Purpose: To evaluate the efficacy of combined treatment with commercially available 0.05% topical cyclosporine (CsA) and topical corticosteroid compared to treatment with topical corticosteroids only after high risk keratoplasty.

Patients and Methods: A total of 47 high-risk keratoplasties were randomly divided into two groups based on the postoperative immunosuppression. Twenty-five eyes (Group 1) were treated with 0.05% CsA and dexamethasone 0.1%, and 22 eyes (Group 2) were treated with dexamethasone only. The clinical outcome of penetrating keratoplasty (PK) was evaluated by the rate of rejection-free graft survival and graft survival evaluation by the Kaplan-Meier log-rank test.

Results: The avarage length of follow-up was 20.2±7.1 months in group1 and 18.5±6.6 months in group 2 (p=0.421). Rejection-free graft survival rates were 60.8% in group 1, and 54.5% in group 2 (Kaplan-Meier log-rank test, p=0.474). In group 1, the graft survival rate was 73.9%; in group 2, the graft survival rate was 68.1%. The difference in the graft survival rates between the groups was also not statistically significant (Kaplan-Meier log-rank test, p=0.518).

Conclusion: In high risk corneal grafts, the efficacy of 0.05 percent commercially available topical cyclosporine combined with dexamethasone topically was not better than that of dexamethasone alone in preventing rejection.

Aim: To determine the incidence, risk factors for and outcomes of delayed suprachoroidal hemorrhage (DSCH) after glaucoma surgery.

Methods: A retrospective case-control study was performed at a tertiary referral eye hospital on patients who presented with DSCH following glaucoma surgery. Cases were compared to a matched-control population that underwent equivalent procedures but did not develop DSCH. The main outcomes parameters were incidence of DSCH, risk factors associated with its occurrence, visual outcome and prognostic factors.

Results: Of the 2752 glaucoma surgeries performed during the 10-year recruitment period, 29 cases of DSCH (1%) were identified. An increased incidence of DSCH was observed after glaucoma drainage device implantation compared to trabeculectomy-associated DSCH (P<0.0001; Odds ratio=3.4; 95%Confidence Interval=1.9 to 5.4). Risk factors for DSCH included low postoperative intraocular pressure (≤3mmHg; P<0.001), aphakia(P<0.001), prior intraocular surgery(P<0.002), hypertension(P <0.001), anticoagulation(P =0.002), ischaemic heart disease(P=0.001) and respiratory disease(P=0.008). The visual outcome of patients with haemorrhage were poor (LogMAR 1.34 ± 0.41) and was significantly worse when compared with the control group (P=0.002).

Conclusions: In this study cohort, DSCH occurred more frequently after glaucoma drainage device implantation compared to trabeculectomy. Caution should be exercised when operating on patients with known ocular and systemic risk factors.

Aim: To describe the prevalence and risk factors of retinal vein occlusion (RVO) in an Asian population.

Methods: The Singapore Malay Eye Study is a population-based, cross-sectional study of 3,280 (78.7%) Malay adults (aged 40 to 80 years) living in Singapore. All participants underwent retinal photography, standardised interview, clinical examinations, and laboratory investigations. RVO (central or branch) was graded based on the Blue Mountains Eye Study (BMES) protocol from retinal photographs.

Results: The overall prevalence of RVO was 0.7% (n=22) (95% confidence intervals [CI]: 0.4, 1.0) (18 branch and 5 central RVO cases). There was no significant gender difference in RVO prevalence. RVO was associated with higher systolic blood pressure (age-adjusted odds ratio (OR) per SD increase 1.54, CI: 1.02, 2.31), ocular perfusion pressure (OR per SD increase 1.49, CI: 1.03, 2.16), a history of angina (OR 5.18, CI: 1.49, 18.0) and heart attack (OR 4.26, CI: 1.47, 12.3), and higher total cholesterol (OR per SD increase 1.55, CI: 1.07, 2.24) and LDL (OR per SD increase 1.47, CI: 1.02, 2.12) cholesterol levels.

Conclusions: The prevalence of RVO in this Asian population was lower than Caucasian whites in the BMES, although the systemic associations of RVO were largely similar to BMES and other studies.

Objective: To present the clinical spectrum of lamellar macular defects and describe the different subtypes based on their OCT configuration and visual prognosis.

Methods: The retrospective observational case series reviewed OCT scans of 92 eyes with lamellar macular defects. Lamellar macular defects were categorized into subtypes of macular pseudohole (MPH), lamellar macular hole (LMH), and foveal pseudocyst (FP) according to their OCT morphology. The defects were quantitatively characterized in terms of base diameter, depth, central foveal thickness, and examined for the presence of associated epiretinal membranes (ERM).

Results: Visual acuity (VA) was significantly correlated with the central foveal thickness and depth of the lamellar defect. MPH was associated with better VA compared with LMH and FP. MPH was of smaller base diameter and had greater central foveal thickness than that of LMH and FP. Fifty-percent of all lamellar defects had an associated ERM.

Conclusions: Different profiles of lamellar macular defects were characterized and quantified by OCT. Deeper and wider lamellar defects were associated with poorer visual outcome. Such objective parameters lamellar macular defects are of value when explaining to patients regarding their decreased acuity. Future prospective investigations are required to study the natural history of lamellar defects of different aetiology and surgical indications.

Background/Aim: Bardet-Biedl syndrome is a multi-organ disease presenting with retinitis pigmentosa leading to blindness. The aim of the study was to investigate the genetic background of Bardet-Biedl syndrome in the Faroe Island. We hypothesised that a common genetic background for the syndrome would be found.

Methods: Patients were identified from the files of the Retinitis Pigmentosa Register at the National Eye Clinic, Denmark. The diagnosis of Bardet-Biedl syndrome was verified from medical files. Mutational screening of BBS1, BBS2, BBS4, BBS5, MKKS, and BBS10 was done by denaturing high performance liquid chromatography.

Results: Out of 13 prevalent cases in the Faroe Islands 10 patients from nine families were included. We identified a novel splice site mutation in BBS1, c.1091+3G>C, predicted to affect protein function by skipping of 16 amino acids. Nine patients were homozygous for this mutation while one patient was compound heterozygous with a recurrent BBS1 mutation, p.Met390Arg. The patients presented with severe ophthalmic phenotypes while the systemic manifestations of the disease were apparently milder.

Conclusion: We identified a novel BBS1 mutation, most probably a founder mutation, further confirming the Faroe Islands as a genetic isolate. The phenotypic expression of the Faroese patients suggests that different mutations in BBS1 affect various organs differently.

Age-related maculopathy (ARM) remains the most common cause of blind registration in people aged 50 years or over in the developed world, and its prevalence continues to rise. Although effective new treatments have become available in the recent past, these are expensive and cumbersome to the healthcare provider and to the patient, and many cases remain resistant to such therapy. There is a biologically plausible rationale whereby macular pigment, which is entirely of dietary origin, may prevent or delay the onset, or ameliorate the clinical course, of ARM. In this article, we review this rationale, and critically appraise the current evidence base germane to the use of supplements containing the macular carotenoids in patients with, or at risk of developing, ARM.

Backgrounds: Since intraocular pressure (IOP) and age are consistent risk factors of glaucoma, it is of special interest to know the association between IOP and possibly relating factors including age in Japan where high prevalence of normal-tension glaucoma has been reported. The aim of this report was to evaluate the distribution of and factors related to applanation IOP in a population-based study in Japan.

Methods: A randomly sampled 3,021 residents (response rate, 78.1%) of Tajimi City, aged 40 years or older underwent screening examinations including measurements of IOP with Goldmann applanation tonometry and central corneal thickness.

