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Blazaki S, Blavakis E, Chlouverakis G, Bontzos G, Chatziralli I, Smoustopoulos G, Dimitriou E, Stavrakakis A, Kabanarou S, Xirou T, Vavvas DG, Tsilimbaris MK. Evolution of macular atrophy in eyes with neovascular age-related macular degeneration compared to fellow non-neovascular eyes. Graefes Arch Clin Exp Ophthalmol 2023; 261:3425-3436. [PMID: 37566302 PMCID: PMC10667153 DOI: 10.1007/s00417-023-06168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Τo evaluate the evolution of macular atrophy (MA) in patients with neovascular AMD (nAMD), compared with their fellow eyes exhibiting dry AMD (dAMD). METHODS This retrospective study included 124 patients from three centers treated with anti-VEGF in their nAMD eye and having dAMD in the fellow eye. Patients without MA at baseline were analyzed to study the time to first MA development. Synchronous and unsynchronous time course of MA was also studied. MA was evaluated using near-infrared images, while all available optical coherence tomography (OCT) images were used to confirm the criteria proposed by the Classification of Atrophy Meetings group for complete MA. RESULTS MA first detection in nAMD eyes increased significantly from year 2 to 6 compared to dAMD eyes. Over the study's follow-up, 45.1% of nAMD-E developed MA, compared to 16.5% of fellow eyes (p < 0.001). When MA in the two eyes was compared in a synchronous paired manner over 4 years, nAMD eyes had an average MA progression rate of 0.275 mm/year versus 0.110 mm/year in their fellow dAMD eyes. Multivariate ANOVA revealed significant time (p < 0.001), eye (p = 0.003), and time-eye interaction (p < 0.001) effects. However, when MA did develop in dAMD eyes and was compared in an asynchronous manner to MA of nAMD eyes, it was found to progress faster in dAMD eyes (dAMD: 0.295 mm/year vs. nAMD: 0.176 mm/year) with a significant time-eye interaction (p = 0.015). CONCLUSIONS In this study, a significant difference in MA incidence and progression was documented in eyes with nAMD under treatment, compared to fellow eye exhibiting dAMD. Eyes with nAMD tended to develop more MA compared to fellow dAMD eyes. However, when atrophy did develop in the fellow dAMD eyes, it progressed faster over time compared to MA in nAMD eyes.
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Affiliation(s)
- Styliani Blazaki
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Emmanouil Blavakis
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Gregory Chlouverakis
- Laboratory of Biostatistics, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Stavrakakis
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Stamatina Kabanarou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Demetrios G Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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2
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Muacevic A, Adler JR, Xirou T, Kabanarou SA. Acute Macular Neuroretinopathy Associated With COVID-19 Infection: Is Double Heterozygous Methylenetetrahydrofolate Reductase (MTHFR) Mutation an Underlying Risk Factor? Cureus 2023; 15:e34873. [PMID: 36855586 PMCID: PMC9968507 DOI: 10.7759/cureus.34873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
The goal of this report is to present a case of coronavirus disease 2019 (COVID-19)-associated acute macular neuroretinopathy (AMN) with an underlying MTHFR mutation. A 36-year-old male presented to the emergency department with a sudden-onset paracentral scotoma in his left eye. Although optical coherence tomography (OCT) was normal initially, four days later, it revealed a hyperreflective band in the outer plexiform layer with disruption of the ellipsoid zone/interdigitation zone. On infrared imaging and en-face OCT, wedge-shaped lesions were detected around the fovea with their tip oriented toward the fovea. OCT angiography, fundus autofluorescence, fundus fluorescein angiography, and visual fields were performed. The patient was positive for COVID-19 infection. The absence of medical history and the negative results of blood tests led to a diagnosis of AMN associated with COVID-19. Genetic testing for coagulation disorders was scheduled and revealed a heterozygous mutation for MTHFR C677T and A1298C. This is the first case of AMN in a patient with COVID-19 infection and a double heterozygous mutation of the MTHFR gene. Infection is the most commonly reported association of AMN, while MTHFR mutation may represent an additional underlying risk factor. Microthrombosis and small-vessel occlusion are thought to be involved in the pathophysiology of AMN, and patients should be tested for COVID-19 because it may be the first manifestation of the infection.
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Affiliation(s)
- Alexander Muacevic
- Ophthalmology, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
| | - John R Adler
- Ophthalmology, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
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3
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Xirou V, Xirou T, Siganos C, Ntonti P, Georgakopoulos C, Stavrakas P, Makri OE, Kanakis M, Tsapardoni F, Fragkoulis I, Garnavou-Xirou C, Kozobolis V. Impact of Cataract Surgery on IOP and Ocular Structures in Normotensive Patients and Primary and Exfoliation Open-Angle Glaucoma Patients. Clin Ophthalmol 2023; 17:1047-1055. [PMID: 37041963 PMCID: PMC10083030 DOI: 10.2147/opth.s402550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023] Open
Abstract
Purpose The aim of this study was to evaluate and compare the changes in Intraocular Pressure (IOP) and other ocular parameters: the Anterior Chamber Angle (ACA), Anterior Chamber Volume (ACV), and Anterior Chamber Depth (ACD) during phacoemulsification surgery in Greek patients with normotensive eyes and those with well-controlled Open-Angle Glaucoma (OAG). Additionally, parameters such as the Corneal Thickness (CCT), Axial Length (AL), Central Macular Thickness (CMT), and Retinal Nerve Fibre Layer (RNFL) were also examined. Patients and Methods This was a prospective observational case-control study that included 50 phakic eyes, 25 normotensive (Group 1), and 25 with OAG: 15 Primary Open-Angle Glaucoma (POAG) and 10 Exfoliation Glaucoma (EXG) (Group 2). Ophthalmic assessment included IOP measurements, ocular biometry, and anterior and posterior segment optical coherence tomography evaluation of the aforementioned ocular parameters, prior and 6 months after phacoemulsification surgery. Results At the 6 months post-operative review, a greater IOP reduction was recorded in eyes with OAG, in comparison to normotensive ones (5.3mmHg and 1.6 mmHg respectively). In addition, a significant but similar increase was recorded in the values of the ACA, ACV, and ACD of both groups between the pre- and the post-op period. Furthermore, the CCT and AL values remained unaltered. Finally, there was a non-statistically significant change in the mean CMT and the mean average RNFL of both groups. Conclusion Eyes with OAG tend to undergo a greater reduction in IOP post-phacoemulsification surgery, in comparison to normotensive eyes. This reduction may not be solely attributed to ocular anatomical changes after phacoemulsification surgery but may also be due to the remodeling of the trabecular meshwork and the ciliary body. This may be especially true in the case of OAG eyes, which already start off with a compromised trabecular endothelium prior to surgery.
