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Contains fulltext : 290816.pdf (Publisher’s version ) (Open Access) PURPOSE: To assess the visual outcome of cataract surgery in patients with retinitis pigmentosa (RP). DESIGN: Retrospective, noncomparative clinical study. METHODS: Preoperative, intraoperative, and postoperative data of patients with RP who were undergoing cataract surgery were collected from several expertise centers across Europe. RESULTS: In total, 295 eyes of 226 patients were included in the study. The mean age at surgery of the first eye was 56.1 ± 17.9 years. Following surgery, best-corrected visual acuity (BCVA) improved significantly from 1.03 to 0.81 logMAR (ie, 20/214 to 20/129 Snellen) in the first treated eye (-0.22 logMAR; 95% CI = -0.31 to -0.13; P < .001) and from 0.80 to 0.56 logMAR (ie, 20/126 to 20/73 Snellen) in the second treated eye (-0.24 logMAR; 95% CI = -0.32 to -0.15; P < .001). Marked BCVA improvements (postoperative change in BCVA of ≥0.3 logMAR) were observed in 87 of 226 patients (39%). Greater odds for marked visual improvements were observed in patients with moderate visual impairment or worse. The most common complications were zonular dialysis (n = 15; 5%) and (exacerbation of) cystoid macular edema (n = 14; 5%), respectively. Postoperative posterior capsular opacifications were present in 111 of 295 eyes (38%). CONCLUSION: Significant improvements in BCVA are observed in most patients with RP following cataract surgery. Baseline BCVA is a predictor of visual outcome. Preoperative evaluation should include the assessment of potential zonular insufficiency and the presence of CME, as they are relatively common and may increase the risk of complications. 01 februari 2023

To review most recent studies and clinical trials regarding pathogenesis, treatment, and prevention of inflammation after the cataract surgery.FLACS gave opportunity to evaluate inflammatory cytokines in the aqueous humour right after the laser procedure, which led to acknowledging the inflammation pathogenesis during the phacoemulsification. Although there is still a lack of evidence, which would prove the long-term benefit of NSAIDs, they are indicated and effective when risk factors for PCME are present. PREMED studies showed that combination of NSAID and steroids after the surgery for healthy subjects is cost-effective. The triamcinolone injection together with topical steroids and NSAIDs for diabetic patients after the cataract surgery was the most cost-effective in preventing PCME according to the PREMED. Dropless cataract surgery is another emerging topic: dexamethasone implants and suspensions look promising as we await more clinical trials with drug-loaded IOLs.Inflammation after the cataract surgery can be prevented, and these methods are one of the most essential topics with growing phacoemulsification rate. Topical NSAIDs are cost-effective not only for patients with risk factors for PCME but also for healthy subjects. New dropless techniques are being successfully introduced in the clinical practice.

Myopia is the most common ocular disorder worldwide with an increasing prevalence over the past few decades. It is a refractive error associated with excessive growth of the eyeball. Individuals with myopia, especially high myopia, are prone to develop sight-threatening complications. Currently, atropine is the only drug that is used to slow myopia progression in clinical practice. However, there are still areas of uncertainty such as treatment strategy, optimal concentration when considering risk–benefit ratio and active treatment period. Since the prevalence of myopia is much higher in Asian countries, most of the research on myopia control has been conducted in Asia. Data on the efficacy and tolerability to atropine eye drops in the non-Asian population remains limited. In this review, we summarize the results of published clinical trials on the effectiveness and tolerability of atropine eye drops for myopia control in non-Asian regions. The efficacy was evaluated by the mean change in spherical equivalent (SE) or axial length (AL). The tolerability of atropine eye drops was analyzed based on patients complains and adverse events. The results of this review suggest that 0.01% atropine eye drops are effective in non-Asian regions achieving less side effects compared to 0.5% concentration.

This study evaluated tear film and ocular surface parameters in patients after cataract surgery. Methods: a prospective clinical study included 48 eyes of 48 patients who underwent uncomplicated phacoemulsification performed by one surgeon. Tear break-up time (TBUT), Schirmer’s I test, Cochet–Bonnet esthesiometry and in vivo laser scanning confocal microscopy was carried out and the OSDI questionnaire was filled out. All tests were assessed before and 1 month after the surgery. Results: there were 32 (66.7%) women; 16 (33.3%) men, mean age was 74.08 ± 5.37. Mean TBUT at baseline was 8.6 ± 1.9 s, after the surgery, it was 7.7 ± 2.7 s, p = 0.004. Schirmer’s I test was 8.7 ± 3.9 mm versus 8.1 ± 3.7 mm, p = 0.002. Mean corneal nerve density at baseline was 15.70 ± 2.34 and at the first postoperative month 14.94 ± 1.48 mm/mm2, p = 0.02. The OSDI questionnaire score increased from 12.15 ± 10.34 before the surgery to 13.79 ± 10.88 in the first postoperative month, p = 0.001. Conclusions: the ocular surface was affected 1 month after the cataract surgery: TBUT was shorter, Schirmer’s I test and corneal nerve density were decreased while the OSDI score increased.

