Search Results - Acta Ophthalmologica Vol. 97, No. S263 ( 2019-12)

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

To determine whether there is a significant correlation between the disease duration and the sensitivity and structure of the retina in patients with neuromyelitis optica spectrum disorder (NMOSD) with no history of optic neuritis (ON). Methods Fifteen eyes of 15 patients with NMOSD (2 men, 13 women; mean age 50.2 ± 11.2 years) who had no history of ON were studied. The retinal sensitivity of the central 10º was determined by macular integrity assessment (MAIA), a microperimetric method, and the retinal structure by spectral‐domain optical coherence tomography (SD‐OCT). For MAIA, the retina was stimulated with a scanning laser ophthalmoscope at 37 loci covering 10° of the central retina. For the retinal structures, the mean thickness of the ganglion cell complex (GCC) thickness and outer nuclear layer (ONL) thickness were measured in the SD‐OCT images. The correlations between the disease duration and the sensitivity and the GCC thickness or the ONL thickness were determined by the Spearman’s rank‐correlation coefficients. Results The mean best‐corrected visual acuity(BCVA) was 0.05 ± 0.03 logMAR units. The mean disease duration was 42.4 ± 37.4 months with a range of 1 to 103 months. The mean retinal sensitivity of the central 10º was 27.6 ± 1.78 dB. The mean GCC thickness was 95.0 ± 8.99 μm, and the mean ONL thickness was 53.8 ± 5.43 μm. There was a significant correlation between the disease duration and the sensitivity of the central 10º (r = 0.48, p = 0.034; Spearman’s rank‐correlation coefficients) and the ONL thickness (r = 0.60, p = 0.016; Spearman’s rank‐correlation coefficients). However, there was not a significant correlation between disease duration and GCC thickness (p  〉  0.05; Spearman’s rank‐correlation coefficients). Conclusions These results indicate that the visual function is impaired even before the development of the ON in patients with NMOSD. We recommend that microperimetry and OCT be used in eyes with NMOSD because subclinical optic neuritis may be present.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

Linking central retinal thickness (CRT) with retinal nerve fibre layer thickness (RNFL) in retinitis pigmentosa (RP) patients. Methods 37 patients with typical RP and 19 age‐matched controls (p = 0.352), who underwent Spectral Domain Optical Coherent Tomography of the macula and optic disc, were included. The RP group was divided in two subgroups: with clinical appearance of macular oedema (ME‐RP; 30 eyes) and without it (no‐ME; 44 eyes). Macula OCT data were averaged in three zones [Z1 (0°–3°), Z2 (3°–8°) & Z3 (8°–15°)] and were evaluated in relation to the RNFL thickness. Results The subgroup ME‐RP differed significantly from the subgroup no‐ME‐RP by increased CRT (Z1) and increased averaged RNFL thickness, and when compared to controls (p ≤ 0.002). No‐ME‐RP group hat reduced CRT thickness (Z1‐3; p ≤ 0.018), compared to controls and ME‐RP, whereas the RNFL thickness in the no‐ME‐RP group was reduced only compared to ME‐RP group (p  〈  0.001). A significant positive interaction was found between the CRT (Z1 & Z2) and RNFL thickness within ME‐RP (p ≤ 0.010). Conclusion The presence of macular oedema correlated well with the increase in RNFL thickness in RP patients. Such association provide evidence for a common underlying mechanism of retinal degeneration. Simultaneous monitoring of CRT and RNFL thickness may help in the future to evaluate the progression of the disease and the efficacy of treatments for ME in RP.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

