Publications by authors named "Olga Makri"

53 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.
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http://dx.doi.org/10.1159/000512579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077472PMC
April 2021

Late-Onset Bilateral Choroidal Metastases from Clear Cell Renal Cell Carcinoma.

Case Rep Urol 2020 9;2020:8862203. Epub 2020 Dec 9.

Department of Ophthalmology, Medical School, University of Patras, Rio, 265 04 Patras, Greece.

Aim: To present a case of clear cell renal cell carcinoma with late-onset bilateral choroidal metastases. . A 57-year-old male patient in the Oncology Clinic complained of reduced vision in the right eye (OD) for 7 days. The patient, who was under immunotherapy with nivolumab, had been diagnosed with clear cell renal cell carcinoma in the left kidney 15 years ago that recurred in the right kidney before 2 years. Metastases in the brain, lungs, and bones had also been diagnosed. On ophthalmological examination, the visual acuity was 20/50 OD and 20/20 in the left eye (OS). Dilated fundus examination in OD revealed a single raised oval-shaped yellowish choroidal nodule infratemporally with macular involvement. A similar lesion, sparing the macula, was observed in OS. Fundus autofluorescence revealed diffuse punctate hyperautofluorescence on the lesions. Serous macular detachment was also observed in OD. A standardized A-scan ultrasound demonstrated an irregular structure of the lesions with moderate to high internal reflectivity. Based on the history and clinical and echographic characteristics, the diagnosis of bilateral choroidal metastases from renal cell carcinoma was set.

Conclusion: Choroidal metastases from the primary renal tumor are extremely rare. The time interval between primary malignancy and choroidal metastasis is reported to be 12-96 months. Bilateral choroidal metastases have been described in 9 cases. We describe a rare case where bilateral choroidal metastases were diagnosed 15 years after the initial diagnosis of clear cell renal cell carcinoma.
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http://dx.doi.org/10.1155/2020/8862203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787867PMC
December 2020

Choroidal Thickness Evaluation in a Transfusion-Dependent Beta-Thalassemia Greek Population.

Clin Ophthalmol 2020 24;14:4511-4518. Epub 2020 Dec 24.

Department of Ophthalmology, University Hospital of Patras, Patras, Greece.

Purpose: To evaluate choroidal thickness in a group of beta-thalassemia patients as assessed by enhanced depth imaging optical coherence tomography.

Patients And Methods: This single-center, observational study involved transfusion-dependent beta-thalassemia (TD-β-thal) patients and healthy controls. One eye of each participant was included in the study. Submacular and peripapillary choroidal thickness, as well as central macular thickness and retinal nerve fiber layer thickness, were evaluated.

Results: Thirty-eight TD-β-thal patients (mean age 42 ± 10.7 years) and 22 healthy controls (mean age 40.3 ± 10.2 years) were included in the study. Subfoveal choroidal thickness was 297.4 ± 74.5 μm in the patient group and 358.4 ± 71.4 μm in the control group (p=0.003). Overall, in the submacular area, the choroid was found to be significantly thinner in the beta-thalassemia population compared to controls in all evaluated points, except for the spot located 1500 μm nasally to the fovea (p=0.093). In the peripapillary area, choroidal thickness was also significantly lower in the thalassemic population compared to the controls (nasal p=0.033, temporal p=0.01, superior p=0.01), except for the inferior quadrant (p= 0.191). We did not observe statistically significant differences in the retinal nerve fiber layer thickness and the central macular thickness between the two groups (p=0.658 and p=0.276, respectively). No correlations with hemoglobin, serum ferritin or iron levels emerged. Patients with the intermediate subtype appeared to have significantly thinner choroids than the ones with thalassemia major.

Conclusion: Our findings suggest that choroidal thickness in the submacular and peripapillary area is significantly reduced in thalassemic patients, compared to healthy individuals. Choroidal thinning in beta-thalassemia possibly reflects the effect of chronic anemia and underlying hemodynamic changes on choroidal tissue.
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http://dx.doi.org/10.2147/OPTH.S285312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769196PMC
December 2020

Effect of intravitreal injection of aflibercept on cardiovascular risk parameters in patients with neovascular age related macular degeneration.

Curr Clin Pharmacol 2020 Oct 16. Epub 2020 Oct 16.

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

Objective: Systemic administration of anti-vascular endothelial growth factors (anti-VEGFs) has been associated with severe cardiovascular adverse events in oncologic patients. The purpose of this pilot study is to evaluate the short-term effect of a single intravitreal injection of aflibercept on biomarkers related to increased risk of cardiovascular disease.

Patients And Methods: Forty-seven treatment naïve patients with neovascular age related macular degeneration in one eye were enrolled in the study. The patients underwent treatment with one intravitreal injection of aflibercept in the affected eye. Laboratory biomarkers of cardiovascular disease were evaluated before the first intravitreal injection of aflibercept and at 7 and 30 days after aflibercept administration. More precisely, we evaluated the levels of homocysteine, total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol and C-reactive protein.

Results: There was not any statistically significant change in the levels of the evaluated parameters up to one month after the first intravitreal injection of aflibercept.

Conclusions: According to our study, administration of a single dose of aflibercept in eyes with neovascular age-related macular degeneration does not seem to affect the evaluated biomarkers that are related to cardiovascular disease.
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http://dx.doi.org/10.2174/1574884715666201016121934DOI Listing
October 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.
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http://dx.doi.org/10.3390/toxics8040085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712466PMC
October 2020

Isolated optic neuritis after pembrolizumab administration for non-small-cell lung carcinoma.

