between change in axial length and theoretical lenticule thickness and spherical equivalent were examined with multiple linear regression analyses, and model prediction was assessed with adjusted R2 statistics. RESULTS Mean (95% confidence interval [CI]) spherical equivalent pre-operatively was - 5.25 (95% CI - 5.38 to - 5.12) diopters (D), at 1 month was 0.04 (95% CI - 0.09 to 0.17) D (p < 0.001), and at 3 months was - 0.02 (95% CI - 0.15 to 0.11) D (p < 0.001). Mean (95% CI) pre-operative axial length was 27,726 (95% CI 25,595 to 25,857) μm. Post-operative axial length at 1 month was significantly shorter at 25,595 (95% CI 25,464 to 25,726) μm (p < 0.001) with no change thereafter (p = 0.647). Pre-operative mean ± standard deviation (SD) refractive target was 0.24 (± 0.3) D, and mean difference between target and post-operative spherical equivalent at 1 month was 0.20 D (95% CI 0.16 to 0.25 D, p < 0.001). Multiple regression analysis showed that change in axial length at 1 month was, on average, 5% lower than theoretical lenticule thickness, indicating an average difference of 5.4 μm (95% CI 5.2 to 5.6 μm). Preoperative spherical equivalent predicted negative association with change in axial length at 1 month (β = - 14.8, 95% CI - 18.2 to - 11.3, adjusted R2 = 0.457, p < 0.001). CONCLUSIONS Calculated lenticule thickness values were less than expected, and post-operative refractive outcomes at 1 month showed a slight under-correction. Further research in this area is needed to validate these findings.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Clinical and ASOCT evaluations of 'bleb-sparing epithelial exchange' in paediatric and adult dysfunctional blebs over 5 years.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Ramanjit Sihota,Harathy Selvan,Talvir Sidhu,Neha Kamble,Dewang Angmo,Suresh Yadav,Tanuj Dada,Ashish Upadhyay

    PURPOSE To evaluate the long-term outcome of 'bleb-sparing epithelial exchange' surgery for dysfunctional filtering blebs in paediatric and adult eyes. METHODS Patients who had undergone bleb revision ≥ 5 years back and were on regular follow-up were included. Age, ocular diagnosis, details of primary filtering surgery including mitomycin-C (MMC) usage, indication and year of bleb revision were recorded. After bleb revision, the mean intraocular pressure (IOP), glaucoma medications and best corrected visual acuity (BCVA) up to 5 years were noted. On last review, clinical details, bleb characteristics and swept source anterior segment tomographic (SSOCT) assessment of bleb were recorded. Comparative analysis of paediatric and adult eyes was performed. MAIN OUTCOME MEASURES Change in IOP and BCVA. 'Complete success' was defined as IOP ≥ 6 to ≤ 18mmHg without use of any topical glaucoma medications and 'Qualified success' when ≥ 1 topical glaucoma medication(s) was required. RESULTS A total of 51 eyes of 51 consecutive patients were studied, among which 22 were children. The mean duration between filtering surgery and bleb revision was 4.54 ± 1.53 years in paediatric and 6.48 ± 3.5 years in the adult group, p = 0.04. Children underwent trabeculotomy + trabeculectomy with 0.04% MMC, while adults underwent trabeculectomy with 0.02% MMC. The mean pre-revision IOP was 6.38 ± 2.80 and 6.51 ± 2.78 mmHg in the paediatric and adult group respectively, p = 0.86. At 3 months post-revision, it increased to 11.81 ± 3.48 and 12.75 ± 3.52 mmHg respectively (p < 0.001). At final review, mean IOP of paediatric group was 10.90 ± 2.59 and adult group was 11.86 ± 2.66 mmHg, p = 0.20. At 5 years, complete success was 68.18% and 72.41%, and qualified success was 31.87% and 27.59% in the former and latter group respectively, p = 0.49. No failures were seen. Kaplan-Meier probability at 5 years for IOP target ≤ 18, ≤ 15 and ≤ 12 in children was 95.45%, 63.64% and 50% and in adults 93.10%, 65.52% and 41.38% respectively. BCVA improved up to 1 year in paediatric group, with continued improvement in adults up to 3 years. SSOCT measured bleb height was 0.88 ± 0.37 and 1.32 ± 0.49mm in children versus adults (p = 0.006) and wall thickness, 0.35 ± 0.22 and 0.58 ± 0.24mm respectively, p = 0.008. CONCLUSION Bleb-sparing epithelial exchange is an equally safe and effective technique with good long-term success in both paediatric and adult dysfunctional blebs.

