ABSTRACT
BACKGROUND: Chronic mucocutaneous candidiasis disease (CMCD) may result from various inborn errors of interleukin (IL)-17-mediated immunity. Twelve of the 13 causal mutations described to date affect the coiled-coil domain (CCD) of STAT1. Several mutations, including R274W in particular, are recurrent, but the underlying mechanism is unclear. OBJECTIVE: To investigate and describe nine patients with CMCD in Eastern and Central Europe, to assess the biochemical impact of STAT1 mutations, to determine cytokines in supernatants of Candida-exposed blood cells, to determine IL-17-producing T cell subsets and to determine STAT1 haplotypes in a family with the c.820C>T (R274W) mutation. RESULTS: The novel c.537C>A (N179K) STAT1 mutation was gain-of-function (GOF) for γ-activated factor (GAF)-dependent cellular responses. In a Russian patient, the cause of CMCD was the newly identified c.854 A>G (Q285R) STAT1 mutation, which was also GOF for GAF-dependent responses. The c.1154C>T (T385M) mutation affecting the DNA-binding domain (DBD) resulted in a gain of STAT1 phosphorylation in a Ukrainian patient. Impaired Candida-induced IL-17A and IL-22 secretion by leucocytes and lower levels of intracellular IL-17 and IL-22 production by T cells were found in several patients. Haplotype studies indicated that the c.820C>T (R274W) mutation was recurrent due to a hotspot rather than a founder effect. Severe clinical phenotypes, including intracranial aneurysm, are presented. CONCLUSIONS: The c.537C>A and c.854A>G mutations affecting the CCD and the c.1154C>T mutation affecting the DBD of STAT1 are GOF. The c.820C>T mutation of STAT1 in patients with CMCD is recurrent due to a hotspot. Patients carrying GOF mutations of STAT1 may develop multiple intracranial aneurysms by hitherto unknown mechanisms.
Subject(s)
Candidiasis, Chronic Mucocutaneous/genetics , Mutation , STAT1 Transcription Factor/genetics , Adolescent , Adult , Candidiasis, Chronic Mucocutaneous/immunology , Child , Cytokines/metabolism , Europe, Eastern , Genetic Predisposition to Disease , Humans , Immunologic Tests , Leukocytes, Mononuclear/immunology , Middle Aged , Phosphorylation , Protein Structure, TertiaryABSTRACT
PURPOSE: Evaluation of the cost and effectiveness of therapy for patients with the wet form of age-related macular degeneration (AMD) in routine clinical practice. METHODS: A retrospective multicentre evaluation of changes in the best-corrected visual acuity in applied kinds of therapy and a comparison with the cost of individual therapeutic procedures. RESULTS: An overall total of 788 eyes of 763 patients with an average age of 73.2 ± 8.6 years was evaluated for a 1-year minimum period. In the ranibizumab and pegaptanib therapy groups, a reduction of 1.3 letters (p = 0.303) and 1.4 letters (p = 0.197) was found, respectively. In the group of photodynamic therapy (PDT) with verteporfin, a reduction of 5.2 letters was achieved (p < 0.001). Under the conditions of routine practice in the Czech Republic, the annual cost is highest (EUR 5,467.63/patient) in patients with pegaptanib therapy. The annual cost in patients with ranibizumab therapy is lower by EUR 1,220.16. The cost is nearly half (EUR 2,783.65) in the group treated with PDT with verteporfin. CONCLUSION: An initiation of AMD therapy by ranibizumab is cost-effective as compared to pegaptanib. Both ranibizumab and pegaptanib are significantly more efficient as compared to PDT with verteporfin. Therapy with ranibizumab and pegaptanib, as compared to PDT with verteporfin, prevents the loss of 1 line of vision on the ETDRS chart for EUR 1,225.98 and 2,286.18, respectively.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Aptamers, Nucleotide/therapeutic use , Health Care Costs/statistics & numerical data , Porphyrins/therapeutic use , Wet Macular Degeneration/drug therapy , Aged , Aged, 80 and over , Angiogenesis Inhibitors/economics , Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/economics , Aptamers, Nucleotide/economics , Cost-Benefit Analysis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Photochemotherapy/economics , Photosensitizing Agents/economics , Photosensitizing Agents/therapeutic use , Porphyrins/economics , Ranibizumab , Retrospective Studies , Treatment Outcome , Verteporfin , Visual AcuityABSTRACT
