Calitatea vieții în glaucom

Ophthalmology Department University of Medicine and Pharmacy „Grigore T. Popa”, Iasi, RomaniaRezumat. Conform Organizației Mondiale a Sănătății glaucomul este a patra cauză de oribire la nivel global, iar cea mai frecventă formă a glaucomului în Europa este cel cu unghi deschis. Glaucomul afectează aproximativ 2% din adulții peste 40 de ani și frecvența acestuia crește odată cu vârsta. Pacienții care suferă de glaucom au calitatea vieții joasă, fiind afectate activitățile de zi cu zi. Procesul patologic implică acuitatea vizuală, câmpul vizual și vederea cromatică. Este vital ca acești pacienți să fie urmăriți de medicul oftalmolog pentru a stabili evoluția bolii și severitatea procesului patologic.The purpose of this study is to identify the implication of blindness for glaucoma patients. According to WHO, glaucoma is the fourth case of global blindness and Primary Open-Angle Glaucoma (POAG) is by far the commonest in Europa. Glaucoma affects approximately 2% of adults over 40 and it increases dramatically with age. A patient with glaucoma often has problems with important day activities and for them the burden of blindness is to keep normal vision-quality and life-quality. The disease comes with visual acuity, visual field and color vision loss and the people affected by it, become depressed. The glaucoma patients have always to manage with their doctor the evolution of the disease and the severity of the disease has to be understanded by their family and their close people. The aging of the population will lead to more individuals with glaucoma and each country has to work on a national program to help its citizens affected by this disease. Purpose. To identify implication of blindness for glaucoma patients. Methods and material. According to WHO 2021, glaucoma is the forth cause of global blindness and is the leading cause of irreversible visual loss. By the year 2020 it is estimated that there will be almost 80 million people in the world with open angle glaucoma (POAG) and angle-closure glaucoma. Bilateral blindness from glaucoma is projected to affect 8.4 million individuals worldwide by 2010 and greater than 11 million by 2020. Of the many types of the disease, POAG is by far the commonest in populations of European origin. Glaucoma affects approximately 2% of adults over the age of 40, and disease prevalence increases dramatically with age. There are many implications of burden in glaucoma: for patients, physician, family/friends or society. For glaucoma patient the burden of blindness is to keep a normal vision-quality and, in the same time, life-quality. A patient with glaucoma often has problems with important daily activities such as walking/stair climbing, driving, reading, faces recognition/social relations or even self-treatment with drops, especially when perimetric damage is advanced or when both eyes are affected. Patients with glaucoma will loss visual acuity, visual field, color vision and will be depressed or anxious. For physicians the burden of blindness is in difficulties to inform the patient about diagnosis and to manage together with patient evolution of the disease. Evaluation of glaucomapatientst istimeconsumingg and the management is a challenge – medical/surgical. For family there are difficulties to understand glaucoma evolution, visual/life modification, and to help in socio-professional integration of the patient. For society is a burden of care cost high in glaucoma, and can be measured not only in monetary cost to the healthcare system but also in the diminished quality of life for glaucoma patients. Is a burden of cost for treatment, losssing of job and to support a blind person. Conclusions. The aging of the population worldwide will lead to substantially more individuals with glaucoma in the coming year. The burdened glaucoma, for patients and cost-care, cbe reduce with a National program, also, for glaucoma screening and for socio-professional including of patients

Optical coherence angiography-tomography – a biomarker of retinal vascularization in patients with multiple sclerosis. Preliminary results

