Car accident leading to "traumatic" macular hole formation proven by optical coherence tomography.

BACKGROUND: We present the case of a car accident where the cause-consequence of the subsequent visual loss in one eye of the victim was proven by optical coherence tomography (OCT). METHODS: A 66-year-old woman was hit by a car from her right side and complained of immediate visual loss after the accident in her right eye. The patient was referred to our outpatient clinic 2.5 months after the car accident in order to elucidate the cause-consequence of the visual loss and the car accident. Following routine ophthalmologic examination OCT was performed in both eyes. RESULTS: Fundus biomicroscopy revealed a full thickness macular hole in the affected eye which was proven by OCT, while OCT showed an arrested stage of macular hole development in the unaffected left eye. Pars plana vitrectomy was performed resulting in closure of the hole. CONCLUSIONS: The arrested stage of macular hole formation seen by OCT in the fellow eye lead us to the conclusion that the accident could have been the trigger in the pathologic changes of the retina in the affected eye. The authors review the current literature related to head injury and macular hole formation.

Cataract surgery anaesthesia: is topical anaesthesia really better than retrobulbar?

PURPOSE: To compare the effectiveness for the patient of retrobulbar anaesthesia (RBA) and topical anaesthesia (TA) in cataract surgery by phacoemulsification. METHODS: We performed a prospective, randomized study on 115 patients operated at our clinic using the two anaesthesia techniques. The RBA group comprised 57 patients (20 women, 37 men; age 72 +/- 10 years); the TA group comprised 58 patients (20 women, 38 men; age 74 +/- 10 years). Measured parameters were: blood pressure; heart rate; blood oxygen saturation level; serum adrenaline, noradrenaline and cortisol levels; white blood cell count; indicated pain during the procedure, and pain as reported by the patient afterwards. Two psychological tests were used: the State-Trait Anxiety Inventory (STAI), and the patient-selected face-scale test. Statistical analysis was performed using Student's t-test and the chi-square test. Results were also analysed using a logistic regression model. RESULTS: Both types of anaesthesia were adequate for the surgical procedure. In the RBA group fewer patients experienced pain during surgery (p < 0.01) and fewer recalled any perioperative discomfort. With RBA the objective parameters were more stable than with TA, and systolic blood pressure was significantly lower (p = 0.01). The logistic model was able to predict perioperative pain with 93% certainty. Pain sensitivity was higher in younger patients and in patients with higher initial cortisol and noradrenaline serum levels. CONCLUSIONS: Both methods of anaesthesia are appropriate, but phacoemulsification with TA is more painful than with RBA. In hypertonic patients and younger patients who are more susceptible to pain, TA should be avoided or used in combination with individualized sedation.

Intraocular lens power calculation for combined cataract surgery, vitrectomy and peeling of epiretinal membranes for macular oedema.

PURPOSE: This study aimed to compare preoperatively calculated and postoperatively achieved refraction following phacoemulsification and intraocular lens (IOL) implantation combined with pars plana vitrectomy with internal limiting membrane or epiretinal membrane removal. METHODS: Twelve eyes of 12 patients who underwent a combined procedure were enrolled in this study. Ultrasound axial length and macular thickness (optical coherence tomography, OCT) measurements were performed pre- and postoperatively. Intraocular lens power was calculated with the SRK/T formula and the planned refraction was compared with results of postoperative automatic refractometry. Comparisons between IOL calculations using the measured axial length and calculations using an adjusted axial length (by adding the macular thickness measured on OCT to the ultrasound axial length) were also performed. RESULTS: Axial length increased (p = 0.02), whereas macular thickness decreased (p = 0.002). The planned refraction was 0.63 +/- 0.38 dioptres, whereas the postoperative refraction error was - 0.16 +/- 0.48 D (p = 0.02), with a mean difference of - 0.79 +/- 0.24 D. During case-to-case comparisons, differences were observed between IOL calculations using the measured axial length and calculations using an adjusted axial length (0.63 +/- 0.38 D versus 0.13 +/- 0.48 D, p = 0.005). Correlation analysis showed a significant relationship between the 'adjusted planned' and the measured postoperative ametropia (r = 0.93, p < 0.001). CONCLUSIONS: The observed myopic shift due to erroneous IOL calculation results from underestimation of the axial length due to a thicker macula and calls for preoperative adjustment of ultrasound axial length when biometry is performed by this method.

Functional assessment of the possible toxicity of indocyanine green dye in macular hole surgery.

