Medical Hypothesis, Discovery & Innovation (MEHDI) Journals
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The Effect of Glaucoma Medication on Choroidal Thickness Measured with Enhanced Depth-Imaging Optical Coherence Tomography
Full text linkThe aim of this study was to examine the effect of the glaucoma medication on Choroidal Thickness (CT) in those with Primary Open-Angle Glaucoma (POAG) and normal cases. This prospective study included 27 patients with newly diagnosed POAG (group 1; 49 eyes), undergoing glaucoma treatment, and 30 patients, whose treatment was terminated due to misdiagnosis (group 2; 57 eyes). Choroidal thickness was measured using Enhanced Depth Imaging (EDI) with Spectral Domain Optical Coherence Tomography (SD-OCT) at the first visit and almost one month later. In group 1, the mean Sub-Foveal CT (SFCT) was 301 ± 91 µm, the mean CT was 264 ± 87 µm at the nasal point, 1 mm to the fovea, and 271 ± 84 µm at the temporal point, 1 mm to the fovea. The second measurements were obtained as 39 ± 8.5 days after treatment began; the SFCT was 319 ± 85 µm (P = 0.0017), the nasal 1 mm CT was 275 ± 88 µm (P = 0.162), and the temporal 1mm CT was 291 ± 80 µm (P = 0.007). In group 2, the mean SFCT was 292 ± 100 µm, the nasal 1 mm CT was 254 ± 97 µm, and the temporal 1 mm CT was 261 ± 97 µm. The second measurements were obtained 37.5 ± 5.5 days after the treatment ended; the SFCT was 295 ± 107 µm (P = 0.212), the nasal 1 mm CT was 262 ± 104 µm (P = 0.709), and the temporal 1 mm CT was 266 ± 104 µm (P = 0.792). Glaucoma medication affects the CT as a marker for choroidal blood flow in patients with glaucoma. Further studies with larger sample sizes are required to examine each glaucoma medication subgroup
Clinical Efficacy of Topical CoQ10 and Vitamin-E Eye-drop in Retinopathy of Prematurity
Full text linkTreatment strategy for retinopathy of prematurity (ROP) includes anti-vascular endothelial growth factor (anti-VEGF) and/or laser therapy. The aim of this study was to investigate the clinical effects of topical Coqun® eye drop (CoQ10 and Vitamin-E) on the progression and treatment of ROP. One hundred and ten infants with type 1 ROP who received Coqun® (Coqun group) and 131 infants with type 1 ROP who did not receive Coqun® (control group) were included in this retrospective analysis. All patients were follow-up until retinal vascular maturation was complete. Intravitreal bevacizumab (IVB) injection or laser photocoagulation (LPC) were apply if needed. Treatment frequency, treatment response and mean follow-up time were compare. The number of IVB was similar between the groups, but infants in the Coqun group underwent significantly fewer LPC procedure than those in the control group (P = 0.022). The mean follow-up time was significantly shorter in infants receiving Coqun® in stage 1 ROP (P = 0.017) and similar in stages 2-4 ROP and aggressive posterior retinopathy of prematurity (APROP). The number of LPC procedure was fewer in the Coqun group in APROP (P = 0.043). These results indicate that faster retinal vascular maturation in infants with low-grade ROP and lower number of treatments with APROP could be achieve with Coqun® therapy. Epub: October 1, 2019
Repeatability, Reproducibility and Agreement of Central Corneal Thickness Measurements by Two Noncontact Pachymetry Devices
Full text linkThis study was designed to assess the repeatability, reproducibility, and agreement of Noncontact Pachymetry (NPC) (Topcan TRK-2P) and the non-contact optical low coherence reflectometer (Lenstar LS 900) devices for measuring Central Corneal Thickness (CCT) of healthy corneas. A total of 82 healthy volunteers were evaluated. The first observer used both the TopconTRK-2P and Lenstar 900 devices while the second observer only used the TopconTRK-2P for the measurements. The measurements with either device were repeated three times for each patient, consecutively. The central corneal thickness measurements with the Topcon TRK-2P revealed mean ± Standard Deviation (SD) values of 553.1 ± 36.1 micrometer (µm) for the first observer and 552.3 ± 35.9µm for the second observer and the mean ± SD of CCT was 537.3 ± 34.8µm with the Lenstar 900. The difference between the CCT measurements of the observers using the Topcon TRK-2P (P = 0.142) was