Efstratios Parikakis - Academia.edu (original) (raw)

Papers by Efstratios Parikakis

Research paper thumbnail of Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, Jan 5, 2015

To evaluate prospectively the anatomical and functional results after ocriplasmin injection in pa... more To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT). Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30-127 days). Best-corrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release. 66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure. Baseline positive predictive factors for VMT release were young age, bei...

Research paper thumbnail of A case of subretinal neovascularization treated with intravitreal ranibizumab in a patient with idiopathic juxtafoveal retinal telangiectasis

Clinical Interventions in Aging

A 65-year-old lady presented with decreased vision in her left eye (LE). Best corrected visual ac... more A 65-year-old lady presented with decreased vision in her left eye (LE). Best corrected visual acuity (BCVA) was 1/20. Complete examination showed idiopathic juxtafoveal retinal telangiectasis associated with subretinal neovascularization and she was treated with intravitreal ranibizumab every month for three months in the LE. After four months, her BCVA increased to 3/10. Fluorescein angiography (FA) showed minimal leakage and optical coherence tomography (OCT) confi rmed absence of intra-or subretinal fl uid in the macula. Examinations were repeated monthly for another 12 months and showed no recurrence. Intravitreal ranibizumab showed promising results for subretinal neovascularization due to idiopathic juxtafoveal retinal telangiectasis. A prospective study with large series of patients and controls may be necessary in order to determine the effectiveness of this treatment.

Research paper thumbnail of Central retinal vein occlusion and pseudoexfoliation syndrome

Clinical Interventions in Aging, 2015

Purpose: The purpose of this study was to investigate the existence of pseudoexfoliation syndrome... more Purpose: The purpose of this study was to investigate the existence of pseudoexfoliation syndrome (PXF) as a risk factor for the development of central retinal vein occlusion (CRVO). Methods: This was a retrospective, comparative study of the prevalence of pseudoexfoliation in three groups of patients: 48 patients with CRVO, 164 patients with branch retinal vein occlusion (BRVO), and 70 control patients (70 eyes). All patients were phakic and had no previous diagnosis of glaucoma. Patients were matched in terms of age and systemic hypertension. All patients had normal intraocular pressure (IOP) at presentation (defined as less than or equal to 21 mmHg). Results: In the CRVO group, 14 out of 48 patients were diagnosed as having PXF (29.17%). In the BRVO group, 14 out of 164 patients had PXF (8.5%), and in the control group, six out of 70 patients had PXF (8.6%). Differences of percentage between groups were statistically significant (P0.001, χ 2 test). When comparing patient subgroup with ischemic CRVO with subgroup with non-ischemic CRVO, we found that in the ischemic CRVO group, 13 out of 27 patients were diagnosed as having PXF (48.15%), and in the non-ischemic CRVO group, one out of 21 patients was diagnosed as having PXF (4.7%; P0.001, χ 2 test). The relative odds of having CRVO in patients with PXF versus patients without PXF were 4.406 (confidence interval [CI], 2.03-9.54). Conclusion: PXF and CRVO, especially ischemic, are strongly associated in our study. Our results indicate that PXF might be an independent factor for CRVO, as it is related with CRVO independently from glaucoma.

Research paper thumbnail of Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study

Graefe's Archive for Clinical and Experimental Ophthalmology, 2015

Purpose To evaluate prospectively the anatomical and functional results after ocriplasmin injecti... more Purpose To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT). Methods Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30-127 days). Bestcorrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release. Results 66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure.

Research paper thumbnail of Spontaneous Resolution of Long-Standing Macular Detachment due to Optic Disc Pit with Significant Visual Improvement

Case reports in ophthalmology, 2014

To report a case of spontaneous resolution of a long-standing serous macular detachment associate... more To report a case of spontaneous resolution of a long-standing serous macular detachment associated with an optic disc pit, leading to significant visual improvement. A 63-year-old female presented with a 6-month history of blurred vision and micropsia in her left eye. Her best-corrected visual acuity was 6/24 in the left eye, and fundoscopy revealed serous macular detachment associated with optic disc pit, which was confirmed by optical coherence tomography (OCT). The patient was offered vitrectomy as a treatment alternative, but she preferred to be reviewed conservatively. Three years after initial presentation, neither macular detachment nor subretinal fluid was evident in OCT, while the inner segment/outer segment (IS/OS) junction line was intact. Her visual acuity was improved from 6/24 to 6/12 in her left eye, remaining stable at the 6-month follow-up after resolution. We present a case of spontaneous resolution of a long-standing macular detachment associated with an optic dis...

Research paper thumbnail of Undiagnosed patent foramen ovale as a rare cause for branch retinal artery occlusion

European journal of ophthalmology, 2015

To present the case of a man with branch retinal artery occlusion (BRAO) and concomitant patent f... more To present the case of a man with branch retinal artery occlusion (BRAO) and concomitant patent foramen ovale (PFO), which was first diagnosed during the evaluation of BRAO. A 35-year-old man presented with blurred vision in the left eye for 2 days. His best-corrected visual acuity (BCVA) was 6/6 in the right eye and 6/12 in the left eye. He had no ophthalmic or medical history. Ophthalmologic examination revealed a left inferior BRAO, confirmed by fluorescein angiography. The patient underwent a thorough diagnostic workup. Cardiologic examination with transesophageal echocardiography revealed a right-to-left shunt across a PFO. The patient was treated with clopidogrel and at the 15-day review, BCVA in his left eye was 6/7.5 and the retinal edema was resolved, as detected on optical coherence tomography, but relative afferent pupillary defect was persistent. The patient had developed no other embolic event at the 9-month follow-up, having undergone an operation for PFO repair. Paten...

