Aqueous Humor Cytokines in Non-Proliferative Diabetic Retinopathy.

Background and Objectives: Cytokines are cell-signaling proteins whose identification may serve as inflammatory markers or early indicators for progressive disease. The aim of our study was to quantify several cytokines in aqueous humor (AH) and their correlations with biochemical parameters in diabetic eyes with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: A total of 62 eyes from 62 patients were included in the study: 37 eyes from nondiabetic patients (group 1), 13 diabetic eyes with no retinopathy changes (group 2) and 12 diabetic eyes with early and moderate NPDR (group 3). AH samples were collected during uneventful cataract surgery. The cytokines IL-1ß, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, TNF-α and VEGF were quantified using multiplex bead-based immunoassay. Due to unreliable results, IL-1ß, TNF-α, IL-10 and IL-12 were excluded. Concentrations were compared between groups. Biochemical parameters (fasting blood sugar, glycated hemoglobin, C-reactive protein) and the duration of diabetes were recorded. Results: VEGF levels were significantly different between groups (p = 0.001), while levels of IL-6, IL-8, IP-10 and MCP-1 were comparable across all groups (p > 0.05). IL-6 concentration correlated with VEGF in group 1 (rho = 0.651, p = 0.003) and group 3 (rho = 0.857, p = 0.007); no correlation could be proved between IL-6, IL-8, IP-10, MCP-1 or VEGF and biochemical parameters. Duration of diabetes was not correlated with the cytokine levels in groups 2 and 3. The receiver operating characteristic (ROC) curve revealed that VEGF concentrations could discriminate early and moderate NPDR from diabetes, with an area under the curve (AUC) of 0.897 (p = 0.001, 95% CI = 0.74−1.0). Conclusions: Diabetes mellitus induces significant intraocular changes in the VEGF expression in diabetic patients vs. normal subjects, even before proliferative complications appear. VEGF was increasingly expressed once the diabetes progressed from no retinopathy to early or moderate retinopathy.

Choroidal Assessment in Patients with Type 2 Diabetes Mellitus and Non-Proliferative Diabetic Retinopathy by Swept-Source Ocular Coherence Tomography and Image Binarization.

Background and Objectives: The aim of this study was to evaluate choroidal structure and vascularity indices in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Sixty-three eyes from sixty-three patients were evaluated: 21 from healthy subjects, 20 with diabetes mellitus (DM) and no diabetic retinopathy (DR), and 22 with DM and non-proliferative diabetic retinopathy without diabetic macular edema (DME). Each patient underwent ocular examination, macular swept-source ocular coherence tomography (SS-OCT) imaging, glycemic control, and systemic high blood pressure (HBP) evaluation. Subfoveal choroidal thickness (SF-CT) was manually assessed on a line scan. Line scan OCT images were exported to ImageJ program. The areas under a 1.5, 3 and 6 mm horizontal line centered on the fovea were assessed by converting the OCT images to binary images, and total choroidal area (TCA), luminal area (LA), stromal area (SA), LA:SA ratio, and choroidal vascularity index (CVI) were evaluated. SF-CT and choroidal parameters were compared between groups, and correlations with ocular and systemic factors were analyzed. Results: SF-CT, TCA, LA, and SA were similar between groups. CVIs were significantly different between groups for all three studied areas (CVI-1.5: 66.21% vs. 66.06% vs. 63.74%, p = 0.003; CVI-3: 65.88% vs. 66.46% vs. 63.79%, p = 0.008; CVI-6: 64.79% vs. 65.40% vs. 63.61%, p = 0.032). NPDR patients had significantly lower CVIs compared to DM patients (p < 0.05). No association of choroidal parameters with glycemic control, DM duration and HBP was found significant (p < 0.05). Conclusions: Choroidal assessment by SS-OCT and image binarization in healthy subjects, subjects with DM without DR, and subjects with DM and NPDR indicated that CVI changes were identifiable and significant in early DR. The lack of association with ocular and systemic factors suggest that CVIs are reliable assessment parameters of choroidal vascular structure.

Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma.

AIM: The study assesed trabeculectomy survival in advanced open angle glaucoma (OAG). METHODS: This is a retrospective longitudinal study in advanced OAG undergoing primary trabeculectomy. Clinical and demographic parameters were recorded. Surgical survival (qualified/complete) was calculated by Kaplan-Meier analysis for multiple upper limits of intraocular pressure (IOP) with/without medication (≤21 mmHg, ≤18 mmHg, ≤15 mmHg, ≤12 mmHg); Cox hazard ratio analysis identified parameters influencing survival. RESULTS: We included 165 eyes from 165 OAG patients: primary forms (POAG) - 86 eyes and secondary (pseudoexfoliative, SOAG) - 79 eyes; mean follow-up interval was 36.21 ± 13.49 months. Clinical parameters were comparable between sub-groups at baseline, except a higher IOP in SOAG vs POAG (36.6 ± 13.2 vs 32.7 ± 11.1 mmHg, p = 0.04); IOP reduction was similar (SOAG vs POAG) 53.93% vs 56.19%, p = 0.45, yet longer hospitalization (8.47 ± 4.39 (SOAG) vs 6.69 ± 3.01 days (POAG), p=0.03) and more medications (0.65 ± 0.24 vs 0.36 ± 0.16, p = 0.05) were needed to achieve comparable final IOP (16.0 ± 9.1 vs 15.1 ± 7.8 mmHg, p = 0.45). Kaplan Meier survival analysis applied for IOP ≤21 mmHg, ≤18 mmHg, ≤15 mmHg and ≤12 mmHg, revealed complete success in 26.2%, 27.3%, 34.5% and 54.6% eyes, respectively; qualified success was found in 45.7%, 48.6%, 77% and 88.6% eyes, respectively. Multiple medications at baseline diminished survival in all tested models (hazard ratio HR > 1, p<0.05), while 5FU+needling improved survival, mostly if combined with lower IOP regime: HR = 0.15, 95% CI = [0.07 -1.12], p = 0.06, if IOP ≤15 mmHg and HR = 0.09, 95% CI = [0.02-1.25], p = 0.06, if IOP ≤12 mmHg. CONCLUSION: Trabeculectomy in advanced OAG reached very good survival rates (77% and 88.6%) at 36 months postoperative, if IOP could be maintained ≤15 mmHg, respectively ≤12 mmHg with medication and additional needling+5FU maneuvers. Specific factors influencing survival were identified for each success definition.

Posterior choroidal boundary morphology and segmentation errors influence on choroidal thickness assessment in diabetic patients - a swept-source OCT study.

Objective: to evaluate the choroidal morphology and choroidal thickness (CT) in normal and diabetic subjects and to compare the differences between automated segmentation (AS) and manual segmentation (MS) of the choroid. Methods: in this observational cross-sectional study we included 48 eyes: 24 normal eyes (group 1), 9 eyes with DM without diabetic retinopathy (DR) (group 2) and 15 eyes with DM and DR (group 3). Swept-source OCT line scans images were analyzed for the presence of the suprachoroidal layer (SCL), choroidal morphology and the CT was measured manually subfoveal and at 750 µ both nasal and temporal to the fovea after AS and MS. SCL was not included in the CT evaluation. CT values were compared between the groups and between the three points of evaluation. Results: SCL was visualized in 21 eyes (43.8%). In diabetic patients, SCL was visible in 11 (45.83%) cases and in nondiabetic patients, in 10 eyes (41.66%). There was a good AS of Bruch's membrane, which was not further corrected manually. There were statistically significant differences between AS and MS at the level of CSJ for all three locations in all three groups (P ≤ 0.01). After MS, the choroid was statistically significantly thicker. Group 2 and group 3 showed a higher CT thickness. There were no statistically significant differences in the CT between groups in all three locations. Conclusions: Defining posterior choroidal boundary and the applied segmentation method can result in differences in CT measurements. Diabetic patients have altered CT and choroidal morphology. Abbreviations: CT = choroidal thickness, AS = automated segmentation, MS = manual segmentation, CSJ = choroidoscleral junction, SCL = suprachoroidal layer, SCS = suprachoroidal space, DM = diabetes mellitus, DR = diabetic retinopathy, RPE = retinal pigmented epithelium, BM = Buch's membrane.

