A. Kavanaugh, Bilal A Shaukat, J. T. Pan, M. Langford
A 37-year-old Indian male presented with a 3-year history of right eye blurred vision. Bilateral ophthalmic examinations revealed shallow, oval areas of macular subretinal fluid containing hypopion-like precipitates and central neurosensory retinal detachments with focal early-stage fluorescein leakage consistent with central serous chorioretinopathy (CSCR). Inadequate response to Eplerenone prompted reassessment yielding a positive BCG vaccine history. Latent tuberculosis infection (LTBI) was diagnosed by a positive interferon- γ response assay (IGRA) in the absence of pulmonary symptoms. Rifampin alone yielded only modest bilateral visual acuity increases and subretinal fluid decreases. Right eye focal macular laser was performed to stabilize vision with modest subretinal fluid decrease, but peripheral retinal lesions were noted on follow up. The patient has been unavailable for follow up evaluation and supportive anti-tuberculosis treatment (ATT) to date. The unresponsiveness to anti-corticosteroid medications in our case of CSCR secondary to LTBI, the reported detection of Mycobacterium tuberculosis DNA in CSCR subretinal fluid, and the resolution CSCR post ATT in 3 previous CSCR secondary to LTBI cases support a possible association of CSCR and LTBI. To our knowledge this is the fourth case of chronic CSCR in a patient with LTBI.
{"title":"Bilateral chronic central serous chorioretinopathy associated with IGRA latent tuberculosis infection: A case report and review","authors":"A. Kavanaugh, Bilal A Shaukat, J. T. Pan, M. Langford","doi":"10.15761/NFO.1000254","DOIUrl":"https://doi.org/10.15761/NFO.1000254","url":null,"abstract":"A 37-year-old Indian male presented with a 3-year history of right eye blurred vision. Bilateral ophthalmic examinations revealed shallow, oval areas of macular subretinal fluid containing hypopion-like precipitates and central neurosensory retinal detachments with focal early-stage fluorescein leakage consistent with central serous chorioretinopathy (CSCR). Inadequate response to Eplerenone prompted reassessment yielding a positive BCG vaccine history. Latent tuberculosis infection (LTBI) was diagnosed by a positive interferon- γ response assay (IGRA) in the absence of pulmonary symptoms. Rifampin alone yielded only modest bilateral visual acuity increases and subretinal fluid decreases. Right eye focal macular laser was performed to stabilize vision with modest subretinal fluid decrease, but peripheral retinal lesions were noted on follow up. The patient has been unavailable for follow up evaluation and supportive anti-tuberculosis treatment (ATT) to date. The unresponsiveness to anti-corticosteroid medications in our case of CSCR secondary to LTBI, the reported detection of Mycobacterium tuberculosis DNA in CSCR subretinal fluid, and the resolution CSCR post ATT in 3 previous CSCR secondary to LTBI cases support a possible association of CSCR and LTBI. To our knowledge this is the fourth case of chronic CSCR in a patient with LTBI.","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Guido, M. Fabrini, Federica Cresti, F. G. Ebert
The aim of this case report is to describe a rare case of jumbo choroidal amelanotic melanoma in a patient with oculocutaneous albinism treated with stereotactic radiotherapy. A 32 years old, Caucasian male, with oculocutaneous albinism, was admitted to our Ocular Oncology Center of Pisa in February 2018. Slit lamp examination of the left eye showed iris transillumination defects and nystagmus. Funduscopic examination revealed a blonde fundus and a poorly pigmented solid lesion that took up the upper half of the vitreous chamber and touched the lens. B-scan and A-scan ultrasound revealed a mushroom shaped lesion that broke through Bruch’s membrane measuring 15 mm in thickness, 8 mm in basal diameter, low internal reflectivity, and regular structure. The clinical and imaging features suggested a diagnosis of jumbo choroidal amelanotic melanoma. The patient was treated with stereotactic radiotherapy with Volumetric-Modulated Arc Therapy (VMAT) with flattening filter-free (FFF) on a VarianTM TrueBeamSTx, 27 Gy in a single fraction. At the 3-month follow-up visit, the tumor showed an exudative retinal detachment which was treated with an intravitreal injection of bevacizumab. At the 5-month follow-up visit slit lamp examination showed cataract, and iris rubeosis. The tumor demonstrated slight regression from 15 mm to 12 mm in thickness. After 17 months from the treatment the lesion was greatly reduced from 12 mm to 5 mm in thickness. Regular systemic assessments including abdominal ultrasound and chest RX were performed and patient was healthy with no signs of systemic metastatic disease. Although rare patients with oculocutaneous albinism may develop uveal melanoma and stereotactic radiotherapy can represent a valid alternative treatment in jumbo melanoma.