Research paper thumbnail of Acute zonal occult outer retinopathy with atypical findings

Case reports in medicine, 2014

Background. To report a case of acute zonal occult outer retinopathy (AZOOR) with atypical electr... more Background. To report a case of acute zonal occult outer retinopathy (AZOOR) with atypical electrophysiology findings. Case Presentation. A 23-year-old-female presented with visual acuity deterioration in her right eye accompanied by photopsia bilaterally. Corrected distance visual acuity at presentation was 20/50 in the right eye and 20/20 in the left eye. Fundus examination was unremarkable. Visual field (VF) testing revealed a large scotoma. Pattern and full-field electroretinograms (PERG and ERG) revealed macular involvement associated with generalized retinal dysfunction. Electrooculogram (EOG) light rise and the Arden ratio were within normal limits bilaterally. The patient was diagnosed with AZOOR due to clinical findings, visual field defect, and ERG findings. Conclusion. This is a case of AZOOR with characteristic VF defects and clinical symptoms presenting with atypical EOG findings.

Research paper thumbnail of Intravitreal Ranibizumab for Stage IV Proliferative Sickle Cell Retinopathy: A First Case Report

Case Reports in Ophthalmological Medicine, 2014

is properly cited.

Research paper thumbnail of Toric intraocular lens implantation for correction of astigmatism in cataract patients with corneal ectasia

Case reports in ophthalmology, 2013

Our purpose was to examine the long-term efficacy of toric intraocular lens (IOL) implantation in... more Our purpose was to examine the long-term efficacy of toric intraocular lens (IOL) implantation in cataract patients with high astigmatism due to corneal ectasia, who underwent phacoemulsification cataract surgery. Five eyes of 3 cataract patients with topographically stable keratoconus or pellucid macular degeneration (PMD), in which phacoemulsification with toric IOL implantation was used to correct high astigmatism, are reported. Objective and subjective refraction, visual acuity measurement and corneal topography were performed in all cases before and after cataract surgery. In all cases, there was a significant improvement in visual acuity, as well as refraction, which remained stable over time. Specifically, in subjective refraction, all patients achieved visual acuity from 7/10 to 9/10 with up to -2.50 cyl. Corneal topography also remained stable. Postoperative follow-up was 18-28 months. Cataract surgery with toric IOL implantation seems to be safe and effective in correcting...

Research paper thumbnail of Bilateral Multifocal Chorioretinitis and Optic Neuritis due to Epstein-Barr Virus: A Case Report

Case Reports in Ophthalmology, 2012

Epstein-Barr virus (EBV) is a DNA virus that mainly causes infectious mononucleosis. Ocular manif... more Epstein-Barr virus (EBV) is a DNA virus that mainly causes infectious mononucleosis. Ocular manifestations are rare and typically mild. Only a few cases of EBV involving the retina or the optic nerve have been reported. Herein, we report the case of a 67-year-old man with bilateral chorioretinitis and optic neuritis due to EBV. The patient had no previous ocular history and presented with decreased vision in both eyes. His past medical history included EBV encephalopathy, which was confirmed serologically, a few months before. Ophthalmological examination revealed bilateral chorioretinitis and optic neuritis, confirmed by fluorescein angiography as well as electrophysiological tests (visual evoked potentials and electroretinogram). It is very important to include EBV in the differential diagnosis of chorioretinal atrophic lesions. Clinicians should be aware of ocular manifestations of EBV, in order to suggest ophthalmological examination and start treatment promptly before irreversible damage to the optic nerve or retina occurs.

Research paper thumbnail of Intravitreal Ranibizumab for the Treatment of Irvine-Gass Syndrome

Ocular Immunology and Inflammation, 2014

Purpose: The purpose of our study was to evaluate the potential efficacy and safety of intravitre... more Purpose: The purpose of our study was to evaluate the potential efficacy and safety of intravitreal ranibizumab in patients with pseudophakic cystoid macular edema (CME). Methods: This retrospective study comprised 7 eyes with CME treated with intravitreal ranibizumab. Patients were examined at 1 week and 1 month after injection and monthly thereafter. Main outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety was assessed by ophthalmic examination and report of systemic adverse effects. Results: There was a statistically significant difference on BCVA (p50.001) and CRT (p50.001) before and after the ranibizumab injection. One injection appeared to be sufficient for the resolution of CME, while recurrence was observed in 1 patient, in a long-term follow-up. No observable ocular or systemic side effects were found. Conclusions: Intravitreal ranibizumab seems to be effective and safe for the treatment of pseudophakic CME, demonstrating a statistically significant difference in BCVA as well as CRT.

Research paper thumbnail of Chronic postoperative endophthalmitis caused by Actinomyces neuii

Journal of Cataract & Refractive Surgery, 2004

Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraoc... more Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraocular lens was performed in the right eye of a 73-year-old white man. Postoperatively, the patient developed a chronic, low-grade intraocular inflammation. Cultures from the aqueous specimen grew Actinomyces neuii, an unusual gram-positive bacillus. The low-grade intraocular inflammation persisted with intensive topical steroid-antibiotic medication and systemic antibiotics. A diagnostic, 3-port, pars plana vitrectomy was performed, and aqueous aspirate specimens were sent for culture and sensitivity and to look for abnormal cells. Intracameral antibiotics were not injected. The specimens were sterile to culture, and chronic inflammatory cells were reported on the vitreous specimen. On examination 6 months later, inflammation had not recurred and the best corrected visual acuity was 6/18.

