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Lavasidis G, Tzamalis A, Tsinopoulos I, Ziakas N. Exploring vismodegib: A non-surgical breakthrough in the management of advanced periocular basal cell carcinoma. Cancer Treat Res Commun 2024; 39:100796. [PMID: 38367414 DOI: 10.1016/j.ctarc.2024.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
The management of periocular basal cell carcinoma (BCC) is challenging due to its proximity to the eyeball. Vismodegib, a Hedgehog pathway inhibitor, has emerged as a therapeutic option for locally advanced and metastatic BCC. To critically appraise the relevant evidence, we conducted a systematic review of observational and experimental studies assessing the efficacy and safety of vismodegib for periocular BCC. Thirty-seven trials, including 435 patients, were eligible. No randomized trials were retrieved. Complete and overall clinical response rates were 20-88 % and 68-100 %, respectively. Disease progression was observed at a maximum rate of 14 %. Recurrence rates varied between 0 % and 31 %. The most common side effects were muscle cramps, dysgeusia, weight loss and alopecia. Treatment with vismodegib improved health-related quality of life. In conclusion, vismodegib represents an important novel treatment for advanced periocular BCC, with good response rates and acceptable tolerability profile. Nevertheless, its full potential needs clarification through randomized controlled trials.
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Affiliation(s)
- Georgios Lavasidis
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece; Department of Ophthalmology, Elpis General Hospital of Athens, Dimitsanas 7, 11522 Athens, Greece.
| | - Argyrios Tzamalis
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; 2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; 2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Nikolaos Ziakas
- MSc Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; 2nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
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Parekh M, Ruzza A, Rovati M, Tzamalis A, Romano D, Gupta N, Vaddavalli P, Bhogal M, Jhanji V, Sawant O, Semeraro F, Ponzin D, Jacob S, Dragnea DC, Rodriguez-Calvo-de-Mora M, Dhubhghaill SN, Fogla R, Sharma N, Jurkunas UV, Ferrari S, Romano V. DMEK surgical training: An instructional guide on various wet-lab methods. Surv Ophthalmol 2023; 68:1129-1152. [PMID: 37392969 DOI: 10.1016/j.survophthal.2023.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplantation procedure that involves selective transplantation of the Descemet membrane and endothelium. DMEK offers significant advantages over other keratoplasty techniques, such as faster visual rehabilitation, better final visual acuity due to minimal optical interface effects, lower risk of allograft rejection, and less long-term dependence on topical steroids. Despite all its advantages, DMEK has been found to be more challenging than other corneal transplantation techniques, and its steep learning curve appears to be an obstacle to its widespread use and adoption by corneal surgeons worldwide. DMEK surgical training laboratories (wet labs) provide a window of opportunity for surgeons to learn, prepare, manipulate, and deliver these grafts in a risk-free environment. Wet labs are a significant learning tool, especially for those institutions that have limited tissue availability in their local centers. We provide a step-by-step guide for preparing DMEK grafts using different techniques on human and nonhuman models with instructional videos. This article should eventually help the trainees and the educators understand the requirements for performing DMEK and conducting a DMEK wet lab and develop their skills and interests from a wide variety of available techniques.
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Affiliation(s)
- Mohit Parekh
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Marco Rovati
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Davide Romano
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Nidhi Gupta
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Pravin Vaddavalli
- Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Onkar Sawant
- Department of Research and Development, Center for Vision and Eye Banking Research, Eversight, Cleveland, OH, USA
| | - Francesco Semeraro
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Soosan Jacob
- Department of Cataract and Glaucoma Services, Dr. Agarwal's Refractive and Cornea Foundation, Chennai, India
| | | | | | | | - Rajesh Fogla
- Department of Ophthalmology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Namrata Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Ula V Jurkunas
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Vito Romano
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Eye Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
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Anastasopoulos E, Koronis S, Matsou A, Dermenoudi M, Ziakas N, Tzamalis A. Safety and Efficacy of Prostaglandin Analogues in the Immediate Postoperative Period after Uneventful Phacoemulsification. Vision (Basel) 2023; 7:45. [PMID: 37368818 DOI: 10.3390/vision7020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Prostaglandin analogues (PGAs) have been associated with the development of pseudophakic macular edema (PME) in complicated cataract cases, but evidence on their effects in uncomplicated phacoemulsification remains controversial. This two-arm, prospective, randomised study included patients with glaucoma or ocular hypertension under PGA monotherapy who were scheduled for cataract surgery. The first group continued PGA use (PGA-on), while the second discontinued PGAs for the first postoperative month and reinitiated use afterwards (PGA-off). Topical non-steroidal anti-inflammatory drugs (NSAIDs) were routinely administered to all patients during the first postoperative month. The patients were followed up for three months and the primary outcome was PME development. Secondary outcomes were corrected distance visual acuity (CDVA), central and average macular thickness (CMT and AMT), and intraocular pressure (IOP). The analysis included 22 eyes in the PGA-on group and 33 eyes in the PGA-off group. No patient developed PME. CDVA was not significantly different between the two groups (p = 0.83). CMT and AMT showed a small but statistically significant increase until the end of follow-up (p < 0.001). Mean IOP values had no significant differences between the groups at each visit (p > 0.05). At the end of follow-up, the IOP values were significantly lower than baseline in both groups (p < 0.001). In conclusion, PGA administration with concomitant topical NSAIDs appears to be a safe practice in the early postoperative period of uncomplicated phacoemulsification.
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Affiliation(s)
| | - Spyridon Koronis
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
| | - Artemis Matsou
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK
| | - Maria Dermenoudi
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
| | - Nikolaos Ziakas
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
| | - Argyrios Tzamalis
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
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Chatzistergiou V, Tzamalis A, Diafas A, Oustoglou E, Mataftsi A, Tsinopoulos I, Ziakas N. Repeatability of corneal pachymetry and epithelial thickness measurements with spectral-domain optical coherence tomography (SD-OCT) and correlation to ocular surface parameters. Int Ophthalmol 2023:10.1007/s10792-023-02713-2. [PMID: 37097425 DOI: 10.1007/s10792-023-02713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To assess the repeatability of corneal pachymetry and epithelial thickness measurements with spectral-domain optical coherence tomography (SD-OCT) and identify correlations between epithelial thickness and ocular surface parameters. METHODS Adults who happened to have prolonged computer use were recruited, excluding those with conditions interfering with corneal measurements or tear production. All subjects filled in the ocular surface disease index (OSDI) questionnaire. Three consecutive measurements of central and peripheral corneal and epithelial thickness were performed with SD-OCT (RTVue XR). Schirmer test I and tear film break-up time (TBUT) were performed. Repeatability was evaluated with intraclass correlation coefficient (ICC), coefficient of variation and repeatability limit. Spearman correlation was used for non-parametric variables. RESULTS 113 eyes of 63 subjects were included in the study. ICC was ≥ 0.989 for all corneal and ≥ 0.944 for all epithelial pachymetry segments. The best repeatability was found centrally and the worst superiorly both for corneal and epithelial measurements. Central epithelial thickness was weakly correlated with Schirmer test I (rho = 0.21), TBUT (rho = 0.02), OSDI symptoms and OSDI score (rho <|0.32|). OSDI symptoms and OSDI score were weakly correlated with Schirmer test I (rho <|0.3|) and TBUT (rho <|0.34|). CONCLUSION RTVue XR measurements of corneal and epithelial thickness are highly repeatable in all segments. The lack of correlation between epithelial thickness and ocular surface parameters could suggest the assessment of epithelial integrity with reliable methods such as SD-OCT.
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Affiliation(s)
- Vasileia Chatzistergiou
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Diafas
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Oustoglou
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Diafas A, Dastiridou A, Samouilidou M, Tzamalis A, Mataftsi A, Tsinopoulos I, Kozobolis V, Ziakas N. The effect of acetazolamide on the retinal and choroidal vasculature of the macula and the optic disc using OCT angiography. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:125-131. [PMID: 36738925 DOI: 10.1016/j.oftale.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/30/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES To investigate the effect of acetazolamide (AZ) on the retinal and choroidal ocular microvasculature in the macula and radial peripapillary capillaries (RPC) of the optic disc with OCT Angiography (OCTA). MATERIALS AND METHODS Nine-month observational cross-sectional study. Forty-five eyes from 45 healthy participants who underwent cataract surgery were recruited. Macular retina and choriocapillaris vessel density (VD) and RPC VD in the optic disc area were compared before and 60min after 250mg acetazolamide per os. Intraocular pressure (IOP) and systemic blood pressure (BP) were also measured before each scan. RESULTS Mean age was 73.1±6.9 years. VDs in the superficial (SCP) and deep (DCP) capillary plexus of the retina and the choriocapillaris (CC) in the macular area showed no significant change (P>.5, for all parameters). VD in the RPC showed no significant change with AZ (P>.5, for all parameters). Foveal and parafoveal thickness increased from 248.98 (±23.89) to 250.33 (±23.74) and from 311.62 (±16.53) to 311.98 (±16.38) (P<.001 and P=.046), respectively. IOP decreased from 13.2 (±3.0) mmHg to 11.8 (±3.2) mmHg (P<.001), while systolic and diastolic BP decreased from 144.8 (±21.8) to 137.7 (±19.0) and from 80.0 (±12.7) to 76.2 (±11.7) (P=.021 and P=.030), respectively. CONCLUSIONS OCTA imaging did not reveal any significant changes in the VD of the optic disc or the retinal and choroidal VD in the macula with oral AZ one hour after its administration in otherwise healthy participants who underwent cataract surgery.
