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Andreas Katsanos,1–3 Esther Arranz-Marquez,1,4 Rafael Cañones,2 Gorka Lauzirika,1 Isabel Rodríguez-Perez,1 Miguel A Teus1,2 1Clínica Novovisión, Madrid, Spain; 2Department of Ophthalmology, University of Alcala, Alcala de Henares, Spain; 3Department of Ophthalmology, University of Ioannina, Ioannina, Greece; 4Ophthalmology Clinic, Rey Juan Carlos Universitary Hospital, Móstoles, Madrid, Spain Purpose: Based on the assumption that high levels of intraocular pressure (IOP) during femtosecond laser-assisted in situ keratomileusis (FS-LASIK) may compromise the retinal nerve fiber layer (RNFL), newer femtosecond platforms that operate without causing significant IOP elevation have been developed in recent years. However, this assumption has not been adequately tested. The aim of the current study was to evaluate possible changes in RFNL thickness in nonglaucomatous myopic patients undergoing FS-LASIK using the 60 KHz IntraLase® device that significantly elevates the IOP for an appreciable period of time vs an advanced surface ablation technique (laser-assisted subepithelial keratomileusis, LASEK) that does not induce any IOP elevation. Methods: This was a prospective, observational, controlled cohort study. One randomly selected eye of 114 consecutive eligible patients was analyzed. Inclusion criteria were myopia up to -6.00 diopters and astigmatism up to -2.00 diopters. As clinically indicated, 50 patients underwent LASEK and 64 underwent FS-LASIK. The RNFL thickness was determined with a spectral-domain optical coherence tomography device preoperatively and 3 months postoperatively by the same masked observer. Results: There was no significant difference in preoperative refractive error, age, or sex between the groups. Preoperatively, central corneal thickness was significantly lower in the LASEK group (529.1±36.1 vs 562.4±31.6 µm, P=0.001). For the LASEK group, there was no significant difference between preoperative and postoperative RNFL thickness in the studied sectors (superior-temporal, temporal, inferior-temporal, average). For the FS-LASIK group, compared to preoperative RNFL measures, statistically significant thicker postoperative values were found for the average RNFL (mean difference: 0.67 µm, 0.7% increase, P=0.008) and the inferior-temporal sector (mean difference: 0.92 µm, 0.6% increase, P=0.02). Conclusion: LASIK with a femtosecond platform that induces high intraoperative IOP did not cause RNFL thinning. The observed differences between preoperative and postoperative values are below the axial resolution limit of optical coherence tomography devices. Keywords: femtosecond laser, glaucoma, surface ablation, LASEK, photorefractive keratectomy, RNFL

Stavroula C Koukoula,1,2 Andreas Katsanos,2,3 Ioannis K Tentes,4 Georgios Labiris,1,2 Vassilios P Kozobolis1,2 1Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece; 2Eye Institute of Thrace, Alexandroupolis, Greece; 3Ophthalmology Department, University of Ioannina, Ioannina, Greece; 4Department of Biochemistry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece Background: Endothelin-1 (ET-1) is the most potent vasoconstrictor in the body. There are reports in the literature correlating plasma levels of ET-1 and its impact on retrobulbar hemodynamics. This study evaluates aqueous humor levels of ET-1 and retrobulbar hemodynamics in patients with exfoliation syndrome (XFS) and exfoliation glaucoma (XFG). Patients and methods: Patients scheduled for cataract surgery were included. Patients were allocated to non-exfoliation non-glaucoma group (controls), XFG and XFS groups. Peak systolic velocity (PSV), end diastolic velocity, and resistivity index of the ophthalmic artery (OA), short posterior ciliary arteries, and central retinal artery (CRA) were determined preoperatively using color Doppler imaging. Aqueous humor samples obtained at the beginning of cataract surgery were analyzed with enzyme-linked immunosorbent assay. Results: Sixty-nine participants of similar age were included (controls: n=24, XFG: n=22, XFS: n=23). Multiple regression analysis showed that ET-1, OA-PSV, OA-resistivity index, CRA-PSV, and CRA-end diastolic velocity were influenced by group but not by sex or age. ET-1 for the XFG group (15.93±2.8 pg/mL) was significantly higher than for the XFS (8.92±2.7 pg/mL) and control (8.44±2.6 pg/mL) groups. The difference in ET-1 titers between the control and XFS groups was not statistically significant. All four hemodynamic parameters affected by group status significantly correlated with ET-1 levels in eyes with XFS. In eyes with XFG, two of the four hemodynamic parameters significantly correlated with ET-1 levels. In control eyes, no correlation between ET-1 and hemodynamic parameters affected by group status was detected. Conclusion: ET-1 aqueous levels in eyes with XFG were significantly higher than those of age-matched controls. Reduced blood flow and increased vascular resistivity were detected in the OA and the CRA in eyes with XFG/XFS. ET-1 levels in eyes with XFG/XFS exhibit a significant correlation with hemodynamic parameters that indicate reduced perfusion. Keywords: pseudoexfoliation, exfoliative glaucoma, color Doppler imaging

