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Neurodegeneration characterizes pathologic conditions, ranging from Alzheimer's disease to glaucoma, with devastating social and economic effects. It is a complex process implicating a series of molecular and cellular events, such as oxidative stress, mitochondrial dysfunction, protein misfolding, excitotoxicity and inflammation. Natural compounds, because of their broad spectrum of pharmacological and biological activities, could be possible candidates for the management of such multifactorial morbidities. However, their therapeutic potential against neurodegenerative diseases has been hampered by their poor bioavailability and subsequent insufficient delivery to the brain. This article provides an overview of the molecular mechanisms through which natural compounds exert their neuroprotective effects, as well as the development of novel natural compound-loaded delivery systems that could improve their neuroavailability., (Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim. To investigate the effect of more than 25-year cigarette smoking on choroidal and retinal thickness, using spectral domain optical coherence tomography (SD-OCT). Methods. Thirty-one smokers and 25 age- and sex-matched nonsmokers, serving as control group, were submitted to slit-lamp biomicroscopy and dilated fundoscopy, SD-OCT, measurements of intraocular pressure (IOP), central corneal thickness (CCT), and axial length (AL). Heidelberg Spectralis was used to calculate choroidal thickness (CT), ganglion cell complex (GCC), outer retina layers (ORL), and macular thicknesses (MT). Results. The smokers' group consisted of 17 males and 14 females with mean age of 57.8 ± 4.5 years, while the controls' group consisted of 14 males and 11 females with mean age of 68.0 ± 4.1 years. CT and GCC thicknesses were significantly reduced in smokers compared to control group. The differences in thicknesses of ORL were marginally significant between two groups. The measurements of MT, IOP, CCT, and AL had the same distributions between smokers and nonsmokers. Conclusions. Tobacco smoking seems to result in thinner choroid and retina compared to nonsmokers. This is the first study in literature that investigates the anatomical effect of smoking for more than 25 years on the choroid and retina.

In medieval Arabic medicine Ophthalmology had a central role. Ocular anatomy was described in many ophthalmological treatises of the physicians of the time. These physicians followed the doctrines of Galen according ocular anatomy, nevertheless their contribution to the history of ocular anatomy was the presentation of ocular anatomical sketches in their manuscripts for the fist time in medical history.

Multifocal electroretinography (mfERG) is an objective, noninvasive examination for the assessment of visual function. It enables the stimulation of multiple retinal areas simultaneously and recording of each response independently, providing a topographic measure of retinal electrophysiological activity in the central 40-50° of the retina. A clinical application of mfERG represents the assessment of retinal toxicity associated with systemic medications. Drug-induced retinopathy represents a disease that, although not common, requires early recognition: if not detected early, it may progress and cause irreversible retinal dysfunction with subsequent visual impairment. This review aims to evaluate the use of mfERG in the assessment of retinal dysfunction associated with various systemic pharmacological agents based on the currently available literature. The most commonly recognized systemic medications affecting retinal function are included, such as chloroquine and hydroxychloroquine, vigabatrin, deferoxamine, ethambutol, interferon-α, tamoxifen, digoxin, sildenafil, canthaxanthin, amiodarone and nefazodone. The role of mfERG in the early diagnosis of retinal toxicity and the evaluation of disease severity is reviewed, as well as its clinical value in monitoring disease progression or recovery after drug cessation., (© 2016 S. Karger AG, Basel.)

Aim: To assess the role of plasma platelet activating factor acetylhydrolase (PAF-AH) in pathogenesis and progression of diabetic retinopathy (DR)., Materials and Methods: Sixty eight diabetics and 23 age-frequency-matched non-diabetic patients underwent blood sampling and the plasma PAF-AH activity was calculated. The diabetic patients were further classified into two groups, according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification, based on indirect fundoscopy and fluorescein angiography. Thirty seven patients with non-proliferative DR (NPDR) and 31 patients with proliferative DR (PDR) were finally included in the study., Results: The plasma PAF-AH activity was increased in diabetic patients with PDR (0.206 μmol/min/ml) compared to control group (0.114 μmol/min/ml, post-hoc Bonferroni comparison test: p<0.0001) and to NPDR group (0.147 μmol/min/ml, post-hoc Bonferroni comparison test: p=0.012)., Conclusions: The activity of PAF-AH in the plasma increases in parallel with DR severity., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In the ophthalmological treatises of the medieval Arabo-Islamic physicians such as al-Mawsili (9th-10th century), al-Kahhal (ca. 940-1010), Haly Abbas (10th century) and al Sadili (14th century) we may find references about ocular cancer, focusing on eyelid tumors and cancerous ulcers of the cornea. These references are similar to the analogous ones of ancient Greek physicians as these are preserved in the medical texts of the most famous Byzantine doctors, indicating the influence of ancient Greek medicine in the Arabo-Islamic one.

Herpes zoster ophthalmicus (HZO) is a clinical manifestation of the reactivation of latent varicella zoster virus (VZV) infection and is more common in people with diminished cell-mediated immunity. Lesions and pain correspond to the affected dermatomes, mostly in first or second trigeminal branch and progress from maculae, papules to vesicles and form pustules, and crusts. Complications are cutaneous, visceral, neurological, ocular, but the most debilitating is post-herpetic neuralgia. Herpes zoster ophthalmicus may affect all the ophthalmic structures, but most severe eye-threatening complications are panuveitis, acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) as well. Antiviral medications remain the primary therapy, mainly useful in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of HZO are critical in limiting visual morbidity. Vaccine in adults over 60 was found to be highly effective to boost waning immunity what reduces both the burden of herpes zoster (HZ) disease and the incidence of post-herpetic neuralgia (PHN).

A 35-year-old water polo player was struck in his right eye during a water polo game. At presentation to our hospital, his visual acuity, intraocular pressure, fundus examination and neurological examination were normal. He received the appropriate treatment (no corticosteroids were applied), but 1 week later he reported blurred vision in his left eye. Visual acuity in the left eye was 6/10 Snellen chart, fluorescein angiography showed a focal retinal pigment epithelium leakage, while optical coherence tomography through the macula revealed mild neurosensory retinal detachment with an increase in retinal thickness. Two weeks later, the situation improved, and 1 month later no signs or symptoms of central serous chorioretinopathy were present. Currently, 9 months later, the situation remains unchanged. Post-traumatic stress was recognised as the key factor for development of central serous chorioretinopathy in our patient, since it was followed by excessive release of catecholamines and increased endogenous cortisol levels., (2015 BMJ Publishing Group Ltd.)