Presbyopia reduces an individual's ability to perform visual tasks at near distances. It is a global problem, affecting over a billion people worldwide. Contact lenses, glasses, refractive surgery, and intraocular lens surgery are the main modalities in presbyopia treatment, although they all have some disadvantages. Thus, there is an increasing need for effective, easy-to-use, and noninvasive approaches for treating presbyopia while not limiting patients’ daily activities. Pharmacological presbyopia treatment as an alternative method has been under investigation in recent years. We reviewed all relevant articles using the keywords “presbyopia,” “presbyopia treatment,” “pharmacological presbyopia treatment,” and “presbyopic corrections” from 2010 to February 9, 2020, and summarized the main results of clinical trials, investigating the drops used for presbyopia treatment.

Purpose To characterize the features of hydrophilic intraocular lenses (IOLs) important in the clinical context of expected prolonged duration time of the IOL within the eye. Design Perspective. Methods Discussion includes possible factors and mechanisms associated with hydrophilic IOLs’ susceptibility to calcification and posterior capsule opacification (PCO) formation. Results Results of recently reported studies show that particular surgeries, such as pars plana vitrectomy (PPV), Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) with intraocular gas or air injection, might predispose the calcification process of hydrophilic IOLs, leading to a significant decrease in visual quality and possibly explantation of IOL. Hydrophilic IOLs are more susceptible than hydrophobic IOLs to PCO formation, which is the most common of late post-surgery complications that are associated with significant side effects. Conclusions We believe that all patients should be informed about the higher risk of calcification and PCO associated with hydrophilic IOLs. We also recommend limiting the use of hydrophilic acrylic IOLs during cataract surgery, especially when it is combined with PPV or endothelial keratoplasty, and in patients with endothelial diseases who will probably require operation on it in the future.

Background and Objectives: The age-related macular degeneration (AMD) pathophysiology is multifactorial, as it consists of interactions between aging, genetic, and environmental factors. We aimed to determine a relationship between AMD and the genes controlling lipid metabolism, and to assess its association with treatment results. The purpose was to find the ABCA1 rs1883025 and CYP4F2 rs2108622 gene polymorphisms in patients with exudative AMD (eAMD) treated with anti-VEGF. Materials and Methods: The study enroled 104 patients with eAMD and 201 healthy persons in a control group. The genotyping of rs1883025 and rs2108622 was performed using the RT-PCR method. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before anti-VEGF therapy, then at three and six months during the therapy, using optical coherence tomography (OCT). The patients were grouped to responders and non-responders according to the changes in BCVA and CRT. Results: The T allele at rs1883025 was more frequent in non-responder eAMD patients compared to responder eAMD patients (41.7% vs. 21.1%, p = 0.009). The analysis of rs2108622 gene polymorphism did not reveal any differences in the distribution of C/C, C/T, and T/T genotypes between the eAMD group and the control group (56.35%, 39.78%, and 3.87% in the eAMD group and 53.33%, 39.05% and 7.62% in the control group, respectively, p = 0.286). The comparison of CRT and BCVA between the rs2108622 genotypes revealed statistically significant differences: CRT was thicker for the CC carriers than for those with CT and TT genotypes (p = 0.030). Conclusion: The rs1883025 T allele was found to play a more significant role in non-responder eAMD patients compared to responder eAMD patients. The rs2108622 genotypes revealed statistically significant differences: CRT was thicker for the CC carriers than for those with CT and TT genotypes.

