Quantitative Parameters Relevant for Diabetic Macular Edema Evaluation by Optical Coherence Tomography Angiography.

Diabetic macular edema (DME) is one of the main ocular complications of diabetes mellitus (DM) that can lead to important vision loss in diabetic patients. In clinical practice, there are cases of DME with unsatisfying treatment responses, despite adequate therapeutic management. Diabetic macular ischemia (DMI) is one of the causes suggested to be associated with the persistence of fluid accumulation. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality, able to give in-depth information about retinal vascularization in a 3-dimensional manner. The OCTA devices currently available can provide various OCTA metrics that quantitatively assess the retinal microvasculature. In this paper, we reviewed the results of multiple studies that investigated the changes in OCTA metrics in the setting of DME and their possible contribution to the diagnosis, therapeutic management, follow-up and prognosis of patients with DME. We analyzed and compared relevant studies that investigated OCTA parameters related to changes in macular perfusion in the setting of DME and we evaluated the correlations between DME and several quantitative parameters, such as vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ)-related parameters, as well as complexity indices of retinal vasculature. The results of our research showed that OCTA metrics, evaluated especially at the level of the deep vascular plexus (DVP), are useful instruments that can contribute to the assessment of patients with DME.

Comparative hematological profiles for dose-dense vs. regular anthracycline-based neoadjuvant chemotherapy in non-metastatic breast cancer.

The aim of the present study was to examine both the feasibility and toxicity of neoadjuvant dose-dense chemotherapy in women with non-metastatic breast cancer. A search within the OncoHelp Association breast cancer database has been performed in order to identify all non-metastatic breast cancer patients who underwent an initial consultation with a medical oncologist between March 2016 and April 2020. The inclusion criteria used were: i) Age, ii) follow-up care obtained at OncoHelp Association, iii) the intent to treat with a neoadjuvant dose-dense anthracycline every two weeks for four cycles (C1-C4) followed by paclitaxel every two weeks for four cycles, with white blood cell growth factor support, and iv) regular anthracycline-based chemotherapy every three weeks for four cycles, followed by paclitaxel every three weeks for four cycles, v) weight, vi) height, vii) Eastern Cooperative Oncology Group (ECOG) performance status, viii) hemoglobin (Hb) level, ix) Platelet count and x) neutrophil count.

Tricalcium phosphate and hydroxyapatite treatment for benign cavitary bone lesions: A prospective clinical trial.

Benign bone tumors are surgically treated by curettage and by filling the defect using bone grafts or bone substitutes, such as hydroxyapatite crystals and tricalcium phosphate. The tricalcium phosphate mixed with hydroxyapatite, although fragile, is a good alternative with good integration. Fifteen patients with benign bone lesions were randomized in two groups surgically treated by curettage and filling of the bone defect using allograft (7 cases) or a mixture of 35% tricalcium phosphate, with 60-85% pore volume, and 65% hydroxyapatite (8 cases). After the surgery, all patients were followed up every 3 weeks until 6 months, and then at 2 months interval until one year for the clinical and radiological assessment. The average age was 35.4 years (from 18 to 54) for the allograft group and 41 years (from 22 to 58) for the patients treated with bone substitute. Eight patients were male and seven female, with relatively equal distribution between both groups. The average bone defect was relatively equal: 14 cc (4-25 cc) for the allograft group and 15.1 cc (4-33 cc) for the ceramic group (P>0.1). During the follow-up, all the lesions gradually disappeared after 12 months, with a time of healing of 18.8 weeks (15-24 weeks) for the allograft group and 20.37 weeks (15-28) for the bone substitute group. There were no significant differences regarding the clinical status and the radiological assessment after 12 months. No patient required extra pain medication after 2 weeks. No complications have been recorded. The surgical treatment of small and medium sized lytic benign tumors has good results with both types of graft that were studied. Using tricalcium phosphate mixed with hydroxyapatite as bone substitute represents a good and low cost alternative, but it is a relatively fragile material with a slower time to integrate compared to the allograft.

A new perspective towards failure of gamma nail systems.

Uncommon causes of nail failures and surgical reinterventions were determined. The study included 23 osteoporotic patients, 13 of whom followed a fast recovery program with early walking (FWB group). The other 10 patients were not allowed full weight bearing until 6 weeks (NFWB group). The T-score was determined before surgery for all cases. A case with a nail breakage after a failed DCS implant fixed in another clinic was also analyzed. The nail was revised and the broken implant underwent a metallurgic and microscopic examination. The average T-score was 2.5 for the patients that followed the fast recovery program and 2.7 for the patients from non-full weight bearing. Four patients, 1 from the NFWB group and 3 from FWB group, presented a screw cut-out. It was found that the errors of the guiding instruments may create dents, scratches or micro-fractures on the titanium coating that lead to an early implant failure. Imperfect reduction leads to incorrect implant placement and a high incidence of failure. Damaging the titanium protective coating, in a low force, high cycles scenario can cause structural failure. Delays in fracture healing and material fatigue are the most common causes of nail failure and can lead to catastrophic complications.

