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Heart failure with preserved ejection fraction (HFpEF) is more prevalent in post- compared to pre-menopausal women. The underlying mechanisms are not fully understood. Data in humans is confounded by age and co-morbidities. We investigated the effects of ovariectomy and estrogen replacement on the left ventricular (LV) gene expression of pro-inflammatory and pro-fibrotic factors involved in HFpEF and putative regulating miRNAs. Nine-week-old C57BL/6 female mice were subjected to ovariectomy (OVX) or SHAM operation. OVX and SHAM groups were sacrificed 1-, 6-, and 12-weeks post-surgery (T1/SHAM; T1/OVX; T6/SHAM; T6/OVX, T12/SHAM). 17ß-estradiol (E2) or vehicle (VEH) was then administered to the OVX groups for 6 weeks (T12/OVX/E2; T12/OVX/VEH). Another SHAM group was sacrificed 12-weeks post-surgery. RNA and miRNAs were extracted from the LV apex. An early 3-fold increase in the gene expression of IL-1α, IL-6, Mmp9, Mmp12, Col1α1, and Col3α1 was observed one-week post-surgery in T1/OVX vs. T1/SHAM, but not at later time points. miRNA-26a was lower in T1/OVX vs. T1/SHAM and was inversely correlated with Col1α1 and Col3α1 expression 1-week post-surgery (r = -0.79 p < 0.001; r = -0.6 p = 0.007). miRNAs-26a, 29b, and 133a were significantly higher, while Col1α1, Col3α1, IL-1α, IL-6, Tnfα, Mmp12, and FasL gene expression was significantly lower in E2- compared to vehicle-treated OVX mice. miRNA-26a was inversely correlated with Col3α1 in T12/OVX/ E2 (r = -0.56 p = 0.02). OVX triggered an early increase in the gene expression of pro-inflammatory and pro-fibrotic factors, highlighting the importance of the early phase post-cessation of ovarian function. E2 replacement therapy, even if it was not immediately initiated after OVX, reversed these unfavorable changes and upregulated cardiac miRNA-26a, previously unknown to be affected by menopausal status.
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Colágeno Tipo I , Estradiol , Regulación de la Expresión Génica , Ventrículos Cardíacos , MicroARNs , Animales , Femenino , Ratones , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Cadena alfa 1 del Colágeno Tipo I/metabolismo , Colágeno Tipo III/genética , Colágeno Tipo III/metabolismo , Regulación hacia Abajo/efectos de los fármacos , Estradiol/farmacología , Terapia de Reemplazo de Estrógeno , Regulación de la Expresión Génica/efectos de los fármacos , Insuficiencia Cardíaca/genética , Insuficiencia Cardíaca/metabolismo , Ventrículos Cardíacos/metabolismo , Ventrículos Cardíacos/efectos de los fármacos , Interleucina-1alfa/genética , Interleucina-1alfa/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Ratones Endogámicos C57BL , MicroARNs/genética , MicroARNs/metabolismo , Ovariectomía , Regulación hacia Arriba/efectos de los fármacosRESUMEN
PURPOSE: To evaluate the clinical significance of preoperative spectral domain optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) thickness in identifying glaucoma and better managing patients scheduled for routine cataract surgery. SETTING: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN: Retrospective cohort study. METHODS: Consecutive patients scheduled for cataract surgery were enrolled from February 2022 to August 2022. Participants underwent routine OCT RNFL studies which were evaluated by a glaucoma specialist. Findings were compared with those of preoperative fundus biomicroscopic examinations conducted by the referring ophthalmologist. The main outcomes were the incidence of newly detected glaucoma based on OCT RNFL findings and the consequent changes in patient management. RESULTS: In total, 486 patients met the inclusion criteria of whom 112 (23%) had abnormal RNFL. 31 patients (6.4%) had abnormal OCT RNFL findings attributed to comorbidities other than glaucoma, and 81 patients (16.7%) were suspected to have glaucoma based on their OCT RNFL findings, from which 44 patients (9%) were newly diagnosed with glaucoma or as glaucoma suspects, resulting in management modifications that included routine glaucoma follow-up (25 patients, 5.1%), initiation of intraocular pressure-lowering treatment (12 patients, 2.5%), and conversion to combined cataract-glaucoma surgery (7 patients, 1.4%). CONCLUSIONS: OCT RNFL for cataract surgery candidates proved valuable in detecting glaucoma that had not been revealed by standard fundus biomicroscopic examination. The additional information provided by OCT RNFL can potentially enhance patient management and optimize outcomes.
