Hypertension, hyperlipidaemia and thrombophilia as the most common risk factors for retinal vein occlusion in patients under 50 years

BACKGROUND AND AIMS

Cardiovascular (CV) diseases are the most common risk factors (RFs) for retinal vein occlusion (RVO) development in general. The aim of this study was to identify the most frequent causes of RVO in patients under 50.

METHODS

We retrospectively evaluated a group of patients with RVO under 50 years. The parameters of interest included age and sex, RVO type, presence of arterial hypertension (HT), hyperlipidaemia (HLD), diabetes mellitus (DM), congenital thrombophilic disorder (TD), obstructive sleep apnoea syndrome (OSAS), thyroid eye disease (TED), use of hormone contraception (HC) or hormone replacement therapy (HRT), glaucoma and other potential RFs. Patients with central RVO (CRVO), hemi-central RVO (HRVO), branch RVO (BRVO), impending CRVO and combined arterial-venous (AV) occlusion were included.

RESULTS

The group consisted of 110 eyes of 103 patients. CV disease was the most common systemic abnormality. 55.3% patients had HT, 17.5% had HLD. TD was the third most frequent RF (12.6%). The cohort also included patients with DM (6.8%), glaucoma (6.8%) and women using HC/HRT (26.2% of female patients). There were isolated cases of RVO due to retinal vasculitis, intense exercise, antiphospholipid syndrome and COVID-19 pneumonia. None of the patients had OSAS, TED or a haemato-oncological disease. The etiology remained unexplained in 20.4% patients. No difference was observed in RF occurrence between patients with CRVO and HRVO and those with BRVO.

CONCLUSION

The most common systemic abnormality in our cohort was CV disease, especially HT and HLD. The risk factors for central, hemi-central and branch RVOs were similar.

Gluteal Hidradenitis Suppurativa: Analysis of 83 Patients

BACKGROUND

In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement.

OBJECTIVE

To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile.

MATERIAL AND METHODS

We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661).

RESULTS

Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions.

LIMITATIONS

The study's limitations include its retrospective nature, bicentric design, and small sample size.

CONCLUSION

The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two "subphenotypes" with a different clinical profiles and management.

Gluteal Hidradenitis Suppurativa: Analysis of 83 Patients

BACKGROUND

In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement.

OBJECTIVE

To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile.

MATERIAL AND METHODS

We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661).

RESULTS

Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions.

LIMITATIONS

The study's limitations include its retrospective nature, bicentric design, and small sample size.

CONCLUSION

The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two "subphenotypes" with a different clinical profiles and management.

Study protocol - Prospective case-control trial - Impact of significant carotid stenosis on retinal perfusion measured with automated retinal oximetry

BACKGROUND

Large vessel carotid stenosis is a significant cause of ischaemic stroke. Indications for surgical revascularisation depend on the severity of the stenosis and clinical symptoms. However, mild symptoms such as TIA (Transient ischaemic attack), amaurosis fugax or minor stroke precede large strokes in only 15% of cases.

AIM

The aim of this prospective study is to evaluate whether retinal perfusion is impacted in significant carotid stenosis. Automated retinal oximetry will be used to better assess perfusion in the post-stenotic basin. We presume the more stenotic the blood vessel, the more reduced the retinal perfusion is, resulting in adaptive changes such as greater arteriovenous saturation difference due to greater oxygen extraction. This could broaden the indication spectrum for revascularisation for carotid stenosis.

METHODS

We plan to enroll yearly 50 patients with significant carotid stenosis and cross-examine them with retinal oximetry. The study group will provide stenotic vessels and, non-stenotic vessels will form the control group. Patients with significant carotid stenosis will undergo an MRI (Magnetic Resonnance imaging) examination to determine the presence of asymptomatic recent ischaemic lesions in the stenotic basin, and the correlation to oximetry parameters.

STATISTICS

The stenosis severity and retinal oximetry parameters will be compared for study and control groups with a threshold of 70%, respectively 80% and 90% stenosis. Results will be then reevaluated with emphasis on MRI findings in the carotid basin.

