Chris Kalogeropoulos

Bartonella and intraocular inflammation: a series of cases and review of literature

Purpose: To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis. Methods: Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature. Results: Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12–62). Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%), vitritis in two eyes (14.2%), neuroretinitis in one eye (7.1%), focal retinochoroiditis in one eye (7.1%), branch retinal vein occlusion (BRVO) due to vasculitis in one eye (7.1%), disc edema with peripapillary serous retinal detachment in one eye (7.1%), and iridocyclitis in one eye (7.1%). Most of the patients (70%) did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis. Conclusion: Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the spectrum of Bartonella intraocular inflammation is very large. In our study the most common clinical entity was intermediate uveitis.

Factors influencing the accuracy of the SRK formula in the intraocular lens power calculation

Several intraocular lens (IOL) power calculation formulas (either theoretical or empirical) are used to determine the emmetropic IOL power) The Sanders-Retzlaff-Kraff (SRK) linear regression formula is among the most widely recognized empirical ones. In the present study intraocular lens power calculation aiming at emmetropia was performed, using SRK formula, in 145 cataractous eyes undergoing lens implantation. The final refraction was evaluated at 8 to 12 months after surgery. The purpose of this study was the identification and quantitative evaluation of the factors which influence significantly the accuracy of SRK in the intraocular lens power calculation. The following factors were studied: (1) the error in preoperative biometry with regard to the difference between post and preoperative axial length measurements, (2) the position of the implantation of the intraocular lens (anterior versus posterior chamber), (3) the intraocular lens style, (4) the intraocular lens power level, (5) the preoperative corneal astigmatism, (6) the surgically induced corneal astigmatism, and (7) the postoperative astigmatism. Multiple regression and stepwise regression analysis showed a strong correlation (R2 = 0.65;p < 0.001) between postoperative refractive error (Rf) and error in preoperative biometry (ΔAL), surgically induced corneal astigmatism (SIA) and postoperative astigmatism (Ap) only. This correlation is expressed by the following equation: Rf = 0.07 −2.55 ΔAL −0.42 SIA + 0.34 Ap. This equation indicates the quantitative effect of each factor on the accuracy of the SRK formula, by defining the pattern of the fluctuations of the amount or state (myopic or hyperopic) of refractive error induced by changes of variables ΔAL, SIA and Ap.

Ocular dirofilariasis: A case series of 8 patients

Purpose: Dirofilaria repens is an endemic parasite in Mediterranean countries that mostly affects animals. Rarely, however, it can infect humans. This case series presents patients with ocular infections due to D. repens. Materials and Methods: A chart review was performed of patients with ocular dirofilariasis after the year 2000, treated at a tertiary referral centre in Greece. Data were collected on the ocular, microbiological, or/and histopathological aspects and treatment. Results: Eight cases of unilateral ocular dirofilariasis were identified, of which 5 were subconjunctival (1 masquerading as nodular scleritis) and were removed through a conjunctival incision, 2 cases were intravitreal and were removed with vitrectomy, and 1 was intraorbital (adjacent to the roof of the orbit). The latter appeared as an encapsulated mass and subsequent histological examination revealed the presence of the parasite. Of the 8 cases recorded after the year 2000, 7 appeared within the last 6 years (4 cases within the last 3 years). The majority of cases involved residents of the Ionian Islands (7 of 8 cases). Conclusions: D. repens can affect various ocular and periocular tissues. A progressive increase in the incidence of dirofilariasis was observed, which is potentially associated with climate changes in warm and moist areas where this parasite is endemic.

Squamous cell papilloma of the conjunctiva due to human papillomavirus (HPV): presentation of two cases and review of literature

Purpose We describe two patients with squamous cell papilloma of the conjunctiva due to human papilloma virus (HPV) and review the literature. Patients and methods Two patients with conjunctival tumors were examined and treated in the University Eye Clinic and diagnosed in the University Pathology Department, University Hospital of Ioannina, Greece. The first patient was a 48-year-old man presenting with an extended papillomatous lesion in bulbar conjunctiva covering part of the cornea of his right eye. The second patient was a 24-year-old man presenting with a polypoidal papillomatous lesion on the caruncle of his right eye. The two lesions were removed surgically, cryotherapy was applied to the adjacent conjunctiva, and topical mitomycin-C was used. The amniotic membrane was used to restore the conjunctival defect in the first patient. The two removed lesions were sent to the Pathology Department for histopathological examination. Immunohistochemistry, DNA in situ hybridization, and polymerase chain reaction (PCR) analysis were performed. Results In the first patient, histopathology showed the presence of a benign squamous papilloma with koilocytosis. DNA in situ hybridization with broad-spectrum probes showed that this patient was positive for HPV DNA. In the second patient, histopathology showed the presence of a squamous papilloma with mild dysplasia and koilocytosis. Immunohistochemical analysis was positive for HPV protein and p16 protein. DNA in situ hybridization with broad-spectrum probes showed that the patient was positive for HPV DNA. PCR analysis showed the presence of HPV 6. According to morphological and molecular findings, both patients were diagnosed with squamous cell papilloma due to HPV. Conclusion HPV can infect the ocular surface. According to clinical results, the ophthalmologist in cooperation with the pathologist can recommend appropriate laboratory examinations to confirm the diagnosis and successfully treat conjunctival papillomas.

