Dimitrios Brouzas

Intravitreal use of bevacizumab (Avastin) for choroidal neovascularization due to ARMD: a preliminary multifocal-ERG and OCT study. Multifocal-ERG after use of bevacizumab in ARMD.

PurposeTo evaluate by MFERG and OCT the macular function before and after intravitreal use of bevacizumab (Avastin) in eyes suffering from CNV due to ARMD.MethodsEighteen eyes with subfoveal CNV due to ARMD were studied before and after intravitreal use of bevacizumab with MFERG and OCT. The post treatment follow up was three months.ResultsBefore treatment, OCT shows an increase of the retinal thickening of the fovea and the electrical response densities in the fovea and parafovea were decreased in all patients. Three months after treatment, OCT showed a real resolution of the subretinal fluid. The electrical responses in the fovea and parafovea remained the same or slightly improved in some cases. The intraocular pressure remained normal and no inflammation was observed.ConclusionThe intravitreal use of bevacizumab may provide anatomical correlates that support the concept of disease amelioration but the functional improvement of the macula three months after treatment is not obvious. However the method is promising and needs further evaluation.

Intraocular triamcinolone acetonide for pseudophakic cystoid macular edema: optical coherence tomography and multifocal electroretinography study.

Purpose: To evaluate pseudophakic cystoid macular edema (CME) by optical coherence tomography (OCT) and multifocal electroretinography (mf-ERG) and determine the efficacy of intravitreal triamcinolone acetonide injections. Methods: In this nonrandomized retrospective study, 14 eyes of 14 patients with persistent pseudophakic CME were treated with triamcinolone acetonide injection and were followed up for 1 year. All patients underwent complete ophthalmologic examination including determination of best-corrected visual acuity, slit-lamp examination, tonometry, and funduscopy. Results of OCT and mf-ERG were also recorded before and after the injection. Results: Visual acuity and mf-ERG values increased in all patients after intravitreal triamcinolone acetonide injections. OCT showed improvement of the retinal thickness in the macular area. Temporary increase of intraocular pressure was controlled with topical use of antiglaucoma drops. Conclusion: Intravitreal triamcinolone acetonide injection is a promising therapeutic tool for chronic pseudophakic edema resistant to other medical treatment. However, further study is needed to assess the treatments long-term efficacy, its safety, and the need for retreatment.

Lens epithelial apoptosis and cell proliferation In human age-related cortical cataract

Purpose To probe the presence of apoptosis in the epithelium of human lenses with age-related cortical cataract as well as to assess cell proliferation, a predicted consequence of apoptotic cell death, in this specific cell population. Methods DNA fragmentation was assessed using terminal digoxigenin-labeled dUTP nick end labeling (TUNEL) in capsulotomy specimens obtained from patients who underwent either extracapsular cataract extraction for the removal of adult-onset cortical cataract (n=27) or clear lens extraction for the correction of high myopia (n=25). Cell proliferation was assayed in 23 epithelia of cataractous lenses, and 20 epithelia of non-cataractous lenses with the proliferation marker MIB1, a monoclonal antibody against the nuclear antigen Ki-67 that is detected throughout the cell cycle but is absent in the resting (G0) cell. Results TUNEL staining was observed in 25 (92.6%) specimens of cataractous lenses, whereas cells undergoing apoptosis were identified in 2 (8%) of the epithelia from non-catarac-tous lenses. Only two MIB1-positive samples were detected, one of which was a capsule obtained during intracapsular cataract extraction. Conclusions The epithelium of human lenses with cortical cataract undergoes low rate apoptotic death. This limited epithelial apoptosis is unlikely to result in any significant cell density decrease since epithelial gaps are likely to be replaced by cell proliferation at the germinative zone of the anterior lens capsule. Nevertheless, the accumulation of small-scale epithelial losses during lifetime may induce alterations in lens fiber formation and homeostasis and result in loss of lens transparency.

