P6506Circulating microparticles preceding endothelial dysfunction and inflammatory process in patients with pseudoexfoliative glaucoma

Background

Pseudoexfoliative glaucoma (PEX) is a type of glaucoma characterized by the secretion of a grey-white, fibrogranular material in several tissues. Microparticles are shed membrane vesicles released from a variety of cell types in response to cellular activation or apoptosis and correlate with the pathogenesis of cardiovascular diseases. Endothelial MPs may be used as biomarkers of endothelial function.

Purpose

To evaluated the role of endothelial dysfunction, arterial stiffness and systemic inflammation in patients with PEX compared to patients with Primary open angle glaucoma (POAG) and control subjects as well as the possible pathophysiologic role of a specific microparticle profile associated with endothelial damage.

Methods

We enrolled 29 subjects with PEX, 57 subjects with POAG and 44 control subjects. Endothelial function was evaluated by flow-mediated dilation (FMD). Pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Growth differentiation factor-15 (GDF-15) and intercellular adhesion molecule1 (ICAM1) were measured to evaluate systemic inflammatory status. Total circulating MPs and EMPs were isolated and analysed by flow cytometry, utilizing specific labels for EMPs (CD 144+) and Annexin V staining for phospatidylserine bearing-MPs (AnnexinV + MPs).

Results

There was a linear impairment in FMD (p=0.005), PWV (p=0.007) and Aix (p=0.02) and a stepwise increase in GDF-15 (p=0.001) and sICAM-1 levels (p=0.08) between the three study groups (control, POAG, PEX). Interestingly, the PEX subjects expressed greater levels of total circulating MPs (Annexin V+) [1698 (1199–5894) MPs/μL vs. 1641 (1470–2705) MPs/μL. vs 493 (417–1512) MPs/μL, p=0.004] and EMPs (CD144+)[1412 (645–1760) MPs/μL3 vs 1380 (498–2496) MPs/μL vs 34 (184–870) MPs/μL, p<0.001] compared to POAG and control subjects.

Conclusion

Pseudoexfoliative glaucoma is associated with impaired endothelial function, arterial wall properties and vascular inflammation with a parallel increase in EMPs. Our findings indicate the significant role of endothelial damage in the progress of glaucomatous disease especially in subjects with pseudoexfoliative glaucoma.

Photodynamic Therapy with Verteporfin of Choroidal Neovascularization in Angioid Streaks: Conventional versus Early Retreatment

PURPOSE

To evaluate the effectiveness of conventional photodynamic therapy with verteporfin (PDT) in a series of patients with macular choroidal neovascularization (CNV) due to angioid streaks and to compare it to the effectiveness of early PDT retreatment.

METHODS

This is a retrospective study of 24 eyes (22 consecutive patients) with subfoveal or juxtafoveal CNV secondary to angioid streaks treated with PDT from September 2000 through February 2003 and that completed at least the first year of follow-up. Until August 2001, retreatments were performed according to the conventional protocol for PDT every 3 months (Group 1, consisting of 11 eyes of 9 patients). After August 2001 (13 more eyes of 13 new patients), retreatments were performed earlier (every 8 weeks) when indicated (Group 2). The follow-up time ranged from 30 to 42 months and from 12 to 30 months in Groups 1 and 2.

RESULTS

At the end of the follow-up, final best-corrected visual acuity decreased in 21 (87.5%), stabilized in 2 (8.3%), and improved in 1 (4.2%) of the total 24 eyes. In all, 19 of the 24 eyes (79.2%) had a final best-corrected visual acuity equal to or less than 20/400. There were not any statistically significant differences in final visual acuity between the two groups.

CONCLUSIONS

In this large series of patients with macular CNV secondary to angioid streaks, the functional and the anatomic results of PDT were not satisfactory, even when retreatments were performed earlier than the conventional time of 3 months.