Results: Among right eyes without glaucoma, glaucoma suspect or other disorders which could affect correct IOP measurements, IOP averaged 14.6 ± 2.7 (standard deviation) and 14.5 ± 2.5 mmHg in men and women, respectively, with no significant inter-gender difference (P=0.342). Multiple regression analyses revealed that age was significantly negatively correlated with IOP [nonstandardized beta (B)=-0.020/year, P=0.0001]. Higher body mass index (B=0.14/BMI, P<0.0001), higher mean blood pressure (B=0.022/mmHg, P<0.0001), a history of diabetes (P=0.0019), thicker cornea (B=0.014/fÊm, P<0.0001), higher myopia (B=0.055/diopters, P=0.0043) and steeper corneal curvature (B=-0.72/mm, P=0.0002) were also significantly correlated with higher IOP.

Conclusions: In an adult Japanese population, applanation IOP averaged 14.5 mmHg and was negatively correlated with age after adjusting for other related factors. Positive correlation between IOP and myopia was found.

Purpose: To develop a system for clinically mapping conjunctival melanomas, taking into account the tumour’s stage of development, location and extent.

Methods: Baseline clinical features of 40 patients with conjunctival melanoma, first treated at our centre between 1993 and 2006, were studied. Maps showing sectorial location and circumferential spread in all areas of conjunctiva were digitally generated from numerical data.

Results: The patients (18 female; 22 male) had a median age of 59 years. Three had multiple tumours and 20 had mixed, invasive and intra-epithelial disease. The TNM T stage was I in 11 patients, II in 20, III in 8 and IV in one. The tumour was medial in 19% of eyes with T stages I and II as compared with 67% of eyes with stages III and IV (Mann-Whitney, < 0.001). Within each T stage of the TNM system, there was much variation in tumour dimensions, circumferential spread and longitudinal extent.

Conclusions: A system for clinically mapping conjunctival tumour location and extent has been developed. This revealed tumour variation within TNM T stages and may facilitate better collection of data for multicentre trials.

Purpose: Matrix perimetry uses frequency-doubling technology (FDT) incorporated into a 5-degree test target. This permits testing of the same number of locations within a defined visual field as standard automated perimetry (SAP) and may improve performance compared with original FDT perimetry. This study investigates the performance of Humphrey Matrix perimetry for detecting glaucomatous visual field loss.

Design: Prospective case control study.

Methods: We recruited 118 participants with glaucomatous visual field loss and 33 normal controls from an urban glaucoma practice. Each participant performed SITA 24-2 SAP then threshold 24-2 Matrix perimetry. Severity of visual field loss was defined using SAP mean deviation [MD] as early (MD > -6dB), moderate (MD –6 to -12dB) or advanced (MD < -12dB). The sensitivity and specificity of Humphrey Matrix perimetry was calculated for different automated indices.

Results: Matrix perimetry sensitivity and specificity was up to 100% for moderate and advanced glaucomatous visual field loss. Receiver operator characteristic (ROC) curve analysis revealed MD to be slightly better than PSD for defining moderate (AUC: MD 0.9968; PSD 0.9855) and advanced defects (AUC: MD 1.000; PSD 0.9865). Matrix was less sensitive (up to 87.3%) for detecting early glaucomatous visual field loss compared with SITA 24-2 SAP (ROC AUC: PSD 0.9484; MD 0.9097).

Conclusions: Matrix perimetry is excellent for detection of moderate to advanced glaucomatous visual field loss but may miss some early defects. It may be well suited to following progression of field loss because of a smaller target size compared with original FDT perimetry.

Soft-to-semisoft cataracts may be challenging to remove with conventional sculpting and chopping phaco techniques. There are risks to intracameral structures during excessive and prolonged instrumentation. At a paracentesis site, corneal trauma may lead to wound leakage and astigmatism. We describe a technique for soft-to-semisoft lens extraction that minimises the mechanical stresses within the eye and utilises low phaco energy during surgery. The endonucleus is positioned in the vertical plane at the level of the capsulorhexis, and then removed in a centrifugal manner. Our single site wagon wheel technique uses the flow dynamics associated with high vacuum and burst phaco to safely remove soft-to-semisoft cataracts.

Aims: To evaluate a new technique in large retinal and choroidal biopsies in patients with uveitis of unknown aetiology and chorioretinal lesions or infiltrate.

Methods: Retrospective, noncomparative, consecutive interventional case series. Patients were identified from the computerised patient database and from histopathology records.

Results: A total of 9 patients were included in the study. The commonest indication of biopsy was panuveitis of unknown aetiology. Positive histological diagnoses from the chorioretinal biopsies were made in 5 cases (55.6%). Complications included vitreous haemorrhages and one case of retinal detachment.

Conclusion: Our technique of large chorioretinal biopsy described appears to be safe. It produced good amounts of chorioretinal tissue for histopathological analysis. Positive histology results were seen in the majority of the sample and especially in those where vitreous biopsy alone proved to be inadequate.

Aims: To determine patients' preferences for provision of glaucoma follow-up services examining preferences for location, access and personnel for delivery of this care.

Methods: 100 patient patients attending the glaucoma outpatient clinic for follow-up review underwent an interview based assessment during which they completed the visual function questionnaire 25 and ranking of scenario options for provision of follow-up care for their glaucoma. Percentage preferences for aspects of care offered in the conjoint analysis scenario packages and generation of utility values for each of the factor levels included in the scenario design were calculated.

Results: Travel time and training of health professional were the most important factors for patients (accounting for over 60%) of their preference. Utility scores were generated for each factor with shorter travel time and examination by a doctor being the most important features to the patients. Patients who lived furthest from the hospital and had severe visual disability considered the number of visits to complete an episode to be an important feature.

Conclusion: Patients ideally would like to travel a short distance and be seen by a doctor when being followed up for their glaucoma.

Aim: To compare the results of scanning laser polarimetry (GDx) with variable corneal compensation (VCC) and enhanced corneal compensation (ECC) when applied to myopic glaucomatous eyes.

Methods: Forty glaucoma eyes with moderate myopia (between -3 and -6 D) and 35 glaucoma eyes with high myopia (-8 D or greater) were enrolled in this study. GDx VCC, GDx ECC and standard automated perimetry (SAP) were performed. The prevalence of an atypical retardation pattern (ARP), the typical scan score (TSS), and retinal nerve fiber layer (RNFL) thickness were compared between VCC and ECC in both groups of myopic subjects. A correlation analysis between RNFL thickness and visual sensitivity was also conducted.

Results: In both myopic groups, mean TSS is significantly lower (p<0.0001) and the prevalence of ARP was significantly higher (p<0.0001) by VCC scans than by ECC scans. TSNIT (temporal, superior, nasal, inferior, temporal) average, and temporal average thickness showed significantly higher values (p<0.001) by VCC than by ECC. A statistically significant association was observed between TSNIT average and mean deviation of SAP by ECC scan.

Conclusions: ECC scans showed a better retardation pattern and structure-function relationship than did VCC, and ECC appeared to be more suitable for RNFL assessment in glaucomatous eyes that are moderately to highly myopic.

Background/Aims: Low socioeconomic status is increasingly being identified as a risk marker for chronic diseases, but few studies have investigated the link between socioeconomic factors and age-related macular degeneration (AMD). The present study aimed to assess the association between socioeconomic status and the prevalence of AMD.

Methods: A population-based cross-sectional study of 3,280 (78.7% response rate) Malay adults aged 40-80 years residing in 15 south-western districts of Singapore. AMD was graded from retinal photographs at a central reading centre using the modified Wisconsin AMD scale. Early and late AMD signs were graded from retinal photographs following the Wisconsin grading system. Socioeconomic status including education, housing type and income were determined from a detailed interview.

Results: Of the participants, 3,265 had sufficient quality photographs for grading of AMD. Early AMD was present in 160 (4.9%) and late AMD in 23 (0.70%). After adjusting for age, gender, smoking, hypertension, diabetes and body mass index, participants with lower educational levels were significantly more likely to have early AMD (multivariate OR 2.2, 95% confidence intervals, 1.2-4.0). This association was stronger in persons who had never smoked (multivariate OR 3.6, 95% confidence intervals, 1.4-9.4). However, no association with housing type or income was seen.