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Affiliation(s)
- A Diafas
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece; St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
| | - A Dastiridou
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - M Samouilidou
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - A Tzamalis
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - A Mataftsi
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - I Tsinopoulos
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - V Kozobolis
- Instituto Oftalmológico de Tracia, Universidad Demócrito de Tracia, Alexandroupoli, Greece
| | - N Ziakas
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
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Koronis S, Matsou A, Tzamalis A, Dermenoudi M, Ziakas N, Anastasopoulos E. Comparison of two protocols of diode laser transscleral cyclophotocoagulation in refractory glaucoma. Eur J Ophthalmol 2023; 33:976-983. [PMID: 38450608 DOI: 10.1177/11206721221127767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Diode laser transscleral cyclophotocoagulation (DLTSCPC) remains the most commonly used cyclodestructive procedure. Nonetheless, there is no common consensus on a standardized technique. METHODS In this prospective randomized pilot study we compare the "pop"-titrated and "slow-burn" DLTSCPC techniques for a follow-up period of 3 months. The major outcomes of this study were intraocular pressure (IOP) before and after the procedure and the incidence of adverse events. Furthermore, postoperative pain, postoperative intraocular inflammation and corrected distance visual acuity (CDVA) were evaluated. RESULTS Mean baseline IOP decreased from 37.9 ± 12.7 mmHg in the pop group and 41.2 ± 9.6 mmHg in the slow-burn group to 20.3 ± 13.9 mmHg and 21.3 ± 13.4 mmHg at the final follow-up visit, corresponding to a 45.8 ± 31.7% and 46.3 ± 32.6% reduction respectively. 64.3% and 57.1% of patients had IOP ≥6 and≤ 21 mmHg in the pop and slow-burn groups respectively. The occurrence of adverse events was similar in both groups, with 1 case of hyphema in the pop group and 2 cases in the slow-burn group, and 1 case of hypotony in each group. Mean CDVA remained unchanged until the end of follow-up from 2.05 ± 0.84 to 2.04 ± 0.8 logMAR in the pop group and from 1.93 ± 0.78 to 1.89 ± 0.7 logMAR in the slow-burn group. Nonetheless, 4 eyes in each group encountered CDVA loss. Postoperative pain and inflammation were also similar between groups. DISCUSSION At the 3rd postoperative month, safety and efficacy was similar in the two techniques. The relative ease of the slow-burn technique may make its application more appealing to ophthalmic surgeons beyond glaucoma specialists.
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Affiliation(s)
- Spyridon Koronis
- Department of Ophthalmology, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Artemis Matsou
- Queen Victoria Hospital NHS Foundation Trust, London, UK
| | - Argyrios Tzamalis
- Department of Ophthalmology, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Maria Dermenoudi
- Department of Ophthalmology, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Nikolaos Ziakas
- Department of Ophthalmology, General Hospital Papageorgiou, Thessaloniki, Greece
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Oustoglou E, Tzamalis A, Banou L, Christou CD, Tsinopoulos I, Samouilidou M, Mataftsi A, Ziakas N. When should cataract surgeons seek assistance from experienced colleagues? Int Ophthalmol 2023; 43:387-395. [PMID: 35864285 DOI: 10.1007/s10792-022-02434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess which cases should be assorted exclusively to high-volume surgeons and identify when should a cataract surgeon seek assistance from a senior colleague. METHODS The medical records of 2853 patients with age-related cataract were reviewed. Preoperative risk factors were documented for each case, and they were divided into surgeons who had more (> 400 surgeries/year) or less experience (< 400 surgeries/year). Ophthalmology residents were excluded from this review. The cases that involved posterior capsule rupture, dropped nucleus, zonular dehiscence and anterior capsular tear with or without vitreous loss were defined as "complicated". RESULTS From the 3247 cataract extraction surgeries that were reviewed, we were unable to identify any statistically significant difference in the complication rates between the two surgeon groups. In the stepwise regression analysis, both groups supported advanced age (> 85) and mature cataracts with up to fourfold odds ratios (OR). Low-volume surgeons had a fivefold OR in the presence of phacodonesis and a fourfold OR in the case of posterior polar cataract. Finally, the low- and high-volume groups had their highest complication rates in the cumulative four and five risk factors, respectively. CONCLUSION In the presence of advanced age, mature cataracts, phacodonesis and posterior polar cataract, the complication rates appear to be higher for the less experienced surgeons. Meticulous preoperative assessment with detailed documentation of each patient's risk factors can result in fewer complications. The medical complexity of each case can be used as indicator of whether a more experienced surgeon should perform the surgery or not.
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Affiliation(s)
- Eirini Oustoglou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lamprini Banou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysanthos D Christou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Samouilidou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tzamalis A, Hristou CDC, Prousali E, Mataftsi A, Ziakas N. What is the Real Cost of Intraoperative Floppy Iris Syndrome in Cataract Surgery? J Ophthalmic Vis Res 2023; 18:138-140. [PMID: 36937203 PMCID: PMC10020785 DOI: 10.18502/jovr.v18i1.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 09/29/2022] [Indexed: 02/24/2023] Open
Abstract
This is a Letter and does not have an abstract. Please download the PDF or view the article in HTML.
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Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Chrysanthos D C Hristou
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Efthymia Prousali
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Christou CD, Esagian SM, Ziakas N, Prousali E, Tzamalis A. Factors predisposing to intraoperative floppy-iris syndrome: An up-to-date meta-analysis. J Cataract Refract Surg 2022; 48:1335-1341. [PMID: 35858619 DOI: 10.1097/j.jcrs.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
Intraoperative floppy-iris syndrome (IFIS) is an increasingly recognized condition that is proven to lead to higher rates of intraoperative complications. This study provides an updated systematic review and meta-analysis regarding all the identified factors predisposing to IFIS. The study was performed in accordance with the PRISMA guidelines. 38 studies were finally included in the meta-analysis. The factors that were found to predispose to IFIS significantly were male sex (odds ratio [OR], 4.25; CI, 2.58-7.01), hypertension (OR, 1.55; CI, 1.01-2.37), tamsulosin (OR, 31.06; CI, 13.74-70.22), finasteride (OR, 4.60; CI, 1.97-10.73), benzodiazepines (OR, 2.88; CI, 1.17-7.12), and antipsychotics intake (OR, 6.91; CI, 2.22-21.50). A decreased dilated pupil preoperatively was found predisposing to IFIS (weighted mean difference -0.93; CI, -1.19 to -0.67). Intracameral epinephrine, which was investigated as a potential prophylactic measure for preventing IFIS, did not reach statistical significance (OR, 0.29; CI, 0.08-1.06). A comprehensive preoperative assessment of all risk factors is vital to stratify the surgical risk, which is crucial in addressing IFIS because unanticipated IFIS could turn a routine surgery into one of significant visual morbidity.
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Affiliation(s)
- Chrysanthos D Christou
- From the 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Koronis S, Diafas A, Tzamalis A, Samouilidou M, Mataftsi A, Ziakas N. Late-onset interface fluid syndrome: A case report and literature review. Semin Ophthalmol 2022; 37:839-848. [PMID: 35866219 DOI: 10.1080/08820538.2022.2102928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To present a case of late-onset interface fluid syndrome (IFS) and a literature review on this rare clinical entity. INTRODUCTION IFS is an uncommon complication of laser in situ keratomileusis (LASIK). Although generally appearing in the early postoperative period, IFS has been reported even years after LASIK. METHODS A case report of IFS manifesting 19 years after uneventful LASIK, which prompted a literature search for similar, late-onset cases in MEDLINE PubMed. This article reports on a case of IFS appearing 19 years after LASIK surgery, including extensive patient history and analytical presentation of clinical findings, ancillary testing, and short-term follow-up. Furthermore, a literature search for similar cases was performed on MEDLINE, focusing on the etiology and management of late-onset IFS. RESULTS Through thorough ancillary testing, the interface fluid was attributed to elevated intraocular pressure (IOP) arising from primary open-angle glaucoma. Antiglaucoma drops resulted in complete fluid regression. A narrative review was conducted based on the 29 case reports that were recovered from the literature search. CONCLUSION IFS represents an uncommon complication that could appear years after LASIK. Careful clinical examination and anterior segment optical coherence tomography promote early diagnosis. Similar cases may manifest due to elevated IOP of variable etiology or as a result of endothelial dysfunction. Depending on the etiology, IOP control or keratoplasty may resolve the condition.