    更新日期:2019-11-01
  • Comparison of anatomical and visual outcomes following different anti-vascular endothelial growth factor treatments in subretinal neovascular membrane secondary to type 2 proliferative macular telangiectasia.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Buğra Karasu,Betul Onal Gunay

    PURPOSE To evaluate central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and visual outcomes following different intravitreal anti-vascular endothelial growth factor (VEGF) treatments in eyes with subretinal neovascular membrane (SRNVM) due to type 2 proliferative macular telangiectasia (Mac Tel 2). MATERIALS AND METHODS A total of 38 eyes of 34 patients who underwent intravitreal aflibercept (IVA), intravitreal ranibizumab (IVR), or intravitreal bevacizumab (IVB) injections secondary to SRNVM due to type 2 proliferative MacTel were retrospectively reviewed. The CMT, central macular volume (CMV), best corrected visual acuity (BCVA), and SFCT were evaluated at baseline and at 2 weeks, at 1 month, and at final visits following treatment. Spectral-domain optical coherence tomography and enhanced depth optical coherence tomography were used for the analysis. RESULTS The mean age of the patients was 58.34 ± 12.48 years (range, 27-79 years). The mean follow-up time was 15.97 ± 6.79 months (range 5-32 months). The mean BCVA showed a statistically significant increase in each group (< 0.001). There was no statistically significant difference in BCVA changes between groups in follow-up periods. There was a significant decrease in CMT following IVA (326.4 ± 168.03 μm to 236 ± 58.33 μm) and IVB (383.71 ± 156.79 μm to 343.85 ± 146.25 μm) (p < 0.001, p = 0.004, respectively) whereas no significant decrease in CMT was observed following IVR (374.57 ± 124.28 μm to 339.71 ± 126.10 μm) (p = 0.65) between baseline and final visit. The SFCT significantly decreased following both IVB and IVR treatments (p = 0.009, p = 0.03, respectively). CONCLUSIONS The IVA, IVR, and IVB were found to be effective with regards to anatomical and visual outcomes in proliferative Mac Tel type 2 patients related with SRNVM. Patients receiving both IVA and IVB needed less injections compared to patients who received IVR. Moreover, IVB and IVR lead to significant decrease in SFCT whereas IVA did not show significant effect on SFCT.

    更新日期:2019-11-01
  • Spontaneous regression of congenital corneal opacity.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Sooyeon Choe,Chang Ho Yoon,Mee Kum Kim,Joon Young Hyon,Young Suk Yu,Joo Youn Oh

    PURPOSE To determine the incidence of spontaneous regression of congenital corneal opacity (CCO) and identify clinical factors associated with the regression. METHODS Medical records and anterior segment photographs were reviewed of 57 eyes in 35 patients with CCO that were not related to congenital glaucoma, tumors, infection, trauma, or metabolic disorders and were followed up without corneal transplantation for longer than one year at Seoul National University Hospital. Spontaneous regression of corneal opacity was defined as a decrease in corneal opacity significant enough for visual axis clearance. Data on demographics, systemic, and ocular characteristics were collected and compared between patients who had spontaneous regression of CCO and those who did not. RESULTS Spontaneous regression of corneal opacity developed in 32 eyes (22 patients, 56.1%) out of 57 CCO eyes (35 patients) at the mean 8.2 ± 5.4 months of age (the median 6.7 months). Absence of combined ocular anomalies such as iris anomaly, lens opacity, and peripheral corneal vascularization was significantly associated with the regression of opacity. CONCLUSIONS Corneal opacity can spontaneously regress in 56.1% of eyes with CCO during the first year of life. Careful follow-up with amblyopia management can be one of treatment options for CCO.