Background: Retrobulbar block is a local anesthetic technique widely used for intraocular surgery. Although retrobulbar anesthesia is considered to be relatively safe, a number of serious adverse events have been reported. To our knowledge, immediate onset of generalized seizures with contralateral hemiparesis after retrobulbar anesthesia has not been reported., Case Presentation: A 62-year-old Caucasian healthy male with a right eye retinal detachment was admitted for pars plana vitrectomy. During retrobulbar anesthesia with ropivacaine and before needle withdrawal, the patient developed twitching of the face which rapidly progressed to generalized tonic-clonic seizures. Arterial oxygen saturation decreased to 75 %. Chin lift was performed and 100 % oxygen was administrated via face mask, which increased saturation to 99 %. Midazolam 2 mg was administrated intravenously to control seizures. After cessation of seizures, left-sided hemiparesis was evident. Brain computed tomography and electroencephalogram were normal 3 h later. The patient underwent pars plana vitrectomy under general anesthesia 4 days later., Conclusion: Serious complications of local anesthesia for ophthalmic surgery are uncommon. We present a case in which generalized tonic-clonic seizures developed during retrobulbar anesthesia, followed by transient contralateral hemiparesis. The early onset of seizures indicated intra-arterial injection of the anesthetic. Our case suggested the need for close monitoring during the performance of retrobulbar anesthesia and the presence of well-trained personnel for early recognition and immediate management of the complications.

Background: Cystoid macular edema (CME) in retinitis pigmentosa (RP) has been managed in several ways as documented in the literature, with little success, though. The aim of our study was to report for the first time in literature the use of aflibercept in a patient with RP and CME., Case Presentation: A 52-year-old man presented for blurred vision in his right eye. Best-corrected visual acuity (BCVA) was 3/10 in his right eye and 7/10 in his left eye. Physical examination and appropriate laboratory tests lead to the diagnosis of bilateral RP with CME in the right eye. Retinal thickness in the foveal area of the right eye was 631 μm. The patient was treated with a single intravitreal injection of 0.05 ml/0.5 mg aflibercept. One month later, BCVA of the right eye increased to 4/10, while BCVA of the left eye was unchanged. RT in the right eye decreased to 129 μm. Multifocal electroretinogram response did not improve, yet peaks were better-shaped and no areas of eccentral vision were present. Three and six months after injection, these improvements were maintained., Conclusion: This first-reported case indicates that intravitreal aflibercept injection for addressing CME in RP seems to be an effective treatment.

Background: The presence of an intraocular cilium is very rare and the response of the eye to the cilium is variable. We present the case of a patient with a cilium found in the vitreous cavity during vitrectomy for rhegmatogenous retinal detachment 40 years following penetrating eye injury. To our knowledge, this is the longest reported presence of a cilium in the vitreous cavity., Case Presentation: A 70-year-old Caucasian woman presented to the emergency department of our hospital complaining of sudden visual impairment and floaters of her right eye initiated 2 weeks earlier. Ophthalmic history included a penetrating injury of the right eye with a sharp metallic object 40 years ago and an uncomplicated phacoemulsification surgery in the same eye 2 years earlier. Fundoscopy revealed an inferior macula off rhegmatogenous retinal detachment. No inflammation was present. During vitrectomy and under scleral indentation at 5-o'clock position, a cilium was found at far retinal periphery. One end of the cilium was embedded in the retina, whereas the other end floated freely in the vitreous. The cilium was removed through the pars plana sclerotomy with intraocular foreign body forceps. The procedure was completed without any complications., Conclusion: Penetrating eye injury is the most possible cause of cilium entrance in vitreous cavity in this case, which suggests that cilium can be well tolerated in vitreous cavity for as long as 40 years.

Background: A number of mutations in the VSX1 and SOD1 genes have been reported to be associated with keratoconus (KC), however the results from different studies are controversial. In this study, we conducted the genotyping of common polymorphisms [VSX1: D144E, H244R, R166W, G160D; SOD1: intronic 7-base deletion (c.169 + 50 delTAAACAG)], in a case-control sample panel of the Greek population., Materials and Methods: A case-control panel, with 33 KC patients and 78 healthy controls, were surveyed. DNA from each individual was tested for the VSX1: D144E, H244R, R166W, G160D and SOD1: intronic 7-base deletion (c.169 + 50 delTAAACAG) polymorphisms by direct sequencing., Results: We observed no polymorphisms of the VSX1 gene in the case-control panel. Concerning the SOD1 intronic 7-base deletion (c.169 + 50 delTAAACAG), our findings suggest that heterozygous carriers are over-represented among KC cases compared to healthy controls (p = 0.002)., Conclusions: We cannot confirm the previously reported association of the polymorphism in the VSX1 gene with KC. Our results suggest a possible causative role of SOD1 in the pathogenesis of KC. Further studies are required to identify other important genetic factors involved in the pathogenesis and progression of KC.

Background: In this study, we conducted the genotyping of D326Y in COL4A3 and M1327V, as well as F1644F in COL4A4 polymorphisms, in a case-control sample panel of Greek origin population., Materials and Methods: A case-control panel, with 45 keratoconus (KC) patients and 78 healthy controls, were surveyed. DNA from each individual was tested for the D326Y in COL4A3 and M1327V, as well as F1644F in COL4A4 polymorphisms by direct sequencing., Results: When analyzing the Hardy-Weinberg equilibrium, we observed no significant deviation from expected numbers in both KC patients and controls. The genotype frequencies in the polymorphisms tested were not found to be significantly associated with KC development risk. The M1327V AA and F1644F TT genotypes were significantly over-represented in healthy individuals., Conclusions: We could hypothesize that mutations in COL4A3 and COL4A4 genes are not involved in KC risk in Greek population. Nevertheless, the M1327V AA and F1644F TT genotypes were significantly over-represented in healthy individuals, suggesting a protective role of these genotypes in KC development risk in our population.