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Affiliation(s)
- Spyridon Koronis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Asterios Diafas
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.,St Paul's Eye Unit, Royal Liverpool University Hotel, Liverpool, UK
| | - Argyrios Tzamalis
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Maria Samouilidou
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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11
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Prousali E, Haidich AB, Dastiridou A, Tzamalis A, Ziakas N, Mataftsi A. Part-time Versus Full-time Spectacles for Myopia Control (ParMA Study): A Randomized Clinical Trial. Cureus 2022; 14:e25995. [PMID: 35720776 PMCID: PMC9202340 DOI: 10.7759/cureus.25995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/05/2022] Open
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12
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Christou CD, Athanasiadou EC, Tooulias AI, Tzamalis A, Tsoulfas G. The process of estimating the cost of surgery: Providing a practical framework for surgeons. Int J Health Plann Manage 2022; 37:1926-1940. [PMID: 35191067 DOI: 10.1002/hpm.3431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/25/2021] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
Over the last decades, health care costs have been increasing at an alarming, exponential rate which is considered unsustainable. Surgical care utilizes one-third of health care costs. Estimating, evaluating, and understanding the cost of surgery is a vital step towards cost management and reduction. Current cost estimation studies and cost-effectiveness studies have vast disparities in their methodology, with published costs of Operating Room varying from as low as $7 and as high as $113 per minute. Costs in surgery are distinguished as direct and indirect. Allocation of direct costs involves identification, measurement, and valuation processes. Allocation of indirect costs involves the allocation of capital and overhead costs and of indirect department costs. Annualised capital costs and overhead hospital costs are then allocated to surgery by either the cost-centre allocation or the activity-based allocation frameworks. Indirect department costs are allocated to a specific surgery by weighted service allocation or hourly rate allocation or inpatient day allocation, or marginal markup allocation. The growing societal, financial and political pressure for cost reduction has brought cost analysis to the forefront of healthcare discussions. Thus, we believe that almost every single surgeon will eventually enter the field of healthcare economics by necessity. This review aims to provide surgeons with a practical framework for engaging in cost estimation studies.
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Affiliation(s)
- Chrysanthos D Christou
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni C Athanasiadou
- Surgical Oncology Department, Theageneio Anticancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Andreas I Tooulias
- First General Surgery Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- Second Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsoulfas
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Tzamalis A, Ziakas N, Chranioti A, Giannoulis D, Kapantais D, Tsatsos M, Tsaousis K. Descemet's stripping automated endothelial keratoplasty using donor tissue from an 83-day-old infant. J Curr Ophthalmol 2022; 34:257-259. [PMID: 36147264 PMCID: PMC9487010 DOI: 10.4103/joco.joco_242_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/19/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification in an adult recipient using endothelial graft from an 83-day-old infant donor. Methods: A corneoscleral button was obtained from an infant donor and a DSAEK graft was prepared using a microkeratome. In comparison to the standard technique of DSAEK graft preparation some modifications were made in order to avoid inadvertent perforation, as the donor cornea had a very spherical shape, probably due to the very young age of the donor. The DSAEK graft was transplanted to the left eye of a 68-year-old woman suffering from Fuchs' endothelial dystrophy. Her preoperative best-corrected visual acuity (BCVA) in that eye was 20/100 and central corneal thickness 831 μm. Results: An uneventful DSAEK combined with phacoemulsification was performed. The main complication noted was detachment of the peripheral part and contraction of the corneal graft, observed two months after the procedure. The implanted tissue remained centrally attached with a BCVA of 20/40, 3 years postoperatively. Conclusion: This case report highlights the difficulties emerging from preparation and implantation using an endothelial graft tissue from the youngest ever reported donor.
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14
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Prousali E, Haidich AB, Tzamalis A, Ziakas N, Mataftsi A. 'The role of accommodative function in myopic development: A review.'. Semin Ophthalmol 2021; 37:455-461. [PMID: 34821535 DOI: 10.1080/08820538.2021.2006724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose: Involvement of the accommodative mechanism in myopia progression has been hypothesised and investigated over the past years, given the emerging myopia crisis across the globe. This review aimed at exploring the clinical role of accommodative function in myopia development.Methods: A literature search of MEDLINE and EMBASE was performed from conception to May 2021.Results:The initial stimulus for accommodation is derived from near work, in an attempt of the eye to obtain a clear image. When there is a lag in the accommodative response, the resulting blurred retinal image is believed to precipitate axial elongation and lead to myopia development. The dynamic accommodative functions implicated in binocular vision evaluation include the accommodative accuracy, amplitude and facility. Association of these accommodative parameters to current treatment options for myopia control is of great clinical interest. Effective myopia treatments, including orthokeratology, multifocal lenses and atropine eyedrops appear to induce changes in the dynamic accommodative response.Conclusions: Current knowledge indicates an evident relationship between the accommodative mechanism and myopia development. Further investigation by future studies is warranted in order to explore the use of accommodative function as a promising myopia-monitoring tool.
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Affiliation(s)
- Efthymia Prousali
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- 2 Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2 Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2 Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Aims:
The aim of this systematic review is to identify all the available data on human
lens proteomics with a critical role in age-related cataract formation in order to elucidate the physiopathology
of the aging lens.
Methods::
We searched on Medline and Cochrane databases. The search generated 328
manuscripts. We included nine original proteomic studies that investigated human cataractous lenses.
Results:
Deamidation was the major age-related post-translational modification. There was a significant
increase in the amount of αA-crystallin D-isoAsp58 present at all ages, while an increase in
the extent of Trp oxidation was apparent in cataract lenses when compared to aged normal lense.
During aging, enzymes with oxidized cysteine at critical sites included GAPDH, glutathione synthase,
aldehyde dehydrogenase, sorbitol dehydrogenase, and PARK7.
Conclusion:
D-isoAsp in αA crystallin could be associated with the development of age-related cataract
in humans by contributing to the denaturation of a crystallin and decreasing its ability to act
as a chaperone. Oxidation of Trp may be associated with nuclear cataract formation in humans,
while the role of oxidant stress in age-related cataract formation is dominant.
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Affiliation(s)
- Christina Karakosta
- Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michalis Aivaliotis
- Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Mataftsi A, Seliniotaki AK, Tzamalis A, Ziakas N. Treatment of non-type 1 retinopathy of prematurity in the Postnatal Growth and Retinopathy of Prematurity (G-ROP) study. J AAPOS 2021; 25:319. [PMID: 34619355 DOI: 10.1016/j.jaapos.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 10/20/2022]
Affiliation(s)
- Asimina Mataftsi
- IInd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece
| | | | - Argyrios Tzamalis
- IInd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Ziakas
- IInd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece
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Tzamalis A, Tsiampali C, Prousali E, Mataftsi A, Ziakas N, Kynigopoulos M. Reliability of Refraction, Keratometry, and Intraocular Pressure Measurements with an Automated All-in-one Device. Optom Vis Sci 2021; 98:1169-1176. [PMID: 34620780 DOI: 10.1097/opx.0000000000001781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This study explores the reliability of TonoRef II (Nidek, Tokyo, Japan), which represents a simple tool to obtain rapid refractometry and tonometry measurements. The present device demonstrates very high repeatability of refraction and intraocular pressure (IOP) readings as compared with subjective measurements and a higher concordance of IOP readings to Goldmann application tonometry (GAT). PURPOSE This study aimed to evaluate the repeatability of measurements acquired with the Autorefractometer/Keratometer/Tonometer TonoRef II and assess their agreement to subjective measurements and readings of other established devices. METHODS In a cross-sectional study, 54 eyes of 54 healthy subjects were enrolled. Each subject underwent five measurements with the TonoRef II, three measurements with the Canon RK-F1 Autorefractor Keratometer (Canon Europe NV, Amstelveen, the Netherlands), three IOP measurements with the Canon TX-F Noncontact Tonometer (Canon Inc., Tokyo, Japan), three measurements with GAT, and a thorough subjective refraction. Repeatability coefficient (r), intraclass correlation coefficient (ICC), and Bland-Altman plots were used to evaluate repeatability of readings and agreement to the subjective values. RESULTS TonoRef II showed high repeatability (ICC >0.9) in all parameters tested (sphere, r = 0.157; cylinder, r = 0.196; IOP, r = 2.653). A strong correlation was found between TonoRef and Canon instruments (P < .001 in all parameters). Mean differences and limits of agreement (mean ± 1.96 standard deviation) were -0.01 ± 0.69 D, -0.11 ± 0.7 D, and 2.1 ± 3.4 mmHg for sphere, cylinder, and IOP, respectively. Both autorefractors achieved a very good to excellent agreement to the values obtained with the subjective refraction for most of the parameters tested, without any significant difference to each other (P > .05). Intraocular pressure measurements of TonoRef II showed higher agreement to the GAT values compared with those obtained with the Canon tonometer (ICC, 0.9114 and 0.7002, respectively; P < .001). CONCLUSIONS Intraocular pressure and refraction readings acquired with TonoRef II demonstrate very high repeatability and agreement to the subjective measurements. Regarding IOP evaluation, TonoRef II shows higher concordance to GAT compared with another established noncontact tonometer.
