Inflammation-suppressing cornea-in-a-syringe with anti-viral GF19 peptide promotes regeneration in HSV-1 infected rabbit corneas.

Pathophysiologic inflammation, e.g., from HSV-1 viral infection, can cause tissue destruction resulting in ulceration, perforation, and ultimately blindness. We developed an injectable Cornea-in-a-Syringe (CIS) sealant-filler to treat damaged corneas. CIS comprises linear carboxylated polymers of inflammation-suppressing 2-methacryloyloxyethyl phosphorylcholine, regeneration-promoting collagen-like peptide, and adhesive collagen-citrate glue. We also incorporated GF19, a modified anti-viral host defense peptide that blocked HSV-1 activity in vitro when released from silica nanoparticles (SiNP-GF19). CIS alone suppressed inflammation when tested in a surgically perforated and HSV-1-infected rabbit corneal model, allowing tissue and nerve regeneration. However, at six months post-operation, only regenerated neocorneas previously treated with CIS with SiNP-GF19 had structural and functional features approaching those of normal healthy corneas and were HSV-1 virus-free. We showed that composite injectable biomaterials can be designed to allow regeneration by modulating inflammation and blocking viral activity in an infected tissue. Future iterations could be optimized for clinical application.

Predicting glaucoma progression using deep learning framework guided by generative algorithm.

Glaucoma is a slowly progressing optic neuropathy that may eventually lead to blindness. To help patients receive customized treatment, predicting how quickly the disease will progress is important. Structural assessment using optical coherence tomography (OCT) can be used to visualize glaucomatous optic nerve and retinal damage, while functional visual field (VF) tests can be used to measure the extent of vision loss. However, VF testing is patient-dependent and highly inconsistent, making it difficult to track glaucoma progression. In this work, we developed a multimodal deep learning model comprising a convolutional neural network (CNN) and a long short-term memory (LSTM) network, for glaucoma progression prediction. We used OCT images, VF values, demographic and clinical data of 86 glaucoma patients with five visits over 12 months. The proposed method was used to predict VF changes 12 months after the first visit by combining past multimodal inputs with synthesized future images generated using generative adversarial network (GAN). The patients were classified into two classes based on their VF mean deviation (MD) decline: slow progressors (< 3 dB) and fast progressors (> 3 dB). We showed that our generative model-based novel approach can achieve the best AUC of 0.83 for predicting the progression 6 months earlier. Further, the use of synthetic future images enabled the model to accurately predict the vision loss even earlier (9 months earlier) with an AUC of 0.81, compared to using only structural (AUC = 0.68) or only functional measures (AUC = 0.72). This study provides valuable insights into the potential of using synthetic follow-up OCT images for early detection of glaucoma progression.

Cataract surgical training in Europe: European Board of Ophthalmology survey.

PURPOSE: To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. SETTING: Countries affiliated to the European Board of Ophthalmology (EBO). DESIGN: Cross-sectional study of anonymous survey results. METHODS: A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. RESULTS: 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CONCLUSIONS: CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.

Acquired nasolacrimal duct obstruction: clinical and histological findings of 275 cases.

BACKGROUND: Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations. METHODS: This retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed. RESULTS: Three tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292). CONCLUSIONS: Chronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.

Cognitive Decline in Multiple Sclerosis Is Related to the Progression of Retinal Atrophy and Presence of Oligoclonal Bands: A 5-Year Follow-Up Study.

