Blindness and glaucoma: A multicenter data review from 7 academic eye clinics

Purpose To evaluate frequency, conversion rate, and risk factors for blindness in glaucoma patients treated in European Universities. Methods This multicenter retrospective study included 2402 consecutive patients with glaucoma in at least one eye. Medical charts were inspected and patients were divided into those blind and the remainder (''controls''). Blindness was defined as visual acuity-0.05 and/or visual field loss to less than 10°. Results Unilateral and bilateral blindness were respectively 11.0% and 1.6%at the beginning, and 15.5%and 3.6% at the end of the observation period (7.5±5.5 years, range:1-25 years)//conversion to blindness (at least unilateral) was 1.1%/year. 134 eyes (97 patients) developed blindness by POAG during the study. At the first access to study centre, they had mean deviation (MD) of -17.1±8.3 dB and treated intraocular pressure (IOP) of 17.1±6.6 mmHg. During follow-up the IOP decreased by 14%in these eyes but MD deteriorated by 1.1±3.5 dB/year, which was 5-fold higher than controls (0.2±1.6 dB/year). In a multivariate model, the best predictors for blindness by glaucoma were initial MD (p<0.001), initial IOP (p<0.001), older age at the beginning of follow-up (p<0.001), whereas final IOP was found to be protective (p<0.05). Conclusions In this series of patients, blindness occurred in about 20%. Blindness by glaucoma had 2 characteristics: late diagnosis and/or late referral, and progression of the disease despite in most cases IOP was within the range of normality and target IOP was achieved//it could be predicted by high initial MD, high initial IOP, and old age

Hydraulic Characterization of Solenoid-actuated Injectors for Diesel Engine Common Rail Systems

Injection systems represent key elements in modern diesel engines because of the fundamental role played in fuel spray formation and evolution during the combustion phase. For this reason, their design needs attention and continuous improvements in order to satisfy environmental standards and consumer demands. The present work illustrates the main phases that form the basis of an activity of hydraulic characterization of a solenoid injector for diesel engine applications. The performance of the injection system has been verified by means of injected flow-rate time histories, fuel injected quantities, leakages through the injector pilot-valve, electric driving signals and pressure transients, for different operating conditions, which refer to single and multiple injections. Furthermore, a complete numerical model of the injector and of the high-pressure hydraulic circuit of the injection apparatus has been developed with the aim of deepening the understanding of the internal dynamics of the injection system, which could not be analyzed only experimentally

PID Controller Modelling and Optimization in Cr Systems with Standard and Reduced Accumulators

The proportional-integrative-derivative (PID) controller and the pressure control valve of a Common Rail system are modelled by taking into account electronic, electrical, hydraulic and mechanical aspects. A fully predictive model of the injection apparatus is realized and validated by means of comparison with experimental data. The effects of the PID parameters on the injection system dynamics are illustrated and discussed on the basis of model results, which refer to steadystate and transient working conditions. The influence of the accumulator size on the rail pressure time history is investigated when the rail volume is dramatically reduced (up to 2.5 cm3). In particular, the effect of the large rail pressure drop that occurs at the end of the main injection for Minirail layout solutions is examined when after injections are implemented. An objective is to try to determine possible suitable values of the PID controller parameters and of the pressure-sensor sampling-frequency for rails of reduced size

Gender, migraine and affective disorders in the course of the life cycle

The relationships existing between migraine and affective disorders are still far from clear. Despite the evidence of a high prevalence, in association, of both conditions, many questions remain unanswered. To what extent is the coexistence of migraine and affective disorders, in particular depression, genetically determined? How important a role is played by pregnancy? What interactions occur between genetic and epigenetic factors? The authors analyse all these open questions and review the state of the art on this intriguing topi

Management of intraocular pressure elevation during hemodialysis of neovascular glaucoma: A case report