AIM: To describe and compare corneal sensation and morphological changes of sub-basal corneal nerves by in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis/uveitis and contralateral, clinically unaffected eyes. METHODS: A prospective clinical study included 30 HSV eyes and 30 contralateral eyes of 30 patients, diagnosed with unilateral HSV keratitis/uveitis. Both eyes underwent a complete ophthalmological examination, Cochet-Bonnet aesthesiometry and LSCM of the central cornea, using the Heidelberg Retina Tomograph III Rostock Cornea Module. After 6mo, the same examination of the HSV affected and contralateral, clinically unaffected eyes was performed. RESULTS: HSV eyes, as compared to contralateral eyes, demonstrated a significant decrease in mean corneal sensation (3.1±1.6 vs 5.3±0.8 cm), total nerve fibres number (5.7±4.4 vs 15.1±5.4), nerve branches (3.4±3.0 vs 8.4±4.7), main nerve trunks (2.3±1.6 vs 5.8±2.2), and nerve fibres density (7.5±5.6 vs 18.1±5.3 mm/mm(2), P

Considering the immunological impairment in age-related macular degeneration (AMD), we aimed to determine the associations of IL-9 rs1859430, rs2069870, rs11741137, rs2069885, and rs2069884 and IL-10 rs1800871, rs1800872, and rs1800896 polymorphisms and their haplotypes, as well as the serum levels of IL-9 and IL-10 with AMD. 1209 participants were enrolled in our study. SNPs were genotyped using TaqMan SNP genotyping assays by real-time PCR method. IL-9 and IL-10 serum levels were evaluated using ELISA kits. Our study results have shown that haplotypes A-G-C-G-G and G-A-T-A-T of IL-9 SNPs are associated with the decreased odds of early AMD occurrence ( p = 0.035 and p = 0.015 , respectively). A set of rare haplotypes was associated with the decreased odds of exudative AMD occurrence ( p = 0.033 ). Also, IL-10 serum levels were lower in exudative AMD than in controls ( p = 0.049 ), patients with early AMD ( p = 0.017 ), and atrophic AMD ( p = 0.008 ). Furthermore, exudative AMD patients with IL-10 rs1800896 CT and TT genotypes had lower IL-10 serum concentrations than those with wild-type (CC) genotype ( p = 0.048 ). In conclusion, our study suggests that IL-10 serum levels can be associated with a minor allele at IL-10 rs1800896 and exudative AMD. The haplotypes of IL-9 SNPs were also associated with the decreased odds of early and exudative AMD.

Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combination with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.

Background: In an experimental model, telomere shortening inhibits neovascularization. It is thus possible that telomere shortening might have a role in the pathogenesis of geographic atrophy in case of age-related macular degeneration (AMD). This is why we aimed to find any associated differences of telomere length and genetic variants in telomere-related genes (TERT, TERT-CLPTM1, TRF1, TNKS2, and TRF2) in patients with atrophic AMD compared to healthy controls. Methods: The study enrolled patients with atrophic AMD (n = 56) and healthy (n = 73) controls. Samples of DNA from peripheral blood leukocytes were extracted by DNA salting-out method. The genotyping of TERT rs2736098, rs401681 in TERT-CLPTM1 locus, TRF1 rs1545827, rs10107605, TNKS2 rs10509637, rs10509639, and TRF2 rs251796 and relative leukocyte telomere length (T/S) measurement were carried out using a real-time polymerase chain reaction method. The results were assessed using the statistical analysis method of “IBM SPSS Statistics 20.0“. Results: We found statistically significantly higher T/S in atrophic AMD patients than in healthy controls (T/S, median (IQR): 1.638 (1.110) vs. 0.764 (0.801), p TRF1 rs10107605 allele (A and C) distributions between the atrophic AMD and control groups (88.36% and 11.64% vs. 95.54% and 4.46%, respectively, p = .041), as well as between the short telomere and long telomere groups (86.92% and 13.08% vs. 96.09% and 3.91%, respectively, p = .008). Conclusions: Our research revealed the leukocyte telomere length having a role in atrophic AMD development, also the association between TRF1 rs10107605 and the telomere length.

Background: Age-related macular degeneration (AMD) affects the central part of the retina and causes blindness. In developed countries, AMD occurs in people over 50 years old. Important factors for AMD pathogenesis are an immune response, inflammation, and genetic factors. This study aimed to determine the impact of IL1RL1 rs1041973 and IL1RAP rs4624606 single nucleotide polymorphisms (SNPs) on the occurrence of AMD and the outcome of treatment with aflibercept and bevacizumab. Patients and Methods: 563 patients with AMD and 281 healthy candidates were evaluated. Patients with exudative AMD were treated with intravitreal bevacizumab and aflibercept and, after 6 months based on the changes in best-corrected visual acuity and central macular thickness, were classified as ‘responders’ or ‘poor-responders’. Genotyping of IL1RL1 rs1041973 and IL1RAP rs4624606 was accomplished using real-time PCR. Age was compared using the Mann-Whitney U-test. Categorical data (gender, genotype, and allele distributions) compared between groups using the χ(2) test or the Fisher’s exact test. Associations of gene polymorphisms were calculated using logistic regression analysis with adjustment for age in exudative and atrophic AMD analysis. An adjusted significance threshold for multiple comparisons α=0.025 was applied. Results: Statistically significant differences in the distribution of IL1RAP rs4624606 genotypes (TT, TA and AA) were found between males with atrophic AMD and controls: 50%, 42.9% and 7.1% vs. 69.7%, 30.3% and 0%, respectively, p=0.015. Moreover, we found that ‘responders’ had a significantly better best-corrected visual acuity than ‘poor-responders’ before treatment (p=0.032). The central macular thickness was significantly lower in exudative AMD patients with IL1RL1 rs1041973 AA genotype than in wild type and heterozygous (CC+CA) genotype carriers before treatment (p=0.017). Conclusion: IL1RAP rs4624606 may be associated with atrophic AMD in males while IL1RL1 rs1041973 may play a protective role against macular thickening in exudative AMD patients.