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Affiliation(s)
| | - Chara Tsiampali
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Prousali
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Pagano L, Gadhvi KA, Borroni D, Iselin KC, Vinciguerra R, Tzamalis A, Kaye SB, Romano V. Bilateral Keratoconus Progression: Immediate Versus Delayed Sequential Bilateral Corneal Cross-linking. J Refract Surg 2021; 36:552-556. [PMID: 32785729 DOI: 10.3928/1081597x-20200629-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare immediate sequential bilateral corneal cross-linking (CXL), wherein both eyes are treated on the same day, to delayed sequential bilateral CXL, where each eye is treated on different days for bilateral progressive keratoconus. METHODS This was a retrospective case note review of all patients who underwent sequential CXL or delayed CXL for keratoconus at Royal Liverpool University Hospital, United Kingdom. Parameters assessed were the change in maximum keratometry and minimum central corneal thickness on corneal tomography scan, corrected distance visual acuity, and cost estimates of treatment. RESULTS A total of 38 patients (31 men and 7 women) with keratoconus with a mean age of 25.3 ± 7.0 years were included. Twenty patients received sequential CXL and 18 received delayed CXL treatment. In both the sequential CXL and delayed CXL groups, the treated eye(s) showed no evidence of progression after the corneal CXL treatment at last follow-up visit after 358 ± 158 days for sequential CXL and 451 ± 205 days for delayed CXL. There were no complications from the treatment in either group. In the delayed CXL group, the mean time interval between the two CXL procedures was 146 ± 129 days. Five of 18 patients (27%) showed progression of keratoconus in their second eye during the waiting time. Economical evaluation showed that four visits were saved for each sequential CXL treatment compared to delayed CXL. CONCLUSIONS Delayed CXL carries a risk of progression in the second eye and is associated with a higher economic burden. [J Refract Surg. 2020;36(8):552-556.].
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Anisimova N, Arbisser L, Tzamalis A, Petrovski BÉ, Shilova N, Petrovski G, Anisimov S, Malyugin B. Corectopia grading: A novel classification system. Semin Ophthalmol 2021; 37:105-110. [PMID: 34057013 DOI: 10.1080/08820538.2021.1926517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: To present and validate the novel grading system for objective classification of corectopia.Subjects and Methods: We evaluated 28 eyes of 28 patients with or without corectopia and validated the grading and classification system for corectopia according to three major criteria: (i) direction, (ii) extent, and (iii) alteration of mydriasis. Intraclass correlation coefficient (ICC) and inter-rater agreement between 7 inexperienced and 1 experienced ophthalmologist against a golden standard (GS) were calculated.Results: The ICC for the 7 inexperienced ophthalmologists regarding the grading of direction and centration of the pupil was 0.83 (95% confidence interval (CI), 0.74 to 0.90; p < .001) and 0.57 (95% CI, 0.43 to 0.72; p < .001), respectively. The inter-rater agreement was the same or almost the same in cases of pupil decentration between the inexperienced, experienced ophthalmologists and the GS (k = 0.82; 95% CI, 0.64-1.00; p < .001). In assessing the direction of pupil displacement, the inter-rater agreement was almost perfect between the inexperienced (k = 0.93; 95% CI, 0.84-1.00; p < .001) and experienced (k = 0.92; 95% CI: 0.82-1.02; p < .001) ophthalmologists and the GS.Conclusion: The first detailed clinical classification is proposed for objective corectopia grading particularly relevant in documenting and assessing progressive disease. It was confirmed to be acceptable for clinical use by inexperienced and experienced ophthalmologists alike.
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Affiliation(s)
- Natalia Anisimova
- Department of Eye Diseases, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Private Eye Center Vostok-Prozrenie, Moscow, Russia
| | - Lisa Arbisser
- Department of Ophthalmology, John A. Moran Eye Center University of Utah, Salt Lake City, Utah, USA
| | - Argyrios Tzamalis
- Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Beáta Éva Petrovski
- Center for Eye Research Department of Ophthalmology, Institute of Clinical MedicineFaculty of Medicine, University of Oslo, Oslo, Norway
| | - Natalya Shilova
- Department of Cataract and Implant Surgery, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sergey Anisimov
- Department of Eye Diseases, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Private Eye Center Vostok-Prozrenie, Moscow, Russia
| | - Boris Malyugin
- Department of Eye Diseases, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Department of Cataract and Implant Surgery, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
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20
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Tzamalis A, Diafas A, Vinciguerra R, Ziakas N, Kymionis G. Repeated Corneal Cross-linking (CXL) in Keratoconus Progression After Primary Treatment: Updated Perspectives. Semin Ophthalmol 2021; 36:523-530. [PMID: 33656958 DOI: 10.1080/08820538.2021.1893762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Corneal collagen cross-linking (CXL) has recently become the preferred practice in the management of progressive keratoconus and other corneal ectasias as it has been proven to be successful in halting progression of the disease with an excellent safety and efficacy profile. However, there is a known variation regarding the response to CXL, depending on several parameters related either to the treatment protocol, patient characteristics, or corneal biomechanical properties. In fact, continuing progression of keratoconus has been noted in some cases despite prior treatment with CXL.Methods: The aim of this article is to provide an updated review of all published results on repeated-CXL, focusing on the indications and the efficacy of repeated treatment and highlighting possible explanations of progression after primary CXL. Conclusions: The diagnosis of primary treatment failure should always be made based on specific clinical and imaging criteria, with repeated and consistent measurements, in order to exclude pseudoprogression. In cases of confirmed progression, physicians need to decide whether repeating CXL could be an option to enhance corneal stability without any complications.
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Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Asterios Diafas
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Nikolaos Ziakas
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - George Kymionis
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile Des Aveugles, Switzerland
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21
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Tzamalis A, Karafotaki K, Karipidi K, Diafas A, Mataftsi A, Tsinopoulos I, Ziakas N. The impact of COVID-19 lockdown on cataract surgery: a surgeons' perspective. Clin Exp Optom 2021; 104:705-710. [PMID: 33689644 DOI: 10.1080/08164622.2021.1880866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
CLINICAL RELEVANCE In the last months, the whole world is dealing with an unprecedented public health crisis due to COVID-19 outbreak. Consequently, many governments have implemented lockdowns on a national level, affecting, among others, ophthalmic surgical practice in a globe scale. BACKGROUND The aim of this study is to evaluate the impact of surgical theatre lockdown due to COVID-19 pandemic on the surgical performance of cataract surgeons. METHODS Intraoperative complications and surgical time of the first 160 cataract surgeries performed by eight consultants (20 cases each) after a two-month lockdown were recorded and analysed in a cross-sectional study. The results were plotted against the last 30 cases of each surgeon before the implementation of the lockdown (240 cases). Cataract surgeons were asked to rate their subjective perspective and difficulties faced after re-opening through a questionnaire. RESULTS The average duration of all surgeries after the lockdown was 19.1 ± 6.2 minutes showing a 14% increase compared to the one before the lockdown (16.8 ± 5.1 minutes, p = 0.0001). The complications rate was 2.09% (5/240 cases) before the abstention and 3.12% (5/160 cases) after the abstention not yielding any statistically significant difference (p = 0.74). When complicated surgeries were excluded from the analysis, surgical time was still higher after the lockdown (18.9 ± 5.9 minutes) than before (16.6 ± 5.0 minutes, p < 0.0001). 37.5% of consultants (3/8) stated that the two-month abstention from cataract surgeries has affected their surgical skills somewhat or a lot, while 62.5% (5/8) reported being more careful in their first cases after the lockdown. Most complications occurred in the hands of one surgeon who stated to be very anxious upon restart. CONCLUSION The operating theatres' lockdown due to COVID-19 pandemic did not seem to affect the intraoperative complications rate in cataract surgery. A slight increase of surgical duration was noted, while most surgeons reported being more careful upon restart.
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Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Kyriaki Karafotaki
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Kalliopi Karipidi
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Asterios Diafas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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22
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Tzamalis A, Christou CD, Tsinopoulos I, Ziakas N. Risk factors of floppy iris syndrome: current insights. Expert Review of Ophthalmology 2021. [DOI: 10.1080/17469899.2021.1877539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
| | - Chrysanthos D. Christou
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
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Oustoglou E, Tzamalis A, Mamais I, Dermenoudi M, Tsaousis KT, Ziakas N, Tsinopoulos I. Reoperations After Cataract Surgery: Is the Incidence Predictable Through a Risk Factor Stratification System? Cureus 2020; 12:e10693. [PMID: 33133858 PMCID: PMC7593208 DOI: 10.7759/cureus.10693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction The objective of the study was to quantify the number of procedures needed to achieve the best possible surgical outcome, depending on the number and type of risk factors identified. Methods Two independent observers reviewed the medical records of 1,502 patients who underwent phacoemulsification surgery, during a two-year period (January 1, 2014 to December 31, 2015). Preoperative risk factors were documented according to the stratification system used. Based on the total risk score, each case was allocated to one of four risk groups with 0, 1-2, 3-5, and >6 total risk factors, respectively. All qualitative and quantitative characteristics were gathered and included in a multivariate analysis. Results A total of 1,792 eyes were included. Αge over 88 years, low cooperation ability with the patient, and surgeries performed by residents tended to have more often complications, while white/intumescent cataract, iridodonesis/phacodonesis, α1 blockers intake, and male gender are risk factors positively associated with more than one surgery. Conclusions Risk factors tend to be prognostic for possible intraoperative complications. The number of procedures needed for the best possible surgical outcome seems to depend on these preoperative risk factors. A stratification method increases the level of awareness of the surgeon, and therefore may decrease the number of complications and even procedures while enhancing the "safe" practice and skills of residents.