The study is designed to determine the relationship between the progress of the wet form of age-related macular degeneration and the activity of the visual cortex examined using functional magnetic resonance imaging. Ten patients with the wet form of age-related macular degeneration (9 female and 1 male) with a mean age of 74.7 years (58-85 years) at various stages of bilateral involvement of the disease were included. Patients did not suffer from any other ocular nor neurological disease. All the patients underwent functional magnetic resonance imaging examinations with stimulation of both eyes using a black-and-white checkerboard of size 25.8 × 16.2 degrees. The group was compared with a group of healthy subjects with an average age of 54.1 years (45-65 years). For statistical evaluation, the Mann-Whitney U test was used. Comparing the extent of visual cortex activations we found a statistically significant difference between both the groups (p = 0.0247). However, the dependence of functional magnetic resonance imaging activity on visual acuity was not statistically significant (p = 0.223). We conclude that in patients with the wet form of age-related macular degeneration, lower functional magnetic resonance imaging activity of the visual cortex was found compared with the control group of healthy subjects. Dependence of functional magnetic resonance imaging activity on visual acuity was not statistically significant.
ABSTRACT
The authors report an unusual case of two etiologically different forms of the optic nerve head edema consequently occurring in short time interval: ischemic optic nerve edema and papilledema. A 58-year old woman was diagnosed with papilledema in the course of idiopathic intracranial hypertension. After successful treatment both papilledema and subjective symptoms subsided during 5 months. Three months later she was presented with worsening of visual functions in her left eye and anterior ischemic optic neuropathy was diagnosed. On this rare case we would like to emphasize the necessity of proper differential diagnosis of optic nerve head edema in relation with the treatment and prognosis.
Subject(s)
Optic Neuropathy, Ischemic/complications , Papilledema/complications , Diagnosis, Differential , Female , Humans , Middle Aged , Optic Neuropathy, Ischemic/diagnosis , Papilledema/diagnosisABSTRACT
The current investigation evaluates the efficiency of the trifocal toric Liberty 677MTY intraocular lens (IOL) in correcting preoperative corneal astigmatism in cataract patients demanding spectacle independence. The retrospective evaluation included 28 eyes of 15 patients with preoperative corneal astigmatism of at least 1.0 Dioptre (D). All patients were followed up for one year postoperatively. Residual refractive errors and visual acuities at multiple distances were measured. Binocular visual acuity and contrast sensitivity defocus curves were plotted. Visual functions and patient satisfaction were assessed. The efficiency of astigmatism correction was determined using the vector analysis method. The mean spherical equivalent refraction (SEQ) improved from 2.72 ± 1.62 D to 0.10 ± 0.48 D. The cylindric refraction decreased from 1.18 ± 0.45 D to 0.16 ± 0.31 D. Vector analysis proved efficient astigmatism correction with a centroid of 0.10 ± 0.34 D at 161°. Ninety-two percent of eyes resulted within 0.5 D from the target refraction. Visual acuities were 0.1 logMAR or better from +1.0 to -3.5 D defocus values. Visual tasks could be performed without major difficulties. Our patients were highly satisfied. Refractive and visual outcomes with the investigated presbyopia-correcting toric IOL are predictable and the lens provides excellent trifocal vision.
