Jesper Hjortdal

Aarhus University Hospital, Aarhus, Central Jutland, Denmark

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Publications (158)358.35 Total impact

  • N. Blom · A. Andreasen · S. Heegaard · J. Hjortdal · K. Nielsen
    Acta Ophthalmologica; 10/2015
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    ABSTRACT: The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.
    Journal of Ophthalmology 09/2015; 2015(11):912481. DOI:10.1155/2015/912481 · 1.43 Impact Factor
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    ABSTRACT: Tear film proteins adhere to the surface of contact lenses (CLs). While the proteins in the tears have been extensively studied with various proteomic techniques, adhered proteins to CLs are less studied. In this pilot study, we have separated proteins with 2D gel electrophoresis prior to the conventional mass spectrometry (MS) in order to analyse the deposited proteins on hydrogel CLs from myopic patients. pHEMA and PVA hydrogel CLs worn by 3 patients for different time lengths were analysed. After wear, the CLs were frozen at -20°C. Proteins were extracted in lysis buffer, separated on 12% polyacrylamide gels and silver-stained. Protein spots were excised and identified with liquid chromatography - tandem MS. Deposited proteins were extracted with a yield of 26-66 μg and separated by 2D gel electrophoresis. The silver-stained gels showed similar protein patterns independent of the patient, hydrogel type and wear time. Seventy-two spots were analysed with MS, representing at least 12 different tear film proteins or protein fragments. Deposited tear film proteins from a single set of CLs worn for 1 day can successfully be analysed first with 2D gel electrophoresis and subsequently with MS, thus making examination of individual patients possible. The protein composition appeared homogeneous between the test persons which is a necessity for additional comparison analysis. The molecular masses of the identified proteins indicate that protein degradation occurs only as a minor event. Myopic patients were investigated in this pilot study, but the combined techniques can easily be applied to other eye diseases. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
    Acta ophthalmologica 07/2015; DOI:10.1111/aos.12800 · 2.84 Impact Factor
  • Maria Hovlykke · Anders Ivarsen · Jesper Hjortdal
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    ABSTRACT: To evaluate the impact of venting incisions on the best corrected visual acuity (BCVA), astigmatism, aberrations, and risk of graft detachment in Descemet stripping automated keratoplasty (DSAEK). This was a retrospective, comparative, consecutive case series of DSAEK procedures performed with (n = 266) and without (n = 110) venting incisions. Patients were treated with DSAEK for Fuchs' endothelial dystrophy at Aarhus University Hospital between 2011 and 2013. Data included preoperative keratometry and postoperative BCVA, subjective astigmatism, and Pentacam® HR tomography with corneal front surface (CFS) aberrations at 1 to 2 years of follow-up. Numbers of triple procedures (concurrent cataract surgery) and post-operative graft detachments were also noted. The venting and non-venting groups were compared by the data-means. Unpaired t-tests and Mann-Whitney tests were used for normally and non-normally distributed data, respectively. Differences in graft detachments were analyzed with Fisher's exact and Chi square test. There was no significant difference in any parameter, except the numbers of triple procedures. BCVA (logMAR) was 0.25 ± 0.18 in the venting group and 0.25 ± 0.19 in the non-venting group (p = 0.92), subjective astigmatism was -1.53 ± 0.99 diopters and -1.33 ± 0.78 diopters (p = 0.15), respectively. CFS astigmatism and higher order aberrations were statistically uniform. The relative risk (RR) of graft detachment was also uniform between the venting versus non-venting group (RR 0.72, p = 0.40), and between triple versus non-triple procedures (RR 0.71, p = 0.43). The preoperative corneal curvature had no impact on the risk of graft detachment (p = 0.74). Venting incisions in DSAEK do not significantly alter BCVA, astigmatism, CFS aberrations or reduce the risk of graft detachment in triple or non-triple procedures.