Conclusions: Low educational level is associated with a higher prevalence of early AMD signs in our Asian population, independent of age, cardiovascular risk factors and cigarette smoking.

We describe the case of a 40 year old man who experienced bilateral simultaneous anterior ischaemic optic neuropathy who was diagnosed with Sticky Platelet Syndrome. Our case highlights the importance of taking a through history and performing appropriate investigations in patients with anterior Ischaemic Optic Neuropathy.

Purpose: To examine the effects of photodynamic therapy (PDT) with verteporfin combined with low-dose intravitreal triamcinolone acetonide (IVTA) for exudative age-related macular degeneration (AMD) that is resistant to photodynamic therapy alone.

Design: Retrospective case series.

Methods: We reviewed retrospectively the medical records of 22 eyes of 21 patients who consecutively received combined PDT and 2 mg IVTA for exudative AMD with a suspected chorioretinal anastomosis or for AMD that was resistant to prior PDT alone. Only those patients who could be followed-up for more than 12 months after this combined therapy were enrolled in the study. Best corrected visual acuity and intraocular pressure measurements were taken during each examination. Color photography, fluorescein/indocyanine green angiography, and optical coherence tomography were done at baseline and every 3 months thereafter. Need for retreatment was based on dye leakage and the presence of serous retinal detachement (SRD) seen by optical coherence tomography.

Results: Visual acuity improved or was maintained in the majority of patients, with the mean change between baseline and the last visit being an improvement of 0.94 lines (p =0.45). Seventeen (77%) of the 22 eyes showed improved or maintained visual acuity after 12-months of follow-up. Eight (36%) of the 22 eyes continued to show an SRD at the 12 month follow-up; this corresponded to unchanged or even decreased leakage of dye. The mean number of retreatments was 1.36, but the incidence of side effects accompanying treatment was not as high as was reported previously for combined therapy that utilised higher-dose IVTA.

Conclusions: PDT combined with low-dose IVTA for exudative AMD seems to be as effective and safe as is combined therapy with the higher-dose IVTA that was reported previously.

Aims: To report the prevalence and correlates of pseudoexfoliation syndrome (PXF) in a rural Burmese population.

Methods: A cross-sectional, population-based survey of the inhabitants 40 years of age and over in the Meiktila District. Ophthalmic examination included Snellen visual acuity, slit lamp examination, tonometry, gonioscopy, dilated fundus examination and full-threshold perimetry.Frequency Doubling Perimetry.

Results: In a population of 2076 subjects (4016 eyes) the prevalence of PXF was 3.4% (95% Confidence interval (CI) 2.14 - 4.67%; 78 eyes). Twelve eyes with PXF were blind. In the univariate analysis, PXF was associated with: increasing age, blindness (odds ratio (OR) 4, 95% CI 1.84 - 8.68, p<0.0004), increasing intraocular pressure (IOP) (OR 1.08, 95% CI 1.04 - 1.11, p<0.00001), nuclear cataract (OR 6.92, 95% CI 2.89-16.59, p<0.00001), cortical cataract (OR 4.78, 95% CI 2.37 - 9.65, p<0.00001), and the presence of an occludable angle (OR 3.05, 95% CI 1.52 – 6.13, p<0.002). In the multivariate analysis, only increasing age and IOP remained significantly associated with PXF.

Conclusions: The prevalence of PXF in the Burmese population is greater than previously reported in other East Asian populations. Increasing age and IOP are the strongest predictors of PXF, and it is associated with cataract, occludable angles and blindness.

Aim: To study alterations in choroidal blood flow (CBF) in the foveal region after panretinal photocoagulation (PRP) in patients with severe proliferative diabetic retinopathy.

Methods: Seventeen eyes of 17 patients with severe non-proliferative diabetic retinopathy (PDR) or with non-high-risk PDR and no macular edema before PRP were included. All patients underwent four sessions of scatter PRP. We measured the choroidal blood velocity (CBVel), choroidal blood volume (CBVol), and CBF in the foveal region before and 1 month after PRP using a laser Doppler flowmetry.

Results: Macular edema did not develop after PRP in any treated eyes. One month after PRP, there was no significant change in the mean CBVel (311.2 ± 61.2 Hz) compared with baseline (327.1 ±74.1 Hz) (P=0.17). In contrast, the mean CBVol and CBF values increased significantly by 51% (from 0.37 ± 0.12 arbitrary units [a.u.] at baseline to 0.52 ± 0.16 a.u., P=0.0025 ) and 46% (from 7.3 ± 2.4 a.u. at baseline to 10.4 ± 4.4 a.u., P=0.0014 ), respectively, 1 month after PRP.

Conclusion: These results indicate that PRP may increase the CBF in the foveal region in eyes with severe diabetic retinopathy. The current results may be caused by vasodilation of the choriocapillaries in the foveal region.

Background: Due to low energy levels in microphotodiode based subretinal visual prostheses external power supply is mandatory. We report on the surgical feasibility and the functional outcome of the extra-ocular part of an approach to connect a subretinal prosthesis to an extra-corporeal connector in the retro-auricular space via a trans-scleral, trans-choroidal cable.

Methods: Seven volunteers with retinitis pigmentosa received an active subretinal implant; energy was supplied by gold wires on a trans-sclerally, trans-choroidally implanted polyimide foil leading to the lateral orbital rim where it was fixated and connected to a silicone cable. The cable was implanted subperiostally beneath the temporal muscle using a trocar to the retro-auricular space where it penetrated the skin for connection to a stimulator. To avoid subretinal movement of the implant three tension relief points have been introduced.

Results: All implantations were performed as planned without complications, no serious adverse events occurred in the post-operative period. Fixation of the implants was stable throughout the entire study duration of 4 weeks; permanent skin penetration proved to be uncomplicated. Motility was minimally restricted in downgaze and ab-/adduction. Explantation was uneventful.

Conclusion: The above described procedure provides a method for stable fixation of a subretinal device with a trans-scleral, trans-choroidal cable connection to an extra-corporeal connector.

Background/aims: To evaluate to what extent the optic nerve head (ONH) parameters as measured with Heidelberg Retina Tomograph (HRT) differed from those measured with optical coherence tomography (OCT) in eyes with compressive optic neuropathy (CON) that had band atrophy (BA) of the optic disc.

Methods: A total of 30 eyes from 19 patients with BA due to chiasmal tumor and 162 eyes from 162 normal subjects were examined with HRT and Stratus OCT using the fast optic nerve scan protocol. Parameters measured by the two devices, including the disc area, cup/disc (C/D) area ratio, cup area, cup volume, rim area, and rim volume, were compared between the eyes of BA patients and controls. Bland-Altman plots were used to evaluate agreement for each parameter between OCT and HRT in both groups of eyes. Inter-method discrepancy of the measurements for each parameter was compared between the two groups of eyes.

Results: Eyes with BA had smaller cup and larger rim parameters than control eyes when measured with HRT, whereas they had significantly larger cup and significantly smaller rim parameters than control eyes when measured with OCT. HRT measurements tended to be consistently lower in the C/D area ratio and cup area and higher in the rim area and rim volume than OCT measurements for both control eyes and eyes with BA. The inter-method discrepancy for all the parameters except the disc area was significantly larger in eyes with BA than in control eyes.

Conclusion: The increased optic disc excavation was detected with OCT but not with HRT in CON eyes with BA of the optic disc. Thus, the distinct algorithms used by these two modalities affected the measurements of ONH parameters, particularly when assessing optic discs with temporal rim thinning.

Aims: To demonstrate ultrahigh resolution, three-dimensional optical coherence tomography (3D-OCT) and projection OCT fundus imaging for enhanced visualization of outer retinal pathology in non-exudative age related macular degeneration (AMD).