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Extracción de Catarata , Glaucoma , Presión Intraocular , Fibras Nerviosas , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Estudios Retrospectivos , Fibras Nerviosas/patología , Masculino , Células Ganglionares de la Retina/patología , Femenino , Presión Intraocular/fisiología , Anciano , Glaucoma/diagnóstico , Glaucoma/cirugía , Persona de Mediana Edad , Agudeza Visual/fisiología , Periodo PreoperatorioRESUMEN
PURPOSE: To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone-iodine (PI) compared with a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium. SETTING: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN: Prospective, randomized, double-blind study. METHODS: Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface preoperatively. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system. RESULTS: The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared with before application ( P < .001). The repeated application of 1% PI showed a significantly lower bacterial count compared with the single application of 5% PI ( P < .05) and resulted in significantly less damage to the corneal epithelium compared with a single 5% PI application ( P < .001). CONCLUSIONS: Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with a less deleterious effect on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.
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Antiinfecciosos Locales , Bacterias , Recuento de Colonia Microbiana , Conjuntiva , Povidona Yodada , Humanos , Estudios Prospectivos , Método Doble Ciego , Antiinfecciosos Locales/toxicidad , Femenino , Masculino , Persona de Mediana Edad , Anciano , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Conjuntiva/microbiología , Conjuntiva/efectos de los fármacos , Epitelio Corneal/efectos de los fármacos , Epitelio Corneal/microbiología , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/prevención & control , Infecciones Bacterianas del Ojo/tratamiento farmacológico , AdultoRESUMEN
BACKGROUND: A focused bibliographic analysis of Israel's ophthalmology research productivity has never been performed. OBJECTIVES: To assess the research output of Israeli ophthalmology departments between the years 2011-2021 and compare to leading countries in the discipline. METHODS: The PubMed search engine was used to detect all medical articles published between the years 2011 and 2021, with at least one author from an Israeli ophthalmology department. Each entry was reviewed for: year of publication, journal, department, sub-specialty, and study design. Journals were ranked according to Scopus Cite Score. Research output and population data of 7 top-ranked countries in ophthalmology (USA, UK, Japan, Germany, Australia, Canada, China) were documented for comparisons. RESULTS: Overall, 1,919 publications were included. Total research output of Israeli ophthalmology departments significantly increased throughout the study period (R2=0.85, P<0.0001). Medical retina publications were the most prevalent (493 articles, 25.6%), and the most commonly utilized design was cohort (536 articles, 28%). Over a third of all articles (669) were published in Q1 ophthalmology journals, and 16% were published in the top-10 journals. Israel was ranked (1/8) and (3/8) in publications per population and physician, respectively, compared to the other assessed countries. CONCLUSIONS: Between 2011-2021, the research productivity of the Israeli ophthalmological community has constantly increased across all sub-specialties and in high-impact journals. Israel's relative contribution to the ophthalmic medical literature is noteworthy internationally.
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Oftalmología , Humanos , Bibliometría , Alemania , Internacionalidad , IsraelRESUMEN
PURPOSE: To describe a rare case of acquired Brown syndrome (ABS) associated with acute rheumatic fever (ARF). CASE REPORT: a healthy 9-year-old girl developed polyarthritis, carditis, and elevated inflammatory markers 10 days after suffering from a sore throat. She was diagnosed with ARF and was treated with systemic antibiotics and high-dose non-steroidal anti-inflammatory drug (NSAID). After 2 weeks, despite improvement of ARF symptoms, the patient presented with binocular vertical diplopia, periorbital pain, and limited elevation in adduction of the left eye. Imaging revealed a thickened trochlea-superior oblique tendon complex, and ABS due to trochleitis was diagnosed. The patient underwent a successful regional corticosteroid injection as a second-line treatment, and within a month, all signs and symptoms of ABS resolved. CONCLUSIONS: ABS is an infrequent yet possible manifestation of ARF.
