UGH Syndrome Resolution after IOL Explantation and Concomitant Carlevale IOL Implantation.

OBJECTIVE: To examine the use of Carlevale IOL placement in patients with UGH, and to evaluate surgical outcomes. DESIGN: In this retrospective study, 28 patients with UGH syndrome that were subjected to IOL explantation and concomitant Carlevale IOL implantation were included in the study. METHODS: Information about VA, IOP, number of glaucoma medication, need for glaucoma surgery, presence of hemorrhage and inflammation were recorded up to 6 months after the procedure. RESULTS: We found a statistically significant increase in mean visual acuity and complete resolution of uveitis in all patients. Mean IOP and the mean number of glaucoma medications were significantly decreased postoperatively, while 14% of patients required additional glaucoma surgery. CONCLUSIONS: IOL explantation and concomitant Carlevale IOL implantation may provide a viable solution for UGH syndrome resolution, increases visual acuity, and decreases the need for glaucoma medication.

Cardiometabolic factors and risk of non-arteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review and meta-analysis of the literature is to evaluate the association between cardiometabolic risk factors (hypertension, diabetes mellitus, hypercholesterolemia/dyslipidemia, HDL cholesterol, LDL cholesterol, lipoprotein(a), and triglycerides) and non-arteritic anterior ischemic optic neuropathy (NAION). METHODS: Pertinent publications were identified through a systematic search in PubMed and EMBASE databases, without language restrictions. The pooled odds ratios (OR) and standardized mean differences (SMD), with their 95% confidence intervals (95% CI) were estimated using random effects (DerSimonian Laird) models, as appropriate. A set of subgroup analyses and meta-regression analysis models were performed. RESULTS: Twenty-one studies (including 1560 patients with NAION and 2292 controls), examining the association between NAION and cardiometabolic risk factors, were eligible for the systematic review and meta-analysis. Hypertension (pooled OR = 1.50; 95% CI: 1.16-1.94), diabetes mellitus (pooled OR = 1.71; 95% CI: 1.33-2.21), and hypercholesterolemia/dyslipidemia (pooled OR = 2.00; 95% CI: 1.53-2.62) were associated with NAION. Among the components of dyslipidemia, higher serum triglycerides were associated with NAION, with a medium effect size (SMD = + 0.58, 95% CI: + 0.12 to + 1.04), whereas synthesis of four studies reporting on HDL and LDL cholesterol did not reveal any significant associations. A significant association between NAION and higher serum lipoprotein(a) levels (pooled OR = 2.88; 95%CI: 1.01-8.21) was also noted. CONCLUSIONS: This systematic review and meta-analysis found that NAION was associated with cardiometabolic factors, suggesting that vascular dysfunction may be implicated in the pathogenesis of the disease. Our findings may alert health care providers to try modifying these risk factors for NAION prevention.

Overcoming barriers of retinal care delivery during a pandemic-attitudes and drivers for the implementation of digital health: a global expert survey.

BACKGROUND/AIMS: The SARS-CoV-2 pandemic has imposed barriers to retinal care delivery worldwide. In this context, retinal services are exploring novel ways to ensure access to healthcare. METHODS: We conducted a worldwide survey among retinal specialists between March 31, 2020 and April 12, 2020. The expert survey was developed on the basis of focus group discussions involving retinal specialists and literature searches. It included 44 questions on alternative ways of care provision including digital health domains such as teleophthalmology, home monitoring or decentralised patient care. RESULTS: 214 retinal experts participated in the survey, of which 120 (56.1%) had more than 15 years of experience in ophthalmology. Most participants were clinicians (n=158, 73.9%) practising in Western Europe (n=159, 74%). In the majority of institutions, teleophthalmology, home monitoring and decentralised patient care have not been implemented before the pandemic (n=46, 21.8.1%; n=64, 29.9%; n=38, 19.1%). During the pandemic, the use of teleophthalmology and home monitoring increased significantly (n=105, p<0.001; n=90, p<0.001). In the subgroup of institutions reporting no teleophthalmology service before and implementing a service during the pandemic (34/70, 48.6%), reimbursement was the sole significant parameter (OR 9.62 (95% CI 2.42 to 38.16); p<0.001). CONCLUSION: Digital health is taking the centre stage tackling unpreceded challenges of retinal care delivery during the SARS-CoV-2 pandemic and may sustainably change the way we practice ophthalmology.

Tracing Ocular Conditions in 15,921 Interwar Refugees, Veria, Greece (1926-1940).

