1. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.236. [Epub ahead of print]

Why rods and cones?

Lamb TD(1).

Author information: 
(1)Eccles Institute of Neuroscience, John Curtin School of Medical Research, The 
Australian National University, Canberra, Australian Capital Territory,
Australia.

Under twenty-first-century metropolitan conditions, almost all of our vision is
mediated by cones and the photopic system, yet cones make up barely 5% of our
retinal photoreceptors. This paper looks at reasons why we additionally possess
rods and a scotopic system, and asks why rods comprise 95% of our retinal
photoreceptors. It considers the ability of rods to reliably signal the arrival
of individual photons of light, as well as the ability of the retina to process
these single-photon signals, and it discusses the advantages that accrue.
Drawbacks in the arrangement, including the very slow dark adaptation of scotopic
vision, are also considered. Finally, the timing of the evolution of cone and rod
photoreceptors, the retina, and the camera-style eye is summarised.Eye advance
online publication, 13 November 2015; doi:10.1038/eye.2015.236.

PMID: 26563661   [PubMed - as supplied by publisher]


2. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.231. [Epub ahead of print]

Diurnal intraocular pressure fluctuation and its risk factors in angle-closure
and open-angle glaucoma.

Srinivasan S(1,)(2,)(3), Choudhari NS(2,)(4), Baskaran M(2,)(5), George RJ(2),
Shantha B(2), Vijaya L(2).

Author information: 
(1)Elite School of Optometry, Medical Research Foundation, Chennai, India.
(2)Jadhavbhai Nathamal Singhvi Glaucoma Department, Medical Research Foundation, 
Sankara Nethralaya, Chennai, India. (3)Institute of Health and Biomedical
Innovation, Queensland University of Technology, Queensland, Australia. (4)VST
Glaucoma Centre, Dr Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad,
India. (5)Singapore Eye Research Institute and Singapore National Eye Center,
Singapore.

PurposeTo evaluate intraocular pressure (IOP) fluctuation during office hours and
its predictive factors in untreated primary angle-closure suspects (PACS);
post-iridotomy primary angle closure (PAC) and primary angle-closure glaucoma
(PACG) eyes with or without IOP-lowering medication(s) as appropriate and
medically treated primary open-angle glaucoma (POAG) eyes.MethodsOne-hundred
seventeen eyes (29 PACS, 30 PAC, 28 PACG, and 30 POAG) of 117 patients were
included in this cross-sectional study. The subjects underwent hourly IOP
measurements with Goldmann tonometer from 0800 to 1700 hours. Subjects with PAC
and PACG had laser peripheral iridotomy at least 2 weeks prior to the inclusion. 
SD of office-hour IOP readings was the main outcome measure.ResultsIOP
fluctuation differed between the groups (P=0.01; Kruskal-Wallis Test). Post hoc
Mann-Whitney U-tests showed significantly less IOP fluctuation in PACS compared
with PACG (P<0.01). Peak office-hour IOP was observed in the morning in untreated
subjects and in the early afternoon in treated subjects. A stepwise linear
regression model identified the presence of peripheral anterior synechiae (PAS), 
thickness of lens, large vertical cup-to-disc ratio (VCDR), and PAC category as
significant predictive factors associated with office-hour IOP
fluctuation.ConclusionsDiurnal IOP fluctuation in asymptomatic PACSs was less
than that in treated PACG subjects and was at least comparable to that in treated
PAC and POAG subjects. The greater the amount of PAS, the thicker the lens, the
larger the VCDR, the greater was the IOP fluctuation during office hours.Eye
advance online publication, 13 November 2015; doi:10.1038/eye.2015.231.

PMID: 26563660   [PubMed - as supplied by publisher]


3. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.197. [Epub ahead of print]

Vision, eye disease, and art: 2015 Keeler Lecture.

Marmor MF(1).

Author information: 
(1)Department of Ophthalmology and Byers Eye Institute, Stanford University
School of Medicine, Palo Alto, CA, USA.

The purpose of this study was to examine normal vision and eye disease in
relation to art. Ophthalmology cannot explain art, but vision is a tool for
artists and its normal and abnormal characteristics may influence what an artist 
can do. The retina codes for contrast, and the impact of this is evident
throughout art history from Asian brush painting, to Renaissance chiaroscuro, to 
Op Art. Art exists, and can portray day or night, only because of the way retina 
adjusts to light. Color processing is complex, but artists have exploited it to
create shimmer (Seurat, Op Art), or to disconnect color from form (fauvists,
expressionists, Andy Warhol). It is hazardous to diagnose eye disease from an
artist's work, because artists have license to create as they wish. El Greco was 
not astigmatic; Monet was not myopic; Turner did not have cataracts. But when eye
disease is documented, the effects can be analyzed. Color-blind artists limit
their palette to ambers and blues, and avoid greens. Dense brown cataracts
destroy color distinctions, and Monet's late canvases (before surgery) showed
strange and intense uses of color. Degas had failing vision for 40 years, and his
pastels grew coarser and coarser. He may have continued working because his
blurred vision smoothed over the rough work. This paper can barely touch upon the
complexity of either vision or art. However, it demonstrates some ways in which
understanding vision and eye disease give insight into art, and thereby an
appreciation of both art and ophthalmology.Eye advance online publication, 13
November 2015; doi:10.1038/eye.2015.197.

PMID: 26563659   [PubMed - as supplied by publisher]


4. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.232. [Epub ahead of print]

Evaluation of ocular pulse amplitude and choroidal thickness in diabetic macular 
edema.

Totan Y(1), Akyüz TK(1), Güler E(2), Güragaç FB(3).

Author information: 
(1)Department of Opthalmology, Medical School, Turgut Özal University, Ankara,
Turkey. (2)Erciş State Hospital, Eye Clinic, Van, Turkey. (3)Gölbaşı Hasvak State
Hospital, Eye Clinic, Ankara, Turkey.