CONCLUSION

This prospective case control study protocol will be used to launch a multicentre trial assessing the relationship between significant carotid stenosis and retinal perfusion measured with automated retinal oximetry. Despite these differences, the findings indicate the potential of retinal oximetry for noninvasive real-time measurements of oxyhaemoglobin saturation in central nervous system vessels. Following calibration upgrade and technological improvement, verification retinal oximetry may potentially be applied to critically ill and anaesthesia care patients. The study on combined scanning laser ophthalmoscope and retinal oximetry supports the feasibility of the technique for oximetry analysis in newly born babies.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT06085612.

The intraocular implant and visual rehabilitation improve the quality of life of elderly patients with geographic atrophy secondary to age-related macular degeneration

INTRODUCTION

The objective of this prospective study was to evaluate the effects of intraocular macular lens implantation and visual rehabilitation on the quality of life of patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

METHODS

Patients with bilaterally decreased near vision (not better than 0.3 logMAR with the best correction), pseudophakia, were included in the project. The Scharioth macula lens (SML) was implanted into the patients' better-seeing eye. Intensive visual rehabilitation of the ability to perform nearby activities was performed for 20 consecutive postoperative days. All subjects were examined before and after SML implantation ophthalmologically. The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) was administered before and 6 months after surgery.

RESULTS

Twenty eligible patients with mean age 81 years (63 to 92 years) were included in the project: 7 males and 13 females. Nineteen of them completed the 6-month follow-up. Near uncorrected visual acuity was 1.321 ± 0.208 logMAR before SML implantation and improved to 0.547 ± 0.210 logMAR after 6 months (dz =  - 2.846, p < 0.001, BF₁₀ = 3.29E + 07). In the composite score of the NEI VFQ-25, there was an improvement in the general score and the specific domains related to the implantation. Participants reported fewer difficulties in performing near activities (dz = 0.91, p = 0.001, BF₁₀ = 39.718) and upturns in mental health symptoms related to vision (dz = 0.62, p = .014, BF₁₀ = 3.937).

CONCLUSION

SML implantation, followed by appropriate rehabilitation, improved near vision and increased the quality of life of visually handicapped patients with AMD in our project.

Myopic Correction with Iris-Fixated Phakic Intraocular Lenses: Twelve-Year Results

PURPOSE

To evaluate a 12-year follow-up of myopic patients after iris-fixated phakic intraocular lenses (IF pIOLs) implantation. Setting. Ophthalmology Department, Military University Hospital in Prague (Czech Republic).

DESIGN

Single-center retrospective cohort study.

METHODS

We describe the results of a cohort study that included 85 eyes of 46 myopic patients who underwent implantation of Verisyse myopia, Veriflex, and Verisyse myopia toric (all Abbott Medical Optics, Inc.) intraocular lenses. Refractive functions and adverse events were assessed preoperatively, at 6 months, and 1, 2, 5, and 12 years after IF pIOL implantation.

RESULTS

Mean spherical equivalent was measured as -9.37 ± 2.87 D, 0.14 ± 0.61 D, and -0.42 ± 1.08 D, preoperatively, at 6 months and 12 years postoperatively, respectively. There was a significant reduction in the cylinder after surgery. At 12 years postoperatively, 90% of eyes had uncorrected distance visual acuity (UDVA) of 20/40 and 64% of 20/20. The safety index was 1.10 for the whole postoperative follow-up period. We found cataract formation in 3 eyes (3.5%). The endothelial cells loss (EC loss) directly caused by IF pIOL implantation was 6.0%, 8.10%, 12.8%, and 11.9%, at 1, 2, 5, and 12 years, respectively. In our cohort, 95% of eyes lost a higher percentage of EC than would be expected from a physiological loss at 12 years postoperatively. We found a significant negative interaction between preoperative pachymetry and EC loss, indicating that the lower pachymetry leads to a faster decline in endothelial cells density (ECD). IF pIOL re-enclavation was found in 28% of eyes. 7% of subluxations were caused by trauma. The mean time of nontraumatic re-enclavation was 6 years postoperatively.

