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Background: Aromatase inhibitor therapy is currently the preferred choice in postmenopausal women with estrogen receptor positive breast cancer. This article reviews the ocular side effects of treatment with aromatase inhibitors (AIs) in patients with breast cancer. Materials and Methods: A comprehensive search was performed on PubMed, Web of Science and Google scholar. Results: After duplication removal, 14 clinical studies and 5 case reports, published between 2008 and 2021, were identified. Most frequently, AI treatment resulted in minor to moderate dry eye symptoms. “De novo” onset of Sjogren syndrome during AI therapy was also reported. Retinal and optic nerve side effects varied from mild, subclinical anatomic and functional impairment to severe decreased vision, secondary to hemi-central retinal artery occlusion, bilateral optic neuritis or uveitis with bilateral macular edema. Conclusion: Visual disturbances encountered during AI treatment may be underestimated. Ophthalmic screening is important for early detection and appropriate treatment.

This review discusses the evidence on diabetic retinopathy (DR) in patients with diabetic foot ulceration (DFU). A systematic literature review was performed on PubMed, Medline, Springer Nature, and Scopus, following the PRISMA guidelines, using the following terms, individually or in combination: “diabetic foot ulcer” OR “diabetic foot syndrome” OR “DFU” and “diabetic retinopathy.” The initial search yielded 648 articles published between 1975 and 2020. After applying exclusion and inclusion criteria, a total of 9 articles were analyzed, assessing the correlations between DR and DFU. In all cases, DR and especially proliferative diabetic retinopathy were significantly higher in the presence of DFU, though the frequency of DR showed large variability (22.5% to 95.6%). There was a significant correlation between advanced stages of DFU and increased frequency of DR and proliferative diabetic retinopathy. On the other hand, there is a risk of accelerated progression of DR in nonhealing DFUs, possibly related to chronic inflammation and associated infection. Hence, patients with DFUs should be monitored by an ophthalmologist, and those with DR should be promptly referred to a specialized diabetic foot clinic.

Diabetic retinopathy (DR) is a microvascular disorder occurring due to the long-term effects of diabetes, leading to vision-threatening damage to the retina. The human body has an elaborate system for managing and regulating the number of key trace metals circulating in the blood and stored cells. Inadequate zinc (Zn) and concurrent excess of copper (Cu) levels are associated with an increased level of oxidative stress, which may aggravate the microvascular lesions in diabetes mellitus. Several studies have revealed a significantly lower serum Zn concentration and increased Cu levels in DR when compared with diabetic patients without retinopathy and normal controls. These abnormalities are correlated with the duration of diabetes and higher levels of HbA1C. Multiple pathological mechanisms are proposed to explain these changes including hyperzincuria associated with polyuria, glycosuria, and proteinuria in diabetic patients, as well as impaired absorption of Zn at the gastrointestinal level. Increased levels of free Cu ions may be attributed to glycation and the release of Cu ions from the Cu-binding sites of proteins. Zn supplements and selective Cu chelators may be useful to alleviate oxidative stress and prevent DR progression.

Objective. This study followed the variability in the foveal avascular zone (FAZ) area measured using optical coherence tomography angiography (OCTA) in patients with type 2 diabetes mellitus and high blood pressure. Material and Methods. This prospective, non-randomized, cohort study evaluated 46 eyes in 26 patients with high blood pressure associated with diabetic non-proliferative retinopathy (mild, medium, and severe forms) and diabetic proliferative retinopathy. Results. Our results showed early macular alterations (microaneurysms, leakage, neovascularizations, intraretinal microvascular abnormalities), a higher class of severity despite a relatively normal clinical aspect and higher values of FAZ associated with neovascularization undetected by SD-OCT (spectral domain-OCT). Conclusion. Measurement of the foveal avascular zone area using OCTA early detects macular alterations that precede classical retinography and SD-OCT determinations. Abbreviations: FAZ = foveal avascular zone; OCTA = optical coherence tomography angiography; IRMA = intraretinal microvascular abnormalities; SD-OCT = spectral domain-optical coherence tomography; OU = both eyes; PD = papillary diameter; ETDRS = early treatment diabetic retinopathy study; BP = blood pressure; OD = right eye.

