Publications by authors named "Chrysanthos Symeonidis"

52 Publications

Peripapillary Choroidal Neovascular Membrane Secondary to Sarcoidosis-Related Panuveitis: Treatment with Aflibercept and Ranibizumab with a 50-month Follow-Up.

Case Rep Ophthalmol 2021 Jan-Apr;12(1):186-192. Epub 2021 Apr 12.

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

A case of peripapillary choroidal neovascular membrane (PCNM) secondary to sarcoidosis-related panuveitis successfully treated with anti-vascular endothelial growth factor (anti-VEGF) agents and systemic immunomodulatory therapy is reported. Diagnosis and follow-up were based on fundoscopic, optical coherence tomography as well as fluorescein angiography findings. A 45-year-old female patient presented with sudden onset bilateral blurring of vision. Fundoscopy revealed bilateral granulomatous panuveitis with solitary peripheral granuloma in the right eye and PCNM in the left eye. Diagnostic work-up including conjunctival biopsy confirmed the diagnosis of sarcoidosis. Topical and systemic corticosteroids controlled the inflammation. Within 4 weeks, PCNM showed rapid enlargement (best-corrected visual acuity [BCVA]: 6/60) with foveal involvement. Monthly intravitreal aflibercept injections and systemic methotrexate were administered. After 5 aflibercept injections, anatomical and functional improvement was noted (BCVA: 6/6). Due to aflibercept unavailability, further treatment included ranibizumab injections. During a 50-month follow-up period, every anti-VEGF injection was followed by total NV regression and 6/6 BCVA. Both aflibercept and ranibizumab appear to be effective in the treatment of PCNM secondary to sarcoidosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000512579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077472PMC
April 2021

An Unusual Case of Perineural Infiltration and Orbital Invasion of Squamous Cell Carcinoma Associated with Actinic Keratosis.

Case Rep Ophthalmol Med 2020 30;2020:8831668. Epub 2020 Dec 30.

Fondation Ophtalmologique Adolphe de Rotschild, 29 Rue Manin, 75019 Paris, France.

Actinic keratosis is considered a precancerous lesion, constituting a precursor to squamous cell carcinoma (SCC) formation. Perineural invasion has been observed in patients with cutaneous carcinoma due to local subcutaneous tissue destruction and primarily involves the trigeminal nerve due to rich innervation provided by the supraorbital nerve in addition to the facial nerve. An unusual case of perineural infiltration and orbital invasion of squamous cell carcinoma associated with actinic keratosis is presented. A 70-year-old Caucasian woman presented with complete left eye ophthalmoplegia, total left upper-eyelid ptosis, and facial pain with paresthesia. Computed tomography revealed a process of the soft tissues in the left cheek infiltrating the infraorbital canal, pterygopalatine fossa, inferior orbital fissure, and left cavernous sinus with periosteal adherence. Magnetic resonance imaging revealed pathological extension via the left infraorbital canal with a considerable area of necrosis. Treatment of facial actinic keratosis may not prevent malignant transformation and can delay diagnosis and treatment of SCC. A deep biopsy appears to be essential for a correct diagnosis. Perineural spread of cutaneous SCC may be characterized by insidious progression in the cranial trigeminal nerve, abnormal ocular motility, diplopia, or external ophthalmoplegia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/8831668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787826PMC
December 2020

The Acute Effects of Electronic Cigarette Vaping and Tobacco Cigarette Smoking on Choroidal Thickness in Young, Healthy, Habitual, Dual Smokers.

Toxics 2020 Oct 11;8(4). Epub 2020 Oct 11.

Department of Ophthalmology, Medical School, University of Patras, 26504 Patras, Greece.

The present study aims to evaluate and compare the acute effects of tobacco cigarettes (TC) smoking and electronic cigarette (EC) vaping on foveal and choroidal thickness (CT) in young, healthy, dual smokers. Participants underwent four trials: 5 min TC; 5 min EC; 30 min EC; and 60 min nothing (sham trial). Scans before and immediately after each trial were obtained using spectral domain optical coherence tomography with the enhanced depth imaging mode. Changes in central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and CT at fourother points, 500 μm and 1000 μm temporally and nasally to the fovea, were measured. Forty-seven participants (33 male, 14 female; mean age 24.85 ± 1.57 years) were included. They smoked 13.53 ± 5.27 TCs/day for 6 ± 2.3 years and vaped ECs for the past 2.4 ± 1.08 years. We did not observe any statistically significant change in SFCT, CFT, and CT of the other points after any of the fourtrials. The acute changes in CFT and CT after EC vaping or TC smoking did not differ significantly compared to the sham trial. Smoking and vaping does not seem to result in statistically significant acute alterations in foveal and CT in young, dual smokers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/toxics8040085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712466PMC
October 2020

Ophthalmology Training in Greece as Perceived by Resident Ophthalmologists in the Times of Crisis: A National, Questionnaire-based Survey.

J Curr Ophthalmol 2020 Jan-Mar;32(1):88-93. Epub 2020 Mar 23.

2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece.

Purpose: To assess the level of perceived satisfaction with the current level of ophthalmology training in Greece from the perspective of residents and to identify deficiencies in the training curriculum.

Methods: This is a prospective, cross-sectional questionnaire-based study. An online, semi-structured questionnaire was designed to evaluate ophthalmology residents' extent of satisfaction with the quality of their postgraduate medical training. The survey was divided in two parts: demographics and evaluation of training. Resident ophthalmologists in all teaching hospitals in Greece were contacted and encouraged to complete it.

