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OBJECTIVE: Diabetic retinopathy is the leading cause of irreversible blindness in the western world, among the working-age people. Its exact pathogenesis, however, remains obscure. Systemic inflammation is regarded to play a significant role in diabetes by contributing, among others, to the development of diabetic retinopathy. This review focuses on the possible involvement of the systemic inflammatory markers in the pathogenesis of diabetic retinopathy. MATERIALS AND METHODS: We performed a systematic search of the literature of published papers until August 2017 using the PubMed search engine. RESULTS: We demonstrated that many systemic inflammatory markers contribute to the pathogenesis and progression of retinopathy, while we highlighted in several occasions their usefulness as a key tool in the monitoring of the disease progression and the treatment efficacy. CONCLUSIONS: To the best of our knowledge this is the first review in the literature that elaborates the possible association of serum inflammatory markers and diabetic retinopathy, a disease that may cause irreversible loss of vision. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study was designed to investigate the potential effect of fish consumption on macular structure and function of healthy individuals. PATIENTS AND METHODS: The participants were Greek, who used to consume less than one portion of fish per week since their childhood. All participants underwent body mass index (BMI) measurements and ophthalmological examination. At their first examination, they were asked to consume at least 2 portions of fish per week over a period of 8 weeks, after which all the measurements were repeated. RESULTS: Eighteen healthy individuals (36 eyes) participated in this study. The central macular thickness was reduced, while the amplitudes in the foveal and parafoveal area were increased after the fish consumption. However, all measurements remained within the normal range at both visits. CONCLUSIONS: Regular fish consumption could enhance the structural and functional status of the macula. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our aim study was to compare 12 and 24-month results of intravitreal ranibizumab therapy in the management of choroidal neovascularization (CNV) secondary to angioid streaks (ST). This could be of clinical importance helping us planning optimal dosing strategies. PATIENTS AND METHODS: Over a 7-year period, a consecutive series of treatment-naïve eyes with macular CNV due to AS were treated with intravitreal ranibizumab (0.5 mg). The main outcome measure was changed in best-corrected visual acuity (BCVA) at 12 and 24 months as compared to baseline. RESULTS: Twenty eyes completed 24-month therapy and regular follow-up visits. BCVA improved at 12 (0.42 ± 0.26 logMAR) and 24 months (0.44 ± 0.22 logMAR) as compared to baseline (0.75 ± 0.26 logMAR) (p < 0.001), but did not change between the 12 and 24-month follow-up (p = 0.48). BCVA improved in 15 (75%) and 16 (80%) of the eyes, but in 5 (25%) and 4 eyes (20%) remained unchanged (p = 0.71) at 12 and 24 months, respectively. CONCLUSIONS: These results suggest that during the first year of intravitreal ranibizumab therapy for patients with macular CNV due to AS, BCVA improved in most of the eyes, and was maintained during the second year. [ABSTRACT FROM AUTHOR]

Purpose: To assess any changes in macular function and morphology in patients with progressive keratoconus undergoing accelerated corneal cross-linking (CXL)., Methods: This prospective case series included 9 eyes of 8 patients with progressive keratoconus undergoing CXL using a high intensity accelerated protocol (9 mW/cm 2 for 14 min) with a total surface dose of 7.5 J/cm 2 . Visual acuity assessment, slit lamp biomicroscopy, dilated fundoscopy, corneal tomography, multifocal electroretinography (mfERG) and spectral domain optical coherence tomography scan were performed at baseline, 2 weeks and 6 weeks postoperatively., Results: Uncorrected and corrected distance visual acuity did not change significantly at 2 weeks and 6 weeks following accelerated CXL compared to baseline. Retinal response density (RRD) of mfERG significantly decreased at 2 weeks postoperatively compared to baseline (p = 0.008) but did not differ from the baseline value at 6 weeks postoperatively in the fovea (ring 1) (p = 0.95). Similarly, P1 latency significantly decreased at 2 weeks (p = 0.04) but did not change at 6 weeks (p = 1.00) postoperatively compared to baseline in the fovea. No changes in RRD or P1 latency were observed in the retinal rings surrounding the fovea (rings 2 to 5). Central foveal thickness did not change at 2 weeks and 6 weeks postoperatively compared to baseline (p = 0.53 and p = 0.93, respectively)., Conclusions: A short-term reversible decrease in macular electrical activity without any structural changes seems to occur after accelerated CXL in patients with progressive keratoconus. The return of macular response to the preoperative values shows the safety of the CXL protocol.

