1
|
Mikropoulos DG, Kymionis GD, Chatzea MS, Xanthopoulou K, Ageladarakis PK, Voudouragkaki IC, Konstas AG. Acute Corneal Melting Induced by the Concomitant Use of a Non-steroidal Anti-inflammatory Agent with an Antiseptic Eye Drop. Ophthalmol Ther 2024; 13:645-649. [PMID: 38127195 PMCID: PMC10787727 DOI: 10.1007/s40123-023-00864-0] [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: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed perioperatively to reduce intraoperative prostaglandin release, diminishing pain, preventing miosis, modulating postoperative inflammation, and reducing the incidence of cystoid macular edema (CME). CASE REPORT A 70-year-old female patient without previous history of ocular or systemic disease was urgently referred to our hospital because of a sudden corneal perforation concerning her left eye (OS). The patient had instilled bromfenac eye drops and antiseptic eye drops twice and four times daily, respectively, for 2 days only, in preparation of scheduled cataract surgery. Slit-lamp examination revealed diffuse inferior corneal melting with a 1 × 2 mm area of full-thickness perforation and a very shallow anterior chamber. Both topical agents were immediately discontinued. Cyanoacrylate glue was applied to seal the perforation and a bandage contact lens was applied together with a topical antibiotic given hourly. Two hours later, the anterior chamber started to reform. The following day, the anterior chamber was fully reformed with a negative Seidel test. At her next follow-up appointment, 1 month later, the glue was detached and the cornea was seen to have successfully healed with only some corneal thinning remaining inferiorly. CONCLUSIONS Perioperative use of topical NSAIDs in combination with antiseptic eye drops may rarely elicit corneal perforation in certain susceptible elderly individuals. Their use should therefore be carefully monitored.
Collapse
Affiliation(s)
- Dimitrios G Mikropoulos
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Georgios D Kymionis
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina S Chatzea
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kassandra Xanthopoulou
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis K Ageladarakis
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Irini C Voudouragkaki
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Anastasios G Konstas
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece.
| |
Collapse
|
2
|
Xanthopoulou K, Milioti G, Daas L, Munteanu C, Seitz B, Flockerzi E. Accelerated Corneal Crosslinking for Treatment of Keratoconus in Children and Adolescents under 18 Years of Age. Klin Monbl Augenheilkd 2023; 240:1131-1142. [PMID: 36436508 DOI: 10.1055/a-1933-3084] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of accelerated (9 mW/cm2, 10 min) epithelium-off (epi-off) corneal crosslinking (A-CXL) in keratoconus (KC) patients < 18 years of age. PATIENTS AND METHODS Our retrospective study included 41 eyes (25 male and 5 female patients, mean age 15.3 ± 1.2 years) who underwent A-CXL (9 mW/cm2, 10 min) because of progressive KC or critical KC at first presentation or asymmetrical finding in the partner eye. Outcome measures were best-corrected visual acuity (BCVA) and tomography readings (Pentacam HR, Oculus, Wetzlar, Germany), evaluated 2 years, 1 year, 6 months preoperatively, prior to surgery (pre-CXL) and 6 weeks, 6 months, 1 year, 2 years, > 2 years postoperatively (post-CXL). The demarcation line was assessed by anterior segment optical coherence tomography (SS-1000 and CASIA 2, Tomey, Nagoya, Japan). RESULTS Total deviation value increased statistically significantly 6 months pre-CXL to pre-CXL. Anterior steep, flat, and mean keratometry values showed a statistically significant increase 6 weeks post-CXL (p < 0.05), followed by a significant decrease until 2 years post-CXL for steep and mean keratometry. Kmax increased 6 weeks post-CXL without statistical significance and decreased significantly even > 2 years post-CXL (p < 0.0001). Posterior keratometry as well as anterior and posterior astigmatism did not show any significant changes post-CXL. Thinnest and apical pachymetry decreased significantly until 6 months post-CXL (p < 0.05) and remained stable > 2 years post-CXL (p > 0.05). BCVA decreased 6 weeks post-CXL but improved significantly > 2 years post-CXL (p = 0.003). The demarcation line reached an average depth of 52.1%. CONCLUSIONS Epi-off A-CXL stabilizes KC progression in patients < 18 years even > 2 years postoperatively and leads to a deep demarcation line. A "pseudoprogression" is observed up to the 6-week follow-up, which is not indicative of the long-term results.