    更新日期:2019-11-01
  • Appearance of pediatric choroidal neovascular membranes on optical coherence tomography angiography.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Sally S Ong,S Tammy Hsu,Dilraj Grewal,J Fernando Arevalo,Mays A El-Dairi,Cynthia A Toth,Lejla Vajzovic

    PURPOSE Compared with fluorescein angiography (FA), the gold standard for diagnosing choroidal neovascularization (CNV) activity, optical coherence tomography angiography (OCTA) is non-invasive without risks associated with fluorescein dye use, and may be especially advantageous in the diagnosis and monitoring of children with CNV. METHODS Eight eyes from eight patients aged 12 months to 18 years were imaged with the investigational Spectralis OCTA (version 6.9, Heidelberg Engineering, Heidelberg, Germany) and the RTVue XR Avanti (Optovue Inc., Fremont, CA, USA). Two patients were imaged during examination under anesthesia while six patients were imaged in the clinic. Demographic information, ocular characteristics, treatment history, and imaging studies (color photos, fluorescein angiography, OCT) were collected and reviewed. RESULTS Three eyes had active CNV while five had quiescent CNV at the time of imaging. CNV was idiopathic or secondary to trauma, retinal vascular dysgenesis versus retinopathy of prematurity, pigmentary retinopathy, Best vitelliform macular dystrophy, panuveitis, morning glory disc anomaly, and optic disc drusen. OCTA of two active CNV demonstrated presence of a main trunk with multiple fine capillaries, vessel loops, and anastomoses. OCTA was repeated after treatment for two CNV and demonstrated a decrease in size with loss of fine capillaries, vessel loops, and anastomoses. For the third active CNV, OCTA verified flow in the CNV complex despite the uncertainty of FA hyperfluorescence in the setting of grossly abnormal retinal vasculature. The five quiescent CNV all lacked fine capillaries, vessel loops, and anastomoses on OCTA. CONCLUSION OCTA demonstrates morphological differences between active and quiescent pediatric CNV.

    更新日期:2019-11-01
  • Surgical outcomes of vitrectomy surgery for proliferative diabetic retinopathy in patients with abnormal renal function.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    P Larrañaga-Fragoso,H Laviers,C McKechnie,H Zambarakji

    PURPOSE To analyse the influence of renal function on the outcomes of vitrectomy for tractional-related complications in cases of severe proliferative diabetic retinopathy (PDR). METHODS Retrospective consecutive case series of 109 eyes that underwent vitreoretinal interventions for traction-related complications of severe PDR from 2014 to 2017. Data collected included patient demographics, best-corrected visual acuity (BCVA), surgical complications, and systemic markers including HbA1c and estimated glomerular filtration rate (eGFR). Renal function categories were defined as low (eGFR < 30 mL/min/1.73 m2), medium (eGFR 30-60 mL/min/1.73 m2), and normal (eGFR > 60 mL/min/1.73m 2). RESULTS A total of 109 eyes (56% (n = 61) female) were included in the study. Overall, mean baseline BCVA improved from 1.33 logMAR to 0.91 logMAR (p < 0.001) postoperatively. Patients with low eGFR had significantly worse baseline BCVA (p = 0.039) and demonstrated greater improvement in mean BCVA (p = 0.059). Multivariate regression analysis indicated that seven predictors explained 65.5% of the variance (R2 = 0.655, F(11,97) = 16.7, p < 0.01). CONCLUSIONS Reduced renal function does not adversely affect visual outcomes of vitrectomy for traction-related complications of PDR.

    更新日期:2019-11-01
  • Topographical profiles of macula and optic nerve head in concomitant strabismus patients as measured using OCT and CSLO.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Yun Wen,Jianhua Yan,Zhonghao Wang,Tao Shen,Xuan Qiu,Daming Deng,Jingchang Chen

    PURPOSE Investigate morphological changes of macula and optic nerve head (ONH) in concomitant strabismic patients using optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy (CSLO). METHODS A cross-sectional study conducted from April 2017 to February 2018 at the Zhongshan Ophthalmic Center, Sun Yat-sen University. Spectral-domain (SD)-OCT and CSLO were used to observe morphological changes of macula and ONH in concomitant strabismic patients with normal vision and healthy controls. In each subject, a 6-mm diameter zone centered at the fovea was scanned and topographical images of the ONH and peripapillary retina were generated. Fundus parameters were recorded and analyzed. RESULTS A total of 138 cases, including 29 patients with concomitant esotropia (ET), 38 constant exotropia (XT), 42 intermittent exotropia (IXT), and 29 healthy controls, were recruited. Compared with controls, OCT revealed that the thickness of nasal intraretinal layers (IRLs) in ET patients was significantly increased, particularly in ganglion cell layer (GCL) and inner nuclear layer (INL). In XT patients, the temporal half of outer retinal layers (ORLs) showed significant increases in thickness. CSLO findings revealed significant changes in the ONH of ET patients consisting of a thinner retinal nerve fiber layer (RNFL) and a decreased RNFL cross-sectional area, height variation contour, maximum contour depression, and contour line modulation (CLM) temporal-superior area. The nasal-superior cup area and rim volume in XT patients were significantly increased. CONCLUSION Topographical profiles of the macula and ONH in concomitant strabismic patients with normal vision present with specific regularities.

