Spyridon K. Charisis

The use of intravitreal etanercept in diabetic macular oedema.

The aim of this pilot study was to investigate the effect of intravitreal administration of etanercept in refractory diabetic macular edema. Seven patients diagnosed with diabetic macular edema, refractory to previous treatment, were enrolled. They all received 2 consecutive intravitreal injections of 2.5 mg (0, 1 ml) of Etanercept (Enbrel), with a two-week interval. In all patients visual acuity assessment, fundoscopy and fluorescein angiography were performed prior to the first injection, weekly for the first month, as well as 2 and 3 months following the first injection. No adverse reactions or adverse events were noticed in any patient. Analysis of the data indicates a trend for improvement of visual acuity, a slight worsening of hard exudates and fluorescein leakage, while hemorrhages remained stable, 3 months after initiation of therapy. However, no statistical significance has been reached. This small pilot study did not reveal any improvement in the clinical course of patients with refractory diabetic macular edema after the intravitreal injection of etanercept. Further research is warranted in order to obtain conclusive results concerning the role of anti-TNF therapy in diabetic macular edema.

One-year results of photorefractive keratectomy and laser in situ keratomileusis for myopia using a 213 nm wavelength solid-state laser

PURPOSE: To study the long‐term results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in low to moderate myopic corrections using the Pulzar Z1 system (CustomVis), a 213 nm wavelength solid‐state laser. SETTING: University refractive surgery center. METHODS: This prospective noncomparative case series comprised 20 patients (40 eyes) who had refractive surgery using the Pulzar Z1 laser system. Manifest refraction, uncorrected visual acuity, best spectacle‐corrected visual acuity (BSCVA), safety, predictability, stability, and confocal microscopy images were evaluated. RESULTS: Ten patients (20 eyes) had PRK and 10 patients (20 eyes) had LASIK. The mean follow‐up was 13.9 months ± 1.1 (SD) (range 12 to 17 months) and 14.6 ± 1.2 months (range 12 to 18 months) in the PRK group and LASIK group, respectively. No eye lost a line of Snellen BSCVA during the follow‐up period; 2 eyes (10%) gained 2 Snellen lines. There was a statistically significant decrease in spherical equivalent manifest refraction postoperatively in both groups (P<.05). Refractive stability was obtained during the first postoperative month and remained stable during the follow‐up period, with no significant changes between any interval in both groups (P>.05). At the last follow‐up, 95% of all eyes were within ±1.00 diopter of emmetropia. No late postoperative complications were observed. CONCLUSION: Refractive surgery using the Pulzar Z1 213 nm wavelength solid‐state laser was a safe, effective procedure in the treatment of low to moderate myopia.

Atorvastatin for Diabetic Macular Edema in Patients with Diabetes Mellitus and Elevated Serum Cholesterol

BACKGROUND AND OBJECTIVE To determine the efficacy of atorvastatin in reducing hard exudates and diabetic macular edema. PATIENTS AND METHODS An uncontrolled clinical case series included 18 eyes with diabetic maculopathy and an elevated baseline lipid profile. All patients were treated with atorvastatin. Ophthalmologic evaluation, including fundus photography and fluorescein angiography, was performed at presentation and repeated at 3, 6, and 12 months. Hard exudates, hemorrhages, and fluorescein leakage at 12 months were evaluated and compared with baseline findings. RESULTS Eighteen subjects with diabetic maculopathy received atorvastatin, and a significant decrease in total cholesterol and low-density lipoprotein cholesterol was seen (P < .05). Hard exudates and fluorescein leakage were decreased. No evidence of an association between change in hemorrhage status and treatment was found. CONCLUSION Oral atorvastatin therapy in patients with diabetes mellitus and dyslipidemia seems to reduce the severity of hard exudates and fluorescein leakage in diabetic maculopathy and could be useful as an adjuvant therapy in the management of diabetic macular edema.

Spontaneous Closure of Macular Holes Developed after Pars Plana Vitrectomy

Purpose: To report a small, retrospective, noncomparative case series (3 patients) of idiopathic macular holes with spontaneous closure in previously vitrectomized eyes. Methods: The first patient developed a macular hole 14 months after vitrectomy for penetrating ocular trauma. In the rest of the patients, the macular holes were documented ten days and two months after vitrectomies for retinal detachment. Results: In all cases the macular holes resolved spontaneously 2 years, 6 and 9 months after their documentation, respectively. Conclusions: Despite the limitations placed by the small sample of studied patients, it seems that spontaneous closure of macular holes developed after vitrectomy can happen as part of their natural course. Both pathogenetic and repair factors involved in macular hole can act spontaneously in a vitrectomized eye.