Outcomes of phacoemulsification combined with two iStent inject trabecular microbypass stents with or without endocyclophotocoagulation.

AIM: Comparing outcomes after combined phacoemulsification, two iStents insertion and endocyclophotocoagulation (ECP) versus phacoemulsification-iStents alone. METHODS: This is a longitudinal retrospective 12 months study in eyes with ocular hypertension or early-to-moderate open angle glaucoma. Level of disease, intraocular pressure (IOP) and tolerance of glaucoma medication were considered before planning surgery. Best-corrected visual acuity (BCVA-logMAR), IOP (mm Hg), number of medications were assessed at baseline, week 1, week 5, month 3, 6, 12 postop. MAIN OUTCOME: percentage (%) in IOP reduction at 12 months vs medicated baseline. SECONDARY OUTCOMES: absolute values of IOP/medication reduction, BCVA and postop complications. RESULTS: The ICE2 (two iStents-cataract extraction-ECP) group included 63 eyes and Phaco-iStent group included 46 eyes. Baseline IOP was higher in the ICE2 than phaco-iStent group (19.97±4.31 mm Hg vs 17.63±3.86 mm Hg, p=0.004) and mean deviation was lower (-7.20±2.58 dB vs -4.94±4.51 dB, p=0.037). Number of medications were comparable at baseline: 2.22±1.06 (ICE2) vs 2.07±1.02 (phaco-iStent), p=0.442. At month 12 postop, IOP in the ICE2 group decreased 35% from baseline vs 21% in the phaco-iStent group (p=0.03); absolute IOP reduction was significantly lower than baseline in each group (p<0.001), yet final IOP was lower in the ICE2 group than phaco-iStent group (13.05±2.18 mm Hg vs 14.09±1.86 mm Hg, p=0.01). Similar results were found for glaucoma medication (1.24±1.05 in ICE2 group vs 1.39±1.03 in phaco-iStent group, p=0.01). Final BCVA was 0.11±0.18 (phaco-iStent group) vs 0.08±0.08 (ICE2 group), p=0.309. Safety outcomes were comparable between groups. CONCLUSION: ICE2 procedure offers better results in IOP/medication reduction at 12 months than phacoemulsification-iStents alone.

Inflammatory model in patients with primary open angle glaucoma and diabetes.

AIM: To assess the inflammatory cytokines expression in aqueous humor in diabetic primary open angle glaucoma (POAG) patients. METHODS: A cross-sectional study on 87 eyes, distributed as following: 26 eyes from diabetic patients, 16 eyes with POAG and 21 eyes from diabetic POAG patients; healthy controls (24 eyes) were recruited from patients undergoing conventional cataract surgery. A volume of 100 µL of aqueous humor (AH) was collected during phacoemulsification and 21 inflammatory markers were quantified using a Luminex® cytometric bead assay: IL-1Ra, IL-1α, IL-1ß, IL-5, IL-6, IL-10, IL-17, GM-CSF, IFNγ, CCL2, CCL3, CCL4, CXCL5, CXCL8, bFGF, VEGF, TNFα. Main changes in cytokine profile were analyzed and compared between groups. Data on demographics, duration of glaucoma, intraocular pressure (IOP), number of anti-glaucoma substances were recorded for correlation analysis and prediction models. RESULTS: Significant differences in cytokine expression between groups were detected for CXCL5 (P<0.001), CXCL8 (P=0.004), IL-1α (P<0.001), IL-2 (P<0.001), CCL4 (P=0.003), CCL5 (P<0.001) and TNFα (P=0.05). Post-hoc analysis identified IL-2 (P=0.009) and CXCL5 (P<0.001) as "separation markers" between POAG and diabetic POAG eyes. In POAG patients, the "separation markers" could highly predict the TNFα levels F(1, 16)=14.639, P<0.001, whereas in diabetic patients F(1, 24)=4.844, P=0.006 and diabetic POAG patients F(1, 19)=2.358, P=0.05 the level of prediction was inferior. CONCLUSION: Our results reveal an inflammatory model based on increased TNFα levels in POAG eyes. Simultaneous co-stimulatory molecules and additional inflammatory pathways need to be further explored in diabetic POAG cases, since the prediction model could only partially explain the increased TNFα level in this category of patients.