Purpose: To investigate the expression of chemokine CXCL-1 in the subretinal fluid (SRF) during rhegmatogenous retinal detachment (RRD) and identify potential correlations with number of quadrants involved and duration of the detachment., Methods and Results: Inclusion criteria were patients aged 18 years or older and primary RRD possibly complicated by proliferative vitreoretinopathy (PVR). CXCL-1 levels were measured in 36 SRF samples from 36 RRD patients. Mean CXCL-1 levels (102 ± 37 pg/mL) were significantly higher (p = 0.050) compared to controls. CXCL-1 levels correlated significantly with age (p = 0.001) and RRD duration (p = 0.002). Maximum CXCL-1 levels coincided with total RRD, 29- to 60-day duration and PVR grade C., Conclusions: The findings of this study may contribute to increased understanding regarding the role of CXCL-1 during the onset and progression of the wound healing process in the context of RRD and PVR.

Purpose: To assess foveal thickness by spectral-domain optical coherence tomography (SD-OCT) during acute anterior uveitis (AAU) in HLA-B27 patients., Methods: Foveal thickness was measured at baseline and after clinical resolution of the uveitis. Data of the affected eyes of 11 patients were compared to those of a fellow, healthy eyes and to those of counterpart volunteers., Results: At baseline mean foveal thickness was 190 ± 28 µm in affected eyes, 166 ± 20 µm in fellow eyes (p < 0.001), and 162±14 µm in control group (p = 0.01). On the second OCT evaluation, no significant change was observed in affected eyes while the difference versus fellow eyes and control group remained statistically significant., Conclusions: A significant increase in foveal thickness was observed in eyes with HLA -B27 AAU when compared with healthy eyes. The difference persisted for at least one month, despite full clinical and functional recovery.

Objective: To investigate the role of Platelet Activating Factor (PAF) in the pathogenesis and development of Age-Related Macular Degeneration (ARMD)., Research Design and Methods: Fifty six patients with ARMD (24 patients with dry ARMD and 32 patients with wet ARMD) and 25 age-matched control participants underwent ophthalmological examination, including visual acuity measurement and evaluation of the retina. The participants were classified into three groups according to their retinal status, based on indirect fundoscopy, Optical Coherence Tomography and fluorescein angiography findings. In order to evaluate the concentrations of PAF in serum, blood samples were collected from all participants and were analyzed with ELISA technique., Results: The concentrations of PAF differed significantly according to macular lesions and were found to be lower in patients with ARMD than control participants., Conclusions: PAF levels are decreased along with the severity of ARMD. Understanding the role of PAF in pathogenesis of ARMD could be the impetus for the development of new therapies field of treatment of ARMD or even other retinal diseases.

The purpose of this review is to bring together to the physiology and psychology of vision and to analyze, based on our own data and on the available literature, the relationship between sight loss and individual reactions. As recent treatments for depression are often effective and have few side-effects, ophthalmologists should consider referral for treatment of depression in patients suffering from vision impairment. For this reason, vision rehabilitation should be more readily available and recommended.

Objective: The purpose of our study was to investigate for the first time a series of vitamin supplements used for age-related macular degeneration (AMD) as potential inhibitors of platelet-activating factor (PAF)., Materials and Methods: Various vitamin supplements were tested in washed rabbit platelets (WRPs), in order to investigate the interaction between vitamin supplements (InShape, Nutrof, Ocuvite, Vitalux) and inhibition of PAF-induced platelet aggregation. Additionally, we examined their ability to affect PAF-metabolism, through their in vitro effect on PAF basic metabolic enzymes (PAF-CPT, lyso PAF-AT, and PAF-AH)., Results: Nutrof exhibited the strongest anti-PAF activity, while Vitalux was the most potent anti-inflammatory factor., Conclusion: This is the first study to bring in surface potent anti-inflammatory and anti-angiogenic activities of some vitamin supplements used against AMD, through their in vitro anti-PAF effects in WRPs and the rabbit plasma and leukocyte PAF metabolism, suggesting a promising role of vitamin supplements and especially resveratrol, concerning its potent anti-angiogenic activity in AMD.

Aim: To evaluate and compare the predictive capacity of four intraocular lens (IOL) power calculation formulas (SRK/T, Hoffer Q, Holladay 1, and Haigis) in eyes shorter than 22.0 mm., Setting and Design: Observational study., Materials and Methods: Participants in our study were 69 consecutive patients with a preoperative axial length (AL) of less than 22.0 mm in one or both eyes. All patients underwent phacoemulsification with IOL implantation and postoperative target of refraction was analyzed. Specifically, the differences in the mean absolute estimation error (AE) for the four formulas were analyzed. Furthermore, the percentage of eyes with AE within ± 0.5 and ± 1.0 D for each formula was estimated, as well as the correlation coefficient (r) between the AL and estimation error (E) for each formula. The Mann-Whitney U test was used to compare differences in the AEs of the formulas. A statistically significant difference was defined as P < 0.05., Results: The Haigis formula had statistically significant smaller mean AE in comparison to Holladay 1, Hoffer Q, and SRK/T. The Haigis formula predicted more eyes with E within ± 0.5 and ± 1.0 D of predicted spherical equivalent compared to other formulas. Correlation between AL and AE revealed a negative r value and P < 0.05 for all formulas., Conclusions: Haigis formula provides more accurate results concerning the postoperative target of refraction in eyes with AL less than 22.0 mm. Hoffer Q could be also used as an alternative.

Background: Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion., Methods: Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search., Results: Treatment modalities were analyzed., Conclusions: There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).

Purpose. To present the case of a 27-year-old male patient with stage IV proliferative sickle cell retinopathy, treated with one intravitreal injection of ranibizumab, showing regression of the neovascularization and no recurrence at the 9-month follow-up. Methods. A 27-year-old male patient presented with blurred vision and floaters in the right eye since three days. His best corrected visual acuity was 6/18. Ophthalmological examination and fluorescein angiography revealed proliferative sickle cell retinopathy stage IV with vitreous hemorrhage and sea fan neovascularization, as well as ischemic areas at the temporal periphery. Results. The patient was treated with one intravitreal injection of ranibizumab, presenting improvement in the visual acuity from 6/18 to 6/6, resolution of vitreous hemorrhage, and regression of the neovascularization. Additionally, he underwent scatter laser photocoagulation at the ischemic areas. At the 9-month follow-up there was no recurrence, while no adverse effects were noticed. Conclusions. Intravitreal ranibizumab may be a useful adjunct to laser photocoagulation in the management of proliferative sickle cell retinopathy and may permit some patients to avoid pars plana vitrectomy for vitreous hemorrhage.