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Affiliation(s)
- Eirini Oustoglou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece, Athens, GRC.,Department of Health and Life Sciences/Epidemiology, Biostatistics and Methodology Research, European University of Cyprus, Nicosia, CYP
| | - Maria Dermenoudi
- Department of Ophthalmology, Health Center of Neapolis, Thessaloniki, GRC
| | - Konstantinos T Tsaousis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaliniki, GRC
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
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Tzamalis A, Kynigopoulos M, Pallas G, Tsinopoulos I, Ziakas N. Influence of Intraocular Lens Asphericity and Blue Light Filtering on Visual Outcome, Contrast Sensitivity, and Aberrometry after Uneventful Cataract Extraction. J Ophthalmic Vis Res 2020; 15:308-317. [PMID: 32864061 PMCID: PMC7431729 DOI: 10.18502/jovr.v15i3.7449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 12/31/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the effect of asphericity and blue light filter (BLF) of three different intraocular lenses (IOLs) on the visual performance, second- and third-order aberrations (defocus, coma, trefoil), and contrast sensitivity after uneventful cataract surgery. Methods One hundred and twenty eyes of 60 patients with clinically significant cataract were randomly assigned to receive one of the three IOL types: Bioline Yellow Accurate (aspheric, with BLF, i-medical, Germany), BioAcryl 60125 (spherical, without BLF, Biotech, France), and H65C/N (aspheric, without BLF, PhysIOL, Belgium). Each IOL was implanted in 40 eyes. Complete ophthalmologic examination, functional acuity contrast testing and wavefront analysis were performed 60 days postoperatively. Results The mean postoperative best-corrected visual acuity (BCVA) was 0.95 ± 0.08, not differing statistically among the IOL groups (P = 0.83). Mean defocus and coma values did not yield any statistically significant difference through the IOL groups varying from –0.784 to –0.614 μm and 0.129 to 0.198 μm (P = 0.79 and 0.34, respectively). Bioline Yellow Accurate IOL presented less trefoil aberrations, 0.108 ± 0.05 μm, compared to the other two IOL types (BioAcryl [0.206 ± 0.19 μm] and Physiol [0.193 ± 0.17 μm], P< 0.05). Contrast sensitivity values did not differ among the groups under all lighting conditions. Bioline Yellow IOL showed a statistically higher loss of contrast sensitivity (between mesopic and mesopic with glare conditions) compared to the BioAcryl and PhysIOL in 12 and 3 cpd spatial frequencies, respectively (P< 0.05). Conclusion Bioline Yellow IOL indicated lower contrast sensitivity under mesopic conditions when glare was applied but resulted in less trefoil aberrations after uneventful cataract surgery. No further differences were noted in postoperative visual performance among three IOL groups.
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Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.,Department of Ophthalmology, Clinic Pallas, Olten, Switzerland
| | | | - Grigoris Pallas
- Department of Ophthalmology, Clinic Pallas, Olten, Switzerland
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Lamprogiannis L, Tzamalis A, Tsaousis KT, Ziakas N, Symeonidis C, Karamitsos A, Dimitrakos S, Tsinopoulos I. Ophthalmology Training in Greece as Perceived by Resident Ophthalmologists in the Times of Crisis: A National, Questionnaire-based Survey. J Curr Ophthalmol 2020; 32:88-93. [PMID: 32510019 PMCID: PMC7265267 DOI: 10.1016/j.joco.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/06/2019] [Accepted: 10/16/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose: To assess the level of perceived satisfaction with the current level of ophthalmology training in Greece from the perspective of residents and to identify deficiencies in the training curriculum. Methods: This is a prospective, cross-sectional questionnaire-based study. An online, semi-structured questionnaire was designed to evaluate ophthalmology residents' extent of satisfaction with the quality of their postgraduate medical training. The survey was divided in two parts: demographics and evaluation of training. Resident ophthalmologists in all teaching hospitals in Greece were contacted and encouraged to complete it. Results: A response rate of 53.8% was achieved. Two out of three participants stated their disappointment with the quality of training they received and deemed the four-year residency training program as insufficient. Surgical training was also viewed as unsatisfactory by the majority of the respondents. An interest in subspecialty training, as well as a significant participation in research activities, was noted. Conclusions: Both training and overall satisfaction with working conditions must be improved to preserve the appeal of ophthalmology for young academics. A new, structured curriculum, reduction of unnecessary bureaucracy, and improved surgical training rank among the most essential priorities in order to improve postgraduate ophthalmology training.
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Affiliation(s)
- Lampros Lamprogiannis
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Argyrios Tzamalis
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Konstantinos T Tsaousis
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Nikolaos Ziakas
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Chrysanthos Symeonidis
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Athanasios Karamitsos
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Stavros Dimitrakos
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Ioannis Tsinopoulos
- 2 Department of Ophthalmology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Macedonia, Greece
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Tzamalis A, Dermenoudi M, Diafas A, Oustoglou E, Matsou A, Ziakas N, Tsinopoulos I. Safety and efficacy of hypertonic saline solution (5%) versus placebo in the treatment of postoperative corneal edema after uneventful phacoemulsification: a randomized double-blind study. Int Ophthalmol 2020; 40:2139-2150. [PMID: 32372161 DOI: 10.1007/s10792-020-01395-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate safety and efficacy of hypertonic saline solution administration after uneventful cataract surgery. DESIGN Prospective double-blind randomized study METHODS: In total, 183 eyes of 183 patients undergoing phacoemulsification were randomly allocated into two equal groups. Treatment group (TG) subjects received single-dose hypertonic (NaCl 5%) solution 4 times daily for 14 days, while placebo group (PG) received single dose of normal saline solution (0.9%) at the same frequency in addition to ordinary postoperative treatment. All patients underwent assessment of central corneal thickness (CCT), endothelial cell density (ECD), best-corrected visual acuity (BCVA), clinical staging of postoperative corneal edema and questionnaire regarding the procedure success and impact on patient's life. Measurements were taken at baseline and 1, 4, 9 and 30 days following surgery. RESULTS CCT increased by 134.67 ± 94.51 μm (25.1 ± 19.4%) on postoperative day 1, without any difference between study groups (p = 0.58). Corneal edema showed a significant recession in TG compared to PG on day 4, in terms of both pachymetry (10.73% vs 7.39%, p = 0.004), BCVA (BCVATG = 0.64 ± 0.24 [logMARTG = 0.25 ± 0.3], BCVAPG = 0.56 ± 0.23 [logMARPG = 0.33 ± 0.3], p = 0.04) and clinical staging (p = 0.02). Similar results were recorded on postoperative day 9 in subjects demonstrating marked corneal edema on the first postoperative day. Endothelial cell loss showed no statistically significant difference between study groups (p = 0.48). No adverse events were recorded in relation to treatment. More patients in the TG (92.4% vs 57.1% in the PG) reported a subjectively clear vision 1 week postoperatively (p = 0.04). CONCLUSION The use of 5% hypertonic saline solution is found to be a safe and effective adjunct in the management of postoperative corneal edema after uneventful phacoemulsification, achieving rapid corneal clearance and expediting a good visual outcome, especially in cases with marked postoperative edema.
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Affiliation(s)
- Argyrios Tzamalis
- Department of Ophthalmology, Faculty of Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece.
| | - Maria Dermenoudi
- Department of Ophthalmology, Faculty of Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Asterios Diafas
- Department of Ophthalmology, Faculty of Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Eirini Oustoglou
- Department of Ophthalmology, Faculty of Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Artemis Matsou
- Department of Ophthalmology, Faculty of Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Nikolaos Ziakas
- Department of Ophthalmology, Faculty of Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- Department of Ophthalmology, Faculty of Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
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Tzamalis A, Diafas A, Riga P, Konstantinidis I, Ziakas N. Onodi Cell Mucocele-Associated Optic Neuropathy: A Rare Case Report and Review of the Literature. J Curr Ophthalmol 2020; 32:107-113. [PMID: 32510023 PMCID: PMC7265265 DOI: 10.1016/j.joco.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 10/31/2022] Open
Abstract
Purpose To present a rare case report of Onodi cell-associated optic neuropathy, conducting a review of the literature. Methods A 36-year-old male presented with an 18-h history of acute deterioration of vision in his left eye (LE). Ophthalmic examination and Magnetic Resonance Imaging (MRI) were consistent with an Onodi cell-associated compressive optic neuropathy. Results Despite immediate, successful surgical decompression, severe optic nerve atrophy and permanent visual loss occurred during early postoperative period. The reported case gives rise to different hypotheses regarding pathophysiology that may lead to irreversible blindness. A systematic review of the respective literature is provided attempting to compare different approaches in the management of Onodi cell-associated compressive optic neuropathy and assess their efficacy in the final visual outcome. Poor initial visual acuity (VA) may represent a bad prognostic factor. Moreover, age and gender do not seem to significantly influence the outcome. Conclusion This report and associated literature review highlight the importance of the radiologic characteristics and early diagnosis in the final visual outcome of the Onodi cell-associated optic neuropathy. High level of suspicion is crucial for early diagnosis of mucoceles, which must be treated promptly by surgical and medical means to enhance visual recovery.