OBJECTIVE: This historical epidemiological study aims to investigate ocular conditions in Greek refugees during the Interwar period (1926-1940) in the region of Imathia, Greece. MATERIALS AND METHODS: The archival material encompasses 15,921 patients who were admitted to the Refugee Hospital of Veria, Imathia, Greece. Descriptive statistics were estimated. RESULTS: Twenty-two cases of ocular conditions were identified. Ten patients had anterior segment conditions, such as keratitis, blepharoconjunctivitis, conjunctivitis, epithelioma, leukoma and an operated cataract. Another patient was diagnosed with ocular trachoma. Four patients presented sympathetic ophthalmia; two additional patients suffered from ophthalmia due to syphilis. One patient was diagnosed with ocular malaria. Four cases of ocular traumas were recorded, among which an ocular burn due to gunpowder, a motorcycle accident leading to a retro-ocular hematoma, and a kick in the eye resulting in ocular trauma were notable. CONCLUSION: The disease spectrum in Greek refugees reflects the adverse conditions during the Interwar era.

INTERNAL LIMITING MEMBRANE PEELING IN MACULAR HOLE SURGERY; WHY, WHEN, AND HOW?

PURPOSE: To review the current rationale for internal limiting membrane (ILM) peeling in macular hole (MH) surgery and to discuss the evidence base behind why, when, and how surgeons peel the ILM. METHODS: Review of the current literature. RESULTS: Pars plana vitrectomy is an effective treatment for idiopathic MH, and peeling of the ILM has been shown to improve closure rates and to prevent postoperative reopening. However, some authors argue against ILM peeling because it results in a number of changes in retinal structure and function and may not be necessary in all cases. Furthermore, the extent of ILM peeling optimally performed and the most favorable techniques to remove the ILM are uncertain. Several technique variations including ILM flaps, ILM scraping, and foveal sparing ILM peeling have been described as alternatives to conventional peeling in specific clinical scenarios. CONCLUSION: Internal limiting membrane peeling improves MH closure rates but can have several consequences on retinal structure and function. Adjuvants to aid peeling, instrumentation, technique, and experience may all alter the outcome. Hole size and other variables are important in assessing the requirement for peeling and potentially its extent. A variety of evolving alternatives to conventional peeling may improve outcomes and need further study.

The Role of Glycemic Control and Variability in Diabetic Retinopathy.

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus (DM) and is considered the leading cause of visual impairment in working-aged adults worldwide. The duration of DM and hyperglycemia have been associated with DR, although the exact role in the pathogenesis of DR and diabetic macular edema remains controversial. As a result, a reasonable question arising is whether control of blood glucose levels may alter the course of DR. Studies have shown that glycemic control remains an important factor for the presence and progression of DR. HbA1c seems to be an indicator which cannot demonstrate exactly the degree of glycemic control, while sudden variations of blood glucose may play an important role in DR; therefore, glycemic variability may be useful to predict DM complications, such as DR.

Anti-platelet effects of vitamin supplements in age-related macular degeneration: an in vitro study.

OBJECTIVE: The purpose of this experimental study was to investigate the role of vitamin supplements (Ocuvite, Vitalux Omega, and Nutrof Total) as possible inhibitors of the onset of age-related macular degeneration (AMD). MATERIALS AND METHODS: The anti-aggregating effect of each vitamin was determined against four accumulative factors namely, platelet activating factor (PAF), adenosine diphosphate (ADP), thrombin receptor-activating peptide (TRAP), and arachidonic acid (AA) in the platelet rich plasma (PRP) of healthy volunteers. RESULTS: Ocuvite, Vitalux Omega, and Nutrof Total were more potent inhibitors against PAF and ADP compared to TRAP and AA. Among the three vitamins, Nutrof Total displayed more potent inhibitions against TRAP and AA, while against PAF and ADP all the three vitamins revealed similar IC50 values. CONCLUSIONS: The vitamins Ocuvite, Vitalux Omega, and Nutrof Total have anti-aggregating effects and therefore can be used against AMD in healthy volunteers.

Evaluation of Choroidal and Retinal Thickness Changes in Parkinson's Disease Using Spectral Domain Optical Coherence Tomography.

PURPOSE: The purpose of this study was to evaluate retinal and choroidal thickness in patients with Parkinson's disease (PD) using spectral domain-optical coherence tomography (SD-OCT). MATERIAL AND METHODS: Participants in our study were 31 PD patients and 25 age-matched healthy controls. All participants underwent best-corrected visual acuity (BCVA) measurement, slit-lamp biomicroscopy, dilated fundoscopy, and SD-OCT. Macular and retinal nerve fiber layer (RNFL) thickness and choroidal thickness in all quadrants were recorded. RESULTS: There was a statistically significant reduction in average, superior, and temporal RNFL thickness, average ganglion cell complex, and choroidal thickness in the subfoveal area and in all quadrants between patients with PD and controls. CONCLUSIONS: The role of the choroidal vasculature in the pathophysiology of PD should be further scrutinized.

