Morphological and Clinical Studies on the Exfoliation Syndrome and Open Angle Glaucoma

Exfoliation syndrome may be defined as a condition in which there is a characteristic clinical pattern of deposition of fine white granular material upon and within ocular and orbital tissues. Morphologically, exfoliation material comprises randomly orientated fibrillar aggregates with the staining and ultrastructural characteristics of a protein. The origin and structure of this protein (exfoliation material) are uncertain. Exfoliation syndrome is a common, but poorly understood cause of glaucoma worldwide. Iris tissue samples from 100 patients operated upon for open angle glaucoma and 31 control subjects with closed angle glaucoma have been subjected to light and electron microscopy. This aimed at establishing a definitive diagnosis for the clinical study described below. Ostensibly normal iris vessels were found close to other vessels with intense perivascular aggregation of exfoliation material. Foci of exfoliation material in the iris stroma exhibited a pattern consistent with 'ghost vessels'. A diffuse distribution would have been anticipated if passive deposition of exfoliation material had taken place. Collagen types I-V and laminin were sought in 16 normal and 20 exfoliative specimens of iris and/or trabecular meshwork, by means of ultrastructural immunogold localisation. Collagen types I-V were not present in the exfoliation material. In this study the glycoprotein laminin has been identified, for the first time, as an integral component of the exfoliation material. The vascular matrices of exfoliative iris exhibited increased amounts of collagen types I and IV in less affected vessels. Depletion of collagen types I, IV and laminin was noted in severely affected vessels. In part II of this thesis the results of two prospective studies are presented. The first investigated the prevalence and clinical characteristics of exfoliation glaucoma. Surgical patients with open angle glaucoma were divided by clinical examination into 3 groups: definite exfoliation (22) ; possible exfoliation (18) and no exfoliation (60). Subsequent morphological assessment delineated two definitive groups: exfoliation glaucoma (26) and primary open angle glaucoma (74). Exfoliation glaucoma patients more frequently had higher untreated 10P at diagnosis, shorter duration of medical therapy, higher treated 10P before surgery and were operated upon more often for high 10P. They also exhibited significantly lower 10P postoperatively compared with age- matched primary open angle glaucoma patients. The second study was performed upon 78 patients and studied the effect of varying the position of a surgical fistula upon the incidence of postoperative hyphaema. This study confirmed that by fashioning the fistula entirely in corneal tissue the incidence and severity of postoperative bleeding is reduced resulting in shorter hospital stay. The incidence of postoperative hyphaema was lower in the exfoliation glaucoma group, but not significantly so. Neither the type of dissection, nor the occurence of hyphaema influenced the 10P at 4 months following surgery

Novel Insights into the Transmission of SARS-CoV-2 Through the Ocular Surface and its Detection in Tears and Conjunctival Secretions: A Review

SARS-CoV-2 is a highly transmissible virus that spreads mainly via person-to-person contact through respiratory droplets, or through contact with contaminated objects or surfaces from an infected person. At present we are passing through a phase of slow and painful understanding of the origin, epidemiological profile, clinical spectrum, and risk profile of the virus. To the best of our knowledge there is only limited and contradictory evidence concerning SARS-CoV-2 transmission through other routes. Importantly, the eye may constitute not only a potential site of virus replication but also an alternative transmission route of the virus from the ocular surface to the respiratory and gastrointestinal tract. It is therefore imperative to gain a better insight into the potential ophthalmological transmission route of the virus and establish directions on best practice and future models of care for ophthalmological patients. This review article critically evaluates available evidence on the ophthalmological mode of viral transmission and the value of earlier identification of the virus on the eye. More evidence is urgently needed to better evaluate the need for protective measures and reliable ocular diagnostic tests to diminish further pandemic spread

Evaluation of a Novel Αb Εxterno MicroShunt for the Treatment of Glaucoma

The surgical management of glaucoma has been revolutionized by the introduction of minimally invasive glaucoma surgery (MIGS). The various MIGS options aim to meaningfully lower intraocular pressure with a better safety profile than traditional glaucoma surgery. The key clinical attributes and the emerging potential of an ab externo MicroShunt (PreserFlo™) are reviewed in the context of published evidence and clinical experience. This novel MicroShunt consists of an 8.5-mm-long tube that is implanted in the eye via an ab externo approach enabling aqueous humor drainage into the sub-Tenon's space through the formation of a bleb, similar in appearance to that created by trabeculectomy. The efficacy and safety of this procedure, the concomitant use of antimetabolites, the impact of tube positioning, and its future value in clinical practice are critically reviewed. Recent evidence has demonstrated the MicroShunt to be less effective than traditional filtration surgery, but with a significant improvement in safety. Cumulative data suggest that the new implant provides tangible clinical benefits to selected patients with glaucoma in need of further intraocular pressure (IOP) lowering. Future research should delineate the precise role of this and other MIGS options in the rapidly evolving glaucoma treatment algorithm.Unidad Docente de Inmunología, Oftalmología y ORLDepto. de Inmunología, Oftalmología y ORLFac. de Óptica y OptometríaFac. de MedicinaTRUEpu