[A New Way to Look Up. Solar Retinopathy Risks and Methods of Prevention Prior to the 2015 Solar Eclipse]

A solar eclipse is an impressive natural phenomenon that was last experienced in Europe in 2006. Last year, on March 20th 2015, a solar eclipse was visible in much of Europe. Solar retinopathy is a recognised potentially sight threatening condition that has been associated with direct or unprotected sun gazing. Public education has been shown to improve behaviour and attitudes that could influence the development of solar retinopathy during an eclipse. We have performed a study through newspapers prior to the 2015 solar eclipse in different European countries, in order to determine the level of public health awareness and attitudes to protection. Methods: 31 online editions of national newspapers were reviewed from six countries where the eclipse was most visible. Solar retinopathy, potential warnings, safe methods of viewing an eclipse and assessment of use and dangers of modern technologies were assessed. Results: All 25 newspapers examined mentioned the solar eclipse and risk to eyesight. Safe methods for viewing the eclipse were discussed in all newspapers. Eclipse eyeglasses were mentioned in 29 of the 31 newspapers reviewed. Children were identified as a high-risk group but advice for children viewing the eclipse varied between countries. Conclusion: Since the solar eclipse of 2006, there has been an increase in the level of education available in the media. Although the safe methods for viewing an eclipse have not changed in recent years, emerging technologies, such as camera phones and the "selfie" trend, have potentially increased the risk of eclipse-associated retinopathy.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Arachnoid Cyst of the Optic Nerve: a Case Report

BACKGROUND

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

HISTORY AND SIGNS

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

THERAPY AND OUTCOME

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

CONCLUSIONS

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

Retinal hemorrhage after photodynamic therapy in patients with subfoveal choroidal neovascularization caused by age-related macular degeneration

PURPOSE

To report the frequency and the evolution of the extensive retinal hemorrhages that can appear within 48 h after the application of photodynamic therapy.

METHODS

Two hundred and fifteen individual eyes of 194 consecutive patients with subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration who underwent photodynamic treatment were included in the study. The visual acuity was measured before and after treatment. Color and red-free photographs were taken. Fluorescein angiography and optical coherence tomography (OCT) were also performed in order to describe the macular hemorrhages.

RESULTS

Four out of 215 eyes developed macular hemorrhage within 48 h after the photodynamic therapy. Before treatment one of the four patients had classic CNV, one predominantly classic and two patients occult CNV without any classic component. In all four cases, the hemorrhage after photodynamic therapy (PDT) was extensive, it extended beyond the arcades and it was not absorbed during the follow-up period, which ranged from 11 to 21 months. The greatest linear dimension of the hemorrhage was extremely high (>12,000 microm).

CONCLUSION

Extensive macular hemorrhage was observed in 1.86% of the studied cases. The hemorrhage was not related to the type of the CNV lesion before treatment. The size and the appearance of hemorrhage within 48 h after treatment support the view that the hemorrhage is a direct consequence of the photodynamic therapy and not related to the natural course of the disease.

Assessment of macular function by multifocal electroretinogram before and after epimacular membrane surgery

PURPOSE

To evaluate macular function before and after successful surgical peeling of idiopathic epimacular membranes by means of multifocal electroretinogram (ERG) and measuring the first order Kernel.

METHODS

Multifocal ERG of 10 patients (10 eyes) with idiopathic epimacular membrane were recorded before and after successful macular peeling. The retinal response densities of areas 1 and 2 were compared pre- and postoperatively and the functional state of the retina beneath the epimacular membrane was evaluated. The postoperative period was 3-6 months.

RESULTS

Preoperatively, the electrical retinal response densities in the foveal and the perifoveal area were apparently decreased. After a mean postoperative period of 3 months the electrical response densities of the above areas improved. This improvement continued 6 months after the operation.

CONCLUSION

In idiopathic epimacular membranes, the decrease in retinal electrophysiologic response was not limited to the fovea but also involved the perifoveal area. The electrical retinal response density of these areas gradually improved after peeling of the epimacular membrane.

Spontaneous recovery of progressive anterior ischemic optic neuropathy

During the last 5 years much discussion has occurred about the progressive anterior ischemic optic neuropathy of nonarteretic type and the usefulness of surgical optic nerve sheath decompression for its treatment. The description of cases with spontaneous recovery of the disease made some authors reserved or against this method and the whole subject has been debated with skeptisism. In this article three cases of progressive nonarteretic anterior ischemic optic neuropathy with spontaneous recovery are described. In all these cases visual acuity, as well as visual evoked responses, was spontaneously ameliorated and the optic disc swelling was resolved. Only the visual fields defects remained almost the same. The question arising from this study is whether or not surgical optic nerve sheath decompression in these cases was the only appropriate method of treatment, as some authors propose.

Multifocal ERG in retinal detachment surgery

PURPOSE

The main purpose of this study is to evaluate the visual function of eyes operated on for rhegmatogenous retinal detachment.

