Nerve Fiber Thickness Research Articles

Variations in retinal nerve fiber layer measurements on optical coherence tomography after implantation of trifocal intraocular lens

To establish the changes produced after implantation of a trifocal intraocular lens (IOL) on retinal nerve fiber layer measurements performed with Fourier-domain optical coherence tomography (OCT). This prospective study included 100 eyes of 50 patients with bilateral cataract in surgical range, no other associated ocular involvement, refractive errors between +5 and -5 spherical diopters, and less than 1.5 D of corneal astigmatism. The eyes were operated by phacoemulsification with implantation of 2 different trifocal IOLs (FineVision and AT LISA tri 839MP) in randomized equal groups. Cirrus OCT and Spectralis OCT were performed before surgery and 3 months later. Both analyzed the thickness of the nerve fiber layer and thickness divided by quadrants (6 in case of Spectralis and 4 in case of Cirrus HD). The mean age of patients was 67.5 ± 5.8 years. The global nerve fiber layer thickness measured with Spectralis OCT was 96.77 μm before surgery and 99.55 μm after. With Cirrus OCT, the global thickness was 85.29 μm before surgery and 89.77 μm after. Statistically significant differences in global thickness measurements between preimplantation and postimplantation of the IOL were found with both OCT in the 2 groups. Statistically significant differences were also found in temporal and superior quadrants. The implantation of a diffractive trifocal IOL alters the results of the optic nerve fiber layer on Fourier-domain OCT in these patients, which should be taken into account in the posterior study of these patients.

MP80-12 RETINAL TOXICITY AFTER CISPLATIN-BASED CHEMOTHERAPY IN PATIENTS WITH TESTICULAR CANCER

MP80-12 RETINAL TOXICITY AFTER CISPLATIN-BASED CHEMOTHERAPY IN PATIENTS WITH TESTICULAR CANCER

Retinal toxicity after cisplatin-based chemotherapy in patients with germ cell cancer.

Visual impairment represents an infrequent form of cisplatin-induced neurotoxicity; however, visual deterioration has been reported in several studies. To evaluate potential morphological and functional retinal alterations in patients with germ cell cancer (GCC) treated with cisplatin-based chemotherapy (CBC). Multi-disciplinary and multi-institutional study design. Examination of 28 eyes of 14 male GCC patients, who had received at least one cycle of CBC. A matched control group of healthy, untreated patients were included in this study. Subjects underwent a retinal nerve fiber thickness (RNFL) measurement, color vision, visual acuity testing, full-field electroretinograms (ff-ERG). To assess a correlation between cumulative cisplatin dose and measured RNFL and ff-ERG Pearson correlation coefficient analysis was performed. Both study groups (CBC recipients vs. healthy controls) consisted each of 14 participants with a median patient age of 30 years (interquartile range (IQR) 26-37 years). Tumor histology was seminoma in 6 of 14 patients (43%), and non-seminomatous GCC in 8 of 14 patients (57%). Median cumulative cisplatin dosis at examination was 627mg/m2 (IQR 413-1013mg/m2). Morphological assessment revealed reduced RNFL in 11 of 14 patients (78.6%). Reduction in RNFL was significantly correlated to the cumulative CBC dose received (rho = + 0.70; p = 0.004). ff-ERG showed significant differences between CBC recipients and the control group in 2 of 5 tested categories (all p values <0.001). This study represents first evidence of chronic subclinical retinal toxicity due to cisplatin-based chemotherapy in patients with GCC. The reduction of RNFL might become clinically relevant in upcoming age-related chronic degenerative disorders such as glaucoma.

GUNN'S DOTS IN RETINAL IMAGES OF 2,286 ADOLESCENTS: Prevalence, Retinal Distribution and Associations.