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Affiliation(s)
- Argyrios Tzamalis
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Faculty of Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Asterios Diafas
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Faculty of Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Paraskevi Riga
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Faculty of Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Iordanis Konstantinidis
- 2 Department of Otorhinolaryngology, Aristotle University of Thessaloniki, Faculty of Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2 Department of Ophthalmology, Aristotle University of Thessaloniki, Faculty of Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
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Christou CD, Tsinopoulos I, Ziakas N, Tzamalis A. Intraoperative Floppy Iris Syndrome: Updated Perspectives. Clin Ophthalmol 2020; 14:463-471. [PMID: 32109982 PMCID: PMC7039091 DOI: 10.2147/opth.s221094] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
Almost fifteen years since its initial description, intraoperative floppy iris syndrome (IFIS) during phacoemulsification surgery remains a challenge for cataract surgeons in all its key aspects that include the stratification of the preoperative risk, preoperative prophylaxis treatment, surgery design and intraoperative management. Since its original association with tamsulosin intake, IFIS has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. The assessment and stratification of the preoperative risk is pivotal in screening patients prone to develop IFIS. For these patients, it is essential that preoperative prophylaxis, employment of necessary measures and surgical technique modifications are considered. A multidisciplinary approach of IFIS is a mandate, thus ophthalmologists, urologists and sometimes other specialties should cooperate to “educate” each other about the risks of their respective fields. They both must be aware of the joint statement on IFIS by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery which suggests either the initiation of tamsulosin after phacoemulsification or the use of a non-selective a1-ARA for benign prostatic hyperplasia treatment. In conclusion, awareness of the risk factors associated with IFIS and their detailed preoperative documentation is crucial in addressing IFIS. The lack of such an awareness can turn a routine, uneventful surgery into one with significant visual morbidity.
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Affiliation(s)
- Chrysanthos D Christou
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Tzamalis A, Malyugin B, Ziakas N, Tsinopoulos I. Angiotensin receptor inhibitors as main predisposing factor for intraoperative floppy iris syndrome in women. J Cataract Refract Surg 2020; 45:696-697. [PMID: 31030782 DOI: 10.1016/j.jcrs.2019.01.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/29/2019] [Indexed: 10/26/2022]
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Mataftsi A, Dermenoudi M, Matsou A, Tzamalis A, Brazitikos P, Talimtzi P, Ziakas N, Tsinopoulos IT. Safety of air tamponade versus corneal hydration for sealing clear corneal incisions in cataract surgery. Graefes Arch Clin Exp Ophthalmol 2020; 258:815-820. [PMID: 31953596 DOI: 10.1007/s00417-020-04602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare safety of wound hydration to anterior chamber air tamponade for securing watertight closure of clear corneal incisions, during uneventful cataract surgery. METHODS Prospective, comparative case-control series. Patients undergoing phacoemulsification were assigned to receive either anterior chamber air bubble (Group A) or intrastromal wound hydration with balanced salt solution (Group B) at the end of the procedure. Two high-volume surgeons operated equal number of cases in each group employing identical surgical technique, except for corneal side incision management. Patients were assessed pre- and postoperatively at day 1, day 4, day 9, and day 30 after surgery. RESULTS One hundred eyes of 100 patients were enrolled, of which 2 were lost to follow-up. The two groups were comparable in terms of preoperative risk factor assessment, baseline central corneal thickness (CCT), preoperative endothelial cell density, as well as cumulative dissipated energy and duration of phacoemulsification (p > 0.05). Mean CCT and best-corrected visual acuity were better in Group B on the first postoperative day, but did not differ between the two groups at all other timepoints. Surgically induced astigmatism was comparable in the two groups (p > 0.05). Endothelial cell density loss at 1 month postoperatively was greater in Group A (34.06%) compared to Group B (16.45%). CONCLUSIONS Wound sealing with intrastromal hydration proved to be safer than air tamponade in terms of preserving endothelial cell density and function.
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Affiliation(s)
- Asimina Mataftsi
- Department of Ophthalmology, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece.
| | - Maria Dermenoudi
- Department of Ophthalmology, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Artemis Matsou
- Department of Ophthalmology, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Argyrios Tzamalis
- Department of Ophthalmology, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Periklis Brazitikos
- Department of Ophthalmology, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Persefoni Talimtzi
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- Department of Ophthalmology, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
| | - Ioannis T Tsinopoulos
- Department of Ophthalmology, Aristotle University of Thessaloniki, 56403, Thessaloniki, Greece
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Mylona I, Chourdakis M, Makedou K, Tzamalis A, Dermenoudi M, Tsinopoulos I. The Role of Nutrition in Primary Open Angle Glaucoma: A Multivariate Analysis. J Am Coll Nutr 2019; 39:438-442. [PMID: 31770075 DOI: 10.1080/07315724.2019.1691952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess whether dietary habits can be associated with the presence of primary open angle glaucoma (POAG), while taking into account hereditary factors and metabolic disease.Methods: A case-control study of 100 POAG patients and 100 controls who were queried on their dietary habits. A nonlinear canonical correlation analysis is employed to assess and plot the relationships between the measured variables.Results: Controls had lower consumption of sweets containing processed sugar and avoided eating visible fat on their meat or meat sausages (which tend to contain high amounts of meat fats not plainly obvious) while consuming pure fruit juice and pears more frequently.Conclusions: Dietary habits and practices may have both research and clinical significance in POAG; Caffeine, processed sugar and animal fat appear to have noteworthy negative effects and while caffeine has been researched extensively, more research is needed in the negative role of the other two factors. Other important dietary factors that may be implicated is fruit fiber and various fruit antioxidants and flavonoids.
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Affiliation(s)
- Ioanna Mylona
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Chourdakis
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kali Makedou
- Laboratory of Biological Chemistry, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Dermenoudi
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Vinciguerra R, Tzamalis A, Romano V, Arbabi EM, Batterbury M, Kaye SB. Assessment of the Association Between In Vivo Corneal Biomechanical Changes After Corneal Cross-linking and Depth of Demarcation Line. J Refract Surg 2019; 35:202-206. [PMID: 30855098 DOI: 10.3928/1081597x-20190124-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/18/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To test for an association between stiffening following corneal cross-linking (CXL) and demarcation line depth. METHODS Sixty-six eyes of 66 patients treated with CXL for progressive keratoconus were included. Dynamic corneal response parameters (DCRs) were measured with the Corvis ST (Oculus Optikgeräte GmbH; Wetzlar, Germany) on the day of CXL and after 1 month. Demarcation line was measured 4 weeks after CXL. A multivariate general linear model was used to test for an association between the change in DCRs and the ratio between demarcation line depth and the postoperative pachymetry. RESULTS The authors found no significant associations between the change in inverse concave integrated radius (1/R) and the demarcation line ratio (P = .46), age (P = .33), sex (P = .11), preoperative maximum keratometry (P = .10), and laterality (P = .82). Similarly, there was no significant correlation between the change in 1/R and the demarcation line ratio (R2 = .002 and P = .75). However, there was a significant association between the preoperative values of 1/R and the respective change in 1/R (P < .0001). The change in 1/R was inversely proportional to the patient's preoperative 1/R; stiffer corneas (lower values of 1/R) were less affected than less stiff corneas (R2 = .23, P < .0001). CONCLUSIONS CXL is associated with changes in DCRs, suggesting a change in corneal biomechanics following CXL. These changes do not appear to be associated with the demarcation line depth. [J Refract Surg. 2019;35(3):202-206.].