Aim. To investigate the ability of Heidelberg Retina Tomograph (HRT3) Topographic Change Analysis (TCA) map to predict the subsequent development of clinical change, in patients with glaucoma. Materials. 61 eyes of 61 patients, which, from a retrospective review were defined as stable on optic nerve head (ONH) stereophotographs and visual field (VF), were enrolled in a prospective study. Eyes were classified as TCA-stable or TCA-progressed based on the TCA map. All patients underwent HRT3, VF, and ONH stereophotography at 9-12 months intervals. Clinical glaucoma progression was determined by masked assessment of ONH stereophotographs and VF Guided Progression Analysis. Results. The median (IQR) total HRT follow-up period was 8.1 (7.3, 9.1) years, which included a median retrospective and prospective follow-up time of 3.9 (3.1, 5.0) and 4.0 (3.5, 4.7) years, respectively. In the TCA-stable eyes, VF and/or photographic progression occurred in 5/13 (38.4%) eyes compared to 11/48 (22.9%) of the TCA-progressed eyes. There was no statistically significant association between TCA progression and clinically relevant (photographic and/or VF) progression (hazard ratio, 1.18; P = 0.762). The observed median time to clinical progression from enrollment was significantly shorter in the TCA-progressed group compared to the TCA-stable group (P = 0.04). Conclusion. Our results indicate that the commercially available TCA progression criteria do not adequately predict subsequent photographic and/or VF progression.

Background: Methanol intoxication is a dangerous situation because it often results in permanent problems such as visual deterioration, metabolic disturbances, neurological dysfunction, and even death. We present, to the best of our knowledge, the first case of irreversible bilateral blindness due to methanol intoxication caused by accidental ingestion of rubbing liquid., Case Presentation: A 49-year-old Greek man developed bilateral irreversible blindness after accidental methanol intoxication. He underwent complete ophthalmological examination, including electroretinogram, visual evoked potentials, multifocal-visual evoked potentials, and optical coherence tomography scan of the optic nerve. Complete laboratory evaluation, urine drug testing, neurological examination, and computed tomography scans were also performed. Visual acuity demonstrated no light perception bilaterally, pupils were semi-dilated and unreactive to light, while the retina was normal in both eyes. Electroretinogram was normal, while visual evoked potentials, multifocal-visual evoked potentials recording, and optical coherence tomography scanning of both optic nerve heads were pathological in both eyes. The neurological examination and the computed tomography scans did not reveal any abnormalities. The laboratory evaluation was normal and the urine drug test was negative for benzodiazepines, opiates, cocaine, amphetamines, salicylates, barbiturates, and phencyclidine., Conclusion: This is the first case report of methanol intoxication which documents both anatomical and functional abnormalities by means of optical coherence tomography and electrophysiological tests correspondingly. The ocular findings and the reported electrophysiological changes support the hypothesis that methanol affects photoreceptors, Müller cells, and the retrolaminar portion of the optic nerve.

Purpose: To evaluate the retinal toxicity of intravitreal trastuzumab in a rabbit model., Methods: Fourteen New Zealand albino rabbits, weighing between 2.5 and 3 kg were used for this study. In the first group (n=6), 0.1 mL trastuzumab 10 mg/mL was injected into the vitreous. In the second group (n=6), the same volume of sterile balanced saline solution was injected intravitreally (sham injection). Additionally, 0.1 mL of 2 other concentrations of trastuzumab (7.5 and 5 mg/mL, respectively), was injected into the vitreous of 2 rabbits. Slit-lamp and funduscopic examinations were performed and the animals were observed for 2 weeks for signs of inflammation, infection, and toxicity. An electroretinogram (ERG) was performed at baseline and 14 days after the injection. The animals were killed on day 14 and a histological examination was performed in the enucleated eyes., Results: The clinical examination was unremarkable on either sham or intravitreal injection of trastuzumab. Conversely, the ERG was greatly affected and in 2 cases extinguished 14 days after trastuzumab injection. Consistent with electrophysiological abnormalities of the retina, signs of retinal edema in experimented eyes, suggesting morphologic retinal damage, were observed. In contrast, in the sham injected eyes, the ERG was normal without histopathologic retinal changes., Conclusions: Intravitreal trastuzumab seems to be toxic to the retina in albino rabbits even at a concentration of 5 mg/mL. Further studies are needed to evaluate the safety of intravitreal trastuzumab in models of choroidal neovascularization, as well as to obtain experience concerning the intravitreal toxicity of trastuzumab in primates too and not only in rabbits.

We report a case of a 52-year-old man who developed superficial and intraretinal hemorrhages, retinal edema and extensive cotton-wool patches, 2 weeks after the subconjuctival injection of gentamicin at the end of a 25 gauge sutureless vitrectomy (pars plana vitrectomy) for the repair of a, macula on, retinal detachment in his left eye. Fluorescein angiography revealed sharply defined zones of retinal vascular non-perfusion, mostly confined to the posterior pole and visual acuity deteriorated to 1/20 and remained unchanged during the follow up time. Our case illustrates the possibility of aminoglycoside toxicity after 25-gauge transconjunctaval sutureless PPV when the latter is administered subconjuctivally. It emphasizes that less toxic subconjuctival antibiotics may be considered for sutureless surgery, since if aminoglycoside toxicity occurs, the patient's vision may be permanently affected.

Objective: The purpose of our study was to investigate the effect of an inadvertent intravitreal injection of botulinum toxin A (BTA) on the intraocular pressure (IOP) and the retina in an animal model., Methods: BTA was injected intravitreally in normotensive rats. IOP was measured preoperatively as well as 1, 2, and 4 weeks postoperatively. Retinas were stained in vivo using a retrograde labelling technique and the density of retinal ganglion cells (RGCs) was determined. Immunohistochemistry was performed for rhodopsin and retinal glial fibrillary acidic protein (GFAP)., Results: Significant temporary IOP elevation occurred in all groups in the immediate postoperative period (ANOVA, p < 0.05). IOP changes in the intermediate period were not statistically significant (ANOVA, p > 0.05). The differences in the density of RGCs after BTA injection were not statistically significant (ANOVA, p > 0.05). All retinas displayed the same immunostaining pattern for rhodopsin and GFAP., Conclusion: Our findings indicate that BTA has probably no severe impact on IOP and the retina after an inadvertent intravitreal injection. However, temporary rise of IOP may possibly occur in the immediate postoperative period due to a volume-effect.