Int J Neurosci 2020 Oct 14:1-6. Epub 2020 Oct 14.

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

Purpose: To report a case of isolated optic neuritis associated with pembrolizumab immunotherapy for metastatic non-small cell lung carcinoma.

Case Presentation: A 76-year-old man, with a history of metastatic non-small cell lung carcinoma, presented with vision loss in his left eye for the past week. He had been treated with pembrolizumab for the underlying disease for 2 months. On presentation, best corrected visual acuity was 20/30 in the right eye and 20/200 in the left eye. Fundoscopy revealed optic nerve edema in the left eye. Visual fields examination in right eye revealed an enlarged blind spot and an extended defect in the inferior nasal quadrant. In the left eye a partial superior arcuate defect and an extended defect in the inferior hemisphere was observed. The mean deviation was -12.15 dB in the right eye and -13.70 dB in left eye. Pembrolizumab was withheld and corticosteroids were administered for a total of nine weeks, first intravenously and then slowly tapered orally, resulting in resolution of optic neuritis, restoration of visual acuity and in relative improvement in the visual field defects after 3 months. Calculated Naranjo Nomogram score was 7, indicating a 'highly probable' correlation.

Conclusions: Optic neuritis is a relatively rare immune-related adverse event after exposure to checkpoint inhibitors cancer immunotherapy. Prompt discontinuation of the offending agent and early initiation of corticosteroid therapy is the mainstay of the treatment.
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http://dx.doi.org/10.1080/00207454.2020.1831489DOI Listing
October 2020

Two-year results of intravitreal injections of aflibercept in Coats' Disease; a case report.

Retin Cases Brief Rep 2020 Jun 5. Epub 2020 Jun 5.

Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.

Purpose: To report long term results of treatment with intravitreal injections of aflibercept in a newly diagnosed case of Coats' disease.

Case Report: An 18-year-old man presented to the Retina Clinic of our Hospital complaining of blurred vision in the right eye (OD) for the past 3 months. His past medical and ocular history were unremarkable. Best corrected visual acuity (BCVA) was 20/200 OD and 20/20 in the left eye. Fundoscopy in OD revealed extensive macular edema with a circinate ring of hard exudates in the posterior pole temporally to the macula. Optical coherence tomography (OCT) demonstrated macular edema with subretinal fluid. Peripheral telangiectasias and light bulb aneurysms in the inferior temporal arcade, as well as in the nasal far periphery were found in OD in fluorescein angiography (FA), confirming the diagnosis of stage 2B Coats' disease. The left eye was normal. The original therapeutic strategy proposed was anti-VEGF injections in OD followed by laser photocoagulation. However, the patient did not consent to laser treatment and was treated with aflibercept monotherapy with 8 monthly intravitreal injections of aflibercept followed by 6 injections every 2 months for a total of 14 injections over a period of 2 years. The BCVA in OD improved to 20/25 while OCT imaging revealed significant decrease in retinal thickness with resolution of macular edema and FA demonstrated prominent regression of aneurysms and leakage.

Conclusion: To our knowledge this is the first case treated with aflibercept monotherapy, suggesting the significant role of vascular endothelial growth factor (VEGF) in vascular permeability in Coats' and supporting the rationale that anti-VEGFs are a valuable therapeutic option for Coats' disease.
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http://dx.doi.org/10.1097/ICB.0000000000001011DOI Listing
June 2020

Effect of intravitreal injection of aflibercept on blood coagulation parameters in patients with age-related macular degeneration.

Ther Adv Ophthalmol 2020 Jan-Dec;12:2515841420903929. Epub 2020 Feb 11.

Department of Hematology, University Hospital of Patras, Patras, Greece.

Purpose: Treatment with intravitreal injections of anti-vascular endothelial growth factor agents has been associated with an increased risk of arterial thromboembolic events. The aim of the present pilot study was to assess the effect of a single intravitreal injection of aflibercept on coagulation.

Methods: Treatment-naïve patients with age-related macular degeneration ( = 47), who were scheduled to undergo treatment with intravitreal injections of aflibercept, were enrolled. None of the included patients received any anticoagulation therapy or had a history of a recent arterial thromboembolic event. Blood samples were collected before the first intravitreal injection, and at 7 and 30 days after aflibercept administration. We evaluated coagulation parameters, such as platelet count and plasma fibrinogen and D-dimer levels; functional clotting parameters, such as prothrombin time, international normalized ratio, and activated partial thromboplastin time; and anticoagulant parameters, such as the levels of Proteins S and C.

Results: The levels of all of the evaluated biomarkers were within the normal range at baseline and at both the time points throughout the study. No statistically significant changes were observed in any of the measured parameters at 1 week and 1 month after aflibercept administration.

Conclusion: A single intravitreal injection of aflibercept in treatment-naïve patients with exudative age-related macular degeneration has no statistically significant effect on blood coagulation parameters for up to 1 month after aflibercept administration. Our results also provide an explorative statistical data, and further studies are required to evaluate any significant clinical effects of aflibercept on blood coagulation parameters.

Clinicaltrialsgov Id: NCT03509623.
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http://dx.doi.org/10.1177/2515841420903929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013113PMC
February 2020

Visual and anatomic outcomes of aflibercept treatment in treatment-naive patients with neovascular age-related macular degeneration; real-life data over 24 months.