Collapse
Affiliation(s)
- Kassandra Xanthopoulou
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Georgia Milioti
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| |
Collapse
|
3
|
Feld S, Flockerzi E, Daas L, Xanthopoulou K, Sideroudi H, Langenbucher A, Seitz B. [Corneal biomechanics before and after cross-linking in patients with keratoconus]. Ophthalmologie 2023; 120:940-946. [PMID: 37043004 DOI: 10.1007/s00347-023-01839-z] [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] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/10/2023] [Accepted: 03/01/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the effect of corneal cross-linking (CXL) on corneal biomechanics and visual acuity. PATIENTS AND METHODS The examination results before and after CXL in 56 eyes of 56 patients between 2017 and 2021 were evaluated retrospectively. The last preoperative examination was compared to the postoperative follow-up values after 6 and 12 months. The main outcome measures included various biomechanical parameters from the Corvis ST (CST), Pentacam and the visual acuity (logMAR, "logarithm of the Minimal Angle of Resolution"). For longitudinal evaluation, a general linear model for repeated measurements was used. A p-value of less than 0.05 was considered to show a statistically significant result. Bonferroni correction was applied for multiple comparisons. RESULTS The maximum corneal refractive power Kmax decreased slightly without statistical significance from 57.1 ± 6.1 diopters (dpt) to 56.6 ± 6.3 dpt after 6 months (p = 0.076) and 56.8 ± 6.6 dpt after 12 months (p = 0.443). The Pentacam parameter Belin/Ambrósio Enhanced Ectasia Total Deviation Display (BAD D) showed a statistically significant increase from the preoperative value of 8.4 ± 3.7 to the postoperative value of 9.1 ± 3.6 after 6 months (p < 0.001) and to 8.9 ± 3.5 after 12 months (p = 0.051). The CST parameter Ambrósio's relational thickness to horizontal profile (ARTh) decreased statistically significantly from 229.9 ± 109.6 to 204.8 ± 84.9 at 6 months (p = 0.017) and 205.3 ± 93.7 at 12 months (p = 0.022). The CST parameter stiffness parameter A1 (SP A1) increased slightly from the preoperative value 69.9 ± 17.2 to 70.4 ± 17.2 after 6 months (p = 1) and 71 ± 18.2 after 1 year (p = 1). Mean best-corrected visual acuity (logMAR) showed an improvement from 0.39 ± 0.3 to 0.34 ± 0.3 at 6 months (p = 0.286) and to 0.31 ± 0.3 at 12 months (p = 0.077). Regarding the ABCD classification, the parameters were determined preoperatively with an average of A2B3C1D2. They showed the same value of A2B3C1D2 after 6 and 12 months. CONCLUSION In progressive keratoconus, corneal cross-linking has the potential to positively influence the biomechanics of the cornea and visual acuity as a low complication treatment option.
Collapse
Affiliation(s)
- S Feld
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland.
| | - E Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - K Xanthopoulou
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - H Sideroudi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - A Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| |
Collapse
|
4
|
Sideroudi H, Flockerzi E, Daas L, Jullien T, Xanthopoulou K, Hamon L, Seitz B. Baseline Characteristics of 1976 Patients With Ectatic Corneal Disorders at a Single Center From 2010 to 2021: A Cross-Sectional Study of the Homburg Keratoconus Center. Eye Contact Lens 2023; 49:392-398. [PMID: 37458424 DOI: 10.1097/icl.0000000000001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES The study objective was to analyze the baseline characteristics of keratoconus (KC) patients at the Homburg Keratoconus Center from 2010 to 2021. METHODS This cross-sectional study included 3,674 eyes, with analysis of demographics, clinical findings, visual function, endothelial measurements, and topographic, tomographic, and corneal biomechanical data from the first visit. RESULTS Mean patient age was 36.3±13.8 years. The mean uncorrected distance visual acuity in log of minimal angle of resolution was 0.60 (20/80, Snellen equivalent), and the corrected mean was 0.3 (20/40). Of 1976 patients, 48.9% reported eye rubbing. Mean values (ranges) were 49.4±6.3 (36.3-78.0) D for steep keratometry, 462.4±66.0 (48.0-659.0) μm for thinnest corneal thickness, 9.7±8.7 (-0.5 to 88.8) for Belin/Ambrósio enhanced ectasia total deviation, 0.8±0.4 (0.0-1.0) for the Corvis biomechanical index, 0.9±0.2 (0.0-1.0) for the tomographic biomechanical index, 0.1±0.5 (-0.9 to 2.0) for the KC match index, 8.3±1.8 (2.2-17.7) mm Hg for corneal hysteresis, 7.1±2.2 (0.0-17.0) mm Hg for corneal resistance factor, and 2,562.9±326.3 (1,011-3,937) cells/mm2 for endothelial cell density. The average ABCDE KC stage was A2B3C1D1E2. Distance-corrected visual acuity correlated strongly with topometric, tomographic, and biomechanical data ( P <0.001). CONCLUSIONS This comprehensive description of baseline features of KC patients at a tertiary center provides a reference for further longitudinal and international multicentric studies.
Collapse
Affiliation(s)
- Haris Sideroudi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | | | | | | | | | | | | |
Collapse
|
5
|
Flockerzi E, Xanthopoulou K, Munteanu C, Daas L, Langenbucher A, Seitz B. The Biomechanical E-Staging: In Vivo Biomechanics in Keratoconus. Klin Monbl Augenheilkd 2023; 240:761-773. [PMID: 37348512 DOI: 10.1055/a-2079-1740] [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] [Indexed: 06/24/2023]
Abstract
Belin's ABCD keratoconus classification system allows keratoconus staging based on the criteria of anterior (A) and posterior (B) corneal curvature, thinnest corneal thickness (C), and best spectacle-corrected visual acuity (D). These parameters also provide a progression assessment, but do not take corneal biomechanics into account. The analysis of corneal biomechanics by the Corvis ST (Oculus, Wetzlar, Germany) allows for separation of healthy and keratoconus corneas, based on the Corvis Biomechanical Index (CBI) and the Tomographic Biomechanical Index (TBI). As Corvis ST measurements are highly reliable and are independent of keratoconus severity, a biomechanical parameter was developed for keratoconus corneas based on the linear term of the CBI. This provides biomechanical keratoconus staging. The Corvis Biomechanical Factor (CBiF) is the basis for the introduction of the biomechanical E-staging, which augments the ABCD classification to the ABCDE classification, thus including the cornerstone of corneal biomechanics. This article highlights strengths and limitations of the ABCDE classification. "Unilateral keratoconus" supposedly turns out to be mostly a snapshot of a highly asymmetric keratectasia. Regular astigmatism is sometimes an important differential diagnosis to keratectasia and may be difficult to differentiate from it. Furthermore, the use of the biomechanical E-staging in daily practice for progression assessment of keratoconus and after its treatment by corneal cross-linking or implantation of intracorneal ring segments will be demonstrated and discussed.