    Albrecht von Graæes Archiv für Ophthalmologie 07/2015; 253(9). DOI:10.1007/s00417-015-3101-4 · 1.91 Impact Factor
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    ABSTRACT: The need for cataract surgery is expected to rise dramatically in the future due to the increasing proportion of elderly citizens and increasing demands for optimum visual function. The aim of this study was to provide an evidence-based recommendation for the indication of cataract surgery based on which group of patients are most likely to benefit from surgery. A systematic literature search was performed in the MEDLINE, CINAHL, EMBASE and COCHRANE LIBRARY databases. Studies evaluating the outcome after cataract surgery according to preoperative visual acuity and visual complaints were included in a meta-analysis. We identified eight observational studies comparing outcome after cataract surgery in patients with poor (<20/40) and fair (>20/40) preoperative visual acuity. We could not find any studies that compared outcome after cataract surgery in patients with few or many preoperative visual complaints. A meta-analysis showed that the outcome of cataract surgery, evaluated as objective and subjective visual improvement, was independent on preoperative visual acuity. There is a lack of scientific evidence to guide the clinician in deciding which patients are most likely to benefit from surgery. To overcome this shortage of evidence, many systems have been developed internationally to prioritize patients on waiting lists for cataract surgery, but the Swedish NIKE (Nationell Indikationsmodell för Katarakt Ekstraktion) is the only system where an association to the preoperative scoring of a patient has been related to outcome of cataract surgery. We advise that clinicians are inspired by the NIKE system when they decide which patients to operate to ensure that surgery is only offered to patients who are expected to benefit from cataract surgery. © 2015 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.
    Acta ophthalmologica 06/2015; DOI:10.1111/aos.12758 · 2.84 Impact Factor
  • Ophthalmology 05/2015; 122(6):e35-6. DOI:10.1016/j.ophtha.2014.11.028 · 6.14 Impact Factor
  • Esben Nielsen · Jesper hjortdal · Mogens Erlandsen · Anders Ivarsen
    ARVO 2015; 05/2015
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    Deepali Sandeep Tambe · Anders Ivarsen · Jesper Hjortdal
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    ABSTRACT: To assess the efficacy and safety of topography-guided photorefractive keratectomy (PRK) for keratoconus and to estimate the subsequent risk of progression. This is a retrospective follow-up study. Between 1998 and 2013, 28 eyes of 23 patients (age 17-60) with grade 1-3 keratoconus received topography-guided PRK. Corrected-distance visual acuity (CDVA), keratometry, pachymetry, and corneal topography were assessed before, after 3 months, and at a late follow-up of a median of 7 years after the procedure. Postoperative complications including subsequent keratoplasty were noted. Of the 28 eyes, 5 (18%percnt;) had undergone corneal transplantation at a median of 7 years (range 3-10) after PRK. Four eyes were not available for follow-up. In the remaining 19 eyes, CDVA was improved in 16 eyes (84.3%percnt;), reduced in 2 eyes (10.5%percnt;), and unchanged in 1 eye (5.2%percnt;). Thus, average CDVA had improved from 0.49 logMAR before PRK to 0.27 logMAR at 3 months, and to 0.24 at the long-term follow-up. The mean spherical equivalent was reduced from - 6.2 to -3.7 dpt after 3 months and to -2.1 dpt at the late follow-up. Similarly, the mean cylinder was reduced from -4.2 to -3.0 dpt after 3 months and at the late follow-up. Topography-guided PRK in keratoconus may be effective for reducing myopia and astigmatism and may offer a temporary or permanent alternative to keratoplasty in contact lens-intolerant keratoconus. In the present study, we found a low risk of keratoconus progression after PRK.
    Case Reports in Ophthalmology 05/2015; 6(2):260-8. DOI:10.1159/000431306
  • Cornea 03/2015; 34(5):e15. DOI:10.1097/ICO.0000000000000402 · 2.04 Impact Factor
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    ABSTRACT: Endophthalmitis is one of the most feared complications after cataract surgery. The aim of this systematic review was to evaluate the effect of intracameral and topical antibiotics on the prevention of endophthalmitis after cataract surgery. A systematic literature review in the MEDLINE, CINAHL, Cochrane Library and EMBASE databases revealed one randomized trial and 17 observational studies concerning the prophylactic effect of intracameral antibiotic administration on the rate of endophthalmitis after cataract surgery. The effect of topical antibiotics on endophthalmitis rate was reported by one randomized trial and one observational study. The quality and design of the included studies were analysed using the Cochrane risk of bias tool. The quality of the evidence was evaluated using the GRADE approach. We found high-to-moderate quality evidence for a marked reduction in the risk of endophthalmitis with the use of intracameral antibiotic administration of cefazolin, cefuroxime and moxifloxacin, whereas no effect was found with the use of topical antibiotics or intracameral vancomycin. Endophthalmitis occurred on average in one of 2855 surgeries when intracameral antibiotics were used compared to one of 485 surgeries when intracameral antibiotics were not used. The relative risk (95% CI) of endophthalmitis was reduced to 0.12 (0.08; 0.18) when intracameral antibiotics were used. The difference was highly significant (p < 0.00001). Intracameral antibiotic therapy is the best choice for preventing endophthalmitis after cataract surgery. We did not find evidence to conclude that topical antibiotic therapy prevents endophthalmitis. © 2015 The Authors Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.