Evaluation of Vitreous Clearance and Potential Retinal Toxicity of Intravitreal Lornoxicam (Xefo)

PURPOSE To evaluate the vitreous clearance and toxicological profile of commercially available lornoxicam (Xefo), after a single intravitreal injection in rabbits. METHODS Twenty-five male albino rabbits (10 rabbits were used for retinal toxicity evaluation, while 15 rabbits were used to evaluate vitreous clearance) were used in this study. Two concentrations of lornoxicam were tested for retinal toxicity: 250 μg/0.1 mL and 1,500 μg/0.1 mL. Each concentration was intravitreally injected randomly in 1 eye of each rabbit (group I received 250 μg/0.1 mL, n=5 and group II received 1,500 μg/0.1 mL, n=5), while in the other eye 0.1 mL of sterile balanced saline solution was injected. Slit-lamp and funduscopic examinations along with intraocular pressure measurements (IOP) were performed prior to injection and at days 1, 15, and 30 after the injection for signs of infection, inflammation, toxicity, and IOP changes. A baseline electroretinogram (ERG) was performed before the experiment and at days 1, 15, and 30 after the intravitreal injection. At the last follow-up day, the animals were sacrificed and the enucleated eyes were prepared for histological evaluation of the retina. Lornoxicam (concentration of intravitreal injection: 250 μg/0.1 mL) clearance from the vitreous was estimated using high-performance liquid chromatography in 30 rabbit eyes. RESULTS There were no statistical differences between the control and experimental eyes, concerning ERG amplitudes and IOP measurements for both groups (I and II), at all examinations. On the contrary, histological examination of the samples revealed extended retinal damage of group II experimental eyes (morphological alterations at the level of the inner nuclear and outer plexiform layers was evident along with disappearance of normal stratification of outer retina with vacuolization and thinning), whereas the morphology of group I experimental eyes did not differ from that of the control eyes. Lornoxicam is eliminated from the vitreous by a first-order kinetic process with a half-life of 1.7 h. CONCLUSIONS Intravitreal lornoxicam causes dose-related toxic effect to the retina at a concentration of 1,500 μg. A dose of 250 μg does not seem to cause histological toxic effects at the level of the retina. Lornoxicam could be considered with interest for further research for the development of alternative treatments for ocular inflammatory conditions.

Tono-Pen XL tonometry during application of a suction ring in rabbits

BackgroundThe purpose of this study is to evaluate the use of Tono-Pen XL in measuring IOP during the application of a suction ring in rabbit eyes with manometrically controlled IOP.MethodsTono-Pen XL was calibrated against direct manometry in 10 rabbit eyes. A suction ring was then applied in 4 rabbit eyes and the IOP was determined manometrically during suction ring application at 350 mmHg vacuum pressure. Finally, in 6 catheterized rabbit eyes the IOP was measured with Tono-Pen XL during suction ring application at suction vacuum from 350 to 650 mmHg, while keeping actual IOP stable at 30 mmHg and 60 mmHg.ResultsLinear regression analysis revealed that the Tono-pen XL was reliable for IOPs between 10 and 70 mmHg (R2 = 0.9855). Direct manometry during suction ring application showed no statistically significant variation of Tono-Pen XL readings when the incanulation manometry intraocular pressure changed from 30 mmHg to 60 mmHg and no statistically significant correlation between suction vacuum and IOP measurements.ConclusionTono-Pen XL measurements are unreliable during the application of a suction ring on living rabbit eyes even when the actual IOP is forced to be within the validated range of Tono-Pen XL measurements. This inaccuracy is probably related to altered corneal and scleral geometry and stress.

Contact transcleral photodynamic cyclo-suppression in human eyes: a feasibility study

OBJECTIVE To evaluate the safety and efficacy of contact transcleral ciliary body photodynamic treatment (CB-PDT) with verteporfin in human eyes. DESIGN Prospective interventional case series. PARTICIPANTS Five glaucomatous blind eyes of 5 patients. METHODS Verteporfin (6 mg/m(2)) was infused in bolus and then the ciliary body was irradiated transclerally with a fibre optic device. Twelve spots were placed 360° and 0.5 mm behind the sclerocorneal limbus. Laser power was 80 mW and irradiation time was 3 minutes. RESULTS The average intraocular pressure reduction was 30% after the first month and remained below pre-treatment levels throughout a 3-month follow-up. No serious adverse events were reported. CONCLUSIONS CB-PDT for refractory glaucoma was safe and efficient in human eyes; larger studies are required to evaluate its possible clinical role.

Contact transcleral ciliary body photodynamic therapy with verteporfin in pigmented rabbits: effect of repeated treatments.

We studied the effect on the intraocular pressure (IOP) and the ciliary body (CB) morphology after four consecutive contact transcleral photodynamic treatments of the ciliary body (CB‐PDT) with verteporfin in pigmented rabbits. Twenty‐two pigmented rabbits underwent CB‐PDT (study group), performed once (six rabbits) or repeated for up to four times (16 rabbits). Six additional rabbits received only laser treatment without photosensitizer administration (control group). CB‐PDT was performed in one eye in rabbits of the study group, with the fellow eye serving as internal control. Verteporfin dosage was 1 mg kg−1as bolus injection and laser settings were 40 mW (600 μm core optical fiber) for 1.5 min per spot, for 10 spots. In repeated CB‐PDT, treatments were performed in 4‐day intervals. Daily IOP measurements were recorded. Histological studies were performed at selected time points. An IOP reduction, more sustained following repeated treatments, was detected in all treated eyes but not in fellow eyes or in the control group. On the average, the IOP was restored to pretreatment levels 4 days after the last treatment. No serious adverse events were observed and the CB architecture was intact at the end of the experiment. Repeated CB‐PDT is safe and results in a short‐term reduction of IOP. Induced CB alterations are reversible.