Collapse
Affiliation(s)
- Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Kassandra Xanthopoulou
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Cristian Munteanu
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Deutschland
| |
Collapse
|
6
|
Flockerzi E, Xanthopoulou K, Daas L, Feld S, Langenbucher A, Seitz B. Evaluation of Dynamic Corneal Response Parameters and the Biomechanical E-Staging After Accelerated Corneal Cross-Linking in Keratoconus. Asia Pac J Ophthalmol (Phila) 2022; 11:514-520. [PMID: 36417675 DOI: 10.1097/apo.0000000000000580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/09/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study evaluated the biomechanical E-staging in progressive keratoconus (KC) corneas before and after epithelium-off accelerated corneal cross-linking (CXL, 9 mW/cm2, 10 min, 5.4 J/cm2). DESIGN German university-based retrospective longitudinal cohort study. METHODS The biomechanical E-staging for ectatic corneal diseases was applied retrospectively on 49 progressive KC corneas of 41 patients who underwent CXL. Main outcome parameters included the Corvis Biomechanical Factor (CBiF, the linearized Corvis Biomechanical Index), the biomechanical E-staging (E1 to E4 result of dividing the CBiF value range into 5 groups), maximal anterior keratometry (Kmax), anterior radius of curvature (ARC), and thinnest corneal thickness (TCT). They were evaluated at 2.1±2.0 months preoperatively (n=49 corneas, 41 patients) and postoperatively after 5.4±1.4, 11.3±1.8, and 23.4±1.6 months. RESULTS The CBiF decreased (5.1±0.5 | 5.0±0.5, P=0.0338) and the E-staging increased significantly (2.4±0.9 | 2.6±0.8, P=0.0035) from preoperatively to the first postoperative follow-up. The difference was not significant after 11 months and there were same values after 23 months. Kmax, ARC, and TCT slightly decreased (Kmax: 56.9±6.3, 54.3±5.1, 56.2±6.6, 54.0±5.2; ARC: 49.8±3.5, 48.9±3.2, 50.8±5.6, 49.0±3.7; TCT: 470±34, 454±36, 459±35, 466±39; preoperatively and 5, 11, and 23 months postoperatively). A postoperatively decreased TCT was associated with an increased E-stage, whereas an equal or increased TCT measurement after CXL was associated with equal or lower E-staging results. CONCLUSIONS The biomechanical E-staging in KC corneas is influenced by TCT measurements and increases within the first postoperative months after CXL. On the long term, it indicates a postoperative KC stabilization, with comparable E-values to preoperatively at 11 and 23 months after CXL.
Collapse
Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | | | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Simon Feld
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
7
|
Maiassi N, Xanthopoulou K, Löw U, Seitz B. The Impact of the First COVID-19 Lockdown Period on the Inpatient and Outpatient Volume of a University Based Tertiary Referral Center with Corneal Subspecialization in Germany. Clin Ophthalmol 2022; 16:1795-1805. [PMID: 35706685 PMCID: PMC9191194 DOI: 10.2147/opth.s335551] [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: 12/14/2021] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background/Aims To determine the impact of COVID-19 on the number of in- and outpatients surgical and diagnostic procedures performed at a southwestern German university hospital with corneal subspecialization. Methods A retrospective examination of the number of inpatients, several outpatients subunits, in- and outpatient surgeries as well as diagnostic procedures at the Department of Ophthalmology, Saarland University Medical Centre during the COVID-19 pandemic "lockdown period" from 18 March until 8 May 2020 in comparison with the corresponding period in 2019 (source: SAP database and electronic patient record FIDUS). Results The year 2020 showed a significant decrease in the number of inpatient surgeries with a total number of 285 vs 412 in 2019. However, the number of corneal transplantations increased significantly (60 in 2020 vs 54 in 2019, p=0.0089). In the various outpatient units of our department, we observed a significant decrease in the number of consultations (1.711 in 2020 vs 3.194 in 2019), especially for cataract surgery consultations (34 vs 137, p<0.0001). The number of outpatient surgeries was significantly reduced in 2020, especially for cataract surgery (64 vs 216, p=0.007) and intravitreal injections (577 vs 768, p<0.0001). Conclusion Despite taking all the necessary precautions to ensure that our medical care can continue to be available reliably and completely safe during the "Corona lockdown period", the number of in- and outpatient surgeries and the number of outpatient consultations decreased significantly. However, the number of corneal transplantations still increased.
