Central retinal artery occlusion due to infective endocarditis.

We present a case of central retinal artery occlusion (CRAO) in a 59-year-old male suffering from infective endocarditis. The patient was receiving antibiotic treatment for the endocarditis for 5 days prior to the event and received conservative treatment for the CRAO without any improvement. A few days after the event, the patient underwent heart surgery with aortic and mitral valve replacement and eventually recovered without any other side-effects. CRAO is a rare but devastating embolic complication of infective endocarditis and can happen regardless of whether a patient is receiving systemic antibiotic treatment or not. These patients need close observation, because an immediate diagnosis and an urgent therapeutic procedure are mandatory, as the prognosis for vision is poor.

Management of bullous keratopathy-related ulcer with autologous serum.

PURPOSE: The aim of this study was to report the use of autologous serum eyedrops (ASEs) for resolution of a corneal ulcer secondary to bullous keratopathy. METHODS: This is a case report. RESULTS: A 66-year-old patient presented with an infected ulcer and hypopyon while using a bandage contact lens for bullous keratopathy. Staphylococcus warneri infection was treated with systemic and topical antibiotics, and ASEs were subsequently administered to enhance reepithelialization and to avoid the need for a bandage contact lens. The ASE treatment led to closure of the epithelium layer within 3 weeks, and it was subsequently tapered over the next 3 months. The clinical picture remained stable subjectively and objectively during the 7 months of follow-up. DISCUSSION: To the best of our knowledge, this is the first report of successful use of ASEs in treating and preventing recurrence of ulcers in the context of bullous keratopathy.

Morphological Characteristics of Drug-Eluting Biodegradable Polymeric Thin Films Developed on the Surface of Intraocular Lenses by Three Techniques: A Comparative Study.

Background Cataract surgery is a very popular operation that requires a postoperative period of frequent instillation of antibiotic and anti-inflammatory eye drops. Modified drug-eluting intraocular lenses (IOLs) may eliminate the need for eye drops after surgery. Aim The purpose of this study is to compare the morphological characteristics of dexamethasone eluting biodegradable polymeric thin films developed on the surface of commercially available IOLs by three different methods. Method This experimental study was conducted between May and August of 2021 in the Lab for Thin Films - Nanobiomaterials - Nanosystems & Nanometrology (LTFN) of the Aristotle University of Thessaloniki. A mixture of two organic polymers [Poly (D, L-lactide-co-glycolide)(PLGA), lactide: glycolide (75:25) and Polycaprolactone (PCL)] and dexamethasone was prepared and then deposited on the surface of three-piece IOLs by spin coating, by spray coating, and by gravure printing. The modified IOLs were sterilized with the use of ultraviolet (UV) radiation and plasma treatment. Their structural properties were studied with the use of atomic force microscopy (AFM). Results Spin coating and gravure printing produced uniform thin films on the surface of the IOLs which were not damaged during the sterilization process. Spray coating led to the partial coating of the surface of the IOLs; the thin films underwent alterations following plasma treatment. Conclusions Thin films developed by spin coating and gravure printing on IOLs demonstrate the desired morphological characteristics that make them suitable candidates for further research.

Long-term follow up of autologous serum treatment for recurrent corneal erosions.

PURPOSE: The aim of the study was to evaluate long-term results of autologous serum treatment for recurrent corneal erosions. METHODS: In this prospective single-centre study, 33 eyes of 33 patients (21 male and 12 female) were treated with autologous serum eye drops for recurrent corneal erosions. Mean age of the patients was 49.3 ± 9.8 standard deviation (range 24-73) years. All subjects had failed to respond to other treatments. Autologous serum drops were administered for a 6-month period: six times daily for the first 3 months and four times daily for the remaining 3 months. Detailed informed consent was obtained from the entire patient group before the study. RESULTS: The mean follow-up period was 30 ± 6.3 standard deviation (range 12-48) months. None of the patients experienced a recurrence while under treatment. Twenty-eight patients (85%) had complete healing of erosions with no relapses of the disease over the whole follow-up period. Five patients (15%) presented a single recurrence 3-12 months after the end of the treatment. No sight-threatening complications were reported over the follow up. There was no statistically significant difference in the best spectacle-corrected visual acuity values (t(stat) = 2.1, F = 0.096, degree of freedom = 40,166, P < 0.41) or in the intraocular pressure measurements (P < 0.38) between the pre- and post-treatment patient groups. CONCLUSIONS: Autologous serum drops proved to be a safe and efficient treatment modality for patients with recurrent corneal erosion syndrome as observed through a long-term follow up.

Primary melanoma of the cornea.

Purpose: To present an extremely rare case of corneal melanoma. Method: An 84-year-old female patient presented to our department with a pigmented corneal lesion in her right eye (OD), 6x4 mm, complaining of mild pain and inability of complete eyelid closure. Tumor growth had been noted the previous year. She had undergone cataract surgery in her right eye three years before, followed by an unspecified postoperative complication. Her visual acuity was 3/10 OD and 9/10 OS. Ophthalmic evaluation and ultrasonography (A- and B-scan) did not reveal any other pathology. The pigmented lesion was surgically removed and the patient underwent a protocol therapy of topical chemotherapy (mitomycin 0.03%, 2x4 for 2 weeks and dexamethasone 0.1%, 2x4 for the following 2 weeks, followed by another cycle of mitomycin 0.03%, 2x4 for another 2 weeks). Results: The surgical removal of the lesion was uncomplicated, as was the postoperative period. The patient's visual acuity improved to 6/10 three months postoperatively. The histologic examination revealed malignant melanoma. Conclusions: Despite its rarity, primary melanoma of the cornea is an existing entity. Treatment of corneal melanoma consists of surgical removal and postoperative topical chemotherapy. Postoperative follow-up is mandatory.