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Tzamalis A, Matsou A, Anastasopoulos E, Ziakas N. Treatment of spontaneous corneal perforation secondary to undiagnosed Sjögren's syndrome using regenerating agent and autologous serum eye drops. Eur J Ophthalmol 2019; 31:NP17-NP21. [PMID: 31137968 DOI: 10.1177/1120672119853106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to report a case of sterile corneal ulcer leading to perforation, which was treated effectively with autologous serum eye drops, topical regenerative agent (poly-carboxymethylglucose sulfate), steroids, and systemic immunosuppression in a patient with undiagnosed primary Sjögren's syndrome. METHODS A 74-year-old female presented with a month's history of gradually worsening blurry vision in her left eye. Ophthalmic examination revealed a central descemetocele with excessive corneal stromal melting and absence of signs of infection. A bandage contact lens was applied for tectonic support along with topical corticosteroid and antibiotic drops. Autoimmune screen disclosed a diagnosis of Sjögren's syndrome, and the patient was commenced on systemic immunosuppression. Forty-eight hours after presentation, the patient developed a localized corneal perforation, presenting with a flat anterior chamber. RESULTS Urgent amniotic membrane transplantation was arranged while topical dexamethasone, moxifloxacin, and autologous serum eye drops were administered. After 24 h of intensive topical treatment, a significant reforming of the anterior chamber and subsequent gradual regeneration of the corneal stroma were noted, thus postponing amniotic grafting. The patient remained under close monitoring, showing progressive clinical improvement. Regenerating agent eye drops (Cacicol20®) were also applied over the next month, with careful and slow tapering of topical dexamethasone. Further improvement of corneal thickness was observed, and visual acuity increased to 20/80. CONCLUSION This case report demonstrates the successful medical treatment of an autoimmune-related sterile corneal perforation without surgical intervention, highlighting the fact that early diagnosis and rigorous medical treatment with autologous serum and regenerating agent eye drops can effectively aid tissue regeneration and favorable visual rehabilitation.
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Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.,St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Artemis Matsou
- 2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Eleftherios Anastasopoulos
- 2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Tzamalis A, Vinciguerra R, Romano V, Arbabi E, Batterbury M, Kaye SB. Intraobserver reproducibility and interobserver agreement of demarcation line depth measurements following corneal cross linking. Eur J Ophthalmol 2019; 30:635-642. [PMID: 30857417 DOI: 10.1177/1120672119835116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate the intraobserver reproducibility of demarcation line depth measurement in keratoconic patients after epithelium-off corneal collagen cross linking and assess the interobserver variability/agreement among examiners of various experience levels. METHODS 56 eyes of 56 patients undergoing corneal collagen cross linking for progressive keratoconus were enrolled. After 4 weeks, all patients underwent an anterior segment optical coherence tomography (AS-OCT; CASIA SS-1000; Tomey, Nagoya, Japan) in the cross-linked eye by four masked examiners (two medical students (S1 and S2) and two corneal fellows (F1 and F2)) in order to identify and measure the demarcation line depth in experienced and non-experienced users. The intraclass correlation coefficient and the coefficient of variation were calculated. Agreement between raters was evaluated using Bland-Altman plots, intraclass correlation coefficient and weighted-kappa statistics comparing raters in pairs. RESULTS The average demarcation line depth of all measurements was 254.34 ± 72.3 μm, varying from 84 to 459 μm. The intraclass correlation coefficient evaluating the reproducibility of measurements for F1 was 0.9379 (95% confidence interval (CI) =0.9035-0.9619), for the second (F2), it was 0.9837 (95% confidence interval = 0.9743-0.9901), while intraclass correlation coefficient between medical students was calculated 0.844. The overall intraclass correlation coefficient among all four observers was 0.8706 (95% confidence interval = 0.8061-0.9185). The coefficient of variation for repeated measurements was 5.981 μm (95% confidence interval = 3.966-7.471) and 3.312 μm (95% confidence interval = 2.468-3.981) for F1 and F2 raters, respectively. The percentage of demarcation line detection was 90.32%. CONCLUSION The reproducibility of demarcation line measures although very good (intraclass correlation coefficient > 0.9), yielded a difference between the two experienced raters. Furthermore, the novice raters did not reach an excellent level of agreement with the expert ones showing greater variability in their recordings.
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Affiliation(s)
- Argyrios Tzamalis
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Vito Romano
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Esmaeil Arbabi
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Mark Batterbury
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stephen B Kaye
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Tzamalis A, Romano V, Cheeseman R, Vinciguerra R, Batterbury M, Willoughby C, Neal T, Ahmad S, Kaye S. Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL. BMJ Open Ophthalmol 2019; 4:e000231. [PMID: 30997402 PMCID: PMC6440609 DOI: 10.1136/bmjophth-2018-000231] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/15/2018] [Accepted: 01/10/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the role of bandage contact lenses (BCL) and topical steroids as risk factors for the development of microbial keratitis after epithelium-off corneal collagen cross-linking (CXL). Methods and Analysis Patients undergoing CXL between February 2011 and July 2017 were included. Patients were divided into two groups: those who were treated postoperatively with a BCL, topical antimicrobial and steroids (group 1) and those who received only a topical antimicrobial until healing of the epithelial defect before introduction of topical steroids (group 2). Results 1273 eyes of 964 patients were included. Group 1 comprised 316 eyes and group 2 comprised 957 eyes. There were no significant differences in the presence of persisting corneal haze or scarring between the two groups (p=0.57). Microbial keratitis occurred in nine eyes (0.71% of eyes) of eight (0.83%) patients (one case was bilateral) out of 1273 eyes. Staphylococcus aureus was cultured from corneal scrapes in seven out of nine (77.8%) cases and from contiguous sites in the two cases. All cases occurred in group 1 (incidence=2.85%) and none in group 2 (p<0.0001). A greater proportion of patients who developed microbial keratitis were atopic (75%, p=0.4). Conclusion The use of BCL and topical steroids prior to healing of the epithelium is a significant risk factor for microbial keratitis. S. aureus is the most common micro-organism and is likely to originate from an endogenous site. Not using a BCL and delaying the introduction of topical steroids until epithelial healing significantly reduce the risk of developing microbial keratitis without increasing the risk of persistent corneal haze.
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Affiliation(s)
- Argyrios Tzamalis
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Vito Romano
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert Cheeseman
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Mark Batterbury
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Colin Willoughby
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Timothy Neal
- Department of Medical Microbiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Sajjad Ahmad
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Stephen Kaye
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Tzamalis A, Matsou A, Dermenoudi M, Brazitikos P, Tsinopoulos I. The role of sex in intraoperative floppy-iris syndrome. J Cataract Refract Surg 2019; 45:41-47. [DOI: 10.1016/j.jcrs.2018.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/30/2018] [Accepted: 08/12/2018] [Indexed: 10/27/2022]
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Symeonidis C, Androudi S, Georgalas I, Tzamalis A, Chalvatzis N, Rotsos T, Souliou E, Diza E, Dimitrakos SA. Chemokine CXCL-1: activity in the vitreous during proliferative vitreoretinopathy. Clin Exp Immunol 2015; 181:338-42. [PMID: 25766782 DOI: 10.1111/cei.12627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/01/2015] [Accepted: 03/10/2015] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to investigate CXCL-1 chemokine levels in the vitreous during rhegmatogenous retinal detachment (RRD) with and without proliferative vitreoretinopathy (PVR) and identify possible correlations with clinical parameters (extent and duration or RRD and PVR grade). Vitreous samples from patients with primary RRD with or without PVR were collected and assayed using a double antibody enzyme-linked immunosorbent assay (ELISA). Eleven vitreous samples from organ donors were employed as a control group. CXCL-1 levels were measured in 35 vitreous samples from 35 RRD patients. Mean CXCL-1 levels (64·82 ± 6·47 pg/ml) were significantly higher (P = 0·048) compared to controls. There was a significant positive correlation between CXCL-1 levels and the extent of the detachment (r = 0·794, P = 0·006). Peak CXCL-1 levels coincided with 3+ quadrant RRD, an interim of 29-60 days' duration and PVR grade B. Increased CXCL-1 levels may be indicative of mild inflammation in the detached retina and the adjacent vitreous. The results of the present study may provide novel insight into the complex interactions taking place during the early and late stages of RRD complicated by PVR.
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Affiliation(s)
- C Symeonidis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Macedonia
| | - S Androudi
- Department of Ophthalmology, University of Thessaly, University Hospital, Larissa, Thessaly
| | - I Georgalas
- Department of Ophthalmology, School of Medicine, University of Athens, 'G. Gennimatas' Hospital, Athens
| | - A Tzamalis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Macedonia
| | - N Chalvatzis
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Macedonia
| | - T Rotsos
- Department of Ophthalmology, School of Medicine, University of Athens, 'G. Gennimatas' Hospital, Athens
| | - E Souliou
- Department of Microbiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - E Diza
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - S A Dimitrakos
- Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Macedonia
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Tsinopoulos IT, Symeonidis C, Tsaousis KT, Mataftsi A, Chalvatzis N, Tzamalis A, Lamprogiannis LP, Dimitrakos SA. Contribution of integrated teaching in the improvement of an undergraduate ophthalmology curriculum. Adv Med Educ Pract 2014; 5:433-437. [PMID: 25429248 PMCID: PMC4241950 DOI: 10.2147/amep.s71759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Conventional medical curriculum is the rule of medical teaching in Greek Medical Schools. Medical students are often taught irrelevant details with little or no reference to their potential clinical significance. Alternatively, integrated teaching warrants that the complete teaching material is covered by each faculty member not considering areas of personal expertise. The aim of this study was to evaluate the implementation of integrated teaching in ophthalmic training. METHODS The main outcome measures of this retrospective study were a) comments and recommendations made anonymously by the fifth-year medical students in the evaluation questionnaires filled in at the end of their training, and b) scores obtained by students in their final examination at the end of their training in the 2nd Department of Ophthalmology as part of the core Curriculum of the Medical School of the Aristotle University of Thessaloniki. The latter outcome was analyzed with respect to the implementation of integrated teaching. RESULTS The score obtained by students in the final examination, which is an objective outcome measure, increased significantly after the implementation of integrated teaching. The final grade (scores out of 10) of students who were trained with the integrated system (6.17±1.67, mean ± standard deviation) was significantly higher compared to those (5.52±2.20) trained with the conventional system (P<0.001). The positive outcome of this process was evident as there was a significant increase in the number of students satisfied with the teaching process compared to previous academic years. CONCLUSION Based on the experience of eight academic years and as a result of interactive assessment process our department has modified its medical student teaching process from conventional to integrated; all teaching staff members are involved in the teaching process, while students are divided in small groups. In conclusion, integrated teaching in small student groups appears to be an efficient teaching method (for both theoretical and clinical skills) of ophthalmic training for medical students.