Background: Brain atrophy, which is associated with cognitive impairment and retinal nerve fiber layer (RNFL) atrophy, is the main biomarker of neurodegeneration in multiple sclerosis (MS). However, data on the relationship between inflammatory markers, such as oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF), and cognition, RNFL atrophy, and brain atrophy are scarce. The aim of this study was to assess the influence of RNFL thickness, brain atrophy markers, intrathecal OCBs, and the immunoglobulin G (IgG) index on cognitive decline over a 5-year period in patients with MS. Methods: This prospective, single-center, observational cohort study included 49 patients with relapsing MS followed up over 5 years. At baseline, the patients underwent brain magnetic resonance imaging (MRI). Cognitive evaluation was performed using the Brief International Cognitive Assessment for MS (BICAMS), and RNFL thickness was assessed using optical coherence tomography (OCT). OCBs and IgG levels in the CSF were evaluated at baseline. The BICAMS, OCT, and MRI findings were re-evaluated after 5 years. Results: A significant reduction in information processing speed, visual learning, temporal RNFL thickness, the Huckman index, and third ventricle mean diameter was found in all 49 patients with relapsing MS over the observation period (p < 0.05). Of the patients, 63.3% had positive OCBs and 59.2% had elevated IgG indices. The atrophy of the temporal segment and papillomacular bundle and the presence of OCBs were significantly related to a decline in information processing speed in these patients (p < 0.05). However, brain atrophy markers were not found to be significant on the general linear models. Conclusions: RNFL atrophy and the presence of OCBs were related to cognitive decline in patients with MS over a 5-year follow-up period, thereby suggesting their utility as potential biomarkers of cognitive decline in MS.

Association Between Structure-function Characteristics and Visual Field Outcomes in Glaucoma Subjects With Intraocular Pressure Reduction After Trabeculectomy.

PRECIS: Improvements in post-trabeculectomy visual field (VF) outcomes were found to be significantly associated with preoperative nerve fiber layer thickness parameters extracted from the sectorized structure-function relationship, baseline VF, and severity of glaucoma. OBJECTIVE: To determine whether the preoperative structure-function relationship helps to predict visual outcomes at 1-year post-trabeculectomy. PATIENTS AND METHODS: In total, 91 eyes from 87 participants who successfully underwent trabeculectomy were included in our study. All eyes received optical coherence tomography imaging and VF assessment using 30-2 standard automated perimetry preoperatively at baseline and postoperatively 1 year after trabeculectomy. The linear mixed-model analysis was used to assess the association of structure and function at baseline, and multivariate analysis to investigate factors associated with postoperative VF outcomes. RESULTS: Results from multivariate and univariate analysis for VF 1 year after trabeculectomy showed that a positive preoperative retinal nerve fiber layer thickness deviation from the structure-function model was found to be significantly associated with improved postoperative VF outcomes [ß=0.06 dB/µm; 95% confidence interval (CI), 0.03-0.09]. Other significant factors included baseline VF MD (ß=-0.18; 95% CI, -0.23 to -0.13) and the presence of severe glaucoma (ß=-1.69; 95% CI, -2.80 to -0.57). Intraocular pressure was positively associated with improved VF outcomes only in univariate analysis (ß=0.06; 95% CI, 0.01-0.11). CONCLUSIONS AND RELEVANCE: Characteristics derived from the baseline structure-function relationship were found to be strongly associated with postoperative VF outcomes. These findings suggest that the structure-function relationship could potentially have a role in predicting VF progression after trabeculectomy.

One year structural and functional glaucoma progression after trabeculectomy.

We evaluated the changes in visual field mean deviation (VF MD) and retinal nerve fibre layer (RNFL) thickness in glaucoma patients undergoing trabeculectomy. One hundred patients were examined with VF and spectral-domain optical coherence tomography (OCT) before trabeculectomy and 4 follow-up visits over one year. Linear mixed models were used to investigate factors associated with VF and RNFL. VF improved during the first 3 months of follow-up (2.55 ± 1.06 dB/year) and worsened at later visits (-1.14 ± 0.29 dB/year). RNFL thickness reduced by -4.21 ± 0.25 µm/year from 1st month of follow-up. Eyes with an absence of initial VF improvement (ß = 0.64; 0.30-0.98), RNFL thinning (ß = 0.15; 0.08-0.23), increasing intraocular pressure (IOP; ß = -0.11; -0.18 to -0.03) and severe glaucoma (ß = -10.82; -13.61 to -8.02) were associated with VF deterioration. Eyes with VF deterioration (ß = 0.19; 0.08-0.29), increasing IOP (ß = -0.09; -0.17 to -0.01), and moderate (ß = -6.33; -12.17 to -0.49) or severe glaucoma (ß = -19.58; -24.63 to -14.52) were associated with RNFL thinning. Changes in RNFL structure and function occur over a 1-year follow-up period after trabeculectomy. Early VF improvement is more likely to occur in patients with mild/moderate glaucoma, whereas those with severe glaucoma show greater decline over one year. Our findings indicate that progression is observable using OCT, even in late-stage glaucoma.