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PURPOSE: To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens. SETTING: Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel. DESIGN: Retrospective, consecutive case series. METHODS: This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt. RESULTS: 17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA ( P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear. CONCLUSIONS: A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.
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Cristalino , Lentes Intraoculares , Errores de Refracción , Humanos , Implantación de Lentes Intraoculares , Estudios Retrospectivos , PolitetrafluoroetilenoRESUMEN
BACKGROUND: Optic neuritis (ON) is an optic nerve inflammation that may lead to different degrees of vision loss. In recent decades, ON research facilitated a better understanding of the disease and its subtypes. This bibliometric analysis aimed to detect the 100 most-cited medical articles related to ON in the last 50 years (1972-2021) and describe publication trends arising from the list. METHODS: The Scopus database was used to locate and screen the 100 most influential ON papers based on the number of citations per article. Each entry was reviewed for the first author (name, gender, institution, and country), year of publication, journal, number of citations, ON subtype, and study design. The mean impact factor (IF) of each journal was calculated. RESULTS: The median number of citations was 265 (range 182-2,396). Observational studies on neuromyelitis optica-associated ON were the most common (27%), and the most influential decade was 2002-2011 (54 papers). Seventy-nine percent of articles were published in neurology journals, and a positive correlation between the mean number of citations per article and the journal mean IF was observed ( r = 0.62, P < 0.001). Between 2009 and 2021, female authors led more ON studies (52%), and more publications originated outside the USA (68%), compared with previous years. CONCLUSIONS: This analysis summarizes the impact and shifting trends of ON research in the last decades.
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Neurología , Neuritis Óptica , Femenino , Humanos , Autoria , Bibliometría , Factor de Impacto de la Revista , MasculinoRESUMEN
BACKGROUND: Ophthalmology practice entails many hours of physical inactivity, a potential long-term health hazard. This study aims to perform a pedometer-based evaluation of the physical activity (PA) levels of ophthalmologists at work. METHODS: This is a prospective observational study. Ophthalmologists from a single tertiary medical center were monitored with electronic pedometers during six morning sessions in the ophthalmology clinics. Working hours and the number of patients seen per clinic session were retrieved. The age and body mass index (BMI) of participants were documented. Step number per working hour (SPH) was calculated for all participants. Comparisons between males and females, practicing ophthalmologists (attendings) and ophthalmology residents (residents), and sub-specialties were performed. Correlations between SPH and age, BMI, and patients seen per clinic session were computed. FINDINGS: Pedometer readings for a total of 673 working hours were analyzed for 24 ophthalmologists, 17% female, 17 attendings, mean age 44.2 years (standard deviation (SD = 9.8). The average number of SPH for all participants was 359.7 (SD = 166.7). The mean PA level of residents was significantly higher than that of attendings (410.17 SPH vs. 338.95 SPH, respectively, p = .019). Oculoplastic surgeons demonstrated significantly higher step counts per hour than cornea specialists (439.90 SPH vs. 245.55 SPH, respectively, p = .002). A negative correlation was observed between SPH and the number of patients seen per clinic session (ρ = -0.274, p = .001). CONCLUSIONS/APPLICATIONS TO PRACTICE: Low number of SPH for ophthalmologists in this study indicates ophthalmology to be a highly sedentary medical occupation. PA levels of ophthalmologists in the workplace may indicate a personal health care challenge.
