Enzymatic markers of pulmonary inflammation in tracheal wash fluid in racehorses: alkaline phosphatase and lactate dehydrogenase

Background: Diagnosis of the lower airway diseases (LAD) in horses relies on clinical signs, endoscopic examinationand cytologic evaluation of lower respiratory tract flushing fluids as well. Specific enzyme activities in respiratory tractfluids of horses could be used as useful indicators in lower airway disorders. The main goal of the study was to evaluate thediagnostic usefulness of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) enzyme activites in tracheal wash(TW) fluids of horses with lower respiratory tract inflammation and/or damage and also in distinguishing of non-septicand septic inflammation in racehorses with LAD.Materials, Methods & Results: A cross-sectional study was conducted in racehorses. TW fluid samples were obtainedfrom 83 racehorses (71 with lower airway diseases and 12 healthy controls) for the study. The One-Way ANOVATest was used for the significance analysis of the differences between the groups in showing the normal distributionof blood serum ALP and LDH properties. Kruskal Wallis H Test and Tamhane T2 test were used for the significanceanalysis of the differences between the groups of tracheal ALP and LDH properties, which were not normally distributed. The sampled horses were classified into 3 groups as healthy control, non septic neutrophilic inflammation(NS-LAD) and septic neutrophilic inflammation (S-LAD) according to the tracheal mucus scores determined duringendoscopic examination, clinical signs, cytologic and bacteriologic examination of collected TW samples. Accordingto cytology results normal neutrophil levels (< 20%) were determined in the healthy control group (14.5%). However, increased neutrophil levels (≥ 20% and ≥ 80%) were encountered in the NS-LAD (61.4%) and S-LAD (24.1%)groups respectively. Also, the signs of degenerative changes and presence of intracellular bacteria in the neutrophilcells in the S-LAD group were observed. Bacteriologic analysis of the samples...(AU)

Enzymatic markers of pulmonary inflammation in tracheal wash fluid in racehorses: alkaline phosphatase and lactate dehydrogenase

Background: Diagnosis of the lower airway diseases (LAD) in horses relies on clinical signs, endoscopic examinationand cytologic evaluation of lower respiratory tract flushing fluids as well. Specific enzyme activities in respiratory tractfluids of horses could be used as useful indicators in lower airway disorders. The main goal of the study was to evaluate thediagnostic usefulness of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) enzyme activites in tracheal wash(TW) fluids of horses with lower respiratory tract inflammation and/or damage and also in distinguishing of non-septicand septic inflammation in racehorses with LAD.Materials, Methods & Results: A cross-sectional study was conducted in racehorses. TW fluid samples were obtainedfrom 83 racehorses (71 with lower airway diseases and 12 healthy controls) for the study. The One-Way ANOVATest was used for the significance analysis of the differences between the groups in showing the normal distributionof blood serum ALP and LDH properties. Kruskal Wallis H Test and Tamhane T2 test were used for the significanceanalysis of the differences between the groups of tracheal ALP and LDH properties, which were not normally distributed. The sampled horses were classified into 3 groups as healthy control, non septic neutrophilic inflammation(NS-LAD) and septic neutrophilic inflammation (S-LAD) according to the tracheal mucus scores determined duringendoscopic examination, clinical signs, cytologic and bacteriologic examination of collected TW samples. Accordingto cytology results normal neutrophil levels (< 20%) were determined in the healthy control group (14.5%). However, increased neutrophil levels (≥ 20% and ≥ 80%) were encountered in the NS-LAD (61.4%) and S-LAD (24.1%)groups respectively. Also, the signs of degenerative changes and presence of intracellular bacteria in the neutrophilcells in the S-LAD group were observed. Bacteriologic analysis of the samples...

A new surgical technique for scleral fixation using a "knot ball" for scleral-fixated intraocular lenses: impact on clinical outcomes / Uma nova técnica cirúrgica para fixação escleral usando um "nó esférico" (knot ball) para lentes ntraoculares para fixação escleral: impacto nos resultados clínicos

