COVID-19 and Laboratory Markers from Romanian Patients-A Narrative Review.

COVID-19 has significantly impacted the whole world, and Romania was no exception. Biomarkers play a crucial role in understanding and managing the disease. However, research regarding laboratory analyses for patients with COVID-19 is fairly limited. For detection, PCR testing is still considered the golden standard, while antibodies are still useful for monitoring both patients and their vaccination status. In our country, biomarkers such as CRP, LDH, transaminases, cardiac, and iron markers have been used to assess the status of patients and even predict illness outcome. CRP, IL-6, LDH, FER, fibrinogen, creatinine, and vitamin D levels have been associated with increased severity, risk of ICU admission, and death. Cardiac markers and D-dimers are also good predictors, but their role seems more important in patients with complications. HDL cholesterol and BUN levels were also suggested as potential biomarkers. Hematological issues in SARS-CoV-2 infections include neutrophilia, lymphopenia and their ratio, while PCT, which is a marker of bacterial infections, is better to be used in patients with co- or supra-infections. The current research is a narrative review that focuses on the laboratory results of Romanian COVID-19 patients. The goal of this article is to provide an update on the research on biomarkers and other laboratory tests conducted inside the borders of Romania and identify gaps in this regard. Secondly, options for further research are discussed and encouraged.

Role of the Vitreous in Retinal Pathology: A Narrative Review.

The vitreous body is an anatomically and biochemically complex structure. Because of its proximity and firm adherence to the retina, researchers have examined the link between these two structures and how their individual pathologies might be connected. Several experimental and clinical studies have already demonstrated the important role of vitreous in the pathogenesis of retinal disorders. This narrative review highlights the role of the vitreous in retinal diseases and the improvements that have been made since the introduction of optical coherence tomography. This leads to a better understanding of vitreoretinal diseases and demonstrates its determinant role in other retinal pathologies, such as diabetic retinopathy or age-related macular degeneration. As we deepen our knowledge of the vitreous's structure, function, and abnormal conditions, we can better link the changes in diseases and identify effective treatments.

Oculo-orbital complications of odontogenic sinusitis.

Introduction: Odontogenic sinusitis is a well-known, but under-studied bacterial infection of the maxillary sinus that can extend to other sinuses, the orbit, or even the endocranium. Material and methods: We performed an observational retrospective study on the patients with odontogenic sinusitis treated in our hospital over a five-year period. We included patients over 18 years old diagnosed with odontogenic sinusitis and ocular complications and we excluded patients with ocular complications nonrelated to dental-originated sinusitis or patients with odontogenic sinusitis without orbital-ocular complications. Results: We examined the charts of 46 patients. From the total number of patients with oculo-orbital complications generated by odontogenic sinusitis, only 7 were women. The mean age was 33,7 with a standard deviation of 15,7 years. The oculo-orbital complications were assessed according to the Chandler classification. The most frequent orbital complication was preseptal cellulitis followed by orbital cellulitis. All the patients were treated with antibiotic covering both anaerobic and aerobic bacteria and 40 of the patients in our study received surgical treatment. The outcomes were favorable for all the patients in our study with clinical resolution. Conclusion: The oculo-orbital complications of odontogenic sinusitis are severe because they can result in vision loss or other ocular sequelae. The bacteriological features of this sinusitis explain the special characteristics of this infection and can facilitate the extent of the infection to the orbit. Prompt intervention with antibiotics covering anaerobic and aerobic bacteria and surgery addressed to the affected sinus/ sinuses, the dental disease and the orbital pathology ensures a big success rate in the therapy of these complications.

Erratum: [Corrigendum] Corneal endothelial changes induced by pars plana vitrectomy with silicone oil tamponade for retinal detachment.

[This corrects the article DOI: 10.3892/etm.2021.10393.].

Automated Retinal Vessel Analysis Based on Fundus Photographs as a Predictor for Non-Ophthalmic Diseases-Evolution and Perspectives.

The study of retinal vessels in relation to cardiovascular risk has a long history. The advent of a dedicated tool based on digital imaging, i.e., the retinal vessel analyzer, and also other software such as Integrative Vessel Analysis (IVAN), Singapore I Vessel Assessment (SIVA), and Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE), has led to the accumulation of a formidable body of evidence regarding the prognostic value of retinal vessel analysis (RVA) for cardiovascular and cerebrovascular disease (including arterial hypertension in children). There is also the potential to monitor the response of retinal vessels to therapies such as physical activity or bariatric surgery. The dynamic vessel analyzer (DVA) remains a unique way of studying neurovascular coupling, helping to understand the pathogenesis of cerebrovascular and neurodegenerative conditions and also being complementary to techniques that measure macrovascular dysfunction. Beyond cardiovascular disease, retinal vessel analysis has shown associations with and prognostic value for neurological conditions, inflammation, kidney function, and respiratory disease. Artificial intelligence (AI) (represented by algorithms such as QUantitative Analysis of Retinal vessel Topology and siZe (QUARTZ), SIVA-DLS (SIVA-deep learning system), and many others) seems efficient in extracting information from fundus photographs, providing prognoses of various general conditions with unprecedented predictive value. The future challenges will be integrating RVA and other qualitative and quantitative risk factors in a unique, comprehensive prediction tool, certainly powered by AI, while building the much-needed acceptance for such an approach inside the medical community and reducing the "black box" effect, possibly by means of saliency maps.