    Acta ophthalmologica 03/2015; 93(4). DOI:10.1111/aos.12684 · 2.84 Impact Factor
  • Anders Gyldenkerne · Anders Ivarsen · Jesper Ø Hjortdal
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    ABSTRACT: To compare corneal curvatures, corneal power calculations, and higher-order aberrations (HOAs) of femtosecond laser-assisted LASIK (FS-LASIK) with small incision lenticule extraction (SMILE) following surgery for moderate to high myopia. A retrospective study of 736 eyes of 368 patients treated with SMILE and 148 eyes of 74 patients treated with FS-LASIK. Preoperative mean spherical equivalent was -7.3 ± 1.5 diopters in the SMILE group and -7.6 ± 1.3 diopters in the FS-LASIK group. Corneal curvatures, corneal power calculations performed by ray tracing, and HOAs measured with Scheimpflug technology before and 3 months after surgery were analyzed. Corneal curvatures changed significantly in the anterior corneal surface, but not in the posterior corneal surface, in both groups; after SMILE, the sagittal curvature was constant for the central 4-mm diameter, in contrast to FS-LASIK where the curvature showed a gradual steepening with increasing diameter. Corneal power calculations were different across the cornea depending on the measurement diameter between the two groups postoperatively. Measured over a 5-mm zone on the total cornea, FS-LASIK induced 0.11 μm more coma (P < .001) and 0.13 μm higher spherical aberration (P < .001) as compared to SMILE; similar results in other HOAs were seen for the anterior corneal surface. Negligible differences in HOAs were induced on the posterior corneal surface. SMILE and FS-LASIK produced distinct changes in anterior corneal shape evident in different postoperative corneal curvatures and power measurements between the two groups. Postoperative HOAs were much lower after SMILE as compared to FS-LASIK. [J Refract Surg. 2015;XX(X):XX-XX.]. Copyright 2015, SLACK Incorporated.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 03/2015; 31(4):1-7. DOI:10.3928/1081597X-20150303-01 · 3.47 Impact Factor
  • Ophthalmology 02/2015; 122(2):e17. DOI:10.1016/j.ophtha.2014.08.004 · 6.14 Impact Factor
  • Anders Gyldenkerne · Anders Ivarsen · Jesper Ø. Hjortdal
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    ABSTRACT: PurposeTo investigate whether the Pentacam HR could accurately predict the surgically induced refractive change in patients operated with small-incision lenticule extraction (SMILE) for myopia or femto-second laser in situ keratomileusis (FS-LASIK) for myopia or hyperopic astigmatism.Methods Data from three groups consisting of (1) 410 myopic eyes of 410 patients operated with SMILE, (2) 111 myopic eyes of 111 patients operated with FS-LASIK, and (3) 40 eyes of 40 patients with hyperopic astigmatism operated with FS-LASIK were retrospectively analysed. The change in manifest refraction due to surgery was compared with the objectively measured change in corneal power by the Pentacam HR in three different ways: Sagittal Power (calculated as for placido topographers), True Net Power (calculated by a Gaussian optics formula), and Total Corneal Refractive Power (calculated by ray tracing). Multiple linear regression analysis was performed to investigate which parameters influenced the Pentacam HR's prediction of the change in subjective refraction due to surgery.ResultsThe Total Corneal Refractive Power Apex, Zone calculation in a diameter of 4.0 mm effectively predicted the surgically induced refractive change for all three patient groups. The spherical equivalent was predicted with an error of 0.08 ± 0.41 D for the SMILE eyes, 0.05 ± 0.61 D for the myopic eyes operated with FS-LASIK, and −0.15 ± 0.49 D for the hyperopic astigmatic eyes treated with FS-LASIK. Regression showed that preoperative refractive error had a significant impact on the prediction error of the Pentacam HR.Conclusions Ray tracing calculations based on Scheimpflug imaging accurately assessed the change in manifest refraction due to corneal laser surgery.
