Effect of Penetration Angle and Velocity During Intravitreal Injection on Pain.

Purpose: To evaluate the effect of velocity and angle of the intravitreal injection of anti-vascular endothelial growth factors on pain sensation.Methods: Patients were randomly assigned to one of four injection methods: straight and fast, straight and slow, tunneled and fast, and tunneled and slow. Later, they graded their pain sensation on a Visual Analog Scale (range 0-10).Results: The cohort included 180 patients. Mean pain score was 2.81 ± 2.34. There was no statistically significant difference in mean pain score among the four groups (p = .858); between the slow-injection (straight and tunneled) and fast-injection groups (p = .514); and between the straight-injection (fast and slow) and tunneled-injection groups (p = .992), nor other background variables.Conclusion: Velocity and angle of intravitreal injections are unrelated to the pain sensation. Therefore, the method may be left to the clinician's discretion. This implies that the sensation is mostly subjective.

A Single Low-Dose of Methylphenidate Improves Abnormal Visual Field Testing.

PURPOSE: To evaluate the effect of methylphenidate on visual field testing in healthy adults with abnormal visual field results. METHODS: This prospective, randomized, controlled interventional clinical trial comprised all patients who had abnormal visual field test results and normal eye examination and ophthalmic history. Eligible patients were randomly assigned to either the study group or the control group. All patients repeated their visual field testing. Study group patients received a single dose of 10 mg methylphenidate prior to that. The main outcome measures were the percent difference in mean deviation and pattern standard deviation between the second and first visual fields. RESULTS: The methylphenidate group had greater improvement in all parameters. Mean deviation improved by median 68% (IQR 19%-78%) in the methylphenidate group vs. 27% [-5% to 55%] in the controls. However, this was not statistically significant (p = .83). Pattern standard deviation improved by median 49% (22%-59%) vs. 7% [-9% to 45%], respectively (p = .012). The visual fields were also reviewed by 3 masked experienced ophthalmologists. They indicated that the second visual field improved in 76.2% of the methylphenidate group vs. 48.5% of the controls (p = .04). A normal repeat visual field occurred in 57.7% vs. 21.2%, respectively. A subgroup analysis of patients with prior experience in visual field testing yielded an even more striking improvement in the methylphenidate group vs. controls. CONCLUSIONS: A single low dose of methylphenidate can improve visual field testing in subjects without ocular pathology, and even more in those with prior experience in perimetry.

Diagnosis of Pseudoexfoliation Syndrome in Pseudophakic Patients.

OBJECTIVE: The aim of this study was to evaluate the sensitivity and specificity of pseudoexfoliation syndrome diagnosis in pseudophakic patients and potential means of improving it. METHODS: This prospective, nonrandomized study comprised 41 consecutive patients (41 eyes) scheduled for cataract surgery at a tertiary medical center during 2016 and 2017. Preoperatively, all patients underwent a detailed slit-lamp examination, including gonioscopic assessment of the iridocorneal angle. The examination was performed by a glaucoma specialist who completed an assessment form documenting the presence/absence of clinical signs of pseudoexfoliation syndrome. It was repeated 1-2 weeks postoperatively by a second, masked, glaucoma specialist. RESULTS: Sixteen patients (39.0%) were diagnosed with pseudoex-foliation syndrome preoperatively. The diagnosis was confirmed postoperatively in 11/16 patients (68.8% sensitivity) and in an additional patient not diagnosed preoperatively (96% specificity). The ability to diagnose pseudoexfoliation syndrome postoperatively was significantly worse than preoperatively (Z = 12.161, p < 0.0001). Pupillary border deposits (75% of cases) and the Sampaolesi line (83.3%) were the cornerstones of the postoperative diagnosis; anterior capsular deposits were evident in only 41.6% of cases diagnosed postoperatively (31.3% of the originally diagnosed cases). CONCLUSIONS: Underdiagnosis of pseudoexfoliation syndrome is common in pseudophakic patients and may have significant implications for future management. Careful attention to pupillary border anatomy and meticulous gonioscopic assessment of the iridocorneal angle are essential for accurate diagnosis. Preoperative documentation of pseudoexfoliation syndrome could help prevent this diagnostic pitfall.