Summary. Optical coherence angiography-tomography uses as a reflective medium the flow of erythrocytes through the retinal circulation, reproducing images of the vascular microstructure from the superficial vascular plexus of the retina. The examination took place in the I Ophthalmology Clinic of the Hospital “St. Spiridon” Iași and included 15 patients diagnosed with multiple sclerosis. We observed in 3 cases, changes in peripapillary vascularization. With the help of OCT angiography we were able to observe a series of elements with the appearance of peripapillary vascular stasis, at the level of the microcirculation of the optic nerve.Introducere: Angiografia-tomografie în coerență optică folosește ca mediu reflectiv fluxul eritrocitelor prin circulația retiniană, reproducând imagini ale microstructurii vasculare din plexul superficial vascular al retinei. Vizualizarea modificărilor poate favoriza înțelegerea etiopatogeniei sclerozei multiple în afectarea nervului optic și a structurilor retiniene. Materiale și metode. În cadrul examinării, în Clinica I Oftalmologie a Spitalului „Sf. Spiridon” Iași, a 15 pacienți diagnosticați cu scleroză multiplă, am observat în 3 cazuri, modificări ale vascularizației peripapilare. Pacienții la care s-au obiectivat aceste modificări nu prezentau afectări oftalmologice, istoric de nevrită optică sau patologii ale altor structuri oculare. În cadrul examinării au fost evaluate acuitatea vizuală, simțul cromatic, câmpul vizual, examenul biomicroscopic al polului anterior și al polului posterior, Tomografia în Coerență Optică (OCT) (Swept-Source OCT Triton de la Topcon) echipat cu modul de Angiografie. Rezultate. Cu ajutorul Angiografiei-OCT am putut observa o serie de elemente cu aspect de stază vasculară peripapilară, la nivelul microcirculației nervului optic. OCT-ul a obiectivat o îngroșare a RNFL- ului peripapilar în anumite cadrane care nu se corelează cu edem papilar sau alte semne inflamatorii. La examenul polului posterior, discul optic este bine delimitat, fără modificări inflamatorii, iar acuitatea vizuală a acestor pacienți este 1, binocular. Discuții. În cazul pacienților cu scleroză multiplă, apariția semnelor de stază vasculară peripapilară ar putea avea rol în apariția nevritei optice? Ar putea fi un semn de recidivă a episodului inflamator? Există corelație între gradul stazei vasculare și afectarea statusului vizual? Dispariția acestor semne poate fi un marker de remisie al bolii? Concluzii. Vom urmări în continuare, pe termen lung, prin Angiografie-OCT atât modificările vasculare de la nivelul nervului optic, cât și la nivel macular și a regiunii foveale avasculare. Aceste rezultate ne vor putea oferi informații asupra vascularizației retiniene și modul în care aceasta este afectată în cadrul episoadelor inflamatorii din scleroza multiplă

The role of OCT in glaucoma

Introduction: Optical coherence tomography (OCT) is a non-invasive optical technique used for in vivo cross- sectional imaging of the optic nerve head and retina. OCT represents a commonly used imaging technology in the evaluation of glaucomatous structural damage. Purpose: To emphasize the fact that OCT is a valuable clinical tool for glaucoma diagnosis and detection of progression. Material and methods: There are different types of OCT. AS-OCT is a non-contact procedure and is more user-friendly when compared to UBM. Time domain (TD)-OCT creates crosssectional images of anterior segment structures and it is used also in glaucoma and retina diagnosis. TD-OCT also provides measurement tools to document and follow changes in the cornea, angle and anterior chamber. Spectral domain (SD)-OCT - glaucoma assessment over the earlier generation of time domain (TD)-OCT due to increased axial resolution and faster scanning speed that lead to lower susceptibility to eye movement artefacts. SD-OCT is used for glaucoma diagnosis, screening and detection of progression. The clinical utility of SD-OCT in glaucoma has focused on the evaluation of retinal nerve fiber layer (RNFL) parameters and allows for the assessment of macular parameters (the highest concentration of retinal ganglion cells-RGC in the retina = 50%). Results: Visual Field (VF) remains the most important test to monitor progression of glaucoma. OCT of optic disc/RNFL/macula using the same instrument with the software-based analysis can be useful. OCT progression analysis cannot replace VF progression analysis. At present OCT progression analysis is not age-corrected. Apparent OCT progression and VF progression are not always correlated. Conclusion: OCT of optic disc/RNFL/macula can be useful, but the diagnosis of glaucoma cannot be made on the basis of OCT alone