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Affiliation(s)
- Vasiliki Xirou
- Ophthalmology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece
- Correspondence: Vasiliki Xirou, Ophthalmology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece, Email
| | - Tina Xirou
- Ophthalmology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece
| | - Charalambos Siganos
- Ophthalmology Department, University Hospital of Heraklion, Heraklion, Greece
| | - Panagiota Ntonti
- Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | - Olga E Makri
- Ophthalmology Department, University Hospital of Patras, Patras, Greece
| | - Menelaos Kanakis
- Ophthalmology Department, University Hospital of Patras, Patras, Greece
| | | | | | | | - Vassilios Kozobolis
- Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece
- Ophthalmology Department, University Hospital of Patras, Patras, Greece
- Eye Institute of Thrace, Democritus University of Thrace, Alexandroupolis, Greece
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4
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Xirou T. Management and prognosis of vitreous haemorrhage. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Kabanarou S, Bitzanakis N, Mamareli V, Makryllou SI, Garvanou‐Xirou C, Gkizis I, Xirou T. Choroidal neovascularization (
CNV
) due to non‐age‐related macular degeneration (
AMD
) causes: Multimodal imaging and treatment outcome in a retrospective case series. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Stamatina Kabanarou
- General Hospital of Athens, Korgialenio‐Benakio, E.E.S, Department of Ophthalmology Greece
| | - Nikolaos Bitzanakis
- General Hospital of Athens, Korgialenio‐Benakio, E.E.S, Department of Ophthalmology Greece
| | - Vasiliki Mamareli
- General Hospital of Athens, Korgialenio‐Benakio, E.E.S, Department of Ophthalmology Greece
| | | | | | - Ilias Gkizis
- General Hospital of Athens, Korgialenio‐Benakio, E.E.S, Department of Ophthalmology Greece
| | - Tina Xirou
- General Hospital of Athens, Korgialenio‐Benakio, E.E.S, Department of Ophthalmology Greece
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Blazaki S, Blavakis E, Smoustopoulos G, Bontzos G, Stavrakakis A, Chlouverakis G, Kabanarou S, Xirou T, Tsilimbaris M. Progression of macular atrophy in patients receiving long-term anti-VEGF therapy for age-related macular degeneration; Real Life Data. Ophthalmologica 2021; 245:152-160. [PMID: 34818657 DOI: 10.1159/000520595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022]
Abstract
Purpose To evaluate the progression of macular atrophy (MA) based on near-infrared reflectance (NIR) and optical coherence tomography (OCT) images, in patients with age-related macular degeneration (AMD), receiving anti-vascular endothelial growth factor (anti-VEGF) treatment for at least a 6-year period. Materials and Methods This retrospective study included 53 naïve patients (53 eyes) with neovascular AMD from two centers, who were treated with anti-VEGF intravitreal injections and had no MA at baseline. MA was evaluated in an annual basis using NIR images, while all available OCT images were used to confirm that the atrophic area fulfilled the criteria proposed by the Classification of Atrophy Meetings (CAM) group for complete retinal pigment epithelium RPE and outer retinal atrophy (cRORA). Incidence and progression of MA were evaluated. Associations with best-corrected visual acuity (BCVA) and total number of injections were also studied. Results Treatment duration of our patients was 7.34 ± 1.54 years. The mean number of anti-VEGF injections was 24.4 ± 13.6. BCVA at baseline was 0.38 ± 0.27 logMAR while at final visit it was 0.60 ± 0.35 logMAR (p=0.731). The cumulative incidence of new MA at years 1, 2, 3, 4, 5, and 6 was 1.89%, 18.87% 32.08%, 39.62%, 49.06% and 50.94% respectively. In patients who developed MA, mean MA area increased from zero at baseline to 5.66 ± 7.18 mm2 at final visit. The estimated annual enlargement of MA was 0.45 mm/year based on square root transformation (1.12 mm2/year, untransformed data). MA progression does not appear to be significantly associated with age (R=0.055; p=0.784), gender (R=0.113; p=0.576), BCVA (R=0.168; p=0.404) and total number of injections (R=0.133; p=0.255). Conclusion In this real-life setting, half of neovascular AMD patients under anti-VEGF treatment, without MA at therapy initiation, developed MA over a period of at least 6 years. In this work, the number of injections did not seem to have a significant association with MA progression.
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Affiliation(s)
- Styliani Blazaki
- Department of Ophthalmology, University Ηospital of Heraklion, Heraklion, Greece
| | - Emmanouil Blavakis
- Department of Ophthalmology, University Ηospital of Heraklion, Heraklion, Greece
| | | | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | | | - Gregory Chlouverakis
- Biostatistics Laboratory, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Stamatina Kabanarou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
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7
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Bontzos G, Kabanarou SA, Gkizis I, Ragkousis A, Xirou T, Peto T. Retinal neurodegeneration, macular circulation and morphology of the foveal avascular zone in diabetic patients: quantitative cross-sectional study using OCT-A. Acta Ophthalmol 2021; 99:e1135-e1140. [PMID: 33423370 DOI: 10.1111/aos.14754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Using OCT-A to investigate the association between neurodegeneration and vascular morphology in diabetic retinopathy (DR). METHODS Cross-sectional study. One hundred and sixty-two patients were enrolled and following fundoscopy were assigned to two groups according to DR severity: 54 patients to the group of no clinical signs of DR (noDR) and 54 to the non-proliferative DR (NPDR) group. Fifty-four age-matched patients without known diabetes were recruited as the control group. Patients underwent full ophthalmic examination followed by OCT-A. Central retinal thickness (CRT), vessel density (VD) in the superficial and deep retinal layers and foveal avascular zone (FAZ) area were measured. Additionally, ganglion cell complex (GCC) layer thickness along with global loss volume (GLV) and focal loss volume (FLV) indices was measured. RESULTS In total, 85 men with mean age of 51.93 ± 9.03 and 77 women with age of 50.14 ± 10.35 were examined. Mean diabetes duration was 4.62 ± 2.16 years in the noDR group and 11.34 ± 2.73 years in the NPDR group (p < 0.001). Superficial VD (sVD) and deep VD (dVD) were significantly different only between noDR and NPDR groups (p < 0.001 for both comparisons), but no statistically significant difference was observed between the controls and the DR groups. Global loss volume was significantly higher in the NPDR (4.38 ± 2.22) compared to the noDR group (3.24 ± 1.76; p < 0.03). Focal loss volume was significantly higher in both noDR (1.22 ± 1.03) and NPDR (2.09 ± 1.72) groups compared to controls (0.95 ± 0.83; p < 0.001 between noDR and NPDR and p = 0.02 between control and noDR groups). Significant associations were found between GLV and deep VD (p < 0.01, r = -0.48), FLV and superficial VD (p < 0.01, r = -0.42) and FLV with deep VD (p < 0.01, r = -0.64). CONCLUSION In this study, we evaluated the impact of DR in both the vascular layers and neural components of the retina as expressed by FAZ, sVD, dVD and GCC thickness, FLV and GLV using OCT-A. We found that FLV was significantly higher in both noDR and NPDR groups indicating that in progressive DR stages FLV values might be increased, which might serve as an early index of neuronal damage in patients with diabetes even in the absence of overt DR signs.