{"title":"Choroidal amelanotic melanoma in a patient with oculocutaneous albinism, a case report","authors":"F. Guido, M. Fabrini, Federica Cresti, F. G. Ebert","doi":"10.15761/NFO.1000248","DOIUrl":"https://doi.org/10.15761/NFO.1000248","url":null,"abstract":"The aim of this case report is to describe a rare case of jumbo choroidal amelanotic melanoma in a patient with oculocutaneous albinism treated with stereotactic radiotherapy. A 32 years old, Caucasian male, with oculocutaneous albinism, was admitted to our Ocular Oncology Center of Pisa in February 2018. Slit lamp examination of the left eye showed iris transillumination defects and nystagmus. Funduscopic examination revealed a blonde fundus and a poorly pigmented solid lesion that took up the upper half of the vitreous chamber and touched the lens. B-scan and A-scan ultrasound revealed a mushroom shaped lesion that broke through Bruch’s membrane measuring 15 mm in thickness, 8 mm in basal diameter, low internal reflectivity, and regular structure. The clinical and imaging features suggested a diagnosis of jumbo choroidal amelanotic melanoma. The patient was treated with stereotactic radiotherapy with Volumetric-Modulated Arc Therapy (VMAT) with flattening filter-free (FFF) on a VarianTM TrueBeamSTx, 27 Gy in a single fraction. At the 3-month follow-up visit, the tumor showed an exudative retinal detachment which was treated with an intravitreal injection of bevacizumab. At the 5-month follow-up visit slit lamp examination showed cataract, and iris rubeosis. The tumor demonstrated slight regression from 15 mm to 12 mm in thickness. After 17 months from the treatment the lesion was greatly reduced from 12 mm to 5 mm in thickness. Regular systemic assessments including abdominal ultrasound and chest RX were performed and patient was healthy with no signs of systemic metastatic disease. Although rare patients with oculocutaneous albinism may develop uveal melanoma and stereotactic radiotherapy can represent a valid alternative treatment in jumbo melanoma.","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Rai, M. Morley, Pema Zangmo, Thukten Tshering, Abi N. Khatiwara, P. Bernstein, T. Maddess
Purpose: To describe the pattern of vitreoretinal surgeries performed in Bhutan. This first national study informs policy making and resource development. Method s: We reviewed the surgical registers of the three hospitals in Bhutan providing VR operations or interventional procedures for VR diseases over three years. Patient demography, indications and types of vitreoretinal surgeries were logged and quantified. Comparisons of the expected and observed frequency used Chi-squared tests. Results : A total of 214 patients received vitreoretinal surgeries, 36 paediatric cases received examination under anaesthesia for diagnostic confirmation followed by vitreoretinal surgery or retinal laser. Additionally, 381 cases received intravitreal anti-vascular endothelial growth factor injections in the operating theatres as mandated in Bhutan. The mean age was 56.2 ± 22.3 years. The majority, 375 cases (59.4%) were males (p<0.001). The common indications for VR surgery were retinal detachment (45.1%), vitreous haemorrhage (13.6%), and macular hole (7.7%). Retinal detachment surgery was the most common surgery performed, followed by silicon oil removal with cataract surgery. The common indications for anti-vascular endothelial growth factor injection were neovascular age-related macular degeneration (168 cases, 44.12%), retinal vein occlusion (132 cases, 34.6%), and diabetic macular oedema and retinopathy (50 cases, 13.1%). Conclusion : Performing high-tech vitreoretinal surgeries in a resource-limited setting is challenging. With an ever-increasing load of vitreoretinal diseases such as retinal detachment, age-related macular degeneration and macular hole, and the complications of systemic diseases such as retinal vein occlusion, vitreous haemorrhage, and diabetic macular oedema and retinopathy, there is a need to improve vitreoretinal services in Bhutan.