Diabetic retinopathy and diabetic foot ulcer are the most frequent, but also the most disabling complications of diabetes mellitus, with a sinister impact on patients’ quality of life. Microvascular changes related to the deleterious effect of chronic hyperglycemia play an important role in the pathophysiology of both clinical entities by multiple molecular pathways. Vision-threating diabetic retinopathy may be treated by laser photocoagulation, anti-vascular endothelial growth factor (VEGF) agents and vitreoretinal surgery. Diabetic foot lesions are best treated by revascularization if needed, off-loading, infection control and therapeutic adjuncts (e.g. special dressings). Treatment should ideally be offered by a multidisciplinary expert team. Prevention and early detection, along with adequate control of glucose, lipids and arterial hypertension are of paramount importance to avoid and mitigate these fearful complications.

Bariatric surgery is an emerging therapeutic approach for obese type 2 diabetes mellitus (T2DM) patients, with proven benefits for achieving target glucose control and even remission of diabetes. However, the effect of bariatric surgery upon diabetic retinopathy is still a subject of debate as some studies show a positive effect while others raise concerns about potential early worsening effects. We performed a systematic review, on PubMed, Science Direct, and Web of Science databases regarding the onset and progression of diabetic retinopathy in obese T2DM patients who underwent weight-loss surgical procedures. A total of 6375 T2DM patients were analyzed. Most cases remained stable after bariatric surgery (89.6%). New onset of diabetic retinopathy (DR) was documented in 290 out of 5972 patients (4.8%). In cases with DR at baseline, progression was documented in 50 out of 403 (12.4%) and regression in 90 (22.3%). Preoperative careful preparation of hemoglobin A1c (HbA1c), blood pressure, and lipidemia should be provided to minimize the expectation of DR worsening. Ophthalmologic follow-up should be continued regularly in the postoperative period even in the case of diabetic remission. Further randomized trials are needed to better understand the organ-specific risk factors for progression and provide personalized counseling for T2DM patients planned for bariatric surgery.

Glaucoma, one of the significant causes of blindness worldwide, is a chronic optic neuropathy, characterized by progressive loss of retinal ganglion cells and specific perimetric defects. This study aimed to assess the association between the risk of glaucoma progression and different systemic vascular abnormalities. A 4-year prospective study was carried out on 204 patients diagnosed with open-angle glaucoma. Associated systemic vascular pathology was documented in 102 cases. Progression was encountered in 57 (55.9%) patients with vascular comorbidities and only in 10 (9.8%) patients with no associated vascular diseases (OR 13.81, P

Objective. This study aimed to determine the possible relationship between variability of diabetic macular edema associated with hypertension retinopathy in patients with type 2 diabetes mellitus and essential high blood pressure, in correlation with contrast sensitivity. Material and Methods. In order to accomplish the objective, this retrospective study evaluated the progression of diabetic macular edema in patients with high blood pressure during day time through measurements of the total macular volume and central macular thickness using optical coherence tomography and contrast sensitivity variations measured through Pelli Robson test, four times a day, along with glycemia and blood pressure measurements. Results. Our results showed a statistically significant correlation between the values of glycemia and central macular thickness, and between contrast sensitivity and macular thickness at every tested hour. Conclusions. The study revealed many statistically significant correlations involving blood pressure, blood glucose levels, Pelli Robson test and central macular thickness. Abbreviations: OCT = optical coherence tomography; DME = diabetic macula edema; SD-OCT = spectral domain optical coherence tomography; LOCS = lens opacities classification system; LE = left eye; ANOVA = analysis of variance.

Diabetic retinopathy is a well-known complication of diabetes, a major cause of vision loss worldwide. Purpose. The present study investigates the correlation between hypertension and evolution of diabetic retinopathy in patients with type II diabetes. Materials and methods. We conducted a prospective study between June and December 2016, on 24 patients hospitalized in Ophthalmology Clinic, Emergency University Hospital Bucharest, with AO: diabetic retinopathy and arterial hypertension under medical treatment. Patients were evaluated at baseline, 2 months, 4 months and 6 months through comprehensive eye examination and measuring the value of blood pressure (BP). Comparative data were analyzed in patients with compensated hypertension (BP = 150 mmHg). Results. Of the 24 patients, 15 had values offset BP (group A) and 9 associated hypertension subcompensated (group B). In group A proportion of patients (at baseline) with diabetic retinopathy absent or nonproliferative was higher than patients in group B (47% vs. 22%, p = 0.052995019518117). Patients in group B had a higher tendency to record an evolution of diabetic retinopathy (in group B, 55.55% of patients had a progression, and in group A, only 26.66%). Conclusions. Incomplete therapeutic control of hypertension may affect the retinal microvasculature impacting the progression of diabetic retinopathy. Maintaining a strict control of systolic BP of permanent value bellow 140 mmHg should be part of the patient management guide of the diabetic patient in order to prevent ophthalmic complications with major risk of vision loss.