ABSTRACT
OBJECTIVE: To present a unique case of a 34-year-old patient with unilateral functional visual loss after chemical burn with normal visual evoked potentials (VEPs) and absent cognitive response (P300 wave). METHODS: Visual functions, complete ophthalmic and neurologic examinations including computed tomography of the brain, electrophysiological testing of the visual pathway up to the cognitive brain cortex were evaluated. Data were collected prospectively during 1-year follow-up and compared with data from published case series and a literature review. RESULTS: No abnormalities were found that could account for such a rapid monocular loss of vision with exception of absence of the P300 wave in the affected eye during cognitive tasks. Vision slowly improved during 1 year without any treatment. CONCLUSIONS: Functional vision loss is a diagnosis of exclusion. In the event of reduced vision in the context of a normal ocular health examination, all other pathology must be ruled out before the diagnosis of functional visual loss is established. Complex visual electrophysiological testing is the preferred tool for objective examination of such disorders.
Subject(s)
Burns, Chemical/physiopathology , Cognition Disorders/physiopathology , Eye Burns/chemically induced , Sensory Thresholds/physiology , Vision Disorders/physiopathology , Adult , Electroretinography , Evoked Potentials, Visual/physiology , Humans , Male , Prospective Studies , Retina/physiology , Visual Acuity/physiology , Visual Field Tests , Visual FieldsABSTRACT
This semi-prospective, parallel, comparative investigation evaluated the clinical outcomes and quality of vision (contrast sensitivity, visual function, dysphotopsia, spectacle use, overall satisfaction) after mono- or bilateral implantation of two presbyopia-correcting intraocular lenses (IOL)-the Liberty® 677MY or the AT LISA® tri 839M-in 50 eyes of 25 cataract patients. Clinical outcomes were assessed 3 and 12 months postoperatively. Eighty-nine percent of eyes implanted with the Liberty IOL and 59% of eyes implanted with the AT LISA IOL achieved a refractive outcome ±0.5 diopters of the target (emmetropia). Refractive outcomes were stable with both lenses. The proportions of eyes with 20/20 uncorrected distance visual acuity (UDVA) and 20/20 uncorrected near visual acuity (UNVA) were higher in the Liberty group than in the AT LISA group (UDVA: 56% vs. 41%; UNVA: 83% vs. 66%). Optical quality assessment results were comparable for the two IOLs. Superior photopic contrast sensitivity was found with the Liberty lens. The rate of Nd:YAG capsulotomy at the 12-month follow-up was 16.7% in the Liberty group and 40.6% for the AT LISA IOL. Considering that both lenses are made from the same material, we propose that the noted differences in clinical outcomes may derive from differences in design and optical surface between the two IOLs.
ABSTRACT
OBJECTIVES: The aim of this study was to assess the clinical outcomes, predictability of results, efficiency of astigmatism correction, and rotational stability of the Bi-Flex 677TAY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary) monofocal toric intraocular lens (IOL) designed for cataract patients with astigmatism. METHODS: The IOLs were implanted either mono- or binocularly, following routine cataract surgery. Visual and refractive outcomes, as well as off-axis rotation were assessed throughout a 1-year follow-up period. All clinical data for this work were collected retrospectively. Vector analysis based on the Alpins method was performed to assess the efficiency of astigmatism correction. RESULTS: No complications or adverse events occurred during surgery or the follow-up period. IOL implantation brought 88% of eyes into the ±0.50 D, and 100% into the ± 1.00 D range compared to the target spherical equivalent refraction, emmetropia. Astigmatism correction brought similar results: 94% of eyes had a residual cylindrical error of not higher than ±0.50 D, and 97% were within ±1.00 D. Vector analysis resulted in a correction index of 0.96 and a difference vector of 0.17. Both refractive and visual outcomes showed long-term stability. During the 12-month follow-up period, no eyes had a rotation of >5°. Absolute rotation after 1 year was 1.42 ± 1.89° (median = 0°), while signed rotation was 1.06 ± 2.12° (median = 0°). CONCLUSION: The Bi-Flex 677TAY monofocal toric IOL, designed by Medicontur Medical Engineering Ltd., represents an efficient and safe solution for cataract patients with astigmatism. Clinical and refractive outcomes are predictable, and rotational stability ensures long-term visual comfort.
