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Mela EK, Drimtzias EG, Christofidou MK, Filos KS, Anastassiou ED, Gartaganis SP. Ocular surface bacterial colonisation in sedated intensive care unit patients. Anaesth Intensive Care 2010; 38:190-3. [PMID: 20191796 DOI: 10.1177/0310057x1003800129] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the time-dependent ocular surface bacterial colonisation of sedated patients hospitalised in an intensive care unit and aimed to evaluate whether proper topical antibiotic prophylaxis could prohibit corneal infection. The study lasted 12 months and included 134 patients undergoing sedation and mechanical respiratory support for various medical reasons. Patients hospitalised for less than seven days and those with pre-existing ocular surface pathology were excluded. All patients were examined on admission by inspecting the cornea for erosions. Followup examinations were performed each subsequent day. Cultures were also obtained from the conjunctival sac of both eyes on admission and every seventh day until the end of sedation. Standard laboratory techniques were used for isolation, identification and antibiotic susceptibility testing of bacteria. Antibiotic treatment for prophylaxis was administered accordingly. Analysis was carried out for 70 patients. Duration of sedation ranged from seven to 122 days. Fifty-four (77%) patients were colonised by at least one bacterial species other than normal flora within seven to 42 days. Multiple bacteria were isolated from 28 patients undergoing prolonged sedation. Prevalent isolates were Pseudomonas aeruginosa, Acinetobacter spp. and Staphylococcus epidermidis. Infectious keratitis was prohibited in all cases. Ocular surface of long-term sedated patients was found to be colonised by various bacterial species and their isolation was closely associated with the time period of hospitalisation. The results of this study suggest that the early identification of ocular surface bacteria colonisation and the administration of topical antibiotics for prophylaxis can prohibit corneal infection in these patients.
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Affiliation(s)
- E K Mela
- Department of Ophthalmology, Microbiology and Anesthesiology, Patras University Hospital, Rion, Patras, Greece
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Gartaganis SP, Georgakopoulos CD, Assouti M, Mela EK, Exarchou A, Giannelou I, Gotsis SS, Ziouti N, Vynios DH, Tripathi BJ, Tripathi RC. Changes in HNK-1 epitope and collagen type IX in the aqueous humour of patients with pseudoexfoliation syndrome. Curr Eye Res 2009; 28:5-10. [PMID: 14704908 DOI: 10.1076/ceyr.28.1.5.23490] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 11/03/2022]
Abstract
PURPOSE To investigate alterations in the proteoglycan (PG) and glycosaminoglycan (GAG) content of the aqueous humour in patients with pseudoexfoliation syndrome (PEX). MATERIALS AND METHODS Aqueous humor samples were obtained during cataract surgery from nineteen patients bearing PEX features and twenty-three age-matched normal controls. Protein and IgG were quantified densitometrically after their electrophoretic separation. Collagen type IX, 3-sulphoglucuronic acid (HNK-1 epitope), biglycan and heparan sulphate proteoglycans were detected in Western and dot blots by using specific monoclonal antibodies (MAbs). The immunochemical analysis was performed in native aqueous humour or after degradation of the glycosaminoglycans with chondroitinases. RESULTS Degradation of the samples with chondroitinases ABC, AC and B revealed that, in the aqueous humour from PEX eyes, collagen type IX and biglycan had a more dermatan sulphate than did normal eyes. In addition, more HNK-1 epitope was observed in PEX eyes, which after similar enzymatic treatment was found to be located mainly in dermatan sulphate sequences. 3-sulphoglucuronic acid was a constituent of the GAG chains of the collagen type IX. We found that the electrophoretic mobility of the bands of collagen type IX and HNK-1 epitope was exactly the same in the aqueous humour of normal and PEX samples; both migrated as four bands at 120, 113, 92.6 and 56 kDa. The PGs bearing heparan sulphate were found only in normal samples. Other PGs were not detected. CONCLUSIONS Because no significant difference was observed in the concentration of albumin and IgG in PEX and normal samples, the blood-aqueous barrier was probably not significantly compromised in PEX patients with cataract but without open-angle glaucoma. The results support the hypothesis that the pathogenesis of PEX can be linked to disturbed metabolism of GAGs and PGs.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, University of Patras Medical School, Patras, Rion, Greece.