Cumulative visual impact of two coagulability disorders: A case report.

Cumulative visual impact of two coagulability disorders were reviewed by presenting a case of a young female patient with a spontaneous abortion and two thromboembolic events in 8 years, whose visual function was severely affected. The particularities of her genetic constellation regarding the retinal circulation are also discussed. The patient developed a central retinal artery occlusion in the right eye during pregnancy in 2010, which led to an extended hematological workup that revealed presence of MTHFR C677T and MTHFR A1298C heterozygote mutations. The screening for myeloproliferative disorders showed JAK2 V617F gene mutation. Test results confirmed the diagnosis of thrombophilia and essential thrombocythemia and she was recommended permanent treatment with low molecular weight heparin, platelet antiaggregant, peripheral vasodilator and neuroprotectors. Despite the treatment, the patient developed central retinal vein occlusion in the fellow eye 8 years after the first thromboembolic event. The visual acuity for the right eye (0.9 logMAR) remained poor and the visual acuity for the left eye recovered completely (from 0.3 logMAR to 0 logMAR). However, new retinal artery or vein occlusions could occur in the future and there is also a risk of thrombosis in other areas, such as cerebral, pulmonary or renal, due to the general coagulability imbalance.

Accuracy of five intraocular lens formulas in eyes with trifocal lens implant.

Accuracy of intraocular lens (IOL) calculation formulas SRK/T, Hoffer Q, Holladay 1, Haigis and Barrett Universal II were compared in prediction of postoperative refraction for multifocal and implants using a single optical biometry device. The authors included 88 refractive lens exchange and cataract surgeries, with AcrySof IQ PanOptix implant (Alcon Laboratories, Inc.). All eyes were divided into three groups based on axial length (AL), group 1: <22 mm (14 eyes), group 2: 22-24.5 mm (68 eyes) and group 3: >24.5 mm (6 eyes). The refractive prediction error (RPE) and mean absolute error (MAE) were calculated for 5 different formulas: SRK/T, Hoffer Q, Holladay 1, Haigis and Barrett Universal II. For eyes with the AL between 22 mm and 24.5 mm the greatest percentage of eyes with RPEs within ±0.25 D was 32.4% for Haigis formula, followed by Barrett Universal II, Hoffer Q and Holladay 1 with 29.4%. The percentage of eyes with RPEs within ±0.50 D was 100% only for Barrett Universal II and Holladay 1, 94.1% for SRK/T and 91.2% for Haigis and Hoffer Q. The first and third group with AL <22 and >24.5 mm were too small to have statistical significance due to the reluctancy to use multifocal IOLs on extreme ALs. ANOVA test showed no statistical difference (P=0.166) between the RPEs measured for each formula in this cohort. This study showed no statistical difference between formulas for this trifocal lens implant. There was a tendency for the RPE to be within ±0.25 D for most of the eyes with the Haigis formula, and within ±0.50 D for all the eyes with the Barrett Universal II formula in the group with the AL between 22 and 24.5 mm.

Photoreceptor assessment in focal laser-treated central serous chorioretinopathy using adaptive optics and fundus autofluorescence.

This study analyzed cone density, cone mosaic, and fundus autofluorescence (FAF) images in patients with focal laser-treated central serous chorioretinopathy (CSC).Observational case series.Forty-two eyes of 21 patients with unilateral treated CSC and bilateral best-corrected visual acuity of 1.0 (decimal fraction) were included. FAF and cone mosaic images were obtained in all patients with an adaptive optics fundus camera. Densities were recorded at 20 points throughout the macula, and choroidal thicknesses were measured.Mean choroidal thicknesses were 419.95 ±â€Š110.33 µm in normal eyes, 459.09 ±â€Š90.07 µm in eyes with active CSC, and 438.61 ±â€Š107.57 µm in treated eyes. The highest density of cones in healthy eyes was 38146 cones/mm, with a 5.66-µm intercellular space (IS), at 700 µm temporal to the center. In eyes with treated CSC, the highest density was 32749 cones/mm, with a 6.13-µm IS, at 500 µm nasal to the center. In all quadrants, median values of maximum cone density were significantly higher in healthy eyes (P = .02, P = .003, P = .0001, and P = .001). Three types of lesions were identified on FAF and were correlated with those on cone mosaic images. Strong correlations were detected between the presence of hypoautofluorescent lesions on the first FAF image and a greater difference between maximum values of photoreceptor density (r = 0.46, P = .03), as well as between the presence of hypoautofluorescent lesions and the duration of pathology (r = 0.68, P < .001).The presence of hypoautofluorescent lesions and the duration of pathology were negative prognostic factors in CSC. Laser treatment could prevent photoreceptor loss.