insignificant. However, significantly lower measurements were found with the Lenstar 900 compared with the Topcon TRK-2P (P ˂ 0.001). The central corneal thickness measurements obtained by the Topcon TRK-2P were found to have high repeatability for both observers with a lower SD, less than 1% Coefficient of Variation (CV) and higher than 0.99 Intra-Class Correlation Coefficient (ICC) (Observer 1: 3.77 SD, 0.68 CV and 0.995 ICC; the second observer: 3.58 SD, 0.65 CV and 0.995 ICC). There was an excellent inter-observer reproducibility between the two observers for Topcon TRK-2P with 2.71 SD, 0.49 CV, and 0.994 ICC. The Bland-Altman plot showed high agreement between the two devices. These results suggest that the TopconTRK-2P is a reliable device for evaluating CCT in healthy corneas compared with Lenstar 900
Bacteriology and Antimicrobial Susceptibility Patterns of Childhood Acute Bacterial Conjunctivitis in Western Greece
Full text linkAcute bacterial conjunctivitis is a common, highly contagious infection in children and is usually treated empirically with broad spectrum topical antibiotics. In the current study we investigated bacteriology and antibiotic susceptibility patterns in childhood acute bacterial conjunctivitis in Western Greece. We conducted a retrospective analysis of presumed acute bacterial conjunctivitis cases in ''Karamandaneio'' Pediatric General Hospital of Patras, Western Greece, between February 1, 2013 and January 31, 2018. Specimens from the lower conjunctiva fornix were isolated from 191 cases and outcomes were analyzed to identify the pathogenic bacteria of acute bacterial conjunctivitis and their corresponding antibiotic susceptibility patterns. Patients were divided into 3 groups; Group A included neonates under 28 days of life, Group B children from 1 month to 2 years and Group C from 2 years to 14 years. Results revealed that Staphylococcus spp., Haemophilus spp. and Streptococcus spp. were the most prevalent pathogens. No significant differences in isolated pathogens were found between the age groups. Antibiotic resistance rates were higher against ampicillin, ceftriaxone, ceftazidime and sulfamethoxazole. Resistance rates to Ciprofloxacin were low while none of the evaluated isolates were resistant to vancomycin. We concluded that predominant pathogens of childhood acute bacterial conjunctivitis in Western Greece were Staphylococcus spp., Haemophilus spp. and Streptococcus spp. Continuous surveillance, focused in distinct geographic areas, is encouraged to prepare more precise protocols of empirical treatment. Epub: October 1, 2019
Visual Prognosis after Explantation of a Corneal Shape-Changing Hydrogel Inlay in Presbyopic Eyes
Full text linkThe purpose of this case series is to report visual outcomes in patients who underwent explantation of the Raindrop® hydrogel corneal inlay. Retrospective chart review comprising four cases of explantation of the Raindrop® corneal shape-changing hydrogel inlay: pre-implantation, pre-explantation, and post-explantation values for uncorrected distance visual acuity, uncorrected near visual acuity, and corrected distance visual acuity (CDVA) were measured; keratometric and tomographic data were collected using the Pentacam system (Oculus, Inc). Three eyes were explanted for progressive haze after implantation that persisted even after removal; one eye was explanted due to poor visual acuity with no haze formation. All patients experienced decreased unaided and corrected distance visual acuity. Persistent increase in corneal thickness and mean keratometry was noted post-explantation. All four patients regained their original near visual acuities, but one patient had persistent one-line loss in CDVA. There are long lasting tomographic corneal changes following Raindrop inlay explantation. In addition, persistent increased corneal thickness could be related to semi-permanent changes in corneal structure and may account for residual haze experienced by patients. After explantation, patients may not return to baseline CDVA
Outcomes of Trabeculectomy With and Without Mitomycin C in Pseudoexfoliative Glaucoma Compared With Mitomycin C in Primary Open Angle Glaucoma