Konstantina Gorgoli,1 Konstantinos Benekos,1 Andreas Katsanos2 1Iris & Retina Private Practice, Ioannina, Greece; 2Ophthalmology Department, University of Ioannina, Ioannina, GreeceCorrespondence: Andreas KatsanosOphthalmology Department, University of Ioannina, Stavros Niarchos Avenue, Ioannina 45500, GreeceTel +302651099705Email katsanos@uoi.gr The use of properly worn face masks by patients during slit-lamp examinations has become imperative during the COVID-19 pandemic. Unfortunately, vapor escaping from the top of a patient’s mask can form condensation on the cool surface of handheld examination lenses. This can make critical ophthalmic examinations such as funduscopy or gonioscopy very challenging. Pressing the patient’s top of the maskagainst the dorsum of the nose or the cheekbones ensures that vapor exhaled by the patient is directed away from the lens, thus avoiding lens fogging. However, touching the patient’s mask carries the risk of contamination. In this article, we offer alternatives to tackle the problem of hand-held examination lens fogging due to face masks, while avoiding the risk of SARS-CoV-2 contamination. View the original paper by Pérez González and colleagues

Georgios Labiris,1,2 Panagiota Ntonti,2 Konstantinos Ntitsos,2 Andreas Katsanos,2 Haris Sideroudi,2 Vasilios Kozobolis1,2 1Department of Ophthalmology, University Hospital of Alexandroupolis, 2Eye Institute of Thrace, Alexandroupolis, Greece Background: The primary objective of this study was to investigate the level of agreement between IOL-Master and OB-820 ocular biometers.Materials and methods: In this prospective randomized case series, we measured the anterior chamber depth (ACD), the axial length (AL), the corneal radii (R1, R2), the ratio of mean corneal radius and spherical equivalent and the corneal astigmatism (cylinder [Cyl]) before and after cataract extraction surgery.Results: Significant differences between pre- and postoperative data were observed for ACD for both biometric devices (P

Abstract Background Recent evidence suggests that diabetes-related lower-extremity complications (DRLECs) may be associated with cognitive changes in people with diabetes. However, existing literature has produced inconsistent findings, and no systematic reviews have been conducted to investigate whether DRLECs impact the cognition of people with diabetes. This systematic review evaluated existing studies that investigated cognition in people with diabetes with DRLECs and without DRLECs. Method Seven databases; MEDLINE, PubMed, CINAHL, EMBASE, Cochrane, PsycINFO and Web of Science were searched from inception until 22/8/2022 for studies that compared cognition in people with diabetes with and without DRLECs. Results were independently screened for eligibility and assessed for methodological quality by two authors, with key data extracted. Studies were eligible for meta-analysis if the studies reported similar cases, controls, and outcome measures. Results Thirteen studies were included in the review, with eleven of medium methodological quality, one of high quality, and one of low quality. Four studies found significant differences in cognition between those with and without DRLECs, four found significant associations between diabetes-related lower-extremity complications and cognition, and five found no differences or associations. One small meta-analysis of eligible studies found that there was no statistically significant difference in cognition in people without, compared to with, peripheral neuropathy (Mean difference = -0.49; 95%CI: -1.59–0.61; N = 3; n = 215). Leave-one-out sensitivity analyses further confirmed that there was no significant difference in cognition among people with and without peripheral neuropathy (p > 0.05). Conclusion DRLECs may be related to cognition in people with diabetes, however, existing evidence is unclear due to variability in used methodologies that may challenge concluding the findings. Future high-quality studies investigating cognition among people with and without DRLECs are needed.

