Retinal Degenerations: Genetics, Mechanisms, and Therapies
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Un-Explained Visual Loss Following Silicone Oil Removal
Roca et al. Int J Retin Vitr (2017) 3:26 DOI 10.1186/s40942-017-0079-6 International Journal of Retina and Vitreous ORIGINAL ARTICLE Open Access Un‑explained visual loss following silicone oil removal: results of the Pan American Collaborative Retina Study (PACORES) Group Jose A. Roca1, Lihteh Wu2* , Maria Berrocal3, Francisco Rodriguez4, Arturo Alezzandrini5, Gustavo Alvira6, Raul Velez‑Montoya7, Hugo Quiroz‑Mercado7, J. Fernando Arevalo8, Martín Serrano9, Luiz H. Lima10, Marta Figueroa11, Michel Farah10 and Giovanna Chico1 Abstract Purpose: To report the incidence and clinical features of patients that experienced un-explained visual loss following silicone oil (SO) removal. Methods: Multicenter retrospective study of patients that underwent SO removal during 2000–2012. Visual loss of 2 lines was considered signifcant. ≥ Results: A total of 324 eyes of 324 patients underwent SO removal during the study period. Forty two (13%) eyes sufered a signifcant visual loss following SO removal. Twenty three (7.1%) of these eyes lost vision secondary to known causes. In the remaining 19 (5.9%) eyes, the loss of vision was not explained by any other pathology. Eleven of these 19 patients (57.9%) were male. The mean age of this group was 49.2 16.4 years. Eyes that had an un-explained visual loss had a mean IOP while the eye was flled with SO of 19.6 6.9 mm± Hg. The length of time that the eye was flled with SO was 14.8 4.4 months. In comparison, eyes that± did not experience visual loss had a mean IOP of 14 7.3 mm Hg (p < 0.0002)± and a mean tamponade duration of 9.3 10.9 months (p < 0.0001). -
Program & Abstracts
The International Symposium on Ocular Pharmacology and Therapeutics www.isopt.net 10th ISOPTClinical March 7-10, 2013, Paris, France Program & Abstracts Retina Glaucoma Inflammation & Infection Basic External Eye DevelopmentDrug Science Diseases ISOPT is Celebrating its 10th Anniversary 10th ISOPTClinical Contents Welcome . Committees. General Information. Reception & Refreshments. Sponsors & Exhibitors . Scientific Program Thursday, March 7 . Friday, March 8 . Saturday, March 9. Sunday, March 10 . E-Posters . Abstracts . Index of Authors . 2 The International Symposium on Ocular Pharmacology and Therapeutics March 7-10, 2013, Paris, France Dear Colleague, ISOPT is Celebrating its 10th Anniversary! Over the years ISOPT has become a place for formal updates of medical ophthalmology and drug utilization combined with informal meetings of clinicians and drug developers. ISOPT’s vision is to increase knowledge and awareness of drug usage in ophthalmology, reflecting innovations and their utilization in practice. ISOPT’s vision will be reflected in the following missions: • Share treatment algorithms in major ophthalmic indications. • Implement data from clinical studies for daily practice • Facilitate innovation – connecting innovators with practitioners ISOPT offers a relevant and updated scientific program in a relaxed atmosphere leading to direct interactions of its delegates. We welcome you in Paris, and invite you to share experiences and insights, whether your field of interest is in retinal diseases, inflammation, cornea and external diseases, glaucoma or basic science. Ron Neumann, MD Sara Krupsky, MD Symposium Chairpersons 3 10th ISOPTClinical Committees Chairpersons Special Program Advisor S. Krupsky, Israel B.D. Kuppermann, USA R. Neumann, Israel Scientific Advisory Board P.A. Asbell, USA A. Das, USA P. Kaufman, USA H. Reitsamer, Austria E.K. -
Dr. Andrea Dziubek, Dr. Edmond Rusjan, Dr. William Thistleton