Background: Our study aims to investigate the possible risk factors for poor vision-related quality of life in patients scheduled to undergo phacoemulsification., Methods: Participants in our study were 220 patients who were eligible for phacoemulsification cataract surgery. All participants underwent a routine ophthalmological examination and completed the Visual Function Questionnaire-25 (VFQ-25), which encompasses 12 subscales and the composite score. Sociodemographic and lifestyle parameters were evaluated as potential risk factors for low VFQ-25 composite score, as well as subscale scores. Multivariate regression analysis was performed., Results: Composite score did not exhibit any significant associations. General Health subscale score was positively associated with higher educational level. Patients who currently worked presented with lower Vision Specific Mental Health subscale score (OR: 0.33, 95 % CI: 0.18 to 0.63). Vision Specific Role Difficulties subscale score was positively associated with exercise (OR: 1.89, 95 % CI: 1.30 to 2.75). Vision Specific Dependency subscale score was independently positively associated with marital status (married vs single/widowed/divorced, OR: 1.83, 95 % CI: 1.08 to 3.12) but inversely with current working status (OR: 0.40, 95 % CI: 0.20 to 0.79). Males exhibited lower Peripheral Vision subscale score compared with females (OR: 0.19, 95 % CI: 0.04 to 0.91)., Conclusions: Baseline vision-related quality of life in cataract patients presenting for surgery seems affected by inherent sociodemographic and lifestyle parameters, such as gender, educational level, marital status, current working status and exercise. Therefore, clinicians should be aware of the discrepancies that risk factors may confer, and should thus focus on the most vulnerable subgroups.

Purpose: The purpose of our study was to assess the macular thickness and the electrophysiological changes in keratoconic patients without any systemic or ocular disorders., Methods: 64 eyes of 32 keratoconus patients as well as 60 eyes of 30 controls participated in the study. All participants underwent a complete ophthalmological examination, including best-corrected visual acuity (BCVA) assessment, color vision testing, fundus examination, intraocular pressure measurement, central foveal thickness (CFT) measurement by optical coherence tomography (OCT) scan, and multifocal-electroretinogram (mf-ERG) recording. CFT, retinal response density (RRD) and P1 latency were measured., Results: There was no statistically significant difference between the two groups concerning CFT and P1 latency in mf-ERG. The RRD in mf-ERG differed significantly between keratoconus patients and controls. Of note, BCVA was positively associated with RRD in keratoconus patients., Conclusion: In some cases of keratoconus, a macular dysfunction not visible ophthalmoscopically may coexist and the low visual acuity could be due not only to the corneal abnormality, but also to the photoreceptor dysfunction. As a result, the preoperative electrophysiological study of patients with keratoconus is crucial to avoid a needless corneal transplantation., (Copyright © 2013 S. Karger AG, Basel.)

A 72-year-old woman presented with unexplained, progressive, painless visual loss in the right eye during the past six months. At presentation visual acuity (VA) was 3/60 in the right eye and 6/6 in the left eye. Anterior segment examination and intraocular pressures were normal. Dilated fundoscopy revealed significant macular oedema in the right eye and a normal fundus appearance in the left eye. Her medical history was noteworthy for breast ductal carcinoma in situ, for which she had undergone right mastectomy three years earlier. She had not received chemotherapy or radiotherapy but she had been under treatment with letrozole 2.5 mg/day over the past three years. She did not receive any other medication. Optical coherence tomography showed intraretinal fluid and a significant increase in retinal thickness in the foveal and parafoveal areas, while fluorescein angiography detected foveal hyperfluorescence and leakage of the dye in the late phase. Multifocal electroretinogram showed a decreased response in both eyes. In suspicion of letrozole-related retinopathy, the patient was advised to stop the medication. The patient agreed to receive an intravitreal injection of 0.05 ml/0.5 mg ranibizumab. One month later, VA in the right eye was 6/9 and macular oedema had apparently improved. This is the first reported case of letrozole-associated macular oedema treated with intravitreal ranibizumab., (© 2012 The Authors; Clinical and Experimental Optometry © 2012 Optometrists Association Australia.)

Introduction: To summarize the currently available evidence of platelet-activating factor (PAF) implication in the pathogenesis of inflammatory ocular diseases., Areas Covered: PAF is a potent mediator of inflammation, implicated in the pathogenesis of chronic inflammatory disorders, allergic reactions, oncogenic transformation, wound repair and hypoxia-induced angiogenesis. It seems to be involved in the protection of ocular surface against various harmful agents through inflammatory processes, which can lead to chronic allergic reactions or even corneal neovascularization and haze, if they do not undergo regulation. Pathogenesis of uveitis, which is significant cause for the blurring of the visual system, has also been associated with PAF's activity. The hypoxia and the breakdown of the blood-retina barrier, observed in severe vascular retinal diseases, such as age-related macular degeneration and diabetic retinopathy, are associated with PAF ocular activity., Expert Opinion: Understanding the pathophysiology of vision threatening diseases could enhance clinical treatment and encourage experimental studies, which could be based on potential beneficial effects of new agents, such as PAF antagonists.

Purpose: The purpose of this study was to evaluate the macular and retinal nerve fiber layer (RNFL) thickness, and the electrical activity of the macula in patients with Alzheimer's disease (AD)., Material and Methods: 30 patients with AD and 30 age and sex matched healthy controls were studied. The thickness and the electrical activity of the macula were evaluated by means of optical coherence tomography (OCT) and multifocal-electroretinogram (mf-ERG)., Results: Visual acuity, as well as visual fields and colour vision testing of all patients were normal. However, the mean foveal thickness was 148.50 μm (vs. 171.50 μm in the control group, p=0.001) and the RNFL thickness was 104.5 μm in the superior area (vs 123 μm in the control group, p < 0.0001) and 116.5 μm in the inferior area (vs. 138 μm in the control group, p < 0.0001) around the optic nerve. The mean P1 response density amplitude of the foveal area was 146.50 nV/deg2 (vs. 293 nV/deg2 in the control group, p < 0.0001) and the perifoveal area was 56.60 nV/deg2 (vs. 81.50 nv/deg2 in the control group, p < 0.001)., Conclusion: Our study showed that in patients with AD, even without visual failure there was a decrease in macular and RNFL thickness, as well as a decrease of the electrical activity of the macula.