Background: It is generally accepted that dialysis may lower plasma osmolality at a faster rate than changes in ocular osmolality. This osmotic difference causes water to migrate from the plasma into the aqueous humor, increasing intraocular pressure. Certain authors have described IOP increase in patients with narrow angles. Case presentation: Here we report a neovascular glaucoma patient who experienced a substantial increase in IOP associated with severe eye pain and blurred vision during sessions of dialysis. The patient had been refractory to several antiglaucoma drugs and improved after intravenous administration of 20 % hyperosmotic glucose solution with dialysis and pan-retinal photocoagulation. Conclusion: It is the first report in which intravenous glucose administration and reduction of neovascularization by argon laser pan-retinal photocoagulation successfully managed IOP increase during dialysis in neovascular glaucoma. Further clinical studies are required to confirm our results

Corioretinopatia sierosa centrale cronica: nuove prospettive terapeutiche con il laser diodo micropulsato iq 577-nm, nostra iniziale esperienza

Introduction: Central Serous Chorioretinopathy (CSC) is an idiopathic disease of the outer blood retinal barrier, involving the macular region and characterized by a localized neuroepithelial detachment of the sensory retina from the retinal pigment epithelium (RPE ), sometimes associated with a serous pigment epithelium detachment (PED ) and RPE cells decompensation. CSC in the majority of cases may be self-limiting and resolve itself spontaneously or become chronic and cause visual disturbances (decreased visual acuity, metamorphopsia, altered contrast and color sensitivity). The aim of this preliminary study is to evaluate the safety and the efficacy of Subthreshold Yellow-577nm Micropulse (SYM) laser photostimulation in the treatment of patients with chronic CSC. Materials and Methods: Three eyes, one from each of three consecutive patients with chronic CSC were included in this study and treated with SYM laser photostimulation. Before treatment and at the 3, 4 and 5 month follow-up visit respectively, patients underwent a Best Corrected Visual Acuity (BCVA ) examination, dilated ophthalmoscopy, Fluorescein Angiography (FA ), and Optical Coherence Tomography (OCT ). The SYM photostimulation treatment was performed with the IQ577 semiconductor yellow laser in its MicroPulse emission mode and using the following settings: spot diameter 50 μm, mean power 520 mW, 5% duty cycle and 200 ms exposure duration. All the neuro-epithelial detachment area was treated with contiguous invisible applications with no intraoperative retinal tissue change endpoint. Results: Three men aged 48, 45 and 65 years old, with a history of chronic CSC for 8, 12 and 11 months respectively, have declining vision and metamorphopsia. After 3, 5 and 4 months after treatment with SYM, all patients recoveredtheir vision completely (BSCVA :20/20). OCT examination confirmed the resolution of the detachment of the neuroepithelium with no signs of alteration of the profile of retinal laser treatment MPD IQ-577 nm. Conclusions: The use of the LD M IQ 577-nm, specifically for EPR has proved painless, effective, safe and potentially repeatable. The ability to promote the reabsorption of subretinal fluid by stimulating the EPR at the parafoveal level, without causing damage to the retinal tissue, has opened new frontiers for the treatment of chronic CSC. If further randomized trials confirm the results of this preliminary study, the treatment SYM IQ 577-nm can be considered to be a new and important, and possibly the main, treatment option for the CSC

Multivariate linear model fitted with Final MD values as dependent variable and Final IOP as predictor, together with the same predictors as in Table 5.

<p>*p<0.1</p><p>**p<0.05</p><p>***p<0.01</p><p>IOP, intraocular pressure; MD, mean deviation</p><p>(except for the Initial IOP).</p

Hazard ratios and confidence intervals for each risk factor in determining blindness.

<p>IOP, intraocular pressure; MD, Mean Deviation; Final, at the end of follow up. Since the model used is a parametric accelerated failure model with a Weibull distribution, the hazard ratio depends on the scale parameter, which is different for each center due to stratification. The presented hazard ratios are a global calculation (i.e. with no strata) although the significance of the covariates was assessed with a stratified model.</p><p>Hazard ratios and confidence intervals for each risk factor in determining blindness.</p

Causes of blindness in the study.

<p>ARMD, age-related macular disease; BVO, branch vein occlusion; CVO, central vein occlusion; PACG, primary angle-closure glaucoma; POAG, primary open-angle glaucoma.</p><p>Causes of blindness in the study.</p