    更新日期:2019-11-01
  • Ocular vascular changes during pregnancy: an optical coherence tomography angiography study.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Pınar Bingöl Kızıltunç,Bulut Varlı,Tuna Çelik Büyüktepe,Huban Atilla

    BACKGROUND Pregnancy is a period presenting with many physiological adaptation mechanisms. One of the structures in which these mechanisms are observed is ocular tissues. The cornea, lacrimal and meibomian glands, and chorioretinal complex are all among the structures affected by changes during pregnancy. In this study we aimed to evaluate the macular and optic disc vessel density (VD) changes by Optical Coherence Tomography Angiography (OCTA) imaging in pregnancy. METHODS A total of 248 eyes from 124 pregnant women and 80 eyes from 40 healthy control women were involved. Vessel densities of macula were evaluated for superficial capillary plexus (SCP) and deep capillary plexus (DCP) in whole macula, foveal, parafoveal and perifoveal region. Peripapillary and whole optic disc VDs were also evaluated. Vessel densities of macula and optic disc were compared between control individuals and pregnant women. Vessel densities in different trimesters were also evaluated. RESULTS Modest but significant differences in VDs of whole macula of SCP and DCP were observed in pregnancy group. Additionally, perifoveal and parafoveal region of SCP, whole disc and radial peripapillary capillary VD were significantly higher in pregnancy group. There was no correlation between VD ratios of macula and optic disc and pregnancy weeks and trimesters. CONCLUSIONS This is the first study focusing on the OCTA parameters in pregnant individuals. These findings suggest that physiological changes during pregnancy are not limited to the cornea, eyelids and the choroid but also to the retinal and optic disc vasculature.

    更新日期:2019-11-01
  • Determination of scotopic and photopic conventional visual acuity and hyperacuity.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    P H Freundlieb,A Herbik,F H Kramer,M Bach,M B Hoffmann

    PURPOSE Visual acuity (VA) is an important determinant of visual function. Here we establish procedures and recommendations for VA testing extending beyond the classical VA and thus make them available for future studies of visual function in health and disease. Specifically, we provide reference values for photopic and scotopic conventional uncrowded visual acuity (cVA) and Vernier-hyperacuity (hVA) and assess their reproducibility and dependence on contrast polarity. METHODS For ten observers with normal vision, we determined photopic ("p"; maximal luminance 220 cd/m2) and scotopic ("s"; maximal luminance 0.004 cd/m2; 40 min of dark adaptation) cVA and hVA, for two contrast polarities i.e. black optotypes on white background and vice versa. To assess intersession effects, two sets of measurements were obtained on different days. RESULTS Compared to pcVA (1.32 decimal VA; - 0.12 ± 0.02 LogMAR), the phVA (14.45 decimal VA; - 1.16 ± 0.04 LogMAR) scaled (in terms of decimal visual acuity) on average with a factor 11.0, the scVA (0.12 decimal VA; 0.91 ± 0.03 LogMAR) with a factor of 0.1, and the shVA (1.47 decimal VA; - 0.17 ± 0.02 LogMAR) with a factor of 1.1. There were neither significant effects of contrast polarity (p > 0.12), nor of session (p > 0.28). CONCLUSIONS Our approach optimises integrated photopic and scotopic cVA and hVA measurements for general use and thus encourages the integration of these important measures of scotopic visual function in future studies. The absence of strong intersession effects demonstrates that no dedicated training session is needed to obtain scotopic and hVA measurements. The combined measures of scotopic and photopic VAs open a field of applications to study interplay and plasticity of the retinal photoreceptor systems and cortical processing in health and visual disease. As a rule of thumb, hyperacuity is 10× higher both in the photopic and scotopic range than conventional acuity. Thus, scotopic hyperacuity is close to photopic conventional acuity.