Multiple sclerosis and SARS-CoV-2 infection

Universitatea de Medicină și Farmacie „Grigore T. Popa” Iași, România, Clinica I Oftalmologie, Spitalul Clinic Județean de Urgență „Sf. Spiridon”, Iași, RomâniaSummary. We analyzed the case of a patient with multiple sclerosis associated with SARS-CoV-2 infection. The clinical appearance of the ophthalmologist does not justify the decrease in AV, which is why it is recommended to perform an MRI in an emergency. The patient accuses the decrease in visual acuity in the left eye. The appearance described is suggestive for multiple sclerosis. PCR testing was positive. After 14 days PCR test was negative but the ophthalmological evolution was unfavorable. Intravenous emergency treatment with Solumedrol was initiated for 5 days. The particularity of the case is due to the fulminant onset of multiple sclerosis in the context of SARS-CoV-2 infection and the unfavorable evolution in terms of AV, despite early treatment.Introducere. Pacientă, în vârstă de 16 ani, se prezintă în Clinica I Oftalmologie a Spitalului „Sf. Spiridon”, Iași, acuzând scăderea acuității vizuale la ochiul stâng cu debut acut. Pacienta nu prezintă alte antecedente personale patologice. AVOD=1 fc, AVOS= pmm., PIOAO=12mmHg. La examinarea polului anterior, nu se constată elemente patologice. La examinarea polului posterior, discul optic este normal colorat, are contur net, C/D=0,1, artere și vene cu calibru normal, maculă fără leziuni. Aspectul clinic oftalmologic nu justifică scăderea AV, motiv pentru care se recomandă efectuarea unui RMN în urgență. Se identifică leziuni în hipersemnal T2 și FLAIR cu restricție de difuzie localizată periventricular pe partea dreaptă, în contrast cu cornul posterior al ventriculului lateral drept cu diametru de 17/15 mm și două în centri senzoriali, una mai mare de 9,6mm parietal drept în substanța albă, periventricular, talamic drept, 9,6 mm în medulla oblongata de 13 mm. Aspectul descris este sugestiv pentru scleroză multiplă. Testarea PCR pentru SARS-CoV-2 a avut rezultat pozitiv, pacienta fiind asimptomatică. S-a format o echipă multidisciplinară alcătuită din oftalmologi, neurologi și medici infecționiști și s-a inițiat tratamentul în urgență intravenos cu Solumedrol timp de 5 zile, continuat cu Medrol per os. Evoluție. După 14 zile, testul PCR pentru SARSCoV- 2 s-a negativat, însă evoluția oftalmologică a fost nefavorabilă. Pacienta se prezintă după 3 luni, în urgență, acuzând percepția unui scotom central la OD. AVOD=0,6, iar AVOS a rămas pmm. La RMN leziunile au aspect staționar. După tratamentul intravenos cu Solumedrol 3 zile și per os cu Medrol, scotomul central de la OD se reduce în dimensiuni și AVOD se îmbunătățește la 0,8 fcnc. Discuții: Rămâne în discuție deschisă dacă infecția cu SARS-CoV-2 la persoane nevaccinate poate precipita debutul fulminant al unor patologii în stare latentă. Concluzii. Particularitatea cazului se datorează debutului fulminant al sclerozei multiple în contextul infecției cu SARS-CoV-2 și evoluției nefavorabile din punct de vedere al AV, în ciuda tratamentului instaurat precoce

Correlations between clinical, imaging and histological findings in a patient with neurofibromatosis type 1 (von Recklinghausen's disease)

Neurofibromatosis type 1 (NF1) or von Recklinghausen disease is one of the most common genetic diseases, affecting 1/4,000 individuals. It is transmitted by autosomal dominant inheritance and the gene NF1, which is responsible for the disease, is located on the long arm of chromosome 17. NF1 is characterized by varied expressions of the disease, even within the same family.We present the case of a 22-year-old patient with NF1 admitted in the Department of Neurosurgery for a two months history of diffuse intercostal nevralgias that did not respond to treatment and discuss the histopathological and immunohistochemical features of her cutaneous and spinal neurofibromas.Our case adds new data to the knowledge of the diverse biological behaviour of NF1, highlighting the fact that this condition is a complex disease even in the same individual. We report here a highly variability among neurofibromas in the same patient from a histopathological point of view. Our data are also important as they demonstrate the fact that the management of a patient with NF1, due to the various and complex manifestations of the disease, requires a multidisciplinary approach, including neurologist, neurosurgeon, ophthalmologist, plastic surgeon, derma-tologist, radiologist and pathologist

“The Silk Road” via subarachnoid cisterns: Cerebrospinal fluid dissemination of meningiomas

Meningiomas are generally slow-growing extra-axial benign tumours and in rare cases they can metastasize both neural and extra-neural. Intracranial meningiomas with leptomeningeal dissemination are extremely rare and the exact pathogenesis still remains unknown. The aim of this review is to analyse the pathways of intracranial and spinal metastatic spread of intracranial meningiomas and to discuss their particular clinical and pathological features. We highlight the fact that there is a possibility of leptomeningeal dissemination, even if cerebrospinal fluid cytology is negative, in patients with a medical history of a resected meningioma. We identified three possible ways of dissemination: haematogenous, through the CSF, or during surgery. From a histopathological point of view, the more malignant the meningioma, the more likely its leptomeningeal dissemination