Autoregulation is essential for a constant circulation of O 2 . The apparent dissimilarity of vulnerability towards increased intraocular pressure in patients with normal‐tension glaucoma (NTGs) and individuals with ocular hypertension (OHTs) has been linked to disturbed autoregulation. The retina is particularly O 2 ‐dependent and susceptible towards oxidative stress. The purpose was to evaluate the impact of a fluctuating O 2 level on retinal vessel diameters and plasma levels of vasoregulators, nitric oxide (NO) and endothelin‐1 (ET‐1), and total antioxidant capacity (TAC) in strictly characterized NTGs, OHTs and age‐matched controls. Methods NTGs ( n  = 10–16), OHTs ( n  = 9–10) and controls ( n  = 9–14) were exposed to 2 h of hypoxia followed by 30 min of normoxia. Fundus pictures and blood samples were taken before hypoxia (“baseline”), during hypoxia (“hypoxia”) and after hypoxia (“recovery”). NO, ET‐1 and TAC was measured in plasma. Retinal arterial and vein diameters were measured with MATLAB. Results Retinal arteries dilated in NTGs and OHTs during hypoxia, while controls constricted. No significant changes were seen in retinal veins. During hypoxia controls and NTGs increased plasma levels of ET‐1 and NTGs sustained a high level in recovery. OHTs did not regulate ET‐1 but maintained a lower level compared to NTGs during hypoxia and recovery. No significant differences were seen in NO. OHTs had a higher TAC compared to NTGs and controls throughout the experiment. Conclusions The present study suggests a link between NTG and dysfunctional autoregulation. ET‐1 increase in controls and NTGs during hypoxia. As a vasoconstrictor, a vascular constriction is expected as evident in controls. The observed dilation in NTGs therefore might indicate that molecular mechanisms for vasoregulation are abolished. Surprisingly, OHTs present a similar pattern of autoregulation to NTGs but there is a prominent difference in the TAC. The higher level of TAC in OHTs compared to NTGs and controls indicates that the antioxidant defence might be important in providing resistance towards glaucomatous neurodegeneration.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

Allergic conjunctivitis to atmospheric molds is well documented, Alternaria being by far the most common. However, the role of microbiota fungi in conjunctivitis is less documented. Several old reports until the seventies have underlined the implication of allergy to Candida albicans in some chronic conjunctivitis. Pityrosporum orbiculare allergy has been well documented in head and neck atopic dermatitis in adults, but there is no report showing the involvement of this fungi in chronic conjunctivitis, even if some authors suspected his involvement in blepharitis. Here we describe some case‐reports of atopic keratoconjunctivitis associated with IgE sensitization to Pityrosporum in adults with seborrheic dermatitis or head and neck dermatitis. Patients was initially treated by ciclosporin since no sensitization to aeroallergens have been highlighted. After local and systemic anti‐fungal treatment, ciclosporin was stopped and sustained improvement was observed under discontinuous treatment. When no sensitization to aeroallergens has been highlighted in atopic keratoconjunctivitis, we suggest to seek for sensitization to microbiota fungi particularly Pityrosporum spp. and Candida a. in patients with head skin lesions.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

To evaluate the surgical experience and the short and long‐term safety and efficacy of the first XEN45 implanted in our Service. Material and Methods We included the first 9 eyes of seven patients that received a XEN45 implant in our Service by two different surgeons. All the patients were diagnosed with primary open‐angle glaucoma (POAG) that was uncontrolled with medical treatment and were pseudophakics. Three had before a superior trabeculectomy. We evaluated pre and post‐surgery: intraocular pressure (IOP), number of ocular hypotensive drugs needed, visual acuity and retinal nerve fiber layer (RNFL) thickness. We reviewed also the difficulties and complications events encountered during surgery and the implant position and bleb characteristics (IBAGS) 1,7 and 15 days, 1,3,6, and 12 months after surgery. Results Mean IOP before surgery was 22.33 ± 6.20 mm Hg and the mean number of ocular hypotensive medications 3.11 ± 0.93. One, 7, 15, days and 1,3,6 and 12 months after surgery, the mean IOP were, respectively 10.55 ( n  = 9), 13.44 ( n  = 9), 16.14 ( n  = 7), 16.20 ( n  = 5), 15.75 ( n  = 8), 19.57 ( n  = 9) and 14.33 ( n  = 5). One year after surgery, the mean number of ocular hypotensive medications was 1.33 ( n  = 5) There were only four intraoperative complications: two eyes had a small bleeding at the iridocorneal angle, in one eye the segment of the implant in the anterior chamber was too long and was cut in the moment of the surgery and in one eye the subconjunctival end of the bleb was bent and not functional and therefore was accessed externally three weeks later. No postoperative complications were observed and no further glaucoma surgeries were required during follow‐up. Conclusion The first XEN45 devices implanted in our Service have shown a good safety and efficacy for the treatment of pseudophakic POAG, with very few intraoperative and no postoperative complications.