PurposeThe aim of this study is to evaluate the ocular pulse amplitude (OPA) and 
choroidal thickness (CT) measurements in patients with diabetic macular edema
(DME) and healthy subjects.MethodsA total of 34 patients (12 male and 22 female) 
who had type 2 diabetes mellitus with DME and 34 sex-matched healthy subjects (13
male and 21 female) were included in this prospective study. The intraocular
pressure (IOP) and OPA were measured with Dynamic contour tonometer (Pascal DCT, 
Switzerland). The subfoveal CT was measured using the Cirrus HD-OCT (Carl Zeiss
Meditec). The CT at 1500 μm and 3000 μm nasal and temporal to the central fovea
was also measured.ResultsThe mean IOP values were 18.4±3.5 and 17.1±2.1 mm Hg in 
DME patients and healthy controls, respectively (P= 0.091). The mean OPA values
in patients with DME (2.58±0.96) and controls (3.52±1.03) were statistically
different (P<0.001). The mean subfoveal CT value was 273.5±30.2 μm in the eyes
with DME and 321.4±36.5 μm in the control group (P< 0.001). In both groups,
linear regression analysis showed no significant association between OPA and CT
measurements. The IOP showed a significantly positive correlation with OPA in
both DME (P=0.002, r=0.526) and controls (P=0.004, r=0.483).ConclusionsThe
current study suggests that both pulsatile choroidal blood flow and CT are
decreased in patients with DME.Eye advance online publication, 13 November 2015; 
doi:10.1038/eye.2015.232.

PMID: 26563658   [PubMed - as supplied by publisher]


5. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.238. [Epub ahead of print]

Addressing the 'forgotten art of fundoscopy': evaluation of a novel teaching
ophthalmoscope.

Schulz C(1,)(2), Moore J(2), Hassan D(2), Tamsett E(2), Smith CF(2).

Author information: 
(1)Ophthalmic Specialist Trainee, Wessex Deanery, Winchester, UK. (2)Brighton and
Sussex Medical School, Brighton, UK.

BackgroundDirect ophthalmoscopy is an essential skill that students struggle to
learn. A novel 'teaching ophthalmoscope' has been developed that allows a third
person to observe the user's view of the fundus.ObjectivesTo evaluate the
potential use of this device as an aid to learning, and as a tool for objective
assessment of competence.MethodsParticipants were randomised to be taught
fundoscopy either with a conventional direct ophthalmoscope (control) or with the
teaching device (intervention). Following this teaching session, participant
competence was assessed within two separate objective structured clinical
examination (OSCE) stations: the first with the conventional ophthalmoscope and
the second with the teaching device. Each station was marked by two independent
masked examiners. Students were also asked to rate their own confidence in
fundoscopy on a scale of 1-10. Scores of competence and confidence were compared 
between groups. The agreement between examiners was used as a marker for
inter-rater reliability and compared between the two OSCE
stations.ResultsFifty-five medical students participated. The intervention group 
scored significantly better than controls on station 2 (19.8 vs 17.6; P=0.01).
They reported significantly greater levels of confidence in fundoscopy (7.3 vs
4.9; P<0.001). Independent examiner scores showed significantly improved
agreement when using the teaching device during assessment of competence,
compared to the conventional ophthalmoscope (r=0.90 vs 0.67;
P<0.001).ConclusionThe teaching ophthalmoscope is associated with improved
confidence and objective measures of competence, when compared with a
conventional direct ophthalmoscope. Used to assess competence, the device offers 
greater reliability than the current standard.Eye advance online publication, 13 
November 2015; doi:10.1038/eye.2015.238.

PMID: 26563657   [PubMed - as supplied by publisher]


6. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.212. [Epub ahead of print]

A 12-year review on the aetiology and surgical outcomes of paediatric
rhegmatogenous retinal detachments in Hong Kong.

Fong AH(1,)(2), Yip PP(2,)(3), Kwok TY(1,)(2), Tsang CW(1,)(2).

Author information: 
(1)Hong Kong Eye Hospital, Kowloon, Hong Kong, China. (2)Department of
Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, 
China. (3)Champion Eye Centre, Hong Kong, China.

PurposeTo evaluate the aetiology, clinical features, and surgical outcomes of
paediatric rhegmatogenous retinal detachments (RRD) in Hong Kong.Patients and
methodsThis is a retrospective consecutive case series of all patients aged 18 or
under who underwent primary retinal detachment repair in the Hong Kong Eye
Hospital from January 2000 to December 2012.ResultsForty-nine eyes of 47 patients
were included. The mean age was 14, and the mean follow-up duration was 6.2
years. The most common aetiology for RRD was idiopathic (28.6%), followed by high
myopia (24.5%), atopic dermatitis (AD) (18.4%), congenital and developmental
abnormalities (16.3%), trauma (8.2%), and intraocular inflammation (4.1%). The
mean preoperative visual acuity was LogMAR 1.0±0.8 (Snellen equivalent 6/60). The
primary anatomical success rate in this series was 65.3%, and the final
anatomical success rate was 85.7%. The mean postoperative visual acuity was
LogMAR 0.9±1.2 (Snellen equivalent 6/48). Patients with congenital and
developmental abnormalities or AD had worse anatomical and functional outcomes
than patients who had no predisposing factor or high myopia.ConclusionsThe
primary and overall anatomical success rates in our series were comparable with
existing literature. High myopia is the most commonly identifiable risk factor in
Hong Kong and AD is associated with a higher re-detachment rates and a poor
visual outcome.Eye advance online publication, 13 November 2015;
doi:10.1038/eye.2015.212.

PMID: 26563656   [PubMed - as supplied by publisher]


7. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.223. [Epub ahead of print]

TLP: a premature concept.

Pircher A(1), Killer HE(1).

Author information: 
(1)Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland.

PMID: 26563655   [PubMed - as supplied by publisher]


8. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.228. [Epub ahead of print]

Reply to: 'TLP: a premature concept'.

Januleviciene I(1), Siaudvytyte L(1), Daveckaite A(1), Ragauskas A(2), Siesky
B(3), Harris A(3).

Author information: 
(1)Eye Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania.
(2)Health Telematics Science Centre of Kaunas University of Technology, Kaunas,
Lithuania. (3)Glaucoma Research and Diagnostic Center, Eugene and Marilyn Glick
Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA.

PMID: 26563654   [PubMed - as supplied by publisher]


9. Eye (Lond). 2015 Nov 13. doi: 10.1038/eye.2015.239. [Epub ahead of print]

Which colours are seen by the patient during cataract surgery? Results of an
intraoperative interview.

Wenzel M(1,)(2), Schulze Schwering M(1,)(3).