Background: To evaluate objectively the anatomical and functional changes of optic nerve in eyes with primary open angle glaucoma (POAG) by the joint use of optical coherence tomography (OCT) and multifocal visual evoked potentials (mfVEP)., Methods: 29 eyes with open angle glaucoma and visual field defects, as well as 20 eyes of 10 age-matched control normal subjects were tested. All participants underwent a complete ophthalmological examination. Moreover, Humphrey visual field test, OCT examination and recording of mfVEP were performed. Amplitude and implicit time of mfVEP, as well as RNFL thickness were measured. Differences in density components of mfVEP and in RNFL thickness among POAG eyes and control eyes were examined using Student's t-test., Results: In glaucomatous eyes the mean Retinal Response Density (RRD) was lower than normal in ring 1, 2 and 3 of mfVEP (p < 0.0001). Specifically the mean amplitude of mfVEP in POAG eyes was estimated at 34.2 ± 17.6 nV/deg2, 6.9 ± 4.8 nV/deg2 and 2.6 ± 1.6 nV/deg2 in rings 1, 2 and 3 respectively. In contrast the mean implicit time was similar to control eyes. In addition, the mean RNFL thickness in POAG eyes was estimated at 76.8 ± 26.6 μm in the superior area, 52.1 ± 16.3 μm in the temporal area, 75.9 ± 32.5 μm in the inferior area and 58.6 ± 19.4 μm in the nasal area. There was a statistically significant difference in RNFL thickness in all peripapillary areas (p < 0.0001) between POAG eyes and controls, with superior and inferior area to present the highest decrease., Conclusions: Our study shows that, although Standard Automatic Perimetry is the gold standard to evaluate glaucomatous neuropathy, the joint use of mfVEP and OCT could be useful in better monitoring glaucoma progression.

Purpose: The purpose of our study was to evaluate the effectiveness of preoperative and postoperative addition of topical diclofenac to chloramphenicol/dexamethasone in patients undergoing uneventful phacoemulsification cataract surgery., Methods: Patients were randomized to (1) chloramphenicol 0.5%-dexamethasone 0.1%, 1 drop 4 times a day (n=41), or (2) chloramphenicol 0.5%-dexamethasone 0.1%, 1 drop 4 times a day, plus diclofenac 0.1%, 1 drop 3 times a day (n=38). Patients in the second group also received diclofenac 0.1% for 3 days before surgery. Topical treatment was administered for 28 days after phacoemulsification. On postoperative days 1, 14, and 28, best corrected visual acuity, macular thickness, endothelial cell density, and central corneal thickness (CCT) were measured., Results: The 2 groups did not have a statistically significant difference for CCT, endothelial cell density, macular thickness, and visual acuity at the 3 time points of the follow-up period., Conclusions: The addition of diclofenac did not seem to offer any additional benefit after uneventful phacoemulsification.

Background: We have previously shown that the slow Wallerian degeneration mutation, whilst delaying axonal degeneration after optic nerve crush, does not protect retinal ganglion cell (RGC) bodies in adult rats. To test the effects of a combination approach protecting both axons and cell bodies we performed combined optic nerve crush and lens injury, which results in both enhanced RGC survival as well as axon regeneration past the lesion site in wildtype animals., Results: As previously reported we found that the Wld(S) mutation does not protect RGC bodies after optic nerve crush alone. Surprisingly, we found that Wld(S) transgenic rats did not exhibit the enhanced RGC survival response after combined optic nerve crush and lens injury that was observed in wildtype rats. RGC axon regeneration past the optic nerve lesion site was, however, similar in Wld(S) and wildtypes. Furthermore, activation of retinal glia, previously shown to be associated with enhanced RGC survival and axon regeneration after optic nerve crush and lens injury, was unaffected in Wld(S) transgenic rats., Conclusions: RGC axon regeneration is similar between Wld(S) transgenic and wildtype rats, but Wld(S) transgenic rats do not exhibit enhanced RGC survival after combined optic nerve crush and lens injury suggesting that the neuroprotective effects of lens injury on RGC survival may be limited by the Wld(S) protein.

Purpose: To compare intravitreal ranibizumab, intravitreal ranibizumab plus photodynamic therapy (PDT), and intravitreal triamcinolone plus PDT in retinal angiomatous proliferation, presenting the results of a 3-year follow-up., Methods: Thirty-seven eyes of 37 patients with retinal angiomatous proliferation were randomized to 1 of the 3 groups. Group 1 (n = 13) received 3 monthly injections of 0.5 mg ranibizumab, Group 2 (n = 13) received 1 session of PDT and 3 monthly injections of ranibizumab, and Group 3 (n = 11) received 1 session of PDT and 1 injection of 4 mg triamcinolone. Retreatment, with the same therapeutic scheme in each group, was considered in case of persistence or recurrence of subretinal/intraretinal fluid., Results: Twelve patients in Groups 1 and 2 and 9 patients in Group 3 completed the 3-year follow-up. A total of 58% of patients in Group 1, 50% in Group 2, and 88.9% in Group 3 had the same or better visual acuity at the end of the follow-up (P = 0.081). Patients in Group 3 exhibited considerable improvement in visual acuity (P = 0.032) and statistically significant decrease in central retinal thickness (P < 0.0001) than the 2 other groups at the end of the follow-up. Also, the patients in Group 3 received on average the lowest number of injections (P < 0.0001). Of note, geographic atrophy mainly at the place of previous retinal angiomatous proliferation lesion was detected in 0% in Group 1, 25% in Group 2, and 55.6% in Group 3 (P = 0.203), while 33.3% of patients in Group 1 developed retinal scar., Conclusion: Treatment with ranibizumab or ranibizumab plus PDT resulted in stabilization of the disease, while treatment with IVT plus PDT achieved better results in terms of functional and anatomical features compared with the other groups.