Results: A response rate of 53.8% was achieved. Two out of three participants stated their disappointment with the quality of training they received and deemed the four-year residency training program as insufficient. Surgical training was also viewed as unsatisfactory by the majority of the respondents. An interest in subspecialty training, as well as a significant participation in research activities, was noted.

Conclusions: Both training and overall satisfaction with working conditions must be improved to preserve the appeal of ophthalmology for young academics. A new, structured curriculum, reduction of unnecessary bureaucracy, and improved surgical training rank among the most essential priorities in order to improve postgraduate ophthalmology training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joco.2019.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265267PMC
March 2020

Comparison of Chemokine CXCL-1 and Interleukin-6 Concentrations in the Subretinal Fluid and Vitreous in Rhegmatogenous Retinal Detachment.

Ocul Immunol Inflamm 2021 Feb 29;29(2):355-361. Epub 2019 Oct 29.

2 Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Macedonia, Greece.

: Comparison of IL-6 and CXCL-1 concentrations and CXCL-1/IL-6 ratio correlations with clinical parameters (RRD extent, duration, and proliferative vitreoretinopathy - PVR-grade) between subretinal fluid (SRF) and vitreous during rhegmatogenous retinal detachment (RRD) complicated with PVR.: A total of 71 eyes of 71 patients with primary RRD possibly complicated with PVR were included; 36 eyes treated with scleral buckling and 35 eyes with pars-plana vitrectomy. Enzyme-Linked Immuno-sorbent Assay was employed for CXCL-1/IL-6 measurement (ng/ml).: Correlation analysis between mean CXCL-1/IL-6 ratio and clinical parameters revealed non-significant results. CXCL-1/IL-6 ratio was significantly elevated in phakic eye vitreous. Optimum circumstances for elevated chemokine levels during RRD were considerable extent (2-3-quadrant) and duration (29-60-day) complicated with PVR C.: SRF appears to be characterized by greater chemokine concentrations while vitreous retains several structural characteristics that may assist in investigating inflammation and improving understanding of underlying pathophysiological mechanisms during RRD complicated with PVR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2019.1672197DOI Listing
February 2021

Bilateral identical intervals between phacoemulsification procedures performed 23 years before retinal detachment.

Oman J Ophthalmol 2018 Sep-Dec;11(3):274-276

2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, 564 03 Thessaloniki, Macedonia, Greece.

We aim to present a case of bilateral rhegmatogenous retinal detachment (RRD) after successful phacoemulsification procedures performed 23 years before RRD onset and surgical management. A 57-year-old female presented with blurred vision due to floaters in the left eye. The patient was followed up with dilated fundus examination. The patient underwent bilateral uneventful cataract extraction 23 years before the baseline visit with the use of phacoemulsification. Dilated fundus examination revealed RRD in the left eye that was managed with a 25G pars plana vitrectomy, cryopexy, and 16% C3F8 expandable gas. Thirty-three days following the procedure in the left eye, the patient presented with RRD in the right eye. Management included a 25G pars plana vitrectomy with cryopexy and 20% SF6 expandable gas. Phacoemulsification ultrasound energy appears to bring about changes in the peripheral vitreous and retina that may manifest several decades following uncomplicated cataract extraction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ojo.OJO_238_2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219343PMC
December 2018

Caseous calcification of the mitral valve annulus: a rare cause of bilateral cerebral and ocular embolisation.

BMJ Case Rep 2018 Jul 18;2018. Epub 2018 Jul 18.

Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece.

A 65-year-old woman presented with sudden bilateral visual loss of recent onset. She was recently diagnosed with multiple acute stroke syndrome for which she was commenced on antiplatelet therapy. Funduscopic examination revealed bilateral inferotemporal retinal artery occlusions. The recent history of multiple cerebral infarcts combined with the current ocular findings prompted a transoesophageal echocardiogram which successfully revealed caseous calcification of the mitral valve annulus as the source of the numerous sequential emboli, a finding which the conventional transthoracic echocardiogram had failed to disclose as a result of suboptimal image quality. Transoesophageal echocardiography should always be considered as part of the diagnostic workup of retinal arterial occlusive disease, particularly in bilateral lesions, due to its higher yield in identifying posteriorly located cardiac valvular and aortic lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2018-224322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058109PMC
July 2018

Amblyopia due to intermediate uveitis as the presenting symptom of Crohn's disease in a 6-year-old boy.

J AAPOS 2017 Dec 2;21(6):512-514. Epub 2017 Nov 2.

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Macedonia, Greece.

A 6-year-old boy presented with unexplained unilateral low visual acuity. Best-corrected visual acuity was counting fingers in the right eye and 20/20 in the left eye. Fundus examination of the right eye revealed intermediate uveitis, with moderate vitritis, snowballs, and snowbanking. Infectious and noninfectious conditions known to be associated with intermediate uveitis were excluded. Vitreous inflammation gradually resolved with oral steroids, and amblyopia treatment with left eye patching was advised. Several months later the boy suffered acute monoarthritis and episodes of mucopurulent diarrhea; a terminal ileum biopsy was consistent with Crohn's disease. This case of Crohn's disease and uveitis is unusual in that ocular inflammation preceded intestinal involvement, with the atypical feature of chronic intermediate uveitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2017.07.218DOI Listing
December 2017

Decreased hyaluronan concentration during primary rhegmatogenous retinal detachment.

