Evaluation of macular function and morphology following accelerated collagen cross-linking in progressive keratoconus

PURPOSE

To assess any changes in macular function and morphology in patients with progressive keratoconus undergoing accelerated corneal cross-linking (CXL).

METHODS

This prospective case series included 9 eyes of 8 patients with progressive keratoconus undergoing CXL using a high intensity accelerated protocol (9 mW/cm² for 14 min) with a total surface dose of 7.5 J/cm². Visual acuity assessment, slit lamp biomicroscopy, dilated fundoscopy, corneal tomography, multifocal electroretinography (mfERG) and spectral domain optical coherence tomography scan were performed at baseline, 2 weeks and 6 weeks postoperatively.

RESULTS

Uncorrected and corrected distance visual acuity did not change significantly at 2 weeks and 6 weeks following accelerated CXL compared to baseline. Retinal response density (RRD) of mfERG significantly decreased at 2 weeks postoperatively compared to baseline (p = 0.008) but did not differ from the baseline value at 6 weeks postoperatively in the fovea (ring 1) (p = 0.95). Similarly, P1 latency significantly decreased at 2 weeks (p = 0.04) but did not change at 6 weeks (p = 1.00) postoperatively compared to baseline in the fovea. No changes in RRD or P1 latency were observed in the retinal rings surrounding the fovea (rings 2 to 5). Central foveal thickness did not change at 2 weeks and 6 weeks postoperatively compared to baseline (p = 0.53 and p = 0.93, respectively).

CONCLUSIONS

A short-term reversible decrease in macular electrical activity without any structural changes seems to occur after accelerated CXL in patients with progressive keratoconus. The return of macular response to the preoperative values shows the safety of the CXL protocol.

Association of serum inflammatory markers and diabetic retinopathy: a review of literature

OBJECTIVE

Diabetic retinopathy is the leading cause of irreversible blindness in the western world, among the working-age people. Its exact pathogenesis, however, remains obscure. Systemic inflammation is regarded to play a significant role in diabetes by contributing, among others, to the development of diabetic retinopathy. This review focuses on the possible involvement of the systemic inflammatory markers in the pathogenesis of diabetic retinopathy.

PATIENTS AND METHODS

We performed a systematic search of the literature of published papers until August 2017 using the PubMed search engine.

RESULTS

We demonstrated that many systemic inflammatory markers contribute to the pathogenesis and progression of retinopathy, while we highlighted in several occasions their usefulness as a key tool in the monitoring of the disease progression and the treatment efficacy.

CONCLUSIONS

To the best of our knowledge this is the first review in the literature that elaborates the possible association of serum inflammatory markers and diabetic retinopathy, a disease that may cause irreversible loss of vision.

Targeting histone deacetylases in endometrial cancer: a paradigm-shifting therapeutic strategy?

OBJECTIVE

Endometrial cancer is increasingly prevalent in western societies and affects mainly postmenopausal women; notably incidence rates have been rising by 1.9% per year on average since 2005. Although the early-stage endometrial cancer can be effectively managed with surgery, more advanced stages of the disease require multimodality treatment with varying results. In recent years, endometrial cancer has been extensively studied at the molecular level in an attempt to develop effective therapies. Recently, a family of compounds that alter epigenetic expression, namely histone deacetylase inhibitors, have shown promise as possible therapeutic agents in endometrial cancer. The present review aims to discuss the therapeutic potential of these agents.

MATERIALS AND METHODS

This literature review was performed using the MEDLINE database; the search terms histone, deacetylase, inhibitors, endometrial, targeted therapies for endometrial cancer were employed to identify relevant studies. We only reviewed English language publications and also considered studies that were not entirely focused on endometrial cancer. Ultimately, sixty-four articles published until January 2018 were incorporated into our review.

