EUROPEAN OPHTHALMIC REVIEW – VOLUME 3 ISSUE 2 – WINTER 2009

We truly live in an era of information overflow. Thus, it is important to promptly obtain an overview of the latest advances and grasp new trends within any subset of ophthalmology. Textbooks now tend to be outdated even before release and many of us instead rely on pertinent, timely and accurate reviews. While reviews will […]

Optical coherence tomography (OCT), first developed for ophthalmic imaging in the 1990s,1 has become a ubiquitous and invaluable tool in the retinal clinic. While it will never replace stereoscopic biomicroscopy, it has demonstrated clear advantages. Adjunctive OCT scanning objectively provides the examiner with 2D cross-sections of the retina, while newer machines are able to reconstruct […]

Digital fundus photography can be used for the documentation of retinal findings, for the screening and diagnostics of ocular and various systemic diseases or for follow-up after treatment. It is probably one of the means by which primary healthcare providers and ophthalmologists will improve their co-operation in the forthcoming years. There is consequently a growing […]

Glaucoma is a chronic neurodegenerative disease characterised by retinal ganglion cell death. The loss of retinal ganglion cells results in typical structural changes in the optic nerve head (ONH) and the retinal nerve fibre layer (RNFL) and in distinctive visual field (VF) defects. Glaucoma is a leading cause of blindness in Europe, with a prevalence […]

Glaucoma is a chronic, progressive optic neuropathy mostly associated with elevated intraocular pressure (IOP).1 Without adequate management, glaucoma can lead to reduced quality of life (QoL) and irreversible visual loss.1 Glaucoma affects approximately 67 million people worldwide and is the second leading cause of blindness in the world.2 Detection of glaucoma progression is crucial for […]

Mechanisms of Progression in Glaucoma Glaucoma is a neurodegenerative disease characterised by progressive loss of retinal ganglion cells (RGCs) over time with associated progressive visual field loss. Elevated intraocular pressure is the strongest risk factor for glaucoma,1 but the mechanisms by which damage occurs in the disease remain incompletely understood; however, a number of important […]

Assessing Glaucoma Progression

Glaucoma is a progressive optic disc neuropathy that has become one of the leading causes of irreversible vision loss worldwide.1 It is characterised by optic disc damage and functional losses in the visual field, and is associated with an elevated intraocular pressure (IOP). If left untreated, glaucoma will cause progressive injury to retinal ganglion cells […]

The objective of glaucoma therapy is to preserve the patient’s vision at moderate cost.1 It is a common perception that glaucoma has a slowly progressing pathology and that the visual function of the patient suffering from glaucoma deteriorates symptomatically only towards the terminal stage of the disease. In fact, scientific proof exists demonstrating how progression […]

Glaucoma surgery has been considered the last resort for glaucoma therapy as surgeons prefer to delay surgery for the potentially visionthreatening complications of classic trabeculectomy despite or because of the use of antimetabolites.1–3 Complications are often related to filtering bleb, such as leaks and infections, or to overfiltration, such as flat anterior chamber, choroidal effusion […]

The development of a visually significant cataract in a patient with glaucoma is a common and often expected event. The decisionmaking process regarding the timing and type of surgery offered for a patient with a visually significant cataract and glaucoma is complex, and depends on factors such as vision, visual potential, intraocular pressure (IOP) control, […]

Glaucoma is a chronic progredient neuropathy with typical structural changes at the optic nerve head and functional defects in the visual fields leading to blindness at the end stage. It is estimated that 60.5 million people worldwide will have this disease by 2010 and this number will increase to about 80 million by 2020. Glaucoma […]

Recent developments in cataract surgery have been dominated by efforts to further down-size the incision for phaco-emulsification (phaco) and intraocular lens (IOL) implantation. This article demonstrates and discusses the benefits and downsides of further down-sizing the cataract incision, the requirements regarding phaco and IOL technology, the pros and cons of the co-axial and bi-axial approaches […]

