scholarly journals Szemészeti tünetek és szemészeti társbetegségek monoklonális gammopathiával járó kórképekben

2021 ◽  
Vol 54 (2) ◽  
pp. 82-88
Author(s):  
Nóra Szentmáry ◽  
Kitti Kormányos ◽  
Gábor Tóth ◽  
Gábor László Sándor ◽  
Orsolya Németh ◽  
...  
Keyword(s):  
Monoclonal Gammopathy ◽  
Retinal Dystrophy ◽  
Corneal Tissue ◽  
Ocular Symptoms ◽  
Vein Occlusion ◽  
Plasma Cell Disorders ◽  
Retinal Artery ◽  
Ophthalmic Treatment ◽  
Ocular Signs

Összefoglaló. Célkitűzés: A monoklonális fehérjetermeléssel járó haematológiai kórképek szemészeti tüneteinek és szemészeti társbetegségeinek összefoglalása irodalmi adatok alapján. Módszer: A Pubmedben rendelkezésre álló adatok kigyűjtése, elemzése és összefoglalása. Eredmények: Immunglobulin-lerakódás a szem szövetei közül leggyakrabban a szaruhártyában figyelhető meg (paraproteinaemiás vagy immuntaktoid keratopathia). A monoklonális fehérjeszaporulattal járó plazmasejtes betegség gyakoribb szemészeti jelei pedig a paraproteinaemiás keratopathia mellett a kristályhordozó histiocytosis (CSH), a hypercupremiás keratopathia, a foveolaris drusen/maculopathia és az orbitalis plasmocytoma. A ritkább szemészeti jelek/tünetek közé az akut/krónikus uveitis, a Doyne retina dystrophia és az arteria vagy vena centralis retinae elzáródása tartoznak. Szemészeti mellékhatás szisztémás szteroidok és a belantamab mafotidin alkalmazásakor jelentkeznek. Következtetések: A monoklonális gammopathiával járó kórképek sokszínű szemészeti panaszokkal jelentkezhetnek a klinikai gyakorlatban, aminek felismerése a megfelelő kivizsgálás elindításával a szemész feladata. A betegek kezelése és gondozása során a haematológusok és szemészek együttműködése a számos ismert szemészeti tünet és társbetegség miatt elengedhetetlen. A megfelelő szemészeti kezeléssel a látóélesség és ezáltal a betegek életminősége jelentősen javítható. Summary. Purpose: To summarize ocular symptoms and ocular comorbidities of monoclonal gammopathy, based on literature data. Methods: A comprehensive Pubmed search has been performed to summarize ocular symptoms and comorbidities before January 2021. Results: Immunglobulin deposition was most commonly observed in the corneal tissue (paraproteinaemic or immuntactoid keratopathy). Beside paraproteinaemic keratopathy, the most common ocular signs and ocular comorbidities of plasma cell disorders with monoclonal gammopathy are crystal-storage histiocytosis (CSH), hypercupremic keratopathy, foveolar drusen/maculopathy and orbital plasmocytoma. Less common ocular signs are acute/chronic uveitis, Doyne retinal dystrophy, central retinal artery or vein occlusion. Ophthalmic side effects are expected following the use of systemic steroids or belantamab mafotidin. Conclusions: Monoclonal gammopathy may present with diverse ocular symptoms in the clinical practice, which should be examined and treated through an ophthalmologist. Therefore, collaboration of haematologists and ophthalmologists is essential for these patients. With appropriate ophthalmic treatment, there is a significant improvement of best corrected visual acuity of these patients, with a significant impact on their quality of life.

scholarly journals Ocular Signs and Ocular Comorbidities in Monoclonal Gammopathy: Analysis of 80 Subjects

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Kitti Kormányos ◽  
Klaudia Kovács ◽  
Orsolya Németh ◽  
Gábor Tóth ◽  
Gábor László Sándor ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Monoclonal Gammopathy ◽  
Ocular Surface Disease ◽  
Control Group ◽  
Hematological Disease ◽  
Ocular Surface Disease Index ◽  
Corrected Visual Acuity ◽  
Smoldering Myeloma ◽  
Ocular Signs

