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Purpose: To investigate the use of analytic approaches for eye-specific outcomes in ophthalmology publications., Design: A review of analytic approaches used in original research articles published in ophthalmology journals., Methods: All 161 research articles published in 5 ophthalmology journals in the first 2 months of 2008 were considered. Publications were categorized according to analytic approach: 1 eye selected, both eyes contribute, or per-individual outcome. Studies were considered suboptimal when criteria for eye selection were not provided or when measurements from both eyes were included without interocular correlation being considered. Visual impairment prevalence data were used to illustrate analytic approach choices., Results: Measurements from both eyes were included in 38% of the 112 studies that used statistical inferential techniques. In 31 (74%), there was no mention of possible correlation. Only 7% used statistical methods appropriate for correlated outcomes. In 35 studies (31%), measurements from 1 eye were selected; 31% of these did not provide selection criteria. In 67%, only univariate tests were used. A review of 47 articles published in 2011 produced similar findings. Characteristics of studies were not found to differ according whether the studies were suboptimal. Using a test appropriate for correlated outcomes resulted in a P value 3.5 times that obtained ignoring the correlation., Conclusions: Between-eye correlation seems not to be assessed commonly in ophthalmology publications, although its knowledge aids the choice of analytic approach when eye-specific variables are of interest. Statistical methods appropriate for correlated ocular outcome data are not being applied widely., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: To develop an in vivo rabbit eyecup preparation that preserves neuronal and vascular connections with normal posterior segment contour, permitting direct access to the retina and facilitating retinal microsurgical and neuroscience research., Methods: Cyanoacrylate glue was applied to the anterior sclera of six Dutch-belted rabbits before open-sky vitrectomy. The glue was used to harden the compliant scleral wall and to fix it to the surrounding periorbital tissues., Results: A normal contour of the posterior segment was retained in all cases. Vitrectomy under air was successfully accomplished and an extensive removal of the vitreous gel was achieved. Fluorescein angiography revealed normal vascular patency of the retinal vessels after vitrectomy., Conclusions: The proposed modification of the rabbit eyecup retains the normal neurovascular connections and configuration of the retina, making it suitable for retinal microsurgical maneuvers or any procedures in which easy access to anatomically undisturbed retina is required.

We examined 92 normal eyes using Javal Ophthalmometer and Corneal Analysis System (EyeSys) intending to compare the keratometric readings obtained by these two instruments. Dioptric power and location at flatter and steeper meridians, keratometric astigmatism values, and average central keratometric power were measured in the central cornea of all eyes. Statistical analysis showed significant differences in flatter meridians' mean power values (mean difference = 0.13 D, P = .008), mean keratometric astigmatism values (mean difference = -0.20 D, P = .001) and steeper meridians' location (mean difference = 7 degrees, P = .0001). There was no significant difference in steeper meridians' mean power values (mean difference = -0.06 D, P = .38), flatter meridian location (mean difference = 5.9 degrees, P = .07), and mean average central keratometric power (mean difference = 0.03 D, P = .471). Clinically meaningful difference was observed only in keratometric astigmatism readings of eyes with keratometric astigmatism higher than 1.50 D (mean difference = -0.84 D). For all the other parameters measured, the differences between the two instruments readings were clinically acceptable.