Methods: A high-speed, ultrahigh 3.5 µm resolution OCT prototype instrument was developed for the ophthalmic clinic. 83 patients with non-exudative AMD were imaged. Projection OCT fundus images were generated from 3D-OCT data by selectively summing different retinal depth levels. Results were compared with standard ophthalmic examination, including fundus photography and fluorescein angiography, when indicated.

Results: Projection OCT fundus imaging enhanced the visualization of outer retinal pathology in non-exudative AMD. Different types of drusen exhibited distinct features in projection OCT images. Photoreceptor disruption was indicated by loss of the photoreceptor inner/outer segment (IS/OS) boundary and external limiting membrane (ELM). RPE atrophy can be assessed using choroid level projection OCT images.

Conclusions: Projection OCT fundus imaging facilities rapid interpretation of large 3D OCT data sets. Projection OCT enhances contrast and visualizes outer retinal pathology not visible with standard fundus imaging or OCT fundus imaging. Projection OCT fundus images enable registration with standard ophthalmic diagnostics and cross-sectional OCT images. Outer retinal alterations can be assessed and drusen morphology, photoreceptor impairment, and pigmentary abnormalities identified.

Purpose: To undertake a systematic review of the literature on the effect of environmental tobacco smoke (ETS) and eye disease.

Methods: Medline (1950-January Week 2 2007), EMBASE (1980 to 2007 Week 07), SCOPUS and Science Direct were searched on ETS exposure and eye disease using various combinations of the following terms: Passive smoking, environmental tobacco smoke, sidestream smoke, involuntary smoking, secondhand smoke; with eye, conjunctiva, sclera, episclera, cornea, lens, iris, retina, choroid, uvea, optic nerve, uveitis, iritis, blindness, visual loss, cataract, thyroid eye disease, conjunctivitis, age-related macular degeneration, dry eye, tears. The above terms were also used to search abstracts published on The Association for Research in Vision and Ophthalmology Annual Meeting abstracts, from 1995 to 2006, and the grey literature, including PhD and MSc theses/dissertations. A search was further conducted specifically on eye diseases where active smoking has been proposed to be a risk factor, including age-related macular degeneration, Graves’ ophthalmology, glaucoma, uveitis, refractive errors, strabismus, tobacco-alcohol amblyopia, non-arteritic ischemic optic neuropathy, Leber’s optic neuropathy and diabetic retinopathy. Given the scarce number of studies found through the above search, all articles found on ETS and eye disease were included in this review.

Results: Seven studies evaluated the possible relationship between ETS and an eye disease. These studies referred to refractive errors in children (n=2), cataract (n=1), age-related macular degeneration (n=3) and Grave’s ophthalmopathy (n=1). The data available was insufficient to establish conclusive relationships between ETS and these eye diseases.

Conclusion: Very scarce data exists in the literature on the effect of ETS on diseases of the eye. It seems appropriate that ETS should be included in future studies addressing the effect of smoking on eye disease.

A 30 year-old African-American woman with systemic lupus erythematosus (SLE) developed severe bilateral optic disc swelling followed several months later by progressive visual field loss. Neuroimaging revealed no abnormalities but a lumbar puncture revealed increased intracranial pressure (ICP), an elevated concentration of protein in the cerebrospinal fluid (CSF). Her condition did not improve despite medical therapy with leflunomide, methotrexate, prednisone, and rituximab. Consideration was given to an optic nerve sheath fenestration or a ventricular shunt procedure. She was referred to the clinic for neuro-ophthalmologic assessment and recommendations. Because of the elevated concentration of protein in her CSF, treatment was initiated with intravenous followed by oral corticosteroids. Despite this treatment, the patient’s visual fields continued to deteriorate, associated with severe, persistent bilateral disc swelling. As surgery carried a high risk of failure, more aggressive medical therapy was pursued. After rheumatologic consultation, the patient started monthly (total 6) treatments with intravenous cyclophosphamide. Her visual fields dramatically improved and the papilledema resolved. This case highlights the challenges of managing papilledema and vision loss and the potential role of cyclophosphamide in the setting of SLE-associated pseudotumor cerebri syndrome.

Background/aims: To describe the prevalence and risk factors of epiretinal membranes (ERM) in Asian Malays and to compare this with a white population.

Methods: The Singapore Malay Eye Study examined 3,280 persons (78.7% response rate) aged 40-80 years in Singapore during 2004-6. ERM were graded from retinal photographs using standardized procedures at the University of Sydney, and rates were compared to those from the Blue Mountains Eye Study (BMES).

Results: Of the 3,280 participants, 3,265 had sufficient quality photographs for grading. The age-standardized prevalence of ERM was 7.9% (95% confidence interval [CI] 7.1-8.7%) in the Singapore Census population. The prevalence of ERM was higher in Malays than in whites from the BMES (age-standardized prevalence: 15.8% [CI 14.2-17.2%] in Malays vs. 6.8% [CI 5.9-7.6%] in whites). Of the 384 persons with ERM, 124 (32.3%) had secondary ERM. Age, female gender, hyperopia and narrower retinal arteriolar diameter were associated with higher prevalence of ERM, after adjusting for age and/or gender.

Conclusions: The prevalence of ERM in Asian Malays was higher than that in the white persons. Risk factors for ERM were older age, female gender, hyperopic refraction and narrower retinal arteriolar diameter.

A 66-year old man complained of recurrent transient monocular visual loss in his left eye during the climax of sexual intercourse. A complete carotid stenosis was found on the contralateral side and 50% on the ipsilateral side. Treatment with enalapril, antithrombotics and statin resulted in complete resolution of the visual symptoms.

Purpose: Autosomal Dominant Optic Atrophy (ADOA) is a genetically heterogenous disease, however a large proportion is accounted for by mutations in OPA1. The aim of this longitudinal study was to investigate disease progression in Australian ADOA patients with confirmed OPA1 mutations.

Methods: Probands with characteristic clinical findings of ADOA were screened for OPA1 mutations, and relatives of identified mutation carriers were invited to participate. Disease progression was determined by sequential examination or using historical records over a mean of 9.6 years (range 1-42 years).

Results: 158 OPA1 mutation carriers were identified in 11 ADOA pedigrees. 69 mutation carriers were available for longitudinal follow up. Using the right eye as the default, best-corrected visual acuity (BCVAR) remained unchanged (defined as visual acuity at or within one line of original measurement) in 43 patients (62%). BCVAR worsened by 2 lines in 13 patients (19%). BCVAR deteriorated in by more than 2 lines in 6 patients (9%). 10% of patients had an improvement in visual acuity. Mean time to follow up was 9.6 years and interestingly mean visual acuity was 6/18 for both the initial and subsequent measurements. There was no statistical significance in the rate of BCVAR loss across different OPA1 mutations (P = 0.55).

Conclusion: OPA1-related ADOA generally progresses slowly and functional visual acuity is usually maintained. Longitudinal disease studies are important for allowing appropriate counselling of patients and this study allows for the better understanding of the natural history of ADOA.

Purpose: To measure the drift of ocular alignment following strabismus surgery utilizing adjustable sutures.

Methods: 106 patients, age 12 to 84 years, underwent adjustable suture strabismus surgery with follow-up of 0.5 to 4 years (mean 24.3 months).

Results: For all subjects measured on distant fixation, there was a mean undercorrection drift of 8.3 + 2.3 PD from week 1 to 48 months postoperatively (p = 0.005). Patients with exotropia demonstrated an undercorrection drift on distant fixation from week one to two years (mean 10.1 + 3.5 PD, p = 0.023). Patients who underwent recession surgery developed a mean 9.1 + 3.3 PD undercorrection drift from week one to three years (p=0.031). Patients who had unilateral recession and resection surgery showed a mean 6.8 + 2.9 PD undercorrection drift from week one to 18 months (p = 0.049). Patients with constant or intermittent postoperative stereopsis had a statistically significant undercorrection drift (< 5.1 P.D.) at certain postoperative periods (p< 0.042), while those without stereopsis had no significant drift.

