A man who lost weight and his sight.
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Diagnosis, Differential↗
Biomedical subjects
M Moschos
Publications and source records attributed to M Moschos.
Neurovisual impairment: a frequent complication of alpha-interferon treatment in chronic viral hepatitis.
Following our earlier observation of clinically evident optic tract neuropathy in patients receiving low-dose interferon (IFN) therapy, we prospectively evaluated 53 consecutive patients treated for chronic hepatitis B or C with a median dose of 3 MU of IFN-a2b thrice weekly. Measurements included routine ophthalmologic evaluation and recordings of visual evoked responses (VER), electroretinograms (ERG), visual acuity, and visual fields, before, at the end of IFN treatment, and at follow-up visits. Baseline P100 latencies of VERs (base-VER) were abnormally prolonged in 24 patients (32 of 106 eyes, 30.2%); age was the only significant covariate associated with increased risk for an abnormal base-VER by multiple logistic regression (relative risk [RR] 5.3 per each 5-year increase in age). In 45 patients (74 eyes) with normal baseline P100 latencies, the end-of-treatment VERs (end-VER) were significantly prolonged compared with baseline, becoming abnormal in 11 (15 of 74 eyes, 20.3%) (138.8+/-8.7 vs. 117.7+/-5.2 ms, P < .001). This subgroup had older age (59.1+/-11.0 vs. 47.5+/-15.3, P=.007) and reduced visual sensitivity compared with their own pretreatment measurements (24.5+/-1.6 vs. 23.0+/-1.2db, P=.019). Changes of end-VERs by age had a sigmoid distribution with a steep increase of values beyond the 5th decade (R2=.326, P < .001). In a logistic regression model, significant predictors of abnormal end-VERs were, patients' age (RR 5.6 per each 5-year increase), presence of hepatitis B virus (HBV) infection (RR 15.1 compared with hepatitis C virus [HCV] infection) and serum cholesterol levels above 240 mg% (RR 7.1 compared with values < 240 mg%). Subconjunctival hemorrhages were seen in 2 cases and funduscopic examination revealed cotton wool spots in one other. ERG recordings and the P100 amplitude remained unchanged. After stopping IFN, the treatment-associated neurovisual abnormalities reversed to normal in 7 patients (10 of 15 eyes) and persisted in 5 (5 of 15 eyes, 33.3%) for up to 37 (median 7.3) months observation, all patients remaining clinically asymptomatic. In conclusion, subclinical neurovisual impairment is a frequent, largely unrecognized complication of low-dose IFN therapy, and patients with chronic hepatitis B and older age appear to be most susceptible. This apparently innocuous complication is long lasting, possibly irreversible in some patients, with yet undetermined consequences on visual function.
Adult↗
Juvenile nasopharyngeal angiofibroma--a rare case of primary orbital development.
PURPOSE: To present a rare case of juvenile nasopharyngeal angiofibroma invading the ophthalmic orbit. METHODS: The CT scan examination and the ultrasound tomography revealed the existence of a homogeneous solid mass causing distention and erosion of the nasal wall as well as dislocation of the ocular bulbus. RESULT: The patient was operated, the mass was carefully liberated from its synechiae and it was totally excised with its capsule. CONCLUSION: A rare case of juvenile nasopharyngeal angiofibroma invading the orbit is presented. The tumor was totally excized and the patient is five years after the operation in good general health without recurrence of the tumor.
Adult↗
Pattern ERG changes in suspected glaucoma.
Pattern ERG (P-ERG) changes were studied in patients with suspected glaucoma. P-ERG was recorded in 48 eyes with good visual acuity, normal visual fields and elevated intraocular pressure ranging between 18 and 26 mm Hg. The amplitude of the P1 wave was within normal limits and ranged between 1.0 and 1.9 microV in 46 eyes (95.8%). In contrast, the amplitude of the N2 wave in 32 eyes (66.6%) was subnormal, ranging between 0.2 and 0.8 microV. The implicit time of the P1 and N2 waves was normal, ranging from 60.1 to 69.4 and from 95.1 to 103.8 ms, respectively. In conclusion, the N2 wave changes of the P-ERG may predict those hypertonic eyes which will eventually develop glaucoma and need early antiglaucoma therapy. On the contrary, in ocular hypertensives with normal N2 wave the development of glaucoma is less likely.
Adult↗
Intravitreal application of ganciclovir in rabbits: ERG and electron-microscopic findings.
