Georgios Kitsos

Central corneal thickness in subjects with glaucoma and in normal individuals (with or without pseudoexfoliation syndrome).

Objective: The evaluation of central corneal thickness (CCT) in subjects with pesudoexfoliation glaucoma (PEXG), primary open-angle glaucoma (POAG), and in normotensive individuals with or without pseudoexfoliation syndrome (PXS). Study design/patients and methods: CCT was evaluated with ultrasound pachymetry in a total of 179 individuals: 32 had bilateral PEXG, 55 had bilateral POAG, 35 had PXS, and 57 were healthy individuals without PXS. Results: CCT in PEXG eyes (526.00 ± 34.30 μm) was significantly thinner compared to POAG eyes (549.36 ± 39.3 μm) (P = 0.027) and normal control eyes with (550.64 ± 39.0 μm) or without PXS (547.36 ± 33.1 μm), (P = 0.039 and 0.048 respectively). No statistically significant difference was found comparing CCT values of POAG eyes to control group eyes. Conclusion: The evaluation of CCT is necessary in all patients with glaucoma and especially in those with PEXG due to the thinner cornea and the risk of underestimation of intraocular pressure.

Perimetric and peri-papillary nerve fibre layer thickness findings in multiple sclerosis

Background and purpose:  Several previous studies have employed optical coherence tomography (OCT) of the optic disc and ‘white‐on‐white’ automated perimetry to evaluate optic neuritis (ON) associated with multiple sclerosis (MS). This study employed OCT, white‐on‐white automated perimetry as well as ‘blue‐on‐yellow’ automated perimetry to evaluate MS patients with or without episodes of ON.

Tele-ophthalmology and conventional ophthalmology using a mobile medical unit in remote Greece

We evaluated the quality of medical services delivered to remote glaucoma patients from a mobile unit. A four-wheel-drive vehicle containing the necessary equipment visited five different remote locations in Greece. During a three-year prospective study, 1205 patients were examined, of whom 230 had glaucoma. The majority of the subjects were examined by the units medical staff using the available instrumentation (e.g. slit-lamp and tonometer), while 56 glaucoma subjects were telemedically examined by consultants at the Patissia General Hospital, in Athens. Control data were obtained from a random sample of 260 urban glaucoma patients. A significantly greater proportion of the remote patients had an inadequate awareness of glaucoma (77%) compared with the urban patients (20%). Significantly more remote patients had poorer compliance (68%) in comparison with urban patients (23%). A significantly larger proportion of the remote patients had high intra-ocular pressure (21%) compared with the urban patients (5%). Technical difficulties occurred in the 13 of the 56 telemedical examinations. Mobile medical units can enhance access to medical services and contribute to the health-care of under-served populations.

Comparative results of central corneal thickness measurements in primary open-angle glaucoma, pseudoexfoliation glaucoma, and ocular hypertension.

BACKGROUND AND OBJECTIVE As clinical measurements of corneal thickness have become widely available, several studies found a positive correlation between central corneal thickness and applanation tonometry measurements. This study evaluated central corneal thickness in different types of glaucoma. PATIENTS AND METHODS An observational cross-sectional study assessed central corneal thickness using a specular microscope in the following groups of patients: 60 eyes with primary open-angle glaucoma, 50 eyes with pseudoexfoliation glaucoma, 50 eyes with ocular hypertension, and 60 eyes without glaucoma or ocular hypertension (control group). RESULTS Central corneal thickness was significantly thinner in cases with pseudoexfoliation glaucoma (P < .0001) and significantly thicker in cases with ocular hypertension (P< .0001). CONCLUSIONS These results agree with the literature, strengthening the position that central corneal thickness varies in different types of glaucoma and, therefore, is a parameter that should be taken under consideration, especially when evaluating cases of pseudoexfoliative glaucoma and ocular hypertension.

Comparison of one-site versus two-site phacotrabeculectomy without the use of antimetabolites intraoperatively in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma

Purpose: The comparison of one-site versus two-site phacotrabeculectomy in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG), with respect to intraocular pressure (IOP), antiglaucomatous medication (AM) requirements and visual acuity (VA). Methods: Forty-seven patients (eyes) with cataract and POAG and 46 sex- and age-matched patients with cataract and PEXG were randomized to one- or two-site phacotrabeculectomy and reviewed with a follow-up at three years. Results: Mean preoperative IOP was 22.04 ± 2.27 mmHg and 22.92 ± 2.35 mmHg in POAG and PEXG groups (p > 0.05) using a mean of 2.76 ± 0.74, 2.74 ± 0.69 AM, respectively (p > 0.05). After three years of follow-up, the mean IOP was 15.04 ± 1.57 mmHg in the one-site, 15.04 ± 1.99 mmHg in the two-site group with POAG, 15 ± 1.8 mmHg in the one-site, 15.32 ± 1.31 mmHg in the two-site group with PEXG, using a mean of 0.68 ± 0.69, 0.84 ± 0.75, 0.96 ± 0.67, and 0.8 ± 0.62 AM, respectively. Mean IOP and AM postoperatively were significantly less compared to preoperatively for each group (p < 0.05). No difference was observed in mean IOP and AM between the four groups at three years postoperatively (p > 0.05). VA improved similarly in four groups at the three-year follow-up (p < 0.05). Intraoperative, postoperative complications, and need for 5-fluorouracil injections were similar between the surgical groups. Conclusion: One-site and two-site phacotrabeculectomy without the use of antimetabolites intraoperatively were similarly safe and effective in IOP control over a three-year follow-up period in patients with POAG and PEXG.