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Oftalmólogos , Oftalmología , Masculino , Humanos , Femenino , Adulto , Actigrafía , Conducta Sedentaria , Ejercicio FísicoRESUMEN
PURPOSE: The purpose of this study was to report the most severe documented ocular injury caused by Ecballium elaterium , an invasive and toxic herb characterized by an explosive seed dispersal. METHODS: A 55-year-old man presented to the emergency department several hours after direct exposure to the contents of E. elaterium to his left eye. Clinical examinations, investigations, and imaging findings are reported. RESULTS: Medical and ocular histories were unremarkable. On presentation, the patient exhibited markedly decreased visual acuity, severe periorbital edema, conjunctival chemosis, and corneal edema. Although other signs gradually improved, corneal edema worsened despite rapid initiation of systemic and topical steroids and normal intraocular pressure. After 4 months of follow-up, the cornea cleared and visual acuity returned to normal; however, a significant decrease in endothelial cell count was observed. CONCLUSIONS: Ecballium elaterium may cause a severe corneal chemical burn, with subsequent long-standing corneal edema and endothelial decompensation. Specular microscopy is a modality of great importance in these cases.
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Edema Corneal , Lesiones de la Cornea , Quemaduras Oculares , Córnea , Edema Corneal/inducido químicamente , Edema Corneal/diagnóstico , Lesiones de la Cornea/complicaciones , Quemaduras Oculares/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Agudeza VisualRESUMEN
PURPOSE: To evaluate whether outcome of bevacizumab treatment in the first treated eye can guide the selection of compound for the second treated eye in patients with bilateral diabetic macular edema. METHODS: Demographic, clinical, and optical coherence tomography data were retrospectively collected from consecutive patients who underwent bevacizumab therapy for bilateral diabetic macular edema. Change in central subfield thickness and visual acuity were evaluated and compared between the first treated eye and second treated eye. RESULTS: A total of 66 eyes of 33 patients were included in the study. The mean ± SD follow-up time was 13 ± 5 months. The mean ± SD central subfield thickness at baseline was 464 ± 30â µm in the first treated eye and 461 ± 29â µm in the second treated eye (p = 0.91). Final central subfield thickness was reduced to 392 ± 27â µm in the first treated eye (p = 0.01 compared with baseline) and 416 ± 25â µm in the second treated eye (p = 0.03 compared with baseline). Using ≥5% or ≥10% reduction of central subfield thickness as diagnostic criteria to predict similar magnitude of thickness reduction in the first treated eye yielded a positive and negative predictive value ranging from 46% to 81%, and sensitivity and specificity ranging from 54% to 84%. Regression models did not show correlation between central subfield thickness reduction in first treated eye and the second treated eye at the end of follow-up. CONCLUSIONS: Bevacizumab therapy reduced macular thickness in both eyes in bilateral diabetic macular edema. Treatment outcome of the first treated eye could not predict the outcome of the second treated eye. Particularly, failure to reduce central subfield thickness in the first treated eye does not preclude a favorable response to bevacizumab therapy in the second eye.
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Diabetes Mellitus , Retinopatía Diabética , Edema Macular , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/tratamiento farmacológico , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Cuerpo VítreoRESUMEN
Lens coloboma is a developmental defect resulting from abnormalities of the zonules and ciliary body. It may present as an isolated pathology or be accompanied by anomalies in different ocular structures. We report the case of a 20-year-old man referred for evaluation of anisometropic amblyopia in the right eye. Manifest refraction was -2.25 +3.00 ×35 in the right eye; corrected distance visual acuity, 20/50. Corneal topography revealed regular astigmatism of +2.46 D at 124°, and wavefront aberrometry revealed an irregular internal astigmatism of +6.27 D at 35°. Only after full pupillary dilation was a peripheral lens coloboma observed. This case demonstrates that even minor distortions of clear and normally positioned lenses may lead to amblyopia and raises the possibility that corneal changes may occur developmentally through the process of emmetropization partly to compensate for lenticular astigmatism arising from the coloboma.
