Search Results (10)

The aim of this paper is to present our experience with the diagnosis and management of nine patients diagnosed with Leber’s hereditay optic neuropathy. Materials and methods: We conducted a prospective, observational study that included nine patients treated with idebenone, followed for a period of 18 months. Results: Our findings suggest that the impact of treatment varies significantly depending on the disease phase. In the acute phase, visual acuity deteriorated from 0.67 logMAR at onset to 0.97 logMAR at 3 months, followed by a slight improvement to 0.88 logMAR at 9 months. In the chronic phase, average values decreased progressively from 1.44 logMAR at onset to 1.26 logMAR at 12 and 18 months. We also observed a consistent treatment benefit over time in eyes harbouring the m.11778 G > A mutation. Although the most powerful predictor of visual outcome remains the mtDNA genotype, young age at onset is correlated with a better prognosis. In the acute phase, more cases of a clinically relevant benefit were observed than expected (33.33% versus 22.22% expected), and fewer clinically relevant worsening cases were observed (0% versus 11.11% expected). Regarding OCT measurement, our study highlighted a significant difference in peripapillary retinal nerve fiber layer thickness between the initial evaluation and the 6-month follow-up (100.83 µm ± 30.2 at baseline versus 96.7 µm ± 24.8 at 6 months). Conclusions: Our paper demonstrates the benefit of idebenone treatment in improving visual acuity in patients with Leber hereditary optic neuropathy. We highlighted the importance of long-term treatment, emphasizing that extended administration is key to achieving favorable outcomes. Full article

Background: Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system (CNS), characterized by inflammation, demyelination, and neurodegeneration, resulting in the disruption of axonal signal conduction. Optic neuritis (ON) occurs in over 70% of MS cases, highlighting the involvement of the optic nerve in the progression of the disease. Optic nerve atrophy secondary to the inflammatory episode can be observed during fundoscopy as pallor in the temporal quadrant or of the entire optic disc. Our study aims to evaluate the diagnostic capacity of fundus ophthalmoscopy when compared with the temporal thickness of the pRNFL (peripapillary retinal nerve fiber layer) measured using optical coherence tomography (OCT). Methods: We analyzed 88 eyes from 44 relapsing remitting MS patients using fundus photography (FP) and OCT optic disc measurements, correlating the temporal pallor of the optic disc seen in fundus photographs (FPs) with structural parameters obtained using OCT. Results: Our analysis revealed the significant capacity of optic disc pallor grading using FPs in MS patients in order to discriminate between normal and quadrants with pallor (p = 0.006) or strong pallor (p = 0.003) and between ones with light pallor and moderate pallor (p = 0.002) or strong pallor (p = 0.001), while being unable to clearly differentiate between normal quadrants and ones with light pallor (p = 0.608) or between pallor and strong pallor (p = 0.33). Conclusions: Fundoscopy and FP are useful screening tools in evaluating optic nerve atrophy in MS patients that could be used to assess neurodegeneration because of their universal availability. With the proposed inclusion of the optic disc as the fifth part of the CNS, the optic nerve will benefit from multiple exploratory techniques in order to increase the understanding of disease progression and patient quality of life. Full article

Background: Numerous conditions, both physiological and pathological, can influence changes in the retinal vascular architecture. In order to be able to highlight pathological aspects of systemic diseases with ocular activity, it is necessary to understand how physiological fluctuations can influence circulation at the retinal level. The present study attempts to evaluate retinal and choroidal vascular and structural changes in healthy female subjects over the course of a menstrual cycle using OCT-A. Methods: We analyzed 22 eyes from healthy reproductive women with a regular menstrual cycle. We performed five OCT-A scans of the subjects every 7–8 days over the course of a month starting from the first day of the menstrual cycle and ending with the first day of the next cycle, measuring perfusion density in the superficial and deep vascular plexuses, choroidal thickness, and FAZ perimeter. Results: There are physiological variations in retinal hemodynamics that can be identified using OCT-A, choroidal thickness having statistically significant increased values in the parafoveal nasal sector during the ovulatory phase (289.18 µm) compared to the early follicular phase (281.9 µm), and the subfoveal sector during the ovulatory phase (319.04 µm) compared to the early follicular phase (308.27 µm). Conclusions: These findings along with abnormally small FAZ perimeters indicate that the menstrual cycle phase should be considered whenever interpreting OCT-A results. Further studies that include larger cohorts, control groups, and hormone serum levels are necessary to confirm and correlate retinal vascular alterations and the phase of the menstrual cycle using OCT-A. Full article