Collapse
Affiliation(s)
- Nadir Maiassi
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Saarland, Germany
| | - Kassandra Xanthopoulou
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Saarland, Germany
| | - Ursula Löw
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Saarland, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Saarland, Germany
| |
Collapse
|
8
|
Xanthopoulou K, Milioti G, Daas L, Munteanu C, Seitz B, Flockerzi E. Accelerated corneal crosslinking causes pseudoprogression in keratoconus within the first 6 weeks without affecting posterior corneal curvature. Eur J Ophthalmol 2022; 32:2565-2576. [PMID: 35535408 DOI: 10.1177/11206721221099257] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the effectiveness of epithelium-off (epi-off) accelerated corneal crosslinking (A-CXL, 9 mW/cm2, 10 min) in adult keratoconus (KC) patients. METHODS The study included 151 KC corneas (124 patients) after A-CXL. The parameters best corrected visual acuity (BCVA) and the tomographic readings (Pentacam HR, Oculus, Germany) were analysed at 24, 12 and 6 months preoperatively, prior to surgery; and 6 weeks, 6 months, 1, 2 and >2 years postoperatively. The demarcation line was assessed by anterior segment optical coherence tomography (Tomey SS-1000, CASIA 2 (Tomey, Nagoya, Japan)). RESULTS Comparing pre- to postoperative findings 6 weeks after A-CXL with paired t-test, the anterior steep (46.8 ± 4.0|47.1 ± 4.1), flat (50.2 ± 4.3|50.6 ± 4.6) and maximal keratometry (57.6 ± 6.8|58.3 ± 6.8) increased (p < 0.05), while the thinnest pachymetry decreased significantly (459 ± 39|444 ± 42, p < 0.05). Lateron, however, there was a decreasing anterior flat (1, 2 and >2 years; p < 0.0001), mean (1 year; p = 0.01 and 2 years; p = 0.03) and maximal keratometry (1, 2 and >2 years; p < 0.0001). The posterior corneal keratometry readings did not change significantly until >2 years after A-CXL (MANOVA; steep, p = 0.008; flat, p = 0.027; mean, p = 0.007). The mean depth of the demarcation line was 242 ± 62 µm (53.6%). The preoperative logMAR BCVA (0.35 ± 0.02) decreased 6 weeks after A-CXL (0.39 ± 0.03) followed by a continuous improvement until the latest follow-up (0.18 ± 0.04). CONCLUSION A-CXL constitutes a successful method for KC stabilization. Signs of KC progression occur within the first 6 weeks postoperatively ("pseudoprogression"), but this is not indicative of the long-term effect.
Collapse
Affiliation(s)
| | - Georgia Milioti
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Loay Daas
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, 39072Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
9
|
Flockerzi E, Häfner L, Xanthopoulou K, Daas L, Munteanu C, Langenbucher A, Seitz B. Reliability analysis of successive Corneal Visualization Scheimpflug Technology measurements in different keratoconus stages. Acta Ophthalmol 2022; 100:e83-e90. [PMID: 33750037 DOI: 10.1111/aos.14857] [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: 12/19/2020] [Accepted: 03/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study assesses the reliability of successive corneal biomechanical response measurements by the Corneal Visualization Scheimpflug Technology (CST, Corvis ST® , Oculus Optikgeräte, Wetzlar, Germany) in different keratoconus (KC) stages. METHODS A total of 173 eyes (15 controls: 15 eyes, and 112 KC patients: stages 1|1-2|2|2-3|3|3-4|4, n = 26|16|36|18|31|26|5 according to Topographical KC Classification, TKC) were repeatedly examined five times with the CST, each after repositioning the patient's head and re-adjusting the device. Tomographical analysis (Pentacam HR® ; Oculus, Wetzlar, Germany) was performed once before and once after CST measurements. Outcome measures included (1) A1 velocity, (2) deformation amplitude (DA) ratio 2 mm, (3) integrated radius, (4) stiffness parameter A1 and (5) Ambrósio relational thickness to the horizontal profile (ARTh). The Corvis Biomechanical Index (CBI) is reported to be extracted out of these parameters. Mean values of the five measurements and Cronbach's α were calculated as a measure for reliability. RESULTS Ambrósio relational thickness to the horizontal profile and SPA1 were significantly higher in controls (534|123) compared to TKC1 (384|88), TKC2 (232|66), TKC3 (152|55) and TKC4 (71|27; p < 0.0001). The other parameters were similar in controls and TKC1 (A1 velocity: 0.148|0.151 m/s; integrated radius: 8.2|8.6 mm-1 ), but significantly higher in TKC stages 2 to 4 (DA ratio 2 mm: 5.5|6.3|8.0; A1 velocity: 0.173|0.174|0.186 m/second; integrated radius: 10.9|12.8|19.0 mm-1 ; p < 0.0001). All parameters proved to be highly reliable (Cronbach's α ≥ 0.834) and the corneal tomography remained unaffected. CONCLUSIONS The individual parameters included in the CBI (consisting of ARTh, SPA1, DA ratio 2 mm, A1 velocity and integrated radius) are highly reliable but differ KC stage-dependently.
Collapse
Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology Saarland University Medical Center Homburg Germany
| | - Larissa Häfner
- Department of Ophthalmology Saarland University Medical Center Homburg Germany
| | | | - Loay Daas
- Department of Ophthalmology Saarland University Medical Center Homburg Germany
| | - Cristian Munteanu
- Department of Ophthalmology Saarland University Medical Center Homburg Germany
| | - Achim Langenbucher
- Department of Experimental Ophthalmology Saarland University Medical Center Homburg Germany
| | - Berthold Seitz
- Department of Ophthalmology Saarland University Medical Center Homburg Germany
| |
Collapse
|
10
|
Xanthopoulou K, Milioti G, Seitz B. Need for explantation of an intrastromal titan ring after penetrating keratoplasty in two patients. Eur J Ophthalmol 2022; 32:NP35-NP41. [DOI: 10.1177/1120672120962031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The most severe complications after penetrating keratoplasty (PKP) include high astigmatism and immunological graft reaction. The introduction of the corneal intrastromal titan ring by Krumeich intended to reduce the incidence of both complications. We present two patients with keratoconus who referred to our department after a PKP combined with the implantation of an intrastromal ring. The first patient suffered from bulbar pain and headaches. The second patient suffered from postoperative high myopia, irregular astigmatism and was contact lens intolerant. In the first patient we recognized anterior movement of the ring inside the stroma and decided to remove it. The second patient was found to have extreme bulging of the transplant. We removed the ring and sequentially performed a repeat-PKP. In both patients the implantation of the ring failed to decrease the postoperative astigmatism and caused symptoms that affected the patients’ everyday life. Therefore, we recommend not to use this titan ring.