METHODS

Fifteen patients were studied suffering from peripheral retinal detachment treated with the Lincoff-Custodis method. Visual field was tested with the Humphrey Field Analyzer and the analyzer program 30-2, which scanned a 0-30 degrees field. The multifocal ERG was recorded with the VERIS III (Visual Evoked Imaging System, Tomey, Nagoya, Japan).

RESULTS

There was great loss of retinal response densities in the area of retinal detachment (1.3 +/- 0.7 nV/deg2). However, a decrease in retinal response densities was also recorded in the reattached retina (6.90 +/- 0.7 nV/deg2).

CONCLUSIONS

MFERG is an objective tool for monitoring the functional abnormalities affecting the vision of eyes operated for retinal detachment.

Arcuate relaxing incisions with a 5.00-mm optical zone for the correction of high postcataract astigmatism

The purpose of this study was to investigate the efficacy and safety of arcuate cuts with a 5-mm optical zone to correct high postoperative astigmatism after extracapsular cataract extraction. We performed 5-mm optical zone arcuate cuts on 23 eyes of 23 patients with high postoperative astigmatism. Ophthalmic examination included uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA) and the amount of the refractive and keratometric cylinder before and 9 months after operation. Surgically induced refractive change was calculated in all cases. A significant reduction in astigmatism was achieved in all cases with minimal axis deviation. No case developed clinically significant irregular astigmatism. The mean magnitude of astigmatism of the surgically induced refractive change calculated from standard keratometry and refractive data was 3.73+/-0.72 and 3.70+/-0.77 dptr, respectively. The mean axis deviation calculated from the keratometric and refractive data was 1.18+/-2.33 and 1.32+/-3.62 degrees, respectively. At the last examination, 78.2% of the eyes had UCVA of 20/40 or better. No eye lost more than two lines of vision, 6 eyes lost one line, 2 eyes gained one and 1 eye gained two lines of BSCVA. The above data show that the 5-mm optical zone arcuate astigmatic keratotomy is an effective and safe method of correcting high postoperative astigmatism.

The a- and b-wave latencies as a prognostic indicator of neovascularisation in central retinal vein occlusion

To evaluate the prognostic value of ERG in cases of central retinal vein occlusion (CRVO) regarding the development of neovascularisation (NV), we studied 20 patients with unilateral CRVO. Half of them were allocated in the perfused group and the other 10 finally developed NV and were allocated in the non-perfused group. Flash ERG was recorded from all patients. Our findings suggest that b-wave latency is the most reliable parameter in predicting NV, followed by the a-wave latency. The b/a wave amplitude of ERG ratio does not seem to be suitable for clinical use.

Recurrent vitreous hemorrhages due to combined pigment epithelial and retinal hamartoma: natural course and indocyanine green angiographic findings

We report the clinical and angiographic features as well as the natural course of an optic disk and juxtapapillary combined pigment epithelial and retinal hamartoma in a 23-year-old white girl. The patient presented 3 episodes of recurrent vitreous hemorrhages in the first 4 years of follow-up, which were spontaneously and totally absorbed. During the last 6 years, she was absolutely free of any ocular symptom. The tumor did not show any growth during the 10 years of follow-up. The digital indocyanine green angiography, which was normal in the early frames, revealed a mild, patchy hyperfluorescence corresponding to the tumor location in the late phase.

Multifocal ERG changes before and after macular hole surgery

To evaluate the visual function of 15 eyes suffering from macular hole the multifocal ERG was used pre and postoperatively. In all the cases a successful vitrectomy has been done with macular hole closure in all the eyes. The Multifocal ERG shows an improvement of retinal response density in regions 1 and 2, even in the 2 eyes with unchanged visual acuity postoperatively. Although a relationship exist between the postoperative retinal response density and the visual acuity, the retinal response density varies between eyes with the same visual acuity.