Author information: 
(1)Eye Hospital, Petrisberg, Trier, Germany. (2)University Eye Hospital, Aachen, 
Germany. (3)Department für Augenheilkunde, University of Tübingen, Tübingen,
Germany.

PurposeTo discover what cataract patients see during phacoemulsification and if
these light phenomena influence their anxiety levels during surgery.MethodsIn
all, 200 patients were interviewed intraoperatively at the Eye Hospital,
Petrisberg, Trier, Germany. The quality of the visual experiences was described
and if these were pleasant, neutral or unpleasant. Systemic sedation was
noted.ResultsAmong 200 patients (209 eyes): 88 were men (91 eyes; 44%) and 112
were women (118 eyes; 56%). Median age (years): men (71), women (70). Mean
operating time was 8 min. 49/209 (23%) were not anxious before and during
surgery. 110/209 (52%) were more anxious before than during surgery, 50/209 (24%)
were still anxious during surgery, 27/209 (13%) got sedation with midazolam
(1-5 mg). Colours in descending order seen: blue, red, pink, yellow, green,
purple, turquois, and orange. The most dominant colour combination was red/blue. 
Structures were seen by 162/209 (78%). Most (61%) intraoperative visual
experiences were pleasant, 38% were neutral, and 1% found them transiently
unpleasant. Three patients felt blinded by the light of the operating
microscope.ConclusionsThe experience of colours and other light phenomena was
pleasant for most patients during phacoemulsification under topical anaesthesia. 
They occur spontaneously when the patient is fixating on the operating light.
They are not dependent on the individual or environment. Sedation only in 13%.
Direct questioning for visual sensations by the operating surgeon may lead to
less need for sedation and lead to less side effects for elderly and
multimorbidity people postoperatively. The surgeon can use this knowledge to
reassure patients during surgery.Eye advance online publication, 13 November
2015; doi:10.1038/eye.2015.239.

PMID: 26563653   [PubMed - as supplied by publisher]


10. Eye (Lond). 2015 Nov 6. doi: 10.1038/eye.2015.218. [Epub ahead of print]

Light damage to the retina: an historical approach.

van Norren D(1,)(2), Vos JJ(2).

Author information: 
(1)Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The
Netherlands. (2)TNO Soesterberg, Soesterberg, The Netherlands.

A brief review of retinal light damage is presented. Thermal damage requires a
local rise in temperature of at least 10 °C, causing an instant denaturation of
proteins. The primary absorber is melanin. Photochemical damage occurs at body
temperature and involves cellular damage by reactive forms of oxygen. The
photosensitizers are photoproducts of the visual pigments. First indications that
non-thermal damage might exist, in particular in the case of eclipse blindness,
was presented by Vos in 1962. Attribution thereof to photochemical action was
presented in 1966 by Noell et al who also measured the first action spectrum, in 
rat. It turned out to be identical to the absorption spectrum of rhodopsin.
However, in 1976 and 1982 Ham et al found a quite different spectrum in monkeys, 
peaking at short wavelengths. The latter spectrum, but not the former, was
confirmed since in numerous publications with animal models including rat. In
ophthalmological practice a 'sunburn' was at first the only complaint caused by
light damage. To avoid this, patients with dilated pupils should always be
advised to wear sunglasses. Since the invention of the laser accidents have been 
reported, the most recent development is youth playfully pointing a strong laser 
pen in their eyes with marked consequences. The operation microscope and
endoilluminators should always be used as brief as possible to avoid
photochemical damage. Arguments for implant lenses that block not only the UV but
also part of the visible spectrum seem too weak to justify extra costs.Eye
advance online publication, 6 November 2015; doi:10.1038/eye.2015.218.

PMID: 26541088   [PubMed - as supplied by publisher]


11. Eye (Lond). 2015 Nov 6. doi: 10.1038/eye.2015.220. [Epub ahead of print]

Light and the evolution of vision.

Williams DL(1).

Author information: 
(1)Department of Veterinary Medicine, University of Cambridge, Madingley Road,
Cambridge, UK.

It might seem a little ridiculous to cover the period over which vision evolved, 
perhaps 1.5 billion years, in only 3000 words. Yet, if we examine the
photoreceptor molecules of the most basic eukaryote protists and even before
that, in those of prokaryote bacteria and cyanobacteria, we see how similar they 
are to those of mammalian rod and cone photoreceptor opsins and the
photoreceptive molecules of light sensitive ganglion cells. This shows us much
with regard the development of vision once these proteins existed, but there is
much more to discover about the evolution of even more primitive vision
systems.Eye advance online publication, 6 November 2015;
doi:10.1038/eye.2015.220.

PMID: 26541087   [PubMed - as supplied by publisher]


12. Eye (Lond). 2015 Nov 6. doi: 10.1038/eye.2015.215. [Epub ahead of print]

Comparison of subfoveal choroidal thickness in healthy pregnancy and
pre-eclampsia.

Kim JW(1), Park MH(2), Kim YJ(2), Kim YT(1,)(3).

Author information: 
(1)Department of Ophthalmology, Ewha Womans University, School of Medicine,
Seoul, South Korea. (2)Department of Obstetrics and Gynecology, Ewha Womans
University, School of Medicine, Seoul, Korea. (3)Global Top 5 Research Program,
Ewha Womans University, School of Medicine, Seoul, Korea.

PurposePregnancy is a known predisposing factor for central serous
chorioretinopathy (CSC). Choroidal thickness (CT) increases in patients with CSC.
This study was designed to evaluate CT in pregnant women.Patients and methodsThis
was a prospective study. Fourteen healthy pregnant women and seven patients with 
pre-eclampsia were included. Twenty-one normal subjects were also recruited. CT
was measured using enhanced-depth imaging optical coherence tomography.ResultsThe
mean CT of normal subjects, healthy pregnant women and patients with
pre-eclampsia were 264.95±21.03, 274.23±29.30 and 389.79±25.13 μm, respectively
(normal subjects vs healthy gravidas: P>0.05; normal subjects vs pre-eclampsia:
P<0.001; healthy gravidas vs pre-eclampsia: P<0.001). CT decreased from
381.05±22.96 μm to 335.17±9.97 μm 1 week after delivery in patients with
pre-eclampsia.ConclusionsPregnancy itself did not increase CT, whereas
pre-eclampsia did appear to result in increased CT. This suggests that additional
unknown factors induce hyperpermeability in pregnant women.Eye advance online
publication, 6 November 2015; doi:10.1038/eye.2015.215.

