Psychometric properties of the Greek version of the NEI-VFQ 25

<p>Abstract</p> <p>Background</p> <p>To evaluate the reliability and construct validity of a Greek version of the NEI-VFQ-25 in patients with chronic ophthalmic diseases.</p> <p>Methods</p> <p>We developed the Greek version of the instrument using forward and backward translation. One hundred-eighty-six patients responded to the questionnaire. To examine reliability, Cronbach's alpha for each subscale was used as an index of internal consistency. Test-retest reliability was evaluated with intraclass correlation coefficients. Regarding construct validity, both convergent and discriminant validities were calculated by means of multi-trait analysis. Rasch analysis was used to estimate the visual ability required by each item for a particular response, and each patient's visual ability. Correspondingly, instrument validity was evaluated by estimating the distribution of residuals for item and subject measures.</p> <p>Results</p> <p>Four patient groups were studied, each including participants with a single cause of visual impairment. Group 1 consisted of 84 glaucoma subjects. Group 2 included 30 subjects with age-related macular degeneration (ARMD); group 3 included 25 subjects with dry-eye syndrome, whereas group 4 included 18 cataract patients. Twenty-nine healthy individuals comprised the control group. NEI-VFQ scores (mean ± SD) for the glaucoma, ARMD, dry-eye, cataract and control groups were: 76.9 ± 20.2, 70.9 ± 20.2, 81.6 ± 16.5, 73.5 ± 24.0 and 93.7 ± 8.9 respectively. Item analysis revealed no significant data skewing. Cronbach's alpha ranged from 0.678 to 0.926, with most subscales having high internal consistency. Intraclass correlation coefficient ranged from 0.717 to 0.910 for all subscales. All items passed the convergent and discriminant validity tests. Strong correlations were detected between visual acuity and "general vision", "distant activities" and "near activities" subscales. Significant correlations were also detected between visual field deficits and the "peripheral vision" and "general vision" subscales. Rasch analysis revealed potential weaknesses of the instrument that are associated with the assumptions of the model itself. Specifically, low precision of the "agreement" items was detected in the estimation of visual ability. Twenty-three percent of the subjects had fit statistics that fell outside the tolerance box.</p> <p>Conclusion</p> <p>Although traditional validation methods indicated that the Greek version of the NEI-VFQ-25 is a valid and reliable instrument for VS-QoL assessment, Rasch analysis detected significant misfits to the model, especially of the "agreement" items. This means that results of the corresponding subscales should be interpreted with extreme caution.</p

Ocular disorders as the prevailing manifestations of antiphospholipid syndrome: a case series

Introduction: Antiphospholipid syndrome is an autoimmune disorder characterized by either a history of vascular thrombosis (one or more clinical episodes of arterial, venous, or small vessel thrombosis in any tissue or organ) or pregnancy morbidity in association with the presence of antiphospholipid antibodies. The systemic features of the syndrome are characterized by large variability depending on the affected organ(s). Among them, neurological and behavioural disturbances, dermatological features as livedo reticularis and renal, ocular, liver or valvular heart manifestations have been reported in antiphospholipid syndrome patients. However, studies on the frequency and clinical presentation of the ocular manifestations as the prevailing (first) sign of antiphospholipid syndrome in patients suffering from "unexplained" ocular disease are missing. Herein, we present three cases suffering from unexplained ocular disease as first manifestation of antiphospholipid syndrome. Case presentation: All the three patients were referred to our department because of unexplained ocular features from the anterior or posterior segment and unexplained neuroophthalmologic symptoms. The first patient had bilateral retinal occlusive disease, the second and the third patient had unilateral nonarteritic anterior ischemic optic neuropathy with macular oedema. Moderate to high levels of antiphospholipid antibodies were detected in all of them at baseline as well as 6 to 12 weeks after initial testing confirming the presence of antiphospholipid antibodies. Anticoagulant treatment with acenocoumarol was instituted resulting in stabilization and/or improvement of ocular signs in all of them. Conclusion: Due to the important diagnostic and therapeutic implications of antiphospholipid syndrome, the possibility of ocular features as the first clinical manifestation of antiphospholipid syndrome should be kept in mind of the physicians particularly in patients with no evident risk factors for ocular disease. In this case, prompt anticoagulant treatment and close follow-up seem to be essential for vision salvation and stabilization. © 2009 Tsironi et al; licensee BioMed Central Ltd

Evaluation of MMP1 and MMP3 gene polymorphisms in exfoliation syndrome and exfoliation glaucoma

