Evaluation of aqueous flare after Descemet’s stripping endothelial keratoplasty and penetrating keratoplasty

Purpose: Evaluation of aqueous flare in patients after Descemet's Stripping Endothelial Keratoplasty (DSEK) and Penetrating Keratoplasty (PK) performed of various indications. Material and methods: In a prospective study 17 eyes in 16 patients were examined. First group consisted of 8 eyes after DSEK, second: 9 eyes after PK. The first procedure was performed of Fuch’s dystrophy - 4 eyes, bullous keratopathy – 4 eyes. The indications in the second were as follows: keratoconus – 2 eyes, corneal cicatrix without neovascularization – 3 eyes, endangering corneal perforation – 4 eyes. Examined group mean age was respectively 67 and 69 years. The overall examining time was six months after the surgery. In the paperaqueous flare was evaluated in the anterior chamber in 1st, 3rd and 6th month after keratoplasty in FM-600 Laser Flare Kowa. Abovementioned device function is based on emission and detection of light produced by diode laser. Keratoplasty was performed in general (No 9) or in local peribulbar (No 8) anaesthesia. Results: Mean aqueous flarein 1st, 3rd, and 6th month after keratoplasty is significantly lower after DSEK (14,46 +/- 4,70 ph/ms; 10,64 +/- 2,91 ph/ms; 5,98 +/- 2,53 ph/ms) in comparison with PK (18,50 +/- 5,82 ph/ms; 15,04 +/- 6,38 ph/ms; 10,68 +/- 3,83 ph/ms). In 6 months observation the mean flare value in DSEK was decreased twice in comparison with PK. Considering indication for keratoplasty mean flare measurements were respectively in 1st, 3rd and 6th month for first group: Fuchs’ dystrophy: 11,85 +/- 5,46 ph/ms; 8,28 +/- 1,80 ph/ms; 4,93 +/- 0,95 ph/ms; bullous keratopathy: 17,08 +/- 1,89 ph/ms; 13,00 +/- 1,27 ph/ms; 7,03 +/- 3,32 ph/ms. In second group respectively: keratoconus: 15,15 +/- 1,34 ph/ms; 11,95 +/- 0,49 ph/ms; 11,25 +/- 0,64 ph/ms; corneal cicatrix without neovascularization: 16,40 +/- 9,27 ph/ms; 12,13 +/- 9,85 ph/ms; 6,87 +/- 4,20 ph/ms; endangering corneal perforation: 21,75 +/- 2,54 ph/ms; 18,78 +/- 3,21 ph/ms; 13,25 +/- 1,92 ph/ms. In the analysis of indications for keratoplasty the lowest mean aqueous flare in 1st, 3rd, and 6th month after procedure was observed in the Fuchs’ dystrophy. In endangering corneal perforation mean flare values were the highest. Conclusions: Our results indirectly indicate that in examined patients after DSEK post-operative inflammatory reaction is lower than in PK. Furthermore flare values might depend on the indications for keratoplasty. The study was performed in group with various indications for keraoplasty. Further studies including protein concentration in AH after DSEK and PK performed in equal indications are needed

Aspects of sustainability in the destination branding process: a bottom-up approach

The concept of sustainability is based on the premise that the inhabitants of a destination should be involved in the way that destination is managed and promoted. At the same time, the literature of place branding emphasizes the important role of local stakeholders in the creation of a true and reliable place brand. In fact, the process of developing a destination brand begins with the aim of shaping the identity of a destination; what the destination stands for. The sustainable dimensions of the destination branding process are explored, while focus groups and structured questionnaires are used to evaluate the usefulness of projection techniques in the process of building a brand identity. It seems that the use of the personification technique could work as an effective destination positioning exercise and as an alternative proposal to the outdated clichés used in tourism promotion

An exploratory analysis of planning characteristics in Australian visitor attractions

This paper provides an exploratory analysis of the planning practices of 408 Australian attraction operators. The results indicate that attraction managers can be divided into four categories: those that do not engage in any formal planning, those that adopt a short-term planning approach, those that develop long-term plans, and those that use both short-term and long-term planning approaches. An evaluation of the sophistication of attraction planning showed a bipolar distribution. Attraction managers favored a planning horizon of three or five years, and were inclined to involve their employees in the planning process. Managers relied strongly on their own research and tourism industry intelligence when formulating business plans. The content of plans tended to focus on operational activities, financial planning and marketing. The study provides a benchmark for the comparison of attraction planning efforts in various contexts. © 2006 Asia Pacific Tourism Association

The serum zinc concentration as a potential biological marker in patients with major depressive disorder

Despite many clinical trials assessing the role of zinc in major depressive disorder (MDD), the conclusions still remain ambiguous. The aim of the present clinical study was to determine and comparison the zinc concentration in the blood of MDD patients (active stage or remission) and healthy volunteers (controls), as well as to discuss its potential clinical usefulness as a biomarker of the disease. In this study 69 patients with current depressive episode, 45 patients in remission and 50 controls were enrolled. The zinc concentration was measured by electrothermal atomic absorption spectrometry (ET AAS). The obtained results revealed, that the zinc concentration in depressed phase were statistically lower than in the healthy volunteers [0.89 vs. 1.06 mg/L, respectively], while the zinc level in patients achieve remission was not significantly different from the controls [1.07 vs. 1.06 mg/L, respectively]. Additionally, among the patients achieve remission a significant differences in zinc concentration between group with and without presence of drug-resistance in the previous episode of depression were observed. Also, patients in remission demonstrated correlation between zinc level and the average number of depressive episodes in the last year. Serum zinc concentration was not dependent on atypical features of depression, presence of psychotic symptoms or melancholic syndrome, age, age of onset or duration of disease, number of episodes in the life time, duration of the episode/remission and severity of depression measured by the Hamilton Rating Scale for Depression (HDRS), and the Montgomery-Asberg Depression Rating Scale (MADRS). Concluding, our findings confirm the correlation between zinc deficit present in the depressive episode, and are consistent with the majority of previous studies. These results may also indicate that serum zinc concentration might be considered as a potential biological marker of MDD