Gábor Holló,1 Andreas Katsanos,2 Anastasios GP Konstas3 1Department of Ophthalmology, Semmelweis University, Budapest, Hungary; 2Department of Ophthalmology, University of Ioannina, Ioannina, 3First and Third Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece Abstract: Exfoliative glaucoma is the most common type of secondary open-angle glaucoma worldwide. It is characterized by high intraocular pressure (IOP) and worse 24-hour IOP characteristics. In order to minimize progression, treatment of exfoliative glaucoma has to provide a low long-term mean IOP and good 24-hour IOP control. To achieve these goals, fixed-dose combination eye drops, argon and selective laser trabeculoplasty, and various forms of surgery (trabeculectomy, deep sclerectomy, viscocanalostomy, ab interno trabeculotomy, trabecular aspiration, and cataract surgery) all need to be considered during the long-term management of the disease. Since exfoliative glaucoma is a disease of the elderly, and is frequently associated with systemic vascular disease, interdisciplinary consultations are of great clinical importance. These management aspects and the current medical, laser, and surgical results are covered in this review, with a special focus on the needs of the general ophthalmologist. Keywords: exfoliative glaucoma, pseudoexfoliative glaucoma, medication, laser trabeculoplasty, deep sclerectomy, viscocanalostomy, trabeculectomy

Luciano Quaranta,1,* Ivano Riva,1,* Andreas Katsanos,2 Irene Floriani,3 Marco Centofanti,4,† Anastasios G P Konstas51Centre for the Study of Glaucoma, University of Brescia, Brescia, Italy; 2Ophthalmology Department, University of Ioannina, Ioannina, Greece; 3Laboratory of Clinical Research, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; 4DSCMT, University of Tor Vergata, Rome, Italy; 5Glaucoma Unit, 1st University Department of Ophthalmology, AHEPA Hospital, Thessaloniki, Greece*These authors contributed equally to this work; †Dr Centofanti passed away on 1 March 2015Abstract: Travoprost is a prostaglandin analogue widely used for reducing intraocular pressure (IOP) in patients affected with glaucoma and ocular hypertension. It exerts its ocular hypotensive effect through the prostaglandin FP receptors, located in the ciliary muscle and the trabecular meshwork. Several studies have shown that topical administration of travoprost induces a mean IOP reduction ranging from 25% to 32%, and sustained throughout the 24-hour cycle. When compared with timolol, travoprost is more effective at reducing IOP, while generally no difference has been found in the head-to-head comparison with other prostaglandin analogues. The fixed combination of travoprost and timolol has demonstrated a hypotensive efficacy comparable to the concomitant administration of the two drugs. Recently, a new preservative-free formulation of travoprost 0.004% has been marketed for reducing tolerability-related problems in subjects affected with ocular surface disease. Low rates of topical and systemic adverse reactions, strong ocular hypotensive efficacy, and once-a-day dosing make travoprost a first-line treatment for patients affected with elevated IOP.Keywords: prostaglandin analogue, glaucoma, ocular hypertension

Aims: To highlight possible correlations of type 2 diabetes mellitus (T2DM) with microscopic / macroscopic characteristics of colorectal cancer tissues, along with the expression of Ten-Eleven Translocation 2 (TET2) and glutathione-S-transferase pi (GST-pi) proteins. Materials and methods: Tumors from 46 patients were embedded in paraffin blocks, stained with hematoxylin-eosin and studied microscopically. Immunohistochemical study of TET2 and GST-pi expression was performed. The results were analyzed and correlated with T2DM as comorbidity. Results: All tumors expressed GST-pi at three levels (weak, moderate, and strong); two out of three tumors showed either weak or moderate TET2 expression. Patients without T2DM tended to have tumors with weak or no expression of TET2 (p=0.038) whereas diabetic patients’ tumors showed a significantly higher percentage of strong or moderate GST-pi expression (p=0.034). On binomial logistic regression, tumors excised from T2DM patients were 6.9 times more likely to show moderate (rather than weak and none) TET2 expression compared to tumors from non-diabetic patients (95% CI [1.33, 35.75]), and a 2.7-fold higher relative likelihood of showing strong (rather than moderate and weak) GST-pi expression (95% CI [0.63, 12.09]), taking into account sex, age, and tumor size. The association between T2DM and TET2 expression remains statistically significant in additional binomial analysis that was performed taking into account certain histological tumor characteristics. Conclusions: TET2 and GST-pi are expressed in malignant colon tumors. T2DM in CRC patients was associated with the highest observed GST-pi expression; absence of T2DM was associated with the lowest observed TET2 expression. T2DM increases the probability of observing GST-pi and TET2 expression at maximum levels, independent of specific tumor microscopic features and certain patient characteristics.