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2019

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Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

Conjunctival Squamous cell carcinoma (SCC) represents a malignant disease that, if untreated, can cause irreversible loss of vision or even death. It is a rare disease, which is why the diagnostic and therapeutic approaches are not always linear. To report a case of a giant conjunctival SCC, including its diagnostic and therapeutic approach. Methods A 82 years old man, with history of basal cell carcinoma in situ of the upper eyelid, was referred to the emergency department by a conjunctival lesion of the right eye with 3 months of evolution and rapid growth. Examination revealed a whitish, conical‐shaped temporal conjunctival lesion (16 x 18 x 6.5mm) in the right eye with no mobility relative to the scleral plane and staining with 1% toluidine blue. Orbital magnetic resonance imaging identified the temporal conjunctival lesion in the right eye, without unequivocal signs of scleral and other intraocular structures invasion. Results This lesion was excised with a 4 mm margin, using 1% toluidine blue dye, through a no‐touch technique. As adjuvant therapy, we performed cryotherapy of the conjunctival margins and scleral bed, which was covered with amniotic membrane. Histological examination confirmed the presence of a well differentiated conjunctival SCC. One month after surgery, he started treatment with mitomycin‐c 0.04 mg/mL. Three months later, there were no signs of relapse. Conclusion Clinical observation allows, in some cases, a high clinical suspicion. The vital staining with topical toluidine blue is an excellent aid in diagnosis, staining most lesions with high sensitivity, and in treatment, allowing to delineate surgical margins. Surgical treatment alone is associated with recurrence rates of up to about 70%, which is why adjuvant therapy, in particular cryotherapy and topical mitomycin‐c, is advocated. Although less common in the daily practice of an ophthalmologist, conjunctival SCC is potentially fatal and, therefore, deserves particular attention.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

To develop a non‐invasive drug delivery system based on superparamagnetic nanoparticles (NP) for the treatment of retinal degeneration on Bardet‐Biedl syndrome (BBS). The delivery system will be used to deliver two small molecules, valproic acid (VPA) and Guanabenz (GBZ). Methods A mixture of two NP (one loaded with VPA and other with GBZ) was applied as eyedrops on 14‐days old mice with the use of a magnetic field. The treatment was assessed in both wild type and a mice model for BBS (Bbs12 −/− ). The effects of the treatment were evaluated 2 weeks post treatment at 1‐month‐old. Retinal structure and function were analysed using electroretinogram recordings (ERG), histology and transmission electron microscopy (TEM). Results In vitro studies showed no important toxic effects in cell cultures for retinal pigmented epithelium (RPE1) and 661W (murine photoreceptor precursor) after treatment with unloaded NP. Scotopic and photopic ERG recordings showed no toxic effect of the NP on photoreceptor (PR) function. TEM analysis indicated the presence of the NP in the PR layer of the retina after eyedrop application. TEM images showed a decrease in Endoplasmic Reticulum (ER) dilatation. The treated group with loaded NP showed an increase in the thickness of the inner nuclear layer, outer nuclear layer, inner PR segment and outer PR segment. Conclusions These results highlight the potential for these NP for non‐invasive drug delivery to the retina. Both the presence of the NP and biological effect were shown in our mouse model. The VPA and GBZ combination has already shown decrease of cell death mediated by ER stress in the Bbs12 −/− model. This is an unmet clinical need with no curative treatment for retinal ciliopathies. The possibility of delaying PR death would increase the therapeutic window of gene therapy potentially increasing its effectivity.

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2019

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Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

To study the role of TGF‐□1 on the expression of RHO GTPase, GSK3, JNK, MMP‐2, □‐catenin and □‐SMA in the myofibroblast cell culture of orbital socket contracture. Methods This research is an experimental research with invitro model of the myofibroblast cell culture of orbital socket contracture. □‐Sma expression examine with immunohistochemistry and confocal microscopy. Examination of the RHO GTPase, GSK3, JNK, MMP‐2, and □‐catenin expression using ELISA KIT, while the morphology of fibroblasts or myofibroblasts was examined by 100× magnification with an inverted Olympus IX 71 microscope and 400× magnification with CLSM FV1000 Results Increased dose of TGF‐□1 in passages 3 decreased the expression of a‐SMA and no morphological changes in myofibroblast cells. The morphology of myofibroblasts cells can not turn back into fibroblasts. Increased doses of TGF‐□1 increase JNK expression, slightly increase RHO GTPase expression, decrease GSK3 and a‐SMA expression, and doesn’t change MMP‐2 and □‐cathenine expression. Conclusions TGF‐□1 increase JNK expression and slightly RHO GTPase, but decrease the expression GSK3 and a‐SMA, and has no effect on MMP‐2 and □‐cathenine expression in Myofibroblast Cell Culture Orbital Soket Contracture.