The Effect of Vitamin E on Oxidative Stress Indicated by Serum Malondialdehyde in Insulin-dependent Type 2 Diabetes Mellitus Patients with Retinopathy.

BACKGROUND: Several studies have focused on oxidative stress on diabetes mellitus (DM). Our purpose was to investigate the impact of oxidative stress on progression of diabetic retinopathy (DR) in insulin-dependent type 2 DM patients, measuring serum malondialdehyde (MDA), as well as to examine the effect of vitamin E on DR progression in the above-mentioned patients. METHODS: Participants in the study were 282 insulin-dependent type 2 DM patients with DR. All participants underwent a thorough ophthalmological examination, so as to grade DR, along with serum MDA measurement. All participants received 300mg vitamin E daily for 3 months and were examined again. Serum MDA pre- and post-intake of Vitamin E was the main outcome. RESULTS: Serum MDA was positively associated with DR stage, while there was a statistically significant difference pre- and post-intake of vitamin E in all DR stages. In a subgroup analysis of patients with proliferative DR, there was a significant difference at baseline between patients who have received prior laser photocoagulation and the treatment naïve patients, while after intake of vitamin E, no statistically significant difference was noticed. CONCLUSION: Oxidative stress has been found to play significant role in the pathogenesis and progression of DR, while vitamin E seems to reduce MDA levels and subsequent oxidative stress, suggesting that it might have protective role in DR progression.

The Role of Dyslipidemia Control in the Progression of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus.

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus (DM) and is considered as the leading cause of visual impairment in working-aged adults worldwide. Dyslipidemia has been associated with DR, but not with progression to the proliferative form of DR, although the exact role in the pathogenesis of DR and diabetic macular edema (DME) remains controversial. As a result, a reasonable question arising is whether control of dyslipidemia may alter the course of DR. Statins do not appear to have an impact on DR progression. On the other hand, fenofibrate has been found to significantly reduce the rate of progression of DR in patients with pre-existing mild DR, although it has no impact on patient's vision nor on the prevention of DR development in patients with type 2 DM without DR. An interesting point that needs further evaluation is why patients without DR or those with severe DR appear to have no benefit from fenofibrate treatment.

In Vitro Effects of Anti-Glaucomatous Eye Drops on Platelet-Activating Factor and its Metabolism.

PURPOSE: The purpose of this study is to determine the effect of various commonly used antiglaucoma eye drops on inflammatory mediators such as the platelet activating factor (PAF). METHODS: Various intraocular pressure (IOP) lowering drops were tested to examine their inhibitory effect on PAF. Multiple eye drops were tested in washed rabbit platelets (WRPs) in order to determine the interaction between these eye drops and the inhibition of PAF in the PAF-induced platelet aggregation model. In addition, we examined the eyedrops' effect on PAF-metabolism, through in vitro analysis on PAF basic metabolic enzymes (PAF-CPT, lyso PAF-AT, and PAF-AH). RESULTS: Latanoprost (Xalatan) was found to be the most potent in inhibiting PAF, suggesting that it is the most effective in decreasing IOP amongst the eye drops tested. Conversely, dorzolamide hydrochloride-timolol (Cosopt) exhibited the least anti-PAF action. CONCLUSIONS: This is the first study examine the relationship between PAF activity and glaucoma medication. Potency in PAF inhibition may be related to drop efficacy.

The Impact of Non-Steroidal Anti-Inflammatory Agents after Phacoemulsification on Quality of Life: A Randomized Study.

INTRODUCTION: The purpose of our study was to investigate the impact of ketorolac addition to the well-established combination of antibiotic-steroid agent in terms of vision-related quality of life. METHODS: Patients were randomized to: (1) fixed combination of tobramycin 0.3%-dexamethasone 0.1%, one drop qid (n = 68) and (2) fixed combination of tobramycin 0.3%-dexamethasone 0.1%, one drop qid, plus ketorolac tromethamine 0.5%, one drop tid (n = 70). All patients completed the VFQ-25 questionnaire to assess their functional vision before cataract surgery and postoperatively on days 7, 28 and 42. The statistical analysis comprised the point-wise comparison between the two groups at the four time points for all sub-scales of the VFQ-25 questionnaire, as well as the composite score. RESULTS: No significant differences were noted regarding the composite score, as well as all subscales in all examined time points. CONCLUSIONS: The addition of ketorolac did not seem to offer any additional benefit in terms of vision-related quality of life.

Treatment Modalities for Idiopathic Macular Telangiectasia: An Evidence-Based Systematic Review of the Literature.