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Gartaganis SP, Georgakopoulos CD, Exarchou A, Mela EK, Psachoulia C, Eliopoulou MI, Kourakli A, Gotsis SS, Tripathi RC. Alterations in conjunctival cytology and tear film dysfunction in patients with beta-thalassemia. Cornea 2003; 22:591-7. [PMID: 14508254 DOI: 10.1097/00003226-200310000-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/25/2022]
Abstract
PURPOSE Patients with beta-thalassemia (beta-tha) represent a group with lifelong transfusion-dependent anemias. This study aimed to describe the conjunctival changes and tear film parameters in these patients. METHODS A total of 52 patients (104 eyes) with beta-tha major and 22 normal control subjects (44 eyes) were studied during 1999 through 2000. Tear film break-up time (BUT), Schirmer test, rose Bengal staining, and cytologic evaluation of the conjunctival epithelium were performed in all subjects. The Papanicolaou and May-Grümwald-Giemsa staining procedures were performed on all smears. Patients and control subjects were compared for tear function parameters and conjunctival changes. RESULTS The BUT, Schirmer test, and rose Bengal staining values were significantly lower (P < 0.001) in beta-tha patients than in control subjects. Keratinized cells were observed in conjunctival samples in 41% of patients, with a decrease in the number of goblet cells per slide in 64% of patients. In 9% of beta-tha patients, there were a slightly greater number of inflammatory cells than in control eyes. CONCLUSION Ocular surface disorder of these patients was characterized by goblet cell loss and conjunctival squamous metaplasia. Our findings were correlated positively with the variable age. Epithelial damage by toxic reaction and disorder of tear quality and quantity are implicated as important factors in the pathogenesis of the ocular surface disease in beta-tha patients.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmmology, University of Patras Medical School, Patras, Grece.
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Gartaganis SP, Georgakopoulos CD, Mela EK, Exarchou A, Ziouti N, Assouti M, Vynios DH. Matrix metalloproteinases and their inhibitors in exfoliation syndrome. Ophthalmic Res 2002; 34:165-71. [PMID: 12097800 DOI: 10.1159/000063661] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [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: 01/18/2023]
Abstract
The purpose of this study was to determine the expression of metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in the aqueous humour of patients with exfoliation syndrome (XFS). XFS and control samples were analysed for their MMP content by zymography and for their tissue inhibitors by ELISA. In XFS eyes, an increase for up to 60% in almost all MMPs was observed, as compared to the controls. MMP-2 and MMP-9 were found to predominate. TIMP-1 levels in XFS samples were slightly decreased, while TIMP-2 levels were similar to those of the controls. Our findings suggest that MMPs may be crucial in the progression of XFS, by degrading the abnormal fibrillar matrix components in the anterior segment tissues of XFS eyes. However, the increased levels of MMPs seem not to be able to overcome the overproduction and accumulation of the exfoliative material.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, University of Patras Medical School, GR-26500 Rion, Patras, Greece.
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Gartaganis SP, Mela EK, Georgakopoulos CD, Georgiou S, Monastirli A, Merk HF, Tsambaos D. Effects of oral acitretin on contrast sensitivity and tear film function: a prospective study. Skin Pharmacol Physiol 2002; 15:200-4. [PMID: 12077473 DOI: 10.1159/000063549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/19/2022]
Abstract
The purpose of this prospective study was to investigate the ocular side effects of short-term therapy with oral acitretin (1 mg/kg/day) in 24 patients with severe and recalcitrant dermatoses. Apart from the routine ophthalmological examination, the following tests were performed: break-up time of tear film for the determination of its stability, Schirmer test for the assessment of lacrimal gland function, rose bengal staining for the detection of possible ocular surface damage and contrast sensitivity test for the evaluation of visual function. No statistically significant differences could be found between the pretreatment values of the assessed parameters and those obtained after 1 and 2 months of therapy. It seems reasonable, therefore, to suggest that ocular surface integrity and tear film and visual function are not affected by short-term oral acitretin administration.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece.
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Gartaganis SP, Georgakopoulos CD, Exarchou AM, Mela EK, Lamari F, Karamanos NK. Increased aqueous humor basic fibroblast growth factor and hyaluronan levels in relation to the exfoliation syndrome and exfoliative glaucoma. Acta Ophthalmol Scand 2001; 79:572-5. [PMID: 11782221 DOI: 10.1034/j.1600-0420.2001.790605.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To quantify the concentrations of basic fibroblast growth factor (bFGF) and hyaluronan (HA) in the aqueous humor of patients with the exfoliation syndrome (XFS) or exfoliative glaucoma (XFG). METHODS Aqueous humor bFGF and HA levels were measured in 13 patients with XFS and in 7 patients with XFG. The results were compared with those obtained from 17 healthy controls. RESULTS Mean bFGF levels were significantly higher in the XFG patients than those in the XFS patients, which in turn were higher than the bFGF levels in the healthy individuals. Aqueous humor HA levels in both patients with the XFS and the XFG were significantly higher compared to the controls. CONCLUSION We suggest that bFGF plays an important role in the pathogenesis of XFS and XFG, as well as in the synthesis of secreted HA, which may result in connective tissue degradation that affects the ocular anterior segment.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, University of Patras Medical School, 26500, Rion, Patras, Greece.