Collapse
Affiliation(s)
| | - Georgia Milioti
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
11
|
Seitz B, Daas L, Hamon L, Xanthopoulou K, Goebels S, Spira-Eppig C, Razafimino S, Szentmáry N, Langenbucher A, Flockerzi E. [Stage-appropriate treatment of keratoconus]. Ophthalmologe 2021; 118:1069-1088. [PMID: 34181061 PMCID: PMC8492599 DOI: 10.1007/s00347-021-01410-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
Keratoconus (KC) is a progressive cone-shaped corneal protrusion that causes paracentral thinning at the apex of the cone and typically occurs asymmetrically on both sides. After a careful anamnesis and classification of the degree of severity a targeted treatment appropriate to the stage of the disease is available. If the visual acuity is no longer sufficient, rigid gas-permeable contact lenses (CL) are fitted by a specialist. Riboflavin UVA cross-linking (CXL) is recommended in cases of progression and visual acuity that is still useful for the patient. Intracorneal ring segments (ICRS) are indicated for CL intolerance in cases of reduced visual acuity and a clear central cornea. If the stage is more advanced, deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) is recommended. A PKP is contraindicated in acute KC but deep stromal sutures for readaptation of the Descemet tear with gas filling of the anterior chamber can considerably shorten the course. Almost no other eye disease is nowadays as easily accessible for an early instrument-based diagnosis and stage-appropriate treatment as KC.
Collapse
Affiliation(s)
- B Seitz
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - L Hamon
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - K Xanthopoulou
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Goebels
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - C Spira-Eppig
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Razafimino
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - N Szentmáry
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - E Flockerzi
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
12
|
Berger T, Xanthopoulou K, Zemova E, Bohle RM, Seitz B, Abdin A. Simultaneous Bilateral Primary Occlusion of the Ophthalmic Artery due to Florid Giant Cell Arteritis. Klin Monbl Augenheilkd 2021; 239:1369-1373. [PMID: 34380160 DOI: 10.1055/a-1554-5182] [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] [Indexed: 10/20/2022]
Abstract
PURPOSE To report a case of simultaneous bilateral ophthalmic artery occlusion in diagnosed giant cell arteritis (GCA). OBSERVATIONS A 77-year-old male patient presented to the emergency department with simultaneous vision loss in both eyes for 3 hours. Headache at both temples and jaw claudication had been present for 3 weeks. Laboratory values demonstrated an initially increased C-reactive protein (CRP) of 202.0 mg/L and an erythrocyte sedimentation rate (ESR) of 100 mm within the first 20 minutes. Duplex sonography of the right and left temporal arteries revealed a "halo sign." A case of GCA was suspected, and intravenous high-dose methylprednisolone therapy was immediately administered. The clinical examination revealed a bilateral central retinal artery occlusion and fluorescein angiography showed a hot optic disc in the right eye and patchy choroidal hypoperfusion in both eyes. Biopsy of the left temporal artery was performed, which confirmed a florid temporal arteritis with complete thrombotic occlusion of the vascular lumen. Despite a good response to the administered therapy (CRP 17.0 mg/L 1 week after initiation), the visual prognosis was significantly limited through retinal and optic nerve involvement. By the follow-up examination 8 weeks later, the near visual acuity was 20/400 in the right and left eye at a distance of 16 inches. CONCLUSION AND IMPORTANCE We hereby present a simultaneous bilateral ophthalmic artery occlusion as a rare complication of GCA. The combination of central retinal artery occlusion, arteritic anterior ischemic optic neuropathy, and choroidal hypoperfusion suggests an acute inflammatory involvement of the ophthalmic artery. In cases of the slightest suspicion of giant cell arteritis, an immediate high-dose steroid therapy initiation is of utmost importance.