Pattern ERG changes in suspected glaucoma

Pattern ERG (P-ERG) changes were studied in patients with suspected glaucoma. P-ERG was recorded in 48 eyes with good visual acuity, normal visual fields and elevated intraocular pressure ranging between 18 and 26 mm Hg. The amplitude of the P1 wave was within normal limits and ranged between 1.0 and 1.9 microV in 46 eyes (95.8%). In contrast, the amplitude of the N2 wave in 32 eyes (66.6%) was subnormal, ranging between 0.2 and 0.8 microV. The implicit time of the P1 and N2 waves was normal, ranging from 60.1 to 69.4 and from 95.1 to 103.8 ms, respectively. In conclusion, the N2 wave changes of the P-ERG may predict those hypertonic eyes which will eventually develop glaucoma and need early antiglaucoma therapy. On the contrary, in ocular hypertensives with normal N2 wave the development of glaucoma is less likely.

Optic nerve coloboma with retinal degeneration associated with cystic microphthalmia of the other eye

In a seventy-five-year old man an optic nerve coloboma with generalised retinal degeneration associated with a cystic microphthalmia of the other eye is described. The MR imaging revealed the existence of a left microphthalmic eye with a lower lid cyst. From the other eye an optic nerve coloboma with a cystic ectasia of the coloboma area freely open to the vitreous cavity was apparent. The ERG recorded from this eye was extinguished.

Cone properties of the light-adapted murine ERG

PURPOSE

Because the mouse lacks a typical Purkinje shift, we have examined its light-adapted ERG to determine whether there was other evidence in addition to tolerance to background light, that could be used to identify cone function in the ERG.

METHODS

Full field corneal ERGs to white flashes, double flashes and flash trains were examined in the presence of a strong full field light adaptation and compared with the human cone ERG.

RESULTS

The following cone-like properties could be identified. (1) The light-adapted murine ERG increases in amplitude gradually during the first 10 minutes of light-adaptation; (2) It is capable of responding to a 50 Hz stimulus, although its overall frequency response is slower than that of the human cone ERG; (3) A corneal positive d-wave occurs to the termination of a flash train; (4) The response increases linearly with light intensity.

CONCLUSION

The light-adapted murine ERG has several properties of cones but it has a slower response than the human cone ERG.

Juvenile nasopharyngeal angiofibroma--a rare case of primary orbital development

PURPOSE

To present a rare case of juvenile nasopharyngeal angiofibroma invading the ophthalmic orbit.

METHODS

The CT scan examination and the ultrasound tomography revealed the existence of a homogeneous solid mass causing distention and erosion of the nasal wall as well as dislocation of the ocular bulbus.

RESULT

The patient was operated, the mass was carefully liberated from its synechiae and it was totally excised with its capsule.

CONCLUSION

A rare case of juvenile nasopharyngeal angiofibroma invading the orbit is presented. The tumor was totally excized and the patient is five years after the operation in good general health without recurrence of the tumor.

The effect of low-dose interferon treatment on visual evoked potentials

Patients suffering from chronic viral hepatitis, treated with interferon alpha-2b in a dose of 3 million units trice weekly subcutaneously, were studied. The influence of interferon on the optic nerve was evaluated by measuring the P100 implicit time of the visual evoked potentials. The results before the treatment were compared with those after 6 and 12 months of therapy, as well as with those of normal subjects. There were statistically significant differences between the groups. Furthermore, in 10 of 56 eyes (17.8%) after 6 months of treatment, and 8 of 22 eyes (36.3%) after 12 months of treatment, the P100 was abnormally delayed. The long term neurovisual effects of low-dose interferon are currently under investigation.

Neurovisual impairment: a frequent complication of alpha-interferon treatment in chronic viral hepatitis