Eur J Ophthalmol 2016 Nov 13;26(6):633-638. Epub 2016 May 13.

2 Department of Ophthalmology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki - Greece.

Purpose: To evaluate the concentration and molecular weight of hyaluronan (HA) polysaccharides as well as hyaluronidase activity in patients with rhegmatogenous retinal detachment (RRD).

Methods: Twenty vitreous samples from 20 patients with RRD and 19 samples from 19 patients with idiopathic epiretinal membrane, macular hole, or vitreomacular traction syndrome were collected during surgical management with pars plana vitrectomy. The molecular weight of various HA fragments was assessed using agarose gel electrophoresis. Enzyme-linked immunosorbent assay was employed for the measurement of HA (in μg/mL). Hyaluronidase activity was evaluated using substrate (HA) sodium dodecyl sulfate polyacrylamide gel electrophoresis.

Results: Agarose gel electrophoresis showed that the vitreous of the control group contained HA of high molecular mass, in contrast with the patient group. Mean HA concentration in the patient group was 50.96 μg/mL and differed significantly from that of the control group, which was 271.81 μg/mL (p<0.0005). Hyaluronidase activity was significantly higher in the vitreous of patients with RRD (p = 0.037).

Conclusions: The vitreous of patients with RRD is characterized by decreased HA concentration compared to controls of the same age and sex and shows higher hyaluronidase catalytic activity. Hyaluronan degradation could be associated with specific vitreous alterations that potentially contribute to retinal break formation and consequently detachment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/ejo.5000802DOI Listing
November 2016

A Focus on the Epidemiology of Uveitis.

Ocul Immunol Inflamm 2018 28;26(1):2-16. Epub 2016 Jul 28.

a Department of Ophthalmology , University of Thessaly , Larissa , Greece.

Purpose: Uveitis is a common, sight-threatening inflammatory ocular disease and includes multiple heterogeneous clinical entities. The prevalence of various types of uveitis depends upon multiple factors, such as age, sex, race, geographic distribution, environmental influence, genetics, and social habits. Epidemiologic research of uveitis is necessary to understand the etiology and immunopathogenesis of this group of diseases. The present study attempts to concentrate on the most recent information on the epidemiology of uveitis and compare it with previous knowledge.

Methods: An extensive literature search was performed in the Medline database (PubMed) and included surveys completed until 2015. Articles that reported prevalence and incidence were studied. References cited in the articles were also studied.

Results: The incidence and prevalence of uveitis differs based on age, anatomic location of the inflammatory process (anterior, intermediate, posterior uveitis, panuveitis), gender, histopathology (granulomatous, non-granulomatous), type of inflammatory process (acute, chronic, recurrent), and etiology (infectious, non-infectious). Prevalence differs by geographic location. Idiopathic anterior uveitis is the most common form of uveitis in the community. Infectious causes are common (30-60%) in the developing countries. Herpes and toxoplasmosis are the leading infectious causes of uveitis. Non-infectious uveitic conditions are generally more common in the developed world. An increase in the prevalence of infectious etiologies, including tuberculosis and syphilis, has been seen in developed countries. Introduction of new treatment options has also changed patterns of disease.

Conclusions: Introduction of new uveitis entities, changes in the incidence of already known disease and increased availability of diagnostic testing have all altered the epidemiology of uveitis in recent years. Knowledge of regional patterns of disease is essential. A more detailed classification of uveitis with the establishment of uniform diagnostic criteria and prospective population based studies would certainly benefit epidemiologic research and clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2016.1196713DOI Listing
August 2018

SUTURELESS CLEAR CORNEAL ULTRASONIC FRAGMENTATION FOR RETAINED LENS FRAGMENTS: A Pilot Study.

Retina 2017 Mar;37(3):494-499

*Second Department of Ophthalmology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece; and †Department of Ophthalmology, University of Thessaly, Larissa, Greece.

Purpose: To describe the safety and efficacy of removing posteriorly dislocated lens fragments with the use of intravitreal ultrasonic fragmentation through a limbal, clear cornea self-sealing incision.

Methods: Patients presenting with posteriorly luxated nuclei were enrolled in this prospective case series. Preoperative examination included evaluation of the corneal endothelium by means of specular microscopy. A 3-port 25+ pars plana vitrectomy was initially performed. Following vitrectomy, sclerotomies were sealed using scleral plugs and a limbal/clear corneal incision was performed for the insertion of the fragmatome probe. The incision was slightly larger (1 mm) than the diameter of the fragmatome probe (20 gauge = 0.81 mm) to avoid wound overheating. At the end of the procedure, an appropriate intraocular lens either sulcus-fixated or angle-supported was implanted. Primary outcome measures were mean postoperative best-corrected visual acuity, intraoperative or postoperative complications, and intraoperative challenging features.

Results: In all eyes, fragmentation was completed successfully with a mean total ultrasound time of 113.4 seconds. Nucleus density was ≥3 in all cases (mean ± SD = 3.8 ± 0.4). Intraoperative challenges included viewing difficulties because of corneal distortion, fragment turbulence, and leakage through the limbal incision potentially compromising fundus visualization. There was statistically nonsignificant reduction in endothelial cell density ranging between 1932 ± 187 cells per square millimeter preoperatively to 1789 ± 213 cells per square millimeter at the first month postoperatively (P = 0.79).