Background: Computer use can cause visual problems. The purpose of our study was to evaluate visual problems due to computer use in young adults., Patients and Methods: Participants in our study were 87 adults, 48 male and 39 female, mean aged 31.3 years old (SD 7.6). All the participants completed a questionnaire regarding visual problems detected after computer use., Results: The mean daily use of computers was 3.2 hours (SD 2.7). 65.5 % of the participants complained for dry eye, mainly after more than 2.5 hours of computer use. 32 persons (36.8 %) had a foreign body sensation in their eyes, while 15 participants (17.2 %) complained for blurred vision which caused difficulties in driving, after 3.25 hours of continuous computer use. 10.3 % of the participants sought medical advice for their problem. There was a statistically significant correlation between the frequency of visual problems and the duration of computer use (p = 0.021). 79.3 % of the participants use artificial tears during or after long use of computers, so as not to feel any ocular discomfort., Conclusions: The main symptom after computer use in young adults was dry eye. All visual problems associated with the duration of computer use. Artificial tears play an important role in the treatment of ocular discomfort after computer use., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The aim was to compare the retinal nerve fibre layer (RNFL) thickness and visual evoked potentials (VEP) among eyes with multiple sclerosis (MS)-associated optic neuritis, unaffected eyes of the same patients and eyes of disease-free controls. Changes in RNFL thickness, visual acuity (VA) and VEP over time are evaluated in MS-associated optic neuritis., Methods: Forty-six eyes of 23 patients (six male and 17 female), who suffer from MS and were diagnosed with unilateral or bilateral optic neuritis, participated in the study. Forty eyes of 20 age- and gender-matched controls were tested. VA measurement, optical coherence tomography and VEP were performed in all patients at presentation and at one, three and six months thereafter., Results: There was a statistically significant difference in VA between MS eyes with optic neuritis and controls (p < 0.0001), as well as between MS eyes with and without optic neuritis (p < 0.005). VA improved over time. Average RNFL thickness was reduced in MS eyes with or without optic neuritis in comparison to control eyes. This reduction in RNFL thickness was more marked over time. The amplitude of P(100) was significantly decreased in MS eyes with optic neuritis in comparison to controls (p < 0.0001) and there was a statistically significant delay in peak time of P(100) in MS eyes with optic neuritis versus the eyes of normal subjects (p < 0.0001), which improved over time., Conclusion: The present study suggests that there is a progressive decrease in RNFL over time in eyes with optic neuritis associated with MS. The amplitude and latency of P(100) in VEP examination returned to normal ranges over time., (© 2012 The Authors. Clinical and Experimental Optometry © 2012 Optometrists Association Australia.)

An 86-year-old man presented with blurred vision and pain in the left eye. A slitlamp examination revealed anterior uveitis with hypopyon. During the investigation of the uveitis, the diagnosis of tuberculosis was confirmed. Hypopyon is a rare manifestation of uveitis due to tuberculosis., (© 2012 The Authors. Clinical and Experimental Optometry © 2012 Optometrists Association Australia.)

Background:   The aim was to evaluate the correlation between the anatomical and functional outcomes before and after treatment of uveitic macular oedema., Methods:   Thirty-three eyes of 33 patients with uveitic macular oedema were included in the present study. Visual acuity (VA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were measured before and after treatment of the macular oedema. Correlation analyses between VA, OCT and mfERG parameters were performed., Results:   The VA and mfERG measurements showed statistically significant improvement after treatment of the macular oedema (p < 0.01) and OCT-measured central foveal thickness decreased significantly from 434 ± 135 µm before treatment to 267 ± 92 µm after treatment (p < 0.001). Correlation analyses showed that uveitic central foveal thickness before treatment was correlated with mfERG N1 response amplitude of area 1 (Spearman's r = -0.62, p < 0.001). VA (logMAR) after treatment had a negative correlation with the mfERG N1 response amplitude of area 1 (Spearman's r = -0.56, p = 0.001). Also, there was no correlation between the final VA and pre-treatment OCT and mfERG measurements., Conclusion:   This study deals with cystoid macular oedema associated with recurrent uveitis. In cystoid macular oedema, the value of mfERG before treatment is related to the central foveal thickness and VA. In contrast, after treatment the decrease of macular thickness is not always followed by an improvement of mfERG and VA. This supports the view that in uveitic macular oedema, the decrease in macular thickness after treatment may not be used as a predictor of improvement of macular function., (© 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia.)

Aim: The aim of this cross-sectional study is to evaluate the macular and retinal nerve fibre layer (RNFL) thickness, as well as the electrical activity of the macula in female patients suffering from anorexia nervosa (AN) without visual failure., Material and Methods: 13 female patients (26 eyes) suffering from AN without visual failure and 20 age and sex-matched healthy female controls (40 eyes) were studied. For the measurement of the macula thickness and the electrical activity of the macula, the optical coherence tomography (OCT) and the multifocal electroretinogram were used respectively., Results: The visual acuity, as well as the visual fields, the colour vision testing and the dark adaptation test of all patients were normal. However, the mean foveal thickness was 140.04 μm (vs 150.85 in the control group, p=0.005), and the RNFL thickness was limited to 116.42 μm in the superior area (vs 123.15 in the control group, p=0.372) and 121.08 μm in the inferior area (vs 137.6 in the control group, p<0.001) around the optic nerve. Also, the mean P1 response density amplitude of the foveal area was 159.04 nV/deg(2) (vs 292.43 in the control group, p<0.0001), and the perifoveal area was 79.04 nV/deg(2) (vs 82.63 in the control group, p=0.118)., Conclusion: The present study shows that in patients with AN, even without visual failure there is a decrease in macular and RNFL thickness, as well as a decrease in the electrical activity of the macula.

We report three subjects of a Greek family affected by triple A syndrome (AAAS). All patients underwent complete ophthalmic examination, full-field electroretinogram (ERG), visual evoked responses (VER), optical coherence tomography (OCT) and molecular analysis of the AAA gene. All patients had alacrima. In two of them, the proband and her brother, bilateral optic atrophy was assessed and the VER were pathological. In contrast, the ERG was normal. OCT showed a decrease of the retinal nerve fiber layer. The third case had only alacrima and the optic nerves were normal. The molecular genetic study of the AAAS gene revealed a homozygous missense mutation p.Ala167Val. To our knowledge this is the first time a family with AAAS has been investigated using OCT, VER and ERG. Our findings illustrate that the retina is not involved. There is also an interfamilial variability concerning the involvement of the optic nerves.

