Biomolecular evaluation of cryopreserved amniotic membranes for ophthalmological use by ELISA and RT-PCR at one and eighteen months.

PURPOSE: To study the presence of certain proteins - EGF (epidermal growth factor), KGF (keratinocyte growth factor), IL-10 (interleukin 10), HGF (hepatocyte growth factor), Alpha2-macroglobulin and IL-1RA (interleukin 1 receptor antagonist) in cryopreserved amniotic membranes at 1 and 18 months and, as a secondary objective, to detect mRNA corresponding to KGF, IL-1Ra, Alpha2-macroglobulin, Fas Ligand, TGF beta (transforming growth factor beta) and Lumican by RT-PCR in membranes preserved at 1 and 18 months. MATERIAL AND METHODS: Four samples of amniotic membrane were divided into 2 groups: the first group (N=2) cryopreserved for 1 month and the second group (N=2) cryopreserved for 18 months, in order to be studied by RT-PCR and ELISA. RESULTS: RT-PCR detected KGF, IL-1Ra, Alpha2-macroglobulin, Fas Ligand, and Lumican. Of these, FAS Ligand mRNA was found in samples preserved for 1and 18 months. KGF, Lumican, and alpha2-microglobulin mRNA were found only at 1 month, and IL-1Ra mRNA was absent in both sample groups. RT-PCR for TGF-beta was inconclusive. ELISA was performed for detection and quantification of 6 proteins (EGF, KGF, IL-10, HGF, Alpha2-macroglobulin and IL-1Ra) in both amniotic membrane groups. All 6 proteins were found in all samples, with a lower concentration at 18 months compared to 1 month of preservation. CONCLUSION: This study shows that membranes cryopreserved in 50% glycerol for 18 months do retain the proteins necessary for regeneration of the corneal surface, giving these membranes their biochemical properties.

[Screening for diabetic retinopathy by non-mydriatic fundus photography: First national campaign in Lebanon]. / Dépistage de la rétinopathie diabétique par rétinographie non mydriatique : première campagne nationale au Liban.

INTRODUCTION: Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Non-mydriatic fundus photography (NMFP) has been adopted as a screening tool for this disease. We aim to determine the prevalence of DR through this method in Lebanese diabetic patients and to evaluate the impact of such screening in this population. MATERIALS AND METHODS: This study explores data from an awareness and screening campaign conducted in Lebanon. Diabetic patients from multiple regions were referred by their endocrinologists to undergo NMFP using the Optomed SmartScope® handheld fundus camera. Photographs were interpreted by a remote observer, and recommendations were given accordingly. The prevalence of DR was calculated, and statistical analyses were performed on the clinical characteristics, fundus findings and number of referrals to ophthalmologists. RESULTS: The campaign lasted 11 months, during which 2205 patients were examined in 37 screening locations. Out of the 97.41% of patients with type 2 diabetes mellitus, 12.56% had signs of DR, with no significant difference between the regions. 6.28% of the photos were uninterpretable. Positive results were associated with a longer duration of diabetes (P<0.01), treatment with insulin (P<0.01), as well as the presence and chronicity of systemic hypertension (P=0.01). 25% of patients with positive testing were retrospectively asked about their follow-up; only one third had an ophthalmologic examination as per the recommendation, among whom 68.18% underwent treatment for proliferative DR and/or diabetic macular edema. CONCLUSION: Tele-ophthalmology is useful in mass screening for DR. The importance of dilated fundus examinations still needs to be highlighted for diabetic patients, and better collaboration between endocrinologists and ophthalmologists is required to improve screening outcomes.

Vitamin D receptor gene FokI polymorphism in Egyptian children and adolescents with SLE: A case-control study.

