Bilateral Acanthamoeba keratitis

Acanthamoeba keratitis is a rare eye infection commonly misdiagnosed as herpes simplex or fungal keratitis. Failure to include it in the differential diagnosis in any contact lens wearer with the typical features of an eye infection, results in a delay in the appropriate treatment with eventual complications and even blindness. This report describes the first case of bilateral Acanthamoeba keratitis ever reported in Malta, which occurred in a young female contact lens wearer.peer-reviewe

Maximising ophthalmic theatre time : part 2

Part 1 of the article can be found through this link : https://www.um.edu.mt/library/oar//handle/123456789/12827Part 2 of the article. Aim: To establish whether the available ophthalmic theatre time is being used efficiently and to find ways how to improve our surgical output and reduce the waiting list. Methods: All ophthalmic surgeries under the care of Mr Franco Mercieca carried out in Theatre 13 in the sample months of May and October 2009, were retrospectively analyzed. Average times were estimated for all types of ophthalmic procedures. The total number of cataract operations and patients listed for surgery were noted from beginning of 2006 till end of 2009. Results: In 2009, this firm has carried out 572 cataract operations, 81% increase from 2008, of which 52% were performed on weekends and public holidays. The theatre usage time in the sample months under study was 89.25% on weekdays and over 94% on extra sessions. Theatre time wastage was an average of 8%, half of which being due to cancellations on the day. On average over 71% of our theatre time is used for cataract surgery. Conclusions: In order to maximize our theatre time efficiency, we need to set up a Preoperative Assessment clinic and encourage more patients to have their surgery under local anaesthesia. To reduce the waiting list the need for a parallel theatre dedicated solely to cataract surgery under local anaesthesia is of paramount importance.peer-reviewe

Maximising ophthalmic theatre time : part 1

Part 2 of the article can be found through this link : https://www.um.edu.mt/library/oar//handle/123456789/12822Aim: To establish whether the available ophthalmic theatre time is being used efficiently and to find ways how to improve our surgical output and reduce the waiting list. Methods: All ophthalmic surgeries under the care of Mr Franco Mercieca carried out in Theatre 13 in the sample months of May and October 2009, were retrospectively analyzed. Average times were estimated for all types of ophthalmic procedures. The total number of cataract operations and patients listed for surgery were noted from beginning of 2006 till end of 2009. Results: In 2009, this firm has carried out 572 cataract operations, 81% increase from 2008, of which 52% were performed on weekends and public holidays. The theatre usage time in the sample months under study was 89.25% on weekdays and over 94% on extra sessions. Theatre time wastage was an average of 8%, half of which being due to cancellations on the day. On average over 71% of our theatre time is used for cataract surgery. Conclusions: In order to maximize our theatre time efficiency, we need to set up a Preoperative Assessment clinic and encourage more patients to have their surgery under local anaesthesia. To reduce the waiting list the need for a parallel theatre dedicated solely to cataract surgery under local anaesthesia is of paramount importance.peer-reviewe

Maximising ophthalmic theatre time : part 2

Part 1 of the article can be found through this link : https://www.um.edu.mt/library/oar//handle/123456789/12827Part 2 of the article. Aim: To establish whether the available ophthalmic theatre time is being used efficiently and to find ways how to improve our surgical output and reduce the waiting list. Methods: All ophthalmic surgeries under the care of Mr Franco Mercieca carried out in Theatre 13 in the sample months of May and October 2009, were retrospectively analyzed. Average times were estimated for all types of ophthalmic procedures. The total number of cataract operations and patients listed for surgery were noted from beginning of 2006 till end of 2009. Results: In 2009, this firm has carried out 572 cataract operations, 81% increase from 2008, of which 52% were performed on weekends and public holidays. The theatre usage time in the sample months under study was 89.25% on weekdays and over 94% on extra sessions. Theatre time wastage was an average of 8%, half of which being due to cancellations on the day. On average over 71% of our theatre time is used for cataract surgery. Conclusions: In order to maximize our theatre time efficiency, we need to set up a Preoperative Assessment clinic and encourage more patients to have their surgery under local anaesthesia. To reduce the waiting list the need for a parallel theatre dedicated solely to cataract surgery under local anaesthesia is of paramount importance.peer-reviewe

Success and complication rates of trabeculectomies augmented with MMC in the management of glaucoma