Hell J Nucl Med 2019 Sep-Dec;22 Suppl 2:55-62

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

Purpose: The aim of this study is to evaluate the 2-year visual and anatomic results of treatment with intravitreal injections of aflibercept in newly diagnosed, treatment-naive patients with neovascular age-related macular degeneration in routine clinical practice of a tertiary hospital of Southwestern Greece.

Methods: In this retrospective, single-center, non-randomized case-series study we analyzed the records of 32 treatment-naive eyes of 28 patients treated with intravitreal injections of aflibercept. Patients received treatment in the Department of Ophthalmology of the University Hospital of Patras from January 2017 to August 2019. The scheduled treatment regimen included a loading dose of 3 consecutive monthly injections of aflibercept and then injections at 8-week intervals for the next 9 months followed by a treat and extend treatment during the second year. Data such as age, gender, best corrected visual acuity (BCVA) and number of injections were recorded. Spectral domain optical coherence tomography (SD-OCT) findings including presence or absence of fluid and automated central macular thickness measurement at baseline, 12 and 24 months were also recorded.

Results: The mean age of the patients (14 male, 14 female) was 78.5±7.73 years. Over a period of 12 months, and after a median number of 6 visits (range 3-10), patients received a median number of 6 intravitreal injections of aflibercept (range 3-8). Twenty eyes completed 2 years of treatment with aflibercept. Over the 2-year period patients conducted a median of 14 visits (range 9-15) and received a median number of 10 IVAs (range 6-13). The median logMAR BCVA at 12 months was significantly better compared to baseline [0.412 (range 0.046-1.097) versus 0.549 (range 0-1.301) respectively; p=0.003] while median logMAR BCVA at 24 months [0.398 (range 0.222-1.097)] did not differ significantly compared to baseline (p=0.295). The central macular thickness at baseline was 398.75±98.16 μm and decreased statistically significantly at 12 (295.81±80.48 μm) and 24 months (289.29±34.25 μm) compared to baseline (p=0.0002 and p=0.002, respectively). At baseline SD-OCT examination subretinal fluid (SRF) was present in 26 eyes (81.25%), intraretinal fluid (IRF) was present in 20 eyes (62.5%) while pigment epithelium detachment (PED) was observed in 28 eyes (87.5%) At 12 months SRF was present in 16 eyes (50%), IRF was present in 10 eyes (31.25%) while PED was observed in 23 eyes (71.88%). At 24 months examination SRF was present in 4 eyes (20%), IRF was present in 10 eyes (50%) while PED was observed in 14 eyes (70%). No serious adverse events occurred during this period.

Conclusion: Treatment with intravitreal injections of aflibercept in a real life setting resulted in a significant improvement in BCVA at 12 months and in a significant anatomic restoration throughout the 24-month follow-up.
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May 2020

Functional and anatomic results of up to 24 months aflibercept treatment for diabetic macular edema in real-life setting.

Hell J Nucl Med 2019 Sep-Dec;22 Suppl 2:47-54

Department of Ophthalmology, University of Patras, Medical School, 265 04, Patras, Greece.

Purpose: Treatment with intravitreal injections of anti-vascular endothelial growth factors, like aflibercept, has revolutionized the management of diabetic macular edema. The purpose of this study is to evaluate the 2-year results of treatment with aflibercept in newly diagnosed, treatment-naive patients with diabetic macular edema in a real-life setting in a tertiary hospital of Southwestern Greece.

Methods: In this retrospective, real-life, single-center, cohort study the records of diabetic patients were reviewed. In the study we included treatment naive eyes that started treatment with intravitreal injections of aflibercept in the Department of Ophthalmology of the University Hospital of Patras. The scheduled treatment regimen of aflibercept was based on the Summary of Product Characteristics of the product and included a loading dose of 5 monthly aflibercept injections followed by bimonthly treatment until the completion of the first year. During the second year a treat and extend treatment regimen was applied. We recorded data such as age, gender, number of visits and injections, best corrected visual acuity (BCVA) and central macular thickness (CMT) as it was evaluated by a spectral domain optical coherence tomography (SD-OCT).

Results: Thirty treatment-naive eyes of 22 patients (14 male, 8 female) received treatment with aflibercept for at least 1 year during the period between January 2017 and August 2019. The mean age of the patients was 68.64±7.35 years. Ninety percent of the patients suffered from type-II diabetes and 9% from type-I. The median time between the diagnosis of diabetic macular edema and initiation of treatment with intravitreal injections of aflibercept was 0.5 months (range 0-3 months). Median baseline logMAR BCVA was 0.398 (range 0.046-1.301). The mean CMT at baseline was 388.0±162.94μm. Over a period of 12 months, and after a mean number of 7.5±2.3 visits, patients received a mean number of 7±1.12 intravitreal injections of aflibercept. Eighteen eyes (60%) received an induction phase with 5 monthly injections according to aflibercept SPC. After 12 months the median BCVA (0.324, range 0.0-1.3) was statistically significantly better compared to baseline (p=0.024) and the CMT (295.67±70.99) was significantly lower compared to baseline (p=0.017). Eighteen eyes (60%) completed 2 years of treatment with aflibercept. Over the 2-year period patients made a mean number of 12.7±3.08 visits and received a mean number of 10.2±1.64 intravitreal injections of aflibercept. The median logMAR BCVA at 2 years (0.301, range 0-0.52) was statistically significantly better compared to baseline (p=0.013) and the CMT (293.53±65.93) was significantly lower compared to baseline (p=0.01). No serious adverse events were recorded during this period.