RESULTS

Studies in cell cultures have demonstrated that histone deacetylase inhibitors exert their antineoplastic activity by promoting expression of p21WAF1 and p27KIP1, cyclin-dependent kinase inhibitors, that have important roles in cell cycle regulation; importantly, the transcription of specific genes (e.g., E-cadherin, PTEN) that are commonly silenced in endometrial cancer is also enhanced. In addition to these abstracts effects, novel compounds with histone deacetylase inhibitor activity (e.g., scriptaid, trichostatin, entinostat) have also demonstrated significant antineoplastic activity both in vitro and in vivo, by liming tumor growth, inducing apoptosis, inhibiting angiogenesis and potentiating the effects of chemotherapy.

CONCLUSIONS

The applications of histone deacetylase inhibitors in endometrial cancer appear promising; nonetheless, additional trials are necessary to establish the therapeutic role, clinical utility, and safety of these promising compounds.

The effect of fish consumption on macula structure and function of healthy individuals: an OCT and mfERG study

OBJECTIVE

The study was designed to investigate the potential effect of fish consumption on macular structure and function of healthy individuals.

PATIENTS AND METHODS

The participants were Greek, who used to consume less than one portion of fish per week since their childhood. All participants underwent body mass index (BMI) measurements and ophthalmological examination. At their first examination, they were asked to consume at least 2 portions of fish per week over a period of 8 weeks, after which all the measurements were repeated.

RESULTS

Eighteen healthy individuals (36 eyes) participated in this study. The central macular thickness was reduced, while the amplitudes in the foveal and parafoveal area were increased after the fish consumption. However, all measurements remained within the normal range at both visits.

CONCLUSIONS

Regular fish consumption could enhance the structural and functional status of the macula.

Lacquer Crack Formation after Photodynamic Therapy

PURPOSE

To report the occurrence of a lacquer crack after photodynamic therapy (PDT) of choroidal neovascularization (CNV) in a patient with pathologic myopia.

METHODS

PDT was performed with verteporfin, which was activated by a diode laser light at 690 nm.

RESULTS

The left eye of a 42-year-old woman was treated with PDT because of juxtafoveal CNV caused by pathologic myopia. No lacquer crack was present in the macula on either fluorescein or indocyanine green angiography before treatment. The CNV subsided after treatment. However, a large lacquer crack underlying a subretinal hemorrhage was formatted in the macula of the treated eye soon after PDT.

CONCLUSIONS

Although the chorioretinal damage produced by PDT is minimal, it is enough to create, directly or indirectly, the basis for the formation of a lacquer crack in an eye with pathologic myopia.

Homosexuality according to ancient Greek physicians

Homosexuality and pedophilia in ancient Greece greatly concerned many researchers who were mainly interested in highlighting the social aspect of this phenomenon in ancient Greek society. An important source on the subject was the paintings of a man and his lover in attic black and red figured pottery, up to the end of the 5th century BC. Another main source was the information that derived from the texts of ancient Greek literature, especially poetry. Homosexuality was not only referring to relationships between males, but it was also manifested in lesbian love. It is believed that in the Homeric world homosexuality was not favored. In Greek society of the archaic period, the restriction of women at home, the satisfaction of sexual needs with courtesans, the marriage for the purpose of maintaining and managing the property, put women aside, marginalizing them in terms of social life, impeding the cultivation of emotional relationships between sexes. At the same time, in the society of those times, the aristocratic ideal, the constant communication of men during military training and the war, the male nudity in sports and the promotion of beauty and bravery in athletic contests, as well as the gatherings and the entertainment of men at the symposia, created a suitable substrate in which male homosexuality could develop. In this context, pedophile relationships were developed mainly during the archaic period, as recorded on vase paintings, where a mature man developed a special relationship with a teenager of the same social class. The mature man had the role of mentor for the juvenile, he would look after him and cover his living expenses and education cost. In this relationship, exhibiting predominantly the social dimension of an initiation process and introduction to adult life, the erotic homosexual intercourse could find a place to flourish. The above-mentioned relationship could not last forever, given that this would later transform into an emotional connection of friendship and trust. Besides, the constant homosexual relationships and male prostitution were considered to be reprehensible behaviors. Regarding the lesbian love, the main example was Sappho and her poems that praised love between women. Nevertheless, the relationship with the girls in the poems is considered to be similar to that Socrates had with his students, an intense personal relationship which would not involve sexual love and could probably be a platonic love. Ancient Greek physicians used their methodological tools in order to interpret homosexuality as a mental disease, but ancient medical dogmas such as the theory of humors, stereopathology and their variations could not offer an explanation for homosexuality.