Background Age‐related macular degeneration (AMD) is the leading cause of blindness in the elderly individuals. The etiology of AMD includes environmental and genetic factors. Methods We aimed to determine the association between CETP (rs5882; rs708272; rs3764261; rs1800775; rs2303790), AGER (rs1800624; rs1800625), and CYP4F2 (rs1558139) gene polymorphisms and development of atrophic AMD. About 52 patients with atrophic AMD and 800 healthy control subjects were evaluated. The genotyping of single‐nucleotide polymorphisms in CETP, AGER, and CYP4F2 was carried out using the real‐time‐PCR method. Results Genetic risk models in the analysis of CETP rs5882 revealed statistically significant variables with increased risk of atrophic AMD in the codominant (p, We aimed to determine the frequency of the genotypes of CETP(rs5882; rs708272; rs3764261; rs1800775; rs2303790), RAGE (rs1800624; rs1800625) and CYP4F2 (rs1558139) in patients (pts) with atrophic age‐related macular degeneration (AMD). We identified 2 polymorphisms with higher risk of atrophic AMD (rs5882 and rs1800625) and one protective polymorphism (rs3764261).

Macular edema (ME) is associated with various conditions; however, the main causes of ME are retinal vein occlusion (RVO) and diabetes. Laser photocoagulation, formerly the gold standard for the treatment of ME, has been replaced by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Despite its efficiency, this treatment requires frequent injections to preserve the outcomes of anti-VEGF therapy, and as many patients do not sufficiently respond to the treatment, ME is typically a chronic condition that can lead to permanent visual impairment. Generalized recommendations for the treatment of ME are lacking, which highlights the importance of reviewing treatment approaches, including recent anti-VEGFs, intravitreal steroid implants, and subthreshold micropulse lasers. We reviewed relevant studies, emphasizing the articles published between 2019 and 2021 and using the following keywords: macular edema, diabetic macular edema, retinal vein occlusion, laser photocoagulation, anti-VEGF, and intravitreal injections. Our results revealed that a combination of different treatment methods may be beneficial in resistant cases. Additionally, artificial intelligence (AI) is likely to help select the best treatment option for patients in the near future.

The aim of the present study was to determine the association between sirtuin 1 (SIRT1), fibroblast growth factor receptor 2 (FGFR2) and signal transducer and activator of transcription 3 (STAT3) polymorphisms, and pituitary adenoma (PA) development, invasiveness, hormonal activity and recurrence. The present study included 143 patients with a diagnosis of PA. The reference group involved 808 healthy subjects. The genotyping of SIRT1 rs12778366, FGFR2 rs2981582 and STAT3 rs744166 was performed using the quantitative polymerase chain reaction method. The SIRT1 rs12778366 polymorphism analysis in the overall group revealed differences in the genotype distribution between patients with PA and control group subjects. The rs12778366 T/C genotype was observed to be different in non-invasive, non-recurrent and inactive PA subgroups compared with the control group, while the C/C genotype was observed to be different in invasive, recurrent and active PA subgroups compared with the control group. STAT3 rs744166 polymorphism analysis in the overall group revealed differences in the genotype distribution between patients with PA and the control groups. The rs744166 G/G genotype was observed to be different in invasive, non-recurrent and active PA subgroups compared with the control group, while the rs744166 A/A genotype was observed to be different in the active PA subgroup compared with the control group, and was also different in terms of invasiveness and recurrence in PA subgroups. The present study demonstrated that SIRT1 rs12778366 is associated with pituitary adenoma development while STAT3 rs744166 is associated with PA invasiveness, hormonal activity and recurrence.