No full textThe aim of this study was to evaluate the outcomes of trabeculectomy with mitomycin C (MMC) in patients with Pseudoexfoliative Glaucoma (PXG) and compare the results with the outcomes of trabeculectomy without MMC in PXG and with MMC in Primary Open Angle Glaucoma (POAG). Ninety eyes (76 patients) submitted to trabeculectomy were included in a one-year retrospective study. Fifty-eight eyes with PXG were divided into group 1 (28 eyes) and group 2 (30 eyes), with and without MMC application respectively. Then, the group 1 results were compared with 32 eyes with POAG that performed trabeculectomy with MMC (group 3). Main outcome measures were intraocular pressure (IOP), number of IOP lowering medications, rate of bleb failure (encapsulation, flattening and/or vascularization) and the number of eyes submitted to surgical procedures after trabeculectomy (needling, 5-fluorouracil – 5FU or 2nd trabeculectomy). Results revealed that compared to trabeculectomy with MMC in POAG and trabeculectomy with MMC in PXG, trabeculectomy without MMC in PXG leads to higher IOP (preoperative mean ± standard deviation [SD] was 28.6 ± 5.4 mmHg in group 1, 32.2 ± 8.2 mmHg in group 2 and 26.1 ± 6.5 mmHg in group 3; and after one year was 13.9 ± 3.9 mmHg in group 1, 16.1 ± 5.9 mmHg in group 2 and 12.5 ± 4.0 mmHg in group 3); higher number of IOP lowering medications (preoperative mean was 3.1 ± 0.60 in group 1, 2.8 ± 0.81 in group 2 and 3.4 ± 0.76 in group 3; and after one year was 1.1 ± 1.1 in group 1, 1.1 ± 1.0 in group 2 and 0.33 ± 0.89 in group 3); higher prevalence of bleb failure (47% in group 1, 53% in group 2, and 18% in group 3); and increased participation in surgical procedures following trabeculectomy (47% in group 1, 57% in group 2, and 6% in group 3). We concluded that trabeculectomy without MMC in PXG had the worst surgical outcome. Thus, PXG appears to be a potential risk factor for filtration bleb failure. Therefore, it could be considered in surgical protocols of MMC application
The Correlation between Changes in Biochemical Parameters and Central Macular Thickness in Patients with Non-Proliferative Diabetic Retinopathy
Full text linkThis study aimed at evaluating the correlation between changes in Hemoglobin A1c (HbA1c) and fasting serum lipids, and Central Macular Thickness (CMT) in patients with Non-Proliferative Diabetic Retinopathy (NPDR). In the current research, both eyes of 68 patients with mild or moderate NPDR, without clinically significant macular edema, were studied. Levels of fasting serum lipids, HbAlc, and CMT were measured during the first visit and at the end of the follow-up period (3 months). For statistical analysis, CMTs of each eye were studied and the correlation of changes was investigated. Additionally, the direction of changes in CMT for each eye was determined, and whether the changes in both eyes were symmetrical was investigated. Out of 68 patients, 24 were male and 44 were female. The mean CMT of all eyes was 290.05 ± 48.90 µm during the first visit and 286.80 ± 37.57 µm on the 3rd month follow-up. The mean HbAlc was 8.71 ± 1.82% at first visit to the hospital and the mean HbAlc was 8.39 ± 1.65% at the final visit. Although the changes in HbA1c and CMT during the follow-up period were statistically insignificant, the correlation of these 2 values was statistically significant (p=0.01). However, amongst l3 patients, the CMTs were asymmetrically changed in each eye during the follow-up period. To the best of the author’s knowledge, this was the first study, which indicated a significant correlation in changes of CMT and HbA1c, even amongst patients with low-grade diabetic retinopathy. Demonstration of asymmetric changes in CMT of each treatment-naive eye of the same patient, during changes in systemic conditions, was another important finding of this study
Corneal Biomechanical Properties and Thickness in Primary Congenital Glaucoma and Normal Eyes: A Comparative Study