    Ophthalmic and Physiological Optics 02/2015; 35(3). DOI:10.1111/opo.12202 · 2.18 Impact Factor
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    ABSTRACT: Age-related macular degeneration (AMD) and cataract often coexist in patients and concerns that cataract surgery is associated with an increased risk of incidence or progression of existing AMD has been raised. This systematic review and meta-analysis is focused on presenting the evidence concerning progression of AMD in patients undergoing cataract surgery. We performed a systematic literature search in the PubMed, Medline, Cochrane Library and CINAHL databases. Two randomized trials and two case-control trials were identified. Quality of the studies was assessed using the Cochrane risk of bias tool, data were extracted, and meta-analyses were performed. Quality of the available evidence was evaluated using the GRADE system. We found that visual acuity at 6-12 months follow-up was significantly better (6.5-7.5 letters) in eyes that had undergone cataract surgery than in unoperated eyes, but the included number of subjects was small, and hence, the quality of evidence was downgraded to moderate. We did not find an increased risk of progression to exudative AMD 6-12 months after cataract surgery [RR 3.21 (0.14-75.68)], but the included number of subjects was small, and thus, the quality of the evidence was moderate. Cataract surgery increases visual acuity without an increased risk of progression to exudative AMD, but further research with longer follow-up is encouraged. © 2015 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.
    Acta ophthalmologica 01/2015; DOI:10.1111/aos.12665 · 2.84 Impact Factor
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    ABSTRACT: While efforts have been made over the years, the exact cause of keratoconus (KC) remains unknown. The aim of this study was to identify alterations in endogenous metabolites in the tears of KC patients compared with age-matched healthy subjects. Three groups were tested: 1) Age-matched controls with no eye disease (N = 15), 2) KC - patients wearing Rigid Gas permeable lenses (N = 16), and 3) KC - No Correction (N = 14). All samples were processed for metabolomics analysis using LC-MS/MS. We identified a total of 296 different metabolites of which >40 were significantly regulated between groups. Glycolysis and gluconeogenesis had significant changes, such as 3-phosphoglycerate and 1,3 diphosphateglycerate. As a result the citric acid cycle (TCA) was also affected with notable changes in Isocitrate, aconitate, malate, and acetylphosphate, up regulated in Group 2 and/or 3. Urea cycle was also affected, especially in Group 3 where ornithine and aspartate were up-regulated by at least 3 fold. The oxidation state was also severely affected. Groups 2 and 3 were under severe oxidative stress causing multiple metabolites to be regulated when compared to Group 1. Group 2 and 3, both showed significant down regulation in GSH-to-GSSG ratio when compared to Group 1. Another indicator of oxidative stress, the ratio of lactate - pyruvate was also affected with Groups 2 and 3 showing at least a 2-fold up regulation. Overall, our data indicate that levels of metabolites related to urea cycle, TCA cycle and oxidative stress are highly altered in KC patients. Copyright © 2015. Published by Elsevier Ltd.
    Experimental Eye Research 01/2015; 132. DOI:10.1016/j.exer.2015.01.007 · 2.71 Impact Factor
  • V.Magnusdottir · J.Hjortdal · K.Nielsen
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    ABSTRACT: Purpose: Shortage of donor corneal tissue exists in Denmark. The Danish Donor Register founded in 1990, contains individuals' consents to donation of a variety of tissues and organs including the cornea. This study describes the registered donors. Methods: Data from the Donor Register was analyzed. Results: Since the beginning of the register, the number of registered citizens has increased and now represents 18% of the total adult population. In addition, the diversity of consents has also evolved. Citizens in the larger cities consent more often than citizens living outside the cities. Females consent more often than men. Of those consenting to donation in the Donor Register, almost 85% of them have agreed to cornea donation. The Danish Cornea Bank however only record less than half of the expected donors among the deceased in hospitals due to the discrepancy in the age among the registered and the age at death. Conclusion: The number of corneas donated and procured is increasing. Corneal transplantation is the most common tissue/organ transplant procedure in Denmark.
  • Journal of refractive surgery (Thorofare, N.J.: 1995) 12/2014; 30(11):727-8. · 3.47 Impact Factor
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    ABSTRACT: Keratoconus (KC) is a bilateral degenerative disease of the cornea characterized by corneal bulging, stromal thinning, and scarring. The etiology of the disease is unknown. In this study, we identified a new biomarker for KC that is present in vivo and in vitro. In vivo, tear samples were collected from age-matched controls with no eye disease (n = 36) and KC diagnosed subjects (n = 17). Samples were processed for proteomics using LC-MS/MS. In vitro, cells were isolated from controls (Human Corneal Fibroblasts-HCF) and KC subjects (Human Keratoconus Cells-HKC) and stimulated with a Vitamin C (VitC) derivative for 4 weeks, and with one of the three transforming growth factor-beta (TGF-β) isoforms. Samples were analyzed using real-time PCR and Western Blots. By using proteomics analysis, the Gross cystic disease fluid protein-15 (GCDFP-15) or prolactin-inducible protein (PIP) was found to be the best independent biomarker able to discriminate between KC and controls. The intensity of GCDFP-15/PIP was significantly higher in healthy subjects compared to KC-diagnosed. Similar findings were seen in vitro, using a 3D culture model. All three TGF-β isoforms significantly down-regulated the expression of GCDFP-15/PIP. Zinc-alpha-2-glycoprotein (AZGP1), a protein that binds to PIP, was identified by proteomics and cell culture to be highly regulated. In this study by different complementary techniques we confirmed the potential role of GCDFP-15/PIP as a novel biomarker for KC disease. It is likely that exploring the GCDFP-15/PIP-AZGP1 interactions will help better understand the mechanism of KC disease.
