Central corneal thickness in subjects with glaucoma and in normal individuals (with or without pseudoexfoliation syndrome)

Georgios Kitsos, Christos Gartzios, Ioannis Asproudis, Eleni BagliOphthalmology Department, University of Ioannina, Ioannina, GreeceObjective: The evaluation of central corneal thickness (CCT) in subjects with pesudoexfoliation glaucoma (PEXG), primary open-angle glaucoma (POAG), and in normotensive individuals with or without pseudoexfoliation syndrome (PXS). Study design/patients and methods: CCT was evaluated with ultrasound pachymetry in a total of 179 individuals: 32 had bilateral PEXG, 55 had bilateral POAG, 35 had PXS, and 57 were healthy individuals without PXS.Results: CCT in PEXG eyes (526.00 ± 34.30 µm) was significantly thinner compared to POAG eyes (549.36 ± 39.3 µm) (P = 0.027) and normal control eyes with (550.64 ± 39.0 µm) or without PXS (547.36 ± 33.1 µm), (P = 0.039 and 0.048 respectively). No statistically significant difference was found comparing CCT values of POAG eyes to control group eyes.Conclusion: The evaluation of CCT is necessary in all patients with glaucoma and especially in those with PEXG due to the thinner cornea and the risk of underestimation of intraocular pressure.Keywords: CCT, pesudoexfoliation syndrome, glaucom

Tetracaine 0.5% eyedrops with or without lidocaine 2% gel in topical anesthesia for cataract surgery

Anthoula T Tsoumani1,2, Ioannis C Asproudis1, Dimitrios Damigos21Department of Ophthalmology University Hospital of Ioannina, 2Department of Medical Psychology, Postgraduate Course of “Pain Management”, University of Ioannina, GreeceBackground and objective: To evaluate the level of pain during phacoemulsification and foldable intraocular lens implantation under instillation of tetracaine 0.5% eyedrops versus a combination of lidocaine 2% gel and instillation of tetracaine eyedrops.Methods: This prospective, randomized, controlled study included 51 patients undergoing phacoemulsification under topical anesthesia. They were randomized into two groups based on the topical anesthetic method they were to receive. Preoperatively all patients were asked to answer a questionnaire. One hour postoperatively, they were asked to grade their intraoperative and postoperative pain on a visual analog scale from 0 to 10.Results: There were no statistically significant differences between the two methods of anesthesia. Gender and the presence of relatives or friends were independent factors playing a significant role in pain sensitivity.Conclusions: The combination of lidocaine 2% gel and tetracaine eyedrops does not have a better analgesic result than a single instillation of tetracaine 0.5% eyedrops.Keywords: ophthalmic pain, cataract, phacoemulsification, tetracaine eyedrops, lidocaine gel, topical anesthesi

Diagnostic and therapeutic approaches to optic disc pit maculopathy in children

Background: Optic disc pit (ODP) is a rare congenital defect of the optic disc that can lead to maculopathy and gradual visual impairment. This review summarizes our current knowledge on the diagnostic and therapeutic approaches to ODP maculopathy (ODP-M) in children. Methods: A thorough literature search was performed using the PubMed/MEDLINE database from 1960 to 2020. An additional search was conducted using Google Scholar for completeness. Results: ODP-M is characterized by the accumulation of subretinal and/or intraretinal fluid. The exact pathogenetic mechanisms are not fully understood, and the origin of the fluid remains unknown. Although ODP-M is more likely to occur during the third or fourth decade of life, cases of children with serous retinal detachment have been recorded. Early diagnosis of ODP-M and prompt, appropriate management are crucial, particularly in patients of amblyogenic age. In adults, ODP-M may resolve spontaneously, but most cases require surgical intervention to prevent permanent loss of vision. However, the fact that ODP-M may spontaneously resolve in children cannot be ignored. Various surgical methods have been described, including pars plana vitrectomy (PPV) combined with various techniques, including laser photocoagulation, intravitreal gas injection, and macular buckling. Conclusions: PPV remains the mainstay surgical approach for ODP-M. However, ODP-M may differ between children and adults. Children constitute a unique population of patients that require a different and probably more tailor-made approach. Detailed clinical examination, combined with a thorough analysis of retinal imaging, may improve our understanding of the background and pathophysiology of the disease and eventually provide us with new insights into the management of ODP-M in the pediatric population. How to cite this article: Kalogeropoulos D, Asproudis I,  Ch’ng SW, Mitra A, Sharma A, Katsikatsos K, Asproudis C, Kalogeropoulos C. Diagnostic and therapeutic approaches to optic disc pit maculopathy in children. Med Hypothesis Discov Innov Optom.2021 Spring; 2(1): 24-35. DOI: https://doi.org/10.51329/mehdioptometry12