Faculty and Staff Publication: Dr. Andrea Dziubek, Dr. Edmond Rusjan, Dr. William Thistleton Pre-Print Citation for Final Published Work: Dziubek, A., Guidoboni, G., Harris, A., Hirani, A. N., Rusjan, E., & Thistleton, W. (2016). Effect of ocular shape and vascular geometry on retinal hemodynamics: a computational model. Biomechanics And Modeling In Mechanobiology, (4), 893. doi:10.1007/s10237-015-0731-8 https://search.proquest.com/docview/1811187248 Biomechanics and Modeling in Mechanobiology manuscript No. (will be inserted by the editor) Effect of ocular shape and vascular geometry on retinal hemodynamics: a computational model Andrea Dziubek · Giovanna Guidoboni · Alon Harris · Anil N. Hirani · Edmond Rusjan · William Thistleton Received: date / Accepted: date Abstract A computational model for retinal hemody- retinal hemodynamics is influenced by the ocular shape namics accounting for ocular curvature is presented. (sphere, oblate spheroid, prolate spheroid and barrel The model combines: (i) a hierarchical Darcy model for are compared) and vascular architecture (four vascular the flow through small arterioles, capillaries and small arcs and a branching vascular tree are compared). The venules in the retinal tissue, where blood vessels of dif- model predictions show that changes in ocular shape ferent size are comprised in different hierarchical levels induce non-uniform alterations of blood pressure and of a porous medium; and (ii) a one-dimensional net- velocity in the retina. In particular, we found that: (i) work model for the blood flow through retinal arteri- the temporal region is affected the least by changes in oles and venules of larger size. The non-planar ocular ocular shape, and (ii) the barrel shape departs the most shape is included by: (i) defining the hierarchical Darcy from the hemispherical reference geometry in terms of flow model on a two-dimensional curved surface embed- associated pressure and velocity distributions in the ded in the three-dimensional space; and (ii) mapping retinal microvasculature. -
Acute Hydrops Following Penetrating Keratoplasty in a Keratoconic Patient
Acute Hydrops following PK • Baradaran-Rafiee et al Iranian Journal of Ophthalmology • Volume 20 • Number 4 • 2008 Acute Hydrops following Penetrating Keratoplasty in a Keratoconic Patient Alireza Baradaran-Rafiee, MD1 • Manijeh Mahdavi, MD2 • Sepehr Feizi, MD3 Abstract Purpose: To report a case with history of penetrating keratoplasty (PK) for keratoconus that developed acute hydrops in the recipient and donor cornea Methods: A 46-year-old man, with history of bilateral keratoconus, who had undergone corneal transplantation in his left eye, presented with complaints of sudden visual reduction, photophobia, redness and pain of the left eye. Results: Review of his clinical course, slit-lamp biomicroscopy, laboratory evaluations including confocal microscopy and ultrasound biomicroscopy revealed acute hydrops in the graft. Second corneal transplantation was done for his left eye and pathologic examination confirmed the diagnosis. Conclusion: Acute hydrops can occur after PK in patients with keratoconus. Although this condition is not common, it should be considered as a differential diagnosis of graft rejection. Keywords: Acute Hydrops, Keratoconus, Corneal Transplantation Iranian Journal of Ophthalmology 2008;20(4):49-53 Introduction Keratoconus is a degenerative, One of the complications of advanced non-inflammatory disease of the cornea, with keratoconus is acute hydrops. Affected onset generally at puberty. It is progressive in patients suffer from acute visual loss with pain 20% of cases and can be treated by lamellar and photophobia. On slit-lamp examination, or penetrating keratoplasty (PK). Its incidence conjunctival hyperemia and diffuse corneal in general population is reported to be about edema with intrastromal cystic spaces are 1/2000.1 Changes in corneal collagen visible. -
Eugene and Marilyn Glick Eye Institute Ophthalmology Update
Indiana University School of Medicine Eugene and Marilyn Glick Eye Institute Ophthalmology Update Department of Ophthalmology Spring 2013 Research team commits to Glick Eye Institute Vision research at the Eugene and researcher, Maria Grant, M.D., will Translational Research in the Marilyn Glick Eye Institute will receive be the first to hold the new Marilyn K. Department of Ophthalmology at a double boost when husband- Glick Senior Chair. They will join the the University of Florida and holds and-wife research scientists from department on July 1. professorships in ophthalmology; the University of Florida join the physiology and functional genomics; Department of Ophthalmology at the Dr. Boulton is currently director medicine; and psychiatry. Her Indiana University School of Medicine of research and professor in the research focuses on understanding this year. Department of Anatomy and Cell and repairing the damage to blood Biology at the University of Florida. vessels in the eye as a result of Michael Boulton, Ph.D., has been His research has focused on age- diabetes. appointed as the first director of related changes in the retina and basic science research and will hold retinal neovascularization. “We are thrilled to welcome Drs. the Merrill Grayson Senior Chair in Boulton and Grant,” said Louis Ophthalmology; his wife and fellow Dr. Grant is currently director of B. Cantor, M.D., Chairman of the (Continued on page 10) Teen is one of first in Indiana to Read about faculty research, new Department of Ophthalmology fac- participate in an intraocular lens grant awards, publications and ulty travel to Zambia and China implant study. -