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Gartaganis SP, Eliopoulou MJ, Georgakopoulos CD, Koliopoulos JX, Mela EK. Bilateral panophthalmitis as the initial presentation of meningococcal meningitis in an infant. J AAPOS 2001; 5:260-1. [PMID: 11507588 DOI: 10.1067/mpa.2001.117096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endophthalmitis is a well-recognized, frequently devastating ophthalmic disease. The colonization of the eye and the subsequent development of endophthalmitis may be exogenous (including postsurgical and post-traumatic infections) or it may be of endogenous origin, representing a metastasis from a focus of infection elsewhere in the body associated with bacteremia (such as meningitis or cellulitis).
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, University of Patras Medical School, Patras, Greece
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Abstract
PURPOSE To evaluate contrast sensitivity function in patients with impaired oral glucose tolerance test (OGTT) compared with normal subjects. METHODS Sixteen patients with impaired OGTT and 11 normal control subjects were tested for contrast sensitivity function at four spatial frequencies. Glucose intolerance was established by the 1985 World Health Organization criteria. RESULTS The two groups were similar in terms of age, visual acuity, refractive correction, and lens opacities. A statistically significant loss of contrast sensitivity was associated with impaired OGTT (p < 0.001) in every spatial frequency tested. CONCLUSIONS Functional visual loss in patients with impaired glucose tolerance using the 1985 World Health Organization criteria indicates that at least part of those patients should be classified as diabetic according to the 1997 American Diabetic Association criteria. It seems that the 1997 American Diabetic Association criteria are more efficient at detecting patients with abnormal visual function.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, University of Patras Medical School, Greece.
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Abstract
PURPOSE To investigate contrast sensitivity function in patients with beta-thalassemia major, after regular transfusion and chelation therapy. METHODS We measured contrast sensitivity at four spatial frequencies in 30 patients with beta-thalassemia major and in 30 matched normal control subjects. All subjects underwent an ophthalmic examination that included fluorescein angiography. The contrast sensitivity results from the two groups were compared between them. Patients' contrast sensitivity values were correlated to the variables age, duration of transfusion, duration of chelation therapy and serum ferritin levels, to select the important predictors. RESULTS Contrast sensitivity function in all beta-thalassemic patients was significantly lower (p<0.0001) compared to the normal control subjects, for all spatial frequencies tested. The most important predictor of contrast sensitivity loss was patients' age. CONCLUSION Contrast sensitivity testing can detect early changes in the visual function of beta-thalassemic patients and should be considered as a monitor for patients under chronic transfusion-chelation therapy.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, University of Patras Medical School, Greece.
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Tzovolou DN, Lamari F, Mela EK, Gartaganis SP, Karamanos NK. Capillary electrophoretic analysis of brimonidine in aqueous humor of the eye and blood sera and relation of its levels with intraocular pressure. Biomed Chromatogr 2000; 14:301-5. [PMID: 10960828 DOI: 10.1002/1099-0801(200008)14:5<301::aid-bmc4>3.0.co;2-q] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/07/2022]
Abstract
The aim of this study was the development of a capillary electrophoretic method for the determination of the levels of the selective alpha(2)-adrenergic receptor agonist brimonidine in aqueous humor of the eye and blood sera and their relation to its efficacy in reducing the intraocular pressure (IOP). Analysis of brimonidine was performed by capillary zone electrophoresis using 20 mM borate, pH 9.3, as operating buffer and detection at 255 nm. Brimonidine levels were determined in aqueous humor and blood sera from seven patients admitted for cataract extraction following ocular administration of the ophthalmic Alphagantrade mark solution. Levels of brimonidine and IOP values were recorded for a 24 h period. Alphagantrade mark administration resulted in a significant reduction of IOP, from within 30 min up to 4-5 h, whereafter a stepwise increase was recorded until 24 h, where mean IOP value returned to that before administration. The IOP reduction was related to the levels of brimonidine in aqueous humor, where maximal levels (80-100%) were obtained within 1-3 h. A 50% amount of the solution was determined after 4-5 h, whereas it reached the minimum level after 12 h. Serum levels reached maximum within 3-4 h, a 50% reduction was recorded in 12 h and minimum level in 24 h. It is concluded that brimonidine administration may significantly reduce IOP in patients when its level is maintained >/=50% of the maximum present in aqueous humor, i.e within a 4-6 h period. Since at this time the level of brimonidine in blood serum has reached maximum value, administration of brimonidine every 6 h may be used to obtain adequate brimonidine levels to maintain a constantly lowered IOP.