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Affiliation(s)
- Georgios Bontzos
- Department of Ophthalmology Korgialenio‐Benakio Hellenic Red Cross Hospital Athens Greece
| | - Stamatina A. Kabanarou
- Department of Ophthalmology Korgialenio‐Benakio Hellenic Red Cross Hospital Athens Greece
| | - Ilias Gkizis
- Department of Ophthalmology Korgialenio‐Benakio Hellenic Red Cross Hospital Athens Greece
| | - Antonios Ragkousis
- Department of Ophthalmology Korgialenio‐Benakio Hellenic Red Cross Hospital Athens Greece
| | - Tina Xirou
- Department of Ophthalmology Korgialenio‐Benakio Hellenic Red Cross Hospital Athens Greece
| | - Tunde Peto
- Department of Ophthalmology Centre for Public Health Institute of Clinical Sciences School of Medicine Queen's University Belfast Belfast UK
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Gkizis I, Garnavou-Xirou C, Bontzos G, Smoustopoulos G, Xirou T. Hypotony Following Intravitreal Silicone Oil Removal in a Patient With a Complex Retinal Detachment With Giant Retinal Tear. Cureus 2021; 13:e16387. [PMID: 34408940 PMCID: PMC8362903 DOI: 10.7759/cureus.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative ocular hypotony after silicone oil removal in complex cases of retinal detachment is a complication that can occur in about 20% of cases and can prevent the successful management of retinal detachments. Thus, it is critical to understand the mechanisms of hypotony and the potential interventions that can be done in order to avoid irreversible tissue damage. We present a case of a 35-year-old man who underwent intraocular surgery for removal of silicone oil tamponade following a combined scleral buckling and pars plana vitrectomy (PPV) surgery for a rhegmatogenous retinal detachment associated with a giant retinal tear. On Day 1 after the operation, the patient was found to have hypotony with optic disc edema, chorioretinal folds, and visual acuity of ‘hand movement’ perception. Two weeks postop, the patient’s condition stabilized, with a visual acuity of 0.38 logMAR, an intraocular pressure (IOP) of 12 mmHg, and the absence of macular edema.
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Affiliation(s)
- Ilias Gkizis
- Ophthalmology, Korgialenio-Benakio General Hospital, Athens, GRC
| | | | - Georgios Bontzos
- Ophthalmology, Korgialenio-Benakio General Hospital, Athens, GRC
| | | | - Tina Xirou
- Ophthalmology, Korgialenio-Benakio General Hospital, Athens, GRC
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9
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Bontzos G, Xirou T, Gkiala A, Smoustopoulos G, Gkizis I, Kontou E, Kabanarou SA, Tsilimbaris M. Long-term progression of myopic maculopathy in degenerative myopia as imaged by SD-OCT and IR imaging. Clin Exp Optom 2021; 105:26-31. [PMID: 33689624 DOI: 10.1080/08164622.2021.1878820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
CLINICAL RELEVANCE Clinicians can benefit from developing an understanding of the natural disease progression of myopic maculopathy in degenerative myopia using optical coherence tomography (OCT). BACKGROUND The prevalence of high myopia is constantly increasing. In this work, infrared imaging and OCT is used to study the natural course of the disease. METHODS This is a retrospective longitudinal study. Medical records of 72 patients with high myopia (< 6.00 D) and a minimum five-year follow-up period were analysed. Collected data on all enrolled patients included demographic characteristics and medical history, as well as recordings on best-corrected visual acuity, slitlamp examination, OCT, and fluorescein angiography in cases of suspected myopic choroidal neovascularisation. Images were independently marked by two graders. RESULTS The mean age of patients was 54.6 ± 14.4 years (59.72% female) with baseline logMAR best-corrected visual acuity of 0.22 ± 0.28. At baseline examination, 70.83% of the study group showed signs of maculopathy and 62.5% diffuse or patchy atrophy. During follow-up, 22.2% of patients with any type of atrophy showed enlarged affected areas. Two patients with baseline lacquer cracks developed new lesions. There was a weak correlation between patient age and maculopathy progression (r = 0.233; p = 0.03). While central retinal thickness was not associated with maculopathy progression (p = 0.203), a moderate correlation was found between choroidal thickness and maculopathy progression (r = -0.516; p < 0.001). CONCLUSION Lesion characteristics in myopic degeneration have been elucidated, taking advantage of the ongoing technological advances in retinal imaging. The understanding of disease patterns and progression is essential for appropriate management of patients, while discovering biomarkers which lead to choroidal neovascularisation development is of urgent importance to establish international diagnostic criteria and treatment protocols.
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Affiliation(s)
- Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece.,Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Anastasia Gkiala
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | | | - Ilias Gkizis
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Evgenia Kontou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
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10
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Gkoumas E, Bontzos G, Xirou T, Chatzispasou E, Kabanarou S. Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) Following a Hypovolemic Episode of Gastric Bleeding. Cureus 2020; 12:e11627. [PMID: 33376641 PMCID: PMC7755784 DOI: 10.7759/cureus.11627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Non-arteritic anterior ischemic optic neuropathy (NAION) is a rare complication following acute bleeding. Patients present with varying vision loss and visual field defects. NAION is more commonly developed in patients with systemic disorders that may affect normal blood flow such as hypertension and diabetes. In this case, we report a 54-year-old man who complained of vision blurring following an episode of acute gastric bleeding. This report aims to review the pathology of this condition and present the findings of newer non-invasive imaging modalities of the vascular layers of the posterior pole of the eye like optical coherence tomography angiography (OCTA), which facilitates the proper diagnosis and prognosis of such cases. Finally, we present the management options for this patient with antiplatelet treatment.
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Affiliation(s)
| | - Georgios Bontzos
- Ophthalmology, Korgialenio-Benakio General Hospital, Athens, GRC
| | - Tina Xirou
- Ophthalmology, Korgialenio-Benakio General Hospital, Athens, GRC
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11
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Ragkousis A, Xirou T, Bontzos G, Gkoumas E, Kontou E. Bilateral Anterior Ischaemic Optic Neuropathy as First Manifestation of Henoch-Schönlein Purpura (IgA Vasculitis). Mediterr J Rheumatol 2020; 32:81-85. [PMID: 34386705 PMCID: PMC8314889 DOI: 10.31138/mjr.32.1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/18/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022] Open
Abstract
A 46-year-old man was referred to our department complaining of a bilateral progressive decrease in his visual acuity. Fundus examination revealed bilateral optic disc oedema, indicative of anterior ischaemic neuropathy (AION), and a macular star in the right eye. Laboratory analysis showed low haematocrit and haemoglobin, elevated creatinine, and increased erythrocyte segmentation rate and C-reactive protein level. Physical examination revealed the presence of purpuric rash on the trunk and the extremities. During the investigation we performed a complete laboratory and imaging examination for autoimmune collagen diseases, vasculitides and infectious diseases, which were all negative. Histologic findings of renal biopsy were compatible with IgA glomerulonephritis and thus Henoch-Schönlein purpura (HSP) diagnosis was established. The patient was treated with methylprednisolone and cyclophosphamide. Six months later, his renal function and his visual acuity had improved, and the rash had subsided. This is a rare case of AION in a patient with HSP.