Purpose. To examine the ocular signs of monoclonal gammopathy and to evaluate ocular comorbidities in subjects with monoclonal gammopathy. Patients and Methods. We analyzed patients from two large referral hematology centers in Budapest, diagnosed and/or treated with monoclonal gammopathy between 1997 and 2020. As a control group, randomly selected individuals of the same age group, without hematological disease, have been included. There were 160 eyes of 80 patients (38.75% males; age 67.61 ± 10.48 (range: 38–85) years) with monoclonal gammopathy and 86 eyes of 43 control subjects (32.56% males; age 62.44 ± 11.89 (range 37–86) years). The hematological diagnosis was MGUS in 9 (11.25%), multiple myeloma in 61 (76.25%), smoldering myeloma in 6 (7.50%), and amyloidosis or Waldenström macroglobulinemia in 2 cases (2.50%–2.50%). Before detailed ophthalmic examination with fundoscopy, 42 subjects with gammopathy (52.50%) and all controls filled the Ocular Surface Disease Index (OSDI) questionnaire. Results. The OSDI score and best-corrected visual acuity (BCVA) were significantly worse in subjects with monoclonal gammopathy than in controls ( p = 0.02 ; p = 0.0005 ). Among gammopathy subjects, we observed potential corneal immunoglobulin deposition in 6 eyes of 4 (3.75%) patients. Ocular surface disease ( p = 0.0001 ), posterior cortical cataract ( p = 0.01 ), and cataract ( p = 0.0001 ) were significantly more common among gammopathy subjects than in controls (χ2 test). Conclusions. Ocular surface disease and cataract are more common, and BCVA is worse in patients with monoclonal gammopathy than in age-matched controls. Therefore, and due to the potential ocular signs and comorbidities of monoclonal gammopathy, we suggest a regular, yearly ophthalmic checkup of these patients to improve their quality of life.

Retinal Vascular Occlusive Disorders - Risk Factors

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Shivcharan Lal Chandravanshi, Sunil Kumar Shrivastava, Priyanka Agnihotri, Smriti Gupta
Keyword(s):  
Risk Factors ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Vein Occlusion ◽  
Department Of Ophthalmology ◽  
Retinal Artery ◽  
Central Retinal Vein

Aims and Objective - The aim of the present study is to identify risk factors associated with different retinal vascular occlusive diseases (RVOD), such as central retinal artery occlusion (CRAO), hemi-retinal artery occlusion (HRAO), branch retinal artery occlusion (BRAO), cilioretinal artery occlusion (Cilio-RAO), central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemi-retinal vein occlusion (HRVO). Patients and Method - A cross-sectional study on 114 consecutive subjects, aged 24-96 years who have attended at the outpatient department of ophthalmology at Shyam Shah Medical College, Rewa, MP, were included in the study. The Duration of study was January 2016 to December 2017. Only patients with CRAO, BRAO, HRAO, Cilio-RAO, CRVO, BRVO, and HRVO were included in the study. Other retinal vascular disorders such as diabetic vaso-occlusive disease, anterior and posterior ischemic and non-ischemic neuropathy, hypertensive retinopathy, sickle cell retinopathy, retinal telangiectasia, retinopathy of prematurity, were excluded from study. Results - We have included 114 patients, 64 cases (56.14%) males, 50 (43.85%) females, aged 56+/-8 years (range 24-96 years).  Bilateral retinal vascular occlusive disorders were seen in only 4 cases (3.5%). Two patients have bilateral CRVO followed by one case of bilateral BRVO and one case of bilateral CRAO.  Out of 114 patients, branch retinal vein occlusion was seen in 62 cases (54.38%), followed by central retinal vein occlusion in 36 cases (31.57%), CRAO in 8 cases (7.01%), and hemi- retinal vein occlusion in 4 cases (3.50%). Hypertension was the most common, (40 cases, 35.08%) risk factor identified for retinal vascular occlusive disorders followed by diabetes 24 cases (21.05%), combined diabetes and hypertension in 22 cases (19.29%), and atherosclerosis in 18 cases (15.78%). Conclusions - Retinal vascular occlusive diseases have systemic as well as ocular risk factors. Understanding of these risk factors is essential for proper treatment of RVOD. Timely identification of risk factors for RVOD may helpful in decreasing ocular and systemic morbidity in these patients.

scholarly journals MP-AzeFlu in Moderate-to-Severe Allergic Rhinitis: A Literature Review

2021 ◽  
pp. 1-10
Author(s):  
Ludger Klimek ◽  
William E. Berger ◽  
Jean Bousquet ◽  
Paul K. Keith ◽  
Peter Smith ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Fluticasone Propionate ◽  
Treatment Options ◽  
Symptomatic Disease ◽  
Intranasal Corticosteroids ◽  
Need For Treatment ◽  
Ocular Symptoms ◽  
Symptom Complex

