George Kymionis

Prevalence of autoantibodies against contractile proteins in coronary artery disease and their clinical implications

In this initial study, we found that autoantibodies against actin and myosin were present during and after an acute coronary syndrome. Moreover, they correlated with persistent troponin-I elevation at follow-up, and with late myocardial infarction.

Trans advanced surface laser ablation (TransPRK) outcomes using SmartPulseTechnology

PURPOSEnTo evaluate early visual rehabilitation, post-operative pain, epithelial healing and haze after transepithelial photorefractive keratectomy (TransPRK) using the SmartPulseTechnology (SPT) of Schwind Amaris (Schwind eye-tech-solutions GmbH, Kleinostheim, Germany).nnnMETHODSnThis was a retrospective comparative evaluation of a cohort of myopic patients undergoing TransPRK with SPT (group 1), with one matched control group that underwent conventional TransPRK (group 2). All cases had a 6-month post-operative follow-up including visual acuity and slit-lamp examination. Subjective evaluation of pain was recorded post-operatively.nnnRESULTSn49 eyes of 25 patients in group 1 and 40 eyes of 20 patients in group 2 were enrolled. The patients visual rehabilitation was significantly faster in group 1, one day and one week post-operatively (P<0.05). From one month onward there was no significant difference between the groups. The epithelial defect size was significantly smaller on post-operative days 1 and 2 for group 1 (P<0.05 in both cases). The pain score was also significantly less in group 1 (P<0.05). The haze level had no significant difference between the groups at any post-operative point (P>0.05).nnnDISCUSSIONnTransPRK using SPT provides promising results in the early post-operative period. Visual rehabilitation, re-epithelialization and pain were faster in the early post-operative period in group 1 in comparison with group 2. Haze formation was not significantly different between the two groups; however, it was consistently less in group 1.

Endothelial keratoplasty in eyes with a retained angle-supported intraocular lens

PurposeTo describe the outcomes of endothelial keratoplasty (EK) for bullous keratopathy in eyes with a retained angle-supported anterior chamber intraocular lens (acIOL).MethodsAmong 263 consecutive EK procedures, 7 DMEK and 11 DSAEK procedures were identified in eyes with an acIOL and included in the present retrospective case series. Pre- and postoperative status including ocular history, anatomical outcome and complications as well as best-corrected visual acuity was evaluated.ResultsOcular history included complicated cataract surgery (nu2009=u200911), ocular trauma (nu2009=u20094) and primary intracapsular cataract extraction (nu2009=u20093). Surgery-related complications included primary graft failure (nu2009=u20091), graft detachment (nu2009=u20091), endophthalmitis (nu2009=u20091) and allograft rejection (nu2009=u20091). A clear cornea at the final examination (14u2009±u20094xa0months) was observed in 14/18 (78%), while the visual outcome was limited due to significant ocular comorbidity in 9 out of 14 uncomplicated procedures.ConclusionThe presented short-term outcomes suggest that both DMEK and DSAEK are feasible in eyes with an angle-supported acIOL yielding an acceptable graft survival rate in the first postoperative year.

Keratoconus Treatment Algorithm

Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.

Supradescemetic voriconazole injection for Candida parapsilosis keratitis

PurposeTo describe a technique for intracorneal application of voriconazole into the supradescemetic space in a case of deep recalcitrant Candida parapsilosis keratitis of a penetrating cornea graft.MethodsA deep intracorneal incision reaching the center of the corneal infiltrate was created with a 20-gauge MVR blade. Then, a 27-gauge hydrodissection cannula was inserted deep into the corneal pocket, and 0.1xa0ml of voriconazole 0.5xa0mg/ml was injected until a bullous detachment of Descemet membrane (DM) covered 1/3 of the graft’s area. DM detachment was documented by anterior segment optical coherence tomography (AS-OCT).ResultsAS-OCT confirmed the creation of a drug depot in the supradescemetic space, which partially regressed during the following hours; 24xa0h after the injection, a complete reattachment of DM was documented. After 4xa0weeks, the stromal infiltrate has cleared completely and no signs of recurrence were observed 3xa0months after injection.ConclusionIn the present case, the supradescemetic voriconazole injection led to resolution of a deep recalcitrant fungal infiltrate. The herein described technique could be tried in similar cases, where an intrastromal injection is indicated, as it may offer a larger intracorneal drug depot.