Dreams in ancient Greek Medicine

Dreams preoccupied the Greek and Roman world in antiquity, therefore they had a prominent role in social, philosophical, religious, historical and political life of those times. They were considered as omens and prophetic signs of future events in private and public life, and that was particularly accentuated when elements of actions which took place in the plot of dreams were associated directly or indirectly with real events. This is why it was important to use them in divination, and helped the growth of superstition and folklore believes. Medicine as a science and an anthropocentric art, could not ignore the importance of dreams, having in mind their popularity in antiquity. In ancient Greek medicine dreams can be divided into two basic categories. In the first one -which is related to religious medicine-dreams experienced by religionists are classified, when resorted to great religious sanctuaries such as those of Asclepius (Asclepieia) and Amphiaraos (Amfiaraeia). These dreams were the essential element for healing in this form of religious medicine, because after pilgrims underwent purifications they went to sleep in a special dwelling of the sanctuaries called "enkoimeterion" (Greek: the place to sleep) so that the healing god would come to their dreams either to cure them or to suggest treatment. In ancient Greek literature there are many reports of these experiences, but if there may be phenomena of self-suggestion, or they could be characterized as propaganda messages from the priesthood of each sanctuary for advertising purposes. The other category concerns the references about dreams found in ancient Greek medical literature, where one can find the attempts of ancient Greek physicians to interpret these dreams in a rational way as sings either of a corporal disease or of psychological distress. This second category will be the object of our study. Despite the different ways followed by each ancient Greek physician in order to explain dreams, their common intention was to give a rational answer for the creation and content of dreams setting aside any supernatural beliefs. In addition they tried to explain in a scientific way the correlation that could have emerged between the story that took place in dreams and the events that happened in everyday life. Nevertheless, ancient Greek physicians focused especially on nightmares, which were associated with physical problems. For those physicians these nightmares included information about the corporal disease of the patient, which had a reflection in the dream, and they could help them to diagnose the problem in order to restore balance of the body.

Dark Adaptation in Patients with Primary Open-Angle Glaucoma, Pseudoexfoliation Glaucoma and Childhood Glaucoma

Purpose To investigate the state of dark adaptation and macular blood flow in different forms of glaucoma. Methods Eighteen eyes of 18 patients with primary open-angle glaucoma, 14 eyes of 14 patients with pseudoexfoliation glaucoma, and 10 eyes of 10 patients with childhood glaucoma (CG) were examined by means of dark adaptometry, scanning-laser retinal flowmetry, and retinal tomography. Results All glaucomatous eyes had comparable optic disc excavation (one-way ANOVA, p = 0.138). Eyes with CG had significantly lower best-corrected visual acuity than the other groups (Tukey, all p < 0.0001). Macular perfusion was comparable in all three groups (one - way ANOVA, p = 0.08). The delay in rod-cone break time in the CG group was significantly higher than in the other groups (Tukey, all p < 0.0001). The scotopic sensitivity threshold in the CG group was significantly greater than in the other groups (Tukey, all p < 0.01). Conclusion This underlying dysfunction of dark adaptation may contribute, at least to some extent, to the decreased visual perception observed in patients with CG.

Intravitreal ranibizumab for choroidal neovascularization secondary to angiod streaks. Comparison of the 12 and 24-month results of treatment in treatment-naïve eyes

OBJECTIVE

Our aim study was to compare 12 and 24-month results of intravitreal ranibizumab therapy in the management of choroidal neovascularization (CNV) secondary to angioid streaks (ST). This could be of clinical importance helping us planning optimal dosing strategies.