Cme Reviewarticle
Volume 58, Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY Copyright © 2003 by Lippincott Williams & Wilkins, Inc. CME REVIEWARTICLE 5 CHIEF EDITOR’S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2003. Instructions for how CME credits can be earned appear on the last page of the Table of Contents. Ocular Changes in Pregnancy Robert B. Dinn, BS,* Alon Harris, MSc, PhD† and Peter S. Marcus, MD‡ *Fourth Year Medical Student, Indiana University School of Medicine; †Professor, Glaucoma Research and Diagnostic Center, Departments of Ophthalmology and Physiology, Indiana University School of Medicine; and ‡Assistant Clinical Professor, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana Visual changes in pregnancy are common, and many are specifically associated with the preg- nancy itself. Serous retinal detachments and blindness occur more frequently during preeclampsia and often subside postpartum. Pregnant women are at increased risk for the progression of preexisting proliferative diabetic retinopathy, and diabetic women should see an ophthalmologist before pregnancy or early in the first trimester. The results of refractive eye surgery before, during, or immediately after pregnancy are unpredictable, and refractive surgery should be postponed until there is a stable postpartum refraction. A decreased tolerance to contact lenses also is common during pregnancy; therefore, it is advisable to fit contact lenses postpartum. Furthermore, preg- nancy is associated with a decreased intraocular pressure in healthy eyes, and the effects of glaucoma medications on the fetus and breast-fed infant are largely unknown. -
Red Spot • Important Is the Time Period from the Event • Therapy Is Reasonable If the Patient Is Treated Within the First 6 Hours
ACUTE VISUAL LOSS KAROLÍNA SKORKOVSKÁ VISUAL LOSS • CENTRAL RETINAL ARTERY OCCLUSION • CENTRAL RETINAL VEIN OCCLUSION • RETINAL DETACHMENT • VITREOUS HAEMORRHAGE • OPTIC NEURITIS • AION VISUAL LOSS - PATIENT´S HISTORY • UNILATERAL / BILATERAL • SUDDEN / SLOWLY PROGRESSIVE • PAIN • COMPLAINTS (FOGGY VISION, FLOATERS, CURTAIN…) • OTHER SYMPTOMS (FEVER, WEIGHT LOSS, REFRACTIVE CHANGE, …) CATARACT • SLOWLY PROGRESSIVE VISUAL LOSS • FOGGY VISION • CHANGE IN REFRACTIVE ERROR (INDEX MYOPIA) • CATARACT VISIBLE ON SLIT LAMP • THERAPY: CATARACT EXTRACTION RETINAL ARTERY OCCLUSION • SUDDEN, UNILATERAL, PAINLESS LOSS OF VISION • VISUAL ACUITY MAY BE „NO LIGHT PERCEPTION“ • BRANCH / CENTRAL RETINAL ARTERY OCCLUSION • RETINAL ISCHEMIA WITH CHERRY RED SPOT • IMPORTANT IS THE TIME PERIOD FROM THE EVENT • THERAPY IS REASONABLE IF THE PATIENT IS TREATED WITHIN THE FIRST 6 HOURS RETINAL ARTERY OCCLUSION - COMPLICATIONS • POOR PROGNOSIS • PERMANENT LOSS OF VISION • OPTIC DISC ATROPHY • NEOVASCULARISATION GLAUCOMA RETINAL ARTERY OCCLUSION - THERAPY • LOWERING OF INTRAOCULAR PRESSURE • RETROBULBAR INJECTION OF VASODILATORS • PARACENTHESIS • SYSTEMIC TROMBOLYSIS (DEPARTMENT OF INTERNAL MEDICINE) • CHECK-UP OF RISK FACTORS OF ISCHEMIA / TROMBOSIS RETINAL VEIN OCCLUSION • SUDDEN, PAINLESS, UNILATERAL VISUAL LOSS • VISUAL ACUITY USUALLY NOT AS MUCH AFFECTED AS IN CRAO • BRANCH / CENTRAL RETINAL VEIN OCCLUSION • OFTEN CARDIOVASCULAR RISK FACTORS (HYPERTENSION, DIABETES, HYPERLIPIDEMIA, ISCHEMIC HEART DISEASE,…) • RETINAL HAEMORHAGES, OPTIC NERVE HEAD OEDEMA, RETINAL -
A Review of Central Retinal Artery Occlusion: Clinical Presentation And