Background and Objectives: This paper aims to describe the single nucleotide polymorphisms (SNPs) of C21orf91 rs1062202 and rs10446073 in patients with herpetic keratitis by evaluating corneal sub-basal nerves, as well as the density of Langerhans cells (LC) and endothelium cells (EC) during the acute phase of the disease. Materials and Methods: A prospective clinical study included 260 subjects: 70 with herpetic eye disease, 101 with previous history of herpes labialis&mdash, but no history of herpetic eye disease&mdash, and 89 with no history of any herpes simplex virus (HSV) diseases. All subjects underwent a complete ophthalmological examination including in vivo laser scanning confocal microscopy (LSCM) of the central cornea. C21orf91 rs1062202 and rs10446073 were genotyped using the real-time polymerase chain reaction (PCR) method with the Rotor-Gene Q real-time PCR quantification system. SNPs were determined using TaqMan genotyping assay, according to the manufacturer&rsquo, s manual. Results: The C21orf91 rs10446073 genotype GT was more frequent in the HSV keratitis group, compared with healthy controls (20.0% vs. 7.9%), OR 2.929[1.11&ndash, 7.716] (p &lt, 0.05). The rs10446073 genotype TT was more frequent in healthy controls (12.4% vs. 1.4%), OR 22.0[2.344&ndash, 260.48] (p &lt, 0.05). The rs10446073 genotype GT increased the risk of EC density being less than 2551.5 cell/mm2, OR 2.852[1.248&ndash, 6.515] (p &lt, 0.05). None of the SNPs and their genotypes influenced the LC density and corneal sub-basal nerve parameters (p &gt, 0.05). Conclusions: Our study reports a new association between herpetic keratitis and human gene C21orf91, with the rs10446073 genotype GT being more common in herpetic keratitis patients and increasing the risk for the disease by a factor of 2.9.

Leber hereditary optic neuropathy (LHON) is one of the most common inherited mitochondrial optic neuropathies, caused by mitochondrial DNA (mtDNA) mutations. Three most common mutations, namely m.11778G>A, m.14484T>G and m.3460G>A, account for the majority of LHON cases. These mutations lead to mitochondrial respiratory chain complex I damage. Typically, LHON presents at the 15–35 years of age with male predominance. LHON is associated with severe, subacute, painless bilateral vision loss and account for one of the most common causes of legal blindness in young individuals. Spontaneous visual acuity recovery is rare and has been reported in patients harbouring m.14484T>C mutation. Up to date LHON treatment is limited. Idebenone has been approved by European Medicines Agency (EMA) to treat LHON. However better understanding of disease mechanisms and ongoing treatment trials are promising and brings hope for patients. In this article we report on a patient diagnosed with LHON harbouring rare m.11253T>C mutation in MT-ND4 gene, who experienced spontaneous visual recovery. In addition, we summarise clinical presentation, diagnostic features, and treatment.

The opacifications of intraocular lenses (IOLs) can significantly impact patients visual quality. Despite the identification of specific risk factors, manufacturing changes, opacifications are not eliminated. Likewise, more attention in recent studies was paid to possible new risk factors, however one of the most important purposes of the studies remains opacifications effect on visual performance, which could be disturbed in different aspects. The aim of this review is to discuss the main risk factors of IOLs opacification in particular IOL types, and its impact on vision quality. Different risk factors were discussed in the study, including the material of IOLs, the impact of the breakdown of blood-aqueous barrier (BAB), and certain surgeries that can be associated with opacification formation. Glistenings occur more often in a hydrophobic material, however, the changes in water content of the IOLs can significantly reduce the formation of glistenings. The studies showed a significant effect of intraocular injection of exogenous air or gas during Descemet-stripping endothelial keratoplasty, Descemet-stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, and pars plana vitrectomy on calcification formation. It raises a concern, as the incidence of these surgeries is increasing. Visual acuity decreases significantly after the calcification in IOLs occurs, and it usually causes IOLs exchange. However, disability glare seems to be more affected in patients with IOLs, which were affected by glistenings than visual acuity. Disability glare is associated with increased levels of straylight, which was widely evaluated in recent studies and it was reported to be a susceptible measurement to detect the presence of IOLs pathology. For future researches, it should be noticed that disability glare and straylight are more appropriate in evaluating IOLs opacification effect on visual quality than visual acuity. While reviewing the main risk factors of IOLs opacifications particular attention must be paid on calcification occurrence in hydrophilic acrylic IOLs after surgeries with intraocular injection of exogenous air or gas.

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016 ; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents ; what data to collect before treatment ; when to modify or withdraw treatment ; how to select agents based on individual efficacy and safety profiles ; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.