To investigate the epidemiology of Gunn's dots and their associations in a population-based cohort of children. Red-free fundus photographs from 2,286 children aged 11 years to 14 years from the Sydney Myopia Study were graded. Gunn's dots were manually marked and counted within a 6 mm grid centered on the optic disc. One or more Gunn's dots were seen in at least one eye in 82.6% of children. The median number of Gunn's dots per eye was 46 (range 0-482). Most Gunn's dots were found inferior and superior of the optic disc (49.3% and 45.8%, respectively, of the total number of Gunn's dots in the population). The odds for having 1 or more Gunn's dots were 3-fold greater in children with dark brown irides compared with children with blue irides (odds ratio 2.99, 95% CI 1.81 to 4.94, P < 0.0001 adjusted for age, sex, retinal nerve fiber layer thickness, refraction, ethnicity, and axial length). In the same analysis, the presence of 1 or more Gunn's dots was less frequent in children with thin retinal nerve fiber layers (first quartile) compared with children with thick retinal nerve fiber layers (fourth quartile) (odds ratio 0.68, 95% CI 0.49-0.93, P = 0.016). No disease or disease-marker associations were identified. Gunn's dots were visible on fundus photographs in most of the school children, most of the dots being located inferiorly and superiorly to the optic disc. Fundus photographically visible Gunn's dots were associated with darker irides and thicker retinal nerve fiber layers. Gunn's dots are a common and apparently harmless finding in children. Assessment of their clinical significance will require long-term follow-up.

Comparison of retinal nerve fiber layer thickness in relation to optic nerve head size and average retinal nerve fiber layer thickness using optical coherence tomography in glaucomatous optic neuropathy

Context: This study is conducted to determine the correlation between retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) size in normal and glaucomatous subjects by optical coherence tomography (OCT). Objective: The objective of this study is to compare the thickness of RNFL in relation to ONH size and average retinal nerve fiber thickness in glaucomatous optic neuropathy using OCT. Subjects and Methods: A prospective study was carried out on one hundred and fifty eyes of 75 patients with 39 normal and 36 glaucoma patients aged between 20 and 60 years. Results: Stratus OCT, values were correlated with the data obtained by ONHs analysis. The values of RNFL thickness showed a high correlation with the ONH size. The RNFLA values were also positively correlated with the *2.27 value. Mean RNFL in glaucoma patients is 72.20 ± 18.79 (standard deviation [SD]) and in *2.27 is 63.57 ± 17.3 (SD) (calculated Z value is 2.58 and P ≤ 0.004) and is highly significant at 4% level in glaucoma patients. Besides correlation coefficient of RNFLA*2.27 in glaucoma patients found positive correspondence with the correlation coefficient 0.867. In normal subject, mean RNFL is 92.16 ± 9.80 and in *2.27, 85.16 ± 10.21 (calculated Z value is 4.34 and P ≤ 0.007) and significant at 3% level in normal subjects. A negative correlation was seen with the value of correlation coefficient − 0.21. Conclusions: RNFL thickness *2.27 measurement has high correlation with each other as obtained by Stratus OCT; moreover, it decreased significantly with an increase in optic disc size. Statistical Analysis Used: To test the difference between two means, Z-test was used. “Z” distribution with population variance not known at that point of time because no normative-based population data were available for Indian population to find out the correlation between two variance correlation coefficient at that point of time.

Analysis of normal retinal nerve fiber layer thickness by age and sex using spectral domain tomography

Background: To analyze the nerve fiber layer thickness in a heterogeneous Indian population according to age and sex and to compare this parameter to published normative data on the Caucasian population to better understand the racial differences. Materials and Methods: A total of 400 patients of both gender belonging to various age groups were evaluated using Cirrus HD optical coherence tomography (OCT), Carl Zeiss, Meditec, Dublin. The results were evaluated and compared to determine the normal retinal nerve fiber layer thickness (RNFLT) and its variations with age and sex. Results: Average nerve fiber thickness along the 3.4 mm diameter circle around the optic nerve head was approximately 90.57 ± 11.59 μm. There was no significant difference seen between males and females for mean, quadrant, and clockwise RNFLT. This was the same in all the subgroups of our study. Conclusions: Our results provide the variations of RNFL in Indian population. To the best of our knowledge, this is the first study in our country done with a high sample size in the Cirrus HD-OCT machine.

Comparative quantitative assessment of the human corneal sub-basal nerve plexus by in vivo confocal microscopy and histological staining.