Eye (2013) 27, 688–697 & 2013 Macmillan Publishers Limited All rights reserved 0950-222X/13 www.nature.com/eye 1 2 1 2 REVIEW A review of central DD Varma , S Cugati , AW Lee and CS Chen retinal artery occlusion: clinical presentation and management Abstract Central retinal artery occlusion (CRAO) is an that in turn place an individual at risk of future ophthalmic emergency and the ocular ana- cerebral stroke and ischaemic heart disease. logue of cerebral stroke. Best evidence reflects Although analogous to a cerebral stroke, there that over three-quarters of patients suffer is currently no guideline-endorsed evidence for profound acute visual loss with a visual acuity treatment. Current options for therapy include of 20/400 or worse. This results in a reduced the so-called ‘standard’ therapies, such as functional capacity and quality of life. There is sublingual isosorbide dinitrate, systemic also an increased risk of subsequent cerebral pentoxifylline or inhalation of a carbogen, stroke and ischaemic heart disease. There are hyperbaric oxygen, ocular massage, globe no current guideline-endorsed therapies, compression, intravenous acetazolamide and although the use of tissue plasminogen acti- mannitol, anterior chamber paracentesis, and vator (tPA) has been investigated in two methylprednisolone. None of these therapies randomized controlled trials. This review will has been shown to be better than placebo.5 describe the pathophysiology, epidemiology, There has been recent interest in the use of and clinical features of CRAO, and discuss tissue plasminogen activator (tPA) with two current and future treatments, including the recent randomized controlled trials on the 1Flinders Comprehensive use of tPA in further clinical trials. -
Acute Visual Loss 5 Cédric Lamirel , Nancy J
Acute Visual Loss 5 Cédric Lamirel , Nancy J. Newman , and Valérie Biousse Abstract Visual loss is a common symptom in neurologic emergencies. Although ocular causes of visual loss are usually identifi ed by eye care specialists, many patients appear in an emergency department or a neurologist’s offi ce when the ocular examination is normal or when it suggests a neurologic disorder. Indeed, many causes of monocular or binocular acute visual loss may reveal or precede a neurologic process. In this situation, a quick and simple clinical examination done at bedside in the emergency department allows the neurologist to localize the lesion and determine whether an urgent neurologic workup or further ophthalmologic consultation is necessary. Keywords Central retinal artery occlusion • Funduscopic examination • Optic neuropathy • Retinal emboli • Visual fi eld • Visual loss Acute vision changes typically precipitate emer- gency consultation. Although ocular causes are usually identifi ed by eye care specialists, many patients appear in an emergency department or a C. Lamirel , MD neurologist’s offi ce when the ocular examination Service d’ophtalmologie , Fondation Ophtalmologique is normal or when it suggests a neurologic disor- Adolphe Rothschild , Paris , France der. Indeed, many causes of monocular or binoc- e-mail: [email protected] ular acute visual loss may reveal or precede a N. J. Newman , MD • V. Biousse, MD () neurologic process. In this situation, a quick and Neuro-Ophthalmology Unit , simple clinical examination done at bedside in Emory University School of Medicine , Atlanta , GA , USA the emergency department allows the neurologist e-mail: [email protected]; [email protected] to localize the lesion and determine whether an K.L. -
Approach to Acute Visual Loss
APPROACH TO ACUTE VISUAL LOSS 11 : 2 Satish Khadilkar, Pramod Dhonde, Mumbai INTRODUCTION Acute visual loss is common in clinical practice. The symptom is very disturbing to patients and requires rapid clinical analysis and therapy, as it can be associated with significant morbidity. Etiologies of acute visual impairment range from retina to the occipital cortex, resulting in a plethora of presentations. For example in a case of retinal disease patient may feel as if a curtain is rising or dropping and in cases of occipital lesions, patients may give history of bumping into the objects without realization. Also, patients tend to mistake diplopia for visual loss, which needs careful analysis. Acute visual loss could either be monocular or binocular. Monocular loss is often related to local eye pathologies as glaucoma, uveitis, retinitis or neurological diseases like optic neuritis (ON) and anterior ischemic optic neuropathy (AION). Binocular diseases are usually associated with lesions affecting structures such as optic chiasma, lateral geniculate body, occipital radiations and