Objective: Endometrial cancer is increasingly prevalent in western societies and affects mainly postmenopausal women; notably incidence rates have been rising by 1.9% per year on average since 2005. Although the early-stage endometrial cancer can be effectively managed with surgery, more advanced stages of the disease require multimodality treatment with varying results. In recent years, endometrial cancer has been extensively studied at the molecular level in an attempt to develop effective therapies. Recently, a family of compounds that alter epigenetic expression, namely histone deacetylase inhibitors, have shown promise as possible therapeutic agents in endometrial cancer. The present review aims to discuss the therapeutic potential of these agents., Materials and Methods: This literature review was performed using the MEDLINE database; the search terms histone, deacetylase, inhibitors, endometrial, targeted therapies for endometrial cancer were employed to identify relevant studies. We only reviewed English language publications and also considered studies that were not entirely focused on endometrial cancer. Ultimately, sixty-four articles published until January 2018 were incorporated into our review., Results: Studies in cell cultures have demonstrated that histone deacetylase inhibitors exert their antineoplastic activity by promoting expression of p21WAF1 and p27KIP1, cyclin-dependent kinase inhibitors, that have important roles in cell cycle regulation; importantly, the transcription of specific genes (e.g., E-cadherin, PTEN) that are commonly silenced in endometrial cancer is also enhanced. In addition to these abstracts effects, novel compounds with histone deacetylase inhibitor activity (e.g., scriptaid, trichostatin, entinostat) have also demonstrated significant antineoplastic activity both in vitro and in vivo, by liming tumor growth, inducing apoptosis, inhibiting angiogenesis and potentiating the effects of chemotherapy., Conclusions: The applications of histone deacetylase inhibitors in endometrial cancer appear promising; nonetheless, additional trials are necessary to establish the therapeutic role, clinical utility, and safety of these promising compounds.

PurposeTo compare endothelial cell loss and complications following Descemet membrane endothelial keratoplasty (DMEK) with use of three commercially available injectors.MethodsFrom 179 consecutive DMEK procedures, 66 cases with uncomplicated graft preparation and completed 12-month follow-up were included in this retrospective study. According to the injector used, 3 groups were formed: group 1 (D.O.R.C. injector, n=16), group 2 (Geuder injector, n=24), and group 3 (Pasteur laboratory pipette, n= 26). Endothelial cell density (ECD) and endothelial cell loss were evaluated preoperatively and at 3, 6 and 12 months postoperatively; surgery-related complications were recorded.ResultsDonor ECD was 2416±179 cells/mm 2 (group 1), 2417±164 cells/mm 2 (group 2), and 2478±234 cells/mm 2 (group 3). At 12 months postoperatively ECD was 1473±403 cells/mm 2 (group 1), 1379±317 cells/mm 2 (group 2), and 1316±456 cells/mm 2 (group 3) (P=0.533, ANOVA). Endothelial cell loss 12 months postoperatively was 39±15% (group 1), 43±13% (group 2), and 47±17% (group 3) (P=0.386, ANOVA). A single case of iris bleeding and reflux of the graft out of the anterior chamber (both in group 3) was noted. Partial graft detachment occurred in group 1 (n=1), group 2 (n=5), and group 3 (n=7) and rebubbling was performed in 6% (group 1), 17% (group 2), and 27% (group 3).ConclusionsTo our knowledge, this is the first clinical study assessing the safety of three different DMEK injectors. Group 1 (D.O.R.C injector) showed the least and group 3 (Pasteur laboratory pipette) the highest endothelial cell loss without reaching statistical significance at 12 months after surgery. Therefore, the graft injector may be chosen according to surgeon's preference.

