Christos Skevas

Depression, Anxiety, and Disturbed Sleep in Glaucoma

Although it has been suggested that glaucoma is associated with circadian misalignment, sleep disorder, anxiety, and depression, these comorbid conditions have not received much attention. This study provides evidence for a significantly higher prevalence of depression, trait anxiety, and sleep disturbances in patients with progressed glaucoma, as compared with glaucoma patients with no or minor visual field defects (VFD). Logistic-regression analyses suggest that severe VFD constitute a significant predictor of depression, trait-anxiety, and sleep disturbance. Results indicate the necessity of regular screening and psychochronobiological treatment in glaucoma patients.

Genetically Modified Neural Stem Cells for a Local and Sustained Delivery of Neuroprotective Factors to the Dystrophic Mouse Retina

A continuous intraocular delivery of neurotrophic factors (NFs) is being explored as a strategy to rescue photoreceptor cells and visual functions in degenerative retinal disorders that are currently untreatable. To establish a cell‐based intraocular delivery system for a sustained administration of NFs to the dystrophic mouse retina, we used a polycistronic lentiviral vector to genetically modify adherently cultivated murine neural stem (NS) cells. The vector concurrently encoded a gene of interest, a reporter gene, and a resistance gene and thus facilitated the selection, cloning, and in vivo tracking of the modified cells. To evaluate whether modified NS cells permit delivery of functionally relevant quantities of NFs to the dystrophic mouse retina, we expressed a secretable variant of ciliary neurotrophic factor (CNTF) in NS cells and grafted the cells into the vitreous space of Pde6brd1 and Pde6brd10 mice, two animal models of retinitis pigmentosa. In both mouse lines, grafted cells attached to the retina and lens, where they differentiated into astrocytes and some neurons. Adverse effects of the transplanted cells on the morphology of host retinas were not observed. Importantly, the CNTF‐secreting NS cells significantly attenuated photoreceptor degeneration in both mutant mouse lines. The neuroprotective effect was significantly more pronounced when clonally derived NS cell lines selected for high expression levels of CNTF were grafted into Pde6brd1 mice. Intravitreal transplantations of modified NS cells may thus represent a useful method for preclinical studies aimed at evaluating the therapeutic potential of a cell‐based intraocular delivery of NFs in mouse models of photoreceptor degeneration.

Bilateral Achromobacter xylosoxidans keratitis after laser in situ keratomileusis

A 31-year-old man was referred to us 2 months after bilateral laser in situ keratomileusis (LASIK). On presentation, the corrected distance visual acuity was hand motion in the right eye and 20/25 in the left eye. Slitlamp examination showed a diffuse central stromal infiltrate, flap melting, and hypopyon in the right eye and marked interface opacities with crystal-like edges in the left eye. Flap lift and irrigation were performed. Because of the progressive keratitis, penetrating keratoplasty (PKP) was done in both eyes. Achromobacter xylosoxidans was isolated from both corneal buttons, and therapy was changed to chloramphenicol prednisolone eyedrops 8 times a day and intravenous meropenem 500 mg 3 times a day according to sensitivity testing. Two months after surgery, both transplants remained clear.

Scanning laser polarimetry and spectral domain optical coherence tomography for the detection of retinal changes in Parkinson's disease

Whether retinal degeneration is part of the degenerative processes in patients with Parkinsons disease (PD) is still unclear. This cross‐sectional study was undertaken to compare the retinal morphology of patients with PD and healthy controls using spectral domain optical coherence tomography (SD‐OCT) and scanning laser polarimetry (SLP).

Visual recovery after retinal detachment with macula-off: is surgery within the first 72 h better than after?