Ultrahigh-resolution anterior segment optical coherence tomography for analysis of corneal microarchitecture during wound healing.

PURPOSE: To employ ultrahigh-resolution (UHR) optical coherence tomography (OCT) for investigation of the early wound healing process in corneal epithelium. METHODS: A custom-built UHR-OCT system assessed epithelial healing in human keratoconic cornea after epi-off crosslinking (CXL) procedure and a wound healing model in rabbits with iatrogenic corneal injury. 3D OCT data sets enhanced obtaining epithelial thickness maps and evaluation of reepithelization stage. Accompanying changes in deeper corneal microarchitecture were analysed. RESULTS: The mean central corneal thickness in 40 eyes with keratoconus at baseline was 482.7 ± 38.2 µm, while mean central epithelial thickness (CET) was 43.8 ± 6.4 µm. At the final visit 20 ± 5 days post-CXL procedure, CET was 35.0 ± 5.8 µm, significantly thinner after reepithelization (p < 0.001). Surgical success was assessed at the final visit through the demarcation line (DL), identified at 43.7 ± 13.5% stromal depth. In rabbits, the mean CET in 20 eyes at baseline was 35.9 ± 2.6 µm. In rabbits that revealed complete wound closure (10/20 eyes) at the last study day at 72 hr, CET was significantly thinner compared to baseline (30.4 ± 2.8 µm versus 35.4 ± 2.9 µm, p = 0.005). An intra-stromal landmark indicating early keratocyte apoptosis was measured at 30.0 ± 5.1% stromal depth. Epithelial thickness maps showed the time-course of corneal healing. CONCLUSION: Ultrahigh-resolution (UHR)-OCT provided precise assessment of epithelial wound and its healing by 3D-mapping. In addition, microarchitectural changes in the cornea in early phases of epithelial healing were revealed.

Ultrahigh-resolution OCT imaging of the human cornea.

We present imaging of corneal pathologies using optical coherence tomography (OCT) with high resolution. To this end, an ultrahigh-resolution spectral domain OCT (UHR-OCT) system based on a broad bandwidth Ti:sapphire laser is employed. With a central wavelength of 800 nm, the imaging device allows to acquire OCT data at the central, paracentral and peripheral cornea as well as the limbal region with 1.2 µm x 20 µm (axial x lateral) resolution at a rate of 140 000 A-scans/s. Structures of the anterior segment of the eye, not accessible with commercial OCT systems, are visualized. These include corneal nerves, limbal palisades of Vogt as well as several corneal pathologies. Cases such as keratoconus and Fuchs's endothelial dystrophy as well as infectious changes caused by diseases like Acanthamoeba keratitis and scarring after herpetic keratitis are presented. We also demonstrate the applicability of our system to visualize epithelial erosion and intracorneal foreign body after corneal trauma as well as chemical burns. Finally, results after Descemet's membrane endothelial keratoplasty (DMEK) are imaged. These clinical cases show the potential of UHR-OCT to help in clinical decision-making and follow-up. Our results and experience indicate that UHR-OCT of the cornea is a promising technique for the use in clinical practice, but can also help to gain novel insight in the physiology and pathophysiology of the human cornea.

Plateau Iris - Therapeutic options and functional results after treatment.