Allergic rhinitis (AR) is prevalent, and many patients present with moderate-to-severe symptomatic disease. The majority of patients are not satisfied with their AR treatment, despite the use of concurrent medications. These gaps underscore the need for treatment with more effective options for moderate-to-severe AR. The authors’ objective was to review systematically the efficacy and safety of MP-AzeFlu for the treatment of AR. The primary outcomes studied were nasal, ocular, and total symptoms. Other outcomes included time to onset and of AR control, quality of life, and safety. Searches of PubMed and Cochrane databases were conducted on May 14, 2020, with no date restrictions, to identify publications reporting data on MP-AzeFlu. Clinical studies of any phase were included. Studies were excluded if they were not in English, were review articles, did not discuss the safety and efficacy of MP-AzeFlu for AR symptoms. Treatment of AR with MP-AzeFlu results in effective, sustained relief of nasal and ocular symptoms, and faster onset and time to control compared with intranasal azelastine or fluticasone propionate. Long-term use of MP-AzeFlu was safe, with benefits in children, adults, and adults aged ≥65 years. Other treatment options, including fluticasone propionate and azelastine alone or the combination of intranasal corticosteroids and oral antihistamine, do not provide the same level of efficacy as MP-AzeFlu in terms of rapid and sustained relief of the entire AR symptom complex. Furthermore, MP-AzeFlu significantly improves patient quality of life. MP-AzeFlu is a currently available combination that may satisfy all these patient needs and expectations.

Arguments for ‘ocular donation’ as standardised terminology to reduce the ‘ick factor’ of ‘eye donation’

2022 ◽  
pp. medethics-2021-108003
Author(s):  
Katrina A Bramstedt
Keyword(s):  
Life Support ◽  
Deceased Donor ◽  
Informed Consent Process ◽  
Tissue Donation ◽  
Ocular Tissue ◽  
Corneal Tissue ◽  
Root Cause ◽  
Eye Donation ◽  
Over Time

This brief report presents the global problem of the shortfall of donor corneal tissue for transplantation, a potential root cause (‘ick factor’ language), and a potential solution (modification of ‘ick factor’ language). Specifically, use of the term ‘eye donation’ is a potential hurdle to ocular tissue donation as it can stimulate the ‘ick factor.’ Verbiage such as ‘ocular (eye tissue)’ could be a method of providing terminology that is less emotive than ‘eye donor’ or ‘eye donation.’ The field of transplantation has experienced terminology shifts over time; for example, ‘cadaver’ has been replaced with ‘deceased donor,’ ‘harvest’ has been replaced with ‘recover,’ and ‘life support’ has been replaced with ‘ventilated.’ Notably, only a small number of regions worldwide are using ‘ocular’ terminology, yet it could be an important step to enhancing the informed consent process and improving donation rates, potentially increasing transplant and optimising patient quality of life for those with treatable blindness.

Integrative medicine and plasma cell disorders.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20044-e20044
Author(s):  
Onyemaechi Okolo ◽  
Betsy C. Wertheim ◽  
Ashley Larsen ◽  
Nathan W. Sweeney ◽  
Krisstina L. Gowin
Keyword(s):  
Quality Of Life ◽  
Support Groups ◽  
Integrative Medicine ◽  
Plasma Cell ◽  
Specific Treatment ◽  
Symptom Burden ◽  
Disease Stage ◽  
Breathing Exercises ◽  
Plasma Cell Disorders