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2019

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Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

The aim of this study was to evaluate the indications of penetrating keratoplasty (PKP) according to age groups. Methods Between September 2017 and April 2019, 120 patients who underwent PKP in our clinic were divided into five groups according to their age ranges. 1st group; 11‐25, 2nd group; 26‐40, 3rd group; 41‐55, 4th group; 56‐70 and 5th group; 71‐90 years old. The frequency of PKP indications were evaluated according to the age groups. Results The records of 120 patients with age range of 11‐89 (60.4 ± 21.9), 61 of whom were female and 59 were male were retrospectively reviewed. 67 of the eyes made PKP were right eyes and 53 of them were left eyes. There was no difference between the groups in terms of laterality. PKP indications were as follows: 14 (12%) keratoconus, 60 (50%) keratitis / post‐traumatic corneal scar, 11 (9%) corneal dystrophy, 7 (6%) corneal ulceration / perforation, 28 (23%) aphakic / pseudophakic bullous keratopathy. According to age groups, the most common PKP indications were as follows, respectively: keratoconus in the 1st group (n=8, 53%), keratitis / post‐traumatic corneal scar in the 2nd group (n=6, 50%), keratitis / post‐traumatic corneal scar in the 3rd group (n=9, 56%), aphakic / pseudophakic bullous keratopathy in the 4th group (n=7, 32%) and keratitis / post‐traumatic corneal scar in the 5th group (n= 35, 63%). Conclusions In our study, the most common indication for PKP was keratitis / post‐traumatic corneal scar. When evaluated according to age groups the difference between groups was not significant. On the other hand, it was observed that keratoconus was the most common PKP indication in the 1st group and the difference was statistically significant when compared with other age groups. Therapeutic reasons for PKP after 25 years of age are prominent due to regional and climatic differences.

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2019

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Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

Combination of refractive surgery procedures (i.e. LASIK) with high‐fluence, accelerated corneal crosslinking (Xtra) has been proposed and introduced in clinical practice, aiming to restore corneal strength, increase stability of visual outcomes, and potentially lower the refractive enhancement rate. However, there is no consensus in the literature regarding the beneficiary effect of this procedure. This presentation will review current clinical evidence on the topic, highlight advantages and disadvantages of this method and, finally, deliver relevant practical tips for young corneal surgeons.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

One noxious agent for cataract formation is ionizing radiation (IR). For doses till or equal 2 Gy it is still unclear, whether opacification occurs and if, how cataract type depends on the animals age at irradiation. Wild‐type and heterozygous Ercc2 +/‐ mice were whole‐body irradiated by 0.5 Gy, 1 Gy and 2 Gy of γ‐radiation (dose rate = 0.3 Gy/min), 10 weeks after birth (P70). Another cohort was exposed to 2 Gy, 2 days after birth (P2). All cohorts were investigated by optical coherence tomography (OCT) and eyes were collected for histology after death. OCT revealed frequent lens alteration in the mice irradiated at P2 and P70. These lesions were only subcapsular located in P70 mice and are dose‐dependent in size. Mice irradiated at P2 showed scattering structures within the posterior cortex, 8.5 mth after irradiation. At least 80% of the irradiated animals displayed at least mild posterior cortical cataracts. Histology of irradiated eyes (P70) unravelled the OCT‐detected lesions as cataractous accumulations of enlarged fibre cells, accompanied by subcapsular placed cells with nuclei. Lesions of P2 mice displayed no correlate to the in vivo data. Therefore, we conclude that IR leads to lens opacification in a dose‐dependent manner and its magnitude correlates strongly with age at irradiation. These results help to assess the sensibility of eye lenses to IR in case of exposure. The LDLensRad project received funding from Euratom in the framework of CONCERT, grant No 662287.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

