Preliminary Study on the Tears Oxidative Stress Status and Sleep Disturbances in Irritable Bowel Syndrome Patients.

According to the latest gastrointestinal disorders diagnostic criteria (ROME IV), the irritable bowel syndrome (IBS) is mainly characterized by the presence of abdominal pain and changes in intestinal transit. However, both sleep impairments and oxidative status changes (in patients' sera, mucosal level, and other body fluids) were reported IBS. Thus, in this study, we aimed to evaluate several aspects regarding the oxidative stress status in patients' tears as well as sleep disturbances by comparison with the intensity of IBS symptoms, as assessed by the visual analogue scale for irritable bowel syndrome (VAS-IBS). Ten IBS patients and fourteen healthy sex- and age-matched volunteers were recruited from the Oftaprof Ophthalmological Clinic (Iași, Romania). Visual analogue scale for irritable bowel syndrome and the Pittsburgh Sleep Quality Index (PSQI) questionnaires were administered to all the patients. Tear samples were collected using the Schirmer test procedure and were subjected to biochemical analysis-superoxide dismutase and glutathione peroxidase activities, malondialdehyde, and total soluble proteins levels were determined. Standard statistical analysis was applied. We found significant differences in oxidative stress marker dynamics in IBS patients as compared to healthy age- and sex-matched controls: increased superoxide dismutase activity (p = 0.02), increased malondialdehyde (p = 0.007), and total soluble proteins levels (p = 0.019). We found no significant differences in tear glutathione peroxidase activity in IBS patients as compared to healthy age- and sex-matched controls (p = 0.55). Furthermore, we observed that the oxidative stress tear markers are correlated with gastrointestinal symptoms severity (as evaluated by VAS-IBS) but not correlated to the sleep quality index and items (as evaluated by PSQI), with significant differences according to patient sex and IBS subtype stratification. In this way, this study brings additional evidence of the oxidative stress role in IBS pathology alongside the evaluation of tear fluid molecular dynamics in IBS for the first time in our best knowledge.

Oxidative stress markers dynamics in keratoconus patients' tears before and after corneal collagen crosslinking procedure.

Keratoconus (KC) is a controversial ophthalmological disease, often considered both multifactorial and multigenic with poor or not entirely understood etiopathogenesis. Corneal collagen crosslinking (CXL) procedure is the most common surgical therapy for KC which both slows corneal thinning and halts disease progression. While extensive studies provide consistent evidence on systemic oxidative stress in KC patients and animal models, little is known on the tear fluid oxidative stress markers such as antioxidant enzymes activity or lipid peroxidation markers. Also, little is known considering the oxidative status dynamics following CXL. In this way, we aimed to evaluate three oxidative stress markers in the tears of KC patients before and after CXL procedure. Total superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymatic activity and malondiladehyde (MDA) levels were assessed from the tears of 20 kC patients who received the recommendation for CXL procedure. Significantly decreased SOD activity (p = 0.0014) was observed in KC patients tears, as compared to age and sex-matched controls which could lead to significant lipid peroxidation boost (p < 0.001). Significantly higher GPx enzyme activity was observed in KC patients, as compared to control (p < 0.001), suggesting a compensatory response to intense lipid peroxidation. Following CXL, SOD activity significantly decreases and GPx activity extensively increases, as compared to baseline KC levels and controls (p < 0.001). This work provides additional evidence on oxidative stress status in the tears of KC considering general oxidative stress markers dynamics both before and after the CXL procedure. We also demonstrated that the CXL procedure could have further relevance in the management of this disorder.

Predictions of ocular changes caused by diabetes in glaucoma patients.