Purpose Maintaining intraocular pressure in range of target values interval is one of the desiderates of antiglaucoma surgery. Intraocular pressure (IOP) variations occur after trabeculectomy or phacotrabeculectomy. The aim of our study is to provide data regarding the magnitude of these variations during one year following the surgical interventions mentioned above. Methods This is a study assessing two groups, one comprising of 28 patients that underwent trabeculectomy with 5-fluorouracil and the other comprising of 26 patients that underwent phacotrabeculectomy with 5-fluorouracil. All patients had surgery for uncontrolled primary open angle glaucoma. The IOP was monitored using Goldmann aplanotonometry 1 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperative. Results The difference between the mean IOP after 1 year and the preoperative IOP was statistically significant in both groups (9.41 +/-4,32 mmHg, 42% reduction in trabeculectomy group, p value 4.45x10-19 and 8.03+/-5,17 mmHg, 34% reduction in phacotrabeculectomy group, p value 1.46x10-9) and the mean IOP was significantly reduced at all time points in both groups. Conclusion IOP was statistically significant reduced after surgery in both groups. The maximal variation occurred after phacotrabeculectomy, with the highest magnitude in the first 6 months after surgery. In the following 6 months, IOP did not change statistically significant after either phacotrabeculectomy or trabeculectomy.

to quantify the inter-test variability (dB) for the Optopol PTS automated perimeter, Glaucoma Fast threshold program.A prospective study was performed on 166 glaucomatous patients and a control group of 30 normal subjects, tested by complete ophthalmological exam and automated perimetry (Optopol PTS-910). The visual field was tested weekly for 4 consecutive weeks. The visual field defects were classified according to the Aulhorn-Karmeyer descriptive scale.For the control group, the medium inter-test variability was of 1.57 +/- 0.24 dB, lower next to fixation and increasing towards the 50 degree isopter. The medium inter-test variability increases along with the perimetric stage :1.57 +/- 0.66 dB for pre-perimetric glaucoma, 2.13 + 1.04 dB for non-specific defects group, 3.23 + 1.01 dB for the stage 1, 3.52 + 2.61 dB, for the stage 2, 3.65 + 1.19dB for the stage 3 and 5.82 +/- 1.67dB for the stage 4. For the cases of preperimetric glaucoma and non-specific defects, a similar profile of variability to the normal subjects can be observed. For the stages 2-4, the profile of the areas with maxim inter-test variability moves towards the relative scotoma and the surrounding area.A better description of the inter-test variability and the evolution of this intricate parameter of the retinal light sensitivity is useful for the differential diagnostic between the real change and the "background noise" in early detection of the functional progression in glaucoma.

Purpose To present the clinical case of a patient with a giant pituitary adenoma that was misdiagnosed for several years and treated as a progressive NTG (Normal Tension Glaucoma). Methods A 57 years old male had his first ocular examination in December 2008 and was diagnosed with NTG and started on topical treatment. The patient was declared unable to perform automated perimetry, so he was referred for Goldmann perimetry. He had several ocular exams over a period of four years, during which the treatment was gradually increased to maximal topical therapy, but the patient still developed a progressive impairment of the visual acuity, visual field and fundus aspect. Results The patient was referred to our clinic in August 2012 for surgical management of his bilateral severe progressive glaucoma. During the hospital admittance, we performed automated perimetry that showed hemianopsia; he was referred afterwards for cerebral MRI and diagnosed with giant extensive pituitary adenoma. The patient had surgery, but he continued to lose visual acuity and optic atrophy installed at both eyes. Conclusion NTG should remain an exclusion diagnosis (after excluding a chiasm compression as well).