Effect of Obstructive Sleep Apnea on Corneal Morphological Characteristics.

PURPOSE: To determine central corneal thickness (CCT) and the corneal parameters in patients with obstructive sleep apnea (OSA), evaluate the relationship between the severity of OSA, minimum peripheral capillary oxygen saturation (min. SpO2), and corneal morphological characteristics. METHODS: Patients with OSA diagnosed by full-night polysomnography before treatment were included. Patients with OSA were divided into 3 groups according to the Apnea-Hypopnea Index (AHI). The control group (CG) was examined to exclude the possibility of OSA and ocular diseases. The following data were recorded: age, sex, body mass index, ophthalmologic evaluation, and the results of polysomnography. RESULTS: A total of 114 eyes were studied: 74 eyes of patients with OSA and 40 eyes of the CG. The mean age was 57 ± 6 years. The mean values of CCT and endothelial cell density (ECD) varied significantly between the patients and the CG (P < 0.001). The mean values of CCT, ECD, cell variation coefficient (CV), and hexagonal cell percentage (HEX) in the group of patients with OSA were 535.28 ± 21.32 µm, 2632 ± 333, cells/mm. 31.8 ± 3.9, and 55.6 ± 6.9%, respectively. The mean CCT and ECD values for each group were lower than those for the CG. A significant negative correlation was found between CCT and ECD for AHI values (r = -0.390, P = 0.011 and r = -0.109, P = 0.040, respectively), and a weak positive correlation between CCT and ECD was found for min. SpO2 (r = 0.282, P = 0.020 and r = 0.332, P = 0.018, respectively). CV and HEX did not significantly differ between the groups and did not correlate with the results of polysomnography. CONCLUSIONS: Hypoxia is associated with significant changes in CCT and ECD. In patients with OSA, these parameters varied significantly when compared with the subjects in the CG. The severity of hypoxemia and the increase in AHI values reduce CCT and ECD in patients.

Endothelial parameters in central and peripheral cornea in patients wearing contact lenses.

AIM: To measure the parameters of endothelium in the central and peripheral parts of the cornea and evaluate the influence of wearing the hard and soft contact lenses on the mentioned parameters. METHODS: A specular microscope was used to measure the corneal endothelium parameters in both eyes of 139 Caucasians (a total of 278). All participants were divided into three groups: soft lens wearers, hard lens wearers and a control group. Factors, such as age, smoking, types of lens material, duration of lens wear and lens air permeability were assessed to determine their impact on the morphometric parameters of the endothelium. RESULTS: A lower percentage of hexagon-like cells and higher cell variation than in other groups were determined in hard contact lens wearers. The difference in density of endotheliocytes between the groups was not observed. The measurements of the morphometric parameters in soft contact lens wearers did not depend neither on the duration of lens wear, nor on air permeability. The relation between the patients' age and the variation of endothelium parameters was determined in the group of hard contact lens wearers. CONCLUSION: Wearing hard contact lenses provokes pleomorphism and polymegethism of the corneal endothelium, while soft contact lenses do not impact any parameters of the endothelium, most likely due to higher air permeability.

X-linked juvenile retinoschisis: phenotypic and genetic characterization.