{"title":"Surgical management of vitreoretinal diseases in Bhutan: A 3-year national study","authors":"B. Rai, M. Morley, Pema Zangmo, Thukten Tshering, Abi N. Khatiwara, P. Bernstein, T. Maddess","doi":"10.15761/NFO.1000251","DOIUrl":"https://doi.org/10.15761/NFO.1000251","url":null,"abstract":"Purpose: To describe the pattern of vitreoretinal surgeries performed in Bhutan. This first national study informs policy making and resource development. Method s: We reviewed the surgical registers of the three hospitals in Bhutan providing VR operations or interventional procedures for VR diseases over three years. Patient demography, indications and types of vitreoretinal surgeries were logged and quantified. Comparisons of the expected and observed frequency used Chi-squared tests. Results : A total of 214 patients received vitreoretinal surgeries, 36 paediatric cases received examination under anaesthesia for diagnostic confirmation followed by vitreoretinal surgery or retinal laser. Additionally, 381 cases received intravitreal anti-vascular endothelial growth factor injections in the operating theatres as mandated in Bhutan. The mean age was 56.2 ± 22.3 years. The majority, 375 cases (59.4%) were males (p<0.001). The common indications for VR surgery were retinal detachment (45.1%), vitreous haemorrhage (13.6%), and macular hole (7.7%). Retinal detachment surgery was the most common surgery performed, followed by silicon oil removal with cataract surgery. The common indications for anti-vascular endothelial growth factor injection were neovascular age-related macular degeneration (168 cases, 44.12%), retinal vein occlusion (132 cases, 34.6%), and diabetic macular oedema and retinopathy (50 cases, 13.1%). Conclusion : Performing high-tech vitreoretinal surgeries in a resource-limited setting is challenging. With an ever-increasing load of vitreoretinal diseases such as retinal detachment, age-related macular degeneration and macular hole, and the complications of systemic diseases such as retinal vein occlusion, vitreous haemorrhage, and diabetic macular oedema and retinopathy, there is a need to improve vitreoretinal services in Bhutan.","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adenosine triphosphate (ATP) prevents protein aggregation. The crystalline lens, although a metabolically quiescent organ, synthesizes a large amount of ATP, ca. 3 mM [1], that exceeds by an order-of-magnitude the concentration required for all the known intracellular functions of ATP, combined. This high intralenticular ATP concentration is shared by many species including humans [2,3]. The production of such an excessive amount of ATP is inconsistent with the usual conservative production of ATP assumed to be operant in nature, which brings into question why such a high concentration of ATP exists in the lens.
{"title":"Implications of the hydrotropic function of intralenticular ATP in cataractogenesis and presbyopiogenesis","authors":"J. Greiner, T. Glonek","doi":"10.15761/NFO.1000247","DOIUrl":"https://doi.org/10.15761/NFO.1000247","url":null,"abstract":"Adenosine triphosphate (ATP) prevents protein aggregation. The crystalline lens, although a metabolically quiescent organ, synthesizes a large amount of ATP, ca. 3 mM [1], that exceeds by an order-of-magnitude the concentration required for all the known intracellular functions of ATP, combined. This high intralenticular ATP concentration is shared by many species including humans [2,3]. The production of such an excessive amount of ATP is inconsistent with the usual conservative production of ATP assumed to be operant in nature, which brings into question why such a high concentration of ATP exists in the lens.","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nganga Ngabou Charles Géraud Fredy, M. Chantal, Adiba Fene Samuel, Kambourou Judicaël, Onka Vissimy
We evaluated refractive disorders in Albino children of Brazzaville and assessed their impact on the visual acuity of these children. Patients and method: Our study was conducted at the University Hospital of Brazzaville in October 2018 as part of a special program of the Congolese Association of Albinos aimed at providing glasses free of charge to albino children. This was a cross-sectional study of 32 children with oculocutaneous albinism. All children received a complete ophthalmological examination. Ametropia was measured by cycloplegic autorefraction performed approximately 45-60 minutes after topical instillation of 3 drops of 1% cyclopentolate administered 5 minutes apart. Results: All children had nystagmus, including 2 cases with strabismus (6.25%). All children had astigmatism, 56.25% of whom were hypermetropic. The mean corrected visual acuity in the better eye was 0.18+/-0.14. The Mean uncorrected visual acuity in the better eye was 0.33+/-0.15. The improvement in visual