Thrombophilic risk factors in the pathogenesis of non-arteritic anterior ischemic optic neuropathy patients.

BackgroundNon-arteritic anterior ischemic optic neuropathy (N-AION) is caused by acute ischemic infarction of the optic nerve head, supplied by the posterior ciliary arteries. Thrombophilia is the tendency/predisposition to vascular thromboses of arteries and veins, and the existence of thrombophilic risk factors leads to blood hypercoagulability and potentially increased risk for thromboses.ObjectivesTo investigate whether there is an association between N-AION and a wide spectrum of thrombophilic risk factors.Patients and methodsSeventy-seven consecutive cases of confirmed N-AION and 60 age- and sex-matched consecutive controls constituted the study group. Fibrinogen levels, deficiency of proteins C, S, ATIII, lupus anticoagulant, activated protein C resistance, factor V Leiden, factor V H1299R, factor II G20210A, MTHFR C677T, MTHFR A1298C, GPIIIa A1/A2, and ACE I/D polymorphisms were analysed.ResultsStatistical analysis of the plasma proteins in our study demonstrated that the only significant difference was the one concerning protein S levels. In particular, the mean value for N-AION patients was 78.8% ± 21.2, and for the control group the mean value was 88% ± 21.2 (p = 0.013). Despite the above-mentioned result, there was not any statistical difference between the two subgroups regarding actual protein S deficiency, as 9/77 (11.7%) patients and 4/60 (6.7%) controls had protein S levels below 60% (p = 0.32). In our study sample, homozygosity for MTHFR C677T polymorphism in the study group as a whole, and the presence of at least one A2 allele of GPIIIa in the subgroup of male patients as compared to healthy male controls, proved to be the most significant thrombophilic risk factors, with odds ratios of 16.78 (95% C.I 0.96–294.42, p = 0.054) and 4.6 (95% C.I 1.52–13.88, p = 0.007) respectively.ConclusionScreening for these polymorphisms would probably constitute a valuable procedure in N-AION patients, as they may have an important contribution to the pathogenesis of the disease.

Neurological manifestations of connective tissue diseases mimicking multiple sclerosis

The objective of the study was to analyze retrospectively the clinical, laboratory and imaging findings of multiple sclerosis (MS), such as the manifestations in a cohort of 132 patients referred to the neurology in and outpatient clinic. The proposed clinical and laboratory diagnostic criteria for MS and connective tissue disorders were systematically assessed in 132 consecutive patients. Cerebrospinal fluid serology and brain or spinal cord MRI were studied in all cases. In patients suspected for connective tissue disorder, schirmer test, rose bengal staining and biopsy of minor salivary glands were performed. A total of 115 (87%) patients were diagnosed to have definite MS, while 17 (13%) were diagnosed to have connective tissue disorder. Positive neurological and MRI findings were observed in both groups. The majority of patients with connective tissue disorder demonstrated extra-neurological manifestations like Raynaud’s phenomenon, arthritis, livedo reticularis, purpura and presence of multiple autoantibodies in their sera. All patients with MS should be screened systematically for connective tissue disorder. In the absence of pathognomonic clinical and laboratory findings, the diagnosis of MS is a diagnosis of exclusion.

Association of Superoxide Dismutase 2 Polymorphism Rs4880 and Open-Angle Glaucoma in a Greek Patients Cohort

Purpose: Glaucoma is a multifactorial optic neuropathy and leading cause of visual impairment and blindness. Multigenic inheritance hypothesis is being investigated over the past decades and numerous mainly causative and synergic polymorphisms have been revealed. Aim of this study is to investigate whether superoxide dismutase 2 (SOD2) polymorphism rs4880 is associated with primary open angle glaucoma (POAG) in Greek population. Materials and method: This is a case control study of 106 POAG patients and 120 thoroughly examined, unrelated, healthy control subjects of Greek origin, surveyed for SOD2 polymorphism rs4880 and potential correlation to POAG. Results: SOD2 rs4880 polymorphism showed no statistically significant difference between POAG patients and healthy controls. Mean intraocular pressure (IOP) of both eyes of the heterozygous (T/C) group was found significantly higher than in homozygous (T/T) group (19.13 ± 0.60 vs. 17.59 ± 0.33, p = 0.02). When we compared the IOP in each eye separately, the (T/C) and (C/C) carriers had significantly higher IOP on their left eye compared to the (T/T) carriers [(Τ/C) 18.79 ± 0.56 vs. (Τ/Τ) 17.2 ± 0.36, p = 0.02 and (C/C) 20.75 ± 2.14 vs. (Τ/Τ) 17.2 ± 0.36, p = 0.03). Conclusion: Our study did not find any significant association between SOD2 rs4880 polymorphism and POAG. Mean IOP of the polymorphic (C) allele carriers was found significantly higher than in homozygous (T/T) group. As we cannot reject the possibility that oxidative stress might be a crucial factor for the POAG development further studies may be needed to confirm the importance of SOD2 gene in POAG pathogenesis.