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Affiliation(s)
- Antonios Ragkousis
- Department of Ophthalmology, "Korgialenio-Benakio" Red Cross Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, "Korgialenio-Benakio" Red Cross Hospital, Athens, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, "Korgialenio-Benakio" Red Cross Hospital, Athens, Greece
| | - Evangelos Gkoumas
- Department of Ophthalmology, "Korgialenio-Benakio" Red Cross Hospital, Athens, Greece
| | - Evgenia Kontou
- Department of Ophthalmology, "Korgialenio-Benakio" Red Cross Hospital, Athens, Greece
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12
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Kabanarou SA, Bontzos G, Xirou T, Kapsala Z, Dimitriou E, Theodossiadis P, Chatziralli I. Multimodal Imaging for the Assessment of Geographic Atrophy in Patients with "Foveal" and "No-Foveal" Sparing. Ophthalmic Res 2020; 64:675-683. [PMID: 33027784 DOI: 10.1159/000512103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the applicability of optical coherence tomography (OCT) angiography (OCTA) for measuring geographic atrophy (GA) areas in age-related macular degeneration (AMD) patients with "foveal" and "no-foveal" sparing disease and compare it to other imaging modalities. METHODS A multimodal imaging protocol was applied, using infrared (IR) imaging, fundus autofluorescence (FAF), OCTA, and en-face OCT in 35 eyes of 23 AMD patients with GA. Patients were classified into 2 groups, with and without foveal sparing disease. GA area measurements for all imaging modalities were compared for each group separately. RESULTS The measured GA area was estimated to be 6.68 ± 3.18 mm2 using IR; 6.99 ± 3.09 mm2 using FAF; 6.56 ± 3.11 mm2 using OCTA, and 6.65 ± 3.14 mm2 using en-face OCT. There was no statistically significant difference in the GA area between different modalities (p = 0.977). When separate analysis was conducted for patients with "foveal" and "no-foveal" sparing disease, although GA measurements in FAF imaging displayed higher numerical values than the other modalities, especially in patients with foveal sparing, no statistically significant difference in the GA area was found between the different imaging modalities in either group (p = 0.816 for foveal sparing; p = 0.992 for no-foveal sparing group). CONCLUSIONS OCTA can be reliably used in the assessment of GA in AMD patients with and without foveal sparing disease. For both groups, measurements are comparable to IR, en-face OCT, and FAF, despite the fact that the latter recorded larger area of GA, mainly in the foveal sparing cases.
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Affiliation(s)
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio Benakio Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio Benakio Hospital, Athens, Greece
| | - Zoi Kapsala
- Department of Ophthalmology, Hippokration General Hospital, Athens, Greece
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Chatziralli I, Dimitriou E, Xirou T, Kabanarou SA, Theodossiadis G, Theodossiadis P. Optical coherence tomography biomarkers as predictive factors for postoperative visual acuity in patients with epiretinal membrane treated with vitrectomy. Oman J Ophthalmol 2020; 13:136-140. [PMID: 33542601 PMCID: PMC7852424 DOI: 10.4103/ojo.ojo_79_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/26/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: The purpose of this retrospective study was to evaluate potential predictive factors of postoperative visual outcome in patients with idiopathic epiretinal membrane (iERM), treated with pars plana vitrectomy (PPV). METHODS: Participants in the study were 46 patients diagnosed with iERM, who underwent PPV. Best-corrected visual acuity measurement and spectral domain-optical coherence tomography (OCT) were performed at baseline (preoperatively), and at months 6 and 12 postoperatively. Demographic characteristics and OCT parameters were assessed as potential predictive factors for postoperative visual outcome. RESULTS: Increasing age, retinal thickness, presence of disorganization of inner retinal layers, ellipsoid zone disruption, and presence of vitreomacular traction were found to be negatively associated with postoperative visual acuity. Gender, presence of subretinal fluid, cysts in the inner or outer nuclear layer, and hyperreflective foci were not found to affect visual acuity. There was statistically significant improvement in visual acuity and central retinal thickness between baseline and months 6 and 12 in the study sample. CONCLUSIONS: It is important to determine predictive factors for visual outcome, so as to inform patients about prognosis and help in the decision-making of patients' management.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
| | - Tina Xirou
- Retina Department, Red Cross Hospital, Athens, Greece
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Bontzos G, Kabanarou SA, Garnavou-Xirou C, Gkizis I, Kontou E, Triantafyllou D, Xirou T. Segmentation errors and motion artifacts in OCT-A associated with epiretinal membranes. Can J Ophthalmol 2020; 55:293-300. [PMID: 32253013 DOI: 10.1016/j.jcjo.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore segmentation errors, image quality, and motion-associated artifacts in eyes with idiopathic epiretinal membrane (ERM). METHODS This is a prospective observational study. We included 39 eyes affected by ERM and 40 eyes from age-matched healthy subjects. Optical coherence tomography-angiography (OCT-A) was performed in both groups. Segmentation was automatically performed by intergraded software. Segmentation was regarded as inaccurate if either border deviated from the correct plane by more than 50 μm. Presence of motion artifacts (blink lines, displacement, stretch artifacts, quilting, vessel doubling) and image quality index were reported. RESULTS Quality index score was 7.2 ± 0.9 for the ERM patients. Phakic eyes with ERM had quality index score of 7.71 ± 1.06, and pseudo-phakic eyes with ERM had a quality index score of 7.32 ± 0.85 (p = 0.22). Motion artifacts were 1.22 ± 0.7 in the study cohort. Segmentation was accurate in all healthy subjects (n = 40). Segmentation errors occurred in 64.1% of ERM patients. The inner plexiform layer was the segmentation boundary most prone to inaccurate segmentation, followed by the internal limiting membrane. Segmentation of retinal pigment epithelial layer was accurate in 96.7% of all cases. CONCLUSIONS OCT-A image quality cannot be accurately reproduced in pathological conditions, such as in ERM patients, and is prone to motion artifacts and segmentation errors. Incorrect segmentation results in anatomically incorrect en-face OCT-A images and subsequently in false quantification measures.
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Affiliation(s)
- Georgios Bontzos
- Department of Ophthalmology, "Korgialenio-Benakio" General Hospital, Athens, Greece.
| | | | | | - Ilias Gkizis
- Department of Ophthalmology, "Korgialenio-Benakio" General Hospital, Athens, Greece
| | - Evgenia Kontou
- Department of Ophthalmology, "Korgialenio-Benakio" General Hospital, Athens, Greece
| | | | - Tina Xirou
- Department of Ophthalmology, "Korgialenio-Benakio" General Hospital, Athens, Greece
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Kabanarou SA, Xirou T, Boutouri E, Gkizis I, Vasilias D, Bontzos G, Chatziralli I. Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery. Sci Rep 2020; 10:5534. [PMID: 32218471 PMCID: PMC7099086 DOI: 10.1038/s41598-020-62561-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
To examine preoperative use of intravitreal dexamethasone implant in patients with refractory diabetic macular edema (DME) undergoing cataract surgery. Participants in this study were 17 patients with DME refractory to previous treatment with anti-vascular endothelial growth factor agents or dexamethasone implant, and co-existent cataract. All participants received intravitreal dexamethasone implant at baseline and underwent phacoemulsification within one month after its insertion. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) changes between baseline, time of cataract surgery and postoperative months 1, 2 and 3 were evaluated. At month 1 after surgery, BCVA improved significantly from 42.3 ± 9.6 to 58.7 ± 11.9 letters compared to baseline (p < 0.001) and the improvement was sustained at month 2 and month 3 postoperatively. One month postoperatively, CST improved significantly compared to baseline (p < 0.001) and the improvement was sustained at month 2 (p < 0.001), while at month 3 CST started to increase, but remained significantly lower than baseline (p = 0.003). At month 3 postoperatively, 35.3% of patients presented recurrence of ME. Patients with refractory DME and cataract can safely undergo phacoemulsification when dexamethasone implant is inserted one month prior to surgery to ensure adequate control of postoperative inflammation and prevent deterioration of ME.