acuity after correction was statistically significant P=0.002. Conclusion: Albinism is associated with a variety of ocular anomalies including ametropia. Hypermetropic astigmatism was the most common refractive error identified in our series. Correction of this ametropia results in a statistically significant improvement in visual acuity. Introduction Albinism is a group of inherited disorders that are characterized by a reduction or absence of melanin pigment in tissues, in conjunction with ocular and visual pathway developmental abnormalities. The most characteristic manifestation of albinism is related to hypopigmentation in the visual system and/or the skin and teguments. This lack of production of melanin is associated with specific changes in the eye such as foveal hypoplasia and misrouting of optic fibres from the retina to the visual cortex [1]. These changes explain the low visual acuity that presents from birth. In addition, albinism is also associated with refractive disorders and reduced visual acuity [2]. The purpose of this study is to determine the refractive disorders in children of Albino Brazzaville and to appreciate their impact on the visual acuity of these children. Patients and methods Patients Our study was conducted at the University Hospital of Brazzaville in October 2018 as part of a special program of the Congolese Association of Albinos aimed at providing glasses free of charge to albino children. Method This was a cross-sectional study of 32 children with oculocutaneous albinism. All the selected children benefited from a complete ophthalmological examination. We used the best subjective corrected *Correspondence to: Nganga Ngabou Charles Géraud Fredy, Department of Ophthalmology, University Hospital of Brazzaville, Brazzaville, Republic of Congo, E-mail: fredygeraud@gmail.com
我们评估了布拉柴维尔白化儿童的屈光性疾病，并评估了它们对这些儿童视力的影响。患者和方法:我们的研究于2018年10月在布拉柴维尔大学医院进行，作为刚果白化病协会的一个特别项目的一部分，该项目旨在为白化病儿童免费提供眼镜。这是一项对32名患有眼皮肤白化病的儿童的横断面研究。所有儿童都接受了完整的眼科检查。在局部滴注3滴1%环戊酸盐5分钟后，通过睫状体麻痹性自折射测量屈光不全。结果:所有患儿均有眼球震颤，其中斜视2例(6.25%)。所有患儿均有散光，其中56.25%为远视。正常眼的平均矫正视力为0.18±0.14。正常眼的平均未矫正视力为0.33±0.15。矫正后视力改善P=0.002，差异有统计学意义。结论:白化病与包括屈光不正在内的多种眼部异常有关。远视散光是本系列中最常见的屈光不正。这种屈光不正的矫正结果在统计上显著改善视力。白化病是一组遗传性疾病，其特征是组织中黑色素减少或缺乏，并伴有眼部和视觉通路发育异常。白化病最典型的表现与视觉系统和/或皮肤和外绒毛的色素沉着有关。黑色素生成的缺乏与眼睛的特定变化有关，如中央凹发育不全和从视网膜到视觉皮层的纤维路径错误。这些变化解释了从出生开始就表现出的低视力。此外，白化病还与屈光障碍和视力下降有关。本研究的目的是确定布拉柴维尔白化病儿童的屈光障碍，并了解其对这些儿童视力的影响。我们的研究于2018年10月在布拉柴维尔大学医院进行，作为刚果白化病协会的一个特别项目的一部分，该项目旨在为白化病儿童免费提供眼镜。方法对32例皮肤白化病患儿进行横断面研究。所有入选的儿童都接受了全面的眼科检查。通讯:Nganga Ngabou Charles g raud Fredy，刚果共和国布拉柴维尔大学医院眼科，E-mail: fredygeraud@gmail.com
{"title":"Refractive errors in albino children in Brazzaville","authors":"Nganga Ngabou Charles Géraud Fredy, M. Chantal, Adiba Fene Samuel, Kambourou Judicaël, Onka Vissimy","doi":"10.15761/nfo.1000229","DOIUrl":"https://doi.org/10.15761/nfo.1000229","url":null,"abstract":"We evaluated refractive disorders in Albino children of Brazzaville and assessed their impact on the visual acuity of these children. Patients and method: Our study was conducted at the University Hospital of Brazzaville in October 2018 as part of a special program of the Congolese Association of Albinos aimed at providing glasses free of charge to albino children. This was a cross-sectional study of 32 children with oculocutaneous albinism. All children received a complete ophthalmological examination. Ametropia was measured by cycloplegic autorefraction performed approximately 45-60 minutes after topical instillation of 3 drops of 1% cyclopentolate administered 5 minutes apart. Results: All children had nystagmus, including 2 cases with strabismus (6.25%). All children had astigmatism, 56.25% of whom were hypermetropic. The mean corrected visual acuity in the better eye was 0.18+/-0.14. The Mean uncorrected visual acuity in the better eye was 0.33+/-0.15. The improvement in visual acuity after correction was statistically significant P=0.002. Conclusion: Albinism is associated with a variety of ocular anomalies including ametropia. Hypermetropic astigmatism was the most common refractive error identified in our series. Correction of this ametropia results in a statistically significant improvement in visual acuity. Introduction Albinism is a group of inherited disorders that are characterized by a reduction or absence of melanin pigment in tissues, in conjunction with ocular and visual pathway developmental abnormalities. The most characteristic manifestation of albinism is related to hypopigmentation in the visual system and/or the skin and teguments. This lack of production of melanin is associated with specific changes in the eye such as foveal hypoplasia and misrouting of optic fibres from the retina to the visual cortex [1]. These changes explain the low visual acuity that presents from birth. In addition, albinism is also associated with refractive disorders and