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Affiliation(s)
- Ioannis T Tsinopoulos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Chrysanthos Symeonidis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Konstantinos T Tsaousis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Nikolaos Chalvatzis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Lampros P Lamprogiannis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Stavros A Dimitrakos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
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Tzamalis A, Pham DT, Wirbelauer C. Comparison of slit lamp-adapted optical coherence tomography features of fellow eyes of acute primary angle closure and eyes with open angle glaucoma. Jpn J Ophthalmol 2014; 58:252-60. [PMID: 24496567 DOI: 10.1007/s10384-013-0301-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/08/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to assess the possibility of discriminating a narrow and occludable chamber angle by means of digital gonioscopy. METHODS In a prospective controlled clinical study 40 eyes of 40 patients were enrolled. 20 patients that had suffered acute angle closure glaucoma (ACG) on the fellow eye were compared to 20 patients with open angle glaucoma (OAG). Anterior segment imaging with SL-OCT (Heidelberg Engineering, Heidelberg, Germany) enabled the delineation, by means of automatic signal analysis, of several important parameters of the anterior chamber angle region, which were compared to those revealed from direct contact glass gonioscopy and ultrasound biometry. RESULTS The anterior segment structures were automatically recognized by the SL-OCT software in 70 % of the ACG patients and in all of the OAG cases (100 %) (p = 0.025). Anterior chamber angle (ACA) was 15.55° ± 6.92° in the ACG group and 34.6° ± 8.9° in the OAG group, whereas angle opening distance (AOD) was 199.55 ± 62.29 μm in ACG and 452.67 ± 123.91 μm in OAG. A good correlation was found in the direct gonioscopic findings (r = 0.85, p < 0.001), but there were significant differences between both groups (p < 0.001). Mean real central anterior chamber depth (rACD) was evaluated to be 1.75 and 2.79 mm in ACG and OAG, respectively, showing a significant difference (p < 0.0001) and the highest (although not statistically significant) sensitivity and specificity above all other parameters tested in discriminating between OAG and ACG eyes. Discrimination criteria revealed a relevant narrowing of the anterior chamber angle region for values below 22° (ACA), 276 μm (AOD) and 2.08 mm (rACD). CONCLUSIONS Digital gonioscopy by means of SL-OCT allowed a non-invasive and objective imaging of the anterior chamber configuration that could be used as a screening method for narrow and occludable angles. The method could contribute to a timely identification of angle closure and alert clinicians to further determine whether a peripheral iridotomy should be performed.
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Affiliation(s)
- Argyrios Tzamalis
- Department of Ophthalmology, Vivantes Klinikum Neukölln, Berlin, Germany,
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Chalvatzis N, Manthou ME, Tzamalis A, Hytiroglou P, Dimitrakos S. Erosive conjunctival and corneal inflammatory changes in a patient receiving weekly docetaxel for breast cancer. Ocul Immunol Inflamm 2013; 22:164-6. [PMID: 23876214 DOI: 10.3109/09273948.2013.812221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nikolaos Chalvatzis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki , Greece
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Tzamalis A, Kynigopoulos M, Chalvatzis N, Dimitrakos S, Schlote T. Association of ocular hypotensive medication types with dynamic contour tonometry and Goldmann applanation tonometry measurements in a glaucoma and ocular hypertensive population. J Ocul Pharmacol Ther 2012; 29:41-7. [PMID: 23066787 DOI: 10.1089/jop.2012.0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the association between different intraocular pressure (IOP)-lowering medications and IOP measurements by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in a glaucoma and ocular hypertensive population. METHODS In a prospective, observational case series study, 410 eyes from 410 consecutive patients with open-angle glaucoma (OAG) or ocular hypertension (OHT), were enrolled. All eyes included in the study received unaltered ocular hypotensive medication for at least 6 months before IOP measurement. All eyes underwent 2 GAT and 3 DCT measurements, and their means were used for the analysis. RESULTS DCT-GAT IOP difference (ΔIOP) did not differ statistically significantly (P=0.49) between OAG and OHT group yielding a mean±SD of 4.26±2.02 mmHg and 4.41±2.25 mmHg, respectively. The number of IOP-lowering agents did not have any statistically significant influence on ΔIOP (p=0.177), DCT (P=0.28) and GAT (P=0.13) measurements. A statistically higher ΔIOP was revealed in monotherapy patients receiving Carbonic Anhydrase Inhibitors (CAIs) (ΔIOP=5.75 mmHg) in comparison to patients receiving Prostaglandin Analogs (ΔIOP=4.09 mm Hg) or beta Blockers (ΔIOP=3.78 mmHg) as single topical therapy (F=4.373, P=0.005). Eyes treated with CAIs as a part of the ocular hypotensive therapy yielded a significantly greater ΔIOP (P=0.0035) than those without CAIs in the therapeutic schema. CONCLUSIONS The difference between DCT and GAT IOP measurements is found to be statistically significantly higher in patients receiving CAIs either as monotherapy or as a part of a combined ocular hypotensive treatment, while DCT and GAT readings remain unaffected. The type of diagnosis and the number of ocular hypotensive medications had no statistically significant influence on ΔIOP.
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Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki , Papageorgiou General Hospital, Thessaloniki, Greece.
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Anastasilakis K, Symeonidis C, Kaprinis K, Mataftsi A, Tzamalis A, Dimitrakos SA. Peripapillary Neovascular Membrane in a Young Pregnant Woman and Prompt Response to Ranibizumab Injections following Uneventful Delivery. Case Rep Ophthalmol 2011; 2:129-33. [PMID: 21589847 PMCID: PMC3094578 DOI: 10.1159/000328385] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Occurrence of choroidal neovascularization (CNV) during pregnancy has been reported as a complication of presumed ocular histoplasmosis syndrome or punctuate inner chorioretinopathy. To our knowledge, idiopathic CNV (ICNV) during pregnancy has only been reported once in the relevant literature. Bevacizumab has been used for the treatment of ICNV in small case series. However, there is limited experience regarding the use of ranibizumab for the management of ICNV. Case Report A 31-year-old woman in the eighth month of her second pregnancy was diagnosed with mild macular and papillary edema. She was followed up using biomicroscopy, fluorescein angiography (FA), and optical coherence tomography (OCT). After 3 months, visual acuity further deteriorated and funduscopy, FA and OCT findings revealed a juxtapapillary choroidal neovascular membrane (CNVM). After two ranibizumab injections, best-corrected visual acuity increased significantly, physiological macular anatomy was restored and no subretinal fluid was observed. Discussion In this case report, we present a young pregnant patient with peripapillary ICNV and neurosensory detachment involving the macula, and treatment of the eye with intravitreal ranibizumab following uneventful delivery. Increased angiogenic factor levels associated with pregnancy may contribute to the onset of CNV although this relationship has to be investigated experimentally. The rapid response to ranibizumab suggests that this anti-VEGF agent may be an alternative treatment option in the management of peripapillary ICNV.
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Tzamalis A, Wirbelauer C, Häberle H, Pham DT. Digitale Gonioskopie als Screening-Verfahren bei Engwinkelglaukom. Klin Monbl Augenheilkd 2009. [DOI: 10.1055/s-0029-1243675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schlote T, Tzamalis A, Kynigopoulos M. Central Corneal Thickness During Treatment With Travoprost 0.004% in Glaucoma Patients. J Ocul Pharmacol Ther 2009; 25:459-62. [DOI: 10.1089/jop.2009.0007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Torsten Schlote
- Outpatient Clinic of Ophthalmology Ambimed, Basel, Switzerland
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Kynigopoulos M, Tzamalis A, Schlote T. Homonymer Gesichtsfeldausfall bei bekannter Migräne mit Aura. Ophthalmologe 2009; 106:256-9. [DOI: 10.1007/s00347-008-1818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kynigopoulos M, Schlote T, Kotecha A, Tzamalis A, Pajic B, Haefliger I. Repeatability of Intraocular Pressure and Corneal Biomechanical Properties Measurements by the Ocular Response Analyser. Klin Monbl Augenheilkd 2008; 225:357-60. [DOI: 10.1055/s-2008-1027256] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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