PMID: 26541086   [PubMed - as supplied by publisher]


13. Eye (Lond). 2015 Nov 6. doi: 10.1038/eye.2015.221. [Epub ahead of print]

Light pollution: the possible consequences of excessive illumination on retina.

Contín MA(1), Benedetto MM(1), Quinteros-Quintana ML(1), Guido ME(1).

Author information: 
(1)Centro de Investigaciones en Química Biológica de Córdoba, (CIQUIBIC,
UNC-CONICET), Departamento de Química Biológica, Facultad de Ciencias Químicas,
Universidad Nacional de Córdoba, Córdoba, Argentina.

Light is the visible part of the electromagnetic radiation within a range of
380-780 nm; (400-700 on primates retina). In vertebrates, the retina is adapted
to capturing light photons and transmitting this information to other structures 
in the central nervous system. In mammals, light acts directly on the retina to
fulfill two important roles: (1) the visual function through rod and cone
photoreceptor cells and (2) non-image forming tasks, such as the synchronization 
of circadian rhythms to a 24 h solar cycle, pineal melatonin suppression and
pupil light reflexes. However, the excess of illumination may cause retinal
degeneration or accelerate genetic retinal diseases. In the last century human
society has increased its exposure to artificial illumination, producing changes 
in the Light/Dark cycle, as well as in light wavelengths and intensities.
Although, the consequences of unnatural illumination or light pollution have been
underestimated by modern society in its way of life, light pollution may have a
strong impact on people's health. The effects of artificial light sources could
have direct consequences on retinal health. Constant exposure to different
wavelengths and intensities of light promoted by light pollution may produce
retinal degeneration as a consequence of photoreceptor or retinal pigment
epithelium cells death. In this review we summarize the different mechanisms of
retinal damage related to the light exposure, which generates light pollution.Eye
advance online publication, 6 November 2015; doi:10.1038/eye.2015.221.

PMID: 26541085   [PubMed - as supplied by publisher]


14. Eye (Lond). 2015 Oct 30. doi: 10.1038/eye.2015.210. [Epub ahead of print]

Comment on 'The Royal College of Ophthalmologists Guidelines on retinal vein
occlusions'.

Ting DS(1).

Author information: 
(1)Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK.

PMID: 26514247   [PubMed - as supplied by publisher]


15. Eye (Lond). 2015 Oct 30. doi: 10.1038/eye.2015.219. [Epub ahead of print]

Comment on 'The Royal College of Ophthalmologists Guidelines on retinal vein
occlusions: executive summary'.

Călugăru D(1), Călugăru M(1).

Author information: 
(1)Department of Ophthalmology, University of Medicine, Cluj-Napoca, Romania.

PMID: 26514246   [PubMed - as supplied by publisher]


16. Eye (Lond). 2015 Oct 30. doi: 10.1038/eye.2015.216. [Epub ahead of print]

Impact of telephone consent and potential for eye donation in the UK: the
Newcastle Eye Centre study.

Ting DS(1), Potts J(1), Jones M(2), Lawther T(1), Armitage WJ(2,)(3), Figueiredo 
FC(1).

Author information: 
(1)Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle University,
Newcastle Upon Tyne, UK. (2)National Health Service Blood and Transplant,
Bristol, UK. (3)School of Clinical Sciences, University of Bristol, Bristol, UK.

AimsTo examine the impact of telephone consent introduced in 2007 on the eye
donation rate and to report the changing trend and potential for improvement in
eye donation in Newcastle upon Tyne, UK.MethodsRelevant data were retrospectively
collected from the local eye retrieval database for two separate years, namely,
2006 (before the introduction of telephone consent) and 2010. All the hospitals
within Newcastle were included in the study.ResultsFrom 2006 to 2010, there was a
3.5-fold increase in eye donation from 32 (of 2479 deaths) to 111 donors per year
(of 2213 deaths) in Newcastle (P<0.001). Consent was obtained via face-to-face
interview in all 32 (100%) and 59 (53.2%) donors in 2006 and 2010, respectively. 
Introduction of telephone consent increased the donation rate by an additional
88.1% (from 59 to 111 donors) in 2010 (P<0.001). In addition, there was a
significant increase in medical notes of the deceased being reviewed from 27.1%
(671/2479 cases) in 2006 to 62.4% (1382/2213 cases) in 2010 (P<0.001). Acceptance
rate of eye donation was 45.7% (32/70) in 2006 and 49.6% (111/224) in 2010
(P=0.575). Acceptance rate was positively associated with registration on organ
donor register (P<0.001) and telephone consent (P<0.001), but not with age
(P=0.883), gender (P=0.234), or location of death (P=0.984) of the potential
donors.ConclusionThere has been a substantial improvement in eye donation rate in
Newcastle over the recent years. Introduction of telephone consent and
high-quality eye donation service serve as effective measures for increasing eye 
donation.Eye advance online publication, 30 October 2015;
doi:10.1038/eye.2015.216.

PMID: 26514245   [PubMed - as supplied by publisher]


17. Eye (Lond). 2015 Oct 30. doi: 10.1038/eye.2015.199. [Epub ahead of print]

Aflibercept as primary treatment for myopic choroidal neovascularisation: a
retrospective study.

Bruè C(1,)(2), Pazzaglia A(3), Mariotti C(1), Reibaldi M(4), Giovannini A(1).

Author information: 
(1)Ophthalmology, Department of Neuroscience, Polytechnic University of Marche,
Ancona, Italy. (2)Ophthalmology, Macerata Hospital, Macerata, Italy.
(3)Ophthalmology, Sant'Orsola Hospital, Malpighi, Italy. (4)Ophthalmology, G.
Rodolico Vittorio Emanuele Hospital, Catania, Italy.

