Prox1 Regulates the Notch1-Mediated Inhibition of Neurogenesis

During development of the spinal cord, Prox1 controls the balance between proliferation and differentiation of neural progenitor cells via suppression of Notch1 gene expression

Ocular alterations in patients suffering from obstructive sleep apnea-hypopnea syndrome

Purpose: To investigate corneal endothelial morphometry and pachymetry in patients newly diagnosed with Obstructive Sleep Apnea – Hypopnea Syndrome (OSAHS) and to determine the correlation between these parameters and OSAHS severity. Our study also aimed to evaluate the effects of Continuous Positive Airway Pressure (CPAP) therapy on central endothelial morphology and corneal thickness. Methods: Fifty-eight (58) patients recently diagnosed with OSAHS and a paired, age- and gender-matched control group (CG) of 58 healthy individuals were enrolled. A detailed ophthalmologic examination and specular microscopy measurement was performed for all participants. Endothelial cell density (ECD), coefficient of variation of cell area (CV), hexagonal cell appearance ratio (% Hex) and central corneal thickness (CCT) were compared between the groups. The specular microscopy results of the OSAHS group were correlated with the polysomnographic variables of each individual. Τhe OSAHS patients who showed good compliance with CPAP treatment were re-evaluated after the commencement of CPAP therapy and their corneal values were compared with their pre-CPAP values. Results: ECD and CCT did not significantly differ between the newly diagnosed OSAHS patients and the CG (p=0,3 , p=0,1 respectively). CV was significantly higher (p=0,002), whilst the Hex ratio was significantly lower (p=0,001) in the OSAHS group. A significant negative correlation was observed between CCT and the REM sleep percentage (p=0,008). Twenty-seven (27) OSAHS patients were re-examined after 9,56±3,55 months (range: 3-18 months) of good adherence to CPAP treatment. Their CV values, indicating polymegathism, showed a statistically significant decrease (p=0,04), whereas the Hex ratio, indicating pleomorphism, showed a statistically significant increase (p=0,008) after the commencement of the treatment. Conclusions: Greater pleomorphism and polymegathism of the corneal endothelium was observed in patients with OSAHS when compared to healthy subjects. Low percentage of REM sleep, usually found in OSAHS patients, may correlate with an increase in corneal thickness, an indicator of poor corneal oxygenation. However, better oxygenation during sleep resulting from increased CPAP compliance had a significant influence on corneal endothelium, providing an improvement in corneal polymegathism and pleomorphism.