PurposeThis study was designed to compare and contrast quantitative data of the human corneal sub-basal nerve plexus (SBP) evaluated by two different methods: in vivo confocal microscopy (IVCM), and immunohistochemical staining of ex vivo donor corneas.MethodsSeven parameters of the SBP in large-scale IVCM mosaicking images from healthy subjects were compared with the identical parameters in ex vivo donor corneas stained by β-III-tubulin immunohistochemistry. Corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), average weighted corneal nerve fiber tortuosity (CNFTo), corneal nerve connection points (CNCP), average corneal nerve single-fiber length (CNSFL), and average weighted corneal nerve fiber thickness (CNFTh) were calculated using a dedicated, published algorithm and compared.ResultsOur experiments showed significantly higher values for CNFL (50.2 vs 21.4 mm/mm2), CNFD (1358.8 vs 277.3 nerve fibers/mm2), CNBD (847.6 vs 163.5 branches/mm2), CNFTo (0.095 vs 0.081 μm-1), and CNCP (49.4 vs 21.6 connections/mm2) in histologically staining specimens compared with IVCM images. In contrast, CNSFL values were higher in IVCM images than in histological specimens (32.1 vs 74.1 μm). No significant difference was observed in CNFTh (2.22 vs 2.20 μm) between the two groups.ConclusionsThe results of this study have shown that IVCM has an inherently lower resolution compared with ex vivo immunohistochemical staining of the corneal SBP and that this limitation leads to a systematic underestimation of several SBP parameters. Despite this shortcoming, IVCM is a vital clinical tool for in vivo characterization, quantitative clinical imaging, and evaluation of the human corneal SBP.

Epiretinal membrane as a source of errors during the measurement of peripapillary nerve fibre thickness using spectral-domain optical coherence tomography (SD-OCT).

We aimed to examine the extent to which measurement errors in the determination of retinal nerve fibre layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) occur in cases of epiretinal membrane and whether systematic deviations are found in the values obtained. A macular scan and a circumpapillary scan were performed on 97 eyes of 97 patients using SD-OCT. Group 1 comprised 53 patients with epiretinal membrane at an age of 70 ± 4.8years (median ± average absolute deviation). Group 2 consisted of 44 patients without any macular pathologies (median age 70 ± 5.8years). Differences in the thickness of the RNFL and segmentation errors in the detection of the RNFL were recorded quantitatively in both groups and checked for statistical significance using non-parametric tests. The median central retinal thickness in Group 1 was 357 ± 79μm (median ± average absolute deviation), and in Group 2 it was 270 ± 11μm (p < 0.001). The result of the quadrant-by-quadrant measurement of the average RNFL in Group 1 and Group 2, respectively, was: temporal 88 ± 17 and 73 ± 9μm, inferior 121 ± 17 and 118 ± 15μm, nasal 87 ± 15 and 89 ± 14μm and superior 115 ± 15 and 114 ± 9μm. Temporally, the difference was statistically significant (p < 0.001). Segmentation errors of the RNFL were found in 19 of 53 eyes (35.8%) in Group 1 and in no eyes (p < 0.001) in Group 2. In eyes with epiretinal membrane, measuring errors in the SD-OCT occur significantly more frequently than in eyes without any retinal pathologies. If epiretinal membrane and glaucoma are present simultaneously, the results of the automated RNFL measurement using SD-OCT should be critically scrutinised, even if no papillary changes are visible clinically.

New aspect for systemic effects of COPD: eye findings.

Chronic obstructive pulmonary disease (COPD) has multisystemic implications and comorbidities. Hypoxia and systemic inflammation are thought to involve oculary structures. In this study, our aim is to evaluate retinal nerve fiber and choroidal thickness and retinal vessel diameter using the spectral-domain optical coherence tomography (SD-OCT) in COPD subjects. Forty-three subjects diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease criteria at the Pulmonology Department of Pamukkale University were enrolled in the study. All subjects underwent respiratory function testing and a carbon monoxide diffusion test. To determine hypoxic state, arterial blood gas analysis was performed. The control group consisted of 31 subjects with comparable age and gender distribution. All participants underwent a standard ophthalmic examination including visual acuity assessment, biomicroscopy, air-puff tonometry, indirect retinoscopy, and SD-OCT measurements. The mean subfoveal choroidal thickness (SFCT), foveal thickness, and retinal arteriolar caliber were found to be similar in both groups, while the mean retinal venular caliber value was markedly higher in the COPD group. The mean peripapillary retinal nerve fiber layer (RNFL) thickness was 100.2±11.8 µm in the COPD group and 105.6 ± 8.1 µm in the control group (P = .03). The inferior quadrant RNFL was significantly thinner in the COPD group. The results of this study showed increasing diameter of the retinal veins, thinning of the RNFL, and SFCT may be associated to chronic inflammation and hypoxia in subjects with COPD. Future guidelines may include ocular findings to the present systemic manifestations of COPD.

