The Role of the European Society of Human Genetics in Delivering Genomic Education

The European Society of Human Genetics (ESHG) was founded in 1967 as a professional organisation for members working in genetics in clinical practice, research and education. The Society seeks the integration of scientific research and its implementation into clinical practice and the education of specialists and the public in all areas of medical and human genetics. The Society works to do this through many approaches, including educational sessions at the annual conference; training courses in general and specialist areas of genetics; an online resource of educational materials (EuroGEMS); and a mentorship scheme. The ESHG Education Committee is implementing new approaches to expand the reach of its educational activities and portfolio. With changes in technology, appreciation of the utility of genomics in healthcare and the public's and patients' increased awareness of the role of genomics, this review will summarise how the ESHG is adapting to deliver innovative educational activity.

CAN Optical Coherence Tomography redefine amblyopia?

Introduction: For many years, amblyopia was regarded as a disorder of the visual system in which an organic cause could not be identified. Optical Coherence Tomography opens new horizons in understanding the etiopathology of amblyopia and seems to highlight morphologic anomalies in the retina of the amblyopic eye.

Purpose: The objective of this paper is to analyze the macular thickness, optic nerve changes, and choroidal thickness found in patients diagnosed with amblyopia based on trials reported in the literature.

Material and methods: This study analyzes 30 clinical trials regarding amblyopia evaluation with Optical Coherence Tomography. The research articles analyzed were published between 2006 - 2016 and were identified on PubMed database.

Results: 19 research studies focused on macular and nerve optic changes, 7 on choroidal changes and 6 on retinal changes after occlusion. The results were discussed according to the type of amblyopia, alteration of macular thickness, optic nerve changes, ganglion cell layer changes, and alteration of choroidal thickness.

Conclusions: The results are of great variability, and it seems that macula and choroid involvement is more frequently suggested compared with optic nerve involvement.

Abbreviations: OCT = Optical Coherence Tomography, RNFL = Retinal Nerve Fiber Layer, GCC = Ganglion Cell Complex, ACD = Anterior Chamber Depth, BCVA = Best Corrected Visual Acuity

Insights in the treatment of congenital nasolacrimal duct obstruction

Introduction: Congenital nasolacrimal duct obstruction is one of the most common causes of epiphora in newborns and the main cause of this condition is the persistence of Hasner membrane. Several treatment options are available, like conservative treatment, probing, irrigation, or more complex techniques.

Objective: The objective of this paper is to discuss the efficiency of different treatment options addressing congenital nasolacrimal duct obstruction based on trials reported in literature.

Methods: Clinical trials were identified on PubMed. The results were discussed regarding patient age, type of treatment and efficiency of the treatment.

Results: 41 trials were reviewed. The rate of resolution according to different treatment options was the following: conservative treatment 14.2-96%, probing 78-100%, irrigation 33-100%, silicon tube intubation 62-100%, inferior turbinate fracture 54.7-97%, balloon dacryocystoplasty 77%, endoscopic intranasal surgery 92.72%, and dacryocystorhinostomy 88.2-93.33%.

Conclusions: The first choice in uncomplicated cases should be a conservative treatment, which can be followed until the age of 1 year, while in complicated cases other solutions should be considered.

Abbreviations: CNDO = Congenital nasolacrimal duct obstruction, DCR = Dacryocystorhinostomy, MCI = Monocanalicular intubation, BCI = Bicanalicular intubation

FUCHS ENDOTHELIAL CORNEAL DYSTROPHY: IS FEMTOSECOND LASER-ASSISTED CATARACT SURGERY THE RIGHT APPROACH?

INTRODUCTION

Femtosecond Laser-assisted cataract surgery represents a modern technology that hopes to lower the risk of complications for patients suffering from Fuchs endothelial dystrophy by using a reduced level of energy that causes less damage to the endothelium, the main concern for patients with Fuchs endothelial dystrophy. The femtosecond laser performs 3 important steps in cataract surgery: corneal incisions, capsulorhexis and nucleus fragmentation without intraocular instrument manipulation.