24-Hour variation of optical coherence tomography-measured retinal thickness in diabetic macular edema.

PURPOSE: To investigate 24-hour variation in retinal thickness in patients with diabetic macular edema (DME) using optical coherence tomography (OCT). METHODS: Fifty-three eyes of 53 diabetic patients with clinically significant macular edema and central subfield thickness (CST) >225 µm, 36 eyes of 36 healthy individuals (normal controls), and 22 eyes of 22 diabetic patients without macular pathology (diabetic controls) underwent 5 OCT measurements at 7 am, 10 am, 3 pm, 8 pm, and 1 am. Visual acuity, blood pressure, blood glucose, and body temperature were measured as well. RESULTS: The CST (p<0.0005), total macular volume (p<0.0005), and visual acuity (p<0.0005) showed significant variation in patients. The CST (450 µm at 7 am) reached a minimum at 3 pm (absolute change of -49 µm, relative change of -17%) before increasing again. Thickening changes were higher in more thickened retinas (p<0.0005, p=0.024, absolute and relative change, respectively). Visual acuity was worse in the morning (0.38 logMAR) and improved to a maximum at 8 pm (0.30 logMAR) (p<0.0005). Blood pressure, blood glucose, and body temperature did not vary over time. CONCLUSIONS: The 24-hour variation of retinal thickness is observed in a large proportion of patients with DME, with a decrease from morning to afternoon. Time of examination should be taken into account when managing such patients.

Intra-operative assessment of toric intra-ocular lens implantation.

We report a new procedure for intra-operative toric intra-ocular lens (IOL) axis assessment in order to achieve optimal implantation. IOL implantation procedure was directly recorded. An assessor estimated the angle formed by the marked 0-180 axis and the toric IOL axis after implantation with the use of the appropriate software. If IOL implantation was assessed to be inaccurate, the surgeon was advised to correct IOL positioning by rotating the IOL clockwise. The assessment procedure was repeated until accurate IOL positioning was achieved.

Acrylic toric intraocular lens implantation: a single center experience concerning clinical outcomes and postoperative rotation.

PURPOSE: To present clinical results of toric intraocular lens (IOL) implantation for preexisting astigmatism correction and determine the time of any postoperative rotation. PATIENTS AND METHODS: Twenty-nine eyes of 19 patients underwent uncomplicated phacoemulsification and were implanted with an Acrysof ((c)) toric IOL. Uncorrected visual acuity, residual astigmatism, and postoperative rotation of the IOL were estimated one and six months after the operation. RESULTS: Uncorrected visual acuity was >/=0.5 in 26 of 29 eyes (89.7%) and >/=0.8 in 19 of 29 patients (65.5%). The mean toric IOL axis rotation was 2.2 +/- 1.5 degrees (range 0.6-7.8 degrees ) one month postoperation and 2.7 +/- 1.5 degrees (range 0.9-8.4 degrees ) six months postoperation. CONCLUSION: Implantation of one-piece hydrophobic acrylic toric IOLs appears to have acceptable stability, which encourages visual outcome and emerges as an attractive alternative for correction of refractive astigmatism.

Prooxidant-antioxidant balance, peroxide and catalase activity in the aqueous humour and serum of patients with exfoliation syndrome or exfoliative glaucoma.

BACKGROUND: Oxidative stress plays an important role in the pathobiology of exfoliation syndrome (XFS) and exfoliative glaucoma (XFG). METHODS: We investigated the prooxidant-antioxidant balance (PAB) in aqueous humour and serum samples of 20 consecutive cases of XFS, 20 of XFG, and 20 age-matched controls, employing a recently described novel assay. The activity of catalase and the levels of (hydrogen) peroxide were also measured in these samples. RESULTS: There was no significant difference between the PAB in the aqueous humour of the XFS group (82.5 +/- 10 AU) and age-matched control patients (78.9 +/- 13.4 AU; p > 0.05). A significant shift of the PAB balance in favour of oxidants was detected in the XFG group (90.2 +/- 7.6 AU) compared with controls (p < 0.001). In the serum of patients with XFS (138.8 +/- 13.2 AU) and XFG (124.08 +/- 13.50 AU), PAB was significantly altered in favour of oxidants as compared to age-matched controls (114.9 +/- 9.91 AU); p < 0.001). Catalase activity in the aqueous from XFS (10.1 +/- 4.5 U/ml) and XFG (12.2 +/- 6 U/ml) patients was significantly lower than that measured in the normal aqueous (14.6 +/- 1.9 U/ml). Similarly, a significantly lower catalase activity was found in XFS (103 +/- 21.4 U/ml) and XFG (116 +/- 38 U/ml) serum samples compared with controls (189.6 +/- 84.3 U/ml). Finally, (hydrogen) peroxide concentration in aqueous and serum samples from patients with XFS (aqueous: 26.9 +/- 6.6 microM; serum: 41 +/- 10 microM) and XFG (aqueous: 21.7 +/- 7 microM; serum: 32 +/- 4 microM) were significantly higher than that of the controls (aqueous: 9.6 +/- 5.8 microM; serum: 24 +/- 9 microM; p < 0.001). CONCLUSIONS: These findings suggest that in XFS oxidative stress is counterbalanced in the aqueous, whereas the development of XFG is accompanied by a disruption of this balance in favour of oxidants.