Background: Among the currently approved antiobesity medications, the glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) liraglutide and semaglutide, and the dual glucose-dependent-insulinotropic-polypeptide (GIP)/GLP-1 RA tirzepatide have been suggested to reduce cardiovascular-risk in overweight or obesity without diabetes. Objectives: The objective of this study was to evaluate the cardio- and neuroprotective potential of these novel agents in the nondiabetic overweight/obese adult population. Data sources and methods: A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate the risk of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality in overweight or obese adults without diabetes treated with GLP-1 or GIP/GLP-1 RAs (vs placebo). Secondary outcomes included the risk of myocardial infarction (MI) and stroke. Results: Sixteen RCTs (13 and 3 on GLP-1 RAs and tirzepatide, respectively) comprising 28,168 participants were included. GLP-1 or GIP/GLP-1 RAs reduced MACE (odds ratio (OR): 0.79; 95% confidence interval (CI): 0.71–0.89; p

Since the end of the 20th century and the establishment of minimally invasive techniques, they have become the preferred operative method by many surgeons. These techniques were applied to liver surgery for the first time in 1991, while as far as transplantation is concerned their application was limited to the living donor procedure. We performed a review of the literature by searching in Pubmed and Scopus using the following keywords: Liver transplantation, Minimally invasive surgery(MIS) living liver donor surgery. Applications of MIS are recorded in surgeries involving the donor and the recipient. Regarding the recipient surgeries, the reports are limited to 25 patients, including combinations of laparoscopic, robotic and open techniques, while in the living donor surgery, the reports are much more numerous and with larger series of patients. Shorter hospitalization times and less blood loss are recorded, especially in centers with experience in a large number of cases. Regarding the living donor surgery, MIS follows the same principles as a conventional hepatectomy and is already the method of choice in many specialized centers. Regarding the recipient surgery, significant questions arise mainly concerning the safe handling of the liver graft.

Intracranial aneurysms represent a major global health burden. Rupture of an intracranial aneurysm is a catastrophic event. Without access to treatment, the fatality rate is 50% in the first 30 days. Over the last three decades, treatment approaches for intracranial aneurysms have changed dramatically. There have been improvements in the medical management of aneurysmal subarachnoid haemorrhage, and there has been an evolution of treatment strategies. Endovascular therapy is now the mainstay of the treatment of ruptured intracranial aneurysms based on robust randomised controlled trial data. There is now an expansion of treatment indications for unruptured intracranial aneurysms to prevent rupture with both microsurgical clipping and endovascular treatment. Both microsurgical and endovascular treatment modalities have evolved, in particular with the introduction of innovative endovascular treatment options including flow diversion and intra-saccular flow disruption. These novel therapies allow clinicians to treat more complex and previously untreatable aneurysms. We aim to review the evolution of treatment strategies for intracranial aneurysms over time, and discuss emerging technologies that could further improve treatment safety and functional outcomes for patients with an intracranial aneurysm.

