Publications by authors named "Tryfon Rotsos"

28 Publications

  • Page 1 of 1

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

Extending the phenotypic spectrum of PRPF8, PRPH2, RP1 and RPGR, and the genotypic spectrum of early-onset severe retinal dystrophy.

Orphanet J Rare Dis 2021 03 12;16(1):128. Epub 2021 Mar 12.

UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK.

Purpose: To present the detailed retinal phenotype of patients with Leber Congenital Amaurosis/Early-Onset Severe Retinal Dystrophy (LCA/EOSRD) caused by sequence variants in four genes, either not (n = 1) or very rarely (n = 3) previously associated with the disease.

Methods: Retrospective case series of LCA/EOSRD from four pedigrees. Chart review of clinical notes, multimodal retinal imaging, electrophysiology, and molecular genetic testing at a single tertiary referral center (Moorfields Eye Hospital, London, UK).

Results: The mean age of presentation was 3 months of age, with disease onset in the first year of life in all cases. Molecular genetic testing revealed the following disease-causing variants: PRPF8 (heterozygous c.5804G > A), PRPH2 (homozygous c.620_627delinsTA, novel variant), RP1 (homozygous c.4147_4151delGGATT, novel variant) and RPGR (heterozygous c.1894_1897delGACA). PRPF8, PRPH2, and RP1 variants have very rarely been reported, either as unique cases or case reports, with limited clinical data presented. RPGR variants have not previously been associated with LCA/EOSRD. Clinical history and detailed retinal imaging are presented.

Conclusions: The reported cases extend the phenotypic spectrum of PRPF8-, PRPH2-, RP1-, and RPGR-associated disease, and the genotypic spectrum of LCA/EOSRD. The study highlights the importance of retinal and functional phenotyping, and the importance of specific genetic diagnosis to potential future therapy.
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http://dx.doi.org/10.1186/s13023-021-01759-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953775PMC
March 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.
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http://dx.doi.org/10.1155/2020/8831668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787826PMC
December 2020

Acute Visual Loss Secondary to Arnold Chiari Type I Malformation Completely Resolving After Decompressive Posterior Fossa Surgery.

Int Med Case Rep J 2020 18;13:657-661. Epub 2020 Nov 18.

Department of Ophthalmology, University of Athens, G Gennimatas General Hospital, Athens, Greece.

We describe the case of a 22-year-old woman of southeast-Asian origin, presenting with unilateral sudden visual loss after a self-healing hearing loss a week before. Ophthalmological examination showed visual acuity of light perception in the left eye, mild RAPD, normal ocular motility and an elevated optic disc with indistinct margins. Neurological examination showed no acute pathology and brain CT-MRI imaging revealed a small-almost subclinical-herniation of the cerebellar tonsils. As investigation eliminated every other infectious or inflammatory cause of papillitis, neurosurgical intervention was proposed. The patient underwent an uncomplicated occipital craniotomy with posterior fossa decompression and had a favorable revolution with regression of papilledema and a fully recovering visual acuity that reached 20/20. Chiari malformation type I refers to an abnormality of the posterior fossa that has a smaller volume than normal, leading to the herniation of cerebellar tonsils, at least 5 mm below the foramen magnum. The occurrence of papilledema associated with Chiari malformation type 1 is rare. Chiari malformation has, until today, mainly been studied among children populations, usually with a poor visual acuity recovery. The originality of our case report consists in the description of an adult patient case showing unilateral, unusual ophthalmological findings and complete recovery after surgical treatment.
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http://dx.doi.org/10.2147/IMCRJ.S253883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680680PMC
November 2020

Deep Phenotyping of PDE6C-Associated Achromatopsia.

Invest Ophthalmol Vis Sci 2019 12;60(15):5112-5123

UCL Institute of Ophthalmology, University College London, London, United Kingdom.

Purpose: To perform deep phenotyping of subjects with PDE6C achromatopsia and examine disease natural history.