Clinical outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma-18 months follow-up.

The aim of this study is to evaluate the clinical outcomes of micropulse transscleral cyclophotocoagulation (mTSCPC) in cases of refractory glaucoma. Patients with refractory glaucoma were selected to undergo mTSCPC, using the MP3 handpiece from Iridex Laser Systems. Follow-up examinations occurred on a regular basis for 18 months after the procedure. One hundred eyes of 97 patients were treated. Mean pre-laser intraocular pressure (IOP) was 39.14 ± 13.84 mmHg. This was reduced significantly to 22.77.8 ± 10.48 mmHg (41.82% reduction; p < 0.001) at week 1. At months 1, 3, 6, 12, and 18 the IOP mean was 23.81 ± 9.44, 24.27 ± 9.17, 23.09 ± 8.47, 22.76 ± 8.14, and 22.77 ± 8.13 mmHg. The success rate at 18 months was the highest 90.91% for the group with IOP below 26 mmHg and the lowest 70.00% for the IOP group 26-30 mmHg. The mean number of anti-glaucoma drops decreased from 2.63 ± 0.87 to 1.78 ± 0.95. The number of treatments performed was 1.26. The pain felt during the procedure was reported as being moderate. No major postoperative complications were noted. Micropulse transscleral cyclophotocoagulation is a non-invasive, repeatable laser procedure that offers both good and stable results in lowering IOP and decreases the use of antiglaucoma medications for up to 18 months.

Bevacizumab in Wet AMD treatment: A tribute to the thirteen years of experience from the beginning of the anti-VEGF era in Romania.

This study aimed to identify and describe anatomical and functional changes on short (1-3 months) and medium (6-12 months) term after intravitreal injections of bevacizumab (Avastin, Genentech) in patients with choroidal neovascularization (CNV) in the context of exudative form of age-related macular degeneration (AMD). We performed a retrospective, analytical, interventional study, based on a series of cases with exudative form of AMD, which also comprised a prospective component related to the inclusion and treatment of the patients with a very new interventional method for that time (2006) and the follow-up of the effects of intravitreal injection of bevacizumab (1.25 mg) therapy in three monthly doses for short (1-3 months) and medium (6-18 months) periods of time. The follow-up of these patients was made by determining visual acuity (VA) as best corrected visual acuity (BCVA) at baseline and at every visit, slit lamp examination with contact or noncontact lenses each time, and optical coherence tomography and/or angiofluorography, applied only for certain patients, at various times of the study. In total, 376 intravitreal injections were administered to 117 eyes of 96 patients. The VA improved in the assessment of 3 months in 77 eyes (66%), either subjective (by the patient) or objectively quantified (by the physician). In 40 eyes (34%), there was no change in VA. In patients for whom optical coherence tomography could be performed, a significant reduction of the macula's thickness was found. The use of bevacizumab in subretinal neovascular membrane treatment is effective and safe on short and medium term, with the improvement of BCVA and reduction of macular edema in a significant number of cases.

A comparative study on the biological activity of essential oil and total hydro-alcoholic extract of Satureja hortensis L.

Satureja hortensis L. presents an increased interest due to its chemical composition, abundant in monoterpenes, aglyconic and glycosylates flavonoids, and phenolic acids, leading to important biological activity. The present study compared the biological activity of volatile oil (VO) and total hydro-alcoholic extract (TE) of Satureja hortensis L. in terms of: i) antioxidant activity; ii) antimicrobial activity; and iii) viability, migration and proliferation on two healthy cell lines (keratinocytes-HaCaT and fibroblasts-1BR3) and two melanoma cell lines (human-A375 and murine-B164A5). Antioxidant activity of VO and TE showed maximal values around 72%. Antimicrobial screening highlighted the inhibitory capacity of VO against all seven tested bacteria strains, with the most pronounced effect against S. aureus and C. albicans, while TE exerted only a slight activity against three bacteria strains. VO showed greater efficacy than TE on both tumor cell lines (A375 and B164A5), the activity of the compounds was higher when low concentrations were used (5, 10 and 25 µM) while at high concentrations (50 and 100 µM) the percentages of viability were increased.

Transluminal Nd:YAG laser embolysis--a reasonable method to reperfuse occluded branch retinal arteries.