Conclusion: Clear corneal, sutureless ultrasonic fragmentation seems to be a novel, safe, and efficient method for the removal of hard posteriorly dislocated lens fragments, sparing the need for a 20-gauge scleral port.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0000000000001197DOI Listing
March 2017

Guidelines for the Management of Wet Age-Related Macular Degeneration: Recommendations from a Panel of Greek Experts.

Adv Ther 2016 05 26;33(5):715-26. Epub 2016 Apr 26.

Department of Ophthalmology, University of Crete, Heraklion, Greece.

Purpose: To propose guidelines for the management of patients with wet age-related macular degeneration (wAMD), taking into account the results of large multicenter studies and clinical experience of retina experts.

Method: A team of retina experts developed a consensus paper after three consecutive meetings. The group was focused on guidelines to help clinical decision-making around the definition of successful treatment and the definition of non-response to therapy.

Results: Parameters suggestive of a successful response to treatments included: any gain in best corrected visual acuity (BCVA) or vision loss that is less than 5-10 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, reduction of central retinal thickness, partial or complete absorption of subretinal fluid (SRF), reduction of intraretinal fluid, reduction of pigment epithelial detachment or restoration of the anatomy of outer retinal layers. Non-response to current treatment was considered in the case of loss of BCVA greater than 10 ETDRS letters, increased retinal edema or increase of SRF as evidenced by optical coherence tomography or new bleeding in biomicroscopy.

Conclusion: The introduction of anti-VEGF agents revolutionized the treatment of wAMD. Given the complexity of the disease, the emerging new agents and the difference of cases recruited in clinical trials compared to those appearing in every-day practice, it is essential to individualize treatment options taking into account the results of clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12325-016-0332-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882369PMC
May 2016

Free-Floating Iris Pigmented Epithelial Cyst in the Anterior Chamber.

Case Rep Ophthalmol Med 2016 21;2016:4731037. Epub 2016 Jan 21.

Department of Ophthalmology, General Hospital "G. Gennimatas", Mesogeion Avenue 158, 156 69 Athens, Greece.

An unusual case of a free-floating peripheral pigmented cyst in the anterior chamber is presented. A 30-year-old Caucasian male presented reporting a visual defect on his right eye in prone position over the past year. Slit-lamp examination revealed a small pigmented free-floating peripheral iris cyst at the 6 o'clock position in the anterior chamber. Ultrasound biomicroscopy revealed an unfixed epithelial pigmented cyst with an extremely thin wall and no internal reflectivity. Due to the lack of severity of visual disturbance of the patient, no surgical treatment was indicated. The patient is to be followed up annually and advised to return immediately in case of pain or any visual symptoms. Free-floating iris cysts in the anterior chamber are uncommon and remain stable in the majority of cases. Management includes only regular observation until any complications arise.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/4731037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745941PMC
February 2016

Posttraumatic Sphingomonas paucimobilis Endophthalmitis.

Case Rep Ophthalmol Med 2015 29;2015:192864. Epub 2015 Dec 29.

1st Department of Ophthalmology, University of Athens, General Hospital "G. Gennimatas", Mesogeion Avenue 158, 156 69 Athens, Greece.

A rare case of Sphingomonas paucimobilis endophthalmitis secondary to a penetrating globe injury with a retained intraocular foreign body is presented. A 30-year-old man presented with severe pain following a penetrating left eye injury. Visual acuity (VA) was 6/120. Slit-lamp examination revealed perforation of the temporal cornea and iris, hypopyon, and a fibrinous membrane covering the pupil. Ultrasonography showed dense vitreous infiltration and an orbital CT-scan confirmed the presence of a metallic foreign body in the vitreous cavity. Topical and systemic therapy were initiated. Pars-plana vitrectomy combined with phacoemulsification was performed in order to remove the foreign body; vitreous samples were acquired and Sphingomonas paucimobilis, sensitive to ceftazidime, was identified. To the best of our knowledge, this is the first report of Sphingomonas paucimobilis endophthalmitis following penetrating ocular injury. In this case, Sphingomonas paucimobilis was not resistant to antibiotics. This allowed for a good healing response following vitrectomy despite the fact that long-term retinal complications resulted in low VA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2015/192864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709607PMC
February 2016

Training of Resident Ophthalmologists in Cataract Surgery: A Comparative Study of Two Approaches.

J Ophthalmol 2015 14;2015:932043. Epub 2015 May 14.

2nd Department of Ophthalmology, Papageorgiou General Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece.

Purpose. To evaluate and compare the efficacy of two different training methods in resident-performed phacoemulsification surgery. Methods. 502 eyes of 467 patients who underwent resident-performed phacoemulsification were included in the study by reviewing their medical records. Residents were allocated into two groups according to the method applied during their training in cataract surgery; Group A included residents that were trained with the "step-by-step" method and Group B those trained with the "one-step" method. Primary outcome was the incidence of main complications, defined as posterior capsular ruptures and/or zonular dehiscence with vitreous loss. Results. Each resident performed a median of 63 phacoemulsification surgeries. A statistically significant difference (p = 0.0032) was noted in the main complications rate between the two groups, yielding a mean of 17.3% in Group A and 7.25% in Group B. Other intraoperative complications were not shown to differ statistically significantly between study groups (p > 0.05). Among the first 40 surgeries of each resident, main complications rate differed also statistically significantly (p = 0.0048) between Group A (21.67%) and Group B (8.5%), while a better surgical performance-yielding statistical significance in Group A (p = 0.017) was indicated in both groups between the 20th and the 30th procedure. Conclusions. Training in cataract surgery using the "one-step" method may lead to an improvement in surgical competency, when measured by complications rates and, therefore, to significantly better quality of training for resident ophthalmologists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2015/932043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446480PMC
June 2015

Macular edema after uncomplicated cataract surgery: a role for phacoemulsification energy and vitreoretinal interface status?