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Astigmatismo , Coloboma , Adulto , Astigmatismo/diagnóstico , Coloboma/diagnóstico , Topografía de la Córnea , Humanos , Implantación de Lentes Intraoculares , Masculino , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To report a case of late-onset interface fluid syndrome (IFS) after laser-assisted in situ keratomileusis (LASIK). METHODS: A 94-year-old man was referred for evaluation because of persistent corneal edema 10 days after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy. RESULTS: After an uneventful DSAEK, the patient was treated with topical antibiotics and steroids. On presentation, a well positioned and oriented DSAEK graft was observed in the right eye, yet the cornea was edematous. Applanation tonometry was normal. Anterior-segment optical coherence tomography (AS-OCT) revealed a LASIK flap with a fluid cleft beneath it. Requery confirmed that LASIK was performed 21 years ago. Topical steroids were stopped, and after 2 weeks, the cornea was clear, and AS-OCT revealed complete resolution of the interface fluid. CONCLUSIONS: Even decades later, IFS should be considered as a source of corneal edema in patients after LASIK. Monitoring these patients with AS-OCT is recommended.
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Edema Corneal , Queratoplastia Endotelial de la Lámina Limitante Posterior , Queratomileusis por Láser In Situ , Anciano de 80 o más Años , Córnea , Edema Corneal/diagnóstico , Edema Corneal/etiología , Edema Corneal/cirugía , Humanos , Queratomileusis por Láser In Situ/efectos adversos , Rayos Láser , Masculino , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk. For patients, these platforms provide the possibility of clinic consultation without the concerns of a clinic visit. We aimed to assess the utilization of telemedicine by oculoplastics specialists worldwide during the COVID-19 pandemic. METHODS: A 13-item survey was distributed internationally to practicing oculoplastic surgeons. Collected data included demographics, clinical practice variables and perceptions regarding telemedicine. Significance of associations and single survey items was evaluated by Chi-squared and z-score of proportions tests, respectively. RESULTS: The questionnaire was completed by 70 oculoplastic surgeons (54.3% male, mean age 47.3 years, median experience 10 years) from eight countries, practicing in various clinical settings (50.0% hospitals, 45.7% private clinics, 4.3% community clinics). Most respondents reported telemedicine to be an effective tool for oculoplastic consultations (67.1%, p = 0.004), while only 12.8% (p < 0.00001) had incorporated this modality into clinical practice prior to the pandemic. Even though a vast majority (98.6%) of participants had limited outpatient activity, most (55.7%) felt unprotected from the virus. Telemedicine had been incorporated by 70.5% (p = 0.001) of respondents during the COVID-19 pandemic, whereas most (57.1%) predicted continued use of the modality. CONCLUSION: Telemedicine can be effectively and rapidly incorporated into the clinical practice of oculoplastic surgeons during the COVID-19 pandemic. Further research into the most effective utilization of these platforms appears warranted.
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COVID-19 , Oftalmólogos , Cirujanos , Telemedicina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
PURPOSE: The coronavirus disease (COVID-19) pandemic has evolved into a formidable healthcare crisis. Ophthalmologists are at daily personal risk of acquiring and transmitting the virus. Implementation of official practical and protective guidelines can be challenging and is often absent. The purpose of this study was to describe the status of ophthalmology practice in Israel, at the early stages of the outbreak. METHODS: A 17-item questionnaire was distributed to ophthalmologists practicing in Israel. Data was obtained regarding demographics and clinical and surgical practice during the pandemic. RESULTS: One hundred and sixty-seven ophthalmologists completed the survey from all regions of Israel. The survey was distributed during the early stages of the outbreak. At this time, no official government guidelines were in place. Most respondents reported no reduction of elective clinic visits and surgeries and no utilization of triage questionnaires. COVID-19 guidelines were reportedly promulgated to hospital ophthalmologists but not to community and private physicians. Personal protective equipment (PPE) measures were reportedly utilized; however, many respondents often acquired them individually. A majority of respondents advocated that healthcare institutions limit clinic and surgery services to emergency services. CONCLUSION: During the critical early stages of the COVID-19 outbreak in Israel, this study emphasizes the delay in development of emergency guidelines, necessary to protect patients and ophthalmologists from this highly transmissible disease.