Methods: Eight subjects with disease-causing variants in PDE6C were assessed in detail, including clinical phenotype, best-corrected visual acuity, fundus autofluorescence, and optical coherence tomography. Six subjects also had confocal and nonconfocal adaptive optics scanning light ophthalmoscopy, axial length, international standard pattern and full-field electroretinography (ERG), short-wavelength flash (S-cone) ERGs, and color vision testing.

Results: All subjects presented with early-onset nystagmus, decreased best-corrected visual acuity, light sensitivity, and severe color vision loss, and five of them had high myopia. We identified three novel disease-causing variants and provide phenotype data associated with nine variants for the first time. No subjects had foveal hypoplasia or residual ellipsoid zone (EZ) at the foveal center; one had an absent EZ, three had a hyporeflective zone, and four had outer retinal atrophy. The mean width of the central EZ lesion on optical coherence tomography at baseline was 1923 μm. The mean annual increase in EZ lesion size was 48.3 μm. Fundus autofluorescence revealed a central hypoautofluorescence with a surrounding ring of increased signal (n = 5). The mean hypoautofluorescent area at baseline was 3.33 mm2 and increased in size by a mean of 0.13 mm2/year. Nonconfocal adaptive optics scanning light ophthalmoscopy revealed residual foveal cones in only one of two cases. Full-field ERGs were consistent with severe generalized cone system dysfunction but with relative preservation of S-cone sensitivity.

Conclusions: PDE6C retinopathy is a severe cone dysfunction syndrome often presenting as typical achromatopsia but without foveal hypoplasia. Myopia and slowly progressive maculopathy are common features. There are few (if any) residual foveal cones for intervention in older adults.
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http://dx.doi.org/10.1167/iovs.19-27761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905659PMC
December 2019

GUCY2D-Associated Leber Congenital Amaurosis: A Retrospective Natural History Study in Preparation for Trials of Novel Therapies.

Am J Ophthalmol 2020 02 5;210:59-70. Epub 2019 Nov 5.

Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; UK Inherited Retinal Dystrophy Consortium, United Kingdom. Electronic address:

Purpose: To describe the natural history of Leber congenital amaurosis (LCA) associated with GUCY2D variants (GUCY2D-LCA) in a cohort of children and adults, in preparation for trials of novel therapies.

Design: Retrospective case series.

Methods: Participants: Patients with GUCY2D-LCA at a single referral center.

Procedures: Review of clinical notes, retinal imaging including fundus autofluorescence (FAF) and optical coherence tomography (OCT), electroretinography (ERG), and molecular genetic testing.

Main Outcome Measures: Demographic data, symptoms at presentation, visual acuity, evidence of progression, OCT and FAF findings, ERG assessment, and molecular genetics.

Results: Twenty-one subjects with GUCY2D-LCA were included, with a mean follow-up ± standard deviation (SD) of 10 ± 11.85 years. Marked reduction in visual acuity (VA) and nystagmus was documented in all patients within the first 3 years of life. Fifty-seven percent (n = 12) exhibited photophobia and 38% (n = 8) had nyctalopia. VA was worse than hand motion in 71% of the patients (n = 15). Longitudinal assessment of VA showed stability in all patients, except 1 patient who experienced deterioration over a follow-up of 44 years. Hyperopia was reported in 13 of the 17 subjects (71%) with available refraction data. Eighteen subjects had either normal fundus appearance (n = 14) or a blond fundus (n = 3), while only 4 of the eldest subjects had mild retinal pigment epithelium (RPE) atrophy (mean, 49 years; range 40-54 years). OCT data were available for 11 subjects and 4 different grades of ellipsoid zone (EZ) integrity were identified: (1) continuous/intact EZ (n = 6), (2) focally disrupted EZ (n = 2), (3) focally disrupted with RPE changes (n = 2), and (4) diffuse EZ disruption with RPE changes (n = 1). All examined subjects had stable OCT findings over the long follow-up period. Full-field ERGs showed evidence of a severe cone-rod dystrophy in 5 of 6 patients and undetectable ERGs in 1 subject. Novel genotype-phenotype correlations are also reported.