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Affiliation(s)
- D N Tzovolou
- Section of Organic Chemistry, Biochemistry and Natural Products, Department of Chemistry, University of Patras, 261 10 Patras, Greece
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Mela EK, Koliopoulos JX, Lagogiannis PK, Giannopoulou AD, Georgakopoulos KD, Gartaganis SP. Bilateral multifocal choroidal metastases as the first manifestation of a breast carcinoma. Eye (Lond) 2000; 14 ( Pt 3A):392-3. [PMID: 11027010 DOI: 10.1038/eye.2000.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Gartaganis SP, Mela EK, Katsimpris JM, Petropoulos JK, Karamanos NK, Koliopoulos JX. Use of topical brimonidine to prevent intraocular pressure elevations following Nd:YAG-laser posterior capsulotomy. Ophthalmic Surg Lasers 1999; 30:647-52. [PMID: 10507567] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the efficacy of topical brimonidine tartrate 0.2% (Allergan, Irvine, CA) in the prophylactic treatment of acute intraocular pressure (IOP) rises following Nd:YAG laser posterior capsulotomy. PATIENTS AND METHODS This was a double-masked, randomized, placebo-controlled clinical study in 60 patients who underwent Nd:YAG laser posterior capsulotomy after extracapsular cataract extraction. Two doses of brimonidine or vehicle were administered before and after capsulotomy. Intraocular pressure was measured prior to commencing instillation and for 48 hours postoperatively. RESULTS Following posterior capsulotomy, the brimonidine group showed a significant mean percent reduction in IOP, while the vehicle group showed a significant mean percent increase in IOP. At 48 hours, mean IOP of both groups had returned to pre-laser level. There were no differences between the 2 groups in the incidence of clinical adverse experiences. CONCLUSION Two-dose brimonidine tartrate 0.2% effectively prevents acute IOP rises after Nd:YAG laser posterior capsulotomy.
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Affiliation(s)
- S P Gartaganis
- Department of Ophthalmology, University of Patras Medical School, Greece
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Abstract
Contrast sensitivity function after cataract extraction and intraocular lens implantation has been mainly correlated to the type or the material of the intraocular lens. Our purpose was to identify other possible factors, like posterior capsule, to contrast sensitivity alterations after cataract surgery, comparing patients operated for cataract by techniques that mainly differed on the posterior capsule's integrity. The intraocular lens implanted was either a posterior or an anterior chamber one, always monofocal and made of PMMA. We measured contrast sensitivity function at four spatial frequencies in two groups of operated individuals (group A and B) and in one group of healthy control individuals. Each group consisted of 42 eyes. Group A comprised eyes with intact, clear posterior capsule and posterior chamber monofocal intraocular lens. Group B comprised eyes with ruptured or removed posterior capsule and anterior chamber monofocal intraocular lens. Control group comprised healthy control eyes. A pair matched design was used to compare contrast sensitivity values among the individuals of the three groups. No statistically significant differences in contrast sensitivity values were found when group B patients were compared to healthy controls (p >0.05). Patients of group A exhibited contrast sensitivity function impairment at intermediate and high spatial frequencies when compared to patients of group B (p <0.05) and to controls (p <0.01). It seems that intact posterior capsule provides inferior visual function, in spite of relatively good visual acuity and apparently satisfactory results.
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Affiliation(s)
- E K Mela
- Department of Ophthalmology, University of Patras Medical School, Greece.
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Abstract
Divergent contrast sensitivity findings have been reported in patients with intraocular lens implants. The purpose of this study was to determine contrast thresholds of patients with good visual acuity after uncomplicated cataract extraction and posterior chamber conventional IOL implantation. Fifty-two eyes of fifty two patients, who had undergone uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens implantation together with 48 eyes of 48 control subjects were tested for contrast sensitivity function. All of the patients had best corrected visual acuity 0.8 (20/25) or better, on the Snellen scale. Patients with concomitant eye disease were excluded. Contrast sensitivity was measured using stationary sine-wave gratings of four spatial frequencies (3.0 to 18.0 cycles/degree), at the testing distance of 8 feet. A loss of contrast sensitivity was found in patients with intraocular lens implants, compared with control subjects of similar age, sex and visual acuity. The loss was statistically significant at intermediate (6 cyc/deg) and high spatial frequencies (12.0 and 18.0 cycles/degree), while it was not statistically significant at low spatial frequencies (3 cyc/deg). This may be the reason of nonspecific visual complaints ('washed-out images'), despite normal Snellen acuity, after cataract surgery and monofocal IOL implantation.
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Affiliation(s)
- E K Mela
- Department of Ophthalmology University of Patras Medical School, Greece
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