Purpose: To investigate possible genetic associations of matrix metalloproteinase-1 (MMP1) and MMP3 gene polymorphisms with exfoliation syndrome (XFS) with (XFS/+G) and without (XFS/-G) glaucoma in a cohort of Greek patients. Methods: A total of 182 unrelated Greek patients with XFS, including 92 patients with XFS/+G, and 214 unrelated age- and gender-matched controls were enrolled in the study. MMP1-1607 1G/2G (rs1799750) and MMP3-1171 5A/6A (rs3025058) polymorphisms were determined using standard PCR/restriction fragment length polymorphism methods. Differences in allele and genotype distributions were analyzed using logistic regression. Results: The distribution of genotypes and alleles in MMP1 and MMP3 polymorphisms was not significantly different between cases with exfoliation syndrome, with or without glaucoma, and controls. However, the allele contrast for the MMP1 variant showed a trend for a significant association with XFS/-G (Odds Ratio=1.47 [1.03-2.10]), since after correction for multiple comparisons, this association was no longer statistically significant. Conclusions: Our study provided some evidence of a possible role of the MMP1 variant in the development of exfoliation syndrome in Greek patients

Evaluation of MMP1 and MMP3 gene polymorphisms in exfoliation syndrome and exfoliation glaucoma

Purpose: To investigate possible genetic association of matrix metalloproteinase-1 (MMP1) and matrix metalloproteinase-3 (MMP3) gene polymorphisms with exfoliation syndrome (XFS) with (XFS/+G) and without glaucoma (XFS/-G) in a cohort of Greek patients.Methods: A total of 182 unrelated Greek patients with XFS, including 92 patients with XFG, and 214 unrelated age- and gender-matched controls were enrolled in the study. MMP1 -1607 1G/2G (rs1799750) and MMP3 -1171 5A/6A (rs3025058) polymorphisms were determined using standard PCR/RFLP methods. Differences in allele and genotype distributions were analyzed using logistic regression. Results: The distribution of genotypes and alleles in MMP1 and MMP3 polymorphisms was not significantly different between cases with exfoliation syndrome, with or without glaucoma, and controls. However, the allele contrast for MMP1 variant showed a trend for significant association for XFS/-G: OR=1.47 (1.03-2.10), since after correction for multiple comparisons this association was no longer statistically significant.Conclusions: Our study provided some evidence of a possible role of MMP1 variant in the development of exfoliation syndrome in Greek patients.Σκοπός: Nα διερευνήσουμε την πιθανή γενετική συσχέτιση της ΜΜP-1 και της MMP-3 σε Έλληνες ασθενείς με ψευδοαποφολιδωτικό σύνδρομο (XFS), με (XFS/+G) ή χωρίς γλαύκωμα (XFS/-G).Μέθοδος: Σύνολο από 182 ασθενείς με ψευδοαποφολιδωτικό σύνδρομο, μεταξύ των οποίων οι 92 είχαν ψευδοαποφολιδωτικό γλαύκωμα, καθώς και 214 υγιείς συμμετείχαν στη μελέτη μας. Δεν υπήρχε στατιστικά σηµαντική διαφορά σε ότι αφορά την ηλικία και το φύλο ανάμεσα στις τρεις ομάδες. Οι πολυμορφισμοί της MMP1 -1607 1G/2G (rs1799750) και της MMP3 -1171 5A/6A (rs3025058) καθορίστηκαν με PCR/RFLP. Διαφορές στην κατανομή των αλληλόμορφων και των γονοτύπων αναλύθηκαν με λογιστική παλινδρόμηση. Αποτελέσματα: Η κατανομή των γονοτύπων και των αλληλόμορφων στους πολυμορφισμούς της ΜΜP1 και της MMP3 δεν είναι στατιστικά σημαντική μεταξύ ατόμων με ψευδοαποφολιδωτικό σύνδρομο, με ή χωρίς γλαύκωμα, και μαρτύρων. Εντούτοις, η αντίθεση αλληλίου για τον πολυμορφισμό της ΜΜΡ1 έδειξε μία τάση για σημαντική συσχέτιση στα άτομα με ψευδοαποφολιδωτικό σύνδρομο χωρίς γλαύκωμα (XFS/-G): OR=1.47 (1.03-2.10), ενώ μετά τη διόρθωση για τις πολλαπλές συγκρίσεις, η σχέση έπαψε να είναι στατιστικά σημαντική.Συμπεράσμα: Η μελέτη μας κατέδειξε κάποια ευρήματα για το πιθανό ρόλο του συγκεκριμένου πολυμορφισμού της ΜΜP1 στην ανάπτυξη του ψευδοαποφολιδωτικού συνδρόμου στους Έλληνες ασθενεί

Bilateral Intracavernous Carotid Artery Aneurysms Presenting as Diplopia in a Young Patient

Introduction. Bilateral intracavernous carotid artery aneurysms (ICAAs) are extremely rare and difficult to treat. Case Report. A 26-year-old female presented in our clinic with acute diplopia due to oculomotor nerve palsy on the left side. Magnetic resonance imaging of the brain showed two heterogeneously enhanced masses indicating bilateral ICAA. An endovascular coil embolization was performed on the left side successfully, resulting in resolution of her symptoms. Conclusion. Thorough systemic evaluation in young patients with diplopia can reveal life-threatening underlying pathology and prevent major complications