Conclusion: GUCY2D-LCA is a severe early-onset retinal dystrophy associated with very poor VA from birth. Despite the severely affected photoreceptor function, the relatively preserved photoreceptor structure based on EZ integrity until late in the disease in the majority of subjects suggests a wide therapeutic window for gene therapy trials.
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http://dx.doi.org/10.1016/j.ajo.2019.10.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013380PMC
February 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.
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http://dx.doi.org/10.1080/09273948.2019.1672197DOI Listing
February 2021

Three-Year Results of Fluorescein Angiography-Guided Standard Photodynamic Therapy with Multiple Spots for Central Serous Chorioretinopathy.

Ophthalmol Retina 2018 07 29;2(7):703-711. Epub 2017 Dec 29.

First Division of Ophthalmology, School of Medicine, National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece.

Purpose: To report the long-term results of fluorescein angiography (FA)-guided standard photodynamic therapy (PDT) for central serous chorioretinopathy (CSCR) and its adverse effects.

Design: Prospective, noncomparative, interventional study.

Participants: Consecutive patients (N = 63 eyes) with acute (39 eyes) or chronic (24 eyes) CSCR.

Methods: All eyes underwent FA-guided conventional PDT, using multiple spots in 1 session if appropriate, and were assessed before PDT, as well as at months 3, 6, and 12 after PDT, and every 6 months thereafter until the end of the 3-year follow-up time.

Main Outcome Measures: Primary outcome measures were the resolution of subretinal fluid (SRF) and the improvement of the Snellen best-corrected visual acuity (BCVA) to better than 20/100 at the end of the study. Secondary outcomes were the changes in mean BCVA and central foveal thickness (CFT) during the follow-up time.

Results: All 63 eyes with acute or chronic CSCR demonstrated complete resolution of SRF at the end of the study. Of the studied eyes, 51 (80.95%) underwent a single PDT application. The mean CFT improved significantly at all time points in the acute CSCR group (P < 0.001) from 515.13±110.5 μm to 297.75±22.3 μm at 3 years and in the chronic CSCR group from 484.12±62.49 μm to 293.81±16.89 μm. At 3 years, a gain of more than 20/100 in Snellen BCVA was seen in 28 acute and 16 chronic CSCR PDT-treated eyes (71.8% vs. 66.67%; P = 0.779). The mean logarithm of the minimum angle of resolution BCVA improved from 0.349±0.18 at baseline to 0.060±0.06 at the end of the study (P < 0.001) for eyes with acute CSCR and from 0.502±0.28 to 0.198±0.11 correspondingly for the eyes with chronic CSCR (P < 0.001). None of the study eyes demonstrated any serious systemic or ophthalmologic complication related to the use of the standard PDT with verteporfin.

Conclusions: Fluorescein angiography-guided conventional PDT achieved outcomes for acute and chronic CSCR comparable with those reported with modified PDT techniques. We did not identify new safety concerns.
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http://dx.doi.org/10.1016/j.oret.2017.11.008DOI Listing
July 2018

Morning Glory Disc Anomaly in a Child with Esotropia.

J Pediatr 2018 12 17;203:458-458.e1. Epub 2018 Jul 17.

First Ophthalmology Department National and Kapodistrian University of Athens Athens, Greece.

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http://dx.doi.org/10.1016/j.jpeds.2018.06.014DOI Listing
December 2018

Optical Coherence Tomography Angiography of Foveal Neovascularization in Diabetic Retinopathy.

Case Rep Ophthalmol 2018 Jan-Apr;9(1):87-91. Epub 2018 Jan 29.

1st Department of Ophthalmology, University of Athens, Georgios Gennimatas General Hospital, Athens, Greece.