Aims To investigate the influence of lag time between the onset of central visual acuity loss and surgical intervention of macula-off retinal detachment. Methods This retrospective case series examined all consecutively treated eyes with primary macula-off retinal detachment at the University Hospital Hamburg (Germany) from February 2010 to February 2015. Records of 1727 patients operated by six surgeons were reviewed. Eighty-nine eyes (5.2%) from 89 patients met the inclusion and exclusion criteria. The main outcome measure studied was final visual acuity as a function of symptom duration of macula-off detachment. Secondary outcome measures studied were influence of age and surgical technique. Symptom duration was defined as the time from the onset of loss of central vision to surgical intervention. Results After 10 days no clinically relevant difference was seen in final visual acuity. Eyes with symptom duration of 3 days or less achieved best final visual acuity (p<0.001). Age and preoperative visual acuity had no influence while vitrectomised eyes had better outcome compared with those with scleral buckling. Conclusions Our study suggests that 1. After 10 days of central visual acuity loss, the final visual outcome is clinically comparable and independent of further delay of surgery up to 30 days. 2. Eyes treated up to 3 days after onset of loss of central vision have better final visual acuity than eyes with longer lag time. However, we did not find statistically significant differences within the first 3 days. 3. Surgery for macula-off retinal detachment may therefore most likely not be postponed without compromising the patients visual prognosis.

Terson's Syndrome—Rate and Surgical Approach in Patients with Subarachnoid Hemorrhage: A Prospective Interdisciplinary Study

OBJECTIVES To analyze the need for surgical intervention in Tersons syndrome (TS) and the rate of TS, as well as the effect of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling, complications, correlations between TS and sex, and the influence of the severity of subarachnoid hemorrhage (SAH) expressed by Glasgow Coma Scale (GCS) score and Hunt and Hess grade on the occurrence of TS. DESIGN Prospective, uncontrolled, interdisciplinary study. PARTICIPANTS A total of 102 patients with SAH over a period of 24 months. METHODS Patients were examined on days 1 and 14. A PPV was indicated in cases of nonresorbing vitreous hemorrhage (VH). Peeling of the ILM was performed with the help of ILM-BLUE (DORC, Zuidland, The Netherlands) using end-gripping ILM forceps. MAIN OUTCOME MEASURES Effect of PPV on visual acuity (VA) and timing of intervention in cases of nonresorbing VH. RESULTS The rate of TS was 19.6% (20/102). The mean age of the patients was 52.1 ± 11.8 years. Patients presenting with an initial GCS of less than 8 or with high Hunt and Hess grades were more affected by TS. Eight (9 eyes) of the 20 patients with TS (40% of the patients with TS) underwent a PPV for nonclearing vitreous bleeding. In 4 patients (4 eyes; 20% of patients with TS), ILM peeling was considered necessary because of sub-ILM bleeding. The mean interval between SAH and PPV was 4.4 months (range, 3-5 months). Postoperative follow-up was 6.4 months. Visual acuity improved in all patients. Best-corrected VAs at first and at last presentations were 2.2 and 0.0625 logarithm of the minimum angle of resolution (logMAR), respectively. For patients who underwent ILM peeling, these values were 1.725 and 0.05 logMAR, respectively. CONCLUSIONS Pars plana vitrectomy and ILM peeling have beneficial effects on the visual rehabilitation of patients with nonclearing VH after TS. We did not identify any safety concerns after PPV in our patients with dense nonclearing hemorrhage that persisted for more than 3 months.

Subjective pain, visual recovery and visual quality after LASIK, EpiLASIK (flap off) and APRK — a consecutive, non-randomized study

IntroductionLaser in situ keratomileusis (LASIK) is superior to surface ablation techniques (SAT) such as alcohol photorefractive keratectomy (APRK) or Epi-LASIK (EpiK) in terms of visual recovery and postoperative pain. This study compares subjective symptoms and visual recovery of two different SATs with LASIK.Materials and MethodsOne hundred and twenty seven patients were operated using one of the three techniques. Patients filled out a questionnaire describing symptoms assessing subjective visual recovery on a linear scale from ‘not functioning’ to ‘full visual function’ and pain on a linear scale from ‘no pain’ to ‘severe daily pain’. Subjective symptoms such as halos, double vision, low night vision, reduced contrast and dry eyes were also evaluated.ResultsVisual recovery was faster and discomfort symptoms less pronounced with the LASIK than with surface ablation procedures. More pain was reported after APRK than after EpiK (flap-off technique) in the early postoperative period, with a maximum of pain on postoperative days 3–4. Subjective visual recovery showed no statistically significant difference between the two surface ablation procedures. Halos, double vision, low night vision, reduced contrast and dry eyes were more extensively reported by the EpiK than the APRK group and were less pronounced in the LASIK than in the SAT group.Discussion and conclusionsOur study does not uniformly support the previously published favourable results of EpiK compared to APRK with regard to subjective recovery of vision and postoperative pain.