e20044 Background: Recent advancements in the treatment of plasma cell disorders (PCD) have led to a revolution in treatment options. Despite improved outcomes, patients have unmet symptom management needs. Integrative medicine (IM) is a method for addressing symptoms in cancer, but its use and efficacy is poorly defined in PCD patients. This analysis describes the utilization of IM among myeloma patients and explores associations with symptom burden. Methods: For 3 months, a 70-question online survey was hosted on HealthTree.org, an online resource for myeloma patients and researchers created by the HealthTree Foundation. The survey included questions about demographics, PCD type, disease stage, complementary practice use, PHQ-2 score (depression screen), and quality of life (sum of 6 interference items; possible score range 0-6). Mean outcome values were compared between IM users and non-users using two-sample t-tests. Proportions of supplement users and IM users were compared between patients currently on myeloma-specific treatment and patients not currently on treatment using chi-square tests. Results: Of 195 total respondents, 17 were excluded for not completing the survey section on IM practices. Median age range was 60-69 years old, 61% were female, 91% were non-Hispanic white, and 57% were overweight or obese. Plasma cell subtypes were active myeloma (81%), smoldering myeloma (12%), MGUS (3%), amyloidosis (2%), and plasmacytoma (1%), and 72% of patients were currently on cancer-specific treatment. On a scale of 1-10 (1=very uncomfortable; 10=very comfortable), patients reported a mean score of 3.7 when discussing IM therapies with their oncologist. The top 10 IM modalities reported were aerobic exercise (83%), nutrition (67%), natural products (60%), strength exercise (52%), support groups (48%), breathing exercises (44%), meditation (42%), yoga (40%), mindfulness-based stress reduction (38%), and massage (38%). Those who participated in meditation had significantly higher PHQ-2 scores (worse depression) than non-participants (1.1 vs. 0.8; p=0.05). Users of support groups (3.4 vs. 2.7; p=0.04), medicinal marijuana (4.0 vs. 2.9; p=0.03), or vitamin C (3.6 vs. 2.7; p=0.01) reported higher mean interference (worse quality of life) than non-users. Compared to patients currently on cancer treatment for PCD, untreated patients were significantly more likely to use curcumin (58% vs. 41%; p=0.04) or green tea (44% vs. 17%; p<0.001), were less likely to use medicinal marijuana (6% vs. 18%; p=0.05), and reported significantly lower fatigue (p=0.02). Conclusions: This international survey-based analysis reveals that most patients participated in IM modalities, though felt uncomfortable discussing them with their oncologist. It is unclear if the use of some IM modalities were due to symptom burden or lead to higher symptom burden. This study provides a foundation in the understanding of IM use in PCD, but more research is needed to evaluate its efficacy.

Safety and Effectiveness of a Single Multiallergen Subcutaneous Immunotherapy in Polyallergic Patients

2021 ◽  
pp. 1-5
Author(s):  
Santiago Nevot-Falcó ◽  
Eloina Gonzalez Mancebo ◽  
Antonio Martorell ◽  
Cristina Martorell Calatayud ◽  
Sheila Cabrejos Perotti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Adherence ◽  
Allergic Symptom ◽  
Subcutaneous Immunotherapy ◽  
Life Questionnaire ◽  
Plane Tree ◽  
Ocular Symptoms ◽  
Poor Treatment ◽  
Retrospective Multicenter Study

<b><i>Background:</i></b> As the number of allergic sensitizations increases the severity of allergic respiratory diseases worsens. Multiple monoallergen immunotherapy can be accompanied by poor treatment adherence and high costs, single multiallergen immunotherapy needs to prove efficacy whilst maintaining a good safety profile. <b><i>Methods:</i></b> Observational, retrospective, multicenter study using a 2-pollen single undiluted multiallergen subcutaneous immunotherapy (SCIT) in routine clinical practice in Spain. Patients with rhinoconjunctivitis, with/without controlled asthma, sensitized to grass, olive, Parietaria, Cupressus, plane tree and/or Salsola pollen were included. Primary and secondary clinical efficacy endpoints were quality of life (mini Rhinitis Quality of Life Questionnaire (miniRQLQ)) and visual analogue scale (VAS) respectively. All adverse events were documented. <b><i>Results:</i></b> Ten centers included 97 patients, median age 32 years. SCIT treatment included combinations of grass mix with olive, Parietaria, Cupressus, plane tree or Salsola or olive with Parietaria, Cupressus or Salsola. The mean duration of SCIT was 1.8 years with a high treatment adherence (73%). Significant improvement in quality of life, nasal and ocular symptoms, activity limitations and practical problems (<i>p</i>&#x3c; 0.0001) and other symptoms (<i>p</i>= 0.024) was observed. Most patients did not develop asthma-like symptoms and a significant improvement of all allergic symptom severity was perceived. VAS showed a significant improvement in rhinoconjunctivitis and asthma by patients and physicians. Twenty-nine patients experienced adverse reactions, 25 had local and 6 had systemic reactions. <b><i>Conclusions:</i></b> Single undiluted multiallergen SCIT treatment of two different pollens is efficacious and safe in both children and adults, showing that it is a suitable option for the treatment of polyallergic patients.