reduced visual acuity [2]. The purpose of this study is to determine the refractive disorders in children of Albino Brazzaville and to appreciate their impact on the visual acuity of these children. Patients and methods Patients Our study was conducted at the University Hospital of Brazzaville in October 2018 as part of a special program of the Congolese Association of Albinos aimed at providing glasses free of charge to albino children. Method This was a cross-sectional study of 32 children with oculocutaneous albinism. All the selected children benefited from a complete ophthalmological examination. We used the best subjective corrected *Correspondence to: Nganga Ngabou Charles Géraud Fredy, Department of Ophthalmology, University Hospital of Brazzaville, Brazzaville, Republic of Congo, E-mail: fredygeraud@gmail.com","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The nasolacrimal duct laceration are involved in 30% of all lacrimal system injuries. Nasolacrimal duct lacerations can be the result of blunt trauma. Nasolacrimal ducts may also become obstructed by indirect trauma as an after effect of nasolacrimal laceration and facial and orbital bone fractures. The patient with nasolacrimal injuries may present with significant concurrent facial wounds, and multiple system injuries. In this is with deep facial laceration after a The laceration extended from medial canthus region, anterior lacrimal crest to infraorbital region of midface nasolacrimal duct laceration was the minimally crest The epidemiology, the most important principles of surgical repair of nasolacrimal duct, special techniques of reconstructive surgery. She received primary micro reconstructive repair with silicone tubing and the extended from medial nasal canthus region with local patient did not
{"title":"Nasolacrimal Duct Laceration","authors":"Ariunbold Tumenjargal, Y. Chu","doi":"10.15761/nfo.1000240","DOIUrl":"https://doi.org/10.15761/nfo.1000240","url":null,"abstract":"The nasolacrimal duct laceration are involved in 30% of all lacrimal system injuries. Nasolacrimal duct lacerations can be the result of blunt trauma. Nasolacrimal ducts may also become obstructed by indirect trauma as an after effect of nasolacrimal laceration and facial and orbital bone fractures. The patient with nasolacrimal injuries may present with significant concurrent facial wounds, and multiple system injuries. In this is with deep facial laceration after a The laceration extended from medial canthus region, anterior lacrimal crest to infraorbital region of midface nasolacrimal duct laceration was the minimally crest The epidemiology, the most important principles of surgical repair of nasolacrimal duct, special techniques of reconstructive surgery. She received primary micro reconstructive repair with silicone tubing and the extended from medial nasal canthus region with local patient did not","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Rotsos, Konstantinos Andreanos, A. Sideri, I. Georgalas, K. Droutsas, D. Brouzas, D. Papaconstantinou
We present a case of scleromalacia perforans in an 80-year-old woman. Her vision has deteriorated over the last two years due to progressive astigmatism induced by sclerocorneal thinning. Introduction Scleromalacia perforans is a rare entity (4% of scleritis) that is commonly seen in patients with rheumatoid arthritis with extraarticular presentation, especially women [1]. It is characterized by a non-inflammatory, often bilateral progressive scleral thinning which can lead to a lack of scleral tissue revealing bare uvea. It has also been described in a number of collagen and vasculitic disorders such as Wegener’s granulomatosis [1], Bechet disease [2] and ankylosing spondylitis [3]. Case report We present an 80-year-old woman with no previous systemic pathology, presented with bilateral progressive visual loss over the last two years. Her last ophthalmological examination was after uneventful cataract surgery in both eyes, two years ago. No serious pathology was recorded, and her uncorrected visual acuity was 20/25 in both eyes. During our examination, visual acuity was count fingers in both eyes which would improve to 20/40 with -5.00cyl x 100° in the right eye and -5.00cyl x 110° in the left eye. Slit lamp examination revealed nasal and temporal scleral thinning with uveal show under a thin conjunctival layer (Figure 1A). Moreover, corneal thinning was observed in both the temporal and nasal limbus (Figure 1B) along with the presence of horizontal corneal striae extending throughout the cornea (Figure 1C). Anterior Segment Optical Coherence Tomography confirmed the absence of scleral tissue and the diagnosis of scleromalacia perforans (Figure 1D). The patient was referred for systemic evaluation in which rheumatoid arthritis was diagnosed. Conclusion Scleromalacia perforans is a severe eye disorder with insidious onset, slow progression [1,2]. Visual loss can occur due to progressive high astigmatism, cataract, glaucoma or globe rupture (usually following trauma) [1,2]. No therapy has yet proven efficient and patients *Correspondence to: Tryfon Rotsos, 15 Alkmanos street, Athens, Greece, 11528; Tel: +306974727279; E-mail: tryfonrotsos@hotmail.com