Juvenile X-linked retinoschisis (XLRS, MIM#312700) belongs to a group of the vitreoretinal dystrophies. We aimed to describe the phenotype-genotype correlation of three XLRS cases in juveniles with different novel mutations from the Lithuanian population. The patients demonstrated macular retinoschisis and typical cyst-like cavities on spectral-domain optical coherence tomography (SD-OCT) images. The mean central foveal thickness was 569.7 µm. Two patients presented with peripheral retinoschisis. Flash electroretinogram demonstrated a reduced b/a ratio (<1.0) in all patients. RS1 (NM_000330.3) gene coding exons Sanger sequencing was performed. RS1 c.599G>T (p.R200L) mutation was detected in one case, showing to be pathogenic in silico analysis. c. (92_97) insC (p.W33fs) mutation was identified for another patient, indicating the variant is possibly damaging in silico analysis. The third case was identified with a pathogenic mutation c.422C>G (p.R141H), HGMD CM981753. These are the first cases of XLRS in the Lithuanian population confirmed by molecular genotyping. Presented patients had a different genotype but similar phenotypic traits.

Long-Term Shape, Curvature, and Depth Changes of the Lamina Cribrosa after Trabeculectomy.

PURPOSE: To evaluate changes in lamina cribrosa (LC) shape, curvature, and depth after trabeculectomy. DESIGN: Prospective, observational case series. PARTICIPANTS: A total of 112 patients (118 eyes) with open- or closed-angle glaucoma undergoing trabeculectomy. METHODS: The optic nerve head was imaged using enhanced depth imaging spectral-domain OCT before trabeculectomy and at 6 follow-up visits throughout the first postoperative year. The anterior LC surface and Bruch's membrane opening were marked in the serial horizontal B scans for the analysis of LC parameters using Morphology 1.0 software. Postoperative morphologic LC changes were assessed. MAIN OUTCOME MEASURES: The postoperative LC global shape index (GSI), nasal-temporal (N-T) and superior-inferior (S-I) curvatures, and mean and sectoral LC depth (LCD). RESULTS: The mean LC GSI increased only during the early postoperative period (P = 0.02), resulting in a change toward the saddle-rut shape. There was a flattening of the LC curvature in N-T (P < 0.001) and S-I (P = 0.003) meridians 12 months after trabeculectomy. A shallowing of the mean and sectoral LCD from baseline was significant throughout the entire follow-up period (P < 0.001) and progressed up to postoperative month 6. Twenty-eight patients showed a deepening of the LC from baseline in at least 1 visit. Eyes with shallower LCD compared with baseline responded to intraocular pressure (IOP) reduction with greater movement anteriorly than eyes with deeper LCD (P = 0.002). Greater IOP reduction (P = 0.007), less retinal nerve fiber layer thinning over the year (P = 0.003), and more superiorly-inferiorly curved baseline LC (P = 0.001) were associated with an increase in GSI. Younger age and IOP reduction were related to LC shallowing (P < 0.001, P = 0.002) and N-T flattening (P < 0.001). CONCLUSIONS: In most eyes, trabeculectomy resulted in long-term flattening and shallowing of the LC. However, in some eyes, LC deepened from baseline. Change in LC global shape appeared to be temporal. Reduction in IOP plays an important role in the early phase of LC change; however, in the later phase, LC remodeling may play a crucial role in view of stable IOP.

Recommendations for ultrasound examination in ophthalmology. Part I: Ultrabiomicroscopic examination.