We present the therapeutic options and functional results in patients with plateau iris (syndrome or configuration) in consecutive case series. Material and method: Our study included newly diagnosed patients with acute angle closure by "plateau iris" (configuration or syndrome), between June 2016 and April 2017. Series of 8 consecutive patients met the inclusion criteria, all being females. All the patients underwent an individualized treatment according to the underlying mechanism and evolution. Functional results (visual acuity, IOP, topical medication) were reported in the current paper. Results: For 10 months, we diagnosed 14 eyes, from 9 patients with acute angle closure by Plateau Iris, distributed as it follows: 6 eyes with closed angle glaucoma (optic disk and visual field changes), 8 eyes with plateau iris syndrome and 2 eyes with plateau iris configuration. 7/ 8 patients were misdiagnosed with primary open angle glaucoma, whereas only one patient had the correct diagnosis of closed angle glaucoma and underwent peripheral laser iridotomy. As treatment options in our study, we recommended and performed argon laser peripheral iridoplasty + iridotomy in 10/ 14 eyes, cataract lens was extracted in 4 eyes and then replaced with PC-IOL, whereas 2 eyes required a filtering anti-glaucoma surgery (trabeculectomy + PI). 2 eyes from the same patient could not be treated as intended as the patient refused the treatment. In this unique case, Pilocarpine (4%) was temporarily indicated. Conclusion: Plateau iris represents a diagnostic trap, but based on a thorough gonioscopic examination and a good patient history, the right diagnosis can be made, all along with a correct therapeutic approach.

Rare case of ocular tuberculosis in a diabetic patient: diagnostic and therapeutic dilemmas.

We present the case of a patient who was diagnosed by chance with macular hypopyon during a conventional interdisciplinary examination. The clinical context and the association of a systemic disease, such as uncontrolled type 1 diabetes, rendered further investigations in this patient. Due to his immunocompromised status, etiology such as ocular fungi, lymphomas, tuberculosis was taken into account. Thorough complex investigations oriented the diagnosis towards ocular tuberculosis involvement.

Iris juvenile xanthogranuloma in an infant - spontaneous hyphema and secondary glaucoma.

Juvenile xanthogranuloma (JXG) is a benign histiocytic skin disorder mainly encountered during infancy and childhood. Although with multiple potential localizations, less than 1% of the cases exhibit ocular manifestations. Some of these might lead to serious complications, specifically, secondary glaucoma that can result in severe and blinding eye disease. The aim of the present case report was to demonstrate typical clinical features, emphasize the difficulties attributed when managing these patients and literature review. We present the case of 4 months old female baby with spontaneous hyphema and secondary unilateral glaucoma due to ocular JXG. The natural history and treatment of the condition were extremely difficult to handle due to multiple opinions in histopathology related to other severe conditions that resembled with the lesions detected in this case: myelomonocytic leukemia and Langerhans cell histiocytosis. Although a minority of patients with JXG have ocular involvement, recognition of this condition is important because a treatment delay can lead to serious complications, such as glaucoma and spontaneous hyphema, as in our case. A thorough differential diagnosis represents the key to a proper management plan in these patients, both on short and long term. "Triple disease" defined as JXG plus neurofibromatosis type 1 (NF-1) and juvenile chronic myelogenous leukemia (JCML) has been reported, but it was not confirmed in our patient.

Non-parametric tests in detecting glaucoma progression.

Automated perimetry still represents the gold standard in long term glaucoma monitoring. On a daily practice basis, glaucoma progression analysis could be difficult due to the long time needed to detect, confirm, and quantify the progression rate. Moreover, "trend" and "event" analysis require a good theoretical basis to perform and interpret. Aim of study was to present an alternative method to conventional Glaucoma Progression Analysis (Humphrey Visual Field Analyzer, Carl Zeiss® Inc.) applied for the early detection of glaucoma progression. Such an "event" analysis orients the clinician in a fast manner on the progression profile in glaucoma patients and might adapt the follow up visits accordingly. Method and material: 41 eyes from 41 patients with open angle glaucoma were studied in a longitudinal manner, over a 24 months' time interval from diagnosis. Results: in the GPA analysis, a positive "event" (progression) was detected in 11/ 41 eyes (26.82%). Non-parametric analysis confirmed progression in all GPA cases, and additionally found 8 more eyes with positive progression (46.34% studied eyes). Mc Nemar concordance analysis between tests was good and relevant (kappa index k=0.596, p=0.000), with positive correlation (r=0.652, p=0.008). In conclusion, NPA tends to overestimate the number of progression cases in a cohort, but it can easily orient the clinician on the profile of the followed patients. In the first years, the GPA analysis can be highly inaccurate, but there is a great need to detect which patients are at significant risk for vision loss (fast progressors). Yet, combining the two methods of detection of glaucoma progression, the practitioners might direct their selected interest and attention towards observing a larger than expected number of patients who are at risk for vision loss over time due to glaucoma, but not necessarily in a fast manner.