To assess visual changes in patients suffering from early type 2 diabetes mellitus (DM2) with good metabolic control and without diabetic retinopathy as a possible implication of subclinical ischemia. Method Sixty patients with early DM2 with good metabolic control and without diabetic retinopathy and sixty age and sex‐matched healthy controls were recruited for the study. Only one eye per subject was randomly selected and included. Psychophysics tests were performed as visual acuity (VA) by ETDRS charts, colour vision using the Farnsworth and L’Anthony D15 desaturated colour tests, contrast sensitivity vision (CSV) using Pelli Robson chart and CSV 1000E test and visual field with the automated Easyfield perimeter. Systemic parameters such as the presence or absence of vascular complications and the HbA1c levels were recorded, as well as the disease duration. Results Patients with DM2 showed worse VA at low contrast level (2.5%, p = 0.002; 1.25%, p = 0.007), worse CSV at high spatial frequencies (12 cpd, p = 0.007; 18 cpd, p = 0.011) and worse colour vision (Farnsworth, p = 0.006; Lanthony, p  〈  0.001) recordings compared to the control group. However, visual field parameters were similar in both groups. Patients with more than 10 years of disease duration obtained lower results with the ETDRS test, and those ones with systemic vascular complications got worse results in CSV and colour vision tests (CSV 18 cpd, p = 0.024; Lanthony test, p = 0.014). There were no significant differences between patients with HbA1c levels higher versus lower than 7%. Conclusions Patients with early DM2, with good metabolic control and no diabetic retinopathy showed visual dysfunction compatible with retinal neurodegeneration. Subclinical ischemia could contribute to neuronal damage, before than the evident vascular changes appear.

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2019

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Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

The retinal pigment epithelium (RPE) and photoreceptors are degenerated in age‐related macular degeneration (AMD). Although the mouse has no macula similar degenerative signs can be observed in mouse compared with human tissue. Thus, ultrastructural studies of mouse AMD models are important to understand more accurately the pathologic AMD events. Using our new dry AMD mouse model, we examined at ultrastructural level the influence of genetic deficiency of PGC1‐α/Nrf‐2 on the PINK1 (PTEN‐induced kinase 1) and PARKIN (E3 ubiquitin ligase) expression pattern by using confocal, electron and immunoelectronmicroscopy. Benefits and challenges in these techniques are discussed to provide important clues about AMD ultrastructural pathogenesis.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

The nasolacrimal recanalization, consisting of retrograde removal of obstructing tissues using electrocauterization, is an evolutionally developed surgical procedure to treat the nasolacrimal duct (NLD) obstruction. To perform the nasolacrimal recanalization requires an understanding of three‐dimensional (3D) structure of the NLD, but very few data are available about its stereotactic shape. This study aims at investigating the anatomy of the NLD through 3D visualization and metric assessment of 3D models obtained from the cranial CT‐scans. Methods This study included 20 males and 20 females (range: 18–68 years), who underwent autopsy at the National Forensic Service Seoul Institute, Seoul, Korea. Post‐mortem cranial CT‐scans were achieved in helical mode with slice thickness of 0.75 mm and 120 kV. 3D models of the NLD were reconstructed from serial CT slices after performing semi‐automated segmentation by tracing and filling the outline of the nasolacrimal duct by Mimics software (version 20.0, Materialise, Leuven, Belgium). Results Overall length of NLD, anteroposterior and transverse entrance diameters of bony NLD (BNLD), and lacrimal sac‐BNLD angle was significantly higher in males than females. Compared with right and left, most variables showed no significant differences in statistics, except for lacrimal sac‐BNLD angle. BNLD orientation type in coronal plane showed outward type than inward by over 80%. Collectively, the whole appearance of the NLD was shaped like a bowleg in which the distal part is relatively turned inward. Conclusion These results suggest that 3D models of the NLD were crucial for understanding structural recognition, mainly related to model‐based image analysis, and useful to aid in the surgical procedure and treatment of the nasolacrimal duct obstruction. The authors wish to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2019 (No. 552019B000100003).