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Affiliation(s)
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Eirini Boutouri
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Ilias Gkizis
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Dimitrios Vasilias
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
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Kontou E, Bontzos G, Triantafyllou D, Garnavou-Xirou C, Ragkousis A, Xirou T. Conservative management of streptococcal necrotizing periorbital fasciitis following primary VZV infection. G Chir 2020; 41:114-117. [PMID: 32038022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 45-year old male patient, with a past history of illicit drug abuse and hepatitis C, presented with a 2 day history of worsening eyelid edema. Examination of the globe was impossible due to eyelid fusion caused by extensive soft tissue damage. Based on the examination, a diagnosis of necrotic fasciitis secondary to VZV infection was Romamade. The patient received empirical treatment with intravenous acyclovir, meropenem and vancomycin. CT imaging demonstrated no ocular involvement. Lesions were cultivated, revealing presence of Streptococcus pyogenes. Intravenous clindamycin was added to his course. Improvement was gradually observed. The patient received treatment for a total of 21 days, resulting in excellent final outcome. His final visual acuity was 0.9 on a Snellen chart, without signs of ocular inflammation. No surgical intervention was required and lesions fully healed with conservative management. Clinical outcomes depend on prompt treatment initiation, whilst delay in the diagnosis can prove fatal.
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Bontzos G, Gkoumas E, Xirou T, Chatzispasou E, Kabanarou S. Non‐arteritic anterior ischemic optic neuropathy due to hypovolemia. Acta Ophthalmol 2019. [DOI: 10.1111/j.1755-3768.2019.5426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Georgios Bontzos
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Evangelos Gkoumas
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Tina Xirou
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
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Kontou E, Bontzos G, Ragkousis A, Gkoumas E, Triantafyllou D, Bitza P, Xirou T. Bilateral anterior ischaemic optic neuropathy with macular star as first manifestation of Henoch‐Schönlein purpura (IgA vasculitis). Acta Ophthalmol 2019. [DOI: 10.1111/j.1755-3768.2019.5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Evgenia Kontou
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Georgios Bontzos
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Antonis Ragkousis
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Evangelos Gkoumas
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | | | - Penelope Bitza
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Tina Xirou
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
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Bontzos G, Garnavou‐Xirou C, Xirou T, Gkizis I, Kabanarou S, Chatziralli I. Do macular OCT‐A measures correlate with functional outcomes in diabetic patients? Acta Ophthalmol 2019. [DOI: 10.1111/j.1755-3768.2019.5428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Georgios Bontzos
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | | | - Tina Xirou
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Ilias Gkizis
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
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Xirou T, Bontzos G, Garnavou‐Xirou C, Kontou E, Gkizis I, Kabanarou S. Segmentation errors in OCT‐angiography associated with epiretinal membranes. Acta Ophthalmol 2019. [DOI: 10.1111/j.1755-3768.2019.5134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tina Xirou
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Georgios Bontzos
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | | | - Eugenia Kontou
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
| | - Ilias Gkizis
- Department of Ophthalmology Korgalenio‐Benakio Hospital Athens Greece
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Garnavou-Xirou C, Xirou T, Gkizis I, Kabanarou SA, Dimitriou E, Theodossiadis P, Chatziralli I. The Role of Disorganization of Retinal Inner Layers as Predictive Factor of Postoperative Outcome in Patients with Epiretinal Membrane. Ophthalmic Res 2019; 63:13-17. [PMID: 31013497 DOI: 10.1159/000499370] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the disorganization of the retinal inner layers (DRIL) as a potential predictive factor of postoperative visual outcome in patients with idiopathic epiretinal membrane (iERM), treated with pars plana vitrectomy (PPV). METHODS Participants in the study were 46 consecutive patients diagnosed with iERM, who underwent PPV. Best corrected visual acuity (BCVA) measurement and spectral-domain optical coherence tomography (SD-OCT) were performed at baseline (preoperatively), and at months 3 and 6 postoperatively. DRIL and additional OCT parameters were assessed at 1-mm-wide foveal centered area. RESULTS DRIL was observed in 47.8% of patients at baseline. There was statistically significant improvement in BCVA and central retinal thickness (CRT) between baseline and months 6 and 12 in all patients. There was a statistically significant difference in BCVA and CRT change between patients with and without DRIL at months 6 and 12 compared to baseline, showing that there was a correlation between change in BCVA or CRT and baseline DRIL. Ellipsoid zone and external limiting membrane were intact in 91.3 and 95.7%, respectively, not affecting our results. CONCLUSIONS Baseline DRIL has been shown to be predictive of postoperative visual outcome in patients with iERM, treated with PPV.
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Affiliation(s)
| | | | | | | | - Eleni Dimitriou
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
| | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece,
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Xirou T, Kabanarou SA, Gkizis I, Garnavou-Xirou C, Velissaris S, Theodossiadis P, Chatziralli I. Chronic Central Serous Chorioretinopathy-Like Maculopathy as Atypical Presentation of Chorioretinal Folds. Case Rep Ophthalmol 2018; 8:568-573. [PMID: 29422860 PMCID: PMC5803743 DOI: 10.1159/000484658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this case report was to present the clinical data and management of a 69-year-old female patient with chorioretinal folds who developed chronic central serous chorioretinopathy-like maculopathy. Case Presentation A 69-year-old female patient presented with a recent-onset slight decrease in visual acuity in her left eye. Her past ocular history was clear. Regarding her medical history, she had only hypertension, treated with per os medications. The patient underwent a complete ophthalmological examination. At presentation, the visual acuity was 6/6 in the right eye and 6/7.5 in the left eye. Intraocular pressure was 16 mm Ηg in both eyes. On fundoscopy, chorioretinal folds were noticed in the left eye. Spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography confirmed the diagnosis of chronic central serous chorioretinopathy-like maculopathy in the left eye, since other causes of chorioretinal folding were excluded. The right eye was normal. No treatment was given to the patient, and at the 6-month follow-up there was improvement in visual acuity, which was 6/6, and decreased subretinal fluid. Conclusions Central serous chorioretinopathy-like maculopathy should be taken into account for the differential diagnosis of patients with chorioretinal folds.
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Affiliation(s)
- Tina Xirou
- Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | | | - Ilias Gkizis
- Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | | | | | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
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Abstract
PURPOSE To present the results of secondary surgical treatment of five patients with massive suprachoroidal hemorrhage (MSCH), which occurred intraoperatively, postoperatively, or following ocular trauma. METHODS Five patients presenting with MSCH were included in this study during or after phacoemulsification surgery (1 patient), glaucoma surgery (1 patient), combined glaucoma and phacoemulsification surgery (2 patients), and after traumatic sclera rupture (1 patient). Diagnosis was confirmed by ophthalmoscopy and B-scan ultrasonography. Pre-existing risk factors and distance visual acuity were documented. All cases received medical therapy and underwent secondary surgical intervention with radial sclerotomies combined with vitrectomy, use of perfluorocarbon, and silicone oil. Postoperative assessment included visual acuity measurement, ocular examination, and ultrasonography. RESULTS In all cases, anatomic restoration of ocular structures was achieved. Distance visual acuity improved in all cases (preoperative Snellen visual acuity ranged from light perception to hand motions; postoperative Snellen visual acuity ranged from 0.05 to 0.3). The mean follow-up period was 17 months. CONCLUSIONS In general, despite the advanced surgical techniques, the prognosis of MSCH remains guarded and the visual outcome poor. However, secondary surgical treatment with combined radial sclerotomies and vitrectomy should be considered in order to minimize the damaging effect and maximize the anatomic and functional restoration.