Optic Neuritis in Multiple Sclerosis—A Review of Molecular Mechanisms Involved in the Degenerative Process

Multiple sclerosis is a central nervous system inflammatory demyelinating disease with a wide range of clinical symptoms, ocular involvement being frequently marked by the presence of optic neuritis (ON). The emergence and progression of ON in multiple sclerosis is based on various pathophysiological mechanisms, disease progression being secondary to inflammation, demyelination, or axonal degeneration. Early identification of changes associated with axonal degeneration or further investigation of the molecular processes underlying remyelination are current concerns of researchers in the field in view of the associated therapeutic potential. This article aims to review and summarize the scientific literature related to the main molecular mechanisms involved in defining ON as well as to analyze existing data in the literature on remyelination strategies in ON and their impact on long-term prognosis

A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes

Pregnancy is a condition often characterized by changes that occur in different parts of the body. Generally, the eyes suffer several changes during pregnancy that are usually transient but may become permanent at times. This may occur due to the release of placental hormones and those of maternal endocrine glands and fetal adrenal glands. Due to hormonal influences, physiological ocular changes during pregnancy have been shown in Caucasian women, so corneal sensitivity, refractive status, intraocular pressure, and visual acuity may change during pregnancy. Within this review, all studies that referred to physiological aspects and to changes of ocular pathology of pregnancy, the effect of the pregnancy on pre-existing (diabetic retinopathy, neuro-ophthalmic disorders) eye disorders, postpartum ocular changes, the intraocular pressure and the effect of hypotensive ophthalmic medicine during pregnancy, the connection between pregnancy and the neuro-ophthalmic pathology, as well as the role of anesthesia were analyzed

Comprehensive Review on the Use of Artificial Intelligence in Ophthalmology and Future Research Directions

Background: Having several applications in medicine, and in ophthalmology in particular, artificial intelligence (AI) tools have been used to detect visual function deficits, thus playing a key role in diagnosing eye diseases and in predicting the evolution of these common and disabling diseases. AI tools, i.e., artificial neural networks (ANNs), are progressively involved in detecting and customized control of ophthalmic diseases. The studies that refer to the efficiency of AI in medicine and especially in ophthalmology were analyzed in this review. Materials and Methods: We conducted a comprehensive review in order to collect all accounts published between 2015 and 2022 that refer to these applications of AI in medicine and especially in ophthalmology. Neural networks have a major role in establishing the demand to initiate preliminary anti-glaucoma therapy to stop the advance of the disease. Results: Different surveys in the literature review show the remarkable benefit of these AI tools in ophthalmology in evaluating the visual field, optic nerve, and retinal nerve fiber layer, thus ensuring a higher precision in detecting advances in glaucoma and retinal shifts in diabetes. We thus identified 1762 applications of artificial intelligence in ophthalmology: review articles and research articles (301 pub med, 144 scopus, 445 web of science, 872 science direct). Of these, we analyzed 70 articles and review papers (diabetic retinopathy (N = 24), glaucoma (N = 24), DMLV (N = 15), other pathologies (N = 7)) after applying the inclusion and exclusion criteria. Conclusion: In medicine, AI tools are used in surgery, radiology, gynecology, oncology, etc., in making a diagnosis, predicting the evolution of a disease, and assessing the prognosis in patients with oncological pathologies. In ophthalmology, AI potentially increases the patient’s access to screening/clinical diagnosis and decreases healthcare costs, mainly when there is a high risk of disease or communities face financial shortages. AI/DL (deep learning) algorithms using both OCT and FO images will change image analysis techniques and methodologies. Optimizing these (combined) technologies will accelerate progress in this area

The Evolvement of OCT and OCT-A in Identifying Multiple Sclerosis Biomarkers

The prevalence of multiple sclerosis (MS) has been increasing among young people in developing countries over the last years. With the continuous development of new technology, the diagnosis and follow-up of these patients has received new parameters that physicians may use in their practice. This paper reviews the main biomarkers identified through Optical Coherence Tomography Angiography (OCT-A) involved in the development and progression of MS and investigates the role it may have in detecting changes to the central nervous system (CNS)