Research paper thumbnail of Cryotherapy for retinopathy of prematurity: A MRI study of the surgical-anatomical relationship of the neonatal conjunctival fornices to the globe

Eye, 2001

Cryotherapy for reti nopathy of prematurity: a MRI study of the surgical anatomical relationship ... more Cryotherapy for reti nopathy of prematurity: a MRI study of the surgical anatomical relationship of the neonatal conjunctival fornices to the globe Abstract Purpose To demonstrate the surgical anatomical relationship of the neonatal conjunctival fornices to the globe in order to ascertain whether adequate cryotherapy is possible in infants with stage 3 retinopathy of prematurity using a trans-scleral approach without opening the conjunctiva. Methods Magnetic resonance (MR) scans of the orbit were performed on an adult and an infant of 38 weeks post-conceptual age with maximal posterior placement of a MR compatible replica of the Schulenburg cryoprobe in the nasal and temporal aspects of the globe. Results In the infant MR scan, the scleral indentation produced by the probe was anterior to the equator on the nasal side and at, or just anterior to, the equator on the temporal side. Nasally, the scleral indentation reached only the more anterior part and not the posterior part of zone 2 and none of zone 1. Temporally, the scleral indentation reached the central part of zone 2 but not the posterior part of zone 2 or zone 1. Conclusion The findings suggest that adequate cryotherapy with a trans-scleral approach without opening the conjunctiva is unlikely to be achieved in the more immature neonate with posteriorly located retinopathy of prematurity. To permit access of the cryoprobe to the more posterior part of the globe, one radial conjunctival incision from the corneal limbus in each quadrant may be required to achieve adequate ablation of the posterior non-vascularised retina in these high-risk infants.

Research paper thumbnail of Axial eye length measurements pre- and post- laser-assisted in situ keratomileusis using the IOL Master: a pilot study

Clinical Ophthalmology, 2010

Research paper thumbnail of The effect of phacoemulsification on late bleb failure or intraocular pressure in patients with glaucoma: a systematic review

Clinical Ophthalmology, 2012

The purpose of our systematic review is to document the adverse events that follow phacoemulsific... more The purpose of our systematic review is to document the adverse events that follow phacoemulsification in eyes with trabeculectomy due to glaucoma and to determine whether phacoemulsification jeopardizes the survival of the trabeculectomy. Our research was based on English-and non-English-language articles obtained using the Medline, Embase, Web of Science and Scopus databases. Additional studies were identified by searching bibliographies in the British Library and abstracts presented at the Association for Research in Vision and Ophthalmology annual meetings. Search terms included randomized controlled trial, controlled clinical trial, random allocation, double-blind method, matched studies and trabeculectomy failure, glaucoma-filtering operation failure, bleb failure and cataract surgery or phacoemulsification. Only prospective or retrospective matched studies testing the survival of a trabeculectomy alone versus clear corneal phacoemulsification after a trabeculectomy in patients with glaucoma were included. Data were independently extracted by two authors using predefined data fields. PubMed yielded 152 results, Scopus 235, Embase 222, and Web of Science (science citation index) 216. We read the abstracts of all the trials, and after reading the full text of 31 studies, we decided that 13 studies should be comprehensively evaluated. Current evidence does not allow us to draw safe conclusions on the scientific question so far.

Research paper thumbnail of Changing from bevacizumab to ranibizumab in age-related macular degeneration. Is it safe?

Clinical Interventions in Aging, 2009

Objective: To report our experiences in changing from intravitreal bevacizumab to ranibizumab in ... more Objective: To report our experiences in changing from intravitreal bevacizumab to ranibizumab in age-related macular degeneration (AMD). Design: Retrospective case series. Participants and methods: We retrospectively reviewed the records of 34 patients (36 eyes) who were treated with monthly injections of intravitreal bevacizumab for six months and then switched to monthly injections of ranibizumab for 12 months. Best-corrected visual acuity measurements (BCVA), contact lens biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography were performed at the baseline examination and then monthly. Chi-square test was used for statistical analysis. Results: Following bevacizumab treatment, retinal thickness decreased (P = 0.033) while BCVA improved (P = 0.040). Changing from bevacizumab to ranibizumab resulted in a transient decrease in BCVA (P = 0.045) and an increase in retinal thickness (P = 0.042). In addition, three eyes presented with a large subretinal hemorrhage. However, final retinal thickness was better than the initial thickness and the value following the bevacizumab course. No major ocular or systemic side effects were noted. Conclusions: Ranibizumab was clinically effective in the long term but the change of treatment from bevacizumab to a half-size molecule with less half-life in the vitreous such as ranibizumab contributed to a transient "instability" in the eye which may have triggered the large subretinal hemorrhage. There is insufficient experience reported in the literature in switching from one agent to another. A prospective study with controls is necessary to determine whether it is safe to change from one medication to another.

Research paper thumbnail of An atypical case of choroidal neovascularization associated with pseudoxanthoma elasticum treated with intravitreal bevacizumab: a case report

BMC Research Notes, 2013

Background: Pseudoxanthoma elasticum is an inherited disorder that is associated with accumulatio... more Background: Pseudoxanthoma elasticum is an inherited disorder that is associated with accumulation of pathologic elastic fibers in the skin, vascular walls and Bruch's membrane in the eye. Choroidal neovascularization is one of the most common causes of acute vision loss in these patients. We report an atypical case of suspected choroidal neovascularization associated with pseudoxanthoma elasticum. Case presentation: A 47-year-old Caucasian woman with pseudoxanthoma elasticum and angioid streaks was referred because of decreased and distorted vision in her right eye of one week's duration. Visual acuity was 6/12 in the right eye and 6/6 in the left eye. Fundus examination revealed angioid streaks and white intraretinal macular deposits bilaterally. Fluorescein angiography did not reveal any obvious leakage in the right eye while optical coherence tomography revealed subretinal fluid associated with an adjacent intraretinal hyperreflective structure. Autofluoresence imaging showed focal areas of increased autofluorescence corresponding to the deposits in both eyes. Over the following year the patient underwent five intravitreal injections of bevacizumab (Genentech/Roche, US) in the right eye, which resulted in visual acuity improving to 6/9 with regression of the hyperreflective structrure and complete resolution of subretinal fluid. Conclusions: Traditionally, fluorescein angiography is effective in the detection of choroidal neovascularization in patients with pseudoxanthoma elasticum. In our case, optical coherence tomography revealed subretinal fluid and an adjacent hyperreflective structure while fluorescein angiography did not reveal any obvious leakage. The sole presence of subretinal fluid does not necessarily imply the presence of choroidal neovascularization and certainly retinal pigment epithelium dysfunction could also explain subretinal fluid in these patients. However, the complete absorption of the fluid and the disappearance of the previously evident hyperreflective structure following treatment, led us to suspect choroidal neovascularization as the primary cause of the above findings. The poor natural course of choroidal neovascularization in these patients increases the importance of early detection and should result in the adaptation of a low-threshold strategy concerning the initiation of treatment.