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Affiliation(s)
- E Feretis
- Department of Ophthalmology, Red Cross Hospital, Athens, Greece
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Chatziralli I, Theodossiadis P, Parikakis E, Dimitriou E, Xirou T, Theodossiadis G, Kabanarou SΑ. Dexamethasone Intravitreal Implant in Diabetic Macular Edema: Real-Life Data from a Prospective Study and Predictive Factors for Visual Outcome. Diabetes Ther 2017; 8:1393-1404. [PMID: 29110201 PMCID: PMC5688995 DOI: 10.1007/s13300-017-0332-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implant and to determine the predictive factors for the final visual outcome. METHODS The study included 54 patients with DME refractory to previous antivascular endothelial growth factor (anti-VEGF) who were treated with intravitreal dexamethasone implant. Predictive factors for visual outcome were assessed. In addition, the change in best-corrected visual acuity (BCVA) and the percentage of patients with edema resolution were evaluated. RESULTS At the end of the 12-month follow-up, patients with DME gained + 5.2 letters (about 1 Snellen line), while 57.4% of patients presented total resolution of macular edema. Negative predictive factors for the final visual outcome were found to be increasing age, increasing macular thickness, phakic status, the presence of intraretinal fluid, hyperreflective foci, hard exudates, as well as external limiting membrane and ellipsoid zone disruption. The mean number of injections was 2.1. CONCLUSIONS The various predictive factors that determine the visual outcome and possibly define patient prognosis after dexamethasone intravitreal implant in DME cases have been studied. The long follow-up showed that dexamethasone intravitreal implant seems to be a safe and effective treatment for this disease, requiring a limited number of injections.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Panagiotis Theodossiadis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Dimitriou
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tina Xirou
- Retina Department, Red Cross "Korgialeneio-Benakeio" Hospital, Athens, Greece
| | - George Theodossiadis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Garnavou-Xirou C, Xirou T, Kabanarou S, Gkizis I, Velissaris S, Chatziralli I. Eccentric Macular Hole after Pars Plana Vitrectomy for Epiretinal Membrane Without Internal Limiting Membrane Peeling: A Case Report. Ophthalmol Ther 2017; 6:391-395. [PMID: 29043565 PMCID: PMC5693830 DOI: 10.1007/s40123-017-0113-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Postoperative eccentric macular hole formation is an uncommon complication after pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling for the treatment of epiretinal membrane (ERM). We present a case of eccentric macular hole formation after PPV for ERM without ILM peeling. Case report A 68-year-old male patient presented with ERM and visual acuity of 6/24 in his left eye. He underwent 23-gauge PPV without ILM peeling for treatment of ERM. One week postoperatively the retina was attached and the epiretinal membrane was successfully removed, while visual acuity was 6/9. One month after PPV, a single eccentric retinal hole below the macula was detected using fundoscopy and subsequently confirmed by optical coherence tomography. At this time the visual acuity was 6/9 and the patient reported no symptoms. No further intervention was attempted and at the 9-month follow-up, the visual acuity and the size of the eccentric macular hole remained stable. Conclusion Eccentric macular holes can be developed after PPV even without ILM peeling and are usually managed conservatively by observation.
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Affiliation(s)
| | | | | | | | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece.
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Xirou T, Chatziralli I. Ocriplasmin in the treatment of vitreomacular traction - for. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.04113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- T. Xirou
- Ophthalmic; Red Cross Hospital; Glyfada Greece
| | - I. Chatziralli
- B’ Ophthalmic Department of University of Athens; Attikon General Hospital; Athens Greece
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Xirou T, Kabanarou S, Gkizis I, Garnavou-Xirou C, Velissaris S, Chatziralli I. Eccentric macular hole after pars plana vitrectomy for epiretinal membrane without internal limiting membrane peeling. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0f059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. Xirou
- Ophthalmic; Red Cross Hospital; Athens Greece
| | | | - I. Gkizis
- Ophthalmic; Red Cross Hospital; Athens Greece
| | | | - S. Velissaris
- Ophthalmic; King's College Hospital; London United Kingdom
| | - I. Chatziralli
- 2nd Department of Ophthalmology; University of Athens; “Attiko” General Hospital; Athens Greece
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Gkizis I, Garnavou-Xirou C, Velissaris S, Kabanarou S, Chatziralli I, Kontou E, Xirou T. Enzymatic vitreolysis with ocriplasmin for symptomatic vitreomacular traction syndrome. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0f057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- I. Gkizis
- Ophthalmology; Korgialeneio-Mpenakeio Hospital; Athens Greece
| | | | | | - S. Kabanarou
- Ophthalmology; Korgialeneio-Mpenakeio Hospital; Athens Greece
| | - I. Chatziralli
- 2nd Department of Ophthalmology; University of Athens- Attikon Hospital; Athens Greece
| | - E. Kontou
- Ophthalmology; Korgialeneio-Mpenakeio Hospital; Athens Greece
| | - T. Xirou
- Ophthalmology; Korgialeneio-Mpenakeio Hospital; Athens Greece
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Xirou T. Non-surgical treatment of idiopathic macular hole (IMH). Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- T. Xirou
- Ophthalmic; Red Cross Hospital; Glyfada Greece
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Kabanarou SA, Xirou T, Mangouritsas G, Garnavou-Xirou C, Boutouri E, Gkizis I, Chatziralli I. Full-thickness macular hole formation following anti-VEGF injections for neovascular age-related macular degeneration. Clin Interv Aging 2017; 12:911-915. [PMID: 28603410 PMCID: PMC5457126 DOI: 10.2147/cia.s135364] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Macular hole (MH) is part of a group of age-related degenerative diseases characterized by pathology of vitreomacular interface. Similarly, neovascular age-related macular degeneration (nAMD) affects older patients and is a leading cause of irreversible visual loss. The purpose of this case series is to describe the development of full-thickness MH in patients with nAMD, following antivascular endothelial growth factor (anti-VEGF) treatment. METHODS Participants in this case series were four patients with nAMD, who received anti-VEGF injections with variable therapeutic response to treatment. Patients were examined at baseline (when AMD was diagnosed) and monthly thereafter. The examination included visual acuity measurement, slit-lamp biomicroscopy, and optical coherence tomography. RESULTS All patients were found to develop full-thickness MH within 1-4 months after the last anti-VEGF injection, even in the absence of pre-existing vitreomacular interface abnormalities in some cases. The median number of injections before the MH formation was 3. CONCLUSION MH formation may represent an adverse effect of anti-VEGF treatment in patients with nAMD and could be also coexisting pathology with nAMD in older individuals.