ABSTRACT
PURPOSE: To assess the efficacy, predictability, and safety of LASIK for the surgical correction of low to moderate myopia with astigmatism using the SCHWIND AMARIS excimer laser. METHODS: Six international study sites enrolled 358 eyes with a manifest refraction spherical equivalent (MRSE) from -0.50 to -7.38 diopters (D) (mean sphere: -3.13+/-1.58 D) with up to -5.00 D of astigmatism (mean: -0.69+/-0.67 D). All eyes underwent treatment with the nonwavefront-guided aspheric algorithm of the SCHWIND AMARIS excimer laser. All eyes were targeted for emmetropia. Refractive outcomes and corneal higher order aberrations were analyzed pre- and postoperatively. Visual quality was assessed using photopic and mesopic contrast sensitivity. Six-month postoperative outcomes are reported. RESULTS: At 6 months postoperative, the MRSE for all eyes was -0.21+/-0.20 D, and 96% (343/358) of eyes had MRSE within +/-0.50 D. Uncorrected visual acuity was 20/20 or better in 98% (351/358) of eyes, and no eyes lost 2 or more lines of best spectacle-corrected visual acuity. The total corneal higher order aberrations root-mean-square increased by 0.09 microm, spherical aberration increased by 0.08 microm, and coma increased by 0.04 microm postoperatively. Photopic and mesopic contrast sensitivity did not change 6 months postoperatively. CONCLUSIONS: Treatment of myopia with astigmatism using the SCHWIND AMARIS excimer laser is safe, efficacious, predictable, and maintains visual quality.
Subject(s)
Astigmatism/surgery , Keratomileusis, Laser In Situ , Lasers, Excimer/therapeutic use , Myopia/surgery , Adolescent , Adult , Astigmatism/physiopathology , Contrast Sensitivity/physiology , Corneal Wavefront Aberration/physiopathology , Humans , Middle Aged , Myopia/physiopathology , Prospective Studies , Treatment Outcome , Visual Acuity/physiology , Young AdultABSTRACT
A two-year-old girl with two weeks of abdominal pain, vomiting, and food refusal, ten months after percutaneous endoscopic gastrostomy insertion because of inadequate peroral intake, was admitted to a tertiary centre hospital. On admission, the extracorporeal part of the gastrostomy was much shortened. X-ray examination revealed migration of the end of the gastrostomy tube with a left-shifted course of the tube through the duodenum. Gastroscopy and subsequently laparotomy were performed. A longitudinal pressure necrosis was identified under the tube, with two perforations in the duodenojejunal region. Ten centimeters of that duodenojejunal region were resected, and end-to-end anastomosis was made. The migration of the gastrostomy was probably caused by insufficient care by the parents. Pathophysiologically, the tube caused the pressure necrosis in the duodenojejunal area; this was supported by histology. This is a hitherto undescribed complication of a percutaneous endoscopic gastrostomy, showing that migration of the gastrostomy to the deeper part of the small bowel can lead to pressure necrosis, a potentially life-threatening condition in children which cannot be treated without invasive procedures.