Range of ultrasounds used in medical imaging is between 2 and 80 MHz. The highest frequencies are applied in medical imaging of an anterior segment of an eyeball. This paper covers the newest method of ultrasound imaging - an ultrabiomicroscopic examination. Its name reflects resolution which has so far been unavailable, and which allows for imaging a structure of the examined tissues. The article includes basic information about the structure and principles of operation of ultrabiomicroscopic examination tools. Moreover, its position among other methods for echographic examination of an eyeball was determined. Examination techniques and the role of standards of conduct at each stage of a diagnostic procedure were discussed. A role of insufficient cooperation between constructors of new ultrasonographic diagnostic tools and software IT specialist with the users of these tools, which results in the lack of consistency between the components of these sets was emphasized. Based on long term experience in ultrabiomicroscopic examinations, the authors shared observations on practical aspects of this method. Finally, indications and contraindications for ultrabiomicroscopic diagnostics were listed. Introduction of an ultrahigh frequency ultrasound probe allowed for the visualization of an post-iridial area of an anterior segment of an eyeball - an area whose diagnosis is impossible with other diagnostic methods. A wide spectrum of diagnostic indications, which covers both diseases and development anomalies of an anterior segment of an eyeball, confirms a special meaning of this method.Range of ultrasounds used in medical imaging is between 2 and 80 MHz. The highest frequencies are applied in medical imaging of an anterior segment of an eyeball. This paper covers the newest method of ultrasound imaging ­ an ultrabiomicroscopic examination. Its name reflects resolution which has so far been unavailable, and which allows for imaging a structure of the examined tissues. The article includes basic information about the structure and principles of operation of ultrabiomicroscopic examination tools. Moreover, its position among other methods for echographic examination of an eyeball was determined. Examination techniques and the role of standards of conduct at each stage of a diagnostic procedure were discussed. A role of insufficient cooperation between constructors of new ultrasonographic diagnostic tools and software IT specialist with the users of these tools, which results in the lack of consistency between the components of these sets was emphasized. Based on long term experience in ultrabiomicroscopic examinations, the authors shared observations on practical aspects of this method. Finally, indications and contraindications for ultrabiomicroscopic diagnostics were listed. Introduction of an ultrahigh frequency ultrasound probe allowed for the visualization of an post-iridial area of an anterior segment of an eyeball ­ an area whose diagnosis is impossible with other diagnostic methods. A wide spectrum of diagnostic indications, which covers both diseases and development anomalies of an anterior segment of an eyeball, confirms a special meaning of this method.

Changes in macular thickness after trabeculectomy with or without adjunctive 5-fluorouracil.

CONFLICT OF INTEREST: None of the authors have any conflict of interest to declare, financial or otherwise. No financial or other support was received for the study. BACKGROUND: The aim of the study was to assess changes in macular thickness after trabeculectomy in respect to the use of 5-fluorouracil (5-FU) as well as to analyse possible associations between the postoperative changes in macular thickness and intraocular pressure (IOP). MATERIALS AND METHODS: The prospective observational study included 106 eyes (100 patients) with glaucoma who underwent trabeculectomy with or without 5-FU. Subsequently 5-FU needling was performed if failure of the filtrating bleb occurred. Macular thickness and the IOP were evaluated before, one week, and six months after the surgery. The mean and sectoral macular thickness was assessed using spectral domain optical coherence tomography. RESULTS: The mean (±SD) IOP reduced from 27.71 (±6.88) mmHg at baseline to 18.3 (±8.1) mmHg one week (p < 0.001) and 15.1 (±7.6) mmHg six months (p < 0.001) after trabeculectomy. One week postoperatively, the mean macular thickness increased from 285.19 (±15.98) µm to 288.9 (±16.31) µm (p < 0.001); macular thickening was significant in all subfields (p < 0.001) and correlated positively with IOP reduction (rho = 0.312, p = 0.001 for central subfield). After six months, macula remained thicker only at the central and inner nasal subfields (p < 0.05). The changes in macular thickness were not affected by the use of 5-fluorouracil. CONCLUSIONS: Trabeculectomy may induce a slight macular thickening which is more pronounced in the early postoperative period. The IOP reduction plays an important role in this process and is associated with thicker postoperative macula. However, the use of adjunctive 5-FU has no influence on macular thickness after glaucoma surgery despite its potential hypotonic, inflammatory and cytotoxic effects.