Glaucoma unresponsive to medical treatment is managed by surgery. Augmentation with mitomycin C (MMC) is considered in patients at high risk of surgery failure. Aim: In this paper we assess and compare the success and complications of this procedure performed in the local state hospital with those of larger international centres. Methods: A retrospective study of the surgery performed between 2003 and 2007 at St. Luke's Hospital by one surgeon (FM) was conducted. The total number of eyes considered in this analysis was 32. Intraocular pressures and complications up to one year post-operatively were recorded. Results: The mean intraocular pressure decreased from 30mmHg pre-operatively to 18mmHg post-operatively. The mean IOP drop registered was 42%. Of the 32 eyes that underwent trabeculectomy augmented by MMC, 23 were classified as a complete success with IOP remaining below 21mmHg at 1 year post-surgery. Six eyes were considered as a partial success since they had an IOP under 21mmHg but this had to be kept under control with the administration of medications. Failure of surgery was classified as uncontrollable UOP, although also on medications. This was seen in 3 eyes. Using the central limit theorem, the significance of the difference in means and difference in percentages of IOP drop and complication rates, between the local state hospital procedures and international centres were calculated. Conclusions: Incidences obtained from this analysis compare very favourably with results from international studies showing no significant differences.peer-reviewe

Success and complication rates of trabeculectomies augmented with MMC in the management of glaucoma

Abstract Glaucoma unresponsive to medical treatment is managed by surgery. Augmentation with mitomycin C (MMC) is considered in patients at high risk of surgery failure. Aim: In this paper we assess and compare the success and complications of this procedure performed in the local state hospital with those of larger international centres. Methods: A retrospective study, of the surgery performed between 2003 and 2007 at St. Luke's Hospital by one surgeon (FM), was conducted. The total number of eyes considered in this analysis was 32. Intraocular pressures and complications up to one year post-operatively were recorded. Results: The mean intraocular pressure decreased from 30mmHg pre-operatively to 18mmHg post-operatively. The mean IOP drop registered was 42%. Of the 32 eyes that underwent trabeculectomy augmented with MMC, 23 were classified as a complete success with IOP remaining below 21mmHg at 1year post-surgery. Six eyes were considered as a partial success since they had an IOP under 21mmHg but this had to be kept under control with the administration of medications. Failure of surgery was classified as uncontrollable IOP, although also on medications. This was seen in 3 eyes. Using the central limit theorem, the significance of the difference in means and difference in percentages of IOP drop and complication rates, between the local state hospital procedures and international centres, were calculated. Conclusion: Incidences obtained from this analysis compare very favourably with results from international studies, showing no significant differences

Evaluation of LOXL1 gene polymorphisms in exfoliation syndrome and exfoliation glaucoma