PURPOSE

The purpose of this study is to determine the efficiency of Femtosecond Laser-assisted cataract surgery in Fuchs endothelial dystrophy.

MATERIAL AND METHODS

5 patients with 6 eyes underwent cataract surgery assisted by Femtosecond Laser LensX at Laser Optisan Clinic. Corneal changes before and after surgery and cumulative dissipated energy (CDE) were analyzed.

RESULTS

Before surgery, our patients presented BCVA between 0.16-0.4, Pachymetry between 450-590 Lm, endothelial cells between 789-2008 mm2. The medium cumulative dissipated energy (CDE) used was 4.58 seconds. After surgery, BCVA improved in all patients and none of them developed corneal decompensation so far.

CONCLUSIONS

Femtosecond Laser-assisted cataract surgery represents a safe alternative in patients with Fuchs endothelial dystrophy and has a low risk of corneal decompensation.

PERSISTENT PUPILLARY MEMBRANE OR ACCESSORY IRIS MEMBRANE?

Frequently, in literature and curent practice, accessory iris membrane (AIM) and persistant pupillary membrane (PPM) are confused. Both AIM and PPM are congenital iris anomalies in which fine or thick iris strands arrise form the collarette and obscure the pupil. AIM, which is also called iris duplication, closely resembles the normal iris tissue in color and thickness and presents a virtual second pseudopupil aperture in the centre while PPM even in its extreme forms presents as a translucent or opaque membranous structure that extends across the pupil and has no pseudopupil. Mydriatiscs, laser treatment or surgery is used to clear the visual axis and optimize visual development. Surgical intervention is reserved for large, dense AIMs and PPMs. Our patient, a 29 year old male, has come with bilateral dense AIM, bilateral compound hyperopic astigmatism, BCVA OD = 0.6, BCVA OS = 0.4, IOP OU = 17 mmHg. To improve the visual acuity of the patient we decided to do a bilateral membranectomy, restoring in this way transparency of the visual axis. After surgery, the visual acuity improved to BCVA OD= 0.8, BCVA OS=0.8.

[Treating anisometric amblyopia with HTS Amblyopia iNet Software--preliminary results]

Amblyopia or "lazy eye" represents a disorder of the visual system characterized by poor vision in an eye that is otherwise physically normal. Anisometropia, the condition in which the two eyes have an unequal refractive error, is considered the second most common cause of amblyopia. The purpose of this study is to determine the efficiency of HTS Amblyopia iNet Software by studying the progress of visual acuity, contrast sensitivity and stereopsis vision in anisometropic amblyopic children. 5 patients (age: 5-13 years), treated with HTS Amblyopia iNet Software at OftaTotal Clinic from Sibiu, between 2010-2013, participated in this clinical trial. Initially, visual acuity ranged from 0.25 to 0.8, contrast sensitivity from 1.35 to 1.65 Log. Unit. and 1 patient presented stereoscopic vision. After treatment, visual acuity ranged from 0.8 to 1, contrast sensitivity from 1.35 to 1.95 Log. Unit., also all patients presented stereoscopic vision. HTS Amblyopia iNet Software represents an effective modern approach in the treatment of anisometropic amblyopia.

[Functional amblyopia]

Amblyopia is a disorder of the visual system that represents unilateral or bi-lateral reduction of visual acuity in which an organic cause cannot be detected. The illness represents a syndrome of visual deficits, not only a deterioration of visual acuity. This syndrome includes: presence of crowding phenomena, contrast sensitivity deterioration, deficits in accommodation, deterioration of spatial orientation and ocular motility dysfunction. Depending on its etiology, amblyopia is classified into four main types: strabismic amblyopia, anisometropic amblyopia, isoametropic amblyopia and stimulus deprivation amblyopia. To successfully treat the "lazy eye" it is essential to remove the amblyopic factor with techniques addressing each disturbing factor. Techniques used for treating amblyopia include: occlusion, optical penalty or pharmacological, therapy with Levodopa and computer vision therapy. Amblyopia treatment is lengthy and it is very important to counsel not only the child but the whole family and to establish a relationship of trust between doctor and patient in order to get high treatment compliance and high child motivation.