Neovascular age-related macular degeneration is a progressive, blinding macular disease that has become a burden both in healthcare systems and the global economy. The vascular endothelial growth factor (VEGF) is the main agent involved in the pathogenic process of the disease. The main goal of the age-related macular degeneration treatment is to maintain and improve visual acuity by injecting intravitreal anti-VEGF agents in either a reactive or proactive manner. Subretinal and intraretinal fluids are the main biomarkers that should be considered when managing the frequency of the therapy. This review discusses both functional and morphological treatment criteria according to current recommendations as opposed to real-life situations encountered during day-to-day clinical practice and highlights situations in which the benefits of continuing therapy are arguable in terms of improving patients’ quality of life. Optimizing the treatment regimen represents an important aim of current clinical ophthalmological practice, as age-related macular degeneration patients usually have a long follow-up period. Full article

TNF inhibitors (TNFi) have revolutionized the therapeutic management of various chronic immune-mediated inflammatory diseases. Despite their known benefits, these therapies are related to paradoxical adverse effects (PAEs), including paradoxical psoriasis (PP). Although the underlying mechanism remains somewhat unclear, some theories suggest that genetic factors, particularly certain single-nucleotide polymorphisms (SNPs), may play an important role. The present review aimed to research and analyze recent findings regarding the pathomechanisms involved in the appearance of PP and the association between various genetic factors and PP in individuals treated with TNFi. We performed a literature search and found that certain genes (IL23R, TNF, FBXL19, CTLA4, SLC12A8, TAP1) are strongly associated with the occurrence of PP in pediatric and adult patients during therapy with TNFi. The identification of the specific SNPs involved in the appearance of PP and other PAEs in patients treated with TNFi for various diseases and in different populations may later favor the recognition of those patients at a high risk of developing such adverse effects and could guide personalized therapeutic strategies in future years. Full article

Eales disease manifests as an obliterative periphlebitis affecting the retina; it originates from the periphery and progresses posteriorly. It is characterized by retinal vessel wall inflammation, ischemia, and retinal neovascularization. In this report, we present the case of a 34-year-old male who attended our clinic with a sudden blurring of vision in his right eye. A diagnosis of bilateral retinal vasculitis with vitreal hemorrhage was ascertained in his RE. A dilated ocular fundus examination revealed perivenous sheathing of the peripheral vessels in both eyes. Fluorescein angiography indicated dye staining, vessel obliteration, capillary drop-out, areas of non-perfusion and the formation of new vessels. Laboratory tests revealed positive results for Borrelia; a PPD skin test and QuantiFERON TB assay were also positive. The patient underwent bilateral retinal laser pan-photocoagulation, followed by systemic treatment with oral steroids, cephazoline, isoniazid, azathioprine, and entecavir. The steroid dose was progressively reduced over 10 months; the treatment with azathioprine continues, as we are monitoring the patient over the long term. After 3 months, the vasculitis had regressed without any vitreal hemorrhage recurrence. Vision acuity improved from 0.4 to 1 in the patient’s right eye. A multidisciplinary approach, which included collaborative management with gastroenterology, infectious disease, pulmonology, and rheumatology specialists, was essential for the diagnosis, treatment, and long-term follow up of the patient. Full article

