Acquired nasolacrimal duct obstruction: clinical and histological findings of 275 cases.

BACKGROUND: Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations. METHODS: This retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed. RESULTS: Three tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292). CONCLUSIONS: Chronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.

Cognitive Decline in Multiple Sclerosis Is Related to the Progression of Retinal Atrophy and Presence of Oligoclonal Bands: A 5-Year Follow-Up Study.

Background: Brain atrophy, which is associated with cognitive impairment and retinal nerve fiber layer (RNFL) atrophy, is the main biomarker of neurodegeneration in multiple sclerosis (MS). However, data on the relationship between inflammatory markers, such as oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF), and cognition, RNFL atrophy, and brain atrophy are scarce. The aim of this study was to assess the influence of RNFL thickness, brain atrophy markers, intrathecal OCBs, and the immunoglobulin G (IgG) index on cognitive decline over a 5-year period in patients with MS. Methods: This prospective, single-center, observational cohort study included 49 patients with relapsing MS followed up over 5 years. At baseline, the patients underwent brain magnetic resonance imaging (MRI). Cognitive evaluation was performed using the Brief International Cognitive Assessment for MS (BICAMS), and RNFL thickness was assessed using optical coherence tomography (OCT). OCBs and IgG levels in the CSF were evaluated at baseline. The BICAMS, OCT, and MRI findings were re-evaluated after 5 years. Results: A significant reduction in information processing speed, visual learning, temporal RNFL thickness, the Huckman index, and third ventricle mean diameter was found in all 49 patients with relapsing MS over the observation period (p < 0.05). Of the patients, 63.3% had positive OCBs and 59.2% had elevated IgG indices. The atrophy of the temporal segment and papillomacular bundle and the presence of OCBs were significantly related to a decline in information processing speed in these patients (p < 0.05). However, brain atrophy markers were not found to be significant on the general linear models. Conclusions: RNFL atrophy and the presence of OCBs were related to cognitive decline in patients with MS over a 5-year follow-up period, thereby suggesting their utility as potential biomarkers of cognitive decline in MS.

Early age-related macular degeneration in patients with myocardial infarction.

PURPOSE: To investigate the prevalence of early age-related macular degeneration (AMD) in patients with acute myocardial infarction (MI). METHODS: Enrolled in the study were 262 acute MI patients (MI group), aged 40-64 years, as well as 1,155 non-MI persons, aged 40-64 years, from a random sample (reference group) of the Kaunas population. RESULTS: The prevalence of early AMD in the random sample was 7.3%, while in MI patients, the prevalence was 54.5% (P < 0.001). For all age groups, the prevalence of early AMD was significantly (P < 0.005) higher in MI patients than in reference-group persons. In the reference group, the prevalence of early AMD increased significantly with age, whereas no such trend was observed in the MI group. At the 45- to 54-year-olds, the prevalence was significantly higher in males than in females (9.9% vs. 3.7%; P < 0.05) in the reference group, while overall, the prevalence of early AMD in the males and females of the much larger reference group was 8.6% versus 6.2%, respectively (P > 0.05). It increased more with age for females (3.7% and 10.8% at the age 45-54 and 55-64 years, P < 0.05, respectively) while in males, frequency of AMD did not differ significantly between latter age groups (9.9% vs. 11.6%; P > 0.05). CONCLUSIONS: We conclude that the prevalence of early AMD is significantly higher in patients with MI than in a random sample of the population.

[Association of age-related maculopathy with ischemic heart disease and its risk factors in middle-aged population of Kaunas city]. / Su amziumi susijusios makulopatijos rysys su isemine sirdies liga ir rizikos veiksniais vidutinio amziaus kaunieciu populiacijoje.