BACKGROUND AND OBJECTIVE: This paper builds different neural network models with simple topologies, having one or two hidden layers which were subsequently employed in the prediction of ocular changes progression in patients with diabetes associated with primer open-angle glaucoma. MATERIAL AND METHODS: For attempting to indicate whether there is a relationship between glaucoma and diabetes, a simulation method, based on artificial neural networks (ANN), Jordan Elman networks (JEN) type, in particular, was applied in conjunction with clinical observation. The study was conducted on a sample of 101 eyes with open angle glaucoma included and, in each case, the patients had associated diabetes mellitus. A high degree of accuracy was exhibited by the models, demonstrating the potential effectiveness of this artificial intelligence technique for predicting ocular changes associated with diabetes. The parameters considered in this study for modelling purpose were: glaucoma age, diabetes age, C/D ratio (cup/disk size), glycated haemoglobin level (HbA1c), intraocular pressure (IOP), patient age, mean deviation (MD) and LENS appearance. RESULTS: Relatively simple models, feed-forward neural networks with one or two intermediate layers, provided clinically meaningful data in direct modelling, the probability of correct answers being of 95%. Inverse modelling was also performed, in which MD depreciation was the output parameter. High accuracy was exhibited, in this case, with Jordan Elman networks, with the confidence interval of ±15%. CONCLUSIONS: The neural models have demonstrated the possibility of their use in successfully predicting the relationship between glaucoma and diabetes in a real clinical environment.

Iontophoretic collagen cross-linking versus epithelium-off collagen cross-linking for early stage of progressive keratoconus - 3 years follow-up study.

PURPOSE: To compare 3-year iontophoretic corneal collagen cross-linking (I-CXL) outcomes with epithelium-off corneal collagen cross-linking (epi-off CXL) for early stage of progressive keratoconus. METHODS: Eighty eyes of 80 patients with early progressive keratoconus treated by I-CXL (n = 40) or epi-off CXL (n = 40) were included in this study. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, corneal topography and pachymetry were assessed at baseline and at 1, 3, 6, 12, 24 and 36 months of follow-up. RESULTS: Visual acuity (VA) showed a significant improvement (p < 0.05) at the end of follow-up in both groups. In the I-CXL group, the UDVA showed a rapid recovery after 3 months (p = 0.04). There was a statistically significant different trend in CDVA between groups with a more favourable outcome for the standard CXL group (p < 0.01). The cylinder improved beginning with 3 months after CXL in both groups. Maximum keratometry showed a significant reduction by 0.9 dioptres (D) in the I-CXL group and by 1.2 D in the epi-off CXL group after 36 months (p = 0.283). Pachymetry values decreased at 3 months while a statistically significant increase occurred in both groups at 24 months. Progression occurred to one patient (2.5%) in I-CXL group. Adverse effects occurred to eight eyes (20%) in the epi-off CXL group. CONCLUSION: Iontophoretic corneal collagen cross-linking (I-CXL) is non-inferior to epi-off CXL for stopping the progression of keratoconus in its early stages with a higher degree of safety for the patients and a faster recovery of VA.

Successful treatment of fungal endophthalmitis using intravitreal caspofungin.

Fungal endophthalmitis is a rare condition often associated with poor prognosis. We present a case of postoperative acute fungal endophthalmitis caused by the yeast-like fungus Stephanoascus ciferrii (Candida ciferrii). The fungus was resistant to fluconazole, voriconazole, and amphotericin B but susceptible to caspofungin. Because the degree of vitreal penetration of caspofungin after its intravenous administration is unclear, we performed multiple intravitreal injections, first with 50 µg/0.1 ml and then with 250 µg/0.1 ml caspofungin. Despite the recurrence of symptoms, intravitreal injection of caspofungin finally abolished the inflammation and achieved ambulatory vision that persisted until 1 year of follow-up. To our knowledge, this is the first report of S. ciferrii endophthalmitis and its successful treatment with intravitreal caspofungin.

Successful treatment of fungal endophthalmitis using intravitreal caspofungin / O primeiro relato de caspofungina intravítrea no tratamento de endoftalmite fúngica

ABSTRACT Fungal endophthalmitis is a rare condition often associated with poor prognosis. We present a case of postoperative acute fungal endophthalmitis caused by the yeast-like fungus Stephanoascus ciferrii (Candida ciferrii). The fungus was resistant to fluconazole, voriconazole, and amphotericin B but susceptible to caspofungin. Because the degree of vitreal penetration of caspofungin after its intravenous administration is unclear, we performed multiple intravitreal injections, first with 50 µg/0.1 ml and then with 250 µg/0.1 ml caspofungin. Despite the recurrence of symptoms, intravitreal injection of caspofungin finally abolished the inflammation and achieved ambulatory vision that persisted until 1 year of follow-up. To our knowledge, this is the first report of S. ciferrii endophthalmitis and its successful treatment with intravitreal caspofungin.