Background: Computer use can cause visual problems. The purpose of our study was to evaluate visual problems due to computer use in young adults., Patients and Methods: Participants in our study were 87 adults, 48 male and 39 female, mean aged 31.3 years old (SD 7.6). All the participants completed a questionnaire regarding visual problems detected after computer use., Results: The mean daily use of computers was 3.2 hours (SD 2.7). 65.5 % of the participants complained for dry eye, mainly after more than 2.5 hours of computer use. 32 persons (36.8 %) had a foreign body sensation in their eyes, while 15 participants (17.2 %) complained for blurred vision which caused difficulties in driving, after 3.25 hours of continuous computer use. 10.3 % of the participants sought medical advice for their problem. There was a statistically significant correlation between the frequency of visual problems and the duration of computer use (p = 0.021). 79.3 % of the participants use artificial tears during or after long use of computers, so as not to feel any ocular discomfort., Conclusions: The main symptom after computer use in young adults was dry eye. All visual problems associated with the duration of computer use. Artificial tears play an important role in the treatment of ocular discomfort after computer use., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To evaluate macular function, before and after photodynamic therapy (PDT) using multifocal electroretinogram (MF-ERG), in eyes suffering from classic subfoveal choroidal neovascularization (CNV) resulting from age-related macular degeneration (ARMD)., Methods: Twenty eyes of 20 patients (10 male, 10 female) with classic subfoveal CNV resulting from ARMD were studied. All received PDT with verteporfin. Fluorescein angiography and mF-ERG were performed in each patient 1 day before and 1 week, 3 months and 6 months after photodynamic therapy., Results: Before treatment, visual acuity (VA) and electrical retinal response densities (RRD) in the foveal and parafoveal areas were low in all patients. The mean VA (ETDRS chart) before PDT was 24.35 (SD, 15). The mean RRD before PDT in area 1 was 4.39 nV/deg(2) (SD, 2.59) and in area 2 it was 2.11 (SD, 1.86). Six months after treatment, the mean VA was stable in 70% of the patients. However, the mean RRD after PDT was 2.24 nV/deg(2) in area 1 (SD, 2.59) and 1.07 nV/deg(2) in area 2 (SD, 1.59)., Conclusion: Multifocal ERG objectively evaluates the macular function in eyes with CNV attributable to ARMD. In this study, the stability of VA coincided with a clear impairment of electrical activity of the foveal and parafoveal areas. This finding suggests that MF-ERG should be adopted to assess the efficacy of PDT objectively in the treatment of ARMD.

Background: To report a case of an arachnoid cyst of the optic nerve with homonymous optic atrophy., History and Signs: A 17-year-old female patient presented with severe visual loss, limited to light perception, of the left eye. She underwent complete ophthalmologic examination, color fundus photography and electrophysiological study. Magnetic resonance imaging (MRI) revealed the presence of a fusiform structure involving the left optic nerve from the orbital apex to the posterior surface of the globe. The clinical and radiographic features are consistent with an arachnoid cyst of the optic nerve., Therapy and Outcome: The patient refused to be treated. Two years later, the VA remained unchanged., Conclusions: The arachnoid cyst of the optic nerve is a rare entity. Its differential diagnosis from the primary optic nerve glioma is difficult and important to be made in order to be treated properly.

Background: To report a case of retinal vasculitis occurring after the placement of permanent tattoos., History and Signs: A 21-year-old male was referred to our department with impairment of visual acuity. Permanent tattoos covered the head, body, arms and legs. The patient was examined with ophthalmoscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography. Systemic medical and laboratory work-up were performed in order to exclude an infectious agent or an inflammatory disease. He had no history of intravenous drug abuse., Therapy and Outcome: Our patient presented severe posterior uveitis associated with retinal vasculitis and cystoid macular edema. Laboratory tests ruled out all diseases causing vasculitis. HIV and B, C hepatitis tests were negative. Cystoid macular edema and vasculitis were resolved after immunosuppressive therapy., Conclusions: This is the first description of a retinal vasculitis associated with cystoid macular edema in a completely healthy individual after the placement of permanent tattoos. A phagocytosis of tattoo pigments leading to their lysis is described in the literature as a mechanism causing vasculitis.