Conclusion: Most patients developed a general drift toward undercorrection, especially following recession or recession with resection surgery and those with exotropia. Surgeons should consider creating a mild overcorrection at time of suture adjustment, while avoiding long term diplopia.

Epigenetic regulation of tumor suppressor genes provides an attractive mechanism for tumors in which mutations and structural changes are rare. The latter may apply to uveal melanoma for which little is known of the genes that contribute to tumor development. In the search for genes, uveal melanoma is often compared to its counterpart in the skin, cutaneous melanoma. One of the major cuteneous melanoma genes is the p16 encoding CDKN2A gene for which mutations and deletions are the major mechanisms of inactivation. Deletions and mutations in CDKN2A are however rare in uveal melanoma; still p16 expression is lacking in half of the cell lines[1]. Using methylation analysis and methylation inhibition in cell culture, we have shown that the underlying mechanism of loss of p16 expression in these cell lines is methylation of CDKN2A. This observation is not disputed but controversy arises when primary tumors are analyzed and estimates are given for the extend of CDKN2A methylation in uveal melanoma[2-4]. The study by Moulin et al is an example of a study that displays some remarkable deviations from results we and others have achieved previously[5,6]. We would like to comment on some of the technical and biological factors that may contribute to the lack of consistency in the results that are achieved in the field of uveal melanoma epigenetics.

Background/Aims: To analyze the clinical manifestations and results of treatment for patients with retinoblastoma in Korea.

Methods: We retrospectively analyzed the medical records of 70 children (92 eyes) diagnosed with retinoblastoma and treated between 2000 and 2006. Data on gender, age at diagnosis, laterality, presenting sign, classification of tumor, treatment modality, and prognosis were collected.

Results: The most common presenting sign was leukocoria (80%). 31.4% developed bilateral retinoblastoma. Using the International Classification of Retinoblastoma, 7.5% were group A, 23.8% were group B, 6.3% were group C, 38.8% were group D, and 23.8% were group E. 26.1% of eyes were treated with chemoreduction and/or focal therapy, namely, they achieved globe preservation and all other eyes were enucleated. The globe preservation was achieved in 100% of group A, 77.8% of group B, 66.7% of group C, and 26.7% of group D.

Conclusions: In Korea, most of children with retinoblastoma showed advanced stage of tumor at time of diagnosis and although they are treated with update therapeutic approach according to the newly introduced classification, the rate of globe preservation did not reach developed countries. Increased surveillance should be performed.

Background/aims: To evaluate in-vivo 3-dimensional (3-D) confocal laser scanning microscopy (CLSM) as a technique for visualising the corneal surface and epithelium.

Methods: Ten human corneas (three from healthy volunteers, three with bullous keratopathy, three from patients following penetrating keratoplasty, and one with corneal erosion) were examined by 3-D CLSM. A novel polymethyl methacrylate (PMMA) contact cap was designed to minimise artefacts due to applanation pressure.

Results: 3-D reconstruction and different visualisation techniques (volume rendering, cross-section, en face view, oblique section and surface reconstruction) were performed to demonstrate alterations to corneal surface and epithelium. Image quality (cell identification, motion blur, absence of compression artefacts, imaging of superficial structures and of subepithelial nerve plexus) was considerably superior to that obtained using a conventional contact cap with a planar surface.

Conclusions: 3-D CLSM permits in-vivo visualisation and analysis of the corneal surface and of spatial arrangement at the cellular level in epithelium in normal and pathological corneas. The novel design of the contact cap minimises artefacts due to applanation pressure and improves the image quality of epithelial structures. The method provides a basis for further in-vivo studies of alterations to corneal surface structure and its cellular arrangement.

Aims: To compare the outcome of prophylactic oral valacyclovir (VAL) or oral acyclovir treatment (ACV) in patients having undergone penetrating keratoplasty for herpetic keratitis (HK).

Methods: We retrospectively evaluated all patients having received a penetrating keratoplasty for HK and being treated postoperatively with either oral VAL or oral ACV (inclusion period from 12/97 to 3/06 and 5/92 to 9/96, respectively). Records were analyzed for postoperative reactivation of recurrent HK, graft rejection, endothelial cell loss, central corneal thickness, and visual acuity after a follow-up of up to 5 years.

Results: Twenty patients received VAL and were compared with nineteen patients being treated with ACV. Two patients developed clinical signs of recurrent herpetic disease in the VAL group compared to three patients in the ACV group. Two patients from both groups each developed an irreversible graft failure. Best corrected visual acuity improved in both treatment groups from baseline (logMAR) -1.97 (VAL); -1.47 (ACV) to -0.85; -0.72 respectively at the 1 year follow-up and slightly deteriorated after 5 years in the ACV group (-0.71 VAL vs. -1.14 ACV).

Conclusion: Prophylactic oral VAL treatment is at least as effective as ACV in preventing recurrence in patients who underwent corneal transplantation for HK. Tolerability of the two drugs is similar, but the dosing for VAL might be more comfortable for patients.

Aims: To determine the prevalence of and risk factors for cataracts in a rural region of central Myanmar.

Methods: A cross-sectional, population-based survey of inhabitants >/= 40 years of age from villages of central Myanmar; 2076 participated and 2044 (82.3%) had an examinable lens in at least one eye. Data recording included smoking history, occupation, education level, betel-nut chewing, height and weight, and dilated lens assessment using Lens Opacities Classification System III grading: nuclear (≥4), cortical (≥2) and posterior subcapsular (≥2) cataracts. Aphakic and pseudophakic eyes were included as operated cataracts for statistical analysis.

Results: The prevalence of any cataract including operated eyes was 40.39% (95% CI, 37.30 - 43.48%): 27.35% nuclear; 20.91% cortical; and 11.34% posterior sub-capsular cataracts. No significant association was found between cataract and betel-nut use, gender, smoking or outdoor occupation. The likelihood of all cataract types increased with age (multivariate analysis including operated eyes: OR 1.154, CI 1.13-1.18, P <0.001). Low level of education and low body mass index were associated with nuclear cataracts. Large village size was associated with increased risk for nuclear cataract (OR 3.23, CI 1.989-5.250, P <0.001) and decreased risk for cortical cataract (OR 0.20, CI 0.08-0.47, P <0.001).

Conclusions: The prevalence of cataract in rural Myanmar is similar to that in other developing Asian regions. Cataracts are strongly associated with increasing age, and are more common in those with lower education and lower body mass index.

Aim: To quantify human corneal recovery after moderate to high myopic laser in situ keratomileusis (LASIK) in a two year prospective follow-up study.

Methods: Fifteen eyes of 15 patients (mean refraction -10.1 ± 2.4 D) were examined preoperatively and postoperatively at day 1, 5 days, 2 weeks, 1, 3 and 6 months and 2 years. Biomicroscopy, visual acuity and refraction were examined prior to imaging studies. An in vivo tandem scanning confocal microscope was used to obtain images from the central cornea. Subbasal nerve density was measured as the total length of nerve trunks in confocal image per mm2. Keratocyte density was calculated manually from stromal sublayers. The thickness of the altered keratocyte zone was measured on both sides of the LASIK interface.

Results: At the end of the follow-up all patients had a 20/20 BCVA and nine of 15 patients were within ±0.5 D of the intended correction. Total corneal thickness remained unaltered, but epithelial hyperplasia was seen at 2 years. Keratocyte density in the anterior stroma and posterior to the flap interface showed a slight decrease during the follow-up. Subbasal nerve density decreased 82 % in five days after LASIK. A gradual increase was observed from two weeks postoperatively, but even 2 years after the operation the nerve density was only 64 % from the preoperative values.

Conclusions: Subbasal nerve fiber density shows a gradual recovery throughout the follow-up. However, only three subjects showed totally regenerated subbasal nerve fibers at 2 years. This may correlate with the observed decrease in the density of the most anterior keratocytes. Corneal remodelling seemed to continue for at least 2 years.

Aims: To examine the incidence of progression of keratoconus suspect to true keratoconus and compare quantitative descriptors of corneal topography between eyes with and without progression.

