ABSTRACT
INTRODUCTION: This retrospective study aimed to assess the effectiveness of using MicroPulse transscleral cyclophotocoagulation (µP-TSCPC) in patients who had previously undergone pars plana vitrectomy (PPV), depending on the endotamponade used. METHODS: For the study, a total of 60 patients were enrolled who underwent PPV followed by tµP-TSCPC as a result of an increase in intraocular pressure (IOP) over the norm of 21 mmHg. In this group of patients, 20 received silicone oil endotamponade during PPV, 20 received sulfur hexafluoride gas SF6, and in another 20 a differentiated balanced salt solution (BSS) was used. RESULTS: The main indications for conducting PPV were (1) retinal detachment (silicone oil endotamponade was used; n = 12); (2) dislocation/subluxation of the patient's own or artificial intraocular lens (balanced salt solution (BSS) endotamponade was used; n = 11); (3) the presence of an epiretinal membrane and/or a macular hole (BSS endotamponade was used; n = 9, or SF6; n = 20); and (4) hemorrhage into the vitreous chamber (silicone oil endotamponade was used; n = 8). CONCLUSION: The choice of endotamponade used during PPV was not found to determine the effectiveness of µP-TSCPC treatment. The effectiveness of µP-TSCPC in patients after PPV depended, above all, on the etiology of the disease, for which PPV was previously performed. The lowest effectiveness of µP-TSCPC was noted in cases where the reason for conducting PPV was hemorrhage into the vitreous chamber and silicone oil endotamponade was used, while the highest effectiveness was noted in cases where PPV was conducted owing to the presence of an epiretinal membrane and/or a macular hole and SF6 endotamponade was used.
ABSTRACT
Alzheimer's disease (AD) remains one of the greatest global concerns. Current treatment of AD - the acetylcholinesterase inhibitors - provides temporary improvement of cognitive functions, but does not affect the core of the underlying pathological process. There is still the need for alternative approaches, preferably ones based on the upstream events in the AD pathogenesis. The nature of AD pathogenesis remains complicated and not entirely explained. It is assumed to comprise of many interrelated events which can sequentially lead to further pathologies - as a kind of vicious cycle. The solution in this case could be to interact with these processes on multiple levels at the same time. The proposed approach hopes to achieve the state of equilibrium between two pathological pathways via reducing their dynamics on appropriate levels. The first step is to inhibit Tumor Necrosis Factor signaling related to inflammatory response. The second is to take advantage of the influence of insulin signaling on amyloid-ß processing to restore its proper clearance. Employing two only partially-beneficial approaches into a novel approach aims at breaking the "vicious cycle" and eliciting synergistic effect via working on different levels simultaneously. The effect of such therapy could allow physicians to completely inhibit neural damage. The proposed strategy may prove easily introducible as an efficacious clinical approach employing novel anti-TNF agents in combination with anti-diabetic agents. Data is needed on its influence on cognitive functions, any occurrence of adverse effects, and the development of models of optimal doses and their temporal location.