    PLoS ONE 11/2014; 9(11):e113310. DOI:10.1371/journal.pone.0113310 · 3.23 Impact Factor
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    ABSTRACT: Purpose: To assess the repeatability, reproducibility, and age dependency of dynamic Scheimpflug-based pneumotonometry (Corvis)-generated parameters and their correlation with dynamic bidirectional pneumotonometry device [Ocular Response Analyzer (ORA)] measurements [corneal hysteresis (CH) and corneal resistance factor (CRF)]. Methods: Eyes of 29 healthy participants between 20 and 30 years old were measured using Corvis and ORA. Measurements were performed twice in a row and repeated after 1 week. Repeatability and reproducibility were examined by calculating intraday and interday coefficients of variation (CVs). Corvis measurements were compared with measurements from 19 participants older than 65 years. Results: The most repeatable and reproducible Corvis-generated parameters, with intraday and interday CVs < 10% were as follows: intraocular pressure (IOP), pachymetry, time to first and second applanation (A1 time, A2 time), radius and amplitude at highest concavity (HC radius and HC deformation amplitude, respectively), time to highest concavity (HC time), deflection length and amplitude at highest concavity [HC deflection length and HC deflection amplitude (millimeter), respectively], and time to highest deflection amplitude [HC deflection amplitude (millisecond)]. However, 7 of 19 analyzed parameters showed CVs > 10%. HC-related parameters showed significant age dependency. The correlation between Corvis and ORA was weak (A2 time and CH, r = 0.36, A1 time and CRF, r = 0.41). Corvis-derived IOP was on average 2.2 ± 2.3 mm Hg higher than cornea-compensated IOP, with large differences in patients with high-average IOP. Conclusions: The considerable variation in repeatability and reproducibility should be taken into account when using the Corvis. Corvis parameters showed poor correlation with CH and CRF obtained by ORA measurements.
    Cornea 11/2014; 34(1). DOI:10.1097/ICO.0000000000000293 · 2.04 Impact Factor
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    ABSTRACT: Acanthamoeba keratitis is a serious sight-threatening disease. The relatively low temperature of the cornea may explain why amoebic infections usually are localized in this tissue and rarely spread to other parts of the eye. In this study, the growth rate of the amoeba Acanthamoeba castellanii was examined at different temperatures. The aim was to establish the optimal growth temperature for A. castellanii and to examine the growth within the vicinity of the core body temperature. The growth rates of four clinical and two environmental strains of A. castellanii were estimated at different temperatures, and temperature limitations for the trophozoite stage was established. Movements influenced by temperature gradients were monitored for two clinical strains of A. castellanii. The highest growth rate for each of the six amoebic strains tested was found to be close to 32 °C. The growth of the trophozoites of all examined strains was greatly reduced or completely halted at temperatures above 36 °C and encysted at the elevated temperature. Thus, the optimal growth temperature for the four strains of A. castellanii is close to the surface temperature of the human cornea, while the higher body core-temperature induced encysting of the amoebae. This may explain why most amoebic eye infections are confined to the cornea.
    Parasitology Research 09/2014; 113(12). DOI:10.1007/s00436-014-4109-0 · 2.10 Impact Factor

Publication Stats

2k Citations
358.35 Total Impact Points


  • 1996–2015
    • Aarhus University Hospital
      • Department of Ophthalmology
      Aarhus, Central Jutland, Denmark
  • 2014
    • University of Oklahoma Health Sciences Center
      Oklahoma City, Oklahoma, United States
  • 1996–2014
    • Aarhus University
      Aarhus, Central Jutland, Denmark
  • 2001
    • Aalborg University
      Ålborg, North Denmark, Denmark
  • 1996–1997
    • University Medical Center Hamburg - Eppendorf
      • Department of Ophthalmology
      Hamburg, Hamburg, Germany