A case of mycotic keratitis due to Fusarium sp. with an undesirable outcome.

Fungal keratitis, an infective disease of the cornea, represents a serious diagnostic and therapeutic problem that, if not recognized on time, could lead to irreversible eye damage. Herein we report a case of fungal keratitis due to Fusarium spp. infection. The 60-year-old man was admitted to our clinic due to an atraumatic acute onset of the disease, with a decrease in the visual acuity, photophobia, redness, and severe pain in the right eye. Clinical observation revealed an ulcer that affected 1/3 of the cornea and a hypopion in the anterior chamber. After the first results of microbiological analyzes, local and systemic antifungal therapy was applied. Due to the fact that the patient voluntarily left the treatment, there was a drastic worsening of the local findings as a full thickness total corneal infiltrate with more intense anterior chamber reaction. Finally, evisceration was performed. Given the fact that fungal keratitis is more prevalent in developing countries, official protocols and available effective antifungals are crucial for adequate treatment and a favorable outcome of this infection.

Ganglion Cell-Inner Plexiform Layer Thickness in Different Glaucoma Stages Measured by Optical Coherence Tomography.

AIM: To compare ganglion cell (GCL) and inner plexiform layer (IPL) thickness in patients at different stages of primary open-angle glaucoma (POAG), determine their sensitivity and specificity values, and correlate thickness values with mean deviations (MD). METHODS: This prospective, cross- sectional study was conducted in a group of patients with confirmed POAG who were compared to an age- and gender-matched control group. Glaucomatous damage was classified according to the Hodapp-Parrish-Anderson scale: glaucoma stage 1 (early), glaucoma stage 2 (moderate), and glaucoma stage 3 (severe). The average, minimum, and all 6 sectoral (superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal) GCL + IPL thicknesses were measured and compared between groups. RESULTS: The average GCL + IPL thickness of 154 eyes of 93 patients in glaucoma stages 1, 2, 3, and 94 eyes of 47 persons in the control group were 76.79 ± 8.05, 65.90 ± 7.92, 57.38 ± 10.00, and 86.01 ± 3.68 µm, respectively. There were statistically significant differences in the average, minimum, and all 6 sectoral GCL + IPL values among the groups. The areas under the receiver operating characteristic curve for average and minimum GCL + IPL thickness values were 0.93 and 0.94, respectively, sensitivity 91.5 and 88.3%, and specificity 98.9 and 100%, respectively. Both thickness values showed significant correlations with MD. Each micrometer decrease in the average GCL + IPL thickness was associated with a 0.54-dB loss in MD. CONCLUSION: GCL + IPL layer thickness is a highly specific and sensitive parameter in differentiating glaucomatous from healthy eyes showing progressive damage as glaucoma worsens. Loss of this layer is highly correlated with overall loss of visual field sensitivity.

Retinal ganglion cell/inner plexiform layer thickness in patients with Parkinson's disease.

Introduction: The aim of the paper was to analyze the changes in the macular ganglion cell layer and inner plexiform layer (GCL-IPL) thickness in patients with Parkinson's disease. Material and methods: The study enrolled 46 patients with established diagnosis of Parkinson's disease and 46 healthy subjects. Both groups were age- and gender-matched. An OCT protocol, namely standardized Ganglion Cell Analysis algorithm was used to measure the thickness of the macular GCL-IPL layer. The average, minimum, and six sectoral (superotemporal, superior, superonasal, inferonasal, inferior, inferotemporal) GCL-IPL thicknesses were measured from the elliptical annulus centered on the fovea. Results: The mean value of the clinical severity of Parkinson's disease was between 2 and 3, according to the Hoehn and Yahr scale. Statistically significant thinning of the GCL-IPL layer was registered in average and minimum GCL-IPL thickness, as well as in the sectoral layer thicknesses in patients with Parkinson's disease in comparison to the controls. There was no correlation between structural changes in the retina and disease duration or severity. A statistically significant difference in thickness between the different stages of the disease was registered only in the inferior sector. Conclusions: Parkinson's disease is accompanied by thinning of the GCL-IPL complex of macula even in the earliest stages. This may indicate a possible retinal dopaminergic neurodegeneration. There is no correlation between duration or severity of Parkinson's disease with thinning of the GCL-IPL complex. .

Foveal Avascular Zone in Normal Tension Glaucoma Measured by Optical Coherence Tomography Angiography.

AIM: To measure diameter of foveal avascular zone (FAZ), FAZ area, and vessel density using Optical Coherence Tomography Angiography (OCT-A) in patients with normal tension glaucoma (NTG) and to establish the possible role of OCT-A in diagnosis and follow-up of patients with NTG. METHODS: Twenty-one eyes of 21 patients with NTG and 30 eyes of 30 healthy subjects underwent complete ophthalmic examination as well as OCT-A on ZEISS AngioPlex. 3 × 3 macula scans were used to measure vertical, horizontal, and maximum diameter of FAZ by two graders. Mean values and interobserver variability were analyzed. Image J was used for analysis of FAZ area and vessel density. RESULTS: Mean vertical diameter (t = 5.58, p < 0.001), horizontal diameter (t = 3.59, p < 0.001), maximum diameter (t = 5.94, p < 0.001), and FAZ area (t = 5.76, p < 0.001) were statistically significantly enlarged in the NTG group compared to those in the control group. Vessel density (t = -5.80, p < 0.001) was statistically significantly decreased in the NTG group compared to that in the control group. CONCLUSION: OCT-A could have an important role in the future in diagnosis of patients with NTG. In patients with NTG, there is larger FAZ area, while the vessel density is reduced in comparison to the control group.