Research paper thumbnail of Photodynamic therapy for juxtapapillary retinal capillary hemangioma: A case report

Acta Ophthalmologica, 2013

ABSTRACT Purpose Various treatment modalities have been described for retinal capillary hemangiom... more ABSTRACT Purpose Various treatment modalities have been described for retinal capillary hemangioma therapy, including observation, laser photocoagulation, cryotherapy, radiotheraphy and vitreoretinal surgery. Our purpose is to present a case of juxtapapillary retinal capillary hemangioma treated with photodynamic therapy(PDT. Methods A 69-year-old woman with no previous ocular history presented with blurred vision and photopsias in the right eye since three months. The patient underwent a thorough ophthalmological examination, including visual acuity measurement by means of Snellen charts, slit-lamp examination, intraocular pressure(IOP) measurement and dilated fundoscopy. Results At presentation, her best corrected visual acuity (BCVA) was 6/9 in the right eye and 6/6 in the left eye. The anterior segment was totally normal and IOP was normal in both eyes as well. Dilated fundoscopy revealed a yellowish, elevated area with blood vessels, on the inferior margin of the right optic disc, as optic disc edema. Fluorescein angiography and angiogram with indocyanin green confirmed the diagnosis of juxtapapillary retinal capillary hemangioma. The patient was treated with PDT with verteporfin and three months later her visual acuity was 6/7.5 in the right eye and the lesion was slightly smaller. Conclusion Retinal capillary hemangioma should be included in the differential diagnosis of optic disc edema. PDT offers promising results as far as anatomical and functional results, providing visual acuity improvement or even stabilization and restriction of enlargement of the lesion.

Research paper thumbnail of A comparison of remaining refractive error after cataract surgery using different monofocal intraocular lenses

Acta Ophthalmologica, 2011

ABSTRACT Purpose The aim of this study was to evaluate the refractive outcomes following cataract... more ABSTRACT Purpose The aim of this study was to evaluate the refractive outcomes following cataract surgery using single-piece and three-piece monofocal intraocular lenses (IOLs).Methods In this retrospective study 114 eyes were enrolled. Monofocal single-piece IOLs were used in group I (Quatrix/Croma., Austria, 61 eyes) and group II (Acrysof IQ /Alcon Laboratories Inc., Texas, 29 eyes) while three-piece IOLs were implanted in group III (Mediconsult A85UV/Mediconsult Intraocular., Germany, 24 eyes). The main clinical outcome parameter evaluated was the remaining spherical equivalent refraction (Remaining SER: post-op SER – target refraction). Kruskal-Wallis non-parametric ANOVA statistic test was used for data analysis.Results The mean target refraction was -0.52D (SD 0.34). The mean remaining SER in group I, [Iota][Iota] and III was +0.46D (SD 0.93), +0.25D (SD 0.61) and -0.29D (SD 0.97) respectively. Kruskal-Wallis H test showed that there was a statistically significant difference in the residual refractive error among the different IOL implants (H (2) =11.255, P=.004).Conclusion According to statistics, single-piece IOL implants Quatrix and AcrySof IQ induced a slight hyperopic shift whereas the refractive outcomes of three-piece implants (Mediconsult A85UV) concurred with the preoperative target. Future prospective studies and a larger number of cases are needed to verify the aforementioned results.

Research paper thumbnail of Epiretinal membranes in a patient with Scheie's syndrome diagnosed using a high-resolution SD-OCT

Acta Ophthalmologica, 2011

ABSTRACT Purpose To report a case of a young woman with Mucopolysaccharidosis I-S (Scheie&#39... more ABSTRACT Purpose To report a case of a young woman with Mucopolysaccharidosis I-S (Scheie's Syndrome) having bilateral epiretinal membranes (ERMs) which have been confirmed by the use of a high resolution spectral-domain optical coherence tomography (Spectralis SD-OCT).Methods A 28 year-old female, diagnosed with Scheie's Syndrome since 8 years old, was examined in our department. For the last 6 years she has been receiving weekly intravenous laronidase. In manifest refraction the patient achieved a visual acuity of 20/40 OD and 20/32 OS with a high hyperopic spherical equivalent correction (+7.50D, OU). Slit-lamp anterior segment examination showed the presence of diffuse corneal haze in both eyes which obscured retinal view. During dilated fundus examination she complained of severe photophobia. An OCT examination using the Spectralis SD-OCT (Heidelberg Engineering, Germany) was performed to evaluate the retinal pathology.Results The SD-OCT examination revealed the presence of epiretinal membranes in both eyes without any signs of macular edema.Conclusion In patients with mucopolysacharidosis I the view of retinal abnormalities with the use of a slit-lamp biomicroscope could be difficult due to corneal haze and severe photophobia. SD-OCT examination is an alternative method to investigate the presence of epiretinal membranes or other retinal pathology in such cases.