AIM: To determine the prevalence of age-related maculopathy in a sample of Lithuanian middle-aged population and to assess the relationship between age-related maculopathy and ischemic heart disease and its risk factors, including smoking, arterial hypertension, obesity, hyperglycemia, and dyslipidemias. MATERIAL AND METHODS: A random sample of urban population of 1357 adults (ranging from 35-64 years of age; 597 males and 760 females) living in Kaunas, Lithuania was examined during the interval from 2001 to 2002. Each participant underwent a comprehensive examination that included an ophthalmic examination. The presence of age-related maculopathy was determined by grading from fundus examination by indirect ophthalmoscopy, slit lamp examination, and color fundus photographs. The history, physical examination findings, and fasting blood samples provided data on possible risk factors. Age-adjusted logistic regression analysis was performed to determine the risk factors for age-related maculopathy. RESULTS: Early age-related maculopathy was detected for 44 males and 40 females. The prevalence of age-related maculopathy increased steadily with age without significant difference between males and females. Multiple logistic regression analysis showed that increased diastolic blood pressure, obesity, hyperglycemia, ischemic ECG-abnormalities and history of myocardial infarction were significantly associated with age-related maculopathy in males aged 40-64 years. Current smoking and hyperglycemia were significantly associated with age-related maculopathy in females aged 40-64 years. CONCLUSIONS: Our study suggests that arterial hypertension, obesity, hyperglycemia, current smoking and positive history of cardiovascular disease are relevant risk factors for age-related maculopathy in middle-aged urban population.

Age-related maculopathy and consumption of fresh vegetables and fruits in urban elderly.

The purpose of this study was to investigate the rate of age-related maculopathy among elderly males and females in relation to frequency of consumption of fresh vegetables and fruit. During ophthalmological investigation of Kaunas city inhabitants aged 65-74 years (240 males and 206 females) age-related maculopathy (early and late) was determined for 22.1% of males and 20.4% of females. Frequency of usage of fresh (uncooked) vegetables and fruits in winter-spring and in summer-autumn seasons by investigated persons was determined, using food frequency questionnaire. In this work an association between age-related maculopathy and usage of vegetables and fruits has been investigated in 170 males and 181 females aged 65-74 years without diabetes who never smoked; age-related maculopathy was found for 18.8% of males and 17.7% of females. Obtained data have demonstrated an inverse association between consumption of vegetables during winter-spring season and age-related maculopathy: usage of vegetables two times a week or more versus usage less than two times a week decreases prevalence of age-related maculopathy 2.0 times among males (OR=0.42; 95% CI 0.18-1.0; p=0.05) and 2.2 times among females (OR=0.37; 95% CI 0.15-0.9; p=0.02). Data have demonstrated a tendency that increasing consumption of fresh vegetables and fruits during both seasons can reduce risk of age-related maculopathy among females. In conclusion, characteristic for Lithuanian urban elderly rare usage of fresh vegetables during winter-spring season can increase risk of age-related maculopathy independently from other risk factors.

[Prevalence and risk factors of age-related maculopathy among middle aged people]. / Vidutinio amziaus zmoniu sergamumas makulopatija, susijusia su amziumi, ir jos rizikos veiksniai.

OBJECTIVE: To investigate the prevalence of age-related maculopathy and the relationships of age-related maculopathy to age, sex, ocular factors, education, work exposures. A population-based cohort study included 1357 subjects (35-64 years of age) living in Kaunas (Lithuania), who were examined during the interval from 2001 to 2002. The diagnosis of age-related maculopathy was based on ophthalmoscopic findings or on fundus photographs. The prevalence of early age-related maculopathy was 7.3% in persons 40-64 years of age. No late age-related maculopathy (AMD) was found. Prevalence of early age-related maculopathy was strongly related to age (P<0.001). No significant prevalence differences were between the sexes. The frequency of age-related maculopathy was higher in eyes with light iris color but association was not significant. No associations were found between cataract or cataract type and ARM. There was no association between education and age-related maculopathy. Exposure to harmful work was found to be related to the presence of early age-related maculopathy in all. The prevalence of age-related maculopathy was significantly higher between men working in high temperature.