Purpose: To report a case of foveal neovascularization in a patient with proliferative diabetic retinopathy as seen on optical coherence tomography angiography (OCT-A).

Methods: Multimodal imaging was used for diagnostic investigation.

Patient: A 61-year-old male with a 16-year history of insulin-dependent diabetes mellitus was referred to our medical retina department for examination and management. Meticulous fundus examination and multimodal imaging revealed proliferative diabetic retinopathy lesions, including neovascularization located in the foveal area.

Results: OCT-A allowed us to detect the neovascular lesion, confirm that it originated from perifoveal capillaries, estimate its retinal depth, and evaluate the vessel blood flow in multiple layers.

Conclusion: To the best of our knowledge this is the first report of OCT-A imaging of foveal neovascularization in diabetic retinopathy. OCT-A is a very useful examination for the diagnostic investigation of patients with diabetic retinopathy.
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http://dx.doi.org/10.1159/000485831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892317PMC
January 2018

Managing high risk glaucoma with the Ahmed valve implant: 20 years of experience.

Int J Ophthalmol 2018 18;11(2):240-244. Epub 2018 Feb 18.

Department of Ophthalmology, University of Athens, General Hospital of Athens, Mesogion 154 Ave, Athens 11527, Greece.

Aim: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery.

Methods: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure (IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes.

Results: Follow-up ranged from 18 to 120mo with a mean follow-up of 63.2mo. IOP before the operation decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference (<0.001). The success rate was 85.2% during the first semester, 76.8% at 12mo and 50.3% at the end of follow up period (18 to 120mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%.

Conclusion: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.
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http://dx.doi.org/10.18240/ijo.2018.02.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824078PMC
February 2018

Multimodal imaging of hypertensive chorioretinopathy by swept-source optical coherence tomography and optical coherence tomography angiography: Case report.

Medicine (Baltimore) 2017 Sep;96(39):e8110

A' Department of Ophthalmology, University of Athens, General Hospital of Athens, Athens, Greece Moorfield's Eye Hospital, London, UK.

Rationale: To investigate malignant hypertension ocular lesions with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCT-A).

Patient Concerns: Visual loss due to malignant hypertension.

Diagnoses: Hypertensive chorioretinopathy.

Interventions: Patients were thoroughly examined on presentation and 30 days after their first visit, with swept-source optical coherence tomography and optical coherence tomography angiography.

Outcomes: Lesions were totally absorbed during the follow-up time. Additionally, they presented fibrin deposits, as multiple solid hyper-reflective structures overlying retinal pigment epithelium, on both-SS-OCT and OCT-A. The last were still detected even larger in size at the last visit of the patients.

Lessons: These novel imaging examinations allow the ophthalmologist to detect in detail the several clinical manifestations of malignant hypertension on the fundus, and draw useful conclusions about their peculiar pathogenesis.
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http://dx.doi.org/10.1097/MD.0000000000008110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626277PMC
September 2017

Detection of nonexudative choroidal neovascularization secondary to angioid streaks using optical coherence tomography angiography.

Eur J Ophthalmol 2017 Aug 30;27(5):e140-e143. Epub 2017 Aug 30.

Department of Ophthalmology, University of Athens, Georgios Gennimatas General Hospital - Greece.

Purpose: To present a case of nonexudative choroidal neovascularization secondary to angioid streaks in a patient with pseudoxanthoma elasticum. The lesion was monitored over an 8-month period with the use of optical coherence tomography angiography.

Methods: Case report.

Results: The neovascular tissue area increased by 0.160 mm2 over a period of 8 months without any sign of exudation seen on optical coherence tomography or fluorescein angiography.

Conclusions: To our knowledge, this is the first report of a nonexudative choroidal neovascularization secondary to angioid streaks. Given that once a patient with angioid streaks develops choroidal neovascularization in one eye there is a high risk of bilateral involvement within a short amount of time, optical coherence tomography angiography can prove a useful tool for monitoring such lesions over time.
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http://dx.doi.org/10.5301/ejo.5000995DOI Listing
August 2017

Bimatoprost/timolol fixed combination (BTFC) in patients with primary open angle glaucoma or ocular hypertension in Greece.