PATIENTS AND METHODS

Over a 7-year period, a consecutive series of treatment-naïve eyes with macular CNV due to AS were treated with intravitreal ranibizumab (0.5 mg). The main outcome measure was changed in best-corrected visual acuity (BCVA) at 12 and 24 months as compared to baseline.

RESULTS

Twenty eyes completed 24-month therapy and regular follow-up visits. BCVA improved at 12 (0.42±0.26 logMAR) and 24 months (0.44±0.22 logMAR) as compared to baseline (0.75±0.26 logMAR) (p<0.001), but did not change between the 12 and 24-month follow-up (p=0.48). BCVA improved in 15 (75%) and 16 (80%) of the eyes, but in 5 (25%) and 4 eyes (20%) remained unchanged (p=0.71) at 12 and 24 months, respectively.

CONCLUSIONS

These results suggest that during the first year of intravitreal ranibizumab therapy for patients with macular CNV due to AS, BCVA improved in most of the eyes, and was maintained during the second year.

Visual problems in young adults due to computer use

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.

Multifocal visual evoked potentials in amblyopia due to anisometropia

PURPOSE

To investigate multifocal visual evoked potentials (mfVEP) of the amblyopic and fellow eye in amblyopia due to anisometropia.

METHODS

We recorded mfVEP in both eyes of 15 anisometropic amblyopic patients and 15 normal control subjects. The responses from the central 7.0 degrees arc of the visual field were measured, and changes in latency and amplitude were compared between the amblyopic, fellow, and normal control eyes.

RESULTS

There was a significant difference in the latency and amplitude of mfVEP between the amblyopic and fellow eyes. The responses in the central region of the visual field (rings 1 and 2) had a longer latency and smaller amplitude in the amblyopic eye. In contrast, there was no difference in mfVEP latency or amplitude between the fellow eye and normal control eyes.

CONCLUSION

These results suggest that mfVEP may be used as an alternative objective method for diagnosis and monitoring of anisometropic amblyopia.

Assessment of macular function by multifocal electroretinogram in age-related macular degeneration before and after photodynamic therapy

PURPOSE

To evaluate macular function, before and after photodynamic therapy (PDT) using multifocal electroretinogram (MF-ERG), in eyes suffering from classic subfoveal choroidal neovascularization (CNV) resulting from age-related macular degeneration (ARMD).

METHODS

Twenty eyes of 20 patients (10 male, 10 female) with classic subfoveal CNV resulting from ARMD were studied. All received PDT with verteporfin. Fluorescein angiography and mF-ERG were performed in each patient 1 day before and 1 week, 3 months and 6 months after photodynamic therapy.

RESULTS

Before treatment, visual acuity (VA) and electrical retinal response densities (RRD) in the foveal and parafoveal areas were low in all patients. The mean VA (ETDRS chart) before PDT was 24.35 (SD, 15). The mean RRD before PDT in area 1 was 4.39 nV/deg(2) (SD, 2.59) and in area 2 it was 2.11 (SD, 1.86). Six months after treatment, the mean VA was stable in 70% of the patients. However, the mean RRD after PDT was 2.24 nV/deg(2) in area 1 (SD, 2.59) and 1.07 nV/deg(2) in area 2 (SD, 1.59).

CONCLUSION

Multifocal ERG objectively evaluates the macular function in eyes with CNV attributable to ARMD. In this study, the stability of VA coincided with a clear impairment of electrical activity of the foveal and parafoveal areas. This finding suggests that MF-ERG should be adopted to assess the efficacy of PDT objectively in the treatment of ARMD.

Polypoidal choroidal vasculopathy and exudative age-related macular degeneration in Greek population

PURPOSE

To study the prevalence, the clinical features, and the visual prognosis without treatment of polypoidal choroidal vasculopathy (PCV) in a large series of Greek patients presenting with exudative maculopathy.

METHODS

The medical records, photographs,as well as fluorescein and indocyanine green(ICG) angiograms of a series of 268 consecutive elderly white Greek patients, who were originally diagnosed as having exudative age-related macular degeneration (AMD) were reviewed retrospectively.