Current Perspectives on the Use of Anti-VEGF Drugs as Adjuvant Therapy in Glaucoma

The approval of one of the first anti-vascular endothelial growth factor (VEGF) agents for the treatment of neovascular age-related macular degeneration one decade ago marked the beginning of a new era in the management of several sight-threatening retinal diseases. Since then, emerging evidence has demonstrated the utility of these therapies for the treatment of other ocular conditions characterized by elevated VEGF levels. In this article we review current perspectives on the use of anti-VEGF drugs as adjuvant therapy in the management of neovascular glaucoma (NVG). The use of anti-VEGFs for modifying wound healing in glaucoma filtration surgery (GFS) is also reviewed. Selected studies investigating the use of anti-VEGF agents or antimetabolites in GFS or the management of NVG have demonstrated that these agents can improve surgical outcomes. However, anti-VEGF agents have yet to demonstrate specific advantages over the more established agents commonly used today. Further studies are needed to evaluate the duration of action, dosing intervals, and toxicity profile of these treatments

Development and Validation of the Life for Low Vision Questionnaire (LIFE4LVQ) Using Rasch Analysis: A Questionnaire Evaluating Ability and Independence

Low vision (LV) has a substantial impact on an individual’s daily functionality and patient-reported outcome measures (PROMs) are increasingly incorporated into the evaluation of this problem. The objective of this study was to describe the design of the new “Life for Low Vision Questionnaire (LIFE4LVQ)”, as a measure of daily functionality in LV and to explore its psychometric properties. A total of 294 participants completed the LIFE4LVQ and the data were subjected to Rasch analysis to determine the psychometric properties of the questionnaire, including response category ordering, item fit statistics, principal component analysis, precision, differential item functioning, and targeting. Test–retest reliability was evaluated with an interval of three weeks and intraclass correlation coefficients (ICC) were used. The correlation between the questionnaire score and Best Corrected Visual Acuity (BCVA) was examined using Spearman’s correlation coefficient. Rasch analysis revealed that for most items the infit and outfit mean square fit values were close to 1, both for the whole scale and its subscales (ability and independence). The separation index for person measures was 5.18 with a reliability of 0.96, indicating good discriminant ability and adequate model fit. Five response categories were found for all items. The ICC was 0.96 (p < 0.001; 95% CI, 0.93–0.98), suggesting excellent repeatability of the measure. Poorer BCVA was significantly associated with worse scores (rho = 0.559, p < 0.001), indicating excellent convergent validity. The functional, 40-item LIFE4LVQ proved to be a reliable and valid tool that effectively measures the impact of LV on ability and independence

A Review of Minimally Invasive Strabismus Surgery (MISS): Is This the Way Forward?

<p><strong>Article full text</strong></p> <br> The full text of this article can be found <a href="https://link.springer.com/article/10.1007/s12325-017-0498-7"><b>here</b>.</a><br> <br> <strong>Provide enhanced digital features for this article</strong><br> If you are an author of this publication and would like to provide additional enhanced digital features for your article then please contact <u>[email protected]</u>.<br> <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.<br> <br> Other enhanced features include, but are not limited to:<br> • Slide decks<br> • Videos and animations<br> • Audio abstracts<br> • Audio slide

A Review of the Clinical Usefulness of Selective Laser Trabeculoplasty in Exfoliative Glaucoma

<p></p><p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found here<b>. </b><a href="https://link.springer.com/article/10.1007/s12325-018-0695-z">https://link.springer.com/article/10.1007/s12325-018-0695-z</a></p><p></p><p></p><p> </p><p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p><br></p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p><br><p></p

Association of POAG Risk Factors and the Thr377Met MYOC Mutation in an Isolated Greek Population

The authors investigated the role of the Thr377Met MYOC mutation with the occurrence of POAG in an isolated Greek village. The Thr377Met MYOC mutation was found to be associated with the glaucomatous risk factors, intraocular pressure, and vertical cup-to-disc ratio but not with central corneal thickness