Collapse
Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Kassandra Xanthopoulou
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Elena Zemova
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Rainer M Bohle
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Alaadin Abdin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| |
Collapse
|
13
|
Seitz B, Daas L, Hamon L, Xanthopoulou K, Goebels S, Spira-Eppig C, Razafimino S, Szentmáry N, Langenbucher A, Flockerzi E. [Erratum to: Stage-appropriate treatment of keratoconus]. Ophthalmologe 2021; 119:151. [PMID: 34338849 DOI: 10.1007/s00347-021-01472-8] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- B Seitz
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - L Hamon
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - K Xanthopoulou
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Goebels
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - C Spira-Eppig
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - S Razafimino
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| | - N Szentmáry
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - E Flockerzi
- Klinik für Augenheilkunde und Hochschulambulanz, Universitätsklinikum des Saarlandes UKS, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
14
|
Shi L, Fries FN, Xanthopoulou K, Stachon T, Daas L, Zemova E, Langenbucher A, Seitz B, Szentmáry N. Correction: Endothelial Cell Density and Central Corneal Thickness following Penetrating Keratoplasty of Acanthamoeba Keratitis Patients - A Retrospective Cross-Sectional Observational Study. Klin Monbl Augenheilkd 2021. [PMID: 33853195 DOI: 10.1055/a-1476-2036] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lei Shi
- Dr Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, The First Affiliated Hospital of University of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Fabian Norbert Fries
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Tanja Stachon
- Dr Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Elena Zemova
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
15
|
Shi L, Fries FN, Xanthopoulou K, Stachon T, Daas L, Zemova E, Langenbucher A, Seitz B, Szentmáry N. Endothelial Cell Density and Central Corneal Thickness following Penetrating Keratoplasty of Acanthamoeba Keratitis Patients - A Retrospective Cross-Sectional Observational Study. Klin Monbl Augenheilkd 2021; 239:1007-1012. [PMID: 33733447 DOI: 10.1055/a-1353-5171] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyze endothelial cell density (ECD) and central corneal thickness (CCT) following penetrating keratoplasty (PKP) in Acanthamoeba keratitis (AK) patients. PATIENTS AND METHODS In this retrospective, clinical, single-center, cross-sectional, observational study, patients were enrolled who underwent PKP at the Department of Ophthalmology of Saarland University Medical Center, Homburg/Saar, Germany between May 2008 and December 2016 with the diagnosis of AK. In all, 33 eyes of 33 patients (14 males, 42%) were enrolled; their mean age at the time of surgery was 39.5 ± 14.3 years. Postoperatively, AK patients received topical polyhexamethylene biguanide, propamidine isethionate, neomycin sulphate/gramicidin/polymixin B sulfate, and prednisolone acetate eye drops (5 ×/day each), and the topical treatment was tapered sequentially with 1 drop every 6 weeks over 6 months. CCT was recorded using Pentacam HR Scheimpflug tomography and ECD with the EM-3000 specular microscope before surgery and 3 and 6 months after surgery as well as after the first and second (complete) suture removal. RESULTS ECD tended to decrease significantly from the time point before surgery (2232 ± 296 cells/mm2) to the time point 3 months after surgery (1914 ± 164 cells/mm2; p = 0.080) and to the time point after the first suture removal (1886 ± 557 cells/mm2; p = 0.066) and decrease significantly to the time point after the second suture removal (1650 ± 446 cells/mm2; p = 0.028). CCT did not change significantly over the analyzed time period (p ≥ 0.475). CONCLUSION In AK, endothelial cell loss does not seem to be accelerated following PKP, despite the postoperative use of diamidine and biguanide. A subsequent prospective comparative study should confirm our retrospective longitudinal analysis.
Collapse
Affiliation(s)
- Lei Shi
- Dr Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, The First Affiliated Hospital of University of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Fabian Norbert Fries
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Tanja Stachon
- Dr Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Elena Zemova
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
16
|
Tóth G, Xanthopoulou K, Stachon T, Németh J, Hécz R, Berkó-Göttel B, Pfuhl T, Smola S, Seitz B, Szentmáry N. Impact of COVID-19 Pandemic on Emergency Inpatient Volume at a Tertiary Eye Care Center in Germany with Corneal Main Specialization. Klin Monbl Augenheilkd 2021; 238:715-720. [PMID: 33733448 DOI: 10.1055/a-1327-3393] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND To estimate the impact of the COVID-19 pandemic on emergency inpatient volume in a tertiary eye care center in Germany with corneal main subspecialization. MATERIAL AND METHODS A retrospective review of ocular emergency patients who attended the inpatient unit of the Department of Ophthalmology of Saarland University, Homburg/Saar, Germany during the COVID-19 pandemic, between 1 March and 30 April 2020, in comparison to the same time period in 2019. For each subject, clinical history and surgical reports were reviewed. After 24 March 2020, PCR examinations for SARS-CoV-2 were performed from throat swab specimens in all patients using real-time RT-PCR. RESULTS Totally, 135 patients were admitted in 2019 and 115 patients in 2020 as emergency cases. The patient age at the time of admission did not differ significantly between the two time periods (63.6 ± 17.9 years vs. 62.5 ± 19.6 years) (p = 0.792), but the average length of hospital stays increased significantly for 2020 (4.0 ± 3.6 vs. 4.4 ± 2.7 days, p = 0.043). The percentage of admissions due to acute corneal hydrops (0% vs. 3.5%) increased significantly from 2019 to 2020 (χ2 = 4.772, p = 0.028), however, there was not a significant difference between the two years for any other diagnosis (χ2 ≤ 3.564, p ≥ 0.059). From 2019 to 2020, the percentage of acute intravitreal anti-VEGF injections decreased significantly (7.9% vs. 1.3%, χ2 = 3.985, p = 0.045), but the proportion of other emergency surgeries did not differ between the two years (χ2 ≤ 3.617, p ≥ 0.057). COVID-19 PCR examination was performed in 66 (57.4%) cases in 2020 and all samples (100%) were negative. CONCLUSIONS The COVID pandemic did not change emergency inpatient volume in our department, but duration of hospital stay was extended on average by 8 hours, mainly due to additional COVID-19-PCR examinations. The proportion of the most frequently performed surgeries did not change remarkably between 2019 and 2020, but with the introduction of Muraine's sutures in 2019, the percentage of admissions with acute corneal hydrops (with or without subsequent surgery) increased for 2020. No urgent surgery had to be postponed due to the COVID-19 pandemic at our department; all operations were performed successfully.