Conclusion: Aflibercept resulted in significant functional and anatomic improvement after 12- and 24-month treatment in diabetic macular edema eyes in a real-life setting. The majority of the eyes completed the 2-year treatment regimen of aflibercept.
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May 2020

Bacteriology and Antimicrobial Susceptibility Patterns of Childhood Acute Bacterial Conjunctivitis in Western Greece.

Med Hypothesis Discov Innov Ophthalmol 2019 1;8(4):266-271. Epub 2019 Oct 1.

Department of Pediatrics, ''Karamandaneio'' General Pediatric Hospital, Patras, Greece.

Acute bacterial conjunctivitis is a common, highly contagious infection in children and is usually treated empirically with broad spectrum topical antibiotics. In the current study we investigated bacteriology and antibiotic susceptibility patterns in childhood acute bacterial conjunctivitis in Western Greece. We conducted a retrospective analysis of presumed acute bacterial conjunctivitis cases in ''Karamandaneio'' Pediatric General Hospital of Patras, Western Greece, between February 1, 2013 and January 31, 2018. Specimens from the lower conjunctiva fornix were isolated from 191 cases and outcomes were analyzed to identify the pathogenic bacteria of acute bacterial conjunctivitis and their corresponding antibiotic susceptibility patterns. Patients were divided into 3 groups; Group A included neonates under 28 days of life, Group B children from 1 month to 2 years and Group C from 2 years to 14 years. Results revealed that spp., spp. and spp. were the most prevalent pathogens. No significant differences in isolated pathogens were found between the age groups. Antibiotic resistance rates were higher against ampicillin, ceftriaxone, ceftazidime and sulfamethoxazole. Resistance rates to Ciprofloxacin were low while none of the evaluated isolates were resistant to vancomycin. We concluded that predominant pathogens of childhood acute bacterial conjunctivitis in Western Greece were spp., spp. and spp. Continuous surveillance, focused in distinct geographic areas, is encouraged to prepare more precise protocols of empirical treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778672PMC
October 2019

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

Effect of a single session of micropulse laser trabeculoplasty on corneal endothelial parameters.

Clin Exp Optom 2020 07 16;103(4):479-483. Epub 2019 Oct 16.

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

Background: To evaluate the effect of a single session of micropulse laser trabeculoplasty on the cornea in eyes with primary open-angle glaucoma and pseudoexfoliation glaucoma.

Methods: This single-centre, prospective, case series enrolled patients with primary open-angle and pseudoexfoliation glaucoma under treatment with glaucoma agents that required additional intraocular pressure reduction. Eyes underwent 360 degrees treatment with 532 nm micropulse laser trabeculoplasty. Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-efficient of variation of endothelial cells were measured before micropulse laser trabeculoplasty and at one, three and six months after treatment.

Results: Twenty eyes of 20 patients (mean age 67.6 ± 8.0 years) with primary open-angle glaucoma and 18 eyes of 18 patients (mean age 71.44 ± 6.43 years) with pseudoexfoliation glaucoma were included in the study. Treatment with micropulse laser trabeculoplasty resulted in statistically significantly lower intraocular pressure compared to baseline in both primary open-angle and pseudoexfoliation glaucoma eyes (p < 0.0001 at both comparisons). Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-efficient of variation of the endothelial cell size showed no significant change between baseline and six months after micropulse laser trabeculoplasty in both primary open-angle and pseudoexfoliation glaucoma eyes.

Conclusion: A single session of micropulse laser trabeculoplasty did not affect central corneal thickness and corneal endothelium parameters in eyes with primary open-angle and pseudoexfoliation glaucoma.
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http://dx.doi.org/10.1111/cxo.12968DOI Listing
July 2020

Expression and Localization of Glycosaminoglycans/Proteoglycan in Pterygium: An Immunohistochemical Study.

Med Hypothesis Discov Innov Ophthalmol 2019 ;8(1):39-43

Biochemistry Laboratory, Department of Chemistry, University of Patras, Greece.

Pterygium is a triangle-shaped fibrovascular hyperplasia of the bulbar conjunctiva on the cornea. The purpose of this study was to analyze Proteoglycans (PGs) by Immunohistochemistry (IHC) in pterygium tissues and to compare the results with normal conjunctiva. Twenty-four patients (14 males) undergoing primary pterygium excision and 17 healthy individuals (10 males), undergoing extracapsular cataract surgery, were included. Pterygium tissues and normal conjunctiva tissues were surgically removed. The tissue sections were fixed in 2% paraformaldehyde and incubated with monoclonal antibodies against PGs anti-mouse IgG. Immunohistochemical study showed stronger expression of keratan sulfate in the stroma of the pterygium compared to normal conjunctiva. An increased expression of heparan sulfate was observed in the epithelial layer and around the pterygium vessels. On the other hand, dermatan sulfate showed an increased expression and localization not only in the sub-epithelial area of the pterygium and normal conjunctiva, yet throughout the stroma of the pterygium. The differences in the expression and localization of the studied extracellular matrix proteoglycans in the pterygium tissue compared to normal conjunctiva may explain the tissue hyperplasia, structure, and the functional properties in pterygium.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433205PMC
January 2019

Comparison of intraocular pressure using Goldmann applanation tonometry versus non-contact tonometry in eyes with high-viscosity silicone oil.