Implications at the ocular level of miRNAs modifications induced by SARS-CoV-2 infection.

The coronavirus disease 2019 (COVID-19) pandemic determined the use of different research methods and investigations in the management of this novel infectious disease. The impact and development of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at cellular level is still a challenge and many directions of investigation have been opened, a complex topic that has been explored is the bidirectional interaction between host micro-ribonucleic acids (miRNAs) and viral miRNA. The main point of this study is to analyze the transcriptional modifications induced by the viral infection at ocular level, mediated by miRNAs. It is known that the ocular transmission is a route of infection, and it can cause multiple neuro-ophthalmological manifestations, such as optic nerve dysfunction, eye movement abnormalities, oscillopsia and intracranial hypertension. We have managed to identify more than six miRNAs specifically involved in eye disorders that are strongly dysregulated by the SARS-CoV-2. These miRNAs regulate different pathways, such as the nuclear factor-kappa B (NF-κB) pathway, the expression of complement factor H (CFH) gene, the expression of transforming growth factor-beta (TGF-ß), fibroblast growth factor (FGF) and platelet-derived growth factor (PDGF) genes. In the context of SARS-CoV-2 infection, many more molecular changes at ocular level need to be elucidated to better understanding the COVID-19.

Corneal endothelial changes induced by pars plana vitrectomy with silicone oil tamponade for retinal detachment.

Silicone oils are effective intraocular tamponade agents in the treatment of severe retinal detachments, because they maintain the adhesion between neurosensory retina and retinal pigment epithelium, thanks to their ability to remove aqueous humor from the surface of the retina. To understand their effectiveness, it is important to know the characteristics of silicone oils. Patients should be closely monitored due to many complications associated with intraocular silicon oil, such as inflammatory reaction, raised intraocular pressure, refraction disorders, cataract, and emulsification. This study presents corneal endothelial changes and some intraocular complications caused by silicone oil used as an intraocular tamponade agent in the case of vitrectomy for complex retinal detachments. The aim of the study was to demonstrate the damage of corneal endothelial cells after the use of silicone oil in patients with retinal detachment surgery. Endothelial specular microscopy measurements were performed and the changes of the following parameters demonstrated the corneal damage: Mean cell density, coefficient of variation, average cell area, percentage of hexagonal cells, and corneal thickness. Three months postoperatively, a statistically significant decrease was observed in the following analyzed parameters: Mean cell density (P=0.04), and percentage of hexagonal cells (P=0.002); the remaining parameters also had a linear decrease (coefficient of variation, average cell area), but were statistically insignificant. Three months postoperatively, the corneal thickness presented a slight increase. Silicone oils are powerful tools when used wisely and within the limits of their use. These are often recommended in cases of severe detachment of the retina in patients at high risk of experiencing intraoperative complications.

In vitro and in ovo experimental study of two anti-VEGF agents used in ophthalmology.

Anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibodies can inhibit neovascularization and also to block the growth of several tumor cell lines. Treatment with anti-VEGF drugs like Bevacizumab (Avastin®) and Aflibercept has proven optimistic results in various malignant diseases. The present study was aimed to investigate Bevacizumab and Aflibercept in vitro effects on two human melanoma cell lines (A375 and SK-Mel-28), as well as on a healthy cell line (HaCaT human keratinocytes), followed by characterization of the in ovo effects on the chorioallantoic membrane (CAM). Our data indicated that Bevacizumab and Aflibercept decreased human melanoma cells viability in a dose-dependent way, a more significant effect was obtained for Aflibercept. Regarding the safety profile of the active compounds tested, they showed a low-moderate irritation score. In the case of the tested samples, the vascular capillaries were not majorly affected. In both cases, the only notable change was the appearance of a slight vascular coagulation. The viability of the embryos after application was good, they survived more than 24 hours after testing the compounds on the CAM.

Cystic hygroma of the neck - case report.

Cystic hygromas (CHs) are benign congenital malformations of the lymphatic system mainly diagnosed in small children aged less than two years old. They may give a multitude of local, sometimes severe complications. The most used method of treatment is surgical removal. In this paper, we present the case of a CH of a 13-year-old boy, localized in the right lateral region of the neck, diagnosed through magnetic resonance imaging (MRI), with excellent results of the surgical treatment.

Injecting botulinum toxin into the treatment of blepharospasm.

The present paper is an introduction to this category of therapy, the injection of botulinum toxin into blepharospasm and, at the same time, an attempt to familiarize our readers with this concept. Our activity in this field started in 2014; the favorable results we have obtained since then have made us write this article. Abbreviations: BEB = Abnormal Benign Essential Blepharospasm, TXB = Botulinum Toxin.