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2019

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Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

The aim was to investigate the association between blood reflux in Schlemm’s canal (SC) and the reduction of intraocular pressure (IOP) after ab interno viscocanalostomy in primary open‐angle glaucoma (POAG). Methods Non‐comparative study of consecutive patients with early to moderate POAG underwent ab interno viscocanalostomy with a follow‐up time of at least 12 months. Indications for glaucoma surgery were inadequate IOP and /or intolerance to eye drops. Through clear cornea incision, the IOP was lowered below episcleral venous pressure by aspiration of aqueous from the anterior chamber to provoke blood reflux into the SC. After a 1‐min waiting period, a goniolens was placed on the globe, and blood reflux was observed and classified into three filling patterns: no filling, partly filling and complete filling. Then, the anterior chamber was filled with viscoelastic material and ab interno viscocanalostomy was performed with a microcatheter system (Visco360). Results In provocative gonioscopy, 12 eyes had no blood reflux (group 1), 19 had patchy blood reflux (group 2), and 14 had complete blood reflux (group 3). For the different reflux patterns, the preoperative IOP was 17.0 mmHg (SD ± 2.8) mmHg for group 1, 18.4 mmHg (SD ± 2.0) for group 2, and 22.2 mmHg (SD ± 2.8) for group 3. The IOP difference between preoperative and 6 months postoperative was 1.8 mmHg (SD ± 1.2) group 1, 4.9 mmHg (SD ± 0.9) for group 2, and 9.9 mmHg (SD ± 2.5) for group 3 (p  〈  0.001). In a linear regression model, there were highly significant differences between the groups even after adjustment for preoperative IOP (p  〈  0.001). Conclusions Blood reflux in SC seems to be a significant positive prognostic indicator in uneventful ab interno viscocanalostomy concerning IOP reduction, possibly representing the patency of the physiologic aqueous outflow system.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

Ophthalmology is one of the specialties that require very special skills because of the delicate and very fine structure of the eye and its adnexa. Today we operate utilizing not only microscopes but also 3 D systems. The skills required are not just difficult to acquire, but also complicated to sustain. Moreover, training in real patients is challenging from regulatory, ethical, moral, emotional and many other reasons. Therefore, utilizing simulators for training and CME is and opportunity with excellent perspective. Currently there are number of centers in Europe that implement simulators for ophthalmology training, however, there is no guideline for simulator training, except for Royal College of Ophthalmology in UK. The purpose of the presentation is to highlight pros and cones in simulation training and discuss the opportunities for improvement of the skills of beginner and established surgeon. Never‐the‐less, simulation training is the future, and ophthalmology educators must look for opportunities how to optimize and improve the complicated learning process for trainees at all levels.

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2019

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Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

In developed countries, retinal degenerative diseases affecting the Retinal Pigment Epithelium (RPE), including Age‐related Macular Degeneration and inherited retinal diseases such as Retinitis Pigmentosa (RP), are the predominant causes of human blindness. Despite the scientific advances achieved in the last years, there is no cure for the majority of patients. In this context, cell therapy based on human pluripotent stem cells is an attractive therapeutic alternative to replace dead or defective RPE cells. Different formulations were proposed: either as a cell suspension or as an engineered tissue. We will discuss the preclinical data obtained with these two strategies. In particular, we will present the preclinical development of our own RPE tissue therapy. This cell therapy consists in RPE cells derived from clinical grade human embryonic stem cells disposed on a biocompatible substrate allowing the formation of a 3D functional sheet, suitable for transplantation. Functionality and safety were evaluated in rodents and the surgical approach in non‐human primates. This therapy is currently evaluated in a phase I/II clinical trial targeting RP patients with mutations in RPE genes.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

To evaluate the microvascular changes in the superficial plexus of the retina and peripapillary plexus in patients with relapsing‐remitting multiple sclerosis (RR MS) by optical coherence tomography angiography (OCT‐A). Method A prospective study was performed in a total of 75 patients. The control group consisted of 84 eyes of 42 subjects without any ocular disease. The study group was formed by 66 eyes of 33 patients with RR MS. Visual function was evaluated by visual acuity with Bailey‐Lovie optotype and contrast sensitivity with Pelli Robson test. The Deep Range Image (DRI) Triton, Swept Source OCT (Topcon Eye Care Company) was used to analyze vascular density of superficial plexus of the retina and the peripapillary area using (OCT‐A). Results The nasal, temporal, superior and inferior parafoveal areas of RR MS patient group showed a significant decrease in vascular flow compared with the control group (p = 0.024, 0.039, 0.001 and 〈 0.014 respectively). No significant differences were found in the peripapillary plexus between controls and patients groups. Conclusions There is a vascular reduction in the macular zone at the superficial plexus level in patients suffering RR MS.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