Eur J Ophthalmol 2020 May 4;30(3):494-499. Epub 2019 Mar 4.

Department of Ophthalmology, School of Medicine, University of Patras, Rio, Greece.

Background: To compare intraocular pressure (IOP) measurements using Goldmann applanation tonometer (GAT) and air tonometer (non-contact tonometry [NT]) in vitrectomized eyes with high-viscosity silicone oil tamponade, as well as in normal eyes.

Patients And Methods: In this prospective comparative study, 32 eyes with silicone oil tamponade of high viscosity (5700 CS) and 32 normal fellow eyes were included. IOP was measured by GAT and air tonometer 30 ± 12 days after vitrectomy, while measurements of central corneal thickness (CCT) were also obtained.

Results: In eyes with silicone oil, IOP was 20.09 ± 4.91 mmHg and 16.75 ± 3.86 mmHg using contact tonometer and air tonometer, respectively ( < 0.0001). In normal eyes, IOP was 16.41 ± 2.15 mmHg and 16.31 ± 2.49 mmHg using the same tonometry techniques and this difference was not statistically significant ( = 0.598). In addition, no significant correlation was detected between IOP measurements using both techniques and age, gender, CCT, and type of lens.

Conclusions: It seems that GAT overestimates IOP in eyes with high-viscosity silicone oil compared with NT, while both IOP measurement techniques in normal eyes provide similar values. Further assessment of available IOP measurement methods could possibly establish the most accurate technique for IOP estimation in vitrectomized eyes with silicone oil tamponade.
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http://dx.doi.org/10.1177/1120672119833556DOI Listing
May 2020

Age-related aqueous humor (AH) and lens epithelial cell/capsule protein carbonylation and AH protein concentration in cataract patients who have pseudoexfoliative diseases.

Mol Vis 2018 31;24:890-901. Epub 2018 Dec 31.

Department of Biology, University of Patras, Patras, Greece.

Purpose: The aim of this study is to investigate the age-correlation of oxidative stress (OS, assessed by the accumulative OS damage marker protein carbonyls) in aqueous humour (AH; together with protein concentration) and lens epithelial cells plus capsule (LECs/capsule) in patients with cataract (CAT), and also suffering from pseudoexfoliation syndrome (PEX), primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).

Methods: AH samples from 78 male/female patients (21, 20, 19 and 18 with CAT, PEX, PXG, and POAG, respectively), and LECs/capsule samples from 104 male/female patients (34, 32, 18, and 20 with CAT, PEX, PXG and POAG, respectively) were collected during phacoemulsification CAT surgery. Average protein carbonyl concentrations were measured in patients grouped in 5-year age intervals (ranging from 56-60 to 86-90). The non-overlapping age ranges and numbers of the tested subjects did not allow comparative follow up studies for the tested diseases.

Results: There is an age-dependent increase of protein carbonyls in AH (nmol mg protein and ml), and in the order CAT
Conclusions: The present study shows for the first time an age-increased OS-induced protein damage (protein carbonyl formation) in the AH and LECs/capsule of CAT patients with PEX, POAG or PXG. The slow rate of change of protein carbonyls strongly suggests a long-term implication of OS in ocular disease pathogenesis. Additionally, protein concentration levels in the AH of CAT patients increase independently of age, and in same as with protein carbonyls increasing order levels for CAT
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334981PMC
May 2019

Analgesic Effect of a Single Drop of Nepafenac 0.3% on Pain Associated with Intravitreal Injections: A Randomized Clinical Trial.

J Ocul Pharmacol Ther 2019 04 28;35(3):168-173. Epub 2019 Jan 28.

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

Purpose: To evaluate the analgesic effect of nepafenac 0.3% in patients undergoing intravitreal injections (IVI) of antivascular endothelial growth factors.

Methods: This is a single-center, prospective, randomized, blinded, triple-arm, placebo-controlled interventional study. Patients were randomized into 3 Groups. Group 1 (n = 33) received nepafenac 0.1%, Group 2 (n = 32) received nepafenac 0.3%, and Group 3 (n = 31) received placebo 40 min before IVI. Using the short form of the McGill Pain Questionnaire (SF-MPQ), pain intensity was assessed with the visual analog scale (VAS), the Main Component of the SF-MPQ, and the present pain intensity (PPI) scores immediately and 6 h postinjection.

Results: Immediately after IVI, the VAS pain score was statistically significantly lower in patients treated with nepafenac 0.1% and 0.3%, compared with placebo (P < 0.001 and P = 0.001, respectively). The PPI scores were statistically significantly lower when nepafenac 0.1% or 0.3% was instilled compared with placebo (P = 0.01 and P < 0.0001, respectively). The Main Component of the SF-MPQ scores were statistically significantly lower after nepafenac 0.1% and 0.3% administration compared with placebo (P = 0.001 and P < 0.001, respectively). Six hours post-IVI the nepafenac 0.3% demonstrated statistically significantly higher analgesic effect compared with nepafenac 0.1% and placebo as this was indicated by the VAS pain score (P = 0.013 and P < 0.00001, respectively) and by the PPI score (P = 0.01 and P < 0.00001, respectively).