Purpose: To evaluate genetic susceptibility of lysyl oxidase-like 1 (LOXL1) gene polymorphisms to exfoliation syndrome (XFS) and exfoliation glaucoma (XFG) in a case-control cohort of American and European patients. Methods: DNA from a total of 620 individuals including 287 exfoliation patients and 333 healthy control subjects were extracted by standard methods. Three single nucleotide polymorphisms (SNPs) of rs1048661 (R141L), rs3825942 (G153D), and rs2165241 were genotyped in these individuals by SNaPshot Assay. The seven coding exons of the LOXL1 gene and their immediate flanking regions were directly sequenced in 95 affected patients. Data management and case-control association studies were performed with SNP-STAT and PLINK programs. The obtained DNA sequences were evaluated with the STADEN package. Results: The 287 unrelated exfoliation cases comprised of 171 American patients (mostly of European background) and 116 patients from 12 European countries. This phenotype was further divided into patients with exfoliation only and no glaucoma (XFO; n=95), exfoliation with glaucoma (XFG; n=133), and exfoliation unclassified (XFU; n=59). Genotypic data were analyzed separately for XFO, XFG, XFU, and XFS (all exfoliations; n=287) and for Americans and Europeans. The observed genotypic frequencies for each exfoliation phenotype or population were tabulated separately and tested for deviation from the Hardy–Weinberg equilibrium (HWE) using a standard Χ2 test. There were no HWE deviations and no significant genotypic differences between these subcategories for the three studied SNPs. For the combined exfoliation cohort, homozygote genotypes of G/G (rs1048661), G/G (rs3825942), and T/T (rs2165241) were significantly overrepresented. Likewise, case-control allelic association for rs1048661 (p=7.74x10−9), rs3825942 (p=3.10x10−17), and rs2165241 (p=4.85x10−24) were highly significant. The corresponding two-locus haplotype frequencies of GG for rs1048661-rs3825942 (p=1.47x10−27), GT for rs1048661-rs2165241 (p=1.29x10−24), and GT for rs3825942-rs2165241 (p=2.02x10−24) were highly associated with exfoliation phenotypes. The combined effect of these three SNPs revealed that the GGT haplotype is overrepresented by 66% in exfoliation cases, and this deviation from controls is highly significant (p=1.93x10−24). This haplotype constituted a major risk factor for development of exfoliation in both XFS and XFG. By contrast, the GAC haplotype was significantly underrepresented (p=4.99x10−18) in exfoliation cases by 83% and may potentially have a protective effect for this condition with an estimated attributable risk percent reduction of 457%. The only other haplotype that was significantly different between cases and controls was TGC (p=5.82x10−9). No observation was made for the GAT haplotype. The combined three haplotypes of GGT, GAC, and TGC were associated with 91% of the exfoliation syndrome cases in the studied populations. Seven coding exons of LOXL1 were also sequenced in 95 affected cases. In addition to the three above-mentioned SNPs, 12 other variations were also observed in these patients(G240G, D292D, A320A, V385V, rs2304719, IVS3+23C>T, IVS3–155G>A, IVS3–101G>A, IVS4+49G>A, rs2304721, IVS5–121C>T, and rs2304722). None were considered a disease-causing mutation. Conclusions: We confirmed a strong association with LOXL1 variants in our patients. For the LOXL1 gene, individual alleles of rs1048661 (G), rs3825942 (G), and rs2165241 (T) are highly associated with XFS and XFG in American and European populations. The GGT haplotype constitutes a major risk haplotype for exfoliation, and GAC may have a protective role. DNA sequencing of 95 affected patients did not show any mutations in this gene. The LOXL1 SNPs are located in the 15q24.1 band and within a genetic locus (GLC1N) that is associated with primary open-angle glaucoma (POAG). However, the LOXL1 genetic predisposition is only limited to exfoliation with or without glaucoma and does not include the POAG phenotype

Glucocorticoids—All-Rounders Tackling the Versatile Players of the Immune System

Glucocorticoids regulate fundamental processes of the human body and control cellular functions such as cell metabolism, growth, differentiation, and apoptosis. Moreover, endogenous glucocorticoids link the endocrine and immune system and ensure the correct function of inflammatory events during tissue repair, regeneration, and pathogen elimination via genomic and rapid non-genomic pathways. Due to their strong immunosuppressive, anti-inflammatory and anti-allergic effects on immune cells, tissues and organs, glucocorticoids significantly improve the quality of life of many patients suffering from diseases caused by a dysregulated immune system. Despite the multitude and seriousness of glucocorticoid-related adverse events including diabetes mellitus, osteoporosis and infections, these agents remain indispensable, representing the most powerful, and cost-effective drugs in the treatment of a wide range of rheumatic diseases. These include rheumatoid arthritis, vasculitis, and connective tissue diseases, as well as many other pathological conditions of the immune system. Depending on the therapeutically affected cell type, glucocorticoid actions strongly vary among different diseases. While immune responses always represent complex reactions involving different cells and cellular processes, specific immune cell populations with key responsibilities driving the pathological mechanisms can be identified for certain autoimmune diseases. In this review, we will focus on the mechanisms of action of glucocorticoids on various leukocyte populations, exemplarily portraying different autoimmune diseases as heterogeneous targets of glucocorticoid actions: (i) Abnormalities in the innate immune response play a crucial role in the initiation and perpetuation of giant cell arteritis (GCA). (ii) Specific types of CD4+ T helper (Th) lymphocytes, namely Th1 and Th17 cells, represent important players in the establishment and course of rheumatoid arthritis (RA), whereas (iii) B cells have emerged as central players in systemic lupus erythematosus (SLE). (iv) Allergic reactions are mainly triggered by several different cytokines released by activated Th2 lymphocytes. Using these examples, we aim to illustrate the versatile modulating effects of glucocorticoids on the immune system. In contrast, in the treatment of lymphoproliferative disorders the pro-apoptotic action of glucocorticoids prevails, but their mechanisms differ depending on the type of cancer. Therefore, we will also give a brief insight into the current knowledge of the mode of glucocorticoid action in oncological treatment focusing on leukemia