    更新日期:2019-11-01
  • Reproducibility and reliability of central corneal thickness determination in more and less profound corneal edema using ultrasound pachymetry, a Scheimpflug camera and anterior segment OCT.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : null
    Kuerten David,Hossein-Zadeh Mandana,Plange Niklas,Walter Peter,Fuest Matthias

    PURPOSE The purpose of this study is to determine the influence of different degrees of corneal edema on the reliability and reproducibility of central corneal thickness(CCT) measurements by a Scheimpflug camera (Pentacam), anterior segment optical coherence tomography(AS-OCT) and ultrasound pachymetry(USP). METHODS Forty-four patients undergoing ophthalmic surgery were included in this prospective study. All measurements were acquired by two investigators. The Pentacam and AS-OCT measurements were performed in randomized order followed by USP. Two measurements were taken by each investigator with each device. CCT was evaluated by using the apex value provided by the Pentacam, the corneal apex cut in the AS-OCT and averaging 2 cycles of 4 measurements for USP. Coefficients of variation (COV) and intraclass correlation coefficients (ICC) were determined. To investigate the reproducibility in different degrees of corneal edema, patients were subdivided into edema more/less than 10% of CCT, ≥/< 600 μm and > 650 μm CCT. RESULTS No significant differences were recorded for each individual investigator and measuring device. However, overall the devices differed significantly in the < 600 μm group (ANOVA p < 0.04). The reproducibility decreased with higher degrees of corneal edema in particular for investigator 1 and USP measurements. No significant overestimation of corneal thickness by the Pentacam was recorded in higher degrees of corneal edema. CONCLUSION USP measurements are highly user dependent especially in higher degrees of corneal edema. Nevertheless, all methods were able to reach a high level of agreement in CCT measurement in higher degrees of corneal edema. Interestingly lower degrees of corneal edema revealed the only significant differences in-between the 3 devices.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Evaluation of disk halo size after small incision lenticule extraction (SMILE).
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-10-31
    Tian Han,Feng Zhao,Xun Chen,Huamao Miao,Zhuoyi Chen,Xingtao Zhou

    PURPOSE To investigate changes in objective disk halo size produced by a glare source after small incision lenticule extraction (SMILE) for myopia correction. METHODS This prospective clinical study included 45 right eyes of 45 patients with a mean age of 25.40 ± 5.06 years and mean spherical equivalent (SE) of - 6.08 ± 1.90 diopters. Disk halo size was measured with a vision monitor before surgery and at postoperative 1 week and 3 months. Other information was collected, including age, SE, lenticule thickness, lenticule diameter, dark pupil, and pupillary response to light parameters (initial diameter; amplitude, latency, duration, and velocity of contraction; latency, duration, and velocity of dilation; and maximum, minimum, and average pupil size). RESULTS Compared to preoperative values, disk halo size increased significantly at postoperative 1 week (P = 0.026) and returned to baseline at postoperative 3 months (P = 0.349). Preoperative disk halo size significantly correlated with SE (r = - 0.346, P = 0.020), minimum pupil size (r = 0.365, P = 0.014), and average pupil size (r = 0.310, P = 0.038). Disk halo size at postoperative 1 week was significantly correlated with age (r = 0.324, P = 0.030) and minimum pupil size (r = 0.297, P = 0.047). Disk halo size at postoperative 3 months was significantly correlated with lenticule diameter (r = - 0.362, P = 0.015), initial diameter (r = 0.311, P = 0.037), maximum pupil size (r = 0.312, P = 0.037), minimum pupil size (r = 0.440, P = 0.002), and average pupil size (r = 0.373, P = 0.012). CONCLUSIONS After SMILE, disk halo size demonstrated a temporary increase and then returned to baseline.