Methods: We retrospectively reviewed 34 eyes with suspect keratoconus in 34 patients. Their age at the initial examination was from 13 to 40 years (24.1 ± 7.5, mean ± standard deviation), and the follow-up periods ranged from 3 to 10 years (6.0 ± 2.2 years). Keratoconus suspect was defined as the fellow eye of a clinically apparent keratoconus but that had no slit-lamp signs of keratoconus (Fleischer's ring, Vogt's striae, and Munson's sign) with best spectacle-corrected visual acuity of 20/20 or better. Eyes were monitored for the progression of apparent slit-lamp findings of keratoconus during the follow-up period. By using Fourier analysis of the corneal topography data, regular astigmatism, asymmetry component, and higher order irregularity component were calculated in the central 3-mm zone. Quantitative descriptors of corneal topography were compared between eyes which progressed to true keratoconus and those which did not.

Results: Five eyes (14.7%) progressed to apparent keratoconus from keratoconus suspect (progression group), and 29 eyes did not (non-progression group). On average, it took 5.2 years for the eyes to develop apparent slit-lamp findings of keratoconus. Cumulative incidence of progression by Kaplan-Meier analysis was 21.5% in 6 years. Asymmetry component and regular astigmatism by Fourier analysis at the initial examination was significantly larger in the progression group than in the non-progression group.

Conclusion: In our retrospective study, approximately 20% of eyes with suspect keratoconus progressed to true keratoconus in 6 years, and these eyes had presented greater asymmetry and regular astigmatism at the initial examination.

Aim: To evaluate the short-term efficacy of intravitreal injections of bevacizumab for severe retinopathy of prematurity (ROP).

Methods: A retrospective chart review was conducted of 23 consecutive eyes (stage 3, 3 eyes; 4A, 18 eyes; 4B, 2 eyes) of 14 patients with vascularly active ROP considered at high risk for progression or development of tractional retinal detachment despite conventional laser ablation therapy. Patients received an intravitreal injection of bevacizumab (0.5 mg) either as the initial treatment (15 eyes) or at the end of vitrectomy (8 eyes).

Results: After injection of bevacizumab as the initial treatment, reduced neovascular activity was seen on fluorescein angiography in 14 of 15 eyes. In three eyes, a tractional retinal detachment developed or progressed after bevacizumab injection. No other ocular or systemic adverse effects were identified. Vitrectomy was performed in 20 eyes and the retina was reattached after one surgery in 18 eyes. Multiple surgeries were necessary in two eyes resulting in retinal reattachment.

Conclusion: Our results suggest that intravitreal injection of bevacizumab seems to be associated with reduced neovascularization without apparent ocular or systemic adverse effects and thus beneficial for treating severe ROP that is refractory to conventional laser therapy.

Aims: To evaluate the effect of intravitreal injections of bevacizumab in the treatment of peripapillary choroidal neovascular membranes.

Methods: Interventional case series of patients with active peripapillary choroidal neovascular membranes. Ophthalmological examination included best-corrected visual acuity, fundus biomicroscopy, fluorescein angiography and optical coherence tomography (OCT). Bevacizumab injections (1.25 mg) were repeated monthly for the first three months. Re-treatment was considered if there were signs of membrane activity.

Results: Six eyes of five patients with peripapillary choroidal membranes were included in the study with a mean follow-up of 13 months (range 6 to 16). Bevacizumab was used as the initial treatment in four eyes and to manage recurrences after surgery in the other two. In five eyes three injections of bevacizumab led to a complete resolution of leakage on fluorescein angiography and OCT. In one eye, membrane activity persisted despite six injections of bevacizumab. Visual acuity improved in five eyes with a mean improvement of 4 lines (average: 2-10 lines). It deteriorated only in the eye that did not to respond to treatment.

Conclusions: The results of this case series suggest that the intravitreal injection of bevacizumab may be an effective treatment for peripapillary choroidal membranes.

Background: The purpose of this study was to determine the age-adjusted incidence of retinoblastoma in the United States over a 30-year period from 1975 to 2004 using a review of existing databases.

Methods: Six hundred fifty-eight patients with retinoblastoma (International Classification of Oncology [ICDO-3] codes C69.2 [retina] and C69.9 [eye, NOS]) were derived from the Surveillance, Epidemiology, and End Results (SEER) program database in the United States from 1975 to 2004. Nine historical SEER registries were utilized. The significance of trend in age-adjusted incidence rate was determined using chi-square test, and 95% confidence intervals were calculated. The patients were stratified according to age at diagnosis, laterality, gender, and race.

Results: There were a total of 658 cases of retinoblastoma, representing 6.1% of all childhood cancers under age 5 years. The mean age-adjusted incidence of retinoblastoma in the United States was 11.8 per million children ages 0-4 years (10.9-12.8; 95% CI). There was no significant trend in age-adjusted incidence for all races/ genders, nor was there any significant variation of incidence between races or between genders. The proportion of bilateral cases (26.7%) versus unilateral cases (71.9%) remained stable over the 30 year period.

Conclusions: The mean age-adjusted incidence rate of retinoblastoma of 11.8 cases per million children ages 0-4 years in the United States is similar to rates reported from European countries. The age-adjusted incidence rate of retinoblastoma in the United States has remained stable for the last 30 years.

Aim: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision.

Methods: Fifty patients (50 eyes) with primary pterygium were randomized to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed-up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery, and recurrence of pterygium.

Results: In the fibrin glue group, the mean operation time was 15.7±2.4 minutes (range, 12-18 minutes); it was 32.5±6.7 minutes (range, 25-40 minutes) in the suture group (P<.001). The intensity of the postoperative pain, foreign body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (P<.001). Intense itchy sensation at the first 2 postoperative visits was lesser among patients in the fibrin glue group (5 patients, 20%) than in the suture group (12 patients, 48%) (P < .05). Two patients in the fibrin glue group had partial graft dehiscence, these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in 1 eye (4%) in the fibrin glue group and in 3 eyes (12%) in the suture group (P<.05).

Conclusion: Using fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort, and results in a lower recurrence rate compared with suturing.

Perceptual visual filling-in at the corresponding area of toxoplasmic retinochoroiditis scotomas in the fellow eye was studied in 14 patients. Targets were programmed to appear inside the scotoma corresponding area in the fellow eye, and at two control points. The results showed faster perceptual filling-in latencies (p<0.0001) in the scotoma corresponding area than at the control points. Conclusions: (i) perceptual filling-in is facilitated at the corresponding area of retinal scotomas; (ii) the neural mechanisms of this visual facilitation might be similar to those found following somatosensory cortex partial deafferentation.

Background: To compare the ability of Glaucoma Progression Analysis (GPA) and Threshold Noiseless Trend (TNT) programs to detect visual field deterioration.

Methods: Patients with open angle glaucoma followed for a minimum of two years and a minimum of seven reliable visual fields were included. Progression was assessed subjectively by four masked glaucoma experts, and compared with GPA and TNT results. Each case was judged to be stable, deteriorated or suspicious of deterioration

Results: A total of 56 eyes of 42 patients were followed with a mean (SD) of 7.8 (+ 1.0) tests over an average of 5.5 (+ 1.04) years. Interobserver agreement to detect progression was good (mean Kappa = 0.57). Progression was detected in 10-19 eyes by the experts, in six by GPA and in 24 by TNT. Using the consensus expert opinion as the gold standard (four clinicians detected progression), GPA sensitivity and specificity was 75% and 83%, respectively, while TNT sensitivity and specificity was 100% and 77%, respectively.

Conclusion: TNT showed greater concordance with the experts than GPA in the detection of visual field deterioration. GPA showed high specificity but lower sensitivity, mainly detecting cases of high focality and pronounced MD slopes.

Aim: To examine the acute effects of wearing swimming goggles upon intraocular pressure (IOP).