Background: Diabetic retinopathy (DR) is a neurodegenerative disease of the retina. The aim of our study was to analyze latency changes in a full-field electroretinogram (ERG) in patients with type 2 diabetes. Material: This prospective study included 15 diabetic patients without DR, 16 diabetic patients with non-proliferative DR, 14 patients with pre-proliferative DR, 15 patients with proliferative DR, and 14 age-matched controls. All the participants underwent ophthalmologic examination and full-field ERGs. The ERGs were recorded with the Metrovision MonPackOne system. The latencies were analyzed for “a”- and “b”-waves in the dark-adapted (DA) 0.01 ERG, DA 3.0 ERG, DA oscillatory potentials, light-adapted (LA) 3.0 ERG, and 30 Hz flicker ERG. Results: The delayed responses of healthy subjects compared to diabetic patients without DR were the DA oscillatory potentials (25.45 ± 1.04 ms vs. 26.15 ± 0.96 ms, p = 0.027). When comparing diabetic patients without DR and with non-proliferative DR, we did not obtain statistically significant delays. Significant delays in the DA 0.01 “b”-wave (61.91 ± 5.52 ms vs. 66.36 ± 8.12 ms, p = 0.029), DA 3.0 “b”-wave (41.01 ± 2.50 ms vs. 44.16 ± 3.78 ms, p = 0.035), and LA 3.0 “a”-wave (16.21 ± 0.91 ms vs. 16.99 ± 1.16 ms, p = 0.045) were found between non-proliferative DR and pre-proliferative DR. When comparing the groups of patients with pre-proliferative DR and proliferative DR, the LA 3.0 ERG “b”-wave (32. 63 ± 2.53 ms vs. 36.19 ± 3.21 ms, p < 0.0001), LA 30 Hz flicker ERG “a”-wave (19.56 ± 3.59 vs. 21.75 ± 4.74 ms, p= 0.025), and “b”-wave (32.23 ± 4.02 vs. 36.68 ± 3.48 ms, p = 0.017) were delayed. Conclusions: the electrophysiological findings from our study indicate that there is a substantial dysfunction of the neural retina in all stages of DR. Full article

The prevalence of multiple sclerosis (MS) has been increasing among young people in developing countries over the last years. With the continuous development of new technology, the diagnosis and follow-up of these patients has received new parameters that physicians may use in their practice. This paper reviews the main biomarkers identified through Optical Coherence Tomography Angiography (OCT-A) involved in the development and progression of MS and investigates the role it may have in detecting changes to the central nervous system (CNS). Full article

Prosthetics are an extension of the human body and must provide functionality similar to that of a non-disabled individual to be effective. Sports prosthetics such as the Flex-Foot Cheetah from Össur have demonstrated the value of creating devices that both provide mechanical support and introduce passive energy return to mimic forces otherwise produced at joints. These energy return mechanisms have not yet been demonstrated for upper limb prosthetics but could improve their effectiveness and provide a greater range of motion and control. Using multi-material 3D printing technology, we extend energy return components to upper limb prosthetics by developing novel force-sensing springs and applying them to a basketball prosthetic. The 3D-printed springs compensate for the forces otherwise generated by wrist and finger flexion while measuring the mechanical deflection. We discuss design guidelines, methods for integrated 3D printed energy return within prosthetics, and broader applications in assistive technologies. Full article

Background and Objectives: There are few data in the literature concerning the learning curve of tractional retinal detachment (TRD) surgery. We have analyzed the experience gained by a vitreoretinal surgeon over 10 years. Materials and Methods: A retrospective, comparative study of 34 TRD cases operated using 20G instruments between 2008 and 2011 (group A) and 94 cases operated using 23G instruments between 2015 and 2019 (group B). The preoperative characteristics, the type of endotamponade, and the anatomical and functional success were reviewed. Results: The group A patients had a significantly higher rate of concomitant vitreous hemorrhage (VH) at presentation (64.7% vs. 37.2%) and of non-macular retinal detachments (52.9% vs. 39.3%). The rate of silicone oil endotamponade was high in both groups (76.4% vs. 68.1%), but in group B 25.5% were left without a tamponade (vs. none in group A). A postoperative anatomical success was obtained in 76.5% of eyes in group A and 84.04% of eyes in group B (where it was improved to 89.3% by reinterventions). The presenting visual acuity (VA) was very low in both groups (0.01 and 0.05, respectively). The proportion of eyes with improved or stabilized VA was 85.3% in group A and 79.8% in group B (statistically non-significant difference). Conclusions: The anatomical success rate improves quite slowly with increasing surgeon experience and can be further improved by reinterventions. Visual improvement does not match the rate of anatomical improvement. With increasing experience and self-confidence, the surgeon will approach more difficult cases, a fact that may slow down the increase in surgical success rates. Full article