Changes in choroidal thickness after intraocular pressure reduction following trabeculectomy.

PURPOSE: To evaluate the changes of peripapillary and subfoveal choroidal thickness (CT) after trabeculectomy. METHODS: Prospective longitudinal study included 37 eyes with open-angle glaucoma. The subfoveal and peripapillary CT was measured using enhanced depth imaging spectral domain optical coherence tomography before trabeculectomy and 1 week, 3 and 6 months postoperatively. The associations between changes in the CT, intraocular pressure (IOP) and axial length were analysed. RESULTS: The medium subfoveal CT (IQR) increased from 182 (97) µm at baseline to 267 (107) µm 1 week, 213 (97) µm 3 months and 207 (91) µm 6 months postoperatively (p < 0.001). The peripapillary CT increased in all four quadrants at all follow-ups (p < 0.05). The subfoveal and peripapillary choroidal thickening correlated with the magnitude of IOP reduction (p < 0.05) and axial length shortening (p < 0.01) during whole follow-up period. There was a peripapillary CT increase of 2.9 µm per mmHg of IOP reduction (p < 0.001, CI 1.5-4.4) and 4.8 µm per mm of baseline axial length (p = 0.049, CI 0.03-9.6) 1 week postoperatively after adjustment for baseline IOP. Six months postoperatively, the decrease in axial length was the only factor associated with peripapillary choroidal thickening (p = 0.031; regression coefficient: 73.29 µm/mm, CI 7.1-139.5). CONCLUSION: Intraocular pressure (IOP) reduction after trabeculectomy caused the increase in subfoveal and peripapillary CT for at least 6 months postoperatively correlating with greater IOP reduction and axial length shortening. In the long term, the decrease in axial eye length, but not IOP, was the only factor to be associated with peripapillary choroidal thickening.

Comparison of intraocular pressure measurements with different contact tonometers in young healthy persons.

AIM: To analyze the correlation of Goldmann applanation tonometer (GAT), I-Care tonometer and Tono-Pen tonometer results in young healthy persons, and to investigate the influence of central corneal thickness (CCT) on intraocular pressure (IOP) measurements recorded with these tonometers. METHODS: We conducted a pilot clinical study in 78 eyes of 78 subjects aged 22-28 years old (44 women and 34 men; mean age 23.8±1.19y). IOP was measured using GAT, I-Care and Tono-Pen tonometers, followed by measurements of CCT. Statistical analysis was performed using SPSS 20.0. RESULTS: The mean IOPs and standard deviation (±SD) for GAT, I-Care and Tono-Pen were 15.62±2.281 mm Hg, 16.29±2.726 mm Hg and 16.32±2.393 mm Hg, respectively. The mean CCT was 555.15±29.648 µm. Clear positive correlations between GAT and I-Care, GAT and Tono-Pen, and I-Care and Tono-Pen tonometers were found (r=0.867, P<0.001; r=0.861, P<0.001; r=0.915, P<0.001, respectively). In comparison between devices, Bland-Altman analysis showed a significant mean difference (MD) in the measurements by GAT and I-Care of -0.679 mm Hg and by GAT and Tono-Pen of -0.705 mm Hg ( P<0.001), but there was no significant difference between I-Care and Tono-Pen ( P>0.05). Both non-gold standard tonometers were affected by CCT; that is, both I-Care and Tono-Pen tonometer values were significantly higher with higher CCT means (>555 µm; MD=-1.282, P<0.001; MD=-0.949, P<0.001, respectively) compared with GAT. CONCLUSION: Both I-Care and Tono-Pen tonometers overestimated IOP compared with the GAT values. Either the I-Care or Tono-Pen tonometer could be used instead of GAT because there was no significant difference between their results. Higher CCT values (>555 µm) were associated with overestimated IOP values.