Following our earlier observation of clinically evident optic tract neuropathy in patients receiving low-dose interferon (IFN) therapy, we prospectively evaluated 53 consecutive patients treated for chronic hepatitis B or C with a median dose of 3 MU of IFN-a2b thrice weekly. Measurements included routine ophthalmologic evaluation and recordings of visual evoked responses (VER), electroretinograms (ERG), visual acuity, and visual fields, before, at the end of IFN treatment, and at follow-up visits. Baseline P100 latencies of VERs (base-VER) were abnormally prolonged in 24 patients (32 of 106 eyes, 30.2%); age was the only significant covariate associated with increased risk for an abnormal base-VER by multiple logistic regression (relative risk [RR] 5.3 per each 5-year increase in age). In 45 patients (74 eyes) with normal baseline P100 latencies, the end-of-treatment VERs (end-VER) were significantly prolonged compared with baseline, becoming abnormal in 11 (15 of 74 eyes, 20.3%) (138.8+/-8.7 vs. 117.7+/-5.2 ms, P < .001). This subgroup had older age (59.1+/-11.0 vs. 47.5+/-15.3, P=.007) and reduced visual sensitivity compared with their own pretreatment measurements (24.5+/-1.6 vs. 23.0+/-1.2db, P=.019). Changes of end-VERs by age had a sigmoid distribution with a steep increase of values beyond the 5th decade (R2=.326, P < .001). In a logistic regression model, significant predictors of abnormal end-VERs were, patients' age (RR 5.6 per each 5-year increase), presence of hepatitis B virus (HBV) infection (RR 15.1 compared with hepatitis C virus [HCV] infection) and serum cholesterol levels above 240 mg% (RR 7.1 compared with values < 240 mg%). Subconjunctival hemorrhages were seen in 2 cases and funduscopic examination revealed cotton wool spots in one other. ERG recordings and the P100 amplitude remained unchanged. After stopping IFN, the treatment-associated neurovisual abnormalities reversed to normal in 7 patients (10 of 15 eyes) and persisted in 5 (5 of 15 eyes, 33.3%) for up to 37 (median 7.3) months observation, all patients remaining clinically asymptomatic. In conclusion, subclinical neurovisual impairment is a frequent, largely unrecognized complication of low-dose IFN therapy, and patients with chronic hepatitis B and older age appear to be most susceptible. This apparently innocuous complication is long lasting, possibly irreversible in some patients, with yet undetermined consequences on visual function.

Clinical experience with cyanoacrylate tissue adhesive

In this paper 385 cases treated with cyanoacrylate tissue adhesive during the years 1980-1995 are studied. The indications, outcomes and complications of cyanoacrylate adhesive are investigated and the results are analysed. It is encouraging that except for three cases of ocular hypotony and two cases of microbial infection no other complications occurred. Even in desperate cases with corneal perforation greater than 3 mm and ocular infection, enucleation was avoided. The early use of a bandage contact lens, inserted just after the glue application and the coverage with topical antibiotics switched every 15 days until the removal of the glue, may explain the small incidence of infection. Our experience from the use of cyanoacrylate tissue adhesive in cases with corneal perforation greater than 3 mm is very encouraging. In these cases a running 10.0 nylon suture was used to create a reticulum over the space of the corneal perforation upon which the glue was applied. The use of cyanoacrylate tissue adhesive offers to the clinician a safe technique for healing corneal wounds that avoids tectonic penetrating keratoplasty with its associated complications.

Keratoconus and tapetoretinal degeneration

In a series of 233 keratoconus cases, electroretinograms (ERGs) and visual evoked responses (VERs) were recorded; the results of this study are discussed. In six cases, the ERGs were extinguished, and the VERs were pathologic. In contrast to this, in four cases, ERGs were normal, but VERs were pathologic. Postoperatively the electrophysiologic findings remained the same, and the ophthalmoscopic examination of the eyes revealed the existence of a diffuse tapetoretinal degeneration or a macular lesion. These data show clearly the coexistence in many cases of keratoconus with diffuse tapetoretinal degeneration or macular lesion. The preoperative value of an electrophysiologic study of keratoconus patients is justified to avoid an unneeded corneal transplant.

The prognostic value of visual evoked response latency in the treatment of amblyopia caused by strabismus

Visual evoked response alterations and especially P100 latency were studied in 60 patents with amblyopia caused by strabismus. Patients were divided in two groups according to the mode of fixation of the strabismic eye. Group A included patients with eccentric fixation, and group B, patients with central fixation of the strabismic eye. In all cases visual evoked responses were recorded before and after a 6-month period during which the patients had full-time occlusion of the sound eye. In cases with eccentric fixation of the strabismic eye, P100 latency was more abnormal than in cases with central fixation. In cases where latencies are clearly abnormal before treatment, the prognosis is poor and the results after occlusion of the sound eye are unstable. In contrast, in the cases with normal or nearly normal visual evoked response latencies, the prognosis is better, and these eyes show satisfactory improvement of visual acuity.