Objective ocular surface tolerance in patients with glaucoma treated with topical preserved or unpreserved prostaglandin analogues

2018 ◽  
Vol 29 (6) ◽  
pp. 645-653 ◽  
Author(s):  
Ammar El Ameen ◽  
Guillaume Vandermeer ◽  
Raoul K Khanna ◽  
Pierre-Jean Pisella
Keyword(s):  
Intraocular Pressure ◽  
Prostaglandin Analogue ◽  
Ocular Toxicity ◽  
Prostaglandin Analogues ◽  
Conjunctival Hyperaemia ◽  
Ocular Symptoms ◽  
Tear Meniscus ◽  
Tear Meniscus Height ◽  
Preservative Free ◽  
Ocular Signs

Purpose: Preservatives in glaucoma medications have been associated with ocular toxicity. We compared ocular signs and symptoms in patients with open-angle glaucoma or ocular hypertension treated in monotherapy with preserved or preservative-free prostaglandin analogues. Methods: Observational cross-sectional clinical study in real life. 82 patients treated for at least 6 months with prostaglandin analogue were assessed for intraocular pressure, ocular symptoms and ocular signs including conjunctival hyperaemia, tear break-up time and tear meniscus height measured using objective and non-invasive methods (OCULUS Keratograph 5M). Patients presenting with symptoms of ocular toxicity with preserved prostaglandin analogues were switched to preservative-free latanoprost, and a second assessment was processed 6 months after. Results: At inclusion, 30 (36.6%) patients were treated with preservative-free latanoprost, 25 (30.5%) with preserved latanoprost, 16 (19.5%) with preserved travoprost and 11 (13.4%) with preserved bimatoprost. Patients treated with preservative-free latanoprost reported significantly less ocular symptoms upon instillation (mainly burning) and between instillations than patients treated with preserved prostaglandin analogues. The mean conjunctival hyperaemia (limbal + bulbar) was significantly lower with preservative-free latanoprost (2.08 ± 0.55) compared to preserved latanoprost (2.50 ± 0.7, p = 0.0085), preserved travoprost (2.67 ± 0.82, p = 0.0083) and preserved bimatoprost (2.68 ± 0.67, p = 0.0041). There were no relevant between-group differences in mean tear meniscus height and break-up time. Ocular symptoms and conjunctival hyperaemia improved when preserved prostaglandin analogues were switched to preservative-free latanoprost for 6 months while intraocular pressure reduction was maintained. Conclusion: Overall, this study suggests a better subjective and objective ocular tolerance when patients were treated with preservative-free latanoprost than with other preserved prostaglandin analogues monotherapy. Switching to preservative-free latanoprost maintained intraocular pressure at the same level as preservative prostaglandin analogue, but improved ocular surface tolerance.

scholarly journals Phakic Intraocular Lenses in Keratoconus

2015 ◽  
Vol 4 (3) ◽  
pp. 103-106
Author(s):  
Jorge L Alio ◽  
Pablo Sanz-Díez
Keyword(s):  
Refractive Surgery ◽  
Optical Quality ◽  
Intraocular Lenses ◽  
Tissue Ablation ◽  
Corneal Tissue ◽  
Effective Operation ◽  
Phakic Intraocular Lenses ◽  
Myopic Astigmatism ◽  
Corneal Thinning

ABSTRACT Purpose To discuss and summarize the indications, contraindications and results in refractive surgery for keratoconus. Summary Keratoconus is an ectatic corneal disease characterized by a progressive corneal thinning and irregular astigmatism that negatively impact in the visual function and the optical quality of the patients. The refractive surgery in keratoconus has been discussed by several authors. The two primary lines of action are phakic lens implantation and corneal tissue ablation using photorefractive keratectomy. The use of phakic intraocular lenses (IOLs) to correct myopia and compound myopic astigmatism associated with keratoconus is gaining popularity. Recent findings The use of phakic IOLs to correct myopia and compound myopic astigmatism associated with keratoconus is gaining popularity. According to a recent study by our group the safety of this procedure in visual terms is high (post-CDVA/ pre-CDVA = 1.19 ± 0.29). It is also an effective operation (post-UDVA/pre-CDVA = 0.90 ± 0.26). How to cite this article Alio JL, Sanz-Díez P. Phakic Intraocular Lenses in Keratoconus. Int J Kerat Ect Cor Dis 2015;4(3):103-106.

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