Subject(s)
Catheters, Indwelling/adverse effects , Duodenal Diseases/etiology , Gastrostomy/adverse effects , Intestinal Perforation/etiology , Prosthesis Failure/adverse effects , Child, Preschool , Device Removal , Duodenal Diseases/surgery , Duodenum/pathology , Enteral Nutrition , Female , Gastroscopy , Humans , Intestinal Perforation/surgery , Necrosis/etiology , Pressure/adverse effectsABSTRACT
OBJECTIVE: To report the visual and refractive outcomes following monocular implantation of a supplementary (piggyback) Scharioth macula lens (SML) in previously pseudophakic eyes with age-related macular degeneration (AMD). METHODS AND ANALYSIS: Prospective European multicentre clinical trial. 50 eyes of 50 pseudophakic patients with either dry or previously treated and stable neovascular AMD for at least 6 months were included. The inclusion criteria were age over 55, corrected distance visual acuity (CDVA) of 0.4-0.1 (decimal), improvement of at least three lines of corrected near visual acuity (CNVA) when tested with a +6.0 dioptre (D) reading addition at 15 cm, compared with a +2.5 D reading addition at 40 cm using a standardised, self-illuminated Early Treatment Diabetic Retinopathy Study near vision chart. The SML intraocular lens (IOL) was implanted as an add-on/piggyback IOL in the ciliary sulcus, monocularly in the better seeing eye of each subject meeting the inclusion criteria. RESULTS: There were no intraoperative complications. One subject had the SML explanted in the postoperative period due to postoperative glare/halos. The mean CNVA improved from 0.23±0.12 (decimal) preoperatively to 0.57±0.33 at 1 year. The mean CDVA remained unchanged measuring 0.19±0.13 preoperatively and 0.19±0.09 at 1 year postoperatively. CONCLUSION: The SML appears to be safe and effective in improving the CNVA in patients with AMD. Data suggest that the CDVA remains unaffected following implantation. Further data are needed to assess the long-term safety and efficacy.
ABSTRACT
PURPOSE: Immunoglobulin substitution therapy is an essential therapeutic approach for patients with primary antibody deficiencies. Different methods of administration, including intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG) preparations, provide effective and tolerable treatment and enable the adjustment of therapy to patients' needs. A new 20% SCIG represents a new therapeutic option and a new route of administration using rapid-push application. The aim of the Czech Hizentra Noninterventional Study With Rapid Push (CHHINSTRAP) is to evaluate patient satisfaction with as well as the tolerability and efficacy of nonmedical switch to 20% SCIG from previous treatment with IVIG or SCIG and rapid push as a new way to administer SCIG. CHHINSTRAP is the first Phase IV, noninterventional, open-label, prospective, multicentric study of this type conducted in Central and Eastern Europe. METHODS: Primary end points, including efficacy, adverse effects, convenience of use, and overall satisfaction, were evaluated by Treatment Satisfaction Questionnaire for Medication version II. Secondary end points, such as serum IgG trough levels, infusion duration, number of application sites, frequency of infections, related hospital admissions, and antibiotic consumption, were obtained from patients at each follow-up visit. FINDINGS: Together, 50 eligible patients with primary antibody deficiency were switched from SCIG or IVIG to an equivalent dose of 20% SCIG and were followed up for 12 months during 5 consecutive visits. The results indicate that patients switched from previous IVIG or SCIG preparations had significantly higher serum trough IgG levels and a lower incidence of infections and related events, such as hospital admissions or consumption of antibiotics. These findings were also reflected in gradually increasing convenience of use and overall satisfaction reported by patients. Apart from duration of application, no differences were found between patients previously receiving SCIG or IVIG. Moreover, our study found a high level of safety of 20% SCIG rapid push, which was comparable to other preparations and application methods. IMPLICATIONS: On the basis of the results of CHHINSTRAP study, we conclude that 20% SCIG is a tolerable and effective immunoglobulin preparation, representing a new therapeutic approach in patients with primary antibody deficiencies. Its efficacy and tolerability have been found in patients on nonmedical switch from previous treatment with IVIG or SCIG.