CONCLUSIONS

The study confirmed the advantages of IF pIOL implantation due to rapid visual recovery and stable visual function over the 12-year follow-up and also showed the influence of lower corneal pachymetry regarding EC loss.

Intraoperative intraocular pressure fluctuation during standard phacoemulsification in real human patients

INTRODUCTION

To evaluate the results of the fluctuations of intraocular pressure (IOP) and calculated mean ocular perfusion pressure (MOPP) during the usual steps of standard phacoemulsification.

METHODS

Nine human eyes were evaluated. The IOP was measured indirectly by electronic applanation tonometer. The MOPP was calculated using the systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the IOP: MOPP = 2/3x[DBP + 1/3x(SBP - DBP)] - IOP. The operations were performed with the INFINITI^® Vision System: main incision 2.2 mm, coaxial handpiece, 2 paracenteses 1.1 mm, bimanual irrigation/aspiration, bottle height 100 cm. As ocular viscoelastic device (OVD) Hypromel 2.5% (UNIMED) was used.

RESULTS

The initial and final IOPs were 17-30 Torr (median 18) and 6-16 Torr (median 8), respectively. The IOP values oscillated between 4 and 63 Torr during the procedure. The highest values of the IOP were achieved at the beginning of phacoemulsification (from 42 to 63 Torr). The maximum pressure higher than 50 mmHg and 60 mmHg was found in 89% and 30% of cases, respectively. The mean ocular perfusion pressure (MOPP) at the beginning of the procedure was 46.4-67.0 (median 53.3) and 0.4-42.0 (median 19.3) during the maximum intraocular pressure.

CONCLUSIONS

Measured IOP as well as MOPP varied in all normal steps of real phacoemulsification. High values of intraoperative IOL induced by irrigation may compromise the intraocular perfusion. These fluctuations may induce impairment of the optic nerve perfusion, as well as retina, or choroid.

Scharioth Macula Lens: A new intraocular implant for low-vision patients with stabilized maculopathy- first experience

AIMS

To present the initial results of Scharioth Macula Lens (SML) implantation. The SML is a new add-on intraocular lens designed to increase uncorrected near visual acuity (UCVA) in patients with stabilized maculopathy.

METHODS

Eight patients were included in the study. All met the indication criteria before SML implantation. An SML was implanted in the better seeing eye. Near and distance visual acuity were tested. Possible complications and patient complaints were recorded and patients were asked about their quality of vision after SML implantation. The examination was carried out on day 1, 1 week, 1, 3 and 6 months after surgery.

RESULTS

Six-month-results are presented. Apart from one, all patients with the SML had good near visual acuity at a recommended reading distance of 15 cm. Preoperatively, the mean (min-max) near UCVA was J13 (J8-J16), mean distance BCVA was 0.27. Postoperatively, the best results were after 1 month - near UCVA was J2.5 (J1-J7), distance BCVA was 0.26. Three months after surgery, this decreased to J4.5 (J1-J8); distance VA remained 0.25. Six months postoperatively - near vision was J4 (J1-J8) and distance VA was unchanged. Patients reported problems with reading speed and reading distance. Daily exercise improved their reading ability. One patient converted to wet AMD 3 months post-implantation.

CONCLUSION

The SML is a new hope for low-vision patients. It acts as a magnifier in the eye. It is a suitable method for increasing near visual acuity in patients with inactive maculopathy.

Correlation between magnetic resonance imaging and ultrasound measurements of eye muscle thickness in thyroid-associated orbitopathy

AIMS

To compare ultrasound (US) and magnetic resonance imaging (MRI) measurements of horizontal eye muscle thickness in patients with thyroid-associated orbitopathy (TAO) and to compare these measurements according to the phase of the disease, the severity of exophthalmos, and the experience of the investigator.

METHODS

A total of 180 orbits of adult patients with TAO were investigated from May 2007 to December 2012. In addition to their general ophthalmic examination, all patients underwent ultrasonographic measurement of horizontal eye muscle thickness with the B-scan technique and MRI examination of the orbit. Correlations between values obtained by US and MRI were determined for different subgroups according to disease activity (active, inactive), exophthalmos values (Hertel < 18 mm; Hertel 18-22 mm; Hertel > 22 mm), and the time period of examination (2007-2009; 2010-2012).