AimThe aim of this study is to evaluate long-term efficacy of intravitreal
injections of aflibercept as primary treatment for subfoveal/juxtafoveal myopic
choroidal neovascularisation (CNV).MethodsThirty-eight treatment-naive eyes of
thirty-eight patients with subfoveal/juxtafoveal myopic CNV received initial
intravitreal aflibercept injections and were followed for at least 18 months.
Aflibercept was applied again for persistent or recurrent CNV, as required.
Statistical analysis was carried out using SPSS.ResultsMean patient age was 45.8 
years, and mean eye refractive error was -7.79 D. For the total patient group
(n=38 eyes), mean logMAR best-corrected visual acuity (BCVA) significantly
improved from 0.69 at baseline to 0.15 at 18 months (P<0.01). Over half of the
treated eyes obtained resolution with one aflibercept injection. Patients were
also grouped according to age, as <50 years (n=20 eyes) and ≥50 years (n=18
eyes). Mean BCVA improvement was significantly greater in eyes of the younger
myopic CNV group, compared with those of ≥50 years (0.21 vs 0.35; P<0.05). The
mean number of aflibercept injections was 1.8 for the <50 years myopic CNV group,
and 3.6 for the ≥50 years myopic CNV group (P<0.001). Correlation between
spherical equivalent refraction and final visual acuity reached statistical
significance only for the <50 years myopic CNV group (P<0.001; Levene's
correlation).ConclusionsIntravitreal aflibercept provides long-term visual acuity
improvement in myopic CNV. The <50 years old myopic CNV group had significantly
fewer injections, with greater visual acuity improvement. Intravitreal
aflibercept in myopic CNV does not require the three-injection loading phase used
for aflibercept treatment of neovascular age-related macular degeneration.Eye
advance online publication, 30 October 2015; doi:10.1038/eye.2015.199.

PMID: 26514244   [PubMed - as supplied by publisher]


18. Eye (Lond). 2015 Oct 30. doi: 10.1038/eye.2015.208. [Epub ahead of print]

Photodynamic therapy and anti-vascular endothelial growth factor for acute
central serous chorioretinopathy: a systematic review and meta-analysis.

Lu HQ(1), Wang EQ(2), Zhang T(1), Chen YX(2).

Author information: 
(1)Department of Ophthalmology, Xi'an No.1 Hospital, Xi'an, Shaanxi, China.
(2)Department of Ophthalmology, Peking Union Medical College Hospital, Beijing,
China.

This systematic review aims to update current evidence on the efficacy and safety
of photodynamic therapy (PDT) and anti-vascular endothelial growth factor
(anti-VEGF) injections for acute central serous chorioretinopathy (CSC). A
comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane
Library. Studies comparing (1) PDT versus placebo, (2) anti-VEGF versus placebo, 
and (3) PDT versus anti-VEGF were included and meta-analyzes were performed when 
appropriate. Ocular and systemic adverse effects were also summarized. Literature
search yielded six comparative studies, among which five were included for this
review. Meta-analysis with three studies indicated that eyes treated with PDT
achieved better best-corrected visual acuity (BCVA) and central macular thickness
(CMT) than the placebo group throughout a follow-up of 12 months. Meta-analysis
with another two studies comparing anti-VEGF injections and placebo showed that
BCVA at first month was better in anti-VEGF group than in placebo group, though
the differences of BCVA and CMT no longer existed at 3 and 6 months after
injection. There was no report directly comparing PDT and anti-VEGF for acute
CSC. No severe complications was reported in included studies. In this review,
current evidence suggested that early treatment of acute CSC by PDT is valuable
in improving visual acuity, reducing subretinal fluid, and maintaining long term 
effectiveness. Anti-VEGF injection could shorten the duration of symptoms and
accelerate visual improvement at early stage of disease. Direct comparison
between these two treatment will be needed in the future.Eye advance online
publication, 30 October 2015; doi:10.1038/eye.2015.208.

PMID: 26514243   [PubMed - as supplied by publisher]


19. Eye (Lond). 2015 Oct 30. doi: 10.1038/eye.2015.213. [Epub ahead of print]

Ultrastructure of medial rectus muscles in patients with intermittent exotropia.

Yao J(1), Wang X(2), Ren H(1), Liu G(1), Lu P(1).

Author information: 
(1)Department of Ophthalmology, The First Affiliated Hospital of Soochow
University, Suzhou, China. (2)Medical College of Soochow University, Suzhou,
Jiangsu Province, China.

PurposeTo study the ultrastructure of the medial rectus in patients with
intermittent exotropia at different ages.Patients and methodsThe medial recti
were harvested surgically from 20 patients with intermittent exotropia. Patients 
were divided into adolescent (age<18 years, n=10) and adult groups (age >18
years, n=10). The normal control group included five patients without strabismus 
and undergoing eye enucleation. Hematoxylin and eosin staining and transmission
electron microscopy were used to visualize the medial recti. Western blot was
used to determine the levels of myosin and actin.ResultsVarying fiber thickness, 
atrophy, and misalignment of the medial recti were visualized under optical
microscope in patients with exotropia. Electron microscopy revealed sarcomere
destruction, myofilament disintegration, unclear dark and light bands, collagen
proliferation, and fibrosis. The adolescent group manifested significantly higher
levels of myosin and actin than the adult group (P<0.05).ConclusionYounger
patients with intermittent exotropia show stronger contraction of the medial
recti compared with older patients. Our findings suggest that childhood was the
appropriate time for surgery as the benefit of the intervention was better than
in adulthood.Eye advance online publication, 30 October 2015;
doi:10.1038/eye.2015.213.

PMID: 26514242   [PubMed - as supplied by publisher]


20. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.205. [Epub ahead of print]

Retinal vessel structure measurement using spectral-domain optical coherence
tomography.

Rim TH(1), Choi YS(2), Kim SS(1), Kang MJ(1), Oh J(3), Park S(3), Byeon SH(1).

Author information: 
(1)Department of Ophthalmology, Severance Hospital, Institute of Vision Research,
Yonsei University College of Medicine, Seoul, South Korea. (2)Department of
Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul,
South Korea. (3)Department of Cardiology, Severance Cardiovascular Hospital,
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, 
South Korea.