Subject(s)
Immunoglobulin G/administration & dosage , Immunologic Deficiency Syndromes/drug therapy , Adolescent , Adult , Aged , Child , Czech Republic , Female , Humans , Immunoglobulin G/adverse effects , Infusions, Subcutaneous , Injections, Subcutaneous , Male , Middle Aged , Patient Satisfaction , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To compare the extent of posterior capsule opacification (PCO) after AquaLase and NeoSoniX phacoemulsification methods using two types of software for PCO quantification. DESIGN: Prospective, randomized clinical trial. METHODS: At the Department of Ophthalmology, University Hospital in Hradec Králové, 50 patients (100 eyes) were analyzed one year after surgery. AquaLase was used in the right eye and NeoSoniX in the left eye of each patient. One year after surgery, digital retroillumination photographs of anterior segments were obtained. The Evaluation of Posterior Capsule Opacification (EPCO) 2000 software (Berlin, Germany) and the Open-Access Systematic Capsule Assessment (OSCA) system (Edinburgh, United Kingdom) were used for PCO assessment. Best-corrected Snellen visual acuity (BCVA) was evaluated before and after surgery. Statistical analysis was performed using parametric tests. RESULTS: The EPCO 2000 results were as follows: mean value for right eyes, 0.324+/-0.305; mean value for left eyes, 0.298+/-0.341; no difference was proved (P=.532). The OSCA results were as follows: for right eyes, 0.7097+/-0.3777; for left eyes, 0.8584+/-0.4323; significant difference (P=.046), worse for left eyes. No correlation between EPCO 2000 and OSCA results was established (P>.001; correlation coefficient, 0.347). BCVA for the right eyes was 0.837+/-0.262 and for the left eyes was 0.849+/-0.224. Neodymium:yytrium-aluminum-garnet capsulotomy was performed in one eye in the NeoSoniX group, and in no eyes in the AquaLase group. CONCLUSIONS: There was no significant difference in PCO measured by EPCO 2000, however, PCO after AquaLase as assessed by EPCO 2000 was slightly denser. The OSCA system gave significantly higher scores in the NeoSoniX group. No correlation between EPCO 2000 and OSCA outcomes was proved.
Subject(s)
Cataract/etiology , Lens Capsule, Crystalline/pathology , Phacoemulsification/methods , Postoperative Complications , Adult , Aged , Aged, 80 and over , Anterior Eye Segment/pathology , Female , Humans , Lens Implantation, Intraocular , Male , Middle Aged , Prospective Studies , Software , Visual AcuityABSTRACT
PURPOSE: To compare the extent of corneal endothelial cell loss and pachymetry changes in 2 age-based groups of patients who had cataract removal by AquaLase (Alcon) phacoemulsification in 1 eye and NeoSoniX (Alcon) phacoemulsification in the contralateral eye. SETTING: Department of Ophthalmology, University Hospital, Hradec Králové, Czech Republic. METHODS: This prospective clinical study comprised 28 patients younger than 80 years (Group A) and 28 patients 80 years or older (Group B) with bilateral cataract having lens removal using AquaLase in the right eye and NeoSoniX in the left eye. The nuclei were graded clinically on the basis of hardness. The endothelial cell count (ECC), pachymetry, and best corrected visual acuity (BCVA) were evaluated preoperatively and postoperatively. The mean ECC and pachymetry values (+/-SD) were calculated in each group, with differences between right and left eyes analyzed using the paired t test. RESULTS: In Group A, the differences in the postoperative changes in ECC and pachymetry between AquaLase and NeoSoniX were not statistically significant. In Group B, there were statistically significant differences in postoperative changes in ECC and pachymetry, with the results better in the AquaLase eyes. The BCVA immediately after surgery was better than preoperatively in all eyes. CONCLUSION: The results suggest that AquaLase cataract extraction is safe for the endothelium, even in older patients with harder cataracts and a lower ECC count preoperatively.