{"title":"High astigmatism induced by scleromalacia perforans","authors":"T. Rotsos, Konstantinos Andreanos, A. Sideri, I. Georgalas, K. Droutsas, D. Brouzas, D. Papaconstantinou","doi":"10.15761/nfo.1000225","DOIUrl":"https://doi.org/10.15761/nfo.1000225","url":null,"abstract":"We present a case of scleromalacia perforans in an 80-year-old woman. Her vision has deteriorated over the last two years due to progressive astigmatism induced by sclerocorneal thinning. Introduction Scleromalacia perforans is a rare entity (4% of scleritis) that is commonly seen in patients with rheumatoid arthritis with extraarticular presentation, especially women [1]. It is characterized by a non-inflammatory, often bilateral progressive scleral thinning which can lead to a lack of scleral tissue revealing bare uvea. It has also been described in a number of collagen and vasculitic disorders such as Wegener’s granulomatosis [1], Bechet disease [2] and ankylosing spondylitis [3]. Case report We present an 80-year-old woman with no previous systemic pathology, presented with bilateral progressive visual loss over the last two years. Her last ophthalmological examination was after uneventful cataract surgery in both eyes, two years ago. No serious pathology was recorded, and her uncorrected visual acuity was 20/25 in both eyes. During our examination, visual acuity was count fingers in both eyes which would improve to 20/40 with -5.00cyl x 100° in the right eye and -5.00cyl x 110° in the left eye. Slit lamp examination revealed nasal and temporal scleral thinning with uveal show under a thin conjunctival layer (Figure 1A). Moreover, corneal thinning was observed in both the temporal and nasal limbus (Figure 1B) along with the presence of horizontal corneal striae extending throughout the cornea (Figure 1C). Anterior Segment Optical Coherence Tomography confirmed the absence of scleral tissue and the diagnosis of scleromalacia perforans (Figure 1D). The patient was referred for systemic evaluation in which rheumatoid arthritis was diagnosed. Conclusion Scleromalacia perforans is a severe eye disorder with insidious onset, slow progression [1,2]. Visual loss can occur due to progressive high astigmatism, cataract, glaucoma or globe rupture (usually following trauma) [1,2]. No therapy has yet proven efficient and patients *Correspondence to: Tryfon Rotsos, 15 Alkmanos street, Athens, Greece, 11528; Tel: +306974727279; E-mail: tryfonrotsos@hotmail.com","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Saccà, A. Pulliero, S. Maestra, M. Geretto, A. Profumo, O. Ilderbayev, C. Rosano, A. Izzotti
Background: Glaucoma is caused by pro-apoptotic signals targeting retinal ganglion cells. In the high-pressure glaucoma, the source of these signals is the progressive degeneration of the trabecular meshwork. The first pathogenic event affecting this tissue is oxidative damage. Accordingly, the use of anti-oxidant to counteract glaucoma pathogenic cascade is a rationale strategy to be explored. In this paper we evaluate the ability of eyedrops containing high dose of polyphenols, hyaluronic acid and fatty acids to protect trabecular meshwork from oxidative stress. Methods: Human Trabecular meshwork endothelial cells were exposed in vitro to hydrogen peroxide either in presence or absence of eyedrops containing high dose of polyphenols. Ex-vivo experiments were performed in calf eye to evaluate the ability of eyedrops to cross cornea either alone or complexed with lipid nanoparticles. The tolerability of eyedrops was tested in vivo in rabbit eye. Results: Polyphenol enriched eyedrops were highly safe when used alone not altering viability, mitochondrial function and DNA integrity of trabecular meshwork cells. Eyedrops was effective in protecting trabecular meshwork cells from oxidative stress. These characteristics were not modified when eyedrops was carried by lipid nanoparticles. In calf eye polyphenolic eyedrops were able to cross cornea, an effect counteracted by the complexation with lipid nanoparticles. In vivo in rabbit eye, eyedrops were well tolerated and persisted for 20 min on outer corneal surface, a time is increased up to 16 h by complexation with nanoparticles. Conclusions: Polyphenolic eyedrops are safe and able to protect trabecular meshwork cells from oxidative stress. Abbreviations: POAG: Primary Open Angle Glaucoma; TM: Trabecular Meshwork; NP: Lipid Nanoparticles; HDPE: High Dose Polyphenols Extract, SDPE: Standard Dose Polyphenols Extract.