Aim To examine the MMP-2 (-1306 C/T) gene polymorphism and the phenotype characterized by soft and hard drusen of early age-related macular degeneration (AMD) and geographic atrophy of late AMD form. Methods The study enrolled 850 investigations (290 AMD patients with soft and hard drusen, 34 with geographic atrophy and a random sample of the population n=526). Early AMD was classified according to the International Classification and Grading System. For geographic atrophy diagnosis the Age-Related Eye Disease Study classification was used. The potential association with single nucleotide polymorphisms on MMP-2 Rs243865 was evaluated for all patients, adjusted for age and sex. The genotyping test of MMP-2 Rs243865 (C-->T) was conducted using the real-time polymerase chain reaction method. Results MMP-2 (-1306 C/T) C/C genotype was more frequently detected in AMD patients with hard drusen than the soft drusen or control group (66.43% vs 53.74%, vs 54.94%, P=0.047). Logistic regression analysis showed that the MMP-2 (-1306) C/C genotype increased the likelihood to develop hard drusen in AMD patients (OR=1.7, 95% CI: 1.06-2.74; P=0.028). No association between MMP-2 (-1306 C/T) gene polymorphism in patients with atrophic AMD and control group was found (54.94%, 37.64%, 7.41% vs 50%, 38.24%, 11.76%; P=0.6). Conclusion The MMP-2 Rs24386 (C-->T) polymorphism is found to be associated with the development of hard drusen in patients with AMD.

Purpose. To determine if the MMP-9 genotype has an influence on development of pituitary adenoma (PA). Methodology. The study enrolled n=86 patients with PA and n=526 healthy controls (reference group). The genotyping of MMP-9 was carried out using the real-time polymerase chain reaction method. Results. Our data demonstrated that the MMP-9 (–1562) C/C genotype was more frequent in PA group than in healthy controls (81.4% versus 64.6%, p=0.002); C/C genotype was more frequently present in PA females compared to healthy control females, 81.5% versus 64.6%, p=0.018, as well. MMP-9 (–1562) C/C genotype was frequently observed for all subgroups: noninvasive and invasive, nonrecurrence, and inactive PA compared to healthy controls: 81.8% versus 64.6%, p=0.021; 81.0% versus 64.6%, p=0.041; 81.8% versus 64.6%, p=0.005; 100.0% versus 64.6%, p<0.001, respectively. MMP-9 (–1562) C/C genotype was more frequent in inactive PA compared to active PA: 100.0% versus 71.4%; p<0.001. Conclusion. MMP-9 (–1562) C/C genotype plays a role in nonrecurrence, inactive, and invasive as well as in nonivasive PA development.

Background and objectives: The purpose of this study was to describe corneal sensitivity and the morphological changes of sub-basal corneal nerves using in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis-affected eyes, and to compare with both contralateral eyes and with the eyes of patients with a previous history of herpes labialis but no history of herpetic eye disease, and with healthy patients with no history of any HSV diseases, during the acute phase of the disease and after six months. Materials and Methods: A prospective clinical study included 269 patients. All of them underwent a complete ophthalmological examination, Cochet-Bonnet aesthesiometry and LSCM within the central 5 mm of the cornea. After six months, all the patients with herpetic eye disease underwent the same examination. Serology tests of the serum to detect HSV 1/2 IgG and IgM were performed. Results: HSV-affected eyes compared with contralateral eyes, herpes labialis and healthy control group eyes demonstrated a significant decrease in corneal sensitivity, corneal nerve fibre density, corneal nerve branch density, corneal nerve fibre length and corneal nerve total branch density (p &lt, 0.05). During follow up after six months, corneal sensitivity and sub-basal nerve parameters had increased but did not reach the parameters of contralateral eyes (p &lt, 0.05). Previous herpes labialis did not influence corneal sensitivity and was not a risk factor for herpetic eye disease. Conclusions: Corneal sensitivity and sub-basal nerve changes in HSV-affected eyes revealed a significant decrease compared with contralateral eyes, and with the eyes of patients with a previous history of herpes labialis, and of healthy controls. Following six months, corneal sensitivity and sub-basal nerve parameters increased, however, they did not reach the parameters of contralateral eyes and the eyes of healthy controls. The best recovery of corneal sensitivity was seen in patients with epithelial keratitis. Herpes labialis was not a risk factor for herpetic eye disease.