Conclusions: A single instillation of nepafenac 0.1% or 0.3% before IVI could effectively alleviate the IVI-related pain. The 0.3% formula exerts its analgesic effect more intensively at 6 h after the IVI.
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http://dx.doi.org/10.1089/jop.2018.0113DOI Listing
April 2019

Dexamethasone implant for immunogammopathy maculopathy associated with IgA multiple myeloma.

Ther Adv Ophthalmol 2019 Jan-Dec;11:2515841418820441. Epub 2019 Jan 8.

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

Background: We describe a case where hyperviscosity retinopathy and immunogammopathy maculopathy were the presenting features of IgA multiple myeloma and report the response of maculopathy to intravitreal injection of dexamethasone implants.

Case Presentation: A 56-year-old man presented at the Department of Ophthalmology with the chief complain of reduced vision for the past 10 days in both eyes. Ophthalmic examination revealed central retinal vein occlusion resembling signs with severe macular edema in both eyes with prominent serous macular detachment. After comprehensive evaluation, an IgA type kappa multiple myeloma was diagnosed complicated with hyperviscosity-associated retinopathy and immunogammopathy maculopathy. Patient was treated with multiple sessions of plasmapheresis, systemic chemotherapy, and finally intravitreal implants of dexamethasone with complete restoration of macular edema and serous macular detachment in both eyes. The visual function and the hyperviscosity-associated retinopathy were partially restored.

Conclusion: Ocular manifestation might be the only presenting sign of a life-threatening disease such as IgA multiple myeloma. A high level of suspicion is required to diagnose and treat such cases promptly and effectively.
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http://dx.doi.org/10.1177/2515841418820441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329023PMC
January 2019

Brinzolamide-brimonidine fixed combination for the prevention of intraocular pressure elevation after phacoemulsification.

Eur J Ophthalmol 2020 Mar 10;30(2):293-298. Epub 2018 Dec 10.

Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece.

Aim: To evaluate the effectiveness of brinzolamide-brimonidine fixed combination to control the intraocular pressure elevation throughout the first 24 h following uncomplicated phacoemulsification cataract surgery.

Patients And Methods: A total of 62 patients who underwent phacoemulsification cataract surgery were included in this prospective randomized comparative case series. The brinzolamide-brimonidine fixed combination group (34 eyes) was administered a single dose of brinzolamide-brimonidine fixed combination immediately after phacoemulsification. No treatment was administered in the control group (28 eyes). Intraocular pressure was measured 1 day before surgery (baseline) and at 6, 12 and 24 h postoperatively.

Results: The brinzolamide-brimonidine fixed combination group had significantly lower intraocular pressure at 6, 12 and 24 h after phacoemulsification compared to baseline (p < 0.0001 for all comparisons), while in control group, intraocular pressure was significantly higher at 6 and 12 h after surgery compared to baseline (p < 0.001 and p < 0.0001, respectively). In control group, an intraocular pressure elevation ⩾ 5 mm Hg was noted in 32.4% of the eyes at 6 and 12 h and in 5.9% of eyes at 24 h after surgery, while in brinzolamide-brimonidine fixed combination group, only 8.8% of the eyes at 6 h postoperatively had such an intraocular pressure elevation.

Conclusion: The administration of a single drop of brinzolamide-brimonidine fixed combination effectively prevented intraocular pressure elevations and intraocular pressure spikes during the first 24 h after uneventful phacoemulsification.
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http://dx.doi.org/10.1177/1120672118817997DOI Listing
March 2020

Micropulse laser trabeculoplasty on pseuodexfoliation glaucoma patients under topical prostaglandin analogue monotherapy: 1-year results.

Graefes Arch Clin Exp Ophthalmol 2019 Feb 28;257(2):349-355. Epub 2018 Nov 28.

Department of Ophthalmology, University of Patras, Medical School, 265 04, Patras, Greece.

Purpose: To evaluate the effectiveness of a single session of micropulse laser trabeculoplasty (MLT) to lower intraocular pressure (IOP) in patients with pseudoexfoliation glaucoma (PEXG).

Methods: In this single-center, one-arm, prospective study patients with PEXG under prostaglandine analogue monotherapy with inadequate IOP control were treated with 360° 532-nm MLT. Patients were evaluated at 1 day, 1 month, 3 months, 6 months, and 12 months post-MLT while they were treated with the same drug regimen as pre-MLT. Mean IOP reduction and percentage of IOP change during the follow-up were calculated. Cases that required any further intervention, like additional hypotensive medication, laser or surgical therapy, throughout the study period were considered failures and removed from the study.

Results: Twenty-seven eyes (27 patients, 17 male) were included in the study. The age of the patients was 72.37 ± 6.29 years and the baseline IOP was 20.41 ± 1.87 mmHg. Treatment with MLT resulted in significantly lower IOP at 1, 3, 6, and 12 months after MLT compared to baseline (p < 0.0001 for all comparisons). By the end of the study, 52.17% of the PEXG eyes demonstrated a ≥ 20% IOP reduction compared to baseline. Four eyes (14.81%) did not respond to MLT (three eyes at 3 months and one eye at 6 months after trabeculoplasty) and were considered failures since they required additional intervention.

Conclusions: Micropulse laser trabeculoplasty appears to be an effective method to lower IOP in patients with PEXG up to 12 month of follow-up period.

Trial Registration: The study is registered on www.ClinicalTrials.gov with registration number NCT03483402.
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http://dx.doi.org/10.1007/s00417-018-4195-2DOI Listing
February 2019

Intravitreal aflibercept for choroidal neovascularization secondary to angioid streaks in a non-responder to intravitreal ranibizumab.