RESULTS

In all, 22 of the 268 (8.2%) patients initially suspected of having AMD were ultimately diagnosed with PCV. In 15 of the 22(68.2%) patients with PCV, the polypoidal lesions were located in the peripapillary area. Large soft drusen were present in only two fellow eyes of the 10 (20%) patients with unilateral PCV compared with 120 fellow eyes of the 148 (81.1%) patients with unilateral AMD. At the last examination, 11 of the 22(50%) patients with PCV and 120 of the 246(48.8%) patients with AMD presented a visual acuity of less than 6/60 in at least one eye due to scar formation in the macula.

CONCLUSIONS

PCV is not an infrequent disease in Greece. A measurable number of Greek patients with findings suggestive of exudative AMD will instead have PCV. ICG angiography is important in differentiating between these two clinical entities. In Greeks, polypoidal lesions are predominantly peripapillary and are not usually associated with macular drusen in the fellow eye. PCV and exudative AMD do not differ significantly in terms of their natural course and visual prognosis in Greek patients.

Retinal Vasculitis and Cystoid Macular Edema after Body Tattooing: a Case Report

BACKGROUND

To report a case of retinal vasculitis occurring after the placement of permanent tattoos.

HISTORY AND SIGNS

A 21-year-old male was referred to our department with impairment of visual acuity. Permanent tattoos covered the head, body, arms and legs. The patient was examined with ophthalmoscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography. Systemic medical and laboratory work-up were performed in order to exclude an infectious agent or an inflammatory disease. He had no history of intravenous drug abuse.

THERAPY AND OUTCOME

Our patient presented severe posterior uveitis associated with retinal vasculitis and cystoid macular edema. Laboratory tests ruled out all diseases causing vasculitis. HIV and B, C hepatitis tests were negative. Cystoid macular edema and vasculitis were resolved after immunosuppressive therapy.

CONCLUSIONS

This is the first description of a retinal vasculitis associated with cystoid macular edema in a completely healthy individual after the placement of permanent tattoos. A phagocytosis of tattoo pigments leading to their lysis is described in the literature as a mechanism causing vasculitis.

Polypoidal choroidal vasculopathy associated with Doyne's familial choroiditis: treatment with thermal laser

PURPOSE

To report the unusual occurrence of polypoidal choroidal vasculopathy (PCV) in a patient with Doyne's familial honeycomb choroiditis (DFHC) and its course after laser treatment.

DESIGN

Interventional case report.

METHODS

Indocyanine green (ICG) angiography guided laser was performed on active polypoidal lesions.

RESULTS

A 45-year-old man with a 15-year history of bilateral DFCH and a scarred macular choroidal neovascularization in the right eye (RE) was referred to us with exudative maculopathy in the left eye (LE). His best-corrected visual acuity (BCVA) was 20/800 in the RE and 20/40 in the LE. ICG angiography revealed a picture that was characteristic for PCV in both eyes. ICG guided argon green laser was performed on the active parapapillary and perifoveal polypoidal lesions of the LE. Eight months after the laser photocoagulation treatment, the macular exudative lesions had subsided and the BCVA improved to 20/20. The favorable anatomic and functional results have remained stable over 3 years.

CONCLUSIONS

This is, to our knowledge, the first case of a PCV that occurred secondary to DFHC.

Polypoidal choroidal vasculopathy associated with Doynes familial choroiditis: treatment with thermal laser

PURPOSE

To report the unusual occurrence of polypoidal choroidal vasculopathy (PCV) in a patient with Doynes familial honeycomb choroiditis (DFHC) and its course after laser treatment.

DESIGN

Interventional case report.

METHODS

Indocyanine green (ICG) angiography guided laser was performed on active polypoidal lesions.

RESULTS

A 45-year-old man with a 15-year history of bilateral DFCH and a scarred macular choroidal neovascularization in the right eye (RE) was referred to us with exudative maculopathy in the left eye (LE). His best-corrected visual acuity (BCVA) was 20/800 in the RE and 20/40 in the LE. ICG angiography revealed a picture that was characteristic for PCV in both eyes. ICG guided argon green laser was performed on the active parapapillary and perifoveal polypoidal lesions of the LE. Eight months after the laser photocoagulation treatment, the macular exudative lesions had subsided and the BCVA improved to 20/20. The favorable anatomic and functional results have remained stable over 3 years.