Research paper thumbnail of Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, Jan 5, 2015

To evaluate prospectively the anatomical and functional results after ocriplasmin injection in pa... more To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT). Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30-127 days). Best-corrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release. 66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure. Baseline positive predictive factors for VMT release were young age, bei...

Research paper thumbnail of A case of subretinal neovascularization treated with intravitreal ranibizumab in a patient with idiopathic juxtafoveal retinal telangiectasis

Clinical Interventions in Aging

A 65-year-old lady presented with decreased vision in her left eye (LE). Best corrected visual ac... more A 65-year-old lady presented with decreased vision in her left eye (LE). Best corrected visual acuity (BCVA) was 1/20. Complete examination showed idiopathic juxtafoveal retinal telangiectasis associated with subretinal neovascularization and she was treated with intravitreal ranibizumab every month for three months in the LE. After four months, her BCVA increased to 3/10. Fluorescein angiography (FA) showed minimal leakage and optical coherence tomography (OCT) confi rmed absence of intra-or subretinal fl uid in the macula. Examinations were repeated monthly for another 12 months and showed no recurrence. Intravitreal ranibizumab showed promising results for subretinal neovascularization due to idiopathic juxtafoveal retinal telangiectasis. A prospective study with large series of patients and controls may be necessary in order to determine the effectiveness of this treatment.

Research paper thumbnail of Central retinal vein occlusion and pseudoexfoliation syndrome

Clinical Interventions in Aging, 2015

Purpose: The purpose of this study was to investigate the existence of pseudoexfoliation syndrome... more Purpose: The purpose of this study was to investigate the existence of pseudoexfoliation syndrome (PXF) as a risk factor for the development of central retinal vein occlusion (CRVO). Methods: This was a retrospective, comparative study of the prevalence of pseudoexfoliation in three groups of patients: 48 patients with CRVO, 164 patients with branch retinal vein occlusion (BRVO), and 70 control patients (70 eyes). All patients were phakic and had no previous diagnosis of glaucoma. Patients were matched in terms of age and systemic hypertension. All patients had normal intraocular pressure (IOP) at presentation (defined as less than or equal to 21 mmHg). Results: In the CRVO group, 14 out of 48 patients were diagnosed as having PXF (29.17%). In the BRVO group, 14 out of 164 patients had PXF (8.5%), and in the control group, six out of 70 patients had PXF (8.6%). Differences of percentage between groups were statistically significant (P0.001, χ 2 test). When comparing patient subgroup with ischemic CRVO with subgroup with non-ischemic CRVO, we found that in the ischemic CRVO group, 13 out of 27 patients were diagnosed as having PXF (48.15%), and in the non-ischemic CRVO group, one out of 21 patients was diagnosed as having PXF (4.7%; P0.001, χ 2 test). The relative odds of having CRVO in patients with PXF versus patients without PXF were 4.406 (confidence interval [CI], 2.03-9.54). Conclusion: PXF and CRVO, especially ischemic, are strongly associated in our study. Our results indicate that PXF might be an independent factor for CRVO, as it is related with CRVO independently from glaucoma.

Research paper thumbnail of Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study

Graefe's Archive for Clinical and Experimental Ophthalmology, 2015

Purpose To evaluate prospectively the anatomical and functional results after ocriplasmin injecti... more Purpose To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT). Methods Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30-127 days). Bestcorrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release. Results 66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure.

Research paper thumbnail of Spontaneous Resolution of Long-Standing Macular Detachment due to Optic Disc Pit with Significant Visual Improvement

Case reports in ophthalmology, 2014

To report a case of spontaneous resolution of a long-standing serous macular detachment associate... more To report a case of spontaneous resolution of a long-standing serous macular detachment associated with an optic disc pit, leading to significant visual improvement. A 63-year-old female presented with a 6-month history of blurred vision and micropsia in her left eye. Her best-corrected visual acuity was 6/24 in the left eye, and fundoscopy revealed serous macular detachment associated with optic disc pit, which was confirmed by optical coherence tomography (OCT). The patient was offered vitrectomy as a treatment alternative, but she preferred to be reviewed conservatively. Three years after initial presentation, neither macular detachment nor subretinal fluid was evident in OCT, while the inner segment/outer segment (IS/OS) junction line was intact. Her visual acuity was improved from 6/24 to 6/12 in her left eye, remaining stable at the 6-month follow-up after resolution. We present a case of spontaneous resolution of a long-standing macular detachment associated with an optic dis...

Research paper thumbnail of Undiagnosed patent foramen ovale as a rare cause for branch retinal artery occlusion

European journal of ophthalmology, 2015

To present the case of a man with branch retinal artery occlusion (BRAO) and concomitant patent f... more To present the case of a man with branch retinal artery occlusion (BRAO) and concomitant patent foramen ovale (PFO), which was first diagnosed during the evaluation of BRAO. A 35-year-old man presented with blurred vision in the left eye for 2 days. His best-corrected visual acuity (BCVA) was 6/6 in the right eye and 6/12 in the left eye. He had no ophthalmic or medical history. Ophthalmologic examination revealed a left inferior BRAO, confirmed by fluorescein angiography. The patient underwent a thorough diagnostic workup. Cardiologic examination with transesophageal echocardiography revealed a right-to-left shunt across a PFO. The patient was treated with clopidogrel and at the 15-day review, BCVA in his left eye was 6/7.5 and the retinal edema was resolved, as detected on optical coherence tomography, but relative afferent pupillary defect was persistent. The patient had developed no other embolic event at the 9-month follow-up, having undergone an operation for PFO repair. Paten...