Int Med Case Rep J 2018 18;11:229-231. Epub 2018 Sep 18.

Department of Ophthalmology, University of Patras, Patras, Greece,

Purpose: To report the 12-month outcomes of a patient switching from intravitreal ranibizumab to aflibercept for choroidal neovascularization (CNV) associated with angioid streaks (AS).

Results: A 42-year-old Caucasian female with CNV associated with AS underwent intensive treatment with ranibizumab without significant functional or anatomic change. Treatment was then switched to aflibercept and the patient received the proposed age-related macular degeneration treatment regimen. After 3 loading doses of aflibercept, best-corrected visual acuity (BCVA) improved from 3/10 to 6/10, while optical coherence tomography (OCT) demonstrated resolution of the subretinal fluid with a reduction of the intraretinal fluid. After 12 months and 7 intravitreal injections of aflibercept, BCVA returned to 3/10, while OCT had demonstrated further morphologic improvement.

Conclusion: Our case shows that aflibercept may be an alternative treatment for advanced cases of CNV associated with AS that respond insufficiently to ranibizumab injections. Prospective studies are required to further evaluate the effect of aflibercept and to propose a standardized treatment protocol for this entity.
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http://dx.doi.org/10.2147/IMCRJ.S166473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149836PMC
September 2018

Pattern dystrophies in patients treated with deferoxamine: report of two cases and review of the literature.

BMC Ophthalmol 2018 Sep 12;18(1):246. Epub 2018 Sep 12.

Department of Ophthalmology, Medical School, University of Patras, 265 04, Patras, Greece.

Background: Deferoxamine (DFO) is one of the most commonly used chelation treatments for transfusional hemosiderosis. Pattern dystrophies constitute a distinct entity of retinal disorders that has been occasionally identified in association with deferoxamine.

Case Presentation: We report two cases of bilateral macular pattern dystrophy in transfusion dependent patients undergoing chronic chelation therapy with deferoxamine due to thalassemias. Our patients were evaluated with multimodal imaging and the results are presented. Both patients had normal cone and rod responses in the full-field electroretinogram and continued the prescribed chelation therapy, after hematology consult. The patients were followed up every 3 months for 2 and 4 years respectively for possible deterioration. Their best corrected visual acuity remained stable with no anatomic change on Optical Coherence Tomography findings.

Conclusion: Multimodal imaging of our patients allowed a better evaluation and possibly earlier detection of the DFO-related changes. Screening and close follow up of patients under chronic chelating therapy is important in order to promptly diagnose and manage possible toxicity either with discontinuation of the offending agent or dose modification.
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http://dx.doi.org/10.1186/s12886-018-0911-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134579PMC
September 2018

An eye for azithromycin: review of the literature.

Ther Adv Ophthalmol 2018 Jan-Dec;10:2515841418783622. Epub 2018 Jul 30.

Department of General Pharmacology, School of Medicine, University of Patras, Patras, Greece.

Azithromycin is used widely in clinical practice and recently it is available in topical solution for ophthalmic use. The purpose of the current publication is to summarize the newest information on azithromycin's clinical usefulness over ocular diseases. A PubMed (National Library of Medicine) and a ScienceDirect search was conducted using the key phrases 'azithromycin', 'meibomian', 'blepharitis', 'trachoma', 'toxoplasmosis' from 2010 to 2017. Articles were limited to articles published in English or at least having an English abstract. There were no restrictions on age, ethnicity, or geographic locations of patients. Topical azithromycin was found effective and safe in various ocular surface infections, in meibomian gland dysfunction and in trachoma. Also, it may substitute fluoroquinolones in corneal UV cross-linking. The World Health Organization targets for trachoma elimination are being reached only after 3 years of annual mass drug administration. Oral azithromycin can participate in combination regiments for toxoplasmosis, mainly because of its very good safety profile and may play a significant role in toxoplasmosis in pregnancy. Azithromycin is one of the safest antibiotics, well tolerated, and with special pharmacokinetic properties. Also, it is characterized by a broad antimicrobial spectrum. Azithromycin is efficacious for the treatment of a lot of ocular diseases and may be included as monotherapy or in combination therapy in new treatment protocols for more ocular infections. However, more research is needed to determine this.
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http://dx.doi.org/10.1177/2515841418783622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066808PMC
July 2018

Christmas tree cataract and myotonic dystrophy type 1.

Eye (Lond) 2018 11 9;32(11):1794-1795. Epub 2018 Jul 9.

Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece.

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http://dx.doi.org/10.1038/s41433-018-0161-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224496PMC
November 2018

Cystoid Macular Edema Due to Accidental Latanoprost Overdose After Uncomplicated Phacoemulsification.

Curr Drug Saf 2018 ;13(3):208-210

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

Objective: We present an interesting case of accidental overdose of latanoprost eye drops.

Case Report: A 71-year-old patient underwent an uncomplicated cataract surgery in his right eye. During the first postsurgical week he mistakenly used latanoprost eye drops six times daily instead of the prescribed tobramycin/dexamethasone eye drops. The patient experienced gradually decreasing visual acuity and was diagnosed with cystoid macular edema seven weeks after surgery. The cystoid macular edema resolved 4 weeks later after treatment with nepafenac 0.3% eye drops and oral acetazolamide. The cystoid macular edema recurred 2 weeks after rechallenge with latanoprost. The rechallenge-induced cystoid macular edema once again resolved after cessation of latanoprost and retreatment with nepafenac eye drops. A Naranjo assessment score of 7 was obtained, indicating a probable relationship between the patient's symptoms and the suspect drug.
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http://dx.doi.org/10.2174/1574886313666180619163845DOI Listing
January 2019

The fine art of pseudoexfoliation.