Optic Pit Maculopathy.

This paper discusses a 32-year-old woman's case who presented a chronic decrease of visual acuity. In this case, the treatment was complex and consisted of a 25 GA vitrectomy, MLI peeling, covering the defect at the optic nerve papilla with that patch, gas endotamponade (C3F8). Abbreviations: MLI = internal limiting membrane; ODP-M = optic disc pit maculopathy.

New perspectives in retinal imaging - angio OCT.

In the last few years, structural and functional optical coherence tomography (OCT) technology has seen new and revolutionary developments. The most important of all is OCT angiography (Angio-OCT). Angio-OCT already plays an important role in clinical ophthalmology as a new, non invasive and dyeless diagnostic tool, which serves as an adjunct to, or even a replacement for fluorescein and indocyanine green (ICG) angiographies. Angio-OCT brings multiple technical and clinical improvements in the study of retinal diseases, glaucoma, and optic nerve disorders. It enables rapid, high-resolution, detailed images of large retinal vessels and capillary networks in seconds by using a strategy called "motion contrast", as opposed to revealing detailed images of large retinal vessels and capillary networks in seconds by using a strategy called "motion contrast" as opposed to the minutes required in conventional fluorescein angiography. These images are uniquely three-dimensional and allow an isolated study of individual capillary beds at different depths of the retina.

Chromovitrectomy.

The term "chromovitrectomy" has been coined to define the use of vital dyes in vitreoretinal surgery. The basic concept for the application of vital dyes during vitreoretinal surgery is to assist in highlighting preretinal membranes and tissues which are very thin and semitransparent and thus difficult to detect. Various dyes are currently being used in routine clinical procedures, however, the ideal staining agent has not yet been found. The vital dyes indocyanine green, infracyanine green, and brilliant blue stain the internal limiting membrane, trypan blue and triamcinolone acetonide help to visualize the epiretinal and vitreous membranes. New dyes with a better safety profile than the synthetic ones are important for optimizing the outcome of modern ophthalmic surgery and natural dyes, such as lutein, offer a potentially safer and more efficient method of identifying intraocular structures such as vitreous and ILM. Any dye, which is intravitreally injected has the potential to become toxic.

AGE-RELATED MACULAR DEGENERATION.

OBJECTIVES: The objective of our study was to review the current knowledge on Age- Related Macular Degeneration, including pathogenesis, ocular manifestations, diagnosis and ancillary testing. SYSTEMATIC REVIEW METHODOLOGY: Relevant publications on Age-Related Macular Degeneration that were published until 2014. CONCLUSIONS: Age-related macular degeneration (AMD) is a common macular disease affecting elderly people in the Western world. It is characterized by the appearance of drusen in the macula, accompanied by choroidal neovascularization (CNV) or geographic atrophy.

DIABETIC MACULAR EDEMA.

Diabetic macular edema (DME) remains the most common cause of vision loss among diabetic patients. New understanding of the underlying pathophysiology has interest in the potential benefits of the specific pharmacologic therapy, such as treatment with intraocular steroids, anti-vascular endothelial growth factor (VEGF), and protein kinase C-beta (PKCß) inhibition. At the last time, laser photocoagulation, according to the guidelines of the Early Treatment of Diabetic Retinopathy Study (ETDRS), continues to be primary standard care treatment in most communities. Optical coherence tomography (OCT) is very useful in monitoring macular edema progression and response to treatment.

[Considerations in a case of refractive surgery]. / Consideratii pe marginea unui caz de chirurgie refractiva.

We present a case report of a 38 year old patient, with medium myopia LASIK --operated, with rhegmatogenous retinal detachment. We present the seriated surgical interventions (posterior vitrectomy with silicone oil, followed by the extrusion of the silicone oil and the extraction of complicated cataract with IOL-CP implantation).

[Malyugin ring--an alternative in the treatment of a miotic pupil]. / Inelul malyugin--alternativa în tratamentul pupilei "refractare".

Small pupil and Intraoperative Floppy Iris Syndrome (lFIS) has always been a challenge in cataract surgery. Iris dilation and mechanical stabilization can be achieved by using intraoperative iris retractors, preferably before capsulorhexis. Malyugin ring is a mechanical iris expansion device, which presents many advantages (gently relaxes the iris tissue, implants easier and less traumatic). The disadvantages of using Malyugin ring consists primarily in the high cost and in an increased duration of surgical procedure.

[Proliferative diabetic retinopathy -- therapeutic approach (clinical case)]. / RETINOPATIE DIABETICA PROLIFERATIVA--ATITUDINEA TERAPEUTICA (CAZ CLINIC).

We present the case of a 54 year old pacient diagnosed with neglected insulin dependent diabetes and proliferative diabetic retinopathy. Surgery was recommended and we practiced posterior vitrectomy, endolaser and heavy silicone oil endotamponade. Post-operative evolution was favorable.