Morphological study of the hypoglossal and lingual nerves

Abstract Background and objectives: In treatment of dental conditions and dental anaesthesiology, a thorough understaoding of course, directions and distribution of nerves and blood vessels supplying the tongue is extremely important. However, the morphology of the nerves supplying the tongue has not yet been fully understood. We applied comparative anatomical approach in order to observe innervation of the tongue in detail, with the focus on the distribution of the lingual nerves and its communication with the hypoglossal nerve. Material and methods: Ten adult human tongues with no grossly detectable abnormalities that were resected from cadavers donated for anatomical study and five monkey tongues were used. Specimens were immersed in water and dissected under a stereomicroscope, and gross examination of the morphology and directions of branches of the hypoglossal and lingual nerves, communicating branches between these two nerves, and their connection status was done. Observations: All branches shared common morphological characteristics: branches near the root of the tongue were relatively straight, while they meandered and formed loops nearer to the apex of tongue. In addition to the branch on the anterior muscle bundle of the hyoglossus muscle, which could be easily observed, there were two more communicating points (total of three communicating branches in both humans and Japanese macaques: in the inner part of the genioglossus muscle and the apex of the tongue). Conclusions: The levels of communicating nerve complexity between the hypoglossal nerve and the lingual nerve and the thickness of nerve fibers varied among individual subjects, but there was a common three-site communication pattern.

Correlation of Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer Thickness in Normal Subjects and in Patients with Glaucoma

Purpose: This study was designed to compare the normal and glaucomatous eyes regarding retinal nerve fiber layer (RNFL) thickness and peripapillary choroidal thickness (PCT), and to investigate the correlation of RNFL thickness and PCT. Subjects and Methods: Subjects were selected as a convenience sample of those from a tertiary referral practice of glaucoma. Thirty-two glaucomatous eyes were accepted as group 1; 30 normal eyes were accepted as group 2. Groups were compared for RNFL thickness and PCT. Correlations of RNFL thickness and PCT were assessed for each peripapillary location. Results: Mean inferior and superior RNFL thickness in group 1 were significantly lower than the control group; mean thicknesses of temporal and nasal quadrants were not different in the two groups. Mean PCT at 500 µm distance in the inferior, at 1500 µm distance in the superior, at 500, 1000, and 1500 µm distance in the temporal, and at 1000 and 1500 µm distance in nasal quadrants were found to be significantly thinner in the glaucoma group compared with the control group. Retinal nerve fiber thickness was strongly correlated with PCT at all points of inferior quadrants at 500 µm distance in the superior. There was no correlation between RNFL thickness and PCT at any point in the control group. Conclusion: Peripapillary choroidal thickness was thinner in glaucomatous eyes compared with normal eyes. Correlation of PCT and RNFL thickness found in patients with glaucoma did not exist in normal subjects.

Asymmetry of Retinal Nerve Fiber Layer and Posterior Pole Asymmetry Analysis Parameters of Spectral Domain Optical Coherence Tomography in Children

ABSTRACTPurpose: To determine inter- and intraocular differences in the retinal nerve fiber (RNFL) and posterior pole asymmetry analysis (PPAA) macular thickness parameters in children using spectral domain optical coherence tomography. Method: A prospective, cross-sectional study involving 126 subjects between the age group of 5–15 years received a standardized eye examination including spectral domain optical coherence tomography for retinal nerve fiber layer and macular thickness measurements. Asymmetry was calculated as the difference between the right and left eyes as well as the superior and inferior area of one randomly selected eye for each subject. Normal ranges were established as the 2.5 and the 97.5 percentiles. Correlation between the right and left eyes were assessed by intraclass correlation coefficients. Results: The difference in the average and superior RNFL between the right and the left eye was not statistically significant. The interocular 2.5 and 97.5 percentile limits for RNFL thickness and total PPAA macular thickness were –7.75 to 12.5 microns and –9 to 21 microns, respectively. The 2.5 and 97.5 percentile limits of the intraocular superior-inferior area difference for the RNFL thickness and PPAA macular thickness were –40 to 37 microns and –32 to 38 microns, respectively. A strong correlation for all parameters between the right and the left eye was seen. Conclusion: The normal interocular RNFL and PPAA macular thickness asymmetry should not exceed 12.5 microns and 21 microns, respectively. Similar intraocular limits for superior-inferior asymmetry should not exceed 40 and 38 microns, respectively.