Effect of a Matrix Therapy Agent on Corneal Epithelial Healing After Standard Collagen Cross-linking in Patients With Keratoconus: A Randomized Clinical Trial.

IMPORTANCE: Corneal abrasions are frequent after standard (epithelium-off [epi-off]) corneal collagen cross-linking (CXL) in patients with progressive keratoconus. A new matrix therapy agent (ReGeneraTing Agent [RGTA]) has been developed to promote corneal wound healing. OBJECTIVE: To assess the effect of the new type of matrix therapy agent on corneal wound healing after epi-off CXL in patients with keratoconus. DESIGN, SETTING, AND PARTICIPANTS: This double-masked randomized clinical trial enrolled 40 patients with keratoconus undergoing epi-off CXL from July 18, 2014, to October 21, 2015, when the last follow-up was completed. The analysis of the intention-to-treat population was performed at the Department of Clinical Pharmacology in cooperation with the Center for Medical Physics and Biomedical Engineering and the Department of Ophthalmology and Optometry of the Medical University of Vienna. INTERVENTIONS: Patients were randomized to receive the matrix therapy agent or hyaluronic acid-containing eyedrops, 0.1%, every other day starting immediately after surgery. The size of the corneal defect was measured using ultrahigh-resolution optical coherence tomography (OCT) and slitlamp photography (SLP) with fluorescein staining. MAIN OUTCOMES AND MEASURES: Corneal wound healing rate, defined as the size of the defect over time. RESULTS: Among the 40 patients undergoing epi-off CXL (31 men; 9 women; mean [SD] age, 31 [10] years), wound healing was significantly faster in the matrix therapy agent group compared with the hyaluronic acid group (4.4 vs 6.1 days; mean difference, 1.7 days; 95% CI, 0.25-3.15 days; P = .008). The defect size was smaller in the matrix therapy agent group than in the hyaluronic acid group as measured with OCT (12.4 vs 23.9 mm2; mean difference, 11.6 mm2; 95% CI, 0.8-23.5 mm2; P = .045) and SLP (11.9 vs 23.5 mm2; mean difference, 11. 6 mm2; 95% CI, 1.3-22.9 mm2; P = .03). A correlation between the defect size measured with OCT and SLP was found (r = 0.89; P < .001). No ocular or serious adverse events occurred. CONCLUSIONS AND RELEVANCE: Use of a new matrix therapy agent appears to improve corneal wound healing after CXL in patients with keratoconus. Monitoring of corneal wound healing using ultrahigh-resolution OCT might be an attractive alternative to SLP because OCT provides an objective and 3-dimensional evaluation of the corneal defect. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02119039.

SHORT TERM EVALUATION OF PERIMETRIC PROGRESSION IN PATIENTS WITH OPEN ANGLE GLAUCOMA AND DIABETES.