    更新日期:2019-11-01
  • Long-term endothelial cell loss with the iris-claw intraocular phakic lenses (Artisan®).
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-10-30
    Virgilio Galvis,John F Villamil,María Fernanda Acuña,Paul A Camacho,Jesús Merayo-Lloves,Alejandro Tello,Sandra Lizeth Zambrano,Juan José Rey,Juan Vicente Espinoza,Angélica María Prada

    PURPOSE To evaluate the endothelial cell loss in patients with iris-claw phakic lenses (Artisan®) in a long-term follow-up. METHODS We analyzed the medical records of patients who had undergone iris-claw phakic lens implantation and who had at least 5 years of follow-up. RESULTS We included 67 eyes with myopic errors (follow-up 9.6 ± 3.0 years) and 10 eyes with mixed astigmatism or hyperopic errors (follow-up 8.8 ± 2.5 years). The mean total endothelial density loss at the last follow-up visit was 18.5% ± 17.0% and 10.5% ± 12.3%, respectively. 29.9% of the eyes in the myopic group and 20% in the hyperopic group lost more than 25% of the preoperative endothelial cell density. During the postoperative follow-up period, 60.8% of the eyes in the myopic group and 40% of the eyes in the hyperopic group lost a higher percentage than the expected physiological loss. Two eyes in the myopic group (3.0%) had a final cell density of less than 1200 cells/mm2. None of the variables studied had a statistically significant association with the percentage of annual endothelial loss in the postoperative period. Three phakic lenses were explanted: two by cataract and one by cataract and severe decrease of the endothelial density (862 cells/mm2). CONCLUSIONS There is a significant endothelial cell loss in a low percentage of the eyes with Artisan® lenses in the long term, and it can decrease to critical levels. Periodic endothelial density evaluations are required for these patients. The selection criteria of surgical candidates could be reevaluated.

    更新日期:2019-11-01
  • Optical coherence tomography (OCT) features of cystoid spaces in choroideremia (CHM).
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-10-28
    Vittoria Murro,Dario Pasquale Mucciolo,Dario Giorgio,Andrea Sodi,Ilaria Passerini,Giacomo Bacci,Sara Bargiacchi,Gianni Virgili,Stanislao Rizzo

    PURPOSE To investigate the prevalence and features of cystoid spaces (CS) in patients with confirmed genetic diagnosis of choroideremia (CHM) using swept source optical coherence tomography (OCT). METHODS We retrospectively reviewed CHM patients examined at the Regional Reference Center for Hereditary Retinal Degenerations at the Eye Clinic in Florence. We took into consideration genetically confirmed CHM patients with ophthalmological and swept source optical coherence tomography (OCT) examinations. The presence/absence and location of cystoid spaces in the retina of each eye were reported. RESULTS A total of 42 eyes of 21 CHM patients were included in our series. The average age of the patients was 36.5 ± 20.1 (range, 13-73 years). The average best-corrected visual acuity (BCVA) for all patients was 0.63 ± 1.00 logMar (range, 0-2,80). CS were present in 15 eyes of eight patients (8/21, 38%). In all cases, CS were located in inner nuclear layer (INL); in five eyes of three patients, CS were detected also in ganglion cell layer (GCL). CS appeared as microcistoyd abnormalities and were detected in retinal areas characterized by retinal pigment epithelium (RPE) and outer retinal layers atrophy at the transition zone. CONCLUSIONS Cystoid spaces in choroideremia showed peculiar features; they are clusters of small-size extrafoveal degenerative cysts mainly located in inner nuclear layer at the transition zone where outer retinal layers and RPE are severely damaged.

    更新日期:2019-11-01
  • Natural history of diabetic macular edema and factors predicting outcomes in sham-treated patients (MEAD study).
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-10-28
    Young Hee Yoon,David S Boyer,Raj K Maturi,Francesco Bandello,Rubens Belfort,Albert J Augustin,Xiao-Yan Li,Zhanying Bai,Yehia Hashad,