Collapse
Affiliation(s)
- Gábor Tóth
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany.,Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Kassandra Xanthopoulou
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
| | - Tanja Stachon
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Réka Hécz
- Pulmonology Hospital, Törökbálint, Hungary
| | - Barbara Berkó-Göttel
- Institute of Virology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thorsten Pfuhl
- Institute of Virology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
17
|
Flockerzi E, Xanthopoulou K, Goebels SC, Zemova E, Razafimino S, Hamon L, Jullien T, Klühspies U, Eppig T, Langenbucher A, Seitz B. Keratoconus staging by decades: a baseline ABCD classification of 1000 patients in the Homburg Keratoconus Center. Br J Ophthalmol 2020; 105:1069-1075. [DOI: 10.1136/bjophthalmol-2020-316789] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
BackgroundThis retrospective cross-sectional study aims to analyse the keratoconus (KC) stage distribution at different ages within the Homburg Keratoconus Center (HKC).Methods1917 corneae (1000 patients) were allocated to decades of age, classified according to Belin’s ABCD KC grading system and the stage distribution was analysed.Results73 per cent (n=728) of the patients were males, 27% (n=272) were females. The highest KC prevalence occurred between 21 and 30 years (n=585 corneae, 294 patients). Regarding anterior (A) and posterior (B) curvature, the frequency of A was significantly higher than B in all age groups for stage 0, 1 and 2 (A0>B0; A1>B1; A2>B2; p<0.03, Wilcoxon matched-pairs test). There was no significant difference between the number of A3 and B3, but significantly more corneae were classified as B4 than A4 in all age groups (p<0.02). The most frequent A|B combinations were A4|B4 (n=451), A0|B0 (n=311), A2|B4 (n=242), A2|B2 (n=189) and A1|B2 (n=154). Concerning thinnest pachymetry (C), most corneae in all age groups were classified as C0>C1>C2>C3>C4 (p<0.04, Wilcoxon matched-pairs test). For the best distance visual acuity (D), a significantly higher number of corneae were classified as D1 compared to D0 (p<0.008; D1>D0>D2>D3>D4).ConclusionThe stage distributions in all age groups were similar. Early KC rather becomes manifest in the posterior than the anterior corneal curvature whereas advanced stages of posterior corneal curvature coincide with early and advanced stages of anterior corneal curvature. Thus, this study emphasises the necessity of posterior corneal surface assessment in KC as enabled by the ABCD grading system.
Collapse
|
18
|
Papadopoulos V, Bangeas P, Xanthopoulou K, Paramythiotis D, Michalopoulos A. Stoma prolapse handmade repair under local anesthesia with variation of Altemeier method in severe patients: a case report and review of the literature. J Surg Case Rep 2017; 2017:rjx027. [PMID: 28458834 PMCID: PMC5400450 DOI: 10.1093/jscr/rjx027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/23/2017] [Indexed: 01/01/2023] Open
Abstract
Stoma prolapse represents one of the most common late complications, occurring in 1–16%. Final rate depends on systematic follow up of the patient and the primary technique. A 49-year-old male patient presented in the Emergency Department, complaining about stoma prolapse, pain and stoma care difficulties. On admission, his colostomy protruded ~20 cm from the skin. The symptoms were local pain and psychological stress. The prolapse was repaired successfully with a simple revision procedure under local anesthesia, by resecting the prolapsed part of the bowel and reconstruction of stoma. Prolapsed part of the colon is removed and the remaining end of the colon is fixated to the abdominal wall. Colorectal surgeons must familiarize with management of stoma complications. Stoma revision under local anesthesia is an alternative and safe method.
Collapse
Affiliation(s)
- Vasileios Papadopoulos
- 1st Surgical Propedeutic Department, Medical Faculty, AHEPAUniversity Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Bangeas
- 1st Surgical Propedeutic Department, Medical Faculty, AHEPAUniversity Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kassandra Xanthopoulou
- 1st Surgical Propedeutic Department, Medical Faculty, AHEPAUniversity Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Surgical Propedeutic Department, Medical Faculty, AHEPAUniversity Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Surgical Propedeutic Department, Medical Faculty, AHEPAUniversity Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
19
|
Kuma A, Yamada S, Miyamoto T, Serino R, Tamura M, Otsuji Y, Kohno K, Cho WY, Kim MG, Jo SK, Kim HK, Jado JC, Humanes B, Lopez-Parra V, Camano S, Lara JM, Cercenado E, Tejedor A, Lazaro A, Jansen M, Castellano G, Stasi A, Intini A, Gigante M, Di Palma AM, Divella C, Netti GS, Prattichizzo C, Pontrelli P, Crovace A, Staffieri F, Fiaccadori E, Brienza N, Grandaliano G, Pertosa GB, Gesualdo L, Xanthopoulou K, Tsouchnikas I, Ouzounidis G, Kokaraki G, Lagoudaki R, Simeonidou C, Karkavelas G, Spandou E, Tsakiris D, Xanthopoulou K, Tsouchnikas I, Ouzounidis G, Kokaraki G, Simeonidou C, Karkavelas G, Spandou E, Kallaras K, Tsakiris D, Schneider R, Meusel M, Betz BB, Held C, Moller-Ehrlich K, Buttner-Herold M, Wanner C, Michael G, Sauvant C, Hosszu A, Antal Z, Hodrea J, Koszegi S, Banki NF, Wagner L, Lenart L, Vannay A, Szabo AJ, Fekete A, Michael A, Faga T, Navarra M, Andreucci M, Lemoine S, Pillot B, Rabeyrin M, Varennes A, Ovize M, Juillard L, Gomes Santana L, Silva Almeida W, Schor N, Watanabe M, Fonseca CD, Pessoa EA, Mendonca MH, Fernandes SM, Borges FT, Vattimo MF, Ow CPC, Tassone F, Koeners MP, Malpas SC, Evans RG, Alfarano C, Guardia MA, Lluel P, Palea S, Young GH, Wu VC, Choi DE, Jeong JY, Chang YK, Chung S, Na