AIM OF STUDY: Progression rate in patients with glaucoma and diabetes. MATERIAL AND METHOD: cohort prospective study in Ophthalmology Clinic "Sf. Spiridon" University Hospital Iasi. We recruited patients with positive history for diabetes and of open angle glaucoma (OAG). The control group included subjects with OAG (74 eyes from 74 patients) and the study group (44 eyes, from 44 patients) included subjects with OAG and diabetes. At enrollment all patients had a complete ophthalmologic evaluation along with full metabolic status assessment. There were included only incipient and moderate forms of glaucoma, with mild or no diabetic retinopathy changes. Perimetric progression was assessed at 24 months with automated methods. RESULTS: globally, from 118 investigated eyes, 56.40% cases had primary open angle glaucoma, 41.03% normal tension glaucoma and 2.36% pseudoexfoliative glaucoma. Glaucoma severity classification showed early defects (mean deviation < -6 db) in the study group of 77.27% vs. 83.78% in control group, whereas moderate defects (mean deviation > -6 db) were found in 22.63% in study group vs. 16.21.0% in control group. Mean age of the patients was higher in absolute value in the open angle glaucoma group (64.31 +/- 1.66 years), vs. diabetes + open angle glaucoma (62.69 +/- 1.8 years), with comparable visual acuities (0.91 +/- 0.15 vs. 0.89 +/- 0.16), CID ratios and other clinical pa- rameters (p > 0.05). Mean baseline lOP in the study group was 18.18 +/- 3.55 mrnHg vs. 17.08 +/- 2.4 nimHg in controls (p > 0.05). Analysis of visual field parameters at baseline showed a significant difference (p = 0.48) between groups in MD levels -3.63 +/- 3.35 db (control group) vs. -4.40 +/- 5.78 db (study group), but no difference (p > 0.05) in PSD levels: 3.71 +/- 3.06 db (control group) vs. 4.05 +/- 3.04 dB (study group). Perimetric progression was estimated at 24 months by Glaucoma Progression Analysis software (GPA-Humphrey Visual Field Analyzer II) using 6 reliable visual field (VF) exams. Progression rate was similar between groups--0.19 +/- 0.78 dB/year (OAG) vs. -0.18 +/- 0.05 dB/year (OAG+DM), p > 0.05 and no other risk factor could have been linked to an increased progression rate, except visual field parameters at final and baseline evaluation, in both groups. CONCLUSIONS: On short term, functional deterioration in open angle glaucoma patients having early or moderate stages, occurs similarly in the presence or absence of diabetes.

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.

Risk factors and long term progression in open angle glaucoma patients.

Aim: Investigation of perimetric progression rate and associated risk factors in open angle glaucoma, in clinical practice. Methods: Retrospective study based on clinical charts reviews of patients with primary open angle glaucoma (POAG) being followed for > 5 years with >/ = 5 SITA Standard visual fields. Demographics, visual acuity (VA), central corneal thickness (CCT), intraocular pressure (IOP) and IOP variation, treatment (number of medications), visual fields and associated systemic pathologies were recorded. Patients were followed at every 3-6 months, when identical tests were performed. VF progression rate was calculated as slope of mean deviation (MD) over time by Glaucoma Progression Analysis software. Results: 121 eyes of 121 patients with POAG were included in the study and were followed for a mean period of 68.81 months (SD +/ - 31.7). The mean MD at start was -3.55 dB (SD +/ -5.19)., with a mean number of VF tests of 9.3+/ -2.9. Progression rate reached -0.21 +/ -0.1 db/ year. Mean IOP of all visits decreased over time from 18.20 mmHg to 16.53 mmHg (p<0.05). Systemic factors like positive history of hypertension reached statistical relevance in terms of increased risk for glaucoma progression, but only after age and sex were corrected. MD slope was explained in ANOVA univariate analysis, by the level of MD at baseline, IOP baseline, number of topical medications and CCT in a proportion equal to 71.7% (p=0.004). Conclusion: Rate of visual field changes in POAG was correlated and dependent on the baseline MD level, IOP at baseline, number of topical medications and a thin CCT.

Combined etiology for bilateral and simultaneous optic neuropathy in a patient with ciancobalamin deficit and hepatitis C treated with peg-interferon and ribavirin.