occipital cortex. Pain is an important association of visual loss. Painful visual impairment is seen in ON, Tolosa Hunt Syndrome, orbital apex syndrome, pituitary apoplexy and glaucoma. On the other hand, diseases of the optic tracts, radiations, occipital cortex and AION tend to be painless. The natural history of the visual impairment is helpful in the differential diagnosis. Transient visual deficit is seen in vascular diseases, demyelinations, raised intracranial tension and hyper coagulable states. Lasting deficits are seen with, strokes, tumors and AION. Following cases will illustrate various clinical situations of acute visual impairment, encountered by clinicians. -
Visual Loss Due to Progressive Multifocal Leukoencephalopathy In
CLINICOPATHOLOGIC REPORTS, CASE REPORTS, AND SMALL CASE SERIES SECTION EDITOR: W. RICHARD GREEN, MD but there was a single nucleotide visible, fine-linear white scarring in Visual Loss Due to substitution (C155T) in exon 1 of this area (Figure 2). In the most se- Progressive Multifocal the WAS gene. verely affected gyri, the cortex was Leukoencephalopathy Six weeks later his vision was bi- also involved and had a darker color, in a Congenital lateral finger counting. A magnetic with apparent expansion and soften- resonance imaging (MRI) scan ing of its affected parts. Immunodeficiency Disorder showed scattered areas of white- Although the individual le- matter foci, predominantly peri- sions were present throughout the A 20-year-old man with Wiskott- pheral and not periventricular, on cerebral hemispheres, they were Aldrich syndrome (WAS) initially de- proton density and T2-weighted most frequent bilaterally in the oc- veloped a mild visual disturbance that scans. He was given intravenous cipital poles, which were also the progressed to blindness, increasing methylprednisolone sodium succi- major site of linear cortico–white- neurological deficits, and death nate because of the possibility of de- matter junction lesions and scar- within 4 months. Wiskott-Aldrich myelination. No improvement oc- ring as well as the regions of diffuse syndrome is an X-linked immuno- curred, and he was registered as blind. cortical involvement. A microsco- deficiency disorder characterized by Reduced sensation and generalized pic examination of the brain sec- thrombocytopenia, eczema, and sus- mild weakness (level 4-5) devel- tions showed small, spherical, white ceptibility to infection.1 This case il- oped in his right-hand side and face. -
Home>>Common Retinal & Ophthalmic Disorders
Common Retinal & Ophthalmic Disorders Cataract Central Serous Retinopathy Cystoid Macular Edema (Retinal Swelling) Diabetic Retinopathy Floaters Glaucoma Macular degeneration Macular Hole Macular Pucker - Epiretinal Membrane Neovascular Glaucoma Nevi and Pigmented Lesions of the Choroid Posterior Vitreous Detachment Proliferative Vitreoretinopathy (PVR) Retinal Tear and Detachment Retinal Artery and Vein Occlusion Retinitis Uveitis (Ocular Inflammation) White Dot Syndromes Anatomy and Function of the Eye (Short course in physiology of vision) Cataract Overview Any lack of clarity in the natural lens of the eye is called a cataract. In time, all of us develop cataracts. One experiences blurred vision in one or both eyes – and this cloudiness cannot be corrected with glasses or contact lens. Cataracts are frequent in seniors and can variably disturb reading and driving. Figure 1: Mature cataract: complete opacification of the lens. Cause Most cataracts are age-related. Diabetes is the most common predisposing condition. Excessive sun exposure also contributes to lens opacity. Less frequent causes include trauma, drugs (eg, systemic steroids), birth defects, neonatal infection and genetic/metabolic abnormalities. Natural History Age-related cataracts generally progress slowly. There is no known eye-drop, vitamin or drug to retard or reverse the condition. Treatment Surgery is the only option. Eye surgeons will perform cataract extraction when there is a functional deficit – some impairment of lifestyle of concern to the patient. Central Serous Retinopathy (CSR) Overview Central serous retinopathy is a condition in which a blister of clear fluid collects beneath the macula to cause acute visual blurring and distortion (Figure 2). Central serous retinochoroidopathy Left: Accumulation of clear fluid beneath the retina.