The most common mitochondrial optic neuropathies are Leber’s Hereditary Optic Neuropathy (LHON) and Dominant Optic Atrophy (DOA). Both diseases are characterized by retinal ganglion cell loss resulting in optic atrophy and are characterized by a complex I defect. The current available therapeutic option for LHON is the recently approved in Europe Idebenone‐©Raxone for patients with a disease duration of 1 year or less. Moreover, gene therapy trials for patients carrying the 11778/ND4 LHON mutation are ongoing in Europe, US and China. Potential therapeutic options for LHON include also EPI‐743, elamipretide, estrogens and drugs aimed at increasing mitochondrial biogenesis and anti‐apoptotic agents such as cyclosporine A. Moreover, the possibility of mitochondrial replacement therapy for female LHON carriers of childbearing age can be offered to prevent the maternal transmission of pathogenic mtDNA mutations. The current active clinical trials on LHON will be presented. For DOA there is no approved drug available at the moment. A potential beneficial effect of idebenone has been suggested, but randomized controlled trials are still needed to confirm these preliminary data. Interestingly, for DOA, a gene therapy approach has been recently successfully used to alleviate retinal ganglion cell loss in a OPA1‐mouse model.

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2019

2466981-7

Acta Ophthalmologica, Wiley, Vol. 97, No. S263 ( 2019-12)

The clinical syndrome of diffuse unilateral subacute neuroretinopathy (DUSN) is a progressive ocular infectious disease caused by a variety of nematode species that involve the outer retina and retinal pigment epithelium. However in the absence of clinical visualization of nematode, diagnosis is ambiguous. To the best of our knowledge, DUSN has been rarely reported to date in South Korea. Therefore, we present a case of DUSN in South Korea and review the related literature. Methods A 49‐year‐old male patient was referred to Kim’s eye hospital for conjunctival injection and gradual deterioration of vision in the left eye for the past 7 days. He had no specific past medical history. The decimal best‐corrected vi‐sual acuity (BCVA) of the left eye was 0.6‐ and intraocular pressure was 22 mmHg by non‐contact tonometer. There were inflammatory cells in the anterior chamber with conjunctiva injection of the left eye. Fundus examination of the left eye revealed a subfoveal depigmentary scar and multiple, focal, gray‐white subretinal tracks. DUSN was suspected with the results of the fundus examination, optical coherence tomography, and fluorescein angiography. However, from the above examination the posterior segment did not seem to be in active phase despite some inflammation in anterior chamber, so only topical steroid was prescribed. Both visual acuity and inflammation in anterior chamber showed improved, and the steroid was tapered. The patient is being followed up on regular basis. Results DUSN is a progressive ocular infectious disease caused by parasites, which may cause slowly progressive vision loss or may even be asymptomatic to the patient. Sometimes patients are not recognize their eye condition in early stage of the disease. Most patients visit ophthalmololgy clinic when they suffer from decreased vision. This phase of the disease may show round yellowish outer retinal lesions with retinal pigment epithelium (RPE) changes and possible mild vitritis or papilloedema. In late stage DUSN, they may suffer from severe visual loss and paracentral or central scotomas. Late stages show multiple chorioretinal atrophic lesions, vessel narrowing, and disc pallor. The choice of treatment in DUSN is laser photocoagulation when the worm is visualized (motile, gray to whitish subretinal track). Photocoagulation will destroy the parasite and will subsequently reduce inflammation. However, when the worm is not found despite repeated examinations, ophthalmologists can consider antihelminthic drugs, such as albendazole. Systemic steroids can be used to control inflammation caused by the parasite and to help prevent deterioration of vision. In our case, the posterior segment did not seem to be in active phase despite some inflammation in anterior chamber, so only topical steroid was prescribed. Conclusion Although there is no evidence of active inflammation of the posterior segment, ophthalmologists should suspect DUSN when a patient presents with progressively reduced vision and anterior uveitis with typical subretinal track and further evaluation should be considered such as fundus examination, OCT and FAG.

Online Resource

1755-375X, 1755-3768

English

Wiley

2019

2466981-7