Methods: This research consisted of a Pilot study and a Validation study. Holes were drilled into the faces of 13 different goggles to allow IOP measurement by applanation tonometry. IOP was measured before goggle wear, 2 minutes after goggle application, 20 minutes after goggle application and after goggle removal. The Pilot study (n = 15) was initially performed to investigate changes in IOP whilst wearing 5 different types of swimming goggles. Anatomical and goggle design parameters from the Pilot study were then used to generate a predictive model and design a Validation study (n = 20). The Validation study tested the predictive model, examined IOP changes using another 8 goggles and clarified whether IOP changes were sustained for the duration of goggle wear.

Results: IOP increased whilst wearing goggles by a mean pressure of 4.5mmHg (sd 3.7, P < 0.001) with this pressure rise being sustained for the duration of goggle wear. A smaller goggle face area (P = 0.013), was consistently associated with greater IOP elevation.

Conclusion: These measurements were not taken while swimming, however they suggest that some swimming goggles can elevate IOP.

Background Bimatoprost 0.03% has been shown to consistently reduce mean intraocular pressure (IOP) more than timolol 0.5% over 2 years. To further evaluate long-term safety and efficacy, once-daily bimatoprost 0.03% was compared with timolol 0.5% BID through year 4.

Methods In this multicenter, double-masked, randomized, controlled trial, glaucoma and ocular hypertension patients (n = 152) who completed phase III bimatoprost trials through month 36 were enrolled in a study extension through month 48. Patients randomized to bimatoprost QD (n = 78) or timolol BID (n = 35) continued on the same regimen for a fourth year. Patients randomized to bimatoprost BID had been switched to QD dosing at month 24 (bimatoprost BID/QD treatment group), and continued with QD dosing through month 48 (n = 39). IOP was measured at 8 AM and 10 AM at months 39, 42, 45, and 48. Safety measures included adverse events, biomicroscopy, ophthalmoscopy, visual acuity, and visual field.

Results Baseline IOP was comparable among groups. During year 4, mean IOP reductions from baseline were 7.0 to 8.1 mm Hg with bimatoprost QD and 6.5 to 7.9 mm Hg with bimatoprost BID/QD, significantly greater than with timolol BID (3.8 to 5.8 mm Hg, P≤.035) at all measurements. Over 4 years, the mean IOP reduction from baseline at 8 AM and 10 AM was 1.9 to 3.9 mm Hg (35% to 100%) larger with bimatoprost QD than with timolol (P≤.013). Low IOPs were achieved by more bimatoprost than timolol patients (P≤.042). No safety concerns developed during long-term bimatoprost treatment; two patients in the timolol treatment group discontinued after month 36 because of adverse events. The most common treatment-related adverse event in the bimatoprost treatment groups was conjunctival hyperemia.

Conclusion Bimatoprost QD provided sustained IOP lowering greater than timolol BID and was well tolerated over long-term use.

Purpose: To investigate the excitation time-dependent increment in luminescence of fundus autofluorescence.

Methods: Fundus autofluorescence (FAF) images were obtained with a confocal scanning laser ophthalmoscope. Consecutive 60 images of each eye were taken by one second time interval immediately after beginning of argon laser excitation. Twenty one eyes of 21 normal subjects were enrolled in the study. To analyze the luminescence of fundus autofluorescence a 80x80 pixels square selection was placed at relatively avascular fundus area of each consecutive image. Individual gray scale values of the selected areas were recorded and time slope was plotted.

Results: Time dependent increment of the autofluorescence was observed in all subjects. Average luminosity value of subjects at the beginning was calculated as 32.5 mean gray value (MGV), and luminosity reached at its maximum (45.4 MGV) between 25-30 seconds.

Conclusion: Excitation time dependent increment in FAF luminosity should to be taken into account while acquiring FAF images for quantitative, comparative and longitudinal studies.

Aims: The Schubert-Bornschein type of complete congenital stationary night blindness (CSNB) is a genetically heterogeneous retinal disorder. It is characterized by a non-progressive disease course, often associated with high myopia and nystagmus. So far mutations in two genes, NYX (nyctalopin) and GRM6 (metabotropic glutamate receptor 6) have been associated with this form of CSNB. The purpose of this study was to identify the genetic defect in affected male patients from Flemish families with complete CSNB.

Methods: Probands with CSNB from 3 large Flemish families underwent ophthalmologic examination. DNA was extracted from peripheral blood and the coding region of NYX along with parts of the 5`UTR and 3`UTR and intronic regions covering the splice sites were PCR amplified and sequenced.

Results: In the affected individuals of 3 Flemish families with the complete form of CSNB a novel NYX mutation, c.855delG was identified. This deletion is predicted to lead to a frameshift mutation, p.Asp286ThrfsX62 causing a premature stop codon.

Conclusion: Previously, both single families with different mutations in NYX as well as different families with an identical mutation, suggestive of a founder mutation, have been described. The c.855delG deletion in NYX seems to be a common mutation associated with CSNB in the Flemish population from Belgium. Thus we suggest performing diagnostic testing for CSNB in the Flemish population initially directed towards the identification of this mutation. Subsequent screening for other mutations in NYX or GRM6 could be performed as a second step.

Vascular endothelial growth factor (VEGF) levels in both the aqueous and vitreous are elevated in ocular ischemia secondary to exudative age-related macular degeneration, diabetes mellitus, and other retinal vascular diseases.1,2 Retinal ischemia upregulates VEGF production resulting in neovascularization of the retina and the iris (NVI). VEGF is significantly elevated in neovascular glaucoma (NVG).3

In the following case series, we demonstrate elevated aqueous VEGF levels in two patients with NVI that significantly declined with concurrent resolution of NVI following off-label intracameral injections of bevacizumab.

Aim: To assess safety and success of the safe surgery system trabeculectomy beyond three years.

Methods: Consecutive case series of 39 eyes in 32 patients. Trabeculectomy was performed using fornix based conjunctival flap, standard trabeculectomy punch, adjustable scleral flap sutures and antimetabolite treatment. Primary outcome of surgical failure was defined by two criteria: A) need for further surgery, glaucoma medications or an intraocular pressure (IOP) > 21mmHg during > 10% of follow up; or B) IOP > 15mmHg for > 10% follow up. A relatively aggressive regime of bleb needling and subconjunctival injections was used postoperatively in an attempt to reduce bleb fibrosis and failure. Mean follow up was 42 months (range 25-55).

Results: The rate of surgical failure was 4.4% per eye-year for criterion A, and 8.0% per eye-year for criterion B. Complications were few and compared favourably to other published series.

Conclusion: The safe surgery system for trabeculectomy provides excellent IOP control both during the operation and in the short and medium term postoperatively, with few complications or surgical failures.

OBJECTIVE: To examine the sensitivity of mf-ERG at measuring changes in retinal electrical activity in response to Avastin (bevacizumab) treatment for age-related Macula degeneration (ARMD).

METHODS: Nine subjects with exudative ARMD, not previously treated with bevacizumab in the investigated eye, underwent pretreatment testing with mf-ERG and intravenous fluorescein angiography (IVFA). A second mf-ERG test was conducted post-treatment. The P1 response amplitudes were examined for the hexagons corresponding to areas of pathology on the IVFA. Inter-test variability was accounted for by examining areas without pathology. Aggregate responses were also generated for central and lesion associated responses.

RESULTS: Changes in P1 response amplitude correlated with changes in visual acuity (R²>0.96). An improvement in Snellen visual acuity correlated with a significant improvement in P1 response amplitude from lesion associated recordings (p<0.03). Changes in P1 response amplitudes were not observed when aggregate responses were generated.

CONCLUSION: This study represents a novel method for assessing an improvement of mf-ERG responses. This is the first study to demonstrate a statistically significant change in retinal electrical activity post-bevacizumab in patients with ARMD. This study demonstrates a method for utilizing mf-ERG to assess changes in retinal electrical activity and to assess the effectiveness of treatments such as bevacizumab.