Assessment of Central Serous Chorioretinopathy by Optical Coherence Tomography and Multifocal Electroretinography

Purpose: To evaluate central serous chorioretinopathy (CSCR) by means of optical coherence tomography (OCT) and multifocal electroretinogram (mf-ERG) at presentation and after resolution of the acute phase. Design: Prospective comparative observational case series with a normal sample. Patients and Method: Twenty-one eyes of 21 patients with unilateral CSCR were examined. Both eyes underwent complete ophthalmological examination, which included measurement of best-corrected visual acuity, fluorescein angiography, OCT and mf-ERG recording. Our results were compared with the corresponding findings of 33 normal volunteers of the same age. Results: At presentation, the averaged mean retinal thickness of the fovea, measured by OCT, was 303 µm in the affected eyes, 69.3% higher compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 11.29 nV/degree2, 50.8% lower compared to the normal controls (p < 0.001). After regression of CSCR, the averaged mean retinal thickness of the fovea was 213 µm in the affected eyes, 19.3% greater compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 16.05 nV/degree2, 30.1% lower compared to normal controls (p < 0.001). It is interesting that 6 of 21 fellow nonaffected eyes showed abnormal values, with an averaged mean retinal thickness of OCT (246 µm) and an averaged mean retinal response density of mf-ERG in area 1 (12 µV/degree2). In the remaining 15 eyes, the OCT and the mf-ERG values were within normal limits.

Severe toxic effect of methylene blue 1% on iris epithelium and corneal endothelium.

Purpose: To report a case of corneal endothelial decompensation and iris pigment dispersion following the inadvertent use of methylene blue 1% for capsular staining during cataract surgery. Design: Case report. Methods: During an otherwise routine phacoemulsification cataract surgery, inadvertent anterior capsule staining with methylene blue 1% instead of trypan blue 0.025% was performed. Copious irrigation of the anterior chamber with balanced salt solution was initiated upon identification of the wrong dye. The operation was completed with minimal ultrasound energy without complications. Results: Iris discoloration and severe corneal edema developed in the early postoperative period, resulting in severe visual loss. The patient developed bullous keratopathy and underwent penetrating keratoplasty 16 months later. Conclusions: In vivo intracameral injection of methylene blue 1% induces extreme cytotoxicity, primarily on the corneal endothelium and iris epithelium.

Visual Outcomes After Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty-Comparison of Specific Matched Pairs.

Purpose: To compare visual rehabilitation after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) for Fuchs endothelial dystrophy. Methods: The medical records of patients undergoing endothelial keratoplasty were retrospectively evaluated. A DMEK (n = 25 eyes) and a DSAEK (n = 25 eyes) group were formed. Specific matched pairs consisting of 1 DMEK and 1 DSAEK eye with the same preoperative best spectacle-corrected visual acuity (BSCVA) were built and compared with regard to visual rehabilitation, subjective refraction, central corneal thickness, and endothelial cell density. Results: Preoperative median BSCVA (logarithm of the minimal angle of resolution) was for both groups 0.7 (range, 0.2–1.70). At 12 months, median BSCVA was 0.0 (range, −0.08 to 0.7) after DMEK and 0.3 (range, 0.1–0.52) after DSAEK (P < 0.001). The spherical equivalent changed after DMEK from 0.0 D (range, −2.75 to 4.63 D) to 0.5 D (range, −1 to 2.5 D) and after DSAEK from −0.32 D (range, −2.50 to 1 D) to 0.63 D (range, −2.38 to 2 D). Central corneal thickness decreased from 718 &mgr;m (range, 566–1041 &mgr;m) to 533 &mgr;m (range, 460–605 &mgr;m) after DMEK and from 650 &mgr;m (range, 527–749 &mgr;m) to 605 &mgr;m (range, 486–650 &mgr;m) after DSAEK. Endothelial cell density decreased from 2448 cells/mm2 (range, 2106–3000 cells/mm2) to 1263 cells/mm2 (range, 589–2282 cells/mm2) after DMEK and from 2348 cells/mm2 (range, 2156–2781 cells/mm2) to 1327 cells/mm2 (range, 664–1972 cells/mm2) after DSAEK. Conclusions: DMEK patients showed faster rehabilitation and higher BSCVA at all postoperative visits; however, the decline in grafts endothelial cell count and change in the spherical equivalent were similar for both procedures.