Background: Posterior capsule opacification (PCO) is still a major long-term complication of modern cataract surgery. We evaluated the impact of sharp-edged intraocular lenses (IOLs) with different haptic designs made from the same hydrophobic acrylic material on posterior and anterior lens capsule opacification. Setting: Eye clinic of Kaunas University of Medicine, Lithuania. Prospective randomised clinical study. Methods: Seventy-four eyes of 74 patients scheduled for cataract surgery were included in a prospective randomised clinical study. Thirty-seven eyes of 37 patients received a three-piece acrylic hydrophobic (AcrySof, MA3OBA, Alcon) IOL; and thirty-seven eyes of 37 patients received a one-piece acrylic hydrophobic (AcrySof, SA3OAL, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsular folds, capsulorrhexis/optic overlapping and posterior capsule opacification (PCO) were evaluated. ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3 mm optic zone were assessed using a photographic image-analysis system (EPCO2000). Follow-ups were performed postoperatively at 1 day, 6 months, 1 year and 2 years. Results: There were no significant differences in best corrected visual acuity, grade of ACO and capsulorrhexis/optic overlapping between IOL types during the follow-up period. Patients in the one-piece acrylic hydrophobic IOL group more frequently presented with capsular folds behind the IOL optic area than those in the three-piece IOL group. In the three-piece acrylic hydrophobic IOL group, PCO values (mean (SD)) of the entire IOL optic area were significantly lower six months postoperative (three-piece: 0.002 (0.009); one-piece: 0.007 (0.017); p = 0.04), one year postoperative (three-piece: 0.004 (0.016); one-piece: 0.026 (0.041); p = 0.001) as well as one year postoperative in the central 3 mm optic zone (three-piece: 0.000 (0.0002); one-piece: 0.019 (0.049); p = 0.001). However, two years postoperative, the PCO values of the groups did not show significant differences (entire IOL optic area: three-piece, 0.136 (0.223); one-piece, 0.154 (0.190); p = 0.18; central zone: three-piece, 0.023 (0.065); one-piece: 0.020 (0.039); p = 0.44). Conclusion: The 2 year follow-up after cataract surgery showed no significant difference in ACO and PCO development between three-piece and one-piece acrylic hydrophobic intraocular lenses.

To evaluate and to compare the preventive effect of different intraocular lenses from different material with a round or sharp optic edge design on posterior capsule opacification.Our clinical study included 165 patients. Mean follow-up was 12.4+/-0.9 months, mean patient age was 67.5+/-7.8 years. Patients in the group 1 (n=46) were implanted acrylic three-piece hydrophobic intraocular lenses, sharp optic edge (AcrySof, MA3OBA, Alcon), in the group 2 (n=38)--acrylic hydrophobic single piece intraocular lenses, sharp optic edge (AcrySof, SA3OAL, Alcon), in the group 3 (n=39)--silicone three-piece intraocular lenses, sharp optic edge (CeeOn 911A, Pharmacia), and in the group 4 (n=42)--polymethyl methacrylate single piece intraocular lenses, round optic edge (Crystal, 5T, Alcon). The posterior capsule opacification was evaluated for the entire optic and in the central 3-mm zone using EPCO 2000 Software.Posterior capsule opacification values of the entire optic were 0.002+/-0.001 in the AcrySof MA3OBA group, 0.007+/-0.002 in the AcrySof SA3OAL group, 0.002+/-0.001 in the CeeOn 911A group, 0.029+/-0.008 in the polymethyl methacrylate intraocular lens group 6 months after surgery. The values were 0.011+/-0.005, 0.025+/-0.006, 0.014+/-0.005 and 0.122+/-0.021, respectively, one year after surgery. The intraocular lenses types with sharp-edge design (acrylic and silicone) showed significantly lower posterior capsule opacification values than round-edge optic design polymethyl methacrylate lenses (p0.05). Posterior capsule opacification values of the central 3-mm zone were 0.000+/-0.000 in the AcrySof MA3OBA group, 0.001+/-0.001 in the AcrySof SA3OAL group, 0.000+/-0.000 in the CeeOn 911A group, 0.002+/-0.001 in the polymethyl methacrylate intraocular lens group 6 months after surgery. The values were 0.0001+/-0.0001, 0.018+/-0.007, 0.004+/-0.002 and 0.028+/-0.009, respectively, one year after surgery. Posterior capsule opacification values differences between AcrySof MA3OBA and polymethyl methacrylate intraocular lenses' groups and between CeeOn 911A and polymethyl methacrylate intraocular lenses' groups one year after cataract surgery were established (p0.05).The sharp-edge foldable intraocular lenses types (AcrySof MA3OBA, AcrySof SA3OAL, CeeOn 911A) showed statistically significant difference in posterior capsule opacification values in one-year follow-up time. The effect of these foldable lenses for prevention of posterior capsule opacification is mainly a result of rectangular, sharp-edged optic design, which creates a sharp capsular bend. A role of material of intraocular lenses (hydrophobic acrylate and silicone) in prevention of posterior capsule opacification during one-year follow-up was not established.