A Leg(acy) to Stand on? A Non-Host Resident Perspective of the London 2012 Olympic Legacies

This study extended the temporal and spatial evaluation of mega-event impacts, by investigating residents’ perceptions of the Olympic legacies from a non-host community perspective. The study site was the Borough of Weymouth and Portland in South West England, which hosted the sailing competitions of the 2012 Olympic Games. Cross-sectional data were collected at two post-event intervals in 2013 and 2016. Across the two stages, the overall perceived legacies improved, with the most significant change related to perceived economic legacies and community legacies at the national level. Since residents’ attitudes toward the 2012 Olympic Games influenced their support for future event hosting, a strategic approach to event planning and leveraging is important to engender positive legacies that benefit broader communities than the host city. Future studies are recommended which replicate and extend this research to more fully understand resident support for mega-events

Cataract Surgery Complications in Uveitis Patients: A Review Article

Uveitis is a leading causes of blindness worldwide, and the development of cataracts is common due to both the presence of intraocular inflammation and the most commonly employed treatment with corticosteroids. The management of these cataracts can be very challenging and often requires additional procedures that can compromise surgical results. The underlying disease affects a relatively young population at higher risk of complications. Preoperative control of inflammation/quiescent disease for at least three months is generally accepted as the minimum amount of time prior to surgical intervention. Phacoemulsification with intraocular lens is the preferred method for surgery, with some studies showing improvement in visual acuity in over 90% of patients. The most common postoperative complications include macular edema, posterior capsule opacification, recurrent or persistent inflammation, glaucoma, epiretinal membrane and IOL deposits, or dislocation. Despite the potential complications, cataract surgery in uveitis patients is considered a safe and successful procedure

Corneal abnormalities are novel clinical feature in Wolfram Syndrome

Purpose To evaluate corneal morphology among patients with Wolfram syndrome (WFS). Design Comparative observational longitudinal case series of WFS patients with a laboratory approach in the WFS1 gene knockout (Wfs1KO) mouse model. Methods A group of 12 patients with biallelic mutations in the WFS1 gene recruited from the whole country and a control group composed of 30 individuals with type 1 diabetes (T1D) were evaluated in a national reference center for monogenic diabetes. All subjects (n = 42) underwent a complete ophthalmic examination, computer videokeratography, and corneal thickness and endothelial measurements. Additionally, WFS patients (n = 9) underwent longitudinal videokeratography and Pentacam evaluation. Corneal characteristics were assessed and compared between both groups. Human and mouse corneas were subjected to immunohistochemistry to detect wolframin expression and microscopic evaluation to study corneal morphology ex vivo. Results Clinical and topographic abnormalities similar to keratoconus were observed in 14 eyes (58.3%) of 8 WFS patients (66.7%). Flat keratometry, inferior-superior dioptric asymmetry, skewed radial axis, logarithm of keratoconus percentage index, index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, index of height asymmetry, and index of height decentration differed between WFS and T1D patients. Immunohistochemistry demonstrated wolframin expression in human and mouse corneas. Compared with Wfs1WT mice, Wfs1KO mice also presented corneal abnormalities. Conclusions Patients with WFS present a high prevalence of changes in corneal morphology compatible with the diagnosis of early stages of keratoconus. Observations in a mouse model suggest that a mutation in the WFS1 gene may be responsible for corneal abnormalities similar to keratoconus

Reduced corneal sensitivity with neuronal degeneration is a novel clinical feature in Wolfram Syndrome

PURPOSE To evaluate corneal sensitivity and corneal nerve morphology among patients with Wolfram syndrome (WFS). DESIGN An observational clinical case series with confirmatory experiments. METHODS We included a group of 12 patients with biallelic mutations in the WFS1 gene and a control group composed of 30 individuals with type 1 diabetes (T1D). All participants (n = 42) underwent a complete ophthalmic examination, esthesiometry, and retinal nerve fiber layer assessment using optical coherence tomography. Morphologic assessment of corneal neuropathy by in vivo corneal confocal microscopy was conducted in 11 patients with WFS (both eyes) and 1 WFS patient (1 eye) as well as in 24 patients with T1D (both eyes in 6 patients and 1 eye in 18 patients). Additionally, corneas from Wfs1KO mice and their wild-type littermates were subjected to laser scanning confocal microscopy. RESULTS Corneal sensitivity was significantly reduced in patients with WFS compared with patients with T1D (4.50 cm [interquartile range, 3.50–5.50 cm] vs 6.00 cm [interquartile range, 6.00–6.00 cm]; P < 10–5). Additionally, corneal nerve fiber and branch density as well as nerve fiber length were low among patients with WFS. Corneal sensitivity correlated with macular average thickness (R = 0.6928; P = .039) and best-corrected visual acuity (R = –0.61; P = .002) in the WFS group. Similarly, Wfs1 knockout mice also presented corneal neurodegeneration changes when corneal nerve fiber density and length were measured using laser scanning confocal microscopy. CONCLUSIONS Decreased corneal sensitivity and corneal nerve degeneration are observed in WFS. Corneal sensitivity is linked with the degree of disease progression as measured by visual acuity and retinal thinning