Eur J Ophthalmol 2015 May-Jun;25(3):192-7. Epub 2014 Nov 27.

Department of Ophthalmology, "424" Military Hospital of Thessaloniki, Thessaloniki - Greece.

Purpose: To study postoperative macular thickness fluctuations measured by spectral-domain optical coherence tomography (SD-OCT) and to investigate a potential correlation among macular edema (ME) incidence, cumulative dissipated energy (CDE) released during phacoemulsification, and vitreoretinal interface status.

Methods: This is a prospective, cross-sectional study of 106 cataract patients with no macular disorder who underwent phacoemulsification. Best-corrected visual acuity measurement, slit-lamp examination, OCT scans were performed preoperatively and 30 and 90 days postoperatively. The intraoperative parameters measured were CDE and total phacoemulsification time. The SD-OCT parameters assessed were central subfield thickness (CST), cube average thickness (CAT), cube macular volume, vitreoretinal interface status, and presence of cystoid or diffuse ME.

Results: Four patients (3.8%) developed subclinical ME. Regarding ME, there was no significant difference between patients with presence or absence of posterior vitreous detachment (chi-square, p = 0.57), although 75% of ME cases were observed in patients with attached posterior vitreous. With regard to comparison between eyes with and without subclinical CME incidence, CDE (p = 0.05), phacoemulsification time (p = 0.001), CST at month 1 (p = 0.002), cube macular volume at month 1 (p = 0.039), and CAT at month 1 (p = 0.050) were significantly higher in the subclinical CME group.

Conclusions: This study provides evidence that OCT macular thickness parameters increase significantly at first and third month postoperatively and that the incidence of pseudophakic ME can be affected by CDE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/ejo.5000536DOI Listing
July 2015

Contribution of integrated teaching in the improvement of an undergraduate ophthalmology curriculum.

Adv Med Educ Pract 2014 19;5:433-7. Epub 2014 Nov 19.

2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece.

Purpose: Conventional medical curriculum is the rule of medical teaching in Greek Medical Schools. Medical students are often taught irrelevant details with little or no reference to their potential clinical significance. Alternatively, integrated teaching warrants that the complete teaching material is covered by each faculty member not considering areas of personal expertise. The aim of this study was to evaluate the implementation of integrated teaching in ophthalmic training.

Methods: The main outcome measures of this retrospective study were a) comments and recommendations made anonymously by the fifth-year medical students in the evaluation questionnaires filled in at the end of their training, and b) scores obtained by students in their final examination at the end of their training in the 2nd Department of Ophthalmology as part of the core Curriculum of the Medical School of the Aristotle University of Thessaloniki. The latter outcome was analyzed with respect to the implementation of integrated teaching.

Results: The score obtained by students in the final examination, which is an objective outcome measure, increased significantly after the implementation of integrated teaching. The final grade (scores out of 10) of students who were trained with the integrated system (6.17±1.67, mean ± standard deviation) was significantly higher compared to those (5.52±2.20) trained with the conventional system (P<0.001). The positive outcome of this process was evident as there was a significant increase in the number of students satisfied with the teaching process compared to previous academic years.

Conclusion: Based on the experience of eight academic years and as a result of interactive assessment process our department has modified its medical student teaching process from conventional to integrated; all teaching staff members are involved in the teaching process, while students are divided in small groups. In conclusion, integrated teaching in small student groups appears to be an efficient teaching method (for both theoretical and clinical skills) of ophthalmic training for medical students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/AMEP.S71759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241950PMC
November 2014

Significant reduction of diabetic macular edema following intravitreal ranibizumab injection in the fellow eye.

Int Ophthalmol 2014 Dec 6;34(6):1271-4. Epub 2014 Sep 6.

Department of Ophthalmology, General Hospital of Athens, Athens, Greece.

A significant therapeutic effect in the fellow eye after intravitreal ranibizumab injections was observed in a 39-year-old diabetic male. The patient was followed-up with fluorescein angiography (FA) and Optical Coherence Tomography (OCT). On referral, best-corrected visual acuity (BCVA) was 6/60 in the right eye and Counting Fingers in the left eye. FA revealed foveal leakage in both eyes. OCT revealed diabetic and cystoid macular edema (DME-CME) in both eyes. The patient was treated with two intravitreal ranibizumab injections in the left eye. BCVA was 6/15 and 6/30 one month after the last injection. OCT revealed significant improvement (DME elimination and significant CME improvement) in both eyes, despite the fact that only the left eye was treated. It is conceivable that, in this eye, chronic vascular damage was limited and a minimal quantity of ranibizumab had a positive effect on vascular permeability, resulting in DME resolution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10792-014-9921-0DOI Listing
December 2014

Total extrusion of a silicone encircling band through the muscle insertions presenting as orbital cellulitis.

Orbit 2014 Aug 15;33(4):308-10. Epub 2014 May 15.