Σκοπός: Η μελέτη της μορφολογίας του κερατοειδικού ενδοθηλίου και του κεντρικού πάχους του κερατοειδούς σε ασθενείς που πάσχουν από το Σύνδρομο «Αποφρακτικών Απνοιών στον Ύπνο» (ΣΑΑΥ), καθώς και η εκτίμηση της συσχέτισης αυτών των κερατοειδικών παραμέτρων με τη βαρύτητα του συνδρόμου. Επιπρόσθετα, σκοπός ήταν να αξιολογηθεί η επίδραση της μάσκας συνεχούς θετικής πίεσης ανώτερων αεραγωγών (CPAP) στη μορφολογία και το πάχος του κεντρικού κερατοειδούς. Μέθοδος: Στη μελέτη συμμετείχαν 58 ασθενείς που μόλις είχαν διαγνωσθεί με το ΣΑAΥ και 58 υγιείς ενήλικες αντίστοιχης ηλικίας και φύλου που αποτέλεσαν την Ομάδα Ελέγχου. Υποβλήθηκαν σε πλήρη οφθαλμολογικό έλεγχο και ενδοθηλιοσκόπηση με κατοπτρικό μικροσκόπιο. Συγκρίθηκαν η πυκνότητα των ενδοθηλιακών κυττάρων (ECD), ο συντελεστής μεταβλητότητας του μεγέθους των κυττάρων (CV), το ποσοστό των εξαγωνικών κυττάρων (% Hex) και το κεντρικό πάχος του κερατοειδούς (CCT) μεταξύ των δύο υποομάδων. Έγινε, επίσης, συσχέτιση μεταξύ των αποτελεσμάτων της ενδοθηλιοσκόπησης και των παραμέτρων της πολυσωματοκαταγραφικής μελέτης ύπνου. Οι ασθενείς με ΣΑAΥ που είχαν άριστη εφαρμογή της θεραπείας με μάσκα CPAP, υποβλήθηκαν σε δεύτερη οφθαλμολογική εξέταση μετά την έναρξη της αγωγής και έγινε σύγκριση των κερατοειδικών παραμέτρων τους πριν και μετά τη θεραπεία. Αποτελέσματα: Οι παράμετροι ECD και CCT δεν είχαν σημαντική διαφορά μεταξύ των νεοδιαγνωσθέντων ασθενών με ΣΑAΥ και της Ομάδας Ελέγχου (p=0,3 , p=0,1 αντίστοιχα). Στην ομάδα των ασθενών με ΣΑΑΥ, ο δείκτης CV βρέθηκε σημαντικά μεγαλύτερος (p=0,002), ενώ ο δείκτης % Hex σημαντικά μικρότερος (p=0,001) απ’ ότι στην Ομάδα Ελέγχου. Μία στατιστικά σημαντική αρνητική συσχέτιση παρατηρήθηκε μεταξύ του CCT και του ποσοστού του REM ύπνου (p=0,008). Είκοσι επτά (27) από τους ασθενείς με ΣΑΑΥ επανεξετάστηκαν μετά από 9,56±3,55 μήνες (εύρος: 3-18 μήνες) εφαρμογής της θεραπείας με μάσκα CPAP. Στους ασθενείς αυτούς, ο συντελεστής CV, ο οποίος αντικατοπτρίζει τον πολυμεγαθισμό των κυττάρων, παρουσίασε σημαντική ελάττωση (p=0,04), ενώ ποσοστό % Hex, το οποίο αντικατοπτρίζει τον πλειομορφισμό των κυττάρων, παρουσίασε σημαντική αύξηση (p=0,008) μετά την έναρξη της αγωγής. Συμπεράσματα: Μεγαλύτερος πλειομορφισμός και πολυμεγαθισμός του ενδοθηλίου του κερατοειδούς ανευρέθηκε σε ασθενείς με ΣΑΑΥ σε σύγκριση με υγιείς ενήλικες. Τα χαμηλότερα ποσοστά REM ύπνου, τα οποία είναι συχνά σε ασθενείς με ΣΑΑΥ, ίσως σχετίζονται με μία αύξηση του πάχους του κερατοειδούς, το οποίο είναι ενδεικτικό κακής οξυγόνωσης του κερατοειδούς. Ωστόσο, η καλύτερη οξυγόνωση κατά τη διάρκεια του ύπνου που οφείλεται στη σωστή εφαρμογή της μάσκας CPAP, είχε μία σημαντική επιρροή στο κερατοειδικό ενδοθήλιο αφού βελτιώθηκε ο πολυμεγαθισμός και ο πλειομορφισμός του