Mediterranean tropical-like cyclones, or Medicanes, present unique challenges for precipitation estimations due to their rapid development and localized impacts. This study evaluates the performance of satellite precipitation products in capturing the precipitation associated with Medicane Daniel that struck Greece in early September 2023. Utilizing a combination of ground-based observations, reanalysis, and satellite-derived precipitation data, we assess the accuracy and spatial distribution of the satellite precipitation products GPM IMERG, GSMaP, and CMOPRH during the cyclone event, which formed in the Eastern Mediterranean from 4 to 7 September 2023, hitting with unprecedented, enormous amounts of rainfall, especially in the region of Thessaly in central Greece. The results indicate that, while satellite precipitation products demonstrate overall skill in capturing the broad-scale precipitation patterns associated with Medicane Daniel, discrepancies exist in estimating localized intense rainfall rates, particularly in convective cells within the cyclone’s core. Indeed, most of the satellite precipitation products studied in this work showed a misplacement of the highest amounts of associated rainfall, a significant underestimation of the event, and large unbiased root mean square error in the areas of heavy precipitation. The total precipitation field from IMERG Late Run and CMORPH showed the smallest bias (but significant) and good temporal correlation against rain gauges and ERA5-Land reanalysis data as a reference, while IMERG Final Run and GSMaP showed the largest underestimation and overestimation, respectively. Further investigation is needed to improve the representation of extreme precipitation events associated with tropical-like cyclones in satellite precipitation products.

The current era of (e-)learning invests heavily on Massive Open Online Courses (MOOCs). Various dedicated MOOC platforms are used, such as Coursera, Udacity, and Open edX. Moodle, one of the most popular open-source Learning Management Systems (LMS), has been also used for MOOC implementations. Usability and user experience (UX) are very important for e-learning software. This paper presents an in-depth comparative UX evaluation of two platforms used for MOOC implementations: Open edX and Moodle. The reported evaluation study combines user interaction metrics and wearable biosensors. Participants performed four typical interaction tasks in both platforms. User performance data (task success, time on task), self-reported data (SUS, AttrakDiff), and stress-related physiological data (skin conductance, heart rate) were collected and analyzed. It was found that Open edX performs better than Moodle in almost every UX aspect we examined. However, the reported results do not imply that building and delivering a MOOC via Moodle is prohibitive. The choice of the platform to be used by an institution is affected by several factors of non-technological nature, such as students' familiarity with an e-learning platform, available financial and human resources, as well as delivery deadlines.

Paradoxical embolism through the foramen ovale is a rare and devastating event requiring urgent treatment. Herein, we present the case of a 23-year-old male who presented with a pulmonary embolism complicated by a left renal artery paradoxical embolism. Urgent vacuum-assisted thrombo-aspiration restored normal perfusion of the left kidney within 5 hours. The patient had a patent foramen ovale and heterozygous thrombophilia. However, a radioisotopic scan performed 2 years later revealed an unexpected decrease in left renal perfusion. Therefore, despite the angiographic success, functional evaluation using a renal scan should be performed to assess renal function.

Background Women are underrepresented in stroke thrombectomy trials, and the impact of sex differences in outcomes after stroke thrombectomy is unclear. We performed a multicenter propensity matching study to define sex‐related differences in outcome after endovascular thrombectomy and integrated results in a meta‐analysis. Methods We included patients with anterior circulation large vessel occlusion consecutively treated with thrombectomy at 2 Comprehensive Stroke Centres (2016–2023). Selection criteria reflected international guidelines. Through systematic review we selected all studies reporting endovascular thrombectomy outcomes in anterior circulation large vessel occlusion stroke, applying propensity score matching. MEDLINE, EMBASE, and Cochrane CENTRAL were searched up to August 15, 2023 according to predefined protocol (OSF.io/je3da). Data were extracted by 2 independent raters, pooled estimates calculated according to random‐effect modeling meta‐analysis and reported as odds ratio (OR) and standard 95% CI. Outcomes were good functional outcome, defined as modified Rankin Scale score 0–2 at 90 days after stroke, and symptomatic intracranial hemorrhage, adjudicated according to European Cooperative Acute Stroke Study II criteria. Results After matching, 698 patients (349 women versus 349 men) had similar cardiovascular risk factors, baseline features, and treatment approach. No significant differences were found for good functional outcome (OR = 0.89, 95% CI = 0.66–1.2) and symptomatic intracranial hemorrhage (OR = 1.00, 95% CI = 0.44–2.26) in the cohort study by sex. Systematic review identified 3 studies (n = 3706), all of high quality. No differences emerged in rates of good functional outcome (OR = 1.00, 95% CI = 0.79–1.21) or symptomatic intracranial hemorrhage (OR = 0.85, 95% CI = 0.60–1.19) depending on sex. Conclusion Women receiving endovascular thrombectomy for anterior circulation large vessel occlusion related stroke have similar rates of good functional outcome and symptomatic intracranial hemorrhage compared to men.