INTRODUCTION: Central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision; at this moment, there is no effective therapy for CRAO and BRAO. Transluminal Nd:YAG laser embolysis (TYE) represents a therapeutic approach used for retinal vascular occlusive diseases. The main indication is branch retinal artery occlusion with visible embolus; for central retinal artery occlusion this tehnique is hardly applicable. The principle of this method consists of intravascular embolus breakage using the 1064 nm Nd:YAG laser, focused on the embolus surface. CASE REPORT: We presented 5 cases with BRAO, 3 with infero-temporal and 2 with supero-temporal BRAO, all of them treated with TYE, with variable results. All the patients had a visible embolus within the BRA, the laser applications being delivered directly to the embolus. CONCLUSION: Despite our short-term experience regarding this therapeutical approach, we can resume that the moment of emboli distruction, as close as possible to the onset of the occlusion, is decisive for regaining vision and that applying the procedure correctly is superior to observation in most cases. Worldwide experience with TYE is still limited, but the technique seems feasible also when treating CRAO caused by visible emboli on the optic disc surface. This most certainly calls for random trials for identifying precisely the role of TYE in treatment of retinal occlusion pathology, though the relatively small number of properly diagnosed cases affects this objective. In all cases, the risks of TYE must be weighed against the possibility of severe and permanent loss of vision secondary to retinal artery occlusions.

[The use of iontophoresis in corneal crosslinking technique]. / Utilizarea iontoforezei în tehnica de crosslinking cornean.

Iontophoresis is a method of facilitating the penetration of a drug through an intact tissue in the presence of an low intensity electrical current. In corneal crosslinking technique, iontophoresis is used for transepitelial impregnation of cornea with riboflavin. Compared to passive technique of corneal impregnation, iontophoresis shortens the time needed for impregnation, the time of exposure to UVA radiation and does not require de-epithelialisation.

[Physiopathology of macular edema in central vein occlusion]. / Fiziopatologia edemului macular în ocluziile venoase retiniene.

Retinal Vein Occlusions are vascular diseases affecting the Central Retinal Vein and its branches causing decreased retinal drainage resulting in significant clinical and functional pathological changes. RVO determines the increase of vascular permeability, with edema and hemorrhage and development of collateral vessels in a few weeks. Among the serious consequences of venous occlusion is the installation of macular edema to which depends long-term visual prognosis. Macular Edema is the accumulation of intraretinal serous fluid in the macular area caused by the breakdown of blood-retinal barrier.

[Hypopyon]. / Hipopionul.

The hypopyon represents an anterior chamber exudative syndrome which has important clinical and prognostic implications. It is very important to be able to differentiate between the sterile and infectiouos hypopyon and also to separate it by pseudohypopyon. A clear view over the etiology is strongly correlated with the therapeutical approach and the patient evolution.

[Adult onset foveomacular vitelliform dystrophy]. / Distrofie foveo-maculara viteliforma a adultului-caz clinic.

We present the case report of a 43 years old patient with adult-onset foveomacular vitelliform dystrophy, a rare disease described for the first time by Gass in 1974. The differential diagnosis was made particularly with Best disease, based on the aspect, the progression of the macular lesions, and the EOG.

[Specular microscopy and clinical correlations]. / Microscopia speculara si corelatii clinice.

Specular microscope displays images of reflected light at an optical interface. Allows qualitative, quantitative and morphometric analysis of corneal endothelium in a noninvasive way using specular reflection. This can be achieved by: Slit Lamp or Specular Microscope. Confocal Microscope is a category of Specular Microscope where the objective and condensor lens have the same focal point. It has a higher resolution and unlike conventional microscope this can scan all corneal layers.

[Transluminal embolysis with Yag-Nd-laser]. / Emboliza transluminala cu laser Yag.

Transluminal YAG laser embolysis (TYE) could be a therapeutical approach for retinal vascular occlusive diseases. The main indication is branch retinal artery occlusion with visible embolus. We are proud to present three BRAO cases managed successfully using TYE technique.

[Macular syndrome]. / Sindromul macular-etiologie/clinica/diagnostic.

The syndrome consists of signs and symptoms associated in a similar clinical picture, yet induced by different causes. The macular syndrome represents a complex of signs (changes in macular architecture) and symptoms associated with central vision disturbances, obviously induced by different causes. Our paper reviews the macula alteration causes, the clinical elements of this dysfunction and the clinical and paraclinical methods of diagnosis in macular diseases.

[Therapeutic options in age-related exudative macular degeneration]. / Optiuni terapeutice în DMLV exudativa.

The age-related macular disease (AMD) is the most frequent cause for blindness over 65 years in the developed countries. The incidence of this pathology (Framingham study) is: 2% (52-64 old), 11 %(65-74 old), 28%(>75 old). Our paper wants to review the therapeutic armamentarium during the last twenty years for treating Wet AMD--the most serious form of this disease.