Anastasia Bakaliou,1 Constantine Georgakopoulos,1 Miltiadis Tsilimbaris,2 Nikolaos Farmakakis1 1Ophthalmology Department, Medical School of Patras, University of Patras, Patras, Greece; 2Ophthalmology Department, Medical School of Crete, University of Crete, Heraklion, GreeceCorrespondence: Constantine Georgakopoulos, Email cgeorg@upatras.grPurpose: To examine the state of the posterior vitreous in eyes with exudative age-related macular degeneration, AMD, non-exudative AMD and in normal eyes.Study: This is a prospective, cross-sectional study.Methods: B-scan ultrasonography and Optical Coherence Tomography, OCT were performed in 165 patients older than 65 years with any AMD and in 22 patients older than 65 years with normal eyes in order to diagnose the eyes with complete posterior vitreous detachment, PVD and the eyes with persistent central vitreomacular adhesion, VMA. All patients were selected from the outpatient clinic of the Ophthalmology Department in the University Hospital of Patras. Fundus Fluoroangiography, FFA was used in order to determine the development of exudative AMD from non-exudative AMD. Follow up time was 48 months.Results: 16/171 eyes with exudative AMD (9.36%) had complete PVD, and the rest 155/171 (90.64%) had central VMA. Eleven of 138 eyes with non-exudative AMD (7.97%) had complete PVD and the remaining 127 eyes (92.03%) had central VMA. During the 48 months of the study, 28 eyes, all with central VMA progressed to exudative AMD.Conclusion: Vitreomacular adhesion is associated with both exudative and non-exudative AMD. Progression of the non-exudative eyes to exudative AMD seems to be lower in eyes with complete PVD. On the other hand, the progression of normal eyes to exudative AMD appears to be independent of the posterior vitreous status. Larger and longer studies need to replicate these findings and support the potential of a protective role of complete posterior vitreous detachment in the evolution of the disease.Keywords: exudative age-related macular degeneration, vitreomacular adhesion, PVD, complete posterior vitreous detachment

Alexandros Rouvas,1 Ioannis Datseris,2 Sofia Androudi,3 Miltiadis Tsilimbaris,4 Stamatina A Kabanarou,5 Nikolaos Pharmakakis,6 Chryssanthi Koutsandrea,7 Alexander Charonis,8 Olga Kousidou,9 Georgia Pantelopoulou9 1 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece; 2OMMA Ophthalmological Institute of Athens, Athens, Greece; 3Ophthalmology Clinic, University of Thessaly, Larissa, Greece; 4Ophthalmological Clinic, University of Crete Medical School, Heraklion, Greece; 5Department of Ophthalmology, General Hospital of Athens ‘korgialenio-Benakio’, Athens, Greece; 6Department of Ophthalmology, University of Patras, Patras, Greece; 7Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece; 8Retina Service, Athens Vision Eye Institute, Athens, Greece; 9Medical Department, Novartis (Hellas), Athens, GreeceCorrespondence: Olga Kousidou, Medical Department, Novartis (Hellas), National Road No. 1 12th Km, Metamorphosis, Athens, GR-144 51, Greece, Tel +30 210 289 7189, Fax +302102835053, Email olga.kousidou@novartis.comPurpose: Real-world evidence on short-term outcomes of ranibizumab in wet age-related macular degeneration (wAMD) following inadequate response to aflibercept is scarce. This study aimed to evaluate the functional and anatomic effects of switching to ranibizumab in cases of wAMD previously treated with aflibercept with inadequate response.Patients and Methods: Prospective, observational study performed in eight ophthalmology hospital/private clinics in Greece, enrolling consented patients with active wAMD, ≥ 50 years-old, who had initiated ranibizumab ≥ 28 days and < 2 months after their last aflibercept injection. Data were collected at enrollment, and at 1, 3 and 6 months post-treatment onset (post-baseline).Results: Between September-2015 and November-2017, 103 eligible patients (56.3% females; mean age: 74.8± 8.6 years) were consecutively enrolled. The age at AMD diagnosis in the study eye was 71.3± 8.8 years. Aflibercept (median of 5 injections received over 11.3 months) had been discontinued for anatomical (in 69.9%) and/or functional (38.8%) reasons. At baseline (median: 24.3 months after wAMD diagnosis), choroidal neovascularization was occult in 69.1% of evaluable study eyes; 60.2% of the study eyes had pigment epithelial detachment (PED); 42.7% cysts; 21.4% fibrosis; 66.0% subretinal, and 59.2% intraretinal fluid. At 6 months post-baseline: a median of 3 ranibizumab injections (range: 1– 6) had been received; the best-corrected visual acuity (BCVA)≥ 0 letter gain rate was 81.8%; the BCVA ≥ 15 letter gain rate was 17.0%; BCVA gain was 3.2 letters [mean increase: 3.2± 10.0 letters; median: 0.0; p = 0.002]; PED greatest basal diameter (GBD; median: 1470.5 μm) also decreased (median decrease: 114.0 μm; p = 0.019). Baseline central retinal thickness (CRT; median: 312.0 μm) remained unchanged. One patient permanently discontinued ranibizumab due to adverse event occurrence, assessed as not causally related to ranibizumab. There were no ranibizumab-related adverse reactions.Conclusion: Six-month treatment with ranibizumab in aflibercept inadequate responders led to visual acuity and PED GBD improvements, with no statistically significant CRT change.Keywords: best corrected visual acuity, central retinal thickness, pigment epithelial detachment

Dimitrios A Karagiannis,1 Meropi Lygerou,2 Georgios Papadopoulos,3 Stamatina A Kabanarou,4 Miltiadis Aspiotis5,†, Doukas C Dardabounis,6 Panagiotis G Minakakis,7 Sofia I Spai,8 Chrysanthi Koutsandrea,9 Panagiotis Oikonomidis,10 Georgia N Pantelopoulou,11 Olga C Kousidou,11 Miltiadis Tsilimbaris12 On Behalf of the ADVICE study group1Ophthalmiatrio Athens Hospital, Athens 10672, Greece; 2OMMA, Ophthalmological Institute of Athens, Athens 11525, Greece; 3Ophthalmology Clinic, General Hospital of Aigio, Aigio, Greece; 4Retina Department, Korgialeneio Benakeio Hellenic Red Cross Hospital, Athens 11526, Greece; 5Ophthalmology Department, University of Ioannina, Ioannina 45500, Greece; 6Ophthalmology Clinic, University Hospital of Alexandroupolis, Dragana 68100, Alexandroupolis, Greece; 7Ophthalmological Clinic, General Hospital of Nikea-Piraeus, Nikea 18545, Greece; 8Ophthalmology Clinic, Sismanogleio General Hospital of Athens, Athens, Greece; 9National and Kapodistrian University of Athens, Filothei, Athens 15237, Greece; 10Ophthalmology Clinic, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece; 11Novartis Hellas, Medical Department, Athens, Greece; 12Ophthalmological Clinic, University Hospital of Heraklion, Heraklion, GreeceCorrespondence: Olga C KousidouNovartis Hellas, Medical Department, 12th Klm National Road No. 1, Athens, GreeceEmail olga.kousidou@novartis.comPurpose: This multicenter, epidemiological, cross-sectional study aimed to estimate the annual cumulative incidence of major macular diseases that cause visual impairment and require therapeutic intervention in the routine care of Greece.Methods: The study was carried out between December 2012 and May 2015 in 20 ophthalmology clinics. Over a one-year recruitment period per study site, all treatment naïve adult patients newly diagnosed with wet age-related macular degeneration, visual impairment due to diabetic macular edema or macular edema secondary to retinal vein occlusion requiring therapeutic management and who had not been diagnosed or treated for the same disease in the past were enrolled after providing informed consent. Study data were collected during the single study visit.Results: A total of 1532 incident cases were enrolled. The estimated annual cumulative incidence of wet age-related macular degeneration, diabetic macular edema and macular edema secondary to retinal vein occlusion requiring therapeutic management was 0.82 [95% confidence interval (CI): 0.76, 0.88; n=723], 0.63 (95% CI: 0.58, 0.69; n=559), and 0.29 (95% CI: 0.25, 0.32; n=250) per 10,000 cases, respectively.Conclusion: The study provides estimates of the incidence of major macular diseases causing visual impairment and requiring treatment in outpatient hospital settings in Greece, indicating a considerable socioeconomic burden to the healthcare system.Keywords: anti-VEGF, diabetic macular edema, epidemiology, incidence, retinal vein occlusion, wet age-related macular degeneration