Surgical treatment of a chronic foveal retinal detachment combined with staphyloma, foveoschisis, and macular hole

To present a case of anatomical success and visual improvement after the treatment of a long-standing foveal retinal detachment in a staphylomatous myopic eye with foveoschisis and macular hole. A 60-year-old woman with high myopia presented with foveoschisis and a lamellar macular hole in her right eye. After 2 years of follow-up without deterioration, her eye developed a full-thickness macular hole and a foveal retinal detachment which caused a severe reduction in visual acuity. However, the patient had no surgical treatment for her condition at that time. Vitrectomy was performed 2 years after the retinal detachment formation. Regardless of the longstanding detachment, anatomical success, and visual improvement were evident after the surgery. Despite a 2-year longstanding foveal detachment on a highly myopic eye with foveoschisis and macular hole, surgical repair could still be satisfactory

Anterior Chamber Dislocation of Dexamethasone Implant in the Presence of Carlevale Sutureless Scleral Fixation Intraocular Lens

Dexamethasone intravitreal implant (Ozurdex®; Allergan, Inc., CA, USA) has been proved to be effective in a variety of clinical settings including cases of pseudophakic cystoid macular edema. Uncommonly, this implant can migrate from the vitreous cavity and into the anterior chamber, especially in vitrectomized eyes with lens capsule defects. We report herein a rare case of anterior chamber migration and illustrate the passageway of the dexamethasone intravitreal implant through a new type of scleral fixated lens, the Carlevale IOL (Soleko-Italy). A 78-year-old woman was left aphakic following a complicated right eye hypermature cataract surgery with posterior capsule rupture and zonular dehiscence. Shortly thereafter, she underwent a planned combined pars plana vitrectomy with the placement of a Carlevale sutureless scleral fixated intraocular lens for the treatment of her aphakia. Due to a subsequent persistent cystoid macular edema that was unresponsive to topical treatment and sub-tenon corticosteroids, an intravitreal dexamethasone implant was injected. Eleven days after implantation, the patient presented with a floating implant in the anterior chamber and corneal edema. Following an immediate surgical removal, corneal edema resolved and visual acuity improved. One year later, results remain stable without macular edema recurrence. Anterior chamber migration of the Ozurdex implant is a potential complication in vitrectomized eyes, even when new types which are larger and specially designed for scleral fixation intraocular lenses are utilized. Corneal complications can be reversible following an immediate removal of the implant

Factors Associated with the Clinical Course of Vitreomacular Traction

Background. To analyze the optical coherence tomography (OCT) characteristics as well as the clinical and demographic features to investigate their possible role to the course of vitreomacular traction syndrome. Methods. The inclusion criteria were vitreomacular adhesion with traction causing distortion of the retinal architecture, with or without the presence of an epiretinal membrane, regardless of the size of the adhesion; age >18 years; follow-up of at least three months; and adequate quality OCT scan. Measurements of foveal thickness, average macular thickness, macular volume, maximum vertical and horizontal vitreomacular adhesion, nasal and temporal angles of traction, hyaloid hyperreflectivity, the presence of an epiretinal membrane (ERM), and cone outer segment tips detachment were obtained. Results. 150 eyes were included in the analysis. 36 eyes (24%) developed complete resolution at the last visit, 19 eyes (12.7%) formed a full-thickness macular hole, and 95 eyes (63.3%) showed no resolution of the traction. Better BCVA at the first visit was associated with an increased likelihood of resolution of the VMT, but increasing age, CMT, and BCVA in the end of the follow-up was associated with a reduction in the likelihood of resolving. Of the other variables that were studied, no statistical significant predictors were identified. Conclusions. Better BCVA in the first visit was associated with an increased likelihood of resolution of the VMT that occurred in 24% of our cases. Other factors such as the vertical area of adhesion and the angle of adhesion were not identified as prognostic factors affecting the clinical course of the disease

Effects of Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea-Hypopnea Syndrome on Corneal Morphological Characteristics

Purpose: To evaluate the effects of continuous positive airway pressure (CPAP) therapy on corneal endothelial morphometry and pachymetry in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: This prospective, observational study included patients with OSAHS who were evaluated right before and after the commencement of CPAP treatment. Each patient underwent a detailed ophthalmologic examination and assessment of their corneal endothelium with a noncontact specular microscope (Tomey EM-3000; Tomey Corp). Endothelial cell density, coefficient of variation of cell area (CV), hexagonal cell appearance ratio (%Hex), and central corneal thickness were measured. The post-CPAP results were compared with the results of a control group. The differences in the corneal parameters between pre- and post-CPAP therapy of the OSAHS group were correlated with the pretreatment polysomnography results. Results: Twenty-seven distinct eyes of 27 patients recently diagnosed with OSAHS and 30 eyes of 30 healthy individuals were used for the statistical analysis. The mean age of patients with OSAHS was 54.2 +/- 11.8 years, and after 9.6 months (range 3-18 mo) of good adherence to CPAP treatment, their CV values, indicating polymegathism, decreased from 41.7 +/- 8.7 to 38.3 +/- 5.8 (P = 0.04), whereas %Hex, indicating pleomorphism, increased from 45.8% +/- 8.2% to 48.4% +/- 6.6% (P = 0.008). Their post-CPAP corneal parameters did not differ significantly from those of the control group (P > 0.05). A significant positive correlation was observed between the decrease in CV and the duration of the treatment (Rs = 0.566, P = 0.002), as well as the pre-CPAP nonrapid eye movement (NREM) sleep percentage (Rs = 0.459, P = 0.02). A negative correlation was noted between the decrease in CV and the percentage of rapid eye movement (REM) sleep (Rs = -0.459, P = 0.02). Conclusions: Better oxygenation during sleep, resulting from increased CPAP adherence, had a significant influence on corneal endothelium, providing an improvement in corneal polymegathism and pleomorphism, with a potential return of CV and %Hex to their normal values. Greater improvement in polymegathism was observed in patients with greater proportion of NREM sleep