Intravitreal application of ganciclovir in rabbits: ERG and electron-microscopic findings

The retinal toxic effect after intravitreal use of ganciclovir has been the subject of our experimental investigation on 20 New Zealand rabbits. Different doses of ganciclovir ranging from 200 to 600 micrograms/0.1 ml were injected intravitreously, and ERG changes were recorded at different time points after drug administration. Finally the animals were killed and the retinal lesions were studied by electron microscopy. According to our experiments, ganciclovir doses of 300-600 micrograms/0.1 ml have a clearly toxic effect on the retina as shown by ERG changes. One month after the injection, the electroretinogram is either extinguished or clearly affected. Noteworthy is the fact that in a dose of 200 micrograms/0.1 ml, the ERG b-wave shows a 20% reduction of its normal amplitude 4 months after ganciclovir delivery. Electron microscopy of the retina revealed in the inner segment of the receptor cells the existence of dilatation and vesiculation of the endoplasmic reticulum in the surrounding nuclear cytoplasm and swelling of the mitochondria with fragmentation of the cristae in several of them. In the outer segment of the photoreceptor cells, degeneration and destruction of the lamellae accompanied by disintegration of the adjacent protoplasm in parts of certain rods and cones appeared. Finally large vacuoles of irregular shape in the synapses and degenerative mitochondria and empty vacuoles in the optic nerve fibers were shown.

Tuberculin sensitivity trends in Hellenic army recruits during the period 1981-91

SETTING

The tuberculin skin test is widely used to define the tuberculous infection in the community. Serial representative tuberculin surveys demonstrate the trend of the risk of tuberculous infection.

OBJECTIVE

The study of tuberculous infection in Hellenic army recruits for the purposes of BCG vaccination, which with chemoprophylaxis and early case-finding are the major strategies used for preventing tuberculosis (TB).

DESIGN

We investigated tuberculin skin sensitivity on 544210 Hellenic Armed Forces recruits during 1981-91. The age of the subjects ranged between 18-28 years (mean 21 +/- 1.5 years). We used the Mantoux technique with tuberculin PPD-RT 23 with Tween 80, dose 2 IU (1/5000) of the Hellenic Pasteur Institute. Tuberculin skin reactions were examined by two experienced readers after 48 hours. Indurations < 5 mm were considered as negative reactions, > or = 10 mm as positive, and 5-9 mm as doubtful reactions.

RESULTS

The results of the present study were compared to other studies undertaken in recruits during the period 1934-80. We found a decrease of positive reactions from 14.2% in 1981 to 6.8% in 1991. The mean annual reduction was 0.74%. The decline has continued since 1947, as previous studies during the period 1934-80 have shown.

CONCLUSION

We conclude that the tuberculin reactivity in recruits of the Hellenic army, although still high in relation to other European countries and North America, is declining steadily. We predict that the number of positive reactions will fall to about 1% by the year 2000, assuming that the same trend continues.

Incidence of tuberculosis in Greek armed forces from 1965-1993

Studies investigating the epidemiology of tuberculosis in Greece are lacking. Tuberculosis (TB) continues to be a public health problem and its dimensions are not clearly defined. The aim of this study was to estimate the incidence of pulmonary and pleural TB in each of the three branches of military personnel serving in the Greek armed forces, during the period 1965-1993. All military personnel with confirmed pulmonary or pleural TB during the period 1965-1993 were studied retrospectively. The age of the patients ranged from 18-45 years. A significant number of TB patients were detected by the regular chest radiography screening using mass miniature radiography during enrollment. The diagnosis of TB was made both by clinical and paraclinical examinations, such as history, symptoms, physical examination, tuberculin skin reactivity, chest X-ray and/or computed tomography of the thorax, bronchoscopy, microbiological examination of specimens (sputum, washings, bronchoalveolar lavage) as well as histological and bacteriological examination of the biopsies. We found that during the period studied, 4,628 patients were hospitalised for TB, 3,588 for pulmonary TB, and 1,040 for TB pleuritis (3,781 in the army, 445 in the navy and 402 in the air force). In 1965, the incidence (per 100,000) of TB (pulmonary and pleural) in the army was 60, in the navy 50, and in the air force 30. This incidence increased gradually from 1965 to 1980, followed by a decrease, since BCG vaccination became obligatory in 1980; values in 1993 were 18 in the army, 25 in the navy, and 15 in the air force. These figures are significantly higher than those reported for the civilian population, probably due to underreporting in the latter. Our results suggest that the incidence of TB in the Greek armed forces, although still high, is declining steadily. Strengthening of the anti-TB campaign is indicated.

