Gerhard Henrik Armauer Hansen (1841–1912) – 100 years anniversary tribute

2012 marks the 100th year of death of Gerhard Henrik Armauer Hansen (1841–1912), who discovered Mycobacterium leprae, but also gave the first systematic scientific work on the leprosy of the eye. The article reviews his life and scientific achievements with special regard to eye and ophthalmology.     

Short‐term progression of wet AMD and correlation with 1‐year treatment results

Purpose: Quantification of short‐term progression of active neovascular age‐related macular degeneration and correlation with 1‐year outcome. Methods: Sixty‐five patients with newly diagnosed treatment‐naive active subfoveal choroidal neovascularization (CNV), who had participated in clinical trials testing anti‐vascular endothelial growth factor therapy, were retrospectively assessed. Early Treatment Diabetic Retinopathy Study best‐corrected visual acuity (BCVA), Spectral Domain Optical Coherence Tomography (SD‐OCT) and fluorescein angiography (FA) were performed twice during the pretreatment period. Changes in BCVA, central retinal thickness (CRT), average macular thickness (AMT) and leakage area were documented within this pretreatment period for all patients and for lesion type I (occult CNV, n = 42) and type II (classic CNV, n = 23). Three‐month and 1‐year BCVA were then correlated with the pretreatment period. Results: The pretreatment period was 19 ± 3 days (range: 2–108). Neither type I nor type II lesions showed a significant BCVA decrease or CRT/AMT increase during this period. On FA, mean leakage area increased significantly during the pretreatment period: in the pooled group from 5.50 ± 0.62 (screening) to 7.60 ± 0.86 mm² (baseline) (p < 0.0001), in type II from 4.65 ± 0.90 to 7.83 ± 1.62 mm² (p < 0.01) and in type I from 6.08 ± 0.85 to 7.45 ± 0.96 mm² (p < 0.0001). The mean increase in leakage area per day was 0.046 ± 0.02 mm², p = 0.034. Type II showed a daily growth of 0.09 ± 0.08 mm² (p < 0.042) and type I 0.045 ± 0.008 mm² per day (p < 0.0001). However, neither leakage area increase nor pretreatment period was correlated with 3‐month or 1‐year BCVA outcome. Conclusions: SD‐OCT and BCVA testing did not reveal deterioration during the pretreatment period. However, the leakage area progressed rapidly. Despite the rapid increasing leakage area, the 19‐day waiting period was not associated with a poorer visual outcome at 3 months and 1 year.     

Endothelial keratoplasty – a review

From its inception over a century ago, penetrating keratoplasty grew to become the most common and most successful form of solid tissue transplantation. Yet clinicians have long recognized the limitations of full‐thickness corneal transplants, including prolonged visual rehabilitation, unpredictable refractive changes, susceptibility to ocular surface complications and vulnerability to traumatic wound rupture. Selective replacement of diseased or damaged posterior corneal layers was conceptualized and implemented a half century ago. However, it has only been within the past decade that improved techniques and instrumentation have allowed endothelial keratoplasty (EK) to become the preferred treatment for patients with endothelial dysfunction. EK provides more rapid visual recovery, minimizes induced astigmatism and, most importantly, better maintains globe integrity than penetrating keratoplasty. Descemet stripping automated EK is currently the most widely used method. This article covers how EK techniques have evolved over time, considers who is or is not an appropriate candidate for EK, describes Descemet stripping automated EK methods and instrumentation, discusses EK postoperative complications and management and compares visual recovery, refractive outcomes and endothelial cell loss with that of standard penetrating keratoplasty.     

Newham Waterworth 1867–1949

ABSTRACT A biographical account of Newham Waterworth is presented, documenting in particular his contribution to the profession of optometry and its struggle to achieve legislative recognition in the State of Tasmania.     

Micropulse diode laser trabeculoplasty – 180‐degree treatment

Purpose: To evaluate the outcome of 180° micropulse diode laser trabeculoplasty (MDLT) in patients with open‐angle glaucoma. Methods: A retrospective review of 40 eyes of 29 MDLT‐treated patients with a minimum follow‐up time of 6 months. Successful outcome was defined as follows: (i) a ≥20% or (ii) a ≥3‐mmHg decrease of intraocular pressure (IOP), no further need for laser‐ or incisional surgery and the number of glaucoma medication was the same or less than preoperative. These definitions will from now on be referred to as definition one and definition two. Results: Life‐table analysis showed an overall success rate of 2.5% (1/40) and 7.5% (3/40) (according to definitions one and two, respectively) after up to 19 months of follow‐up. The average time for failure was by definition one 2.9 months (standard deviation, SD ± 3.5, range 1–12 months) and by definition two 3.3 months (SD ± 3.9, range 1–16 months). There were no intra‐ or postoperative complications caused by MDLT. Postoperative inflammatory reaction, cells and flare, was scanty. Conclusion: Our results suggest that 180° MDLT is a safe but ineffective treatment in patients with open‐angle glaucoma.     

Keratoprostheses in clinical practice – a review

The search for a substitute for the natural cornea dates back more than 200 years. Although several devices have been developed and trialled, very few have had successful long‐term results and continue in regular clinical use. Keratoprosthesis (KPro) surgery is complex and should be performed in centres with an experienced multidisciplinary team. Currently available KPro devices range from the totally synthetic, such as the Boston KPro, to the totally biological tissue‐engineered artificial cornea. The osteo‐odonto keratoprothesis combines a synthetic optic with a biological haptic. All keratoprostheses have significant limitations, although visual improvement is possible with each of the devices in clinical use today. This review discusses these devices with emphasis on their indications, surgical techniques and results, before briefly exploring emerging devices and innovative approaches for the future.     

Interphotoreceptor retinoid-binding protein––an old gene for new eyes

Evolving 40 times independently, eyes are striking examples of convergent evolution in that 11-cis retinaldehyde is always used for photon capture, yet the mechanism for its regeneration may be dramatically different in between systems. In particular, insects, cephalopods and vertebrates show varying physical separation of the cis → trans photoisomerization and chromphore reisomerization. In the vertebrate retina, these two processes are actually distributed between different cells. This compartmentalization is made possible by the phylogenetic innovation of the two-layered optic cup of the vertebrate retina. This unprecedented design created the subretinal space as a novel anatomical compartment allowing photoreceptors access to the retinal pigment epithelium (RPE) and Müller cells, the two cell types which share the burden of 11-cis retinoid regeneration. To take advantage of this arrangement, early vertebrates appear to have recruited for retinoid binding, the ββα-spiral fold proven useful in enoyl-CoA isomerase/hydratases, and the carboxy-terminal proteases for stabilizing hydrophobic ligands. Quadruplication of this functional domain within a single polypeptide lead to the emergence of interphotoreceptor retinoid-binding protein (IRBP). IRBP is the main soluble component of the IPM, and is prevented from diffusing out of the subretinal space because its large size excludes it from the photoreceptor/Müller cell zonulae adheretes. Despite this physical entrapment, IRBP is rapidly turned over within the IPM through a process that coordinates secretion of the protein by the photoreceptors, and its removal from the matrix by RPE and photoreceptor endocytosis. The present review will summarize what is known about the structure and function of IRBP to anticipate future avenues of research.