RESUMO Endoftalmite fúngica é uma ocorrência rara, muitas vezes associada com mau prog nóstico. Apresentamos um caso de endoftalmite fúngica aguda pós-operatória causada por fungo de levedura incomum, Stephanoascus ciferrii (Candida ciferrii). O fungo foi resistente ao fluconazol, ao voriconazol e à anfotericina B e susceptível à caspofun gina. Dado que a penetração vítrea da caspofungina após administração intravenosa não é clara, optou-se por realizar múltiplas injecções intravítreas, primeiro de 50 µg e depois de 250 µg de caspofungina, e finalmente obteve-se a resolução da inflamação e a visão recuperada foi mantida por pelo menos um ano após o ocorrido. No nosso conhecimento, este é o primeiro relato de endoftalmite por Stephanoascus ciferrii e o primeiro relato de endoftalmite fúngica tratada com sucesso com caspofungina intravítrea.

Evaluation of Iontophoretic Collagen Cross-linking for Early Stage of Progressive Keratoconus Compared to Standard Cross-linking: A Non-Inferiority Study.

INTRODUCTION: The purpose of this study was to evaluate the efficacy and safety of iontophoretic collagen cross-linking (I-CXL) compared to epithelium-off standard collagen cross-linking (CXL) in treating the early stages of progressive keratoconus. METHODS: This retrospective cohort study at Oftaprof Clinic, Iasi, Romania included 40 eyes of 40 patients with progressive keratoconus stage I according to the Amsler classification who underwent I-CXL and the results were compared with a matched group of 40 eyes from 40 patients who received standard CXL. The follow-up period was 24 months. Uncorrected (UCVA) and corrected (CDVA) distance visual acuities, corneal topography, and pachymetry were evaluated in all patients. RESULTS: The mean patient age was 26.52 ± 3.77 years for the standard CXL group and 28.32 ± 4.91 for the I-CXL group. The mean UCVA and CDVA improved significantly in both groups. At 12 months, the improvement of UCVA was greater in the I-CXL group (P < 0.05). There was a statistically significant different trend in CDVA between groups with a more favorable outcome for the standard CXL group (P < 0.01). The manifest cylinder decreased by a mean of 0.962 ± 0.114 D in the epithelium-off CXL group and by 0.831 ± 0.082 D in the I-CXL group (P < 0.001). At 24 months, the K max values improved by 1.2 ± 0.199 D in the standard group and by 0.908 ± 0.177 D in the I-CXL group (P < 0.001). CONCLUSION: All parameters either improved or remained unchanged after the iontophoretic collagen cross-linking intervention. I-CXL was found to be as effective as the standard technique.

Outcomes of iontophoretic corneal collagen crosslinking in keratoconic eyes with very thin corneas.

The purpose of this retrospective study was to report the results of iontophoretic corneal collagen crosslinking (I-CXL) with riboflavin and ultraviolet A irradiation in patients affected by keratoconus, each with thinnest pachymetry values of <400 µ (with epithelium) and not treatable using standard epithelium-off technique.Fifteen eyes of 15 patients affected by progressive keratoconus and with thinnest pachymetry values <400 µ underwent I-CXL. The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, maximum and minimum keratometry (K max and K min) readings, corneal thickness at the thinnest point (CTTP), endothelial cell density (ECD), and intraocular pressure (IOP) were assessed before I-CXL, at 1, 3, 6, and 12 months postoperatively.The mean UDVA and CDVA significantly increased 12 months after I-CXL (P = .002 for both comparisons). The K max readings significantly decreased at 6 and 12 months postoperatively (P = .04 and P = .02, respectively). The mean CTTP improved at the end of the follow-up (P = .008). ECD was unchanged. No side effects or damage to the limbal region was observed during the follow-up period.I-CXL has been proved to be effective in halting keratoconus progression in eyes with very thin corneas, with no side effects during the follow-up period. This procedure could be used in patients with more advanced keratoconus.

Translating data and measurements from stratus to cirrus OCT in glaucoma patients and healthy subjects.