Massive choroidal hemorrhage after intravitreal administration of bevacizumab (Avastin ® ) for AMD followed by controlateral sympathetic ophthalmia

Purpose: To report a severe ocular complication initiated ten days after intravitreal administration of bevacizumab (Avastin®), in a patient with exudative age-related macular degeneration (AMD). Patients and method: Case report. Results: Ten days after intravitreal injection of 1.25 mg Avastin®, the patient manifested acute loss of vision with excruciating pain. An extensive choroidal detachment was evident in close contact with the lens, which necessitated an emergency sclerotomy with reconstruction of the anterior chamber. Four months later, the eye proceeded to phthisis bulbi. Five months after the injection, the patient complained of mild pain, photophobia, and visual acuity deterioration from the fellow eye. The diagnosis of sympathetic ophthalmia was suggested and treated with intravitreal injections of triamcinolone acetonide every three months with good response, complicated by elevation of intraocular pressure which we managed with Ahmet valve implantation. Conclusion: Serious ocular complications after intravitreal of Avastin® can not be excluded, including massive choroidal hemorrhage and sympathetic ophthalmia of the fellow eye.

The a- and b-wave latencies as a prognostic indicator of neovascularisation in central retinal vein occlusion.

To evaluate the prognostic value of ERG in cases of central retinal vein occlusion (CRVO) regarding the development of neovascularisation (NV), we studied 20 patients with unilateral CRVO. Half of them were allocated in the perfused group and the other 10 finally developed NV and were allocated in the non-perfused group. Flash ERG was recorded from all patients. Our findings suggest that b-wave latency is the most reliable parameter in predicting NV, followed by the a-wave latency. The b/a wave amplitude of ERG ratio does not seem to be suitable for clinical use.

Evaluation of retinal nerve fibre layer thickness and visual evoked potentials in optic neuritis associated with multiple sclerosis

Background:  The aim was to compare the retinal nerve fibre layer (RNFL) thickness and visual evoked potentials (VEP) among eyes with multiple sclerosis (MS)‐associated optic neuritis, unaffected eyes of the same patients and eyes of disease‐free controls. Changes in RNFL thickness, visual acuity (VA) and VEP over time are evaluated in MS‐associated optic neuritis.

Efficacy of Photodynamic Therapy in the Management of Occult Choroidal Neovascularization Associated with Serous Pigment Epithelium Detachment

Aims: To evaluate the efficacy of photodynamic therapy (PDT) in the treatment of subfoveal occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (PED) in eyes with age-related macular degeneration. Methods: Hundred and fifty-three patients (161 eyes) with subfoveal occult CNV due to age-related macular degeneration, were divided into two groups. The first group (70 patients, 75 eyes) included eyes with occult CNV associated with serous PED of at least 1 disc diameter in size and the second (83 patients, 86 eyes) eyes with late leakage of undetermined source. All the patients were treated with PDT. The follow-up time ranged from 12 to 48 months. Results: At the last examination, in the first group, the visual acuity (VA) improved or remained stable in 17 (22.7%) and decreased in 58 (77.3%). In the second group, the VA improved or remained stable in 37 (43%) and decreased in 49 (57%). The difference in the change (decrease) in the VA between the two groups was statistically very significant (p = 0.0075). Retinal pigment epithelium tear occurred in 15 eyes (20%) of the first group. Conclusion: Our study showed that the visual prognosis of eyes treated with PDT due to subfoveal occult CNV associated with serous PED is not favorable. We believe that the distinction between the two forms of occult CNV is essential, as they carry a different prognosis.