PurposeTo assess the reliability and validity of spectral-domain optical
coherence tomography (SD-OCT) measurements of retinal vessel lumen diameters and 
wall thicknesses.MethodsSD-OCT was used to characterize the circular region
around the optic disc of 40 eyes (20 subjects). The inner and outer sides
(vitreal and choroidal sides) of the vessel wall and the luminal diameter were
measured using intensity graphs.ResultsMean arterial and venous luminal diameters
were 95.1±16.1 and 132.6±17.8 μm, respectively. The wall thicknesses of inner and
outer sides of the artery were 23.9±4.9 and 21.2±3.5 μm, respectively. The wall
thicknesses of the inner and outer sides of the vein were 20.7±4.2 and
16.3±4.3 μm, respectively. There were significant differences between the inner
and outer wall thicknesses in both the artery and vein (P<0.01). Intra- and
interobserver intraclass correlation coefficients (ICCs) for lumen measurements
were >0.95, and for wall thicknesses were >0.85, except for the outer wall
thickness measurements. The mean value of outer and inner wall thicknesses showed
good reproducibility, with ICCs of >0.85.ConclusionIntensity graph-assisted
measurements using SD-OCT provided more objective information in finding
boundaries of vessels. Luminal diameters and wall thicknesses obtained with OCT
showed good overall reproducibility, with inner wall thicknesses being thicker,
and with better reproducibility compared with outer wall thicknesses, where ICC
values were the lowest among the inner wall thicknesses, mean thicknesses of
inner and outer walls, and luminal diameters. When using SD-OCT measurements,
caution is therefore advised when using only the outer wall as representative of 
the wall thicknesses.Eye advance online publication, 23 October 2015;
doi:10.1038/eye.2015.205.

PMID: 26493040   [PubMed - as supplied by publisher]


21. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.206. [Epub ahead of print]

High-hyperopia database, part I: clinical characterisation including morphometric
(biometric) differentiation of posterior microphthalmos from nanophthalmos.

Relhan N(1), Jalali S(1), Pehre N(2), Rao HL(3), Manusani U(1), Bodduluri L(1).

Author information: 
(1)Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji
Reddy Campus, L V Prasad Eye Institute, Hyderabad, India. (2)Kode Venkatadri
Chowdary, David Brown Children's Eye Care Centre, L V Prasad Eye Institute,
Tadigadapa, Vijayawada, India. (3)Center for Clinical Epidemiology and
Biostatistics, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad,
India.

PurposeTo characterise and differentiate posterior microphthalmos (PM) and
nanophthalmos (NO) using morphometric parameters.Patients and methodsConsecutive 
case database of patients with hyperopia >+7.00 D sphere was analysed
retrospectively for clinical and biometric characterisation. Thirty-eight
consecutive high-hyperopic subjects (75 eyes) with axial lengths <20.5 mm
underwent uniform comprehensive ocular evaluation. Twenty-five subjects were
diagnosed as PM and 13 as NO based on the horizontal corneal diameter. Parameters
analysed included visual acuity, refraction, horizontal corneal diameter,
anterior chamber depth, lens thickness, axial length, fundus changes, and
associated ocular pathology.PRIMARY OUTCOME MEASURES: ocular biometry difference 
between PM and NO.
SECONDARY OUTCOME MEASURES: differences in associated ocular pathologies between 
PM and NO.ResultsHyperopia ranged from +7 to +17 D and was similar in the two
groups. Lens thickness was statistically more in NO than in PM group
(4.53±0.75 mm vs 3.82±0.48 mm, P <0.001), whereas anterior chamber depth was more
in the PM than in NO group (3.26±0.36 mm, vs 2.59±0.37 mm, P<0.001). NO had
higher association with angle-closure glaucoma (66.7% vs 0%) and pigmentary
retinopathy (38.5 vs 8.0%) but lesser association with macular folds (0% vs 24%) 
as compared with PM. NO was associated with poorer visual acuity.ConclusionPM and
NO have significant differences in lens thickness, anterior chamber depth,
prevalence of glaucoma, pigmentary retinopathy, macular pathology, and visual
acuity while being similar in hyperopic refraction.Eye advance online
publication, 23 October 2015; doi:10.1038/eye.2015.206.

PMID: 26493039   [PubMed - as supplied by publisher]


22. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.214. [Epub ahead of print]

A randomized clinical trial comparing fixed vs pro-re-nata dosing of Ozurdex in
refractory diabetic macular oedema (OZDRY study).

Ramu J(1), Yang Y(2), Menon G(3), Bailey C(4), Narendran N(2), Bunce C(1),
Quartilho A(1), Prevost AT(5), Hykin P(1), Sivaprasad S(1).

Author information: 
(1)NIHR Moorfields Biomedical Research Centre, London, UK. (2)The Royal
Wolverhampton NHS Trust, Birmingham, UK. (3)Frimley Health NHS Foundation Trust, 
Surrey, UK. (4)Bristol Eye Hospital, Bristol, UK. (5)Division of Health and
Social Care Research, King's College London London, UK.

ObjectiveTo compare the clinical effectiveness and safety of 5-monthly fixed
dosing vs pro-re-nata (PRN) Ozurdex treatment in patients with refractory
diabetic macular oedema (DMO).DesignProspective, multicentre, randomized
active-controlled non-inferiority clinical trial.ParticipantsParticipants were
100 patients who attended Medical Retina Clinics for management of
centre-involving refractory DMO.InterventionsParticipants were randomized 1 : 1
to either 5-monthly fixed dosing or optical coherence tomography (OCT)-guided PRN
regimen of Ozurdex therapy for DMO. Data were collected on best-corrected visual 
acuity (BCVA), patient-reported outcome measures (PROM), macular thickness and
morphology, diabetic retinopathy status, number of injections and adverse events 
from baseline for a period of 12 months.Main outcome measuresThe primary outcome 
was the difference between arms in change in BCVA from baseline to 12 months. The
prespecified non-inferiority margin was five ETDRS letters. Key secondary
outcomes included change in PROM scores, change in macular thickness, change in
retinopathy and macular morphology, and safety profile.ResultsThe mean change in 
BCVA was +1.48 (SD 14.8) in the fixed arm vs -0.17 (SD 13.1) in the PRN arm, with
adjusted effect estimate +0.97, 90% confidence interval (-4.01, +5.95), P=0.02
(per protocol analysis). The conclusions of the ITT analysis were primarily
supportive, -0.34 (-5.49, 4.81) P=0.07, but sensitive to an alternative
assumption on missing data, +0.28 (-4.72, 5.27) P=0.04.ConclusionsThe mean change
in BCVA with 5-monthly fixed dosing of Ozurdex was non-inferior to OCT-guided PRN
Ozurdex therapy for refractory DMO based on a per protocol analysis.Eye advance
online publication, 23 October 2015; doi:10.1038/eye.2015.214.