Research paper thumbnail of Acute zonal occult outer retinopathy with atypical findings

Case reports in medicine, 2014

Background. To report a case of acute zonal occult outer retinopathy (AZOOR) with atypical electr... more Background. To report a case of acute zonal occult outer retinopathy (AZOOR) with atypical electrophysiology findings. Case Presentation. A 23-year-old-female presented with visual acuity deterioration in her right eye accompanied by photopsia bilaterally. Corrected distance visual acuity at presentation was 20/50 in the right eye and 20/20 in the left eye. Fundus examination was unremarkable. Visual field (VF) testing revealed a large scotoma. Pattern and full-field electroretinograms (PERG and ERG) revealed macular involvement associated with generalized retinal dysfunction. Electrooculogram (EOG) light rise and the Arden ratio were within normal limits bilaterally. The patient was diagnosed with AZOOR due to clinical findings, visual field defect, and ERG findings. Conclusion. This is a case of AZOOR with characteristic VF defects and clinical symptoms presenting with atypical EOG findings.

Research paper thumbnail of Intravitreal Ranibizumab for Stage IV Proliferative Sickle Cell Retinopathy: A First Case Report

Case Reports in Ophthalmological Medicine, 2014

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Research paper thumbnail of Toric intraocular lens implantation for correction of astigmatism in cataract patients with corneal ectasia

Case reports in ophthalmology, 2013

Our purpose was to examine the long-term efficacy of toric intraocular lens (IOL) implantation in... more Our purpose was to examine the long-term efficacy of toric intraocular lens (IOL) implantation in cataract patients with high astigmatism due to corneal ectasia, who underwent phacoemulsification cataract surgery. Five eyes of 3 cataract patients with topographically stable keratoconus or pellucid macular degeneration (PMD), in which phacoemulsification with toric IOL implantation was used to correct high astigmatism, are reported. Objective and subjective refraction, visual acuity measurement and corneal topography were performed in all cases before and after cataract surgery. In all cases, there was a significant improvement in visual acuity, as well as refraction, which remained stable over time. Specifically, in subjective refraction, all patients achieved visual acuity from 7/10 to 9/10 with up to -2.50 cyl. Corneal topography also remained stable. Postoperative follow-up was 18-28 months. Cataract surgery with toric IOL implantation seems to be safe and effective in correcting...

Research paper thumbnail of Bilateral Multifocal Chorioretinitis and Optic Neuritis due to Epstein-Barr Virus: A Case Report

Case Reports in Ophthalmology, 2012

Epstein-Barr virus (EBV) is a DNA virus that mainly causes infectious mononucleosis. Ocular manif... more Epstein-Barr virus (EBV) is a DNA virus that mainly causes infectious mononucleosis. Ocular manifestations are rare and typically mild. Only a few cases of EBV involving the retina or the optic nerve have been reported. Herein, we report the case of a 67-year-old man with bilateral chorioretinitis and optic neuritis due to EBV. The patient had no previous ocular history and presented with decreased vision in both eyes. His past medical history included EBV encephalopathy, which was confirmed serologically, a few months before. Ophthalmological examination revealed bilateral chorioretinitis and optic neuritis, confirmed by fluorescein angiography as well as electrophysiological tests (visual evoked potentials and electroretinogram). It is very important to include EBV in the differential diagnosis of chorioretinal atrophic lesions. Clinicians should be aware of ocular manifestations of EBV, in order to suggest ophthalmological examination and start treatment promptly before irreversible damage to the optic nerve or retina occurs.

Research paper thumbnail of Intravitreal Ranibizumab for the Treatment of Irvine-Gass Syndrome

Ocular Immunology and Inflammation, 2014

Purpose: The purpose of our study was to evaluate the potential efficacy and safety of intravitre... more Purpose: The purpose of our study was to evaluate the potential efficacy and safety of intravitreal ranibizumab in patients with pseudophakic cystoid macular edema (CME). Methods: This retrospective study comprised 7 eyes with CME treated with intravitreal ranibizumab. Patients were examined at 1 week and 1 month after injection and monthly thereafter. Main outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety was assessed by ophthalmic examination and report of systemic adverse effects. Results: There was a statistically significant difference on BCVA (p50.001) and CRT (p50.001) before and after the ranibizumab injection. One injection appeared to be sufficient for the resolution of CME, while recurrence was observed in 1 patient, in a long-term follow-up. No observable ocular or systemic side effects were found. Conclusions: Intravitreal ranibizumab seems to be effective and safe for the treatment of pseudophakic CME, demonstrating a statistically significant difference in BCVA as well as CRT.

Research paper thumbnail of Chronic postoperative endophthalmitis caused by Actinomyces neuii

Journal of Cataract & Refractive Surgery, 2004

Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraoc... more Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraocular lens was performed in the right eye of a 73-year-old white man. Postoperatively, the patient developed a chronic, low-grade intraocular inflammation. Cultures from the aqueous specimen grew Actinomyces neuii, an unusual gram-positive bacillus. The low-grade intraocular inflammation persisted with intensive topical steroid-antibiotic medication and systemic antibiotics. A diagnostic, 3-port, pars plana vitrectomy was performed, and aqueous aspirate specimens were sent for culture and sensitivity and to look for abnormal cells. Intracameral antibiotics were not injected. The specimens were sterile to culture, and chronic inflammatory cells were reported on the vitreous specimen. On examination 6 months later, inflammation had not recurred and the best corrected visual acuity was 6/18.