Background Childhood-onset systemic lupus erythematosus (cSLE) is a lifelong autoimmune disorder. The vitamin D receptor (VDR) gene is a potential candidate gene for cSLE susceptibility. In this study, we aimed to investigate the FokI polymorphism in the VDR gene in Egyptian children and adolescents with SLE, to determine whether this polymorphism could be a genetic marker for cSLE susceptibility or disease activity and we also measured the serum level of 25-hydroxyvitamin D [25(OH) D] to assess its relation to such polymorphism. Methods This was a case-control study, which included 300 patients with cSLE and 300 age, sex, and ethnicity-matched healthy controls. All participants were genotyped for the VDR gene FokI (rs2228570) polymorphism by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), while the serum [25(OH) D] levels were measured by enzyme-linked immunosorbent assay (ELISA). Results The VDR FokI FF genotype and F allele were overrepresented among cSLE patients compared with the controls, [odds ratio (OR) = 2.7; 95% confidence interval (CI): 1.6-4.4 for the FF genotype; p = 0.000; and OR = 1.6; 95% CI: 1.27-2.05 for the F allele; p = 0.000, respectively]. We found a significant association between VDR FokI FF genotype with lupus nephritis (OR: 4.8; 95% CI: 2.2-10.6; p = 0.002); and high disease activity index score ( p = 0.01). Conclusions The FokI polymorphism in the VDR gene may contribute to susceptibility to SLE in Egyptian children and adolescents. Moreover, the FF genotype constituted a risk factor for the development of lupus nephritis and was associated with low serum [25(OH) D] levels as well as higher disease activity index score among studied patients with cSLE.

Thick keratoconic cornea associated with posterior polymorphous corneal dystrophy.

INTRODUCTION: We herein report a case of bilateral unusually thick non-edematous keratoconic corneas with associated endothelial features of posterior polymorphous corneal dystrophy (PPCD). CASE REPORT: We report the case of a 27-year-old myopic woman who presented for refractive surgery. Slit lamp exam showed bilateral corneal protrusion with diffuse deep stromal and endothelial vesicular opacities and small paracentral bands. Topography showed generalized advanced corneal steepening in both eyes with increased anterior and posterior central corneal elevations in comparison to the best fit sphere. Ultrasound pachymetry showed central corneal thickness of 605µm (RE) and 612µm (LE). On specular biomicroscopy, cell density of 2503 cells/mm2 RE and 1526 cells/mm2 LE with significant cellular pleomorphism and polymegathism were noted. DISCUSSION: Clinical and paraclinical findings together suggest the presence of simultaneous keratoconus and PPCD. The literature has suggested an association between PPCD and steep cornea. Moreover, many reports have also described cases of associated PPCD and keratoconus with characteristic thinning and ectasia, in comparison to the unusual thick corneas noted in our patient, despite the absence of edema. Identification of genetics factors is further needed to clarify this association. CONCLUSION: This case describes a patient whose corneas present features of both keratoconus and PPCD and is unique due to the presence of increased corneal thickness despite the absence of edema.

[GDx-VCC NFI analysis in Lebanese glaucoma patients]. / Analyse de l'indice NFI du GDx VCC dans le glaucome au Liban.

PURPOSE: To describe the Nerve Fiber Indicator (Nerve Fiber Index; NFI) parameter findings and progression in Lebanese glaucoma patients or suspects. STUDY DESIGN: Retrospective, observational study. PATIENTS AND METHODS: A review was conducted of the GDx VCC examinations performed between January 2003 and December 2008 in an ophthalmological diagnostic center, in 1063 Lebanese subjects referred for this testing by their ophthalmologists. This group of subjects included confirmed glaucoma patients and glaucoma suspects. GDx VCC examination was repeated one or more times, at a one-year interval, in only 136 patients. Since we only had access to their GDx VCC examinations, the number of subjects in each category was unknown prior to the exam. After GDx VCC examination, we divided the subjects into three categories according to their NFI score. Subjects were considered to be normal when the NFI score was below 30, glaucoma suspects when the score was between 30 and 40, and confirmed glaucoma patients when the score was above 40. RESULTS: Among the 1063 patients studied, 525 were female and 538 male, with a mean age of 56.8 ± 14.2 years at the time of examination. The mean NFI score was 27.01 ± 14.23, higher in males than females in the various age groups, and higher in older than in younger subjects, the greatest difference being between the 11- to 20-year and the 81- to 90-year age groups (P=0.015). Eight hundred and eighty patients had an NFI score within normal limits, the score was consistent with glaucoma suspect in 280 patients and with confirmed glaucoma in 103 patients. Among the 136 patients who underwent multiple GDx VCC examinations, 69 were initially classified as normal. Upon repeat GDx VCC examinations over a five year period, 24 of these 69 patients (34.78%) presented with scores consistent with glaucoma suspect or confirmed glaucoma. CONCLUSION: This study demonstrates that glaucoma was detected or suspected in at least one of three subjects referred for GDx VCC examination (383/1063). NFI scores were higher in males than females and in older compared to younger subjects.