PMID: 26493038   [PubMed - as supplied by publisher]


23. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.202. [Epub ahead of print]

Depth evaluation of intended vs actual intacs intrastromal ring segments using
optical coherence tomography.

Barbara R(1), Barbara A(2), Naftali M(3).

Author information: 
(1)Department of Ophthalmology, Bnai Zion Medical Centre, Haifa, Israel.
(2)Hadassah Optimal Private Medical Centre, Affiliated to Hadassah Medical
Centre, Haifa, Israel. (3)Ophthalmology Unit, Baruch Padeh Medical Centre,
Poriya, Israel.

PurposeEvaluation of actual vs intended intrastromal corneal ring segments (ICRS)
implantation depth as measured by anterior segment optical coherence tomography
(OCT)MethodsProspective study evaluating 30 Intacs segments implanted manually in
19 eyes of 15 patients suffering from keratoconus. Segment depth evaluation was
performed using anterior segment OCT. Measurements were performed above and below
the segment at 3 points in relation to the incision site. Statistical analysis
was performed using the SAS software for ANOVA, matched t-test, and GLIMMIX
procedure.ResultsIntacs segment depth was 153-μm shallower than intended (58% vs 
80%). Segment layout demonstrated the proximal and distal portions to be 13-μm
shallower and 12-μm deeper (on average), respectively. Intacs segment thickness
does not influence implantation depth. Intacs segments implanted in the same eye 
do not share similar implantation depths. Stromal compression is likely to
occur.ConclusionIntacs are implanted at a shallower depth than intended. The
'pocketing' stage prior to implantation most likely has a stronger effect on the 
segment's final implantation depth than does the incisions' depth.Eye advance
online publication, 23 October 2015; doi:10.1038/eye.2015.202.

PMID: 26493037   [PubMed - as supplied by publisher]


24. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.201. [Epub ahead of print]

Primary posterior continuous curvilinear capsulorhexis combined with diffractive 
multifocal intraocular lens implantation.

Ouchi M(1).

Author information: 
(1)Ouchi Eye Clinic, Kyoto, Japan.

PurposeTo evaluate the effect of mild posterior capsule opacity (PCO) on visual
acuity (VA) in eyes implanted with a diffractive multifocal intraocular lens
(IOL) compared with a monofocal IOL, and the effect of posterior continuous
curvilinear capsulorhexis (PCCC) combined with diffractive multifocal IOL
implantation.MethodsFor the initial evaluation, we compared charge-coupled device
(CCD) camera photographs taken through both a monofocal IOL-loaded model eye and 
a diffractive IOL-loaded model eye under the conditions of both with and without 
an opaque filter for the simulation of mild PCO. The clinical evaluation involved
20 patients who underwent bilateral implantation of the same diffractive
multifocal IOL. In all 20 cases, PCCC was performed in 1 eye (PCCC group) and not
performed in the fellow eye (NCCC group). Postoperative clinical results were
then compared between the two groups.ResultsThe CCD photographs revealed that the
diffractive IOL-loaded eye was more strongly affected by the simulated PCO than
was the monofocal IOL-loaded eye. In the clinical setting, the PCCC group
registered better results than NCCC group in distance and near VA, low-contrast
VA, and contrast sensitivity testing.ConclusionsDiffractive multifocal IOLs tend 
to be more influenced by mild PCO than do monofocal IOLs, and PCCC prior to IOL
implantation can contribute to the avoidance of this effect.Eye advance online
publication, 23 October 2015; doi:10.1038/eye.2015.201.

PMID: 26493036   [PubMed - as supplied by publisher]


25. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.204. [Epub ahead of print]

A rare penetrant TIMP3 mutation confers relatively late onset choroidal
neovascularisation which can mimic age-related macular degeneration.

Warwick A(1,)(2), Gibson J(3), Sood R(3), Lotery A(1,)(2).

Author information: 
(1)Clinical Neurosciences Research Group, Clinical and Experimental Sciences,
Faculty of Medicine, University of Southampton, Southampton, UK. (2)Eye Unit,
University Southampton NHS Trust, Southampton, UK. (3)Centre for Biological
Science, Faculty of Natural and Environmental Sciences, University of
Southampton, Southampton, UK.

PurposeTo perform a genotype-phenotype correlation for three patients
heterozygous for a missense mutation in the tissue inhibitor of metalloproteinase
3 (TIMP3) gene.MethodsRetrospective, observational case series. The medical
records and photographs were reviewed for three patients diagnosed at the time
with neovascular age-related macular degeneration (AMD). All were later found to 
carry a predicted C113G mutation in the TIMP3 gene, other known mutations in
which are associated with Sorsby's fundus dystrophy.ResultsAll three patients
developed drusen and bilateral choroidal neovascularisation with subsequent
disciform scarring and atrophy. Visual acuity rapidly deteriorated to <6/60 in
both eyes. The age of onset varied from 56 to 64 years and the interval to
contralateral eye involvement varied from 4 to 6 years. Two of the three patients
had a family history of AMD. All three patients were heterozygous for the C113G
nucleotide change, resulting in a Ser38Cys change at the N terminus of the TIMP3 
protein.ConclusionThis case series suggests the C113G TIMP3 variant may represent
a novel highly penetrant mutation causing choroidal neovascularisation of
relatively late onset for Sorsby's fundus dystrophy, mimicking early onset
AMD.Eye advance online publication, 23 October 2015; doi:10.1038/eye.2015.204.

PMID: 26493035   [PubMed - as supplied by publisher]


26. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.198. [Epub ahead of print]

The Royal College of Ophthalmologists' National Ophthalmology Database Study of
cataract surgery: report 2, relationships of axial length with ocular
copathology, preoperative visual acuity, and posterior capsule rupture.

Day AC(1), Donachie PH(2,)(3), Sparrow JM(2,)(4), Johnston RL(2,)(3); Medscape.

Author information: 
(1)The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation 
Trust and UCL Institute of Ophthalmology, London, UK. (2)The Royal College of
Ophthalmologists' National Ophthalmology Database, Euston, London, UK.
(3)Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK. (4)Bristol Eye
Hospital, Bristol, Bristol, UK.