Subject(s)
Endothelium, Corneal/pathology , Phacoemulsification/methods , Postoperative Complications , Aged , Aged, 80 and over , Cell Count , Equipment Safety , Humans , Lens Implantation, Intraocular , Middle Aged , Phacoemulsification/instrumentation , Prospective Studies , Visual AcuityABSTRACT
Due to immaturity of both specific and non-specific immune mechanisms, neonates are at risk of serious infections. The risk group definition is vague, clinical signs are non-specific and common laboratory markers are not as useful as in later ages, especially due to delayed reactions. In an attempt to find early, sensitive and specific markers, we assessed a defined set of surface leukocyte markers and humoral factors in cord blood. Several differences were noted--children in the risk group had a higher proportion of CD19+/23+, CD16+/64+, CD45RO cells and higher levels of IL-6. We find it promising that already at birth there are notable signs of reaction to infection and that a follow-up of a set of infectious markers could be useful to identify the children in need of antibiotic treatment and for diminishing unnecessary treatment.
Subject(s)
Antigens, CD/blood , Infections/immunology , Interleukin-6/blood , Biomarkers/blood , Humans , Infant, Newborn , Risk FactorsABSTRACT
AIMS: To present the initial results of Scharioth Macula Lens (SML) implantation. The SML is a new add-on intraocular lens designed to increase uncorrected near visual acuity (UCVA) in patients with stabilized maculopathy. METHODS: Eight patients were included in the study. All met the indication criteria before SML implantation. An SML was implanted in the better seeing eye. Near and distance visual acuity were tested. Possible complications and patient complaints were recorded and patients were asked about their quality of vision after SML implantation. The examination was carried out on day 1, 1 week, 1, 3 and 6 months after surgery. RESULTS: Six-month-results are presented. Apart from one, all patients with the SML had good near visual acuity at a recommended reading distance of 15 cm. Preoperatively, the mean (min-max) near UCVA was J13 (J8-J16), mean distance BCVA was 0.27. Postoperatively, the best results were after 1 month - near UCVA was J2.5 (J1-J7), distance BCVA was 0.26. Three months after surgery, this decreased to J4.5 (J1-J8); distance VA remained 0.25. Six months postoperatively - near vision was J4 (J1-J8) and distance VA was unchanged. Patients reported problems with reading speed and reading distance. Daily exercise improved their reading ability. One patient converted to wet AMD 3 months post-implantation. CONCLUSION: The SML is a new hope for low-vision patients. It acts as a magnifier in the eye. It is a suitable method for increasing near visual acuity in patients with inactive maculopathy.
Subject(s)
Lens Implantation, Intraocular/instrumentation , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Macula Lutea/physiopathology , Macula Lutea/surgery , Macular Degeneration/surgery , Visual Acuity/physiology , Aged , Aged, 80 and over , Female , Humans , MaleABSTRACT
The purpose of our study was to determine the amount of glycated proteins and advanced glycation end products (AGE) in cataractous lens homogenates of patients who underwent phacoemulsification, and to define a simple in vitro protein model of glycoxidation. Analysis of 30 cataractous lenses (15 diabetic and 15 non-diabetic) revealed a significant increase in both glycated lens proteins of diabetics compared with the controls (0.15 vs 0.08 nmol/mg protein, P < 0.01) and AGE-linked fluorescence at 440 nm (4.8 vs 2.8 AU/mg protein, P < 0.01). The presence of AGE fluorescence in lenses indicates the role of oxidative stress in cataractogenesis. Fifty-six days incubation of alanine and aspartate aminotransferases, used as model proteins, with 500 mM D-fructose at 25 and 37 degrees C led to a complete inhibition of ALT and AST activities. The fluorescence of both aminotransferases rose according to the chosen incubation temperature: 37 degrees C > 25 degrees C > 4 degrees C. ALT and AST incubated in a medium containing D-fructose are subject to nonenzymatic glycation followed by a consequent formation of AGE products. Our data: i) support the concept of glycation-glycoxidation pathway appearing in diabetic patients; ii) form a base for determination of the efficiency of various antioxidative compounds in vitro.