PURPOSE: To evaluate the possible toxicity of indocyanine green (ICG) dye in macular hole surgery by comparing functional results after successful surgeries performed with and without staining. DESIGN: Prospective observational case series. METHODS: In a study conducted at our department, 30 eyes of 29 patients with idiopathic macular hole underwent pars plana vitrectomy, with peeling of the internal limiting membrane (ILM). In 21 eyes (group A), ICG staining was used to visualize the membrane; in nine eyes (group B), no dye was applied. Pre- and postoperative examinations (at three, six, 12, and 20 months) included visual acuity (VA) (Snellen chart), slit-lamp biomicroscopy, multifocal electroretinography (mfERG), and optical coherence tomography (OCT). For statistical analysis, the Mann-Whitney U test and Newman-Keuls post hoc analysis were used. RESULTS: The macular hole was closed in all patients. At 20 months, VA improvement (logarithm of minimal angle of resolution units) compared with baseline was more pronounced in group B (P < .001) than in group A (P = .022); VA was also better for group B compared directly with group A (P = .048). For mfERG, preoperative responses were subnormal. Postoperatively, responses initially decreased, but at 20 months significant improvement was seen in both groups (P < .001). When data from the groups are compared at 20 months, significantly greater mfERG improvement was found in group B in both central and perimacular areas (P < .001). CONCLUSIONS: The significantly better outcomes without staining may suggest dye toxicity. Alternative internal limiting membrane visualization substances with fewer adverse effects (trypan blue, triamcinolone) may be preferable.

[Role of the music in the operating theatre]. / A zene szerepe a szemészeti mutoben.

PURPOSE: To investigate the effect of music on patients, surgeons and staff in the operating theatre at our Ophthalmology department in Mária street Clinic. PATIENTS AND METHODS: I. 150 patients, 7 staff and 19 surgeons have been asked to fill out a questionnaire. II. 29 patients who were listening music during surgery and as control group 27 patients having surgery without music therapy filled out a different questionnaire dealing with their preference on different kinds of music. In order to obtain more complete results, psychophysiology tests (STAI H test, Face-scale), blood pressure and pulse rate were measured, as well. RESULTS: Almost all the patients, and every surgeon and staff member like music. Music does not disturb the staff during their work, but does not help in their concentration. The majority of them considered music useful in the recovery of their patients. According to the answers most of the patients think that music has beneficial effect on their treatment compared to those patients who did not hear music. Subjective answers show a mild anxiety during surgery, that is supported with the data of the psychophysiological test results. CONCLUSION: Results so far demonstrate that the use of music therapy at our department during ophthalmic surgery is beneficial. Further examinations are necessary to measure the objective effect of music during surgery.

Soluble semicarbazide-sensitive amine oxidase (SSAO) activity is related to oxidative stress and subchronic inflammation in streptozotocin-induced diabetic rats.

Diabetes is known to increase the risk of Alzheimer's disease (AD) and vascular dementia via oxidative stress and inflammation. There are speculations that SSAO activity might be related to the development of AD. Our aim was to investigate whether changes of soluble SSAO activity, oxidative stress and inflammation markers are related to each other in diabetes. Soluble and tissue-bound SSAO activities (from serum and aorta, respectively) were determined in streptozotocin (STZ)-induced diabetic rats without insulin treatment, receiving insulin once, or twice daily compared to control animals. After three weeks of treatment soluble and tissue-bound SSAO activities (seSSAO and aoSSAO, respectively), serum total antioxidant status (TAS), high sensitivity C-reactive protein (hsCRP), fructose amine levels and routine laboratory parameters were determined. SeSSAO activity significantly increased in the diabetic groups without treatment and receiving insulin once daily, and a marked decrease in aoSSAO activity was seen in all diabetic groups. Increased oxidative stress was correlated with hsCRP elevation, while hsCRP and seSSAO activity were also significantly correlated. In all groups seSSAO and aoSSAO activities were in negative correlation with each other. Our results support the view that poor metabolic control leads to increased oxidative stress, which in turn may cause the elevation of hsCRP levels. Soluble SSAO on the one hand acts as an adhesion molecule--thus possibly being a factor responsible for the late complications of diabetes--and on the other hand, it may contribute to oxidative stress. Our parsimonious conclusion is that there is a relation between the risk factors of AD and vascular dementia (diabetes, oxidative stress and chronic inflammation) and SSAO activity, which may originate from the vessel wall.

Correlation of clinical and genetic findings in Hungarian patients with Stargardt disease.

PURPOSE: Autosomal recessive Stargardt disease (arSTGD) presents with substantial clinical and genetic heterogeneity. This study was conducted to correlate foveolar thickness (FT) and total macular volume (TMV), measured by optical coherence tomography (OCT), with other clinical characteristics and with specific genetic variation in Hungarian patients with arSTGD. METHODS: After a standard ophthalmic workup, both eyes of 35 patients with STGD from Hungary and of 25 age-matched healthy control subjects were tested with OCT. FT and TMV were measured automatically with the OCT mapping software in the nine Early Treatment Diabetic Retinopathy Study areas of 3500 microm in diameter. All patients were screened for mutations by a combination of the ABCR400 microarray and direct sequencing. RESULTS: The patients with STGD presented with markedly thinned retina in the foveola and decreased macular volume, 72 microm and 1.69 mm3, respectively, compared with 169 microm and 2.48 mm3 in the normal subjects, respectively. Statistically significant correlation was observed between visual acuity (VA) and TMV and between VA and FT. Disease-associated mutations were detected in 23 (65.7%) of 35 patients, including 48.5% with both alleles and 17.2% with one allele. The most frequent ABCA4 alleles in Hungarian patients with STGD were L541P/A1038V (in 28% of all patients), G1961E (20%) and IVS40+5G-->A (17%). Specific genotypes correlated with some phenotypic features and allowed for predictions of the disease progression. CONCLUSIONS: Hungarian patients with STGD presented with extensive foveolar thinning and macular volume loss. Genetic analysis detected several ABCA4 alleles at high frequency in the cohort of patients, suggesting founder effect(s). Unusually homogeneous distribution of disease-associated mutations aided genotype-phenotype correlation analyses in this population.