To evaluate the effectiveness of clear corneal incisions and opposite clear corneal incisions for correcting corneal astigmatism during phacoemulsification.Twenty-nine patients (37 eyes) underwent phacoemulsification with foldable intraocular lens implantation through a 4.0 mm clear corneal tunnel. In the group 1 (28 eyes) the corneal tunnel incisions were placed on the steepest axis (pre-operative astigmatism/ =1.5). In the group 2 (9 eyes) an additional penetrating incision (3.0 mm) was placed on the opposite side to enhance flattening effect (pre-operative astigmatism =1.5). Keratometry was done in all eyes on the day prior to surgery and on the first day, 2-3 weeks and 6 months post-operatively. RESULTS. After 6 months, the corneal astigmatism decreased from 0.96 D+/-0.03 to 0.78 D+/-0.06, p/=0.05 in the first group and from 2.23 D+/-0.21 to 1.56 D+/-0.18, por = p/0.05 in the second group.Clear corneal incision on the steepest axis has neutralizing effect on pre-operative astigmatism. Adding opposite clear corneal incisions can greatly enhance this flattening effect [corrected].

Posterior capsule opacification (PCO) or secondary cataract is still the most common complication of cataract surgery. PCO results from the proliferation, growth, migration and transdifferentiation of lens epithelial cells left on the anterior capsule at the time of cataract surgery. Two types of PCO that are distinguished clinicaly are the fibrous and the pearl. It can be treated with Nd-YAG laser capsulotomy, but procedure is not without complications and it is not free of costs. For the United States, it has been estimated that the overall expenses for treatment of PCO are exceeded by the costs for cataract treatment itself. Consequently, a lot of experimental and clinical studies have been performed on this topic. They have led to a better understanding of the pathogenesis of the development of PCO and strategies to prevent PCO.

Evaluate the outcome of cataract surgery in Clinic of Ophthalmology, Kaunas University of Medicine (COKUM) and to compare it with the outcome of the European Cataract Outcome Study Group (ECOSG) data.The study was started on the 1st of October, 2000 and ended on the 30th April, 2001 on the basis of the protocol of the European Cataract Outcome Study Group. Every patient at each participating unit having surgery during the first study month was evaluated. The study was closed 6 months after surgery.The study enroled 3944 patients, out of them 361 was from COKUM. The mean induced astigmatism was 0.86+/-0.21 D in COKUM and 0.63+/-0.23 D in ECOSG. The visual acuity of the operated eye was 0.3 or lower in 28.1 percent of patients, 0.4-0.7 in 31.7 percent and 0.8 or higher in 40.2 percent of COKUM patients in the whole study group percentages were 11.8, 27.6 and 60.6, respectively. 44.3 percent of COKUM patients; underwent phacoemulsiphication, while among ECOSG this procedure was the most common (91.8 percent). The number of complications during surgery was 5.5 percent of all cases in COKUM while in European countries it was 3.7 percent.Cataract surgery data collected from 39 units in 18 European countries allowed participants to compare their performance with that of colleagues in an anonymous manner. This study is also an indicator of cataract surgery development in COKUM and in Lithuania.

As there is some evidence that the risk for Alzheimer’s disease (AD) is partially attributable to environmental exposure to some metals and metalloids, we examined an association between AD and arsenic, chromium, and selenium in 53 AD patients and 217 controls. Urinary arsenic, blood chromium, and selenium were determined by inductively coupled plasma mass spectrometry. Logistic regression models calculating odds ratios (ORs) and 95% confidence intervals (CI) were used to estimate AD association with arsenic, chromium, and selenium. In AD patients, urinary arsenic and blood chromium were significantly higher, while blood selenium was significantly lower compared to controls. Increased blood selenium was related to a significant decrease in the odds of AD after adjustment for risk factors. Blood selenium per 1 kg × 10−9/m3 × 10−4 increment was associated with 1.4 times lower risk of AD (OR = 0.71; 95% CI 0.58–0.87). A significant increase in the odds of AD associated with increased blood chromium was also seen in the adjusted model: the OR per 1 kg × 10−9/m3 × 10−3 chromium increment was 2.39 (95% CI 1.32–4.31). The association of urinary arsenic with the risk of AD was not significant. The data obtained provide evidence that selenium reduces the risk of Alzheimer’s disease, while chromium increases it.