The retinal toxic effect after intravitreal use of ganciclovir has been the subject of our experimental investigation on 20 New Zealand rabbits. Different doses of ganciclovir ranging from 200 to 600 micrograms/0.1 ml were injected intravitreously, and ERG changes were recorded at different time points after drug administration. Finally the animals were killed and the retinal lesions were studied by electron microscopy. According to our experiments, ganciclovir doses of 300-600 micrograms/0.1 ml have a clearly toxic effect on the retina as shown by ERG changes. One month after the injection, the electroretinogram is either extinguished or clearly affected. Noteworthy is the fact that in a dose of 200 micrograms/0.1 ml, the ERG b-wave shows a 20% reduction of its normal amplitude 4 months after ganciclovir delivery. Electron microscopy of the retina revealed in the inner segment of the receptor cells the existence of dilatation and vesiculation of the endoplasmic reticulum in the surrounding nuclear cytoplasm and swelling of the mitochondria with fragmentation of the cristae in several of them. In the outer segment of the photoreceptor cells, degeneration and destruction of the lamellae accompanied by disintegration of the adjacent protoplasm in parts of certain rods and cones appeared. Finally large vacuoles of irregular shape in the synapses and degenerative mitochondria and empty vacuoles in the optic nerve fibers were shown.
Animals↗
Keratoconus and tapetoretinal degeneration.
In a series of 233 keratoconus cases, electroretinograms (ERGs) and visual evoked responses (VERs) were recorded; the results of this study are discussed. In six cases, the ERGs were extinguished, and the VERs were pathologic. In contrast to this, in four cases, ERGs were normal, but VERs were pathologic. Postoperatively the electrophysiologic findings remained the same, and the ophthalmoscopic examination of the eyes revealed the existence of a diffuse tapetoretinal degeneration or a macular lesion. These data show clearly the coexistence in many cases of keratoconus with diffuse tapetoretinal degeneration or macular lesion. The preoperative value of an electrophysiologic study of keratoconus patients is justified to avoid an unneeded corneal transplant.
Adolescent↗
Tuberculin sensitivity trends in Hellenic army recruits during the period 1981-91.
SETTING: The tuberculin skin test is widely used to define the tuberculous infection in the community. Serial representative tuberculin surveys demonstrate the trend of the risk of tuberculous infection. OBJECTIVE: The study of tuberculous infection in Hellenic army recruits for the purposes of BCG vaccination, which with chemoprophylaxis and early case-finding are the major strategies used for preventing tuberculosis (TB). DESIGN: We investigated tuberculin skin sensitivity on 544210 Hellenic Armed Forces recruits during 1981-91. The age of the subjects ranged between 18-28 years (mean 21 +/- 1.5 years). We used the Mantoux technique with tuberculin PPD-RT 23 with Tween 80, dose 2 IU (1/5000) of the Hellenic Pasteur Institute. Tuberculin skin reactions were examined by two experienced readers after 48 hours. Indurations < 5 mm were considered as negative reactions, > or = 10 mm as positive, and 5-9 mm as doubtful reactions. RESULTS: The results of the present study were compared to other studies undertaken in recruits during the period 1934-80. We found a decrease of positive reactions from 14.2% in 1981 to 6.8% in 1991. The mean annual reduction was 0.74%. The decline has continued since 1947, as previous studies during the period 1934-80 have shown. CONCLUSION: We conclude that the tuberculin reactivity in recruits of the Hellenic army, although still high in relation to other European countries and North America, is declining steadily. We predict that the number of positive reactions will fall to about 1% by the year 2000, assuming that the same trend continues.
Adolescent↗
Incidence of tuberculosis in Greek armed forces from 1965-1993.
Studies investigating the epidemiology of tuberculosis in Greece are lacking. Tuberculosis (TB) continues to be a public health problem and its dimensions are not clearly defined. The aim of this study was to estimate the incidence of pulmonary and pleural TB in each of the three branches of military personnel serving in the Greek armed forces, during the period 1965-1993. All military personnel with confirmed pulmonary or pleural TB during the period 1965-1993 were studied retrospectively. The age of the patients ranged from 18-45 years. A significant number of TB patients were detected by the regular chest radiography screening using mass miniature radiography during enrollment. The diagnosis of TB was made both by clinical and paraclinical examinations, such as history, symptoms, physical examination, tuberculin skin reactivity, chest X-ray and/or computed tomography of the thorax, bronchoscopy, microbiological examination of specimens (sputum, washings, bronchoalveolar lavage) as well as histological and bacteriological examination of the biopsies. We found that during the period studied, 4,628 patients were hospitalised for TB, 3,588 for pulmonary TB, and 1,040 for TB pleuritis (3,781 in the army, 445 in the navy and 402 in the air force). In 1965, the incidence (per 100,000) of TB (pulmonary and pleural) in the army was 60, in the navy 50, and in the air force 30. This incidence increased gradually from 1965 to 1980, followed by a decrease, since BCG vaccination became obligatory in 1980; values in 1993 were 18 in the army, 25 in the navy, and 15 in the air force. These figures are significantly higher than those reported for the civilian population, probably due to underreporting in the latter. Our results suggest that the incidence of TB in the Greek armed forces, although still high, is declining steadily. Strengthening of the anti-TB campaign is indicated.