Int J Ophthalmol 2016 18;9(1):69-75. Epub 2016 Jan 18.

1st Department of Ophthalmology, University of Athens, Athens 11527, Greece.

Aim: To evaluate the efficacy and tolerability of the fixed combination of bimatoprost 0.03% and timolol 0.5% (BTFC) in patients in Greece with primary open angle glaucoma (POAG) or ocular hypertension (OHT) whose previous therapy provided insufficient lowering of intraocular pressure (IOP).

Methods: A multicenter, prospective, open-label, non-interventional, observational study of the use of BTFC in clinical practice was conducted at 41 sites in Greece. The primary endpoint was the reduction in IOP from baseline at study end, approximately 12wk after initiation of BTFC therapy.

Results: A total of 785 eligible patients were enrolled in the study and 97.6% completed the study. The mean±SD IOP reduction from baseline at 12wk after initiation of BTFC was 6.3±2.8 mm Hg (n=764; P<0.001). In patients (n=680) who replaced their previous IOP-lowering monotherapy (a single drug, or a fixed combination of 2 drugs in a single ophthalmic drop) with once-daily BTFC, the mean±SD IOP reduction from baseline at 12wk was 6.2±2.8 mm Hg (P<0.001). IOP was reduced from baseline in 99.2% of patients, and 58.0% of patients reached or exceeded their target IOP. Substantial mean IOP reductions were observed regardless of the previous therapy. BTFC was well tolerated, with 96.0% of patients who completed the study rating the tolerability of BTFC as "good" or "very good." Adverse events were reported in 8.3% of patients; only 0.6% of patients discontinued the study due to adverse events.

Conclusion: In clinical practice in Greece, BTFC is well tolerated and effectively lower the IOP in patients with POAG or OHT who requires additional IOP lowering on their previous therapy.
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http://dx.doi.org/10.18240/ijo.2016.01.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768494PMC
March 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.
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http://dx.doi.org/10.1155/2016/4731037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745941PMC
February 2016

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.
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http://dx.doi.org/10.1007/s10792-014-9921-0DOI Listing
December 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.
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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.
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http://dx.doi.org/10.3109/09273948.2013.863942DOI Listing
December 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.
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http://dx.doi.org/10.2147/OPTH.S44200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716554PMC
July 2013

A case of a young asymptomatic woman with optic disc drusen and vasculitis.

Case Rep Ophthalmol 2011 May 27;2(2):232-7. Epub 2011 Jul 27.

Department of Ophthalmology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK.

Purpose: We present the case of a young woman with optic disc drusen and peripheral vasculitis.

Methods: Diagnosis was based on fundoscopic, optical coherence tomography as well as fluorescein angiography (FA) findings.

Results: An asymptomatic 34-year-old female patient with no systemic pathology was referred to our hospital from her optician for retinal findings. Fundoscopy revealed mild disc swelling that could be attributed to the presence of optic disc drusen in both eyes. There was fundoscopic evidence of periphlebitis in the periphery confirmed by FA findings.

Conclusions: In our case, the unique feature was the presence of optic disc drusen and retinal periphlebitis. The patient's disc configuration may have contributed to a predisposition for vasculitis in addition to vessel tortuosity.
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http://dx.doi.org/10.1159/000329715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150971PMC
May 2011

Phacoemulsification in a patient with small pupil and a large iris cyst.

Eur J Ophthalmol 2012 Mar-Apr;22(2):278-9

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

Purpose: Peripheral iris cysts are generally asymptomatic and nonprogressive. They are usually located in the inferotemporal quadrant of the anterior segmen:, most commonly in the iridociliary sulcus. We report our management strategy in a patient with small pupil and a large iris cyst.