Aim: our study tried to find a mathematical conversion method of the measurements obtained in Time Domain (TD) OCT to Spectral Domain (SD) OCT. Material and method: A prospective randomized, double blind study that included 244 eyes, from 121 patients (normal subjects, glaucoma suspects, glaucoma), in whom we analyzed the retinal nerve fiber layer (RNFL) and the optic disc in the same session by using TD OCT (Stratus) and SD OCT (Cirrus), was performed. The means for RNFL thickness (overall value and per quadrants), neural area and cup/ disc (C/ D) ratio, were measured. Results: We found statistically significant differences between parameters measured in TD OCT and SD OCT (p<0.001). Powerful correlations were calculated between parameters measured with the two OCT machines. Data dispersion showed a linear relation between measurements. One can use the following mathematical equations for conversion: Mean RNFL (Cirrus) = 15.77 + 0.748 x Mean RNFL (Stratus) Mean neural area (Cirrus) = 0.508 + 0.388 x Mean neural area (Stratus) Mean C/ D ratio (Cirrus) = 0.157 + 0.792 x Mean C/ D (Stratus) Conclusions: data based on our calculated mathematical conversion equations can be converted into SD OCT. Therefore, we offered a useful tool for the long term monitoring of our patients although the initial measurements in TD OCT made comparisons for patients later measured with SD OCT impossible. Abbreviations: RNFL = retinal nerve fiber layer, TD OCT = time domain optical coherence tomography, SD OCT = spectral domain optical coherence tomography, VF = visual field, CI = confidence interval, ISNT segments = inferior, superior, nasal, temporal segment.

SELECTIVE LASER TRABECULOPLASTY--SHORT TERM EFFICACY AND SAFETY PROFILE IN OPEN ANGLE GLAUCOMA OR OCULAR HYPERTENSION TREATMENT.

UNLABELLED: Selective laser trabeculoplasty--medium term efficacy and safety profile in open anlgle glaucoma or ocular hypertension treatment: SLT effect in reducing the intraocular pressure (IOP) in patients with open angle glaucoma or ocular hypertension. MATERIAL AND METHOD: 70 eyes from 70 patients were included in the study in 2014 (12 months); the established design for this research was prospective and interventional. Patients received indication for SLT treatment as initial procedure or as adjuvant method in reducing the intraocular pressure when insufficient control with topical medication was noted. A single laser procedure was performed on 360 degrees. The result was verified and compared with baseline values of IOP at 1 month, 3 months respectively. RESULTS: IOP decreased at 1 month with 22.47% vs. baseline IOP and with 26.58% at 3 months. The IOP dynamics showed an additional 5.30% decrease between the intermediate and final values, with statistical significance for all the measured parameters (p = 0.001). CONCLUSION: SLT applied on 360 degrees in a single session represents a safe and efficient procedure. The IOP decrease is marked at 1 month, but the effect continues until later, at 3 months interval after treatment. The higher the initial IOP was, the greater effect SLT has in decreasing the IOP level. Most frequently LST helps control the IOP, but rarely allows reducing or eliminating the glaucoma medication.

[Management of intraoperative floppy iris syndrome]. / Managementul sindromului de flaciditate iriana intraoperatorie.

PURPOSE: To evaluate the incidence of IFIS in male patients whith alfa 1-AB treatment for benign prostatic hyperplasia (BPH) who underwent cataract surgery and also the pre and intraoperatory management and IFIS profilaxy. SETTING: Iasi "Sf Spiridon" Emergency Hospital and "Oftaprof" private practice METHODS: Observational retrospective study that took place over a period of 2 years (july 2009-july 2011) and reviewed 2484 eyes that underwent cataract surgery. A number of 1199 eyes were from 1049 male patients. RESULTS: Out of the 1049 male patients, 139 (13,25%) underwent treatment for BHP using the medication as follows: 119 used tamsulosin (85,6%); 18 used doxazosin, (12,94%); 2 used alfuzosin (1,43%). Out of the 139 men, 32 (23,02%) showed IFIS but only the ones treated with tamsulosin. After introducing a surgical protocol that comprised of the use of large amounts of vascoelastic material (Viscoat), intracamerular fenilefrin (Mezaton), the use of iris retractors and low faco parameters the incidence and severity of IFIS was significantly reduced. CONCLUSIONS: Correct evauation before surgery is necessary in order to anticipate the condition as its frequency and severity can be reduced by a proactive behavior which demands experience and adequate endowment.