[Optical biopsy of the retina in vivo: on optical coherence tomography and its clinical use in ophthalmology]. / A retina optikai biopsziája in vivo: az optikai koherencia tomográfiáról es annak szemészeti alkalmazásáról.

Optical Coherence Tomography (OCT) is a novel, non invasive imaging method, which enables in vivo assessment of living tissues, providing near histological resolution images. The first description of its clinical introduction was in ophthalmology, which substantially changed our view of specific retinal diseases. OCT technology is slowly penetrating into other medical fields, supposedly opening new perspectives with the possibility of in vivo optical biopsy. The aim of this paper is to review the clinical use of OCT, with special emphasis on ophthalmology.

Laser treatment of zone I prethreshold and stage 3 threshold retinopathy of prematurity.

PURPOSE: To analyze the structural outcomes of zone I prethreshold and stage 3 threshold retinopathy of prematurity following laser ablation. PATIENTS AND METHODS: This nonrandomized observational case series evaluated 71 eyes of 36 infants who weighed less than 1,250 g at birth. Infants were treated at either prethreshold or threshold severity. The structural outcomes were compared using Fisher's exact test. RESULTS: The structural outcome was favorable in 96% and 80% of the prethreshold and threshold groups, respectively (P = .069). When an unfavorable outcome was defined as dragging of the temporal vessels, the difference was significant (P = .0257). CONCLUSION: Early treatment of zone I disease may result in a better structural outcome.

MRI for the evaluation of scleral invasion and extrascleral extension of uveal melanomas.

AIM: To study the diagnostic value of MRI for the detection of scleral infiltration and extrascleral extension of uveal melanoma. MATERIALS AND METHODS: Twelve consecutive patients with clinically suspected large uveal melanoma were examined by MRI. All of the patients underwent enucleation or exenteration. The clinical and histopathological findings were compared. RESULTS: The clinical diagnosis of uveal malignant melanoma was confirmed by histology in each case. MRI allowed detection of scleral infiltration with a sensitivity of 100% and a specificity of 50%. For extrascleral extension, MRI had a sensitivity of 100% and specificity of 89%. CONCLUSIONS: Using fat suppression technique and enhancement with contrast medium, MRI proved to be a valuable ancillary method for the assessment of scleral infiltration and extrascleral extension.

[Determination of serum semicarbazide-sensitive amine oxidase activity in diabetic retinopathy in type-2 diabetes]. / A szérum szemikarbazid-szenzitív aminoxidáz enzim aktivitásának vizsgálata 2-es típusú cukorbetegség talaján kialakult diabeteses retinopathiában szenvedókben.

INTRODUCTION: Recent data suggest that the copper-containing semicarbazide-sensitive amine oxidase enzyme (SSAO) may play a role in vascular endothelial damage through conversion of certain endogenous monoamines, like methylamine into cytotoxic aldehydes, hydrogen peroxide and ammonia. SSAO is present in various human tissues and in the serum. Elevated SSAO activities have been reported in patients with both types of diabetes mellitus. The purpose of this study was to examine the possible association between serum SSAO activity and the different severity stages of diabetic retinopathy. PATIENTS AND METHODS: A prospective study was performed on a defined group of Type 2 diabetic patients (n = 93) compared to non-diabetic control subjects (n = 42). All participants underwent a detailed ocular examination (slit lamp, colour retinal photography, fluorescein angiography) and standard laboratory investigations. Age at diagnosis, duration of diabetes, presence of systemic hypertension, medication and BMI were recorded. Serum SSAO activity was determined by a radiometric procedure using [14C]-benzylamine as substrate. RESULTS: In the total group of Type 2 diabetic patients SSAO activity (mean +/- SD) was significantly elevated compared to non-diabetic controls (n = 93, 131.72 +/- 53.07 vs. n = 42, 89.56 +/- 26.89 pmol.mg-1 protein.hour-1, p < 0.0001). After dividing patients to four subgroups according to the severity of diabetic retinopathy, serum SSAO activity was significantly higher in patients with high-risk proliferative diabetic retinopathy (n = 16, 166.96 +/- 70.56 pmol.mg-1 protein.hour-1) compared to those without retinopathy (n = 42, 119.54 +/- 50.49 pmol.mg-1 protein.hour-1, p < 0.02). CONCLUSION: The results support the hypothesis that elevated SSAO activity may be involved in the pathogenesis of microvascular diabetic late complications, such as retinopathy. The pharmacological manipulation of SSAO activity might be an interesting new concept for prevention and treatment of diabetic retinopathy.