Method: Retrospective, case report.

Results: A 65-year-old man was referred, reporting blurred vision OS. Best-corrected visual acuity (BCVA) was 6/12 OD and 6/48 OS. Anterior chamber (AC) examination OS revealed an iris cyst protruding inferotemporally occupying almost one-third of AC volume. Intraocular pressure (IOP) was 32 mmHg OS and 19 mmHg OD. Aspiration with a 27-G cannula, without cyst resection, was performed. Phacoemulsification and intraocular lens implantation were uneventful. The BCVA improved to 6/9 1 week postoperatively and to 6/6 a month later. In the first postoperative visit, IOP dropped to 16 mmHg. The cyst was significantly decreased in size. Six months postoperatively, BCVA remained unchanged while AC examination revealed that the cyst remained in place with no signs of enlargement.

Conclusions: In this case, cyst aspiration was elected as a treatment procedure that led to significant decrease in size. This management option, combined with an uncomplicated cataract extraction procedure, resulted in an excellent visual and a positive anatomic outcome.
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http://dx.doi.org/10.5301/ejo.5000026DOI Listing
August 2012

Spontaneous traumatic macular hole closure in a 50-year-old woman: a case report.

J Med Case Rep 2011 Jul 6;5:290. Epub 2011 Jul 6.

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

Introduction: Traumatic macular holes (TMH) are well-known complications of ocular contusion injury. Spontaneous closure occurs in approximately 50% of cases, but rarely after the age of thirty. We report a case of spontaneous closure of a full thickness macular hole due to a blunt trauma and we suggest possible mechanisms for this closure.

Case Presentation: A 50-year-old Greek woman was referred with a history of reduced best-corrected visual acuity after blunt trauma to her right eye. Diagnosis was based on fundoscopic, optical coherence tomography as well as fluorescein angiography findings with follow-up visits at two days, 20 days and five months. Fundoscopy revealed a full-thickness TMH with a minor sub-retinal hemorrhage and posterior vitreous detachment. The presence of a coagulum in the TMH base was observed. Subsequently, TMH closure was observed.

Conclusion: The clot in the TMH base, potentially a hemorrhage by-product containing a significant quantity of platelets, may have simulated the clot observed after autologous serum use, thus facilitating a similar effect. This may have stimulated glial cell migration and proliferation, thus contributing to spontaneous hole closure.
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http://dx.doi.org/10.1186/1752-1947-5-290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224546PMC
July 2011

Interleukin-6 and the matrix metalloproteinase response in the vitreous during proliferative vitreoretinopathy.

Cytokine 2011 May 25;54(2):212-7. Epub 2011 Feb 25.

Department of Ophthalmology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, United Kingdom.

Purpose: To investigate the levels of IL-6 in the vitreous of patients with RRD complicated with PVR and correlate the IL-6 levels with matrix metalloproteinase (MMP)-1,-2,-3,-8,-9 and tissue inhibitor of metalloproteinases (TIMP)-1 with respect to RRD extent, duration and PVR grade.

Design: Cohort study.

Participants: Twenty-eight vitreous samples from 28 eyes of 28 patients with RRD complicated with PVR.

Methods: Institutional study. Twenty-eight vitreous samples from 28 eyes of 28 patients with RRD complicated with PVR were collected during pars plana vitrectomy (PPV) and were compared to vitreous control samples. IL-6, MMP-1,-3,-8 and TIMP-1 levels were measured using ELISA while enzymatic activity of MMP-2, and -9 was determined employing gelatin zymography.

Results: Protein IL-6 (p=0.030), MMP-1 (p=0.003), MMP-3 (p=0.003), TIMP-1 (p=0.001) levels as well as enzymatic activity of proMMP-9 (p=0.013), MMP-9 (p=0.017) and proMMP-2 (p=0.010), were significantly increased in PVR patients as compared to controls. IL-6 levels correlated with MMP-1 (p=0.002), proMMP-2 (p=0.006), MMP-3 (p=0.001) and TIMP-1 (p=0.006). Regression analysis revealed positive correlations between IL-6 and all MMPs and TIMP-1.