C-wave study in cone dysfunction syndrome

An electroretinogram (ERG) and C-wave were recorded from 15 patients suffering from cone dysfunction syndrome. Our results show that the photopic ERG was diminished with extinction of the oscillatory potentials. On the other hand, the mean value of the C-wave amplitude was diminished and the implicit time prolonged. This may serve as a further diagnostic sign of the disease.

C wave of electroretinogram and visual evoked response in optic neuritis due to demyelinating diseases

In 21 consecutive cases with unilateral optic neuritis due to demyelinating disease, ERG, C wave of ERG and VER were recorded and studied in both eyes. Also 8 cases suffering from optic atrophy due to trauma or glaucoma were included. The analysis of data shows that the C-wave is significantly diminished in both eyes, namely the affected and the sound, in the cases of optic neuritis. Also in comparison to VER, C wave has a comparative probability in diagnosing optic neuritis due to demyelinating disease. The C wave of ERG is normal in the cases of optic atrophy. The mechanism of C wave involvement during the course of demyelinating disease may be related with an abnormality of the ionic homeostasis of the subretinal space.

ERG and electron microscopic findings after intravitreal use of aminoglycosides

The electroretinographic (ERG) changes and the retinal lesions shown by electron microscopy were studied in rabbits after intravitreal use of amikacin and tobramycin. We studied 40 eyes of 20 rabbits in which different doses ranging from 250 micrograms to 1000 micrograms of aminoglycosides were injected into the vitreous cavity. Tobramycin, and to some extent amikacin, were toxic to the retina even in doses of 500 micrograms as shown by ERG changes. The pathologic retinal lesions shown by electron microscopy were characterized by membranous inclusions in the retinal pigment epithelium, tumefaction of the photoreceptors, and partial disorganization of the inner layers. In doses of 250 micrograms or less, these two antibiotics seem to be nontoxic after a follow-up of three months.

C wave study in optic neuritis due to demyelinating disease

The C wave was recorded from 20 eyes suffering from neuritis due to demyelinating disease and in 5 eyes showing optic atrophy due to trauma or to increased intracranial pressure. Our results show that in cases with optic neuritis the C wave amplitude was clearly lower than normal. It is interesting that in the other 'healthy', at least clinically, eye the C wave was subnormal too. On the contrary, in the eyes with optic atrophy the C wave was normal. These findings are against the possibility of an efferent neuronal pathway involvement, which influences the level of the retinal pigment epithelium, and support the view of its involvement during the course of the demyelinating disease that causes the optic neuritis.

Acute bilateral optic neuritis

This paper presents the case study of six patients suffering from acute bilateral optic neuritis simultaneously manifested in both eyes. The clinical picture and the full laboratory investigation failed to establish a real cause of the disease. Finally the lack of general neurological symptoms and the good prognosis of the disease after a two year follow-up is stressed.

Extracapsular extraction and anterior-chamber flexible lens implantation

Extracapsular extraction with anterior-chamber lens implantation is a method which has a place in cataract surgery. We discuss 60 cases of cataract operated on by this method and its advantages. We had good results in cases without glaucoma, keratopathy, or diabetes mellitus, and depending on the ease with which a posterior capsulotomy was done, where this was imperative, without the risks of the YAG laser capsulotomy.

A severe endophthalmitis after Lincoff-Custodis procedure

A case of serious endophthalmitis two years after a Lincoff-Custodis procedure is presented. Even after the removal of the silastic sponge a phthisis bulbi appeared with loss of vision. Such a catastrophic complication is possible even after a period as long as two years if the appropriate therapeutic measures are not taken.

[Treatment of the epithelial cysts of the iris by Argon laser photocoagulation (author's transl)]

In this work seven cases with epithelial cyst of the iris resulting from trauma or cataract surgery were studied and treated by Argon laser photocoagulation. The authors analyse theirs results stressing the fact that no alteration of the lens or the cornea has been provoked after a follow-up of three years.

[Intravitreal injection of gentamicin--experimental findings (author's transl)]

In this experimental investigation the authors studied the electro-retinographic alterations and the histological lesions of the retina of rabbits following the intravitreal injection of different doses of gentamicin.

[Some observations on the use of cyclocryopexy in the treatment of various forms of glaucoma (author's transl)]

Cyclocryopexy constitutes a method for the therapy of absolute or hemorrhagic painful glaucoma. The authors describe its technique, its indications and the postoperative results obtained in 38 patients, from which they make appropriate conclusions.