[Laser refractive surgery for moderate or high myopic astigmatism--1 year outcome]. / Corectia laser a astigmatismelor miopice medii si înalte--rezultate la un an.

PURPOSE: To evaluate the medium term postoperative clinical outcomes in eyes with medium and high myopic astigmatism that had excimer laser refractive surgery (LASIK and PRK). SETTING: Oftaprof Clinic, Iasi. MATERIAL AND METHODS: This prospective interventional study comprised 74 eyes with myopic astigmatism 2D who had excimer laser refractive surgery. Aspheric treatments with a wavefront-optimized ablation profile were performed using the Wavelight Allegretto Eye-Q excimer laser system. The follow-up period was 12 months. RESULTS: Uncorrected distance visual acuity(UD VA) improved from 0,08 +/- 0,09 (SD) to 0,74 +/- 0,16 (SD) 3 months postoperatively and maintained at 0,75 +/- 0,16 (SD) 12 months postoperatively; all eyes achieved UDVA 0,5 or better and 71% of them achieved UDVA 1 or better 12 months postoperatively. REFRACTIVE RESULTS: The mean cylinder and the mean spheric equivalent have significantly decreased after laser refractive surgery (p=0,001); 98% of eyes were within +/- 1D of the attempted astigmatic correction, and 76% were within +/- 0,5D. Only one eye lost one line of corrected distance visual acuity (CDVA), 14 eyes gained one line of CDVA and 6 eyes gained 2 or more lines of CDVA. Intraoperative complications were: limbal vessels haemorrhage during flap creation (6 eyes), flap slightly descentered inferiorly (2 eyes). Postoperative complications were: diffuse lamelar keratitis (3 eyes after LASIK) and moderate epithelial haze (4 eyes after PRK). CONCLUSIONS: PRK and LASIK have safety, efficacy and predictibility of correcting moderate to high myopic astigmatism using Wavelight Allegretto Eye-Q excimer laser system.

[Long-term clinical course after cataract surgery in patients with diabetes mellitus]. / Evolutia functionala pe termen lung dupa operatia de cataracta la pacientii cu diabet.

PURPOSE: To determine the visual outcome at 5 years postoperatively in patients operated for cataract associated with diabetes mellitus. PATIENTS AND METHODS: Retrospective study on a group of 41 eyes in patients with diabetes, who were operated for cataract (the same surgeon) by facoemulsification and IOL implantation in the capsular bag, without intraoperative complications, for 60 months (during 2003-2007). RESULTS: 27 patients with diabetes were included in the study, the average duration of diabetes was 10, 3 years. Average postoperative visual acuity (VA) was 0.5 at six weeks postoperatively. Preoperative VA improvement was observed in 78%. There was a decrease in VA of 85% at more than 5 years after surgery and 15% of eyes had preserved VA. VA decrease was due to the occurrence, progression and worsening of retinopathy (69%) and diabetic maculopathy, posterior capsular opacification (34%), glaucoma, age-related macular degeneration (12%). CONCLUSIONS: Visual acuity was maintained in 15% and decreased in 85% of patients due to diabetic retinopathy, glaucoma, age-related macular degeneration.

[Long-term course of visual acuity in patients with cataract surgery]. / Evolutia pe termen lung a acuitatii vizuale la pacientii operati de cataracta.

PURPOSE: To compare immediate and 5 years postoperatively visual acuity (VA), after uncomplicated cataract surgery and emphasizing the main causes of visual acuity loss. MATERIAL AND METHODS: This is a retrospective study that included 475 eyes that underwent uncomplicated cataract surgery between 2003-2007 by the same surgeon. 51 patients (73 eyes) returned to the last followup visit, 5 years postoperatively. RESULTS: Of 73 eyes, 18 eyes (24.66%) had VA < 0.5, 53 eyes (72.60%) had VA between 0.5-1 and 2 eyes (2.74%) had VA > 1, 5 years postoperatively. 26% (19 eyes) revealed reduced best corrected visual acuity in comparison to that from 6 weeks postoperatively Causes that led to reduced VA are: posterior capsular opacification (46.57%), age related macular degeneration (26.02%), glaucoma (10.95%), diabetic retinopathy (9.58%). CONCLUSIONS: Approximately a quarter of patients showed reduced VA after more than 5 years postoperatively; more than three quarters had VA > 0.5 on the last follow-up visit. The most frequent causes of reduced VA are age-related macular degeneration, glaucoma, appearence or worsening of diabetic retinopathy, posterior capsular opacification.