Background: Cataract remains a challenge for ophthalmologists in uveitic eyes. The aim of this study is to report the clinical course of phacoemulsification with intraocular lens implantation in eyes suffering from uveitis., Patients and Methods: Patients presenting a uveitis were prospectively followed from June 2001 to June 2003. Ocular surgery was performed according to a standard protocol, autoimmune follow-up visits were focused on the early detection of complications of uveitis: increased ocular inflammation, synechiae, retraction of the rhexis, opacification of the posterior capsule or onset of cystoid macular edema., Results: Thirty-two eyes of 24 patients suffering from uveitis were operated with cataract surgery between June 2001 and June 2003. The mean age at surgery was 56 years (range 24 - 86 years). Mean preoperative visual acuity in uveitis patients presenting cataract was 0.3 +/- 0.3, and final visual acuity was 0.8 +/- 0.3. Three patients presented minor postoperative complications. One patient had a cystoid macular edema that appeared 5 months after surgery and one patient had a relapse of herpetic dendritic keratopathy despite topical antiviral therapy combined with steroid drops. The latter presented a slight increase of intraocular pressure (24 mm Hg)., Conclusions: In patients with uveitis requiring cataract surgery, intraocular lens implantation is safe. Visual prognosis is better when pre- and postoperative inflammation is minimized. Macular scars or other retinal lesions are poor prognostic indicators.

Purpose: To study the prevalence, the clinical features, and the visual prognosis without treatment of polypoidal choroidal vasculopathy (PCV) in a large series of Greek patients presenting with exudative maculopathy., Methods: The medical records, photographs,as well as fluorescein and indocyanine green(ICG) angiograms of a series of 268 consecutive elderly white Greek patients, who were originally diagnosed as having exudative age-related macular degeneration (AMD) were reviewed retrospectively., Results: In all, 22 of the 268 (8.2%) patients initially suspected of having AMD were ultimately diagnosed with PCV. In 15 of the 22(68.2%) patients with PCV, the polypoidal lesions were located in the peripapillary area. Large soft drusen were present in only two fellow eyes of the 10 (20%) patients with unilateral PCV compared with 120 fellow eyes of the 148 (81.1%) patients with unilateral AMD. At the last examination, 11 of the 22(50%) patients with PCV and 120 of the 246(48.8%) patients with AMD presented a visual acuity of less than 6/60 in at least one eye due to scar formation in the macula., Conclusions: PCV is not an infrequent disease in Greece. A measurable number of Greek patients with findings suggestive of exudative AMD will instead have PCV. ICG angiography is important in differentiating between these two clinical entities. In Greeks, polypoidal lesions are predominantly peripapillary and are not usually associated with macular drusen in the fellow eye. PCV and exudative AMD do not differ significantly in terms of their natural course and visual prognosis in Greek patients.

Purpose: To report the occurrence of a lacquer crack after photodynamic therapy (PDT) of choroidal neovascularization (CNV) in a patient with pathologic myopia., Methods: PDT was performed with verteporfin, which was activated by a diode laser light at 690 nm., Results: The left eye of a 42-year-old woman was treated with PDT because of juxtafoveal CNV caused by pathologic myopia. No lacquer crack was present in the macula on either fluorescein or indocyanine green angiography before treatment. The CNV subsided after treatment. However, a large lacquer crack underlying a subretinal hemorrhage was formatted in the macula of the treated eye soon after PDT., Conclusions: Although the chorioretinal damage produced by PDT is minimal, it is enough to create, directly or indirectly, the basis for the formation of a lacquer crack in an eye with pathologic myopia.

Purpose: To evaluate by multifocal electroretinogram (MF-ERG) macular function before and after photodynamic therapy (PDT) in myopic eyes with choroidal neovascularization (CNV)., Patients and Methods: Ten eyes with classic subfoveal CNV due to pathologic myopia were studied with MF-ERG before and after PDT in order to evaluate the results of PDT with verteporfin. The post-treatment follow-up was 6 months. Visual acuity testing, ophthalmic examinations, fluorescein and indocyanine green angiograms, and MF-ERG recordings were used to evaluate the results of PDT with verteporfin. The post-treatment period was 6 months., Results: Before treatment, the electrical response densities in the foveal and perifoveal areas were apparently decreased in all patients. Six months after treatment, the mean retinal response densities in the same areas were found to be higher than before treatment., Conclusions: MF-ERG evaluates objectively the macular function in myopic eyes with CNV. After successful PDT, the electrical activity of the foveal and parafoveal areas is higher than before treatment. This finding postulates the efficacy of PDT in the treatment of CNV.