Indian J Ophthalmol 2018 06;66(6):852

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

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http://dx.doi.org/10.4103/ijo.IJO_227_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989514PMC
June 2018

Analgesic Effect of Topical Nepafenac 0.1% on Pain Related to Intravitreal Injections: A Randomized Crossover Study.

Curr Eye Res 2018 08 16;43(8):1061-1064. Epub 2018 Apr 16.

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

Purpose: To evaluate the analgesic effect of nepafenac 0.1%, a topical non-steroidal anti-inflammatory agent, in patients undergoing treatment with intravitreal injections (IVIs).

Material And Methods: It is a single center, prospective, randomized, double-blinded, placebo-controlled, crossover interventional study. Fifty-two patients scheduled to undergo IVI of anti-vascular endothelial growth factors were included in the study. Patients were randomized in a 1:1 ratio to receive topical nepafenac 0.1% or placebo 1 h before subsequent IVIs. Using the short form of the McGill Pain Questionnaire (SF-MPQ), pain intensity was assessed with the Visual Analogue Scale (VAS), the Main Component of the SF-MPQ (MC-SF-MPQ), and the Present Pain Intensity (PPI) scores immediately and 6-h post-injection.

Results: The VAS pain score was statistically significant lower immediately and 6-h post-IVI in patients treated with nepafenac (p = 0.001 and < 0.001, respectively). The MC-SF-MPQ scores were also statistically significant lower after nepafenac administration at both time points (p < 0.001). Finally, the PPI score was statistically significant lower when nepafenac was instilled before IVI (p = 0.015 immediately and p < 0.001 at 6-h post-injection).

Conclusions: A single drop of nepafenac 0.1% before IVI could effectively alleviate the IVI-related pain immediately and up to 6 h after the injection.
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http://dx.doi.org/10.1080/02713683.2018.1461908DOI Listing
August 2018

The Effect of Ranibizumab on Normal Neurosensory Retina in the Eyes of Patients with Exudative Age Related Macular Degeneration.

Open Ophthalmol J 2017 29;11:368-376. Epub 2017 Dec 29.

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

Background: Anti-vascular endothelial growth factors have become the mainstay treatment for neovascular age related macular degeneration. Prolonged suppression of vascular endothelial growth factor raises concerns as it may result in harmful effects on retina.

Objective: The purpose of this retrospective chart review is to evaluate the 1-year effect of treatment with intravitreal injections of ranibizumab on normal neurosensory retinal tissue of patients with exudative age related macular degeneration using the Optical Coherence Tomography (OCT).

Method: The study included ixty five eyes of 62 patients (32 male and 30 female; mean age 74.97±8.5 years) with exudative age related macular degeneration treated with intravitreal injections of ranibizumab with a treatment regimen over a period of 1 year. The MM5 thickness maps acquired with the Optovue RTVue-100 Fourier-domain OCT at baseline, at 3 months, after the 3 loading doses of ranibizumab, and at the 1 year follow-up visit were used for analysis. Changes of inner and outer retinal thickness in four selected points of normal retina on the MM5 scan were evaluated.

Results: The patients received a mean of 6.4 ± 1.8 (median 6, range 3-11) intravitreal injections of ranibizumab over a period of 12 months. No significant change was observed in inner and outer retinal thickness at pre-selected spots of normal retina during the first year of intravitreal administration of ranibizumab.

Conclusion: One year treatment with ranibizumab on an individualized, according to need dosing regimen does not seem to induce any detectable structural damage in the unaffected, normal retina.
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http://dx.doi.org/10.2174/1874364101711010368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759102PMC
December 2017

Fibrinous Anterior Uveitis Following Topical Tetracaine Abuse.

Curr Drug Saf 2017 ;12(3):216-218

Department of Ophthalmology, University of Patras, Medical School, 265 04, Patras. Greece.

Background: A 54-year-old man presented complaining of severe pain and blurred vision in his left eye. Slit-lamp biomicroscopy revealed a large epithelial defect with an underlying prominent ring infiltrate and severe anterior uveitis with fibrinous exudates and hypopyon. Patient admitted abuse of topical tetracaine, which was discontinued and topical treatment with a non-steroidal antiinflammatory agent, an antibiotic, a cycloplegic agent were instituted while a therapeutic contact lens was applied. Response to treatment was favorable with a rapid resolution of anterior uveitis within days while the epithelial defect fully healed within a month. Four months later the patient returned with a new subtotal epithelial defect with no previous history of trauma or topical anesthetic abuse.

Conclusion: In conclusion, while a common complication of topical tetracaine abuse is toxic keratopathy, we describe a case where tetracaine abuse was also complicated with a severe fibrinous anterior uveitis. Interestingly, in our case, anaesthetic abuse was complicated in the mid-term with a spontaneous corneal epithelial defect attributed to possible anaesthetic-induced anatomical changes, such as poor adhesion between the stroma and the epithelium.
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http://dx.doi.org/10.2174/1574886312666170518121551DOI Listing
June 2018