[Comparision of two new optical biometry devices with an ultrasonic immersion biometer]. / Compararea a doua noi biometre optice cu un biometru ultrasonic.

PURPOSE: To compare two new optical biometry devices with an ultrasonic immersion biometer. SETTING: Oftaprof Clinic, Iasi, Romania. METHODS: In this prospective comparative observational study were included 420 eyes that underwent cataract extraction. Axial length measurements were performed using a Allegro BioGraph biometer, which uses optical low-coherence reflectometry (OLCR), an IOLMaster 500 biometer, which uses partial coherence interferometry (PCI) and an OcuScan ultrasonic biometer. The measurement duration and the number of eyes in which the measurements with each device could be performed were compared. Intraocular lens (IOL) power calculation was performed and the IOL prediction error was calculated for each eye four weeks postoperatively. RESULTS: The mean difference in axial length measurements was 0.02 mm +/- 0.04 (SD) between the new PCI and the OLCR device, 0.14 +/- 0.13 (SD) mm between the ultrasonic biometer and the new PCI device and 0.18 +/- 0.09 (SD) mm between the ultrasonic biometer and the OLCR device (P=.52, P=.001 and P<.001, respectively). Measurements with the OLCR device took significantly longer than with the ultrasonic device (mean difference 88 +/- 27 seconds), and measurements with the ultrasonic device took significantly longer than with the new PCI device (mean difference 188 +/- 46 seconds) (P<.001). The mean absolute error in IOL power prediction was 0.49 D +/- 0.29 (SD) with the OLCR device and 0.52 +/- 0.33 (SD) D with the PCI unit and 0.77 +/- 0.65 (SD) with the ultrasonic biometer. The measurements could be performed in 420 eyes (100%) with the ultrasonic biometer, in 152 eyes (36.2%) with the OLCR device and in 151 eyes (35,9%) with the new PCI device. CONCLUSIONS: Measurements of the axial length were comparable between OLCR device and the new PCI device. There was a good correlation between the measurements with optical devices and the ultrasonic biometer. Measurements with the OLCR device took the longest to perform. Implant power calculation were comparable between the two optical devices. The ultrasonic biometry remains a very useful tool in cases with severe lens opacification which are extremely frequent in our service.

[Non-pentrating deep sclerectomy--between safety and efficacy]. / Sclerectomia profunda nepenetranta: intre siguranta si eficacitate.

PURPOSE: To find the indications that would benefit the most from non penetrating deep sclerectomy (NPDS) major advantages. METHOD: Retrospective study that included 40 eyes with open angle glaucoma (primary or pseudoexfoliative) which were subject to NPDS as ambulatory surgery without an implant, but with intraoperative application of mitomycin C. We have determined the LOP C/D ratio, visual acuity and the number of antiglaucoma drugs preoperatively and at 3 months postoperatively. We have analyzed the intraoperative and postoperative complications of NPDS and also the profile of the patients selected for this surgery. RESULTS: Global success (LOP < 21 mmHg + C/D ratio that remained unchanged postoperatively + visual acuity that remained unchanged postoperatively) was obtained in 90% of cases; the number of antiglaucoma drugs was significantly decreased (from 2.72 +/- 0.73 preoperatively to 0.26 +/- 0.21 postoperatively, p < 0.00002). Complete success (LOP < 21 mmHg without antiglaucoma medication) was achieved in 80% of cases. The rate of qualified success (LOP < 21 mmHg with antiglaucoma medication) was 95%; 50% of eyes have LOP < 15 mmHg at 3 months. Intraoperative complications were rare (4 cases) and minor. Postoperative complications were: ocular hypotony (1 case), bleb fibrosis (2 cases), bleb-related endophthalmitis (1 case). The best candidates for NPDS were patients over 70 years with important extraocular comorbidities, advanced open angle glaucoma with preserved visual acuity or monophthalmic patients. CONCLUSIONS: NPDS with intraoperative application of Mitomycin C as ambulatory surgery provides significant LOP reduction while preserving visual acuity and has a low rate of complications in elderly patients with advanced open angle glaucoma or monophthalmic patients.