[Ocular manifestations in progeria]

The observation of a 17-year-old teenager with progeria, ventricular septal shortcoming with wide anterolateral [correction of arteriolateral] myocardial ischemia. From an ocular point of view, he shows senescence with senile ectropion, evolutive cataract, retinal angiosclerosis. The role of the manifestation of ocular senescence in Hutchinson-Gilford Syndrome is emphasized.

Cytologic detection of Enterobius vermicularis and Strongyloides stercoralis in routine cervicovaginal smears and urocytograms

Four cases of Enterobius vermicularis infection and one case of Strongyloides stercoralis infection were found during the examination of 22,700 routine Papanicolaou-stained cervicovaginal smears and 434 urinary sediments. Ova of E. vermicularis were observed in the urocytograms from three girls and in the vaginal smear of a young woman. In a second woman, a S. stercoralis larva was detected in the routine vaginal smear. A clear background or a mild inflammatory pattern was noted in the smears in these cases.

Cytologic findings in oral contraceptive users among Israeli Jewish women

A group of 3,317 Jewish Israeli women were studied to evaluate a possible correlation between previous and recent oral contraceptive usage and cervical cytopathologic findings in Papanicolaou smears. A positive correlation was established between oral contraceptive usage and the occurrence of inflammatory findings: the rate of inflammatory changes depended on the length of usage, with a time lapse of at least one year preceding the appearance of such inflammatory changes. The cessation of oral contraceptive usage was associated with a decrease in the rate of inflammatory findings. No cases of cervical intraepithelial neoplasia or malignancy were found.

Hormonal and cytopathological changes in vaginal and cervical smears from women undergoing chemotherapy for extragenital malignant diseases

The effects of various chemotherapeutic drugs on the squamous epithelium of the cervicovaginal tissues were investigated in a test group of 74 and a control group of 44 women with advanced extragenital malignancy. The cytological findings were as follows: (A) cytohormonal changes reflecting estrogenic withdrawal in pre- and postmenopausal women, (B) reversible cytopathological changes reflecting a cytotoxic reaction, and (C) absence of premalignant and malignant changes.

Cytologic evaluation of hormonal dynamic in the postmenopause

There is increasing evidence that the postmenopausal ovary retains some endocrine function and thus can contribute a certain extent to the persistence of the vaginal epithelium proliferation a long time after the cessation of menstruations. Vaginal cytology plays an important role in the assessment of the vaginal epithelium response to hormonal stimuli, though less accurate than the blood and the urine estimations. It was established that there was a good correlation between the vaginal cytology and the biochemical estimations [2]. The fact that vaginal cytology cannot distinguish the proliferative patterns induced by estrogens, progesterone and androgens is true. With this in mind we did a cytological study in postmenopausal women, using our classification for the cytological typing based on the depth of the epithelial atrophy. The findings are discussed with special reference to the ethnic origin, reproductive life and concurrent illnesses.

Photohydration of testosterone and 4-androstene-3,17-dione in aqueous solution

Irradiation of testosterone, 4-androstene-3,17-dione, or their "half-molecule" 4,4a,5,6,7,8-hexahydro-4a-methyl-2(3H)-naphthalenone in dilute aqueous solutions with ultraviolet light of 254 nm wavelength caused rapid addition of water across the olefinic bond with formation of 5,17 beta-dihydroxy-5 alpha-androstan-3-one, 5-hydroxy-5 alpha-androstane-3-17-dione, and 9-hydroxy-10-methyl-2-decalone, respectively. Time-lapse spectrometry in the ultraviolet region showed that the photohydration of the androgenic steroids was extremely efficient and virtually free of the side reactions. Preparative photolytic reactions carried out in water-methanol solutions allowed isolation and characterization of photoproducts.