Long-Lasting Endotamponades in Vitreoretinal Surgery

In modern vitreoretinal surgery, a variety of long-lasting endotamponades is available. These endotamponades differ in physical and chemical properties and their usage is based on certain pathological and surgical considerations. With modern endotamponades the treatment and prognosis for some severe diseases of the posterior segment was improved. Besides these supportive features of new endotamponades, the surgeon has to keep in mind that certain steps, like a complete removal of the vitreous and of any traction, are crucial for the success of an operation and that the most supportive step for the retina is complete endotamponade. This review gives an overview of longlasting endotampoandes in vitreoretinal surgery and of the indications for their usage.

Radial Optic Neurotomy in Central Retinal Vein Occlusion Does Not Influence Ocular Hemodynamics

Purpose: Radial optic neurotomy (RON) is used for the treatment of central retinal vein occlusion. Its effects on visual acuity differ substantially between patients. Our study aims to evaluate if RON has an impact on ocular microcirculation and if analysis of ocular microcirculation might serve as a predictor for surgical success. Procedures: A complete ophthalmologic examination including color Doppler imaging of the retrobulbar vessels was performed before and 2–4 months after RON in 12 patients. Results: Mean visual acuity was 0.09 ± 0.03 prior to and 0.24 ± 0.12 after RON. Visual acuity improved in 7 (+3.5 ± 0.9 lines), was stable in 3 (±0 lines) and worsened in 2 cases (–6 and –2 lines). Doppler parameters were not affected by RON, and no correlations between visual acuity and perfusion parameters were found. Conclusions: Our data indicate that RON does not influence ocular microcirculation. None of the assessed hemodynamic parameters appears to be a predictor for surgical success.

Sustained Neural Stem Cell-Based Intraocular Delivery of CNTF Attenuates Photoreceptor Loss in the nclf Mouse Model of Neuronal Ceroid Lipofuscinosis.

A sustained intraocular administration of neurotrophic factors is among the strategies aimed at establishing treatments for currently untreatable degenerative retinal disorders. In the present study we have analyzed the neuroprotective effects of a continuous neural stem (NS) cell-based intraocular delivery of ciliary neurotrophic factor (CNTF) on photoreceptor cells in the nclf mouse, an animal model of the neurodegenerative lysosomal storage disorder variant late infantile neuronal ceroid lipofuscinosis (vLINCL). To this aim, we genetically modified adherently cultivated NS cells with a polycistronic lentiviral vector encoding a secretable variant of CNTF together with a Venus reporter gene (CNTF-NS cells). NS cells for control experiments (control-NS cells) were modified with a vector encoding the reporter gene tdTomato. Clonal CNTF-NS and control-NS cell lines were established using fluorescent activated cell sorting and intravitreally grafted into 14 days old nclf mice at the onset of retinal degeneration. The grafted cells preferentially differentiated into astrocytes that were attached to the posterior side of the lenses and the vitreal side of the retinas and stably expressed the transgenes for at least six weeks, the latest post-transplantation time point analyzed. Integration of donor cells into host retinas, ongoing proliferation of grafted cells or adverse effects of the donor cells on the morphology of the host eyes were not observed. Quantitative analyses of host retinas two, four and six weeks after cell transplantation revealed the presence of significantly more photoreceptor cells in eyes with grafted CNTF-NS cells than in eyes with grafted control-NS cells. This is the first demonstration that a continuous intraocular administration of a neurotrophic factor attenuates retinal degeneration in an animal model of neuronal ceroid lipofuscinosis.