Background/Aims: To investigate fundus autofluorescence (FAF) findings in eyes with myopic choroidal neovascularization (CNV).

Methods: Observational case series. Twenty-seven consecutive eyes with CNV for at least 1 year were included. We evaluated FAF patterns, time after the onset of CNV seen on FAF, and FAF changes.

Results: We observed the following patterns. Pattern I (n=2), relative hypoautofluorescence around the CNV surrounded by hyperautofluorescence a mean of 17 months after CNV onset; pattern II (n=11), small lobular or multilobular well-defined FAF defects within a relatively hypoautofluorescent region surrounded by hyperautofluorescence a mean of 35 months after onset; pattern III (n=4), lobular or multilobular well-defined FAF defects surrounded by hyperautofluorescence a mean of 59 months after onset; and pattern IV (n=10), large lobular or crescent-shaped well-defined FAF defects a mean of 107 months after onset. Well-defined FAF defects corresponded to chorioretinal atrophy on color fundus photographs. During the follow-up period, two eyes with pattern I evolved into pattern II. Lobular or multilobular well-defined FAF defects enlarged in 11 eyes (pattern II, 9 eyes; pattern III, 2 eyes).

Conclusion: Autofluorescent changes progress over time through pattern grading. A pattern classification might be helpful to predict chorioretinal atrophy changes around myopic CNV.

Aim: Recent phylogenetic analyses on the herpes simplex virus type 1 (HSV-1) genes US4, encoding glycoprotein G (gG), and US7 (encoding gI) of clinical herpes simplex virus type 1 (HSV-1) isolates have led to the classification of HSV-1 into three genotypes, arbitrarily designated as A, B and C. The prevalence of the HSV-1 gG and gI genotypes and their potential disease association was determined in a large cohort of patients with herpetic keratitis (HK).

Methods: Primary corneal HSV-1 isolates of 178 HK patients were genotyped by a PCR-based restriction fragment length polymorphism method targeting the viral genes gG and gI encoding genes US4 and US7, respectively.

Results: Genotype B was more frequently expressed by the corneal HSV-1 isolates compared to genotypes A and C. Fifty-five of 178 corneal isolates (31%) had different genotypes in both loci. No clinically relevant associations were observed between the HSV-1 genotypes and disease outcome in the HK patients studied.

Conclusions: The data presented demonstrate a high frequency of recombinant corneal HSV-1 isolates and suggest that clinical outcome of HSV-1-induced keratitis is independent of a gG or gI genotype.

Aims: To evaluate the postoperative alignment drift following traditional strabismus surgery utilizing direct attachment of muscle to sclera.

Methods: The ocular alignment drift (change from the first postoperative week) of 106 patients who underwent scleral fixation strabismus surgery at age 0.5 to 35 years with 5 years maximal follow-up was analyzed.

Results: There was a mean undercorrection drift of 4.6 + 8.9 PD at distance fixation (p=0.025) and 3.4 + 7.6 PD at near (p=0.053) for all subjects, and 11.3 + 8.6 PD distance (p=0.008) and 10.6 + 6.0 PD near (p=0.016) for exotropic patients. Recession surgery produced an undercorrection drift of 5.3 + 8.8 PD (p=0.021) at distance fixation. Esotropic patients and those undergoing unilateral recession/resection surgery had no significant drift. Patients overcorrected at the one week postoperative visit later developed an undercorrection drift at distance (10.3 + 7.9 PD, p=0.002) and near fixation (5.5 + 9.2 PD at 36 months, p=0.041), while undercorrected patients showed no significant drift and largely stayed undercorrected.

Conclusion: Fixed scleral-suture strabismus surgery generally produces a postoperative undercorrection drift, especially following recession surgery, exotropia or overcorrection at the first postoperative week.

Purpose: To describe a new image analysis method and software for anterior chamber images obtained by the anterior-segment optical coherence tomography (AS-OCT).and to assess its intraobserver and interobserver measurement reproducibility.

Methods: Twenty 8-bit grayscale 600 x 300 AS-OCT images with apparent wide angles and twenty images with apparent narrow angles were consecutively selected from a database. Two glaucoma fellowship-trained ophthalmologists used proprietary image analysis software to analyze the images twice. Algorithms defined the borders and curvatures of anterior chamber (AC) structures and measured AC parameters using scleral spur location as the only observer input. Intraobserver and interobserver reproducibility of scleral spur location and angle parameters was calculated in terms of limits of agreement (LOA; mean of differences ?1.96 x standard deviation (SD) of differences) and coefficient of variation (CV; SD of differences / overall mean).

Results: The analysis software successfully measured all parameters in all images. When the same image was assessed twice by the same grader, the mean differences were ranged from 0 to 0.010 mm in linear measurements and 0.001 to 0.006 mm2 in angle area measurements. LOA tended to be greater in the wider angles. The upper and lower limit values of LOAs were approximately 1/5 ~ 1/4 of the overall means. Measurements between two graders had higher variance. Reproducibility in terms of CV was better in wide angles when compared to narrow ones. The reproducibility of scleral spur placement between observers was poorer in narrow angles (p =0.001). About 50% of the inter-observer variance in angle area measurements was attributable to the variance of scleral spur placement while this proportion was only 10~20% in linear measurements.

Conclusions: Determination of angle parameters using semi-automated software leads to variability in measurement which is increased when more than one observer identifies the scleral spur. Variability differs in narrow and open angles, and therefore including both types is essential when evaluating angle assessment software. Fully automated analysis and higher image resolution would likely improve quantification of Visante?AS-OCT images.

Background/aims: To assess the outcomes of 23-gauge sutureless transconjunctival vitrectomies (TSV), as compared to 25-gauge TSV in macular hole surgeries.

Methods: A retrospective, consecutive, interventional case series of 47 eyes with idiopathic macular holes treated by 23- or 25-gauge TSV were analyzed.

Results: The operative time was 37.2 ± 8.9 min with 23-gauge TSV and 34.2 ± 8.7 min with 25-gauge TSV (P = 0.388). The anatomical success rate was 96% with 23-gauge TSV and 92% with 25-gauge TSV (P > 0.999). The logarithm of the minimal angle of resolution of best-corrected visual acuity (BCVA) at the sixth postoperative month was 0.19 ± 0.16 with 23-gauge TSV and 0.19 ± 0.25 with 25-gauge TSV (P = 0.521). Postoperative improvement in BCVA was comparable between the two TSVs. IOP on postoperative day 1 was lower with 25-gauge TSV (12.3 ± 4.9 mmHg) than with 23-gauge TSV (17.4 ± 5.8 mmHg) (P = 0.036). Complications included retinal break, intraoperative bleeding and slippage of the infusion cannula with 23-gauge TSV, while retinal detachment and postoperative hypotony occurred in the 25-gauge TSV group (P = 0.570).

Conclusion: 23-gauge TSV appears to be as safe and effective as 25-gauge TSV in macular hole surgery.

Aims: To establish the range of normal distance stereoacuity and evaluate its development in visually normal children by using the Frisby Davis distance stereotest(FD2).

Methods: The distance stereoacuity of visually normal children aged less than 11 years and of adults was measured with FD2 using a standard testing protocol.

Result: This study involved 94 visually normal children aged 36-131 months and 46 visually normal adults aged 20-49 years. The distance stereoacuity of the children aged 36-59 months was 40.61 ± 9.823 (SD) seconds of arc; that of the children aged 60-119 months, 14.18 ± 8.152 (SD) seconds of arc; and that of the adults, 12.50 ± 4.802 (SD) seconds of arc. The FD2 distance stereoacuity of the children aged 36-59 months differed significantly from that of the older subjects (p = 0.000), and the FD2 distance stereoacuity of the children aged more than 59 months did not differ significantly from that of the adults (p = 0.813).

Conclusion: Distance stereoacuity reaches adult levels at approximately 5 years of age. Our data of the age-related normal values could represent a reference frame for the comparison of data obtained for clinical populations.