Research paper thumbnail of Cryotherapy for retinopathy of prematurity: A MRI study of the surgical-anatomical relationship of the neonatal conjunctival fornices to the globe

Eye, 2001

Cryotherapy for reti nopathy of prematurity: a MRI study of the surgical anatomical relationship ... more Cryotherapy for reti nopathy of prematurity: a MRI study of the surgical anatomical relationship of the neonatal conjunctival fornices to the globe Abstract Purpose To demonstrate the surgical anatomical relationship of the neonatal conjunctival fornices to the globe in order to ascertain whether adequate cryotherapy is possible in infants with stage 3 retinopathy of prematurity using a trans-scleral approach without opening the conjunctiva. Methods Magnetic resonance (MR) scans of the orbit were performed on an adult and an infant of 38 weeks post-conceptual age with maximal posterior placement of a MR compatible replica of the Schulenburg cryoprobe in the nasal and temporal aspects of the globe. Results In the infant MR scan, the scleral indentation produced by the probe was anterior to the equator on the nasal side and at, or just anterior to, the equator on the temporal side. Nasally, the scleral indentation reached only the more anterior part and not the posterior part of zone 2 and none of zone 1. Temporally, the scleral indentation reached the central part of zone 2 but not the posterior part of zone 2 or zone 1. Conclusion The findings suggest that adequate cryotherapy with a trans-scleral approach without opening the conjunctiva is unlikely to be achieved in the more immature neonate with posteriorly located retinopathy of prematurity. To permit access of the cryoprobe to the more posterior part of the globe, one radial conjunctival incision from the corneal limbus in each quadrant may be required to achieve adequate ablation of the posterior non-vascularised retina in these high-risk infants.

Research paper thumbnail of Axial eye length measurements pre- and post- laser-assisted in situ keratomileusis using the IOL Master: a pilot study

Clinical Ophthalmology, 2010

Research paper thumbnail of The effect of phacoemulsification on late bleb failure or intraocular pressure in patients with glaucoma: a systematic review

Clinical Ophthalmology, 2012

The purpose of our systematic review is to document the adverse events that follow phacoemulsific... more The purpose of our systematic review is to document the adverse events that follow phacoemulsification in eyes with trabeculectomy due to glaucoma and to determine whether phacoemulsification jeopardizes the survival of the trabeculectomy. Our research was based on English-and non-English-language articles obtained using the Medline, Embase, Web of Science and Scopus databases. Additional studies were identified by searching bibliographies in the British Library and abstracts presented at the Association for Research in Vision and Ophthalmology annual meetings. Search terms included randomized controlled trial, controlled clinical trial, random allocation, double-blind method, matched studies and trabeculectomy failure, glaucoma-filtering operation failure, bleb failure and cataract surgery or phacoemulsification. Only prospective or retrospective matched studies testing the survival of a trabeculectomy alone versus clear corneal phacoemulsification after a trabeculectomy in patients with glaucoma were included. Data were independently extracted by two authors using predefined data fields. PubMed yielded 152 results, Scopus 235, Embase 222, and Web of Science (science citation index) 216. We read the abstracts of all the trials, and after reading the full text of 31 studies, we decided that 13 studies should be comprehensively evaluated. Current evidence does not allow us to draw safe conclusions on the scientific question so far.

Research paper thumbnail of Changing from bevacizumab to ranibizumab in age-related macular degeneration. Is it safe?

Clinical Interventions in Aging, 2009

Objective: To report our experiences in changing from intravitreal bevacizumab to ranibizumab in ... more Objective: To report our experiences in changing from intravitreal bevacizumab to ranibizumab in age-related macular degeneration (AMD). Design: Retrospective case series. Participants and methods: We retrospectively reviewed the records of 34 patients (36 eyes) who were treated with monthly injections of intravitreal bevacizumab for six months and then switched to monthly injections of ranibizumab for 12 months. Best-corrected visual acuity measurements (BCVA), contact lens biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography were performed at the baseline examination and then monthly. Chi-square test was used for statistical analysis. Results: Following bevacizumab treatment, retinal thickness decreased (P = 0.033) while BCVA improved (P = 0.040). Changing from bevacizumab to ranibizumab resulted in a transient decrease in BCVA (P = 0.045) and an increase in retinal thickness (P = 0.042). In addition, three eyes presented with a large subretinal hemorrhage. However, final retinal thickness was better than the initial thickness and the value following the bevacizumab course. No major ocular or systemic side effects were noted. Conclusions: Ranibizumab was clinically effective in the long term but the change of treatment from bevacizumab to a half-size molecule with less half-life in the vitreous such as ranibizumab contributed to a transient "instability" in the eye which may have triggered the large subretinal hemorrhage. There is insufficient experience reported in the literature in switching from one agent to another. A prospective study with controls is necessary to determine whether it is safe to change from one medication to another.

Research paper thumbnail of An atypical case of choroidal neovascularization associated with pseudoxanthoma elasticum treated with intravitreal bevacizumab: a case report

BMC Research Notes, 2013

Background: Pseudoxanthoma elasticum is an inherited disorder that is associated with accumulatio... more Background: Pseudoxanthoma elasticum is an inherited disorder that is associated with accumulation of pathologic elastic fibers in the skin, vascular walls and Bruch's membrane in the eye. Choroidal neovascularization is one of the most common causes of acute vision loss in these patients. We report an atypical case of suspected choroidal neovascularization associated with pseudoxanthoma elasticum. Case presentation: A 47-year-old Caucasian woman with pseudoxanthoma elasticum and angioid streaks was referred because of decreased and distorted vision in her right eye of one week's duration. Visual acuity was 6/12 in the right eye and 6/6 in the left eye. Fundus examination revealed angioid streaks and white intraretinal macular deposits bilaterally. Fluorescein angiography did not reveal any obvious leakage in the right eye while optical coherence tomography revealed subretinal fluid associated with an adjacent intraretinal hyperreflective structure. Autofluoresence imaging showed focal areas of increased autofluorescence corresponding to the deposits in both eyes. Over the following year the patient underwent five intravitreal injections of bevacizumab (Genentech/Roche, US) in the right eye, which resulted in visual acuity improving to 6/9 with regression of the hyperreflective structrure and complete resolution of subretinal fluid. Conclusions: Traditionally, fluorescein angiography is effective in the detection of choroidal neovascularization in patients with pseudoxanthoma elasticum. In our case, optical coherence tomography revealed subretinal fluid and an adjacent hyperreflective structure while fluorescein angiography did not reveal any obvious leakage. The sole presence of subretinal fluid does not necessarily imply the presence of choroidal neovascularization and certainly retinal pigment epithelium dysfunction could also explain subretinal fluid in these patients. However, the complete absorption of the fluid and the disappearance of the previously evident hyperreflective structure following treatment, led us to suspect choroidal neovascularization as the primary cause of the above findings. The poor natural course of choroidal neovascularization in these patients increases the importance of early detection and should result in the adaptation of a low-threshold strategy concerning the initiation of treatment.