Ocular surface disease incidence in patients with open-angle glaucoma.

Introduction: Ocular surface disease (OSD) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, tear film instability with potential damage to the ocular surface, accompanied by increased tear film osmolarity and inflammation of the ocular surface. It is a consequence of disrupted homeostasis of lacrimal functional unit. The main pathogenetic mechanism stems from tear hyperosmolarity and tear film instability. The etiological classification is hyposecretory (Sy-Sjögren and non-Sjögren) and evaporative (extrinsic and intrinsic) form. Delphi panel classification grades disease stages. Antiglaucoma topical therapy causes exacerbation or occurrence of symptoms of dry eye due to main ingredients or preservatives (benzalkonium chloride ­ BAK), which are dose- and time-dependent. BAK reduces the stability of the lipid layer of tears, the number of goblet cells, induces apoptosis and inflammatory infiltration. Objective: The aim of this study was the analysis of the OSD incidence in open-angle glaucoma patients caused by topical medicamentous therapy. Methods: Retrospective analysis of examined patients with open-angle glaucoma was used. Results: Increased incidence of moderate and advanced OSD Index degrees in the group of primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma. According to the Delphi Panel Scale the most common grade is IIb (POAG and pseudoexfoliative glaucoma). Evaporative form of OSD prevailed in all treatment groups. High percentage of dry eye in patients with higher concentrations of preservatives applied was noticed. Conclusion: OSD should be timely diagnosed and treated. Dry eye has an impact on surgical outcome and postoperative visual acuity, and in order to improve patient compliance and quality of life, symptoms of dry eye should be addressed and medications with lower concentrations of preservatives should be applied.

Optical coherence tomography in the evaluation of structural changes in primary open-angle glaucoma with and without elevated intraocular pressure.

Background/Aim: Glaucoma is a progressive optic neuropathy characterized by damage of the retinal ganglion cells and their axons and glial cells. The aim of this study was to evaluate the differences and connections between changes in the visual field and the thickness of the peripapillary retinal nerve fiber layer (RNFL), using optical coherence tomography (OCT) in patients with primary open-angle glaucoma with normal and elevated intraocular pressure (IOP). Methods: This prospective study included 38 patients (38 eyes) with primary open-angle glaucoma with normal intraocular pressure (NTG) and 50 patients (50 eyes) with primary open-angle glaucoma with elevated intraocular pressure (HTG), paired by the same degree of structural glaucomatous changes in the optic nerve head and by age. OCT protocols 'fast RNFL thickness' and 'fast optic disc' were used for testing. The patients' age, gender, best corrected visual acuity (BCVA), IOP, stereometric and functional parameters were compared. Results: The average age of the examined population was 65.49 ± 9.36 (range 44-83) years. There was no statistically significant difference by age and by gender between the two study groups (p = 0.795 and p = 0.807, respectively). BCVA was higher in patients with NTG but there was no statistically significant difference compared to HTG patients (p = 0.160). IOP was statistically significantly higher in patients with HTG compared to NTG patients (17.40 ± 2.77 mmHg vs 14.95 ± 3.01 mmHg, p = 0.009). The cup/disc (C/D) (p = 0.258), mean deviation (MD) (p = 0.477), corrected patern standard deviation (CPSD) (p = 0.943), disk area (p = 0.515), rim area (p = 0.294), rim volume (p = 0.118), C/D area R (p = 0.103), RNFL Average (p = 0.632), RNFL Superior (p = 0.283) and RNFL Inferior (p = 0.488) were not statistically significantly different between the groups. Conclusion: OCT measurements of the RNFL thickness provide clinically significant information in monitoring of glaucomatous changes. There are no differences in the patterns of RNFL defects per sectors and quadrants between NTG and HTG, measured by OCT.

Lactate dehydrogenase and oxidative stress activity in primary open-angle glaucoma aqueous humour.

Lactate dehydrogenase (LDH) and lactate are some of the hypoxy biochemical parameters. Extracellular activity of this enzyme increases under the condition of oxidative stress, since the cell integrity can be disrupted during the lipid peroxidation process. Subsequently that leads to the increase level of the lactic acid and lactic acid salts. The objective of this investigation is establishing the level of LDH, LDH1 (HBDH) and the lactate concentration in aqueous humour in patients with primary open-angle glaucoma. Biochemical analysis have been made by enzymatic-colometric method (lactate) and UV-kinetic method (LDH and HBDH) in aqueous humour of 30 patients (42 eyes) with primary open-angle glaucoma (POAG) and 30 patients (40 eyes) with cataract (the control group). The increased values of lactate and the activity of LDH and HBDH enzyme in aqueous humour of POAG patients in correlation with the control group are the results not only of oxidative stress but also of hypoxy and the mitochondry oxidative function (p<0,001). The increased activity of the examined biochemical parameters in the aqueous humour of the POAG patients points to the fact that other mechanisms, besides IOP, have a role in glaucoma pathogenesis.