Correlation between Interleukin-6 and Thrombin-Antithrombin III Complex Levels in Retinal Diseases.

PURPOSE: This study aims to evaluate and correlate the levels of interleukin-6 (IL-6) and thrombin-antithrombin III complex (TAT) in the vitreous of patients with different vitreoretinal pathologies. METHODS: Vitreous samples were collected from 78 patients scheduled for pars plana vitrectomy at a tertiary medical center. Patients were divided by the underlying vitreoretinal pathophysiology, as follows: macular hole (MH)/epiretinal membrane (ERM) (n = 26); rhegmatogenous retinal detachment (RRD) (n = 32); and proliferative diabetic retinopathy (PDR) (n = 20). Levels of IL-6 and TAT were measured by enzyme-linked immunosorbent assay and compared among the groups. RESULTS: A significant difference was found in the vitreal IL-6 and TAT levels between the MH/ERM group and both the PDR and RRD groups (P < 0.001 for all). Diabetes was associated with higher IL-6 levels in the RRD group. Different relationships between the IL-6 and TAT levels were revealed in patients with different ocular pathologies. CONCLUSION: Our results imply that variations in vitreal TAT level may be attributable not only to an inflammatory reaction or blood-retinal barrier breakdown, but also to intraocular tissue-dependent regulation of thrombin.

Sexual dysfunction, cardiovascular risk factors, and inflammatory biomarkers in women undergoing coronary angiography.

We studied sexual dysfunction (SD) prevalence and lack of sexual activity in 117 women undergoing coronary angiography. SD was consistent with a low (≤26.55) Female Sexual Function Index questionnaire (FSFI) score. The mean age was 61.8 years (range: 40-75 years). SD prevalence was 76.1% (n = 89), and 41 (35.0%) women reported a lack of sexual activity. Regression analyses showed that only age was independently associated with SD (odds ratio 1.088; 95% confidence interval 1.024-1.157; p = .006) and lack of sexual activity (odds ratio 1.144; 95% confidence interval 1.064-1.230; p < .0001), regardless of cardiovascular risk factors, inflammatory biomarkers blood levels, and the number of stenotic coronary arteries.

[Sexual dysfunction and coronary artery disease in adult women].

BACKGROUND: The prevalence of sexual dysfunction in adult women with coronary artery disease (CAD) has seldom been studied, and the association between sexual dysfunction severity and with CAD severity has never been studied. AIM: To study the prevalence of sexual dysfunction and its severity by CAD severity in adult women. METHODS: Adult women undergoing coronary angiography at the Tel Aviv Medical Center completed a sexual questionnaire titled Female Sexual Function Index (FSFI). Scores of 23 or lower in this questionnaire were consistent with sexual dysfunction. The cohort was divided into three groups: 1. Women without CAD. 2. Women with one vessel disease. 3. Women with two or more vessel disease. CAD was defined as one or more coronary artery stenosis of 50% or more, and/or history of myocardial infarction. The prevalence of sexual dysfunction and cardiovascular risk factors was compared between these groups. RESULTS: The study included 104 adult women (age range: 42-92 years; mean age: 11.2 +/- 68.7 years). Sixty-five (62.5%) ,women had one-vessel disease (n = 27) or more (n = 38). Overall, 39 (37.5%) women had no coronary stenosis and/or history of myocardial infarction. Most women (n = 68; 65.4%) had no sexual activity. Among the 36 sexually active women, 11 (30.6%) women had a normal sexual function. Normal sexual function was two-times more prevalent in women without CAD relative to women with CAD (7.7% vs. 15.4%; p = 0.049). These findings were not statistically significant following adjustment for age. The odds for normal sexual function were low as more coronaries were stenotic, but these findings were not statistically significant. CONCLUSIONS: A trend towards association between CAD severity and sexual dysfunction severity in adult women has been demonstrated for the first time. Sexual dysfunction and lack of sexual activity are very common among adult women with CAD. There is a negative association between the number of coronary arteries involved and normal sexual function, but this trend should be studied in a larger cohort.