[Keratoconus screening in a Lebanese students' population]. / Dépistage du kératocône dans une population universitaire au Liban.

OBJECTIVE: Screening for keratoconus and potential risk factors in a medical student population in Lebanon using anterior topography. POPULATION AND METHODS: We randomly selected 110 medical students doing rotations in the Hôtel-Dieu de France hospital in Lebanon between November 2009 and February 2010. Ninety-two students agreed to participate in the screening protocol, which included a questionnaire and an anterior topography. The topography was performed using the placido disk Tomey(®) Topographic Modeling System TMS-4. The results were interpreted using the analysis programs supplied with the machine and by an experienced ophthalmologist. RESULTS: Ninety-two students participated in the study (83.6%): 49 males (53.2%) and 43 females (46.8%). The mean age was 23.6±1 year. Fifty-eight students were ametropic (63.1%): 44 participants were myopic (47.8%), 40 had astigmatism (43.4%), and six were hyperopic (6.5%). Three students (six eyes) were diagnosed with keratoconus. The prevalence of keratoconus was 3.3%, of which 2.2% were already known cases. The prevalence of forme frustre keratoconus was 1.1%. Eleven students (12.1%) had a family history of keratoconus, only one was diagnosed with the disease. Atopy and eye rubbing were not found significantly related to keratoconus in this population. CONCLUSION: Keratoconus is a prevalent disease among our population of Lebanese medical students, which confirms the clinical impression that keratoconus is relatively frequent in Lebanon. Further studies need to be conducted on a larger and more representative sample to assess keratoconus prevalence and risk factors in Lebanon.

[Prevalence, causes, and risk factors for blindness and visual impairment among nursing home residents in Lebanon]. / Prévalence, causes et facteurs de risque de la cécité et de la malvoyance chez les personnes âgées des maisons de retraite libanaises.

AIMS: To determine the prevalence, causes, and risk factors for blindness and visual impairment in the elderly population of Lebanese nursing homes, to encourage the development of an effective campaign against blindness. METHODS: Transversal study in all nursing homes in two Lebanese regions (298 residents). All respondents (89.6%) underwent a complete ocular examination. Personal and medical data were also gathered for each participant. RESULTS: The prevalence of blindness (visual acuity20/200 in the best eye) was 36%. The rate of blindness in underprivileged residents was found to be double that of the well-off residents (27% and 15%, respectively). Cataract was the leading cause of blindness, followed by age-related macular degeneration and open-angle glaucoma. At least 55% of the causes of blindness and 58% of the causes of visual impairment are potentially curable or avoidable. CONCLUSION: Blindness and visual impairment were high among Lebanese nursing home residents. This is an unfortunate observation given that the leading ocular diseases are treatable and that good vision is essential to these residents' quality of life.

[Epidemiology of diabetic retinopathy in Lebanon]. / Caractéristiques épidémiologiques de la rétinopathie diabétique au Liban.