PurposeTo describe the relationships of axial length with ocular copathology,
preoperative visual acuity, and posterior capsule rupture rates in patients
undergoing cataract surgery.DesignThe Royal College of Ophthalmologists' National
Ophthalmology Database (NOD) study.MethodsAnonymised data on 180 114 eyes from
127 685 patients undergoing cataract surgery between August 2006 and November
2010 were collected prospectively from 28 sites. Data parameters included:
demographics, biometry, ocular copathology, visual acuity measurements, and
surgical complications including posterior capsule rupture, or vitreous loss or
both (PCR).ResultsConsultant surgeons performed a higher proportion of operations
on eyes whose axial length were at the extremes. Glaucoma and age related macular
degeneration were more common in eyes with shorter axial lengths, whilst previous
vitrectomy was associated with longer axial lengths. Eyes with brunescent or
white cataracts or amblyopia were more common at both axial length extremes.
Preoperative visual acuities were similar for eyes with axial length measurements
up to approximately 28 mm and worse for eyes with longer axial length
measurements. PCR rates showed little change with axial length (overall mean
1.95%, 95% CI: 1.89 to 2.01%), except for a borderline increase in eyes with
axial length <20.0 mm where rates were 3.6% (95% CI: 2.0 to 6.3%). The likelihood
of PCR in eyes with axial length <20.0 mm was 1.88 times higher than those of
≥20.0 mm (P=0.0373).ConclusionRates of ocular comorbidities vary by axial length.
PCR rates in eyes with very short or long axial lengths were lower than
expected.Eye advance online publication, 23 October 2015;
doi:10.1038/eye.2015.198.

PMID: 26493034   [PubMed - as supplied by publisher]


27. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.203. [Epub ahead of print]

Complement pathway biomarkers and age-related macular degeneration.

Gemenetzi M(1), Lotery AJ(2,)(3).

Author information: 
(1)Royal Eye Unit, Kingston Hospital NHS Foundation Trust, Southampton, UK.
(2)Southampton Eye Unit, Southampton University Hospital, Southampton, UK.
(3)Clinical and Experimental Sciences, Faculty of Medicine, University of
Southampton, Southampton, UK.

In the age-related macular degeneration (AMD) 'inflammation model', local
inflammation plus complement activation contributes to the pathogenesis and
progression of the disease. Multiple genetic associations have now been
established correlating the risk of development or progression of AMD.
Stratifying patients by their AMD genetic profile may facilitate future AMD
therapeutic trials resulting in meaningful clinical trial end points with smaller
sample sizes and study duration.Eye advance online publication, 23 October 2015; 
doi:10.1038/eye.2015.203.

PMID: 26493033   [PubMed - as supplied by publisher]


28. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.209. [Epub ahead of print]

South Asian diabetic macular oedema treated with ranibizumab (ADMOR)-real-life
experience.

Ghanchi F(1), Hazel CA(1).

Author information: 
(1)Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.

PurposeDiabetic macular oedema (DMO) is a leading cause for visual impairment in 
the working age population in the UK. Ranibizumab has been shown to be effective 
in treatment of DMO in studies based on mainly Caucasian populations. This study 
reports the 12-month outcome in a cohort of South Asian subjects with DMO treated
with ranibizumab.MethodsDMO in 51 eyes of 41 South Asian patients was treated
with ranibizumab 0.5 mg according to the modified DRCRnet protocol I. Visual
acuity (VA) and central macular thickness (CMT) were recorded at baseline, 3, 6, 
and 12 months. Results were compared for eyes with different baseline visual
acuities and different baseline macular thicknesses.ResultsOver the 12-month
period, the mean ETDRS VA increased from 55.3±13.4 letters to 63.8±15.2 letters
for all eyes. At 12 months, 70.6% eyes gained 5 or more letters acuity and 17.6% 
eyes gained 15 letters or more. During the same period, the mean CMT decreased
from 532±129 to 318±136 μm. Eyes that had received previous laser treatments had 
a mean letter gain of 9.2 letters, compared with 8.5 for all eyes at 12
months.ConclusionsRanibizumab 0.5 mg is safe and effective at reversing vision
loss due to DMO in patients of South Asian origin at 12 months. Ranibizumab
treatment appears to be effective in patients with longstanding DMO who received 
prior laser treatments. Further studies are needed to define the long-term
outcome in patients of different ethnicity and DMO.Eye advance online
publication, 23 October 2015; doi:10.1038/eye.2015.209.

PMID: 26493032   [PubMed - as supplied by publisher]


29. Eye (Lond). 2015 Oct 23. doi: 10.1038/eye.2015.207. [Epub ahead of print]

Prolonged organ culture reduces the incidence of endothelial immune reactions.

Maier P(1), Heinzelmann S(1), Böhringer D(1), Reinhard T(1).

Author information: 
(1)Eye Centre, University Hospital Freibur, Germany.

PurposeThe number of antigen-presenting cells decreases during organ culture of
corneoscleral discs. This might result in a decrease of immune reactions with
increasing duration of organ culture. To investigate this hypothesis, we
performed a retrospective analysis of all penetrating keratoplasties that were
consecutively performed over the last 5 years.Patients and methodsAll cases of
penetrating keratoplasties (n=1006) were divided into two groups, with the
division made at the median of the storage time (21 days). These two groups were 
compared by a Cox proportional hazards survival model regarding the incidence of 
endothelial immune reactions, clear graft survival, and chronic endothelial cell 
loss following penetrating keratoplasty considering patient's age, donor's age,
and risk situation as co-variates.ResultsWe observed statistically significantly 
fewer endothelial immune reactions (20.1% (95% confidence interval 15.5-24.5%)
after 2 years) in the group with a storage time of more than 21 days compared
with the group with a storage time of <21 days (26.5% (95% confidence interval
21.6-31.2%) after 2 years). However, the duration of organ culture did not have a
statistically significant effect on clear graft survival or chronic endothelial
cell loss.ConclusionOur results demonstrate that an increased duration of organ
culture leads to a lower incidence of endothelial immune reactions following
penetrating keratoplasty. However, we do not recommend increased storage times in
general as overall graft survival did not improve. The reason for this apparent
paradox may be that the endothelial cell count decreases during storage time.Eye 
advance online publication, 23 October 2015; doi:10.1038/eye.2015.207.

PMID: 26493031   [PubMed - as supplied by publisher]