Conclusions: Taking into account the previously established effect of interleukins in MMP activity, the findings of this study suggest a role of IL-6 in MMP stimulation during PVR development.
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http://dx.doi.org/10.1016/j.cyto.2011.02.001DOI Listing
May 2011

Initial clinical experience of ranibizumab therapy for neovascular age-related macular degeneration.

Clin Ophthalmol 2010 Nov 10;4:1271-5. Epub 2010 Nov 10.

Medical Retina Service, Moorfields Eye Hospital, London, UK.

Purpose: To describe the visual acuity and safety outcomes for the first 50 patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab at Moorfields Eye Hospital.

Methods: A retrospective analysis of case notes from the first 50 consecutive patients with Primary Care Trust funding for ranibizumab therapy for nAMD. Visual acuity outcomes and adverse events were noted, as were service delivery-related indicators.

Results: The mean (±standard deviation) age of the 50 patients was 81 ± 17 years. The mean follow-up of patients was 13.6 ± 2 (range 7.7-18) months. The mean change in visual acuity ± standard error was +4.6 ± 2.2 letters at the end of follow-up, with 26% gaining 15 letters or more. The mean (median) number of injections was 4.7 (4.5) per 12-month period. The mean (median) delay in Primary Care Trust funding approval was 35 days (32 days) prior to the final appraisal document from the National Institute of Health and Clinical Excellence.

Conclusions: The real-world outcomes of ranibizumab therapy in this initial cohort of patients with nAMD are comparable with those reported in the pivotal, randomized, controlled trials using fewer injections and a prn strategy of retreatment to achieve the gain in visual acuity.
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http://dx.doi.org/10.2147/OPTH.S14684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993128PMC
November 2010

Choroidal neovascularization due to punctate inner choroidopathy: long-term follow-up and review of literature.

Clin Ophthalmol 2010 Aug 9;4:871-6. Epub 2010 Aug 9.

First Department of Ophthalmology, University of Athens Medical School, Athens, Greece.

Introduction: The aim of the article was to report on the long-term follow-up of choroidal neovascularization (CNV) cases secondary to punctate inner choroidopathy (PIC) either treated with photodynamic therapy (PDT) or followed without treatment. A comprehensive review of existing literature on the various treatment modalities is incorporated.

Methods: Nine eyes of 8 female patients with CNV due to PIC were followed retrospectively for an average of 105 months (range, 36-162 months). Mean age of the patient cohort on presentation was 28 years (range, 21-39). Four eyes were treated with PDT, whereas in 4 patients, including 1 with bilateral involvement, the disease followed its natural course without treatment. Snellen visual acuity and the extent of neovascularization and subretinal fibrosis were evaluated on presentation and at the end of the follow-up period.

Results: Improvement of vision was observed in 6 eyes (66.7%), including all cases treated with PDT, and in 2 of 5 eyes left untreated. The size of the neovascular lesion, including both CNV and subretinal fibrosis, increased in all cases left untreated (55.6%) and remained stable in all cases treated with PDT (44.4%).

Conclusion: Without treatment, the CNV due to PIC is slowly progressive. Our short cohort appears to have benefited from PDT in terms of maintaining visual acuity and stabilizing the extent of CNV and fibrosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921295PMC
http://dx.doi.org/10.2147/opth.s10394DOI Listing
August 2010

Electrodiagnostic and two-wavelength fundus autofluorescence imaging investigations in acute idiopathic maculopathy.

Doc Ophthalmol 2010 Oct 18;121(2):155-60. Epub 2010 Jun 18.

Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.