Correlation of optic neuritis and retinal nerve fibre thickness using optical coherence tomography in a cohort of multiple sclerosis patients

Background: Optical coherence tomography (OCT) is a fast, non-invasive imaging technology that produces 3D, high-resolution images of the retina. Direct visualisation of the retina allows a unique opportunity to study the effects of multiple sclerosis (MS)-associated neurodegeneration on retinal ganglion cells as well as effects of retrobulbar demyelination on axonal and retinal architecture through measurement of retinal nerve fibre layer (RNFL) thickness and total macular volume (TMV). These findings are clinically important as axonal loss is irreversible and correlates with disability.Aim: To determine the role and usefulness of OCT in a local cohort of MS patients.Setting: Neurology Clinic, Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa.Methods: Nineteen patients with MS currently being treated with interferon β-1b underwent OCT examination of both eyes. RNFL thickness and macular volume were measured and correlated with clinical disease characteristics, history of optic neuritis and level of disability.Results: Mean RNFL thickness was 77.3 μm with no significant difference in mean RNFL in eyes with a history of optic neuritis (ON) and those without (p = 0.4). Eyes with a history of ON did, however, have significantly thinner RNFL compared with the contralateral eye (p = 0.04). Despite a strong correlation between TMV and RNFL (p = 0.001), a subset of patients with normal RNFL had TMV that was less than 1% of what was expected. There was no correlation between RNFL and disability scores.Conclusion: OCT enables a direct axonal ‘optical biopsy’, for monitoring disease progression and treatment response in MS. RNFL thinning occurs independently of a history of optic neuritis and may represent a chronic optic neuropathy in patients with MS.Keywords: Multiple sclerosis; optical coherence tomography

MONITORING OF OPHTHALMOLOGICAL INDICATORS IN PATIENTS WITH MULTIPLE SCLEROSIS

Актуальность. По данным литературы, более чем в 70% случаев у пациентов с длительностью рассеянного склероза более 5 лет и не имеющих ретробульбарного неврита в анамнезе в патологический процесс вовлечен зрительный анализатор, что проявляется снижением толщины перипапиллярных нервных волокон.

Quantitative sensory testing (QST). English version.

Quantitative sensory testing (QST) is a standardized and formalized clinical sensitivity test. Testing describes a subjective (psychophysical) method that entails a cooperation of the person to be examined. Within its framework, calibrated stimuli are applied to capture perception and pain thresholds, thus providing information on the presence of sensory plus or minus signs. The presented QST battery imitates natural thermal or mechanical stimuli. The aim is to acquire symptom patterns of sensory loss (for the functioning of the thick and thin nerve fibers) as well as a gain of function (hyperalgesia, allodynia, hyperpathia) with a simultaneous detection of cutaneous and deep tissue sensibility. Most of the tested QST parameters are normally distributed only after a logarithmic transformation (secondary normal distribution)-except the number of paradoxical heat sensations, of cold and heat pain thresholds, and vibration detection thresholds. A complete QST profile can be measured within 1h. QST is suitable not only for clinical trials but also in practice as a diagnostic method to characterize the function of the somatosensory system-from the peripheral nerve fiber receptor to the projection pathways to the brain.

CLINICAL EVALUATION OF THE EFFECTIVENESS OF MEDICATIONS NEUROTRANSMITTER ACTIONS IN THE TREATMENT OF PATIENTS WITH PRIMARY GLAUCOMA

Aim was to study the effectiveness of neuromedin in the treatment of patients with primary glaucoma with compensated intraocular pressure (IOP). patients and methods. There were 40 patients (80 eyes): 10 eyes with early stage, 36 — advanced, 33 — advanced and 1 eye with end-stage glaucoma. IOP was offset by drops in the history of the 26 eyes underwent surgical treatment. Neuromedin was administered at 20 mg 2 times a day, 25 days. Efficacy was evaluated by visual status, fluid dynamics and morphometric parameters of the disk. results. Under the influence of neuromedin reduced the number of cattle and increased the number of zones with normal retinal sensitivity in the initial stage of 14.9%. In the advanced stage, the acuity improved to 66.6 per cent, in 33.3% of cases has not changed. In advanced stage, the visual acuity increased to 51.5% and 48.5% had not changed. In advanced stage, the effect is less pronounced: the number of livestock type 1 and 2 declined by 3.0±0.6 to 2.9±0.8% respectively, while the absolute number of livestock has not changed, the number of zones with normal sensitivity increased by 7.4±2,0%. Field of view is increased at all seeing eyes. Decreased true IOP, activation of the outflow chamber moisture. In initial and advanced stages significantly decreased the area of excavation, increased the area of the neuroretinal belt and the thickness of the retinal nerve fibers. In advanced stages it only changes the thickness of the retinal nerve fibers. More pronounced than in traditional therapy, the visual acuity improvement, the expansion of the field of view, the effect on retinal sensitivity and indicators HRT, probably due to a central action of neuromedin and activation of ganglion cells in a state of parabiosis. In recent years, in the literature there have been reports about the possible generality of the pathogenetic mechanisms of primary glaucoma and neurodegenerative diseases due to mitochondrial dysfunction, therefore, the positive dynamics of visual functions on the background of treatment with neuromedin can be explained by the ability of the drug to affect the energy potential of cells, to have a positive impact on cognitive function. Conclusion. Neuromedin has a positive impact on the state of visual functions, hydrodynamics and morphometric parameters of the disk.