Electroretinogram changes before and after silicone oil removal in eyes with macula-off rhegmatogenous retinal detachment

Background: Pars plana vitrectomy (PPV) with silicone oil (SO) injection for rhegmatogenous retinal detachment (RRD) repair may adversely affect electroretinographic responses. This study was aimed at assessing retinal function using electrodiagnostic testing after successful PPV with SO tamponade in the eyes with macula-off RRD. Methods: In this interventional comparative study, eligible participants were recruited prospectively over 1 year. We included the eyes that underwent a single successful three-port PPV with SO tamponade for the primary repair of macula-off RRD. Full-field electroretinogram (ffERG) and multifocal electroretinogram (mfERG) were recorded 1 day before and 3 days after SO removal. The amplitude and implicit time of the a- and b-waves for ffERG and P1 and N1 waves for mfERG were evaluated. The unaffected fellow eyes of the patients were selected as controls. Results: We included the ten eyes of ten patients (seven men and three women) with a mean (standard deviation) age of 58.8 (6.2) years. The mean (SD) interval between the diagnoses of macula-off RRD and PPV was 11.7 (3.6) days. The mean (SD) duration of SO tamponade was 147.8 (34.9) days. Using ffERG, significantly lower a- and b-wave amplitudes were found in the eyes before and after SO removal or compared to the unaffected fellow eyes (all P < 0.05). Using the mfERG, treated eyes had significantly lower P1 amplitudes in the central R1+R2+R3 rings and in the R4 and-R5 peripheral rings of the macular area in the eyes before and after SO removal or compared to the unaffected fellow eyes (all P < 0.05). The wave implicit time in ffERG and mfERG did not differ significantly in the eyes before and after SO removal or compared to the unaffected fellow eyes (all P > 0.05). Conclusions: The electrical retinal response density in ERG waveforms increased following SO removal, indicating amelioration of the electrical activity of the retina and macula. These results indicate that the adverse effects of SO tamponade on electroretinography responses may be reversible with removal. In addition, ffERG and mfERG can be used to monitor retinal function in the eyes with macula-off RRD and SO tamponade. Further clinical trials are required to verify the preliminary findings of this study

Role of intestinal microbiome in the pathogenesis of age-related macular degeneration

Background: The microbiome is strongly linked to many extra-intestinal disorders. Gut commensal microbiota, in particular, plays an active role in human immune and intestinal homeostasis. Complex interactions of the microbiota with host genetics and other underlying factors lead to intestinal dysbiosis, which is thought to be linked to ocular inflammatory diseases. Thus, the aim of this review is to analyze the role of intestinal microbiome in age-related macular degeneration (AMD). Methods: A thorough literature search was performed using PubMed/MEDLINE, limited to English language publications, from January 2004 to March 2020. An additional search was made employing Google Scholar to complete the collected data as per the above-mentioned time-line and language limitations. The main keywords used included age-related macular degeneration, microbiome, dysbiosis, autoimmunity, gut microbiota, epigenetics, immune-mediated inflammatory diseases, and gut-retina axis. Results: Recent studies have proposed the role of intestinal microbiota in the pathogenesis of AMD. Changes in the microbiome have been shown to trigger several ocular inflammatory processes. There is increasing evidence demonstrating that intestinal microbial imbalance may play an important role in the pathogenesis of AMD. Conclusions: This review summarizes how alterations in the intestinal microbiota can be associated with the pathogenesis of AMD and how new therapeutic modalities can be designed to target this microbiome to limit the severe nature of this disease. Future advances in microbiome research may unveil a new era in understanding and managing AMD