Unilateral hypertensive choroidopathy as a sole manifestation in malignant hypertension: optical coherence tomography angiography findings-case report.

BACKGROUND: We present a case of hypertensive choroidopathy due to malignant hypertension with exudative retinal detachment as a sole finding. We use OCT- angiography for initial diagnosis and report findings from extensive follow up. CASE PRESENTATION: A 51-year-old female with no past medical history, presented to our clinic with painless loss of vision in her left eye. Fundus examination revealed only exudative retinal detachment in her left eye that was confirmed with Optical Coherence Tomography. Fluorescein angiography showed hyperfluorescent spots with leakage in late phases. OCTA manifested a focal dark area in the choriocapillaris slab corresponding to flow signal voids, signifying regions of non-perfusion. Her blood pressure was 220/120 mmHG. Complete blood work -up failed to reveal any other possible etiology. During follow-up period of 9 months blood pressure normalized, patient regained visual function and choriocapillaris perfusion was completely restored. DISCUSSIONS AND CONCLUSIONS: Hypertensive choroidopathy with exudative retinal detachment can be the only sign of malignant hypertension and no pre-existing history of a systemic disease is required in order to become apparent. OCTA reveals areas of non-perfusion at choriocapillaris level, proving that it is an essential tool in the diagnosis and follow up of patients with hypertensive choroidopathy. Finally, we propose that early diagnosis prevents permanent damage of the RPE and leads to complete choroidal remodeling and better visual outcomes.

"Association between platelet activating factor acetylhydrolase and diabetic retinopathy: Does inflammation affect the retinal status?".

AIM: To assess the role of plasma platelet activating factor acetylhydrolase (PAF-AH) in pathogenesis and progression of diabetic retinopathy (DR). MATERIALS AND METHODS: Sixty eight diabetics and 23 age-frequency-matched non-diabetic patients underwent blood sampling and the plasma PAF-AH activity was calculated. The diabetic patients were further classified into two groups, according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification, based on indirect fundoscopy and fluorescein angiography. Thirty seven patients with non-proliferative DR (NPDR) and 31 patients with proliferative DR (PDR) were finally included in the study. RESULTS: The plasma PAF-AH activity was increased in diabetic patients with PDR (0.206 µmol/min/ml) compared to control group (0.114 µmol/min/ml, post-hoc Bonferroni comparison test: p<0.0001) and to NPDR group (0.147 µmol/min/ml, post-hoc Bonferroni comparison test: p=0.012). CONCLUSIONS: The activity of PAF-AH in the plasma increases in parallel with DR severity.

Diels-Alder Cycloadditions of Masked o-Benzoquinones with Alkenes.

Diels-Alder cycloadditions of 3-oxobut-1-enyl substituted orthoquinone monoketals with olefinic dienophiles furnished functionalized ortho-endo bicyclo[2.2.2]octenone derivatives with high regio- and stereoselectivities. The competition between self-dimerization and Diels-Alder cycloaddition with an external dienophile usually exists, except in the case of 5-substituted orthoquinone monoketal.

Is topical diclofenac essential before and after uneventful phacoemulsification cataract surgery?

PURPOSE: The purpose of our study was to evaluate the effectiveness of preoperative and postoperative addition of topical diclofenac to chloramphenicol/dexamethasone in patients undergoing uneventful phacoemulsification cataract surgery. METHODS: Patients were randomized to (1) chloramphenicol 0.5%-dexamethasone 0.1%, 1 drop 4 times a day (n=41), or (2) chloramphenicol 0.5%-dexamethasone 0.1%, 1 drop 4 times a day, plus diclofenac 0.1%, 1 drop 3 times a day (n=38). Patients in the second group also received diclofenac 0.1% for 3 days before surgery. Topical treatment was administered for 28 days after phacoemulsification. On postoperative days 1, 14, and 28, best corrected visual acuity, macular thickness, endothelial cell density, and central corneal thickness (CCT) were measured. RESULTS: The 2 groups did not have a statistically significant difference for CCT, endothelial cell density, macular thickness, and visual acuity at the 3 time points of the follow-up period. CONCLUSIONS: The addition of diclofenac did not seem to offer any additional benefit after uneventful phacoemulsification.