Changes in choroidal thickness and corneal parameters in diabetic eyes.

PURPOSE: To evaluate the effect of diabetes mellitus (DM) on central corneal thickness (CCT), corneal endothelial parameters (endothelial cell density [ECD], average size [AVE], hexagonality [A6], polymegathism [SD]), and subfoveal choroidal thickness (SFCT), and to determine whether these parameters depend on the duration of DM and hemoglobin A1c (HbA1c) level. METHODS: A total of 62 patients with type 2 DM and 65 healthy subjects were examined using a noncontact specular microscope, A-scan ultrasound, and spectral-domain optical coherence tomography. The study parameters included medical history, age, eye axial length, CCT, ECD, AVE, A6, SD, and SFCT. The duration of DM and HbA1c level of the 2 latest tests were noted. RESULTS: The SFCT (258.0 ± 74.4 µm) and ECD (2721.8 ± 264.1 cells/mm2) were significantly lower, and the CCT (566.7 ± 35.7 µm) higher, in diabetic patients than in the control group (313.1 ± 88.5 µm, 2967.3 ± 220.6 cells/mm2, 550.0 ± 56.4 µm, respectively) (p<0.05). There were no differences in age, sex, or axial length between the diabetic and control groups (p>0.05). Diabetic retinopathy and macular edema did not influence SFCT significantly (p>0.05). No differences in endothelial parameters between groups and no correlations among HbA1c, duration of DM, and any of the examined parameters were found (p>0.05). CONCLUSIONS: Diabetic patients have thicker corneas, lower ECD, and thinner subfoveal choroid than healthy subjects.

Quantitative histopathological assessment of ocular surface squamous neoplasia using digital image analysis.

The aim of this retrospective pilot study was to evaluate the Aperio nuclear V9 algorithm as an image analysis tool to observe the histopathological changes of ocular surface squamous neoplasia (OSSN). A histopathological assessment, including the Ki-67 proliferative index (PI) of immunohistochemically-stained tumor conjunctiva (TC) and healthy conjunctiva (HC) tissues, was performed in six cases of OSSN. The Aperio V9 algorithm was applied to digital images of the tissue specimens to count the Ki-67 PI and to measure the nuclear area indices. This digital algorithm was validated using stereological and visual analysis methods. The visual scoring of Ki-67 PI ranged from 22 to 60% (mean, 38.5%), and from 5 to 20% (mean 9.5%) in TC and HC tissue, respectively. The computer-aided analysis, using the Aperio nuclear V9 algorithm, revealed that the Ki-67 PI ranged from 21.5 to 43.5% (mean, 33.6%), and from 1.9 to 21.0% (mean, 11.8%) in the TC and HC tissue, respectively. The stereological method demonstrated that the Ki-67 PI ranged from 30.1 to 51.5% (mean, 41.0%), and from 3.2 to 30.1% (mean, 15.1%) in the TC and HC tissues, respectively. The strongest association in the collinearity of regression analysis was observed between the Aperio nuclear V9 algorithm/stereological models in the TC tissue (r2=0.7; P=0.04) and the HC tissue (r2=0.7; P=0.03), and the visual/stereological models in the TC tissue (r2=0.7; P=0.04) and the visual/Aperio nuclear V9 algorithm models in the HC tissue (r2=0.7; P=0.04). A weak and statistically insignificant association was identified between the visual/Aperio nuclear V9 algorithm analysis in the TC tissue (r2=0.4; P=0.2) and the visual/stereological models in the HC tissue (r2=0.5; P=0.13). No significant difference was observed between the nuclear area of the TC (mean, 36.5 µm2) and HC (mean, 35.7 µm2; P=0.88) tissues. It was concluded that the Aperio nuclear V9 algorithm is a useful tool for the reliable analysis of histopathological changes of OSSN. The results of this computer-aided algorithm correlate strongly with the stereological method when assessing the Ki-67 PI.