AIMS: To assess the prevalence of diabetic retinopathy, evaluate risk factors underlying its development, and assess the epidemiological characteristics of documented diabetes in the Lebanese population. PATIENTS AND METHOD: The population-based study was conducted in three regions in Lebanon from January 2nd 2000 until June 30th 2000. The study group comprised 112 known diabetic patients who had previously been identified among 4,063 randomly selected individuals. All known diabetic patients underwent an interview, a physical examination, and a thorough retinal examination that included evaluation for the absence or presence of diabetic retinopathy. Retinal examination was performed by an ophthalmologist using direct and indirect ophthalmoscopy through dilated pupils. Several risk factors were then evaluated in order to delineate those related to occurrence of diabetic retinopathy. RESULTS: The prevalence of known diabetes was 2.95%. Of the 120 known diabetic patients, 112 accepted to be examined. The sex ratio (m:f) was 1.43, the mean patient age was 60.98 years, the mean age at onset of diabetes was 51.75 years, and the mean duration of diabetes was 9.19 years. Type 1 diabetes was found in 1.8% of the patients, whereas 98.2% had type 2 diabetes. Diabetic retinopathy was detected in 19 patients (16.96%). Duration of diabetes, frequency of fundoscopic surveillance, and altered vision were found to be significantly related to the occurrence of diabetic retinopathy. CONCLUSION: In our study, diabetic retinopathy was found in 16.96% of known diabetic patients, a lower rate than in most of other countries. Most of the diabetic patients (84.82%) were aware that diabetes causes ocular disease, yet only a few (17.85%) were under regular fundoscopic surveillance.

Microcephaly, cutis verticis gyrata of the scalp, retinitis pigmentosa, cataracts, sensorineural deafness, and mental retardation in two brothers.

We describe the cases of two brothers with microcephaly, primary cutis verticis gyrata of the scalp, prominent supraorbital ridges, large nose, hypertelorism, exotropia, progressive retinitis pigmentosa, cataracts, sensorineural hearing loss, kyphoscoliosis, and mental retardation. A review of the literature focusing on the major clinical findings suggests that our cases may represent a hitherto unreported new syndrome.

Exclusion of chromosome 15q21.1 in autosomal-recessive Weill-Marchesani syndrome in an inbred Lebanese family.

We report an inbred family where 3 siblings had short stature, brachydactyly, limitation of joint movements, microspherophakia, luxated lenses, glaucoma, and heart malformations. Parents of the affected siblings were relatively short, but did not have any of the other features present in their siblings. Those clinical features are consistent with the Weill Marchesani syndrome (MIM 277600). Both autosomal-recessive and autosomal-dominant pedigrees have been reported, with a possible linkage to chromosome 15q21.1 in the latter. Linkage analysis at 15q21.1 in this Lebanese family allowed us to exclude the role of this region in the etiology of the syndrome. Speculations regarding the pathogenesis of the disorder are discussed.

Two sibs with myoclonic epilepsy, congenital deafness, macular dystrophy, and psychiatric disorders.

We present a family with four children born to second-cousin parents. Two of the children had myoclonic epilepsy, congenital deafness, a dystrophic pattern of the macular pigment epithelium, incomplete right bundle branch block, and psychiatric disorders appearing after fever episodes. Results of all laboratory investigations including mitochondrial DNA analysis were normal. Despite the fact that this condition resembles one reported by Latham and Munro in 1937, it is possible that we might be reporting on a new autosomal recessive syndrome.

Laser in situ keratomileusis for hyperopia.

PURPOSE: To study the efficacy of laser in situ keratomileusis (LASIK) for hyperopia. METHODS: We performed LASIK on 21 eyes using the Nidek EC-5000 excimer laser with software version 2.18 AH. The Chiron Automated Corneal Shaper was used to create the flap. Retreatments were needed in seven eyes due to decentration or undercorrection. RESULTS: Although a high rate of satisfaction was noted among patients, complications were encountered such as decentration (three eyes), undercorrection (four eyes); one patient progressed to low myopia with a loss of spectacle-corrected visual acuity and one patient had regression 3 months after the initial LASIK. CONCLUSION: Although this technique has several advantages over other techniques (holmium, ALK, PRK, hexagonal RK), it has a high rate of retreatment and some complications. Software refinement is needed, and patients should be adequately informed about what to expect from this technique.

Excimer laser photorefractive keratectomy in Lebanon.