Background: The aim was to evaluate the macular structure and function in children with human immunodeficiency virus (HIV) disease without cytomegalovirus retinitis or visual symptoms., Methods: Thirty-eight eyes of 19 HIV-positive children (Group A) were examined. Group B included 20 (40 eyes) age- and sex-matched control subjects. Each individual underwent a complete ophthalmic examination, optical coherence tomography (OCT) scan and multifocal electroretinogram (mfERG) recording., Results: In all patients, visual acuity and colour vision testing were normal. The mean foveal thickness in groups A and B was 190.28 ± 26.58 (SD) µm and 169.47 ± 10.17 µm, respectively (p = 0.0002). In Group A, the mean retinal response density of the fovea (area 1) was 19.87 ± 10.16 nV/deg(2) and the latency was 38.56 ± 1.18 ms. In the parafoveal area (area 2), the mean retinal response density was 10.82 ± 2.34 nV/deg(2) and the mean latency was 36.52 ± 1.73 ms. In the perifoveal area (area 3), the mean retinal response density was 10.83 ± 0.90 nV/deg(2) and the mean latency was 36.36 ± 1.90 ms. In Group B, the mean retinal response density of area 1 was 22.02 ± 0.9 nV/deg(2) and the mean latency was 32.56 ± 1.25 ms. In area 2, the mean retinal response density was 12.23 ± 0.55 nV/deg(2) and the mean latency was 30.84 ± 1.22 ms. Finally, in the perifoveal area (area 3), the mean retinal response density was 12.74 ± 0.44 nV/deg(2) and the mean latency was 29.7 ± 11.09 ms. The differences in amplitude and latency were statistically significant., Conclusion:   Increased foveal thickening and significant decrease of the electrical activity of areas 1, 2 and 3 were found in HIV-positive children. These findings suggested some subclinical dysfunction of the photoreceptors and the inner retinal layers of the fovea in HIV-positive children with normal vision and without ocular disease., (© 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia.)

Background: The aim of this study was to evaluate, by optical coherence tomography (OCT) and multifocal electroretinography (mfERG), the macular function of eyes with choroidal neovascularisation due to age-related macular degeneration (AMD) before and after the intravitreal use of ranibizumab., Methods: Fifteen eyes with choroidal neovascularisation due to AMD were studied with OCT and mfERG before, during and at the end of the treatment, one year after the first injection of ranibizumab. The eyes received 0.5 mg ranibizumab every month for the first three months, followed by doses every three months. Thus, during the 12-month study, a total of six ranibizumab injections were given., Results: The level of visual acuity increased significantly with time. A linear mixed-effect analysis showed a borderline negative association between the amount of foveal thickness and time, with a decrease in the mean foveal thickness for one time increment. The retinal response density of the mfERG showed a significant increase in ring 1 and remained almost unchanged in ring 2, whereas there was a statistically insignificant increase in ring 3. Finally, the mean latency remained unchanged throughout the 12 months of treatment in all three rings., Conclusion: The intravitreal use of ranibizumab might result in an increase of the mfERG in the foveal area. Only a borderline inverse association was shown between the amount of foveal thickness and time. Also, the level of visual acuity statistically significantly improved over time. Randomised long-term clinical trials are needed to determine the potential clinical benefit of ranibizumab., (© 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia.)

Background: Ophthalmic viscosurgical devices (OVDs) are widely used in phacoemulsification cataract surgery to maintain adequate intraocular space, stabilize ocular tissue during the operation and decrease the possible damage of the corneal endothelium. Our study has the purpose to compare the corneal and foveal changes of Viscoat and Visthesia in patients undergoing uneventful phacoemulsification cataract surgery., Methods: Participants in our study were 77 consecutive patients, who were randomized into two groups based on type of OVD used during phacoemulsification: Viscoat or Visthesia. All patients underwent a complete ophthalmological examination i.e., measurement of best corrected visual acuity (BCVA) by means of Snellen charts, intraocular pressure examination by Goldmann tonometry, slit lamp examination, fundus examination, optical coherence tomography, specular microscopy and ultrasound pachymetry preoperatively and at three time points postoperatively (day 3, 15, 28 postoperatively). The differences in baseline characteristics, as well as in outcomes between the two groups were compared by Mann-Whitney-Wilcoxon test and Student's t-test, as appropriate., Results: Intraoperatively, there was no statistically significant difference in the duration of the ultrasound application between the two groups, while Viscoat group needed more time for the operation performance. It is also worthy to mention that Visthesia group exhibited less intense pain than patients in Viscoat group. Postoperatively, there was a statistically significant difference in central corneal thickness, endothelial cell count and macular thickness between the two groups, but BCVA (logMAR) did not differ between the two groups., Conclusions: Our study suggests that Viscoat is more safe and protective for the corneal endothelium during uneventful phacoemulsification cataract surgery, while Visthesia is in superior position regarding intraoperative pain. Patients of both groups acquired excellent visual acuity postoperative. Finally, this is the first study comparing OVDs in terms of macular thickness, finding that Visthesia cause a greater increase in macular thickness postoperatively than Viscoat, although it reaches normal ranges in both groups.

Background/aim: The E peptide of the IGF-1Ec transcript has been documented to stimulate the growth of different cell lines, via a type I IGF-1 receptor (IGF-1R)-independent mechanism. The aim of the present study was to determine the implication of the IGF-1Ec isoform into the posterior capsule opacification process in human lens epithelium., Materials and Methods: The expression of the IGF-1 system was characterized in human HLE-B3 lens epithelium cells and the mitogenic activity of IGF-1 and synthetic E peptide and the effects of growth hormone (GH) and dihydrotestosterone (DHT) were examined, using qualitative real-time PCR, RT-PCR, Western blot analysis and trypan blue exclusion assays in wild-type and IGF-1R knock-out HLE-B3 cells., Results: The data showed that HLE-B3 cells express only the IGF-1Ea and IGF-1R transcripts. GH increased the expression of IGF-1Ea and of the previously undetectable IGF-1Eb mRNA. Finally, IGF-1 did not present any activity in the knock-out cells., Conclusion: The IGF-1Ea isoform is the main source for the formation of mature IGF-1 in HLE-B3 cells. The effects of exogenous IGF-1 depend on the existence of IGF-1R. IGF-1 Ec is not expressed even in the presence of GH or DHT nor has it any effect on cell proliferation.