Adolescent↗
C-wave study in cone dysfunction syndrome.
An electroretinogram (ERG) and C-wave were recorded from 15 patients suffering from cone dysfunction syndrome. Our results show that the photopic ERG was diminished with extinction of the oscillatory potentials. On the other hand, the mean value of the C-wave amplitude was diminished and the implicit time prolonged. This may serve as a further diagnostic sign of the disease.
Adolescent↗
C wave of electroretinogram and visual evoked response in optic neuritis due to demyelinating diseases.
In 21 consecutive cases with unilateral optic neuritis due to demyelinating disease, ERG, C wave of ERG and VER were recorded and studied in both eyes. Also 8 cases suffering from optic atrophy due to trauma or glaucoma were included. The analysis of data shows that the C-wave is significantly diminished in both eyes, namely the affected and the sound, in the cases of optic neuritis. Also in comparison to VER, C wave has a comparative probability in diagnosing optic neuritis due to demyelinating disease. The C wave of ERG is normal in the cases of optic atrophy. The mechanism of C wave involvement during the course of demyelinating disease may be related with an abnormality of the ionic homeostasis of the subretinal space.
Adolescent↗
C wave study in optic neuritis due to demyelinating disease.
The C wave was recorded from 20 eyes suffering from neuritis due to demyelinating disease and in 5 eyes showing optic atrophy due to trauma or to increased intracranial pressure. Our results show that in cases with optic neuritis the C wave amplitude was clearly lower than normal. It is interesting that in the other 'healthy', at least clinically, eye the C wave was subnormal too. On the contrary, in the eyes with optic atrophy the C wave was normal. These findings are against the possibility of an efferent neuronal pathway involvement, which influences the level of the retinal pigment epithelium, and support the view of its involvement during the course of the demyelinating disease that causes the optic neuritis.
Adolescent↗
ERG and electron microscopic findings after intravitreal use of aminoglycosides.
The electroretinographic (ERG) changes and the retinal lesions shown by electron microscopy were studied in rabbits after intravitreal use of amikacin and tobramycin. We studied 40 eyes of 20 rabbits in which different doses ranging from 250 micrograms to 1000 micrograms of aminoglycosides were injected into the vitreous cavity. Tobramycin, and to some extent amikacin, were toxic to the retina even in doses of 500 micrograms as shown by ERG changes. The pathologic retinal lesions shown by electron microscopy were characterized by membranous inclusions in the retinal pigment epithelium, tumefaction of the photoreceptors, and partial disorganization of the inner layers. In doses of 250 micrograms or less, these two antibiotics seem to be nontoxic after a follow-up of three months.
Amikacin↗
Acute bilateral optic neuritis.
This paper presents the case study of six patients suffering from acute bilateral optic neuritis simultaneously manifested in both eyes. The clinical picture and the full laboratory investigation failed to establish a real cause of the disease. Finally the lack of general neurological symptoms and the good prognosis of the disease after a two year follow-up is stressed.
Acute Disease↗
[C-wave changes in macular diseases].
C-wave and ERG records have been taken from patients with juvenile macular degeneration, cone dysfunction syndrome, non exudative macular degeneration and from patients who have taken hydroxychloroquine for more than a year. The study of these recordings showed that in juvenile macular degeneration the involved area might be larger than ophthalmoscopically visible. In cone dysfunction syndrome the prolonged latence implicit time can serve as a further diagnostic sign of the disease. In non exudative macular degeneration there is more extensive R.P.E. involvement than usually believed and finally in hydroxychloroquine retinopathy, the C-wave is a better criterion to monitor the disease than ERG.
Adolescent↗
Extracapsular extraction and anterior-chamber flexible lens implantation.
Extracapsular extraction with anterior-chamber lens implantation is a method which has a place in cataract surgery. We discuss 60 cases of cataract operated on by this method and its advantages. We had good results in cases without glaucoma, keratopathy, or diabetes mellitus, and depending on the ease with which a posterior capsulotomy was done, where this was imperative, without the risks of the YAG laser capsulotomy.
Aged↗
Changes of oscillatory potentials of the ERG in diabetic retinopathy.
Disturbances of the oscillatory potentials of the ERG are examined in diabetic patients with and without vascular lesions of the retina. More specifically, the changes of the oscillatory potentials are investigated in relation to the manifestation and evolution of diabetic retinopathy and neovascularization of the optic disk and the retina. Particular stress is laid on the direct relation between the disturbances of the oscillatory potentials and the occurrence of neovascularization, as well as on the prognostic significance of these disturbances.
Aneurysm↗
[Lysinuria and changes in the crystalline lens].
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Adult↗