We report on 50 eyes of 50 patients treated by photorefractive keratectomy (PRK) using the Summit Technology OmniMed excimer laser. Follow up ranged from 3 to 9 months, and the eyes were divided into three groups on the basis of the initial myopia (< 6.00 diopters (D), 6.00 D to 10.00 D, and > 10.00 D). Mean preoperative spherical equivalent refraction in each group was -4.15 D, -7.88 D, and -12.00 D respectively, and -0.24 D, -1.41 D, and -1.70 D postoperatively. Ninety percent in group 1, 56.25% in group 2 and 35.71% in group 3 had a final refraction within 1.00 D of the attempted correction. Complications consisted of one case of infectious keratitis, medically treated with no sequelae; one case of significant loss of spectacle corrected visual acuity related to corneal haze; and one case of corticosteroid-induced elevated eye pressure controlled with topical treatment. In this series, PRK appeared to be effective and safe for the correction of myopia of less than -6.00 D. For higher myopia, other methods of treatment should be used.

Results of transverse keratotomies for astigmatism after penetrating keratoplasty: a retrospective study of 48 consecutive cases.

BACKGROUND: High astigmatism is still a common complication of penetrating keratoplasty which often limits the final corrected visual acuity. Surgical correction of high astigmatism persistent after suture removal remains rather controversial. In our present study, we used the technique of transverse keratotomies for the surgical correction of high astigmatism following penetrating keratoplasty because of its simplicity and corrective potential. METHODS: We present a retrospective clinical study based on the results of 48 consecutive transverse keratotomy procedures performed on the graft. Three eyes were operated on twice, for a total of 51 procedures. The astigmatism had to be stable for at least 6 months after suture removal, with poor corrected visual acuity with spectacles or contact lenses. The operative protocol (number of incisions, optical zone size) was decided based on the degree of astigmatism. The mean post-operative observation period was 5.11 +/- 3.93 months (range, 1 to 24 months). RESULTS: The mean preoperative cylinder was 8.96 +/- 2.22 diopters and 4.91 +/- 1.79 D postoperatively. The mean cylindrical change was 4.51 +/- 2.77 D. The spherical equivalent remained unchanged in most cases. In a majority of cases, the corrected visual acuity for distance and near vision was improved. No cases of persistent graft edema caused by immunologic rejection or endothelial failure were observed. Moreover, in no case was there worsening of the best corrected visual acuity. CONCLUSIONS: The technique of transverse incisions in the graft to correct or reduce high postkeratoplasty astigmatism is simple, efficient, and relatively safe. The main problem was poor predictability.

[Cataract surgery after injection of silicone]. / Chirurgie de la cataracte après injection d'huile de silicone.

Thirty eyes were studied retrospectively, after cataract surgery following intraocular silicone oil injection. Cataract surgery took place before silicone oil removal in 9 eyes, at the same time as silicone oil removal in 2 eyes, and after silicone oil removal in 19 eyes. Extracapsular extraction was performed in 27 eyes, and intracapsular extraction was performed in 3 eyes. A posterior chamber intraocular lens was placed in 14 cases, and an anterior chamber intraocular lens in one case. Capsular fibrosis was observed in 19 cases, and it was treated with YAG laser in 10 eyes during follow-up. Twenty five eyes had a postoperative follow up of 3 to 37 months. Total retinal detachment occurred in 2 eyes.

[Cyclodiathermy: is it effective in the treatment of glaucoma?]. / La cyclodiathermie: a-t-elle encore une valeur dans le traitement du glaucome?

The authors describe the non penetrating technique of cyclodiathermy in the treatment of different types of glaucoma and publish the results and the complications of the application of this technique on thirty three eyes among their patients. These eyes included congenital glaucoma (8 eyes), aphakic glaucoma (5 eyes), after silicone surgery (5 eyes), neovascular glaucoma (4 eyes), traumatic glaucoma (4 eyes), secondary glaucoma (3 eyes), Sturge-Weber-Krabbe (2 eyes) and open angle glaucoma (2 eyes). Their study with a mean follow up of 2.5 years shows an overall success rate of 60%. The success is defined as an ocular tension less than or equal to 22 mmHg in the absence of serious complications. All the encountered complications are mentioned. Phtysis occurred in not more than 3% of cases (1 eye). They establish a comparison with the published results and complications of the other cyclodestructive procedures: Sonocare, transcleral laser Yag, transcleral laser Ruby and cyclocryotherapy. This comparison does not prove the superiority of these other procedures with regard to the non penetrating cyclodiathermy. They conclude that this non penetrating cyclodiathermy is a non expensive procedure which still have its good therapeutic value.