PURPOSE: The purpose of this systematic review was to stratify the literature on the therapeutic approaches for macular telangiectasia (Mactel type 1 and 2) to provide evidenced-based practical guidelines for the optimal standard care of these conditions. METHODS: A comprehensive search of PubMed was performed using a specific search algorithm. All articles retrieved were carefully screened and their references were manually reviewed for additional relevant data. Level of evidence was provided for each treatment modality, graded as level I, II, III, IV, and V, and indicative of very strong, strong, substantial, relatively weak, and weak evidence, respectively. RESULTS: 1445 abstracts were checked and 123 were found to be relevant. Out of them, 102 were eligible for the purpose of our review and 86 were focused on treatment of macular telangiectasia. Most publications combined cases of Mactel type 1 and type 2, despite their distinct pathophysiology. In Mactel type 1, laser photocoagulation of the telangiectasia remains the mainstay in controlling macular edema, while anti-vascular endothelial growth factor (anti-VEGF) agents provide short-term benefits. In Mactel type 2, current treatment options are not effective in the management of the non-proliferative stage, while anti-VEGF agents seem to be effective in the treatment of choroidal neovascularization complicating the disease. CONCLUSION: It is important to differentiate the type of macular telangiectasia to plan appropriate treatment.

Impact of prostaglandin glaucoma drops on platelet-activating factor action: an in vitro study.

AIM: The aim of this study was to investigate the effect of different prostaglandin analogs on platelet-activating factor (PAF) levels. METHODS: Three prostaglandin analogs were selected: bimatoprost 0.3 mg/mL, latanoprost 50 µg/mL, and tafluprost 15 µg/mL. Each drug sample was tested for its ability to cause platelet aggregation, which was measured as PAF-induced aggregation, before and after the addition of various concentrations of the examined sample, creating a linear curve of percentage inhibition (ranging from 0% to 100%) versus different concentrations of the sample. The concentration of the sample that inhibited 50% PAF-induced aggregation was calculated based on this curve, and this value was defined as IC50. In addition, the effect of eye drops on PAF metabolism was examined, through an in vitro analysis on PAF basic metabolic enzymes (PAF-cholinephosphotransferase, PAF-acetyl-CoA:1-O-alkyl-sn-glycero-3-phosphocholine acetyltransferase, and PAF-acetylhydrolase). RESULTS: The IC50 values for Lumigan UD® (bimatoprost 0.3 mg/mL), Monoprost® (latanoprost 50 µg/mL), and Saflutan (tafluprost 15 µg/mL) were 8.7, 0.28, and 1.4 µg/mL, respectively. DISCUSSION: All three prostaglandin analogs suspended PAF, but bimatoprost induced the most potent inhibition, compared to tafluprost and to the weak effect of latanoprost.

HYPERREFLECTIVE FOCI AS AN INDEPENDENT VISUAL OUTCOME PREDICTOR IN MACULAR EDEMA DUE TO RETINAL VASCULAR DISEASES TREATED WITH INTRAVITREAL DEXAMETHASONE OR RANIBIZUMAB.

PURPOSE: To evaluate the potential role of hyperreflective foci (HF) in predicting visual outcome in patients undergoing treatment for macular edema due to retinal vascular diseases. METHODS: Data and images of 92 patients with macular edema due to diabetes mellitus or branch retinal vein occlusion, treated with either intravitreal dexamethasone implant or ranibizumab, were analyzed. All patients underwent best-corrected visual acuity measurement, slit-lamp examination, spectral domain optical coherence tomography at baseline and at all time points of the follow-up (Month 1, 2, 3, 6, and 9). Generalized least squares random effects linear or logistic regression analysis was used to investigate potential factors associated with the final best-corrected visual acuity and number of HF, respectively. RESULTS: Increasing age (P < 0.001), central retinal thickness (P < 0.001), number of HF (P = 0.028), presence of subretinal fluid (P < 0.001), intraretinal fluid (P < 0.001), intraretinal cysts (P < 0.001), and disruption of ellipsoid zone/external limiting membrane (P < 0.001) were significantly associated with poorer visual outcome. Factors associated with HF were increasing central retinal thickness (P = 0.003), presence of subretinal fluid (P = 0.049), intraretinal fluid (P = 0.002), cysts (P = 0.015), and disruption of ellipsoid zone (P = 0.047). No significant differences in change in best-corrected visual acuity, central retinal thickness, and HF were observed between the two treatment groups. CONCLUSION: Hyperreflective foci are associated with poorer visual outcome in patients with macular edema due to retinal vascular diseases. Similar reductions in HF are achieved by intravitreal steroid and anti-vascular endothelial growth factor agent.