    PURPOSE To describe the natural history of diabetic macular edema (DME) with respect to best-corrected visual acuity (BCVA) and central retinal thickness (CRT) outcomes and to identify baseline patient characteristics and systemic factors associated with improvement or worsening of outcomes in sham-treated patients. METHODS The study population was sham-treated patients (n = 350) in the 3-year MEAD registration study of dexamethasone intravitreal implant for treatment of DME. Patients had center-involved DME and received sham intravitreal injections in the study eye at ≥ 6-month intervals. Potential prognostic factors for outcomes were evaluated using multiple linear regression analysis. RESULTS Visual and anatomic outcomes were poorer in patients who left the study early (n = 198) than in study completers (n = 152). Mean change in BCVA from baseline at the last visit with available data was + 0.9 letters; 37.5% of patients had no change in BCVA, 23.2% had gained > 10 letters, and 16.0% had lost > 10 letters. Older age and baseline diabetic retinopathy score > 6 were associated with worse BCVA outcomes; thicker baseline CRT and larger number of hypertension medications used were associated with larger reductions in CRT during the study. CONCLUSIONS BCVA and CRT outcomes were variable in this population of DME patients with generally good glycemic control. In DME patients without active treatment, older age and baseline diabetic retinopathy score > 6 were associated with less improvement in BCVA; thicker baseline CRT and a larger number of antihypertensive medications used predicted better improvement in CRT. TRIAL REGISTRATION The MEAD study trials are registered at ClinicalTrials.gov with the identifiers NCT00168337 and NCT00168389.

    更新日期:2019-11-01
  • Near reading speed changes after panretinal photocoagulation in diabetic retinopathy patients: a prospective study using an iPad application for the measurement of reading speed.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-10-28
    Ji Soo Kim,Jin Young Kim,Kyung Tae Kim,Ju Byung Chae,Jae Hyung Kim,Dong Yoon Kim

    PURPOSE To investigate the changes in the near reading speed after panretinal photocoagulation (PRP) in diabetic retinopathy patients. METHODS This non-randomized, prospective, clinical study enrolled diabetic retinopathy patients who underwent PRP from January 2016 to June 2017. The near reading speed was measured before and 1 week, 1 month, and 4 months after PRP by using an iPad application for the assessment of reading speed; near best-corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT) were also analyzed. The reading speed of age-matched healthy individuals was compared with that of diabetic retinopathy patients. RESULTS Forty-seven patients were enrolled in this study. The baseline near reading speed of diabetic retinopathy patients was significantly slower than that of age-matched healthy controls. The near reading speed was reduced at 1 week after PRP, but recovered at 1 and 4 months after PRP. Near BCVA showed a similar pattern after PRP. SFCT increased at 1 week after PRP and significantly decreased at both 1 and 4 months after PRP. CONCLUSION The near reading speed of diabetic patients was significantly slower than that of age-matched healthy controls. The speed was temporarily reduced at 1 week after PRP, potentially due to short-term impairment of parasympathetic nerve innervation.

    更新日期:2019-11-01
  • Analysis of corneal stromal roughness after iFS 150 kHz and LenSx femtosecond LASIK flap creation in porcine eyes.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-10-28
    Juan Gros-Otero,Samira Ketabi,Rafael Cañones-Zafra,Montserrat Garcia-Gonzalez,Alberto Parafita-Fernandez,Cesar Villa-Collar,Santiago Casado,Miguel Teus

    PURPOSE To describe and compare the stromal bed roughness obtained after laser in situ keratomileusis (LASIK) flap creation using a corneal femtosecond laser platform (iFS 150) and a "dual" femtosecond (FS) laser platform (LenSx). METHODS This ex vivo experimental study was conducted in an animal model using 12 freshly enucleated porcine eyes, six with each femtosecond laser. The standard laser treatment parameters were used for the experiment. After LASIK flap creation, the corneal stromal roughness was assessed using atomic force microscopy (AFM) in contact mode immersed in liquid. In each sample, surface measurements were obtained in 60 regions of six eyes per FS laser in 10 20 × 20-micron areas of the central corneal stroma at 512 × 512-point resolution. The surface roughness was measured and the root-mean-square (RMS) values of the roughness were obtained. RESULTS The mean RMS ± standard deviation values were 430 ± 150 nm for the corneal femtosecond laser platform and 370 ± 100 nm for the dual FS laser platform (P < 0.011). CONCLUSIONS In this experimental study with AFM, we found smoother stromal beds after LASIK flap creation with LenSx compared to iFS 150 kHz. Further studies are needed to understand visual implications of the differences found.

    更新日期:2019-11-01
  • New era in endoscopic vitreoretinal surgery.
    Graefes Arch. Clin. Exp. Ophthalmol. (IF 2.250) Pub Date : 2019-10-28
    Flavio Rezende,Natalia Vila

    更新日期:2019-11-01
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