The aim is to characterise a case of acute idiopathic maculopathy (AIM) using detailed electrophysiology and 2-wavelength fundus autofluorescence (FAF) imaging. A 32-year-old woman presented with reduced visual acuity in her right eye. Imaging investigations performed included 1 & 2 wavelength FAF, fluorescein and ICG angiography and Fourier domain OCT imaging. International-standard pattern and full-field electroretinography (PERG; ERG), electro-oculography (EOG) and multifocal ERG testing were performed. Multifocal ERGs demonstrated evidence of localised macular dysfunction consistent with mild right pattern ERG P50 reduction. Full-field ERGs were within normal limits. The EOG was normal bilaterally. The use of 1 & 2 wavelength FAF imaging revealed a low density macular area, not explained by luteal pigment absorption, that was associated with macular dysfunction. Two-wavelength FAF imaging allows the accurate quantification of macular pigment and the imaging of the underlying relative distribution of lipofuscin. AIM was characterised by a discrete area of disrupted retinal pigment epithelium metabolism and atrophy associated with localised macular dysfunction. Complimentary use of dual-wavelength FAF imaging and electrophysiology may have application to disorders other than AIM.
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http://dx.doi.org/10.1007/s10633-010-9235-0DOI Listing
October 2010

Cystoid macular edema.

Clin Ophthalmol 2008 Dec;2(4):919-30

Medical Retina Service, Moorfields Eye Hospital, London, UK.

We review the epidemiology, pathophysiology, and etiology of cystoid macular edema (CME). Inflammatory, diabetic, post-cataract, and macular edema due to age-related macular degeneration is described. The role of chronic inflammation and hypoxia and direct macular traction is evaluated in each case according to different views from the literature. The different diagnostic methods for evaluating the edema are described. Special attention is given to fluoroangiography and the most modern methods of macula examination, such as ocular coherence tomography and multifocal electroretinography. Finally, we discuss the treatment of cystoid macular edema in relation to its etiology. In this chapter we briefly refer to the therapeutic value of laser treatment especially in diabetic maculopathy or vitrectomy in some selected cases. Our paper is focused mainly on recent therapeutic treatment with intravitreal injection of triamcinolone acetonide and anti-VEGF factors like bevacizumab (Avastin), ranibizumab (Lucentis), pegaptamid (Macugen), and others. The goal of this paper is to review the current status of this treatment for macular edema due to diabetic maculopathy, central retinal vein occlusion and post-cataract surgery. For this reason the results of recent multicenter clinical trials are quoted, as also our experience on the use of intravitreal injections of anti-VEGF factors and we discuss its value in clinical practice.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699812PMC
http://dx.doi.org/10.2147/opth.s4033DOI Listing
December 2008

Tilted disc syndrome: an OCT and mfERG study.

Doc Ophthalmol 2009 Aug 23;119(1):23-8. Epub 2009 Jan 23.

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

Purpose: To evaluate retinal thickness and function in eyes with tilted disc syndrome with optical coherence tomography (OCT) and multifocal electroretinogram (mfERG).

Methods: Twenty-one eyes of 12 patients (4 males and 8 females) with tilted disc were studied with OCT3 and mfERG and compared with 40 eyes of 20 age and sex-matched control subjects. The thickness of the fovea and the thickness of retinal nerve fibre layer (RNFL) along a 3.4-mm-diameter circle centred on the optic nerve head were evaluated using OCT3. The macular cone function was tested by mfERG.

Results: The OCT-derived RNFL thickness was significantly decreased in the superior area of eyes with tilted disc with a mean value equal to 106.47 microm (SD 24.1). The mean response amplitude density of the fovea (11.75 nV/deg(2)) and parafovea (8.22 nV/deg(2)) was significantly lower in eyes with tilted disc than in normal eyes.

Conclusion: OCT and mfERG can be objective tools for assessing anatomical and functional damage of the macula. Our results suggest that in tilted disc syndrome even without visual impairment the optic nerve and the macula show dysfunction not visible by other means.
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http://dx.doi.org/10.1007/s10633-009-9165-xDOI Listing
August 2009