Full text linkThe correct estimation of Intraocular Pressure (IOP) is the most important factor in the management of various types of glaucoma. Primary congenital glaucoma is a type of glaucoma that can cause blindness in the absence of control of the IOP. In this retrospective observational study, 95 eyes, including 48 healthy eyes and 47 eyes with Primary Congenital Glaucomatous (PCG) were studied. Two groups were matched for age, gender, and Goldman Applanation Tonometry (GIOP). Corneal Hysteresis (CH), Corneal Resistance Factor (CRF), and Goldman intraocular pressure were measured by ORA (IOPg), and corneal compensated Intraocular Pressure (IOPcc) was measured for each patient using the Ocular Response Analyzer (ORA). Central Corneal Thickness (CCT) was measured by ultrasonic pachymetry. For each patient, one eye was selected randomly. Student’s t-test and analytical regression were used for statistical analysis. The two groups were matched for age (P = 0.34), gender (P = 0.47), and GIOP (P = 0.17). Corneal hysteresis and CRF were significantly lower in PCG than in normal eyes (P < 0.0001), yet CCT was significantly thicker in PCG than normal eyes (P < 0.0001). The regression equation on the effect of CH, CRF, and CCT on GIOP in the PCG group showed that CH and CRF (P-value = 0.001 and P-value<0.0001) also had a significant effect yet CCT did not (P-value = 0.691). A significant decrease in CH and CRF was found in the PCG group compared to the normal controls. In the PCG group, the CCT was greater than normal. These results showed the usefulness of biomechanical properties (CH, CRF) in order to interpret IOP measurements. Furthermore, GIOP measurement may not be confined to consideration of CCT alone. A low CH and CRF value could be responsible for under-estimation of GIOP in the PCG group, in comparison to the normal controls
A Review of Antimicrobial Therapy for Infectious Uveitis of the Posterior Segment
Full text linkTreatment of infectious posterior uveitis represents a therapeutic challenge for ophthalmologists. The eye is a privileged site, maintained by blood ocular barriers, which limits penetration of systemic antimicrobials into the posterior segment. In addition, topical and subconjunctival therapies are incapable of producing sufficient drug concentrations, intraocularly. Posterior infectious uveitis can be caused by bacteria, virus, fungi, or protozoa. Mode of treatment varies greatly based on the infectious etiology. Certain drugs have advantages over others in the treatment of infectious uveitis. Topical and systemic therapies are often employed in the treatment of ocular infection, yet the route of treatment can have limitations based on penetration, concentration, and duration. The introduction of intravitreal antimicrobial therapy has advanced the management of intraocular infections. Being able to bypass blood-ocular barriers allows high drug concentrations to be delivered directly to the posterior segment with minimal systemic absorption. However, because the difference between the therapeutic and the toxic doses of some antimicrobial drugs falls within a narrow concentration range, intravitreal therapy could be associated with ocular toxicity risks. In many cases of infectious uveitis, combination of intravitreal and systemic therapies are necessary. In this comprehensive review, the authors aimed at reviewing clinically relevant data regarding intraocular and systemic antimicrobial therapy for posterior segment infectious uveitis. The review also discussed the evolving trends in intraocular treatment, and elaborated on antibiotic pharmacokinetics and pharmacodynamics, efficacy, and adverse effects
Intravitreal Dexamethasone Implant in the Treatment of Non-Infectious Uveitic Macular Edema
Full text linkMacular Edema (ME) is a common complication, leading to severe vision loss in patients with Non-Infectious Uveitis (NIU). The treatment of uveitic ME is still very challenging for many ophthalmologists. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combatting uveitic ME. However, there is not enough evidence to support the efficacy of any of these agents. Intravitreal Dexamethasone Implant (IDI) (Ozurdex; Allergan Inc, Irvine, CA) is a widely administered corticosteroid for the long-term management of uveitic ME in certain cases. Ophthalmic implant is made up of a biodegradable copolymer that contains glycolic acid and lactic acid. Recent studies have demonstrated that dexamethasone implant effectively improves uveitis-related ME. The authors suggest that this effect could be sustained for at least six months with close monitoring and re-treatment, as needed. The current study reviewed major clinical studies about IDI in eyes with NIU and briefly overviewed their results