RESULTS

Positive moderate correlation between US and MRI values for the medial rectus muscle (MRM; r = 0.690) and for the lateral rectus muscle (LRM; r = 0.572) was found. Significantly higher correlation was found for the MRM (P < 0.0001) and the LRM (P = 0.0008) in the time period 2010-2012 than in that of 2007-2009. Increasing correlation was found for MRM with increasing values of exophthalmos but this increase was not statistically significant. In the active phase of the disease compared to the inactive phase, statistically significant increased correlation (P = 0.019) was found for the LRM.

CONCLUSIONS

Ultrasonographic measurement of horizontal eye muscles thickness in TAO moderately correlates with values obtained using MRI. The accuracy of ultrasonographic measurements in particular increases with the experience of the investigator.

Long term visual outcome after arteriolar constriction in patients with branch retinal vein occlusion

AIM

To evaluate the final best corrected visual acuity (BCVA) in patients with branch retinal vein occlusion (BRVO) treated with either (1) laser arteriolar constriction (ACo) or (2) the standard treatment recommended by the Branch Vein Occlusion Study Group (grid laser photocoagulation (GLP) or only observation (if indication criteria for GLP were not met).

METHODS

358 BRVOs were treated in three different ways: early ACo (n=133) performed ≤9 weeks after onset of BRVO, late ACo (n=62) performed >9 weeks after onset and controls which included GLP and observation (n=163). The groups were further divided according to initial BCVA into: ≤0.1; 0.16-0.3 and ≥0.4.

RESULTS

Based on the proportion of 1 year BCVA≤0.1 as a risk category, the results of early ACo (3.8%) were significantly better than for the controls (22.7%, P<0.001) and late ACo (16.1%, P=0.006). The greatest difference in final BCVA was in patients with the worst initial VA (≤0.1). In the intermediate initial BCVA group 0.16-0.3, a significant difference was only found between the early ACo group and controls (P=0.007). There was no significant difference between any treatment group and prevalence of a final BCVA≤0.1 for patients with an initial BCVA≥0.4.

CONCLUSIONS

Early ACo significantly reduces the prevalence of a final BCVA≤0.1 in patients with BRVO and an initial BCVA≤0.3 compared to controls (standard treatment treated with GLP or observed).

Progression of macular atrophy after PDT combined with the COX-2 inhibitor Nabumetone in the treatment of neovascular ARMD

AIM

To evaluate photodynamic therapy (PDT) combined with the preferential the cyclooxygenase-2 (COX-2) inhibitor, nabumetone in the treatment of the neovascular age-related macular degeneration (ARMD).

METHODS

A prospective, double-blind, randomized study on 60 patients with subfoveal CNV secondary to ARMD without any previous treatment. Patients were divided into a nabumetone or placebo group. The main endpoints were the change of best-corrected visual acuity (BCVA), central macular thickness (CRT) and number of required PDT treatments.

RESULTS

In the nabumetone group, 27 patients (90%) and 28 (93%) in the placebo group completed the follow-up of 12 months. In the nabumetone group, the mean CRT decreased from 332 μm (SD 68 μm) to 220 μm (SD 46 μm). In the placebo group, CRT decreased from 331 μm (SD 72 μm) to 254 μm (SD 61 μm). The mean BCVA was 0.68 log MAR (SD 0.22 log MAR) in the nabumetone group and 0.62 log MAR (SD 0.23 log MAR) in the placebo group at baseline. This stabilised in the placebo group to 0.66 log MAR (SD 0.33) but deteriorated in the nabumetone group to 0.86 log MAR (SD 0.41 log MAR). There was a significant reduction in the number of required PDTs in the nabumetone group, but significant progression of the RPE atrophy area.

CONCLUSION

Combined PDT with oral intake of the COX-2 inhibitor, nabumetone reduced the number of required PDT retreatments, but worsening BCVA caused by macular atrophy progression. Therefore the combination of the PDT with the nabumetone is not recommended.