Department of Ophthalmology, University of Athens , Athens , Greece and.

Introduction: We present an unusual case of anterior migration of a solid silicone encircling band 9 years after scleral buckling surgery.

Materials And Methods: An 83-year old woman presented with acute onset of pain and discharge in her left eye. She had undergone cataract surgery complicated by endophthalmitis and managed with pars plana vitrectomy nine years earlier.

Results: The patient was treated with transection and removal of the extruding encircling band. Pain ceased within two days. Two weeks postoperatively, the conjunctiva was well adapted without any discharge, ocular motility was as preoperatively.

Discussion: Anterior migration of an encircling band through all four rectus muscle insertions is a very uncommon late complication following scleral buckling surgery. The remarkably good preservation of ocular motility in our case can be attributed to the slow advancement of the encircling band over nine years, which allowed a gradual reattachment of the rectus muscle insertions to the sclera.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/01676830.2014.904373DOI Listing
August 2014

Comparison of interleukin-6 and matrix metalloproteinase expression in the subretinal fluid and the vitreous during proliferative vitreoretinopathy: correlations with extent, duration of RRD and PVR grade.

Cytokine 2014 Jun 29;67(2):71-6. Epub 2014 Mar 29.

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece.

Introduction: The full extent of IL-6 involvement in PVR pathophysiology has not yet been comprehensively investigated. The aim of this study was the comparison of the IL-6 effect on MMP expression between SRF and the vitreous in the context of RRD complicated by PVR.

Materials And Methods: Thirty-one SRF samples from 31 eyes of 31 consecutive patients suffering from RRD with PVR were collected during treatment by scleral buckling. Twenty-eight vitreous samples from 28 eyes of 28 RRD patients with PVR were collected during surgical management with pars plana vitrectomy (PPV). Enzyme Linked Immunosorbent Assay was employed for the measurement of MMP-1, -3, -8 and TIMP-1 concentrations (in ng/ml). MMP gelatinolytic activity was determined with the use of gelatin zymography analysis using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE).

Results: Correlation analysis in the SRF revealed a significant correlation between MMP-1/IL6 and RRD duration. Regression analysis in the SRF revealed a significant correlation between the MMP-9/IL-6 and RRD extent. In the same fluid, with respect to PVR grade, ANOVA revealed a significant relationship with the proMMP-2/IL-6, MMP-2/IL6 and TIMP-1/IL-6 ratios. Graphical representation of the results revealed that, between the SRF and vitreous groups, significant peak values were observed for all MMP/IL-6 and TIMP-1/IL-6 ratios included in this study with the exception of the MMP-2/IL-6 ratio.

Conclusions: It appears that there is a significant correlation between the presence of IL-6 and MMP/TIMP ratio in the SRF, indicating that IL-6 may contribute to the increased MMP/TIMP ratio during PVR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cyto.2014.02.012DOI Listing
June 2014

Chemokine CXCL-1 expression in the subretinal fluid during rhegmatogenous retinal detachment.

Ocul Immunol Inflamm 2014 Dec 19;22(6):449-53. Epub 2013 Dec 19.

2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital , Thessaloniki, Macedonia , Greece .

Purpose: To investigate the expression of chemokine CXCL-1 in the subretinal fluid (SRF) during rhegmatogenous retinal detachment (RRD) and identify potential correlations with number of quadrants involved and duration of the detachment.

Methods And Results: Inclusion criteria were patients aged 18 years or older and primary RRD possibly complicated by proliferative vitreoretinopathy (PVR). CXCL-1 levels were measured in 36 SRF samples from 36 RRD patients. Mean CXCL-1 levels (102 ± 37 pg/mL) were significantly higher (p = 0.050) compared to controls. CXCL-1 levels correlated significantly with age (p = 0.001) and RRD duration (p = 0.002). Maximum CXCL-1 levels coincided with total RRD, 29- to 60-day duration and PVR grade C.

Conclusions: The findings of this study may contribute to increased understanding regarding the role of CXCL-1 during the onset and progression of the wound healing process in the context of RRD and PVR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273948.2013.863942DOI Listing
December 2014

Subretinal fibrosis and uveitis: a spectral domain OCT study of its evolution and the minimal therapeutic effect of the off-label treatment with ranibizumab.

Ocul Immunol Inflamm 2014 Dec 16;22(6):497-500. Epub 2013 Oct 16.

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital , Thessaloniki, Macedonia , Greece .

Purpose: The subretinal fibrosis and uveitis (SFU) syndrome is a rare multifocal posterior uveitis characterized by progressive subretinal fibrosis and significant visual loss.

Methods: Slit-lamp examination, dilated fundoscopy, fluorescein angiography, Spectral Domain-Optical Coherence Tomography (SD-OCT) and laboratory testing were employed.

Results: A 52-year-old male presented with bilateral (best-corrected visual acuity: 2/10) visual loss. Clinical examination revealed bilateral anterior uveitis with posterior synechiae and posterior uveitis. Medical workup revealed no pathologic findings. Treatment included 1 gr intravenous prednisone followed by oral prednisone, immunosuppresive therapy and three ranibizumab injections in the right eye with no improvement. One year later, there was significant subretinal fibrosis. In the second year follow-up, the picture was slightly worse, with persisting bilateral macular edema and fibrosis.