Research paper thumbnail of Photodynamic therapy for juxtapapillary retinal capillary hemangioma: A case report

Acta Ophthalmologica, 2013

ABSTRACT Purpose Various treatment modalities have been described for retinal capillary hemangiom... more ABSTRACT Purpose Various treatment modalities have been described for retinal capillary hemangioma therapy, including observation, laser photocoagulation, cryotherapy, radiotheraphy and vitreoretinal surgery. Our purpose is to present a case of juxtapapillary retinal capillary hemangioma treated with photodynamic therapy(PDT. Methods A 69-year-old woman with no previous ocular history presented with blurred vision and photopsias in the right eye since three months. The patient underwent a thorough ophthalmological examination, including visual acuity measurement by means of Snellen charts, slit-lamp examination, intraocular pressure(IOP) measurement and dilated fundoscopy. Results At presentation, her best corrected visual acuity (BCVA) was 6/9 in the right eye and 6/6 in the left eye. The anterior segment was totally normal and IOP was normal in both eyes as well. Dilated fundoscopy revealed a yellowish, elevated area with blood vessels, on the inferior margin of the right optic disc, as optic disc edema. Fluorescein angiography and angiogram with indocyanin green confirmed the diagnosis of juxtapapillary retinal capillary hemangioma. The patient was treated with PDT with verteporfin and three months later her visual acuity was 6/7.5 in the right eye and the lesion was slightly smaller. Conclusion Retinal capillary hemangioma should be included in the differential diagnosis of optic disc edema. PDT offers promising results as far as anatomical and functional results, providing visual acuity improvement or even stabilization and restriction of enlargement of the lesion.

Research paper thumbnail of A comparison of remaining refractive error after cataract surgery using different monofocal intraocular lenses

Acta Ophthalmologica, 2011

ABSTRACT Purpose The aim of this study was to evaluate the refractive outcomes following cataract... more ABSTRACT Purpose The aim of this study was to evaluate the refractive outcomes following cataract surgery using single-piece and three-piece monofocal intraocular lenses (IOLs).Methods In this retrospective study 114 eyes were enrolled. Monofocal single-piece IOLs were used in group I (Quatrix/Croma., Austria, 61 eyes) and group II (Acrysof IQ /Alcon Laboratories Inc., Texas, 29 eyes) while three-piece IOLs were implanted in group III (Mediconsult A85UV/Mediconsult Intraocular., Germany, 24 eyes). The main clinical outcome parameter evaluated was the remaining spherical equivalent refraction (Remaining SER: post-op SER – target refraction). Kruskal-Wallis non-parametric ANOVA statistic test was used for data analysis.Results The mean target refraction was -0.52D (SD 0.34). The mean remaining SER in group I, [Iota][Iota] and III was +0.46D (SD 0.93), +0.25D (SD 0.61) and -0.29D (SD 0.97) respectively. Kruskal-Wallis H test showed that there was a statistically significant difference in the residual refractive error among the different IOL implants (H (2) =11.255, P=.004).Conclusion According to statistics, single-piece IOL implants Quatrix and AcrySof IQ induced a slight hyperopic shift whereas the refractive outcomes of three-piece implants (Mediconsult A85UV) concurred with the preoperative target. Future prospective studies and a larger number of cases are needed to verify the aforementioned results.

Research paper thumbnail of Epiretinal membranes in a patient with Scheie's syndrome diagnosed using a high-resolution SD-OCT

Acta Ophthalmologica, 2011

ABSTRACT Purpose To report a case of a young woman with Mucopolysaccharidosis I-S (Scheie&#39... more ABSTRACT Purpose To report a case of a young woman with Mucopolysaccharidosis I-S (Scheie's Syndrome) having bilateral epiretinal membranes (ERMs) which have been confirmed by the use of a high resolution spectral-domain optical coherence tomography (Spectralis SD-OCT).Methods A 28 year-old female, diagnosed with Scheie's Syndrome since 8 years old, was examined in our department. For the last 6 years she has been receiving weekly intravenous laronidase. In manifest refraction the patient achieved a visual acuity of 20/40 OD and 20/32 OS with a high hyperopic spherical equivalent correction (+7.50D, OU). Slit-lamp anterior segment examination showed the presence of diffuse corneal haze in both eyes which obscured retinal view. During dilated fundus examination she complained of severe photophobia. An OCT examination using the Spectralis SD-OCT (Heidelberg Engineering, Germany) was performed to evaluate the retinal pathology.Results The SD-OCT examination revealed the presence of epiretinal membranes in both eyes without any signs of macular edema.Conclusion In patients with mucopolysacharidosis I the view of retinal abnormalities with the use of a slit-lamp biomicroscope could be difficult due to corneal haze and severe photophobia. SD-OCT examination is an alternative method to investigate the presence of epiretinal membranes or other retinal pathology in such cases.