We report the case of a 53-year-old female patient who developed bilateral sudden visual acuity loss after 15 weeks from the initiation of Peg-Interferon and Ribavirin treatment for hepatitis C. Debut was simultaneous and asymmetric, reported in the morning, at awakening. No pain or other symptom was reported by the patient. Results. At presentation, visual acuity was 0.2 in RE and 3/ 50 in LE. Pupillary reflexes were sluggish and severe dyschromatopsia was documented in both eyes (Ishihara plates). Fundus examination revealed bilateral pale optic disc edema, more prominent in LE, with splinter hemorrhages in the RNFL around the optic disk. Visual field exam demonstrated severe defects in 3 quadrants of the RE, whereas in the LE, it was impossible to perform the investigation due to VA<0.1. Neurologic evaluation was normal; other possible causes of systemic vasculitis were excluded by negative lab tests. Acute inflammatory markers (fibrinogen and ESR) and mild pancytopenia were the only documented laboratory changes in this patient. Anamnesis cleared the traditional risk factors for conventional AION (hypertension, diabetes, ischemic heart disease, and hypercholesterolemia). Cranial and orbital CT scan and MRI findings were normal. Patient was withdrawn from the Interferon and Ribavirin treatment and was administered methyl prednisolone pulse therapy (1g/ day) for 3 days, continued with oral Prednisone (60 mg/ day) tapered slowly for over 12 weeks. VA increased to 0.8 during treatment in the RE, but visual recovery in the LE was not as spectacular (0.16) as in the fellow eye. Modified latencies and amplitudes in evoked visual potentials examination during 4 months time emphasized bilateral optic atrophy. Optic nerve sufferance was amplified by a low level of vitamin B12, detected by chance at the last eye visit. Due to the general condition, dietary supplementation was not possible. Conclusion. A case of a patient with bilateral and simultaneous NAION caused by IFN and Ribavirin treatment for hepatitis C, who was also vitamin B12 deficient, was analyzed. Therefore, a combined etiology for optic atrophy was explained.

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.

PLATEAU IRIS SYNDROME--CASE SERIES.

Plateau iris is characterized by closing the anterior chamber angle due to a large ciliary body or due to its anterior insertion that alters the position of iris periphery in respect to the trabecular meshwork. There are two aspects that need to be differentiated: plateau iris configuration and plateau iris syndrome. The first describes a situation when the iris root is flat and the anterior chamber is not shallow, the latter refers to a post laser iridotomy condition in which a patent iridotomy has removed the relative pupillary block, but goniscopically confirmed angle closure recurs without central shallowing of the anterior chamber. Isolated plateau iris syndrome is rare compared to plateau iris configuration. We hereby present two case reports of plateau iris syndrome in young patients who came to an ophthalmologic consult by chance.

[Perimetric changes in advanced glaucoma]. / Modificari perimetrice în glaucoamele avansate.

AIM: The evaluation of various perimetric aspects in advanced glaucoma stages correlated to morpho-functional changes. MATHERIAL AND METHOD: Retrospective clinical trial over a 10 months time period that included patients with advanced glaucoma stages, for which there have been recorded several computerised visual field tests (central 24-2 strategy, 10-2 strategy with either III or V--Goldman stimulus spot size) along with other morpho-funtional ocular paramaters: VA, lOP optic disk analysis. RESULTS: We included in our study 56 eyes from 45 patients. In most cases 89% it was an open angle glaucoma (either primary or secondary) Mean visual acuity was 0.45 +/- 0.28. Regarding the perimetric deficit 83% had advanced deficit, 9% moderate and 8% early visual changes. As perimetric type of defect we found a majority with general reduction of sensitivity (33 eyes) + ring shape scotoma. In 6 eyes (10.7%) having left only a central isle of vision we performed the central 10-2 strategy with III or V Goldmann stimulus spot size. Statistic analysis showed scarce correlation between the visual acuity and the quantitative perimetric parameters (MD and PSD), and variance analysis found present a multiple correlation parameter p = 0.07 that proves there is no liniary correspondence between the morpho-functional parameters: VA-MD(PSD) and C/D ratio. CONCLUSIONS: In advanced glaucoma stages, the perimetric changes are mostly severe. Perimetric evaluation is essential in these stages and needs to be individualised.