Conclusions: This is the first SFU syndrome report monitored with SD-OCT. This novel imaging modality can localize the lesion level, guide the therapeutic approach and may prove helpful in assessing disease prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273948.2013.841959DOI Listing
December 2014

Fifteen-minute consultation: congenital nasolacrimal duct obstruction.

Arch Dis Child Educ Pract Ed 2014 Apr 23;99(2):42-7. Epub 2013 Sep 23.

IInd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, , Thessaloniki, Greece.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/archdischild-2012-303417DOI Listing
April 2014

Measurements of elastic modulus for human anterior lens capsule with atomic force microscopy: the effect of loading force.

Int Ophthalmol 2014 Jun 15;34(3):519-23. Epub 2013 Sep 15.

2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, 56429, Thessaloníki, Greece,

The purpose of the study was to appraise the effect of loading force magnitude on the determination of the elastic modulus of the anterior lens capsule through atomic force microscopy. Four human anterior lens capsules taken during phacoemulsification cataract surgery were studied, free of epithelial cells, with atomic force microscopy. For the experiment, five different indentation loading forces were applied to near areas of the specimen. Experimental data was exported and analyzed according to the Hertz model to obtain the Young's modulus with regards to the elastic behavior of the material. Force-distance curves were acquired by applying a load of 2, 5, 10, 20 and 30 nN. When examining the results it was evident that determination of Young's modulus of the anterior lens capsule is dependent on the loading force concerning the examined range. Loading forces of 10 and 20 nN led to results without significant difference (p > 0.05) and more reproducible (coefficients of variation 12.4 and 11.7 %, respectively).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10792-013-9846-zDOI Listing
June 2014

Macular hole formation in a patient with Irvine-Gass syndrome: coincidence or rare complication?

Clin Ophthalmol 2013 15;7:1437-9. Epub 2013 Jul 15.

1st Department of Ophthalmology, University of Athens, Athens, Greece.

Background: Macular edema (ME) is caused by abnormal retinal capillary permeability and has also been described as a postoperative complication of cataract surgery (Irvine-Gass syndrome).

Objective: To present a patient with Irvine-Gass syndrome in the right eye complicated with a macular hole (MH) in the same eye and possible associations between these two entities.

Case Report: A 72-year-old male with a history of uneventful bilateral cataract surgery was followed-up with biomicroscopy and optical coherence tomography (OCT). Four weeks after cataract surgery oculus dexter (OD), there was progressive visual deterioration (best corrected visual acuity [BCVA]: 0.5). OCT disclosed cystoid ME. A parabulbar triamcinolone injection, dexamethasone 0.1% and ketorolac 0.4% eye drops, both 4 times per day OD were administered. Six weeks later (BCVA OD: 0.2), OCT revealed cystoid ME and full-thickness MH.

Conclusion: ME secondary to diabetes or central retinal vein occlusion may lead to MH by inducing focal vitreomacular traction and by triggering inflammatory mechanisms which facilitate a marked thinning of the fovea. MH may occur even in cases of pseudophakic ME, representing a rare complication of Irvine-Gass syndrome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S44200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716554PMC
July 2013

Surgical outcomes in phacoemulsification after application of a risk stratification system.

Clin Ophthalmol 2013 16;7:895-9. Epub 2013 May 16.

Second Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.

Background: The purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to surgeons with matching experience may reduce intraoperative complications.

Methods: Nine hundred and fifty-three consecutive patients (1109 eyes) undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group A (n = 498 patients, 578 eyes) and group B (n = 455 patients, 531 eyes). Patients from group A were allocated to surgeons with varying experience with only a rough estimate of the complexity of their surgery. Patients from group B were assigned to three risk groups (no added risk, low risk, and moderate-high risk) according to risk factors established during their preoperative assessment and were respectively allocated to resident surgeons, low-volume surgeons, or high-volume surgeons. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group.

Results: The intraoperative complication rate was significantly lower in group B than in group A (group A, 5.88%; group B, 3.2%; P < 0.05). Patients from group B with no added risk and allocated to resident surgeons had a significantly lower rate of intraoperative complications than those from group A allocated to resident surgeons (group A, 7.2%; group B, 3.08%; P < 0.05).

Conclusion: Our study demonstrates that allocation of cataract patients to surgeons matched for experience according to a uniform and reliable preoperative assessment of their risk of complications allows for better surgical outcomes, especially for resident surgeons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S42726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663436PMC
May 2013

Matrix metalloproteinase (MMP-2, -9) and tissue inhibitor (TIMP-1, -2) activity in tear samples of pediatric type 1 diabetic patients: MMPs in tear samples from type 1 diabetes.

Graefes Arch Clin Exp Ophthalmol 2013 Mar 20;251(3):741-9. Epub 2012 Dec 20.

2nd Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki Ring Road, Thessaloniki, 564 03 Macedonia, Greece.

Background: The presence of matrix metalloproteinase (MMP-2, -9) and tissue inhibitor (TIMP-1, -2) activity in tear samples of pediatric type 1 diabetes mellitus (DM) patients and potential correlations with clinical parameters (Schirmer testing, glycosylated hemoglobin-HB(A1C)) were investigated.

Methods: Tear samples from the right eyes of 27 type 1 DM patients and 17 healthy control subjects were included in this study. The MMP gelatinolytic activity was determined by gelatin zymography analysis using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), while MMP and TIMP concentrations (in ng/ml) were quantified in tears of type 1 diabetic patients and healthy controls, with the use of enzyme-linked immunosorbent assay (ELISA).