Intraeye retinal nerve fiber layer and macular thickness asymmetry measurements for the discrimination of primary open-angle glaucoma and normal tension glaucoma

PurposeThe aim of this study was to evaluate the diagnostic capability of intraeye retinal nerve fiber layer (RNFL) thickness and macular thickness (MT) asymmetry measurements for the discrimination of normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) using spectral domain optical coherence tomography (SD-OCT). MethodsA total of 90 subjects were enrolled including 30 consecutive healthy subjects, 30 consecutive subjects with POAG, and 30 consecutive subjects with NTG. RNFL thicknesses around the optic disc as well as MT measurements were taken with circular and radial SD-OCT scans. Intraeye retinal and MT asymmetry were calculated as the absolute difference between superior and inferior hemispheres of the eye using posterior pole asymmetry analysis protocol. Analysis of variance was used for comparison and areas under the receiver operating characteristic (AROC) were obtained for different parameters among the three diagnostic groups. ResultsThere was a significant difference in MT asymmetry for all comparison groups (normal-NTG, p<0.05; normal-POAG, p<0.001; and NTG-POAG, p<0.001). Intraeye retinal nerve fiber thickness asymmetry measurements were not different between the groups (normal-NTG, p<0.187; normal-POAG, p<0.056; and NTG-POAG, p<0.837). The area under ROC curves exceeded 0.800 for all the studied parameters, including the MT asymmetry except for intraeye RNFL thickness asymmetry which had the lowest AROC as well as the least sensitivity for identifying subjects with NTG from normal (AROC=0.626, sensitivity=30%); POAG from normal (AROC=0.644, sensitivity=37%) and NTG from POAG (AROC=0.533, sensitivity=13%). ConclusionThe intraeye MT asymmetry holds significant potential as a distinguishing parameter for NTG and POAG.