CONCLUSIONS

This is, to our knowledge, the first case of a PCV that occurred secondary to DFHC. (Eur J Ophthalmol 2004; 14: 264-8).

Arachnoid Cyst of the Optic Nerve: a Case Report

BACKGROUND

To report a case of an arachnoid cyst of the optic nerve with homonymous optic atrophy.

HISTORY AND SIGNS

A 17-year-old female patient presented with severe visual loss, limited to light perception, of the left eye. She underwent complete ophthalmologic examination, color fundus photography and electrophysiological study. Magnetic resonance imaging (MRI) revealed the presence of a fusiform structure involving the left optic nerve from the orbital apex to the posterior surface of the globe. The clinical and radiographic features are consistent with an arachnoid cyst of the optic nerve.

THERAPY AND OUTCOME

The patient refused to be treated. Two years later, the VA remained unchanged.

CONCLUSIONS

The arachnoid cyst of the optic nerve is a rare entity. Its differential diagnosis from the primary optic nerve glioma is difficult and important to be made in order to be treated properly.

Phacoemulsification with Intraocular Lens Implantation in Patients with Uveitis

BACKGROUND

Cataract remains a challenge for ophthalmologists in uveitic eyes. The aim of this study is to report the clinical course of phacoemulsification with intraocular lens implantation in eyes suffering from uveitis.

PATIENTS AND METHODS

Patients presenting a uveitis were prospectively followed from June 2001 to June 2003. Ocular surgery was performed according to a standard protocol, autoimmune follow-up visits were focused on the early detection of complications of uveitis: increased ocular inflammation, synechiae, retraction of the rhexis, opacification of the posterior capsule or onset of cystoid macular edema.

RESULTS

Thirty-two eyes of 24 patients suffering from uveitis were operated with cataract surgery between June 2001 and June 2003. The mean age at surgery was 56 years (range 24 - 86 years). Mean preoperative visual acuity in uveitis patients presenting cataract was 0.3 +/- 0.3, and final visual acuity was 0.8 +/- 0.3. Three patients presented minor postoperative complications. One patient had a cystoid macular edema that appeared 5 months after surgery and one patient had a relapse of herpetic dendritic keratopathy despite topical antiviral therapy combined with steroid drops. The latter presented a slight increase of intraocular pressure (24 mm Hg).

CONCLUSIONS

In patients with uveitis requiring cataract surgery, intraocular lens implantation is safe. Visual prognosis is better when pre- and postoperative inflammation is minimized. Macular scars or other retinal lesions are poor prognostic indicators.

A preliminary assessment of macular function by MF-ERG in myopic eyes with CNV with complete response to photodynamic therapy

PURPOSE

To evaluate by multifocal electroretinogram (MF-ERG) macular function before and after photodynamic therapy (PDT) in myopic eyes with choroidal neovascularization (CNV).

PATIENTS AND METHODS

Ten eyes with classic subfoveal CNV due to pathologic myopia were studied with MF-ERG before and after PDT in order to evaluate the results of PDT with verteporfin. The post-treatment follow-up was 6 months. Visual acuity testing, ophthalmic examinations, fluorescein and indocyanine green angiograms, and MF-ERG recordings were used to evaluate the results of PDT with verteporfin. The post-treatment period was 6 months.

RESULTS

Before treatment, the electrical response densities in the foveal and perifoveal areas were apparently decreased in all patients. Six months after treatment, the mean retinal response densities in the same areas were found to be higher than before treatment.

CONCLUSIONS

MF-ERG evaluates objectively the macular function in myopic eyes with CNV. After successful PDT, the electrical activity of the foveal and parafoveal areas is higher than before treatment. This finding postulates the efficacy of PDT in the treatment of CNV.