Purpose To quantify the inter-test variability (dB) for the Optopol automated perimeter, Glaucoma Fast Treshold program, in normals and glaucoma patients. Methods A prospective study was performed on 204 glaucoma patients and a control group of 30 normal subjects, tested by complete ophthalmological exam and automated perimetry (Optopol PTS-910). The visual field was tested weekly for 4 consecutive weeks, using the Glaucoma Fast Threshold strategy. The visual field defects were classified according to the Aulhorn-Karmeyer descriptive scale. Results For the control group, the average inter-test variability was of 1.57+/- 0.24 dB, lower next to fixation and increasing towards the 50 degree isopter. The average inter-test variability increases along with the perimetric stage: 1.57+/-0.66 dB for pre-perimetric glaucoma, 2.13+1.04 dB for non-specific defects group, 3.23 + 1.01dB for the stage 1, 3.52 + 2.61dB, for the stage 2, 3.65 + 1.19dB for the stage 3 and 5.82 +/- 1.67dB for the stage 4. For the cases of preperimetric glaucoma and non-specific defects, a similar profile of variability as for the normal subjects could be observed. For the stages 2-4, the profile of the areas with maxim inter-test variability moves towards the relative scotoma and the surrounding area. Conclusion A better description of the inter-test variability and the evolution of this intricate parameter of the retinal light sensitivity is useful for the differential diagnostic between the real change and the « background noise » in early detection of the functional progression in glaucoma.

Purpose To investigate the role of TSD and RH inter-test variability upon the variability of the stereometric parametres. Methods 204 glaucomatous patients underwent regularly complete ophthalmological follow-up for 3 years and HRT3 exam (yearly). The exclusion criteria were optic disc or retinal pathology that might interfere with the detection of glaucoma progression, TSD >30μm and progression of glaucomatous defect on optic disc photography or TCA. Results TSD inter-test variability 0.05, for C/D Area Ratio, r=-0.13, p=0.22, for RNFL Thickness r=0.06, p=0.52). Conclusion At TSD 25μm, the variability of the RH is a major factor determining test/retest variability for RNFL Thickness, Rim Area, C/D Area, Rim Volume and Linear C/D. Inter-test variability of RH

The study investigates the correlations between structure and function in early detection of glaucoma progression.A prospective study was carried on 204 patients diagnosed with POAG and a follow-up period of 4 years. All the patients underwent complex ophthalmological examination, C/D ratio, Disk Damage Likelyhood Scale (DDLS), automated perimetry and Heidelberg retina tomographyThe relations between structure and function were investigated for all patients, but also according to clinical stage of glaucomatous damage. Structural progression was more frequently associated with perimetric progression for patients with moderate advanced glaucoma. For patients with preperimetric glaucoma and early glaucoma, the progression was present more often for structural test (19,04% and 29,3%), while perimetric progression was less frequent objectivated and weak correlated with structural progression (16,66%). For the 15 cases diagosed with both structural and functional progression, the locations of the structural lesion and functional defect were better correlated in cases involving the poles of the optic disc.Structure-function relation depends on clinical stage of glaucoma and the location of the glaucomatous defects. In early stages, structural investigations can detect progression before perimetry, while in advanced stages, the functional tests are more useful for early detection of progression.

Antiphospholipid syndrome (APS) is a disorder characterised by recurrent arterial or venous thrombosis and/or pregnancy losses, in the presence of persistently elevated levels of anticardiolipin antibodies and/or evidence of circulating lupus anticoagulant (these abnormalities are detected by blood tests). Primary APS occurs when there is no evidence of associated diseases. APS in the presence of an underlying disease, usually systemic lupus erythematosus, is called secondary APS.

The aesthetic appearance after the treatment of orbito-sinusal tumors can sometimes be dramatic. In this study we compared exenteration versus conservative procedures (survival rate, Visual Quality of Life (QoL) and Social QoL. Findings: 23 patients underwent exenteration and 43 conservative surgery. The probability for surviving was almost equal at 2 and 5 years and. the social QoL was also similar (p>0.202). The visual QoL was significantly lower in the patients that underwent exenteration surgery (p Conclusions QoL aspects should be considered when choosing treatment for orbito-sinusal tumors.