{"title":"Protection of trabecular meshwork cells by eyedrops containing high concentration of polyphenols","authors":"S. Saccà, A. Pulliero, S. Maestra, M. Geretto, A. Profumo, O. Ilderbayev, C. Rosano, A. Izzotti","doi":"10.15761/NFO.1000228","DOIUrl":"https://doi.org/10.15761/NFO.1000228","url":null,"abstract":"Background: Glaucoma is caused by pro-apoptotic signals targeting retinal ganglion cells. In the high-pressure glaucoma, the source of these signals is the progressive degeneration of the trabecular meshwork. The first pathogenic event affecting this tissue is oxidative damage. Accordingly, the use of anti-oxidant to counteract glaucoma pathogenic cascade is a rationale strategy to be explored. In this paper we evaluate the ability of eyedrops containing high dose of polyphenols, hyaluronic acid and fatty acids to protect trabecular meshwork from oxidative stress. Methods: Human Trabecular meshwork endothelial cells were exposed in vitro to hydrogen peroxide either in presence or absence of eyedrops containing high dose of polyphenols. Ex-vivo experiments were performed in calf eye to evaluate the ability of eyedrops to cross cornea either alone or complexed with lipid nanoparticles. The tolerability of eyedrops was tested in vivo in rabbit eye. Results: Polyphenol enriched eyedrops were highly safe when used alone not altering viability, mitochondrial function and DNA integrity of trabecular meshwork cells. Eyedrops was effective in protecting trabecular meshwork cells from oxidative stress. These characteristics were not modified when eyedrops was carried by lipid nanoparticles. In calf eye polyphenolic eyedrops were able to cross cornea, an effect counteracted by the complexation with lipid nanoparticles. In vivo in rabbit eye, eyedrops were well tolerated and persisted for 20 min on outer corneal surface, a time is increased up to 16 h by complexation with nanoparticles. Conclusions: Polyphenolic eyedrops are safe and able to protect trabecular meshwork cells from oxidative stress. Abbreviations: POAG: Primary Open Angle Glaucoma; TM: Trabecular Meshwork; NP: Lipid Nanoparticles; HDPE: High Dose Polyphenols Extract, SDPE: Standard Dose Polyphenols Extract.","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique able to show real-time volumetric data on chorioretinal vasculature. The most commonly used angiographic techniques in visualizing vascular changes are fluorescein (FA) or indocyanine green angiography (ICGA). Dye-based techniques require intravenous dye injection which can cause side effects. The physician has the responsibility to decide which diagnostic instrument is more appropriate. Legal implications are due to the side effects of dye injection. OCTA test can be performed without side effects.