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Affiliation(s)
- Stamatina A Kabanarou
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - Tina Xirou
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - George Mangouritsas
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | | | - Eirini Boutouri
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - Ilias Gkizis
- Retina Department, Korgialeneio Benakeio, Hellenic Red Cross Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
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Chatziralli I, Kabanarou SA, Parikakis E, Chatzirallis A, Xirou T, Mitropoulos P. Risk Factors for Central Serous Chorioretinopathy: Multivariate Approach in a Case-Control Study. Curr Eye Res 2017; 42:1069-1073. [PMID: 28306346 DOI: 10.1080/02713683.2016.1276196] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this prospective study was to investigate the potential risk factors associated independently with central serous retinopathy (CSR) in a Greek population, using multivariate approach. MATERIALS AND METHODS Participants in the study were 183 consecutive patients diagnosed with CSR and 183 controls, matched for age. All participants underwent complete ophthalmological examination and information regarding their sociodemographic, clinical, medical and ophthalmological history were recorded, so as to assess potential risk factors for CSR. Univariate and multivariate analysis was performed. RESULTS Univariate analysis showed that male sex, high educational status, high income, alcohol consumption, smoking, hypertension, coronary heart disease, obstructive sleep apnea, autoimmune disorders, H. pylori infection, type A personality and stress, steroid use, pregnancy and hyperopia were associated with CSR, while myopia was found to protect from CSR. In multivariate analysis, alcohol consumption, hypertension, coronary heart disease and autoimmune disorders lost their significance, while the remaining factors were all independently associated with CSR. CONCLUSIONS It is important to take into account the various risk factors for CSR, so as to define vulnerable groups and to shed light into the pathogenesis of the disease.
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Affiliation(s)
- Irini Chatziralli
- a 2nd Department of Ophthalmology , Ophthalmiatrion Athinon , Athens , Greece
| | - Stamatina A Kabanarou
- b Medical Retina Department , Korgialeneio Benakeio, Red Cross Hospital , Athens , Greece
| | | | | | - Tina Xirou
- b Medical Retina Department , Korgialeneio Benakeio, Red Cross Hospital , Athens , Greece
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Xirou T. Introduction: DME in vitrectomized eyes. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. Xirou
- Red Cross Hospital; Glyfada Greece
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Papastefanou V, Vázquez-Alfageme C, Xirou T, Degli-Esposti S, Patel P, Sagoo M. Anatomic features of choroidal naevi: Swept-source optical coherence tomography vs Enhanced depth imaging tomography. Preliminary results in 31 patients. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V. Papastefanou
- Medical Retina; Moorfields Eye Hospital; London United Kingdom
| | | | - T. Xirou
- Medical Retina; Moorfields Eye Hospital; London United Kingdom
| | | | - P. Patel
- Medical Retina; Moorfields Eye Hospital; London United Kingdom
| | - M.S. Sagoo
- Medical Retina; Moorfields Eye Hospital; London United Kingdom
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Georgiadis O, Kabanarou SA, Batsos G, Feretis E, Xirou T. Bilateral Hypertensive Retinopathy Complicated with Retinal Neovascularization: Panretinal Photocoagulation or Intravitreal Anti-VEGF Treatment? Case Rep Ophthalmol 2014; 5:231-8. [PMID: 25232335 PMCID: PMC4163695 DOI: 10.1159/000365865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To present the case of a patient with bilateral hypertensive retinopathy complicated with retinal neovascularization who received anti-VEGF intravitreal injection in one eye and panretinal photocoagulation (PRP) in the fellow eye. METHODS A 33-year-old male patient presented with gradual visual loss in both eyes for the last 5 months. At that time, he was examined by an ophthalmologist and occlusive retinopathy due to malignant systematic hypertension was diagnosed. He was put on antihypertensive treatment but no ophthalmic treatment was undertaken. At presentation, 5 months later, best-corrected visual acuity (BCVA) was 0.1 in the right eye (RE) and 0.9 in the left eye (LE). Fundus examination was compatible with hypertensive retinopathy complicated with retinal neovascularization. Fluorescein angiography (FFA) revealed macular ischemia mainly in the RE and large areas of peripheral retinal ischemia and neovascularization with vascular leakage in both eyes. The patient was treated with two anti-VEGF (ranibizumab) injections with 2 months interval in the RE and PRP laser in the LE. RESULTS Follow-up examination after 12 months showed mild improvement in BCVA, and FFA documented regression of retinal neovascularization in both eyes. CONCLUSION Hypertensive retinopathy can be rarely complicated with retinal neovascularization. Treatment with PRP can be undertaken. In our case, the use of an intravitreal anti-VEGF agent seemed to halt its progression satisfactorily.
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Abstract
Purpose To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. Methods A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyanine angiography did not reveal choroidal involvement. Laboratory analysis showed rising IgG titers for Bartonellahenselae. Results Cat scratch disease was diagnosed, and a 4-week course of doxycycline was initiated. The patient responded well to the antibiotics. Both retinitis and arterial occlusion were resolved, the visual field was regained and the patient reported elimination of her symptoms. Conclusions Cat scratch disease should be considered in the differential diagnosis in young patients with retinal occlusive disease.
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Affiliation(s)
- Georgios Batsos
- Retina Department, Red Cross Hospital, University of Athens, Athens, Greece
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Xirou T, Theodossiadis PG, Apostolopoulos M, Kabanarou SA, Feretis E, Ladas ID, Koutsandrea C. Macular hole surgery with short-acting gas and short-duration face-down positioning. Clin Ophthalmol 2012; 6:1107-12. [PMID: 22973086 PMCID: PMC3422152 DOI: 10.2147/opth.s32077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To report on the outcomes of vitrectomy and sulfur hexafluoride (SF6) gas tamponade for idiopathic macular holes with 2 days of face-down positioning. Patients and methods This was a prospective, nonrandomized, observational sequential case-series study on 23 consecutive patients receiving macular hole surgery using 20% SF6 and advised to stay in a face-down position for 2 days postoperatively (SF6 group). These patients were compared to 23 consecutive patients who had previously undergone macular hole surgery, had received 14% C3F8, and were advised to maintain a face-down position for 2 days (C3F8 group). Patients in both groups underwent vitrectomy, internal limiting membrane peeling, and fluid gas exchange using either SF6 or C3F8. Preoperative and postoperative data included best corrected visual acuity recorded in LogMAR units, slit-lamp biomicroscopy, and optical coherence tomography. Results At a 6-month follow-up, macular hole closure was noted in 23/23 eyes (100%) and in 22/23 eyes (96%) in the SF6 and C3F8 groups, respectively. The improvement in visual acuity (measured through Snellen acuity lines both preoperatively until 6 months postoperatively) was 4.08 ± 2.31 (95% confidence interval [CI]: 3.08–5.08) for the SF6 group and 2.87 ± 2.30 (95% CI: 1.87–3.86) for the C3F8 group; this difference was not statistically significant (P = 0.06). Conclusion Vitrectomy with internal limiting membrane peeling and a short-acting gas tamponade using SF6 with posture limitation for 2 days may give a high success rate in macular hole surgery.