ABSTRACT Purpose: Scleral fixation surgery is a pivotal procedure that depends on the availability of robust and innovative surgical fixation methods. There continues to be a need for innovation in suture fixation techniques, particularly for intraocular lens implantation. Methods: We conceived and designed a "knot ball" scleral fixation technique for suture burial in a retrospective sample of 108 patients with primary (n=40) or secondary (n=68) scleral-fixated intraocular lens. Importantly, our technique did not require additional scleral flap or tunnel procedures. We evaluated pre- and postoperative best-corrected visual aquity (BCVA) and postoperative complications. All data were analyzed and compared between groups. Results: The preoperative mean BCVA improved significantly in both groups using the "knot ball" fixation technique (p<0.01). The extent of the improvement in the best-corrected visual acuity and late complications one month post-surgery were not significantly different between the groups (p>0.05). These clinical outcomes were consistent with those described in the ophthalmology literature. Conclusion: A "knot ball" scleral fixation technique is reported; to the best of our knowledge, this is the first report of such a technique, which offers a less invasive and simplified surgical procedure for transscleral fixation of scleral-fixated intraocular lenses. Moreover, the technique appears to display similar effectiveness and safety compared with existing scleral fixation techniques. We suggest that the "knot ball" technique warrants further research focus and clinical evaluation in future studies.

RESUMO Objetivo: A cirurgia de fixação escleral é um procedimento fundamental que depende da disponibilidade de métodos robustos e inovadores de fixação cirúrgica. No entanto, existe uma necessidade de inovação nas técnicas de fixação de sutura, particularmente para a implantação de lentes intraoculares. Métodos: Concebemos e desenhamos uma técnica de fixação escleral utilizando um "nó esférico" para o encerramento da sutura em uma amostra retrospectiva de 108 pacientes com lente intraocular de fixação escleral (SF-IOL) primária (n=40) e secundária (n=68). Importante considerar que nossa técnica não exigiu procedimentos adicionais de aleta escleral ou de túnel. Observamos a melhor acuidade visual corrigida (MAVC) pré e pós-operatória e as complicações pós-operatórias. Todos os dados foram analisados entre os grupos. Resultados: A melhor acuidade visual corrigida média pré-operatória (logMAR) melhorou significativamente em ambos os grupos com a utilização da técnica de fixação do nó esférico (p<0,01). A extensão da melhora melhor acuidade visual corrigida e as complicações tardias, um mês após a cirurgia, não foram significativamente diferentes entre os grupos (p>0,05). Esses resultados clínicos foram, em geral, comparáveis aos publicados na literatura de oftalmologia. Conclusão: Até onde sabemos, a técnica de fixação escleral de "nó esférico" é relatada pela primeira vez na literatura e representa um procedimento cirúrgico promissor, menos invasivo e simplificado para a fixação transescleral de SF-IOLs. Além disso, a técnica parece exibir eficácia e segurança comparáveis às técnicas de fixação escleral existentes. Sugerimos que a técnica do nó esférico receba mais atenção e avaliações clínicas no futuro.

A new surgical technique for scleral fixation using a "knot ball" for scleral-fixated intraocular lenses: impact on clinical outcomes.

PURPOSE: Scleral fixation surgery is a pivotal procedure that depends on the availability of robust and innovative surgical fixation methods. There continues to be a need for innovation in suture fixation techniques, particularly for intraocular lens implantation. METHODS: We conceived and designed a "knot ball" scleral fixation technique for suture burial in a retrospective sample of 108 patients with primary (n=40) or secondary (n=68) scleral-fixated intraocular lens. Importantly, our technique did not require additional scleral flap or tunnel procedures. We evaluated pre- and postoperative best-corrected visual aquity (BCVA) and postoperative complications. All data were analyzed and compared between groups. RESULTS: The preoperative mean BCVA improved significantly in both groups using the "knot ball" fixation technique (p<0.01). The extent of the improvement in the best-corrected visual acuity and late complications one month post-surgery were not significantly different between the groups (p>0.05). These clinical outcomes were consistent with those described in the ophthalmology literature. CONCLUSION: A "knot ball" scleral fixation technique is reported; to the best of our knowledge, this is the first report of such a technique, which offers a less invasive and simplified surgical procedure for transscleral fixation of scleral-fixated intraocular lenses. Moreover, the technique appears to display similar effectiveness and safety compared with existing scleral fixation techniques. We suggest that the "knot ball" technique warrants further research focus and clinical evaluation in future studies.

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction.