This issue of ACTA, printed and electronic

The cover illustration is a schematic drawing showing surgical technique for retinal vein cannulation and tissue plasminogen injection. This is reported by van Overdam et al. in this issue of Acta. Chan et al. in China review conflicting reports on the efficacy of corneal collagen cross-linking in infectious keratitis. Klefter et al. in Denmark measure increased retinal oxygen extraction in hyperglycaemia in patients with diabetes. van den Akken-van Marle et al. in Leiden recommend a risk factor guided screening programme for retinopathy of prematurity. Lin et al. in Taiwan correlate diabetic polyneuropathy and retinopathy in a nationwide study. vRezar et al. in Vienna report long-term benefits from anti-VEGF treatment for macular oedema in BRVO. Early treatment gives better visual outcome. Hautamäki et al. in Helsinki suggest that interleukin-8 may play a role in neovascularization in AMD. Fauser et al. in Köln measured elevated local inflammatory cytokines in neovascular AMD eyes. van Overdam et al. in Rotterdam show a surgical technique for retinal vein cannulation and tissue plasminogen injection in CRVO. Peters et al. in Sweden associate visual field index under 50% and/or mean defect worse than 18 dB with poor quality of life. Matlach et al. in Germany find trabeculectomy to reduce IOP more than canaloplasty, but with more complications. Rönnback et al. in Copenhagen and Singapore find genotype–phenotype heterogeneity in autosomal dominant optic atrophy. Mathew et al. in Houston and Uppsala find lamellar splitting in histological examination of keratoconus. Ekström and Taube in Uppsala suggest that pseudoexfoliation is a risk factor for cataract formation. Aclimandos et al. in UK, Belgium, France and Switzerland inform us about EBO's subspeciality examinations. Pérez-Cambrodí et al. in Spain and Poland review cataract aspiration with hollow needle in antiquity. The following articles are published in the electronic issue of ACTA and are accessible on www.actaophtalmologica.com, where you can also access the printed articles. Anitua et al. in Spain and USA examine the use of blood derived formulations used for the treatment of ocular surface disorders. Aptel et al. in France find great variation in progression visual field damage in POAG. Pillunat et al. in Germany stress nocturnal blood pressure dips in patients with glaucoma and relate this to daytime blood pressure measurements. Hussnain et al. in USA found more decline in corneal hysteresis in patients with glaucoma, but diabetes had no impact. Sheu et al. in Taiwan examined the effect of anti-VEGF drugs on retinal pigment epithelial cells and found variable effects on mitochondrial bioenergetics. Murakami et al. in Japan found reduced blood flow in macula to be associated with visual deterioration. Achiron et al. in Israel quantify metamorphopsia in DME and other macular diseases. Petrovic et al. in Slovenia and Czeck Republic relate a gene for reactive oxygen species modulation to the progression of diabetic retinopathy. García et al. in Spain and USA confirm the role of complement factor H gene in AMD and found variable effects of different haplotypes. Vagge et al. in Italy used near-infrared reflectance to image choroidal lesions in neurofibromatosis. Stemplewitz et al. in Germany found reduce macular volume and retinal nerve fibre thickness in patients with Parkinson's disease. Hoskin et al. in Australia emphasize the risk of fishing accidents and the need for eye protection. Vestergaard et al. in Odense find penetrating eye injuries to be most common in young men. Kuiper et al. in Utrecht discuss aqueous humour versus vitreal measurements of interleukins in diagnosis of ocular lymphoma. Tachibana et al. in Japan find improvement in horizontal but not vertical metamorphopsia following epiretinal membrane peeling. Suh et al. in Korea connect a connective tissue growth factor gene with pseudoexfoliation. Tode et al. in Germany use anti-interleukin-6 treatment for necrotizing scleritis. Örnek et al. in Turkey report transient thinning of choroid with bevacizumab injections for DME. Fonollosa et al. in Spain used a kinase inhibitor, vemurafenib to treat macular oedema in uveitis. Schäffer et al. in Austria relate anterior vitreous attachment and pseudophakic retinal detachments. I wish you a Merry Christmas, happy holidays and a prosperous New Year!