Results: MMP-9, TIMP-1, -2 levels, MMP-9/TIMP-1, and MMP-9/TIMP-2 ratios in the patient group were significantly elevated. There was a significant correlation between TIMP-2 and HB(A1C) values, as well as between MMP-2 and MMP-9.

Conclusions: Significant correlations between TIMP-2 and HB(A1C) and between Schirmer test results and HB(A1C) were revealed. Significant increase in tear MMP and TIMP levels in pediatric type 1 diabetic patients may be suggestive of disease progression and localized pathologic remodelling. Further studies are required in order to ascertain whether MMPs and TIMPs could be employed as indicators of early disease progression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-012-2221-3DOI Listing
March 2013

New biologic-response modifiers in ocular inflammatory disease: beyond anti-TNF treatment.

Expert Rev Clin Pharmacol 2012 Sep;5(5):543-55

Department of Ophthalmology, University of Thessalia, Larissa, Greece.

Current treatment guidelines for chronic ocular inflammatory disease recommend the use of steroid-sparing agents. The development of conventional immunomodulatory agents has largely changed the visual outcome in these patients. However, disease refractory to these treatment modalities has led to the use of new biologic-response modifiers, agents that target specific components of the pathogenetic process. The purpose of this review is to summarize the mechanism of action, experimental evidence, side effects and current experience with the use of rituximab, daclizumab, abatacept, anakinra and IFN-α in ocular inflammatory disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1586/ecp.12.37DOI Listing
September 2012

Retinal vasculitis in rheumatic diseases: an unseen burden.

Clin Rheumatol 2013 Jan 6;32(1):7-13. Epub 2012 Sep 6.

Department of Ophthalmology, University of Thessalia, Larissa, Greece.

Retinal vascular inflammation, a potentially blinding condition (herein: retinal vasculitis (RV)) is commonly associated with a heterogeneous group of diseases characterized by systemic inflammatory cell infiltration and/or necrosis of blood vessel walls. RV may arise as an isolated ocular disorder, as part of systemic vasculitis (Wegener's granulomatosis and Adamantiadis-Behcet Disease), or it can be secondary to an underlying connective tissue disease (systemic lupus erythematosus, sarcoidosis, and rheumatoid arthritis), systemic infection, or malignancy. Depending on the type of RV, it can be a potentially disabling condition, in the short or long term. Early diagnosis is the key to successful treatment and better prognosis. However, early diagnosis can be difficult, because these conditions usually present with nonspecific visual symptoms for a long period before diagnostic manifestations occur. The retina should be examined in warranted patients with verified rheumatic disease, since retinal vasculitis may be asymptomatic at the beginning (peripheral retinal disease). RV can be detected clinically (often accompanied by uveitis, scleritis, or macular edema) or revealed on fluorescein fundus angiography, even if minimal signs of retinal vessel inflammation are present. RV may also represent one of the possible extra-articular manifestations of the rheumatic disease. Rheumatologists should be familiar with the ocular manifestations of these disorders, since they may not only be sight-threatening, but more importantly, could be the presenting or even the very first manifestations of active, potentially lethal systemic disease in a patient with nonspecific rheumatologic presentation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10067-012-2078-1DOI Listing
January 2013

Interleukin-6 and matrix metalloproteinase expression in the subretinal fluid during proliferative vitreoretinopathy: correlation with extent, duration of RRD and PVR grade.

Cytokine 2012 Jul 10;59(1):184-90. Epub 2012 May 10.

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece.

Purpose: To investigate interleukin (IL)-6 protein levels in the subretinal fluid (SRF) of patients with rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR); to correlate the IL-6 levels with matrix metalloproteinases (MMP)-1, -2, -3, -8, -9 and tissue inhibitor of metalloproteinases (TIMP)-1 with respect to RRD extent, duration and PVR grade.

Methods: Thirty-one SRF samples from 31 eyes of 31 patients with RRD complicated with PVR and five SRF samples from five eyes of five patients suffering from RRD not complicated with PVR were collected during treatment by scleral buckling. Enzyme-Linked Immunosorbent Assay was employed for the measurement of IL-6, MMP-1, -3, -8 and TIMP-1 levels while the enzymatic activity of MMP-2 and MMP-9 was assessed by gelatin zymography.

Results: Protein levels of IL-6 (p=0.050), MMP-1 (p=0.001), MMP-3 (p=0.005), MMP-8 (p=0.003), TIMP-1 (p=0.001) as well as enzymatic activity of proMMP-2 (p=0.001), MMP-2 (p=0.023) and MMP-9 (p=0.015), were significantly higher in the SRF of PVR patients compared to controls. IL-6 levels correlated significantly with TIMP-1 (r=0.528, p=0.035). Regarding clinical parameters of the detachment, IL-6 levels correlated with RRD extent (r=0.592, p=0.016), but not with RRD duration (p=0.857) and PVR grade (p=0.594). Regression analysis revealed positive correlations between IL-6 and MMP-2.

Conclusions: There was a significant correlation between IL-6 and TIMP-1 levels in the SRF of PVR patients. The findings of this study are in agreement with relevant studies concerning IL-6 involvement in the modulation of MMP expression and are indicative of IL-6 and MMP activity during PVR, mainly that of MMP-2 and TIMP-1.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cyto.2012.04.019DOI Listing
July 2012