The in vitro antimicrobial activity of silicone oils used in ophthalmic surgery

BACKGROUND

The aim of the study was in vitro assessment and comparison of the antimicrobial activity of three types of silicone oils used in ophthalmic surgery.

METHODS

The silicone oils (Arciolane 1300 centistokes, Arciolane 5500 centistokes and Oxane Hd, heavy silicone oil) were inoculated with microbes common in endophthalmitis and their growth was observed continuously. Control tests of microbial growth were performed on silicone oil-free media, i.e. saline and standard enrichment media. In both tested oils and control media, the microbes were cultured aerobically for 21 days, bacteria at 37 °C and yeasts and fungi at 30 °C. Prior to and during incubation at given intervals (days 0, 2, 4, 7, 9, 11, 14, 16, 18 and 21), 10 μl samples were taken from all test tubes. These were diluted in saline in a series of test tubes, with the minimum concentration reaching 10(-8). From each dilution, 25 μl were inoculated onto agar media. After 24 h of aerobic incubation at 37 °C (bacteria) and 48 h at 30 °C (yeasts and fungi), the grown colonies were counted and the numbers of colony-forming units in 1 ml (CFU/ml) were determined.

RESULTS

In vitro, the highest antimicrobial effect was observed for the Oxane Hd silicone oil.

CONCLUSIONS

If endophthalmitis is treated by pars plana vitrectomy, the application of Oxane Hd silicone oil into the vitreous cavity at the end of surgery may contribute to the elimination of microorganisms from the intraocular space but clinical trials are needed to assess its safety.

[The effect comparison of ranibizumab and sodium pegaptanib on the retinal pigment epithelium ablation size in the treatment of age-related macular degeneration]

AIM

To evaluate the effect difference of ranibizumab and sodium pegaptanib in the ablation treatment of the retinal pigment epithelium (RPE) in age-related macular degeneration

MATERIAL AND METHODS

Retrospective analysis of data of patients with age-related macular degeneration treated by means of anti-VEGF therapy at the Department of Ophthalmology, School of Medicine, Palacky University, Olomouc, Czech Republic, E.U. during the period May 2009 - October 2010. For the analysis were used data from patients with follow-up period longer than 6 months and present serous RPE ablation caused by occult choroidal neovascularization (CNV), verified by optic coherence tomography (OCT) and fluoresceine angiography (FAG).

STUDY GROUP

Ranibizumab was used as treatment during the period in 37 eyes of 37 patients (average age 73.2 years; right eye (RE) in 20 cases, left eye (LE) in 17 cases. Sodium pegaptanib was applied in 17 eyes of 17 patients (average age 72.4 years; RE in 10 cases and LE in 7 cases), The follow-up period in the ranibizumab group was 8.51 (SD 3.32) months, and in the pegaptanib group 9.94 (SD 5.50) months.

RESULTS

In the ranibizumab group decreased the average RPE ablation base from 2865 microm (SD 810 microm) to 2270 microm (SD 1265 microm) and the prominence of the ablation from 334 microm (SD 160) to 238 microm (SD 178 microm). In patients treated by pegaptanib, decreased the average basis from 3245 microm (SD 930 microm) to 2159 microm (SD 1185 microm), and the prominence of the ablation from 354 microm (SD 173 microm) to 208 microm (SD 107 microm). The statistical significance test did not prove significant differences (level of significance p = 0.05) in the change either of the base or the prominence of the RPE ablation in any group of patients (prominence p = 0.09, base p = 0.21; Mann-Whitney test). In three patients (8.1%) treated by ranibizumab, the RPE rupture occurred. No RPE rupture was recorded in patients treated by sodium pegaptanib.

CONCLUSION

Although no statistically significant difference in the efficacy of both drugs in the treatment of the RPE ablation was found, in patients treated by sodium pegaptanib, there is evident tendency of higher efficacy in decrease of the RPE ablation prominence, and lower incidence of RPE rupture. The study is limited by small number of patients and short follow-up period.