Tectonic epikeratoplasty with ethanol-stored donor corneas

To evaluate the efficacy and outcomes of tectonic epikeratoplasty with use of ethanol-preserved corneal grafts for the management of perforated corneal melts. The present retrospective case series includes 10 eyes which underwent tectonic epikeratoplasty for perforated corneal melts. The stromal remainders of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation were stored in 95% ethanol and used as emergency tectonic grafts for restoring globe integrity after sterile and infectious perforated corneal melts. In 6 cases with subtotal corneal melt, DMEK remainders (endothelium-denuded corneoscleral buttons) were used for ‘limbus to limbus’ tectonic epikeratoplasty and in 4 cases DSAEK remainders (anterior stroma) were used to seal focal perforated melts. Graft storage time was 5.1u2009±u20094.9 (ranging from 0.5 to 17) months. The surgeries were successful in all cases with restitution of the globe integrity. During the postoperative course 4 cases developed a graft melt (corneoscleral button for limbus to limbus tectonic epikeratoplasty, nu2009=u20093; lamellar patch, nu2009=u20091) within 2–6xa0months after the initial procedure. Three patients underwent successful repeat tectonic epikeratoplasty. In the fourth case of graft melt the globe was enucleated due to underlying expulsive haemorrhage and severe pain. The short-term results of the present case series suggest that the use of ethanol-stored stromal remainder of donor corneas after endothelial keratoplasty is an efficient temporary measure for tectonic restoration of perforated corneas.

Optical Coherence Tomography Angiography of Foveal Neovascularization in Diabetic Retinopathy.

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.

Surgical management of spontaneous, late-onset Descemet membrane detachment after penetrating keratoplasty for keratoconus: a case report

BackgroundTo report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty.Case presentationA 55-year old patient presented with sudden visual loss in his left eye 28xa0years after penetrating keratoplasty for keratoconus. Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue, accompanied by corneal graft oedema. Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema. We proceeded with a full-thickness, partially circumferential incision in the graft-host junction, followed by repositioning and re-suturing of the graft in place, and intracameral air injection in order to achieve reattachment of Descemet membrane.ConclusionsCorneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment.

Treatment of anterior corneal scarring, following DSAEK graft failure, with combined graft exchange and phototherapeutic keratectomy

BackgroundTo present a method, alternative to penetrating keratoplasty, for the restoration of impaired corneal clarity with anterior stromal scarring following long-standing corneal graft failure.Case presentationA 48-year old female who had previously underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of pseudophakic bullous keratopathy, presented with long-standing corneal oedema and anterior corneal scarring. A significant improvement in corrected distance visual acuity was demonstrated, as corneal clarity was restored following graft exchange and phototherapeutic keratectomy (PTK).ConclusionsThe combination of corneal graft exchange and phototherapeutic keratectomy may represent an effective therapeutic option for long-standing corneal oedema with concomitant anterior corneal scarring after failure of a DSAEK graft.

Early anti-VEGF treatment for hemorrhagic occlusive retinal vasculitis as a complication of cataract surgery

BackgroundWe report a case of hemorrhagic occlusive retinal vasculitis (HORV) after prophylactic intracameral vancomycin use during an uneventful cataract surgery treated with early anti-VEGF treatment.Case presentationA 51-year-old female underwent uneventful cataract surgery with prophylactic intracameral vancomycin during the procedure. On the seventh post-operative-day, she presented with sudden painful, visual loss. Fundus examination revealed peripheral hemorrhagic retinal vasculitis. She received anti-VEGF therapy to prevent further vision loss and retinal neovascularization due to extensive retinal ischemia. At the 6-month follow-up visit, visual acuity was 20/20 with no sign of neovascularization.ConclusionsPostoperative HORV is a devastating condition that can occur after otherwise uncomplicated cataract surgery. The nature of this rare condition remains unknown. Early anti-VEGF administration seems to demonstrate favorable results.