Subject(s)
Cataract/metabolism , Crystallins/metabolism , Glycation End Products, Advanced/metabolism , Glycosylation , Lens, Crystalline/metabolism , Aged , Aged, 80 and over , Diabetes Complications/metabolism , Female , Humans , In Vitro Techniques , Male , Middle Aged , Oxidative Stress , PhacoemulsificationABSTRACT
AIM: To compare the degree of posterior capsule opacification (PCO) after AquaLase and NeoSoniX phacoemulsification methods during an 8-year follow-up period using two types of software. DESIGN: Prospective, randomized clinical trial. METHODS: AquaLase was used in the right eye and NeoSoniX in the left eye of each patient with bilateral cataract. RESULTS: Fifty patients were analyzed 1 year, 46 patients 3 years, and 37 patients 8 years after cataract surgery. Mean EPCO 2000 values were for the AquaLase group 0.324 ± 0.305 and for the NeoSoniX group 0.298 ± 0.341 (P = 0.53) 1 year after surgery, for the AquaLase group 0.582 ± 0.506 and for the NeoSoniX group 0.594 ± 0.515 (P = 0.87) 3 years after surgery, and for the AquaLase group 0.648 ± 0.567 and for the NeoSoniX group 0.673 ± 0.542 (P = 0.30) 8 years after surgery. The OSCA results were for the AquaLase group 0.7097 ± 0.3778 and for the NeoSoniX group 0.8584 ± 0.4323 (P = 0.046) 1 year after surgery, for the AquaLase group 0.9667 ± 0.736 and for the NeoSoniX group 0.9540 ± 0.5250 (P = 0.91) 3 years after surgery, and for the AquaLase group 1,035 ± 0,952 and for the NeoSoniX group 1,103 ± 0,741 (P = 0.44) 8 years after surgery. CONCLUSION: There was minimal PCO difference between these 2 approaches, AquaLase and NeoSoniX. Neither AquaLase nor NeoSoniX technique was able to prevent a natural progression of PCO.
Subject(s)
Capsule Opacification/etiology , Phacoemulsification/adverse effects , Follow-Up Studies , Humans , Phacoemulsification/methods , Postoperative Complications/etiology , Prospective Studies , Time FactorsABSTRACT
PURPOSE: Intravitreal implantation of dexamethasone implant (Ozurdex®) is being widely used for the treatment of macular edema (ME) after branch or central retinal vein occlusion, diabetic ME, and persistent ME associated with uveitis or Irvine-Gass syndrome. We describe a complication: migration of the dexamethasone implant into the anterior chamber through basal iridectomy (Ando) in a pseudophakic patient with development of corneal edema and secondary high intraocular pressure. METHODS: This is a case report of migration of Ozurdex® through basal iridectomy in a pseudophakic patient with iris claw lens. CONCLUSIONS: Pseudophakic patients, with a history of vitrectomy, even those with a basal iridectomy (Ando), are at high risk for migration of the Ozurdex® into the anterior chamber and development of corneal edema.
Subject(s)
Anterior Chamber/pathology , Dexamethasone/administration & dosage , Drug Implants/adverse effects , Glucocorticoids/administration & dosage , Iridectomy , Prosthesis Failure/etiology , Pseudophakia/etiology , Aged , Corneal Edema/etiology , Humans , Intravitreal Injections , Lens Implantation, Intraocular , Macular Edema/drug therapy , Male , Ocular Hypertension/etiology , PhacoemulsificationABSTRACT
We demonstrated the effectiveness of transpupillary thermotherapy (TTT) for the treatment of choroidal neovascularization (CNV) by patients with age- related macular degeneration (ARMD). CNV secondary to ARMD is a leading case of vision loss in patients older than 50 years. TTT is new promising method for the treatment CNV by ARMD. It is able to close CNV while maintaining visual function and in small percentage visual function improving. We have performed TTT by 30 patients (30 eyes) with subfoveolar CNV. We have demonstrated the stabilization or improvement of visual acuity by 16 patients (52%), improvemend two or more lines was documented by 5 patients (17%).