Contrast Sensitivity and Color Vision in Eyes With Retinitis Pigmentosa and Good Visual Acuity: Correlations With SD-OCT Findings

BACKGROUND AND OBJECTIVE To investigate the morphological substrate of the changes in visual function in eyes with retinitis pigmentosa and good visual acuity using spectral-domain optical coherence tomography (SD-OCT). PATIENTS AND METHODS A total of 30 eyes of 17 patients with retinitis pigmentosa and visual acuity of 20/40 or better underwent contrast sensitivity and color vision testing. The retinal thickness at the fovea and macula and the length of the photoreceptor inner/outer segment (IS/OS) junction were assessed by SD-OCT. Structural-functional correlations were investigated. RESULTS Contrast sensitivity correlated well with IS/OS length (Spearman r = 0.719, P < .001) and foveal thickness (r = 0.672, P < .001) and moderately with macular thickness (r = 0.422, P = .025). Moreover, color vision correlated significantly with IS/OS length (r = -0.725, P < .001) and foveal thickness (r = -0.661, P < .001). CONCLUSION In eyes with retinitis pigmentosa and good visual acuity, the structural changes observed on OCT scans correspond well to subtle measures of central visual function, complementary to visual acuity testing.

Findings of an experimental study in a rabbit model on posterior capsule opacification after implantation of hydrophobic acrylic and hydrophilic acrylic intraocular lenses

Purpose Study on cell growth on the posterior capsule after implantation of hydrophobic acrylic (Acrysof SA 60 AT) and hydrophilic acrylic (Akreos Disc) intraocular lenses (IOL) in a rabbit model and comparison of posterior capsule opacification (PCO). Methods Phacoemulsification was performed in 22 rabbit eyes, and two different IOL types (Acrysof SA60 AT and Akreos Disc) were implanted. These IOLs had the same optic geometry (square edged) but different material and design. Central PCO (CPCO), peripheral PCO (PPCO), Sommering’s ring (SR) formation, type of growth, extension of PCO, cell type, inhibition, and fibrosis were evaluated three weeks after surgery. Histological sections of each globe were prepared to document the evaluation of PCO. Results No statistically significant difference was observed between a hydrophobic acrylic IOL and a hydrophilic acrylic IOL in relation to the CPCO, PPCO, type of growth, extension, cell type, inhibition, and fibrosis. Statistically significant difference was observed in relation to the formation of SR with Acrysof SA 60 AT group presenting more SR than Akreos Disc group. Conclusion PCO was not influenced by the material of the IOL or the design of the haptics of the IOLs we studied.

Ocular adnexal marginal zone lymphoma of mucosa-associated lymphoid tissue

Ocular adnexal lymphomas are a group of heterogeneous neoplasms representing approximately 1–2% of non-Hodgkin lymphomas and 8% of extranodal lymphomas. The incidence of primary ocular adnexal lymphoid tumors has raised over the last decades, and this could be probably attributed to the more sophisticated diagnostic techniques. Due to the wide spectrum of clinical manifestations, ocular tissue biopsy is important in order to set a precise diagnosis based on histological, immunophenotypical and, in some cases, molecular findings. The most common subtype, which may account for up to 80% of primary ocular adnexal lymphomas, is extranodal marginal zone lymphoma (EMZL) of mucosa-associated lymphoid tissue. This lymphoma is usually asymptomatic in the early phase of the disease causing a delay in the final diagnosis and prompt therapy. The pathogenesis of a proportion of these tumors has been linked to chronic inflammatory stimulation from specific infectious factors (e.g., Chlamydia psittaci) or to autoimmunity. The further improvement in diagnostic methods and the further understanding of the pathogenesis of ocular adnexal EMZL may contribute to the establishment of a more successful multidisciplinary therapeutic planning.

Psychological Aspects and Depression in Patients with Symptomatic Keratoconus

Purpose To assess the psychological status of keratoconus sufferers and to determine the relationship between depression and visual impairment in this group of patients. Methods Fifty-six patients with keratoconus and forty-seven age- and gender-matched healthy control subjects were retroprospectively analyzed. Every participant underwent a complete ophthalmological examination. Keratoconus diagnosis was confirmed with corneal topography and tomography. Zung Depression Inventory Questionnaire and Patient Health Questionnaire-9 (PHQ-9) were completed by everyone. Results Visual acuity (logMAR 0.53 ±0.30 versus 0.11 ± 0.16), PHQ-9 score (10.20 ± 4.00 versus 5.40 ± 5.01), and Zung score (46.52 ± 8.70 versus 38.53 ± 8.41) showed a statistically significant difference between keratoconus patients and healthy controls (p < 0.001 for all). Worse visual acuity was strongly correlated with older individuals (rho = 0.339, p=0.011) and higher PHQ-9 (rho = 0.765, p < 0.001) and Zung score (rho = 0.672, p < 0.001). Conclusion Depressive disorders appear to be directly associated with keratoconus, both in frequency and intensity. Worse visual acuity and older age could be identified as predictive factors for their emotional status. Moreover, the disease itself could be recognized as an independent risk factor for depression development, underlying the need for close monitoring and supportive management. To the best of our knowledge, our study is the first in the literature to elaborate the association between keratoconus and depression, by assessing two different questionnaires simultaneously.