The Processes of Ocular Scar Formation

This review of corneal wound healing following refractive surgery is modified and updated from a previous review of general corneal wound healing.1 To help understand the wound healing response after keratorefractive procedures, it is first important to review the structure of the cornea. Understanding the structure also can help explain some of the complications that […]

It has been over five years since riboflavin–ultraviolet A (UVA) corneal collagen cross-linking treatment was introduced.1 Longterm stability of up to six years has been reported for this treatment in stopping the progression of keratoconus (KC).1,2 It is estimated that >1,000 corneal cross-linking (CXL) procedures are performed monthly worldwide.3 Other available treatment modalities for KC […]

Descemet-stripping automated endothelial keratoplasty (DSAEK) has become the procedure of choice to treat corneal endothelial dysfunction. Developed by Melles et al.1 and modified by others,2 DSAEK evolved from posterior lamellar keratoplasty (PLK) and deep lamellar endothelial keratoplasty (DLEK). The host Descemet membrane is removed and a graft consisting of posterior stroma, Descemet membrane, and endothelial […]

Posterior chamber intraocular lenses (IOLs) with a square posterior optic edge have been associated with better results in terms of posterior capsule opacification (PCO) prevention, regardless of the material used in their manufacture.1–3 Although this IOL design featurecan be appropriately assessed in morphological studies using scanning electron microscopy (SEM), such studies of new IOLs have […]

The fact that short-wavelength blue light has a phototoxic effect on the retina was discovered in the late 1970s.1–3 It is known that certain fish species change the colour of their corneas in response to the level of illumination and regulate the amount of short-wavelength light reachingthe retina.4 It was further proposed that this phenomenon […]

Aetiology and Presentation of Limbal Stem Cell Deficiency The corneal and conjunctival epithelia are derived from the surface ectoderm during development and are separated anatomically from each other by only a 1.5–2.0mm-wide limbus. However, they exhibit very distinct phenotypes, and do not generally transdifferentiate from one phenotype to another.1

Whether bi-manual or co-axial, the microincision phacoemulsification techniques of today allow for a neutral cylinder, thus reducing high-degree aberrations (in particular the coma type). The hydrophilic acrylic intraocular lenses (IOLs) are more compliant as they are inserted through a minimum 1.6–1.8mm incision, whereas the hydrophobic IOLs are inserted through 2–2.2mm incisions but generate fewer secondary […]

Diabetic retinopathy remains the most common preventable cause of blindness in the working-age population in the industrialised world. However, in the UK degeneration of the macular and posterior pole (principally age-related macular degeneration [AMD]) remains the major cause of visual loss in the population as a whole. A review of UK blind and partial-sighted registration […]

Choroidal neovascularisation (CNV) is one of the most severe causes of visual impairment in patients with uveitis. The disruption of homeostasis between the retinal pigment epithelium (RPE) and Bruch’s membrane can generate a vicious circle leading to choroidal neoangiogenesis. Both non-infectious and infectious uveitis can present CNV as a possible complication. Infectious uveitis is provoked […]

Wet Age-related Macular Degeneration – A Multifactorial Disease Once considered to be primarily a vascular disease arising from angiogenesis, choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD), or wet AMD, is now viewed as a complex multifactorial disease with numerous non-vascular components. As proposed by Spaide, the vascular component consists of endothelial cells, circulating […]

The first successful pars plana vitrectomy (PPV) was performed in 1970 in an eye with vitreous haemorrhage secondary to diabetesrelated changes.1 Since then, advances in instrumentation such as wide-angled viewing systems, smaller instruments, the use of heavy liquids and more sophisticated software have enabled the role of PPV in diabetic eyes to evolve, and it […]

The entire eye must function as the organ for vision and is organised with two major goals: normal function of the visual cell and the need to maintain ideal optical conditions for the light to access the visual cells, located in the back of the eye. The blood–ocular barriers play a fundamental role in the […]

When Do Retinal Ganglion Cells Die? Most of our understanding of retinal ganglion cell (RGC) death in the nervous system comes from studies of animal models, as human pathological tissues are so rare; however, the occasional access to human tissues generally tends to confirm what is seen in othermammals. During development, RGCs are produced in […]