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Affiliation(s)
- Tina Xirou
- Vitreoretinal Unit, Red Cross Hospital, University of Athens, Greece
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Xirou T, Kidess A, Kourentis C, Xirou V, Feretis E, Kabanarou SA. Lamellar macular hole formation following vitrectomy for rhegmatogenous retinal detachment repair. Clin Ophthalmol 2012; 6:571-4. [PMID: 22553416 PMCID: PMC3340123 DOI: 10.2147/opth.s30107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate lamellar macular hole formation in six patients after rhegmatogenous retinal detachment repair. METHODS A retrospective review of medical records of patients who underwent primary pars plana vitrectomy for rhegmatogenous retinal detachment repair was performed. Optical coherence tomography characteristics and best-corrected visual acuity were evaluated. Patients who developed lamellar macular hole after pars plana vitrectomy for rhegmatogenous retinal detachment repair were identified. RESULTS A total of 1185 eyes underwent pars plana vitrectomy for retinal detachment between 2004 and 2009. Optical coherence tomography evaluation was available in 450 cases. Six of these cases demonstrated lamellar macular hole formation, which was diagnosed by OCT-3. The mean time from retinal detachment surgery to lamellar hole diagnosis was 4.1 months. The presence of an epiretinal membrane on the surface of the juxtafoveal retina was a common finding in all six patients. Visual acuity was improved after successful retinal reattachment and remained unchanged after lamellar hole formation. CONCLUSION Lamellar macular holes developing after pars plana vitrectomy is a rare complication. Stability of optical coherence tomography findings and best-corrected visual acuity after lamellar macular hole formation may be observed for at least two years.
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Affiliation(s)
- Tina Xirou
- Retina Department, Hellenic Red Cross General Hospital, Athens, Greece
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Xirou T, Xirou V, Mangouritsas G, Feretis E, Kabanarou SA. Full Thickness Macular Hole Closure after Exchanging Silicone-Oil Tamponade with C(3)F(8) without Posturing. Case Rep Ophthalmol 2011; 2:166-9. [PMID: 21677885 PMCID: PMC3104863 DOI: 10.1159/000327695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose To report a case of macular hole closure after the exchange of a silicone-oil tamponade with gas C3F8 14%. Method A 64-year-old female patient with a stage IV macular hole underwent a three-port pars-plana vitrectomy and internal limiting membrane peeling. Due to the patient's chronic illness (respiratory problems), a silicone-oil tamponade was preferred. However, the macula hole was still flat opened four months postoperatively. Therefore, the patient underwent an exchange of silicone oil with gas C3F8 14%. No face-down position was advised postoperatively due to her health problems. Results Macular hole closure was confirmed with optical coherence tomography six weeks after exchanging the silicone oil with gas. Conclusions Macular hole surgery using a silicone-oil tamponade has been proposed as treatment of choice for patients unable to posture. In our case, the use of a long-acting gas (C3F8 14%), even without posturing, proved to be more effective.
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Affiliation(s)
- Tina Xirou
- Retina Department, Hellenic Red Cross General Hospital, Athens, Greece
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Abstract
PURPOSE We present a rare case of ocular leishmaniasis complicated by proliferative vitreoretinopathy in a child with active visceral leishmaniasis. METHODS A 10-year-old boy with active visceral leishmaniasis presented with a 5- day history of redness, photophobia, and blurred vision in his left eye. Visual acuity was measured and the child had a complete ocular examination. RESULTS Snellen best-corrected visual acuity (BCVA) was 10/10 in the right eye and 7/10 in the left eye at presentation. Ophthalmic examination of the right eye was normal but the left eye showed clinical signs of panuveitis. Laboratory investigations were negative. Treatment with systemic and local steroids was initiated and clinical improvement achieved. Eight months later, the patient had a relapse of systemic and ocular disease with severe panuveitis in both eyes. A combined tractional-rhegmatogenous retinal detachment was present in the left eye. Pars plana vitrectomy was undertaken in the left eye and the patient was started on systemic and local steroid treatment. Retinal reattachment was achieved postoperatively but visual acuity in the left eye remained poor. CONCLUSIONS Early diagnosis, prompt systemic and ocular treatment, as well as close ophthalmic examination are essential in such cases.
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Kabanarou SA, Xirou T, Kourentis C, Fotiou P, Tadros C, Morphis G, Kaintatzis A, Feretis E. Vitreoretinal interface changes in acute-onset postoperative endophthalmitis. Klin Monbl Augenheilkd 2009; 226:224-6. [PMID: 19384770 DOI: 10.1055/s-0028-1109286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to assess the significance of different clinical appearances of the vitreoretinal interface in the surgical management of acute postoperative endophthalmitis. PATIENTS AND METHODS 22 patients underwent vitrectomy and were divided intraoperatively in 3 groups according to the degree of vitreoretinal interface changes: 10 patients had white infiltrates in the vitreous cortex but no retinal hemorrhages (group A), eight patients had white infiltrates in the vitreous cortex and retinal hemorrhages (group B) and four patients had advanced vitreous opacification, strong vitreoretinal adhesions and retinal hemorrhages (group C). In group A vitrectomy was performed and the vitreous cortex was removed cautiously, while in groups B and C the vitreous cortex was not removed in the first procedure. RESULTS Visual acuity improved in 14 patients, remained stable in 2 patients and deteriorated in 6 patients. The visual prognosis was better in group A. None of the cases was complicated with retinal detachment following vitrectomy, but in groups B and C 37.5 % and 50 % of the patients, respectively, went into phthisis. CONCLUSIONS Intraoperative assessment of the vitreoretinal interface insult in acute postoperative endophthalmitis contributes to an optimal surgical management, and it also has a prognostic value.
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Affiliation(s)
- S A Kabanarou
- Department of Ophthalmology, Korgialenio-Benakio, Red Cross Hospital, Athens, Greece.
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Tadros C, Xirou T, Kourentis C, Kidess A, Kabanarou S, Anastasakis A, Arvanitis M, Liaska A, Feretis E. 429 Gestion chirurgicale des corps étrangers intraoculaires selon leur localisation. J Fr Ophtalmol 2009. [DOI: 10.1016/s0181-5512(09)73553-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Katsimpris JM, Xirou T, Paraskevopoulos K, Petropoulos IK, Feretis E. Effect of local hypothermia on the anterior chamber and vitreous cavity temperature: in vivo study in rabbits. Klin Monbl Augenheilkd 2003; 220:148-51. [PMID: 12664368 DOI: 10.1055/s-2003-38175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aims to record the variations of the anterior chamber and vitreous cavity temperature after application of local hypothermia. MATERIAL AND METHODS Local hypothermia was applied on 20 rabbits' eyes after general anesthesia using a liquid which had been placed in a special plastic container and had been frozen at -20 degrees C. In 10 rabbits (Group A) the frozen container was placed on the eyes without direct contact with the cornea, the hypothermia being applied through the eyelids, for 10 min. In the other 10 rabbits (Group B), the container was in direct contact with the cornea for 10 min. After that time, both the anterior chamber and vitreous cavity temperatures were measured in both groups using a special 20 G tip and were recorded with a digital thermometer (BAT-10, Physitemp Instruments Inc.). Reactions on the fundus were assessed by indirect ophthalmoscopy one day after hypothermia application. RESULTS Mean reduction from the body temperature of temperature in the anterior chamber and in the vitreous was 10 +/- 1 degrees C and 4.2 +/- 0.5 degrees C respectively for Group A, and 20 +/- 0.8 degrees C and 8.5 +/- 0.5 degrees C respectively for Group B. All differences were statistically significant. CONCLUSIONS Our study shows that local hypothermia application, even without direct contact with the cornea, reduces significantly the temperature in the center of the vitreous in rabbits. This temperature reduction could be beneficial in conditions of intraocular inflammation, where hypothermia could act synergetically with other means to decrease the anterior and/or posterior segment inflammation.
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Affiliation(s)
- John M Katsimpris
- Department of Ophthalmology, General Hospital of Patras Agios Andreas, Patras, Greece.
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