This issue of ACTA, printed and electronic

The cover photograph shows the effect of eye drops on diabetic macular oedema. The dexamethasone cyclodextrin nanoparticle eye drops are described by Ohira et al. in this issue of Acta. Kessel et al. review the literature and conclude that cataract surgery does not increase the risk of progression of AMD to the exudative stage. Jellema et al. in the Netherlands and Switzerland review strabismus surgery in patients with Graves' disease and find the field to be poorly standardized. They propose new criteria for measuring surgical success. Ohira et al. in Japan, Sweden and Iceland describe novel eye drops containing dexamethasone in cyclodextrin nanoparticles. The eye drops improve visual acuity and decrease retinal thickness in patients with diabetic macular oedema. Rassmussen et al. in Copenhagen found that delay in diagnosis and treatment of exudative AMD results in poorer visual outcome. Vottonen et al. in Finland associate increased amplitude of visually evoked potential with improved visual acuity and decreased retinal thickness following anti-VEGF treatment in wet AMD. Ceynowa et al. in Sweden found morning glory anomaly in 3/100 000 children. This was frequently associated with macular oedema, cerebral abnormalities and cutaneous vascular abnormalities. Raffa et al. in Sweden and Saudi Arabia found increased ocular morbidity in moderate to late preterm infants. They found a correlation between gestational age and visual acuity. van Leeuwen et al. in the Netherlands examined rehabilitation needs of visually impaired young adults. Need for employment was most prevalent, followed by peer interaction and social and civic life. Thomseth et al. in Denmark found no association between ocular use of chloramphenicol in first trimester of pregnancy and congenital malformations. Stenwall et al. in Uppsala point out that cytokine content of serum influences the anti-inflammatory effect of serum eye drops. Nielsen et al. in Aarhus used mass spectroscopy to characterize proteins that adhere to contact lenses. Ramberg et al. in Copenhagen find squamous cell dysplasia of the conjunctiva to be relatively rare and mostly in old men. It tends to recur and may progress to carcinoma. Van Bergen et al. in Belgium recommend bevacizumab to complement mitomycin-C in glaucoma filtering surgery. Sundelin and Dafgård Kopp in Stockholm found high complication rates in secondary orbital implants and 28% needed reoperation. Uusitalo et al. in Finland describe an infected tarsal cyst. The following articles and letters are published electronically only and are accessible on www.actaophthalmologica.com as all are articles published in ACTA from the beginning. Jonas et al. in China and Germany correlate high cerebrospinal pressure with retinal vein occlusions. Lopez Torres et al. in Switzerland associate reduced retinal vessel diameter in the peripapillary area with reduced responses on multifocal ERG. Debellemanière et al. in France used adaptive optics imaging to observe cone loss related to subclinical hydroxychloroquine toxicity. Pastor-Idoate et al. in Spain, Portugal, UK and the Netherlands describe possible genetic biomarkers that predict proliferative vitreoretinopathy. Ji et al. in China describe increasing macular pigment density with age in healthy people. Lens opacities affect the one-wavelength reflectometry. Chen et al. in China measured vascular endothelial growth factor and placenta growth factor and aqueous humour of patients with neovascular glaucoma. Munk et al. in USA, Austria and Switzerland found vitreoretinal adhesion to slow resolution of cystoid macular oedema in uveitis, but not affect visual outcomes. Jiang et al. in China study pterygium surgery and recommend a sutureless limbal conjunctival autograft using tissue glue. Yuksel et al. in Turkey compared two methods to obtain corneal donor buttons. ‘Morgue trephination technique’ resulted in less donor disfigurement than ‘classic sclerocorneal removal technique’, while transplant quality and outcome was similar. Bittersohl et al. in Germany found retinal nerve fibre thickness not to be a reliable diagnostic tool for Parkinson's disease. Gupta et al. in Singapore report thin choroid in high myopia. Chihaia et al. in Germany comment on the recent paper by Jarventauata et al. on peripheral hypertrophic subepithelial corneal degeneration. They add their experience and dispute the nomenclature. Yoo et al. in Korea and USA suggest that sleeping position may influence asymmetrical glaucoma damage. Shiraya et al. in Japan report greater burn expansion with endolaser compared to transpupillary retinal photocoagulation. Sugihara et al. in Japan describe pseudoexfoliation material on intraocular lenses. Jouve et al. in France used intravitreal anti-VEGF treatment in a pregnant woman and discuss pros and cons. Pratyusha and Votruba in the United Kingdom describe retinal changes in acquired lipodystrophy. Cinar et al. in Turkey found myelinated nerve fibres on fundus photographs in 0.3% of people. Clemens et al. in Germany describe microrips in retinal pigment epithelium that may precede RPE tears. Mittal et al. in India and United Kingdom show histopathology of lymphoma with crystal storing histiocytosis. Stoyanova et al. in the Netherlands recommend bandage and scleral contact lenses for ocular graft-versus-host disease. I hope you enjoy this issue of Acta.

Optical coherence tomography as a tool to evaluate retinal changes in Parkinson's disease.

Though Parkinson's disease (PD) is primarily a disease of the basal ganglia, recent evidence suggests that PD affects the retina. The study was designed to evaluate the thickness of retinal nerve fiber layer (RNFL) and thickness and volume of the macula in PD and hence explore the utility of optical coherence tomography (OCT) in studying retinal changes in PD. A prospective, hospital based evaluation of 30 patients with PD and 30 healthy controls was carried out. Various parameters such as RNFL, central macular thickness (CMT), central and total macular volumes (TMV) and retinal thickness were analyzed using OCT. (a) RNFL thickness was not significantly different between the patients and controls. A significant negative correlation was found between the RNFL thickness in the right nasal superior sector and the UPDRS motor score. (b) CMT was found to be significantly reduced in the right eye and a negative correlation with the UPDRS motor score was noted. (c) TMV was significantly greater in patients compared to the controls. (d) The outer retinal layer in the right nasal quadrant and the right inferior quadrants were found to be significantly thinner in patients with PD. We did not find any significant abnormality in the RNFL thickness in patients with PD. Decreased CMT in patients with PD and a significant negative correlation of RNFL thickness and CMT with severity of PD suggest a remote possibility of dopaminergic depletion in the retina. However long term studies are warranted to validate our findings.