{"title":"Optical coherence tomography angiography versus fluorescein or indocyanine green angiography: legal implications for ophthalmologists","authors":"G. Gioia, M. Salducci","doi":"10.15761/nfo.1000232","DOIUrl":"https://doi.org/10.15761/nfo.1000232","url":null,"abstract":"Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique able to show real-time volumetric data on chorioretinal vasculature. The most commonly used angiographic techniques in visualizing vascular changes are fluorescein (FA) or indocyanine green angiography (ICGA). Dye-based techniques require intravenous dye injection which can cause side effects. The physician has the responsibility to decide which diagnostic instrument is more appropriate. Legal implications are due to the side effects of dye injection. OCTA test can be performed without side effects.","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The world’s first clinical trial using induced pluripotent stem cell sheets for corneal epithelial stem cell deficiency is underway. Elsewhere, we have analysed the protocol and argued it basically ethical. Main points for debates: We raise three ethical points. First, the new therapy should demonstrate greater therapeutic effects when compared with other treatment methods. Second, cost is a potential barrier to widespread adoption. Third, the shortage of eye donors in Japan raises ethical concerns of fairness, as Japan relies on donors in other countries Conclusion: While there are many issues to be debated and addressed for this new eye therapy, we believe the ophthalmology field will assume moral leadership in the pursuit of iPSC clinical research. Background On December 26, 2018, the review committee of Osaka University, Japan, granted conditional approval for a clinical trial to transplant corneal cell sheets from induced pluripotent stem cells (iPSC) in patients with corneal epithelial stem cell deficiency [1]. We previously objected to the protocol in a separate iPSC transplantation study for heart failure patients as ethically impermissible [2]. However, the protocol in the latest corneal trials appears to meet ethical standards very well. It appears to be fully reliable in its handling of adverse events (rejection or tumorigenicity), as transplanted corneal sheets can be easily removed. Since the new study is already underway, an ethical discussion is even more critical. Main points for debates Below, we raise three points for debate for this up and coming therapy. First, the potential benefits of the study seem to warrant the risk to which research subjects are exposed. The question of whether iPSC sheet grafts can truly surpass allogeneic donated eye transplants or amniotic membranes in quality and therapeutic effects warrants rigorous scientific assessment. The subjects in this transplant study are patients with corneal epithelial stem cell deficiency. Some ophthalmology specialists note that in other cornea diseases, endothelial dysfunction is particularly salient. iPSC sheets replace mainly the epithelium. On the other hand, amniotic membrane demonstrates a record of effectiveness within certain parameters. Demonstrating greater therapeutic effects will be key to adding another future option to cornea transplant methods. *Correspondence to: Akira Akabayashi, Department of Biomedical Ethics, School of Public Health, University of Tokyo Graduate School of Medicine, Tokyo, Japan, E-Mail: akirasan-tky@umin.ac.jp
{"title":"The world’s first clinical trial using iPS cell sheets for corneal epithelial stem cell deficiency","authors":"A. Akabayashi, E. Nakazawa, Nancy S. Jecker","doi":"10.15761/nfo.1000234","DOIUrl":"https://doi.org/10.15761/nfo.1000234","url":null,"abstract":"Background: The world’s first clinical trial using induced pluripotent stem cell sheets for corneal epithelial stem cell deficiency is underway. Elsewhere, we have analysed the protocol and argued it basically ethical. Main points for debates: We raise three ethical points. First, the new therapy should demonstrate greater therapeutic effects when compared with other treatment methods. Second, cost is a potential barrier to widespread adoption. Third, the shortage of eye donors in Japan raises ethical concerns of fairness, as Japan relies on donors in other countries Conclusion: While there are many issues to be debated and addressed for this new eye therapy, we believe the ophthalmology field will assume moral leadership in the pursuit of iPSC clinical research. Background On December 26, 2018, the review committee of Osaka University, Japan, granted conditional approval for a clinical trial to transplant corneal cell sheets from induced pluripotent stem cells (iPSC) in patients with corneal epithelial stem cell deficiency [1]. We previously objected to the protocol in a separate iPSC transplantation study for heart failure patients as ethically impermissible [2]. However, the protocol in the latest corneal trials appears to meet ethical standards very well. It appears to be fully reliable in its handling of adverse events (rejection or tumorigenicity), as transplanted corneal sheets can be easily removed. Since the new study is already underway, an ethical discussion is even more critical. Main points for debates Below, we raise three points for debate for this up and coming therapy. First, the potential benefits of the study seem to warrant the risk to which research subjects are exposed. The question of whether iPSC sheet grafts can truly surpass allogeneic donated eye transplants or amniotic membranes in quality and therapeutic effects warrants rigorous scientific assessment. The subjects in this transplant study are patients with corneal epithelial stem cell deficiency. Some ophthalmology specialists note that in other cornea diseases, endothelial dysfunction is particularly salient. iPSC sheets replace mainly the epithelium. On the other hand, amniotic membrane demonstrates a record of effectiveness within certain parameters. Demonstrating greater therapeutic effects will be key to adding another future option to cornea transplant methods. *Correspondence to: Akira Akabayashi, Department of Biomedical Ethics, School of Public Health, University of Tokyo Graduate School of Medicine, Tokyo, Japan, E-Mail: akirasan-tky@umin.ac.jp","PeriodicalId":91933,"journal":{"name":"New frontiers in ophthalmology (London)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67500395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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