KR, Kim SS, Lee KW, Choi DE, Jeong JY, Chung S, Chang YK, Na KR, Kim SS, Lee KW, Yang Y, Zhang L, Fu P, Zhao Y, Zhang X, Jadot I, Decleves AE, Colombaro V, Martin B, Voisin V, Habsch I, Deprez E, Nortier J, Caron N, Iwakura T, Fujikura T, Ohashi N, Yasuda H, Fujigaki Y, Vasco CF, Watanabe M, Fonseca CD, Vattimo MDFF, Draibe J, Y ld r m Y, Aba O, Y lmaz Z, Kadiroglu AK, Y lmaz ME, Gul M, Ketani A, Colpan L, Neiva LBDM, Borges FT, Fonseca CD, Watanabe M, Vattimo MDFF, Suller Garcia J, Oliveira ASD, Naves MA, Borges FT, Schor N, Van Swelm RPL, Wetzels JFM, Verweij VGM, Laarakkers CMM, Pertijs JCLM, Swinkels DW, Masereeuw R, Sereno J, Rodrigues-Santos P, Vala H, Rocha-Pereira P, Fernandes J, Santos-Silva A, Teixeira F, Reis F, Altuntas A, Yilmaz HR, Altuntas A, Uz E, Demir M, Gokcimen A, Bayram DS, Aksu O, Sezer MT, Yang KH, Jung YJ, Kim D, Lee AS, Lee S, Kang KP, Park SK, Kim W, Junglee NA, Searell CR, Jibani MM, Macdonald JH, Wu CC, Chen CC, Lu KC, Lin YF, Estrela GR, Wasinski F, Pereira R, Malheiros D, Camara NOS, Araujo RC, Ramos MF, Passos CDS, Razvickas CV, Borges F, Ormanji M, Schor N, Plotnikov E, Morosanova M, Pevzner I, Zorova L, Manskikh V, Skulachev M, Skulachev V, Zorov D, Pinto CF, Watanabe M, Fonseca CD, Vattimo M. EXPERIMENTAL ACUTE KIDNEY INJURY. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
20
|
Kachrimanidou M, Tsorlini E, Katsifa E, Vlachou S, Kyriakidou S, Xanthopoulou K, Tsergouli K, Samourli T, Papa A. Prevalence and molecular epidemiology of methicillin-resistant Staphylococcus aureus in a tertiary Greek hospital. Hippokratia 2014; 18:24-27. [PMID: 25125947 PMCID: PMC4103036] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of health- and community-associated infections; its prevalence in Greece is among the highest in Europe. We investigated the prevalence and molecular epidemiology of MRSA in a tertiary Greek hospital. MATERIAL AND METHODS Spa typing and random polymorphic DNA analysis were used to investigate the molecular epidemiology of 28 MRSA isolates during May 2010 to May 2011 in a tertiary hospital in Northern Greece. RESULTS Nine spa types were detected; t003 was the predominant (32.1%) one, detected in various wards and throughout the study period, while t037 was recovered only from intensive care unit patients, and only in April 2011, suggestive of an epidemic. Additional rare types were detected for the first time in Greece. CONCLUSIONS Spa typing and random polymorphic DNA analysis gave an insight into the epidemiology of MRSA in a Northern Greece hospital. Concerning the distribution in the hospital, the predominant spa type t003 was present in various wards, and was constantly detected throughout the study period, very suggestive of an epidemic, while other types were detected only in specific wards. Our data underline the need for surveillance, typing and constant reassessment of existing strategies to control MRSA.
Collapse
Affiliation(s)
- M Kachrimanidou
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece ; Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - E Tsorlini
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - E Katsifa
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - S Vlachou
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - S Kyriakidou
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - K Xanthopoulou
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| | - K Tsergouli
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| | - T Samourli
- Department of Microbiology, of George Papanikolaou Hospital, Thessaloniki, Greece
| | - A Papa
- 1 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
21
|
Abstract
A human outbreak of West Nile virus (WNV) infections occurred in 2010 in central Macedonia, northern Greece. Most cases were observed close to four rivers forming a large Delta, a major Mediterranean wetland. WNV lineage 2 sequences were obtained from two pools of Culex pipiens mosquitoes trapped in sites where encephalitis cases occurred a few days before the trapping. The Greek strain showed the highest homology to Hungarian and South African strains, differing from the Russian WNV lineage 2 strain, which suggests that at least two lineage 2 strains have been introduced and established in Europe, causing severe disease to humans.
Collapse
Affiliation(s)
- A Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | |
Collapse
|
22
|
Legakis NJ, Xanthopoulou K, Ioannidou H, Papavassiliou J. Direct quantitative determination of acidic end products in clinical specimens for presumptive diagnosis of anaerobic infections. Ann Microbiol (Paris) 1982; 133:281-90. [PMID: 7149527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Acidic metabolic products determined directly in clinical specimens of 51 anaerobic and 12 aerobic infections by quantitative gas-liquid chromatography (GLC) were correlated with the bacteriologic findings. The presence of appreciable amounts of succinic acid, more than 1 microM per ml, propionic and isovaleric acid, at concentrations not exceeding 3 microM per ml, was strong evidence for Bacteroides fragilis infections. When isobutyric acid was also detected, a B. melaninogenicus infection could be presumed. However, the presence of other anaerobes or aerobes could not be excluded. The presence of Clostridium spp. could also be presumed by the detection of butyric acid at a concentration greater than 4 microM per ml and of acetic, propionic and isobutyric acid at relatively high concentrations. In specimens from aerobic infections, no other acid except acetic and lactic acid could be detected. Our data also show that quantitative GLC is not valid in Peptococcus and Peptostreptococcus spp. infections except in some cases where Peptococcus alone or together with aerobic organisms are found.
Collapse
|