PURPOSE: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. METHODS: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. RESULTS: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. CONCLUSIONS: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction / Comparação da sensação de dor durante a extração de óleo de silicone sob anestesia tópica e retrobulbar

ABSTRACT Purpose: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. Methods: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. Results: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. Conclusions: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

RESUMO Objetivo: Comparar a sensação de dor de pacientes durante a remoção do óleo de silicone sob anestesia tópica e retrobulbar, usando uma técnica via pars plana combinada. Métodos: Os pacientes foram selecionados, de acordo com suas atitudes durante cirurgia vitreorretiniana prévia e exames oftalmológicos, e divididos em dois grupos: anestesia tópica e retrobulbar. Para a remoção passiva do óleo de silicone, utilizou-se uma técnica combinada em ambos os grupos. A sensação de dor dos pacientes e o conforto do cirurgião foram classificados através de uma escala de dor durante cada etapa da cirurgia. Resultados: Os grupos anestesia tópica e retrobulbar incluíram 36 e 33 pacientes, respectivamente. A sensação de dor durante a aplicação da anestesia foi significativamente maior no grupo retrobulbar (p<0,001). O grupo anestesia tópica sentiu mais dor durante a inserção do trocarte (p<0,001). Não houve diferença significativa entre os grupos em relação à sensação geral de dor e a complicações. Conclusões: A sensação de dor é comparável entre a anestesia tópica e a retrobulbar durante a remoção de óleo de silicone. A combinação de anestesia tópica e uma técnica via pars plana é uma opção alternativa eficaz e segura para a cirurgia de remoção de óleo de silicone.

Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's).

We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.

Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's) / Glaucoma de ângulo fechado bilateral agudo como uma primeira apresentação da granulomatose com poliangeíte (de Wegener)

ABSTRACT We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.

RESUMO Relatamos um caso glaucoma bilateral agudo de ângulo fechado em um paciente sem diagnóstico prévio de granulomatose com poliangeíte (Wegener). Um homem de 59 anos apresentou-se com uma forte dor de cabeça, dor nos olhos, visão turva, dificuldade em respirar e febre baixa. Observamos quemose conjuntival, edema da córnea e câmara anterior rasa. A gonioscopia demonstrou ângulos fechados bilateralmente. Ele foi tratado com manitol intravenoso, acetazolamida oral, olho e colírios antiglaucomatosos. Durante os dois dias seguintes a sua visão melhorou e as pressões intra-oculares diminuíram. A seguir, foram realizadas iridotomias a laser bilateralmente e ele foi referido para os departamentos de doenças pulmonares, nefrologia e reumatologia. Ele foi diagnosticado com poliangeíte granulomatosa. Glaucoma bilateral agudo de ângulo fechado é uma entidade clínica muito rara e sua associação com a granulomatose de Wegener é desconhecida e deve acrescentar-se à lista de manifestações oculares de granulomatose com poliangeíte.

Dynamic changes in optic disc morphology, choroidal thickness, anterior chamber parameters, and intraocular pressure during Valsalva maneuver.

PURPOSE: To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. METHODS: This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. RESULTS: VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p >0.05). IOP and PD significantly increased during VM (for both; p <0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p <0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p <0.05). CONCLUSIONS: VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.

Dynamic changes in optic disc morphology, choroidal thickness, anterior chamber parameters, and intraocular pressure during Valsalva maneuver / Mudanças dinâmicas na morfologia do disco óptico, espessura da coroide, parâmetros de câmara anterior e pressão intraocular durante a manobra de Valsalva

ABSTRACT Purpose: To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. Methods: This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. Results: VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p >0.05). IOP and PD significantly increased during VM (for both; p <0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p <0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p <0.05). Conclusions: VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.

RESUMO Objetivo: Investigar os efeitos da manobra de Valsalva (VM) sobre a morfologia do disco óptico, a espessura da coroide e parâmetros câmara anterior. Métodos: Estudo observacional, prospectivo incluiu 60 olhos de 60 indivíduos saudáveis. Os parâmetros da câmara anterior, incluindo da espessura central da córnea (CCT), profundidade da câmara anterior (ACD), ângulo da câmara anterior (ACA), volume de câmara anterior (ACV), diâmetro da pupila (PD), comprimento axial (AL), espessura da coroide subfoveal e peripapilar, parâmetros de disco óptico e pressão intraocular (IOP) foram medidos em repouso e durante VM. Resultados: A VM não apresentou influência significativa em AL, espessura da coroide subfoveal e peripapilar, área de disco óptico, área da rima neural, área da escavação, relação da área escavação-disco, a relação vertical escavação-disco, volume da rima neural, volume da escavação, medidas de volume cabeça do nervo (para todos; p >0,05). IOP e PD aumentaram significativamente durante VM (para ambos; p <0,001). A VM diminuiu os valores CCT, ACD, ACA e ACV significativamente (para todos; p <0,001). Além disso, o volume da escavação do nervo óptico diminuiu e a razão horizontal escavação-disco aumentou significativamente durante VM (para ambos; p <0,05). Conclusões: A VM pode causar alterações transitórias na pressão intraocular, na morfologia do disco óptico e em parâmetros câmara anterior.